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Potential Complications (potential + complications)
Selected AbstractsHair Removal Using a Long-Pulsed Nd:YAG Laser: Comparison at Fluences of 50, 80, and 100 J/cm2DERMATOLOGIC SURGERY, Issue 5 2001David J. Goldberg MD Background. Unwanted hair is a widespread cosmetic problem. Many temporary methods of hair removal have proved unsatisfactory. A variety of laser systems with varying wavelengths, pulse durations, and energy fluences are currently utilized for hair removal. Optimal laser parameters continue to require further investigation. Objective. To evaluate the efficacy and safety of a long-pulse millisecond Nd:YAG hair removal laser utilizing fluences of either 50, 80, or 100 J/cm2. Methods. Fifteen subjects were treated with a contact cooled 50 msec Nd:YAG laser at fluences 30, 50, or 100 J/cm2. Reduction in hair regrowth was measured at 3 months after treatment by comparing the terminal hair count to the baseline values. Potential complications were also evaluated. Results. Average hair reduction at 3 months after treatment was 29%, 29%, and 27% in areas treated with a 50-msec Nd:YAG laser at fluences of 50, 80, and 100 J/cm2, respectively. Although short-term blistering was noted in two subjects, no hyperpimentation, hypopigmentation, or scarring was observed at 3 months after treatment. Conclusion. Long-pulse millisecond Nd:YAG laser hair removal with fluences of either 50, 80, or 100 J/cm2 leads to similar efficacy with no significant adverse effects. [source] Photodynamic therapy with topical 5-aminolevulinic acid as a post-operative adjuvant therapy for an incompletely resected primary nasopharyngeal papillary adenocarcinoma: A case reportLASERS IN SURGERY AND MEDICINE, Issue 5 2006Cheng-Ping Wang MD Abstract Background and Objectives Surgical excision of primary nasopharyngeal papillary adenocarcinoma is sometimes incomplete with remaining microscopic disease. Post-operative radiotherapy only has limited efficacy but may cause many complications. Study Design/Materials and Methods Photodynamic therapy (PDT) was used as a post-operative adjuvant therapy for an incompletely resected primary nasopharyngeal papillary adenocarcinoma. A special form of 20% topical 5-aminolevulinic acid (5-ALA), which was originally a liquid form and became a gel form after applied on the nasopharynx, was used as the photosensitizer. A 2-mm optic fiber delivered the light (633 nm wavelength) to the lesion with a fluence rate of 100 mW/cm2 generated by a diode laser under 5 mm 0° endoscope assistance. The total energy delivered was 150 joules/cm2. Results No significant acute side effect was noted and the nasopharyngeal wound healed rapidly. The patient is alive without locoregional recurrence or distant metastasis for 5 years. Articulation, salivation, and swallowing functions are all well preserved. Conclusion Post-operative adjuvant PDT can successfully cure an otherwise difficult to treat disease with preservation of good life quality of the patient. Potential complications of PDT (e.g., photosensitivity) can be prevented by a special formulation of topical 5-ALA preparation. Lasers Surg. Med. © 2006 Wiley-Liss, Inc. [source] Dietary Supplements in the Setting of Mohs SurgeryDERMATOLOGIC SURGERY, Issue 6 2002Siobhan C. Collins MD background. The use of dietary supplements has become increasingly popular. While many are safe in small doses, others may have potentially harmful effects, particularly in surgical patients. objective. To study the incidence of dietary supplement use in patients presenting for Mohs surgery. methods. One hundred consecutive patients presenting for Mohs surgery completed a questionnaire providing all current medications. During the consultation, the patients were then asked specifically about their current use of any dietary supplements. Responses differing from those on the questionnaire were recorded. results. Forty-nine of 100 patients (49%) were currently taking dietary supplements. Of this group, 17 patients (35%) self-reported the use of supplements; 32 patients (65%) did not. Thirty women (59%) were currently using dietary supplements regularly compared to 19 men (39%). Women were also more likely to self-report the use of supplements compared to men: 14 women (47%) versus three men (15%). Forty-eight of the 100 study patients (48%) were currently taking anticoagulant medications such as aspirin, warfarin, nonsteroidal anti-inflammatory drugs (NSAIDs), or clopidogrel bisulfate. Fifty instances were noted where patients were taking one or more dietary supplements that have demonstrated anticoagulant properties. Of this group, 21 instances (42%) where patients took a combination of prescription and over-the-counter (OTC) anticoagulants and one or more dietary supplements shown to have effects on coagulation were recorded. conclusion. Of the almost 50% of patients taking dietary supplements, one-third reported usage, while two-thirds did not. Women used dietary supplements more frequently than men and were more than three times more likely to offer this information. Furthermore, many supplements have been shown to have effects on coagulation, including vitamin E, garlic, ginkgo, feverfew, and fish oils. Use of these substances alone or in combination may potentiate the anticoagulant effects of each other or prescribed medications. It is therefore important for the dermatologic surgeon to communicate openly with patients regarding dietary supplements to avoid potential complications during or following surgery. [source] Decreased Tear Expression with an Abnormal Schirmer's Test Following Botulinum Toxin Type A for the Treatment of Lateral Canthal RhytidesDERMATOLOGIC SURGERY, Issue 2 2002Seth L. Matarasso MD background. Inactivation of muscles of facial expression by chemodenervation with botulinum toxin remains an off-label indication. Nevertheless, it continues to be a safe and effective technique to improve dynamic rhytides and is the treatment of choice for the hypertrophic lateral fibers of the orbicularis oculi muscle that can cause the superimposed crow's feet. objective. Although infrequent and self-limiting, the complication of unexpected muscle weakness from toxin diffusion or erroneous placement is documented. methods. However, injection into the pretarsal portion of the orbicularis oculi muscle resulting in unilateral ocular irritation and diminished tear expression as evidenced by a dry eye and an abnormal Schirmer's test has rarely been reported. Direct injection into the pretarsal fibers of the muscle as opposed to diffusion of the toxin into the muscle fibers or the lacrimal gland was consistent with the onset of action of the toxin and the prolonged duration of the ocular symptoms. results. Treatment consisted of ocular lubrication until the effects of the toxin dissipated and muscle tone returned. Subsequent treatment did not result in a result in a recurrence of adverse sequelae. conclusions. Facial muscles are small, not isolated, and often have fibers that interdigitate. An important factor in the administration of botulinum toxin is the identification of the muscles responsible for the corresponding rhytide. Precise knowledge of muscular anatomy and function will aid in minimizing this and other potential complications. [source] Does MPA mean ,Major Problem for Assessments'?FISH AND FISHERIES, Issue 4 2006Considering the consequences of place-based management systems Abstract Marine protected areas (MPAs) have been increasingly proposed, evaluated and implemented as management tools for achieving both fisheries and conservation objectives in aquatic ecosystems. However, there is a challenge associated with the application of MPAs in marine resource management with respect to the consequences to traditional systems of monitoring and managing fisheries resources. The place-based paradigm of MPAs can complicate the population-based paradigm of most fisheries stock assessments. In this review, we identify the potential complications that could result from both existing and future MPAs to the science and management systems currently in place for meeting conventional fisheries management objectives. The intent is not to evaluate the effects of implementing MPAs on fisheries yields, or even to consider the extent to which MPAs may achieve conservation oriented objectives, but rather to evaluate the consequences of MPA implementation on the ability to monitor and assess fishery resources consistent with existing methods and legislative mandates. Although examples are drawn primarily from groundfish fisheries on the West Coast of the USA, the lessons are broadly applicable to management systems worldwide, particularly those in which there exists the institutional infrastructure for managing resources based on quantitative assessments of resource status and productivity. [source] Pediatrics Access Problems in hemodialysis with a permanent central venous catheterHEMODIALYSIS INTERNATIONAL, Issue 1 2005J. Muscheites Hemodialysis is a common treatment of chronic renal failure, also in childhood. Due to the high standard of technique there are only few contraindications for this treatment at present. Limitations are given by the vessel access. But in the last years, hemodialysis has been made practicable by the permanent central venous catheter, however, with more problems. As an example for potential complications in the treatment with the permanent catheter we present an unusual case report about a twenty-one- year-old girl suffering from chronic renal failure due to reflux nephropathy, Prader-Willi- syndrome, myelonatrophia of undetermined origin with spastic diplegia of the legs, and increasing sphincter ani dysfunction. We started the renal replacement therapy when the girl was 15 years old. It was not possible to create an AV fistula due to very small vessels. Two Gore-Tex ® implants were clotted in absence of thrombophilia. Afterwards, the hemodialysis was performed by a permanent central venous catheter. The catheter had to be changed 15 times. The reasons for changing the catheter were problems of flow during hemodialysis due to clotting, dislocations, spontaneous removing of the catheter by herself, and infections. Altogether a sepsis occurred four times. The first transplantation failed due to a rupture of the transplanted kidney. A second transplantation was not possible because of the high BMI. Intermittently, the girl was treated with peritoneal dialysis (PD) in the hospital, because the PD couldn't be done at home due to different reasons. Only on weekends could the girl go home. The PD had to be finished after 6 months due to a severe psychotic syndrome. The girl died at age 21, caused by a sepsis following the 15th change of the catheter. A huge problem of frequent catheter changing is the limited availability of vessel accesses , the limits of treatment by hemodialysis. [source] The purse-string suture revisited: a useful technique for the closure of cutaneous surgical woundsINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 4 2007Philip R. Cohen MD The purse-string suture provides complete or partial closure of round postoperative skin defects. It is a rapid and simple procedure to perform. Tension placed on the suture uniformly advances the skin from the entire periphery of the wound, resulting in a significant reduction of the defect size and enhancement of hemostasis at the wound edge. The history, modifications of the technique, advantages, and potential complications of the purse-string suture are reviewed. It is not only useful following the removal of nonmelanoma skin cancer but also after the local excision of melanoma. In addition, this technique is especially suitable for the repair of round surgical wounds for patients who are unable to modify their active lifestyles during the week following surgery, individuals concurrently being treated with anticoagulants, antiplatelet agents or both, and people with extensive postoperative defects that would otherwise require either a skin graft or a large cutaneous flap. Typically, the site of the surgical wound following partial or complete closure with the purse-string suture demonstrates excellent long-term cosmetic and functional results. [source] Smallpox vaccination site complicationsINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 6 2006Kirk H. Waibel MD The typical resolution of the smallpox vaccination site is a smooth scar, a sequela that is discussed during prevaccination counseling. In addition, other types of lesion may develop at the scar site, including short- or long-term benign and malignant changes, as reviewed below. Although current recommendations do not discuss potential scar complications or scar surveillance, healthcare providers would benefit from an awareness of these potential complications, and should consider periodic scar surveillance as part of a general physical examination. [source] How to use laparoscopic surgical instruments safelyINTERNATIONAL JOURNAL OF UROLOGY, Issue 3 2009Eiji Higashihara The development of laparoscopic surgery has been accompanied by a rapid increase in the number of laparoscopic surgical procedures carried out in the field of urology. In 2002 laparoscopic nephrectomy was approved for coverage under Japanese national health insurance, and in 2003 there were over 1000 registered cases in which this procedure was carried out. This suggests that laparoscopic nephrectomy, a procedure formerly conducted at only a few institutions, is now spreading to hospitals across Japan. Laparoscopic surgery involves the use of specialized instruments within a restricted field of vision, and risky surgical techniques can potentially result in visceral or vascular damage. In order to promote the use of safe laparoscopic surgery procedures, the Japanese Urological Association and the Japanese Society of Endourology and Extracorporeal Shock Wave Lithotripsy (ESWL) have inaugurated a certification program for urologic laparoscopy. This program not only encourages development in this field of surgery and provides technical certification to ensure appropriate levels of expertise, but also reviews methods for the correct use of instruments such as trocars and hemostats. The purpose of this video is to present correct methods for the use of a variety of laparoscopic instruments, in order to increase the safety of this procedure. The video has been designed to be useful not only for practitioners who are just beginning laparoscopy, but also for those who already have extensive laparoscopic experience. The video discusses five laparoscopic instruments (trocar, electric surgical devices, ultrasonic surgery devices, clips and clip appliers and endo-staplers), and demonstrates their correct use. In addition, animal models are used to illustrate the potential complications that can be associated with some methods of use. [source] Transcatheter Mitral Valve Repair for Functional Mitral Regurgitation: Coronary Sinus ApproachJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 6 2007NICOLO PIAZZA M.D. Mitral regurgitation has become recognized as an important health problem. More specifically, functional mitral regurgitation is associated with worse outcomes in heart failure, postmyocardial infarction, and perioperative coronary artery bypass surgery patients. Many patients with severe mitral regurgitation are denied or refused mitral valve surgery. A less invasive procedure with possibly fewer potential complications may thus be attractive for patients with severe mitral regurgitation. Devices used for coronary sinus (CS) mitral annuloplasty are directed toward patients with functional mitral regurgitation. Because of its easy accessibility and close relationship to the posterior mitral annulus (MA), alterations of the CS geometry with percutaneous devices may translate to displacement of the posterior annulus and correct mitral leaflet coaptation. This review will focus on the contemporary CS annuloplasty devices: (1) Edwards MONARC system; (2) Cardiac Dimensions CARILLON; and (3) Viacor Shape Changing Rods system. In addition, important information obtained from recent imaging studies describing the relationship between the CS, MA, and coronary arteries will be reviewed. [source] In situ chemical analysis of modern organic tattooing inks and pigments by micro-Raman spectroscopyJOURNAL OF RAMAN SPECTROSCOPY, Issue 9 2008Kelvin W. C. Poon Abstract The chemical composition of tattooing pigments has varied greatly over time according to available technologies and materials. Beginning with naturally derived plant and animal extracts, to coloured inorganic oxides and salts, through to the modern industrial organic pigments favoured in today's tattooing studios. The demand for tattooing is steadily growing as it gains cultural popularity and acceptance in today's society, but ironically, increasing numbers of individuals are seeking laser removal of their tattoos for a variety of reasons. Organic pigments are favoured for tattooing because of their high tinting strength, light fastness, enzymatic resistance, dispersion and relatively inexpensive production costs. Adverse reactions have been reported for some organic inks, as well as potential complications, during laser removal procedures stemming from the unintentional creation of toxic by-products. Currently, regulatory bodies such as the US Food and Drug Administration have not approved any coloured inks to be injected into the skin, and tattoo ink manufacturers often do not disclose the ingredients in their products to maintain proprietary knowledge of their creations. A methodology was established using micro-Raman spectroscopy on an animal model to correctly identify the constituents of a selection of modern, organic tattoo inks in situ or post procedure, within the skin. This may serve as a preliminary tool prior to engaging in Q-switched laser removals to assess the risks of producing potentially hazardous compounds. Likewise, the pigments responsible for causing adverse reactions in some patients may be quickly identified to hasten any corresponding treatment. Copyright © 2008 John Wiley & Sons, Ltd. [source] PHENOPSIS, an automated platform for reproducible phenotyping of plant responses to soil water deficit in Arabidopsis thaliana permitted the identification of an accession with low sensitivity to soil water deficitNEW PHYTOLOGIST, Issue 3 2006Christine Granier Summary ,,The high-throughput phenotypic analysis of Arabidopsis thaliana collections requires methodological progress and automation. Methods to impose stable and reproducible soil water deficits are presented and were used to analyse plant responses to water stress. ,,Several potential complications and methodological difficulties were identified, including the spatial and temporal variability of micrometeorological conditions within a growth chamber, the difference in soil water depletion rates between accessions and the differences in developmental stage of accessions the same time after sowing. Solutions were found. ,,Nine accessions were grown in four experiments in a rigorously controlled growth-chamber equipped with an automated system to control soil water content and take pictures of individual plants. One accession, An1, was unaffected by water deficit in terms of leaf number, leaf area, root growth and transpiration rate per unit leaf area. ,,Methods developed here will help identify quantitative trait loci and genes involved in plant tolerance to water deficit. [source] The treatment of oesophageal varices using a Sengstaken,Blakemore tube: considerations for nursing practiceNURSING IN CRITICAL CARE, Issue 2 2004Teresa Christensen SUMMARY , The Sengstaken,Blakemore tube is slowly becoming the least preferred method for the treatment of oesophageal varices, possibly due to the potential complications that are inherent in its placement , Nursing practice pertaining to the care of this patient group appears ad hoc and reliant on local knowledge and experience, as opposed to recognized evidence of best practice [source] Conservative treatment of L -asparaginase-associated lipid abnormalities in children with acute lymphoblastic leukemia,PEDIATRIC BLOOD & CANCER, Issue 5 2010Hofit Cohen MD Abstract Objective To determine the incidence and clinical consequences of asparaginase-associated lipid abnormalities in children with acute lymphoblastic leukemia (ALL). Methods Sixty-five newly diagnosed children and adolescents aged 0.4,21 years with ALL or lymphoblastic lymphoma were retrospectively evaluated for lipid abnormalities. They were treated according to the ALLIC-BFM 2002 protocol between 2002 and 2005. Fasting cholesterol levels were measured in all patients and triglycerides (TG) in 42/65 patients. Results Prior to treatment, mean cholesterol level was 149,±,50,mg/dl, and increased to maximal level 274,±,124,mg/dl during treatment. Mean TG level during treatment was 459,±,526,mg/dl (range 54,3,009). Twelve patients (28%) had TG levels <200,mg/dl, 18 (43%) had 200,400,mg/dl, 3 (7%) had 400,600,mg/dl, 4 (10%) between 600 and 1,000,mg/dl, and 5 (12%) patients had >1,000,mg/dl. No association was found between TG levels and age or gender. One of the 12 patients with TG >400,mg/dl developed left saggital sinus thrombosis and left frontal lobe infarct. TG level at the time of the event was 2,640,mg/dl. None of the five patients with TG levels >1,000,mg/dl developed pancreatitis. Children with TG levels between 400 and 600,mg/dl were treated by fasting. Fibrates and heparin were added to those with levels >600,mg/dl. Lipid abnormalities normalized in all children upon completion of asparaginase treatment. Conclusions Abnormalities of lipid profile in children with ALL during asparaginase therapy are relatively common. We recommend measuring TG before and during asparaginase treatment. Initiation of conservative treatment could prevent further increase of TG and decrease the risk of potential complications. Pediatr Blood Cancer 2010;54:703,706. © 2010 Wiley-Liss, Inc. [source] Endoscopic laser coagulation of feeding vessels in large placental chorioangiomas: report of three cases and review of invasive treatment optionsPRENATAL DIAGNOSIS, Issue 3 2009Waldo Sepulveda Abstract Objective To report three cases of large placental chorioangiomas managed with endoscopic laser coagulation of the feeding vessels, and review the literature regarding cases of chorioangioma treated with invasive techniques. Methods Intrauterine endoscopic surgery was performed using a 2.5-mm fetoscope under epidural anesthesia. Coagulation of the feeding vessels was attempted with laser energy, and the operation was completed with amniodrainage. Results The feeding vessels were successfully coagulated in one case, resulting in a term delivery. Histopathologic examination of the placenta confirmed a capillary chorioangioma with extensive necrosis. There were intraoperative complications in the other two cases, including bleeding at the site of coagulation requiring intrauterine transfusion in one, and incomplete vascular ablation in the other. In the former case the infant was born prematurely and developed chronic renal insufficiency. In the latter, the fetus died within the first week of the surgery. Conclusions There are limited interventions available for the management of large, symptomatic placental chorioangiomas. Although they can be treated with endoscopic laser coagulation of the feeding vessels, fetal bleeding, exsanguination, and death are potential complications of the procedure; therefore, this technique should be used with caution. The role of this treatment modality in the early devascularization of placental chorioangiomas prior to the development of significant complications warrants consideration. Copyright © 2009 John Wiley & Sons, Ltd. [source] Laryngeal Abscess after Injection Laryngoplasty with Micronized AlloDerm,THE LARYNGOSCOPE, Issue 9 2004Philip E. Zapanta MD Objective: Patients with unilateral vocal cord paralysis usually present with dysphonia and occasionally with swallowing problems. Operative management includes thyroplasty type I, injection laryngoplasty, arytenoid adduction, and reinnervation. Recent publications have documented the safety of micronized AlloDerm (Cymetra, LifeCell Corporation, Branchburg, NJ) for injection laryngoplasty, but we report the first documented case of a laryngeal abscess after injection laryngoplasty with Cymetra. Study Design: Single case report of a laryngeal abscess after injection laryngoplasty with Cymetra. Methods: The patient's clinical course is presented and discussed, and the pertinent literature is reviewed. Results: Prompt hospital admission with intravenous antibiotics and steroids resolved this airway emergency. Follow-up visits showed a significantly improved postoperative voice with an intact airway. Conclusion: A review of the literature reveals that this case of a laryngeal abscess after injection laryngoplasty with Cymetra is the first of its kind. Studies have shown that the use of AlloDerm in the head and neck region is safe, but otolaryngologists need to be cognizant of potential complications when working with this material. [source] High frequency jet ventilation through a supraglottic airway device: a case series of patients undergoing extra-corporeal shock wave lithotripsyANAESTHESIA, Issue 12 2009D. J. Canty Summary High frequency jet ventilation has been shown to be beneficial during extra-corporeal shock wave lithotripsy as it reduces urinary calculus movement which increases lithotripsy efficiency with better utilisation of shockwave energy and less patient exposure to tissue trauma. In all reports, sub-glottic high frequency jet ventilation was delivered through a tracheal tube or a jet catheter requiring paralysis and direct laryngoscopy. In this study, a simple method using supraglottic jet ventilation through a laryngeal mask attached to a circle absorber anaesthetic breathing system is described. The technique avoids the need for dense neuromuscular blockade for laryngoscopy and the potential complications associated with sub-glottic instrumentation and sub-glottic jet ventilation. The technique was successfully employed in a series of patients undergoing lithotripsy under general anaesthesia as an outpatient procedure. [source] Review of imaging of scaphoid fracturesANZ JOURNAL OF SURGERY, Issue 1-2 2010Michael Smith Abstract Scaphoid fractures are the most common fractures of the carpus, accounting for 79% of all carpal fractures. Early diagnosis of scaphoid fractures is imperative owing to potential complications following the fracture, including non-union, avascular necrosis, carpal instability and osteoarthritis. Plain radiography remains the initial imaging modality to assess scaphoid fractures. Magnetic resonance imaging (MRI) is excellent in the detection of clinically suspected, but initially radiographically negative, scaphoid fractures. Cost-effectiveness analysis studies have demonstrated MRI is effective in this setting. Gadolinium enhanced MRI has been shown to be superior to unenhanced MRI in the detection of avascular necrosis. Computerized tomography scan is the preferred modality to assess the intricacies of scaphoid fracture, including fracture location and deformity, as well as union status. This review paper explores the recent advances in imaging of the scaphoid, with reference also to avascular necrosis and non-union following a scaphoid fracture. [source] Lasers in skin resurfacingAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 2 2000Jeffrey S Dover SUMMARY Laser skin resurfacing has revolutionized the approach to facial skin rejuvenation over the last decade. It has also added an approach to managing both atrophic and hypertrophic scars. This paper will review the basic principles of laser skin resurfacing, the different lasers used, the approach to treatment and potential complications of the procedure, followed by a discussion of future prospects in the field. [source] Percutaneous nephrolithotomy with ultrasonography-guided renal access: experience from over 300 casesBJU INTERNATIONAL, Issue 6 2005Mahmoud Osman OBJECTIVE To report our experience with over 300 patients treated with percutaneous nephrolithotomy (PNL), for although PNL was established as a treatment in the 1970s, its use diminished with the introduction of extracorporeal shockwave lithotripsy (ESWL); clinical experience with ESWL showed its limitations, and the role of PNL for treating urolithiasis was redefined, which with improvements in instruments and lithotripsy technology has expanded the capability of percutaneous stone disintegration. PATIENTS AND METHODS The study included 315 patients (156 males, 159 females, aged 13,85 years) treated with PNL in our department between 1987 and 2002. The mean (range) stone diameter was 27 (7,52) mm. The kidney was punctured under ultrasonography guidance via a lower-pole calyx whenever possible. The working channel was dilated using an Alken dilator under X-ray control. If necessary, a flexible renoscope was used. Ultrasonic, pneumatic and laser probes were used for lithotripsy. RESULTS Four weeks after treatment the total stone-free rate was 96.5%; 45.7% of all patients were primarily stone-free, 21.3% had clinically insignificant residual stones that passed spontaneously within 4 weeks after PNL, and 33% of the patients needed auxiliary measures (a second PNL, ESWL, ureterorenoscopy). Overall, the early complication rate was 50.8%, the most common complications being transient fever (27.6%), clinically insignificant bleeding (7.6%) or both (3.2%); 3.5% of the patients developed urinary tract infections (with no signs of urosepsis), 3.2% had renal colic and 2.9% upper urinary tract obstruction. One patient (0.3%) developed acute pancreatitis after PNL; one died from urosepsis and one needed selective angiographic embolization of the punctured kidney due to bleeding. No patient required transfusions and there were no injuries to neighbouring organs. CONCLUSIONS These results show that PNL causes no significant blood loss or major complications in almost all patients. Two aspects may especially reduce the potential complications: ultrasonography-guided renal puncture and using PNL in an experienced centre. PNL is a highly efficient procedure that provides fast and safe stone removal. [source] The Anatomic Relationship of Femoral Vein to Femoral Artery in Euvolemic Pediatric Patients by Ultrasonography: Implications for Pediatric Femoral Central Venous AccessACADEMIC EMERGENCY MEDICINE, Issue 5 2008Fred H. Warkentine MD Abstract Background:, Knowledge of the femoral vein (FV) anatomy in pediatric patients is important in the selection of appropriate size central line catheters as well as the approach to central venous access. This knowledge may avoid potential complications during central line access. Objectives:, To describe the relationship of the FV to the femoral artery (FA). To measure FV diameter and FV depth using ultrasonography (US) in newborns, infants, and children up to 9 years of age. Methods:, This study was a prospective descriptive study at a tertiary care children's hospital. A convenience sample of euvolemic children was enrolled aged 0,9 years presenting to an urban pediatric emergency department. All patients underwent a standardized US evaluation using a Sonosite Titan bedside machine by a single emergency physician. The FA and FV were identified by four criteria: relative positions, FV compressibility, FV enlargement by Valsalva maneuver, and absence of FV pulsatility. The position of the FV relative to the FA was described as being completely overlapped by the FA, having partial (<50%) overlap by the FA, and having no overlap by the FA. The FV depth was measured from the skin to the superior border of the vein using the US machine's caliper function. Results:, A total of 84 patients were studied. The FV was found to be completely overlapped by the FA in 8% of subjects and partially overlapped by the FA in 4% of subjects. The mean FV diameter ranged from 4.5 mm in young infants to 10.8 mm in patients 9 years of age. The mean FV depth ranged from 6.5 mm in neonates to 11.2 mm in patients 9 years of age. Conclusions:, External landmarks were not always predictive of internal anatomy. The FV was completely or partially overlapped by the FA in 12% of cases. Thus, visualization of femoral vessels should be recommended prior to attempting pediatric femoral central venous access. [source] Switching atypical antipsychotics: a reviewACTA NEUROPSYCHIATRICA, Issue 6 2004Pierre Chue Background:, Atypical antipsychotics are increasingly used in the treatment of diverse psychiatric disorders; however, there is little information on the ,why, when, and how' of switching between the different atypical antipsychotics currently available. Objective:, To review the data on switching and atypical antipsychotics. Methods:, A literature search was initially conducted using the key words followed by a search of relevant articles including conference abstracts; relevant pharmaceutical companies were also contacted. Results:, Clinical trial data are limited in terms of parameters measured, and case reports describe specific problems. Few studies are based on real world populations of psychiatric patients over the long-term. Careful patient and drug selections matched to a carefully supervised and appropriate cross titration based upon the pharmacodynamic and pharmacokinetic properties of all of the drugs involved is important to avoid potential complications such as re-emergence or worsening of psychosis and withdrawal, rebound, and emergent phenomena including new or uncovered side-effects. Psychoeducation and involvement of patients and caregivers in the process are also necessary for a successful switch. Conclusion:, Despite the prevalence of switching in real world clinical practice, there is a paucity of data to guide clinicians with respect to effective and safe strategies. There are no criteria defining a successful switch. With the increasing range and formulations of atypical antipsychotics available, there is a rationale for their early use to avoid the practical problems associated with switching from conventional antipsychotics as well as the opportunity to maintain patients on an optimal atypical antipsychotic monotherapy. [source] Clinical decision paths in KPro SurgeryACTA OPHTHALMOLOGICA, Issue 2009G GRABNER Purpose To analyse the currently available methods for treating very severe anterior segment disease, such as stem cell transplantation with amniotic membrane transplantation, lamellar and penetrating keratoplasty techniques, and the different Kpro´s currently available, in regard to the initial clinical findings, the potential complications encountered and the surgical requirements needed for the different techniques. Factors considered are: uni- or bilaterality, limbal stem cell status, dry eye status and availability of healthy teeth. Methods A systematic analysis of surgical options available for different stages of a variety of anterior segment diseases and currently published results of VA and complications Results With a systematic approach it becomes clear that some popular reconstructive surgical techniques should be avoided in cases where a very low chance of success is to be expected (e.g. amniotic membrane and stem cell transplantation and /or PKP in very dry eyes ,> these would have to be treated with OOKP). Conclusion Following a simple the clinical decision path the anterior segment surgeon will be presented with standardized guidelines for treating those patients where conventional surgical procedures have to be avoided and replaced by rather rarely performed KPro techniques. [source] PaCE: a technique to avoid subretinal fluid drainage in retinal detachment surgeryACTA OPHTHALMOLOGICA, Issue 1 2006Manzar Saeed Abstract. Purpose:,Subretinal fluid (SRF) drainage and thus the potential complications of this procedure during scleral buckling can be avoided by inducing SRF absorption preoperatively. The technique described in this series is named PaCE (Pneumatic Cryo Explant). Methods:,A total of 22 eyes of 22 patients with primary bullous rhegmatogenous retinal detachment (RRD) were included in this prospective non-comparative case trial. All satisfied specific inclusion criteria similar to those used in previous pneumatic retinopexy (PR) studies. Under direct visualization, 0.3 ml C3F8 100% was injected into the vitreous cavity through the pars plana. Postoperative posturing was encouraged. Retinopexy with either cryotherapy or laser was performed, combined with scleral buckling (SB) when the SRF was absorbed. Avoidance of SRF drainage and persistent reattachment of the retina at the end of the 12-month follow-up was considered a successful outcome. A change in vision by one line (logMAR) was considered significant. Results:,Resolution of SRF before retinopexy and the SB procedure was achieved in 20 of 22 eyes (90.9%) and hence SRF drainage was not required. Visual improvement was achieved in 95% of cases. One eye (4.5%) lost vision due to a total RD after gas injection (further surgery was not carried out). Conclusion:,PaCE should be considered in any suitable case of primary RRD where SRF drainage is deemed necessary. The potential complications associated with this procedure are relatively less serious and it does not compromise the viability of subsequent procedures. [source] Allergic rhinitis: more than just a stuffy noseACTA PAEDIATRICA, Issue 7 2009Magnus P Borres Abstract Allergic rhinitis is more than just sneezing and an itchy nose. Complications of this disease are numerous and can have a significant impact, both mentally and physically. That is why it is important not only to detect, investigate and treat allergic rhinitis but also to actively identify potential complications. Mental functions such as learning, sleep and activity levels can deteriorate, and the eustachian tubes, sinuses and airway functions can be affected. Otitis, sinusitis and asthma are overrepresented among individuals who suffer from allergic rhinitis. This article highlights how allergic rhinitis can affect cognitive functions, and what consequences this can have on school performance, work and quality of life. Conclusion:, Health professionals and school personnel need to increase their awareness of the ramifications of this disease and actively work to prevent deterioration in both academic achievement and workplace productivity. [source] ANABOLIC AGENTS FOR IMPROVING MUSCLE REGENERATION AND FUNCTION AFTER INJURYCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 7 2008Gordon S Lynch SUMMARY 1In the present review, we describe how muscles can be injured by external factors, internal factors or during the performance of some actions during sports. In addition, we describe the injury to a muscle that occurs when its blood supply is interrupted, an occurrence common in clinical settings. An overview of muscle regeneration is presented, as well as a discussion of some of the potential complications that can compromise successful muscle repair and lead to impaired function and permanent disability. 2Improving muscle regeneration is important for hastening muscle repair and restoring muscle function and the present review describes ways in which this can be achieved. We describe recent advances in tissue engineering that offer considerable promise for treating muscle damage, but highlight the fact that these techniques require rigorous evaluation before they can become mainstream clinical treatments. 3Growth-promoting agents are purported to increase the size of existing and newly regenerating muscle fibres and, therefore, could be used to improve muscle function if administered at appropriate times during the repair process. The present review provides an update on the efficacy of some growth-promoting agents, including anabolic steroids, insulin-like growth factor-I (IGF-I) and b2 -adrenoceptor agonists, to improve muscle function after injury. Although these approaches have clinical merit, a better understanding of the androgenic, IGF-I and b-adrenoceptor signalling pathways in skeletal muscle is important if we are to devise safe and effective therapies to enhance muscle regeneration and function after injury. [source] Clinical complications following thyroid fine-needle biopsy: a systematic reviewCLINICAL ENDOCRINOLOGY, Issue 2 2009Stergios A. Polyzos Summary Thyroid fine-needle biopsy (FNB) is a simple, reliable, inexpensive and generally safe diagnostic procedure in the management of thyroid nodules. Post-FNB local pain and minor haematomas are the most common complications, while serious complications seem to be rare. Given that use of FNB minimizes unnecessary surgery and subsequent operative morbidity and mortality as well as the fact that the majority of FNB complications resolve spontaneously, the overall safety of FNB is not questioned. However, awareness of the potential complications and careful estimation of the risk-benefit ratio in an individual basis may further decrease the low morbidity of FNB. In this systematic review we tried to collect and summarize all reported clinical complications following diagnostic thyroid FNB, aiming to make physicians aware of possible complications and to provide preventive measures to avoid them. [source] Effects of sinus lifting on voice qualityCLINICAL ORAL IMPLANTS RESEARCH, Issue 6 2003A prospective study, risk assessment Abstract: A variety of potential complications associated with sinus lift surgery have been reported in the literature. However, potential alterations of voice quality following sinus elevation have so far not been mentioned or evaluated scientifically. For the majority of patients, slight changes of the voice pattern are of no importance. However, for voice professionals, whose voices have become part of their distinctive profession or trademark, minimal changes may have dramatic consequences. This specific group of patients, such as speakers, actors and singers, depend on the particular quality and timbre of their voice for their livelihood. Consequently, the purpose of this study was to assess the effects of sinus lifting on voice quality in the above patient group. In a collaborative interdisciplinary effort, the Departments of Oral Surgery and Otorhinolaryngology, Section of Phoniatrics and Logopedics, thoroughly evaluated a series of voice parameters of four patients undergoing sinus lifting pre- and postoperatively. The parameters analyzed included pitch, dynamic range, sound pressure level, percent jitter, percent shimmer and noise-to-harmonics ratio with special emphasis on formant analysis. No changes were detected in any of the commonly evaluated parameters. These were rated subjectively by patients and their friends or relatives and objectively with instrumental tools under isolated phoniatric lab conditions. In conclusion, sinus lift surgery appears to be a safe, predictable evidence-based method for regenerating the highly atrophic posterior maxilla, which does not jeopardize the individual characteristic voice pattern of high-profile patients critically dependent on their voices for their livelihood. Résumé Quelques complications potentielles associées à la chirurgie d'épaississement du plancher sinusal ont été rapportées dans la littérature. Les altérations potentielles de la qualité de la voix suivant l'épaississement du plancher sinusal n'ont pas encore été mentionnées et évaluées scientifiquement. Pour la majorité des patients, des petites variations dans le timbre de la voix ne sont pas importantes. Cependant, pour les professionnels de la phonation pour lesquels la voix est devenue une partie importante de leur profession, des variations même faibles peuvent entraîner des conséquences dramatiques. Ce groupe spécifique de patients, tels que les orateurs, les acteurs et les chanteurs dépendent essentiellement de la qualité et du timbre particulier de leur voix dans leur vie professionnelle. Par conséquent, le but de cette étude a été d'estimer les effets d'un épaississement du sinus sur la qualité de la voix dans ce groupe de patients. Dans un effort interdisciplinaire collaboratif, les départements de chirurgie buccale et d'otorhino-laringologie, la section de phonétique et de logopédie ont évalué de manière très précise une série de paramètres de la voix avant et après l'opération chez quatre patients ayant subi un épaississement du sinus maxillare. Les paramètres analysés contenaient la hauteur, l'étalement, le niveau de pression du son, le pourcentage de trac, le pourcentage de chatoiements et la proportion bruit-harmonie avec une insistance spéciale sur l'analyse du formant. Aucun changement n'a été détecté dans aucun des paramètres évalués couramment. Ces derniers étaient estimés subjectivement par les patients et par leurs amis ou parents, et objectivement à l'aide des instruments sous des conditions de laboratoire de phonétique isolé. En conclusion, la chirugie d'épaississement du plancher sinusal semble une méthode sûre, avec un pronostic basé sur l'évidence, permettant de regénérer les maxillaires très atrophiés qui n'empêche pas la caractéristique individuelle de la voix chez des patients avec des profils où la voix est essentielle à leur vie active. Zusammenfassung Der Einfluss einer Sinusbodenelevation auf die Stimmqualität, eine Langzeitstudie und Risikoanalyse. In der Literatur werden eine ganze Reihe von möglichen Komplikationen beschrieben, die bei dem chirurgischen Eingriff der Sinusbodenelevation auftreten können. Veränderungen der Stimme, die als Folge einer Sinusbodenelevation vorkommen können, wurden aber bis heute weder beschrieben, noch wissenschaftlich ausgewertet. Für den Grossteil der Patienten haben leichte Veränderungen der Stimme keine Bedeutung. Für Personen aber, deren Stimme bei der Ausübung ihres Berufes wichtig ist, eventuell ein Teil ihres Berufes oder gar Markenzeichen geworden ist, können kleine Veränderungen dramatische Folgen haben. Diese ausgewählte Gruppe von Patienten, wie zum Beispiel Nachrichtensprecher, Schauspieler oder Sänger, sind im täglichen Leben auf die spezifische Art und den Klang ihrer Stimme angewiesen. Daher war das Ziel dieser Studie, Einflüsse einer Sinusbodenelevation auf die Stimmqualität bei den oben erwähnten Patienten zu untersuchen. In einer interdisziplinären Zusammenarbeit untersuchten die Klinik für Oralchirurgie und Otorhinolaryngologie und die Abteilung für Phonetik und Logopädie an 4 Patienten vor und nach der Sinusbodenelevation sehr eingehend verschiedene Parameter der Stimme. Die untersuchten Parameter waren Tonhöhe, Tonvolumen, den durch den Ton erzeugten Luftdruck, Schwingungen, Vibrationen und das Verhältnis zwischen Nebengeräuschen und harmonischem Klang mit speziellem Augenmerk auf formative Analysen. Man erkannte bei keinem der oben untersuchten Parametern eine Veränderung. Sie wurden sowohl subjektiv durch die Patienten und ihre Freunde oder Verwandten, sowie objektiv mit Messinstrumenten unter absolut schallisolierten Laborbedingungen gemessen. Über die Sinusbodenelevation kann man zusammenfassend sagen, dass es sich um eine sichere, voraussagbare und auf wissenschaftlichen Grundlagen basierende Operationsmethode zum Wiederaufbau einer massiv athrophischen Maxilla im Seitenzahnbereich handelt. Sie gefährdet die individuellen Stimmcharakteristika von kritischen und sehr anspruchsvollen Patienten, die in ihrem täglichen Leben auf ihre charakteristische Stimme angwiesen sind, nicht. Resumen Se han descrito en la literatura una variedad de complicaciones asociadas con la cirugía de la elevación del seno. Pero hasta el momento no se han mencionado ni evaluado científicamente alteraciones potenciales de la calidad de voz tras la elevación del seno. Para la mayoría de los pacientes, pequeños cambios en el patrón de voz no tienen importancia. De todos modos, en los profesionales de la voz, cuyas voces se han convertido en parte distintiva de su profesión o marca, pequeños cambios pueden tener consecuencias dramáticas. Este grupo específico de pacientes, tales como locutores, actores y cantantes, dependen de la calidad particular y timbre de su voz para su sustento. Consecuentemente, el propósito de este estudio fue valorar los efectos de la elevación del seno en la calidad de voz en el anterior grupo de pacientes. En un esfuerzo de colaboración interdisciplinaria, los departamentos de Cirugía Oral y Otorrinolaringología, Sección de Foniatría y Logopedia, evaluaron e profundidad una serie de parámetros de voz de 4 pacientes que se someterían a elevación del seno pre y postoperatoriamente. Los parámetros analizados incluyeron tono, rango dinámico, nivel de presión sonoro, porcentaje de reverberación, porcentaje de tremulación y relación ruido a harmónicos con especial énfasis en el análisis formante. No se detectaron cambios en ninguno de los parámetros evaluados comúnmente. Estos se valoraron subjetivamente por los pacientes y sus amigos o parientes y objetivamente por herramientas instrumentales bajo condiciones de laboratorio de aislamiento foniátrico. En definitiva, la cirugía de elevación del seno parece ser un método seguro, predecible basado en la evidencia para regenerar el maxilar posterior altamente atrófico, que no pone en peligro las características del patrón de voz de los pacientes de características especiales dependientes de manera crítica de sus voces para su sustento. [source] Endoscopic sphenopalatine artery ligation , when, why and how to do it.CLINICAL OTOLARYNGOLOGY, Issue 6 2005An on-line video tutorial Keypoints ,,Endoscopic ligation of the sphenopalatine artery (ESPAL) has recently become the treatment of choice for refractory epistaxis. This paper reviews the background, indications and potential complications of ESPAL. ,,The main focus of this article is an online video tutorial on the anatomy and surgical technique of ESPAL. Web links lead to video clips of operative steps and therefore this paper should be read in front of a computer with access to the internet. ,,To study the techniques the links detailed below should be followed. (For computers running realplayer software the .wmv extension in each of these links should be replaced with the .rm extension.) ,,Incision, http://www.nhsgg.org.uk/content/streams/Figure3.wmv ,,Flap elevation, http://www.nhsgg.org.uk/content/streams/Figure4.wmv ,,Pedicle location, http://www.nhsgg.org.uk/content/streams/Figure5.wmv ,,Clip application, http://www.nhsgg.org.uk/content/streams/Figure6.wmv [source] Morbidity and complications of protective loop ileostomyCOLORECTAL DISEASE, Issue 6 2009G. F. Giannakopoulos Abstract Objective, The creation of a loop ileostomy is considered suitable to protect a distal anastomosis in colorectal surgery. This technique is, however, associated with failure, complications and even mortality. The aim of this study was to quantify retrospectively the morbidity associated with an ileostomy and its subsequent closure. Method, One hundred and nineteen patients with a temporary loop ileostomy, created between January 2000 and July 2007 were retrospectively analysed from a review of patient records. Results, All ileostomies were closed after a median period of 106 days (interquartile range: 69,174 days). Stoma-related morbidity occurred in 23 (19%) patients. After ileostomy closure, 16 major complications were seen in 14 (12%) patients and 43 minor complications occurred in 25 (21%) patients. Sixty-three patients (53%) had neither stoma-related morbidity or peri- or postoperative complications after stoma closure. Conclusion, Protective loop ileostomy was found to be associated with a high morbidity. This raises the question of the mode of identifying the specific patients with a low anastomosis who should be provided an ileostomy for protection, set against the potential complications of the formation and closure of the ileostomy. [source] | |||||||||||||||||||||||||||||||