SUMMARY Post-mastectomy immediate breast reconstruction in the US continues to experience an upward trend owing to heightened awareness, innovations in reconstructive technique, growing evidence of improved patient reported outcomes and shifts in mastectomy patterns. Women with unilateral breast cancer are increasingly electing to undergo contralateral prophylactic mastectomy, instead of unilateral mastectomy or opting for breast conservation. The ascent in prophylactic surgeries correlates temporally to a shift towards prosthetic methods of reconstruction as the most common technique. Factors associated with the choice for implants include younger age, quicker recovery time, along with documented safety and enhanced aesthetic outcomes with newer generations of devices. Despite advances in autologous transfer, its growth is constrained by the greater technical expertise required to complete microsurgical transfer and potential barriers such as poor relative reimbursement. The increased use of radiation as an adjuvant treatment for management of breast cancer has created additional challenges for plastic surgeons who need to consider the optimal timing and method of breast reconstruction to perform in these patients.

The findings suggest that the acetabular labrum continues to function to resist femoral head translation despite chondral-labral separation and that labral preservation, particularly with larger tears, may be important for maintaining hip stability. Further studies are needed to determine the effect of partial labral excision on the stability ratio with the hip in provocative positions such as extension, external rotation, and abduction.

Background: Post-myocardial infarction (MI) ventricular septal defects (PIVSD) are an uncommon but life-threatening complication of acute MI. Although surgical closure has been the standard of care, mortality, and recurrence of VSD remain high even after emergent surgery. Transcatheter VSD closure (TCC) devices have become an alternative or adjunct to surgical closure.Methods: Online database search was performed for studies that included adults with PIVSD who underwent medical treatment (MT) alone, surgical closure (SC) (early or late), and TCC (early, late, or for post-surgical residual VSD).Results: Twenty-six studies were included with a total of 737 patients who underwent either MT (N = 100), SC (early (n = 167), late (n = 100)), and TCC (early (n = 176), late (n = 115), or post-surgical residual VSD (n = 79)). The 30-day mortality among MT group was 92 ± 6.3%, among SC was 61 ± 22.5% (early 56 ± 23%, late 41 ± 30%), and for all TCC patients was 33 ± 24% (early 54 ± 32.7%, late 16 ± 26%), and TCC for post-surgical residual VSD 11 ± 34.9%. The mortality among overall SC, overall TCC and early TCC groups was significantly lower as compared with the MT (P < 0.001 for all comparisons).The overall mortality among all TCC, and late TCC groups was significantly lower when compared with the late SC (P < 0.0001, P < 0.0001, respectively). Conclusion: Closure of PIVSD decreases mortality as compared with MT alone and should be attempted as early as possible after diagnosis. Selection of TCC versus SC should be based on factors including complexity of the defect, availability of closure devices, expertise of the operator, and clinical condition of patient. K E Y W O R D S closure device, management, post-infarction VSD, transcatheter

No abstract

No abstract

Background Immediate breast reconstruction (IBR) is often deferred, when post-mastectomy radiotherapy (PMRT) is anticipated, due to high complication rates. Nonetheless, because of robust data supporting improved health related quality of life associated with reconstruction, physicians and patients may be more accepting of trade-offs. The current study explores national trends of IBR utilization rates and methods in the setting of PMRT, using the National Cancer Data Base (NCDB). The study hypothesis is that prosthetic techniques have become the most common method of IBR in the setting of PMRT. Methods NCDB was queried from 2004-2013 for women, who underwent mastectomy with or without IBR. Patients were grouped according to PMRT status. Multivariate logistic regression was used to calculate odds of IBR in the setting of PMRT. Trend analyses were done for rates and methods of IBR using Poisson regression to determine incidence rate ratios (IRR). Results In multivariate analysis, radiated patients were 30% less likely to receive IBR (p<0.05). The rate increase in IBR was greater in radiated compared to non-radiated patients (IRR: 1.12 vs. 1.09). Rates of reconstruction increased more so in radiated compared to non-radiated patients for both implants (IRR 1.15 vs. 1.11) and autologous techniques (IRR 1.08 vs. 1.06). Autologous reconstructions were more common in those receiving PMRT until 2005 (p<0.05), with no predominant technique thereafter. Conclusion Although IBR remains a relative contraindication, rates of IBR are increasing to a greater extent in patients receiving PMRT. Implants have surpassed autologous techniques as the most commonly used method of breast reconstruction in this setting.

P ercutaneous coronary intervention (PCI) of saphenous vein grafts (SVG) is associated with higher periprocedural complications compared with native vessel PCI because of distal embolization of atheroma from degenerative graft lesions leading to no-reflow phenomenon and periprocedural myocardial infarction (MI).1,2 Current guidelines give the use of embolic protection device (EPD) a Class I indication (Level of Evidence B) for SVG intervention when technically feasible to minimize distal embolization. 3 The guideline recommendations are mainly based on only 1 randomized controlled trial (RCT) that compared distal EPD versus no-EPD in SVG intervention. 4 Several studies published later on the use of EPD in SVG intervention have shown conflicting results. 5-10 A large National Cardiovascular Data Registry (NCDR) CathPCI Registry study showed no benefits in routine use of EPD during SVG intervention, with an association between EPD use and a higher incidence of periprocedural complications.11 Despite modifications and newer versions, EPD use can increase procedural time and complexity and may be associated with procedure-related complications. 4,11,12 Moreover, in the recent era, no-reflow and periprocedural MI during SVG intervention has decreased 13,14

No abstract