Conservative Treatment Group Research Articles

Сравнительный анализ аккомодационной способности у детей с гиперметропией, анизометропией, амблиопией после интрастромального кератомилеза с фемтолазерным сопровождением

Purpose. Analysis of the accommodative ability in children with hyperopic anisometropia, amblyopia of operated amblyopic and paired leading eyes after femtolaser-assisted laser intrastromal keratomileusis (FS-LASIK). Material and methods. In the 1st group were 20 children with hyperopic anisometropia and amblyopia after FS-LASIK. In the 2nd were children receiving conservative treatment. Results. After 6 months, when analyzing the accommodation, the coefficient of the accommodative response (CAR) of amblyopic eye in the 1st group was 0.05±0.07 conv. units, in the 2nd group was -0.1±0.19 conv. units (рm-u=0.03). The microfluctuation coefficient (CMF) of the amblyopic eye was increased, but the CMF of the paired leading eye in children after FS-LASIK approached the norm and amounted to 58.4±5.4 µF / min. In the conservative treatment group CMF remained high and was 60.8±4.44 µF / min (рm-u= 0.08). The objective accommodative response of the amblyopic eye in the 1st group increased by -1.13±0.03 diopters, in the 2nd group – by -0.82±0.48 diopters (рm-u=0.05). Conclusion. FS-LASIK helps to improve the accommodative ability in children with hyperopia, anisometropia and amblyopia. Key words: accommodation, hyperopia, anisometropia, amblyopia, FS-LASIK.

Hematoma Evacuation via Image-Guided Para-Corticospinal Tract Approach in Patients with Spontaneous Intracerebral Hemorrhage.

IntroductionCorticospinal tract injury caused by direct hematoma compression and secondary damage induced from blood toxic substances might influence the outcomes in patients with intracerebral hemorrhage (ICH). This study aimed to evaluate the safety and efficacy of hematoma evacuation via image-guided para-corticospinal tract approach based on the protection of compressed or residual corticospinal tract.MethodsSeventy-five patients with ICH who underwent the image-guided para-corticospinal tract approach were retrospectively collected into the surgery group. Diffusion tensor imaging or computed tomography angiography was performed to identify the relationship between important white matter tracts and hematoma. The neuronavigation system for the preoperative imaging data loaded was used to identify the location of the burr hole, insertion trajectory, and depth of insertion. Cortical entry points and insertion trajectories were kept parallel to the corticospinal tract route into the hematoma based on the protection of compressed or residual corticospinal tract. Hematoma was removed under the image-guided para-corticospinal tract approach. Seventy-five age-, sex-, hematoma site-, and volume-matched patients with ICH who underwent conservative treatment were selected as controls. Demographical, clinical, radiological, and treatment-related data were retrospectively analyzed. Functional outcome was evaluated by modified Rankin scale on day 90.ResultsA total of 150 patients with ICH were retrospectively enrolled. The median Glasgow coma scale (GCS) score on admission was 11 (IQR 8–13). Deep hematoma (thalamus and basal ganglion) was present in 86.7% (130 patients). The mean hematoma volume on admission was 47 ± 19 mL, and the postoperative hematoma volume was 11 ± 10 mL. A higher proportion of favorable outcome was observed in the surgery group than in conservative treatment group (32.0% versus 17.4%; p = 0.037).ConclusionHematoma evacuation via image-guided para-corticospinal tract approach based on the protection of compressed or residual corticospinal tract seems to be safer in patients with ICH with a relatively higher functional independence.

Comparison of Conservative and Surgical Treatments in Symptomatic Pregnancy Hydronephrosis

Objectives: This study aimed to evaluate the factors affecting the treatment choice in pregnant women with symptomatic hydronephrosis. Methods: Hospital records of pregnant women who visited our clinic due to symptomatic hydronephrosis between December 2010 and December 2020 were analysed retrospectively. Patients were divided into 2 groups: conservative and surgical (JJ stent) treatment groups. Age, gestational week, primipara, trimester, visual analogue scale (VAS), and preterm birth rates as well as clinical, laboratory, and ultrasonography findings were compared between the groups. Results: The study included 227 pregnant women (conservative treatment group, 133; JJ stent group, 94). Age, gestational week, primipara, trimester, hydronephrosis side, fever, pyelonephritis, pyuria, preterm labour and abortion, as well as blood urea nitrogen, creatinine, C-reactive protein, and white blood cell levels did not differ significantly between the groups (p > 0.05). In the JJ stent group, VAS, creatinine value, culture positivity rate, degree of hydronephrosis, and renal pelvis anterior-posterior (AP) diameter were significantly higher than those in the conservative treatment group (p < 0.05). The cut-off value for renal pelvis AP diameter was 16.5 mm in the first 2 trimesters and 27.5 mm in the third trimester. Conclusions: Surgical treatment should not be delayed in pregnant women who do not respond to conservative treatment and have impaired renal function and grade 3–4 hydronephrosis. Early surgical intervention is necessary in patients with a renal pelvis AP diameter of >16.5 mm in the first 2 trimesters and >27.5 in the third trimester.

Comparison of Treatment Options of Three- and Four-Part Humerus Proximal Fractures in Patients Over 50 Years of Age.

IntroductionOur aim was to evaluate different treatment methods including conservative treatment (CT), locking-plate osteosynthesis (OS) and hemiarthroplasty (HA) in three- and four-part humeral fractures in patients older than 50 years.MethodsForty-seven patients that have at least one year of follow-up were divided into three groups: 18 patients treated with OS, 14 patients treated conservatively and 15 patients treated with HA. For further evaluation, constant shoulder score, disabilities of the arm, shoulder and hand score (DASH), American Shoulder and Elbow Society (ASES) score had been used. Shoulder range of motion was also assessed.ResultsOS and CT groups had better scores than HA group. In OS group, average Constant score was 71.6 ± 16.2, DASH score was 12.1 (5.2-24.2) and ASES score was 77.5 (50.8-96.6). In CT group, average Constant score was 69.6 ± 19.2, DASH score was 16.4 (12.5-36.7) and ASES score was 76.6 (45.4-87.9). DASH scores (p = 0.032), Constant scores (p = 0.001), forward elevation (p < 0.001), abduction (p < 0.001), internal (p = 0.022) and external rotation (p = 0.048) were significantly improved in OS and CT groups than HA group.ConclusionsHA should not be considered a priority in surgical planning in Neer three-part and four-part proximal humerus fractures. CT is superior for patients with additional morbidity and advanced age. But in patients who are younger and can tolerate the surgical procedure, the priority should be OS.

Comparative study between conservative treatment and percutaneous pinning of non displaced lateral condyle Humeral Fractures in young children

Objective: To compare the results of above-elbow cast conservative treatment and surgical percutaneous pinning of nondisplaced (grade1) lateral condyle humerus fractures in young children. Patients and Methods: This is a prospective study held on twenty patients at Samannoud general hospital, Gharbiae, Egypt. Ten patients underwent conservative treatment in the form of above-elbow cast, and ten patients underwent surgical treatment in the form of percutaneous pinning fixation. Results: One patient (10%) had a secondary displacement in the conservative treatment group after a week and needed surgical intervention. No other complications were reported in this group. One patient (10%) had a mild pin tract infection in the pinning group, which resolved after removal. All patients in the study restored elbow full range of motion one week from plaster removal. Sixteen patients (6 conservative and ten pinnings) had overgrowth after the procedure with no statistical difference between the two groups, that was not also clinically evident. No significant difference in any outcome was detected between the groups.Conclusion: Lateral condyle humerus fractures need proper radiological evaluation on initial presentation after trauma and close follow-up. The present study demonstrated no significant difference in outcomes on the short term scale between conservative versus surgical treatment for grade 1 fractures, except for the possible re-displacement (10%) comparable to the literature. Patients’ parents/guardians would be offered conservative treatment as a first option if good compliance and close follow-up in the first few weeks are possible, which would avoid the potential complications of anaesthetics and surgical risks.

The Ultrasonic Electrical Stimulation Treating Recent Pain after Minimally Invasive Intervention with Disc Degenerative Diseases

Objective:To explore the analgesic effect of ultrasonic electrical stimulation for recent pain after minimally invasive interventional therapy for intervertebral disc degenerative diseases (DDD). Methods:From January to August 2019, 130 patients with DDD who were treated by minimally invasive intervention of intervertebral disc, and then were randomly divided into electrical stimulation group and conservative treatment group. After minimally invasive intervention, the electrical stimulation group was treated by ultrasonic electrical stimulation once a day for 7 days. The conservative treatment group was treated with conventional acupuncture and massage once a day for 3 days.The pain degree of before treatment and 3 days, 7 days and 1 month(m) after treatment were evaluated by pain numberical rating scale (NRS), the curative effect of 1 m post-cure was evaluated by NRS weighting method. Results:There was no significant difference of NRS score between the two groups before treatment (P &gt; 0.05). NRS of electrical stimulation group were significant lower than those in conservative treatment group, which was evaluated at several time point for 3 days, 7 days and one month after treatment (P &lt; 0.001). The curative effect of electrical stimulation group on one month after interventional treatment was significantly higher than that of conservative treatment group (P &lt; 0.001). Conclusion:The therapeutic effect of ultrasonic electrical stimulation is better than that of traditional acupuncture and massage for recent pain after minimally invasive interventional therapy with DDD, it is worthy to popularize in clinical treatment. Key words: After interventional therapy with DDD; The recent pain; ultrasonic electrical stimulation

Coagulation Factor Activity and Hemostatic Markers of Endothelial Dysfunction in Patients with Peripheral Arterial Disease.

PurposeWe aimed to evaluate the impact of intrinsic coagulation factors and hemostatic markers of endothelial dysfunction on complications in patients with atherosclerotic peripheral arterial disease (PAD).MethodsMaterials and This prospective study enrolled 120 PAD patients at Fontaine stages 2b to 3 who underwent open surgical, endovascular, or conservative treatment. Coagulation factors (FVIII, FIX, and FXI) and endothelial hemostatic markers, including von Willebrand factor (vWF) activity and level, soluble endothelial protein C receptor, and plasminogen activator inhibitor-1 (PAI-1) levels, were assessed.ResultsAt 3 months after open bypass grafting, activity of FVIII significantly increased from a median of 175% to 233% (P<0.001). At 3 months after endovascular treatment, the activities of FVIII, FIX, and FXI significantly increased from medians of 157%, 180%, and 156% to 184%, 218%, and 181%, respectively (P<0.05). Six patients with increased FVIII activity developed bypass graft thrombosis. Four patients in the endovascular group and three patients in the conservative treatment group with increased activity of vWF developed myocardial infarction (P=0.049). The subjects who developed restenosis had increased vWF activity (P=0.023) and decreased nitric oxide metabolite levels (P=0.003). Three subjects who received conservative treatment and developed PAD progression at 12 months had increased PAI-1 activity (P=0.028).ConclusionPatients with advanced PAD had a hypercoagulable status, and performance of open or endovascular revascularization was associated with further hypercoagulability. Increased activity of coagulation factors and altered levels of hemostatic markers of endothelial dysfunction were associated with PAD complications such as graft thrombosis, myocardial infarction, disease progression, and restenosis.

Percutaneous vertebral augmentation for osteoporotic vertebral compression fractures will increase the number of subsequent fractures at adjacent vertebral levels: a systematic review and meta-analysis.

This study aimed to investigate whether percutaneous vertebral augmentation (PVA) was associated with clinical and radiological subsequent adjacent fractures in patients with osteoporotic vertebral compression fractures. The systematic review was performed following PRISMA guidelines. Data were retrieved from PubMed, EMBASE, Cochrane Library, Google Scholar, Web of Science, and ClinicalTrial.gov, from database inception to March 2020. Eligible studies were those that assessed subsequent adjacent fractures after PVA in comparison with conservative treatment (CT). The number of patients with adjacent secondary vertebral fractures was calculated, and the pooled risk ratio (RR) with its 95% confidence intervals (95% CI) was used. Moreover, heterogeneity, sensitivity, and publication bias analyses were performed. Twenty-four studies were included finally. Moreover, 20/421 (4.75%) patients from the PVA group and 25/359 (6.96%) patients from the CT group had clinical subsequent adjacent fractures, and 46/440 (10.45%) patients from the PVA group and 36/444 (8.10%) patients from the CT group had radiological subsequent adjacent fractures. Both had no significant difference between the two groups (RR = 0.67, 95% CI [0.38, 1.19], p = 0.17)/(RR = 1.13, 95% CI [0.75, 1.70], p = 0.576). However, the number of fractured vertebrae was higher in the PVA group than in the CT group (RR = 1.41, 95% CI [1.03, 1.93], p = 0.03). A sensitivity analysis did not identify specific trials that seriously deflected. No obvious publication bias was identified. The systematic review revealed that PVA did not increase the incidence for subsequent adjacent fractures regardless of whether they were clinical or radiological fractures. However, PVA can increase the number of subsequent fractures at adjacent vertebral levels.

Medium-term efficacy of arthroscopic debridement vs conservative treatment for knee osteoarthritis of Kellgren-Lawrence grades I-III.

BACKGROUNDArthroscopic debridement is a mature treatment for knee osteoarthritis (KOA). Due to the differences in the research subjects, methods, and efficacy evaluation indexes, there are great differences in the surgical efficacy reported in the literature.AIMTo compare the medium-term efficacy of arthroscopic debridement and conservative treatment for KOA of Kellgren-Lawrence grades I-III.METHODSPatients with KOA of Kellgren-Lawrence grades I-III who were admitted to the orthopedic clinic of our hospital from July 2018 to December 2018 and agreed to undergo arthroscopic surgery were included in an arthroscopic debridement group, and those who refused surgical treatment were included in a conservative treatment group. Gender, age, body mass index (BMI), side of KOA, American hospital for special surgery knee score (HSS score) before treatment, visual analogue scale (VAS) score during walking and rest before treatment, conservative treatment content, and surgical procedure were recorded. Outpatient visits were conducted at the 1st, 3rd, 6th, 12th, and 24th mo after treatment in the two groups. The changes of HSS score and VAS score in each group before and after treatment were statistically analyzed, and the differences of HSS score and VAS score in different treatment stages between the two groups were also compared.RESULTSIn the conservative treatment group, there were 80 patients with complete follow-up data, including 20 males and 60 females, aged 58.75 ± 14.66 years old. And in the knee arthroscopic debridement group, there were 98 patients with complete follow-up data, including 24 males and 74 females, aged 59.27 ± 14.48 years old. There was no statistically significant difference in the general data (gender, age, BMI, side of KOA, Kellgren-Lawrence grade distribution, HSS score, and VAS score) between the two groups before treatment. The HSS scores of the conservative treatment group at the 1st, 3rd, 6th, 12th, and 24th mo after treatment were significantly higher than that before treatment (P < 0.05). There was no statistical difference in HSS score of the conservative treatment group among the 1st, 3rd, 6th, 12th, and 24th mo (P > 0.05). The HSS score of the knee arthroscopic debridement group at the 1st mo after surgery was significantly higher than that before surgery (P < 0.05). HSS scores of the knee arthroscopic debridement group at the 3rd, 6th, 12th, and 24th mo were significantly higher than those before surgery and at the 1st mo after surgery (P < 0.05). There were no statistically significant differences in HSS scores at the 3rd, 6th, 12th, and 24th mo after surgery (P > 0.05). HSS scores at the 3rd, 6th, 12th, and 24th mo were significantly higher in the arthroscopic debridement group than in the conservative treatment group (P < 0.05). There was no statistical difference in HSS scores between the two groups before treatment and at the 1st mo of follow-up (P > 0.05). VAS scores during walking and rest were significantly decreased in both groups, and the VAS score during rest was significantly lower in the arthroscopic debridement group than in the conservative treatment group, but there was no significant difference in the VAS score during walking between the two groups after treatment.CONCLUSIONCompared with conservative treatment, arthroscopic debridement can significantly improve the knee resting pain and knee functional status of patients with KOA of Kellgren-Lawrence grades I-III within 2 years after treatment.

Hematoma Evacuation via Image-Guided Para-Corticospinal Tract Approach in Patients With Spontaneous Intracerebral Hemorrhage

Background: Corticospinal tract injury from conventional craniotomy might influence the outcomes of intracerebral hemorrhage (ICH). The aim of the study was to evaluate the safety and efficacy of hematoma evacuation via image-guided para-corticospinal tract approach. Methods: Seventy-five ICH patients who underwent the image-guided para-corticospinal tract approach were retrospectively collected into surgery group. Diffusion tensor imaging (DTI) or CT angiography (CTA) was performed to identify the relationship of important white matter tracts and hematoma. The neuronavigation system where the preoperative imaging data is loaded was used to identify the burr hole location, and depth of insertion. The approach was introduced into the sulcus under navigation guidance and parallel to the CST into the hematoma along the trajectory chosen. Hematoma was removed under the image-guided para-corticospinal tract approach. Seventy-five age-, sex-, hematoma site- and volume-matched ICH patients who underwent conservative treatment were randomly selected as controls. Demographical, clinical, radiological and treatment-related data of patients were analyzed retrospectively. Functional outcome was evaluated by modified Rankin Scale at 90 days. Findings: 150 patients were retrospectively collected. The median Glasgow Coma Scale (GCS) score on admission was 11 (range, 5-15). The percent of thalamus/basal ganglion regions were 86.7% (130 patients). The mean hematoma volume was 47 ± 19 mL. A higher proportion of favorable patients was observed in surgery group than conservative treatment group (32.0% versus 17.4%; P=0.037). Interpretation: Hematoma evacuation via image-guided para-corticospinal tract approach seems to be safe in ICH patients with a relatively high functional independence. Funding: The ministry of science and technology of China and Southwest Hospital. Declaration of Interest: All authors declare that they have no conflicts of interest. Ethical Approval: This retrospective trial was approved by the Southwest Hospital. Ethics approval was obtained from the Ethics Committee of the Southwest Hospital of Third Military Medical University.

Technique de l’embrochage percutané d’arthrorise contre orthèse d’extension pour le traitement du mallet-finger osseux aigu : étude rétrospective

PurposeThis study aimed to compare the clinical, radiological, aesthetic and economic outcomes of extension pin block technique and extension orthosis in closed mallet fractures with more than 1/3 of articular surface involvement without subluxation (Wehbe and Schneider classification type IB and IC). Materials and methods39 patients (11 women and 28 men; mean age: 40.9±11.5 years) who had mallet fractures were retrospectively reviewed. Twenty-one patients were treated with the extension pin block technique, and the remaining 18 were treated with the extension orthosis. Fracture classification, measurement of articular surface involvement, presence of subluxation, and the fragment displacement were performed according to the Wehbe and Schneider classification. Crawford's criteria, extension lag, distal interphalangeal joint (DIPJ) range of motion, dorsal bump, and visual analog scale were evaluated. Fracture union, articular incongruity, and all other complications were followed and analyzed. The Michigan Hand Questionnaire (MHQ) was used to evaluate the aesthetic perception of the patient's finger. Direct and indirect costs were calculated for each treatment method. ResultsAt the final follow-up (mean: 18.4±6.2 months), there was no significant difference with respect to clinical outcomes between groups (p=0.335) and pain (p=0.131). Fracture union was achieved in all cases. Both extension lag (p=0.150) and DIPJ flexion (p=.261) were not different between groups. Dorsal bump was more frequent in the conservative treatment group (p=0.048). Aesthetic scores were similar between groups (p=0.477), but female patients rated significantly lower aesthetic scores than males (p=0.003) regardless of the treatment method. The direct medical (p=0.001), indirect (p=0.009) and cumulative costs (p=0.001) were significantly higher in surgical treatment group. One pin tract infection, one nail dystrophy, and one joint space narrowing were seen in the surgical treatment group versus none in the conservative treatment group (p=0.698). ConclusionsConservative treatment does not result in inferior clinical, radiographic and aesthetic outcomes compared to surgical fixation in closed mallet fractures with more than 1/3 of articular surface involvement without subluxation. Extension orthosis which is non-invasive, and cheap, maybe the treatment of choice in closed mallet fractures. Level of evidenceIV; Retrospective cohort.

Tonsillectomy Combined With Steroid Pulse Therapy Prevents the Progression of Chronic Kidney Disease in Patients With Immunoglobulin A (IgA) Nephropathy in a Single Japanese Institution.

BackgroundDespite the abundant experience of tonsillectomy with steroid pulse therapy (TSP) for patients with immunoglobulin A (IgA) nephropathy, the therapeutic efficacy of TSP on renal prognosis remains controversial. The purpose of this study was to evaluate the efficacy of whether TSP effectively prevents chronic kidney disease (CKD) progression.MethodsThis was a single-center, retrospective observational study. A total of 149 patients were enrolled in the current study who were confirmed with IgA nephropathy by renal biopsy between February 2011 and August 2019. The impact of TSP on CKD progression was compared with conservative treatment during a follow-up period of 3 years.ResultsIn total, 110 patients received TSP and 39 patients received conservative treatment. There were no differences between the two groups in the initial CKD stages: 65.1% of patients had CKD G1-2, 32.2% had CKD G3, and 2.7% had CKD G4-5. The initial urine protein was 0.7 g/gCr, which was not different between the two groups. Kaplan-Meier analysis showed that patients with TSP had a significantly better renal prognosis than those in the conservative treatment group after one and a half years (p = 0.007). Multivariable analysis revealed that TSP had a significant impact on the prevention of CKD progression, with an adjusted odds ratio of 0.07 (95% confidence interval, 0.01-0.87; p=0.039). However, we could not confirm the predictive value of the Oxford Classification on TSP efficacy. Additionally, the initial urinary protein level was a risk factor for CKD progression.ConclusionsTSP was associated with a lower risk of CKD progression. In this regard, our study supports that TSP may be a reasonable treatment option for patients with IgA nephropathy. In the featured study, it needs to be elucidated which histopathological classifications benefit from TSP treatment.

Therapeutic management of acute type A aortic intramural hematoma

ObjectivesThe proper therapeutic management for acute type A aortic intramural hematoma (IMH) is still controversial. The purpose of this study was to compare the outcomes following emergency surgery or conservative treatment for patients with this disease.MethodsFrom January 2015 to December 2018, 124 consecutive patients were diagnosed with an acute type A aortic IMH and were included in this study. According to our surgical indications, they were divided into two groups: an operation group (OG) and a conservative treatment group (CG).ResultsOf 124 patients, 83 (66.9%) patients accepted emergency surgery and 41 (33.1%) patients accepted strict conservative treatment. There were no differences between these two groups in early mortality and complications. However, the late mortality of patients in the CG was significantly higher than for patients in the OG. A maximum aortic diameter in the ascending aorta and aortic arch ≥ 45 mm and maximum thickness of IMH in the same section ≥ 8 mm were risk factors for IMH related death in patients undergoing conservative treatment.ConclusionsThe mortality associated with emergency surgery for patients with acute type A aortic IMH was satisfactory. In clinical centers with well-established surgical techniques and postoperative management, emergency surgical treatment may provide a better outcome than medical treatment for patients with acute type A aortic IMH.

Comparative study on clinical efficacy of different methods for the treatment of intramural aortic hematoma

To explore the difference of curative effect between different treatment modalities, in order to provide reference for the treatment of aortic intramural hematoma (IMH). 168 patients with aortic intramural hematoma diagnosed and treated from January 2010 to July 2020 were selected in the Second Affiliated Hospital of Nanchang University. Among them, 48 patients were diagnosed with Stanford A aortic intramural hematoma and 120 were diagnosed with Stanford B aortic intramural hematoma. According to the therapeutic methods, patients were divided into conservative treatment group and endovascular treatment group (TEVAR). For endovascular treatment group, according to the different timing of surgery, can be divided into acute phase group (onset within 72 h) and non-acute phase group (time of onset > 72 h).The clinical data and follow-up data were collected and analyzed by variance analysis and χ2 test. There were 168 patients diagnosed with aortic intramural hematoma 39 of them were (81.25%) Stanford A aortic intramural hematoma patients with pleural or pericardial effusion. For patient with Stanford A aortic intramural hematoma, endovascular treatment was performed in 15 patients (31.2%), and 33 cases (68.8%) for conservative treatment. The average follow-up (24.9 ± 13.9) was months. There were 120 patients with Stanford type B aortic intramural hematoma (71.4%), 60 patients received endovascular treatment (50%), and 60 patients (50%) received conservative treatment, with an average follow-up of (27.8 ± 14.6) months. For Stanford A type aortic intramural hematoma patients when the maximum aortic diameter ≥ 50 mm or hematoma thickness ≥ 11 mm, with high morbidity and mortality, positive endovascular treatment can reduce complications and death. For patients with Stanford type B aortic intramural hematoma, when the maximum aortic diameter ≥ 40 mm or hematoma thickness ≥ 10 mm, with high morbidity and mortality, positive endovascular treatment can reduce complications and death. Both Stanford type A and B aortic intramural hematoma patients could benefit from the endovascular treatment when the initial maximum aortic diameter is ≥ 50 mm or the hematoma thickness is ≥ 11 mm.

P195 Predictors of colectomy in patients with acute severe ulcerative colitis: single-center retrospective analysis

Abstract Background Acute severe ulcerative colitis is observed in 25% of patients1. Near 40% of this severe patients might undergo surgery2 and the mortality rate in this group of patients reaches 6.3%3. Untimely surgery leads to severe metabolic disorders, infectious postoperative complications, and increases the risk of death4,5. Eventually, the purpose of this study is identify predictors of colectomy in patients with acute severe ulcerative colitis. Methods A retrospective study included 74 patients with acute severe ulcerative colitis, who were treated at the clinic in 2017(Fig. 1). The patients were divided into the groups: group of colectomy - 54/74 (73%) and group of conservative treatment 20/74 (27%) (Fig 1). The predictors, like serum albumin, C-reactive protein, hemoglobin, endoscopic picture of «extensive ulcers», and clinical data were analyzed. The statistical analysis was performed using the software«Statistica 13.3» and «RStatistica». Results There were no difference by gender, age and duration of the disease in the groups. Mean of albumin and hemoglobin levels were significantly lower in the colectomy group. The endoscopy «extensive ulcers» was significantly more common in the operated patients (Tab 1). Also univariate, multivariate and ROC analyses were performed (Tab 2), (Fig 2). The risk of colectomy when endoscopy «extensive ulcers» combined with an albumin level&amp;lt;31 g/l and hemoglobin&amp;lt;107 g/l, was 100%. A nomogram for predicting the probability of colectomy was constructed (Fig 3). This logistic model has a statistically significantly high predictive value (AUC=0.93, p=0.006). Conclusion The endoscopic picture of «extensive ulcers» in combination with an albumin level of less than 31 g/l and hemoglobin less than 107 g/l are predictors of colectomy with high predictive value.

Preventive covered stent placement at the gastroduodenal artery stump in angiogram-negative sentinel hemorrhage after pancreaticoduodenectomy.

To evaluate the clinical outcomes of preventive covered stent placement at the gastroduodenal artery stump in patients with angiogram-negative sentinel hemorrhage after pancreaticoduodenectomy. Between July 2006 and September 2018, patients undergoing computed tomography angiography or diagnostic angiography for sentinel hemorrhage after pancreaticoduodenectomy were retrospectively reviewed. Patients having angiogram-negative angiography and undergoing preventive covered stent placement or conservative treatment were included. Clinical outcomes, technique success, and complications were evaluated. A total of 25 patients (mean age 62.5years) were evaluated, including 15 patients underwent preventive covered stent placement at the gastroduodenal artery stump and 10 patients received conservative treatments. The clinical success rates were 50% (5/10) and 86.7% (13/15) for conservative treatments and covered stent groups, respectively (p = 0.07). In the conservative treatment group, delayed massive hemorrhage occurred in five patients, two of whom died of recurrent bleeding due to gastroduodenal artery pseudoaneurysm within 16days, and two had intraluminal hemorrhage within 5days. In the covered stent group, one patient had inferior pancreaticoduodenal artery pseudoaneurysm 1day after the placement of the covered stent, and one had recurrent bleeding due to duodenal ulcer within 14days. The 30-day mortality was 40% (4/10) and 0 in the conservative treatment and covered stent groups, respectively (p = 0.02). The difference in the overall survival was nonsignificant between the two groups (p = 0.23). The preventive covered stent placement at the gastroduodenal artery stump is safe and reduces delayed massive hemorrhage and short-term mortality in patients with angiogram-negative sentinel hemorrhage after pancreaticoduodenectomy.

Effects of thymectomy on late-onset non-thymomatous myasthenia gravis: systematic review and meta-analysis

BackgroundThe effects of thymectomy on late-onset non-thymomatous myasthenia gravis (NTMG) remain controversial. The objective of this study was to conduct a systematic review in order to answer two questions pertinent to late-onset NTMG: (1) do patients with late-onset NTMG experience the same effects from thymectomy as their early-onset counterparts? (2) Compared with conservative treatment, does thymectomy have any benefits for late-onset NTMG patients?MethodsWe searched the PubMed, EMBASE, and Cochrane Library databases for studies published from January 1, 1950 to March 10, 2021. Outcomes were measured via clinical stable remission/pharmacological remission (CSR/PR) and improvement rates. We used Stata software to analyze the data.ResultsWe ultimately included a total of 12 observational articles representing the best evidence answering the questions of our study objective. Of these, nine studies, which included 896 patients overall (766 early-onset and 230 late-onset), compared postoperative outcomes between early- and late-onset NTMG. The remaining three articles, which included 216 patients (75 in the thymectomy group and 141 in the conservative-treatment group), compared thymectomy with conservative treatment for late-onset NTMG. The early- versus late-onset NTMG studies demonstrated that patients in the former category were 1.95× likelier than their late-onset counterparts to achieve clinical remission (odds ratio [OR] 1.95; 95% confidence interval [CI] 1.39–2.73; I2 = 0%). No difference was seen in improvement or remission + improvement rates between these two groups. When comparing thymectomy with conservative treatments in late-onset NTMG patients, neither did we observe any difference in CSR/PR.ConclusionWe found that late-onset NTMG patients had a lower chance of achieving CSR after thymectomy than early-onset patients. Thymectomy in late-onset NTMG also yielded no benefit to CSR or PR compared with conservative treatments. In late-onset NTMG patients, thymectomy should therefore be performed with caution, and the appropriate cutoff between early- and late-onset MG should be further explored in order to tailor and execute the proper therapeutic strategies.

Usefulness of inflammatory markers in detecting esophagojejunostomy leakage

Introduction and aimTotal gastrectomy is utilized in different pathologies. Esophagojejunostomy leakage is a frequent complication. Our aim was to determine the association of the neutrophil-lymphocyte ratio (NLR) with esophagojejunostomy leakage that subsequently required invasive treatment. Materials and methodsA retrospective study included patients that underwent esophagojejunostomy within the time frame of 2002-2017. Patients were grouped into those with or without anastomotic leakage that had conservative treatment (group A) and those with anastomotic leakage that had invasive treatment (group B). ROC curves and the Youden index were used for the optimum cutoff values of the NLR. ResultsFifty-seven patients were included. Thirty-two (56.14%) were men, and mean patient age was 61.8 ± 13.4 years. Forty-five patients were assigned to group A and 12 to group B. Mean NLR was higher for group B on postoperative day 3 (group A 9.5 ± 7.5 vs. group B 13.9 ± 4.9) (p = 0.05). Mean total leukocytes was higher in group B on postoperative day 5 (group A 7.8 ± 3.4 × 103/mcl vs. group B 10.3 ± 4.4 × 103/mcl) (p = 0.03). NLR and total leukocyte accuracy on postoperative day 3 was calculated with ROC curves, at 0.78 and 0.63, respectively. For the NLR and leukocyte count, sensitivity was 91.7% and 58%, specificity was 64.4% and 60%, positive predictive value was 40% and 28%, and negative predictive value was 96% and 84%, respectively. ConclusionsPostoperatively, the NLR identified the total gastrectomy with esophagojejunostomy patients that subsequently required an invasive procedure secondary to esophagojejunostomy leakage.

Anterior resection syndrome: a randomized clinical trial of a 5-HT3 receptor antagonist (ramosetron) in male patients with rectal cancer.

No effective treatment exists for anterior resection syndrome (ARS) following sphincter-saving surgery for rectal cancer. This RCT assessed the safety and efficacy of a 5-HT3 receptor antagonist, ramosetron, for ARS. A single-centre, randomized, controlled, open-label, parallel group trial was conducted. Male patients with ARS 1 month after rectal cancer surgery or ileostomy reversal were enrolled and randomly assigned (1 : 1) to 5 μg of ramosetron (Irribow®) daily or conservative treatment for 4 weeks. Low ARS (LARS) score was calculated after randomization and 4 weeks after treatment. The study was designed as a superiority test with a primary endpoint of the proportion of patients with major LARS between the groups. Primary outcome analysis was based on the modified intention-to-treat population. Safety was assessed by monitoring adverse events during the study. : A total of 100 patients were randomized to the ramosetron (49 patients) or conservative treatment group (51 patients). Two patients were excluded, and 48 and 50 patients were analysed in the ramosetron and control groups, respectively. The proportion of major LARS after 4 weeks was 58 per cent (28 of 48 patients) in the ramosetron group versus 82 per cent (41 of 50 patients) in the control group, with a difference of 23.7 per cent (95 per cent c.i. 5.58 to 39.98, P = 0.011). There were minor adverse events in five patients, which were hard stool, frequent stool or anal pain. These were not different between the two groups. There were no serious adverse events. : Ramosetron could be safe and feasible for male patients with ARS. NCT02869984 (http://www.clinicaltrials.gov).

Outcomes in nonagenarians with acute coronary syndrome. Is medical treatment important?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Nonagenarians have a high rate of comorbidities and are underrepresented in studies of ischemic heart disease. It is unknown whether treatment at discharge is useful in preventing adverse events at follow up. Purpose The aim of this study is to evaluate the secondary prevention with medical treatment in nonagenarians with acute myocardial infarction. Methods A multicenter, observational and retrospective study was carried out in nonagenarians admitted by acute coronary syndrome (ACS) between January 2005 and December 2018. Baseline characteristics, interventional procedures, treatment at discharge and outcomes at 1 year were evaluated. Patients with type 2 acute myocardial infarction were excluded. Results 680 patients (92,6 ± 2,4 years old) were included. Hypertension was present in 79.4% of the entire population. Percutaneous coronary intervention (PCI) was performed in 32.1% of patients, and this group had a higher GRACE score compared to the conservative treatment group (177 versus 172; p = 0.001). Patients with ST-segment elevation myocardial infarction (STEMI) were more likely to receive an invasive strategy than the non-ST segment elevation myocardial infarction (NSTEMI) (61.5% versus 41.5%; p= 0.001). 263 patients died at 1 year follow up with in-hospital mortality of 17%. In STEMI group, patients with statins and dual antiplatelet therapy at discharge had lower mortality during follow up compared to those who did not received (26.7 % versus 41.5%; p = 0.001 and 31% versus 22%; p = 0.02, respectively) (Image 1). Conclusions Nonagenarian patients with ACS have a high prevalence of hypertension and ICP procedures are not performed frequently. They also have a high mortality rate, although statins and dual antiplatelet therapy could be an effective secondary prevention. Abstract Figure.