Kepler Universitätsklinikum

Tranexamic acid (TXA) has been increasingly acknowledged as a beneficial pharmacological agent in plastic surgery. However, despite its proven efficacy and safety, there is limited research on its intravenous application in gender-affirming mastectomy, particularly regarding its effect on drain duration, drain output, and length of hospital stay. In this retrospective single-center study, patients who underwent double incision mastectomy with free nipple grafts were categorized into two cohorts: one group receiving TXA and a control group without TXA utilization (TXA vs no-TXA). Demographic characteristics, surgical data, and complication rates were analyzed and compared. A total of 75 patients were included, with 34 procedures performed without the administration of TXA and 41 patients receiving TXA. The median age of the study population was 24 years (range 18-57). Postoperative bleeding requiring surgical revision was significantly less frequent in the TXA group (p = 0.038). Total drain output (p = 0.048), drain duration (p < 0.001) and length of hospital stay (p = 0.008) were significantly reduced in the TXA group. No thromboembolic events or seizures were observed. This study demonstrated that intravenously administered TXA significantly reduces the incidence of postoperative hematoma, length of hospital stay, drain duration, and output after gender-affirming mastectomy. Based on these findings, we would recommend the use of TXA in double incision mastectomy with free nipple grafts to minimize the occurrence of seroma formation and major bleeding-related complications. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

To describe the clinical findings and report the incidence of patients developing non-infectious intraocular inflammation (IOI) following intravitreal faricimab injections (IVFs). A retrospective review of electronic medical records was conducted for patients receiving faricimab intravitreal injections for neovascular age-related macular degeneration (nAMD) and diabetic macular oedema (DMO) at Moorfields Eye Hospital, London, United Kingdom, over a 24-month period. 3985 eyes from 3151 patients were included and underwent a total of 28,535 IVFs (20,982 for nAMD, 7553 for DMO). 57 eyes from 46 patients presented at least one episode of IOI. The 2-year estimated incidence of IOI was 0.20% [95% CI 0.15-0.26] per injection, 1.43% [95% CI 1.08-1.85] per eye and 1.46% [95% CI 1.07-1.94] per patient. Mean visual acuity (VA) was significantly different between the day of IVF (0.48 ± 0.43 logMAR, range: 0-1.8) and the day of IOI diagnosis (0.67 ± 0.52, range: 0-2.3) (p < 0.001). VA after IOI resolution showed no significant difference from baseline (p > 0.99). Intravitreal injections were resumed in 42 eyes. IVFs re-challenge was attempted in 9 eyes, with 5 developing another episode of IOI. This study describes one of the largest reported cohorts of IOI cases following faricimab treatment. It confirms that the incidence of IOI is rare and aligns with the rates of IVF-related adverse effects reported in clinical trials and in recent real-world studies. Overall, faricimab demonstrated a favourable safety profile with good prognosis in cases of IOI.

Introduction: Radical Antegrade Modular Pancreatosplenectomy (RAMPS) was developed to improve surgical radicality for left-sided pancreatic ductal adenocarcinoma (PDAC). Although widely accepted, the optimal surgical approach-open versus minimally invasive (MI)-is still being debated. Methods: We conducted a multicenter retrospective cohort study across three Austrian centers, including all patients undergoing RAMPS between 2016 and 2023 indicated for suspected (pre-)malignant pancreatic lesions. Patients were grouped based on the surgical approach (MI vs. open). The primary endpoints were resection margin status and lymph node yield following PDAC resection. Secondary outcomes included survival for PDAC patients and postoperative complications; non-PDAC resections were also taken into account. Results: A total of 57 patients were included, of whom 34 had PDAC. In PDAC patients, the rate of tumor-free margins and the median lymph node yield were equivalent between the MI and open approaches (R0 rate: MI 92.9% vs. open 85%, p = 0.484; median lymph node yield: MI 16 (IQR 10-23) vs. open 19 (IQR 15-25), p = 0.314). Two-year overall survival was also comparable (MI: 71.6% vs. open: 66.4%, p = 0.479). Postoperative outcomes at 90 days, like CR-POPF and major complications (Clavien-Dindo ≥ IIIa), did not differ between the two approaches. MI-RAMPS showed non-significant favorable trends in median length of stay (p = 0.093) and likelihood of receiving adjuvant chemotherapy (p = 0.075). Conclusions: In our experience, MI-RAMPS demonstrates oncologic equivalence and similar early postoperative outcomes to open RAMPS, with potential advantages such as shorter length of stay and likelihood of receiving adjuvant chemotherapy.

Zusammenfassung Die Leitlinien 2025 des European Resuscitation Council (ERC) empfehlen zum Atemwegsmanagement während kardiopulmonaler Reanimation (CPR) von Erwachsenen (Advanced Life Support) einen stufenweisen Ansatz. Dieser orientiert sich an den Kompetenzen der handelnden Personen, der Situation und den Patient:innen. Die Sektion Notfallmedizin der Österreichische Gesellschaft für Anästhesiologie, Reanimation und Intensivmedizin (ÖGARI) teilt die wissenschaftlich fundierten Empfehlungen des ERC und bestätigt den Anwendungsvorteil von Larynxmasken gegenüber Larynxtuben. Gleichzeitig wird aber darauf hingewiesen, dass vor dem Hintergrund der spezifischen Gegebenheiten in Österreich bei einer etwaigen Umstellung von Larynxtuben auf Larynxmasken entsprechende Schulungsmöglichkeiten für die Rettungsdienstmitarbeiter zu beachten sind.

Background: Postoperative pain levels and opioid requirements vary considerably, even among patients undergoing similar surgical interventions. The pupillary pain index-a pupillometry-derived measure of nociception-antinociception balance-may help individualize postoperative analgesia. We therefore tested the hypothesis that a pupillary pain index-guided opioid titration at the end of surgery reduces postoperative pain and opioid consumption compared with standard care. Methods: At the end of surgery, a portable infrared pupilometer was used to measure pupillary dilation reflex during stepwise tetanic stimulation (10-60 mA), generating a pupillary pain index score. Adult patients undergoing elective ear-nose-throat surgery under general anesthesia were randomized to pupillary pain index-guided opioid therapy or standard care. Opioid administration in the pupillary pain index group followed predefined pupillary pain index cutoffs; in the control group, analgesia was managed per routine practice. Postoperative opioid consumption and pain-assessed using a numerical rating scale (NRS, 0-10)-were recorded every 30 min for 2 h in the post-anesthesia care unit. Linear models with covariates including remifentanil, weight, nose surgery, and sex were calculated to compare outcomes between groups. Results: Mean (±SD) opioid consumption during the first 2 postoperative hours was 4.9 ± 4.3 mg in the pupillary pain index-guided group and 6.5 ± 4.3 mg in the control group (adjusted p = 0.12). Mean pain scores were 2.0 ± 1.1 and 2.6 ± 1.4, respectively (adjusted p = 0.10). Conclusions: Pupillary pain index-guided analgesia resulted in a nearly 25% reduction in opioid consumption and lower pain scores, although not statistically significant. This suggests that PPI-guided analgesia is not inferior to standard care in terms of pain management.

Managing left bundle branch block (LBBB) after transcatheter aortic valve implantation (TAVI) remains challenging. The aim of this study was to develop a novel, simplified electrocardiogram (ECG) algorithm for predicting infranodal conduction delay in LBBB (both new onset as well as preexisting) patients after TAVI and to compare its performance vs current European Society of Cardiology (ESC) ECG criteria. A multicenter analysis of prospectively enrolled patients undergoing electrophysiology testing for preexisting or new-onset LBBB after TAVI was conducted. The novel algorithm was developed by analyzing various combinations of the PR interval, QRS duration pre-TAVI and post-TAVI, and changes in these parameters to identify patients with infranodal conduction delay (defined as a His-ventricular interval ≥70 milliseconds). A total of 769 patients with LBBB (12% preexisting) after TAVI underwent risk stratification using electrophysiology testing at 7 institutions (mean age 81 ± 7 years; 57% female; 21% His-ventricular ≥70 milliseconds). A novel algorithm using solely a PR interval of 190 milliseconds and a QRS interval of 160 milliseconds revealed a sensitivity of 88% and an negative predictive value of 92% for the rule-out of infranodal conduction delay (PR interval post-TAVI <190 milliseconds AND QRS duration post-TAVI <160 milliseconds) and a specificity and positive predictive value of 85% and 41%, respectively, for the rule-in of infranodal conduction delay (PR interval post-TAVI ≥190 milliseconds AND QRS duration post-TAVI ≥160 milliseconds). By comparison, the ESC ECG criteria showed a sensitivity of 72%, a negative predictive value of 88%, specificity of 53%, and a positive predictive value of 28%. The novel, simplified ECG algorithm showed a superior performance for the rule-out and rule-in of infranodal conduction delay compared with current ESC ECG criteria.

Background: As demonstrated by the PACIFIC trial, biomarker-driven patient selection is crucial. While treatment based on programmed death ligand-1 (PD-L1) and mutational status have become routine, tests for biomarkers available from pretherapeutic blood samples are currently a topic of scientific interest. Methods: This analysis was conducted on patients from the ALLSTAR RWD study, which is a nationwide, prospective registry for inoperable non-small cell lung cancer (NSCLC) stage III. Patients were amenable if they had a full routine pre-treatment blood sample, from which the following biomarkers were extracted: neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), derived monocyte-to-lymphocyte ratio (dMLR) and lactate dehydrogenase (LDH) levels. The intention was to find a cutoff for each of these biomarkers to predict locoregional control (LRC), progression-free survival (PFS) and overall survival (OS). Results: MLR and dMLR demonstrated their predictive potential with cutoff values of 0.665 and 0.945, respectively. Stratifying the whole cohort by means of these cutoffs demonstrated significantly better locoregional control for patients below the threshold, both in the whole cohort (N = 175; 55.7% vs. 75.5%; p-value = 0.018) and in the Durvalumab subgroup (N = 106; 57.5% vs. 77.3%; p-value = 0.030). Similar findings were observed for PFS in the whole cohort (N = 175; 20.5% vs. 56.1%; p-value p < 0.001) and in the Durvalumab subgroup (N = 106; 31.2% vs. 64.6%, p-value < 0.001). dMLR could also significantly predict PFS (N = 173; 17.4% vs. 56.3%; p-value < 0.001), which was corroborated in the Durvalumab subgroup (N = 108; 23.1% vs. 64.1%; p-value = 0.003). Conclusions: This explorative analysis demonstrates the predictive potential of MLR and dMLR for LRC and PFS. These blood biomarkers can be readily integrated into clinical routines since they are easily available.