Knowledge Of Potential Complications Research Articles

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.

Postoperative complications in ophthalmic plastic and reconstructive surgery

Complications are an inevitable part of surgery and, despite the best preparative efforts, events may not unfold as planned and unanticipated complications inescapably occur. A thorough knowledge of potential complications in order of likelihood and importance is paramount in achieving the best possible outcome, not simply to minimize the occurrence of these events but also to provide the capacity to optimally evaluate and manage such events should they arise. This review summarizes the evaluation and management of complications associated with commonly performed surgical procedures in the field of ophthalmic plastic and reconstructive surgery.

Air sac cannula placement in birds

Air sac cannulas are indicated in birds with upper respiratory obstruction or for ventilation during surgical procedures involving the head and neck. Proper technique, knowledge of potential complications, and an understanding of the indications for air sac tube placement are important for scientists, veterinarians, and technicians who work with birds.

P0482 COLONIC STRICTURE AND OBSTRUCTION RELATED TO COW???S MILK PROTEIN ALLERGIC ENTEROCOLITIS (AE)-A CASE REPORT

Introduction: Gastrointestinal (GI) food allergies constitute an increasing pediatric problem. Adverse immunological reactions to dietary food proteins in the GI tract range from mild to severe. Complications of GI allergies are not well described. We report a colonic stricture resulting from AE, which has not been previously reported in the literature. Methods: A 4 month-old boy was admitted with two days of non-bilious vomiting, feeding intolerance and abdominal distention. His neonatal history was significant for a full-term infant who developed bilious emesis and bloody stools at 24 hours of life after feeding standard infant cow’s milk-based formula. Abdominal X-ray (AXR) was unremarkable. An upper GI series excluded malrotation. He was diagnosed with medical necrotizing enterocolitis Stage I and treated with antibiotics and bowel rest. He was discharged after weaning to an amino-acid based formula, then to breastmilk. At two months of life, the baby was re-admitted with diarrhea, emesis and abdominal distention. Barium enema (BE) was negative for stricture or obstruction, and the patient improved on bowel rest. He continued with feeding issues of fussiness during feeding and emesis. The mother eliminated milk and soy from her diet, and the baby was treated for GERD. The baby also had chronic anemia (hemoglobin averaged 8gm/dL). One week prior to admission, the mother reported taking whole cream in her coffee, followed by the baby having diarrhea, then constipation for several days. Results: AXR revealed dilated bowel loops. Stools were guaiac positive, and laboratory values were significant for anemia and hypoalbuminemia. Emesis became bilious. Repeat BE suggested a filling defect in the sigmoid colon. Focused BE was repeated and defined a 1–2 cm narrowing of the sigmoid colon. The patient was taken to the operating room for definitive treatment. Upper endoscopy and flexible sigmoidoscopy were grossly normal. At exploration, the sigmoid colon was severely strictured for a distance of 3 cm. Sigmoid resection and primary anastomosis were performed. Pathology revealed a 7mm circumference. Mucosal histology showed moderate chronic esophagogastroduodenitis and chronic proctitis, with a rich eosinophilic infiltrate, consistent with allergic gastroenterocolitis. Conclusion: Post-op, he was placed on an amino-acid based formula, and breastmilk was discontinued. His symptoms vastly improved. He fed well, continued to gain weight, and emesis resolved. AE targets the gastrointestinal mucosa resulting in an undefined cascade of events. Knowledge of potential complications may help shed light on the precise mechanism.

Complications of colonoscopy

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]. 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].

Gallstones, from gallbladder to gut

PREVIEWGallstones may be incidental and asymptomatic or painful and accompanied by life-threatening obstruction or infection. A thorough knowledge of potential complications is therefore critical, especially because some asymptomatic stones require prompt treatment. In this article, Drs Agrawal and Jonnalagadda provide valuable instructions for recognizing and treating the various manifestations of gallstone disease.

Medical care of the neurosurgical patient.

Proper medical care before and after surgery play an important role in the overall care of patients requiring neurosurgery and will have an impact on the neurological recovery. Prevention of spinal cord destruction resulting from the cascade of events which occur secondary to central nervous system trauma is a critical part of a patient's preoperative care. High doses of methylprednisolone sodium succinate given within the first 8 hours of trauma are currently recommended to provide protection to neural tissue after trauma. Other promising drugs for patients with spinal trauma, such as 21-aminosteroids and GM-1 gangliosides, may become available in the near future. Knowledge of potential complications after surgery and methods to prevent complications from occurring is an important part of the postoperative care of neurosurgical patients. This includes management of micturition and defecation dysfunction, management of postoperative pain, physical therapy to speed recovery, and providing good supportive care to the recumbent patient.

Teaching of patients undergoing total hip replacement surgery

We studied the effect of patient teaching in 60 patients who underwent primary total hip replacement surgery. All the patients received an illustrated patient guide. In addition to the general patient teaching given by doctors, nurses and physiotherapists, a randomly chosen group of 27 patients received a session of intensified patient teaching. At the follow-up, 2–3 months postoperatively, 61% of patients thought that they had received the main part of their information from the physiotherapists, 9% from their doctors and 4% from the nursing staff. The importance of a well-illustrated guide was pointed out. The knowledge of potential complications, such as infection, remained poor; 37% could not name one single relevant complication. At the follow-up, the younger or better educated patients did not score any better. The experimental group who had received intensified teaching differed only slightly from the controls, but they knew significantly better when to inform their doctor of potential complications. Also, the experimental group showed greater interest in obtaining more information about their replaced hip. Patients in the experimental group showed significantly better adherence to the instructions for the postoperative rehabilitation programme. Our results showed that the experimental group was clearly motivated, and to a certain degree followed the rehabilitation instructions more clearly. Doctors and nurses should have more well-illustrated educational material available on total hip replacement, and use this material for individual patients. Admission to the hip service should include an individual teaching session.

Polyorchidism: Functional classification and management strategy

Polyorchidism is rare. We report a recent case and review the literature. A simple classification based on anatomic and functional arrangements of the testes and their drainage systems is described. Combining this classification with a knowledge of potential complications, we propose a management strategy.

General Principles in the Prevention of Surgical Complications in Orthopedic Surgery

Preventive measures in orthopedic surgery are best accomplished by full knowledge of potential complications, thoughtful preoperative planning, the careful and precise execution of the operative procedure, meticulous hemostasis, and the implementation of appropriate measures in the postoperative period.