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At least 253 records · Page 14Linked to original sources
PubMed2004

Abdominal drainage after hepatic resection is contraindicated in patients with chronic liver diseases.

OBJECTIVE: The aim of this study was to determine whether abdominal drainage is beneficial after elective hepatic resection in patients with underlying chronic liver diseases. SUMMARY BACKGROUND DATA: Traditionally, in patients with chronic liver diseases, an abdominal drainage catheter is routinely inserted after hepatic resection to drain ascitic fluid and to detect postoperative hemorrhage and bile leakage. However, the benefits of this surgical practice have not been evaluated prospectively. PATIENTS AND METHODS: Between January 1999 and March 2002, 104 patients who had underlying chronic liver diseases were prospectively randomized to have either closed suction abdominal drainage (drainage group, n = 52) or no drainage (nondrainage group, n = 52) after elective hepatic resection. The operative outcomes of the 2 groups of patients were compared. RESULTS: Fifty-seven (55%) patients had major hepatic resection with resection of 3 Coiunaud's segments or more. Sixty-nine (66%) patients had liver cirrhosis and 35 (34%) had chronic hepatitis. Demographic, surgical, and pathologic details were similar between both groups. The primary indication for hepatic resection was hepatocellular carcinoma (n = 100, 96%). There was no difference in hospital mortality between the 2 groups of patients (drainage group, 6% vs. nondrainage group, 2%; P = 0.618). However, there was a significantly higher overall operative morbidity in the drainage group (73% vs. 38%, P < 0.001). This was related to a significantly higher incidence of wound complications in the drainage group compared with the nondrainage group (62% vs. 21%, P < 0.001). In addition, a trend toward a higher incidence of septic complications in the drainage group was observed (33% vs. 17%, P = 0.07). The mean (+/- standard error of mean) postoperative hospital stay of the drainage group was 19.0 +/- 2.2 days, which was significantly longer than that of the nondrainage group (12.5 +/- 1.1 days, P = 0.005). With a median follow-up of 15 months, none of the 51 patients with hepatocellular carcinoma in the drainage group developed metastasis at the drain sites. On multivariate analysis, abdominal drainage, underlying liver cirrhosis, major hepatic resection, and intraoperative blood loss of >1.5L were independent and significant factors associated with postoperative morbidity. CONCLUSION: Routine abdominal drainage after hepatic resection is contraindicated in patients with chronic liver diseases.

Abdomen↗
PubMed2004

Prescriptions for contraindicated category X drugs in pregnancy among women enrolled in TennCare.

Filling of prescriptions for medications labelled as category X by the United States Food and Drug Administration (considered to be contraindicated for use in pregnancy) was identified among 95 284 women enrolled in TennCare, Tennessee's programme for Medicaid enrollees and individuals without health insurance. Using administrative claims data, 391 women (4.10/1000) were identified as having filled category X prescriptions during pregnancy. This included 118 women (1.24/1000) who filled prescriptions for non-contraceptive oestrogens, 81 (0.85/1000) for sedatives, and 71 (0.75/1000) for statins. While many women had physician visits with a diagnosis consistent with a possible indication for an individual drug outside of pregnancy, none of these indications is included for use during pregnancy. Older women and disabled women were more likely than younger women (P < 0.0001) and women enrolled for other reasons (P < 0.0001) to fill category X prescriptions. Nearly two-thirds of the 391 women filled prescriptions after clinical signs or pregnancy tests would indicate pregnancy; nearly 40% filled a category X prescription after a pregnancy-related physician visit. Although the absolute rate of category X medication use in pregnancy is low, substantial numbers of women and their fetuses are exposed during pregnancy. Women above the age of 35 years and women enrolled in TennCare because of disabilities were more likely to fill prescriptions for category X medications during pregnancy than others, implying that risk communication to practitioners and women should focus on identification of these women to reduce their risk of exposure.

Adolescent↗
PubMed2004

Therapeutic plasmapheresis in patients with severe hyperthyroidism in whom antithyroid drugs are contraindicated.

Four patients with Graves' disease in whom antithyroid drugs could not be used were treated by plasmapheresis preoperatively. On admission all patients had severe hyperthyroidism. All patients were treated by beta blockers, cholestyramine and inorganic iodine before plasmapheresis. Plasmapheresis course consisted of three sessions. Removed plasma was replaced by a synthetic colloid solution and human albumin other than fresh-frozen plasma. Plasmapheresis led to decreases in serum T3 concentrations >78-40% and free T4 concentrations >69%. Near-total thyroidectomy could be performed in all patients. Although screening coagulation tests were within normal limits, patients 1 and 4 experienced more blood loss than usual during the operative procedure. Plasmapheresis could be used as an alternative therapeutic option in the preoperative management of severe hyperthyroid patients with contraindications to antithyroid drugs. However, this is an invasive procedure and patients should be followed carefully for prolonged clinic/subclinic coagulopathy due to plasma exchange.

Adult↗
PubMed1992

Percutaneous laparoscopic cholecystectomy: indications, contraindications and complications.

The indications, contraindications and complications of percutaneous laparoscopic cholecystectomy (PLC) were established from a group of 308 patients referred for cholecystectomy. Of the 308 patients 86% underwent PLC, 5% were commenced laparoscopically, but converted to open cholecystectomy and 9% were performed as open cholecystectomy from the outset. Complications included two bile leaks from the gall-bladder bed, one cystic duct stump leak and three retained stones. Pre-operative rather than intra-operative duct imaging was used so that common duct stones could be removed before operation. PLC is a safe procedure that has now become the standard technique for cholecystectomy.

Age Factors↗
PubMed2003

Contraindications to thrombolysis in patients taking coumarins.

A short cut review was carried out to establish what level of INR was a contraindication to thrombolysis in patients taking warfarins. Altogether 296 papers were found using the reported search, but none presented any evidence to answer the clinical question. More research is needed in this area and, in the mean time, local advice should be followed.

Aged↗
PubMed2004

Recognizing the clinical contraindications to the use of oral sodium phosphate for colon cleansing: a case study.

Oral sodium phosphate has been demonstrated in numerous clinical trials to be an effective and well-tolerated colonic cleansing agent. However, there exists a potential to induce shifts in intravascular volume. The phosphate load often results in hyperphosphatemia, which may precipitate hypocalcemia. A review at the authors' institution identified four patients with adverse events related to oral sodium phosphate. Three of these cases had pre-existing comorbidities that predisposed them to the adverse event, or had received doses higher than that used or recommended in previous trials. Recommendations for relative and absolute contraindications to the use of oral sodium phosphate are described.

Administration, Oral↗
PubMed2001

[Acupuncture: complications, contraindications and informed consent].

With the widespread usage of acupuncture, the number of reports about complications of this treatment increases. Harmless disturbances are common and include minor bleedings or haematomas, pain during insertion or after withdrawal of the needle, and skin symptoms. In every second acupuncture treatment, at least one of these complications occurs. Orthostatic dysregulations are relatively rare and can be observed in only 1% of patients. They can be prevented by treating the patient in a lying position, especially in the first treatment session. Stab injuries of internal organs most often affect the lungs, resulting in a pneumothorax. At least 23 cases have been published, 2 of them with fatal consequences. An inquiry of Norwegian doctors even suggests that until 1995 in Norway alone 250 cases of pneumothorax after acupuncture occurred. Stab injuries of other internal organs or the CNS are only described in case reports, but some of them had fatal consequences. Stab injuries of peripheral nerves or large vessels and systemic bacterial infections like sepsis or endocarditis are very rare but serious consequences have been described. The transmission of viral infections due to insufficiently sterilised acupuncture needles loses more and more importance. The incidence of local infections can possibly be influenced, but even in Europe this complication still occurs frequently. The overview of published complications leads to the contraindications of acupuncture. Disturbances of coagulation, immune deficiency, abnormal heart valves or prosthetic valves are the most important ones to name. Suggestions for obtaining informed consent may be helpful while performing clinical trials.

Acupuncture Therapy↗
PubMedDate not supplied

Is aortic valve replacement with bileaflet prostheses still contraindicated in the elderly?

BACKGROUND: Prolonged survival in the Western world has increased the number of elderly patients referred for open-heart surgery during the last decade. Aortic valve disease is the most common heart valve disease in aged patients. Which aortic valve substitute is best employed in the elderly is still a debated matter. The main concern is about the thromboembolic and hemorrhagic risks related to mechanical valves and anticoagulation. OBJECTIVE: The study aimed at reviewing clinical results after isolated aortic valve replacement with bileaflet prostheses in patients over 70 years and at retrospectively comparing them with those of a group of otherwise comparable patients under 50 years of age who underwent isolated aortic valve replacement with a mechanical device. METHODS: The study population included 118 consecutive elderly patients (group A) operated on between January 1988 and January 1999 and 122 young patients (group B) who underwent aortic valve replacement during the same time period. Patients with associated coronary artery disease, mitral stenosis or regurgitation, type A aortic dissection, and infective endocarditis were excluded from the study. Preoperative clinical data, early and late postoperative mortality, all valve-related complications, and all data concerning the anticoagulation status - including the mean international normalized ratio (INR) and the mean time interval between each INR assay - were compared between the two groups. RESULTS: The hospital mortality was significantly lower in group B (2.45%) than in group A (9.3%; p = 0.022). The mean follow-up period was 50.98 +/- 2.23 months. The 12-year actuarial survival was significantly lower (69.6 +/- 0.08%) in group A than in group B (94.4 +/- 0.02%; p < 0.001). No significant difference was found in terms of valve-related and anticoagulation-related complication rates and actuarial freedom as well as mean interval between consecutive INR checks (p = 0.219) and mean INR value (p = 0.914). CONCLUSIONS: Bileaflet prostheses in elderly patients can achieve excellent early and late clinical results, with a low incidence of anticoagulation-related complications and an extremely low risk of a reoperation. Older age can no longer be considered a contraindication to bileaflet prosthesis implantation in the aortic position.

Adult↗
PubMed1998

Entering the ninth decade is not a contraindication for carotid endarterectomy.

The role of carotid endarterectomy (CEA) in stroke prevention is now better defined. However, its role in patients older than 79 years of age is controversial. This group of patients has been excluded in most clinical trials. In this study the authors reviewed their experience with CEA patients >79 years old. The records of all patients older than 79 years of age who underwent a CEA in a recent time period from January 1988 to December 1996 were retrospectively reviewed. Forty-one patients (31 men, 10 women) were identified by computer search. The indication for operation included transient ischemic attack in 12 (29.3%), amaurosis fugax in nine (22%), stroke in two (4.9%), and nonhemispheric symptoms in three (7.3%). Fifteen patients (36.6%) were asymptomatic. Medical risk factors included coronary artery disease in 26 (63.4%), hypertension in 22 (53.7%), and smoking in 12 (29.3%). The procedure was performed under EEG monitoring in all patients. General anesthesia was administered in 37 (90%) and regional anesthesia in four (10%). Shunts were used in four (10%) patients. The internal carotid artery was patched in 16 patients (39%). One patient (2.4%) developed a perioperative stroke and only one patient developed perioperative myocardial infarction (MI). None of the patients died within 30 days of surgery. In addition to the one MI case, five patients developed minor complications. The average length of time for stay after CEA was 3.4 days. Patients were followed up for an average of 20.7 months. Six patients died during follow-up. Four of those died from an MI and two from a stroke. The authors conclude that with proper selection of patients, CEA is safe in the octogenarian. Age alone should not be a contraindication for CEA.

Aged↗
PubMed1991

Cochlear implants as a contraindication to magnetic resonance imaging.

Magnetic resonance imaging poses little risk to the majority of patients undergoing scanning. However, cochlear implantation should pose a contraindication to this imaging process. This conclusion is based on several findings of in vitro testing of three cochlear implants: the 3M/House and 3M/Vienna designs and the Nucleus device. Specifically, tremendous torques are generated by each of these devices when they are introduced into the coil of a magnetic resonance imager; in addition, the 3M products not only were noted to induce an electrical current, but also were significantly magnetized and rendered afunctional. The clinical implications are discussed.

Cochlear Implants↗
PubMed2002

Acute sickle cell hepatopathy represents a potential contraindication for percutaneous liver biopsy.

After several complications following percutaneous liver biopsy in patients with sickle cell disease, we reviewed our experience. We examined 14 patients with sickle cell disease who underwent a percutaneous liver biopsy. Clinicopathologic findings were correlated with outcome. Of 14 patients, 5 (36%) suffered serious hemorrhage; 4 died (80%; 28% of all patients). None of the 9 patients without biopsy complications was in an acute sickling crisis at the time of biopsy; 4 of 5 patients with complications were in acute sickling crisis. Of the 5 patients with complications, 4 underwent biopsy for an emergency indication. Chronic venous outflow obstruction, marked hepatic sequestration of erythrocytes, and sinusoidal dilatation were strongly associated with complications. Data obtained by biopsy in group 1 were not of substantial value in clinical management, in contrast to group 2 (8/9; 89%). Acute hepatic disease complicating sickle cell anemia represents a newly identified contraindication to percutaneous liver biopsy.

Acute Disease↗
PubMed2003

Peroxisome proliferator-activated receptor-gamma in thyroid eye disease: contraindication for thiazolidinedione use?

A male type-2 diabetic, treated with the peroxisome proliferator-activated receptor (PPAR) agonist, Pioglitazone, experienced exacerbation of his thyroid eye disease (TED), which had been stable and inactive for more then 2 yr. Expansion of the orbital fat developed, and we have investigated the effects of PPAR gamma agonists, including Pioglitazone and, subsequently, an antagonist on the adipogenesis of preadipocytes from TED orbits and Graves' neck fats. The percentage of differentiating cells, assessed by oil red O staining, morphological changes, and PPAR gamma transcript levels, was determined for preadipocytes in hormone/agonist-induced models of adipogenesis, supplemented or not with PPAR gamma agonists or antagonist. The PPAR gamma agonists resulted in a 2- to 13-fold increase, and a PPAR gamma antagonist produced a 2- to 7-fold reduction in adipogenesis in vitro. Effects were dose dependent and maximal at 1 or 10 micro M. We suggest that care should be exercised when selecting patients for treatment with PPAR gamma agonists and that such agonists may be contraindicated in individuals with a previous history of autoimmune thyroid or eye diseases. Our work also suggests that PPAR gamma antagonists could provide a novel therapy for TED patients in the active stage of disease.

Adipocytes↗
PubMed2003

Epidural analgesia at end of life: facing empirical contraindications.

UNLABELLED: In a patient with unbearable cancer pain at the end of life, long-lasting analgesia without impairment of consciousness could only be achieved with an epidural infusion of local anesthetics combined with opioids and clonidine. Despite leptomeningeal infection during prolonged treatment, epidural analgesia at the lumbar level provided analgesia using very large doses of local anesthetics combined with clonidine and morphine. Thus, terminal sedation was avoided, allowing the patient's end-of-life planning of an "aware" death surrounded by her family. It may be useful to reconsider institutional pain management standards when unbearable pain occurs in patients with limited life expectancy. IMPLICATIONS: We report a patient with severe visceral and neurogenic pain from metastatic carcinoma of the colon resistant to multimodal oral analgesic therapy. Although there were empirical contraindications, epidural analgesia was successful, allowing the patient's end-of-life planning of an "aware" death surrounded by the family.

Abdominal Pain↗
PubMed2003

Percutaneous vertebroplasty: indications, contraindications, and technique.

Percutaneous vertebroplasty is an emerging interventional technique in which surgical polymethylmethacrylate is injected via a large bore needle into a vertebral body under imaging guidance. This technique provides increased strength and pain relief in vertebrae weakened by a variety of bone diseases. The current indication for vertebroplasty is intractable non-radicular pain caused by compression fractures due to osteoporosis, myeloma, metastases and aggressive vertebral haemangioma. Contraindications include bleeding disorder, unstable fracture and lack of definable vertebral collapse. Our technique of percutaneous vertebroplasty is illustrated in this pictorial review.

Back Pain↗
PubMed2002

Use of cisapride with contraindicated drugs in The Netherlands.

OBJECTIVE: To investigate the prevalence of concomitant use and coprescribing of cisapride with potentially interacting drugs to evaluate the impact of these warnings from 1994 to 1998. DESIGN: Retrospective follow-up study of patients using cisapride. SETTING: Data for this study were obtained from the pharmacy database of the Dutch PHARMO record linkage system (n = 834,000). RESULTS: From 1994 to 1998, the prevalence rate of the observed versus expected use of any potentially interacting drug decreased significantly over time (p < 0.01). However, the number of days-at-risk and number of coprescriptions of potentially interacting drugs among cisapride users increased on average by 13% and 9% per year, respectively. This increase was almost exclusively explained by a large increase in concomitant prescribing of clarithromycin, the most commonly used potentially interacting drug. Decreases in prevalence rates were observed for all individual potentially interacting drugs, except for concomitant use of fluconazole and miconazole. CONCLUSIONS: Over the last few years, healthcare professionals have refrained from dispensing potentially interacting drugs to patients who use cisapride, probably as a result of drug warnings implemented during this period. The limited absolute effects result from an increase of coprescription and concomitant use of clarithromycin and fluconazole among cisapride users. Because therapeutically equivalent alternatives were available for both drugs, such combinations were avoidable. Communicating information on these drug-drug interactions to prescribers and pharmacists and inclusion of cardiovascular morbidity as a relative contraindication for prescribing cisapride with these drugs may substantially decrease the risk of potentially adverse events to cisapride.

Cisapride↗
PubMed1992

Preoperative corticosteroids. A contraindication to lung transplantation?

Regular preoperative application of corticosteroids has been considered as a contraindication to lung transplantation for fear of an increased risk of postoperative morbidity and mortality. Recently, however, we have accepted patients for transplantation in whom treatment with steroid medication could not be terminated preoperatively. Up to February 1991, 27 unilateral and bilateral transplantations in 26 patients were analyzed. Corticosteroid therapy was discontinued at least three months prior to transplantation in 13 patients (group 1), whereas in 14 cases, the patients continued their daily corticosteroid therapy to the time of transplantation (prednisolone, 0.1 to 0.3 mg/kg/day; group 2). There were no significant differences between the groups with respect to sex, age, diagnosis, or type of transplantation. One limited bronchial dehiscence occurred; the incidence of postoperative bronchial stenosis was identical in both cohorts; one patient died in each group. In conclusion, no increased morbidity or mortality could be found following lung transplantation with regular preoperative administration of prednisolone up to 0.3 mg/kg/day. Thus, patients who cannot be weaned from their steroid medication but who otherwise are acceptable candidates should not be excluded from lung transplantation.

Adolescent↗
PubMed1993

Preventive therapy for the patient with both universal indication and contraindication for isoniazid.

BACKGROUND: The delphi method of decision making was used to address an unusual clinical case in which various aspects of the case required opposing management strategies. METHODS: A panel of 30 pulmonary experts was surveyed repeatedly until a convergence of treatment approaches was reached for a patient who was considered to have both a universal indication for and a universal contraindication against prevention therapy. Participants were asked to evaluate the appropriateness of proposed treatments on a scale from 1 to 9, with 1 being extremely inappropriate, 5 being equivocal, and 9 being extremely appropriate. The delphi survey data responses were compared using measures of central tendency (ie, the mean and median) and measures of variability (ie, the standard deviation and interquartile range). RESULTS: Although no treatment was wholeheartedly supported by the experts, analysis of the three-round delphi survey responses resulted in two possible treatments: rifampin, 600 mg daily, for four months, or no treatment with close observation. Interestingly, the experts working in a non-university setting favored the rifampin treatment, and those working in a university setting favored no treatment with close observation. CONCLUSIONS: The delphi method has the potential to be used for clinical decision making.

Adult↗
PubMedDate not supplied

Extremely high body mass index is not a contraindication to laparoscopic gastric bypass.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is an effective operation for morbidly obese patients who have failed conservative weight loss treatments. It is currently indicated for patients with BMI >40 kg/m2 or >35 with significant co-morbidities. Controversy exists whether there is an upper limit to BMI beyond which this operation should not be performed. METHODS: Between April 1999 and February 2001, 82 patients (19 male, 63 female) underwent LRYGBP. Average age was 43.6, and average BMI was 56 kg/m2. These patients were divided into those with BMI < 60 and those with BMI > or =60 kg/m2. RESULTS: There were 61 patients with BMI < 60 and 21 patients with BMI > or =60. The groups were similar in age, gender, distribution or incidence of co-morbid conditions (diabetes, coronary artery disease, hypertension, sleep apnea, asthma) between the groups. The BMI > or =60 group had a significantly longer length of stay (6.6 days vs 5.3 days, P <0.05), and only 1 patient (BMI 85) developed an anastomotic leak and died. 2 patients in this group (BMI 62 and 73) developed small bowel obstruction requiring lysis of adhesions. 1 patient in the BMI < 60 group developed a gastrojejunal stricture requiring balloon dilatation. CONCLUSION: While patients with a BMI > or =60 are at higher risk for postoperative complications, they are also at higher risk from continued extreme obesity. In our series, 85% of these patients had an uneventful postoperative course and began shedding excess weight. BMI > or =60 should not be a contraindication for LRYGBP.

Adult↗