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PubMed2005

A Delphi consensus on criteria for contraindications, assessment indicators and expected outcomes related to tibialis posterior transfer surgery.

A team of experts in the field of reconstructive surgery for leprosy-affected people was identified. Using the Delphi method, an exercise was undertaken to ascertain whether a consensus on essential criteria and indicators for Tibialis Posterior Transfer (TPT) could be reached among the team. This paper describes the Delphi Exercise, giving results at each stage of consensus development. The final outcome was that essential criteria, including contraindications for surgery, pre- and post- operative assessments and expected outcomes, were agreed. The criteria are presented with recommendations.

Consensus↗
PubMed2005

Reexamining contraindications for minimally invasive mitral valve surgery.

Historically, contraindications to minimally invasive or robotic mitral valve surgery have included prior mastectomy, thoracic reconstruction, or chest radiation. However, we believe that by granting flexibility in the choice of skin incision site while performing careful dissection, surgeons can provide these patients the outstanding results afforded by a minithoracotomy. We present a patient who had undergone a prior mastectomy and radiation treatment in whom we performed a minimally invasive mitral valve repair through a right-sided minithoracotomy using the previous mastectomy incision.

Cardiac Surgical Procedures↗
PubMed2003

Systemic thrombolytic therapy after recent abdominal aortic aneurysm repair: an absolute contraindication?

Systemic thrombolysis in the early postoperative period can cause fatal hemorrhage. Systemic thrombolysis is often considered contraindicated after major vascular procedures; thus, experience with this scenario is limited. A 67-year-old man experienced massive pulmonary embolization after his abdominal aortic aneurysm was repaired with a bifurcated, woven Dacron graft. Because systemic thrombolysis was the only option for our patient's survival, he underwent this procedure with recombinant tis-sue-type plasminogen activator just 2 weeks after the Dacron graft repair of his abdominal aortic aneurysm. After clinical stabilization, abdominal and pelvic computed tomography showed no periprosthetic graft hemorrhage. The successful systemic thrombolysis suggests that this therapy may prove useful in extreme situations.

Aged↗
PubMed1999

[Myocardial infarct with ST segment depression: an absolute contraindication to thrombolytic therapy?].

The benefit of thrombolytic reperfusion has been demonstrated widely in patients who present with ST segment elevation and develop myocardial infarction. Instead, the role of thrombolytic therapy in patients who present with ST segment depression and develop myocardial infarction is still unresolved. The purpose of this paper is to review the literature on the subject and give rise to reconsideration of thrombolytic therapy in this subgroup of patients who are usually excluded from receiving thrombolytic agents because of the absence of indications and the presence of contraindications.

Angioplasty, Balloon, Coronary↗
PubMed1999

Are vaccination rates higher if providers receive free vaccines and follow contraindication guidelines?

BACKGROUND AND OBJECTIVES: Economics has been suggested as a barrier to vaccination, but data that link clinician reports to actual immunization rates are limited. This study examined the relationship between clinicians' self-report regarding likelihood of vaccinating and actual age at vaccination from a registry of children seen by the clinicians. METHODS: Standardized telephone survey results of 29 providers were compared to the immunization records of children seeing these providers, using analysis of contingency tables (on time versus late) and conditional hierarchical linear models with log age at diphtheria-tetanus-pertussis (DTP)#3, DTP#4, and measles-mumps-rubella (MMR)#1 as the dependent variables. RESULTS: Children seeing providers likely to refer an uninsured child for immunization were vaccinated at a later log age at DTP#4 but not for DTP#3 or MMR#1 than children seeing providers unlikely to refer. Vaccination rates were higher for MMR#1 (77% versus 48%), DTP#3 (84% versus 71%), and DTP#4 (82% versus 66%) among providers who received free vaccine, compared with children seen by providers who did not receive free vaccine. These results remained significant in the hierarchical analyses. Providers likely to vaccinate an 18-month-old with watery diarrhea had higher vaccination rates than those unlikely to vaccinate for MMR#1, DTP#3, and DTP#4; the results were also significant in the hierarchical analyses. CONCLUSION: Children are vaccinated later in the practices of providers who are likely to refer uninsured children to a public vaccine clinic for vaccination, who do not receive free vaccine supplies, or who overinterpret contraindications.

Age Factors↗
PubMed1999

[The indications and contraindications for the use of lung resection for tuberculoma in a diabetic patient].

Basing on retrospective analysis of clinico-radiological and morphological investigations, studying of immediate and late (follow-up from 1 to 15 years) results of the tuberculoma surgical treatment in 132 patients with diabetes mellitus (DM) the indications and contraindications for pulmonary resection conduction were elaborated. An optimal term of the chemotherapy course conduction before the operation, constituting 2-5 m.o., was determined. In differential diagnosis between tuberculoma and the tumor, when the tuberculosis is stabilized and DM is compensated the operation is performed without preliminary chemotherapy conduction.

Adolescent↗
PubMed1999

Shoulder arthroplasty. Indications, contraindications and complications.

Prosthetic substitution of the glenohumeral joint, begun at the end of the last century, has developed greatly in recent years. Today the most widely used shoulder prostheses are defined as "modular" because of their extensive adaptability. The capacity to adapt to anatomic variations must be incorporated within their structure, and normal articular biomechanics must be respected. The choice of prosthesis must be based on the condition of the joint surfaces, on the anatomic and functional condition of the rotator cuff. So endoprosthesis of the shoulder is indicated for avascular necrosis of the head of the humerus, fractures and pseudoarthrosis of the extreme proximal end of the humerus, arthropathy following rotator cuff rupture. Total shoulder prosthetization is indicated for glenohumeral osteoarthritis, rheumatoid arthritis and outcomes of endoprosthesis. The principal contraindications for shoulder replacement include an infection in progress, Charcot's arthropathy and severe neurological pathologies. The complications of shoulder prostheses include infection, dislocation, loosening of a component, periprosthetic humeral and glenoid fractures, nerve injuries, fractures of a prosthetic component and ectopic ossification. At present prosthetic substitution of the glenohumeral joint offers good results. Indispensable conditions for these results include anatomic and functional integrity of the musculature, good bone quality, correct positioning of the prosthetic components and a proper rehabilitation program.

Arthroplasty, Replacement↗
PubMed2000

[Thyrotoxicosis: indications and contraindications for radioiodine treatment].

Treatment of tyrotoxicosis with I131 has been performed successfully for more than 50 years. In the beginning some fears occurred concerning possible oncogenity and gonadal lesions in children. Those restrictions are a history now. Radiotherapy can be used as a method of choice in merely intensified thyrotoxicosis especially with diffused thyroid gland enlargement (with the exception of trachea and oesophagus compression cases), after depletion of other efficient treatment methods, with the lack of patient's consent to operation or to thyrostatic treatment. Gravidity, high possibility of pregnancy (4-12 months after the end of treatment) and breast-feeding time are the obvious contraindications. Though hypothyroidism is inevitable side effect after the therapy (replacement therapy is needed) generally proposed doses of I131 should not be limited to avoid low efficacy of the treatment.

Contraindications↗
PubMedDate not supplied

Cochlear implant. Histopathological guide to indications and contraindications: a post mortem study on temporal bones.

We have studied the temporal bones of 4 deceased donors, individuals one with cochlear saccular degeneration, another with Mondini dysplasia, another with an ossification of the basal turn of the cochlea and the round window, post meningitis and the fourth who was implanted 10 years before. The indications and contraindications for cochlear implant placement are discussed.

Cochlea↗
PubMed2000

Laparoscopic cholecystectomy in cirrhosis: contraindication or privileged indication?

Until recently, cirrhosis has been considered to be an absolute or relative contraindication of laparoscopic cholecystectomy. An evaluation of benefits and risks of laparoscopic cholecystectomy in the treatment of gall bladder lithiasis in cirrhotic patients is presented. Thirty-three consecutive laparoscopic cholecystectomies in patients with cirrhosis were performed between March 1990 and March 1997. During the same period, no open cholecystectomy was performed in patients with cirrhosis. There was no morbidity or mortality; the conversion rate was 6% (2/33). No patient received blood transfusion, and the mean hospital stay was 2.8 days. These results favorably compare with the results of open cholecystectomy. Specific advantages of laparoscopic cholecystectomy in patients with cirrhosis include the absence of wound infection and a lower rate of postoperative hepatic failure. Finally, laparoscopic surgery reduces the risk of viral contamination (the hepatitis B virus, the hepatitis C virus, or the human immunodeficiency virus) of the surgical staff.

Adult↗
PubMed2001

[Is allergy a contraindication for tonsillectomy?].

Many immunologists indicate that tonsillectomy (TE) performed in patients with allergy has an unfavourable impact on the development of allergy and asthma. This warning has significantly decreased the number of TE in children, and resulted in an increase in the occurrence of peritonsillar abscesses, and high incidence of obstructive breathing disturbances during sleep associated with developmental physical and mental consequences in children. The subjective of this study was to find out the influence of TE on the development of allergy in 29 children, in whom their allergy was confirmed 1-5 years after TE. The allergic disease has improved or disappeared in 24 children (82.8%), no changes were recorded in 4 children (13.8%), deterioration has occurred only in 1 child (3.4%) who developed asthma, while in common population, asthma occurs in 10% of children. The results of this study confirm that TE does not have an unfavourable impact on the development of allergy, and therefore allergy does not represent a contraindication for tonsillectomy. (Fig. 1, Ref. 22.)

Asthma↗
PubMed2001

[Extra-oral implants: indications and contraindications].

Osseointegrated facial prostheses are an interesting solution for maxillofacial rehabilitation when reconstructive surgery cannot be proposed. Progress in epithesis materials and in implantation techniques have renewed interest in maxillofacial prostheses. The best indications are for rehabilitation of nasal, auricular and orbitopalpebral defects. Another indication is complex loss of facial tissue. Endo-osseous epitheses are recommended mainly when there is no possibility of reasonable and satisfactory surgical reconstruction, when local carcinologic prognosis is uncertain, and to respond to the patient's demands. We detail here the precautions necessary when irradiation has been performed previously and finally present the contraindications against epitheses on osseointegrated implants.

Biocompatible Materials↗
PubMed2001

Botulinophilia: contraindication for therapy with botulinum toxin.

Botulinum toxin inhibits neuromuscular transmission and is one of the most potent toxins. It has proven to be effective in the treatment of hyperhidrosis and is being more frequently demanded for therapy. Patients with body dysmorphic disorder also seek costly treatment with botulinum toxin. This botulinophilia is a new venenophilia. Body dysmorphic disorder is defined as a preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person's concern is markedly exessive. The patient's preoccupation causes clinically significant distress or impairment in socially, occupational, or other important areas of functioning. The sweat test according to Minor is negative. Patients with botulinophilia are among the most difficult patients managed by the dermatologist. They are demanding and time-consuming. In our clinic, 23.1% of a series of patients seeking treatment with botulinum toxin screened positive for body dysmorphic disorder. Botulinophilia is a contraindication for therapy with botulinum toxin but is an indication for psychotherapy.

Adult↗
PubMed2002

[Precautions for use and contraindications of thiazolidinediones. A cardiologist opinion].

The European marketing authorization ( product licence ) for thiazolidinediones (rosiglitazone and pioglitazone) contraindicate their use in type 2 diabetic patients with cardiac failure or history of cardiac failure. A warning and special precautions for use apply to fluid retention and cardiac failure. The main experimental and clinical data currently available are reviewed. Guidance are given to prescribing physician for the initiation of thiazolidinediones in type 2 diabetic patients and for management of these patients, particularly those at risk for cardiac failure. The cardiologist advice (and possibly diagnosis by echocardiography) is recommended when clinical doubts exist.

Cardiology↗
PubMed2002

[Tocolysis: indications and contraindications. When to start and when to stop].

Clinical trials have demonstrated that most tocolytic agents such as beta mimetics, atosiban and indometacine -exception made for magnesium sulfate- extend the duration of pregnancy, when compared to placebo. They reduce the rate of delivery at 24 hours, 48 hours and at 7 days. There is no proof however for their beneficial effect on perinatal or neonatal outcomes. Usual obstetrical contraindications of tocolytic treatments (infection, genital haemorrhage, fetal distress and certain maternal conditions) are often determined on a case by case basis, rather than upon evidence based medicine. Tocolysis may be considered in case of maternal infection without chorioamniotitis or during moderate hemorrhage due to placenta preavia (NP 4). There is no objective argument to refute a tocolytic attempt due and in accordance with a low gestationnal age limit. The risk for neonatal respiratory distress syndrome is higher at 34 weeks compared to 35 and 36 weeks. The studies were however realized before the corticosteroid era of fetal lung maturation. There are no available randomized trials concerning the benefits of tocolysis after 34 weeks of amenorrhea. Furthermore, there are no satisfactory trials preconising a specific tocolytic agent based on amniotic liquid study of lung maturity. In case of advanced cervical dilatation, rare studies have concluded the usefulness of tocolysis to allow fetal lung maturation by corticosteroids. Most studies have evaluated the effectiveness of tocolytic treatment during 48 hours. There is no evidence for continuing tocolytic treatment after an effective tocolysis prescribed during the first 48 hours. For intermediate situations, between franc success or failure of tocolysis (such as reduction but persistent painful uterine contractions or major cervical modification at a low gestational age despite reduction of uterine contractile activity), literature guidelines are poorly contributive. The management of such patients is most often empirical.

Clinical Trials as Topic↗
PubMed2000

[Contraindications for the endoscopic treatment of vesicoureteral reflux].

The endoscopic treatment of vesicoureteral reflux (VUR) has acquired a great importance as a therapeutic option during the last years. We present our experience with two substances, teflon paste and macroplastic, used in 86 patients, with 147 refluxing renal units. After first injection, the successful rate was 86% for teflon pastes versus 91% for macroplastic in the middle grade VUR units. We analyze our complications rates (14.25%) and we conclude that there is a close relation with a right technic performance. In our experience we consider a major contraindication for this technical option patients less than 1 year of life. At the same time we presume that an special care must be taken in monorenal patients as well.

Contraindications↗
PubMed1999

Positive washing cytology in patients with pancreatic cancer indicates a contraindication of pancreatectomy.

BACKGROUND: Although peritoneal washing cytology has been widely used in the field of gynecology, it has not been performed so frequently in patients with pancreatic cancer. Only a few papers have reported surgical implications of peritoneal washing cytology. MATERIALS AND METHODS: We reviewed results of peritoneal washing cytology performed immediately after laparotomy in 50 Japanese patients with pancreatic cancer. The 50 patients were divided into two groups according to the results of cytology. Clinicopathological findings were compared between these two groups. RESULTS: Cytology of peritoneal washing was positive in 13 (26%) of the 50 patients. Nine of the 13 patients had no visible peritoneal dissemination. There were no significant differences regarding the age, tumor size and serum level of the carcinoembryonic antigen. Moderately to poorly differentiated adenocarcinoma and perineural invasion (ne3) and lymphatic permeation (ly3) of marked degree were more frequent in the positive group than in the negative group (p < 0.01). The survival curve of the 37 patients with negative cytology was significantly better than that of the 13 with positive cytology (p < 0.01). Four of 13 patients with positive cytology underwent a potentially curative resection but died within 12 months. Three of these four patients died of peritonitis carcinomatosa with massive malignant ascites and one died of local recurrence. CONCLUSIONS: Positive peritoneal washing cytology is not rare in patients with pancreatic cancer and indicates a contraindication of pancreatectomy.

Adenocarcinoma↗