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At least 19 recordsLinked to original sources
PubMed1994

Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial. Diabetes Control and Complications Trial Research Group.

The Diabetes Control and Complications Trial has demonstrated that intensive diabetes treatment delays the onset and slows the progression of diabetic complications in subjects with insulin-dependent diabetes mellitus from 13 to 39 years of age. We examined whether the effects of such treatment also occurred in the subset of young diabetic subjects (13 to 17 years of age at entry) in the Diabetes Control and Complications Trial. One hundred twenty-five adolescent subjects with insulin-dependent diabetes mellitus but with no retinopathy at baseline (primary prevention cohort) and 70 adolescent subjects with mild retinopathy (secondary intervention cohort) were randomly assigned to receive either (1) intensive therapy with an external insulin pump or at least three daily insulin injections, together with frequent daily blood-glucose monitoring, or (2) conventional therapy with one or two daily insulin injections and once-daily monitoring. Subjects were followed for a mean of 7.4 years (4 to 9 years). In the primary prevention cohort, intensive therapy decreased the risk of having retinopathy by 53% (95% confidence interval: 1% to 78%; p = 0.048) in comparison with conventional therapy. In the secondary intervention cohort, intensive therapy decreased the risk of retinopathy progression by 70% (95% confidence interval: 25% to 88%; p = 0.010) and the occurrence of microalbuminuria by 55% (95% confidence interval: 3% to 79%; p = 0.042). Motor and sensory nerve conduction velocities were faster in intensively treated subjects. The major adverse event with intensive therapy was a nearly threefold increase of severe hypoglycemia. We conclude that intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy and nephropathy when initiated in adolescent subjects; the benefits outweigh the increased risk of hypoglycemia that accompanies such treatment.

Adolescent↗
PubMed1994

Intestinal and extraintestinal complications of Crohn's disease: predictors and cumulative probability of complications.

Of 238 patients with Crohn's disease seen at our clinics from April 1973 to August 1988, 203 patients were selected for this study, since they fulfilled the following criteria: they had been followed up for more than 6 months as outpatients or had been treated as inpatients for more than 1 month. They were studied to elucidate: (a) the different types and incidence of various complications, (b) the factors related to complications present at the time of diagnosis, (c) predictors of new complications arising after diagnosis, and (d) the cumulative incidence of complications occurring during the course of the disease from the times of onset and diagnosis. Of the intestinal complications, perianal fistula was most common (33%), followed by strictures with dilatations of the proximal bowel (21%), and internal fistula (14%). Of the extraintestinal complications, menstrual disturbance was the most common (18% of the female patients), followed by arthritis (10%), and aphthous stomatitis (10%). As for the factors influencing complications present at the time of diagnosis, the pattern of bowel involvement was significantly correlated with the presence of intestinal stricture, while the erythrocyte sedimentation rate was significantly correlated with the presence of perianal fistula. A significant predictor of new complications arising after diagnosis was the general well-being of patients at the time of diagnosis. Patients who, at diagnosis, already have complications such as stricture, abdominal abscess, internal or external fistula, massive hemorrhage, and free perforation or anal lesions are more likely to develop new complications in addition to those present at diagnosis, compared with patients without any complications at diagnosis (P = 0.055).

Adult↗
PubMed1992

Psychosocial factors and complications of IDDM. The Pittsburgh Epidemiology of Diabetes Complications Study. VIII.

OBJECTIVE: To investigate whether psychosocial factors are associated with diabetic complications. RESEARCH DESIGN AND METHODS: Questionnaires on quality of life, depressive symptomatology, and personality type were completed and a clinical assessment was performed. The study population was an incident cohort of childhood-onset insulin-dependent diabetic (IDDM) subjects whose duration of IDDM was greater than or equal to 25 yr (n = 175). RESULTS: Patients with macrovascular disease (P less than 0.01) or nephropathy (P less than 0.05) reported significantly poorer quality of life compared with those who were free from all complications. Patients with macrovascular disease also reported greater depressive symptomatology (P less than 0.05). Quality of life significantly deteriorated according to the presence of multiple (greater than or equal to 4) complications (P less than 0.001). Higher depression symptom scores were also related to the presence of greater than or equal to 4 complications (P less than 0.001). Those with multiple complications reported less type A behavior than those without any complications (P less than 0.05). CONCLUSIONS: This study shows that psychosocial differences exist according to both the number and the type of diabetic complications present. Because poorer quality of life and symptoms of depression may both result form complications, prospective follow-up is needed to clarify their temporal interrelationships, and to determine whether type A personality affords any protection against complications or is diminished as a result of developing complications.

Adult↗
PubMed1994

Vascular complications in adult patients after orthotopic liver transplantation: role of color duplex sonography in the diagnosis and management of vascular complications.

Vascular complications after orthotopic liver transplantation are one of the most serious problems in liver-grafted patients, and if undetected they may result in graft failure and death unless prompt revascularization or retransplantation is performed. As the outcome of treatment of vascular complications depends on an early diagnosis, the role of color-coded duplex sonography (CCD) for diagnosis and treatment was analyzed during a 17-month observation period. Altogether, 88 consecutive liver allografts in 77 adult patients were studied by serial CCD. Vascular complications occurred with an incidence of 12.9%. Hepatic artery complications represented the most frequent event with an incidence of 11.6%. CCD showed a sensitivity of 100%, a specificity of 97% and a positive predictive value of 0.84. With the use of CCD, vasculature and localization of the site of arterial complications can be directly visualized and the various types of complications can be differentiated, thus reducing the time needed for diagnosis. Early hepatic artery complications, occurring during the first 3 days after transplantation, which were immediately diagnosed by CCD examination and rapidly treated by revascularization had a good clinical outcome. In contrast, the outcome of vascular complications requiring retransplantation was found to be poor. As radiologic intervention offers an alternative to the treatment strategy of vascular complications in liver-grafted patients, CCD is the method of choice to noninvasively monitor the initial and follow-up examinations after intervention.

Adolescent↗
PubMed1986

Complications in arthroscopy: the knee and other joints. Committee on Complications of the Arthroscopy Association of North America.

A questionnaire was sent to members of the Arthroscopy Association of North America surveying complications in arthroscopic surgery of the knee and other joints. There were 395,566 arthroscopies reported including 375,069 knee arthroscopies, 14,329 shoulder arthroscopies, 4,478 ankle arthroscopies, 1,569 elbow arthroscopies, and 121 wrist arthroscopies. There were 2,215 complications reported. The overall complication rate was 0.56%. Specific procedures were surveyed for the first time. The complication rate reported for meniscal repair was 2.4%. The complication rate in anterior cruciate ligament (ACL) procedures (repairs and reconstructions) was 1.8%. The procedure with the highest complication rate was the anterior staple capsulorrhaphy of the shoulder (5.3%). Surgery in the subacromial space resulted in a complication rate of 0.76%. None of these complication rates included failures. As newer procedures are instituted into clinical practice that involve various joints, and are more technically demanding, the complication rate is increasing.

Anesthesia↗
PubMed1992

Medical complications of cocaine: changes in pattern of use and spectrum of complications.

We sought to determine whether changes in patterns of cocaine use, characterized by widespread abuse of cocaine alkaloid, have altered the nature and severity of medical complications over the past decade. Infectious complications, almost invariably associated with intravenous use, accounted for nearly all hospital admissions in the early 1980s. Cardiovascular, neurologic and psychiatric complications rose dramatically after 1987 both in absolute number and as a proportion of total complications. This rise parallelled increases in the absolute number and proportion of hospitalized patients smoking cocaine alkaloid or using intranasal cocaine, both disproportionately associated with non-infectious complications. While infectious complications were often local in nature, serious neurologic and cardiovascular sequelae were observed. These data indicate that changes in patterns of cocaine use have altered the nature and increased the severity of medical complications with a shift from infectious to cardiovascular, neurologic and psychiatric complications which may be life-threatening and associated with substantial morbidity.

Administration, Intranasal↗
PubMed1983

Stage IB carcinoma of the cervix, the Norwegian Radium Hospital: results and complications. III. Urinary and gastrointestinal complications.

The combination of surgery and radiotherapy for early cases of cancer of the cervix has been accused of producing prohibitive complication rates. In a series of 612 patients with cancer of the cervix, Stage IB, the frequency of major complications from the urinary and gastrointestinal tract has been studied, and an attempt has been made in determining the most probable etiology of these complications. No significant increase in complications can be attributed to the use of preoperative intracavitary irradiation. In patients with pelvic lymph node metastases the combination of radical surgery and a full course of radiotherapy is associated with a high complication risk, as 12% of these patients developed major complications. Their 5-year survival, however, was high: 54%.

Brachytherapy↗
PubMed1981

Respiratory complications after upper abdominal surgery. The incidence of chest X-ray abnormalities, arterial hypoxemia and clinically recorded pulmonary complications.

The incidence of postoperative chest X-ray abnormalities, arterial hypoxemia and clinically recorded pulmonary complications was studied in fifty-two 40-75-year-old men admitted for elective surgery for peptic ulcer or gallbladder disease. Twenty-eight (54%) patients had an abnormal chest X-ray and twenty-three (43%) arterial hypoxemia, whereas only four patients (8%) were identified with clinical signs and symptoms of respiratory complications. Forty-one patients (79%) were found with pulmonary complications by at least one of the three methods. Twelve patients had both an abnormal chest X-ray and arterial hypoxemia. Only two of these were identified with clinical signs indicating pulmonary complications. The great discrepancy between results based on clinical signs and symptoms noted in the patients' records and results based on postoperative chest X-ray and measurements of the arterial oxygen tension, respectively, should be of great importance when comparing the incidence of pulmonary complications after different forms of surgery and when assessing risk factors and clinical consequences of respiratory complications.

Adult↗
PubMed1988

Financial risk, hospital cost, and complications and comorbidities in medical non-complications and comorbidity-stratified diagnosis-related groups.

A number of methods are being studied to modify and improve the accuracy of the Medicare Diagnosis-Related Group (DRG) hospital classification system. This study analyzed resource consumption for 2,431 medical Medicare patients in the 53 non-complicating condition-stratified (i.e., non-complication and comorbidity) medical DRGs. Resource consumption per patient increased as the number of complications and comorbidities per patient per DRG increased, as measured by total hospital cost, hospital length of stay, the number of diagnoses and procedures per patient, the percent outliers, and mortality. Patients with more than four complications and comorbidities generated significant financial risk ($5,667 loss per patient) under DRG reimbursement. This study raises the question of the equity of DRG reimbursement for the medical non-complication and comorbidity-stratified DRGs. A method for DRG adjustment based on complications and comorbidities should be implemented by Congress to assure equitable payment for patients in these medical DRGs.

Costs and Cost Analysis↗
PubMedDate not supplied

Spontaneous whole blood platelet aggregation, hematological variables and complications in insulin-dependent diabetes mellitus: the Pittsburgh Epidemiology of Diabetes Complications Study.

The role of platelet aggregation in the pathogenesis of diabetes complications remains unclear despite a number of reports suggesting associations in univariate analyses. The Pittsburgh Epidemiology of Diabetes Complications Study is a prospective study initiated in 1985 to determine risk factors for the development of complications in insulin-dependent diabetes mellitus (IDDM). This report focuses on the cross-sectional correlation between platelet count and aggregation and IDDM complications, in 563 participants aged 18 years and older seen at baseline. Spontaneous whole blood platelet aggregation (SWBPA) and other hematological variables [hematocrit, total platelet count (TPC), red blood cell count (RBC), fibrinogen and white blood cell count (WBC)] were evaluated as risk factors for IDDM complications (nephropathy, neuropathy, and retinopathy) in the baseline cross-sectional data of the Pittsburgh Epidemiology of Diabetes Complications Study. SWBPA was determined by a method based on the percentage fall in platelet count after shaking a fresh citrated blood sample kept at 37 degrees C. Subjects with chronic aspirin use or on dialysis were excluded from analysis. An increased TPC was observed in subjects with overt nephropathy (291.4 +/- 65.1 versus 261.2 +/- 64.9, p less than 0.001) compared with subjects without nephropathy. Similar results were found for proliferative retinopathy. The association with nephropathy (but not with retinopathy) persisted in multivariate analyses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Factors associated with avoidance of severe complications after 25 yr of IDDM. Pittsburgh Epidemiology of Diabetes Complications Study I.

To identify characteristics associated with long-term avoidance of insulin-dependent diabetes mellitus (IDDM) complications, subjects taking part in an epidemiologic natural history study of childhood-onset IDDM, with a duration of disease greater than or equal to 25 yr, were studied. Nineteen percent of 175 subjects had avoided overt nephropathy, definite cardiovascular and peripheral vascular disease, clinical neuropathy, and proliferative retinopathy. Approximately half of the nonrenal complications occurred in the absence of renal disease. Subjects free of these advanced complications were characterized by a longer duration of disease (P less than 0.05), better lipid profile and blood pressure (P less than 0.01), and considerably lower glycosylated hemoglobin levels (P less than 0.001). Health-related behaviors, including recent medical contact, regular glucose monitoring, physical activity in youth, and avoidance of cigarette smoking, did not relate to complication status, although regular (at least weekly) alcohol consumption was more prevalent (P less than 0.05) in those without complications. We conclude that a lower mean glycosylated hemoglobin level is strongly related to the avoidance of all IDDM complications.

Adult↗
PubMed1991

The association of physical activity and diabetic complications in individuals with insulin-dependent diabetes mellitus: the Epidemiology of Diabetes Complications Study--VII.

The relationship between leisure-time physical activity and diabetes complications was examined in 628 individuals with insulin-dependent diabetes mellitus. Neuropathy was based upon clinical exam; retinopathy by fundus photographs; nephropathy by urine samples and macrovascular disease by clinician diagnosis. Past week physical activity was found to be inversely related to complication status but since current inactivity could be the result of the complications, historical activity (estimated leisure activity during ages 14-17) was also examined in relation to complication status. Males reporting higher levels of historical physical activity had a significantly lower prevalence of nephropathy and neuropathy but not retinopathy as demonstrated by multivariate analysis (controlling for duration of disease, age, and current activity levels). The lack of similar findings in women may be due to their low levels of reported physical activity. The consistent relationship between historical leisure physical activity and development of complications in males suggests that activity may be protective or at least not detrimental to the individual with insulin-dependent diabetes.

Adolescent↗
PubMed1995

Multicentre study on prevalence of endocrine complications in thalassaemia major. Italian Working Group on Endocrine Complications in Non-endocrine Diseases.

OBJECTIVE: Thalassaemia major is a common and serious medical problem, worldwide. However, there are few data concerning the various endocrine disorders which occur in this condition. We have surveyed 25 Italian centres in order to establish the prevalences and times of onset of endocrine disorders in patients with beta-thalassaemia major. PROJECT AND PATIENTS: A questionnaire specifically designed to investigate the prevalences of endocrinopathies was sent to 25 paediatric and haematology departments. The following data were recorded in the questionnaire: sex, age, height and weight, pubertal status according to Tanner's classification, history of secondary amenorrhoea, type of endocrinopathy and hormone levels at diagnosis, associated complications, serum ferritin level, liver enzymes (ALT) and compliance with treatment. RESULTS: An analysis of data from 1861 patients showed that failure of puberty was the major clinical endocrine problem and was present in 51% of boys and 47% of girls, all over the age of 15 years. Secondary amenorrhoea was recorded in 23% of patients (mean age 18.3 years), primary hypothyroidism in 6.2% (mean age 15.8 years), insulin dependent diabetes mellitus in 4.9% (mean age 18.1 years) and hypoparathyroidism in 3.6% of the patients (mean age 18.7 years). At present, the majority are in the second or third decades of life. The prevalences of hypothyroidism, insulin dependent diabetes mellitus and hypoparathyroidism differed in the various centres, whereas the frequency of pubertal disorders was very similar. CONCLUSIONS: Our study has demonstrated several points. Endocrine evaluation in thalassaemic patients must be carried out regularly, especially in those patients over the age of 10 years with iron overload and poor compliance with chelation therapy. The prevalences of some complications, such as insulin dependent diabetes and hypothyroidism, were lower than previously recorded. Hence, it is to be hoped endocrine complications will be less common in the future, for patients who have started chelation therapy during the first years of life. Because of the improved survival of thalassaemic patients with insulin dependent diabetes, and the high incidence of multiple endocrine complications, it is important to carry out careful follow-up studies for the early detection of any other associated complications to facilitate correct treatment.

Adolescent↗
PubMed1995

The relationship between smoking and microvascular complications in the EURODIAB IDDM Complications Study.

OBJECTIVE: To examine the relationship between smoking and both glycemic control and microvascular complications in patients with insulin-dependent diabetes mellitus (IDDM). RESEARCH DESIGN AND METHODS: This was a prevalence survey of 3,250 men and women aged 15-60 years with IDDM from 31 diabetes centers in 16 European countries. Participants completed a questionnaire, had retinal photographs taken, and performed a 24-h urine collection. HbA1c, frequency of hypoglycemic and ketoacidotic episodes, urinary albumin excretion rates, and retinopathy were compared by smoking category. RESULTS: The prevalence of smoking was 35% in men and 29% in women. Current smokers had poorer glycemic control and, among men, were more likely to have had a ketoacidotic episode than were those who never smoked. Ex-smokers had equivalent glycemic control and marginally more hypoglycemic episodes did than those who never smoked. Current smokers had a higher prevalence of microalbuminuria and total retinopathy than did those who never smoked. Ex-smokers had a higher prevalence of macroalbuminuria and proliferative retinopathy than did those who never smoked, but both had a similar prevalence of microalbuminuria. Adjustment for either current or long-term glycemic control could not fully account for these differences. CONCLUSIONS: Smoking is associated with poorer glycemic control and an increased prevalence of microvascular complications compared with not smoking. Ex-smokers can achieve glycemic control equivalent to and have a prevalence of early complications similar to that of those who never smoked. We suggest that poorer glycemic control can account for some of the increased risk of complications in smokers, and that quitting smoking would be effective in reducing the incidence of complications. Urgent action is required to reduce the high smoking rates in people with IDDM.

Adolescent↗
PubMed1989

Antenatal complications and perinatal outcome in patients with nausea and vomiting-complicated pregnancy.

The incidence of nausea and vomiting-complicated pregnancy was determined in a district hospital in Hong Kong. Nausea was present in 11.4% and vomiting in 63.5% of pregnant women. Patients with vomiting complicating early pregnancy have a statistically significant higher incidence of antepartum haemorrhage of indeterminate origin. The incidences of medical diseases complicating pregnancy, other major antenatal complications, and the neonatal outcome were not different between vomiting and non-vomiting patients.

Adult↗
PubMed1989

Complications of endodrainage retinotomies created during vitreous surgery for complicated retinal detachment.

The authors report nine cases of endodrainage retinotomy site complications that occurred after vitreous surgery for complicated retinal detachments (RDs). Postoperative subretinal neovascularization developed in four eyes at the retinotomy drainage site. In two eyes, postoperative proliferation at a posteriorly placed endodrainage site created traction macular detachments. Redetachment due to retinotomy opening caused by postoperative drainage site proliferation developed in three eyes. The retinas of all nine eyes were eventually reattached, and vision improved from the preoperative level. These complications are related to retinal pigment epithelium and/or Bruch's membrane damage during internal subretinal fluid drainage and retinotomy endolaser photocoagulation. Careful evaluation of extrusion instruments, drainage techniques, retinotomy placement, and subsequent endolaser treatment is necessary to minimize these complications.

Adolescent↗
PubMed1988

Fertility after complicated and non-complicated use of IUDs. A controlled prospective study.

From 1980 to 1985, 600 women participated in a prospective study of three copper IUDs. Women who had removed their IUD by April 1985 because of IUD-related complications or planned pregnancy after non-complicated use were examined for return of fertility. Within 39 months after removal, all 97 women who planned pregnancy had conceived. By April 1987, one of the 147 women with a previous IUD complication needed a fertility work-up. Among the remaining 146 women, 72 women had conceived, while 74 women neither had pregnancy plans nor had conceived after IUD removal. Three (1.8%) out of the 169 pregnancies after IUD removal were extrauterine; 17 (10.1%) were spontaneous abortions. One percent of the women planning pregnancy requested induced abortion, compared to 29% among women who removed the IUD due to complications (p less than 0.01). From these data we conclude that use of copper-containing IUDs did not affect subsequent fertility.

Adult↗
PubMed1990

Normal tissue reactions and complications following high-energy neutron beam therapy. II: Complication rates adjusted for censoring.

A dose response analysis was performed on patients at risk for significant radiation injuries following neutron radiotherapy. Complication rates were calculated at various dose intervals using a maximum likelihood method that is formally equivalent to the product limit estimator of survival. The variance of each complication rate was used to weight a logistic regression on log dose. The treatment sites that were analyzed were head and neck, pelvis, thorax, and pancreas. Except for osteomyelitis of the mandible, complications of all types were considered collectively at each site and dose increment since there were too few complications to determine dose response functions for individual types of injuries. The head and neck was observed to be the site with the highest tolerance to radiation whereas the thorax was the most sensitive site.

Dose-Response Relationship, Radiation↗