Late Complications of Allogenic Stem Cells Transplantation in Leukaemia

BACKGROUND: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) can cure leukaemia. However, long term complications of post transplantation interfere with the patients’ full recovery. The objective of this review was to identify the various long term complications and to assess their individual prevalences. METHODS: Electronic databases including PubMed, Google Scholar and Cochrane were searched for years 2004-2017. The keywords used were leukaemia, allogenic stem cell transplantation, prevalence, side effects, long term, delayed, adverse effects, complications and outcome. RESULTS: A total of ten articles were included for analysis. There were 5 prospective studies, 3 retrospective studies and 2 cross sectional studies. A total of 40,069 patients, (20,189 males and 17,191 females) participated in these 10 studies. The gender of 2689 patients were not disclosed. Most common late complications and prevalence were chronic graft versus host disease (43% at 5 years post HSCT), secondary tumor (21% at 20 years post HSCT), hypothyroidism (11% at 15 years), bronchiolitis obliterans (9.7% at 122 days), cardiovascular disease (7.5% at 15 years) and avascular necrosis (5.4% at 10 years). The prevalence of azoospermia was 71.1% and depression, 18%. For the latter two conditions no time limit was available. Follow up duration ranged from 2 years till 30 years post HSCT. CONCLUSION: While allogenic stem cell transplantation is an effective cure for leukaemia, the procedure is associated with complications that can have their onset many years after the procedure.

Complications of proximal hypospadias repair with transverse preputial island flap urethroplasty: A 15-year experience with long-term follow-up / 亚洲男科学杂志(英文版)

There is still debate regarding the optimal surgical approach for proximal hypospadias. This retrospective study aims to evaluate the long-term outcomes using transverse preputial island flap urethroplasty. A total of 320 patients were included, with a mean follow-up of 40.2 months (range: 1-156 months). Complications were encountered in 125 patients (39.1%), including fistulas in 53 (16.6%), urethral strictures in 31 (9.7%), and diverticula in 41 (12.8%). The mean timing of presentation with a complication was 15.8 months (median: 1.7, range: 1-145), of which 79.2% were early complications and 20.8% were late complications. In all, 20.8% of the patients with complications presented after ≥1 year, and 12.8% presented after ≥5 years. Univariate analysis revealed that age at the time of surgery, flap length, and location of the urethral meatus were not correlated with complications. A stricture was present in 31.7% (13/41) of those with diverticula (P < 0.001), while late urethral diverticula were accompanied by urethral strictures in 11.1% (1/9) of cases (P = 0.213). These results indicate that transverse preputial island flap urethroplasty still has a high incidence of complications, even when performed by highly experienced physicians. Most complications of hypospadias are diagnosed within 1 year postoperatively, while fistulas and urinary strictures generally occur within 2 months and diverticula tend to be present by 1 year.

Complications of proximal hypospadias repair with transverse preputial island flap urethroplasty: a 15-year experience with long-term follow-up / 亚洲男科学杂志(英文版)

There is still debate regarding the optimal surgical approach for proximal hypospadias. This retrospective study aims to evaluate the long-term outcomes using transverse preputial island flap urethroplasty. A total of 320 patients were included, with a mean follow-up of 40.2 months (range: 1-156 months). Complications were encountered in 125 patients (39.1%), including fistulas in 53 (16.6%), urethral strictures in 31 (9.7%), and diverticula in 41 (12.8%). The mean timing of presentation with a complication was 15.8 months (median: 1.7, range: 1-145), of which 79.2% were early complications and 20.8% were late complications. In all, 20.8% of the patients with complications presented after ≥1 year, and 12.8% presented after ≥5 years. Univariate analysis revealed that age at the time of surgery, flap length, and location of the urethral meatus were not correlated with complications. A stricture was present in 31.7% (13/41) of those with diverticula (P < 0.001), while late urethral diverticula were accompanied by urethral strictures in 11.1% (1/9) of cases (P = 0.213). These results indicate that transverse preputial island flap urethroplasty still has a high incidence of complications, even when performed by highly experienced physicians. Most complications of hypospadias are diagnosed within 1 year postoperatively, while fistulas and urinary strictures generally occur within 2 months and diverticula tend to be present by 1 year.

Hernia diafragmática secundaria a trauma: presentación tardía / Complicated diaphragmatic hernia: late outcome of trauma

Resumen Introducción: La hernia diafragmática complicada de presentación tardía constituye una urgencia quirúrgica. Los objetivos del presente estudio son la descripción de las características del diagnóstico de las hernias diafragmáticas de presentación tardía, tratamiento, resultados y la identificación del punto de corte entre el inicio de los síntomas y el desarrollo de necrosis. Pacientes y Métodos: Estudio retrospectivo de una serie de casos constituida por todos los pacientes operados por hernia diafragmática complicada de presentación tardía entre los años 2006 y 2016. Se midieron variables categóricas y continuas que se presentan con estadística descriptiva. Se utilizaron curvas Receiver Operating Characteristics (ROC) a las 6 y 12 h desde el inicio de los síntomas, para determinar el punto de corte del tiempo de presentación clínica en pacientes sometidos a resección de algún órgano. Una vez establecido el punto de corte se calcularon la sensibilidad; especificidad; las razones de verosimilitud positiva y negativa; los valores predictivos positivo y negativo; y la prevalencia. Resultados: La presentación clínica, estudio, diagnóstico y tratamiento fue similar a lo descrito en la literatura quirúrgica. Se estableció el punto de corte a las 12 h con sensibilidad de 80% y especificidad de 83%. Conclusiones: El diagnóstico y tratamiento de estos pacientes debería ser llevado a cabo antes de las 6 h desde el inicio de los síntomas. Aun cuando el universo descrito es reducido, se sugiere que después de las 12 h desde el momento de la estrangulación, los órganos comprometidos se encontrarán necróticos requiriendo resección quirúrgica.

Introduction: Late presentation of traumatic diaphragmatic hernia constitutes a true surgical emergency. The purposes of this study were to describe the diagnostic characteristics, treatment and outcomes of late presentation diaphragmatic hernias and to identify a cutoff point from the onset of symptoms to necrosis development. Patients and Methods: A retrospective series of cases constituted by all patients subjected to emergency diaphragmatic hernia repair form 2006 to 2016 was studied. Categorical and continuous variables were measured and analyzed with descriptive statistics. Receiver Operating Characteristics (ROC) curves at 6 and 12 hours from the onset of symptoms were used to determine the cutoff point for organ resection. Once stablished the cutoff point, sensitivity, specificity, positive and negative predictive values and prevalence were calculated. Results: Clinical presentation, diagnostic study and surgical treatment were similar to what has been already described. The cutoff point was defined at 12 hours from the onset of symptoms with 80% sensitivity and 83% sensibility. Conclusions: The diagnosis and treatment of these cases should be carried on before the first 6 hours after the onset of symptoms. Even though the universe of this study was small, we may suggest that after 12 hours form the onset of symptoms, the implicated organs would be found necrotic requiring surgical resection.

A Review of Helicobacter pylori Infection in Patients with Diabetes Mellitus.

Gastrointestinal symptoms, such as abdominal discomfort, chronic abdominal pain, dysphagia, heartburn, nausea, vomiting, diarrhea and constipation are more common in patients with Diabetes Mellitus (DM) than in the general population. Studies published in the past two decades have suggested a link between Helicobacter pylori (H. pylori) infection and DM in many aspects. These include; higher H. pylori infection prevalence however the data on the prevelance of H. pylori infection in patients with DM are scanty and contradictory, the eradication rate of H. pylori seems to be lower in DM patients than in non-diabetic controls, control of dyspeptic symptoms with eradication as well as association with late complications in DM patients. The aim of the present review is to gain a better understanding of H. pylori infection in DM patients.

The 2013-2015 Ebola outbreak in West Africa

Zaire Ebola virus (EBOV) is a fatal human pathogen, with a high case fatality rate (CFR) averaging up to 78%. In March 2014, the World Health Organization (WHO) was made aware of a ZEBOV outbreak in rural Guinea, West Africa. Epidemiologic investigation linked the clinical and laboratory confirmed cases with the presumed first fatality of the outbreak in December 2013. EBOV from Guinea is a separate clade from other ZEBOV strains reported from the Democratic Republic of Congo (DRC) and Gabon. Since the outbreak in March, ZEBOV was also reported in Conakry, Guinea's capital and spread to other neighboring countries. In its largest outbreak, ZEBOV disease expanded through Guinea, Liberia, Sierra Leone, and Nigeria and to Spain, the USA, and the UK. The WHO declared the 2013-2015 West African Ebola epidemic a public health emergency of international concern considering its presumable capacity for further international spread. Early manifestations of EVD (Ebola virus disease) include a high fever, body aches, malaise, and fatigue. Severe diarrhea and other gastrointestinal manifestations such as vomiting were common, while bleeding was a more sporadic finding. The fatality rate was 43% and highest in patients aged > or = 45 years and the overall fitted mean incubation period was 10.3 days (95% CI 9.9~10.7). We present a review of the literature on the emergence of Ebola, and the epidemiologic, clinical, and laboratory records of patients in whom EVD was diagnosed in Sierra Leone, Guinea, Liberia, Mali, the USA, and Spain, its zoonotic origin, and the transmission of ZEBOV, as well as presenting original literature on the current Ebola outbreak.

Effect of endoscopic sphincterotomy on function of sphincter of Oddi and long-term complications / 中华消化内镜杂志

Objective To investigate the effect of EST on function of sphincter of Oddi and on the long-term complications.Methods A total of 68 patients with common bile duct stones were recruited from January 2009 to January 2013 in The First People's Hospital of Hangzhou.All patients were under follow-up to observe the incidence of late complications after EST.Oddi sphincter manometry and bile bacterial culture were performed before EST and one year later.Results With the 13-36 months follow-up,the incidence of late complications was 16.9％ (11/65).The peak pressure and frequency of contraction of Oddi sphincter after EST were significantly lower than those before EST,but there were no significant differences between patients with complication and without (P ＞ 0.05).After EST,positive rate of biliary bacteria in patients with complications was much higher than that in patients without complications [70％ (7/10)vs.31.7％ (13/41),P =0.026],although there were no significant differences between them before EST [54.5％(6/11) vs.46.3％ (25/54),P =0.618).Logistic regression analysis showed that cholecystolithiasis,bile duct diameter (＞ 1.5 cm),number of stone (＞ 3),maximun diameter of stone (＞ 20 mm),large EST were independent risk factors for late complications of EST.Conclusion Importance should be attached to the late complications of EST with Oddi sphincter function declination,and biliary enteric reflux being the basic factor in late compilations after EST,which are also influenced by many risk factors.

Complicaciones tardías en cohorte de lesionados medulares traumáticos de origen laboral / Late complications in a cohort of work related traumatic spinal cord injured patients

Introducción: Las complicaciones tardías en el lesionado medular (LM) son frecuentes, pesquisables y prevenibles mediante un programa de seguimiento. Objetivo: Determinar las complicaciones tardías que presentan los LM atendidos en Hospital del Trabajador (HT) de Asociación Chilena de Seguridad (ACHS), sometidos a programa de control de seguimiento, que viven en regiones rurales lejanas de Santiago. Pacientes y Métodos: Se evaluaron los pacientes LM en control de seguimiento en HT ACHS entre 2000 y 2006, a los que se les realizó evaluación multidisciplinaria, estudios de pesquisa de laboratorio, imaginología y entrevista de enfermería. El análisis estadístico se realiza por pruebas paramétricas. Resultados: Se controlaron 78 pacientes, 74 hombres y 4 mujeres, edad 48,7 +/- 11,8 años; la LM más frecuente fue paraplejia completa (52,6 por ciento). Todos los pacientes presentaron alguna complicación durante el período observado. Las complicaciones más frecuentes fueron dislipidemia (80,8 por ciento), dolor (71,8 por ciento), espasticidad (53,8 por ciento), infección urinaria (52,6 por ciento), constipación (48,7 por ciento) e insomnio (46,2 por ciento). 33,3 por ciento de los pacientes presentaron úlceras por presión. La prevalencia de diabetes mellitus fue 10,2 por ciento. Mediante ecografía abdominal se pesquisó 24,4 por ciento de colelitiasis y 24,4 por ciento de hígado graso. Discusión: La incidencia acumulada complicaciones tardías en los LM de nuestra cohorte es muy similar al descrito previamente, existiendo mayor frecuencia de enfermedades crónicas no trasmi-sibles (ECNT) que en la población general, debido a disminución de actividad física y alteración del metabolismo de lípidos y carbohidratos. Conclusiones: La alta incidencia acumulada de complicaciones tardías en LM recomienda desarrollar programas de evaluación de seguimiento multidisciplinario que permitan detectarlas precozmente.

Introduction: Late complications in spinal cord injured (SCI) are common, detectable and preventable by a follow up program. Aim: To determine late complications suffered by SCI treated at Hospital del Trabajador (HT) of Asociación Chilena de Seguridad (ACHS), subject to follow-up evaluation program and living in distant rural areas of Santiago. Patients and Methods: Patients evaluated in follow-up evaluation program of HT ACHS between 2000 and 2006 who underwent multidisciplinary evaluation, laboratory studies and imaging research and nursing interview. Statistical analysis was performed by parametric tests. Results: 78 patients were monitored, 74 men and 4 women, age 48.7 +/- 11.8 years; the most frequent SCI was complete paraplegia (52.6 percent). All patients had complications during the observation period. The most frequent complications were dyslipidemia (80.8 percent), pain (71.8 percent), spasticity (53.8 percent), uri-nary tract infection (52.6 percent), constipation (48.7 percent) and insomnia (46.2 percent). 33.3 percent of patients had pressure ulcers. The prevalence of diabetes mellitus was 10.2 percent. Abdominal ultrasound detected 24.4 percent of gallstones and 24.4 percent of fatty liver. Discussion: The incidence of late complications in our SCI cohort is very similar to that described previously, existing more frequent in chronic diseases than in the general population, due to decreased physical activity and altered lipid and carbohydrate metabolism. Conclusions: High incidence of late complications in SCI recommends develop a multidisciplinary evaluation program and screening tests to early detection of them.

Late Onset Iatrogenic Diaphragmatic Hernia after Laparoscopy-Assisted Total Gastrectomy for Gastric Cancer

Through the advent of surgical techniques and the improvement of laparoscopic tools including the ultrasonic activated scissor, laparoscopic gastrectomy has been increasingly used in far more cases of benign or malignant gastric lesions for the benefit of patients without compromising therapeutic outcomes. Even though possible complications provoked by the ultrasonic activated scissor can be prevented during the procedure with increasing advanced laparoscopic experience and supervision, unexpected late complications after the operations rarely occur. An extremely rare case of left incarcerated diaphragmatic hernia of the transverse colon developed in an 81-year-old female patient as a late complication, 8 months after laparoscopy-assisted total gastrectomy for gastric cancer, with laparoscopy successfully resumed and without the need to sacrifice any portion of the bowel.

Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation

Advances in hematopoietic cell transplantation (HCT) technology and supportive care techniques have led to improvements in long-term survival after HCT. Emerging indications for transplantation, introduction of newer graft sources (e.g. umbilical cord blood) and transplantation of older patients using less intense conditioning regimens have also contributed to an increase in the number of HCT survivors. These survivors are at risk for developing late complications secondary to pre-, periand post-transplant exposures and risk-factors. Guidelines for screening and preventive practices for HCT survivors were published in 2006. An international group of transplant experts was convened in 2011 to review contemporary literature and update the recommendations while considering the changing practice of transplantation and international applicability of these guidelines. This review provides the updated recommendations for screening and preventive practices for pediatric and adult survivors of autologous and allogeneic HCT.

Os avanços na tecnologia do transplante de células hematopoéticas (TCH) e do tratamento de suporte levaram a melhoria na sobrevida a longo prazo após os TCH. Indicações emergentes de transplante, introdução de novas fontes de células (p.ex. sangue de cordão umbilical) e transplante de pacientes mais velhos utilizando regimes de condicionamento menos intensos também contribuíram para o aumento no número de sobreviventes após TCH. Estes sobreviventes estão sob risco de desenvolver complicações tardias devido a exposições e fatores de risco pré, peri e pós-transplante. Práticas recomendadas para a triagem e a prevenção de complicações em sobreviventes de TCH foram publicadas em 2006. Um grupo internacional de especialistas foi formado em 2011 para rever a literatura contemporânea e atualizar as recomendações, considerando as mudanças nas práticas de transplante e a aplicabilidade internacional destas recomendações. Esta revisão fornece as recomendações atualizadas para o diagnóstico precoce e práticas para prevenção de complicações aos sobreviventes de TCH autólogo e alogênico, adultos e crianças.

Late Complications after Preoperative Chemoradiation for Rectal Cancers / 고신대학교의과대학학술지

OBJECTIVES: To compare the late complications after operations for rectal cancers with and without preoperative chemoradiation. METHODS: From January 2003 to December 2005, 55 patients underwent operation after preoperative chemoradiation for adenocarcinoma of the rectum. All of them received the full scheduled dose of radiation with concurrent chemotherapy. The interval between preoperative chemoradiation and surgery was 4-6 weeks. 47 patients who had tumors below 8 cm from the anal verge were enrolled into the study group (CRT group). During same period, we selected 153 patients who had adenocarcinoma of the rectum below 8cm from the anal verge, underwent surgery alone without postoperative radiotherapy non-CRT group). We compared the early and the late postoperative complications between the CRT group and the non-CRT group. RESULTS: Of the late complications, the incidence of anastomotic stricture was significantly higher in the CRT group (P = 0.018). The incidence of anal stricture was higher in the CRT group (P = 0.164). In the CRT group, 3 cases (17.6%) had failed to preserve the anal function due to moderate or severe anal stricture. Of the 3 cases, protective ileostomy was persistent in 2 cases, colostomy was performed in one case. Otherwise, the late complications of the CRT group were intestinal obstruction in 2 cases (4.3%), lymph edema in 2 cases (4.3%). CONCLUSION: In CRT group, failure of anal function preservation due to anastomotic stricture or anal stricture was more common and serious than non-CRT group. We emphasize the need for careful management for postoperative anal stricture after preoperative chemoradiation.

Analysis of Complications after Treatment of Calcaneal Fracture / 대한족부족관절학회지

PURPOSE: Problematic late sequelae are common following a calcaneal fracture regardless of the initial treatment. We retrospectively evaluated the painful conditions and reviewed the results of the operative treatment in patients with previously treated calcaneal fractures. MATERIALS AND METHODS: Between October 1996 and September 2001, forty-three patients who underwent subsequent surgical treatment for late sequelae of calcaneal fracture were reviewed. The initial treatment consisted of only immobilization in a cast in 7 patients, closed reduction with pin fixation (Essex-Lopresti technique) in 22 and open reduction and internal fixation in 14. Painful conditions in the hind foot included subtalar arthritis in 31 patients, calcaneofibular impingement in 13, peroneal tendinitis in 6, displaced posterior bony fragment in 3, sural neuritis in 2, subtalar and midtarsal arthritis in 1 and displaced plantar bony fragment in 1. The surgical procedures for the late complications were performed at a mean of 19 months (range, 6 to 35 months) after the injury and consisted of lateral wall ostectomy and in situ subtalar fusion in 28 patients, only lateral wall ostectomy in 5 patients, lateral wall ostectomy and subtalar distraction arthrodesis in 3, removal of displaced posterior bony fragment in 3, sural nerve transposition in the peroneus brevis in 2, triple arthrodesis in 1 and removal of displaced plantar bony fragment in 1. Mean postoperative follow up period was 57 months (range, 33 to 82 months). The results of treatment were evaluated on the basis of pain, improvement in the ability to perform activities of daily living, to return to work or to a pre-injury level of activity. RESULTS: Pain was partially relieved in 38 patients (88%), but not relieved in 5. Function improved in 34 patients (79%), and 32 (74%) returned to work or to a pre-injury level of activity. There was a trend that the longer the interval between the injury and the operation, the longer the subsequent interval until the patient returned to full activities or work. CONCLUSION: Meticulous physical examination and intensive prompt treatment for remaining pain after initial treatment of calcaneal fractures are recommended for patient's satisfaction and returning to work.

Late Complications after Excisional Operation for Choledochal Cyst

PURPOSE: Even after excision of choledochal cyst, late postoperative complications can develop. This study was conducted to examine the long-term outcome of cyst excision. METHODS: Of 50 choledochal cysts treated over a 10-year period (1991~2000), excluding cancer and rare types, 39 patients (type I: 21, IVa: 18) who underwent cyst excision were reviewed to evaluate the late outcome. RESULTS: Median follow-up period was 24 months after surgery. Late complications (5 intrahepatic duct stone, 4 cholangitis, 4 pancreatitis, and 1 malignancy) developed in 14 (35.9%) patients. Of the 5 patients with intrahepatic duct stone, 2 underwent choledochoscopic stone removal, one of whom additionally underwent balloon dilatation for anastomotic stricture. The remaining 3 patients were free of symptoms and didn't need further management. Of the 4 patients with cholangitis, one underwent left lateral sectionectomy for remaining intrahe patic cyst in type IVa and another patient balloon dilatation for anastomotic stricture. The remaining 2 patients developed cholangitis because of incomplete excision and ascending cholangitis, and they were conservatively managed. Of the 4 patients with pancreatitis, 2 developed pancreatitis because of pancreas divisum and probably residual distal cyst. The symptoms of all four patients with pancreatitis were mild and treated with conservative management. Periampullary cancer developed 18 months after cyst excision in one patient. CONCLUSION: To minimize hepatopancreatobiliary complications and malignancy after cyst excision, complete excision of the extrahepatic bile duct should be performed. Moreover, long-term follow-up is necessary because of these late complications.

Analysis of Complications of Lung and Heart- Lung Transplantations / 대한이식학회지

PURPOSE: The lung and heart-lung transplantation is a life-saving procedure for end stage lung disease with or without congenital heart disease. The risk of infection and rejection is higher than other solid organ transplantations, and this study is to analyze the complications and its outcome in order to improve patient management and long term survival following lung and heart-lung transplantation. METHODS: We have performed five lung transplantations and one heart-lung transplantation between July 1996 to December 2002 and we retrospectively reviewed medical records and analyzed early and late complications. RESULTS: Total of 6 patients (4 male and 2 female) with mean age of 48.2 years old (range, 34~59) underwent transplantation. Emphysematous lung disease was the most common indication (3 patients-50%), followed by one case of idiopathic pulmonary fibrosis and 2 cases of Eisemmenger's syndrome. Four early complications occurred in 3 patients: one case each of CVA, prolonged air leak, acute heart rejection, and ulcer perforation. Seven late complications occurred in 6 patients: one case each of aspergillosis infection, pulmonary tuberculosis, post-transplantation lymphoproliferative disease, CMV gastritis, pneumonia, and gastric ulcer bleding. CONCLUSION: Prompt detection of complications necessitating surgical interventions following thoracic organ transplantation is important for prolonged survival.