Citations

Background: Managing an in-season anterior shoulder instability poses a special challenge for team physicians, as they need to balance the aim of promptly returning the athlete to play while mitigating the chances of recurrence and further injury to the shoulder. Purpose: To investigate and report on the treatment preferences of National Hockey League (NHL) team physicians when managing in-season first-time anterior shoulder instability in professional hockey players. Study Design: Cross-sectional study. Methods: A survey consisting of 33 sport-specific questions focused on the treatment options and preferences for anterior shoulder instability in hockey players was developed, and 32 NHL team physicians were invited to anonymously complete the survey. Following the collection of the data, the distribution of the responses to each question was documented as counts and percentages. Results: Of the 32 invited team physicians, 31 (97%) completed all (n = 28) or most (n = 3) of the survey. The mean experience of the respondents was 13 ± 11 years. A total of 28 (90%) respondents would attempt nonoperative treatment of an in-season initial anterior shoulder dislocation with an isolated soft tissue injury, while 28 (90%) would recommend operative treatment of the same injury with bony involvement. Of the 31 respondents, 30 (97%) utilized rehabilitation parameters rather than time from injury when determining whether a player could return to play. Of those parameters, clinical strength (100%), range of motion (87%), anterior apprehension (84%), and pain (65%) were the most utilized. For surgical management of an isolated soft tissue lesion, 28 (90%) of the respondents preferred arthroscopic repair, while 2 (7%) preferred open repair. Conclusion: Of the 32 NHL team physicians surveyed, 28 preferred nonoperative management for the treatment of initial anterior shoulder dislocations with isolated soft tissue injuries, while initial operative management was preferred by the same number of team physicians for any injuries with bony involvement.

ABSTRACTBackgroundPrevious studies of maternal alcohol consumption and craniosynostosis have reported null or inverse associations. We updated a previous analysis of National Birth Defects Prevention Study (NBDPS) data to further examine associations between maternal alcohol consumption and craniosynostosis.MethodsNBDPS was a multi‐site, population‐based case–control study. Mothers of craniosynostosis cases and randomly selected liveborn controls delivered during 1997–2011 completed a telephone interview about pregnancy exposures. We examined associations for self‐reported periconceptional maternal alcohol consumption (during the month before conception through the third gestational month) and odds of craniosynostosis in offspring. We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between any alcohol consumption and binge consumption and craniosynostosis, overall and by affected suture. Finally, we performed a probabilistic bias analysis using a range of assumptions about the sensitivity and specificity of self‐reported consumption by case/control status.ResultsWe analyzed interview data from 1435 mothers of craniosynostosis cases and 11,216 mothers of controls. Periconceptional alcohol consumption prevalence was similar among case (36.9%) and control (38.2%) mothers. We observed point estimates near or below 1.0 for alcohol consumption (any and binge) and all suture subtypes of craniosynostosis, with all CIs including the null. Our bias‐adjusted estimates for periconceptional alcohol consumption were higher than our conventional estimates but supported the null findings.ConclusionsWe observed primarily null associations between maternal periconceptional alcohol consumption and craniosynostosis. However, our findings do not diminish the prevailing clinical guidance in the United States that pregnant people should abstain from alcohol consumption.

Abstract This historical narrative presents a comprehensive historical journey delving into the diverse facets of gender identity and expression across ancient cultures. It explores these civilizations' perspectives on gender diversity, highlighting instances that challenged conventional gender norms. Transitioning to the modern era, the narrative examines the dynamic landscape of LGBTQ+ and trans movements, spotlighting influential figures whose advocacy has significantly influenced societal perceptions and advanced the rights of gender diverse individuals. Their contributions continue to shape contemporary affirming care practices. Exploring the emergence of gender-affirming surgery, the narrative highlights pioneering surgeons and original techniques employed in these transformative procedures. It shows the courage and innovation of early surgeons who laid the groundwork for contemporary practices. At the core of this historical narrative lies the pivotal role of plastic surgeons in gender-affirming care. It emphasizes the significance of a collaborative multidisciplinary approach among medical professionals to ensure comprehensive and patient-centered care for transgender individuals seeking affirming interventions. However, intertwined with this narrative are legislative barriers that have hindered progress in gender-affirming care. The narrative navigates these obstacles, highlighting their complexities and emphasizing the urgent need for sustained medical advocacy and legislative reforms to foster an inclusive healthcare landscape. Ultimately, this narrative stands as a testament to the ongoing struggle and resilience within the realm of gender-affirming care, shedding light on its profound impact on individuals' lives, emphasizing the ongoing need for compassionate, comprehensive, and inclusive healthcare practices.

Background Iatrogenic cervical artery dissection (CeAD) results from various procedures including interventional angiographic procedures and diagnostic angiography. Iatrogenic CeAD is rare, resulting in limited literature on management and outcomes. This observational cohort study investigates approaches and outcomes of iatrogenic CeAD after endovascular interventions. Methods We conducted a retrospective review for patients who underwent endovascular intervention with resulting iatrogenic CeAD at Mayo Clinic, Rochester, MN, from 1998 to 2021. Pertinent patient factors were extracted and descriptive statistics generated. Results Between 1998 and 2021, 21,191 patients underwent catheter-based cerebral angiography. Thirty-two had iatrogenic CeADs (23 women; median age 59 [range 40.5–92.9]). Common comorbidities included hypertension (62.5%), smoking (56.3%), and hyperlipidemia (46.9%). Nine (28.1%) had dissection with diagnostic angiograms, 6 (18.8%) endovascular thrombectomy, 15 (46.9%) intracranial aneurysm treatment/coiling, and 2 (6.3%) intracranial angioplasty with/without stenting. All dissections were diagnosed by cerebral angiography during the same session as initial interventions. Four (12.5%) underwent hyperacute stenting. Thirty (93.7%) were placed on antithrombotic therapy with aspirin alone (34.4%) or dual-antiplatelet therapy with aspirin and clopidogrel (37.5%). Median duration of acute treatment was three months. Follow-up imaging showed excellent radiological course. Conclusions Iatrogenic CeAD with endovascular interventions is rare and typically benign. Most are managed medically without complications or long-term negative outcomes. Oral single or dual-antiplatelet therapies are preferred compared to previous studies which emphasize intravenous anticoagulation. The duration of acute therapy varied from three months to lifelong. Key factors influencing clinical decision-making may include occlusion rate, pseudoaneurysm formation, intracranial extension, distal collateral circulation, and resultant ischemia.

Abstract Worldwide, valvular heart disease (VHD) is a common cause of hospitalization for acute heart failure. In acute heart failure caused by VHD, symptoms result from rapid haemodynamic changes and subsequent decline in cardiac function, and if left untreated, leads to acute decompensation and cardiogenic shock. Current evidence remains scarce and recommendations regarding the management of acute heart failure caused by VHD are lacking in most recent international guidelines. Herein, we review the management of acute heart failure caused by VHD with a focus on transcatheter therapies and describe currently available evidence based on a systematic literature search on the following valve pathologies: (i) aortic stenosis, (ii) aortic regurgitation, (iii) mitral regurgitation, and (iv) mitral stenosis. Articles reporting outcomes following urgent or emergent valve intervention in the setting of cardiogenic shock or acute heart failure were considered. After screening a total of 2234 articles, 76 published between 1994 and 2023 were included in subsequent analysis. Based on available evidence, proposed treatment algorithms to guide optimal management of acute heart failure caused by VHD were created. As the number of patients presenting with acute heart failure caused by VHD continues to rise and outcomes following transcatheter valve interventions continue to improve, it is inevitable that minimally invasive options will play an increasingly important role in the acute setting, especially given these patients are at an increased operative risk. This review aims to present an organized approach to the complex management and interventional treatment of patients with acute heart failure caused by VHD.

Glucagon-like peptide-1 (GLP-1) receptor agonists are medications used to treat type 2 diabetes and may aid in weight loss efforts. The surgical management of patients taking GLP-1 agonists differs from others due to the slowed gastric emptying effects of GLP-1 medications. Patients taking these medications may have a higher risk of pulmonary aspiration during hand surgery than other patients, which affects their presurgical management. This article reviews GLP-1 agonists and their role in diabetes and weight loss, as well as current recommendations for surgical management of patients taking GLP-1 agonists.