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Serious Complications (serious + complications)
Selected AbstractsCyclophosphamide in treatment of systemic lupus erythematosus: 7 years' experienceINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 1 2003P. H. Feng Summary This paper describes our experience with cyclophosphamide in the treatment of systemic lupus erythematosus. Since 1965, 42 such patients have been treated either singly with cyclophosphamide or in combination with steroid. Serious complications have been rare except for amenorrhoea, which occurred in 14 out of 32 patients within the reproductive period. Our experience suggests that cyclophosphamide has an important, though not primary, part to play in the therapy of this disease. [source] Nutritional factors associated with survival following enteral tube feeding in patients with motor neurone diseaseJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 4 2010A. Rio Abstract Background: Motor neurone disease (MND) is a progressive neurodegenerative disease leading to limb weakness, wasting and respiratory failure. Prolonged poor nutritional intake causes fatigue, weight loss and malnutrition. Consequently, disease progression requires decisions to be made regarding enteral tube feeding. The present study aimed to investigate the survival, nutritional status and complications in patients with MND treated with enteral tube feeding. Methods: A retrospective case note review was performed to identify patients diagnosed with MND who were treated with enteral tube feeding. A total of 159 consecutive cases were identified suitable for analysis. Patients were treated with percutaneous endoscopic gastrostomy (PEG), radiologically inserted gastrostomy (RIG) or nasogastric feeding tube (NGT). Nutritional status was assessed by body mass index (BMI) and % weight loss (% WL). Serious complications arising from tube insertion and prescribed daily energy intake were both recorded. Results: Median survival from disease onset was 842 days [interquartile range (IQR) 573,1263]. Median time from disease onset to feeding tube was PEG 521 days (IQR 443,1032), RIG 633 days (IQR 496,1039) and NGT 427 days (IQR 77,781) (P = 0.28). Median survival from tube placement was PEG 200 (IQR 106,546) days, RIG 216 (IQR 83,383) days and NGT 28 (IQR 14,107) days. Survival between gastrostomy and NGT treated patients was significant (P , 0.001). Analysis of serious complications by nutritional status was BMI (P = 0.347) and % WL (P = 0.489). Conclusions: Nutritional factors associated with reduced survival were weight loss, malnutrition and severe dysphagia. Serious complications were not related to nutritional status but to method of tube insertion. There was no difference in survival between PEG and RIG treated patients. [source] The predictors of complications in patients with drug-induced liver injury caused by antimicrobial agentsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 11 2010S. TREEPRASERTSUK Aliment Pharmacol Ther,31, 1200,1207 Summary Background, Antimicrobials are the leading cause of idiosyncratic drug-induced liver injury in most series. Aim, To determine the incidence and the predictors of complications in patients with drug-induced liver injury caused by antimicrobial agents requiring hospitalization. Methods, Medical records of patients with drug-induced liver injury caused by antimicrobial agents were identified by ICD-10, for the period between 2002 and 2006. Clinical information and blood tests during hospitalization were recorded. The causality assessment of drug-induced liver injury was determined by the Roussel UCLAF causality assessment method (RUCAM) scale. Results, Of 47 594 in-patient admissions per year, the annual incidence of drug-induced liver injury was 0.03%. Male: female ratio was 7:3 with a median age of 47 years. Eighty reactions of drug-induced liver injury were caused by anti-tuberculosis drugs (85%) and by antibiotics (15%). The median (IQR) of RUCAM scale was 6 (5,8). A total of 36% had HIV infection and 9% of patients had diabetes mellitus. Median (IQR) duration of hospitalization was 9 (5,15) days. Serious complications and death were found in 27.5% and 26%, respectively. By a multivariable logistic analysis, the presence of jaundice was found to be significantly associated with an unfavourable outcome. Conclusion, Although rare, antimicrobial agents-related drug-induced liver injury requiring hospitalization has a high mortality rate. The presence of jaundice predicts poor outcome. [source] Epidural Catheter Analgesia in Dogs and Cats: Technique and Review of 182 Cases (1991,1999)JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 2 2001Bernie D. Hansen DVM, DACVECC Abstract Objective: To characterize the indications and techniques for catheterization of the epidural space to treat pain in dogs and cats in a veterinary teaching hospital intensive care unit, and describe the analgesic regimens used in those patients. To provide a detailed description of the technique of epidural catheterization in companion animals. Design: Retrospective case series and clinical practice review. Setting: The Veterinary Teaching Hospital at the North Carolina State University College of Veterinary Medicine. Animals: Records from 160 dogs and 22 cats that had epidural catheters placed were identified. Interventions: Epidural catheterization for the purpose of providing analgesia for a variety of surgical and medical disorders was performed on both awake and anesthetized patients. Measurements and main results: The most frequently used analgesic agents were preservative-free morphine and bupivacaine. 2The range of duration of catheter dwell time was 1.3,332 hours, with a mean duration of 50 hours and a median of 39 hours. Suspicion of catheter malpositioning prompted radiographic imaging of the catheter in 44 patients, and malpositioning was confirmed in 6 of those. Catheter tip positioning was recorded in 46 patients. The tip was located at L3-L6 in 16, and T5-L3 in 30. Twenty-seven of those 30 patients were catheterized to treat pain associated with thoracotomy, forelimb amputation, pancreatitis, or peritonitis. Fifty-one (28%) patients received no analgesics beyond those provided by the epidural catheter. Conclusions: Epidural administration of analgesia appeared to provide significant pain relief and was adequate as a sole analgesic treatment in some patients. Serious complications in these critically ill animals appeared to be uncommon. (J Vet Emerg Crit Care 2001; 11(2): 95,103) [source] Serious complications of cosmetic NewColorIris implantationACTA OPHTHALMOLOGICA, Issue 6 2010Justin E. Anderson Acta Ophthalmol. 2010: 88: 700,704 Abstract. Purpose:, This case report describes serious postoperative complications and markedly elevated intraocular pressure (IOP) associated with the NewColorIris cosmetic implant. Methods:, We report an interventional case series of two patients who suffered multiple complications after NewColorIris implantation carried out in Panama. Assessment included visual acuity, photography, endothelial cell count and anterior segment optical coherence tomography (OCT) when possible. Results:, Both patients presented with endothelial cell loss, uveitis, pigment dispersion and elevated IOP. Anterior segment OCT demonstrated irregularities in the position and configuration of the implants within the anterior chamber with resultant areas of implant,iris and implant,endothelial contact. One patient had acute postoperative hyphaema that resolved with anterior chamber tissue plasminogen activator injection. Both patients required explantation OU, one eye has required trabeculectomy, and one eye with bullous keratopathy is being evaluated for Descemet's stripping endothelial keratoplasty. Conclusions:, Implantation of the NewColorIris cosmetic implant can lead to serious complications including hyphaema, uncontrolled IOP, severe endothelial cell loss, bullous keratopathy and anterior uveitis. Explantation may lead to improvement, but permanent damage to the trabecular meshwork and corneal endothelium persists. [source] Fractionated Laser Skin Resurfacing Treatment Complications: A ReviewDERMATOLOGIC SURGERY, Issue 3 2010ANDREI I. METELITSA MD BACKGROUND Fractional photothermolysis represents a new modality of laser skin resurfacing that was developed to provide a successful clinical response while minimizing postoperative recovery and limiting treatment complications. OBJECTIVES To review all of the reported complications that develop as a result of fractional ablative and nonablative laser skin resurfacing. METHODS A literature review was based on a MEDLINE search (1998,2009) for English-language articles related to laser treatment complications and fractional skin resurfacing. Articles presenting the highest level of evidence and the most recent reports were preferentially selected. RESULTS Complications with fractional laser skin resurfacing represent a full spectrum of severity and can be longlasting. In general, a greater likelihood of developing post-treatment complications is seen in sensitive cutaneous areas and in patients with intrinsically darker skin phototypes or predisposing medical risk factors. CONCLUSIONS Although the overall rate of complications associated with fractional laser skin resurfacing is much lower than with traditional ablative techniques, recent reports suggest that serious complications can develop. An appreciation of all of the complications associated with fractional laser skin resurfacing is important, especially given that many of them can be potentially prevented. The authors have indicated no significant interest with commercial supporters. [source] A Refined Surgical Treatment Modality for Bromhidrosis: Double W Incision Approach with Tumescent TechniqueDERMATOLOGIC SURGERY, Issue 8 2009HANG LI PHD BACKGROUND Axillary bromhidrosis has a strong negative effect on one's social life. A high success rate and few complications are criteria for an ideal treatment method. OBJECTIVE To evaluate a new surgical treatment modality for bromhidrosis: Double W incision with full-exposure excision under tumescent anesthesia. MATERIALS & METHODS Twenty patients with bromhidrosis were treated. Patients were placed in a supine position with their treated arms abducted to 110°. After injection of 60 mL of tumescent solution into each axilla, two small W incisions were made at the superior and inferior axillary poles of the hair-bearing area. The whole hair-bearing skin was undermined at the level of the superficial fat to obtain adequate skin eversion. The flaps were everted to offer full exposure of the apocrine glands, and meticulous excision of each gland was performed. Finally, the incisions were re-approximated, and bulky compressive dressings were applied to the area for 72 hours. RESULTS Of the 40 axillae (20 patients), 32 (80.0%) showed excellent results, and eight (20.0%) had good results. Malodor was significantly decreased. There were no serious complications. CONCLUSION This technique can produce excellent results with a lower complication rate than most other surgical modalities and can be performed without costly equipment. [source] Depigmentation Therapy with Q-Switched Ruby Laser After Tanning in Vitiligo UniversalisDERMATOLOGIC SURGERY, Issue 11 2001Young-Jo Kim MD Background. In vitiligo universalis, repigmentation therapy is seldom effective. Besides, bleaching cream which is often used in depigmentation therapy may lead to several serious complications. Objective. Q-switched (QS) ruby laser can destroy melanosomes in melanocytes and keratinocytes by selective photothermolysis. Methods. We have attempted to destroy melanocytes by using the QS ruby laser after tanning in a patient with extensive vitiligo. Results. The patient had excellent results with no evidence of repigmentation after 1 year. Conclusion. Depigmentation therapy with QS ruby laser after tanning is an effective and safe way of removing remnants of normal pigmentation in patients with vitiligo universalis. [source] Blindness following a diabetic foot infection: a variant to the ,eye,foot syndrome'?DIABETIC MEDICINE, Issue 7 2000K. C. J. Yuen SUMMARY Aims The ,eye,foot syndrome' was initially described by Walsh et,al. to highlight the important association of foot lesions in patients with diabetic retinopathy. We present a case of a 58-year-old patient with Type 2 diabetes mellitus who developed blindness following endogenous staphylococcal endophthalmitis from an infected foot ulcer. Results Our case describes the link between the eye and the foot but is somewhat different to the association as described by Walsh et,al. Endogenous endophthalmitis is rare with diabetic patients being especially at risk, and we report the first case of endogenous staphylococcal endophthalmitis related to a diabetic foot lesion. Conclusions Our case illustrates several important issues in the management of diabetic patients admitted to hospital with infection; the need to thoroughly examine the feet to ascertain any foot lesions and any underlying peripheral vascular disease or peripheral neuropathy, to treat aggressively any infected foot lesions to prevent serious complications of septicaemia and to consider rare conditions like endogenous endophthalmitis in any diabetic patient presenting with acute visual impairment and septicaemia. [source] CLINICAL INVESTIGATION OF UPPER GASTROINTESTINAL HEMORRHAGE AFTER PERCUTANEOUS ENDOSCOPIC GASTROSTOMYDIGESTIVE ENDOSCOPY, Issue 3 2010Shinji Nishiwaki Background:, Upper gastrointestinal (GI) hemorrhage after percutaneous endoscopic gastrostomy (PEG) is sometimes reported as one of the serious complications. Our purpose was to clarify the cause of upper GI hemorrhage after PEG. Patients and Methods:, We retrospectively investigated the causes of upper GI hemorrhage among a total of 416 patients out of 426 consecutive patients who underwent PEG in our institution, excluding 10 patients who showed upper GI tumors on PEG placement. Results:, Among 17 patients who developed upper GI hemorrhage after PEG, three and four patients showed PEG tube placement and replacement-related hemorrhage, respectively; these lesions were vascular or mucosal tears around the gastrostomy site. Ten patients experienced 12 episodes of upper GI hemorrhage during PEG tube feeding. The lesions showing bleeding were caused by reflux esophagitis (five patients), gastric ulcer (two patients), gastric erosion due to mucosal inclusion in the side hole of the internal bolster (two patients), and duodenal diverticular hemorrhage (one patient). Anticoagulants were administered in six patients, including four patients with replacement-related hemorrhage and one patient each with reflux esophagitis and gastric ulcer. Conclusions:, Reflux esophagitis was the most frequent reason for upper GI hemorrhage after PEG. The interruption of anticoagulants should be considered for the prevention of hemorrhage on the placement as well as replacement of a gastrostomy tube. [source] Successful Endoscopic Band Ligation for Treatment of Postpolypectomy HemorrhageDIGESTIVE ENDOSCOPY, Issue 4 2000Yohei Mizuta We describe a case of large pedunculated tubulovillous adenoma of the stomach associated with postpolypectomy hemorrhage, which was successfully treated by endoscopic band ligation. The case study involved a 60-year-old Japanese woman with a pedunculated polyp with a slightly lobular surface, measuring 25 mm in diameter. It was detected on the posterior wall of the middle body of the gastric remnant. The lesion was diagnosed as a tubulovillous adenoma by a biopsy specimen and treated by endoscopic polypectomy using the detachable snare to prevent postpolypectomy hemorrhage. There was no episode of immediate postpolypectomy hemorrhage, but hematemesis occured 18 h after the excision. Endoscopic examination of the stomach showed the mark left by bleeding on the cutting surface and the absence of the detachable snare. Endoscopic intervention by rubber band ligation was performed to prevent the recurrent bleeding. Complete hemostasis was obtained and no serious complications occured. [source] Intramural esophageal bronchogenic cysts: a review of the literatureDISEASES OF THE ESOPHAGUS, Issue 6 2007A. Turkyilmaz SUMMARY., Bronchogenic cysts are rare congenital cystic lesions mostly located in the middle and superior mediastinum. Esophageal bronchogenic cysts are extremely rare. We review here 23 cases reported in English in the literature to date of intramural esophageal bronchogenic cyst and their features, including our patient. Although they are extremely rare, intramural esophageal bronchogenic cysts should be kept in mind in the differential diagnosis of benign esophageal lesions. With accurate diagnosis and treatment the prognosis is excellent and serious complications may be prevented. [source] Serum concentrations of high-mobility group box chromosomal protein 1 before and after exposure to the surgical stress of thoracic esophagectomy: a predictor of clinical course after surgery?DISEASES OF THE ESOPHAGUS, Issue 1 2006K. Suda SUMMARY., High-mobility group box chromosomal protein 1 (HMGB-1) has recently been shown as an important late mediator of endotoxin shock, intra-abdominal sepsis, and acute lung injury. However, its role in the systemic inflammatory response syndrome after major surgical stress, which may lead to multiple organ dysfunction syndrome, has not been thoroughly investigated. We hypothesized that serum HMGB-1 participates in the pathogenesis of postoperative organ system dysfunction after exposure to major surgical stress. A prospective clinical study was performed to consecutive patients (n = 24) with carcinoma of the thoracic esophagus who underwent transthoracic esophagectomy with three field lymph node resection between 1998 and 2003 at Keio University Hospital, Japan. Serum HMGB-1 concentrations were measured by enzyme-linked immunosorbent assay. Preoperative serum HMGB-1 levels correlated with postoperative duration of SIRS, mechanical ventilation, and intensive care unit stay. Three of the 24 patients had serious postoperative complications: sepsis in two, and acute lung injury in one. Serum HMGB-1 levels in patients without complications increased within the first 24 h postoperatively, remained high during postoperative days 2,3, and then decreased gradually by postoperative day 7. In patients with serious complications, serum HMGB-1 was significantly higher than that found in patients without postoperative complications at every time point except postoperative day 2. Preoperative serum HMGB-1 concentration seems to be an important predictor of the postoperative clinical course. Transthoracic esophagectomy induces an increase in HMGB-1 in serum even in patients without complications. Postoperative serum HMGB-1 concentrations were higher in patients who developed complications, and may be a predictive marker for complications in this setting. [source] Intracardiac Echocardiography in Patients with Pacing and Defibrillating Leads: A Feasibility StudyECHOCARDIOGRAPHY, Issue 6 2008Maria Grazia Bongiorni M.D. Background: Lead extraction, an important and necessary component of treatment for many common device and lead-related complications, is a procedure that can provoke much anxiety in even the most experienced operators given the potentially serious complications. The principal impediment to lead extraction is the body's response to an intravascular foreign body with matrix intravascular neoformation, which causes the lead to adhere to the endocardium or vascular structure, increasing the risk of vascular or myocardial damage with lead removal. Fluoroscopic visualization, the commonly visualization used tool, has several limits in terms of anatomical structures visualization. The aim of this study was to assess the safety and feasibility of intracardiac echocardiography (ICE) in patients undergoing pacing and defibrillating leads before and during a transvenous device removal, and its potential role in detecting intracardiac leads and areas of fibrous adherence. Methods: ICE interrogation was performed in 25 consecutive patients with pacing and defibrillating implantable cardioverter defibrillators (ICD) leads before and during device removal. Results: A programmed ICE analysis was completed in 23 out of 25 patients with excellent resolution, providing a "qualitative-quantitative" information on anatomical structures, cardiac leads, and related areas of fibrous adherence. No ICE-related complications occurred. Conclusions: ICE evaluation is safe and feasible in patients with pacing and defibrillating leads before and during transvenous lead removal, offering an excellent visualization of cardiac leads and related areas of adherence. ICE can assist pacing and ICD lead removal and could improve procedure efficacy and safety. [source] Three-Dimensional Echocardiography of Post-Myocardial Infarction Cardiac RuptureECHOCARDIOGRAPHY, Issue 3 2004Timothy Puri B.S. Ventricular septal defects and pseudoaneurysms are two serious complications of acute myocardial infarction and are associated with a high mortality if not surgically treated. Two-dimensional echocardiography provides excellent diagnostic information in such cases, but three-dimensional echocardiography may provide superior anatomic data of these potentially fatal complications. We describe two cases in which three-dimensional echocardiography provided incremental morphological information. (ECHOCARDIOGRAPHY, Volume 21, April 2004) [source] Immunomodulatory therapy for chronic hepatitis B virus infectionFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 1 2005D. Sprengers Abstract Hepatitis B virus (HBV) is one of the most prevalent viral pathogens of man with around 350 million chronically infected patients. It has been postulated that in persistently infected individuals the HBV-specific immune response is too weak to eliminate HBV from all infected hepatocytes, but sufficiently strong to continuously destroy HBV-infected hepatocytes and to induce chronic inflammatory liver disease. The primary aim in the treatment of chronic hepatitis B is to induce sustained disease remission and prevent serious complications like liver failure and/or hepatocellular carcinoma. The recent emergence of drug-resistant HBV mutants and post-treatment relapse as a consequence of nucleoside analogue monotherapy emphasizes that the principal goal should be to stimulate a successful immune response. In this paper we will focus on the immune response to HBV and we will review reported data on immunotherapeutic strategies like immunomodulatory drugs (cytokines and Thymic derivates) and vaccine therapies using currently available recombinant anti-HBV vaccines, lipopeptide-based T cell vaccine and newly developed genetic vaccines. [source] European Study on Orthopaedic Status of haemophilia patients with inhibitorsHAEMOPHILIA, Issue 5 2007M. MORFINI Summary., ,Development of inhibitors against factor VIII (FVIII) or factor IX (FIX) in haemophilia patients is one of the most serious complications of repeated exposure to replacement therapy and has major clinical and economic consequences. To evaluate the relationship between inhibitor status of haemophilia patients and their quality of life (QoL) and degree of arthropathy and to compare the orthopaedic status of patients with/without inhibitors. An observational, cross-sectional, case control study enrolling: group A (n = 38), males aged 14,35 years, with severe congenital haemophilia A or B who had inhibitors against FVIII/FIX >5 years; group B (n = 41), as group A, but aged 36,65 years and group C (n = 49), as group A, but without inhibitors. Socio-demographics: medical history, clinical characteristics and QoL were assessed. In groups A and B, 16% and 27% were hospitalized for orthopaedic procedures vs. 4% in group C. Patient mobility was also severely reduced in groups A and B, with 24% and 22% using wheelchairs vs. 4% in group C, and 50% and 51% needing a walking aid vs. 29% in group C. Significantly more joint pain was reported by patients in group A vs. those in group C; clinical/radiological orthopaedic scores were also worse in group A vs. group C. Significantly more joint abnormality was reported by patients in group A vs. group C. The burden of orthopaedic complications and the impact on QoL are more severe in haemophilia patients who have developed inhibitors than in those without inhibitors. [source] Prospective evaluation of the retrograde percutaneous translaryngeal tracheostomy (Fantoni procedure) in a surgical intensive care unit: Technique and results of the Fantoni tracheostomyHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 4 2006Ralf Konopke MD Abstract Background. Controversy surrounds the safety and practicality of the retrograde percutaneous translaryngeal tracheostomy (Fantoni procedure) compared with other percutaneous methods. Methods. We used the Fantoni tracheostomy for 245 patients in our intensive care unit (ICU) over a period of 3 years 6 months and conducted a prospective analysis. Results. We are able to report a low incidence of complications (1.2%) with the Fantoni procedure. Advantages of the method are reduced tissue trauma and optimal adaptation of the stoma to the cannula, leading to less stomal bleeding and fewer infectious complications. We observed no procedure-related mortality. Under mandatory bronchoscopic control, proper puncture location and cannula placement are ensured, which prevents tracheal wall injury and paratracheal placement of the cannula. Conclusions. Our experience shows that the major advantage of the use of the Fantoni tracheostomy is the retrograde dilatation of the stoma, which prevents serious complications compared with other techniques. © 2005 Wiley Periodicals, Inc. Head Neck28: 355,359, 2006 [source] Mortality differences among organisms causing septicemia in hemodialysis patientsHEMODIALYSIS INTERNATIONAL, Issue 1 2006Mark D. DANESE Abstract Septicemia is a serious problem in hemodialysis patients because it can lead to life-threatening complications and a persistently elevated risk of death. Most analyses have not examined whether there are differences in mortality risk among the organisms that cause these episodes of septicemia. This study was a retrospective cohort analysis of first septicemia hospitalizations during the first year of hemodialysis. Time to death (both in-hospital and within 12 weeks post-discharge) was compared among the different septicemia-causing organisms based on discharge diagnoses in Medicare billing data from 1996 to 2001. The effect of various complications on mortality risk was also evaluated. There were 22,130 septicemia hospitalizations identified. The most common organism identified was Staphylococcus aureus (27%), with no other organism having an incidence >10%. The overall unadjusted death rate from admission through 12 weeks of follow-up was 34%. During the first hospitalization, the death rate was 14%, and during the 12-week period after the hospitalization it was 20%. In adjusted analyses, S. aureus was associated with a 20% higher risk of death both during the in-hospital period and the 12-week post-discharge period, when compared with all other specified organisms. Hospitalizations complicated by meningitis, stroke, or endocarditis were also associated with increased risk of mortality, independent of the organism causing septicemia. Septicemia hospitalizations are associated with a high mortality rate,both during the initial hospitalization and after discharge. Meningitis, stroke, and endocarditis represent particularly serious complications. Overall, septicemia hospitalizations (especially for S. aureus) are serious events, and patients would benefit from better treatment and prevention. [source] The use of oseltamivir during an influenza B outbreak in a chronic care hospitalINFLUENZA AND OTHER RESPIRATORY VIRUSES, Issue 1 2009Holly Seale Background, Residents of nursing homes and long-term care facilities are at a higher risk of outbreaks of influenza and of serious complications of influenza than those in the community. In late July 2005, a 90-bed chronic care psycho-geriatric hospital in Sydney, Australia, reported cases of influenza-like illness (ILI) occurring amongst its residents. Methods, An investigation to confirm the outbreak, and its cause, was undertaken. Influenza vaccination levels amongst residents, and the effects of antiviral drugs used for prevention and treatment, were assessed. Oseltamivir was only given to the residents, in the form of both treatment and prophylaxis. Results, A total of 22 out of 89 residents met the clinical case definition of ILI with onset on or after 27 July 2005. This represents an attack rate of 25%. Oseltamivir was commenced on day 9 of the outbreak. Influenza B was identified in six residents as the causative agent of the outbreak. No deaths or acute hospitalization were recorded for this outbreak and there were no further reported cases after the introduction of oseltamivir. Vaccine effectiveness was 75% and the strain of influenza B isolated was well matched to that year's vaccine. Conclusions, There are few data on the use of oseltamivir in influenza B outbreaks. Early antiviral intervention appeared to curtail this outbreak of influenza B in a chronic care facility. We found high vaccine effectiveness in this frail, institutionalized population, highlighting the importance of influenza vaccination for residents of chronic care facilities. [source] Influenza-associated hospitalization in urban Thai childrenINFLUENZA AND OTHER RESPIRATORY VIRUSES, Issue 5-6 2007Piyarat Suntarattiwong Background, Studies in North America and Europe have shown that young children are at increased risk of serious complications and hospitalization from influenza infection. In Thailand, however, influenza is commonly considered a mild infection that rarely requires hospitalization. An improved understanding of the burden of serious complications from influenza infection in young children is needed to inform clinical treatment and vaccination guidelines. Methods, We conducted a prospective study of children 0,5 years of age with lower respiratory tract infection or influenza-like illness admitted to a pediatric tertiary-care hospital in Bangkok, Thailand during July 2004 to July 2005. All respiratory specimens were tested for influenza using a rapid antigen test and tissue cell culture. Results, Thirty-nine of 456 (8.6%) hospitalized children had culture-positive influenza. Eighty percent of hospitalized influenza patients had no underlying chronic illnesses. Nineteen (49%) influenza patients required hospital stays of 5 days or more and two patients required mechanical ventilation. Influenza activity demonstrated bimodal seasonal variation with peak activity from August to October and January to April. Cough was present in 38 (97%) cases and fever >38.5°C was significantly associated with influenza. Conclusion, Influenza is an important cause of hospitalization in children <5 years of age in Thailand. Children <5 years should be considered as a target group when establishing clinical guidelines for antiviral treatment and influenza vaccination. [source] Predominant T helper type 2-inflammatory responses promote murine colon cancersINTERNATIONAL JOURNAL OF CANCER, Issue 9 2006Emi Osawa Abstract Colon cancer is one of the most serious complications of inflammatory bowel diseases, especially ulcerative colitis (UC). Previous studies have shown that characteristic immunological event during inflammation in UC is the expression of T helper-type 2 (Th2) cell-derived cytokines. In this study, we investigated the influence of a predominant Th2-type cytokine response in colitis on carcinogen-induced colon tumors. Wild type (WT), interferon gamma (IFN-,) gene deficient (,/,) [Th2 dominant] or interleukin (IL)-4,/, [Th1-dominant] mice of BALB/c background were used in this study. To compare tumor formation, mice were given the carcinogen azoxymethane (AOM) and intrarectal administration of trinitrobenzene sulfonic acid (TNBS), to induce colitis. Thirty-three weeks after initial treatment, the total colon was examined. When IFN-,,/, mice were treated with AOM and TNBS, significantly higher number of tumors were seen (8.4 ± 1.7) than in WT (3.3 ± 2.9) or IL-4,/, (3.1 ± 3.4) mice, which received identical treatments. A separate set of experiment, using less doses of AOM and TNBS also showed the higher frequency of tumor formation in IFN-,,/, mice than in IL-4,/, mice. Histologically, the tumors were well- or moderately-differentiated adenocarcinomas. No invasion into the submucosal or serosal layers of the intestine was seen. In immunohistological staining, some tumors in IFN-,,/, mice showed distinct nuclear expression of ,-catenin, in contrast to the strong membrane staining seen in tumors of IL-4,/, mice. In conclusion, colonic inflammation associated with Th2-donimant cytokine responses enhanced the formation of malignant neoplasms. © 2005 Wiley-Liss, Inc. [source] Prevention and treatment of glucocorticoid-induced osteoporosis in daily dermatologic practiceINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 7 2008Hester Vermaat Background Systemic glucocorticoids (GCs) are often needed to treat dermatologic patients. The long-term use of GCs, however, is associated with potentially severe side-effects. GC-induced osteoporosis (GIO) is one of the most serious complications, but the risk of the occurrence of GIO seems to be generally underestimated. Aim To provide an update of the recent advances in the prevention of GIO in dermatologic practice. Methods Review of the literature and several European and US guidelines up to August 2007. Results Data regarding the prevention and treatment of GIO are limited and guidelines for the prevention of GIO are not fully consistent. Conclusion The prophylaxis of osteoporosis needs to be started early during treatment with GCs. Calcium and vitamin D supplements in all patients on systemic GCs and bisphosphonates in patients who take GCs for more than 3 months are practical and effective measures. [source] Efficacy of 10% silver nitrate solution in the treatment of common warts: a placebo-controlled, randomized, clinical trialINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 2 2007Sedigheh Ebrahimi MD Background, Warts are a common skin lesion, especially in children and young adults, caused by human papillomaviruses. So far, there is no definitive therapy for warts and the treatment is modified regularly to obtain the best result with the least discomfort to the patient. The aim of this placebo-controlled clinical trial was to evaluate the clinical efficacy, tolerability, and safety of 10% silver nitrate solution for the treatment of common warts. Methods, Sixty individuals attending pediatrics and dermatology clinics and health centers in Yasuj, south-west of Iran, were recruited. The patients were divided into two groups: 30 patients received 10% silver nitrate solution (case group) and 30 control patients received black ink (placebo group). Silver nitrate solution was used every other day for 3 weeks. After 3 weeks, the patients were evaluated for healing, and treatment was continued for another 3 weeks if the lesions were still present. Results, Complete regression of lesions was achieved in 19 of the 30 (63.33%) case patients. No significant side-effect was noted in the treated patients apart from temporary brownish discoloration of the skin which resolved 1 week after treatment. Conclusion, This study demonstrated that 10% silver nitrate solution can be used effectively for the treatment of warts with no serious complications. [source] Successful renal transplantation in the right iliac fossa 2 years after serious deep venous thrombosis in a patient with systemic lupus erythematosusINTERNATIONAL JOURNAL OF UROLOGY, Issue 10 2005NORIHIKO TSUCHIYA Abstract Deep venous thrombosis (DVT) possibly occurs in the perioperative period, and induces serious complications such as a pulmonary embolism. On the other hand, allograft renal vein thrombosis leads to a high incidence of graft loss. We experienced a case in which a serious DVT occurred prior to renal transplantation; however, a successful renal transplantation in the right iliac fossa was performed after 2 years of anticoagulant therapy. It is suggested that the external iliac vein even after suffering from DVT can be anastomosed to an allograft vein successfully, when enough blood ,ow or a lower venous pressure is con,rmed. However, one should be aware of the risk factors and the adequate management of thrombosis in renal transplantation because of the serious complications of DVT and the poor prognosis of allograft vein thrombosis. [source] Adjuvant hydrodistension under epidural anesthesia for interstitial cystitisINTERNATIONAL JOURNAL OF UROLOGY, Issue 9 2003TETSUO YAMADA ABSTRACT Background: Hydrodistension is the first choice of treatment for interstitial cystitis because it allows for diagnosis, bladder biopsy and treatment. However, the method and efficacy of hydrodistension are variable. We performed adjuvant hydrodistension and examined the efficacy and factors that influence prognosis. Methods: Fifty-two patients participated in the present study as subjects; they satisfied the diagnostic inclusion and exclusion criteria established by the National Institute of Diabetes, Digestive and Kidney Disease (NIDDK) in 1987, USA. Under epidural anesthesia, the bladder was repeatedly distended up to the maximal bladder capacity for treatment, diagnosis and biopsy. Hydrodistension was performed again on the following day for approximately 30 min under epidural anesthesia in a ward until macroscopic hematuria disappeared. Results: Five patients were classified into the good, 30 into the moderate and 17 into the poor response group. In the good response group, three patients had type I allergy and one patient did not fulfil all of the positive factors in the NIDDK criteria. The poor response group included one patient with collagen disease. The poor response group was further divided into two subgroups based on bladder capacity. One subgroup included eight patients with a bladder capacity of less than 100 mL and vesicoureteral reflux (VUR). The other subgroup included nine patients with a bladder capacity of more than 100 mL. Among these nine patients there were five patients who lacked one or two positive factors in the NIDDK criteria. Conclusion: Adjuvant hydrodistension under epidural anesthesia is effective for about 70% of patients for more than 3 months. It can be performed in a ward without any serious complications. It was observed that patients lacking one or two positive factors were included in the good and poor response groups. [source] Nordic guidelines for neuraxial blocks in disturbed haemostasis from the Scandinavian Society of Anaesthesiology and Intensive Care MedicineACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2010H. BREIVIK Background: Central neuraxial blocks (CNBs) for surgery and analgesia are an important part of anaesthesia practice in the Nordic countries. More active thromboprophylaxis with potent antihaemostatic drugs has increased the risk of bleeding into the spinal canal. National guidelines for minimizing this risk in patients who benefit from such blocks vary in their recommendations for safe practice. Methods: The Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) appointed a task force of experts to establish a Nordic consensus on recommendations for best clinical practice in providing effective and safe CNBs in patients with an increased risk of bleeding. We performed a literature search and expert evaluation of evidence for (1) the possible benefits of CNBs on the outcome of anaesthesia and surgery, for (2) risks of spinal bleeding from hereditary and acquired bleeding disorders and antihaemostatic drugs used in surgical patients for thromboprophylaxis, for (3) risk evaluation in published case reports, and for (4) recommendations in published national guidelines. Proposals from the taskforce were available for feedback on the SSAI web-page during the summer of 2008. Results: Neuraxial blocks can improve comfort and reduce morbidity (strong evidence) and mortality (moderate evidence) after surgical procedures. Haemostatic disorders, antihaemostatic drugs, anatomical abnormalities of the spine and spinal blood vessels, elderly patients, and renal and hepatic impairment are risk factors for spinal bleeding (strong evidence). Published national guidelines are mainly based on experts' opinions (weak evidence). The task force reached a consensus on Nordic guidelines, mainly based on our experts' opinions, but we acknowledge different practices in heparinization during vascular surgery and peri-operative administration of non-steroidal anti-inflammatory drugs during neuraxial blocks. Conclusions: Experts from the five Nordic countries offer consensus recommendations for safe clinical practice of neuraxial blocks and how to minimize the risks of serious complications from spinal bleeding. A brief version of the recommendations is available on http://www.ssai.info. [source] Prevalence of Fever in Patients Undergoing Left Atrial Ablation of Atrial Fibrillation Guided by Barium EsophagraphyJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2009RUBINDER S. RUBY M.D. Background: Real-time esophageal imaging is critical in avoiding esophageal injury. However, the safety of esophageal imaging with barium has not been specifically explored. Methods: Three hundred seventy consecutive patients underwent left atrial (LA) ablation of atrial fibrillation (AF) under conscious sedation. One hundred eighty-five patients (50%) underwent the ablation procedure with, and 185 patients (50%) underwent the procedure without administration of barium. Fever, as a surrogate for aspiration, was defined as a maximal temperature ,100°F within the first 24 hours following the ablation procedure. Results: Thirty of the 370 patients (8%) developed fever within 24 hours after LA ablation. The prevalence of fever was 9% (17/185) among patients who received barium and 7% (13/185) among those who did not receive barium (P = 0.6). Evaluation revealed the following causes of fever in 14 of the 30 patients (47%) with no difference in prevalence between the 2 groups: pericarditis, venous thromboembolism, hematoma, and infiltrate on chest radiography. Multivariate analysis failed to reveal any factors associated with development of fever. None of the patients experienced serious complications such as respiratory failure or atrioesophageal fistula. Conclusions: Fever may occur in approximately 10% of patients undergoing LA ablation of AF. Administration of barium is not associated with fever or other complications such as aspiration pneumonia. Real-time imaging of the esophagus with barium administration in conjunction with conscious sedation appears to be safe. [source] Review of non-invasive ventilation in the emergency department: clinical considerations and management prioritiesJOURNAL OF CLINICAL NURSING, Issue 23 2009Louise Rose Aims and objectives., We aimed to synthesise evidence from published literature on non-invasive ventilation to inform nurses involved in the clinical management of non-invasive ventilation in the emergency department. Background., Non-invasive ventilation is a form of ventilatory support that does not require endotracheal intubation and is used in the early management of acute respiratory failure in emergency departments. Safe delivery of this intervention requires a skilled team, educated and experienced in appropriate patient selection, available devices and monitoring priorities. Design., Systematic review. Method., A multi-database search was performed to identify works published in the English language between 1998,2008. Search terms included: non-invasive ventilation, continuous positive airway pressure and emergency department. Inclusion and exclusion criteria for the review were identified and systematically applied. Results., Terminology used to describe aspects of non-invasive ventilation is ambiguous. Two international guidelines inform the delivery of this intervention, however, much research has been undertaken since these publications. Strong evidence exists for non-invasive ventilation for patients with acute exacerbation of congestive heart failure and chronic obstructive pulmonary disease. Non-invasive ventilation may be delivered with various interfaces and modes; little evidence is available for the superiority of individual interfaces or modes. Conclusions., Early use of non-invasive ventilation for the management of acute respiratory failure may reduce mortality and morbidity. Though international guidelines exist, specific recommendations to guide the selection of modes, settings or interfaces for various aetiologies are lacking due to the absence of empirical evidence. Relevance to clinical practice., Monitoring of non-invasive ventilation should focus on assessment of response to treatment, respiratory and haemodynamic stability, patient comfort and presence of air leaks. Complications are related to mask-fit and high air flows; serious complications are few and occur infrequently. The use of non-invasive ventilation has resource implications that must be considered to provide effective and safe management in the emergency department. [source] Role of sonographically guided fine-needle aspiration biopsy of adrenal masses in patients with lung cancerJOURNAL OF CLINICAL ULTRASOUND, Issue 1 2004Ksenija Kocijan Abstract Purpose The aims of this retrospective study were to determine the accuracy and safety of sonographically guided fine-needle aspiration biopsy (FNAB) in evaluating enlarged adrenal glands in patients with lung cancer and to correlate the metastatic involvement of the adrenal glands with the surgical stage of the primary lung tumor. Methods During an 11-year period, 64 patients with cytologically proven lung cancer had undergone sonographically guided FNABs of an adrenal mass. The accuracy of this method was assessed on the basis of cytologic findings and the safety, on the number of complications reported after FNAB. The location of the adrenal metastasis relative to the primary tumor (ipsilateral, contralateral, or bilateral) was correlated with the surgical stage of the disease. Results FNAB results were accurate in 58 of the 64 cases (91%), and the procedure was associated with no serious complications. In 6 (9%) of the 64 patients, the FNAB specimen had been inadequate. Cytologic analysis of the aspirates revealed malignancy in 52 (90%) of the 58 patients in whom the FNAB specimen had been adequate for an accurate diagnosis. The adrenal metastases were ipsilateral in 21 patients, contralateral in 15, and bilateral in 16, for an ipsilateral-to-contralateral ratio of 1.4:1. Among patients with operable disease, an ipsilateral pattern of metastasis was present in 65%, whereas among those with inoperable disease, the ipsilateral pattern was present in only 31%. The difference between these 2 groups was statistically significant (p < 0.05). Conclusions Sonographically guided FNAB is accurate and safe for evaluating enlarged adrenal glands in patients with lung cancer. Our results also suggest that a solitary ipsilateral adrenal metastasis in a patient with resectable primary lung cancer may represent a regional extension of the disease rather than systemic spread. © 2003 Wiley Periodicals, Inc. J Clin Ultrasound 32:12,16, 2004 [source] | ||||||||||||||||||||||||||||||||||||||||