Trends in genitourinary cancer mortality in the United States: analysis of the CDC-WONDER database 1999-2020.

Introduction: Sociodemographic disparities in genitourinary cancer-related mortality have been insufficiently studied, particularly across multiple cancer types. This study aimed to investigate gender, racial, and geographic disparities in mortality rates for the most common genitourinary cancers in the United States. Methods: Mortality data for prostate, bladder, kidney, and testicular cancers were obtained from the Centers for Disease Control and Prevention (CDC) WONDER database between 1999 and 2020. Age-adjusted mortality rates (AAMRs) were analyzed by year, gender, race, urban-rural status, and geographic region using a significance level of p < 0.05. Results: Overall, AAMRs for prostate, bladder, and kidney cancer declined significantly, while testicular cancer-related mortality remained stable. Bladder and kidney cancer AAMRs were 3-4 times higher in males than females. Prostate cancer mortality was highest in black individuals/African Americans and began increasing after 2015. Bladder cancer mortality decreased significantly in White individuals, Black individuals, African Americans, and Asians/Pacific Islanders but remained stable in American Indian/Alaska Natives. Kidney cancer-related mortality was highest in White individuals but declined significantly in other races. Testicular cancer mortality increased significantly in White individuals but remained stable in Black individuals and African Americans. Genitourinary cancer mortality decreased in metropolitan areas but either increased (bladder and testicular cancer) or remained stable (kidney cancer) in non-metropolitan areas. Prostate and kidney cancer mortality was highest in the Midwest, bladder cancer in the South, and testicular cancer in the West. Discussion: Significant sociodemographic disparities exist in the mortality trends of genitourinary cancers in the United States. These findings highlight the need for targeted interventions and further research to address these disparities and improve outcomes for all populations affected by genitourinary cancers.

Comprehensive Systematic Review of Breast Implant Illness: Symptoms, Management, and Long-Term Outcomes.

BACKGROUND: Breast augmentation using silicone implants is common, with over 300,000 annual US surgeries. It was initially approved in 1962, there were safety concerns with the use of silicone implants, leading to a 1992-2006 FDA moratorium. Recently, Breast Implant Illness (BII) was described as a cluster of symptoms associated with silicone implants, with a lack of diagnostic criteria, which increased the likelihood of implant removal and a variety of treatment options. This comprehensive review aims to shed light on the extent, symptoms, management, and outcomes of BII. METHODS: Multiple electronic databases were systematically searched in May 2023 for studies on Breast Implant Illness utilizing terms related to BII and its symptoms, diagnosis, and treatment. Out of 1204 studies, 20 met the inclusion criteria and were included in the systematic review. The Newcastle-Ottawa Scale for the included cohort prospective and retrospective studies, and the tool for evaluating the methodological quality of case reports and case series were utilized during quality assessment. RESULTS: There were 20 papers on Breast Implant Illness published between 1995 and 2022, including a peak of papers published in 2020 and 2022. The majority of the studies came from the USA, with a variety of research methods, including case reports. Reports of arthralgia and fatigue were common findings. These symptoms were frequently alleviated by surgical procedures such as en bloc explantation and capsulectomy, highlighting the intricacy of the problem and the need for individualized treatment plans. CONCLUSION: The review underscores the critical need for further research into BII, advocating for a multidisciplinary strategy that prioritizes patient safety, informed decision-making, and comprehensive care. As the medical community progresses in understanding and managing BII, emphasizing evidence-based practices and patient-provider communication will be essential in addressing this complex condition effectively. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Incidental Diagnosis of Metastatic Colorectal Cancer in a Habitual Hookah Smoker: A Case Report Emphasizing Early Detection and Lifestyle Risks.

Colorectal cancer (CRC) is a major health concern and a significant contributor to global oncological mortality, influenced by genetic predisposition and lifestyle factors. Hookah smoking, prevalent in the Middle East, has been associated with an increased risk of various cancers, including CRC. This case report discusses the incidental discovery of metastatic CRC in a 42-year-old habitual hookah smoker, shedding light on the potential association between hookah use and CRC pathogenesis. Additionally, it addresses the diagnostic complexities posed by the asymptomatic nature of CRC, often identified through non-specific indicators such as abnormal liver enzymes. Furthermore, the case illustrates the crucial role of family medicine in detecting diseases, highlights the significance of multidisciplinary care in managing advanced CRC, and emphasizes the importance of public health initiatives to raise awareness about the risks of hookah smoking and promote regular health screenings in at-risk populations.

Predictors of forniceal rupture in patients with obstructing ureteral calculi: Analysis of multicenter data.

Background: Renal forniceal rupture (FR) is a unique complication of obstructive uropathy. This study aimed to identify the predictors of FR among patients presenting with renal colic due to obstructing ureteral calculi. Materials and Methods: After obtaining ethics approval, electronic records of patients from three National Guard hospitals in Saudi Arabia were reviewed between 2016 and 2020 to identify patients who presented with renal colic and were diagnosed with FR due to obstructive ureteric stones (FR group). An equivalent number of consecutive patients presenting with renal colic due to obstructing ureteric stones without FR was selected as a control group (non-FR group). Patients were grouped according to age group (<30, 30-40, 41-50, and >50 years), body mass index (BMI) class, gender, comorbidities, grade of hydronephrosis, location of the stone in the ureter, size of the stone (<3 mm, 3-7 mm, and >7 mm), and stone former status. Baseline patients' and stone characteristics were compared, and a regression analysis was performed to identify predictors of FR. Results: A total of 50 patients with FR were identified, and a control group of 50 patients without FR were selected. The baseline patients' and stone demographic characteristics in terms of age (P = 0.42), gender (P = 0.275), BMI (P = 0.672), comorbidity, grade of hydronephrosis (P = 0.201), and stone location (P = 0.639) were comparable between the FR group and the non-FR group. However, the stone size was statistically significant between both groups (P = 0.014). On multivariable analysis, it was found that the stone size was associated with a significantly higher increase in the incidence of FR (odds ratio [OR]: 6.5 [1.235-34.434]; P = 0.027). Furthermore, the age group between 30 and 40 years was potentially at a lower risk for FR (OR: 0.262 [0.069-0.999]; P = 0.049). Conclusion: This multicenter study showed that the stone size 3-7 mm had a six-fold increase in the chance of FR, and the age group between 30 and 40 years is potentially at a lower risk for FR.

Efficacy of Exclusive Fat Grafting for Breast Reconstruction: An Updated Systematic Review and Meta-analysis.

BACKGROUND: Exclusive fat grafting is an alternative method to implant- or flap- based reconstruction techniques following mastectomies or breast conservation therapies. Its efficacy has been explored before but new data has come to light, resulting in previous results becoming outdated. Concerns have also been raised about the oncological safety of this procedure which must be evaluated alongside the efficacy to gain a comprehensive understanding of the merits of this alternative technique. METHODS: We queried the PubMed electronic database from its inception until August 2023 for studies evaluating the efficacy and oncological safety of exclusive fat grafting breast reconstruction following cancer-related mastectomy or breast conservation therapy. Results of the analysis were pooled and presented as means or valid proportions. Results of the analysis were pooled using a random-effects model and presented with 95% confidence intervals (95% CIs) where appropriate. RESULTS: 41 studies were included in our analysis. Pooled results show that on average, 1.7 sessions of exclusive fat grafting were required to complete reconstruction in Breast Conservation Therapy (BCT) patients, with an average volume of 114.2 ml being injected. For mastectomy patients with irradiated breasts, 4.7 sessions were needed on average with 556.8 ml being required to complete reconstruction, compared to their non-irradiated Counterparts requiring only 2.6 sessions and 207.2 ml to complete reconstruction. Oncological recurrence events were found in 29/583 non-irradiated mastectomy patients (p = 0.014) and in 41/517 BCT patients (p = 0.301) CONCLUSION: Exclusive fat grafting is an oncologically safe and reasonably efficacious alternative to more common methods of breast reconstruction. More data is needed to fully characterize the oncological safety of this procedure in irradiated and non-irradiated mastectomy patients. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Topical minoxidil reported hair discoloration: a cross-sectional study.

Minoxidil is a widely utilized medication androgenic alopecia. An original investigation on its potential to cause hair darkening in treated people is lacking. We conducted an observational study using two face-validated questionnaires that dermatologists altered to assess minoxidil's hair discolouration risk. This Saudi Arabian survey collected data in October and November 2022. One questionnaire targeted the population, while the other targeted dermatologists. Survey 1 included 453 patients, 56.7% of whom were 18-24 and mostly female. It's interesting that 26% (n=118) detected hair greying and 14.8% (n=67) noticed other color changes. With P-values of 0.0001, longer-term minoxidil users and those with a family history of hair greying had higher hair discolouration. Dermatologists completed Survey 2 (57 participants). Nearly 60% of dermatologists have ten years of experience. 42.1% of dermatologists saw grey hair after minoxidil use. 17.5% of doctors blame minoxidil for hair graying. This observational study examined the data of over 400 patients to determine if minoxidil could cause hair discoloration. Based on the data, we hypothesize that this drug may cause hair discoloration with prolonged use and in people with a family history of hair greying.

Effective Collaboration in the Surgical Management of Macroglossia in Beckwith-Wiedemann Syndrome.

Beckwith-Wiedemann syndrome (BWS) is a complex congenital overgrowth disorder necessitating a multidisciplinary approach for effective management. A 5-year-old Saudi girl with BWS received comprehensive care involving various specialists, including a plastic surgeon who performed a keyhole technique tongue reduction to address macroglossia. The intervention resulted in significant improvements in speech and quality of life, with no postoperative complications. Intensive speech therapy further enhanced speech development. This case report emphasizes the importance of a multidisciplinary approach and the critical role of the plastic surgeon in managing BWS patients with macroglossia to achieve optimal outcomes.

A Systematic Evaluation of the Quality of Health Information on Cleft Lip and Palate in the Arabic Language.

Background: The internet serves as a vital health information resource, yet the quality of data on specific health conditions, especially in Arabic, is often overlooked. This research assesses the quality of Arabic online information about cleft lip and palate (CLP) and proposes avenues for enhancement. Methods: From July to August 2022, a systematic evaluation of Arabic articles on CLP was performed using the DISCERN tool for quality assessment. Searches on Google and Bing resulted in 119 articles that met the study's criteria. Results: The quality of available Arabic information on CLP displayed substantial gaps. Commercial sources dominated (49.6%), followed by private (32.8%) and nonprofit entities (17.6%). The average DISCERN score was 2.26 of 5 (SD = 1.06), indicating the need for enhanced content, particularly concerning treatment risks. Conclusions: The study underscores the subpar quality of Arabic CLP information online, which might mislead patients and impede access to accurate advice. Nonprofit organizations should bolster their online footprint, offering refined health content. A deep dive into DISCERN scores reveals pinpointed improvement areas. Clinicians should direct patients and their families to reliable information sources. Addressing these gaps promises improved CLP knowledge in Arabic, fostering superior patient education and outcomes for those with this condition.

Top 50 Highly Cited Publications in Facelift Surgery: A 50-Year Bibliometric Analysis Review.

INTRODUCTION: Facelift surgery, also known as rhytidectomy, is a commonly performed procedure to address aging-related changes in the face and neck. Over the years, its techniques and methodologies have evolved. This study aimed to provide a bibliometric analysis of the top 50 most cited publications related to facelift surgery over a fifty-year period (1973-2023). METHODS: The authors obtained data from the Web of Science Core Collection on July 15, 2023. Using a predefined search strategy, the most cited articles from 1973 to 2023 on facelift surgery were identified. The publications were analyzed for their type of study, journal of publication, geographic origin, and primary outcomes. Furthermore, the authorship gender distribution was assessed. RESULTS: The majority of the publications (34 out of 50) were published in the "Plastic and Reconstructive Surgery" journal. The USA contributed to 72% of the research, followed by the UK, Mexico, Australia, and Germany. The primary outcomes varied from surgical techniques, anatomical studies, risk factors, patient-specific outcomes, and facial rejuvenation techniques, to comparative and historical progression of techniques. Notably, male authors dominated the field with 47 out of 50 papers having both a first and senior male author. CONCLUSION: Facelift surgery has seen substantial research development over the past fifty years. The USA has been at the forefront of this research, with a predominant focus on surgical techniques and anatomical studies. Male dominance in authorship indicates potential scope for increased gender diversity in this specialty. Annual updates are recommended for continued insights. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Pediatric Burns: A Systematic Review and Meta-Analysis on Epidemiology, Gender Distribution, Risk Factors, Management, and Outcomes in Emergency Departments.

Pediatric burns pose a significant public health concern, ranking as the fifth most common nonfatal injury globally. This review consolidates data on the epidemiology, outcomes, and management of pediatric burns presenting to emergency departments. A systematic review was conducted across multiple databases, yielding 22 articles from 1992 to 2020. Utilizing the methodological index for non-randomized studies (MINORS) instrument, non-comparative studies scored from 2 to 11 with an average of 6.87, while comparative studies ranged from 12 to 16, averaging 13.67. The review included a total of 828,538 pediatric patients who were evaluated in the systematic review. Predominantly male victims ranged from 53% to 83%. The youngest victims were aged between 0 to 4 years. Burn etiology was largely attributed to scalds. A majority suffered from second-degree burns, with some studies reporting up to 89%. Limited data on total body surface area (TBSA) were documented, with only 2.5% requiring hospitalization. Common interventions included immediate resuscitation and skin grafting. Essential areas for future research are identified, including household risks, pre-treatment decisions, and the significant role of family dynamics in burn injury recovery. Pediatric burns remain a considerable concern, particularly among males and in household environments. The data underline the imperative for prevention strategies and optimized emergency care to positively influence outcomes for burn victims. Future research areas range from evaluating pre-treatment decisions to assessing community awareness regarding burn first aid.

Can a Machine Ace the Test? Assessing GPT-4.0's Precision in Plastic Surgery Board Examinations.

Background: As artificial intelligence makes rapid inroads across various fields, its value in medical education is becoming increasingly evident. This study evaluates the performance of the GPT-4.0 large language model in responding to plastic surgery board examination questions and explores its potential as a learning tool. Methods: We used a selection of 50 questions from 19 different chapters of a widely-used plastic surgery reference. Responses generated by the GPT-4.0 model were assessed based on four parameters: accuracy, clarity, completeness, and conciseness. Correlation analyses were conducted to ascertain the relationship between these parameters and the overall performance of the model. Results: GPT-4.0 showed a strong performance with high mean scores for accuracy (2.88), clarity (3.00), completeness (2.88), and conciseness (2.92) on a three-point scale. Completeness of the model's responses was significantly correlated with accuracy (P < 0.0001), whereas no significant correlation was found between accuracy and clarity or conciseness. Performance variability across different chapters indicates potential limitations of the model in dealing with certain complex topics in plastic surgery. Conclusions: The GPT-4.0 model exhibits considerable potential as an auxiliary tool for preparation for plastic surgery board examinations. Despite a few identified limitations, the generally high scores on key parameters suggest the model's ability to provide responses that are accurate, clear, complete, and concise. Future research should focus on enhancing the performance of artificial intelligence models in complex medical topics, further improving their applicability in medical education.

ChatGPT Conquers the Saudi Medical Licensing Exam: Exploring the Accuracy of Artificial Intelligence in Medical Knowledge Assessment and Implications for Modern Medical Education.

Background The application of artificial intelligence (AI) in education is undergoing rapid advancements, with models such as ChatGPT-4 showing potential in medical education. This study aims to evaluate the proficiency of ChatGPT-4 in answering Saudi Medical Licensing Exam (SMLE) questions. Methodology A dataset of 220 questions across four medical disciplines was used. The model was trained using a specific code to answer the questions accurately, and its performance was assessed using key performance indicators, difficulty level, and exam sections. Results ChatGPT-4 demonstrated an overall accuracy of 88.6%. It showed high proficiency with Easy and Average questions, but accuracy decreased for Hard questions. Performance was consistent across all disciplines, indicating a broad knowledge base. However, an error analysis revealed areas for further refinement, particularly with category (Option) A questions across all sections. Conclusions This study underscores the potential of ChatGPT-4 as an AI-assisted tool in medical education, demonstrating high proficiency in answering SMLE questions. Future research is recommended to expand the scope of training and evaluation as well as to enhance the model's performance on complex clinical questions.

An unusually high prevalence of isolated prostatic ductal adenocarcinoma among Saudi patients: A registry-based study.

Objective: We conduct a secondary analysis on the demographics, tumor characteristics, survival, and risk factors for mortality among patients with prostatic ductal adenocarcinoma (PDA) in the Kingdom of Saudi Arabia (KSA). Methods: This is a registry-based retrospective study that included all patients diagnosed with prostate cancer in the KSA. The data were collected from the Saudi Cancer Registry, which collects tumor data from all private, military, and health ministry hospitals in Saudi Arabia through five regional offices. Results: Among 3607 prostate cancer patients detected during the specified period, 209 (5.8%) had ductal adenocarcinoma. The median interquartile range age of patients was 72.0 years (64.0-78.0). Adenocarcinoma lesions were malignant among all the patients. Grade III tumors were most frequently apparent lesions (61.2%), followed by Grade II tumors (26.3%), Grade I tumors (7.2%), and Grade VI tumors (5.3%). A total of 33 patients died, representing 15.8% of the whole sample. The 1-year survival rate was 78.1%. More than a third of patients who were residing in the Western region deceased (38.0%), whereas no deaths were reported in other regions with a statistically significant difference based on regions (P < 0.001). Conclusion: To the best of our knowledge, this is the first registry-based study to investigate PDA in the KSA; these efforts were done to further understand this deadly condition and to further enhance patient care in the KSA.

Effect of Tranexamic Acid on the Reduction of Blood Loss in Craniosynostosis Surgery: A Systematic Review and Meta-analysis.

Although many published studies have investigated the benefits of tranexamic acid (TXA) in reducing perioperative bleeding, no large meta-analysis has been conducted to demonstrate its overall benefit. Methods: A systematic review was performed by following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. PubMed, Cochrane, Ovid, Embase, Web of Science, ClinicalTraisl.Gov, and Scopus databases were searched for articles reporting the benefit of TXA in reducing perioperative bleeding in craniosynostosis surgery from establishment through October 2022. The results of our meta-analysis were pooled across the studies using a random-effects model, and presented as a weighted mean difference with 95% confidence interval (95% CI). Results: The database search yielded 3207 articles, of which 27 studies with a corresponding number of 9696 operations were eligible. The meta-analysis included only 18 studies, accounting for 1564 operations. Of those operations, 882 patients received systemic TXA, whereas 682 patients received placebo (normal saline), no intervention, low dose TXA, or other control substances. This meta-analysis demonstrated a significant beneficial effect of TXA in reducing perioperative bleeding, particularly when compared with other controlled substances, with a weighted mean difference of -3.97 (95% CI = -5.29 to -2.28). Conclusions: To our knowledge, this is the largest meta-analysis in the literature investigating the benefit of TXA in reducing perioperative blood loss in craniosynostosis surgery. We encourage implementing TXA-protocol systems in hospitals after the appraisal of the data presented in this study.

Establishment of Saudi Arabia's Plastic Surgery Interest Club: First-year Outcomes and Future Directions.

The purpose of this article is to share our first-year outcomes and the overall impact of the plastic surgery interest club (PSIC) since its establishment, and to discuss the future directions that any interested club may follow and benefit from. Methods: This cross-sectional study utilized a self-developed questionnaire that experts in the field revised. The authors recruited active PSIC members during the year 2021-2022 to assess the overall impact of the club in their various interests of the field as well as to have an overview of their opinions of this newly done initiative in Saudi Arabia. The data collection spanned from October 2021 to September 2022. Results: The authors analyzed the responses from 66 active members with a response rate of 78%. We found various significant positive impacts of the PSIC in the community of plastic surgery in Saudi Arabia. There was a significant difference in the interest in pursuing a career in plastic surgery before and after being a member of PSIC, with a P value of 0.0001. The members became noticeably more interested in pursuing an academic career and publishing field data after enrolling in PSIC research activities. Conclusions: The authors provided an analysis of 1-year outcomes of the PSIC in Saudi Arabia; there were many positive impacts of such an initiative in enhancing the local community of plastic and reconstructive surgery. The authors strongly encourage the adaption of such initiatives in various parts of the globe to develop the field of plastic surgery further.

Botulinum toxin type A for lower limb lengthening and deformity correction: A systematic review and meta-analysis.

BACKGROUND: Botulinum toxin type A (BTX-A) is the most popular therapeutic agent for muscle relaxation and pain control. Lately, BTX-A injection received great interest as a part of multimodal pain management for lower limb lengthening and deformity correction. This systematic review aimed to determine the role of BTX-A injection in pain management for during lower limb lengthening and/or deformity correction. METHODS: We searched Medline, Embase, and CENTRAL. We included randomized controlled trials (RCTs) that compared the BTX-A injection to placebo for individuals undergoing lower limb lengthening and/or deformity correction. We sought to evaluate the following outcomes: pain on visual analogue scale (VAS), range of motion parameters, average opioid consumption, and adverse events. The standardized mean difference (SMD) was used to represent continuous outcomes while risk ratio (RR) was used to represent dichotomous outcomes. RESULTS: A total of 4 RCTs that enrolled 257 participants (337 limbs) deemed eligible. Adjuvant BTX-A injection showed a significant reduction in post-operative pain compared to placebo (SMD = -0.28, 95% CI -0.53 to -0.04). No difference was found between BTX-A injection and placebo in terms of range of motion parameters, average opioid consumption, or adverse events after surgical limb lengthening and/or deformity correction (RR = 0.77, 95% CI -0.58 to 1.03). CONCLUSIONS: Adjuvant BTX-A injection conferred a discernible reduction in post-operative pain during surgical limb lengthening and/or deformity without increasing the risk of adverse events. PROSPERO REGISTRATION NUMBER: CRD42021271580.

Insertable cardiac monitoring devices versus external cardiac monitoring for detecting atrial fibrillation and preventing the recurrence of stroke: A systematic review and meta-analysis.

BACKGROUND: Atrial Fibrillation (AF) is a major risk factor for stroke, which is the second leading cause of death worldwide. It remains uncertain whether insertable cardiac monitors (ICMs) enhance the ability to recognize AF over external cardiac monitoring in patients who have experienced a stroke. AIM: We conducted a systematic review and meta-analysis to determine whether ICM devices are more effective than external cardiac monitoring for the detection of AF in stroke patients. METHODS: We included studies that reported an AF detection rate in stroke patients with a follow-up of at least 12 months. We analyzed the data of 1233 patients from 3 randomized control trials (RCTs). RESULTS: When compared to external cardiac monitoring, ICM devices (Medtronic Reveal LINQ and Reveal XT) showed a significantly higher detection rate of AF (RR = 5.04, 95% CI = 2.93-8.68; p < 0.05; ARR = 10.47%, NNT = 10). The ICM arm had significantly higher usage of oral anticoagulants (OAC) as compared to the control arm. (RR = 2.76, 95% CI = 1.89-4.02, p < 0.05). Additionally, ICM usage was associated with a higher incidence of mild to moderate adverse events (RR = 10.52, 95% CI =1.35-82.14; p = 0.02) and a higher number of severe adverse events as compared to the control arm (RR = 7.61, 95% CI = 1.36-42.51; p = 0.02). CONCLUSION: ICM devices are associated with better detection rates of AF and higher usage of OAC as compared to external cardiac monitoring in post-stroke patients. However, ICM insertion is associated with a higher incidence of mild/moderate and severe adverse effects.

A Systematic Literature Review of the Clinical Presentation, Management, and Outcome of Gestational Gigantomastia in the 21st Century.

BACKGROUND: Gestational gigantomastia (GG) is an uncommon pregnancy condition, and the underlying cause of GG has yet to be determined. Medical management and surgery are two treatment options for GG, and breast reduction or mastectomy with delayed reconstruction is the only available surgical option. We have conducted this systematic review to summarize and critically analyze all the GG data in the literature. METHODS: The preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines were adhered to in reporting this article. A systematic search was conducted in February 2022 for published case reports and case series on GG using the PubMed, MEDLINE, and Cochrane databases. The following keywords were used: macromastia, gestational gigantomastia, and gestational. RESULTS: A total of 639 articles were searched, and only 66 case reports published between 1962 and 2022 were included. The mean patient's age at presentation was 28.79 years old. The majority of the patients were in their first trimester (n = 23, 47%). The main complaint was rapid bilateral breast enlargement (n = 54, 80.59%). Bromocriptine was the most common medical management used (n = 19/35, 54.28%). Bilateral breast reduction was the most common surgery (n = 24/48, 50%). Most patients had uneventful recovery (n = 40/54, 74.07%). CONCLUSION: Gigantomastia is a difficult condition, in terms of its management. We have found that surgery is the gold-standard among all the cases reported; while Bromocriptine was the most commonly administered medical therapy. This systematic review provides a guideline for plastic surgeons to better facilitate their care of these patients. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Venous Thromboembolism Risk Assessment Models in Plastic Surgery: A Systematic Review and Meta-Analysis.

Postoperative venous thromboembolism (VTE) is the most common complication of plastic surgery procedures. Diverse risk assessment models (RAMs) exist to stratify patients by VTE risk, but due to a lack of high-quality evidence and heterogeneity in RAM data, there is no recommendation regarding RAM that can be used for plastic surgery patients. This study compares the reliability and outcomes of Caprini and American Society of Anesthesiologists (ASA) physical status classification RAMs used in plastic surgery to help surgeons stratify the risk of VTE. Methods: MEDLINE and Embase databases were searched between February 2010 and December 2021. All published English articles that report the incidence of VTE stratified by a RAM among patients who underwent plastic surgery were included. The results of the presented meta-analysis were pooled using a random-effects model. Results: The database search revealed 809 articles, out of which eight studies (n = 1,348,606) were eligible. Out of the eight studies, six utilized the Caprini score, and three utilized ASA score. Super-high-risk patients were significantly more likely to present with VTE than their high-risk [odds ratio (OR), 2.92; 95% confidence interval (CI), 1.26-6.78], medium-risk (OR, 5.29; 95% CI, 2.38-11.79), or low-risk counterparts (OR, 10.00; 95% CI, 2.32-43.10) at Caprini score. High-risk patients in ASA score showed significant increase in VTE incidents (OR, 2.72; 95% CI, 1.10-6.72). Conclusions: Both Caprini and ASA RAMs showed compelling evidence of efficacy in our study. However, the Caprini RAM is more predictive of postoperative VTE incidents in high-risk plastic surgery patients than the ASA grading system.