Head Lesions Research Articles

Unusual manifestation of pancreatic cancer in a young patient

Pancreatic cancer, often described as the most devastating among cancers, characterized by a malignant tumor with a grim prognosis and a limited response to systemic therapy. Its characterization is common in old age and very rare and unusual in the young age. We present an unusual case of a male patient, 35 years old. A case of diabetes and of pancreatic cancer in the head of the pancreas with stomach and bone metastases, highlighting its diagnostic challenges and management. The patient presented with changed bowel habits for a month, generalized body aches for a week, hip joint pain with decreased mobility for a week, decreased oral intake for three to four days, and hematuria for two days. The patient complained of irregular bowel habits, which included fatty and oily feces, minor abdominal discomfort, and intermittent constipation. According to the patient, he developed generalized bone pain in upper as well as lower back unlike usually present in pancreatic cancer. A contrast-enhanced CT scan of the abdomen and pelvis revealed indications of a heterogeneously enhancing lesion in the pancreatic head, with an interior necrotic component measuring 32x31 mm and generating a substantial dilatation of the pancreatic duct and CBD. A tentative diagnosis of pancreatic cancer in the head of the pancreas with stomach and bone metastases was made based on clinical history and testing. Given the poor prognosis associated with pancreatic cancer patients, the patient was admitted for conservative and palliative care. This case emphasizes the rarity of pancreatic cancer in young patients and that further research is needed to understand its epidemiology and etiology.

Ad libitum feeding systems for lactating sows: effects on productivity and welfare of sows and piglets

The nutritional requirements of sows change during lactation and thus require adapted and dynamic feeding regimes that consider the sows’ behavioral needs and production traits. The present study evaluated the effect of four different feeding systems on productivity and aspects of the welfare of 61 sows and their piglets during lactation. A non-ad libitum system (CON) was compared with two computer-monitored (COMP, COMP + ) ad libitum feeding systems, that allowed sows to access feed via displacement of an electronic sensor, as well as a third purely mechanical ad libitum feeding system (MECH). Daily feed disappearance, piglet growth, piglet growth per feed disappearance as well as sows’ weight and conception rate were recorded. Health indicators of sows and piglets were scored as well as sow behavior analyzed for a total of 96 hours/sow from video recordings taken on days 2–4 and 23 postfarrowing (n = 35 sows). Sows from all three ad libitum systems (COMP, COMP+, MECH) showed a lower feed disappearance than CON (P < 0.01). Additionally, average daily piglet growth tended to be higher (P = 0.05) and piglet growth per sow feed disappearance was significantly higher in all three ad libitum systems than in CON (P < 0.01). Piglet mortality, sow weight loss and subsequent conception rates did not differ between treatment groups. Piglets in COMP and COMP + had fewer head lesions (P = 0.01). Sows in all three ad libitum systems spent more time with their head in the trough than in the non-ad libitum system (P < 0.01). Occurrence of sow stereotypies (vacuum chewing, biting fixtures) was rare (typically < 2% of scans) and did not differ between treatments. Our data suggest that sows fed ad libitum eat what they need and can convert feed more efficiently into the piglets’ growth without additional weight loss. Furthermore, the increased time sows spent in ad libitum systems with their head in the trough points toward longer feeding times, which might be beneficial in terms of meeting pigs’ behavioral need to forage. Taken together, our initial studies on sow feeding behavior and feed efficiency will benefit the development of new lactation feeding systems that promise to improve animal welfare and productivity while reducing feed costs.

Treatment of osteochondral injuries of the humeral head using fresh osteochondral allograft transplantation

BackgroundLarge osteochondral lesions of the humeral head can result from locked posterior dislocations, avascular necrosis, and osteochondritis dissecans. Fresh osteochondral allograft (OCA) transplantation is a treatment option for young patients with focal osteochondral defects of the humeral head. The purpose of this case series was to assess graft survivorship, subjective patient-reported outcomes (PROMs), and satisfaction among seven patients who underwent OCA transplantation of the humeral head. MethodsWe identified seven patients who underwent humeral head OCA transplantation between 2008 and 2017. A custom questionnaire for patient reported outcome measures including ASES, QuickDASH, Likert satisfaction, and reoperations was mailed to each patient. Clinical failure was defined as further surgery that involved removal of the allograft. ResultsMedian follow-up duration was 10 years (range, 4.6 to 13.5 years) with a median age of 21.6 years (range, 18.5 to 43.5 years). Most patients (86%) reported improved function and reduced pain. At final follow-up, 71% of patients reported ongoing problems with their shoulder including pain, stiffness, clicking/grinding, limited range of motion, and instability. Return to recreational activities was high at 86% but 43% expressed limitations with activity due to their shoulder. Overall satisfaction was high at 71% with mean ASES and QuickDASH scores at 62.4 and 29.2 respectively. Reoperation after OCA occurred in one patient (14%). ConclusionsAmong this case series of seven patients who underwent OCA transplantation of the humeral head, patient satisfaction was high at 10 year follow-up and most returned to recreational activity although most also had persistent shoulder symptoms.

Prognostic factors for GEM + nab-PTX combination therapy in elderly patients with pancreatic cancer.

678 Background: Japanese Clinical Practice Guidelines for Pancreatic Cancer 2022 recommends gemcitabine (GEM) + nab-paclitaxel (nab-PTX) therapy (GnP regimen) as the first line chemotherapy for elderly patients with pancreatic cancer. In Japan, it is reported that about 69% of pancreatic cancer patients are elderly, and Only few group reported the safety of GnP regimen. In this study, we investigated the anti-tumor efficacy and prognostic factors of GnP regimen in patients with pancreatic cancer at our hospital, with a particular focus on age. Methods: 160 patients who started GnP therapy as the first line treatment for unresectable pancreatic cancer between February 2016 and December 2021 were included in the study. 70 years of age or older was defined as elderly, and patient background and treatment efficacy were compared in two groups: non-elderly patients (n=84) and elderly patients (n=76). Prognostic factors were also compared between the overall population and the elderly. Results: Patients with a primary lesion in the pancreatic head were 32 (38.1%) of the non-elderly patients and 35 (46.1%) of the elderly patients. 60 patients (71.4%) of the non-elderly and 38 (50.0%) of the elderly had distant metastases. The median overall survival was 16.0 months for the non-elderly and 17.7 months for the elderly, with no significant difference (p=0.93). Significant prognostic factors for the overall subject population were ECOG PS (HR 1.80, p=0.019), liver metastasis (HR 2.36, p&lt;0.01), CRP (HR 1.91, p&lt;0.01) and NLR (HR 2.65, p&lt;0.01). The only significant prognostic factor in the elderly was liver metastasis (HR 2.59, p&lt;0.01). Conclusions: GnP regimen in pancreatic cancer can be expected to have the same antitumor effect in elderly patients as in non-elderly patients. However, significant prognostic factors were reduced in the elderly, we need to identify specific factors to determine the indication for treatment in the elderly patients.

Malignant and Benign Head and Neck Tumors of the Pediatric Age: A Narrative Review.

Malignant tumors of the head and neck are rare in children, but it is important to know these lesions and identify them early in order to have a good outcome for these patients. Benign lesions of the head and neck are much more frequent and have an excellent prognosis. For this reason, it is necessary to recognize the warning signs and symptoms and understand when to refer the patient to a reference center for the treatment of these pathologies. The clinical presentation of both benign and malignant lesions in children may be similar as usually, both categories have compressive effects. This confirms the fact that the clinical diagnosis is not sufficient and always requires instrumental investigations and biopsies. In this narrative review, we analyzed both malignant lesions such as lymphoma, rhabdomyosarcoma, thyroid tumors, salivary gland tumors, neuroblastoma, and nasopharyngeal carcinoma, and benign ones such as cystic dermoid teratoma, hemangioma, juvenile angiofibroma and fibrosis dysplasia. Indeed, we set out to discuss the most common lesions of this site by evaluating their characteristics to highlight the differentiation of malignant tumors from benign lesions and their correct clinical-therapeutic management. A literature search was carried out in the PubMed and Google Scholar databases to identify all narrative reviews addressing malignant and benign head and neck tumors of the pediatric age. In conclusion, the care of children affected by head and neck benign lesions and malignancy must be combined and multidisciplinary. It is essential to recognize the diseases early in order to differentiate and intervene as soon as possible for the correct clinical-therapeutic management.

Management of first branchial anomalies in children: 20 years of experience.

Branchial cleft anomalies (BCAs) are common pediatric head and neck lesions; however, only 1-4% involve the first branchial cleft. The rare occurrence of first BCAs, their presentation at a young age, and the possible facial nerve involvement make diagnosis and treatment challenging. A retrospective chart review was conducted for children diagnosed with their first BCA between 2000 and 2020. Data on demographics, presenting symptoms, physical findings, imaging features, previous surgery, and treatment outcomes were collected and analyzed. The cohort included 17 patients with a median age of 5 years at presentation. Seven (41%) had undergone previous surgical intervention before definitive surgery. Eight were classified as Work Type II anomalies, and nine as Work Type I. Sixteen patients (94%) underwent definitive surgical excision at a median age of 6.9. A parotid approach was used in 10 (62%), with dissection of the mass from the facial nerve, and a retro-auricular or end-aural approach was used in 6 (38%). Complete excision was achieved in 14/16 patients (88%). Three patients had transient facial nerve paresis postoperatively. Recurrence was noted in 3/16 patients (18%). Enhancement in imaging was positively correlated with post-operative complications (R = 0.463, P = 0.018). First, BCA poses a diagnostic and surgical challenge; thus, definitive surgical treatment is often delayed. The surgical approach should be tailored to the type of anomaly (Work type I or II) and possible facial nerve involvement. Risk factors for post-operative complications are a history of recurrent infections and previous surgical interventions. The presence of contrast enhancement in preoperative imaging should alert surgeons to perioperative challenges and the risk of post-operative complications.

Embolotherapy of Head and Neck Lesions: Basics and Clinical Tips

Embolotherapy of Head and Neck Lesions: Basics and Clinical Tips

Fine needle aspiration cytology of head and neck lesions: A study at tertiary care hospital of Gujarat

Fine needle aspiration cytology of head and neck lesions: A study at tertiary care hospital of Gujarat

Single Stage Bilateral Adrenalectomy (Cortical-Sparing) and Pancreatectomy (Corpus-Sparing) in a Patient with Von Hippel-Lindau Disease.

Von Hippel-Lindau (VHL) disease is an autosomal dominant syndrome and affects many organs. We aim to report an adult patient with VHL disease having bilateral adrenal pheochromocytoma and multiple neuroendocrine tumors of the pancreas who was successfully treated with simultaneous function-preserving adrenalectomy and pancreatectomy. A 27-year-old woman was admitted to hospital with hypertension. The computed tomography of the abdomen revealed a solid tumor in both adrenal glands with the sizes of 12x7 cm on the right and 4x4 cm on the left. She also had two pancreatic solid masses in the head and three in the tail with varying sizes. The laboratory tests are all within normal limits except elevated 24-hour urinary metanephrine and normetanephrine. I-123 MIBG scanning showed increased uptake in both adrenal glands. Fine needle aspiration biopsy of the tumor on head of pancreas via endoscopic ultrasonography showed neuroendocrine tumor. Those findings were compatible with bilateral pheochromocytoma and multiple pancreatic neuroendocrine tumors and genetic tests revealed the mutation which confirmed the diagnosis of VHL disease. After suppression with alpha-1 inhibitor, right total, left cortical-sparing adrenalectomy, Whipple procedure for the pancreatic head lesions and spleen-preserving distal pancreatectomy were performed and pancreatic corpus was preserved. This case showed that multiple function-preserving procedures can be safely performed with oncological principles in patients with VHL disease.

Doxycycline sclerotherapy in paediatric branchial cleft sinus

Branchial cleft anomalies are the second most common head and neck lesion in children after thyroglossal cyst. They are congenital lesions resulting from improper involution of the branchial apparatus. The most common treatment of choice is surgical excision, which gives a good outcome. Nevertheless, there has been recent literature exploring sclerosant therapy as a viable alternative to nonsurgical treatment. We present the case of a seven-year-old girl with first branchial cleft cyst who presented with recurrent serous discharge persisting for four years and was successfully treated with sclerotherapy injection with doxycycline.

Role of fine needle aspiration cytology (FNAC) in head and neck lesions in coastal population at a tertiary care hospital – A study of 500 cases

Head and neck swellings are a very common presentation encountered by clinicians and patients across all age groups. Various lesions give rise to head and neck lumps. Swellings can arise from soft tissues, lymph nodes, thyroid gland, salivary glands etc. FNAC being minimally invasive, quick and inexpensive helps in differential diagnosis of head and neck masses.A retrospective study was conducted at Karwar institute of medical sciences Karwar from January 2018 to December 2021 in coastal population, to evaluate the role of FNAC in palpable head and neck masses and also to study their distribution and To evaluate the diagnostic accuracy, sensitivity and specificity of FNAC in diagnosing Head and neck lesions and cyto-histopathological correlation (wherever possible). 500 patients with head and neck swelling underwent FNAC. FNAC diagnosis was correlated with detailed clinical history and investigations. Out of 500 fine needle aspiration procedures 35.6% (178) were of lymph node, 33.8% (169) were of thyroid, 9.6% from salivary gland (48), 17.8% (89) from skin and soft tissue swellings and 3.2% (16) inconclusive. The present study concluded that most of the swellings in head and neck region are benign and affect females more than males. Overall accuracy rate more than 90% and diagnostic accuracy in differentiating non-neoplastic lesions from neoplastic lesions is well established. Our study found that fine needle aspiration cytology to be an easy, safe, rapid, convenient, least invasive, accurate and relatively complication-free outpatient method for diagnosis of lesions of the head and neck

Enterobacteriaceae and Enterococcaceae are the dominant bacterial families translocating to femur heads in broiler chicks

ABSTRACT As a result of rapid growth of broilers, bacterial chondronecrosis with osteomyelitis has emerged in the last decade, with bacterial translocation from the gut to internal organs, including the femur head. In this study, we isolated translocated bacteria in femur heads, blood, and liver, during ageing of broilers, and identified the bacteria using 16S rDNA sequencing. We also provided histopathological descriptions of femur head lesions. Bacteria were isolated from blood, liver, and femoral head samples. In the femoral heads, an age-related presence of bacteria was observed, with high prevalence at 2 days post-hatch, and no bacteria isolated from femoral heads of broilers older than 14 days. Bacterial identification using 16S rRNA gene sequencing demonstrated that bacteria present in blood, liver, and femur belonged to different taxonomic groups. Bacteria isolated from blood and liver samples belonged predominantly to the Enterobacteriaceae, Enterococcaceae, and Staphylococcaceae, while Escherichia/Shigella and Enterococcus spp. were the most prevalent taxa in femoral head samples. No bacteria were isolated from the femoral head of any of the birds with histopathological lesions. All 19-day-old and 22-day-old birds in this study showed cartilage retention in both legs, and had signs of separation between the articular cartilage and the growth cartilage in one or both legs. This study shows that young clinically healthy broilers have a higher prevalence of bacteria in the femoral head compared to older broilers and that presence of bacteria in blood and liver is common during ageing of broilers. RESEARCH HIGHLIGHTS Large number of bacteria isolated from femoral heads of clinically healthy broilers. The prevailing taxa in femoral heads were Escherichia/Shigella and Enterococcus spp. Continuous presence of bacteria in blood and liver of clinically healthy broilers. Enterobacteriaceae, Enterococcaceae, and Staphylococcaceae prevail in blood and liver.

Ultrasound-guided wire localisation: a GPS for hidden head and neck tumours? A case series.

Ultrasound-guided wire (USGW) localisation for small non-palpable tumours before a revision head and neck surgery is an attractive pre-operative option to facilitate tumour identification and decrease potential complications. We describe five cases of pre-operative USGW localisation of non-palpable head and neck lesions to facilitate surgical localisation and resection. All patients undergoing pre-operative USGW localisation for non-palpable tumours of the head and neck region at London Health and Sciences Center, London, Ontario, Canada, were included. All the USGW localisations were performed by the same interventional radiologist, and the surgeries were performed by fellowship trained head and neck surgeons. Five patients were included. All patients were undergoing revision surgery for recurrent or persistent disease. All successfully underwent a pre-operative USGW localisation of the non-palpable lesion before revision surgery. All lesions were localised intra-operatively with no peri-operative complications. USGW localisation is a safe and effective pre-operative technique for the identification of small non-palpable head and neck tumours.

Diagnostic Accuracy of [68Ga]Ga Labeled Fibroblast-Activation Protein Inhibitors in Detecting Head and Neck Cancer Lesions Using Positron Emission Tomography: A Systematic Review and a Meta-Analysis.

Several studies have examined the use of positron emission tomography (PET) using [68Ga]Ga-radiolabeled fibroblast-activation protein inhibitors (FAPi) across multiple subtypes of head and neck cancer (HNC). The purpose of the present study was to evaluate the diagnostic accuracy of a newly developed molecular imaging approach in the context of HNC through a comprehensive review and meta-analysis. A thorough literature review was conducted to identify scholarly articles about the diagnostic effectiveness of FAP-targeted PET imaging. The present study incorporates original publications assessing the efficacy of this innovative molecular imaging test in both newly diagnosed and previously treated HNC patients. This systematic review examined eleven investigations, of which nine were deemed suitable for inclusion in the subsequent meta-analysis. The quantitative synthesis yielded a pooled detection rate of 99% for primary HNC lesions. Additionally, on a per patient-based analysis, the pooled sensitivity and specificity for regional lymph node metastases were found to be 90% and 84%, respectively. The analysis revealed a statistical heterogeneity among the studies for the detection rate of primary HNC lesions. The quantitative findings presented in this study indicate a favorable diagnostic performance of FAP-targeted PET imaging in detecting primary HNC tumors. In contrast, discordant results concerning the diagnostic accuracy of lymph node metastases were found. However, further multicentric trials are required to validate the efficacy of FAP-targeted PET in this specific group of patients.

Pancreatic pseudoaneurysm mimicking pancreatic tumor: A case report and review of literature

BACKGROUND Pancreatic pseudoaneurysm is a rare vascular complication of chronic pancreatitis (CP) or necrotizing pancreatitis with an incidence of 4% to 17%, but it is potentially life-threatening. It is well known that most pancreatic pseudoaneurysms are clinically associated with pancreatic pseudocysts and are usually in the peripancreatic body-tail. A minority of intrapancreatic pseudoaneurysms occur in the absence of pseudocyst formation. Noninvasive computed tomography (CT) and magnetic resonance imaging (MRI) are most commonly used examinations for screening pancreatic pseudoaneurysms. Notably, the rare intrapancreatic pseudoaneurysm in the pancreatic head can mimic a hypervascular solid mass and be misdiagnosed as a pancreatic tumor. CASE SUMMARY We report the case of a 67-year-old man who had been admitted to our hospital due to recurrent abdominal pain for 1 mo that was aggravated for 5 d. CT and MRI revealed a mass in the pancreatic head with significant expansion of the main pancreatic duct and mild atrophy of the pancreatic body-tail. He was admitted to the department of hepatobiliary and pancreatic surgery due to the possibility of a pancreatic tumor. The patient was then referred for endoscopic ultrasonography (EUS) with possible EUS-FNA. However, EUS showed a cystic lesion in the pancreatic head with wall thickness and enhancing nodules, which was doubtful because it was inconsistent with the imaging findings. Subsequently, color doppler flow imaging demonstrated turbulent arterial blood flow in the cystic lesion and connection with the surrounding vessel. Therefore, we highly suspected the possibility of CP complicated with intrapancreatic pseudoaneurysm, combined with the patient's long-term drinking history and the sonographic features of CP. Indeed, angiography revealed an oval area of contrast medium extravasation (size: 1.0 cm × 1.5 cm) at the far-end branch of the superior pancreaticoduodenal artery, and angiographic embolization was given immediately at the same time. CONCLUSION EUS is an important differential diagnostic tool when pancreatic pseudoaneurysm mimics the imaging appearance of a hypervascular pancreatic tumor.

A Curious Case of IgG4-Related Disease Masquerading As an Occult Abdominal Malignancy

Introduction IgG4-related disease is an autoimmune, fibroinflammatory disorder involving multiple organ systems in the body. Diagnosis is often suggested by strong IgG4-positive stain on tissue biopsy. Patients respond well to steroids; and in cases of relapse, steroid-sparing agents like rituximab, azathioprine or cyclosporine can be used. Case Presentation Here we present the case of a 77 year-old African-American female with a past medical history significant for cerebrovascular accident, chronic hepatitis C infection status post treatment with antivirals, left chronic dacryoadenitis and chronic iron-deficiency anemia. She presented to the hematology office for a follow-up visit for chronic anemia and complained of new onset right upper quadrant pain and unexplained weight loss. Subsequent abdominal and pelvic imaging showed hypoechoic lesion in pancreatic head along with multiple epigastric, omental and gastro-hepatic nodules/lymph nodes suspicious for malignancy. This was followed by esophagogastroduodenoscopy (EGD) with endoscopic ultrasound (EUS) which revealed gastric body/antral erosions along with multiple enlarged abdominal lymph nodes and heterogeneous, hypoechoic irregular mass in the pancreatic head/neck, all of which were biopsied. While awaiting biopsy results, due to high suspicion for malignancy, PET-FDG was performed which showed hypermetabolic lesions corresponding to the EUS findings and a FDG-avid right paravertebral mid thoracic soft tissue mass favored to represent a neurogenic tumor, unrelated to abdominal disease. Laboratory work-up was significant for elevated IgG levels with particularly high titres of IgG subclass 4. Biopsy results from EUS showed no evidence of malignant cells, no clonal proliferation on flow cytometry in either the lymph nodes or pancreatic tissue. Cytology of pancreatic tissue biopsy revealed lymphoid infiltration, extensive edema and fibrosis with no malignant cells. Immunohistochemistry studies revealed strong positive stain for IgG4 suggestive of IgG4-related disease. Of note, the patient had been following up with ophthalmology for a few years for chronic inflammatory dacryoadenitis of the left eye, which can likely be attributed to IgG4-related disease. After shared-decision making with the patient regarding treatment options, treatment was initiated with a plan of rituximab for 4 cycles along with corticosteroid. As of this abstract submission, the patient received one dose of rituximab, pending assessment of response to treatment. Discussion Heterogeneous pancreatic masses on abdominal imaging should be considered malignant until otherwise proven. In cases where these masses are associated with diffuse abdominal and pelvic lymphadenopathy, definitive diagnosis is made through obtaining biopsies from the easily accessible sites. A benign, auto-immune, fibroinflammatory condition which mimics this presentation is IgG4-related disease, whose treatment is far less complicated than a metastatic carcinoma. It often involves lacrimal glands. A high index of suspicion backed by the biopsy results showing strong stain affinity to IgG4 and elevated blood IgG4 levels are required. Treatment involves initiation of steroids followed by steroid-sparing agents like azathioprine, cyclosporine or rituximab in cases of relapse after steroid induction. However, as in our case, combination therapy of simultaneous use of steroids with rituximab can be used after shared decision making with patients.

Scope position is a determining factor for diagnostic performance of endoscopic ultrasound-guided fine-needle aspiration for mass lesions in the pancreatic head

Scope position is a determining factor for diagnostic performance of endoscopic ultrasound-guided fine-needle aspiration for mass lesions in the pancreatic head

Predictors for post-traumatic hip osteoarthritis in patients with transverse acetabular fractures following open reduction internal fixation: a minimum of 2 years’ follow-up multicenter study

BackgroundThe predictors of post-traumatic osteoarthritis (PTOA) in patients with transverse acetabular fractures (TAFs) following open reduction internal fixation (ORIF) remain unclear. This study aimed to investigate the risk factors for PTOA in TAFs after ORIF.MethodsData of TAF patients receiving ORIF were collected from January 2012 and February 2021. Patients suffered PTOA were classified as the osteoarthritis group (OG), while those without PTOA were classified as the non- osteoarthritis group (NG) with a minimum follow-up of 2 years. PTOA was diagnosed according to Tönnis OA classification during the period of follow-up. Univariate analysis, logistic regression analysis, and receiver operating characteristic (ROC) curve analyses were used to evaluate demographics, injury-related characteristics, perioperative and post-discharge information.ResultsThree hundred and eleven TAF patients were analyzed in this study, including 261 males and 50 females, with a mean age of 40.4 years (range 18 to 64 years). The incidence of PTOA was 29.6% (92 of 311) during the mean follow-up of 36.8 months (range 24 to 70 months). Several factors of PTOA were found using univariate analysis, including transverse fracture associated with posterior wall acetabular fracture (TPW-AF, p = 0.002), acetabular roof fracture (ARF, p = 0.001), femoral head lesion (FHL, p = 0.016), longer time from injury to surgery (TIS, p＜0.001) and physical work after surgery (PWAS, p＜0.001). Logistic regression analysis showed that TPW-AF (p = 0.007, OR = 2.610, 95%CI: 1.302–5.232), ARF (p = 0.001, OR = 2.887, 95%CI: 1.512–5.512), FHL (p = 0.005, OR = 2.302, 95%CI: 1.283–4.131), TIS (p<0.0001, OR = 1.294, 95%CI: 1.192–1.405) and PWAS (p<0.0001, 3.198, 95%CI: 1.765–5.797) were independent risk factors of PTOA. Furthermore, ROC curve analysis indicated 11.5 days as the cut-off values to predict PTOA.ConclusionsOur findings identified that TPW-AF, ARF, FHL, TIS and PWAS were independent risk factors for PTOA in patients with TAFs following ORIF. It can help orthopedic surgeons to take early individualized interventions to reduce its incidence.

SAT059 Metastatic Insulinoma Diagnosed Postpartum

Abstract Disclosure: A. Faber: None. H. Lam: None. R. Simon: None. Introduction: Insulinomas are rare neuroendocrine tumors derived from the beta cells of the pancreas. These tumors generally occur at a rate of four cases per million per year, and they are seen across all demographics. Affected patients present with symptoms of hypoglycemia, including confusion, diaphoresis, and palpitations. Insulinomas occur as single or multiple tumors, and can be benign or malignant. Insulinomas with metastases are defined as malignant. The primary treatment is surgical resection. However, in the case of metastatic insulinomas prognosis can be quite poor with limited treatment options. Case Presentation: A 24-year-old female employed as a nurse with otherwise negative medical history originally presented around 3 months postpartum with epigastric pain which was attributed to gas. Symptoms progressed to include lightheadedness, palpitations, and sweating. She checked her blood glucose during these events and noted it to be consistently in the 30s-40s. She would treat these episodes with food and had short-term improvement in symptoms. She presented to an outside hospital where imaging revealed: hepatomegaly with innumerable hypodense liver lesions, hypo-enhancing pancreatic head lesion, sclerotic focus in T4 vertebral body, as well as multiple enlarged upper abdominal lymph nodes including peripancreatic, porta hepatis, and gastrohepatic. Liver biopsy revealed well-differentiated neuroendocrine tumor, WHO grade 3 likely from a pancreatic primary and chemotherapy was initiated with carboplatin and paclitaxel with some response. However, hypoglycemia became refractory to management with 5% dextrose drip, so she was transferred to our facility for escalation of care. TPN was initiated and dextrose drip was escalated eventually to 40% dextrose. She was also given octreotide, hydrocortisone, and eventually diazoxide. Given degree of tumor burden as well as abdominal ascites and clinical condition, surgery was deemed high risk and not recommended. Tumor board meeting was held and her chemotherapy regimen was changed to Carboplatin/Etoposide/Atezolizumab. She subsequently underwent hepatic artery embolization twice with improvement of hypoglycemia. Despite decreasing dextrose drip requirements by over 50%, patient was unable to be liberated from dextrose infusion and had multiple discussions about management options and prognosis. The patient eventually elected to go home with home hospice. Discussion: Insulinoma diagnosed in pregnancy or shortly after pregnancy is extremely rare. There are only three case reports of malignant insulinoma diagnosed in or after pregnancy. Given the degree of extensive metastases at time of presentation, we expect our patient’s insulinoma was present prior to delivery. Hypoglycemia may have only manifested in the postpartum period when there was decreased levels of placenta-derived counterregulatory hormones. Presentation: Saturday, June 17, 2023

Determination of the diagnostic potential of research methods in the differentiation of pancreatic cancer and chronic pancreatitis based on evidence-based medicine

Background. Currently, the use of the principles of evidence-based medicine is an integral part of assessing the effectiveness and safety of modern technology for the diagnosis and treatment of any disease or clinical condition. Differential diagnosis of pancreatic cancer and chronic pancreatitis is one of the most controversial issues in surgical pancreatology. The reduced number of cases of resectable pancreatic cancer indicates the need to develop programs for the differentiation of these pathologies with the wide implementation of modern diagnostic methods.&#x0D; Purpose − to compare the results of diagnostic methods (which are standardly used in accordance with clinical guidelines for the diagnosis of chronic pancreatitis) based on evidence-based medicine and quantitative assessments of their specificity, sensitivity, and general accuracy in terms of the differential diagnosis of chronic pancreatitis and pancreatic cancer in order to determine the most significant results for the differentiation of these pathologies.&#x0D; Materials and methods. The results of diagnostic methods were compared in 80 patients, among them 38 (47.5%) had pancreatic cancer, and 42 (52.5%) − chronic pancreatitis with predominant lesion of the pancreatic head. The patients underwent general clinical blood and urine tests, biochemical blood tests, and the following procedures and examinations available in the clinic: ultrasound examination of the abdominal organs, spiral computed tomography, fibrogastroduodenoscopy, endoscopic retrograde cholangiopancreatography, magnetic resonance imaging, CA 19-9 tumor marker test, ultrasound-guided percutaneous puncture of the pancreas, aspiration of pancreatic juice, urgent intraoperative biopsy, and histological examination of surgically resected areas of the pancreas. Based on the received data, we performed a comparison of their quality, accuracy, and informativeness.&#x0D; Results. Ultrasound imaging is a screening method for suspected pancreatic cancer, however, the overall accuracy, sensitivity, and specificity of the method are quite low (82.5%, 76.32%, 88.10%, respectively). When analyzing the qualitative characteristics of endoscopic retrograde cholangiopancreatography, the overall accuracy, sensitivity, and specificity indicators for the differential diagnosis of pancreatic cancer were 71%, 78.6%, and 63.3%, respectively. The interval assessment of the accuracy of the method of transcutaneous biopsy of the pancreas aimed at determining chronic pancreatitis was (34.9; 96.8)%; for pancreatic cancer – (8.5; 75.5)%. The interval assessment of the accuracy of the method of endoscopic aspiration of pancreatic juice for chronic pancreatitis was (6.8; 93.2)%; for pancreatic cancer – (19.4; 99.4)%. An increase in the level of CA 19-9 was found in 40.5% of patients (CI95% from 27.0% to 55.5%), while the average level was significantly higher in pancreatic cancer. The level of the CA 19-9 tumor marker depended on the size of the tumor and the spread of the process, and during the dynamic observation in the settings of treatment, it had a tendency to decrease, which indicated chronic pancreatitis. The significance of intraoperative morphological verification of the diagnosis of pancreatic cancer in histological examination was 98%, in cytological examination – 95.3%, in 4.7% urgent intraoperative biopsy was questionable. In all examinations, the surrounding tumor tissue showed a morphological pattern of chronic pancreatitis, in 36 (88%) cases – with foci of metaplasia and intraductal neoplasia of the epithelium, which can be considered as a background for the development of intraductal adenocarcinoma. At the same time, cancerous occlusion of the ducts led to their expansion above the point of narrowing with pronounced fibrous changes and inflammatory reaction of the stroma that was accompanied by widespread atrophy of the parenchyma.&#x0D; Conclusions. On the basis of evidence-based medicine, it was established that spiral computed tomography is the most informative method for the differential diagnosis of pancreatic cancer with chronic pancreatitis, with an overall accuracy of 92.2%, sensitivity of 89.2%, and specificity of 95%. The low qualitative indicators of ultrasound diagnostics can be increased due to its complex combination with the CA 19-9 tumor marker test with an overall accuracy of 92.3%, with sensitivity and specificity of 95% and 91%, respectively, which is significantly different from such indicators when the method was used separately (82.5%, 76.3%, and 88.1%, respectively). In the cases when the complex combination of endoscopic retrograde cholangiopancreatography with the measurement of the level of the CA 19-9 tumor marker was used, the overall accuracy of the method was 95.2%, with sensitivity of 95% and specificity of 95.5%, which is significantly different from such indicators obtained when the method was used separately (71%, 78.6% and 63.3%, respectively). Advances in modern imaging methods cannot replace histological examination as the «gold standard» for the correct determination of the morphological substrate of these pancreatic lesions.