Intradermal Incobotulinum Toxin A for Postbreast Cancer Treatment Asymmetry: A Literature Review and Case Report.

BACKGROUND: Botulinum toxin (BTX) is globally the most common aesthetic procedure. Its usage has expanded beyond facial treatments to therapeutic areas, including managing scars and postsurgical deformities. Breast cancer survivors often face significant deformities and asymmetry during recovery. OBJECTIVES: This study systematically reviewed literature from the past 4 years on botulinum toxin applications in breast cancer survivors and presented a case report of a patient treated with Incobotulinum toxin (IncoBonTA; Xeomin, Merz Pharmaceuticals GmbH, Frankfurt, Germany) for left breast deformity postchemotherapy and radiotherapy. METHODS: Following PRISMA guidelines, a systematic search was conducted on PubMed and Scopus using keywords: "botulinum toxin," "breast cancer," and "breast asymmetry," identifying relevant literature from 2020 to 2024. Five full-text articles were included. Additionally, a 2024 case report of a patient with significant breast asymmetry postsurgery and radiotherapy was published. RESULTS: The literature review indicated botulinum toxin's primary uses in breast cancer include pain management, upper limb impairment, postsurgical scars, and capsular contracture. Although some benefits were reported, further research is needed. In the case report, the patient was treated in one session with IncoBonTA at two different dilutions based on contracture severity without complications. CONCLUSION: The review showed promising advances in using botulinum toxin for deformities secondary to oncological treatment in breast cancer patients. The therapy was administered to a 53-year-old patient, resulting in significant aesthetic improvement, especially at the nipple and areola, suggesting that it was a viable option for these patients.

The impact of clinical seizures and adverse brain MRI patterns in neonates with hypoxic-ischemic encephalopathy and abnormal neurodevelopment.

INTRODUCTION: This study aimed to investigate the associations among seizures, clinical characteristics, and brain injury on Magnetic Resonance Imaging (MRI) in infants with Hypoxic Ischemic Encephalopathy (HIE), and to determine whether these findings can predict unfavorable neurodevelopmental outcomes. METHOD: Clinical and electrographic seizures were assessed by amplitude-integrated electroencephalogram, and the extent of brain injury was evaluated by using MRI. At 12‒24 months of age, developmental impairment or death was assessed. Between 2012 and 2020, 143 newborns were admitted for HIE, and 8 infants were excluded from the study. RESULTS: Eighty-five infants were diagnosed with greater than moderate HIE and 65 infants underwent therapeutic hypothermia. In addition, 38 infants experienced clinical seizures (clinical seizure group, CSG), 49 infants had electrographic seizures (Electrographic Seizure Group, ESG), and 48 infants had no seizures (no seizure group, NSG). The proportion of infants with neurodevelopmental impairment or death was significantly higher in the CSG than in the NSG (57.7 % and 26.1 %, p = 0.026). A risk factor analysis indicated that cord blood pH (adjusted Odds Ratio [aOR = 0.01]; 95 % Confidence Interval [95 % CI 0.001‒0.38]; p = 0.015) and MRI findings (aOR = 4.37; 95 % CI 1.25‒15.30; p = 0.012) were independently associated with abnormal neurodevelopment, after adjustment. DISCUSSION: Clinical seizures in infants with HIE were independently associated with abnormal neurodevelopment. However, cord blood pH and abnormal brain MRI findings were consistently linked to long-term neurodevelopmental outcomes.

Thyroid surgery under nerve auto-fluorescence & artificial intelligence tissue identification software guidance.

Thyroid cancer is a common malignancy that requires comprehensive clinical evaluation prior to adequate surgical management. Over the last three decades thyroid surgery has tripled and is considered one of the most commonly performed procedures in general surgery. These procedures are associated with potential postoperative complications with significant deterioration in the patient's quality of life. While the current rates of recurrent laryngeal nerve injury following thyroidectomy have decreased secondary to intraoperative neuromonitoring, thyroid surgery remains the leading cause of iatrogenic injury. The authors herein present a case of a thyroid nodule with cervical lymph node involvement undergoing total thyroidectomy guided by near-ultraviolet (NUV) imaging nerve auto-fluorescent technology to visualize, identify and protect vital structures.

Dietary pattern and risk of thyroid cancer: a systematic review and meta-analysis protocol.

INTRODUCTION: Until now, the thyroid cancer case number has increased, and it is not entirely possible to attribute this continuous growth to more meticulous thyroid nodule selection and more accurate diagnostic techniques. While there is currently no conclusive evidence linking dietary factors to thyroid cancer, certain dietary patterns seem to have an impact on the development of the disease. There are interesting connections among diet, environment, metabolism and thyroid carcinogenesis; a deeper comprehension of the underlying mechanisms should help the identification of modifiable risk factors for thyroid cancer. This protocol aims to guide a systematic review and meta-analysis of the literature to search for an association between dietary pattern and risk of thyroid cancer. METHODS AND ANALYSIS: The databases to search for observational studies will be PubMed, Embase, Scopus, Web of Science and LILACS, from inception to 10 December 2024. No language limitation or publication period will be imposed. The outcome will be the patients with thyroid cancer. Three impartial reviewers will choose the studies and extract data from the original publications. The Newcastle-Ottawa Quality Scale will assess the risk of bias, and the certainty of the evidence will be achieved by using the Grading of Recommendations Assessment, Development and Evaluation. The R (V.4.3.1) will be performed for data synthesis, and to measure heterogeneity, we will compute the I2 statistics. Additionally, a quantitative synthesis will be performed if the included studies are sufficiently homogenous. ETHICS AND DISSEMINATION: It is not necessary to acquire ethical approval, as this study will be a review of the published data. A peer-reviewed publication will publish the systematic review's findings. PROSPERO REGISTRATION NUMBER: International Prospective Register of Systematic Reviews (PROSPERO) CRD 42023463802.

Acute severe ulcerative colitis: defining the precise moment for colectomy.

INTRODUCTION: Acute severe ulcerative colitis (ASUC) is a critical manifestation of ulcerative colitis (UC), often necessitating colectomy when medical management fails. Despite advancements in therapeutic interventions such as corticosteroids, biologics, and JAK inhibitors, a significant proportion of patients require surgery, with colectomy rates ranging from 10% to 15%. AREAS COVERED: This paper reviews the factors influencing the timing and necessity of colectomy in ASUC management, emphasizing the importance of multidisciplinary decision-making involving gastroenterologists and surgeons. EXPERT OPINION: Key surgical indications include failure of medical therapy, toxic megacolon, perforation, uncontrolled bleeding, and systemic deterioration. Delays in surgery can result in higher morbidity and mortality rates, making timely intervention essential. This review highlights surgical techniques, including total colectomy and end ileostomy, and discusses potential complications, urging a balanced approach to optimize patient outcomes.

Effectiveness of a protocol with antimicrobial photodynamic therapy for treating osteoradionecrosis: a retrospective study.

OBJECTIVE: To compare the treatment of osteoradionecrosis (ORN) using a protocol that incorporates antimicrobial photodynamic therapy with a conventional treatment protocol. METHODOLOGY: This retrospective study analyzed 55 patients diagnosed with ORN at a reference hospital between 2002 and 2021. Patients were treated using two different clinical protocols. Clinical treatment success was defined as the epithelialization of the ORN lesion, along with the absence of pain and local infection. RESULTS: A total of 53 ORN lesions were included, with a median development time of 30 months. The patient cohort was predominantly male (83.02%), with a median age of 58 years. The main causes of ORN were prosthetic trauma (28.30%) and dental extractions due to infection (32.07%). Good oral hygiene and hygiene of the lesion were identified as protective factors for achieving clinical success, with a significant correlation to lesion epithelialization (p ≤ 0.0001). ORN developed more rapidly in tumors of the oral cavity, with a median time of 8 months, compared to oropharyngeal tumors, which had a median time of 39 months (p = 0.01). CONCLUSION: The proposed treatment protocol, which includes antimicrobial photodynamic therapy, demonstrated greater effectiveness compared to the conventional protocol, achieving clinical success in 75% of the lesions analyzed in a shorter timeframe (p ≤ 0.0001). Additionally, maintaining proper oral and lesion hygiene is crucial for successful outcomes, and ORN develops more rapidly in patients with oral cavity tumors.

Pulmonary Artery Endograft Implantation Using a Parallel Stent Grafting Technique to Enable the Treatment of a Bronchial Anastomosis Complication After Lung Transplantation.

BACKGROUND: Bronchial stenosis associated with bronchial anastomosis dehiscence after lung transplantation is a catastrophic complication following lung transplantation with a paucity of therapeutic solutions. PURPOSE: To describe an adaptation of the parallel stent grafting technique in the pulmonary arterial territory to treat this challenging situation. RESEARCH DESIGN: This is a case report of a 52-year-old patient who presented bronchus stenosis and bronchial anastomosis dehiscence after lung transplantion. Bronchial stenting and lung retransplantation were contraindicated. Therefore, an endovascular approach using pulmonary artery endograft placement to prevent bleeding during repeated right bronchial balloon dilation was propposed. The technique consists of the deployment of an aortic extender endoprosthesis in the right main pulmonary artery and a balloon expandable stent in the upper lobe pulmonary artery (using a parallel graft configuration) through the common femoral and right internal jugular veins, respectively. Intraoperative transesophageal echocardiogram and one-lung ventilatory ventilation are needed. RESULTS: The patient underwent a new bronchoscopy 16 days after the procedure, that showed epithelization at the previous eroded zone, enabling bronchocopic balloon dialtion to be safely performed. A post-operative contrast-enhanced CT scan revealed an adequate positioning of the stent grafts. Despite all eforts, the patient succumbed to ventilator associated pneumonia on postoperative day 108. DATA ANALYSIS: The technique's advantages include its feasibility even in situations in which other techniques may be contraindicated and its potential use in emergencies. Its limitations include the need for experienced interventionists to perform it, and the potential risk of acute tricuspid regurgitation. CONCLUSION: This study illustrates the early feasibility of the parallel stent grafting technique applied to the pulmonary artery territory. However, it's safety profile regarding infectious risk was not demontrated.

Comparing Parent Perception of Neurodevelopment after Primary versus Staged Repair of Neonatal Symptomatic Tetralogy of Fallot.

OBJECTIVE: To assess the association between primary and staged repair of neonatal symptomatic tetralogy of Fallot (sTOF) and neurodevelopmental outcomes in preschool through school-age children. STUDY DESIGN: Multicenter cohort (n = 9 sites) study of patients with sTOF who underwent neonatal intervention between 2005 and 2017. The neurodevelopmental outcomes measures included caregivers' ratings of executive function with the Behavior Rating Inventory of Executive Function, and psychosocial functioning with the Behavior Assessment System for Children - third Edition (BASC-3). Results were compared with normative data and by treatment strategy (primary repair vs staged repair). A parent survey assessed history of disabilities and access to services related to neurodevelopment. RESULTS: Although the majority of patients (median age 8.3 years, IQR 5.7-11.2) had median Behavior Rating Inventory of Executive Function and BASC-3 scores within the normal range, a proportion had clinically elevated (abnormal) scores, especially in the school-age patient subgroup (Behavior Rating Inventory of Executive Function 24%-30% and BASC 20%-37%). There were no statistically significant differences based on treatment strategy for either the Behavior Rating Inventory of Executive Function or BASC-3. However, lower birth weight, genetic syndrome, and medical complexity were significantly associated with worse executive function, and lower maternal education was associated in school-age children with lower executive and psychosocial functioning. Ongoing disabilities were relatively common (learning disability 35%, speech delay 33%, developmental delay 31%), although up to 50% of children were not receiving educational or developmental services. CONCLUSIONS: Elevated executive and psychosocial concerns are present in the patient population with sTOF. Although initial treatment strategy appears unrelated to neurodevelopmental outcomes, lower birth weight, genetic syndrome, and medical complexity and lower maternal education are risk factors. Early recognition of neurodevelopmental concerns can facilitate access to appropriate neurodevelopmental services in this high-risk group.

Hypercalcemia and Acute Kidney Injury Associated with Disseminated Paracoccidioidomycosis.

Paracoccidioidomycosis is an acute to chronic systemic mycosis caused by the fungi Paracoccidioides. Hypercalcemia is a rare and not fully understood presentation of this infection. We present a case report of paracoccidioidomycosis associated with hypercalcemia and acute kidney injury (AKI) in an immunocompetent patient. An immunocompetent 30-year-old man from Brazil presented with papular erythematous-violaceous skin lesions, disseminated lymphadenopathy, pain in the left hypochondrium, fever with night sweats, and loss of 25 kilograms in 5 months. The result of a biopsy of the lesions was positive for Paracoccidioides brasiliensis. Laboratory findings were high total calcium and 1,25-dihydroxy vitamin D, with low parathyroid hormone, low albumin, and AKI. Computed tomography scans revealed splenic infarcts without bone lesions. Treatment was performed with methylprednisolone and liposomal amphotericin B. Calcium levels and kidney function normalized within 20 days of hospitalization. The patient was discharged 49 days after admission. A follow-up 6 months later revealed total clinical and serological remission.

Efficacy and safety of narrowband ultraviolet B phototherapy for prurigo nodularis: a tertiary center experience.

BACKGROUND: Prurigo nodularis is a chronic pruritic dermatosis and narrowband-UVB (NB-UVB) phototherapy is considered an effective and safe treatment option in patients with multiple comorbidities. OBJECTIVE: In this study, the authors aimed to evaluate the efficacy and safety of NB-UVB phototherapy in the management of prurigo nodularis and to compare response rates according to lesions localization. METHODS: Thirty prurigo nodularis patients who had been treated with NB-UVB phototherapy were included in this study. The data for this study were retrieved retrospectively from patient follow-up forms in the phototherapy unit. RESULTS: NB-UVB phototherapy led to a complete response (CR) in 24 (80%) patients while partial response (PR) was achieved in 6 (20%) patients. Regarding prurigo nodularis localization, the CR rate was statistically higher in those with diffuse and central involvement (p < 0.05). Erythema and/or pruritus were observed in 4 (13.3%) patients with prurigo nodularis. STUDY LIMITATIONS: This study is limited because it is single-centered and has a retrospective design. CONCLUSIONS: NB-UVB phototherapy is an effective and safe treatment option for prurigo nodularis patients especially those with multiple comorbidities and using several medications. Patients with diffuse and central involvement may respond better to phototherapy than those with peripheral involvement.

Skin cancer after heart transplantation: a systematic review.

BACKGROUND: Cancer is an important cause of morbidity and mortality after solid organ transplants. Skin cancer is the most prevalent non-lymphoid malignancy occurring during heart transplantation follow-up. Due to the complexity of immunosuppressive therapy and the high prevalence and incidence of skin cancer in this population, dermatologists play an important role in the short and long-term follow-up of heart transplant recipients. OBJECTIVES: The goal of this study is to present data from a systematic literature review focusing on the occurrence of skin cancer in patients who have undergone heart transplantation. METHODS: The authors conducted a systematic review of the literature in the EMBASE and PubMed databases from August to September 2021 to investigate the incidence of skin cancer in heart transplant patients. The authors selected retrospective and prospective cohort studies presenting data on the frequency of skin cancer in patients following heart transplantation. Exclusion criteria included articles that did not stratify the organ transplant type and studies that did not evaluate the frequency of skin cancer in the specific population. RESULTS: Based on the search strategy, the authors found 2589 studies, out of which 37 were eligible for inclusion in this study. Provided data are from 20 different countries, over the period 1974 to 2015. Incidence of non-melanoma skin cancer (NMSC) ranges from 0.97% to 52.8%. The incidence of squamous cell carcinoma (SCC) ranges from 1.19% to 89% and the incidence of basal cell carcinoma (BCC) ranges from 2% to 63%. Malignant Melanoma (MM) incidence ranges from 0.94% to 4.6% STUDY LIMITATIONS: The analysis involved an exclusive focus on heart transplant patients, and the statistical analysis of the sample may have been hampered. The significant heterogeneity among the studies emerged as a challenge during the analysis of the results. Furthermore, the study is limited by variations in follow-up periods among the included studies. CONCLUSION: Although gathering methodologically heterogeneous data, this systematic review was able to show the epidemiological importance of skin cancer in heart transplant patients. This study reinforces the important role dermatologists play in the short and long-term follow-up of heart transplant patients.

Effect of Early Postoperative Mobilization on Functional Recovery, Hospital Length of Stay, and Postoperative Complications After Immediate Internal Pudendal Artery Perforator Flap Reconstruction for Irradiated Abdominoperineal Resection Defects: A Prospective, Randomized Controlled Trial.

BACKGROUND: Patients undergoing perineal defect reconstruction with the internal pudendal artery perforator (IPAP) flap traditionally face 5 days of postoperative bed rest (BR) to minimize surgical risks. However, prolonged BR can exacerbate postoperative physiologic changes such as increased fatigue, reduced body mass, and declining lung function, while also leading to complications such as pneumonia, delirium, deep vein thrombosis, and pressure injuries. This study assessed the effectiveness, feasibility, and safety of an adapted early mobilization (EM) program for these patients. METHODS: This prospective, randomized, controlled clinical study involved 51 patients assigned to adapted EM (n = 25) or BR (n = 26). Whereas EM included core exercises, orthostasis training, gait training, muscle strengthening, and aerobic exercises after surgery, BR followed standard bed rest protocols. The primary outcome was independent ambulation for 3 m on postoperative day 5. The secondary outcomes included 6-min walk test (6MWT) distances on days 5 and 30, hospital length of stay, healing time, postoperative complications, fatigue prevalence, and quality of life. RESULTS: On day 5, EM improved ambulation significantly compared with BR (68.0% vs 38.5%; P = 0.035) and achieved greater 6MWT distances on days 5 (108.78 vs 47.73 m; P = 0.041) and 30 (243.8 vs 166.29 m; P = 0.018). The EM patients were discharged earlier (66.7% by day 10 vs 33.3% of the BR patients; P = 0.043), with comparable healing times (P = 0.06) and postoperative complication rates (68% vs 80.8%; P = 0.296). Fatigue prevalence and quality of life did not differ significantly between the two groups. CONCLUSION: Early mobilization after IPAP flap reconstruction is safe and feasible, promoting early ambulation and recovery and facilitating earlier discharge without increasing complications.

Treatment of lower limb telangiectasias with Nd: Yag 1064 nm laser with and without tumescent anesthesia - TTL technique.

INTRODUCTION: Transdermal laser is an option for varicous veins treatment, yet it may be painful. In this study, we will present a technique for performing tumescent anesthesia associated to transdermal laser (TTL) to reduce pain during treatment. OBJECTIVE: The study compares pain during treatment of telangiectasias in lower limb with and without tumescent anesthesia to offer a less painful procedure. METHODS: 50 CEAP C1 patients with bilateral telangiectasias on thighs underwent transdermal laser treatment, using tumescent anesthesia on one side and standard technique on the other. Pain was assessed via the Visual Analogue Scale. The outcomes were compared with Student's t-test. Significance was set at p < .05. RESULTS: Laser treatment without tumescent anesthesia resulted in a VAS pain score of 7.9, versus 0.0 with anesthesia, showing a significant statistical difference. CONCLUSION: Tumescent anesthesia and transdermal laser (TTL) is capable of reducing pain in laser treatment of telangiectasias and reticular veins.

Lower Extremity Arterial Calcification Predicts Referral to a Closed Unit After Primary Total Hip Arthroplasty.

BACKGROUND: We aimed to determine the association between lower extremity arterial calcification (LEAC) and referral to a closed unit (CU), length of stay, 90-day readmissions, and 1-year mortality in primary total hip arthroplasty (THA) patients. METHODS: We retrospectively analyzed 705 patients who underwent primary THA, identifying 64 patients (9.13%) who had LEAC and 641 who did not have LEAC. Patients who had LEAC were older (77 ± 10.0 versus 67 ± 11.5 years; P < 0.001) and had more comorbidities, except for a history of thromboembolic and oncologic diseases (P > 0.05). A preoperative antero-posterior pelvic radiograph was used to assess the presence of LEAC. Admission to CU, length of stay, 90-day readmissions, and 1-year mortality were recorded. A logistic regression model was used to identify risk factors for referral to CU. RESULTS: Patients who had LEAC had a higher incidence of admission to the intensive care unit (8 of 64 [12.5%] versus 8 of 641 [1.09%]; P < 0.001), a longer hospital stay (4.7 ± 1.8 versus 4.2 ± 1.3 days; P = 0.006), more readmissions (16 of 64 [25%] versus 33 of 641 [5.15%]; P < 0.001), and a higher 1-year mortality rate (6 of 64 [9.3%] versus 0 of 641 [0%]; P < 0.001) than patients who did not have LEAC. Of the patients who had LEAC admitted to CU, only 3 of 8 had a previous indication to do so in the preoperative assessment performed by the Department of Anesthesiology, while all non-LEAC ones referred to CU did so. Logistic regression analysis showed that LEAC was a risk factor for admission to CU (odds ratio = 4.77; 95% confidence interval: 1.12 to 20.25; P = 0.034). CONCLUSIONS: The presence of LEAC was a risk factor for transfer to CU, longer in-hospital stays, more readmissions, and a higher 1-year mortality rate. Identifying patients who have LEAC can aid in the preoperative assessment and risk stratification of patients planned for primary THA.

Epstein-Barr virus-associated post-transplant smooth muscle tumours in a kidney transplant patient.

We report on a 14-year-old girl who developed post-transplantation smooth muscle tumours (PTSMT) located in the spleen, lungs, liver, and central nervous system (CNS), 4 years after kidney transplantation. She was asymptomatic, and the disease was detected during the work-up for a urinary tract infection. Diagnosis was performed by the analysis of a tissue specimen, through the biopsy of a lung tumour, which revealed a proliferation of spindle-shaped cells which were positive for actin and vimentin. In situ hybridization studies were positive for Epstein-Barr virus, and her serologic status was negative prior to transplantation. We reduced immunosuppression by stopping mycophenolate and switching tacrolimus for sirolimus. After 18 months of follow-up, she remains asymptomatic, and the CNS tumour reduced its diameter from 24 × 21 mm to 14 × 13 mm. PTSMT should be considered in the differential diagnosis of transplanted patients who develop neoplastic complications associated with immunosuppression.

Exocrine pancreatic insufficiency in a child with STEC-HUS: a forgotten complication.

BACKGROUND: Exocrine pancreatic insufficiency (EPI) is an extremely rare complication of hemolytic uremic syndrome related to Shiga toxin-producing Escherichia coli (STEC-HUS) and, to our knowledge, only one patient has been reported to have received pancreatic enzyme replacement therapy (PERT). Furthermore, STEC-HUS is not usually included among EPI causes. CASE DIAGNOSIS/TREATMENT: We report a 4-year-old girl with STEC-HUS who required dialysis and 4 days after admission developed acute pancreatitis (ACPAN) and diabetes mellitus (DM). Amylase and lipase normalized 15 days later but on the 73rd day of admission, she presented abdominal discomfort, bloating, and bulky and malodorous stools with a low fecal elastase-1 level (FE-1) of 15.74 µg/g confirming EPI diagnosis. She received 3 months of PERT until normalization of FE-1 levels. CONCLUSIONS: In children with STEC-HUS with ACPAN or DM, a high index of suspicion for EPI is required, since its symptoms are often mild, nonspecific, or delayed. In addition, STEC-HUS should be further recognized as a cause of secondary EPI.

Clinical and urodynamic findings in children and adolescents with neurogenic bladder undergoing augmentation cystoplasty: a systematic review.

BACKGROUND: Augmentation cystoplasty (AC) is a procedure to improve the clinical and urodynamic parameters of neurogenic bladder (NB) in children and adolescents refractory to other treatments. We performed a systematic review to investigate these parameters in children and adolescents with NB undergoing AC. METHODS: We followed PRISMA guidelines and searched electronic databases until March 2024 for studies involving patients aged three to 19 years diagnosed with NB undergoing AC. We assessed clinical and urodynamic parameters before and after surgery, focusing on improvements in urinary incontinence, vesicoureteral reflux (VUR), bladder capacity, compliance, and end filling detrusor pressure (EFP). RESULTS: A total of 212 NB patients underwent AC and were evaluated for urinary incontinence before and after surgery. Two studies showed a 76.5% to 78.9% improvement in incontinence without bladder outlet procedures (BOP). Another study found no significant difference in incontinence improvement rates between AC with and without BOP. The VUR resolution rate assessed in three studies ranged from 12.5 to 64%. Three studies showed a variation in bladder capacity from 52.8 to 70% of the expected bladder capacity pre-AC to 95.9 to 119%, post-AC. A fourth study showed a variation in bladder capacity from 87 ml pre-AC to 370 ml post-AC. Two studies showed a variation from 3.2 to 4.6 ml/cm H2O pre-AC to 13.7 to 41.3 ml/cm H2O post-AC in bladder compliance. The EFP in three studies varied from 37.2 to 47.6 cm H2O pre-AC to 11 to 17.4 cm H2O post-AC. CONCLUSION: After AC, urinary incontinence, bladder capacity, EFP, and bladder compliance improved in children and adolescents with NB.

Early Results of Fenestrated and Branched Endovascular Repair of Complex Aortic Aneurysms with a Custom-made National Device Available in the Brazilian Public Health System.

BACKGROUND: Multicenter studies conducted in developed countries demonstrated that custom-made devices are safe, effective, and durable for treating complex abdominal aneurysms. However, the situation in developing countries, such as Brazil, is different. Funding and time to have the endoprosthesis delivered are the major concerns. In order to overcome these conditions, high-volume Brazilian university hospitals started gaining experience with a custom-made device produced in the country. OBJECTIVE: The present study aimed to describe the practice of 2 tertiary centers and report the early results of fenestrated and branched endovascular repair of complex aortic aneurysms with a custom-made national device available in the Brazilian public health system. METHODS: Retrospective analysis of all consecutive patients that underwent fenestrated and branched endovascular aneurysm repair (F/BEVAR) of complex aortic aneurysms using custom-made manufactured endoprosthesis in 2 tertiary centers from January 2020 to July 2022. RESULTS: Thirteen cases were included (10 male, mean age 69 ± 9 years). 70% were complex abdominal aneurysms, and 30% were type II, III, and IV thoracoabdominal aneurysms (mean aneurysm diameter 69.2 ± 8.12 mm). F/BEVAR included 33 visceral arteries. The Apolo® device was used in all cases. Technical success was achieved in 12 out of 13 patients (92.3%). Thirty-day major adverse events included one death (7.7%), 5 acute renal failure (38.4%), 2 spinal cord ischemia (15.4%). The 1-year survival rate was 92.3%. CONCLUSIONS: Fenestrated and branched endovascular repair of complex aortic aneurysms with the custom-made Apolo® device has proven safe and effective in high-volume tertiary centers in the Brazilian public health system. Considering the complexity of the cases, the early patency of vessels and low initial mortality support this device continuation and expansion to treat complex aortic aneurysms in a developing country.

Exercise-Induced Laryngeal Obstruction History, Mechanisms, and Diagnostics Across the Globe.

Exercise-induced laryngeal obstruction (EILO) poses several diagnostic and management challenges. This review explores EILO's historical evolution, complex nomenclature, global epidemiology, clinical presentation, diagnostic modalities, and underlying pathophysiological mechanisms. Recent efforts to standardize terminology, includes EILO as a subcategory of the broader disorder of inducible laryngeal obstruction. EILO prevalence ranges from 5% to 8%, primarily affecting adolescents and young adults. EILO diagnosis remains challenging, with continuous laryngoscopy during exercise emerging as the gold standard. Multidisciplinary collaboration and adoption of standardized assessments are vital for effective management. Future research should focus on elucidating underlying mechanisms, optimizing diagnostic strategies, and improving EILO-specific outcomes.

Breathing Easy During Training. Strategies for Managing Exercise-Induced Bronchoconstriction.

Exercise-induced asthma (EIA) and exercise-induced bronchoconstriction (EIB) are closely related conditions that can make it challenging to differentiate between them. These conditions necessitate that asthmatic patients adhere to established asthma guidelines for baseline treatment. Short-acting beta-agonists are emphasized as the primary treatment for managing symptoms. The management of EIA and EIB in children is particularly complex due to their high levels of spontaneous physical activity. Patients must identify and avoid environmental triggers that may exacerbate their symptoms whenever possible. For effective management, physicians should regularly assess treatment efficacy through the remission of symptoms. However, athletes may require more specialized and serial testing to tailor their treatment plans effectively and ensure optimal performance. This article encapsulates the critical points concerning managing exercise-induced respiratory issues in asthmatic individuals, highlighting the need for careful and tailored approaches for different patient groups.