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At least 307 records · Page 17Linked to original sources
PubMed1994

Tricompartmental knee replacement. A comparison of orthopaedic surgeons' self reported performance rates with surgical indications, contraindications, and expected outcomes. Knee Replacement Patient Outcomes Research Team.

The chance of a person with osteoarthritis of the knee receiving a knee replacement is highly variable. To understand better the reasons for this variation, all practicing orthopaedists in Indiana were surveyed about their management of severe knee osteoarthritis and their perception of tricompartmental knee replacement as a therapeutic option. Their perceptions of indications and outcomes of knee replacement were compared with the self reported annual number of patients for whom they performed (or referred to other surgeons for) tricompartmental knee replacements. A completed survey was returned by 220 (79%) of the 280 orthopaedists surveyed; analyses were limited to the 188 respondents who had cared for at least one patient with osteoarthritis of the knee in the prior 2 weeks (mean = 13). These surgeons reported performing (or referring patients for) a mean of 31 knee replacements in the prior year (SD 45, median 21, range 0-480 knee replacements). There was strong agreement (> 95%) among respondents for seven (21%) of 33 surgical indications and contraindications, and more general agreement (> 60%) for 21 (64%). In the five factors (15%) for which there was disagreement, there was no consistent relationship between opinions and self reported knee replacement performance rate. Surgeons reporting more knee replacements had significantly higher estimates of pain relief and functional improvement following surgery, and lower estimates of prosthesis infection and failure rates. When all responses were considered together, four decision factors correlated independently with the performance of more knee replacements, but these four factors explained only 24% of the variation in self reported knee replacement performance.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Laparoscopic cholecystectomy in morbid obesity. Indications or contraindications?].

In early reports on the experience with laparoscopic cholecystectomy severe obesity was considered a contraindication for this procedure. The prospectively documented data of 370 consecutive patients undergoing laparoscopic cholecystectomy were analysed to investigate, whether this point of view is still justified. 35 of these 370 patients were classified as being severely obese (body-mass-index greater than 33 kg/m2). Median operation time was significantly longer in these patients than in the remaining patients (p < 0.05). In selected cases the operative technique had to be slightly modified due to extreme abdominal wall thickness. Dissection of Calot's triangle was not more difficult than in non-obese patients. There was no statistically significant difference concerning conversion rates between severely obese patients (11.4%) and the other group of patients (15.5%). Also, the number of complications was not increased in the obese patients. Since the higher complication rate in severely obese patients after conventional abdominal surgery is mainly due to the incision, laparoscopic cholecystectomy is the preferable procedure to treat symptomatic gallstone disease in these patients.

Adolescent↗
PubMedDate not supplied

[Indications and contraindications for intranasal endoscopic and microscopic surgery of the nose and sinuses].

The indications of the pure endoscopic surgery (CEN) and of the combined microscopic and endoscopic surgery (MCEN) in naso-sinusal pathology, they are established by means of the mixed valuation and systematization of the anamnesis, the endoscopy and the computerized tomography (TC). In the anamnesis the antecedents will be related carefully in the current history. In the exploration will be studied with full particulars the nose and the paranasal sinuses by means of the endoscopy and the TC (coronal and axial) with the purpose of valuing perfectly the anatomical variations and the sinusal content. The result of it is the listing of indications, that which the authors comment the corresponding to adults and children. For last the authors commented the absolute and relative contraindications.

Adult↗
PubMed1994

Comparison of subcutaneous unfractionated heparin with a low molecular weight heparin (Fragmin) in patients with venous thromboembolism and contraindications to coumarin.

Intravenous heparin followed by oral anticoagulant therapy (e. g. with coumarin) is still the most widely used treatment for deep venous thromboembolism. Self-administered subcutaneous injections of heparin have been thought of as a promising alternative to coumarin, but the high doses required for ongoing prophylaxis have raised concerns about the possible development of bone disease. Certainly, long-term heparin therapy has been reported to cause osteoporosis in both laboratory animals and humans. This study aimed to compare the efficacy and safety of unfractionated (UF) heparin with that of a low molecular weight heparin (Fragmin, Kabi Pharmacia) in the prevention of recurrent deep venous thrombosis (DVT) and pulmonary embolism (PE) in a consecutive series of patients with contraindications to coumarin therapy. The patients comprised 40 men and 40 women, aged between 19 and 92 years (mean age, 68 years). They had all previously been diagnosed as having acute DVT and had been treated with conventional doses of heparin while in hospital. All patients had at least one of the following conditions: recent blood loss (either spontaneous or during admission while receiving heparin therapy); active gastroduodenal ulcer disease; psychological or physical inability or unwillingness to understand and accept the need for regular laboratory monitoring during coumarin treatment; chronic alcoholism; dementia; pregnancy; recent neurosurgery, and pericardial effusion; or were over 80 years of age. They were randomly allocated to receive either UF heparin, 10,000 IU s.c. b.d., or Fragmin, 5000 IU anti-Factor Xa s.c. b.d., for a period of 3-6 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Blood brain barrier breaking. Is still an absolute contraindication to early surgical reperfusion of the brain?

In the early treatment of the patients with cerebrovascular insufficiency due to internal carotid artery stenosis, the presence of a cerebral infarct and especially the blood brain barrier breaking (BBB) are considered by many as a contraindication to early reperfusion by carotid endarterectomy (CEA). Generally, it has been recommended to differ the operation at least for 4-6 weeks because of the high risk to convert an ischemic infarct into an hemorrhagic one. On the other hand, because unfavorable natural history has been reported as for the progressing unstable neurological deficit as for the minor recent strokes, respectively by Millikan and Dosik, it seem to be justified a more aggressive management with the aim of: 1) eliminating the stenosis as embolic source of emboli; 2) obtaining early brain reperfusion to increase the probability of good recovery. Some previous experiences reported in the literature demonstrated satisfactory results of early reperfusion even in presence of BBB. The Authors present 4 cases of early CEA in patients with BBB. After the CT scan the patients have been submitted preoperatively to non invasive tests (duplex scanning and transcranial Doppler sonography) to assess the presence of the internal carotid artery stenosis and the viability of the intracranial cerebral arteries with special regard to the middle cerebral artery. All the patients underwent CEA in loco-regional anesthesia and particularly systemic blood pressure was carefully monitored and any hypertensive status was early corrected by prompt antihypertensive therapy (i.v. nitrates and or calcium blocking agents).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Side effects of anabolic steroids and contraindications.

The endocrine side effects are mainly androgenic and concern particularly but not exclusively females and children. Depending on individual sensitivity, the dosage used and the androgenicity of the drug concerned, signs of virilization ranging from slight voice disturbances to severe derangement of reproduction can develop, the latter occurring in both sexes. Progestational effects are of little importance. Hepatic alterations are caused almost exclusively by 17 alpha-alkylated steroids and can range from abnormal liver function tests to life-threatening liver tumours. Atherogenic changes in the lipid-lipoprotein balance, again a domain of the 17 alpha-alkylated preparations, might increase the risk of coronary heart disease. The metabolic influences of anabolic compounds can--at excessive dosage levels--create a prediabetic condition and polycythaemia. The influence of anabolic agents on psyche and behavior in normal doses are mostly positive, rendering the drugs useful for adjuvant therapy in patients whose general condition is poor, irrespective of the origin. If given in excessive doses they can cause grave psychic and behavioral disturbances and possibly dependence. Anabolic-androgenic steroids should be used with caution in patients who are particularly sensitive to side effects, where fluid retention must be prevented, in subjects with liver diseases, skeletal metastases of mammary carcinoma, and when longitudinal growth is not completed. They are contraindicated in carcinoma of the prostate and mammary carcinoma in the male and their use should be discouraged in pregnancy and during lactation.

Adolescent↗
PubMed1993

[Indications and contraindications to glomectomy in patients with bronchial asthma].

Thirty-year experience in surgical treatment of more than 3,000 patients with severe and moderately severe bronchial asthma showed that unilateral glomectomy produces a stable positive result in 69.5% of patients in follow-up repiods of two and more decades. Clinical recovery occurred in 23.2% of patients. Immunocorrection methods, such as hemosorption, plasmapheresis, plasmacytopheresis, xenosplenoperfusion, and the use of splenoperfusate raise the efficacy of the operation to 80-90%. The indications and contraindications for glomectomy in patients with bronchial asthma and methods for immunocorrection treatment of patients after glomectomy were developed.

Anesthesia, Local↗
PubMed1993

[Aztreonam as monotherapy in urinary tract infections with a systemic repercussion in patients with a relative contraindication for the use of aminoglycosides].

A comparative study has been performed to evaluate the clinical efficacy and safety of aztreonam in the treatment of urinary tract infections with systemic affectation, in a group of patients who showed a relative contraindication to be treated with aminoglycosides. The group studied was formed by 30 patients (21 females and 9 males). Mean age of said group was 78 years and percentage of patients over 65 years was 93%. Moreover, 53.3% of patients showed nephropathy, 30% diabetes mellitus and 16.6% hearing disorders. Responsible germ of the infection was identified through blood and urine culture in 24 patients (80%) being the most frequent isolated E. Coli (60%). The cure rate was of 76.6% and improvement rate was 13.3%. Three deaths happened on the studied group (10%). In a patient superinfection due to Enterococcus was detected. There were no significative adverse effects (hypersensibility reactions, hematological disorders, nephrotoxicity or hepatotoxicity). Aztreonam could be an efficacious alternative in the treatment of urinary infection with systemic affectation, caused by gram-negative germs, showing low toxicity.

Aged↗
PubMed1993

[Lung transplantation. Contraindications and new indications].

The authors review the recent changes observed in the indications for lung transplantation. Several classical contra-indications have been alleviated or even cancelled. Chronic infection presenting as cystic fibrosis has become one of the first indications for lung replacement. Respirator-dependent patients are at an operative risk comparable to the overall results. Long-term corticosteroid therapy and pleural adhesions are no longer formal contraindications but should be approached with extreme caution. In recent years, single lung transplantation has been extended to diseases, such as emphysema and pulmonary hypertension, which were formerly indications for double-lung or heart-lung transplantation. The reasons for this include donor shortage and the better 1-year survival following single lung transplantation. The most recent development is paediatric lung transplantation. The legitimacy of redo transplantation is controversial.

Adolescent↗
PubMed1995

Contraindications and complications of hysteroscopy.

If the contraindications to hysteroscopy are observed, complications should be small. The risks of fluid overload, especially in operative cases, is the most common critical problem, so that accurate recording of fluid use and collection are essential. The inexperienced, unsupervised surgeon is most likely to encounter significant complications.

Contraindications↗
PubMed1996

[The conditions, indications and contraindications of treatment of diabetes using subcutaneous infusion of insulin].

Adequate treatment of insulin dependent diabetes with insulin, properly implemented and accurately indicated, ensures good control which guarantees a favourable effect on the clinical course of diabetes. The main advantage of treatment is to maintain a stable insulinaemia during the interprandial period and during the night, during the postprandial period its necessary rise to ensure glycogen formation in the liver and peripheral glucose utilization. In some diabetics for certain reasons the usual injection treatment fails and it is thus necessary to know all essential conditions of non-conventional treatment-continuous insulin infusions. In the submitted paper the authors emphasize the objective and purpose of insulin treatment by a continuous infusion. Attention is drawn to the most frequent therapeutic errors, to conditions which call for caution, contraindications are defined.

Contraindications↗
PubMed1994

Prescribing nicotine substitutes for tobacco cessation: considerations and contraindications.

This article deals with the topic of nicotine replacement drugs and their use in smoking cessation. Questions frequently arise as to their prescription by dentists. Provided patients are carefully selected on the basis of medical and psychological profiles, there is no ethical or legal contraindication to dentists prescribing these aids. This article reviews the current literature and answers commonly asked questions concerning these effective drugs.

Administration, Cutaneous↗
PubMed1996

[Methodology in puncture tracheostomy. Technique, indications and contraindications].

Percutaneous dilatational tracheostomy is a relatively new minimally invasive method for bedside tracheostomy of immobilized adult patients. This procedure is based on the Seldinger technique: after percutaneous puncture of the trachea beneath the cricoid a guidewire is placed into the trachea. Afterwards the wound channel around the wire is dilated until a tracheal cannula can be put in place. The surgeon requires not only precise knowledge of cervical anatomy and manual skills to perform this technique but should also be aware of contraindications and how to proceed if there are technical problems. Based on our personal experience of more than 300 percutaneous dilatational tracheostomies, appropriate recommendations are given.

Adolescent↗
PubMed1996

Indications and contraindications in emergency acupuncture treatment.

This essay suggests the indications and relative contraindications in the emergency treatment and cure by acupuncture and moxibustion based on an analysis of the characteristics and principles of treatment in emergency cases and the many-sided regulating effects of acupuncture and moxibustion. It also introduces, case by case, methods of acupuncture and moxibustion treatment in 22 frequently encountered emergency situations, and stresses the fact that emergency treatment with acupuncture and moxibustion must be based on the various new achievement and experience and strictly observe rules of operation. It states that only by doing so can the therapeutic effect be enhanced and adverse reactions prevented.

Acupuncture Therapy↗
PubMed1996

[Indications, contraindications and differential therapeutic alternatives in heart transplantation. Current status and results of a survey by the German Transplantation Programs. Thoracic Organ Transplantation Study Group of the German Society of Cardiology--Heart and Lung Research].

In conjunction with the report on "Posttransplant care and rehabilitation", the consensus paper on "Indications, contraindications, and therapeutic alternatives to cardiac transplantation" reflects the current practice in German cardiac transplant centers. This paper is based on a survey organized in 1994 by the Working Group on Thoracic Organ Transplantation of the German Society of Cardiology in which all German transplant centers participated.

Combined Modality Therapy↗
PubMed1996

[Short-term change in sural venous thrombosis in patients in surgical intensive care when anticoagulants are contraindicated].

Venous thrombo-embolic disease in neurosurgical and surgical intensive care units is a frequent disorder (between 4.3 and 43 per cent of patients according to studies). The treatment is often difficult. We carried out a retrospective study from January 1994 to September 1995 of 57 patients in neurosurgical and surgical intensive care who developed thrombosis of a sural vein and in whom anticoagulant at therapeutic doses was contraindicated. After a median follow up 14 days echography showed proximal extension of the thrombosis in 4 patients and distal extension in 3 others. Five cases of pulmonary embolism occurred during the follow up period, one of which led to death. No complications (pulmonary embolism or proximal extension of venous thrombosis) occurred in those patients receiving heparin at prophylactic doses (0/11 versus 8/46 in the non-heparin group; p = 0.13). No case of pulmonary embolus occurred in those patients with partial or complete regression of the thrombosis (0/21 versus 5/36 in the group with stable or extending thrombi, p = 0,05). Echographic monitoring enabled therapeutic modification in 5 cases. These results indicate that sural venous thrombosis in the context of neurosurgical and surgical intensive care is a potentially grave situation and that the prescription of anticoagulant therapy even at preventive dose should always be considered. Further, we propose regular echographic monitoring until the patient is mobile.

Adult↗
PubMed1997

Neonatal circumcision: anatomic contraindications.

Complications from neonatal circumcision may result from inexperience or poor technique, but may also result from poor patient selection based on penile anatomy. The anatomic contraindications to neonatal circumcision are therefore presented in an effort to prevent complications.

Circumcision, Male↗
PubMed1997

[Preoperative aspirin therapy--a contraindication for kidney transplantation?].

INTRODUCTION: The influence of ASA treatment on haemostasis is still debated. There are doubts in case of emergency operations, especially in transplant patients, concerning dosage and change of medication. METHODS: Our results are based on an analysis of the therapeutical behavior in German transplantation centers. The question of transplant suitability, dosage and haemostatic effects will be discussed in comparison to the literature. RESULTS: 85.7% of the transplantation centers perform the operation despite of and under ASA treatment. In these cases an increased bleeding tendency is tolerated and observed in 33.3% of the centers. An increased mortality has not been reported. Most of the transplantation centers accept a dosage of 100 mg ASA daily. Only 14.3% of the transplantation centers refuse the operation in ASA treated patients. CONCLUSIONS: Correctly indicated ASA treatment (cardiac arrhythmia, patients with embolism or thrombosis) isn't a contraindication for renal transplantation (daily dosage up to 100 mg). In elective cases however, a preoperative change of the medication is recommended, e.g. the use of heparin instead of ASA.

Aspirin↗