Stability of diluted chlorhexidine for skin testing in drug allergy evaluations.

Background: Chlorhexidine gluconate (CHX), a common cause of perioperative anaphylaxis, is frequently used for skin testing in allergy evaluations. Although CHX's maximal nonirritating concentrations are known, the stability of its dilutions for skin testing remains unexplored, particularly when sterile water for injection (SWFI) or normal saline (NS) are used as diluents.

Objective: Our aim was to evaluate the stability and precipitation of CHX when diluted with SWFI or NS for drug allergy skin testing.

Addressing Late-arriving Surgeons in Support of First-case On-time Starts.

Introduction: First-case on-time starts (FCOTS) is an established metric of perioperative efficiency, impacting global perioperative throughput. Late-arriving surgeons are a common cause of late operating room (OR) starts. This project reflects a quality improvement effort to reduce late surgeon arrivals by 30% for 24 months and improve FCOTS.

Ecodesign Enhancement of Polymeric Resins: Reinforcing with Synthetic and Natural Fibers Using Theory of Inventive Problem Solving-Algorithm of Inventive Problem Solving for Sustainable Composite Design.

This study examines the enhancement of the mechanical strength of polymer resins through reinforcement with synthetic (glass) and natural (hemp, jute) fibers, using the TRIZ-ARIZ methodology to optimize composite design for improved mechanical properties, sustainability, and economic efficiency. Mechanical testing, thermogravimetric analysis (TGA), and scanning electron microscopy (SEM) were conducted to evaluate the properties of the composite materials. Regarding tensile strength testing, the results showed the following: jute fiber achieved the best results, with a maximum tensile values of 43.

Delivering the news of an intraoperative death; literature-based guidance from the American Association for Thoracic Surgery Wellness Committee.

Objectives: Fortunately, operating room deaths and unexpected deaths are infrequent occurrences. However, when they occur, the surgeon is called upon to deliver this news to family and loved ones. There is a paucity of literature on this topic and little guidance preparing cardiothoracic surgeons for this important but difficult situation.

The American Board of Orthodontics: Scenario-based clinical examination development and preparation.

This article outlines the development process for the scenario-based clinical examination of the American Board of Orthodontics (ABO). It emphasizes the importance of gaining hands-on experience with patients and critically analyzing the facts when formulating sound clinical judgments. These exercises enhance critical thinking skills, allowing for self-assessment and reflection on patient outcomes.

Surgical treatment and outcomes of pectus arcuatum.

Objective: Pectus arcuatum is a rare variant of pectus deformities that can cause varying degrees of cardiac compression. A review of the evaluation, surgical repair, and outcomes of pectus arcuatum is presented.

Methods: A retrospective review of all patients undergoing surgical treatment of pectus arcuatum at a single institution was conducted between January 1, 2010, and May 31, 2024.

The QIBA Profile for Dynamic Susceptibility Contrast MRI Quantitative Imaging Biomarkers for Assessing Gliomas.

The dynamic susceptibility contrast (DSC) MRI measures of relative cerebral blood volume (rCBV) play a central role in monitoring therapeutic response and disease progression in patients with gliomas. Previous investigations have demonstrated promise of using rCBV in classifying tumor grade, elucidating tumor viability after therapy, and differentiating pseudoprogression and pseudoresponse. However, the quantification and reproducibility of rCBV measurements across patients, devices, and software remain a critical barrier to routine or clinical trial use of longitudinal DSC MRI in patients with gliomas.

Lung transplant outcomes in recipients of advanced age: Are two always better than one?

Background: Lung transplantation has become more common in patients aged 65 years and older. We aimed to examine outcomes across age groups and identify risk factors for decreased survival.

Methods: United Network for Organ Sharing data for all primary lung transplants from January 1, 2006, to March 8, 2023, were retrospectively reviewed.

LI-RADS US Surveillance Version 2024 for Surveillance of Hepatocellular Carcinoma: An Update to the American College of Radiology US LI-RADS.

In 2017, the American College of Radiology introduced the US Liver Imaging Reporting and Data System (LI-RADS) as a framework for US surveillance of patients at risk for developing hepatocellular carcinoma. This has aided in the standardization of technique, clinical reporting, patient management, data collection, and research. Emerging evidence has helped inform changes to the algorithm, now released as LI-RADS US Surveillance version 2024.

Midterm survival, clinical, and hemodynamic outcomes of a novel mechanical mitral valve prosthesis.

Objective: To evaluate the midterm survival, clinical, and hemodynamic outcomes of the On-X mechanical mitral valve, based on the 5-year results of the Prospective Randomized On-X Anticoagulation Clinical Trial (PROACT).

Method: PROACT Mitral was a multicenter study evaluating 401 patients who underwent mitral valve replacement (MVR) with either Standard or Conform-X On-X mitral valves, comparing low-dose and standard-dose warfarin. Here we report prespecified secondary outcomes of survival, New York Heart Association (NYHA) functional classification, and valve hemodynamics as assessed by core lab-adjudicated echocardiography at 1, 3, and 5 years in the pooled population.

Incidence and timing of postoperative complications after total hip and knee arthroplasty.

Background: Follow-up protocols after total hip or knee arthroplasty (THA or TKA, respectively) have little uniformity, which can lead to emergency department (ED) visits for postoperative complications. We sought to determine the incidence and timing of postoperative complications after THA or TKA.

Methods: We conducted a population-based retrospective cohort study of all adults in Ontario who underwent primary THA or TKA between 2010 and 2019.

Evaluation of immediate vancomycin-induced hypersensitivity reaction to severe perioperative anaphylaxis.

The evaluation of vancomycin hypersensitivity reactions is challenging, as skin testing is not validated. Intradermal testing with vancomycin in human serum albumin-based sterile saline could be a new approach to the evaluation of IgE-independent hypersensitivity reactions.

Opsomyoclonus: A rare complication of West Nile virus.

West Nile virus is a mosquito-borne illness that usually presents as asymptomatic or with a viral syndrome, and normally is treated with supportive care or immunotherapy. However, some patients can develop neurologic symptoms of viral meningoencephalitis. This article describes a patient who developed opsomyoclonus, a rare complication of West Nile virus meningoencephalitis.

Radiographic Enhancement of Lymph Nodes 9 Months after Omental Lymph Node Transfer.

Lymphedema is a frequent complication of breast cancer treatment. As the survival rates of breast cancer continue to increase, the number of women with lymphedema will also increase. Surgical treatment of lymphedema has made significant advances during the past 20 years, and our understanding of these procedures continues to evolve.

Asthma and respiratory comorbidities.

Asthma is a common respiratory condition with various phenotypes, nonspecific symptoms, and variable clinical course. The occurrence of other respiratory conditions with asthma, or respiratory comorbidities (RCs), is not unusual. A literature search of PubMed was performed for asthma and a variety of respiratory comorbidities for the years 2019 to 2024.

Postmenopausal Endometriosis: Clinical Insights and Imaging Considerations.

Endometriosis is a chronic systemic condition characterized by the presence of ectopic endometrial-like tissue outside of the uterus. It occurs most often in reproductive-aged patients and less frequently in postmenopausal women. In postmenopausal patients, endometriosis is more common in those undergoing hormone replacement therapy or taking tamoxifen.

Occipital Vascularized Bone Graft for Reconstruction of a C3-C7 Defect.

The number of spinal reconstruction cases is growing, as are the accompanying complications. Wound complications after spinal reconstruction can be fatal and can affect up to 19% of patients undergoing major spine surgery. The discipline of spinoplastic surgery is characterized by the use of vascularized bone grafts to reconstruct spinal defects, which provide better results compared with nonvascularized and allogenic equivalents, owing to their superior blood supply.