Breast cancer detection in women with implants has been questioned. We sought to evaluate the impact of breast implants on mammographic outcomes. A retrospective review of women undergoing mammography between March 1 and October 30, 2013 was performed. Demographic characteristics and mammogram results were compared between women with and without breast implants. Overall, 4.8 per cent of 1863 women identified during the study period had breast implants. Median age was 59 years (26–93). Women with implants were younger (53.9 vs 59.2 years, P < 0.0001), had lower body mass index (25.4 vs 28.9, P < 0.0001), and were more likely to have dense breast tissue (72.1% vs 56.4%, P = 0.004) than those without. There were no statistically significant differences with regards to Breast Imaging Recording and Data System 0 score (13.3% with implants vs 21.4% without), call back exam (18.9% with vs 24.1% without), time to resolution of abnormal imaging (58.6 days with vs 43.3 without), or cancer detection rate (0% with implants vs 1.0% without). Because implants did not significantly affect mammogram results, women with implants should be reassured that mammography remains useful in detecting cancer. However, future research is required to determine whether lower call back rates and longer time to resolution of imaging findings contribute to delays in diagnosis in patients with implants.

INTRODUCTION: Endoscopic retrospective cholangiopancreatography (ERCP) is a technically challenging procedure rarely associated with severe post-procedure complications. Pregnancy promotes cholelithiasis due to hormonal changes and ERCP may be indicated. Surgical intervention is preferred during the second trimester of pregnancy. However, limited data is available on the safety of ERCP in early pregnancy. METHODS: Over a 7 year period, all pregnant patients with complicated gallstone disease were studied retrospectively at Loma Linda University Medical Center in California (n = 41). Five patients underwent ERCP during either the first or second trimester for choledocholithiasis or gallstone pancreatitis. One patient underwent laparascopic cholecystectomy during the same hospitalization. All patients underwent sphincterotomy and stone removal with balloon sweeps. Fluoroscopy was utilized in all five cases. RESULTS: Three patients delivered full term, healthy babies. Two of the patients experienced spontaneous abortions within one week after ERCP. Both cases of spontaneous abortion were in their first trimester of pregnancy. There were no other clear etiologies reported for cause of both abortions. CONCLUSION: ERCP is reported to be a relatively safe procedure in pregnancy. More studies are required to investigate the safety of ERCP in early pregnancy.

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Goal:The goal of this study was to determine the financial impact of adopting the US Multi-Society Task Force (USMSTF) polypectomy guidelines on physician reimbursement and disposable equipment costs for gastroenterologists in the academic medical center and community practice settings.Background: In 2020, USMSTF guidelines on polypectomy were introduced with a strong recommendation for cold snare rather than cold forceps technique for removing diminutive and small polyps. Polypectomy with snare technique reimburses physicians at a higher rate compared with cold forceps and also requires different disposable equipment. The financial implications of adopting these guidelines is unknown.Materials and Methods: Patients that underwent screening colonoscopy where polypectomy was performed at an academic medical center (Loma Linda University Medical Center) and community practice medical center (Ascension Providence Hospital) between July 2018 and July 2019 were identified. The polypectomy technique performed during each procedure was determined (forceps alone, snare alone, forceps plus snare) along with the number and size of polyps as well as disposable equipment. Actual and projected provider reimbursement and disposable equipment costs were determined based on applying the new polypectomy guidelines.Results: A total of 1167 patients underwent colonoscopy with polypectomy. Adhering to new guidelines would increase estimated physician reimbursement by 5.6% and 12.5% at academic and community practice sites, respectively. The mean increase in physician reimbursement per procedure was significantly higher at community practice compared with the academic setting

Introduction: Oral incompetence (OI) following facial nerve injury or sacrifice remains a frustrating problem for patients and clinicians alike. Dynamic procedures for facial paralysis often do not fully address OI and static surgeries are frequently needed. Current static options frequently involved multiple facial incisions. Methods: We describe a novel technique to address OI due to lower division facial nerve paralysis and report outcomes in an initial series of patients. Results: OI symptoms improved in 94% of patients following a single-stage surgery. Revision was required in one patient with subsequent resolution of symptoms. Major complications (19%) included persistent OI, wound dehiscence, and bothersome lip “bulk”. Conclusion: Lip wedge resection with orbicular oris plication resolves OI in facial paralysis patients with the added benefit of only a single incision on the face.