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1

Uterine involution and fertility of holstein cows subsequent to early postpartum PGF2alpha treatment for acute puerperal metritis.  

PubMed

The objective was to evaluate the effect of 2 doses of PGF(2alpha) injected early postpartum on uterine involution, serum concentration of acute phase proteins at 12 d postpartum, and fertility in Holstein cows with acute puerperal metritis. Only cows diagnosed with retained fetal membranes and metritis and treated with ceftiofur hydrochloride for 5 d were used in the study. Two hundred cows were assigned randomly to be treated (n = 100) or to serve as controls (n = 100). Treatment consisted of 2 i.m. injections of PGF(2alpha) 8 h apart on d 8 postpartum. A subsample of 90 cows was selected randomly (45 treated cows; 45 controls) to evaluate uterine diameter using ultrasonography, uterine score, and serum concentrations of acute phase proteins at 12 d postpartum. The outcome variable for all cows was conception rate at first service. Postpartum, primiparous, treated cows had smaller uterine diameters and lower uterine scores than controls. Cows with a uterine diameter <5.1 cm at 12 d postpartum were 5.5 times more likely to conceive at first service than cows with larger uterine horn diameter. Treatment significantly reduced the concentrations of serum alpha1-acid glycoprotein. Within primiparous cows, treatment also increased conception at first service by 17%. It was concluded that 2 doses of PGF(2alpha) 8 h apart at 8 d postpartum in primiparous cows with acute puerperal metritis decreased the diameter of uterine horns and serum concentration of alpha1-acid glycoprotein at 12 d postpartum and increased the conception rate at first service. PMID:15377603

Melendez, P; McHale, J; Bartolome, J; Archbald, L F; Donovan, G A

2004-10-01

2

Behavioral Complications of Early Pallidotomy  

Microsoft Academic Search

A review of stereotactic medial pallidotomy of the 1950s in five neurosurgical centers is presented. The surgical technique varied from one center to the other. The results of surgery, however, seemed to be quite equal, being positive in 70–90% of the patients. The surgical mortality ranged from 0 to 13%. Behavioral complications were adequately analyzed and reported from one center

Lauri V. Laitinen

2000-01-01

3

Early respiratory complications after liver transplantation.  

PubMed

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

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

2013-12-28

4

Early respiratory complications after liver transplantation  

PubMed Central

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 complicationsearly clinical manifestations after OLT and influence on patient outcome. PMID:24409054

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

2013-01-01

5

Sonographic and MR features of puerperal uterine inversion.  

PubMed

Puerperal uterine inversion is a rare and potentially life-threatening complication of a mismanaged third stage of labour. Early diagnosis is mandatory for proper management of the patient. Complete uterine inversion is a clinical diagnosis. However, incomplete uterine inversion is difficult to identify and warrants further workup. Sonographic evaluation, although a bedside procedure, may be confusing. The conspicuity of findings is much greater on MR examination than on ultrasound. Only a few diagnostic imaging findings in uterine inversion have been described in previous reports. We present the case of a 26-year-old woman who had a full-term vaginal delivery and presented after 20 days with acute urinary retention and mild vaginal bleeding. She was diagnosed as a case of neglected subacute incomplete uterine inversion. Both greyscale and Doppler sonographic and MR features of the case are described with an emphasis on better delineation of uterine and adnexal anatomy on MR imaging. PMID:24619161

Thakur, Shruti; Sharma, Sanjiv; Jhobta, Anupam; Aggarwal, Neeti; Thakur, Charu S

2014-06-01

6

The early complications of subtalar dislocation.  

PubMed

Although the treatments and results of subtalar dislocations are usually considered as nonproblematical, review of 10 cases seen over a 6-year period proved otherwise. Difficulties were encountered with four of these cases consisting of associated foot injuries, failure to recognize the dislocation, incarceration of the dislocation, vascular complications, and iatrogenic infection. The management of these cases is discussed. PMID:7274906

Mac, S S; Kleiger, B

1981-03-01

7

Complications In Pregnancy Part I: Early Pregnancy  

E-print Network

high risk situations because they impact not only the mother but also the embryo or fetus. This review prior to gestational viability. Late complications occur primarily in the third trimester and impact the fetus and the mother since the fetus is typically viable. Common medical problems may impact and affect

8

Impact of early or delayed elective resection in complicated diverticulitis  

PubMed Central

AIM: To investigate the outcomes of early and delayed elective resection after initial antibiotic treatment in patients with complicated diverticulitis. METHODS: The study, a non-randomized comparison of the two approaches, included 421 consecutive patients who underwent surgical resection for complicated sigmoid diverticulitis (Hinchey classification?I-II) at the Department of Surgery, University Medical Center Hamburg-Eppendorf between 2004 and 2009. The operating procedure, duration of hospital and intensive care unit stay, outcome, complications and socioeconomic costs were analyzed, with comparison made between the early and delayed elective resection strategies. RESULTS: The severity of the diverticulitis and American Society of Anesthesiologists score were comparable for the two groups. Patients who underwent delayed elective resection had a shorter hospital stay and operating time, and the rate of successfully completed laparoscopic resections was higher (80% vs 75%). Eight patients who were scheduled for delayed elective resection required urgent surgery because of complications of the diverticulitis, which resulted in a high rate of morbidity. Analysis of the socioeconomic effects showed that hospitalization costs were significantly higher for delayed elective resection compared with early elective resection (9296 € ± 694 € vs 8423 € ± 968 €; P = 0.001). Delayed elective resection showed a trend toward lower complications, and the operation appeared simpler to perform than early elective resection. Nevertheless, delayed elective resection carries a risk of complications occurring during the period of 6-8 wk that could necessitate an urgent resection with its consequent high morbidity, which counterbalanced many of the advantages. CONCLUSION: Overall, early elective resection for complicated, non-perforated diverticulitis is shown to be a suitable alternative to delayed elective resection after 6-8 wk, with additional beneficial socioeconomic effects. PMID:22219596

Bachmann, Kai; Krause, Geeske; Rawnaq, Tamina; Tomkotter, Lena; Vashist, Yogesh; Shahmiri, Shanly; Izbicki, Jakob R; Bockhorn, Maximilian

2011-01-01

9

Early post-operative complications in oral implantology.  

PubMed

Hematoma, postoperative bleeding, edema, early infection, dehiscence, emphysema, air embolism, loss of primary stability of the implant, acute sinusitis, postoperative cutaneous or mucosal anesthesia and loss of central visual field are early postoperative complications. The incidence of early post-operative complication during the first days of postoperative follow-up was inquired. Eleven patients were implanted by 27 DPI implants. The patients were followed up the first day, the second day and the tenth day after the one-phase surgical technique. Dehiscence in 2 patients, edema in 10 patients, hematoma in 2 patient and postoperative bleedings in 3 patients were established. Three implants were removed because loss of primary stability. It is indicated that by proper preoperative and intraoperative as well as postoperative approach it is possible to influence early postoperative complications. Even though postoperative complications are sometimes unavoidable, choosing the most appropriate surgical technique and keeping oral cavity hygiene are the most important factors in prevention. It is concluded that only the loss of primary stability is incorrigible and successes of implanto-prosthetic rehabilitation can be properly and fully evaluated only after 5 to 10 years of follow up period. PMID:9951171

Lauc, T; Kobler, P

1998-12-01

10

Early results and complications of 210 living donor nephrectomies.  

PubMed

The aim of this study is to evaluate the early complications seen after donor nephrectomy in living donor renal transplantation. Between November 1989 and June 1998, 270 living donor nephrectomies were performed at the Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Sixty donor records which were incomplete were discarded from this study. A questionnaire with relevant queries was prepared and sent to all the donors. The information sought included age, gender, marital status, drug addiction and smoking, blood pressure, blood group, serological tests, blood tests for hematology and biochemistry, coagulation profile, urine reports, nephrectomy site, duration of anesthesia, intra-operative and early post-nephrectomy complications, hypertension, respiratory and genitourinary complications, water and electrolyte imbalance, hemorrhage, and wound infection. Statistical analysis was done using Fox Pro and SPSS software. It was noted that females donated more kidneys to there relatives (p < 0.05) and had a higher prevalance of anemia (p < 0.01). More males were addicted to smoking and/or opium than females (p < 0.01), and fewer addicts donated their kidneys (p < 0.05). The site of nephrectomy was similar between men and women. Complications were significantly greater in addicted donors (p < 0.05). Hemorrhage occurred more commonly in association with right nephrectomy (p < 0.05), while wound infection occurred more commonly in men (p < 0.05). There were no deaths. Our results suggest that living donor nephrectomy is safe and is assosiated with minor complications causing little morbidity and no mortality. PMID:17657120

Shamsa, A; Rasulian, H; Mahdi, M Pour; Kadkhodayan, A; Yarmohammadi, A A; Parizadeh, R

2003-01-01

11

Effect of Early Post Cesarean Feeding on Gastrointestinal Complications  

PubMed Central

Background: Gastrointestinal complications are the main complication in patients after cesarean section. Previous studies have reported different results about the effect of early post cesarean feeding on vomiting, nausea, flatulence and illus. Objectives: To identify the effect of early post cesarean feeding on gastrointestinal complications. Materials and Methods: This randomized controlled trial was conducted on 82 women who underwent cesarean section in Mashhad Omolbanin hospital. They were randomly assigned to two equal experimental and control groups. The experimental group started oral fluids four hours after surgery, followed by a regular diet after bowel sounds returned. Mothers in the control group received fluid intravenously during the initial 12 hours, and then if bowel sounds were heard, they were permitted to receive oral fluids and they could start a solid diet if they had defecation. Vomiting and flatulence were assessed with a visual analog scale. Nausea was assessed with an observation questionnaire and illus was assessed via bowel sounds, gas passing and defecation 4, 12, 24, 36 and 48, hours post surgery in the two groups. Also, they were studied for the time of gas passing, bowel sound return, defecation, sitting, walking and breast-feeding. Data were analyzed using the chi-square, Fisher's exact test, t-test and Man-Whitney U test. Results: No mother experienced nausea, vomiting and illus. Flatulence severity 4 and 12 hours after surgery was similar in both groups (P = 0.856, P = 0.392). However, flatulence severity 24, 36 and 48 hours after surgery, was less in the experimental group (P = 0.030, P = 0.016, P = 0.001). Also, bowel sound return, time of gas passing, defecation, sitting and walking were less in the experimental group (P = 0.001). Conclusion: This study showed that early feeding decreased post cesarean gastrointestinal complications.

Adeli, Mohadese; Razmjoo, Nastaran; Tara, Fatemeh; Ebrahimzade, Saeed

2013-01-01

12

Maternal and neonatal complications of elective early-term deliveries.  

PubMed

Approximately 10% to 15% of all deliveries in the United States are performed before 39 completed weeks of gestation without a true medical indication for early delivery, despite long-standing recommendations against this practice. Early-term deliveries are those that occur between 3707 and 3867 weeks. It is now recognized that maternal and neonatal complications have increased for deliveries that occur at early- vs late-term gestation. The reasons for the increase in the rate of elective early-term deliveries are unclear but likely involve both patient and physician factors. Various strategies have been used to increase awareness of the morbidities associated with the practice of elective early-term delivery and to reduce its frequency. Insurers and quality accrediting agencies are increasingly holding hospitals accountable for their rates of elective early-term deliveries, and this pressure will likely continue to lead to widespread change in the practice of obstetrics. The interventions to increase adherence to evidence-based medicine guidelines that are described within this review may also be applicable to other areas of medicine. PMID:24182707

Jensen, Jani R; White, Wendy M; Coddington, Charles C

2013-11-01

13

Neglected puerperal inversion of the uterus: ignorance makes acute a chronic form  

PubMed Central

Inversion of uterus is a rare complication of vaginal delivery. The reported incidence of puerperal inversion varies from approximately 1 in 550 to 1 in several thousand normal deliveries. Maternal mortality has been reported to be as high as 15%, mainly because of associated life threatening blood loss and shock. Early diagnosis, prompt and aggressive management decrease the morbidity and mortality to minimal. We report a case of 21 year old primi, who presented to us with uterine inversion after delivery at a rural set up by untrained birth attendant (“Dai”). She was managed surgically with Haultain's operation and discharged after 5 days. She didn't turn up for follow up and was readmitted after 4 weeks with uterine reinversion associated with endometritis. A recent case is described, followed by a short review of literature. PMID:23077710

Minakshi, Sardha; Shivani, Atri; Arshad, Anjum

2012-01-01

14

Central nervous system infectious complications early after liver transplantation.  

PubMed

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

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

2010-05-01

15

[Early gynecological complications as the result of legal abortion].  

PubMed

Gynecological complications occurring during the 7-day hospitalization following therapeutic abortion are studied on the basis of a series of 1234 patients treated between March 1965 and March 1969 in Berlin. There were 3 cases of complications due to preexistent disease (usually the indication for abortion) and 13 cases of nongenital complications (thrombophlebitis, thromboembolism, pneumonia, pyelitis). Gynecological complications included uterine perforation (13 cases), cervical tears (26 cases), uterine hemorrhage (18 cases), placental retention (12 cases), and inflammation (90 cases). Complications occurred less frequently with vacuum extraction (7.9%) than with classical instrumental methods (18.8%), and less frequently before the 12th week of pregnancy (14.7%) than thereafter (36.6%). To these complications must be added those which occur after the 1st postoperative week. The relatively high complication rate should be an incentive for the improvement of contraceptive services and technology. PMID:5555449

Lunow, E; Isbruch, E; Hamann, B

1971-01-01

16

Early neurological complications of coronary artery bypass surgery  

Microsoft Academic Search

A prospective study of 312 patients undergoing elective coronary artery bypass surgery was undertaken to determine the incidence, severity, and functional impact of postoperative neurological complications. Detailed evaluation of the patients showed that neurological complications after surgery were common, occurring in 191 of the 312 patients (61%). Although such a high proportion of the total developed detectable changes, serious neurological

P J Shaw; D Bates; N E Cartlidge; D Heaviside; D G Julian; D A Shaw

1985-01-01

17

[Endoscopic collection of v. saphena magna--early complication rates].  

PubMed

Endoscopic harvesting of v. saphena magna for CABG procedures represents a modern method, which in comparison to conventional methods reduces postoperative wound complications. We have analyzed 40 patients, who uderwent CABG procedure with endoscopic harvested venous graft. PMID:20662442

Kurfirst, V; Dusil, I; Rezler, M; Mokrácek, A

2009-11-01

18

Puerperal group A streptococcal infection: beyond Semmelweis.  

PubMed

Ignaz Semmelweiss made one of the most important contributions to modern medicine when he instituted handwashing in an obstetric clinic in Austria in 1847, decreasing mortality there from more than 10% to 2%. Unfortunately, puerperal sepsis remains a leading cause of maternal mortality throughout the world. Group A streptococcus (GAS), Streptococcus pyogenes, is an organism associated with high rates of morbidity and mortality from puerperal infections. When associated with sepsis, known as streptococcal toxic shock syndrome, mortality rates approach 30-50%. Group A streptococcus can cause invasive infections in the form of endometritis, necrotizing fasciitis, or streptococcal toxic shock syndrome. The clinical presentation of women with puerperal GAS infections is often atypical with extremes of temperature, unusual and vague pain, and pain in extremities. Toxin production by the organism may allow GAS to spread across tissue planes and cause necrosis while evading containment by the maternal immune system in the form of a discrete abscess. Endometrial aspiration in addition to blood cultures may be a useful rapid diagnostic tool. Imaging may appear normal and should not dissuade the clinician from aggressive management. When suspected, invasive GAS infections should be treated emergently with fluid resuscitation, antibiotic administration, and source control. The optimal antibiotic regimen contains penicillin and clindamycin. Source control may require extensive wound or vulvar debridement, hysterectomy, or a combination of these, which may be life-saving. The benefit of immunoglobulins in management of puerperal GAS infections is unclear. PMID:24785617

Anderson, Brenna L

2014-04-01

19

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

PubMed Central

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

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

2014-01-01

20

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

ERIC Educational Resources Information Center

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

Fenech, Marianne; Sumsion, Jennifer

2007-01-01

21

Early postoperative complications in patients with Crohn's disease given and not given preoperative total parenteral nutrition  

PubMed Central

Objective The effect of preoperative total parenteral nutrition (TPN) on the rate of early (within 30 days) postoperative complications in patients with moderate to severe Crohn's disease (CD) was examined. Material and methods A series of 15 consecutive patients with CD (mean CD activity index score, 270) given preoperative TPN for 18–90 days (mean, 46 days) and undergoing bowel resection and primary anastomosis was compared with matching controls (105 patients) consecutively selected from all CD patients operated in Stockholm County during a preceding 20-year period without preoperative TPN. Results During the preoperative TPN, all the patients studied displayed clinical remission of CD as reflected in improvement in their general well-being, relief of abdominal pain, and abatement of fever and diarrhea. There was no significant early postoperative complication in the TPN-treated group, whereas there were 29 patients with early postoperative complications in the control group, which means a significantly higher rate of postoperative complications when preoperative TPN was not provided. During the preoperative TPN, some crucial variables increased such as the body weight, the serum concentrations of albumin and triiodothyronine reflecting improved nutritional state, whereas the serum concentration of haptoglobin and the white cell count decreased reflecting decreased inflammatory activity. Conclusions This study shows that preoperative TPN for at least 18 days may be recommended to be given to patients with moderate to severe CD until clinical remission is achieved in order to minimize the risk of early postoperative complications. PMID:22242614

Jacobson, Stefan

2012-01-01

22

Early Process and Dropping Out From Short-Term Group Therapy for Complicated Grief  

Microsoft Academic Search

Early group process variables were investigated as predictors of dropping out for patients who participated in short-term group psychotherapy for complicated grief. Constructs assessed included affect, cohesion, group climate, and therapeutic alliance. Using logistic regression analyses, the authors investigated differences between dropouts and remainers at Sessions 1 and 4. Results indicated that after the 1st therapy session, imminent dropouts reported

Mary McCallum; William E. Piper; John S. Ogrodniczuk; Anthony S. Joyce

2002-01-01

23

A controlled trial of anti-tuberculosis chemotherapy in the early complicated pneumoconiosis of coalworkers  

Microsoft Academic Search

A controlled trial in coalminers under the age of 50 in South Wales with sputum-negative, early complicated pneumoconiosis was used to compare three regimes: (1) chemotherapy (rest in hospital and 1 g. streptomycin, 200 mg. INH, 10 g. PAS, for 3 months; then 200 mg. INH, 10 g. PAS for 9 months); (2) rest (in hospital for 3 months); and

J. D. Ball; G. Berry; W. G. Clarke; J. C. Gilson; J. Thomas; Catherine Exall; Marjorie Roberts

1969-01-01

24

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

PubMed Central

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

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

2014-01-01

25

Early complications after cleft palate repair: a multivariate statistical analysis of 709 patients.  

PubMed

This study presents a large consecutive institutional experience with primary cleft palate repairs. The purpose of this study was to determine the incidence of early complications after cleft palate surgery in a series of nonsyndromic children treated at the authors' comprehensive cleft center. This retrospective analysis includes 709 consecutive patients with cleft palate treated by 6 different staff surgeons at Guwahati Comprehensive Cleft Care Center between April 2011 and December 2012. Secondary cases were excluded from this study. The patients were initially followed up between 1 week and 1 month after surgery. The overall incidence of early complications was determined, and the effect of the extent of clefting, the type of repair, the age at repair, and the operating surgeon were analyzed. Early complications in this study include dehiscence of the wound, fistula formation, hanging palate, and total or partial flap necrosis. There was a 2.4% rate (17/709) of take-back to the operating room in the immediate postoperative period for control of bleeding, although no blood transfusions were required. The incidence of postoperative fistulas in this series was 3.9% (20/512). There was a statistically significant increase in the incidence of cleft palatal fistula for Veau IV clefts, but there were no significant differences with respect to operating surgeon, patient sex, patient age, and type of palatoplasty. The complication and fistula rate is consistent with other published reports from developed countries and provides evidence for the value of this model for surgical delivery in the developing world. PMID:25148623

Deshpande, Gaurav Shekhar; Campbell, Alex; Jagtap, Rasika; Restrepo, Carolina; Dobie, Hannah; Keenan, Henry Tait; Sarma, Hiteswar

2014-09-01

26

Dental complications of rickets in early childhood: case report on 2 young girls.  

PubMed

Vitamin D is an essential hormone for calcium gut absorption. It is also involved in child growth, cancer prevention, immune system responses, and tooth formation. Due to inadequate vitamin D intake and/or decreased sunlight exposure, vitamin D deficiency has resurfaced in developed countries despite known inexpensive and effective preventive methods. Vitamin D deficiency is a common cause of rickets, a condition that affects bone development in children and that can have serious dental complications. Deficiency during pregnancy can cause enamel hypoplasia of primary teeth. Enamel regeneration is currently impossible; hypoplasia is therefore irreversible, and once affected, teeth are prone to fast caries development. Deficiency during early childhood can affect permanent teeth and ensuing caries can sometimes lead to tooth loss at a young age. Oral manifestations of rickets should be diagnosed early by both physicians and dentists to prevent severe dental complications. This case study presents 2 young girls with rickets in early childhood who suffered from subsequent serious tooth decay. PMID:24616355

Davit-Béal, Tiphaine; Gabay, Julie; Antoniolli, Pauline; Masle-Farquhar, Jeanne; Wolikow, Maryse

2014-04-01

27

Antithrombotic therapy - predictor of early and long-term bleeding complications after transcatheter aortic valve implantation  

PubMed Central

Introduction Dual antiplatelet therapy (DAPT) – aspirin and clopidogrel – is recommended after transcatheter aortic valve implantation (TAVI) without an evidence base. The main aim of the study was to estimate the impact of antithrombotic therapy on early and late bleeding. Moreover, we assessed the impact of patients’ characteristics on early bleeding and the influence of bleeding on prognosis. Material and methods Between 2009 and 2011, 83 consecutive TAVI patients, age 81.1 ±7.2 years, were included. Bleeding complications were defined by the Valve Academic Research Consortium (VARC) scale. The median follow-up was 12 ±15.5 months (range: 1 to 23) and included 68 (81.9%) patients. Results Early bleeding occurred in 51 (61.4%) patients. Vitamin K antagonists (VKA) pre-TAVI (p = 0.001) and VKA + clopidogrel early post-TAVI (p = 0.04) were the safest therapies; in comparison to the safest one, peri-procedural DAPT (p = 0.002; p = 0.05) or triple anticoagulant therapy (TAT) (p = 0.003, p = 0.05) increased the risk for early bleeding. Predictors for early bleeding were: clopidogrel pre-TAVI (OR: 4.43, 95% CI: 1.02–19.24, p = 0.04), preceding percutaneous coronary intervention (PCI) (10.08, OR: 95% CI: 1.12–90.56, p = 0.04), anemia (OR: 4.00, 95% CI: 1.32–12.15, p = 0.01), age > 85 years (OR: 5.96, 95% CI: 1.47–24.13, p = 0.01), body mass index (BMI) (OR: 0.86, 95% CI: 0.74–0.99, p = 0.04). Late bleeding occurred in 35 patients (51.4%) on combined therapy, and none on VKA or clopidogrel monotherapy (p = 0.04). Bleeding complications did not worsen the survival. Conclusions This study seems to suggest that advanced age, BMI, and a history of anemia increased the risk for early bleeding after TAVI. Clopidogrel pre-TAVI should be avoided; therefore, time of preceding PCI should take into account discontinuation of clopidogrel in the pre-TAVI period. Vitamin K antagonists with clopidogrel seems to be the safest therapy in the early post-TAVI period, similarly as VKA/clopidogrel monotherapy in long-term prophylaxis. PMID:24482651

Witkowski, Adam; Dabrowski, Maciej; Banaszewski, Marek; Ksiezycka-Majczynska, Ewa; Chmielak, Zbigniew; Kusmierski, Krzysztof; Hryniewiecki, Tomasz; Demkow, Marcin; Orlowska-Baranowska, Ewa; Stepinska, Janina

2013-01-01

28

Early aggressive macrovascular disease and type 1 diabetes mellitus without chronic complications: a case report  

PubMed Central

Background Type 1 diabetes (T1DM) is considered to be one of the most significant risk factors for the development of coronary artery disease (CAD). However, the specific risk predictor models for T1DM are subject to many limitations. Case presentation We report the case of a 42-year-old Caucasian woman presenting with T1DM for 26 years. During her chronic hyperglycemic evolution (mean of HbA1c?>?3 percentage points above the superior limit) without microvascular complications, this patient presented with early and aggressive coronary artery disease, despite the lack of classical risk factors for CAD Conclusions The rapidly progressive macrovascular disease observed in this case demonstrates the different degrees of aggressiveness and unpredictable clinical evolution observed in some cases. It also confirms the need for a multi-factorial, early and optimized clinical management regime. PMID:23742649

2013-01-01

29

Complications and the effect of varicocelectomy on semen analysis, fertility, early ejaculation and spontaneous abortion.  

PubMed

Varicocele is still an enigma. Its effects on semen analysis, fertility and, more recently, early ejaculation and spontaneous abortion in spouses are not yet fully understood. In this retrospective study, we evaluated these four parameters (semen analysis, fertility, early ejaculation and spontaneous abortion among spouses) in relation to varicocele and varicocelectomy during a 13-year period. A total of 1,711 patients with varicocele underwent varicocelectomy by high inguinal method (251 cases), subinguinal method (1,375 cases), scrotal method (34 cases), and subinguinal method with local anesthesia (38 cases). Our complication rate was acceptable. Sperm count, motility and morphology increased three months post operation in 55, 51, and 46%, respectively (P value 0.000, 0.000, and 0.015, respectively). Paternity was 56% after one year of post varicocelectomy follow-up. Only 7 out of 82 azoospermic men had sperm in their semen after varicocelectomy and only one of them with mild spermatogenic hypoplasia became a father. The spontaneous abortion rate in the spouses of respondents was 59%. Early ejaculation improved in 75% of the respondents. In conclusion, varicocelectomy does not improve sperm parameters in all men, but it improves pregnancy rate, early ejaculation, and scrotal pain. PMID:21060180

Shamsa, Ali; Nademi, M; Aqaee, M; Fard, A Nouraee; Molaei, Mahmood

2010-11-01

30

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

PubMed

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

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

2014-10-01

31

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

PubMed Central

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

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

2013-01-01

32

Early complications of medial opening wedge high tibial osteotomy using autologous tricortical iliac bone graft and T-plate fixation  

Microsoft Academic Search

Despite several advantages of medial opening wedge high tibial osteotomy, this procedure has been noted to have a high rate of complications especially with the use of a spacer plate for fixation. We retrospectively evaluated the early complications of 138 medial opening wedge high tibial osteotomies done using autologous tricortical iliac bone graft and T-plate fixation(AO locking compression T-plate, Ti\\/3H

Dong Ju Chae; Gautam M. Shetty; Kook Hyun Wang; Antonio Santa Cruz Montalban Jr; Jong In Kim; Kyung Wook Nha

2011-01-01

33

Suppression of puerperal lactation using jasmine flowers (Jasminum sambac).  

PubMed

The efficacy of jasmine flowers (Jasminum Sambac) applied to the breasts to suppress puerperal lactation was compared that of Bromocriptine. Effectiveness of both regimens was monitored by serum prolactin levels, clinical evaluation of the degree of breast engorgement and milk production and the analgesic intake. While both bromocriptine and jasmine flowers brought about a significant reduction in serum prolactin, the decrease was significantly greater with bromocriptine. However, clinical parameters such as breast engorgement, milk production and analgesic intake showed the 2 modes of therapy to be equally effective. The failure rates of the 2 regimens to suppress lactation were similar; however, rebound lactation occurred in a small proportion of women treated with bromocriptine. Jasmine flowers seem to be an effective and inexpensive method of suppressing puerperal lactation and can be used as an alternative in situations where cost and nonavailability restrict the use of bromocriptine. PMID:3214386

Shrivastav, P; George, K; Balasubramaniam, N; Jasper, M P; Thomas, M; Kanagasabhapathy, A S

1988-02-01

34

Radiological and clinical features of adult non-puerperal mastitis  

PubMed Central

Objective: To describe the radiological and clinical features of adult non-puerperal mastitis and to determine the most accurate method of preventing unnecessary surgical procedures. Methods: Clinical and imaging findings were retrospectively reviewed in 51 females with non-puerperal mastitis, which was confirmed by biopsy/surgical pathology. All 51 patients had pre-operative MRI; 45 patients also had sonograms and 25 also had mammograms, pre-operatively. Results: Of the 51 cases with non-puerperal mastitis, 94.1% (48/51) were confirmed as having acute or chronic inflammation, and the other 3 had plasma cell mastitis; areola papillaris inflammation was found in 39.2% (20/51) of the cases. Overall, 6 of the 25 cases that were examined with mammography and 2 of the 45 cases that were examined with sonography appeared normal, but all 51 lesions were positively identified on MRI. Asymmetrical density (12/25) on mammograms and solitary or separated/contiguous, clustered, hypoechoic mass-like lesions (31/45) on ultrasound were the most common signs of non-puerperal mastitis. On enhanced MRI, 90.2% (46/51) of patients showed non-mass-like enhanced lesions. Multiple regional enhancements in the pattern of distribution (32/46) and separated or contiguous, clustered, rim-like enhancements in the pattern of internal enhancement (29/46) were the most common manifestations in non-mass-like enhanced lesions. Of the 51 patients, mastitis Type 1 and Type 2 in the time–signal intensity curve were detected in 47.1% and 51.0% of the patients, respectively. The breast imaging reporting and data system categories with the highest number of patients were Category 0 (9/25) on mammography, Category 4a on sonography (18/45) and Category 4a on MRI (29/51). Conclusion: The findings from mammography and ultrasound are non-specific; therefore, using MR can be helpful in the diagnosis, especially in the presence of non-mass-like enhancements that are multiple, regional, separated, or contiguous, clustered and rim-like. Advances in knowledge: Mastitis is often neglected because of the lack of typical clinical signs and symptoms. This study has assessed and described the clinical features and imaging findings of adult non-puerperal mastitis on mammograms, sonograms and MRI and found that MRI is more specific in the diagnosis of disease. PMID:23392197

Tan, H; Li, R; Liu, H; Gu, Y; Shen, X

2013-01-01

35

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

ERIC Educational Resources Information Center

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…

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

2009-01-01

36

[Preventive care for early detection of diabetes mellitus complications: a model project in Wolfsburg].  

PubMed

In the city of Wolfsburg, an annual screening to detect diabetic complications was introduced. In this model, project internists and general practitioners were remunerated for the documentation of diabetic complications. Ophthalmologists were remunerated for the documentation of screening for diabetic eye disease. The patients received a copy of the results. 1,563 patients (2.57% of 60,800 persons insured by the Volkswagen health insurance in the city) received ophthalmologic examination. 1,554 patients (2.6%) were examined by internists and general practitioners (58 practices). Out of 2,879 eyes examined in no retinopathy was detected 80.9%. In 14.1%, mild or moderate retinopathy was observed as well as 3.3% severe non-proliferative retinopathy and 1.3% proliferative retinopathy. 32 amputations were documented. Three of them were not related to diabetes. 32 patients had diabetic foot ulcers (75% males). The implementation of screening for diabetic complications was very successful. Based on the results, an evidence based disease management programme can be started focussing especially on improved tertiary prevention of diabetic complications. PMID:10939154

Grüsser, M; Hoffstadt, K; Jörgens, V

2000-06-01

37

C-reactive protein is an early predictor of septic complications after elective colorectal surgery  

E-print Network

from hospital after elective colorectal surgery. Patients with CRP values higher than 125 mg/l on the 4 Septic complications are responsible for most morbidity after colorectal surgery. Among them, anastomotic lack predictive accuracy for anastomotic leakage in gastrointestinal surgery (4). Routine imaging

Paris-Sud XI, Université de

38

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

ERIC Educational Resources Information Center

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

McNab, Theresa C.; Blackman, James A.

1998-01-01

39

Preoperative Factors and Early Complications Associated With Hemiarthroplasty and Total Hip Arthroplasty for Displaced Femoral Neck Fractures  

PubMed Central

Displaced femoral neck fractures are common injuries in the elderly individuals. There is controversy about the best treatment with regard to total hip arthroplasty (THA) versus hemiarthroplasty. This study uses the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to evaluate the preoperative risk factors associated with the decision to perform THA over hemiarthroplasty. We also evaluate the risk factors associated with postoperative complications after each procedure. Patients older than 50 years undergoing hemiarthroplasty or THA after fracture in the NSQIP database from 2007 to 2010 were compared to each other in terms of preoperative medical conditions, postoperative complications, and length of stay. Multivariate logistic regression models were used to adjust for preoperative risk factors for undergoing a THA versus a hemiarthroplasty and for complications after each procedure. In all, 783 patients underwent hemiarthroplasty and 419 underwent THA for fracture. Hemiarthroplasty patients had longer hospital stays. On multivariate logistic regression, the only significant predictor for having a THA after fracture over hemiarthroplasty was being aged 50 to 64 years. The patient characteristics/comorbidities that favored having a hemiarthroplasty were age >80 years, hemiplegia, being underweight, having a dependent functional status, being on dialysis, and having an early surgery. High body mass index, American Society of Anesthesiologists (ASA) class, gender, and other comorbidities were not predictors of having one procedure over another. Disseminated cancer and diabetes were predictive of complications after THA while being overweight, obese I, or a smoker were protective. High ASA class and do-not-resuscitate status were significant predictors of complications after a hemiarthroplasty. This study identified clinical factors influencing surgeons toward performing either THA or hemiarthroplasty for elderly patients after femoral neck fractures. Younger, healthier patients were more likely to receive THA. Patients particularly at higher risks of complications after hemiarthroplasty should be monitored closely. PMID:25360335

Buerba, Rafael A.; Leslie, Michael P.

2014-01-01

40

Early complications after low anterior resection for rectal cancer using the EEA TM stapling device  

Microsoft Academic Search

Complications following 178 low anterior resections for rectal carcinoma with the EEA autosuture device are reported prospectively.\\u000a The operative mortality was 2.8 percent. Clinical anastomotic leakage developed in 27 patients, but in none of the 30 patients\\u000a over 76 years of age. Two of the five hospital deaths were related to leakage. Long-term steroid treatment and previous pelvic\\u000a radiotherapy were

Henning Kold Antonsen; Ole Kronborg

1987-01-01

41

The goal of blood pressure control for prevention of early diabetic microvascular complications.  

PubMed

Lowering blood pressure may confer a benefit to diabetic microvascular complications comparable with glycemic control. Hypertension is causally related to kidney outcomes and is a risk factor for the development of diabetic retinopathy. The prevalence of hypertension increases as kidney disease progresses, so that it coexists with diabetes in up to 80% of those with overt nephropathy. A significant number of patients have hypertension or rising blood pressures in earlier stages, or even before microvascular complications appear. Because microalbuminuria markedly increases the risk of overt nephropathy as well as of cardiovascular complications, primary prevention (i.e., preventing or delaying the onset of microalbuminuria) continues to be explored, predominantly through use of renin-angiotensin blockade. Available data reviewed suggest that primary prevention through blood pressure reduction is more likely to benefit select groups (those with hypertension, cardiovascular risks, or old age). This review discusses the relationship between hypertension, diabetes, and kidney disease, the rationale for primary prevention, and the data that led to that conclusion. PMID:21526351

Williams, Mark E

2011-08-01

42

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

PubMed

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

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

2014-02-01

43

Early Supplemental Parenteral Nutrition is Associated with Increased Infectious Complications in Critically Ill Trauma Patients  

PubMed Central

Background Parenteral nutrition (PN) is often used in severely injured patients when caloric goals are not achieved enterally. The purpose of this study is to determine whether early administration of parenteral nutrition is associated with an increased risk for infection following severe injury. Methods Retrospective cohort study of severely injured blunt trauma patients enrolled from eight trauma centers participating in the “Inflammation and the Host Response to Injury” (Glue Grant) study. We compared patients receiving PN within seven days following injury to a control group who did not receive early PN. We then focused on patients who tolerated at least some enteral nutrition during the first week and evaluated the potential influence of supplemental PN on outcomes in this “enteral tolerant” subgroup. The primary outcome was the occurrence of a nosocomial infection following the first post-injury week. Secondary outcomes included the type of infection and hospital mortality. Results Of the 567 patients enrolled, 95 (17%) received early PN. Early PN use was associated with a greater risk of nosocomial infection (relative risk 2.1; 95% CI 1.6-2.6, P=<0.001). In the enteral tolerant subgroup (n=249), early PN was also associated with an increase in nosocomial infections (RR=1.6; 95% CI 1.2-2.1, P=0.005) in part due to an increased risk of blood stream infection (RR=2.8; 95% CI 1.5-5.3, P=0.002). Mortality tended to be higher in patients receiving additional EN + PN versus EN alone (RR 2.3; 95% CI 1.0-5.2, P=0.06). Conclusion In critically ill trauma patients who are able to tolerate at least some EN, early PN administration may contribute to increased infectious morbidity and a worse clinical outcome. PMID:18926446

Sena, Matthew J.; Utter, Garth H.; Cushcieri, Joseph; Maier, Ronald V.; Tompkins, Ronald G.; Harbrecht, Brian G.; Moore, Ernest E.; O'Keefe, Grant E

2014-01-01

44

Clinical assessment of peripheral perfusion to predict postoperative complications after major abdominal surgery early: a prospective observational study in adults  

PubMed Central

Introduction Altered peripheral perfusion is strongly associated with poor outcome in critically ill patients. We wanted to determine whether repeated assessments of peripheral perfusion during the days following surgery could help to early identify patients that are more likely to develop postoperative complications. Methods Haemodynamic measurements and peripheral perfusion parameters were collected one day prior to surgery, directly after surgery (D0) and on the first (D1), second (D2) and third (D3) postoperative days. Peripheral perfusion assessment consisted of capillary refill time (CRT), peripheral perfusion index (PPI) and forearm-to-fingertip skin temperature gradient (Tskin-diff). Generalized linear mixed models were used to predict severe complications within ten days after surgery based on Clavien-Dindo classification. Results We prospectively followed 137 consecutive patients, from among whom 111 were included in the analysis. Severe complications were observed in 19 patients (17.0%). Postoperatively, peripheral perfusion parameters were significantly altered in patients who subsequently developed severe complications compared to those who did not, and these parameters persisted over time. CRT was altered at D0, and PPI and Tskin-diff were altered on D1 and D2, respectively. Among the different peripheral perfusion parameters, the diagnostic accuracy in predicting severe postoperative complications was highest for CRT on D2 (area under the receiver operating characteristic curve = 0.91 (95% confidence interval (CI) = 0.83 to 0.92)) with a sensitivity of 0.79 (95% CI = 0.54 to 0.94) and a specificity of 0.93 (95% CI = 0.86 to 0.97). Generalized mixed-model analysis demonstrated that abnormal peripheral perfusion on D2 and D3 was an independent predictor of severe postoperative complications (D2 odds ratio (OR) = 8.4, 95% CI = 2.7 to 25.9; D2 OR = 6.4, 95% CI = 2.1 to 19.6). Conclusions In a group of patients assessed following major abdominal surgery, peripheral perfusion alterations were associated with the development of severe complications independently of systemic haemodynamics. Further research is needed to confirm these findings and to explore in more detail the effects of peripheral perfusion–targeted resuscitation following major abdominal surgery. PMID:24894892

2014-01-01

45

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

SciTech Connect

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

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

1985-10-01

46

Avoiding early complications and reoperation during occipitocervical fusion in pediatric patients.  

PubMed

Object Surgical arthrodesis for pediatric occipitocervical (OC) instability has a high rate of success in a wide variety of challenging circumstances; however, identifying potential risk factors can help to target variables that should be the focus of improvement. The aim of this paper was to examine risk factors predictive of failure in a population of patients who underwent instrumented OC arthrodesis using a uniform surgical philosophy. Methods The authors conducted a retrospective cohort study of pediatric patients who underwent OC fusion from 2001 to 2013 at a single institution to determine risk factors for surgical failure, defined as reoperation for revision of the arthrodesis or instrumentation. The primary study outcome was either radiographic confirmation of successful OC fusion or surgical failure requiring revision of the arthrodesis or instrumentation. The secondary outcome was the underlying cause of failure (hardware failure, graft failure, or infection). Univariate analysis was performed to assess the association between outcome and patient demographics, cause of OC instability, type of OC instrumentation, bone graft material, biological adjuncts, and complications. Results Of the 127 procedures included, 20 (15.7%) involved some form of surgical failure and required revision surgery. Univariate analysis revealed that patients with deep wound infections requiring debridement were more likely to require surgical revision of the hardware or graft (p = 0.002). Subgroup analysis revealed that patients with skeletal dysplasia or congenital spinal anomalies were more likely to develop hardware failure than patients with other causes of OC instability (p = 0.020). Surgical failure was not associated with the method of C-2 fixation, type of rigid OC instrumentation, bone graft material, use of bone morphogenetic protein or biological adjuncts, cause of instability, sex, age, or having previous OC fusion operations. Conclusions Pediatric patients in the present cohort with postoperative wound infections requiring surgical debridement had higher surgical failure rates after OC fusion. Those with skeletal dysplasia and congenital spinal anomalies were more likely to require reoperation for hardware failure. Better understanding of the mode of surgical failure may enable surgeons to develop strategies to decrease the need for reoperation in pediatric patients with OC instability. PMID:25171720

Mazur, Marcus D; Sivakumar, Walavan; Riva-Cambrin, Jay; Jones, Jaes; Brockmeyer, Douglas L

2014-11-01

47

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

PubMed Central

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

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

2014-01-01

48

Risk factors for early and late biliary complications in pediatric liver transplantation.  

PubMed

BC are a common source of morbidity after pediatric LT. Knowledge about risk factors may help to reduce their incidence. Retrospective analysis of BC in 116 pediatric patients (123 LT) (single institution, 05/1990-12/2011, medium follow-up 7.9 yr). One-, five-, and 10-yr survival was 91.1%, no patient died of BC. Prevalence and risk factors for anastomotic and intrahepatic BC were examined. There were 29 BC in 123 LT (23.6%), with three main categories: 10 (8.1%) primary anastomotic strictures, eight (6.5%) anastomotic leaks, and three (2.4%) intrahepatic strictures. Significant risk factors for anastomotic leaks were total operation time (increase 1.26-fold) and early HAT (<30 days post-LT; increase 5.87-fold). Risk factor for primary anastomotic stricture was duct-to-duct choledochal anastomosis (increase 5.96-fold when compared to biliary-enteric anastomosis). Risk factors for intrahepatic strictures were donor age >48 yr (increase 1.09-fold) and MELD score >30 (increase 1.2-fold). To avoid morbidity from anastomotic BC in pediatric LT, the preferred biliary anastomosis appears to be biliary-enteric. Operation time should be kept to a minimum, and HAT must by all means be prevented. Children with a high MELD score or receiving livers from older donors are at increased risk for intrahepatic strictures. PMID:25263826

Lüthold, Samuel C; Kaseje, Neema; Jannot, Anne-Sophie; Mentha, Gilles; Majno, Pietro; Toso, Christian; Belli, Dominique C; McLin, Valérie A; Wildhaber, Barbara E

2014-12-01

49

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

PubMed Central

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

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

2011-01-01

50

A family history of serious complications due to BCG vaccination is a tool for the early diagnosis of severe primary immunodeficiency  

PubMed Central

Severe Combined Immunodeficiency (SCID) is one of the most severe forms of primary immunodeficiency (PID). Complications of BCG vaccination, especially disseminated infection and its most severe forms, are known to occur in immunodeficient patients, particularly in SCID. A carefully taken family history before BCG injection as well as delaying vaccination if PID is suspected could be a simple and effective method to avoid inappropriate vaccination of an immunodeficient child in some cases until the prospect of newborn screening for SCID has been fully developed. We describe a patient with a very early diagnosis of SCID, which was suspected on the basis of the previous death of two siblings younger than one year due to severe complications secondary to the BCG vaccine. We suggest that a family history of severe or fatal reactions to BCG should be included as a warning sign for an early diagnosis of SCID. PMID:24016734

2013-01-01

51

Factors influencing early results and complication rates of the thrombolytic treatment of lower limb ischemia with recombinant tissue-type plasminogen activator.  

PubMed

The aim of the study was to determine the effect of comorbidity conditions on the early outcome and complication rates of thrombolytic treatment of lower limb ischaemia with recombinant tissue plasminogen activator (rt-PA). Clinical and procedural data of 82 patients treated for acute/subacute arterial/graft occlusion were analysed retrospectively. Early results and adverse events were recorded and evaluated statistically. Early resolution of ischemic symptoms was achieved in 67 (82%) patients with a median dose of 25.4 mg of rt-PA. Major bleeding was reported in 9 and minor bleeding in 6 cases (intracranial hemorrhage rate 1%, mortality rate 1%, major amputation rate 1%). Comorbidity conditions and patient characteristics did not statistically influence success and complication rates. Bleeding was observed in patients who received a higher dose of the thrombolytic agent (30.0 mg vs 24.3 mg). Comorbidity conditions have no effect on early outcome and adverse events after thrombolytic management of lower limb ischemia. Higher doses of rt-PA with prolonged infusion times increase the risk of occurrence of treatment-related bleeding. PMID:17069188

Asciutto, Giuseppe; Geier, Bruno; Marpe, Barbara; Hummel, Thomas; Mumme, Achim

2006-01-01

52

World J Surg . Author manuscript C-reactive protein is an early predictor of septic complications after  

E-print Network

complications after elective colorectal surgery Pablo Ortega-Deballon 1 * , Fran ois Radaisç 1 , Olivier Facy 1 for most morbidity after colorectal surgery. Among them, anastomotic leakage results in increased morbidity for anastomotic leakage in gastrointestinal surgery ( ). Routine imaging is neither reliable nor4 cost

Paris-Sud XI, Université de

53

Surgical Anatomy, Transperitoneal Approach, and Early Postoperative Complications of a Ventral Lumbar Spine Surgical Model in Lewis Rats  

PubMed Central

Surgical models in animals are used extensively to study small molecules and devices for lumbar intervertebral disc repair, replacement, and fusion. Although the ventral lumbar animal models themselves are well described, critical assessment of morbidity and mortality avoidance when using the models have not been reported. Hypothesizing that technique modifications and the relative prevalence and severity of complications would be correlated, we collected and examined peri- and postoperative data stratified by surgical technique. We here report complications associated with the transperitoneal approach to the lumbar spine in 268 Lewis rats and offer data-driven suggestions regarding complication avoidance through technique modification. Compared with wider exposure, limiting the width of exposure to a maximum of 3 mm resulted in fewer neurologic complications in the lower limbs. In addition, avoiding extracorporeal reflection of the small intestine during the exposure was associated with lower incidence of postoperative gastrointestinal distress and fewer situations requiring euthanasia. These findings underscore the importance of detailed approaches in minimizing postoperative morbidity and attrition in surgical models. PMID:24210017

Damle, Sheela R; Krzyzanowska, Agata; Frawley, Robert J; Cunningham, Matthew E

2013-01-01

54

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

PubMed Central

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

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

2014-01-01

55

A lactating woman presenting with puerperal pneumococcal mastitis: a case report  

PubMed Central

Introduction Streptococcus pneumoniae is an uncommon etiologic agent in soft-tissue infections. Case presentation We report the case of a 35-year-old Caucasian woman who presented to our facility with puerperal pneumococcal mastitis, and review the only other three cases of pneumococcal mastitis described in the medical literature. Conclusions The roles of the various pneumococcal vaccines in preventing this disease are discussed. PMID:23618042

2013-01-01

56

Influence of puerperal uterine infection on uterine involution and postpartum ovarian activity in dairy cows.  

PubMed

This article presents the results of a clinical trial designed to study the effect of puerperal uterine infection on uterine involution and on ovarian activity in dairy cows, monitored twice weekly from parturition until the sixth week postpartum (wpp). Infection significantly retarded uterine involution assessed by the uterine body diameter and a score of intrauterine fluid volume (IUFV). By the sixth wpp, cows with normal puerperium (controls) and cows that showed mild puerperal endometritis had similar uterine body diameter and IUFV, indicating spontaneous recovery within the postpartum voluntary waiting period. However, in cows with severe puerperal endometritis, although uterine body diameter had regressed to pregravid size, IUFV remained significantly higher than in control and mild endometritis cows, indicating that chronic endometritis was established. The IUFV score was positively and significantly correlated with uterine swab bacterial growth density and allowed diagnosis of endometritis after the third wpp. Cows with mild or severe endometritis had a significantly higher prevalence and persistence of pathogenic bacteria (Escherichia coli, Actinomyces pyogenes, Gram-negative anaerobes - GNA) than controls. Actinomyces pyogenes was associated to GNA in 74% of isolations. Ovarian activity measured by ultrasound scanning of the ovaries and plasma progesterone (P4) concentrations was more abnormal (prolonged anoestrus, prolonged luteal phases and ovarian cysts) in cows with severe endometritis than in controls. PMID:11882243

Mateus, L; da Costa, L Lopes; Bernardo, F; Silva, J Robalo

2002-02-01

57

Clinical, bacteriological, and histopathological study of toxic puerperal metritis in Iraqi buffalo.  

PubMed

Data were collected from 42 buffalo with toxic puerperal metritis in 2 large herds, with a history of dystocia, prolapse, and retained placenta. All buffalo were subjected to detailed clinical examination including external inspection, vaginoscopy, and transrectal palpation of the cervix, uterus, and ovaries. Swabs for bacteriology and biopsies for histopathology were collected from the uterine lumen from each cow. Character, odor, and estimation of polymorphonuclear cells of the vaginal mucus were scored. Blood samples were collected from cows for creatine kinase and aspartate amino-transferase measurement. The most predisposing factor causing toxic puerperal metritis was retained placenta (52.4%), and the most prevalent bacteria in uterine lumen were Escherichia coli, Arcanobacterium pyogenes, Staphylococcus aureus, and Fusobacterium necrophorum (18.5, 16.7, 13.0, and 9.3%, respectively). High levels of polymorphonuclear cells were observed in buffalo infected with A. pyogenes and gram-negative anaerobic bacteria (62.1 and 76.4%). A high prevalence of gram-negative anaerobes was isolated from uteri harboring A. pyogenes (13.0%). Buffalo with toxic puerperal metritis had significantly higher creatine kinase and aspartate aminotransferase activities than controls (499.2 +/- 23.9 and 208.3 +/- 11.3 vs. 242.7 +/- 12.9 and 166.8 +/- 11.5 U/L, respectively). In a conclusion, gram-negative anaerobes and other facultative pathogens including A. pyogenes were important pathogens that cause severe uterine inflammation. PMID:17881686

Azawi, O I; Omran, S N; Hadad, J J

2007-10-01

58

Comparison of Early and Late Complications after Various Bariatric Procedures: Incidence and Treatment During 15 Years at a Single Institution  

Microsoft Academic Search

Background  Bariatric procedures are effective in the life-long treatment of clinically severe obesity, but they are technically demanding\\u000a and have known complications. The present study presents mortality and morbidity with different procedures from the prospective\\u000a 15-year bariatric database of the University Hospital of Patras in Greece.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  From June 1994 through December 2008, 1,162 morbidly obese patients underwent various bariatric procedures at

George Skroubis; Stavros Karamanakos; George Sakellaropoulos; Konstantinos Panagopoulos; Fotis Kalfarentzos

2011-01-01

59

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

ERIC Educational Resources Information Center

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…

Costa, Kristina

2012-01-01

60

[Retrospective appreciation of results of treatment and early and late radiologic mucositis and other postradiological complications in patients with parotid gland cancer irradiated postoperatively].  

PubMed

We describe results and complications of combined (surgery and radiotherapy) treatment of parotid gland cancer. 86 patients, 31 women and 55 men, have been treated between the years 1984-1997 in Cancer Center--Institute in Warsaw. Mean age of patients was 56.6 years and ranged from 15 to 84 years. Surgical treatment was microscopically radical in 16 patients, macroscopically radical in 59 patients and debulking was performed on 11 patients. 5-year overall survival has been estimated as 58.2%. Distant metastases were observed in 23.3% of patients, local recurrences were observed in 12.8% of patients. Late serious postirradiation skin reaction (grade IV EORTC) was observed 6 months after completion of radiotherapy in 1 patient, and symptoms subsided completely during next 18 months. Late mucosal postirradiation complications (grade I and II EORTC) after 6 to 8 months after radiotherapy were described in 22.9% of patients and after 24-26 months in 15.9% of patients. There were no serious--grade III and IV EORTC--mucosal complications. Observed xerostomia was minimal due to compensation of saliva production by contralateral major salivary glands and did not worsen patients quality of life. Early middle ear postradiological inflammation occurred in 18.6% of patients, late reaction in the middle ear (6 to 8 months after completion of radiotherapy) was observed in 19% of all patients. In the group of 57 patients who survived 2 years after radiotherapy 1 developed temporo-mandibular joint fibrosis. Late postradiological changes in petrosal bone were detected in 2 patients (1 in Rtg imaging and 1 in CT imaging)-they were painful and primarily suspected as recurrence. None of the patients had clinically overt temporal lobe complications. Our patients survival results were a little worse than reported in the literature. Observed tolerance of combined treatment was very good. PMID:15307475

Laskus, Zofia; Kawecki, Andrzej

2004-01-01

61

Non Puerperal Uterine Inversion in A Young Female- A Case Report  

PubMed Central

We report a case of 28-year-old, primipara who presented with complaints of mass descending per vaginum along with excessive bleeding and foul smelling vaginal discharge for the past six months. Clinical examination revealed an inverted uterus, cervix and vagina with a large submucosal fundal fibroid. A diagnosis of non-puerperal uterine inversion was made. Surgical management included vaginal myomectomy with repositioning of the uterus using an abdomino-vaginal approach and a successful outcome. Histopathology confirmed the diagnosis of leiomyoma. Hence, we conclude that uterus-sparing surgery should be considered in young females desirous for future pregnancy until the final pathology is known. PMID:25386493

Samal, Sunil Kumar; Pallavee, P; Ghose, Seetesh

2014-01-01

62

Pregnancy Complications  

MedlinePLUS

... Emergency Preparedness and Response Pregnant Women and Flu Pregnancy Complications On this Page Before Pregnancy During Pregnancy ... to decrease the risk of pregnancy complications. Before Pregnancy Make sure to talk to your doctor about ...

63

LASIK Complications  

Microsoft Academic Search

Laser in situ keratomileusis (LASIK) is a rapidly evolving ophthalmic surgical procedure. Several anatomic and refractive complications have been identified. Anatomic complications include corneal flap abnormalities, epithelial ingrowth, and corneal ectasia. Refractive complications include unexpected refractive outcomes, irregular astigmatism, decentration, visual aberrations, and loss of vision. Infectious keratitis, dry eyes, and diffuse lamellar keratitis may also occur following LASIK. By

Samir A Melki; Dimitri T Azar

2001-01-01

64

Impact of clean delivery-kit use on newborn umbilical cord and maternal puerperal infections in Egypt.  

PubMed

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

Darmstadt, Gary L; Hassan, Mohamed; Balsara, Zohra P; Winch, Peter J; Gipson, Reginald; Santosham, Mathuram

2009-12-01

65

An unusual presentation of a submucous leiomyoma accounting to a non-puerperal uterine inversion: A case report  

PubMed Central

Non-puerperal uterine inversion is an extremely rare gynaecological event that is usually associated with uterine tumours such as submucous or cervical leiomyomas. In this report, we describe a case of uterine inversion due to a large submucous leiomyoma in a 42-year-old multiparous and obese Caucasian woman. PMID:24592087

Atalay, Mehmet Aral; Demir, Bilge Cetinkaya; Solak, Nese; Atalay, Fatma Oz; Kucukkomurcu, Sakir

2013-01-01

66

Puerperal choriocarcinoma  

PubMed Central

A 32-year-old lady presented postnatally with headaches, blurred vision and left leg numbness, which was initially diagnosed as migraine with sciatica. Subsequently, she developed seizures and was admitted to ITU. Investigations revealed abnormal grey matter perfusion in the right occipital region of the brain, multiple lung nodules, lesions in the liver and a pancreatic mass. A ?-human chorionic gonadotrophin level was over 132 000 IU/l, and metastatic choriocarcinoma was diagnosed. She responded well to combination chemotherapy and made a full recovery. PMID:22714612

Beavington, L; Mossa, M

2011-01-01

67

Antibiotic treatment patterns across Europe in patients with complicated skin and soft-tissue infections due to meticillin-resistant Staphylococcus aureus: a plea for implementation of early switch and early discharge criteria.  

PubMed

This retrospective observational medical chart review aimed to describe country-specific variations across Europe in real-world meticillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft-tissue infection (cSSTI) treatment patterns, antibiotic stewardship activity, and potential opportunities for early switch (ES) from intravenous (i.v.) to oral formulations and early discharge (ED) from hospital using standardised data collection and criteria and economic implications of these opportunities. Patients were randomly sampled from 12 countries (Austria, Czech Republic, France, Germany, Greece, Ireland, Italy, Poland, Portugal, Slovakia, Spain and the UK), aged ?18 years, with documented MRSA cSSTI, hospitalised between 1 July 2010 and 30 June 2011, discharged alive by 31 July 2011. Of 1502 patients, 1468 received MRSA-targeted therapy. Intravenous-to-oral switch rates ranged from 2.0% to 20.2%, i.v. length of therapy from 10.1 to 18.6 days and hospital length of stay (LoS) from 15.2 to 25.0 days across Europe. Of 341 sites, 82.9% had antibiotic steering committees, 23.7% had i.v.-to-oral switch antibiotic protocols and 12.9% had ED protocols for MRSA cSSTI. ES and ED eligibility ranged from 12.0% (Slovakia) to 56.3% (Greece) and from 10% (Slovakia) to 48.2% (Portugal), respectively. Potential cost savings per ED-eligible patient ranged from €414 (Slovakia) to €2703 (France). MRSA cSSTI treatment patterns varied widely across countries, but further reductions in i.v. therapy, hospital LoS and associated costs could be realised. These data provide insight into clinical practice patterns across diverse European healthcare systems and identify potential opportunities for local clinicians and policy-makers to improve clinical care and cost-effectiveness of this therapeutic area. PMID:24928311

Eckmann, Christian; Lawson, Wendy; Nathwani, Dilip; Solem, Caitlyn T; Stephens, Jennifer M; Macahilig, Cynthia; Simoneau, Damien; Hajek, Petr; Charbonneau, Claudie; Chambers, Richard; Li, Jim Z; Haider, Seema

2014-07-01

68

[Diabetes and cardiovascular complications].  

PubMed

The prevalence of obesity and diabetes is increasing dramatically. Currently, 800,000 patients are suffering from diabetes mellitus in Austria. Chronic hyperglycemia results in micro- and macrovascular complications, which reduce life expectancy up to 8 years. Furthermore, diabetes is among the most important risk factors for premature atherosclerosis and coronary artery disease. The incidence of coronary artery disease in diabetics is relatively high with about 146 cases per 10,000 patient years. Apart, it could be demonstrated that the presence of diabetes mellitus worsens the prognosis after an acute coronary syndrome. Considering ischemic stroke, the situation is nearly the same, as it is known that diabetes mellitus increases the risk for ischemic stroke events up to 5 times. Beside the macrovascular complications, microvascular complications like diabetic retinopathy, diabetic nephropathy and diabetic neuropathy also play a critical role. Retinopathy can be detected in nearly every patient after a diabetes duration of 20 years. Diabetic nephropathy, which is a major complication of diabetes mellitus, accounts for 19% of end stage renal disease. Microalbuminuria, which is an early marker of diabetic nephropathy, can be found in 30% of the patients after 10 years of diabetes. Due to the severity of the diabetic complications an early intensified antidiabetic treatment is highly important for the prevention of micro- and macrovascular events. PMID:20229155

Resl, Michael; Clodi, Martin

2010-01-01

69

Postpartum practices of puerperal women and their influencing factors in three regions of Hubei, China  

PubMed Central

Background 'Sitting month' is a Chinese tradition for women's postpartum custom. The present study aims to explore the postpartum dietary and health practices of puerperal women and identify their influential factors in three selected regions of Hubei, China. Methods A cross-sectional retrospective study was conducted in the selected urban, suburban and rural areas in the province of Hubei from 1 March to 30 May 2003. A total of 2100 women who had given birth to full-term singleton infants in the past two years were selected as the participants. Data regarding postpartum practices and potentially related factors were collected through questionnaire by trained investigators. Results During the puerperium, 18% of the participants never ate vegetables, 78.8% never ate fruit and 75.7% never drank milk. Behaviour taboos such as no bathing, no hair washing or teeth brushing were still popular among the participants. About half of the women didn't get out of the bed two days after giving birth. The average time they stayed in bed during this period was 18.0 h. One third of them didn't have any outdoor activities in that time periods. The educational background of both women and their spouses, location of their residence, family income, postnatal visit, nutrition and health care educational courses were found to be the influencing factors of women's postpartum practices. Conclusion Traditional postpartum dietary and health behaviours were still popular among women in Hubei. Identifying the factors associated with traditional postpartum practices is critical to develop better targeting health education programs. Updated Information regarding postpartum dietary and health practices should be disseminated to women. PMID:17087836

Liu, Nian; Mao, Limei; Sun, Xiufa; Liu, Liegang; Chen, Banghua; Ding, Qiang

2006-01-01

70

Influence of various treatment methods on bacteriological findings in cows with puerperal endometritis.  

PubMed

The aim of the study was to identify the species of microorganisms isolated from the uterus of healthy cows (control group) and cows affected with puerperal metritis (PM) before and after an experimental therapy with an immunomodulator and antibiotics versus commonly applied methods (antibiotic + beta-blocker or antibiotic + PGF2alpha). Examinations were carried out on 110 cows with PM in three farms with similar system of rearing and nutrition. The control group consisted of 21 cows without postpartum disturbances. Smears from the uterus were taken before treatment and then at 21st day of observation. Escherichia coli and other species of Enterobacteriaceae family were isolated from 48.2% of PM cows and 47.6% of healthy cows. The degree of Arcanobacterium pyogenes infection was statistically lower in healthy than in sick cows (9.5% versus 30.0%). Streptococcus sp. was isolated from 13.6% of PM cows and from 16% of control ones. Staphylococci were isolated from 10% of PM and from 30% of control cows. Other bacteria species were isolated from about 10% of the examined cows. The best elimination of infections (66%) was noted in cows treated with the intrauterine antibiotic in combination with PGF2alpha i.m. injection. Examination showed that species of bacteria in the postparturient uterus were similar in healthy and sick cows. However, Arcanobacterium pyogenes was isolated 3 times more often from the sick animals. This pathogen was identified in 11 cows out of 19 (57.9%) culled subsequently because of infertility after the metritis puerperalis was clinically cured. PMID:15478861

Kaczmarowski, M; Malinowski, E; Markiewicz, H

2004-01-01

71

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

PubMed Central

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

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

2012-01-01

72

Usefulness of C-reactive protein, serum amyloid A component, and haptoglobin determinations in bitches with pyometra for monitoring early post-ovariohysterectomy complications.  

PubMed

The aim of this study was to assess changes in serum concentrations of C-reactive protein (CRP), serum amyloid A component (SAA), and haptoglobin (Hp) in bitches with pyometra undergoing ovariohysterectomy that developed postoperative wound infection-related complications. The study revealed that difficulties in postoperative wound healing were induced by infections with Escherichia coli and Staphylococcus spp. leading to re-increased levels of CRP and SAA immediately after surgery and persistently high Hp levels throughout the experiment. Our results indicate that acute-phase proteins in bitches undergoing surgery because of pyometra are useful markers for monitoring the postoperative period. Moreover, they enable prompt therapeutic management once complications develop. PMID:19477501

Dabrowski, R; Kostro, K; Lisiecka, U; Szczubia?, M; Krakowski, L

2009-09-01

73

One-Year Survival Among Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock, and its Relation to Early Revascularization Results From the GUSTO-I Trial  

Microsoft Academic Search

Background—Although 30-day survival is increased in patients with acute myocardial infarction complicated by cardiogenic shock who undergo coronary revascularization, the longer-term outcome in such patients and the duration of benefit from revascularization are unknown. Methods and Results—We analyzed 30-day survivors of acute myocardial infarction in the Global Utilization of Streptokinase and Tissue-Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) trial and

Peter B. Berger; Robert H. Tuttle; David R. Holmes; Eric J. Topol; Philip E. Aylward; John H. Horgan; Robert M. Califf

74

Culture-independent pilot study of microbiota colonizing open fractures and association with severity, mechanism, location, and complication from presentation to early outpatient follow-up.  

PubMed

Precise identification of bacteria associated with post-injury infection, co-morbidities, and outcomes could have a tremendous impact in the management and treatment of open fractures. We characterized microbiota colonizing open fractures using culture-independent, high-throughput DNA sequencing of bacterial 16S ribosomal RNA genes, and analyzed those communities with respect to injury mechanism, severity, anatomical site, and infectious complications. Thirty subjects presenting to the Hospital of the University of Pennsylvania for acute care of open fractures were enrolled in a prospective cohort study. Microbiota was collected from wound center and adjacent skin upon presentation to the emergency department, intraoperatively, and at two outpatient follow-up visits at approximately 25 and 50 days following initial presentation. Bacterial community composition and diversity colonizing open fracture wounds became increasingly similar to adjacent skin microbiota with healing. Mechanism of injury, severity, complication, and location were all associated with various aspects of microbiota diversity and composition. The results of this pilot study demonstrate the diversity and dynamism of the open fracture microbiota, and their relationship to clinical variables. Validation of these preliminary findings in larger cohorts may lead to the identification of microbiome-based biomarkers of complication risk and/or to aid in management and treatment of open fractures. PMID:24395335

Hannigan, Geoffrey D; Hodkinson, Brendan P; McGinnis, Kelly; Tyldsley, Amanda S; Anari, Jason B; Horan, Annamarie D; Grice, Elizabeth A; Mehta, Samir

2014-04-01

75

Hypoglycemia: The neglected complication  

PubMed Central

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

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

2013-01-01

76

Complications of shoulder instability surgery.  

PubMed

Complications of shoulder instability surgery may results from errors made during the preoperative, intraoperative, or postoperative periods. Some complications are preventable whereas the risk of others can be reduced. A few complications remain unpreventable. Two sources of error in the preoperative period that can lead to complications are an incorrect diagnosis and failure to address a patient's expectations of treatment. These errors and their subsequent complications are preventable. Preventing complications during the intraoperative period begins with proper patient positioning and a thorough knowledge of shoulder anatomy. Understanding the indications and limitations of the various stabilization procedures, as well as applying proper surgical technique, is essential to avoid a surgical misadventure. Complications recognized in the postoperative period include recurrent instability, limitation of motion, inability to return to the previous level of sport, problems related to hardware, pain, development of osteoarthritis, and neurovascular injuries. Infection and hematoma formation may also occur; both need to be recognized and treated early to maximize outcome. A protocol for treating each complication that may occur often is helpful. Knowledge of the complications that can arise is paramount to preventing their occurrence. This knowledge comes through experience, study, and continued research. PMID:8582009

Wall, M S; Warren, R F

1995-10-01

77

Diagnosis of acute puerperal metritis by electronic nose device analysis of vaginal discharge in dairy cows.  

PubMed

The objective of this study was to estimate the diagnostic accuracy of an electronic nose device using vaginal discharge samples to diagnose acute puerperal metritis (APM) in dairy cows. Uterine fluid was sampled manually with a gloved hand and under sterile conditions for electronic nose device analysis (day in milk (DIM) 2, 5, and 10) and bacteriologic examination (DIM 5), respectively, and on additional days, if APM was diagnosed during the daily clinical examinations. A dataset containing samples from 70 cows was used to create a model and to validate the APM status predicted by this model, respectively. Half of the dataset (n = 35; 14 healthy and 21 metritic cows) was provided with information regarding the APM diagnosis and contained all three measurements (DIM 2, 5, and 10) for each cow and was used as a training set whereas the second half was blinded (n = 35; 14 healthy and 21 metritic cows) and contained only the samples collected on DIM 5 of each cow and was used to validate the created prediction model. A receiver operating characteristic curve was calculated using the prediction results of the validation test. The best observed sensitivity was 100% with specificity of 91.6% when using a threshold value of 0.3. The calculated P-value for the receiver operating characteristic curve was less than 0.01. Overall, Escherichia coli was isolated in eight of 28 (28.6%) and 22 of 42 (52.4%) samples collected from healthy and metritic cows, respectively. Trueperella pyogenes and Fusobacterium necrophorum were isolated in 14 and six of 28 (50.0% and 21.4%) and 17 and 16 of 42 (40.5% and 38.1%) samples collected from healthy and metritic cows, respectively. The prevalence of Escherichia coli and Trueperella pyogenes was similar in the samples obtained from metritic cows used for the training set and the validation test. The results are promising especially because of the objective nature of the measurements obtained by the electronic nose device. PMID:24746098

Burfeind, O; Bruins, M; Bos, A; Sannmann, I; Voigtsberger, R; Heuwieser, W

2014-07-01

78

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

PubMed

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

Hedberg, J; Sundström, J; Sundbom, M

2014-07-01

79

Treatment of complications of parotid gland surgery  

PubMed Central

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

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

2005-01-01

80

Pregnancy Complications: Gonorrhea  

MedlinePLUS

... in the community. Home > Pregnancy > Pregnancy Complications > Gonorrhea Pregnancy complications Pregnancy complications may need special medical care. ... the United States. Can gonorrhea cause complications during pregnancy and for your baby? Yes. Gonorrhea can lead ...

81

Pregnancy Complications: Preeclampsia  

MedlinePLUS

... in the community. Home > Pregnancy > Pregnancy Complications > Preeclampsia Pregnancy complications Pregnancy complications may need special medical care. ... health care provider right away. What health and pregnancy complications can preeclampsia cause? Without treatment, preeclampsia can ...

82

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

PubMed Central

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

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

2014-01-01

83

Effect of early intravenous heparin on coronary patency, infarct size, and bleeding complications after alteplase thrombolysis: results of a randomised double blind European Cooperative Study Group trial.  

PubMed Central

OBJECTIVE--To determine whether concomitant treatment with intravenous heparin affects coronary patency and outcome in patients treated with alteplase thrombolysis for acute myocardial infarction. DESIGN--Double blind randomised trial. TREATMENT REGIMENS--Alteplase 100 mg (not weight adjusted) plus aspirin (250 mg intravenously followed by 75-125 mg on alternate days) plus heparin (5000 units intravenously followed by 1000 units hourly without dose adjustment) was compared with alteplase plus aspirin plus placebo for heparin. SETTING--19 cardiac centres in six European countries. SUBJECTS--652 patients aged 21-70 years with clinical and electrocardiographic features of infarcting myocardium in whom thrombolytic therapy could be started within six hours of the onset of major symptoms. MAIN OUTCOME MEASURE--Angiographic coronary patency 48-120 hours after randomisation. RESULTS--Coronary patency (TIMI grades 2 or 3) was 83.4% in the heparin group and 74.7% in the group given placebo for heparin. The relative risk of an occluded vessel in the heparin treated group was 0.66 (95% confidence interval 0.47 to 0.93). Mortality was the same in both groups. There were non-significant trends towards a smaller enzymatic infarct size and a higher incidence of bleeding complications in the group treated with heparin. CONCLUSIONS--Concomitant intravenous heparin improves coronary patency in patients with alteplase. Whether this can be translated into improved clinical benefit needs to be to be tested in a larger trial. PMID:1540431

de Bono, D P; Simoons, M L; Tijssen, J; Arnold, A E; Betriu, A; Burgersdijk, C; Lopez Bescos, L; Mueller, E; Pfisterer, M; Van de Werf, F

1992-01-01

84

[Early and late complications of craniocerebral trauma. Chronic subdural hematoma/hygroma, carotid-cavernous sinus fistula, abscess formation, meningitis and hydrocephalus].  

PubMed

A group of 318 patients suffering from severe head injury, 51 of whom died of their (head) injury, is reviewed. A small contusional cerebral haemorrhage had occurred in 50.6%, and 30% had had basal skull fractures. In the entire group, 2.8% developed posttraumatic hydrocephalus. Shunt implantation was necessary between the 11th and 123rd posttraumatic days (mean 52nd). All patients with inflammatory problems, e.g. meningitis or intracranial abscess, developed posttraumatic hydrocephalus. In 10 of the 12 patients with hygromas, an operative procedure with bur hole trepanation was necessary. Half of the patients with hygromas were polytraumatized but only 25.85% of the entire group. Two patients in the group and a further 49 patients with chronic subdural haematomas were operated on by a bur hole trepanation and appropriate drainage for several days. In 2 cases the development of the chronic subdural haematoma had been documented by CAI. All patients with frontobasal skull fractures were operated on by a transethmoidal approach only the 1st day. Only 2 of the laterobasal skull fractures needed an operation. One of these caused was by a pneumocephalus. In 0.9% of the patients an intracranial abscess was present; these all had a basal skull fracture, 1 after gunshot injury. Among the patients with basal skull fractures 3.1% developed carotid artery-cavernous sinus fistula. One of these three fistulas has been documented as yielding to spontaneous closure. After reangiography for balloon occlusion an aneurysm was found. Following primary operation, 2.5% of patients required revision operation because of renewed bleeding. The posttraumatic treatment of the complications is discussed. PMID:8284682

Kunz, U; Mauer, U; Waldbaur, H; Oldenkott, P

1993-11-01

85

Aortic complications after bariatric surgery  

Microsoft Academic Search

Obesity and its correlated comorbities are nowadays considered a public health concern. In the last few years a myriad of strategies searched an effective procedure to reduce weight and decreases related comorbities. Among these strategies, the bariatric procedures have been achieved a significantly increase, being able to promote an expressive and lasting weight reduction. Diverse early and late complications are

Diego Felipe GAIA; José Honório PALMA; João Nelson; Rodrigues BRANCO; Enio BUFFOLO

86

Gastrointestinal complications in renal transplantation  

Microsoft Academic Search

One wonders whether the use of cyclosporin, histamine receptor antagonists, low doses of steroids, and early diagnosis and treatment actually modify the incidence, morbidity, and mortality of gastrointestinal (GI) and pancreatic complications in renal transplantation. To find out, we reviewed 614 kidney transplant recipients between January 1984 and December 1988. One hundred patients (16.2%) were found to have GI and\\/or

G. Benoit; M. Moukarzel; G. Verdelli; C. Hiesse; C. Buffet; H. Bensadoun; B. Charpentier; A. Jardin; D. Fries

1993-01-01

87

Pregnancy Complications: Genital Herpes  

MedlinePLUS

... Home > Pregnancy > Pregnancy Complications > Genital herpes and pregnancy Pregnancy complications Pregnancy complications may need special medical care. ... been added to your dashboard . Genital herpes and pregnancy Genital herpes is a sexually transmitted disease (also ...

88

Pregnancy Complications: Chlamydia  

MedlinePLUS

... in the community. Home > Pregnancy > Pregnancy Complications > Chlamydia Pregnancy complications Pregnancy complications may need special medical care. ... younger than 25. Can chlamydia cause problems during pregnancy? Yes. If you get it before or during ...

89

Pregnancy Complications: Syphilis  

MedlinePLUS

... in the community. Home > Pregnancy > Pregnancy Complications > Syphilis Pregnancy complications Pregnancy complications may need special medical care. ... syphilis each year. Can syphilis cause problems during pregnancy and for your baby? Yes. You can pass ...

90

Gastrointestinal complications of diabetes.  

PubMed

Gastrointestinal complications of diabetes include gastroparesis, intestinal enteropathy (which can cause diarrhea, constipation, and fecal incontinence), and nonalcoholic fatty liver disease. Patients with gastroparesis may present with early satiety, nausea, vomiting, bloating, postprandial fullness, or upper abdominal pain. The diagnosis of diabetic gastroparesis is made when other causes are excluded and postprandial gastric stasis is confirmed by gastric emptying scintigraphy. Whenever possible, patients should discontinue medications that exacerbate gastric dysmotility; control blood glucose levels; increase the liquid content of their diet; eat smaller meals more often; discontinue the use of tobacco products; and reduce the intake of insoluble dietary fiber, foods high in fat, and alcohol. Prokinetic agents (e.g., metoclopramide, erythromycin) may be helpful in controlling symptoms of gastroparesis. Treatment of diabetes-related constipation and diarrhea is aimed at supportive measures and symptom control. Nonalcoholic fatty liver disease is common in persons who are obese and who have diabetes. In persons with diabetes who have elevated hepatic transaminase levels, it is important to search for other causes of liver disease, including hepatitis and hemochromatosis. Gradual weight loss, control of blood glucose levels, and use of medications (e.g., pioglitazone, metformin) may normalize hepatic transaminase levels, but the clinical benefit of aggressively treating nonalcoholic fatty liver disease is unknown. Controlling blood glucose levels is important for managing most gastrointestinal complications. PMID:18619079

Shakil, Amer; Church, Robert J; Rao, Shobha S

2008-06-15

91

Biliary complications after liver transplantation  

Microsoft Academic Search

Opinion statement  \\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a The incidence of biliary complications after liver transplant is estimated to be 8% to 20%. Post-liver transplant biliary\\u000a complications may lead to acute and chronic liver injury. The early recognition and prompt treatment of such complications\\u000a improves the long-term survival of the patient and graft.\\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a An understanding of the type of biliary reconstruction, the rationale for

Sanjay Jagannath; Anthony N. Kalloo

2002-01-01

92

Gastrointestinal complications after cardiac surgery.  

PubMed Central

Gastrointestinal complications after cardiac surgery are uncommon, but are associated with a high morbidity and mortality. Over 11 years 8559 procedures requiring cardiopulmonary bypass were performed in this unit and 35 patients were identified who developed gastrointestinal complications after surgery, an incidence of 0.41%. There were nine deaths in this group, a mortality of 25.7% compared with an overall mortality after cardiac surgery in Ireland ranging from 3.24% to 4.81%. These complications required surgery in 21 patients. The most common indication for surgical intervention was upper gastrointestinal bleeding in 10 patients, three patients had acute pancreatitis, two patients had perforated peptic ulcer; two patients had intestinal ischaemia, with five cases of colon pathology. The difficulties of making an early diagnosis are outlined and a low threshold to exploratory laparotomy is recommended. PMID:8422146

Egleston, C. V.; Wood, A. E.; Gorey, T. F.; McGovern, E. M.

1993-01-01

93

Pregnancy Complications/Health Problems Complication Explanation  

E-print Network

1 Pregnancy Complications/Health Problems Complication Explanation Preterm Labor Labor that starts Premature Rupture of Membranes (PROM) Amniotic fluid bag surrounding baby ruptures or leaks before labor in pregnancy and goes away after delivery. Preeclampsia (hypertension) Pregnancy induced high blood pressure

Stromswold, Karin

94

Complications following Acute Ischemic Stroke  

Microsoft Academic Search

The objective of this study was to assess typical early-onset complications following ischemic stroke in a large, hospital-based cohort to provide clinical data for future randomized trials and quality standards in clinical routine. 3,866 patients with acute ischemic stroke were prospectively documented in 14 Neurology Departments with an acute stroke unit. Within the first week after admission, increased intracranial pressure

Christian Weimar; Michael P. Roth; Gesine Zillessen; Jörg Glahn; Martin L. J. Wimmer; Otto Busse; Roman L. Haberl; Hans-Christoph Diener

2002-01-01

95

Puerperal blockade of cholecystokinin (CCK 1 ) receptors disrupts maternal behavior in lactating rats  

Microsoft Academic Search

Blockade of cholecystokinin (CCK) receptors potentiates the morphine-induced disruption of maternal behavior. The present\\u000a study was undertaken to determine whether treatment with lorglumide, a CCK1 antagonist during late pregnancy and early lactation can influence the maternal behavior during lactation. A possible influence\\u000a of this treatment on general activity was also assessed. Twenty-seven female Wistar rats were pretreated with lorglumide (1.0mg\\/kg\\/day;

Cláudia M. Miranda-Paiva; Antonia G. Nasello; Alberto J. Yim; Lucianoo F. Felicio

2002-01-01

96

Pulmonary complications after esophagectomy  

Microsoft Academic Search

Background. Pulmonary complications are common in patients who have undergone esophagectomy. There are no good predictive variables for these complications. In addition, the role that preoperative treatment with chemotherapy and radiation may play in postoperative complications remains unclear.Methods. We performed a retrospective review of all patients who underwent esophagectomy by a single surgeon at our institution over a 6-year period.

Christopher E Avendano; Patrick A Flume; Gerard A Silvestri; Lydia B King; Carolyn E Reed

2002-01-01

97

Transoesophageal Echocardiography Related Complications  

PubMed Central

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

Mathur, S K; Singh, Pooja

2009-01-01

98

Colonic Stent-Related Complications and Their Management  

PubMed Central

Since its introduction in the early 1990s, the self-expandable metal stent (SEMS) has been increasingly used for the management of malignant colorectal obstruction, not only as a palliative method but also as a preoperative treatment in surgical candidates. However, more recently, concerns have been raised over stent complication rates. Early complications include pain, perforation, and rectal bleeding, and late complications include stent migration and stent obstruction. With the increasing use of SEMS for treatment, physicians need to be more aware of complications occurring after the placement of these stents. This review covers the technical considerations and management of complications after colonic stenting. PMID:25325000

Han, Seung-Hee

2014-01-01

99

Maternal and neonatal complications of macrosomia.  

PubMed

This case control study, aimed at identifying complications of macrosomia, was conducted in two major hospitals of Yaoundé, Cameroon over a 6-month period from 1 October 2012. Maternity records were compared of births weighing ?4000?g with those weighing between 3000?g and 3500?g. The main outcome variables were mode of delivery, low genital lacerations, Apgar score, birth injuries, postpartum haemorrhage and early neonatal death. Data were analysed using SPSS 18.0. Chi-square test or Fisher's exact test and t-test were used for comparison. P?complications observed were poor uterine contractions during labour, second-degree perineal tears, Caesarean section, instrumental delivery and postpartum haemorrhage. Neonatal complications were birth injuries, poor 5-minute Apgar score and early neonatal death. In our setting, macrosomia is associated with increased maternal and neonatal complications. PMID:24958734

Elie, Nkwabong

2014-10-01

100

Tattoo-associated complications.  

PubMed

Tattoo rates in the United States have been rising in recent years, with an expected concomitant rise in tattoo-associated complications. Tattoo complications range from cutaneous localized and generalized inflammatory eruptions, to local bacterial or viral infections, and finally to infectious endocarditis and hepatitis. Many complications may be avoided with proper counseling prior to tattoo placement, especially in high risk individuals. It is important for physicians to be able to recognize and diagnose complications from tattoos to avoid morbidity and possible mortality. PMID:23287600

Juhas, Elizabeth; English, Joseph C

2013-04-01

101

Coagulation and Placenta-Mediated Complications  

PubMed Central

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

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

2014-01-01

102

Coagulation and placenta-mediated complications.  

PubMed

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

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

2014-10-01

103

Vascular complications of osteochondromas  

Microsoft Academic Search

Purpose: Osteochondromas are the most common benign tumor of the bone. They are sometimes responsible for vascular complications involving either veins or arteries, principally around the knee.Methods: We report six cases of such complications. An extensive review of literature through a computerized research was performed.Results: We found 97 cases that were previously reported in the English literature giving sufficient details

Marc-Antoine Vasseur; Oliver Fabre

2000-01-01

104

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

PubMed Central

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

Moran, Lia; Gilad, Jacob

2007-01-01

105

Neurologic complications of carcinoid.  

PubMed

We reviewed the records of all patients treated for carcinoid tumors at Memorial Sloan-Kettering Cancer Center from 1974 through 1984. Of 219 patients, 90 developed metastatic complications, and of these, 36 developed neurologic complications. Metastases, the most common neurologic complication, included epidural spinal cord compression (14 patients), intracranial metastases (13 patients), leptomeningeal metastases (1 patient), and peripheral nerve lesions (5 patients). Nonmetastatic complications were hepatic encephalopathy (six patients), herpes zoster infection (two patients), cerebral infarction due to septic emboli (one patient), superior sagittal sinus thrombosis (one patient), and carcinoid myopathy (one patient). The carcinoid syndrome was seen in eight patients (4%). Response of neurologic metastases to conventional radiation therapy was usually favorable. We conclude that (1) the frequency and type of neurologic complications associated with carcinoid tumors are similar to those seen with other systemic cancers; (2) CNS metastases are relatively common in patients with metastatic carcinoid (29%); and (3) the carcinoid syndrome is less common than CNS metastasis. PMID:3703281

Patchell, R A; Posner, J B

1986-06-01

106

Management of complicated duodenal diverticula.  

PubMed

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

Oukachbi, N; Brouzes, S

2013-06-01

107

Gastrointestinal complications of diabetes mellitus  

PubMed Central

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

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

2013-01-01

108

Encephalitis complicating smallpox vaccination.  

PubMed

A smallpox vaccination program has been initiated. The vaccine is a live virus that was used in the last century. Postvaccinal encephalitis is a complication of this vaccine. The clinical presentation, course, neuroimaging findings, and spinal fluid abnormalities are similar to a disorder that physicians are familiar with, acute disseminated encephalomyelitis. This complication can be prevented with the administration of antivaccinia gamma globulin at the time of vaccination. Antivaccinia gamma globulin is not efficacious once this complication occurs. Intravenous methylprednisolone is the recommended therapy, although intravenous immunoglobulin and plasmapheresis should be investigated in the treatment of postvaccinal encephalitis. PMID:12873847

Miravalle, Augusto; Roos, Karen L

2003-07-01

109

[Neurological complications in uremia].  

PubMed

Neurological complications due to the uremic state or hemodialysis, contribute to the important cause of mortality in patients with uremia. Despite continuous advances in uremic treatment, many neurological complications of uremia, like uremic encephalopathy, peripheral neuropathy and myopathy fail to fully respond to hemodialysis. Moreover, hemodialysis or kidney transplantation may even induce neurological complications. Hemodialysis can directly or indirectly be associated with Wernicke's encephalopathy, dialytic dementia, dysequilibrium syndrome, cerebrovascular accidents, osmotic myelinolysis and mononeuropathy. Renal transplantation can give rise to rejection encephalopathy and acute femoral neuropathy. The use of immunosuppressive drugs after renal transplantation can cause reversible posterior leukoencephalopathy encephalopathy. The clinical, pathophysiological and therapeutical aspects of central nervous system, peripheral nervous system and myopathy complications in uremia are reviewed. PMID:18686653

Fong, Chin-Shih

2008-06-01

110

Complications of Circumcision  

PubMed Central

In the United States, circumcision is a commonly performed procedure. It is a relatively safe procedure with a low overall complication rate. Most complications are minor and can be managed easily. Though uncommon, complications of circumcision do represent a significant percentage of cases seen by pediatric urologists. Often they require surgical correction that results in a significant cost to the health care system. Severe complications are quite rare, but death has been reported as a result in some cases. A thorough and complete preoperative evaluation, focusing on bleeding history and birth history, is imperative. Proper selection of patients based on age and anatomic considerations as well as proper sterile surgical technique are critical to prevent future circumcision-related adverse events. PMID:22235177

Krill, Aaron J.; Palmer, Lane S.; Palmer, Jeffrey S.

2011-01-01

111

Pregnancy Complications: Shoulder Dystocia  

MedlinePLUS

... In the NICU Home after the NICU Your premature baby Birth Defects Loss and grief Pregnancy loss Newborn loss ... and the baby do well and have no permanent damage. But there may be some complications. For ...

112

Systemic Amyloidosis Complicating Dermatoses.  

National Technical Information Service (NTIS)

Certain dermatoses may be complicated by systemic amyloidosis. The underlying disorders in eight of 100 patients with secondary systemic amyloidosis studied at autopsy were: hidradenitis suppurativa, stasis ulcers, psoriatic arthritis, basal cell carcinom...

M. H. Brownstein, E. B. Helwig

1970-01-01

113

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 ...

114

Chickenpox (Varicella) Complications  

MedlinePLUS

... People at High Risk for Complications Interpreting Lab Tests Assessing Immunity Managing People at Risk for Severe Varicella Preventing Varicella in Healthcare Settings Monitoring the Impact of Varicella Vaccination Conducting Varicella Surveillance Laboratory Testing ...

115

Complications of circumcision  

Microsoft Academic Search

Circumcision remains the most common operation performed on males. Although, not technically difficult, it is accompanied\\u000a by a rate of morbidity and can result in complications ranging from trivial to tragic. The reported incidence of complications\\u000a varies from 0.1% to 35% the most common being infection, bleeding and failure to remove the appropriate amount of foreskin.\\u000a Forty patients suffering from

O. Latifoglu; R. Yavuzer; S. Ünal; A. Sari; S. Çenetoglu; N. K. Baran

1999-01-01

116

[Type 2 diabetes complications].  

PubMed

People with type 2 diabetes are at increased risk of many complications, which are mainly due to complex and interconnected mechanisms such as hyperglycemia, insulino-resistance, low-grade inflammation and accelerated atherogenesis. Cardi-cerebrovascular disease are frequently associated to type 2 diabetes and may become life threatening, particularly coronaropathy, stroke and heart failure. Their clinical picture are sometimes atypical and silencious for a long time. Type 2 diabetes must be considered as an independent cardiovascular risk factor. Nephropathy is frequent in type 2 diabetes but has a mixed origin. Now it is the highest cause of end-stage renal disease. Better metabolic and blood pressure control and an improved management of microalbuminuria are able to slowdown the course of the disease. Retinopathy which is paradoxically slightly progressive must however be screened and treated in these rather old patients which are globally at high ophthalmologic risk. Diabetic foot is a severe complication secondary to microangiopathy, microangiopathy and neuropathy. It may be considered as a super-complication of several complications. Its screening must be done on a routine basis. Some cancer may be considered as an emerging complication of type 2 diabetes as well as cognitive decline, sleep apnea syndrome, mood disorders and bone metabolism impairments. Most of the type 2 diabetes complications may be prevented by a strategy combining a systematic screening and multi-interventional therapies. PMID:23528336

Schlienger, Jean-Louis

2013-05-01

117

Obstetric complications and congenital malformation in schizophrenia  

Microsoft Academic Search

Recent years have witnessed increasingly intense research activity concerning early life somatic trauma and dysmorphogenesis which are associated with the later development of schizophrenia. The two somatic factors that have received the most extensive scientific attention as antecedents of schizophrenia are obstetric complications (OCs) and the congenital malformations termed `minor physical anomalies' (MPAs). Head circumference (HC) at birth has also

Thomas F McNeil; Elizabeth Cantor-Graae; Baher Ismail

2000-01-01

118

Very low rates of neutropenic complications and chemotherapy dose modifications in early breast cancer patients receiving adjuvant FEC100 or TAC and an individualised G-CSF and anti-infective support: results of a retrospective chart review  

Microsoft Academic Search

Summary  PURPOSE: Granulocyte-colony stimulating factors (G-CSFs) can effectively protect cancer patients receiving chemotherapy from\\u000a neutropenic complications. To increase the efficacy, an individualised algorithm for the administration of G-CSF and anti-infectives\\u000a was developed. Its impact on the neutropenic complications and entailed dose modifications in breast cancer patients receiving\\u000a FEC-100 or TAC was evaluated. PATIENTS AND METHODS: Supportive therapy comprised G-CSF (filgrastim, lenograstim

J. Klocker; J. Schumer; M. Kanatschnig; E. P. Forsthuber; R. Likar; D. Geissler

2010-01-01

119

Complications of hysterectomy.  

PubMed

Hysterectomy is the most common gynecologic procedure performed in the United States, with more than 600,000 procedures performed each year. Complications of hysterectomy vary based on route of surgery and surgical technique. The objective of this article is to review risk factors associated with specific types of complications associated with benign hysterectomy, methods to prevent and recognize complications, and appropriate management of complications. The most common complications of hysterectomy can be categorized as infectious, venous thromboembolic, genitourinary (GU) and gastrointestinal (GI) tract injury, bleeding, nerve injury, and vaginal cuff dehiscence. Infectious complications after hysterectomy are most common, ranging from 10.5% for abdominal hysterectomy to 13.0% for vaginal hysterectomy and 9.0% for laparoscopic hysterectomy. Venous thromboembolism is less common, ranging from a clinical diagnosis rate of 1% to events detected by more sensitive laboratory methods of up to 12%. Injury to the GU tract is estimated to occur at a rate of 1-2% for all major gynecologic surgeries, with 75% of these injuries occurring during hysterectomy. Injury to the GI tract after hysterectomy is less common, with a range of 0.1-1%. Bleeding complications after hysterectomy also are rare, with a median range of estimated blood loss of 238-660.5 mL for abdominal hysterectomy, 156-568 mL for laparoscopic hysterectomy, and 215-287 mL for vaginal hysterectomy, with transfusion only being more likely after laparoscopic compared to vaginal hysterectomy (odds ratio 2.07, confidence interval 1.12-3.81). Neuropathy after hysterectomy is a rare but significant event, with a rate of 0.2-2% after major pelvic surgery. Vaginal cuff dehiscence is estimated at a rate of 0.39%, and it is more common after total laparoscopic hysterectomy (1.35%) compared with laparoscopic-assisted vaginal hysterectomy (0.28%), total abdominal hysterectomy (0.15%), and total vaginal hysterectomy (0.08%). With an emphasis on optimizing surgical technique, recognition of surgical complications, and timely management, we aim to minimize risk for women undergoing hysterectomy. PMID:23635631

Clarke-Pearson, Daniel L; Geller, Elizabeth J

2013-03-01

120

Complicated necrotizing otitis externa.  

PubMed

Necrotizing (malignant) otitis externa (NOE) is a rare and invasive infection originating in the external acoustic meatus seen most commonly in diabetes and other immunocompromised states. After a protracted course, disease can smolder and extend into the mastoid, skull base, dural sinuses, and intracranially. We present a case of NOE complicated by mastoiditis, dural sinus thrombosis, and Bezold's abscess in an uncontrolled diabetic presenting with a prolonged course of facial nerve palsy. We stress the importance of maintaining a high index of clinical suspicion for NOE in diabetic patients and offering timely, aggressive treatment to mitigate its complications. PMID:23927998

Nawas, Mariam T; Daruwalla, Vistasp J; Spirer, David; Micco, Alan G; Nemeth, Alexander J

2013-01-01

121

Complications of hip fractures: A review  

PubMed Central

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.

Carpintero, Pedro; Caeiro, Jose Ramon; Carpintero, Rocio; Morales, Angela; Silva, Samuel; Mesa, Manuel

2014-01-01

122

[Complications of experimental lung transplantations].  

PubMed

Experimental lung transplantations are burdened with a very high rate of complications even is there is a strict consideration of sterile precautions. These complications occur predominantly directly in connection with organ rejection. Extrathoracic complications are rare and predominantly attributed to arterial embolism. All untreated receivers of lung had thoracic complications in autopsy. Only 5% of immune suppressively treated receivers were free of complications. Most frequent complications are pleuropulmonary infections. Weighty complications are haemorrhagic infarcts of the transplant and insufficiency of the bronchus. Only without complications can survived about years the chronic rejection. PMID:7025481

Engelmann, C; Kaltwasser, K; Danzmann, E; Riesner, R; Schimmack, L; Reutgen, H; Voigt, H

1981-01-01

123

Non-infectious pulmonary complications after bone marrow transplantation  

PubMed Central

Bone marrow transplantation (BMT) is a successful and recognised treatment option for patients with a number of haematological and non-haematological malignant and non-malignant conditions. Pulmonary complications both infectious and non-infectious are common after BMT. Multiple factors are thought to contribute to pulmonary complications, including the type and duration of immunological defects produced by the underlying disease and treatment, the development of graft-versus-host disease (GVHD), and the conditioning regimens employed. These complications are classified as early or late, depending on whether they occur before or after 100 days from transplantation. Early non-infectious pulmonary complications typically include pulmonary oedema, upper airway complications, diffuse alveolar haemorrhage, cytolytic thrombi, and pleural effusion. Bronchiolitis obliterans, veno-occlusive disease, and secondary malignancies occur late after BMT. Idiopathic pneumonia syndrome, GVHD, and radiation induced lung injury can occur in early or late period after BMT. PMID:12151565

Khurshid, I; Anderson, L

2002-01-01

124

Tattoos: dermatological complications  

Microsoft Academic Search

From the Eskimo in Greenland to the tribes in Polynesia­the whole world knows the art of tattoo. Despite their wide popularity the relation between the skin diseases and the tattooed pictures aren't studied in depth. With the appearance of professional tattoo studios, the risk of infectious complications was reduced. Simultaneously, on a global scale there has been an increase in

Jana Kazandjieva; Nikolai Tsankov

2007-01-01

125

Treatment of complicated grief  

PubMed Central

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

Rosner, Rita; Pfoh, Gabriele; Kotoucova, Michaela

2011-01-01

126

Pulmonary complications of hemoglobinopathies.  

PubMed

Hemoglobinopathies are diseases caused by genetic mutations that result in abnormal, dysfunctional hemoglobin molecules or lower levels of normal hemoglobin molecules. The most common hemoglobinopathies are sickle cell disease (SCD) and the thalassemias. In SCD, an abnormal hemoglobin alters the erythrocyte, causing a chronic hemolytic anemia, which can lead to pulmonary parenchymal damage and impaired vascular function. Pulmonary complications of SCD include the acute chest syndrome (ACS), reactive airways disease, pulmonary hypertension (PH), and pulmonary fibrosis. Episodes of ACS and the development of PH both increase the risk of death in patients with SCD. Both ? and ? thalassemia are characterized by impaired production of hemoglobin subunits, and severity of disease varies widely. Although screening studies suggest that PH is a common complication for patients with thalassemia, its impact on survival is unknown. Understanding the pathogenesis, diagnostic options, and prevention and treatment strategies for such complications is critical for clinicians who care for these patients. In this review, we discuss the mechanisms and clinical presentation of pulmonary complications associated with hemoglobinopathies, with a focus on recent advances in pathogenesis and treatment. PMID:20923801

Vij, Rekha; Machado, Roberto F

2010-10-01

127

Neurological Complications of Transplantation  

PubMed Central

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

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

2013-01-01

128

Complications of sphenoid sinusitis  

Microsoft Academic Search

Regarding the skull base, no structure is as centrally located as the sphenoid sinus. It sits at the junction of the anterior and middle cranial fossae, and is surrounded by vital structures. Although relatively rare, complications of the inflammatory and infectious conditions of sphenoid sinusitis are the result of direct extension of disease to the surrounding tissues, or a propagated

Andrew Goldman

2003-01-01

129

CT of superior mesenteric vein thrombosis complicating periappendiceal abscess.  

PubMed

Acute mesenteric vein thrombosis is a rare complication of appendicitis. In this report we describe the clinical association of these entities and emphasize how early diagnosis by CT can expedite treatment. PMID:8454761

Yu, J S; Bennett, W F; Bova, J G

1993-01-01

130

Obstetrical Complications and Violent Delinquency: Testing Two Developmental Pathways.  

ERIC Educational Resources Information Center

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…

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

2002-01-01

131

Embryonic stem cell research and the argument of complicity  

Microsoft Academic Search

While the argument of complicity is only rarely discussed in bioethics, it is of obvious relevance to the issue of imported embryonic stem cells in countries in which the derivation of stem cells from early human embryos is legally prohibited and\\/or morally rejected. Complicity means that making use of the results or products of an illegal or morally problematic activity

Dieter Birnbacher

2009-01-01

132

Blepharoplasty complications: prevention and management.  

PubMed

This article presents common and rare complications following blepharoplasty, with discussion of avoidance of these complications through presurgical planning and review. Management of the complications is provided, with surgical details supported by images and advice for the best approaches. The complications discussed include hemorrhage, infection, corneal abrasion, ptosis, lacrimal gland injury, and residual excess skin. PMID:23186771

Whipple, Katherine M; Lim, Lee Hooi; Korn, Bobby S; Kikkawa, Don O

2013-01-01

133

Fistulas complicating diverticulitis  

Microsoft Academic Search

This study was undertaken to assess the appropriate management of patients with diverticulitis complicated by fistula formation.\\u000a A retrospective chart review was conducted on patients with symptoms of a fistula who presented between 1975 to 1995. There\\u000a were 42 patients (32 women, 76%; 10 men, 24%) who ranged in age from 46 to 89 years (mean 69.8±9.8). Six patients had

C.-A. Vasilevsky; P. Belliveau; J. L. Trudel; B. L. Stein; P. H. Gordon

1998-01-01

134

Neurologic Complications of Sarcoma  

Microsoft Academic Search

Sarcomas are a heterogeneous group of tumors that rarely involve the nervous system. Neurologic effects of sarcoma are more\\u000a often due to tumors outside of the central nervous system. However, as long-term survival rates in childhood sarcoma improves,\\u000a reports of late neurologic complications have increased. With recent advances in treating local sarcomas with targeted molecular\\u000a therapies, the incidence of late

Santosh Kesari; Lara J. Kunschner

135

Gastrointestinal Complications in Patients Undergoing Heart Operation  

PubMed Central

Introduction: Gastrointestinal (GI) complications following heart operation may be life-threatening. Systematic analysis of risk factors to allow early identification of patients at risk for GI complication may lead to the development of strategies to mitigate this complication as well as to optimize management after its occurrence. Methods: Of 8709 consecutive patients undergoing heart operation during 7 years (1997–2003), 46 (0.53%) developed GI complications requiring surgical consultation. Preoperative, intraoperative, and postoperative predictors of complication and death were identified and compared with a control group. Results: Significant (P < 0.05) preoperative predictors of complication were prior cerebrovascular accident (CVA), chronic obstructive pulmonary disease (COPD), type II heparin-induced thrombocytopenia, atrial fibrillation, prior myocardial infarction, renal insufficiency, hypertension, and need for intra-aortic balloon counter-pulsation. The most frequent serious GI complication was mesenteric ischemia, which developed in 31 (67%) patients. Twenty-two (71%) of these patients were explored, and 14 (64%) died within 2 days of heart operation. Of the 9 patients with mesenteric ischemia who were not explored, 7 (78%) died within 3 days of heart operation. Other complications included diverticulitis (5), pancreatitis (4), peptic ulcer disease (4), and cholecystitis (2). The mortality rate in this group of other diagnoses was lower (40%), and death occurred later (32 days) after heart operation (P = 0.03 compared with mesenteric ischemia). Predictors of death from GI complication included New York Heart Association (NYHA) class III and IV heart failure, smoking, chronic obstructive pulmonary disease, history of syncope, aspartate aminotransferase (AST) >600U/L, direct bilirubin >2.4mg/dL, pH < 7.30, and the need for >2 pressors. Conclusions: The most common catastrophic GI complication after cardiac surgery is mesenteric ischemia, which is frequently fatal. This complication may be a result of atheroembolization, heparin-induced thrombocytopenia, or hypoperfusion. Techniques to reduce the occurrence of and/or preemptively diagnosis postcardiotomy mesenteric ischemia are necessary to decrease its associated mortality. PMID:15912039

Mangi, Abeel A.; Christison-Lagay, Emily R.; Torchiana, David F.; Warshaw, Andrew L.; Berger, David L.

2005-01-01

136

Neurologic complications of cardiac tests and procedures.  

PubMed

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

Sila, Cathy

2014-01-01

137

[Complications of hemorrhoids].  

PubMed

The most common and serious complications of haemorrhoids include perianal thrombosis and incarcerated prolapsed internal haemorrhoids with subsequent thrombosis. They are characterised by severe pain in the perianal region possibly with bleeding. In a short history of the perianal thrombosis, acute surgical incision or excision is indicated, which can result in rapid relief of the painful symptoms. In incarcerated prolapsed internal haemorrhoids, emergency haemorrhoidectomy may also be indicated. Segmental haemorrhoidectomy in the most affected quadrants followed by further elective surgery for haemorrhoids in the next stage is preferred. PMID:24881480

Slauf, P; Antoš, F; Marx, J

2014-04-01

138

Postoperative abdominal complications after cardiopulmonary bypass  

PubMed Central

Background To summarize the diagnostic and therapeutic experiences on the patients who suffered abdominal complications after cardiovascular surgery with cardiopulmonary bypass(CPB). Methods A total of 2349 consecutive patients submitted to cardiovascular surgery with CPB in our hospital from Jan 2004 to Dec 2010 were involved. The clinical data of any abdominal complication, including its incidence, characters, relative risks, diagnostic measures, medical or surgical management and mortality, was retrospectively analyzed. Results Of all the patients, 33(1.4%) developed abdominal complications postoperatively, including 11(33.3%) cases of paralytic ileus, 9(27.3%) of gastrointestinal haemorrhage, 2(6.1%) of gastroduodenal ulcer perforation, 2(6.1%) of acute calculus cholecystitis, 3(9.1%) of acute acalculus cholecystitis, 4(12.1%) of hepatic dysfunction and 2(6.1%) of ischemia bowel diseases. Of the 33 patients, 26 (78.8%) accepted medical treatment and 7 (21.2%) underwent subsequent surgical intervention. There were 5(15.2%) deaths in this series, which was significantly higher than the overall mortality (2.7%). Positive history of peptic ulcer, advanced ages, bad heart function, preoperative IABP support, prolonged CPB time, low cardiac output and prolonged mechanical ventilation are the risk factors of abdominal complications. Conclusions Abdominal complications after cardiovascular surgery with CPB have a low incidence but a higher mortality. Early detection and prompt appropriate intervention are essential for the outcome of the patients. PMID:23046511

2012-01-01

139

[Acute hepatic vascular complications].  

PubMed

Acute hepatic vascular complications are rare. Acute portal vein thrombosis (PVT) and the Budd-Chiari syndrome (BSC) are the leading causes. Coagulopathy and local factors are present in up to 80% of cases. Diagnosis is established by colour-coded Doppler sonography, contrast-enhanced computed tomography or magnetic resonance imaging. Patients with acute PVT present with abdominal pain and disturbed intestinal motility. In the absence of cirrhosis anticoagulation with heparin is established followed by oral anticoagulation. In severe cases, surgical thrombectomy or transjugular thrombolysis with stent shunt may be necessary. Acute or fulminant BCS may require emergency liver transplantation or a transjugular intrahepatic portosystemic stent shunt, if patients present with acute liver failure. Milder cases receive anticoagulation for thrombolysis of occluded hepatic veins. Sinusoidal obstruction syndrome (SOS) is diagnosed after total body irradiation or chemotherapy, the term SOS replacing the former veno-occlusive disease. The treatment of congenital vascular malformations, complications in the setting of OLTX as well as patients with hepatic involvement of hereditary hemorrhagic telangiectasia requires significant expertise in a multidisciplinary approach. PMID:21667100

Ochs, A

2011-07-01

140

Osteomyelitis complicating Streptococcus milleri endocarditis.  

PubMed Central

A patient with osteomyelitis of the spine complicating bacterial endocarditis due to Streptococcus milleri is discussed. To our knowledge, this is the first time this organism has been associated with this complication. Images Figure 1 PMID:2385559

Barham, N. J.; Flint, E. J.; Mifsud, R. P.

1990-01-01

141

Complications Related to Gastric Endoscopic Submucosal Dissection and Their Managements  

PubMed Central

Endoscopic submucosal dissection (ESD) for early gastric cancer is a well-established procedure with the advantage of resection in an en bloc fashion, regardless of the size, shape, coexisting ulcer, and location of the lesion. However, gastric ESD is a more difficult and meticulous technique, and also requires a longer procedure time, than conventional endoscopic mucosal resection. These factors naturally increase the risk of various complications. The two most common complications accompanying gastric ESD are bleeding and perforation. These complications are known to occur both intraoperatively and postoperatively. However, there are other rare but serious complications related to gastric ESD, including aspiration pneumonia, stenosis, venous thromboembolism, and air embolism. Endoscopists should have sufficient knowledge about such complications and be prepared to deal with them appropriately, as successful management of complications is necessary for the successful completion of the entire ESD procedure.

Saito, Itaru; Tsuji, Yosuke; Sakaguchi, Yoshiki; Niimi, Keiko; Ono, Satoshi; Kodashima, Shinya; Yamamichi, Nobutake; Koike, Kazuhiko

2014-01-01

142

Complications of neuroimaging.  

PubMed

Modern imaging techniques with computed tomography (CT) and magnetic resonance imaging (MRI) have revolutionized neuroimaging. While eliminating the risks of invasive procedures, new risks must now be considered before ordering neuroimaging. Advanced imaging techniques with CT may pose a risk of significant radiation exposure. Contrast may pose a risk in patients with pre-existing renal failure. MR is associated with risks related to the static magnetic field, to risks associated with the magnetic field gradients, and to risk from contrast media. Neurointervenional techniques allow for nonoperative treatment of a variety of intracranial and spinal pathologies, but with associated risks of embolization, radiation exposure, bleeding complications at the access site and a potential for contrast-related nephropathy. PMID:24365444

Rosenblum, Jordan D; Pasternak, Olga; Mitchell, Myrosia M

2014-01-01

143

Gastrointestinal complications of oncologic therapy.  

PubMed

Gastrointestinal complications are common in patients undergoing various forms of cancer treatment, including chemotherapy, radiation therapy, and molecular-targeted therapies. Many of these complications are life-threatening and require prompt diagnosis and treatment. Complications of oncologic therapy can occur in the esophagus (esophagitis, strictures, bacterial, viral and fungal infections), upper gastrointestinal tract (mucositis, bleeding, nausea and vomiting), colon (diarrhea, graft-versus-host disease, colitis and constipation), liver (drug hepatotoxicity and graft-versus-host disease), and pancreas (pancreatitis). Treatment of the different gastrointestinal complications should be tailored to the individual patient and based on the underlying pathophysiology of the complication. PMID:18941434

Davila, Marta; Bresalier, Robert S

2008-12-01

144

Genital herpes complicating pregnancy.  

PubMed

Approximately 22% of pregnant women are infected with herpes simplex virus (HSV)-2, and 2% of women will acquire HSV during pregnancy. Remarkably, up to 90% of these women are undiagnosed because they are asymptomatic or have subtle symptoms attributed to other vulvovaginal disorders. Diagnosis of genital herpes relies on laboratory confirmation with culture or polymerase chain reaction assay of genital lesions and type-specific glycoprotein G-based serologic testing. Neonatal herpes is the most severe complication of genital HSV infection and is caused by contact with infected genital secretions at the time of labor. Maternal acquisition of HSV in the third trimester of pregnancy carries the highest risk of neonatal transmission. Despite advances in the diagnosis and treatment of neonatal herpes, little change in the incidence or serious sequelae from this infection has occurred. As such, prevention of the initial neonatal infection is critically important. Obstetricians are in a unique position to prevent vertical HSV transmission by identifying women with genital lesions at the time of labor for cesarean delivery, prescribing antiviral suppressive therapy as appropriate, and avoiding unnecessary invasive intrapartum procedures in women with genital herpes. Enhanced prevention strategies include identification of women at risk for HSV acquisition during pregnancy by testing women and possibly their partners for HSV antibodies and providing counseling to prevent transmission to women in late pregnancy. PMID:16199646

Brown, Zane A; Gardella, Carolyn; Wald, Anna; Morrow, Rhoda Ashley; Corey, Lawrence

2005-10-01

145

Maxillary odontogenic sinusitis, complicated with cerebral abscess--case report.  

PubMed

Maxillary sinus inflammation, when untreated or incorrectly treated, may extend locoregionally, the remaining paranasal sinuses being the first affected anatomical structures. This is why the understanding of the inflammatory pathology of the maxillary sinus, and particularly of the complications it can generate, is extremely important. The purpose of this presentation is to point out that inflammations of the paranasal sinuses are susceptible to develop complications in certain conditions and threaten the patient's life due to the proximity of vital structures. This is the case of a 16 years old male patient who developed a left maxillary and frontal sinusitis, complicated with cerebral abscess. Early detection, multidisciplinary approach and proper indication of surgical treatment, as well as early suspicion of complication, especially in young male adolescents, are extremely important. PMID:22712359

Oni?or-Gligor, F; Lung, T; Pintea, B; Mure?an, O; Pop, P B; Juncar, M

2012-01-01

146

Pancreatic sphincterotomy: Technique, indications, and complications  

PubMed Central

Pancreatic sphincterotomy serves as the cornerstone of endoscopic therapy of the pancreas. Historically, its indications have been less well-defined than those of endoscopic biliary sphincterotomy, yet it plays a definite and useful role in diseases such as chronic pancreatitis and pancreatic-type sphincter of Oddi dysfunction. In the appropriate setting, it may be used as a single therapeutic maneuver, or in conjunction with other endoscopic techniques such as pancreatic stone extraction or stent placement. The current standard of practice utilizes two different methods of performing pancreatic sphincterotomy: a pull-type sphincterotome technique without prior stent placement, and a needle-knife sphincterotome technique over an existing stent. The complications associated with pancreatic sphincterotomy are many, although acute pancreatitis appears to be the most common and the most serious of the early complications. As such, it continues to be reserved for those endoscopists who perform a relatively high-volume of therapeutic pancreaticobiliary endoscopic retrograde cholangio-pancreatography. PMID:17696223

Buscaglia, Jonathan M; Kalloo, Anthony N

2007-01-01

147

Intracranial complications of chronic otitis media.  

PubMed

The objective of this study was to review our experience on intracranial complications (ICC) secondary to chronic otitis media (COM), and to investigate its clinical characteristics and treatment approaches. From January 1996 to December 2012, 17 patients with ICC secondary to COM were identified and included in this study, and were analyzed retrospectively. 13 out of these 17 cases (76.4 %) have cholesteatoma. The most common intracranial complication is brain abscesses (52.9 %), followed by meningitis (29.4 %), perisinus abscess (11.7 %), and epidural abscess (6 %). All patients underwent emergency mastoidectomy within the first 24 h after clear diagnosis. 7 patients underwent brain abscess drainage or abscess excision at the time of ear surgery. The mortality rates are 0 %. No recurrence was found in the 24-month follow-up period. Cholesteatoma was strongly associated with ICC. An early diagnosis and active surgical intervention in collaboration with proper antibiotic treatment is the key to cure. PMID:24162767

Sun, Jiaqiang; Sun, Jingwu

2014-11-01

148

Gastrointestinal complications of oncologic therapy  

Microsoft Academic Search

Gastrointestinal complications are common in patients undergoing various forms of cancer treatment, including chemotherapy, radiation therapy, and molecular-targeted therapies. Many of these complications are life-threatening and require prompt diagnosis and treatment. Complications of oncologic therapy can occur in the esophagus (esophagitis, strictures, bacterial, viral and fungal infections), upper gastrointestinal tract (mucositis, bleeding, nausea and vomiting), colon (diarrhea, graft–versus–host disease, colitis

Marta Davila; Robert S Bresalier

2008-01-01

149

Managing apheresis complications during the hematopoietic stem cell collection.  

PubMed

Adverse reactions may occur during the Hematopoietic Progenitor Cells via Apheresis (HPC-A) -collection, although they are rare. They can be associated with physical, psychological, or environmental factors. The most common complications are hypocalcemia related to citrate toxicity, allergic reactions, and vasovagal reactions. Recognizing and treating the symptom early can reduce the severity of most of these reactions. Procedural steps are outlined in this chapter for the proper management of apheresis complications. PMID:22890925

Marlow, S Darlene; House, Myra

2012-01-01

150

Severe complication of rubber band ligation of internal hemorrhoids  

Microsoft Academic Search

In light of recent reports describing severe and even fatal complications, the authors would like to report good results in\\u000a two patients with massive edema and one with localized necrosis following rubber band ligation of internal hemorrhoids, which\\u000a were recognized early and treated aggressively. The potential for severe complications emphasizes the need for determining\\u000a other causes of rectal symptoms before

Eli I. Shemesh; Ira J. Kodner; Robert D. Fry; David M. Neufeld

1987-01-01

151

Complications at the Time of Transcatheter Aortic Valve Implantation  

PubMed Central

Transcatheter aortic valve implantation (TAVI) improves the prognosis of patients with severe aortic stenosis who are deemed too high risk for surgical valve replacement.1 However, this evolving technology is associated with a wide range of potential complications — some specific to TAVI, some often fatal. Prevention, early recognition, and effective treatment of these complications will significantly improve the outcome of this procedure and are essential prerequisites before the therapy is extended to lower-risk patient subsets. PMID:22891127

Brecker, Stephen J.D.; Roy, David; Jahangiri, Marjan

2012-01-01

152

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

PubMed

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

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

2014-10-01

153

Hypothyroidism: a growing complication of cancer treatment.  

PubMed

Hypothyroidism is an often underreported complication of cancer treatment. With the growing number of biological and targeted therapies, hypothyroidism may become a more prevalent clinical problem. Signs and symptoms of hypothyroidism may be easily attributed to the cancer or cancer treatment, leading to unnecessary dose modifications or discontinuation of effective therapies. Furthermore, these symptoms have a negative effect on quality of life. Measurement of TSH levels in at-risk patients prior to initiating treatment and at regular intervals during treatment will allow early intervention and effective treatment of hypothyroidism. PMID:19856608

Kurtin, Sandra E

2009-10-01

154

Complicated diverticulitis following renal transplantation  

Microsoft Academic Search

PURPOSE: Colonic perforations in renal transplant recipients have historically been associated with mortality rates as high as 50 to 100 percent. However, these previous series generally predate the use of cyclosporine-based immuno-suppressive protocols. METHODS: We retrospectively reviewed all patients who had undergone renal transplant from our institution and who developed complicated diverticulitis. Complicated diverticulitis was defined as diverticulitis involving free

Eric D. Lederman; David J. Conti; Neil Lempert; T. Paul Singh; Edward C. Lee

1998-01-01

155

Neurological complications of pertussis inoculation  

Microsoft Academic Search

Findings are presented in 36 children, seen in the past 11 years, who are believed to have suffered from neurological complications of pertussis inoculation (given as triple vaccine). The clustering of complications in the first 24 hours after inoculation suggests a causal rather than a coincidental relation. Possible contributory factors were present in one-third of patients studied and support the

M. Kulenkampff; J. S. Schwartzman; J. Wilson

1974-01-01

156

Clinical complications of osseointegrated implants  

Microsoft Academic Search

Statement of problem. There is no comprehensive review of the literature that identifies the complications reported in clinical dental implant studies. Purpose. This article attempted to determine the types of complications that have been reported and to provide data regarding their frequency. Methods. All available clinical studies from 1981 to 1997, published in English or with English abstract, that presented

Charles J. Goodacre; Joseph Y. K. Kan; Kitichai Rungcharassaeng

1999-01-01

157

The ABC's of stroke complications.  

PubMed

Stroke is the third leading cause of death in the United States, with more than 140,000 deaths per year. Complications related to stroke resulting in morbidity and mortality are very common and may result from cerebral and extracerebral causes. Cerebral causes include cerebral edema, hemorrhagic conversion of an ischemic infarct, and progression of penumbra to infarction. Extracerebral complications include deep vein thrombosis and pulmonary embolism, urinary tract infection, and aspiration. Many of these complications are largely preventable and often tracked as "quality metrics" in institutions with a stroke center designation. The focus of the article is primarily on common poststroke complications, such as aspiration, DVT, decubitus ulcers, seizures, and urinary catheter infections. Knowledge about potential poststroke complications is critical to earlier diagnosis, proper preventive strategies, and management. PMID:21207342

Freeman, W David; Dawson, Steven B; Flemming, Kelly D

2010-11-01

158

Ocular Complications of Leprosy in Yemen  

PubMed Central

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

Salem, Raga A. A.

2012-01-01

159

[The diabetic foot: the Cinderella of complications].  

PubMed

The problems of the diabetic foot in general are badly known by patients as well as caregivers. They represent yet a major health problem. Recall that if the ulcers are treated early and adequately, they will heal in 70 to 90% of cases. "The diabetic foot" encompasses the whole of the anomalies of the function and/or of the structure of the foot, linked directly or indirectly to hyperglycaemia. The involvement of nerves, arteries and infection can concentrate on the foot that is also called the "crossroads of complications". These various complications are reviewed in detail. The neuropathy mainly sensitive with the diminution or even the disappearance of the sensitivity to pain and its modes of detection as well as this awful and poorly known complication that is the Charcot foot. The arteriopathy sub-diagnosed and yet very frequent, its modes of detection and its treatment. The difficulties of diagnosis of infection, another serious danger for the foot, its classification and treatment. The care of the wounds whose size and depth are too often under-estimated, their classification of important prognostic value. The care of the diabetic foot wounds too often treated as "classic" wounds forgetting those topics mentioned above will be described focusing on their specific characteristics which are debridement and above all offloading. The importance of the primary and secondary prevention will be highlighted. PMID:21089420

Dumont, I

2010-09-01

160

Obturator Nerve Injury: An Infrequent Complication of TOT Procedure  

PubMed Central

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

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

2014-01-01

161

Pancreaticoduodenectomy: expected post-operative anatomy and complications.  

PubMed

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

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

2014-09-01

162

Complications of unilateral weight bearing.  

PubMed

The most common and significant complication of excessive unilateral weight bearing in adult horses is support limb laminitis. Young horses with unilateral lameness problems develop support limb laminitis infrequently compared with adult horses. PMID:19203705

Baxter, Gary M; Morrison, Scott

2008-12-01

163

Oral complications in radiation therapy.  

PubMed

The dentist is integral to managing care for patients with head and neck cancer. Oral complications may manifest during and/or following radiation therapy and can last for the lifetime of the individual. This article reviews a number of these complications as well as the resources available to dentists for managing care of radiation oncology patients and improving their quality of life. PMID:15055655

Harrison, Jody S; Dale, Robert A; Haveman, Carl W; Redding, Spencer W

2003-01-01

164

Neurologic Complications in Percutaneous Nephrolithotomy  

PubMed Central

Purpose Percutaneous nephrolithotomy (PCNL) has been the preferred procedure for the removal of large renal stones in Iran since 1990. Recently, we encountered a series of devastating neurologic complications during PCNL, including paraplegia and hemiplegia. There are several reports of neurologic complications following PCNL owing to paradoxical air emboli, but there are no reports of paraplegia following PCNL. Materials and Methods We retrospectively reviewed the medical records of patients who had undergone PCNL in 13 different endourologic centers and retrieved data related to neurologic complications after PCNL, including coma, paraplegia, hemiplegia, and quadriplegia. Results The total number of PCNL procedures in these 13 centers was 30,666. Among these procedures, 11 cases were complicated by neurologic events, and four of these cases experienced paraplegia. All events happened with the patient in the prone position with the use of general anesthesia and in the presence of air injection. There were no reports of neurologic complications in PCNL procedures performed with the patient under general anesthesia and in the prone position and with contrast injection. Conclusions It can be assumed that using room air to opacify the collecting system played a major role in the occurrence of these complications. Likewise, the prone position and general anesthesia may predispose to these events in the presence of air injection. PMID:23526482

Basiri, Abbas; Soltani, Mohammad Hossein; Kamranmanesh, Mohammadreza; Tabibi, Ali; Mohsen Ziaee, Seyed Amir; Nouralizadeh, Akbar; Sharifiaghdas, Farzaneh; Poorzamani, Mahtab; Gharaei, Babak; Ozhand, Ardalan; Lashay, Alireza; Ahanian, Ali; Aminsharifi, Alireza; Sichani, Mehrdad Mohammadi; Asl-Zare, Mohammad; Ali Beigi, Faramarz Mohammad; Najjaran, Vahid; Abedinzadeh, Mehdi

2013-01-01

165

Unusual complication of toxic megacolon in typhoid colitis.  

PubMed

Colitis is a rare manifestation of enteric fever in children. Toxic megacolon complicating typhoid colitis is even rarer and requires early recognition and aggressive management due to the high mortality associated with this condition. The authors report a rare case of Toxic megacolon secondary to typhoid colitis in a seven-year-old girl. PMID:23900751

Arun Babu, Thirunavukkarasu; Ananthakrishnan, Shanthi; Jayakumar, P; Kullu, Poonam

2014-05-01

166

Cancer in an ileoanal reservoir: a new late complication?  

Microsoft Academic Search

The functional success rate of the ileoanal reservoir procedure for ulcerative colitis is quite high. Despite the few early and late complications described there is now wide-spread acceptance of this procedure in the management of ulcerative colitis. We report a patient who developed an adenocarcinoma in the rectal cuff four years after having a pelvic pouch procedure. This new late

H Stern; S Walfisch; B Mullen; R McLeod; Z Cohen

1990-01-01

167

[Diagnosis of stroke due to cocaine and its complications].  

PubMed

INTRODUCTION. Cocaine is an independent cerebrovascular risk factor both for ischaemic and haemorrhagic events, above all among persons under 55 years of age. CASE REPORT. A case report of stroke due to the consumption of cocaine is used to review its pathophysiology and the complexity involved in the management and diagnosis of the associated complications. One of these complications reported in relation to the consumption of cocaine is vasospasm. This condition shares findings observed in ultrasound imaging studies with other conditions, such as early-onset post ischaemic hyperperfusion. Yet, there are important differences between the two as regards their treatment and prognosis. CONCLUSIONS. The consumption of cocaine is associated with cerebrovascular disease through a number of different mechanisms, which each give rise to different complications. By identifying these complications, correct management can be implemented. PMID:23884871

Larrosa-Campo, D; Ramon-Carbajo, C; Benavente-Fernandez, L; Alvarez-Escudero, R; Zeidan-Ramon, N; Calleja-Puerta, S; Pascual, J

2013-08-16

168

Complications in alveolar distraction osteogenesis of the atrophic mandible.  

PubMed

To improve the starting point for placement of dental implants, 45 patients suffering from atrophied edentulous mandibles, with a vertical height varying between 7.3 and 15.8mm, were treated by alveolar vertical distraction osteogenesis (VDO). The mean follow-up period was 3 years, ranging from 1 to 7 years. Associated complications, as occurred during instalment of the distractor device, VDO period and consolidation phase, and also after dental implant placement, were evaluated. Observed complications were: early fractures (2%), late fractures (17%), bleeding or haematoma (4%), infections (6%), skin perforation (2%), mucosal dehiscence (8%), sensory disturbances (28%), sagging chin (13%) and failure of dental implants (13%). In 10 patients 2 complications and in 1 patient 3 complications were monitored. All complications occurred in the first year. It is concluded that VDO to restore vertical bone height in patients with mandibular atrophy is a surgically delicate technique with a high risk of various complications. The likelihood of the most striking complication, namely fracture occurrence, increases with decreasing residual bone height. PMID:17919888

Perdijk, F B T; Meijer, G J; Strijen, P J van; Koole, R

2007-10-01

169

Complications of Minimally Invasive Cosmetic Procedures: Prevention and Management  

PubMed Central

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

Levy, Lauren L; Emer, Jason J

2012-01-01

170

Pulmonary complications in hematopoietic SCT: a prospective study.  

PubMed

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

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

2014-10-01

171

Fasting: The History, Pathophysiology and Complications  

PubMed Central

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

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

1982-01-01

172

Neurologic Complications in Infective Endocarditis  

PubMed Central

Neurologic complications of infective endocarditis (IE) are common and frequently life threatening. Neurologic events are not always obvious. The prediction and management of neurologic complications of IE are not easily approached algorithmically, and the impact they have on timing and ability to surgically repair or replace the affected valve often requires a painstaking evaluation and joint effort across multiple medical disciplines in order to achieve the best possible outcome. Although specific recommendations are always tailored to the individual patient, there are some guiding principles that can be used to help direct the decision-making process. Herein, we review the pathophysiology, epidemiology, manifestations, and diagnosis of neurological complications of IE and further consider the impact they have on clinical decision making. PMID:25360207

Morris, Nicholas A.; Matiello, Marcelo; Samuels, Martin A.

2014-01-01

173

Complications of intraoperative radiation therapy  

SciTech Connect

The authors have studied the severe complications occurring after treatment with intraoperative radiation therapy (IORT) in patients with locally advanced carcinoma of the rectum. Four groups of patients were compared: Group 1 (80 patients) had treatment with surgery alone for mobile and resectable tumors; Group 2 (23 patients) had treatment with high dose preoperative irradiation followed by surgical resection for tumors which were fixed to adjacent structures and initially unresectable for cure; Group 3 (24 patients, primary disease) and Group 4 (17 patients, locally recurrent disease) had locally advance tumors as in Group 2 but were treated with IORT after preoperative irradiation and attempted surgical resection. All but 3 complications occurred within one year of therapy. Severe complications were seen in 16% of patients in Group 1, 35% in Group 2, 21% in Group 3 and 47% in Group 4 (32% in Groups 3 and 4 combined).

Tepper, J.E.; Gunderson, L.L.; Orlow, E.; Cohen, A.M.; Hedberg, S.E.; Shipley, W.U.; Blitzer, P.H.; Rich, T.

1984-10-01

174

Endoscopic treatment of Crohn's complications.  

PubMed

The progression to fistula and strictures is part of the natural history of Crohn's disease (CD) and these complications negatively affect the quality of life of CD patients. Surgery is the traditional treatment of CD strictures. However, due the chronicity of the inflammatory process and the associated fibrosis, postoperative recurrence occurs frequently. The lack of specific drug to treat fibrotic strictures and their irreversible nature has drawn the attention to less invasive and bowel-sparing therapeutic modalities. Endoluminal therapies may provide effective option in relieving symptoms associated with CD complications and reduce the need for repeated surgery with substantial clinical benefit. This review will discuss the current use and efficacy of the endoscopic treatment of CD complications. New endoscopic modalities and recent advances will be also evaluated. PMID:24849124

Buda, Andrea; Okolo, Patrick I

2014-11-01

175

Complicated grief in late life  

PubMed Central

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

Miller, Mark D.

2012-01-01

176

Caregiving, bereavement and complicated grief  

PubMed Central

Most deaths are preceded by chronic illness and disability and the provision of support by family caregivers. The purpose of this article is to describe how the caregiving experience affects bereavement, with an emphasis on the relationship between challenging caregiving situations and difficult grieving processes – often referred to as `complicated grief'. The article starts with a brief summary of the general literature on caregiving and bereavement. It then defines complicated grief and discusses why some caregivers may struggle with the death of their loved one. Finally, it offers practical suggestions for what professionals can do to help caregivers both before and after the death has occurred. PMID:20463850

Boerner, Kathrin; Schulz, Richard

2010-01-01

177

Complications from international surgery tourism.  

PubMed

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

Melendez, Mark M; Alizadeh, Kaveh

2011-08-01

178

Surgical Complications of Gynecologic Surgery  

PubMed Central

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

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

1977-01-01

179

Complications Due to Breastfeeding Associated Hypernatremic Dehydration  

PubMed Central

Objective: The aim was to assess the incidence, presenting features, and complications of breastfeeding associated hypernatremic dehydration among hospitalized neonates. Materials and Methods: A retrospective study over a period of 18 months to identify term and near term (?35 weeks of gestation) breastfed neonates, who were admitted with serum sodium concentration of ?150 mEq/l and no apparent explanation for their hypernatremia other than inadequate breastmilk intake. Results: The incidence of breastfeeding associated hypernatremic dehydration among 2100 term and near term neonates was 1.38%. The median serum sodium at presentation was 164 mEq/l (range: 151-191 mEq/l). The mean weight loss in these patients was 10.16% ±6.6%. The reasons for seeking medical attention were refusal of feeds (72.41%), lethargy (68.96%), decreased urine output (44.82%), jaundice (27.58%) and fever (24.13%). Five patients (17.24%) had seizures and three (10.34%) had coagulopathy. Other complications included hypoglycemia, hypocalcemia, acute kidney injury (AKI) (37.93%) and intraventricular hemorrhage. The mean serum creatinine was 1.82 ± 2.5 mg/dl (range: 0.19-9.6). A statistically significant association was seen between serum sodium concentration at presentation and AKI. It was also found that those patients who had AKI had a higher weight loss and had presented later to the hospital than those without AKI. One patient died within 12 h of admission. This child had disseminated intravascular coagulopathy, AKI, and hypoglycemia. Conclusions: Breastfeeding associated hypernatremic dehydration is a serious condition with many serious complications and even results in death if detected late. Health care providers have increasing responsibilities of promoting proper breastfeeding techniques and taking measures for early diagnosis and treatment of this problem.

Ahmed, Asif; Iqbal, Javeed; Ahmad, Ikhlas; Charoo, Bashir A; Ahmad, Qazi Iqbal; Ahmad, Sheikh Mushtaq

2014-01-01

180

Cardiac Risks and Complications of Noncardiac Surgery  

PubMed Central

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.

Goldman, Lee

1983-01-01

181

Phase separation complicates waxy crude volume correction  

SciTech Connect

Throughout the 1980s and the early 1990s research addressed the complications of phase separation within paraffinic crude oils when transported by sea at lower temperatures. One objective was to identify the critical temperature at which phase separation occurred and to determine a method for obtaining the critical temperature onboard a vessel. Various correlations were produced based on analysis with different criteria/parameters but it remained necessary for a vessel to establish this parameter with a simple test procedure. This resulted in determining the density for various crude oils over an expected carriage temperature range to determine whether this procedure would accurately detect the phase separation temperature. The paper describes the generalized equation that was developed for volume correction, points out the sources of errors, and describes a mass calculation as an alternative technique to quantify crude oils.

Gunner, T.J. [Gunner (Tim J.), West Sussex (United Kingdom); Drury, M.J. [Drury (Malcolm J.), Surrey (United Kingdom)

1995-05-08

182

Prevention of the Musculoskeletal Complications of Hemophilia  

PubMed Central

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

Rodriguez-Merchan, E. C.

2012-01-01

183

Major Depression and Complicated Grief  

MedlinePLUS

... and bereavement 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 ...

184

The complication of pneumatic retinopexy.  

PubMed Central

There have been 26 published series with a total of 1274 detachments operated with pneumatic retinopexy. Eighty percent were reattached with a single procedure and 98% with reoperations. New breaks occurred in 13% and PVR in 4%. The complications published in 101 papers on pneumatic retinopexy in the last 5 years are analyzed as to frequency, prevention, management, and results. PMID:2095021

Hilton, G F; Tornambe, P E; Brinton, D A; Flood, T P; Green, S; Grizzard, W S; Hammer, M E; Leff, S R; Mascuilli, L; Morgan, C M

1990-01-01

185

Constraints complicate centrifugal compressor depressurization  

SciTech Connect

Blowdown of a centrifugal compressor is complicated by process constraints that might require slowing the depressurization rate and by mechanical constraints for which a faster rate might be preferred. The paper describes design constraints such as gas leaks; thrust-bearing overload; system constraints; flare extinguishing; heat levels; and pressure drop.

Key, B. (Hoover and Keith Inc., Houston, TX (United States)); Colbert, F.L. (Paragon Engineering Services Inc., Houston, TX (United States))

1993-05-10

186

Complicating the Concept of Culture  

ERIC Educational Resources Information Center

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…

Anderson-Levitt, Kathryn M.

2012-01-01

187

Permanent makeup: indications and complications  

Microsoft Academic Search

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

Christa De Cuyper

2008-01-01

188

Imaging the Complications of Osteochondromas  

Microsoft Academic Search

Most osteochondromas are asymptomatic and incidental with typical radiographic characteristics. When symptomatic, complications due to space-occupying effects, mechanical deformity, or malignant transformation are usually the underlying causes. This article addresses the imaging strategy for their identification and evaluation. Lee, J. M.et al. (2002). Clinical Radiology57, 18–28.

K. C. Y. Lee; A. M. Davies; V. N. Cassar-Pullicino

2002-01-01

189

Complications of mediastinal neural tumours  

Microsoft Academic Search

Thirty-two mediastinal neural tumours were seen in the East Anglian Regional Thoracic Surgical Unit at Cambridge between October 1952 and July 1970. The descending order of frequency was neurofibroma, ganglioneuroma, neurilemmoma, neurofibrosarcoma, and neuroblastoma. The literature relating to these tumours is reviewed and the pathological and clinical complications encountered in this series and in the literature are described.

Christopher Parish

1971-01-01

190

Anaesthetic complications in plastic surgery.  

PubMed

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

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

2013-05-01

191

Manufacturing Complicated Shells And Liners  

NASA Technical Reports Server (NTRS)

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.

Sobol, Paul J.; Faucher, Joseph E.

1993-01-01

192

Risks and complications in rhinoplasty  

PubMed Central

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

Rettinger, Gerhard

2008-01-01

193

Lymphatic complications after vascular interventions  

PubMed Central

Introduction Lymphorrhea due to classical and mini-invasive surgical interventions on femoral and popliteal arteries is a serious hindrance to patient treatment. Depending on the experience of a particular center, the incidence and frequency of this type of complication may constitute a serious clinical problem. While the level of lymphorrhea intensity and its duration result in certain foreseeable consequences, their treatment can be a time-consuming and multistep procedure. Aim To compare different types of vascular interventions with lymphorrhea occurrence. Material and methods The authors conducted a retrospective analysis of lymphatic complications based on the material collected between 2005 and 2012 at the Department of Vascular and Endovascular Surgery of the Military Institute of Medicine in Warsaw and in the Department of Interventional Cardiology and Angiology of the Institute of Cardiology in Anin, Warsaw, in 2009–2012. Results Maintaining due thoroughness when dissecting tissues and treating the cutting line in this area with ligatures and tissue puncture are the most reliable methods of minimizing the risk of lymphatic leakage after surgical procedures performed in a classical way. The lymphatic complication under analysis is far less likely to occur when procedures are performed as planned and an endovascular technique is used – statistical significance p < 0.05. Minimally invasive and fully percutaneous procedures performed via needle puncture, including the use of the fascial closure technique to close the femoral artery, eliminate the likelihood of the occurrence of this vascular complication – statistical significance was found with p value less than 0.05. Conclusions We concluded that in every case by minimizing the vascular approach we protected the patient against lymphatic complications. PMID:25337168

Obara, Andrzej; Maruszynski, Marek; Witkowski, Adam; Dabrowski, Maciej; Chmielak, Zbigniew

2014-01-01

194

Mechanisms and management of TAVR-related complications.  

PubMed

Patients with severe aortic stenosis who are at high surgical risk or not considered to be suitable candidates for surgical aortic valve replacement are increasingly being treated with transcatheter aortic valve replacement (TAVR). Although this novel treatment modality has been proven to be effective in this patient population, serious complications occur in approximately one-third of patients during the month after the procedure. Such events include myocardial infarction, cerebrovascular events, vascular complications, bleeding, acute kidney injury, valve regurgitation, valve malpositioning, coronary obstruction, and conduction disturbances and arrhythmias, which can all lead to death. Prevention of these complications should be based on patient screening and selection by a dedicated 'heart team' and the use of multimodality imaging. Anticipation and early recognition of these complications, followed by prompt management using a wide range of percutaneous or surgical rescue interventions, is vital to patient outcome. Continuous patient assessment and reporting of complications according to standardized definitions, in addition to growing operator experience and upcoming technological refinements, will hopefully reduce the future rate of complications related to this procedure. PMID:24101101

Fassa, Amir-Ali; Himbert, Dominique; Vahanian, Alec

2013-12-01

195

A rare neurological complication of typhoid fever: Guillain-Barre' syndrome  

PubMed Central

Guillain-Barre’ syndrome is a rare complication of typhoid fever, and only a few such cases have been reported in the pediatric age group. We report a young boy with blood culture proven typhoid fever that developed this very rare neurological complication quite early in the course of the disease. Following treatment with intravenous antibiotics and intravenous immunoglobulin, he improved.

Kapoor, Kapil; Jain, Sumidha; Jajoo, Mamta; Talukdar, Bibek

2014-01-01

196

Lipohypertrophy and lipoatrophy complicating treatment with highly purified bovine and porcine insulins  

Microsoft Academic Search

Lipoatrophy and lipohypertrophy were the most frequently reported local complications of conventional insulin therapy. Early reports following the introduction of highly purified insulins suggested a reduction in the frequency of lipohypertrophy and lipoatrophy. Since highly purified insulins have been in common usage for 10 years, the present frequency of these complications was assessed in a study of 281 insulin treated

P. G. McNally; N. I. Jowett; J. J. Kurinczuk; R. W. Peck; J. R. Hearnshaw

1988-01-01

197

A rare neurological complication of typhoid fever: Guillain-Barre' syndrome.  

PubMed

Guillain-Barre' syndrome is a rare complication of typhoid fever, and only a few such cases have been reported in the pediatric age group. We report a young boy with blood culture proven typhoid fever that developed this very rare neurological complication quite early in the course of the disease. Following treatment with intravenous antibiotics and intravenous immunoglobulin, he improved. PMID:25250072

Kapoor, Kapil; Jain, Sumidha; Jajoo, Mamta; Talukdar, Bibek

2014-05-01

198

Complications of chronic suppurative otitis media: a retrospective review.  

PubMed

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

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

2013-01-01

199

Retinal complications after bungee jumping.  

PubMed

Bungee jumping is becoming a popular sport in the Western world with some cases of ophthalmic complications being reported in recent literature. The authors reported a case of a 23-year-old healthy female who presented retinal complications following a bungee jumping. Her fundi showed superficial retinal hemorrhages in the right eye and a sub-internal limiting membrane hemorrhage affecting the left eye. A general examination, including a full neurological examination, was normal and laboratorial investigations were all within normal values. More studies are necessary to identify risk factors and the true incidence of related ocular lesions, but until then, we think this sport activity should be desencouraged, especially to those that are not psychological and physically fit. PMID:7642337

Filipe, J A; Pinto, A M; Rosas, V; Castro-Correia, J

200

Suicide bereavement and complicated grief  

PubMed Central

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

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

2012-01-01

201

Surgical management of complicated diverticulitis  

Microsoft Academic Search

One hundred forty patients who had complicated diverticular disease were identified in a retrospective review at the Lahey\\u000a Clinic between 1967 and 1982. Of these patients, 86 underwent resection with primary anastomosis with a 1 percent mortality\\u000a rate and an 18 percent morbidity rate; 13 had resection with anastomosis and creation of a proximal colostomy with no death\\u000a and a

Alan W. Hackford; David J. Schoetz; John A. Coller; Malcolm C. Veidenheimer

1985-01-01

202

Neurologic Complications of Lung Cancer  

Microsoft Academic Search

Lung cancer frequently causes neurological complications from direct and indirect effects. Brain metastases occur in 41% of\\u000a patients with non-small cell lung cancer and 35% with small cell lung cancer at autopsy. Presenting symptoms can be quite\\u000a protean. MRI continues to be the gold standard of detecting metastases. Biopsy or resection should be considered for patients\\u000a with a single lesion,

Suriya A. Jeyapalan; Anand Mahadevan

203

[Respiratory complications in compressive goiters].  

PubMed

Authors' experience in respiratory complications of compressive goiter is reviewed. Three cases with typical symptoms, relative therapy and outcome are reported. Appearance of respiratory distress should urge to avoid delay in elective surgery performing. In case of acute respiratory failure, immediate emergency tracheostomy is mandatory, subsequently followed by elective intervention. In case of malignancy, if radical surgery is not possible, tracheostomy is the short and medium-term palliative surgical treatment of choice. PMID:1751337

De Toma, G; Sgarzini, G; Gabriele, R; Campli, M; Adami, E A; De Cesare, E

1991-01-01

204

Genetic hypofibrinolysis in complicated pregnancies  

Microsoft Academic Search

Objective: To assess the hypofibrinolytic 4G\\/4G mutation of the plasminogen activator inhibitor (PAI-1) gene as a possible factor contributing to severe preeclampsia, abruptio placentae, fetal growth restriction, and stillbirth.Methods: We compared 94 women from a previous report who had obstetric complications to 95 controls with normal pregnancies matched for ethnic background and age. We collected blood and extracted DNA after

Charles J Glueck; Michael J Kupferminc; Robert N Fontaine; Ping Wang; Babette B Weksler; Amiram Eldor

2001-01-01

205

Complications of acute otitis media in children  

Microsoft Academic Search

The clinical picture and the treatment of acute otitis media (AOM) and its complications have changed during the past decades.\\u000a The availability of antibiotics has decreased the incidence of complications of AOM significantly. The treatment of complications\\u000a of AOM is conservative in most cases. Mastoidectomy is needed when abscess-forming mastoiditis or intracranial complications\\u000a develop. Although intratemporal and intracranial complications of

Kimmo Leskinen

2005-01-01

206

Severe complication of a bonded mandibular lingual retainer.  

PubMed

Bonding a flexible spiral wire retainer to the lingual surfaces of all 6 anterior mandibular teeth is a commonly used type of retention. Complications are rare but can be serious enough to produce biologic damage. This article presents a serious complication of a lingual flexible spiral wire retainer. Four years after the orthodontic treatment, a 20-year-old man sought treatment for a broken flexible spiral wire retainer. The clinical examination showed about 35° of buccal root torque of that tooth. A cone-beam computed tomography image showed that the root and the apex of the tooth were almost completely out of the bone on its buccal side. Surprisingly, the tooth's vitality was preserved. The tooth was moved back, nearly to its original position; clinically, only a gingival recession remained. Orthodontists and dentists should be aware of possible complications of bonded retainers. Patients should be clearly informed how to detect problems at an early stage. PMID:22920708

Pazera, Pawel; Fudalej, Piotr; Katsaros, Christos

2012-09-01

207

Management of complications by uniportal video-assisted thoracoscopic surgery  

PubMed Central

Since the video-assisted thoracoscopic surgery (VATS) anatomic lobectomy for lung cancer was described two decades ago, many units have successfully adopted this technique. VATS lobectomy is a safe and effective approach for the treatment not only of early stage lung cancer but also for more advanced disease. It represents a technical challenge. As the surgeon’s experience grows, more complex or advanced cases are approached using the VATS approach. However, as VATS lobectomy has been applied to more advanced cases, the rate of conversion to open thoracotomy has increased, particularly early in the surgeon’s learning curve, mostly due to the occurrence of complications. The best strategy for facing complications of VATS lobectomy is to prevent them from happening. Avoiding complications is subject to an appropriate preoperative workup and patient selection. Planning for a VATS resection as safely as possible involves the consideration of the patient´s characteristics and the anticipated technical aspects of the case. Awareness of the possibility of intraoperative complications of VATS lobectomy is mandatory to avoid them, and the development of management strategies is necessary to limit morbidity if they occur. PMID:25379209

Fieira Costa, Eva; Delgado Roel, Maria; Fernandez, Lucia Mendez; Paradela de la Morena, Marina; de la Torre, Mercedes; Gonzalez-Rivas, Diego

2014-01-01

208

Pulmonary Hemorrhage Complicating a Typical Hemolytic-Uremic Syndrome  

Microsoft Academic Search

We describe a case of pulmonary bleeding and subsequent acute respiratory distress syndrome (ARDS) in a 20-month-old female suffering from a typical postdiarrheal hemolytic-uremic syndrome (HUS). Acute renal failure was treated early by peritoneal dialysis. It is of interest to underline that thrombocytopenia or any coagulative impairment was absent when this complication occurred, and spontaneous diuresis recovery was ongoing. All

M. Piastra; A. Ruggiero; A. Langer; E. Caresta; A. Chiaretti; S. Pulitanò; G. Polidori; R. Riccardi

2004-01-01

209

Brachial Plexus Impingement: An Unusual Complication of Bilateral Breast Augmentation  

Microsoft Academic Search

Breast augmentation is one of the most commonly performed aesthetic procedures, with many studies documenting the early and\\u000a long-term complications that might be expected. This report describes the case of an active young woman who experienced severe\\u000a pain, particularly with movement. Surgical exploration showed the cause of this pain to be impingement of the patient’s lower\\u000a brachial plexus by the

MG Berry; J. J. Stanek

2008-01-01

210

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

PubMed

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

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

2013-10-01

211

Complications associated with laparoscopic sleeve gastrectomy for morbid obesity: a surgeon's guide  

PubMed Central

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

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

2013-01-01

212

Clinical characteristics and complications in oral caustic ingestion in children.  

PubMed

The aim of this study is to evaluate the prevalence of gastrointestinal symptoms in caustic ingestion, the severity of lesions and the role of early conducted endoscopy in prediction of outcome. In a cross-sectional study all children hospitalized for caustic ingestion during two years, aged 12 years and younger were evaluated for clinical history, endoscopic findings, method of treatment and observed complications. Out of 51 children, 8 consumed acidic and 43 alkaline materials. The mean age of the children was 35.9 +/- 18 months. Thirty four (66.7%) patients were male and 17 (33.3%) were female. In endoscopic survey, 38% had grade 1 and 62% had a burning intensity of grade 2 or higher. During the follow-up, esophageal structure developed in 5 cases and Gastric Outlet Obstruction (GOO) in 1 case. Two of 5 patients with stricture were treated by endoscopic dilatation and 3 of them underwent colon transposition surgery. Gastrectomy was done for the patient with GOO. Esophageal structure as a complication had a more incidence in acid ingestion. Gastric Otlet Obstruction (GOO) occurred in a case of acid ingestion. One of the patients died. Positive statistical relation between early endoscopic findings and complications found in control endoscopy suggest that early endoscopy probably is safe and provides important prognostic information. The role of prevention as a comprehensive strategy promoted by medical councils and the mass media is imperative. PMID:19137870

Rafeey, M; Shoaran, M

2008-10-01

213

Complications of intra-aortic balloon pumping. Preventable or not preventable?  

PubMed

This article summarized the most common and most serious complications associated with the use of the intra-aortic balloon pump, while at the same time focuses on guidelines for prevention. Complications associated with intra-aortic balloon pump use potentially threaten the outcome of the patient. Although risk factors play a role in the development of complications, many are preventable through early detection and intervention. It is important that the critical care nurses have an awareness of the potential complications of intra-aortic balloon pumping as early detection and rapid intervention will serve to decrease the incidence of the more serious and devastating complications associated with the use of the intra-aortic balloon pump. PMID:9095812

Stavarski, D H

1996-12-01

214

Ocular Complications of Chloroquine Therapy  

PubMed Central

Ocular complications of long-term chloroquine therapy were observed in 18 of 45 patients so treated. This therapy was used in patients with rheumatoid arthritis, lupus erythematosus, sarcoidosis, discoid lupus and other chronic “collagen disease”. Thirteen patients had reversible corneal opacifications, and seven had irreversible retinal changes, with visual loss and visual field defects. Pathological evidence of chloroquine retinopathy was obtained in one patient. Physicians are therefore warned to use this drug only after careful consideration. If it is used, repeated ocular examinations should include assessment of visual acuity, visual fields on a tangent screen and fundus examination through a dilated pupil. ImagesFig. 4Fig. 7Fig. 8 PMID:14275038

Lloyd, Lois A.; Hiltz, John W.

1965-01-01

215

Postoperative Complications After Gynecologic Surgery  

PubMed Central

Objective To estimate the association of age, medical comorbidities, functional status, and unintentional weight loss (as a marker of frailty) with postoperative complications in women undergoing major gynecologic surgery. Methods We conducted a cross-sectional analysis of the American College of Surgeons National Surgical Quality Improvement Program 2005-2009 participant use data files were used to analyze gynecologic procedures. The primary outcome was composite 30-day major postoperative complications. Results A total of 22,214 women were included in our final analysis. The overall prevalence of composite 30 day major postoperative complications was 3.7% (n=817). Age 80 years or older (adjusted odds ratio (OR)=1.8(95% Confidence Interval (CI) 1.25,2.58)), dependent functional status (adjusted OR= 2.37(95% CI 1.53,3.68)), and unintentional weight loss (adjusted OR = 2.49(95% CI 1.48,4.17)) were significantly associated with postoperative morbidity after adjusting for diabetes mellitus (adjusted OR= 1.44(95% CI 1.15,1.79)), known bleeding disorder (adjusted OR= 2.29 (95% 1.49,3.52)), morbid obesity (adjusted OR= 1.77(95% CI 1.45,2.17)), ascites (adjusted OR= 3.27(95% CI 2.18,4.90)), preoperative systemic infection (adjusted OR= 3.02(95% CI 2.03,4.48)), procedures for gynecologic cancer (adjusted OR= 1.60(95% CI 1.27,2.0)), disseminated cancer (adjusted OR= 2.57(95% CI 1.64,4.03)), emergency procedures (adjusted OR = 1.82(95% CI 1.18,2.79)), operative time greater than 4 hours vs. less than 1 hour (adjusted OR = 2.91(95%CI 2.18,3.89)) and wound class 4 vs. 1(adjusted OR= 4.28(95%CI 1.82,10.1). Conclusion Age 80 years or older, medical comorbidities, dependent functional status, and unintentional weight loss are associated with increased major postoperative complications after gynecologic procedures. PMID:21934441

Erekson, Elisabeth A.; Yip, Sallis O.; Ciarleglio, Maria M.; Fried, Terri R.

2011-01-01

216

Neurological complications of coeliac disease  

PubMed Central

A variety of neurological disorders have been reported in association with coeliac disease including epilepsy, ataxia, neuropathy, and myelopathy. The nature of this association is unclear and whether a specific neurological complication occurs in coeliac disease remains unproved. Malabsorption may lead to vitamin and trace element deficiencies. Therefore, patients who develop neurological dysfunction should be carefully screened for these. However, malabsorption does not satisfactorily explain the pathophysiology and clinical course of many of the associated neurological disorders. Other mechanisms proposed include altered autoimmunity, heredity, and gluten toxicity. This review attempts to summarise the literature and suggests directions for future research. PMID:12151653

Pengiran, T; Wills, A; Holmes, G

2002-01-01

217

Ocular complications of bungee jumping  

PubMed Central

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

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

2012-01-01

218

[Neurological complications in cancer patients].  

PubMed

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

Hundsberger, Thomas; Roth, Patrick; Roelcke, Ulrich

2014-08-20

219

Automatic Monitoring Of Complicated Systems  

NASA Technical Reports Server (NTRS)

Collection of computer programs developed for expert computer system performing complicated, tedious, and repetitive portions of analysis of telemetry data from spacecraft. Provides nonstop, accurate surveillance of incoming data, also frees operators to concentrate their expertise on unexpected abnormal operating conditions. When unable to explain discrepancies with certainty resulting from data out of synchronization or other falso-alarm conditions, triggers alarm devices to request assistance from designated individuals. Concept useful in such terrestrial systems as production lines, power-distribution networks, chemical processes, large airplanes, and other assemblies of interdependent equipment.

Schwuttke, Ursula M.

1990-01-01

220

Neonatal meningitis complicating with pneumocephalus  

PubMed Central

Pneumocephalus is a rare condition characterized by the presence of gas within the cranial cavity. This gas may arise either from a trauma, a tumor, a surgical, or a diagnostic procedure or occasionally from an infection. Pneumocephalus as a complication of bacterial meningitis, in absence of trauma or a procedure, is extremely rare, particularly in a newborn. A case of pneumocephalus occurring in a baby, suffering from neonatal meningitis, acquired probably through unsafe cutting and tying of the cord, is reported here. Cutting, tying, and care of the umbilical cord is of utmost importance to prevent neonatal infection as the same is a potential cause of serious anaerobic infections, besides tetanus. PMID:24741257

Kumari, Anita; Agrawal, Satish C.

2014-01-01

221

Management of Complications After Tension-Free Midurethral Slings  

PubMed Central

Since their introduction in 1996, tension-free midurethral slings (MUS) have been proven to have long-term efficacy and safety. They are considered the gold standard treatment of female stress urinary incontinence, especially in cases that are associated with urethral hypermobility. However, they are not free of complications and, although rare, some of these complications can be challenging for both patients and physicians. Some complications occur intraoperatively, whereas others appear in the early or late postoperative period. There is less controversy in the diagnosis and treatment of complications such as vaginal extrusion or urinary system erosion, whereas de novo voiding problems are at best not completely understood. Voiding dysfunction after MUS placement may vary in a wide range from urinary frequency or urgency to retention and is usually attributed to the obstructive or irritative effect of the sling. However, present urodynamic criteria for the diagnosis of female infravesical obstruction are not satisfactory, and the best management policy for de novo voiding dysfunction remains controversial. In the majority of cases, the diagnosis of obstruction leading to a urethral release surgery depends on a combination of several clinical findings. The timing of urethral release surgery varies depending on the preferences of the surgeon, and the outcome of this surgery is not always predictable. The purpose of this review was to assess the diagnosis and management of the immediate, short-term, and long-term complications of MUS in light of the current literature in an attempt to determine the best management policy. PMID:24175037

Cetinel, Bulent

2013-01-01

222

Complications after laparoscopic gastric banding in own material  

PubMed Central

Introduction Complications after bariatric procedures are the most difficult to diagnose among all complications in abdominal surgery. Furthermore, they are extremely difficult to treat conservatively and surgically. Laparoscopic treatment of complications after bariatric procedures requires great skills. Complications after laparoscopic adjustable gastric banding (LAGB) are remarkably diverse. Aim Presentation of complications after LAGB in our own material. Material and methods From 2005 to 2010, in the 1st Department of General and Endocrine Surgery, in 110 patients adjustable gastric banding was applied. All procedures were conducted laparoscopically. The group consisted of 76 women (69.1%) and 34 men (30.9%). The average age of women was 37.7 ±13.80 years old. The average age of men was 38.9 ±11.50 years old. The average body mass was 128.5 ±24.35 kg for women and 125.4 ±23.60 kg for men. The average body mass index (BMI) for women was 44.08 ±3.03 kg/m2 and for men 43.66 ±2.90 kg/m2. The average waist circumference was 113.5 ±12.75 cm in women and for men it was 124.40 ±14.8 cm. Results In the analysed material, which consisted of 110 patients after LAGB, 36% developed at least 1 complication. Among early complications, injury of diaphragm, pneumothorax, pleural empyema, gastric perforation and thrombophlebitis were observed. Among late complications, oesophagitis, infections around the port, migration of the gastric band into the gastric lumen, band slippage, vomiting and lack of body mass loss were observed. The most common reasons for the removal of the band were band slippage, its migration to the gastric lumen and extension of the gastric reservoir. Conclusions The LAGB is a relatively easy procedure with a short time of performance and short hospitalization. However, it can bring the risk of intraoperative, perioperative and late complications which require surgical intervention. The present research results are comparable to world data. Complications after LAGB were observed the most frequently in the first years of application of the procedure. PMID:23256021

Dadan, Jacek; Soldatow, Maria; Ladny, Robert Jerzy; Golaszewski, Pawel; Wroblewski, Eugeniusz; Dabrowski, Andrzej

2012-01-01

223

Postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate groin incisions.  

PubMed

The focus of this study was to document postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate incisions. Data from 172 consecutive patients with newly diagnosed carcinoma of the vulva were studied. One hundred and one patients primarily treated with modified radical vulvectomy and complete inguinofemoral lymphadenectomy using separate groin incisions (n = 187) were included in this study. One or more complications were documented in 77 of the 101 (76%) patients. Complications after groin dissection were observed in 66% of the patients. The main complications were wound breakdown (17%) and/or infection (39%) of the groin, lymphocyst formation (40%), and lymphedema (28%). In 98 of 187 (52%) groin dissections, one or more complications were documented. The presence of lymph node metastases, postoperative radiation, age older than 65 years, and removal of the vena saphena magna were not significant risk factors for the occurrence of complications. The occurrence of early complications after groin dissection was significantly related to the late-complication lymphedema (P = 0.002). Our results confirm relatively high rates of wound breakdown, infection, lymphocyst formation, and lymphedema even with separate groin incisions. The occurrence of early complications was related to lymphedema. No other risk factors could be identified. PMID:12911732

Gaarenstroom, K N; Kenter, G G; Trimbos, J B; Agous, I; Amant, F; Peters, A A W; Vergote, I

2003-01-01

224

Entry Complications in Laparoscopic Surgery  

PubMed Central

To review the complications associated with laparoscopic surgery and provide clinical direction regarding the best practice based on the best available evidence. The laparoscopic entry techniques and technologies reviewed include the classic pneumoperitoneum (Veress/trocar), the open (Hasson), the direct trocar insertion, the use of disposable shielded trocars, radially expanding trocars and visual entry systems. Medline, Pubmed and Cochrane Databases were searched for English language articles published before December 2008. It is an evidence based fact that minimal access surgery is superior to conventional open surgery since this is beneficial to the women, community and the healthcare system.Over the past 50 years, many techniques, technologies and guidelines have been introduced to eliminate the risks associated with laparoscopic entry. No single technique or instrument has been proved to eliminate laparoscopic entry associated injury. Proper evaluation of the women, supported by surgical skills and good knowledge of the technology and instrumentation is the keystone to safe access and prevention of complications during laparoscopic surgery. PMID:22442503

Krishnakumar, S; Tambe, P

2009-01-01

225

Bacterial infections complicating tongue piercing  

PubMed Central

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

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

2010-01-01

226

[Infectious complications after esophageal surgery].  

PubMed

The incidence of wound infection, which is an intrasurgical field infection, is lower than the incidence of pneumonia, which is an extrasurgical field infection, after esophageal cancer surgery. Several trials predicting postoperative infectious complications have been reported. One measured the phytohemagglutinin- and concanavalin A-induced proliferation of peripheral blood mononuclear cells in patients; one measured the white blood cell (WBC) count 2 h after surgery and the decrease in WBC count on first postoperative day; and another showed that the decrease in serum IgG2 level can predict the occurrence of methicillin-resistant Staphylococcus aureus (MRSA) infections. Useful strategies for managing infectious complications have also been reported. Applying mupirocin calcium hydrate ointment to the nasal cavity decreases the incidence of MRSA infections. Autologous blood collection reduces the need for allogeneic transfusion in patients undergoing resection of esophageal cancer, and avoidance of allogeneic transfusion may reduce the risk of postoperative infection. The total exposure to preoperative chemoradiotherapy should be limited to 40 Gy or less to prevent postoperative pneumonia. PMID:12599924

Ozawa, Soji; Kitagawa, Yuko; Okamoto, Nobuhiko; Shimizu, Yoshimasa; Kitajima, Masaki

2002-12-01

227

[Skin complications of diabetes mellitus therapy].  

PubMed

Author summarizes potencial skin complications related to the therapy with insulin or peroral antidiabetics. These are mainly allergic reactions and lipodystrophic changes complicating or even precluding the therapy. PMID:16771093

Olsovský, J

2006-05-01

228

Managing Complications of Diabetes in Later Life  

MedlinePLUS

... previous page Related Topics Diabetes Related Documents PDF Living with Diabetes Download PDF Managing Complications of Diabetes in Later Life Download Join our e-newsletter! Resources Managing Complications ...

229

"Sickle Cell Disease in the Emergency Department: Atypical Complications and Management"  

PubMed Central

Sickle cell disease is the most common inherited blood disorder in the United States. This disorder of hemoglobin structure leads to a chronic hemolytic anemia and complex chronic disease manifested by sudden, severe, and life-threatening complications. These acute complications can occur in any organ system beginning in early childhood and lasting throughout life. The intermittent nature and acuity of these complications lend the emergency department to be an important site of care. The hallmark of sickle cell disease is the vasoocclusive painful event. Other more “typical” complications include fever, acute chest syndrome, priapism, and ischemic stroke. Children with sickle cell disease can also present with other “atypical” complications that can have devastating consequences if they are unrecognized. Detailed discussion of these “atypical” sickle cell disease complications, organized by organ system involved, will be the focus of this article. PMID:21927581

Brandow, Amanda M.; Liem, Robert

2011-01-01

230

Anesthesia Complications Drop by Half, Study Finds  

MedlinePLUS

... use between 2010 and 2013, and found the rate of complications decreased from 11.8 percent to 4.8 percent. The most common minor complication was nausea and vomiting (nearly 36 percent) and the most common major complication was medication error (nearly 12 percent). "Our goal was to determine ...

231

Complications of midurethral slings and their management  

PubMed Central

While midurethral slings are associated with a low rate of morbidity, complications can arise intraoperatively or following the procedure. Management of midurethral sling complications is relatively straightforward and urgency is dictated by the severity of the complications, potential for long-term negative effects, and bother to the patient. PMID:23092771

Nitti, Victor W.

2012-01-01

232

Complications of percutaneous vertebroplasty and their prevention  

Microsoft Academic Search

Complications due to vertebroplasty may be divided into two categories whether or not they are related to polymethylmethacrylate (PMMA) cement leakage from the compressed vertebral body. PMMA leakage is a very frequent occurrence in vertebroplasty is also the main source of complications. Neurological complications are due to cement leakage into the spinal canal and less exceptionally into the intervertebral foramen.

J. D. Laredo; B. Hamze

2004-01-01

233

[Therapy of complicated Crohn's disease].  

PubMed

During their disease course, the majority of Crohn's disease patients will develop a complicated disease which is characterized by the occurrence of fistulas and/or stenosis. Symptomatic, perianal fistulas should be surgically drained before anti-inflammatory therapy will be initiated. Antibiotics, such as metronidazole, improve disease symptomatic however, they are not sufficient to induce continuous fistula closure. For this purpose, azathioprine/6-mercaptopurine as well as anti-TNF antibodies are useful when administered continuously. Surgical options include seton drainage, fistula excision, fistula plugs and mucosa flaps. As ultima ratio, temporary ileostomy and proctectomy are to be discussed. Non-perianal fistulas often require surgical approaches. Symptomatic strictures or stenosis can be treated by anti-inflammatory medications (only if they are cause by inflammation), endoscopic balloon dilatation or surgery. PMID:24618311

Scharl, Michael; Barthel, Christiane; Rogler, Gerhard

2014-03-12

234

Progeria syndrome with cardiac complications.  

PubMed

A case report of 6-year-old boy with progeria syndrome, with marked cardiac complications is presented. The boy had cardiorespiratory failure. Discoloured purpuric skin patches, alopecia, prominent forehead, protuberant eyes, flattened nasal cartilage, malformed mandible, hypodentition, and deformed rigid fingers and toes were observed on examination. The boy was unable to speak. A sclerotic systolic murmur was audible over the mitral and aortic areas. Chest x-rays showed cardiac enlargement and the electrocardiogram (ECG) showed giant peaked P waves (right atrial hypertrophy) and right ventricular hypertrophy. Atherosclerotic dilated ascending aorta, thickened sclerotic aortic, mitral, and tricuspid valves with increased echo texture, left and right atrial and right ventricular dilatation, reduced left ventricular cavity, and thickened speckled atrial and ventricular septa were observed on echocardiography. PMID:24601202

Ilyas, Saadia; Ilyas, Hajira; Hameed, Abdul; Ilyas, Muhammad

2013-09-01

235

Management of vascular complications of bacterial endocarditis.  

PubMed

Peripheral arterial emboli that result from bacterial endocarditis may be silent or catastrophic. Cardiac surgical intervention may prevent embolism, but the guidelines for timing of intervention are unclear. An accepted approach is to intervene only if two episodes of peripheral embolism occur. Our recent experience suggests a more refined approach is in order. Eight children with active bacterial endocarditis have been treated with embolic complications. One patient with abdominal pain and GI bleeding was treated with heparin for multiple peripheral mesenteric emboli. Four patients had femoral embolectomies, one twice. Three patients developed embolomycotic aneurysms of the aorta in two cases and the common iliac in one; all were ruptured and two survived with staged reconstruction in one and extra-anatomic bypass in the other. Staph aureus and Strep viridans were the organisms involved most often. A review of the details of care in these patients leads to the following conclusions: angiographic survey reveals that most patients have multiple emboli; early embolectomy may prevent formation of infected aneurysms; Staph aureus infected patients are at risk for development of infected aneurysms; patients with large floppy vegetations in the left heart on echocardiography are at high risk for embolism; and 2 to 3 weeks from onset of endocarditis is the peak time for embolic risk. PMID:3755471

Nakayama, D K; O'Neill, J A; Wagner, H; Cooper, A; Dean, R H

1986-07-01

236

[The implantable cardiac defibrillator: indications and complications].  

PubMed

The implantation of an implantable cardiac defibrillator (ICD) is indicated as a secondary prevention measure for sudden cardiac death in patients surviving a life-threatening ventricular arrhythmia that had no reversible or treatable cause. An ICD is indicated as a primary prevention measure for sudden cardiac death in patients with a left-ventricular ejection fraction (LVEF) ? 35%. A biventricular ICD is indicated in patients with heart failure class ? II according to the New York Heart Association classification, a widened QRS complex and an LVEF ? 35%. Guidelines do not differentiate between men and women or according to age, but there is no evidence in the literature for decreased mortality from applying ICD therapy in women and in patients older than 70-75 years. This is relevant in discussions over the cost-effectiveness of the treatment. Sudden cardiac death occurs most frequently in patients with an LVEF ? 35%; the effect of ICDs as a primary prevention measure in this patient group has, however, never been investigated. The most important complications following ICD implantation are inappropriate ICD shocks and lead dysfunction. Automated home-monitoring enables early detection of technical defects. PMID:24252404

Simmers, T A Tim; Bracke, Frank A L E

2013-01-01

237

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

SciTech Connect

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.

Chang, Jung Min; Lee, Jeong Min; Suh, Kyung Suk; Yi, Nam Joon; Kim, Yong Tae; Kim, Se Hyung; Han, Joon Koo, E-mail: hanjk@radcom.snu.ac.kr; Choi, Byung Ihn [Seoul National University College of Medicine, Department of Radiology and Institute of Radiation Medicine (Korea, Republic of)

2005-12-15

238

Maternal serum soluble HLA-G in complicated pregnancies.  

PubMed

Preeclampsia, intrauterine growth retardation (IUGR), oligohydramnios, abortus, preterm birth and premature rupture of the membranes (PROM) are significant complications of pregnancy. Insufficient trophoblastic invasion plays an important role in the pathophysiology of pregnancy complications. Soluble human leukocyte antigen-gestation (HLA-G)1/G5 is a molecule associated with trophoblast invasion. When pregnancy complications are predicted early, strategies to prevent these complications can be implemented. The aim of this study was to investigate the relationship between first trimester maternal serum soluble HLA-G1/G5 levels and high-risk pregnancies. A total of 232 pregnant women were followed prospectively. Maternal blood samples were collected for determination of soluble HLA-G1/G5 levels at 11-14 weeks, during which routine serum free beta human chorionic gonadotropin (?hCG) and pregnancy associated plasma protein-A (PAPP-A) level determinations in addition to nuchal translucency (NT) measurements for Down's syndrome screening were done during 20-22 weeks gestation. The subjects were classified into normal pregnancy, preeclampsia, oligohydramnios, IUGR, preterm birth and PROM groups. First trimester maternal serum soluble HLA-G1/G5 levels were not significantly different between the groups. First trimester soluble HLA-G1/G5 did not predict high-risk pregnancies. Studies with larger number of cases are need to confirm our findings. PMID:23795671

B?y?k, Ismail

2014-03-01

239

Alcohol abuse-related severe acute pancreatitis with rhabdomyolysis complications.  

PubMed

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

Su, Mao-Sheng; Jiang, Ying; Yan, Xiao-Yuan Hu; Zhao, Qing-Hua; Liu, Zhi-Wei; Zhang, Wen-Zhi; He, Lei

2013-01-01

240

Cognitive functioning in complicated grief.  

PubMed

Complicated grief (CG) is increasingly recognized as a debilitating outcome of bereavement. Given the intensity of the stressor, its chronicity, and its association with depression, it is important to know the impact CG may have on cognitive functioning. This exploratory and descriptive study examined global and domain-specific cognitive functioning in a help-seeking sample of individuals with CG (n = 335) compared to a separately ascertained control sample (n = 250). Cognitive functioning was assessed using the Montreal Cognitive Assessment (MoCA). Controlling for age, sex and education effects, CG participants had lower total MoCA, visuospatial and attention scores relative to control participants. The two groups did not differ significantly in the domains of executive function, language, memory or orientation. Age, sex, and education accounted for much of the variance in MoCA scores, while CG severity and chronicity accounted for a very small percentage of MoCA score variance. Major depression was not a significant predictor of MoCA scores. This study is consistent with previous work demonstrating lower attention and global cognitive performance in individuals with CG compared to control participants. This study newly identifies the visuospatial domain as a target for future studies investigating cognitive functioning in CG. PMID:25088285

Hall, Charles A; Reynolds, Charles F; Butters, Meryl; Zisook, Sidney; Simon, Naomi; Corey-Bloom, Jody; Lebowitz, Barry D; Begley, Amy; Mauro, Christine; Shear, M Katherine

2014-11-01

241

Surgical complications of neuroblastoma resection.  

PubMed

Locally advanced neuroblastomas in infants and very young children often require intricate dissection to separate the tumors from the anatomic structures that they have enmeshed. The rationale for these procedures is based mainly on the premise that near-total resection is almost as effective as total extirpation, given favorable circumstances of age and stage. The principal reason for not undertaking or aborting such resections has been to avoid the fallacy of intentionally sacrificing vital structures, causing serious disability, in circumstances in which cure is either impossible or equally likely to accrue from a lesser procedure. This report describes five surgical mishaps, two of which resulted in postoperative deaths. The potential for these complications was greatest during resection of locally advanced tumors in small babies. We suspect that this hazard is more prevalent than its scarcity in the literature would suggest and that potential for unintended injury should be a prominent factor in the decision to proceed or desist with resection of a large neuroblastoma. PMID:3992477

Azizkhan, R G; Shaw, A; Chandler, J G

1985-05-01

242

Ophthalmological complications of the hypertriglyceridaemias.  

PubMed

Hypertriglyceridaemia is an inappropriate elevation in plasma of chylomicrons, very low density lipoprotein, or both, functioning in the transport of exogenous and endogenous neutral fat respectively (lewis, 1976; Miller, 1979). The elevation may be due to rare genetically-determined defects or to a specific imbalance between triglyceride production and utilization, either secondary to or accentuated by other metabolic disturbances such as obesity or diabetes mellitus. Various surveys indicate that some degree of hypertriglyceridaemia affects more than 10 per cent of the adult population, with a male preponderance and a reduced expression during childhood (Lewis, 1976). Ophthalmological complications of hypertriglyceridaemia include eruptive and other forms of xanthomata including xanthelasmata, corneal arcus, lipaemia retinalis, effects on retinal blood flow, and lipid emboli affecting vision. The clinical features overlap those of hypercholesterolaemia and these features may lead to initial presentation and diagnosis of either disorder. Recognition of the underlying disorder is important since with treatment the incidence of major cardiovascular and other problems such as pancreatitis may be reduced, and with familial disorders other affected members may then be sought. PMID:6943819

Winder, A F; Dodson, P M; Galton, D J

1980-04-01

243

Neurologic complications of craniovertebral dislocation.  

PubMed

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

de Carvalho, Mamede; Swash, Michael

2014-01-01

244

Gastrointestinal complications of systemic sclerosis.  

PubMed

Systemic sclerosis is an autoimmune disease characterized by progressive skin thickening and tightness. Pulmonary interstitial fibrosis and kidney damage are the most important indicators for mortality; however, the gastrointestinal tract is the most commonly damaged system. Virtually all parts of the gastrointestinal (GI) tract can be involved, although the esophagus is the most frequently reported. The mechanisms that cause such extensive damage are generally unclear, but vascular changes, immunological abnormalities, excessive accumulation of collagen in the submucosa, smooth muscle atrophy and neuropathy may participate because these are the most common histological findings in biopsies and autopsies. Most patients with GI tract involvement complain about dyspepsia, nausea, vomiting, abdominal bloating/distension, and fecal incontinence. These symptoms are generally mild during the early stage of the disease and are likely ignored by physicians. As the disease becomes more advanced, however, patient quality of life is markedly influenced, whereby malnutrition and shortened survival are the usual consequences. The diagnosis for systemic sclerosis is based on manometry measurements and an endoscopy examination. Supportive and symptomatic treatment is the main therapeutic strategy; however, an early diagnosis is critical for successful management. PMID:24222949

Tian, Xin-Ping; Zhang, Xuan

2013-11-01

245

Vascular complications after transcatheter aortic valve implantation (TAVI): risk and long-term results.  

PubMed

Vascular complications are the main safety limitations of transcatheter aortic valve implantation (TAVI). The aim of the study was to assess the incidents, predictors, and the impact of early vascular complications on prognosis after TAVI. This was a single-center analysis of vascular complications related to TAVI. Early vascular complications were defined as incidents within 30 days after TAVI and comprised complications related to transvascular: transfemoral/transsubclavian ,and transapical bioprosthesis implantation. Evaluated risk factors were: (1) clinical characteristics, (2) TAVI route, and (3) center experience. In patients with transvascular TAVI the impact of: (1) diameters of access arteries, vascular sheathes and difference between them, (2) arterial wall calcification, and (3) ProStar devices used for access site closure were assessed. Arterial wall calcification and arteries diameters were measured by 64-slice computer tomography. Arterial wall calcification was graded according to 5° scale. Results: between 2009-2011; follow-up 1-23 months (12 ± 15.55), 83 consecutive patients, and 62-91 (81.10 ± 7.20) years, underwent TAVI: 67 (80.72%) patients had transvascular, and 16 (19.27%) patients had transapical bioprosthesis implantation. We noted 44 (53.01%) early vascular complications: 17 (20.48%) were major and 27 (32.53%) were minor incidents. Independent predictors of early vascular complications were: history of anaemia (OR 3.497: 95% CI [1.276-9.581]; p = 0.014), diabetes (OR 0.323: 95% CI [0.108-0.962]; p = 0.042), percutaneous coronary intervention performed as preparation for TAVI (OR 4.809: 95 % CI [1.172-19.736]; p = 0.029), and arterial wall calcification (OR 1.945: 95% CI [1.063-3.558]; p = 0.03). Of 6 (7.22%) in-hospital and 10 (12.98%) late deaths: 5 (83.33%) patients and 8 (80%) patients respectively had post-procedural vascular complications. Vascular complications, which occurred in 30-days after TAVI, predict late mortality (p = 0.036). Conclusions derived were: (1) TAVI patients with history of anaemia and diabetes required careful monitoring for early vascular complications. (2) If coronary intervention before TAVI is required, it should be performed in the time allowing vascular injuries to heal. (3) Calcification of access arteries is an independent predictor of post-procedural vascular complications; therefore, its estimation should be a regular element of preceding computer tomography. (4) Vascular complications seem to be predictors of late mortality after TAVI. PMID:24132402

Czerwi?ska-Jelonkiewicz, Katarzyna; Micha?owska, Ilona; Witkowski, Adam; D?browski, Maciej; Ksi??ycka-Majczy?ska, Ewa; Chmielak, Zbigniew; Ku?mierski, Krzysztof; Hryniewiecki, Tomasz; Demkow, Marcin; St?pi?ska, Janina

2014-05-01

246

[Leukostasis and tumor lysis: important complications of hyperleukocytosis].  

PubMed

The occurrence of hyperleukocytosis (leukocytes >?100.000/?l) is associated with complications such as leukostasis, tumor lysis and consumption coagulopathy in patients with acute leukemia much more often than in patients with chronic malignant hematological diseases. To manage these situations may be complex as organ failure is often imminent or manifest, infectious complications arise and indications for induction chemotherapy are usually urgent. Prophylaxis and therapy of the tumor lysis syndrome consists of hydration, lowering of uric acid and the management of electrolyte disturbances. Leukostasis requires immediate reduction of the leukocyte count by leukapheresis, administration of hydroxycarbamide and, ultimately, by causative and specific treatment of the underlying disease itself. In patients with curable diseases or favorable long-term prognosis, transfer to the intensive care unit must be evaluated early in the course of impending organ dysfunction, especially in cases of acute respiratory failure. PMID:23943008

Schellongowski, P; Staudinger, T

2013-09-01

247

Complications and management of breast enhancement using hyaluronic acid.  

PubMed

The authors report on their experience with using hyaluronic acid of non-animal origin manufactured using commercially available technology (Macrolane, Q-Med AB, Sweden) for breast enhancement in 4000 women treated since 2004 and describe the most common complications and their successful treatment. On average, 30 mL to 40 mL of Macrolane was injected into each breast. Of 274 women who returned to the clinic during 2007, <10% experienced local adverse events (eg, gel dislocation, Macrolane nodules and rare cases of infection). There were no serious systemic events and treatment was well tolerated. To prevent local complications, such as infection, an aseptic injection technique was required and early treatment of adverse events is recommended. While only small volumes of Macrolane were injected, it is comparatively easy and safe to perform breast enhancement of up to one cup size to correct asymmetry between breasts and to create fullness in the upper portion of the breast. PMID:25332644

Ishii, Hidenori; Sakata, Kazuaki

2014-01-01

248

Avoiding patellar complications in total knee replacement.  

PubMed

Patellofemoral complications are common after total knee replacement (TKR). Leaving the patellar unsurfaced after TKR may lead to complications such as anterior knee pain, and re-operation to surface it. Complications after patellar resurfacing include patellar fracture, aseptic loosening, patellar instability, polyethylene wear, patellar clunk and osteonecrosis. Historically, patellar complications account for one of the larger proportions of causes of failure in TKR, however, with contemporary implant designs, complication rates have decreased. Most remaining failures relate to patellofemoral tracking. Understanding the causes of patellofemoral maltracking is essential to prevent these complications as well as manage them when they occur. Cite this article: Bone Joint J 2014;96-B(11 Suppl A):84-6. PMID:25381415

Russell, R D; Huo, M H; Jones, R E

2014-11-01

249

Factors associated with complicated buprenorphine inductions.  

PubMed

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

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

2010-07-01

250

Otolaryngological complications of occipitocervical injury.  

PubMed

Occipitocervical injuries are rare, accounting for 15% of all fatal spinal trauma. In patients who survive the initial incident, early detection and appropriate management is vital to avoid significant neurological disability and mortality. We present the case of a patient with neck trauma who was initially cleared of spinal injuries in the emergency department but who later developed acute hearing loss. We describe how the investigation of the hearing loss led to the detection of this devastating injury and report its successful management. Patients with persistent neck pain following trauma, particularly in the presence of degenerative spinal disease, should have cervical spine computed tomography to exclude occipitocervical injuries and other occult injuries. PMID:25350165

Qureishi, A; Khan, T; Johnston, M; Bommireddy, R; Klezl, Z

2014-11-01

251

Complications of arthroscopic surgery of the hip  

PubMed Central

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

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

2012-01-01

252

Complications/sequelae of neck rejuvenation.  

PubMed

Neck lift surgery performed in isolation or in conjunction with a facelift provides a more youthful cervicomental angle. Complications related to neck lift surgery vary from contour irregularities that may improve with time or conservative measures,to contour irregularities that persist and may benefit from delayed surgical intervention, to expanding hematomas that require immediate surgical intervention. This article reviews complications of neck lift surgery and their etiologies, methods to minimize the incidence of these complications, and management. PMID:24745390

Batniji, Rami K

2014-05-01

253

Extracardiac complications of the Fontan circuit  

Microsoft Academic Search

The Fontan operation is the primary surgical procedure used in the palliation of patients with univentricular cardiac physiology.\\u000a With improved survival of children with congenital heart disease, long-term complications of the Fontan circuit are being\\u000a encountered more frequently. Radiologists are more likely to see both the cardiac and extracardiac complications of the Fontan\\u000a circuit. Awareness of the common extracardiac complications

Geetika Khanna; Sanjeev Bhalla; Rajesh Krishnamurthy; Charles Canter

254

Hemoperitoneum: a rare complication of hemorrhoid treatment.  

PubMed

Pile suturing has always been used by surgeons to treat hemorrhoidal disease. We report a case of hemoperitoneum complicating a pile suture. Ultrasonography and computed tomography scan indicated the need for an emergency laparoscopic procedure and conservative management. As other authors have pointed out, we do not know how to prevent this type of complication. This case suggests the possibility of life-threatening complications following treatment procedures for hemorrhoids and underlines the importance of conservative treatment when this is possible. PMID:22706732

Andreuccetti, J; Gaj, F; Crispino, P; Dassatti, M R; Negro, P

2014-04-01

255

Complications after uterine artery embolization for leiomyomas  

Microsoft Academic Search

OBJECTIVE:To determine the frequency and severity of complications that occur as a result of uterine artery embolization for leiomyomas.METHODS:As part of an ongoing study of outcome after uterine embolization, prospective data regarding complications that occurred in 400 consecutive patients were gathered. Each patient had a minimum of a 3-month interval from the procedure at the time of analysis. Each complication

James B Spies; Amy Spector; Antoinette R Roth; Chandra M Baker; Lauren Mauro; Kerry Murphy-Skrynarz

2002-01-01

256

Prevention and management of hysterectomy complications.  

PubMed

Hysterectomy is the most common gynecologic surgical procedure performed in the United States. Although most hysterectomies proceed without incident, complications with serious consequences may occur. This chapter reviews the incidence, predisposing factors, intraoperative risk, diagnosis, and management and prevention of complications of hysterectomy. These include hemorrhage, infection, thromboembolism, injury to viscera, and neuropathy. The prepared surgeon is familiar with anatomy, surgical risk factors, current recommendations for prophylaxis and prevention, as well as modern management of complications of hysterectomy. PMID:24488052

Hodges, Kelly R; Davis, Beth R; Swaim, Laurie S

2014-03-01

257

Potential complications and precautions in vertical alveolar distraction osteogenesis: a retrospective study of 40 patients.  

PubMed

The aim of this retrospective study was to analyse the outcome of 44 cases of vertical alveolar distraction osteogenesis (ADO) and to investigate the complications, precautions, and treatment associated with ADO. The 44 alveolar distractions were performed on 40 patients. Extraosseous distraction was used in all cases. Complications associated with the intraoperative, postoperative, distraction, and consolidation periods were recorded and evaluated. Intraoperative complications were noted in two patients (4.5%) where fracture of the basal bone was evident. Three (6.8%) complications were recorded postoperatively, and 12 (27.3%) complications were recorded during the activation period. During the consolidation period, 4.5% of the patients (n = 2) were affected. The total prevalence of complications was 43.2% (n = 19), and the success rate of the ADO was 95.5%. Most complications occurred in the anterior mandibular region. Although complications associated with vertical ADO were not rare, the use of this procedure for maxillofacial defects results in satisfactory outcomes. Early diagnosis and management of related complications are crucial for increasing the success rate of ADO procedures. PMID:23375448

Ugurlu, Faysal; Sener, B Cem; Dergin, Guhan; Garip, Hasan

2013-10-01

258

Image-guided chemoport insertion by interventional radiologists: A single-center experience on periprocedural complications  

PubMed Central

Purpose: To report our early experience in image-guided chemoport insertions by interventional radiologists. Materials and Methods: This was a cross-sectional study conducted in a tertiary center with 161 chemoport insertions done from June 2008 to June 2010. The chemoports were inserted either at the angiography suite or at the mobile operation theater unit. Ninety percent of the chemoports had right internal jugular vein (IJV) as the entry site. Other entry sites included the left IJV, subclavian veins and the inferior vena cava. Immediate and early complications were recorded. All insertions were performed under image guidance with the aid of ultrasound and fluoroscopy. Results: The technical success rate was 99.4%. In terms of immediate complications, there were only two cases of arterial puncture that resolved with local compression. No pneumothorax or air embolism was documented. Twenty-six early complications were recorded. The most common early complication was catheter blockage (12/161; 7.4%), followed by catheter-related infection (9/161; 5.6%). Other complications were catheter malposition, venous thrombosis and catheter dislodgement or leak. A total of 11 (6.8%) chemoports had to be removed within 30 days; most of them were due to infections that failed to respond to systemic antibiotic therapy. In terms of place of procedure, there were no significant differences in complication rates between the angiography suite and the mobile operation theater unit. Conclusion: Image-guided chemoport insertion by interventional radiologist gives low periprocedural complication rates. Using right IJV as the entry site, the image guidance gives good success rate with least complication. PMID:24082475

Yaacob, Yazmin; Nguyen, Dang V; Mohamed, Zahiah; Ralib, A Razali A; Zakaria, Rozman; Muda, Sobri

2013-01-01

259

Recognizing and managing complications in blepharoplasty.  

PubMed

The goal of this article is to enhance the surgical precision and accuracy of surgeons performing upper and lower eyelid blepharoplasty. The most common blepharoplasty complications are described and how to avoid them is discussed in detail. Complications range from mild to severe and for each, preoperative measures to prevent, perioperative measures to avoid, and postoperative measures to minimize complications are detailed. After reading this article the surgeon should have a greater understanding of blepharoplasty complications and how to best manage and avoid them. PMID:24200381

Whipple, Katherine M; Korn, Bobby S; Kikkawa, Don O

2013-11-01

260

Radiological diagnosis of dialysis-associated complications.  

PubMed

In daily clinical practice, the radiologist in the context of diagnosis often faces dialysis-associated complications. The complications are numerous and range from infections, catheter dysfunctions, haematomas, cardiovascular diseases, digital ischaemia, and pseudoaneurysms to shunt stenosis. In this pictorial essay, we take a close look at the imaging diagnostics of the most common complications in dialysis patients. Teaching Points • The occurrence of venous stenosis in haemodialysis patients is up to 41 %. • Catheters usually have a fibrin sheath that can be rinsed but not aspirated. • The steal phenomenon occurs in 75-90 % of patients with a shunt system. • Arterial pseudoaneurysms can cause a number of complications. PMID:25095722

Zandieh, Shahin; Muin, Dina; Bernt, Reinhard; Krenn-List, Petra; Mirzaei, Siroos; Haller, Joerg

2014-10-01

261

Dermatological complications of circumcision: lesson learned from cases in a pediatric dermatology practice.  

PubMed

We discuss 11 cases of boys who presented with dermatologic complications of circumcision in an outpatient pediatric dermatology clinic. A medical practitioner had previously circumcised all patients during the newborn period. The majority of cases were found incidentally during initial thorough dermatologic examination. Late cutaneous complications included penile skin bridge, glandular adhesion of remnant foreskin, concealed penis, and a penile epidermal inclusion cyst. Minor surgical procedures under local anesthesia were performed in all but two cases. These cases should help dermatologists recognize the common late cutaneous complications of male newborn circumcision and provide insight into potential options for early intervention and management. PMID:23683078

Tempark, Therdpong; Wu, Tim; Singer, Craig; Shwayder, Tor

2013-01-01

262

Massive Liver Mass and Parenteral Nutrition Extravasation Secondary to Umbilical Venous Catheter Complications  

PubMed Central

Umbilical vein catheters (UVC) are widely used in neonatal medicine. Serious complications from UVC placement are uncommon but do exist, including infection, thrombosis, arrhythmias, and hemorrhage. Although rare, hepatic complications, in particular, have been associated with significant morbidity and mortality. Correct positioning of the catheter prior to starting infusion of hyperosmolar solutions and early recognition of UVC-related complications are crucial in minimizing iatrogenic injury. We report the case of a neonate who was found at 10 days of age to have large pleural and peritoneal effusions and a massive fluid collection in the liver due to malposition of a UVC.

Yeh, Joanna; Vargas, Jorge H; Wozniak, Laura J; Smith, Jeffrey B; Boechat, M Ines; Touma, Marlin

2014-01-01

263

Massive liver mass and parenteral nutrition extravasation secondary to umbilical venous catheter complications.  

PubMed

Umbilical vein catheters (UVC) are widely used in neonatal medicine. Serious complications from UVC placement are uncommon but do exist, including infection, thrombosis, arrhythmias, and hemorrhage. Although rare, hepatic complications, in particular, have been associated with significant morbidity and mortality. Correct positioning of the catheter prior to starting infusion of hyperosmolar solutions and early recognition of UVC-related complications are crucial in minimizing iatrogenic injury. We report the case of a neonate who was found at 10 days of age to have large pleural and peritoneal effusions and a massive fluid collection in the liver due to malposition of a UVC. PMID:25337502

Yeh, Joanna; Vargas, Jorge H; Wozniak, Laura J; Smith, Jeffrey B; Boechat, M Ines; Touma, Marlin

2014-07-01

264

Toxic shock syndrome: A rare complication to enhanced external counterpulsation.  

PubMed

Enhanced external counterpulsation (EECP) is known to reduce angina pectoris in patients in whom revascularization is not possible. The therapy is associated with few adverse effects. A case with a previously unknown complication - toxic shock syndrome - that occurred twice in an EECP-treated patient is described. Toxic shock syndrome initially resembles the state of septic shock. Early recognition of the syndrome and initiation of therapy is of vital importance to prevent rapid progression and a possibly fatal outcome. Awareness of this condition among cardiologists offering EECP is essential. PMID:21165367

Jørgensen, Peter Godsk; Lindberg, Jens Aage; May, Ole

2010-12-01

265

Toxic shock syndrome: A rare complication to enhanced external counterpulsation  

PubMed Central

Enhanced external counterpulsation (EECP) is known to reduce angina pectoris in patients in whom revascularization is not possible. The therapy is associated with few adverse effects. A case with a previously unknown complication – toxic shock syndrome – that occurred twice in an EECP-treated patient is described. Toxic shock syndrome initially resembles the state of septic shock. Early recognition of the syndrome and initiation of therapy is of vital importance to prevent rapid progression and a possibly fatal outcome. Awareness of this condition among cardiologists offering EECP is essential. PMID:21165367

J?rgensen, Peter Godsk; Lindberg, Jens; May, Ole

2010-01-01

266

Sedation-related complications in gastrointestinal endoscopy  

PubMed Central

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

Amornyotin, Somchai

2013-01-01

267

Complications of orthotopic liver transplantation: imaging findings  

Microsoft Academic Search

Orthotopic liver transplantation has become the major treatment for end-stage chronic liver disease and for severe acute liver failure. Despite the improvement in survival due to advances in organ preservation, improved immunosuppressive therapy agents, and refinement of surgical techniques, there are significant complications after liver transplantation. These complications mainly include biliary strictures, stones, and leakage; arterial and venous stenoses and

P. Boraschi; F. Donati

2004-01-01

268

Botulinum toxin: clinical techniques, applications, and complications.  

PubMed

This article outlines practice routines, clinical techniques, applications, and complications of botulinum toxin type A treatment of mimetic facial and neck muscles. Detailed descriptions are provided for each clinical indication that maximize the treatment of the intended muscle groups while minimizing potential complications. PMID:22205526

Stephan, Scott; Wang, Tom D

2011-12-01

269

Complications of IVF and ovulation induction  

Microsoft Academic Search

BACKGROUND: The frequency and importance of complications of IVF and other ovulation induction (OI) are poorly known. We examined the occurrence of serious complications and miscarriages leading to hospitalization or operation after IVF (including microinjections and frozen embryo transfers) and OI treatment (with or without insemination). METHODS: Women who received IVF (n = 9175) or OI treatment (n = 10

Reija Klemetti; Tiina Sevón; Mika Gissler; Elina Hemminki

2005-01-01

270

Complications of carotid endarterectomy and their prevention  

Microsoft Academic Search

Mortality and morbidity associated with carotid endarterectomy may be minimized by proper selection of patients and proper operative and postoperative management. Complications include cardiac and airway problems related to anesthesia, infection, hematoma, nerve pareses, parotitis, arterial disruption, false aneurysms, and carotid-cavernous fistula. The most serious complication is the occurrence of neurologic deficits as a result of cerebral emboli or ischemia.

Jesse E. Thompson

1979-01-01

271

Complications with Outpatient Angiography and Interventional Procedures  

SciTech Connect

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

Young, Noel; Chi, Ka-Kit; Ajaka, Joe; McKay, Lesa; O'Neill, Diane; Wong, Kai Ping [Department of Radiology, Westmead Hospital, Westmead, Sydney, NWS, 2145 (Australia)

2002-03-15

272

JAMA Patient Page: Lung Complications After Surgery  

MedlinePLUS

... on the lungs, the heart, and the upper abdomen. The October 14, 2009, issue of JAMA is a theme issue devoted to surgical care and includes an article about pulmonary complications after surgery. COMPLICATIONS FOR MORE INFORMATION • American Lung Association www. ...

273

Osteogenesis imperfecta as a complication of pregnancy.  

PubMed

Osteogenesis imperfecta is a complex disorder that rarely complicates pregancy. The successful obstetric management of a patient with severe osteogensis imperfecta is presented along with a detailed review of maternal osteogenesis imperfecta in the recent English literature. A review of the disease process, its complications, and associated disorders is presented. PMID:619339

Key, T C; Horger, E O

1978-01-01

274

Prevention of Postoperative Complications following Pancreatic Surgery  

Microsoft Academic Search

Major pancreatic resection is still accompanied by considerable morbidity and even mortality. Complications which occur after pancreatic surgery are chiefly associated with exocrine pancreatic secretion, hence, the inhibition of exocrine pancreatic secretion perioperatively is a promising concept in the prevention of complications. The hormone somatostatin and its synthetic analogue octreotide have been shown to profoundly inhibit exocrine pancreatic secretion, particularly

M. Büchler; H. Friess

1993-01-01

275

[Complication due to intraperitoneal dialysis catheter insertion].  

PubMed

During the last 6 years 300 stylet and Tenckhoff catheters were inserted into the peritoneal cavity. In 5 cases an abdominal viscus has been perforated or injured. The complications were twice a perforation of bowel, twice a perforation of bladder and once an injury of aorta. The authors discussed the therapeutic procedure (conservative or operative) and the late consequences of those complications. PMID:8756747

Majdan, M; Or?owska-Kowalik, G; Jaroszy?ski, A; Ksiazek, A

1996-02-01

276

Complications associated with arthroscopic shoulder surgery  

Microsoft Academic Search

We review the literature on complication of arthroscopic shoulder surgery and their management. Computer data based searches were used to identify articles regarding complications of shoulder arthroscopy, as well as hand searches of Arthroscopy and Journal of Shoulder and Elbow Surgery over the last decade. Arthroscopic shoulder surgery has become a popular therapeutic and diagnostic procedure during the past two

Stephen C. Weber; Jeffrey S. Abrams; Wesley M. Nottage

2002-01-01

277

Surgical emphysema and pneumomediastinum complicating dental extraction.  

PubMed

Subcutaneous and mediastinal emphysema is a rare complication of dental extraction and the use of air turbines has often been implicated. We describe a case which highlights a serious complication of the use of an air rotor for the removal of a right second mandibular molar. PMID:10893812

Ali, A; Cunliffe, D R; Watt-Smith, S R

2000-06-10

278

Complications of surgery for radiotherapy skin damage  

SciTech Connect

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.

Rudolph, R.

1982-08-01

279

Common post-operative complications in children  

PubMed Central

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

Pawar, Dilip

2012-01-01

280

Psychological complications in 281 plastic surgery practices.  

PubMed

Surgery is a high-stakes stressor with possible consequences that include death, pain, disfigurement, economic losses, and alterations in social roles. Often, the most disturbing complications to surgeons and patients are psychological rather than physical. Ineffective management of psychological complications of surgery can have profound consequences, resulting in delayed recuperative times, delayed return to work, poor patient compliance, dissatisfaction with the surgical outcome, hostility toward surgeons, and anxiety. The purpose of this study was to investigate in a large randomized group of plastic surgery practices the relative incidence of negative psychological outcomes and to compare these with the incidence of adverse physical outcomes to gain a greater appreciation of the relative magnitude of each type of perioperative complication. The study design was a descriptive, correlational survey that assessed psychological complications reported by plastic surgeons. The Plastic Surgery Questionnaire was sent to 702 randomly selected board-certified plastic surgeons. The sample consisted of 281 board-certified plastic surgeons (40 percent response rate). The study instrument was found to be highly reliable, with inter-item Cronbach's alpha r = 0.85. The demographics were representative of the specialty as a whole. It was found in general that psychological complications were much more prevalent than physical problems such as hematoma or infection. Anxiety reactions were commonly encountered by 95.4 percent of surgeons; disappointment (96.8 percent), depression (95.0 percent), nonspecific physical complaints (92.2 percent), and sleep disorders (88.5 percent) were the next most commonly reported complications. Most surgeons (75.8 percent) reported that screening for depression was important, but only 18.8 percent identified screening for post-traumatic stress disorder as important, even though 86 percent had diagnosed post-traumatic stress disorder in their postoperative patients. Psychological complications occur at rates equal to or greater than those of physical complications in the plastic surgery practice. Patients who experience physical complications are much more likely to simultaneously experience psychological complications. Patients with preexisting psychological conditions are more at risk for postoperative psychological complications. Disappointment, anxiety, and depression were the most frequently seen psychological complications. Nursing personnel are perceived by plastic surgeons to have the primary role in screening patients for pertinent psychological history. Directed research should be undertaken to determine which treatment regimens are most effective in reducing preoperative psychological complications. Controlled clinical trials of pharmaceuticals and alternative therapies must be designed and carried out in a prospective manner to establish the optimum treatment for alleviation of adverse emotional consequences of surgery. The next frontier for the specialty is to actively and consciously investigate and improve our patients' emotional and psychological results from surgery. PMID:10513902

Borah, G; Rankin, M; Wey, P

1999-10-01

281

[Complications after coronary angiography and balloon dilatation].  

PubMed

All major complications within four weeks after diagnostic cardiac catheterization (DCCA; n = 4,778) or percutaneous transluminal coronary angioplasty (PTCA; n = 3,073) were analysed prospectively in 7,851 patients (5,769 men, 2,082 women; mean age 59.4 [16-88] years). There were 116 such complications in 114 patients, 46 (0.9%) after DCCA, 70 (2.3%) after PTCA. 76% of all complications occurred during the first two days after the procedure: bleeding in 29 patients, false aneurysms in 15, arterial occlusions in 12, venous ones in three, cerebral ischaemia in 12, fulminant pulmonary emboli in three, cardiac complications in 27, and others in 15. There were five deaths in connection with a DCCA, 18 with PTCA. Complications were twice as common in women as in men (DCCA: 1.5% vs 0.7%, P < 0.05; PTCA: 4.2% vs 1.7%, P < 0.001). Complications after DCCA were more frequent in those aged over 55 years (1.2% vs 0.3%, P < 0.05); after PTCA they were more frequent in those aged over 65 years (4.1% vs 1.3%, P < 0.05). Other risk factors for complications were: peripheral arterial occlusive disease for arterial occlusion (P < 0.001), high heparin dosage with DCCA (P < 0.05), and additional venous puncture with DCCA (P < 0.01). PMID:8243238

Bach, R; Espinola-Klein, C; Ozbek, C; Jung, F; Schieffer, H

1993-11-19

282

Complications and failure of airway management.  

PubMed

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

Cook, T M; MacDougall-Davis, S R

2012-12-01

283

Inflammatory Breast Diseases during Lactation: Milk Stasis, Puerperal Mastitis, Abscesses of the Breast, and Malignant Tumors - Current and Evidence-Based Strategies for Diagnosis and Therapy  

PubMed Central

Background Breast diseases during the lactation period are of high importance because they can be an essential cause for early cessation of breastfeeding. Methods To provide a comprehensive overview on the current recommendations of diagnostics and therapies, a systematic literature research was performed on a variety of online medical databases. Results The primary aim of all therapy is a quick reduction of pain to allow continued breastfeeding. Each particular form of breast disease requires a specific therapy. These can range from conservative measures to antibiotics and surgical procedures. All therapeutic measures, including pharmacotherapy, are normally not an indication for cessation of breastfeeding. Conclusion Because the majority of breast diseases during the postnatal period occur only after the women have left the maternity clinics, all involved healthcare workers should educate women especially on preventive measures. PMID:22619640

Abou-Dakn, Michael; Richardt, Anna; Schaefer-Graf, Ute; Wockel, Achim

2010-01-01

284

Complications in hair-restoration surgery.  

PubMed

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

Konior, Raymond J

2013-08-01

285

Extraintestinal complications of inflammatory bowel disease  

Microsoft Academic Search

Opinion statement  \\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a Extraintestinal complications of inflammatory bowel disease (IBD) are often secondary to the underlying disease. Therefore,\\u000a the first priority is to get active IBD into remission with medications, since surgery for IBD is not indicated for the treatment\\u000a of extraintestinal complications.\\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a Symptoms of extraintestinal complications usually can be treated with simple agents; the treatment of patients with

Ad A. van Bodegraven; Ben A. C. Dijkmans; Paul Lips; Tom J. Stoof; A. Salvador Peña; Stephan G. M. Meuwissen

2001-01-01

286

Vascular complications after splenectomy for hematologic disorders  

PubMed Central

The most widely recognized long-term risk of splenectomy is overwhelming bacterial infection. More recently, thrombosis has become appreciated as another potential complication of the procedure. Because of these long-term risks, the indications for and timing of splenectomy are debated in the medical community. Accordingly, the adverse effects and benefits of splenectomy for hematologic disorders and other conditions demand further study. This comprehensive review summarizes the existing literature pertaining to vascular complications after splenectomy for hematologic conditions and attempts to define the potential pathophysiologic mechanisms involved. This complex topic encompasses diverse underlying conditions for which splenectomy is performed, diverse thrombotic complications, and multiple pathophysiologic mechanisms. PMID:19636061

Buchanan, George R.

2009-01-01

287

Switching antiretroviral therapy to minimize metabolic complications  

PubMed Central

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

Lake, Jordan E; Currier, Judith S

2011-01-01

288

Early Literacy  

Microsoft Academic Search

\\u000a This chapter explores the connections and disconnections between children’s oral language\\u000a \\u000a and early literacy\\u000a \\u000a . It begins with studies of oral language\\u000a \\u000a as a predictor of early literacy\\u000a \\u000a and then moves on to exploring early literacy\\u000a \\u000a development in homes, early education and care, and the first years of school. Examples of pedagogies incorporating children’s\\u000a ‘funds of knowledge’ from homes and

Susan Hill

289

Eleven years of experience with the neurologic complications in Korean patients with acute aortic dissection: a retrospective study  

PubMed Central

Background This study attempts to explore the clinical features, possible mechanisms and prognosis of the neurologic complications in patients with acute aortic dissection (AD). Methods Medical records of 278 consecutive patients with AD (165 with type A and 113 with type B dissection) over 11.5 years were retrospectively analyzed for clinical history, CT findings, neurologic complications and outcome. Neurologic complications were classified into early-onset or delayed-onset complications. Independent t-test or Chi-square test (or Fisher exact test) was used for comparing the different groups. Multivariable logistic regression analysis was performed to determine the independent association between variables. Results The mean age of the included patients (145 male and 133 female) was 59.4 years (range 19–91 years). 41 patients (14.7%) had a neurologic complication, which included 21 with early-onset complication and 23 with delayed-onset complication, including 3 with both. Advanced age and classic type of dissection were independently associated with the neurologic complication in patients with type A dissection. The most frequent manifestation was ischemic stroke (26 patients, 9.4%), followed by hypoxic encephalopathy (9, 3.2%), ischemic neuropathy (5, 1.8%), spinal cord ischemia (5, 1.8%), seizure (2, 0.7%), hoarseness (1, 0.4%) and septic encephalopathy (1, 0.4%). Overall in-hospital mortality was 10.1%, whereas the complicated group had a mortality rate of 43.9%. Renal impairment, pulse deficit, neurologic complication and nonsurgical treatment were independent variables for determining in-hospital mortality in patients with type A dissection. Conclusions The dominance of neurologic symptom in the early stage of AD may make its early diagnosis difficult. Besides chest pain and widened mediastinum in chest x-ray, variable neurologic symptoms including left hemiparesis with asymmetric pulse and hypotension may suggest underlying AD. PMID:23692963

2013-01-01

290

Section 8. Management of portal venous complications in pediatric living donor liver transplantation.  

PubMed

Portal vein (PV) complications after living donor liver transplant (LDLT) have been a major concern in pediatric liver transplantation. The incidence of PV complications is more in pediatric (0%-33%) than in adult recipients. Early diagnosis and treatment of PV complications may ensure optimal graft function and good recipient survival. Small preoperation PV size (<4 mm) and slow portal flow (<10 cm/s) combined with lower hepatic artery resistance index (<0.65) are strong warning signs that may predict the development of post LDLT PV complications. Portal vein angioplasty/stenting is conventionally performed through the percutaneous transhepatic approach; however, this can also be performed through transjugular, trans-splenic, and intraoperative approaches. Depending on the situation, using optimal method is the key point to minimize complication (5%) and gain high success rate (80%). PV occlusion of greater than 1 year with cavernous transformation seems to be a factor causing technical failure. Good patency rate (100%) with self-expandable metallic stents was noted in long-term follow-up. In conclusion, PV stent placement is an effective, long-term treatment modality to manage PV complications after pediatric LDLT. Early diagnosis and treatment are essential to maximize the use of stent placement and achieve good success rates. PMID:24849830

Cheng, Yu-Fan; Ou, Hsin-You; Yu, Chun-Yen; Tsang, Leo Leung-Chit; Huang, Tung-Liang; Chen, Tai-Yi; Concejero, Allan; Wang, Chih-Chi; Wang, Shih-Ho; Lin, Tsan-Shiun; Liu, Yueh-Wei; Yang, Chin-Hsiang; Yong, Chee-Chien; Chiu, King-Wah; Jawan, Bruno; Eng, Hock-Liew; Chen, Chao-Long

2014-04-27

291

An unusual complication following radiological percutaneous gastrostomy  

E-print Network

with complications. Clinicians should have a high index of suspicion about malrotation when performing procedures like percutaneous gastrostomy and radiologically guided entrostomy. If there is an index of suspicion they should be screened prior to the procedure....

Veenith, Tonny; Bhagwat, Manasi; Bailey, Andrew

2008-08-12

292

Acute polyradiculoneuropathy complicating systemic lupus erythematosus.  

PubMed Central

Two elderly patients with systemic lupus erythematosus (SLE) are presented. Both developed an acute polyradiculoneuropathy which is an unusual complication of this disease. Features of their presentation are discussed. PMID:3714625

Morgan, S. H.; Kennett, R. P.; Dudley, C.; Mackworth-Young, C.; Hull, R.; Hughes, G. R.

1986-01-01

293

PREVENTING POSTOPERATIVE COMPLICATIONS IN THE ELDERLY  

PubMed Central

SYNOPSIS Postoperative complications are directly related to poor surgical outcomes in the elderly. This review outlines evidence based quality initiatives focused on decreasing neurologic, cardiac, and pulmonary complications in the elderly surgical patient. Delirium is the most common neurologic complication in the elderly. Important anesthesia quality initiatives for prevention of delirium in elderly surgical patients include use of structured clinical protocols focused on delirium risk factor modification, avoiding meperidine when managing postoperative pain, and careful selection and titration of drugs when sedation is required. There are few age-specific quality measures aimed at prevention of cardiac and pulmonary complications. However, some recommendations for adults such as avoidance of long acting muscle relaxants and perioperative use of statins and beta blockers in high risk patients can be applied to the geriatric surgical population. In the future, process measures may provide a more global assessment of quality in the elderly surgical population. PMID:21295754

Sieber, Frederick E.; Barnett, Sheila Ryan

2011-01-01

294

[Complications of transrectal biopsy of the prostate].  

PubMed

The aim of the study was to assess frequency of various complications of transrectal multifocal biopsy of the prostate (TMBP), to specify prophylactic measures against such complications. Primary TMBP under US guidance was made in 612 patients (mean age 65.8 years, mean level of PSA 12.6 ng/ml). TMBP complications include: hematuria (220 patients, 35.9%), hemospermia (166 patients, 27.1%), pain in the perineum and the rectum (189, 30.9%), acute prostatitis (21 patients, 3.4%), acute orchiepididymitis (7 patients, 1.1%), acute urine retention (9 patients, 1.5%), long-term rectal hemorrhage (13 patients, 2.1%), loss of consciousness during the biopsy (7 patients, 1.1%). The analysis of TMBP complications leads to the conclusion that adequate preparation of the patients and accurate conduction of the prostatic biopsy technique under US guidance make this invasive manipulation diagnostically effective and safe. PMID:15989026

Pushkar', D Iu; Govorov, A V

2005-01-01

295

Pulmonary hypertension complicating connective tissue disease.  

PubMed

Pulmonary hypertension (PH) may complicate connective tissue disease (CTD), particularly systemic sclerosis (SSc, scleroderma), and markedly increases mortality. More than 70% of cases of PH complicating CTD occur in SSc, which is the major focus of this article. Pulmonary complications (i.e., interstitial lung disease [ILD] and PH) are the leading causes of scleroderma-related deaths. "Isolated" PH (i.e., without ILD) complicates SSc in 7.5 to 20% of cases; secondary PH may also occur in patients with SSc-associated ILD. Several clinical markers and specific autoantibody profiles have been associated with PH in SSc. The role of PH-specific therapy is controversial, as prognosis and responsiveness to therapy are worse in SSc-associated PH compared with idiopathic pulmonary arterial hypertension. We discuss medical therapies for CTD-associated PH and the role of lung transplantation for patients failing medical therapy. PMID:24037627

Lynch, Joseph P; Belperio, John A; Saggar, Rajeev; Fishbein, Michael C; Saggar, Rajan

2013-10-01

296

Cirrhosis and its complications: Evidence based treatment  

PubMed Central

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

Nusrat, Salman; Khan, Muhammad S; Fazili, Javid; Madhoun, Mohammad F

2014-01-01

297

Avoidance and Management of Stomal Complications  

PubMed Central

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

Kwiatt, Michael; Kawata, Michitaka

2013-01-01

298

Human Papillomavirus (HPV) and Genital Warts: Complications  

MedlinePLUS

... JavaScript on. Read more information on enabling JavaScript. Human Papillomavirus (HPV) and Genital Warts Skip Content Marketing Share this: Main Content Area Complications Cancer Some types of HPV can cause cervical cancer. Other types are associated ...

299

Chronic Kidney Disease and Its Complications  

PubMed Central

Chronic kidney disease (CKD) is a complex disease impacting more than twenty million individuals in the United States. Progression of CKD is associated with a number of serious complications, including increased incidence of cardiovascular disease, hyperlipidemia, anemia and metabolic bone disease. CKD patients should be assessed for the presence of these complications and receive optimal treatment to reduce their morbidity and mortality. A multidisciplinary approach is required to accomplish this goal. PMID:18486718

Thomas, Robert; Kanso, Abbas; Sedor, John R.

2008-01-01

300

Unusual complications of ventriculo peritoneal shunt surgery  

PubMed Central

Ventriculo peritoneal (VP) shunt surgery is one of the common neurosurgical procedures employed in the management of hydrocephalus. Numerous complications related to this procedure are reported in the literature. Peritoneal catheter-related complications are the usual causes of the shunt malfunction. We report three unusual cases of peritoneal shunt catheter migration in children. Two cases are of anal and one vaginal extrusion. Possible mechanisms of migration and management strategies were discussed. PMID:23189000

Teegala, Ramesh; Kota, Laxmi Prasanna

2012-01-01

301

Self-expanding prostheses complicating augmentation mammoplasties.  

PubMed

A new and serious complication was experienced by patients of three independent surgeons following routine augmentation procedures. In each case reported, double-lumen prostheses had been used. All cases were reoperated with a diagnosis of capsular contracture. However, at surgery it was found that the outer lumen of the prostheses had overfilled with 60-160 cc of interstitial fluid, probably because of an osmotic gradient. The possible causes of this unfortunate complication are considered. PMID:8017225

Signorini, M; Grisotti, A; Ponzielli, G; Pajardi, G; Gilardino, P

1994-01-01

302

Management of choledochal cysts and their complications.  

PubMed

Choledochal cysts are increasingly reported in adults. The presence of cyst-related complications alters its presentation and complicates the management. We reviewed our experience to find the clinical presentation, complications, and the management of choledochal cysts. The records of 132 patients with choledochal cysts presented to us between 2003 and 2010 maintained as a prospective database were analyzed for demography, clinical presentation, radiological investigation, management, and outcome. There were 12 children and 120 adults. Based on preoperative cholangiogram, 93 (71%) patients had Type I and 39 (29%) Type IVA cysts. The overall incidence of complicated choledochal cyst was 4 of 12 (33%) in children and 85 of 120 (71%) in adults. The most common complication was cystolithiasis (49%) followed by cholangitis (32%), acute pancreatitis (10%), hepatolithiasis (7%), malignancy (3%), portal hypertension (2%), and chronic pancreatitis (2%). Acute pancreatitis and cholangitis were managed conservatively. Endoscopic stenting was performed in patients with cholangitis and those requiring staged treatment as a result of portal hypertension. Overall 114 patients underwent cyst excision with Roux-en-y hepaticojejunostomy. The overall morbidity was 17.5 per cent (wound infection 13% and bilioenteric anastomotic leak 7%). There was one postoperative death resulting from cardiac failure. Three patients developed anastomotic stricture and underwent redo hepaticojejunostomy. Choledochal cysts in adults are often associated with complications. Complications are more common in adults compared with children. Acute pancreatitis, cholangitis and portal hypertension are managed conservatively and then followed up by definitive surgery. Cyst excision with Roux-en-Y hepaticojejunostomy is necessary to prevent the recurrence of complications. PMID:22524764

Saluja, Sundeep Singh; Nayeem, Mohammed; Sharma, Barjesh Chander; Bora, Giriraj; Mishra, Pramod Kumar

2012-03-01

303

Management of intraoperative penile implant complications  

Microsoft Academic Search

The three-piece inflatable penile prosthesis has the highest patient satisfaction and lowest mechanical revision rate of any\\u000a medically implanted device. Revisions of inflatable penile prostheses are more often required for nonmechanical reasons than\\u000a for device failure. Intraoperative complications of penile implant placement can be distressing for the prosthetic surgeon,\\u000a but with recognition of the dilemma, most of these complications can

Gerard D. Henry

2005-01-01

304

Complications of injectable fillers, part I.  

PubMed

Dermal filling has rapidly become one of the most common procedures performed by clinicians worldwide. The vast majority of treatments are successful and patient satisfaction is high. However, complications, both mild and severe, have been reported and result from injection of many different types of dermal fillers. In this Continuing Medical Education review article, the author describes common technical errors, the signs and symptoms of both common and rare complications, and management of sequelae in clear, easily adaptable treatment algorithms. PMID:23636629

DeLorenzi, Claudio

2013-05-01

305

Complications of closing wedge high tibial osteotomy  

Microsoft Academic Search

Closing wedge high tibial osteotomy is a common, effective and well-established procedure to treat unicompartment osteoarthrosis\\u000a of the knee. It is, however, not without its complications. This article will discuss some of these complications and present\\u000a an overview of the current literature. It will examine current thoughts on aetiology, techniques to try to avoid, and methods\\u000a of treatment of these

James A. W. Tunggal; Gordon A. Higgins; James P. Waddell

2010-01-01

306

Standardizing the reporting of percutaneous nephrolithotomy complications  

PubMed Central

Accurate reporting of complications is an essential component to critical appraisal and innovation in surgery and specifically with percutaneous nephrolithotomy (PCNL). We review the evolution of complication reporting for PCNL and suggest future directions for innovation. A selective review was carried out using Pubmed. Key search terms and their combinations included percutaneous, anatrophic, nephrolithotomy, PCNL, complications, Clavien, Martin score, bleeding, bowel injury, perforation, fever, sepsis. The references from relevant papers and reviews as well as AUA and EAU guidelines were also scanned for inclusion. PCNL has become the procedure of choice for large renal stones owing to decreased morbidity over alternative procedures. Both common and rare complications have been described in large case series, small randomized controlled trials, and case reports in an unstandardized form. Although these reports have provided an informative starting point, a standardized complication reporting methodology is necessary to enable appropriate comparisons between institutions, time periods, or innovations in technique. The Clavien-Dindo grading system has become widely accepted in urology and has facilitated the study of PCNL complications. Future research should focus on adaptions of this system to render it more comprehensive and applicable to PCNL. PMID:24497689

Voilette, Philippe D.; Denstedt, John D.

2014-01-01

307

Diabetic complications and dysregulated innate immunity  

PubMed Central

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

Graves, Dana T; Kayal, Rayyan A

2011-01-01

308

Preoperative Chemotherapy Does Not Increase Complications After Nonsmall Cell Lung Cancer Resection  

Microsoft Academic Search

Background. Neoadjuvant chemotherapy before resec- tion of nonsmall cell lung cancer seems to increase survival, mainly in the early stage. Risks of postoperative complications after chemotherapy and surgery remain controversial. Here we review our experience with pa- tients treated in one thoracic surgery center. Methods. Patients undergoing resection for nonsmall cell lung cancer after induction chemotherapy between January 1993 and

Emilie Perrot; Benoit Guibert; Pierre Mulsant; Sonia Blandin; Isabelle Arnaud; Pascal Roy; Laurence Geriniere; Pierre-Jean Souquet

2010-01-01

309

MD Anderson study finds side effects, complications, and mastectomy are more likely after partial breast irradiation:  

Cancer.gov

Accelerated partial breast irradiation (APBI) brachytherapy, the localized form of radiation therapy growing increasingly popular as a treatment choice for women with early-stage breast cancer, is associated with higher rate of later mastectomy, increased radiation-related toxicities and post-operative complications, compared to traditional whole breast irradiation (WBI), according to researchers from The University of Texas MD Anderson Cancer Center.

310

Managing complications associated with laparoscopic Roux-en-Y gastric bypass for morbid obesity  

PubMed Central

Obesity has become a major health concern in Canada. This has resulted in a steady rise in the number of bariatric surgical procedures being performed nationwide. The laparoscopic Roux-en-Y gastric bypass (LRYGB) is not only the most common bariatric procedure, but also the gold standard to which all others are compared. With this in mind, it is imperative that all gastrointestinal surgeons understand the LRYGB and have a working knowledge of the common postoperative complications and their management. Early postoperative complications following LRYGB that demand immediate recognition include anastomotic or staple line leak, postoperative hemorrhage, bowel obstruction and incorrect Roux limb reconstructions. Later complications may be challenging to differentiate from other gastrointestinal disorders and include anastomotic stricture, marginal ulceration, fistula formation, weight gain and nutritional deficiencies. We discuss the principles involved in the management of each complication and the timing of referral to specialist bariatric centres. PMID:22854113

Griffith, P. Sahle; Birch, Daniel W.; Sharma, Arya M.; Karmali, Shahzeer

2012-01-01

311

Managing complications associated with laparoscopic Roux-en-Y gastric bypass for morbid obesity.  

PubMed

Obesity has become a major health concern in Canada. This has resulted in a steady rise in the number of bariatric surgical procedures being performed nationwide. The laparoscopic Roux-en-Y gastric bypass (LRYGB) is not only the most common bariatric procedure, but also the gold standard to which all others are compared. With this in mind, it is imperative that all gastrointestinal surgeons understand the LRYGB and have a working knowledge of the common postoperative complications and their management. Early postoperative complications following LRYGB that demand immediate recognition include anastomotic or staple line leak, postoperative hemorrhage, bowel obstruction and incorrect Roux limb reconstructions. Later complications may be challenging to differentiate from other gastrointestinal disorders and include anastomotic stricture, marginal ulceration, fistula formation, weight gain and nutritional deficiencies. We discuss the principles involved in the management of each complication and the timing of referral to specialist bariatric centres. PMID:22854113

Griffith, P S; Birch, Daniel W; Sharma, Arya M; Karmali, Shahzeer

2012-10-01

312

Liver regeneration after liver resection: Clinical aspects and correlation with infective complications  

PubMed Central

AIM: To investigate whether early liver regeneration after resection in patients with hepatic tumors might be influenced by post-operative infective complications. METHODS: A retrospective analysis of 27 liver resections for tumors performed in a single referral center from November 2004 to January 2010. Regeneration was evaluated by multidetector computed tomography at a mean follow-up of 43.85 d. The Clavien-Dindo classification was used to evaluate postoperative events in the first 6 mo after transplantation, and Centers for Disease Control and Prevention definitions were used for healthcare associated infections data. Generalized linear regression models with Gaussian family distribution and log link function were used to reveal the principal promoters of early liver regeneration. RESULTS: Ten of the 27 patients (37%) underwent chemotherapy prior to surgery, with a statistically significant prevalence of patients with metastasis (P = 0.007). Eight patients (30%) underwent embolization, 3 with primary tumors, and 5 with secondary tumors. Twenty patients (74%) experienced complications, with 12 (60%) experiencing Clavien-Dindo Grade 3a to 5 complications. Regeneration ? 100% occurred in 10 (37%) patients. The predictors were smaller future remnant liver volume (-0.002; P < 0.001), and a greater spleen volume/future remnant liver volume ratio (0.499; P = 0.01). Patients with a resection of ? 5 Couinaud segments experienced greater early regeneration (P = 0.04). Nine patients experienced surgical site infections, and in 7 cases Clavien-Dindo Grade 3a to 4 complications were detected (P = 0.016). There were no significant differences between patients with primary or secondary tumors, and either onset or infections or severity of surgical complications. CONCLUSION: Regardless of the onset of infective complications, future remnant liver and spleen volumes may be reliable predictors of early liver regeneration after hepatic resection on an otherwise healthy liver. PMID:24944488

Pagano, Duilio; Spada, Marco; Parikh, Vishal; Tuzzolino, Fabio; Cintorino, Davide; Maruzzelli, Luigi; Vizzini, Giovanni; Luca, Angelo; Mularoni, Alessandra; Grossi, Paolo; Gridelli, Bruno; Gruttadauria, Salvatore

2014-01-01

313

Unusual imaging characteristics of complicated hydatid disease.  

PubMed

Hydatid disease, a worldwide zoonosis, is caused by the larval stage of the Echinococcus tapeworm. Although the liver and the lungs are the most frequently involved organs in the body, hydatid cysts of other organs are unusual. Radiologically, they usually demonstrate typical imaging findings, but unusual imaging characteristics of complicated cyst of hydatid disease, associated with high morbidity and mortality, are rarely described in the literature. The purpose of this study is to review the general features of hydatidosis and to discuss atypical imaging characteristics of the complicated hydatid disease in the human, with an emphasis on structure and rupture of the cystic lesion as well as ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI) features of the disease. In our study, the available literature and images of the cases with complicated hydatidosis involving liver, lung, brain, spine and orbit were reviewed retrospectively. In hydatid disease, there are many potential local and systemic complications due to secondary involvement in almost any anatomic location in humans. Radiologically, in addition to the presence of atypical findings such as perifocal edema, non-homogenous contrast enhancement, multiplicity or septations and calcification, various unusual manifestations due to rupture or infection of the cyst have been observed in our cases with complicated hydatid disease. To prevent subsequent acute catastrophic results and the development of recurrences in various organs, it should be kept in mind that complicated hydatid cysts can cause unusual USG, CT, and MRI findings, in addition to typical ones, in endemic areas. Therefore, familiarity with atypical radiological appearances of complicated hydatid disease may be valuable in making a correct diagnosis and treatment. PMID:17275238

Turgut, Ahmet Tuncay; Altin, Levent; Topçu, Salih; Kiliço?lu, Bülent; Aliinok, Tamer; Kaptano?lu, Erkan; Karademir, Alp; Ko?ar, U?ur

2007-07-01

314

Assessment of Complications After Pancreatic Surgery  

PubMed Central

Objective: To define a simple and reproducible classification of complications following pancreaticoduodenectomy (PD) based on a therapy-oriented severity grading system. Background: While mortality is rare after PD, morbidity rates remain high. The lack of standardization in evaluating morbidity after PD has severely hampered meaningful comparisons over time and among centers. We adapted a novel classification of complication to stratify morbidity by severity after PD, to test whether the incidence of pancreatic fistula has changed over time, and to identify risk factors in a single North American center. Methods: The classification was applied to a consecutive series of 633 patients undergoing PD between February 2003 and August 2005. Another series of 141 patients treated between 1987 and 1990 was also analyzed to identify changes in the incidence and severity of fistula. Univariate and multivariate analyses were performed to link respective complications with preoperative and intraoperative parameters, length of hospital stay, and long-term survival. Results: A total of 263 (41.5%) patients did not develop any complication, while 370 (58.5%) had at least one complication; 62 (10.0%) patients had only grade I complications (no need for specific intervention), 192 patients (30.0%) had grade II (need for drug therapy such as antibiotics), 85 patients (13.5%) had grade III (need for invasive therapy), and 19 patients (3.0%) had grade IV complications (organ dysfunction with ICU stay). Grade V (death) occurred in 12 patients (2.0%). A total of 57 patients (9.0%) developed pancreatic fistula, of which 33 (58.0%) were classified as grade II, 17 (30.0%) as grade III, 5 (9.0%) as grade IV, and 2 (3.5%) as grade V. Delayed gastric emptying was documented in 80 patients (12.7%); half of them were scored as grade II and the other half as grade III. A significant decrease in the incidence of fistula was observed between the 2 periods analyzed (14.0% vs. 9.0%, P < 0.001), mostly due to a decrease in grade II fistula. Cardiovascular disease was a risk factor for overall morbidity and complication severity, while texture of the gland and cardiovascular disease were risk factors for pancreatic fistula. Conclusion: This study demonstrates the applicability and utility of a new classification in grading complications following pancreatic surgery. This novel approach may provide a standardized, objective, and reproducible assessment of pancreas surgery enabling meaningful comparison among centers and over time. PMID:17122618

DeOliveira, Michelle L.; Winter, Jordan M.; Schafer, Markus; Cunningham, Steven C.; Cameron, John L.; Yeo, Charles J.; Clavien, Pierre-Alain

2006-01-01

315

Catecholamine predictors of complicated grief treatment outcomes.  

PubMed

Could sympathetic hyperarousal limit treatment success in complicated grief? The present study investigated persons with complicated grief, a chronic condition with distinct symptoms including persistent intense yearning and longing for the person who died, avoidance of reminders that the person is gone, deep relentless sadness, self-blame, bitterness, or anger in connection with the death, and an inability to gain satisfaction or joy through engaging in meaningful activities or relationships with significant others. Length of bereavement did not correlate with complicated grief scores. Catecholamines (i.e., epinephrine, norepinephrine, dopamine) in plasma were assessed pre- and post-psychotherapeutic treatment. Participants with the highest levels of epinephrine at pre-treatment had the highest levels of complicated grief symptoms at post-treatment, accounting for baseline levels of symptoms. This predictive relationship was not seen for depressive symptoms. The present study supports the hypothesis that catecholamine levels are affected by bereavement, and in turn, can affect the ability of those with complicated grief to benefit from psychotherapy. PMID:23044089

O'Connor, Mary-Frances; Shear, M Katherine; Fox, Rachel; Skritskaya, Natalia; Campbell, Bevin; Ghesquiere, Angela; Glickman, Kim

2013-06-01

316

Gut microbiota-related complications in cirrhosis  

PubMed Central

Gut microbiota plays an important role in cirrhosis. The liver is constantly challenged with commensal bacteria and their products arriving through the portal vein in the so-called gut-liver axis. Bacterial translocation from the intestinal lumen through the intestinal wall and to mesenteric lymph nodes is facilitated by intestinal bacterial overgrowth, impairment in the permeability of the intestinal mucosal barrier, and deficiencies in local host immune defences. Deranged clearance of endogenous bacteria from portal and systemic circulation turns the gut into the major source of bacterial-related complications. Liver function may therefore be affected by alterations in the composition of the intestinal microbiota and a role for commensal flora has been evidenced in the pathogenesis of several complications arising in end-stage liver disease such as hepatic encephalopathy, splanchnic arterial vasodilatation and spontaneous bacterial peritonitis. The use of antibiotics is the main therapeutic pipeline in the management of these bacteria-related complications. However, other strategies aimed at preserving intestinal homeostasis through the use of pre-, pro- or symbiotic formulations are being studied in the last years. In this review, the role of intestinal microbiota in the development of the most frequent complications arising in cirrhosis and the different clinical and experimental studies conducted to prevent or improve these complications by modifying the gut microbiota composition are summarized.

Gomez-Hurtado, Isabel; Such, Jose; Sanz, Yolanda; Frances, Ruben

2014-01-01

317

Hodgkin's Lymphoma: A Review of Neurologic Complications.  

PubMed

Hodgkin's lymphoma is a hematolymphoid neoplasm, primarily of B cell lineage, that has unique histologic, immunophenotypic, and clinical features. Neurologic complications of Hodgkin's Lymphoma can be separated into those that result directly from the disease, indirectly from the disease, or from its treatment. Direct neurologic dysfunction from Hodgkin's Lymphoma results from metastatic intracranial spinal disease, epidural metastases causing spinal cord/cauda equina compression, leptomeningeal metastases, or intradural intramedullary spinal cord metastases. Indirect neurologic dysfunction may be caused by paraneoplastic disorders (such as paraneoplastic cerebellar degeneration or limbic encephalitis) and primary angiitis of the central nervous system. Hodgkin's lymphoma treatment typically includes chemotherapy or radiotherapy with potential treatment-related complications affecting the nervous system. Neurologic complications resulting from mantle-field radiotherapy include the "dropped head syndrome," acute brachial plexopathy, and transient ischemic attacks/cerebral infarcts. Chemotherapy for Hodgkin's lymphoma may cause cerebral infarction (due to emboli from anthracycline-induced cardiomyopathy) and peripheral neuropathy. PMID:20975772

Grimm, Sean; Chamberlain, Marc

2011-01-01

318

Plasmodium vivax malaria complicated by splenic infarct.  

PubMed

An 11-year-old girl presented with Plasmodium vivax malaria complicated by shock and acute renal failure. The diagnosis of malaria was based on demonstration of trophozoites of P. vivax in the peripheral blood smear and a positive rapid malarial antigen test for P. vivax but negative for P. falciparum. She responded to parenteral artesunate and supportive care. During the course of her infection, she developed pain in her left hypochondrium. Ultrasonography showed multiple hypo-echoic lesions in the spleen and CT scan revealed multiple splenic infarcts. Management was restricted to close clinical monitoring and analgesia. We consider that this is the first report of splenic infarct complicating the course of childhood P. vivax malaria in the English literature. Physicians should suspect and investigate for this rare complication if a patient with malaria complains of left upper quadrant abdominal pain, pleuritic left lower chest pain and/or enlarging tender splenomegaly during the course of malaria infection. PMID:24090806

Aggarwal, Varun; Nagpal, Anjali; Agrawal, Yatendra; Kumar, Virendra; Kanwal, Sandeep Kumar; Dhingra, Bhavna

2014-02-01

319

Neurological Complications of Solid Organ Transplantation  

PubMed Central

Solid organ transplantation (SOT) is the preferred treatment for an expanding range of conditions whose successful therapy has produced a growing population of chronically immunosuppressed patients with potential neurological problems. While the spectrum of neurological complications varies with the type of organ transplanted, the indication for the procedure, and the intensity of long-term required immunosuppression, major neurological complications occur with all SOT types. The second part of this 2-part article on transplantation neurology reviews central and peripheral nervous system problems associated with SOT with clinical and neuroimaging examples from the authors’ institutional experience. Particular emphasis is given to conditions acquired from the donated organ or tissue, problems specific to types of organs transplanted and drug therapy-related complications likely to be encountered by hospitalists. Neurologically important syndromes such as immune reconstitution inflammatory syndrome (IRIS), posterior reversible encephalopathy syndrome (PRES), and posttransplantation lymphoproliferative disorder (PTLD) are readdressed in the context of SOT. PMID:24167649

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

2013-01-01

320

Complications of Blepharoplasty: Prevention and Management  

PubMed Central

Blepharoplasty is an operation to modify the contour and configuration of the eyelids in order to restore a more youthful appearance. The surgery involves removing redundant skin, fat, and muscle. In addition, supporting structures such as canthal tendons are tightened. Other conditions such as ptosis, brow ptosis, entropion, ectropion, or eyelid retraction may also need to be corrected at the time a blepharoplasty is performed to ensure the best functional and aesthetic result. Due to the complexity and intricate nature of eyelid anatomy, complications do exist. In addition to a thorough pre operative assessment and meticulous surgical planning, understanding the etiology of complications is key to prevention. Finally, management of complications is just as important as surgical technique. PMID:22655191

Oestreicher, James; Mehta, Sonul

2012-01-01

321

Complications of Therapy in Parkinson's Disease  

PubMed Central

Despite several more effective combinations, the incidence of disability and intractable complications from levodopa therapy for Parkinson's disease is unchanged. Many of these appear to be related to the development of denervation hypersensitivity as well as to drug tolerance and loss of effect. They include dyskinesia, `wearing off' phenomenon, `on-off' phenomenon, and various psychic changes. More current forms of therapy with bromocriptine and drug holidays are described, emphasizing methods of preventing and controlling the incapacitating complications associated with long term drug therapy. Some future therapeutic considerations are also described. PMID:21286582

Kofman, Oscar S.

1983-01-01

322

[Haematopoietic stem cell transplantation and oral complications].  

PubMed

New haematopoietic stem cell transplantation procedures make the treatment available to patients who previously did not qualify, such as the elderly. In addition, the spectrum of oral complications associated with haematopoietic stem cell transplantation has altered as a result of the recent developments. This article is a review of the main principles of haematopoietic stem cell transplantation and provides information on oral complications which may develop, such as mucositis, infections, bleeding, graft-versus-host disease, xerostomia, hyposalivation, altered taste, secondary tumors, osteoporosis, osteonecrosis and growing and developing disturbancies. Finally, the role of dental care providers in cases of haematopoietic stem cell transplantation is addressed. PMID:19585886

Raber-Durlacher, J E; von dem Borne, P A; Stokman, M A; Gortzak, R A Th

2009-06-01

323

Subdural haematoma: a complication of cochlear implantation.  

PubMed

Cochlear implants have transformed the treatment of sensorineural hearing loss. They have few major complications. The authors describe the case of a man fitted with a cochlear implant who suffered a postoperative subdural haematoma. The haematoma is thought to have been caused by bleeding from emissary veins opened by the drill passages used to anchor the sutures for the receiver/stimulator. The authors have abandoned tie down sutures in cochlear implants, preferring an appropriately deep well with squared-off rims, which would secure the implant in place. They have had no further complications of this nature. PMID:15667688

Sunkaraneni, V S; Banerjee, A; Gray, R F

2004-12-01

324

Complications after tibia plateau fracture surgery.  

PubMed

High-energy tibial plateau fractures are often the result of blunt trauma and are associated with severe soft-tissue injury. Fixation techniques demand considerable surgical skill and mature judgment. The available surgical options do not always guarantee a favourable outcome. Operative treatment includes internal and external fixation, hybrid fixation and arthroscopically assisted techniques. Operative management of high-energy fractures remains difficult and challenging and may be associated with serious complications, such as knee stiffness, ankylosis, deep infection, post-traumatic arthritis, malunion and nonunion. Prevention of the complications can optimise the clinical outcome in these patients. PMID:16118010

Papagelopoulos, Panayiotis J; Partsinevelos, Antonios A; Themistocleous, George S; Mavrogenis, Andreas F; Korres, Demetrios S; Soucacos, Panayotis N

2006-06-01

325

Cutaneous complications related to permanent decorative tattooing.  

PubMed

Decorative tattooing involves the introduction of exogenous pigments and/or dyes into the dermis to produce a permanent design. Practiced for thousands of years, it has gained tremendous popularity during the past 20 years, especially among the young. Tattoo-associated cutaneous complications have only been reported since the end of the 19th Century. With the increased prevalence of tattooed individuals, dermatologists have witnessed increasing numbers of patients presenting with complaints about their tattoos. Complications primarily include infections, hypersensitivity reaction to tattoo pigments, benign and sometimes malignant tumors arising on tattoos, and the localization of various dermatoses to tattoos. PMID:20441423

Kluger, Nicolas

2010-05-01

326

Infective complications of tattooing and skin piercing.  

PubMed

Body piercing appears to be gaining popularity and social acceptance. With the increase in the number of piercings and tattoos, it is likely that health care providers may see an increase in the complications resulting from these piercings. These may include the transmission of hepatitis viruses and bacteria at the time of the piercing or in the course of wound care. We review the infectious complications that have resulted from body piercing and tattooing that has been documented in the medical literature. PMID:20701856

Messahel, Ahmed; Musgrove, Brian

2009-01-01

327

Gastrointestinal complications of leukemia and its treatment  

SciTech Connect

Leukemia represents 4% of all cancer deaths and is the leading cause of death from malignancy for all patients under 30 years of age. Various rare, usually preterminal gastrointestinal complications of leukemia have been reported. These complications are becoming more common and no longer should be considered unusual. Their increasing incidence is the result of new, more aggressive treatment methods and increased patient lifespan. The authors describe the relative incidence and common radiographic presentations of leukemia-related gastrointestinal disease and emphasize that its prognosis is favorable with prompt diagnosis and treatment.

Hunter, T.B.; Bjelland, J.C.

1984-03-01

328

Complications in facelift surgery: avoidance and management.  

PubMed

Rhytidectomy remains a challenging surgical procedure for even the most experienced aesthetic plastic surgeons. The challenges are compounded by complications that are inherent to this procedure and place added pressure on the doctor-patient relationship. Expectations for both parties are high and the margin for error nil. This article presents a personal approach to the avoidance and management of complications associated with facelift surgery. It presents the author's personal approach as a plastic surgeon in the practice of aesthetic plastic surgery over the past 25 years. Clinical pearls are provided to obtain optimum results in rhytidectomy and limit associated sequelae. PMID:24200374

Chaffoo, Richard A K

2013-11-01

329

[Managing complications in intraoperative floppy iris syndrome].  

PubMed

The intraoperative floppy iris syndrome (IFIS) describes an ophthalmologically relevant phenomenon which is observed after systemic intake of alpha blockers for treatment of benign prostate hyperplasia. This leads to an increase in intraoperative complications in cataract surgery characterized by a flaccid iris which billows in response to currents with a tendency to prolapse towards the area of surgery. This results in damage to the iris by the instruments used or posterior capsule rupture with loss of lens material. We describe the preoperative and intraoperative measures and techniques to deal with this challenging situation in order to minimize development of IFIS and reduce the complication rate. PMID:23338529

Handzel, D M; Rausch, S; Kälble, T; Briesen, S

2013-04-01

330

Giant aortic arch aneurysm complicating Kawasaki's disease  

PubMed Central

Kawasaki disease (KD) is a common acute vasculitis in pediatric population that usually involves small- and middle-sized arteries, commonly coronary arteries. Although the incidence and natural course of coronary aneurysms after KD are well documented in studies, related reports on peripheral arterial and aortic aneurysms are scarce. We report the occurrence of a giant aortic aneurysm involving the horizontal part of aortic arch in a 28-month-old boy diagnosed with KD. This complication was managed by steroids therapy in the beginning. Because of mechanical complication and potential risk of rupture, surgery was undertaken.

Hakim, Kaouthar; Boussada, Rafik; Chaker, Lilia; Ouarda, Fatma

2014-01-01

331

microRNA in the development of diabetic complications.  

PubMed

Today's world population is currently faced with a new type of non-transmissible pandemic: obesity. This lifestyle-related condition is driving the emergence of the diabetes pandemic through the development of low-level chronic inflammation. In recent years, a novel class of non-coding RNA, microRNA (miRNA), have emerged as being important regulators of numerous biological functions. Among these functions are basic maintenance of cell signalling and tissue architecture. Disruption of miRNA levels can contribute not only to the development of the chronic inflammation observed in obese diabetics, but also the development of both pancreatic ?-cell dysfunction and loss, along with insulin resistance in metabolic tissues. These primary events set the scene for dysfunction of other tissues, including the retina, kidney, peripheral nerves, heart and the vasculature as a whole. Here, miRNAs again play a deterministic role in the development of a range of diseases collectively termed diabetic complications. Disturbances in miRNA levels appear to be reflected in the serum of patients and this may prove to be diagnostic in patients prior to clinical manifestation of disease, thus improving management of diabetes and its associated complications. Not only are miRNAs displaying promise as an early biomarker for disease, but a number of these miRNAs are displaying therapeutic potential with several in pre-clinical development. The present review aims to highlight our current understanding of miRNAs and their interaction with inflammatory signalling in the development and progression of diabetes and its complications. Utilization of miRNAs as biomarkers and therapeutic targets will also be considered. PMID:24059587

McClelland, Aaron D; Kantharidis, Phillip

2014-01-01

332

Novel EXOSC3 mutation causes complicated hereditary spastic paraplegia.  

PubMed

We describe two pairs of siblings from a consanguineous family manifesting autosomal recessive hereditary spastic paraplegia caused by a novel mutation in the EXOSC3 gene, previously reported in pontocerebellar hypoplasia type 1. Clinical findings included delayed motor milestones, early-onset spastic paraplegia, variable cognitive disability, and cerebellar signs. Cerebral imaging demonstrated enlarged cisterna magna and mild hypoplasia and atrophy of the lower vermis with a normal pons. Genetic analysis using homozygosity mapping followed by whole exome sequencing identified homozygous c.571G>T; p.G191C mutation in the EXOSC3 gene. We suggest that EXOSC3 mutations may present not only as pontocerebellar hypoplasia type 1, but also as a complicated form of hereditary spastic paraplegia without pontine hypoplasia or atrophy. PMID:25149867

Halevy, Ayelet; Lerer, Israela; Cohen, Rony; Kornreich, Liora; Shuper, Avinoam; Gamliel, Moria; Zimerman, Bat-El; Korabi, Isam; Meiner, Vardiella; Straussberg, Rachel; Lossos, Alexander

2014-11-01

333

[Labiaplasty: plastic or cosmetic surgery? Indications, techniques, results and complications].  

PubMed

Labiaplasty is the surgical term for labia minora reduction. This procedure has become popular with plastic surgery patients because physical discomfort and cosmetic concerns are virtually always combined. Demand for this procedure is becoming common amongst very young patients who appear to have nurtured a complex since their early adolescent years, disturbing their love life. There are several possible corrective surgical techniques, the postoperative courses of which vary significantly. The traditional method (longitudinal resection) remains the most widely used, but requires resection of the larger part of the labia minora, which is why in our opinion the V plasty technique seems more appropriate. The benefits, technical details, complications and postoperative course of the V plasty technique are detailed by the author in this article. PMID:19223103

Benadiba, L

2010-04-01

334

Sigmoid Volvulus Complicating Pregnancy Managed by Resection and Primary Anastomosis  

PubMed Central

Sigmoid volvulus is an extremely rare cause of intestinal obstruction in pregnancy. The rarity of the condition and the fact that pregnancy itself clouds the clinical picture invariably leads to a delay in diagnosis with an increased risk of gangrene of the gut. The majority of these patients would then require resection and colostomy. However, an early diagnosis and intervention as in our patient, which would require a high index of clinical suspicion, could significantly improve the outcome of the foetus and the mother. A case of sigmoid volvulus in pregnancy is reported which was managed by resection and primary anastomosis. A review of literature revealed no previous reports of sigmoid volvulus in pregnancy managed by primary anastomosis following resection of the sigmoid volvulus. The literature is also reviewed regarding predisposing factors, management options and the outcome of sigmoid volvulus complicating pregnancy. PMID:21509281

Machado, Norman O; Machado, Lovina S M

2009-01-01

335

Mechanical complications during central venous cannulations in pediatric patients  

Microsoft Academic Search

Objective  Identification of early mechanical complications (EMC) of central venous catheterizations (CVC) in pediatric patients and\\u000a determination of EMC risk factors.\\u000a \\u000a \\u000a \\u000a Design  Prospective observational study.\\u000a \\u000a \\u000a \\u000a Setting  Pediatric intensive-care unit in a university hospital.\\u000a \\u000a \\u000a \\u000a Patients and measurements  Eight-hundred and twenty-five CVC were performed in 546 patients. Age, weight, gender, mechanical ventilation, analgesia,\\u000a resident CVC failure, CVC indication, admission diagnosis, emergency or scheduled procedure, type of

Corsino Rey; Francisco Álvarez; Victoria De La Rua; Alberto Medina; Andrés Concha; Juan José Díaz; Sergio Menéndez; Marta Los Arcos; Juan Mayordomo-Colunga

2009-01-01

336

How I treat renal complications in sickle cell disease.  

PubMed

Renal disease is one of the most frequent and severe complications experienced by patients with sickle cell disease; its prevalence is likely to increase as the patient population ages. We recommend regular monitoring for early signs of renal involvement and a low threshold for the use of hydroxyurea as preventative measures for end-stage renal disease. Once renal complications are detected, a careful assessment of the patient is required to rule out other causes of renal disease. Proteinuria and hypertension should be managed aggressively and the patient referred to a specialist nephrology center when progressive decline in renal function is noted. For the few patients who develop advanced chronic kidney disease, timely planning for dialysis and transplantation can significantly improve outcome, and we recommend an exchange blood transfusion policy for all patients on the transplant waiting list and for those with a functioning graft. Alongside the invasive treatment regimes, it is important to remember that renal failure in conjunction with sickle cell disease does carry a significant burden of morbidity and that focusing on symptom control has to be central to good patient care. PMID:24764565

Sharpe, Claire C; Thein, Swee Lay

2014-06-12

337

Modified Mandibulotomy Technique to Reduce Postoperative Complications: 5-Year Results  

PubMed Central

Purpose To review the 5-year outcomes of our modified mandibulotomy technique. Retrospective review of a tertiary level oral cancer center. Materials and Methods During a 5-year period, 30 patients who had a uniform surgical technique consisting of a lower lip-splitting, modified stair-step osteotomy with thin saw blade and osteotome after plate-precontouring and combination fixation with monocortical osteosynthesis (miniplate) and bicortical osteosynthesis (maxiplate and bicortical screws), with at least 14 months postoperative follow-up, were selected and reviewed retrospectively. Results There were 8 women and 22 men with an average age of 56.5 years. All the patients involved malignancies were squamous cell carcinoma. The main primary sites of the those who underwent a mandibulotomy were the tonsil, the base of tongue, the oral tongue, the retromolar pad area, and others. Others included buccal cheek, floor of mouth, and soft palate. 23 patients received postoperative radiation therapy, and among whom 8 patients also received chemotherapy. Total four (13%) mandibulotomy-related complications occurred, only two (6.7%) requiring additional operation under general anesthesia. Conclusion Our modified mandibulotomy meets the criteria for an ideal mandibulotomy technique relatively well because it requires no intermaxillary fixation, can precise preserve the occlusion in a precise way, allows early function, requires no secondary procedures, and has few complications. PMID:23918577

Na, Hye-Young; Choi, Eun-Joo; Kim, Hyung Jun; Cha, In-Ho

2013-01-01

338

Septic pylephlebitis as a rare complication of Crohn's disease.  

PubMed

Thrombophlebitis of the portal venous system (PVS) with superimposed bacterial infection (septic pylephlebitis) is an extremely rare complication of Crohn's disease (CD), and therefore diagnosis of septic pylephlebitis is difficult without high clinical suspicion. A 16-year old male patient who was diagnosed with CD 3 months earlier was admitted with recurrent fever and abdominal pain. CD activity had been well controlled with conventional medical treatment during a follow-up period. Abdominal contrast-enhanced computed tomography showed massive thrombosis in the PVS without evidence of intra-abdominal infection, and blood cultures were positive for Streptococcus viridians. There was no evidence of deep vein thrombosis or pulmonary thromboembolism, and all laboratory tests for thrombophilia were normal. Based on these findings, the patient was diagnosed with septic pylephlebitis complicated with CD, and was successfully treated with intravenous antibiotic therapy combined with anticoagulation. This case suggests that early comprehensive evaluation is crucial for immediate diagnosis and proper treatment of septic pylephlebitis in patients with CD who present with fever and abdominal pain of unknown origin, even with stable disease activity and absence of other intra-abdominal infections. PMID:23624737

Shin, A Ri; Lee, Chang Kyun; Kim, Hyo Jong; Shim, Jae-Jun; Jang, Jae Young; Dong, Seok Ho; Kim, Byung Ho; Chang, Young Woon

2013-04-01

339

Diabetic Complications in Obese Type 2 Diabetic Rat Models  

PubMed Central

We overviewed the pathophysiological features of diabetes and its complications in obese type 2 diabetic rat models: Otsuka Long-Evans Tokushima fatty (OLETF) rat, Wistar fatty rat, Zucker diabetic fatty (ZDF) rat and Spontaneously diabetic Torii (SDT) fatty rat. Pancreatic changes with progression of diabetes were classified into early changes, such as islet hypertrophy and degranulation of ? cells, and degenerative changes, such as islet atrophy and fibrosis of islet with infiltration of inflammatory cells. Renal lesions in tubuli and glomeruli were observed, and nodular lesions in glomeruli were notable changes in OLETF and SDT fatty rats. Among retinal changes, folding and thickening were interesting findings in SDT fatty rats. A decrease of motor nerve conduction velocity with progression of diabetes was presented in obese diabetic rats. Other diabetic complications, osteoporosis and sexual dysfunction, were also observed. Observation of bone metabolic abnormalities, including decrease of osteogenesis and bone mineral density, and sexual dysfunction, including hypotestosteronemia and erectile dysfunction, in obese type 2 diabetic rats have been reported. PMID:24770637

Katsuda, Yoshiaki; Ohta, Takeshi; Miyajima, Katsuhiro; Kemmochi, Yusuke; Sasase, Tomohiko; Tong, Bin; Shinohara, Masami; Yamada, Takahisa

2014-01-01

340

Lymphatic Leak Complicating Central Venous Catheter Insertion  

SciTech Connect

Many of the risks associated with central venous access are well recognized. We report a case of inadvertent lymphatic disruption during the insertion of a tunneled central venous catheter in a patient with raised left and right atrial pressures and severe pulmonary hypertension, which led to significant hemodynamic instability. To our knowledge, this rare complication is previously unreported.

Barnacle, Alex M., E-mail: alexbarnacle@yahoo.co.uk; Kleidon, Tricia M. [Great Ormond Street Hospital for Children, Department of Radiology (United Kingdom)

2005-12-15

341

Prediction factors for breast reconstruction postoperative complications  

PubMed Central

Abstract Breast cancer is a major health problem that requires multiple forms of treatment, including surgery, adjuvant chemotherapy and radiotherapy and more recently, reconstructive surgery. The aim of this study is to determine the factors that can predict the chances of a patient having postoperative complications after breast reconstruction. PMID:24868263

Chiru, MR; Lascar, I

2013-01-01

342

Patterns of acid reflux in complicated oesophagitis.  

PubMed Central

Oesophageal manometry and 24 hour ambulatory pH recordings from the distal oesophagus were carried out in 25 patients with complications of oesophagitis (stricture, Barrett's oesophagus or oesophageal ulcer) and compared with 25 patients with uncomplicated oesophagitis. Acid reflux was more severe in the complicated group with 26.2% of time below pH 4 compared with 11.3% in uncomplicated patients (p less than 0.01). This difference was most marked at night, when complicated patients had long periods of acid reflux with 35.6% time less than pH 4 compared with 5.2% uncomplicated (p less than 0.001). The mean duration of nocturnal acid reflux was 15.4 minutes (2.1 minutes uncomplicated, p less than 0.001). Oesophageal motility was markedly abnormal in all groups, but with no demonstrable differences in lower oesophageal sphincter pressure or peristalsis between the groups. Patients with complications of oesophagitis have different patterns of acid reflux from uncomplicated patients, with prolonged nocturnal bathing of the oesophageal mucosa, which may be the cause of stricture formation, metaplasia, or ulceration. PMID:3428675

Robertson, D; Aldersley, M; Shepherd, H; Smith, C L

1987-01-01

343

Surgical complications of typhoid fever: Enteric perforation  

Microsoft Academic Search

Typhoid fever remains a prevalent disease in developing nations as the result of adverse socioeconomic factors. The most frequent complication, and principal cause of mortality, is perforation of the terminal ileum. This report presents our experience with 96 patients surgically treated at Cayetano Heredia University Hospital in Lima, Peru from 1972 to 1986. The clinical characteristics and the diverse surgical

Miguel Santillana

1991-01-01

344

Chylothorax as a complication of oesophageal sclerotherapy.  

PubMed Central

Chylothorax is an unusual complication of sclerotherapy for oesophageal varices. A patient is described in whom a massive chylous effusion followed sclerotherapy with repeated injections of 1.5% sodium tetradecyl sulphate. The thoracic duct traverses the posterior mediastinum in close proximity to the oesophagus, and may be disrupted by injections at mid oesophageal level. PMID:1549822

Nygaard, S D; Berger, H A; Fick, R B

1992-01-01

345

Chylothorax as a complication of oesophageal sclerotherapy.  

PubMed

Chylothorax is an unusual complication of sclerotherapy for oesophageal varices. A patient is described in whom a massive chylous effusion followed sclerotherapy with repeated injections of 1.5% sodium tetradecyl sulphate. The thoracic duct traverses the posterior mediastinum in close proximity to the oesophagus, and may be disrupted by injections at mid oesophageal level. PMID:1549822

Nygaard, S D; Berger, H A; Fick, R B

1992-02-01

346

Risks for Complicated Grief in Family Caregivers  

Microsoft Academic Search

Complicated Grief (CG) is a recently recognized disorder experienced by the bereaved and characterized by intense distress that interferes with functioning. Estimates indicate that about 20 % of bereaved individuals may develop CG. Family caregivers of those who are chronically ill may face unique risks for CG, such as pre-death stressors associated with caregiving. In this article, existing literature on

Angela Ghesquiere; Yamile M. Martí Haidar; M. Katherine Shear

2011-01-01

347

Cardiovascular complications of pediatric chronic kidney disease  

PubMed Central

Cardiovascular disease (CVD) mortality is a leading cause of death in adult chronic kidney disease (CKD), with exceptionally high rates in young adults, according to the Task Force on Cardiovascular Disease. Recent data indicate that cardiovascular complications are already present in children with CKD. This review summarizes the current literature on cardiac risk factors, mortality and morbidity in children with CKD. PMID:17120060

2006-01-01

348

Severe Complications of Inflammatory Bowel Disease  

Microsoft Academic Search

Patients who have inflammatory bowel disease (IBD) occasionally have severe complications or emergency situations that require expedited, expert medical care, including toxic colitis, fistulas, abdominal abscesses, malig- nancy, primary sclerosing cholangitis, and pouchitis. Morbidity and mortal- ity rates of Crohn's disease and ulcerative colitis (UC) are increased over the expected rates in the unaffected population. Knowledge of the presenting features,

Francisco Marrero; Mohammed A. Qadeer; Bret A. Lashner

349

Emergency management of complicated jejunal diverticulosis.  

PubMed

Jejunal diverticulosis is a rare condition that is usually found incidentally. It is most often asymptomatic but presenting symptoms are nonspecific and include abdominal pain, nausea, diarrhea, malabsorption, bleeding, obstruction, and/or perforation. A retrospective review of medical records between 1999 and 2012 at a tertiary referral center was conducted to identify patients requiring emergency management of complicated jejunal diverticulosis. Complications were defined as those that presented with inflammation, bleeding, obstruction, or perforation. Eighteen patients presented to the emergency department with acute complications of jejunal diverticulosis. Ages ranged from 47 to 86 years (mean, 72 years). Seven patients presented with evidence of free bowel perforation. Six had either diverticulitis or a contained perforation. The remaining five were found to have gastrointestinal bleeding. Fourteen of the patients underwent surgical management. Four patients were successfully managed nonoperatively. As a result of the variety of presentations, complications of jejunal diverticulosis present a diagnostic and therapeutic challenge for the acute care surgeon. Although nonoperative management can be successful, most patients should undergo surgical intervention. Traditional management dictates laparotomy and segmental jejunal resection. Diverticulectomy is not recommended as a result of the risk of staple line breakdown. The entire involved portion of jejunum should be resected when bowel length permits. PMID:24887799

Johnson, Kevin N; Fankhauser, Grant T; Chapital, Alyssa B; Merritt, Marianne V; Johnson, Daniel J

2014-06-01

350

Psychological complications in sickle cell disease  

Microsoft Academic Search

Summary This review examines the evidence for some of the common psychological complications found across the life span of patients with sickle cell disease (SCD), which are likely to be encountered by haematologists responsible for their medical management. Electronic searches of medical and psychological databases were conducted with a focus on three main areas: psychological coping, quality of life and

Kofi A Anie

2005-01-01

351

Coronary Artery Vasospasm Complicating Acute Myocarditis  

PubMed Central

A 17-year-old boy had a 2-day prodrome of fever and mild sore throat followed by 2 episodes of severe anginal chest discomfort and substantial transient ST-segment elevations in the anterior leads of the electrocardiogram. A subsequent evaluation showed the 2 episodes were most likely coronary vasospasm complicating acute viral myocarditis. Images PMID:3176473

Ferguson, David W.; Farwell, Allan P.; Bradley, William A.; Rollings, Robert C.

1988-01-01

352

Complications to Avoid with Pre-Diabetes  

MedlinePLUS

Complications to Avoid with Pre-diabetes Updated:Mar 8,2014 If I ignore the pre-diabetes, how could diabetes reduce the quality or length of my ... treat one of them, you treat them all. Pre-diabetes • Introduction • About Pre-diabetes • What's the Problem? Intro ...

353

Minimal Brain Dysfunction: Associations with Perinatal Complications.  

ERIC Educational Resources Information Center

Examined with over 28,000 7-year-old children whose mothers registered for prenatal care was the relationship between perinatal complications and such characteristics as poor school achievement, hyperactivity, and neurological soft signs associated with the diagnosis of minimal brain dysfunction (MBD). Ten perinatal antecedents were studied:…

Nichols, Paul L.

354

Gastrointestinal and Nutritional Complications After Bariatric Surgery  

Microsoft Academic Search

The prevalence of obesity has increased to epidemic proportions, making obesity and its comorbid conditions a major public health concern. Bariatric surgery is the most effective treatment, but it carries substantial morbidity. The subsequent gastrointestinal and nutritional complications are often not recognized or properly managed. As part of the multidisciplinary team taking care of obese patients, gastroenterologists should be familiar

G. Anton Decker; James M. Swain; Michael D. Crowell; James S. Scolapio

2007-01-01

355

Capacity Disruption Management for Complicated Operation System  

Microsoft Academic Search

Some complicated operation systems, such as communication system, auto-plant, refinery and semiconductor fab when critical operational capacities are injured by unexpected events. However, due to the limitation of maintenance technique, a multiple periods of time are usually needed for the restoration process. In this paper, a regular and expedite capacity support from alliance and the attitude factor of the decision

Bao Xing; Xiao Di

2010-01-01

356

Selecting a Principal: Keep It Complicated!  

ERIC Educational Resources Information Center

When searching for a new principal, many search committees tend to use the lists of competencies published in the literature and provided by state departments of education as if they were checklists. Instead, they should focus on more complicated competencies, such as acumen, judgment, and ability to manage the dilemmas of practice.

Naso, Paul A.

2011-01-01

357

Measuring Leakage From Large, Complicated Machinery  

NASA Technical Reports Server (NTRS)

Test chamber improvised from large bag. Cumulative sizes of leaks in large, complicated machinery measure with relatively simple variation of helium leak-checking technique. When used to check Space Shuttle main engine, new technique gave repeatable and correct results within 0.5 stdin.3/min (1.4 x 10 negative to the seventh power stdm3/s).

Bottemiller, S.

1987-01-01

358

Development of early uteroplacental circulation.  

PubMed

A crucial event in human development is trophoblast invasion, a process that will enable chorionic and maternal circulations to develop in a synchronized fashion. Early embryo and trophoblast are very sensitive to the conditions in which they grow, and progressive development of placental circulations is essential for normal pregnancy development. It has been demonstrated that inadequate trophoblast invasion is a major finding in many clinical deleterious conditions facing the obstetrician. Pathologic studies of placentas of pregnancies complicated by intrauterine growth restriction or preeclampsia demonstrate shallow trophoblast invasion of the spiral arteries. This has also been seen in early spontaneous miscarriages. In our study, we used color Doppler sonography to assess the uteroplacental circulation and predict outcome of first-trimester gestations. One hundred women with viable pregnancies of 7 to 12 weeks gestational age were prospectively evaluated. Color Doppler imaging was used to identify the location of blood flow within the uteroplacental circulation, and spectral Doppler imaging was used to analyze waveforms obtained from the decidual spiral arteries. Abnormal color Doppler findings were associated with a significantly higher prevalence of complicated pregnancies. Among women with abnormal Doppler findings, 12 (43%) of 28 pregnancies ended in miscarriage, whereas among women with normal findings only one (1.4%) of 72 women miscarried (p<.055). This study indicates that abnormal flow patterns of the early uteroplacental circulation due most likely to abnormal trophoblast invasion are associated with an increased prevalence of pregnancy complications. What causes inadequate invasion remains a mystery. Abnormal nitric oxide synthesis, due to possible endothelial cell dysfunction, has been demonstrated in some of these complicated pregnancies but, whether this is cause of effect, is not known. Every step of embryonal-maternal interaction from fertilization and onward has major implications on subsequent development of embryo, fetus, neonate and adult human being. Trophoblast invasions and transformation of the spiral arteries are possibly the most significant interactions and will have the most profound effect on pregnancy development. PMID:11753503

Jaffe, R

2001-01-01

359

Complicated urinary tract infections associated with diabetes mellitus: Pathogenesis, diagnosis and management  

PubMed Central

Diabetes mellitus has a number of long-term effects on the genitourinary system. These effects predispose to bacterial urinary tract infections (UTIs) in the patient with diabetes mellitus. Complicated UTIs are also common and potentially life-threatening conditions. They include emphysematous pyelonephritis, emphysematous pyelitis/cystitis, xanthogranulomatous pyelonephritis, renal/perirenal abscess, and renal papillary necrosis. Improved outcomes of these entities may be achieved by early diagnosis, knowledge of common predisposing factors, appropriate clinical and radiological assessment, and prompt management. Herein we review complicated UTIs associated with diabetes mellitus in terms of pathogenesis, clinical manifestations, radiological features, and current management options. PMID:23869299

Mnif, Mouna Feki; Kamoun, Mahdi; Kacem, Faten Hadj; Bouaziz, Zainab; Charfi, Nadia; Mnif, Fatma; Naceur, Basma Ben; Rekik, Nabila; Abid, Mohamed

2013-01-01

360

sTREM-1 as a Prognostic Marker of Postoperative Complications in Cardiac Surgery  

PubMed Central

Cell-activating receptor TREM-1 (triggering receptor expressed on myeloid cells 1) regulates congenital immune response and contributes to systemic inflammatory response syndrome (SIRS) development. It is able to multiply cytokine production while stimulated together with the main receptors of the congenital immune system. The purpose of the paper is to study the potential use of soluble TREM-1 (sTREM-1) as a marker of intensive SIRS and a criterion for postoperative complications prediction following on-pump coronary artery bypass surgery (CABG). Results show that early postoperative sTREM-1 concentrations demonstrate their potential prognostic value regarding SIRS-associated complications. PMID:24049646

Golovkin, A. S.; Matveeva, V. G.; Grigoriev, E. V.; Shukevich, D. L.; Bayrakova, Y. V.; Barbarash, L. S.

2012-01-01

361

Fournier's Gangrene Complicating Hematologic Malignancies: a Case Report and Review of Licterature  

PubMed Central

Fournier’s gangrene (FG) is a rare but severe necrotizing fasciitis of the external genitalia that may complicate the clinical course of hematologic malignancies and sometimes may be the first sign of the disease. The clinical course of FG is very aggressive and the mortality is still high despite the improvement in its management. Early recognition of FG and prompt appropriate treatment with surgical debridement and administration of antibiotics are the cornerstone of the management of this very severe disease. A review of the scientific literature focusing on the topic of FG complicating hematologic disorders is reported PMID:24363882

D'Arena, Giovanni; Pietrantuono, Giuseppe; Buccino, Emilio; Pacifico, Giancarlo; Musto, Pellegrino

2013-01-01

362

Early screening for preeclampsia.  

PubMed

Preeclampsia, which affects about 3 to 5% of pregnant women, is the most frequent medical complication in pregnancy and the most important cause of maternal and perinatal morbidity and mortality. During the past three decades, numerous clinical, biophysical, and biochemical screening tests have been proposed for the early detection of preeclampsia. Literature shows large discrepancies in the sensitivity and predictive value of several of these tests. No single screening test used for preeclampsia prediction has gained widespread acceptance into clinical practice. Instead, its value seems to be in increasing the predictive value of panels of tests, which include other clinical measurements. The aim of this review was to examine the combination of maternal risk factors, mean arterial blood pressure, and uterine artery Doppler, together with biomarkers in the preeclampsia prediction. PMID:22267116

Costa, Fabrício da Silva; Murthi, Padma; Keogh, Rosemary; Woodrow, Nicole

2011-11-01

363

A Systematic Review of Complications and Failures Associated with Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation  

PubMed Central

Background Patellofemoral instability affects activities of daily living and hinders athletic participation. Over the past 2 decades more attention has been paid to medial patellofemoral ligament reconstruction (MPFL) for treatment of recurrent patellar dislocations/subluxations. Numerous techniques have been reported; however, there is no consensus regarding optimal reconstruction. Purpose This study sought to report on the various techniques for MPFL reconstruction described in the literature and to assess the rate of complications associated with the procedure. Study Design Meta-analysis. Methods A systematic review of the literature was performed in early October 2010 using keywords “medial patellofemoral ligament,” “MPFL”, “reconstruction,” “complication(s),” and “failure(s)”. Articles meeting the inclusion criteria were reviewed. Graft choice, surgical technique, outcome measures, and complications were recorded and organized in a database. Descriptive statistical analysis was performed on the data collected. Results Twenty-five articles were identified and reviewed. A total of 164 complications occurred in 629 knees (26.1%). These adverse events ranged from minor to major including patella fracture, failures, clinical instability on post-operative examination, loss of knee flexion, wound complications, and pain. Twenty-six patients returned to the operating room for additional procedures. Conclusions Medial patellofemoral ligament reconstruction has a high rate of success for patients with patellofemoral instability; however, the complication rate of 26.1% associated with this procedure is not trivial. This study quantified complications and documented the variety of complications reported in outcomes-based literature. PMID:22679297

Shah, Jay N.; Howard, Jennifer S.; Flanigan, David C.; Brophy, Robert H.; Carey, James L.; Lattermann, Christian

2013-01-01

364

HLA-DR as a marker for increased risk for systemic inflammation and septic complications after cardiac surgery  

Microsoft Academic Search

ObjectiveThis study investigated the predictive value of a decrease in monocyte HLA-DR expression as an early marker for postoperative SIRS and septic complications. We hypothesized that decreased HLA-DR levels in the first 24 h after cardiac surgery is not related to postoperative SIRS\\/sepsis. We also compared HLA-DR levels of patients with postoperative complications to those with an uncomplicated course.Design and settingProspective

Wolfgang Oczenski; Herbert Krenn; Ruth Jilch; Herbert Watzka; Ferdinand Waldenberger; Ursula Köller; Sylvia Schwarz; Robert D. Fitzgerald

2003-01-01

365

Early Childhood.  

ERIC Educational Resources Information Center

This book summarizes theory and discusses major issues pertaining to child development in the early childhood years. Chapter I provides an introduction to the conceptual framework and major theories of child development. Chapter II deals with motor, sensory, and perceptual development. Chapter III focuses on the cognitive-developmental theory of…

Peters, Donald L.; Willis, Sherry L.

366

CT Findings of Colonic Complications Associated with Colon Cancer  

PubMed Central

A broad spectrum of colonic complications can occur in patients with colon cancer. Clinically, some of these complications can obscure the presence of underlying malignancies in the colon and these complications may require emergency surgical management. The complications of the colon that can be associated with colon cancer include obstruction, perforation, abscess formation, acute appendicitis, ischemic colitis and intussusception. Although the majority of these complications only rarely occur, familiarity with the various manifestations of colon cancer complications will facilitate making an accurate diagnosis and administering prompt management in these situations. The purpose of this pictorial essay is to review the CT appearance of the colonic complications associated with colon cancer. PMID:20191069

Shin, Hyeong Cheol; Kim, Il Young; Kim, Young Tong; Kim, Chang-Jin

2010-01-01

367

Neurological Complications of Biologic Therapy in Psoriasis  

PubMed Central

Biologic agents have been a significant advancement in the management of psoriasis. Along with significant clinical improvement, there have been concerns for emerging side effects with the use of biologics. Reports have emerged showing the association between efalizumab and the development of progressive multifocal leukoencephalopathy and other demyelinating disorders. Tumor necrosis factor-alpha inhibitors have been associated with various demyelinating disorders. As such, it is imperative for dermatologists to be well informed regarding how to notify patients about the risks of biologic treatment. Dermatologists must be able to identify the signs and symptoms of neurological complications and recognize when to refer patients to neurologists for diagnostic workup, disease confirmation, and any necessary treatment. This review is a compilation of evidence showing the association between biologic therapy and neurological complications, as well as an overview of the clinical presentation and diagnosis of such diseases. PMID:20725577

Sanders, Catherine; Bechtel, Ann

2009-01-01

368

Neurosurgical management for complicated catastrophic antiphospholipid syndrome.  

PubMed

Antiphospholipid syndrome (APS) is an autoimmune condition involving arterial and venous thrombosis. An unusual APS variant, catastrophic antiphospholipid syndrome (CAPS), includes rapid multi-organ failure from widespread small vessel thrombosis. Central nervous system complications arise in one-third of CAPS patients. In rare cases, CAPS co-manifests with cerebellar hemorrhage presenting a neurosurgical emergency. We present a 65-year-old woman with CAPS-related cerebellar hematoma, co-morbid idiopathic thrombocytopenic purpura, deep vein thrombosis and altered mental status, with treatment complicated by thrombocytopenia. The patient suddenly deteriorated, secondary to a cerebellar subdural hematoma, and underwent decompression and excision of the hematoma. After recovery in the intensive care unit, she developed a new spontaneous epidural hematoma requiring additional surgery. Management of these patients is hematologically complex and often requires a multi-disciplinary team of physicians. This patient provides an important learning point for clinicians - consider CAPS when hemorrhage and thrombosis are present. PMID:24269552

Drazin, Doniel; Westley Phillips, H; Shirzadi, Ali; Drazin, Noam; Schievink, Wouter

2014-04-01

369

Blind loop: rare but important surgical complication  

PubMed Central

Background Surgical complications worldwide are dreaded by both patients and physicians alike. They represent significant and serious morbidity and mortality, and contribute substantially to increased costs of healthcare. Case presentation Our Case Report describes a 65yo Caucasian man with an extensive operative history for Crohn’s disease, including 4 laparotomies with small bowel resections to ameliorate small bowel obstructions. He presented with signs and symptoms of a chronic draining sinus, but was found to have a Blind Loop of bowel. This finding is believed to be the result of a surgical complication. Conclusion While the Case Reports discusses this particular patient presentation, the paper defines, describes and offers treatment strategies for Enterocutaneous Fistulas (ECF). We offer aim to add Blind Loop to the differential diagnosis when presented with a patient with signs and symptoms of ECF. PMID:25176257

2014-01-01

370

[Haemocholecyst: a rare complication of anticoagulant treatment].  

PubMed

We report a case of a 50-year-old woman, taking antivitamin K for double mitro-aortic valvular replacement, having presented a clinical picture of acute cholecystitis with marked hypotension. The radiological and biologic exams showed a deep hypocoagulability, vesicular gallstones, a haemoperitoneum and retroperitoneal haematoma. After correction of biological anomalies, the patient was operated. The gallbladder was distended containing large clots and four stones without any evidence of perforation. One of the gallstones led to cystic duct obstruction. Haemocholecyst is a rare complication of anticoagulant therapy, which may occur in the setting of gallbladder stones. The usual complication was the vesicular perforation. In spite of its rarity, haemocholecyst should be suspected when an anticoagulant treated patient presents symptoms of acute cholecystis with or without haemorrhagic shock. PMID:15324963

Mikou, M M; Mouaffak, Y; Benyacob, A; Mosaddek, A; Faroudy, M; Ababou, A; Lazreq, C; Sbihi, A

2004-07-01

371

[Circumcision and orchiopexy: management of complications].  

PubMed

Circumcision and orchidopexy are among the most frequently performed pediatric urological procedures. Although they may be classified as surgical interventions suitable for junior surgeons, either procedure can lead to serious consequences including the loss of the respective organ. In this paper, the general aspects of pediatric urological surgery (e.g., distinctive features of informing underage patients, the handling of children in the operating room, and relevant pediatric anesthesiological aspects) are described first. Then, the most important sources of error will be highlighted and potential complications and their management during all stages of the procedure will be illustrated. Apart from the so-called freehand circumcision, this paper also deals with potential complications when using the Plastibell® device. In regard to orchidopexy, laparoscopic procedure shall be discussed in addition to the standard procedure. PMID:24733101

Promm, M; Rösch, W H

2014-05-01

372

Gastrointestinal complications following percutaneous coronary intervention (PCI)  

Microsoft Academic Search

IntroductionPercutaneous Coronary Intervention (PCI) is widely used in the emergency and elective setting. If drug-eluting stents are deployed, dual antiplatelet therapy must continue for 12 months. Antiplatelet agents are a recognised cause of overt and occult gastrointestinal (GI) bleeding. The aim of this study was to determine the rate of GI complications following PCI in a tertiary cardiothoracic centre.MethodsA cohort

G E Dolman; C M Wijayasekara; J R F Cummings

2011-01-01

373

Organ and Metabolic Complications: Lipids\\/Atherosclerosis  

Microsoft Academic Search

The incidence of and mortality from atherosclerotic complications, particulary coronary atherosclerosis, is strikingly increased\\u000a in dialysed patients. One of the factors involved is dyslipoproteinemia. The main cause of dyslipoproteinemia is reduced activity\\u000a of enzymes catabolising lipoproteins (hepatic triglyceride lipase, lipoprotein lipase), but additional abnormalities clearly\\u000a contribute. Specific patterns of dyslipoproteinemia are present in patients with the nephrotic syndrome, diabetes mellitus

Eberhard Ritz; Michal Nowicki; Andrzej Wiecek

374

Acute transverse myelitis complicating breakthrough varicella infection.  

PubMed

We report a 10-year-old girl who presented with acute transverse myelitis after breakthrough varicella infection. The diagnosis was based on the development of motor weakness, paraparesis and bladder dysfunction, spinal magnetic resonance imaging findings and detection of anti-varicella zoster virus IgG antibody in the cerebrospinal fluid. This case report highlights that breakthrough varicella can result in serious complications such as acute transverse myelitis. PMID:24853543

Aslan, Asl; Kurugol, Zafer; Gokben, Sarenur

2014-11-01

375

Cardiovascular complications of cocaine: Imaging findings  

Microsoft Academic Search

Cocaine is the second most commonly abused illicit drug in the US and the most common one involved in emergency department\\u000a visits, the majority of which are related to the cardiovascular system. Cardiovascular complications related with cocaine\\u000a abuse include myocardial ischemia and infarction, myocarditis, hypertrophic cardiomyopathy, dilated cardiomyopathy, aortic\\u000a dissection, thrombosis, stroke and cerebral hemorrhage, and different forms of visceral

Carlos S. Restrepo; Carlos A. Rojas; Santiago Martinez; Roy Riascos; Alejandro Marmol-Velez; Jorge Carrillo; Daniel Vargas

2009-01-01

376

Oxidative stress and diabetic vascular complications  

Microsoft Academic Search

Vascular complications of diabetes represent the leading cause of morbidity and mortality in affected patients. Production\\u000a of reactive oxygen species is increased in diabetic patients, especially in those with poor glycemic control. Reactive oxygen\\u000a species affect vascular smooth muscle cell growth and migration, endothelial function, including abnormal endothelium-dependent\\u000a relaxation and expression of a proinflammatory phenotype, and modification of the extracellular

Seok Man Son; Matthew K. Whalin; David G. Harrison; W. Robert Taylor; Kathy K. Griendling

2004-01-01

377

Arrhythmias Complicating Acute Myocardial Infarction—Bradyarrhythmias  

Microsoft Academic Search

In acute myocardial infarction (AMI) in addition to myocardium, the specialized conduction system can be affected directly\\u000a by ischemia, necrosis, or auto-nomic imbalance [1]. Many serious arrhythmias develop within 1 hour of onset of symptoms, before\\u000a presentation to the hospital and patient monitoring [2, 3]. It is important to recognize and treat them in this setting, as\\u000a they may complicate

Dan L. Musat; Delia Cotiga; Walter Pierce; Aysha Arshad

378

Pyometra complicating a LeFort colpocleisis.  

PubMed

An 81-year-old woman presented with uterine procedentia and incomplete bladder emptying. She initially experienced significant relief of her symptoms with a pessary but developed chronic vaginal bleeding and discharge. She subsequently underwent a LeFort colpocleisis. She presented to the office 7 weeks later complaining of a persistent vaginal discharge and loss of appetite. She was admitted to the hospital and was diagnosed with a pyometra and underwent a supracervical hysterectomy without complications. PMID:18773135

Toglia, Marc R; Fagan, Matthew J

2009-03-01

379

Postoperative complications after laparoscopic incisional hernia repair  

Microsoft Academic Search

  Background: The popularity of laparoscopic repair of incisional hernias is increasing due to the apparent advantages of laparoscopy.\\u000a Patients and methods: A group of 150 consecutive patients with incisional hernias were treated by laparoscopic IPOM technique\\u000a with a Goretex Dualmesh between September 1999 and September 2001 and subsequently followed up. Some minor and major complications\\u000a could clearly identify advantages as

D. Berger; M. Bientzle; A. Müller

2002-01-01

380

Neurologic Complications of Pediatric Systemic Cancer  

Microsoft Academic Search

Each year in the United States, an average of one to two children per 10,000 develop cancer. Survival rates for children with\\u000a cancer have continued to increase quite dramatically over the last several decades. Many cancer patients have symptomatic\\u000a neurologic complications during the course of their illness, and neurologic problems are a common reason for hospitalization\\u000a of both adult and

Nicole J. Ullrich; Scott L. Pomeroy

381

Oral complications of cancer therapies. Description and incidence of oral complications  

SciTech Connect

No part of the body reflects the complications of cancer chemotherapy as visibly and as vividly as the mouth. The infectious, hemorrhagic, cytotoxic, nutritional, and neurologic signs of drug toxicity are reflected in the mouth by changes in the color, character, comfort, and continuity of the mucosa. The stomatologic complications of radiotherapy for oral cancer are physical and physiological in nature, transient or lasting in duration, and reversible or irreversible in type. Some linger as permanent mementos long after the cancer has been destroyed. They stem from radiation injury to the salivary glands, oral mucosa, oral musculature, alveolar bone, and developing teeth. They are expressed clinically by xerostomia, trismus, radiation dermatitis, nutritional stomatitis, and dentofacial malformation. In both cancer chemotherapy and cancer radiotherapy, the oral complications vary in pattern, duration, intensity, and number, with not every patient developing every complication. 21 references.

Dreizen, S. (Univ. of Texas Dental Branch, Houston (USA))

1990-01-01

382

Complex dynamics in learning complicated games  

E-print Network

Game theory is the standard tool used to model strategic interactions in evolutionary biology and social science. Traditional game theory studies the equilibria of simple games. But is traditional game theory applicable if the game is complicated, and if not, what is? We investigate this question here, defining a complicated game as one with many possible moves, and therefore many possible payoffs conditional on those moves. We investigate two-person games in which the players learn based on experience. By generating games at random we show that under some circumstances the strategies of the two players converge to fixed points, but under others they follow limit cycles or chaotic attractors. The dimension of the chaotic attractors can be very high, implying that the dynamics of the strategies are effectively random. In the chaotic regime the payoffs fluctuate intermittently, showing bursts of rapid change punctuated by periods of quiescence, similar to what is observed in fluid turbulence and financial markets. Our results suggest that such intermittency is a highly generic phenomenon, and that there is a large parameter regime for which complicated strategic interactions generate inherently unpredictable behavior that is best described in the language of dynamical systems theory

Tobias Galla; J. Doyne Farmer

2011-09-20

383

Complex dynamics in learning complicated games  

PubMed Central

Game theory is the standard tool used to model strategic interactions in evolutionary biology and social science. Traditionally, game theory studies the equilibria of simple games. However, is this useful if the game is complicated, and if not, what is? We define a complicated game as one with many possible moves, and therefore many possible payoffs conditional on those moves. We investigate two-person games in which the players learn based on a type of reinforcement learning called experience-weighted attraction (EWA). By generating games at random, we characterize the learning dynamics under EWA and show that there are three clearly separated regimes: (i) convergence to a unique fixed point, (ii) a huge multiplicity of stable fixed points, and (iii) chaotic behavior. In case (iii), the dimension of the chaotic attractors can be very high, implying that the learning dynamics are effectively random. In the chaotic regime, the total payoffs fluctuate intermittently, showing bursts of rapid change punctuated by periods of quiescence, with heavy tails similar to what is observed in fluid turbulence and financial markets. Our results suggest that, at least for some learning algorithms, there is a large parameter regime for which complicated strategic interactions generate inherently unpredictable behavior that is best described in the language of dynamical systems theory. PMID:23297213

Galla, Tobias; Farmer, J. Doyne

2013-01-01

384

Nox as a target for diabetic complications.  

PubMed

Oxidative stress has been linked to the pathogenesis of the major complications of diabetes in the kidney, the heart, the eye or the vasculature. NADPH oxidases of the Nox family are a major source of ROS (reactive oxygen species) and are critical mediators of redox signalling in cells from different organs afflicted by the diabetic milieu. In the present review, we provide an overview of the current knowledge related to the understanding of the role of Nox in the processes that control cell injury induced by hyperglycaemia and other predominant factors enhanced in diabetes, including the renin-angiotensin system, TGF-? (transforming growth factor-?) and AGEs (advanced glycation end-products). These observations support a critical role for Nox homologues in diabetic complications and indicate that NADPH oxidases are an important therapeutic target. Therefore the design and development of small-molecule inhibitors that selectively block Nox oxidases appears to be a reasonable approach to prevent or retard the complications of diabetes in target organs. The bioefficacy of these agents in experimental animal models is also discussed in the present review. PMID:23767990

Gorin, Yves; Block, Karen

2013-10-01

385

Complications Following BellaGen(TM) Injection  

PubMed Central

BellaGen™ is an injectable acellular dermal matrix granule derived from donated human skin tissue that was recently developed for soft tissue augmentation. Its use has been sporadically reported in penile girth enhancement procedures. Many cases of complications have been reported after injecting acellular dermal matrices like AlloDerm or SureDerm™ but few reports on complications associated with BellaGen™ injection. We report here on penile skin inflammation and necrosis following augmentation phalloplasty with BellaGen™, which developed 3 days after the injection and persisted for more than 2 weeks. The patient had a 15 year history of type 2 diabetes mellitus, and he was treated with oral antibiotics and wet dressings with KMNO4 solution to combine preservation of the remaining penile soft tissue with debridement of avascular tissue. The lesion improved with this treatment, but the patient experienced pain for about 2 weeks. All patients should be informed of the potential complications with the use of injectable acellular dermal matrices before treatment. Patient selection for augmentation is also important to have the most desirable results. PMID:22346264

Park, Mi Kyung; Kim, Hyun Kyu; Park, Kui Young; Li, Kapsok; Hong, Chang Kwun

2011-01-01

386

Pancreatic transplantation: Radiologic evaluation of vascular complications  

SciTech Connect

Transplantation of the pancreas is an increasingly common therapeutic option for preventing or delaying complications of type I diabetes mellitus. The authors studied the relative roles of various radiologic examinations in diagnosing vascular complications in these grafts including arterial and venous thrombosis, stenosis, and anastomotic leak (the most common vascular factors that necessitate pancreatectomy of the transplant), as defined with pathologic or arteriographic data. The results of 78 scintigraphic flow studies, 40 abdominal and pelvic computed tomographic (CT) scans, 27 sonograms, and eight color Doppler studies were evaluated in 52 patients who received a total of 27 cadaveric and 26 living-donor grafts over a 12-year period. These results were correlated with the data from 45 gross and microscopic pathologic studies and 37 arteriograms to determine their relative value in enabling detection of graft thrombosis and other vascular complications. Scintigraphy, CT, sonography, and color Doppler were all sensitive in detection of generalized graft abnormalities but lacked specificity in defining the underlying etiologic factors.

Snider, J.F.; Hunter, D.W.; Kuni, C.C.; Castaneda-Zuniga, W.R.; Letourneau, J.G. (Univ. of Minnesota Hospital and Clinic, Minneapolis (USA))

1991-03-01

387

Complications of nephropathia epidemica: three cases.  

PubMed

Haemorrhagic fever with renal syndrome (HFRS) in Scandinavia is called nephropathia epidemica (NE), and is caused by the Puumala-virus, which belongs to the Hanta-virus genus. The clinical course of NE is mostly benign, complications are uncommon, and deaths are rarely observed. We report the cases of three patients who developed serious complications in the course of NE caused by the Puumala-virus. One patient died within 24 h after admission, another developed progressive neuromuscular dysfunction (Guillain-Barré syndrome) which required auxiliary ventilation for several weeks before a slow recovery, and a third patient developed empty sella syndrome with pituitary gland insufficiency. In the first two cases the diagnosis of NE was confirmed by a rapid avidity assay for IgG antibody against Puumala-virus. In the third case the clinical course, and demonstration of NE immunity 16 years later, suggested that NE might have caused the hypopituitarism. Some patients with NE caused by the Puumala-virus may require intensive-care treatment, and the development of late complications such as empty sella syndrome and hypopituitarism should be taken into consideration. PMID:1353521

Forslund, T; Saltevo, J; Anttinen, J; Auvinen, S; Brummer-Korvenkontio, M; Korhonen, A; Poutiainen, M

1992-07-01

388

Complications Following BellaGen™ Injection.  

PubMed

BellaGen™ is an injectable acellular dermal matrix granule derived from donated human skin tissue that was recently developed for soft tissue augmentation. Its use has been sporadically reported in penile girth enhancement procedures. Many cases of complications have been reported after injecting acellular dermal matrices like AlloDerm or SureDerm™ but few reports on complications associated with BellaGen™ injection. We report here on penile skin inflammation and necrosis following augmentation phalloplasty with BellaGen™, which developed 3 days after the injection and persisted for more than 2 weeks. The patient had a 15 year history of type 2 diabetes mellitus, and he was treated with oral antibiotics and wet dressings with KMNO4 solution to combine preservation of the remaining penile soft tissue with debridement of avascular tissue. The lesion improved with this treatment, but the patient experienced pain for about 2 weeks. All patients should be informed of the potential complications with the use of injectable acellular dermal matrices before treatment. Patient selection for augmentation is also important to have the most desirable results. PMID:22346264

Park, Mi Kyung; Kim, Hyun Kyu; Park, Kui Young; Li, Kapsok; Seo, Seong Jun; Hong, Chang Kwun

2011-12-01

389

Magnetic resonance cholangiography in the assessment and management of biliary complications after OLT  

PubMed Central

Despite advances in patient and graft management, biliary complications (BC) still represent a challenge both in the early and delayed period after orthotopic liver transplantation (OLT). Because of unspecific clinical presentation, imaging is often mandatory in order to diagnose BC. Among imaging modalities, magnetic resonance cholangiography (MRC) has gained widespread acceptance as a tool to represent the reconstructed biliary tree noninvasively, using both the conventional technique (based on heavily T2-weighted sequences) and contrast-enhanced MRC (based on the acquisition of T1-weighted sequences after the administration of hepatobiliary contrast agents). On this basis, MRC is generally indicated to: (1) avoid unnecessary procedures of direct cholangiography in patients with a negative examination and/or identify alternative complications; and (2) provide a road map for interventional procedures or surgery. As illustrated in the review, MRC is accurate in the diagnosis of different types of biliary complications, including anastomotic strictures, non-anastomotic strictures, leakage and stones. PMID:25071883

Girometti, Rossano; Cereser, Lorenzo; Bazzocchi, Massimo; Zuiani, Chiara

2014-01-01

390

Technique, Complication, and Long-Term Outcome for Endovascular Treatment of Iliac Artery Occlusion  

SciTech Connect

The aim of this study was to report technical details, procedure-related complications, and results of endovascular treatment in chronic iliac artery occlusion. Between 2001 and 2008, endovascular treatments of 127 chronic iliac artery occlusions in 118 patients (8 women and 110 men; mean age, 59 years) were retrospectively reviewed. The study was based on Ad Hoc Committee on Reporting Standards (Society for Vascular Surgery/International Society for Cardiovascular Surgery Standards). All occlusions were treated with stent placement with or without preliminary balloon angioplasty. Kaplan-Meier estimators were used to determine patency rates. Univariate and multivariate analyses were performed to determine variables affecting successful recanalization, major complications, early stent thrombosis ({<=}30 days), and primary and secondary patency rates. Initial technical success was achieved in 117 (92%) procedures. Successful recanalization was obtained by antegrade approach in 69 of 77 (90%) procedures and by retrograde approach in 52 of 105 (50%) procedures (p < 0.001). Complications were encountered in 28 (24%) patients [minor in 7 patients (6%) and major in 22 patients (19%)]. One death occurred in the operative period secondary to iliac artery rupture. Early stent thrombosis was seen in eight (7%) patients. Presence of critical limb ischemia (p = 0.03), subintimal recanalization (p = 0.03), and major complication (p = 0.02) were the independent predictors of early stent thrombosis on multivariate analysis. Primary and secondary patency rates at 5 years were 63 and 93%, respectively. Presence of critical limb ischemia, TASC type C iliac lesions, combined occlusions of both common and external iliac arteries, and major complications were associated with decreased patency rates on univariate analysis, whereas these factors were not independent predictors of stent patency on multivariate analysis. In conclusion, endovascular treatment of iliac artery occlusion has a high technical success rate with favorable long-term patency rate. Success of recanalization increases with use of the antegrade approach and with the presence of a stump of artery before the occlusion.

Ozkan, Ugur, E-mail: radugur@yahoo.com; Oguzkurt, Levent; Tercan, Fahri [Baskent University, Department of Radiology, Faculty of Medicine (Turkey)

2010-02-15

391

Importance of controlling diabetes early--the concept of metabolic memory, legacy effect and the case for early insulinisation.  

PubMed

Most of the microvascular complications of diabetes are related to the degree and the length of exposure to hyperglycaemia. New data from the follow-up studies of the Diabetes Control and Complications Trial-the Epidemiology of Diabetes Intervention and Complications Study (DCCT-EDIC), and the United Kingdom Prospective Diabetes Study (UKPDS) emphasize the role of glycemic control early in the course of the disorder and its value in prevention of later complications. The phenomenon of ongoing beneficial effects on diabetic complications after a period of improved glycemic control even if followed by a return to usual (often poorer) metabolic control has been described as representing "metabolic memory" by the DCCT/EDIC investigators and as a "legacy effect" by the UKPDS investigators. This article reviews these concepts and explores the role of early use of insulin as a tool to achieve good glycemic control in type 2 diabetes. PMID:21818992

Ranjit Unnikrishnan, I; Anjana, R M; Mohan, V

2011-04-01

392

[Application of antihelicobacter therapy in patients, suffering pyloroduodenal zone ulcers, complicated by hemorrhage].  

PubMed

There were examined 113 patients, suffering pyloroduodenal zone ulcers, complicated by an acute hemorrhage. H. pylori was revealed in 108 (96%) patients. To escape a false-negative results a serological method was applied, which was used to determine a content of IgG antibodies to H. pylori with the help of diagnostic panel GastroPanel (Biohit PLc firm, Finland). The H. pylori presence in patients must be considered as a risk factor for the early recurrent hemorrhage occurrence. A timely conducted examination, determination of H. pylori and timely prescription of antihelicobacter therapy promote the improvement of the treatment results in patients, suffering gastroduodenal ulcers, complicated by an acute hemorrhage due to reduction of the occurrence rate of early recurrence of hemorrhage. PMID:22629797

Iaroshenko, K O

2012-02-01

393

Early postoperative prediction of cerebral damage after pediatric cardiac surgery  

Microsoft Academic Search

BackgroundCerebral damage is a serious complication of pediatric cardiac surgery. Early prediction of actual risk can be useful in counseling of parents, and in early diagnosis and rehabilitation therapy. Also, if all children at risk could be identified therapeutic strategies to limit perioperative cerebral damage might be developed. The aim of this study is to create a mathematical model to

Gerhard Trittenwein; Alessandra Nardi; Heike Pansi; Johann Golej; Gudrun Burda; Michael Hermon; Harald Boigner; Gregor Wollenek

2003-01-01

394

Advances in the epidemiology, pathogenesis, and management of Cushing's syndrome complications.  

PubMed

Cushing's syndrome (CS) is a clinical condition resulting from chronic exposure to glucocorticoid excess. As a consequence, hypercortisolism contributes significantly to the early development of systemic disorders by direct and/or indirect effects. Complications such as obesity, hypertension, diabetes, dyslipidemia, and hypercoagulability cause premature atherosclerosis and increase cardiovascular mortality. Impairment of the skeletal system is a relevant cause of morbidity and disability in these patients especially due to the high prevalence of vertebral fractures. In addition, muscle weakness, emotional lability, depression, and impairment of quality of life are very common. Clinical management of these patients is complex and should be particularly careful in identifying global cardiovascular risks and aim at controlling all complications. Although the primary goal in the prevention and treatment of complications is the correction of hypercortisolism, treatment does not completely eliminate these comorbidities. Given that cardiovascular risk and fracture risk can persist after cure, early detection of each morbidity could prevent the development of irreversible damage. In this review we present the various complications of CS and their pathogenetic mechanisms. We also suggest the clinical management of these patients based on our extensive clinical experience and on the available literature. PMID:22652826

Arnaldi, G; Mancini, T; Tirabassi, G; Trementino, L; Boscaro, M

2012-04-01

395

Impact of Sequencing of Postmastectomy Radiotherapy and Breast Reconstruction on Timing and Rate of Complications and Patient Satisfaction  

SciTech Connect

Purpose: There are few long-term studies of how the sequencing of postmastectomy radiotherapy (PMRT) and breast reconstruction (BR) affects the time to development of complications or patient satisfaction with BR. We therefore studied this issue. Methods and Materials: One hundred thirteen women who underwent BR at Beth Israel Deaconess Medical Center (Boston, MA) from 1999-2006 and also received PMRT were included. Complications requiring surgery were categorized as early (within 90 days of BR) or late. The median length of follow-up after BR was 46.5 months. Patients' general and esthetic satisfaction was assessed with a validated questionnaire. Results: Complications occurred among 32% of 57 women receiving PMRT before BR and 44% of 57 patients having BR before PMRT (p = 0.176). Early complications were more frequent in patients who had PMRT first (18%) than for those with BR first (11%) (p = 0.210); conversely, late complication rates in the two groups were 14% and 33%, respectively (p = 0.009). General satisfaction was comparable between the PMRT-first and BR-first groups (68% and 68%, respectively; p = 0.995); esthetic satisfaction rates were also similar (50% and 62%, respectively; p = 0.238). Conclusions: The sequencing of PMRT and BR did not have a substantial impact on the total risk of complications or patients' general and esthetic satisfaction. However, early complications tended to develop in patients having PMRT first, whereas patients having BR first had a higher risk of late complications. Additional study of the effects of sequencing of PMRT on particular types of reconstructions may help devise strategies for reducing these risks.

Adesiyun, Tolulope A.; Lee, Bernard T.; Yueh, Janet H.; Chen, Chen [Harvard Medical School, Boston, MA (United States); Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA (Israel); Colakoglu, Salih; Anderson, Katarina E.M.; Nguyen, Minh-Doan T. [Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA (Israel); Recht, Abram, E-mail: arecht@bidmc.harvard.ed [Harvard Medical School, Boston, MA (United States); Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA (Israel)

2011-06-01

396

Swedish midwives' care of women who are at high obstetric risk or who have obstetric complications  

Microsoft Academic Search

Objective: to describe how midwives experience the care of women who are at high obstetric risk or who have an obstetric complication during pregnancy, childbirth and early parenthood.Design: a qualitative approach using a phenomenological method.Participants: 10 Swedish midwives, recognised as highly skilled clinicians with at least five years of clinical experience in the studied context, from four different hospitals.Findings: the

Marie Berg; Karin Dahlberg

2001-01-01

397

Colostomy closure: how to avoid complications  

PubMed Central

Purpose Colostomy is an operation frequently performed in pediatric surgery. Despite its benefits, it can produce significant morbidity. In a previous publication we presented our experience with the errors and complications that occurred during cases of colostomy creation. We now have focused in the morbidity related to the colostomy closure. The technical details that might have contributed to the minimal morbidity we experienced are described. Methods The medical records of 649 patients who underwent colostomy closure over a 28-year period were retrospectively reviewed looking for complications following these procedures. Our perioperative protocol for colostomy closure consisted in: clear fluids by mouth and repeated proximal stoma irrigations 24 h prior to the operation. Administration of IV antibiotics during anesthesia induction and continued for 48 h. Meticulous surgical technique that included: packing of the proximal stoma, plastic drape to immobilize the surgical field, careful hemostasis, emphasis in avoiding contamination, cleaning the edge of the stomas to allow a good 2-layer, end-to-end anastomosis with separated long-term absorbable sutures, generous irrigation of the peritoneal cavity and subsequent layers with saline solution, closure by layers to avoid dead space, and avoidance of hematomas. No drains and no nasogastric tubes were used. Oral fluids were started the day after surgery and patients were discharged 48–72 h after the operation. Results The original diagnoses of the patients were: anorectal malformation (583), Hirschsprung’s disease (53), and others (13). 10 patients (1.5%) had complications: 6 had intestinal obstruction (5 due to small bowel adhesions, 1 had temporary delay of the function of the anastomosis due to a severe size discrepancy between proximal and distal stoma with a distal microcolon) and 4 incisional hernias. There were no anastomotic dehiscences or wound infection. There was no bleeding, no anastomotic stricture and no mortality. Conclusion Based on this experience we believe that colostomy closure can be performed with minimal morbidity provided a meticulous technique is observed. PMID:20714731

Levitt, Marc A.; Lawal, Taiwo A.; Pena, Alberto

2010-01-01

398

[Complications after intramedullary nailing of the tibia].  

PubMed

As demonstrated by the experience, treatment of fractures of the tibial intramedullary nail proved to be the most advantageous method of operating as: put the rod runs in the biomechanical axis of the limb, is inside of the bone, is a minimally invasive procedure (carried out with small cuts). Initially, the method of intramedullary nailing was used for the treatment of fractures of the shaft center of the tibia. However, the development of surgical techniques has meant that the method can also be used to treat fractures of the proximal and distal tibia. The most common complications of surgical treatment by this method, apart from infection include: changing the limb axis, rotation of the factions against each other, and degenerative changes in the knee depend on the introduction of nail art. The aim of this study is to analyze in order to treat patients with lower leg fractures using intramedullary nailing. It was carried out based on the collected medical records and clinical examination, which included 45 patients. It was found that the most common complication observed after treatment was varus tibial fragments (5 cases - 11% of respondents). Less commonly observed disorder in the form of the axis of rotation of the limb (1 case) and anteflexion -1 case. During the test showed that the axis of the limb abnormalities were associated with the initial surgery. There was no significant progression of the axis of the limb abnormalities in the period from the date of surgery to complete primary union. Complications in the form of secondary osteoarthritis of the knee reported in studies of other authors, did not occur in any of the analyzed in the work cases. PMID:22420180

Pob?ocki, Krzysztof; Domaradzki, Marcin; Gawdzik, Jerzy; Prochacki, Pawe?; Rajewski, Rajmund

2011-01-01

399

Risk of biliary complications in bariatric surgery.  

PubMed

Gallstones are commonly observed after rapid weight loss, particularly after bariatric surgery. Preventive measures of gallstone formation and potential related complications are still debated. This study aimed to propose a standardized strategy according to the results of the literature. Thus, preventive measures should be determined according to patient status (evaluated clinically and by routine ultrasound) and the type of bariatric surgery. Cholecystectomy should be performed in patients with symptomatic gallstones irrespective of the planned operation, or for asymptomatic gallstones during a gastric by-pass. In other settings, ursodesoxycholic acid should be given postoperatively for 6 months. PMID:20920904

Desbeaux, A; Hec, F; Andrieux, S; Fayard, A; Bresson, R; Pruvot, M-H; Mulliez, E

2010-08-01

400

Salvage of first metatarsophalangeal joint arthroplasty complications.  

PubMed

There are two broad categories of surgical techniques for first metatarsophalangeal joint arthroplasty. Resection arthroplasty is a resection of the base of the proximal phalanx with or without an interposition graft of capsule or adjacent tendon. The second technique involves a partial or complete joint replacement. The primary indication for these procedures is first metatarsophalangeal joint pain caused by arthritic change. The salvage surgical options for failed metatarsophalangeal joint arthoplasty are directed toward decreasing or eliminating the symptoms arising from the complications of these procedures. PMID:12760573

Baumhauer, Judith F; DiGiovanni, Benedict F

2003-03-01

401

Pulmonary Complications of Sickle Cell Disease  

PubMed Central

Sickle cell disease (SCD) is a common monogenetic disorder with high associated morbidity and mortality. The pulmonary complications of SCD are of particular importance, as acute chest syndrome and pulmonary hypertension have the highest associated mortality rates within this population. This article reviews the pathophysiology, diagnosis, and treatment of clinically significant pulmonary manifestations of SCD, including acute chest syndrome, asthma, and pulmonary hypertension in adult and pediatric patients. Clinicians should be vigilant in screening and treating such comorbidities to improve patient outcomes. PMID:22447965

Miller, Andrew C.

2012-01-01

402

Techniques, indications and complications of corneal debridement.  

PubMed

The cornea is the most exposed surface of the eye and, as such, is vulnerable to external trauma and the risk of infection. Many corneal diseases alter shape, surface, and transparency and thus result in reduced vision. The external position of the cornea, however, lends itself to diagnostic and therapeutic maneuvers that are commonly performed and readily done in the clinic. More sophisticated techniques require the use of complex equipment such as excimer and femtosecond laser. Complications that develop from poor healing and/or secondary infection are best avoided with appropriate technique, antisepsis, and modification of wound healing. We review corneal debridement in the management of corneal disease. PMID:24239444

McGrath, Lindsay A; Lee, Graham A

2014-01-01

403

Ocular complications in renal transplant recipients.  

PubMed Central

The occurrence of ocular complications among 62 recipients of functioning renal transplants was reviewed 6 months to 7 1/2 years after transplantation. Posterior subcapsular cataracts were found in 29 (46.7%). A positive correlation was found between the development of cataracts and the total dose of corticosteroid, the number of days on which the dose exceeded 100 mg, and the number of rejection episodes treated with high doses of corticosteroid. Identification of specific high-risk periods in regard to cataract formation could lead to use of preventive therapy, as yet undetermined, during these periods. Lower doses of corticosteroids should be used to treat rejection episodes. PMID:329970

Pavlin, C. R.; deVeber, G. A.; Cook, G. T.; Chisholm, L. D.

1977-01-01

404

Complications of laparoscopic antireflux surgery in childhood  

Microsoft Academic Search

Background: The aim of this study was to assess the complications associated with the laparoscopic treatment of gastroesophageal reflux\\u000a disease (GERD) in children.\\u000a \\u000a \\u000a \\u000a \\u000a \\u000a Methods: From March 1992 to March 1998, we used the laparoscopic approach to treat 289 children affected by gastroesophageal reflux\\u000a disease. The patients' ages ranged between 4 months and 17 years (median, 4.3 years), and their body

C. Esposito; P. Montupet; G. Amici; P. Desruelle

2000-01-01

405

A complicated case of mitral valve disease.  

PubMed Central

A patient with rheumatic mitral stenosis and previous cerebral embolism had a myocardial infarction during cardiac catheterisation. She later developed severe mitral regurgitation one year after open valvotomy and at valve replacement was found to have a papillary tumour of the mitral valve. Unexplained low cardiac output occurred four days after operation. Postmortem examination showed thrombotic occlusion of the xenograft prosthesis, a complication not previously seen with tissue valves. Both of these rare events were suggested by the patient's clinical course and could have been diagnosed with cross sectional echocardiography. Images PMID:3970791

James, S E; McKay, R; Ross, D N

1985-01-01

406

Post legalisation challenge: minimizing complications of abortion.  

PubMed

Abortion has been legalized in Nepal since September 2002 by 11th amendment to the Muluki Ain. The present study was conducted in Paropakar Shree Panch Indra Rajya Laxmi Devi Maternity Hospital to assess the magnitude of induced abortion, its causes and the types of complications, in the post legalization phase. Prospective descriptive analyses of the patients who were admitted with history of induced abortion from 16th Dec 2003 to 13th March 2004 was carried out. A total of 305 cases of abortion complications were admitted during the three-month study period, which is 39.7% of the total gynaecological admissions (768). Of these 31 (10.25%) patients had history of induced abortion. Half of the induced abortion cases (52%) were of age group 21-29 yrs and 42% had three or more children. 39% of the cases had history of induced abortion at more than 12 weeks and almost half of the cases (48%) had history of family planning. The most common reason for seeking abortion was too many children (59%) followed by illegitimate pregnancy (16%). Twenty-one patients gave history of abortion being performed by doctors and the most common method used was D and C (75%). 77% of cases presented as incomplete abortion and one case presented with uterine perforation, bowel injury and peritonitis. Twenty patients had evacuation under sedation while five had manual vacuum aspiration (MVA); one patient required laparatomy. In two third of the patients intravenous fluid and antibiotics were used. Four patients required blood transfusion. Abortion complications constitute almost 40% of the total gynaecological admissions. Ten percent of the abortion cases had history of induced abortion. Medical persons, mainly doctors, performed most of the cases of induced abortion and D and C was the most commonly used method. However the patients had faced various types of complications. Untrained provider, resulting in serious life threatening injuries, performed more than a third of the cases of induced abortion at more than twelve weeks gestation. This points to the need for improved monitoring of the quality of services provided, and adherence to the criteria set by the procedural order. PMID:15821380

Ojha, N; Sharma, S; Paudel, J

2004-01-01

407

Complications of radiofrequency ablation of hepatic tumors: Frequency and risk factors  

PubMed Central

Radiofrequency ablation (RFA) has become an important option in the therapy of primary and secondary hepatic tumors. Surgical resection is still the best treatment option, but only a few of these patients are candidates for surgery: multilobar disease, insufficient liver reserve that will lead to liver failure after resection, extra-hepatic disease, proximity to major bile ducts and vessels, and co-morbidities. RFA has a low mortality and morbidity rate and is considered to be safe. Thus, complications occur and vary widely in the literature. Complications are caused by thermal damage, direct needle injury, infection and the patient’s co-morbidities. Tumor type, type of approach, number of lesions, tumor localization, underlying hepatic disease, the physician’s experience, associated hepatic resection and lesion size have been described as factors significantly associated with complications. The physician in charge should promptly recognize high-risk patients more susceptible to complications, perform a close post procedure follow-up and manage them early and adequately if they occur. We aim to describe complications from RFA of hepatic tumors and their risk factors, as well as a few techniques to avoid them. This way, others can decrease their morbidity rates with better outcomes. PMID:24672640

Fonseca, Alexandre Zanchenko; Santin, Stephanie; Gomes, Luiz Guilherme Lisboa; Waisberg, Jaques; Ribeiro Jr., Marcelo Augusto Fontenelle

2014-01-01

408

Early Synchronisation  

NASA Astrophysics Data System (ADS)

Synchronisation is an essential component of any high speed photographic experiment to combine the three principal components - subject, camera and lighting. Today there are many available equipments to ensure synchronisation for the current industrial and research problems but when the exception occurs, the skill of the good researcher again becomes necessary. It was not until the manufactured plates and films became available in the 1880's that high speed photography became a real tool and the early users had to solve their own timing problems. In general the early techniques were relatively simple but quite effective. Muybridge in his "Animal Motion Studies" arranged that the subjects operated the cameras by cords to the lens shutters. This was extremely effective. But a few researchers wished to look at very rapid events and needed more automatic methods. For example Mach began on photographing bullets and shells requiring timings in the microsecond range. Because he and his collaborators always took photographs and his reputation was so great, his work was always noted and assumed to be original. Some thirty years earlier, in Berlin, Toepler and Holtz under Professor Riess were working on Electrostatic Generators and Sparks which led Toepler on to his brilliant development of the Schlieren technique. His early application of this technique involved the synchronisation of two spark gaps, one as an illuminant and the other as an event such that shock waves were made visible by his Schieren system. The "pictures" in his published papers look like photo-graphs but in fact were engravings from his own drawings after viewing at least hundreds of images. His circuits and the later Mach circuits must be the earliest of our modern electronic circuits and fully deserving of our recognition.

Lunn, George H.

1989-06-01

409

Hepatobiliary Complications of Sickle Cell Disease among Children Admitted to Al Wahda Teaching Hospital, Aden, Yemen  

PubMed Central

Objectives: This study aimed to describe the pattern of hepatobiliary complications among patients with sickle cell disease (SCD) and to assess their correlation with age, gender and other risk factors. Methods: This cross-sectional study assessed 106 patients with SCD who were admitted to Al Wahda Teaching Hospital in Aden, Yemen, between January and June 2009. A full history, thorough examination, essential laboratory investigations (including a complete blood count, liver function test and viral markers test) and an abdominal ultrasound were performed on all patients. The clinicopathological characteristics of the hepatobiliary complications were analysed for their correlation to different risk factors such as age and gender. Results: It was found that 46.2% of the patients with SCD had hepatobiliary complications. Of these, 36.7% had viral hepatitis, 26.0% had cholecystitis and 20% had gallstones. A total of 60.4% of the affected patients were male. The mean levels of alanine aminotransferase (59.4 and 56.0 U/L) and aspartate transaminase (40.1 and 38.3 U/L) were significantly elevated in patients with viral hepatitis and cholecystitis, respectively. Hepatitis B virus surface antigen showed higher positivity (10.4%) than anti-hepatitis A and anti-hepatitis C antibodies. Hepatobiliary complications increased significantly with age and were notably higher among those who were often admitted to hospital and/or underwent frequent blood transfusions. Conclusion: This study suggests that hepatobiliary complications are common among SCD patients and the likelihood of developing such complications increases as patients age. Thus, regular clinical follow-ups, abdominal ultrasound studies and periodic liver function tests, as well as serological tests for viral hepatitis, are strongly recommended. These can help in the early detection of these complications and allow opportunities for their management and prevention. PMID:25364561

Qhalib, Hana A.; Zain, Gamal H.

2014-01-01

410

Prognostic Significance of Complications after Laparoscopic Colectomy for Colon Cancer  

PubMed Central

Aims This study sought to evaluate the prognostic significance of postoperative complications for colon cancer patients undergoing laparoscopic surgery. Methods From May 2006 to May 2009, a total 224 patients who underwent laparoscopic curative resection (R0) for colon cancer were included in our retrospective study. Postoperative complications were evaluated according to a standardized grading system. The main outcome measurements of our study were overall survival (OS) and relapse-free survival (RFS), which were then compared between the no complication and complication groups. Univariate and multivariate analysis were used to assess the correlation between complications and prognosis. Results Fifty-nine postoperative complications occurred in 43 patients. The overall morbidity rate was 26.3%. The 5-year OS in the complication group was 41.4% compared with 78.5% in the no complication group (P<0.001). The cumulative incidence of relapse was also more aggressive in patients with complications (5-year RFS: complication group 40.9% vs. no complication group 82.1%, P<0.001). Multivariate analysis identified complications as a significant factor increasing the risk for both OS (RR 2.737; 95% CI 1.512–4.952; P?=?0.001) and RFS (RR 4.247; 95% CI 2.291–7.876; P<0.001). Conclusion Postoperative complications could pose a significant adverse impact not only on OS but also on RFS in patients with colon cancer even when laparoscopic R0 resection is available. PMID:25299478

Xia, Xiang; Wu, Weidong; Zhang, Kundong; Cen, Gang; Jiang, Tao; Cao, Jun; Huang, Kejian; Huang, Chen; Qiu, Zhengjun

2014-01-01

411

Urological complications of illicit drug use.  

PubMed

Illicit drug use is prevalent worldwide; over 24 million people are estimated to have used recreational drugs during the past month in the UK and USA alone. Illicit drug use can result in a wide spectrum of potential medical complications that include many urological manifestations. To ensure optimal care and treatment, urologists need to be cognizant of these complications in their patients, particularly among youths. Ketamine uropathy is thought to affect over one-quarter of ketamine users and can lead to severe lower urinary tract symptoms, as well as upper tract obstruction. Cannabis use has been associated with an increased risk of bladder cancer, prostate cancer and nonseminomatous germ cell tumours in case-control studies. Fournier's gangrene has been reported following injection of heroin and cocaine into the penis. Excessive use of cough medicines can lead to the development of radiolucent stones composed of ephedrine, pseudoephedrine and guaifenesin. As the current evidence is mostly limited to case reports and case series, future epidemiological studies are needed to fully address this issue. PMID:24535583

Skeldon, Sean C; Goldenberg, S Larry

2014-03-01

412

Perianal complications of pediatric Crohn's disease.  

PubMed

The management of perianal disease (PD) in children with Crohn's disease was reviewed. Of 325 patients (184 boys), 200 (62%) developed PD. The mean age at diagnosis of Crohn's disease was 11.2 years (range, 5 to 17 years). Skin tags were present in 114 (35%) patients, fissures in 165 (51%), fistulas in 41 (15%), and perirectal abscesses in 47 (13%). One hundred fifty-three patients had PD as one of the first symptoms; 71 of these had complete remission of PD and the remaining 82 had chronic symptoms. Forty-two patients were initially free of PD, only to develop it later. PD occurred in 50% of patients with gastroduodenal Crohn's disease, 57% with jejunal, 68% with ileal, 64% with ileocecal, 60% with ileocolic, and 51% with colonic. Local minor operation was necessary in 38 (12%) patients, fistulotomy in 12, and abscess drainage in 26. Four patients required either intestinal resection and/or enterostomy for progressive PD. Fifty-three patients received metronidazole, with amelioration in 38. It is concluded that PD is a common complication of Crohn's disease in children and adolescents. Its presentation may antedate that of the primary disease. Most PD follows a benign course. There is a limited role for operation, but a need for meticulous perineal care and a potential benefit with metronidazole therapy. We advocate conservatism in the management of perianal complications of Crohn's disease in pediatric patients. PMID:2061798

Palder, S B; Shandling, B; Bilik, R; Griffiths, A M; Sherman, P

1991-05-01

413

Acute phlegmonous gastritis complicated by delayed perforation  

PubMed Central

Here, we report on a case of acute phlegmonous gastritis (PG) complicated by delayed perforation. A 51-year-old woman presented with severe abdominal pain and septic shock symptoms. A computed tomography scan showed diffuse thickening of the gastric wall and distention with peritoneal fluid. Although we did not find definite evidence of free air on the computed tomography (CT) scan, the patient’s clinical condition suggested diffuse peritonitis requiring surgical intervention. Exploratory laparotomy revealed a thickened gastric wall with suppurative intraperitoneal fluid in which Streptococcus pyogenes grew. There was no evidence of gastric or duodenal perforation. No further operation was performed at that time. The patient was conservatively treated with antibiotics and proton pump inhibitor, and her condition improved. However, she experienced abdominal and flank pain again on postoperative day 10. CT and esophagogastroduodenoscopy showed a large gastric ulcer with perforation. Unfortunately, although the CT showed further improvement in the thickening of the stomach and the mucosal defect, the patient’s condition did not recover until a week later, and an esophagogastroduodenoscopy taken on postoperative day 30 showed suspected gastric submucosal dissection. We performed total gastrectomy as a second operation, and the patient recovered without major complications. A pathological examination revealed a multifocal ulceration and necrosis from the mucosa to the serosa with perforation. PMID:24696618

Min, Sun Young; Kim, Yong Ho; Park, Won Seo

2014-01-01

414

Complications from micronutrient deficiency following bariatric surgery.  

PubMed

We report a case of clinically significant micronutrient deficiencies following biliary pancreatic diversion (BPD) surgery. Our patient was admitted to hospital six years after BPD surgery following a low impact humeral fracture complicated by postoperative wound infection. On presentation she complained of a widespread rash and loss of night vision. Laboratory testing confirmed hypoalbuminaemia, deficiencies of vitamins A, E and D and of the trace elements copper, zinc and selenium. Bone densitometry confirmed osteoporosis. The skin rash was thought to be due to zinc deficiency and improved with conservative measures and trace element replacement. Her night blindness resolved 48 hours after receiving high dose parenteral vitamin A. Six months later she was readmitted to our intensive care unit with wound dehiscence at her fracture site and clinical features of sepsis and encephalopathy. This case highlights the importance of devising treatment and follow-up guidance prior to surgery and multidisciplinary team involvement including the patient so that long-term metabolic complications are avoided. PMID:24847133

Wilson, Helen O; Datta, Dev Bn

2014-11-01

415

Multiple sclerosis: a complicated picture of autoimmunity  

Microsoft Academic Search

Understanding of autoimmune diseases, including multiple sclerosis, has expanded considerably in recent years. New insights have been provided by not only animal models but also studies of patients, often in conjunction with experimental therapies. It is accepted that autoimmune T cells mediate the early steps of new multiple sclerosis lesions, and although uncertainties remain about the specific targets of autoreactive

Roland Martin; Henry F McFarland

2007-01-01

416

Traditional endonasal and microscopic sinus surgery complications versus endoscopic sinus surgery complications: a meta-analysis.  

PubMed

The aim of this study was to compare the incidence of complications of endoscopic sinus surgery (ESS) to the incidence of complications of traditional and microscopic sinus surgery. A meta-analysis was carried out on 28 series of patients (a total of 13,405) who had undergone ESS, 8 series of patients (3,887 in total) who had undergone traditional endonasal sinus surgery and 7 series of patients (1,630 in total) who had undergone microscopic sinus surgery. The authors used the Bayesian inference package WinBUGS operating from within the statistical computer program R (version 2.7.1). Major complications had a higher incidence after traditional sinus surgery than ESS but this fact did not cause a significant statistical difference, whereas microscopic surgery had significantly more complications than ESS (p < 0.05). Carrying out our meta-analytic study, comparing major and minor complications of endonasal surgical approaches, was very difficult due to several methodological biases of data extraction and evaluation from studies concerning a broad timespan. Regarding major complications, we only found a significant statistical difference (p < 0.05) between the endoscopic (1%) and the microscopic methods (2.0%), but, if we had analyzed the data considering the natural learning curve of the latest ESS surgical approach, and if we had not considered the results produced in the first 10 years (1988-1998) concerning ESS in our meta-analysis, we would have found a statistically significant difference (p < 0.05) between the endoscopic (0.4%) and the traditional (1.1%) approach as well. PMID:21984058

Re, Massimo; Massegur, Humbert; Magliulo, Giuseppe; Ferrante, Luigi; Sciarretta, Vittorio; Farneti, Giovanni; Macrì, Giovanni; Mallardi, Vito; Pasquini, Ernesto

2012-03-01

417

Ventilator-associated complications, including infection-related complications: the way forward.  

PubMed

Acute respiratory failure represents the most common condition requiring admission to an adult intensive care unit. Ventilator-associated pneumonia (VAP) has been used as a marker of quality for patients with respiratory failure. Hospital-based process-improvement initiatives to prevent VAP have been successfully used. The use of ventilator-associated complications (VACs) has been proposed as an objective marker to assess the quality of care for this patient population. The use of evidence-based bundles targeting the reduction of VACs, as well as the conduct of prospective studies showing that VACs are preventable complications, are reasonable first-steps in addressing this important clinical problem. PMID:23182526

Kollef, Marin H

2013-01-01

418

[The megaureter--a possible complication after resected retroperitoneal tumor].  

PubMed

The authors present a very rare complication of a retroperitoneal tumor resection: unilateral iliopelvic segmental megaureter. This condition was subsequently complicated with a diffuse peritonitis caused by parietal microperforations. PMID:15560561

Vasile, I; Neme?, R; Vilcea, I D; Calot?, F; Tomescu, P; Tenovici, Mihaela; Pa?alega, M; Me?in?, C; Ghelase, F

2004-01-01

419

Repair of Infrapopliteal Postembolectomy Complications with Variant Embolization Techniques  

SciTech Connect

Infrapopliteal pseudoaneurysms and arteriovenous fistulae are known complications of Fogarty balloon embolectomy. Management of these complications in two patients with associated critical foot ischemia by modified interventional embolization techniques is described.

Del Grande, Filippo [Institute of Diagnostic Radiology, University Hospital, Raemistrasee 100, CH-8091 Zuerich (Switzerland); Cassina, Paolo C. [Department of Surgery, University Hospital, Raemistrasee 100, CH-8091 Zuerich (Switzerland); Leu, Anders J. [Division of Angiology, University Hospital, Raemistrasee 100, CH-8091 Zuerich (Switzerland); Pfammatter, Thomas [Institute of Diagnostic Radiology, University Hospital, Raemistrasee 100, CH-8091 Zuerich (Switzerland)

2001-07-15

420

Long-Term Complications of Diabetes (For Parents)  

MedlinePLUS

... complications and health problems. Back Continue Nerve Damage (Diabetic Neuropathy) Another complication that people who have had diabetes ... develop is a type of nerve damage called diabetic neuropathy. Diabetic neuropathy can involve nerves in many different ...

421

Pregnancy Complications: Bleeding and Spotting from the Vagina  

MedlinePLUS

... Bleeding and spotting from the vagina during pregnancy Pregnancy complications Pregnancy complications may need special medical care. ... dashboard . Bleeding and spotting from the vagina during pregnancy Bleeding and spotting from the vagina during pregnancy ...

422

MD Anderson researchers find that APBI is associated with more mastectomies, toxicities, complications, compared to traditional radiation  

Cancer.gov

Accelerated partial breast irradiation brachytherapy, the localized form of radiation therapy growing increasingly popular as a treatment choice for women with early-stage breast cancer, is associated with higher rate of later mastectomy, increased radiation-related toxicities and post-operative complications, compared to traditional whole breast irradiation.

423

Complications of ERCP: Ethical Obligations and Legal Consequences  

Microsoft Academic Search

Endoscopic retrograde cholangiopancreatography (ERCP) is a skill and technique demanding high-risk procedure with an overall complication rate of about 5–10%. Pancreatitis remains the most common complication of ERCP, however, bleeding after sphincterotomies, infections and cardiopulmonary complications as well as perforations may also occur. Patient- and procedure-related risk factors of ERCP complications are mainly predictable so that ERCP often can be

István Rácz; Stanislav Rejchrt; Majid Hassan

2008-01-01

424

Vascular complications of transplantation: part 2: pancreatic transplants.  

PubMed

Vascular complications after solid organ transplantation are not uncommon and may lead to graft dysfunction and ultimately graft loss. A thorough understanding of the surgical anatomy, etiologies, and types of vascular complications, their presentation and the options for management are important for managing these complex patients. This article reviews the basic surgical anatomy, the vascular complications, and endovascular management options of vascular complications in patients with pancreas transplants. PMID:24556832

Khaja, Minhaj S; Matsumoto, Alan H; Saad, Wael E

2014-12-01

425

Complications following Surgery for Lumbar Stenosis in a Veteran Population  

PubMed Central

Study Design Secondary analysis of the prospectively collected Veterans Affairs National Surgical Quality Improvement Program (VASQIP) database. Objective Determine rates of major medical complications, wound complications, and mortality among patients undergoing surgery for lumbar stenosis; and examine risk factors for these complications. Summary of Background Data Surgery for spinal stenosis is concentrated among older adults, for whom complications are more frequent than among middle-aged patients. Many studies have focused on infections or device complications, but fewer have focused on major cardiopulmonary complications, using prospectively collected data. Methods We identified patients who underwent surgery for a primary diagnosis of lumbar stenosis between 1998 and 2009 from the VASQIP database. We created a composite of major medical complications, including acute myocardial infarction, stroke, pulmonary embolism, pneumonia, systemic sepsis, coma, and cardiac arrest. Results Among 12,154 eligible patients, major medical complications occurred in 2.1% ; wound complications in 3.2%; and 90-day mortality in 0.6%. Major medical complications, but not wound complications, were strongly associated with age. American Society of Anesthesiologists (ASA) class was a strong predictor of complications. Insulin use, chronic corticosteroid use, and preoperative functional status were also significant predictors. Fusion procedures were associated with higher complication rates than decompression alone. In logistic regressions, ASA class and age were the strongest predictors of major medical complications (OR for ASA class 4 vs. classes 1 or 2: 2.97, 95% CI 1.68, 5.25, p=0.0002). After adjustment for comorbidity, age, and functional status, fusion procedures remained associated with higher medical complication rates than decompression alone (OR 2.85, 95% CI 2.14, 3.78, p<0.0001). Conclusion ASA class, age, type of surgery, insulin or corticosteroid use, and functional status were independent risk factors for major medical complications. These factors may help in selecting patients and planning procedures, improving patient safety. PMID:23778366

Deyo, Richard A.; Hickam, David; Duckart, Jonathan P.; Piedra, Mark

2013-01-01

426

Intra aortic balloon pump: literature review of risk factors related to complications of the intraaortic balloon pump  

PubMed Central

The increasing use of the intra aortic balloon pump is attributed to the relatively easy percutaneous insertion and the low threshold of use over the past few years, especially in elderly patients with multi-vessel diseases and an affected ejection fraction. Unfortunately, the clinical assessment of the complications associated to the use of this supporting device, underestimates the frequency of such complications. This report has looked at the current literature and attempt to identify incremental risk factors related to the development of adverse effects during support with an intaaortic balloon pump. The paper concludes that in contrary to early reports, newer studies have shown that complications following intraaortic balloon pump treatment, is decreasing. Moreover the literature suggests that the thrombosis and infective complications are relevant to the duration of the pump treatment, while the ischemic problems of the limbs are mostly linked to the atherosclerotic status of the common femoral artery. PMID:22047038

2011-01-01

427

Complicated Grief and Suicidal Ideation in Adult Survivors of Suicide  

ERIC Educational Resources Information Center

While the prevalence of complicated grief has been demonstrated to be elevated in survivors of suicide, the association between complicated grief and suicidal ideation among adult survivors of suicide has not been explored. The purpose of the present study is to examine the association between complicated grief and suicidal ideation in suicide…

Mitchell, Ann M.; Kim, Yookyung; Prigerson, Holly G.; Mortimer, Mary Kay

2005-01-01

428

How Patients with Diabetes Perceive Their Risk for Major Complications  

Microsoft Academic Search

CONTEXT. To educate patients with diabetes about their illness and to motivate these patients to pursue intensive treatment, physicians often inform them about their risk for serious complications. However, little is known about patient perceptions of these risks. OBJECTIVE. To compare patient perceptions of risk for major complications of dia- betes with actual risk for these complications. DESIGN. Structured interviews

DAVID MELTZER; BRIAN EGLESTON

429

Management of non-catheter-associated complicated urinary tract infection.  

PubMed

This article presents an overview of non-catheter-associated complicated urinary tract infection (UTI) from a urologic point of view. Discussion includes the evaluation and workup a complicated UTI through history, physical examination, laboratory analysis, and radiographic studies. Specific types of complicated UTI, such as urinary obstruction and renal abscess, are reviewed. PMID:24484579

Dielubanza, Elodi J; Mazur, Daniel J; Schaeffer, Anthony J

2014-03-01

430

Does chemotherapy increase the risk of respiratory complications after pneumonectomy?  

Microsoft Academic Search

Objective: The impact of induction chemotherapy on postoperative complications after pneumonectomy remains unclear. The aim of the study was to test the hypothesis that chemotherapy may increase the risk of postoperative respiratory complications. Methods: Data from 202 consecutive standard pneumonectomies performed for lung cancer were collected and analyzed. Postoperative and 90-day mortality, overall morbidity, and respiratory complication rates were evaluated

Francesco Leo; PierGiorgio Solli; Giulia Veronesi; Davide Radice; Antonio Floridi; Roberto Gasparri; Francesco Petrella; Alessandro Borri; Domenico Galetta

431

The treatment of complicated groin and incisional hernias  

Microsoft Academic Search

One hundred years ago, Edoardo Bassini said: “L'ernia é una malattia meccanica.” Before that, Ambroise Paré (1598) and Joseph-Pierre Desault (1798) asserted the mechanical nature of strangulation. Beside strangulation, the most serious of all complications even today, I have studied huge hernias, which are natural complications, and recurrent hernias, which are the complications of suboptimal repairs. In this article, I

René E. Stoppa

1989-01-01

432

Complications after subpectoral biceps tenodesis using a dual suture anchor technique  

PubMed Central

Purpose: A variety of fixation techniques for subpectoral biceps tenodeses have been described including interference screw and suture anchor fixation. Biomechanical data suggests that dual suture anchor fixation has equivalent strength compared to interference screw fixation. The purpose of the study is to determine the early complication rate after subpectoral biceps tenodesis utilizing a dual suture anchor technique. Materials and Methods: A total of 103 open subpectoral biceps tenodeses were performed over a 3-year period using a dual suture anchor technique. There were 72 male and 31 female shoulders. The average age at the time of tenodesis was 45.5 years. 41 patients had a minimum of 6 months clinical follow-up (range, 6 to 45 months). The tenodesis was performed for biceps tendonitis, superior labral tears, biceps tendon subluxation, biceps tendon partial tears, and revisions of prior tenodeses. Results: There were a total of 7 complications (7%) in the entire group. There were 4 superficial wound infections (4%). There were 2 temporary nerve palsies (2%) resulting from the interscalene block. One patient had persistent numbness of the ear and a second patient had a temporary phrenic nerve palsy resulting in respiratory dysfunction and hospital admission. One patient developed a pulmonary embolism requiring hospital admission and anticoagulation. There were no hematomas, wound dehiscences, peripheral nerve injuries, or ruptures. In the sub-group of patients with a minimum of 6 months clinical follow-up, the only complication was a single wound infection treated with oral antibiotics. Conclusions: Subpectoral biceps tenodesis utilizing a dual suture anchor technique has a low early complication rate with no ruptures or deep infections. The complication rate is comparable to those previously reported for interference screw subpectoral tenodesis and should be considered as a reasonable alternative to interference screw fixation. Level of Evidence: Level IV-Retrospective Case Series PMID:25114415

Abtahi, Amir M.; Granger, Erin K.; Tashjian, Robert Z.

2014-01-01

433

Bird fancier's lung complicated by pulmonary nocardiosis *,**  

PubMed Central

We report the case of an 84-year-old male who was admitted to the hospital with persistent cough and dyspnea. An initial chest X-ray revealed pulmonary infiltrates. Nocardia asteroides was detected in sputum, and the patient was treated with antibiotics. However, his symptoms did not completely resolve. He was admitted multiple times, and his symptoms relapsed after every discharge. He was finally suspected of having hypersensitivity pneumonitis and was diagnosed with bird fancier's lung. Pulmonary nocardiosis is likely to develop in patients with chronic pulmonary disorders, such as COPD, as well as in immunosuppressed hosts. To our knowledge, this is the first report of a case of bird fancier's lung complicated by pulmonary nocardiosis. PMID:23503493

Komiya, Kosaku; Ishii, Hiroshi; Tsubone, Tetsuo; Okabe, Eiji; Matsumoto, Bunroku; Kadota, Jun-ichi

2013-01-01

434

Imaging of hidradenitis suppurativa and its complications.  

PubMed

We present a 56-year-old man with known diabetes mellitus and a 10-year history of hidradenitis suppurativa (HS) and highlight, through MR imaging findings, the relentless natural progression of the disease, characterized by recurrent exacerbations of abscesses and fistulae and complications of perianal fistulae and sacral osteomyelitis. We also demonstrate the appearance of this condition on PET-CT with F-18 FDG, which was performed for staging after postexcision tissue specimen revealed well-differentiated squamous cell carcinoma. The association of arthritis and possible dactylitis was also manifested in our patient. Discussion of HS in the radiology literature is limited and, to our knowledge, there has been no case report describing these imaging findings in the same patient. PMID:25221681

Poh, Feng; Wong, Siew Kune

2014-01-01

435

Imaging of Hidradenitis Suppurativa and Its Complications  

PubMed Central

We present a 56-year-old man with known diabetes mellitus and a 10-year history of hidradenitis suppurativa (HS) and highlight, through MR imaging findings, the relentless natural progression of the disease, characterized by recurrent exacerbations of abscesses and fistulae and complications of perianal fistulae and sacral osteomyelitis. We also demonstrate the appearance of this condition on PET-CT with F-18 FDG, which was performed for staging after postexcision tissue specimen revealed well-differentiated squamous cell carcinoma. The association of arthritis and possible dactylitis was also manifested in our patient. Discussion of HS in the radiology literature is limited and, to our knowledge, there has been no case report describing these imaging findings in the same patient.

2014-01-01

436

Cavitary alveolar sarcoidosis complicated by an aspergilloma.  

PubMed

Cavitation in pulmonary sarcoidosis is rather unusual and even rarer in the alveolar form of the disease. A review of the literature revealed only 13 documented patients with cavitating alveolar sarcoidosis. Of the 13 patients, clinical information was available in only eight cases. Aspergilloma complicating cavitary alveolar sarcoidosis has been documented only once before. A 38-year-old woman with progressive dyspnoea for 3?years presented owing to a bout of haemoptysis. Imaging prior to presentation demonstrated mediastinal lymphadenopathy and coalescent parenchymal alveolar opacities along with air bronchograms, suggestive of alveolar sarcoidosis. On presentation, cavitations were visible in both lungs within the consolidation along with an intracavitary mass in the left upper lobe, which on evaluation was recognised as an aspergilloma. Bronchoscopy disclosed non-caseating granulomas on histopathology confirming pulmonary sarcoidosis. Cavitary alveolar sarcoidosis with aspergilloma formation can result in a diagnostic dilemma, especially in endemic tuberculous areas. PMID:25326564

Gera, Kamal; Panjabi, Chandramani; Dash, Devijyoti; Shah, Ashok

2014-01-01

437

Steroids: Pharmacology, Complications, and Practice Delivery Issues  

PubMed Central

Background Since their identification nearly 80 years ago, steroids have played a prominent role in the treatment of many disease states. Many of the clinical roles of steroids are related to their potent antiinflammatory and immune-modulating properties. Methods This review summarizes the basic pharmacology, complications, and practice delivery issues regarding steroids. Results Clinically relevant side effects of steroids are common and problematic. Side effects can occur at a wide range of doses and vary depending on the route of administration. The full spectrum of side ef