Incidence Of Severe Complications Research Articles

Digital subtraction angiography-guided esophagography, intraluminal drainage, and endoscopic clipping–complex managements for intrathoracic esophagogastric anastomotic leak

BackgroundIntrathoracic esophagogastric anastomotic leak is a critical complication after esophagectomy. Recently, novel complex diagnostic and therapeutic managements for intrathoracic esophagogastric anastomotic leak have been performed at our institution. Materials and methodsSixty-seven consecutive patients with intrathoracic esophagogastric anastomotic leak after esophagectomy from January 2009 to May 2015 at our institution were reviewed. Thirty-nine patients received conventional managements (conventional group), in which they were diagnosed via contrast swallow when there was a suspicion of anastomotic leak and were subsequently treated with a metallic stent. Twenty-eight patients received complex managements (complex group), in which they were diagnosed using digital subtraction angiography, an intraluminal drainage tube was placed, and clips were subsequently performed under an endoscope. The outcomes of the two groups were retrospectively analyzed. ResultsThere were no significant differences (P > 0.05) between the two groups in the preoperative general clinical data, whereas the postoperative data exhibited some differences. Compared with the conventional group, the confirmation time and recovery time are significantly decreased in the complex group (P < 0.01 and P < 0.01, respectively), and the incidence of severe complications is also lower (P < 0.01); however, there were no significant differences in the mortality rate between the two groups (P > 0.05). ConclusionsComplex managements may represent a useful therapeutic option for postoperative esophagogastric anastomotic leak.

Comparison of two kinds of noninvasive ventilation mode in premature infants with respiratory failure

Objective To investigate the difference of two models of respiratory failure in preterm infants with nasal continuous positive airway pressure(nCPAP) and nasal biphasic positive airway pressure(nBiPAP). Methods Comparative analysis of 81 cases of premature infants with respiratory failure requiring respiratory support was needed.They were applied nCPAP and nBiPAP ventilation mode treatment.The use of breathing machine and total oxygen inhalation time, the number of treatment failures, the PEEP parameters of the ventilator, the total number of recent complications and secondary infections were compared. Results In the nBiPAP treatment group, the average time of noninvasive ventilation was(96.34 ± 31.5)h, the total time of oxygen inhalation was(10.11 ± 9.39)d, 3 cases of treatment failure, the incidence of severe complications was 5.56%(2/36), PEEP(4.08±0.73)cmH2O(1 cmH2O=0.098 kPa). In the nCPAP group, the average time of noninvasive ventilation was(114.14±41.69)h, the total time of oxygen inhalation was(17.53±15.96)d, 15 cases were failed, the incidence of severe complications was 15.56%(7/45), PEEP(5.11±1.01)cmH2O.There were significant differences between the two groups(P 0.05). Conclusion nBiPAP as one of the first choice treatment for premature infants with respiratory failure significantly better than nCPAP, as soon as the proper use can avoid invasive ventilation. Key words: Positive airway pressure; Mechanical ventilation; Preterm infants; Newborn; Respiratory failure

Evaluation of the Short- and Long-Term Outcome Predictors in Patients Undergoing Posterior Pelvic Exenteration: A Single-Center Experience

Background: Pelvic exenteration (PE) is a radical surgery and is actually used to manage advanced cancers of differing origins. Risk factors for poor prognosis, correlated to this intervention, have been partially evaluated; thus it is useful to make an accurate assessment of the predictors correlated to short- and long-term outcomes with use of PE. Materials and Methods: A retrospective review was conducted involving 28 patients who underwent posterior PE, with curative intent; the procedure was performed for gynecologic and nongynecologic neoplasms at the University of Messina, Messina, Sicily, Italy. Results: The overall morbidity rate was 46.4%, the incidence of severe complications (grade 3/4) was 14%, and the perioperative mortality was 7.1%. A median survival of 29 months was recorded for the entire sample, with 3- and 5-year overall survivals of 37.5% and 16.7%, respectively. Conclusions: The only factor—when using a multivariate model—that was significantly associated with morbidity was Eastern Cooperative Oncology Group (ECOG) performance status. This study demonstrated that the origins of primary cancers did not affect patients' long-term survival significantly, while higher numbers of anastomoses, major complications, and, above all, higher ECOG scores were associated with shorter long-term survival. Based on the experience illustrated in this study, it is fundamentally important to select patients for treatment, paying special attention to their ECOG scores. (J GYNECOL SURG 32:84)

Diagnosis and treatment for intrathoracic gastroesophageal anastomotic leak: investigation of a new mode

To investigate the feasibility of a new mode to diagnose and treat intrathoracic gastroesophageal anastomotic leak. From January 2007 to December 2014, fifty-five patients were confirmed intrathoracic gastroesophageal anastomotic leak among those were performed surgical operation due to esophageal or cardiac carcinoma in the First Affiliated Hospital of Soochow University. To retrospectively analyze the clinical data of these patients, thirty-six male and nineteen female were included with the ages from 49 to 81 years (average age of (67±6)years). Among them, forty-two were middle esophageal carcinoma, eleven were lower esophageal carcinoma and two were cardiac carcinoma. According to the differences of diagnosis and treatment methods for anastomotic leak, fifty-five patients were divided into two groups. Thirty-one patients distributed from January 2007 to November 2011 were received conventional management (conventional group): to definitively diagnose by contrast swallow when suspected to be developing anastomotic leaks, to place an esophageal stent when the drainage was sufficient and the infection was controlled. Twenty-four patients distributed from March 2011 to December 2014 were received new-mode management (new-mode group): to perform a anastomotic radioscopy under digital subtraction angiography -guidance instantly when suspected anastomotic leak and find out the fistula, search the shape and size, place a drainage tube into the fistula to drain or lavage the vomica according to the exploration results, pull back the tube gradually and close the leak by clips under endoscope later. The pathoclinical features, the confirmation time (time from clinical signs emergence to leak confirmation), the hospital duration after confirmation, the incidence of severe complications and total mortality were compared between the two groups by t-test and χ(2) test or Fisher's exact test. There was no significant statistical differences in pathoclinical features between two groups (P>0.05). The confirmation time was significantly reduced in new-mode group than that in conventional group ((1.2±0.8) d vs. (3.6±2.2) d, t=5.212, P=0.000), and so was the hospital duration after confirmation ((26±12) d vs. (55±25) d, t=4.992, P=0.000) and the incidence of severe complications (16.7% vs. 48.4%, χ(2)=6.019, P=0.014), although there was no statistical differences in total mortality (4.2% vs. 22.6%, P=0.119). The new mode of early interventional diagnosis, early fistula drainage through nose and clipping under endoscope later is able to shorten diagnosis and treatment period, reduce incidence of severe complications.

Major Gastrointestinal Cancer Resections in the Elderly in India: Poised for Future Challenges

Background: There are no data on surgical outcomes of major gastrointestinal cancer resections in the expanding Indian oncogeriatric population. Methods: A prospective database of patients who underwent major gastrointestinal cancer resections during varying time periods (2006-2014) was analyzed retrospectively. Results: Two thousand six hundred and forty three patients with a median age of 53 were analyzed. Four hundred and seventy two (17.9%) patients were aged ≥65 years and 235 (8.9%) patients were ≥70 years. Mortality rates were not significantly higher in the elderly (≥65 years) or the very elderly (≥70 years) when compared to younger controls, being 2.8 vs. 1.6% (p = 0.09) and 3.0 vs. 1.7% (p = 0.162) respectively. Overall morbidity was similar for patients ≥65 or <65 years (24.2 vs. 21.7%, p = 0.253), but was higher in patients ≥70 years (29.8 vs. 21.4%, p = 0.003). The incidence of severe complications, however, was not significantly greater in this age group (13.2 vs. 12.5%, p = 0.74). Conclusions: Major gastrointestinal cancer resections in the elderly Indian population, though uncommon, are safe when performed at experienced high volume centres. These results should serve as a starting point for the gradual development of dedicated oncogeriatric programs in the Indian subcontinent.

A comparison between two methods for tumor localization during totally laparoscopic distal gastrectomy in patients with gastric cancer.

PurposeThe aim of this study was to compare two methods of tumor localization during totally laparoscopic distal gastrectomy (TLDG) in patients with gastric cancer.MethodsFrom March 2014 to November 2014, patients in whom TLDG had been engaged for middle third gastric cancer enrolled in this study. The patients were allocated to either the radiography or endoscopy group based on the type of tumor localization technique. Clinicopathologic outcomes were compared between the 2 groups.ResultsThe accrual was suspended in November 2014 when 39 patients had been enrolled because a failed localization happened in the radiography group. The radiography and endoscopy groups included 17 (43.6 %) and 22 patients (56.4 %), respectively. Mean length of the proximal resection margin did not differ between the radiography and endoscopy groups (4.0 ± 2.6 and 2.8 ± 1.2 cm, respectively; P = 0.077). Mean localization time was longer in the radiography group than in the endoscopy group (22.7 ± 11.4 and 6.9 ± 1.8 minutes, respectively, P < 0.001). There were no statistically significant differences in the incidence of severe complications between the 2 groups (5.9% and 4.5%, respectively, P = 0.851).ConclusionAs an intraoperative tumor localization for TLDG, radiologic method was unsafe even though other comparable parameters were not different from that of endoscopy group. Moreover, intraoperative endoscopic localization may be advantageous because it is highly accurate and contributes to reducing operation time.

Aloe vera and Vitis vinifera improve wound healing in an in vivo rat burn wound model.

Aloe vera and Vitis vinifera have been traditionally used as wound healing agents. The present study aimed to investigate the effects of aloe emodin and resveratrol in the burn wound healing procedure. Burn wounds are common in developed and developing countries, however, in developing countries, the incidence of severe complications is higher and financial resources are limited. The results of the present study demonstrated that neither aloe emodin or resveratrol were cytotoxic to THP-1 macrophages at concentrations of 1, 100 and 500 ng/ml. A significant increase in wound-healing activity was observed in mice treated with the aloe emodin and resveratrol, compared with those which received control treatments. The levels of IL-1β in the exudates of the burn wound area of the treated mice increased in a time-dependent manner over 7 days following burn wound injury. At 10 days post-injury, steady and progressive wound healing was observed in the control animals. The present study confirmed that increased wound healing occurs following treatment with aloe emodin,, compared with resveratrol, providing support for the use of Aloe vera plants to improve burn wound healing.

Prospective assessment of complications on a daily basis is essential to determine morbidity and mortality in routine pediatric surgery

Aims of the studyWe aimed to assess postoperative complications prospectively on a daily basis and hypothesized that this would lead to an increase in the number of detected complications. MethodsSurgical complications were assessed prospectively during a period of 8months. Systematic documentation was carried out daily during a team meeting (period S). Data were compared to those of a preceding period of 8-months of nonsystematic assessment (period N) in which complications had been documented in a self-reporting fashion. Complications were classified according to the Clavien–Dindo classification. ResultsA total of 1291 patients (mean age: 6.6years) were included. During period S complications were determined in 16% of 790 operations compared to 4% of 741 procedures in period N (p<0.01). This difference was owing to an increased detection of minor complications (grade I–III), i.e. wound infection, dysuria after hypospadias repair or postoperative bleeding. In contrast, the incidence of severe complications (grade IV+V) was not significantly different between the time periods (1.3% in period S and 0.8% in period N). Most frequent major complications were cardiopulmonary arrest, enterocolitis, and death. Severe complications accounted for 8% of complications discussed during weekly morbidity and mortality conferences in period S versus 22% in period N (p<0.05). ConclusionOur results indicate that a systematic documentation of complications on a daily basis reveals a more realistic picture of the incidence of pediatric surgical complications and should be the method of choice.

Verification of inferior right hepatic vein-conserving segments 7 to 8 resection of the liver.

This study aims to investigate the safety of inferior right hepatic vein (IRHV)-conserving surgery by comparing the surgical data and postoperative complications between IRHV-conserving segments 7 to 8 (S7 to S8) resection and conventional right hemihepatectomy (RH). Five patients who underwent IRHV-conserving S7 to S8 segmentectomy between 2007 and 2011 (IRHV group) and 25 liver cancer patients who underwent RH without biliary tract reconstruction during the same period (RH group) were investigated. The surgical data, postoperative complications, and duration of hospital stay were compared. The IRHV and RH groups included 2 (40%) and 13 (52%) hepatocellular carcinoma patients, respectively. There were no significant differences in liver function before surgery between the groups. The presence of the IRHV did not adversely affect the processing of the short hepatic vein or frontal dissection of the inferior vena cava. The operative time was shorter (median, 366 minutes versus 501 minutes; P = 0.0001), the postoperative bilirubin level was lower (12 mg/dL versus 1.8 mg/dL; P = 0.037), and the duration of hospital stay was shorter (10 days versus 14 days; P = 0.002) in the IRHV group. No significant differences were noted in the intraoperative blood loss, postoperative transaminase levels, or the incidence of severe complications (Clavien grade IIIb or higher) between the groups. IRHV-conserving resection of the liver is a safe surgical procedure that is useful in preventing postoperative elevation of bilirubin level and in shortening the duration of hospital stay.

Prevalence and Predictors of Postoperative Complications in Patients Older Than 80 Years

Background: The number of elderly patients undergoing surgery is steadily growing. Therefore, this study was designed to determine the prevalence and predictors of postoperative complications in patients older than 80 years. Methods: The medical records of 532 patients above 80 years in age who underwent elective or emergent noncardiac surgery between June 2011 and May 2013 were reviewed retrospectively. Preoperative concomitant disease, operation site, anesthetic technique, and postoperative complications were analyzed. Results: A total of 81.4% of the patients had pre-existing concomitant diseases, while 22.9% had severe systemic diseases. The incidence of severe complications within the first month after operation was 4.1%, and the in-hospital mortality rate was 1.3%. Among the severe postoperative complications, respiratory and cardiovascular complications were commonly observed. In multivariate logistic regression analysis, the predictors of postoperative severe complications included American Society of Anesthesiologists physical status classification of 3 or greater (odds ratio [OR], 5.271; 95% confidence interval [CI], 2.019-13.758; p=0.001), neurosurgery (OR, 23.132; 95% CI, 2.528-211.707; p=0.005) and duration of operation (OR, 1.006; 95% CI, 1.001-1.012; p=0.027). Conclusion: Proper preoperative evaluation and appropriate treatment for age-related concomitant diseases are suggested for patients older than 80 years in order to reduce postoperative complications. After operation, the respiratory and cardiovascular systems should be carefully monitored.

Assessment of Age in Ulcerative Colitis Patients with Ileal Pouch Creation—An Evaluation of Outcomes

The aim of the study was to determine if age at the creation of an ileal pouchanal anastomosis (IPAA) has an impact on the outcomes in patients with ulcerative colitis (UC). A retrospective review of all patients who underwent IPAA for UC from 1999 to 2011 was performed. Long-term functional outcome was assessed using both the Cleveland Clinic and St Mark's incontinence scores. Eighty-nine patients, with a median age of 46 (range, 16 to 71) years, formed the study group. The median duration of disease prior to their pouch surgery was 7 (0.5 to 39) years. There were 57 (64%) patients who were aged ≤50 years old and 32 (36%) who were >50 years old. Fifty-seven (64%) patients developed perioperative complications of which 51 (89.5%) were minor. High ileostomy output (n = 21, 23.6%) and urinary symptoms (n = 13, 14.6%) were the most commonly encountered complications. The older patients were more likely to have an ASA score ≥3 and a longer length of stay. Although there was a higher incidence of complications in the older group of patients, the difference was not statistically significant. There were no significant differences in the incidence of severe complications. Forty-nine (55%) patients completed our questionnaire on the evaluation of their functional outcomes. There were no significant differences in the Cleveland Clinic and St Mark's incontinence scores between the older (n = 19, 38.8%) and younger (n = 30, 61.2%) patients. There were also no significant differences in the frequency of bowel movements during the day or overnight after sleep between the 2 groups. IPAA procedure for patients with UC can be safely performed. Long-term functional outcome is not significantly influenced by the age at which the IPAA was created.

Posttransplant lymphoproliferative disorders following liver transplantation: Where are we now?

Liver transplantation has emerged as a life-saving treatment for several patients with acute liver failure, end stage liver disease and primary hepatic malignancies. However, long term immunosuppressive therapy aiming to reduce the risk of transplant rejection increases the incidence of several complications including malignancies. This is illustrated by the observation of a high ratio between observed and expected cases of lymphoproliferative disorders following liver transplantation. Despite a huge heterogeneity in morphological appearance of these disorders ranging from reactive-like lesions to real lymphomas, they are collectively termed posttransplant lymphoproliferative disorders. In this review we will provide an overview of this rare but challenging disorder as a complication of liver transplantation.

Pediatric head and neck complications of Streptococcus pneumoniae before and after PCV7 vaccination.

To discuss pediatric head and neck complications of pneumococcal infections before and after the introduction of the PCV7 vaccine. Cross-sectional analysis of a national database. Kids National Inpatient Database. A retrospective review of the Kids National Inpatient Database yielded 31,738 pediatric reports involving complications of meningitis, mastoiditis, periorbital cellulitis, and Bezold abscesses due to Streptococcus pneumoniae diagnoses. Each report was analyzed for incidence, length of stay, mean hospital cost, and inpatient admittance from the emergency department. Finally, we calculated the expected annual incidence of each complication via variance-weighted analysis to determine the expected incidence if the vaccine was not administered. We identified a significant decrease in the incidence of several complications after the introduction of the PCV7 vaccine and also when comparing these findings to our predicted incidence calculations if the vaccine was not administered. Inpatient admittance from the emergency department for Bezold abscess, periorbital cellulitis, mastoiditis, and meningitis was significantly increased in the pediatric age group (ages 1-4; P < .05). Furthermore, there was a significant increase in the cost to provide care for each of the described conditions (P < .05). The PCV7 vaccine produced a measurable reduction in head and neck complications associated with S pneumoniae. However, our data suggest that these benefits were also met with increased inpatient admittance from the emergency department, hospital costs, and length of stay, each of which may be attributed to the selection of a more pathogenic subtype.

Efficacy analysis of radiofrequency ablation of hepatocellular carcinoma guided by ultrasound combined with preoperative three-dimensional reconstruction

Objective To investigate the efficacy of radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) guided by ultrasound combined with preoperative three-dimensional reconstruction.Methods The clinical data of 96 patients with HCC who were admitted to the Affiliated Tumor Hospital of Guangzhou Medical University from January 2009 to December 2012 were retrospectively analyzed.All the 96 patients were with solitary tumor,and the diameters of the tumor ranged between 3 and 5 cm.Forty-three patients received RFA of HCC guided by ultrasound combined with preoperative three-dimensional reconstruction and were in the RFA group ; 53 patients with small HCC who received surgical resection were in the resection group.The efficacy of the treatment in the 2 groups was compared.Patients were followed up by out-patient examination or phone call till March 31,2014.The count data were analyzed using the chi-square test or Fisher exact probability,the survival curve was drawn by Kaplan-Meier method,and the survival rates of the 2 groups were compared using the Log-rank test.Results The complete ablation rate of the RFA group was 95.3％ (41/43).Of the 53 patients in the resection group,32 received wedge resection,17 received local resection of the tumor and 4 received anatomical lobectomy.The incidences of severe complications in the RFA group and the resection group were 4.7％ (2/43) and 24.5％ (13/53),with no significant differences between the 2 groups (x2 =2.385,P ＜ 0.05).One patient in the RFA group and 3 in the resection group missed the follow-up.Needle tract implantation was not observed in the RFA group.The 1-,2-,3-year tumor recurrence rates were 21.8％,44.9％ and 50.4％ in the RFA group,and 26.4％,36.8％ and 49.4％ in the resection group.There was no significant difference in the 3-year tumor recurrence rate between the 2 groups (x2 =0.000,P ＞ 0.05).The 1-,2-,3-year overall survival rates were 90.6％,76.1％ and 57.9％ in the RFA group,and 88.5％,73.4％ and 65.3％ in the resection group.There was no significant difference in the 3-year overall survival rate between the 2 groups (x2 =0.000,P ＞ 0.05).Conclusions For small HCC with diameter ranged between 3 and 5 cm,RFA guided by ultrasound combined with preoperative three-dimensional reconstruction could improve the success rate of complete ablation rate with less complications,and the efficacy is similar to that of surgical resection. Key words: Liver neoplasms ; Three-dimensional reconstruction ; B ultrasound ; Efficacy

The impact of maternal obesity, age, pre-eclampsia and insulin dependent diabetes on severe maternal morbidity by mode of delivery-a register-based cohort study.

To determine the rate of severe maternal morbidity related to delivery by delivery mode and to assess if the impact of studied risk factors varies by delivery mode. A register-based study including all women having singleton delivery in Finland in 2007-2011, n = 292,253, data derived from the Finnish Medical Birth Registry and Hospital Discharge Registry. Diagnoses and interventions indicating a severe maternal complication were searched and the mode of delivery was assessed by data linkage. The impact of obesity, maternal age 35 years or more, pre-eclampsia and insulin dependent diabetes on severe maternal morbidity (all severe complications, severe infections and severe) was studied in each mode of delivery and calculated as Odds ratios. The overall incidence of severe complications was 12.8/1,000 deliveries. The total complication rate was lowest in vaginal deliveries (VD) in all risk groups. Obesity increased the risk for all severe complications and severe infections in the total population, but not significantly in specific delivery modes. Age increased the risk of hemorrhage in VD. Pre-eclampsia increased the risk for hemorrhage in all deliveries except elective CS. In women with pre-eclampsia, overall morbidity was similar in VD, attempted VD and elective CS. The presence of any studied risk factor increased the risk for complications within the risk groups by the high proportion of emergency CS performed. An attempt of VD is the safest way to deliver even for high-risk women with the exception of women with pre-eclampsia, who had a similar risk in an attempt of VD and elective CS.

Socio Economic Status May Affect Live Liver Donation and Not Post-Transplantation Outcomes.

Poor socio-economic status (SES) has been associated with worse outcomes and survival in liver transplantation. The effect of SES within the Canadian universal health care coverage remains unclear. We evaluated the effect of SES using census information and recipient postal codes. Methods: Dichotomic variables were examined using fischer's exact, continuous variables using student-t or mann-whitney. Cox regression and Kaplan-Meier using log-rank were used to calculate hazard-ratio and survival. RESULTS: We performed 1630 liver transplants between 2000 and 2012, mean income was $46460. Gender adjusted income was lower in those who received a live donation $45789 vs. $46708 (p=0.021). However, women were more are more likely to receive a live donation with an income threshold of over 40k (15% vs.8%, p=0.008), and were less likely to develop NODAT (15% vs. 29% p=0.035). Hepatitis C and Alcoholic Cirrhosis are less common indications in men when the 45k income threshold is crossed (p=0.001). Median length of stay was 4 days lower in the overall income group over 45k. Incidence of severe complications (Clavien 3 and 4) were similar between income groups (p=0.10). Income adjusted by gender did not negatively affect immediate post-transplant complications. CONCLUSION: Gender adjusted income disparities may have an effect on live donation, length of stay, and underlying liver disease. Lower SES does not negatively influence complications or survival.

Congenital aural atresia and stenosis: Surgery strategies and long-term results

Objective: To compare the patients who underwent surgery for congenital aural atresia (CAA) with congenital aural stenosis (CAS) for the stability of hearing results and complications during long-term follow-up. Design: Retrospective review. Study sample: Seventy-five CAA patients and fifty CAS patients who underwent congenital meatoplasty with canalplasty and tympanoplasty between 2007 and 2012. Results: Paired comparison analyses detected no significant difference in preoperative ABG but significant changes in postoperative ABG, ΔABG, the number of ABG < 30 dB and ABG < 10 dB between CAA and CAS. Complications such as postoperative stenosis, bony regrowth, external aural canal (EAC) infection, EAC eczema, total deaf, and lateralization of the tympanic membrane (TM) were observed in 61.3% of patients with CAA and 20% of patients with CAS. Chi square test detected significant differences in complications between patients with CAA and CAS (χ2 = 20.73, p < 0.01). Conclusion: Meatoplasty with canalplasty and tympanoplasty in individuals with CAS can yield reliable and lasting positive hearing results with a low incidence of severe complications. The existence and preoperative condition of patients’ TM and EAC skin helped improve hearing results and decrease the incidence of complications. However, the final hearing results and complications required stricter indications for CAA patients.

Dengue human infection models supporting drug development.

Dengue is a arboviral infection that represents a major global health burden. There is an unmet need for effective dengue therapeutics to reduce symptoms, duration of illness and incidence of severe complications. Here, we consider the merits of a dengue human infection model (DHIM) for drug development. A DHIM could allow experimentally controlled studies of candidate therapeutics in preselected susceptible volunteers, potentially using smaller sample sizes than trials that recruited patients with dengue in an endemic country. In addition, the DHIM would assist the conduct of intensive pharmacokinetic and basic research investigations and aid in determining optimal drug dosage. Furthermore, a DHIM could help establish proof of concept that chemoprophylaxis against dengue is feasible. The key challenge in developing the DHIM for drug development is to ensure the model reliably replicates the typical clinical and laboratory features of naturally acquired, symptomatic dengue.

MP71-02 A COMPARISON OF MORBIDITY ASSOCIATED WITH TRANS-URETHRAL RESECTION OF THE PROSTATE (TURP) AND TRANSVESICAL PROSTATECTOMY (TVP) FOR PATIENTS WITH PROSTATE VOLUME 80 – 110G

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II1 Apr 2014MP71-02 A COMPARISON OF MORBIDITY ASSOCIATED WITH TRANS-URETHRAL RESECTION OF THE PROSTATE (TURP) AND TRANSVESICAL PROSTATECTOMY (TVP) FOR PATIENTS WITH PROSTATE VOLUME 80 – 110G Elcio Nakano, Eduardo M. Yoshinaga, Giovanni Marchini, Paulo Cordeiro, Fabio Tanno, Miguel Srougi, and Alberto Antunes Elcio NakanoElcio Nakano More articles by this author , Eduardo M. YoshinagaEduardo M. Yoshinaga More articles by this author , Giovanni MarchiniGiovanni Marchini More articles by this author , Paulo CordeiroPaulo Cordeiro More articles by this author , Fabio TannoFabio Tanno More articles by this author , Miguel SrougiMiguel Srougi More articles by this author , and Alberto AntunesAlberto Antunes More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2161AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To compare retrospectively the morbidity of surgical management of benign prostatic hyperplasia (BPH) with monopolar TURP and TVP when treating patients with large prostates METHODS We performed a retrospective analysis on our prospectively collected database searching for patients who underwent surgical treatment of symptomatic BPH between Jan/08 and Jun/13. Inclusion criteria: patients candidates to surgical management of BPH with prostate volume between 80 and 110g, which were suitable to both open and endoscopic approach (chosen according to surgeon preference). Analyzed data included patient age, comorbidities (ASA score; Charlson index – severe if ≥2), serum prostate specific antigen (PSA), prostate volume (transabdominal ultrasound), use of Foley catheter, and surgical complications (Clavien score). Student T test and Chi-Square/Fisher Exact test were used. Significance was set at p≤0.05. RESULTS 1460 patients underwent surgical treatment of BPH: 296 TVP, 1064 TURP. Of those, 87 (29.4%) TVP and 104 (9.8%) TURP met our prostate volume inclusion criteria and were considered for further analysis. Groups were similar in regards to use of Foley, PSA, PSA density, ASA and Charlson scores (table 1). Patients in the TVP group were older (p<0.001) and had larger prostates (p<0.001). TVP provided a larger resected prostate volume when compared to TURP (72.2 vs. 40.8%, respectively; p<0.001), with a higher decrease in PSA levels (p<0.001). The incidence of severe complications (Clavien≥3) was similar between cohorts (p=0.18). In a subanalysis of patients with more comorbidities (Charlson ≥2 and ASA ≥2), severe complications occurred more in the TVP group (p≤0.05) (table 2). CONCLUSIONS TURP and TVP techniques for patients with prostate volume between 80 and 110g have a similar rate of complications. Patients with more comorbidities have a higher index of complications when treated with TVP. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e789 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Elcio Nakano More articles by this author Eduardo M. Yoshinaga More articles by this author Giovanni Marchini More articles by this author Paulo Cordeiro More articles by this author Fabio Tanno More articles by this author Miguel Srougi More articles by this author Alberto Antunes More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Nursing Experience during Perioperative Period of Cervical Spinal Cord Injury

&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To discuss the nursing experience during the perioperative period of cervical spinal cord injury. &lt;strong&gt;Method:&lt;/strong&gt; Retrospectively analyze the clinical data of cervical spinal cord injury cases treated by our department from January to December of 2012 and apply the preoperative nursing and postoperative nursing for them.&lt;strong&gt; Results: &lt;/strong&gt;The overall incidence of severe complications is 73.3% during the perioperative period, including hyponatremia of 46.7%, respiratory failure of 6.7%, urinary system infection of 40%, pulmonary infection of 26.7%, and stress ulcer of 26.7%. There is 1 case died of the disease before operation but no postoperative death, and the death rate during perioperative period is 6.7%. &lt;strong&gt;Conclusion: &lt;/strong&gt;The rehabilitation nursing for patients with cervical spinal cord injury during perioperative period can reduce the complication and improve life quality, so it is worth being popularized.&lt;/p&gt;