Consecutive Cases Research Articles

Metallic Intraocular Foreign Bodies Following Torsional Phacoemulsification Surgery

ABSTRACT Purpose This study aimed to determine the rate of retained metallic intraocular foreign bodies (IOFBs) following torsional phacoemulsification cataract surgery by an experienced surgeon and elucidate related surgical factors, particle origin theories from existing literature, and postoperative visual impact. Methods An observational study was conducted on 300 consecutive cases of cataract who underwent torsional phacoemulsification by a single surgeon using two-handed stop-and-chop technique. The incidence of retained IOFBs was observed and correlated with the surgical parameters and the density of cataract. Results Retained IOFBs were observed in 6 of 300 (2%) cases operated. These were significantly associated with higher cumulative dissipated energy and the density of cataract, but without impacting final vision. Conclusion Phacoemulsification retains inherent risks of metallic particle liberation from ultrasonically stressed instrumentation interacting within confined spaces. However, small retained IOFBs appear visually inconsequential over limited follow-up. Advances in technique, engineering design, and surgical quality control hold promise for further enhancing safety of the procedure.

Transcapsular scleral fixation of the standard capsular tension ring and in-the-bag intraocular lens implantation for severely subluxated lenses.

To present a technique of transcapsular scleral fixation of the standard capsular tension ring (CTR) through equatorial capsulotomy and in-the-bag intraocular lens (IOL) implantation in subluxated lenses. This retrospective consecutive case series included patients with subluxated lenses by more than 180 degrees who underwent lens extraction, transcapsular scleral fixation of the standard CTR through equatorial capsulotomy, in-the-bag IOL implantation and with at least 6mo follow-up. Preoperative and postoperative best corrected visual acuity (BCVA), intraocular pressure (IOP), complications, and postoperative IOL tilt and decentration were recorded. Nine eyes of 7 patients with a mean follow-up of 11.0±3.7mo were included in this study. The BCVA was significantly improved from 0.64±0.22 logMAR preoperatively to 0.21±0.19 logMAR postoperatively (P<0.001). The IOP was within the normal range postoperatively. The mean tilt of the IOL was 4.30°±2.31° (range, 1.0° to 8.9°) and the mean decentration of the IOL was 0.37±0.12 mm (range, 0.14 to 0.50 mm). No visually threatened intraoperative and postoperative complications were detected during the follow-up period. This is a safe and effective surgical technique for managing patients with severely subluxated lenses. It has achieved favorable outcomes with fewer surgical manipulations and less need for advanced capsular support devices.

Comprehensive Analysis of Neurologic Complications Following Transradial Cerebral Angiography.

Transradial access (TRA) for cerebral angiography has become more popular due to fewer complications and greater patient comfort compared to transfemoral access. However, the frequency and nature of neurologic complications linked to TRA remain unclear. This study aimed to determine the incidence of symptomatic neurologic complications after transradial cerebral angiography, identify risk factors, and characterize clinical and imaging features of these complications. We retrospectively analyzed 1,679 consecutive cases of transradial cerebral angiography from a single institution between January 2018 and December 2020. Neurologic complications were defined as any symptomatic changes confirmed by diffusion-weighted imaging revealing ischemic lesions. A case-control matching method was used to enhance the reliability of the results. Clinical, procedural, and anatomical factors were examined for predictors of neurologic complications. Neurologic complications occurred in 1.0% (n=19) of cases, with 85% occurring within six hours post-procedure. No significant predictors of neurologic complications could be identified among the clinical, procedural, or anatomical factors assessed. Overall, 58% of patients experienced transient or reversible complications. Patients with permanent symptoms had mild to moderate disability (mRS scores of 1 or 2), with no severe disability (mRS score ≥3). Diffusion-weighted imaging commonly showed multifocal cortical or subcortical ischemic patterns, typically affecting the right middle cerebral artery territory or multiple territories, suggesting embolic mechanisms as a potential cause. Neurologic complications following transradial cerebral angiography were rare but occurred early in the post-procedural period. The observed ischemic patterns, particularly the right-sided predominance, suggest embolic mechanisms as a potential cause. However, further large-scale, multicenter prospective studies are essential to identify risk factors more clearly and enhance patient safety in this increasingly utilized transradial approach. ACA＝ anterior cerebral artery; ICAS＝ intracranial atherosclerotic stenosis; PCA＝ posterior cerebral artery; SCA＝ subclavian artery; TFA＝ transfemoral access; TRA＝ Transradial access; VAO＝ vertebral artery orifice; VBA＝ vertebrobasilar artery.

Early experience with the Aristotle Colossus 0.035' macrowire for mechanical thrombectomy in 30 consecutive cases.

Recent literature continues to demonstrate the successful role of large-bore aspiration catheters in thrombus ingestion during mechanical thrombectomy. However catheter-to-microwire step-off and distal navigation are ongoing challenges in thrombectomy. A new to market 0.035' macrowire (Aristotle 35 Colossus Guidewire, Scientia Vascular, West Vale City, UT) may address such challenges. We report here our early experience in 30 mechanical thrombectomy cases. We analyzed a prospectively maintained database of the senior authors to identify cases utilizing a 0.035' macrowire with 0.035' aspiration catheters for mechanical thrombectomy. Thirty consecutive cases were identified. Seventeen (57%) patients were female with an average age of 75.3 ± 2.2 years (range 55-97). Average presenting NIHSS was 13.0 ± 1.7. Thrombus locations included 7% (n = 2) in the cervical ICA, 47% (n = 14) in the M1, 43% (n = 13) in the M2, and 3% (n = 1) in the P1. An 088' ID aspiration catheter was navigated to at least the M1 segment in all anterior circulation cases and the basilar in the posterior circulation case. The 0.035' macrowire was placed proximal to the occlusion in all cases allowing coaxial 035' and 071' catheter aspiration passes. TICI 2C/3 was achieved in 87% of cases (n = 26) and TICI 2B in the remaining cases. There were no wire-related perforations or vessel dissections. The Colossus 0.035' macrowire may offer advantages over its smaller counterparts by reducing ledge effect and the need to cross the thrombus. Further comparative studies against currently available microwires in various anatomies are warranted.

Pediatric endoscopic pilonidal sinus treatment: lessons learned after 100 consecutive cases.

Pediatric endoscopic pilonidal sinus treatment (PEPSiT) has favorable short-term-outcomes, but there is a lack of reliable data on medium and long-term follow-up. The objective of our study was to evaluate the effectiveness and advantages of PEPSiT versus conventional surgery of pilonidal sinus in the pediatric population. A quasi-experimental study was carried out in pediatric patients undergoing pilonidal sinus surgery at a single institution from 2019 to 2022. Excision and healing by secondary intention (EHSI), excision and primary closure (EPC), and PEPSiT were compared. The surgical technique chosen was surgeon-dependent. In total, 149 patients were studied-100 undergoing PEPSiT, 28 undergoing EHSI, and 21 undergoing EPC. Median full healing process was 4weeks [interquartile range (IQR): 3-8] in PEPSiT, 16weeks in EHSI (IQR: 12-26.5), and 7weeks (IQR: 4-10) in ECP (p < 0.01). Pain on the visual analogue scale (VAS) and need for analgesics were lower in the PEPSiT group (p < 0.01). Mean time to return to normal life was shorter with PEPSiT-177days earlier than EHSI (95% CI 124.7-230.2; p < 0,01) and 7.2days earlier tan EPC (95% CI 20.2-138.6; p < 0,009). Complications with PEPSiT were 9.3 times lower tan EHSI [odds ratio (OR) 9.3; 95% confidence interval (CI) 3.5-24.7] and 8.5 times lower than ECP (OR = 8.5; 95% CI 2.9-24.4). EHSI had 5.3 times more probability of recurrence than PEPSiT (OR = 5.3; 95% CI 1.3-22.7), and ECP 15.2 times more (OR = 15.2; 95% CI 3.2-71.7). Endoscopic pilonidal sinus treatment is effective in medium-term follow-up, with fewer complications than classic techniques. It allows for an early return to normal life without restrictions.

Conventional curettage adenoidectomy vs endoscopic microdebrider adenoidectomy - A comparative study.

Adenoidectomy is a frequently done ENT procedure. The purpose of the current article is to assess endoscopic powered adenoidectomy as a potential replacement for the traditional curettage approach. Two hundred forty consecutive adenoidectomy cases were randomly divided into two groups of one hundred twenty each. Between August 2020 to February 2023 after getting ethical clearance from Institutional Ethical Committee, Group I underwent Conventional Curettage Adenoidectomy (CA), while Group II underwent Endoscopic Micro-debrider Adenoidectomy (EMA). Average operative time in CA Group was 31.4min and in EMA group was 55.7min. In CA group, mean intraoperative blood loss was 64.4 mL, however, in EMA group, mean blood loss was 86.7 mL (p 0.001). In EMA Group, the resection was consistently complete, with 112 out of 120 cases having an adenoid grade of less than I in post-op. However in the CA group, in 44 (36.7%) of the patients, there was more than 25% remaining adenoid tissue postoperatively and more than 50% remnant adenoid tissue was found in 12 cases (10%) post-op. Post-operative pain was studied with the CA Group demonstrating an average 7 days' postoperative pain score of 3.90 whereas EMA Group demonstrating an average 7 days' postoperative pain score of 0.9. It was observed that EMA was a secure and reliable tool for adenoidectomy. Endoscopic powered adenoidectomy performed better in the completion of resection, accuracy of resection under vision, collateral damage, and post-operative pain. Contrarily, conventional Curettage adenoidectomy scored higher in terms of shorter surgery times and less intraoperative hemorrhage.

The role of exfoliative cytology in diagnosis of oral lesions.

The study aimed to evaluate the use of oral exfoliative cytology and highlight its limited effectiveness in diagnosing oral diseases. A total of 1000 consecutive cases of oral cytology were retrieved from the files of an Oral Pathology Service, comprising the period between January 2002 and December 2022. Patient data and clinical details of the lesions were collected, and all slides were reviewed. Categorical data were presented in absolute and relative frequency (%), while numerical data were expressed as the median with minimum and maximum values. The Chi-square (X2) test was employed for frequency comparisons, with a significance level of 5%. Men constituted 64.6% (n = 646) of the cases, with a statistically significant predominance of white individuals (69.4%; n = 694). Of the 1000 evaluated cases, 87.8% (n = 878) were graded using Papanicolaou staining. Regarding provisional diagnoses, most clinicians (79.1%) suspected fungal lesions (n = 817). Analysis of the agreement between provisional and final cytological diagnoses revealed a statistically significant disagreement. This work reinforces the limited use of exfoliative cytology in diagnosing oral lesions. Exfoliative oral cytology should be restricted to specific cases, particularly for diagnosing fungal disease, and occasionally when oral cancer is suspected, but a biopsy cannot be performed at that time.

Plasma brain-derived tau correlates with cerebral infarct volume.

A blood-based biomarker that accurately reflects neuronal injury in acute ischemic stroke could be an easily accessible and cost-effective complement to clinical and radiological evaluation. Here, we investigate whether plasma levels of the novel biomarker brain-derived tau (BD-tau) reflect cerebral infarct volumes and whether BD-tau can improve clinical outcome prediction. The present study included 713 consecutive cases from two different hospital-based cohorts, the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS) and SAHLSIS phase 2 (SAHLSIS2). Acute stroke severity was determined by the Scandinavian Stroke Scale converted to the National Institutes of Health stroke scale (NIHSS) in SAHLSIS and by the NIHSS in SAHLSIS2. All participants were assessed for functional outcome 3 months after stroke by the modified Rankin Scale, and 254 participants in SAHLSIS had quantitative neuroimaging available. Plasma BD-tau concentrations and cerebral infarct volumes were highly correlated (ρ 0.72, p<0.001). BD-tau improved the prognostic accuracy of suffering an unfavorable outcome over age and stroke severity in the whole cohort. However, the gain in predictive power was dependent on stroke severity and infarct location. The largest improvement was observed for mild ischemic strokes (NIHSS <5; area under the curve [AUC]=0.73 for age+NIHSS versus AUC=0.84 with addition of BD-tau; DeLong p 0.02), posterior circulation stroke (AUC=0.75 vs. AUC=0.84; DeLong p 0.06) and more specifically for infarcts in the brainstem/cerebellum (AUC=0.74 vs. 0.87; DeLong p 0.009). Plasma BD-tau can provide information on the extent of acute neuronal damage in ischemic stroke and adds prognostic value for outcome, especially for mild and posterior circulation strokes.

The PAUL Glaucoma Implant in the management of uveitic glaucoma-3-year follow-up.

Evaluate the mid-term outcomes of the PAUL Glaucoma Implant (PGI) in the management of uveitic glaucoma. This was a single-centre, multi-surgeon, retrospective analysis of 50 consecutive cases of PGI for uveitic glaucoma performed between April 2019 and August 2021. Primary outcomes include: complete and qualified success (IOP ≥5 mmHg to ≤21 mmHg with ≥20% IOP reduction) or failure (IOP exceeding the success criteria, additional glaucoma procedures, no perception of light vision). Secondary outcomes included: visual acuity, IOP, medications, complications and intraluminal stent removal. We included 50 eyes of 41 patients. Mean age was 45.8 ± 19.8 years (range 6-81 years) in this heterogenous and complex cohort. Mean pre-op IOP was 30.6 ± 9.8 mmHg on 3.9 ± 0.9 medications. In total, 62% of patients were on acetazolamide, and 64% required systemic immunosuppression. At final follow-up (mean: 35.8 ± 9.8 months, range 5-58 months), IOP and medications were significantly reduced (12.2 ± 4.4 mmHg, requiring 1.1 ± 1.3 medications, p < 0.0001). Resulting in 48% complete and 92% qualified success rates. Failure occurred in 8% of cases, 6% due to hypertension but only one case of prolonged hypotony (2%). To date, this study represents the first publication looking specifically at the efficacy and safety of the PGI in the management of complex uveitic glaucoma. With an average follow-up of 3 years, it shows high levels of complete and qualified success with few complications.

Intraoperative label-free tissue diagnostics using a stimulated Raman histology imaging system with artificial intelligence: An initial experience.

Accurate intraoperative tissue diagnostics could impact on decision making regarding the extent of resection (EOR) during brain tumor surgery. Stimulated Raman histology (SRH) is a label-free optical imaging method that uses different biochemical properties of tissue to generate a hematoxylin-eosin-like image and, in combination with an artificial intelligence-based image classifier, offers the opportunity to obtain rapid intraoperative tissue diagnoses. The goal of this study was to report on our initial experience with SRH to evaluate its accuracy in comparison to final tissue diagnosis. We evaluated 70 consecutive adult cases with brain tumors. We compared results of the three different SRH classifier (diagnostic, molecular and tumor/non-tumor) to the respective final histopathological result. Similarly, we evaluated the isocitrate dehydrogenase (IDH) mutations in 18 patients using SRH. Lastly, we compared SRH results of samples taken from the tumor margins with early postoperative MRI. Prediction accuracy was evaluated by logistic regression and Receiver Operator Curve (ROC) analysis. We included 19 gliomas, 9 metastases, 22 meningiomas and 14 other tumor entities. Regarding accuracy of intraoperative SRH predictions, regression analysis showed an Area Under the Curve (AUC) of 0.77 (95 % C.I. 0.64-0.89, p = 0.0008), suggesting agreement of predictions with final diagnosis. For specific tumor entities, variable accuracies were observed: The highest accuracy was obtained for meningiomas followed by high-grade glioma. IDH mutations were predicted with an AUC of 0.93 (95 % C.I. 0.88-0.98; p < 0.0001). The SRH examination of tissue samples from tumor margins corresponded with postoperative MRI in 4 out of 5 cases. Our initial experience with SRH shows that this novel imaging technique is a promising approach to obtain rapid intraoperative tissue diagnosis to guide surgical decision making based on histology and cell-density. With further refinement of AI-based automated image classification and a better integration into the surgical workflow, prediction accuracy and reliability could be improved.

Giant lipomas: A 130-year literature review, case series, and introduction of an intuitive management algorithm

Background: Lipomas are the most common benign mesenchymal tumors in adults. On the other hand, giant lipomas, defined as lipomas over &gt;10 cm in length of over 1000 g in weight, are less frequently seen, can be clinically challenging to manage, and require careful attention. While most cases are benign, soft, asymptomatic masses, there is potential for functional limitation, nerve compression syndromes, and sarcomatous changes in such lesions. Methods: A case series is presented and an extensive review of the literature was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) declaration, since the first description of a giant lipoma reported in 1894, with the aim of providing an updated and comprehensive “state-of-the-art” on the management, diagnosis, and treatment of this entity. PubMed, Scopus, and Google Scholar databases were queried for relevant articles using the search terms “Giant lipoma” and “Massive lipoma” from 1894 to 2024. Results: Five consecutive clinical cases were reported. A total of 79 patients were identified from the 65 collected reports. Clinical characteristics of the lesions, surgical details, and patient characteristics are obtained and summarized. Preoperative/postoperative radiological/histological features are reported. Conclusion: Surgical excision remains the gold standard treatment for giant lipomas. According to existing literature, most recommendations are based on expert opinions and there is a paucity of guidelines or universal consensus on a treatment pathway for standardized, multidisciplinary management of such a challenging clinical condition.

Gender-affirming Chest Surgery: A Prospective Series of 155 Consecutive Cases of Double Incision Mastectomy.

Mastectomy is the first single surgery that transgender men and nonbinary people frequently undergo. We present a prospective series of 155 cases of double incision mastectomy (DIM) with nipple-areolar complex (NAC) graft. From January 2019 to December 2022, 165 outpatients were operated on, and 155 are included in the study. We analyzed age, resection weight, blood loss, duration of the procedure, complications, and follow-up. The Student t test combined with the nonparametric Mann-Whitney U test was used for statistical analysis. If the P value was less than 0.05, the test was considered significant. A total of 111 (72.6%) patients experienced no complications. Complications (27.4%) were minor: 4 seromas, 8 hematomas, 10 partial necrosis of the NAC, and 8 depigmentation of the NAC. Thirteen patients presented axillary dog ears requiring secondary excision. Two patients had hypertrophic scars. No case of infection was observed. We find a statistically significant correlation between hematoma and perioperative blood loss (P < 0.05), and between dog ears requiring secondary procedure and body mass index (P < 0.001), weight of resection (P < 0.01), and blood loss (P < 0.001). DIM with NAC graft is a safe, reliable, top surgery procedure. Complications are minor, and postoperative morbidity is low. This study shows a correlation between blood loss during surgery and postoperative hematoma, and between dog ears requiring a surgery and body mass index, weight of resection, and blood loss. This surgery gives nice aesthetic results enhancing patients' quality of life by improving body image.

Incidence of Incisional Hernias after Single-Port Versus Multi-Port Robotic Radical Prostatectomy.

Purpose: To determine if single-port robotic-assisted radical prostatectomy (SP-RARP) has higher rates of incisional hernias when compared with multi-port robotic-assisted radical prostatectomies (MP-RARP). Materials and Methods: A retrospective, single-institution review of all consecutive robotic prostatectomy cases between January 2017 and December 2022. Analyzed multi-port and single-port robotic prostatectomies performed by two high-volume surgeons. Measured primary outcome for the development of incisional hernias, as defined by computed tomography imaging and clinical documentation. Multivariable logistic regression was used to determine the effect of the single-port approach on incisional hernia outcomes. Results: A total of 493 patients were included in the study (320 SP-RARPs and 173 MP-RARPs). The overall incisional hernia rate was 8.5% (SP-RARP 8.1% vs MP-RARP 9.2%, p = 0.669). A median follow-up time was 16.6 months and a median time from procedure to hernia diagnosis was 7.4 months. SP-RARP had shorter OR time than the MP-RARP (236 minutes vs 276 minutes, p < 0.001). Patients who developed hernias had higher body mass index (BMIs) than those who did not (30.7 vs 29, p = 0.009). Multivariable logistic regression analysis revealed that patients with higher BMI (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.01-1.14) and a history of prior operation (OR 2.23, 95% CI 1.71-4.29) were more likely to develop incisional hernias. Cox regression analysis accounting for the difference in follow-up period demonstrated that SP-RARP 3.4× more likely to develop incisional hernias than MP-RARP (hazard ratio 3.38, 95% CI 1.50-7.58). Conclusions: Patients with higher BMIs and prior history of abdominal surgeries are at increased risk of developing postoperative incisional hernias. SP-RARP procedures confer a higher risk of postoperative incisional hernias.

Outpatient lateral lumbar interbody fusion: single-institution consecutive case series.

Outpatient spine surgery could reduce hospital costs and improve patient outcomes. Outpatient lateral lumbar interbody fusion (LLIF) can be performed for select patients. This study identified and compared the demographic, clinical, and surgical characteristics of patients who underwent outpatient versus inpatient single-level LLIF. A retrospective review was conducted of a prospectively collected database of patients who underwent first-time single-level LLIF at a single institution performed by the same surgeon from January 1, 2017, through December 31, 2022. Demographic characteristics, including age, sex, BMI, and medical comorbidities, were collected. Surgical factors, such as level of surgery, operative duration, and estimated blood loss, were also collected. Length of stay and 30-day readmission were the primary outcomes of interest. Patients discharged on the day of surgery or the following day were considered to be in the outpatient group. ANOVA and chi-square tests were performed to compare continuous and categorical variables, respectively. Univariate logistic regression was used to examine the correlation between baseline demographic and surgical variables and outpatient surgery. If a variable significantly correlated with outpatient surgery on univariate analysis, it was subsequently used in multivariate logistic regression. A total of 107 patients underwent first-time single-level LLIF, and 48 (44.9%) did not have posterior instrumentation. Fifty-three (49.5%) patients were women. The median age and BMI were 66.3 years and 28.9, respectively. The mean length of stay was 1 day (range 0-4 days), with 71 (66.4%) of 107 single-level LLIFs managed on an outpatient basis. There were no readmissions within 30 days. Patients in the outpatient group were more likely than patients in the inpatient group to be male (59% [42/71] vs 25% [9/36], p = 0.002), have a low LACE (risk criteria based on length of stay, acuity of the admission, comorbidity of the patient, and emergency department use within 6 months before admission) readmission index (63% [45/71] vs 28% [10/36], p < 0.001), and have a stand-alone construct (62% [44/71] vs 11% [4/36], p < 0.001). The outpatient cohort also had a shorter mean operative duration (104.4 vs 175.5 minutes, p < 0.001) and lower mean estimated blood loss (20 vs 100 mL, p < 0.001). There was no difference in age between the groups. Factors that remained significant on multivariate logistic regression were male sex (OR 0.14, 95% CI 0.04-0.53; p = 0.004), lower LACE readmission index (OR 0.06, 95% CI 0.02-0.25; p < 0.001), and stand-alone construct (OR 8.17, 95% CI 1.49-44.74; p = 0.02). Multiple baseline and surgical characteristics were more common in the outpatient setting. With appropriate patient selection, single-level LLIF can be achieved on an outpatient basis.

Are psychotherapists' first clinical impressions fundamentally biased? An experimental approach.

Fifty years ago, the Rosenhan experiment was one of the most impactful psychological studies across decades. One of the main claims of the experiment was that clinicians could be negatively biased in their first clinical impressions, which would negatively impact further clinical decisions. We conducted two experiments (N = 56 and 64) in which psychotherapists were asked to give their first clinical impressions in two consecutive cases after a brief presentation of the case (case description and video excerpt) and a short recall task of the information provided. The attentional focus in the recall task served as an independent variable. Therapists had to adopt either a symptom-focused or a strength-focused attentional focus to recall the cases, that is, therapists rated their first case in either the symptom-focused or the strength-focused condition and the second case in the opposite condition. In both studies, therapists in the symptom-focused conditions rated patients as slightly more distressed, less resilient, and less psychosocially integrated in comparison to the strength-focused conditions. However, even statistically significant, these effects were rather small to clinically negligible. Our preliminary results suggest that the first clinical impressions of contemporary psychotherapists are vulnerable in both experiments to be slightly, but not as dramatically, distorted as the Rosenhan experiment would suggest at the time. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Distinguishing ABCA4 from PRPH2-related disease: qualitative analysis of examination and imaging features

ABSTRACT Introduction ABCA4 and PRPH2-related diseases are both phenotypically heterogeneous and clinically difficult to differentiate. There may be examination and imaging features that can aid in establishing a clinical diagnosis. Methods A single-center, retrospective, consecutive case series including patients with a molecular confirmation of pathologic variants in either the ABCA4 or PRPH2 were included. Chi-square analysis, Fisher exact test, and Student’s t-test comparing prevalence of specific examination and imaging features between ABCA4 and PRPH2 Results Of the 127 eyes from 64 patients included, the ABCA4 group was more significantly associated with peripapillary sparing on both fundus imaging (73% vs. 40%; p = 0.006) and FAF (71% vs. 44%; p = 0.025), macular (64% vs. 12%; p < 0.001) and peripheral pisciform flecks (22% vs. 3.6%; p = 0.025). The PRPH2 group was more highly associated with macular chorioretinal atrophy (86% vs. 55%; p = 0.003). Conclusions Peripapillary sparing and pisciform flecks are more highly associated with ABCA4-related disease, while macular chorioretinal atrophy is more highly associated with PRPH2-related disease. Logistic regression demonstrates that bull’s eye maculopathy and macular flecks are predictive of the ABCA4 genotype.

Surgical Site Infections in Simultaneous Colorectal and Liver Resections for Metastatic Colorectal Adenocarcinoma.

Surgical site infections (SSIs) are a major driver of morbidity after combined liver and colorectal surgery for metastatic colorectal cancer. Available literature is inadequate to characterize risk factors and benchmarks for quality improvement. Consecutive cases of simultaneous liver and colorectal surgery for colorectal adenocarcinoma from November 2013 through September 2022 were reviewed for SSIs per National Surgical Quality Improvement Program (NSQIP) and National Healthcare Safety Network (NHSN) criteria. Univariable and multivariable logistic regression evaluated associations with NSQIP 30-day organ-space SSIs. In 580 procedures, the rate of 30-day organ-space SSIs was 16% (n=94) using NSQIP criteria and 11% (n=64) using NHSN criteria; 4% (n=24) had incisional SSIs by both criteria. Most organ-space SSIs were perihepatic, and a minority were associated with bile (26%) or anastomotic (15%) leak. Independent risk factors for organ-space SSIs included major liver resection, upper abdominal (compared with lower abdominal/pelvic) colorectal procedure, and ostomy reversal. Organ-space SSI rates increased over time by approximately 16% per calendar year (p=0.02) despite a declining rate of major liver resection; incisional SSI rates remained low. Overall, major morbidity was 22%, with 7-day median length of stay (interquartile range 6-9) and 0.3% 90-day mortality. Organ-space SSIs are a significant driver of postoperative morbidity in simultaneous liver and colorectal resections for metastatic colorectal adenocarcinoma. Our findings confirm simultaneous resection remains safe and interventions to mitigate the risk of perihepatic organ-space SSIs in high-risk patients are warranted.

Two-Year Outcomes Using Fast-Acting, Sub-Perception Therapy for Spinal Cord Stimulation: A European, Real-World, Multicenter Experience.

Background/Objectives: Over the last 20 years, spinal cord stimulation (SCS) has seen the development of various paresthesia-free paradigms. Recently, a novel modality has emerged (Fast-Acting Sub-perception Therapy, FAST) that engages the surrounding inhibition mechanism of action. We evaluated long-term, real-world outcomes of preferential FAST-SCS use in patients with chronic pain. Methods: In this multi-center, observational, consecutive case series, medical chart data from chronic pain patients preferentially using FAST-SCS (no exclusions) were retrospectively reviewed. Results: Data from 167 patients in 13 European centers were analyzed; 74% of patients suffered from persistent spine pain syndrome type 2 and 87% presented with low back and/or leg pain. At the last follow-up (mean 1.6 years), the numerical rating scale (NRS) overall pain score decreased by 5.1 ± 2.5 points versus baseline, from 8.0 ± 1.2 to 2.9 ± 2.2 (n = 167, p < 0.0001). 87% of patients reported ≥50% pain relief, and 55% were "high responders" with overall NRS pain scores ≤2/10. At the last follow-up, functional disability improved significantly (the Oswestry Disability Index reduced by 29.2 ± 21.5 points, n = 65, p < 0.0001) and patients had a significant gain in quality of life (EQ-5D-5L visual analog scale increased by 52.0 ± 26.9 points, n = 86, p < 0.0001). Results at the 2-year follow-up showed a sustained, substantial reduction in pain; 67% of patients were high responders and the NRS overall pain score decreased by 5.6 ± 2.4 versus baseline (n = 52, p < 0.0001). Conclusions: Our real-world outcomes suggest that in patients with chronic low back and/or leg pain, FAST-SCS therapy provided durable and profound pain relief and led to significant improvements in disability and quality of life.

Current trends in types of pancreatoduodenectomy: Focus on the advancement of robot-assisted pancreatoduodenectomy with 630 consecutive cases.

Pancreatoduodenectomy (PD) is a complex abdominal surgery, and the adoption of robotic PD has been on the rise because of its numerous benefits. This study aimed to investigate the current PD trends, focusing on advancements in robotic surgery. Between 2015 and 2023, 1231 patients underwent open PD, whereas 630 underwent robot-assisted PD (RAPD). Demographics and surgical outcomes were analyzed according to the time period. Moreover, a propensity score-matched (PSM) analysis was performed to evaluate the clinical outcomes. The proportion of RAPD cases gradually increased from 6.3% in 2015 to 50.9% in 2020, reaching a plateau of >50% thereafter. The proportion of patients receiving neoadjuvant chemotherapy increased during the late period (11.4% vs. 17.6%), with many of these patients undergoing open PD. Additionally, RAPD was performed in patients with a high probability of postoperative pancreatic fistula. However, the two groups demonstrated no significant difference in the occurrence of clinically relevant postoperative pancreatic fistula (10.6% vs. 9.5%, p = .532). Among periampullary cancer cases, RAPD demonstrated comparable survival outcomes to open PD after PSM (5-year survival rate: 61.8% vs. 49.8%, p = .189). RAPD has become a stable approach, accounting for over 50% of all PD cases in high-volume centers, and it can be safely performed. However, open PD remains important owing to the development of neoadjuvant therapy and the aging population. Therefore, establishing appropriate indications to maximize the benefits of both RAPD and open PD is necessary.

Recurrence score-predicted value derived from estrogen receptor, tumor-infiltrating lymphocytes, progesterone receptor, and Ki-67 may substitute for the Oncotype DX recurrence score in estrogen receptor (ER)+/human epidermal growth factor receptor 2 (HER2)− breast cancer

Oncotype DX is the only multigene assay supported by the National Comprehensive Cancer Network (USA) with Level 1 evidence for use on node-negative and postmenopausal node-positive patients with estrogen receptor (ER)+/human epidermal growth factor receptor 2 (HER2)-breast cancer to predict the prognosis and to estimate chemotherapy add-on effects. However, the test's high cost prevents its use in most cases. Therefore, we aimed to obtain an alternative recurrence score (RS) prediction formula using the optimal clinicopathological factors. We retrospectively reviewed data of 81 patients with ER+/HER2− primary breast cancer in our hospital where Oncotype DX RS was measured. Stepwise multivariate linear regression analysis was conducted with several selected clinicopathological factors of 60 consecutive cases in the training group. The obtained RS-predicted values were validated against Oncotype DX RS using 21 additional consecutive cases. The RS prediction formula derived from the combination of ER, tumor-infiltrating lymphocytes (TILs), progesterone receptor (PgR), and Ki-67-labeling index produced a favorable model with a correlation coefficient (r) of 0.731103 for the Oncotype DX RS (p = 0.0002) and an adjusted R2 coefficient of 0.510013. The RS-predicted values and the actual Oncotype DX RS were classified into four 2 × 2 groups, by using an RS of 26 as a threshold for adding chemotherapy with a concordance rate of 95.2 % (20/21) and a kappa coefficient of 0.829. RS-predicted values of combined ER, TILs, PgR, and Ki-67 may be an appropriate substitute for Oncotype DX RS in certain situations.