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At least 127 records · Page 7Linked to original sources
PubMed1997

Residual neuromuscular block is a risk factor for postoperative pulmonary complications. A prospective, randomised, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium.

BACKGROUND: After anaesthesia involving pancuronium a high incidence of both residual neuromuscular block and postoperative pulmonary complications (POPC) has been reported. The aim of this study was to compare the incidence of POPC following the use of pancuronium, atracurium, and vecuronium, and to examine the effect of residual neuromuscular block on the incidence of POPC. METHODS: A total of 691 adult patients undergoing abdominal, gynaecological, or orthopaedic surgery under general anaesthesia were randomised to receive either pancuronium, atracurium, or vecuronium. Perioperatively, the response to train-of-four (TOF) nerve stimulation was evaluated manually. Postoperatively, the TOF ratios were measured mechanomyographically, and through a 6-day follow-up the patients were examined for pulmonary complications. RESULTS: The incidence of residual block, defined as a TOF ratio < 0.7, was significantly higher in the pancuronium group (59/226: 26%) than in the atracurium/vecuronium groups (24/450: 5.3%). In the pancuronium group, significantly more patients with residual block developed POPC (10/59: 16.9%) as compared to patients without residual block (8/167: 4.8%). In the atracurium/vecuronium groups, the incidence of POPC was not significantly different in patients with (1/24: 4.2%) or without (23/426: 5.4%) residual block. Multiple regression analysis indicated that abdominal surgery, age, long-lasting surgery, and a TOF ratio < 0.7 following the use of pancuronium were potential risk factors for the development of POPC. CONCLUSION: Postoperative residual block caused by pancuronium is a significant risk factor for development of POPC.

Adult↗
PubMed2000

[Commission of inquiry scrutinized complications of carotid surgery. Half of the complications could be explicable by errors or dubious indications].

As carotid endarterectomy is a prophylactic procedure, it would seem particularly important to analyze complications with an aim to avoiding them. All carotid endarterectomies in Sweden are registered, and all serious complications (death and permanent neurological deficit) are analyzed in detail, classified and discussed within the profession. During the period 1994-1996 the frequency was 4.3 percent (technical causes in 17 percent, contraindications in 8 percent and dubious indications in 21 percent, but correct indication and surgery in 54 percent). Thus, even when conditions are optimal there is a certain price to pay for the prevention of ischemic stroke.

Adult↗
PubMed2005

Clinical benefit, complication patterns and cost effectiveness of laser in situ keratomileusis (LASIK) in moderate myopia: results of independent meta analyses on clinical outcome and postoperative complication profiles.

PURPOSE: Laser in situ keratomileusis (LASIK) means a patient investment of 2426 Euro per eye, which usually cannot be funded by European health care insurers. In the context of recent resource allocation discussions, however, the cost effectiveness of LASIK could become an important indication of allocation decisions. Therefore an evidence based estimation of its incremental cost effectiveness was intended. METHODS: Three independent meta analyses were implemented to estimate the refractive gain (dpt) due to conventional LASIK procedures as well as the predictability of the latter (%) (fraction of eyes achieving a postoperative refraction with maximum deviation of +/- 0.5 dpt from the target refraction). Study reports of 1995 - 2004 (English or German language) were screened for appropriate key words. Meta effects in refractive gain and predictability were estimated by means and standard deviations of reported effect measures. Cost data were estimated by German DRG rates and individual clinical pathway calculations; cost effectiveness was then computed in terms of the incremental cost effectiveness ratio (ICER) for both clinical benefit endpoints. A sensitivity analysis comprised cost variations of +/- 10 % and utility variations alongside the meta effects' 95% confidence intervals. RESULTS: Total direct costs from the patients' perspective were estimated at 2426 Euro per eye, associated with a refractive meta benefit of 5.93 dpt (95% meta confidence interval 5.32 - 6.54 dpt) and a meta predictability of 67% (43% - 91%). In terms of incremental costs, the unilateral LASIK implied a patient investion of 409 Euro (sensitivity range 351 - 473 Euro) per gained refractive unit or 36 Euro (27 - 56 Euro) per gained percentage point in predictability. When LASIK associated complication patterns were considered, the total direct costs amounted up to 3075 Euro, resulting in incremental costs of 519 Euro / dpt (sensitivity range 445 - 600 Euro / dpt) or 46 Euro / % (34 - 72 Euro / %). Most frequently reported LASIK complications were "central islands / over- / undercorrection / regression" (meta incidence estimate 24%) and "haze" (15%), which were identified by means of an independent meta analysis. CONCLUSION: Bearing incremental costs of 519 Euro per gained refractive unit in mind, the conventional LASIK procedures showed an encouraging cost effectiveness range; the latter estimate may serve as a rationale for future allocation discussions in ophthalmology.

Cost-Benefit Analysis↗
PubMed1991

The importance of computer observation of postoperative complications in ophthalmology presented on the model of postoperative complications following cataract surgery.

Medical documentation is getting more extensive, it is not standardised and can hardly be used to provide the exact and proper feedback. The crisis of data storage, processing and uninterrupted flow of information is becoming concial in the medical institutions as well. An example of informatic model of observation of postoperative complications following cataract surgery is presented in this work. The model has a very flexible pattern, and can, therefore, with minor changes, be used in observation of all postoperative complications in ophthalmology. It is based on the use of personal computer with professional software support (data base III programme was used for creation of data base, while statistical graphic analysis was carried out by following programmes: MICROSTAT, ABSTAT, STATGRAPHIC and FRAMEWORK). It has to be pointed out that any doctor, after only a short (optional) education, could prepare such models for his own purposes, and could thus assist in overcoming the information in medicine. In conclusion, the authors state computer is simple to work with, fast, economical and precise. Computerisation of health service shall include it in one of the aspects of practical realisation of the third technological revolution.

Cataract Extraction↗
PubMedDate not supplied

[Do extended preventive indications for cervix cerclage increase labor complications? A statistical analysis on direct and indirect complications of cerclage using Bavarian perinatal data 1978-1980].

On the basis of 159.710 single pregnancies with 11.321 cerclages documented in the Bavarian Perinatal Survey of 1978-1980, with 2.676 single-child births, and 514 cerclages performed on the authors' own patients, possible complications of the extended indication for cerclage were determined as follows: The late abortion rate was not increased. Possibly because the group represented a negative selection, rupture of the membranes prior to labour, infant mortality due to infection, and premature labour were significantly more common in gravidae who had undergone cerclage. However, it was not possible to identify a causal connection between these and the cerclage operation. With regard to indirect complications there was an appreciable increase in the number of caesarean deliveries among cerclage patients, a slight increase in the number of cases in which labour lasted over 12 hours, and a significant increase in the number of lacerations of the cervix. There was no increase in the incidence of post-term births, malformations, stillbirths, or infantile acidosis among the children of patients who had undergone cerclage.

Abortion, Spontaneous↗
PubMed2005

Reduction of radiotherapy-induced late complications in early breast cancer: the role of intensity-modulated radiation therapy and partial breast irradiation. Part I--normal tissue complications.

Radiotherapy after conservation surgery has been proven to decrease local relapse and death from breast cancer, and is now firmly established in the management of early breast carcinoma. Currently, the challenge is to minimise the morbidity caused by this treatment without losing its efficacy. This review will be divided into two parts, with Part I focusing on the radiation factors contributing to late normal tissue complications after radiotherapy for early breast cancer. Three major normal tissue side-effects will be discussed: cosmetic outcome, cardiac complications and pulmonary side-effects.

Atrophy↗
PubMed2005

Marked initial displacement predicts complications in physeal fractures of the distal radius: an analysis of fracture characteristics, primary treatment and complications in 109 patients.

BACKGROUND: Factors predicting redisplacement in the cast and early complications in distal radial physeal injuries have not been analyzed before. PATIENTS AND METHODS: We analyzed 109 consecutive children with displaced physeal fractures of the distal radius treated by manipulation under anesthesia RESULTS: Acute carpal tunnel syndrome developed in 2 patients. Posttraumatic swelling necessitating trimming, splitting or removal of the primary circular cast occurred in one-sixth of the patients. Half of the fractures healed in malunion despite an anatomic primary reduction in 85% of the cases. According to logistic regression models, marked initial malposition of the fracture (< 50% displacement or < 20% angulation) was an independent risk factor for complications and redisplacement. Non-anatomic reduction of the fracture was an additional independent risk factor for redisplacement. INTERPRETATION: The risk of an acute carpal tunnel syndrome should be remembered in patients with marked primary displacement of the fracture. To avoid redislocation, pin fixation of the fracture in patients close to skeletal maturity should be considered if there is a marked initial malposition of the fracture, or if fully anatomic reduction cannot be achieved.

Adolescent↗
PubMed2002

Ertapenem versus piperacillin-tazobactam for treatment of mixed anaerobic complicated intra-abdominal, complicated skin and skin structure, and acute pelvic infections.

BACKGROUND: Anaerobes are an important component of many serious, deep tissue infections, especially complicated intra-abdominal (IAI), complicated skin and skin structure (SSSI), and acute pelvic (PI) infections. This study compares the efficacy of ertapenem, 1 g once a day, in the treatment of adults with anaerobic IAI, SSSI, and PI to piperacillin-tazobactam, 3.375 g every 6 hours. METHODS: Three randomized, double-blind trials comparing ertapenem to piperacillin-tazobactam for treatment of IAI, SSSI, and PI were conducted. This subgroup analysis included 623 patients, whose baseline culture grew one or more anaerobic pathogens, from these three studies. RESULTS: Anaerobes most commonly isolated were Bacteroides fragilis group (IAI) and peptostreptococci (SSSI and PI). The median duration of ertapenem and piperacillin-tazobactam therapy, respectively, in these subgroups was 6 and 7 days for IAI, 7 and 8 days for SSSI, and 4 and 5 days for PI. Cure rates for all evaluable patients with anaerobic infection were 89.3% (242/271) for ertapenem and 85.9% (220/256) for piperacillin-tazobactam (95% CI for the difference, adjusting for infection, -2.6% to 9.3%), indicating that the two treatments were equivalent. Cure rates by infection, for ertapenem and piperacillin-tazobactam, respectively, were as follows: IAI, 86.4% (133/154) and 82.4% (117/142); SSSI, 84.4% (27/32) and 82.4% (28/34); PI, 96.5% (82/85) and 93.8% (75/80). The frequency and severity of drug-related adverse experiences were comparable in both treatment groups. CONCLUSION: In this subgroup analysis, ertapenem was as effective as piperacillin-tazobactam for treatment of adults with moderate to severe anaerobic IAI, SSSI, and PI, was generally well tolerated, and had a similar safety profile.

Abdomen↗
PubMed2002

Vascular complications in percutaneous transhepatic management of complicated hepatolithiasis with difficult intrahepatic biliary strictures: are they avoidable?

Little has been reported about hemobilia in the management of complicated residual or recurrent hepatolithiasis with intrahepatic biliary strictures by percutaneous stricture dilation and percutaneous transhepatic cholangioscopic lithotomy. To analyze retrospectively the incidence, possible factors, and management of hemobilia in such patients, a consecutive series of 177 patients was studied from 1983 to 2001: 90 patients in the early, 7.5-year period and 87 patients in the later period, in which some procedures were modified. Minor hemobilia occurred during percutaneous puncture in 6 patients: 4 (4.4%) in the early period and 2 (2.3%) in the later period. Massive hemobilia developed in 14 patients (15.5%) in only the early period, during stricture dilation, lithotripsy, or lithotomy. Immediate arteriography revealed arterial bleeding (7), extravasation (3), pseudoaneurysm (3), or an undetermined source (1). Transcatheter arterial intervention enabled successful hemostasis. Massive hemobilia is a potential serious complication of percutaneous stricture dilation and percutaneous transhepatic cholangioscopic lithotomy but is avoidable.

Adult↗
PubMed2005

Efficacy of tigecycline in complicated skin and skin structure infections and complicated intra-abdominal infections.

Treatment of complicated skin and skin structure infection (cSSSI) and complicated intra-abdominal infection (cIAI) currently present a therapeutic challenge because many of the pathogens involved are becoming resistant to standard antimicrobial therapy. Tigecycline is a novel glycylcycline that exhibits expanded broad-spectrum antibacterial activity against certain resistant pathogens. Results from randomised Phase III studies comparing the clinical and microbiological efficacy of tigecycline with combination antimicrobial therapy for the treatment of cSSSI and cIAI are encouraging. Tigecycline has the potential to be used as monotherapy for the treatment of cSSSI and cIAI.

Abdominal Abscess↗
PubMed2003

The MPTP-treated primate as a model of motor complications in PD: primate model of motor complications.

Motor complications are a common cause of treatment failure in Parkinson's disease (PD). Although the underlying mechanisms remain obscure, research with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-treated primates may facilitate their investigation. Repeated administration of L-dopa to MPTP-treated primates results in a loss of drug efficacy ("wearing off") and periods of immobility ("on-off"). Immediately after each dose of L-dopa, animals show an initial worsening of motor performance ("beginning-of-dose deterioration") and, at the end of action of each dose, they exhibit a decline to levels of disability below those seen at baseline ("rebound worsening"). Dyskinesia (chorea, dystonia, athetosis) appears rapidly in MPTP-treated primates given L-dopa. The greater the degree of nigral denervation, the less exposure to L-dopa that is required to induce dyskinesia. The onset and intensity of dyskinesia are related to the dose and frequency of L-dopa administration. Increasing brain exposure to L-dopa increases the severity and intensity of involuntary movements. In contrast, long-acting dopamine agonists (DAs) induce a far lower incidence of dyskinesia, and continuous dopaminergic stimulation may provide a means of avoiding its onset. Recent data from MPTP-treated primates suggest that switching from L-dopa to a long-acting DA may reverse the priming process associated with induction of dyskinesia. Responses of MPTP-treated primates have proved to be highly predictive of antiparkinsonian activities of drugs in humans and their ability to induce dyskinesia, but they may also have utility in evaluating the mechanisms that underlie a range of long-term motor complications affecting patients with PD.

1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine↗
PubMed1996

Long-term outcome when major complications follow coronary artery bypass graft surgery. Recovery after complicated coronary artery bypass graft surgery.

OBJECTIVE: To determine whether information available 1 week after surgery correlates with long-term function in patients who suffer major complications after coronary artery bypass graft (CABG) surgery. DESIGN: An inception cohort study. SETTING: A 526-bed community teaching hospital. PATIENTS: All 67 patients who required at least 7 days of CT-ICU care following 2,751 consecutive CABG operations. MAIN OUTCOMES: Hospital survival, long-term survival, and functional ability at long-term follow-up. RESULTS: Forty-three patients survived hospitalization (64%), while 24 died 37 +/- 45 days (range, 7 to 190 days) after surgery. When 42 patients were surveyed 22 +/- 9 months after surgery, 21 of the survivors enjoyed excellent, independent function, 7 were moderately impaired but living at home, 6 were institutionalized with severe limitations, and 8 had died. Patients with very severe cardiac or neurologic dysfunction 1 week after surgery had an extremely poor outcome. When mechanical ventilation was required for causes other than primary failure of the respiratory system, long-term function and hospital survival were poor. Twelve of 14 patients with pulmonary complications survived hospitalization, and all 12 were alive at long-term follow-up. CONCLUSION: More than half of patients requiring 7 days or more of ICU treatment after CABG surgery survive, and many enjoy excellent long-term function. However, those with very severe cardiac or neurologic dysfunction 1 week after surgery have little chance for independent recovery.

Activities of Daily Living↗
PubMed2006

The effect of intensive glycemic treatment on coronary artery calcification in type 1 diabetic participants of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study.

The Epidemiology of Diabetes Interventions and Complications (EDIC) study, an observational follow-up of the Diabetes Control and Complications Trial (DCCT) type 1 diabetes cohort, measured coronary artery calcification (CAC), an index of atherosclerosis, with computed tomography (CT) in 1,205 EDIC patients at approximately 7-9 years after the end of the DCCT. We examined the influence of the 6.5 years of prior conventional versus intensive diabetes treatment during the DCCT, as well as the effects of cardiovascular disease risk factors, on CAC. The prevalences of CAC >0 and >200 Agatston units were 31.0 and 8.5%, respectively. Compared with the conventional treatment group, the intensive group had significantly lower geometric mean CAC scores and a lower prevalence of CAC >0 in the primary retinopathy prevention cohort, but not in the secondary intervention cohort, and a lower prevalence of CAC >200 in the combined cohorts. Waist-to-hip ratio, smoking, hypertension, and hypercholesterolemia, before or at the time of CT, were significantly associated with CAC in univariate and multivariate analyses. CAC was associated with mean HbA(1c) (A1C) levels before enrollment, during the DCCT, and during the EDIC study. Prior intensive diabetes treatment during the DCCT was associated with less atherosclerosis, largely because of reduced levels of A1C during the DCCT.

Adult↗
PubMed1990

Prevalence of complications in IDDM by sex and duration. Pittsburgh Epidemiology of Diabetes Complications Study II.

The prevalence of and interrelationships among all four major complications of insulin-dependent diabetes mellitus (IDDM) and their risk factors are being examined in a large epidemiologic study of IDDM subjects diagnosed in childhood. This article focuses on the baseline prevalence of complications in the 657 subjects diagnosed between 1950 and 1980 and currently aged 8-48 yr, with a mean duration of 20 yr. In addition to background retinopathy being virtually universal after 20 yr of diabetes, proliferative retinopathy affects 70% of IDDM subjects after 30 yr duration. As with overt nephropathy, prevalence of proliferative retinopathy is marginally higher in females than in males at short durations; the previously reported male excess is limited to the subjects with IDDM of longer duration (greater than or equal to 25 yr). Somewhat different patterns of microalbuminuria are also seen by sex. Males show a threefold increase in prevalence from 10 to 25 yr duration, whereas females show a more constant prevalence across these durations. A further rise in microalbuminuria is seen in males but not females at greater than or equal to 30 yr duration, giving a combined prevalence of microalbuminuria and overt nephropathy at greater than or equal to 30 yr duration of 84% (males) and 59% (females). Distal symmetrical polyneuropathy shows a constant rise with duration and is only marginally higher in men. Prevalence of cardiovascular (coronary and cerebral) disease shows no sex difference, whereas peripheral vascular disease is particularly common in women after 30 yr duration (greater than 30%) compared with men (11%) when determined by ankle/arm blood pressure ratio less than 0.8 at rest or after exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1999

Effect of intensive diabetes treatment on carotid artery wall thickness in the epidemiology of diabetes interventions and complications. Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group.

The Epidemiology of Diabetes Interventions and Complications (EDIC) is a multicenter longitudinal observational study of the Diabetes Control and Complications Trial (DCCT) cohort. One of the major objectives of EDIC is to study the development and progression of atherosclerotic cardiovascular disease in type 1 diabetes. In this study, we evaluated the role of cardiovascular risk factors and antecedent therapy in the DCCT on carotid intima-media wall thickness (IMT) in type 1 diabetes. At approximately 18 months after the end of the DCCT, high-resolution B-mode ultrasonography was used to assess the carotid arteries of 1,325 patients with type 1 diabetes, 19-51 years of age, with duration of diabetes ranging from 6.3 to 26.1 years. An age- and sex-matched nondiabetic population (n = 153) was studied with the same protocol. The ultrasound protocol was carried out in 28 EDIC clinics by centrally trained and certified sonographers using one of three scanning systems. Determination of IMT from videotaped images was performed by a single reader at the Central Ultrasound Reading Unit. Univariate associations with greater IMT were strongest for older age and longer diabetes duration, greater waist-to-hip ratio (men only), higher blood pressure, higher LDL cholesterol, and smoking. The DCCT therapy group (intensive versus conventional) and HbA1c, measured at the time of the ultrasound or the mean HbA1c during the DCCT, were not significantly related to IMT. Multivariate analyses suggest that age, height, smoking, and BMI were the major predictors of common carotid IMT, whereas age, smoking, and LDL cholesterol predicted internal carotid IMT. There were significant differences between the IMT values of the internal carotid artery in the EDIC male cohort and similarly aged male nondiabetic control subjects. There were no significant differences between the IMT values in the EDIC female cohort and similarly aged female nondiabetic control subjects. At this point in the planned 10-year follow-up of the DCCT cohort, neither intensive therapy nor HbA1c level appears to influence the early signs of atherosclerosis. Traditional risk factors, including age, smoking, and LDL cholesterol, were related to IMT. As the cohort is only now entering the age interval during which rapid progression and clinical expression of atherosclerosis are expected, further follow-up will help to determine the role of hyperglycemia, and its interaction with other risk factors, on the development of atherosclerosis.

Adult↗
PubMed1996

The relationship between socioeconomic status and diabetes control and complications in the EURODIAB IDDM Complications Study.

OBJECTIVE: To determine whether there are socioeconomic differences in diabetes control and complications in people with IDDM. RESEARCH DESIGN AND METHODS: We conducted a prevalence survey of 1,217 men and 1,170 women with IDDM age 25-60 years from European clinics. Age at completion of education defined socioeconomic status: < or = 14 years defined those with primary education; 15-18 years, as secondary education; and > 19 years, as college education. Glycemic control, lipids, diet, retinopathy, neuropathy, and heart disease were assessed centrally. RESULTS: People with a primary education were older and had diabetes for longer than those with a college education. The mean percentage of HbA1c was worst in the primary-educated men (6.6 vs. 6.1%, P = 0.0007 for trend) and women (6.5 vs. 6.0%, P = 0.0007). Total cholesterol level was higher in primary-educated than in college-educated men (5.6 vs 5.3 mmol/l, P = 0.002), as was triglyceride level (1.23 vs. 1.02 mmol/l, P = 0.0001). College-educated people were the least likely to be current smokers (P < 0.0001), and were most likely to partake in vigorous exercise (P < 0.001). Surprisingly, There was little difference in the prevalence of heart disease by educational status in men, while it was highest in the least educated women, but proliferative retinopathy was more common in primary- than in college-educated men (16 vs 10%, P = 0.04) as was macroalbuminuria (15 vs 9%, P = 0.03). Glycemic control could not fully account for these differences. CONCLUSIONS: Healthy lifestyles are more prevalent in better educated men and women with IDDM, but these are not reflected in heart disease prevalence in men. The lower prevalence of severe microvascular complications in better educated men, unaccounted for by better glycemic control, requires further investigation.

Adult↗