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PubMed2000

Relatively short diagnostic delays (<8 hours) produce morbidity and mortality in blunt small bowel injury: an analysis of time to operative intervention in 198 patients from a multicenter experience.

OBJECTIVE: Blunt small bowel injury (SBI) is uncommon, and its timely diagnosis may be difficult. The impact of operative delays on morbidity and mortality has been unclear. The purpose of this study was to determine the relationship of diagnostic delays to morbidity and mortality in blunt SBI. METHODS: Patients with blunt SBI with perforation were identified from the registries of eight trauma centers (1989-1997). Patients with duodenal injuries were excluded. Data were extracted by individual chart review. Patients were classified as multi-trauma (group 1) or near-isolated SBI (group 2 with Abbreviated Injury Scale score < 2 for other body areas). Time to operation and its impact on mortality and morbidity was determined for each patient. RESULTS: A total of 198 patients met inclusion criteria: 66.2% were male, mean age was 35.2 years (range, 1-90 years) and mean Injury Severity Score was 16.7 (range, 9-47). 100 patients had multiple injuries (group 1). There were 21 deaths (10.6%) with 9 (4.5%) attributable to delay in operation for SBI. In patients with near-isolated SBI, the incidence of mortality increased with time to operative intervention (within 8 hours: 2%; 8-16 hours: 9.1%; 16-24 hours: 16.7%; greater than 24 hours: 30.8%, p = 0.009) as did the incidence of complications. Delays as short as 8 hours 5 minutes and 11 hours 15 minutes were associated with mortality attributable to SBI. The rates of delay in diagnosis were not significantly associated with age, gender, intoxication, transfer status, or presence of associated injuries. CONCLUSION: Delays in the diagnosis of SBI are directly responsible for almost half the deaths in this series. Even relatively brief delays (as little as 8 hours) result in morbidity and mortality directly attributable to "missed" SBI. Further investigation into the prompt diagnosis of this injury is needed.

Abdominal Injuries↗
PubMed1997

The early postoperative morbidity of transurethral resection of the prostate and of 4 minimally invasive treatment alternatives.

PURPOSE: We compared the early postoperative morbidity of transurethral resection of the prostate to minimally invasive treatment alternatives with respect to the objective rate of complications and subjective morbidity assessed by a patient addressed diary-type questionnaire. MATERIALS AND METHODS: Parameters evaluated preoperatively were the International Prostate Symptom Score (I-PSS), free flow study, post-void residual, transrectal ultrasonography and a pressure-flow study. The patients underwent transurethral resection (28), transrectal high intensity focused ultrasound (20), visual laser ablation (15), transurethral needle ablation (15) and transurethral electrosurgical vaporization (17) of the prostate. On the day of hospital discharge the patients received the questionnaire and were asked to answer daily 7 questions concerning micturition status. After 6 weeks the questionnaire was returned and an I-PSS, uroflowmetry and post-void residual were obtained. RESULTS: Preoperatively, there was no statistically significant difference regarding the I-PSS, peak flow rate, prostate volume and degree of bladder outlet obstruction. After 6 weeks the peak flow rate improved most prominently after transurethral electrosurgical vaporization (+ 13.2 ml. per second), transurethral resection of the prostate (+ 12.3 ml. per second) and visual laser ablation (+ 11.1 ml. per second). The I-PSS decreased most significantly after transurethral resection (-14.1) and transurethral electrosurgical vaporization (-8.4). There was no difference regarding the rate of adverse events within the first 6 weeks postoperatively in the 5 treatment arms. Mean duration of catheter drainage plus or minus standard deviation was 3.7 +/- 1.2 days after transurethral resection of the prostate, 6.8 +/- 1.7 days after high intensity focused ultrasound, 7.8 +/- 1.5 days after visual laser ablation, 2.0 +/- 0.4 days after transurethral needle ablation and 3.3 +/- 0.8 days after transurethral electrosurgical vaporization. Analysis of the questionnaire revealed that the daytime frequency, degree of hematuria and incontinence were comparable for all 5 procedures within the first 6 weeks postoperatively. Postoperative dysuria was greatest after visual laser ablation and transurethral electrosurgical vaporization. Regarding the degree of nocturia, there was no improvement after visual laser ablation, while the remaining 4 procedures yielded a significant and comparable decrease. The most significant subjective improvement in uroflowmetry was reported after transurethral resection of the prostate and transurethral electrosurgical vaporization. Regarding the global quality of life question, the patients were generally more worried after visual laser ablation and transurethral needle ablation compared to the other 3 procedures. CONCLUSIONS: The overall morbidity of transurethral resection of the prostate within the first 6 weeks postoperatively is equivalent to that of the 4 minimally invasive treatment alternatives evaluated in our study. When comparing the 4 minimally invasive procedures, no dramatic differences were notable, although visual laser ablation seems to be associated with a greater degree of morbidity as assessed by this questionnaire.

Aged↗
PubMed2003

Radiofrequency tonsil reduction: safety, morbidity, and efficacy.

OBJECTIVES: To evaluate the safety, morbidity, and efficacy of radiofrequency tissue volume reduction of tonsils using two different surgical techniques and to compare these two techniques with each other and with classic tonsillectomy. STUDY DESIGN: A nonrandomized retrospective review of tonsil reductions was made between 2000 and 2002 using in vivo studies associated with tonsil reduction and tonsillectomy performed either in the hospital operating room or in the outpatient treatment area. METHODS: We studied 150 patients and divided them into three main groups based on surgical technique. Group A consisted of 50 consecutive patients who underwent tonsil "ablation," Group B contained another 50 consecutive individuals who received tonsil "coblation," and Group C consisted of 50 patients who underwent classic tonsillectomy (cold dissection). Each group consisted of two subcategories of children (age range, 1-12 y) and adults (age range, 12-60 y) with chronic tonsillar hypertrophy. Most of the pediatric patients underwent adenoidectomy during the same surgical procedure. Indications for tonsillectomy were those listed by the American Academy of Otolaryngology-Head and Neck Surgery. A retrospective chart review was used to assess procedures, safety, morbidity, and efficacy of tonsil reduction and tonsillectomy. Four specific end points of morbidity were investigated: pain, return to normal diet, return to normal activity, and use of pain medication. Efficacy of tonsillectomy was determined by the clinical observation of the remaining tonsillar tissue and compared with pretreatment photographs of the tonsils. RESULTS: There were no complications in any of the groups. Efficacy was assessed based on the mean tonsil reduction and was found to be 100% for tonsillectomy, 86% for the tonsil coblation technique, but only 53.6% for the ablation technique. Morbidity was minimal in groups A and B and significantly greater in Group C. The number of pain days, narcotic-use days, and days before return to normal diet and activity were greatly reduced in groups A and B when compared with classic tonsillectomy (group C). Pain levels on day 1 were less than 3 (on a scale of 1-10) in groups A and B. The number of pain days and narcotic-use days was less than 4 days in groups A and B. Similarly, most patients returned to solid diet and normal activity by day 4. Pain levels, number of narcotic-use days, and number of days to return to normal diet and activity were significantly higher for classic tonsillectomy. CONCLUSIONS: Tonsil coblation has distinct advantages when compared with tonsil ablation and standard tonsillectomy. Tonsil coblation resulted in greater than 86% elimination of tonsillar tissue in both children and adults. In most patients, pain levels were minimal and limited to the first 48 hours after surgery. Return to normal diet and activity was much earlier in the coblation group versus classic tonsillectomy.

Adolescent↗
PubMed2003

Short-term functional donor site morbidity after radial forearm fasciocutaneous free flap harvest.

OBJECTIVES/HYPOTHESIS: The existing literature on postoperative donor extremity function describes a spectrum of morbidity in the long term (>3 mo after surgery). However, the consensus is that there is minimal to no impact of flap harvest on patients' activities of daily living. No previous reports have examined functional donor site morbidity in the early postoperative period; such may affect patients' overall perioperative progress, especially with respect to donor extremity dominance. The authors' objective was to quantify functional morbidity of the donor site in radial forearm fasciocutaneous free flaps during the early postoperative period. STUDY DESIGN: Retrospective case series review. METHODS: Patient data were obtained from hospital records of 12 consecutive patients who underwent head and neck reconstruction with radial forearm fasciocutaneous free tissue transfer over a 6-month period at a tertiary academic medical center. Functional results of each patient's donor extremity obtained preoperatively and at 5 to 8 days after surgery were determined by quantifying forearm supination and pronation, wrist flexion and extension, and sharp and dull hand sensations in radial, median, and ulnar nerve distributions. RESULTS: Mean patient age was 57 years (age range, 42-71 y). The nondominant extremity was the donor site in 9 of 12 patients. Using the paired two-tailed t test, statistically significant differences were demonstrated in preoperative versus postoperative forearm supination (P <.032), pronation (P <.006), wrist flexion (P <.000), and wrist extension (P <.000). Three of 12 patients demonstrated diminished sharp sensation in the "anatomical snuffbox" distribution. CONCLUSION: The authors describe statistically significant functional forearm and wrist range-of-motion morbidity associated with the harvest of a radial forearm fasciocutaneous free flap in the early postoperative period.

Activities of Daily Living↗
PubMed1980

Time-related peripartum determinants of postpartum morbidity.

Five time-related peripartum events were prospectively studied in 101 high-risk, internally monitored parturients. These included the duration of labor, the duration of ruptured membranes, the number of vaginal examinations, the length of time from first vaginal examination to delivery, and the duration of internal monitoring. Seventy patients were delivered vaginally and 31 by cesarean section. Several of the time-related peripartum events were found to be individually related to postpartum morbidity. However, combined evaluation by stepwise discriminant analysis revealed that the duration of labor alone was the primary determinant of postpartum morbidity. These findings imply that the observation of a relationship between postpartum morbidity and any of several peripartum time-related factors in isolation may be mediated by its relationship in time to labor duration. This suggests, in turn, that intensive labor monitoring techniques in high-risk patients would not be expected to increase postpartum morbidity above that expected from increases in labor duration alone. The results further suggest that the duration of labor may be the only time-related peripartum event useful in evaluating the risk for postpartum infection in monitored patients in labor who undergo cesarean section.

Adolescent↗
PubMed1981

Surgery for morbid obesity: indications, complications, alternatives.

Morbid obesity (100 pounds over ideal body weight) carries with it numerous medical complications and increased mortality which can be improved by weight loss. Medical treatment of obesity is usually not successful, and jejunoileal bypass surgery often produces considerable chronic morbidity which seriously compromises its benefits. Gastric bypass is equally effective and avoids the most severe long-term complications of jejunoileal bypass, but has a higher operative morbidity. Gastric plication will perhaps offer the least operative and chronic morbidity, though few long-term statistics are as yet available.

Humans↗
PubMed2006

Determinants of perinatal mortality and serious neonatal morbidity in the second twin.

OBJECTIVE: To identify potential determinants of perinatal mortality and neonatal morbidity among second twins relative to first twins. METHODS: A retrospective cohort design was used to study twin deliveries in Nova Scotia from 1988 to 2002. Monoamniotic or conjoined twins and twin pairs with major congenital anomaly or antepartum fetal death of either twin were excluded. The primary outcome was a composite measure of perinatal mortality and neonatal morbidity, including birth asphyxia, respiratory distress, neonatal trauma, and infection. Risk of adverse outcome of second twins relative to first-born co-twins was determined by matched-pair analysis. RESULTS: Of 1,542 twin pairs, the second twin was at greater risk of composite adverse outcome (relative risk [RR] 1.62, 95% confidence interval [CI] 1.38-1.9) than the first twin. This excess risk was evident independent of presentation, chorionicity, or infant sex but was associated with planned vaginal delivery, birth weight discordance, and prolonged interdelivery interval. Term second twins were less likely to suffer excess morbidity with elective cesarean (RR 1.0, 95% CI 0.14-7.10) than with planned vaginal delivery (RR 3.0, 95% CI 1.47-6.11). The major contributors to neonatal morbidity in the second twin were birth asphyxia at 37 weeks or later and respiratory distress syndrome at less than 37 weeks. CONCLUSION: The second twin is at greater risk of adverse perinatal outcome than the first twin, independent of presentation, chorionicity, or infant sex. Planned vaginal delivery, birth weight discordance, and prolonged interdelivery interval increase this infant risk. Elective cesarean delivery at term may improve perinatal outcome for the second twin. However, the number of cesarean births required to prevent one case of composite adverse outcome, assuming causality, was 33.

Adult↗
PubMed2003

A randomized controlled trial comparing transurethral resection of the prostate, contact laser prostatectomy and electrovaporization in men with benign prostatic hyperplasia: analysis of subjective changes, morbidity and mortality.

PURPOSE: We analyze subjective changes, morbidity and mortality in men with lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH) after transurethral resection of the prostate, contact laser prostatectomy and electrovaporization. MATERIALS AND METHODS: A prospective, randomized controlled trial was conducted on men with lower urinary tract symptoms, who met the criteria of the International Scientific Committee on BPH, had a prostate volume between 20 and 65 ml., and had Schäfer's obstruction grade 2 or greater. Objective morbidity was recorded for up to 12 months. Subjective morbidity was measured by a questionnaire completed by patients. Subjective changes were quantified using the International Prostate Symptom Score, Symptom Problem Index, Quality of Life question and BPH Impact Index. These indexes and the morbidity questionnaire were measured weekly for the first 6 weeks postoperatively and then at 3, 6 and 12 months. RESULTS: Transurethral prostatic resection was analyzed in 50 men, laser treatment in 45 and electrovaporization in 46. Baseline characteristics, and changes in the symptom scores up to 12 months postoperatively were similar. Perioperative blood loss and perforation were greatest in the resection group, and retention was greatest in the laser group. During the first 6 postoperative weeks there was less pain and less hematuria after resection, and less incontinence after laser prostatectomy. CONCLUSIONS: Subjective changes are similar for transurethral prostatic resection, contact laser and electrovaporization. In the first 6 weeks after treatment there are only slight differences in pain, hematuria and incontinence among the therapies.

Aged↗
PubMedDate not supplied

Association between poorer quality of life and psychiatric morbidity in patients with different dermatological conditions.

OBJECTIVE: To determine the relationship between skin-related quality of life and psychiatric morbidity in patients with different skin conditions. METHODS: We recruited all adults attending the outpatient clinics of the Dermatological Institute IDI-IRCCS, Rome, Italy, during 14 predetermined days. Eligible patients, who gave their informed consent, completed the Skindex-29 and the 12-item General Health Questionnaire (GHQ-12). We used a stringent cut-off threshold (> or =5 on the GHQ-12) for identification of psychiatric morbidity. Skindex-29 scale scores were computed separately for GHQ noncases and GHQ cases. RESULTS: A total of 2,136 patients were included in the analysis. For all skin conditions, GHQ cases had substantially poorer score in all 3 domains of quality of life, Symptoms, Emotions, and Functioning. Most differences remained significant after adjusting for clinical severity, age, sex, and education in multiple regression models. These differences were not as marked in the Symptoms scale for some conditions known to be nearly asymptomatic (eg, alopecia, vitiligo, nevi), suggesting that, although patients with psychiatric morbidity might be more burdened by their symptoms, nevertheless they do not perceive nonexistent symptoms. CONCLUSION: In most skin conditions we considered, psychiatric morbidity was strongly associated with poorer quality of life. Although the cross-sectional nature of our study does not allow identification of the direction of this association, care for the psychological condition of patients might have an impact on their quality of life.

Adult↗
PubMedDate not supplied

Psychiatric morbidity and toxic burden in patients with environmental illness: a controlled study.

OBJECTIVE: Patients with environmental illness experience a large number of psychological symptoms. The nature of these symptoms and their pathogenesis (toxicogenic versus psychogenic) is controversial. The objective was to (1) characterize the nature of the psychological symptoms according to well-established diagnostic criteria, and (2) to investigate the association between toxicological factors and psychological symptoms. METHODS: Toxic burden, somatic morbidity, and psychiatric morbidity were assessed in 309 outpatients with environmental illness and 59 semiconductor industry workers matched for age and gender. Psychiatric disorders were assessed by a structured psychiatric interview (SCID), and distress was assessed by the Symptom-Checklist-90-Revised (SCL-90-R). Routine and specific laboratory tests in blood and urine samples were used to assess chemical exposures. RESULTS: Overall psychiatric morbidity was significantly higher in patients than in controls according to SCID (75% versus 24%). Somatoform, mood, and anxiety disorders were significantly more frequent in patients with environmental illness. They also revealed marked stress on the SCL-90-R somatization subscale and scored significantly higher than controls on most of the other subscales. Industry workers from the control group tended to have higher urine metal concentrations than environmental illness patients and similar concentrations of solvents in blood. CONCLUSION: Our data extend previous findings of high psychiatric morbidity in patients with environmental illness. They do not support the notion of a direct causal link between chemical exposure and the psychological symptoms.

Environmental Illness↗
PubMed2003

Massive splenomegaly is associated with significant morbidity after laparoscopic splenectomy.

OBJECTIVE: To evaluate the impact of spleen weight on operative and clinical outcome in a series of 108 consecutive laparoscopic splenectomies. BACKGROUND: Laparoscopic splenectomy as an alternative to open splenectomy for splenomegaly is regarded as controversial. METHODS: Patients underwent laparoscopic splenectomy for a range of hematological disorders between November 1992 and February 2000. Multiple linear and logistic regression analysis were used to assess the effect of massive splenomegaly (>1000 g) on perioperative mortality and morbidity, after adjusting for the joint effects of patient age, weight, pre- and postoperative full blood counts, operating time, estimated blood loss, conversion rate, reoperation rate, and duration of hospital stay. RESULTS: Massive splenomegaly was recorded in 27 of 108 (25%) cases. In this group, splenic weight ranged from 1000 to 4750 g (median, 2500 g). Patients with splenic weight >1000 g had a significantly longer median operating time (170 vs. 102 minutes, P < 0.01), conversion rate (5/27 vs. 4/81, P < 0.05), postoperative morbidity (15/27 vs. 4/81, P < 0.01), and median postoperative stay (5 vs. 3 days, P < 0.01). Multivariate analysis found splenic weight to be the most powerful predictor of morbidity (P < 0.01). Patients with splenomegaly (>1000 g) were 14 times likely to have post operative complications. One patient died 3 days after surgery, following a pulmonary embolus (spleen weight 500 g, mortality 1/108, 0.9%). CONCLUSIONS: Laparoscopic splenectomy is feasible in patients with giant spleens. However, it is associated with greater morbidity, and the advantages of minimal access surgery in this subgroup of patients are not so clear.

Adolescent↗
PubMed2004

Immediate, early, and late morbidity with laparoscopic ventral hernia repair and tolerance to composite mesh.

The laparoscopic repair of ventral hernias is still a controversial therapeutic option, and little is known of its medium- and long-term morbidity. The purpose of the study is to evaluate the postoperative morbidity of laparoscopic ventral hernia repair and analyze the clinical factors that might be related to it. 86 consecutive patients who had ventral hernia and underwent endoscopic surgery in a Universitary teaching hospital. Epidemiological, clinical, postoperative complications, tolerance, aesthetic evaluation of the wall and recurrence rate are analyzed. The mean follow-up (100%) was 42 months (range: 1-5 years) and included clinical and ultrasonographic evaluation. The overall postoperative morbidity rate was 23.2%, with one case of mortality following a sepsis due to intestinal perforation; the rate of re-admissions and recurrences was 3.5%. Statistically significant relationships were shown between the complications and infra-umbilical location (P < 0.001), age over 60 years and female sex (P < 0.05). The dynamic ultrasound study showed 91% and 94% of the patients to be adhesion-free at 1 and 3 years respectively. Aesthetic assessment of the wall at 3 years showed persistent asymmetries in 5% of the patients and a 92% degree of personal satisfaction. The morbidity with laparoscopic ventral hernia repair is not negligible. The surgeon must know these complications and be able to treat them appropriately.

Adult↗
PubMed1979

Mortality and morbidity during 13.5 years' follow-up in relation to blood pressure. The study of men born in 1913.

A total of 973 50-year-old men, randomly selected from the general population in Göteborg, Sweden, were invited to a survey in 1963. Altogether 855 men (88%) participated. They have been followed up for 13.5 years, and this report presents mortality and morbidity during this time in relation to BP at the time of the initial examination. BP was strongly associated with mortality regardless of its cause. This was due to a close relation of BP to mortality from ischaemic heart disease and a weak but significant relation to mortality from cancer. BP was also strongly related to morbidity from myocardial infarction, stroke and angina pectoris, showed a tendency towards relation to morbidity from intermittent claudication and kidney stone, and was negatively related to morbidity from neoplasm for survivors. BP was also related to pension but not to sick leave. There is no indication of a decreasing importance of BP as a risk factor in this age period.

Aged↗
PubMed2005

Epidemiology and morbidity of scabies and pediculosis capitis in resource-poor communities in Brazil.

BACKGROUND: Pediculosis capitis and scabies are common parasitic skin diseases, especially in resource-poor communities, but data on epidemiology and morbidity are scanty. OBJECTIVES: To assess the prevalence, seasonal variation and morbidity of pediculosis capitis and scabies in poor neighbourhoods in north-east Brazil. METHODS: The study comprised cross-sectional surveys of a representative population of an urban slum (n = 1460) in Fortaleza, the capital of Ceará State (Brazil) and a fishing community 60 km south of the city (n = 605). Study participants were examined for the presence of scabies and pediculosis capitis. In a longitudinal study in the slum, variation of prevalence in different seasons of the year was assessed. RESULTS: Prevalence of pediculosis capitis was 43.4% in the slum and 28.1% in the fishing community. Children aged 10-14 years and females were most frequently affected. Scabies was present in 8.8% of the population in the slum and in 3.8% of the population in the fishing community. There was no consistent pattern of age distribution. Superinfection was common in patients with scabies, and cervical lymphadenopathy in patients with pediculosis capitis. Multivariate analysis showed that age < or = 15 years, being of female sex and living in the urban slum were independent factors contributing to the simultaneous coinfestation with pediculosis capitis and scabies. The longitudinal data from the urban slum showed a characteristic seasonal variation of pediculosis capitis, but no fluctuation of scabies. CONCLUSIONS: Pediculosis capitis and scabies are hyperendemic in the study areas and are associated with considerable morbidity. There is an urgent need to develop control measures for these parasitic skin diseases in resource-poor communities. This is the first community-based study describing in detail the epidemiology and morbidity of scabies and head lice infestation in Brazil.

Adolescent↗
PubMed1988

Psychiatric morbidity in subjects with inner ear disease.

A prospective assessment of psychiatric morbidity in a sample of 207 patients with inner ear disorders, attending an ENT clinic, was carried out. As a group, they were found to have higher psychiatric morbidity on the general health questionnaire (GHQ) than either normal samples or samples affected by other forms of physical disease. Within the sample tinnitus patients scored the highest, and presbyacusis patients the lowest. High GHQ scores predicted an exaggerated self-rating of symptom severity in a visual analogue scale. Past psychiatric history did not play a role in the development of psychiatric morbidity. Elderly subjects complained more often of fear of collapsing in the street but this was not related, as has been suggested, to the subsequent development of agoraphobic symptoms. Factor analysis of GHQ items for the 'cases' yielded 'depression', 'anxiety' and 'personality' factors. No correlation was found between these factors and the rest of the clinical variables. It is concluded that tinnitus shows the clearest association with psychiatric morbidity and hence merits detailed psychological analysis. Such a study has been started at Addenbrooke's Hospital.

Adult↗
PubMed2006

Health-related quality of life among haemodialysis patients--relationship with clinical indicators, morbidity and mortality.

AIM: To verify the association between quality of life and morbidity, mortality and clinical indicators in haemodialysis patients. BACKGROUND: While a number of therapies have been reported to increase quality of life in end-stage renal disease, patients report that they remain substantially burdened by limited physical functioning and by dialysis-related symptoms. Indeed, quality of life may be the most critical outcome for those undergoing haemodialysis. Furthermore, quality of life has been associated with clinical indicators, morbidity and survival in haemodialysis patients. DESIGN: Descriptive cohort study of patients undergoing haemodialysis at the Nephrology Hemodialysis Unit of the Hospital de Clínicas in Porto Alegre, Brazil. METHODS: Forty haemodialysis patients were followed for 12 months and evaluated for demographics, time on dialysis, diabetes mellitus, clinical indicators (dose of dialysis--Kt/V, haematocrit and serum albumin) and comorbidities. The comorbidities were evaluated with the end-stage renal disease severity index and health-related quality of life with The Medical Outcomes Study 36 (SF-36). RESULTS: Men present higher health-related quality of life scores in the energy and fatigue component (P = 0.04). Patients treated for over one year at the beginning of follow up and patients with less schooling had better results in General Health Perception (P < 0.05). The health-related quality of life evaluation of patients who later died showed that they already had a worse perception of physical functioning as compared to the survivors (P = 0.05). Patients with diagnosed diabetes perceived their physical functioning more negatively compared with those with other etiologies of end-stage renal disease (P = 0.045). We found a correlation between physical functioning and serum albumin (r = 0.341, P < 0.05) and between physical functioning and haematocrit (r = 0.317, P < 0.05). The end-stage renal disease severity index was more strongly related to physical functioning (r = -0.538, P < 0.001). Comparing the patients' results to the indicators above and below the established targets, we observed a trend to worse health-related quality of life in patients with Kt/V above target. However, in the case of albumin, patients with results above target tended to have better results. CONCLUSION: A close relationship was observed between quality of life and morbidity and mortality. Among the clinical indicators, albumin and haematocrit have the greatest influence on quality of life. RELEVANCE TO CLINICAL PRACTICE: Haemodialysis patients experience various problems that may adversely influence their quality of life. Special care must be given to those who have diabetes mellitus, high morbidity scores, low serum albumin and low haematocrits.

Brazil↗
PubMed2005

Factors associated with morbidity in liver hydatid surgery.

BACKGROUND: The purpose of the present paper was to determine the association between clinical evolutionary and laboratory variables with postoperative morbidity in patients surgically treated for liver hydatidosis (LH). METHODS: A case-control nested cohort study was undertaken. Patients were studied and surgically treated in Hospital Regional of Temuco between 1994 and 2001. The morbidity variable registered with a minimum 12-month follow-up period was considered in a dichotomous way. The association with clinical, laboratory, evolutionary, and surgical variables was studied. Descriptive statistics, bivariate analysis using chi(2) and Fisher's exact test for categorical variables; t-test, anova, and Kruskal-Wallis for continuous variables; odds ratio calculations, and ordinal and multivariate logistic regression models were applied. RESULTS: The cohort was composed of 202 patients surgically treated for LH, 112 women (55.5%) and 90 men (44.5%), with an average age of 45.2 years. Average morbidity of the series, with a median follow-up period of 53 months, was 16.4%. Six variables were significantly associated in the bivariate analysis (age, haematocrit, total leucocyte count, alkaline phosphatase, history of previous surgery for LH and existence of biliary communications), but only two achieved statistical significance in the multivariate model (age and history of previous surgery for LH; P = 0.017 and 0.018; and odds ratio of 1.0 and 4.1, respectively). CONCLUSIONS: In surgical decision making for patients with LH, the history of previous surgery for LH must be considered as a risk factor for postoperative morbidity.

Adult↗
PubMed2006

Anesthesia and periinterventional morbidity of rigid bronchoscopy for tracheobronchial foreign body diagnosis and removal.

BACKGROUND: Undiagnosed tracheobronchial foreign body aspiration (FBA) or delayed extraction can lead to serious morbidity. The aim of this study was to evaluate anesthetic and periinterventional morbidity of a straightforward regime using rigid bronchoscopy to rule out or remove a tracheobronchial foreign body in children with suspicion of FBA. METHODS: We retrospectively analyzed rigid bronchoscopy charts of children with suspicion of acute (< or = 24 h) and subacute (>24 h-2 weeks) tracheobronchial FBA (1990-2003). Patient characteristics, duration of fasting, technique/course of anesthesia induction, and duration/course of rigid bronchoscopy were taken. Anesthetic, periinterventional complications and length of hospital stay were noted. Data are given in median (range [interquartile range]). RESULTS: A total of 287 children were included in this study. Median age was 1.7 years (0.2-14.2 [1.2-2.5]); in 72.1% a tracheobronchial foreign body was found and removed. Fasting time before induction of anesthesia was 5 h (1-14 [4.0-7.0]). Anesthesia adverse events were seen in 0.7%, whereas periinterventional complication from rigid bronchoscopy was observed in 7.6%. Hospital discharge within 4 h after bronchoscopy was possible in 65.2%. Complications of delayed diagnosis (>24 h) were prolonged duration of rigid bronchoscopy because of severe mucosal changes or difficulties in foreign body extraction. CONCLUSIONS: General anesthesia for rigid bronchoscopy to rule out a tracheobronchial foreign body in children carries low morbidity. Most of the complications originated from the foreign body itself especially in patients with late diagnosis. The risk for serious complications caused by retained foreign bodies outweighs the low morbidity of explorative rigid bronchoscopy in children with suspected FBA or children with prolonged cough or pulmonary infection unresponsive to medical treatment.

Anesthesia, General↗