Low Recurrence Research Articles

Frontline use of rituximab may prevent ADAMTS13 inhibitor boosting during caplacizumab treatment in patients with iTTP: post hoc analysis of a phase 2/3 study in Japan

BackgroundA recent Phase 2/3 study in Japanese patients showed that caplacizumab was effective in treating immune-mediated thrombotic thrombocytopenic purpura (iTTP), with a low rate of iTTP recurrence. ADAMTS13 activity is monitored weekly during caplacizumab treatment to guide discontinuation of caplacizumab and consequently avoid exacerbations or relapse. The aim of this study was to assess changes in ADAMTS13 activity/inhibitor levels during caplacizumab treatment in this patient population.MethodsA post hoc analysis of the Phase 2/3 study in Japanese patients was conducted. Patients ≥ 18 years old with confirmed iTTP received 10 mg of caplacizumab daily in conjunction with therapeutic plasma exchange (TPE) and immunosuppression for 30 days post-TPE. Outcomes included time to recovery of ADAMTS13 activity, ADAMTS13 activity level at treatment end, incidence of ADAMTS13 inhibitor re-elevation (ie, inhibitor boosting) during treatment, time to platelet count recovery, number of days of TPE, and safety. Outcomes according to presence of inhibitor boosting were also assessed.ResultsNineteen patients had confirmed iTTP and were included in this analysis. Median (95% confidence interval) time to recovery of ADAMTS13 activity to ≥ 10%, ≥ 20%, and ≥ 60% was 14.6 (5.9–24.8), 18.5 (5.9–31.8), and 47.5 (18.5–60.9) days, respectively. Median (range) ADAMTS13 activity level at caplacizumab treatment end was 62.0% (29.0–101.0). Nine patients had ADAMTS13 inhibitor boosting. Delayed response of ADAMTS13 activity was observed in patients with inhibitor boosting. The median time to platelet count response and median number of TPE days were shorter in patients with inhibitor boosting compared with patients without inhibitor boosting. Rituximab was administered to almost all patients with inhibitor boosting (88.9%), after completion of TPE. Patients without inhibitor boosting who were treated with rituximab received it prior to completion of TPE. Only one patient experienced a recurrence, which occurred shortly after caplacizumab discontinuation due to an adverse event.ConclusionsIn patients with iTTP, caplacizumab with TPE and immunosuppression may reduce the risk of ADAMTS13 inhibitor boosting if rituximab is administered early in the iTTP treatment period. Early administration of rituximab in addition to caplacizumab may prevent iTTP recurrence with inhibitor boosting.Trial registrationNCT04074187.

Ten-year outcomes of a randomized clinical trial of endothermal ablation versus conventional surgery for great saphenous varicose veins.

Surgical ligation and stripping (surgery) and endothermal ablation are both effective treatments for varicose veins, improving quality of life (QoL) up to 5 years. Few data are available on long-term outcomes. The aim of this study was to evaluate the outcomes 10 years after interventions in an RCT. Previously this RCT demonstrated that endothermal ablation is associated with superior postprocedural QoL, more rapid recovery, and lower rates of early clinical recurrence. This analysis reports outcomes at 10 years. Patients with symptomatic varicose veins owing to unilateral great saphenous vein reflux were randomized to either surgery or endovenous laser ablation (EVLA). Outcomes at 10 years included clinical recurrence and QoL. Data were obtained for 206 of 280 patients (73.6%) at 10 years. Both groups retained significant QoL improvement compared with pretreatment levels (Aberdeen Varicose Vein Questionnaire (AVVQ), Short Form 36 (SF-36®), and EQ-5D™; P < 0.001). Clinical disease progression from baseline was observed in only 10.7% of patients. The clinical recurrence rate was lower in the EVLA group (37 versus 59%; P = 0.005). The number needed to treat with EVLA to avoid one clinical recurrence within 10 years was five. This was associated with significantly higher (better) generic QoL scores with EVLA in several SF-36® domains, including bodily pain (median 84 (i.q.r. 51-100) versus 62 (41-84); P = 0.009) and general health (77 (62-87) versus 67 (52-82); P = 0.017). AVVQ scores in the EVLA group were also lower (better) (3.1 (0-7.7) versus 6.3 (0.7-13.3); P = 0.029). Both surgery and endothermal ablation are effective treatments for varicose veins at 10 years, with durable improvement in QoL and a very low rate of disease progression. However, endothermal ablation was associated with superior clinical and QoL outcomes. Registration number: NCT00759434 (http://www.clinicaltrials.gov).

Clinical Outcomes of Elective Early Discontinuation of Immunotherapy Based on Objective Response in Microsatellite Instability-High Metastatic Colorectal Cancer

BackgroundPatients with microsatellite-high (MSI-H) metastatic colorectal cancers (CRC) may experience long-lasting benefit from immune checkpoint inhibitors (ICI) upon stopping therapy. However, optimal timing and patient selection criteria for early treatment withdrawal remain undefined. In this single-center retrospective study, we characterized the clinical response and associated survival outcomes of patients who received elective early versus late treatment discontinuation. MethodsWe retrospectively analyzed patients with MSI-H metastatic CRC treated with ICI therapy from May 2015 to April 2024. Early ICI discontinuation was defined as treatment withdrawal before 2 years, and late ICI discontinuation as after 2 years. Response was assessed using Response Evaluation Criteria in Solid Tumors. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan Meier method. Efficacy outcomes between early and late ICI discontinuation groups were compared using a log-rank test. ResultsOf 36 patients with MSI-H metastatic CRC, 12 underwent elective early ICI discontinuation and 9 experienced late ICI discontinuation. After a median follow-up of 32 months post-treatment, 91.7% (11/12) in the early discontinuation group remain off therapy without progression. PFS and OS outcomes between the early and late discontinuation groups were similarly favorable (P = .88 and P = .85, respectively), despite a 12-month difference in median duration of ICI therapy (13.3 and 25.6 months, respectively). The most common reason for elective early treatment discontinuation was clinical remission (n = 10), defined as a complete response, or a partial response with negative PET and/or ctDNA testing. ConclusionsEarly ICI discontinuation guided by response criteria resulted in low rates of recurrence. Survival outcomes between early and late ICI discontinuation groups were comparable, suggesting that treatment duration can be individualized based on clinical response without compromising favorable long-term prognosis.

Ethanol sclerotherapy of endometriomas prior to IVF/ICSI improves progressive pregnancy and live birth rate

Research QuestionWhat is the impact of ethanol sclerotherapy of endometriomas prior to IVF/ICSI on pregnancy rates? DesignWe reviewed women with endometrioma(s) larger than 25 mm having IVF/ICSI cycles. All patients with a history of ovarian cystectomy were excluded. Two groups were compared: patients who had transvaginal ethanol sclerotherapy of their endometrioma(s) before ovarian stimulation and patients whose endometrioma(s) were left in situ (untreated) at the time of IVF/ICSI (control group). Analyses were adjusted for confounding factors by inverse probability of treatment weighting. The primary endpoint was progressive pregnancy rates per IVF/ICSI cycle including fresh and frozen embryo transfers. Secondary endpoints were live birth rates, the number of mature oocytes retrieved, pregnancy loss. Endometriomas recurrence rates after sclerotherapy and procedural complications were also analyzed. ResultsA total of 96 cycles (67 patients) were included: 46 cycles (34 patients) in the ethanol sclerotherapy group and 50 cycles (33 patients) in the control group. After propensity score weighting, the pregnancy and live-birth rates were significantly higher in the ethanol sclerotherapy group compared to the control group (weighted OR, 2.9 ; 95 CI, 1.4 – 6.6 and weighted OR 2.4 ; 95 CI, 1.1 – 5.4 respectively), with a lower rate of pregnancy loss (weighted OR 0.3 ; 95 CI, 0.1 – 0.9). Ovarian response was similar in the two groups. The recurrence rate of endometrioma at 6 months after sclerotherapy was 20 %. ConclusionSclerotherapy of endometrioma before ovarian stimulation may increase pregnancy rate, with a low rate of recurrence and a minimal risk of complication.

Better performance of the APPLE score for the prediction of very early atrial fibrillation recurrence post-ablation

ObjectiveThe benefits of rhythm control in early atrial fibrillation (AF) are increasingly recognized. This study aimed to investigate whether early AF ablation contributes to long-term sinus rhythm maintenance and to identify a suitable predictive score. MethodsAccording to diagnosis-to-ablation time, this study prospectively enrolled 245 patients with very early AF, 262 with early AF, and 588 with late AF for radiofrequency ablation from June 2017 to December 2022. Clinical data, risk scores, and follow-up results were collected and analyzed. ResultsBaseline characteristics were similar among the three cohorts. During a median follow-up period of 26 months, AF recurrence was observed in 61 (24.9%), 66 (25.2%), and 216 (36.7%) patients in the very early, early, and late AF cohorts, respectively. In the multivariable-adjusted model, very early and early AF were associated with a reduced risk of AF recurrence, with hazard ratios of 0.72 (95% confidence interval [CI] 0.52–0.99) and 0.57 (95% CI 0.41–0.78), respectively. The APPLE score demonstrated the highest predictive power for very early AF, with an area under the curve (AUC) of 0.74. However, its predictive power decreased with time from diagnosis, showing low predictive power for late AF (AUC = 0.58). In addition, the time-dependent concordance index showed consistent results. For very early AF, the Akaike information criterion and decision curve analysis showed that APPLE had the highest predictive value. ConclusionVery early AF ablation was associated with a lower recurrence rate, and the APPLE score provided a higher predictive value for these patients. (URL: https://www.chictr.org.cn/; Unique identifier: ChiCTR-OIN-17013021)

Wound vacuum-assisted closure temporization after tumor resection of soft tissue sarcomas-A cost analysis in a propensity-score matched population.

Vacuum-assisted closure (VAC) temporization is a technique associated with high local control rates used in myxofibrosarcoma. We sought to compare the costs and postoperative outcomes of VAC temporization and single-stage (SS) excision/reconstruction. We conducted a retrospective analysis of patients with myxofibrosarcoma surgically treated at our institution between 2000 and 2022. Variables of interest included total, direct, and indirect costs for initial episode of care, 90 days and 1 year after initial admission, and postoperative outcomes. Costs were compared between the VAC temporization and SS groups. After matching, 13 patients in the SS group and 23 in the VAC group were analyzed. We found no difference in median and mean total inpatient costs, between the VAC temporization and SS group. While total 90-day and 1-year costs were higher in the VAC group compared to the SS group, mean costs were similar. There were no differences in postoperative complications between groups. A subanalysis of the entire cohort (n = 139) revealed lower local recurrence and overall death rates in the VAC temporization group. VAC temporization had similar inpatient costs and postoperative outcomes toSS excision/reconstruction. While median 90-day and 1-year costs were higher in the VAC group, mean costs did not differ.

Efficacy of Corticosteroids for Sore Throat Management in Adults: A Systematic Review and Meta-Analysis of Randomized Trials.

Sore throat (acute pharyngitis) is among the most common complaints among adults and is a reason for seeking healthcare globally. Antibiotics are widely used among patients with infectious sore throat. Previous research has indicated that corticosteroids could offer an alternative symptomatic treatment for sore throats.To estimate the corticosteroid efficacy as an additional therapy for sore throat adult patients, the literature search included PubMed, Medline, OVID, Cochrane CENTRAL, and Scopus for articles published until July 1st, 2024. The outcomes included the onset of pain relief (average time), complete resolution of pain (average time), absolute reduction of pain at 24 and 48 hours, requirement of antibiotics, and adverse effects related to treatment. Standardized mean difference (SMD) and risk difference were used to report numerical and dichotomous results. Five studies were included. Among the five included studies, corticosteroids showed significant effectiveness in resolving pain at 24 hours (average risk difference: 0.2200, 95% CI: 0.0500 to 0.3899, p = 0.0112) but with notable heterogeneity (I² = 82.4255%). At 48 hours, the benefit was not statistically significant (average risk difference: 0.4063, 95% CI: -0.1857 to 0.9984, p = 0.1786, I² = 98.9219%). Corticosteroids also decreased the average time to onset of pain relief (average SMD: -0.6590, 95% CI: -1.2857 to -0.0323, p = 0.0393, I² = 89.7914%), although with high heterogeneity. Other findings indicated a possible reduction in antibiotic use and fewer days missed from work. Adverse effects were minimal and occurred at similar rates in both corticosteroid and placebo arms. Corticosteroids can decrease pain intensity and duration in adults with acute sore throats. However, significant heterogeneity among studies and methodological limitations render the overall evidence inconclusive. While some studies noted reduced antibiotic use and lower symptom recurrence, high-quality RCTs are needed to address these limitations and provide more definitive guidelines for corticosteroid use in treating acute pharyngitis.

Outcomes of Low-Risk Differentiated Thyroid Cancer (DTC) without Radioactive Iodine (RAI) Ablation Therapy Post-Thyroidectomy: An Experience from a Tertiary Centre in Karachi.

To assess the outcomes of low-risk differentiated thyroid cancer (DTC) with tumour size 1 to 4 cm post-thyroidectomy in patients who never received radioactive iodine (RAI) ablation and to compare the outcomes with those who received RAI therapy. Observational study. Place and Duration of the Study: Department of Nuclear Medicine, Karachi Institute of Radiotherapy and Nuclear Medicine (KIRAN) Hospital, Karachi, Pakistan, from January 2016 to December 2020. A total of 130 consecutive patients of low-risk DTC of both genders aged between 18-75 years were identified who underwent thyroidectomy. Patients were classified as either being treated or not treated with RAI, based on RAI data post-thyroidectomy. Patients were followed up for two to five years depending on their date of diagnosis from 2016 to 2020, using thyroglobulin (Tg), anti-thyroglobulin (anti-Tg), and thyrotropin (TSH) levels and ultrasound neck. Association betweenpatients who received RAI and who did not receive RAI was determined and a p-value<0.05 was considered as statistical significance. Patients had mean age of 34.5 ± 10.4 years with majority of females (75.4%). Majority of the patients (94.6%) had total thyroidectomy with no neck dissection (83.1%). RAI therapy was conducted among 70.8% participants, of which, 56.9% participants received a dose of 100 mci. Most of the patients had positive outcomes as there was no recurrence among 96.2% participants. There was a significant difference in RAI therapy with total thyroidectomy as compared to subtotal, RAI dose, tumour stage, neck dissection, and lymph node involvement (p ≤0.001). After complete tumour resection, a highly selected group of patients with low-risk local disease have shown low rate of recurrence when managed without RAI. Interestingly, the disease recurrence was also only seen in patients who received RAI therapy in comparison to those who did not receive RAI therapy. Outcomes, Differentiated thyroid cancer, Radioactive iodine, Ablation therapy, Post-surgery.

Gender medicine in lung diseases

Gender-specific differences in the diagnostics and treatment must be considered for various lung diseases. In the case of pneumothorax, in addition to differences in etiology there are also relevant differences in treatment and recurrence rates between men and women. For example, to achieve low recurrence rates catamenial pneumothorax requires interdisciplinary collaboration with gynecology. The incidence of lung cancer has equalized in recent years and in addition, various gender-specific prognostic factors have become relevant. Several meta-analyses have identified female gender as apositive prognostic factor for lung cancer, in addition to the higher prevalence of various driver mutations in women. In current trials of multimodal treatment for lung cancer, gender differences in tolerability and patient outcome are already apparent. In subgroup analyses better event-free survival was observed in women, although immune-mediated adverse events were more common in women.

Impact of size and fragmentation of the anteroinferior glenoid rim on clinical and functional outcomes of non-operatively treated Bony Bankart lesions in middle-aged population

IntroductionThe optimal treatment approach for Bony Bankart remains a subject of considerable debate among shoulder surgeons. Existing literature highlights low recurrence rates and high patient satisfaction with nonoperative treatment, particularly in the middle-aged population. This study aimed to evaluate the recurrence rate of dislocation, as well as the clinical and functional outcomes in middle-aged individuals treated nonoperatively following an acute bony Bankart fracture. Additionally, the impact of glenoid rim size and fragmentation on the treatment outcome was investigated.Material and methodsA prospective analysis was conducted on 20 patients aged over 50 with nonoperatively treated bony Bankart fractures, ensuring a minimum follow-up of 24 months. The study population was categorized based on fragment size (small and medium) according to Kim classification and glenoid rim fragmentation (type 1b and 1c) according to Scheibel classification. Data including UCLA score, Rowe score, recurrence rate, clinical instability, and range of motion (ROM) were collected and analyzed.ResultsThe average UCLA and Rowe scores were 32.15 ± 2.85 and 93.85 ± 2.19, respectively, with no instances of dislocation recurrence. The affected shoulder exhibited no significant reductions in ROM compared to the contralateral side, except for a loss of external rotation (ER) (13.08° ± 7.51; p = 0.005). No differences were observed based on fragment size, although patients with multifragmented glenoid rims showed a greater loss of ER compared to those with a solitary fragment, albeit not reaching statistical significance.ConclusionNonoperative treatment appears to be a viable and effective option for middle-aged individuals with bony Bankart fractures, resulting in favorable functional outcomes and a low risk of recurrence. Additionally, a notable loss of external rotation was observed in fractures with glenoid rim fragmentation.Level of evidenceIV.

Impact of Poor Glycemic Control and Vascular Complications on Diabetic Foot Ulcer Recurrence

Background: Diabetes mellitus is a growing global health issue that leads to serious complications like diabetic foot ulcers (DFUs), which can worsen health and increase death rates in diabetic patients. In Sorong, Southwest Papua, Indonesia, the recurrence of DFUs is a major public health problem, affecting patients' well-being and adding significant healthcare costs. This study aimed to identify the factors that contribute to DFU recurrence in this region to help improve prevention and treatment strategies. Methods: A cross-sectional study was conducted in Sorong, Indonesia, including 53 diabetic patients with recurrent DFUs. Data were collected through structured interviews, physical examinations, and laboratory tests. Risk factors such as metabolic, vascular, behavioral, and demographic elements were analyzed. Statistical analysis, including univariate, bivariate, and multivariate techniques, was performed to identify independent predictors of DFU recurrence. Results: The study found that poor glycemic control, with a mean HbA1c of 8.3±1.4, and vascular complications, such as peripheral artery disease and neuropathy, were the most significant predictors of DFU recurrence. Behavioral factors like smoking and physical inactivity, along with longer diabetes duration and previous ulcer history, also showed a strong correlation with recurrence. Logistic regression identified HbA1c levels, peripheral artery disease, and smoking habits as independent predictors. Conclusion: This study determined the need for comprehensive care that focuses on controlling blood sugar levels, managing vascular issues, and promoting healthy behaviors to prevent diabetic foot ulcer recurrence in Sorong, Southwest Papua. Future efforts should target these risk factors to lower recurrence rates and improve patient health. More research is needed to find effective ways to prevent DFU recurrence in this population.

Mohs micrographic technique in high-risk basal cell carcinoma: a 3D prediction of safety margins.

Compared with standard excision with a two-dimensional histological examination, Mohs micrographic surgery offers a lower recurrence rate and a greater extent of healthy tissue sparing for the treatment of high-risk basal cell carcinoma (BCC). The aims of this study were to first quantify the healthy tissue spared through the micrographic technique compared to traditional surgery for high-risk tumours. Then, to speculate, through the analysis of the distal micrographic resection margin, the adequate width of safety margins for standard excision. A cohort of patients with high-risk BCC was treated with Mohs surgery. Safety margins, tumours residual final breach and hypothetical standard excision safety margins areas were recorded. A total of 96 patients were included. A reduction of 27.96% (95% Confidence Interval (CI): 17.90-38.02) of healthy skin removed was observed using a micrographic method compared to the standard approach. Standard excision with a 6mm safety margin was associated with 86.46% (95% CI: 79.62-93.30) of complete excision. Greater margins were not associated with a statistically significant improvement of complete excision. Mohs surgery should be considered the gold standard operative treatment for high-risk BCC. However, if micrographic techniques are not feasible, the standard excision with a predetermined margin of 6 mm, should be considered as the best option.

Genetic Variation of SH2B3 in Patients with Myeloid Neoplasms

To observe the genetic variation of SH2B3 in patients with myeloid neoplasms. The results of targeted DNA sequencing associated with myeloid neoplasms in the Department of Hematology, Xuanwu Hospital, Capital Medical University from November 2017 to November 2022 were retrospectively analyzed, and the patients with SH2B3 gene mutations were identified. The demographic and clinical data of these patients were collected, and characteristics of SH2B3 gene mutation, co-mutated genes and their correlations with diseases were analyzed. The sequencing results were obtained from 1 005 patients, in which 19 patients were detected with SH2B3 gene mutation, including 18 missense mutations (94.74%), 1 nonsense mutation (5.26%), and 10 patients with co-mutated genes (52.63%). Variant allele frequency (VAF) ranged from 0.03 to 0.66. The highest frequency mutation was p.Ile568Thr (5/19, 26.32%), with an average VAF of 0.49, involving 1 case of MDS/MPN-RS (with SF3B1 mutation), 1 case of MDS-U (with SF3B1 mutation), 1 case of aplastic anemia with PNH clone (with PIGA and KMT2A mutations), 2 cases of MDS-MLD (1 case with SETBP1 mutation). The other mutations included p.Ala567Thr in 2 cases (10.53%), p.Arg566Trp, p.Glu533Lys, p.Met437Arg, p.Arg425Cys, p.Glu314Lys, p.Arg308*, p.Gln294Glu, p.Arg282Gln, p.Arg175Gln, p.Gly86Cys, p.His55Asn and p.Gln54Pro in 1 case each. A wide distribution of genetic mutation sites and low recurrence of SH2B3 is observed in myeloid neoplasms, among of them, p.Ile568Thr mutation is detected with a higher incidence and often coexists with characteristic mutations of other diseases.

Evaluation of an In-House Genetic Testing Method for Confirming Prader-Willi and Angelman Syndromes in Sri Lanka.

Prader-Willi syndrome (PWS, MIM 176,270) and Angelman syndrome (AS, MIM 105,830) are caused by imprinting defects of chromosome 15q11-13, with loss of maternal gene expression causing AS and paternal gene expression causing PWS. The diagnosis, once established in most cases by using a methylation-specific PCR test, enables appropriate therapeutic interventions and avoids the need for further investigations. Genetic testing for PWS/AS is limited in Sri Lanka (and in other low- and middle-income countries), mainly because parents are unable to pay for testing as these are not funded by the health service. Ninety cases (46 female) with clinical features suggesting PWS (n = 37) and AS (n = 53), referred by a pediatric endocrinologist and a pediatric neurologist, were recruited. Clinical information and blood samples were obtained following informed consent. DNA was extracted and methylation-specific PCR (MS-PCR) was performed following bisulfite modification of DNA by using an in-house method and a kit. Results were validated using known positive controls. Parent-child trio DNA samples were used in cases with confirmed PWS and AS to determine if the disease was due to a deletion or uniparental disomy. The cost of the MS-PCR testing of the two modification methods and the microsatellite analysis was determined. Among the suspected PWS cases, 19/37 were positive, while 5/53 of the suspected AS cases were positive. The lower identification rate of AS is probably related to the overlap of clinical features of this condition with other disorders. The kit-based modification method was more reliable, less time-consuming, and cost-effective in our laboratory. The kit-based modification followed by MS-PCR described in this study enables more affordable genetic testing of suspected PWS/AS cases, and this is likely to improve patient care by targeting appropriate therapy for the affected cases. Parental genetic counselling is made possible regarding the low recurrence risk, especially where a deletion or uniparental disomy is confirmed. In MS-PCR, negative cases with a strong clinical suspicion of AS, UBE3A mutation testing is required. In addition, imprinting center mutation/deletion testing may also be needed in strongly clinically suspected, MS-PCR negative PWS and AS cases.

Optimal Management for Primary High Grade Ta Bladder Cancer: Role of re-staging TURBT and Intravesical Adjuvant Therapy.

This study aims to investigate the impact of risk group classification, restaging transurethral resection (re-TURBT), and adjuvant treatment intensity on recurrence and progression risks in high-grade Ta tumours in patients with non-muscle invasive bladder cancer (NMIBC). Data from a comprehensive bladder cancer database were utilized for this study. Patients with primary high-grade Ta tumours were included. Risk groups were classified according to AUA/SUO criteria. Tumour characteristics and patient demographics were analysed using descriptive statistics. Cox proportional hazard regression models were used to assess the effect of re-TURBT and other clinical/treatment-related predictors on recurrence- and progression-free survivals. The survivals by selected predictors were estimated using Kaplan-Meier method, and groups were compared by the log-rank test. Among 218 patients with high-grade Ta bladder cancer, those who underwent re-TURBT had significantly better 5-year recurrence-free survival (71.1% vs. 26.8%, p = 0.0009) and progression-free survival (98.6% vs. 73%, p = 0.0018) compared with those with initial TURBT alone. Full BCG treatment (induction and maintenance) showed lower recurrence risk, especially in high-risk patients. However, residual disease at re-TURBT did not significantly affect recurrence risk. This study highlights the significance of risk group classification, the role of re-TURBT, and the intensity of adjuvant treatment in the management of high-grade Ta tumours. A risk-adapted model is crucial to reduce the burden of unnecessary intravesical treatment and endoscopic procedures.

A Decade of Single-Center Experience in Children With Congenital Pyriform Sinus Fistula (CPSF).

To investigate the efficacy and safety of carbon dioxide (CO2) laser cauterization in the treatment of pediatric congenital pyriform sinus fistula (CPSF), and to track and follow up the long-term outcome of the postoperative patients. This retrospective study was conducted at a single center, where clinical data and follow-up information of children with CPSF who underwent CO2 laser cauterization with the assistance of a suspension laryngoscope and microscope were collected and analyzed their clinical characteristics and prognosis. Subsequently, multiple logistic regression analysis was performed to identify potential predictors of the number of laser cauterization procedures. A total of 238 children diagnosed with CPSF were recruited for this study, with 235 patients successfully achieving closure of the internal fistula through one or more CO2 laser cauterization procedures without recurrence. The median duration of follow-up was 6.46 (5.20, 7.64) years. Merely three patients (1.3%) developed recurrent cervical infection and eventually underwent open neck surgery. There were no instances of permanent perioperative complications throughout the follow-up. Additionally, our analysis revealed that the age at the first operation of CO2 laser cauterization was an independent risk factor associated with the number of operations. The CO2 laser cauterization for children with CPSF is an effective and safe treatment with a low recurrence rate and minimal complications during the follow-up period. Consequently, it is advisable to consider CO2 laser cauterization as a viable therapeutic option for managing pediatric CPSF. 4 Laryngoscope, 2024.

Retrospective analysis of transabdominal preperitoneal hernia repair in emergency cases: A cohort study.

This study aimed to evaluate the feasibility, safety, and efficacy of laparoscopic transabdominal preperitoneal hernia repair (TAPP) for inguinal hernias in emergency settings, providing insights from a long-term follow-up. We retrospectively analyzed all patients who underwent emergency TAPP repair in ASST Nord Milano from January 2005 to December 2023. A prospectively collected database of 54 consecutive TAPP hernia repairs was reviewed. The study evaluated the feasibility and safety of TAPP through operative time and the conversion rate. Effectiveness was gauged by recurrence and complication rates as well as acute and chronic pain using the Visual Analog Scale (VAS). Long-term follow-up included assessing recovery to normal activity. Overall, data from 54 consecutive patients were analyzed. Median age was 72 (IQR=11), with 21 men and 33 women (38.8% vs. 61.2%). The primary diagnosis was a primary hernia (61.1%), while a recurrent type was identified in 21 patients (38.9%). Femoral hernia was identified in 36 cases (48%). The median operative time was 100min (IQR=53min) with 6 cases of conversion (11.1%). One recurrence (1.85%) was noted and the complication rate was 5.55 %. At a median follow-up of 38months, there was a low grade of chronic pain (VAS 3) in a patient (1.85%) and one recurrence (1.85%). TAPP is a safe, feasible, and effective option for emergency inguinal hernia repair, exhibiting low complication and recurrence rates on long-term follow-up when performed by surgeons with minimally invasive surgery experience and in selected patients.

Superior vena cava syndrome: presentation of 7 cases and literature review

Superior vena cava syndrome (SVCS) is the result of obstruction of venous flow through the SVC. Mortality due to SVCS is rare (0.3%); however, the median survival in patients with SVCS secondary to malignancy is 6 months. Extrinsic occlusion due to malignancy is the most common cause; however, intraluminal thrombosis secondary to central venous catheters and pacemaker wires represents 30% of cases. The SVC is the main drainage pathway for the head, neck, and upper torso region, so SVCS is characterized by facial and neck edema, dyspnea, and distension of the neck and chest veins. Symptoms vary depending on the severity, location, and speed of onset of the obstruction and the establishment of collateral veins. Diagnosis is based on clinical presentation and imaging studies such as chest angiotomography and digital subtraction venography (gold standard). Regarding treatment, radiation therapy and chemotherapy were considered first-line; however, nowadays endovascular therapy (ET) (angioplasty, stent placement, and catheter-directed thrombus extraction) has demonstrated higher success rates and lower recurrence rates. Surgical diversion is reserved for cases of extensive venous thrombosis or occlusion not amenable to ET. We conducted a literature review and described 7 cases of SVCS treated with successful ET and their main complications at the national cancer institute of Mexico. SVCS is a condition with a diagnostic challenge. Currently, the use of endovascular treatment through angioplasty and stent placement leads to immediate improvement in patients, thus establishing it as first-line treatment.

Propensity score matched comparison of transperitoneal laparoscopic ureterolithotomy and percutaneous nephrolithotomy for management of large impacted proximal ureteral stones with long-term follow-up.

Impacted proximal ureteral stones (IPUS) present challenging clinical scenarios due to their persistent nature and associated complications. While ureterorenoscopy (URS) lithotripsy is recommended as the primary treatment, controversies exist regarding the optimal management of such stones. In this retrospective analysis, we compared the operative outcomes and long-term results of transperitoneal laparoscopic ureterolithotomy (LU) and percutaneous nephrolithotomy (PCNL) for IPUS larger than 15mm. Propensity score matching (PSM) was employed to mitigate potential selection biases. Following PSM, 83 patients in each cohort exhibited comparable baseline characteristics. LU demonstrated a superior surgical success rate (100% vs. 96.4%, p = 0.244) and significantly lower perioperative hemoglobin decline (0.6 ± 0.4g/dL vs. 1.5 ± 0.7g/dL, p = 0.036) compared to PCNL. Additionally, LU exhibited a higher stone-free rate after 2 months (100% vs. 91.6%, p = 0.043), but a longer duration of catheterization (7.4 ± 1.2 days vs. 3.5 ± 2.2 days vs., p = 0.011). Conversely, PCNL was associated with a higher incidence of total complications (21.7% vs. 9.6%, p = 0.033) and stone recurrence during a mean period of 40-month follow-up (20.5% vs. 8.4%, p = 0.027). Transperitoneal LU and PCNL represent effective interventions for managing IPUS exceeding 15mm. Notably, LU emerges as a preferable option over PCNL, offering superior stone clearance rates, reduced perioperative complications, and lower recurrence rates.

Symmetric versus asymmetric surgery for the treatment of intermittent exotropia with equal dominance.

Long-term surgical outcomes were compared between bilateral lateral rectus recession (BLR) and unilateral lateral rectus recession combined with medial rectus resection in the same eye (R&R) for therapy of basic type intermittent exotropia (IXT) with equal dominance. Two hundred and sixty-eight subjects (3-11 years old) with basic IXT with equal dominance who underwent BLR or R&R surgery were enrolled to this study, and with a minimum follow-up period of 18 months. One hundred and fourteen patients underwent BLR surgery and 144 underwent R&R surgery at a single centre. Surgical outcomes between groups were compared. Surgery results were divided into 3 categories: undercorrection/recurrence (exotropia/phoriaå 10PD), success(esotropia/phoria ≤5PD to exotropia/phoria≤10PD), and overcorrection (esotropia/phoriaå 5 PD) according to postoperative deviation angle. No statistical difference was detected between BLR group and R&R group at all intervals with the exception of the last examination, demonstrating a higher success rate and a lower recurrence rate in the BLR group than R&R group at last visit (P = 0.04). Additionally, the BLR group demonstrated a smaller exodrift than the R&R group at distance and near fixation (P = 0.01; P = 0.03). Stereoacuity and exotropia control showed overall improvement following both surgeries, and this improvement had no statistical difference between groups(P > 0.05). BLR showed better long-term results than R&R in the treatment of basic type intermittent exotropia with equal dominance given its low recurrence rate. Both BLR and R&R surgeries could improve stereoacuity function and exotropia control, and to same extents.