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Venous sinus stenting versus ventriculoperitoneal shunting for idiopathic intracranial hypertension: propensity score weighted, cost consequence analysis.
No full textINTRODUCTION: Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure, papilledema, and neurological symptoms. When medical management fails, treatment options include venous sinus stenting (VSS) and ventriculoperitoneal shunting (VPS). Comparative data on cost effectiveness remain limited. We aimed to compare clinical outcomes, healthcare utilization, and costs between VSS and VPS in patients with IIH using a propensity score weighted analysis.
METHODS: This was a retrospective single center study. Baseline characteristics, complications, reoperations, unplanned 30 day emergency department visits and readmissions, unsatisfactory treatment response, salvage procedures, and inflation adjusted index procedure costs were collected. Propensity score weighting with overlap weights was applied to balance covariates. Weighted regression analyses were used to compare outcomes between groups.
RESULTS: 139 patients were treated with VSS (n=99) or VPS (n=40). Baseline characteristics were well balanced after overlap weighting. Inflation adjusted index procedure costs and length of stay were similar between the VSS and VPS groups. VSS was associated with significantly lower rates of any complication (3.5% vs 37.7%, P\u3c 0.001), unplanned 30 day emergency department visits (11.1% vs 36.6%, P=0.002), 30 day readmissions (1.3% vs 33%, P\u3c 0.001), and reoperations, including revisions and surgically treated complications (1.3% vs 30.9%, P\u3c 0.001). There were no significant differences in unsatisfactory treatment response, need for salvage procedures, or overall subsequent procedures.
CONCLUSIONS: While initial costs and clinical outcomes were similar, VPS was associated with higher complication rates, more revision related reoperations, and greater short term healthcare utilization. These findings suggest that VSS may provide a safer and more cost effective approach for patients with IIH who have failed medical therapy
THE KEYSTONE MUSCULOCUTANEOUS PERFORATOR ISLAND FLAP: a 5 TH KEYSTONE FLAP SUBTYPE KEYSTONE MUSCULOCUTANEOUS FLAP.
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Outcomes of Hemiarch versus Zone 2 Arch Replacement for DeBakey I Aortic Dissection.
No full textOBJECTIVES: The objective of this study was to compare perioperative and long-term outcomes of hemiarch versus zone 2 arch replacement for DeBakey type I acute aortic dissection.
METHODS: From 2002 to 2023, 743 patients underwent surgical repair for DeBakey type I acute aortic dissection with either hemiarch (N = 605, 81.4%) or zone 2 arch replacement (N = 138, 18.6%). 4:1 propensity-score matching yielded a cohort of 437 hemiarch patients (76.1%) and 137 zone 2 patients (23.9%). Key outcomes included 30-day mortality, ten-year survival, and distal reintervention.
RESULTS: In the matched cohort, 30-day mortality was 11.9% for hemiarch and 8.0% for zone 2 arch replacement (P = 0.198). On multivariable analysis, zone 2 arch replacement was not associated with increased risk of 30-day mortality. Ten-year survival was similar between groups, at 56.2% (50.6%-62.6%) in the hemiarch group and 59.8% (46.4%-77.1%) in the zone 2 group. Distal reintervention was more common after zone 2 arch replacement (46.7% vs 15.8%), though the majority of reinterventions in the zone 2 group were thoracic endovascular aortic repair procedures (95.3%). In contrast, over half (53.6%) of distal reinterventions after hemiarch repair were open procedures.
CONCLUSIONS: Zone 2 arch replacement resulted in comparable early and late survival compared to hemiarch replacement. Although distal reinterventions were more common after zone 2 arch replacement, these were predominantly low-risk thoracic endovascular aortic repair procedures. In appropriately selected patients, zone 2 arch replacement may enable more complete aortic repair without added perioperative risk
Beta-Blocker therapy improves survival after concomitant septal myectomy and aortic valve replacement.
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Improving Clinical Photography for All Skin Types: The Role of a Mobile Gray Backdrop.
No full textWe introduce the pearl of a collapsible gray mobile backdrop to standardize clinical photography for diverse pediatric populations. We reviewed existing literature on optimal background colors for different skin types and implemented a neutral gray collapsible backdrop in our pediatric dermatology clinic. The gray mobile backdrop minimized color contamination, provided sufficient contrast for all Fitzpatrick skin types, and improved image quality and consistency across clinic settings. A collapsible gray backdrop is a cost-effective and practical solution for enhancing clinical photography in pediatric dermatology, facilitating more accurate documentation and improved patient care
Ex Vivo Assessment of Keratinocytic Carcinomas Using a Fast Mid-Infrared Probe.
No full textA fast mid-infrared spectral probe was used to record infrared (IR) spectra of fresh skin tissue removed from patients with biopsy-proven keratinocytic cancer (KC) during Mohs surgery. A 150-patient library of IR spectral data was obtained to see if KC on the epidermal side (outside) of tissue samples can be differentiated from adjacent nonmalignant tissue and normal skin. A linear support vector machine model minimized overtraining predicting the contributions to decisions at each step in the spectrum. Training with an equal cost for KC and nontumor cases samples demonstrated a KC sensitivity of 93% ± 5% and specificity 82% ± 6% (threefold testing esd) on the full library. Success in this test problem warrants future studies to see if differentiation of melanoma from benign melanocytic as well as other skin lesions is possible on live skin. This study was approved by the Advarra Institutional Review Board, #PRO00053468