Presence Of Medical Complications Research Articles

Perinatal posttraumatic stress disorder as a predictor of mother-child bonding quality 8 months after childbirth: a longitudinal study

BackgroundNegative childbirth experiences can be related to the onset of perinatal post-traumatic stress symptomatology (P-PTSS), which significantly impacts the mother and the infant. As a response in the face of the discomfort caused by P-PTSS, maladaptive emotion regulation strategies such as brooding can emerge, contributing to the consolidation of post-partum depressive symptoms. Ultimately, both types of symptomatology, P-PTSS and post-partum depression, can act as risk factors for developing mother-child bonding difficulties. Still, this full set of temporal paths has to date remained untested. The present longitudinal study aimed to analyze the risk factors associated with the appearance of P-PTSS after post-partum and to test a path model considering the role of P-PTSS as an indirect predictor of bonding difficulties at eight months of postpartum.MethodsAn initial sample of pregnant women in the third trimester of gestation (N = 594) participated in a longitudinal study comprising two follow-ups at two and eight months of postpartum. The mothers completed online evaluations that included socio-demographic data and measures of psychological variables. A two-step linear regression model was performed to assess the predictive role of the variables proposed as risk factors for P-PTSS, and a path model was formulated to test the pathways of influence of P-PTSS on bonding difficulties.ResultsA history of psychopathology of the mother, the presence of depression during pregnancy, the presence of medical complications in the mother, and the occurrence of traumatic birth experiences all acted as significant predictors of P-PTSS, explaining 29.5% of its variance. Furthermore, the path model tested further confirmed an indirect effect of P-PTSS, triggered by a negative childbirth experience, on subsequent bonding difficulties eight months after labor through its association with higher levels of brooding and, ultimately, postpartum depression levels. A further path showed that bonding difficulties at two months postpartum can persist at eight months postpartum due to the onset of brooding and postpartum depression symptoms.ConclusionWe identified a set of robust predictors of P-PTSS: the mother’s previous history of depression, perinatal depression during pregnancy, the presence of medical complications in the mother and the occurrence of traumatic birth experiences, which has important implications for prevention. This is particularly relevant, as P-PTSS, when triggered by a negative childbirth experience, further indirectly predicted the development of mother-child bonding difficulties through the mediation of higher use of brooding and symptoms of postpartum depression. These findings can serve as a basis for developing new longitudinal studies to further advance the understanding of perinatal mechanisms of mental health.

The Impact of Postoperative Pulmonary Complications on Perioperative Outcomes in Patients Undergoing Pneumonectomy: A Multicenter Retrospective Cohort Study of the German Thorax Registry.

Postoperative pulmonary complications have a deleterious impact in regards to thoracic surgery. Pneumonectomy is associated with the highest perioperative risk in elective thoracic surgery. The data from 152 patients undergoing pneumonectomy in this multicenter retrospective study were extracted from the German Thorax Registry database and presented after univariate and multivariate statistical processing. This retrospective study investigated the incidence of postoperative pulmonary complications (PPCs) and their impact on perioperative morbidity and mortality. Patient-specific, preoperative, procedural, and postoperative risk factors for PPCs and in-hospital mortality were analyzed. A total of 32 (21%) patients exhibited one or more PPCs, and 11 (7%) died during the hospital stay. Multivariate stepwise logistic regression identified a preoperative FEV1 < 50% (OR 9.1, 95% CI 1.9-67), the presence of medical complications (OR 7.4, 95% CI 2.7-16.2), and an ICU stay of more than 2 days (OR 14, 95% CI 3.9-59) as independent factors associated with PPCs. PPCs (OR 13, 95% CI 3.2-52), a preoperative FEV1 < 60% in patients with previous pulmonary infection (OR 21, 95% CI 3.2-52), and continued postoperative mechanical ventilation (OR 8.4, 95% CI 2-34) were independent factors for in-hospital mortality. Our data emphasizes that PPCs are a significant risk factor for morbidity and mortality after pneumonectomy. Intensified perioperative care targeting the underlying risk factors and effects of PPCs, postoperative ventilation, and preoperative respiratory infections, especially in patients with reduced pulmonary reserve, could improve patient outcomes.

A Study on Factors Associated with Caesarean Section Delivery at Tangail District of Bangladesh

<i>Background and Objectives</i>: Caesarean section or C-section is a major obstetric life-saving intervention that has a substantial effect on maternal and neonatal health. This study sought to explore factors associated with increasing C-section rate at Tangail district in Bangladesh. <i>Materials and Methods</i>: A cross-sectional survey was conducted using a structured questionnaire at different hospitals and clinics in Tangail among 200 women who underwent cesarean. For analyzing the factors of C-section, the explanatory variables were demographic and anthropometric data, pre-pregnancy history, pregnancy period and delivery information. <i>Results</i>: The common medical indicators for C-section were prolonged labor (21%), fetal distress (19%), previous C-section (13%), amniotic rupture (12.5%), abnormal presentation of the baby (12%), uterine rupture (8.5%), failed labor induction (7.5%) and eclampsia/hypertension (3%). The majority (49.5%) of C-section was performed because of maternal request, 34% were emergency and 16.5% were elective. Majority of the respondents showed neutral (46%) to negative (51%) mindset towards C-section. C-section decision making influences included family pressure (25%), afraid of labor pain (11.5%), mother’s health risk (15%), baby’s health risk (38.5%), both mother and baby’s health risk (19.5%), presence of medical complications (62%), respondent’s choice (23%), doctor’s preference (5%), other related reasons (10%). <i>Conclusions</i>: It is concluded that a combination of both medical and non-medical factors is associated with C-section delivery.

Impact of selected risk factors on uterine healing after cesarean section in women with single-layer uterine closure: A prospective study using two- and three-dimensional transvaginal ultrasonography.

Modern obstetrics must meet many challenges, including long-term complications resulting from the presence of a uterine niche after cesarean section. To assess the impact of selected risk factors on the uterine healing process after cesarean section. The uterus was closed with a single-layer continuous suture covering the entire thickness of the myometrium, excluding the decidua. A prospective, case-controlled study was carried out at 2nd Department of Gynecology and Obstetrics, Wroclaw Medical University, Poland. Women who delivered by cesarean section at our Department were invited to undergo an ultrasonographic assessment of the cesarean section scar from 6 to 9 weeks after the procedure. In all cases, the uterus was closed with a single-layer continuous suture. The ultrasound examination of the niche was performed according to the modified Delphi protocol. The volume of the niche was calculated and a 3D model was created. The obtained data were analyzed with clinical information from the maternal medical history and the course of the pregnancy. A total of 204 patients participated in the study. Five patients had a residual myometrial thickness (RMT) <2.2 mm and 35 had a residual myometrial thickness to adjacent myometrial thickness ratio (RMT/AMT) ≤0.5. In 45% of women, pregnancy course was complicated by gestational diabetes mellitus (GDM), gestational hypertension and hypothyroidism. The cervical canal was colonized with pathogenic flora in 22% of women. No correlation between maternal and gestational age at delivery, presence of medical complications during pregnancy, colonization of the cervical canal, and presence of niche and its parameters were found. Our study revealed that the selected risk factors, such as systemic diseases during pregnancy and in the maternal medical history, as well as the colonization of the cervical canal, have no impact on uterine scar healing in women undergoing single-layer uterine closure spanning the entire thickness of the myometrium, excluding the decidua.

Risk factors for high length of hospital stay and in-hospital mortality in hip fractures in the elderly

PurposeTo determine the risk factors influencing in-hospital mortality and/or increased hospital stay in patients older than 65 years with proximal femur fracture. MethodsRetrospective study of patients aged over 65 years operated on for hip fracture between January 2015 and December 2017. Medical, psychological, functional and analytical comorbidities present at admission as well as treatment, complications and analytical follow-up during admission and functional status and residence at discharge are studied for a total of 54 variables. A bivariate analysis was performed using a composite endpoint between in-hospital mortality and the increase of more than 10 days of hospital stay. Results360 patients were included with a mean age of 84 years. 75% were women and 53.5% suffered a pertrochanteric fracture. The mean number of comorbidities per patient was 2.7 (0–7), the most frequent being hypertension, dementia and diabetes. In-hospital mortality was 3.6% (n: 13) and mean hospital stay was 8.4 days (1–35), with 16.4% exceeding 10 days. The presence of medical complications (P < .001), hemoglobin level at admission (P < .001), arterial hypertension (P = .012), obesity (P = .018) and parkinson (P = .034) were related to the occurrence of the studied cut-off point. ConclusionArterial hypertension, obesity, Parkinson’s disease, hemoglobin level at admission and occurrence of medical complications are variables that increased the risk of in-hospital mortality and/or a hospital stay above 10 days in patients older than 65 years with proximal femoral fracture.

Examining the association of medical complications and posttraumatic stress symptoms in pediatric solid organ transplant patients and their caregivers.

Post-traumatic stress symptoms (PTSS) have been reported by pediatric solid organ transplant (SOT) patients and their caregivers well after transplantation. This study examined the relationship between PTSS, medication adherence, and medical complications in SOT patients and their caregivers. A secondary aim examined the association between patient and caregiver-reported PTSS. Pediatric SOT patients (N=69) and caregivers (N=73) reported on PTSS by completing the Child PTSD Symptom Scale (patients 8-17years) or the Impact of Events Scale-Revised (patients 18years and older and caregivers). Patient medication adherence was assessed using the Medication Level Variability Index (MLVI). Patients were dichotomized as experiencing a post-transplant medical complication (ie, transplant-related hospital admission prior to the year completing measures of PTSS) or no complications. Medication adherence was not significantly associated with patient or caregiver PTSS. A moderate effect size was found for elevated young adult and caregiver PTSS and the presence of a medical complication. Generally, the association between self-reported patient and caregiver PTSS was low. The presence of elevated PTSS in young adult patients may be partially explained by the presence of proximal medical complications and more so by comorbid psychiatric diagnoses in child and adolescent patients (based on exploratory analyses). Caregivers of patients with medical complications within the past year reported higher levels of PTSS. Overall, transplantation and its associated impact on PTSS may be unique experience for patients versus caregivers. Qualitative research may further elucidate these experiences and inform future clinical interventions.

Factores de riesgo para el ingreso prolongado y mortalidad intrahospitalaria en la fractura del fémur proximal en pacientes mayores de 65 años

PurposeTo determine the risk factors influencing in-hospital mortality and/or increased hospital stay in patients older than 65 years with proximal femur fracture. MethodsRetrospective study of patients aged over 65 years operated on for hip fracture between January 2015 and December 2017. Medical, psychological, functional and analytical comorbidities present at admission as well as treatment, complications and analytical follow-up during admission and functional status and residence at discharge are studied for a total of 54 variables. A bivariate analysis was performed using a composite endpoint between in-hospital mortality and the increase of more than 10 days of hospital stay. Results360 patients were included with a mean age of 84 years. 75% were women and 53.5% suffered a pertrochanteric fracture. The mean number of comorbidities per patient was 2.7 (0-7), the most frequent being hypertension, dementia and diabetes. In-hospital mortality was 3.6% (n: 13) and mean hospital stay was 8.4 days (1-35), with 16.4% exceeding 10 days. The presence of medical complications (p<0.001), hemoglobin level at admission (p<0.001), arterial hypertension (p=0.012), obesity (p=0.018) and parkinson (p=0.034) were related to the occurrence of the studied cut-off point. ConclusionArterial hypertension, obesity, Parkinson's disease, hemoglobin level at admission and occurrence of medical complications are variables that increased the risk of in-hospital mortality and/or a hospital stay above 10 days in patients older than 65 years with proximal femoral fracture.

Hospital readmission in stroke survivors one year versus three years after discharge from inpatient rehabilitation: Prevalence and associations in an Asian cohort.

ObjectiveTo examine the prevalence and risk factors for readmission after inpatient rehabilitation in stroke survivors, in a developed multi-ethnic Southeast Asian country.MethodsA retrospective cohort study of 1,235 stroke survivors who completed inpatient rehabilitation in a tertiary rehabilitation centre.ResultsA total of 296 (24.0%) patients with stroke were readmitted within the first year, and 87 (7.0%) patients were readmitted 1–3 years after stroke. Significant risk factors for readmission of patients in the first year post-stroke were older age (p = 0.027), lower admission Functional Independence Measure (FIM) motor (p = 0.001) and cognition scores (p = 0.025), a Charlson Comorbidity Index (CCI) ≥1 (p < 0.001) and the presence of at least one medical complication during initial hospitalization (p < 0.001), while FIM gain was found to be protective (p < 0.001). Looking at readmission after 1 year post-stroke, a CCI ≥1 (p < 0.001) and the presence of medical complications during initial hospitalization (p < 0.001) were risk factors for readmission, while FIM gain (p = 0.001) was protective. Common causes for readmission include recurrent stroke and falls.ConclusionThere is a high readmission rate in stroke survivors, even after the first year post-stroke. Interventions, such as fall risk assessments, vaccinations, meticulous catheter care, intensified secondary risk factors interventions and continued post-discharge rehabilitation, may hold promise for reducing readmission rates.LAY ABSTRACTReadmission of stroke patients results in high morbidity and healthcare costs. Although many studies have examined readmission of stroke survivors in the first year post-stroke, there is a scarcity of studies into readmission after the first year post-stroke, and the effect of rehabilitation on these patients. This study investigated 1,235 patients 3 years post-stroke rehabilitation. Of these patients, 296 (24.0%) were readmitted within the first year, and 87 (7.0%) were readmitted 1–3 years post-stroke. Significant risk factors for readmission included older age, lower functional scores on admission, presence of chronic medical conditions and medical complications during their initial hospital stay. However, functional improvement during inpatient rehabilitation was associated with a reduced readmission rate. This study demonstrates that there is a high readmission rate even after the first year post-stroke. It also highlights the importance of rehabilitation in reducing readmission in stroke survivors.

Utilización de Tissucol® en pacientes mastectomizadas en un hospital de tercer nivel. Estudio retrospectivo

ObjectiveTo de effective adjunct therapy to avoid postmastectomy seromas, reducing morbidity and costs during hospitalisation (shorter hospitalisation time), and to assess its safety and the presence of medical complications during its use. Patients and methodA retrospective cohort study with two cohorts of patients treated with or without Tissucol was conducted from January 2016 to February 2017. Patients who underwent mastectomy without immediate reconstruction during the study period were included. Patients in the Tissucol group were administered the fibrin adhesive intraoperatively. ResultsOf 308 surgical patients, 53 underwent non-reconstruction mastectomies and were included in the study; among these, fibrin adhesive was used in 33.9%. Its use was associated with lower drainage use (16.6% of patients required 2, 3 or 4 drains vs 11.8%%; P<.02), as well as fewer maintenance days (6.62+5.32 compared with 2.93 +3.94; P=.017) and days of hospital stay (6+4.3 compared with 3.1+1.4 days; P=.014). Fibrin adhesive was also associated with a reduction in seromas (<50-200cc), with 64.7% compared with 23.1%; P<.02. There was no evidence of allergic reactions or adverse events after its use. ConclusionThe use of fibrin adhesive is safe and was associated with fewer seromas, lower use of drainage and fewer maintenance days. This procedure was also associated with shorter hospital stay, implying less postoperative morbilidity and subsequent optimisation of medical resources and cost savings.

Survival Rate of Limb Replantation in Different Age Groups.

Revascularization of damaged limbs/digits is technically feasible, but indications for surgical replantation remain controversial. The authors analyzed the survival rate of upper limb amputations and the associated factors in different age groups. They grouped 371 limb/digit amputees (average age, 44 years; range, 2-85 years) treated in their hospital during the past 10 years into three groups based on age (young, ≤ 15 years, n = 12; adult, 16-64 years, n = 302; elderly, ≥ 65 years, n = 57) and analyzed their injury type (extent of injury and stump status), operation method, presence of medical complications (Charlson comorbidity index), and survival rate. There were 168 replantations, and the overall replantation survival rate was 93%. The Charlson comorbidity index of the replantation patients was 0 in 124 cases; 1 in 32; 2 in 9; and 3 in 3, but it did not show any significant difference in survival rate after replantation. Eight elderly patients (14%) did not opt for replantation. Younger patients tended to undergo replantation, but they had lower success rates due to their severe injury status. The results of this study show that the survival rate of replantation in elderly patients is equal to that in adults. Stump evaluation is important for survival, but the presence of medical complications is not associated with the overall survival rate.

Profile of tobacco users amongst treatment seekers: A comparison between clinic and community sample

Background and objectives: Despite the huge burden of tobacco use or addiction, there has been a glaring scarcity of resources to tackle the problem. Although some of the tobacco users want to quit, very few have the opportunity to seek help from available treatment facilities. The study aimed to find out the profile of treatment seekers from clinic and community programs and also to compare the two groups. Method: This is a cross sectional, retrospective study of subjects enrolled in the clinic and various community outreach programs of a Tobacco Cessation Centre from the year 2002-2011. Modified intake form developed by the WHO was administered to the subjects. Results: Significant difference was found between the two groups with regard to the age of treatment seeking, education and socio economic status. Older subjects reported in greater numbers to the clinic, whereas younger subjects belonged to the community group. Community group had lower level of education, belonged to lower or upper lower socio economic status whereas clinic group had higher level of education and were from the middle or upper socio economic status. Curiosity (Z score = 3.2,P = 0.001) played a significant role in initiating the use in clinic group whereas role model (Z score = 5.1, P = <0.0001) and low self esteem (Z score = 2.0, P = 0.023) were significantly associated with community sample. Presence of medical complications (Z score = 12.5, P = <0.0001), awareness of physical harm of nicotine (Z score = 5.0, P = <0.0001) and awareness of addiction was significantly more in the clinic group. Interpretation and Conclusions: The difference in the socio-demographic and clinical profile of tobacco users in these two treatment groups is noteworthy, and is expected to offer useful information for the clinicians and as well as for the policy makers.

Psychological Statuses of Premenopausal Women Before and After Hysterectomy

Objective: This paper aims to explore the trend, extent and impacting factors of the change in the psychological status of women before and after hysterectomy. Methods: A prospective study was performed to investigate the psychological statuses of 98 female subjects who underwent hysterectomy upon admission and three months after the hysterectomy. Results: The self-rating of the psychological status survey showed significantly lower factor scores including the postoperative BDI and SCL-90 (except paranoid factors) scores than those before the surgery and the same HAMD score as the nurse-administered rating scale. The incidence rate of moderate to severe depression dropped from 48.98% to 13.54% after the surgery. Differently aged patients showed different change extents of SCL-90, and the postoperative BDI and HAMD scores were significantly positively correlated with the preoperative levels. The preoperative HAMD score was negatively correlated with the length of education and positively correlated with the chief complaint. The postoperative HAMD score was positively correlated with the parity and the presence of medical complications and negatively correlated with age. Conclusion: Hysterectomy benefits the psychiatric and somatic health of the patients, and the women who were younger, more prolific, less educated, complain of dysmenorrhea or menorrhagia and have other medical disorders are more prone to perioperative depression.

Factors associated with feeding progression in extremely preterm infants.

Among infants born prematurely, competence at oral feeding is necessary for growth and hospital discharge. Extremely preterm (EP) infants (28 weeks of gestational age [GA]) are at risk for a variety of medical complications, which can limit the infant's capacity to develop oral feeding competence. This study examined feeding progression by assessing timing of acquisition of five early feeding milestones among EP infants and the impact of immaturity and medical complications. A chart review was conducted for 94 EP infants who participated in a larger longitudinal randomized study. Feeding progression was defined as infants' postmenstrual age (PMA) at five milestones: first enteral feeding, full enteral feeding, first oral feeding, half oral feeding, and full oral feeding. GA at birth and five medical complications (neurological risk, bronchopulmonary dysplasia, necrotizing enterocolitis, patent ductus arteriosus, and gastroesophageal reflux disease) were used as potential factors influencing the feeding progression. Linear mixed models were used to examine feeding progression across the milestones and contributions of GA at birth and five medical complications on the progression, after controlling for milk type as a covariate. EP infants gradually achieved feeding milestones; however, the attainment of the feeding milestones slowed significantly for infants with younger GA at birth and the presence of medical complications, including neurological risk, bronchopulmonary dysplasia, necrotizing enterocolitis, and patent ductus arteriosus but not gastroesophageal reflux disease. Milk type was a significant covariate for all analyses, suggesting that infants fed with breast milk achieved each of five milestones earlier than formula-fed infants. Improved understanding of the timing of essential feeding milestones among EP infants and the contribution of specific medical conditions to the acquisition of these milestones may allow for more targeted care to support feeding skill development.

Psychosocial Determinants of Longer Length of Stay on a Canadian Stroke Inpatient Rehabilitation Unit

Objective: The relationship between availability of psychosocial resources and inpatient stroke rehabilitation length of stay (LOS) has been inadequately studied. The purpose of this prospective observational study was to identify psychosocial determinants that prolong LOS of patients in a stroke rehabilitation program. Methods: Patients admitted to a multidisciplinary inpatient stroke rehabilitation program in southern Ontario, Canada, were consecutively recruited from October 2008 to August 2010. Patients diagnosed as having had a cerebrovascular event resulting in neurological impairments that required intensive rehabilitation were eligible for the study. Independent variables included psychosocial (awaiting long-term care placement, poststroke depression, inadequate family support, limited access to community home care services), medical (comorbidity, medical complications), neurological (type and location of stroke, neurological deficits), and functional (Functional Independence Measure [FIM] score on admission and discharge, Modified Rankin Disability Scale score) factors. The main outcome measure was length of hospital stay (days). Results: A total of 117 patients were recruited. The mean and median LOS were 49.8 and 45 days respectively. Most patients (92.3%) were discharged home. On multivariate linear regression analysis, the significant determinants associated with longer LOS were awaiting long-term care placement (P<0.001), low admission FIM score (P=0.001), post-stroke depression (P=0.007), difficulties arising from inadequate family support (P=0.033), limited access to community home care services (P=0.035), and presence of medical complication(s) (P=0.039). These 6 factors, 4 of which were psychosocial, accounted for 48.8% of the total variance in LOS. Conclusion: Psychosocial factors were key determinants of longer LOS in addition to medical/neurological factors such as severity of stroke and medical complications. Health care systems must incorporate psychosocial information to a greater extent and recognize its fundamental role in rehabilitation outcomes.

Self-Regulation in Newly Arrived International Adoptees

ABSTRACTMany newly arrived international adoptees (IA) have difficulties with eating, sleeping, and self-soothing/self-stimulating (SS) behaviors. However, to date the prevalence of these problems and associated risk factors have not been clearly identified. Therefore, we proposed to evaluate 387 IA for the presence of these self-regulation and behavioral difficulties, and examined the relationships between these behaviors and pre-adoptive risk factors including growth measures, orphanage care, age at arrival and presence of medical complications. Data on participants were collected in a retrospective chart review and entered into a standardized data collection sheet by a trained research assistant. This exploratory study included 133 M and 254 F with an average age (M = 16) months at the time of the study. Children in the study represented adoptees from seventeen countries. Forty-nine per cent (49%) of the retrospective sample exhibited SS behaviors, 48% had sleep disturbances, and 34% had eating issues. Many had difficulties in more than one area. Country of origin, pre-adoption residence, and arrival nutritional status all related to the presence of these problems. Hence, self-regulation difficulties are common but both the course and influence of those behaviors on family functioning remains unknown.

Efficacy of a clinical stroke score in monitoring complications in acute ischaemic stroke patients could be used as an independent prognostic factor

Presence of medical complications in stroke patients has been established. The efficacy of a stroke score in intensive monitoring of these complications in acute ischaemic stroke patients has not been studied. Eighty-seven patients with acute ischaemic stroke were assessed with National Institute of Health Stroke Scale (NIHSS) by the examiner within days of admission; (1, 7, 30, and 90 days). Onset and types of complications were documented within the duration of the study period, using a questionnaire and laboratory investigations. Fifty-nine [67.8%] patients in the study population had complications, with mean initial NIHSS score 17.1 ± 7.9; mortality was 39%, and 27.8% of survivors had good recovery. In patients without complications, the mean initial NIHSS score was 11.4 ± 6.0; mortality was not observed, and 50% of survivors had good recovery. All patients without complications survived. High NIHSS scores, (with minimal changes below baseline) were related to high mortality and morbidity in the complications group.

Prevalence of de Quervain's Disease in the General Population and Risk Factors

Background & Aims : De Quervain's disease is known as a representative disease that causes wrist pain, however, its epidemiology remains unclear. The purpose of this study was to elucidate the prevalence of de Quervain's disease among the general population and to identify its risk factors. Methods : The subjects participated in the examinations consisted of 402 people (total of 804 hands), including 157 males and 245 females with mean age of 64.1 years. We recorded the subjects' background and medical history and then performed physical examinations. We determined the prevalence of de Quervain's disease and conducted a statistical analysis to investigate their background factors. Results : De Quervain's disease was present in 3.7% (15/402 people) and the prevalence by age group was 9.8% in their forties, 3.6% in their fifties, 1.8% in their sixties, 3.9% in their seventies, and 3.7% in their eighties. The prevalence was significantly higher in females than in males. No difference was found in terms of the mean age, hand dominance, height, weight, heaviness of labor activity and presence of medical complication. Conclusions : In the general population, 3.7% of 402 people had de Quervain's disease, and its risk factor was identified to be females.

Tratamiento quirúrgico del adenocarcinoma pancreático mediante duodenopancreatectomía cefálica (Parte 1). Complicaciones postoperatorias en 204 casos en un centro de referencia

Introduction Cephalic duodenopancreatectomy (CDP) is the treatment of choice in cancer of the head of the pancreas. However, it continues to have a high post-surgical morbidity and mortality. The aim of this article is to define variables that influence post-surgical morbidity and mortality after cephalic duodenopancreatectomy due to pancreatic adenocarcinoma (PA) cancer of the head of the pancreas (CHP). Material and methods The variables were prospectively collected form patients operated on between 1991 and 2007, in order to investigate the factors of higher morbidity. Results A total of 204 patients had been intervened due to PA, of whom 57 were older than 70 years. Of these patients, 119 had a CPD, 11 extended lymphadectomy, 66 with pyloric conservation, and 8 with extension to total pancreatectomy due to involvement of the section margin. Portal or mesenteric vein resection was included in 35 cases. Post-surgical complications were detected in 45% of cases, the most frequent being: slow gastric emptying (20%), surgical wound infection (17%), pancreatic fistula (10%), and serious medical complications (8%). Further surgery was required in 13%, and the over post-surgical mortality was 7%. A patient age greater than 70 years, post-surgical haemoperitoneum, gastroenteric dehiscence, and the presence of medical complications were post-surgical mortality risk factors in the multivariate analysis. Pancreatic fistula was not a factor associated with post-surgical mortality. Conclusions Cephalic duodenopancreatectomy is a safe technique but with a considerable morbidity. Patients over 70 years of age must be carefully selected before considering surgery. Serious medical complications must be treated aggressively to avoid an unfavourable progression.

Surgical treatment of pancreatic adenocarcinoma by cephalic duodenopancreatectomy (Part 1). Post-surgical complications in 204 cases in a reference hospital

IntroductionCephalic duodenopancreatectomy (CDP) is the treatment of choice in cancer of the head of the pancreas. However, it continues to have a high post-surgical morbidity and mortality.The aim of this article is to define variables that influence post-surgical morbidity and mortality after cephalic duodenopancreatectomy due to pancreatic adenocarcinoma (PA) cancer of the head of the pancreas (CHP). Material and methodsThe variables were prospectively collected form patients operated on between 1991 and 2007, in order to investigate the factors of higher morbidity. ResultsA total of 204 patients had been intervened due to PA, of whom 57 were older than 70 years. Of these patients, 119 had a CDP, 11 extended lymphadectomy, 66 with pyloric conservation, and 8 with extension to total pancreatectomy due to involvement of the section margin. Portal or mesenteric vein resection was included in 35 cases. Post-surgical complications were detected in 45% of cases, the most frequent being: slow gastric emptying (20%), surgical wound infection (17%), pancreatic fistula (10%), and serious medical complications (8%). Further surgery was required in 13%, and the over post-surgical mortality was 7%. A patient age greater than 70 years, post-surgical haemoperitoneum, gastroenteric dehiscence, and the presence of medical complications were post-surgical mortality risk factors in the multivariate analysis. Pancreatic fistula was not a factor associated with post-surgical mortality. ConclusionsCephalic duodenopancreatectomy is a safe technique but with a considerable morbidity. Patients over 70 years of age must be carefully selected before considering surgery. Serious medical complications must be treated aggressively to avoid an unfavourable progression.

Health-related quality of life in children with newly diagnosed cancer: a one year follow-up study

BackgroundMost studies on health-related quality of life (HRQOL) in children with cancer focussed on survivors. Only few studies have evaluated patients during ongoing oncological treatment. The aim of this study was a prospective assessment of HRQOL in children during the first year after diagnosis of cancer and an examination of demographic, medical, and parental predictors of HRQOL.MethodsFifty-two patients (mean age: 10.9 years) were assessed 6 weeks and 1 year after diagnosis with the TNO-AZL Questionnaire for Children's Health-Related Quality of Life. Parents completed the Brief Symptom Inventory.ResultsCompared to a community sample, patients reported more physical complaints, reduced motor functioning and autonomy, and impaired positive emotional functioning 6 weeks after diagnosis. HRQOL significantly improved over the year. However, at 1 year, patients still showed reduced motor and emotional functioning. At 6 weeks, children with leukemia were most affected. At 1 year, patients with brain tumors complained about more physical symptoms than the other groups. Intensity of treatment and presence of medical complications mainly influenced HRQOL at 6 weeks but less at 1 year. Parental psychopathology was associated with better cognitive functioning in the child.ConclusionThis prospective study found several domains of HRQOL to be compromised 6 weeks and 1 year after the diagnosis of cancer. Although HRQOL significantly increased over the year, there were important differences between diagnostic groups. The findings highlight the importance of repeated evaluation of HRQOL in children undergoing cancer treatment and consideration of specific differences between diagnostic groups.