Iatrogenic Causes Research Articles

Subarachnoid Fat Globules Following Spinal Surgery: A Case Report (P3-4.003)

<h3>Objective:</h3> To present a rare case of intracranial subarachnoid fat globules in a patient with a recent history of lumbar laminectomy. <h3>Background:</h3> Fat globules in the subarachnoid space are a rare phenomenon which has previously been described in association with the rupture of dermoid/epidermoid tumors of the central nervous system, or secondary to subarachnoid fat embolism in the setting of traumatic spinal injury. Computed tomography (CT) characteristics of the fat tissue resemble pneumocephalus with the hypodense appearance which might create a diagnostic challenge requiring magnetic resonance imaging (MRI). Here, we present a rare case of a patient with subarachnoid fat globules without any preceding intracranial/intraspinal tumor or traumatic injury of the neuroaxis. <h3>Design/Methods:</h3> Retrospective case review <h3>Results:</h3> A 65-year-old male presented with five weeks of daily, bitemporal, throbbing headache. Headaches started two weeks after a lumbar laminectomy. He reported his headaches built up gradually in the afternoon with increasing intensity throughout the day. They improved when lying down and sleeping overnight. There were no other associated complaints. The patient was evaluated for potential intracranial hypotension as the etiology of his headaches. Initially his CT brain reported potential air pockets in the suprasellar cistern region. MRI of the brain later identified these as multiple lobules of fat in the subarachnoid space in the inferior margin of the cerebellum, 4th ventricle and suprasellar and quadrigeminal cisterns. MRI of the neuroaxis was otherwise negative for fat tissue in the subarachnoid space. MRI of the lumbar spine showed localized soft tissue fluid collection. CT myelogram confirmed cerebrospinal fluid (CSF) leak at L4–5 in the vicinity of the thecal sac. <h3>Conclusions:</h3> The differential diagnosis of subarachnoid fat globules should include iatrogenic causes such as spinal surgery. <b>Disclosure:</b> Dr. Zhao has nothing to disclose. Dr. Beck has nothing to disclose. Dr. Erol has nothing to disclose. Dr. Gul has nothing to disclose. The institution of Dr. Beach has received research support from Neurona.

Otolaryngologists and iatrogenic facial nerve injury: a meta-analysis

BackgroundIatrogenic facial nerve injury is one of the otolaryngologists’ major fears during surgeries. Despite technological advances, the risk of iatrogenic facial nerve palsy remains high. The aim of this study is to meta-analyse papers published about different iatrogenic causes of facial nerve injury. This is a meta-analysis study carried out at ENT departments of Cairo and MUST universities from April to October 2022. It was structured according to the recommendations of the reporting system for meta-analysis (PRISMA).ResultsA total of 168 manuscripts were revised, and after the comprehensive search, 44 studies met our inclusion criteria; 736 cases out of 15,846 (4.6%) were included. The patients who underwent otolaryngologic surgeries are 716 (97.3%), and those who underwent other related procedures are 20 (2.7%).ConclusionMultiple causes of iatrogenic facial nerve injury have been reported. The commonest cause is parotid surgeries (364 cases, 49.5%), and the least common cause is arterial embolization (3 cases, 0.4%). It is more common in females more than males and in adults more than young. The most common injured part is extra-temporal part (199 cases, 27%), and the marginal mandibular branch is the most common injured branch in (160 cases, 21.7%). Geographically, it is more distributed in Germany (175 cases, 23.8%).

Etiological study of superficial radial nerve neuropathy: series of 34 patients.

Superficial radial nerve (SRN) neuropathy is a rare focal neuropathy leading to pain and paresthesia of the dorsolateral aspect of the hand. Reported causes include trauma, extrinsic compression, or it may be idiopathic. We describe the clinical and electrodiagnostic (EDX) features of 34 patients with SRN neuropathy of varied etiology. This is a retrospective study of patients with upper limb neuropathy referred for EDX studies who were found to have SRN neuropathy based on clinical and EDX findings. Twelve patients also had ultrasound (US) evaluations. Decreased pinprick sensation was noted in the distribution of the SRN in 31 (91%) patients, and a positive Tinel's sign was observed in 9 (26%). Sensory nerve action potentials (SNAPs) were not recordable in 11 (32%) patients. Of the patients who had a recordable SNAP, the latency was delayed, and the amplitude was decreased in all cases. Of the 12 patients who underwent US studies, 6 (50%) had an increased cross-sectional area of the SRN at or immediately proximal to the site of injury/compression. A cyst was located adjacent to the SRN in 2 patients. The most common cause of SRN neuropathy was trauma in 19 (56%) patients, of which 15 were iatrogenic. A compressive etiology was identified in 6 patients (18%). No specific etiology was detected in 10 patients (29%). This study is aimed at raising the awareness among surgeons about the clinical features and varied causes of SRN neuropathy; such knowledge may potentially lessen iatrogenic causes of injury.

Urethral strictures. Diagnosis and treatment

Urethral strictures represent the intrinsic and permanent narrowing of the urethral lumen with urodynamic effects and genitourinary complications resulting from obstruction in the path of urine and seminal fluid elimination. In men, urethral stricture refers to a narrowed segment of the anterior urethra caused by a process of fibrosis and scarring of the urethral mucosa and surrounding spongiosum tissue ("spongiofibrosis"). In the male posterior urethra, there is no spongiosum tissue, and the term stenosis is preferred in this location. The definition of meatal stenosis is accepted as a distal narrowing at the level of the meatus, without involving the navicular fossa. There is no universal definition of female urethral stricture. Female urethral stricture is defined by most authors as "a fixed anatomical narrowing" that leads to a reduction in urethral caliber. This reduced urethral caliber is defined as being between &lt;10 Fr and &lt;20 Fr, with most studies defining it as &lt;14 Fr, compared to the normal urethral caliber of 18-30 Fr. In transgender patients, the term stricture is used to define narrowing of the reconstructed urethra despite the absence of spongiosum tissue around it.[1] In men, a marked increase in incidence is observed after the age of 55, with a median age of 45.1 years. The estimated incidence is generally 229-627 cases per 100,000 men [2]. The anterior urethra is most commonly affected (92.2%), especially the bulbar urethra (46.9%) [3]. In women, 2-29% of patients with refractory lower urinary tract symptoms have obstructive flow at the level of the bladder, of which 4-20% will have urethral strictures [4]. There is a significantly increased incidence in women over 64 years of age. In children, most strictures are traumatic: iatrogenic causes account for 27.8-48% and external trauma for 34-72% of cases [1]. Congenital (13%), inflammatory (4%), or postinfectious (1%) strictures are less commonly observed. The bulbar urethra is the most frequently affected part of the urethra [1]. After hypospadias repair, meatal stenosis and urethral strictures are reported in 1.3-20% of cases, depending on the severity of hypospadias and the technique used [5]. There is a significantly higher incidence of this type of stricture in resource-rich countries due to a higher rate of surgical interventions. It has been reported that up to 18% of urethral strictures involving the meatus or navicular fossa are caused by surgical repair of hypospadias, lichen sclerosus, instrumental/traumatic causes, or idiopathic causes. Post-circumcision meatal stenosis has been reported in less than 0.2% of infants undergoing circumcision. In transgender patients ("trans men"), approximately 51% will suffer from a urethral stricture, while in "trans women" (male to female), the incidence is 14.4% [6].

Esophageal Perforation Etiologies, Management, and Outcomes at a Tertiary Academic Medical Center

Background: Esophageal perforations can occur spontaneously, but most are iatrogenic and related to procedures. The literature reports death rates from 10% to 26%. Our goals were to summarize demographics, comorbidities, managing services, perforation sites, outcomes, and complications of esophageal perforations at a tertiary academic medical center. Methods: This was a retrospective chart review. ICD and CPT codes were used to identify 89 subjects who experienced esophageal perforation from 2008 to 2020. Patients under age 18 were excluded from the study. Results: Patients diagnosed with esophageal perforation averaged 67 years. Perforations affected more males than females. Most perforations were contained and referred from outside hospitals. Thoracic esophageal perforations predominated followed by cervical and abdominal. Iatrogenic causes were identified in 56% of cases. The most common underlying diseases were gastrointestinal, cardiac, and cancer. Most patients were managed by a multidisciplinary team. The most common complication was empyema managed with chest tubes. Conclusions: We report an esophageal perforation mortality rate of 9%. Approximately 1% of perforations directly led to death. All uncontained thoracic perforations were complicated by empyema and managed with chest tubes. We observed more contained versus uncontained perforations, which may have contributed to higher survival rate. Our institution’s multidisciplinary approach to managing perforations potentially contributed to better outcomes and increased survival. Esophageal perforation remains a medical emergency, but perhaps with prompt recognition and interdisciplinary management, outcomes may not be as dreadful as previously reported.

Iatrogenic Cardiac Tamponade Secondary to Central Venous Catheter Placement: A Literature Review.

Cardiac tamponade is the fluid accumulation within the pericardial sac that compresses the heart and decreases cardiac output. More than 20% of the cases are surgical or non-surgical iatrogenic causes. Cardiac tamponade has been described as a rare complication of central venous catheter placement with an incidence in adults as low as less than 1% but with significantly high mortality of more than 60%. The purpose of this article is to review the incidence, clinical manifestations, pathophysiology, diagnosis, and management of cardiac tamponade after central venous catheter placement as well as different methods to prevent this fatal complication from occurring.

Iatrogenic Cerebral Amyloid Angiopathy Post Neurosurgery: Frequency, Clinical Profile, Radiological Features, and Outcome.

Prion-like transmission of amyloid-ß through cadaveric dura, decades after neurosurgical procedures, has been hypothesized as an iatrogenic cause of cerebral amyloid angiopathy (CAA). We investigated new and previously described patients to assess the clinical profile, radiological features, and outcome of this presumed iatrogenic CAA-subtype (iCAA). Patients were collected from our prospective lobar hemorrhage and CAA database (n=251) with patients presenting to our hospital between 2008 and 2022. In addition, we identified patients with iCAA from 2 other Dutch CAA-expertise hospitals and performed a systematic literature-search for previously described patients. We classified patients according to the previously proposed diagnostic criteria for iCAA, assessed clinical and radiological disease features, and calculated intracerebral hemorrhage (ICH)-recurrence rates. We evaluated the spatial colocalization of cadaveric dura placement and CAA-associated magnetic resonance imaging markers. We included 49 patients (74% men, mean age 43 years [range, 27-84]); 15 from our database (6% [95% CI, 3%-10%]; 45% of patients <55 years), 3 from the 2 other CAA-expertise hospitals, and 31 from the literature. We classified 43% (n=21; 1 newly identified patient) as probable and 57% (n=28) as possible iCAA. Patients presented with lobar ICH (57%), transient focal neurological episodes (12%), or seizures (8%). ICH-recurrence rate in the new patients (16/100 person-years [95% CI, 7-32], median follow-up 18 months) was lower than in the previously described patients (77/100 person-years [95% CI, 59-99], median follow-up 18 months). One patient had a 10 year interlude without ICH-recurrence. We identified no clear spatial relationship between dura placement and CAA-associated magnetic resonance imaging markers. During follow-up (median, 18 months), 20% of the patients developed transient focal neurological episodes and 20% cognitively declined. iCAA seems common in patients presenting with nonhereditary CAA under the age of 55. Clinical and radiological features are comparable with sCAA. After diagnosis, multiple ICH-recurrences but also long symptom-free intervals can occur. Harmonized registries are necessary to identify and understand this potentially underrecognized CAA-subtype.

MP09-16 INFORMING AN APPROACH TO THE SUBCAPSULAR RENAL HEMATOMA (SRH): A TEN-YEAR REVIEW OF THE NATURAL HISTORY AND PROGRESSION OF SRH

You have accessJournal of UrologyCME1 Apr 2023MP09-16 INFORMING AN APPROACH TO THE SUBCAPSULAR RENAL HEMATOMA (SRH): A TEN-YEAR REVIEW OF THE NATURAL HISTORY AND PROGRESSION OF SRH Elizabeth Lynch, Jacob Gaines, Justin James, Tareq Aro, David Hoenig, Zeph Okeke, Arthur Smith, and Arun Rai Elizabeth LynchElizabeth Lynch More articles by this author , Jacob GainesJacob Gaines More articles by this author , Justin JamesJustin James More articles by this author , Tareq AroTareq Aro More articles by this author , David HoenigDavid Hoenig More articles by this author , Zeph OkekeZeph Okeke More articles by this author , Arthur SmithArthur Smith More articles by this author , and Arun RaiArun Rai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003224.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The subcapsular renal hematoma (SRH) is a rare radiologic finding, but one with significant potential risks in the acute and chronic settings. The urologic community needs to better understand the clinical course of SRH in order to anticipate the severity of possible complications during management. METHODS: A natural language processing search algorithm in Nuance mPower Clinical Analytics screened CT and MRI studies for “renal hematomas” across nine Northwell Health hospitals, including a Level 1 Trauma Center from 2011 to 2021. Patients with at least 3 cross-sectional exams to track progression and time to resolution were included. Retrospective chart review assessed etiology of hematoma, interventions and management of clinical sequelae. RESULTS: We included 97 patients with acute diagnosis of SRH in the native kidney. Etiologies included traumatic (21%), spontaneous (32%), and iatrogenic causes (47%), as seen in Table 1. Three patients developed Page kidney with hypertension secondary to renin-angiotensin-aldosterone system activation, two of which had solitary kidneys, each requiring new hemodialysis or operative hematoma evacuation. The Page kidney with a contralateral functional kidney was managed conservatively. Six patients developed infected perinephric hematomas, five requiring drainage by interventional radiology (IR) and one requiring nephrectomy, on day 85, on average. 21 patients had perinephric bleeding requiring IR angiography, 17 of which underwent renal artery embolization. One patient had intractable pain, requiring operative hematoma evacuation on day 34. Another patient developed abdominal compartment syndrome requiring decompressive laparotomy. 94 patients had repeat imaging within ten months, and 20 (21%) demonstrated hematoma resolution. 18 patients had imaging between 10 and 15 months, of which 8 (44%) had resolved. The average time to resolution was 368 days. CONCLUSIONS: Subcapsular hematoma is a rare finding, most commonly after renal biopsy. 35% of patients required intervention including hemodialysis, embolization and nephrectomy. One third of spontaneous SRH required embolization, most commonly those with underlying renal masses. Page kidney phenomenon is rare (3%), but possibly more likely in solitary kidney. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e111 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elizabeth Lynch More articles by this author Jacob Gaines More articles by this author Justin James More articles by this author Tareq Aro More articles by this author David Hoenig More articles by this author Zeph Okeke More articles by this author Arthur Smith More articles by this author Arun Rai More articles by this author Expand All Advertisement PDF downloadLoading ...

MP42-06 ASSESSING THE ACCURACY OF PREOPERATIVE RADIOGRAPHIC IMAGING IN DETERMINING URETERAL STRICTURE LENGTH AT TIME OF ROBOTIC URETERAL RECONSTRUCTION

You have accessJournal of UrologyCME1 Apr 2023MP42-06 ASSESSING THE ACCURACY OF PREOPERATIVE RADIOGRAPHIC IMAGING IN DETERMINING URETERAL STRICTURE LENGTH AT TIME OF ROBOTIC URETERAL RECONSTRUCTION Labeeqa Khizir, Alain Kaldany, Hiren V. Patel, and Sammy E. Elsamra Labeeqa KhizirLabeeqa Khizir More articles by this author , Alain KaldanyAlain Kaldany More articles by this author , Hiren V. PatelHiren V. Patel More articles by this author , and Sammy E. ElsamraSammy E. Elsamra More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003280.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: During robotic ureteral reconstruction, accurate measurement of ureteral stricture length is important for surgical planning. We aimed to determine the accuracy of using conventional fluoroscopic imaging compared to ureteroscopy and direct measurement with measuring tape during intra-operative robotic repair. METHODS: A retrospective review was conducted for 15 patients with ureteral stricture disease at a single institution treated with robotic repair. Data was collected regarding etiology of ureteral stricture disease, measured preoperative radiographic stricture length on fluoroscopy, and measured intraoperative robotic stricture length. A Wilcoxon matched-pairs rank test was performed to compare ureteral length measurements. RESULTS: The most common etiologies of ureteral stricture were prior medical history of stone disease (n=10), prior ureteropelvic junction obstruction repair (n=3), and other iatrogenic causes (n=2) (Table 1). A majority of patients had ureteral stricture repair using buccal mucosa (n=7) or appendiceal onlay (n=6) grafts (Table 1). A total of 11 patients (73%) had >1 cm difference in stricture length between radiographic and robotic measurement (Figure 1). Of these patients, 73% (n=8) had prior medical history of stone disease (Table 1). The intraoperative robotic length was significantly longer compared to preoperative radiographic length (Median difference 1.2 cm, 98% CI 0.15-2.3, p<0.05) (Figure 1). CONCLUSIONS: Conventional preoperative radiographic measurement significantly underestimates the ureteral stricture length compared to intraoperative measurement. This may have clinical significance in influencing operative planning, technique, and the length of graft that is harvested. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e568 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Labeeqa Khizir More articles by this author Alain Kaldany More articles by this author Hiren V. Patel More articles by this author Sammy E. Elsamra More articles by this author Expand All Advertisement PDF downloadLoading ...

Rhabdomyolysis Caused by a Behavioral Manifestation of Acute Mania

AbstractIntroductionWhile seen in patients with bipolar disorder due to NMS, antipsychotic side effects, or substance use, rhabdomyolysis resulting from behaviors seen in mania has not been reported in recent literature. We present a case of a patient with rhabdomyolysis due to exertion during a manic episode.CaseA 29-year-old male with a history of bipolar disorder type 1 was brought to the ED in June 2022 after he was found on the roof of a local theater sharing excerpts from a book he had written. Temperatures outside were 100–102 Fahrenheit. On presentation, the patient had rapid, pressured speech and demonstrated flight of ideas. He was religiously preoccupied. He had been previously admitted to Psychiatric Emergency Services in April 2022 for mania and was discharged with lithium and lamotrigine. He had been titrating these medications with his outpatient psychiatrist.The patient’s labs showed an elevated creatinine of 1.49, up from his baseline of 1.09. Further workup revealed an elevated CK of 3,538. Additional abnormalities included an AST of 70, calcium of 10.6, total bilirubin of 1.6, and WBC of 15.5. He was afebrile, oriented, and had no obvious signs of infection. The patient received 2 liters of Lactated Ringers (LR) and was admitted to Internal Medicine. Later, he was agitated overnight and received 10mg olanzapine and 2mg lorazepam. Lithium level following fluid resuscitation was 0.6.On interview the next day, the patient described working on a creative religious piece that he wanted to share with others, leading to him climbing on the roof. He had been hyper-focused on this work, with 1–4 hours of sleep nightly. He also had been frequently doing gymnastics, walking long distances, and climbing other buildings. He endorsed diffuse muscle pain, but this was not reproducible on exam.150mL/hr of LR was started, and PO fluid intake was encouraged. He agreed to resume his medications and was started on lithium 900mg and lamotrigine 50mg. His CK continued to downtrend. WBC count decreased and was 12.9 at discharge. Lamotrigine was titrated up to home dose of 100mg. His mania improved, and he was ultimately discharged home with outpatient follow-up.ConclusionRhabdomyolysis results from the release of toxic cellular compounds from muscle fibers. Complications include acute renal failure, hyperkalemia, and compartment syndrome. Causes include substance use, medications, trauma, seizures, ischemia, overexertion, and dehydration. Recently reported cases of mania-associated rhabdomyolysis involve iatrogenic causes, such as neuromuscular malignant syndrome (NMS) and non-NMS antipsychotic side effects.Other causes include high-risk drug use during mania. Rhabdomyolysis due to behavioral manifestations of mania have been documented more rarely in older reports, similarly, addressing excessive exercise and dehydration. Therefore, our case represents a reminder of the medical sequalae resulting from actions undertaken during acute mania. This highlights the importance of implementing effective treatment to prevent such episodes.FundingNo Funding

Erythema Ab Igne: A Clinical Review

Erythema ab igne (EAI) is a skin condition caused by chronic heat-induced damage. The rash usually progresses over weeks to months of repeated or prolonged exposure to subthreshold-intensity infrared radiation that is not hot enough to cause a burn. The diagnosis is clinical based on patient history and physical examination, but a biopsy can reveal dilated vasculature, interface dermatitis, and pigment incontinence. Erythema ab igne initially was described in association with patients cooking over wood-fire stoves but has been shown over the decades to have a variety of causes. Herein, we describe various etiologies of EAI, including new heat-producing technologies, cultural practices, psychiatric illnesses, and even iatrogenic causes. However, the cause most commonly is application of heat for treatment of chronic pain, which may be a diagnostic clue for an underlying chronic illness. Although there are no current US Food and Drug Administration-approved therapies for treatment of EAI hyperpigmentation, the prognosis is excellent because removal of the heat source often will result in spontaneous resolution over time. Finally, chronic EAI rarely has been reported to evolve into squamous cell carcinoma, poorly differentiated carcinoma, cutaneous marginal zone lymphoma, and even Merkel cell carcinoma.

Pneumomediastinum in COVID-19 disease: Clinical review with emphasis on emergency management.

Pneumomediastinum can be primary (spontaneous) or secondary to iatrogenic, traumatic, and non-traumatic causes. The incidence of spontaneous and secondary pneumomediastinum is higher in patients with coronavirus disease 2019 (COVID-19) compared to the general population. So, pneumomediastinum should be considered in the differential diagnosis of any patient with COVID-19 presenting with chest pain and breathlessness. A high level of suspicion is required to diagnose this condition promptly. Unlike in other disease conditions, pneumomediastinum in COVID-19 has a complicated course with higher mortality in intubated patients. No guidelines exist for managing pneumomediastinum patients with COVID-19. Therefore, emergency physicians should be aware of the various treatment modalities besides conservative management for pneumomediastinum and life-saving interventions for tension pneumomediastinum.

Etiological Assessment of Tympanic Perforations: Case of the ENT Departement of Sikasso Hospital

Tympanic membrane perforation is a loss of substance that creates an abnormal communication between the middle ear and the external auditory canal, it follows a middle ear infection or direct trauma and is usually seen in young people. The aim of this study was to determine the etiologies of tympanic membrane perforations in the ENT department of the hospital in Sikasso. This was a prospective study over a period of 6 months from June to November 2014 in the ENT department of Sikasso hospital, involving all patients seen in consultation for tympanic membrane perforation. We collected 110 cases of tympanic perforations out of a total of 1844 patients received, i.e. a prevalence of 5.15% of cases. The average age of our patients was 25 years with extremes from 09 months to 72 years. The majority of our patients (32.7%) consulted for otorrhea, followed by hearing loss (21%), otalgia (20%), tinnitus with or without vertigo (14.50%) and trauma (11.80%). Infections were incriminated in the majority of cases (70.9%) and traumatic causes in 29.1%. Tympanic substance loss was marginal in 47 cases (including 11 attic cases highly suspicious for cholesteatoma), central (punctiform) in 46 ears and judged total in 17 cases. Unilateral perforations were found in 95 patients and bilateral in 15 cases and predominated in the left ear. Pure tone audiometry was performed in 83 patients, and found transitional hearing loss in 51.8%, perceptual hearing loss in 13.3% and mixed hearing loss in 34.9% of cases. Tympanic membrane perforations are relatively common in our practice, and occur mainly in young subjects. Otological infections and trauma are the main causes. They are accompanied by hearing loss. Iatrogenic causes due to attempts to remove foreign bodies dominated the traumatic causes in our study.

Histomorphological study of gingival recession in the experiment

Among periodontal diseases, one of the most common forms is gingival recession, which is a progressive displacement of the marginal gingiva in the apical direction. Studies by a number of authors indicate an increase in the prevalence and intensity of recession from 9.7 % to 99.3 % (at the age of 15 years to adult age, respectively) [1–3]. The reasons for the development of recession may be the following factors: anatomical and physiological features of the structure of the alveolar process, anomalies of teeth, dentition and dental occlusion, microbial factor (hard and soft dental deposits), acute or chronic gum injury, bad habits, and iatrogenic causes [10, 9, 11, 17]. Gingival recession is the cause of dentin sensitivity, as well as a factor in additional plaque retention, which stimulates further loss of periodontal attachment [11, 17]. Any aesthetic violations significantly reduce the quality of life. In this aspect, gum recession, which causes exposure of the roots of the teeth, has an extremely negative effect on the psycho-emotional state of a patient. An integrated approach to the problem under consideration is of great importance, in particular, in elderly and senile people, where systemic disorders of mineral metabolism often come to the fore [4, 8, 12, 14, 15, 16]. Experimental modeling of periodontal pathologies is of great clinical and rehabilitation significance [6, 7, 10, 11, 13]. Currently, there are various methods of treating gingival recession using a complex of therapeutic, surgical, orthodontic, and orthopedic methods. However, the results of observations and monitoring of the effectiveness of known methods of treating gingival recession do not indicate long-term restoration of periodontal tissues [5, 10, 11, 17]. Thus, the foregoing indicates the feasibility of conducting experimental and clinical studies to find methods aimed at activating recovery processes in periodontal tissues and allowing to increase the effectiveness of treatment of patients with gingival recession.

Oral Candidiasis in Adult and Pediatric Patients with COVID-19

Oral Candidiasis (OC) is an opportunistic fungal infection of the oral cavity, frequently reported under local and systemic predisposing circumstances. While the recurrence of OC HIV-infected subjects has been well described and reported, the association between oral candidiasis and the SARS-CoV-2 infection is a recent finding that still is worthy of further study. The present paper focuses on this novel association, reporting the incidence and prevalence of OC occurring during and after COVID-19 and the possible etiopathogenic mechanisms underlying the onset of OC in COVID-19 subjects. The work found that the immune inflammatory hypo reactions and immunosuppression found in children and adults with COVID-19 could favor the proliferation colonization of Candida species and the following infection. At the same time, poor oral hygiene and iatrogenic causes seem to be the main risk factors.

A comparative blind study between skin biopsy and seed amplification assay to disclose pathological α-synuclein in RBD

To compare the diagnostic accuracy of the immunofluorescence (IF) technique and aSyn-seed amplification assay (aSyn-SAA) of skin and cerebrospinal fluid (CSF) in disclosing pathological α-syn in idiopathic idiopathic REM sleep behavior disorder (iRBD) as early phase of a synucleinopathy. We prospectively recruited 41 patients with iRBD and 40 matched clinical controls including RBD associated with type 1 Narcolepsy (RBD-NT1, 21 patients), iatrogenic causes (2 pt) or OSAS (6 pt) and 11 patients with peripheral neuropathies. IF from samples taken by skin biopsy and aSyn-SAA from skin and CSF samples were analysed blinded to the clinical diagnosis. IF showed a good diagnostic accuracy (89%) that was lower in the case of skin and CSF-based aSyn-SAA (70% and 69%, respectively) because of a lower sensitivity and specificity. However, IF showed a significant agreement with CSF aSyn-SAA. In conclusion, our data may favor the use of skin biopsy and aSyn-SAA as diagnostic tools for a synucleinopathy in iRBD.

Perinatal Outcomes and Neurodevelopment 1 Year after Birth in Discordant Twins According to Chorionicity.

Background and Objectives: This study aimed to compare maternal complications, perinatal outcomes, and neurodevelopment 1 year after the birth between concordant and discordant twins in monochorionic and dichorionic twins. Materials and Methods: This retrospective study included twin pregnancies delivered between 24 + 1 and 38 + 2 weeks of gestation between January 2011 and September 2019. Chorionicity was confirmed by ultrasonography and was categorized into monochorionic and dichorionic. Each was then divided into two groups (concordant and discordant) according to birth weight discordancy. Maternal complications and neonatal outcomes, including neurodevelopmental delays, were compared between the two groups. Results: A total of 298 pairs of twin pregnancies were enrolled, of which 58 (19.26%) women were pregnant with monochorionic diamniotic twins and 240 (80.54%) with dichorionic diamniotic twins. In both monochorionic and dichorionic twins, the discordant twins had a greater incidence of emergency deliveries because of iatrogenic causes than the concordant twins. Among dichorionic twins, discordant twins had lower birth weight rates and higher hospitalization rates and morbidities than concordant twins. Among monochorionic twins, discordant twins had a lower birth weight and higher neonatal mortality than concordant twins. The neonatal size was not a predictor of neurodevelopment in this group. Based on the logistic regression analysis, male sex, respiratory distress syndrome, and bronchopulmonary dysplasia were risk factors for the neurodevelopmental delay; birth weight discordancy was significant only in dichorionic twins. Conclusions: Perinatal outcomes in discordant twins may be poor, and neurodevelopment 1 year after birth was worse in discordant twins than in concordant twins. Discordancy in twins can be a risk factor for neurodevelopmental delay.

Literature Review for Office-Based Anesthesia

Literature Review for Office-Based Anesthesia

Abstract No. 60 Role of Interventional Radiology in Management of Chest Tubes After Endobronchial Valve Deployment

The purpose of this study is to compare chest tubes placed in patients who develop pneumothoraces after endobronchial valve (EBV) placement with tubes placed for pneumothoraces from other etiologies. As EBV placement is becoming more common, it is important to understand the nuances in managing these patients. This is a retrospective study involving non-pregnant, adult patients who had chest tubes placed for pneumothoraces by IR at an academic institution between January 2011 and September 2021. Using the EMR, data was compiled into a database and patients were divided by pneumothorax etiology, including EBV placement, iatrogenic, lung disease, malignancy, and trauma. Demographics, comorbidities, and additional care required after tube placement were collected. Characteristics of chest tube placement including number, size, duration, and if additional tube manipulations were required after placement were collected. A total of 197 patients were recorded, 39% female and 61% male, with a mean age of 57 years old. These patients were broken down into pneumothorax causes: EBV deployment (19%), surgery (42%), lung disease (12%), malignancy (3%), and trauma (24%). Mean size of chest tubes placed due to EBV deployment, iatrogenic causes, lung disease, malignancy, and trauma were 16, 11, 13, 14, and 12 French, respectively. Mean duration of chest tubes placed due to EBV deployment, iatrogenic causes, lung disease, malignancy, and trauma were 12, 4, 8, 9, and 6 days, respectively. 44% of patients post EBV deployment required further manipulation of their chest tube, while the percentage of patients requiring manipulation who developed pneumothoraces from other etiologies ranged from 0-13% (Table 1). Patients who had pneumothoraces post EBV deployment more frequently required more than one chest tube, with larger chest tubes, on average, compared with other etiologies. In addition, chest tubes in post EBV patients had longer average durations and required more interventions to resolve pneumothoraces compared with other etiologies.

Vacuum-stent: A combination of endoscopic vacuum therapy and an intraluminal stent for treatment of esophageal transmural defects.

Endoscopic vacuum therapy (EVT) has gained a greater role in management of transmural defects in the upper gastrointestinal (GI) tract, including anastomotic leakage and esophageal perforation (e.g. Boerhaave syndrome and iatrogenic causes). The vacuum-stent is a new treatment modality, combining the benefits of EVT and an intraluminal stent. This prospective case series describes the first ten cases of a transmural defect in the upper GI tract treated with a vacuum-stent in a tertiary referral center. All patients signed informed consent for prospective registration of relevant data on treatment and outcomes in a specially designed database. Outcome parameters were successful closure of the defect, number of endoscopies, duration of treatment and adverse events. In total, ten patients treated with a vacuum-stent were included. Eight patients had anastomotic leakage after esophageal resection, of whom six were treated with vacuum-sponge and vacuum-stent, and two with vacuum-stent only. One patient had Boerhaave syndrome, treated with vacuum-sponge and vacuum-stent, and one had an iatrogenic perforation during pneumodilation for achalasia, treated with vacuum-stent only. Success rate was 100%, requiring a median of 5 (IQR 3-12) EVT-related endoscopies with a treatment course of median 18 (IQR 12-59) days. One patient developed an esophageal stricture, but no other vacuum-stent related adverse events were observed. The vacuum-stent, which combines benefits of EVT and an intraluminal stent, shows great feasibility and efficacy in treatment of transmural defects in the upper GI tract. Future studies should point out whether this device can prevent major (re-)surgery in these patients.