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 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

With nearly a third of American adults considered be obese, it is increasingly important that orthopaedic surgeons be familiar with management issues pertinent to these patients. Preoperative examination must assess cardiopulmonary status and other comorbid conditions, most notably diabetes. Intraoperative considerations include requirements for special equipment, patient positioning, intravenous line placement, central monitoring lines, and anesthesia specific to the physiologic changes in obese patients. Postoperatively, obese patients have higher rates of deep vein thrombosis and wound sepsis than do nonobese patients, and they may differ from other patients in supplemental oxygen requirements, medication dosing, and outcomes in intensive care units. Obese patients can successfully undergo virtually all orthopaedic procedures; however, the procedures are frequently more technically challenging, and obese patients appear to have higher rates of prosthetic failure, infection, hardware failure, and fracture malunion, although many of these complications can be minimized by appropriate countermeasures.
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PMID:Perioperative management of the obese orthopaedic patient. 1682 90

We sought to better describe the expected incidence of mechanical and infectious complications associated with central venous cannulation of critically ill children. We undertook a retrospective analysis of a prospective data collection of 1056 consecutive percutaneous central venous catheters inserted under the supervision of an experienced surgeon. There were 245 (23%) subclavian (SC), 118 (11%) internal jugular (IJ), and 693 (66%) femoral (F) catheters placed in 289 children with an average age of 6.4 +/- 5.1 years (range, 4 weeks to 18 years) admitted to a burn intensive care unit. Catheter sepsis occurred in 7.4% of SC, 7.6% of IJ, and 4.9% of F catheters (NS, P = .25), for an overall sepsis rate of 5.8%. The number of catheter lumens did not impact infection rate. Infection rates increased in catheters left in situ more than 10 days, increasing to 37.5% at 14 days. Acute mechanical complications occurred in three insertions (0.3%), including two (0.8%) SC, zero (0%) IJ, and one (0.1%) F catheters (NS, P = .20). All three were arterial cannulations that were recognized and treated successfully without surgery. There were no pneumothoraces, vascular lacerations, acute thromboses, or catheter emboli. There were six (0.6%) cases of deep venous thrombosis that occurred in cannulated sites: one (0.4%) SC, two (1.6.%) IJ, and three (0.4%) F sites (NS, P = .23). Patient age did not influence complication rates. A total of 239 (23%) of the CVCs were placed in infants less than 24 months; 273 (26%) 2 to 5 years, 259 (25%) 6 to 10 years, and 285 (27%) >10 to 18 years. Catheter sepsis occurred in 6.7%, 5.9%, 6.2%, and 4.6%, respectively (NS, P = .75). There was no difference in rates of infection or mechanical complication between younger and older children. When closely supervised by an experienced surgeon, a low rate of infection (5.8%), acute mechanical complication (0.3%), and deep venous thrombosis (0.6%) accompanies central venous cannulation of critically ill children.
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PMID:Mechanical and infectious complications of central venous cannulation in children: lessons learned from a 10-year experience placing more than 1000 catheters. 1699 5

Colorectal carcinoma emergencies during pregnancy are exceptionally rare. Three women 38, 31 and 36 years old, in the third trimester of gestation received treatment, respectively, for acute abdomen due to perforation of rectal carcinoma, ileus due to a sigmoid tumor, and deep venous thrombosis (DVT) from a cecal tumor compromising the right iliac vein. In the first two patients urgent cesarean sections were carried out with Hartmann's procedure and a loop colostomy was performed to resolve the ensuing intraabdominal sepsis and ileus, respectively. In the third patient, a cesarean section was carried out to treat the underlying DVT more aggressively, while right colectomy was postponed for three weeks. Restoration of the alimentary tract was achieved two months later in the first case, while in the second and third cases total colectomy due to familial polyposis and right colectomy were performed three weeks after the cesarean section. An overview of the clinical features, diagnostic pitfalls and therapeutic approaches to manage complications of colorectal cancer during pregnancy are discussed.
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PMID:Colorectal cancer emergencies during pregnancy case reports. 1700 43

Enoxaparin, a low-molecular-weight heparin used to treat and prevent deep venous thrombosis, has been evaluated in several clinical trials. Thrombosis induced by enoxaparin with no evidence of heparin-induced thrombocytopenia (HIT) is seldom described. We report a rare case in which an 89-year-old African-American female developed large, multiple, painful lesions induced by enoxaparin administration. Laboratory investigations for HIT, disseminated intravascular coagulation, protein C, protein S, factor V, factor VIII, antithrombin III, and homocysteine deficiency were negative. Unfortunately, despite aggressive management for 2 weeks, the patient developed severe sepsis and died.
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PMID:Enoxaparin-induced skin necrosis: a fatal outcome. 1766 18

Patients with severe sepsis are at increased risk for developing thrombembolic phenomena. This article aims to clarify the association between systemic inflammation activation and coagulation, pathogenesis of coagulation abnormalities during severe sepsis. The article reviews incidence and deep venous thrombosis risk factors among these patients and summarizes recent evidence-based guidelines for deep venous thrombosis prophylaxis.
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PMID:[Thrombotic complications of sepsis and their pharmacological prophylaxis]. 1772 47

Venous thromboembolism (VTE) is known as a common complication in surgical and non-surgical patients. We hypothesized that according to the underlying risk factors and the acute illness, the prevalence ofVTE in non-surgical patients admitted to hospital is widely underestimated. For three months each patient admitted to the department of internal medicine with an acute illness, but without known deep venous thrombosis (DVT) was investigated by ultrasound compression sonography. Patients' history, risk factors and extent of immobilisation were documented. In patients with newly detected DVT D-dimer and fibrinogen were measured as well as computer tomography scans performed. Follow-up investigations of the DVT population were performed at four weeks and three months. Six hundred seventeen patients (49.3% men) were included. In 16 patients (men = 7) a previously unknown thrombosis (2.6%) was detected, mainly in patients with acute cardio-pulmonary disease (56%) and the elderly (mean age 75.6 years). Eight patients had femoro-popliteal (50.0%), four a femoral (25.0%), and four a popliteal vein thrombosis (25.0%). Five had pulmonary embolism (31.3%). In patients with DVT D-dimer was 875 +/- 1,228 mg/l, fibrinogen 568 +/- 215 mg/dl and C-reactive-protein 58.54 +/- 73.65 mg/dl. One patient died from sepsis during hospitalisation, one died from sudden cardiac death at home. None of the other 14 surviving patients relapsed. The study shows a 2.6% risk for DVT in outpatients with acute illness admitted to the department of internal medicine. These data demonstrate the high risk of DVT is in non-surgical patients. Early prophylaxis has to be considered in internal medicine patients especially in the elderly.
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PMID:Prevalence of deep vein thrombosis (DVT) in non-surgical patients at hospital admission. 1793 99

The development of deep vein thrombosis in an osteoarticular infection in children is rare. We report the case of two siblings with an osteoarticular infection in the hip and in the knee, respectively, who developed deep vein thrombosis and, in one sibling, pulmonary thromboembolism. The only hematological alteration found was reduction of anti-thrombin III in both patients. This reduction was acquired and secondary to sepsis due to Staphylococcus aureus. Anti-thrombin III levels recovered after 2 weeks of treatment. The association of deep vein thrombosis and osteoarticular infection with sepsis should lead to suspicion of hematological deficiencies, including acquired anti-thrombin III deficiency.
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PMID:[Deep vein thrombosis associated with osteoarticular infection in two siblings with anti-thrombin III deficiency]. 1819 27

The study objective was to review the existing literature regarding complications of anti-incontinence sling procedures. PubMed listings using keywords related to slings and associated complications with no date or language restrictions through May 2007 and the Manufacturer and User Facility Device Experience Database were searched for specific device- and procedure-related complications. Where no information was available, published abstracts were cited. Published reports of complications for all types of anti-incontinence sling procedures are analyzed and reported. Sling-related complications are multiple but can be summarized from studies on 13737 cumulative patients as involving: voiding dysfunction (8 studies, 881 patients, 16.3% average overall incidence [OI]); detrusor overactivity (20 studies, 1950 patients, 15.4% OI); urinary retention (14 studies, 943 patients, 14.2% OI); erosion/extrusion (19 studies, 2197 patients, 6.03% OI); impact on quality of life-dyspareunia (2 studies, 175 patients, 4.3% OI); infections-most often urinary tract infections but severe infections such as abscess are reported (19 studies, 1487 patients, 5.5% OI); hematoma-most often pelvic or vaginal (4 studies, 3691 patients, 2% OI); pain (6 studies, 597 patients, 7.3% OI); abdominal and pelvic organ injury-bladder, urethra, vagina, and intestines (10 studies, 1816 patients, 3.3% OI); systemic complications-deep vein thrombosis, sepsis (case reports); and death (case reports). Cure rates for all slings are as follows: subjective (16 studies, 1541 patients, 95% OI, range 63%-99%), objective (15 studies, 1203 patients, 82% OI, range 51%-97%), and failure (8 studies, 599 patients, 11.5% OI, range 4%-37%). It is likely that sling-related complications are under-reported in the published medical literature and in the Manufacturer and User Facility Device Experience Database. This review reports on the incidence of known complications for all types of slings. Some complications are common to all sling techniques; however, with development of minimally invasive slings, device-related complications are reported and compared.
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PMID:A comprehensive review of suburethral sling procedure complications. 1831 81

Despite numerous publications, there is still only one randomised clinical trial with vena cava filter in the treatment of venous thromboembolism (VTE). This study has shown a potential and early benefit on the risk of pulmonary embolism (PE) (the first three months) but a late negative effect on the risk of deep vein thrombosis (DVT) recurrences (beyond the sixth month) especially on the risk of filter thrombosis. Consequently, the international recommendations are against a systematic use of vena cava filter to treat VTE (grade 1A) and they suggest to use them in case of a recurrence despite adequate treatment or in case of a contra-indication to anticoagulants (grade 2C). But these two conditions are frequent with VTE associated with cancer since, the risk of VTE recurrences is about 5 to 10% despite prolonged low-molecular-weight heparins (LMWH) treatment and the major bleeding risk is also about 5 to 10% in this case. These VTE recurrences are frequently early (first month of treatment) and contra-indications to anticoagulants due to major bleeding are mostly temporary. In this way, retrievable vena cava filters (possible retrieval until six months after placement) could be useful in order, to prevent recurrences during the thromboembolic risk period without any prolonged increasing risk of vena cava thrombosis. However, vena cava filters could be associated with some complications (tilt, migration sepsis...). So without any strong validation, they have still to be considered as a therapeutic strategy needing to be evaluated especially in cancer patient.
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PMID:[Vena cava filters and treatment of venous thromboembolism in cancer patients]. 1845 34

We report a case of severe deep venous thrombosis (DVT) treated with multimodality therapy that was complicated by sepsis due to thrombus likely infected by Salmonella virchow. We review the current therapeutic options in the therapy of severe DVT and cardiovascular pathology associated with non-typhoid Salmonella.
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PMID:Endovascular treatment of septic thrombophlebitis: a case report of a rare complication and review of the literature. 1914 79


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