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Residual defect after surgical closure of atrial septal defect is extremely uncommon. This communication reports four cases encountered in a tertiary care center during the last three decades. Clinical diagnosis was challenging, and the diverse presentations included acute ischemic stroke, cyanosis, and right ventricular volume overload. The morphology of the residual defects was complex, and multimodality imaging (transesophageal echocardiography, peripheral venous contrast studies, computed tomography, and balloon occlusion) enabled accurate recognition. Percutaneous device closure was feasible in one but required repeat surgery owing to unfavorable anatomy in the others. The communication focuses on difficulties in diagnosis and management.
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http://dx.doi.org/10.4103/apc.apc_151_24 | DOI Listing |
Orv Hetil
September 2025
1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Klinikai Központ, Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinika Szeged, Tisza Lajos körút 111., 6725 Magyarország.
JMIR Med Inform
September 2025
Department of Radiology, Air Force Medical Center, Air Force Medical University, Fucheng Road 30, Haidian District, Beijing, CN.
Background: Lateral malleolar avulsion fracture (LMAF) and subfibular ossicle (SFO) are distinct entities that both present as small bone fragments near the lateral malleolus on imaging, yet require different treatment strategies. Clinical and radiological differentiation is challenging, which can impede timely and precise management. On imaging, magnetic resonance imaging (MRI) is the diagnostic gold standard for differentiating LMAF from SFO, whereas radiological differentiation on computed tomography (CT) alone is challenging in routine practice.
View Article and Find Full Text PDFJAMA Netw Open
September 2025
Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Importance: As obesity rates rise in the US, managing associated metabolic comorbidities presents a growing burden to the health care system. While bariatric surgery has shown promise in mitigating established metabolic conditions, no large studies have quantified the risk of developing major obesity-related comorbidities after bariatric surgery.
Objective: To identify common metabolic phenotypes for patients eligible for bariatric surgery and to estimate crude and adjusted incidence rates of additional metabolic comorbidities associated with bariatric surgery compared with weight management program (WMP) alone.
JAMA Netw Open
September 2025
Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City.
Importance: Advances in diagnostics have enabled the detection of more gastrointestinal pathogens, but misuse of diagnostics can lead to inappropriate antibiotic use and excess financial burdens. Ensuring appropriate use of diagnostics is crucial for optimizing patient care and promoting stewardship of health care resources.
Objective: To elicit parents' and clinicians' perspectives on expectations for care of pediatric diarrhea with a focus on diagnostic testing and to evaluate the potential for an electronic clinical decision support tool (ECDST) to improve appropriate use of diagnostics.
Age Ageing
August 2025
Department of Nursing Health Services Research, Graduate School of Health Care Sciences, Institute of Science Tokyo, Yushima, Bunkyo-ku, Tokyo, Japan.
Background: Little is known about how ambulatory care sensitive condition (ACSC)-related readmissions can be reduced in acute care settings.
Objective: This study examined the association between transitional care for hospitalised older patients with ACSC and ACSC-related readmissions.
Methods: This retrospective observational cohort study included patients aged 65 years and older admitted with ACSC as the primary diagnosis from 1 April 2022 to 31 January 2023, using linked data from the Diagnosis Procedure Combination and the medical functions of the hospital beds database.