Prasoon P. Mohan

Comparison of Endovascular and Open Repair of Ruptured Abdominal Aortic Aneurysm in the United States in the Past Decade

PurposeThe purpose of this study is national-level comparison of the endovascular (EVAR) and open repair (OAR) of ruptured abdominal aortic aneurysm (AAA) in the United States from 2001 to 2010.MethodsThe data were obtained from nationwide inpatient sample from the Department of Health and Human Services. Ruptured AAA treated by OAR or EVAR were selected using combination ICD-9 codes.ResultsThere were 42,126 cases of ruptured AAA of which 8,140 (19.3xa0%) were repaired by EVAR. EVAR patients were older (74.1 vs. 72.8xa0years, pxa0<xa00.001) and had higher incidence of comorbidities compared with OAR group. EVAR patients had lower in-hospital mortality (25.9 vs. 39.1xa0%, pxa0<xa00.001) and shorter hospital stay (10.4 vs. 13.7xa0days, pxa0<xa00.001). More patients were discharged home following EVAR (36.8 vs. 21.5xa0%, pxa0<xa00.001). There was reduced need for institutional rehabilitation following EVAR (26.3 vs. 29.1xa0%, pxa0<xa00.001). Females had significantly higher mortality compared with males after both EVAR (32.2 vs. 24.1xa0%, pxa0<xa00.001) and OAR (46.2 vs. 36.9xa0%, pxa0<xa00.001). The hospital mortality (41.3–25.8xa0%, pxa0<xa00.001) and mean length of stay (11.8–9.7xa0days, pxa0<xa00.01) of EVAR steadily improved over the study period.ConclusionsNational level comparison of data from the past decade shows that in suitable cases, EVAR for ruptured AAA is associated with reduced hospital mortality, shorter hospital stay, and reduced need for rehabilitation. EVAR outcomes showed consistent improvement with time. Regardless of the type of repair, women had higher mortality compared with men.

Uterine artery embolization and its effect on fertility.

A systematic review of literature analyzing fertility following uterine artery embolization (UAE) is presented. Twenty-one studies describing pregnancy and complications of pregnancy following UAE were included. Low-level evidence from these studies suggests that pregnancy rates following UAE are comparable to the age-adjusted rates in the general population. Although pregnancy complication rates were similar to those in patients with untreated fibroid tumors, a few studies have reported higher miscarriage rates following UAE. Further randomized controlled trials comparing UAE versus other fertility-preserving treatments are necessary to confirm these findings.

Should Patients with Autosomal Dominant Polycystic Kidney Disease Be Screened for Cerebral Aneurysms

SUMMARY: Autosomal dominant polycystic kidney disease is a genetic disorder affecting 1 in 1000 people worldwide and is associated with an increased risk of intracranial aneurysms. It remains unclear whether there is sufficient net benefit to screening this patient population for IA, considering recent developments in imaging and treatment and our evolving understanding of the natural history of unruptured aneurysms. There is currently no standardized screening protocol for IA in patients with ADPCKD. Our review of the literature focused on the above issues and presents our appraisal of the estimated value of screening for IA in the setting of ADPCKD.

Nationwide trends in abdominal aortic aneurysm repair and use of endovascular repair in the emergency setting.

PURPOSEnTo analyze nationwide trends in abdominal aortic aneurysm (AAA) repair and the use of endovascular abdominal aortic aneurysm repair (EVAR) in the emergency setting.nnnMATERIALS AND METHODSnData were obtained from the Nationwide Inpatient Sample (NIS) using the International Classification of Diseases, Ninth Revision-Clinical Modification (ICD-9-CM) codes for open and endovascular repairs from 2001-2009. Trends in outcome parameters and hospital charges were compared.nnnRESULTSnThe number of emergency EVAR procedures increased from 382 in 2001 to 1,247 in 2009 (P < .001). During the study period, length of hospital stay associated with total number of EVAR procedures decreased from 3.8 days to 3.4 days (P < .05), and the in-hospital mortality decreased from 2.4% to 2% (P = .32). From 2001-2009, mean hospital charges associated with EVAR increased from

Topical testosterone in scrotal agenesis

50,630 to

Irreversible Electroporation of Hepatic and Pancreatic Malignancies: Radiologic-Pathologic Correlation

91,401 (74% increase), whereas charges associated with open repairs increased from

Gastrostomy and Gastrojejunostomy

54,578 to

Image Quality and Radiation Dose Comparison between Filtered Back Projection and Adaptive Statistical Iterative Reconstruction in Non-contrast Head CT Studies

128,925 (136% increase). The proportion of patients needing rehabilitation or nursing home placement after EVAR increased from 5.8% to 7.7% (P < .01), and need for home health increased from 6.9% to 10.5% (P < .01).nnnCONCLUSIONSnThere was a significant increase in the number of emergency EVAR procedures during the study period; however, the overall in-hospital mortality associated with EVAR remained unchanged, and the length of hospital stay showed a decreasing trend. The total hospital charges for EVAR were lower than the charges for open abdominal aneurysm repair throughout the study period; the difference in charges between the procedures showed a significant increasing trend with time.

Ultrasound-Assisted Catheter-Directed Thrombolysis for Submassive Pulmonary Embolism:

A term boy was referred to our paediatric urology centre with ambiguous genitalia. He was noted to have the stigmata of popliteal ptrerygium syndrome including ankyloblepharon filiforme adnatum, alveolar synechiae, syndactyly of fingers and toes, large cleft palate, pits on lower lips and bilateral alveolar notches [1]. On examination he had a normal phallus with an absent scrotum. The perineal skin below the penis was smooth with a poorly defined midline raphe. The left testis was ectopic, situated in medial upper thigh, and the right testis was incompletely descended, palpable in the superficial inguinal pouch. The diagnosis was confirmed by the detection of the mutation in the popliteal pterygium gene IRF-6. At 4 years of age, he was treated with the application of a topical testosterone preparation (0.1% Testogel) over the perineum below the penis and over the ectopic left testis. After 6 weeks of treatment, the skin of the thigh overlying the ectopic left testis became scrotalised, with rugosity and change in colour (Fig. 1), whereas no changes were noted in the perineum. In due course, the scrotum will be reconstructed using a rotatory flap from the scrotalised skin over the thigh after tissue expansion.

Percutaneous Retrieval of IVC Filters With Struts Penetrating the Vertebral Body

Irreversible electroporation (IRE) is a novel therapy that has shown to be a feasible and promising alternative to conventional ablative techniques when treating tumors near vital structures or blood vessels. The clinical efficacy of IRE has been evaluated using established imaging criteria. This study evaluates the histologic and imaging response of hepatic and pancreatic malignancies that were surgically resected after IRE. In total, 12 lesions ablated with IRE were included, including 3 pancreatic carcinomas, 5 primary tumors of the liver, and 4 metastatic tumors of the liver. The rate of complete response to IRE was 25% based on the histologic evaluation of the resected tumors. Although treatment-related vessel wall changes were noted in several cases in histologic findings, there was no evidence of vascular luminal narrowing or obliteration in any of the specimens. The imaging response to IRE before surgical resection usually resulted in underestimation of disease burden when compared with the histologic response seen on the resected specimens.