Differences In Terms Of Complications Research Articles

Surgical management of non-epithelial ovarian malignancies: advantages and limitations of laparoscopy

ObjectiveTo compare open and laparoscopic surgery in the management of non-epithelial ovarian malignancies. Study designRetrospective study from University Hospital of Clermont-Ferrand, France, of 20 patients undergoing surgery for non-epithelial ovarian malignancies. We compared the outcome of 13 open surgeries and 7 laparoscopic surgeries. The main outcome measures were stage and size of the tumor, surgical procedure, hospital stay, adjuvant treatment, follow-up and fertility. ResultsThe mean age of the patients and the type of tumor at the time of diagnosis were similar in the two groups but the tumor size was significantly larger in the laparotomy group (14.0cm vs. 6.7cm; p<0.05). Treatment was conservative in 85.6% vs. 61.5% in the laparoscopy and laparotomy groups respectively. Tumor stages were not statistically different in the two groups. The hospital stay was shorter in the laparoscopy group (3.1 days vs. 6.9 days p=0.03) and there were no differences in terms of complications, surgical procedures, number of lymph nodes removed and adjuvant treatment. ConclusionsLaparoscopy respecting the usual oncologic principles appears to be a good alternative to laparotomy for the initial management of non-epithelial ovarian malignancies. The limiting factors of this technique remain the tumor size, the tumor stages and the surgeon's experience.

Comparative Analysis of ABO-Incompatible Living Donor Kidney Transplantation With ABO-Compatible Grafts: A Single-Center Experience in Korea

IntroductionSerious organ shortages have necessitated the use of ABO-incompatible (ABOi) kidneys transplantation, which has been increasingly preformed in Korea. However there are few detailed comparative data regarding patient and graft survival, graft function, and complications in Korean patients receiving ABO-compatible (ABOc) and ABOi kidney transplants (KT). MethodsThis retrospective study compared 35 consecutive ABOi living donor KTs with 138 ABOc living donor KTs using same immunosuppressive regimens. We examined preoperative demographic factors, immunologic risk factors, patient and graft survivals, postoperative renal function, acute rejection episodes, infections, medical and surgical complications, duration of hospital stay as well as cause for readmission, and their rates. ResultsPatient survival, graft survival, and graft function over the 2 years after transplantation were similar between the 2 groups. There were no significant differences in terms of complications with exception of bleeding and BK virus infection. Acute antibody-mediated rejection episodes, bleeding complications, BK virus infections, and preoperative hospital stay were significantly greater in the ABOi group (P = .001, P = .002, P = .005, and P < .001 respectively). ConclusionsWe concluded that, despite some disadvantages, ABOi KT is a viable, safe option for patients whose only available donor is blood group incompatible.

Clinical outcomes of temporary shunting for infants with cerebral pseudomeningocele

Although in the case of subdural collections temporary shunting has been suggested as a viable alternative for definitive drainage of the accumulated fluid until restoration of the normal CSF dynamics, there is no agreement on the best management strategy for pseudomeningocele. The authors performed a retrospective chart review in order to evaluate the clinical outcomes of infants temporarily shunted for pseudomeningocele without encephalocele at our institution (The University of Illinois at Peoria/Illinois Neurological Institute) in the period from 2004 to 2012. The epidemiological characteristics, clinical management, and final outcomes of such subpopulation were compared with a control group which received temporary shunting for subdural hematomas (SDH) during the same period. Four patients (100% male) ranging in age from 8.9 to 27.1 months (mean = 13.88) with pseudomeningocele and 17 patients (64.7% male) ranging in age from 1.9 to 11.8 months (mean = 4.15) with SDH were identified. Although the initial management included sequential percutaneous subdural tapping in 82% of the patients, all children ultimately failed such strategy, requiring either subdural-peritoneal (81% of the cases) or subgaleal-peritoneal (19% of the cases) shunting. The mean implant duration was 201 days for the pseudomeningocele group and 384 days for the SDH one. Mean post-shunt hospitalization was 2 days for patients with pseudomeningocele and 4 days for patients with SDH. There was no statistical difference in terms of complications, length of hospitalization post-shunting, or clinical outcomes between the patients with pseudomeningocele and those with SDH. Temporary shunting of infants with pseudo-meningocele constitutes a viable therapeutic alternative with favorable clinical outcomes and a low risk of shunt dependency similar to those of children with SDH.

Resultados de un protocolo de manejo sobre la vía aérea artificial en pacientes críticos sometidos a ventilación mecánica

ObjectiveTo determine the results of the implementation of a protocol in an intensive care unit (ICU) referred to critically ill patients requiring a prolonged artificial airway. DesignA prospective, observational cohort study was carried out. InterventionManagement strategies were established on the airway by endotracheal intubation (ETI) or tracheostomy, and guidelines were developed for action in the decannulation process. SettingA polyvalent ICU. PatientsWe studied 169 patients subjected to mechanical ventilation (MV), 67 with ETI ≥ 10 days of MV and 102 with percutaneous (PT) or surgical tracheostomy (TQ). Variables of interestICU and hospital stays, days of ETI and MV, mortality, tracheostomy, anatomical risk factors, surgical complications, and postoperative decannulation period. ResultsETI versus tracheotomy involved fewer days of MV (17 vs. 30 days, p<0.001), a shorter ICU stay (20 vs. 35 days, p<0.001), and a shorter hospital stay (34 vs. 51 days, p<0.001).There were more TQ procedures in patients with risk factors (47% TP vs. 89% TQ, p<0.001). Intraoperative minor bleeding was the most common complication, being associated with TQ (31% vs. 11%, p = 0.03). TP was associated with a shorter cannulationperiod (25 days vs. 34 days, p<0.04). ConclusionsThe protocol variants showed no differences in terms of complications and mortality, when orienting application to patients with similar characteristics.

Metabolic phenotype in obese children and adolescents with preserved insulin sensitivity

Rising prevalence of childhood obesity is accompanied by the increased risk of associated metabolic complications and other comorbidities. Nevertheless, a distinct subgroup of the obese appear to have a normal metabolic phenotype, and these individuals are referred to as the metabolically healthy obese. Prevalence of metabolically healthy individuals within the population of the obese is estimated up to 44%. Metabolically healthy obese are at lesser risk for impaired glucose regulation, dyslipidemia, non-alcoholic fatty liver disease and hypertension, and the preserved insulin sensitivity is the most frequently used criterion in identification of these individuals. Results of the research conducted in Institute for Mother and Child Health Care of Serbia 'Dr Vukan Čupić' indicate that a subgroup with low prevalence of metabolic complications of obesity is also present within population of obese children and adolescents in Serbia. A significant association of preserved insulin sensitivity with favorable metabolic phenotype is also supported by the results. Known data suggest the need for a different approach in the treatment of obesity in the subpopulation of the metabolically healthy obese. Due to differences in terms of complications and treatment, these individuals should also be regarded as a separate entity in further research.

Early Complications of a Reduction Mammoplasty Technique in the Treatment of Macromastia With or Without Breast Cancer

BackgroundThis study was planned to investigate the early postoperative complications after reduction mammoplasty applied either for benign or malignant reasons and reliability of the technique with respect to wound healing. Patients and MethodsTwo hundred and eighty-six reduction procedures were evaluated prospectively. Fifty-two patients underwent reduction mammoplasty for macromastia and 101 for macromastia with breast cancer. The wound complications were evaluated in 2 groups, as minor and major complications. Seroma, hematoma, surgical site infection, delayed wound healing, and minor wound dehiscence were included in the minor complication group. Severe complications, such as necrosis of nipple-areola complex and major incisional wound dehiscence, were included in the major complications group. ResultsMean (SD) age of the patients was 48.8 ± 10.3 years, mean (SD) body mass index was 29 ± 3.3 kg/m2, and mean (SD) weight of resected specimen was 958 ± 72 g. Mean (SD) preoperative and postoperative volumes for each breast were 1245 ± 75 cm3 and 436 ± 27 cm3, respectively. Minor and major complication rates were 25/153 (16.3%) and 3/153 (1.9%), respectively. There was no significant difference in terms of complications between the patients with and without breast cancer. Body mass index was found to be the only factor associated with the complication rates. DiscussionReduction mammoplasty is a surgical technique that has satisfactory cosmetic results in the treatment of macromastia. This technique also is safe in the treatment of breast cancer patients with macromastia and does not increase complication rates.

Postoperative complications after abdominal surgery in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease is a well-known independent risk factor for the development of postoperative pulmonary and cardiac complications after thoracic or nonthoracic surgery. We aimed to determine the risk factors and complications of abdominal surgery in chronic obstructive pulmonary disease patients. Thirty-two patients diagnosed with chronic obstructive pulmonary disease out of 89 patients who underwent abdominal surgery at Zonguldak Karaelmas University Medical School Hospital enrolled in the study. Pulmonary and cardiac complication ratios were found high in chronic obstructive pulmonary disease patients. Postoperative pulmonary and cardiac complications were documented in 21.8% and 28.1% of chronic obstructive pulmonary disease patients respectively. There were no differences in terms of complications, according to the severity of the disease in chronic obstructive pulmonary disease patients. While smoking and age did not effect the postoperative complications in chronic obstructive pulmonary disease patients, bronchodilator use increased postoperative cardiac risks. We found that laparoscopic surgery reduced the risk for postoperative pulmonary complications compared with open surgical procedures. No differences were found in terms of complication regarding to the type of incision and the duration of surgery. The patients with chronic obstructive pulmonary disease had high ratio of the pulmonary and cardiac complications. The complication rate was higher for surgical sites closer to the diaphragm such as the upper abdomen. Laparoscopy will reduce the risk for postoperative pulmonary complications compared with open surgical procedures. Based on our preliminary data and considering the lack of controlled trials, bronchodilators should be used with great caution particularly in the individuals with chronic obstructive pulmonary disease and cardiac comorbidity.

Safety profile of primary intraocular lens implantation in children below 2 years of age

AimTo study the safety profile of primary intraocular lens (IOL) implantation in children below 2 years of ageMethodsRetrospective, non-comparative, consecutive and interventional clinical case series of all patients who underwent...

Outcomes of Adjuvant Chemoradiation After Pancreaticoduodenectomy With Mesenterico-Portal Vein Resection for Adenocarcinoma of the Pancreas

Surgery followed by chemotherapy and radiation (CRT) offers patients with pancreatic adenocarcinoma a chance for extended survival. In some patients, however, resection is difficult because of vascular involvement by the carcinoma, necessitating resection and grafting of the mesenterico-portal vessels. The purpose of this study was to compare outcomes between pancreaticoduodenectomy (PD) with and without mesenterico-portal vein resection (VR) in patients receiving adjuvant CRT for pancreatic adenocarcinoma. Between 1993 and 2005, 160 patients underwent PD with 5-FU-based adjuvant CRT followed by maintenance chemotherapy at the Johns Hopkins Hospital; 20 (12.5%) of the 160 underwent VR. Clinical outcomes, including median survival, overall survival, and complication rates were assessed for both groups. Patients who underwent VR had significantly longer operative times (p = 0.009), greater intraoperative blood loss (p = 0.01), and longer postoperative lengths of stay (p = 0.03). However, postoperative morbidity, median survival, and overall survival rates were similar between the two groups. Most patients (70%) from both groups were able to complete CRT, and a subgroup analysis demonstrated no appreciable differences in terms of complications. None of the VR patients who received adjuvant CRT developed veno-oclusive disease or graft failure/leakage. In a cohort of patients treated with adjuvant 5-FU-based CRT at the Johns Hopkins Hospital, having a VR at the time of PD resulted in similar complication rates and survival. These data support the feasibility and safety of adjuvant CRT in patients undergoing VR at the time of PD.

Vertical Scar Mammaplasty in Gigantomastia: Retrospective Study of 115 Patients Treated Using the Modified Lejour Technique

Since 1996, the original technique of superior pedicle vertical scar mammaplasty described by Lejour has been modified by decreasing skin and glandular undermining, limiting liposuction, avoiding tight glandular stitches, and adding a small horizontal scar for very large breasts. Between 1996 and 2002, 115 consecutive patients underwent a bilateral reduction mammaplasty of more than 500 g per breast using the modified Lejour technique. The early, late, and delayed complications were studied according to four parameters: glandular resection, age, smoking habits, and body mass index (BMI). There was no difference in terms of complications according to the glandular resection. Patients with a high BMI were found to have a higher rate of wound dehiscence. The occurrence of partial areolar necrosis proved to be related to smoking habits. Patients younger than 20 years presented a lower rate of seroma. The modified Lejour technique has proved to be safe and effective for large breasts.

Phenotypic expression of genotype-phenotype correlation in cystic fibrosis patients carrying the 852del22 mutation

Currently, more than 1,000 mutations have been identified in the cystic fibrosis transmembrane regulator (CFTR) gene. While some mutations are common worldwide, the majority are restricted in certain ethnic groups. We have found that in Southern Italy, the 852del22 mutation is well represented with a frequency of 3.5%. We have screened, by reverse dot blot, denaturing gradient gel electrophoresis (DGGE), and gene sequencing, the entire coding regions of CFTR gene in 371 consecutive cystic fibrosis (CF) patients from Southern Italy and have identified 17 patients carrying rare genotypes, among which 13 [6 M; median age 21.7 years (range: 4.5-47.7 years)] carry the 852del22 mutation. To assess the phenotypic expression of CF in patients with the 852del22 mutations we have compared these patients with a group of age and gender matched patients homozygous for the DeltaF508 mutation [n = 34; 19 M; median age 19.9 years (range: 3.8-34.6 years)]. Overall, we found no difference in terms of complications, patient survival (17.6% vs. 30.7%; P = NS), estimated time needed to develop a severe lung disease (22.1 vs. 24.5 years; P = NS), nutritional status, and rate of infection or colonization by most common pathogens between patients in the two groups. Finally, we have found that a late diagnosis was associated with a poor outcome (severe lung disease) regardless of genotype. Our data show that 852del22 mutation results in a phenotypic expression of disease as severe as that determined by the more typical DeltaF508 and, as in the latter case, there is no strict genotype/phenotype correlation.

Use of medical resources, complications and long-term outcome in patients hospitalized with acute chest pain. A comparison between a city university hospital and a county hospital

Objective: The primary aim was to test the hypothesis that there is a difference in long-term outcome after hospital discharge among patients hospitalized with acute chest pain in a university hospital and a county hospital. Secondary aims were to compare these two hospitals with regard to use of medical resources, occurrence of complications and risk indicators for death. Patients: All patients hospitalized at Sahlgrenska University Hospital in Göteborg (with a catchment population of 706 inhabitants/km 2) and Uddevalla County Hospital (with a catchment population of 34 inhabitants/km 2) due to symptoms of acute chest pain during a period of 6 months. Results: Complications, use of medical resources and mortality during the subsequent 2 years after discharge were compared among 1592 hospitalizations in a city hospital and 822 in a county hospital due to acute chest pain. Angina pectoris after the first event, congestive heart failure and various arrhythmias were more frequently reported in the county hospital. The use of medical resources differed. Thus, the use of betablockers, heparin, antiarrhythmics, diuretics and nipride was more frequent in the county hospital, whereas the use of nitrates, digitalis, coronary angiography, percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) was more frequent in the city hospital. Despite these differences, the mortality 2 years after hospital discharge was similar (14.7% in the city hospital and 12.8% in the county hospital, P=0.26). Two factors, intravenous digitalis in hospital and a prescription of insulin at discharge, were significantly more associated with death in the county hospital compared with the city hospital. Conclusions: When comparing a city university hospital with a county hospital with regard to patients admitted with chest pain, major differences in terms of complications and use of medical resources were found. Thus, various complications were reported more frequently in the county hospital. The use of medical resources varied, some being used more frequently in the county hospital, whereas others were used more frequently in the university hospital. Despite these differences the mortality 2 years after hospital discharge was similar in the two cohorts.