Late Local Complications Research Articles

Personalized physiotherapy for patients with late complications after lip fillers administration

Lip contouring with preparations based on synthetic hyaluronic acid is one of the most popular cosmetic procedures. However, in recent years, there has been an explosive increase in the number of complications. There are many physiotherapeutic methods for the treatment of late complications of lip contouring. Nevertheless, currently there are no differentiated approaches to the choice of physiotherapy techniques and their combination, depending on the filler and the clinical and functional picture of the complication. Objective: to develop and evaluate the use of personalized physiotherapy in patients with complications after the administration of lip fillers, taking into account patients’ genetic predisposition. Material and methods. The study involved 51 patients aged 30-42 years with a diagnosis of L57.4 - cutis laxa senilis, who received late complications (local swelling, dry and pale lip skin, filler contouring, soreness, sensitivity change) at the filler injection site. All patients underwent genetic testing on the Cosmetology panel before the start of treatment. There were 3 groups that received physico-pharmacological methods: longidase laserophoresis, collagenase diadinamophoresis, or their combination in the lip area at the filler injection site. Result. When analyzing the data after the course of treatment, the patients with the combined protocol showed a significant improvement in the quality of life, both in the near and long-term research period. This was expressed in a statistically significant decrease in intradermal edema, rapid regression of pain syndrome, and more accelerated biodegradation of the superficially injected filler in the main group compared to other study groups. Conclusion. In patients with late local complications after the injection of hyaluronic acid fillers, the combined protocol with the inclusion of longidase laserophoresis and collagenase diadinamophoresis significantly shortens the recovery period, contributes to a faster reduction of local edema, pain, neuropathy phenomena, and to accelerated biodegradation of the superficially injected filler, as well as ensures a stable clinical result. Personalized physiotherapy is an effective factor in relieving complications after lip contouring.

Personalized physiotherapy of patients with late complications after the introduction of lip fillers

BACKGROUND: Lip contouring with preparations based on synthetic hyaluronic acid is one of the most popular cosmetic procedures. But in recent years, there has been an explosive increase in the number of complications. There are many physiotherapeutic methods for the treatment of late complications of lip contouring. However, currently there are no differentiated approaches to the choice of physiotherapy techniques and their combination with each other, depending on the nature of the filler and the clinical and functional picture of the complication.
 AIM: to develop and evaluate the use of personalized physiotherapy in patients with complications after the introduction of lip fillers, taking into account their genetic predisposition.
 MATERIAL AND METHODS: The study involved 52 patients aged 3042 years with a diagnosis of "L57.4 Senile atrophy (lethargy) of the skin", who received late complications (local swelling, dry and pale lip skin, filler contouring, soreness, sensitivity change) at the filler injection site. All patients underwent genetic testing on the Cosmetology panel before the start of treatment. There were 3 groups that received physico-pharmacological methods: laserophoresis of longidase, diadinamophoresis of collagenase or a combination of them in the lip area at the filler injection site.
 RESULTS: When analyzing the data after the course of treatment, patients with the combined protocol showed a significant improvement in the quality of life, both in the near and long-term research period. This was expressed in a statistically significant decrease in intradermal edema, rapid regression of pain syndrome and more accelerated biodegradation of the superficially injected filler in the main group compared to other study groups/
 CONCLUSION: In patients with late local complications after the introduction of hyaluronic acid fillers, the combined protocol with the inclusion of laser-phoresis of longidase and collagenase diadinamophoresis significantly shortens the recovery period, contributes to a faster reduction of local edema, pain, neuropathy phenomena, accelerated biodegradation of the superficially injected filler, and also allows for a stable clinical result. Personalized physiotherapy is an effective factor in relieving complications after lip contouring.

The "Two-Step" approach for classifying the severity of acute pancreatitis: A retrospective study.

The Revised Atlanta Classification (RAC) and Determinant-Based Classification (DBC) are currently two widely adopted systems for evaluating the severity of acute pancreatitis (AP). This study aimed to overcome the inaccuracies and limitations that existed in them. We retrospectively analyzed 298 patients with AP. The "Two-Step" approach was divided into an early organ failure (OF) assessment: (I) none, (II) transient, (III) single persistent, and (IV) multiple persistent; and a later local complications assessment: (A) none, (B) sterile, and (C) infectious. Patients with AP who died before the second step were classified into category X. The "Two-Step" approach was then compared to the RAC and DBC. As the patients' grades increased (I to IV), organ support treatment rates, intensive care unit lengths of stay, and mortalities increased. Invasive intervention rates displayed increasing trends with local complications aggravated (A to C). Patients in category X were older and had higher Marshall scores with the highest grades of severity. By combining the early OF grades and the late local complications, the "Two-Step" approach represents an accurate classification system required for stratified studies of AP, and introduces the category X as the severest forms of AP.

Prevention of Severe Acute Pancreatitis With Cyclooxygenase-2 Inhibitors: A Randomized Controlled Clinical Trial.

OBJECTIVES:Severe acute pancreatitis (SAP) is still a big challenge. Accumulated data showed that overexpression of cyclooxygenase-2 (COX-2) in acute pancreatitis and experimental pancreatitis could be attenuated with COX-2 inhibitors. This study was aimed to evaluate whether the occurrence of SAP could be prevented by selective COX-2 inhibitors.METHODS:A total of 190 patients with predicted SAP were randomized into convention group or convention plus COX-2 inhibitors (C+COX-2-Is) group. Besides conventional treatment to all patients in 2 groups, parecoxib (40 mg/d intravenous injection for 3 days) and celecoxib (200 mg oral or tube feeding twice daily for 7 days) were sequentially administrated to the patients in the C+COX-2-Is group. The primary outcome was predefined as the occurrence of SAP. The serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) for all of the patients were measured.RESULTS:The occurrence of SAP in the C+COX-2-Is group was decreased 47.08% compared with the convention group, 21.05% (20/95) vs 39.78% (37/93), P = 0.005. A reduction of late local complications was also shown in the C+COX-2-Is group, 18.95% (18/93) vs 34.41% (32/95), P = 0.016. The serum levels of IL-6 and TNF-α were significantly lower in the C+COX-2-Is group than those in the convention group, P < 0.05. Parecoxib relieved abdominal pain more rapidly and decreased the consumption of meperidine. An incremental reduction of cost for 1% decrease of SAP occurrence was RMB475.DISCUSSION:Sequential administration of parecoxib and celecoxib in patients with predicted SAP obtained about half-reduction of SAP occurrence through decreasing serum levels of TNF-α and IL-6. This regimen presented good cost-effectiveness.

Cistogastrostomía laparoscópica como tratamiento para pseudoquiste pancreático: reporte de un caso

The pancreatic pseudocyst is one of the late local complications of acute pancreatitis, for the management of this entity, there are multiple strategies that range from expectant management, minimally invasive therapy and surgical resolution. Since surgery is the definitive treatment, the laparoscopic approach takes force as a strategy in selected patients. A 47-year-old female patient with multiple comorbidities with pancreatitis of bile origin with subsequent development of pancreatic pseudocyst in whom surgical resolution with a laparoscopic approach is decided. Discussion: The laparoscopic approach shows favorable results; with a procedure duration of 170 minutes on average; the open technique shows several complications: pancreatic fistulas in 40%, enteric fistulas of 20%, incisional hernia of 25%, and mortality of 9 to 25%; Laparoscopic gastrocystostomy allows a much wider communication between the cyst and stomach compared to the endoscopic approach, safe hemostasis and better management of complications. Surgery for the treatment of pseudocyst continues to be the cornerstone; The laparoscopic approach shows the advantages of laparoscopy, with lower morbidity rates compared to open procedures.

Fix and replace; an emerging paradigm for treating acetabular fractures.

Although technically challenging even for the experienced surgeon, simultaneous open reduction and internal fixation (ORIF) of acetabular fracture and total hip replacement (THR) have some potential advantages over the more traditional treatment options in specific patient subgroups; theoretically allowing immediate weight bearing and faster rehabilitation, reducing the cost of inpatient stay, and reducing the risks of early and late local complications associated with standard treatment for this type of injury. We review the evolution of the indications and techniques, outline the surgical challenges, and discuss implant options and outcomes for this treatment paradigm.

A retrospective review of the incidence of various complications in different delayed breast reconstruction methods

Background: Breast reconstruction is a common standard procedure in many centres after breast cancer surgery. The aim of the present study was to investigate and compare the incidence of various complications in different reconstruction methods. Method: Six hundred and eighty-five patients were retrospectively classified into five groups: (1) Deep inferior epigastric perforator flap (DIEP), (2) latissimus dorsi flap (LD), (3) lateral thoracodorsal flap (LTDF), (4) expander with secondary implant (EXP), and (5) direct implant (DI). Demographic and perioperative data, the incidence of complications, and follow-up data were collected. Results: There was a significant difference between groups regarding overall early complications (p < 0.001). The DIEP group had the highest incidence of overall complications (50.0%) (p < 0.05). DIEP also had the highest incidence of fat necrosis (18.3%), skin necrosis (22.1%), and incidence of reoperation for complications (26.9%) compared to the other reconstruction methods. In the entire group of patients, the overall incidence of late complications (occurring >30 days after surgery) that needed surgical corrections was 54.7%. The incidence of late complications was 46.2% for DIEP, 66.4% for LD, 74.8% for LTDF, 44.9% for EXP, and 62.9% for DI. The DIEP group had higher incidences of late local complications (fat necrosis, skin necrosis, haematoma, seroma, and wound rupture combined), and scars requiring treatment than the other reconstruction methods. Conclusion: Meticulous registration of incidence of different complications in five different breast reconstruction methods revealed high complication rates with all methods. The differences in incidence of complications were related to the operation method used. Based on these results, careful individual planning of a breast reconstruction is mandatory.

Fractures of the acetabulum in elderly patients: An update

The incidence of acetabular fractures in elderly patients is increasing. Poor bone quality and concomitant diseases are the main features of these patients. Fracture patterns are marked by a high degree of variability in terms of patient and fracture characteristics. Preoperative planning with plain radiographs and computed tomography, including 3-dimensional reconstructions, is recommended. Treatment remains challenging because of precarious general health, severe osteopenia, comminution, and associated femoral head damage. Treatment options available include closed management, open reduction with internal fixation, percutaneous fixation in situ, and acute or staged total hip arthroplasty (THA) whether alone or combined with osteosynthesis. In the case of significant destruction of the articular cartilage, primary THA may provide the best solution. Whichever surgical method is chosen, the objective is rapid mobilisation of the patient on a walker or crutches. Late local complications that may occur after nonoperative or operative treatment include posttraumatic arthritis, nonunion, malunion, wound infection, dislocation, intrusive hardware, nerve palsy, and heterotopic bone formation. In this article an overview of the current trends in the management of acetabulum fractures in the elderly is presented.

Composite reconstruction in advanced cancer of the mouth floor: Autogenous frozen‐thawed mandibular bone and free flaps

Mandibular symphyseal resection requires composite reconstructions, often with unsatisfactory morphofunctional results. Seven patients with advanced squamous cell carcinoma of the floor of the mouth underwent block resection with immediate reconstruction, using the removed mandible treated with liquid nitrogen and covered with a free forearm flap. In all cases, the resection was radical and no major postoperative complications occurred. Two patients died in 6 months for distant metastases and regional recurrence. In the other 5 patients, no local recurrence occurred at a mean follow-up of 52 months (36-70). Immediate cosmetic and functional results were good. Of the 5 patients, 4 had late complications requiring further surgery. This technique of bone reimplantation produces no donor site morbidity, perfect immediate morphological result, and is of low cost. The free forearm flap is effective in sealing the oral cavity, though further clinical and experimental studies are necessary to reduce late local complications.

CYSTOPROSTATECTOMY FOR EFFECTIVE PALLIATION OF SYMPTOMATIC BLADDER INVASION BY PROSTATE CANCER

We evaluated the palliative effect of cystoprostatectomy (CP) for palliating pelvic symptoms in patients with bladder invasion by prostate cancer. A total of 38 patients with clinical T4 prostate cancer, including primary tumors in 17 and recurrence following radiation therapy in 21, underwent palliative CP. Local symptoms, the need for surgical procedures to relieve obstruction, and chronic tube drainage for urinary obstruction before surgery and 3 months after surgery were compared. Average followup was 23 months. Time to local and systemic symptom recurrence, biochemical progression and metastasis was measured and disease specific survival was determined. Local symptoms were reported by 34 patients (89%) before surgery and by 8 (21%) after surgery (p = 0.000). Preoperatively a total of 22 tubes were inserted in 13 patients to overcome urinary obstruction. Average indwelling tube duration was 6.9 months. A total of 24 transurethral prostatic tumor resections were performed in 11 patients. Following CP local symptoms were relieved permanently in 30 patients. The average interval between surgery and clinical systemic disease was 26 months. Median time to biochemical progression, metastasis and systemic symptoms was 8, 18 and 26 months, respectively. Median disease specific survival was 31 months (range 1.7 to 81.2). No perioperative deaths occurred. Rectal injuries occurred in 5 cases (13%) during surgery. Radical CP provides effective and durable palliation in patients with locally advanced prostate cancer. This procedure can be performed with acceptable morbidity in a select group of patients.

Dynamic graciloplasty versus implant of artificial sphincter for continent perineal colostomy after Miles' procedure: Technique and early results

Abdominoperineal resection (APR) is still the standard surgical treatment of anorectal cancers close to the dentate line. Unfortunately, a permanent iliac colostomy is a severe limitation of the quality of life. Attempts to construct a continent perineal colostomy after anorectal excision have been made over the last 15 years with uncertain benefits. We report on our early results of two different procedures consisting of a laparoscopic approach to abdominoperineal rectal excision, fashioning a perineal colostomy with dynamic graciloplasty or implant of an artificial sphincter. Between 2000 and 2004, a total of six patients underwent laparoscopic abdominoperineal resection or reversal of Miles' procedure and construction of perineal colostomy with dynamic graciloplasty (three cases) or implant of an artificial bowel sphincter (three cases). A diverting loop ileostomy was constructed in all patients to prevent contamination. Data concerning the perioperative management, postoperative morbidity and mortality and function after total anorectal reconstruction at the time of discharge, at postoperative month 1 and after ileostomy closure were collected and evaluated in a prospective non-randomised fashion. No early postoperative complications occurred in both groups. No late complication occurred in the dynamic graciloplasty group, whilst one patient of the artificial sphincter group had an ulceration of the tubing and the control pump through the suprapubic skin and the labium skin respectively on postoperative day 35. Another patient in this group, with an erosion of the transposed colon wall, died of myocardial infarction on postoperative day 75 after removal of the prosthesis. Postoperative stay after artificial sphincter implant and dynamic graciloplasty ranged from 12 to 27 days and 16 to 24 days, respectively. The loop ileostomy was closed at postoperative month 3 in all remaining patients except for one in the dynamic graciloplasty group, who died one day before hospitalization for ostomy closure because of an accidental, not disease/operation related reason. Follow-up of patients of the dynamic graciloplasty and artificial sphincter groups ranged from 3 to 24 months and 2.5 to 9.5 months, respectively. Patients in the dynamic graciloplasty group had no complications and follow-up showed satisfactory continence (SF36 form). All patients in the artificial sphincter group had late local complications with erosion of the prosthesis through the wall, its consequent removal and construction of a permanent iliac colostomy. Laparoscopic APR has been reported to be as safe as open APR. There are no published, available data on laparoscopic APR and laparoscopic reversal of Miles' procedure with total anorectal reconstruction with either dynamic graciloplasty or implant of artificial sphincter. Preliminary results showed that laparoscopic APR and APR reversal with continent perineal colostomy and dynamic graciloplasty may be a possible option in selected patients whilst the implant of an artificial sphincter should not be considered as a safe surgical option in such patients.

The long gamma nail: a DGH experience

Subtrochanteric fractures constitute a difficult problem for the trauma surgeon. The long Gamma nail (LGN) represents an efficient technique in the management of these fractures. A retrospective analysis of 51 LGN with an average follow up of 16 weeks is presented. The average age of the patients was 72 years and the mean time to union was 11 weeks. The incidence of peroperative, early local and late local complications was 8, 8 and 4%, respectively or 20% in total. The thirty-day mortality was 8%. Our results in the use of the LGN have been good. Its introduction provides the trauma surgeon with a tool for allowing earlier mobilisation, decreasing operative time, surgical trauma, blood loss and wound problems. The LGN is a device by which most complex fractures in the proximal femur can be managed with a single implant.

Intensive care management of acute pancreatitis

Acute pancreatitis is characterized by an intense inflammatory process which leads to early widespread organ dysfunction and late local complications. Currently, for the 80% of patients who suffer a moderate attack, management is largely supportive. The remaining 20% who develop severe pancreatitis have an increased risk of major complications which may require intensive care management. In these patients both general supportive and some specific therapeutic measures may be necessary. General measures include restoration and maintenance of plasma volume, respiratory, renal and nutritional support, analgesia and antibiotics. Specific measures, such as inhibition of pancreatic secretion or pancreatic enzyme activation, have not been successful in clinical trials. However, most of these studies have included small numbers of patients with moderate pancreatitis. Further evaluation of this approach is required with larger numbers and sicker patients. When bacterial infection of pancreatic necrosis becomes evident, surgical intervention should be considered. This includes percutaneous drainage, endoscopic removal of impacted gallstones and aggressive surgery for necrosis.

Re: Late Local Complications after Definitive Radiotherapy for Prostatic Adenocarcinoma by J. G. Moreno and T. E. Ahlering J. Urol., 147: 926-928, 1992

Re: Late Local Complications after Definitive Radiotherapy for Prostatic Adenocarcinoma by J. G. Moreno and T. E. Ahlering J. Urol., 147: 926-928, 1992

Late Local Complications After Definitive Radiotherapy for Prostatic Adenocarcinoma

Definitive radiation treatment of prostatic adenocarcinoma has been reported to produce good long-term local disease control, and distant disease failure is almost always associated with good local palliation. We examined late local complications in patients who died with recurrent prostate cancer after definitive radiotherapy as compared to patients treated with hormonal deprivation alone for advanced disease.Between 1979 and 1989 the tumor registry listed 33 men in whom definitive radiotherapy failed documented by bone scan or biopsy and 54 men who were managed with palliative hormonal therapy for noncurable disease. A complication was defined as a local problem requiring a procedure or hospitalization. Overall 23 of the radiotherapy cases (70%) had a local complication as compared to 16 of the patients (30%) who underwent only hormonal therapy. Local complications after radiotherapy included urethral stricture (10 cases), prostatic obstruction (8), hematuria (4), radiation cystitis (3), ureteral obstruction (2) and rectosigmoid radiation injury (4). Local complications after hormonal therapy consisted of prostatic obstruction (11 cases), ureteral obstruction (3) and hematuria (3). The radiotherapy group had 2 urinary and 2 fecal diversions, and the hormonal therapy group had none. In summary, we found a higher risk of late local complications in patients who had recurrence and died with metastatic prostate cancer after definitive radiotherapy, as compared to patients who only received hormonal therapy. These results question the belief that patients with distant disease in whom radiotherapy fails enjoy good long-term local palliation.