Complications In Young Patients Research Articles

Risk of Microvascular Complications and Macrovascular Risk Factors in Early-Onset Type 1 Diabetes after at Least 10 Years Duration: An Analysis of Three Population-Based Cross-Sectional Surveys in Germany between 2009 and 2016.

Aims To estimate the risk of microvascular complications and macrovascular risk factors among persons with early-onset (diagnosed at ages 0 to <5 years) and long-duration type 1 diabetes and determine temporal trends and associations with potential predictors. Methods We conducted three population-based cross-sectional surveys in Germany (N = 1789) to obtain information on exposures and five outcomes (retinopathy, nephropathy, dyslipidemia, hypertension, and a composite endpoint combining all four outcomes). For each outcome, log-binomial spline regression was applied to estimate the risk and dose-response relationship with diabetes duration and exposures. Results The risk for microvascular complications increased after 14 years since diabetes diagnosis whereas dyslipidemia and hypertension were already prevalent at 10 years. The 15-year risk (95% confidence interval) of the composite endpoint for female and male patients was 22.9% (18.8%–27.9%) and 19.2% (15.5%–23.8%), respectively. Temporal trends suggested a decreasing risk between 2009 and 2016. Glycemic control, lifestyle-related factors, and SES, but not health care-related factors, were associated with the risk of the composite endpoint. Conclusions In early-onset type 1 diabetes, there exists a considerable risk of complications and comorbidities already in young ages. Future research should focus on prevention of diabetic complications in young patients and clarification of pathways of the associations found.

Association of Co-Morbidity and Treatment with the Complications of Acute Coronary Syndrome in Young Patients Less Than 45 Years.

Approximately 5%-10% of acute coronary syndrome (ACS) cases occur in people younger than 45 years of age. This study aimed to identify complications of ACS and the associated factors in young patients. In this cross-sectional study, data from 147 ACS patients aged less than 45 years were analysed. The mean age was 39.1 (4.9) years, the male to female ratio was 3:1; 21.2% of patients presented with unstable angina, 58.5% had non-ST elevation myocardial infarction and 20.4% had ST elevation myocardial infarction. The most frequent risk factor of ACS was dyslipidaemia (65.3%), followed by hypertension (43.5%). In total, 49.7% of patients had inpatient complication(s), with the most common being heart failure (35.4%), followed by arrhythmia (20.4%). The significant factors associated with ACS complications were current smoking [adjusted odds ratio (AOR) 4.03; 95% confidence interval (CI): 1.33, 12.23; P-value = 0.014], diabetic mellitus [AOR 3.03; 95% CI: 1.19, 7.71; P-value = 0.020], treatments of fondaparinux [AOR 0.18; 95% CI: 0.08, 0.39; P-value < 0.001] and oral nitrates [AOR 0.18; 95% CI: 0.08, 0.42; P-value < 0.001]. Smoking status and diabetes mellitus were modifiable risk factors while pharmacological treatment was an important protective factor for ACS complications in young patients.

Retinal vascular imaging technology to monitor disease severity and complications in type 1 diabetes mellitus: Asystematic review.

Type 1 diabetes mellitus (T1DM) is a major disease affecting a large number of young patients. In the recent years, retinal vascular imaging has provided an objective assessment of vascular health in patients with T1DM. Our study aimed to review the current literature on retinal vascular parameters in young patients with T1DM in order to understand the following: (i) How retinal vessels are affected in T1DM (ii) How such vascular changes can be predictive of future diabetic microvascular complications METHODS: We performed a systematic review and extracted relevant data from 17 articles. We found significant correlations between retinal vessel changes and diabetes-related risk factors (eg, hypertension, hyperlipidemia, and obesity), diabetes-related features (eg, diabetes duration and glycemic control), and diabetes-related microvascular complications (eg, diabetic retinopathy, nephropathy, and neuropathy). Our findings suggest that retinal microvasculature is associated with both disease severity and complications in young patients with T1DM.

Complications of skull reconstruction after decompressive craniectomy

Introduction: Decompressive craniectomy can be a life-saving procedure. Later reconstruction of the skull using the stored bone flap ("cranioplasty") is often associated with complications. These complications require new procedures and often result in the reconstruction of the skull using an expensive patient-specific cranial implant.Patients & methods: All adult patients who underwent cranioplasty after decompressive craniectomy in the last 10 years in our center were included (74 patients). Bone flap size, duration of the procedure, age, and other clinical parameters were included in our analysis.Results: 29.7% of our patients who received in the first place an autologous cranioplasty developed a complication which necessitated removal of the bone flap and the implantation of a custom-made implant. Descriptive statistics demonstrate a significantly higher amount of complications in younger patients (20–40 years, p = 0.027). We also saw a trend toward lower complications when bone flaps were stored according to a biobank protocol (p = 0.075).Conclusions: Cranioplasty using the stored bone flap after decompressive craniectomy is associated with a high percentage of complications. Selecting patients at risk could possibly indicate cases where an immediate custom-made implant technique would be required.

Raised preoperative international normalised ratio (INR) identifies patients at high risk of perioperative death after simultaneous renal and cardiac surgery for tumours involving the peri-diaphragmatic inferior vena cava and right atrium.

To identify preoperative factors that predict 30-day mortality in patients undergoing simultaneous cardiac and renal surgery for urological tumours involving the peri-diaphragmatic vena cava and right atrium- The ability to predict mortality and therefore avoid surgery in those patients likely to die would be valuable. We retrospectively reviewed perioperative outcomes in patients managed between December 2007 and January 2016 by a single team. The relationships of outcome measurements were analysed using Fisher's exact and Mann-Whitney U-tests. Of the 46 patients identified, 41 (89%) underwent surgery (20 males and 21 females). The median (range) age was 65 (17-95) years. Histology confirmed 37 renal cell cancers, one adrenal cancer, two primitive neuroectodermal tumours, and one leiomyosarcoma. The overall 30-day mortality rate was 7% (three of 41 patients). The international normalised ratio (INR), age, and estimated glomerular filtration rate (eGFR) correlated significantly with 30-day mortality. The mortality rate was high in patients with an INR ≥1.5 and <1.5 (with three of the five patients dying) compared to those with an INR <1.5 (0/36 patients died; 30 day mortality 0%). The INR correlated with serious complications (≥Clavien-Dindo Grade III), which occurred in all five patients with an INR ≥1.5 and <1.5 vs 12/36 (33%) with an INR <1.5 (P < 0.002). The median (range) eGFR in those that died was 36 (26-37) mL/min/1.73 m2 compared to 52 (24-154) mL/min/1.73 m2 in those that survived (P = 0.018). In patients undergoing combined cardiac and renal tumour surgery raised preoperative INR is associated with a high risk of 30-day mortality when the patient is elderly (>70 years) and of significant post-operative complications in younger patients (<70 years). Surgery in patients with a normal INR is challenging but much safer.

Postoperative Complications in Pediatric Tonsillectomy and Adenoidectomy in Ambulatory vs Inpatient Settings.

A large-scale review is needed to characterize the rates of airway, respiratory, and cardiovascular complications after pediatric tonsillectomy and adenoidectomy (T&A) for inpatient and ambulatory cohorts. To identify risk factors for postoperative complications stratified by age and operative facility type among children undergoing T&A. This retrospective review included 115,214 children undergoing T&A in hospitals, hospital-based facilities (HBF), and free-standing facilities (FSF) in California from January 1, 2005, to December 31, 2010. The analysis used the State of California Office of Statewide Health Planning and Development private inpatient data and Emergency Department and Ambulatory Surgery public data. Inpatient (n = 18,622) and ambulatory (n = 96,592) cohorts were identified by codes from the International Classification of Diseases, Ninth Revision, and Current Procedural Terminology. Data were collected from September 2011 to March 2012 and analyzed from March through May 2012. Rates of airway, respiratory, and cardiovascular complications. A total of 18,622 inpatients (51% male; 49% female; mean age, 5.4 [range, 0-17] years) and 96,592 ambulatory patients (37% male; 35% female; 28%, masked; mean age, 7.6 [range, 0-17] years) underwent analysis. The ratio of ambulatory to inpatient procedures was 5:1. Inpatients demonstrated more comorbidities (≤8, compared with ≤4 for HBF and ≤3 for FSF patients) and, in general, their complication rates were 2 to 5 times higher (seen in 1% to 12% of patients) than those in HBFs (0.2% to 5%), and more than 10 times higher than those in the FSFs (0% to 0.38%), with rates varying markedly by age range and facility type. Tonsillectomy and adenoidectomy was associated with increased risk for all complication types in both settings, reaching an odds ratio of 8.5 (95% CI, 6.6-11.1) for respiratory complications in the ambulatory setting. Inpatients aged 0 to 9 years experienced higher rates of airway and respiratory complications, peaking at an odds ratio of 7.5 (95% CI, 3.1-18.2) for airway complications in the group aged 0 to 11 months. Large numbers of pediatric patients undergo T&A in ambulatory settings despite higher rates of complications in younger patients and patients with more comorbidities. Fortunately, a high percentage of these patients has been appropriately triaged to the inpatient setting. Further research is needed to elucidate the subgroups that warrant postoperative hospitalization.

Association of Chronic Constipation With Gastrointestinal Complications in Younger Patients

Association of Chronic Constipation With Gastrointestinal Complications in Younger Patients

Features of mitral valve prolapse in young patients

Due to the significant increase of complications in young patients with mitral valve prolapse detection of this disease is important.Aim. With the aim of studying the features of mitral valve prolapse 135 persons with mitral valve prolapse at the age of 18–25 years were examined.Methods and results. The features of mitral valve prolapsed were studied with echocardiography, electrocardiography, cardiointervalography. It was established that mitral valve prolapse (MVP) in young age had different clinical picture. Patients with MVP 1 degree mainly had autonomic instability, and with 2 degree - mostly signs of connective tissue dysplasia.Conclusion. The presence of MVP is associated with abnormalities of the rhythm and conductivity: 1 degree - sinus tachycardia; the 2nd - sinus arrhythmia, signs of left ventricular hypertrophy and impaired repolarization of the myocardium.

A Randomized Controlled Trial of Crown Therapy in Young Individuals with Amelogenesis Imperfecta

Amelogenesis imperfecta (AI) is a rare, genetically determined defect in enamel mineralization. Existing treatment recommendations suggest resin-composite restorations until adulthood, although such restorations have a limited longevity. New crown materials allow for minimal preparation techniques. The aim of this study was to compare the quality and longevity of 2 crown types—Procera and IPS e.max Press—in adolescents and young adults with AI. A secondary aim was to document adverse events. We included 27 patients (11 to 22 y of age) with AI in need of crown therapy in a randomized controlled trial using a split-mouth technique. After placing 119 Procera crowns and 108 IPS e.max Press crowns following randomization, we recorded longevity, quality, adverse events, and tooth sensitivity. After 2 y, 97% of the crowns in both crown groups had excellent or acceptable quality. We found no significant differences in quality between Procera and IPS e.max Press crowns. Tooth sensitivity was significantly reduced after crown therapy (P < 0.001). Endodontic complications occurred in 3% of crowns. The results show that it is possible to perform crown therapy with excellent results and without severe complications in young patients with AI. The study is registered at http://www.controlled-trials.com (ISRCTN70438627).

Oxidized Low-Density Lipoprotein and Adhesion Molecules as a Marker of Macro-and Micro-Vascular Complications in Young Patients with Type 1 Diabetes

Oxidized Low-Density Lipoprotein and Adhesion Molecules as a Marker of Macro-and Micro-Vascular Complications in Young Patients with Type 1 Diabetes

Reverse shoulder arthroplasty as salvage for failed prior arthroplasty in patients 65 years of age or younger

This study examined outcomes and complications in young patients undergoing revision reverse total shoulder arthroplasty (RTSA) for failed prior total shoulder arthroplasty or hemiarthroplasty and compared them with those of an age-matched cohort undergoing primary RTSA. RTSA as a revision for failed shoulder arthroplasty was performed on 36 patients younger than 65 years. Follow-up was available for 32 patients at an average of 55.3 months. Results were compared with those of an age-matched cohort of 37 patients (33 available for follow-up; average, 54.7 months) undergoing primary RTSA. Average age for both groups was 59.3 years. Outcomes were compared before and after revision surgery and between cohorts. Preoperative visual analog scale (VAS) for pain and subjective shoulder value (SSV) scores were similar in both groups, 7.3 of 10 and 24%, respectively, before revision, and 7.0 of 10 and 19% before primary RTSA (P = .3). Postrevision VAS and SSV scores improved to 1.4 of 10 and 60% (P < .0001). Average American Shoulder and Elbow Surgeons and Simple Shoulder Test scores after revision were 69.7 and 58.8, with 9 complications (28.1%; 6 major and 3 minor). VAS and SSV scores improved to 2.1 of 10 and 76% after primary RTSA (P < .0001). American Shoulder and Elbow Surgeons and Simple Shoulder Test scores after primary RTSA were 74 and 67.3, with 6 complications (18.2%; 5 major and 1 minor). Only the postoperative SSV score was statistically different in comparing primary and revision RTSA (P < .05). RTSA is effective in reducing pain and improving function after failed arthroplasty in young patients, but complication rates are high and expectations should be managed appropriately. Subjective outcome scores are worse than those for age-matched patients undergoing primary RTSA, but pain, functional scores, and complication rates are similar.

Laparoscopic versus open liver resection for elderly patients with malignant liver tumors: A single‐center experience

Laparoscopic liver resection is associated with less perioperative blood loss, shorter hospital stay, and fewer postoperative complications in younger patients. However, it remains unclear if these short-term benefits could also be applicable to elderly patients with medical comorbidities. To evaluate the perioperative outcomes of laparoscopic liver resection in patients with advanced age. Patients aged ≥ 70 years old who received liver resections for malignant liver tumors between January 2002 and December 2012 were included. The perioperative outcomes of 17 patients with laparoscopic approach were matched and compared with 34 patients with conventional open approach in a 1:2 ratio. There was no significant difference with regard to age, gender, incidence of comorbid illness, hepatitis B positivity, and Child grading of liver function. The median tumor size was 3 cm for both groups. The types of liver resection were similar between the two groups with no significant difference in the duration of operation (laparoscopic: 195 min vs open: 210 min, P = 0.436). The perioperative blood loss was 150 mL in the laparoscopic group and 330 mL in the open group (P = 0.046) with no significant difference in the number of patients with blood transfusion. The duration of hospital stay was 6 days (3-15 days) for the laparoscopic group and 8 days (5-105 days) for the open group (P = 0.005). Laparoscopic liver resection is safe and feasible for elderly patients. The short-term benefits of laparoscopic approach continued to be evident for geriatric oncological liver surgery.

Symptomatic Thromboembolism as an Uncommon Postoperative Complication in Young Patients with Spinal Deformity

Background/PurposeThromboembolism continues to be one of the most appalling postoperative complications. We aim to extend the findings of earlier authors on clinically symptomatic thromboembolic complications in young patients (<30 years old) operated due to major spinal deformity. MethodsWe retrospectively studied 297 patients (98 males and 199 females), with a mean age of 17.8 ± 4.2 years (range, 1.8–29.8 years) and a mean follow-up period of 12.3 ± 5.9 months (range, 6–84 months), who had been operated due to major spinal deformity from August 2005 to December 2012. A complete clinical examination was performed in all patients throughout the postoperative period to find out any symptomatic thromboembolism. ResultsWe found three (1.01%) and two (0.67%) cases with symptomatic thromboembolism and extensive pulmonary embolism, respectively. All of them had a positive history of anterior spine surgery, and one of them had been placed in a poor posture for a long time to improve the inflammation of a surgical wound. ConclusionDespite the rarity of thromboembolism after surgery for major spinal deformities in young patients, the possibility still exists, and patients with a positive history of anterior spinal surgery or poor posturing are probably more susceptible.

Thoracoscopic vs Open Lobectomy in Infants and Young Children with Congenital Lung Malformations

Although thoracoscopic lobectomy is a widely accepted surgical procedure in adult thoracic surgery, its role in small children remains controversial. The purpose of this study was to evaluate perioperative outcomes after thoracoscopic and open lobectomy in infants and young children with congenital lung malformations at a single academic referral center. A cohort study of 62 consecutive children who underwent elective pulmonary lobectomy for a congenital lung lesion between 2001 and 2013 was performed. Patient demographics and perioperative outcomes were evaluated in univariate and logistic regression analyses. Forty-nine patients underwent thoracoscopy and 13 had a thoracotomy. Six children undergoing thoracoscopy required conversion to thoracotomy (conversion 12.2%). Perioperative outcomes, including median blood loss (2.0 vs 1.1 mL/kg; p = 0.34), chest tube duration (3 vs 3 days; p = 0.33), hospital length of stay (3 vs 3 days; p = 0.42), and morbidity as defined by the Accordion Grading Scale (30.6% vs 30.8%; p = 0.73), were similar between thoracoscopy and thoracotomy, respectively. Although thoracoscopy was associated with increased operative duration compared with thoracotomy (239.9 vs 181.2 minutes, respectively; p = 0.03), thoracoscopy operative times decreased with increasing institutional experience (p = 0.048). Thoracoscopic lobectomy infants younger than 5 months of age had a 2.5-fold higher rate of perioperative adverse outcomes compared with older children (p = 0.048). In small children undergoing pulmonary lobectomy, both thoracoscopy and thoracotomy are associated with similar perioperative outcomes. The cosmetic and musculoskeletal benefits of the thoracoscopic approach must be balanced against institutional expertise and a potentially higher risk for complications in younger patients.

Clinical characteristics and treatment of 22 eyes of morning glory syndrome associated with persistent hyperplastic primary vitreous

PurposeTo describe the clinical manifestations and treatment outcomes in a retrospective case series of morning glory syndrome (MGS) associated with persistent hyperplastic primary vitreous (PHPV).MethodsThe medical records of 85 eyes/74...

Outcomes in the emergency endovascular repair of blunt thoracic aortic injuries

Thoracic aorta blunt injury (BAI) is a highly lethal lesion. A large number of victims die before obtaining emergency care. Thoracic endovascular aneurysm repair (TEVAR) is a less invasive method compared with open surgery and may change protocols for BAI treatment. This retrospective study was developed to evaluate the potential issues about thoracic endografting in the management of these patients. Twenty-seven patients with a BAI underwent aortic stent grafting. Intervention was preceded by the treatment of more urgent associated lesions in nine cases. In-hospital mortality was 7.4%. No paraplegia or ischemic complications developed because of the coverage of the left subclavian artery. In one case (3.2%), a type I endoleak was detected, proximal endograft infolding in two cases (7.4%) and endograft distal migration in further two cases were detected during follow-up (6-110 months). Thoracic endovascular aneurysm repair of BAI showed encouraging results in terms of perioperative mortality and morbidity. Concerns still remain about the potential mid- and long-term complications in younger patients.

Endothelial biomarkers as indicators of cardiovascular complications in young patients with arterial hypertension

This study evaluated nitric oxide (NO) and endothelin‐1 (ET‐1) as clinically relevant biomarkers in young patients with early arterial hypertension (AH). Male patients (n=65, 20–45 years of age) with AH duration &lt;6 years and blood pressure (BP) &lt;160/100 mm Hg were studied. A control group consisted of 32 age‐matched healthy subjects. Endothelium‐dependent vasodilation (EDVD) was evaluated by measuring post‐occlusion reactive hyperemia in the brachial artery. NO production was evaluated by plasma concentration and 24‐hour urinary excretion of nitrite + nitrate. Plasma concentration of ET‐1 was measured by immunoenzyme assay. The plasma NO/ET‐1 ratio was calculated. EDVD was 12.3% lower in patients with AH than in healthy subjects, and this decrease correlated with the duration of AH. The NO/ET‐1 ratio was significantly lower in the AH group (2.0±0.4 vs 6.2±0.6, p&lt;0.001), and the NO/ET‐1 ratio decreased with AH duration. NO/ET‐1 values below 3.0 were associated with atypical diurnal BP profile and cardiac arrhythmias. NO/ET‐1 values below 1.0 were associated with severe cardiovascular complications. Thus, the ratio of NO to ET‐1 appears to be a useful marker for cardiovascular complications in young patients with arterial hypertension.

Intracerebral hemorrhage in a case of antiphospholipid antibody syndrome

BACKGROUND AND PURPOSE: The patients with lupus anticoagulants may have an increased risk for the development of ischemic brain lesions and subdural hematoma in the presence of other known risk factors. There are lots of reports related to antiphospholipid syndrome with subdural hematoma, but intra-axial bleeding is a rare complication. CASE DESCRIPTION: We report a 37-year-old man with ptosis, central typed facial palsy, hemiparesis on the right side and motor aphasia. A CT scan and MRI showed a large cerebral hematoma located in the left fronto-parietal region and other foci of hemorrhage on the right hemisphere. Only persistently abnormal finding in laboratory studies was positive for antiphospholipid antibodies. Based on above findings we concluded that anti-phospholipid antibodies have resulted in intracerebral hemorrhage. CONCLUSION: In the present case, we report and point that hemorrhagic complication in young patients with antiphospholipid antibody syndrome associated with fragility of the vessels and/or platelet dysfunction is another and rare cause of intracerebral bleeding.

Anesthetic complications in pediatric patients undergoing cochlear implantation

Cochlear implantation (CI) is effective in the treatment of childhood sensorineural hearing loss and is associated with minimal surgical complications. We investigated the incidence of anesthetic complications in young patients undergoing general anesthesia for CI. Retrospective chart review. A retrospective chart review of 123 patients younger than 18 years, who underwent CI between 2007 and 2008, was conducted for identification of intra- and postoperative anesthesia-related complications. The relation of collected variable to the complication events was analyzed using logistic regression. Of the 123 CI procedures, eight patients had nine anesthesia-related complications, yielding a complication rate of 6.5% and included the following: postoperative wheezing/stridor (5 cases), laryngospasm (3 cases), and emesis during inhalational induction (1 case). Divided by age group, 12 patients were <12 months with one complication (8%), 18 patients were between 1 and 2 years with one complication (5.6%), 35 patients were between 2 and 5 years with one complication (3%), 39 patients were between 5 and 12 years with five complications (13%), and 19 patients were older than 12 years with no complication (0%). Logistic regression failed to identify a significant association of any collected variable(s) with the observed complications. The incidence of complications is similar to that previously reported in elderly patients (4.3%) (Pearson χ(2) , P = .523). General anesthesia is well tolerated by pediatric patients undergoing CI, even under 1 year of age. Significant perioperative complications are primarily respiratory, are usually free of long-term sequelae, and occur with an incidence similar to other reported age groups.

Clinical Characteristics of Acute Diverticulitis With Abscess in Japan

Data regarding the natural history of acute diverticulitis in young patients is conflicting. We undertook a systematic review and meta-analysis in order to find whether there are true differences in disease behavior and recurrence rates according to the patients' age. Prospective and retrospective comparative cohort studies were included. The outcomes assessed were: operation rates during hospitalization; complicated disease at admission; recurrence rates; and overall mortality. The cut-off age for the comparisons was 50 years. Relative risks (RR) with 95% confidence intervals are reported. Nineteen studies (17 of them retrospective) were included. The total number of participants was 28526. Diverticulitis affected more males in the younger group, compared to the elders (RR 1.51, 1.26-1.81). Prior episode or symptoms were not significantly different according to patients' age (RR 1.16, 0.78-1.73). Complicated disease did not take place more in any age group (RR 1.04, 0.69-1.59), however, analysis of the prospective cohorts only did show tendency towards more complications in young patients (RR 1.55, 0.95-2.52). There was no difference in the rate of surgeries during hospitalization (RR 0.95, 0.79-1.15). Overall mortality was significantly lower in young patients (RR 0.08, 0.04-0.14), and the recurrence rate of diverticulitis was significantly higher in this group (RR 1.44, 1.23-1.86). Within a mean follow-up period between 19.7 to 120 months, the recurrence rate in the young patients was 20.7% compared to 14.6% in the elders. Diverticulitis in young patients seems to be of the same severity as in elders, with lower mortality rates and higher probability of recurrent attacks.