Case Of Fistula Research Articles

Frequency and incidence of oncogenic RAS mutations in patients with metastatic pancreatic ductal adenocarcinoma: Derived from the real-world evidence database Foundation Medicine Insights.

777 Background: Approximately 60,000 patients are diagnosed with pancreatic cancer in the United States annually, with half of all cases diagnosed at the metastatic stage. 1 The most common type, pancreatic ductal adenocarcinoma (PDAC), accounts for ~90% of all pancreatic cancers 2 and is characterized by frequent KRAS oncogenic mutations. Newer investigational therapeutics target HRAS and NRAS, in addition to KRAS. To comprehensively characterize the incidence of RAS mutations in patients with PDAC, we analyzed mutational frequency data from the Foundation Medicine Insights (FMI) database. Methods: NGS-based comprehensive genomic profiling (CGP) data from 27,298 PDAC tissue samples were accessed from the FMI database (May 7, 2024 data cut). Only ‘short variants’ in RAS genes ( KRAS , NRAS , and HRAS) occurring at amino acid positions G12, G13, or Q61 that had a frequency 0.1% or greater were included. To estimate the number of new US cases of RAS -mutant PDAC, pancreatic cancer incidence estimates 3 were adjusted by the derived RAS mutational frequency values. All incidence estimates were rounded to the nearest 100. Results: Oncogenic RAS mutations were identified in 92% of PDAC patients, with nearly all being KRAS (91.8%) and the remaining NRAS (0.2%). No HRAS mutations passed our minimum frequency threshold requirement. Individual RAS mutations with frequency >1% included KRAS G12D (39.9%), KRAS G12V (28.6%), KRAS G12R (14.6%), KRAS Q61H (4.2%), KRAS G12C (1.7%), and KRAS Q61R (1.4%). Applying these RAS mutation rates to reported PDAC incidence, we estimate that ~56,000 new patients with PDAC in USA per year will have tumors harboring an oncogenic RAS mutation, including ~51,000 of those with a RAS G12 mutation specifically. Conclusions: Oncogenic RAS mutations are identified from NGS testing in nearly all patients with advanced PDAC. Both the frequency and diversity of RAS mutations in PDAC suggest that PDAC is largely a RAS-driven cancer and that targeting RAS may be useful broadly in this disease. Mutational frequency and incidence at G12, G13, and Q61 amino acid positions in KRAS and NRAS among patients with PDAC. RAS G12 RAS G13 RAS Q61 RAS mutant Mutational Frequency KRAS 85.7% 0.8% 6.3% 91.8% NRAS 0.1% Below threshold 0.1% 0.2% Incidence KRAS 51,300 600 3,700 55,600 NRAS 100 Below threshold 100 200

P-2341. Was Viral Interference Responsible for the Unusual 2021-22 Influenza Season?

Abstract Background Viral interference is a short-term, non-specific immunity that limits infection by a second virus when a person has been infected by a first virus. Epidemiological and biological data supports the existence of viral interference, most likely caused by interferon production in response to an infection. The 2021-22 influenza season in the US displayed a highly unusual pattern in which a single influenza variant displaying a bimodal pattern, with a fall rise in transmission followed by a winter decrease and subsequent increase. The addition of a refractory period to a simulation of co-circulation of an Omicron-variant COVID-19 like virus and an H3N2-like influenza virus produced similar transmission dynamics to that observed in the 2021-22 influenza season.Figure 1. Covid-19 Omicron variant and influenza cases in the US population and in the simulation.A: Reported Covid-19 Omicron variant and influenza cases in US in the 2021-22 season. B: Simulated COVID-19 and influenza cases with and without refractory period with varied prior immunity to COVID-19. Left Y-axis, influenza cases; right Y-axis, Covid-19 cases. Methods We used the Agent-based modeling platform FRED (Framework for Reproducing Epidemiological Dynamics), with inclusion of a model of Omicron-variant COVID-19 like virus and an H3N2-like influenza virus. Results In a simulation including a 7-day refractory period, the introduction of an Omicron-like variant in December of the season after influenza transmission was already widespread caused influenza transmission to subside while the Omicron-like variant was circulating at high rates. Influenza still circulated at lower levels and rebounded after the Omicron-like variant surge decreased since there was no cross-immunity between the 2 viruses and a large pool of influenza susceptible agents remained. The epidemic curve from this simulation resembled in shape the epidemic curve of H3N2 influenza in 2021-22 (Figure). This effect was not present in similar simulations without a refractory period and was similar over the values of prior population immunity included in the simulation set. Conclusion Viral interference caused by widespread COVID-19 Omicron variant transmission is a plausible explanation for the unusual influenza infection pattern seen in the 2021-22 season. It is likely that viral interference is often influential in the interactions of a number of respiratory pathogens and should therefore be included in simulations that include multiple co-circulating respiratory pathogens. Disclosures All Authors: No reported disclosures

P-1326. Trends in Transgender Sexual Health: New Findings from Syphilis Cases

Abstract Background Syphilis has been on an alarming rise with worldwide cases in excess of 7 million in 2020 and US case rates tripling over the last 20 years. Sexually transmitted infections disproportionally impact sexually minoritized groups, including transgender and gender diverse (TGD) adults. Yet, syphilis rates among TGD people are relatively understudied. We sought to investigate syphilis trends specifically in the TGD community. Methods We performed a retrospective chart review and identified 33 TGD adults diagnosed with syphilis, from a total cohort population of 1,072 transgender persons tested for syphilis from 2010-2023. Persons diagnosed with syphilis were identified by one of the following criteria: International Classification of Diseases-10 (ICD) code, positive treponemal test (Tp), or positive non-treponemal test (NT). Diagnoses were further delineated into individual cases of syphilis to account for re-infections. True cases were defined as having positive Tp and NT, presumed positive as positive Tp or NT, and false positives as having a negative Tp or NT. Variables such as syphilis incidence and prevalence were calculated. Various qualitative aspects of disease progression and case presentation were analyzed via manual chart review. Results We identified 22 true cases, 8 presumed positives, and 12 false positives. Syphilis incidence was 2.79% and lifetime prevalence of 1.95%. While the number of syphilis tests increased per year, test positivity rates remained fairly constant at 3-4%. The vast majority of cases presented as primary syphilis (72%), and were most often completely asymptomatic (59%), with chancre (24%) and unexplained headache (14%) being the most common symptoms across all stages. There was only one case (3%) of confirmed neurosyphilis, which is higher than the national incidence (0.8-1.7%). Titers at time of diagnosis spanned a large range of values and was not predictive of stage of presentation, nor was there a clear correlation in titer kinetics and response to treatment. Conclusion With a relative paucity of investigations looking at syphilis rates in the TGD community, especially in the United States, understanding the epidemiology of this population could prove critical in prevention efforts. Disclosures All Authors: No reported disclosures

P-1929. Impact of the COVID-19 Pandemic on the Risk Factors and Outcomes Associated with Candidemia

Abstract Background Cases of candidemia surged during the COVID-19 pandemic, possibly due to the intensive treatments used in critically ill patients. This study aims to explore the impact of the pandemic on risk factors and clinical outcomes associated with candidemia. Methods We retrospectively analyzed patients ≥ 18 years diagnosed with candidemia at a single facility in Albany, Georgia, between January 2017 and May 2023. Patients were categorized into three groups based on their COVID-19 status and admission date (January 21, 2020, marking the first US case): 1) pre-pandemic (before January 21, 2020), 2) pandemic with COVID-19 (after January 21, 2020), and 3) pandemic without COVID-19 (after January 21, 2020). We compared risk factors for candidemia and in-hospital mortality across these groups. Results A total of 89 patients were included, with 44% pre-pandemic and 56% during the pandemic (half with COVID-19) (Table 1). Baseline characteristics were similar, except for a higher median number of comorbidities in the pre-pandemic group (p=0.008). Notably, the COVID-19 group had a significantly higher proportion of patients with no comorbidities (12%) compared to the pre-pandemic (0%) and pandemic without COVID-19 (4%) groups (p=0.01). Patients with COVID-19 were predominantly diagnosed with candidemia in the ICU (92%) compared to pre-pandemic (49%) and pandemic without COVID-19 (44%) groups (p< 0.001). Additionally, mechanical ventilation and vascular catheters were more frequent in the COVID-19 group (88% and 96%, respectively) compared to the pre-pandemic (31% and 62%) and pandemic without COVID-19 (40% and 68%) groups (p< 0.001 for both) (Table 2). While immunosuppressive medications were uncommon, glucocorticoid use was significantly higher in the COVID-19 group (76%) compared to the pre-pandemic (18%) and pandemic without COVID-19 (24%) groups (p=0.008). In-hospital mortality was highest among patients with COVID-19 (76%) compared to patients before the pandemic (44%) and those without COVID-19 during the pandemic (32%) (p< 0.005). Conclusion Patients with COVID-19 displayed a higher prevalence of candidemia risk factors and significantly worse clinical outcomes, including higher in-hospital mortality, compared to the other groups. Disclosures All Authors: No reported disclosures

The women’s inclusion agenda: Gender and everyday practices across registers of finance

Abstract Financial institutions spanning Global North and South are increasingly adopting an agenda of ‘women’s financial inclusion’. The women’s inclusion agenda in finance reflects dynamics of deep marketization that prescribe common economic policy solutions, transcending formerly significant distinctions of geography and social context. In this case, the closing of gender gaps is the universally proscribed policy. Yet this agenda elicits vastly different practices in ‘high’ finance registers where women are recruited as professionals, and microfinance registers where women are incorporated as borrowers. Relating multisited ethnographic materials from a US gender diversity organization and microfinance institutions in India, we ask: on what terms does inclusion take place? First, we examine how gender is constructed across finance institutions by essentializing women as virtuous. These constructions play out according to context-specific gender politics on questions of women’s economic empowerment – concerning neoliberal iterations of feminism in the US case, and financialization of social reproduction in India. Second, what do women’s everyday engagements with the inclusion agenda indicate about the terms of financial inclusion? Women contend with characterizations of themselves as risk-averse professionals and responsible borrowers, respectively, with ambivalence. Their contextually located ambivalent responses are points of both leverage and critique for the financial inclusion agenda.

Clinical case of multiple metachronous intraorbital arteriovenous fistulas in a patient with congenital heart disease

Intraorbital arteriovenous fistulas are rare arteriovenous shunts inside the orbit without connection with the cavernous sinus. This article describes a clinical case of multiple metachronous intraorbital arteriovenous shunts in a patient with univentricular heart disease and secondary erythrocytosis. Transarterial embolization of the first shunt had a positive clinical effect for 2 months. The recurrence of symptoms was caused by the formation of a new shunt on the same draining vein, but in a place remote from the previous locus. Repeated embolization gave a positive effect for the same period. The next relapse had a more malignant course, up to dislocation of the eyeball. The right orbit decompression has given a stable positive clinical effect up to the present moment. Based on extremely limited literature data of such cases and our own experience, we concluded that an individual and multidisciplinary approach to such patients with careful postoperative follow-up is necessary.

An iliac arteriovenous fistula associated with leg swelling 2 years after the removal of a hemodialysis catheter: A case report.

Temporary central venous catheters are commonly used for patients who require emergency hemodialysis. In rare instances, this procedure can result in a very serious complication known as arteriovenous fistula (AVF). Although some cases of femoral arteriovenous fistula have been reported previously in the literature; however, the incidence of iliac AVF precipitated by a hemodialysis catheter is exceedingly uncommon. The purpose of this study is to report a case in which a hemodialysis catheter caused a femoral arteriovenous fistula and to describe the successful treatment, thereby providing a reference for the diagnosis and treatment of such conditions in the future. Herein, we report the case of a patient with diabetes and end-stage kidney disease (ESKD) who presented with an iliac arteriovenous fistula as a complication of hemodialysis catheter insertion into the right femoral vein. Two years after hemodialysis catheter removal, the patient was admitted to our institution with swelling of the right lower limb and calf pain. The patient was subsequently diagnosed with an iliac arteriovenous fistula by computed tomography angiography and angiography. The patient was transferred to the Vascular Surgery Department for surgical treatment. The patient's leg swelling improved after surgery. After 1 year of follow-up, there was no occurrence of swelling in the patient's right leg. If the patient has a history of femoral venous catheter placement and develops limb swelling, in addition to considering the presence of a femoral arteriovenous fistula, it is important to consider the possibility of an iliac AVF. Iliac AVF are rare disorders. The primary goal for treatment of IAVF is to relieve associated symptoms. Based on the results of this study, the endovascular approach is safe and effective for the treatment of iliac AVF. Iliac AVFs are rare disorders. The primary goal of treatment for iliac AVFs is to relieve associated symptoms. Based on the results of this study, the endovascular approach is safe and effective in the treatment of iliac AVFs.

Analysis of artery injury types and clinical characteristics of patients with transcatheter angioembolization after percutaneous nephrolithotomy.

There is no systematic classification of renal vascular injuries conducted for severe post-percutaneous nephrolithotomy (PCNL) bleeding. The aim of the present study was to explore the various types of artery injury and clinical characteristics of patients who underwent transcatheter angioembolization (TAE) after PCNL. A retrospective analysis was performed on 52 patients who underwent renal arteriography (RA) because of severe bleeding after PCNL between April 2009 and December 2023. Among the patients, 38 underwent TAE due to positive RA results. Clinical data on the TAE patients, such as gender, age, body mass index, TAE interval, hemoglobin (Hb) decrease, operation time, stone size, the number and size of tracts, and clinical bleeding type, were summarized. The types of artery injury in TAE patients and their relationships with clinical characteristics were analyzed. Retrospective analysis revealed that, among the 38 TAE patients (32 males and 6 females), the mean TAE interval, average Hb decrease, mean tract number, and mean tract size reached 5.00 (6.25) days, 44.50 (24.50) g/L, 1 (0.25), and F20(6), respectively. Among the TAE patients, four kinds of vascular injury were observed, namely, 18 cases of pseudoaneurysm (PA), 12 cases of arteriocaliceal fistula (ACF), 7 cases of arteriovenous fistula (AVF), and 1 case of arterioperirenal fistula (APF). Analysis of the clinical characteristics of the three types of vascular injury (PA, ACF, and AVF) revealed that the number of tracts was the only factor that differed. The RA results indicate that the types of postoperative renal artery injury mainly include PA, ACF, AVF, and APF, and the number of tracts may be related to the type of vascular injury.

A Surgical Case of Coronary Pulmonary Artery Fistula with Direct Measurement of the Shunt Flow

A Surgical Case of Coronary Pulmonary Artery Fistula with Direct Measurement of the Shunt Flow

Endoluminal Visualization of Dural Arteriovenous Fistula Using Virtual Angioscopy

BackgroundVirtual Angioscopy (VA) has been used for vessel investigation and treatment planning in fields such as vascular surgery. To our knowledge, the utilization of VA in neurointerventional cases has not been demonstrated. Methods2 cases of dural arteriovenous fistula (dAVF) where virtual angioscopy was utilized were reviewed. Results2 cases of dAVF are reported where virtual angioscopic images were derived from 3D volume rendered (VR) images. The endoluminal visualization of the fistula served as additional tool that helped anatomic understanding and treatment planning. ConclusionThese cases demonstrate the utility of VA in endoluminal visualization of dural arteriovenous fistula that may aid in treatment planning considerations.

EP99 Abdominal Wall Abscess: An Exceedingly Rare Case of Cholecysto-cutaneous Fistula

eP99 Abdominal Wall Abscess: An Exceedingly Rare Case of Cholecysto-cutaneous Fistula

Protect or prevent? A practicable framework for the dilemmas of COVID-19 vaccine prioritization.

Determining COVID-19 vaccination strategies presents many challenges in light of limited vaccination capacity and the heterogeneity of affected communities. Who should be prioritized for early vaccination when different groups manifest different levels of risks and contact rates? Answering such questions often becomes computationally intractable given that network size can exceed millions. We obtain a framework to compute the optimal vaccination strategy within seconds to minutes from among all strategies, including highly dynamic ones that adjust vaccine allocation as often as required, and even with modest computation resources. We then determine the optimal strategy for a large range of parameter values representative of various US states, countries, and case studies including retirement homes and prisons. The optimal is almost always one of a few candidate strategies, and, even when not, the suboptimality of the best among these candidates is minimal. Further, we find that many commonly deployed vaccination strategies, such as vaccinating the high risk group first, or administering second doses without delay, can often incur higher death rates, hospitalizations, and symptomatic infection counts. Our framework can be easily adapted to future variants or pandemics through appropriate choice of the compartments of the disease and parameters.

Socio-demographic factors associated with obstetric fistula services among women of reproductive age in Garissa County, Kenya

Background: Approximately 3000 instances of fistulas are known to emerge annually in Kenya, with a 1/1000-woman incidence. Within the ever-increasing backlog are 300,000 cases of untreated fistulas, which are important to guide the application of appropriate therapies. Finding sociodemographic variables associated with the emergence of obstetric fistula was the goal of this study. Methods: Between October 2022 and March 2023, three large Kenyan hospitals participated in unmatched case control research. Patients having fistulas after deliveries during the last five years were considered cases. The control group consisted of women who did not currently have a history of fistula and were regularly seen in the obstetrics and gynaecology clinics at these institutions. A relationship between an object and its matching 95% confidence interval was measured using the odds ratio. components with a p value <0.05. Results: Age (χ2=10.3864, df=3, p=0.0156), educational level of the respondent (χ2=12.3001, df=3, p=0.0064), distance to nearest health facility (χ2=8.6592, df=3, p=0.0342) and height of respondents (χ2=36.6312, df=1, p<0.0001) were significantly associated with obstetric fistula. Participants residing more than 5 km from the nearest health facility exhibited a 2.51 times higher likelihood of developing obstetric fistula (AOR=2.51, 95% CI=1.0056-6.2874, p=0.0486). Individuals with a height <150 cm faced a substantially elevated risk, with an odds ratio of 12.09 (95% CI=5.0958-28.6797, p<0.001). Conclusions: Sociodemographic factors such as age, marital status, religious affiliation, and education level were identified as significant contributors to obstetric fistula occurrence. This study underscores the urgency of a comprehensive approach to tackle genital fistula, combining medical, social, and economic interventions.

Image-guided percutaneous mesenteric biopsy: diagnostic yield and safety profile.

To evaluate the diagnostic yield and safety profile of percutaneous image-guided biopsy of mesenteric lesions. Image-guided percutaneous biopsies of the mesentery at a single institution from 2000 to 2022 were identified and reviewed. Relevant demographic and procedural data were abstracted from the medical record. Surgical pathology was reviewed to evaluate if the biopsy was diagnostic and concordant with the patient's final diagnosis. One hundred ninety five patients (mean age, 62.6 ± 14.; M/F, 113/82; mean BMI, 30.4) underwent mesenteric biopsy procedure. Of these, 173 (89%) were performed using ultrasound and 22 (11%) were performed using CT or a hybrid/combined approach. Core needle biopsy was used in 164 (84%) patients, fine-needle aspiration (FNA) was used in 21 (11%), and both were used 10 (5%). Mean/median number of biopsy passes was 2.8 ± 1.3 and 3, respectively (core mean 2.7 ± 1.2; FNA mean 3.4 ± 1.5). Average lesion size was 5.3 ± 4.4cm in the long axis and 2.9 ± 2.0cm in the target plane. Diagnostic yield of core biopsies was 97.7% (n = 170/174) and FNA was 80.6% (n = 25/31) for an overall combined yield of 96.4% (n = 188/195). Of diagnostic biopsies, 95.7% (n = 180/188) were concordant with the final diagnosis, 70.8% (n = 138) of which were considered malignant. Overall concordant diagnostic rate was 180/195 (92.3%). Neuroendocrine tumor pathology was the only factor associated with lower diagnostic yield (13/15, 87%).For all biopsies, average shortest skin-to-target-distance on CT was 6.3 ± 2.8cm, decreased to 4.1 ± 1.3cm with US compression (approximately 35% reduction, p < 0.001). Additionally, ultrasound created a safe path not available on CT in 29 (15%) biopsies. Moderate IV sedation was used in 91.3% (n = 178) of mesenteric procedures. Complications occurred in 11 (5.6%) biopsies, and all were considered minor. This represents a large cohort of image-guided percutaneous biopsies of mesenteric lesions with the majority representing core biopsy performed under US guidance. This technique offers high diagnostic yield and a favorable safety profile for tissue diagnosis. Furthermore, compression with ultrasound reduced skin-to-target distance by 35% and created a biopsy path that would not be possible on CT in 15% of US cases.

Assessing the risk factors for surgical site infections after anal reconstruction surgery in patients with anorectal malformations: a retrospective analysis.

This study aimed to identify surgical site infection (SSI) risk factors after anal reconstruction surgery in patients with anorectal malformations (ARMs). This retrospective analysis from January 2013 to December 2022, including all pediatric surgical facilities in Hokkaido, Japan, examined consecutive patients with ARMs, excluding cloacal cases, regarding perioperative and SSI factors during their initial anal reconstruction surgeries. This study involved 157 cases of major clinical groups and 7 cases of rare/regional variants, among whom 4% developed SSIs. SSIs occurrence varied by type and was primarily observed from the neo-anus to the perineal region. Organ/space SSIs occurred in rectourethral fistula (prostatic/bulbar) and perineal (cutaneous) fistula type. Surgical procedures were abdominal sacroperineal rectoplasty, posterior sagittal anorectoplasty, laparoscopic-assisted anorectal pull-through, cutback anoplasty, and Pott's anoplasty, varied based on the ARM type and facility. In perineal (cutaneous) fistula, vestibular fistula, and anal stenosis cases, a significant association was observed between perianal muscle division and SSIs in patients aged > 4months (p = 0.04). No significant SSI factors were found in other ARM types. The choice of procedure as an interventional perioperative factor is suggested to be associated with SSIs. These findings may contribute to making informed decisions regarding surgical procedures in such cases.

Clinical analysis of endoscopic retrograde cholangiopancreatography and stent implantation for the pancreaticobiliary injuries in children

Objective: To investigate the therapeutic effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) and stent implantation in the treatment of pancreaticobiliary injuries in children. Methods: A retrospective analysis was conducted on the clinical data of children diagnosed with pancreaticobiliary injury and undergoing ERCP and stent implantation at Beijing Children's Hospital, Capital Medical University from January 2021 to December 2022. Demographic information, clinical data, endoscopic treatment methods, postoperative complications and clinical prognosis of the children were collected. The etiology, location of pancreaticobiliary injury, occurrence of complications after endoscopic treatment, and the time for improvement and recovery after endoscopic treatment were analyzed. The patients were divided into five groups according to the etiologies of pancreaticobiliary duct injuries: post-surgical, pancreatic trauma, acute pancreatitis, chronic pancreatitis, and systemic lupus erythematosus groups. They were also classified into four groups according to the sites of pancreaticobiliary duct injuries: common bile duct, pancreatic head, pancreatic body, and pancreatic tail groups. Multi-factor analysis of variance was used for comparing the time of improvement and recovery among different groups. Results: Among 22 patients, there were 8 males and 14 females, and the age was 7.5 (3.3,10.8) years. There were 19 cases of pancreatic or bile duct fistula, and 3 cases of pancreatic or bile duct stenosis. A total of 33 endoscopic procedures were performed on the 22 patients, out of which, 3 duct stenosis were failed to insert the stent because the catheter failed to pass through the stenosis site. The success rate was 91% (30/33). The pancreatic duct or bile duct stent was inserted, with the stent located at pancreatic or bile duct fistula. Postoperative complications included pancreatitis in 3 cases (9%, 3/33), hyperamylasemia in 5 cases (15%, 5/33), and postoperative infection in 4 cases (12%, 4/33). All patients were followed up for more than 1 year. Significant improvement was observed in external drainage and imaging monitoring among patients with successfully placed stents. There was no significant difference in the improvement time of ERCP in the treatment of pancreaticobile duct injury caused by different etiology (F=0.65,P=0.637). However, there were significant differences in healing time (F=6.46,P=0.004), among which the healing time of injuries caused by systemic lupus erythematosus was significantly different from that after surgery, trauma, acute pancreatitis and chronic pancreatitis (all P<0.05). There was no significant difference in the improvement and healing time among different injury sites (all P>0.05). Conclusions: ERCP and stent implantation can safely and effectively improve the clinical symptoms of children with pancreaticobiliary injury. Early intervention can improve long-term prognosis.

Silicone stent versus fully covered metallic stent in tracheoesophageal fistula: a single-center retrospective study

BackgroundIn cases of tracheoesophageal fistula (TEF), closure of the fistula by tracheal stent implantation is an effective treatment. In this study, we investigated the efficacy and complications of silicone and metallic tracheal stents for TEF.MethodsWe retrospectively reviewed all patients who underwent tracheal stent insertion for TEF between January 2021 and April 2024 at our institution. Complications were assessed bronchoscopically.ResultsMetallic stents were placed in 21 patients (18 men, 85.7%) and silicone stents in 17 patients (14 men, 82.4%). No differences were observed between the two groups in terms of age, gender, location or size of fistula, primary disease, symptoms or comorbidities. A total of 26 fistulas were found in the metallic stent group, and 19 fistulas were found in the silicone stent group. Stent insertion was successful in all cases. The differences in efficacy and complications after stent placement were not statistically significant between the two groups. Mucus retention was the most frequent complication (P = 0.221), followed by granulation tissue (38.1% with metallic stent and 29.4% with silicone; P = 0.734) and migration (14.3% with metallic stent and 29.4% with silicone; P = 0.426).ConclusionsSilicone and metallic stents are viable clinical options for treating TEF. Both are equally effective and safe and have acceptable complication rates in TEF.

S118 Analysis of Fistula Cases in Crohn’s Disease Patients from Brazilian National GEDIIB Registry

S118 Analysis of Fistula Cases in Crohn’s Disease Patients from Brazilian National GEDIIB Registry

One Stage Modified KOYANAGI-HAYASHI Technique with Tunica Vaginalis Intermediate Layer for Severe Hypospadias Surgery

Introduction: In recent years, the modified Koyanagi-Hayashi technique has attracted considerable interest due to its satisfactory results and low risk of major postoperative complications for the patient during surgery for severe hypospadias. The aim of this work is to evaluate this technique and compare our results with those of other research series. Materials and methods: A single-center prospective study of an inhomogeneous series of 32 children with proximal hypospadias and a mean age of 44 months was operated on by the same surgeon using the Koyanagi-Hayashi technique. Preoperative hormonal stimulation with testosterone was indicated in 17 children. The tunica vaginalis was used as the urethroplasty covering plane for all patients. Functional results were assessed, and a questionnaire was completed to evaluate the functional and aesthetic satisfaction of the parents and the surgeon. Results: Complete curvature of the penis was obtained in all patients except 2, who retained a minimal curvature, not requiring surgical correction at this time. There were 6 cases of urethral fistula, 2 cases of total urethroplasty release, 2 cases of partial release, 9 cases of glanduloplasty release, one urethrocele, and 2 meatus strictures. Overall, the success rate after the first procedure was 31.20%, rising to 74.95% after the first repeat procedure and 84.32% after the second. The result was very satisfactory for the parents at 84.37% and satisfactory at 15.62%. Conclusion: The Koyanagi technique modified by Hayashi is a good alternative for severe forms of hypospadias. Correction of the curvature of the penis is generally achieved without further procedures, and the aesthetic result is generally satisfactory. Using the tunica vaginalis as an intermediate plane to cover the urethroplasty has greatly reduced the rate of serious complications. The complication rate is high, and parents need to be aware of the risk of repeat surgeries. But these complications are always easy to manage

Utility of preoperative 18F-flurodeoxyglucose PET/CT scanning in preoperative evaluation and surgical planning for pulmonary tuberculosis.

The objective of this study was to investigate the utility of preoperative 18F-FDG PET/CT scanning in preoperative evaluation and surgical planning for pulmonary tuberculosis. The study involved a retrospective analysis of clinical data and preoperative chest 18F-FDG PET/CT data of 24 patients with pulmonary tuberculosis who underwent pneumonectomy at the Shanghai Public Health Clinical Center between December 2017 and January 2022. All 24 patients successfully underwent chest 18F-FDG PET/CT imaging, and complete data pertaining to the maximum standardized uptake value, mean standardized uptake value, minimum standardized uptake value, total lesion glycolysis, and metabolic tumor volume were obtained. Surgical excision plans were finalized using the chest 18F-FDG PET/CT findings along with the conventional chest CT scans. Pneumonectomy was successfully completed in all 24 patients, and these included 13 cases of pulmonary lobectomy, two cases of total pneumonectomy, one case of combined pulmonary lobectomy, one case of segmentectomy, and seven cases of pulmonary wedge resection. The actual surgical procedures had a conformity rate of 100% to the preoperative surgical plans that were made. The intraoperative bronchial stump embedding rate was 69% (11/18 cases), the incidence rate of postoperative air leakage was 3.8% (1/24 cases), and there were no reported cases of postoperative bronchopleural fistula or death. Preoperative 18F-FDG PET/CT scans had significant utility in surgical planning, the selection of surgical methods, and the formulation of postoperative antituberculosis treatment courses for patients with pulmonary tuberculosis. The use of 18F-FDG PET/CT shows considerable promise in being promoted clinically for the surgical management of patients with pulmonary tuberculosis.