Case example of a jail-based cancer prevention clinical trial: Social determinants of health framework, novel experimental design, and retention strategies to facilitate long-term follow-up of clinical trial participants.

Clinical trials conducted with incarcerated populations are rare. We present a case example of one such jail-based cancer prevention clinical trial to demonstrate the importance of including a theory-driven approach to intervention framing, novel experimental designs to boost access to low-risk trials, and retention strategies for long-term follow-up of hard-to-reach populations. As such we offer a social determinant of health framework to ensure cancer prevention research is conducted through the lenses of health promotion and health equity. Deviations from the gold-standard randomized control design, transparent systematic allotment, and street-based outreach retention strategies contribute to the feasibility of conducting clinical trials in carceral settings and after people leave jail. Best practices presented can be used in design and conduct of future clinical trials with criminal legal system-involved populations.

Chronic Portal Vein Thrombosis with Percutaneous Main Portal Vein Reconstruction and Coil Embolization of a Massive Coronary Vein: A Case Report.

BACKGROUND Portal vein thrombosis (PVT) is a well-recognized complication in patients with cirrhosis and frequently requires a nuanced approach to treatment. There is a paucity of existing literature and evidence-based recommendations regarding the optimal treatment approach to chronically occluded portal veins. Management options range from observation to anticoagulation and interventional therapies such as transjugular intrahepatic portosystemic shunts (TIPS), thrombolysis, or surgical thrombectomy. For select patients with little success from traditional medical therapies and previously failed TIPS procedures, a direct transhepatic approach to restoring blood flow and resolving variceal bleeding may be appropriate. CASE REPORT A 31-year-old man with a past medical history of portal hypertension, refractory ascites, gastroesophageal varices, and decompensated cirrhosis secondary to alcohol abuse had previously undergone an unsuccessful TIPS placement. Preprocedural imaging demonstrated a cirrhotic liver, splenomegaly, and gastroesophageal varices compatible with portal hypertension. Also noted were focal calcifications in the region of the diminutive main portal vein, medial splenic vein, and superior mesenteric vein, compatible with sequalae of chronic thrombosis. Restoration of flow through the occluded segment of the main portal vein and cessation of variceal bleeding was successfully resolved through the combination of portal vein reconstruction and massive volume embolization of the large coronary vein using a direct, percutaneous approach. CONCLUSIONS A direct, percutaneous approach to main portal vein reconstruction and massive volume embolization after a previously failed TIPS may be a potential alternative approach for select patients.