Possible Causes Of Complications Research Articles

Ilaser Submucous Destruction in the Treatment of Hemorrhoids

Aim: to improve the results of treatment in patients with hemorrhoids of the 2nd and 3rd stages.Materials and methods. The prospective study included 60 patients with hemorrhoids of the 2nd and 3rd stages. All patients underwent destruction of internal hemorrhoids with a fiber laser with a diode pump with a wavelength of 1940 nm. The technique is based on the effect of laser energy on the cavernous tissue of the internal hemorrhoidal node and on the terminal branches of the upper rectal artery. The efficiency of the destruction of internal hemorrhoids and the frequency of relapses of the disease were evaluated. The effectiveness of the proposed method was evaluated using anoscopy, measurement of the size of internal hemorrhoidal nodes, transrectal ultrasound with dopplerography. The analysis of the intensity of the pain syndrome, the consumption of nonsteroidal anti-inflammatory drugs and the assessment of the quality of life on the SF-36 scale was carried out. Sphincterometry was performed in all patients to determine the possible effect of laser radiation on the rectal locking apparatus. To assess the possible causes of complications, a single-factor analysis of the amount of energy transferred to each hemorrhoidal node and the total amount of energy spent on the operation was conducted.Results. In all patients, by day 7 after surgery, the pain syndrome in 43 patients (75.4 %) corresponded to 0 points according to VAS. In 3 patients (5 %) intraoperative hemorrhage developed. In the early postoperative period, 5 patients (8.3 %) had 7 complications: 5 cases of thrombosis of the external hemorrhoidal node and 2 — of acute urinary retention. The conducted single-factor analysis showed the dependence of the development of complications on the energy transferred to each hemorrhoidal node and its total amount for the entire operation. In terms of up to 6 months, there were no signs of a return of the disease in any case (hemorrhoidal prolapse and blood discharge). The detected hemorrhoids before the operation, a month after the operation, were not visualized, which persisted after 6 months. The performed transrectal ultrasound examination with spectral-wave dopplerography for up to 6 months allowed to diagnose a persistent decrease in blood flow along the terminal branches of the upper rectal artery compared with preoperative values. When performed sphincterometry, there was no change in the parameters of the anal sphincter function compared to preoperative parameters.Conclusion. The proposed method applying a fiber laser with a diode pump with a wavelength of 1940 nm makes it possible to affect transdermally the internal hemorrhoidal node without damaging the mucosa of the anal canal. The absence of postoperative wounds in the anal canal leads to a decrease in pain syndrome, and by day 7 there are no clinical manifestations of hemorrhoids. The method of laser destruction of internal hemorrhoids can be used in outpatient conditions and can improve the quality of life of patients in the early postoperative period.

Fungal Elements in Sputum Cytology Among Active and Post_Treated Pulmonary Tuberculosis Patients in Al Managil Teaching Hospital, Gezira State, Sudan (2020)

Sputum cytology is still one of the most effective and producible sample for diagnosis and evaluation of lung diseases and disorders. For this, it can used for evaluation of apportunistic fungal pathogens on pulmonary tuberculosis patients, which is of leading cause of death worldwide. On this cross sectional laboratory base study, which used to evaluate the sputum cytology for presence of opportunistic fungal elements. A total 110 early morning expectorate sample collected from the period 1/3 to 30/6/2020. 69/110 (63%) from patients come for first diagnosis to the center of T.B and HIV. Al Managil teaching hospital, and 41/110 (37%) follow-up starting from second month until six month post- treated follow up. From each sample two slides was prepared. One of them fixed immediately before air-drying in 95% ethanol and later stain by PAS technique, the other fixed after air-drying on absolute methanol and stain by Giemsa stain. Regardless to other method of fungal identification such as serology or mycological culture, only depends on microscopic identification. The study found that 95/110 (86%) was negative for fungal elements, and 15(14%) was positive, 9(8%) positive in diagnosis group and 6(5%) in follow-up group. Moreover the most common infectious agents was Candida species 9/110 (8%), 6/110 (5%) present as yeast and 3/110 (2%) as Pseudohyhae. Followed by Aspergillus species 5/110 (4%) then actinomyces species 1/110(.9%). The incidence of infection is higher in rural (82%) males (55%) farmers (36%). In the majority of the pateints with negative results for fungi MDR-TB not detected 87(79%), followed by positive for fungi and also MDR-TB not detected 15 (13.6%), then (negative and positive) for fungi and MDR-TB with high rate with the same percentage 3(2.8%), and finely very low MDR-TB 1(.9%), medium MDR-TB 1(.9%) without any detection of fungal elements. The study recommended including fungal testing and antifungal drugs on the pulmonary TB treatment plan as possible causes of complications.

Implant removal associated complications after ESIN osteosynthesis in pediatric fractures

PurposeESIN (elastic stable intramedullary nailing) is considered the gold standard for various pediatric fractures. The aim of this study was to analyze the incidence and type of complications during or after TEN (titanium elastic nail) removal.MethodsA retrospective data analysis was performed. Metal removal associated complications and preoperative extraosseous length/outlet angle of TENs as possible causes of complications were assessed.ResultsThe complication rate in 384 TEN removals was 3.1% (n = 12). One major complication (rupture of M. extensor pollicis brevis) was documented. One refracture at the forearm occurred, however, remodeling prior TEN removal was completed. Ten minor complications were temporary or without irreversible restrictions (3 infections, 5 scaring/granuloma, 2 temporary paraesthesia).In 38 cases (16 forearms, 10 femora, 9 humeri, 3 lower legs), intra-operative fluoroscopy had to be used to locate the implants. In patients with forearm fractures, extraosseous implant length was relatively shorter than in cases without fluoroscopy (p = 0.01), but outlet angle of TENs was not significantly different in these two groups (28.5° vs 25.6°). In patients with femur fractures, extraosseous implant length and outlet angle were tendentially shorter, respectively, lower, but this did not reach statistical significance.ConclusionRemoval of TENs after ESIN is a safe procedure with a low complication rate. Technically inaccurate TEN implantation makes removal more difficult and complicated. To prevent an untimely removal and patient discomfort, nail ends must be exactly positioned and cut. Intraoperative complications may be minimized with removal of TENs before signs of overgrowth.EvidenceLevel III, retrospective.

Evaluation of stress distribution in critical anatomic regions following the Le Fort I osteotomy by three-dimensional finite element analysis

In this study, we aimed to measure the stresses both on the pterygoid plates and the cranial base during the down-fracture and at the time of pterygomaxillary osteotomy by using the finite element analysis method to have an idea about the possible causes of complications. Three different surgical approaches were applied to the obtained models. In the Model 1, Le Fort I cuts without pterygomaxillary separation was applied. In the Model 2, same standard Le Fort I cuts were applied with pterygomaxillary separation. Then both models were subjected to a force of 150 N over the anterior spina nasalis to simulate down-fracture. In the third model, same standard Le Fort I cuts were applied. Following this procedure, a force of 50 N was applied with a sharp osteotome to the pterygomaxillary junction to simulate osteotomy. According to the results of this experimental study, the cranial base stress values decreased during the down-fracture in the Model 2. Moreover, it was found that the force transmitted to the base of the skull is less when the height of the pterygomaxillary osteotome is limited to 1 cm as we applied in Model 3.

Cardiac arrest after induction of anesthesia in neurosurgical patients

The paper reports two clinical cases observed with a time lag of four years. In both cases, there were severe clinical symptoms of intracranial hypertension before the surgery. Prompt full-scale resuscitation was required in both cases due to asystole that developed immediately after induction of anesthesia and tracheal intubation. In one case, cardiac activity was successfully recovered by complex resuscitation with the emergency drainage of the cerebral ventricles. The possible causes of complications and preventive measures were discussed.

Abstract 1584: Lead toxicity and oxidative stress: Possible causes of complications and grave prognosis in acute leukemic Nigeria patients

Abstract Toxic metals, especially implants are common causes of leukemia. Established relationship exsists between leukemia and oxidative stress. Leukemic cells produce larger amounts of reactive oxygen species (ROS). Cytokines are particulate immune proteins that serve as chemical messengers. They can have their production affected in many ways, including malignancy. Antioxidants, which control the oxidative stress state, represent a major line of physiological defense. The relationship between antioxidant status and the levels of well-known markers of oxidative stress that are measured as lipid peroxides reflects better health indices. This study, apart from investigating possible relationship between toxic metals especially Lead (Pb) in leukemic Nigeria patients, also evaluate the cytokine and antioxidant defense in this patients. Fifty subjects including 25 acute leukemia patients and 25 apparently healthy aged matched controls were recruited for the study. Toxic trace elements (Cd, Pb, Hg, and As) were determined with AAS. The total antioxidants potential (TAP) was determined using the ferric reducing/antioxidants power (FRAP) assay and MDA was measured to evaluate the level of lipid peroxidation. Cytokines (IFN-λ, IL-4 and IgE) plasma levels were measured with ELISA. We observed significant increase in the mean plasma level of Pb in leukemic patients compared to controls (p<0.05). This significant different was not observed in Cd, Hg and As (p>0.05). The total antioxidant (TAP) reduced significantly in leukemic patient (p<0.05), while the increased index of lipid peroxidation (MAD) was not significantly different from controls (p >0.05). The plasma level of all the cytokine investigated was significant increase in acute leukemia patients compared with controls (p< 0.05). Interestingly, Pb correlated inversely with TAP, and positively with Cd and Cytokines. This study implicates Pb in the pathogenesis of leukemia in Nigeria patients. Pb, apart from its potential influence in enhancing toxic effect of other metals, especially Cd, possibly plays a role in depletion of antioxidant level in Leukemic patients. The reduction in total antioxidant may be in addition to increase consumption of antioxidants by aggressive production of free radical usually associated with acute leukemia. In addition, increase production of cytokine and its correlation with Pb and TAP may imply possible complications. In conclusion, this study reveals a multiple contributing factors and possible complication in the grave prognosis of leukemia in Nigeria. These factors include Pb toxicity, reduced total antioxidant, increased lipid peroxidation and possible danger of ‘cytokine storm’. Thus, antioxidant supplementation may be worthwhile in early leukemia prophylaxis intervention and could possibly prevent the grave effect of complications associated with acute leukemia. Citation Format: Oluyemi Akinloye, Mary Bolanle Ajadi, Adebayo M. Adegbenro, Ganiyu O. Arinola. Lead toxicity and oxidative stress: Possible causes of complications and grave prognosis in acute leukemic Nigeria patients. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1584. doi:10.1158/1538-7445.AM2014-1584

Advantages of US in percutaneous dilatational tracheostomy: randomized controlled trial and review of the literature.

To compare procedure times and complication rates of preincisional ultrasonographic (US) evaluation and perioperative US guidance in percutaneous dilatational tracheostomy ( PDT percutaneous dilatational tracheostomy ) with those of the current standard of care, PDT percutaneous dilatational tracheostomy performed without image guidance. Between December 2007 and January 2011, 341 patients were included in this institutional review board-approved study after informed consent was obtained from the patients or their relatives. The patients were divided randomly into two groups. In group A (n = 166), the possible causes of complications, such as aberrations of tracheal, thyroidal, and vascular structures, were determined with US, and tracheal measurements were performed by using US. The clinician's initial considerations at physical examination were compared with the US findings. PDT percutaneous dilatational tracheostomy was subsequently performed with US guidance in suitable cases. In group B (n = 175), PDT percutaneous dilatational tracheostomy was performed solely on the basis of physical landmarks. The procedure times and complication rates were compared across groups by using the Fisher exact test. In group A, the puncture sites designated at the physical examination were reconsidered in 39 (23.8%) of 164 cases. The perioperative complication rates were slightly lower in group A (7.8% [12 of 154]) than in group B (15.0% [25 of 167]); however, the difference did not achieve statistical significance (P = .054). The mean procedure times for groups A and B were 24.09 minutes ± 8.05 (standard deviation) (range, 14-68 minutes) and 18.62 minutes ± 6.34 (range, 12-81 minutes), respectively (P = .001), and the numbers of patients in each group who required multiple puncture attempts were six (3.9%) of 154 and 23 (13.6%) of 169 (P = .003), respectively. The use of US guidance before and during PDT percutaneous dilatational tracheostomy could render the procedure easier and safer, with fewer complications but a slightly longer procedure time.

Histopathological observation on the complications associated with augmentation mammoplasty by injection of polyacrylamide hydrogel

Objective To explore the histopathological changes in the breast after injection of polyacrylamide hydrogel (PAHG) and the possible causes of complications associated with PAHG augmentation mammoplasty. Methods The breast samples from 87 women, who had undergone PAHC augmentation mammoplasty in other hospitals or clinics and occurred complications, received repair surgery in our hospital. We examined the pathological changes in these breast tissues. Results The women injected with PAHG into the breast occurred complications clinically, including nodularity and lumps, gel migration, pain, and infection. The main histopathological changes in the mammary tissues taken from the majority of individuals with com-plication were integration and migration of PAHG within the fat, muscle and glandular tissues of the breast. The most marked findings (34/87, 39.08%) were foreign body reactions without prominent fibrosis or fibrous capsule. Destruction of glandular tissue and inflammatory changes could also be found in some patients (12/87, 13.8%). Carcinogenetic changes of the mammary gland were not found. Conclusions PAHG is a migratory material, which penetrates diffusely within the breast and not be fully absorbed. PAHG can induce foreign body reaction, which forms different histopathologic stages and can induce cell injury in the breast gland and the nearby muscular tissues. Key words: Mammoplasty; Polyacrylamide hydrogel; Complications; Histopathology

Tumors of the Jugular Foramen—Diagnosis and Management

Objective: With the advent of modern neurosurgical techniques and multidisciplinary “skull base groups,” surgery has become the treatment of choice for jugular foramen lesions. Tumors with large intracranial extension represent, however, a considerable challenge to the skull base surgeon. With the availability of new diagnostic procedures these tumors have been more precisely studied and questions arise of whether, when, and how these lesions should be treated. Data from 110 consecutive patients, surgically treated in the past 18 years, were retrospectively analyzed to identify surgical outcomes. Methods: Between 1987 and 2006, 110 patients with jugular foramen tumors presenting with intracranial-intradural extension were operated upon at the Neurological Institute of Curitiba and State University of Campinas, Brazil. A multidisciplinary craniocervical approach was the standard method of treatment. The same surgical technique was used to resect all tumors. Preoperative embolization was performed in cases of paragangliomas and well-vascularized meningiomas. Saphenous graft bypass was carried out in 2 patients before removal of the lesions due to infiltration of the ICA. A new muscle-fascia flap was developed by our group and was used to cover the surgical defect. When necessary, the facial nerve was reconstructed with nerve grafts (great auricular nerve) or XII/VII anastomosis. Results: Paragangliomas were the most frequent lesions, followed by schwannomas and meningiomas. There were 62 paragangliomas, 18 schwannomas, and 11 meningiomas. The most common signs and symptoms were hearing loss and dysfunction of cranial nerves IX, X, and XI. Complete tumor removal was achieved in 89% of benign tumors and 80% of paragangliomas. Lower cranial nerves deficit was the most frequent complication (10 patients, 9.4%); it was transient in 4 cases. Facial and cochlear nerve paralysis occurred in 8 patients (7.5%). The function of facial nerve recovered spontaneously in 3. CSF leak was observed in 4 patients (3.7%). Four patients (3.7%) died after surgery. Conclusion: Radical removal of benign jugular foramen tumors is the treatment of choice and may be curative. Single-stage removal of complex cases of jugular foramen tumors may be performed safely with acceptable morbidity. Postoperative lower cranial nerves deficit is the most serious surgical complication. The possible causes of complications in these large tumors and the strategies used to avoid them will be presented.

Epidemiology of bacterial hand infections

The aim of the study was to delineate and update the bacteriological spectrum, characterize patterns and sites of injury, evaluate laboratory tests and possible causes of complications in patients with bacterial hand infections. All hand infections operated on in the department of orthopedics at Odense University Hospital during the period 1992-2001 were reviewed retrospectively. A standard protocol was used to collect data for each patient. We also examined all laboratory reports and recorded the identity of the etiologic organism, if known, for all cases of bacterial hand infections. Four hundred and eighteen patients (296 men and 122 women) with hand infections were operated on between 1992 and 2001 in our department. The median age of the patients was 40 years (range 1-93). The average interval from primary injury to operation was 10 days (range 1-50). The etiology was laceration/puncture in 35%. The site of infection was subcutaneous in 45% followed by tendon, joint and bone in 27, 18 and 5%, respectively. The bacteria isolated from the patients showed that 184 cultures (44%) were pure Staphylococcus aureus followed by 49 cultures (11.7%) of mixed organisms. Body temperature and C-reactive protein (CRP) were normal in three quarters of all patients with hand infections in our series. However the erythrocyte sedimentation rate (ESR) was elevated in 50% of the patients and was a significantly better test for infection in this study than CRP (p = 0.002). Neither the severity of infection nor the etiology of infection was related in any way to the initial temperature, CRP or ESR in this study. Complications were noted in 14.8% of all patients, and were especially related to diabetes, and mixed infection. Despite modern antibiotics, hand infections with a variety of organisms continue to be a source of morbidity and possible long-term disability. Most hand infections are the result of minor wounds that have been neglected. A complete history and physical examination is necessary to exclude other associated medical conditions (diabetes, arthritis, immunosuppression) that may compromise therapy. Furthermore, our study confirms that Staphylococcus aureus is responsible for most instances of hand infection, followed by mixed organisms. Gram-negative organisms are frequently cultured in patients with diabetes and intravenous drug abuse.

二分脊椎症例に対する回腸利用膀胱拡大術における尿管新吻合法としての Le Duc-Camey 法の検討

We investigated the results of Le Duc-Camey procedure as a method of ureteroileal implantation on augmentation cystoplasty in patients with myelodysplasia. A total of 14 patients (25 renal units) underwent ureteroileal implantation with Le Duc-Camey procedure on augmentation cystoplasty. The possible causes of complications concerning ureteroileal implantation that developed during the postoperative observation were classified as preoperative factors and postoperative factors.: The preoperative factors were the causative disease required ureteroneostomy, the grade of preoperative VUR, and the ureteral diameter at the anastomosis with the ileum.: The postoperative factors were the volume, and the compliance of the urinary bladder, and the maximum intravesical pressureled by the peristalsis of the utilized intestine. With the mean observation period of 31.6 months, no complications developed but VUR observed in 4 renal units of 4 patients. The patients with VUR had a larger ureteral diameter at the anastomosis site to the ileum among the preoperative factors and a significantly larger maximum intravesical pressure led by the intestinal peristalsis among the postoperative factors when compared with the patients without VUR. Regarding ureteroileal implantation with Le Duc-Camey procedure on augmentation cystoplasty in patients with myelodysplasia. It seems necessary to consider some countermeasures for the dilated ureters and for the unexpected 2 elevation of intravesical pressure due to the peristalsis of the utilized intestine.

Pancreatitis after sphincter of Oddi manometry.

The nature, frequency, severity, and possible causes of complications after 207 sphincter of Oddi manometry measurements were studied in 146 patients. Acute pancreatitis was diagnosed in 6% (12 of 207) of the investigations and in 8% (12 of 146) of the patients examined. The pancreatitis was mild in all patients. After cannulation of the pancreatic duct, acute pancreatitis occurred in 10 of 95 (11%) patients compared with one of 93 (1%) when the manometry catheter entered the bile duct only (p less than 0.02). Seven (58%) of the patients who developed acute pancreatitis, however, were found to be suffering from chronic pancreatitis. Some 26% of all sphincter of Oddi manometry measurements on patients with this diagnosis were complicated by an acute attack of pancreatitis compared with 3% (p less than 0.001) in patients without signs of chronic pancreatitis. In all patients the pancreatitis developed within three hours of manometry. We conclude that pancreatitis may occasionally follow sphincter of Oddi manometry measurement, even in patients without pancreaticobiliary disease, and that underlying chronic pancreatitis constitutes a definite risk. Sphincter of Oddi manometry measurement in control subjects should therefore be performed only in centres where the safety of the procedure has been established, and the presence of chronic pancreatitis should be excluded beforehand. Cannulation of the pancreatic duct should be avoided. Manometry can be safely performed, however, as an outpatient procedure.

Früh- und Spätkomplikationen von Extremitätenverletzungen: Ein kasuistischer Beitrag zum Problemkreis ,,offene Fraktur - Gasbrand"

The wide range of possible injuries in children necessitates our limiting ourselves to injuries of the extremities. The definitions of "early" and "late" complications are given, and examples of both are shown in illustration. Possible causes of complications in the course of healing are listed.

DECONVOLUTION OF REFRACTION SEISMOGRAMS FROM LARGE UNDERWATER EXPLOSIONS

The P-wave spectra of seismograms from large underwater explosions are frequently dominated by reverberations. When this is so, a simple reverberation model similar to that of Backus (1959) gives a good approximation to the source spectrum. The basic wavelet determined by this method is not necessarily minimum‐delay. A few promising deconvolutions have been carried out, revealing a sequence of arrivals of comparable amplitudes separated by short time intervals. Synthetic seismograms which have been constructed from these spike sequences differ very little from the field records. However, the technique often yields output seismograms which are not easily interpreted. A study using synthetic seismograms suggests five reasons for this: 1) low signal‐to‐noise ratios, which result in too narrow a frequency band in which signal is predominant; 2) pulses arriving at the recorder having undergone phase changes during transmission, especially in combination with 3) very close spacing of the sequence of arrivals, causing overlap of the deconvolved output pulses; 4) the presence of arrivals which are not propagated along simple ray‐theory paths, and 5) poor estimation of the source parameters. Nonlinear effects and complex geology at the source are other possible causes of complications in the deconvolved records.

Fatal bone marrow embolism following thoracotomy

A case of congenital heart disease in an adult is presented in which exploratory thoracotomy with sternal transection was carried out. Two days postoperatively, the patient became unduly anxious and somewhat dyspneic. Four days postoperatively, the patient suddenly became extremely dyspneic, apprehensive and cyanotic and went into cardiac arrest five minutes later. Successful cardiac massage was carried out, but the patient died several hours later with the cause of her death unexplained at the time. Bone marrow in relatively large amount was found in the branches of the pulmonary arterial supply, and either this per se, or embolization of the heart or brain via a patent septal defect is regarded as the cause of death. A summary of the clinical and pathologic features, as well as the laboratory aids in the diagnosis is presented to focus on a possible cause of complication and death following thoracotomy of this type.

UNDER WHAT CIRCUMSTANCES IS IT ADVISABLE TO REMOVE THE VERMIFORM APPENDIX WHEN THE ABDOMEN IS OPENED FOR OTHER REASONS?

The importance of the vermiform appendix as a possible cause of complication in gynecologic pelvic surgery was suddenly and sharply brought to my attention some time since by the case of a patient who came under my care in December, 1894, suffering from general pelvic discomfort and painful menstruation. I made a median abdominal incision and found the uterus retroflexed, the ovaries adherent and the vaginal outlet relaxed. The uterus was suspended, the varicose ovarian veins ligated and the vaginal outlet repaired. The patient was little if at all improved by my treatment, to our mutual disappointment. After leaving my care she went to live in Pennsylvania, and some months later I had a letter from her, informing me that she had had an attack of appendicitis, for which she had been operated on by my old friend Dr. John Deaver. The result of the operation was a complete relief