A systematic review of long-term complications of mechanical tubal occlusion.

OBJECTIVES: To collate the available evidence of the rare but identified late complications of mechanical tubal occlusion. The primary objective is to describe the nature of these longer-term acute presentations. Secondary objectives are: 1) to delineate their aetiology, 2) characterise imaging findings and 3) identify successful management options. STUDY DESIGN: Literature search using National Institute of Clinical Excellence Healthcare Databases Advanced Search and terms (complicat* OR torsion OR infect* OR migrat* OR extru*) AND (tubal occlusion OR sterili*). Results reviewed by CM and JH for eligibility. RESULTS: 33 published case reports of long-term complications of mechanical tubal occlusion. 30 demonstrated migration of the device. 16 had infective pathology. Multiple modalities of imaging used with no clear evidence that one was superior. Medical and surgical management was used with removal of device proving definitive treatment. CONCLUSIONS: Long-term complications of mechanical tubal occlusion are rare and show a varied clinical course. Clinicians should be mindful of this when evaluating patients in the acute setting, as there is no identified timeline as to when complications may occur. Imaging is almost always essential for diagnosis and the modality should be directed by the clinical presentation. Definitive management is by removal of the occlusive device, but this carries its own risks.

Peri-operative Variables Associated With Prolonged Intensive Care Stay Following Cytoreductive Surgery for Ovarian Cancer.

BACKGROUND: Peri-operative variables associated with prolonged Intensive Care Unit (ICU) admission following cytoreductive surgery for ovarian cancer were investigated. PATIENTS AND METHODS: A retrospective review was carried out of patients admitted to the ICU following cytoreductive surgery for ovarian cancer in a single tertiary referral centre from 2015-2019. Patients were categorized according to length of ICU stay (<48 h and ≥48 h), and peri-operative variables were compared across the two groups. RESULTS: A total of 56 patients were admitted to the ICU post-operatively, 37 for <48 h and 19 for ≥48 h (range=3-11 days). Greater duration of procedure and estimated blood loss, bowel resection, higher post-operative lactate level, lower post-operative albumin level and requirement for post-operative blood products were associated with prolonged ICU stay. Increased intraoperative fluid requirement was an independent predictor of extended ICU stay. CONCLUSION: Utilizing identified intra-operative risk factors to perform individualized risk assessments might improve planning of ICU resources. Optimizing intraoperative fluid management may improve short-term patient outcomes.

Trends in mortality from ischemic heart disease in Canada, 1986-2000.

This study examined trends in ischemic heart disease (IHD) mortality rates in Canada from 1986 to 2000, including analyses at the county level. The study population comprised Canadians aged 35 and over. Age-standardized mortality rates (ASMRs) were computed. Linear regression and Poisson regression were used to calculate average annual percentage change (AAPC) by age, sex, county and province. A substantial decrease in mortality rates was observed in those aged 35 and over for both sexes; the AAPC indicated a decline of 3.44 percent for males and 3.42 percent for females. The ASMRs were plotted for three time periods; the rates increased with each successive age group and decreased with each consecutive time period for both sexes. A significant decline in the IHD mortality rate was found in 47.2 percent and 46.9 percent of the counties among males and females, respectively; those counties had a statistically significant lower prevalence of daily smoking in both genders, and obese in females only. Only two counties showed a significant increase in the ASMRs of IHD in males and females, respectively. Enhanced prevention and control strategies should be considered to address IHD in countries where more modest decreases (or no decrease at all) in IHD mortality have been observed.