Interbalkan Medical Center

Lumbar spinal stenosis (LSS) is a common degenerative spinal disorder in older adults and a leading indication for surgery. Decompression via laminectomy remains the gold standard when conservative measures fail, but the addition of posterior fusion in cases without clear instability remains controversial. Anatomical and biomechanical considerations lie at the center of this debate. Central canal stenosis, lateral recess narrowing, and degenerative spondylolisthesis represent the main contributors to LSS, but they also raise the question of whether they signal true instability. Definitions of instability vary considerably across studies and guidelines, and thresholds for diagnosis remain inconsistent. While fusion is appropriate in the presence of instability, the lack of standardized criteria causes an uncertainty that may influence surgeons to fuse in cases without having definitive radiographic criteria for instability. The aim of this review is to compare laminectomy alone with laminectomy plus posterior fusion in the surgical management of LSS. Emphasis is given on anatomical and biomechanical considerations, instability definitions, clinical outcomes, and guideline recommendations. High-quality multicenter randomized trials are needed to develop universally accepted instability definitions, guide management of borderline cases, and optimize patient outcomes.

Abstract Background Identifying pathogenic/likely pathogenic variants in high-risk cancer genes is key to cancer risk management.Prophylactic surgeries like RRM and RRSO are guideline-recommended options. This study aims to provide real-world evidence on their clinical implementation. Methods Between 2020 and 2025, 203 women referred for genetic testing at Genekor Medical S.A., were detected with P/LP variants in cancer susceptibility genes, for which risk-reducing surgical options are either recommended or considered for discussion. Referring clinicians were invited to complete a questionnaire to assess whether prophylactic surgical options had been discussed, if the patients had agreed to undergo such procedures, and whether the surgeries have already been performed or postponed. Results Among the individuals referred for genetic testing, 168(83%) were referred following a cancer diagnosis, while 35(17%) were unaffected individuals referred due to a family history. 153 individuals (76%) harbored BRCA1/2, 31(15%) harbored PALB2, PTEN, TP53 and 19 (9%) harbored BRIP1,RAD51C, RAD51D P/LP variants. RRSO was discussed with 78/153 (51%) of BRCA1/2 carriers and agreed in 60/78 (77%) cases. Addition of hysterectomy to RRSO was discussed in 16/78 (21%) of cases and agreed in 10/16 (63%). RRM was discussed with 113/203 (56%) of patients and agreed in 73/113(65%). In PALB2, PTEN, TP53 carriers, RRM was discussed in 21/31 (68%) cases, and accepted in 9/21 (43%), while in 5 cases both RRM/RRSO were discussed with 3 women agreeing. Finally, for 19 BRIP1,RAD51C, RAD51D carriers, in 9 cases the physician discussed RRSO as an option, with the examinees agreeing in 7 of them and in 5 cases RRM was discussed with agreement to proceed in 2 of them. In all cases, 22 individuals although agreed to proceed with RRM and/or RRSO, decided to postpone the procedure. Conclusions This study highlights the high awareness and acceptance of surgical management demonstrating the adherence to the recommendations. Age under 35 years and receiving therapy at the time of genetic testing were significant factors in lowering risk reduction RRSO and hysterectomy performance rates. Stage IV cancer was the main reason for not discussing surgical intervention. Citation Format: K. Papazisis, M. Paraskeva, S. Giassas, M. Skondra, R. Iosifidou, C. Tolis, G. Kesisis, E. Zairi, V. Venizelos, C. Markopoulos, I. Natsiopoulos, E. Bleka, I. Xanthakis, A. Ananiadis, D. Matheos, D. Stefanou, A. Adamidis, A. Meintani, G. Kapetsis, D. Bouzarelou, E. Papadopoulou, G. Nasioulas. High-risk cancer susceptibility genes mutation carriers’ compliance with surgical risk reduction for breast and ovarian cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS3-05-05.

Lumbosacral transitional vertebrae (LSTV) are common congenital spinal anomalies that may redistribute mechanical loads to adjacent segments. This study aims to provide a comprehensive, quantitative synthesis of the relationship between LSTV & the prevalence, anatomical distribution, and severity of lumbar spondylolisthesis. A systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines. PubMed, Scopus, and Web of Science were searched through November 2025. Studies comparing adult individuals with LSTV to those without were included. Risk of bias was assessed using ROBINS-I. Random-effects meta-analysis was used to calculate pooled odds ratios (OR) for prevalence and distribution, and mean differences for slip severity. Twelve retrospective cohort studies (n = 3929) were included. LSTV was not associated with an increased overall prevalence of degenerative spondylolisthesis (OR 1.28; 95% CI 0.86-1.91; p = 0.22). However, LSTV significantly altered the level of slippage. Patients with LSTV demonstrated strongly increased odds of spondylolisthesis at L4-L5 (OR 13.78; 95% CI 4.30-44.18; p < 0.0001) and a significant protective effect at L5-S1 (OR 0.07; 95% CI 0.02-0.23; p < 0.0001). No significant difference in slip severity was observed in pooled analyses (p = 0.31). LSTV does not increase the overall risk of spondylolisthesis but acts as a biomechanical modifier that markedly redistributes pathology. It protects the transitional segment while shifting mechanical stress and instability to the cranial adjacent level (L4-L5).

Abstract Sustainable agricultural intensification requires a precise understanding of how land use decisions influence soil organic carbon (SOC) sequestration under varying environmental conditions. We apply causal machine learning to evaluate the heterogeneous impact of winter wheat-based rotations on SOC at the field-level across Lithuania. Using a nationwide dataset collected over five years (2018–2022), including crop types, management practices, soil properties, and environmental conditions, we estimate how the effects of winter wheat-based rotation vary across space and climate. Our results indicate that winter wheat generally enhances SOC levels, but its effectiveness is modulated by climate. Cooler regions experience higher SOC gains, whereas warmer regions show diminished or even negative effects. Future climate projections suggest that the potential for winter wheat sequestration may decline under high-emission scenarios. These findings highlight the importance of localized agricultural strategies that account for climate variability to maximize SOC sequestration and ensure long-term soil sustainability.

Hipertensi merupakan salah satu penyakit teratas penyebab disabilitas pada orang dewasa di Indonesia. Meskipun prevalensi hipertensi sudah mengalami penurunan 3,3% dibandingkan tahun sebelumnya menjadi 30,8%, akan tetapi angka ini masih dikategorikan tinggi dan dapat menyebabkan berbagai komplikasi lainnya. Tujuan penelitian ini adalah untuk mengetahui korelasi antara konsumsi natrium dengan tekanan darah yang dilaksanakan di UPT Panti Sosial Husnul Khotimah. Metode yang digunakan dalam penelitian analitik kuantitatif dengan menggunakan pendekatan crossectional, dimana penelitian dilakukan pada saat pengambilan data antara variabel independen dengan variabel dependen yang dilakukan secara bersama-sama pada waktu yang sama, dengan besar populasi 73 responden lansia yang tinggal sekurang-kurangnya tiga bulan di UPT Panti Sosial Husnul Khotimah Pekanbaru. Hasil penelitian menunjukkan bahwa terdapat korelasi antara konsumsi natrium dengan tekanan darah sistolik (p&lt;0,05) dan dengan nilai korelasi (r=0,4).

Background and ObjectivesThe number of critically ill patients with haematological conditions is increasing, yet transfusion practices in this population remain poorly defined. This study aimed to compare transfusion strategies in critically ill patients with versus without haematological conditions.Study Design and MethodsThis international, prospective observational substudy of the International Point Prevalence Study of Intensive Care Unit [ICU] Transfusion Practices (InPUT) evaluated transfusion use in ICU patients with and without haematological conditions, including benign or malignant diseases or a history of stem cell transplantation. Outcomes included use of red blood cells (RBCs), platelets, plasma, haemostatic interventions, transfusion indications and thresholds.ResultsOf 3643 ICU patients, 131 (3.6%) had a haematological condition. These patients were more likely to receive RBC (odds ratio [OR] 1.58, 95% confidence interval [CI] 1.09–2.29) and platelet transfusions (OR 8.32, 95% CI 5.09–13.6), primarily due to low haemoglobin rather than physiological triggers. Platelet thresholds were lower (median 23 × 109/L vs. 64 × 109/L) compared to non‐haematology patients. Both platelet and plasma transfusions were more frequently administered prophylactically rather than for active bleeding. Haemostatic interventions were more often used in haematology patients, at higher doses and typically without viscoelastic testing. Transfused haematology patients had higher 28‐day mortality and longer ICU stays.ConclusionICU patients with haematological conditions receive transfusions differently, particularly regarding platelet and plasma use. These findings underscore the need for prospective studies to define optimal transfusion thresholds in this growing and vulnerable patient population, although the study's limited sample size and lack of diagnostic granularity may affect interpretation.

Transfemoral (TF) TAVR can be challenging in patients with prior aortic coarctation repair and bypass grafts due to extreme tortuosity. A 74-year-old man with severe symptomatic aortic stenosis and a prior left-subclavian-to-descending aortic bypass presented for TAVR. CT showed a large, calcified annulus (perimeter-derived diameter 27.6 mm; area 573.7 mm²) and a serpiginous, calcified bypass graft. After initial failure to advance the system through the graft, we pre-shaped a Lunderquist wire with an acute bend ~40 cm from the tip to redirect the delivery vector. A 27.5-mm balloon-expandable MyVal was then advanced and deployed uneventfully, with no paravalvular leak. Intentional pre-shaping of a stiff wire can facilitate TF device traversal across aorto-subclavian bypass grafts with severe tortuosity, enabling safe, precise deployment when TF remains the preferred route.

Abstract Background/Introduction Paravalvular leak is a complication of valve replacement with 1% to 3% of patients developing symptoms including heart failure or hemolysis. Purpose This study aims to evaluate the long-term outcomes in whom the primary indication for paravalvular leak closure was hemolysis. Methods We included patients from five Greek hospitals between February 2013 and March 2024. The primary endpoint was the assessment of short and long-term changes in hemolysis parameters, including lactate dehydrogenase, hemoglobin, and indirect bilirubin at 1, 6, 12, and 24 months post-procedure versus baseline values. Secondary endpoints included clinical success, defined as improved hemolysis with transfusion-free status for at least 6 months and survival analysis during the follow-up. Results The study included 42 patients who underwent transcatheter closure of paravalvular leak for hemolytic anemia, with a 15±9 month follow up. Mean age was 69.7±10.3 years and 69% were male. For the primary endpoint, the mean pre-procedural lactate dehydrogenase was 1196±592 IU/L. Although reductions at 1 month (891±1051 IU/L, p=0.221), 6 months (504±378 IU/L, p=0.060), and 12 months (569±312 IU/L, p=0.085) were not statistically significant, a remarkable decrease was observed at 24 months (479±364 IU/L, p=0.040). Hemoglobin levels did not significantly change from pre-procedural values (9.91±1.7 g/dl) at 1 month (10.85±4.3 g/dl, p=0.196), 6 months (10.98±1.91 g/dl, p=0.051), 12 months (10.98±2.19 g/dl, p=0.097) and 24 months (13.09±5.7 g/dl, p=0.065). Indirect bilirubin, with a baseline of 2.4±2.19 mg/dl, showed significant reductions at all time points: 1 month (1.50±1.9 mg/dl, p&amp;lt;0.001), 6 months (0.66±0.44 mg/dl, p=0.003) and 12 months (0.76±0.42 mg/dl, p=0.005). A more than 50% reduction in lactate dehydrogenase was achieved by 44.4% of patients at 1 month, 61.5% at 6 months, 66.7% at 12 months, and 81.3% at 24 months. Similarly, &amp;gt;50% reduction in indirect bilirubin was observed in 58.3% at 1 month, 62.5% at 6 months, and 80% at 12 months. For the secondary endpoints, the need for transfusions significantly decreased from 63.4% pre-procedure to 14.7% at 6 months (p&amp;lt;0.001). Clinical success was achieved in 85.3% of patients. The technical success was 88.1%. The rates of remaining moderate paravalvular leak were 88.1% pre procedurally versus 7.1% at discharge, p&amp;lt;0.001. During the follow-up period of 15±9 months, the survival rate was 66.7%, with 14 patient deaths. Conclusions Transcatheter paravalvular leak closure significantly reduced hemolysis indices (lactate dehydrogenase, indirect bilirubin) with sustained benefits over 24 months. While hemoglobin showed a non-significant increase, transfusion requirements markedly decreased, with most patients remaining transfusion-free for at least 6 months. Overall, transcatheter paravalvular leak closure appears to be an effective option for selected patients.

Intertrochanteric fractures are very common injuries in the elderly population and are typically managed with cephalomedullary nailing. Even though this approach generally has successful outcomes, complications like implant failure or peri-implant fractures could still occur, especially in osteoporotic patients. An 87-year-old female with a previously operated intertrochanteric femoral fracture presented with a subcapital femoral neck fracture combined with breakage of the cephalic lag screw. Imaging showed no signs of non-union or malalignment in the pertrochanteric region. The patient underwent cemented dual mobility total hip arthroplasty after removal of the broken lag screw and cephalomedullary nail. Intraoperatively, a distal femoral spiral fracture occurred. This was stabilized with lag screws and a locking plate. The patient recovered uneventfully and returned to full weight-bearing 3 months postoperatively. This case highlights a rare complication and presents a therapeutic approach in the context of contemporary literature.