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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. PMID:26937442

  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. Epidemiology of puerperal psychoses.

    PubMed

    Kendell, R E; Chalmers, J C; Platz, C

    1987-05-01

    Computer linkage of an obstetric register and a psychiatric case register made it possible to investigate the temporal relationship between childbirth and psychiatric contact in a population of 470 000 people over a 12-year period: 54 087 births resulted in 120 psychiatric admissions within 90 days of parturition [corrected]. The 'relative risk' of admission to a psychiatric hospital with a psychotic illness was extremely high in the first 30 days after childbirth, particularly in primiparae, suggesting that metabolic factors are involved in the genesis of puerperal psychoses. However, being unmarried, having a first baby, Caesarian section and perinatal death were all associated with an increased risk of psychiatric admission or contact, or both, suggesting that psychological stresses also contribute to this high psychiatric morbidity. Women with a history of manic depressive illness, manic or depressive, had a much higher risk of psychiatric admission in the puerperium than those with a history of schizophrenia or depressive neuroses, and the majority of puerperal admissions met Research Diagnostic Criteria for manic or depressive disorder. Probably, therefore, puerperal psychoses are manic depressive illnesses and unrelated to schizophrenia. PMID:3651704

  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 with the holmium laser

    NASA Astrophysics Data System (ADS)

    Beaghler, Marc A.; Stewart, Steven C.; Ruckle, Herbert C.; Poon, Michael W.

    1997-05-01

    The purpose of this study is to report early complications in our initial experience with the holmium laser in 133 patients. A retrospective study of patients undergoing endourological procedures with the holmium laser was performed. Complications included urinary tract infection (3), post-operative bradycardia (1), inverted T-waves (1), intractable flank pain (1), urinary retention (1), inability to access a lower pole calyx with a 365 micron fiber (9), stone migration (5), termination of procedure due to poor visualization (2). No ureteral perforations or strictures occurred. The holmium laser was capable of fragmenting all urinary calculi in this study. In our initial experience, the holmium laser is safe and effective in the treatment of genitourinary pathology. Use of laser fibers larger than 200 microns occasionally limit deflection into a lower pole or dependent calyx.

  7. 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

  8. 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

  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. EARLY COMPLICATIONS IN THE ORTHOPEDIC TREATMENT OF BONE METASTASES

    PubMed Central

    Teixeira, Luiz Eduardo Moreira; Miranda, Ricardo Horta; Ghedini, Daniel Ferreira; Aguilar, Rafael Bazílio; Novais, Eduardo Nilo Vasconcelos; de Abreu e Silva, Guilherme Moreira; Araújo, Ivana Duval; de Andrade, Marco Antônio Percope

    2015-01-01

    Objective: To assess the early complications in the orthopedic treatment of metastatic bone lesions and the factors associated with these complications. Method: There were assessed, retrospectively, 64 patients that underwent surgical treatment for bone metastases, analyzing the complications that occurred in the pre-operative and early post- operative period and associating them with the tumor origin, type of procedure done, the need of blood reposition before the surgery, the need of new surgical procedures and the mortality due to the complications. Results: Early complications in the treatment were observed in 17 (26.6%) patients, of which six (35.2%) ended up dying due to these complications. Regarding the type, 15 (23.8%) cases were due to surgical complications, four (6.3%) clinical and three (4.7%) patients showed clinical and surgical complications. There was no significant difference in the frequency of complications or mortality when assessed the type of reconstruction or affected region. The tumors with a renal origin needed more blood reposition and showed a bigger frequency of complications. Conclusion: The complications occurred in 26.6%. The complications are not related to the kind of treatment performed or to the region affected. The renal origin tumors showed a higher risk of hemorrhage.

  11. 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

  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 >100×10/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 474×10/L in the leukapheresis group compared with 175×10/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 (>650×10/L in ALL and >400×10/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. 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

  14. Early management of atrial fibrillation to prevent cardiovascular complications.

    PubMed

    Nattel, Stanley; Guasch, Eduard; Savelieva, Irina; Cosio, Francisco G; Valverde, Irene; Halperin, Jonathan L; Conroy, Jennifer M; Al-Khatib, Sana M; Hess, Paul L; Kirchhof, Paulus; De Bono, Joseph; Lip, Gregory Y H; Banerjee, Amitava; Ruskin, Jeremy; Blendea, Dan; Camm, A John

    2014-06-01

    Atrial fibrillation (AF) is generally considered a progressive disease, typically evolving from paroxysmal through persistent to 'permanent' forms, a process attributed to electrical and structural remodelling related to both the underlying disease and AF itself. Medical treatment has yet to demonstrate clinical efficacy in preventing progression. Large clinical trials performed to date have failed to show benefit of rhythm control compared with rate control, but these trials primarily included patients at late stages in the disease process. One possible explanation is that intervention at only an early stage of progression may improve prognosis. Evolving observations about the progressive nature of AF, along with the occurrences of major complications such as strokes upon AF presentation, led to the notion that earlier and more active approaches to AF detection, rhythm-reversion, and maintenance of sinus rhythm may be a useful strategy in AF management. Approaches to early and sustained rhythm control include measures that prevent development of the AF substrate, earlier catheter ablation, and novel antiarrhythmic drugs. Improved classifications of AF mechanism, pathogenesis, and remodelling may be helpful to enable patient-specific pathophysiological diagnosis and therapy. Potential novel therapeutic options under development include microRNA-modulation, heatshock protein inducers, agents that influence Ca(2+) handling, vagal stimulators, and more aggressive mechanism-based ablation strategies. In this review, of research into the basis and management of AF in acute and early settings, it is proposed that progression from paroxysmal to persistent AF can be interrupted, with potentially favourable prognostic impact. PMID:24536084

  15. The Effect of Surveillance and Appreciative Inquiry on Puerperal Infections: A Longitudinal Cohort Study in India

    PubMed Central

    Hussein, Julia; Ramani, K. V.; Kanguru, Lovney; Patel, Kalpesh; Bell, Jacqueline; Patel, Purvi; Walker, Leighton; Mehta, Rajesh; Mavalankar, Dileep

    2014-01-01

    Objective To evaluate the effects of an intervention comprising surveillance and an organisational change called Appreciative Inquiry on puerperal infections in hospitals in Gujarat state, India. Methods This longitudinal cohort study with a control group was conducted over 16 months between 2010 and 2012. Women who delivered in six hospitals were followed-up. After a five month pre-intervention period, the intervention was introduced in three hospitals. Monthly incidence of puerperal infection was recorded throughout the study in all six hospitals. A chi-square test and logistic regression were used to examine for associations, trends and interactions between the intervention and control groups. Findings Of the 8,124 women followed up, puerperal infections were reported in 319 women (3.9%) over the course of the study. Puerperal sepsis/genital tract infections and urinary tract infections were the two most common puerperal infections. At the end of the study, infection incidence in the control group halved from 7.4% to 3.5%. Levels in the intervention group reduced proportionately even more, from 4.3% to 1.7%. A chi-square test for trend confirmed the reduction of infection in the intervention and control groups (p<0.0001) but the trends were not statistically different from one another. There was an overall reduction of infection by month (OR = 0.94 95% CI 0.91–0.97). Risk factors like delivery type, complications or delivery attendant showed no association with infection. Conclusion Interruption of resource flows in the health system occurred during the intervention phase, which may have affected the findings. The incidence of infection fell in both control and intervention groups during the course of the study. It is not clear if appreciative inquiry contributed to the reductions observed. A number of practical and methodological limitations were faced. Trial Registration Controlled-Trials.com ISRCTN03513186 PMID:24498089

  16. [Metaphylaxis of puerperal disorders in cattle].

    PubMed

    Eulenberger, K; Eulenberger, K; Schulz, J; Wolf, M

    1990-10-01

    The effects of metaphylactic measures in cattle herds with the aim of diminishing puerperal disturbances and ensurement of high reproductive performance were studied. About 5000 cows in more than 30 groups (experimental and controls) were included into the clinical investigations. Dietary supplementation by sodium propionic acid over a period of 4 weeks, oxytocin or parasympathomimetics administered during the first 3 days post partum had a certain metaphylactic effect, only when the therapeutic principle met the prevalent cause of the given puerperal disturbance. In herds with high incidence of noninfectious retention of fetal membranes the metaphylactic application of Se and Vitamin E (10 days ante partum) can be taken into account. Stimulation of the ovarian activity by GnRH is recommended in animals which fail to have developed follicular activity by the 12th-15th day post partum. PMID:2245774

  17. 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

  18. Early biliary complications following pancreaticoduodenectomy: prevalence and risk factors

    PubMed Central

    Malgras, Brice; Duron, Sandrine; Gaujoux, Sébastien; Dokmak, Safi; Aussilhou, Béatrice; Rebours, Vinciane; Palazzo, Maxime; Belghiti, Jacques; Sauvanet, Alain

    2016-01-01

    Background Early biliary complications (EBC) following pancreaticoduodenectomy (PD) are poorly known. This study aimed to assess incidence, predictive factors, and treatment of EBC including bilio-enteric stricture, transient jaundice, biliary leak, and cholangitis. Method From 2007 to 2011, 352 patients underwent PD. Statistical analysis including logistic regression was performed to determine EBC predictive factors. Results 49 patients (14%) developed 51 EBC, including 7(2%) bilio-enteric strictures, 15(4%) transient jaundices, 9(3%) biliary leaks, and 20(6%) cholangitis with no mortality and a 18% reoperation rate. In multivariate analysis, male gender, benign disease, malignancy with preoperative chemoradiation, and common bile duct (CBD) diameter ≤5 mm were predictive of EBC. Of the 7 strictures, all were associated with CBD ≤5 mm and 5(71%) required reoperation. Transient jaundice resolved spontaneously in all 15 cases. Among 8 patients with serum bilirubin level >50 μmol/L (3 mg/dL) at POD3, 7(88%) developed bilio-enteric stricture. Biliary leak resolved spontaneously in 5(56%); otherwise, it required reoperation. Cholangitis recurred after antibiotics discontinuation in 5(25%). Conclusions EBC following PD do not increase mortality. EBC are more frequent with male gender, benign disease, malignancy with preoperative chemoradiation, and CBD ≤5 mm. Transient jaundice or cholangitis has a favorable outcome, whereas bilio-enteric stricture or biliary leak can require reintervention. PMID:27037207

  19. Early central nervous complications after umbilical cord blood transplantation for adults.

    PubMed

    Narimatsu, Hiroto; Miyamura, Koichi; Iida, Hiroatsu; Hamaguchi, Motohiro; Uchida, Toshiki; Morishita, Yoshihisa

    2009-01-01

    Early central nervous complications (CNS) are significant after allogeneic stem cell transplantation; however, the clinical characteristics of early CNS complications have not yet been well described. The medical record of 77 patients who underwent cord blood transplantation (CBT) between March 2001 and November 2005, at 8 centers of the Nagoya Blood and Marrow Transplantation Group were retrospectively reviewed. The preparative regimen included myeloablative CBT (n = 31) or reduced-intensity (RI)-CBT (n = 46). Of the 77 patients, 10 (13%) developed early CNS complications. Causes included Cyclosporine encephalopathy (n = 5), tacrolimus encephalopathy (n = 2), thrombocytic microangiopathy (n = 1), and unknown (n = 3). The median time of onset was 19 days (range: 2-58 days). All of the 10 patients developed impaired consciousness. Seizures developed in 6 patients. Early CNS complications spontaneously subsided in 3 patients. Three patients responded to cyclosporine or tacrolimus discontinuation. The remaining 4 patients died within 30 days of developing of early CNS complications. No relationship was detected between the preparative regimen and the onset of early CNS complications, while an HLA disparity showed borderline significance (hazard ratio, 3.24; 95% confidential interval, 0.94-11.20; P = .06). Early CNS complications are a significant problem after CBT, and the clinician has to be aware of the possibility of these complications. PMID:19135947

  20. Medicine in stamps-Ignaz Semmelweis and Puerperal Fever

    PubMed Central

    Ataman, Ahmet Doğan; Vatanoğlu-Lutz, Emine Elif; Yıldırım, Gazi

    2013-01-01

    Puerperal fever was common in mid-19th-century hospitals and often fatal, with mortality at 10%–35%. Ignaz Philipp Semmelweis was a Hungarian gynecologist who is known as a pioneer of antiseptic procedures. Semmelweis discovered that the incidence of puerperal fever could be drastically cut by the use of hand disinfection in obstetrical clinics. He is also described as the “savior of mothers” and “father of infection control”. This paper provides an overview on the process of preventing puerperal fever and the life story of the physician behind this attempt, Ignaz Semmelweis, through philately. PMID:24592068

  1. [Incidence of complications and early mortality in surgical management of coxal femoral fractures].

    PubMed

    Raunest, J; Kaschner, A; Derra, E

    1990-01-01

    In a retrospective study the clinical course of 393 patients treated for proximal femur fractures is evaluated. Intraoperative complications occurred in 2% whereas early complications related to the operative procedure were seen in 19.8% and unspecific complications in 36.8%. Factor analysis proved the following items to be associated with a high risk of complication: age (p less than 0.01), preexistent diseases, kind of operative procedure (p less than 0.05) and the lapse of time between trauma and operation. The extraordinary high incidence of unspecific complications is explained by the prevailing proportion of elderly patients with a corresponding multimorbidity. A decrease in complications and lethality can be achieved by early operative treatment. With regard to the necessity of early mobilization we prefer a hemiarthroplasty in fractures of the femoral neck for elderly patients. Stable pertrochanteric fractures are treated by a dynamic hip screw whereas instable pertrochanteric fractures are an indication for Ender nailing. PMID:2355790

  2. 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

  3. Early Practice: External Sinus Surgery and Procedures and Complications.

    PubMed

    Schneider, John S; Day, Andrew; Clavenna, Matthew; Russell, Paul T; Duncavage, James

    2015-10-01

    External approaches to the paranasal sinuses are rarely used in the endoscopic era. However, their indications for use have not changed, and in every surgeon's career those indications may present themselves. For residents training in the endoscopic era, these procedures are also very rarely seen. In this article, the external approaches to the maxillary, ethmoid, and frontal sinuses are described: their original descriptions, modern use, and potential complications. It is hoped that this article will serve to instruct residents and practitioners alike in these techniques. PMID:26143105

  4. Phasic disappearance of left circumflex coronary artery from an early complication of mitral valve surgery.

    PubMed

    Devabhaktuni, Subodh; Sunkara, Nirmal; Ahsan, Chowdhury

    2015-11-01

    LV pseudoaneurysm can be a late complication of mitral valve replacement. In our case, it was an early postoperative complication. This pseudoaneurysm was causing compression of LCX artery during systole, leading to presentation of NSTEMI two weeks after the surgery. PMID:26576286

  5. Phasic disappearance of left circumflex coronary artery from an early complication of mitral valve surgery

    PubMed Central

    Devabhaktuni, Subodh; Sunkara, Nirmal; Ahsan, Chowdhury

    2015-01-01

    Key Clinical Message LV pseudoaneurysm can be a late complication of mitral valve replacement. In our case, it was an early postoperative complication. This pseudoaneurysm was causing compression of LCX artery during systole, leading to presentation of NSTEMI two weeks after the surgery. PMID:26576286

  6. [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

  7. [The ways of reduction of early postoperative complications and the recurrences in complex rectal fistulas].

    PubMed

    Amirov, T J; Rustam, A M; Gamzaev, S M

    2013-09-01

    The results of treatment of 84 patients, suffering complex rectal fistulas, with the magnet-laser therapy application in early postoperative period were analyzed. The reduction of the early postoperative complications rate--by 12.5%, of the patients stationary stay--by (3.9 +/- 0.4) days, of the rehabilitation period--in 1.5 times, of the labor capacity restoration--by (7.2 +/- 1.3) days there were noted. PMID:24501927

  8. Uterine leiomyoma associated non-puerperal uterine inversion misdiagnosed as advanced cervical cancer: A case report☆

    PubMed Central

    Umeononihu, Osita Samuel; Adinma, Joseph Ifeanyi; Obiechina, Nworah J.; Eleje, George Uchenna; udegbunam, Onyebuchi Izuchukwu; Mbachu, Ikechukwu Innocent

    2013-01-01

    INTRODUCTION Uterine inversion is an un-common complication of parturition which often occurs in the immediate postpartum period. The chronic (non-puerperal) uterine inversion is rarer and most times tumour associated. PRESENTATION OF CASE A 51-year old grand multiparous lady presented with a month history of abnormal vaginal bleeding associated with offensive vaginal discharge, lower abdominal pain and dizziness. The initial evaluation suggested severe anaemia secondary to advanced cervical cancer. Examination under anaesthesia (EUA), staging and biopsy was attempted but this was however inconclusive due to profuse haemorrhage. A repeat EUA revealed chronic uterine inversion secondary to fundal submucous uterine leiomyoma. Myomectomy was done with tissue histology confirming benign uterine leiomyoma. Two weeks later, a modified Haultain's procedure was done followed by simple hysterectomy and posterior colpoperineorrhaphy. She had satisfactory recovery. DISCUSSION This is the first reported case of chronic non-puerperal uterine inversion in our hospital. When it occurs, it is usually tumour associated with the commonest tumour being prolapsed myoma and leiomyosarcoma. The diagnosis is based on high index of suspicion. CONCLUSION Chronic uterine inversion is a rare gynaecological condition and can be misdiagnosed as advanced cervical cancer or other causes of severe genital haemorrhage in women. A high index of suspicion is needed for its proper diagnosis. Sometimes, an EUA and biopsy was required to determine the cause here and conveniently it could be described as a “gynaecolological near miss”. PMID:24091076

  9. Early Childhood Teachers and Regulation: Complicating Power Relations Using a Foucauldian Lens

    ERIC Educational Resources Information Center

    Fenech, Marianne; Sumsion, Jennifer

    2007-01-01

    This article both supports and complicates the positioning of reconceptualists who frame the regulation of early childhood services as repressive. Drawing on Foucault's construction of power and, in particular, his notion of an "analytics of power", the authors analyse findings from an Australian study investigating university-qualified early…

  10. 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

  11. 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

  12. 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

  13. 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

  14. Effect of Early Statin Treatment in Patients with Cardiogenic Shock Complicating Acute Myocardial Infarction

    PubMed Central

    Sim, Doo Sun; Cho, Kyung Hoon; Ahn, Youngkeun; Kim, Young Jo; Chae, Shung Chull; Hong, Taek Jong; Seong, In Whan; Chae, Jei Keon; Kim, Chong Jin; Cho, Myeong Chan; Rha, Seung-Woon; Bae, Jang Ho; Seung, Ki Bae; Park, Seung Jung

    2013-01-01

    Background and Objectives The benefit of early statin treatment following acute myocardial infarction (MI) complicated with cardiogenic shock (CS) has not been well studied. We sought to assess the effect of early statin therapy in patients with CS complicating acute MI. Subjects and Methods We studied 553 statin-naive patients with acute MI and CS (Killip class IV) who underwent revascularization therapy between November 2005 and January 2008 at 51 hospitals in the Korea Acute Myocardial Infarction Registry. Patients were divided into 2 groups: those who received statins during hospitalization (n=280) and those who did not (n=273). The influence of statin treatment on a 12-month clinical outcome was examined using a matched-pairs analysis (n=200 in each group) based on the propensity for receiving statin therapy during hospitalization. Results Before adjustment, patients receiving statin, compared to those not receiving statin, had a more favorable clinical profile, were less likely to suffer procedural complications, and more likely to receive adequate medical therapy. Patients receiving statin had lower unadjusted in-hospital mortality and composite rate of mortality, MI, and repeat revascularization at 12 months, which remained significantly lower after adjustment for patient risk, procedural characteristics, and treatment propensity. Conclusion In CS patients with acute MI undergoing revascularization therapy, early statin treatment initiated during hospitalization was associated with lower rates of in-hospital death and 12-month adverse cardiac events. PMID:23508129

  15. Obesity and early complications following reduction mammaplasty: an analysis of 4545 patients from the 2005-2011 NSQIP datasets.

    PubMed

    Nelson, Jonas A; Fischer, John P; Chung, Cyndi U; West, Ari; Tuggle, Charles T; Serletti, Joseph M; Kovach, Stephen J

    2014-10-01

    Reduction mammoplasty is a proven treatment for symptomatic macromastia, but the association between obesity and early postoperative complications is unclear. The purpose of this study was to perform a population level analysis in an effort to determine the impact of obesity on early complications after reduction mammaplasty. This study examined the 2005-2011 NSQIP datasets and identified all patients who underwent reduction mammoplasty. Patients were then categorised according to the World Health Organisation obesity classification. Demographics, comorbidities, and perioperative risk factors were identified among the NSQIP variables. Data was then analysed for surgical complications, wound complications, and medical complications within 30 days of surgery. In total, 4545 patients were identified; 54.4% of patients were obese (BMI > 30 kg/m(2)), of which 1308 (28.8%) were Class I (BMI = 30-34.9 kg/m(2)), 686 (15.1%) were Class II (BMI = 35-39.9 kg/m(2)), and 439 (9.7%) were Class III (BMI > 40 kg/m(2)). The presence of comorbid conditions increased across obesity classifications (p < 0.001), with significant differences noted in all cohort comparisons except when comparing class I to class II (p = 0.12). Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). This was further isolated when comparing morbidly obese patients to non-obese (p < 0.001), class I (p < 0.001), and class II (p = 0.01) patients. This population-wide analysis - the largest and most heterogeneous study to date - has demonstrated that increasing obesity class is associated with increased early postoperative complications. Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. PMID:24506446

  16. Esophageal perforation, the most feared complication of TEE: early recognition by multimodality imaging.

    PubMed

    Bavalia, Nisha; Anis, Ather; Benz, Michael; Maldjian, Pierre; Bolanowski, Paul J; Saric, Muhamed

    2011-03-01

    Esophageal perforation is the most feared complication of transesophageal echocardiography (TEE), although the overall risk is extremely low. We report a case of esophageal perforation in a 77-year-old woman who had no apparent contraindications to TEE. Chronic steroid therapy for symptoms of asthma as well as osteophytic changes of the cervical vertebrae contributed to her increased risk of perforation. Unlike in prior reports, the perforation in this case was fortuitously recognized rapidly due to ingestion of a carbonated beverage for evaluation of a hiatal hernia suspected during a subsequent transthoracic echocardiogram performed because of inadequate TEE images after a difficult intubation. The incidence of esophageal perforation in our series (1 in 5,000 TEEs, 0.02%) is similar to that reported in the literature. Early recognition and prompt surgical repair of the esophageal perforation led to favorable outcome in our patient. PMID:21366685

  17. 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. PMID:27034693

  18. Early hospital readmission for gastrointestinal-related complications predicts long-term mortality after pancreatectomy

    PubMed Central

    Hicks, Caitlin W.; Tosoian, Jeffrey J.; Craig-Schapiro, Rebecca; Valero, Vicente; Cameron, John L.; Eckhauser, Frederic E.; Hirose, Kenzo; Makary, Martin A.; Pawlik, Timothy M.; Ahuja, Nita; Weiss, Matthew J.; Wolfgang, Christopher L.

    2015-01-01

    BACKGROUND The purpose of this study was to investigate the prognostic significance of early (30-day) hospital readmission (EHR) on mortality after pancreatectomy. METHODS Using a prospectively collected institutional database linked with a statewide dataset, we evaluated the association between EHR and overall mortality in all patients undergoing pancreatectomy at our tertiary institution (2005 to 2010). RESULTS Of 595 pancreatectomy patients, EHR occurred in 21.5%. Overall mortality was 29.4% (median follow-up 22.7 months). Patients with EHR had decreased survival compared with those who were not readmitted (P = .011). On multivariate analysis adjusting for baseline group differences, EHR for gastrointestinal-related complications was a significant independent predictor of mortality (hazard ratio 2.30, P = .001). CONCLUSIONS In addition to known risk factors, 30-day readmission for gastrointestinal-related complications following pancreatectomy independently predicts increased mortality. Additional studies are necessary to identify surgical, medical, and social factors contributing to EHR, as well as interventions aimed at decreasing postpancreatectomy morbidity and mortality. PMID:26384793

  19. Puerperal cerebral venous thrombosis: therapeutic benefit of low dose heparin.

    PubMed

    Nagaraja, D; Haridas, T; Taly, A B; Veerendrakumar, M; SubbuKrishna, D K

    1999-03-01

    Advances in imageology have improved the diagnostic yield of cerebral venous/sinus thrombosis (CVT). However, its management remains a challenge. The present study was carried out to study the role of heparin in CVT. Therapeutic outcome of 150 patients of puerperal CVT manifesting within one month of delivery or abortion, was analyzed. The diagnosis was supported by cranial computed tomography and/or angiography whenever required. Seventy three patients, 46 with non-haemorrhagic infarction and 27 with haemorrhagic infarction, received 2500 units of subcutaneous heparin, three times a day within 24 hours of hospitalization till 30th post partum day or symptomatic relief. Seventy seven patients during the same period, 50 with non-haemorrhagic infarction and 27 with haemorrhagic infarction, who did not receive heparin formed the control group. Repeat CT scans were done when indicated. Among the heparin group, 34 patients made full recovery. There were eight deaths, all among the patients with haemorrhagic lesion. In control group, only 14 patients recovered completely (P=<0.001) and 18 died (P=<0.001). There were no adverse effects of heparin. Low dose heparin is safe and efficacious in puerperal CVT, even in patients with haemorrhagic infarction. PMID:10339707

  20. 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; Foà, 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

  1. 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; Foà, 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

  2. [Influence of laser -- infrared irradiation on local complications of early postoperative period in hernias of anterior abdominal wall].

    PubMed

    Gasymov, E M

    2005-01-01

    Results of laser-infrared irradiation (LIRI) of postoperative wound after surgical treatment of recurrent hernias of anterior abdominal wall were analyzed. LIRI decreased number of local complications in early postoperative period in patients both with recurrent and primary hernias. The method was more effective for the treatment of local complication in patients with recurrent hernia that is confirmed by reduced of frequency of infiltrates, seromas and suppurations. PMID:16247383

  3. Pre- and post-operative management of dental implant placement. Part 2: management of early-presenting complications.

    PubMed

    Bryce, G; Bomfim, D I; Bassi, G S

    2014-08-01

    Despite morbidity factors that include pain and complications with healing, there is currently little available guidance regarding optimal pre-and post-operative protocols for dental implant placement. While the first paper of this two-part series discussed the management of post-operative pain, the second instalment reviews pre- and post-operative means of managing early complications associated with dental implant placement. PMID:25146803

  4. 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

  5. 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.

  6. [Puerperal inhibition of lactation with metergoline or bromocriptine].

    PubMed

    Fischer, T; Streitmatter, A; Gerede, A; Frauendorf, A; Krause, M; Feige, A

    1995-01-01

    In a controlled, randomised, prospective, clinical study, the effect of prolactin suppression and clinical course of the lactation suppressors Bromocriptine and Metergoline were investigated. During 7 months 150 patients were studied. 81 of those patients, who did not nurse, were treated by Bromocriptine (primary lactation suppression: n = 62, secondary suppression: n = 19) and 69 of the patients were treated by Metergoline (primary suppression: n = 54, secondary suppression: n = 15). The drugs were administrated orally to all subjects, dosed 2 x 2.5 mg/d of Bromocriptine for 14 days and 3 x 4 mg/d of Metergoline for 10 days, starting in average after 13 hours. Puerperal suppression of prolactine were compared with randomised breast feeding subjects (n = 30). In Bromocriptine treated women the average plasma prolactin level decreased from 78.4 +/- 22 ng/ml to 17.0 +/- 3.3 ng/ml during five days of treatment. In Metergoline treated women the plasma prolactin level decreased from 129.7 +/- 15.1 ng/ml to 56.9 +/- 10.0 ng/ml during the first days of treatment. Prolactin level of breast feeding subjects decreased from 233.6 +/- 21.4 ng/ml to 185.8 +/- 23.7 ng/ml during the same period (p < 0.05). There is no statistical significancy of clinical difference of both drugs, but a statistical trend was seen. With Bromocriptine treated women were suppressed efficiently in 71 of 81 cases, 10 refused. Refusals were divided in two quality levels, level I with subjects with moderate complaints and little puerperal lactation, level II with subjects with considerable complaints including strong puerperal lactation. With Metergoline suppressed women, treatment was efficiently in 51 of 69 cases, but refusals of level I were observed in 11 cases and refusals of level II were observed in 7 cases. The results show that Bromocriptine and Metergoline are effective on suppression of lactation. Under the current drug dose of Metergoline an advantage of Bromocriptine were observed. Only further studies could investigate, whether an adaptation of drug dose would improve the clinical efficiency of Metergoline. PMID:7553254

  7. Randomized Clinical Trial for Early Postoperative Complications of Ex-PRESS Implantation versus Trabeculectomy: Complications Postoperatively of Ex-PRESS versus Trabeculectomy Study (CPETS).

    PubMed

    Arimura, Shogo; Takihara, Yuji; Miyake, Seiji; Iwasaki, Kentaro; Gozawa, Makoto; Matsumura, Takehiro; Tomomatsu, Takeshi; Takamura, Yoshihiro; Inatani, Masaru

    2016-01-01

    We compared early postoperative complications between trabeculectomy and Ex-PRESS implantation. Enrolled patients with 39 primary open-angle or 25 exfoliative glaucoma were randomly assigned to receive trabeculectomy (trabeculectomy group) or Ex-PRESS implantation (Ex-PRESS group). Primary outcomes were early postoperative complications, including postoperative anterior chamber inflammation, frequencies of hyphema, flat anterior chamber, choroidal detachment, hypotonic maculopathy, and the change of visual acuity. The postoperative flare values in trabeculectomy group were higher than those in the Ex-PRESS group (overall, P = 0.004; and 10 days, P = 0.02). Hyphema occurred significantly more frequently in the trabeculectomy group (P = 0.0025). There were no significant differences of the other primary outcomes between the two groups. Additionally, duration of anterior chamber opening was significantly shorter in the Ex-PRESS group (P = 0.0002) and the eyes that had iris contact with Ex-PRESS tube had significantly shallower anterior chambers than did the eyes without the iris contact (P = 0.013). The Ex-PRESS implantation prevented early postoperative inflammation and hyphema in the anterior chamber and shortened the duration of anterior chamber opening. Iris contact with the Ex-PRESS tube occurred more frequently in eyes with open-angle glaucoma and shallow anterior chambers. PMID:27184606

  8. Oliver Wendell Holmes (1809–1894) and his essay on puerperal fever

    PubMed Central

    Dunn, P M

    2007-01-01

    Doctor, teacher of anatomy, conversationalist, essayist, and poet, in 1843 Holmes combined his medical and literary skills in a masterly dissertation on the epidemiology and prevention of puerperal fever. PMID:17585102

  9. 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

  10. 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

  11. Failure to rescue patients from early critical complications of oesophagogastric cancer surgery

    PubMed Central

    Weledji, Elroy P.; Verla, Vincent

    2016-01-01

    ‘Failure to rescue’ is a significant cause of mortality in gastrointestinal surgery. Differences in mortality between high and low-volume hospitals are not associated with large difference in complication rates but to the ability of the hospital to effectively rescue patients from the complications. We reviewed the critical complications following surgery for oesophageal and gastric cancer, their prevention and reasons for failure to rescue. Strategies focussing on perioperative optimization, the timely recognition and management of complications may be essential to improving outcome in low-volume hospitals. PMID:27054032

  12. Failure to rescue patients from early critical complications of oesophagogastric cancer surgery.

    PubMed

    Weledji, Elroy P; Verla, Vincent

    2016-05-01

    'Failure to rescue' is a significant cause of mortality in gastrointestinal surgery. Differences in mortality between high and low-volume hospitals are not associated with large difference in complication rates but to the ability of the hospital to effectively rescue patients from the complications. We reviewed the critical complications following surgery for oesophageal and gastric cancer, their prevention and reasons for failure to rescue. Strategies focussing on perioperative optimization, the timely recognition and management of complications may be essential to improving outcome in low-volume hospitals. PMID:27054032

  13. 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

  14. 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…

  15. [Influence of the kind of anesthesia and length of hospitalization on the frequency of early complications of abortion].

    PubMed

    Andolsek, L; Hren, M

    1976-01-01

    A case-control study of the safety of early vacuum aspiration, when performed as an outpatient/inpatient procedure in local/general anaesthesia was undertaken in Ljubljana. Three thousand and four healthy women were observed. General anaesthesia was applied to 1509 women and local to 1495 women. The inpatient procedure required at least overnight stay, the outpatient one only five hours. No differences in complication rates of any clinical importance between the different types of services and anaesthesia were observed. The overnight stay resulted in no decrease in complications but in an even greater bed occupancy beyond that expected. PMID:1004001

  16. [Non-puerperal mastitis. Clinical study of 30 patients].

    PubMed

    Paredes López, A; Moreno, G

    1995-06-01

    Non puerperal mastitis is an inflammatory disease that resembles carcinoma, the course is insidious and frequently this entity is misdiagnosed. The recurrence has been reported until 60%. This report is a prospective clinical investigation, of 30 patients with diagnosis of periductal mastitis, in these women were analyzed; age, marital stage, deliveries, breast feeding symptoms like tumour, inflammatory signs, mammary ductal fistula, mamography, cytology, bacteriology, histopathology, medical and surgical treatment. The middle age was 36 years old, 70% between 30 and 50 years old, 26 patients were multiparous, breast feeding were mentioned for 20 women. The tumor was palpable 70% of the cases, localized preferentially in the retroareolar segment, inflammatory changes were observed in 25 cases, 19 patients with fistula. The cytology was negative in 13 cases. In the bacterial culture were isolated, Staphylococcus aureus in 7 cases, Proteus vulgaris in 2 cases and seven cases resulted negative. Mamographic exams were realized in 23 patients; one case resulted adenocarcinoma. The medical treatment were with Eritromycin and Metronidazol and then, ducts resection surgery were performed in 16 cases, one case with adenocarcinoma was performed a modified radical mastectomy. The results were satisfactory 22 women improved, 6 cases with recurrence and two cases with spontaneous improvement. PMID:7642146

  17. Early complications and late sequelae of induced abortion: a review of the literature

    PubMed Central

    Edström, Karin G. B.

    1975-01-01

    An attempt to evaluate the recent literature on somatic complications of induced abortion shows that a great amount of data of widely varying quality has been collected. Many areas of research are still not covered in a way that permits valid conclusions to be drawn. Two important points emerge from the review: first, there is a need for uniform definitions of complications and some uniformity in the analysis of data collected; secondly, carefully selected control groups are needed in this kind of research. The areas most urgently requiring further study differ from country to country. From a global point of view, the existence or inexistence of significant late sequelae and the influence of the patient's health status on the complication rate seem to be of the highest priority. PMID:770027

  18. Can Early Rehabilitation after Total Hip Arthroplasty Reduce Its Major Complications and Medical Expenses? Report from a Nationally Representative Cohort

    PubMed Central

    Chiung-Jui Su, Daniel; Yuan, Kuo-Shu; Weng, Shih-Feng; Hong, Rong-Bin; Wu, Ming-Ping; Wu, Hing-Man; Chou, Willy

    2015-01-01

    Objective. To investigate whether early rehabilitation reduces the occurrence of posttotal hip arthroplasty (THA) complications, adverse events, and medical expenses within one postoperative year. Method. We retrospectively retrieve data from Taiwan's National Health Insurance Research Database. Patients who had undergone THA during the period from 1998 to 2010 were recruited, matched for propensity scores, and divided into 2 groups: early rehabilitation (Early Rehab) and delayed rehabilitation (Delayed Rehab). Results. Eight hundred twenty of 999 THA patients given early rehabilitation treatments were matched to 205 of 233 THA patients given delayed rehabilitation treatments. The Delayed Rehab group had significantly (all p < 0.001) higher medical and rehabilitation expenses and more outpatient department (OPD) visits than the Early Rehab group. In addition, the Delayed Rehab group was associated with more prosthetic infection (odds ratio (OR): 3.152; 95% confidence interval (CI): 1.211–8.203; p < 0.05) than the Early Rehab group. Conclusions. Early rehabilitation can significantly reduce the incidence of prosthetic infection, total rehabilitation expense, total medical expenses, and number of OPD visits within the first year after THA. PMID:26146625

  19. 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

  20. 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

  1. Fracture complications.

    PubMed

    Hershey, Kristen

    2013-06-01

    This article highlights 2 important complications of fracture: acute compartment syndrome and fat embolism syndrome (FES). FES is most commonly associated with long-bone and pelvic fracture, whereas acute compartment syndrome is often associated with tibia or forearm fracture. The onset of both of these complications may be difficult to assess in the nonverbal patient or in the patient with multiple trauma. Careful, serial assessment of the patient with fracture is necessary to recognize and treat these complications promptly. Early treatment and supportive care are crucial to positive outcomes for patients with complications of fracture. PMID:23692947

  2. Early post-transplant complications following ABO-incompatible kidney transplantation

    PubMed Central

    Naciri Bennani, Hamza; Abdulrahman, Zhyiar; Allal, Asma; Sallusto, Federico; Delarche, Antoine; Game, Xavier; Esposito, Laure; Doumerc, Nicolas; Debiol, Bénédicte; Kamar, Nassim; Rostaing, Lionel

    2016-01-01

    Background: Living-kidney transplantation is increasing because of the scarcity of kidneys from deceased donors and the increasing numbers of patients on waiting lists for a kidney transplant. Living-kidney transplantation is now associated with increased long-term patient- and allograft-survival rates. Objectives: The purpose of this retrospective study was to identify, in a cohort of 44 ABO-incompatible (ABOi) live-kidney transplant patients, the main complications that occurred within 6 months post-transplantation, and to compare these findings with those from 44 matched ABO-compatible (ABOc) live-kidney transplant patients who were also from our center. Patients and Methods: This single-center retrospective study assessed post-transplantation complications in 44 ABO-i versus 44 matched ABO-c patients. All patients were comparable at baseline except that ABO-i patients had greater immunological risks. Results: During the 6-month post-transplant period, more ABO-i patients presented with postoperative bleeds, thus requiring significantly more blood transfusions. Bleeds were associated with significantly lower values of fibrinogen, platelets, prothrombin time, and hemoglobin levels. Surgical complications, patient- and graft-survival rates, and kidney-function statuses were similar between both groups at 6 months post-transplantation. Conclusions: We conclude that impairment of hemostatic factors at pre-transplant explained the increased risk of a post-transplant bleed in ABO-i patients. PMID:27047806

  3. Medical and surgical management after spinal cord injury: vasopressor usage, early surgerys, and complications.

    PubMed

    Inoue, Tomoo; Manley, Geoffrey T; Patel, Nihari; Whetstone, William D

    2014-02-01

    The optimal mean arterial blood pressure for maintenance of spinal cord perfusion is not known. Our aim was to describe vasopressor usage and examine their effects in patients with spinal cord injury (SCI). We undertook a retrospective cohort study of 131 patients with SCI who received any kind of vasopressors to maintain blood pressure in the neurocritical care unit of a Level 1 trauma center (2005-2011). Vasopressor usage and complications were obtained from the medical record. Neurological outcomes were evaluated by the American Spinal Injury Association score. Dopamine was the most commonly used vasopressor (48.0%), followed by phenylephrine (45.0%), norepinephrine (5.0%), epinephrine (1.5%), and vasopressin (0.5%). Logistic regression analysis demonstrated that complications (e.g., ventricular tachycardia, troponin elevation, atrial fibrillation, heart rate >130 or <50, etc.) due to vasopressors were independently associated with the overall usages of dopamine (odds ratio [OR] 8.97; p<0.001) and phenylephrine (OR, 5.92; p=0.004), age ≥60 years old (OR, 5.16; p=0.013), and complete SCI (OR, 3.23; p=0.028). There was no difference in neurological improvement with either dopamine (OR, 1.16; p=0.788) or phenylephrine (OR 0.96; p=0.940). Incomplete SCI (OR, 2.64; p=0.019) and surgery <24 h after SCI (OR, 4.25; p=0.025) were independently associated with improved outcome. In summary, vasopressors are associated with increased complications in SCI patients. Further prospective studies are required in order to determine the potential benefits and risks of blood pressure management in patients with SCI. PMID:24020382

  4. Translational Research Efforts in Biomarkers and Biology of Early Transplant-Related Complications

    PubMed Central

    Paczesny, Sophie; Diaz-Ricart, Maribel; Carerras, Enrique; Cooke, Kenneth R.

    2015-01-01

    In the time since the first allogeneic hematopoietic stem cell transplantation (HSCT) was performed over 40 years ago, this life-saving procedure has been used increasingly for patients with hematologic, metabolic, and malignant diseases. Despite major advances in our understanding of the immunologic processes (both beneficial and injurious) that are associated with HSCT and improvements in supportive and critical care medicine, successful outcomes are still limited by several serious complications. As such, the establishment of effective therapeutic strategies for these complications will be crucial as increasing numbers of high-risk transplants are performed each year. The development of such approaches is fundamentally dependent upon a basic understanding of pathophysiologic mechanisms of disease and also on our ability to successfully translate these insights back to the bedside. This brief review will highlight breakthroughs in translational research endeavors that have paved the way for the development of novel strategies intended to change the standard of care and optimize outcomes for patients in whom allogeneic HSCT offers the only hope for a cure. PMID:21195297

  5. Suppression of Puerperal Lactation with an Ergot Alkaloid: A Double-blind Study

    PubMed Central

    Varga, L.; Lutterbeck, P. M.; Pryor, J. S.; Wenner, R.; Erb, H.

    1972-01-01

    A double-blind trial was performed in 60 women to establish the effectiveness of an ergot alkaloid, 2-Br-alpha-ergocryptine (ergocryptine; CB 154), in suppressing puerperal lactation and to compare it with stilboestrol and a placebo. At the doses selected ergocryptine and stilboestrol were equally effective. PMID:4556543

  6. 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

  7. Relation of Atrial Fibrillation in Acute Myocardial Infarction to In-Hospital Complications and Early Hospital Readmission.

    PubMed

    Kundu, Amartya; O'Day, Kevin; Shaikh, Amir Y; Lessard, Darleen M; Saczynski, Jane S; Yarzebski, Jorge; Darling, Chad E; Thabet, Ramses; Akhter, Mohammed W; Floyd, Kevin C; Goldberg, Robert J; McManus, David D

    2016-04-15

    Atrial fibrillation (AF) is a common complication of acute myocardial infarction (AMI) and contributes to high rates of in-hospital adverse events. However, there are few contemporary studies examining rates of AF in the contemporary era of AMI or the impact of new-onset AF on key in-hospital and postdischarge outcomes. We examined trends in AF in 6,384 residents of Worcester, Massachusetts, who were hospitalized with confirmed AMI during 7 biennial periods between 1999 and 2011. Multivariate logistic regression analysis was used to examine associations between occurrence of AF and various in-hospital and postdischarge complications. The overall incidence of AF complicating AMI was 10.8%. Rates of new-onset AF increased from 1999 to 2003 (9.8% to 13.2%), and decreased thereafter. In multivariable adjusted models, patients developing new-onset AF after AMI were at a higher risk for in-hospital stroke (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.6 to 4.1), heart failure (OR 2.0, 95% CI 1.7 to 2.4), cardiogenic shock (OR 3.7, 95% CI 2.8 to 4.9), and death (OR 2.3, 95% CI 1.9 to 3.0) than patients without AF. Development of AF during hospitalization for AMI was associated with higher rates of readmission within 30 days after discharge (21.7% vs 16.0%), but no significant difference was noted in early postdischarge 30-day all-cause mortality rates (8.3% vs 5.1%). In conclusion, new-onset AF after AMI is strongly related to in-hospital complications of AMI and higher short-term readmission rates. PMID:26874548

  8. Acute Page kidney following renal allograft biopsy: a complication requiring early recognition and treatment.

    PubMed

    Chung, J; Caumartin, Y; Warren, J; Luke, P P W

    2008-06-01

    The acute Page kidney phenomenon occurs as a consequence of external compression of the renal parenchyma leading to renal ischemia and hypertension. Between January 2000 and September 2007, 550 kidney transplants and 518 ultrasound-guided kidney biopsies were performed. During that time, four recipients developed acute oligo-anuria following ultrasound-guided allograft biopsy. Emergent doppler-ultrasounds were performed demonstrating absence of diastolic flow as well as a sub-capsular hematoma of the kidney. Prompt surgical exploration with allograft capsulotomy was performed in all cases. Immediately after capsulotomy, intraoperative Doppler study demonstrated robust return of diastolic flow. Three patients maintained good graft function, and one kidney was lost due to acute antibody-mediated rejection. We conclude that postbiopsy anuria associated with a subcapsular hematoma and acute absence of diastolic flow on doppler ultrasound should be considered pathognomonic of APK. All renal transplant specialists should be able to recognize this complication, because immediate surgical decompression can salvage the allograft. PMID:18444936

  9. 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

  10. Hepatic osteodystrophy complicated with bone fracture in early infants with biliary atresia

    PubMed Central

    Okada, Tadao; Honda, Shohei; Miyagi, Hisayuki; Minato, Masashi; Taketomi, Akinobu

    2012-01-01

    Biliary atresia (BA) is one of the major hepatobiliary abnormalities in infants and one of the causes of hepatic osteodystrophy. Bone disease may be caused by the malabsorption of calcium and magnesium by vitamin D in hepatobiliary diseases in which bile flow into the intestines is deficient or absent. Bone fracture before Kasai hepatic portoenterostomy or within one month after the procedure in an infant with BA is very rare. We herein report two infants: one infant with BA who initially presented with a bone fracture before Kasai hepatic portoenterostomy, and the other at 4 wk after Kasai hepatic portoenterostomy, and also provide a review of the literature. Moreover, we conclude that clinicians should consider BA in infants with bone fracture during early infancy. PMID:23293713

  11. Early Pulmonary Complications following Total Knee Arthroplasty under General Anesthesia: A Prospective Cohort Study Using CT Scan

    PubMed Central

    Song, Kai; Rong, Zhen; Yang, Xianfeng; Yao, Yao; Shen, Yeshuai; Shi, Dongquan; Xu, Zhihong; Chen, Dongyang; Zheng, Minghao; Jiang, Qing

    2016-01-01

    Purpose. Postoperative pulmonary complications (PPCs) are common after major surgeries. However, the number of studies regarding PPCs following total knee arthroplasty (TKA) is limited. The aim of this study was to determine the incidence of early PPCs following TKA by computed tomography (CT) scan and to identify associated risk factors. Methods. Patients, who were diagnosed with osteoarthritis or rheumatoid arthritis and underwent primary TKA at our institution, were included in this prospective cohort study. Patients received a standard procedure of TKA under general anesthesia. Chest CT scan was performed during 5–7 days postoperatively. Univariate analysis and multivariate logistic regression analysis were employed to identify the risk factors. Results. The total incidence of early PPCs following TKA was 45.9%. Rates of pneumonia, pleural effusion, and atelectasis were 14.4%, 38.7%, and 12.6%, respectively. Lower body mass index and perioperative blood transfusion were independent risk factors for PPCs as a whole and associated with atelectasis. Postoperative acute episode of hypoxemia increased the risk of pneumonia. Blood transfusion alone was related to pleural effusion. Conclusions. The incidence of early PPCs following TKA was high. For patients with relevant risk factors, positive measures should be adopted to prevent PPCs. PMID:27069922

  12. A rare case of tertiary syphilis complicated with aortic aneurysm in this era of early use of highly effective antibiotics.

    PubMed

    Vasudevan, Biju; Verma, Rajesh; Pragasam, Vijendran; Nema, Shekar

    2014-01-01

    This 35-year-old man presented with history of hemoptysis and breathlessness on exertion of 3 months duration. Examination revealed feeble left radial, brachial and carotid pulses. Chest radiograph showed a superior mediastinal mass and contrast enhanced computed tomography chest showed a large aortic arch with mass and compression effects. Endosonographic examination was suggestive of aortic aneurysm. During further evaluation, serum Venereal Disease Research Laboratory test was found to be positive in titers of 1:32. Treponema pallidum hemagglutination test was performed and showed positive titers of 1:64. Neurosyphilis was ruled out by normal cerebrospinal fluid examination findings. Patient was treated with injectable benzathine penicillin and aortic aneurysm repair was planned. The authors present a rare case of tertiary syphilis complicated with aortic aneurysm in this era of early use of highly effective antibiotics. PMID:24958987

  13. Early combined treatment with steroid and immunoglobulin is effective for serious Kawasaki disease complicated by myocarditis and encephalopathy.

    PubMed

    Suga, Kenichi; Inoue, Miki; Ono, Akemi; Terada, Tomomasa; Kawahito, Masami; Mori, Kazuhiro

    2016-01-01

    Severe-type Kawasaki disease (KD) complicated by serious myocarditis and encephalopathy can be successfully treated without abnormality of the coronary arteries by steroid pulse treatment and intravenous immunoglobulin (IVIg). A 4-year-old Japanese girl was diagnosed with KD due to a 6-day history of fever, rash, flushed lips, conjunctival hyperemia, palmar edema, and cervical lymphadenopathy. The day after initiation of IVIg and aspirin, cardiac gallop rhythm was identified. Cardiac ultrasonography revealed severe left ventricular dysfunction. Disturbance of consciousness, hallucinations, and slurred speech were also observed. Magnetic resonance imaging showed no abnormalities, but electroencephalography revealed high-voltage slow waves. Despite this serious disease, cardiac function and neurological abnormalities showed complete recovery without dilatation of the coronary arteries by steroid pulse treatment and additional IVIg. Follow-up at 15 months revealed no abnormality of the coronary arteries. In conclusion, we suggest that early combined treatment with steroid and IVIg is effective for serious KD complicated by myocarditis and encephalopathy. J. Med. Invest. 63: 140-143, February, 2016. PMID:27040070

  14. [Health education in pregnancy and postpartum: meanings attributed by puerperal women].

    PubMed

    Guerreiro, Eryjosy Marculino; Rodrigues, Dafne Paiva; Queiroz, Ana Beatriz Azevedo; Ferreira, Márcia de Assunção

    2014-01-01

    Descriptive study, qualitative, that aimed to capture the content of social representations of puerperal women on health education in pregnancy and postpartum in primary health care. Users were 31 Family Health Centers in Fortaleza, Ceará, over 18 years in the postpartum period, with at least six visits to prenatal and one postpartum consultation. It was held a lexical analysis of data from semi-structured interviews with the software ALCESTE. The representations of puerperal women on health education are linked to institutional educational practices, with emphasis on lectures, family and school education, and community education. It predominate the traditional pedagogy, with the transmission of information, punctual and widespread. It is necessary to change the pedagogical logic, expanding educational groups with knowledge sharing. PMID:24676063

  15. 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

  16. 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

  17. [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

  18. Early diagnosis and treatment may prevent the development of complications in an adult patient with glycogen storage disease type Ia.

    PubMed

    Araoka, Toshikazu; Takeoka, Hiroya; Abe, Hideharu; Kishi, Seiji; Araki, Makoto; Nishioka, Keisuke; Ikeda, Masaki; Mazaki, Tetsuro; Ikemura, Shiori; Kondo, Makiko; Hoshina, Azusa; Nagai, Kojiro; Mima, Akira; Murakami, Taichi; Mimura, Rokuro; Oka, Kazumasa; Saito, Takao; Doi, Toshio

    2010-01-01

    Type Iota(a) glycogen storage disease (GSD Iota(a)) is caused by the deficiency of glucose-6-phosphatase activity, which results in metabolic disorder and organ failure, including renal failure. GSD Iota(a) patients are generally diagnosed at a median age of 6 months. However, we report a 20-year-old Japanese female with newly diagnosed GSD Iota(a) . The renal disorder of GSD Iota(a) is considered to be produced by glomerular hyperfiltration, TGF-beta expression which is induced by renin-angiotensin-aldosterone system (RAS) and uric acid, and the increase in both small dense LDL and modified LDL which is characteristic of GSD Iota(a) as well as hypertriglyceridemia. With the administration of intensive therapies, including angiotensin type 1-receptor blocker and some lipid lowering drugs, along with traditional dietary therapy, daily proteinuria of the patient improved from 2.1 g to 0.78 g. Although the patients of GSD Iota(a) should receive an early and accurate diagnosis and effective therapies before the age of 1 year, the combination of traditional dietary therapies and intensive therapies may have therapeutic potential for the complications of adult patients. In this report, we describe the management of renal disease and the characteristic features of this metabolic disorder. PMID:20720360

  19. 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.

  20. 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

  1. Association Between Early Helicobacter pylori Eradication and a Lower Risk of Recurrent Complicated Peptic Ulcers in End-Stage Renal Disease Patients

    PubMed Central

    Chang, Shen-Shong; Hu, Hsiao-Yun

    2015-01-01

    Abstract End-stage renal disease (ESRD) patients exhibit an increased incidence of peptic ulcer disease. Helicobacter pylori plays a central role in the development of peptic ulcers. The effect of early H pylori eradication on the recurrence of complicated peptic ulcer disease in ESRD patients remains unclear. The aim of the present study was to explore whether early H pylori eradication therapy in ESRD patients can reduce the risk of recurrent complicated peptic ulcers. We conducted a population-based cohort study and recruited patients with ESRD who had developed peptic ulcers. We categorized patients into early (time lag ≦120 days after peptic ulcer diagnosis) and late H pylori eradication therapy groups. The Cox proportional hazards model was used. The endpoint was based on hospitalization for complicated recurrent peptic ulcers. The early and late H pylori eradication therapy groups consisted of 2406 and 1356 ESRD patients, respectively, in a time lag of 120 days. After adjusting for possible confounders, the early eradication group exhibited a lower rate of complicated recurrent peptic ulcer disease (hazard ratio [HR] = 0.76, 95% confidence interval [CI] = 0.64–0.91, P = 0.003) in a time lag of ≦120 days, but a similar rate of complicated recurrent peptic ulcer disease in time lags of ≦1 year (HR = 0.97, 95% CI 0.79–1.19, P = 0.758) and 2 years (HR = 1.11, 95% CI 0.86–1.44, P = 0.433) compared with the late eradication group. We recommend administering H pylori eradication within 120 days after peptic ulcer diagnosis to H pylori infected ESRD patients who have developed peptic ulcers. PMID:25569660

  2. 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

  3. Early experience using an online reporting system for interventional radiology procedure-related complications integrated with a digital dictation system.

    PubMed

    Gupta, Sanjay; Patel, Jay; McEnery, Kevin; Wallace, Michael J; Ahrar, Kamran; Suitor, Chuck; Hicks, Marshall E

    2011-08-01

    The absence of user-friendly systems for reporting complications is a major barrier to improving quality assurance (QA) programs in interventional radiology (IR) services. We describe the implementation of a QA application that is completely integrated with the radiology dictation system. We implemented an IR QA process as a module within the electronic medical record and radiologist dictation system applications used at our institution. After a radiologist completes a dictation, he or she must select from a drop-down list of complications before proceeding to the next case. Delayed QA events can be entered using the same applications. All complication entries are sent to a database, which is queried to run reports. During the study period, all the 20,034 interventional procedures were entered in the QA database, 1,144 complications were reported, 110 (9.6%) of which were classified as major. Although majority of the complications (996) were entered at the time of dictation, 148 complications (12.9%) were entered afterwards. All major complications were referred to the IR peer review committee, and 30 of these were discussed in the morbidity and mortality meetings. We studied post-lung-biopsy pneumothorax and chest tube rates and initiated a quality improvement process based on the results.The integration of the IR QA reporting system into the workflow process and the mandatory requirements for completion has the potential to minimize the work effort required to enter complication data, and improve participation in the QA process. PMID:20717701

  4. 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

  5. Obstructive sleep apnoea in a puerperal patient with Hallermann-Streiff syndrome.

    PubMed

    Shiomi, T; Guilleminault, C; Izumi, H; Yamada, S; Murata, K; Kobayashi, T

    1999-10-01

    A 26 yr old puerperal female with Hallermann-Streiff syndrome developed serious obstructive sleep apnoea syndrome during pregnancy. She underwent an elective Caesarean section delivery, but ending the pregnancy did not improve her clinical symptoms. By treating her with nasal continuous positive airway pressure, a worsening of her headaches and glaucoma was prevented. The administration of acetazolamide controlled all of her symptoms. Treatment with nasal ventilation is the best initial approach. It is also important to assure normal oxygenation before pregnancy since the foetus may suffer from the severe deprivation that may occur in these patients. PMID:10573253

  6. Microvascular complications of diabetes.

    PubMed

    Cypress, Marjorie; Tomky, Donna

    2006-12-01

    The microvascular complications of diabetes are serious, and can be life threatening. They involve injury to the blood vessels in the retina, kidney, nervous system, gingiva, and skin. Controlling the risk factors for microvascular complications involves controlling glucose level, blood pressure, and lipids, along with healthy lifestyle changes. Early identification of these complications can promote early interventions and prevent of slow progression of these diseases. Nurses can play a major role through patient care and self-management education. PMID:17059984

  7. Significance of nitric oxide concentration in plasma and uterine secretes with puerperal endometritis in dairy cows.

    PubMed

    Li, DeJun; Liu, YunFeng; Li, YanFei; Lv, Ying; Pei, XiaoYing; Guo, DingZong

    2010-04-01

    Endometritis is an inflammation of the endometrial lining of the uterus without systemic signs, which is associated with chronic postpartum infection of the uterus with pathogenic bacteria. Nitric oxide (NO) is an inflammatory mediator that among other effects causes smooth muscle relaxation and mediated cytoimmunity and inflammation toxicity. To see if the nitric oxide concentration in plasma and uterine secrets is related with postpartum endometritis, NO concentrations in plasma and uterine secrets were measured in dairy cows with puerperal endometritis (clinical endometritis (n = 60) and subclinical endometritis (n = 58)). Cows with clinical or subclinical endometritis showed higher concentrations of NO in both plasma and uterine secrets when compared with normal cows and the highest concentrations of NO in plasma and uterine secrets were found in dairy cows with clinical endometritis. Expression level of NOS2 mRNA in endometrial biopsies from cows with puerperal endometritis was also higher and the highest expression of NOS2 mRNA was found in cows with clinical endometritis. The results showed that concentrations of NO in plasma and uterine fluid are related with the degree of endometritis which may be useful to diagnose the endometritis in dairy cows. PMID:20414720

  8. 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

  9. Impact of Clean Delivery-kit use on Newborn Umbilical Cord and Maternal Puerperal Infections in Egypt

    PubMed Central

    Hassan, Mohamed; Balsara, Zohra P.; Winch, Peter J.; Gipson, Reginald; Santosham, Mathuram

    2009-01-01

    This cross-sectional cohort study explored the impact of the use of clean delivery-kit (CDK) on morbidity due to newborn umbilical cord and maternal puerperal infections. Kits were distributed from primary-care facilities, and birth attendants received training on kit-use. A nurse visited 334 women during the first week postpartum to administer a structured questionnaire and conduct a physical examination of the neonate and the mother. Results of bivariate analysis showed that neonates of mothers who used a CDK were less likely to develop cord infection (p=0.025), and mothers who used a CDK were less likely to develop puerperal sepsis (p=0.024). Results of multiple logistic regression analysis showed an independent association between decreased cord infection and kit-use [odds ratio (OR)=0.42, 95% confidence interval (CI) 0.18–0.97, p=0.041)]. Mothers who used a CDK also had considerably lower rates of puerperal infection (OR=0.11, 95% CI 0.01–1.06), although the statistical strength of the association was of borderline significance (p=0.057). The use of CDK was associated with reductions in umbilical cord and puerperal infections. PMID:20099758

  10. 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

  11. 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

  12. Is photodynamic therapy a selective treatment? Analysis of local complications after endoscopic photodynamic therapy of early stage tumors of gastrointestinal, tracheobronchial, and urinary tracts

    NASA Astrophysics Data System (ADS)

    Spinelli, Pasquale; Dal Fante, Marco; Mancini, Andrea

    1995-03-01

    Selectivity is the most emphasized advantage of photodynamic therapy (PDT). However, at drug and light doses used for clinical applications, response from normal tissue surrounding the tumor reduces the real selectivity of the drug-light system and increases the surface of the area responding to the treatment. It is now evident that light irradiation of a sensitized patient produces damage at a various degree not only in the tumor but also in non-neoplastic tissues included in the field of irradiation. We report our experience in endoscopic PDT of early stage tumors in tracheobronchial, gastrointestinal and urinary tracts, describing early and late local complications caused by the damage of normal tissues adjacent to the tumors and included in the field of light irradiation. Among 44 patients treated, local complications, attributable to a poor selectivity of the modality, occurred in 6 patients (14%). In particular, the rate of local complications was 9% in patients treated for esophageal tumors, 14% in patients with gastric tumors, 9% in patients with tracheobronchial tumors, and 67% in bladder cancer patients. Clinical pictures as well as endoscopic findings at various intervals from treatment showed that mucositis is a common event following endoscopic PDT. It causes exudation and significant tissue inflammatory response, whose consequences are different in the various organs treated. Photoradiation must be, as much as possible, limited to the malignant area.

  13. May Renal Resistive Index Be an Early Predictive Tool of Postoperative Complications in Major Surgery? Preliminary Results

    PubMed Central

    Meco, Massimo; Ruggieri, Nadia; Cosseta, Daniele; Cirri, Silvia; Zito, Paola Cosma; Gollo, Yari; Raimondi, Ferdinando

    2014-01-01

    Background. Patients who undergo high-risk surgery represent a large amount of post-operative ICU-admissions. These patients are at high risk of experiencing postoperative complications. Renal Resistive Index was found to be related with renal dysfunction, hypertension, and posttraumatic hemorrhagic shock, probably due to vasoconstriction. We explored whether Renal Resistive Index (RRI), measured after awakening from general anesthesia, could have any relationship with postoperative complications. Methods. In our observational, stratified dual-center trial, we enrolled patients who underwent general anesthesia for high-risk major surgery. After awakening in recovery room (or during awakening period in subjects submitted to cardiac surgery) we measured RRI by echo-color-Doppler method. Primary endpoint was the association of altered RRI (>0.70) and outcome during the first postoperative week. Results. 205 patients were enrolled: 60 (29.3%) showed RRI > 0.70. The total rate of adverse event was 27 (18.6%) in RRI ≤ 0.7 group and 19 (31.7%) in RRI > 0.7 group (P = 0.042). Significant correlation between RRI > 0.70 and complications resulted in pneumonia (P = 0.016), septic shock (P = 0.003), and acute renal failure (P = 0.001) subgroups. Patients with RRI > 0.7 showed longer ICU stay (P = 0.001) and lasting of mechanical ventilation (P = 0.004). These results were confirmed in cardiothoracic surgery subgroup. RRI > 0.7 duplicates triplicates the risk of complications, both in general (OR 2.03 93 95% CI 1.02–4.02, P = 0.044) and in cardiothoracic (OR 2.62 95% CI 1.11–6.16, P = 0.027) population. Furthermore, we found RRI > 0.70 was associated with a triplicate risk of postoperative septic shock (OR 3.04, CI 95% 1.5–7.01; P = 0.002). PMID:24967414

  14. Non-puerperal mastitis masking pre-existing breast malignancy: importance of follow-up imaging.

    PubMed

    An, Jin Kyung; Woo, Jeong Joo; Lee, Seung A

    2016-04-01

    Mastitis is an inflammatory condition of the breast with common symptoms of pain, swelling, erythema, warmth, and fever. Diagnosis of mastitis is easily made on the basis of typical symptoms and ultrasonographic findings, such as diffusely increased echogenicity of the parenchyma and subcutaneous fat, or skin thickening. However, when it occurs in women middle-aged or older, associated malignancy should be considered. In our cases, we detected irregular hypoechoic malignant masses after the disappearance of inflammatory changes. Therefore, when non-puerperal women have inflammatory signs on their breast, follow-up imaging should be performed. In particular, in the case of persistent or growing palpability after the recovery of breast inflammation, percutaneous core biopsy and short-term follow-up with ultrasonography should be considered to exclude the associated malignancy. PMID:26169080

  15. Non-puerperal mastitis masking pre-existing breast malignancy: importance of follow-up imaging

    PubMed Central

    2016-01-01

    Mastitis is an inflammatory condition of the breast with common symptoms of pain, swelling, erythema, warmth, and fever. Diagnosis of mastitis is easily made on the basis of typical symptoms and ultrasonographic findings, such as diffusely increased echogenicity of the parenchyma and subcutaneous fat, or skin thickening. However, when it occurs in women middle-aged or older, associated malignancy should be considered. In our cases, we detected irregular hypoechoic malignant masses after the disappearance of inflammatory changes. Therefore, when non-puerperal women have inflammatory signs on their breast, follow-up imaging should be performed. In particular, in the case of persistent or growing palpability after the recovery of breast inflammation, percutaneous core biopsy and short-term follow-up with ultrasonography should be considered to exclude the associated malignancy. PMID:26169080

  16. 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

  17. Analysis of a Streptococcus pyogenes Puerperal Sepsis Cluster by Use of Whole-Genome Sequencing

    PubMed Central

    Ben Zakour, Nouri L.; Venturini, Carola

    2012-01-01

    Between June and November 2010, a concerning rise in the number of cases of puerperal sepsis, a postpartum pelvic bacterial infection contracted by women after childbirth, was observed in the New South Wales, Australia, hospital system. Group A streptococcus (GAS; Streptococcus pyogenes) isolates PS001 to PS011 were recovered from nine patients. Pulsed-field gel electrophoresis and emm sequence typing revealed that GAS of emm1.40, emm75.0, emm77.0, emm89.0, and emm89.9 were each recovered from a single patient, ruling out a single source of infection. However, emm28.8 GAS were recovered from four different patients. To investigate the relatedness of these emm28 isolates, whole-genome sequencing was undertaken and the genome sequences were compared to the genome sequence of the emm28.4 reference strain, MGAS6180. A total of 186 single nucleotide polymorphisms were identified, for which the phylogenetic reconstruction indicated an outbreak of a polyclonal nature. While two isolates collected from different hospitals were not closely related, isolates from two puerperal sepsis patients from the same hospital were indistinguishable, suggesting patient-to-patient transmission or infection from a common source. The results of this study indicate that traditional typing protocols, such as pulsed-field gel electrophoresis, may not be sensitive enough to allow fine epidemiological discrimination of closely related bacterial isolates. Whole-genome sequencing presents a valid alternative that allows accurate fine-scale epidemiological investigation of bacterial infectious disease. PMID:22518858

  18. Use of Databases for Early Recognition of Risk of Diabetic Complication by Analysis of Liver Enzymes in Type 2 Diabetes Mellitus

    PubMed Central

    Malenica, Maja; Prnjavorac, Besim; Causevic, Adlija; Dujic, Tanja; Bego, Tamer; Semiz, Sabina

    2016-01-01

    Introduction: Because of increasing prevalence of T2MD worldwide, it’s very important to recognize risk factors for diabetic complications, as soon as possible. Symptoms of complications appear a few or many years after tissue damage. So, it’s imperative to establish surveillance of diabetics with laboratory and other diagnostic procedures for early recognition of diabetic complications. Follow up of clinical curs of diabetes, by using databases of patients, provide possibility for permanent analysis of important laboratory parameters and any changes could be registered. Although an emerging evidence suggests a strong association of ALT (alanine aminotransferase) and γGT (gamma glutamyl transferase) activity with type 2 diabetes mellitus (T2DM), only a limited number of studies have analyzed the association of AST (aspartate aminotransferase), ALT, γGT, and ALP (alkaline phosphatase) activities in controlled T2DM. Material and Methods: Gender differences are of special interest in trying to follow diabetes progression and development of its complications. Here the activities of ALT, AST, γGT, ALP were analyzed as well as levels of glycosylated hemoglobin (HbA1c) and fasting plasma glucose (FPG) in 40 T2DM patients and 40 age-matched healthy subjects. Blood samples were collected from all participants in regular 3-months intervals up to 6 months period. Standard IFCC enzyme protocols were used to determine enzyme activities. Results and discussion: In first measured interval, significantly higher activities of ALT (p= 0,050) and glucose levels (p=0,045) were shown in male. A significant correlation was shown between ALT and AST activity with FPG and HbA1c levels in first and third measured interval. ALT activity was much higher in the group of patients with poor glycemia control. Average levels of activities of enzymes stay nearly in normal limits, but changes of enzymes activities should be recognized as soon as possible, earlier than tissue changes and diabetic complications become irreversible. PMID:27147797

  19. [Congenital heart disease in adults: residua, sequelae, and complications of cardiac defects repaired at an early age].

    PubMed

    Oliver Ruiz, José María

    2003-01-01

    Nowadays, it is estimated that 85% of the infants born with congenital heart disease (CHD) will survive to adulthood, thanks mainly to surgical or therapeutic procedures performed during infancy or childhood. The clinical profile and disease pattern of adults with CHD is changing. The prevalence of certain adult CHDs, such as tetralogy of Fallot, transposition of the great arteries or univentricular heart, is rising, but these conditions have practically become new diseases as a result of therapy. Most surviving patients present residua, sequelae, or complications, which can progress during adult life. These disorders can present electrophysiological disturbances, valvular disease, persistent shunts, myocardial dysfunction, pulmonary or systemic vascular disease, problems caused by prosthetic materials, infectious complications, thromboembolic events, or extravascular disorders involving multiple organs or systems. In tetralogy of Fallot, the most striking problems that affect long-term prognosis are pulmonary valve regurgitation, right ventricle dysfunction, and atrial or ventricular arrhythmias. The main problems appearing after physiological atrial repair of transposition of the great arteries are related to right ventricular function, since it is structurally unprepared for systemic circulation, and atrial arrhythmias. Surgical repair of univentricular heart using Fontan techniques should be considered a palliative procedure that does not modify the underlying structural disorder and exposes the postoperative patient to severe complications and problems. The increase in the number of patients with CHD who will reach adulthood in the coming decades makes it necessary to carefully consider the new healthcare demands that are being generated, who should be responsible for them, and how and where solutions can be found. PMID:12550003

  20. Not the Ceiling, but the Floor: Innovative Harlem Early Childhood Education Effort Complicated by Varying Government Regulations

    ERIC Educational Resources Information Center

    Costa, Kristina

    2012-01-01

    This case study was produced in conjunction with the Center for American Progress's accompanying report on these issues, "Increasing the Effectiveness and Efficiency of Existing Public Investments in Early Childhood Education." This report establishes a set of policies and administrative changes on the federal level that will begin to address…

  1. EMR is not inferior to ESD for early Barrett’s and EGJ neoplasia: An extensive review on outcome, recurrence and complication rates

    PubMed Central

    Komeda, Yoriaki; Bruno, Marco; Koch, Arjun

    2014-01-01

    Background and study aims In recent years, it has been reported that early Barrett’s and esophagogastric junction (EGJ) neoplasia can be effectively and safely treated using endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). Multiband mucosectomy (MBM) appears to be the safest EMR method. The aim of this systematic review is to assess the safety and efficacy of MBM compared with ESD for the treatment of early neoplasia in Barrett’s or at the EGJ. Methods A literature review of studies published up to May 2013 on EMR and ESD for early Barrett’s esophagus (BE) neoplasia and adenocarcinoma at the EGJ was performed through MEDLINE, EMBASE and the Cochrane Library. Results on outcome parameters such as number of curative resections, complications and procedure times are compared and reported. Results A total of 16 studies met the inclusion criteria for analysis in this study. There were no significant differences in recurrence rates when comparing EMR (10/380, 2.6 %) to ESD (1/333, 0.7 %) (OR 8.55; 95 %CI, 0.91 – 80.0, P = 0.06). All recurrences after EMR were treated with additional endoscopic resection. The risks of delayed bleeding, perforation and stricture rates in both groups were similar. The procedure was considerably less time-consuming in the EMR group (mean time 36.7 min, 95 %CI, 34.5 – 38.9) than in the ESD group (mean time 83.3 min, 95 %CI, 57.4 – 109.2). Conclusions The MBM technique for EMR is as effective as ESD when comparing outcomes related to recurrence and complication rates for the treatment of early Barrett’s or EGJ neoplasia. The MBM technique is considerably less time-consuming. PMID:26135261

  2. 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

  3. [Peloid therapy in the complex sanatorium treatment of children of early age with complications of perinatal brain damage].

    PubMed

    Ponomareva, S O; Babina, L M

    2003-01-01

    The search for novel approaches to multimodality prophylaxis and treatment of sequelae of perinatal nervous system affection as well as introduction of the early diagnostic criteria are topical problems in present-day pediatric neurology. Peloid therapy efficacy in combined sanatorium treatment was studied (Peloterm unit) in 44 infants aged 1 to 3 years. They suffered from sequelae of perinatal affections of the central nervous system including infantile cerebral paralysis. A positive effect (improvement of motor and psychic-speech development) was achieved in 98% cases. This indicates validity of this method in the treatment of CNS affections following perinatal affection of the brain in infants over 1 year of age. PMID:14753007

  4. [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

  5. Early Percutaneous Heparin-Free Veno-Venous Extra Corporeal Life Support (ECLS) is a Safe and Effective Means of Salvaging Hypoxemic Patients with Complicated Chest Trauma

    PubMed Central

    Chen, Thay-Hsiung; Shih, James Yao-Ming; Shih, Joseph Juey-Ming

    2016-01-01

    Background The objective of this study was to assess the feasibility and safety of heparin-free veno-venous extracorporeal life support (VV ECLS) as a means of salvaging polytrauma patients with life-threatening hypoxemia. Methods This is a retrospective observational study on 7 consecutive trauma patients who underwent VV ECLS for severe chest trauma unresponsive to conventional measures. Results The median time to ECLS was within 10 hrs (IQR 2-53) of mechanical ventilation. Surgical interventions were performed before and during ECLS based on management priorities consistent with advanced trauma life support guidelines. No heparin was used for at least 4 days in this group with activated coagulation time (ACT) approximating 170 seconds by the 3rd and 4th day. There were no thromboembolic complications. Four patients were successfully discharged and three of these survivors had concomitant traumatic brain injury (TBI) without neurologic sequel. Conclusions Early VV ECLS can be used for salvage of patients with traumatic lung injury. Acute trauma care can be continued as needed under heparin-free ECLS without the fear of thromboembolic complications. PMID:27122937

  6. Successful Reduction of Acute Puerperal Uterine Inversion with the Use of a Bakri Postpartum Balloon

    PubMed Central

    Ida, Akinori; Ito, Koichi; Kubota, Yoko; Nosaka, Maiko; Kato, Hiroshi; Tsuji, Yoshiyuki

    2015-01-01

    Uterine inversion is a state wherein the endometrial surface is inverted. Although this condition may be observed in nonpregnant women, it most commonly develops at the time of delivery. In the present case, a 37-year-old woman without any remarkable history developed acute puerperal uterine inversion after the successful induction of labor. Following the delivery, she complained twice of severe lower abdominal pain; subsequently, hemorrhage was noted at the site of partial detachment of the placenta. These findings led to a diagnosis of placenta accreta, and the patient developed a state of shock. A Bakri postpartum balloon was inserted into the uterine cavity under ultrasonographic guidance and was filled with physiological saline for treatment of this condition. With this procedure, the uterine inversion was completely reduced and the hemorrhage was stopped. Moreover, no reinversion was observed in the postoperative period. These findings suggest that a Bakri postpartum balloon can be used to noninvasively reduce uterine inversion and prevent its recurrence. PMID:25954560

  7. 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.

  8. 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

  9. Anorexia nervosa - medical complications.

    PubMed

    Mehler, Philip S; Brown, Carrie

    2015-01-01

    In contrast to other mental health disorders, eating disorders have a high prevalence of concomitant medical complications. Specifically, patients suffering from anorexia nervosa (AN) have a litany of medical complications which are commonly present as part of their eating disorders. Almost every body system can be adversely, affected by this state of progressive malnutrition. Moreover, some of the complications can have permanent adverse effects even after there is a successful program of nutritional rehabilitation and weight restoration. Within this article we will review all body systems affected by AN. There is also salient information about both, how to diagnose these medical complications and which are the likely ones to result in permanent sequelae if not diagnosed and addressed early in the course of AN. In a subsequent article, the definitive medical treatment for these complications will be presented in a clinically practical manner. PMID:25834735

  10. 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

  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. Leukotriene B4 enhances innate immune defense against the puerperal sepsis agent Streptococcus pyogenes

    PubMed Central

    Soares, Elyara M.; Mason, Katie L.; Rogers, Lisa M.; Serezani, Carlos H.; Faccioli, Lucia H.; Aronoff, David M.

    2012-01-01

    Puerperal sepsis is a leading cause of maternal mortality worldwide. Streptococcus pyogenes (Group A Streptococcus; GAS) is a major etiologic agent of severe postpartum sepsis yet little is known regarding the pathogenesis of these infections. Tissue macrophages provide innate defense against GAS and their actions are highly regulated. The intracellular second messenger cAMP can negatively regulate macrophage actions against GAS. Because leukotriene (LT) B4 has been shown to suppress intracellular cAMP in macrophages, we hypothesized that it could enhance innate defenses against GAS. We assessed the capacity of LTB4 to modulate anti-streptococcal actions of human macrophages, including placental and decidual macrophages and used a novel intrauterine infection model of GAS in mice lacking the 5-lipoxygenase (5LO) enzyme to determine the role of endogenous LTs in host defense against this pathogen. Animals lacking 5LO were significantly more vulnerable to intrauterine GAS infection than wild-type mice and showed enhanced dissemination of bacteria out of the uterus and a more robust inflammatory response compared to wild-type mice. Additionally, LTB4 reduced intracellular cAMP levels via the BLT1 receptor and was a potent stimulant of macrophage phagocytosis and NADPH oxidase-dependent intracellular killing of GAS. Importantly, interference was observed between the macrophage immunomodulatory actions of LTB4 and the cAMP-inducing lipid prostaglandin E2, suggesting that interplay between pro- and anti-inflammatory compounds may be important in vivo. This work underscores the potential for pharmacological targeting of lipid mediator signaling cascades in the treatment of invasive GAS infections. PMID:23325886

  15. Diphtheria Complications

    MedlinePlus

    ... Search The CDC Cancel Submit Search The CDC Diphtheria Note: Javascript is disabled or is not supported ... message, please visit this page: About CDC.gov . Diphtheria Home About Diphtheria Causes and Transmission Symptoms Complications ...

  16. Eye Complications

    MedlinePlus

    ... Text Size: A A A Listen En Español Eye Complications You may have heard that diabetes causes ... work well if you begin them right away. Eye Insight To understand what happens in eye disorders, ...

  17. 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. PMID:26241219

  18. 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

  19. [Complications of liver cirrhosis].

    PubMed

    Wittenburg, H; Tennert, U; Berg, T

    2011-09-01

    The occurrence of complications increases the mortality in patients with cirrhosis of the liver. Therefore, early detection and treatment of complications of cirrhosis is of major importance. Following diagnosis of cirrhosis, a screening gastroscopy detects esophageal varices. Primary prevention of variceal bleeding can be initiated with β-receptor antagonists or variceal band ligation. With the first episode of ascites or the manifestation of other complications of cirrhosis such as hepatic encephalopathy and hepatorenal syndrome, a paracentesis excludes spontaneous bacterial peritonitis. Hepatorenal syndrome can be treated with a combination of vasopressors and albumine. Furthermore, occurrence of complications in patients with cirrhosis of the liver should prompt the evaluation of an indication for liver transplantation. PMID:21611819

  20. 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

  1. 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

  2. Survey of Early Complications of Primary Skin Graft and Secondary Skin Graft (Delayed) Surgery after Resection of Burnwaste in Hospitalized Burn Patients

    PubMed Central

    Enshaei, A.; Masoudi, N.

    2014-01-01

    Introduction: Burning is the second most common cause of home injuries in Iran that is often the cause of conflicts between children and young adults. Burning can lead to early and late complications that scar and contracture are the most common. Burn waste treatment is done by two methods: excision and then skin graft after the formation of granulation tissue; and excision and graft simultaneously that in this study, these two methods are compared. Methods: This was performed as a quasi-experimental analysis and retrospective study on all patients who were hospitalized for burn scar. All patients who have associated with weak eningimmune diseases such as diabetes, acquired immunodeficiency or congenital, taking steroids and patients undergoing chemotherapy etc. are excluded. The method of grafting in patients is primary graft procedure that was compared with patients who are treated using secondary graft. Data collected through review of patients’ hospital and clinic chart. Results: The mean burn percentage in the primary repair group was 14.4% and in the delayed repair group was 16.6%, respectively. The incidence of hematoma in both groups was zero. Skin necrosis and graft rejection and infection in the primary repair group was in 3.7% of patients and in the delayed repair group was in 1.2% of cases (P=0.5) Conclusion: Based on the findings of this study, no difference was observed between the two methods of excision and primary graft with delayed graft in the incidence of graft rejection. Due to the shorter treatment of primary graft and patient satisfaction and also according to the findings of this study excision and primary graft method seems appropriate method for treating old waste burning. PMID:25363185

  3. 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

  4. 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

  5. [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

  6. Complications of collagen fillers.

    PubMed

    Lucey, Patricia; Goldberg, David J

    2014-12-01

    As the skin ages, a deficiency in collagen occurs, thus injectable collagen products have become a sensible and popular option for dermal filling and volume enhancement. Several types of collagen have been developed over the years, including animal sources such as bovine and porcine collagen, as well as human-based sources derived from pieces of the patient's own skin, cadaver skin, and later cultured from human dermal fibroblasts. While collagen overall has a relatively safe, side effect profile, there are several complications, both early and late onset, that practitioners and patients should be aware of. Early complications, occurring within days of the procedure, can be divided into non-hypersensitivity and hypersensitivity reactions. The non-hypersensitive reactions include injection site reactions, discoloration, maldistribution, infection, skin necrosis, and the very rare but dreaded risk of vision loss, whereas the hypersensitivity reactions present usually as delayed type IV reactions, but can also rarely present as an immediate type I reaction. Late complications, occurring within weeks to even years after injection, include granuloma formation, foreign body reactions, and infection secondary to atypical mycobacteria or biofilms. This review will give a detailed overview of the complications secondary to cutaneous collagen injections. PMID:25536127

  7. 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

  8. Neurologic complications following pediatric renal transplantation.

    PubMed

    Ghosh, Partha S; Kwon, Charles; Klein, Melanie; Corder, Julie; Ghosh, Debabrata

    2014-06-01

    We reviewed neurologic complications after renal transplantation in children over a 20-year period. Neurologic complications were classified as early (within 3 months) and delayed (beyond 3 months). Of 115 children, 10 (8.7%) had complications. Early complications were found in 4.35% of patients: seizures in 4 (posterior reversible leukoencephalopathy syndrome due to immunosuppressant toxicity, sepsis/presumed meningitis, and indeterminate) and headaches in 1. One patient with seizures received levetiracetam for 6 months and 1 with headaches received amitriptyline prophylaxis. Late complications were noted in 4.35% of patients: seizures in 3 (posterior reversible leukoencephalopathy syndrome due to hypertension, hypertensive encephalopathy), headaches in 2, and tremors in 1. Two patients with seizures were treated with anti-epilepsy medications; 1 with migraine received cyproheptadine prophylaxis. Neurologic complications develop in children after renal transplantation. Seizures due to posterior reversible leukoencephalopathy syndrome were the commonest complication. Early detection and appropriate management of these complications is important. PMID:23752071

  9. Late complications of tracheotomy.

    PubMed

    Wood, D E; Mathisen, D J

    1991-09-01

    Complications of tracheotomy are largely preventable. Although some authors cite these complications as indications for prolonged endotracheal intubation to avoid tracheotomy, others believe that the laryngotracheal complications of prolonged endotracheal intubation warrant early tracheotomy. Obviously, unnecessary tracheotomies should not be performed, and the controversy regarding the timing of conversion of endotracheal intubation to tracheotomy is handled in an earlier article in this issue. We feel, however, that a properly performed tracheotomy has a low incidence of complications that are more easily managed than are the complex laryngotracheal complications of prolonged endotracheal intubation. Significant post-tracheotomy tracheal stenosis occurs in 8% of patients and is secondary to an overly large tracheotomy stoma or damage at the tracheostomy tube cuff site. Stoma stenosis can be minimized by not making an overly large tracheal stoma and by prevention of undue leverage on the tracheostomy tube. Cuff stenosis can be minimized by the use of the high-volume low-pressure cuffs with careful prevention of overdistention of the cuff. Bronchoscopic dilatation, laser resection, and Silastic T-tube placement provide control of the airway until definitive surgical resection and reconstruction can be performed safely. Tracheoesophageal fistula is an uncommon but life-threatening complication that can be prevented by avoiding overdistention of the tracheostomy tube cuff and by avoiding the concomitant use of a stiff nasogastric tube. These patients are best managed conservatively until they are able to be weaned from a ventilator. A single-stage repair of both the esophagus and the trachea should then be done. Tracheoinnominate artery fistula can be avoided by correct placement of the tracheostomy stoma through the second and third tracheal rings rather than lower in the trachea and by avoidance of overinflation of tracheostomy tube cuffs. PMID:1934960

  10. 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

  11. 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

  12. [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

  13. 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

  14. Early goal-directed therapy after major surgery reduces complications and duration of hospital stay. A randomised, controlled trial [ISRCTN38797445

    PubMed Central

    Pearse, Rupert; Dawson, Deborah; Fawcett, Jayne; Rhodes, Andrew; Grounds, R Michael; Bennett, E David

    2005-01-01

    Introduction Goal-directed therapy (GDT) has been shown to improve outcome when commenced before surgery. This requires pre-operative admission to the intensive care unit (ICU). In cardiac surgery, GDT has proved effective when commenced after surgery. The aim of this study was to evaluate the effect of post-operative GDT on the incidence of complications and duration of hospital stay in patients undergoing general surgery. Methods This was a randomised controlled trial with concealed allocation. High-risk general surgical patients were allocated to post-operative GDT to attain an oxygen delivery index of 600 ml min-1 m-2 or to conventional management. Cardiac output was measured by lithium indicator dilution and pulse power analysis. Patients were followed up for 60 days. Results Sixty-two patients were randomised to GDT and 60 patients to control treatment. The GDT group received more intravenous colloid (1,907 SD ± 878 ml versus 1,204 SD ± 898 ml; p < 0.0001) and dopexamine (55 patients (89%) versus 1 patient (2%); p < 0.0001). Fewer GDT patients developed complications (27 patients (44%) versus 41 patients (68%); p = 0.003, relative risk 0.63; 95% confidence intervals 0.46 to 0.87). The number of complications per patient was also reduced (0.7 SD ± 0.9 per patient versus 1.5 SD ± 1.5 per patient; p = 0.002). The median duration of hospital stay in the GDT group was significantly reduced (11 days (IQR 7 to 15) versus 14 days (IQR 11 to 27); p = 0.001). There was no significant difference in mortality (seven patients (11.3%) versus nine patients (15%); p = 0.59). Conclusion Post-operative GDT is associated with reductions in post-operative complications and duration of hospital stay. The beneficial effects of GDT may be achieved while avoiding the difficulties of pre-operative ICU admission. PMID:16356219

  15. Treatment of complications of parotid gland surgery

    PubMed Central

    Marchese-Ragona, R; De Filippis, C; Marioni, G; Staffieri, A

    2005-01-01

    Summary Although several reports in the literature have documented the surgical technique, and the oncological outcome achieved with parotidectomy, only a few articles have described the complications of parotid gland surgery and their management. Several complications have been reported in parotid surgery. We re-classified the complications of parotidectomy in intra-operative and post-operative (early and late). The commonest complications after parotidectomy are temporary or permanent facial palsy and Frey’s syndrome. PMID:16450773

  16. 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

  17. 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

  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. Diagnostic Value of the Combined Measurement of Serum Hcy, Serum Cys C, and Urinary Microalbumin in Type 2 Diabetes Mellitus with Early Complicating Diabetic Nephropathy

    PubMed Central

    Wang, Tengkai; Wang, Qian; Wang, Zhimei; Xiao, Zuomin; Liu, Lunqin

    2013-01-01

    Diabetic nephropathy (DN) is a major cause of end-stage kidney disease, and therefore early diagnosis and intervention may help reverse renal damage. One hundred and sixty-eight patients with T2DM and 56 healthy volunteers (control group) were enrolled at Shandong University Qilu Hospital between April 2010 and October 2012. All subjects underwent blood sampling for sera homocysteine (Hcy) and cystatin C (Cys C) assays and a urine microalbumin test. The patients were divided into three groups according to the urine microalbumin excretion rate (UMAER): the simple DM group (SDM group, n = 51), the early-stage DN group (EDN group, n = 60), and the clinical DN and renal failure group (CDN group, n = 57). Correlation analysis was performed to examine the association between sera Hcy and Cys C levels with UMAER. Our findings showed that sera Hcy level, Cys C level, and UMAER increased significantly in the SDM group (P < 0.05, P < 0.01), the EDN group (P < 0.01), and the CDN group (P < 0.01) as compared with the control group. These three biochemical markers also increased significantly with DN progression (P < 0.01). Correlation analysis showed that sera Hcy and Cys C levels were positively correlated with UMAER (r = 0.702, P < 0.01; r = 0.873, P < 0.01). In conclusion, our results showed that sera Hcy and Cys C levels increased consistently with the development and progression of DN as indicated by UMAER. Sera Hcy and Cys C are sensitive biomarkers for the detection of early-stage DN and monitoring its progression. PMID:24159393

  20. [Complications of laparoscopy in gynecology].

    PubMed

    Abboud, J; Kesrouani, A; Attieh, E; Attallah, D

    1999-05-01

    In a review of the literature the authors describe the complications encountered during gynecological laparoscopy, insisting on the preparation phase, the conversion to laparotomy and the death cases. Vascular, digestive and urinary lesions, as well as anesthetic difficulties are discussed, aiming at a better prevention. Early recognition of the problem is an important prognostic factor for these patients. PMID:10401185

  1. Early abdominal pregnancy complicated by parasitic dermoid cyst: diagnosis by diffusion-weighted magnetic resonance imaging and management by laparoendoscopic single-site surgery.

    PubMed

    Takeda, Akihiro; Imoto, Sanae; Mori, Masahiko; Yamada, Junko; Nakamura, Hiromi

    2012-01-01

    A 26-year-old primigravida patient was referred with suspicion of ectopic pregnancy 39 days after her last menstrual period. Her serum β-human chorionic gonadotropin value was 3812 mIU/mL. As we suspected the existence of ectopic pregnancy with bilateral dermoid cysts, laparoendoscopic single-site surgery was performed. After dissection of dense pelvic adhesion, cystectomy was performed for a left ovarian dermoid cyst. Although there was a right ovary at the correct position, a parasitic dermoid cyst firmly attached to the peritoneal surface of cul-de-sac was identified. After excision of the parasitic dermoid cyst, early abdominal pregnancy tissue implanted in the peritoneal hollow of right deep pararectal space was identified under the guidance of diffusion-weighted magnetic resonance imaging and was excised. With systemic administration of methotorexate, the postoperative course was uneventful. PMID:22935307

  2. 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

  3. 3.0 Tesla MRI in the early evaluation of inferior alveolar nerve neurological complications after mandibular third molar extraction: a prospective study

    PubMed Central

    Pranno, N; Barchetti, F; Sorrentino, V; Lo Mele, L

    2014-01-01

    Objectives: To evaluate the use of 3.0 T MRI in the prognosis of inferior alveolar nerve (IAN) sensory disorders after mandibular third molar extraction, in the early post-operative period. Methods: 343 IANs were examined before and 3 days after surgery. Two radiologists evaluated the course of the nerve and the relative signal intensity (RSI). Cohen's kappa coefficient (κ) and intraclass correlation coefficient (ICC) were used to evaluate the interobserver (k = 0.891) and intra-observer variability (ICC = 0.927; 0.914, respectively). The IANs were divided into four groups on the basis of neurosensory disorders recovery time. ANOVA was used to evaluate the differences among the RSIs of the four groups, and multiple comparisons were performed with Tukey's range test. Results: No differences in the course of IANs were found before and after surgery. In 280 IANs, no iatrogenic paraesthesia was found (Group A). 63 IANs showed a neurosensory impairment. 38 IANs showed recovery of post-operative paraesthesia at 3-month follow-up (Group B). 16 IANs showed a full recovery of iatrogenic paraesthesia at 6-month follow-up (Group C). Seven IANs displayed a full recovery at 12-month follow-up and two IANs showed persistence of neurosensory disorders at 18-month follow-up (Group D). The one-way ANOVA results indicated statistically significant difference among all groups (p < 0.05), except between Groups C and D (p = 0.504). Conclusions: The early evaluation of RSI values represents a valid tool to determine the prognosis of IAN sensory disorders after mandibular third molar extraction. PMID:24947977

  4. 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

  5. Genome sequence of a serotype M28 strain of group a streptococcus: potential new insights into puerperal sepsis and bacterial disease specificity.

    PubMed

    Green, Nicole M; Zhang, Shizhen; Porcella, Stephen F; Nagiec, Michal J; Barbian, Kent D; Beres, Stephen B; LeFebvre, Rance B; Musser, James M

    2005-09-01

    Puerperal sepsis, a major cause of death of young women in Europe in the 1800s, was due predominantly to the gram-positive pathogen group A Streptococcus. Studies conducted during past decades have shown that serotype M28 strains are the major group A Streptococcus organisms responsible for many of these infections. To begin to increase our understanding of their enrichment in puerperal sepsis, we sequenced the genome of a genetically representative strain. This strain has genes encoding a novel array of prophage virulence factors, cell-surface proteins, and other molecules likely to contribute to host-pathogen interactions. Importantly, genes for 7 inferred extracellular proteins are encoded by a 37.4-kb foreign DNA element that is shared with group B Streptococcus and is present in all serotype M28 strains. Proteins encoded by the 37.4-kb element were expressed extracellularly and in human infections. Acquisition of foreign genes has helped create a disease-specialist clone of this pathogen. PMID:16088825

  6. 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

  7. 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.

  8. 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

  9. 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

  10. Complications in Eyelid Surgery.

    PubMed

    Karimnejad, Kaveh; Walen, Scott

    2016-05-01

    Eyelid surgery consists of challenging reconstructive and cosmetic procedures. Because of the complex anatomy and corresponding vital functions of the upper and lower eyelids, the avoidance of eyelid complications is of vital importance. Complications after eyelid surgery include basic complications (infection, granuloma) and vision-threatening complications. Preoperative history, physical examination, surgical planning, and meticulous surgical technique must be undertaken to prevent complications after eyelid surgery. In addition, patient knowledge, expectations, and motivations must be determined before surgery is performed. PMID:27105805

  11. 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

  12. Complications of 278 consecutive abdominoplasties.

    PubMed

    Stewart, K J; Stewart, D A; Coghlan, B; Harrison, D H; Jones, B M; Waterhouse, N

    2006-01-01

    The case notes of 278 consecutive patients who underwent abdominoplasty, during a five-year period, in one institution under the care of four surgeons were reviewed. Patient details, early and late complications and revision procedures were noted. Seventy-five percent of patients had a 'full' abdominoplasty with undermining to costal cartilage and repositioning of the umbilicus and 23% had 'mini abdominoplasties', 2% were revision operations. Eighteen percent of patients suffered from early complications the most common of which were seroma (5%), haematoma (3%), infection (3%), skin or fat necrosis (2.5%) and delayed healing (2%). Twenty-five percent of patients had late complications which were often relatively minor. These included 'dog ears' (12%), localised fatty excess (10%) and unsatisfactory scars (8%). Twenty-four percent of patients underwent revision surgery. Most commonly further liposuction (12%), dog ear revision (10%) and scar revision (5%). Analysis failed to reveal significant risk factors. Despite an apparently high complication and revision rate the subjective impression is of a satisfied patient cohort. PMID:17046623

  13. Urological complications following inguinal hernioplasty.

    PubMed

    Gulino, Gaetano; Antonucci, Michele; Palermo, Giuseppe; Sasso, Francesco; Tienforti, Daniele; D'Addessi, Alessandro; Bassi, Pier Francesco

    2012-09-01

    Aim of this paper is to report a systematic review of the literature about the incidence and putative mechanisms of genital tract injuries following open and laparoscopic herniorraphy and their effects on sexual function and fertility and to point out the measures of prevention and of treatment. The most frequently described events have been intraoperative complications as bladder or spermatic cord structure damage, immediate postoperative complications as ischaemic orchitis, urinary retention, urinary tract infection, hydrocele or scrotal haematoma and bacterial orchitis, or long-term complications as chronic orchialgia, testis atrophy, sexual dysfunction and infertility. The evidence of literature shows that urological complication after hernioplasty are under-reported. Only a small number of studies to date have essentially dealt with sexual quality of life after inguinal hernia surgical repair. The sexual needs of patients with groin hernias are rarely discussed. Extensive laparoscopic procedures, due to the need of learning curve, have increased the risk of vas damage and infertility in young patients candidate to hernioplasty. Early diagnosis prevents urological complication as well as possible legal claims after hernia repair: it should be include careful history, objective and subjective symptoms and signs of uro-genital pathologies, lab data when necessary, immediate eco-color-Doppler imaging and urgent urological consultation. Despite the lack of prospective randomized trials, there is a growing evidence in literature about positive impact of hernioplasty on sexual function, encouraging future studies on this issue. PMID:23210400

  14. 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

  15. [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

  16. Skin Complications of IBD

    MedlinePlus

    ... Home > Resources > Skin Complications of IBD Go Back Skin Complications of IBD Email Print + Share After arthritis, ... about 5% of people with inflammatory bowel disease. SKIN DISORDERS COMMONLY SEEN IN IBD ERHTHEMA NODOSUM The ...

  17. 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 ...

  18. Pregnancy Complications: Preexisting Diabetes

    MedlinePlus

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

  19. Eye Complications in IBD

    MedlinePlus

    ... Home > Resources > Eye Complications in IBD Go Back Eye Complications in IBD Email Print + Share Approximately 10% ... doctor’s attention sooner rather than later. TYPES OF EYE DISORDERS UVEITIS One of the most common eye ...

  20. 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

  1. 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

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. Complications of Rhinitis.

    PubMed

    Keswani, Anjeni; Peters, Anju T

    2016-05-01

    Chronic rhinitis involves inflammation of the upper airways. An association with comorbid conditions, such as rhinosinusitis, asthma, and chronic obstructive pulmonary disease, has been commonly observed in epidemiologic studies. The underlying pathogenesis of these disorders may be similar. Complications of rhinitis include sleep disturbances, learning impairment, and decreased quality of life. It is vital to recognize the complications of rhinitis so that treatment strategies can address rhinitis as well as its comorbidities and complications in a coordinated manner. PMID:27083108

  8. Complicated Perianal Sepsis.

    PubMed

    Mitra, Abhishek; Yadav, Amitabh; Mehta, Naimish; Varma, Vibha; Kumaran, Vinay; Nundy, Samiran

    2015-12-01

    Management of benign anorectal conditions like abscesses and haemorrhoids is usually uneventful. However, complicated perianal complications can result and have sparsely been reported in literature. Hereby, we report a series of seven patients who presented with rare sequelae like necrotising fasciitis, intraperitoneal or retroperitoneal involvement. All patients responded well to surgical management. Accordingly, complicated perianal sepsis warrants a timely and aggressive surgical intervention. PMID:27011454

  9. 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

  10. Complications of Sinusitis

    MedlinePlus

    ... nerve ending. Some patients notice temporary improvement with oral corticosteroids; however, others may not experience any improvement. Mucocele A mucocele is a complication of sinusitis caused ...

  11. Lung Cancer Ablation: Complications

    PubMed Central

    Hiraki, Takao; Gobara, Hideo; Fujiwara, Hiroyasu; Ishii, Hiroaki; Tomita, Koji; Uka, Mayu; Makimoto, Satoko; Kanazawa, Susumu

    2013-01-01

    Although radiofrequency ablation for lung cancer is generally safe (with a mortality rate <1%), it may cause various complications. Common complications include pneumothorax, pleural effusion, and parenchymal hemorrhage. Although most complications can be treated conservatively or with minimal therapy, physicians should be aware of rare but serious complications. Potentially fatal complications include massive hemorrhage, intractable pneumothorax due to bronchopleural fistula, pulmonary artery pseudoaneurysm, systemic air embolism, and pneumonitis. Other serious complications include injury to the nearby tissues (e.g., brachial nerve plexus, phrenic nerve, diaphragm, and chest wall), needle tract seeding, lung abscess, empyema, and skin burn. Although cavitation of the ablation zone is usually insignificant clinically, such a cavity occasionally ruptures, leading to pneumothorax and bleeding. Cavities may also serve as a scaffold for fungal colonization. Precautions to minimize risk should be taken whenever possible. Nevertheless, serious complications may occur, and thus physicians should be aware of the appropriate treatments for these complications. This article reviews complications associated with lung cancer ablation. PMID:24436533

  12. 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

  13. Acute cholecystitis as a postoperative complication.

    PubMed Central

    Ottinger, L W

    1976-01-01

    The clinical course and management of 40 patients who underwent operation for acute cholecystitis developing as a postoperative complication were reviewed. Of note was the mortality of 47%, the high incidence of gangrene, perforation, empyema, and cholangitis, and the atypical clinical presentation of acute cholecystitis under these conditions. Awareness of this possible complication, knowledge of its clinical features, and early surgical intervention are important facets of successful management. PMID:952563

  14. 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

  15. Coagulation and Placenta-Mediated Complications

    PubMed Central

    Greer, Ian A.; Aharon, Anat; Brenner, Benjamin; Gris, Jean-Christophe

    2014-01-01

    Pregnancy is a physiological hypercoagulable state, preparing the mother for the hemostatic challenge of delivery. However, this is associated with an increased risk of venous thrombosis and placenta-mediated complications, which present major challenges for mother and fetus. Although these conditions are heterogeneous in their pathophysiology, hereditary and acquired thrombophilia has been associated with recurrent pregnancy loss and gestational vascular complications, such as early-onset pre-eclampsia and placental abruption. Prevention of such placenta-mediated complications, which collectively complicate up to 15% of pregnancies, is a major issue for women’s health. Prospective interventional studies stratified by current knowledge of pathophysiological mechanisms related to placental and systemic hemostatic alterations will impact on the management of pregnancies at risk of these complications. PMID:25386350

  16. Complications of fractures of the clavicle.

    PubMed

    Yates, D W

    1976-02-01

    Most fractures of the clavicle unite without incident. The number and diversity of the methods of treatment in use suggest that in most cases good results are obtained despite medical supervision. Yet occasionally complications do arise. This paper describes two such cases and reviews the literature in search of a common factor to account for these complications. Cases presenting with early and late complications of fractures of the clavicle are described and the literature on the subject reviewed. The incidence of complications is highest in cases of direct violence to the shoulder region producing comminuted fractures. Surgical management is outlined in general terms. It is suggested that more prolonged and rigorous immobilization of cases "at risk" may reduce the incidence of non-union and prevent late neurovascular complications. PMID:1254331

  17. Complications of Transjugular Biopsies

    PubMed Central

    Navuluri, Rakesh; Ahmed, Osman

    2015-01-01

    Transvenous biopsy was first performed in 1964 by Charles Dotter. Now routinely performed in the liver and kidney by interventional radiologists, the transjugular approach to biopsy has assumed a central role in coagulopathic patients. Major arterial complications from transjugular liver and renal biopsy are rare. In this article, the authors describe such complications in both organs that necessitated selective endovascular coil embolization. PMID:25762847

  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. PMID:27022521

  19. [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

  20. [Complications of patient positioning].

    PubMed

    Staender, S

    1995-01-01

    Complications related to wrong or improper perioperative positioning are preventable events. Nevertheless patients may suffer from these complications much more than from the original pathology. In a short review a focus is set on the prone and supine position. Finally remarks for prevention are added. PMID:8590298

  1. 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

  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. Complicated migraine: case report.

    PubMed

    Meco, G; Bozzao, L; Formisano, R; Del Castillo, G; Linfante, I

    1988-06-01

    The occurrence of long lasting focal neurological deficit as a complication of migraine is well known. A high incidence of C.T. scan abnormalities have been seen in subjects affected by severe complicated migraine; in some cases such lesions had the aspect of cerebral infarction. In this report we will relate case of a 29 year old woman with complicated migraine and multifocal suffering within the area of the hind brain circulation. The hypodense area we found with C.T. in the left cerebellar hemisphere and the reversibility of this lesion could support the hypothesis of focal edema in our case. PMID:3042690

  4. 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

  5. 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

  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. Neurological Complications of AIDS

    MedlinePlus

    ... Diversity Find People About NINDS Neurological Complications of AIDS Fact Sheet Feature Federal domestic HIV/AIDS information ... Where can I get more information? What is AIDS? AIDS (acquired immune deficiency syndrome) is a condition ...

  8. Complications and Treatments

    MedlinePlus

    ... been shown to decrease several complications of SCD. Stem cell transplants ( A stem cell transplant , also called a bone marrow transplant, is a procedure that infuses healthy cells , called stem cells , into the body to replace damaged or diseased ...

  9. Extraintestinal Complications: Kidney Disorders

    MedlinePlus

    ... but some less serious ones occur more frequently. Kidney stones These are probably the most commonly encountered kidney complications of IBD—particularly oxalate stones. Kidney stones are more common in Crohn's patients with disease ...

  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. 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 » ...

  12. Chickenpox (Varicella) Complications

    MedlinePlus

    ... gov . Chickenpox Home About Chickenpox Signs & Symptoms Complications Transmission Prevention & Treatment Photos Fact Sheet for Kids Vaccination ... Surveillance Outbreaks Control & Investigation of Varicella Outbreaks Outbreaks Manual Manual Appendices References & Resources Multimedia Related Links Medline ...

  13. [Complications of liposuction].

    PubMed

    Sattler, G; Eichner, S

    2013-03-01

    Liposuction is the most frequent aesthetic procedure worldwide for adipose tissue reduction and treatment of lipedema. It is being employed with increasing frequency. In 2010, in the USA more than 200.000 liposuctions were performed. Apart from aesthetic indications, liposuction also is suitable for treatment of benign adipose tissue diseases. This intervention is not a simple procedure but requires extensive knowledge and experience to prevent irreversible medical or aesthetic complications. Severe complications including necrotizing fasciitis, toxic shock syndrome, hemorrhage, perforation of inner organs und pulmonary embolism - some even with lethal outcome - occasionally have been reported. These complications were mostly due to inadequate hygiene measures, inappropriate patient selection, use of excessive local anesthesia during mega-liposuction (tumescent technique) and inadequate post-operative surveillance. The complication rate usually reflects a lack of medical experience as well as technical inadequacies. PMID:23494094

  14. Complications of pancreatic surgery

    PubMed Central

    Andrén-Sandberg, Åke

    2011-01-01

    Many diseases, including pancreatitis benign tumors and cancer, may require pancreas surgery. Pancreatic resection can lead to a prolonged survival in pancreatic cancer and even a potential chance for cure. However, the pancreatic surgery can result in complications, and high postoperative morbidity rates are still presence. This article reviews the pancreatic abstracts of American Pancreas Club 2011, which involves the more common complications, their prevention and treatment. PMID:22363072

  15. Postoperative surgical complications of lymphadenohysterocolpectomy

    PubMed Central

    Marin, F; Pleşca, M; Bordea, CI; Voinea, SC; Burlănescu, I; Ichim, E; Jianu, CG; Nicolăescu, 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

  16. [Embolic complications in bacterial endocarditis].

    PubMed

    Schünemann, S; Werner, G S; Schulz, R; Bitsch, A; Prange, H W; Kreuzer, H

    1997-12-01

    Embolic complications are a major prognostic determinant in the clinical course of infective endocarditis (IE) with an incidence of about 30-50%. In order to analyze risk factors leading to embolism in native (NVE) and prosthetic valve endocarditis (PVE), we reviewed 177 consecutive patients; 43% were female, 57% male, PVE occurred in 24% of all patients all left-sided, among the NVE were 11% right-sided IE. Major embolic complications occurred in 40% of all patients. In NVE, a higher rate of embolic events (45% vs. 26%; p < 0.05), and a larger vegetation size compared to PVE was observed (14 +/- 6 mm vs. 11 +/- 5 mm; p < 0.05). The most important risk factor for embolic complications in NVE was Staphylococcus aureus (odds ratio 6.4). Furthermore, double valve endocarditis, fever, and mitral valve endocarditis were associated with the risk for embolism. In case of severe regurgitation the rate of embolic complications was reduced (54% vs. 77%; p < 0.05). In PVE, fever was a risk factor for embolic events. Staphylococcus aureus was also a frequent microorganism in embolism (45% vs. 22%). The in-hospital mortality was significantly increased in case of embolism (NVE 40% vs. 11%; p < 0.001; PVE 36% vs. 9% p < 0.05). About 50% of all embolic events occurred before admission. In NVE, due to high in-hospital mortality, the rate of patients with embolism undergoing surgery was lower (57% vs. 72%; p < 0.05); whereas in PVE no significant difference was observed. In patients with NVE, aspirin therapy because of coronary artery disease appeared to reduce the rate of embolic complications (11% vs. 47%). However, the low number of patients on aspirin (9%) does not allow recommendations regarding a potential benefit. In conclusion, identification of risk factors leading to embolism in IE may be useful in considering early surgical therapy. However, the high rate of embolic complications before hospital admission indicates a need for improving the diagnostic delay in the prehospital phase. PMID:9499500

  17. On complicity theory.

    PubMed

    Kline, A David

    2006-04-01

    The received account of whistleblowing, developed over the last quarter century, is identified with the work of Norman Bowie and Richard DeGeorge. Michael Davis has detailed three anomalies for the received view: the paradoxes of burden, missing harm and failure. In addition, he has proposed an alternative account of whistleblowing, viz., the Complicity Theory. This paper examines the Complicity Theory. The supposed anomalies rest on misunderstandings of the received view or misreadings of model cases of whistleblowing, for example, the Challenger disaster and the Ford Pinto. Nevertheless, the Complicity Theory is important for as in science the contrast with alternative competing accounts often helps us better understand the received view. Several aspects of the received view are reviewed and strengthened through comparison with Complicity Theory, including why whistleblowing needs moral justification. Complicity Theory is also critiqued. The fundamental failure of Complicity Theory is its failure to explain why government and the public encourage and protect whistleblowers despite the possibility of considerable harm to the relevant company in reputation, lost jobs, and lost shareholder value. PMID:16609713

  18. 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

  19. Treating Complicated Grief

    PubMed Central

    Simon, Naomi M.

    2015-01-01

    IMPORTANCE The death of a loved one is one of life’s 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

  20. [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

  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. Post dengue neurological complication.

    PubMed

    Hasliza, A H; Tohid, H; Loh, K Y; Santhi, P

    2015-01-01

    Dengue infection is highly endemic in many tropical countries including Malaysia. However, neurological complications arising from dengue infection is not common; Gullain-Barre syndrome (GBS) is one of these infrequent complications. In this paper, we have reported a case in which a 39-year-old woman presented with a neurological complication of dengue infection without typical symptoms and signs of dengue fever. She had a history of acute gastroenteritis (AGE) followed by an upper respiratory tract infection (URTI) weeks prior to her presentation rendering GBS secondary to the post viral URTI and AGE as the most likely diagnosis. Presence of thrombocytopenia was the only clue for dengue in this case. PMID:27099661

  5. Complications of percutaneous nephrostolithotomy.

    PubMed

    Dunnick, N R; Carson, C C; Braun, S D; Miller, G A; Cohan, R; Degesys, G E; Illescas, F F; Newman, G E; Weinerth, J L

    1985-10-01

    In 224 patients, renal stones were removed from the urinary tract using either direct extraction with a basket or forceps (59 patients), ultrasonic lithotripsy (164 patients), or infusion chemotherapy (one patient). Residual stone fragments were present more frequently in patients treated with ultrasonic lithotripsy (27%) than with direct extraction (5%). Other complications included hemorrhage (eight patients), catheter dislodgement (four patients), large amounts of urine extravasation (three patients), glycine ascites (three patients), infection (two patients), pneumothorax (one patient), and a prolonged ileus (one patient). More complications occurred among the first 50 patients than the last 50 patients, even though more difficult cases, including patients with staghorn calculi, were accepted during the latter period. Although a learning curve exists, complications can be minimized by attempting to treat more favorable cases during the initial experience. PMID:4034977

  6. Silicone breast implants: complications.

    PubMed

    Iwuagwu, F C; Frame, J D

    1997-12-01

    Silicone breast implants have been used for augmentation mammoplasty for cosmetic purposes as well as for breast reconstruction following mastectomy for more than three decades. Though the use of the silicone gel filled variety has been banned in the USA except for special cases, they continue to be available elsewhere in the world including the UK. Despite the immense benefit they provide, their usage is associated with some complications. Most of these are related to the surgery and can be reduced by good surgical management. The major complications associated with their use is adverse capsular contracture, an outcome which can be very frustrating to manage. This article reviews the commonly reported complications and suggested management alternatives. PMID:9613406

  7. 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

  8. 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

  9. Avoiding Complications in Gigantomastia.

    PubMed

    Kling, Russell E; Tobler, William D; Gusenoff, Jeffrey A; Rubin, J Peter

    2016-04-01

    Gigantomastia is a disabling condition for patients and presents unique challenges to plastic surgeons. Presentation can occur throughout different phases of life, and treatment often begins with nonoperative measures; however, the most effective way to relieve symptoms is surgical breast reduction. Because of the large amount of tissue removed, surgeons can encounter different intraoperative and postoperative complications. By understanding this disease process and these complications, surgeons can attempt to minimize their occurrences. The authors present an overview of the cause, preoperative evaluation, techniques, and outcomes. Additionally, they present outcomes data from their center on 40 patients. PMID:27012802

  10. Adverse Event and Complication Management in Gastrointestinal Endoscopy.

    PubMed

    Richter, James M; Kelsey, Peter B; Campbell, Emily J

    2016-03-01

    Gastrointestinal endoscopy is a remarkably safe set of diagnostic and therapeutic techniques, and yet a small number of significant complications and adverse events are expected. Serious complications may have a material effect on the patient's health and well-being. They need to be anticipated and prevented if possible and managed effectively when identified. When complications occur they need to be discussed frankly with patients and their families. Informed consent, prevention, early detection, reporting, and systems improvement are critical aspects of effective complication management. Optimal complication management may improve patient satisfaction and outcome, as well as preserving the reputation and confidence of the endoscopist, and may minimize litigation. PMID:26753887

  11. 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: ...

  12. 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 ...

  13. Complications from radiotherapy.

    PubMed

    Dhermain, Frédéric; Barani, Igor J

    2016-01-01

    Radiotherapy (RT) of the brain is associated with significant stigma in the neuro-oncology community. This is primarily because of the potentially severe complications with which it may be associated. These complications, especially in subacute and latent settings, are often unpredictable, potentially progressive, and irreversible. The onset of complications may start from the first fraction of 2Gy, continuing over several months after end of RT with persistent drowsiness and apathy. It may also extend over many years with progressive onset of neurocognitive impairments such as memory decline, and diminished focus/attention. For long-term survivors, such as young patients irradiated for a favorable low-grade glioma, quality of life can be seriously impacted by RT. It is essential, as in the pediatric field, to propose patient-specific regimens from the very outset of therapy. The use of molecular biomarkers to better predict survival, control of comorbidities along with judicious use of medications such as steroids and antiepileptics, improved targeting with the help of modern imaging and RT techniques, modulation of the dose, and fractionation aimed at limiting integral dose to the healthy brain all have the potential to minimize treatment-related complications while maintaining the therapeutic efficacy for which RT is known. Sparing "radiosensitive" areas such as hippocampi could have a modest but measurable impact with regard to cognitive preservation, an effect that can possibly be enhanced when used in conjunction with memantine and/or donepezil. PMID:26948357

  14. 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

  15. 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

  16. 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

  17. Epigenetics of diabetic complications

    PubMed Central

    Villeneuve, Louisa M; Natarajan, Rama

    2013-01-01

    Type 1 and Type 2 diabetes are complex diseases associated with multiple complications, and both genetic and environmental factors have been implicated in these pathologies. While numerous studies have provided a wealth of knowledge regarding the genetics of diabetes, the mechanistic pathways leading to diabetes and its complications remain only partly understood. Studying the role of epigenetics in diabetic complications can provide valuable new insights to clarify the interplay between genes and the environment. DNA methylation and histone modifications in nuclear chromatin can generate epigenetic information as another layer of gene transcriptional regulation sensitive to environmental signals. Recent evidence shows that key biochemical pathways and epigenetic chromatin histone methylation patterns are altered in target cells under diabetic conditions and might also be involved in the metabolic memory phenomenon noted in clinical trials and animal studies. New therapeutic targets and treatment options could be uncovered from an in-depth study of the epigenetic mechanisms that might perpetuate diabetic complications despite glycemic control. PMID:24077653

  18. Complicating Methodological Transparency

    ERIC Educational Resources Information Center

    Bridges-Rhoads, Sarah; Van Cleave, Jessica; Hughes, Hilary E.

    2016-01-01

    A historical indicator of the quality, validity, and rigor of qualitative research has been the documentation and disclosure of the behind-the-scenes work of the researcher. In this paper, we use what we call "methodological data" as a tool to complicate the possibility and desirability of such transparency. Specifically, we draw on our…

  19. 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

  20. Complications of hip fractures: A review.

    PubMed

    Carpintero, Pedro; Caeiro, Jose Ramón; Carpintero, Rocío; Morales, Angela; Silva, Samuel; Mesa, Manuel

    2014-09-18

    Nowadays, fracture surgery represents a big part of the orthopedic surgeon workload, and usually has associated major clinical and social cost implications. These fractures have several complications. Some of these are medical, and other related to the surgical treatment itself. Medical complications may affect around 20% of patients with hip fracture. Cognitive and neurological alterations, cardiopulmonary affections (alone or combined), venous thromboembolism, gastrointestinal tract bleeding, urinary tract complications, perioperative anemia, electrolytic and metabolic disorders, and pressure scars are the most important medical complications after hip surgery in terms of frequency, increase of length of stay and perioperative mortality. Complications arising from hip fracture surgery are fairly common, and vary depending on whether the fracture is intracapsular or extracapsular. The main problems in intracapsular fractures are biological: vascularization of the femoral head, and lack of periosteum -a major contributor to fracture healing- in the femoral neck. In extracapsular fractures, by contrast, the problem is mechanical, and relates to load-bearing. Early surgical fixation, the role of anti-thromboembolic and anti-infective prophylaxis, good pain control at the perioperative, detection and management of delirium, correct urinary tract management, avoidance of malnutrition, vitamin D supplementation, osteoporosis treatment and advancement of early mobilization to improve functional recovery and falls prevention are basic recommendations for an optimal maintenance of hip fractured patients. PMID:25232517

  1. Complicated Gallstones after Laparoscopic Sleeve Gastrectomy

    PubMed Central

    Sioka, Eleni; Zacharoulis, Dimitris; Zachari, Eleni; Katsogridaki, Georgia; Tzovaras, George

    2014-01-01

    Background. The natural history of gallstone formation after laparoscopic sleeve gastrectomy (LSG), the incidence of symptomatic gallstones, and timing of cholecystectomy are not well established. Methods. A retrospective review of prospectively collected database of 150 patients that underwent LSG was reviewed. Results. Preoperatively, gallbladder disease was identified in 32 of the patients (23.2%). Postoperatively, eight of 138 patients (5.8%) became symptomatic. Namely, three of 23 patients (13%) who had evident cholelithiasis preoperatively developed complicated cholelithiasis. From the cohort of patients without preoperative cholelithiasis, five of 106 patients (4.7%) experienced complicated gallstones after LSG. Total cumulative incidence of complicated gallstones was 4.7% (95% CI: 1.3–8.1%). The gallbladder disease-free survival rate was 92.2% at 2 years. No patient underwent cholecystectomy earlier than 9 months or later than 23 months indicating the post-LSG effect. Conclusion. A significant proportion of bariatric patients compared to the general population became symptomatic and soon developed complications after LSG, thus early cholecystectomy is warranted. Routine concomitant cholecystectomy could be considered because the proportion of patients who developed complications especially those with potentially significant morbidities is high and the time to develop complications is short and because of the real technical difficulties during subsequent cholecystectomy. PMID:25105023

  2. [Complications of Gaucher's disease].

    PubMed

    Modrego Pardo, P J; Garzarán, G; González, N; Baiges, J J; Gazulla, J

    1992-10-01

    We discuss two cases of Gaucher's disease of the adult with neurological complications. First of the patients came to Hospital due to sudden pain in dorso-lumbar region and motor weakness of lower extremities. In the neurological exploration there were no concluding objective deficit signs except an unstable deambulation. After several hours of rest, symptoms disappeared progressively. In the radiology of the raquis a crushed in the last three dorsal vertebral was seen; this finding together with the clinic the patient showed, suggested a mild and transitory medullar compression. Second patient suffered an intraparenchymatous brain hemorrhage on the course of a platelet depletion and with other mild coagulation disorders. This type of complication have never been described in Gaucher's disease. PMID:1470721

  3. 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

  4. Complications of allergic rhinitis.

    PubMed

    Settipane, R A

    1999-01-01

    With unfortunate high frequency, clinicians consider allergic rhinitis to be more of a nuisance than an illness. When in fact, allergic rhinitis is not only a very common disease process, affecting up to a cumulative frequency of 42% of the U.S. population by age 40, but can lead to significant short-term and long-term medical complications. Poorly controlled symptoms of allergic rhinitis may contribute to sleep loss, secondary daytime fatigue, learning impairment, decreased overall cognitive functioning, decreased long-term productivity and decreased quality of life. Additionally, poorly controlled allergic rhinitis may also contribute to the development of other related disease processes including acute and chronic sinusitis, recurrence of nasal polyps, otitis media/otitis media with effusion, hearing impairment, abnormal craniofacial development, sleep apnea and related complications, aggravation of underlying asthma, and increased propensity to develop asthma. Treatment of allergic rhinitis with sedating antihistamine therapy may result in negative neuropsychiatric effects that contribute to some of these complications. Sedating antihistamines may also be dangerous to use in certain other settings such as driving or operating potentially dangerous machinery. In contrast nonsedating antihistamines have been demonstrated to result in improved performance in allergic rhinitis. PMID:10476318

  5. 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

  6. 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…

  7. Complications employing the holmium:YAG laser.

    PubMed

    Beaghler, M; Poon, M; Ruckle, H; Stewart, S; Weil, D

    1998-12-01

    We report the operative and early postoperative complications and limitations in 133 patients treated with the holmium laser. Complications included urinary tract infection (N = 3), postoperative bradycardia (1), inverted T-waves (1), intractable flank pain (1), urinary retention (1), inability to access a lower-pole calix with a 365-microm fiber (9), stone migration (5), and termination of procedure because of poor visibility (2). No ureteral perforations or strictures occurred, and no complications were directly attributable to the laser. The holmium laser was capable of fragmenting all urinary calculi in this study. In our initial experience, the holmium laser is safe and effective in the treatment of urinary pathology. Use of laser fibers larger than 200 microm occasionally limits deflection of the endoscope into a lower-pole or dependent calix. PMID:9895258

  8. Neurologic complications of metronidazole.

    PubMed

    Sarna, Justyna R; Furtado, Sarah; Brownell, A Keith W

    2013-11-01

    Metronidazole (Flagyl®) is an antimicrobial agent commonly used in clinical practice. Although it is generally well tolerated with minimal side effects, there are a host of still under-recognized neurologic complications of metronidazole treatment. The following review is aimed at summarizing current literature pertaining to metronidazole-induced neurotoxicity including clinical syndromes, neuroradiological findings, prognosis and proposed pathophysiology. Recognition of the neurotoxic effects of metronidazole is critical as prompt discontinuation is generally associated with full clinical recovery and radiological resolution. PMID:24257215

  9. 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

  10. Complications of Macular Peeling

    PubMed Central

    Asencio-Duran, Mónica; Manzano-Muñoz, Beatriz; Vallejo-García, José Luis; García-Martínez, Jesús

    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

  11. [Management of complications in bariatric surgery].

    PubMed

    Weiner, R A; Stroh, C; El-Sayes, I; Frenken, M; Theodoridou, S; Scheffel, O; Weiner, S

    2015-01-01

    Bariatric surgery is known to be the most effective and long-lasting treatment for morbid obesity and associated comorbidities. These comorbidities together with cardiopulmonary decompensation make morbidly obese patients a high risk group for operative interventions. Early detection of postoperative complications is a challenging task in these patients and requires accurate and timely interpretation of any alarm signals. Symptoms, such as tachycardia and abdominal pain are highly suspicious. The same applies to elevated inflammatory parameters and fever. Early diagnostic laparoscopy is mandatory once cardiopulmonary complications have been excluded. Moreover, it has a higher sensitivity and specificity than other radiological modalities and is a minimally invasive procedure with a highly satisfactory outcome. PMID:24622739

  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. Neuropsychiatric complications of antiretroviral therapy.

    PubMed

    Cespedes, Michelle S; Aberg, Judith A

    2006-01-01

    Neuropsychiatric adverse effects related to potent antiretroviral therapy are among the complications that can lead to poor adherence, treatment interruptions, or change of antiretroviral therapy regimens. For a historical perspective, we review early literature and case reports with CNS adverse effects attributed to antiretrovirals. The variability of the cerebrospinal fluid penetration of individual antiretrovirals may contribute to their potential for behavioural and psychiatric manifestations. The majority of neuropsychiatric complications related to potent antiretroviral therapy have been associated with the use of the efavirenz. Updates on the risk of neuropsychiatric manifestations with efavirenz use in patients with a history of psychiatric disorders or substance abuse are reviewed. We include a critical review of recently published data on the long-term CNS adverse effects with efavirenz. Special attention is given to the results of recent investigations on the relationship between the pharmacogenomics of genes responsible for efavirenz metabolism and the plasma concentration of efavirenz. It is important to note that there is no established direct correlation of efavirenz concentrations and symptoms. It is not recommended for practitioners to adjust efavirenz doses in order to prevent or alleviate CNS adverse effects. Patients may be placed at risk for virological failure and resistance if they receive suboptimal doses of efavirenz. The aim of this article is to give a concise review and an update on recent literature concerning neuropsychiatric effects of antiretroviral use in HIV-infected patients. Our intent is to present practitioners with data that can be used in a practical way to both educate and improve outcomes in the HIV-infected patient population. PMID:16970510

  14. 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

  15. 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

  16. 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

  17. [Endoscopic management of the complications of pancreatitis].

    PubMed

    Coronel, Emmanuel; Czul, Frank; Gelrud, Andres

    2013-01-01

    Acute and chronic pancreatitis may lead to complications that prior the recent advancement of therapeutic endoscopy had to be treated with conventional surgery. The current techniques in interventional endoscopy allow us to access the pancreas and treat some of the complications in a minimally invasive way leading to less morbidity in our patients. Approximately 90% of acute pancreatitis episodes are edematous with early resolution of clinical symptoms and rarely leading to major complications. Patients with necrotizing pancreatitis are susceptible to local and systemic complications particularly in the setting of organ failure. On the other hand chronic pancreatitis is as a chronic inflammatory process that leads to fibrosis of the gland and in occasions to exocrine and/or endocrine insufficiency. The main objective of therapeutic endoscopy in chronic pancreatitis is to relief the obstruction and decreases the pressure in the pancreatic duct with the intention to alleviate abdominal pain. In this review we will address the indications and endoscopic techniques to treat the different complications of pancreatitis such as pseudo cyst drainage, walled off necrosis debridement, disconnected duct syndrome and different options for endoscopic therapy in chronic pancreatitis. PMID:24108377

  18. Focus on treatment complications and optimal management surgery.

    PubMed

    Van Schil, Paul E; Hendriks, Jeroen M; Lauwers, Patrick

    2014-06-01

    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

  19. 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

  20. Complicated bile duct stones.

    PubMed

    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

  1. Gastrointestinal complications after ischemic stroke.

    PubMed

    Camara-Lemarroy, Carlos R; Ibarra-Yruegas, Beatriz E; Gongora-Rivera, Fernando

    2014-11-15

    Ischemic stroke is an important cause of morbidity and mortality, and currently the leading cause of adult disability in developed countries. Stroke is associated with various non-neurological medical complications, including infections and thrombosis. Gastrointestinal complications after stroke are also common, with over half of all stroke patients presenting with dysphagia, constipation, fecal incontinence or gastrointestinal bleeding. These complications are associated with increased hospital length of stay, the development of further complications and even increased mortality. In this article we review the epidemiology, pathophysiology, diagnosis, management and prevention of the most common gastrointestinal complications associated with ischemic stroke. PMID:25214444

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. Serum Adiponectin and hsCRP Levels and Non-InvasiveRadiological Methods in the Early Diagnosis ofCardiovascular System Complications in Children andAdolescents with Type 1 Diabetes Mellitus

    PubMed Central

    Gökşen, Damla; Levent, Ertürk; Kar, Sakine; Özen, Samim; Darcan, Şükran

    2013-01-01

    Objective: Adiponectin and high-sensitivity C-reactive protein (hsCRP) can be used as early biochemical markers of cardiovascular diseases (CVDs). Radiologically, non-invasive flow-mediated dilation (FMD) of the brachial artery and carotid intima-media thickness (CIMT) measurements may be used as indicators in the early diagnosis of CVDs. To compare the biochemical markers of atherosclerosis with radiological markers of CVDs (CIMT, FMD, ventricular systolic and diastolic functions) and to assess the relationship of these parameters with metabolic control in diabetic children and adolescents. Methods: A total of 55 patients with type 1 diabetes mellitus (T1DM) of at least 5-year duration and 30 healthy subjects were included in the study. Serum adiponectin, hsCRP, hemoglobin A1c (HbA1c), and lipid levels were evaluated in the patients and in the controls. CIMT, FMD, ventricular systolic and diastolic functions were assessed by echocardiography. Results: Mean age of the patients with diabetes was 17.6 years; mean diabetes duration was 10.4 years. Mean serum hsCRP was elevated in children with diabetes (0.21±0.31 vs. 0.10±0.16 μg/mL, p=0.00), while no significant difference from the controls was found in adiponectin levels. Mean CIMT was significantly higher in diabetic children compared to the control group (0.53±0.11 vs. 0.34±0.46 mm, p=0.00). Mean FMD of the diabetic children was significantly lower than that of the controls (6.86±2.85% vs. 12.13±1.99%, p=0.00). Diabetes duration was positively correlated with CIMT and negatively correlated with FMD. Right ventricular (RV) and left ventricular (LV) myocardial performance index (MPI) were higher in the patient group (p=0.00). Conclusions: Our data suggest that in addition to standard echocardiography, tissue Doppler echocardiography, FMD, and CIMT can be used as early-stage radiological markers and hsCRP as an early-stage biochemical marker of atherosclerosis in the routine follow-up of T1DM patients. Conflict of interest:None declared. PMID:24072086

  8. 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

  9. 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

  10. Gastrointestinal complications and cardiac surgery.

    PubMed

    Allen, Sara J

    2014-06-01

    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 .3-87%. 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

  11. 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

  12. Urinary diversion metabolic complications - underestimated problem.

    PubMed

    Krajewski, Wojciech; Piszczek, Radosław; Krajewska, Magdalena; Dembowski, Janusz; Zdrojowy, Romuald

    2014-01-01

    Bladder cancer is one of the most frequent human cancers. In 2011 more than six thousand people in Poland developed BC and more than three thousand died because of it. Treatment of bladder cancer depends on its stage. In less advanced tumours (Ta, Tcis, T1) transurethral resection of bladder tumor with adjuvant immunotherapy is often therapeutic. In more advanced cases (≥ T2) radical cystectomy is needed. There are several surgical types of post-cystectomy urinary diversion divided into two fundamental types - enabling and not enabling urine continence. The most common procedures include ureterocutaneostomy, ileal or colon conduit, orthopic ileal bladder, heterotopic continent bladder replacement (pouch) and urinary diversion via the rectum. Depending on type of cystectomy, various metabolic complications occur, because the absorptive-secretory function of used bowel segment is intact. Complications include bowel dysfunction, malabsorption of various vitamins, acid-base imbalance, electrolyte imbalance, abnormalities in bone metabolism, formation of renal calculi, secondary malignancies and disturbances in function of kidneys or liver. Early diagnosed complications can be treated easier, recognised in advanced stages are often irreversible. In our paper we present review of different approaches to bladder cancer treatment and metabolic complications occurring after these procedures. PMID:25166450

  13. 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

  14. [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

  15. Pulmonary Complications of Drug Abuse

    PubMed Central

    Gottlieb, Leon S.; Boylen, Thomas C.

    1974-01-01

    Complications resulting from drug abuse more frequently affect the lung than any other organ. The spectrum of pulmonary complications associated with drug abuse is wide. The current practice of using mixtures of drugs is mainly responsible for the increase in pulmonary complications. The chief complications observed in a series of 241 drug abuse patients were aspiration pneumonitis (12.9 percent), pulmonary edema (10.0 percent), and pneumonia (7.5 percent). ImagesFigure 1.Figure 2.Figure 3.Figure 4.Figure 5.Figure 6.Figure 7.Figure 8.Figure 9.Figure 10. PMID:4812215

  16. 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

  17. Iatrogenic aortic pseudoaneurysm: a forgotten complication.

    PubMed

    Almeida, Samuel; Bico, Pedro; Almeida, António R; Laranjeira Santos, Álvaro; Banazol, Nuno; Fragata, José; Rabaçal, Carlos

    2014-02-01

    Pseudoaneurysms of the ascending aorta are a rare complication of cardiac surgery. However, the poor prognosis associated with this condition if untreated makes early diagnosis and treatment important. We present the case of a 66-year-old woman who had undergone mitral valvuloplasty 12 days previously, who was admitted with a diagnosis of new-onset atrial fibrillation. The transthoracic echocardiogram showed a clot in the right atrium and anticoagulation was initiated, followed by antibiotic therapy. After further investigation, the patient was diagnosed with a pseudoaneurysm of the ascending aorta and underwent surgical repair, followed by six weeks of antibiotic therapy. She was readmitted six months later for an abscess of the lower sternum and mediastinum. After a conservative approach with antibiotics and local drainage failed, recurrence of a large pseudoaneurysm compressing the superior vena cava was documented. A third operation was performed to debride the infected tissue and to place an aortic allograft. There were no postoperative complications. PMID:24508151

  18. 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; Piñeiro, 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 ≥39.5°C), 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

  19. 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

  20. 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

  1. Left ventricular pseudoaneurysm as a fatal complication of purulent pericarditis.

    PubMed

    Sunkara, Bharath; Briasoulis, Alexandros; Afonso, Luis; Ramappa, Preeti

    2015-01-01

    We report a case of a 48-year-old man with purulent pericarditis by Streptococcus viridans, despite aggressive treatment with antibiotics and partial pericardiectomy was complicated by left ventricle pseudo-aneurysm resulting in a fatal outcome. The case highlights the course of complicated purulent pericarditis and the use of noninvasive imaging for assessing early signs of pseudoaneurysm and its typical progression. PMID:26163100

  2. Radiologist's perspective for the Meckel's diverticulum and its complications

    PubMed Central

    Kotha, V K; Saboo, S S; Shanbhogue, A K P; Virmani, V; Marginean, E C; Menias, C O

    2014-01-01

    The Meckel's diverticulum is the commonest congenital anomaly of the gastrointestinal tract, often presenting with complications such as gastrointestinal bleeding, intussusception, bowel obstruction and diverticulitis, which are often misdiagnosed. Imaging plays an important role in the early diagnosis and characterization of these conditions and is very helpful in decision making. The Meckel's diverticulum and its complications have myriad presentations and appearances on various imaging modalities. Thus, sound knowledge of the anatomy, embryology, clinical presentation, imaging characteristics and complications is crucial to the practice of abdominal imaging. We present a review of the literature and current radiological practices in the diagnosis and management of the Meckel's diverticulum and its various complications with special emphasis on the imaging of various complications, mimickers and pathological correlation. PMID:24611767

  3. Complications of Laparoscopic Gynecologic Surgery

    PubMed Central

    Fuentes, Mariña Naveiro; Naveiro Rilo, José Cesáreo; Paredes, Aida González; Aguilar Romero, María Teresa; Parra, Jorge Fernández

    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

  4. [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

  5. Bone and metabolic complications of urinary diversions.

    PubMed

    Cano Megías, Marta; Muñoz Delgado, Eva Golmayo

    2015-02-01

    Hyperchloremic metabolic acidosis is a complication of urinary diversion using ileum or colon. Its prevalence ranges from 25% and 46% depending on the procedure used and renal function of the patient. It is a consequence of intestinal fluid and electrolyte exchange between intestinal mucosa and urine. The main mechanism is absorption of ammonium and chloride from urine. Long-term chronic metabolic acidosis in these patients may lead to impaired bone metabolism and osteomalacia. Regular monitoring of pH, chlorine, bicarbonate, and calcium-phosphorus metabolism is therefore essential for early diagnosis and treatment. PMID:25481805

  6. 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

  7. Serious Vascular Complications after Nonsurgical Rhinoplasty: A Case Report.

    PubMed

    Chen, Qiqing; Liu, Yu; Fan, Dongliang

    2016-04-01

    There has been an increased global demand for dermal filler injections in recent years. Although hyaluronic acid-based dermal fillers generally have a good safety profile, serious vascular complications have been reported. Here we present a typical case of skin necrosis following a nonsurgical rhinoplasty using hyaluronic acid filler. Despite various rescuing managements, unsightly superficial scars were left. It is critical for plastic surgeons and dermatologists to be familiar with the vascular anatomy and the staging of vascular complications. Any patients suspected to experience a vascular complication should receive early management under close monitoring. Meanwhile, the potentially devastating outcome caused by illegal practice calls for stricter regulations and law enforcement. PMID:27200245

  8. 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

  9. Psychological complications of pediatric obesity.

    PubMed

    Vander Wal, Jillon S; Mitchell, Elisha R

    2011-12-01

    Psychological complications associated with pediatric obesity include low self-esteem, depression, body dissatisfaction, loss-of-control eating, unhealthy and extreme weight control behaviors, impaired social relationships, obesity stigma, and decreased health-related quality of life. Bioecological models offer a framework for understanding the interaction between pediatric obesity and psychological complications and illustrate system-level approaches for prevention and intervention. As the medical setting is often the first point of contact for families, pediatricians are instrumental in the identification and referral of children with psychological complications. Motivational interviewing, patient talking points, brief screening measures, and referral resources are important tools in this process. PMID:22093858

  10. PEG tubes: dealing with complications.

    PubMed

    Malhi, Hardip; Thompson, Rosie

    A percutaneous endoscopic gastronomy tube can be used to deliver nutrition, hydration and medicines directly into the patient's stomach. Patients will require a tube if they are unable to swallow safely, putting them at risk of aspiration of food, drink and medicines into their lungs. It is vital that nurses are aware of the complications that may arise when caring for a patient with a PEG tube. It is equally important that nurses know how to deal with these complications or from where tc seek advice. This article provides a quick troubleshooting guide to help nurses deal with complications that can arise with PEG feeding. PMID:26016095

  11. Gastrointestinal Complications After Bariatric Surgery

    PubMed Central

    Ma, Irene T.

    2015-01-01

    Bariatric surgery is increasingly being performed in the medically complicated obese population as convincing data continue to mount, documenting the success of surgery not only in achieving meaningful weight loss but also in correcting obesity-related illnesses. Several surgical procedures with varying degrees of success and complications are currently being performed. This article discusses the short- and long-term gastrointestinal complications for the 4 most common bariatric surgical procedures: laparoscopic adjustable gastric banding, vertical sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch.

  12. [Postoperative thromboembolic complications and preventive measures].

    PubMed

    Vegar-Brozović, Vesna; Prajdić-Predrijevac, D

    2003-01-01

    Modern surgical procedures become very extensive and aggressive in every surgical branch. Due to expressive development of anesthesia techniques with large monitoring systems support is provided to patients for broad spectrum of disorders. Therefore, we need to protect patients from imminent complications, as development of deep venous thrombosis and embolic pulmonary incidents. The main target in prophylaxis is to divide patients by risk and the type of surgical procedures during the time of "bed recovery". Today, current farmacological treatment is prone to control and prevent such events and to decrease mortality. Patients are divided in three groups: low risk (small operations with early mobilization); medium risk (surgery with risk in patients history); high risk (severe patients and long surgery, prolonged recovery). The best solutions in current medicine is to prevent most of complications, by administration of low molecular heparin (LMWH). Advantages of that treatment are: no need of intensive monitoring, long-time treatment, safe usage in "day case surgery" Beside LMWH, we still use heparin, although we tend to trial newer treatments and supports for prevention of complications. For special groups of patients recent trials examine heparinoid like drug-hyrudin, provided by chemical engeneering. That drug is metabolised in liver. Current therapy and prevention of DVT and pulmonary embolia is LMWH. It entered in every alghorythm of surgical and anaesthetic procedures and become CONDITIO SINE QUA NON. PMID:15017863

  13. Endothelial Dysfunction and Microvascular Complications in Type 1 Diabetes Mellitus

    PubMed Central

    Jin, Seon Mi; Yang, Sei Won; Bae, Eun Jung; Shin, Choong Ho; Chung, Hae Rim; Kim, You Yeh; Yun, Yong Soo

    2008-01-01

    We examined whether alterations in vascular endothelial function and early structural changes in atherosclerosis are associated with microvascular complications in patients with type 1 diabetes mellitus (DM). Flow-mediated dilation (FMD) of the brachial artery and carotid intima-media thickness (IMT) measurement were performed in 70 young adults (aged 19 to 35 yr), 48 with type 1 DM, and 22 normal controls. Patients with diabetes had a lower peak FMD response (7.8±3.9 vs. 11.1±1.9%, p<0.001) and increased IMT (0.51±0.10 vs. 0.42±0.07 mm, p<0.001) compared with controls. Twenty (41.7%) of the patients had microvascular complications including neuropathy, nephropathy, or retinopathy. In these complicated diabetic patients, we found a lower FMD response (6.1±2.5 vs. 9.9±3.5%, p=0.001) compared with diabetics without microvascular complications. The presence of microvascular complications was also associated with older age and longer duration of the disease. However, no differences were observed in IMT, body size, blood pressure, HbA1c, C-reactive protein, low-density lipoprotein or high-density lipoprotein cholesterol levels between complicated and non-complicated patients. Endothelial dysfunction and early structural atherosclerotic changes are common manifestations in type 1 DM, and endothelial dysfunction is thought to be an early event in the atherosclerotic process and important in the pathogenesis of microvascular complications. PMID:18303203

  14. Living with Diabetes: Foot Complications

    MedlinePlus

    ... your feet or toes may also cause problems. Neuropathy Although it can hurt, diabetic nerve damage can ... Diabetes Forecast® magazine: cc-feet-and-hands-peripheral-neuropathy, In this section Living With Diabetes Complications Skin ...

  15. Medical complications of anorexia nervosa.

    PubMed

    Shuttleworth, E; Sharma, S; Lal, S; Allan, P J

    2016-05-01

    Anorexia nervosa is a psychiatric disorder with potential life-threatening medical sequelae. This article reviews the principal medical complications associated with anorexia nervosa, highlights associated diagnostic pitfalls and emphasizes the importance of a multidisciplinary approach to management. PMID:27166107

  16. Complications in Pediatric Facial Fractures

    PubMed Central

    Chao, Mimi T.; Losee, Joseph E.

    2009-01-01

    Despite recent advances in the diagnosis, treatment, and prevention of pediatric facial fractures, little has been published on the complications of these fractures. The existing literature is highly variable regarding both the definition and the reporting of adverse events. Although the incidence of pediatric facial fractures is relative low, they are strongly associated with other serious injuries. Both the fractures and their treatment may have long-term consequence on growth and development of the immature face. This article is a selective review of the literature on facial fracture complications with special emphasis on the complications unique to pediatric patients. We also present our classification system to evaluate adverse outcomes associated with pediatric facial fractures. Prospective, long-term studies are needed to fully understand and appreciate the complexity of treating children with facial fractures and determining the true incidence, subsequent growth, and nature of their complications. PMID:22110803

  17. Pneumothorax complicating isolated clavicle fracture

    PubMed Central

    Hani, Redouane; Ennaciri, Badr; Jeddi, Idriss; El Bardouni, Ahmed; Mahfoud, Mustapha; Berrada, Mohamed Saleh

    2015-01-01

    Isolated clavicle fractures are among the commonest of traumatic fractures in the emergency department. Complications of isolated clavicle fractures are rare. Pneumothorax has been described as a complication of a fractured clavicle only rarely in English literature. In all the reported cases, the pneumothorax was treated by a thoracostomy and the clavicle fracture was treated conservatively. In our case, the pneumothorax required a chest drain insertion and the clavicle fracture was treated surgically with good result. PMID:26421097

  18. Chronic Pulmonary Complications of Sickle Cell Disease.

    PubMed

    Mehari, Alem; Klings, Elizabeth S

    2016-05-01

    Sickle cell disease (SCD), the most common genetic hemolytic anemia worldwide, affects 250,000 births annually. In the United States, SCD affects approximately 100,000 individuals, most of African descent. Hemoglobin S (HbS) results from a glutamate-to-valine mutation of the sixth codon of the β-hemoglobin allele; the homozygous genotype (HbSS) is associated with the most prevalent and severe form of the disease. Other SCD genotypes include HbSC, composed of one HbS allele and one HbC (glutamate-to-lysine mutation) allele; and HbS-β-thalassemia(0) or HbS-β-thalassemia(+), composed of one HbS allele and one β-thalassemia allele with absent or reduced β-chain production, respectively. Despite advances in care, median survival remains in the fifth decade, due in large part to chronic complications of the disease. Chronic pulmonary complications in SCD are major contributors to this early mortality. Although our understanding of these conditions has improved much over the past 10 to 15 years, there remains no specific treatment for pulmonary complications of SCD. It is unclear whether conventional treatment regimens directed at non-SCD populations have equivalent efficacy in patients with SCD. This represents a critical research need. In this review, the authors review the state-of-the-art understanding of the following pulmonary complications of SCD: (1) pulmonary hypertension; (2) venous thromboembolic disease; (3) sleep-disordered breathing; (4) asthma and recurrent wheezing; and (5) pulmonary function abnormalities. This review highlights the advances as well as the knowledge gaps in this field to update clinicians and other health care providers and to garner research interest from the medical community. PMID:26836905

  19. [Catheter ablation and the complications].

    PubMed

    Steven, D; van den Bruck, J H; Plenge, T; Lüker, J; Sultan, A

    2015-12-01

    Catheter ablation of atrial fibrillation has developed into a standard therapy and even in some cases as a first line therapy. This has resulted in a clear increase in the number of procedures in recent years. The published data from experienced centers indicate that the number of complications decreases with increasing experience; however, due to the parallel increase in the number of inexperienced centers, the average complication rate shows a tendency to increase. In the long term this necessitates a reliable quality assurance in order not to leave the choice of the "safe centers" up to the patient. Vascular complications are the most common, which in most cases have an uneventful course and do not necessitate further interventions. Particularly the incidence of ischemic stroke can be well-countered by strict control of periprocedural anticoagulation. The frequency of occurrence of phrenic nerve lesions, which are more common when selecting cryoenergy, can be reduced by stimulation of the phrenic nerve during ablation of the right pulmonary vein. The most feared complication of an atrioesophageal fistula is rare. No data for an effective avoidance of complications are available. A postprocedural therapy with proton pump inhibitors for 4-6 weeks, the intraprocedural measurement of esophageal temperature and reduction of the ablation energy on the posterior wall of the left atrium can possible help to reduce the frequency of complications. PMID:26558906

  20. 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

  1. Obturator Nerve Injury: An Infrequent Complication of TOT Procedure

    PubMed Central

    Aydogmus, S.; Kelekci, S.; Aydogmus, H.; Ekmekci, E.; Secil, Y.; Ture, S.

    2014-01-01

    Transvaginal mid-urethral slings have become the most preferred surgical treatment option for female stress urinary incontinence. However, various complications have been reported for these operations occurring especially during penetration of the retropubic space. It can negatively affect patient's quality of life. Early treatment increases the chance of complete normalization of the functions. In this case report we presented a case of obturator nerve damage that was diagnosed and treated at early stage after TOT operation. PMID:25343052

  2. 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

  3. 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; Kiliç, Şebnem; Franco, Jose L; Raccio, Andrea C Gómez; 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; Nuñez-Nuñez, M Enriqueta; Bezrodnik, Liliana; Marques, Jose Gonçalo; Pereira, María I; Listello, Viviana; Slatter, Mary A; Nademi, Zohreh; Kowalczyk, Danuta; Fleisher, Thomas A.; Davies, Graham; Neven, Bénédicte; 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

  4. Management of the complications of BPH/BOO

    PubMed Central

    Speakman, Mark J.; Cheng, Xi

    2014-01-01

    Most men will develop histological BPH if they live long enough. Approximately, half will develop benign prostatic enlargement (BPE) and about half of these will get BOO with high bladder pressures and low flow, this in turn leads to detrusor wall hypertrophy. Many of these men will only have lower urinary tract symptoms (LUTS) but a significant number will also suffer the other complications of BPH. These include urinary retention (acute and chronic), haematuria, urinary tract infection, bladder stones, bladder wall damage, renal dysfunction, incontinence and erectile dysfunction. Recognition of the complications of BPH/BOO early allows more effective management of these complications. This is particularly important for the more serious urinary infections and also for high-pressure chronic retention (HPCR). Complications of LUTS/BPH are very rare in clinical trials because of their strict inclusion and exclusion criteria but are more common in real life practice. PMID:24744522

  5. 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

  6. [Therapeutic soft lenses following keratoplasty, indications and complications].

    PubMed

    Severin, M; Konen, W; Kilp, H

    1983-01-01

    A reported on 27 eyes (25 patients) which were fitted with soft permanent lenses following penetrating keratoplasty. The eyes were divided into three groups, according to the nature of the epithelial damage caused by the lens: 1) mechanical damage; 2) primary damage to the endothelium with secondary epithelial resistance. In 52% of the cases superficial neovascularization occurred, but this did not lead to serious complications. In the first and second groups, infiltrates were only seen after longterm use. The highest rate of complications, with infiltrates occurring relatively early and with liquefaction, was observed in the third group. In the first group the permanent lens led to lasting stabilization of the condition with a relatively low risk. In the second group the lens brought freedom from complaints with complications occurring only after 1-2 years. In the third group it was found that complications with negative courses may arise after only a short time. PMID:6190037

  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. Complications

    MedlinePlus

    ... My Health Advisor Tools To Know Your Risk Alert Day Diabetes Basics Home Symptoms Diagnosis America's Diabetes ... Volunteer Center American Diabetes Month® American Diabetes Association Alert Day® Become a Member Advocacy Home Take Action ...

  9. 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

  10. 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

  11. 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

  12. [Prevention of respiratory complications after abdominal surgery].

    PubMed

    Rezaiguia, S; Jayr, C

    1996-01-01

    Abdominal surgery, especially upper abdominal surgical procedures are known to adversely affect pulmonary function. Pulmonary complications are the most frequent cause of postoperative morbidity and mortality. This review article aimed to analyse the incidence and risk factors for postoperative pulmonary morbidity and their prevention. The most important means for preoperative assessment is the clinical examination; pulmonary function tests (spirometry) are not reliably predictive for postoperative pulmonary complications. Age, type of surgical procedure, smoking and nutritional state have all been identified as potential predictors for postoperative complications. However, usually there is not enough preoperative time available to obtain beneficial effects of stopping smoking and improvement of nutritional state. In patients with COPD, a preoperative multidisciplinary evaluation including the primary care physician, pulmonologist/intensivist, anesthesiologist and surgeon is required. Consensus as to preoperative physiologic state, therapeutic preparation, and postoperative management is essential. Simple spirometry and arterial blood gas analysis are indicated in patients exhibiting symptoms of obstructive airway disease. There are no values that contra-indicate an essential surgical procedure. Smoking should stop at least 8 weeks preoperatively. Preoperative therapy for elective surgery with antibiotics, beta2-agonist, or anticholinergic bronchodilator aerosols, as well as training in cough and lung expansion techniques should begin at least 24 to 48 hours preoperatively. Postoperative therapy should be continued for 3 to 5 days. Usually, anaesthesia is responsible for early complications, whereas surgical procedures are often associated with delayed morbidity. Laparoscopic procedures are recommended, as postoperative morbidity and hospital stay seem reduced in patients without COPD. Regional anaesthesia is given as having less adverse effects on pulmonary function than general anaesthesia. However, for unknown reasons these benefits are not associated with a decrease in postoperative respiratory complications. Moreover, the quality or the type of postoperative analgesia does not influence postoperative respiratory morbidity. Postoperatively, oxygen administration increases SaO2, but cannot abolish desaturation due to obstructive apnea. The various techniques of physiotherapy (chest physiotherapy, incentive spirometry, continuous positive airway pressure breathing) seem to be equivalent in efficacy; but intermittent positive pressure breathing has no advantages, compared with the other treatments and could even be deleterious. Chest physiotherapy and incentive spirometry are the most practical methods available for decreasing secretion contents of airways, whereas continuous positive airway pressure breathing is efficient on atelectasis. In stage II or III COPD patients, admission in a intensive therapy unit and prolonged mechanical ventilation may be required. PMID:9033757

  13. Complicated grief in late life

    PubMed Central

    Miller, Mark D.

    2012-01-01

    Complicated grief (CG) is a syndrome that affects 10% to 20% of grievers regardless of age, although proportionally more will face the death of loved ones in late life, CG is characterized by preoccupying and disabling symptoms that can persist for decades such as an inability to accept the death, intense yearning or avoidance, frequent reveries, deep sadness, crying, somatic distress, social withdrawal, and suicidal ideation. This syndrome is distinct from major depression and post-traumatic stress disorder, but CG maybe comorbid with each. This communication will focus on the impact of CG in late life (over age 60) and will include a case vignette for illustrating complicated grief therapy. PMID:22754292

  14. [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

  15. 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

  16. Complications of the diabetic foot.

    PubMed

    Kim, Paul J; Steinberg, John S

    2013-12-01

    The diabetic foot is at high risk for complications because of its role in ambulation. Peripheral neuropathy and peripheral vascular disease can lead to chronic foot ulcers, which are at high risk for infection, in part attributable to areas of high pressure caused by lack of tolerance of the soft tissue and bone and joint deformity. If left untreated, infection and ischemia lead to tissue death, culminating in amputation. Treatment strategies include antibiosis, topical therapies, offloading, debridement, and surgery. A multidisciplinary team approach is necessary in the prevention and treatment of complications of the diabetic foot. PMID:24286952

  17. 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

  18. Managing complications in cirrhotic patients.

    PubMed

    Peck-Radosavljevic, Markus; Angeli, Paolo; Cordoba, Juan; Farges, Oliver; Valla, Dominique

    2015-02-01

    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

  19. Complications from international surgery tourism.

    PubMed

    Melendez, Mark M; Alizadeh, Kaveh

    2011-08-01

    Medical tourism is an increasing trend, particularly in cosmetic surgery. Complications resulting from these procedures can be quite disruptive to the healthcare industry in the United States since patients often seek treatment and have no compensation recourse from insurance. Despite the increasing number of plastic surgery patients seeking procedures abroad, there have been little reported data concerning outcomes, follow-up, or complication rates. Through a survey of American Society of Plastic Surgeons (ASPS) members, the authors provide data on trends to help define the scope of the problem. PMID:21813883

  20. 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

  1. Complications Following Direct Anterior Hip Procedures: Costs to Both Patients and Surgeons.

    PubMed

    Lee, Gwo-Chin; Marconi, Dante

    2015-09-01

    A systematic review of the literature on clinical outcomes following direct anterior approach (DAA) hip arthroplasty was performed. An aggregated 11,810 hip procedures were analyzed for intraoperative and early postoperative complications. The most common complication following DAA hip arthroplasty was nerve dysfunction (2.8%) followed by intraoperative fractures (2.3%). Postoperative dislocation, wound complications, and revision THA within the first 12 months were reported in 1.2% of cases. Thus, while DAA hip arthroplasty can be successfully performed, it is not without complications. Without definitive evidence of clinical superiority, surgeons considering switching to DAA should benchmark their personal complication rates against published reports. PMID:26118568

  2. 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

  3. Intraoperative complications during oral implantology.

    PubMed

    Lamas Pelayo, Joana; Peñarrocha Diago, Miguel; Martí Bowen, Eva; Peñarrocha Diago, Maria

    2008-04-01

    Dental implant placement is a controlled, programmed surgical procedure, not without its complications. The aim of the present paper is to study the intraoperative complications in implant surgery, carrying out a review of articles appearing in Medline over the last 10 years. Among the intra operative complications related with surgery, hemorrhagic accidents occur most frequently in the interforaminal region, since the majority of the vascular branches enter the mandibular bone in this region. Nerve damage can arise as a consequence of inferior alveolar nerve transposition or lateralization; or the excessive intrusion of drills or implant fixture into the mandibular canal. Mandibular fractures secondary to implant placement occur more easily when placing implants in atrophic mandible. Occasionally, incorrect positioning or lack of relative parallelism in the placing of the implants causes damage to an adjacent tooth. Absence of primary stability may occur as a result of overworking the implant bed during preparation, also to poor bone quality, and more frequently to immediate post-extraction implantation. Another possible complication is the migration of implants into the maxillary sinus. PMID:18379448

  4. 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

  5. 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

  6. 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…

  7. Teaching Energy Geography? It's Complicated

    ERIC Educational Resources Information Center

    Huber, Matt

    2016-01-01

    The premise of this essay is that energy geographies are complicated, and this in itself presents some pedagogical difficulties. As someone who wants students to critically examine and confront the complexity of energy systems, it can be frustrating when students react to demonstrate frustration, apathy, or even confusion. In what follows, I will…

  8. 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 ...

  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. 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

  11. 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…

  12. 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.

  13. 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

  14. 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

  15. CARDIAC COMPLICATIONS OF CHEMOTHERAPY: ROLE OF IMAGING

    PubMed Central

    Tan, Timothy C.; Scherrer-Crosbie, Marielle

    2014-01-01

    Opinion Statement New advances in cancer diagnosis and treatment have increased survival rates in patients with cancer. In parallel with the increase in the number of cancer survivors is an increasing prevalence of cardiac complications from cancer treatment. Chemotherapy-induced cardiac dysfunction is a major contributor to adverse morbidity and mortality rates in cancer patients. Evidence suggests that both clinical symptoms and the traditional left ventricular ejection fraction (LVEF) may lack sensitivity as measures of cardiotoxicity. The early identification of subclinical LV dysfunction is becoming increasingly important, as this may allow cancer patients and their physicians to make informed decisions about therapeutic options. The features of echocardiography make it a useful tool in the diagnosis and monitoring of cardiotoxicity. This review will examine the role of cardiac imaging in detecting cardiotoxicity, focusing primarily on the conventional and more recent echocardiographic approaches for assessing subclinical cardiotoxicity. PMID:24519487

  16. Cardiac Risks and Complications of Noncardiac Surgery

    PubMed Central

    Goldman, Lee

    1983-01-01

    When internists are consulted to assess risks and to aid in the perioperative management of surgical patients, they often can rely on substantial clinical data to guide the consultation. Perioperative cardiac risk can be estimated based on the severity of underlying heart failure, the occurrence of a recent myocardial infarction or various arrhythmias, the presence of aortic stenosis, the patient's age, the type of planned surgery (including whether it is an emergency or elective procedure), and the patient's general medical condition. Preoperative exercise testing or cardiac catheterization to assess risk are not routinely indicated, but perioperative hemodynamic monitoring to improve management is recommended in patients at high risk. Postoperative hypertension, arrhythmias, and heart failure commonly occur in the first 2 days after surgery, but the risk of myocardial infarction persists for at least 5 or 6 days after surgery. Effective perioperative consultation must include careful postoperative observation to detect cardiac complications at an early stage and to assist in their management.

  17. 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

  18. 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

  19. 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

  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. [Infectious complications after brain tumor removal: some aspects of their prevention, diagnosis, and treatment].

    PubMed

    Kondrat'ev, A N; Nazarov, R V; Kondrat'eva, E A; Gegraeva, L O; Mikhaĭliuk, V G; Unzhakov, V V

    2007-01-01

    A hundred and fifty-five case histories of neurosurgical patients with the complicated early postoperative period were analyzed. Early postoperative regional pyoinflammatory complications were developed in 21 (4.4%) of 481 patients. There was meningitis in 17 (3.5%) cases, ventriculitis in 2 (0.4%), and wound infection (skin flap suppuration and postoperative wound fistula). Systemic pyoinflammatory complications were observed in 8% of the patients. Among them, there were pyoinflammatory complications in the respiratory system in 30 (6.2%) cases, pyonecrotic cystitis in 5 (1%), and sepsis in 2 (0.4%). Risk factors for regional and systemic complications are shown. Based on the findings, recommendations are given to prevent and treat pyoseptic complications in neurosurgical patients. PMID:17684994

  2. 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

  3. Sub-Tenon's anaesthesia: complications and their prevention

    PubMed Central

    Kumar, C M; Eid, H; Dodds, C

    2011-01-01

    The advent of a new technique that is considered much safer than previously established one leads to its rapid adoption. This usually leads to the identification of previously unreported complications of the new technique, and a re-assessment of its position in clinical care, which is precisely the state of play with the sub-Tenon's block. The sub-Tenon's block was introduced into the clinical practice in early 1990. A systematic recent search of subject headings such as complications of sub-Tenon's block, subtenon, orbital block, orbital block complications, and orbital anaesthesia was performed in Medline, EMBASE, and Cochrane database. Indeed there are complications of sub-Tenon's block published as case reports and the exact incidence of these complications is not known. Management and preventive measures of these complications are described. Although the sub-Tenon's block appears to be relatively safer than needle-based blocks but a proper prospective, randomized, double-blind controlled trial is essential for scientific proof that sub-Tenon's block is better than needle-based blocks. PMID:21455245

  4. Anesthetic and surgical complications in 219 cases of myotonic dystrophy.

    PubMed

    Mathieu, J; Allard, P; Gobeil, G; Girard, M; De Braekeleer, M; Bégin, P

    1997-12-01

    The objective of this study was to assess the frequency, type, and severity of perioperative complications after a first surgery under general anesthesia in patients with myotonic dystrophy (DM) and to measure the association with suspected risk factors. Numerous cases of perioperative complications in DM patients have been reported. Hazards have been associated with the use of thiopentone, suxamethonium, neostigmine, and halothane. A retrospective study of perioperative complications was conducted for 219 DM patients who had their first surgery under general anesthesia at the Chicoutimi Hospital. The overall frequency of complications was 8.2% (18 of 219). Most complications (16 of 18) were pulmonary, including five patients with acute ventilatory failure necessitating ventilatory support, four patients with atelectasis, and three patients with pneumonia. Using multivariate analysis, we found that the risk of perioperative pulmonary complications (PPC) was significantly higher after an upper abdominal surgery (odds ratio (OR), 24.4; 95% CI, 4.0 to 149.3) and for patients with a severe muscular disability, as assessed by the presence of proximal limb weakness (OR, 14.1; 95% CI, 1.5 to 134.4). The likelihood of PPC was not related to any specific anesthetic drug. Because of the increased risk of PPC, careful monitoring during the early postoperative period, protection of upper airways, chest physiotherapy, and incentive spirometry are mandatory in all symptomatic DM patients, particularly those with a severe muscular disability or those who have undergone an upper abdominal surgery. PMID:9409361

  5. Predicting postoperative pulmonary complications in high-risk populations

    PubMed Central

    Gali, Bhargavi; Sprung, Juraj

    2015-01-01

    Purpose of review Our objective is to describe prediction models for surgical patients who have suspected obstructive sleep apnea (OSA) at risk for postoperative respiratory complications and for surgical patients at risk for postoperative acute respiratory distress syndrome (ARDS). Recent findings Because of the increased rate of severe perioperative respiratory complications in patients with OSA, the American Society of Anesthesiologists issued practice guidelines for perioperative management. When OSA is diagnosed preoperatively, the rate of postoperative pulmonary complications is low and not associated with OSA severity. However, OSA continues to be an important risk because a substantial proportion of patients in the contemporary surgical population have undiagnosed OSA. Strategies based on preoperative and immediate postoperative clinical signs and symptoms can help identify patients with a high likelihood of OSA, postoperative desaturations, and pulmonary complications. ARDS is another serious postoperative complication associated with high mortality rate and limited treatment options, and its prevention is critical. Practice changes have led to a dramatic reduction in ARDS incidence. A recently developed prediction model can help identify high-risk patients. Summary Evidence is emerging that early identification of modifiable risk factors and implementation of ‘protective’ management strategies may lead to reduction of severe postoperative pulmonary complications. PMID:23407151

  6. Management of Complications Following Emergency and Elective Surgery for Diverticulitis

    PubMed Central

    Holmer, Christoph; Kreis, Martin E.

    2015-01-01

    Background The clinical spectrum of sigmoid diverticulitis (SD) varies from asymptomatic diverticulosis to symptomatic disease with potentially fatal complications. Sigmoid colectomy with restoration of continuity has been the prevailing modality for treating acute and recurrent SD, and is often performed as a laparoscopy-assisted procedure. For elective sigmoid colectomy, the postoperative morbidity rate is 15-20% whereas morbidity rates reach up to 30% in patients who undergo emergency surgery for perforated SD. Some of the more common and serious surgical complications after sigmoid colectomy are anastomotic leaks and peritonitis, wound infections, small bowel obstruction, postoperative bleeding, and injuries to the urinary tract structures. Regarding the management of complications, it makes no difference whether the complication is a result of an emergency or an elective procedure. Methods The present work gives an overview of the management of complications in the surgical treatment of SD based on the current literature. Results To achieve successful management, early diagnosis is mandatory in cases of deviation from the normal postoperative course. If diagnostic procedures fail to deliver a correlate for the clinical situation of the patient, re-laparotomy or re-laparoscopy still remain among the most important diagnostic and/or therapeutic principles in visceral surgery when a patient's clinical status deteriorates. Conclusion The ability to recognize and successfully manage complications is a crucial part of the surgical treatment of diverticular disease and should be mastered by any surgeon qualified in this field. PMID:26989382

  7. Placental exosomes in normal and complicated pregnancy.

    PubMed

    Mitchell, Murray D; Peiris, Hassendrini N; Kobayashi, Miharu; Koh, Yong Q; Duncombe, Gregory; Illanes, Sebastian E; Rice, Gregory E; Salomon, Carlos

    2015-10-01

    While there is considerable contemporary interest in elucidating the role of placenta-derived extracellular vesicles in normal and complicated pregnancies and their utility as biomarkers and therapeutic interventions, progress in the field is hindered by a lack of standardized extracellular vesicle taxonomy and isolation protocols. The term "extracellular vesicle" is nonspecific and refers to all membrane-bound vesicles from nanometer to micrometer diameters and of different biogenic origins. To meaningfully ascribe biological function and/or diagnostic and therapeutic utility to extracellular vesicles, and in particular exosomes, greater specificity and vesicle characterization is required. The current literature relating to exosome biology must be interpreted in this context. Exosomes are a subtype of extracellular vesicle that are specifically defined by an endosomal biogenesis and particle size (40-120 nm) and density (1.13-1.19 g/mL(-1)). Exosomes are specifically package with signaling molecules (including protein, messenger RNA, microRNA, and noncoding RNA) and are released by exocytosis into biofluid compartments. Exosomes regulate the activity of both proximal and distal target cells, including translational activity, angiogenesis, proliferation, metabolism, and apoptosis. As such, exosomal signaling represents an integral pathway mediating intercellular communication. During pregnancy, the placenta releases exosomes into the maternal circulation from as early as 6 weeks of gestation. Release is regulated by factors that include both oxygen tension and glucose concentration and correlates with placental mass and perfusion. The concentration of placenta-derived exosomes in maternal plasma increases progressively during gestation. Exosomes isolated from maternal plasma are bioactive in vitro and are incorporated into target cells by endocytosis. While the functional significance of placental exosomes in pregnancy remains to be fully elucidated, available data support a role in normal placental development and maternal immunotolerance. Similarly, the role of exosomes in the etiology and progression of complications of pregnancy remains in a formative stage. Changes in the release of placenta- and nonplacenta-derived exosomes, their concentration in maternal plasma, composition, and bioactivity have been reported in association with pregnancies complicated by gestational diabetes and preeclampsia. The data, however, are confounded by the use of different isolation methodologies and vesicle subpopulations. The application of specific and well-characterized isolation methodologies is requisite to resolving the precise role of exosomes in complications of pregnancies and their ultimate clinical utility. PMID:26428497

  8. Suicide bereavement and complicated grief.

    PubMed

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

    2012-06-01

    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

  9. 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

  10. [Diabetic complications within ocular surface].

    PubMed

    Wylegała, Edward; Moćko, Lucyna; Woyna-Orlewicz, Anna; Teper, Sławomir; Orzechowska-Wylegała, Bogusława

    2006-11-01

    Authors present one of the ocular diabetic complications--diabetic keratoepitheliopathy. The aim of this article is to summarize the knowledge about diabetic keratoepitheliopathy, its causes, manifestations and treatment options. Diabetes mellitus is associated with structural and functional disturbances in eyelids, conjunctiva and cornea. There are also changes in tear film present. Diabetic neuropathy resulting from the biochemical poor control of diabetes is the probable basic cause of the pathology. Mechanisms responsible for these changes are still not well understood. The corneal and conjunctival complications may occur spontaneously. But more often they arise from undue stress of intraocular surgery procedures. The incidence of diabetic keratoepitheliopathy in diabetic patients is high. However, it is rarely diagnosed. Effectiveness of symptomatic treatment with use of common medications is not satisfactory and it needs further investigation. PMID:17345849

  11. Cast and splint immobilization: complications.

    PubMed

    Halanski, Matthew; Noonan, Kenneth J

    2008-01-01

    During the past three decades, internal fixation has become increasingly popular for fracture management and limb reconstruction. As a result, during their training, orthopaedic surgeons receive less formal instruction in the art of extremity immobilization and cast application and removal. Casting is not without risks and complications (eg, stiffness, pressure sores, compartment syndrome); the risk of morbidity is higher when casts are applied by less experienced practitioners. Certain materials and methods of ideal cast and splint application are recommended to prevent morbidity in the patient who is at high risk for complications with casting and splinting. Those at high risk include the obtunded or comatose multitrauma patient, the patient under anesthesia, the very young patient, the developmentally delayed patient, and the patient with spasticity. PMID:18180390

  12. 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.

  13. Sugar intolerance complicating acute gastroenteritis.

    PubMed Central

    Trounce, J Q; Walker-Smith, J A

    1985-01-01

    Sugar intolerance occurred in 31 of 200 children admitted to hospital with acute gastroenteritis. In 28 this was transient and settled rapidly, but in the remaining three it indicated a more serious and persistent problem. The most important predisposing factor was viral infection, in particular with rotavirus. The current regimen for the management of sugar intolerance complicating acute gastroenteritis at this hospital is outlined. PMID:4062353

  14. 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

  15. 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

  16. 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

  17. Laparoscopic surgery complications: Postoperative peritonitis

    PubMed Central

    Drăghici, L; Drăghici, I; Ungureanu, A; Copăescu, C; Popescu, M; Dragomirescu, C

    2012-01-01

    Introduction: Complications within laparoscopic surgery, similar to classic surgery are inevitable and require immediate actions both to diminish intraoperative risks and to choose the appropriate therapeutic attitude. Peritonitis and hemorrhagic incidents are both part of the complications aspect of laparoscopic surgery. Fortunately, the incidence is limited, thus excluding the rejection of celioscopic methods. Patient’s risks and benefits are to be analyzed carefully prior recommending laparoscopic surgery. Materials and methods: This study presents a statistical analysis of peritonitis consecutive to laparoscopic surgery, experience of „Sf. Ioan” Emergency Hospital, Bucharest, and Department of Surgery (2000-2010). Results:There were 180 (0,96%) complicated situations requiring reinterventions, from a total of 18676 laparoscopic procedures. 106 cases (0,56%) represented different grades of postoperative peritonitis. Most frequently, there were consecutive laparoscopic appendicectomia and colecistectomia. During the last decade, few severe cases of peritonitis followed laparoscopic bariatric surgical procedures. Conclusions: This study reflects the possibility of unfavorable evolution of postoperative peritonitis comparing with hemorrhagic incidents within laparoscopic surgery. PMID:23049630

  18. 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

  19. Neurologic complications after liver transplantation

    PubMed Central

    Živković, Saša 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

  20. 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

  1. 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

  2. [Hemorrhagic complications during warfarin treatment].

    PubMed

    Gumulec, J; Kessler, P; Penka, M; Klodová, D; Králová, S; Brejcha, M; Wróbel, M; Sumná, E; Blatný, J; Klaricová, K; Riedlová, P; Lasota, Z

    2006-03-01

    Bleeding is probably the major complication of anticoagulant treatment with vitamin K antagonists represented nowadays mostly by warfarin in the Czech Republic. The main risk factors in hemorrhagic complications of warfarinisation are the intensity and instability of the anticoagulant treatment, individual patient characteristics, warfarin interactions with other drugs and the length of the anticoagulant therapy. Severe bleeding in warfarin patients is most effectively brought about by a fast and complete undoing of the anticoagulation effect of the drug employing the prothrombin complex concentrate and slow i.v. vitamin K1 infusion regardless of the reason for the anticoagulation. This approach can secure the minimalisation of the bleeding's negative consequences. A less severe bleeding or asymptomatic increase in the international normalized ratio can be treated effectively by skipping or decreasing of the warfarin dosage and/or oral administration of vitamin K1 (i.v. administration only in selected higher risk cases) that does result only in a partial consolidation of coagulopathy but of such type that the risk of thrombotic event requires. The article's goal is to contribute to the treatment standardization in patients with warfarin overdose and/or with hemorrhagic complications due to warfarin treatment and it is available at www.thrombosis.cz. The guidelines include a ready-reference chart whose objective is immediate and quick crash course in the clinical practice. PMID:16637455

  3. 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

  4. 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

  5. Complications of chronic suppurative otitis media: a retrospective review.

    PubMed

    Yorgancılar, E; Yildirim, M; Gun, R; Bakir, S; Tekin, R; Gocmez, C; Meric, F; Topcu, I

    2013-01-01

    The purpose of this study was to review our patients with complications of chronic suppurative otitis media (CSOM) and compare with literature. This retrospective study was performed over 10 years in our tertiary referral university hospital. During this period 4,630 patients with CSOM were admitted to the department and 906 patients underwent a surgery. From the records of the 4,630 patients, 121 patients (2.6%) with complications were identified. Of the 906 CSOM patients that underwent a surgery, 511 had cholesteatoma, and 395 had granulation and/or polyp tissue. Ninety-four of 511 (18.4%) patients with cholesteatoma and 27 of 395 (6.8%) patients with granulation and/or polyp tissue had a complication. Of the 121 complicated CSOM patients, 57 extracranial (47.1%) and 37 intracranial (30.6%). Multiple combined complications were occurred in 27 (22.3%) patients. The mastoid abscess was the commonest extracranial complication (28.3%); it was followed by labyrinthitis (9%), facial nerve paralysis (8.4%), and Bezold's abscess (1.3%). The most common intracranial complication was lateral sinus thrombophlebitis (19.5%), followed by perisigmoid sinus abscess (13.5%), meningitis (9%), brain abscess (6.5%), and extradural abscess (4.5%). Most frequent intraoperative finding of complicated CSOM patients was cholesteatoma, with the exception of patients with facial nerve paralysis. There was no mortality in any of our patients. The additional morbidities were recorded in 25 patients (20.6%). In this study, we emphasize the importance of an accurate and early diagnosis, followed by adequate surgical therapy and a multidisciplinary approach. PMID:22249835

  6. 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

  7. Serious Vascular Complications after Nonsurgical Rhinoplasty: A Case Report

    PubMed Central

    Chen, Qiqing; Liu, Yu

    2016-01-01

    Summary There has been an increased global demand for dermal filler injections in recent years. Although hyaluronic acid-based dermal fillers generally have a good safety profile, serious vascular complications have been reported. Here we present a typical case of skin necrosis following a nonsurgical rhinoplasty using hyaluronic acid filler. Despite various rescuing managements, unsightly superficial scars were left. It is critical for plastic surgeons and dermatologists to be familiar with the vascular anatomy and the staging of vascular complications. Any patients suspected to experience a vascular complication should receive early management under close monitoring. Meanwhile, the potentially devastating outcome caused by illegal practice calls for stricter regulations and law enforcement. PMID:27200245

  8. 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

  9. 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

  10. Supergravity computations without gravity complications

    SciTech Connect

    Cheung, Clifford; D'Eramo, Francesco; Thaler, Jesse

    2011-10-15

    The conformal compensator formalism is a convenient and versatile representation of supergravity (SUGRA) obtained by gauge-fixing conformal SUGRA. Unfortunately, practical calculations often require cumbersome manipulations of component field terms involving the full gravity multiplet. In this paper, we derive an alternative gauge fixing for conformal SUGRA which decouples these gravity complications from SUGRA computations. This yields a simplified tree-level action for the matter fields in SUGRA which can be expressed compactly in terms of superfields and a modified conformal compensator. Phenomenologically relevant quantities such as the scalar potential and fermion mass matrix are then straightforwardly obtained by expanding the action in superspace.

  11. Pulmonary complications of inflammatory myopathy.

    PubMed

    Miller, Shelly A; Glassberg, Marilyn K; Ascherman, Dana P

    2015-05-01

    Pulmonary complications cause significant morbidity and mortality in the idiopathic inflammatory myopathies. Advances in biomarker discovery have facilitated clinical phenotyping, allowing investigators to better define at-risk patient subsets and to potentially gauge disease activity. This serologic characterization has complemented more traditional assessment tools. Pharmacologic management continues to rely on the use of corticosteroids, often in combination with additional immunosuppressive agents. The rarity of myositis-associated interstitial lung disease and lack of controlled trials have limited analyses of treatment efficacy, mandating the development of standardized outcome measures and improvement of data sharing between disciplines. PMID:25836641

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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, Ludwig’s 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

  19. 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

  20. Infectious Complications After Liver Transplantation

    PubMed Central

    Hernandez, Maria Del Pilar; Martin, Paul

    2015-01-01

    Orthotopic liver transplantation (OLT) is the standard of care for patients with decompensated cirrhosis and for patients with hepatocellular carcinoma. More than 6000 liver transplants are performed annually in the United States. High patient and graft survival rates have been achieved in great part due to the availability of potent immunosuppressive agents. Systemic immunosuppression has rendered the liver recipient susceptible to de novo infections as well as reactivation of preexisting latent infections. Infections occurring during the first month post-OLT are usually nosocomial, donor-derived, or the result of a perioperative complication. The development of opportunistic infections (OIs) such as Aspergillus and the reactivation of latent infections such as Mycobacterium tuberculosis are more frequent 1 to 6 months posttransplant, when the net state of immunosuppression is the highest. Immunosuppressive therapy is tapered 6 to 12 months post-OLT; therefore, infections occurring during that time period and afterward generally resemble those of the general population. Screening strategies applied to determine the risk of an infection after transplantation and the use of prophylactic antimicrobial therapy have reduced the incidence of OIs after OLT. This article will review the various causes of infection post-OLT and the therapies used to manage complications. PMID:27134589

  1. [Bronchopleural fistula: a serious complication after thoracic surgery].

    PubMed

    Purek, L; Licker, M; Frey, J G; Spiliopoulos, A; Tschopp, J M

    2009-05-13

    Postsurgical bronchopleural fistula (BPF) is a serious complication accompanied with a high mortality, requiring early and correct diagnosis. The acute form of BPF is usually a technical failure of the surgical stump requiring an immediate surgical reoperation. The subacute or chronic BPF is more difficult to diagnose because of non specific symptoms. It requires well targeted antibiotics depending on microbiology, an adequate drainage of the thoracic cavity and very often repeated surgical or endoscopic procedures. PMID:19526974

  2. Charcot neuroarthropathy: An often overlooked complication of diabetes.

    PubMed

    Botek, Georgeanne; Anderson, Martha A; Taylor, Ryan

    2010-09-01

    In patients with long-standing, poorly controlled diabetes and peripheral neuropathy, a red, hot, swollen foot without open ulceration should raise the suspicion of Charcot neuroarthropathy, an often-overlooked diabetic foot complication. The authors discuss key diagnostic features and how to differentiate this condition from cellulitis, osteomyelitis, and other conditions. They review key elements of the workup and emphasize the importance of early diagnosis and prompt treatment to preserve a functioning foot. PMID:20810870

  3. 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

  4. 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

  5. Complications of head injury and their therapy.

    PubMed

    Marion, D W

    1991-04-01

    Common intracranial complications following head injury are meningitis, usually associated with a basilar skull fracture or open-depressed skull fracture; delayed hematoma; hydrocephalus; and vascular injuries. Prophylactic antibiotics are not recommended for the management of basilar skull fractures. The best means of preventing infection from open-depressed skull fractures is operative debridement and thorough irrigation, though recent evidence suggests that select cases can be safely managed without operation. Serial CT scans should be obtained in severely head-injured patients to identify delayed hematomas. CT and MRI scans obtained several weeks or months after severe head injury frequently reveal enlarged ventricles, though only a small percentage of these patients have clinical hydrocephalus. Those that do, often benefit from a shunt. Vascular injuries frequently are not detected until ischemic symptoms develop hours or days after the injury. Recommended treatment for intimal tears or dissection is full anticoagulation, but in those with cerebral contusions or other intracranial lesions, this may present an unacceptable risk for intracranial hemorrhage. Pulmonary infections frequently occur following head injury, and can be associated with admission to the ICU and intubation. A large percentage of these infections are caused by enteric gram-negative organisms, and aggressive treatment with appropriate antibiotics is necessary. Aspiration of gastric contents is common in head-injured patients and is frequently complicated by bacterial superinfection. The routine use of antacids and H2 blocking agents leads to bacterial colonization of the stomach with anaerobes and gram-negative aerobes. Thus, empiric therapy for aspiration pneumonia should include clindamycin. Sinusitis is a frequent cause of fever and leukocytosis in patients with nasotracheal or nasogastric tubes in place for several days and often subsides spontaneously with removal of the tubes. Pulmonary edema is often caused by excessive fluid administration during resuscitation of these patients, and can be avoided by monitoring central venous pressures. Pulmonary edema may also be caused by ARDS, excessive catecholamine release, or primary cardiac failure. Most of these patients will benefit from early intubation and PEEP. Pulmonary emboli most often originate from deep venous thrombi, and there is increasing evidence that prophylaxis with low-dose heparin and pulsating boots can significantly reduce the incidence of both complications. Erosive gastritis is found in the majority of severely head-injured patients and may be due to ischemia of the gastric mucosa as well as gastric hyperacidity.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:1821750

  6. Wound-healing complications following biopsy of the irradiated breast.

    PubMed

    Pezner, R D; Lorant, J A; Terz, J; Ben-Ezra, J; Odom-Maryon, T; Luk, K H

    1992-03-01

    A retrospective review evaluated results of 38 posttreatment biopsies (with resulting benign pathologic findings) that were performed on 32 irradiated breasts or axillae in 31 of 232 patients who underwent conservation treatment of early-stage breast cancer. Postbiopsy wound-healing complications developed in eight (30%) of 27 patients who were undergoing open biopsies but in none of 11 who underwent only needle biopsies. Wound-healing complications occurred in two of five patients who underwent incisional skin biopsy, three of five who underwent mammographic needle-localized excisional biopsy, and three of 17 who underwent other types of open biopsies. Frequency of wound-healing complications following open biopsy was not related to patient age, diabetes mellitus, cigarette smoking, or use of chemotherapy. Wound-healing complications were related to breast size, developing in four (67%) of six patients with large breasts (brassiere cup size D or DD) as compared with that in only four (19%) of 21 patients with smaller breasts. Significant worsening of cosmetic breast retraction was frequently associated with wound-healing complications, especially wounds that took more than 1 month to heal. PMID:1550480

  7. 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

  8. Extensive intratemporal cholesteatomas: presentation, complications and surgical outcomes.

    PubMed

    Vashishth, Ashish; Singh Nagar, Tilak Raj; Mandal, Shantanu; Venkatachalam, Vellore Pattabhiram

    2015-02-01

    The purpose of the study was to review the clinical features, complications, surgical management and post-operative outcomes of medially invasive extensive cholesteatomas and intracranial complications of cholesteatoma. The retrospective review was carried out at a tertiary referral center and included 20 patients presenting with extensive intratemporal cholesteatomas between 2011 and 2013. Inclusion criteria were involvement of the labyrinth, facial nerve, posterior fossa dura and intracranial complications. The mean age of the patients was 20 years. Profuse foul-smelling otorrhoea and severe otalgia/temporal headache were the most common presenting features. Intracranial complications were observed in nine patients, most commonly temporal lobe abscess; 14/20 patients exhibited profound hearing loss. One case exhibited massive labyrinthine petrous apex cholesteatoma. Labyrinthine destruction was seen in all cases of facial nerve involvement. Management of intracranial complications preceded canal wall-down mastoidectomy with or without partial labyrinthectomy and subtotal petrosectomy (transotic) with blind sac closure for petrous cholesteatoma. Facial nerve infiltration was observed in one case, whereas eight cases exhibited gross dehiscence of the fallopian canal. Disease clearance was complete in all cases with two mortalities in patients with intracranial complications. Post-operative course was uncomplicated in all other patients apart from a case of wound dehiscence. All patients remain disease free after a minimum and maximum follow-up of 6 months and 2 years, respectively. Extensive intratemporal cholesteatomas and intracranial complications caused by them continue to pose a challenge to the management of otitis media in the current era and merit early recognition, surgical management and follow-up. PMID:24318471

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. Managing Complications of Diabetes in Later Life

    MedlinePlus

    ... Related Documents PDF Living with Diabetes Download PDF Managing Complications of Diabetes in Later Life Download Join our e-newsletter! Resources Managing Complications of Diabetes in Later Life Tools and Tips Printer-friendly ...

  16. 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

  17. 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

  18. 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

  19. [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

  20. 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

  1. Neurologic complications of lightning injuries.

    PubMed Central

    Cherington, M; Yarnell, P R; London, S F

    1995-01-01

    Over the past ten years, we have cared for 13 patients who suffered serious neurologic complications after being struck by lightning. The spectrum of neurologic lesions includes the entire neuraxis from the cerebral hemispheres to the peripheral nerves. We describe these various neurologic disorders with regard to the site of the lesion, severity of the deficit, and the outcome. Damage to the nervous system can be a serious problem for patients struck by lightning. Fatalities are associated with hypoxic encephalopathy in patients who suffered cardiac arrests. Patients with spinal cord lesions are likely to have permanent sequelae and paralysis. New technology for detecting lightning with wideband magnetic direction finders is useful in establishing lightning-flash densities in each state. Florida and the Gulf Coast states have the highest densities. Colorado and the Rocky Mountain states have the next highest. Images PMID:7785254

  2. 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

  3. ORTHOPEDIC COMPLICATIONS IN HIV PATIENTS.

    PubMed

    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

    2009-01-01

    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. PMID:27004170

  4. 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. PMID:27004170

  5. Complicated grief in Aboriginal populations

    PubMed Central

    Spiwak, Rae; Sareen, Jitender; Elias, Brenda; Martens, Patricia; Munro, Garry; Bolton, James

    2012-01-01

    To date there have been no studies examining complicated grief (CG) in Aboriginal populations. Although this research gap exists, it can be hypothesized that Aboriginal populations may be at increased risk for CG, given a variety of factors, including increased rates of all-cause mortality and death by suicide. Aboriginal people also have a past history of multiple stressors resulting from the effects of colonization and forced assimilation, a significant example being residential school placement. This loss of culture and high rates of traumatic events may place Aboriginal individuals at increased risk for suicide, as well as CG resulting from traumatic loss and suicide bereavement. Studies are needed to examine CG in Aboriginal populations. These studies must include cooperation with Aboriginal communities to help identify risk factors for CG, understand the role of culture among these communities, and identify interventions to reduce poor health outcomes such as suicidal behavior. PMID:22754293

  6. 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

  7. Pulmonary hypertension complicating multiple myeloma.

    PubMed

    Krishnan, Udhay; Mark, Tomer M; Niesvizky, Ruben; Sobol, Irina

    2015-09-01

    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

  8. 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

  9. Neurologic Complications in the Intensive Care Unit.

    PubMed

    Rubinos, Clio; Ruland, Sean

    2016-06-01

    Complications involving the central and peripheral nervous system are frequently encountered in critically ill patients. All components of the neuraxis can be involved including the brain, spinal cord, peripheral nerves, neuromuscular junction, and muscles. Neurologic complications adversely impact outcome and length of stay. These complications can be related to underlying critical illness, pre-existing comorbid conditions, and commonly used and life-saving procedures and medications. Familiarity with the myriad neurologic complications that occur in the intensive care unit can facilitate their timely recognition and treatment. Additionally, awareness of treatment-related neurologic complications may inform decision-making, mitigate risk, and improve outcomes. PMID:27098953

  10. Neurological complications in beta-thalassemia.

    PubMed

    Zafeiriou, Dimitrios I; Economou, Marina; Athanasiou-Metaxa, Miranta

    2006-09-01

    Over the years, several reports have demonstrated involvement of the nervous system in beta-thalassemia patients. Neurological complications have been attributed to various factors such as chronic hypoxia, bone marrow expansion, iron overload, and desferrioxamine neurotoxicity. In most cases, neurological involvement does not initially present with relevant signs or symptoms (i.e., is subclinical) and can only be detected during neurophysiological or neuroimaging evaluation. Abnormal findings in the visual, auditory, and somatosensory evoked potential recordings are mainly attributed to DFO neurotoxicity. On the other hand, nerve conduction velocity abnormalities are associated either to chronic hypoxia and older age or to hemosiderosis, whether by means of pancreas involvement or not. Neuropsychological studies available reveal a considerably high prevalence of abnormal IQ, not correlating, however, to factors such as hypoxia or iron overload. It is proposed that factors associated to severe chronic illness, rather than the disease per se, could be responsible for these findings. Such factors include regular school absence due to transfusions and frequent hospitalizations, physical and social restrictions resulting from the disease and its treatment, abnormal mental state due to the awareness of being chronically ill, and, last, the overly protective family attitude that leads to restricted initiative and psychosocial development. As life expectancy for beta-thalassemia patients extends, the use of neurophysiologic and neuropsychologic monitoring becomes imperative, enabling early detection of neural pathway impairment and allowing for appropriate management, in order to achieve a better life quality for this patient group. PMID:16574362

  11. 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 Children’s 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

  12. Risk factors for complications in patients with ulcerative colitis

    PubMed Central

    Borovicka, Jan; Seibold, Frank; Vavricka, Stephan R; Lakatos, Peter L; Fried, Michael; Rogler, Gerhard

    2016-01-01

    Background Patients with ulcerative colitis may develop extraintestinal manifestations like erythema nodosum or primary sclerosing cholangitis or extraintestinal complications like anaemia, malabsorption or they may have to undergo surgery. Objective The aim of this study was to investigate potential risk factors for complications like anaemia, malabsorption or surgery in ulcerative colitis. Methods Data on 179 patients with ulcerative colitis were retrieved from our cross-sectional and prospective Swiss Inflammatory Bowel Disease Cohort Study data base for a median observational time of 4.2 years. Data were compared between patients with (n = 140) or without (n = 39) complications. Gender, age at diagnosis, smoking status, disease extent, delay of diagnosis or therapy, mesalamine (5-ASA) systemic and topical therapy, as well as other medication were analysed as potential impact factors. Results In the multivariate regression analysis a delay of 5-ASA treatment by at least two months (odds ratio (OR) 6.21 (95% confidence interval (CI) 2.13–18.14), p = 0.001) as well as a delay with other medication with thiopurines (OR 6.48 (95% CI 2.01–20.91), p = 0.002) were associated with a higher risk for complications. This significant impact of a delay of 5-ASA therapy was demonstrated for extraintestinal manifestations (EIMs) as well as extraintestinal complications (EICs). Extensive disease as well as therapy with methotrexate showed a significantly increased risk for surgery (extensive disease: OR 2.62 (1.02–6.73), p = 0.05, methotrexate: OR 5.36 (1.64–17.58), p = 0.006). Conclusions A delay of 5-ASA therapy of more than two months in the early stage of ulcerative colitis (UC) constitutes a risk for complications during disease course. Extensive disease is associated with a higher risk for surgery. PMID:27087958

  13. 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

  14. Neurological complications in hyperemesis gravidarum.

    PubMed

    Zara, Gabriella; Codemo, Valentina; Palmieri, Arianna; Schiff, Sami; Cagnin, Annachiara; Citton, Valentina; Manara, Renzo

    2012-02-01

    Hyperemesis gravidarum can impair correct absorption of an adequate amount of thiamine and can cause electrolyte imbalance. This study investigated the neurological complications in a pregnant woman with hyperemesis gravidarum. A 29-year-old pregnant woman was admitted for hyperemesis gravidarum. Besides undernutrition, a neurological examination disclosed weakness with hyporeflexia, ophthalmoparesis, multidirectional nystagmus and optic disks swelling; the patient became rapidly comatose. Brain MRI showed symmetric signal hyperintensity and swelling of periaqueductal area, hypothalamus and mammillary bodies, medial and posterior portions of the thalamus and columns of fornix, consistent with Wernicke encephalopathy (WE). Neurophysiological studies revealed an axonal sensory-motor polyneuropathy, likely due to thiamine deficiency or critical illness polyneuropathy. Sodium and potassium supplementation and parenteral thiamine were administered with improvement of consciousness state in a few days. WE evolved in Korsakoff syndrome. A repeat MRI showed a marked improvement of WE-related alterations and a new hyperintense lesion in the pons, suggestive of central pontine myelinolysis. No sign or symptom due to involvement of the pons was present. PMID:21720901

  15. 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

  16. 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

  17. Cerebrovascular complications of Fabry's disease.

    PubMed

    Mitsias, P; Levine, S R

    1996-07-01

    Fabry's disease (FD) is a rare, sex-linked disorder resulting from alpha-galactosidase deficiency. Cerebrovascular complications have been reported in the literature but have not been systematically analyzed. We report 2 patients and review 51 previously reported cases (descriptive meta-analysis) to clarify the clinical, radiologic, and pathologic features. The average age at onset of cerebrovascular symptoms was 33.8 years for hemizygous individuals (n = 43) and 40.3 years of heterozygotes (n = 10). The most frequent symptoms and signs were as follows (in descending order of frequency): hemiparesis, vertigo/dizziness, diplopia, dysarthria, nystagmus, nausea/vomiting, head pain, hemiataxia, and ataxia of gait, in the hemizygote group; and memory loss, dizziness, ataxia, hemiparesis, loss of consciousness and hemisensory symptoms, in the heterozygote group. The vertebrobasilar circulation was symptomatic in 67% of the hemizygotes and 60% of the heterozygotes. Intracerebral hemorrhage was found in 4 patients (3 hemizygotes and 1 heterozygote). Elongated, ectatic, tortuous vertebral and basilar arteries were the most common angiographic and pathologic features. For the hemizygotes, the recurrence rate for cerebrovascular disease was 76% and the death rate was 55%; 86% of the heterozygotes had recurrent cerebrovascular event(s) and 40% died. The cerebrovascular manifestations of FD, in both hemizygotes and heterozygotes, are predominantly due to dilative arteriopathy of the vertebrobasilar circulation, frequently recur, and portend a poor prognosis. PMID:8687196

  18. 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.

  19. Neurologic complications of craniovertebral dislocation.

    PubMed

    de Carvalho, Mamede; Swash, Michael

    2014-01-01

    Craniovertebral dislocation is uncommon, but its diagnosis is important taking into account the potential severity of the neurologic complications. A number of causes are known; the most common are Down syndrome, rheumatoid arthritis, Paget's disease, other metabolic bone diseases, and craniocervical trauma. Down's syndrome is a relatively common clinical condition but craniovertebral subluxation is only observed in a small percentage of patients. About half of all cervical spine injuries affect the atlanto-occipital region and C2 vertebra. In rheumatoid arthritis, craniocervical dislocation occurs in up to 40% of patients with severe disease. In Paget's disease, involvement of the craniovertebral region occurs in about 30% of all cases. The clinical neurologic syndrome is characterized by local pain, features of upper spinal cord and medullary compression, positive Lhermitte phenomenon, syncope associated with neck flexion, vertebral artery obstruction or dissection leading to stroke, and asymmetrical lower cranial nerve palsies. Neuroimaging is essential to confirm the clinical diagnosis and to categorize severity. The treatment of this disorder is usually surgical, but traction and external immobilization is relevant in some cases. Specific conditions may require additional treatments such as radiotherapy, antibiotics, or chemotherapy. PMID:24365311

  20. 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.

  1. Incidence of complications following laparoscopic hernioplasty.

    PubMed

    Phillips, E H; Arregui, M; Carroll, B J; Corbitt, J; Crafton, W B; Fallas, M J; Filipi, C; Fitzgibbons, R J; Franklin, M J; McKernan, B

    1995-01-01

    Smaller individual series on the outcome of laparoscopic hernioplasty techniques have been reported. This study reports on the complications of 3,229 laparoscopic hernia repairs performed by the authors in 2,559 patients. The TAPP (transabdominal preperitoneal) technique was the most frequently performed: 1,944 (60%). The totally preperitoneal technique was performed 578 (18%) times. The IPOM (intraperitoneal onlay mesh) repair was performed 345 (11%) times. The plug-and-patch technique was used 286 (9%) times and simple closure of the hernia defect without mesh was used in 76 (2%) repairs. Overall, there were 336 (10%) complications: 17 (0.5%) major and 265 (8%) minor. There were 54 (1.6%) recurrences, with a mean follow-up of 22 months. The TAPP technique had 19 (1%) recurrences and 141 (7%) complications. There were four bowel obstructions in this subgroup from herniation of small bowel through the peritoneal closure and trocar sites. The totally preperitoneal technique had no recurrence and 60 (10%) complications. The IPOM group had 7 (2%) recurrences and 47 (14%) complications. The plug-and-patch technique had 26 (9%) recurrences and 24 (8%) complications. The simple closure of the internal ring had 2 (3%) recurrences and 10 (13%) complications. Laparoscopic hernioplasty is not without complications. Laparoscopic hernioplasty is not without complications. Training, experience, and attention to technique will prevent some of these complications. PMID:7725207

  2. Maternal and fetal complications of the hypothyroidism-related pregnancy

    PubMed Central

    Tudosa, Rodica; Vartej, P; Horhoianu, Irina; Ghica, C.; Mateescu, Stela; Dumitrache, I

    2010-01-01

    ABSTRACT Thyroid pathology worsens during pregnancy. Hypothyroidism can be pre-existent or may begin during pregnancy period. Most of the patients who presented hypothyroidism during pregnancy have a history of thyroid disease for which they have undergone treatment (medical, surgical or radioisotopes). Hypothyroidism is difficult to be diagnosed during pregnancy as the signs can belong to pregnancy itself. Changes in thyroid function have a major negative impact on both mother and fetus. Complications that arise depend on the severity of hypothyroidism, on how appropriately and early the treatment will be initiated, on other obstetrical and extragenital pathologies associated with the present pregnancy. Clinical symptoms are polymorphic, often nonspecific, and are related mainly to the time of occurrence and to the severity of thyroid hormone deficiency. The appropriate, early administered treatment and maintenance of a normal level of thyroid hormones minimize the risk of maternal and fetal complications and make it possible that the pregnancy may be carried to term without severe complications. PMID:21977134

  3. [Gastrocolocutaneous fistula: an uncommon complication of percutaneous endoscopic gastrostomy].

    PubMed

    Ruiz Ruiz, J M; Rando Muñoz, J F; Salvá Villar, P; Lamarca Hurtado, J C; Sánchez Molinero, Ma D; Sanjurgo Molezun, E; Vázquez Pedreño, L; Manteca González, R

    2012-01-01

    Endoscopic percutaneous gastrostomy is a safe technique although with potential complications before which the clinician has to be on alert in order to early detect them even after a long period of normal functioning. Most of them represent minor problems. Gastrocolocutaneous fistula is a rare but severe complication favored by some risk factors such as previous post-surgical adherences, deformities of the spine, or excessive gastric inflation at the time of performing the technique. We present the case of a patient with PEG with this complication that occurred after the first tube replacement. Our goal was in two senses: on the one hand, to analyze the preventive aspects and basic guidelines for a safe PEG placement to minimize the risks; on the other hand, to alert on the possible presence of this entity to prevent a progressive nutritional impairment. This complication ought to be included in the differential diagnosis of the diarrhea syndrome in the patient carrying a PEG. The diagnostic techniques of choice are radiologic tests such as CT scan and contrast media administration through the tube. Surgical therapy should be reserved to patients with acute peritonitis in order to perform a new gastrostomy. PMID:22566339

  4. Distal femoral complications following antegrade intramedullary nail placement.

    PubMed

    Fantry, Amanda J; Elia, Gregory; Vopat, Bryan G; Daniels, Alan H

    2015-03-01

    While antegrade nailing for proximal and diaphyseal femur fractures is a commonly utilized fixation method with benefits including early mobilization and high rates of fracture union, both intraoperative and postoperative complications may occur. Intraoperative errors include leg length discrepancy, anterior cortical perforation, malreduction of the fracture, and neurovascular injury, and postoperative complications include nonunion, malunion, infection, and hardware failure. This case series reviews complications affecting the distal femur after intramedullary nailing including fracture surrounding a distal femoral interlocking screw (Case #1), nonunion after dynamization with nail penetration into the knee joint (Case #2), and anterior cortical perforation (Case #3). Prevention of intraoperative and postoperative complications surrounding intramedullary nailing requires careful study of the femoral anatomy and nail design specifications (radius of curvature), consideration of the necessity of distal interlocking screws, the need for close radiographic follow-up after nail placement with X-rays of the entire length of the nail, and awareness of possible nail penetration into the knee joint after dynamization. PMID:25874066

  5. Distal Femoral Complications Following Antegrade Intramedullary Nail Placement

    PubMed Central

    Fantry, Amanda J.; Elia, Gregory; Vopat, Bryan G.; Daniels, Alan H.

    2015-01-01

    While antegrade nailing for proximal and diaphyseal femur fractures is a commonly utilized fixation method with benefits including early mobilization and high rates of fracture union, both intraoperative and postoperative complications may occur. Intraoperative errors include leg length discrepancy, anterior cortical perforation, malreduction of the fracture, and neurovascular injury, and postoperative complications include nonunion, malunion, infection, and hardware failure. This case series reviews complications affecting the distal femur after intramedullary nailing including fracture surrounding a distal femoral interlocking screw (Case #1), nonunion after dynamization with nail penetration into the knee joint (Case #2), and anterior cortical perforation (Case #3). Prevention of intraoperative and postoperative complications surrounding intramedullary nailing requires careful study of the femoral anatomy and nail design specifications (radius of curvature), consideration of the necessity of distal interlocking screws, the need for close radiographic follow-up after nail placement with X-rays of the entire length of the nail, and awareness of possible nail penetration into the knee joint after dynamization. PMID:25874066

  6. 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

  7. Fournier's gangrene complicating ulcerative pancolitis.

    PubMed

    Katsanos, Konstantinos H; Ignatiadou, Eleftheria; Sarandi, Maria; Godevenos, Dimitrios; Asproudis, Ioannis; Fatouros, Michael; Tsianos, Epameinondas V

    2010-06-01

    Fournier gangrene is a very rare and a rapidly progressing, polymicrobial necrotizing faciitis or myonecrosis of the perineal, perianal and genital regions, with a high mortality rate. Infection is associated with superficial traum, urological and colorectal diseases and operations. The most commonly found bacteria are Escherichia coli followed by Bacteroides and streptococcal species. Diabetes mellitus, alcoholism, and immunosuppression are perpetuating co-factors. Fournier's gangrene complicating inflammatory bowel disease has been reported in three patients so far, two with Crohn's disease. A 78-year-old man diagnosed with ulcerative pancolitis was referred for fever, and painful perianal and scrotal swelling after perianal surgery for a horseshoe-type perianal abscess. Since bowel disease diagnosis, patient was on mesalazine and achieved long-term remission. Perianal abscess occurred suddenly one week before perianal surgery without any evidence of pre-existing fistula or other abnormalities. Physical examination showed extensive edema and crepitus of perineum and genitalia and patient had symptoms of significant toxicity. The diagnosis of Fournier's gangrene was made and patient underwent emergency surgery with extensive surgical debridement of the scrotal and perianal area and Hartman procedure with a diverting colostomy. In addition, patient started on therapy with mesalazine 3gr, methylprednisolone 16 mg, parenteral nutrition and broad spectrum of antibiotics. Two days after the first operation the patient needed a second operation for perianal debridement. On the fourth day, blood cultures showed E. coli. Patient had an uneventful recovery and was discharged after 34 days of hospitalization. On follow up, disease review is scheduled and colostomy closure is planned. PMID:21122507

  8. [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

  9. Intraoperative laparoscopic complications for urological cancer procedures

    PubMed Central

    Montes, Sergio Fernández-Pello; Rodríguez, Ivan Gonzalez; Ugarteburu, Rodrigo Gil; Villamil, Luis Rodríguez; Mendez, Begoña 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

  10. Management of biliary complications after liver transplantation

    PubMed Central

    Memeo, Riccardo; Piardi, Tullio; Sangiuolo, Federico; Sommacale, Daniele; Pessaux, Patrick

    2015-01-01

    Biliary complications (BC) currently represent a major source of morbidity after liver transplantation. Although refinements in surgical technique and medical therapy have had a positive influence on the reduction of postoperative morbidity, BC affect 5% to 25% of transplanted patients. Bile leak and anastomotic strictures represent the most common complications. Nowadays, a multidisciplinary approach is required to manage such complications in order to prevent liver failure and retransplantation. PMID:26689137

  11. Massive hiatus hernia complicated by jaundice

    PubMed Central

    Furtado, Ruelan V.; D'Netto, Trevor J.; Hook, Henry C.; Falk, Gregory L.; Vivian, SarahJayne

    2015-01-01

    Giant para-oesophageal hernia may include pancreas with pancreatic complication and rarely jaundice. Repair is feasible and durable by laparoscopy. Magnetic resonance cholangiopancreatography is diagnostic. PMID:26246452

  12. Massive hiatus hernia complicated by jaundice.

    PubMed

    Furtado, Ruelan V; D'Netto, Trevor J; Hook, Henry C; Falk, Gregory L; Vivian, SarahJayne

    2015-01-01

    Giant para-oesophageal hernia may include pancreas with pancreatic complication and rarely jaundice. Repair is feasible and durable by laparoscopy. Magnetic resonance cholangiopancreatography is diagnostic. PMID:26246452

  13. Complicated grief in survivors of suicide.

    PubMed

    Mitchell, Ann M; Kim, Yookyung; Prigerson, Holly G; Mortimer-Stephens, MaryKay

    2004-01-01

    Complicated grief is a newly defined and distinctive psychiatric disorder that occurs in response to a significant loss through death. New findings suggest that survivors who were close to the deceased are at heightened risk for complicated grief. Little is known about whether close kinship (spouses, parents, children, siblings, vs. in-laws, aunts/uncles, nieces/nephews, friends, or coworkers) to a suicide victim also represents a heightened risk for complicated grief. Assessing for complicated grief is important, especially with survivors of suicide, because of the potential for associated health risks. This report contains preliminary data from an exploratory, descriptive pilot study examining complicated grief in adult survivors of suicide. Sixty bereaved subjects, within one month after the suicide of a family member or significant other, were assessed for complicated grief symptoms. Statistically significant differences, as measured with the Inventory of Complicated Grief, were noted between closely related and distantly related survivors of the suicide victim. These preliminary results indicate that health care professional's assessments and interventions for complicated grief should take into consideration the bereaved's familial and/or social relationship to the deceased. The closely related survivors of suicide had higher levels of complicated grief and could be at risk of developing physical and/or mental health problems, including suicidal ideation, in the future. PMID:15384652

  14. [Respiratory complications after oesophagectomy for cancer].

    PubMed

    D'journo, X-B; Michelet, P; Avaro, J-P; Trousse, D; Giudicelli, R; Fuentes, P; Doddoli, C; Thomas, P

    2008-06-01

    Surgery is the cornerstone of treatment for resectable tumours of the oesophagus. Recent advances of surgical techniques and anaesthesiology have led to a substantial decrease in mortality and morbidity. Respiratory complications affect about 30% of patients after oesophagectomy and 80% of these complications occur within the first five days. Respiratory complications include sputum retention, pneumonia and ARDS. They are the major cause of morbidity and mortality after oesophageal resection and numerous studies have identified the factors associated with these complications. The mechanisms are not very different from those observed after pulmonary resection. Nevertheless, there is an important lack of definition, and evaluation of the incidence is particularly difficult. Furthermore, respiratory complications are related to many factors. Careful medical history, physical examination and pulmonary function testing help to identify the risk factors and provide strategies to reduce the risk of pulmonary complications. Standardized postoperative management and a better understanding of the pathogenesis of pulmonary complications are necessary to reduce hospital mortality. This article discusses preoperative, intraoperative, and postoperative factors affecting respiratory complications and strategies to reduce the incidence of these complications after oesophagectomy. PMID:18772826

  15. Management of Complications of Distal Radius Fractures

    PubMed Central

    Chung, Kevin C.; Mathews, Alexandra L.

    2015-01-01

    Synopsis Treating a fracture of the distal radius may require the surgeon to make a difficult decision between surgical treatment and nonsurgical management. The use of surgical fixation has recently increased owing to complications associated with conservative treatment. However, conservative action may be necessary depending on certain patient factors. The treating surgeon must be aware of the possible complications associated with distal radius fracture treatments to prevent their occurrence. Prevention can be achieved with a proper understanding of the mechanism of these complications. This article discusses the most recent evidence on how to manage and prevent complications following a fracture of the distal radius. PMID:25934197

  16. 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

  17. 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

  18. Chronic complications of diabetes mellitus related to the respiratory system.

    PubMed

    Vojtková, Jarmila; Ciljaková, Miriam; Michnová, Zuzana; Turčan, Tomá

    2012-01-01

    The quality of life in patients with diabetes mellitus is mainly determined by chronic diabetic complications which may affect all organ tissues including respiratory system. Microangiopathy of pulmonary capillaries, autonomic neuropathy, myopathy of respiratory muscles or changes in collagen belong to supposed pathophysiological pathways. This paper brings brief review about reported functional consequences in subjects with diabetes - decreased vital lung capacity and pulmonary volumes, decreased diffuse lung capacity for carbon monoxide, lower basal bronchial tone, lower cough reflex sensitivity, increased incidence of sleep obstructive apnea, increase in respiratory infections, disorders in respiratory muscles or phrenical nerve. Examination of pulmonary functions may serve for early detection of chronic complications in patients with diabetes. PMID:23146790

  19. 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

  20. Pulmonary Hypertension Complicating Fibrosing Mediastinitis.

    PubMed

    Seferian, Andrei; Steriade, Alexandru; Jaïs, Xavier; Planché, Olivier; Savale, Laurent; Parent, Florence; Amar, David; Jovan, Roland; Fadel, Elie; Sitbon, Olivier; Simonneau, Gérald; 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

  1. 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

  2. Tube Thoracostomy: Complications and Its Management

    PubMed Central

    Kesieme, Emeka B.; Dongo, Andrew; Ezemba, Ndubueze; Irekpita, Eshiobo; Jebbin, Nze; Kesieme, Chinenye

    2012-01-01

    Background. Tube thoracostomy is widely used throughout the medical, surgical, and critical care specialities. It is generally used to drain pleural collections either as elective or emergency. Complications resulting from tube thoracostomy can occasionally be life threatening. Aim. To present an update on the complications and management of complications of tube thoracostomy. Methods. A review of the publications obtained from Medline search, medical libraries, and Google on tube thoracostomy and its complications was done. Results. Tube thoracostomy is a common surgical procedure which can be performed by either the blunt dissection technique or the trocar technique. Complication rates are increased by the trocar technique. These complications have been broadly classified as either technical or infective. Technical causes include tube malposition, blocked drain, chest drain dislodgement, reexpansion pulmonary edema, subcutaneous emphysema, nerve injuries, cardiac and vascular injuries, oesophageal injuries, residual/postextubation pneumothorax, fistulae, tumor recurrence at insertion site, herniation through the site of thoracostomy, chylothorax, and cardiac dysrhythmias. Infective complications include empyema and surgical site infection. Conclusion. Tube thoracostomy, though commonly performed is not without risk. Blunt dissection technique has lower risk of complications and is hence recommended. PMID:22028963

  3. 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 patient’s 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

  4. [Use of erbium laser for treatment of dental implant complications].

    PubMed

    Kulakov, A A; Khamraev, T K; Kasparov, A S; Amirov, A R

    2012-01-01

    The paper presents the results of the use of Er:YAG laser for surgical treatment of 48 patients aged 25-73 years with early and late dental implant complications were presented. Among all lasers used in the field of dentistry, the Er:YAG laser seems to possess characteristics most suitable for oral treatment, due to its ability to ablate both soft and hard tissues as well as bacterial biofilms and calculus without causing major thermal damage to the adjacent tissue. PMID:23268221

  5. 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

  6. 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

  7. 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

  8. 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

  9. [Cardiac and extracardiac complications in Kawasaki disease].

    PubMed

    Kamada, Masahiro

    2014-09-01

    In terms of frequency and prognosis, discussions of the complications of Kawasaki disease have focused on coronary artery aneurysms and stenosis. However, as revealed by autopsy findings, medium and small muscular arteries in various organs could be injured in patients with Kawasaki disease, leading to the development of a variety of complications. Accurate diagnosis of Kawasaki disease can be especially difficult when incomplete Kawasaki disease is accompanied by rare complications involving the central nervous system, digestive system, and other systems in the body, which leads to delay in treatment and subsequent development of coronary artery aneurysms and delayed improvement of the existing complications. Doctors who treat Kawasaki disease should be familiar with the rare but important complications of Kawasaki disease. PMID:25518404

  10. Puberty as an accelerator for diabetes complications.

    PubMed

    Cho, Yoon Hi; Craig, Maria E; Donaghue, Kim C

    2014-02-01

    Much is written about how difficult it is to deal with diabetes during adolescence, and rightly so. Less is understood as to how puberty may be an accelerator of vascular complications. With the increase in childhood diabetes, complication risks need to be revisited in relation to puberty and the secular increase in adiposity. Recent data suggest greater risk for severe vascular complications in those with diabetes during puberty, compared with young people who develop diabetes after puberty. It is also widely recognized that higher hemoglobin A1c (HbA1c) results are often seen during the pubertal period. This article will review complication outcomes in relation to puberty and examine mechanisms by which puberty may modify risk above glycemic exposure, and possible gender disparities in the risk of complications in the adolescent period. PMID:24443957

  11. [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

  12. 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.

  13. 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

  14. [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

  15. A Delayed Complication of Temporal Craniotomy Leading to a Potentially Difficult Airway.

    PubMed

    Rayadurg, Vivek; Bhadrinarayan, V; Gopalakrishna, K N; Savardekar, Amey

    2016-04-01

    Pseudoankylosis of the temporomandibular joint may occur as a complication of frontotemporal craniotomy. We report a patient who presented for surgery with a restricted mouth opening resulting from an infectious complication after frontotemporal craniotomy. Early identification of the potentially difficult airway helped manage this patient. We explain the mechanism of this late complication that may result in a difficult airway. If this is not identified preoperatively when a patient presents for emergency surgery or when the patient is in altered sensorium, it may lead to an unanticipated difficult airway. PMID:26825991

  16. 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

  17. Gastrointestinal Complications in Patients Who Undergo Radical Cystectomy with Enhanced Recovery Protocol.

    PubMed

    Djaladat, Hooman; Daneshmand, Siamak

    2016-07-01

    Gastrointestinal (GI) complications are among the most common complications following radical cystectomy and urinary diversion. The most common is postoperative ileus, although its precise pathophysiology is not completely understood. Enhanced recovery after surgery (ERAS) protocols include evidence-based steps to optimize postoperative recovery and shorten hospital stay, mainly through expedited GI function recovery. They include avoiding bowel preparation and postoperative nasogastric tube, early feeding, non-narcotic pain management, and the use of cholinergic and mu-receptor opioid antagonists. We reviewed the literature in regard to GI complications using enhanced recovery protocols and share our institutional experience with over 300 patients. PMID:27125653

  18. 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 crucial, especially in elderly patients with autoimmune bullous diseases, so as to limit disease duration and prevent further complications. Dermatologists should make a correct judgment and manage this condition appropriately, based on clinical manifestations. PMID:26724884

  19. 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

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

    PubMed

    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

  1. [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

  2. 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

  3. Common complications in critically ill patients.

    PubMed

    Wollschlager, C M; Conrad, A R; Khan, F A

    1988-05-01

    Patients in intensive care units (ICUs) are subject to many complications connected with the advanced therapy required for their serious illnesses. Complications of ventilatory support include problems associated with short-term and long-term intubation, barotrauma, gastrointestinal tract bleeding, and weaning errors. Cardiac tachyarrhythmias can arise from a patient's intrinsic cardiac disease, as well as from drug therapy itself. Hemodynamic monitoring is crucial to careful patient management, but it is associated with technical complications during insertion such as pneumothorax, as well as interpretive errors such as those caused by positive end-inspiratory pressure. Acute renal failure can develop as a result both of therapy with drugs such as aminoglycosides and hypotension of many etiologies, as well as the use of contrast media. Nosocomial infection, which is a dreaded complication in ICU patients, usually arises from sources in the urinary tract, bloodstream, or lung. Complications frequently can arise if the interactions of drugs commonly used in the ICU are not recognized. Further, the ICU patient is subject to nutritional complications, acid base problems, and psychological disturbances. This monograph deals with the frequency, etiology, and prevention of these common ICU complications. PMID:3286162

  4. Complications After Open Distal Clavicle Excision

    PubMed Central

    Chronopoulos, Efstathis; Gill, Harpreet S.; Freehill, Michael T.; Petersen, Steve A.

    2008-01-01

    Isolated distal clavicle excision performed as an open procedure has been considered safe and, in the literature, has been considered the standard for comparison with arthroscopic distal clavicle excisions. However, we noticed isolated open distal clavicle excision was associated with a number of complications. We therefore raised two questions about the complication rate in a cohort of our patients who had undergone this procedure: (1) What was the complication rate and how did it compare to that in the existing literature on this subject? and (2) Were the complications in our cohort similar to those previously reported? We studied 42 patients who underwent an isolated distal clavicle excision between 1992 and 2003. There were 27 complications (64%), which was substantially higher than rates previously reported. Complications in our cohort not previously reported included continued acromioclavicular joint tenderness and scar hypertrophy. Our study suggests complications after open distal clavicle excisions may be more frequent than and may differ from previously reported rates and types. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18264853

  5. Complications and failure of airway management.

    PubMed

    Cook, T M; MacDougall-Davis, S R

    2012-12-01

    Airway management complications causing temporary patient harm are common, but serious injury is rare. Because most airways are easy, most complications occur in easy airways: these complications can and do lead to harm and death. Because these events are rare, most of our learning comes from large litigation and critical incident databases that help identify patterns and areas where care can be improved: but both have limitations. The recent 4th National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society provides important detailed information and our best estimates of the incidence of major airway complications. A significant proportion of airway complications occur in Intensive Care Units and Emergency Departments, and these more frequently cause patient harm/death and are associated with suboptimal care. Hypoxia is the commonest cause of airway-related deaths. Obesity markedly increases risk of airway complications. Pulmonary aspiration remains the leading cause of airway-related anaesthetic deaths, most cases having identifiable risk factors. Unrecognized oesophageal intubation is not of only historical interest and is entirely avoidable. All airway management techniques fail and prediction scores are rather poor, so many failures are unanticipated. Avoidance of airway complications requires institutional and individual preparedness, careful assessment, good planning and judgement, good communication and teamwork, knowledge and use of a range of techniques and devices, and a willingness to stop performing techniques when they are failing. Analysis of major airway complications identifies areas where practice is suboptimal; research to improve understanding, prevention, and management of such complications remains an anaesthetic priority. PMID:23242753

  6. 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

  7. 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

  8. 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

  9. [Complications and failure after partial laryngectomy].

    PubMed

    Pajor, A; Latkowski, B; Murlewska, A; Kaczmarczyk, D; Pietruszewska, W

    1997-01-01

    The frequency and type of failures and complications after 259 partial laryngectomies in patients treated for cancer of larynx in Otolaryngology Department of Medical University of Lodz from 1980 to 1996 were evaluated. Among the failures a local and nodal recurrence, a distant metastasis and a second primary malignant tumor were taken into consideration. Furthermore, among the complications disfunction of breathing, swallowing, voice emission and abnormal healing were analyzed. The most often failure was local recurrence which had been observed in 36 patients (13.9%) and the most often complication was a granulation in larynx which had been observed in 45 patients (17.4%). PMID:9757655

  10. [Complications of breast augmentation - a case report].

    PubMed

    Zedníková, I; Třešková, I; Schmiedhuber, P; Hes, O

    2012-08-01

    As with any surgery, breast augmentation does have certain risks and complications. The aim of this article is to point out a rare complication of breast augmentation - axillary silicone lymphadenopathy (defined as the presence of silicone in the lymph nodes). The authors present a case report of silicone lymphadenopathy in a young woman after the rupture of a silicone breast implant. As the number of women with breast implants is increasing, it is necessary to bear this rare complication of breast augmentation in mind in differential diagnosis of axillary lymphadenopathy. PMID:23153428

  11. Stillbirth in the pregnancy complicated by diabetes.

    PubMed

    Starikov, Roman; Dudley, Donald; Reddy, Uma M

    2015-03-01

    Pregestational diabetes currently complicates 4% of pregnancies, while gestational diabetes complicates approximately 8% of pregnancies. Increased risk of stillbirth in diabetic pregnancies has been a well-known and recognized complication for decades. While stillbirth rates for diabetic pregnancies have decreased due to screening, treatment, and antenatal surveillance of these patients, about 4% of all stillbirths remain attributable to diabetes, and diabetic pregnancies continue to be at increased risk for perinatal mortality. The purpose of this article is to review the literature on the epidemiology, pathophysiology, and prevention, as well as future research, of diabetes-associated perinatal mortality. PMID:25667005

  12. Umbilical venous catheterization gone wrong: Hepatic complications

    PubMed Central

    Sherwani, Poonam; Vire, Adweta; Anand, Rama; Jajoo, Mamta

    2016-01-01

    Hepatic complications of malposition of umbilical venous catheter (UVC) are uncommon and occur due to extravasation of hypertonic fluids and the blood products in the liver tissue. Various hepatic complications include thrombosis of hepatic vessels, hepatic necrosis, hepatic fluid collections, and hematoma, with the intraparenchymal liver lesions seen along the course of ductus venosus. Radiologists must be aware of these complications and their imaging findings, as the timely recognition and immediate management can prevent the fatal outcome. Here, we present a rare case of intraparenchymal liver lesions associated with malposition of UVC in a preterm baby. PMID:27081222

  13. Complications in hair-restoration surgery.

    PubMed

    Konior, Raymond J

    2013-08-01

    Most complications associated with hair restoration are completely preventable and arise from variables that are directly controlled by the surgeon and the patient. Physicians who thoroughly grasp the nuances of modern surgical techniques and fully understand the physiologic dynamics of the balding process are least likely to generate a physician-controlled error. Highly motivated, well-educated patients who carefully follow instructions and take an active role in the postoperative recovery process minimize the chance of patient-controlled errors. This article discusses potential complications associated with surgical hair restoration, and the roles of the patient and physician in minimizing the risk of complications. PMID:24017992

  14. 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

  15. 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

  16. Diabetic Peripheral Microvascular Complications: Relationship to Cognitive Function

    PubMed Central

    Ba-Tin, Lorraine; Strike, Paul; Tabet, Naji

    2011-01-01

    Peripheral microvascular complications in diabetes are associated with concurrent cerebrovascular disease. As detailed cognitive assessment is not routinely carried out among diabetic patients, the aim was to establish whether the presence of clinical “peripheral” microvascular disease can identify a subgroup of patients with early evidence of cognitive impairment. Detailed psychometric assessment was performed in 23 diabetic patients with no microvascular complications (Group D), 27 diabetic patients with at least one microvascular complication: retinopathy, neuropathy, and/or nephropathy (Group DC), and 25 healthy controls (Group H). Groups D and DC participants had significantly lower scores on reaction time (P = 0.003 and 0.0001, resp.) compared to controls. Similarly, groups D and DC participants had significantly lower scores on rapid processing of visual information (P = 0.034 and 0.001, resp.) compared to controls. In contrast, there was no significant difference between Groups D and DC on any of the cognitive areas examined. The results show that diabetes, in general, is associated with cognitive dysfunction, but the additional presence of peripheral microvascular disease does not add to cognitive decline. The study, however, indirectly supports the notion that the aetiology of cognitive impairment in diabetes may not be restricted to vascular pathology. PMID:22162800

  17. Splenic infarction: sonographic patterns, diagnosis, follow-up, and complications.

    PubMed

    Goerg, C; Schwerk, W B

    1990-03-01

    Forty splenic infarcts in 23 patients were examined with ultrasound (US). At clinical presentation, splenic infarction was associated with severe left upper quadrant pain (n = 10) or diffuse abdominal pain (n = 4) or was asymptomatic (n = 9). In this retrospective study, predominantly wedge-shaped (n = 17) or round (n = 23), irregularly delineated (n = 33) or smooth (n = 7), hypoechoic (n = 40) and anechoic (n = 5) lesions were found at first examination. During follow-up observation, four patients died because of complications unrelated to infarct, and five patients underwent splenectomy as a consequence of US findings. Expanding intralienal liquefaction, increasing subcapsular hemorrhage, free peritoneal blood (even in spleens shown to have an intact surface at sonography), and flow phenomena in the area of infarction demonstrated at B-mode pulsed Doppler US were identified as infarct-related complications associated with the risk of splenic rupture. Despite the high self-healing tendency in splenic infarction, short-term follow-up with US is recommended for early recognition of these possible complications. PMID:2406785

  18. A Rare Complication of Radiofrequency Tonsil Ablation: Horner Syndrome.

    PubMed

    Kucur, Cuneyt; Ozbay, Isa; Oghan, Fatih; Yildirim, Nadir; Zeybek Sivas, Zuhal; Canbaz Kabay, Sibel

    2015-01-01

    Chronic tonsillitis is a common disease, and several different surgical techniques are used to treat this condition. In recent years, techniques such as radiofrequency ablation and coblation have been commonly used for tonsil surgery. In this report, we present the cases of two pediatric patients who developed ptosis, miosis, and enophthalmos (Horner syndrome) after radiofrequency ablation for tonsil reduction and discuss the technique of radiofrequency ablation of the tonsils. In the early postoperative period, miosis and ptosis were observed on the right side in one patient and on the left side in the other patient. Both patients were treated with 1 mg/kg/day methylprednisolone, which were tapered by halving the dose every 3 days. Miosis and ptosis improved after treatment in both patients. Along with the case presentation, we discuss the effectiveness and complications of radiofrequency ablation of the tonsils. These unusual complications of tonsil ablation may help ENT physicians who do not yet have a preferred surgical technique for tonsillectomy to make an informed decision. Limited data are available about the possible complications of radiofrequency ablation of the tonsils. The present report contributes to the literature on this topic. PMID:26064747

  19. A Rare Complication of Radiofrequency Tonsil Ablation: Horner Syndrome

    PubMed Central

    Ozbay, Isa; Yildirim, Nadir; Zeybek Sivas, Zuhal; Canbaz Kabay, Sibel

    2015-01-01

    Chronic tonsillitis is a common disease, and several different surgical techniques are used to treat this condition. In recent years, techniques such as radiofrequency ablation and coblation have been commonly used for tonsil surgery. In this report, we present the cases of two pediatric patients who developed ptosis, miosis, and enophthalmos (Horner syndrome) after radiofrequency ablation for tonsil reduction and discuss the technique of radiofrequency ablation of the tonsils. In the early postoperative period, miosis and ptosis were observed on the right side in one patient and on the left side in the other patient. Both patients were treated with 1 mg/kg/day methylprednisolone, which were tapered by halving the dose every 3 days. Miosis and ptosis improved after treatment in both patients. Along with the case presentation, we discuss the effectiveness and complications of radiofrequency ablation of the tonsils. These unusual complications of tonsil ablation may help ENT physicians who do not yet have a preferred surgical technique for tonsillectomy to make an informed decision. Limited data are available about the possible complications of radiofrequency ablation of the tonsils. The present report contributes to the literature on this topic. PMID:26064747

  20. [Clinical and ultrasonic predictors of postoperative complications after carotid endarterectomy].

    PubMed

    Shmyrev, V I; Nosenko, E M; Romanova, M S; Nosenko, N S; Kalinin, A A; Evdokimov, A G; Sakharov, A B

    2015-01-01

    For the period from 2007 to 2012 carotid endarterectomy was performed in 150 patients with cerebrovascular insufficiency I-IV degrees and atherosclerotic lesion of carotid arteries. Dynamic observation was performed by using of duplex scanning of brachiocephalic arteries, transcranial duplex scanning, multislice CT with contrast study of extracranial and intracranial arteries. Different degrees of vascular wall thickening of operated internal carotid artery including neo- and myointimal hyperplasia, restenosis and other complications were observed in 19 (12.6%) patients after carotid endarterectomy on background of cerebrovascular insufficiency progressing. It was revealed that transient ischemic attack or stroke, acute heart failure in early postoperative period, arterial hypertension with crisis course predominantly, diabetes mellitus 2 type, obesity, male sex, elderly age and smoking were clinical markers for complications after carotid endarterectomy. Ultrasonic markers of complications after carotid endarterectomy included terms of development and degree of vascular wall thickening in case of neointimal hyperplasia and restenosis, hyperperfusion syndrome and stroke, significant changes of blood flow velocity and indexes of peripheral vascular resistance. PMID:26031815

  1. 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

  2. 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

  3. 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

  4. 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

  5. Complications of thyroidectomy for large goiter

    PubMed Central

    Berri, Toufik; Houari, Rachida

    2013-01-01

    Thyroidectomy is a routinely common practiced surgery. Morbidity and mortality from thyroid surgery are disregarded nowadays and undervalued in the literature. Perioperative risks and complications still exist for large goiters and can be life-threatening. These complications may occur during the anesthesia and intubation, intra-, or postoperatively. We set out through a case of a large cervical multinodular goiter (MNG) and a review of literature the perioperative complications and how to avoid them. During the total thyroidectomy operation, an accidental devascularisation of a parathyroid gland, a cervical hematoma which was evacuated by surgical reoperation, hemodynamic disorder and a transitory hypoparathyroidism were the postoperative complications that occurred. Surgery for large goiters remains difficult; so adequate preoperative assessment, particular attention and careful operative procedure should be followed to obtain better surgical outcomes. PMID:24847400

  6. 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

  7. 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

  8. Neurological complications of beta-thalassemia.

    PubMed

    Nemtsas, P; Arnaoutoglou, M; Perifanis, V; Koutsouraki, E; Orologas, A

    2015-08-01

    The thalassemias are the most common single gene disorder in the world. Over the last years, several reports have demonstrated neurological complications in beta-thalassemia patients. In most cases, these complications remained subclinical and were detected only during neuropsychological, neurophysiological, or neuroimaging evaluation. Cognitive impairment, abnormal findings on evoked potentials, complications due to extramedullary hematopoiesis, cerebrovascular disease, and peripheral neuropathy comprise the broad spectrum of neurological involvement. Chronic hypoxia, iron overload, desferrioxamine neurotoxicity, and bone marrow expansion are implicated, but sufficient explanatory evidence is lacking and development of biomarkers is needed. This review summarizes current knowledge of the neurological complications. As life expectancy for beta-thalassemia patients increases, we support the use of neurophysiological, neuropsychological, or neuroimaging monitoring, enabling the evaluation of neural pathway impairment, to achieve appropriate management and as a result a better quality of life for this patient group. PMID:25903043

  9. 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

  10. Ocular Complications of Diabetes and Therapeutic Approaches

    PubMed Central

    Vieira-Potter, Victoria J.; Karamichos, Dimitrios; Lee, Darren J.

    2016-01-01

    Diabetes mellitus (DM) is a metabolic disease defined by elevated blood glucose (BG). DM is a global epidemic and the prevalence is anticipated to continue to increase. The ocular complications of DM negatively impact the quality of life and carry an extremely high economic burden. While systemic control of BG can slow the ocular complications they cannot stop them, especially if clinical symptoms are already present. With the advances in biodegradable polymers, implantable ocular devices can slowly release medication to stop, and in some cases reverse, diabetic complications in the eye. In this review we discuss the ocular complications associated with DM, the treatments available with a focus on localized treatments, and what promising treatments are on the horizon. PMID:27119078

  11. Complications of deep brain stimulation surgery.

    PubMed

    Beric, A; Kelly, P J; Rezai, A; Sterio, D; Mogilner, A; Zonenshayn, M; Kopell, B

    2001-01-01

    Although technological advances have reduced device-related complications, DBS surgery still carries a significant risk of transient and permanent complications. We report our experience in 86 patients and 149 DBS implants. Patients with Parkinson's disease, essential tremor and dystonia were treated. There were 8 perioperative, 8 postoperative, 9 hardware-related complications and 4 stimulation-induced side effects. Only 5 patients (6%) sustained some persistent neurological sequelae, however, 26 of the 86 patients undergoing 149 DBS implants in this series experienced some untoward event with the procedure. Although there were no fatalities or permanent severe disabilities encountered, it is important to extend the informed consent to include all potential complications. PMID:12378060

  12. 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 ...

  13. [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

  14. [Management of Infective Endocarditis with Neurological Complication].

    PubMed

    Fukuda, Wakako; Daitoku, Kazuyuki; Minakawa, Masahito; Suzuki, Yasuyuki; Fukuda, Ikuo

    2015-11-01

    Neurological complications in patients with infective endocarditis are frequent and mortality is higher in those with neurological complications than in those without. The spectrum of neurological complications includes cerebral infarction, intracranial hemorrhage, intracranial infectious aneurysm, transient ischemic attack (TIA), meningitis, encephalopathy and brain abscess. The appropriate timing of valve surgery following a cerebrovascular event remains controversial because cardiopulmonary bypass may exacerbate neurological deficits. Previous studies suggest delaying valve surgery for 2 to 4 weeks following embolic stroke and at least 4 weeks following hemorrhagic stroke however, urgent valve surgery may be needed depending on the hemodynamic state of the patient. In the event of intracranial infectious aneurysm, therapeutic management is not perfectly standardized. We retrospectively reviewed the surgical results of infective endocarditis patients with neurological complications. Current trends in surgical timing and therapeutic decision-making are discussed. PMID:26469254

  15. Hepatic amebiasis: a reminder of the complications.

    PubMed

    Rao, Suchitra; Solaymani-Mohammadi, Shahram; Petri, William A; Parker, Sarah K

    2009-02-01

    The complications of amebic liver abscess are underappreciated in developed countries and are often misdiagnosed. We report a 16-month-old male child with amebic liver abscess, initially misdiagnosed with pneumonia, who became critically ill with peritoneal, pleural and pericardial extension, and gastric perforation. In addition to highlighting the complications of amebic liver abscess, this case demonstrates the value of PCR testing as a diagnostic and molecular tool. PMID:19242252

  16. 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

  17. Contemporary management of complicated monochorionic twins.

    PubMed

    Moise, Karen Y; Kugler, Lisa; Jones, Tyra

    2012-01-01

    Monochorionic twins are at increased risk for unique complications including twin-twin transfusion syndrome (TTTS), selective intrauterine growth restriction (sIUGR), and twin-reversed arterial perfusion (TRAP) sequence. Twin-twin transfusion syndrome is treated with laser photocoagulation whereas selective reduction is an option in previable sIUGR or TRAP sequence. The nurse is integral in the management, education, care and support of women with complicated pregnancies. PMID:22536818

  18. 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

  19. 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

  20. Extrahepatic Complications of Nonalcoholic Fatty Liver Disease.

    PubMed

    Chacko, Kristina R; Reinus, John

    2016-05-01

    Nonalcoholic fatty liver disease (NAFLD) is an important cause of liver disease that is often associated with the metabolic syndrome. There is a growing awareness that extrahepatic complications occur in individuals with NAFLD, especially an increased risk of cardiovascular disease. Development of diabetes mellitus, chronic kidney disease, colorectal cancer, and endocrinopathies has been linked to NAFLD. This article reviews the extrahepatic complications affecting individuals with NAFLD and the pathogenesis underlying their development. PMID:27063276

  1. Anorexia nervosa complicating inflammatory bowel disease.

    PubMed

    Mallett, P; Murch, S

    1990-03-01

    Two cases of inflammatory bowel disease, occurring in adolescence and complicated by anorexia nervosa, are presented. The management of the bowel disease with corticosteroids appeared to precipitate the eating disorder in one case whereas covert withdrawal of steroid treatment led to life threatening complications of inflammatory bowel disease in the other. The difficulties of managing two serious conditions, each ideally treated in a specialist centre, are discussed and the dangers of treating adolescents with shape modifying drugs are highlighted. PMID:2334208

  2. Complications of second and third trimester pregnancies.

    PubMed

    Abbrescia, Kelly; Sheridan, Barry

    2003-08-01

    The second and third trimester of pregnancy is a period of extensive physical growth and maturation of the fetus. Unfortunately, it is also a period that is marked by complications that can be life threatening for both the mother and fetus. The top three complications that affect pregnancy are hemorrhage, infection, and the hypertensive diseases of pregnancy. This article focuses on preterm labor, premature rupture of membranes, chorioamnionitis, bleeding in later pregnancy, and the hypertensive diseases of pregnancy. PMID:12962354

  3. Management of complications of congenital hand disorders.

    PubMed

    Comer, Garet C; Ladd, Amy L

    2015-05-01

    This article reviews treatment and presents complications seen in the treatment of 7 common congenital hand differences, including syndactyly, camptodactyly, ulnar and radial polydactyly, thumb hypoplasia, radial longitudinal deficiency, and epidermolysis bullosa. The management of these conditions is challenging but has evolved over the last several decades with refined understanding of the disease processes and treatments. The goal of this article is to synthesize prior knowledge and provide further insights into these conditions that will help the surgeon avoid treatment complications. PMID:25934210

  4. Late complications of reversed gastric tube oesophagoplasty.

    PubMed Central

    Sitges, A C; Sánchez-Ortega, J M; Sitges, A S

    1986-01-01

    This paper reports two late complications of oesophageal replacement using the reversed gastric tube described by Gavriliu. One patient developed obstruction of the gastric tube and the other a perforation of a diverticulum within the gastric tube, both occurring more than 10 years after the original operation. The occurrence of such complications should be made known to surgeons who are contemplating using this form of oesophageal replacement. Images PMID:3085258

  5. 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

  6. Percutaneous Transhepatic Biliary Drainage Complicated by Bilothorax

    PubMed Central

    Kim, Stephanie H.; Zangan, Steven M.

    2015-01-01

    Percutaneous transhepatic biliary drainage (PTBD) is a well-established and safe technique for the management of biliary obstructions and leaks. While approach is variable based on operator preference, patient anatomy, and indications; PTBD is commonly performed via a right-sided intercostal route. With a right-sided approach, pleural complications may be encountered. The authors describe a case of a right PTBD complicated by a leak into the pleural space, with the subsequent development of bilothorax.

  7. Diabetic complications and dysregulated innate immunity

    PubMed Central

    Graves, Dana T; Kayal, Rayyan A

    2011-01-01

    Diabetes mellitus is a metabolic disorder that leads to the development of a number of complications. The etiology of each diabetic complication is undoubtedly multifactorial. We will focus on one potential component that may be common in many diabetic complications, dysregulation of innate immunity associated with an increased inflammatory response. High glucose levels lead to shunting through the polyol pathway, an increase in diacylglycerol which activates protein kinase C, an increase in the release of electrons that react with oxygen molecules to form superoxides, and the non-enzymatic glycosylation of proteins that result in greater formation of advanced glycation end products. Each of these can lead to aberrant cell signalling that affects innate immunity for example, by activating the MAP kinase pathway or inducing activation of transcription factors such as NF-kappaB. This may be a common feature of several complications including periodontal disease, atherosclerosis, nephropathy, impaired healing and retinopathy. These complications are frequently associated with increased expression of inflammatory cytokines such as TNF-alpha, IL-1beta and IL-6 and enhanced generation of reactive oxygen species. Cause and effect relationship between dysregulation of key components of innate immunity and diabetic complications in many instances have been demonstrated with the use of cytokine blockers and antioxidants. PMID:17981625

  8. The changing face of diabetes complications.

    PubMed

    Gregg, Edward W; Sattar, Naveed; Ali, Mohammed K

    2016-06-01

    The global increase in type 2 diabetes prevalence is well documented, but international trends in complications of type 2 diabetes are less clear. The available data suggest large reductions in classic complications of type 2 diabetes in high-income countries over the past 20 years, predominantly reductions in myocardial infarction, stroke, amputations, and mortality. These trends might be accompanied by less obvious, but still important, changes in the character of morbidity in people with diabetes. In the USA, for example, substantial reductions in macrovascular complications in adults aged 65 years or older mean that a large proportion of total complications now occur among adults aged 45-64 years instead, rates of renal disease could persist more than other complications, and obesity-related type 2 diabetes could have increasing effect in youth and adults under 45 years of age. Additionally, the combination of decreasing mortality and increasing diabetes prevalence has increased the overall mean years lived with diabetes and could lead to a diversification of diabetes morbidity, including continued high rates of renal disease, ageing-related disability, and cancers. Unfortunately, data on trends in diabetes-related complications are limited to only about a dozen countries, most of which are high income, leaving the changing character for countries of low and middle income ambiguous. PMID:27156051

  9. A classification of complications in urogynecology

    PubMed Central

    Futyma, Konrad; Rechberger, Tomasz

    2014-01-01

    The frequency of female pelvic floor reconstruction surgery with synthetic materials has been systematically rising for the last 30 years. Nowadays, they are widely used in urogynecology with a high cure rate, and a statistically significant better outcome compared to classical vaginal repair procedures. This type of operation progressed in some areas from an indication for recurrent prolapse to that of using them in primary procedures. Nevertheless, implantation of synthetic material is associated with the occurrence of specific complications and side-effects. The number and type of complications varies, depending on the study, reaching as much as 10% in some centers. The International Continence Society (ICS) and International Urogynecological Association (IUGA) have introduced an interesting tool for the evaluation of complications related directly to the insertion of prostheses and grafts in the female pelvic floor. The purpose of this classification is to describe possible complications with numbers and letters which together form a code containing comprehensive information about the complication. This article presents the clinical and practical aspects of this classification and first comments about its usability. The presented classification may serve as a tool for the development of national and international registries of urogynecological procedures that would be a great source of information on the number and type of operations performed, their effectiveness and potential complications. PMID:26327842

  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. 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

  13. A surgeon’s nightmare: Complications

    PubMed Central

    Gemici, Kazım; Okuş, Ahmet; Yıldız, Melda; Şahin, 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. [Management and prevention of complications in open urethral surgery. End-to-end anastomosis and buccal mucosa urethroplasty].

    PubMed

    Kocot, A; Riedmiller, H

    2014-07-01

    Open operative procedures for urethral reconstruction (i.e. stricture resection with primary end-to-end anastomosis and buccal mucosa urethroplasty) are established and proven techniques with a low complication profile and high success rates. The aim of this operative technique is removal of the urethral obstruction to avoid far-reaching complications for the whole urinary tract. Despite excellent long-term results, complications are not completely avoidable in both techniques. A successful complication management requires the complete spectrum of reconstructive techniques in addition to appropriate operative expertise in order to be able to achieve the optimal result even in cases of complications. Simultaneously the recognition of potential risks contributes to a further reduction of early and delayed complications both in the approach to the operative intervention as well as intraoperatively. PMID:24927779

  19. Cavitating mesenteric lymph node syndrome: a rare complication of celiac disease.

    PubMed

    Rodríguez-Sánchez, Joaquín; Martín-Dávila, Francisco; López-Viedma, Bartolomé; Galván-Fernández, M D; Alonso-Lablanca, María; Olmedo-Camacho, José; García-Rojo, Marcial; Rodríguez-Sánchez, Eduardo

    2011-12-01

    Among the many complications of celiac disease, mesenteric lymph node syndrome cavitated is considered one of the rarest, there is few case series published in the literature. The etiology and pathophysiology are unknown but because of its high mortality rate, estimated to be around 50%, it should recognize at an early stage in order to institute appropriate therapy as soon as possible. PMID:22217351

  20. A Case Report of Candida albicans Costochondritis after a Complicated Esophagectomy

    PubMed Central

    Dean, Nicola R.; Watson, David I.

    2016-01-01

    Summary: We present an unusual case of Candida albicans costochondritis after a complicated Ivor Lewis esophagectomy. This case exhibits that pain, erythema, and swelling over the costal cartilages should alert the possibility of infective costochondritis, especially in a postoperative patient. If a fungal agent is identified, aggressive surgical debridement and early commencement of antifungal therapy are likely determinants for a satisfactory outcome.