ITEMS IN AFP WITH MESH TERM:
Perioperative Antiplatelet Therapy - Article
ABSTRACT: Aspirin is recommended as a lifelong therapy that should never be interrupted for patients with cardiovascular disease. Clopidogrel therapy is mandatory for six weeks after placement of bare-metal stents, three to six months after myocardial infarction, and at least 12 months after placement of drug-eluting stents. Because of the hypercoagulable state induced by surgery, early withdrawal of antiplatelet therapy for secondary prevention of cardiovascular disease increases the risk of postoperative myocardial infarction and death five- to 10-fold in stented patients who are on continuous dual antiplatelet therapy. The shorter the time between revascularization and surgery, the higher the risk of adverse cardiac events. Elective surgery should be postponed beyond these periods, whereas vital, semiurgent, or urgent operations should be performed under continued dual antiplatelet therapy. The risk of surgical hemorrhage is increased approximately 20 percent by aspirin or clopidogrel alone, and 50 percent by dual antiplatelet therapy. The present clinical data suggest that the risk of a cardiovascular event when stopping antiplatelet agents preoperatively is higher than the risk of surgical bleeding when continuing these drugs, except during surgery in a closed space (e.g., intracranial, posterior eye chamber) or surgeries associated with massive bleeding and difficult hemostasis.
Who Should Operate in Carotid Disease? - Editorials
Common Questions About Vasectomy - Article
ABSTRACT: Vasectomy offers a safe, effective, and permanent method of male contraception, with an overall failure rate of less than 1% in pooled studies. Men older than 30 years in a stable, committed relationship appear to be the best candidates for vasectomy. The no-scalpel technique reduces operative complications, shortens operative time, and hastens resumption of sexual activity. Use of a jet injector instead of a needle to provide local anesthesia (no-needle vasectomy) may reduce pain. Bleeding and infection are short-term complications of vasectomy; long-term complications include sperm granuloma and postvasectomy pain syndrome. One postvasectomy semen analysis demonstrating azoospermia performed after three months and 20 ejaculations is sufficient to establish sterility. Vasectomy reversal is more likely to be successful if performed less than 15 years after vasectomy and in men whose female partner is younger than 40 years.
ABSTRACT: Laparoscopic adjustable gastric banding procedures have a favorable risk-benefit profile and are increasingly important as part of the overall management of obesity. These procedures are effective at inducing weight loss and improving comorbid conditions, including diabetes mellitus, hypertension, and sleep apnea. Laparoscopic adjustable gastric banding has several typical complications, and family physicians should recognize these as part of a team-based approach to the management of obesity. Gastric band slippage, port or tubing malfunction, stomal obstruction, band erosion, pouch dilation, and port infection are examples of complications that may occur after laparoscopic adjustable gastric banding. Upper gastrointestinal tract imaging is often required to diagnose these complications. Some complications can be managed in the primary care setting through behavioral diet modification or removal of fluid from the band (band deflation); however, other complications require surgical repair or removal of the band.
Nodule Arising in a Surgical Scar - Photo Quiz