Author(s) Menown I.B.A.; De Silva R.; Mitra R.; Balachandran K.; More R. et al.
Source European Heart Journal; Oct 2019; vol. 40 ; p. 1744
Background: Thin stent struts may be associated with reduced vessel injury and use of biodegradable polymers may further improve long term outcomes. However, data with earlier stents has been inconsistent; thus further studies with newer devices are needed. Purpose(s): To evaluate the efficacy and safety of a new ultra-thin (65um) strut cobalt chromium sirolimus-eluting stent with a hybrid design (closed cell at ends and open cells in middle to reduce edge injury and optimise conformability) in all-comers patients undergoing percutaneous coronary intervention (PCI).

Method(s): We enrolled 752 patients from 14 sites undergoing PCI into a prospective, non-randomised, multi-centre, open-label, observational registry. Inclusion of patients with complex anatomy (long stent lengths, bifurcations and chronic total occlusions) was encouraged. Clinical follow-up was scheduled at 1, 9, 12 and 24 months. The primary endpoint was incidence of major adverse cardiac events (MACE)-cardiac death, non-fatal myocardial infarction (MI), or target vessel revascularization (TVR)-at 9 months.

​Result(s): Mean patient age was 64.7+/-12.2 years, 20.7% had diabetes, 58.8% had dyslipidaemia, 40.4% had multi-vessel disease, 22% had previous PCI, 4.7% had previous coronary-artery bypass graft, and 19.6% had a clinical history of previous MI. Mean lesion length was 25.7+/-17.3 mm. The primary endpoint of cumulative MACE up to 9 months (from 624 patients reaching 9 months follow-up) occurred in 12 patients (1.92%), including 6 (0.96%) cardiac death, 5 (0.80%) MI and 6 (0.96%) clinically indicated TVR. Definite stent thrombosis was reported in 3 patients (0.48%) and probable stent thrombosis in 2 patients (0.32%). Conclusion(s): Use of an ultra-thin strut biodegradable polymer sirolimuseluting stent in all-comers patients undergoing PCI was associated with good clinical efficacy and safety.

Author(s) Muralidharan V.; Zahedi D.; Kaur B.; Goulding J.M.R.
Source Clinical and experimental dermatology; Dec 2019
Psychodermatology remains a niche sub-specialty in the United Kingdom (UK), with very few dedicated services available for patients with such problems. Despite this, up to 85% of dermatology patients say that psychosocial aspects of their skin disease are a major component of their condition, indicating an enormous unmet need.s1 Our perception is that general dermatologists and psychiatrists may lack confidence in diagnosing and managing patients with psychodermatological problems, the vast majority of whom will not be cared for in a specialist service.Copyright © 2019 British Association of Dermatologists.

• Available in full text at Clinical and experimental dermatology from Wiley Online Library Medicine and Nursing Collection 2019 - NHS

Author(s) Nevins E.J.; Strong C.; Al-Zubaidi S.; Wayman J.; Karat D. et al.
Source Journal of patient safety; Dec 2019; vol. 15 (no. 4)
OBJECTIVES: Expert opinion remains divided regarding whether routine urethral catheterization is required before nononcological laparoscopic pelvic surgery. Catheterization is thought to reduce the incidence of bladder injury when inserting a suprapubic laparoscopic port and prevent obstruction of the view of the pelvis because of bladder filling. However, catheterization comes with a risk of nosocomial infection and harbors financial cost. Moreover, indwelling catheters inhibit early mobilization and increase postoperative discomfort.

METHOD(S): A systematic review was undertaken using the Meta-Analysis of Observational Studies guidelines to identify eligible publications. End points included bladder injury, positive postoperative urinary microbiology, and postoperative urinary symptoms.

RESULT(S): The reported incidence rates of laparoscopic bladder injury in included publications ranges from 0% to 1.3%. Importantly, bladder injury has occurred during both catheterized and noncatheterized operations. Our meta-analysis also shows that patients who are catheterized have a 2.33 times relative risk of developing postoperative positive microbiology in their urine (P = 0.01) and a 2.41 times relative risk of postoperative urinary symptoms (P = 0.005), when compared with noncatheterized patients.

​CONCLUSION(S): This meta-analysis indicates that omitting a catheter in emergency and elective nononcological laparoscopic pelvic surgery may be a safe option. Catheterization does not remove the risk of bladder injury but results in more urinary tract infections and symptoms. It may be reasonable to ask a patient to void immediately before anesthesia, after which an on-table bladder scan should be performed. If there is minimal residual volume, a urinary catheter may not be necessary, unless operative time is estimated to be greater than 90 minutes.

Author(s) Chandran A.; Bhanji A.; Rao J.
Source British Journal of Oral and Maxillofacial Surgery; Dec 2019; vol. 57 (no. 10)
Introduction/Aims A surgeon's experience undertaking larger case volumes is often linked to better performance. The aim was to assess a single surgeons performance in NMHNSC excisions over five years. We analysed time and case number to reach a consistent competency with regards to excision margins. Materials/Methods Skin pathology data sets were collected retrospectively from 2014 to 2018 The data collected involved a single surgeon operating in multiple hospitals and settings. Information regarding patient demographics, histological features of NMHNSC and excision margins were collected from pathology reports for each operation.

Results/Statistics The results showed from January 2014 to April 2014 there was a 6.8% involved margin rate and a 11.4% close margin rate. This improved with further case volume over the five years. By September2018 to December 2018it was noted that the involved margin rate had reduced to 3.8% and the close margin rate had increased slightly to 13.4%. We present the longitudinal statistics.

​Conclusions/Clinical relevance This study has shown that there appears to be improvement in performance of excisions of NMHNSC as the surgeon gains experience over time to reach a consistent performance. There was a clear initial learning curve to achieve this which took several cases. This likely differs from numbers presented in the literature believed to achieve competency in other bodily surgical procedures.Copyright © 2019

Author(s) Markose G.; Corsar K.; Graham R.M.
Source British Journal of Oral and Maxillofacial Surgery; Dec 2019; vol. 57 (no. 10)
With advances in CT scanning and 3D printing facilities the use of surgical models / stents in maxillofacial surgical planning for implants and oncological work is fairly routine. We present a case where the use of custom cutting guides aided 3D sculpting of a rather overgrown mandible in a young girl with a central giant cell granuloma. En bloc resection can be challenging due to the variable size and location of the tumours and their proximity to surrounding vital tissues. To overcome the challenge of precise resection, computer-aided models were used to assess vital structures, the extent of the affected area and plan surgery.

​The models were able to accurately identify the course of the mandibular canal. A mirror image of the normal side of the mandible was superimposed on the overgrown mandible and patient-specific guiding templates for resection were fabricated which allowed significant recontouring of the mandible with relative ease. The guiding templates provide significant advantages by guiding surgery, leading to more precise resection of the bone with less blood loss, shorter operation time and avoiding damage to the inferior alveolar nerve. We discuss the pre-operative and operative steps in the surgery and review the results.Copyright © 2019

Author(s) Semkova K.; Calonje E.; Carr R.; Grainger M.; Green R. et al.
Source Journal of the American Academy of Dermatology; Dec 2019; vol. 81 (no. 6); p. 1257-1270
Background: We present a distinctive type of acquired vascular proliferation, for which we propose the name of poikilodermatous plaque-like hemangioma. Objective(s): The aim of this study was to summarize the clinical and histopathologic features in a case series of poikilodermatous plaque-like hemangioma.

Method(s): Sixteen cases were identified from the routine clinical and referral practices of the authors. Clinical characteristics, including demographic details and clinical morphology, were collated. The salient histopathologic features, including immunohistochemical staining results, were summarized.

​Result(s): The lesions were usually solitary erythematous-to-violaceous poikilodermatous plaques on the lower extremities and pelvic girdle, with an indolent clinical course. Mean age of affected patients was 72 (range 58-80) years, and there was a male predominance. Histology comprised a distinctive band-like proliferation of vascular channels suggestive of postcapillary venules within the superficial dermis with a background of fibrosis, edema, and loss of elastic fibers. Despite the clinical atrophic appearance, acanthosis was a frequent finding. Limitation(s): Retrospective study. Conclusion(s): Poikilodermatous plaque-like hemangioma is a distinctive and previously undescribed vascular proliferation defined by a constellation of consistent and reproducible clinical and histologic features.Copyright © 2019 American Academy of Dermatology, Inc.

Author(s) Garg S.; Chichareon P.; Modolo R.; Tomaniak M.; Onuma Y. et al.
Source European Heart Journal; Oct 2019; vol. 40 ; p. 3108
Objectives: To investigate the impact of ticagrelor monotherapy following one-month dual antiplatelet therapy (DAPT) on clinical outcomes after percutaneous coronary intervention (PCI) in patients with established cardiovascular disease (CVD) who were enrolled in the Global Leaders Trial.