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Late Complications (late + complications)
Selected AbstractsEarly and Late Complications after a Nonabsorbable Hydrogel Polymer Injection: A Series of 14 Patients and Novel ManagementDERMATOLOGIC SURGERY, Issue 2007OREN GOLDAN MD First page of article [source] Migraine and Raynaud Phenomenon: Possible Late Complications of Kawasaki DiseaseHEADACHE, Issue 3 2002Cris S. Constantinescu MD Migraine and Raynaud phenomenon often coexist and may reflect similar vascular reactions. Both have been associated with vascular endothelial cell dysfunction. Kawasaki disease is a systemic vasculitis of unknown etiology that affects children and may lead to the formation of coronary artery aneurysms. Endothelial cell dysfunction has been demonstrated late in Kawasaki disease and is not restricted to coronary vessels. We report the case of a patient who developed typical migraine with aura and Raynaud phenomenon at the age of 14, 12 years after onset of Kawasaki disease. His migraine responded well to pizotifen, and both migraine and Raynaud phenomenon improved after initiation of treatment with valproic acid. We postulate that both migraine and Raynaud phenomenon in this case represent late consequences of Kawasaki disease and result from extracoronary endothelial dysfunction. [source] Therapeutic targets in the management of Type 1 diabetesDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue S1 2002P. D. Home Abstract For historical reasons, diabetes has long been linked with blood and urine glucose control, partly because these were clearly linked to acute symptoms, and partly because glucose became measurable around 200 years ago. Today it is recognized that there is far more to diabetes than simply monitoring symptoms and blood glucose. Intensive management has an impact on the quality of life. Late complications have their own risk factors and markers. Monitoring and early detection of these risk factors and markers can lead to changes in treatment before tissue damage is too severe. Accordingly, professionals now find themselves monitoring a range of adverse outcomes, markers for adverse outcomes, risk factors and risk markers for microvascular and arterial disease, acute complications of therapy, and the care structures needed to deliver this. Adverse outcomes lend themselves to targets for complication control in populations, and markers of adverse outcomes (such as retinopathy and raised albumin excretion rate) in treatment cohorts. Surveillance systems will have targets for yearly recall and review of early complications. Metabolic (surrogate) outcomes can be monitored in individual patients, but monitoring is only of value in so far as it guides interventions, and this requires comparison to some intervention level or absolute target. Even for blood glucose control this is not easy, for conventional measures such as glycated haemoglobin have their own problems, and more modern approaches such as post-prandial glucose levels are controversial and less convenient to measure. In many people with type 1 diabetes targets for blood pressure, LDL cholesterol, and serum triglycerides will also be appropriate, and need to be part of any protocol of management. Copyright © 2002 John Wiley & Sons, Ltd. [source] Azathioprine or 6-mercaptopurine before colectomy for ulcerative colitis is not associated with increased postoperative complicationsINFLAMMATORY BOWEL DISEASES, Issue 5 2002Uma Mahadevan Abstract Aim To determine whether the use of azathioprine/6-mercaptopurine before colectomy is associated with an increased rate of postoperative complications. Methods All patients who underwent colectomy with ileal pouch,anal anastomosis for ulcerative colitis between 1997 and 1999 were identified. Medical records were abstracted for demographics, extent and duration of disease, dose and duration of corticosteroids and azathioprine/6-mercaptopurine, albumin, and Truelove/Witts score. Early (30-day) and late (6-month) complications were identified. Noncorticosteroid immunosuppressive use was coded as none, azathioprine/6-mercaptopurine within 1 week of surgery, or therapy with other immunosuppressive agents within 1 month of surgery. A logistic regression analysis assessed the association between these variables and complications. Results Early complications occurred in 49 of 151 (32%) patients not treated with immunosuppressive agents, 12 of 46 (26%) azathioprine/6-mercaptopurine-treated patients, and 4 of 12 (33%) patients treated with other immunosuppressive agents (p = 0.71). Late complications occurred in 72 of 148 (49%), 20 of 46 (43%), and 8 of 12 (67%) patients in these same groups, respectively. Intravenous or oral steroids at doses of 40 mg/d or greater (p < 0.01) and severe or fulminant disease (p = 0.0094) were associated with greater early complication rates. Conclusion Early complications after restorative proctocolectomy for ulcerative colitis are associated with high dose steroids and severe disease but not use of azathioprine/6-mercaptopurine. [source] Postoperative morbidity, functional results and quality of life of patients following orthotopic neobladder reconstructionINTERNATIONAL JOURNAL OF UROLOGY, Issue 3 2003Tatsuaki Yoneda Abstract Aim: To evaluate postoperative morbidity, functional results and health-related quality of life of patients with an orthotopic neobladder. Methods: A total of 37 patients with orthotopic neobladder (modified Studer method: 35 cases; Hautmann method: one case; sigmoid neobladder: one case) were included in the present study. Postoperative morbidity and neobladder function were analyzed. To determine quality of life, the Sickness Impact Profile questionnaire was used. The quality of life of patients who underwent orthotopic neobladder was compared with that of patients who underwent ileal conduit. Results: In 37 consecutive patients with neobladder reconstruction, early complications included 10 cases of pyelonephritis (27.0%) and one of stenosis of ureterointestinal anastomosis (2.7%). Two patients died of ARDS and sepsis following peritonitis and pneumonia in the perioperative period. Late complications included pyelonephritis in three patients (8.6%). In 32 cases, except for an early postoperative case and those that died, complete daytime and night-time continence was achieved in 31 patients (96.9%) and 16 patients (50.0%), respectively. Concerning health-related quality of life, the mean sum scores per category of the Sickness Impact Profile were calculated for 32 patients with orthotopic neobladder and 30 patients with ileal conduit. There were no significant differences in overall satisfaction, however, the scores for patients with orthotopic neobladder reconstruction were significantly higher than those for patients with ileal conduit in the three categories of emotions, feelings and sensation, social interaction and recreation. Conclusion: Orthotopic neobladder reconstruction exhibited good functional results with acceptable complications. Patients who underwent neobladder reconstruction were satisfied with their voiding. Assessment of quality of life using the Sickness Impact Profile questionnaire demonstrated that orthotopic neobladder improved their quality of life better than ileal conduit, especially with regard to mental, physical and social functioning in daily life. [source] Experience with the Hansen Robotic System for Atrial Fibrillation Ablation,Lessons Learned and Techniques Modified: Hansen in the Real WorldJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 11 2009OUSSAMA M. WAZNI M.D. Introduction: The Hansen robotic system has only recently been used in the United States for catheter ablation procedures in humans. Atrial fibrillation (AF) ablation may be performed utilizing this system. We report our management of complications with early experience of this system. Methods and Results: All 71 patients in whom the system was utilized were included. In all patients, a 2-operator technique was to be employed; one operator manipulates the ablation catheter via the robot and the other manipulates the circular mapping and intracardiac echocardiogram catheters. There was no procedure-related mortality. All vascular complications occurred in the first 25 procedures performed. There were 6 intraoperative procedural-related complications. These included significant vascular complications (n = 4), one of whom required iliac vein stenting, and 2 cardiac tamponade (one related to a pop-phenomenon),successfully treated by pericardiocentesis. Early complications (n = 3) were 1 tamponade several hours post-procedure, 1 vascular complication, and 1 pericarditis. Late complications included 5 patients with severe pulmonary vein stenosis (all in first 27 patients) and 1 patient with gastroparesis. All complications were successfully managed without persistent morbidity and occurred earlier in our experience. This led to specific alterations in our vascular access and ablation techniques. These include the use of a longer 14 Fr sheath, through which the robotic sheath is more safely advanced. The choice of ablation catheter and titration of power, particularly when the catheter has a perpendicular orientation to the atrial wall, is also important. Conclusions: The suggested modifications may make the system easier to use with the potential to reduce complications. [source] Radical radiotherapy with high-dose-rate brachytherapy for uterine cervix cancer long-term results,JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 6 2007TH Khor Summary The aim of this is to report the results of radical radiotherapy in carcinoma of the cervix treated by high-dose rate (HDR) intracavitary brachytherapy and external beam radiotherapy (XRT) at a single centre in Singapore. This is a retrospective analysis of 106 consecutive cases with histologically proven cervical cancer, treated by HDR brachytherapy and XRT at the Mount Elizabeth Hospital from 1990 to 1993. External beam radiotherapy to the pelvis was delivered with 6 MV photons, to 45,50.4 Gy in 1.8 Gy fractions. High-dose-rate brachytherapy comprised two to three applications of an intrauterine tandem with paired ovoids, to a median dose of 18 Gy to point ,A', carried out during XRT. All 106 patients completed treatment. Their ages ranged from 32 to 80 years (median 57 years). Most patients presented with stage II or III disease (44 and 37%, respectively) and with squamous cell carcinoma (91%). Median follow-up time was 59 months (range 2,169 months). The 5-year relapse-free survival rate across all stages was 71%. The corresponding overall survival rate was 69%. Local control was achieved in 86 patients (81%); six patients had residual disease (6%), and 14 patients had local recurrence (13%). Fourteen patients developed metastatic disease (13%). On univariate analysis, tumour stage, haemoglobin level, number of brachytherapy treatments and overall treatment time were found to be prognostic factors for overall survival. Late complications were mild (Radiation Therapy Oncology Group score 1,2), except for one patient with grade 4 rectal toxicity. The complication rates were 8, 14 and 45%, respectively, for the rectum, bladder and vagina (stenosis). The use of two to three fractions of HDR intracavitary brachytherapy in addition to pelvic XRT achieves good outcomes. [source] Long-term complications in survivors of advanced stage neuroblastoma,PEDIATRIC BLOOD & CANCER, Issue 3 2005Caroline Laverdière MD Abstract Background Few studies have assessed late effects in neuroblastoma (NB) survivors, particularly those with advanced stage disease. Methods Retrospective analysis of a cohort of advanced stage NB survivors followed in a late effect clinic at a single institution. Screening tests to detect late effects were tailored depending on the individual's treatment exposures. Results The study included 63 survivors (31 males). The median age at diagnosis was 3.0 years. The median follow-up from diagnosis was 7.06 years. All patients had surgery and received chemotherapy, 89% received radiation therapy (RT), 62% immunotherapy, and 56% autologous stem cell transplant. Late complications were detected in 95% of survivors and included: hearing loss (62%), primary hypothyroidism (24%), ovarian failure (41% of females), musculoskeletal (19%), and pulmonary (19%) abnormalities. The majority of complications were moderate, with only 4% being life-threatening. Survivors who received cisplatin were at greater risk to develop hearing loss compared to those not so treated (OR 9.74; 95% CI: 0.9,101.6). A total dose of cyclophosphamide greater than 7.4 g was associated with ovarian failure (P,=,0.02). Conclusions Late complications occur frequently in survivors of advanced stage NB. The majority of these problems are of mild-moderate severity. Long-term follow-up (LFTU) and screening of this population is essential. © 2005 Wiley-Liss, Inc. [source] The urethral Kock pouch: long-term functional and oncological results in menBJU INTERNATIONAL, Issue 4 2003A.A. Shaaban The Department of Urology in Mansoura has a well-known experience in, among many things, urinary tract reconstruction in patients with bladder cancer. They review their results in 338 male patients who had a radical cystectomy and Kock pouch. They found good functional and oncological outcomes in properly selected patients. However, they also drew attention to several valve-related complications. OBJECTIVE To evaluate our experience with men who underwent radical cystectomy and urethral Kock pouch construction between January 1986 and January 1996. PATIENTS AND METHODS Complications were classified as early (within the first 3 months after surgery) or late. Continence was assessed by interviewing the patient; they were considered continent if they were completely dry with no need of protection by pads, condom catheter or medication. The patients were followed oncologically and Kaplan-Meier survival curves constructed. Urodynamic studies were used to define the possible causes of enuresis. RESULTS Three patients died after surgery from pulmonary embolism. There were 67 early complications in 63 patients. The mean (sd) follow-up was 87.8 (49.1) months. There were 111 treatment failures from cancer; of these, four men only had an isolated local recurrence in the urethra. Late complications included 72 pouch stones in 55 patients, and 36 deteriorated renal units caused by reflux (17), uretero-ileal stricture (11), nipple valve eversion (four) or stenosis (four). Interestingly, 65 renal units that were dilated before surgery improved significantly afterward. Ileo-urethral strictures occurred in seven men and anterior urethral strictures in six. Nine patients were totally incontinent and two had chronic urinary retention. Daytime continence was complete in 94% of men, with nocturnal enuresis in 55; the latter had significantly more residual urine, and a higher amplitude and duration of phasic contractions. CONCLUSIONS Orthotopic bladder substitution after cystectomy for cancer is feasible, with good functional and oncological outcomes in properly selected patients. Nevertheless, the use of a hemi-Kock pouch is associated with many valve-related complications. [source] Long-term results of orthotopic neobladder reconstruction after radical cystectomyBJU INTERNATIONAL, Issue 6 2003J.N. Kulkarni Objective To assess, in a retrospective study, the long-term results of neobladder reconstruction after radical cystectomy, as this is the standard of care for muscle-invasive bladder cancer. Patients and methods Data were retrieved for all patients with muscle-invasive transitional cell carcinoma of the bladder treated by radical cystectomy and orthotopic neobladder substitution between 1988 and 1998. All perioperative and long-term complications were recorded. The voiding pattern, frequency of micturition and continence were assessed, and a complete urodynamic profile recorded. Results In all, 102 patients underwent radical cystectomy with orthotopic neobladder reconstruction in the study period; their mean (range) follow-up was 73 (36,144) months. Neobladder substitution was with an ileocaecal segment in 35 patients, sigmoid colon in 34 and ileum in 33. Early complications occurred in 32 patients (31%) although open surgical intervention was required in only nine (9%). The death rate after surgery was 3.9%. Late complications occurred in 31 patients (30%) and were primarily caused by uretero-enteric and vesico-urethral strictures (9% each). Most patients had daytime (89%) and night-time (78%) continence. The mean maximum pouch capacity (mL) and pouch pressure at capacity (cmH2O) were 562.5 and 23 (ileocaecal), 542 and 17.8 (sigmoid) and 504 and 19.1 (ileal), respectively; the mean postvoid residual was 29, 44 and 23 mL, respectively. Nine patients with ileocaecal neobladders, and 20 and seven with sigmoid and ileal neobladders, required clean intermittent catheterization. Twenty-four patients had recurrence of disease, of whom 20 died. Conclusions Orthotopic neobladder reconstruction requires complex surgery but has an acceptable early and late complication rate in properly selected patients. It provides satisfactory continence without compromising cure rates. [source] A modified intussuscepted nipple in the Kock pouch urinary diversion: assessment of perioperative complications and functional resultsBJU INTERNATIONAL, Issue 4 2002M. Soulié Objective ,To assess the complications and continence of a modified intussuscepted nipple in Kock pouch urinary diversions. Patients and methods ,From February 1992 to December 2000, 40 patients (mean age 55.8 years, range 21,74) with bladder cancer (24), gynaecological tumours (eight) or previous lower tract reconstructive surgery (eight) underwent cystectomy and cutaneous continent urinary diversion using the Kock pouch procedure. The first 23 procedures (group I) used Henriet's technique, whereas a modified fixation of the intussuscepted efferent limb was applied in the last 17 (group II). Complications and functional results (focused on continence and the upper urinary tract) were reviewed. Results ,The median (range) follow-up was 47.6 (10,124) months; one patient died 4 weeks after surgery. Early complications occurred in 11 (28%) and re-operation was required in two (5%). Of the late complications reported (38%), extussusception (8%) and efferent nipple prolapse (3%) only occurred in group I and required surgical revision. Late complications were minor (15%) including two asymptomatic refluxes and four with stoma sclerosis. The continence rate at 6 months in groups I and II were 78% and 94%, respectively ( P = 0.13). Conclusion ,Efferent limb prolapse and extussusception of the Kock pouch were the main complications requiring surgical revision. Applying the modified nipple fixation the complications can be reduced and reservoir continence improved. [source] Late complications after ligation and bypass for popliteal aneurysm,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 2 2004U. J. Kirkpatrick Background: Ligation and bypass is standard treatment for popliteal aneurysm. This technique does not abolish collateral circulation to the aneurysm, which may continue to expand and/or rupture. This study assessed whether complete thrombosis of the aneurysm sac occurs after operation and examined the long-term clinical outcome. Methods: The records of all patients who underwent popliteal aneurysm repair in a university hospital over 10 years were reviewed. Patients who had undergone ligation and bypass were recalled for clinical and ultrasonographic examination to determine the fate of the aneurysm sac. Results: Persistent blood flow in the aneurysm sac was present in 12 of 36 legs a median of 48 months after operation. This was associated with symptomatic enlargement of the aneurysm in six patients. The incidence of sac enlargement was lower in bypassed aneurysms with no intrasac flow on duplex examination. Conclusion: Ligation and bypass does not always abolish blood flow in the sac of a popliteal aneurysm. It may be associated with continued expansion and late complications. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Delayed ocular complications of mustard gas poisoning and the relationship with respiratory and cutaneous complicationsCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 4 2006Mohammad Etezad-Razavi MD Abstract Background:, This study was aimed to determine the correlation between ocular complications and respiratory or cutaneous complications in a group of 40 Iranian veterans with late complications of sulphur mustard (SM) poisoning. Methods:, Thorough ophthalmologic examination was performed on all severely SM-poisoned veterans in the province of Khorasan, Iran. Spirometric evaluation of pulmonary function, as well as estimation of the burned skin area, was performed for all the patients. The severities of ocular, respiratory and cutaneous complications were classified into four grades in each patient and were compared with each other, using Spearman's rank correlation test. Results:, Forty male patients (aged 43.8 ± 9.8 years) with confirmed SM poisoning were studied 16,20 years after their initial exposure. Common symptoms were recorded as itching (42.5%), burning sensation (37.5%), photophobia (30%) and tearing (27.5%). Abnormal conjunctival and limbal findings were chronic conjunctivitis (17.5%), perilimbal hyperpigmentation (17.5%), vascular tortuosity (15%) and limbal ischaemia (12.5%). Abnormal corneal findings were subepithelial opacity (15%), corneal thinning (15%), diffuse corneal opacity (10%), neovascularization (7.5%) and epithelial defects (5%). A significant positive correlation was found between the severity of ocular and respiratory complications (r = 0.322, P = 0.043). Cutaneous complications revealed no significant correlation with either ocular or respiratory complications. Conclusions:, SM causes delayed destructive lesions in the ocular surface and cornea, leading to progressive visual deterioration and ocular irritation. Late complications of SM poisoning in the eyes, respiratory system and skin are mainly due to SM's local irritant effects. [source] Recurrent gastroesophageal reflux in neurologically impaired patients after fundoplicationACTA PAEDIATRICA, Issue 1 2007A Goessler Abstract Goessler A, Huber-Zeyringer A, Hoellwarth M.E. "Recurrent gastroesophageal reflux in neurologically impaired patients after fundoplication." Acta Paediatr 00, Stockholm. ISSN 0803-5253. Aim: To evaluate the outcome and analyse the main causes of complications and failures of antireflux surgery for gastroesophageal reflux disease (GERD) in neurologically impaired patients (NIP). Methods: From 1985 to 1999 44 NIP (mean age 12 years) underwent surgery for GERD. Type of surgery, complications and recurrent reflux were analysed. Results: Twenty-seven patients (61%) showed preoperatively severe failure to thrive. All patients showed pathologic results in 24-h pH monitoring. Surgical treatment consisted of ventral (n = 25, Thal) or dorsal (n = 4, Toupet) semifundoplication or a Nissen fundoplication (n = 15). Postoperatively, all patients showed an impressive growth, regress of symptoms and improvement of results of diagnostic investigations. Late complications and recurrence of reflux were significantly related to preoperative extreme dystrophy (p < 0.0025). In six patients (15%) severity of symptoms related to recurrent reflux required a reoperation 17.8 month postoperatively (range 8,35 month). Recurrent reflux was found in 40% after ventral semifundoplication and in 46% after Nissen fundoplication (8 and 47 months postoperatively, respectively). Conclusion: Symptoms improved impressively after fundoplication in mentally retarded children. The incidence of recurrent reflux is not related to the type of surgery, however, it occurs significantly earlier with ventral semifundoplication when compared with Nissen fundoplication. Both late complications as well as recurrent reflux are related significantly to preoperative dystrophy. [source] The role of taurine in diabetes and the development of diabetic complicationsDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 5 2001Svend Høime Hansen Abstract The ubiquitously found ,-amino acid taurine has several physiological functions, e.g. in bile acid formation, as an osmolyte by cell volume regulation, in the heart, in the retina, in the formation of N -chlorotaurine by reaction with hypochlorous acid in leucocytes, and possibly for intracellular scavenging of carbonyl groups. Some animals, such as the cat and the C57BL/6 mouse, have disturbances in taurine homeostasis. The C57BL/6 mouse strain is widely used in diabetic and atherosclerotic animal models. In diabetes, the high extracellular levels of glucose disturb the cellular osmoregulation and sorbitol is formed intracellularly due to the intracellular polyol pathway, which is suspected to be one of the key processes in the development of diabetic late complications and associated cellular dysfunctions. Intracellular accumulation of sorbitol is most likely to cause depletion of other intracellular compounds including osmolytes such as myo -inositol and taurine. When considering the clinical complications in diabetes, several links can be established between altered taurine metabolism and the development of cellular dysfunctions in diabetes which cause the clinical complications observed in diabetes, e.g. retinopathy, neuropathy, nephropathy, cardiomyopathy, platelet aggregation, endothelial dysfunction and atherosclerosis. Possible therapeutic perspectives could be a supplementation with taurine and other osmolytes and low-molecular compounds, perhaps in a combinational therapy with aldose reductase inhibitors. Copyright © 2001 John Wiley & Sons, Ltd. [source] Simultaneous cytological diagnosis of herpes simplex virus infection and primary lung cancer: Report of two casesDIAGNOSTIC CYTOPATHOLOGY, Issue 11 2008Nicoletta Maounis M.D., Ph.D. Abstract Herpes simplex is an uncommon cause of lower respiratory tract infection that requires prompt diagnosis and treatment to prevent late complications. We report two cases with simultaneous herpes simplex virus infection of the lower respiratory tract and lung carcinoma. Cytology of bronchial brushing and washing fluids and postbronchoscopic sputum established the diagnosis, which was further corroborated by real-time polymerase chain reaction. Diagn. Cytopathol. 2008;36:818,822. © 2008 Wiley-Liss, Inc. [source] LONG-TERM OUTCOME OF ENDOSCOPIC PAPILLOTOMY FOR CHOLEDOCHOLITHIASIS WITH CHOLECYSTOLITHIASISDIGESTIVE ENDOSCOPY, Issue 2 2010Tatsuya Fujimoto Aim:, To assess long-term outcome of endoscopic papillotomy alone without subsequent cholecystectomy in patients with choledocholithiasis and cholecystolithiasis. Methods:, Retrospective review of clinical records of patients treated for choledocholithiasis and cholecystolithiasis from 1976 to 2006. Of 564 patients subjected to endoscopic papillotomy and endoscopic stone extraction, 522 patients (279 men, 243 women; mean age 66.2 years) were followed up and predisposing risk factors for late complications were analyzed. Results:, The mean duration of follow up was 5.6 years. Cholecystitis and recurrent choledocholithiasis occurred in 39 (7.5%) and 60 (11.5%) patients, respectively. Cholecystitis, including one severe case, resolved with conservative treatment. Recurrent choledocholithiasis was successfully treated endoscopically except in one case. Pneumobilia was found to be a significant risk factor for cholecystitis (P = 0.019) and recurrent choledocholithiasis (P = 0.013). Biliary tract cancer occurred in 16 patients; gallbladder cancer in 13 and bile duct cancer in three. Gallbladder cancer developed within 2 years after endoscopic papillotomy in seven of the 13 patients (53.8%). Conclusion:, Pneumobilia was the only significant risk factor for cholecystitis and recurrent choledocholithiasis in our study population. As for the long-term outcome, it was unclear whether endoscopic papillotomy contributed to the occurrence of biliary tract cancer. [source] Report from the Rockefellar Foundation Sponsored International Workshop on reducing mortality and improving quality of life in long-term survivors of Hodgkin's disease: July 9,16, 2003, Bellagio, ItalyEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 2005Peter Mauch Abstract:, A workshop, sponsored by the Rockefellar Foundation, was held between 9 to 16 July, 2003 to devise strategies to reduce mortality and improve quality of life of long-term survivors of Hodgkin's disease. Participants were selected for their clinical and research background on late effects after Hodgkin's disease therapy. Experts from both developed and developing nations were represented in the workshop, and efforts were made to ensure that the proposed strategies would be globally applicable whenever possible. The types of late complications, magnitude of the problem, contributing risk factors, methodology to assess the risk, and challenges faced by developing countries were presented. The main areas of late effects of Hodgkin's disease discussed were as follows: second malignancy, cardiac disease, infection, pulmonary dysfunction, endocrine abnormalities, and quality of life. This report summarizes the findings of the workshop, recommendations, and proposed research priorities in each of the above areas. [source] Treatment results of 1070 patients with nasopharyngeal carcinoma: An analysis of survival and failure patternsHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 7 2005To-Wai Leung FRCR Abstract Background. The aim of this analysis was to evaluate the outcomes of patients with nasopharyngeal carcinoma (NPC) treated primarily by external beam irradiation (ERT) and to explore for possible ways to improve the treatment results. Methods. One thousand seventy patients with nonmetastatic NPC treated from 1990 to 1998 were retrospectively analyzed. The distribution according to the Union Internationale Contre le Cancer (UICC) (1997 edition) staging system at initial diagnosis was as follows: stage I, n = 113; stage IIA, n = 38; stage IIB, n = 360; stage III, n = 306; stage IVA, n = 136; stage IVB, n = 117; T1, n = 284; T2a, n = 88; T2b, n = 398; T3, n = 149; T4, n = 151; N0, n = 321; N1, n = 393; N2, n = 238; N3a, n = 29; N3b, n = 89. Two hundred eight patients were given neoadjuvant chemotherapy. Ninety-seven patients were diagnosed with locally persistent disease and were salvaged with high dose rate intracavitary brachytherapy. Multivariate analysis was performed with the Cox regression proportional hazards model. Results. The 5-year actuarial local failure,free survival, regional failure,free survival, distant metastasis,free survival, progression-free survival, cancer-specific survival, and overall survival rates were 80.9%, 93.3%, 77.2%, 62.7%, 71.4%, and 66.5%, respectively. Isolated distant metastasis occurred in 191 patients (18%). The distributions were as follow: stage I, 2.1% (two of 95); stage IIA, 5.7% (two of 35); stage IIB, 14.9% (45 of 302); stage III, 26.4% (62 of 235); stage IVA, 40% (40 of 100); stage IVB, 47.1% (40 of 85). Results of the multivariate analysis of various clinical endpoints were discussed. By studying these failure patterns, it is hoped that we could refine future treatments according to the failure patterns of patients with different risks of locoregional and distant failure. Conclusions. The 18% incidence of isolated distant metastasis is too high to be ignored. Maximizing the local control and minimizing the risk of distant metastasis and late complications should be the key objectives in designing future clinical trials. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Coarctation of the Aorta: A Secondary Cause of HypertensionJOURNAL OF CLINICAL HYPERTENSION, Issue 6 2004L. Michael Prisant MD Coarctation of the aorta is a constriction of the aorta located near the ligamentum arteriosum and the origins of the left subclavian artery. This condition may be associated with other congenital disease. The mean age of death for persons with this condition is 34 years if untreated, and is usually due to heart failure, aortic dissection or rupture, endocarditis, endarteritis, cerebral hemorrhage, ischemic heart disease, or concomitant aortic valve disease in uncomplicated cases. Symptoms may not be present in adults. Diminished and delayed pulses in the right femoral artery compared with the right radial or brachial artery are an important clue to the presence of a coarctation of the aorta, as are the presence of a systolic murmur over the anterior chest, bruits over the back, and visible notching of the posterior ribs on a chest x-ray. In many cases a diagnosis can be made with these findings. Two-dimensional echocardiography with Doppler interrogation is used to confirm the diagnosis. Surgical repair and percutaneous intervention are used to repair the coarctation; however, hypertension may not abate. Because late complications including recoarctation, hypertension, aortic aneurysm formation and rupture, sudden death, ischemic heart disease, heart failure, and cerebrovascular accidents may occur, careful follow-up is required. [source] Management of refractory ascites and hepatorenal syndromeJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 4 2002Anuchit Chutaputti Abstract, Refractory ascites and hepatorenal syndrome (HRS) are the late complications of the terminal stages of cirrhosis. The definitions of refractory ascites and HRS proposed by the International Ascites Club in 1996 are now widely accepted, and are useful in diagnosis, treatment and research in this field. In both conditions, the only treatment of proven value for improved survival is liver transplantation. However, because of better understanding about the pathophysiology of HRS, including the roles of portal hypertension, ascites formation and hemodynamic derangements, treatments such as transjugular intrahepatic portasystemic shunt (TIPS) and new pharmacological agents may be considered to alleviate the problem prior to transplantation. Symptomatic treatment of refractory ascites includes TIPS and repeated large volume paracentesis. Transjugular intrahepatic portasystemic shunt can improve survival while waiting for liver transplantation. Practical management guidelines for TIPS and large volume paracentesis, including the prevention and management of further complications, are considered in this review. © 2002 Blackwell Publishing Asia Pty Ltd [source] Radiation-induced brain disorders in patients with pituitary tumoursJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 3 2004A Bhansali Summary Radiation-induced brain disorders (RIBD) are uncommon and they are grave sequelae of conventional radiotherapy. In the present report, we describe the clinical spectrum of RIBD in 11 patients who received post-surgery conventional megavoltage irradiation for residual pituitary tumours. Of these 11 patients (nine men, two women), seven had been treated for non-functioning pituitary tumours and four for somatotropinomas. At the time of irradiation the age of these patients ranged from 30 to 59 years (mean, 39.4 ± 8.3; median, 36) with a follow-up period of 6,96 months (mean, 18.3 ± 26.4; median, 11). The dose of radiation ranged from 45 to 90 Gy (mean, 51.3 ± 13.4; median, 45), which was given in 15,30 fractions (mean, 18.6 ± 5.0; median, 15) with 2.8 ± 0.3 Gy (median, 3) per fraction. The biological effective dose calculated for late complications in these patients ranged from 78.7 to 180 Gy (mean, 99.1 ± 27.5; median, 90). The lag time between tumour irradiation and the onset of symptoms ranged from 6 to 168 months (mean, 46.3 ± 57.0; median, 57). The clinical spectrum of RIBD included new-onset visual abnormalities in five, cerebral radionecrosis in the form of altered sensorium in four, generalized seizures in four, cognitive dysfunction in five, dementia in three and motor deficits in two patients. Magnetic resonance imaging (MRI)/CT of the brain was suggestive of radionecrosis in eight, cerebral oedema in three, cerebral atrophy in two and second neoplasia in one patient. Associated hormone deficiencies at presentation were hypogonadism in eight, hypoadrenalism in six, hypothyroidism in four and diabetes insipidus in one patient. Autopsy in two patients showed primitive neuroectodermal tumour (PNET) and brainstem radionecrosis in one, and a cystic lesion in the left frontal lobe following radionecrosis in the other. We conclude that RIBD have distinctive but varying clinical and radiological presentations. Diabetes insipidus and PNET as a second neoplastic disorder in adults following pituitary irradiation have not been reported previously. [source] Retrospective study of indications for and outcome of perineal urethrostomy in catsJOURNAL OF SMALL ANIMAL PRACTICE, Issue 5 2005M. Bass Objectives: To evaluate indications for and outcome of perineal urethrostomy in cats. Methods: The medical records of 59 cats that had undergone perineal urethrostomy were evaluated. Short-term follow up information (for a period of four weeks following surgery) was available for all of the cats. Long-term follow up information (for a period of at least four months) was available for 39 cats. Results: Early complications occurred in 25.4 per cent of cats and late complications were observed in 28.2 per cent of cats. The most frequent late complication was recurring bacterial urinary tract infection. Clinical Significance: Despite frequent complications and recurring signs of lower urinary tract disease, 32.2 per cent of the cats had a disease-free long-term outcome (mean four years, median 3.9 years), and 88.6 per cent of clients interviewed thought that their cats had a good quality of life after surgery. [source] Retransplantation for late liver graft failure: Predictors of mortalityLIVER TRANSPLANTATION, Issue 2 2000Marcelo Facciuto As patient survival after orthotopic liver transplantation (OLT) improves, late complications, including late graft failure, more commonly occur and retransplantation (re-OLT) is required more often. Survival after re-OLT is poorer than after primary OLT, and given the organ shortage, it is essential that we optimize our use of scarce donor livers. We sought to identify variables that predict poor outcome after late re-OLT. Among adults who underwent OLT between September 1989 and October 1997, we identified transplant recipients who survived greater than 6 months (n = 964) and analyzed those who required late re-OLT (,6 months after primary OLT). We recorded the indication for the initial OLT and interval from OLT to re-OLT. We also analyzed data collected at the time of re-OLT, including age, sex, indications for primary OLT and re-OLT, United Network for Organ Sharing status, preoperative laboratory values (white blood cells, platelets, hemoglobin, albumin, bilirubin, creatinine, and prothrombin time), Child-Pugh-Turcotte score, number of rejection episodes before re-OLT, and interval between OLT and re-OLT. In addition, we analyzed surgical factors (including procedure performed and use of packed red blood cells, fresh frozen plasma, and platelets), postoperative immunosuppression, and donor factors (age, ischemic time). Forty-eight patients (5%) underwent late re-OLT at a median of 557 days (range, 195 to 2,559 days) post-OLT. Survival rates after re-OLT at 90 days, 1 year, and 5 years were 71%, 60%, and 42%, respectively. Patients surviving 90 days or greater after re-OLT had an 85% chance of surviving to 1 year. Sepsis was the leading cause of death (15 of 25 deaths; 60%). Recipient age older than 50 years (P = .04), preoperative creatinine level greater than 2 mg/dL (P = .004), and use of intraoperative blood products (packed red blood cells, P = .001; fresh frozen plasma, P = .002; platelets, P = .004) had significant impacts on survival. Late re-OLT was associated with increased mortality. Careful patient selection, with particular attention to recipient age and renal function, may help improve results and optimize our use of scarce donor livers. [source] Prevention of lymphatic injuries in surgeryMICROSURGERY, Issue 4 2010Boccardo Francesco M.D. Background: The problem of prevention of lymphatic injuries in surgery is extremely important if we think about the frequency of both early complications such as lymphorrhea, lymphocele, wound dehiscence, and infections and late complications such as lymphangites and lymphedema. Nowadays, it is possible to identify risk patients and prevent these lesions or treat them at an early stage. This article helps to demonstrate how it is important to integrate diagnostic and clinical findings to better understand how to properly identify risk patients for lymphatic injuries and, therefore, when it is useful and proper to do prevention. Methods: Authors report their experiences in the prevention and treatment of lymphatic injuries after surgical operations and trauma. After an accurate diagnostic approach, prevention is based on different technical procedures among which microsurgical procedures. It is very important to follow-up the patient not only clinically but also by lymphoscintigraphy. Results and Conclusions: It was identified a protocol of prevention of secondary limb lymphedema that included, from the diagnostic point of view, lymphoscintigraphy and, as concerns therapy, it also recognized a role to early microsurgery. It is necessary to accurately follow-up the patient who has undergone an operation at risk for the appearance of lymphatic complications and, even better, to assess clinically and by lymphoscintigraphy the patient before surgical operation. © 2010 Wiley-Liss, Inc. Microsurgery, 2010. [source] Significance of Postoperative Arrhythmias in Congenital Heart DiseasePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2008JOLIEN W. ROOS-HESSELINK M.D., Ph.D. The survival of patients with congenital heart disease (CHD) has increased immensely and nowadays, most children reach adulthood. The long-term outcome is hampered by the occurrence of late complications such as arrhythmias. Supraventricular and ventricular arrhythmias have an impact notably not only on morbidity but also on mortality in patients with congenital heart disease. Therefore, life-long follow-up in most of these patients is required. [source] Delayed Complications Following Pacemaker ImplantationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2002KENNETH A. ELLENBOGEN ELLENBOGEN, K.A., et al.: Delayed Complications Following Pacemaker Implantation. Acute complications resulting from permanent pacemaker implantation are well known and include perforation of the right atrium or right ventricle. Recently, several reports have described the occurrence of perforation and pericarditis as late complications following pacemaker implantation. These complications may occur days to weeks following uncomplicated pacemaker implantation and may lead to death if they are not recognized early. Five patients with late complications caused by active-fixation leads are reported and the clinical features of their presentation and management are reviewed. Late perforation of the right atrium or right ventricle is an uncommon complication after pacemaker implantation but should be suspected by the general cardiologist in a patient who has a device implanted within a week to several months prior to the development of chest pain. [source] Permanent Pacemaker Therapy Before and After the Reunification of Germany: 16 Years of Experience at an East German Regional Pacing CenterPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 6 2000P. KARNATZ The reunification of Germany had a significant influence on the management of patients with bradyarrhythmias. The current study was performed in a regional pacing center heated in the former German Democratic Republic. It compares the situation of patients with critical bradyarrhythmias before and after the reunification of Germany in 1990 focusing on (1) indication for pacemaker implantation. (2) pacemaker modalities and function, (3) type of leads, (4) frequency of reintervention, and (5) early and late complications. The study covers 9 years before and 7 years after the reunification. A total of 1,125 patients were included, and the database was formed by the patients' files and the protocols of implantation. The situation before reunification was characterized by a nonavailability of modern physiological pacing devices and insufficient diagnostic equipment. Between 1981 and 1990, 384 patients underwent pacemaker implantation solely receiving single chamber devices with no or only minimal feasibility of programming. Between 1990 and 1996, 741 patients were treated, and they all received modern pacemakers having the capability of multiprogramming and telemetry. Regarding complications of pacemaker therapy, lead related problems significantly decreased after the reunification (dislocation, 5.3% vs 1.7%, P < 0.05; exit block, 6.7% vs 1.4%. P < 0.05) opposite to pacemaker infections, which significantly increasing after dual chamber pacemakers were implanted (2.2% vs 6.0%, P < 0.05). The reunification of Germany dramatically improved the situation of patients with critical bradyarrhythmias leading to free access to high-tech pacing equipment within a few months. However, the abrupt change from antiquated to modern pacemaker therapy created some new problems, especially regarding application and handling of modern physiological pacing devices. [source] Reduced intensity and non-myeloablative allogeneic stem cell transplantation in children and adolescents with malignant and non-malignant diseasesPEDIATRIC BLOOD & CANCER, Issue 1 2008Prakash Satwani MD Abstract Allogeneic hematopoietic stem cell transplant (AlloSCT) from related or unrelated histocompatible donors has been well established as potentially curative therapy for children and adolescents with selected malignant and non-malignant diseases. In the malignant setting non-myeloablative (NMA)/reduced intensity (RI)-AlloSCT eradicates malignant cells through a graft versus malignancy effect provided by alloreactive donor T-lymphocytes and/or natural killer cells. In patients with non-malignant diseases NMA/RI AlloSCT provides enough immunosuppression to promote engraftment and correct underlying genetic defects. In children, myeloablative AlloSCT is not only associated with acute short-term toxicities but also long-term late complications such as growth retardation, infertility, and secondary malignancies. NMA/RI-AlloSCT in children may be associated with reduction in use of blood products, risk of infections, transplant-related mortality, and length of hospitalization. Despite the success of RI-AlloSCT in adults, large prospective and/or randomized multicenter studies are necessary in children and adolescent recipients to define the appropriate patient population, optimal conditioning regimens, cost-benefits, survival and differences in short-term and long-term effects compared to conventional myeloablative conditioning. Pediatr Blood Cancer 2008;50:1,8. © 2007 Wiley-Liss, Inc. [source] Conservative treatment of spontaneous tracheal rupturePEDIATRIC PULMONOLOGY, Issue 7 2006Ahmet Akyol MD Abstract Spontaneous tracheobronchial ruptures are uncommon injuries, especially in the pediatric age group. Tracheal injuries, independent of their origin, may be life-threatening. Here we present the first report of a 14-year-old boy who presented with subcutaneous emphysema, pneumomediastinum, and pneumothorax on day 3, due to spontaneous posterior tracheal-wall rupture following paroxysmal productive coughing. The diagnosis was established using a computed tomography scan of the chest, and tracheobronchoscopy and esophagoscopy under general anesthesia. He was endotracheally intubated and ventilated in the intensive care unit. Such tracheal defects, bridgeable by an endotracheal tube, may permit conservative treatment. The patient was discharged on day 10, and follow-up revealed no late complications. Pediatr Pulmonol. 2006; 41: 690,693. © 2006 Wiley-Liss, Inc. [source] | |||||||||||||||||||||||||||||||