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PubMedDate not supplied

[The contraindications, indications and conditions for completing choledochotomy with a precision suture of the choledochus].

Based on literature and personal data (146 choledochotomies) the authors have developed a scheme of contraindications, indications and conditions for using the precision suture of the choledochus in patients with benign lesions of bile ducts. For this method of completing choledochotomy to be realized, the indications should be correlated with the complex of conditions. To most important conditions the authors refer the possibility to use the precision technique as well as the delicate highly informative diagnostic and curative endocholedochal manipulations. The choice of the variant of the precision suture of the choledochus is influenced by a group of conditions responsible for the state of the hepatocholedochus. Based on the proposed scheme the precision suture was used in 62 patients. No complications resulting from using this method of completing choledochotomy were noted.

Adult↗
PubMedDate not supplied

[Febrile convulsions: should some drugs be contraindicated?].

Should certain drugs be contraindicated in children who have had febrile seizures or who present a risk of convulsions? There are no publications dealing specifically with this problem. However, many drugs can induce convulsions and may be dangerous if they are associated with another determining factor (e.g. fever). Camphor known to be toxic and its use must be avoided in young children. Other terpenes given to children with colds may be convulsant if they are used for prolonged treatment or associated with other convulsant drugs (sympathomimetics, piperazine derivatives, antihistamines, etc.). On the basis of a retrospective study of 23 cases of febrile convulsion among 343 cases of infantile convulsion reported to the Poison Control Center and the Pharmacovigilance Center of Marseille between 1973 and 1991, we propose that camphor and sympathomimetics be avoided and that potential convulsant drugs and their association be used with caution. A prospective study is underway to determine responsibility of certain drugs in the occurrence of recurrence of febrile convulsions.

Antitussive Agents↗
PubMed2003

Smallpox vaccine: contraindications, administration, and adverse reactions.

Since the terrorist attacks of September 11, 2001, and the anthrax exposures in the following weeks, concern that smallpox could be used as a biologic weapon has increased. Public health departments and the U.S. military have begun the process of vaccinating soldiers and civilian first-responders. Smallpox vaccination carries some serious risks: approximately one in 1 million primary vaccinees and one in 4 million revaccinees will die from adverse vaccine reactions. The most serious side effects of smallpox vaccine include progressive vaccinia, postvaccinial central nervous system disease, and eczema vaccinatum. Some of these reactions can be treated with vaccinia immune globulin or cidofovir. Proper patient screening and site care are essential. Family physicians must learn to screen potential vaccinees for contraindications (e.g., immunodeficiency, immunosuppression, certain skin and eye diseases, pregnancy, lactation, allergy to the vaccine or its components, moderate or severe intercurrent illness) and to treat vaccine-associated adverse reactions.

Adverse Drug Reaction Reporting Systems↗
PubMed1992

[The gallbladder with severe pathologic changes: a contraindication for laparoscopic cholecystectomy?].

In the beginnings of laparoscopic cholecystectomy a severe pathological alteration of the gallbladder or stones of the common bile duct were regarded as relative contraindications to the method. However increasing experience and improve technic have shown, that even a severe pathology of the gallbladder such as chronic cholecystitis with wall thickening, acute or subacute inflammation or a porcelaine gallbladder can be laparoscopically managed. Operation time in such cases is longer, but median hospital stay is the same as in uncomplicated cases. However postoperative morbidity may be increased. For patients with CBD stones preoperative ERCP with papillotomy followed by laparoscopic cholecystectomy some days later offers a treatment with low morbidity and optimal comfort for the patient.

Adult↗
PubMed2003

Contraindicated antiretroviral drug combinations.

The proper implementation of combination antiretroviral treatment regimens is fundamental to successful therapeutic outcomes for patients with HIV/AIDS. Unfortunately, some patients are still being prescribed contraindicated antiretroviral regimens that include: 1. stavudine plus zidovudine; 2. Invirase plus two nucleoside analog reverse transcriptase inhibitors (NRTIS); 3. zalcitabine plus didanosine; 4. zalcitabine plus stavudine; and, 5. zalcitabine plus lamivudine. Inappropriate regimens such as these either have limited effectiveness or potential severe toxicity.

Anti-Retroviral Agents↗
PubMed2004

[A contribution to contemporary absolute and relative contraindications for breast conserving surgeries (BCS) in early carcinoma of the breast in the first or second stage].

Absolute and relative contraindications for BCS (Breast Conserving Surgery) are stated according to the EUSOMA (European Society of Mastology). Statement includes the risk factors for local recidive, and unfavourable progress of the illness itself. Stress is put on the health treatment fallowing BCS.

Breast Neoplasms↗
PubMed1992

Ductus-dependent fetal cardiac defects contraindicate indomethacin tocolysis.

The hemodynamics of critical aortic stenosis in the fetus make it a ductus-dependent cardiac defect because the ductus arteriosus supplies blood not only to the descending aorta but also to the aortic arch and coronary vessels. In utero closure of the ductus arteriosus has been reported in association with tetralogy of Fallot, truncus arteriosus, maternal use of prostaglandin inhibitors, and as idiopathic events. This is the first report of a ductus-dependent congenital heart defect (critical aortic stenosis) where treatment with indomethacin, a prostaglandin synthetase inhibitor, precipitated premature closure of the ductus and hydrops fetalis. Review of reported cases of premature closure of the ductus show that acute, in utero closure of the ductus in a fetus with limited cardiopulmonary reserves has a worse prognosis than with previously reported cardiac anomalies. This study strongly supports published concerns of increased perinatal morbidity and mortality when fetuses are exposed to prostaglandin inhibitors in utero, and shows that ductus-dependent fetal cardiac defects are contraindications to the maternal use of prostaglandin inhibitors during pregnancy.

Adult↗
PubMed2004

[Indications and contraindications for surgical treatment of morbid obesity--the choice of operative method].

Surgery for morbid obesity should be considered in case of failure of conservative treatment (diet, physical activity, psychotherapy, supportive medications). It is strongly recommended also for patients with significant concomitant diseases (e.g. cardiovascular, pulmonary etc) difficult to manage with traditional therapy. Patients' selection for surgery seems to be essential issue. Typical indications for surgical procedure include: BMI > 40 or BMI > 35 in patients with at least two obesity-related diseases, ineffective conservative treatment. Main contraindications are GI tract diseases (esophagitis, peptic ulcer), severe cardiovascular insufficiency, alcohol or drug abuse and mental disorders. There are two types of operative procedures currently performed restrictive and malabsorptive. The first group consists of following operations: 1) Silicon Ring Vertical Gastroplasty (SRVG), 2) Vertical Banded Gastroplasty (VBG), 3) Adjustable Silicon Gastric Banding (ASGB), 4) Non-Adjustable Gastric Banding (NGB). The latter group comprises: 1) Roux-Y Gastric By-Pass (RYGB) and 2) Bilipancreatic diversion. The paper describes complications, advantages and disadvantages for both groups of bariatric procedures and points out factors that should be considered in patients' selection for various types of operation.

Adolescent↗
PubMed2005

[Indications and contraindications of vaginal hysterectomy for non-prolapsed uterus].

OBJECTIVE: To study the indications and contraindications of vaginal hysterectomy for non-prolapsed uterus. METHODS: Totally 2086 patients underwent vaginal hysterectomy during the period of June 1992-June 2003 were analysed and the surgery quality and incidence of complications among patients with different sizes of uteri, with or without history of pelvic or abdominal surgery, with history of vaginal delivery and adnexectomy were compared. RESULTS: (1) The patients with uteri > 16 weeks of gestation were associated with longer operating time [(73 +/- 25) vs (42 +/- 16) min)], more blood loss [(237 +/- 86) vs (101 +/- 58) ml] and higher rate of pelvic infection (1.69% vs 0.78%) when compared to the patients with uteri < or = 16 weeks. The differences were statistically significant (P < 0.01). (2) There was no significant difference in the operating time and intraoperative blood loss between the patients with and without history of pelvic or abdominal surgery (P > 0.05), however, the surgery group had higher side injury rate during operation. In addition, 119 patients complicated with ovarian cyst underwent vaginal ovarian cystectomy successfully. CONCLUSION: Vaginal hysterectomy for patients with uteri < or = 16 weeks of gestation is safe and feasible. The procedure is relatively difficult for uteri > 16 weeks and should be determined according to the operator's experience and the patient's condition. A history of pelvic or abdominal operation increases the side injury rate in vaginal hysterectomy. The successful rate of vaginal hysterectomy in patients with uteri < or = 16 weeks of gestation is not affected by the history of vaginal delivery. During vaginal hysterectomy, ovarian cystectomy is feasible for the ovarian cyst < or = 6 cm. Skillful operator and use of appropriate instrument expand the indication of vaginal hysterectomy.

Blood Loss, Surgical↗
PubMedDate not supplied

Low serum albumin is not a contraindication for early iatrogenic bile duct injury repair.

UNLABELLED: Most iatrogenic bile duct injuries are recognized in the early postoperative period (first 48 hours). These patients usually have additional complications such as a suboptimal hydroelectrolitic status, subhepatic collections, external biliary fistula and malnutrition. In these circumstances, besides the elevation of bilirubin and transaminases associated with the injury, hypoalbuminemia is frequently encountered. The timing for repair is decided according to the condition of each patient. We report the impact of preoperative abnormal low serum albumin levels on the results of biliary tract reconstruction after a iatrogenic biliary lesion. METHOD: Patients who underwent biliary reconstruction in our center from 1998 to 2002 were analyzed. Only patients with complex injuries (Strasberg E, Bismuth III-IV, Stewart-Way III) were included. Major postoperative complications were recorded and correlated with preoperative liver function tests. RESULTS: Seventy seven patients were analyzed. In 41 cases, the injury was a consequence of a laparoscopic operation. All patients were treated by a Roux-en-Y hepatojejunostomy. No operative mortality was recorded. The most frequent postoperative complications were postoperative biliary fistula (8/77-9%, p < 0.017) and subhepatic collections (9/77-9%, p < 0.39). All fistulae closed spontaneously and the subhepatic collections were drained. Overall, complications were more common in the group with hypoalbuminemia (p < 0.002). CONCLUSION: Early repair is indicated if there is no systemic contraindication (sepsis, multiple organic failure, electrolytic imbalance). Abnormalities in the liver function tests, particularly a low serum albumin, should not delay the operation. Although significantly more postoperative complications are observed in an early repair, long-term results are comparable to those of an elective repair.

Adolescent↗
PubMed2006

Clinical inquiries. What are contraindications to IUDs?

Based on limited evidence, use of intrauterine devices (IUDs) is not contraindicated for women with HIV/AIDS (strength of recommendation [SOR]: C), multiple sexual partners (SOR: C), previous actinomyces colonization (SOR: C), most types of fibroids (SOR: C), or previous ectopic pregnancy (SOR: C). The risk to IUD users of pelvic inflammatory disease (PID) is similar to women using no contraception (SOR: B). Nulliparous women may experience increased insertion discomfort and higher rates of expulsion (SOR: B). IUD use of <3.5 years is not associated with decreased fertility (SOR: B).

Bacterial Infections↗
PubMed1990

[A high level of alkaline phosphatase in the blood serum is not a contraindication to embolization of the hepatic artery in malignant neoplasms of the liver].

The paper discusses the experience gained with embolization of the hepatic artery performed in 7 patients showing blood alkaline phosphatase levels higher than 19.3 mmol/hr.1. Tumor accounted for 10-80% of liver volume. The procedure did not involve either complications or fatal outcomes. Remission was achieved in the majority of patients. It was inferred that alkaline phosphatase activity is not indicative of extent of liver involvement by tumor. High alkaline phosphatase level is not a contraindication for hepatic artery embolization.

Adult↗
PubMedDate not supplied

[The indications and contraindications for emergency adenomectomy in patients with severe concomitant diseases].

The authors have performed 631 urgent suprapubic transvesical adenomectomies in patients with prostate adenoma complicated by acute urine retention or hemorrhage. Prearranged and urgent interventions had, by the authors' experience, virtually the same rate of postoperative complications and lethal outcomes. The risk in urgent adenomectomy performed in 294 patients was attributed to their concurrent affections: postinfarction cardiosclerosis, myocardial ischemia or hypertensive crisis, hemiparesis after brain apoplexy, bronchial asthma, diabetes mellitus, hepatic cirrhosis, chronic lymphoid leukemia, drug polyallergy, multiple tumors of the urinary bladder, stomach, etc., in stage T1-3NOMO. 80 patients had intermittent chronic renal failure. In compensation of severe concurrent diseases and satisfactory condition of the patients urgent adenomectomy was conducted within 24 hours since hospitalization. Longer interval (within 24-72 hours) was necessary in subcompensation of the concurrent diseases, intermittent chronic renal failure which were intensively treated. The authors achieved uneventful postoperative course for 272 (92.5%) high-risk patients. Postoperative lethality made up 3.06%. According to 1-11-year follow-up 7 patients died, for the most part of blood and respiratory diseases. Functional long-term outcomes were good in 83.5% of the patients. Basing on their experience, the authors specify indications to urgent adenomectomy and optimal time of its conduction. Contraindications to urgent adenomectomy were revised and narrowed.

Acute Disease↗
PubMed1995

Efficacy of cyclosporin A (CyA) in psoriasis: an overview of dose/response, indications, contraindications and side-effects.

Since 1985, the efficacy of cyclosporin A (CyA) in severe psoriasis has been evaluated in a number of open and controlled studies, all of which have clearly established CyA as an effective antipsoriatic agent. The efficacy of CyA has also provided new insights into the pathophysiology of psoriasis. The effects of CyA treatment can be seen within weeks; they are dose-dependent and quickly reversible on stopping treatment. Hypertension and nephrotoxicity remain the greatest concerns associated with long-term use. In general, the incidence of hypertension is approximately 10%. A dosage of approximately 2.5-5 mg/kg/day of CyA induces a slight, but significant, dose-dependent increase in serum creatinine. Studies of pre- and post-treatment renal biopsies have also disclosed slight, but significant, increases in interstitial fibrous tissue which are negatively correlated to creatinine clearance. This review assesses the current knowledge of the prospects of CyA in the treatment of psoriasis with respect to dose/response, indications, contraindications and side-effects.

Biopsy↗
PubMed1995

[Tricyclic antidepressants in depressed patients with cardiovascular diseases: a contraindication?].

Depressive disorder and cardiovascular diseases occur quite frequently together in the same patient, especially in older patients. On the one hand depressions can increase the risk of cardiovascular diseases, on the other hand cardiac disease can lead to depressive disorders in need of treatment. Thus the problem of prescribing tricyclics for patients with cardiovascular diseases is of great clinical relevance. In our review we summarize first of all the important cardiovascular effects of tricyclics in healthy persons and patients with cardiovascular diseases. Indications and (relative) contraindications for this medication with respect to cardiovascular disorders and proposals for diagnostic procedures in the beginning and during the course of antidepressant medication are following. Finally we present some recommendations for the treatment of tricyclic-induced side effects.

Antidepressive Agents, Tricyclic↗
PubMed1994

Hepatosplenic candidiasis--a contraindication to marrow transplantation?

To determine whether a prior history of hepatosplenic candidiasis resulted in increased Candida-associated morbidity and mortality after marrow transplant, 15 consecutive patients with biopsy-proven hepatosplenic candidiasis were observed prospectively. All patients received amphotericin B before transplant. Amphotericin B was continued at a dose of 0.5 mg/kg/day from conditioning through marrow engraftment, at which time it was discontinued if computerized tomography (CT) evidence of disease was stable or improved. Patients were observed for progression of candidiasis for the first 100 days after transplant. The amount and duration of antifungal therapy received before transplant varied widely. The majority of patients (73%) had persistently abnormal CT scans before transplant. After transplant, 3 of 15 died (20%) with evidence of fungal disease, although fungal species differed from those diagnosed pretransplant, compared with a historical mortality rate of 90% in posttransplant patients with documented hepatosplenic candida. Comparison CT scans obtained before and after transplant showed improvement in 9 of 15 (60%), complete resolution in 2 of 15 (13%), and none showed progression. We conclude that hepatosplenic candidiasis is not an absolute contraindication to marrow transplant when patients receive amphotericin B therapy before transplant and continue therapy until engraftment is established.

Amphotericin B↗
PubMed1994

Contraindications and complications of laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is a commonly performed procedure for the removal of symptomatic gallstones. Compared with open cholecystectomy, laparoscopic cholecystectomy is associated with less postoperative pain, earlier discharge from the hospital and a more rapid recovery. However, there are specific contraindications to the procedure, including empyema of the gallbladder, gangrenous cholecystitis, coagulopathy, portal hypertension and peritonitis. Complications from laparoscopic cholecystectomy include common duct injury, bleeding, bile leakage and wound infection. An understanding of these issues allows the family physician to more appropriately select patients for laparoscopic removal of the gallbladder.

Cholecystectomy, Laparoscopic↗
PubMedDate not supplied

Treatment of idiopathic thrombocytopenic purpura (ITP) in patients with refractoriness to or with contraindication for corticosteroids and/or splenectomy with immunosuppressive therapy and danazol.

BACKGROUND: The best treatment for patients with idiopathic thrombocytopenic purpura (ITP) who are refractory to or have contraindications for splenectomy and corticosteroid remains uncertain. We report here our experience with vinca alkaloids (VA), azathioprine (Azp) and danazol in 33 such patients (6 M/27 F), median age 66 (23-83). PATIENTS: Group A (n = 19), Group B (n = 11), Group C (n = 17) patients were treated with VA, Azp and danazol. Fourteen patients were given more than one immunosuppressor agent. Sixteen patients were given 2 mg/week bolus infusions of vincristine (Vcr), while weekly slow infusions of vinblastine (Vnb, 0.1 mg/kg), for 2-4 weeks, were administered to the remaining 3 cases of Group A. Azp was administered at a daily dose of 150 mg for a median duration of 6 months. Danazol was administered at a median daily dose of 400 mg (400-800 mg), for a median length of 5 months. Response was defined as any increase of platelet count to higher than 30 x 10(9)/l, when platelet count was < 20 x 10(9)/l or any doubling of the basal platelet count otherwise. Remission, any increase of platelet count to higher than 100 x 10(9)/l lasting for 3 months or longer without therapy. RESULTS AND CONCLUSIONS: In Group A, there was a response rate of 63%, with 2 remissions (10%). All responses were observed after the first infusion. Two additional patients, who responded transitorily to VA, went into spontaneous remission 19 and 51 months after the last infusion of VA. In Group B, the response rate was 45%, with 1 remission (9%). The response was never observed before one month. One additional patient went into spontaneous remission 60 months after stopping Azp. In Group C, the response rate was 56% with 2 remissions (12%); 2 patients relapsed while on therapy, 4 continue to require therapy and 1 died from a stroke while on therapy. Four patients in Group A and two in Group B discontinued the therapy because of severe side effects. Danazol was generally well tolerated but for one patient was interrupted after only 5 days because of severe dyspepsia. In conclusion, the clinical usefulness of VA and Azp is very limited and burdened by severe side-effects. Danazol seems to be safer but no more effective and its long-term toxicity is not known. There were two hemorrhagic deaths in this series of patients.

Adrenal Cortex Hormones↗