Complication Of Use Research Articles

Pulmonary Artery Rupture After Attempted Removal of a Pulmonary Artery Catheter

Pulmonary Artery Rupture After Attempted Removal of a Pulmonary Artery Catheter

The rectal trumpet: Use of a nasopharyngeal airway to contain fecal incontinence in critically ill patients

Objective: Our objective was to determine if a nasopharyngeal airway (rectal trumpet) could be used as a fecal containment device with less trauma than traditional devices, such as a fecal incontinence pouch or balloon rectal catheter. Design: A single-subject clinical series was used. Setting and Subjects: A nonrandom sample of critically ill adult and geriatric patients (n = 22) with ongoing fecal incontinence who were receiving care in an intensive care and intermediate care unit in a university teaching hospital was used. Instruments: Direct observation, medical record review, a questionnaire, and interviews were used. Methods: The bedside nurses identified patients as study candidates. Clinical findings were documented in the medical record. The nurses providing patient care completed questionnaires. Main Outcome Measures: Main outcome measures were parameters related to efficacy, practicality, and complications of use of the rectal trumpet: stool containment, skin and anal sphincter integrity, patient comfort, and ease of insertion. Results: All 22 patients (100%) had containment or improved containment of stool. Observable healing or restoration of skin integrity occurred in 90% of the patients with acquired skin injury (n = 20). None of the patients suffered any change in tone or damage to the anal sphincter. Although 41% of the patients experienced discomfort with insertion of the rectal trumpet, 86% had no discomfort while it was maintained in position. Insertion of the rectal trumpet was rated as easy by 84% of the responding nurses (n = 63). Conclusions: Use of a rectal trumpet was well tolerated by patients and practical for nurses. Incontinence was contained and no untoward effects were noted. Benefits to the patient included wound healing and improved comfort. (J WOCN 2002;29:193-201.)

Acetabular revision after failed total hip arthroplasty in patients with congenital hip dislocation and dysplasia. Results after a mean of 8.6 years.

Revision of a total hip arthroplasty in a patient who has had congenital hip dysplasia or dislocation is often more difficult than a standard revision operation. The purpose of this study was to assess the efficacy and complications of use of a cementless hemispherical acetabular component for revision of an acetabular component of a failed total hip replacement in patients whose initial problem was arthritis secondary to congenital dislocation or dysplasia. The mean duration of follow-up was approximately eight years. We reviewed a consecutive series of sixty-one hips in fifty-three patients who underwent a cementless acetabular revision with use of a hemispherical acetabular component, with or without concurrent femoral revision. Data were collected prospectively. The mean age of the patients at the time of the index operation was fifty-six years. A mean of 1.9 ipsilateral hip operations had been performed previously. Thirty-nine hips (64 percent) had a so-called high hip center prior to the index revision. With one exception, the uncemented acetabular component was fixed with screws. Fifty-one acetabular components were placed with so-called line-to-line fit, and ten were oversized by one to three millimeters. In thirty-eight hips, the femoral component was revised as well. Twenty-nine femora were reconstructed with use of a cemented device, and nine were revised with an uncemented patch-porous-coated femoral stem (a stem on which the porous coating appears in patches). Four patients (five hips) died prior to the five-year minimum follow-up interval. With the exception of one hip treated with resection arthroplasty because of deep infection, none of the hips in these deceased patients had been revised or had a loose component. One living patient (one hip) had a resection arthroplasty, and one additional patient (two hips) had both stable acetabular components rerevised at the time of femoral rerevision at another institution because of loosening and osteolysis. One patient refused to return for follow-up, but the components had not been revised. The remaining fifty-two hips in forty-six patients were followed for a mean of 8.6 years (range, 5.0 to 12.7 years). The mean Harris hip score was 80 points (range, 56 to 100 points) at the time of the latest follow-up. No acetabular component had been revised, although two had migrated. No other acetabular component was loose according to our radiographic criteria. Thus, the mechanical failure rate on the acetabular side was 3 percent (two of sixty-one) for the entire series and 4 percent (two of fifty-two) for the patients who had been followed for a mean of 8.6 years. On the femoral side, the mechanical failure rate was 3 percent (one of twenty-nine) for the cemented stems and six of nine for the uncemented patch-porous-coated stems. Of the approaches used in this difficult series of patients requiring revision, the hybrid arthroplasty (a cementless acetabular component and a cemented femoral component) yielded overall good results after an intermediate duration of follow-up.

Torsades de pointes secondary to intravenous haloperidol after coronary bypass grafting surgery

Postoperative delirium occurs in about 2% of patients undergoing major cardiac surgery including coronary artery bypass grafting surgery (CABG). Haloperidol (Sabex, Boucherville, Canada) is a drug commonly used in the intensive care unit for the treatment of delirium and is usually considered safe even at high doses and is rarely implicated in the development of malignant ventricular arrhythmias such as torsades de pointes. The purpose of this study is to report such a complication of use of haloperidol after myocardial revascularization. The patient reported underwent uneventful triple bypass surgery. Administration of large intravenous doses of haloperidol was necessary for control of psychomotor agitation due to delirium. Torsades de pointes occurred in the absence of QT prolongation on the third postoperative day following use of the drug with no other obvious etiological factor. Awareness of this rare complication is key to judicious use of this drug in the post CABG patient in whom such an arrhythmia may have very deleterious consequences because of the underlying cardiac condition.

Safety of sublaminar wires with Isola instrumentation for the treatment of idiopathic scoliosis.

To investigate the incidence of acute neurologic complications of use of sublaminar wires with third-generation spine instrumentation for the treatment of idiopathic scoliosis. To assess the safety of sublaminar wires in the surgical treatment of idiopathic scoliosis. The use of sublaminar wires in spine deformity for neuromuscular scoliosis and the Luque system has been reported. Use of sublaminar wires is an integral part of the technique in the surgical treatment of spine deformity with Isola instrumentation (AcroMed, Cleveland, OH). To date, the safety of this technique has not been documented. The average age of the patients was 37 years (range, 11-74 years). Preoperative diagnosis was adolescent idiopathic scoliosis in 75 patients and adult idiopathic scoliosis in 66. One hundred nine were primary surgeries, and 32 were revision. Detailed evaluation of the curve type, curve magnitude, number of vertebrae instrumented, level of vertebrae wired, postoperative neurologic deficit, and the findings of intraoperative spinal cord monitoring was performed. Wires were always passed just before corrective maneuvers were performed. A total of 1366 wires were placed, 65% (n = 888) in the thoracic region, 22% (n = 300) in the thoracolumbar, and 13% (n = 178) in the lumbar. No permanent change in intraoperative spinal cord monitoring was detected. Stagnara wake-up test was performed in all patients. No patient with adolescent idiopathic scoliosis had neurologic complication. Two adults underwent revision surgery and had transient dysesthesia in the leg, which completely resolved with observation. Despite the increasing complexity of spinal instrumentation systems, sublaminar wire placement is a safe and useful adjunct in the surgical treatment of neurologically intact patients with idiopathic scoliosis.

Complications of use of intrauterine devices among HIV-1-infected women

A WHO expert group and the International Planned Parenthood Federation recommend against use of intrauterine devices (IUDs) in HIV-1-infected women based on theoretical concerns about pelvic infection and increased blood loss. We investigated whether the risk of complications after IUD insertion is higher in HIV-1-infected women than in non-infected women. 649 (156 HIV-1 infected 493 non-infected) women in Nairobi, Kenya, who requested and met local eligibility criteria for insertion of an IUD were enrolled. We gathered information on IUD-related complications, including pelvic inflammatory disease, removals due to infection, pain, or bleeding, expulsions, and pregnancies at 1 and 4 months after insertion. Patients' HIV-1 status was masked from physicians. Complications were identified in 48 of 615 women (11 [7.6%] HIV-1-infected women, 37 [7.9%] non-infected). Incident pelvic inflammatory disease (two [1.4%] HIV-1 infected, one [0.2%] non-infected) and infection-related complications (any tenderness, removal of IUD for infection or pain; ten [6.9%] HIV-1 infected, 27 [5.7%] non-infected) were also rare and similar in the two groups. Complication rates were similar by CD4 (immune) status. Multivariate analyses suggested no association between HIV-1 infection and increased risks for overall complications (odds ratio 0.8 [95% CI 0.4-1.7]) or infection-related complications (1.0 [0.5-2.3]), adjusted for marital status, study site, previous IUD use, ethnic origin, and frequency of sexual intercourse, but a slight increase cannot be ruled out. Our data suggest that IUDs may be a safe contraceptive method for appropriately selected HIV-1-infected women with continuing access to medical services.

A primer on continuous renal replacement therapy for critically ill patients.

To characterize the multiple continuous renal replacement therapy (CRRT) techniques available for the management of critically ill adults, and to review the indications for and complications of use, principles of drug removal during CRRT, drug dosage individualization guidelines, and the influence of CRRT on patient outcomes. MEDLINE (January 1981-December 1996) was searched for appropriate publications by using terms such as hemofiltration, ultrafiltration, hemodialysis, hemodiafiltration, medications, and pharmacokinetics; selected articles were cross-referenced. References selected were those considered to enhance the reader's knowledge of the principles of CRRT, and to provide adequate therapies on drug disposition. CRRTs use filtration/convection and in some cases diffusion to treat hemodynamically unstable patients with fluid overload and/or acute renal failure. Recent data suggest that positive outcomes may also be attained in patients with other medical conditions such as septic shock, multiple organ dysfunction syndrome, and hepatic failure. Age, ventilator support, inotropic support, reduced urine volume, and elevated serum bilirubin concentrations have been associated with poor outcomes. Complications associated with CRRT include bleeding due to excessive anticoagulation and line disconnections, fluid and electrolyte imbalance, and filter and venous clotting. CRRT can complicate the medication regimens of patients for whom it is important to maintain drug plasma concentrations within a narrow therapeutic range. Since the physicochemical characteristics of a drug and procedure-specific factors can alter drug removal, a thorough assessment of all factors needs to be considered before dosage regimens are revised. In addition, an algorithm for drug dosing considerations based on drug and CRRT characteristics, as well as standard pharmacokinetic equations, is proposed. The use of CRRT has expanded to encompass the treatment of disease states other than just acute renal failure. Since there is great variability among treatment centers, it is premature to conclude that there is enhanced survival in CRRT-treated patients compared with those who received conventional hemodialysis. This primer may help clinicians understand the need to individualize these therapies and to prospectively optimize the pharmacotherapy of their patients receiving CRRT.

Complications of use of the Ilizarov technique in the correction of limb deformities in children.

We reviewed the records of the first forty patients who had been managed at our institution with the Ilizarov technique for the correction of limb deformities, including limb-length inequality, to delineate the complications of this method of treatment. The duration of follow-up ranged from two and one-half to four years. A complication was defined as any untoward occurrence to a patient either during the course of treatment or after removal of the fixator. A major complication was considered one that necessitated an additional operative procedure; caused lasting sequelae, such as malunion, deformation of new bone, joint contracture or stiffness, or nerve palsy; or prolonged the treatment. A minor complication was regarded as one that responded to non-operative treatment and did not cause lasting sequelae, such as transient decreased motion of the joint, paresthesia, or pin-track infection. There were eighty-eight complications--thirty-eight, major, and the remaining fifty, minor--in the sixty-one segments of the limb that were treated; this represented an average of almost one and one-half complications for each segment. Twenty-nine unplanned operative procedures were performed either during treatment with the Ilizarov technique or after removal of the fixator. As anticipated, the prevalence of major complications was highest in the patients who had had more complex and prolonged treatment. Such complications were encountered less often as the surgeons gained experience with the procedure, but the rate of minor complications remained relatively constant, despite the increased experience.(ABSTRACT TRUNCATED AT 250 WORDS)

Complications of use of carbon fibre in the temporomandibular joint: a case report

The aetiology of recurrent temporomandibular joint dislocation is numerous. A case is described of frequent dislocation which was finally treated using a carbon fibre sling. However this was removed 3 years later due to the presence of a radiolucency in the head of the condyle. Radiographic and photographic appearances of this carbon fibre induced radiolucency are shown.

Unusual complication of use of a Hertel exophthalmometer in a patient with Graves' ophthalmopathy.

Unusual complication of use of a Hertel exophthalmometer in a patient with Graves' ophthalmopathy.

Cocaine

This article discusses cocaine as America's leading illicit drug of abuse. Cocaine pharmacology, metabolism, and methods of administration are related to medical symptoms and complications of use. Reasons for increased use as well as signs suggestive of individual abuse are given, and treatment issues specific to cocaine are discussed. Urine testing for cocaine and other abused drugs is encouraged, and specific reliable techniques are suggested.

Complications of use of the neodymium

Complications of use of the neodymium

Complications of Use of the Neodymium:Yttrium-Aluminum-Garnet Laser in Neurosurgery

Review of the clinical records of 32 patients who underwent operation for brain tumors with the use of the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser during a 4-month period revealed 5 cases of complications related to laser use. One death was presumed to be due to intratumor explosion (the popcorn effect) after excessive Nd:YAG laser application. The other death was due to heat necrosis of the brain stem after radiation of an ependymoma of the 4th ventricle. Two patients suffered neurological deficits. One had facial palsy after radiation of the site of attachment of a meningioma to the petrous bone. The other suffered aphasia and hemiparesis due to heat damage to the cerebral cortex after laser coagulation of the overlying dura mater. The fifth patient suffered postoperative hemorrhage in a residual necrotic chromophobe adenoma after a transsphenoidal approach using the Nd:YAG laser. These complications are preventable. Suggestions are made for the safe use of this laser.

Acute Cardiomyopathy Secondary to Intravenous Amphetamine Abuse

Brief Reports1 October 1982Acute Cardiomyopathy Secondary to Intravenous Amphetamine AbuseTHOMAS D. CALL, M.D., JOSEPH HARTNECK, M.D., W. ANDREW DICKINSON, M.D., CLARK W. HARTMAN, M.D., ALAN G. BARTEL, M.D.THOMAS D. CALL, M.D.Search for more papers by this author, JOSEPH HARTNECK, M.D.Search for more papers by this author, W. ANDREW DICKINSON, M.D.Search for more papers by this author, CLARK W. HARTMAN, M.D.Search for more papers by this author, ALAN G. BARTEL, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-97-4-559 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIntravenous drug abuse can cause serious medical problems. Endocarditis and noncardiac pulmonary edema are the main cardiopulmonary complications of use of intravenous street drugs (1, 2). Previous reports have not shown any consistent direct myocardial complications secondary to use of these drugs (3). We report a case of a woman who developed acute cardiomyopathy with myocardial dysfunction and pulmonary edema immediately after intravenous amphetamine abuse. Possible causes for this severe cardiac abnormality, as well as its clinical importance, are discussed.A 22-year-old white woman presented to the energency room 10 hours after intravenous amphetamine use with chest pain and shortness...

Bronchial Rupture, A Complication of Use of the Robertshaw Double-lumen Tube

Bronchial Rupture, A Complication of Use of the Robertshaw Double-lumen Tube

Letter: Unusual complication of use of Sengstaken-Blakemore tube.

Letter: Unusual complication of use of Sengstaken-Blakemore tube.

Complications in use of soft contact lenses in corneal disease.

Two hundred seventy-eight patients with corneal disease were fitted with soft hydrophilic contact lens for therapeutic purposes, such as comfort, protection, or healing. In about half the number of cases, the lens was felt to be beneficial, primarily in those cases with edema, dry eyes, ulcers, or trichiasis. Serious complications were relatively few, mainly consisting of inflammation with stromal infiltrates. Eleven patients develped stromal infiltrates, at least four of which were definite infections, causing permanent damage. It was concluded, however, that in many cases of corneal disease the advantages of applying a soft contact lens far outweighs its risks. The importance of frequent observation and prophylactic antibiotics is stressed in cases with epithelial defect and in dry eyes.

Engagement of ventricular myocardium by struts of mitral prosthesis: Fatal complication of use of open-cage cardiac valves

Engagement of ventricular myocardium by struts of mitral prosthesis: Fatal complication of use of open-cage cardiac valves

Complications in Use of Temporary Intracranial Arterial Clip

Complications in Use of Temporary Intracranial Arterial Clip

ACUTE URINARY SUPPRESSION FOLLOWING SULFADIAZINE THERAPY

Acute urinary suppression following the administration of sulfadiazine is rare but is a severe complication of use of the drug. The attendant development of uremia may lead to a fatal termination if urinary drainage is not reestablished immediately. In a review of recent literature, urinary suppression from sulfadiazine has been reported but once. 1 Renal colic and both gross and microscopic hematuria have been mentioned not infrequently following its use. 2 So far, no cases of anuria following the administration of sulfanilamide have been reported. The following is a report of a case in which acute urinary suppression developed following average doses of sulfadiazine: L. E., a white man aged 26, single, American, a night club operator, entered the surgical service Feb. 23, 1942 for removal of an orbital tumor on the left side. General physical examination was not remarkable. The blood pressure was 120 systolic and 80 diastolic. There