Late Complications In Patients Research Articles

Percutaneous Endoscopic Gastrostomy Experience: Early and Late Complications

Background
 This study retrospectively evaluated the early and late complications of patients who had a percutaneous endoscopic gastrostomy (PEG) tube placed, discussed complication frequency of different diseases and finally pointed on some advices to reduce complications.
 
 Methods
 The study was conducted with 99 patients who had a PEG tube placed in the endoscopy unit of a training and research hospital. Patients’ age, gender, diagnosis, types of early and late complications, and complication development rates were evaluated.
 
 Results
 Mean age of the patients was 70.42±16.75(18-94) years and 48.5% were male. Early complications occurred in 11.1%, of which 6.05% were bleeding at the entry site of the PEG tube, and 5.05% were peristomal infection. 39.4% of the patients had late complications, including tube dislodgement in 18%, infection in 8.1%, aspiration pneumonia in 7.1% and other complications in 6%. No complications were observed in 51.5% of the patients, and early or late complications were observed in 48.5% of the patients. 2% of the patients had both early and late complications. The incidence of late complications was significantly higher in patients with Alzheimer’s disease (p=0.027).
 
 Conclusion
 In the follow-up of patients who had a PEG tube placed in the previous six months, the most common early complication was bleeding in 6.05%, and the most common late complication was tube dislodgement in 18%. Despite its potential complications, the PEG tube is a safe method for long-term enteral feeding. Alzheimer patients are at risk for late complications more than other diseases.

Bilateral spontaneous pneumothorax as a late complication of COVID‐19, a clinical case report

Bilateral spontaneous pneumothorax and sudden dyspnea can occur as late complication in patients with COVID-19 even without any history of mechanical ventilation usage. Bilateral spontaneous pneumothorax can occur as a late complication in patients with COVID-19, even without any history of mechanical ventilation. Here, we present a patient with mild COVID-19 pneumonia with a left massive pneumothorax in the third week of hospitalization and the addition of a right pneumothorax.

Long-term follow-up of patients with extensive segmental infantile hemangioma of the cervical or facial region: A French single-center prospective study

BackgroundInfantile hemangiomas (IHs) can be part of PHACE (posterior fossa anomalies, hemangioma, arterial anomalies, cardiac anomalies, eye anomalies) syndrome when they are segmental, extensive, and located on the face or neck. The initial assessment is codified and well known, but there are no recommendations for the follow-up of these patients. The aim of this study was to assess the long-term prevalence of different associated abnormalities. MethodsPatients with a history of large segmental IHs of the face or neck. diagnosed between 2011 and 2016 were included in the study. Each patient underwent an ophthalmological, dental, ENT (ear, nose, and throat), dermatological, neuro-pediatric, and radiological assessment at inclusion. Eight patients including five with PHACE syndrome were prospectively evaluated. ResultsAfter a mean follow-up of 8.5 years, three patients presented with an angiomatous aspect of the oral mucosa, two with hearing loss, and two with otoscopic abnormalities. No patients developed ophthalmological abnormalities. The neurological examination was altered in three cases. Brain magnetic resonance imaging follow-up was unchanged in three out four patients and revealed atrophy of the cerebellar vermis in 1 patient. Neurodevelopmental disorders were found in five of the patients and learning difficulties were observed in five patients. The S1 location appears to be associated with a higher risk of neurodevelopmental disorders and cerebellar malformations, while the S3 location was associated with more progressive complications, including neurovascular, cardiovascular, and ENT abnormalities. ConclusionOur study reported late complications in patients with a large segmental IH of the face or neck, whether associated with PHACE syndrome or not, and we proposed an algorithm to optimize the long-term follow-up.

Risk Factors and Quality of Life in Patients with Diffuse Pouchitis After Ileal Pouch Anal Anastomosis According to the Chicago Classification for J Pouch: a Retrospective Multicenter Cohort Study in China

BackgroundPouchitis is a common late complication in patients with ulcerative colitis (UC) who undergo ileal pouch–anal anastomosis (IPAA). The heterogeneous nature of the clinical and endoscopic presentations could affect the evaluation of therapeutic interventions for pouchitis. Thus, identifying the risk factors and clinical outcomes of pouch inflammation at different sites and severity is becoming increasingly important for colorectal surgeons. MethodsData on patients who underwent IPAA January from 2008 to June 2022 in our three pouch centers affiliated with the China UC Pouch Center Union were retrospectively collected. Pouchitis was categorized as a different phenotype according to the Chicago Classification. J pouches were classified into short (14 ± 2 cm) and long pouches (22 ± 2 cm) according to the distribution of ileal pouch length in our institute. ResultsAltogether, 143 patients with a median follow-up time of 5.0 years (interquartile range: 2.0–8.0) were enrolled. Among them, 41 patients (28.7%) developed pouchitis and 32 patients (78%) had diffuse inflammation of the pouch. Patients with diffuse pouchitis had a higher pouchitis disease activity index and more seriously impaired improvement of long-term quality of life than those with pouch phenotypes. A short J pouch, recurrent UC, and preoperative high white blood cell count were independent risk factors for diffuse pouchitis. Furthermore, a short J pouch could effectively predict the occurrence of diffuse pouchitis with an area under the receiver-operating characteristic curve of 0.614, a sensitivity of 62.5%, and a specificity of 60.4% (p = 0.049) and significantly decreased the overall diffuse pouchitis-free survival compared to a long J pouch (p = 0.0002). ConclusionDiffuse pouchitis is a common phenotype of pouchitis that seriously impairs long-term prognosis. For colorectal surgeons, decision-making regarding pouch construction with an appropriate length should be considered to prevent the development of diffuse pouchitis. Graphical Abstract [Display omitted]

The Outcome of Ultrathin-Strut Biodegradable Polymer-Coated Sirolimus-Eluting Stents in Coronary Artery Disease Patients - A Feasibility Study.

Drug-eluting coronary stents with ultrathin struts and biodegradable polymers have been shown to reduce inflammation, neointimal proliferation, and thrombus formation, leading to less early and late complications in patients with coronary artery disease as compared to thinner strut and durable polymer second-generation stents. In Oman, currently, second-generation stents are used for all patients. The purpose of this feasibility study was to evaluate the clinical safety and performance of ultrathin-strut (60 μm) biodegradable polymer-coated sirolimus-eluting stents in an all-comers patient population. This was a prospective, observational, single-center, and single-arm investigator-initiated study from August 2018 to August 2019. Inclusion criteria: 18 years of age, patients with symptomatic coronary artery disease indicated for percutaneous coronary intervention, and stenting of at least one coronary lesion. All patients were followed clinically or telephonically at 12 months after the index procedure. A total of 88 patients were recruited in the study, but 10 patients were lost to follow-up and hence excluded from the analysis. The overall mean age was 63 ± 13 years and 78% were males. The main comorbid conditions were hypertension (58%), diabetes mellitus (49%), and hyperlipidemia (26%). Fifty-three percent presented with unstable angina or non-ST elevation myocardial infarction (MI), 10% with ST elevation MI, recent MI 16%, 18% with stable angina, and 1.3% in cardiogenic shock. The mean left ventricular ejection fraction of the cohort was 46 ± 14%. Angiographically, Type A lesions were seen in 25%, Type B in 32%, and Type C in 42%. Left anterior descending stenting was done in 44%, right coronary artery in 32%, left circumflex artery in 14%, left main in 5%, and graft stenting in 4%. Device success was 96%. Procedural success was seen in 97% of patients. At 1-year follow-up, 93% were asymptomatic; overall device-oriented clinical events were 6.8% including cardiac death in 2.7%, target-vessel MI in 2.7%, and target-lesion revascularization in 1.3% which all occurred in uncontrolled diabetic patients. At index admission and 1 year, ultrathin-strut biodegradable polymer-coated sirolimus-eluting stent study showed low device-related adverse clinical events which are comparable to published data for the second-generation stents. This feasibility study shows that these stents can be used in all types of stent-indicated patients with added advantages of biodegradable polymer and ultrathin struts. In addition, measures to prevent, diagnose, and control diabetes need to be taken in Oman as this cohort of patients develop ST after stenting.

Comparison of open and laparoscopic inguinal hernia surgery based on chronic pain, paraesthesia and recurrence

Aim: To assess the preoperative and operative findings and postoperative early and late complications in patients who were operated on electively and to compare the factors affecting these results through open and laparoscopic hernia techniques. Materials and Methods: In this retrospective study, the patients were initially divided into two groups as open inguinal hernia repair (OIHR) and laparoscopic inguinal hernia repair (LIHR); then the LIHR group was divided into two subgroups as transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) groin hernia repair with respect to the operation techniques. Preoperative, operative, and early and sixth-month late-period complications of the patients were statistically analyzed. Results: In a total of 241 patients included in the study, 170 patients were included in the OIHR group, and 71 patients were included in the LIHR group (TAPP=20, TEP=51). No statistically significant difference was noted between the OIHR and LIHR groups and between the TAPP and TEP subgroups in terms of chronic pain, paraesthesia, and recurrence. Conclusions: We believe that there is no difference in long-term results between open and laparoscopic elective inguinal hernia surgery.

Мукормикоз у пациентов с COVID-19

Rhinocerebral mucormycosis is characterized by a severe course and is one of the late complications in patients who have undergone COVID-19. For the successful treatment of this disease, the earliest possible diagnosis and the appointment of specific conservative therapy in combination with surgical intervention are necessary. Objective. To study the risk factors for the development of invasive mycoses, the clinical manifestations of this pathology, and the results of its treatment in patients who underwent SARS-CoV-2. Research methods. Retrospective analysis of the case histories of 25 patients with mucormycosis. Demographic, subjective, and objective data (medical history, complaints, endoscopic examination), radiological techniques (CT scans), histological, microscopic and cultural studies as well as the results of medical and surgical treatment were analyzed. Result of the study. Groups of patients with comorbid pathology, potentially predisposed to the development of this disease, as well as groups of drugs, the use of which predisposes to the risk of developing mucormycosis, were identified. Conclusion. The predisposing background to the development of mucormycosis is hyperglycemic conditions and the use of high doses of corticosteroids and broad-spectrum antibiotics as part of the COVID-19 treatment protocol. According to epidemiological data, the largest number of cases of invasive rhinocerebral mucormycosis coincided with the highly virulent SARS-CoV-2 delta strain. Early initiation of specific antifungal therapy combined with surgery results in more effective treatment.

Radiation-induced cancer after treatment for nasopharyngeal carcinoma: a study from a high prevalence area.

Radiation-induced cancer (RIC) is a late complication in patients who have been treated for nasopharyngeal carcinoma (NPC). The comparison of index anatomic location, index histological type, and survival of RIC in patients with NPC after different radiotherapy modalities (intensity-modulated radiotherapy [IMRT], 3-dimensional conformal radiotherapy [3D-CRT], and conventional 2D radiotherapy) is currently unavailable. A total of 38,565 patients with NPC who received curative-intent radiotherapy at Sun Yat-sen University Cancer Center between January 1986 and December 2017 were reviewed. A total of 141 patients who developed RIC and fulfilled the study criteria were included. Categorical variables were compared by the χ2 test or Fisher's exact test. Kaplan-Meier curves were used to evaluate overall survival. Cox proportional hazards models were used to examine the independent significance of RIC treatment. Among IMRT, 3D-CRT, and conventional 2D radiotherapy, the incidence of mandible RIC was higher in patients who received 3D-CRT (0.07%) than in those who received IMRT (0%). The proportion of mandible RICs was higher in patients who received 3D-CRT (16.667%) than in those who received IMRT (0%) and conventional 2D radiotherapy (3.529%). Regarding the histological type, the incidence of squamous cell carcinoma (SCC) was higher in patients who received conventional 2D radiotherapy (0.266%) than in those who received 3D-CRT (0.175%); patients who received IMRT had a higher proportion of SCC than those who received 3D-CRT/conventional 2D radiotherapy (86.4% vs. 41.7% vs. 74.2%); the incidence of sarcoma was higher in patients who received 3D-CRT (0.175%) than in those who received IMRT (0.025%); and the proportion of sarcoma was higher in patients who received 3D-CRT (41.667%) than in those who received IMRT (6.818%) and conventional 2D radiotherapy (17.647%). Patients who received surgery for RICs had better survival than those who received no surgery (64.49 vs. 12.42 months). In the univariate and multivariate analyses, surgery was an independent prognostic factor for overall survival. Our results have implications for long-term follow-up of RIC, multidisciplinary management, and patient counseling of RIC after nasopharyngeal carcinoma treatment by treating clinicians.

Acquired Chiari type I malformation: a late and misunderstood supratentorial over-drainage complication.

Acquired Chiari I malformation is an uncommon but possible late complication of supratentorial shunting in children. This condition can be caused by an abnormal thickening of the cranial vault and consequent reduction of the posterior cranial fossa (PCF) volume especially in children with already a small PCF volume. The management of Acquired Chiari I malformation is very challenging, and several options have been proposed for this condition. These are aimed to expand the PCF volume both through decompression and PCF remodeling in order to relieve symptoms of acquired Chiari I malformation. A cranial vault remodeling or a standard Chiari decompression is two proposed techniques aimed to expand the PCF volume thus relieving symptoms . We describe the case of a 16-year-old girl undergone surgical removal of sellar-suprasellar glioneuronal tumor and ventriculo-peritoneal shunting, who developed an acquired symptomatic Chiari type I malformation some years after ventricular-peritoneal shunting. For this condition, she underwent successful standard Chiari decompression with C0-C1 craniectomy and duroplasty. We retrospectively analyzed MRI and CT scan performed during follow-up, in order to evaluate the volume of the posterior cranial fossa and to measure the variation of skull thickness at different periods. MRI and CT scan analysis showed a progressive thickening of the calvaria, in particular of the occipital bone, leading to a progressive reduction of PCF volume with the establishment of acquired Chiari type I malformation. In this case, standard C0-C1 Chiari decompression was effective in restoring PCF volume and relieving symptoms. Acquired Chiari I malformation due to chronic overhunting could be a severe and late complication in patient undergone supratentorial shunting. These patients require careful clinical and radiological follow-up to avoid over-drainage. According to our analysis, a careful selection of pediatric patients for supratentorial shunting should be made according to pre-operative PCF volume in order to foresee higher odds of possible late complications from over-drainage.

Long-Term Thyroid Function Outcome after Head and Neck Radiotherapy: External Validation and Comparisons of Thyroid Gland Dose-Volume Constraints

<h3>Purpose/Objective(s)</h3> Primary hypothyroidism is a common late complication in patients who underwent head and neck radiotherapy, occurring at incidences as high as 20-50% among long-term survivors. Various radiation dose-volume constraints for the thyroid gland have been proposed in retrospective series, but none has been externally validated for predicting long-term thyroid function outcome. <h3>Materials/Methods</h3> We undertook a systematic review of the literature and identified 22 distinct radiation dose-volume constraints of the thyroid gland for head and neck radiotherapy planning. We reviewed the thyroid gland dosimetry of 488 consecutive head and neck cancer patients who had normal baseline thyroid function and underwent definitive radiotherapy between January 2013 and December 2015 in two tertiary oncology centers. Thyroid function was monitored at least yearly after radiotherapy. Primary hypothyroidism was defined as serum TSH levels above the upper limit of normal. Time to hypothyroidism was estimated using cumulative incidence function with death designated as a competing event. Univariable and multivariable analyses were conducted using Gray's test the Fine-Gray sub-distribution hazard model. Diagnostic performances of the 22 constraints were compared using time-dependent receiver operating characteristic curves. <h3>Results</h3> With a median follow-up of 6.8 years, 205 (42.0%) patients developed post-radiation primary hypothyroidism. The 5-year primary hypothyroidism rate was 30.5%. Among all candidate dose-volume parameters (Dmin, Dmax, Dmean, V25, V30, V30, V35, V40, V45, V50, V30-60, VS45 and VS60), thyroid volume spared from 60Gy (VS60) had the largest areas under curve of 0.715, 0.694 and 0.698, at 1 year, 3 years and 5 years after radiotherapy, respectively. The sensitivity, specificity, positive predictive value and negative predictive value for VS60 ≥10cc on 5-year hypothyroidism risk were 84.4%, 40.3%, 38.5% and 85.4%, respectively. Among all evaluated constraints, VS60 ≥10cc had the highest F-score of 0.59, suggesting a superior overall diagnostic accuracy. The 5-year hypothyroidism risk for patients with thyroid VS60 ≥10cc and VS60 <10cc were 14.7% and 38.2%, respectively (p <0.001). In multivariate regression, young age, VS60 <10cc and small thyroid volume and were independent predictors for post-radiation primary hypothyroidism. The adjusted sub-hazard ratio for post-radiation primary hypothyroidism for VS60 <10cc was 2.00 (95% C.I., 1.33 – 3.07; p <0.001). <h3>Conclusion</h3> Our external validation study identified thyroid VS60 as the best radiation dose-volume parameter to predict long-term thyroid gland function in patients who underwent head and neck radiotherapy. VS60 >10cc is a potentially useful constraint that limits 5-year primary hypothyroidism risk to below 15%. As far as it is feasible during radiotherapy optimization, higher VS60 targets should be considered to further reduce the risk of this late complication among head and neck cancer patients.

Pulmonary thromboembolism in mild and asymptomatic COVID-19 cases. A clinical conundrum in post-COVID era

We present a case series of patients with pulmonary embolism of unknown etiology who did not have any risk factors. According to the findings, the most likely cause of the pulmonary embolism was undiagnosed, asymptomatic, or mild Corona Virus disease-2019 (COVID-19) infections in the recent past. In the current post-pandemic era, where there has been a surge of sudden unexplained deaths and pulmonary embolism cases, this case series emphasizes the importance of pulmonary embolism evaluation in patients seeking medical care for dyspnea. Physicians should be aware of the possibility of pulmonary embolism as a late complication in patients with mild, asymptomatic, or undiagnosed COVID-19 infection.

Pulmonary Thromboembolism in Mild and Asymptomatic COVID-19 Cases – A Clinical Conundrum in Post COVID era

We present a case series of patients with pulmonary embolism of unknown etiology who did not have any risk factors. According to the findings, the most likely cause of the pulmonary embolism was undiagnosed, asymptomatic, or mild Corona Virus disease-2019 (COVID-19) infections in the recent past. In the current post-pandemic era, where there has been a surge of sudden unexplained deaths and pulmonary embolism cases, this case series emphasizes the importance of pulmonary embolism evaluation in patients seeking medical care for dyspnea. Physicians should be aware of the possibility of pulmonary embolism as a late complication in patients with mild, asymptomatic, or undiagnosed COVID-19 infection.

Large inferior retinectomies for proliferative vitreoretinopathy in silicone oil-filled eyes

BackgroundTo describe the anatomical and functional outcomes and late complications in patients who developed inferior proliferative vitreoretinopathy (PVR) in silicone oil-filled eyes and who required reoperation with large inferior retinectomy.MethodsThis is a single-center, retrospective, interventional case series analysis. The study involved 18 individuals with tractional retinal re-detachment due to PVR development inferiorly in eyes who had undergone prior pars plana vitrectomy and silicone oil as a tamponade. All patients included in the study underwent secondary surgery with large inferior retinectomy (from 120° to 270°) and silicone oil filling.ResultsThe mean follow-up period was 44.0 ± 31.5 (± SD) months (range: 4 to 96 months. The anatomical success, defined as the complete reattachment of the retina until the last follow-up, was observed in 88.9% of the cases. The postoperative visual acuity ranged from 20/100 to hand motion at 60 cm. Only two cases (11.1%) did not achieve anatomical success at the last follow-up due to recurrent PVR and retinal re-detachment (one including hypotony). All of the patients were pseudophakic. The PVR grade, as well as the presence of PVR prior to primary surgery, showed no statistical correlation with BCVA, the extent of retinectomies, and final macular status. There was a statistically significant correlation between "Final BCVA" and "Initial BCVA" (r = 0.654) and between "Final BCVA" and "Extent of Retinectomy" (r = 0.615).ConclusionsReoperation in eyes filled with silicone oil may be required when PVR is developed. Secondary surgery in these cases with large inferior retinectomy and silicone oil implantation may reach good anatomical success with low rates of late complications, besides improving visual acuity. A better BCVA at the time of re-RD diagnosis and cases of retinectomies with greater extensions showed a positive correlation with better functional outcomes.Trial registration Research Ethics Committee of the Suel Abujamra Institute reviewed and approved this study protocol (approval number, 5.404.961).

Hyperbaric Oxygen for Lower Limb Trauma (HOLLT): an international multi-centre randomised clinical trial.

Hyperbaric oxygen treatment (HBOT) is sometimes used in the management of open fractures and severe soft tissue crush injury, aiming to reduce complications and improve outcomes. Patients with open tibial fractures were randomly assigned within 48 hours of injury to receive standard trauma care or standard care plus 12 sessions of HBOT. The primary outcome was the incidence of necrosis or infection or both occurring within 14 days of injury. One-hundred and twenty patients were enrolled. Intention to treat primary outcome occurred in 25/58 HBOT assigned patients and 34/59 controls (43% vs 58%, odds ratio (OR) 0.55, 95% confidence interval (CI) 0.25 to 1.18, P = 0.12). Tissue necrosis occurred in 29% of HBOT patients and 53% of controls (OR 0.35, 95% CI 0.16 to 0.78, P = 0.01). There were fewer late complications in patients receiving HBOT (6/53 vs 18/52, OR 0.22, 95% CI 0.08 to 0.64, P = 0.007) including delayed fracture union (5/53 vs 13/52, OR 0.31, 95% CI 0.10 to 0.95, P = 0.04). Quality of life measures at one and two years were superior in HBOT patients. The mean score difference in short form 36 was 2.90, 95% CI 1.03 to 4.77, P = 0.002, in the short musculoskeletal function assessment (SMFA) was 2.54, 95% CI 0.62 to 4.46, P = 0.01; and in SMFA daily activities was 19.51, 95% CI 0.06 to 21.08, P = 0.05. In severe lower limb trauma, early HBOT reduces tissue necrosis and the likelihood of long-term complications, and improves functional outcomes. Future research should focus on optimal dosage and whether HBOT has benefits for other injury types.

Usefulness of hepatobiliary scintigraphy for predicting late complications in patients with choledochal cysts

PurposeHepatobiliary scintigraphy is a minimally invasive imaging method that evaluates bile flow dynamics. At our hospital, it has been performed for postoperative evaluation of patients with choledochal cysts (CC). This study evaluated the usefulness of biliary scintigraphy for predicting late complications in patients with CCs.MethodsThe study included pediatric patients with CC who underwent surgery at Chiba University Hospital from 1978 to 2020, followed by postoperative biliary scintigraphy and subsequent radiologic evaluation. The patients were divided into two groups according to the presence or absence of “biliary cholestasis” on biliary scintigraphy.ResultsThe study included 108 patients, with a median age at surgery of 2 years and 11 months. The median follow-up period was 5203 days, with 11 hepatolithiasis cases and 8 cholangitis cases. No patients had cholangiocarcinoma. Twelve patients were considered to have “cholestasis” following biliary scintigraphy evaluation. There was no significant difference in the occurrence of hepatolithiasis between the cholestasis and non-cholestasis groups (p = 0.47), but cholangitis was significantly more common in the cholestasis group (p = 0.016).ConclusionBiliary cholestasis on postoperative hepatobiliary scintigraphy was a risk factor for cholangitis in patients with CCs. These particular patients should be monitored carefully.

MRI Assessment of the Early Disc Degeneration Two Levels above Fused Lumbar Spine Segment: A Comparison after Unilateral and Bilateral Transforaminal Lumbar Interbody Fusion (TLIF) Procedure.

Background: Adjacent segment degeneration (ASD) has become a great concern as a late complication in patients following fusion spine surgery with a potential need for revision surgery. Segments above the fused spine have higher mobility and they are especially prone to accelerated disc degeneration. The purpose of our study is to investigate early disc degenerative changes two levels above a surgically fused lumbar spine segment and to compare MRI analyses after unilateral and bilateral TLIF procedures. Methods: A total of 117 patients were included in this cross-sectional retrospective single center study (after bilateral TLIF surgery: n = 91, and after unilateral TLIF: n = 26). In both groups, the average patient age was similar: 62.84 years (SD = 12.53) in the unilateral TLIF group and 60.67 years (SD = 11.89) in the bilateral TLIF group. On average, MRI was performed 2.5 years after surgery (SD = 2.09). The modified eight-level Pfirrmann grading system was used for the assessment of disc degeneration severity. Descriptive statistics and the Mann–Whitney test were used to show differences in the Pfirrmann grades regarding the after-surgery period and the patient age. The Wilcoxon signed-rank test results were used to display differences in the Pfirrmann grades before and after surgery. Results: The comparison of mean values, regardless of the type of surgery, shows that this mean value is on average higher in the first segment adjacent to the fused spine segment. The assessment of the intervertebral disc structure in BIL TLIF is higher in both the first and the second segment. Early disc degeneration progression is subtle yet detectable (UNI TLIF 9.28% vs. BIL TLIF 16.74%). The assessment of the intervertebral disc structure is on average lower in patients aged less than 50 years at time of surgery compared with patients aged more than 50 years in UNI TLIF, and higher in the BIL TLIF group, for both the first and the second segment. Conclusion: Patients who had undergone unilateral TLIF fusion surgery have a lower rate of early disc degenerative changes. Considering a significantly higher rate of progressive disc degenerative changes in the elderly with bilateral fusion surgery, extra caution is required in the selection of appropriate surgical technique.

Open Treatment of Abdominal Aortic Aneurysm in the Endovascular Era

The aim of the study was to analyse outcomes and determine the early and late complications in patients after open surgical treatment of AAA in the endovascular era. Two hundred and fourteen patients between January 2012 and December 2021 with open repair in primary infrarenal and juxtarena aneurysm in elective setting were included in the study. Pre-, intra-, and postoperative clinical data were statistically analysed. The mean age of the 214 patients was 65.5 ± 9.3 years. The mean follow-up was 22.1 ± 2.1 months. Men represented the majority of the studied group (85.5%). The mean aortic diameter was 58.2 ± 13.4. The median ICU (days) stay was 5 ± 4.9 days for infrarenal aneurysm and 6 ± 6.1 days for juxtarenal aneurysm. Four patients died within 30 days, giving an in-hospital mortality rate of 1.9%. In multivariate logistic regression, COPD (p = 0.015) was the only predictor significantly associated with the mortality. A comparison of survival and reintervention using a Kaplan–Meier curve showed no significant difference between the groups in terms of risk stratification and the groups with juxtarenal versus infrarenal aneurysms. In conclusion, open aneurysm repair is in the era of endovascular aneurysm repair, being safe and effective, especially when performed in specialised high-volume centres with large expertise.

Prediction of late complications of acute myocardial infarction in diabetic patients

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Kharkiv national medical university Background The combination of acute myocardial infarction (AMI) and type 2 diabetes mellitus (DM) is common in patients, and the prognosis is usually worse than in patients without type 2 DM. Late complications of AMI in the presence of type 2 DM have a negative impact on the viability of patients. Purpose To predict the development of late complications in patients with AMI and concomitant type 2 DM. Methods A total of 109 ST elevation myocardial infarction (STEMI) and 2 type DM patients were included. The patients were treated from 01 September 2018 till 31 December 2020. The study involved clinical assessment of the patient’s condition, C1q tumor necrosis factor - related protein 3 (CTRP3) and adropin quantification. Late complications of AMI were included atrial fibrillation, atrioventricular blockage, chronic heart failure 2-3 functional classes, aneurysm of the apex and ventricular, ejection fraction ≤49%. We measured serum-concentrations of CTRP 3 and adropin by enzyme immunoassay. Reference values of CTRP 3 were 315.85 (287.06 – 371.02) ng/ml and adropin – 23.58 (20.86 – 26.29) pg/ml. Qualitative data were presented as percentages; quantitative as median and interquartile range (25 and 75 percentiles). The nonparametric Mann-Whitney rank criterion was used to compare quantitative indicators. Binary logistic regression was used to build a model for predicting late complications in patients with AMI with type 2 DM. Results In total, 75 men (68.8%) and 34 women (31.2%) were included in the study. CTRP 3 levels on day 14 in patients with AMI and type 2 DM was determined 262.01 (225.32 – 288.84) ng/ml and adropin concentration on day 14 - 19.97 (16.35 – 20.99) pg/ml according to CTRP 3 reference values (p&amp;lt;0.05). No late complications were identified in 9 patients and 65 patients had late complications. The most important indicators for constructing the model were: CTRP3 quality, adropin quality, total cholesterol (TC), triglycerides on day 14 (TG), ejection fraction (EF) on day 14, low density lipoproteides (LDL) on day 14, the size of the left atrium on day 14 (LA). Binary logistic regression was used to obtain a mathematical model in order to determine the probability of developing late complications (P) of AMI: P=[1+ exp(-4.046×Adropin-2.714×CTRP3+6.270×TC-2.988×TG-0.288×EF-7.407×LDL-1.398×LA+19.259)]-1.The accuracy of the model was 94.6%. Conclusion This study showed that the use of a model to detect late complications of AMI may in the long term predict the development of uncomfortable cardiovascular events of AMI, accompanied by type 2 DM. Of course, the sample size was relatively small, which should be increased in the future to confirm the findings.

Attainment of Best Practice Recommendations and Late Complications of Patients with Type 1 and Type 2 Diabetes Mellitus

Background: There is a need for information on the current practices of diabetes management to take some actions and improve the attainment of therapeutic goals. Objective. We aimed to describe the attainment of therapeutic targets and late complications of patients with type 1 (T1D) and type 2 (T2D) diabetes mellitus. Material and Methods. In the fourth wave of the International Diabetes Management Practices Study, 1,966 Mexican patients were analyzed (T1D: n=157, 8%; T2D: n=1809, 92%). The cross-sectional phase regarding metabolic profile, current complications, and management are analyzed. Results. Out of T1D patients, 77.6% received insulin alone, and 27.4% had insulin and oral glucose-lowering drugs (OGLD, mostly metformin). Out of T2D patients, 63% received OGLD exclusively (mostly metformin), 4.3% insulin alone, 30.4% OGLD, and insulin, and 2% were on a diet and exercise exclusively. Only 19.7% T1D and 35.9% T2D patients had HbA1c &lt;7% (p=0.01), and only 5.0% of T1D and 3.9% of T2D met the combined therapeutic target of HbA1c &lt;7% + BP &lt;130/80 mmHg + LDL &lt;100 mg/dl. Late diabetes-related complications occurred in 42.7% of T1D and 52.8% of T2D patients, mostly microvascular disease. Macrovascular complications were more frequent in patients with T2D, as compared with T1D (36.8% vs. 16.4%, p&lt;0.001). The number of late complications increased steadily with disease duration, more pronounced in patients with T2D. Conclusions. This study evidences substantial lags in the attainment of clinical goals of patients with diabetes mellitus. There are noticeable differences in the achievement of current therapeutic targets between patients with T1D and T2D in a sample of the Mexican practice.

Problems caused by late complications in patients undergoing prosthetic reconstruction after bone and soft tissue tumor surgery

Problems caused by late complications in patients undergoing prosthetic reconstruction after bone and soft tissue tumor surgery