Acapedia’s Post

How ACCLARENT AERA® Eustachian Tube Balloon dilation works?  - Mechanism of action (1) Pathology lies within the cartilaginous segment of the Eustachian tube Histopathology research has demonstrated that balloon dilation may: -Shear or crush portions of the epithelium; usually sparing the basal layer and allowing for rapid healing -Crush lymphocytes and lymphoid follicle -Combined, these effects reduce overall inflammatory burden and may be the underlying reason for lasting clinical improvement in Eustachian tube dilation and ventilation - Indications: The ACCLARENT AERA® Eustachian Tube Balloon Dilation System is intended to dilate the Eustachian tube for treatment of persistent Eustachian tube dysfunction in patients ages 18 and older. For patients ages 8-17 years, The ACCLARENT AERA Eustachian Tube Dilatation System, alone or in combination with adjunctive procedures, is intended to treat patients with objective signs of persistent obstructive Eustachian tube dysfunction from inflammatory pathology, resulting in chronic otitis media with effusion and are refractory to at least one surgical intervention for persistent obstructive Eustachian tube dysfunction. 1-Kivekäs I, Chao WC, Faquin W, et al. Histopathology of balloon-dilation Eustachian tuboplasty. Laryngoscope. 2015 Feb;125(2):436-441 2-Traditional 510(k): Device Labeling Modification to ACCLARENT AERA(R) Eustachian Tube Balloon System, (K230742), dated December 13, 2023. #acclarent #ACCLARENTAERA

📃Scientific paper: Whole ureter replacement with Yang–Monti principle: successful treatment of challenging conditions Abstract: Background No clear consensus has been reached on the reconstruction of long-segment or total ureter discontinuation. Here we present our experience using the Yang–Monti technique in total ureter reconstruction. Methods This study was a single-center retrospective study of patients who underwent Yang–Monti ileal whole ureter reconstruction (from the ureteropelvic junction[UPJ] to the ureterovesical junction). Data were collected on patients’ baseline characteristics, stricture etiology, the time interval between insult and surgical repair, pre/postoperative serum creatinine, estimated glomerular filtration rate (eGFR), split renal function, complications during admission and follow-ups, and the indwelling durations of JJ tubes and nephrostomy tubes, if presented. Results Seven patients underwent Yang–Monti ileal ureter reconstruction in 2010–2020 at our hospital. One of the patients underwent single-session bilateral ureter repair. Radiation therapy-related fibrosis and degloving injury were the most common etiologies for ureter injury. The median interval between ureter insult and operation was 8 months. The median follow-up was 36.7 months. The average operation time was 11.4 h, and the average blood loss was 273 ml. Postoperatively, no significant differences were found in serum creatinine, eGFR, or split renal function. As for postoperative complications, two patients experienced ileus and were treated conservatively. One patient had UPJ stenosis, which reso... Continued on ES/IODE ➡️ https://etcse.fr/9bixU ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.

🚨 New Publication Alert! I'm excited to share our latest study on the use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in patients with penetrating abdominal vascular injuries, now online in the American Journal of Surgery. Our research, utilizing the TQIP database and propensity score matching, highlights some critical findings: ➡️ Higher in-hospital mortality with REBOA use (46.8% vs. 36.3%) ➡️ Increased transfusion needs, acute kidney injury, and surgical complications ➡️ Subgroup analysis further supports the need for cautious application of REBOA in this population These findings highlight the importance of identifying trauma patients who might truly benefit from REBOA. Let’s keep advancing our understanding of its role in trauma care to improve outcomes for critically injured patients. 🩸💡 #TraumaSurgery #REBOA #PenetratingTrauma #AbdominalInjury #CriticalCare

Today’s cardiovascular case study is a PCI treatment for an elderly patient with renal tumors.   The patient is a 66-year-old male with a main complaint of recurrent chest pain for four months. The diagnosis reveals coronary atherosclerotic disease with unstable angina pectoris. Recently it was discovered that there were several tumors in his left kidney. Additional comorbidities include acute cholecystitis, gallbladder polyps and gallstones, anemia, hypertension, rheumatoid arthritis.   Active cancer, severe or end-stage chronic kidney disease, and planned surgery in the near future are all major criteria in the ARC-HBR criteria for patients with high risk of bleeding. The patient requires renal surgery after PCI and therefore a stop of antiplatelet drugs during the perioperative period. Taking these all into consideration, BioFreedom™, a unique polymer- and carrier-free drug coated stent, was selected. BioFreedtom™ has a proven indication of one-month DAPT after PCI.   A total of 240 cancer patients and 400 recently-scheduled-for-surgery patients were enrolled in the LEADERS FREE study. The conclusion of these subgroup analysis confirmed the safety and effectiveness of the regimen of BioFreedom™ stent combined with one-month DAPT in patients, compared to the control group.   The BioFreedom™ drug coated stent has been the recommended treatment stent in the ESC guidelines for patients with high bleeding risk.   #healthcare #medical #cardiovascular #heartstent #PCI #interventionalcardiology #biofreedom

Renal Nutcracker Syndrome- a tale of two research articles. Journal of Vascular Surgery recent articles “Nutcracker Syndrome (a Delphi consensus) has NCS “experts” deciding on treatments for NCS when the VAST majority of AT surgeons are in the USA and are they included in this study??? How is AT not advised as a treatment for NCS and LRV transpo is? This is a failure to all NCS patients. https://lnkd.in/gS-4jMCY https://lnkd.in/gDy7vJu4

In JAMA Network Open, clinicians from Israel reviewed over six thousand patients with diabetes and obesity, who underwent bariatric surgery or received GLP-1 meds. For those with diabetes duration of ten years or less, mortality was 68% lower for the bariatric surgery group, mediated via greater weight loss; risk of non-fatal major adverse cardiovascular events did not differ between the two groups. One limitation is that patients were on older generation GLP-1 meds, such as liraglutide or exenatide, rather than the more powerful semaglutide and tirzetapide drugs. However, this data underscores the necessity for physicians to discuss medication and surgical therapies for obesity in patients with diabetes sooner rather later, to achieve greater impact. https://lnkd.in/ef5JNkFD

𝐈𝐦𝐩𝐫𝐨𝐯𝐢𝐧𝐠 𝐎𝐩𝐢𝐨𝐢𝐝 𝐏𝐫𝐞𝐬𝐜𝐫𝐢𝐛𝐢𝐧𝐠 𝐀𝐟𝐭𝐞𝐫 𝐂𝐚𝐧𝐜𝐞𝐫 𝐒𝐮𝐫𝐠𝐞𝐫𝐲 Managing acute postoperative pain is a critical aspect of recovery for patients undergoing major cancer surgeries. While opioids are a key component of pain management, ensuring they are prescribed appropriately is vital to minimise risks and enhance patient safety. A recent study published in the Canadian Journal of Anesthesia explored this issue in depth, focusing on breast, gynaecological, and head and neck cancer surgeries. Led by Kenny Lee, Opioid Stewardship Pharmacist, with contributions from Dr Amanda Johns, Head of Acute Pain Services, and Professor Jonathan Clark, Director of Head and Neck Research at COBL, the research had two primary aims. The first aim was to identify patients who were overprescribed opioids at the time of discharge following surgery. The second was to determine the potential predictors of overprescribing, such as clinical or patient-related factors. By uncovering these contributors, the study aims to guide improvements in opioid prescribing practices, ensuring they are both effective and safe for cancer surgery patients. Reflecting on the study, Dr Amanda Johns noted: “I think its success was due to the genuine collaboration between three different surgical teams, the pharmacy department, and the acute pain service. This research has guided our opioid stewardship programme at COBL and inspired further collaborative research in this area.” This work underscores COBL’s commitment to evidence-based practice and collaboration, aiming to set a higher standard for postoperative pain management and opioid stewardship. Click here to view the full paper: https://ow.ly/HVMH50UnbkZ Chris O'Brien Lifehouse Chris O'Brien Lifehouse Research Institute #cobl #integratedprostheticsandreconstruction #ipr #collaboration #opiod #opiodprescribing #cancersurgery #cancercare #choosehope #chrisobrienlifehouse #publication

🧠 Mastering Intracerebral Hemorrhage (ICH) Management 🧠 Check out this comprehensive slide summarizing critical targets for managing intracerebral hemorrhage (ICH). Kudos to Victor J. Del Brutto, MD, MSc for creating such an insightful visual that breaks down the layered approach needed in ICH care! 📊👏 🔍 Treatment Targets Breakdown: ⭐ Primary Goal: Limit Hematoma Expansion The first and foremost goal in ICH management is to curb hematoma expansion, as early stabilization can significantly impact outcomes. Strategies here emphasize rapid blood pressure (BP) control and hemostatic therapy. 💉 Key Interventions: 1️⃣ Blood Pressure Reduction: • Post-hoc analyses from studies like INTERACT-2 and ATACH-II highlight that early BP control within 2 hours can reduce hematoma growth and improve survival outcomes. 📉 2️⃣ Hemostatic Therapy: • Includes options like rFVIIa and Tranexamic Acid, which showed potential benefits when administered early (under 2.5 hours) as seen in trials like FAST, TICH-2, and ongoing research such as the FASTEST trial. 🩺 3️⃣ Anticoagulation Reversal: • For patients on anticoagulants, rapid reversal is critical. Notable therapies include PCCs for Vitamin K antagonists, Idarucizumab for Direct Thrombin inhibitors, and upcoming options like Andexanet alfa for FXa inhibitors. Studies underscore the importance of achieving INR <1.3 for minimizing hematoma expansion. 🩸 4️⃣ ICP Management & Hematoma Evacuation: • ICP control and selective surgical evacuation are crucial for reducing mass effect and preventing further damage. Procedures like open craniotomy (STICH trials) and minimally invasive surgery (MISTIE-III, ENRICH) show promise for carefully chosen patients. 🧑⚕️ 🌐 Future Directions: • As newer studies emerge, standardized protocols for BP control, hemostatic intervention, and anticoagulation reversal will continue to evolve, with the potential to set new standards in ICH management. 🎖️ This slide by Victor J. Del Brutto, MD, MSc serves as a valuable reminder of the nuanced approach needed to tackle ICH effectively. It’s a testament to the importance of quick, targeted interventions in improving outcomes for these patients. #CriticalCare #StrokeManagement #ICH #MedicalEducation #Neurocriticalcare #SNCC

When receiving treatment for cancer, HBOT can work in synergy with surgery, chemotherapy, and radiation. HBOT may also mitigate side effects of chemotherapy (such as “chemo brain”), radiation, and decrease the recovery time after surgical procedures. In addition, HBOT is FDA approved to treat latent radiation injury. Furthermore, the metabolic approach to cancer treatment incorporates specific dietary modifications, such as the ketogenic diet, and employs various personalized lifestyle therapies in combination with hyperbaric oxygen therapy (HBOT). Some physicians and patients are concerned that HBOT may actually accelerate the growth of cancer. Several recent studies have shown this not to be the case. In fact, studies have shown that oxygen can help shrink tumors and make them less resistant to chemo, radiotherapy, and other medications and supplementations The use of Hyperbaric Oxygen Therapy to treat cancer side effects aims to reduce the damage to healthy tissue and blood vessels caused by radiation exposure, helping the body become stronger and fight off the disease. Book your session on www.oxygen-therapy.uk; text/Whatsapp/call on 0795 468 5031 or email: info@oxygen-therapy.uk Let me know if you are interested in renting or buying your own chamber. #oxygentherapy #oxygen #hbot #hyperbaricoxygentherapy #hyperbaricoxygentreatment #hyperbaricoxygenchamber #oxygentreatment #chamberrental #peterborough #stamford #oakham #stives #stnoest #welovepeterborough #deepings #newborough #grantham #pboro #ruthland #lincs #cambs #bourne #northampton #corby #wellingborough #ketterning #oundle #thrapston #rushden #bedford @all @followers @everyone @friends Please note that although the use of Hyperbaric Oxygen has been established in the treatment or management for a variety of indications, the evidence for its use remains uncertain which means that it is not proven by “randomized prospective controlled clinical experiment or trial” or “double blind study” which is considered to be the strongest form of scientific evidence by conventional medical standards.

https://lnkd.in/gjuvQZMj our article in #DCR underscoring the need for #venousthromboembolism #VTE prophylaxis in #inflammatoryboweldisease ....in this paper #UC patients exposed to #tofacitinib at the time of surgery had a 3x increased risk of 90-day postoperative VTE... Tara Russell MD MPH PhD Crohn's & Colitis Foundation Diseases of the Colon & Rectum...should we be sending all postoperative #IBD patients home on #VTE prophylaxis?