Browsing by Subject " complications"

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  • Hällfors, Eerik; Saku, Sami A.; Mäkinen, Tatu J.; Madanat, Rami (2018)
    Background: Different measures for reducing costs after total joint arthroplasty (TJA) have gained attention lately. At our institution, a free-of-charge consultation phone service was initiated that targeted patients with TJA. This service aimed at reducing unnecessary emergency department (ED) visits and, thus, potentially improving the cost-effectiveness of TJAs. To our knowledge, a similar consultation service had not been described previously. We aimed at examining the rates and reasons for early postdischarge phone calls and evaluating the efficacy of this consultation service. Methods: During a 2-month period, we gathered information on every call received by the consultation phone service from patients with TJAs within 90 days of the index TJA procedure. Patients were followed for 2weeks aftermaking a call to detectmajor complications and self-initiated EDvisits. Datawere collected fromelectronic medical charts regarding age, gender, type of surgery, date of discharge, and length of hospital stay. Results: We analyzed 288 phone calls. Calls were mostly related to medication (41%), wound complications (17%), and mobilization issues (15%). Most calls were resolved in the phone consultation. Few patients (13%) required further evaluation in the ED. The consultation service failed to detect the need for an ED visit in 2 cases (0.7%) that required further care. Conclusion: The consultation phone service clearly benefitted patients with TJAs. The service reduced the number of unnecessary ED visits and functioned well in detecting patients who required further care. Most postoperative concernswere related to prescribed medications, wound complications, and mobilization issues. (c) 2017 Elsevier Inc. All rights reserved.
  • Jokela, Johanna; Tapiovaara, Laura; Lundberg, Marie; Haapaniemi, Aaro; Bäck, Leif; Saarinen, Riitta (2018)
    Objectives. To evaluate the incidence and nature of complications associated with diagnostic and interventional sialendoscopies and to report intervention failures in a prospective setup. Study Design. Prospective observational study. Setting. Academic tertiary care university hospital. Subjects and Methods. Patients who underwent diagnostic or interventional sialendoscopy between October 2015 and December 2016 were prospectively enrolled. Patient data, operation-related factors, treatment failures, and complications were recorded into a database and analyzed. Results. A total of 140 sialendoscopies were attempted or performed on 118 patients; 67 (48%) were for a parotid gland and 73 (52%) for a submandibular gland. The sialendoscopy was interventional in 81 cases (58%), diagnostic in 56 (40%), and not possible to perform in 3 (2.1%). A total of 21 complications were registered for 21 sialendoscopies (15%) and 21 patients (18%). The most common complication was infection, in 9 cases (6.4%). Other observed complications were salivary duct perforation (4 cases), prolonged glandular swelling (3 cases), transient lingual nerve analgesia (2 cases), basket entrapment (2 cases), and transient weakness in the marginal branch of the facial nerve (1 case). All complications were related to interventional procedures or papilla dilatation. Failure to treat occurred in 21 (15%) sialendoscopies: sialendoscopy itself was unsuccessful in 3 cases, and an intended intervention failed in 18 cases. Conclusion. Complications in sialendoscopy are usually related to interventional procedures. The complications are mainly minor and temporary but lead to additional follow-up visits, further treatments, and sometimes hospitalization. Sialendoscopic procedures are safe but not free of complications.
  • Chaudhry, Shafqat Rasul; Kahlert, Ulf Dietrich; Kinfe, Thomas Mehari; Lamprecht, Alf; Niemelä, Mika; Hänggi, Daniel; Muhammad, Sajjad (2020)
    Background: Aneurysmal subarachnoid hemorrhage (SAH) is a highly complex disease with very high mortality and morbidity. About one-third of SAH patients suffer from systemic infections, predominantly pneumonia, that can contribute to excess mortality after SAH. Immunodepression is probably the most important mechanism leading to infections. Interleukin-10 (IL-10) is a master regulator of immunodepression, but it is still not clear if systemic IL-10 levels contribute to immunodepression, occurrence of infections and clinical outcome after SAH. Methods: This explorative study included 76 patients with SAH admitted to our neurointensive care unit within 24 h after ictus. A group of 24 patients without any known intracranial pathology were included as controls. Peripheral venous blood was withdrawn on day 1 and day 7 after SAH. Serum was isolated by centrifugation and stored at -80 degrees C until analysis. Serum IL-10 levels were determined by enzyme-linked immunoassay (ELISA). Patient characteristics, post-SAH complications and clinical outcome at discharge were retrieved from patients' record files. Results: Serum IL-10 levels were significantly higher on day 1 and day 7 in SAH patients compared to controls. Serum IL-10 levels were significantly higher on day 7 in patients who developed any kind of infection, cerebral vasospasm (CVS) or chronic hydrocephalus. Serum IL-10 levels were significantly higher in SAH patients discharged with poor clinical outcome (modified Rankin Scale (mRS) 3-6 or Glasgow Outcome Scale (GOS) 1-3). Conclusion: Serum IL-10 might be an additional useful parameter along with other biomarkers to predict post-SAH infections.
  • Jalanko, T.; Helenius, I.; Pakarinen, M.; Koivusalo, A. (2018)
    Study Design: A retrospective cohort study of consecutively operated neuromuscular scoliosis patients. Background and Aim: Surgical correction of neuromuscular scoliosis can be complicated by early gastrointestinal complications, but data on the extent and severity of them is scarce. The aim of the study was to determine the incidence, course, and risk factors of gastrointestinal complications after neuromuscular scoliosis correction. Material and Methods: Ninety-one patients ( Results: The average age at surgery was 14.5 (SD 2.9) and follow-up time was 4.9 (SD 2.3) years. Gastrointestinal complications occurred in 12 (13%) patients and included prolonged paralytic ileus (7%, 6/91), dysphagia (7%, 6/91), and gastroparesis (1%, 1/91). Hospital stay was 22 (SD 11) days in patients with gastrointestinal complications and 16 (SD 20) days in non-complicated patients (p = 0.005). Dysphagia required permanent feeding gastrostomy in one patient whereas other complications were transient and none caused death. The risk factors for postoperative gastrointestinal complications were preoperative main curve correction 90 degrees (RR = 5.5 (95% CI 1.3-23); p = 0.020), disturbance in intraoperative spinal cord monitoring (RR = 6.0 (95% CI 1.1-34); p = 0.043), and intravenous opioid medication over 5 days postoperatively (RR = 7.9 (95% CI 1.8-35), p = 0.006). Conclusion: Gastrointestinal complications occurred in 13% of patients after neuromuscular scoliosis correction. Marked gastrointestinal complications extended postoperative hospitalization period, but they were transient in majority (92%) of cases and none caused death. Rigid scoliosis was the most significant risk factor for gastrointestinal complications. Gastrointestinal complications appear to be less frequent after posterior only spinal fusion with total pedicle screw instrumentation and Ponte osteotomies.
  • Karjalainen, E. K.; Renkonen-Sinisalo, L.; Mustonen, H. K.; Lepistö, A. H. (2019)
    AimRestorative proctocolectomy with ileal pouch-anal anastomosis is considered by many surgeons to be the standard procedure for surgical management of ulcerative colitis. There is controversy about whether or not a covering ileostomy should be constructed. The aim of this study was to evaluate the outcomes and morbidity for patients with ulcerative colitis who underwent restorative proctocolectomy with or without a diverting ileostomy. MethodThis is a retrospective study of a consecutive series of 510 patients with ulcerative colitis who were operated on in Helsinki University Hospital between January 2005 and June 2016. A diverting ileostomy was performed in 119 patients (the stoma group) compared with 391 patients with no stoma. ResultsDehydration and intestinal obstruction occurred more often in the stoma group (P ConclusionOur study shows that a diverting ileostomy is associated with considerable morbidity but it does not seem to prevent later failure of the pouch. We suggest that a diverting ileostomy should only be constructed for high-risk patients.
  • Orlanski-Meyer, Esther; Topf-Olivestone, Chani; Ledder, Oren; Dotan, Iris; Folmer-Hansen, Lars; Kindermann, Angelika; Assa, Amit; Kolho, Kaija-Leena; Kolacek, Sanja; Carroll, Matthew W.; Strisciuglio, Caterina; Aloi, Marina; Hansen, Richard; Navon, Dan; Winter, Harland S.; Navas-Lopez, Victor M.; de Ridder, Lissy; Smets, Francoise; Weiss, Batia; Turner, Dan (2020)
    Introduction: Contemporary pediatric data on pouch outcomes are sparse, especially in the era of laparoscopic surgeries. We aimed to assess outcomes and predictors in children with ulcerative colitis/inflammatory bowel disease (IBD)-unclassified who underwent colectomy and ileal pouch-anal anastomosis. Methods: This was a multicenter retrospective cohort study from 17 IBD centers affiliated with the pediatric IBD Porto group of ESPGHAN. An electronic REDcap system was used to collate baseline characteristics, demographic, clinical, management and surgical data, short- and long-term outcomes, and to identify potential predictors of pouch outcome. Results: Of the 129 patients included, 86 (67%) developed pouchitis during follow-up of median 40 months (interquartile range 26-72), of whom 33 (26%) with chronic pouchitis. Patients operated on by surgeons performing
  • Laine, M.; Siren, J.; Koskenpato, J.; Punkkinen, J.; Rantanen, T.; Typpö, I.; Kokkola, A.; Sallinen, V. (2018)
    Background and Aims: Severe, medically uncontrollable gastroparesis is a rare entity, which can be treated using a high-frequency gastric electric stimulator implanted surgically. Previous follow-ups have proven positive outcomes with gastric electric stimulator in patients with gastroparesis. The aim of this study was to evaluate the efficacy and safety of gastric electric stimulator in patients, in whom gastroparesis could not be controlled by conservative means in our country. Materials and Methods: This is a retrospective multi-center cohort comprising all patients who had been implanted gastric electric stimulator for severe, medically refractory gastroparesis during 2007-2015 in Finland. Results: Fourteen patients underwent implantation of gastric electrical stimulator without any postoperative complications. Laparoscopic approach was used in 13 patients (93%). Prior implantation, all patients needed frequent hospitalization for parenteral feeding, 13 had severe nausea, 11 had severe vomiting, 10 had notable weight loss, and 6 had frequent abdominal pain. After operation, none of the patients required parenteral feeding, 11 patients (79%) gained median of 5.1 kg in weight (P <0.01), and symptoms were relieved markedly in 8 and partially in 3 patients (79%). Of partial responders, two continued to experience occasional vomiting and one mild nausea. Five patients needed medication for gastroparesis after the operation. One patient did not get any relief of symptoms, but gained 6 kg in weight. No major late complications occurred. Conclusion: Gastric electrical stimulator seems to improve the nutritional status and give clear relief of the symptoms of severe, medically uncontrollable gastroparesis. Given the low number of operations, gastric electrical stimulator seems to be underused in Finland.
  • Sabahi, Mohammadmahdi; Salehipour, Arash; Kazemi, Azin; Sadeghi, Mohammadreza; Decaro, Nicola; Mozhgani, Sayed-Hamidreza; Jalilian, Farid Azizi; Yaghoobi, Mojtaba Hedayat (2019)
    Aim: The prevalence of human parvovirus B19 (B19V) and its association with other diseases in Iran are yet to be systematically assessed. This study aimed to evaluate the prevalence and disease association of B19V across Iran from 2000 to 2019. Methods: The literature search, based on different keywords in different databases, was performed. A total of 29 eligible studies were included and the essential information was collected from each article. Results: The results of this study show a relatively high prevalence of the B19V-associated diseases in all age groups of the Iranian population. Conclusion: The transmission of B19V and its complications should be prevented by developing preventative strategies.
  • Itäinen-Strömberg, Saga; Hekkala, Anna-Mari; Aro, Aapo L.; Vasankari, Tuija; Airaksinen, Kari Eino Juhani; Lehto, Mika (2020)
    Background Nonvitamin K antagonist oral anticoagulants (NOACs) are increasingly used in patients with atrial fibrillation (AF) undergoing elective cardioversion (ECV). The aim was to investigate the use of NOACs and warfarin in ECV in a real-life setting and to assess how the chosen regimen affected the delay to ECV and rate of complications. Methods Consecutive AF patients undergoing ECVs in the city hospitals of Helsinki between January 2015 and December 2016 were studied. Data on patient characteristics, delays to cardioversion, anticoagulation treatment, acute ( Results Nine hundred patients (59.2% men; mean age, 68.0 +/- 10.0) underwent 992 ECVs, of which 596 (60.0%) were performed using NOACs and 396 (40.0%) using warfarin. The mean CHA(2)DS(2)-VASc score was 2.5 (+/- 1.6). In patients without previous anticoagulation treatment, NOACs were associated with a shorter mean time to cardioversion than warfarin (51 versus. 68 days, respectively; p <.001). Six thromboembolic events (0.6%) occurred: 4 (0.7%) in NOAC-treated patients and 2 (0.5%) in warfarin-treated patients. Clinically relevant bleeding events occurred in seven patients (1.8%) receiving warfarin and three patients (0.5%) receiving NOACs. Anticoagulation treatment was altered for 99 patients (11.0%) during the study period, with the majority (88.2%) of changes from warfarin to NOACs. Conclusions In this real-life study, the rates of thromboembolic and bleeding complications were low in AF patients undergoing ECV. Patients receiving NOAC therapy had a shorter time to cardioversion and continued their anticoagulation therapy more often than patients on warfarin.
  • Rautio, Pilvi (Helsingfors universitet, 2017)
    Suun alueen lävistykset ovat yleistyneet länsimaissa. Lävistyksen hankkimisen on epäilty olevan yhteydessä muuhun riskikäyttäytymiseen. Kieli- ja huulilävistys ovat yleisimmät lävistystyypit. Tässä kirjallisuuskatsauksessa on keskitytty kyseisten lävistysten aiheuttamiin ongelmatilanteisiin. Lävistysten komplikaatiot voidaan jakaa välittömiin sekä pitkän aikavälin komplikaatioihin. Yleisimpiä lävistysten aiheuttamia haittoja ovat paikallinen tulehdus sekä ajan kuluessa paikalliset ienvetäymät. Myös kielikorun aiheuttamat hampaiden kiillevauriot ovat tavallista. Haittojen esiintyvyyttä voidaan vähentää huolellisella suuhygienialla, lävistyksen asettamisella anatomisesti sopivaan kohtaan sekä välttämällä korun kanssa leikkimistä suussa. Lävistyksen vuoksi ensiapuun hakeudutaan useimmin paikallisen tulehduksen vuoksi. Tulehdus voi estää potilasta itse poistamaan lävistyksen. Koru voidaan jättää dreeniksi, mikäli tulehduskohtaan kehittyy märkää. Harvinaisempia komplikaatioita ovat systeemiset infektiot, hermon tai verisuonen vaurioituminen, allergiset reaktiot sekä paikallinen parodontiitti. Vakavimmat komplikaatiot ovat liittyneet kielilävistyksiin. Arviot komplikaatioiden yleisyydestä ovat vaihtelevia ja asian määrittäminen vaatii lisää seurantatutkimuksia.
  • Nummi, Antti (Helsingin yliopisto, 2018)
    Objectives: The objective was to evaluate tolerability of BCG treatment and to determine if interruption impacts on treatment outcome. Furthermore, the incidence and characteristics of severe complications were recorded. Methods: We included 418 patients who received BCG instillations in our institution during 2009-2015. Reason for interruption, treatment outcome, number of instillations and diagnosis of BCG infection were recorded retrospectively. Results: Of the 418 patients who started BCG, 176 (42.1%) interrupted and discontinued BCG treatment, 23 (5.5%) interrupted due to suspicion of BCG infection. Systemic BCG infection was found in 7 (1.7%) patients and local in 5 (1.2%) patients. Other reasons for interruption were other adverse effects in 71 patients (17.0%), BCG failure in 46 patients (11.0%) and other reasons in 36 patients (8.6%). 86% of interruptions due to adverse effects occurred within the first 18 instillations. The probability of tumor recurrence (20.0% vs 10.7%) and disease progression (5.4% vs 1.2%) was higher with patients whose BCG treatment was interrupted. Conclusions: Severe complications are encountered in only <5% of patients. The propability of adverse effects and severe complications depend mostly on the host’s characteristics rather than on the BCG dose or the number of BCG instillations.