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Vallabhaneni SR, Patel SR, Campbell B, Boyle JR, Cook A, Crosher A, Holder SM, Jenkins MP, Ormesher DC, Rosala-Hallas A, Jackson RJ. Editor's Choice - Comparison of Open Surgery and Endovascular Techniques for Juxtarenal and Complex Neck Aortic Aneurysms: The UK COMPlex AneurySm Study (UK-COMPASS) - Peri-operative and Midterm Outcomes. Eur J Vasc Endovasc Surg 2024; 67:540-553. [PMID: 38428672 DOI: 10.1016/j.ejvs.2024.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Treatment of juxtarenal and complex neck abdominal aortic aneurysms (AAAs) is now commonly by endovascular rather than open surgical repair (OSR). Published comparisons show poor validity and scientific precision. UK-COMPASS is a comparative cohort study of endovascular treatments vs. OSR for patients with an AAA unsuitable for standard on label endovascular aneurysm repair (EVAR). METHODS All procedures for AAA in England (November 2017 to October 2019) were identified, AAA anatomy assessed in a Corelab, peri-operative risk scores determined, and propensity scoring used to identify patients suitable for either endovascular treatment or OSR. Patients were stratified by aneurysm neck length (0 - 4 mm, 5 - 9 mm, or ≥ 10 mm) and operative risk; the highest quartile was considered high risk and the remainder standard risk. Death was the primary outcome measure. Endovascular treatments included fenestrated EVAR (FEVAR) and off label standard EVAR (± adjuncts). RESULTS Among 8 994 patients, 2 757 had AAAs that were juxtarenal, short neck, or complex neck in morphology. Propensity score stratification and adjustment method comparisons included 1 916 patients. Widespread off label use of standard EVAR devices was noted (35.6% of patients). The adjusted peri-operative mortality rate was 2.9%, lower for EVAR (1.2%; p = .001) and FEVAR (2.2%; p = .001) than OSR (4.5%). In standard risk patients with a 0 - 4 mm neck, the mortality rate was 7.4% following OSR and 2.3% following FEVAR. Differences were smaller for patients with a neck length ≥ 5 mm: 2.1% OSR vs. 1.0% FEVAR. At 3.5 years of follow up, the overall mortality rate was 20.7% in the whole study population, higher following FEVAR (27.6%) and EVAR (25.2%) than after OSR (14.2%). However, in the 0 - 4 mm neck subgroup, overall survival remained equivalent. The aneurysm related mortality rate was equivalent between treatments, but re-intervention was more common after EVAR and FEVAR than OSR. CONCLUSION FEVAR proves notably safer than OSR in the peri-operative period for juxtarenal aneurysms (0 - 4 mm neck length), with comparable midterm survival. For patients with short neck (5 - 9 mm) and complex neck (≥ 10 mm) AAAs, overall survival was worse in endovascularly treated patients compared with OSR despite relative peri-operative safety. This warrants further research and a re-appraisal of the current clinical application of endovascular strategies, particularly in patients with poor general survival outlook owing to comorbidity and age.
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Affiliation(s)
- Srinivasa R Vallabhaneni
- Liverpool University Hospitals NHS Foundation Trust, Aintree University Hospital, Liverpool, UK; Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK.
| | - Shaneel R Patel
- Liverpool University Hospitals NHS Foundation Trust, Aintree University Hospital, Liverpool, UK; Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
| | - Bruce Campbell
- Royal Devon University Healthcare Trust, Exeter, UK; University of Exeter Medical School, Exeter, UK
| | - Jonathan R Boyle
- Cambridge University Hospitals NHS Trust, Cambridge, UK; Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | | | - Alastair Crosher
- Liverpool University Hospitals NHS Foundation Trust, Royal Liverpool University Hospital, Liverpool, UK
| | - Sophie M Holder
- Liverpool University Hospitals NHS Foundation Trust, Royal Liverpool University Hospital, Liverpool, UK
| | - Michael P Jenkins
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - David C Ormesher
- East Lancashire Hospitals NHS Trust, Royal Blackburn Teaching Hospital, Blackburn, UK
| | - Anna Rosala-Hallas
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Richard J Jackson
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
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Abstract
Rhinophyma is a form of rosacea and is often cosmetically disfiguring. There are various therapeutic ablation modalities. Surgery is often associated with down-time and side-effects. We describe successful treatment with low-dose isotretinoin as a safe alternative with a lower risk of complications. We also discuss the advantages and disadvantages of various therapeutic modalities.
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Affiliation(s)
- L Pohl
- Karlsruhe MVZ Dres. Raulin und Kollegen, Kaiserstr. 104, 76133, Karlsruhe, Deutschland
| | - S Karsai
- Dermatologikum Hamburg, Stephansplatz 5, 20354, Hamburg, Deutschland
| | - C Raulin
- Karlsruhe MVZ Dres. Raulin und Kollegen, Kaiserstr. 104, 76133, Karlsruhe, Deutschland.
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Abstract
The majority of women take at least one form of medication during pregnancy. Due to often discrepant information about the risk assessment of pharmaceuticals during pregnancy, physicians are often beset by uncertainty with respect to prescription and the fear of medicolegal consequences is high. As prospective clinical trials on drug safety during pregnancy are prohibited due to ethical reasons and animal studies are of limited applicability to humans, drug recommendations often only rely on observational data. An objective examination of the topic not only contributes to effective treatment of illnesses in pregnancy but also prevents impairment of fetal outcome by omission of necessary maternal treatment. The aim of this article is to give a structured presentation of medications that can be used during pregnancy for treating medical conditions of the ear, nose and throat, in the sense of practical guidelines.
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Affiliation(s)
- R Riepl
- Klinik für Hals-Nasen-Ohrenheilkunde und Kopf-Hals-Chirurgie, Universität Ulm, Frauensteige 12, 89073, Ulm, Deutschland.
| | - U Friebe-Hoffmann
- Klinik für Gynäkologie und Geburtshilfe, Universität Ulm, Ulm, Deutschland
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Böhringer D, Widmer D, Eberwein P, Maier P, Reinhard T. [Surgical removal of Salzmann's nodules using intraoperative mitomycin C]. Ophthalmologe 2016; 113:794-6. [PMID: 27461013 DOI: 10.1007/s00347-016-0335-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Salzmann's nodules comprise a heterogeneous group of greyish superficial corneal opacities. A substantial percentage is most likely caused by dystrophies. This could explain the recurrences after surgical removal. The Eye Center of the University Hospital Freiburg has been using mitomycin C intraoperatively during surgical removal of Salzmann's nodules since 2007 to prevent recurrences. We recently performed an uncontrolled prospective trial to evaluate this approach and also reviewed the literature. Worldwide, a total of 38 eyes have been treated with mitomycin C during surgery for Salzmann's nodules. No recurrences have been reported so far with follow-up exceeding at least 2 years in almost all eyes. No severe side effects have been observed to date. We therefore think that mitomycin C during surgery for Salzmann's nodules is advisable despite the lack of evidence from a randomized clinical trial. However, all patients must consent to the off label use of mitomycin C.
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Affiliation(s)
- D Böhringer
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
| | - D Widmer
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - P Eberwein
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - P Maier
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - T Reinhard
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
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Mercier A, Auger-Aubin I, Lebeau JP, Schuers M, Boulet P, Van Royen P, Peremans L. Why do general practitioners prescribe antidepressants to their patients? A pilot study. Biopsychosoc Med 2014; 8:17. [PMID: 25110516 PMCID: PMC4126991 DOI: 10.1186/1751-0759-8-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 07/25/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The frequency of antidepressant (ADs) prescription is high, with general practitioners (GPs) responsible for about 80% of the prescriptions. Some studies considered prescriptions meet DSM criteria, while others stress inadequate use. The importance of biological and psychosocial determinants of GP prescription behaviour remains little explored. We aimed to describe the importance of these biological and psychosocial determinants and their weight in the daily practice of GPs'. METHODS During a week chosen at random, 28 GPs collected the AD prescriptions made within the previous six months, regardless of the reason for the patient contact. Bio psychosocial and AD treatment characteristics were recorded for all patients. In a random sample of 50 patients, patient characteristics were assessed via a structured face-to-face interview with the GP. RESULTS The frequency of AD prescription was 8.90% [3.94 -17.02]. The GPs initiated 65.6% [60.1-70.8] of the prescriptions. The rate of AD prescription for non-psychiatric conditions was 18%. Patients had from 1 to 9 conditions, showing a high level of multi-morbidity. There was a strong influence of past medical history and contextual problems, such as work related problems. CONCLUSION AD prescription is related to complex contextual situations and multi-morbid patients. GPs use a bio psycho social approach, rather than a purely biological assessment. Awareness of these influences could improve prescription by GPs.
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Affiliation(s)
- Alain Mercier
- Department of General Practice, Rouen University and CIC Inserm 0204, University of Rouen, Rouen, France
- Department of Family practice, Rouen University, Faculty of Medicine, 20 Bd Gambetta, Rouen 76000, France
| | | | | | - Matthieu Schuers
- Department of General Practice, Rouen University and CIC Inserm 0204, University of Rouen, Rouen, France
| | - Pascal Boulet
- Department of General Practice, Rouen University and CIC Inserm 0204, University of Rouen, Rouen, France
| | - Paul Van Royen
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Lieve Peremans
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
- Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
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Reddy K V, R H. Ethical and legal aspects of conducting clinical trials in alcohol withdrawal syndrome. J Clin Diagn Res 2014; 8:HE01-6. [PMID: 24995195 PMCID: PMC4080016 DOI: 10.7860/jcdr/2014/6801.4323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 02/07/2014] [Indexed: 11/24/2022]
Abstract
Alcohol Withdrawal Syndrome (AWS) is a condition where the patients will be mentally unstable initially and where later, with therapy, they gradually return to normalcy. As AWS comprises two stages; a mentally unstable state and a normal state of mind, the ethical and legal issues behind recruitment of these subjects become a little ambiguous in a clinical trial. This study was taken up to clarify the uncertainty regarding the biphasic states of minds (i.e. unstable mind and sound mind) of the subjects who were involved in a clinical trial done on AWS. Law and ethics regarding the clinical trials which involve psychiatric subjects need to be strengthened and amended from time to time, in order to protect the interests of both patients and physicians.
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Affiliation(s)
- Vikram Reddy K
- Postgraduate Student, Department of Pharmacology, Kempegowda Institute of Medical Sciences, Bangalore, India
| | - Harsha R
- Postgraduate Student, Department of Pharmacology, Kempegowda Institute of Medical Sciences, Bangalore, India
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