Contraindications Research Articles

Local Treatment of Colorectal Liver Metastases in the Presence of Extrahepatic Disease: Survival Outcomes from the Amsterdam Colorectal Liver Met Registry (AmCORE).

The simultaneous presence of colorectal liver metastases (CRLMs) and extrahepatic metastases in patients with colorectal cancer (CRC) can be considered a relative contraindication for local treatment with curative intent. This study aims to assess the survival outcomes of patients with CRLMs and extrahepatic metastases after comprehensive local treatment of all metastatic sites. Patients with CRLMs who received local treatment of all metastatic sites were extracted from the prospective AmCORE registry database and subdivided into two groups: CRLM only vs. CRLM and extrahepatic metastasis. To address potential confounders, multivariate analysis was performed. The primary endpoint was overall survival (OS). In total, 881 patients with CRLM only and 60 with CRLM and extrahepatic disease were included, and the median OS was 55.7 months vs. 42.7 months, respectively. Though OS was significantly lower in patients with concomitant extrahepatic metastases (HR 1.477; 95% CI 1.029-2.121; p = 0.033), the survival curve plateaued after 6.2 years. Extrahepatic manifestations were pulmonary (43.3%), peritoneal (16.7%) and non-regional lymph node metastases (10.0%). In patients with pulmonary and non-regional lymph node metastases, OS did not significantly differ from patients with CRLM-only disease; concomitant peritoneal metastases showed an inferior OS (HR 1.976; 95% CI 1.017-3.841, p = 0.041). In this comparative series, OS was inferior for patients with multi-organ metastatic CRC versus patients with CRLMs alone. Nonetheless, the long-term survival curve plateau seemed to justify local treatment in a subset of patients with multi-organ metastatic CRC, especially for patients with CRLMs and pulmonary or lymph node metastases.

Cardiopulmonary Exercise Testing in Evaluating Transthyretin Amyloidosis.

Cardiopulmonary exercise testing (CPET) has an established role in the assessment of patients with heart failure. However, data are lacking in patients with transthyretin (ATTR) amyloidosis. To use CPET to characterize the spectrum of functional phenotypes in patients with ATTR amyloidosis and assess their association with the cardiac amyloid burden as well as the association between CPET parameters and prognosis. This single-center study evaluated patients diagnosed with ATTR amyloidosis from May 2019 to September 2022 who underwent CPET at the National Amyloidosis Centre. Of 1045 patients approached, 506 were included and completed the study. Patients were excluded if they had an absolute contraindication to CPET or declined participation. The mean (SD) follow-up period was 22.4 (11.6) months. Comparison of CPET parameters across disease phenotypes (ATTR with cardiomyopathy [ATTR-CM], polyneuropathy, or both [ATTR-mixed]), differences in CPET parameters based on degree of amyloid infiltration (as measured by cardiovascular magnetic resonance [CMR] with extracellular volume mapping), and association between CPET parameters and prognosis. Among the 506 patients with ATTR amyloidosis included in this study, the mean (SD) age was 73.5 (10.2) years, and 457 participants (90.3%) were male. Impairment in functional capacity was highly prevalent. Functional impairment in ATTR-CM and ATTR-mixed phenotypes (peak mean [SD] oxygen consumption [VO2], 14.5 [4.3] mL/kg/min and 15.7 [6.2] mL/kg/min, respectively) was observed alongside impairment in the oxygen pulse, with ventilatory efficiency highest in ATTR-CM (mean [SD] ventilatory efficiency/volume of carbon dioxide expired slope, 38.1 [8.6]). Chronotropic incompetence and exercise oscillatory ventilation (EOV) were highly prevalent across all phenotypes, with both the prevalence and severity being higher than in heart failure from different etiologies. Worsening of amyloid burden on CMR was associated with decline in multiple CPET parameters, although chronotropic response and EOV remained abnormal irrespective of amyloid burden. On multivariable Cox regression analysis, peak VO2 and peak systolic blood pressure (SBP) were independently associated with prognosis (peak VO2: hazard ratio, 0.89 [95% CI, 0.81-0.99; P = .03]; peak SBP: hazard ratio, 0.98 [95% CI, 0.97-0.99; P < .001]). In this study, ATTR amyloidosis was characterized by distinct patterns of functional impairment between all disease phenotypes. A high prevalence of chronotropic incompetence, EOV, and ventilatory inefficiency were characteristic of this population. CPET parameters were associated with amyloid burden by CMR and with peak VO2, and SBP, which have been shown to be independent predictors of mortality. These findings suggest that CPET may be useful in characterizing distinct patterns of functional impairment across the spectrum of amyloid infiltration and predicting outcomes, and potentially offers a more comprehensive method of evaluating functional capacity for future prospective studies.

The Management of a Geriatric Patient Using Dabigatran Therapy on Dentigerous Cyst with Oral Bleeding.

Jaw cysts represent a great matter of interest in oral and maxillofacial surgery. Jaw cyst surgery is a common intervention in oral surgery but, in the case of a multidisciplinary patient, the oral surgeon needs to meet with other specialists. A cyst is an epithelium-lined sac containing fluid and/or semisolid material due to epithelial cell proliferation, degeneration, and liquefaction; the hypertonic solution withdraws liquids from the surrounding tissues, while internal pressure exerts an equal strength on the cyst walls. Dentigerous cysts are the second most common odontogenic cysts after radicular cysts, and commonly few or no symptoms are reported. However, the most common diagnosis for dentigerous cyst is represented by eruption of the affected tooth or accidental diagnosis. Commonly, dentigerous cysts may be related to impacted third molars; in the case of impacted third molars and a dentigerous cyst, the tooth should be removed along with the cyst in the same intervention. Mandibular dentigerous cysts are common in children and adults, while dentigerous cysts are a rare neoformation in elderly patients. Treatment usually involves removal of the entire cyst and the associated unerupted tooth. This intervention may be more difficult if the cyst is large, the third molar is in contact with the mandibular nerve, and/or the patient has a medical history that may represent a relative or absolute contraindication. We present the case of a rare symptomatic manifestation of dentigerous cyst in an elderly patient in treatment with dabigatran therapy; for the treatment of dentigerous cysts in the elderly, we suggest a multidisciplinary approach with the use of the histological examination and a careful follow-up.

State of the Art: Pouch Surgery in the 21st Century.

An ileoanal pouch with IPAA is the preferred method to restore intestinal continuity in patients who require a total proctocolectomy. Pouch surgery has evolved during the past decades thanks to increased experience and research, changes in the medical management of patients who require an ileal pouch, and technological innovations. To review the main changes in pouch surgery over the past 2 decades, with a focus on staging, minimally invasive and transanal approaches, pouch design, and anastomotic configuration. The decision on the staging approach depends on the patient's conditions, their indication for surgery, and the risk of anastomotic leak. A minimally invasive approach should be performed whenever feasible, but open surgery still has a role in this technically demanding operation. Transanal IPAA may be performed in experienced centers and may reduce conversion to open surgery in the hostile pelvis. The J-pouch is the easiest, fastest, and most commonly performed design, but other designs may be used when a J-pouch is not feasible. A stapled anastomosis without mucosectomy can be safely performed in the majority of cases, with a low incidence of rectal cuff neoplasia and better functional outcomes than handsewn. Finally, Crohn's disease is not an absolute contraindication to an ileoanal pouch, but pouch failure may be higher compared to other indications. Many technical nuances contribute to the success of an ileoanal pouch. The current standard of care is a laparoscopic J-pouch with double-stapled anastomosis, but this should not be seen as a dogma, and the optimal approach and design should be tailored to each patient. See video from symposium.

Perinatal outcomes following abdominoplasty: a retrospective study and review of current literature

BackgroundAbdominoplasty surgery is a common body contouring surgery to remove excess fat and skin and restore weakened or separated abdominal muscles caused by aging, pregnancy, or weight fluctuations. There is scant literature regarding patient and pregnancy outcomes following abdominoplasty. We sought to determine if there was a correlation between adverse pregnancy outcomes and a history of abdominoplasty. MethodsWe used a large federated de-identified national health research network with data sourced from 68 health care organizations within the United States (TriNetX, data accessed August 19, 2022). All patients with a record of pregnancy were identified using ICD-10/9 codes and were grouped into those with a history of abdominoplasty and those without. We evaluated the perinatal outcomes of fetal growth restriction, abnormal umbilical artery dopplers, gestational hypertension, pre-eclampsia, preterm delivery, preterm prelabor rupture of membranes, gestational diabetes, macrosomia, stillbirth, abnormal placentation, and wound disruption/infection occurring during a patient's pregnancy following abdominoplasty. Propensity matching was performed to account for potential confounders. An alpha level of < 0.05 was considered statistically significant. ResultsOf the 44,737 patients meeting our criteria, 304 had a history of abdominoplasty while 44,433 did not (Control). We found that patients with a history of abdominoplasty had significantly higher gravidity, were largely located in the Southern and Midwest region, and had higher counts of vaginal deliveries and cesarean sections, when compared to the Control cohort (Table 1). After propensity score matching, we found lower risk of pre-eclampsia and PPROM in patients with abdominoplasty (OR [95%CI] = 0.46 [0.32, 0.67], p < 0.0001, Table 2). Furthermore, abdominoplasty was associated with increased risk of preterm delivery (OR [95%CI] = 2.15 [1.48, 3.13], p = 0.0002, Table 2). We did not find significant differences in the other perinatal outcomes (Table 2). DiscussionOur data suggest that abdominoplasty may be associated with a relative increase in rates of preterm delivery and cesarean delivery, but other perinatal outcomes are not increased. This provides evidence that future desire for pregnancy need not be a relative contraindication to abdominoplasty.

The Effect of Age on Pancreaticoduodenectomy; Comorbidities, Short-term Outcomes, and Survival.

To evaluate the complications, mortality, and survival rates of patients aged >70 years undergoing pancreaticoduodenectomy, and to determine associated risk factors. Descriptive study. Place and Duration of the Study: General Surgery Clinic of Eskişehir Osmangazi University Medical Faculty Hospital, Eskişehir, Turkiye, from January 2014 to September 2020. A retrospective scrutiny of 94 patients who had undergone pancreaticodueodenectomy, was carried out. The patients were separated into two age groups of younger and older than 70 years, and were compared in respect of clinicopathological characteristics, comorbidities, perioperative characteristics, and complications. Independent risk factors for the endpoints of perioperative mortality and survival were investigated. No significant difference was determined between the groups in respect of biochemical values, and perioperative and histochemical characteristics. Comorbidities were present at a higher rate in the older patients (77.8% vs. 38.8%, p<0.001). The postoperative complication rates were similar (33.3% vs. 32.7%, p=0.944). Perioperative mortality (first 30 days) was determined at a significantly higher rate in the older age group (20.0% vs. 4.1%, p=0.016). The age of patients >70 years increased the risk of mortality 4.851-fold but was not an independent predictive factor (p=0.086). The groups were similar in respect of disease-free survival (DFS) and overall survival (OS, Log-rank p=0.780, p=0.386). Age [Hazard Ratio (HR): 1.029, p=0.048] and pancreas adenocarcinoma (HR: 1.846, p=0.028) were determined to be independent prognostic factors for DFS, and pancreas adenocarcinoma (HR 1.940, p=0.023) for OS. Older age was not seen to change survival in patients undergoing pancreaticoduodenectomy, but mortality within the first 30 days was affected. Age is not accepted as an absolute contraindication. It is recommended that pancreaticoduodenectomy is performed on patients aged >70 years with careful patient selection, prudent preoperative preparation, a meticulous surgical technique, and close multidisciplinary postoperative support. Pancreaticoduodenectomy, Elderly, Comorbidity, Complication, Mortality, Survival.

Analysis of tranexamic acid usage in adult spinal deformity patients with relative contraindications: does it increase the risk of complications?

Complex spinal deformity surgeries may involve significant blood loss. The use of antifibrinolytic agents such as tranexamic acid (TXA) has been proven to reduce perioperative blood loss. However, for patients with a history of thromboembolic events, there is concern of increased risk when TXA is used during these surgeries. This study aimed to assess whether TXA use in patients undergoing complex spinal deformity correction surgeries increases the risk of thromboembolic complications based on preexisting thromboembolic risk factors. Data were analyzed for adult patients who received TXA during surgical correction for spinal deformity at 21 North American centers between August 2018 and October 2022. Patients with preexisting thromboembolic events and other risk factors (history of deep venous thrombosis [DVT], pulmonary embolism [PE], myocardial infarction [MI], stroke, peripheral vascular disease, or cancer) were identified. Thromboembolic complication rates were assessed during the postoperative 90 days. Univariate and multivariate analyses were performed to assess thromboembolic outcomes in high-risk and low-risk patients who received intravenous TXA. Among 411 consecutive patients who underwent complex spinal deformity surgery and received TXA intraoperatively, 130 (31.6%) were considered high-risk patients. There was no significant difference in thromboembolic complications between patients with and those without preexisting thromboembolic risk factors in univariate analysis (high-risk group vs low-risk group: 8.5% vs 2.8%, p = 0.45). Specifically, there were no significant differences between groups regarding the 90-day postoperative rates of DVT (high-risk group vs low-risk group: 1.5% vs 1.4%, p = 0.98), PE (2.3% vs 1.8%, p = 0.71), acute MI (1.5% vs 0%, p = 0.19), or stroke (0.8% vs 1.1%, p > 0.99). On multivariate analysis, high-risk status was not a significant independent predictor for any of the thromboembolic complications. Administration of intravenous TXA during the correction procedure did not change rates of thromboembolic events, acute MI, or stroke in this cohort of adult spinal deformity surgery patients.

Safety of high-dose rate (HDR) brachytherapy for patients with prostate cancer and history of prior chemoradiation for rectal cancer: A case series

PurposeA history of prior pelvic radiation therapy (RT) for rectal cancer is a relative contraindication for definitive RT for prostate cancer. High-dose-rate (HDR) brachytherapy can significantly limit the dose to surrounding tissues compared to external beam RT. However, there is limited data surrounding its safety in patients with prior pelvic RT. Methods and MaterialsA retrospective chart review was performed at the University of California, San Francisco to identify patients diagnosed with prostate cancer with a history of pelvic RT for rectal cancer who were treated with high-dose-rate brachytherapy (HDR-BT) between 2006 and 2022. Inclusion criteria were biopsy-confirmed prostate cancer with no evidence of distant disease on clinical examination or imaging, and at least one post-treatment clinic appointment. ResultsSeven patients were treated with salvage HDR-BT at a median interval of 17.7 years after RT for rectal cancer. HDR-BT doses included 3600 cGy in six fractions (n = 5), 2700 cGy in 2 fractions (n=1), or 2800 cGy in four fractions (n = 1). There was no acute grade ≥2 gastrointestinal toxicity, and 1 patient developed late grade 2 rectal bleeding. Two patients developed acute grade 2 genitourinary toxicity consisting of urinary frequency and urgency, which persisted through long-term follow up. At a median follow up of 29.5 months after HDR brachytherapy, one patient developed regional and distant failure, and another had seminal vesicle recurrence. ConclusionsHDR-BT is a safe treatment for patients with prostate cancer who previously received RT for rectal cancer. Further studies are needed to better characterize the long-term toxicity of HDR-RT in this population.

Evolution of Liver Transplantation Indications: Expanding Horizons.

Liver transplantation (LT) has significantly transformed the prognosis of patients with end-stage liver disease and hepatocellular carcinoma (HCC). The traditional epidemiology of liver diseases has undergone a remarkable shift in indications for LT, marked by a decline in viral hepatitis and an increase in metabolic dysfunction-associated steatotic liver disease (MASLD), along with expanded indications for HCC. Recent advancements in surgical techniques, organ preservation and post-transplant patients' management have opened new possibilities for LT. Conditions that were historically considered absolute contraindications have emerged as potential new indications, demonstrating promising results in terms of patient survival. While these expanding indications provide newfound hope, the ethical dilemma of organ scarcity persists. Addressing this requires careful consideration and international collaboration to ensure equitable access to LT. Multidisciplinary approaches and ongoing research efforts are crucial to navigate the evolving landscape of LT. This review aims to offer a current overview of the primary emerging indications for LT, focusing on acute-on-chronic liver failure (ACLF), acute alcoholic hepatitis (AH), intrahepatic and perihilar cholangiocarcinoma (i- and p-CCA), colorectal liver metastasis (CRLM), and neuroendocrine tumor (NET) liver metastases.

Trials of endovascular thrombectomy of basilar-artery occlusion compared to real-life data

BackgroundTwo recent clinical trials showed mechanical thrombectomy (MT) of basilar-artery occlusions (BAO) in stroke to be safe and effective: Endovascular Treatment for Acute BAO (ATTENTION) and BAO Chinese Endovascular (BAOCHE). The trials restricted patient inclusion on both age and pre-stroke mRS, and with both trials conducted in China, population differences may affect generalisability of the trial results. MethodsConsecutive patients with BAO undergoing MT were registered from 2017 to 2021 with retrospective data collection at a single centre with a predominantly Caucasian catchment population of 2.7 million. Age and pre-stroke modified Rankin Scale (mRS) were not absolute contraindications for MT. We present functional outcome as mRS at 90 days, patient characteristics and procedural safety compared to the trial intervention groups. ResultsOf the 108 included patients, 50 % achieved mRS 0–3 at 90 days and mortality was 32 %, which was no different from ATTENTION (46 %, p = 0.40, 37 %, p = 0.31, respectively) and BAOCHE (46 %, p = 0.50, 31 %, p = 0.93). Pre-stroke mRS 0 was seen in 62 %, 89 %, and 77 % of the study patients, ATTENTION, and BAOCHE, respectively. Proximal segment BAO was less common (22 % vs. 31 %, p = 0.04, and 65 %, p < 0.01) and intracranial stenting less frequently used (9 % vs. 40 % and 55 %, p < 0.01) in study patients compared to ATTENTION and BAOCHE, respectively. ConclusionOutcome of MT in BAO stroke in a clinical patient cohort was similar to recent trials, despite broader patient inclusion and differences in both occluded BAO segment and use of stenting. Our study suggest that MT is safe and effective in a Caucasian population.

Use of the Drospirenone-Only Contraceptive Pill in Adolescents with Endometriosis

Study ObjectiveTo evaluate the efficacy and tolerability of a progestin-only pill containing 4 mg drospirenone (DRSP) as a hormonal therapy for the management of endometriosis-associated symptoms in adolescents and young adults. DesignRetrospective cohort study. MethodsA retrospective chart review was performed of all adolescents who were prescribed DRSP continuously (without placebo) for treatment of endometriosis at a single pediatric tertiary care center between 2019 and 2022. Electronic medical records were reviewed to obtain demographics and clinical characteristics of the patients. Measured outcomes included symptom resolution and medication discontinuation. The study was deemed IRB exempt. ResultsA total of 61 patients with endometriosis were prescribed DRSP during the study period, with a median age of 18.9 years (SD 2.3). The majority (97%) were laparoscopically confirmed to have endometriosis, and 85% had stage I disease. Before DRSP use, the most common medications trialed were norethindrone (57%) and norethindrone acetate (68%), and 56% had at least one medical contraindication to receiving estrogen-containing therapy. Of those with follow-up, 52% established an absence of bleeding/spotting, and 67% reported less pain at follow-up. One in 4 patients discontinued DRSP during the study period, most commonly due to breakthrough bleeding. ConclusionDRSP is a well-tolerated and effective option for the treatment of endometriosis-associated symptoms in adolescents and young adults.

Selection of surgery type for patients with inguinal hernias

The purpose of the study: to investigate the quality of life of patients with inguinal hernias after Lichtenstein’s surgery using the implants with a tissue-gripping system and conduct a comparative assessment of this technique and the results of classical laparoscopic surgery. The prospective controlled clinical study included the results of follow-up of 99 patients with inguinal hernias. The first group included the patients who underwent LHR surgery of the inguinal canal using a composite self-fixing polypropylene mesh. In the patients of the second group, LHR was performed using a composite polypropylene mesh, which was fixed with polypropylene suture material. The third group consisted of the patients operated on using the technique of laparoscopic transabdominal preperitoneal surgery. Indicators of physical and psychological health components were studied in the patients using the SF-36 questionnaire in the preoperative period and 3, 6, and 12 months after surgery. Results: The patients with inguinal hernias in the long-term postoperative period had different periods of restoration of quality of life, which were determined by the type of surgical intervention and the type of fixation of the synthetic implant. Three months after surgery, significant signs of normalization of indicators of the physical health component were recorded only in groups of the patients after LHR using self-fixing implants and TAPP. In the patients with suture fixation of implants during LHR, the first signs of restoration of the physical component of health, comparable to self-fixing meshes, were observed 6 months after surgery. Changes in indicators of the psychological health component in the patients of the LHR and TAPP groups did not differ at all study intervals. Conclusion: The use of implants with a tissue-gripping system when performing LHR leads to optimization and reduction of physical rehabilitation in patients with inguinal hernias, which makes it possible to recommend the use of self-fixing meshes for open repair in cases of relative and absolute contraindications to TAPP.

What do we know about eligible organ donors? Analysis of data from a local Registry.

The imbalance between supply and demand for organ donations remains a hot topic for international debate. Brain-dead organ donors (DBDs) constitute the majority of organ donations in Poland. To identify the factors that guided intensivists in qualifying a brain-dead patient as a potential organ donor, and whether the factors that significantly influenced the decision to qualify constituted an actual contraindication. We performed a retrospective study based on data from the Silesian ICU Registry from 2010-2020 and publicly available information from Poltransplant. We compared the demographic and clinical characteristics of patients diagnosed with brain death who were identified as eligible and ineligible organ donors. Out of 25,465 patients enrolled in the Silesian ICU Registry, brain death was diagnosed in 385 (1.51%) study participants, and 61 of the records were excluded due to data incompleteness. In the remaining group (n = 324), there were 201 men and 123 women. Of them, only 180 study participants were reported as eligible donors (55.5%). Six patients had absolute contraindications to organ donation. A relatively small number of patients diagnosed with brain death were qualified by intensivists as eligible organ donors, with a limited number of medical factors influencing this decision. This means that other non-medical factors may affect the qualification of DBDs for organ procurement.

Dental Implant Placement in Medically Compromised Patients: A Literature Review.

As a discipline of dentistry, oral implantology deals with the diagnosis, design, insertion, restoration, and/or management of alloplastic or autogenous oral structures for the purpose of regaining contour, function, aesthetics, and speech in a partially or completely edentulous patient. The present review aims to provide the currently available knowledge about the impact of certain systemic disorders and the usage of some medications on the survival rate of dental implant therapy and to highlight the importance of patient management under these conditions. Diabetes, osteoporosis, cardiovascular diseases, and the intake of some medications can increase the risk of the failure of a dental implant. Even though there are relatively few medical contraindications to dental implant treatment, certain conditions may increase the risk of failure or complications.

Standard technical specifications for methacholine chloride (Methacholine) bronchial challenge test (2023)

Standard technical specifications for methacholine chloride (Methacholine) bronchial challenge test (2023)

Primary Hip Arthroscopy in Patients With Acetabular Dysplasia: A Systematic Review of Published Clinical Outcomes at Minimum 5-Year Follow-up

Background: Hip arthroscopy in patients with borderline hip dysplasia has satisfactory outcomes at short-term follow-up; however, the data on midterm outcomes are inconsistent, and failure rates are high in some studies, limiting understanding of the role and utility of hip arthroscopy in this patient cohort. Purpose: To provide an up-to-date, evidence-based review of the clinical outcomes of primary hip arthroscopy in patients with frank or borderline hip dysplasia at ≥5-year follow-up and report the failure rate and progression to total hip arthroplasty in this cohort. Study Design: Systematic review; Level of evidence, 4. Methods: A comprehensive literature search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included if they evaluated outcomes of primary hip arthroscopy in patients with lateral center-edge angle (LCEA) <25° at ≥5-year follow-up. Risk of bias assessment was performed using the methodological index for non-randomized studies scoring system. Level of evidence was determined using criteria from the Oxford Centre for Evidence-Based Medicine. Results: Nine studies were included in this review. Patients with LCEA <25° demonstrated satisfactory clinical outcomes, high patient satisfaction, and significant postoperative improvements in patient-reported outcomes (PROs) at follow-up ranging from a ≥5 to 10 years. Studies comparing patients with dysplasia to those without did not demonstrate significant differences in preoperative, postoperative, or delta PROs or in failure, reoperation, or revision rates. There was no overall significant correlation between outcomes and LCEA stratification. Conclusion: Hip arthroscopy in carefully selected patients with LCEA <25° can be successful at mid- to long-term follow-up and may provide clinical outcomes and failure rates comparable with patients with normal LCEA, understanding that this is a singular, 2-dimensional radiographic measure that does not differentiate instability from impingement or combinations thereof, warranting future studies delineating these differences. These findings suggest that hip dysplasia may not be an absolute contraindication for isolated hip arthroscopy and may serve as a viable intervention with consideration of staged future periacetabular osteotomy (PAO). Importantly, this review does not suggest that hip arthroscopy alters the natural history of dysplasia; therefore, patients with dysplasia should be counseled on the potential utility of PAO by appropriate hip preservation specialists.

State-of-the-Art of Transcatheter Left Atrial Appendage Occlusion.

Left atrial appendage occlusion (LAAO) is an increasingly used alternative to oral anticoagulation in patients with atrial fibrillation, especially in patients with absolute/relative contraindications to these therapies. This review will cover three main aspects of the procedure. In the fist part of the manuscript, we focus on patient selection. We describe three main categories of patients with primary indication to LAAO, namely patients with previous or at a high risk of intracerebral bleeding, patients with a history of major gastrointestinal bleeding and patients with end-stage renal disease and absolute contraindication to novel oral anticoagulants. Some other potential indications are also described. In the second part of the manuscript, we review available devices, trying to highlight different aspects and potential specific advantages. The last section overviews different ways for pre-, intra- and postprocedural imaging, in order to improve procedural safety and efficacy and ameliorate patient outcome. The characteristics of available contemporary devices and the role of imaging in procedural planning, intraprocedural guidance and follow-up are described.

Health Professionals’ Perspectives on Commercially Available Intravenous Nutrient Therapies: A Preliminary Report

Background: Intravenous nutrient therapies (IVNTs) have gained popularity on the commercial market. Targeted at people with a variety of ailments and needs, the procedures allegedly offer numerous benefits and quick results, widely advertised on the websites of drip bars and health clinics as well as in the available literature. What is less often presented is the point of view of the customers of such services and the opinions of health personnel. Although the latter perspective seems to be crucial, little is known about it. Therefore, the purpose of this study was to present the opinions and experiences of health professionals (n = 188) on commercially available IVNTs dedicated to adults. Methods: The study was conducted between April 2019 and March 2020 by means of a survey using an ad hoc questionnaire made available mainly to health professionals attending public health postgraduate courses at the Poznan University of Medical Sciences, Poland. Results: As many as 91.5% of the respondents had heard of commercially available IVNTs (mostly from the media), and 47.3% knew of a facility offering such services. Among the possible situations where the use of IVNTs would be justified, the most commonly mentioned was a diagnosed nutrient deficiency (37.8%), while the least common ones were libido problems (1.1%) and the need to speed up metabolism (2.1%). For 25.5% of the respondents, there was no good rationale for using IVNTs. As many as 15.4% had no opinion on the subject. Health risks of IVNTs were recognised by 95.2% of professionals, with the biggest concerns being the lack of full information on patients’ health status and medical contraindications (84%), the risk of overdose and interactions (77.1%), and hypersensitivity or allergic reactions (75.5%). Among the reasons for IVNTs’ popularity, the respondents listed not only fads spread by celebrities and social media (89.4%) and the need for quick, effortless remedies (77.1%), but also reasons inherent in the Polish healthcare system. As many as 80.3% of the respondents stressed the need for public health institutions to take a stand on commercial IVNTs. Knowing of an IVNT facility was not significantly associated with the opinions of professionals in key areas. Conclusion: Postgraduate public health courses are a good opportunity to engage health professionals in discussions about the current challenges, trends, and needs in the area of health promotion and healthcare. This study’s findings shed some light on the opinions about IVNTs held by health professionals, who are important stakeholders of the healthcare system. Thus, these findings may help to better understand the popularity of IVNTs and incorporate health professionals’ perspectives in future efforts aiming to increase the awareness of IVNT-related health risks among both professionals and patients.

Immediate prepectoral breast reconstruction in nipple-sparing mastectomy with Wise-pattern incision in large and ptotic breasts: Our experience and short-term results

IntroductionCurrent trends in treatment of breast cancer advocate nipple-sparing mastectomy (NSM) as the technique of choice in selected patients. A large and ptotic breast is often considered a relative contraindication for NSM, due to the increased risk of skin and nipple necrosis. MethodsA retrospective review was performed for patients who underwent immediate prepectoral breast reconstruction (PPBR) after NSM with Wise-pattern incision between February 2020 and February 2023 at our institution. This procedure was offered to patients with grade II or III ptosis or large breasts who were candidates to NSM for therapeutic or prophylactic purpose. Exclusion criteria were: a preoperative nipple-sternal notch distance greater than 30cm, previous radiotherapy, pinch test < 1cm, BMI greater than 34 and active smoke. We present our short-term results with this technique. ResultsDuring the considered period, 62 patients (76 breasts) had NSM with Wise-pattern incision. Patients had immediate PPBR with implant or tissue expander, both entirely wrapped with ADM. The median age of the patients was 57.0 years (IQR 50.0-68.6) with a median BMI of 25.5 (IQR 23.3-28.4). The median mastectomy specimen weight was 472g (341-578). Median implant volume was 465g (IQR 370-515). Major complications occurred in 8 patients (10.5%). Three patients had total NAC necrosis (3.9%), partial NAC necrosis occurred in 2 patients (2.6%). Two patients developed implant infection (2.6%). Univariate analysis showed a statistically significant correlation between major complications and the mastectomy specimen weight (p 0.003). ConclusionsIf oncologically indicated, NSM with Wise-pattern incision and immediate PPBR can safely be performed in selected patients with large and ptotic breasts.

SANE Knowledge of HIV nPEP: Identifying Deficits.

Discussing the risk of exposure to human immunodeficiency virus (HIV) and assessing the need for HIV nonoccupational postexposure prophylaxis (nPEP) are essential components of providing care to victims of sexual assault. Current literature on the topic of HIV nPEP for victims of sexual assault surrounds risk of exposure, patient adherence, access and barriers, current practices, and standardized order sets. A significant gap in the literature concerning sexual assault nurse examiner (SANE) knowledge of HIV infection and HIV nPEP evidence-based practice guidelines was identified. The purpose of this research was to assess SANE knowledge surrounding HIV infection and evidence-based practice recommendations for HIV nPEP use in victims of sexual assault. A 20-item knowledge survey was created using QuestionPro. The aim of the survey was to measure SANE knowledge of HIV transmission, pathophysiology, nPEP medications, and evidence-based practice guidelines for victims of sexual assault. In addition to the 20 knowledge items, 15 demographic questions were included. The study design was cross-sectional, descriptive, and comparative. A total of 411 participants completed the survey. Data analysis revealed knowledge deficits for topics such as risk of HIV transmission, nPEP indications, laboratory testing, drug regimens, nPEP timing, mechanism of action, medication contraindications, and adherence issues. The overall mean score for the knowledge survey among all participants was 13.36 out of 20 (66.8%). A knowledge deficit among SANEs surrounding HIV infection and HIV nPEP evidence-based practice guidelines for patients who experienced sexual assault was identified. The study highlights the need for additional education for specialized nurses who are providing care to victims of sexual assault.