ABSTRACT
BACKGROUND: Wound complications after lower extremity arterial reconstruction can range from a minor lymphatic leak that causes minimal disability to a severe infection that jeopardizes the limb and life of the affected patient. This study was designed to define more clearly the incidence, severity, and the cost of these complications. METHODS: During a 1-year period the infrainguinal incisions of all patients undergoing lower limb arterial reconstruction were evaluated prospectively. One hundred fifty-six infrainguinal incisions were monitored serially for the presence of infection, hematoma, seroma, serous leak, necrosis, or wound dehiscence. The need for additional treatment or services related to these complications and the cost of these services were determined. RESULTS: Complications occurred in 10% of 77 infrainguinal incisions that were isolated to the groin (groin incisions) e.g., after aortobifemoral bypass, femoral endarterectomy). In only one of these patients was significant cost related to treatment of a complication. Complications occurred in 44% of 79 incisions used for femoral popliteal/tibial and pedal bypasses (distal incisions). In this latter group independent predictors of any complication were age (p=0.02) and obesity (p=0.05); predictors of in-hospital infection were preoperative evidence of venous stasis (p=0.01) and preoperative infection in the same extremity (p=0.08). Fifteen distal wound complications provided additional expense related to reoperation, extended hospitalization or rehospitalization, and rehabilitation or visiting nurse services, with a mean cost per patient undergoing reconstruction of $688. CONCLUSIONS: After lower limb arterial reconstruction, infrainguinal wound complications in isolated groin incisions produce minimal morbidity and cost, whereas complications in incisions after distal bypass are both frequent and associated with significant additional expense.
Subject(s)
Arteries/surgery , Groin/surgery , Leg/surgery , Postoperative Complications/etiology , Surgical Wound Infection/etiology , Female , Health Care Costs , Humans , Incidence , Leg/blood supply , Male , Postoperative Complications/economics , Prospective Studies , Risk Factors , Surgical Wound Infection/economics , Surgical Wound Infection/epidemiologyABSTRACT
Twenty female juvenile delinquents who acknowledged engaging in prostitution, 20 juvenile delinquents who denied doing so, and 20 same-age control subjects responded to Colby and Kohlberg's (1987) Moral Judgment Interview (MJI), a moral dilemma about prostitution, and Joffe and Naditch's (1977) test of coping and defending. Delinquents scored lower on moral maturity and coping and higher on defensiveness than nondelinquents. Post hoc analyses revealed that low-coping delinquents (but not high-coping delinquents or control subjects) made significantly lower level moral judgments on the prostitution dilemma than on the less personally relevant MJI dilemmas. Groups did not differ in their prescriptive judgments on the MJI, but prostitutes made weaker judgments against prostitution than the other delinquents. Prescriptive judgments were not related to moral maturity. The results elucidate the relation between moral judgment and moral behavior.
Subject(s)
Adaptation, Psychological , Defense Mechanisms , Judgment , Juvenile Delinquency/psychology , Morals , Sex Work/psychology , Adolescent , Female , Humans , Interview, Psychological , Personality Development , SocializationABSTRACT
Fifty-one patients were analyzed after a randomized double-blind study comparing Hexabrix and Renografin 60 in peripheral arteriography. The arteriographic studies and the volumes of contrast material used in both groups were similar. Hexabrix caused significantly less pain and discomfort than Renografin 60, and the diagnostic quality of the radiographs was comparable. A slightly higher incidence of minor side effects was noted in the Hexabrix group, mostly nausea and vomiting and urinary retention.
Subject(s)
Angiography , Contrast Media , Diatrizoate Meglumine , Diatrizoate/analogs & derivatives , Iodobenzoates , Triiodobenzoic Acids , Angiography/adverse effects , Clinical Trials as Topic , Contrast Media/adverse effects , Diatrizoate/adverse effects , Diatrizoate Meglumine/adverse effects , Double-Blind Method , Drug Combinations/adverse effects , Female , Humans , Ioxaglic Acid , Male , Pain/etiology , Triiodobenzoic Acids/adverse effectsABSTRACT
Fifty-one patients were analyzed after a randomized double-blind study comparing Hexabrix and Renografin 60 in peripheral arteriography. The arteriographic studies and the volumes of contrast material used in both groups were similar. Hexabrix caused significantly less pain and discomfort than Renografin 60, and the diagnostic quality of the radiographs was comparable. A slightly higher incidence of minor side effects was noted in the Hexabrix group, mostly nausea and vomiting and urinary retention.
