Follow-up Report Research Articles

Association between CD8+ Tumor Infiltrating Lymphocytes and the Clinical Outcome of Patients with Operable Breast Cancer Treated with Adjuvant Dose-Dense Chemotherapy-A 10 Year Follow-Up Report of a Hellenic Cooperative Oncology Group Observational Study.

Tumor-infiltrating lymphocytes (TILs) contribute to breast cancer (BC) prognosis. We investigated the prognostic impact of CD8+ TILs in patients with early breast cancer treated with adjuvant chemotherapy in a large observational clinical trial. Along with a 10 year follow-up, considering the efficacy and safety, we report the results of the translational part of our study. We examined the patients' tumors for total (t), stromal (s), and intratumoral (i) CD8 lymphocyte density (counts/mm2) on tissue-microarray cores. The impact of CD8+ TILs counts on DFS and OS, and its correlation with breast cancer subtypes and standard clinicopathological parameters, were investigated, along with efficacy and safety data. Among the 928 eligible patients, 627 had available CD8+ data. Of which, 24.9% had a high expression of sCD8, iCD8, and total CD8, which were correlated with higher Ki67, TILs density, ER/PgR negativity, and higher histological grade. The 5year DFS and OS rates were 86.1% and 91.4%, respectively. Patients with high iCD8 and tCD8 had longer DFS and OS compared to those with low counts/mm2 (DFS: HR = 0.58, p = 0.011 and HR = 0.65, p = 0.034 and OS: HR = 0.63, p = 0.043 and HR = 0.58, p = 0.020, respectively). Upon adjustment for clinicopathological parameters, iCD8 and tCD8 retained their favorable prognostic significance for DFS and OS, whereas high sCD8 was only prognostic for DFS. Menopausal status, tumor size, and nodal status retained their prognostic significance in all examined multivariate models. CD8+ TILs, and especially their intratumoral subset, represent a potential favorable prognostic factor in early BC.

NIMG-77. MAGNETIC RESONANCE IMAGING AND AMINO ACID POSITRON EMISSION TOMOGRAPHY IN DIFFERENTIATING TUMOR RECURRENCE FROM RADIATION NECROSIS IN HIGH GRADE GLIOMAS

Abstract BACKGROUND AND PURPOSE Differentiating tumor recurrence (TR) from radiation necrosis (RN) in high grade glioma (HGG) following radiotherapy can be challenging. The ability of conventional magnetic resonance imaging (MRI) to differentiate TR from post-therapeutic effects is often limited. Multiparametric advanced MRI (perfusion) and positron emission tomography (PET) with amino acid tracers, specifically 18F-Fluoroethyl-Tyrosine (FET) can provide relevant additional information on tumor metabolism, which allows for a more accurate diagnosis to differentiate tumor recurrence from radiation necrosis in high grade gliomas. MATERIALS AND METHODS Prospective analysis of 62 lesions in 62 patients with HGG who underwent both MRI and FET-PET imaging within three weeks intervals was done independently by a neuroradiologist and nuclear medicine physician. The study was conducted in a tertiary care oncology center between July 2018 and August 2021. Manually segmented regions of interest were placed over the areas of maximum enhancement/suspicion on MRI and FET uptake, which were used to calculate the relative cerebral volume (rCBV) and tumor to background ratios, respectively. Definitive diagnosis (TR versus RN) was made on clinico-radiological follow-up or histopathological report (wherever available). RESULTS Out of the 62 lesions that were studied, 46 and 16 had TR and RN, respectively. The sensitivity and specificity for determination of TR in HGG with conventional MRI were 98% and 62.5% respectively, while with FET-PET it was 91% and 87.5% respectively. The PPV , NPV and accuracy for MRI were 88%, 91% , 89% , while for FET-PET it was 95%, 78% and 90% respectively. A combination of MRI and PET parameters (mean target-to-background ratio), demonstrated an increase in diagnostic accuracy to 97%. CONCLUSION Cumulative imaging with MRI and FET-PET offers a multiparametric assessment of glioma recurrence that is correlative and complimentary, with higher accuracy and clinical value.

COVID-19 and Clinically Isolated Syndrome: Coincidence or Causative Link? A 12-Month Follow-Up Case Report

A 35-year-old female with positive anamnesis of COVID-19 infection presented with a seven-day history of headache along with tingling and numbness involving the right lower limb and visual disturbance on the right side of her vision. Magnetic resonance imaging (MRI) of the brain and C-spine were consistent with acute demyelinating lesions. However, the MAGNIMS criteria for a multiple sclerosis diagnosis were not met, and, subsequently, a diagnosis of clinically isolated syndrome (CIS) was made. At 12 months, the patient showed new inflammatory lesions in the right frontal lobe and at the septocallosal interface, a lesion of the right hemi-cord at C3, and subsequent development of vertigo and unsteadiness and signs consistent with a brainstem/cerebellar relapse. On the basis of clinical and radiological criteria in the 2017 McDonald criteria, a diagnosis of relapsing remitting multiple sclerosis was made.

Clinical report of six-month follow-up after cementing PEEK crown on molars

We conducted a six-month clinical follow-up on computer-aided design/computer-aided manufacturing-fabricated molar polyetheretherketone PEEK crowns to investigate their therapeutic effect. Only the PEEK crowns were examined as our study focused on short-term clinical evaluation of the new PEEK material. Twenty-three cases of PEEK crowns placed on the molars of 20 subjects (7 males and 13 females, mean age: 60.6 ± 14.2 years) were included in the study. The evaluation items were the condition of the crowns at the time of cementation and after six months, patient satisfaction, masticatory ability, and occlusal force. Mann–Whitney U tests with a significance level of 5% were used to examine the difference in glucose concentration by masticatory ability, occlusal pressure, and occlusal force, with and without PEEK crowns. The occlusion, margin fit, and contact of all 23 cases at the time of cementing were good. Six months after cementation, there was no crown desorption, fracture or crack, and prosthodontics was not needed in the 22 cases (one patient dropped out). No wear of the dental antagonist was observed. Patient satisfaction was generally high. There was no significant difference in masticatory ability between the groups with and without PEEK crowns. The subject's occlusal force was within the normal range. PEEK crowns used on molars can replace metal crowns and hold promise for an appropriate and effective treatment.

Treatment Outcome of Patients With Chronic Active Antibody-Mediated Rejection After Kidney Transplantation: Follow-Up Report of a Single Center Retrospective Study

Treatment Outcome of Patients With Chronic Active Antibody-Mediated Rejection After Kidney Transplantation: Follow-Up Report of a Single Center Retrospective Study

Withdrawal of Denosumab in Patients With Primary Hyperparathyroidism: A Follow-up Report of the DENOCINA Study

ObjectivesWe investigated the development in the primary outcomes: changes in bone mineral density (BMD) measured by dual x-ray absorptiometry at the lumbar spine, total hip, and femoral neck after 2 years. MethodsIn patients with primary hyperparathyroidism, we investigated the effects of 30-mg cinacalcet per day plus 60 denosumab every 6 months for 1 year (Deno group), versus denosumab plus placebo for 1 year (DenoPlacebo-group), versus placebo plus placebo injection for 1 year (Placebo group). After the study’s termination, most patients receiving denosumab were switched to bisphosphonate treatment. ResultsForty-three out of 45 participants were subject to follow-up. A total of 35 patients completed a 2-year follow-up dual x-ray absorptiometry-scan (Deno: n = 13; DenoPlacebo: n = 12; and Placebo: n = 10). None of the groups showed statistically significant changes in BMD or experienced decreases in mean BMD below the study’s baseline level. Overall, the changes in T-scores from the final study measurement to follow-up were similar among the groups (P = .38 for lumbar spine T-score, .63 for total hip, and .97 for femoral neck by 1-way ANOVA). P-calcium was not different over time (P = .20 for change over time and P = .08 for the difference between the groups by repeated measures ANOVA). A total of 5 participants suffered a fracture during the study or follow-up periods, all but one was in the placebo group. ConclusionEvidence suggests that it is possible to at least maintain BMD, and thus potentially lower the fracture risk by a short course of denosumab followed by antiresorptive therapy, where applicable in patients with primary hyperparathyroidism.

Cone-beam Computed Tomography Evaluation of Non-surgical management of a Large Periapical Lesion using Calcium hydroxide intracanal medicament: A 1-year follow-up case report

This case report aims to assess the healing of a large periapical lesion non-surgically using Calcium hydroxide (CH) with the aid of Cone Beam Computed Tomography (CBCT). A 28-year-old female patient presented with pain and swelling in the lower anterior teeth (31, 32, 41, 42) (Federation Dentaire Internationale (FDI) tooth notation system). Patient history and pre-operative radiographic examination revealed incomplete root canal treatment in relation to 31, 32, 41, 42 with periapical abscess. During the first visit, the access cavity was modified, followed by determination of the working length and biomechanical preparation. In the present case report, (CH) intracanal medicament(ICM) was placed in the canals for 2 weeks, and the process was repeated until the canals were dry. Once the canals were dry and the teeth became asymptomatic, obturation was performed. Permanent coronal seal was provided using composite restorative material. One year periodic follow-up was carried out to assess the healing of the periapical lesion, following which, post-operative healing was assessed with the help of CBCT- Periapical Index (CBCT-PAI) and was compared with the pre-operative CBCT-PAI. Regression of the lesion and formation of the trabecular pattern of the bone were noted. Intracanal medication with calcium hydroxide complemented the instrumentation with irrigation and optimal disinfection of the root canal system. In this case report, the use of CBCT as a diagnostic tool helped in the accurate measurement of periapical lesion size.

51.2 Improving Access and Quality of Psychodynamic Psychotherapy Supervision for Child and Adolescent Psychiatry Fellows at Oregon Health & Science University: Follow-up Report

This presentation will provide an overview of the incorporation of psychodynamic psychotherapy supervision at a child and adolescent psychiatry fellowship training program, highlighting the benefit of a quality improvement process addressing new and ongoing challenges during the second year of this project.

Tibial condylar valgus osteotomy for the treatment of intra-articular varus deformity of the knee.

The increasing incidence and distribution of primary and post-traumatic knee osteoarthritis (OA) in the young, active population has renewed interest in joint-preserving procedures. High tibial osteotomy (HTO) represents the most common treatment for medial knee OA associated with varus tibial deformity. However, deformities may also be related to intra-articular defects that an extra-articular procedure could not correct. The tibial condylar valgus osteotomy (TCVO) represents an intra-articular surgical technique for treating advanced medial knee OA with lateral joint subluxation. Currently, only a few papers with small samples and limited follow-up report the use of TCVO for the treatment of intra-articular deformities. Indications and operative techniques are various and not standardized. After an extensive search of PubMed, Scopus and Cochrane library, the main purpose of this paper is to summarize and discuss the indications, surgical techniques, and outcomes of intra-articular osteotomies while also reporting the preoperative planning and surgical procedure performed at our institution. These characteristics allow earlier weight-bearing and faster complete recovery. TCVO is an effective procedure to correct lower limbs' intra-articular defects from degenerative conditions developmental and post-traumatic deformities. This surgical technique, working at the intra-articular level, leads to some benefits related to restoring joint congruence and stability by realigning the axis of the lower limb and reducing the lateral joint subluxation. Moreover, the improved valgisation and lateralization of the mechanical axis and the limitation of the osteotomy to the medial condyle led to a better load distribution to the not osteotomy-involved compartment.

Installation Immediate Implant with Sinus Lift Crestal Approach Technique: A Case Report of 4-year Follow-up

When the first dental implants were developed in 1977, implants were placed 6‒8 months after extraction. The long healing time involves absorption of the extraction socket alveolar bone and a prolonged treatment period. To solve this problem, an “immediate implant” was studied, which is placed immediately after tooth extraction. Along with the timing of implant placement, studies on sinus lift were also conducted to overcome the lack of vertical bone height due to the presence of sinus and resorption of alveolar bone in implant placement in the maxillary posterior area. In this case, extraction, sinus lift, and implant placement were performed simultaneously with a crestal approach through the extraction socket in a patient with insufficient vertical bone height for implant placement. As a result, the treatment period of 3‒4 months was shortened, and the number of surgeries was reduced. The implant has shown satisfactory results in both bone and tissue during a 4-year follow-up.

Association of the Estimated Pulse Wave Velocity with Cardio-Vascular Disease Outcomes among Men and Women Aged 40–69 Years in the Korean Population: An 18-Year Follow-Up Report on the Ansung–Ansan Cohort in the Korean Genome Environment Study

The estimated pulse wave velocity (ePWV) can predict adverse cardiovascular disease (CVD) outcomes in patients with increased CVD risks. However, data on its predictive capacity for CVD outcomes in the general population are limited. This study aimed to investigate the association between the ePWV and CVD outcomes among Korean adults. Ten thousand thirty patients aged 40–69 years from the Ansung–Ansan cohort in a prospective community-based cohort study were followed up for over 18 years. The ePWV was categorized into quartiles. Cox proportional hazard models were used to estimate the risk of cardiovascular (CV) mortality and CVD outcomes (composites of CV mortality, myocardial infarction, coronary artery disease, stroke, heart failure, and peripheral artery disease). The incidence of CV mortality and CVD outcomes was 7.0% and 22.1% in the fourth (highest) ePWV quartile and 0.1% and 4.5% in the first (lowest) quartile, respectively. After relevant covariate adjustments, the patients in the fourth quartile showed a significantly higher CV mortality risk (hazard ratio (HR), 7.57; 95% confidence interval (CI), 1.83–31.25). The patients in the third and fourth quartiles had higher CVD outcome risks (third: HR, 1.61; 95% CI, 1.19–2.16; fourth: HR, 1.56; 95% CI, 1.05–2.31) than those in the first quartile. This association was more clearly observed among women than among men. An elevated ePWV is associated with CV mortality and CVD outcomes. The ePWV is expected to serve as a potential marker for identifying high-risk groups for CVD events.

Multicomponent Exercise Program to Improve the Immediate Sequelae of COVID-19: A Prospective Study with a Brief Report of 2-Year Follow-Up.

COVID-19 placed teams of professionals in a hostile and unfamiliar environment where the lack of knowledge of its pathology led to the adaptation of programs used so far for other conditions to try to address the immediate sequelae of COVID-19 infection. That is why the aim of this study was to assess the effects of a multicomponent exercise program (MEP) in improving cardio-respiratory performance, health status, disability due to dyspnea, aerobic capacity and endurance, and the immediate sequelae of COVID-19. Thirty-nine patients referred from different hospital services were included in this study. An intervention of seven weeks with sessions twice a week was carried out, where patients underwent intervallic training sessions followed by strengthening exercises and individualized respiratory physiotherapy exercises. The results of this study show a significant improvement in cardio-respiratory performance, health status, disability due to dyspnea, and aerobic capacity and endurance after intervention; and an increase in health status and reduction in disability due to dyspnea at the 2-year follow-up. In addition, none of the patients had any adverse effects either pre-post treatment or at the 2-year follow-up. Individualized and monitored MEP in survivors of COVID-19 showed positive effects in a pre-post evaluation and the 2-year follow up, improving the immediate sequelae of post-COVID-19 patients. This highlights the importance of the professional background of the rehabilitation teams in adapting to an unknown clinical environment.

Comprehensive management of mutilated dentition with fixed mandibular implant prosthesis and maxillary overdenture- A 6 year follow-up case report

Rehabilitation of mutilated dentition is esthetic and functional challenge. The present condition of dentition, patient’s level of motivation for maintaining oral hygiene, social status etc are the key factors to successful rehabilitation. Maxillary teeth supported overdenture against mandibular complete denture is a potential risk for enhancing residual ridge resorption of mandibular arch. In such situation mandibular implant prosthesis is a better treatment option. In this case report a comprehensive management of patient with mutilated dentition has been carried out in phased manner.Here three roots with healthy periodontium were preserved in maxillary arch. Fixed implant prosthesis was made in mandibular arch. Presently patient has been followed up for 6 years and found to be highly satisfied and having a good oral hygiene. Maxillary overdenture against mandibular fixed implant prosthesis should be considered as effective rehabilitative modality in rehabilitating such cases.

Characteristics and prognosis of children with recurrent T-cell acute lymphoblastic leukemia: a long-term follow-up report in China

This study assessed the relapse characteristics and prognosis of 145 children newly diagnosed with T-cell acute lymphoblastic leukemia (T-ALL). The overall complete response (CR) rate was 91.7% (133/145), and the overall recurrence rate was 31.6% (42/133). The recurrence rate in the intermediate-risk (IR) group and high-risk (HR) group was 15.4% and 47.1%, respectively (p < 0.001). Patients with young age, early T-cell precursor ALL, central nervous system (CNS) involvement, TCRγ gene rearrangement, karyotypic abnormalities, or absence of TCRβ gene rearrangement (p < 0.05) tended to relapse. All recurrences occurred within 36 months after diagnosis. The HR group recurred earlier than the IR group (p= 0.026). The 3-year overall survival (OS) rate was significantly lower in the HR group than in the IR group (p < 0.001). All relapsed children died within 12 months after recurrence. Early intervention may benefit children with a high risk of recurrence.

P7.03: Analysis of Immune Cells Draining From the Abdominal Cavity as a Novel Tool to Early Prediction of Clinical Events. Prospective Multicenter Study - INIGMA Follow-up Report

Introduction: International Network for Intestinal Graft Monitoring and Analysis – INIGMA” project is a multicenter study started in 2015. The rationale of this work consists in that the abdominal drainage fluid collected after intestinal transplant (ITx) contains immune cells trafficking from the implanted intestine, and changes of immune cell composition, especially increase of neutrophils, correlated with the appearance of future clinical events (rejection, infection, or other events). The main objective of this project is to validate this non-invasive method for predict the development of abdominal complications after the first post-op days, based on the analysis of draining cell composition and their correlation with clinical follow-up. Here, we aimed to present a follow-up of our study. Material and Methods: This prospective observational study started in 2008 by Favaloro Foundation University Hospital, Argentina and turned into a multicenter study involving the University of Gothenburg, Sweden; University of Leuven, Belgium and La Paz University Hospital, Spain from 2015 to 2022. The cell composition of the abdominal draining fluid and blood collected during the first post-op days was analyzed by differential cell counter and was correlated with the clinical outcome. Results: A total of 38 patients (pts) with complete biochemical and clinical information were enrolled by 3 of the 4 centers (Table 1). Blood samples showed a predominance of neutrophils and marked leukopenia, independently of the age, immunosuppressive protocol used, and clinical event reported. Whereas draining cell composition showed neutrophilic predominance when patients suffered intra-abdominal clinical complications that change to a leukocyte prevalence when the clinical event resolved. When a new shift to a neutrophil dominant content is observed in the drainage, it anticipates the development of a clinical event in the peritoneal cavity (26/38 pts). Table 2 summarizes the association between neutrophils and clinical events. Sensitivity=92,9%; Specificity=80%; PPV=92.9%, NPV=80%. Conclusion: our preliminary results suggest that abdominal clinical events can be early predicted after ITx by analyzing the changes in the drainage cell composition, particularly when a shift to a neutrophilic dominance is registered. Thus, cell counts from the drainage should be included as part of the daily evaluation of pts receiving an ITx. This analysis provides further support to use this non-invasive approach to monitor the grafts and the transplanted pts providing easily information for clinical management decisions. A larger pts cohort should be required to validate this methodology.

IMPLEMENTATION OF VALUE STREAM MAPPING TO REDUCE WASTE IN WARRANTY CLAIM PROCESS AT COMMERCIAL VEHICLE AUTOMOTIVE COMPANY

In the automotive industry, after-sales service becomes one of the marketing strategies used. The obstacles arose when there was a problem with the products, but the services related follow-up decisions problem report from customers seems too long because the information delivered by the dealer has not been fulfilled. This research aims to identify waste and implement improvements that can reach the standard after-sales service time set by the company. This study uses the value stream mapping (VSM) method combined with a root cause analysis approach to reduce waste. The problem identification found that the most prolonged decision was the starting system. Then, the dominant waste is a waiting process. The VSM improved processing time efficiency by 34.47% or 33.97 hours (1.4 days). This result proved that the overall reporting time reached 60 hours (2 days) as the company target.

Severely resorbed mandible treatment: a 12-years follow-up case report

Rehabilitation of severely atrophic jaws has been a major problem for elderly patients and dentists. When conventional rehabilitation treatments are not possible, bone intervention is deemed necessary. Mandibles with less than 12 millimeters (mm) in height imply insufficient retention of the prosthesis, intolerance to mucosal load, pain and, consequently, incapacity of oral functions and decreased facial aesthetics. Endosseous implants are a widely accepted therapy for SRM rehabilitation, but it depends on the amount of bone available for a good prognosis. The Tent Pole technique is based on the addition of bone graft and expansion of the soft tissue matrix, mainly for cases of SRM with 6 mm or less of bone height available for rehabilitative treatments with endosseous dental implants. The objective of this report is to present and update a previously published clinical case of SRM reconstruction and rehabilitation using the tent pole technique, with 12 years of follow-up. The female patient, who underwent treatment at 63 years of age, received treatment using the Tent Pole surgical technique for mandibular reconstruction with cranial autogenous particulate bone graft. The treatment was favorable during the 12 years of control, the CT scan showed that the grafted bone was stable in volume and the mandible was enlarged in three dimensions.

Performance of artificial intelligence-based breast cancer screening in a community setting: a real-world evaluation study

Despite improvements in treatment strategies, breast cancer survival rates in India remain low because of poor awareness and advanced stages at presentation. Early diagnosis and treatment can improve the survival rates of patients with breast cancer. A population-based breast cancer screening programme with mammography is often not feasible in resource-constrained settings. Thermalytix, a novel breast cancer screening technology, applies artificial intelligence algorithms over thermal images to generate an automated interpretation report indicating breast health. The Thermalytix testing equipment is portable, requires minimal skills to operate, and operation is 20 times less expensive than a mammography. The test has been used to screen women in community settings in India. This study was done to assess the performance of the Thermalytix test in identifying women suspicious of breast cancer in community settings. Women who underwent Thermalytix tests in community-based screening camps in the Indian states of Karnataka and Maharashtra between Aug 12, 2017, and May 31, 2021, were included in this study. The Thermalytix test captured five thermal images in multiple views from each participant and the tool automatically generated a triage report. A more detailed report with annotations of probably abnormal regions and an overall breast health score ranging from 0 to 5 (B-score) was also generated. A B-score of 4 or 5 on triage indicates a high level of concern and prompts a recommendation to follow-up with breast ultrasonography. A B-score of 3 prompts a recommendation to repeat the Thermalytix test after 3 months. A B-score of 1 or 2 indicates thermal patterns of low level, usually prompting a recommendation to continue routine screening. Participants with B-scores of 4 or 5 on the Thermalytix test were followed-up with a telephone call to obtain information about their subsequent tests, such as mammography, ultrasonography, or histopathological examination. Women with a follow-up report were categorised as having "Normal", "Abnormal-Benign", or "Abnormal-Malignant" findings (as per their Breast Imaging Reporting and Data System score of 1, 2 or 3, or 4 or 5, respectively). 13 932 women were included in the analysis. 775 women complained of a breast lump, 625 (4·5%) of whom were given B-scores of 4 or 5 after Thermalytix testing and were referred for follow-up breast ultrasonography. 117 (18·7%) of these 625 women underwent standard follow-up investigations. Abnormalities were detected in 78 of the 117 followed-up women (74 benign and four malignant breast lesions), indicating that Thermalytix has a positive predictive value of 66·7% in detecting benign and malignant breast lesions. In resource-constrained countries where systematic screening programmes with mammography is not scalable or feasible, the portable, radiation-free Thermalytix test is a promising option for affordable and accessible breast cancer screening. This screening test is not resource-intensive and can be set up in remote locations and operated with minimal training. The Thermalytix test can be used to triage women for referral for further evaluation in secondary or tertiary health-care centres, which makes it a logistically and economically feasible option for breast cancer screening in low-income and middle-income countries. This programme was sponsored by Niramai Health Analytix and was executed in collaboration with National Health Mission, Maharashtra, India, and Bruhat Bengaluru Mahanagara Palike, Municipal Corporation of Bangalore City, Karnataka, India.

Treatment of Primary Congenital Lymphedema Via the Godoy Method: A Case Report of 17-year Follow-up

The present research aimed to report the treatment of primary congenital lymphedema using the Godoy method with a 17-year follow-up period. A 2-month-old male patient with bilateral primary congenital lymphedema of the lower limbs was sent to the Clinica Godoy-Brazil for specialized treatment. The physical examination revealed bilateral lower limb edema affecting the feet and middle third of the legs. The patient was made to use hand-crafted stockings made of grosgrain fabric. When the child reached 10 years of age, mechanical lymphatic therapy was conducted. A considerable reduction in the edema was achieved but with periods of improvement and worsening. In the last 4 years of the 17 years of treatment, the limbs have remained within or near the range of normality. The present findings demonstrate that the Godoy method is effective in controlling edema in cases of primary congenital lymphedema. When the family has difficulties, others who take care of the child should get involved to ensure the treatment of this type of lymphedema.

MO24-5 Everolimus in angiomyolipoma of tuberous sclerosis – a ten years follow-up case report

Tuberous sclerosis complex (TSC) affects approximately one to two million people worldwide. Nowadays renal lesions are the leading cause of death in Angiomyolipoma (AML) related to tuberous sclerosis. The new role of Everolimus (mTOR Inhibitor) has come in patients of Large AML with TSC in the last decade.