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Otology
Published in Adnan Darr, Karan Jolly, Jameel Muzaffar, ENT Vivas, 2023
Jameel Muzaffar, Chloe Swords, Adnan Darr, Karan Jolly, Manohar Bance, Sanjiv Bhimrao
Contraindications: Bone disease where skull is too thin to support BAHA implant e.g. osteogenesis imperfecta<3 yrs. Usually 4–5 yrs to allow optimal bone thickness of 4 mm Two-stage procedure with sleeper screw with 3-month interval to reduce OI failureMicrotia: Consider post-aural flaps, MDT for positioning, delay after 6 yrs (95% adult size)Chronic skin disordersRelative contraindications: Psychiatric disease or psychological immaturityAlcohol/drug abuse
Communication skills
Published in Michael Parker, Charlie James, Fundamentals for Cosmetic Practice, 2022
Relative contraindications are far harder to explain to a patient and subsequently must be broached very sensitively. Start by exploring exactly which treatments your patient was after, why they wanted that particular treatment and what the overall cosmetic outcome they were after was. This approach may seem somewhat patron-ising, but it will help you gather more information about your patient’s ideas and expectations from treatment. Relative contraindications are subjective to a practitioner performing any treatment, and sadly, they are a “grey area” in which there no absolute rights or wrongs. Remember you have a duty of care to your patient, and this may be the only time in your practice that a paternalistic approach is sensible or advisable.
Thoracic Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
In some respects, the contraindications are more important than the indications. Perhaps, more important than the indications are the contraindications! There is very limited value in performing emergency thoracotomy in moribund patients with blunt trauma. However, contrary to earlier canonical teaching there is increasing evidence to support the use of pre-hospital thoracotomy which in selected patients is associated with good outcomes,46–48 and patients may occasionally arrive in the emergency department with an opened chest.
Electrochemotherapy with intravenous bleomycin for patients with cutaneous malignancies, across tumour histology: a systematic review
Published in Acta Oncologica, 2022
Freya A. Bastrup, Mille Vissing, Julie Gehl
Electroporation destabilises the cell membrane and allows different hydrophilic substances to enter the cell [1], such as the cytotoxic drug bleomycin. Bleomycin is favourable for ECT compared to other anticancer drugs, in that it is already established as a treatment for cancer and has the largest increase in efficacy after electroporation, enhancing the cytotoxic effect 300–5000 fold [1,2,12]. ECT is indicated for cutaneous malignancies of any histology, size and quantity, which either are symptomatic or which other treatment modalities have not been possible to treat [9]. Contraindications include pregnancy, allergy or hypersensitivity. ECT is applicable all over the surface of the body and shows high response rates across different tumour subtypes [13]. Often the procedure is performed with general anaesthesia, which requires hospitalisation [9].
Current advances in the management of cluster headaches
Published in Expert Opinion on Pharmacotherapy, 2021
Theodoros Mavridis, Marianthi Breza, Christina Deligianni, Dimos D. Mitsikostas
Ergot derivatives such as oral ergotamine and intranasal or intravenous dihydroergotamine (DHE) have been used as a treatment for CH bouts but with little evidence of clear efficacy. The initial dose of oral ergotamine is 2 mg sublingual and can be repeated every 30 minutes with a max dose of 6 mg daily. Intranasal DHE has a level U recommendation from the AHS [29], denoting insufficient evidence to make. Intravenous DHE has shown better results for inpatient management of the refractory episodic CH [40]. The initial dose of DHE is 1 mg IV bolus and can be repeated after 1 hour with a max dose of 3 mg per day. Ergots can also induce medication overuse headache (MOH) with very low doses and their use must be limited to less than 10 days per month. Contraindications are coronary artery disease due to the constriction of the coronal vessels [41], arterial hypertension, and cerebrovascular diseases. Due to their impact on the vascular system, they should not be used in combination with other vasoconstrictor drugs. Other contraindications include Raynaud disease, renal or hepatic failure, pregnancy, and lactation [27,36].
Consensus Document on Non-Suitability for Transcatheter Mitral Valve Repair by Edge-to-Edge Therapy
Published in Structural Heart, 2021
D. Scott Lim, Howard C. Herrmann, Paul Grayburn, Konstantinos Koulogiannis, Gorav Ailawadi, Mathew Williams, Vivian G. Ng, Katherine H. Chau, Paul Sorajja, Robert L. Smith, Mayra Guerrero, David Daniels, Juan F. Granada, Michael J. Mack, Martin B. Leon, Patrick McCarthy
The working group initially focused on which patient types would be unsuitable for TEER mitral repair, and could be considered suitable for inclusion in a single-arm registry TMVR study rather than a randomized trial (the so-called “red light” category of patients for TEER mitral repair, using red-yellow-green traffic light analogy). Subsequent manuscripts will address the “green” and “yellow” light subsets. We identified four subtypes of patients unsuitable for mitral TEER therapies (Table 1) – those in whom (1) mitral stenosis would likely result, (2) inadequate reduction of mitral regurgitation would be expected to occur, (3) the procedure should not be performed due to technical, imaging, or anatomic reasons, and (4) there is futility in performing the procedure secondary to cardiac or non-cardiac co-morbidities. Importantly, as mentioned, these unsuitable patient types can be an absolute or relative contraindication, as modified by the clinical circumstances.