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PubMed2002

Experienced, recreational scuba divers in Australia continue to dive despite medical contraindications.

OBJECTIVE: In Australia, a medical examination is required before undertaking a scuba diving course in order to screen for contraindications to diving. No further medical screening is required, and yet divers may develop diseases during their diving careers. This study aimed to survey experienced recreational scuba divers to determine the prevalence of diseases contraindicated in diving. METHODS: A cross-sectional, postal survey was taken of divers belonging to scuba diving clubs across Australia. RESULTS: Three hundred forty-six divers returned completed questionnaires. Two hundred fifty-four (73.4%) were male, and 258 (74.6%) were aged 31 to 60 years. The mean years of diving equaled 10.6 +/- 9.18 years, and the mean number of dives undertaken was 414 +/- 740 dives. One hundred sixty-two (46.8%) divers were overweight, 45 (13.0%) divers required regular medication, and 39 (11.3%) divers smoked. Thirty-six (10.4%) divers reported a past or present history of asthma, and the same number reported hypertension or coronary heart disease. Eighty-six (24.9%) divers reported past or present psychological symptoms. Forty-two (12.1%) divers reported hearing difficulties, and 81 (23.4%) divers reported past or present tinnitus. Two divers had a past history of epilepsy, 2 had a history of pneumothorax, and I was diabetic. CONCLUSIONS: Experienced, recreational scuba divers continue to dive despite medical contraindications. This raises the questions: Did the divers fail to disclose these conditions at the initial examination, or did these conditions develop subsequently? Is the risk associated with these conditions clinically significant, and should screening examinations be undertaken at regular intervals? The high prevalence of hearing difficulties and tinnitus may be the result of aural barotrauma and requires further research.

Adult↗
PubMed1990

Combined endoscopic and surgical gastrostomy when percutaneous endoscopic gastrostomy is contraindicated.

The resurgence of enteral feeding, as both a more physiologic and cost-effective means of alimenting patients, has coincided with the increased popularity of endoscopically placed gastrostomies. Indeed, numerous retrospective studies have shown that percutaneous endoscopic gastrostomy (PEG) is superior to its surgical counterpart. There are, however, both absolute and relative contraindications to percutaneous placement. Reported here are three patients who were poor surgical candidates, yet had contraindications to percutaneous placement. Described is a method of combined endoscopic and surgical placement under local anesthesia used successfully in these patients. General anesthesia and laparotomy were not required. A 2-cm incision with endoscopic guidance was used and the gastrostomy was placed under direct vision and secured with a gastric purse string and sutured to the abdominal wall. There was no morbidity or mortality among the three cases reported. All gastrostomies were considered functional within 48 hrs. The authors feel this method is an excellent alternative when PEG is contraindicated. In addition, it may represent the safest and most effective method of gastrostomy placement in the majority of patients requiring a gastrostomy.

Adult↗
PubMed1989

Use of a contraindications checklist by practice nurses performing immunizations at a well child clinic.

At the inception of a general practice well child clinic, a checklist card was introduced into the clinic notes to summarize specific and relative contraindications to immunizations. This card was used by the practice nurses as they ran the immunization procedures during the clinic. A failure on the checklist led to a consultation with the clinic doctor who decided whether to proceed with the immunization. Of 155 immunizations given during the six-month period, only 23 (15%) failed the checklist and required the child to be assessed by the clinic doctor. Of these, nine (39%) were for simple upper respiratory tract infection. All the children were deemed fit to receive immunization. Only one child was found to have a specific contraindication to pertussis. The checklist cards allowed the smooth operation of the immunization procedures by practice nurses who were able to check comprehensively whether there were any contraindications and whether immunizations were being inappropriately refused.

Child Health Services↗
PubMed1988

[Indications and contraindications of peridural anesthesia in obstetrics. Review of the literature].

With the help of an extensive review of the french and foreign literature, and personal statistics concerning 500 peridural anesthesias (PDA), the authors analyze the indications and contraindications of this type of anesthesia, in 1987. It is possible to differentiate well accepted indications: caesarean section, inducement, labor test, dynamic dystocia, delivery of fragile fetus, desire of the patient; definite contraindications: patient's refusal, coagulation disorders, emergency situations, some cardiopathies; debatable indications: breech delivery, scarred uterus, twin delivery, maternal medical problem, where each particular case must be evaluated. In his study, the authors demonstrate that indications tend to become broader and contraindications to become more infrequent. They stress a necessary co-operation between obstetrician and anesthetist to make this decision.

Anesthesia, Epidural↗
PubMed1985

Evaluation of the opportunities for and contraindications to immunization in a tropical paediatric clinic.

The immunization status and frequency of contraindications to immunization were studied in 446 children attending the paediatric clinic of a teaching hospital in south India. In all, 27% of the children were up to date in their immunizations, 19% had a contraindication, and 57% required and could safely be given immunizations. A policy of offering immunizations in paediatric clinics to all who require them and who do not have a contraindication would result in protection of a significant number of unimmunized children.

Child↗
PubMed1997

[Lifesaving thrombolysis--in the light of contraindications].

The authors review the different methodological suggestions concerning thrombolysis, especially from the aspects of the absolute and relative contraindications of the treatment. They present case reports to prove that in patients with life threatening thromboembolic diseases some points of contraindications may be disregarded. They suggest a new strategy of absolute and relative contraindications be made considering the currently available recently introduced thrombolytic therapy.

Adult↗
PubMed2006

Channeling and prevalence of cardiovascular contraindications in users of cyclooxygenase 2 selective nonsteroidal antiinflammatory drugs.

OBJECTIVE: To assess use and channeling of cyclooxygenase 2 selective inhibitors (coxibs) over time and to estimate the percentage of coxib users with cardiovascular contraindications. METHODS: The study population comprised all coxib and nonselective nonsteroidal antiinflammatory drug (NSAID) users in the Integrated Primary Care Information project between January 2000 and December 2004. The prevalence of risk factors for NSAID-related upper gastrointestinal ulcer complications, cardiovascular disease, and cerebrovascular disease at the start of treatment was compared between users of coxibs and users of nonselective NSAIDs. RESULTS: The study population included 72,841 nonselective NSAID users and 10,739 coxib users. The prevalence of risk factors for NSAID-related gastrointestinal complications was higher in coxib users than nonselective NSAID users (odds ratio [OR] 1.18, 95% confidence interval [95% CI] 1.10-1.26). Similarly, the prevalence of prior cardiovascular disease was higher in coxib users than in nonselective NSAID users (OR 1.35, 95% CI 1.28-1.43). Channeling of coxibs to patients with NSAID-related gastrointestinal risk factors declined after 2001 but increased again in 2004, whereas the channeling of coxibs to patients with cardiovascular disease remained constant. Less than 15% of all coxib users had history of ischemic coronary or cerebrovascular disease. Among coxib users with increased risk for NSAID-related gastrointestinal disorders, 27% had history of ischemic coronary or cerebrovascular disease. CONCLUSION: This study demonstrates that coxibs were preferentially prescribed to patients with risk factors for NSAID-related gastrointestinal disorders and/or cardiovascular diseases. Only one-quarter of coxib users with increased risk for NSAID-related gastrointestinal complications had cardiovascular conditions compatible with recent European safety contraindications for coxibs.

Adolescent↗
PubMed1993

Crohn's disease as a contraindication to Kock pouch (continent ileostomy).

Crohn's disease is often described as a contraindication to the construction of a Kock pouch (KP), but a consensus opinion is less definite. One hundred consecutive patients with a KP were reviewed after a minimum follow-up time of 2 1/2 years. The 95 patients with inflammatory bowel disease were analyzed for serious complications. All eight patients in whom the diagnosis of Crohn's disease or inflammatory disease of indeterminate type was made suffered serious complications requiring resections of the pouch or continuing treatment. By contrast, of the 87 cases with ulcerative colitis, only 17 (20 percent) had complications, six of which were readily and simply corrected. Our findings suggest that Crohn's disease should continue to be regarded as a firm contraindication to the KP procedure. It should be actively sought out preoperatively, and it should be treated aggressively if it is discovered after surgery. If such a patient requires further surgery, the KP should be removed.

Adolescent↗
PubMed1999

Advanced age--indication or contraindication for laparoscopic colorectal surgery?

PURPOSE: It has been proposed that laparoscopic colorectal surgery offers several benefits to patients. The aim of this study was to evaluate particularly whether older patients can benefit by laparoscopic colorectal procedures or if minimally invasive procedures are contraindicated. METHODS: All patients who underwent elective surgery were divided into age-related groups: patients 50 years of age or younger, patients ranging from 51 to 70 years of age, and patients older than 70 years. The groups by age were compared with each other relative to their cardiopulmonary status, indication, procedure, conversion, morbidity, mortality, duration of surgery, perioperative blood transfusion, stay on the intensive care unit, and hospitalization. Statistical analysis included univariate analysis by chi-squared tests and Student's t-tests comparing patients older than 70 years with patients 50 years of age or younger and with patients ranging from 51 to 70 years of age (statistical significance was defined as P < 0.05). RESULTS: Within five years 298 patients (male/female ratio, 0.38) underwent a laparoscopic or laparoscopic-assisted colorectal procedure. Of these, 95 (31.9 percent) patients were older than 70 years, 138 (46.3 percent) patients ranged from 51 to 70 years of age, and 65 (21.8 percent) patients were 50 years of age or younger. Pathologic findings in cardiopulmonary function increased with age. There were no statistically significant differences among the younger, middle-aged, and older patients relative to the incidence of conversion (3.1 vs. 9.4 vs. 7.4 percent, respectively), major complications (4.6 vs. 10.1 vs. 9.5 percent, respectively), minor complications (12.3 vs. 15.2 vs. 12.6 percent, respectively) or total laparotomy rate (7.7 vs. 12.3 vs. 12.6 percent, respectively). P > 0.05 for all comparisons. However, duration of surgery, stay on the intensive care unit, and postoperative hospitalization were significantly prolonged in patients older than 70 years (P < 0.05 for all comparisons) but were reduced during the five years of experience with these procedures. CONCLUSIONS: If preoperative assessment of comorbid conditions and perioperative care was ensured, laparoscopic procedures were shown to be safe options in the elderly. The outcome of laparoscopic colorectal surgery in patients older than 70 years is similar to that noted in younger patients. Advanced age is no contraindication for laparoscopic colorectal surgery.

Adult↗
PubMed2001

[Unenhanced spiral computerized tomography in acute diagnosis of flank pain. Examination in contraindications for contrast medium administration].

The diagnostic value of unenhanced helical computed tomography was investigated in a prospective study. In 53 patients (aged 35 to 82 years) with acute flank pain tomography was performed in addition to abdominal plain film and ultrasound examination. All 53 patients had a contraindication for intravenous administration of contrast medium. Ureteral calculi were either confirmed or excluded by retrograde ureteropyelography in 44 cases, in 9 patients by asservation of calculi and clinical follow-up. Helical computed tomography was able to precisely identify all of the 34 ureteral calculi, whereas abdominal plain films led to 6 false positive and 17 false negative findings. In 1 patient with retroperitoneal lymphoma (diagnosed by CT) false positive findings occurred. Unenhanced helical computed tomography reaches a distinctively increased diagnostic value (sensitivity 100%, specificity 95%, accuracy 97%) in the evaluation of acute flank pain as compared to conventional radiologic imaging and ultrasound. This non-invasive procedure is to be considered method of choice for patients with contraindications for the application of radiopaque material.

Acute Disease↗
PubMed2003

Absolute contraindications in relation to potential drug interactions in outpatient prescriptions: analysis of the first five million prescriptions in 1999.

OBJECTIVES: Adverse drug interactions increase morbidity and mortality. To prevent these, situations leading to adverse prescriptions must be clarified. This study quantifies and analyses prescriptions with potential adverse drug interactions in primary health care in the north of France over a 3-month period. METHODS: All prescriptions administered between 1 January and 31 March 1999 were analysed to identify potential interactions amongst drugs appearing on the same prescription sheet. The regional French healthcare database was compiled to further classify contra-indications. RESULTS: There were 5,358,374 prescriptions administered to 44% of the overall population of the Nord-Pas de Calais area (1,754,372 patients/3,990,167 general population). There were 14,390 prescriptions classified as either absolute (26%) or relative contraindications (74%). Nine drug categories accounted for most of the absolute contraindications: dopaminergic antiparkinsonians, neuroleptic agents, migraine treatments (such as ergot alkaloids, sumatriptan and other triptan derivatives), prokinetic drugs (cisapride), antibacterial drugs (macrolides), antifungals (imidazoles), antiarrhythmics, betablockers and analgesics (opioids and floctafenine). In 54% of patients exposed, the incurred risk was either QT prolongation/Torsade de Pointes or antagonism of dopaminergic antiparkinson agents with dopamine receptor antagonists prescribed as antipsychotic agents. CONCLUSIONS: Among a non-selected population of ambulatory outpatients, the number of quarterly prescriptions with contra-indications with potentially harmful drug interaction was 27 in 10,000 prescriptions. This would extrapolate to nearly 200,000 contra-indications on the same-prescription sheets in France in the first quarter of 1999.

Contraindications↗
PubMed2005

Colovesical fistula: not a contraindication to elective laparoscopic colectomy.

PURPOSE: Traditionally, diverticular fistula was thought to be a contraindication for laparoscopic colectomy. The advent of hand-assisted laparoscopy has allowed repair of a diverticular fistula to be technically feasible laparoscopically. We present our experience with laparoscopic colectomy in patients with diverticular fistulas. METHODS: Patients with colovesical or colovaginal fistulas secondary to diverticular disease were consecutively entered into a database over a five-year period. All operations were electively performed by a single group of colorectal surgeons. Patient demographics, American Society of Anesthesiologists classification, type of surgery, operating time, hospital length of stay, and early and late complications were recovered by chart review. These results were then compared to results from a group of patients who had undergone elective laparoscopic colectomy for recurrent diverticulitis during the same period by the same group of surgeons. RESULTS: Altogether, 40 consecutive operations for diverticular fistulas were performed, 36 of which were started laparoscopically (90 percent). The average patient age was 65 years and the average American Society of Anesthesiologists class was 2. Patient demographics were similar among the group with recurrent diverticulitis (n = 149). The average hospital stay was 6.2 days for the fistula group and 4.4 days in the recurrent diverticulitis group. The average operating time was 220 minutes for the fistula group vs. 176 minutes for the uncomplicated group (P < 0.002). The conversion rate was significantly higher in the fistula group (25 percent vs. 5 percent, P < 0.001). There were no postoperative anastomotic leaks or bleeding episodes requiring reoperation in the fistula group. CONCLUSIONS: Diverticular fistula should no longer be considered a contraindication for laparoscopic colectomy. These cases are more complex, as evidenced by the longer operating times and higher conversion rates when compared with resections for uncomplicated recurrent diverticulitis. Although the length of hospital stay was longer for patients who underwent laparoscopic colectomy for diverticular fistula, those whose operations were completed laparoscopically had the same outcome as patients with uncomplicated disease. We anticipate that minimally invasive surgery will become the standard of care for colovesical fistula, as it now is for uncomplicated diverticular disease.

Aged↗
PubMed2005

Patient information leaflets--patients' comprehension of information about interactions and contraindications.

OBJECTIVE: To determine how well patients could correctly recognize and comprehend the various information items on patient information leaflets, and to explore the reasons underlying poor comprehensibility. METHODS: Leaflets from 30 randomly selected, commonly prescribed medicines were examined by experts using protocols to evaluate leaflet layout, language and content. The same leaflets were also evaluated by patients who had their medicines dispensed at 24 randomly selected Swedish pharmacies. A questionnaire was used for the patients' examination. RESULTS: The results showed that most information on the leaflets is sound and is well comprehended by the patients. For two information items regarding 'risks of interactions' and 'contraindications' the patient scores were low, indicating poor comprehensibility. CONCLUSION: Leaflets with low scores on warnings of interactions and contraindications were found to deliver more complex messages to older patients as compared to leaflets with high scores for these items.

Adult↗
PubMed2002

[Benzodiazepines and benzodiazepine-like anxiolytics and hypnotics. The implausible contraindication of closed angle glaucoma].

Official drug information materials mention angle-closure glaucoma as an absolute or relative contraindication for benzodiazepines, albeit with some unexplained variability. A systematic review of the literature reveals that this contraindication seems to be based on only one published case while 22 other investigations, some of them controlled, tend to favor that benzodiazepines reduce intraocular pressure. The common 1990-2001 database of the Drug Commission of the German Medical Profession and the Federal Institute for Drugs and Medical Devices contained one spontaneous report of glaucoma related to a benzodiazepine-like hypnotic.

Anti-Anxiety Agents↗
PubMed1992

Contraindications to vasoconstrictors in dentistry: Part II. Hyperthyroidism, diabetes, sulfite sensitivity, cortico-dependent asthma, and pheochromocytoma.

Dentists are aware of contraindications to the use of vasoconstrictors in patients with cardiovascular diseases. However, there are some other noncardiac conditions we should know. This article discusses the absolute contraindications to the use of vasoconstrictors in patients with a history of hyperthyroidism, diabetes, allergy to sulfites, asthma, and pheochromocytoma.

Adrenal Cortex Hormones↗
PubMed1992

Compulsory and non-compulsory immunizations: contraindications perceived by medical practitioners.

A total of 284 general practitioners (GPs), paediatricians and doctors of public vaccination centres (DPVC) were interviewed to investigate their willingness to immunize children with compulsory (diphtheria-tetanus, oral polio) and non-compulsory (measles, pertussis) vaccines in the presence of 19 different medical histories. We observed a reluctance to immunize in the case of false contraindications, a lack of information mainly about non-compulsory immunizations, and doubts about the real contraindications to polio, measles and pertussis vaccines. The frequency of correct answers to the question posed was significantly higher in the group with less than 20 years of experience, and the DPVCs proved better informed about immunization. However, the crucial role played by the GPs and paediatricians' advice can prejudice the correct use of active immunization.

Attitude of Health Personnel↗
PubMed1992

Hyperbaric oxygen therapy: contraindications and complications.

The literature is replete with references regarding the use of hyperbaric oxygen (HBO) therapy to treat various human maladies. However, the oral and maxillofacial surgery literature is lacking in information regarding patient selection criteria and possible contraindications to HBO therapy, as well as possible risks and/or complications of such therapy. This article details patient selection criteria, discusses relative and absolute contraindications to HBO therapy, and describes the potential risks and complications of this therapy.

Contraindications↗
PubMed2006

Pulmonary artery hypertension: is it really a contraindicating factor for early extubation in children after cardiac surgery?

BACKGROUND: One of the perceived major contraindications to early extubation after pediatric cardiac surgery is preoperative pulmonary arterial hypertension (PAH). The objective of this study is to present the results of early extubation (within 6 hours after open heart surgery) in children who had varying degrees of preoperative pulmonary arterial hypertension. METHODS: We reviewed the charts of 100 consecutive children who underwent subaortic ventricular septal defect closure and also had preoperative PAH. Outcomes measured included early extubation rate, clinical status of patients, and hospital costs. RESULTS: The median age at surgery was 2.5 years (range, 0.4 to 30). Sixty-five patients were extubated successfully in the operating room; 25 additional patients were extubated in the intensive care unit within 6 hours from surgery, increasing the early extubation rate from 65% to 90%. Postoperative complications were present in 12 patients; 10 of these patients required mechanical ventilation for more than 6 hours, and 1 of them died postoperatively in septic shock. Two patients required reintubation 25 and 26 hours, respectively, after initial extubation in the operating room, for causes unrelated to pulmonary hypertensive crises or ventilatory failure. The mean cost of procedures in patients who had successful early extubation was USD 3,786.50 +/- 302.45. Every additional day in the intensive care unit, in case of delayed extubation, increased the overall cost of the procedure by 10%. CONCLUSIONS: Pulmonary artery hypertension does not seems to be a contraindicating factor to early extubation in patients who underwent ventricular septal defect closure, and may be considered a feasible way to decrease postoperative intensive care unit stay and hospital costs.

Adolescent↗