Pleuropulmonary complications of fine bore naso-enteric feeding tubes

Fine bore naso-enteric feeding tubes are commonly used for enteral alimentation. Although regarded as generally safe, complications associated with their use occur. Case reports presented here highlight the potential hazards of these tubes. Pleuropulmonary complications are reviewed and guidelines suggested for the safe insertion of such tubes.     

Complications associated with prone positioning in elective spinal surgery

Complications associated with prone surgical positioning during elective spine surgery have the potential to cause serious patient morbidity. Although many of these complications remain uncommon, the range of possible morbidities is wide and includes multiple organ systems. Perioperative visual loss (POVL) is a well described, but uncommon complication that may occur due to ischemia to the optic nerve, retina, or cerebral cortex. Closed-angle glaucoma and amaurosis have been reported as additional etiologies for vision loss following spinal surgery. Peripheral nerve injuries, such as those caused by prolonged traction to the brachial plexus, are more commonly encountered postoperative events. Myocutaneous complications including pressure ulcers and compartment syndrome may also occur after prone positioning, albeit rarely. Other uncommon positioning complications such as tongue swelling resulting in airway compromise, femoral artery ischemia, and avascular necrosis of the femoral head have also been reported. Many of these are well-understood and largely avoidable through thoughtful attention to detail. Other complications, such as POVL, remain incompletely understood and thus more difficult to predict or prevent. Here, the current literature on the complications of prone positioning for spine surgery is reviewed to increase awareness of the spectrum of potential complications and to inform spine surgeons of strategies to minimize the risk of prone patient morbidity.     

Surgical diseases in patients under long-time dialysis and after kidney transplantation (author's transl)]

In uremic patients under long-time dialysis and after kidney transplantation surgical diseases with severe complications may occur, such as gastro-duodenal ulcers, inflammatory and ischaemic diseases of the colon, acute pancreatitis, intestinal obstruction. Most of the complications have only poor symptoms. If complications are suspected, an "aggressive diagnostic regimen" is mandatory. The incidence of cancer is higher in these patients. Complications can be diminished by prophylactic operations, such as gastric resection in gastro-duodenal ulcer. A restriction in elective and emergency operations has no longer a place in these patients.     

A rare complication following laparoscopic TEP repair: case report and discussion of the literature

Transabdominal pre-peritoneal and totally extra-preperitoneal (TEP) are common laparoscopic techniques used to repair inguinal hernias. With better equipment and techniques for creation of pneumoperitoneum serious complications are now infrequent. However, complications from these techniques that are beyond the control of the surgeon do occur. This report details a rare complication related to infection. It is the first such documented complication of TEP hernia repair. There follows a short literature review of rare complications of laparoscopic hernia repair. Surgeons should familiarize themselves with these potential pitfalls for a number of reasons including, counseling when obtaining consent and heightened awareness for infrequent complications during postoperative follow-up.     

Management of Urologic Complications of Renal Transplantation

Renal transplantation is now considered the treatment of choice for end-stage renal disease despite its medical and surgical complications. The main surgical complications of renal transplantation are urologic and related to the quality of the transplant ureter and the quality of the ureterovesical anastomosis. These complications are a major concern in most cases because they occur in a high-risk clinical setting in patients with a solitary functioning kidney. They generate considerable morbidity and excess cost but have little impact on long-term graft survival when they are managed rapidly. The incidence of these complications has decreased over time with a better knowledge of their mechanisms of onset and progress in surgical techniques. The complication rate currently appears to be stabilizing despite the increasingly frequent use of transplants derived from frailer and older extended criteria donors. Some complications may occur during the first postoperative month, corresponding to urinary fistulas and ureteric obstructions by extrinsic compression. Other complications may occur later, such as ureteric stenosis or vesicoureteric reflux. Patients with these complications must be managed in a specialized unit to ensure optimal preservation of graft function and graft survival.Patient summaryThis article describes the urologic complications of renal transplantation. Early onset ureteric fistulas require rapid surgical management to avoid other later complication. The treatment of ureteric stenoses has benefited from progress in endourology, but many cases still require conventional surgical management.     

Skin necrosis in nasal dorsum following rhinoplasty

As a result of the successful outcomes obtained by the plastic surgeons, rhinoplasty has become one of the most frequently performed esthetic operations. Many patients undergo this operation in order to look and function better. However, similar to all surgical procedures, some complications may also occur after rhinoplasty and the complication rates are reported to be 8–15%. Rhinoplasty complications are classified as hemorrhagic, infection, traumatic, functional, and esthetic problems. While the majority of these do not pose a life-threatening condition, major complications that would threaten life such as rhinorrhea, pneumothorax, and subarachnoid hemorrhage can occur. In the current study, two patients who developed skin necrosis in the nasal dorsum following rhinoplasty are presented.     

Atrophic brain at high risk in neurosurgery: report of a case complicated by postoperative intracerebral hemorrhage and tension pneumocephalus

The author reports a patient whose postoperative course was complicated by the coexistence of subcortical hematoma contralateral to the operative site and tension pneumocephalus. This case report and review of the literature suggest that these two complications are both attributed to the intraoperative procedure, which rapidly and greatly relaxes the brain. The potential risk of neurosurgical procedures for an atrophic brain, in which such complications are apt to occur, is discussed.     

Salvage of complications of hallux valgus surgery

Complications following hallux valgus surgery can occur and are a frequent source of patient dissatisfaction. The treatment of these complications begins with careful preoperative planning to ensure that the chosen procedure is appropriate for the specific patient. When complications occur, treatment must also be individualized to address the symptoms of the patient. This article presented an overview of the more common complications that are seen following hallux valgus surgery. Nonsurgical and surgical options for treatment were outlined to assist in the management of these complications.     

Percutaneous treatment of urologic complications following renal transplantation

Summary Urologic complications continue to occur in renal transplant recipients. Furthermore, standard, secondary operative intervention for these problems has been associated with high morbidity and even mortality. Currently, percutaneous techniques are being used with increasing frequency for these patients to temporize or even avoid the need for subsequent operative procedures. The indications, techniques, and results of such intervention are reviewed.     

General surgical complications after cardiac surgery

General surgical complications present significant risk to life, limb, and viscera in the postoperative cardiac surgery patient. Whether they are the product of hypoperfusion, intercurrent disease, or iatrogenic mishap, their management is often complicated by other problems such as anticoagulation, potentially infected prostheses, and the general state of ill health of some cardiac surgical patients. These complications are a challenge because even though they occur infrequently, they demand prompt diagnosis in order to render appropriate treatment and to avoid the disaster of delay. Conservatism should be the hallmark of treatment in these patients. With prompt diagnosis and judicious surgical intervention, the mortality and morbidity of these unusual but serious complications may be reduced.     

Zur Wahl des Operationsverfahrens bei hüftnahen Femurfrakturen

Coxofemoral fractures occur frequently in elderly patients, who are suffering simultaneously from osteoporosis, coxarthrosis, infirmity and cerebral insufficiency. Due to these causes even an optimal osteosynthesis may result in a failure; in such cases, therefore, a partial or total replacement of the hip joint must be performed as an exceptional indication. The indications for the different surgical procedures are described. 95 coxofemoral fractures of our own patients are analysed depending on the treatment; the complications are demonstrated. A case report illustrates how complications were dealt with.     

Management principles of common surgical complications

Surgical complications result in patient morbidity and mortality, and it is important to audit surgical practice in order to reduce the incidence of complications. Clearly, avoidance is better than cure, but when complications occur intra- or postoperatively, expeditious detection and management are required. Further investigations such as imaging and blood tests are important for diagnosis. Surgical complications can be classified temporally (intra-/immediate/early and late postoperative periods); and regionally (local versus systemic). Common complications occur commonly: bleeding and infection are probably the most important complications to be aware of. The goal of complication management is rapid recovery, and often a multidisciplinary approach with senior surgeon input is required.     

Thoracic surgical radiology

Chest radiographs of patients in the intensive care or postoperative setting can be difficult to interpret. Postoperative complications may be life-threatening and require prompt management. Knowledge of the diverse radiological appearances of these complications as well as familiarity with the clinical settings in which specific complications are likely to occur is vital for prompt, effective treatment. Following pulmonary resection, patients often have postoperative complications that differ according to the type of surgery and the time elapsed since surgery was performed. This article describes the potential complications and gives illustrated explanations of normal postoperative appearances, for example following pneumonectomy, as well as demonstrating important complications such as bronchopleural fistula. The article highlights the differences in the appearance of the chest radiograph of atelectasis and consolidation, with illustrated examples.     

Strategies to improve outcomes from operative childhood management of DDH

The operative management of DDH is technically challenging. To achieve excellent results, surgeons need to select the most appropriate operative treatment, minimize the risk of complications, and be aggressive in the management of serious complications, such as redislocation and AVN, when they occur. We have described specific steps and strategies to assist in each of these key steps.     

Percutaneous nephrolithotomy in transplanted kidney

Renal transplant patients with urologic complications can be managed safely with percutaneous techniques. The development of renal calculi in transplanted kidneys is uncommon, but in these cases complications such as infection and urinary tract obstruction with impairment of graft function can occur. We report 2 cases managed successfully with percutaneous nephrolithotomy.     

Silo pouch stoma: a rescue procedure for intestinal catastrophe in gastroschisis

Silo pouch formation is a standard procedure to prevent compartment syndrome in gastroschisis. Intestinal complications such as perforation and volvulus can occur and their management can be perplexing. We present three such patients in which we formed a stoma through the silo pouch owing to these complications. Creation of stoma through the silo is a novel, safe temporizing technique to decompress the bowel while delayed reduction continues. Subsequently, when the baby and the bowel improve, the stoma can be closed.     

Transesophageal echocardiography-related complications

PURPOSE: The use of transesophageal echocardiography has increased over the past several years. It is generally considered a safe diagnostic and monitoring tool. Whereas complications associated with echocardiographic examination rarely occur, such complications must be known to echocardiographers performing these examinations. The purpose of this review is to summarize potential complications associated with transesophageal echocardiography. SOURCES: A systematic search of the English and French literature was undertaken using PubMed from the National Library of Medicine. Relevant articles were obtained from a Medline search spanning the years 1975-2007, and their reference lists were used to retrieve additional articles. PRINCIPAL FINDINGS: Complications of transesophageal echocardiography are primarily related to the gastrointestinal, cardiovascular, and respiratory systems, and include infection, toxic drug reaction, local reaction through contamination of the probe, and ultrasound cavitation. Strategies to prevent these complications are reviewed. CONCLUSION: Whereas transesophageal echocardiography is associated with a low complication rate, the echocardiographer must be knowledgeable about the types of complications and their predisposing factors, and should be meticulous in preventing their occurrence.     

Complications of bariatric surgery

The rise in bariatric operations has been exponential because of the greater acceptance for these procedures. Although complication rates are relatively low, they can result in formidable disability.Adverse outcomes also result in medical malpractice claims that are particularly problematic for bariatric surgery practices. For these reasons, surgeons performing these operations must be knowledgeable and must possess the technical skills required for managing complications when they occur. The purpose of this article is to review the major complications that occur following anti-obesity procedures and to provide recommendations regarding their management.     

Complications of arthrodesis and nonunion

Complications of joint fusions can include those applicable to any surgery such as bone and/or soft-tissue infection, wound dehiscence, and failure of fixation. Other complications are specific to fusion procedures and would include malalignment, proximal or distal joint deterioration, and delayed union or nonunion. The latter negative outcomes can occur from medical comorbidities, patient noncompliance, or inappropriate fixation. This article addresses many of these complications including techniques for evaluation, accurate diagnosis, and current treatment options. Special attention is paid to the subject of nonunion, as it is one of the most common and difficult adverse outcomes of arthrodesis procedures.     

Semirigid and malleable rod penile prostheses

Rod penile prosthesis implantation has a high functional success rate, and the devices have a low mechanical failure rate. The rods are easily implanted. Transient problems, such as pain or penile edema lasting longer than 4 weeks, occur in 10 to 15 per cent of patients, and serious complications such as infection or prosthesis erosion occur in 1 to 5 per cent.