Local flap guidance for scalp reconstruction following Mohs micrographic surgery.

Keratinocyte carcinomas (KCs) are commonly located on the scalp and often treated with excision with peripheral and deep en face margin assessment (PDEMA), with Mohs micrographic surgery (MMS) being the most frequently used method. Resection of these malignancies results in wounds with a wide variety of sizes, ranging from small, sub-centimeter defects, to extensive, nearly complete scalp defects. MMS is often the preferred treatment for tumor resection and margin clearance, as it allows for maximal healthy tissue preservation and has the lowest recurrence rates.

Alcohol-Related Liver Disease, Followed by Metabolic Dysfunction-Associated Steatotic Liver Disease, Emerges as the Fastest-Growing Aetiologies for Primary Liver Cancer in the United States.

Objective: Primary liver cancer (PLC) is projected to be the third leading cause of cancer mortality in the United States in 2040. We examine the burden of PLC in the United States, stratified by sex, state and aetiological risk factors.

Methods: Data on PLC prevalence, incidence, death and disability-adjusted life years (DALYs) were extracted from the Global Burden of Disease Study 2021.

How Reliable Is the Posterior Belly of the Digastric Muscle in Preventing Carotid Injury During Neck Dissection?

The posterior belly of the digastric muscle, referred to as the "resident's friend," serves as a valuable anatomical landmark because identification of its location during head and neck surgery helps to secure vital structures. A 53-year-old female was referred for an oral cavity mass with a biopsy confirmed squamous cell cancer. A physical exam revealed a 4 cm long and 2 cm wide right ulcerated oral tongue mass.

Temple Volumization: A Review of Anatomy and Optimal Injection Techniques.

Background: Cosmetically unappealing temporal volume loss can develop as a result of facial aging.

Objective:  To present an evidenced-based approach towards safe and effective temple filling.

Methods: We review the underlying anatomy of the temple and optimal anatomy-driven injection techniques associated with temple volumization.

Variations in Trauma Education Practices Across Emergency Medicine Residencies: Insights from a National Survey of Program Directors.

Purpose: Care of the acutely injured trauma patient is integral to the practice of emergency medicine. It is currently unknown how most emergency medicine residencies structure their residents' trauma experience and little guidance for competency assessment is provided by the Residency Review Committee. Our study aimed to determine current emergency medicine residency practices in trauma resuscitation.

Safety and efficacy of enclomiphene and clomiphene for hypogonadal men.

Background: Both clomiphene citrate and its isomer, enclomiphene, have become widespread within urologic practice; thus, understanding these medications' comparative benefits and risks is crucial for optimizing treatment and providing improved therapeutic options. We sought to investigate the longitudinal benefits and risks associated with enclomiphene, compared to clomiphene, and to provide valuable insights for clinicians when making treatment decisions in the management of hypogonadism.

Methods: We retrospectively studied patients at our academic center who had been prescribed clomiphene and, later, enclomiphene for hypogonadism.

Investigating the Transfer of Lisinopril into Human Milk: A Quantitative Analysis.

Lisinopril is commonly prescribed to manage conditions such as hypertension and heart failure. While concerns about fetal toxicity have traditionally limited the use of lisinopril in women of reproductive age, recent ACOG guidelines promote aggressive treatment of hypertension, which may require the use of pharmacologic agents not previously considered in the postpartum period. We aimed to estimate infant exposure to maternal lisinopril via breastmilk and report the tolerance of the breastfed infant.

Ultrarare Variants in DNA Damage Repair Genes in Pediatric Acute-Onset Neuropsychiatric Syndrome or Acute Behavioral Regression in Neurodevelopmental Disorders.

Introduction: Acute onset of severe psychiatric symptoms or regression may occur in children with premorbid neurodevelopmental disorders, although typically developing children can also be affected. Infections or other stressors are likely triggers. The underlying causes are unclear, but a current hypothesis suggests the convergence of genes that influence neuronal and immunological function.

Urachal Adenocarcinoma: A Case Report of a Rare Tumor.

Urachal adenocarcinoma is a rare and aggressive bladder cancer involving the urachus, an embryological fibrous remnant of the allantois extending from the bladder to the umbilicus. Usually discovered in the advanced stages, this cancer can commonly present with a poor prognosis. We report a case of a 34-year-old male patient with an unremarkable medical history who presented to the emergency department with severe, sudden onset, sharp abdominal pain.

Erectile dysfunction as a holistic indicator of well-being: a narrative review.

Introduction: Erectile dysfunction (ED), affecting around 52% of men aged 40-70, is a significant marker of overall health and a potential warning sign of multiple conditions like cardiovascular diseases (CVDs), diabetes, and mental health disorders. Recognizing and addressing ED through a holistic approach involving nutrition, physical activity, sleep, and stress management can improve both erectile and overall health outcomes.

Aims: To provide a narrative review of the available literature on the relationship between ED and overall health, elaborate on the possible mechanisms explaining this association, and discuss the effects of lifestyle on ED.

National and Geographic Trends in Medicare Reimbursement for Pain Management 2014-2023.

Background: Increasing enrollment in Medicare has coincided with reductions in reimbursement for various procedures, including interventional pain procedures. No previous analysis of state-to-state differences in Medicare reimbursement rates for practicing pain management physicians has been performed.

Objective: To quantify recent national and geographical trends for interventional pain procedures.

Cerebrospinal Fluid Leak Secondary to Whiplash Injury.

Although rare, cerebrospinal fluid (CSF) leaks can prove to be detrimental if severe. Usually secondary to dural punctures, CSF leaks can present as severe headaches, neck pain, blurry vision, confusion, and nausea. However, patients can also be asymptomatic.

Massive Gastrointestinal Bleeding Related to NSAID Use in a Patient with Ileorectal Anastomosis.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce pain and inflammation in over 30 million individuals daily. Gastrointestinal bleeding (GIB) associated with NSAID consumption has been well documented in gastric and duodenal bleeding; however, NSAID-associated GIB distal to the duodenum lacks extensive documentation. This report highlights small bowel occult bleeding related to NSAID use in a patient with a surgical history of robotic total colectomy with ileorectal anastomosis completed 1 year prior.

Physician infertility: a structured literature review.

Physician infertility has become a growing concern because of the increasingly high rates of infertility physicians experience associated with their strenuous work schedules, environmental exposures, and delayed family planning due to their necessitated years of training. Fortunately, there has been an increase in awareness, advocacy, and urgency for institutional support alongside this suboptimal association. This awareness is reflected in the vast existing literature regarding physician infertility; in this scoping review, we aggregated and assessed the current data as well as identified gaps in the available research.