Knowledge Of Potential Complications Research Articles

A Cross-Sectional Study on Awareness and Knowledge of Sleeve Gastrectomy in the Eastern Province of Saudi Arabia.

Obesity is a global health concern associated with a plethora of chronic diseases. Genetic and lifestyle factors play a pivotal role in its development, making it a significant challenge for healthcare systems worldwide. In this context, sleeve gastrectomy has emerged as a prominent bariatric surgical intervention, but the level of awareness and knowledge regarding its indications and complications in the Eastern Province of Saudi Arabia is underexplored. This descriptive cross-sectional study was conducted over one year, from January 2022 to December 2022. The study aimed to assess the level of awareness among adults residing in the Eastern Province of Saudi Arabia regarding the indications and potential complications associated with sleeve gastrectomy. The study utilized random sampling and distributed a well-designed questionnaire in both English and Arabic. The questionnaire, validated for reliability, covered demographic data, general knowledge of sleeve gastrectomy, awareness of its indications, and knowledge of potential complications. The study included 1730 participants, with a majority in the 18-25 age group, predominantly female, and possessing a bachelor's degree. Awareness of sleeve gastrectomy was remarkably high, with 99% of respondents having heard of it, but only 50.1% accurately recognized the correct body mass index range for classifying obesity. Knowledge scores revealed 61.7% with poor knowledge, 31% with moderate knowledge, and 7.2% with good knowledge levels. Only 56.1% correctly identified the indications for sleeve gastrectomy. While participants displayed awareness of common complications, such as nutritional deficiencies, knowledge gaps persisted. This study exposes significant gaps in awareness and knowledge regarding sleeve gastrectomy, particularly concerning its indications and potential complications. It underscores the urgent need for targeted educational initiatives and active healthcare provider engagement in disseminating accurate information. Bridging these knowledge gaps through tailored public health campaigns can empower individuals to make informed decisions about the management of obesity.

ECMO for Circulatory Support

Extracorporeal membrane oxygenation (ECMO) is a form of circulatory and respiratory support used for patients who have an almost complete loss of function of native lungs or heart. ECMO helps supplement organ function while treatment for the primary pathology is initiated. Initiation and maintenance of ECMO requires specialized skill, and knowledge of potential complications is necessary to ensure rapid and good return of organ function while minimizing patient morbidity and mortality. Weaning from ECMO requires complex studies to assess return of native cardiac function. Major complications include bleeding thrombosis and ischemia.

S2057 Novel Gabriel Feeding Tube Produces Duodenal Ulcer

INTRODUCTION: Early enteral feeding is an essential part of the care of the critically ill patient. Post pyloric feeding in these patients may lower the risk of aspiration pneumonia. Traditional feeding tubes often do not reach the proximal duodenum or do not remain in place if placed correctly. Endoscopic placement is an option but it is invasive, costly, and may ultimately be ineffective due to tube migration back to the stomach. A novel device, the Gabriel Feeding Tube with Balloon, has been designed to address these issues. This device utilizes peristalsis to move its balloon tip to the small intestine. While effective, we are reporting a case of duodenal bulb ulceration as a complication of the Gabriel Feeding Tube balloon. CASE DESCRIPTION/METHODS: A 63 year old female with a history of GERD and Hepatitis C cirrhosis presented for elective lumbar fusion surgery. Her postoperative course was complicated by a dural tear leading to admission to the intensive care unit. In the ICU, she developed pneumonia with altered mental status. Enteral feeding was initiated after placement of a Gabriel feeding tube with balloon. Seven days post placement of the Gabriel Feeding tube, the patient developed maroon-colored stool suggestive of an upper gastrointestinal bleed. An esophagogastroduodenoscopy revealed a large, 11 mm semi-circumferential white based ulcer in the duodenal bulb extending into the postbulbar duodenum. The Gabriel Feeding tube was removed and the patient was treated with a proton pump inhibitor. The patient was negative for H. pylori. No further bleeding occurred. DISCUSSION: Post-pyloric nasogastric tubes have been shown to have lower risk of pneumonia without increase in complications nor decline in nutritional support. The balloon in the Gabriel Feeding Tube ensures proper placement of the tube and assists in movement via peristalsis. However, the balloon may result in unexpected ulceration due to pressure on the intestinal wall as was discovered in this patient. Complications of the Gabriel Feeding Tube have not been reported in the literature. To our knowledge, this is the first reported case of duodenal ulceration as a complication of the Gabriel Feeding Tube with Balloon. More widespread use of this device may result in reporting of this or other complications. Knowledge of potential complications will enhance assessment of risks and benefits and ultimately improve medical decision making in the critically ill patient.Figure 1.: Clean Based Ulcer in the Postbulbar Duodenums.

Complications from percutaneous microwave ablation of liver tumours: a pictorial review.

Percutaneous microwave ablation of liver tumours is a well-established technique that has been proven to be effective in the curative and palliative treatment of small volume primary and secondary liver tumours. Microwave ablation is designed to achieve larger areas of necrosis compared to radiofrequency ablation and has a good safety profile among liver tumour treatments. Mortality is unreported and major complications are rare. Knowledge of potential complications is essential for interventional radiologists performing liver ablation in order to reduce patient morbidity. The aim of this review is to illustrate major complications post microwave ablation in a pictorial format as well as a discussion on how best to avoid these complications.

Therapeutic Potential of Thymoquinone in Glioblastoma Treatment: Targeting Major Gliomagenesis Signaling Pathways.

Glioblastoma multiforme (GBM) is one of the most devastating brain tumors with median survival of one year and presents unique challenges to therapy because of its aggressive behavior. Current treatment strategy involves surgery, radiotherapy, immunotherapy, and adjuvant chemotherapy even though optimal management requires a multidisciplinary approach and knowledge of potential complications from both the disease and its treatment. Thymoquinone (TQ), the main bioactive component of Nigella sativa L., has exhibited anticancer effects in numerous preclinical studies. Due to its multitargeting nature, TQ interferes in a wide range of tumorigenic processes and counteract carcinogenesis, malignant growth, invasion, migration, and angiogenesis. TQ can specifically sensitize tumor cells towards conventional cancer treatments and minimize therapy-associated toxic effects in normal cells. Its potential to enter brain via nasal pathway due to volatile nature of TQ adds another advantage in overcoming blood-brain barrier. In this review, we summarized the potential role of TQ in different signaling pathways in GBM that have undergone treatment with standard therapeutic modalities or with TQ. Altogether, we suggest further comprehensive evaluation of TQ in preclinical and clinical level to delineate its implied utility as novel therapeutics to combat the challenges for the treatment of GBM.

Current techniques and outcomes in hysteroscopic sterilization: current evidence, considerations, and complications with hysteroscopic sterilization micro inserts.

To describe the current data regarding effectiveness, complications, postoperative evaluation, and surgical interventions associated with Essure hysteroscopic sterilization. Hysteroscopic sterilization is a commonly performed procedure that is offered as a well tolerated, effective, outpatient method of permanent sterilization. Over the past several years, concerns have been raised regarding correct placement and postoperative complications. This has led to statements by both the Food and Drug Administration (FDA) in October, 2016 and American Association of Gynecologic Laparoscopists in February, 2017, as a significant portion of women seek removal of these devices. A current black-box warning issued by the FDA in 2016 recommends discussion of 'the probabilities of rates or events' of adverse outcomes associated with Essure placement. Although hysteroscopic sterilization is usually a safe, effective option for permanent contraception, new evidence regarding complications has emphasized the need for proper education and counseling. Appropriate patient selection and knowledge of potential complications is paramount to ensuring patients, and medical providers are well informed and have realistic expectations regarding potential placement and postoperative issues.

Practical Guide to Bone Marrow Sampling for Suspected Myelodysplastic Syndromes

Myelodysplastic syndromes (MDS) comprise a group of diverse clonal hematopoietic stem cell malignancies that are characterized by ineffective hematopoiesis and progressive bone marrow failure. Clinical symptoms are generally nonspecific. The diagnosis, classification, and risk stratification of MDS rely on the evaluation of peripheral blood and bone marrow sampling using the Revised International Prognostic Scoring System tool. Accurate diagnosis and risk stratification require a good-quality bone marrow sample. Bone marrow samples are obtained using two complementary techniques: bone marrow aspiration and bone marrow biopsy. Knowledge of what constitutes an adequate bone marrow sample and a proper bone marrow sampling technique may help advanced practitioners obtain quality samples while minimizing patient discomfort and risk. Patient preparation and positioning, site selection, sampling equipment, and sampling technique can help lead to the collection of high-quality bone marrow samples. Postprocedural care and knowledge of potential complications can reduce a patient's pain and optimize recovery.

Complications associated with anterior cervical surgery

Fortunately, the incidence of major complications associated with anterior cervical spine surgery is low. Surgeons should remain cognizant of the possible intraoperative and postoperative complications, along with methods of prevention and treatment. This review briefly discusses the complications of esophageal, vertebral, and neurological injury, along with spinal fluid leak and hematoma. In general, anterior cervical spine procedures are highly successful with infrequent complications. However, the range of associated morbidity (and mortality) can be broad with each potential complication. Knowledge of potential complications is essential, including associated risk factors, methods of prevention, and treatment. This review briefly discusses intraoperative and immediate postoperative complications.

ED-14 * QUALITY OF LIFE IN ADULTS WITH GLIOMAS: LITERATURE REVIEW

AIM: Patients with malignant gliomas are subject to multiple medical problems that can significantly impact their overall survival and quality of life, including cognitive and psychiatric disorders, seizures, headaches, and side effects of chemotherapy. Optimal management requires a multidisciplinary approach and knowledge of potential complications of both the disease and its treatment. METHODS: Literature search was conducted to identify studies reporting original data on baseline quality of life. Two electronic databases were searched from inception to June 2014. 38 full-text articles were selected for critical reading. The authors performed a systematic literature review that included 1660 patients. RESULTS: The most commonly reported complication among patients with glioma is cognitive changes. Of the 1660 patients in this review, 348 (21%) were found to have changes in cognition. These changes are believed to be due to either the tumor itself, neurosurgical intervention, postoperative medications or psychological effects. Motor deficits, fatigue, headache and depression are also among the top 5 commonly reported complications. 192 (12%) patients reported motor deficits, 158 (10%) patients reported fatigue, 190 (11.4%) patients suffered from headaches, and 136 (8%) patients suffered from depression during the course of their illness. It was also shown that among glioma patients, those with depression were significantly more likely to experience complications and had significantly shorter survival times when compared to non-depressed glioma patients. Other reported complications include language and communication deficits in 119 (7%) patients, emotional distress in 83 (5%) patients, seizures in 80 (4.7%) patients, pain in 71 (4%) patients, adverse drug and chemotherapy reactions in 76 (5%) patients. CONCLUSIONS: High grade gliomas are extremely aggressive tumors that require intensive treatment. The findings of this review highlight the many contributory factors that significantly reduce the overall quality of life in patients with high-grade glioma.

The most common complications after wisdom-tooth removal: part 1: a retrospective study of 1,199 cases in the mandible.

The knowledge of potential complications after surgical removal of third molars and adequate risk assessment is indispensable in oral surgery. The present retrospective study analyzed the influence of different parameters, such as the patient’s age and gender, retention type, and radiological projection (using orthopantomography) of wisdom teeth on the mandibular canal on postoperative complications after the removal of 1,199 wisdom teeth. Overall, 101 (8.4%) complications occurred: 50 cases of alveolar osteitis (4.2%), 12 temporary (1%) and 6 persistent (0.5%) sensation disorders, 15 abscesses (1.25%), 7 dehiscences (0.6%), 5 cases of post-operative bleeding (0.4%), 4 sequestra (0.32%), 1 fistula (0.08%) and 1 hematoma (0.08%). The risk for developing alveolar osteitis was 6% for patients who suffered from a previous pericoronal infection and was higher for female than male patients. Smoking showed no influence on alveolar osteitis. A significant correlation (p<0.0001) could be shown between the radiological projection of wisdom teeth on the mandibular canal and post-operative sensation disorders. The experience of the surgeon and pre-operative 3-dimensional imaging (cone- beam computed tomography, computed tomography) did not reduce this risk. No correlation was found for patient’s age and gender. In conclusion, the surgical decision to remove wisdom teeth must be made with caution in cases of complete radiological projection of the wisdom tooth on the mandibular canal.

Complications With K-Wire Insertion for Percutaneous Pedicle Screws

Retrospective study. To determine the risk profile and complications associated with anterior vertebral body breach by Kirschner (K)-wire during percutaneous pedicle screw insertion. Percutaneous techniques and indications are rapidly expanding with numerous studies now supporting the use of percutaneous pedicle screw stabilization as an adjunct for multiple pathologies such as degenerative, tumor, and trauma. With regards to complication rates, little has been documented. A total of 525 consecutive percutaneous pedicle screws were retrospectively reviewed and the rate of anterior vertebral body breach was recorded, including any potential adverse clinical outcomes. Of 525 percutaneous pedicle screw insertions, there were 7 anterior breaches recorded. We rated the breaches as a minor breach (<5 mm; n=3), moderate breach (5-25 mm; n=2), and major breach (>25 mm; n=2). Two patients had a postoperative ileus with a retroperitoneal hematoma on postoperative computed tomography scan. No patient required reoperation or blood transfusion. The indications for minimally invasive spinal fusion have expanded to include conditions such as degenerative, trauma, deformity, infection, and neoplasia. Although the rate of anterior K-wire breach is low, the technique requires the acquisition of a new set of skills including the safe passage of a K-wire, and knowledge of potential complications that may ensue.

Glioblastoma and Other Malignant Gliomas

Glioblastomas and malignant gliomas are the most common primary malignant brain tumors, with an annual incidence of 5.26 per 100,000 population or 17,000 new diagnoses per year. These tumors are typically associated with a dismal prognosis and poor quality of life. To review the clinical management of malignant gliomas, including genetic and environmental risk factors such as cell phones, diagnostic pitfalls, symptom management, specific antitumor therapy, and common complications. Search of PubMed references from January 2000 to May 2013 using the terms glioblastoma, glioma, malignant glioma, anaplastic astrocytoma, anaplastic oligodendroglioma, anaplastic oligoastrocytoma, and brain neoplasm. Articles were also identified through searches of the authors' own files. Evidence was graded using the American Heart Association classification system. Only radiation exposure and certain genetic syndromes are well-defined risk factors for malignant glioma. The treatment of newly diagnosed glioblastoma is based on radiotherapy combined with temozolomide. This approach doubles the 2-year survival rate to 27%, but overall prognosis remains poor. Bevacizumab is an emerging treatment alternative that deserves further study. Grade III tumors have been less well studied, and clinical trials to establish standards of care are ongoing. Patients with malignant gliomas experience frequent clinical complications, including thromboembolic events, seizures, fluctuations in neurologic symptoms, and adverse effects from corticosteroids and chemotherapies that require proper management and prophylaxis. Glioblastoma remains a difficult cancer to treat, although therapeutic options have been improving. Optimal management requires a multidisciplinary approach and knowledge of potential complications from both the disease and its treatment.

Complications of Bronchial Stapling in Thoracic Surgery

The use of staplers for thoracic surgery has been widely accepted and regarded as a safe procedure. However, complications of stapling are occasionally experienced. The aim of this retrospective study was to analyze complications of bronchial stapling. A retrospective multi-institutional review was conducted by the Central Japan Lung Cancer Surgery Study Group, comprising 29 institutions. All instances of bronchial stapling in thoracic surgery were reviewed during the research period. Bronchial stapling was performed 2,030 times, using 36 kinds of staplers. The total number of complications related to stapling was 36 (1.8 %); 31 events occurred intraoperatively and five events occurred postoperatively. The intraoperative complications were air leakage (N = 20) and stapling failure (N = 11), which were caused by stapler-tissue thickness mismatch (N = 17), stapler defect (N = 3), tissue fragility (N = 2), and unknown reasons (N = 9). In all 31 cases, intraoperative complications were recovered intraoperatively with additional suturing, and no further complications were observed postoperatively. The postoperative complications were bronchopleural fistula (BPF) (N = 4) and bleeding from the chest wall (intercostal artery) (N = 1). The rate of BPF was 0.2 % (4 of 2,030). Two of four BPFs induced critical conditions. Postoperative bleeding was caused by the use of Duet TRS(TM). Both total complications and BPF occurred more frequently in the main bronchus than in the lobar or segmental bronchus. No relationship was seen between the incidence of complications and cartridge colors in lobar bronchial stapling. The compression types of staplers were associated with the incidence of complication. Intraoperative and postoperative complications of bronchial stapling were studied. Generally, bronchial stapling in recent thoracic surgery was safe, but rare postoperative complications may induce critical conditions. Knowledge of potential complications and causes of bronchial stapling may decrease the incidence of stapling complications.

High-Risk Patients with Hypertension: Clinical Management Options

Hypertension, one of the most common human diseases worldwide, affects nearly 1 billion individuals. Complaints related to hypertension are commonly evaluated and treated in the acute care settings such as emergency departments and acute care medical clinics. The evaluation, treatment, and disposition of these patients require thorough knowledge of potential complications and treatment options. This manuscript details a structured approach to evaluating high-risk patients with acute hypertension-related complaints and provides recommendations for treatment and disposition.

Primary Unreamed and Unlocked Intramedullary Nailing of Femoral Shaft Fractures

In this retrospective study, we present our experience using open Küntscher nailing (K-nailing) which is still performed in developing countries for femoral fractures. Of 157 acute fractures treated between January 2003 and December 2009, 100 were stable (63.7%) and 135 were located within the middle third of the shaft (86%). Comminution was absent or minimal in 135 (86%) cases. Fracture union was achieved at an average of 14 weeks (range, 10 - 25). The duration of follow-up was 17 months (range, 6 - 36). Final evaluation showed that 129 (82.2%) patients had a good result according to modified Kempf's criteria. The predominant complications were infection (n=5; 3.2%), nonunion (n=9; 5.5%), implant failure (n=11; 7%), and malunion (n=27; 17.3%). Open reduction and fixation with a tight fitting Knail can give good results in selected acute femoral shaft fractures but knowledge of potential complications is needed. femoral shaft fracture, Intramedullary nailing, Open reduction.

Extended Szabo (Anchor-Wire) Technique Concept for Stent Implantation in Congenital Heart Lesions

We report the usefulness of the Szabo (anchor-wire) technique and two modifications of such based on the same concept for stent implantation in congenital heart lesions. The modifications of the original technique are related to the localization of the cell of the stent through which the anchor wire, which stops the stent advancement, is introduced: proximal in the original technique and central or distal in the reported modifications. These techniques were performed in six patients: in two to maintain permeability of the ductus arteriosus, in three to achieve a fenestration of the interatrial septum, and in one to implant a stent in a right ventricle-to-pulmonary artery conduit close to the bifurcation. We describe the technique as well as the most important difficulties and complications encountered. The Szabo or anchor-wire technique concept is a new tool for stent implantation that can provide more accurate stent positioning compared with conventional angiographically guided implantation in different congenital heart defects. As with any new tool, this technique demands a learning curve and knowledge of potential complications.

Complications of colonoscopy

Summary Endoscopic complications are rare but inevitable, occurring in fewer than 0.35% of procedures [B]. Knowledge of potential complications and their expected frequency can lead to an improved informed consent process [C]. Complications from the procedure include perforation, hemorrhage, postpolypectomy coagulation syndrome, infection, preparation-associated complications, and death, and are more likely to occur with therapeutic procedures rather than diagnostic procedures [B]. Risk factors for poylpectomy-associated complications include the location and size of the polyp, experience of the operator, polypectomy technique and possibly the type of electrocoagulation current used [B]. Use of saline solution injection under large sessile polyps decreases depth of thermal injury [A] and may decrease complications [B]. Early recognition of complications and prompt intervention may decrease patient morbidity [C]. Treatment of complications range from supportive for postpolypectomy coagulation syndrome, to repeat colonoscopy with injection or electrocoagulation for bleeding, to surgical repair for free perforation [B]. Consideration of the risks and benefits may improve clinical outcome by identifying potential complications and taking appropriate steps to minimize the risks [C].

Failure of Laparoscopic Sleeve Gastrectomy – Further Procedure?

Background: Worldwide, the incidence of morbid obesity is increasing, and surgery is the only effective longterm treatment. Laparoscopic sleeve gastrectomy (LSG) is associated with acceptable weight loss and reduced comorbidities. It is considered a safe procedure with sporadic complications. This publication aims to describe failures of LSG in terms of ineffective weight loss or early weight regain, and analyze secondary treatment options. Methods: From October 2001 to December 2010, 937 patients underwent LSG in our department. Initially, all procedures were scheduled as a two-stage procedure (LSG followed by biliopancreatic diversion with duodenal switch). However, the second procedure was not performed in 64 patients (body mass index > 60 kg/m²). Since 2005, the frequency of second stage procedures after weight regain has been increasing; their outcome is analyzed. Results: Of the 937 patients, 17 (1.8%) experienced staple line leakage. Mean time to first reintervention or endoscopic stent placement was 15.6 ± 22 days (range 2–78). From 2005 to 2010, 106 secondary procedures were performed. Insufficient weight loss or weight regain were the indications in 88 cases. Sixteen (15%) patients had severe gastroesophageal reflux which was resolved by Roux-en-Y gastric bypass (RYGB). Stenosis was observed in 2 (2.6%) patients, which required endoscopic dilatation and stent placement in one case and gastric bypass in the other. Conclusions: LSG is a feasible and popular bariatric procedure. Mortality (0.4%) was much higher than after gastric bypass (0.03%) and gastric banding (0%) The knowledge of potential complications and their management is crucial. All restrictive procedures require patient compliance, but increased food uptake after RYGB and LSG is common. Malabsorptive procedures are more effective for long-term weight loss. Duodenal switch and omega-loop gastric bypass are more efficient second stage procedures than re-sleeve or RYGB.

Quality Initiatives: Strategies for Anticipating and Reducing Complications and Treatment Failures in Hepatic Radiofrequency Ablation

Radiofrequency (RF) ablation is one of several local treatment strategies that can be used for the destruction of a variety of primary and secondary liver tumors. As experience with RF ablation grows, it becomes increasingly evident that successful ablation requires meticulous technique. In addition, knowledge of potential complications is critical for both the interventionalist and the radiologist, whose postablation interpretation can facilitate identification of complications and treatment failures. Hepatic RF ablation offers significant advantages in that it is less invasive than surgery and carries a low risk of major complications. Successful prevention of complications and treatment failures begins at initial consultation and continues with preablation evaluation of specific patient factors such as coagulation profiles, use of medications, and risk factors for infection. Other predisposing factors include background liver cirrhosis, prior hepatectomy, and portal hypertension. During ablation, careful attention must be given to tumor size, number, and location. For large or multiple ablations, separate ablation sessions can help reduce the prevalence of postablation syndrome, and clustered electrodes and multiple overlapping treatment zones may be used to reduce the risk of treatment failure. It is critical to reevaluate tumors during ablation to determine the best approach and to compensate for changes in size and relative location due to patient positioning. With use of these strategies, hepatic RF ablation can be performed with greater safety, better patient tolerance, and a reduced risk of complications and treatment failures.

The effectiveness of the antegrade reamed technique: the experience and complications from 415 traumatic femoral shaft fractures

This retrospective study presents the experience gained through use of reamed femoral nails and reports results and respective complications. This study included 415 femur fractures (312 men and 101 women with a mean age of 27.8 years) that were treated from 1993 to 2004. The fractures were classified according to AO, and 74 open fractures were included and typed according to the Gustilo classification. Dynamic nailing was performed for nearly all type A fractures and static nailing for types B and C. After a mean follow-up of 1.5 years, union rate was 97.8%. The complications were: 9 non-unions, 14 delayed-unions, 4 torsional malunions, 6 limb length discrepancies (shortening) and 30 nerve pareses due to traction. Deep venous thrombosis (DVT) occurred below the knee in 4 patients, while there were recorded 3 pulmonary and 2 fat embolisms, 1 superficial and 1 deep infection. There were 28 broken screws identified postoperatively. Logistic regression analysis revealed that type B and C were associated with increased risk of complications, with respective odds ratios of 3.1 (95% CI = 1.3–7.2, P = 0.011) and 4.3 (95% CI = 1.8–10.3, P = 0.001) when compared to type A patterns. All patients returned to their activities in a mean time of 10 months. Intramedullary nailing is still the treatment of choice for femoral shaft fractures, but knowledge of potential complications and their association with certain fracture patterns is needed.