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PubMed1999

Psychological complications in 281 plastic surgery practices.

Surgery is a high-stakes stressor with possible consequences that include death, pain, disfigurement, economic losses, and alterations in social roles. Often, the most disturbing complications to surgeons and patients are psychological rather than physical. Ineffective management of psychological complications of surgery can have profound consequences, resulting in delayed recuperative times, delayed return to work, poor patient compliance, dissatisfaction with the surgical outcome, hostility toward surgeons, and anxiety. The purpose of this study was to investigate in a large randomized group of plastic surgery practices the relative incidence of negative psychological outcomes and to compare these with the incidence of adverse physical outcomes to gain a greater appreciation of the relative magnitude of each type of perioperative complication. The study design was a descriptive, correlational survey that assessed psychological complications reported by plastic surgeons. The Plastic Surgery Questionnaire was sent to 702 randomly selected board-certified plastic surgeons. The sample consisted of 281 board-certified plastic surgeons (40 percent response rate). The study instrument was found to be highly reliable, with inter-item Cronbach's alpha r = 0.85. The demographics were representative of the specialty as a whole. It was found in general that psychological complications were much more prevalent than physical problems such as hematoma or infection. Anxiety reactions were commonly encountered by 95.4 percent of surgeons; disappointment (96.8 percent), depression (95.0 percent), nonspecific physical complaints (92.2 percent), and sleep disorders (88.5 percent) were the next most commonly reported complications. Most surgeons (75.8 percent) reported that screening for depression was important, but only 18.8 percent identified screening for post-traumatic stress disorder as important, even though 86 percent had diagnosed post-traumatic stress disorder in their postoperative patients. Psychological complications occur at rates equal to or greater than those of physical complications in the plastic surgery practice. Patients who experience physical complications are much more likely to simultaneously experience psychological complications. Patients with preexisting psychological conditions are more at risk for postoperative psychological complications. Disappointment, anxiety, and depression were the most frequently seen psychological complications. Nursing personnel are perceived by plastic surgeons to have the primary role in screening patients for pertinent psychological history. Directed research should be undertaken to determine which treatment regimens are most effective in reducing preoperative psychological complications. Controlled clinical trials of pharmaceuticals and alternative therapies must be designed and carried out in a prospective manner to establish the optimum treatment for alleviation of adverse emotional consequences of surgery. The next frontier for the specialty is to actively and consciously investigate and improve our patients' emotional and psychological results from surgery.

Anxiety↗

PubMed2004

Complications of radical and partial nephrectomy in a large contemporary cohort.

PURPOSE: Standardized criteria for reporting the early complications of urological procedures are lacking. We reviewed the early complications of radical nephrectomy (RN) and partial nephrectomy (PN) in a large contemporary cohort using a standardized complication grading scale. MATERIALS AND METHODS: Between 1995 and 2002, 1,049 patients underwent RN (66%) or PN (34%) for renal cortical neoplasm. Records were reviewed for perioperative complications. Complications were graded using a 5-tiered scale based on the severity of impact or intensity of therapy required. RESULTS: A total of 235 complications occurred in 180 patients (17%). Overall 55% and 31% of complications were grade I and grade II, respectively. There were 3 perioperative deaths (0.2%). PN was not associated with more complications compared to RN when accounting for other variables. PN cases had more procedure related complications compared to RN (9% versus 3%, respectively, p = 0.0001) due to complications of urinary leak and the reintervention rate was subsequently higher (2.5% versus 0.6%, p = 0.02). All but 1 of the reinterventions for PN involved either endoscopy or radiology. By multivariate analysis operative time (p <0.0001) and solitary kidney (p = 0.06) were associated with procedure related complications of PN. CONCLUSIONS: RN and PN are associated with low rates of serious morbidity and mortality. Compared to RN, PN is associated with higher rates of procedure related complications, the majority of which are minor. Overall, however, PN is not associated with more complications than RN.

Adolescent↗

PubMed2006

A single surgeon's 12-year experience with tissue expander/implant breast reconstruction: part I. A prospective analysis of early complications.

BACKGROUND: Multiple prior reports are conflicted regarding the true incidence of complications following implant-based breast reconstruction. A review of a single surgeon's extensive experience with tissue expander/implant reconstruction provides the opportunity to critically evaluate outcomes in a uniformly treated patient population. The objective of this study was to analyze the development of early complications in patients following two-stage implant breast reconstruction. METHODS: A review of all tissue expander/implant reconstructions performed by a single surgeon over the 12-year period from July of 1992 to June of 2004 was performed. A prospectively maintained database was analyzed with respect to reconstructive and early complication data on 1522 reconstructions in 1221 patients. Early complications were defined as those occurring 12 months or less from initiation of reconstruction. RESULTS: The overall rate of early complications was 5.8 percent; the rate of premature expander removal was 2.7 percent. The most common complication was infection (2.5 percent). The incidence of complications after tissue expander insertion (8.5 percent) was significantly higher than that after the exchange procedure (2.7 percent). The rate of complications was significantly higher in patients with a history of preoperative chest wall irradiation. There was no difference in the incidence of complications in patients who were expanded during chemotherapy and those who were not. CONCLUSIONS: Tissue expander/implant reconstruction is a safe, reliable method of reconstruction with minimal early complications. Early complications are more common after expander insertion. Chemotherapy administered during tissue expansion does not increase the rate of complications. The rate of complications, although higher in previously irradiated patients, remains low.

Breast Implantation↗

PubMed2005

A prospective study of the incidence of complications associated with dermatological surgery.

BACKGROUND: Dermatological surgery is a relatively new and expanding subspecialty within dermatology. Little information is available about complications in this kind of surgery in the European setting. OBJECTIVES: The aim of this study was to assess the incidence of anaesthetic, haemorrhagic and infectious complications in dermatological surgery and to highlight the factors associated with these complications. METHODS: Data were collected prospectively over a 3-month period for all surgical procedures performed by a network of dermatologists (n = 84 dermatologists) in France, including the excision of all benign or malignant tumours but excluding sebaceous cysts and pyodermas. Information was collected regarding dermatologists, patients, procedures and complications. RESULTS: A total of 3788 surgical procedures were available for review; 236 complications, mostly minor, occurred in a total of 213 surgical procedures (6%), bleeding being the most common (3%). Vaso-vagal syncope was the main anaesthetic complication (51 of 54). Infectious complications occurred in 79 patients (2%). Superficial suppuration accounted for 92% of surgical site infections. Only one patient had a systemic infection. Complications requiring additional antibiotic treatment or repeat surgery accounted for only 22 cases of 3788 (1%). No statistically significant correlation was found with the characteristics of the dermatologists, especially with respect to their training or amount of surgical experience. Similarly, no link could be established between complications and surgical conditions. Multivariate analysis showed that anaesthetic or haemorrhagic complications were independent factors for infectious complications. Sex, administration of an anticoagulant or immunosuppressant, type of procedure performed and duration exceeding 24 min were independent factors for haemorrhagic complications. CONCLUSIONS: This study shows a low rate of complications associated with dermatological surgery performed by dermatologists under local anaesthesia on an outpatient basis.

Adolescent↗

PubMed2005

Evaluation of the end colostomy complications and the risk factors influencing them in Iranian patients.

INTRODUCTION: The aim of this study was to assess the prevalence of end colostomy complications and the evaluation of factors influencing outcome. PATIENTS AND METHODS: Three hundred and thirty patients with end colostomy were studied. All patient were recalled for examination for recent complications. Early complications included stoma site pain, early dermal irritation (during the first month after surgery), mucosal bleeding, stomal prolapse and psychosocial complications. Late complications included peristomal hernia, stomal stenosis, late dermal irritation (after the first month), stomal retraction, stomal necrosis and other stoma complications (perforation, fistula etc.). Probable underlying factors were studied. To evaluate risk factors affecting complications, univariable analysis and then multivariable analysis by binary logistic regression was performed. RESULTS: One hundred and one (30.6%) patients had no complications and the remainder had at least one of early or late complications. Overall, psychosocial complications, 56.4%; mucosal bleeding, 34.5%; early dermal irritation, 23.5% were the most frequent complications. Peristomal hernia (11.2%) was the most common late complication. Those aged > 40 years had significant associations with psychosocial problem (OR = 2.77), mucosal haemorrhage (OR = 2.19), and early dermal irritation (OR = 3.14). The risks of peristomal hernia and early dermal irritation are greater in the patients with BMI > 25 kg/m2 (OR = 2.08 and 2.55, respectively). CONCLUSION: The risk of most prevalent complications of colostomy construction increases in elder patients. The high prevalence of psychosocial and skin problems in patients with a colostomy, needs special attention especially from the viewpoint of education by trained stoma nurses and preparation of standard equipment.

Aged↗

PubMed2002

Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings.

PURPOSE: To report the complications and imaging findings in a large group of patients who underwent Roux-en-Y gastric bypass (GBP) surgery. MATERIALS AND METHODS: Four hundred sixty-three patients were evaluated for upper gastrointestinal (GI) complications following Roux-en-Y GBP surgery. Major complications were those that required surgical or radiologic intervention and minor complications were those that resolved spontaneously. The time from surgery to complication and findings from upper GI series and computed tomography (CT) of the major complications and minor leaks were reviewed. RESULTS: Forty-four patients had 56 major complications: 23 small-bowel obstructions (14 internal hernias and nine adhesions), 16 major leaks, 15 anastomotic strictures, and two fistulas. There were 13 minor leaks and 18 other complications. Internal hernias were late complications and had a variety of findings at upper GI series and CT. Leaks were early complications and usually originated from the gastrojejunal anastomosis; findings from upper GI series and CT demonstrated extraluminal gas, contrast material, or both. Anastomotic strictures were late complications and were diagnosed at upper GI series with rounded dilation of the pouch and delayed emptying. CONCLUSION: Upper GI complications that required intervention occurred in 9.5% of patients. CT and upper GI series can depict most major complications.

Adult↗

PubMedDate not supplied

Extended complications of urethroplasty.

INTRODUCTION: An extensive study of complications following urethroplasty has never been published. We present 60 urethroplasty patients who were specifically questioned to determine every possible early and late complication. MATERIALS AND METHODS: Retrospective chart review of urethroplasty patients between August 2000 and March 2004. An "open format" questioning style allowed maximal patient reporting of all complications, no matter how minor. RESULTS: 60 patients underwent 62 urethroplasties (24 anterior anastomotic, 19 buccal mucosal and 10 fasciocutaneous, 9 posterior anastomotic) with mean follow-up of 29 months. Early complications occurred in 40%, but only 3% were major (rectal injury and urosepsis). Early minor complications included scrotal swelling, scrotal ecchymosis and urinary urgency. Late complications occurred in 48%, but only 18% were significant (erectile dysfunction, chordee and fistula). Late minor complications included a feeling of wound tightness, scrotal numbness and urine spraying. Fasciocutaneous urethroplasty caused the most significant complications, and buccal mucus urethroplasty the least, while also resulting in the lowest recurrence rate (0%). CONCLUSIONS: Serious complications after urethroplasty (3% early and 18% late) appear similar to those reported elsewhere, but minor bothersome complications appear to occur in much higher numbers than previously published (39% early and 40% late). While all the early complications were resolved and most (97%) were minor, less than half of the late complications were resolved, although most (82%) were minor. These complication rates should be considered when counseling the urethroplasty patients, and generally tend to support the use of buccal mucosal onlay urethroplasty as it had the lowest rate of serious side effects.

Adolescent↗

PubMed2007

Total joint arthroplasty: When do fatal or near-fatal complications occur?

BACKGROUND: With the recent trend toward minimally invasive total joint arthroplasty and the increased emphasis on faster recovery and shorter hospital stays, it has become increasingly important to recognize the timing and severity of the various complications associated with elective total joint arthroplasty to ensure that early patient discharge is a safe practice. METHODS: We evaluated the systemic and local complications associated with primary unilateral lower-extremity arthroplasties performed during one year in 1636 patients. A total of 966 patients had a primary total hip arthroplasty, and 670 had a primary total knee arthroplasty. All complications that occurred in the hospital and for six weeks following the index surgery were recorded. The circumstances leading to the complications and the details of the therapeutic intervention for each complication were recorded. Analyses were performed to predict the factors that predispose patients to serious complications. RESULTS: One patient (0.06%) in the cohort died during the hospital stay. There were a total of 104 major (life-threatening) complications, including cardiac arrest (one), tachyarrhythmia (thirty-three), pulmonary edema or congestive heart failure (ten), myocardial infarction (six), hypotensive crisis (four), pulmonary embolus (twenty-five), acute renal failure (fourteen), stroke (six), bowel obstruction or perforation (three), and pneumothorax (one). There were seventeen major local complications. Ninety-four (90%) of the major complications occurred within four days after the index surgery. Although older age, increased body mass, and preexistent comorbidities were important predisposing factors for serious medical complications, 58% of the patients who had life-threatening complications develop had no identifiable predisposing factors. CONCLUSIONS: This study demonstrated that most of the complications of lower-extremity total joint replacement occur within the time-frame of the typical hospital stay. Given the serious nature of some of these complications and the inability to identify many of the patients who may be at risk, we caution against early discharge of patients from the hospital after elective total joint arthroplasty in the lower extremity.

Adolescent↗

PubMed2003

Surgical and postoperative complications associated with tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture: 397 cases (1998-2001).

OBJECTIVE: To identify surgical and postoperative complications of tibial plateau leveling osteotomy (TPLO) in dogs with rupture of the cranial cruciate ligament (CCL) and compare their incidence with those reported in the literature for other commonly performed CCL stabilization procedures. DESIGN: Retrospective study. ANIMALS: 346 dogs undergoing 397 TPLO procedures. PROCEDURE: Medical records of dogs undergoing 563 consecutive TPLO procedures were reviewed. Complications were recorded and assigned to groups on the basis of the period during which the complication was observed. RESULTS: 397 TPLOs met the criteria for inclusion in the study. Complications (n = 136) were recorded in 113 of the 397 (28%) procedures. Multiple complications developed in 10 dogs. In 19 dogs, a second surgery was performed to manage complications. Development of a complication after surgery was not associated with age or body weight of the dog, tibial plateau angle prior to stifle joint surgery, or experience of the surgeon. Factors significantly associated with complications were breed and performance of an arthrotomy concomitantly with TPLO. CONCLUSIONS AND CLINICAL RELEVANCE: TPLO was associated with development of numerous complications, some of which required surgical correction. Most complications resolved with nonsurgical treatment. Several complications were unique to the TPLO procedure because of the surgical technique and implants required. Although TPLO was associated with a greater number of complications than other CCL stabilization methods, the incidence of major complications was similar.

Animals↗

PubMed2002

The knowledge of obstetric complications among primigravidae in a rural health centre in the district of Blantyre, Malawi.

UNLABELLED: An informed individual is better placed to make reasonable decisions. It is therefore of vital importance that women be knowledgeable about obstetric complications to enable them to respond appropriately to complications that may arise. This study aimed to explore primigravidae's knowledge of obstetric complications. A descriptive study design was used to determine what knowledge primigravidae had of obstetric complications. Recognition of obstetric complications in pregnancy, during labour and after delivery and actions that participants would take if they developed any complications in pregnancy and after delivery were explored. Participants' actions were not sought for problems faced during labour because the researcher felt the participants would have little control of the situation with regard to choice during labour. METHODS: Participants were selected by means of purposive sampling from a population of pregnant women who fitted defined criteria attending antenatal clinic at a health centre. Thirty-three primigravidae from the rural setting with a gestation period between 28 and 42 weeks were interviewed. RESULTS: The findings showed that participants were more aware of obstetric complications that could occur in pregnancy than of complications that may occur during and after delivery. Participants had limited knowledge of complications that may need immediate treatment during all three periods. Eighty-two percent (95% ci: 67-96) of the primigravidae had some knowledge and could make an informed decision to go to a health facility with pregnancy complications. Sixty-one percent (95% ci: 42-79) of the primigravidae had knowledge and could make an informed decision to go to a health facility with complications after delivery. These findings have critical implications for the provision of information on obstetric complications. The information given should cover all three periods, with emphasis on those obstetric complications that require immediate treatment.

Adolescent↗

PubMed2006

Primigravidae's knowledge about obstetric complications in an urban health centre in Malawi.

UNLABELLED: Pregnant women in Malawi receive information about pregnancy, labour and delivery during routine antenatal visits. This study aimed to explore knowledge of obstetric complications amongst primigravidae attending an urban health centre in Blantyre, Malawi. A descriptive study design was used. Recognition of obstetric complications in pregnancy, during labour and after delivery and actions that participants would take if they developed any complications in pregnancy and after delivery were explored. Actions that women would take for complications that occur during labour were not probed, as women have little control over actions taken when complications arise during labour. METHODS: Participants were selected by means of purposive sampling from a population of pregnant women who fitted defined criteria and who were attending antenatal clinic at a health centre. Forty-five primigravidae from the urban setting with a gestation period between 28 and 42 weeks were interviewed. Data were analysed manually. RESULTS: The findings showed that participants were more aware of obstetric complications that could occur in pregnancy than of complications that may occur during and after delivery. Sixty percent of the participants were knowledgeable about obstetric complications in pregnancy. The majority of the participants, 73% and 82.2% did not know of any problems that could occur during and after the birth of the baby respectively. Participants had limited knowledge of complications that may need immediate treatment during all three periods. Fifty-eight percent (95% ci: 43; 73) of the primigravidae had some knowledge and could make an informed decision to go to a health facility with pregnancy complications. However, only 24% (95% ci: 11; 38) of the primigravidae had some knowledge and could make an informed decision to go to a health facility with complications after delivery. These findings suggest a critical need for provision of information on obstetric complications especially those that may occur during and after birth with emphasis on those obstetric complications that require immediate treatment.

Adolescent↗

PubMed2001

Risk factors for postoperative complications in oral cancer and their prognostic implications.

BACKGROUND: The surgical treatment of head and neck cancer can be limited by the risk of postoperative complications. Early identification of risk factors based on clinical characteristics may assist therapeutic planning. OBJECTIVES: To identify risk factors for these complications and to evaluate their prognostic significance. METHODS: The medical records of 110 patients with oral squamous cell carcinoma admitted from January 1, 1990, to December 31, 1994, who underwent radical surgery were reviewed. Data collected included demographic information, comorbidities, extended clinical severity stage, treatment, complications, and survival. The chi(2) test was used to verify the association between the variables. Survival analysis was performed with the Kaplan-Meier method. Logistic and Cox proportional hazards regression were used to build models with independent predictive factors for the risk of complications and death, respectively. RESULTS: The overall complication rate was 50%. Dehiscence and infection rates were 20.9% and 22.7%, respectively. The death rate was 3.6%. Forty-seven patients (42.7%) were electively referred to the intensive care unit (ICU). The occurrence of postoperative complications was associated with extended clinical severity stage (P =.02), type of surgery (P =.03), ICU (P =.03), type of reconstruction (P =.02), Functional Severity Index (P =.03), neck dissection (P =.002), and APACHE II (Acute Physiology and Chronic Health Evaluation II) (P =.008). The number of complications was significantly correlated with the length of hospital stay (r = 0.24, P =.01) and with the Functional Severity Index (r = 0.19, P =.04). Five-year overall survival was affected by the type of complications (none, 41.7%; local, 34.1%; and local plus systemic, 0% [P<.001]), ICU (no, 46.3%; yes, 20.7% [P =.001]), and extended clinical severity stage (stage 1, 75.6%; stage 2, 50%; stage 3, 28.6%; and stage 4, 10.2% [P<.001]). In a multivariate analysis bilateral neck dissection (relative risk = 3.57, P =.01) and an APACHE II score greater than 10 (relative risk = 3.86, P =.02) were independent risk factors for complications. The predictive prognostic model consisted of the following: staying in the ICU (hazard ratio = 1.83), local plus systemic complications (hazard ratio = 6.27), and extended clinical severity stage (stage 3, hazard ratio = 3.57; stage 4, hazard ratio = 6.34). CONCLUSIONS: Bilateral neck dissection and the APACHE II score were identified as risk factors for postoperative complications in oral cancer, which also increase the length of hospital stay. The occurrence of systemic complications, advanced extended clinical severity stage, and staying in an ICU adversely affect the prognosis. Therefore, the prompt recognition of the adverse risk factors for postoperative complications may guide proactive interventions that may improve survival and achieve cost-effectiveness.

APACHE↗

PubMed2002

[Analysis of complications about gynecologic endoscopic procedures in 14 hospitals of Shanghai during 1992-2001].

OBJECTIVE: To investigate the objective law of complication in endoscopic operation of gynecology. METHOD: We retrospectively reviewed and analyzed the complications of endoscopic surgery during the decade occurred in 9 municipal or teaching hospitals and 5 district hospitals in Shanghai. RESULTS: There were total 10,263 cases of operative laparoscopy and 18,306 cases of hysteroscopy. The laparoscopic complication rate was 1.51% (155/10,263) and incidence of hysteroscopic complication was 0.09% (16/18,306). The major common complications in laparoscopic procedures were bleedings (70/10,263, 0.68%), 18 infections (18/10,263, 0.18%) and 12 organic injuries (12/10,263, 0.12%). The complication rate in laparoscopic surgery made by the inexperienced was six times greater than that by the experienced (P < 0.01). Complication rate decreased to 0.90% in 2001 from 7.25% in 1992. The complications in hysteroscopy were 6 uterine perforations, 3 hyperhydration syndromes, 3 postoperative bleedings, 2 cardio-brain syndrome, 1 organic injury, and 1 died. The mortality was 0.005%. The complication rate in the hospital developing hysteroscopic surgery less than 1,000 cases was 16 times greater than in that over 1,000 cases (P < 0.01). CONCLUSIONS: It is suggested by our data that the complication in laparoscopy showed downward year by year and some serious complications were increased with extension of operative surgery. Complication has to do with the experience of surgeons. To decrease complication, surgeons should pay a great attention to the indication chosen correctly, training step by step and basic skills.

Blood Loss, Surgical↗

PubMed1996

GI complications after orthotopic lung transplantation.

OBJECTIVES: Recently, lung transplantation has been performed with increasing frequency and improved outcomes. GI complications have been observed and reported in patients undergoing cardiac and renal transplantations but only recently have been reported in patients after lung transplantation. No large cohort has been systematically analyzed for all GI complications after lung transplantation. The present study describes, categorizes, and assesses risk factors for the development of such GI complications. METHODS: Records of 45 patients who underwent 47 single or bilateral orthotopic lung transplants between November 1991 and January 1994 were reviewed. RESULTS: Twenty-three patients (51%) had 64 GI complications requiring 13 operations on eight patients. The incidence of major abdominal procedures in the entire transplant cohort was 18% (8/45). Their operative mortality rate was 63% (5/8). Eighteen different types of nonoperative complications occurred and were subclassified into major and minor complications. Complications were defined as major if they required medical or surgical intervention and altered patient management. Most GI complications (73%) occurred within 1 month after transplantation. No risk factors were identified to ascertain who will develop GI complications. CONCLUSIONS: GI complications occur in more than one-half of lung transplant recipients early after transplantation and in the absence of identifiable risk factors. Because there are no precedent risk factors to suggest who will develop GI complications, clinicians must be alert to any warning signs and symptoms. The majority of complications are nonoperative, responding to conservative therapy, but there is a higher overall mortality rate for patients requiring operative intervention, necessitating an aggressive search for major, life-threatening complications in these immunosuppressed patients.

Female↗

PubMed1998

Effect of postoperative complications on health and employment following liver transplantation.

The influence of postoperative complications on employment and health status following orthotopic liver transplantation (OLT) remains elusive. Postoperative complications were scored prospectively using a standardized medical outcome classification in each patient transplanted at Duke University from October 1992 to January 1995. Functional status was evaluated by using the Karnofsky score. Between 12 and 18 months following transplantation, patients were asked to complete mailed questionnaires to assess employment and health status (SF-36). The response rate was 86% (42 of 49 eligible patients). The mean patient age was 48 yr. Sixteen of 42 patients (38%) exhibited minimal or no postoperative complications, and 62% exhibited moderate to severe postoperative complications. Age, gender, education, UNOS status for severity of disease, insurance status, and Karnofsky score did not correlate with postoperative complications. Postoperative complications did not predict employment post-transplantation. Paradoxically, patients with minimal or no postoperative complications perceived that their health status was significantly impaired post-transplantation, as evidenced by a median score of 0 in the role-physical subscale of the SF-36, in contrast to those patients with moderate or severe postoperative complications who exhibited a median score of 25 (p < 0.01). Similarly, patients with minimal or no postoperative complications had significantly lower scores on the mental health subscale than those with moderate or severe complications, with median score of 60 vs. 78 (p < 0.03). The physical functioning subscale was not affected by postoperative complications. Thirteen of 42 (31%) respondents returned to full employment post-transplantation. Health perceptions differed with respect to employment status post-transplantation. Patients unemployed post-transplantation exhibited a median score of 55 in the physical functioning subscale, a value much lower than the median score of 80 in the patients who were employed post-transplantation (p < 0.02). No differences in the role physical or mental health subscales were noted with respect to employment status post-transplantation. Employment status was unaffected by Karnofsky status, indicating that functional status does not predict employment. In conclusion, patients exhibited very poor health perceptions post-transplantation, irrespective of postoperative complications. Prospective evaluation of patients undergoing liver transplantation revealed that medical complications did not affect employment post-transplantation.

Employment↗

PubMed2002

Complications after uterine artery embolization for leiomyomas.

OBJECTIVE: To determine the frequency and severity of complications that occur as a result of uterine artery embolization for leiomyomas. METHODS: As part of an ongoing study of outcome after uterine embolization, prospective data regarding complications that occurred in 400 consecutive patients were gathered. Each patient had a minimum of a 3-month interval from the procedure at the time of analysis. Each complication was categorized and graded as to severity and outcome using the complication classification developed by the Society of Cardiovascular and Interventional Radiology (SCVIR) and a modified set of The American College of Obstetricians and Gynecologists (ACOG) criteria for complications of hysterectomy and myomectomy. All adverse events that occurred during the follow-up period were included, including those that occurred after the 3-month minimum interval. Confidence intervals (CIs) were calculated for each complication. RESULTS: There were no deaths and no major permanent injuries. One patient required hysterectomy as a result of a complication, and one patient had an undiagnosed leiomyosarcoma. There were ten in-hospital complications and an additional 27 complications within the first 30 days, with 34 patients experiencing a periprocedural complication for a rate of 8.5% (95% CI 6.0%, 11.7%). There were five serious complications (SCVIR class D), comprising 1.25% (95% CI 0.3%, 2.5%) of the study group. Using ACOG definitions for perioperative complications, the overall morbidity was 5% (95% CI 3.1%, 7.7%). CONCLUSION: The short-term complication rate was low in women undergoing uterine embolization.

Adult↗

PubMed1986

Pathogenesis of cardiovascular complications in children following scorpion envenoming.

Scorpion envenoming is known to produce serious complications in children, and the complications differ with different species seen in the world. Peripheral failure, hypotension, myocarditis and seizures are the serious complications related to scorpion envenoming. The pathogenesis of cardiovascular complications caused by the Buthotus (Buthus) tamulus species is likely to be related to the direct effect of the venom on the myocardium rather than to catecholamine-induced hypoxia, as reported earlier. A scorpion sting is a common event both in urban and rural areas and the complications are more severe in children than in adults. Though several species have been identified throughout the world, stings by the Buthotus tamulus species are most commonly seen in southern states of India. Many complications have been reported related to the venom of different species of scorpion but the pathogenesis of cardiovascular complications seems to differ with different species. Most of the published reports suggest that hypotension and myocarditis were frequently observed following scorpion stings, whereas, in our children, peripheral failure and hypotension are the complications observed initially. Myocarditis and other serious complications are observed only during follow-up. The complications and lethal effects of scorpion venom seen in our earlier study indicated that in children cardiovascular complications were seen more frequently than neurological or haematological complications. The aim of the present study is to identify the frequency and nature of the cardiovascular complications and the pathogenesis of myocarditis following scorpion envenoming.

Cardiovascular Diseases↗

PubMedDate not supplied

Increased expression of tissue factor and receptor for advanced glycation end products in peripheral blood mononuclear cells of patients with type 2 diabetes mellitus with vascular complications.

The aim of the study was to determine the correlation between the expression of tissue factor (TF) and the receptor for advanced glycation end products (RAGEs) and vascular complications in patients with longstanding uncontrolled type 2 diabetes (T2D). TF and RAGE mRNAs as well as TF antigen and activity were investigated in 21 T2D patients with and without vascular complications. mRNA expression was assessed by reverse transcriptase-polymerase chain reaction (RT-PCR) in nonstimulated and advanced glycation end product (AGE) albumin-stimulated peripheral blood mononuclear cells (PBMCs). TF antigen expression was determined by enzyme-linked immunosorbent assay (ELISA) and TF activity by a modified prothrombin time assay. Basal RAGE mRNA expression was 0.2 +/- 0.06 in patients with complications and 0.05 +/- 0.06 patients without complications (P =.004). Stimulation did not cause any further increase in either group. TF mRNA was 0.58 +/- 0.29 in patients with complications and 0.21 +/- 0.18 in patients without complications (P =.003). Stimulation resulted in a nonsignificant increase in both groups. Basal TF activity (U/10(6) PBMCs) was 18.4 +/- 13.2 in patients with complications and 6.96 +/- 5.2 in patients without complications (P =.003). It increased 3-fold in both groups after stimulation (P =.001). TF antigen (pg/10(6) PBMCs) was 33.7 +/- 28.6 in patients with complications, 10.4 +/- 7.8 in patients without complications (P =.02). Stimulation tripled TF antigen in both groups of patients (P =.001). The RAGE/TF axis is up-regulated in T2D patients with vascular complications as compared to patients without complications. This suggests a role for this axis in the pathogenesis of vascular complications in T2D.

Coronary Disease↗