Recognition Of Late Complications Research Articles

Focus Session “Changing epidemiology in pediatric neurosurgery”

Referral medical centers are not reliable points of observation to record epidemiological changes concerning the various diseases, even those that find in some of these centers the best care available. However, the analysis of the admissions, the treatment offered, and the outcomes observed in high specialized centers may still provide useful information on the way care is delivered in a given period of time for some specific pathological conditions. Such an analysis may confirm beliefs and perceptions by the doctors and the population of the changes occurring in the practice of medical specialties or, on the other hand, deny substantial modifications in the way treatment is delivered. The medical literature is not necessarily a dependable source of information. Indeed, too many factors contribute to the perception of changes in medical practice, which might not have actually occurred such as better diagnostic identification, more accurate reporting, changes in the policy of patient’s recruitment, governmental regulations, and so on. Head injuries provide the best example of reports indicating either increased or decreased admissions attributed to the same cause such as the introduction of specific guidelines for hospital admission or the major availability of CT scan for every general hospital. For some authors, for example, the wider access to CT in the territory assures great advantages for the population by allowing prompt admission and better screening of those patients who need hospitalization in tertiary care centers; for others, such an organization has the potential disadvantage of inexpert interpretation of scans carried out in small peripheric hospital with increasing morbidity and mortality due to missed or too late referral to specialized hospital or trauma centers. Pediatric neurosurgery is a field that has taken great strides and appears in a continuous evolution. Nevertheless, one might wonder whether the patterns of patient’s workload and treatment outcomes have really changed over the last decades considerably. Certainly, the epidemiology of some nosographic entities has changed due to the effectiveness of primary or secondary prevention: see, for example, the decreased incidence of myelomeningocele resulting from folate addition to the diet or the diffusion of prenatal diagnosis. However, the impact of such a decreased incidence on the clinical practice may not necessarily reflect such a pattern as the decreased number of affected subjects may be compensated by a better recognition of late complications in the survivors and more careful care of their complications. More refined prenatal diagnoses have certainly decreased the number of newborns with malformative hydrocephalus as well as better medical care that of post-infective hydrocephalus. However, the resulting minor demand for the clinical management of these types of hydrocephalus is compensated for by the increasing prevalence of acquired cases such those resulting from increased survivals of severely premature babies. Similar considerations apply to other main fields of pediatric neurosurgery, namely neuroncology or craniosynostosis. On such a ground, we have invited some colleagues who have kindly accepted to participate in this Focus Session to evaluate the “changing” epidemiology of some specific diseases as observed in their referral pediatric neurosurgery centers and the impact of the changes in the daily clinical practice by retrospectively comparing the neurosurgical activity carried out in a recent period of time with that delivered in a previous period utilized as a “historical control.” Childs Nerv Syst (2009) 25:785 DOI 10.1007/s00381-009-0868-9

Late complications after treatment for Hodgkin lymphoma

Long-term survivors of Hodgkin lymphoma face a number of late effects that can significantly affect the length and quality of their life. These include increased risk of second malignancy, cardiovascular disease, pulmonary dysfunction, infections, and endocrinopathy. Of these late effects, second malignancies and cardiac disease are the two leading contributors to the excess mortality seen in long-term Hodgkin lymphoma survivors. An improved understanding of the range of late complications after Hodgkin lymphoma therapy and the identification of treatment-related and patient-related risk factors can guide the development of screening and prevention programs for long-term survivors who have completed treatment. In addition, increasing recognition of late complications has in part led to substantial changes in the treatment of Hodgkin lymphoma over the years. Continued long-term follow-up of patients treated with modern therapy and documentation of late effects associated with newer treatment will be essential.

Late complications of myocardial infarction.

RECOGNITION of the late complications of myocardial infarction necessitates a morphologic approach, a recognition that the pumping action of the heart is importantly affected by asynergy, aneurysm, or papillary muscle dysfunction,1,2 and the assumption that such abnormal morphology can be recognized and quantitated. Thus, congestive heart failure or dysrhythmias during acute infarction may be followed weeks or months later by recurrent pump failure. Simple description of the coronary tree, eg, critical stenosis of one, two, or three vessels, may be a wholly inadequate description of postinfarction status. It is the purpose of this review to examine the factors leading to the recognition and treatment of late complications in myocardial infarction and to attempt a separation of highand low-risk groups. Table 1 lists major and minor late complications, ie, those arising after the 14th day, in 100 patients with acute transmural myocardial infarction. Table 2 lists the frequency of abnormal clinical and laboratory indexes in those with and those without the complications listed in Table 1. A mitral regurgitant murmur, for example, was four times more common in patients shown to have either

Late Complications of Cardiac Surgery

While the results of cardiac surgery have improved dramatically during the past 20 years, and operative mortality and morbidity have greatly declined, more early and late complications have evolved as the complexity of cardiac surgery has increased. The recognition of late complications may be greatly facilitated by an acquaintance with those observed most frequently.