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PubMed1997

Cholecystoenteric fistula is not a contraindication for laparoscopic cholecystectomy: report of five cases treated by laparoscopic approach.

The authors present five cases (three female, two male, mean age 50.8) of cholecystoduodenal fistula incidentally discovered during laparoscopic cholecystectomy and treated by laparoscopic approach. The laparoscopic technique adopted is described and all patients recovered promptly with no immediate or long-term post-operative complications. Discharge from the hospital was after 4.5 days, and after 6 months follow-up all patients were in good clinical condition. These results indicate that when the surgeon is skilled in advanced laparoscopic operative techniques such as duodenal mobilization and intracorporeal suturing and knotting, cholecystoduodenal fistula can no longer be considered a contraindication for laparoscopic treatment.

Aged↗
PubMed1998

[Current status of cataract surgery. Modern methods--internal medicine risk factors and contraindications].

Modern cataract surgery is characterized by minimal invasive techniques that have been introduced during the past decade. These include phacoemulsification, capsulorhexis, foldable intraocular lenses and small tunnel incisions. High success rates coupled with low complication rates have resulted in a change in indications--cataract surgery is no longer performed merely to prevent blindness, but also to improve vision in patients whose professional or private visual demands are compromised by the onset of lens opacification. To ensure that their cooperation with the ophthalmic surgeon results in optimal benefit to the patient, it is important for general practitioners and internists to be conversant with the risk factors and contraindications for cataract surgery.

Aged↗
PubMed1998

Is diffuse xanthogranulomatous pyelonephritis a contraindication to retroperitoneoscopic nephroureterectomy? A case report.

Diffuse xanthogranulomatous pyelonephritis (XGP) is a rare form of chronic infection of the child's kidney. The clinical presentation is nonspecific, and investigation often reveals a nonfunctional kidney. Preoperative diagnosis is very difficult even with ultrasonography and computed tomography. Total nephrectomy is the treatment of choice, but it is considered very difficult and is usually contraindicated for laparoscopic or retroperitoneoscopic techniques. Reported here is a case of retroperitoneal laparoscopic nephroureterectomy for XGP.

Adolescent↗
PubMed1998

Removal of asymptomatic third molars: indications, contraindications, risks and benefits.

The removal of third molar teeth is one of the most common surgical procedures performed by dentists in the United States. Although prophylactic removal of third molars is supported by many to prevent disease, the removal of asymptomatic third molars should be based upon individual clinical and radiographic assessment of each patient. After educating the patient as to the indications, contraindications, risks, and benefits of removal of third molars, the patient and dentist should reach a mutual decision as to whether to proceed with surgery.

Contraindications↗
PubMed1979

Dipivefrin and echothiophate: contraindications to combined use.

A study was undertaken to determine whether the antiesterase activity of echothiophate iodide would prevent the conversion of dipivefrin to epinephrine. Dipivefrin was administered singly and in combination with echothiophate to 24 adult rabbits. Administration of dipivefrin lowered the intraocular pressure (IOP) 8 +/- 1 mm Hg (P less than .001). When echothiophate was given before and concomitant with dipivefrin, there was no further decrease in IOP compared with that produced by echothiophate alone (5 +/- 1 mm Hg). Addition of epinephrine to eyes receiving dipivefrin plus echothiophate resulted in a significant additional decrease in IOP of 4 +/- 1 mm Hg (P less than .001). When echothiophate was given after dipivefrin had lowered the IOP and both drugs were continued, the IOP rose to baseline levels. These results fit the theory that the esterase converting dipivefrin to epinephrine is inactivated by cholinesterase inhibitors. The clinical use of cholinesterase inhibitors and dipivefrin may be contraindicated.

Administration, Topical↗
PubMed1998

Ciprofloxacin as a therapeutic modality in pediatric burn wound infections: efficacious or contraindicated?

BACKGROUND: Food and Drug Administration regulations state that ciprofloxacin hydrochloride may cause arthropathies. For this reason, such therapy is contraindicated in the pediatric population. However, several studies in children with cystic fibrosis have found the drug to be efficacious. Our hypothesis was that ciprofloxacin treatment is justified in the case of multiresistant organisms in burn populations. DESIGN: During a 4-year period (January 1, 1993, to December 31, 1997) we treated 56 of our pediatric burn patients with ciprofloxacin when cultures proved resistant to other antibiotics. The burn area was 65% of the total body surface area. The average patient age was 8.4 years. Of the 56 patients who received ciprofloxacin, 50 received the recommended dose. Biopsy specimens were assessed for quantitative bacteriology and antibiotic sensitivity. Radiologic review was conducted to examine for arthropathy. RESULTS: All patients showed unequivocal reduction in quantitative bacterial counts, and susceptibility to ciprofloxacin remained stable without the development of resistance. Of the 56 patients treated, 42 had a major reduction in their quantitative wound biopsies from 10(6) to less than 100 colonies per gram of tissue, while the remaining 14 were observed to have a 2- to 3-log decrease. No arthropathy was detected in any of the 56 patients receiving ciprofloxacin. Review of the patients' charts showed no documented adverse events associated with the use of ciprofloxacin. All patients survived their thermal injury and the complications associated with it without any untoward problems or complications of arthropathy. CONCLUSION: On the basis of these data, ciprofloxacin therapy in the treatment of immunosuppressed pediatric burn patients is efficacious and does not cause arthropathy.

Adolescent↗
PubMed2004

Pharmacotherapy for performance anxiety disorders: occasionally useful but typically contraindicated.

Pharmacotherapy is an effective part of treatment for most anxiety disorders, but not for specific phobia or performance anxiety. In them it is contraindicated, because it interferes with the effectiveness of exposure therapies and the extinction of fear responses. Interference with exposure-extinction is a drug side effect that should rarely if ever be tolerated in treating them. This article reviews the many indications for pharmacotherapy in treating most anxiety disorders and contrasts its usefulness in treatment of anxiety disorders with its relatively rare usefulness in treating specific phobias and performance anxiety. In both the latter disorders, benzodiazepines interfere with exposure and generally are best avoided, although temporary use, with safeguards, can sometimes be helpful for a specific phobia. The recent discovery that D-cycloserine (DCS) facilitates exposure and the extinction of anxiety offers promise that it could in the future be usefully and broadly employed to catalyze and enhance exposure therapies.

Antimetabolites↗
PubMed1978

A new relative contraindication for lumbar myelography.

We have taken myelograms of six patients with grave post-tuberculous thoracic gibbus of the spine and gross deformity of the thoracic cage. Two of these patients suffered violent convulsions and fracture of the neck of the femur. In one patient the myelogram was taken with Conray Meglumine and in another with Dimer X. We suggest that a grave deformity of the thoracic cage is a relative contraindication for lumbar myelography with these water-soluble contrast media. We assume that the reduced tissue oxygenation in these patients results in a lower threshold for convulsions.

Femoral Neck Fractures↗
PubMed1990

[May the internal iliac artery in the pelvic area be ligated in situ bilaterally for hemostasis? Indications and contraindications].

The bilateral ligation of the internal iliac arteries in situ is successful in preventing haemostasis and the treatment of potentially lethal haemorrhage. In spite of using a resorbable thread (catgut) for ligation a complete recanalization of this large artery could only be observed after nine months in an animal experiment. Clinically this ligation of the artery in situ without severance has not impaired erective potency in patients with an otherwise healthy vascular system. Since many patients did not show any disturbance prior to the vessel's recanalization the early established parallel circulation is sufficient to compensate for the perfusion deficit. A contraindication for the ligation is a previous major procedure, especially, in cases of irradiation or an occlusive vascular disease.

Adult↗
PubMed1977

[Indications and contraindications of regional anesthesia (author's transl)].

A short introduction about common techniques of regional anesthesia and statistical data about the percentage of such procedures carried out in our institute are presented. Important techniques and aims of regional anesthesia are clearly pointed out. The results of our study are discussed in detail, as are the advantages, disadvantages, indications, and contraindications of regional anesthesia. Finally the paper concludes with our impression of regional anesthesia, its significance and status in China.

Adult↗
PubMed1980

Indication and contraindication for surgery of spontaneous intracerebral hematomas. Therapy and results.

The indication for surgery in spontaneous intracerebral hematoma is given when, in spite of the administration of dexamethasone in high dosage, an improvement of the initial neurological symptoms could not be observed, or if a worsening is seen. With the help of CT the size of the hematoma could be controlled so that if in comparison to initial findings an increase in mass displacement or herniation is observed, surgery should be performed immediately. In cases of deep coma with vegetative unstable states, as well as in cases of bleeding into the basal ganglia, surgery is contraindicated.

Age Factors↗
PubMed1981

Indications and contraindications of sanatorium treatment of children with renal and urinary diseases.

The necessity for the treatment and follow-up of children with kidney disease is emphasized. Apart from specific treatment with antibiotics, corticoids and immunosuppressives in cases of pyelonephritis, urological diseases and glomerulonephritis, the possibility of a non-specific physiotherapeutic treatment in the framework of a six-week cure is pointed out. The first sanatorium for children with renal disease in the GDR has, after initial experience and together with the GDR's Society for Child Nephrology, revised the list of indications which is presented in this paper. In addition to indications, also the contraindications are given. A gross first survey of 975 treatments is presented.

Adolescent↗
PubMed2004

Laparoscopic Fowler-Stephens procedure is contraindicated for intraabdominal testicular major duct anomalies.

The laparoscopic one- and two-stage Fowler-Stephens procedure has gained large popularity in the treatment of the child with a high intraabdominal testis. It is largely debated which technique (e.g., testicular autotransplant or Fowler-Stephens procedure) offers the best results for high intraabdominal testes. We describe a case of a 3-year-old boy for whom previous bilateral inguinal exploration results were negative for testes or testicular remnants. The diagnostic laparoscopy showed two iliac intraabdominal testes with short spermatic vessels, closed inguinal rings, and complete dissociation of didime-epididime. A left open orchidopexy was perfomed, and testicular autotransplant was proposed for the right testes located 4 cm from the internal inguinal ring. Long-term follow-up evaluation (1.8 years) of the left testis showed it in the scrotum with good testicular size (1.5 cm). We believe that there are two main reasons to contraindicate the Fowler-Stephens technique: associated malformation that does not permit the development of the collateral blood flow via the vasal artery necessary for a viable testis, and previous surgery that represents a risk factor for testicular atrophy. The laparoscopic anatomic classification for the intraabdominal testis is reliable and can disclose the most suitable surgical technique. Laparoscopy is a valuable tool in the diagnosis and treatment of the nonpalpable testicle.

Journal Article↗
PubMed1987

Hypertriglyceridemia: a contraindication to the use of bile acid binding resins.

Bile acid binding resins are indicated for treatment of elevated plasma low-density lipoprotein cholesterol concentrations. In normoglyceridemic patients, plasma concentrations of low-density lipoprotein cholesterol and total cholesterol are closely linked, and for this reason resin treatment of elevated total cholesterol levels in these patients is rational and warranted. Hypertriglyceridemic patients may also have elevated total cholesterol concentrations, and several such patients have been treated with resin. However, resin therapy in these patients is hazardous, since the elevated cholesterol level mainly results from increased plasma concentrations of very-low-density lipoproteins or chylomicrons rather than low-density lipoproteins. In these patients, resin treatment has either no effect or an adverse effect on plasma triglyceride and cholesterol concentrations. The data presented show that fewer than 5 percent of patients whose total plasma triglyceride concentration exceeded 500 mg/dl had elevated low-density lipoprotein cholesterol concentrations, irrespective of total plasma cholesterol concentrations, and no patient whose plasma triglyceride concentration exceeded 1,000 mg/dl had elevated low-density lipoprotein cholesterol levels. Treatment with bile acid binding resins in hypercholesterolemic patients is contraindicated in the presence of hypertriglyceridemia.

Cholesterol↗
PubMed1974

Is positive pelvic lymphadenopathy a contraindication to radical surgery in recurrent cervical carcinoma?

The extent of disease at the time of surgical exploration determines whether radical surgery can be performed in the patient who has a postirradiation cervical cancer recurrence. Contraindications to extirpative surgery includes spread of disease beyond the confines of the removable organs. This includes common iliac and periaortic lymph node metastasis. Some authors have advocated aborting the procedure when pelvic nodes are involved. In a review of 170 patients undergoing radical surgery for cervical cancer recurrence, 25 percent with positive nodes survived 5-yr compared with 36 percent with negative nodes. The finding of positive pelvic lymph nodes in itself should not be the sole reason for abandoning the operative procedure.

Female↗
PubMed1989

Large trials with simple protocols: indications and contraindications.

The design of a clinical trial derives from its objective, which in its turn is dictated by the needs of clinical practice. Therefore, a common condition, a simple treatment, and a simple outcome measure are opportunities rather than design options. The argument that the direction of the net treatment effect can be expected to be similar across patient subgroups is inconsistent with biologic reality, and may misguide interpretation of both individual and pooled trial results. If no data on patient characteristics are recorded, scientific generalization is hampered and there is limited opportunity to learn about mechanisms of action and about specific indications and contraindications. If the treatment influences an intermediary outcome, which is assumed to have a causal role in the disease process that the treatment eventually seeks to influence, the effect on the intermediary outcome is of great importance--for clinical practice is very much centered around this outcome and the effects on intermediary outcomes may serve as an aid in explaining why there is an effect or why not. In conclusion, there are some research questions that may warrant large and simple trials, but many clinically very relevant research questions require a more complex trial design.

Clinical Protocols↗
PubMed1983

The use of Laminaria japonica in intracavitary radiation therapy when anesthesia is contraindicated.

Laminaria tents have been used to dilate the cervix for interruption of pregnancy and other intrauterine procedures. Their use is presented in 5 patients with cervical and endometrial carcinoma where general anesthesia was contraindicated. Cervical dilation was sufficient with a single Laminaria to carry out intrauterine and intravaginal instrumentation for radiation therapy with no local or general anesthesia.

Adenocarcinoma↗
PubMed1994

Spinal anaesthesia for caesarean section following epidural analgesia in labour: a relative contraindication.

Three cases are described in which epidural analgesia was performed during labour using an infusion of bupivacaine 0.125-0.25%. When, in all 3 cases, caesarean section was required for failure to progress, hyperbaric bupivacaine was given in doses of 10 mg, 12.5 mg and 15 mg respectively. Within 2-4 min all 3 patients had a high block, complained of difficulty in breathing and subsequently developed apnoea. The trachea was intubated after administration of thiopentone and succinylcholine and the operation continued. Cardiovascular support was provided by the administration of ephedrine injected intermittently intravenously. The spinal block receded and the patients were able to return to the ward without any further complications. All three mothers remain in good health and do not regret having had spinal anaesthesia for caesarean section. In contrast to previously reported cases of high spinal anaesthesia following unsuccessful epidural anaesthesia for caesarean section, this report describes 3 cases of high spinal following the administration of spinal anaesthesia upon an ongoing epidural infusion of local anaesthetic during labour. As no guidelines are available as to the recommended dose of spinal anaesthetic under such circumstances and, in view of the several case reports describing a similar complication under different circumstances, we suggest that spinal anaesthesia is contraindicated upon ongoing epidural analgesia or following a failed epidural.

Journal Article↗