Prevalence and predictors of complications following facial reconstruction procedures.

Facial reconstruction procedures are immensely challenging and are done for a multitude of reasons. The purpose of this report is to provide nationally representative estimates of different types of facial reconstructive procedures and to examine prevalence and predictors of a wide range of complications associated with these procedures in the USA. The Nationwide Inpatient Sample, the largest inpatient dataset for the USA, was used. Data for the years 2004-2010 related to facial reconstruction procedures were identified through ICD-9-CM procedure codes. Associated complications were identified using secondary diagnosis field codes. Multivariable logistic regression models were used to examine the association between patient/hospital-level factors and the occurrence of complications. A total 26,374 facial reconstruction procedures were performed. About 20% of all patients who had facial reconstruction procedures developed a complication. Frequently occurring complications included postoperative pneumonia (4.9% of hospitalizations), hemorrhage (3.9%), other infections (3.6%), non-healing wounds (3.5%), and iatrogenically induced complications (3.2%). Significant factors found to be consistently associated with different types of complications included age, co-morbid burden, sex, and type of admission. The reported results are generalizable within limitations and can be used by health care providers to tailor quality improvement initiatives to minimize or better treat complications in the high-risk cohorts.

Outcomes of stem cell transplant patients with acute respiratory failure requiring mechanical ventilation in the United States.

SCT indications and procedures are increasing worldwide. We sought to estimate the prevalence of acute respiratory failure (ARF) of any cause in hospitalized SCT patients, and assess the impact of invasive mechanical ventilation (IMV) on outcomes. We hypothesize that duration of IMV in such patients is an independent predictor of higher mortality. We performed a retrospective analysis of the largest all-payer hospitalization data set in the United States, Nationwide In-patient Sample for years 2004-2010. Of the 101 462 SCT hospitalizations, 6074 (6%) developed ARF and were the final cohort. Type of SCT with ARF included autologous 1987 (32.7%), allogeneic 3467 (57.1%) and cord blood 655 (10.8%). Duration of IMV included <96 h (17.1%) and ⩾96 h (41.1%). Overall in-hospital mortality (IHM) was 50.6% (3075). Predictors of IHM were IMV <96 h (odds ratio=3.42 (2.44-4.79), P<0.0001) or IMV ⩾96 h (OR=4.61 (3.17-6.70), P<0.0001). Type of SCT, comorbid burden, gender, hospital-teaching status/bed size or insurance did not influence IHM. IMV ⩾96 h was associated with higher hospital charges (mean $762 515, 95% estimate 0.3991 (0.3123-0.4859), increase of $304 474, P<0.0001) and higher length of stay (mean 61.5 days, 95% estimate 0.2198 (0.1531-0.2866), increase of 13 days, P<0.0001). In conclusion, ARF in hospitalized SCT patients is not an uncommon occurrence and is associated with 50% mortality. Duration of IMV (⩾96 h) was an independent predictor of higher mortality rates. Hospital resource utilization was significant.

[Neuropsychiatric manifestations and quinolones. Apropos of a case]. / Manifestations neuropsychiatriques et quinolones. A propos d'un cas.

The authors specified, briefly, the different subgroups and prevalence of the molecules from the quinolone family: Nalidixic acid (synthesised in 1958), the quinolones of second generation (oxilinic acid, piromidique, pipemidique and flumequine) and the quinolones of third generation (ciprofloxacine, norfloxacine, ofloxacine, perfloxacine). After having mentioned the extent and the importance of using these antibiotics in infections, they stressed the fact that the quinolones are antibiotics which are largely prescribed in clinics and hospitals. The authors reported afterwards the observation of a young female, without any precedent neuropsychiatric disorders having shown a complex clinical state with neurological and psychiatric disturbances during the first day of treatment for a urinary infection with 4 tablets of flumequine 400 mg per day (instead of 3 recommended). Mrs. A. 25 years of age was seen to during the night at The "Consultation Psychiatrique d'Orientation et d'Accueil" (C.P.O.A.). of Sainte-Anne hospital by the resident psychiatric of a General Hospital "after behavioural disturbances". In fact, about 3 hours before and 15 minutes after the third dose of flumequine (2 tablets of 400 mg), this makes the total dose taken over 12 hours is equal to 400 x 4 = 1,600 mg, the patient developed an intense discomfort with blurred vision accompanied by nausea, followed by a state of restlessness and incomprehensible speech. A testimony by relatives revealed that she suffered, shortly afterwards, a generalised fit which affected her 4 limbs with a fixation of her eyes and hypersalivation and convulsions without either swallowing the tongue or involuntary urination.(ABSTRACT TRUNCATED AT 250 WORDS)