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Complications after oesophagectomy with possible contribution of neoadjuvant therapy including an EGFR-antibody to a fatal outcome
Michael Knauer, Anton Haid, Karlheinz Ammann, Alois Lang, Felix Offner, Martina Türtscher, Peter Cerkl, Etienne Wenzl
World Journal of Surgical Oncology , 2007, DOI: 10.1186/1477-7819-5-114
Abstract: We present the case of a patient with fatal complications after oesophagectomy and neoadjuvant chemotherapy including cetuximab for squamous-cell esophageal cancer. A transthoracic en-bloc oesophagectomy was performed. Few days later the patient died due to gas exchange dysfunction and circulation instability after a previously unseen combination of drain-erosion of the stomach with subsequent pleurisy and air leak of the left main bronchus.So far we have never observed this fatal combination of drain erosion of the stomach with fibrinous pleurisy and unmanageable progressive tracheal defect before. The role of cetuximab in the multifactorial aetiology of damages of stomach and trachea after oesophagectomy remains unclear since we are not able to link the complication directly to cetuximab or definitely exclude it as a sole surgical complication. Clinicians should be aware of the possibility of fatal side effects and careful recording of all complications is necessary in ongoing and planned studies to obtain more evidence about safety and tolerance of targeted therapies.Oesophageal cancer represents the sixth leading cause of cancer-related death in the world. Despite recent advances in surgical critical care medicine and combined modality therapies 5-year overall survival rates (10–14%) are unsatisfactorily low [1]. The only curative therapy in localized cancer is provided by radical surgery. However, more than 50% of all patients are diagnosed with inoperable or metastatic disease [2]. Next to radical surgery compared with chemoradiotherapy alone [3], neoadjuvant chemotherapy approaches have been studied with a pathologic complete response rate (pCR) of up to 24% [4]. Although some authors state that still no standard recommendation can be given for a multimodality therapy outside clinical trials [5], randomised trials exist showing survival benefits after neoadjuvant chemotherapy and therefore neoadjuvant chemotherapy is considered part of standard practice in ma
Complications from students\' small animal surgical laboratories
BD Sanni, IL Elisha, AZ Hassan, JB Adeyanju
Nigerian Veterinary Journal , 2003,
Abstract: Three hundred and seventy four (374) post surgical complications were recorded in a retrospective study of operations carried out during the student's small animal surgical laboratories Zaria between 1990 and 1993. Wound dehiscence (28.1%), wound infection (24%), and haemorrhage (13.9%) were the commonest complications observed. Other complications include death, oedema, peritonitis, aural asymmetry, evisceration, intestinal obstruction, herniation, perivascular sloughing, moist dermatitis, intramedulary pin (IM) migration, self-mutilation, adhesions, myositis and ankylosis. Correction of skin defects, caudectomy and castration resulted in higher number of complications. Interviews of instructors of the surgical laboratories, conducted through questionnaires revealed that the use of stray dogs with poor nutritional and health status, septic surgical procedures, poor use of surgical instrument and seldom cleaned/disinfected kennels were some of the factors that led to high incidence of complications. Management of complications entailed the use of systemic antibiotics, treatment of surgical site as an open wound or in some cases reconstructive surgery. Recommendations are made on how to avert occurrence of post surgical complications from students' small animal surgical laboratories. KEY WORDS: Surgical complications, student practical, dogs Nigerian Veterinary Journal Vol.24(2) 2003: 57-62
Pulmonary Complications as a Cause of Death after Renal Transplantation  [PDF]
Ventsislava Pencheva, Daniela Petrova, Diyan Genov, Ognian Georgiev
Open Journal of Internal Medicine (OJIM) , 2014, DOI: 10.4236/ojim.2014.42007
Abstract: Objectives: To analyse the risk factors for death as a result of pulmonary complications in kidney transplant patients. Material and Methods: 267 patients after renal transplantation were prospectively studied. The kidney recipients were followed for the development of pulmonary complications and their outcome for a period of 7 years. Different noninvasive and invasive diagnostic tests were used in cases suspected for lung disease. Results: Risk factors for death as a result of pulmonary complications are development of lung diseases in the first six months after operation (P < 0.05), and immunosuppressive regimens that include mycophenolate mofetil (HR: 3.216; 95% CI: 1.067 - 5.577; P = 0.011). The factors associated with lower rate of fatal outcome are positive serology test for Cytomegalovirus of the recipient before transplantation (P = 0.034) and use of azathioprine (HR: 0.720; 95% CI: 0.526 - 0.986; P = 0.04). Conclusions: The risk factors may be used to identify patients at increased risk for death due to the pulmonary complications. Strictly monitoring of higher-risk patients can reduce the morbidity and mortality after renal transplantation.
Imaging of psot-surgical complications in urinary pathologies
Luca Bertini,Sarah Campagnano,Maria Luisa De Cicco,Cristina Valentini
Emergency Care Journal , 2009, DOI: 10.4081/ecj.2009.5.23
Abstract: Urinary tract surgical interventions are complex end followed by frequent complications which in some cases become fatal. The recent advances on the surgical techniques during the last few years changed the prognosis of this patient reducing the rate of complications in meaningful way. Radical nephrectomy, partial resection of the kidney, urinary derivations and also endoscopic procedures on the bladder and the prostate can be followed from vascular, urological or gastrointestinal complications. The task of the radiologist is mainly to ready recognize the post-surgical complications and to differentiate them from the normal post-operative aspects, but in order to make this the anatomical modifications and the normal post-operative radiological aspects must be known so as to direct the diagnosis using the most appropriate imaging method.
Surgical and Postoperative Complications of Prepubertal Ovariohysterectomy in Dogs
B.H. Sontas,T.S.F. Toydemir,H. Ekici
Journal of Animal and Veterinary Advances , 2012,
Abstract: In this study, a total of 25 clinically healthy, six to eight week old, mixed breed female puppies were used to investigate the surgical and postoperative complications of ovariohysterectomy performed at 10 weeks of age. Fourteen animals were completely ovariohysterectomized (group Po) in a routine manner and eleven animals were sham operated (group Lp). No deaths occured during the surgical procedures whereas three puppies died during postoperative period because of infectious diseases. In group Po, two animals had both surgical and postoperative complications whereas five animals had only postoperative complications. In group Lp, no surgical complications occured but two of eleven puppies had postoperative complications. Of all the animals that participated to the study, 36% had complications and 64% did not have any complication. No significant differences were observed in the number of surgical and postoperative complications between the groups except suture reaction or incisional swelling (p<0.01). Apart from the infectious diseases that resulted with death, no other postoperative complications required a medical treatment.These findings suggest that, in dogs, complete ovariohysterectomy with proper anesthetic and surgical techniques performed at 10 weeks of age is a safe and reliable contraception method.
Post surgical complications from students' large animal surgical exercise
B.D. Sanni, E.O. Olainipekun, A.K. Sackey, S.T. Fadason, E.O. Gyang
Nigerian Veterinary Journal , 2002,
Abstract: A retrospective study of post surgical complications was conducted on records of students' Large Animal Surgical Laboratories in the Faculty of Veterinary Medicine (F.V.M.), Ahmadu Bello University (A.B.U), Zaria from 1989 to 1993. Three hundred and eleven surgical complications were recorded from five surgical procedures namely dehorning, orchidectomy, vasectomy, rumenotomy and enterotomy. The commonest complications were wound dehiscence (25.4%), sinusitis (16.7%), and hemorrhage (14.6%). Others included fever (11.3%), edema (10.6%) slipped ligature (6.4%), wound infection (5.5%), peritonitis (4.8%), death (2.6%), intestinal obstruction/adhesion (1.3%), physiological bloat (0.6%) and myiasis (0.3%). Dehorning, castration and rumenotomy resulted in more complications. Surgical site debridement and surgical reconstruction coupled with antibiotic therapy were used in the management of complications. Responses from questionnaires administered to instructors of the surgical laboratories, revealed that post surgical complications were due to poor health status of sheep and goats used, broken asepsis during surgery, wrong use of instrument, poor surgical technique and dirty pens in which they were kept after surgery. Surgical complications no doubt contribute to tremendous high cost of running the students' surgical laboratories which was estimated to cost N80,000 per annum. In order to minimize these complications and consequently to reduce money spent on surgical reconstruction and antibiotic therapy some recommendations are made. KEY WORDS: Surgical complications, students' practical, sheep and goats (Nigerian Veterinary Journal: 2002 23(2): 40-45)
Clinical Experiences of Bronchopleural Fistula-related Fatal Hemoptysis after the Resection of Lung Cancer: A Report of 7 Cases  [cached]
Zhenming ZHANG,Yun WANG
Chinese Journal of Lung Cancer , 2012, DOI: 10.3779/j.issn.1009-3419.2012.01.08
Abstract: Background and objective Massive hemoptysis was a rare but severe postoperative complication of lung cancer. The aim of the present study is to investigate the mechanisms, risk factors, early symptoms, prevention, and treatment options for fatal hemoptysis. Methods From April 2007 to May 2011, 1,737 patients with lung cancer were surgically treated in the West China Hospital of Sichuan University. Twenty patients died during the perioperative period, seven of whom died of massive hemoptysis. These seven cases were analyzed, and their clinical data, as well as related literatures, were reviewed. Results Massive hemoptysis is the second cause of death after lung cancer surgery. Six patients died directly of massive hemoptysis. One patient underwent secondary surgery because of massive hemoptysis, but eventually died because of lung infection and respiratory failure. Early symptoms of hemorrhage were observed in four cases, and the overall incidence rate of massive hemoptysis was 0.4% (7/1,737). Conclusion Bronchovascular stula (BVF) caused by bronchopleural fistula (BPF) is the mechanism for massive hemoptysis. Diabetes is a high risk factor. Early diagnosis and surgical treatment of BPF or BVF can prevent the occurrence of death as a result of massive hemoptysis.
Surgical Complications of Cochlear Implantation
Basir Hashemi,Akbar Bayat,Tayebe Kazemei
Iranian Journal of Medical Sciences , 2010,
Abstract: Cochlear implantation is a method used for the treatment ofpatients with profound hearing loss. This procedure may theaccompanied by some major or minor complications. Weevaluated the surgical complications of cochlear implantationin Fars province (south of Iran). A total of 150 patients withcochlear implantation were enrolled in the present study. Mostof the patients were pre-lingual children and most of our deviceswere nucleus prosthesis. We had three device failuresand four major complications, including one misplaced electrode,one case of meningitis, one case of foreign body reactionto suture and one case with extensive hematoma. Thesecomplications were managed successfully by surgical interventionor re-implantation. Facial nerve damage or woundbreakdown was not seen. Minor complications including smallhematoma, edema, stitch infection and dizziness were found in15 cases, which were managed medically. In our center, therate of minor complications was comparable to other centersin the world. But the rate of major surgical complications waslower than other centers.
Surgical Complications in Early Period after Renal Transplantation
Janis Jushinskis, Vadims Suhorukovs, Sergejs Trushkovs, Janis Bicans, Victors Shevelevs, Rafails Rozentals
Acta Chirurgica Latviensis , 2010, DOI: 10.2478/v10163-011-0004-2
Abstract: Introduction. Growing number of elderly transplant recipients and expansion of the criteria for organ donation may increase the risk of post-transplant complications and impact outcomes. Aim of the Study. The aim of this study was to define the rate of surgical complications needing re-operations and their impact on posttransplant outcomes. Materials and methods. Study includes 202 consecutive deceased donor renal transplantations performed from 01.01.2004 till 31.12.2006. with further follow-up for 3 years. We analyzed the rate of re-operations, associated donor, recipient and transplantation factors and impact on post-transplant outcomes. Results. Reasons for re-operations were bleeding and hematoma formation (n=27), urological complications (n=18) and lymphocele (n=26). Hematomas were associated increased donor body mass index (BMI, p=0,067), presence of glomerular sclerosis at zero-time biopsy (p=0,034) and with development of urological complications (p=0,004) and delayed graft function (p=0,012). Urological complications were not associated with donor, recipient and transplant factors. Lymphocele were associated with donor factors (non-traumatic brain death, p=0,034, asystoly and hypotension, p=0,077, BMI, p=0,061, presence of glomerular sclerosis at zero-time biopsy, p=0,030), re-transplantations (p=0,092) and ATG use (p=0,094). Graft loss and patient survival during the follow-up period were not associated with mentioned surgical complications. Conclusions. Post-transplant surgical complications are associated with donor condition but without impact on three-year graft and patient survival.
Bilateral Spontaneous Pneumothorax, Pneumomediastinum, and Subcutaneous Emphysema: Rare and Fatal Complications of Asthma  [PDF]
Zeynep Karakaya,?erafettin Demir,S?nmez Serkan Sagay,Olcay Karakaya,Serife ?zdin?
Case Reports in Emergency Medicine , 2012, DOI: 10.1155/2012/242579
Abstract: Simultaneous bilateral spontaneous pneumothorax (SBSP) and pneumomediastinum are complications rarely observed synchronously during an acute asthma attack. It is a clinical condition that manifests itself with serious respiratory distress and must be rapidly diagnosed and treated. Although bilateral spontaneous pneumothorax has already been reported in asthma patients in the literature, its concurrence with subcutaneous emphysema and pneumomediastinum is extremely rare except for iatrogenic conditions. By sharing this case about a 39-year-old patient who presented to the emergency room with severe respiratory distress and developed cardiopulmonary arrest during his physical examination, our aim is to emphasize that a rapid diagnosis and treatment by the emergency physicians is the only way for survival in these patients. 1. Introduction Asthma is a disease characterised by symptoms including wheezing, dyspnea, cough, tightness in the chest, chronic airway inflammation and increased airway resistance [1]. Simultaneous bilateral spontaneous pneumothorax (SBSP), subcutaneous emphysema, and pneumomediastinum that develop during an asthma attack are important and life-threatening complications that are observed singly or rarely synchronously. Collection of air in the pleural cavity and the subsequent collapse of the lungs is a condition known as pneumothorax [2]. The ratio of simultaneous bilateral spontaneous pneumothorax is approximately 1.3% among all cases of pneumothorax [3]. In patients with SBSP, the incidence of an underlying lung disease is greater than in the patients with unilateral spontaneous pneumothorax [4]. Pneumomediastinum is the presence of gas or free air in the mediastinum. Although it is generally a benign condition, its concurrence with pneumothorax may prove fatal during a serious asthma attack. A rapid diagnosis and treatment may be life-saving in these patients. 2. The Case A 39-year-old male patient was brought to the emergency room with respiratory distress and chest pain. The patient’s general condition was poor and his mental state was agitated. His BP was 100/60?mmHg; the heart rate was 130?bpm and his respiratory rate was 33 breaths per minute. The patient was cyanotic and the pulse oximeter revealed an oxygen saturation of 68%. Since the patient went into respiratory arrest and lost consciousness during the examination, a rapid endotracheal intubation was performed in order to keep the airway open and respiration was supported with the help of a bag valve mask. In the auscultation of the lungs, reduced respiratory sounds were
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