Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure with significant complications. Splenic hematoma is an extremely rare but known complication following ERCP that has been increasingly reported in the past several years. We report the case of a 44-year-old patient with a history of sleeve gastrectomy who underwent an ERCP that was complicated by both acute pancreatitis and splenic hematoma. She was managed conservatively under close monitoring in the intensive care unit. Clinicians should be aware of this potentially life-threatening complication to make a prompt diagnosis and begin early appropriate management.

Goals: The purpose of our study was to evaluate trends of hospitalization, acute kidney injury (AKI) and mortality in cirrhotic patients with spontaneous bacterial peritonitis (SBP). Background: SBP is a frequent bacterial infection in cirrhotic patients leading to increased morbidity and mortality. Materials and Methods: A total of 4,840,643 patients hospitalized with cirrhosis from 2005 to 2014 were identified using the Nationwide Inpatient Sample database, of which 115,359 (2.4%) had SBP. We examined annual trends and used multivariable mixed-effects logistic regression analyses to obtain adjusted odds ratios by accounting for hospital level and patient level variables. Results: We identified a striking increase in hospitalizations for SBP in cirrhotic patients (0.45% to 3.12%) and AKI in SBP patients (25.6% to 46.7%) from 2005 to 2014. Inpatient mortality decreased over the study period in patients with SBP (19.1% to 16.1%) and in patients with SBP plus AKI (40.9% to 27.6%). Patients with SBP had a higher inpatient mortality rate than those without SBP [15.5% vs. 6%, adjusted odd ratio (aOR): 2.02, P<0.001]. AKI was 2-fold more prevalent in cirrhotics with SBP than those without SBP (42.8% vs. 17.2%, aOR: 1.91, P<0.001) and concomitant AKI was associated with a 6-fold mortality increase (aOR: 5.84, P<0.001). Cirrhotic patients with SBP had higher hospitalization costs and longer length of stays than patients without SBP. Conclusions: Despite a higher hospitalization rate and prevalence of concomitant AKI, mortality in patients with SBP decreased during the study period. SBP is associated with high likelihood of development of AKI, which in turn, increases mortality.

Objectives: To assess national trends of AP (acute pancreatitis) admissions, outcomes, prevalence of AKI (acute kidney injury) in AP, and impact of AKI on inpatient mortality. Methods: We queried the Nationwide Inpatient Sample database from 2003 to 2012 to identify AP admissions using ICD-9-CM codes. After excluding patients with missing information on age, gender, and inpatient mortality, we used ICD-9-CM codes to identify complications of AP, specifically AKI. We examined trends with survey-weighted multivariable regressions and analyzed predictors of AKI and inpatient mortality by multivariate logistic regression. Additionally, both AKI and non-AKI groups were propensity-matched and regressed against mortality. Results: A total of 3,466,493 patients (1.13% of all discharges) were hospitalized with AP, of which 7.9% had AKI. AP admissions increased (1.02%→1.26%) with rise in concomitant AKI cases (4.1%→11.7%) from year 2003–2012. Mortality rate decreased (1.8%→1.1%) in the AP patients with a substantial decline noted in AKI subgroup (17.4%→6.4%) during study period. Length of stay (LOS) and cost of hospitalization decreased (6.1→5.2 days and $13,654 to $10,895, respectively) in AKI subgroup. Complications such as AKI (OR: 6.08, p < 0.001), septic shock (OR: 46.52, p < 0.001), and acute respiratory failure (OR: 22.72, p < 0.001) were associated with higher mortality. AKI, after propensity matching, was linked to 3-fold increased mortality (propensity-matched OR: 3.20, P < 0.001). Conclusion: Mortality, LOS, and cost of hospitalization in AP has decreased during the study period, although hospitalization and AKI prevalence has increased. AKI is independently associated with higher mortality.

No description available.

SAMMANFATTNING Bakgrund: Vattenfödslar har förekommit i över 200 år och fick sitt genombrott på 1970-1980 talet, främst i Frankrike och Ryssland. Det finns ett flertal dokumenterade fördelar för kvinnan att bada under förlossningen såsom ett snabbare förlossningsförlopp, minskat behov av farmakologisk smärtlindring och minskad risk för instrumentell förlossning och kejsarsnitt. På grund av uttalanden från bland andra Amerikanska neonatologer om de potentiella risker som finns för barnet har många obstetriker och barnmorskor valt att undvika vatten som ett alternativ vid förlossning. Syfte: Syftet med föreliggande arbete var att kartlägga hur vanligt det är med komplikationer för barnet efter en vattenfödsel. Metod: En litteraturöversikt valdes där sammanlagt 16 vetenskapliga artiklar inkluderades till resultatet. Artiklarna var peer reviewed och svarade på arbetets syfte. Resultat: Det framkom totalt fem olika kategorier som belyste komplikationer för barnet efter vattenfödsel. Apgarpoäng, fysiska komplikationer, pH-värde och överflyttning till neonatalavdelning och mortalitet. Komplikationerna i vardera kategori varierade i allvarlighetsgrad och förekom mycket sällan i förhållande till det totala antalet deltagare i studierna. Merparten av alla vattenfödslar medförde inte några ökade risker för barnet och infektionsrisken i samband med vattenfödsel visade sig vara lägre än vid landfödslar. Slutsats: För en lågrisk-kvinna med enkelbörd, normal graviditet och förväntat normal förlossning tyder forskningen på att det inte finns några ökade risker för barnet med att födas i vatten.

A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of MSc (Med) Johannesburg, 2011 / Peripheral sensory neuropathy is a common neurological complication of antiretroviral therapy, typically occurring within 6-months of starting Highly Active Antiretroviral Therapy (HAART) which includes stavudine. Therefore, the primary aim of the study was to determine the 6-month incidence of ATN in patients free of neuropathy and beginning stavudine-based HAART for the first time. Also, we examined whether initiating stavudine-based HAART altered the symptoms of patients who had a pre-existing, virus-mediated distal symmetrical polyneuropathy (HIV-DSP). Seventy-five HIV-positive patients were screened for neuropathy, at the Chris-Hani Baragwanath Hospital, using the AIDS Clinical Trials Group neuropathy screening tool. The bilateral presence of atleast one sign (decreased vibration sense in the great toe or absent ankle reflex) and one symptom (pain, paraesthesia or numbness) in the feet was indicative of neuropathy. On recruitment, 52 patients presented without neuropathy and 13 patients presented with HIV-DSP. After 3- months of follow-up (n=46), 23% (10/46) of patients had developed peripheral neuropathy, and by 6-months (n=44), 41% (18/44) of patients had developed neuropathy. Greater disease severity was the only risk factor significantly associated with the development of neuropathy. Eleven (61%) of the 18 patients that developed neuropathy, developed painful symptomatic neuropathy, and only 6 (55%) of these patients were receiving treatment for symptom relief. In patients with HIV-DSP, numbness was the most common symptom reported at baseline and was the only symptom to reduce in frequency across the 6-months. In conclusion, we found that the development of neuropathy is common in the first 6-months of patients initiating stavudine-based HAART.

Introduction Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is an invasivetechnique aimed at stabilizing hemodynamically unstable patients. The technique is underconstant development and in 2016 a new REBOA balloon requiring a smaller sized sheathwas introduced aiming to decrease complications and mortality. Studies show contradictoryfindings concerning outcome and complications of REBOA. Aim To investigate if survival and complications of patients treated with REBOA changed overtime by comparing two time periods, 2011-2015 and 2016-2020. Methods This was a retrospective registry study. Data was extracted from the Aortic Balloon Occlusion(ABO) trauma registry and 217 patients were included in the study. Patients were divided intotwo calendar periods, an early period (2011-2015) and a late period (2016-2020). Results Mortality at the emergency department was 24 % in the early period compared to 9 % in thelate period (p= 0.018). Mortality within 24 hours was reported in 40 % in the early period and36 % in the late period. In the early period, mortality within 30 days was 59 % and 36 % inthe late period. Access related complications such as extremity ischemia was reported in 1 %in the early period and 12 % in the late period (p = 0.001). Conclusion Early mortality at the emergency department has decreased over time. Access relatedcomplications were present in both the early and late period but extremity ischemia was morecommon in the late period.

No description available.

Introduction: Routine drain placement is still widely used in both sleeve gastrectomy (SG) and Roux en Y gastric bypass (REYGB). There is mounting evidence that drains may increase complication risk without preventing reoperation or other complications. Methods: Data from 2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Participant Use File was evaluated for drain use during laparoscopic REYGB and SG. Primary outcomes were superficial and deep surgical site infections (SSI), reintervention/reoperation, and readmission. Preoperative patient risk factors were also compared to evaluate for association with drain placement. Results: A total of 148 260 patients fit the inclusion criteria. Drains were used in 23 190 (15.6%) cases and not used in 125 070 (84.4%). Drain placement during surgery was associated with increased odds of superficial SSI, deep incisional SSI, and organ space SSI. Patients with drains were found to have increased odds of requiring at least 1 reoperation or intervention within 30 days of surgery. Preoperative risk factors associated with drain placement included diabetes mellitus, a history of chronic obstructive pulmonary disease, and oxygen dependence. Smokers were slightly less likely to have a drain placed. There was no significant association with chronic steroid and immunosuppressant usage. Conclusion: There is mounting data against drain placement during bariatric surgery. Prior studies using MBSAQIP data have shown an increased complication rate with drains, and our data set supports the idea that drains may increase complications after surgery. While no randomized prospective trials have been performed looking at drain usage in bariatric surgery, the growing retrospective data certainly inform against the regular use of drains.

No description available.