Management and Complications of Arnold Chiari Hydrocephalus at Tertiary Health Care Center

Objective: to investigate the role of CT and MRI in diagnosis of Arnold chiari malformation of hydrocephalus and its treatment with VP shunt along with complications. Study Design: Prospective study Place and duration: Department of Neurosurgery, DG Khan Medical College from May 4, 2018 to May 4, 2019. Methodology: Fifty patients of congenital hydrocephalus who were not treated previously were selected. Detailed history about disease and clinical examination of patients was performed. Follow ups were done at neurosurgery OPD. SPSS software for data analysis was used and mean ± SD, frequency and percentages were calculated for variables. P value ≤0.05 was considered as significant. Results: Treatment in case of congenital hydrocephalus as VP shunt, intra-aneurysmal coiling, excision of meningomyelocele with VP shunt and suboccipital craniectomy + upper cervical laminectomy (scucl) were observed as 10%, 6%, 8% and 8% respectively.  Twelve percent of patients were not treated. Conclusion: CT and MRI are the main diagnostic tools for diagnosis of Arnold chiari malformation and VP shunt is the treatment of choice. Among complications of VP shunt infection of shunt and shunt block are the main complications

Sling Complications

https://digitalscholarship.unlv.edu/wrin_briefs/1003/thumbnail.jp

Complications

Background: Complications is a short story published in literary magazine dotdotdash and explores the expression of identity. Arguably no genre of creative production can investigate identity like fiction can, with its privileged access to interiority and psychology that is akin to thought. Fiction that directly engages with mistaken identity offers a way to deepen this investigation. \u27Complications\u27 plays with the several meanings of the word to investigate unstable identity in the modern subject: a medical complication leads to an untimely death; complicated family dealings put a young person in an untenable situation. Contribution: First person point of view is used with innovative effect in \u27Complications\u27, where a complex narrative structure blurs the neat distinction between two protagonists. The work was included in an edition of the literary journal themed around the idea of the sacred. Despite the provocations of postmodernism we regard the continuity and stability of our personal identities among our most sacred notions. But modern life increasingly troubles this assumption; the work’s original approach to narrative structure illustrates how people may be forced to assimilate ruptures that threaten to overwhelm them. Significance: In his preface to the edition the editor selects \u27Complications\u27 for comment and writes that it \u27details how the past comes to life, additionally exploring how sacredness imbues our own identity, how our self-identity shifts and changes in our conversation with the world, and how our names and bodies, although serendipitous markers of ourselves, are sometimes set aside from our conscious self\u27 (Sj Finch, dotdotdash 07 (Winter 2011), p.8). dotdotdash is nationally distributed and at the time of publication had a circulation of 500, with 5% of short fiction submissions published. It receives grant funding from DCA and Australia Council of the Arts via Express Media

Complications of frontal defects

A case where the severe course of an orbital phlegmon led to a functionally and cosmetically poor condition is presented. Thirty-five years later, it was possible to achieve a satisfactory result through several operations performed with interdisciplinary cooperation. The orbit and forehead were reconstructed with porous polyethylene, thus ensuring a cosmetically good result. In two operations, the left eye was freed from its upward fixation through cicatrectomy and mobilization of the mucles, so that the eyes were straight again in the primary position. There is a limited binocular visual field. Binocular vision could be restored again after an interruption of 35 years

In-depth critical analysis of complications following robot-assisted radical cystectomy with intracorporeal urinary diversion

Background: Robot-assisted radical cystectomy with intracorporeal urinary diversion (iRARC) is an attractive option to open cystectomy, but the benefit in terms of improved outcomes is not established. Objective: To evaluate the early postoperative morbidity and mortality of patients undergoing iRARC and conduct a critical analysis of complications using standardised reporting criteria as stratified according to urinary diversion. Design, setting, and participants: A total of 134 patients underwent iRARC for bladder cancer at a single centre between June 2011 and July 2015. Intervention: Radical cystectomy with iRARC. Outcome measurements and statistical analysis: Patient demographics, pathologic data, and 90-d perioperative mortality and complications were recorded. Complications were reported according to the Clavien-Dindo (CD) classification and stratified according to urinary diversion type and either surgical or medical complications. The chi-square test and t test were used for categorical and continuous variables respectively. Multivariable logistic regression was performed on variables with significance in univariate analysis. Results and limitations: The 90-d all complication rate following ileal conduit and continent diversion was 68% and 82.4%, and major complications were 21.0% and 20.6% respectively. The 90-d mortality was 3% and 2.9% for ileal conduit and continent diversion patients, respectively. On multivariate analysis, the blood transfusion requirement was independently associated with major complications (p = 0.002) and all 30-d (p = 0.002) and 90-d (p = 0.012) major complications. Male patients were associated with 90-d major complications (p = 0.015). Critical analysis identified that surgical complications were responsible for 39.4% of all 90-d major complications. The incidence of surgical complications did not decline with increasing number of iRARC cases performed (p = 0.742, r = 0.31). Limitations of this study include its retrospective nature, limited sample size, and limited multivariate analysis due to the low number of major complications events. Conclusions: Although complications following iRARC are common, most are low grade. A critical analysis identified surgical complications as a cause of major complications. Addressing this issue could have a significant impact on lowering the morbidity associated with iRARC. Patient summary: We looked at the surgical outcomes in bladder cancer patients treated with minimally invasive robotic surgery. We found that surgical complications account for most major complications and previous surgical experience may be a confounding factor when interpreting results from a different centre even in a randomised trial setting