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At least 811 records · Page 45Linked to original sources
PubMed1996

[Medical assessment prior to gastroplasty: indications and contraindications].

Because of the common failure of the various medical procedures used for the treatment of morbid obesity, surgeons have searched alternatives among which gastroplasty appears to offer now the best efficacy/safety ratio. Such approach has become more and more popular in our country, but success is almost highly variable from patient to patient. A careful medical assessment is necessary before performing gastroplasty. It mainly aims at choosing the appropriate indications (failure of previous well-applied medical therapy, exclusion of any hormonal cause of obesity, presence of complications due to weight excess, ...) and at excluding cardiovascular (unstable coronaropathy, carotid stenosis, ...), digestive (recurrent oesophagitis, ...) or psychiatric contra-indications. Such medical assessment before gastroplasty should allow to increase the success rate and to reduce the incidence of complications after the surgical procedure.

Adolescent↗
PubMed1996

[Monoplane, biplane and multiplane transesophageal echocardiography. Indications, contraindications, complications and examination technique].

Major clinical applications and examination technique of transesophageal echocardiography are described on the basis of personal experience and literature data. Capabilities of monoplane and more recent biplane and multiplane transducers are discussed. Transesophageal examination appears to be complementary to transthoracic technique; it is also utilized in the preoperative and intraoperative monitoring of surgical procedures and during interventional catheterization. The clinical indications for transesophageal echocardiography include aortic dissection, dysfunction of valvar prosthesis, detection of an intracardiac source of embolism, assessment of infective endocarditis, congenital and valvular heart disease, and evaluation of cardiac masses. Another application is the assessment of cardiovascular function of critically ill patients in the coronary, medical, or surgical intensive care unit, due to limited transthoracic echocardiographic acoustic windows. When performing a transesophageal examination, a methodical approach is preferred consisting of a sequence of transducer positions and views. With each successive advance in transducer technology the number of available imaging planes has increased. The monoplane device can optimally image only two primary planes of the heart, i.e. short-axis and frontal planes. The biplane probe adds substantially more diagnostic information over a monoplane transducer because of a second imaging array in the longitudinal orientation. The multiplane device produces a continuum of transverse and longitudinal images by rotation of the electronic array and more readily provides intermediate and off-axis images between the primary planes.

Contraindications↗
PubMed1997

Transjugular intrahepatic portosystemic shunt as a form of treatment for portal hypertension: indications and contraindications.

The TIPS clearly has had a major impact on the treatment of complications of portal hypertension in the cirrhotic patient. Currently, TIPS is performed in community hospitals as well as university centers in the United States. While the shunt is placed under local anesthesia in a nonoperative fashion, it must be remembered that it does function as a highly effective side-to-side shunt with its attendant complications including hepatic encephalopathy and occasional liver failure. Early reports of clinical and hemodynamic results after TIPS have clearly demonstrated it to be an effective bridge to liver transplantation. Nonetheless, transplantation candidates who experience their initial episode of variceal hemorrhage still should be managed with sclerotherapy or variceal band ligation. However, if bleeding recurs during a course of treatment or cannot be acutely controlled, TIPS has proved invaluable in stabilizing patients prior to liver transplantation. Refractory variceal bleeding in Child's class C patients, in whom the perioperative mortality associated with surgical shunts is high, is also reasonable indication for TIPS. Potential, but less well-proved indications for TIPS include refractory ascites, hepatic hydrothorax, and the Budd-Chiari syndrome. Refractory variceal hemorrhage in Child's class A or B patients, bleeding from portal hypertensive gastropathy, and HRS represent possible, but unproved, indications. Preoperative reduction in portal hypertension prior to liver transplantation does not appear to represent an appropriate indication for TIPS. In spite of the wide acceptance of TIPS, it will be important to continue to study its indications and its complications so that it can be optimally used in the treatment of patients with portal hypertension.

Algorithms↗
PubMed1996

[Bladder catheter or suprapubic fistula? Indications and contraindications].

Even in closed sterile transurethral catheter drainage, infections of the lower urinary tract are documented in 50% of cases after 1 week of indwelling catheter. Not all of these cases develop symptomatic catheter-associated urinary tract infection. Suprapubic catheter drainage of the bladder results in markedly later urinary tract infection, presenting 50% of patients infected on day 40. The markedly later onset of catheter-associated urinary tract infection makes the suprapubic approach to bladder drainage suitable for all those patients, who may need catheters for more than 3 days postoperatively. Transfusion-dependent bleeding after puncture in 2-4% of cases and perforation of adjacent organs in 0.3% are the main complications. Suprapubic insertion of a catheter is contraindicted in patients with bleeding disorders and in those with bladder cancer in their history.

Catheters, Indwelling↗
PubMed1996

Renal milk of calcium: contraindication to extracorporeal shockwave lithotripsy.

Renal milk-of-calcium (MOC) cysts are rare findings, with only approximately 60 cases reported in the literature. The diagnosis depends on the demonstration of the typical "half-moon" configuration on horizontal beam radiography; classical ultrasound finding is a gravity-dependent, echogenic shadowy material in a renal cyst. The importance of the MOC syndrome lies in its recognition and differentiation from a renal stone in order to avoid unwarranted surgery or extracorporeal shock-wave lithotripsy (ESWL). We have encountered five patients with renal MOC and present the typical clinical and radiological features in order to facilitate differential diagnosis.

Adult↗
PubMed1997

[A case of cholesterol crystal embolism following coronarography: a contraindication of the procedure?].

Authors report on one patient with cholesterol embolization following cardiac catheterization and coronary by-pass surgery. During the immediate post-operative period, neurological and renal complications occurred because of recurrent cholesterol embolization. One month after surgery the patient died from a sudden neurological coma. Cholesterol crystal embolization appears to be a contra-indication to heart surgery, even in a strongly symptomatic patient, when the spontaneous course of the existing cardiac disease is not life-threatening in the short term.

Aged↗
PubMedDate not supplied

[Contraindications to vaccination. The decisions of primary care professionals in Málaga].

OBJECTIVE: To measure the correctness of decisions concerning counter-indications to vaccination (CV), taken by Primary Care professionals involved with the vaccination programme; to identify their associations with personal or organisational variables; and to sound out professionals' views on the source of false counter-indications and training for the programme. DESIGN: A crossover study. SETTING: Primary care centres in the city of Málaga and its metropolitan area. PARTICIPANTS: 173 nurses and 68 doctors from these centres. INTERVENTIONS: A questionnaire to professionals about their clinical decisions and views of CV. RESULTS: The worse average score was that recorded in the clinical situation involving live virus vaccines (634 points out of 1,000) and whooping cough vaccination (791 points). General counter-indicative items reached a higher score (865). CONCLUSIONS: Professional criteria on CV must be brought up to date and unified.

Attitude of Health Personnel↗