Incidence Of Short-term Complications Research Articles

Risk factors and incidence of short-term complications following open reduction and internal fixation of scapula fractures.

To determine the short-term complication rates following open reduction and internal fixation of scapula fractures, factors affecting the development of adverse events, and complication rates based on the anatomic location of the fracture. Thirty-day complication rates for patients who underwent open reduction and internal fixation of the scapula were compared between glenoid, body, coracoid, and acromion fracture locations, as identified by International Classification of Disease codes. Possible adverse events included postoperative surgical site infection, renal insufficiency, intubation, pneumonia, deep vein thrombosis, pulmonary embolism, urinary tract infection, wound dehiscence, stroke, and blood transfusion. A total of 251 scapula fractures were identified, with 161 having known fracture locations: 105 glenoid, 20 body, 9 coracoid, and 27 acromial fractures. The rate of any adverse event for all scapular fractures was 2.0%, with no significant difference between anatomic locations (p = 0.79). The overall rates of transfusion, surgical site infection, and return to OR were 0.4%, 0.8%, and 3.98%. Steroid use associated with a significantly increased risk of any adverse event (OR: 55.57, p = 0.038) and outpatient status demonstrated a protective effect on reoperation (OR: 0.11, p = 0.014). There were no significant differences in the rates between groups [transfusion (p = 0.91); surgical site infection (p = 0.17); reoperation (p = 0.85)]. Complication rates within thirty days of ORIF for scapula fracture were low. Reoperation was the most common complication, followed by surgical site infection, wound dehiscence, stroke, transfusion, and pneumonia. Steroid use was a risk factor for developing any adverse event, and outpatient status was protective against reoperation. The 30-day complication profile of glenoid, body, coracoid, and acromial fractures was not significantly different. The low complication rates support the relative short-term safety of operative intervention with internal fixation. Level III.

Optional or optimal? off-label stenting for intracranial atherosclerotic stenosis: A scoping review.

Intracranial atherosclerotic stenosis is a major cause of ischemic stroke. In addition to the Wingspan stent system, several self-expanding stents have been used off-label to treat intracranial atherosclerotic stenosis lesions. The purpose of this review is to assess the existing data on the off-label use of self-expanding stents in intracranial atherosclerotic stenosis, to highlight methodological limitations in current study designs, and thus providing strategies and precautions for clinical practice. The PubMed, EMBASE, and the Cochrane Library databases were systematically searched for relevant articles published up to April 2022. In addition to the meta analysis of Enterprise, Neuroform EZ and closed cell stent respectively, we used a narrative synthesis to summarize and discuss the appropriate strategies and precautions for the use of each stent. We identified 17 studies (1091 patients with 1124 lesions) reporting 6 types of off-label self-expanding stents. The most common endpoints reported were incidence of short-term complications (range: 0-15.8%, median: 3.8%), long-term complications (range: 0-12.0%, median: 0%). Potential risks include infeasibility of stenting hard lesions or tortuous vessels, stent migration, and in-stent thrombosis. Less is known about the conditions that are appropriate for an optimal stent (e.g., open-cell, close-cell, hybrid cell). There was considerable heterogeneity across studies with regards to study populations and study designs. The potential risks and benefits should be carefully considered when using off-label stents for intracranial atherosclerotic stenosis, particularly given the current evidence power. As a potential option for the Wingspan stent, based on device's approval only, a tailored approach with lesion-specific devices could be beneficial in certain patients.

Safety of laparoscopic cholecystectomy in patients with a cerebrospinal fluid shunt in the peritoneal cavity.

The management of patients with a cerebrospinal fluid (CSF) shunt located in the peritoneal cavity undergoing laparoscopic surgery is an issue that has not yet been settled. These patients are at risk of increased intracranial pressure caused by peritoneal insufflation, shunt dysfunction, and shunt infection/retrograde meningitis. This study aimed to determine the need for perioperative shunt intervention in CSF shunt patients undergoing laparoscopic cholecystectomy. We reviewed and analyzed five shunt patients who underwent laparoscopic cholecystectomy in our institution between 2012 and 2022, as well as 17 patients described in previous reports. Among the 22 patients, shunt type was ventriculoperitoneal in 14 and lumboperitoneal in eight. The most common indication for CSF shunt was hydrocephalus caused by cerebral vascular accident (50.0%). Laparoscopic cholecystectomy was performed for cholecystolithiasis in 13 patients (59.1%), acute cholecystitis in eight (36.4%), and gallbladder polyp in one (4.5%). Shunt clamping or externalization was performed in six patients. Two patients in the group that did not undergo shunt clamping or externalization experienced complications (intra abdominal abscess and subcutaneous emphysema). However, the incidence of short-term complications (both overall and shunt-related) and median length of hospital stay did not significantly differ between the two groups. Routine shunt clamping, externalization, or removal might not be necessarily required in patients with a ventriculoperitoneal or lumboperitoneal shunt undergoing laparoscopic cholecystectomy.

Is the age at surgery in Crohn’s disease clinically relevant? Differences and peculiarities: a wide single centre experience after long-term follow-up

PurposeThe Montreal classification for Crohn’s disease includes “age at diagnosis” as a parameter but few is reported about the age at surgery. The aim of this study is to evaluate the short- and long-term differences in the postoperative surgical outcome and disease behaviour, according to the age at the first surgery.MethodsPatients consecutively operated for abdominal Crohn’s disease during the period 1986–2012 at our centre were systematically analysed according to their age at first surgery. In our retrospective cohort, the age at first surgery ranged from 13 to 83 years, and patients were arbitrarily divided into four groups: ≤ 19 (G1), 20–39 (G2), 40–59 (G3) and ≥ 60 (G4) years old.ResultsIn total, 1051 patients were included with a median follow-up time of 232 months. The four groups exhibited statistically significant differences in age at diagnosis, smoke habit, time between diagnosis and surgery, disease location and behaviour, history of perianal fistula or abscess, severe malnutrition requiring total parental nutrition before surgery, type of surgery, total length of resected bowel, median duration of hospitalization, incidence of abdominal recurrences and number of surgical recurrences. G1 displays an inverse linear trend with time in the severity of clinical characteristics when compared to G4 groups. On the contrary, the incidence of short-term complications, types of abdominal recurrence and presence of concomitant perianal disease did not vary among groups. In addition, at multivariate analysis, the age at surgery and the disease location were the only independent risk factors for abdominal surgical recurrence.ConclusionDespite first surgery is extremely more frequent between 20 and 59 years, patients from G1 and G4 groups showed clinical differences and peculiarities when compared to the other age groups. The most indolent CD behaviour and occurrence of surgical recurrence was observed in patients having their first abdominal surgery in the elderly, while patients operated before the age of 19 experienced a more aggressive disease course.

Incidence of short-term complications after sterilization between pre-operative antibiotic versus pre- and post-operative antibiotic administration in female cats

A sterilization program is implied to control the cat population and set up as national rabies control activities. In Thailand, a few studies have been conducted on postoperative complications and undesired incidents after massive sterilization. This study determined the incidence of short-term sterilization complications in cats with or without postoperative antibiotic administration and the risk of short-term surgical complications. The investigators conducted a clinical trial study. Female cats (n=492) who participated in Chiang Mai municipal birth control activity were assessed and recorded those complications between with and without postoperative antibiotics. The risk factors were analyzed using risk ratios (RR) with a 95% confidence level. Twenty-five cats (5.08%) showed short-term complications in the study. The incidence of short-term complications was not significantly different between cats with postoperative antibiotics (4.92%) and without postoperative antibiotics (5.24%). Cats with external parasites had 2.35 times a short-term complication (RR=1.05-5.27;95%Cl). Duration in captive area, this factor showed that prolong of a cat kept in cage or indoor area play role as a protective factor which less than 2-day in a cage or indoor as the baseline, the risk ratios were 0.38 in 5-day and 0.18 in 7-day, respectively. In conclusion, cat sterilization without post-operative antibiotic administration could be performed under ordinary operation with an aseptic concept.

Does dehydration prior to primary total joint arthroplasty increase risk of perioperative complications?

BackgroundPrior studies have suggested that preoperative dehydration increases odds of perioperative complications in several areas of orthopedic surgery. This study aimed to evaluate whether preoperative hydration status is associated with the incidence of short-term complications after primary total joint arthroplasty.MethodsThe 2012–2019 National Surgical Quality Improvement Program (NSQIP) database was used to explore the relationship between preoperative dehydration (ratio of preoperative BUN divided by preoperative Creatinine (BUN/Creatinine) > 20) and perioperative outcomes of total hip (THA) and total knee arthroplasty (TKA) patients. Univariate comparisons and multivariate regression analyses were conducted to identify specific complications that occurred more often in patients with preoperative dehydration.ResultsOf 188,629 THA and 332,485 TKA patients, 46.3 and 47.0% had preoperative dehydration, respectively. After controlling for demographics and comorbidities, dehydrated THA patients were no more likely to experience a complication compared to their non-dehydrated counterparts (relative risk [RR] = 0.97, 99.7% Confidence Interval [CI]: 0.92–1.03, P = 0.138) nor increased risk of blood transfusion (RR = 1.02, CI = 0.96–1.08, P = 0.408). Similar to THA patients, dehydrated TKA patients were not more likely to have a complication after surgery (RR = 0.97, CI = 0.92–1.03, P = 0.138) and were at no greater risk of transfusion (RR = 1.02, CI = 0.96–1.07, P = 0.408). A sub-analysis covering only patients with BUN and Cr values determined within 24 h after surgery was performed and similarly found no significant increase in perioperative complications or transfusion.ConclusionOverall, preoperative dehydration in patients undergoing THA/TKA did not appear to increase risk of transfusion or other perioperative complications. Further research is needed to characterize the role of hydration prior to elective total joint arthroplasty.

Endoleak Detection after Endovascular Aortic Aneurysm Repair Using Ultrasound Based on Nanoscale Bubble Contrast Agents and Their Effects on Vascular Smooth Muscle Cell Proliferation and Migration

Abdominal aortic aneurysm (AAA) is the most common vascular disease that causes disability and death. Its morbidity is relatively subtle, and the mortality rate is high. Clinically, endovascular aortic aneurysm repair (EVAR) has gradually become the primary treatment of AAA due to its unique advantages such as low trauma and low incidence of short-term complications. However, the outcome of EVAR is greatly compromised by the possible occurrence of endoleaks. Contrast-enhanced ultrasound (CEUS) is a promising alternative technique to detect endoleaks following EVAR due to lack of exposure to ionizing radiation. Traditional ultrasound contrast agents with an overlarge size (microscale) leading to reluctant accumulation in target organs and instability trigger the requirement of nanoscale contrast agents that enter tumor tissues through the enhanced permeability and retention effect. In this study, we used ultrasound based on nanoscale bubble contrast agents to evaluate endoleak detection after endovascular aortic aneurysm repair and analyzed the effects of nanoscale bubble contrast agents on vascular smooth muscle cell (VSMC) proliferation and migration. Among 52 AAA patients a month following EVAR, there were 16 cases of endoleaks after EVAR detected by nanobubble contrast-enhanced ultrasound, including 6 cases of type I endoleak (1 case of type Ia endoleak and 5 cases of type Ib endoleak), 7 cases of type II endoleak, and 3 cases of type III endoleak; there were 12 cases of endoleak after EVAR detected by computed tomography angiography (CTA), including 6 cases of type I endoleak (1 case of type Ia and 5 cases of type Ib), 5 cases of type II endoleak, and 1 case of type III endoleak. Six months after EVAR, 3 cases of type III endoleak were detected by both nanobubble contrast-enhanced ultrasound and CTA. Vascular smooth muscle cells (VSMCs) used for in vitro experiments were subjected to ultrasound irradiation and platelet-derived growth factor (PDGF) treatment with or without the addition of nanobubble contrast agents. After high-intensity and long-term irradiation (0.75 W/cm2 and 1 W/cm2 irradiation for 120 s and 150 s, respectively) by ultrasound with or without the addition of nanobubble contrast agents, PDGF-induced VSMC migration was inhibited ( P < 0.01 ). Low-intensity and short-term ultrasound irradiation did not differ PDGF-induced VSMC migration ( P > 0.05 ), but 0.5 W/cm2 and 90 s ultrasound irradiation could significantly inhibit PDGF-induced VSMC migration without the addition of nanobubble contrast agents ( P < 0.05 ). When VSMCs were irradiated at 1, 0.75, 0.5, and 0.35 W/cm2 for 30 s to 150 s, ultrasound irradiation with or without the addition of nanobubble contrast agents remarkably reduced PDGF-induced VSMC proliferation, as evidenced by reduced OD values ( P < 0.05 ). In conclusion, ultrasound based on nanoscale bubble contrast agents is an effective alternative detection method for the occurrence of AAA patients who are not suitable for CTA.

Adult split liver transplantation: A PRISMA-compliant Chinese single-center retrospective case-control study.

Although pediatric split liver transplantation (SLT) has been proven safe and the waitlist mortality rate has been successfully reduced, the safety of adult SLT has not been confirmed.Using 1:2 matching, 47 recipients who underwent adult SLT were matched to 94 of 743 recipients who underwent adult whole graft liver transplantation (WGLT). Eventually, 141 recipients were included in the case-control study. Subgroup analysis of 43 recipients in the SLT group was performed based on the presence of the middle hepatic vein (MHV) in the grafts.No significant differences in 5-year survival (80.8% vs 81.6%, P = .465) were observed between the adult SLT and WGLT groups. However, compared to recipients in the WGLT group, those in the SLT group had more Clavien-Dindo grade III-V complications, longer hospitalization duration, and higher mortality within 45 days. Furthermore, on multivariate analysis, 45-day postoperative mortality in recipients in the SLT group was mainly affected by hyperbilirubinemia within postoperative day (POD) 7-14, surgery time, and intraoperative blood loss. Subgroup analysis showed no significant differences in hyperbilirubinemia within POD 7-14, complications, and survival rate between SLTMHV(+) and SLTMHV [-].Adult SLT is safe and effective based on long-term survival rates; however, a reduction in the incidence of short-term complications is required. Non-obstructive hyperbilirubinemia within POD 7 to 14 is an independent predictor of short-term mortality after SLT.

Effects of propofol on intracranial pressure and prognosis in patients with severe brain diseases undergoing endotracheal suctioning

BackgroundTo investigate whether the administration of intravenous propofol before endotracheal suctioning (ES) in patients with severe brain disease can reduce the sputum suction response, improve prognosis, and accelerate recovery.MethodsA total of 208 severe brain disease patients after craniocerebral surgery were enrolled in the study. The subjects were randomly assigned to the experimental group (n = 104) and the control group (n = 104). The experimental group was given intravenous propofol (10 ml propofol with 1 ml 2% lidocaine), 0.5–1 mg/kg, before ES, while the control group was subjected to ES only. Changes in vital signs, sputum suction effect, the fluctuation range of intracranial pressure (ICP) before and after ES, choking cough response, short-term complications, length of stay, and hospitalization cost were evaluated. Additionally, the Glasgow Outcome Scale (GOS) prognosis score was obtained at 6 months after the operation.ResultsAt the baseline, the characteristics of the two groups were comparable (P > 0.05). The increase of systolic blood pressure after ES was higher in the control group than in the experimental group (P < 0.05). The average peak value of ICP in the experimental group during the suctioning (15.57 ± 12.31 mmHg) was lower than in the control group (18.24 ± 8.99 mmHg; P < 0.05). The percentage of patients experiencing cough reaction- during suctioning in the experimental group was lower than in the control group (P < 0.05), and the fluctuation range of ICP was increased (P < 0.0001). The effect of ES was achieved in both groups. The incidence of short-term complications in the two groups was comparable (P > 0.05). At 6 months after the surgery, the GOS scores were significantly higher in the experimental than in the control group (4–5 points, 51.54% vs. 32.64%; 1–3 points, 48.46% vs. 67.36%; P < 0.05). There was no significant difference in the length of stay and hospitalization cost between the two groups.ConclusionsPropofol sedation before ES could reduce choking cough response and intracranial hypertension response. The use of propofol was safe and improved the long-term prognosis.The study was registered in the Chinese Clinical Trial Registry on May 16, 2015 (ChiCTR-IOR-15006441).

The Addition of ω-3 Fish Oil Fat Emulsion to Parenteral Nutrition Reduces Short-Term Complications after Laparoscopic Surgery for Gastric Cancer

The incidence of short-term complications after laparoscopic surgery for gastric cancer is higher. Whether ω-3 fish oil fat emulsion can reduce short-term complications of gastric cancer after laparoscopic surgery is controversial. The purpose of this study was to explore the effect of ω-3 fish oil fat emulsion on postoperative recovery of patients with gastric cancer after laparoscopic surgery. A total of 111 patients were included in this study. These patients were given parenteral nutrition for 5 day or more after surgery. We used univariate analysis and multivariate analysis to determine whether ω-3 fish oil fat emulsion could affect the incidence of short-term complications after gastric cancer laparoscopic surgery. The incidence of postoperative short-term complications in patients with parenteral nutrition supplemented with ω-3 fish oil fat emulsion was significantly lower than that in patients without ω-3 fish oil fat emulsion (12/51 VS 26/60, P = 0.027). ω-3 fish oil fat emulsion is an independent risk factor for short-term postoperative complications in patients with gastric cancer (OR = 0.393, CI:0.155-0.996, P = 0.049). In conclusion, the addition of ω-3 fish oil fat emulsion to parenteral nutrition after operation can effectively reduce the incidence of short-term complications in patients with gastric cancer after laparoscopic surgery.

Reduced morbidity by using LigaSure compared to conventional inguinofemoral lymphadenectomy in vulvar cancer patients: A randomized controlled trial

BackgroundInguinofemoral lymphadenectomy (IFL) is part of the surgical treatment of different malignancies of the genital tract and/or the lower limb including vulvar carcinoma, penile carcinoma and melanoma. IFL is associated with morbidity in up to 85% of the patients. The aims of this MAMBO-IC study (Morbidity And Measurement of the Body) are to study the feasibility of using LigaSure for IFL and to assess the differences in the incidence of short-term complications using LigaSure versus conventional IFL randomized within each individual patient. MethodsIn this multicenter randomized controlled trial (RCT), women diagnosed with squamous cell carcinoma of the vulva with an indication for bilateral IFL were included. It was randomly assigned for which groin the LigaSure was used; the other groin was treated with conventional IFL (sharp/diathermia). We estimated the incidence of ≥1 complication(s) per groin using logistic regression and compared this between the two surgical methods, adjusting for possible confounders. ResultsWe included 40 groins of 20 patients. The estimated incidence of ≥1 complication(s) was 29% after LigaSure versus 70% after conventional IFL (risk difference 41% (95% CI 19–62), p < 0.001). Patients’ reported restriction of daily living activities and maximum pain score were equal for both treatment methods. There were no differences in the surgeon reported workload scores. ConclusionsThis RCT shows that LigaSure for IFL is feasible and associated with significantly less short-term surgical complications compared to conventional IFL. Further studies with a larger sample size are needed to validate our findings. ISRCTN15057626.

Long-term symptom control following resection of cervical lymphatic malformations: a case series

BackgroundPrevious literature has reported on the incidence of short-term complications following resection of cervical lymphatic malformations (LMs) in children, however no research has yet investigated the long-term symptomatic course in these patients. This study aims to provide families and providers with an understanding of expectations for long-term symptom control, specifically in association with subsequent upper respiratory infections (URIs).MethodsA retrospective chart review produced a case series of patients who underwent resection of cervical LM at a pediatric tertiary care center between 2007 and 2016. Demographic data, disease characteristics, operative details, and postoperative care were evaluated. Telephone surveys were conducted to ascertain the course of postoperative symptoms at the surgical site.ResultsForty-three patients responded to the telephone survey. Thirty-seven (86.0%) had at least one postoperative surgical site symptom during subsequent URIs, with 28 (65.1%) reporting redness, 34 (79.1%) reporting swelling, and 18 (41.9%) reporting pain. Patients who experienced any of these symptoms universally indicated that they developed soon after the surgical resection, and over half reported that they improved over time. Postoperative seroma was associated with swelling during subsequent URIs (p = 0.04). Patients age 7 or were greater were more likely than those under 7 to report pain with URIs (p = 0.006). All 8 patients with drain placement for at least 2 days reported swelling during subsequent URIs. The incidence of the queried symptoms did not vary significantly based on sex, stage, histology, surgical subsite, or presence of residual disease.ConclusionWhile preoperative symptoms associated with cervical LMs are also frequently encountered postoperatively, particularly in some patient subgroups, improvement over time should be expected.Level of evidence4

Duodenum-preserving pancreas head resection in the treatment of pediatric benign and low-grade malignant pancreatic tumors

BackgroundTo investigate the safety, feasibility, and complications of using duodenum-preserving pancreas head resection (DPPHR) to treat pediatric benign and low-grade malignant pancreatic head tumors. MethodsPatients with pancreatic head tumors that underwent resection were retrospectively analyzed for perioperative factors and postoperative complications. ResultsThirty-five patients with a median age of 10 years at diagnosis were identified. Patients were divided by procedures into the DPPHR (n = 22), local enucleation (n = 7) and pylorus-preserving pancreatoduodenectomy (PPPD, n = 6) groups. No significant difference was found in operation time between the DPPHR and PPPD groups (P > 0.05). Significantly, longer drainage time, duration of somatostatin use and hospital stay were observed in the DPPHR group than in the PPPD group (P < 0.05). The incidences of short-term complications were not significantly different among the three groups (P > 0.05). The incidence of long-term complications was markedly lower in both the DPPHR and local enucleation groups than in the PPPD group (P < 0.05). ConclusionDPPHR might be a safe treatment option for pediatric patients with benign and low-grade malignant pancreatic head tumors. The incidence of long-term complications was significantly lower with DPPHR. However, perioperative management might be challenging for surgeons.

Comparison of short-term complications following Cesarean section or Cesarean section with concurrent ovariohysterectomy in bitches and queens: a pilot study

Cesarean section is a common treatment for canine and feline dystocia. Ovariohysterectomy may or may not be recommended concurrently. There are apparently no data in the literature providing evidence to guide decision-making regarding the advantages and disadvantages of performing these procedures concurrently. Animal signalment, history upon presentation, medical and anesthetic management of dystocia, and incidence of short-term complications were compared between bitches and queens undergoing Cesarean section alone and those undergoing concurrent Cesarean section and ovariohysterectomy. Short-term complications were defined as those happening after recovery from anesthesia and extubation and within several days after patient discharge. Complete data were available for two queens undergoing Cesarean section alone and two queens undergoing concurrent Cesarean section and ovariohysterectomy, and for 20 bitches undergoing Cesarean section alone and 22 bitches undergoing concurrent Cesarean section and ovariohysterectomy. No short-term complications were reported in any of these patients. An important limitation was small sample size; therefore, further investigations, perhaps by pooling data from several institutions, would be beneficial.

A retrospective comparative analysis between endoscopic treatment and surgical treatment for early gastric cancer accorded with expanded indications of endoscopic submucosal dissection

Objective To compare the efficacy of endoscopic treatment with surgical treatment for early gastric cancer accorded with expanded indications of endoscopic submucosal dissection (ESD). Methods A total of 165 patients (167 lesions) with early gastric cancer underwent ESD (ESD group, 77 cases) or surgery (surgery group, 88 cases) from January 2011 to December 2016. The lesions fulfilled expanded indications of ESD, and were pathologically identified as differentiated or undifferentiated adenocarcinoma. Chi-square test, continuity-adjusted Chi square test, and Fisher exact test were used to analyze the incidence of lesion residual, local recurrence, metachronous recurrence, short-term complications and long-term complications. The 3-year overall survival rate and 3-year disease-free survival rate of the two groups were analyzed by Kaplan-Meier method. Results There were no differences on the incidence of lesion residual (P=0.473), local recurrence (P=1.000) and metachronous recurrence (P=1.000) between the ESD group and the surgery group. The 3-year overall survival rate (100.0% VS 98.3%, P=0.343) and the 3-year disease-free survival rate (98.1% VS 96.7%, P=0.655) were not significantly different between the two groups. There was no significant difference on the incidence of short-term complications between the two groups [7.8% (6/77) VS 5.7% (5/88), χ2=0.294, P=0.588]. The incidence of long-term complications in the ESD group was lower than that in the surgery group [0 (0/77) VS 8.0% (7/88), continuity-adjusted χ2=4.588, P=0.032]. Conclusion For patients with early gastric cancer fulfilled expanded indications of ESD, ESD has a lower incidence of long-term complications with similar efficacy compared to surgery. Key words: Retrospective studies; Stomach neoplasms; Surgical procedures; Endoscopic submucosal dissection

The Turkish Neonatal Jaundice Online Registry: A national root cause analysis.

BackgroundNeonatal jaundice (NNJ) is common, but few root cause analyses based on national quality registries have been performed. An online registry was established to estimate the incidence of NNJ in Turkey and to facilitate a root cause analysis of NNJ and its complications.MethodsA multicenter prospective study was conducted on otherwise healthy newborns born at ≥35 weeks of gestation and hospitalized for only NNJ in 50 collaborator neonatal intensive care units across Turkey over a 1-year period. Patients were analyzed for their demographic and clinical characteristics, treatment options, and complications.ResultsOf the 5,620 patients enrolled, 361 (6.4%) had a bilirubin level ≥25 mg/dL on admission and 13 (0.23%) developed acute bilirubin encephalopathy. The leading cause of hospital admission was hemolytic jaundice, followed by dehydration related to a lack of proper feeding. Although all infants received phototherapy, 302 infants (5.4%) received intravenous immunoglobulin in addition to phototherapy and 132 (2.3%) required exchange transfusion. The infants who received exchange transfusion were more likely to experience hemolytic causes (60.6% vs. 28.1%) and a longer duration of phototherapy (58.5 ± 31.7 vs. 29.4 ± 18.8 h) compared to infants who were not transfused (p < 0.001). The incidence of short-term complications among discharged patients during follow-up was 8.5%; rehospitalization was the most frequent (58%), followed by jaundice for more than 2 weeks (39%), neurological abnormality (0.35%), and hearing loss (0.2%).ConclusionsSevere NNJ and bilirubin encephalopathy are still problems in Turkey. Means of identifying at-risk newborns before discharge during routine postnatal care, such as bilirubin monitoring, blood group analysis, and lactation consultations, would reduce the frequency of short- and long-term complications of severe NNJ.

Long Term Follow-Up of ABO Incompatible Kidney Transplantation—A Study from India

Background: There is a need to do ABO incompatible kidney transplantation in a country like India where deceased donor transplantation is not common. More than 90% transplantations are done with living donors. Although short term results have been reported from 4 centers, there is paucity of data on long term follow-up of such patients. Methods: The data of 18 patients who had undergone ABO incompatible transplantation exceeding a follow-up of 12 months up to 66 months were analyzed. It was compared with the data of compatible kidney transplantation during the same period. Results: In both the groups, there was a similar incidence of urinary tract infection and gastroenteritis with complete recovery. Tuberculosis was successfully treated in 2 patients who had undergone ABO incompatible transplantation. The graft function was excellent with an average follow-up period of 38.2 months. There was no patient mortality during the follow-up period. Conclusion: The long term outcome of ABO incompatible kidney transplantation is similar to compatible kidney transplantation despite the increased incidence of short term complications.

Incidence of short-term complications and associated factors after primary trabeculectomy in Chiang Mai University Hospital.

Background:To determine the incidence of early postoperative complications and associated factors after primary trabeculectomy in Thai glaucoma patients.Design:This was a retrospective observational study performed in Chiang Mai University Hospital.Participants:One hundred and eighteen glaucoma patients participated in the study.Methods:All glaucoma patients underwent primary trabeculectomy with mitomycin C (MMC) using fornix-based conjunctival flap technique between December 2011 and May 2013. Surgical complications during the first 3 months of follow-up were recorded, and associated risk factors were analyzed.Main Outcome Measures:The incidence of posttrabeculectomy complications was the main outcome measure.Results:One hundred and eighteen eyes of 118 patients were included. Early postoperative complications developed in 55 eyes (56.7%). Complications included hypotony (25 eyes, 27.2%), serous choroidal detachment (CD) (14 eyes, 15.6%), subconjunctival hemorrhage (12 eyes, 13.0%), hyphema (11 eyes, 12.4%), bleb leak (8 eyes, 8.8%), encapsulated bleb (2 eyes, 2.2%), aqueous misdirection (1 eyes, 1.1%), corneal epithelial defect (1 eyes, 1.1%), and overfiltration (1 eyes, 1.1%). There were no reported cases of endophthalmitis or blebitis. Hypotony was associated with serous CD (P = 0.006), and hyphema was associated with neovascular glaucoma (NVG) patients (P = 0.009). NVG was not associated with the increased rate of surgical failure (P = 0.083).Conclusions:The incidence of early complications after first-time trabeculectomy with MMC was high (56.7%) in this Thai clinic setting, but most were transient and self-limited conditions. The correlations between hypotony and CD as well as hyphema and NVG were compatible with the previous studies.

Comparison between endoscopic sphincterotomy and endoscopic papillary balloon dilation in treatment of extrahepatic bile duct stones

Objective To compare endoscopic sphincterotomy( EST) and endoscopic papillary balloon dilation( EPBD)in treating extrahepatic bile duct stones in terms of similarities and differences. Methods The clinical data of 277 patients with extrahepatic bile duct stones,who were treated from August 2009 to July 2011 in gastroenterology department of Shanghai Changhai Hospital,were retrospectively analyzed,with 168 patients receiving EST and 109 receiving EPBD. The general condition,stone diameter,stone extraction method,operation time,stone-free rate by single procedure,postoperative hospital stay and short-term complications were compared between EST group and EPBD group. Results There were no significant differences in the age,sex ratio,or combination with duodenal diverticulum between the two groups. The mean diameters of the stones were not significantly different between the two groups( [11. 3 ± 6. 2]mm in EST group vs [10. 1 ± 5. 7]mm in EPBD group,P = 0. 105 6). There was no significant difference in the proportions of different stone extraction methods between EST group and EPBD group. The operation time,stone-free rate by single procedure,postoperative hospital stay,and total incidence of short-term complications in EST group were( 21. 2 ±3. 1) min,95. 2%,( 4. 1 ±1. 9) d,and 10. 1%,and those in EPBD group were( 20. 7 ±2. 5) min,94. 5%,( 4. 1 ±2. 0) d,and 12. 8%,respectively; with no significant differences found between the two groups( all P 0. 05). The incidence of hemorrhage in EST group was significantly higher than that in the EPBD group( 3. 6% vs 0%,P 0. 05). The incidence of hyperamylasemia in EPBD group was significantly higher than that in the EST group( 8. 3% vs 2. 4%,P 0. 05).Conclusion EST and EPBD each have their own advantages and disadvantages in the treatment of extrahepatic bile duct stones.Operation mode should be chosen according to the specific condition of patients,but not the size of the stones.

Laparoscopy for extraperitoneal rectal cancer reduces short-term morbidity: Results of a systematic review and meta-analysis.

The role of laparoscopy in the treatment of extraperitoneal rectal cancer is still controversial. The aim of the study was to evaluate differences in safety of laparoscopic rectal resection for extraperitoneal cancer, compared with open surgery. A systematic review from 2000 to July 2012 was performed searching the MEDLINE and EMBASE databases (PROSPERO registration number CRD42012002406). We included randomized and prospective controlled clinical studies comparing laparoscopic and open resection for rectal cancer. Primary endpoints were 30-day mortality and morbidity. Then a meta-analysis was conducted by a fixed-effect model, performing a sensitivity analysis by a random-effect model. Relative risk (RR) was used as an indicator of treatment effect. Eleven studies, representing 1684 patients, met the inclusion criteria: four were randomized for a total of 814 patients. Mortality was observed in 1.2% of patients in the laparoscopic group and in 2.3% of patients in the open group, with an RR of 0.56 (95% CI 0.19-1.64, p = 0.287). The overall incidence of short-term complications was lower in the laparoscopic group (31.5%) compared to the open group (38.2%), with an RR of 0.83 (95% CI 0.73-0.94, p = 0.004). Surgical complications, wound complications, blood loss and the need for blood transfusion, time for bowel movement recovery, food intake recovery, and hospital stay were significantly lower or less frequent in the laparoscopic group. The incidence of intra-operative injuries, anastomotic leakages, and surgical re-interventions was similar in the two groups. Only operative time was in favour of the open group. Based on the evidence of both randomized and prospective controlled series, mortality was lower after laparoscopy although not significantly so, while the short-term morbidity RR, including subgroup analysis, was significantly lower after laparoscopy for extraperitoneal rectal cancer compared to open surgery.