ENT and Allergy Associates’ Post

Michael Garshick, MD, director of the cardio-rheumatology program, cardiologist, and assistant professor at the Ronald O. Perelman Department of Dermatology with NYU Grossman School of Medicine, speaks with Cardiovascular Business on the significance of inflammation in cardiovascular health and the strides made in preventive cardiac care. He emphasises the need for improved biomarkers to more specifically detect the impact of inflammation in vessels that can lead to heart attacks and strokes. Checkout his video interview to learn more: https://lnkd.in/dqfTTQu4   #CoronaryInflammation #CardiacCT #cardiovasculardisease #heartattack #inflammation

Happy 100 year birthday to the American Heart Association ! There are many reasons why I'm alive today - and most of them came from research funded by the AHA. Here are just a few amazing discoveries that have affected my life and my family members' lives. 1924: American Heart Association is founded 1957: The first battery-operated, wearable pacemaker is implanted in a patient 1960: First successful pacemaker surgeries reported 1960: First artificial heart valve replacement 1960: Specialized heart cells discovered 1961: Saving hearts with CPR. Combining mouth-to-mouth breathing with chest compressions creates cardiopulmonary resuscitation, the lifesaving actions of CPR. 1961: Pioneering surgery with the aid of a microscope. 1964: AHA's first female career investigator grantee, Mildred Cohn, whose work contributed to the development of the MRI. 1964: Imaging technique for diagnosing Myocardial disease 1965: Pediatric pioneer takes AHA reins Dr. Helen Taussig becomes the first woman president of the American Heart Association. Taussig is considered the founder of pediatric cardiology, and with surgeon Dr. Alfred Blalock and laboratory technician Vivien Thomas, pioneered the "blue baby" operation that helped establish the field of pediatric cardiac surgery. 1966: Cath lab - Technique to correct septal defects (heart defects) in newborns, demonstrates that major heart procedures can be performed through a catheter. 1990: First drug, synthetic lung surfactant, approved for premature infants with heart, lung defects. 2001: Mechanical pump (LVAD) helps patients awaiting transplant. 2003: The FDA approves the first drug-coated stent to keep blocked arteries open. 2007: Nobel Prize for discovery in gene targeting - genetic causes to heart disease. 2008: Simpler CPR for bystanders: Hands‐Only CPR. 2014: The Children's Heart Foundation (CHF) partners with the American Heart Association to establish the AHA/CHF Congenital Heart Defect Research Awards. and so much more. Please learn CPR. American Heart Association #AHA #CHD #Heartdisease

📃Scientific paper: Primary scrotal lipoma in a pediatric patient: a case report with current literature review Abstract: Backgrounds Primary scrotal lipomas are benign fatty tumors that develop from adipocytes of the scrotum. The exact cause of their development is unknown. They are typically painless and may exhibit symptoms of heaviness and discomfort. Case presentation A 9-year-old boy presented with a painless scrotal mass that had been present since birth. The mass was located in the left hemiscrotum. Ultrasound showed an enlarged left testicle with an abnormal outline and heterogeneous texture. Magnetic resonance imaging demonstrated a mass arising from the left hemiscrotum with no invasion of the testis. Under general anesthesia and through a scrotal incision, the mass was excised. Histopathological examination revealed a lipoma. Conclusion Primary scrotal lipomas are benign lesions with an unclear pathogenesis. They are very uncommon in the pediatric age group. Ultrasound is the first-line modality for diagnosing lipomas; however, it may provide ambiguity. MRI provides a more accurate assessment of the mass. Surgical excision of the mass is the standard treatment for primary scrotal lipomas. Continued on ES/IODE ➡️ https://etcse.fr/8eV ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.

📃Scientific paper: Primary scrotal lipoma in a pediatric patient: a case report with current literature review Abstract: Backgrounds Primary scrotal lipomas are benign fatty tumors that develop from adipocytes of the scrotum. The exact cause of their development is unknown. They are typically painless and may exhibit symptoms of heaviness and discomfort. Case presentation A 9-year-old boy presented with a painless scrotal mass that had been present since birth. The mass was located in the left hemiscrotum. Ultrasound showed an enlarged left testicle with an abnormal outline and heterogeneous texture. Magnetic resonance imaging demonstrated a mass arising from the left hemiscrotum with no invasion of the testis. Under general anesthesia and through a scrotal incision, the mass was excised. Histopathological examination revealed a lipoma. Conclusion Primary scrotal lipomas are benign lesions with an unclear pathogenesis. They are very uncommon in the pediatric age group. Ultrasound is the first-line modality for diagnosing lipomas; however, it may provide ambiguity. MRI provides a more accurate assessment of the mass. Surgical excision of the mass is the standard treatment for primary scrotal lipomas. Continued on ES/IODE ➡️ https://etcse.fr/8eV ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.

“Our diversity is our strength”. This is one of the main motos of the European Society of Cardiology. And this paper is one more excellent proof for this. Three ESC bodies (the Council on Stroke; the European Association of Cardiovascular Imaging; and the European Heart Rhythm Association) and 16 top experts coming from four different specialties (Internal Medicine, Cardiology, Neurology and Radiology) joined their expertise to develop this multidisciplinary Clinical Consensus Statement which was just published at the European Heart Journal. What is this paper about? It is about those persons who have an ischemic stroke with no apparent cause despite recommended investigation – what we call Embolic Stroke of Undetermined Source (ESUS). They are not few -  one of six ischemic stroke patients is an ESUS. When a physician treats a patient with ESUS, the diagnostic work-up aims to presume the underlying stroke etiology. However, in ESUS, this may be challenging as multiple potential thromboembolic sources frequently coexist. And commonly, when we presume that we found the underlying etiology, we tend to underestimate the thromboembolic potential of other comorbidities which may be present in our patient and which we consider as co-incidental findings. Still, half of all stroke recurrences are caused by a different etiology than the one which caused the first stroke. A comorbidity which is considered as an incidental finding today, could well be the cause of tomorrow’s recurrent stroke. Therefore, rather than trying to presume which particular mechanism is the actual embolic source in an ESUS patient, it is crucial to assess the overall thromboembolic risk of the patient through synthesis of the individual risks linked to all pathologies present, regardless if presumed to be causally associated or not. This Clinical Consensus Statement proposes a comprehensive multi-dimensional assessment of the overall thromboembolic risk in patients with ESUS through the composition of individual risks associated with each of the six broad etiologies of stroke, i.e. supracardiac atherosclerosis; patent foramen ovale and other right-to-left shunts; left atrial disease including atrial arrhythmias and atrial cardiomyopathy; left ventricular disease; valvular heart disease; and cancer. I am grateful to all these brilliant people who contributed their knowledge and expertise to help us help our patients: Helmut Baumgartner, Wolfram Doehner, erwan donal, Thor Edvardsen, Jeff Healey, Bernard Iung, Hooman Kamel, MD, Scott Kasner, Eleni Korompoki, Babak Navi, Christian Pristipino, Luca Saba, Renate Schnabel, Emma Svennberg, and Gregory Lip. The full text is available at the European Heart Journal at https://lnkd.in/g4e5UT2F

🔍Insights in Pediatric Cardiology: Atrial Septal Defect Closure 🩺 1.0 CME Credit 👩⚕️ Authors: Jelle P G van der Ven, Eva van den Bosch, Vivian Paola Kamphuis, Covadonga Terol Espinosa de los Monteros, Devi Gnanam, Ad J J C Bogers, Johannes M P J Breur, Rolf M F Berger, Nico Blom, Laurens Koopman, Arend D J Ten Harkel, Willem A Helbing 🧬 Study Overview: A multicenter prospective study explores the changes in ventricular performance and serum biomarkers following surgical and percutaneous atrial septal defect closure in children. 🔬 Key Findings: Ventricular Performance: A temporary reduction in right ventricular performance was observed post-surgical closure, not evident in percutaneous closures. Biomarker Analysis: NT-proBNP levels correlated with less favorable left ventricular global longitudinal strain at the 2-week follow-up. Long-Term Outcomes: Right ventricular performance at 1-year follow-up remained below baseline, while left ventricular performance returned to baseline. 🤔 Implications for Practice: Understanding these dynamics can aid in tailoring postoperative care and monitoring strategies for children undergoing these procedures. 🔗 https://lnkd.in/d7_H_gai 🏥 #PhysicianInsights #MedicalPractice #CardiologyUpdate #cme #PediatricCardiology #ASDClosure

January 4, 2024/Heart, Vascular and Thoracic/Preventive Cardiology Lipoprotein(a): Progress on One of the Last Untreatable Frontiers of Cardiovascular Risk It's time to increase testing for this major cardiovascular risk factor in advance of new therapies Once a week, Steven Nissen, MD, has a clinic in which almost every patient has elevated levels of lipoprotein(a), or Lp(a). Patients come to this clinic from around the world, yet their profiles are highly similar: Most have had multiple family members suffer a myocardial infarction (MI) or stroke — and/or undergo bypass surgery or coronary stent placement — by their 40s or 50s. “These patients typically tell us, ‘I just had my Lp(a) checked and it’s really high; I’m scared to death,’” relates Dr. Nissen, Chief Academic Officer for Cleveland Clinic’s Heart, Vascular & Thoracic Institute. He adds that while there are currently no FDA-approved therapies for lowering Lp(a) levels, there are now four promising investigational therapies in clinical trials, and Cleveland Clinic is leading several of those trials. “We are a focal point for much of the research into treating Lp(a)-related cardiovascular risk,” Dr. Nissen says, “and we are advocates for patients getting their Lp(a) levels checked. In addition to raising awareness of Lp(a) as an important risk factor, this identifies individuals at elevated risk of cardiovascular events so we can treat all their other risk factors super aggressively and consider enrollment in a clinical trial of an investigational therapy if appropriate.”

The association of perioperative blood transfusion with survival outcomes after major cancer surgery: a population-based cohort study in South Korea Saeyeon Kim et al. Surg Today. 2024. Surg Today. 2024 Jan 4. doi: 10.1007/s00595-023-02783-w. Online ahead of print. Authors Saeyeon Kim # 1 2, In-Ae Song # 1 3, Tak Kyu Oh 4 5 Affiliations 1Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-Ro, 173, Beon-Gil, Bundang-Gu, Seongnam, 13620, South Korea. 2Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Gumi-Ro, 173, Beon-Gil, Bundang-Gu, Seongnam, 13620, South Korea. 3Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea. 4Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-Ro, 173, Beon-Gil, Bundang-Gu, Seongnam, 13620, South Korea. airohtak@hotmail.com. 5Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea. airohtak@hotmail.com. #Contributed equally. PMID: 38175292 DOI: 10.1007/s00595-023-02783-w Abstract Purpose: The correlation between perioperative blood transfusions and the prognosis after major cancer surgery remains controversial. We investigated the association between perioperative blood transfusion and survival outcomes following major cancer surgeries and analyzed trends in perioperative blood transfusions. Methods: Data for this population-based cohort study were obtained from the National Health Insurance Service of South Korea. Adult patients who underwent major cancer surgery between January 1, 2016, and December 31, 2020, were included. The primary endpoint was 90-day mortality. Results: The final analysis included 253,016 patients, of which 55,094 (21.8%) received perioperative blood transfusions. In the multivariable logistic regression model, select factors, including neoadjuvant/adjuvant chemotherapy, an increased preoperative Charlson Comorbidity Index, moderate or severe liver disease, liver cancer surgery, and small bowel cancer surgery, were associated with an increased likelihood of blood transfusion. In the multivariable Cox regression model, patients who received blood transfusion had a significantly higher risk of 90-day mortality (hazard ratio: 5.68; 95% confidence interval: 5.37, 6.00; P < 0.001) than those who did not. Conclusion: We identified potential risk factors for perioperative blood transfusions. Blood transfusion is associated with an increased 90-day mortality risk after major cancer surgery. Keywords: Blood transfusion; General surgery; Mortality; Neoplasms. © 2024. The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd. https://lnkd.in/d5BFApFs

A recent publication in "Transplantation", by Chanan and colleagues, titled "Perioperative Considerations in Older Kidney and Liver Transplant Recipients: A Review," freshly explores the nuances of pre, intra, and post-operative factors in older patients undergoing kidney and liver transplants. Some key highlights: - Growth in Older Adult Population: Increasing number of older adults (>65 years) are being waitlisted for and undergoing kidney and liver transplantation, highlighting the significance of transplantation for this age group. - Contemporary Review Focus: Examination of unique preoperative, intraoperative, and postoperative issues faced by older adults undergoing kidney or liver transplantation, with an emphasis on geriatric syndromes. - Common Geriatric Syndromes: Identifies frailty, sarcopenia, and cognitive dysfunction as prevalent conditions among older patients listed for transplantation, affecting their treatment and outcomes. - Preoperative Considerations: Discusses the importance of comprehensive risk stratification in older transplant recipients, taking into account the specific challenges and conditions common in this age group. - Intraoperative Challenges: Emphasizes the need for evidence-based anesthetic practices, maintaining adequate perfusion pressure, and employing minimally invasive surgical techniques to address intraoperative concerns. - Postoperative Management Concerns: Highlights the importance of managing acute postoperative pain, preventing cardiovascular complications and delirium, optimizing immunosuppression, avoiding nephrotoxicity, and focusing on rehabilitation and perioperative kidney injury prevention. - Call for Future Research: Underscores the necessity for ongoing studies throughout the perioperative period to identify interventions that can enhance preoperative physiological status, prevent postoperative complications, and improve both medical and patient-centered outcomes in older transplant recipients.

Lumbar Puncture Anatomy and Physiology , Indications , Contraindications , Complications The order in which the spinal needle will traverse the lumbar spine is as follows: Skin Subcutaneous tissue Supraspinous ligament Interspinous ligament Ligamentum flavum Epidural space Dura Arachnoid Subarachnoid space The distance from the skin to the epidural space is approximately 55 mm or 2/3 the length of the spinal needle.The subarachnoid space is the area where the cerebrospinal fluid (CSF) sample is obtained. During the advancement of the needle, a “pop” sensation is felt, which usually occurs during passage through the ligamentum flavum. Indications A lumbar puncture may be indicated for both diagnostic and therapeutic reasons. The lumbar puncture may aid in the diagnosis of certain diseases that range from infectious (encephalitis, meningitis), inflammatory (multiple sclerosis and Guillain-Barre syndrome), and oncologic to metabolic processes. It may also aid in the diagnosis of subarachnoid hemorrhage. A lumbar puncture may also be indicated for the intrathecal administration of certain medications such as analgesics, chemotherapeutic agents, and antibiotics. Contraindications Contraindications to performing a lumbar puncture include skin infection near or at the site of lumbar puncture needle insertion, central nervous system (CNS) lesion or spinal mass leading to increased intracranial pressure, platelet count less than 20,000 mm3 (ideally the platelet count should be greater than 50,000 mm3), use of unfiltrated heparin or low-molecular-weight heparin in the past 24 hours, coagulopathies (i.e., hemophilia, von Willebrand disease) and vertebral trauma. A head computed tomogram (CT) should be obtained before performing a lumbar puncture if there is a concern for increased intracranial pressure. Signs and symptoms of possible increased intracranial pressure include altered mental status, focal neurological deficits, new-onset seizure, papilledema, immunocompromised state, malignancy, history of focal CNS disease (stroke, focal infection, tumor), concern for mass CNS lesion and age greater than 60 years old. Complications The complications of a lumbar puncture include post-lumbar puncture headache, bleeding, infection, spinal hematoma, and cerebral herniation.The most common complication observed after a lumbar puncture is a post-lumbar puncture headache.Removal of the spinal needle with the stylet in place has been shown to reduce the incidence of post lumbar puncture headache.Use of an atraumatic spinal needle (pencil-point spinal needle) and a smaller gauge is associated with fewer post-lumbar headaches as compared to cutting needle. Spinal hematoma is of particular concern in patients with coagulopathies or currently receiving certain anticoagulant medications.If a spinal subarachnoid hematoma develops, the patient may complain of acute back pain or new neurologic symptoms. The diagnosis can be confirmed with (MRI) scan of the brain.