Frequency Of Serious Complications Research Articles

Echocardiographic Assessment of Mitral Valve Prolapse Prevalence before and after the Year 1999: A Systematic Review.

Background: Over the last five decades, a fair number of echocardiographic studies have evaluated the prevalence of mitral valve prolapse (MVP) in various cohorts of individuals, including heterogeneous study populations. The present systematic review has been primarily designed to summarize the main findings of these studies and to estimate the overall MVP prevalence in the general community. Methods: All echocardiographic studies assessing the MVP prevalence in various cohorts of individuals, selected from PubMed and EMBASE databases, were included. There was no limitation of time period. The risk of bias was assessed by using the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: The full texts of 21 studies with 1354 MVP individuals out of 63,723 participants were analyzed. The overall pooled prevalence of MVP was 4.9% (range of 0.6-21%). When dividing the studies in two groups according to the echocardiographic criteria used for MVP diagnosis (less specific old criteria or more specific new criteria, respectively), the estimated pooled prevalence of MVP was 7.8% (range of 2-21%) for the older studies (performed between 1976 and 1998) and 2.2% (range of 0.6-4.2%) for the more recent ones (conducted between 1999 and 2021). Potential selection bias, hospital- or referral-based series, and the use of less specific echocardiographic criteria for MVP diagnosis have been indicated as the main reasons for the higher MVP prevalence detected by the older studies. MVP was commonly associated with a narrow antero-posterior thoracic diameter, isolated ventricular premature beats and nonspecific ST-T-wave abnormalities on a resting electrocardiogram, mild-to-moderate mitral regurgitation (MR), the reduced probability of obstructive coronary artery disease, and a low frequency of serious complications, such as severe MR, infective endocarditis, heart failure, stroke, and atrial fibrillation. Conclusions: MVP has a low prevalence in the general population, regardless of age, gender, and ethnicity, and is associated with a good outcome.

Outcome after microvascular decompression for trigeminal neuralgia in a single center—relation to sex and severity of neurovascular conflict

BackgroundTrigeminal neuralgia (TN), a severe type of facial pain, is mainly caused by a neurovascular conflict (NVC). The severity of the NVC seems associated with the outcome following microvascular decompression (MVD) surgery. This study aimed to investigate the outcome after MVD and whether it is affected by NVC severity and sex.MethodsTN patients (n = 109) were followed for 5 to 10 years after MVD. Barrow Neurology Index (BNI), Patients Global Impression of Change (PGIC), complications, and time to relapse were evaluated. The NVC severity was retrospectively reviewed from presurgical MRI. Demographic and clinical factors and NVC severity were analyzed for potential association with outcome after MVD.ResultsThe success rate (BNI ≤ 2) was 80% after 5 to 10 years follow-up for TN patients with severe NVC (grade 2–3) and 56% for TN patients with mild NVC (grade 0–1, P = 0.003). No sex difference was observed in outcome for patients with both mild (P = 0.924) and severe NVC (P = 0.883) respectively. Three patients (2.8%) during the hospital stay, and two patients (1.8%) at 6 weeks, experienced a complication requiring invasive treatment. At long-term 52/109 patients (47.7%) reported some type of persistent adverse event, of which the majority were mild and required no treatment.ConclusionsMVD offers an 80% probability of long-term pain relief in TN patients with severe NVC, with low frequency of serious complications. NVC severity significantly affects outcome after MVD, while no sex differences in outcome were found. In consistency with previous work, the results stress the importance of adequate neuroradiological assessment of the NVC for preoperative patient selection.

Living liver donor hilar anatomical variations and impact of variant anatomy on transplant outcomes.

Donor anatomy is an essential part of donor selection and operative planning in living donor liver transplantation. In this study, variations of hilar structures, and the effects of variant anatomy on donor and recipient outcomes were evaluated. Living donor liver transplantations in a single center between January 2013 and December 2020 were retrospectively reviewed. In total, 203 liver transplantations were analyzed. Type 1 arterial anatomy, type 1 portal vein anatomy and type 1 bile duct anatomy were observed in 144 (70.9%), 173 (85.2%), and 129 (63.5%) donors, respectively. Variant biliary anatomy was observed more frequent in donors with variant portal vein branching than in those with type 1 portal anatomy (60.0% vs 32.3%, P = .004). The overall survival rates calculated for each hilar structure were similar between recipients receiving grafts with type 1 anatomy and those receiving grafts with variant anatomy. When donors with variant anatomy and donors with type 1 anatomy were compared in terms of hilar structure, no significant difference was observed in the frequency of complications and the frequency of serious complications. Biliary variations are more common in individuals with variant portal vein anatomy. Donor anatomic variations are not risk factors for inferior results of recipient survival or donor morbidity.

A Prospective Observational Study on the Tolerability of Transnasal Bronchoscopy With a Surgical Mask for Aerosol Control.

BackgroundAs far as we know, there are no reports comparing the safety and cough frequency of transnasal bronchoscopy (TNB) with transoral bronchoscopy (TOB).MethodsThe subjects were 50 patients who underwent either TNB or TOB and completed the pain score questionnaire between May and November 2020. Complications, pain scores, and cough frequency (times per minute) were compared between the patients with TNB and TOB. A surgical mask was worn over the mouthpiece during the examination.ResultsThirty-two and 18 patients underwent TNB and TOB, respectively. Between the two groups, there were no significant differences in examination time and frequency of serious complications. In pain scores, there were no significant differences in terms of anesthesia suffering, several pains during the examination, and availability of re-examination. The TNB group did not feel the prolonged examination time compared to the TOB group (p=0.04). Cough frequency was lower in the TNB group than in the TOB group (0.36 vs 0.73, p=0.027). Moreover, cough frequency in the 25 TNB patients who underwent thin bronchoscopy was significantly lower (0.19 vs 0.73, p<0.01).ConclusionsTNB with a surgical mask was well tolerated and safe. Cough frequency in the transnasal thin bronchoscopy was extremely low, suggesting aerosol reduction can be expected.

Success and unsolved issues of embolization of the uterine arteries in uterine fibroid

Introduction: According to the clinical recommendations of the Healthcare Ministry of Russia (2021), uterine artery embolization (UAE) in uterine fibroid is an alternative to surgical treatment in case of high surgical risk and absence of contraindications in women who do not desire pregnancy. The advantages of UAE are associated with lesser blood loss, shorter hospital stay, and recovery of the working capacity. Here, we present an analysis of the literature and our 14-year clinical experience in performing UAE in uterine fibroid. Screening and primary diagnosis of uterine fibroid and indications and contraindications of UAE in the current publications were analyzed. Different methods of EUA implementation were described, and the advantages of the transradial access (TRA) are demonstrated on the basis of the actual clinical experience.&#x0D; Conclusion: The results obtained in the use of TRA revealed the reduction of radioscopy time and surgery time in general, which are beneficial in terms of the reduction of radiation exposure. Besides, an argument for the given access is a considerably lower frequency of serious complications at the access site. The main obstacles to the introduction and wide use of TRA are based on the lack of specialist experience, absence of specialized training programs, and use of unsuitable and traumatizing instruments. One of the unsolved questions is the absence of an anesthesia protocol, which must be developed with the participation of both gynecologists and specialists on X-ray endovascular diagnostics and treatment.

Infections and Immune System Impairment in Multiple Myeloma: Increasing Frequency of Serious Complications in the “Novel Agents Era”— a Retrospective Real Life Analysis

New treatments options introduced during recent decades have improved the survival of multiple myeloma(MM)patients.Managing the complications of the disease and its treatment, such as infections become more important as MM-patients survive longer. Infections are a significant cause of morbidity and a leading cause of death in MM-patients.Effect of novel therapies on the risk of infection remains to be established and new trials on prophylactic measures are needed.These advances have transformed myeloma into a chronic condition, with multiple relapses resulting in cumulative immunosuppression and higher risk of infection. In addition to the immunodeficiency related to myeloma, the type of anti-myeloma therapy used also plays a role in the development of infectious events.We aimed to study the development of severe infectious events of grade 3-4 requiring often hospitalization in a group of patients under treatment at diagnosis as well as at relapse. We evaluated the impact of the type of anti-myeloma therapy and of the disease features on patients' infectious complications in the context of novel agents.We retrospectively reviewed data from 195 myeloma patients diagnosed from 1999 to 2016 in order to assess type and outcome of infections (Table 1). 7 of these were life-threatening (3 viral interstitial pneumonias and 4 gram negative sepsis)and 103 have resulted in discontinuation of therapy(respectively 73 bacterial, 10 fungal,18 viral and 2 parasitic-infectious-complications). We focus on time of occurrence and number of prior therapeutic lines and on disease biological aggressiveness.Our aim was to define risk-factors and to organize an effective antimicrobial prophylaxis strategy in our cohort of patients.In our analysis 30 patients presented a FUO(fever of unknown origin)without isolation of pathogens.They were 19 elderly-patients and 11 young in a neutropenic phase after chemotherapy. They showed defervescence following antibiotic therapy with piperacillin-tazobactam.165 patients presented infectious complications with a well-known etiology (Figure 1): 100 bacterial, 45 viral, 15 fungal and 5 parasitic infections. Pathogens isolated were:Candida-Albicans followed by C.Parapsylosis and Aspergillus-Flavus among fungal infections,E.Coli,Klebsiella-Pneumoniae and Pseudomonas-aeruginosa between bacterial complications,CMV,HSV,HZV in viral manifestations and Leishmanias among parasitic-events.Advanced age is a meaningful risk-factor togheter with biologically aggressiveness and relapse condition. The majority of patients were older than 65 years (125 as 76%) in a relapse setting (125 as 77%).Kind of anti-myeloma therapy used also plays a role in the development of infection. Specifically the predominant part of patients developing fungal infections(13 as 89%)showed neutropenia after chemotherapy or previous therapy with Imids. The majority of patients with viral infections(39 as 87%) presented lymphopenia and previous therapies bortezomib-based.Bacterial infections have shown mostly prevalent in neutropenic-phases (88 as 88%) usually in relapse phases (78 as 78%)or in hypogammaglobulinemic patients(68 as 68%).Finally most of parasitic infections have been shown after high doses steroid treatment and with more than 2 of therapeutic lines(100%).Severe infections represent a significant comorbidity in MM, often underestimated, in all phases of the disease expecially in refractory/relapsed patients.Immunoglobulin-replacement-therapy or antibiotic-prophylaxis may possible have a protective-role in high risk old patients with high ISS stage and aggressive disease. Variety of factors underlies susceptibility to infections including defects of innate and adaptive-immunity(neutropenia,hypogammaglobulinemia).Need for antimicrobial-prophylaxis depends on risk for and seriousness of infections.Based on our experience,in the first three-months of therapy with IMIDs we now begin prophylactic antibacterial and antifungal therapy (quinolone and fluconazole).All patients treated to date(30 in total)did not require therapy-discontinuation.High-risk-patients should receive antimicrobial-prophylaxis and trials on prophylactic-measures are needed.Key to the management of infection is the understanding of the specific risk factors and periods in order to perform a risk adjusted prophylactic and treatment strategies. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Safe Zones for Spinopelvic Screws in Patients With Lumbosacral Transitional Vertebra.

Retrospective matched-pair analysis. Lumbosacral transitional vertebrae (LSTV) have a reported prevalence of 4-36% in the population. The safe zones for screw placement for spinopelvic fusion in adult spinal deformity surgery for patients with LSTV have not been described in the literature. Our study aimed to assess the safety of S1-pedicle screw (S1PS), S2-alar screw (S2AS), S2-alar-iliac screw (S2AIS), and iliac screw (IS) placement in patients with LSTV. Out of the 819 examined patients, 49 patients with LSTV were included in our retrospective analysis with a matched pair control group. We used the 3-dimensional planning tool mediCAD for screw placement of S1PS, S2AS, S2AIS, IS with different angles, length and diameters. We evaluated a total of 10 192 screw trajectories. No serious complications occurred due to the trajectories used for S1PS. LSTV increased the risk of vessel injury for S2AS trajectories (P = .001) but not for S2AIS (P = .526). Besides the presence of an LSTV, the screw trajectory had a major influence on the frequency of serious complications. Sacral anchoring of long spinal constructions using S1PS, S2AS, S2AIS and IS is also possible in the presence of LSTV. For S2AS the trajectory with 30° lateral and caudal angulation of 10° showed the least vascular injuries and the least sacro-iliac-joint violations in patients with LSTV. S2AIS trajectories with 40° lateral and 0° sagittal angulation reduced the risk of serious complications in our patients collective with LSTV.

Рівні катехоламінів у пацієнтів промислового міста з пароксизмальною фібриляцією передсердь неклапанного ґенезу

Atrial fibrillation is one of the most complex health problems in the world, as the incidence of embolic complications is 2.1 % per year among patients with paroxysmal atrial fibrillation. Currently, atrial fibrillation is considered a potentially fatal arrhythmia, given the wide range of its negative consequences associated not only with a significant deterioration in the quality of life, but also with a significant increase in the frequency of serious complications. One of the most important roles in the genesis of cardiac arrhythmias is played by the sympathoadrenal system. Elevated catecholamines levels have arrhythmogenic properties and may contribute to recurrent arrhythmias. To evaluate catecholamine levels among industrial city patients with non-valvular paroxysmal atrial fibrillation. The daily excretion of norepinephrine in the 1 group was 25.95 [23.10; 32.50] mcg/day, and in the 2 group 27.90 [23.40; 32.80] mcg/day and was significantly higher in the groups of patients by 12.6 and 18.0 %, respectively, compared with the 3 group of healthy individuals, where the level of this indicator was 24.20 [22.60; 26.70] mcg/day (p &lt; 0.05). The level of norepinephrine had the largest area under the curve (AUC = 0.64, 95% CI 0.53-0.74) among the analyzed catecholamines in the urine for the development of recurrent arrhythmia, with a cutoff point &gt; 24.8 mcg/day sensitivity of 75.00% and specificity of 54.41 %. For norepinephrine levels &gt; 24.8 mcg/day, the relative risk of arrhythmia recurrence was 2.63.95 % CI 1.15-6.03. The results obtained in our work indicate the involvement of the sympathoadrenal system in the course of paroxysmal atrial fibrillation. The level of norepinephrine had the highest quality model for the development of arrhythmia recurrence among the analyzed catecholamines, with its level exceeding 24.8 mcg/day increasing the relative risk of arrhythmia recurrence.

Complications Associated With Anesthesia Services in Endoscopic Procedures Among Patients With Cirrhosis.

Anesthesia services for endoscopic procedures have proliferated with the promise of increased comfort and safety. Cirrhosis patients are higher risk for sedation, yet limited data are available describing anesthesia complications in this population. This cross-sectional study utilized the National Anesthesia Clinical Outcomes Registry, a multicenter quality-improvement database from 2010 to 2015. Patients with cirrhosis undergoing an endoscopy were identified by International Classification of Diseases, Ninth Revision (ICD-9)/Current Procedures Terminology (CPT) codes. The outcome of interest was serious anesthesia-related complication defined as cardiovascular, respiratory, neurological, drug related, patient injury, death, or unexpected admission. A mixed-effects multivariate logistic regression model determined odds ratios (ORs) between variables and serious complications, adjusting for potential confounders. In total, 9,007 endoscopic procedures were performed among patients with cirrhosis; 92% were esophagogastroduodenoscopies. The majority (81%) were American Society of Anesthesiologists (ASA) class ≥3, and 72% had a history of hepatic encephalopathy, ascites, varices, hepatorenal syndrome, or spontaneous bacterial peritonitis identified by ICD-9/CPT codes. In total, 87 complications were reported, 33 of which were serious. Frequency of serious complications was 0.4% or 378.6 per 100,000 procedures (95% confidence interval [CI], 260.8, 531.3). The majority of serious complications were cardiovascular (21 of 33), including 15 cardiac arrests. Serious complications were significantly associated with ASA 4/5 (OR, 3.84; 95% CI, 1.09, 13.57) and general anesthesia (OR, 4.71; 95% CI, 1.20, 18.50), adjusting for age, sex, ASA class, anesthesia type, inpatient status, portal hypertension history, and variable complication reporting practices. Anesthesia complications among endoscopic procedures in cirrhosis are rare overall. Serious complications were predominantly cardiac and associated with sicker patients undergoing general anesthesia. The complexity of end-stage liver disease may warrant more intensive care during endoscopic procedures, including anesthesia monitoring.

Update on adherence to a vaccination protocol for invasive bacterial diseases in HIV patients

Abstract HIV+ patients present an increased risk of vaccine-preventable invasive bacterial diseases (IBDs), infections characterized by high lethality and frequency of serious complications. Considering that these patients frequently have to face a complex clinical-care pathway, it has been necessary to design a clear vaccination protocol in order to prevent IBDs and to guarantee adequate patient adherence. In 2013 the Local Health Unit Company of Modena's Public Health Department and the University Hospital of Modena developed a shared vaccination protocol to prevent the most common causes of IBDs: Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae type B. The protocol applies to HIV+ patients receiving antiretroviral therapy who have a CD4 + cell count &amp;gt; 200 cells / µL. It provides the following vaccination schedule: administration of PCV13 + MenACWY vaccines; after 15 days administration of MenB + Hib vaccines; after 45 days administration of the MenB vaccine; after at least 60 days, administration of PPSV23 + MenACWY vaccines. The first vaccination counselling is proactively carried out by the Public Health Department healthcare workers and takes place at the Infectious Diseases Division in order to improve patient acceptance and adherence to the protocol. From October 2013 to January 2020, 503 HIV+ patients (378 males and 125 females) were vaccinated. Among these patients, 338 (67.2%) completed the vaccination schedule; 110 (21.9%) interrupted the schedule, 34 (6.7%) have a vaccination schedule currently underway and 21 (4.2%) never started the planned vaccination protocol. Overall, the percentage of patients who have completed the vaccination schedule or have scheduled appointments is 73.9%. The data analysis shows a high adherence to the protocol thanks to the collaboration between public health and infectious disease specialists, which improves the compliance of patients with a complex clinical-care pathway. Key messages HIV patients present an increased risk of IBDs and require a tailor-made vaccination protocol. Collaboration between specialists improves the compliance of patients with a complex clinical-care pathway.

Impact of a reconstructive stage on the postoperative course in patients with oral cancer

The study objectiveis to assess effect of the reconstructive stage on the course of the postoperative period in patients with oral cancer.Materials and methods.A retrospective analysis of medical records of 174 patients (121 men and 53 women) aged 36 to 84 years (average 58.26 ± 8.72 years) with oral cancer undergoing treatment from January 2009 to June 2016 was performed. Depending on the nature of the reconstructive stage, the patients were divided into 3 groups. The group 1 consisted of 59 patients, to eliminate the defects of which flaps were taken on axial blood supply, the group 2 included 83 patients who had a reconstructive phase of the operation included a microsurgical reconstruction; 32 patients who had not used additional plastic material to eliminate the defect made up the control group. The following parameters were taken as evaluation parameters: the duration of the operation and hospitalization, the time spent in the intensive care unit, the frequency of serious and frivolous complications. The criterion for distinguishing serious and unserious complications is the fact that the patient returned to the operating room.Results.The reconstructive stage increased the operation duration by 72.12 min in the group 1 and by 285.72 min in the group 2, the length of stay in the intensive care unit – by 0.67 and 2.58 days, respectively, the hospital stay – by 33.9 and 40.4 %. The incidence of complications was higher in the groups 1 and 2 than in the control (6.6 %), and the type of reconstruction had almost no effect on it (42.37 % in the group 1 and 38.55 % in group 2). The frequency of serious complications was higher in the group 2, the frequency of partial flap necrosis – in the group 1.Conclusion.The inclusion of a reconstructive stage into the protocol of surgical treatment for oral cancer is absolutely reasonable, because it gives the patients a chance to return to their normal lives. Microsurgical reconstruction is a costly and labour-consuming procedure; however, it has almost the same number of complication as reconstructive surgery with flaps with an axial blood supply.

Treatment Outcomes in the Primary Tube Versus Trabeculectomy Study after 1 Year of Follow-up

To report 1-year treatment outcomes in the Primary Tube Versus Trabeculectomy (PTVT) Study. Multicenter, randomized clinical trial. Two hundred forty-two eyes of 242 patients with medically uncontrolled glaucoma and no previous incisional ocular surgery, including 125 in the tube group and 117 in the trabeculectomy group. Patients were enrolled at 16 clinical centers and assigned randomly to treatment with a tube shunt (350-mm2 Baerveldt glaucoma implant) or trabeculectomy with mitomycin C (MMC; 0.4 mg/ml for 2 minutes). Intraocular pressure (IOP), glaucoma medical therapy, visual acuity, visual fields, surgical complications, and failure (IOP of more than 21 mmHg or reduced by less than 20% from baseline, IOP of 5 mmHg or less, reoperation for glaucoma, or loss of light perception vision). The cumulative probability of failure during the first year of follow-up was 17.3% in the tube group and 7.9% in the trabeculectomy group (P= 0.01; hazard ratio, 2.59; 95% confidence interval, 1.20-5.60). Mean± standard deviation IOP was 13.8±4.1 mmHg in the tube group and 12.4±4.4 mmHg in the trabeculectomy group at 1 year (P= 0.01), and the number of glaucoma medications was 2.1±1.4 in the tube group and 0.9±1.4 in the trabeculectomy group (P < 0.001). Postoperative complications developed in 36 patients (29%) in the tube group and 48 patients (41%) in the trabeculectomy group (P= 0.06). Serious complications requiring reoperation or producing a loss of 2 Snellen lines or more occurred in 1 patient (1%) in the tube group and 8 patients (7%) in the trabeculectomy group (P= 0.03). Trabeculectomy with MMC had a higher surgical success rate than tube shunt implantation after 1 year in the PTVT Study. Lower IOP with use of fewer glaucoma medications was achieved after trabeculectomy with MMC compared with tube shunt surgery during the first year of follow-up. The frequency of serious complications producing vision loss or requiring reoperation was lower after tube shunt surgery relative to trabeculectomy with MMC.

Surgical treatment of hepatocellular carcinoma at Landspitali The National University Hospital of Iceland 1993 - 2012

Hepatocellular carcinoma (HCC) is one of the most common cancers in the world. The incidence in Iceland is very low probably due to a low prevalence of cirrhosis. The only curative treatment is surgery, either transplant or resections, but only about 30% of patients are operable at the time of diagnosis. The aim of this study was to determine the number of patients who undergo liver resection due to HCC and to investigate outcomes after surgery at Landspitali University Hospital in Iceland. A retrospective study of all HCC patients, 18 years of age or older, who underwent surgical resection at Landspitali University Hospital from January 1st 1993 to December 31st 2012. Data was collected from clinical records. Descriptive statistical analysis was used. During the time period 22 patients were operated with a liver resection and of those patients 12 (55%) had a major hepatectomy. 105 individuals in total were diagnosed with HCC in the time period, six patients had transplantation which results in 28 operations (27%). The average size of the tumors was 8.5 cm (3-22). Four individuals had cirrhosis. The frequency of intra-operative complications was 23% and post-operative complications 32% (Clavien-Dindo grade III and IV). A total of three individuals needed reoperation. The 30 day mortality rate was 0%. Twelve (55%) individuals were diagnosed with recurrence during the research period and eleven died. The one year mortality rate was 23%. The proportion of operable individuals with HCC in Iceland is low, few of whom have cirrhosis or other chronic liver disease. The mortality rate is comparable to other researches but the frequency of serious complications is higher probably due to tumor size.

Recognition and management of foreign body ingestion and aspiration.

Foreign body ingestion and foreign body aspiration commonly affect children. The most vulnerable age is between six months and four years, when children tend to explore new objects with their mouths. Many of these events remain asymptomatic, with the swallowed object passing through the gastrointestinal tract without causing harm. However, the frequency of serious complications as a result of the ingestion of hazardous objects has increased in recent years, in particular button batteries and magnets. To increase the likelihood of identifying foreign body ingestion and aspiration, healthcare professionals should maintain a high index of suspicion, be aware of the variation in presentations and include it as a differential diagnosis in children presenting with non-specific symptoms, such as fever, cough, drooling, dysphagia and abdominal pain. Management of most foreign body ingestions is conservative, using a 'watch-and-wait' approach. Children should be triaged as an emergency if they have signs or symptoms of airway obstruction or a history that indicates dangerous foreign body ingestion. Early recognition and management leads to improved outcomes for patients. Nurses have a vital role in providing education and practical advice to parents, which reduces the occurrence of these events. Stronger legislation is required to ensure manufacturers emphasise the potential dangers of certain products and design child-safe devices.

SURAL NEURO-CUTANEOUS FLAP IN THE MANAGEMENT OF FOOT AND ANKLE SOFT TISSUE DEFECTS IN A DIABETIC POPULATION.

Soft tissue defects in the foot and ankle region are challenging conditions particularly in diabetic patients. We evaluated the reliability of the sural flap in treating such defects among a diabetic population. This is a continuous retrospective series of 14 patients with type 2 diabetes treated with an ipsilateral sural flap for soft tissue defects around the rear foot (11 cases) and over the malleolar areas (3 cases). Three patients had an open tibia fracture (Gustillo IIIb), four had chronic osteitis and seven had a chronic heel ulcer. The mean follow-up at 28 months showed healing of the flap at a mean of 24 days, donor site healing in two weeks, one case of total flap necrosis, three cases of skin edge necrosis, two cases of temporary venous congestion and 10 cases of hypoesthesia of the lateral border of the foot. No infection or recurrence of infection was encountered. We found the sural flap useful, reproducible and reliable in treating soft tissue defects in diabetic patients with a low frequency of serious complications.

Metastatic bone disease in the era of bone-targeted therapy: clinical impact.

Advances in the diagnosis and treatment of tumors by surgery, chemotherapy, biotherapy, radiotherapy and other modalities have increased the survival of cancer patients over the last 20 years. As a consequence, bone now represents the third most common site of metastatic involvement after the lung and liver. Approximately 20-25% of patients with neoplastic disease develop clinically evident bone metastases (BMs) during the natural course of their illness, with a further 50% of such lesions being identified during autopsy. BMs are the major cause of morbidity in cancer patients because of their epidemiological and clinical impact. Pain is the most frequent symptom in about 75% of patients but other serious complications can also occur, such as pathological fractures, spinal cord compression, hypercalcemia and bone marrow suppression. These complications worsen the patient's general condition and reduce patients' mobility, facilitating the development of lung infections, skin ulcers, deep vein thrombosis, etc., and ultimately reducing prognosis and quality of life. The frequency of serious complications depends on the site and type of lesions and the treatment administered. Over the last 10 years, the introduction of bisphosphonates for the treatment of patients with BMs has led to a marked decrease in the frequency of complications, thus improving quality of life and clinical outcome. Furthermore, progress in understanding the pathophysiology of bone metastases has resulted in the development of new bone-targeted molecules such as denosumab. We therefore felt it would be useful to report on the epidemiological, clinical and economic impact of bone disease in a cancer setting.

Malnutrition is related to a higher frequency of serious complications in patients with cirrhosis

IntroductionPatients with cirrhosis are at risk of malnutrition and this has been recognized as a predictor of morbidity and mortality. The aim of this study was to compare the frequency of serious complications (variceal bleeding, ascites, hepatic encephalopathy and infections) between cirrhotic patients with and without malnutrition. Subjects and methodsAn observational, analytic, cross-sectional study. The nutritional status of cirrhotic patients was evaluated according to Subjective Global Assessment (SGA). Characteristics of cirrhotic patients with and without malnutrition were compared. Results103 cirrhotic patients were included, 58 (56.3%) were women; the media of age was 55±12.2 years. According to SGA, 45 patients (43.7%) were classified as well-nourished, and 58 (56.3%) as malnourished. The development of serious complications was related to nutritional status. Malnourished patients had higher frequency of development of ascites (67.2% vs. 42.2%, P=0.01, OR=2.8; 95% CI: 1.3–6.3) and infections (21.4% vs. 6.7%, P=0.03, OR=4.5; 95% CI: 1.2–16.6). ConclusionsThe presence of serious complications, such as, ascites and development of bacterial and fungal infections, was more frequent between cirrhotic patients with malnutrition than in those well-nourished.

Spondylodiscitis After Ingestion of a Lithium Button Battery: A Case Report.

Ingestion of a foreign body is a common problem in the pediatric population. Disc or button batteries represent an important category of foreign body ingestion because of the potential for serious complications if they are not removed promptly. Although the incidence of ingestions involving button batteries has leveled off, the frequency of serious complications from these ingestions has continued to rise1. Orthopaedic sequelae, however, remain rare1. We present the case of a nineteen-month-old girl who developed spondylodiscitis after ingesting a lithium button battery. The patient’s family was informed that data concerning the case would be submitted for publication, and they provided consent. A nineteen-month-old girl presented to the emergency department as a transfer from another hospital after chest radiographs showed a 20-mm disc-shaped foreign body lodged in the esophagus (Figs. 1-A and 1-B). The parents reported that the child had decreased oral intake and increased salivation over the twenty-four hours before presentation. The patient was urgently taken to the operating room and underwent the uncomplicated removal of a lithium button battery under direct visualization with a rigid esophagoscope. During the procedure, it was noted that there was substantial coagulative necrosis around the esophagus and around the foreign body, suggesting that it had been present for a prolonged period of time. The area of necrosis appeared to be less than full thickness in extent. On the first postoperative day, the patient underwent an esophagogram that was consistent with esophageal inflammation; there was no leakage of contrast. She was slowly advanced from a clear liquid diet, as recommended by the National Battery Ingestion Hotline of the National Capital Poison Center, and was discharged to home uneventfully. Fig. 1 Anteroposterior ( Fig. 1-A ) and lateral ( Fig. 1-B ) radiographs at initial presentation showing the button battery lodged in the esophagus. The patient initially …

Nationwide biopsy survey of renal diseases in the Czech Republic during the years 1994–2011

We describe data on 10,472 renal biopsies gathered by the Czech Registry of Renal Biopsies over a period of 18 years. We assessed the main demographic, clinical and histological data of individuals who underwent renal biopsies of native kidneys in 31 centers in the Czech Republic (population 10.3 million) during the period 1994-2011. We evaluated 10,472 renal biopsies: males 57.8%, children (≤15 years) 13.6%, elderly (>60 years) 19.1%. The most frequent biopsy-proven diseases were primary (55.7%) and secondary (29.1%) glomerulonephritides (GN). Tubulointerstitial nephritis (TIN) was observed in 3.4 % and vascular diseases in 4.1%. The samples were non-diagnostic in 4.2%. Among primary GN the most frequent diagnoses were IgA nephropathy (IgAN) (37.4%), membranous GN (MGN) (13%) and focal segmental glomerulosclerosis (FSGS) (12.6%). Among secondary GN, systemic lupus erythematosus (SLE) represented 23.2%, hereditary diseases 19.8% and necrotizing vasculitis (NV) 19.4%. Among adults, mild renal insufficiency [serum creatinine (SCr) 111-200 μmol/l] was present in 24.7%, advanced renal insufficiency (SCr 201-400 μmol/l) in 15.3, and 12.3% of patients had SCr > 400 μmol/l. The most common diseases in patients with nephrotic proteinuria were minimal change disease (MCD) (39.7%) among children, IgAN (26.2%) in adults aged 16-60 years and amyloidosis (42.7%) among the elderly. The mean annual incidence (per million population) was: primary GN 30.9, secondary GN 18.1, IgAN 11.6, MGN 4.0, SLE 4.0, FSGS 3.9, MCD 3.4, NV 3.2, diabetic nephropathy 2.3, thin basement membrane glomerulopathy 2.0, mesangioproliferative GN 1.9, and TIN 1.9. Ultrasound needle guidance was used in 66.8%. The frequency of serious complications (symptomatic hematoma, gross hematuria, blood transfusion) was approximately 3.2%. This report provides representative population-based data on native biopsy-proven renal diseases in the Czech Republic. Over the 18 years of nationwide biopsy survey, we noted an increase of the mean age of renal biopsy cases, an increasing proportion of elderly, and a cardinal change in biopsy technique towards ultrasonography needle guidance.

Presenting features of newly diagnosed rheumatic heart disease patients in Mulago Hospital : a pilot study : cardiovascular topics

Rheumatic heart disease (RHD) continues to cause gross distortions of the heart and the associated complications of heart failure and thromboembolic phenomena in this age of numerous high-efficacy drugs and therapeutic interventions. Due to the lack of contemporary local data, there is no national strategy for the control and eradication of the disease in Uganda. This study aimed to describe the presenting clinical features of newly diagnosed patients with RHD, with particular reference to the frequency of serious complications (atrial fibrillation, systemic embolism, heart failure and pulmonary hypertension) in the study group. One hundred and thirty consecutive patients who satisfied the inclusion criteria were recruited over a period of eight months from June 2011 to January 2012 at the Mulago Hospital, Uganda. Data on demographic characteristics, disease severity and presence of complications were collected by means of a standardised questionnaire. Seventy-one per cent of the patients were female with a median age of 33 years. The peak age of the study group was 20 to 39 years, with the commonest presenting symptoms being palpitations, fatigue, chest pain and dyspnoea. The majority of the patients presented with moderate-to-severe valvular disease. Pure mitral regurgitation was the commonest valvular disease (40.2%), followed by mitral regurgitation plus aortic regurgitation (29%). Mitral regurgitation plus aortic regurgitation plus mitral stenosis was found in 11% of patients. There was only one case involving the tricuspid valve. The pulmonary valves were not affected in all patients; 45.9% of patients presented in severe heart failure in NYHA class III/IV, 53.3% had pulmonary hypertension, 13.9% had atrial fibrillation and 8.2% had infective endocarditis. All patients presented with dilated atria (> 49 mm). A significant proportion of RHD patients present to hospital with severe disease associated with severe complications of advanced heart failure, pulmonary hypertension, infective endocarditis and atrial fibrillation. There is a need to improve awareness of the disease among the population, and clinical suspicion in primary health workers, so that early referral to specialist management can be done before severe damage to the heart ensues.