Notes

Computerized info abstraction pertaining to quality security along with outcome examination within light oncology.
2%) had been prescribed LABD, again with no difference in prescriptions by payer. Those with a COPD-related hospitalization who had been prescribed LABD were younger, had lower body mass index, were more likely to be current smokers and had higher rates of hospitalizations for COPD during the study period than those not prescribed LABD.

While disparities in LABD utilization may occur due to cost or other barriers to filling prescriptions, in our study, prescriptions for LABD were common and did not differ by payer status.
While disparities in LABD utilization may occur due to cost or other barriers to filling prescriptions, in our study, prescriptions for LABD were common and did not differ by payer status.
Treatment of acute borderline cellular rejection (BCR) after kidney transplant has shown mixed results with no consensus on the necessity and modality of interventions.

The emphasis of our study was to assess the histopathologic response when BCR of kidney transplant is being treated with rapid steroid regimen. We analyzed all diagnosed acute BCR between 2018 and 2020. Patients were divided to a treatment responder group (RG) and non-responder group (NRG). All diagnosed BCR were treated with rapid steroid regimen and followed by a biopsy to assess response. Demographic data, recipients' comorbidities and clinical data, donor type, and induction immunosuppression regimen data were collected.

Ninety-one patients had acute BCR and were treated with rapid steroid followed by a repeat biopsy. Sixty-three (69%) patients showed persistence BCR and were considered NRG. Age, gender, and race were similar between the two groups. Class I and II calculated panel reactive antibodies were similar between the groups. No significant difference in the median serum creatinine (SCr) was noted between the groups. RG and NRG had a median SCr of 1.6 mg/dL (1.2 - 2.1) and 1.5 mg/dL (1.4 - 2.0), respectively (P < 0.79). The median SCr at the time of the follow-up biopsy was not different between the groups SCr of 1.6 mg/dL (1.2 - 2.0) vs. 1.4 mg/dL (1.2 - 2.2) for the RG and NRG, respectively (P < 0.93).

When rapid steroid regimen was used to treat acute BCR after kidney transplant, only smaller number of patients showed response based on the histology evaluation of the follow-up post-treatment biopsies.
When rapid steroid regimen was used to treat acute BCR after kidney transplant, only smaller number of patients showed response based on the histology evaluation of the follow-up post-treatment biopsies.Based on the findings of two consecutive cases of upper extremity compartment syndrome encountered at our institution, we hypothesize that the presence of compartment syndrome in the unstable COVID-19 patient may be associated with high mortality and low limb salvage rates. A literature search was conducted with key search terms, including "compartment syndrome, fasciotomy, COVID, and coronavirus." Articles describing patients with a confirmed COVID-19 diagnosis who developed extremity compartment syndrome were included in our study. The primary outcome investigated was patient survival. Secondary outcomes included limb survival and limb salvage. Limb salvage was calculated in patients who survived to time of discharge, whereas limb survival was counted for all patients. We then added our two cases to the findings reported in our literature to determine current overall limb salvage and patient survival rates. Our review of the literature yielded six case reports of ten extremities that developed compartment syndrome in the COVID-19 positive patient. Overall survival was four of six patients (67%). The overall limb survival rate at the time of hospital discharge was three of 10 (30%). With the addition of our two cases, overall survival was four of eight (50%) and overall limb survival rate was three of 12 (25%). Furthermore, with inclusion of our two cases, the patient survival rate of hemodynamically unstable patients was only three of seven (43%). The development of compartment syndrome in the unstable COVID-19 patient may be a harbinger of death, and the decision to proceed with operative intervention is challenging, complex, and in some cases must prioritize life over limb.Circumflex aortic arch (CAA) is a rare congenital anomaly where the aortic arch crosses the midline, posterior to the esophagus and trachea, and descends on the contralateral side. If patent ductus arteriosus (PDA) is present, this forms a true vascular ring. CAA can compress the trachea and esophagus leading to a myriad of symptoms which can present at any age. We describe our experience with three patients of the CAA, presenting across different age groups.
Nearly one-third of the patients with interstitial lung disease (ILD) require surgical biopsy for a definite diagnosis. Video-assisted thoracoscopic surgical (VATS) biopsy has replaced open lung biopsy, but the number of biopsy required to achieve an accurate diagnose is controversial.

Our study aims to show that a well-planned single VATS biopsy is as effective as multiple biopsies for the accurate diagnosis of ILD by reduced days of hospital stay.

We included 111 patients with suspected ILD who underwent VATS biopsy in our study. Patients were separated into three groups according to the number of biopsies obtained. The differences between groups for diagnostic yield, mean time for chest tube removal, perioperative complications, and approximate volume per biopsy were analyzed statistically.

Eighteen single, 74 double, and 19 triple biopsies were made. Mean times of chest tube removal and hospital stay for single, double, and triple biopsy were 3.5, 4.8, and 6.1days respectively. The number of biopsltidisciplinary evaluation, is an effective and safe diagnostic tool with lower days of hospital stay.
1. The classical knowledge that multiple biopsies should be taken from different regions of the lung in the diagnosis of interstitial lung diseases has changed over time.2. Diagnostic concordance between multiple biopsy specimens is above 85%.3. A "single" biopsy, decided with multidisciplinary evaluation, is an effective and safe diagnostic tool with lower days of hospital stay.Although atrioventricular septal defects are categorized according to the anatomical atrioventricular orifice, the location of the intracardiac shunt in atrioventricular septal defects is important from a surgical perspective. Herein, we report three cases of atrioventricular septal defects with a small or no ostium primum defect. Case 1 (3-month-old girl) was diagnosed preoperatively with a ventricular septal defect, secundum atrial septal defect, and mitral valve cleft. After the operation, the diagnosis was corrected to an atrioventricular septal defect and was repaired completely. Case 2 (9-year-old girl) underwent pulmonary artery banding for a ventricular septal defect with a straddling mitral valve. selleckchem After the experience with Case 1, we realized similarities between Cases 1 and 2. Therefore, we corrected the diagnosis to atrioventricular septal defect and achieved definitive repair. Based on these experiences, we accurately diagnosed Case 3 (3-month-old boy) with an atrioventricular septal defect. This variant is poorly known; however, proper morphological understanding is necessary to facilitate anatomical repair and prevent postoperative atrioventricular blocks. Some cases of this variant may be diagnosed as a ventricular septal defect with straddling mitral valve and are unable to receive definitive repair. The direction of the cleft, absence of atrioventricular valve offsetting, and trileaflet of the left atrioventricular valve all seem useful for making a diagnosis, and these can be easily confirmed by echocardiography.Ventral hernias following left ventricular assist device (LVAD) placement are rare. With the improvement in technology, and miniaturization of devices associated with intrapericardial placement, these complications have largely been abolished. The mere presence of a large ventral hernia should not exclude recipients from being candidates for orthotopic heart transplantation.We hereby present an unusually long intra-atrial course of the right coronary artery incidentally detected on computed tomography angiography. Although usually asymptomatic, an intra-atrial right coronary artery may be injured during iatrogenic procedures which require right heart catheterisation.Pulmonary vein abnormalities are very commonly encountered in general thoracic surgical practice. While performing a lobectomy, ideally all the pulmonary veins should be identified before ligating the corresponding vein. Failing to recognize a common pulmonary vein may lead to an unwarranted pneumonectomy which may end up morbid for the patient. In this report, we present a patient with left lower lobe bronchiectasis who underwent a left lower lobectomy and was identified to have a common left pulmonary venous trunk intra-operatively.We describe a case of a 32-year-old man with a paraganglioma causing encasement of ostioproximal segments of the left internal carotid artery and left external carotid artery with concurrent presence of bilobulated mediastinal paraganglioma, with similar imaging characteristics, causing encasement of the coronary arteries.
Surgical septal myectomy is the treatment of choice for patients of hypertrophic cardiomyopathy who are symptomatic despite maximal medical therapy. Residual obstruction results in the persistence of symptoms and poorer outcomes. The length (depth) of the septum excised as far towards the apex is important. A combined approach of trans-aortic and trans-apical is needed to achieve this in specific cases with associated mid-cavity obstruction. We present a case of a complex long-segment septal hypertrophy which underwent a successful septal reduction using a combined trans-aortic and trans-apical approach.

The online version contains supplementary material available at 10.1007/s12055-022-01377-4.
The online version contains supplementary material available at 10.1007/s12055-022-01377-4.Left ventricular assist devices (LVADs) improve survival and quality of life for patients with advanced heart failure but are associated with high rates of thromboembolic and hemorrhagic complications. Antithrombotic therapy is required following LVAD implantation, though practices vary. Identifying a therapeutic strategy that minimizes the risks of thromboembolic and hemorrhagic complications is critical to optimizing patient outcomes and is an area of active investigation. This paper reviews strategies for initiating and maintaining antithrombotic therapy in durable LVAD recipients, focusing on those with centrifugal-flow devices.The incidence of absent pulmonary valve (APV) in tetralogy of Fallot is 2.4 to 6.3%. About 1-3% of the patients with tetralogy of Fallot will have unilateral absence of pulmonary artery (UAPA). However, coexistence of APV with tetralogy of Fallot (TOF) and UAPA is extremely rare. This rare subset can present in two forms. In one group, the main pulmonary artery continues as either left or right pulmonary artery (UAPA) and there is true absence of contralateral pulmonary artery. The second group is termed as unilateral anomalous origin of pulmonary artery (UAOPA), in which the contralateral lung is supplied either by patent ductus arteriosus or a collateral from the aorta. There are a limited number of these cases in the literature. We present a rare case of TOF with APV and UAPA managed using a different surgical technique. Also, we have done contemporary literature review.
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