Faculty Bibliography

BACKGROUND:Adrenal venous sampling is routinely used to lateralize aldosterone hypersecretion but has an unclear role in adrenocorticotropic hormone-independent autonomous hypercortisolism. We define clinical scenarios where adrenal venous sampling provides value for surgical decision-making. METHODS:We performed a single-center retrospective review of patients undergoing adrenal venous sampling for hypercortisolism (January 2012-April 2025). Lateralization was defined by a lateralization ratio >2 using aldosterone as a reference hormone. We also conducted a scoping review of studies describing adrenal venous sampling use in hypercortisolism identified through a comprehensive literature search. RESULTS:Nine patients with isolated hypercortisolism were included, of which 88.9% were female, with a median age of 60 years (range, 41-76). Seven patients presented with mild autonomous cortisol secretion and 2 with overt Cushing's syndrome. Six patients had bilateral adrenal nodules. Mean nodule size was 2.71 ± 0.85 cm. Eight patients underwent a 1-mg dexamethasone suppression test, with all patients meeting the >1.8 μg/dL threshold for elevated serum cortisol (mean dexamethasone suppression test cortisol: 7.13 ± 4.82 μg/dL). Adrenal venous sampling lateralization corresponded to the larger or unilateral nodule in 5 patients, was nonlateralizing in 3, and correctly lateralized to the smaller nodule in 1 patient with similarly sized lesions (1.9 cm versus 2.0 cm), enabling correct-side surgery and resolution of symptoms of overt Cushing's. Seven isolated hypercortisolism patients underwent adrenalectomy, all with benign pathology. Nine studies were included in the scoping review, demonstrating heterogeneous adrenal venous sampling lateralization criteria. CONCLUSION/CONCLUSIONS:Adrenal venous sampling may be useful in select patients with adrenocorticotropic hormone-independent hypercortisolism and similarly sized bilateral adrenal nodules in order to prevent incorrect-side adrenalectomy or unnecessary bilateral adrenalectomy.

BACKGROUND/UNASSIGNED:We reviewed published studies describing postoperative spinal hematomas (ESH) across all spinal levels, with an emphasis on thoracic cases. Postoperative epidural spinal hematomas (ESH) most commonly occur in the thoracic spine, followed by the lumbar and cervical regions. They may arise in association with anticoagulation or antiplatelet therapy, epidural anesthesia or interventional procedures, trauma, or spinal decompression and/or fusion. Thoracic ESH (TESH) represent the highest risk group, with reported incidences ranging from 0.12% to 4.46%. METHODS/UNASSIGNED:We assessed the varied etiologies of ESH/TESH, and analyzed the multitude of risk factors, imaging findings, and optimal timing of surgical intervention for addressing these lesions. RESULTS/UNASSIGNED:Reported incidences of postoperative epidural spinal hematomas (ESH) ranged from 0.1-3%, with pooled studies showing an overall rate of ~0.52-0.69%. Notably, thoracic procedures (TESH) occurred more frequently, with rates ranging from 0.12% to 4.46%. One review of 40 studies found a 0.52% overall incidence of ESH, including 0.84% thoracic, 0.63% lumbar, and 0.32% cervical lesions. Multilevel ESH/TESH hematomas were more common after posterior (0.70%) vs. anterior (0.24%) surgery, and were five-fold more frequent following minimally invasive (1.94%) vs. open procedures (0.42%). CONCLUSIONS/UNASSIGNED:Postoperative epidural spinal hematomas occur in ~0.52-0.69% of spinal procedures, with thoracic lesions showing higher reported rates (0.12%-4.46%). The strongest predictors of neurological recovery included; the rapid recognition of new postoperative neurological deficits, immediate postoperative MR studies, and emergency surgery. We therefore recommend early/STAT diagnosis and surgery for ESH/TESH (i.e. performed as soon as possible rather than simpley within a < 24 h window) to optimize outcomes.

INTRODUCTION/BACKGROUND:Most injuries occur in low- and middle-income countries (LMICs), yet the trauma literature largely reflects high-income countries (HICs), and no research-methodology course is tailored to LMIC acute care surgeons or to trauma-specific infrastructure such as injury registries. We surveyed acute care surgeons to inform an American Association for the Surgery of Trauma (AAST) research-methodology curriculum. METHODS:A voluntary 25-item Research Electronic Data Capture survey developed by the AAST International Relations Committee, covering research experience, infrastructure access, and training priorities, was distributed (January-June 2025) by email and social media to AAST members and partner international trauma organizations. Respondents were classified by World Bank income group and compared using chi-square or Fisher exact tests. RESULTS:Of 132 respondents, 72 (55%) practiced in HICs and 60 (45%) in LMICs. versus HIC peers, LMIC respondents reported less research experience (73% versus 90%; P = 0.01), fewer publications (38% versus 74%; P < 0.001), and markedly less access to a trauma registry (20% versus 86%), statistical support, and a research coordinator (all P ≤ 0.006). A higher proportion of LMIC respondents selected registry design (52% versus 26%), scientific writing (67% versus 46%), and literature appraisal (47% versus 28%), while HIC respondents favored statistics and retrospective research (P < 0.05); and more likely to agree a mentor would help their research (93% versus 60%; P < 0.001). Course interest was high in both groups. CONCLUSIONS:Interest in research-methodology training was strong across income settings, but LMIC surgeons reported distinct, infrastructure-linked needs centered on trauma-registry building, scientific writing, foundational skills, and mentorship. Course design should reflect these differences rather than export a high-income model.

Although the health benefits of good sleep have been recognized for centuries, many people continue to struggle with sleep disorders triggered by many factors. Despite numerous studies on sleep disorders, a comprehensive understanding of their risk factors and potential mechanisms remains elusive. This review critically examines how circadian desynchrony acts as the primary driver linking sleep disorders and circadian clock dysfunction to dysregulated lipid metabolism and chronic vascular inflammation, ultimately accelerating atherosclerosis, and mainly focuses on the interplay of sleep-induced metabolic issues with the genetic and environmental factors that alter sleep patterns. Maintaining optimal sleep rhythm, quality, and timing is essential to decrease the risk of metabolic and cardiovascular diseases.

OBJECTIVES/OBJECTIVE:F]FES) positron emission tomography/computed tomography (PET/CT) in patients with estrogen receptor (ER)-positive breast cancer. MATERIALS AND METHODS/METHODS:F]FES PET/CT compared with conventional workup. Pooled proportions of management changes were calculated across the included studies, including subgroup and sensitivity analyses. RESULTS:F]FES PET/CT was beneficial in 39% (95% CI: 24-58%) by improving diagnostic certainty and supporting current treatment options. CONCLUSION/CONCLUSIONS:F]FES PET/CT impacted management in 38% of patients with ER-positive breast cancer. KEY POINTS/CONCLUSIONS:F]fluoroestradiol PET/CT had a substantial impact on the management of patients with ER-positive breast cancer.

In 2024, more than 300,000 women in the United States were diagnosed with invasive breast cancer. Despite significant advances in chemotherapy and radiation, surgery continues to be a central tenet of these patients' care, with most patients requiring surgery for definitive treatment. Postoperative pain control and anxiety surrounding options for pain relief consistently rank as a major concern of patients before surgery. In a nation recovering from an opioid epidemic with more than 100,000 overdose deaths a year, patients and providers alike are looking for nonnarcotic and nonpharmaceutical approaches to mitigate pain. This study is a proof of concept and initial investigation of a novel vibrating device (Relievvr) that is applied directly to the breast to provide sensory input that may modulate patient-perceived discomfort. The study enrolled 22 women undergoing outpatient breast surgery who used the device as part of their postoperative protocol. At 2 weeks postoperatively, 95% of women said they would use the device if they had surgery again, and 95% of women said they would recommend the device to a friend having the same surgery. These findings serve as proof of concept that a vibrating device based on the gate control theory of pain can be a feasible, nonopioid adjunct for managing postoperative breast surgery pain, with high levels of patient satisfaction and ease of use.