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Main Complications (main + complications)

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CURRENT STATUS IN THE OCCURRENCE OF POSTOPERATIVE BLEEDING, PERFORATION AND RESIDUAL/LOCAL RECURRENCE DURING COLONOSCOPIC TREATMENT IN JAPAN

DIGESTIVE ENDOSCOPY, Issue 4 2010
Shiro Oka
Bleeding, perforation, and residual/local recurrence are the main complications associated with colonoscopic treatment of colorectal tumor. However, current status regarding the average incidence of these complications in Japan is not available. We conducted a questionnaire survey, prepared by the Colorectal Endoscopic Resection Standardization Implementation Working Group, Japanese Society for Cancer of the Colon and Rectum (JSCCR), to clarify the incidence of postoperative bleeding, perforation, and residual/local recurrence associated with colonoscopic treatment. The total incidence of postoperative bleeding was 1.2% and the incidence was 0.26% with hot biopsy, 1.3% with polypectomy, 1.4% with endoscopic mucosal resection (EMR), and 1.7% with endoscopic submucosal dissection (ESD). The total incidence of perforation was 0.74% (0.01% with the hot biopsy, 0.17% with polypectomy, 0.91% with EMR, and 3.3% with ESD). The total incidence of residual/local recurrence was 0.73% (0.007% with hot biopsy, 0.34% with polypectomy, 1.4% with EMR, and 2.3% with ESD). Colonoscopic examination was used as a surveillance method for detecting residual/local recurrence in all hospitals. The surveillance period differed among the hospitals; however, most of the hospitals reported a surveillance period of 3,6 months with mainly transabdominal ultrasonography and computed tomography in combination with the colonoscopic examination. [source]

Conversion to sirolimus-based immunosuppression in maintenance liver transplantation patients

LIVER TRANSPLANTATION, Issue 5 2007
Isabelle Morard
Sirolimus (SRL) has been proposed to replace calcineurin inhibitors (CNI) in case of CNI-induced toxicity. The aim of this study was to evaluate the efficacy and safety of conversion from CNI to SRL in maintenance liver transplantation (LT) patients. Between 2002 and 2006, conversion was performed in 48 patients (17 female, 31 male; mean age 57 ± 10 yr) after a median delay of 19.4 months (range 0.2,173 months) after LT. Indication for conversion was renal impairment (RI) (78%), CNI neurotoxicity (13%), or post-LT cancer (9%). Median follow-up was 22.6 ± 11 months. Median SRL dosage and trough levels were 2.4 ± 1.3 mg and 8.1 ± 2.7 ,g/L. Immunosuppression consisted of SRL alone (33%), or SRL + mycophenolate mofetil (MMF) (39%), SRL + prednisone (15%), SRL + CNI (4%), or SRL + MMF + prednisone (8%). Mean glomerular filtration rate (GFR) improved from 33 to 48 mL/minute in patients with severe RI (P = 0.022) and from 56 to 74 mL/minute in patients with moderate RI (P = 0.0001). After conversion, main complications were albuminuria (36%), hyperlipidemia (49%), dermatitis (14%), edema (14%), oral ulcers (12%), joint pain (4%), infection (2%), and pneumonia (2%). Acute rejection (AR) occurred in 17% of the patients. SRL was withdrawn in 17% of the patients. In conclusion, conversion from CNI to SRL is safe and is associated with significant renal function improvement. Liver Transpl 13:658,664, 2007. © 2007 AASLD. [source]

A modified intussuscepted nipple in the Kock pouch urinary diversion: assessment of perioperative complications and functional results

BJU INTERNATIONAL, Issue 4 2002
M. 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]

Impact of neurofibromatosis 1 upon quality of life in childhood: a cross-sectional study of 79 cases

BRITISH JOURNAL OF DERMATOLOGY, Issue 4 2009
P. Wolkenstein
Summary Background, Neurofibromatosis 1 (NF1) has a significant impact on quality of life (QoL). Objectives, To evaluate QoL in NF1 according to phenotype from the viewpoint of children and proxy. Methods, One hundred and forty families with a child aged between 8 and 16 years, seen consecutively at the National Academic Paediatric Referral Centre for NF1 for a phenotype evaluation, were contacted by mail. Families agreeing to participate were sent two questionnaires, the DISABKIDS for children and proxy and the cartoon version of the Children's Dermatology Life Quality Index (CDLQI). QoL scores were compared with those in other major diseases and were analysed according to age, gender and phenotype. Results, Eighty families agreed to participate, and 79 returned the questionnaires. Using DISABKIDS, NF1 had a higher impact on health-related QoL than asthma (mean ± SD 75·18 ± 18·22 vs. 79·78 ± 13·41; P = 0·005). The total score was more altered when assessed by proxy than by children (71·20 ± 17·94 vs. 75·18 ± 18·22; P = 0·002). Orthopaedic manifestations, learning disabilities and presence of at least two plexiform neurofibromas were independently associated with a higher impact (P < 0·01). The CDLQI score was slightly altered (11·3%). Dermatological signs, such as café-au-lait spots and freckling, did not have a significant impact. Conclusions, Orthopaedic manifestations, learning disabilities and plexiform neurofibromas are the main complications impacting on QoL during childhood NF1. QoL could be considered as an endpoint for intervention studies in this context. [source]