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64667 Ethics of Treating Actinic Keratoses in Patients of Advanced Age.
No full textAmerican Academy of Dermatology (AAD) Annual Meeting 2025; March 7 - 11, 2025; Orlando, F
Round table discussion. Neurogenic thoracic outlet syndrome
No full textThe diagnosis and treatment of neurogenic thoracic outlet syndrome (NTOS) remains an area of controversy. Criteria for diagnosis are not uniform. Advanced imaging modalities such as magnetic resonance imaging (MRI) may have varying utility based on institutional expertise, availability of equipment and familiarity with protocols. The use of diagnostic scalene blocks, or botulinum toxin injection is very dependent on surgeon experience and preference. Techniques for surgical management vary among surgeons, with biases between surgical subspecialities. In the field of hand surgery, outcomes following surgical treatment of NTOS are one of the most variable, with different surgeons achieving good outcomes with routine use of either rib sparing scalenectomy or first rib resection in primary management of supraclavicular NTOS. Further high-quality studies are needed to guide surgeons on best practices for management of NTOS. In this round table discussion, a group of expert surgeons from different surgical specialties discuss areas of consensus and controversy in NTOS
Preoperative Cryoneurolysis Improves Pain and Function for at Least 12 Months after Total Knee Arthroplasty: A Multicenter Registry Study
No full textBACKGROUND: With the incidence of total knee arthroplasty (TKA) projected to surpass 1.5 million cases annually in the United States by 2050, optimizing perioperative pain control remains a critical priority. This study investigated the effects of preoperative cryoneurolysis in patients undergoing primary unilateral TKA, focusing on 1) pain intensities, 2) opioid utilizations, 3) functional recoveries, and 4) sleep disturbances over 12 months postoperatively. METHODS: This observational study utilized data from the Innovations in Genicular Outcomes Research, identifying patients undergoing TKA who did versus those who did not receive cryoneurolysis from September 2021 to December 2024, and following them for 12 months postoperatively. Of 356 patients analyzed, 174 received preoperative cryoneurolysis and 182 served as controls. Baseline demographics were collected or tabulated. Pain level was quantified using the Brief Pain Inventory-Short Form instrument and postoperative opioid use, with sleep disturbance measured using the Patient-Reported Outcomes Measurement Information System questionnaire. Physical function was assessed by the Knee Injury and Osteoarthritis Outcome Score, joint replacement questionnaire. Outcomes were assessed preoperatively and at regular weekly, monthly, and quarterly intervals postoperatively. Comparative analysis was performed using generalized linear mixed-effects regression, with significance set at P \u3c 0.05. RESULTS: Patients who received cryoneurolysis demonstrated significantly lower pain scores (2.0 versus 2.4, P \u3c 0.001) and reduced opioid utilization across the year (24 versus 41%, P \u3c 0.001). Patients who received cryoneurolysis had improved functional outcomes relative to controls (Knee Injury and Osteoarthritis Outcome Score, joint replacement: 65.2 versus 63.9, P = 0.004). Sleep disturbances were also lower in the cryoneurolysis group (52.3 versus 53.3, P \u3c 0.001). CONCLUSIONS: Cryoneurolysis administered before TKA is associated with reduced long-term opioid dependence, improved pain control, and decreased sleep disturbance for 12 months postoperatively, reaching a minimally clinically important difference. These findings replicate our prior analysis with growing evidence of continued benefit at extended follow-up
Umbilical Cord Blood Transplantation Provides an Alternative for Patients With Chronic Granulomatous Disease Lacking HLA-Matched Donors: A PIDTC Report
No full textBACKGROUND: Allogeneic hematopoietic cell transplantation corrects the phagocytic defect in patients with chronic granulomatous disease (CGD) and resolve infection risk and immune dysregulation. Umbilical cord blood transplantation (UCBT) is an option for patients lacking suitable HLA-matched bone marrow or peripheral blood stem cell donors. However, information related to UCBT for CGD is limited to a few small case series and limited subsets of larger cohorts where detailed information is lacking. OBJECTIVES: To describe UCBT procedures and outcomes in patients with CGD. STUDY DESIGN: Thirty-nine patients with CGD who underwent UCBT at Primary Immune Deficiency Treatment Consortium (PIDTC) centers between 2001 and 2019 were included. RESULTS: All patients were male, and most (97%) had X-linked CGD due to pathogenic variants in CYBB. High infection burden (1.72/person years) and inflammatory disease (38%) were common in the year pre-UCBT. Median age at receipt of UCBT was 2.1 (range 0.3-14.0) years. Most (87%) patients received UCB from unrelated donors, and most (72%) patients received busulfan and cyclophosphamide-based conditioning. All but two (95%) patients received serotherapy with anti-thymocyte globulin or alemtuzumab. Neutrophil and platelet recovery occurred at a median of 18 (range 12-46) and 38 (range 21-186) days, respectively. Nine patients experienced early graft failure [donor myeloid chimerism \u3c 10% or receipt of second hematopoietic cell transplantation (HCT) within 100 days] for a cumulative incidence of 23.1% (95% CI 11.3-37.3). There were no cases of late graft failure (after 100 days), and median whole blood and myeloid donor chimerism of engrafted patients were \u3e 95% at all time points. One of the nine patients with early graft failure had autologous reconstitution. The remaining 8 patients underwent repeat HCT; six of the patients survived and achieved durable myeloid engraftment on long-term follow-up. Twenty-eight patients were alive at a median follow-up of 4.28 (IQR 2.66-6.08) years. Estimated 3-year overall and event-free survival were 73.7% (95% CI 56.5-84.9) and 56.2% (95% CI 39.3-70.1), respectively. No identifiable factors, including history of infection or inflammatory disease in the year prior to UCBT, year of UCBT, age at UCBT, conditioning regimen, cell dose, and recipient and donor HLA match, were associated with graft failure or survival. Infections decreased with time post-UCBT and pre-existing inflammatory disease resolved in all surviving patients CONCLUSIONS: UCBT for CGD is associated with high rates of early graft failure. Nevertheless, UCBT can provide an effective alternative for CGD patients when HLA-matched donors are not available with resolution of disease. Strategies to overcome high rates of early graft failure while optimizing conditioning regimens to minimize toxicity are needed
The Clinical Anatomy of the Vascular System | Ch 96
No full textAt the end of the fourth week of the embryonic period, the development of the upper limb arteries, along with other parts of the upper limb, begins with the activation of mesenchymal cells from the lateral mesoderm. At this stage, upper limb buds begin to form from a mass of mesenchymal cells covered by ectoderm. Later in its development, this mass differentiates into bone, cartilage, and blood vessels. Specifically, the anterior circumflex humeral artery (ACHA) and posterior circumflex humeral artery (PCHA) develop from branches of the axis artery, which is a lateral branch of the seventh intersegmental artery (Gilbert and Nelson 2021; Tang and Varacallo 2021)
The Clinical Anatomy of the Vascular System | Ch 114
No full textDuring the 14 mm stage of embryonic development, one of the branches of the deep popliteal artery descends through the posterior crural region, resembling the adult posterior tibial artery (Senior 1919). The other branch arises more distally and is the posterior superficial fibular artery. The former passes backward along the medial side of the tibialis nerve to reach the posterior aspect of the leg and then descends along the posterior aspect of the nerve until it enters the sole of the foot, becoming the medial plantar artery in the adult (Senior 1919). The latter passes from the medial to lateral aspect of the tibial nerve, traveling anterior and lateral to the nerve until it forms branches that end blindly (Senior 1919). At the 17.8 mm stage, the portion of the posterior superficial tibial artery between the popliteal artery and the origin of the lateral plantar artery becomes the adult posterior tibial artery. During the 18 mm stage, behind the medial malleolus, the posterior superficial tibial artery finds its relationship between the tibial artery and the flexor hallucis longus (Senior 1919). At the 24.5 mm stage, the proximal portion of this artery blends with the corresponding section of the posterior superficial fibular artery as far as the termination of the popliteal artery, forming the adult posterior tibial artery (Senior 1919)
The Clinical Anatomy of the Vascular System | Ch 83
No full textThe development of the inferior vena cava (IVC) involves three paired embryonic veins and takes place during weeks 6–10 of gestation. The posterior cardinal veins are the first to develop posteriorly and mostly regress, except for their distal aspect, which leads to the formation of the iliac bifurcation (Ureyen et al. 2013). The suprarenal IVC forms from an anastomosis between the right subcardinal and vitelline veins (Berman and Minocha 2020). Next, the subcardinal veins develop anteromedially to the posterior cardinal veins. The right subcardinal vein persists to the right of the IVC throughout normal development, whereas the left subcardinal vein completely regresses (Ureyen et al. 2013). The subcardinal veins are responsible for forming most of the infrarenal IVC (Berman and Minocha 2020). Finally, the paired supracardinal veins form dorsally to the subcardinal veins. As with the subcardinal veins, the left supracardinal vein regresses while the right persists and eventually forms the infrarenal portion of the IVC (Ureyen et al. 2013)
The Clinical Anatomy of the Vascular System | Ch 49
No full textVascular formation begins in the human embryo on approximately day 18 of development (Gerecht-Nir et al. 2004). Attaining the complex vascularity of the adult involves extensive vascular regression and remodeling via vasculogenesis and angiogenesis to accommodate further growth and development. Specifically, veins of the thoracic wall undergo complex rounds of vascular modeling and remodeling. The formation of a three-membered system of paired veins consisting of the umbilical veins from the chorion, the cardinal veins from the embryo, and the vitelline veins from the yolk sac provides the framework for the eventual development of the thoracic wall veins
