[Cutaneous complications of coumadin therapy].
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Biomedical subjects
Publications and source records attributed to R Adar.
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The treatment results in 133 patients who underwent bilateral upper dorsal sympathectomy (BUDS) for palmar hyperhidrosis (HH) are reported. Group 1 (67 patients) was followed for 5 to 10 yr (mean 7) and Group 2 (66 patients) was followed for 1 to 4 yr (mean 2). Early results and complications, early and late sequelae, late recurrence and patient satisfaction with the results of the operation were analyzed. The immediate success rate was 98%, and late recurrence of HH was noted in 5.3% of the patients. The incidence of technical complications was lower in Group 2 than in Group 1, otherwise both groups were similar. Persistent, severe Horner's syndrome was present in only one patient at late follow-up. Troublesome compensatory HH persisted in one-third of the patients. Overall patient satisfaction was good, and only 10 patients regretted having undergone the operation. BUDS appears to be the best solution for severe palmar HH in properly selected patients.
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Advances in medicine that have led to more sophisticated methods of diagnosing, treating and monitoring patients take an ever increasing toll in iatrogenic complications. It may be argued that the net effect is an improvement in care, but it is self-evident that minimizing iatrogenic complications will increase the benefit to the patients of the ever increasing complex methods of treatment. Iatrogenic complications tend to be sporadic and varied in nature, and are difficult to study as a group. Psychological and medicolegal problems add to this difficulty. However, if the incidence of iatrogenic complications is to be decreased, a concerted effort has to be made to study them. Them report deals with an effort.
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Two rare event occurred in one patient: luxation erecta, an unusual form of dislocation at the shoulder, and axillary artery injury, hitherto undescribed in this type of dislocation. The arterial injury consisted of rupture of the intima with secondary thrombosis and occlusion. Following resection of the contused artery and saphenous vein graft replacement normal circulation was restored.
During the period 1973-79, 26 infections occurred in 931 vascular operations. The overall infection rate was 2.8%, and 80% of the infections occurred in groin incisions. There was a significantly higher infection rate when a synthetic graft was inserted, when there was an infected foot ulcer prior to operation, or when early reoperation was necessary. Several regimens of antibiotic treatment are described. The current practice of a short perioperative course of cefazolin, combined with irrigation of the wound with 1% povidone-iodine solution before closure of the skin resulted in an acceptably low rate of infection (less than 2%) during the last three years of the study period. There is no advantage in continuing postoperative antibiotic therapy for more than one to three days.