Early, symptomatic cardiovascular disease is more common in first-degree relatives of individuals with premature PVD than in relatives of healthy individuals or of probands with premature CAD. Occult vascular disease in the lower extremity is prevalent among asymptomatic siblings of probands with premature PVD. These observations indicate that susceptibility to premature PVD has a familial basis.

This study demonstrates a significant benefit from the routine use of TXA for total knee arthroplasty and is one of the first studies to demonstrate a small but significant benefit for IV administration in comparison to intraarticular administration. The routine use of TXA as a central element of a PBMP provides a cost savings and can help reduce the rate of transfusions for total knee arthroplasty.

Introduction Due to limited data on hospital resources consumed in caring for the oldest-old, we examined the use of pancreaticoduodenectomy (PD)-relevant hospital resources in patients of increasing age treated in high-volume-hospitals (HVH) participating in the University HealthSystem Consortium (UHC). Methods Perioperative outcomes, resource use and direct costs were compared across increasing age groups in 12,766 PDs (< 70 years n=8,564, 70-79 years n=3,302, ≥ 80 years n=900) performed in 79 HVHs between 2010 and 2014. Linear regression models with and without covariate adjustments were used to assess the impact of older age. Results The oldest-old experienced fewer readmissions and had equivalent ICU-use and mortality rates compared to both younger cohorts. However, those ≥ 80-years experienced more complications, blood transfusions, greater TPN use, longer LOS and higher direct hospital costs compared to those < 70 years (Table 2). No differences were found between patients ≥ 80-years and those 70–79 years with respect to the administration of blood products, TPN or the direct cost of PD. Conclusion Our findings suggest the ability to deliver quality pancreatic surgical care to an aging population without strong associations to increased resource utilization. As the number of octogenarians undergoing PD continues to grow, the impact of this technically complex procedure on other important cancer care metrics including patient reported outcomes and quality of life requires further assessment.

A 51-year-old female Jehovah's Witness with a history of uterine fibroids traveled from her home country of Colombia to the US for a 2-month visit to assist her daughter in caring for her newborn baby. Soon after arriving in the US, she experienced heavy vaginal bleeding that continued for 2 weeks. She developed dyspnea with exertion, chest pain, and fatigue. She went to an urgent care center for evaluation and was found to have a hemoglobin level of 4.6 g/dL (range, 11.0-14.5 g/dL; to convert to g/L, multiply by 10.0); she was then referred to a local hospital for further care. The patient recalled that on a recent laboratory test, her hemoglobin level was 14 g/dL.The patient, who speaks no English, described through an interpreter her reaction upon learning that she required hospitalization in the US: I was very afraid. I had already been in a situation once in Colombia where the doctor put so much pressure on me. She told me transfusion was my only option. My daughter said, "We know of other treatments that can be used." The doctor said, "There are no other treatments." I imagined that I would be in that situation again.

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Severe anaemia in patients who cannot receive blood transfusion is an indication for the use of hyperbaric oxygen therapy (HBO). Most reports of the use of HBO for anaemia involve patients with acute blood loss. This report details a case of HBO used for a patient with severe pernicious anaemia. A 35-year-old Jehovah’s Witnesses believer presented to a hospital with fatigue, dyspnoea and haemoglobin of 26 g/L. She was diagnosed with pernicious anaemia. As she could not receive blood transfusion due to her religious beliefs, vitamin B12 supplementation and HBO were administered and resulted in significant improvement in her condition. The mechanisms of action of HBO, including increased systemic plasma oxygenation, can alleviate signs and symptoms of anaemia regardless of its aetiology. HBO administration can greatly enhance the plasma arterial oxygen content, leading to clinical improvement in patients with anaemia who cannot receive blood transfusion.

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