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PubMed2006

Factors associated with postpartum physical and mental morbidity among women with known HIV status in Lusaka, Zambia.

The objective of our study was to investigate factors associated with postpartum physical and mental morbidity among women in Lusaka, Zambia with particular reference to known HIV status. Our study was part of the Breastfeeding and Postpartum Health (BFPH) longitudinal cohort study conducted between June 2001 and July 2003. Women were recruited at 34 weeks gestation and followed up to 16 weeks postpartum. Data on maternal health were collected at 3, 7, 10, and 14 days and at 3, 4, 5, 6, 9, 12, and 16 weeks postpartum. Maternal mental health data were collected from April 2002 onwards at recruitment and at seven days and six weeks postpartum. Data on physical morbidity were collected for 429 women (218 HIV-negative, 211 HIV-positive) and data on mental morbidity were collected for 272 women (134 HIV-negative, 138 HIV-positive). Multivariate logistic regression was used to examine factors associated with postpartum physical or mental morbidity. Postpartum physical morbidity was associated with HIV status, parity > or =5 and age < 20 years. Neither antenatal nor postpartum mental morbidity, as indicated by a self-reporting questionnaire 20-item (SRQ-20) score > or =7, were associated with HIV status or with postpartum physical morbidity in this population. Larger comparative studies are required to corroborate or contest these findings.

Adolescent↗
PubMed2001

The degree of antenatal ventriculomegaly is related to pediatric neurological morbidity.

OBJECTIVE: Our hypothesis was that the degree of antenatally diagnosed cerebral ventriculomegaly is related to aneuploidy, perinatal mortality and long-term neurological morbidity. METHODS: Ninety-one cases of ventriculomegaly identified from 1 June 1994 to 1 July 1999 were examined for prenatal, intrapartum and neonatal complications. Pediatric follow-up was reviewed for infants with ventriculomegaly from birth up to as long as 4 years. Minor neurological morbidity was defined as a score of 70-80 on the clinical adaptive test/clinical linguistic and auditory milestone scale and included mild motor or language delay. Major morbidity included a score of < 70, evidence of cerebral palsy, or seizure disorder. The incidence of neurological complications was compared, on the basis of the degree of ventriculomegaly, with group 1 being > 10-15 mm and group 2 being > 15 mm. RESULTS: Twenty-seven cases (18 with neural tube defects and nine with holoprosencephaly) were excluded. Among the remaining 64 patients, 39 had a ventricular diameter of > 10-15 mm and comprised group 1. Five of the 39 cases (12.8%), all with other ultrasound anomalies, elected to terminate. The incidence of aneuploidy in group 1 was 14.2%. Among the 19 cases with isolated ventriculomegaly, 17 (89%) were normal and two (11%) had minor neurological morbidity. In group 1 there were two cases associated with cytomegalovirus (CMV) infection. Of the 25 cases in group 2, eight (32%), all with other ultrasound anomalies, elected to terminate. The incidence of aneuploidy in group 2 was 17.4%. For the nine cases with isolated ventriculomegaly of > 15 mm, one (11%) was normal (p < 0.001), five (56%) had minor neurological morbidity requiring a ventriculoperitoneal shunt (p = 0.035), and three (33%) had major neurological morbidity (p = 0.045) when compared to cases of isolated ventriculomegaly in group 1. There was one case of CMV infection in group 2. All perinatal deaths in both groups were associated with other anomalies. CONCLUSIONS: Amniocentesis to determine karyotype and the presence of CMV is warranted for all cases of ventriculomegaly of > 10 mm. The degree of antenatal ventriculomegaly is related to pediatric neurological morbidity and, when it is > 15 mm, it is associated with an increase in abnormal neurological development.

Aneuploidy↗
PubMed1993

Relationship between postoperative anemia and cardiac morbidity in high-risk vascular patients in the intensive care unit.

OBJECTIVE: To determine if postoperative anemia is associated with postoperative myocardial ischemia and morbid cardiac events DESIGN: Case control study. SETTING: Postanesthesia care unit and surgical intensive care unit. PATIENTS: A total of 27 high-risk patients undergoing infra-inguinal arterial bypass procedures. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: After informed consent, patients were continuously monitored by ambulatory electrocardiographic recorders from the evening before surgery up to 80 hrs during the postoperative period. Myocardial ischemia was defined as > or = 1 mm of horizontal or downsloping ST depression or > or = 2 mm ST segment elevation persisting for at least 60 secs on the ambulatory electrocardiogram. Morbid cardiac events were defined as: cardiac death, myocardial infarction, unstable angina, and ischemic pulmonary edema. Using a receiver operating characteristic curve, a hematocrit of 28% was determined to be the best threshold hematocrit value below which morbid cardiac events were most likely to occur. Statistical significance between hematocrit and cardiac outcome was determined by Fisher's exact test where appropriate. Thirteen of 27 patients had a hematocrit < 28%. Of these 13 patients, ten demonstrated postoperative myocardial ischemia and six sustained a morbid cardiac event. Of 14 patients with a hematocrit > or = 28%, two displayed myocardial ischemia and none sustained a morbid cardiac event. A hematocrit of < 28% was significantly associated with myocardial ischemia (p = .001) and morbid cardiac events (p = .0058). No significant differences in baseline heart rate and heart rate at the onset of myocardial ischemia were noted between the anemic and nonanemic patients. CONCLUSIONS: This study suggests that postoperative anemia may play a role in postoperative myocardial ischemia and cardiac morbidity.

Aged↗
PubMed2004

Risk factors for febrile morbidity after hysterectomy.

OBJECTIVE: To identify risk factors for febrile morbidity after hysterectomy for nonmalignant indications. METHODS: We performed a retrospective cohort study of 686 women who had a hysterectomy between January and September 1997 by abdominal (n = 408), laparoscopic-assisted vaginal (n = 90), or vaginal (n = 188) approaches. Potential risk factors for febrile morbidity were extracted from the medical records. By means of multivariable logistic regression, we evaluated demographic, reproductive, clinical, and operative risk factors for febrile morbidity. RESULTS: The risk of postoperative febrile morbidity in this population was 14%. Only 50% of women received prophylactic antibiotics, whereas almost 20% received no antibiotics at all, and 30% were administered antibiotics after surgical incision. Risk factors for febrile morbidity after hysterectomy, after controlling for age, body mass index, operative time, and prophylactic antibiotic administration, were abdominal approach (odds ratio 2.7; 95% confidence interval 1.6, 4.3) and blood loss at surgery of more than 750 mL (odds ratio 3.5; 95% confidence interval 1.8, 6.8). CONCLUSION: Hysterectomy by abdominal approach and increased blood loss at the time of surgery significantly increase the risk of febrile morbidity. Preventive efforts should focus on methods to reduce postoperative febrile morbidity, including meticulous surgical technique and routine use and appropriate timing of prophylactic antibiotic therapy.

Adult↗
PubMed2006

Co-morbid drug and alcohol and mental health issues in a rural New South Wales Area Health Service.

OBJECTIVE: In 2003 the New South Wales (NSW) Centre for Rural and Remote Mental Health (CRRMH) conducted an analysis of co-morbid drug and alcohol (D&A) and mental health issues for service providers and consumers in a rural NSW Area Health Service. This paper will discuss concerns raised by rural service providers and consumers regarding the care of people with co-morbid D&A and mental health disorders. DESIGN: Current literature on co-morbidity was reviewed, and local area clinical data were examined to estimate the prevalence of D&A disorders within the mental health service. Focus groups were held with service providers and consumer support groups regarding strengths and gaps in service provision. SETTING: A rural Area Health Service in NSW. PARTICIPANTS: Rural health and welfare service providers, consumers with co-morbid D&A and mental health disorders. RESULTS: Data for the rural area showed that 43% of inpatient and 20% of ambulatory mental health admissions had problem drinking or drug-taking. Information gathered from the focus groups indicated a reasonable level of awareness of co-morbidity, and change underway to better meet client needs; however, the results indicated a lack of formalised care coordination, unclear treatment pathways, and a lack of specialist care and resources. DISCUSSION: Significant gaps in the provision of appropriate care for people with co-morbid D&A and mental health disorders were identified. Allocation of service responsibly for these clients was unclear. It is recommended that D&A, mental health and primary care services collaborate to address the needs of clients so that a coordinated and systematic approach to co-morbid care can be provided.

Comorbidity↗
PubMed1989

Factors influencing neonatal morbidity in gestational diabetic pregnancy.

The influence of obstetric factors and indices of maternal blood glucose control on neonatal morbidity was examined in 261 women with gestational diabetes. A reference group of 218 women, matched for age and day of delivery, within 1 week, was used for comparison. Perinatal morbidity was significantly more frequent in the gestational diabetic pregnancies (23%) than in the reference group (13%), whereas the occurrence of large-for-gestational-age infants was not different between the groups. Infants born to women with gestational diabetes were categorized to a no-morbidity group (n = 200) and a morbidity group (n = 61). The group with morbidity had significantly shorter gestational age at delivery, higher frequency of caesarean section, higher maternal pre-pregnancy weight and higher area under the glucose tolerance curve. There was no significant difference in third-trimester blood glucose between the groups. Discriminant analysis revealed that the most significant influence on neonatal morbidity was gestational age at delivery. After correction for this factor the only factor with added significance for neonatal morbidity was maternal pre-pregnancy weight. The present study clearly illustrates that other factors beside blood glucose control are of importance for neonatal outcome in gestational diabetic pregnancy.

Adult↗
PubMed2001

Incidence and predictors of severe obstetric morbidity: case-control study.

OBJECTIVE: To estimate the incidence and predictors of severe obstetric morbidity. DESIGN: Development of definitions of severe obstetric morbidity by literature review. Case-control study from a defined delivery population with four randomly selected pregnant women as controls for every case. SETTING: All 19 maternity units within the South East Thames region and six neighbouring hospitals caring for pregnant women from the region between 1 March 1997 and 28 February 1998. PARTICIPANTS: 48 865 women who delivered during the time frame. RESULTS: There were 588 cases of severe obstetric morbidity giving an incidence of 12.0/1000 deliveries (95% confidence interval 11.2 to 13.2). During the study there were five maternal deaths attributed to conditions studied. Disease specific morbidities per 1000 deliveries were 6.7 (6.0 to 7.5) for severe haemorrhage, 3.9 (3.3 to 4.5) for severe pre-eclampsia, 0.2 (0.1 to 0.4) for eclampsia, 0.5 (0.3 to 0.8) for HELLP (Haemolysis, Elevated Liver enzymes, and Low Platelets) syndrome, 0.4 (0.2 to 0.6) for severe sepsis, and 0.2 (0.1 to 0.4) for uterine rupture. Age over 34 years, non-white ethnic group, past or current hypertension, previous postpartum haemorrhage, delivery by emergency caesarean section, antenatal admission to hospital, multiple pregnancy, social exclusion, and taking iron or anti-depressants at antenatal booking were all independently associated with morbidity after adjustment. CONCLUSION: Severe obstetric morbidity and its relation to mortality may be more sensitive measures of pregnancy outcome than mortality alone. Most events are related to obstetric haemorrhage and severe pre-eclampsia. Caesarean section quadruples the risk of morbidity. Development and evaluation of ways of predicting and reducing risk are required with particular emphasis paid on the management of haemorrhage and pre-eclampsia.

Adult↗
PubMed1993

Abnormal erythrocyte rheology in patients with morbid obesity.

The objectives of this study were to investigate the rheological properties of the erythrocyte in patients with morbid obesity and to follow them up after a short-term weight loss. A fluorescent polarization method was used to assess erythrocyte membrane biorheology and to measure its fluidity. Eighteen subjects participated in the study: 8 healthy controls and 10 patients with morbid obesity. The erythrocyte membrane fluidity was obtained in the healthy subjects and in the patients with morbid obesity prior to and after a ten-day zero-calorie diet. Fluidity was determined by steady-state fluorescence polarization after incorporation of the lipophilic probe 1,6-diphenyl-1,3,5 hexatriene (DPH). With this method, the anisotropy parameter at 37 degrees C, which is inversely related to membrane fluidity, was obtained. The patients with morbid obesity revealed an abnormal erythrocyte rheology. The exhibited an abnormally low erythrocyte membrane fluidity as compared with normal subjects. The anisotropy parameter at 37 degrees C was 1.417 +/- 0.093 in these obese patients compared with 1.279 +/- 0.043 in normal-weight controls (p < 0.01). Upon a short-term significant weight loss from a body mass index (BMI) (weight/height2) of 39 +/- 5 to 36 +/- 5 kg/m2 (p < 0.05), the anisotropy parameter did not change (1.401 +/- 0.190). Thus, fluidity measurements permit recognition of an abnormal erythrocyte rheology in patients with morbid obesity. This abnormality may partially explain the excess cardiovascular and thromboembolic morbidity in morbid obesity.

Adult↗
PubMed2005

Screening for psychological morbidity in HIV-infected and HIV-uninfected pregnant women using community counselors in Zimbabwe.

OBJECTIVE: To examine the prevalence of psychological morbidity in HIV-infected and uninfected pregnant women seeking antenatal care in Zimbabwe. METHODS: Pregnant women were screened for psychological morbidity at the initial antenatal care visit using the 14-item Shona Symptom Questionnaire (SSQ) before voluntary HIV counseling and testing (VCT). The primary outcome measure was "cases," as determined by a SSQ score of >or= 8. Demographic characteristics and HIV status were compared between cases and noncases to determine the risk factors for psychological morbidity. RESULTS: Of the 437 participants, psychological morbidity was detected in 73 (17%) women before undergoing VCT. Risk factors for psychological morbidity included having a spouse older than 35 years of age. HIV infection by itself was not a risk factor for psychological morbidity for women. CONCLUSIONS: There is a high burden of psychological morbidity among pregnant women in Zimbabwe. Mental health services should be integrated into antenatal care to improve psychological health for all women in Zimbabwe.

Adolescent↗
PubMed2006

Towards better measurements in bereavement research: order of questions and assessed psychological morbidity.

The aim of this study was to determine if the order of questions in a study on men who have lost a wife in cancer affects self-assessed measures of psychological morbidity. Data were collected from 76 men who had lost a wife owing to cancer in the breast, ovary or colon in 1999. They were randomly allocated to one of two questionnaires with identical content but varying design. One version began with questions about the wife's disease and ended with the respondent's current wellbeing (morbidity-last group). The other version had a reversed order (morbidity-first group). Results showed that the design of the questionnaire affected self-assessed psychological morbidity; all relative risks for these measures were above 1.0 in the morbidity-last group. The highest relative risk was obtained for anxiety (as measured by HADS), 3.4 (0.8-15.0), and depression (as measured by a visual-digital scale), 3.1 (1.2-8.5). Psychological morbidity is assessed as higher when questions appear in the end, rather than the beginning, of a bereavement-related questionnaire. In order to avoid a detrimental bias in a study on bereavement, psychological morbidity is probably best measured first in such a questionnaire.

Adult↗
PubMed1995

Morbid jealousy in alcoholism.

BACKGROUND: Morbid jealousy is an incompletely understood syndrome. The association between morbid jealousy and alcoholism is unclear. METHOD: Morbid jealousy was assessed in 207 male patients with alcohol dependence (DSM-III-R) using a semi-structured interview schedule administered both to patients and their spouses. RESULTS: Thirty-four per cent (71 out of 207) suffered from morbid jealousy. Morbid jealousy had different manifestations. Some patients expressed it only when intoxicated, others even when sober and in some the jealousy took the form of a delusional disorder. CONCLUSIONS: Alcoholism appears to have an aetiological role in the development of morbid jealousy. Detecting morbid jealousy when it is expressed only under the influence of alcohol has preventive implications.

Adult↗
PubMed2006

Psychiatric morbidity in children with medically unexplained chronic pain: diagnosis from the pediatrician's perspective.

CONTEXT: There is very little general evidence to support the clinical management, particularly diagnosis, of medically unexplained chronic pain (UCP) in children. OBJECTIVE: We sought to assess in children with UCP if clinical characteristics held important by general pediatricians help to accurately diagnose psychiatric morbidity and, alternatively, if the same can be achieved using dedicated questionnaires. METHODS: We used a cross-sectional diagnostic study in a pediatric outpatient clinic of a university hospital. Our participants were 134 patients, aged 8 to 18 years, who were referred for UCP. Performed were (1) diagnostic test reflecting the pediatricians' choice of clinical characteristics and (2) selected questionnaires. Classification was performed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, by a child psychiatrist using the Diagnostic Interview Schedule for Children-Parent Version IV and the Semi-structured Clinical Interview for Children and Adolescents. Results were analyzed by logistic regression. RESULTS: Psychiatric morbidity was present in 80 of the children. A minority had a medical explanation for the pain (15% definite, 17% probable). The clinical diagnostic model included age, social-problem indicators, family structure, parental somatization, and school problems. In the quintile of children in whom this model predicted the highest risk, 93% indeed had psychiatric morbidity at reference testing. In the quintile with the lowest predicted risk, indeed only 27% had psychiatric morbidity. The Dutch Personality Inventory for Youth and the Child Behavior Checklist matched the pediatricians' choice of clinical characteristics. In the quintile of children with the highest predicted risk based on these questionnaires, 89% had psychiatric morbidity. In the quintile with the lowest predicted risk, only 15% had psychiatric morbidity. CONCLUSIONS: A pediatrician-chosen set of clinical characteristics of children with UCP proves useful in diagnosing psychiatric morbidity. Using selected questionnaire screening yields similar results.

Adolescent↗
PubMed2006

Neonatal risk factors for respiratory morbidity during the first year of life among premature infants.

CONTEXT AND OBJECTIVE: There have been dramatic increases in very low birth weight infant survival. However, respiratory morbidity remains problematic. The aim here was to verify associations between pulmonary mechanics, pulmonary structural abnormalities and respiratory morbidity during the first year of life. DESIGN AND SETTING: Prospective cohort study at Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro. METHODS: Premature infants with birth weight < 1500 g were studied. Lung function tests and high-resolution chest tomography were performed before discharge. During the first year, infants were assessed for respiratory morbidity (obstructive airways, pneumonia or hospitalization). Neonatal lung tests and chest tomography and covariables potentially associated with respiratory morbidity were independently assessed using relative risk (RR). RR was subsequently adjusted via logistic regression. RESULTS: Ninety-seven newborn infants (mean birth weight: 1113 g; mean gestational age: 28 weeks) were assessed. Lung compliance and lung resistance were abnormal in 40% and 59%. Tomography abnormalities were found in 72%; respiratory morbidity in 53%. Bivariate analysis showed respiratory morbidity associated with: mechanical ventilation, prolonged oxygen use (beyond 28 days), oxygen use at 36 weeks, respiratory distress syndrome, neonatal pneumonia and patent ductus arteriosus. Multivariate analysis gave RR 2.7 (confidence interval: 0.7-10.0) for simultaneous lung compliance and chest tomography abnormalities. Adjusted RR for neonatal pneumonia and mechanical ventilation were greater. CONCLUSIONS: Upon discharge, there were high rates of lung mechanism and tomography abnormalities. More than 50% presented respiratory morbidity during the first year. Neonatal pneumonia and mechanical ventilation use were statistically significant risk factors.

Brazil↗
PubMed2006

Pharmacotherapy of alcoholism in patients with co-morbid psychiatric disorders.

There has been an exponential increase in recent years of literature pertaining to the treatment of individuals with alcohol use disorders and co-morbid psychiatric disorders. Patients with mood and anxiety disorders in particular have a very high prevalence of alcoholism. Alcoholism confers significant morbid risks to patients with psychiatric disorders, and vice versa, including markedly increased risk of suicide. Only recently have studies examined the impact of various psychiatric medications on alcohol use among patients with these disorders. Evidence supporting the benefits of antidepressants for co-morbid alcoholism and depression continues to mount. Although these studies have demonstrated benefits in terms of quantitative decreases in the volume and frequency of consumption, the benefits in terms of remission from alcoholism have yet to be shown conclusively. The first randomised, controlled trial involving subjects with co-morbid alcoholism and bipolar disorder was recently conducted, yielding promising results for valproate in this population. The literature regarding co-morbid alcoholism and anxiety disorders has also seen recent progress, particularly in the study of post-traumatic stress disorder (PTSD). A placebo-controlled study of sertraline suggests some benefit in terms of alcohol use among individuals with early-onset PTSD and less severe alcohol dependence. Atypical antipsychotics such as olanzapine and quetipaine have been examined in several open studies of subjects with alcoholism co-morbid with a variety of psychiatric conditions including bipolar disorder, PTSD and schizophrenia. This paper selectively reviews the evidence that is currently available for the pharmacological management of alcoholism among persons with co-morbid psychiatric illness. Effectiveness, safety and tolerability are considered, and directions for future study are discussed.

Alcoholism↗
PubMed1995

Morbidity of donor and recipient sites after free flap surgery. A prospective study.

Although free flap transfer is a routine procedure, we know of few studies about post-operative morbidity at recipient and donor sites. The strength of the shoulder extension after harvesting of a latissimus dorsi free flap (n = 12) and the patients' subjective opinions of morbidity at recipient and donor sites (n = 23) were assessed two and six weeks, and three,six, and nine months after transfer of free muscle flaps. The patients' subjective opinions were measured on a scale from 1 (normal) to 5 (very troublesome) and the strength of the shoulder was measured in N. The flaps used were latissimus dorsi (n = 18), rectus abdominis (n = 4), and gracilis (n = 1). All but one were transplanted to a lower extremity. The extension strength of the shoulder decreased from 105 N to 70 N immediately after the operation (p < 0.05), and strength did not improve during follow up. Subjectively assessed morbidity at the recipient site and cosmetic disability decreased from troublesome or very troublesome to moderate (p < 0.05). Swelling decreased from moderate at two weeks to normal or slight at nine months (p < 0.05). The subjective morbidity at the donor site decreased from slight at two weeks to normal at nine months for functional disability (p < 0.05). Cosmetic disability at the donor site was minimal during follow up. This study shows that shoulder extension strength deteriorated permanently after part of the latissimus dorsi muscle had been removed even though subjective morbidity was minimal. Morbidity at the recipient site decreased significantly with time. Subjective opinion of morbidity after latissimus dorsi transplantation did not differ from that after rectus abdominis transplantation.

Adolescent↗
PubMed2004

Prediction of genitourinary tract morbidity after brachytherapy for prostate adenocarcinoma.

OBJECTIVE: To investigate whether preoperative genitourinary variables in patients undergoing brachytherapy for localized prostate adenocarcinoma could predict postoperative genitourinary tract morbidity. PATIENTS AND METHODS: We retrospectively reviewed medical records of 105 men who received either iodine 125 or palladium 103 radioactive seed implants with or without external beam radiotherapy or hormone blockade from January 1, 1998, through December 31, 2000, at the Mayo Clinic in Jacksonville, Fla. Patients with one or more of the following were classified as having a high risk of postoperative genitourinary tract morbidity: American Urological Association symptom scores greater than 15, maximum urinary flow rate less than 10 mL/s, postvoid residual urinary volume greater than 100 mL, or prostate volume greater than 40 cm3. Of the 105 men, 59 (56%) were classified as high risk and 46 (44%) as low risk. Mean follow-up after brachytherapy was 23.6 months. Modified Radiation Therapy Oncology Group scores were used to assess postoperative genitourinary tract morbidity. The term significant genitourinary tract morbidity was applied to patients with a Radiation Therapy Oncology Group grade of 3 or 4 after at least 6 months of follow-up. RESULTS: Significant morbidity occurred in 37% of high-risk vs 15% of low-risk patients (P = .006). In high-risk patients, transurethral resection or incision of the prostate was required in 5 patients, urethral dilation in 4, direct-vision internal urethrotomy in 1, and placement of a suprapubic catheter in 1. In low-risk patients, transurethral incision of the prostate was required in only 1 patient. Urinary flow rate was a significant individual predictor of postoperative morbidity (P = .03). CONCLUSIONS: A combination of urinary flow rate, prostate volume, postvoid residual urinary volume, and American Urological Association symptom score can help identify patients with underlying voiding dysfunction. Urinary flow rate was a statistically significant predictor of genitourinary tract morbidity after brachytherapy for localized prostate adenocarcinoma. Patients and physicians should consider these factors before a patient decides to undergo brachytherapy.

Adenocarcinoma↗
PubMed1991

An investigation of maternal morbidity with identification of life-threatening 'near miss' episodes.

This study was designed to investigate the pattern of obstetric morbidity and to determine the frequency of serious life-threatening episodes as a basis for clinical audit. The records of over 2,000 maternities from a National Health Service Consultant Unit during a six-month period were analysed. Morbidity was noted in almost a quarter of the cases, and life-threatening episodes, termed 'near miss' morbidity, were identified. As the maternal death rate has fallen in this country, maternal morbidity has come to represent a more useful indicator of obstetric care than mortality. The results of this study identify the need for an agreed set of definitions for 'near miss' morbidity, and suggest that not only should it be included for discussion in unit perinatal meetings, but that Regional obstetric morbidity enquiries would provide valuable denominator data on morbidity.

Female↗
PubMedDate not supplied

[Morbidity and mortality in surgery for gastric cancer].

BACKGROUND DATA: Surgery stays as the only effective therapy against gastric cancer. Several factors have been postulated to influence morbidity and mortality risk in gastric cancer surgery. OBJECTIVE: Determine morbidity and mortality of gastric cancer surgery and establish risk factors. METHOD: We reviewed the charts of patients who underwent surgery for gastric adenocarcinoma. Morbidity and mortality is reported. Demographic factors, preoperative physical evaluation, biochemical parameters, surgical technique and tumor biology were analyzed as risk factors for morbidity and mortality. RESULTS: During a seven year period, 120 patients were operated for gastric cancer. Median age was 58.07 years. Subtotal gastrectomy was the most common surgical procedure in 51 patients (42.5%). Morbidity was 26.66% (n = 32). Medical most common complication was renal failure (n = 6, 14.63%) and surgical most common complication was wound infection (n = 7, 17.07%). Mortality was 13.33% (n = 16). Statistically significant risk factors for morbidity were age, ECOG status, Goldman Cardiac Risk Index and a total lymphocyte count. Statistically significant risk factors for mortality were Goldman Cardiac Risk Index, albumin, creatinine, and total lymphocyte count. CONCLUSIONS: Morbidity and mortality after gastric cancer surgery is influenced by preoperative conditions of patients.

Adenocarcinoma↗