Frequency Of Various Complications Research Articles

Total Knee Arthroplasty in Hemodialysis Patients: Routine or Complex Surgery?

Background. Chronic hemodialysis significantly increases the risks associated with knee replacement. Among the late complications of knee arthroplasty in hemodialysis patients, deep periprosthetic joint infection (PJI) and aseptic loosening are more frequent. The frequency of revision interventions in patients with end-stage kidney disease (ESKD) is substantially higher compared to patients with normal kidney function.
 The aim of the study — based on the perioperative parameters and midterm outcomes to justify the primary knee replacement in chronic hemodialysis patients as complex case of arthroplasty.
 Methods. A retrospective randomized single-center cohort study was conducted, including 62 patients with various forms of knee osteoarthritis. Patients were divided into two groups: Group 1 — 29 (46.8%) patients with end-stage renal disease (ESRD) undergoing dialysis, Group 2 — 33 (53.2%) patients without kidney pathology. The average follow-up period in both groups was 3.7 years (min — 1, max — 6). The following parameters were assessed: patient age, length of hospital stay, morphocortical index, body mass index (BMI), duration of hemodialysis, functional assessment of the knee joint using the KSS Function Score and Forgotten Joint Score-12 (FJS-12), radiological results on the KRESS, and the frequency of various complications.
 Results. In Group 1, patients had significantly lower BMI compared to Group 2. Length of hospital stay in Group 1 were 1.7 times longer. According to the KSS Function Score, no significant differences were observed between the groups in the first 36 months after the operation. However, by the 4th year of follow-up, average KSS Function Score in Group 1 decreased to 77.3 points, which was due to infectious complications. The FJS-12 showed worse scores in Group 2, averaging 68.7 points. After more than three years post-operation, no statistically significant differences were observed between the groups, which was associated with an increase in the number of complications in Group 1. Results on the KRESS after 43 months did not differ between the groups and averaged 4.8 points. Group 1 had more orthopedic complications and cases of PJI, accounting for 7 out of 37.
 Conclusion. Age and constitutional characteristics of patients undergoing hemodialysis significantly differ from the normal population. The frequency of complications in Group 1 was 23.5%. These patients require the implantation of more constrained implant components and modular systems. Therefore, primary knee replacement in hemodialysis patients can be classified as a complex case of arthroplasty.

The role of magnetic resonance imaging in radiation Diagnosis of abdominal aortic aneurysm

Aneurysmal lesion of the abdominal aorta is a common disease, the frequency of which exceeds 8% [1, 2]. A quarter of the initially examined patients at risk of this pathology are diagnosed with complicated forms [3], which negatively affects the life expectancy of this category of patients. Their lethality reaches 83% [4]. The frequency of various complications associated with the duration and trauma of open surgical interventions ranges from 7 to 39% [5, 6]. At the same time, the existing algorithms for examining patients with AAA, aimed at the timely detection of preand postoperative complications, require significant correction [6, 7]. The presented data and the variety of X-ray methods and techniques for diagnosing an aneurysm of the abdominal aorta indicate the need for further search for ways to solve this urgent problem. Determining the role of magnetic resonance imaging in the algorithm for radiological diagnosis of diseases and complications of abdominal aortic aneurysm.

Organizational and clinical potential of the Federal Register of children with short bowel syndrome

BACKGROUND: Short bowel syndrome is a medical and social problem characterized by high mortality and disability rates, controversial tactics, resource-intensive therapy, and lack of legal support. In 2016, the Russian Association of Pediatric Surgeons initiated the creation of the Federal Register of Children with Short Bowel Syndrome.
 AIM: This study conducts an audit of the Register to identify the prevalence of the pathological syndrome, establish the causes of its formation and trends in transforming the therapeutic paradigm, determine the pattern, nature, and frequency of various complications, establish factors limiting its informativeness involving representatives of implementors and users, and justify changes increasing database organization and clinical significance.
 MATERIALS AND METHODS: The Register has 334 patients registered. Of these, 23 children died, and five were removed from the Register at 18. The Quinta software package was used to collect, process, and manage geographically distributed data with information about patients data, identification of medical organizations, diagnosis, the content of therapeutic measures, and the structure of complications.
 RESULTS: The Register contains data on patients from 71 regions of Russia. Bowel resections prevailed among the initial interventions due to necrotizing enterocolitis (18.0%) and intestinal atresia (17.4%). Reconstructive interventions (125), including serial transverse enteroplasty and spiral intestinal lengthening and tailoring techniques, were implemented in 37 and 24 cases. One hundred and eighty patients needed parenteral nutrition: 18 patients required total parenteral nutrition, and 162 patients needed partial parenteral nutrition. Enteral feeding was used in 193 cases, meeting the needs of 31 children and supplementing parenteral therapy for 162 children. The structural flaw of the Register is the absence of a section on palliative care.
 CONCLUSIONS: The identified limitations of the Register indicate the need to improve the provided primary information, form a platform for supporting medical decisions, create a palliative care unit, and integrate with state health development programs.

Frequency of Various Complications in Teenage Pregnancy and Adult-Age Pregnancies: A Cross Sectional Study

Introduction: A major public health issue in the world is teenage pregnancy and its consequences. Sixteen million birth occurs in teenage pregnant women between 15-19 years of age in the world. Aim/Objectives: To find the frequencies of pre-eclampsia, postpartum hemorrhage, birth asphyxia, anemia and intrauterine death (IUD) in teenage pregnancy and adult-age pregnancy. Methodology: A total of two hundred patients were booked for ante-natal care and patients were divided into two different groups equally i.e., teenage pregnancy and adult-age pregnancy (TP Group and AP Group). Teenage pregnancy group ranged from 14 to 19 years, and AP Group ranged from 20-30 years. One hundred (100) pregnant ladies were registered for each group. Those pregnant women who had co-morbid were excluded from the study. Pregnant women were booked for ante-natal care from twenty-eight weeks of pregnancy to forty-one weeks of pregnancy for both groups. Result: The mean age of pregnant women was 16.25 ±4.90 years in the teenager pregnancy group (TP Group) and 26.00 ± 5.00 years in the adult-age pregnancy group (AP Group). The mean BMI of patients was 24.50 ± 0.75 kg/m2 in the TP Group while it was 26.25 ± 3.50 Kg/m2 in the AP Group. The concentration of mean hemoglobin was 9.25 ± 0.75 mg/dl in the teenager pregnancy group and it was 12.50 ± 0.50 mg/dl in the adult-age group (AP Group) and the p-value was 0.003 (significant). Mean systolic blood pressure was 130mm of Hg in the TP Group, and 120mm of Hg in the AP Group while mean diastolic blood pressure was 85mm of Hg in Teenage pregnancy and 75mm of Hg in Adult-age pregnancy. Anemia, pre-eclampsia, intrauterine death (IUD), postpartum hemorrhage (PPH) and birth asphyxia were more in the teenage pregnancy group as compared to the adult-age pregnancy group. The mean gestational age in teenage pregnancy was 30.75±1.25 weeks and it was 38.80 ± 0.70 week in the adult-age pregnancy group. Conclusion: The frequency of pre-eclampsia, postpartum hemorrhage, birth asphyxia, intrauterine death and anemia were more in teenage pregnancy (TP Group).

Comparative evaluation of the results of conservative and surgical methods of treatment of children with destructive forms of pyelonephritis

BACKGROUND: The relevance of destructive pyelonephritis in pediatric practice is determined by frequency of various complications of the disease associated with a high risk of irreversible morphofunctional changes in parenchyma of affected kidney, the lack of tactical consensus in the professional community and regulatory documents regulating the procedure for diagnostic and therapeutic support of this contingent of patients.
 AIM: Substantiation of the tactics of effective treatment children with destructive pyelonephritis, based on the results of a multifactorial retrospective analysis of the course and outcomes of the disease.
 MATERIALS AND METHODS: The results of the analysis of medical documentation of 38 patients with destructive pyelonephritis aged 3204 months (median 93.5) who received inpatient treatment in 20152019 in three specialized clinics in Moscow are presented.
 RESULTS: More than half of the patients (28 children) in the acute period of the disease received conservative therapy, including infusion and antibacterial, the escalation of which was carried out with the preservation or increase of manifestations of the systemic inflammatory response syndrome, as well as negative dynamics according to ultrasound or CT data. In the group of patients (n = 10), indications for surgical treatment were formulated decapsulation of the kidney, opening of apostemas and abscessed foci, drainage of the paranephral space. During the examination in catamnesis, realized in 50%. It was found that in the majority (91%) of children treated conservatively, a statistically significant decrease in the volume of the kidney on the affected side was registered. These complications were not detected among the operated patients.
 CONCLUSION: The pharmacy of choice for starting antibacterial therapy should be inhibitor-protected beta-lactams, carbapenems, if the etiological significance of staphylococcus is suspected, it is advisable to connect linezolid. In case of laboratory signs of hypercoagulation, it is necessary to connect anticoagulants. Surgical tactics can minimize the risk of complications associated with the purulent-destructive process, contributing to regenerative processes in the kidney parenchyma. The objectification of the results of the catamnestic examination is due to the performance of nephroscintigraphy.

Идиопатическая гидроцефалия взрослых: современное состояние проблемы

The term "idiopathic hydrocephalus" in adults is a broader concept that includes larger spectrum of patients compared to "idiopathic normotensive hydrocephalus". It includes both young and elderly patients with various forms of the disease, patients with various levels of obstruction. Th ere is no general classification and general approach to treat patients with such a pathology. Endoscopic triventriculostomy in idiopathic aqueductal stenosis and cerebrospinal fluid shunting after a positive test of cerebrospinal fluid (tap test) evacuation in idiopathic normotensive hydrocephalus are proved to be effective. In patients with other forms of cerebrospinal fluid pathway obstruction, treatment approach is represented by the opinions of some surgeons. At the same time, most surgeons consider the use of cerebrospinal fluid shunting operations to be effective and justified, and they use endoscopic techniques as an option for examining ventricular system and for performing auxiliary manipulations. The high frequency of various complications of bypass surgery and slightly lower efficiency of endoscopic operations indicates the need to systematize patients; to improve selection criteria and to expand the indications for the use of endoscopic surgical techniques.

Complications of fractional ablative carbon dioxide laser in various aesthetic procedures: a retrospective study

<p class="abstract"><strong>Background:</strong> Though fractionated CO<sub>2</sub> laser technology resurface patients with a lower rate of complications than non-fractionated ablative laser treatment, adverse effects can still occur even with the best technology.</p><p class="abstract"><strong>Methods:</strong> In this retrospective study we evaluated 65 patients for early and delayed complications after laser treatment with Sellas Cis-Fl™ fractional CO<sub>2</sub> laser system of wavelength 106400 nm for various aesthetic indications over the period of 12 months from October 2017 to September 2018<strong>. </strong>Follow up was done for the period of 2 months after the last session to determine the nature and frequency of various complications. Patient’s subjective assessment of the complications was recorded in the form of patient subjective score (PSS) which ranged from 1 to 10.<strong></strong></p><p class="abstract"><strong>Results:</strong> In the current study, the most common aesthetic indication for fractional CO<sub>2</sub> laser was post acne scarring (38.4%). The most common early side effects reported were erythema (95.38%) and burning sensation (92.30%) after the procedure. Post procedural dryness and edema was seen in 72.3% and 69.23% patients. Among the delayed complications most frequently observed was persistent erythema (46.15%) followed by post inflammatory hyperpigmentation (44.61%).</p><p><strong>Conclusions:</strong> Though fractional CO<sub>2</sub> laser is relatively a safe procedure, undesirable sequelae may still occur as a result of inappropriate selection of laser parameter, injudicious patient selection, inadequate preoperative counselling and suboptimal postoperative care. Dermatologist should keep the possibility of all the side effects that can occur after fractional CO<sub>2</sub> laser and must take appropriate precautions during the procedure to avoid them.</p>

Features of the course of anterior uveitis associated with HLA-B27 antigen

To perform comparative analysis of the frequency of various complications of anterior uveitis associated with HLA-B27 antigen in patients with and without spondyloarthritis. Retrospective analysis included 189 patients with anterior uveitis (AU) associated with histocompatibility antigen (HLA-B27). The Follow-up period lasted 10 years. 189 patients with AU associated with antigen HLA-B27 were divided into two groups. The first group included 108 patients with various diseases of the spondyloarthritis (SpA) group; the second study group consisted of 81 patient with no signs of SpA. Number of patients with complications was 1.5 times higher in the first group. Complicated cataract, glaucoma, synechiae, myodesopsia occurred significantly more frequently in patients of the first group compared to AU patients of the second group, where idiopathic AU was more prevalent. Cystoid macular edema, corneal degeneration, optic nerve atrophy were observed more often in patients with SpA, but differences between the groups were statistically insignificant. Combination of complications also occurred significantly more often in SpA patients. Comparison of the frequency of AU attacks showed that the amount of uveitis attacks per 100 patient-years was higher in patients with SpA. Mean number of AU attacks per year was also higher in the first study group, but differences between the groups were statistically insignificant. Retrospective analysis of 189 patients with AU associated with HLA-B27 antigen revealed significantly higher frequency of complications, together with more frequent acute episodes in patients with SpA in comparison with patients without it confirming the notion that a systemic inflammatory disease can influence the severity of the course of AU.

Акушерські та перинатальні наслідки розродження жінок із варикозною хворобою

The objective: studying of obstetric and perinatal outcomes of delivery of women with varicose illness. Materials and methods. We surveyed 60 patients, among which 30 – with the diagnosed varicose illness which made main group and 30 pregnant women without obstetric and somatic pathology, the delivery through natural patrimonial ways which made control group. The complex of the conducted researches included clinical, tool and laboratory methods. Results. At women of control group all labors were well-timed, and in main group the frequency of premature births made 10.01.0%. High frequency of various complications of pregnancy it is noted both during pregnancy, and at delivery. So, in first of all, it concerns the frequency of a premature rupture of fetal covers (main group – 56.75.7%) with the subsequent disturbances of activity of uterus at the time of delivery (main group – 46.74.7%). In turn it led to development of distress of fetus (main group – 6.70.7%) and, respectively, the cesarean sections (main group – 16.71.7%). At an assessment of condition of newborns we considered number of children who were born respectively on groups (the control – 30 and main – 30). Conclusion. Results of our researches testify to existence of high frequency of obstetric and perinatal pathology at women with varicose illness. It, certainly, testifies to need of improvement of algorithm of diagnostic and treatment-and-prophylactic actions. Key words: obstetric and perinatal outcomes, varicose illness.

Особливості ендокринологічного статусу та фетоплацентарного комплексу у вагітних з аденоміозом

The objective: to study the features of the endocrinological status and the fetoplacental complex in pregnant women with adenomyosis, the course of pregnancy and childbirth in these women, to develop new, systematize and improve the existing methods of diagnosis, treatment and prevention of complications and reproductive losses. Materials and methods. We examined 90 pregnant women who were divided into groups: 30 healthy women – control group, a comparison group of 30 women with adenomyosis receiving classic progesterone therapy and the main group of 30 women with adenomatosis who received advanced preserving, metabolic therapy and diet therapy. The condition of the feto-placental complex, the frequency of IUGR, hemodynamic disturbances on the part of the fetus, and the level of estriol, progesterone, cortisol, chronic gonadotropin (CGL), placental lactogen were evaluated. Results. The main complication in pregnant women with adenomyosis was placental dysfunction (the comparison group was 60.0% and the main group was 33.3%), whose structure was performed by compensated (58.2%) and subcompensated forms (35.8%). The frequency of preterm labor threat was 20.0% in comparison group and 13.3% in main one, while in the control group – 1 case, which is 3.3%. Frequency of SCR was in the comparison group – 20.0% and in the main – 3.3%. Low levels of estriol, progesterone, HHG, placental lactogen, increased cortisol levels in comparison and main groups were determined, and after treatment the indicators of the main group significantly improved. Conclusions. With timely correction of violations, prevention of fetoplacental insufficiency and complex treatment with the use of advanced classical progesterone therapy in combination with metabolic and diet therapy we can significantly reduce the frequency of various complications in pregnant women with adenomyosis. Key words: adenomyosis, pregnancy, non-pregnancy, diet therapy, metabolic therapy, preservation therapy, preventive care.

Spectrum of complications in childhood Enteric Fever as reported in a Tertiary Care Hospital.

Objective:To find out frequency of various complications in children admitted with Enteric Fever at a tertiary care hospital.Methods:This was prospective cross sectional study, carried out in the Pediatric Medicine department of The Children’s Hospital Lahore from Dec 2014 to March 2017. Children of both genders with age range of 6 months to 16 years diagnosed as enteric fever on the basis of clinical features and positive Typhidot, or blood culture were included in the study. All 180 patients were scrutinized for all possible complications. Where ever required and feasible appropriate and relevant investigations were done to document complications. Data was analyzed by SPSS version 20.Results:Mean age of children was 7.2±3.38, majority 94 (52.2%) were 5-10 years old. Out of 180 patients, complications were noted in 58 (32.2%). Neurological complications 30.7% encompassed maximum complications followed by hepatobiliary 24.61%, abdominal 16.92% hematological 9.23%, bone and joints 7.69%, respiratory system 6.1% and cardiovascular system 4.41%. Mortality rate was 1.6%. Thrombocytopenia and leucopenia were significantly associated with complications with p value of 0.002 and 0.003 respectively.Conclusion:Enteric fever is causing our children to suffer by its numerous perplexing and fatal complications. The most vulnerable age for enteric fever and its complication is 5-10 years. To combat these issues large scale vaccination remains promising option at least in most susceptible age group.

Postoperative Complications Associated With rhBMP2 Use in Posterior/Posterolateral Lumbar Fusion.

Study Design:Retrospective database review.Objective:Posterior/posterolateral lumbar fusion (PLF) is an effective treatment for a variety of spinal disorders; however, variations in surgical technique have different complication profiles. The aim of our study was to quantify the frequency of various complications in patients undergoing PLF with and without human recombinant bone morphogenetic protein 2 (rhBMP2).Methods:We queried the orthopedic subset of the Medicare database (PearlDiver) between 2005 and 2011 for patients undergoing PLF procedures with and without rhBMP2. Complication and reoperation rates were analyzed within 1 year of the index procedure. Complications assessed include: acute renal failure, deep vein thrombosis, dural tear, hematoma, heterotopic ossification, incision and drainage, cardiac complications, nervous system complications, osteolysis, pneumonia, pseudarthrosis, pulmonary embolism, radiculopathy, respiratory complications, sepsis, urinary retention, urinary tract infection, mechanical, and wound complications. Chi-square analysis was used to calculate the complication differences between the groups.Results:Our data revealed higher overall complication rates in patients undergoing PLF with rhBMP2 versus no_rhBMP2 (76.9% vs 68.8%, P < .05). Stratified by gender, rhBMP2 males had higher rates of mechanical complications, pseudarthrosis, and reoperations compared with no_rhBMP2 males (P < .05), whereas rhBMP2 females had higher rates of pseudarthrosis, urinary tract infection, and urinary retention compared with no_rhBMP2 females (P < .05).Conclusion:Our data revealed higher overall complication rates in PLF patients given rhBMP2 compared with no_rhBMP2. Furthermore, our data suggests that rhBMP2-associated complications may be gender specific.

Complications encountered during interventional endoscopic ultrasound - a tertiary care center experience

Background and Objectives:Interventional endoscopic ultrasound (EUS) includes fine needle aspiration (FNA), pancreatic cystogastrostomy, aspiration of cystic cavity or collection, hepaticogastrostomy, and coiling. It is considered safe. This study was undertaken to note frequency of various complications that arose with interventional EUS at our center.Methods:This was a retrospective cohort study done at a tertiary level referral center. Records of all patients who underwent EUS intervention over a period of 6 years (October 2010 to September 2016) were reviewed. Procedure-related minor adverse events such as throat pain and abdominal pain were noted. Complications were defined as acute pancreatitis, perforation, mucosal tear, hepatic encephalopathy, pneumomediastinum, pneumoperitoneum, peritoneal leak, bleeding, hematoma, and fever requiring hospital admission.Results:A total of 4654 EUS were done, of which 2030 intervention performed. Of these, 1780 were EUS FNA, 146 aspiration, 64 cystogastrostomy, and 40 others. Procedure-related minor adverse events were noted in 42% cases (throat pain - 31% and abdominal pain - 11%). Complications were observed in 35 patients (1.72%); minor mucosal bleeding (12), mild acute pancreatitis (5), asymptomatic duodenal hematoma (4), fever requiring hospitalization (3), duodenal perforations (2), cervical esophageal tear (2), mild hepatic encephalopathy (2), pneumomediastinum (1), pneumoperitoneum (1), bleeding from gastroduodenal artery (1), cystogastostomy site bleeding (1), and peritoneal leak (1). All the complications were managed conservatively except duodenal perforations which required surgery and peritoneal leak requiring drain placement percutaneously. On subgroup analysis, there were significant fewer complications with operator experience of >1000 EUS (P = 0.002).Conclusion:EUS intervention is a safe procedure, especially in experienced hands.

CLINICAL AND EPIDEMIOLOGICAL FACTORS DETERMINING PROPAGATION AND CLINIC OF UROGENITAL TRICHOMONIASIS IN WOMEN

The problem of urogenital trichomoniasis (UGT) is relevant not only due to its high prevalence and multiple organ lesions, but also to the ability to have a negative impact on reproductive health. In Kazakhstan, UGT is one of the leading infections in the structure of sexually transmitted infections: in 2011 51.5%; 2012 — 43.5%; 2013 — 42.0% with the prevalence of co-infection with other STIs, in which the rate of complications is increased by 2 times and are more profound with the involvement of inflammation in the upper urogenital tract. The recorded incidence of trichomoniasis in the RK is characterized by annual rate decrease (since 2011 a 1.5 times decrease) due to small fluctuations of syphilis, gonorrhea, chlamydia morbidity which indicates a large reservoir of latent infection, and low level of diagnostics. Most clearly demonstrates this situation an incidence of UGT in 2 cities: so in Astana in 2013, the recorded incidence decreased by 2.8 times compared to 2011; in Almaty — 6 times in 2012 and 4.3 times in 2013. Conducted clinical and epidemiological analysis of UGT morbidity in women allowed to identify the following: in recent years the tendency of UGT to growth with a significant proportion of latent asymptomatic forms (for more than one quarter of patients with UGT, UGT is most common in young adults, average age 30.5±2.5 years); in half of the cases recorded, mixed trichomonas infection, mostly in combination with Chlamydia, which causes a high incidence of complications of the upper urogenital tract; there is a high frequency of trichomonas infection combination with infections caused by Candida, mycoplasma, which determines the prospects of the combination therapy UGT in combination with drugs, correcting immunodeficiency. There is quite a high incidence of gynecological pathology, the severity of which depends on the frequency of the spectrum of pathogens that are associated with T. vaginalis. The data obtained allows to select women with trichomonas infection of the urogenital tract with the complication risk that affect the reproductive function; UGT develops together with urogenital tract disbacteriosis with a predominance of Staphylococcus species, having adhesive, lizotsimogenic, hemolytic activity that must be considered when conducting a combined therapy with drugs, correcting microflora. The frequency of various complications was significantly higher in patients with mixed infection. Particular attention is drawn to the attention of the high frequency of adnexitis, uterine fibroids, their rate was equivalent to and higher than the corresponding figures of 1.9 times and 5 times, respectively (38.0% versus 20.0% and 7.8%, p 0,05) at monoinfection. In this group of ovarian cyst recorded in 10.1% of cases. Basically, the above-mentioned diseases were observed in patients with trichomonas, chlamydial infection. Adnexitis and uterine fibroids in all 30 cases were recorded in patients co-infected with this that has made 75,0±6,8%. Our findings are consistent with studies of high risk of pelvic inflammatory disease in women with trichomoniasis. Other studies have reported increases of 1.9 times the risk of tubal infertility in women with trichomoniasis. Trichomoniasis can also play a role in cervical neoplasia and postoperative infections.

Postoperative Complications Associated with rhBMP2 use in Posterior Lumbar Fusion

Introduction The growing number of degenerative conditions in aging population has contributed to the increased rates of lumbar posterior spinal fusion (PLF). While PLF has been shown to be effective for the treatment of various different spinal disorders, variations in surgical technique (such as bone graft used) for PLF have potential for different complication profiles. Human recombinant bone morphogenetic protein 2 (rhBMP2) is a bone graft material commonly used in the US to enhance spinal fusion rates after PLF. There are some reports of complications related to the use of rhBMP-2 in PLF arising from relatively small case series. Aim of our study was to quantify the frequency of various complications in elderly patients undergoing PLF with and without rhBMP2. Material and Methods We queried the orthopaedic subset of the Medicare database (PearlDiver) between 2005 and 2011. Current Procedure Terminology (CPT) codes were used to identify patients undergoing PLF procedures with and without rhBMP2, and International Statistical Classifcation of Diseases 9 (ICD-9) codes were used for complications. Complication and re-operation rates were analyzed within 1 year after the index procedure. Complications included: Acute Renal Failure, Deep Vein Thrombosis, Dural Tear, Hematoma, Heterotopic Ossification, Incision and Drainage, Myocardial Infarction or other cardiac complication, Nerve, Osteolysis, PLF Reoperation, Pneumonia, Pseudoarthrosis, Pulmonary Embolism, Radiculopathy, Respiratory Complications, Sepsis, Urinary Retention, Urinary Tract Infection, Mechanical (failure of other internal orthopedic device, implant, and graft) and Wound Complications. Chi-square analysis was used to calculate the complication differences between the groups. Results There were 20,143 patients who underwent a PLF from 2005–2011, and 27% (5421) of those cases received rhBMP2, while 73% (14722) had the PLF procedure without it. The majority of PLF cases were female (62%) and 65–69 years of age (27%) patients. The overall complication rate was similar between the rhBMP2 and no-rhBMP2 groups, 78.8% and 76.4%, respectively. However, most of the complications had a significantly lower rate in the rhBMP2 group compared with the no-rhBMP2 group (Dural tear 2.2% versus 3%; Incision and Drainage 6.9% vs 7.8%; Myocardial Infraction 3.8% vs 4.4%; Nerve 1.1% vs 2%; Pulmonary Embolism 2.2% vs 2.8%; Radiculopathy 9.4% vs 11.1%; Sepsis 3% vs 3.9%; Wound 8.2% vs 9.6%, respectively). Complications that were in the rhBMP2 group were Mechanical 8% vs 6.2%; Pseudoarthrosis 3% vs 1.8%; Urinary retention 9.9% vs 8.7% ( p &lt; 0.05) and Urinary Tract Infection 30.30% vs 29.60%. Interestingly, heterotopic ossification, demonstrated less than 11 patients in both groups.

CURRENT CAPABILITIES OF COMPUTED TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING FOR THE DETECTION OF COMPLICATIONS AFTER COMBINED PANCREAS AND KIDNEY TRANSPLANTATION

Objective: to give computed tomography (CT)- and magnetic resonance imaging (MRI)-based new anatomic-topographic relationships in patients after combined pancreas and kidney transplantation and to describe main visualization tasks and the types and frequency of various complications occurring in different periods after transplantation. Material and methods. Spiral CT and MRI images were analyzed in 45 patients after pancreas and kidney transplantation. A total of 51 studies (35 CTs and 16 MRIs) using intravenous contrast enhancement (n=34 (66%)) were performed. Results. A total of 55 complications, among which pancreatitis after pancreas transplantation was most common (55%), were found. Necrotizing pancreatitis following pancreas transplantation, which required open operative or percutaneous intervention, was diagnosed in 6.6%. Vascular complications were detected in 22%. Conclusion. The current capabilities of CT and MRI enable us to quickly obtain objective information on the status of transplanted organs, their vascular architectonics, as well as on the presence and type of occurred complications. Timely correction of identified complications positively affects the survival of transplanted organs and quality of life in a recipient.

The Practice of Skin‐Bleaching for a Cosmetic Purpose in Immigrant Communities

Using skin-lightening compounds for a cosmetic purpose that are normally restricted to medical use or forbidden has become a world-wide practice. Complications are numerous. Immigrant communities often import their practice from their original country. A review of the literature on the subject of complications of cosmetic skin-bleaching, with special focus on data concerning immigrants originating from highly endemic countries, was conducted. Complications of cosmetic skin-bleaching are common, involving mainly the skin although some general complications are also reported with a growing incidence. The high frequency of this practice, added to the frequency of various complications, suggests it might be considered as a genuine public health problem currently.

Maternofoetal complications and their association with proteinuria in a tertiary care hospital of a developing country.

Objective. To investigate association between maternofoetal complications and the amount of proteinuria measured by spot urine protein creatinine ratio in patients with preeclampsia. Methods. 200 consecutive patients with preeclampsia were recruited in the study. The complications like first episode of severe hypertension, renal insufficiency, raised level of aspartate transaminase, signs of neurological involvement, thrombocytopenia, eclampsia, and need to shift in intensive care units were studied. The maternal outcome was studied in terms of type of labour, outcome of pregnancy, mode of delivery, indication of cesarean section, and maternal mortality. The foetal complications and outcome parameters were birth weight, Apgar score at the time of birth and at five minutes, need of high dependency unit care, and perinatal mortality. Result. The frequency of various maternal and foetal complications was between 14–53% and 22–92%, respectively. Maternal mortality was 3%, whereas perinatal mortality was 23%. Statistically significant association was found between the frequencies of various complications in mother and newborn and spot UPCR. Conclusion. The rate of various maternofoetal complications in preeclampsia is higher in developing countries than in developed world. Maternofoetal complications and outcome correlate with maternal spot UPCR.

The importance of early treatment to decrease therapy-related complications in Burkitt lymphoma (BL), Burkitt-like leukemia/lymphoma (BLL), and acute lymphocytic leukemia (ALL) treated with disease-specific systemic therapy.

6577 Background: BL, BLL and ALL are highly aggressive malignancies. We conducted a study to determine the relationship between the time to start of disease-specific systemic therapy and the frequency of various complications during treatment. Methods: A multi-center chart review was conducted for a total of 175 patients (pts) from Cleveland Clinic and Beaumont Health System, who received thearapy between Jan 2000 and Oct 2012. Pts were classified into two groups based on time to start of disease-specific systemic therapy. The first group started therapy within 1 week of the presenting symptoms and the second group started therapy in ≥ 1 week. Pts characteristics, stage of disease, incidence of acute renal failure (ARF) [Am J Med. 1983;74(2):243], Tumor lysis syndrome (TLS) [Cairo-Bishop definition], major bleeding [requiring transfusion, drop in hemoglobin &gt; 2 g/dL, or bleeding in critical sites], venous thrombotic events (VTEs) [documented by imaging], neutropenic fever (NF) [Clin Infect Dis. 2011;52(4):e56], and mortality rate were retrieved from the records. Results: Of 175 pts (66 BL, 13 BLL, 96 ALL), 67 % were males, 92.6 % had stages III or IV disease. Chi-Square test analysis showed pts treated with disease specific systemic therapy within 1 week as compared to those whose treatment began ≥ 1 week after symptoms onset had less incidence of ARF (16.7% vs 38.5% p=0.001), less TLS (3.6% vs 16.5% p=0.006), less VTEs (8.3% vs 16.6% p=0.007), less NF (3.6% vs 24.2% p=0.001) and most importantly had a lower mortality rate during the therapy (1.2% vs 8.8% p=0.036). Further analysis of the data showed no significant difference in the incidence of major bleeding between the two groups (9.5% vs 17.8 p=0.129), although there was a trend toward fewer episodes in pts started on therapy within 1 week. Conclusions: This study confirmed an increased risk of therapy related complications including higher mortality in pts with BL, BLL and ALL when the therapy was initiated ≥ 1 week after symptoms onset. These findings indicate that clinicians should start disease specific therapy within 1 week.

Midodrine and Clonidine in Patients With Cirrhosis and Refractory or Recurrent Ascites: A Randomized Pilot Study

Splanchnic arterial vasodilatation and subsequent activation of anti-natriuretic and vasoconstrictive mechanisms have an important role in cirrhotic ascites. The aim of this study was to evaluate the effects of midodrine, clonidine, and their combination on systemic hemodynamics, renal function, and control of ascites in patients with cirrhosis and refractory or recurrent ascites. Sixty cirrhotic patients with refractory or recurrent ascites were prospectively studied after long-term administration of clonidine (n=15) or midodrine (n=15), or both (n=15) plus standard medical therapy (SMT), or SMT alone (n=15), in a randomized controlled trial at a tertiary center. A significant increase in urinary volume, urinary sodium excretion, mean arterial pressure, and decrease in plasma renin activity (P<0.05) was noted after 1 month. There was also a significant decrease in cardiac output (P<0.05) and increase in systemic vascular resistance (P<0.05) in all groups, except clonidine. There was no change in glomerular filtration rate and model for end-stage liver disease score. Midodrine and a combination of midodrine and clonidine plus SMT were superior to SMT alone in the control of ascites (P=0.05), and there was a trend towards better control of ascites in the clonidine group (P=0.1). The mortality and frequency of various complications were similar in all groups. These results suggest that midodrine, clonidine, and their combination plus SMT improves the systemic hemodynamics without any renal or hepatic dysfunction, and is superior to SMT alone for the control of ascites. However, the combination therapy was not superior to midodrine or clonidine alone.