Severe back labor pain masks a scald caused by shower hydrotherapy: a case report.

Shower hydrotherapy is generally considered benign during labor. We report a case of extensive scalds in a primigravida who used shower hydrotherapy to treat severe back labor pain from fetal malposition. Interestingly, her back pain was so severe that she felt no pain as her scald developed, describing the hot water from the showerhead as the only measure which "soothed" her pain.

Vascular Complications With Intra-aortic Balloon Pump (IABP): Experience From a Large Canadian Metropolitan Centre.

Background: Intra-aortic balloon pump (IABP) insertion in critically ill patients has been associated with both vascular and nonvascular complications, which have restricted its use. The primary objective for this study was to determine the frequency and predictors of vascular complication in our centre.

Methods: We conducted a retrospective cohort study of consecutive patients treated with an IABP between January 2014 and June 2018.

Outcomes of hybrid procedures for peripheral arterial disease: 5-year single center experience.

Objective: The objective of the study was to present patients with peripheral vascular disease (PVD) who underwent hybrid procedures at our institution, the results of these interventions for a 5-year period and determine patency, mortality, failure, and amputation rates compared to the literature.

Material And Methods: Observational, single center, retrospective, and cross-sectional study which analyzed data gathered from the vascular quality initiative from patients who had hybrid revascularization procedures from January 2010 to December 2015.

Results: 87 patients were identified: 51 (58%) male, 36 (41%) female, 9 (10%) had critical limb ischemia (CLI), and 78 (90%) claudication.

Cannabis significantly alters DNA methylation of the human ovarian follicle in a concentration-dependent manner.

Cannabis is increasingly consumed by women of childbearing age, and the reproductive and epigenetic effects are unknown. The purpose of this study was to evaluate the potential epigenetic implications of cannabis use on the female ovarian follicle. Whole-genome methylation was assessed in granulosa cells from 14 matched case-control patients.

The follicular fluid adipocytokine milieu could serve as a prediction tool for fertility treatment outcomes.

Research Question: Can the adipocytokine milieu of the follicular niche improve the ability to predict treatment outcomes in infertile patients?

Design: Follicular fluid samples from overweight patients were analysed and compared with samples from matched normal-weight patients. Concentrations of adiponectin, chemerin, C-reactive protein, interleukin-6 (IL-6), IL-10, IL-18, insulin, leptin, prolactin, resistin, tumour necrosis factor alpha (TNF-α) and bone morphogenetic protein-15 (BMP-15) were assessed by multiple magnetic bead immunoassay (MMBI) and enzyme-linked immunosorbent assay and correlated with fertility treatment outcomes.

Results: Analysis of samples from 22 overweight and 22 normal-weight patients demonstrated that TNF-α can predict oocyte maturation rate.

Planned oocyte cryopreservation (Planned OC): systematic review and meta-analysis of cost-efficiency and patients' perspective.

Background: Advances in vitrification techniques have enabled planned oocyte cryopreservation ('Planned OC').

Objectives: To explore the cost-efficiency and utilisation of planned OC, as well as patients' perspectives on the process.

Search Strategy: A systematic search in PubMed/MEDLINE, Embase, Cochrane Database and PsychINFO, for all relevant studies published between January 2007 and December 2019.

Endovascular repair of abdominal aortic aneurysm in octogenarians: clinical outcomes and complications.

Background: Endovascular aneurysm repair (EVAR) is associated with decreased perioperative morbidity and mortaliy in comparison with open repair, and thus octagenarians are traditionally offered EVAR given their age and medical comorbidities. The aim of this study was to investigate outcomes and predictors of complications associated with EVAR in octogenarians.

Methods: We conducted a retrospective chart review of consecutive patients aged 80 years and older who received an EVAR between August 2010 and January 2017 at a single centre in Toronto, Ontario.

Does body mass index impact assisted reproductive technology treatment outcomes in gestational carriers.

Background: The purpose of this study was to assess whether increased body mass index (BMI) negatively affects assisted reproductive technology (ART) outcomes among gestational carriers.

Methods: A retrospective matched case-control cohort, including all gestational carrier (GC) cycles performed at CReATe Fertility Centre (Toronto, ON, Canada) between 2003 and 2016.

Setting: A Canadian fertility clinic, with a large surrogacy program.

Unplanned early hospital readmissions in a vascular surgery population.

Background: Patients who undergo vascular surgery are burdened by high early readmission rates. We examined the frequency and cause of early readmissions after elective and emergent admission to the vascular surgery service at our institution to identify modifiable targets for quality improvement.

Methods: Over a 5-year period, all patients admitted and readmitted to the vascular surgery service were identified.

Vascular Complications and Procedures Following Transcatheter Aortic Valve Implantation.

Objectives: Vascular complications (VCs) remain a significant cause of morbidity in transcatheter aortic valve implantation (TAVI) patients and are associated with worse outcomes. This research analysed the incidence, impact, and predictors of VCs in transfemoral cases.

Methods: A retrospective chart review was performed of 388 consecutive TAVI patients between January 2007 and April 2015, which included 237 transfemoral cases.

Utility of the Vascular Quality Initiative in improving quality of care in Canadian patients undergoing vascular surgery.

The Vascular Quality Initiative (VQI) is a national cooperative quality-improvement initiative designed to evaluate processes of care and outcomes in vascular surgery. The purpose of this report is to show the utility of such a database to provide insight into the standard of care provided, to highlight areas of local quality improvement, to benchmark our data against local, regional and national trends, and to ultimately improve safety in Canadian patients undergoing vascular surgery. We present the history of the database, its spread in the Canadian health care system and examples of quality improvements achieved from analyses of data recorded and retrieved from the VQI.

Pre-operative Aneurysm Thrombus Volume, But Not Density, Predicts Type 2 Endoleak Rate Following Endovascular Aneurysm Repair.

Background: The impact of aneurysm thrombus characteristics on type 2 endoleak rate following endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) is unclear. The purpose of this study is to determine the impact of pre-operative aneurysm thrombus volume and density on the incidence of type 2 endoleak following EVAR for infrarenal AAA.

Methods: A retrospective analysis was completed on all patients who underwent standard EVAR at an academic medical institution between May 1, 2010 and June 1, 2016 with a minimum follow-up period of 12 months.

Outcomes of minor amputations in patients with peripheral vascular disease over a 10-year period at a tertiary care institution.

Objectives: Choosing an optimal amputation level requires balance between maximizing limb salvage while minimizing chances of non-healing wounds and re-amputation. Our aim was to assess the long-term outcome for minor amputations in patients with peripheral vascular disease.

Methods: A retrospective study of minor amputations between January 1, 2005 and December 31, 2015 was performed.

Opioid weaning and pain management in postsurgical patients at the Toronto General Hospital Transitional Pain Service.

Background: The perioperative period provides a critical window to address opioid use, particularly in patients with a history of chronic pain and presurgical opioid use. The Toronto General Hospital Transitional Pain Service (TPS) was developed to address the issues of pain and opioid use after surgery.

Aims: To provide program evaluation results from the TPS at the Toronto General Hospital highlighting opioid weaning rates and pain management of opioid-naïve and opioid-experienced surgical patients.

Long-term results of thigh arteriovenous dialysis grafts.

Introduction:: A proportion of hemodialysis patients exhaust all options for arteriovenous access in upper extremities. Arteriovenous thigh grafts are a potential vascular access option in such patients.

Methods:: We performed a retrospective study of all thigh arteriovenous access grafts placed between 1995 and 2015.

Acceptance and Commitment Therapy to manage pain and opioid use after major surgery: Preliminary outcomes from the Toronto General Hospital Transitional Pain Service.

: Chronic postsurgical pain (CPSP) and associated long-term opioid use are major public health concerns. : The Toronto General Hospital Transitional Pain Service (TPS) is a multidisciplinary, hospital-integrated program developed to prevent and manage CPSP and support opioid tapering. This clinical practice-based study reports on preliminary outcomes of the TPS psychology program, which provides acceptance and commitment therapy (ACT) to patients at risk for CPSP and persistent opioid use.

Smoking Cessation Rates among Patients Undergoing Vascular Surgery in a Canadian Center.

Background: Smoking is the single most important modifiable risk factor for patients with vascular disease. The aim of this study was to determine the prevalence of smoking and cessation rates among patients undergoing vascular surgery in a Canadian center.

Methods: As part of the Vascular Quality Initiative, a prospectively maintained database was used to identify the patients undergoing vascular surgery between 2010 and 2013.

Smoking, Pain Intensity, and Opioid Consumption 1-3 Months After Major Surgery: A Retrospective Study in a Hospital-Based Transitional Pain Service.

Introduction: The present study investigated the associations between smoking, pain, and opioid consumption in the 3 months after major surgery in patients seen by the Transitional Pain Service. Current smoking status and lifetime pack-years were expected to be related to higher pain intensity, more opioid use, and poorer opioid weaning after surgery.

Methods: A total of 239 patients reported smoking status in their presurgical assessment (62 smokers, 92 past smokers, and 85 never smokers).

Temporary inferior vena cava filter indications, retrieval rates, and follow-up management at a multicenter tertiary care institution.

Objective: The aim of this study was to investigate the practice pattern of inferior vena cava (IVC) filters and to determine factors predictive of filter retrievals at a multicenter, tertiary care institution.

Methods: A retrospective review of all IVC filter procedures performed between January 2001 and July 2013 was conducted. Data collected included demographics, venous thromboembolism risk factors, medical comorbidities, insertional and retrieval characteristics, referring services, complications, discharge, and follow-up management.

Using a multimedia presentation to improve patient understanding and satisfaction with informed consent for minimally invasive vascular procedures.

Objective: As vascular procedures become more complex, patient understanding of their treatment(s) can become more difficult. We wished to evaluate the utility of multimedia presentations (MPs) to improve patient understanding of their vascular interventions.

Methods: Patients undergoing endovascular aneurysm repair (EVAR), peripheral angioplasty, Hickman catheter and peripherally inserted central catheter (PICC) insertion were randomized into a control group receiving traditional verbal consent, and a MP group that were shown a two minute simplified video of their procedure on an iPad™ computer in addition to the traditional verbal consent.

Surgically placed abdominal wall catheters on postoperative analgesia and outcomes after living liver donation.

Living donor liver resections are associated with significant postoperative pain. Epidural analgesia is the gold standard for postoperative pain management, although it is often refused or contraindicated. Surgically placed abdominal wall catheters (AWCs) are a novel pain modality that can potentially provide pain relief for those patients who are unable to receive an epidural.

Continuous regional anaesthesia provides effective pain management and reduces opioid requirement following major lower limb amputation.

Objectives: Postoperative stump pain after major lower limb amputation is a significant impediment to the recovery of amputees. The vast majority of patients require opioid analgesics following surgery, which are associated with opioid-related side-effects. Here, we investigate whether intraoperative placement of a peripheral nerve stump catheter followed by continuous infusion of local anesthetic is as effective at pain control as current analgesic practices.

Intraductal papillary-mucinous tumor of the pancreas: presentation in a young adult.

Intraductal papillary-mucinous tumor (IPMT) of the pancreas is a premalignant lesion that can result in the hypersecretion of mucous and subsequent pancreatitis. In this report, one of the youngest cases of IPMT is described. Initial pancreaticogram was normal.