Abstract: Problem Statement: Abdominoplasty has become an increasingly popular procedure. Riskfactors affecting woundcomplications of abdominoplasty are not adequately defined in literature. Identification of these riskfactors is crucial for better patient’s selection and counseling. The objectives of this study were to determine wound complication rate followingabdominoplasty and to examine the relationship of a set of possible riskfactors with the incidence of complications. Approach: We studied 116 patients (107 women and 9 men) who underwent abdominoplasty at Jordan University Hospital, between June 1997 and June 2007. Data were collected from patients’ medical records and analyzed to determine types and rates of surgical woundcomplications. Fourteen possible riskfactors were investigated using logistic regression analysis to evaluate their relationship with the occurrence of woundcomplications. Riskfactors examined were: age, sex, body mass index, parity number, smoking history, history of diabetes mellitus, previous gastroplasty for morbid obesity, previous abdominal surgical scars, type of abdominoplasty, plication of recti, hernia repair, operative time and operative blood loss. Results: A total of 29 patients (two males and 27 females) (25%) had woundcomplications. The most common complication was seroma. It was encountered in 15 cases (12.9%). Six patients (5.2%) had wound infection. Partial skin necrosis was encountered in four cases (3.4 %). Two patients (1.7%) developed wound dehiscence and two patients (1.7%) had hematoma. The only factors significantly increased the complication rate were: increased body mass index (p = 0.002) and history of smoking (p = 0.004). Conclusions and Recommendations: This study confirms the adverse effect of overweight and cigarette smoking on the incidence of wound complication rate followingabdominoplasty. We recommend that overweight patients and smokers undergoing abdominoplasty should be adequately counseled and informed about the increased risks. In addition, prophylactic measures should be properly taken to decrease wound complication rate in these groups of patients.
In our study, in spite of not fi nding any relationship between the number of samples and the total of number of hemorrhagic and hemospermia complications, there was an association between the numbers of samples with hematuria and rectal bleeding. The explanation for this fact is that, with a higher number of samples, the probability of injuring a prostatic and/or rectal blood vessel is higher, thereby causing hematuria and/or rectal bleeding. Higher numbers of samples were not related to hemospermia, which can be explained by the fact that most patients did not report ejaculations following the biopsy. Otherwise, the results might have been similar to those from patients with hematuria and rectal bleeding.
The followingcomplications were analyzed: fistulae, abscesses, anastomotic dehiscence, and abdominal sepsis. Socio-demograph- ic data (sex, ethnicity, age, schooling), clinical features (BMI, age at diagnosis, disease duration, family history, history of smoking, use of corticosteroids, immunomodulators or anti-TNF drugs within 8 weeks prior to surgery, Montreal classification of CD), and surgical characteristics (age at first surgery, time between diagnosis and first surgery, need for more than one surgery, number of surgeries, surgical indication, surgical time, technique and position of the anastomosis, presence of complications and their classification, and size of the removed specimen) were also analyzed.
The query used was: (postoperative complications[MeSH Terms]) OR postop- erative complications[Title/Abstract]) OR postoperative complication[Title/ Abstract]) OR postoperative complication[MeSH Terms]) OR complications, postoperative[MeSH Terms]) OR complications, postoperative[Title/Abstract]) OR complication, postoperative[Title/Abstract]) OR complication, postoper- ative[MeSH Terms]) OR surgical wound dehiscence[MeSH Terms]) OR surgical wound dehiscence[Title/Abstract]) OR dehiscence surgical wound[Title/ Abstract]) OR dehiscence surgical wound[MeSH Terms]) OR anastomotic leaks[MeSH Terms]) OR anastomotic leaks[Title/Abstract]) OR anastomotic leakage[Title/Abstract]) OR anastomotic leakage[MeSH Terms]) OR anastomotic leakage[MeSH Terms]) OR anastomotic leakage[Title/Abstract]) OR healing wound[Title/Abstract]) OR healing wound[MeSH Terms]) OR istula[MeSH Terms]) OR istula[Title/Abstract]) OR pharyngocutaneous istula[Title/Ab- stract]) OR pharyngocutaneous istula[MeSH Terms]) OR cutaneous istu- la[MeSH Terms]) OR cutaneous istula[Title/Abstract]) OR skin istula[Title/ Abstract]) OR skin istula[MeSH Terms]) OR external istula[MeSH Terms]) OR external istula[Title/Abstract]) OR salivary gland istula[Title/Abstract]) OR salivary gland istula[MeSH Terms]) OR pharyngostoma[MeSH Terms]) OR pharyngostoma[Title/Abstract]) OR postla ryngectomy pharyngocutaneous istula[Title/Abstract]) OR postlaryngectomy pharyngocutaneous istula[MeSH Terms]) AND (factor risk[MeSH Terms]) OR factorsrisk[MeSH Terms]) OR risk factor[MeSH Terms]) OR riskfactors[Title/Abstract]) OR causalities[Title/Ab- stract]) OR causalities[MeSH Terms]) OR multifactorial causality[MeSH Terms]) OR multifactorial causality[Title/Abstract]) OR predisposing factors[Title/ Abstract]) OR predisposing factors[MeSH Terms]) OR prognostic factors[MeSH Terms]) OR prognostic factors[Title/Abstract]) OR etiology[Title/Abstract]) OR etiology[MeSH Terms])) AND (laryngectomy[MeSH Terms]) OR laryngectomy[Ti- tle/Abstract]) OR pharyngectomy[Title/Abstract]) OR pharyngectomy[MeSH Terms]) OR pharyngolaryngectomy[MeSH Terms]) OR pharyngolaryngectomy[Ti- tle/Abstract]) OR laryngectomies[Title/Abstract]) OR laryngectomies[MeSH Terms]) OR neoplasms laryngeal[MeSH Terms]) OR cancer of larynx[MeSH Terms]) OR cancer of larynx[Title/Abstr act]) OR larynx cancer[Title/Abstract]) OR larynx cancer[MeSH Terms]) OR head neck cancer[MeSH Terms]) OR head neck cancer[Title/Abstract]) OR laryngeal cancer[Title/Abstract]) OR laryngeal cancer[MeSH Terms]) OR laryngopharyngectomy[MeSH Terms]) OR laryngophar- yngectomy[Title/Abstract]).
In the second stage were established the following inclusion criteria: articles published in the last five years, which are related to predisposing factors for infection of the surgical wound post-cesarean section available in the selected databases. Exclusion criteria were: articles that do not present the full text and access restricted, at risk of not present in the data abstracts consistent with variables defined for the purpose of this study and the impossibility of analysis and interpretation of the results presented in them; articles that are duplicates in the database, and found items from the selected key words, but not related to the purpose of the study, as well as letters to the editor and editorials.
Infectious complications associated with regional anesthesia and pain therapy can result in devastating morbidity and mor- tality, including abscess, meningitis or spinal cord compression secondary to abscess formation. Possible riskfactors include underlying sepsis, diabetes, immunosuppression, corticos- teroids use, localized bacterial colonization or infection, and prolonged catheters use. Meningitis or epidural abscess may result from colonization of distant or localized infection, with subsequent hematogenous dissemination and commitment of the central nervous system (CNS). The anesthesiologist may also carry microorganisms into the CNS by contaminating into the material to be used for regional anesthesia, or when not following the aseptic technique.
Pneumonia was defined as new onset of pulmonary infiltrates with clinical symptoms (fever, cough, purulent tracheobronchial secretions, and dyspnea at rest), leukocytosis, and detection of potentially pathogenic bacteria in the sputum or bronchoalveolar lavage culture. Other infectious complications were wound infection, liver abscess, subphrenic abscess, cholangitis, peritonitis, and urinary tract infection. These were confirmed by clinical observation (fever, purulent discharge from wound, abdominal pain), and laboratory markers of inflammation with positive cultures (blood, bile, pus, and urine), and findings from chest X- rays and/or chest computed tomography. The Acute Physiology and Chronic Health Evaluation (APACHE) II score was used to assess the severity of illness at ICU admission . Postoperative laboratory data presented in Table 1 represent values that were Table 2. Preoperative characteristics of 179 recipients of NIV.
ABSTRACT – Context - Superobese patients who undergo gastric bypass have a greater incidence of complications. The greater incidence of comorbidity in this group leads to a higher surgical risk, and a need for special care. By analyzing the riskfactors identiied in the preoperative period, scoring them, constructing a score and assessing the occurrence of serious complications and death, we will have elements to identify which patients are at greater risk. Objective - To determine the accuracy of the Recife Score for predicting serious postoperative complications and death in superobese patients who undergo Roux-en-Y gastric bypass surgery by the conventional method. Methods - An ambidirectional study was conducted to validate the diagnostic test on 203 severely obese patients submitted to Roux-en-Y gastric bypass at the Hospital das Clínicas of the Federal University of Pernambuco, Recife, PE, Brazil, from September 1997 to May 2007. The dependent variables were major postoperative complications and death. The independent variable was the Recife Score. The data were analyzed using the Epi-Info 3.5.1 program. The accuracy of the Recife Score was analyzed considering the following parameters: sensitivity, speciicity, positive predictive value, negative predictive value, positive verisimilitude ratio and negative verisimilitude ratio. Results - The accuracy of the Recife Score with cut-off points higher than 3 and higher than 5 to predict serious postoperative complications was, respectively, a frequency of complications of 12.3%, with a risk ratio of 2.83, sensitivity of 57.1% and speciicity of 69.8%, and 12.5%, with a risk ratio of 1.88, sensitivity of 7.1% and speciicity of 96.3%. The accuracy of the Recife Score with cut-off points higher than 3 and higher than 5 to predict death was, respectively, a frequency of death of 7.7%, with a risk ratio of 10.62, sensitivity of 83.3% and speciicity of 69.5%, and 12.5%, with a risk ratio of 4.88, sensitivity of 16.7% and speciicity of 96.5%. Conclusion - A Recife Score >3 prior to conventional gastric bypass presents a high level of accuracy in the prediction of serious postoperative complications and death.
The cyclosporine concentrations used were associated with nephrotoxicity in patients undergoing myeloablative therapy. The concentrations varied from <150 ng/mL to >250 ng/mL; furthermore, when patients presented a serum cyclosporine concentration higher than 250 ng/mL, the devel- opment of toxicity was faster. These differences related to cyclosporine concentration were not explained by riskfactors such as age, basal creatinine or concurrent use of nephrotoxic antibiotics. It was ascertained that the highest mean concen- tration of cyclosporine was associated with the highest risk for the development of nephrotoxicity (p-value < 0.001). In addi- tion, comparing patients who took amphotericin B with those who had not taken this antifungal, stratified by cyclosporine concentration, showed that this drug was a significant inde- pendent risk factor for the development of nephrotoxicity (p-value < 0.01). 19
Of the 145 patients who underwent sur- gery, 27 patients (18.6%) presented pulmo- nary complications during the 72-hour post- operative period, and 23 (15.9%) of them had undergone pulmonary parenchyma resection. The single most common form of complica- tion was tracheobronchitis, in 29.6% (8/27), followed by bronchospasm in 14.8% (4/27). The average body mass index (BMI) of the patients with postoperative pulmonary complications was 22.2 kg/m 2 (standard de-
In this work we observed a high isolation rate of microbio- logical agents in FN episodes; this was statistically associated with higher mortality. Bacteremia was the most common microbiological isolate identified with a predominance of GNB, particularly MR. Riskfactors for FN were duration and severity of neutropenia and the isolation of a microbiolog- ical agent, and the presence of alarm signs was associated with poor outcomes. The high rate of GNB resistant to piperacillin/tazobactam, the front-line antibiotics in our pro- tocol, and the early need to escalate to carbapenems raises the question as to whether it is necessary to change our antibiotic treatment protocol for high-risk neutropenia. Fur- ther prospective studies with a larger number of patients and episodes of FN should be conducted to confirm these results.
DISCUSSION: Common indication for decompressive craniectomies include traumatic brain injuries following road traffic accidents. In our study 39 patients underwent decompressive craniectomy following traumatic brain injury for road traffic accidents,4 patients underwent decompressive craniectomy following hypertensive gangliocapsular bleed. Meticulous cranioplasty is important for good cosmetic results, as well as long-term protection of brain from external environment.
In order to investigate the association of two components of MS (HDL-c and TG) with alcohol use in both genders, 3 levels of alcohol consumption were compared in studied individuals. In individuals with MS, it was found that moderate or high consumption of alcohol was related to higher prevalence of HDL-c normal or increased when compared to abstainers. Prevalence of hypertriglyceridemia was higher among individuals with high alcohol consumption (47.8%) compared with those with moderate consumption (22.7%) and abstainers (25.3%) (p, 0.0005); therefore, a higher alcohol consumption in males could explain a higher prevalence of hypertriglyceridemia, as well as the association between moderate/high consumption alcohol with normal or high HDL-c. Despite higher plasma levels of HDL-c with alcohol consumption and the clear prevalence of alcohol consumption among men, there was no significant difference in HDL-c between genders. Epidemiologic studies demonstrate higher levels of HDL-c in alcohol consumers. Alcohol affects lipoprotein metabolism in several stages. Regular consumption may be associated with increased synthesis of lipoproteins, decreased degradation of HDL-c, greater hepatic metabolism of LDL-cholesterol, further increase of triglycerides, with the inhibition of the oxidation of free fatty acids. Alcohol consumption is also responsible for modifying the dynamic metabolism of HDL- c . In South Korean, a study observed significantly higher TG levels among excessive drinkers men. Such high consumption of alcohol was associated with high risk of MS due to high BP, impaired fasting glucose, abdominal obesity and TG .
Patients were stratified by medical or surgical ward and by the risk of VTE (low, medium, or high). The absolute difference in the proportion of patients receiving appropriate VTE prophylaxis between the two periods and the 95% confidence interval for that difference were calculated for each stratum. Comparisons between the two periods in terms of the clinical characteristics of the patients were tested using the chi-square test or t-test, as appropriate. The analysis included all eligible patients. Values of p < 0.05 were considered statistically significant. All data were analyzed using the Statistical Package for the Social Sciences, version 17.0 (SPSS Inc., Chicago, IL, USA), and WINPEPI, version 11.4 (http:// www.brixtonhealth.com/pepi4windows.html).
Tuberculosis continues to be a major public health problem. Although efforts to control the epidemic have reduced mortality and incidence, there are several predisposing factors that should be modified in order to reduce the burden of the disease. This review article will address some of the riskfactors associated with tuberculosis infection and active tuberculosis, including diabetes, smoking, alcohol use, and the use of other drugs, all of which can also contribute to poor tuberculosis treatment results. Tuberculosis can also lead to complications in the course and management of other diseases, such as diabetes. It is therefore important to identify these comorbidities in tuberculosis patients in order to ensure adequate management of both conditions.
Seven children had minor respiratory complications (SpO 2 90-80%), and 14 children had major respiratory complications (SpO 2 ≤ 80% [n = 2]; laryngospasm [n = 9]; bronchospasm [n = 5]; intraoperative bronchospasm [n = 2]; apnea [n = 1]; pneumonia [n = 1]; and acute pulmonary edema [n = 3]; Table 4). The group with respiratory complications remained in the PICU for ≥ 24 h, and the main medical interventions were antibiotic therapy (n = 1) for pneumonia, use of loop diuretics (n = 3) for acute pulmonary edema, continuous administration of nebulized bronchodilator or adrenaline (n = 12) for bronchospasm and laryngospasm, and reintubation (n = 3) for acute pulmonary edema and severe bronchospasm in the presence of URTI (Table 4). The postoperative mortality rate was zero, and the children with and without respiratory complications remained hospitalized for 3 ± 1 days and 5 ± 2 days, respectively.
Multiple riskfactors play role in development of SSI which can be broadly classified into – Bacterial factor, Patient factor and local wound factor. The interaction between these three determines the development of SSI and so it is difficult to prove an independent association of a specific factor for development of SSI particularly when looking at different groups of surgical patients. So there is difference in rates of SSI in different studies.
Safe vascular access is one of the key factors for modern medical practice; however, the intravascular devices (IVDs) needed for establishing reliable access are significantly associated with iatrogenic disease, especially bacteremia and candidemia [1,2]. Over 250,000 bloodstream infections (BSI) related to the presence of IVDs occur each year in the U.S., with an attributed death rate of 12-25%; BSIs also extend hospital internment, with additional costs of US$33,000-35,000/ patient [3,4]. Among IVDs, the use of central venous catheters (CVCs) is frequently followed by both local and systemic complications, including septic thrombophlebitis, endocarditis, metastatic infections, and bacteremias .
Almost 30% of the children had a cognitive impairment or language impairment --- impairments defined as scores falling one standard deviation below the mean. In contrast to stunted growth, cognitive and language development were not associated with biological riskfactors, but only with social ones. Cognitive development was associated with the HOME score; language development was associated with the HOME score and the quality of the neighborhood in terms of infrastructure, and interaction and trust. The data sug- gest that childhood cognitive and language development in disadvantaged communities are strongly dependent on envi- ronmental conditions, implying that improvement of these environmental conditions may promote child development. Indeed, the review of Komro et al. 8 indicated that strate-