Median Visual Analog Scale Research Articles

Effect of Immediate Postpartum Skin-to-Skin Contact Between Mothers and Newborns on Episiotomy Pain: A Randomized Controlled Trial

Objective: To determine the effect of immediate skin-to-skin contact (SSC) between mothers and their newborns on episiotomy pain.Material and Methods: This randomized controlled trial enrolled 60 participants who underwent vaginal delivery. The participants were divided into two groups: an immediate SSC group and a no SSC group (n=30 for each group). SSC was initiated within 10 minutes after birth with a contact duration of at least 30 minutes. Episiotomy pain severity was evaluated using a visual analog scale (VAS) at one hour after birth in both groups. The pain scores were analyzed using the Mann-Whitney U test and the optimum contact time for reducing episiotomy wound pain was evaluated by a receiver operating characteristic (ROC) curve.Results: The median VAS of episiotomy pain at one hour after delivery in the SSC group was statistically significantly lower than the no SSC group (1.9 (0.8-3.1) vs. 3.4 (2-5.2) cm, p-value<0.001). The contact time for optimal pain reduction was at least 30 minutes of SSC.Conclusion: Immediate SSC contact between a mother and her neonate after delivery can effectively reduce episiotomy pain.

Risk factors for recurrent endometriosis after conservative surgery in a quaternary care center in southern Thailand.

To determine the 2-year recurrence rate of endometriosis after conservative surgery and the risk factors for recurrence. This study retrospectively analyzed women with endometriosis who underwent conservative surgery and had at least a 2-year follow-up at a quaternary care hospital in southern Thailand from January 2000 to December 2019. Recurrent endometriosis was defined as either presence of endometrioma with a diameter ≥ 2 cm for more than three consecutive menstrual cycles or relapse of pelvic pain with the same or higher visual analog scale (VAS) score as before surgery. Multivariate logistic regression analysis was used to identify the risk factors for recurrence. The median (interquartile range [IQR]) age was 34 (29, 38) years in 362 cases and nearly three-quarters (74.2%) were nulliparous. Cyclic pain was the most common clinical presentation (48.9%) and the median (IQR) VAS score of pelvic pain was 6 (5, 9). Ovarian cystectomy was the most common procedure (68.1%). The 2-year recurrent endometriosis rate after conservative surgery was 23.2%, and the overall recurrence rate was 56.4%. The risk factors of recurrence were preoperative moderate to severe pelvic pain (adjusted odds ratio [aOR] 1.93; 95% confidence interval [CI], 1.12-3.34; p = 0.017), adhesiolysis/ablation/ovarian cystectomy without unilateral oophorectomy (aOR 2.71; 95% CI, 1.40-5.23; p = 0.002), and duration of postoperative hormonal treatment < 24 months (aOR 10.58; 95% CI, 5.47-20.47; p < 0.001). The 2-year recurrence rate after conservative surgery for endometriosis was 23.2%. Preoperative moderate to severe pelvic pain, procedures except unilateral oophorectomy, and postoperative hormonal treatment < 24 months were risk factors for recurrence.

Risk Factors for Neurologic Deficits in Patients With Spinal Epidural Abscess: An Analysis of One-Hundred-Forty Cases.

retrospective study. In addition to surgical treatment of spinal epidural abscesses (SEA), a conservative, medical treatment for patients without acute neurologic deficits has been proposed. However, the risk factors for neurologic deficits are unclear. This study aims to identify factors predisposing patients with SEA to neurological impairment. All patients treated for SEA between 2008 and 2021 were identified from a prospective vertebral-osteomyelitis registry of a tertiary referral centre. Patient demographics, comorbidities, pathogens, degree of osseous destruction, location of SEA and preoperative neurologic status were retrospectively collected. Differences between patients with (Group 1) and without (Group 2) pretreatment neurologic deficits were assessed by univariate and logistic regression analysis. A total of 140 patients with SEA were included. Forty-three patients (31%) had a neurologic deficit and 97 patients (69%) had no neurologic deficit prior to therapy. The prevalence of diabetes mellitus (35% vs 19%, P = .03), median visual analogue scale leg pain (8 vs 5, P = .01), median American Society of Anesthesiologists (ASA) Score (3 vs 2.6, P = .003) and mean Body-Mass-Index (29 vs 26, P = .02) differed between Group 1 and 2 in univariate analysis. In multivariable analysis, diabetes mellitus (odds ratio = 2.7), female sex (odds ratio = 2.5) and ASA-Score (odds ratio = 2.4) were significant contributors for neurologic deficits. In patients with a SEA without neurologic deficits, the ASA score and diabetes mellitus should be considered, especially in female patients. These patients may be at a higher risk for developing a neurologic deficit and may benefit from an early surgical treatment.

3D-Printed Modular Endoprosthesis Reconstruction Following Total Calcanectomy in Calcaneal Malignancy.

The use of 3D-printed endoprosthesis has been proposed as a viable limb-salvage procedure following total calcanectomy in patients with calcaneal malignancy. However, certain drawbacks persist concerning the prosthetic design. In this case series, we designed a modular endoprosthesis incorporating a novel drainage system, aiming to improve the functional outcomes and to promote wound healing. We retrospectively analyzed patients with calcaneal malignancy who underwent 3D-printed modular endoprosthesis reconstruction. Clinically, we evaluated functional outcomes using the 10-cm visual analog scale (VAS) score, the 1993 version of the Musculoskeletal Tumor Society (MSTS-93) score, and the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Complications were also recorded. Five male patients met the final inclusion criteria. The median age was 20 years (range 13-47 years). The median follow-up time was 28 months (range, 13-65 months). Median postoperative functional MSTS-93, VAS, and AOFAS scores were 27 points (range, 25-29), 0 points (range, 0-1), and 86 points (range, 83-93), respectively. Wound healing was observed in all patients, and there were no complications related to the endoprosthesis at the last follow-up. The use of 3D-printed modular endoprosthesis was associated with satisfactory short-term outcomes in patients undergoing calcaneal reconstruction. The incorporation of a novel design featuring an integrated draining system has the potential to enhance wound healing and expedite functional recovery. Level IV, case series.

Efficacy of polymethylmethacrylate membrane hemodiafilter Filtryzer® PMF™-21A in improving pruritus in hemodialysis patients: a prospective interventional study

BackgroundHemodialysis-associated pruritus (HAP) occurs in 60–80% of hemodialysis patients. This significant complication not only decreases quality of life through sleep disturbance and depression, but also leads to poor survival outcomes. The polymethylmethacrylate (PMMA) membrane was the first synthetic polymer membrane for the hollow-fiber artificial kidney created in 1977. PMMA membrane dialyzers have been reported to be effective for improving various complaints, including pruritus, and nutritional status. In Japan, a PMMA membrane hemodiafilter Filtryzer® PMF™-A (PMF-A) was launched in November 2021 and subsequently became available for online hemodiafiltration (OHDF). This study aimed to determine whether PMF-A effectively improves pruritus in hemodialysis patients.MethodsParticipants were 20 patients (median age 74.5 years) on predilution OHDF (pre-OHDF) or postdilution OHDF (post-OHDF) using an Asymmetric Triacetate Membrane® hemodiafilter (FIX-210E eco or FIX-210S eco), who were experiencing pruritus of “very mild” or higher severity based on the Shiratori severity score either during the daytime or nighttime. After switching to post-OHDF with PMF-21A (substitution flow rate: 10 L/session), the substitution flow rate was gradually increased according to results of pruritus evaluation every 2 weeks over 3 months. The primary endpoint was the severity of pruritus evaluated using visual analogue scale (VAS) and the Shiratori severity score. Secondary endpoints included white blood cell count (WBC), hemoglobin level (Hb), platelet count (Plt), serum albumin level (Alb), high-sensitivity C-reactive protein (hsCRP), IL-6, dry weight (DW), and solute removal performance.ResultsThe median VAS score was significantly decreased 2 weeks after switching compared with baseline (44 mm) and remained significantly decreased at Week 12 (22 mm; p < 0.01). From baseline to Week 12, 16 patients (80%) showed improvement in VAS score. The percentage of patients with mild to moderate daytime pruritus according to the Shiratori severity score decreased significantly from 80.0% to 45.0% (p < 0.05), whereas no significant change was observed for nighttime pruritus (p = 0.267). Pre-dialysis serum β2-MG levels were significantly higher at Week 12 compared with baseline. No significant changes were observed in WBC, Hb, Plt, serum Alb, hsCRP, IL-6, or DW.ConclusionsOHDF with PMF-21A may be more effective in improving HAP.

Yoke procedure as a salvage treatment option for failed reverse total shoulder arthroplasty with irreconstructible glenoid

Glenoid bone loss is a known challenge in primary and revision reverse total shoulder arthroplasty. In severe deficiency, even placing the baseplate in alternative centerline or using an augmented baseplate may be insufficient. This study reports on the use of a soft tissue resurfacing technique using Achilles tendon allograft, coined Yoke procedure, for salvage treatment of glenoid deficient shoulder requiring reconstruction. All patients who underwent the Yoke procedure between 2014 and 2020 by a single surgeon at a single academic center were identified and had their charts retrospectively reviewed. Demographics and surgical information were recorded. Preoperative X-rays and 3D-CT scans were reviewed to classify patient glenoid types, evaluate glenoid medialization, and measure shoulder angles. Preoperative and postoperative range of motion (ROM) and patient-reported outcome scores were evaluated, including anterior elevation (AE), external rotation (ER), internal rotation (IR), Visual Analog Scale (VAS), Subjective Shoulder Score (SSV), Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons (ASES) scores. Postoperative radiographs and follow-up notes were reviewed to evaluate postoperative complication profiles at 1 year. Seven patients with median age of 69 years (range 54-77) underwent Yoke procedure and had median 12-month follow-up (range 9 - 56). All patients were female and had median of 2 prior shoulder surgeries (range 0-13). Of all the patients, the most common comorbidity was osteoporosis (6) followed by rheumatoid arthritis (3). Of the 5 patients who had previous arthroplasty, the most common indications were baseplate failure (4), followed by instability (3) and infection (3). Median VAS score improved from 8 (range 3-9) to 2 (range 1-4). Median SST improved from 8% (range 0-42%) to 33% (range 17-83%). Median ASES score improved from 15 (range 5-38) to 52 (range 40-78). Median AE and ER improved from 20° (range 0°- 75°) to 100° (range 40°- 145°) and 10° (range 0°- 20°) to 20° (range 0°- 55°), respectively. There was no change in median IR. As of last follow-up, one patient reported postoperative complications of anterior superior implant escape, heterotopic ossification, and scapular notching. The Yoke procedure is a promising salvage treatment that can offer patients consistent pain reduction and moderate functional improvements at short-term follow-up. In the setting of poor bone quality and severe glenoid deficiency, glenoid baseplate implantation may not be absolutely necessary for a pain-relieving, functionally acceptable outcome.

Ultrasound-Guided Popliteal Sciatic Nerve Block: A Minimally Invasive Method for Pain Control During Endovascular Treatment of Critical Limb Ischemia

PurposeTo evaluate the safety and effectiveness of ultrasound-guided popliteal sciatic nerve block (PSNB) for pain control in endovascular treatment of critical limb ischemia (CLI). Materials and MethodsThis retrospective study included 252 patients who underwent endovascular treatment for CLI between January 2020 and August 2022. Of these, 69 patients underwent PSNB, whereas moderate procedural sedation and analgesia was delivered in 183 patients. Pain scores were assessed using the visual analog scale (VAS) before and during the intervention. Technical and clinical success of PSNB, duration of the procedure, time to onset of nerve block, time for block resolution, and adverse events were recorded. Patient and operator satisfaction were assessed using the Likert scale. ResultsAll PSNB procedures were technically and clinically successful, and the mean procedural duration of PSNB was 5.0 minutes ± 0.8 (range, 4–7 minutes). Prolonged effect of PSNB was observed in 3 patients, which resolved within 24 hours. No adverse events were encountered. Median VAS score was significantly lower in the PSNB group than in the moderate procedural sedation and analgesia group during endovascular treatment (0 [range, 0–2] vs 3 [range, 0–7]; P < .001). Patient satisfaction was comparable (“very satisfied” in 66 [95.7%] vs 161 [88.0%]; P = .069). However, operator satisfaction was significantly higher in the PSNB group (“very satisfied” in 69 [100%] vs 161 [88.0%]; P = .003). ConclusionsPSNB is safe and effective for pain control during endovascular treatment of CLI. Low adverse event rates with high patient and operator satisfaction make PSNB a reasonable alternative for high-risk patients.

Previous Lumbar Spine Surgery Decreases the Therapeutic Efficacy of Dorsal Root Ganglion Pulsed Radiofrequency in Patients with Chronic Lumbosacral Radicular Pain.

Chronic lumbosacral radicular pain (CLRP) as a possible adverse consequence of lumbar spine surgery represents a serious medical challenge. Pulsed radiofrequency of dorsal root ganglion (PRF-DRG) treatment is known to be effective in alleviating CLRP. This retrospective study compares the efficacy of a single CT-guided PRF-DRG procedure in the treatment of unilateral CLRP between patients without (non-PSS) and with (PSS) previous lumbar spine surgery. Non-PSS and PSS groups included 30 and 20 patients, respectively. Outcomes (pain intensity and disability) were evaluated by means of the visual analog scale (VAS) and Oswestry disability index (ODI) immediately after the procedure (VAS), as well as three and six months after the procedure, respectively. Non-PSS group showed a significant (p ˂ 0.001) decrease of VAS (median) at all follow-up intervals (from 6 to 4; 4; 4.5 points, respectively). The PSS group showed a significant yet transient VAS (median) decrease (from 6 to 5 points) immediately after the procedure only (p < 0.001). The decrease of VAS was more pronounced in the non-PSS group after three and six months (p = 0.0054 and 0.011, respectively) in intergroup comparison. A relative decrease of VAS ≥ 50% during follow-up was achieved in 40%; 43.3%; 26.7% (non-PSS), and 25%; 5%; 0% (PSS) of patients. ODI (median) significantly decreased in the non-PSS group (from 21.5 to 18 points) at three and six months (p = 0.014 and 0.021, respectively). In conclusion, previous lumbar spine surgery decreases the therapeutic efficacy of PRF-DRG procedure in CLRP patients.

Percutaneous Vertebral Reconstruction (PVR) Technique of Pathological Compression Fractures: An Innovative Combined Treatment of Microwave Ablation, Bilateral Expandable Titanium SpineJack Implants Followed by Vertebroplasty.

(1) Background: to retrospectively evaluate safety and efficacy of combined microwave ablation (MWA) and bilateral expandable titanium SpineJack (SJ) implants followed by vertebroplasty (VP) for the treatment of painful thoracolumbar pathological vertebral compression fracture. (2) Methods: from July 2017 to October 2022, twenty-eight patients (13 women and 15 men; mean age 68 ± 11 years) with a history of primary neoplasm and thirty-six painful vertebral metastases with vertebral compression fracture underwent combined MWA and bilateral expandable titanium SpineJack implants with vertebroplasty. We analyzed safety through complications rate, and efficacy through vertebral height restoration and pain decrease, evaluated using a visual analogue scale (VAS), and Functional Mobility Scale (FMS), and local tumor control. Contrast-enhanced CT scans were performed at 1, 3, and 6 months and a contrast-enhanced spine MRI at 6 months after the procedure. (3) Results: Technical success rate was 100%. No procedure-related major complications or death occurred. Vertebral height restoration was observed in 22 levels (58%), with a mean anterior height restoration of 2.6 mm ± 0.6 and a mean middle height restoration of 4.4 mm ± 0.6 (p < 0.001). Mean VAS score of pain evaluation on the day before treatment was 6.3 ± 1.5 (range 4-9). At the 6-month evaluation, the median VAS score for pain was 0.4 ± 0.6 (range 0-2) with a mean reduction of 93.65% (6.8 ± 0.7 vs. 0.4 ± 0.6; p < 0.000) compared with baseline evaluation. Contrast-enhanced CT scans were performed at 1, 3, and 6 months and a contrast-enhanced spine MRI was performed at 6 months after the procedure, showing no local recurrence, implant displacement, or new fractures in the treated site. (4) Conclusions: combined microwave ablation and bilateral expandable titanium SpineJack implants with vertebroplasty is a safe and effective procedure for the treatment of pathological compressive vertebral fractures. The vertebral stabilization achieved early and persistent pain relief, increasing patient mobility, improving recovery of walking capacity, and providing local tumor control.

Effectiveness of Benzydamine Hydrochloride + Cetylpyridinium Chloride (Difflam®) Lozenges in Alleviating Sore Throat among COVID-19 Patients: A Real-World Evidence Study in the Clinical Practice

Objective: Since the start of the pandemic, the SARS-CoV-2 which causes COVID-19 infection, has aggressively taken a toll on millions of lives worldwide. Recent studies have shown that newer variants consistently present with a greater frequency of sore throat. This study explored the real-world effectiveness of benzydamine hydrochloride + cetylpyridinium chloride (Difflam®) lozenge in alleviating sore throat of Filipino patients, under condition of routine medical practice. Study Design: Observational, uncontrolled study design Setting: Ambulatory / out-patient health facilities Method: This study included patients with mild to moderate COVID-19 infection in a real-world setting confirmed either with rapid antigen test (RAT) or positive real-time polymerase chain reaction (RT-PCR), who manifested with symptoms and signs of dysphagia / odynophagia. They were prescribed with Difflam® lozenge as an adjunct to standard care, in accordance with the respective local prescribing information and routine clinical practice. Results: A decreasing trend was observed in the median visual analogue scale (VAS) pain scores from baseline up to the seventh day. The difference from the baseline VAS score was significant in all observation period from day 1 to day 7 (p&lt;0.001). The greatest difference was seen on day 4 and 5 (median VAS scores of 1 and 0, respectively). The mean duration of symptoms before total resolution of sore throat (VAS score = 0) was 4.4 SD ± 1.9 days with majority of participants (87 %) reporting resolution at the end of seven days observation. The mean length of time before negativity of COVID-19 RAT was 3.9 SD ± 1.6 days. Majority did not experience adverse events, and if so, were generally mild. Conclusion: The benzydamine hydrochloride + cetylpyridinium chloride (Difflam®) lozenge reduced the duration of COVID-19 (RAT negative) and completely alleviated symptoms of dysphagia and odynophagia among patients with mild to moderate COVID-19 infection within four to five days of initiation of therapy

Surgical treatment ofsnapping proximal hamstring tendon syndrome: the resolution ofsnapping andexcellent patient satisfaction.

Snapping proximal hamstring is an uncommon phenomenon, with few case reports documenting surgical treatment. The purpose of this study is to report snapping resolution, minimum 2-year post-operative patient-reported outcome (PRO), satisfaction scores and complications from patients who underwent surgical release of the conjoint tendon from the sacrotuberous ligament with reattachment to the ischial tuberosity. Prospectively collected data from two institutional databases were retrospectively reviewed for patients who underwent hamstring repair for partial- or full-thickness tears. Patients were included if they demonstrated 'snapping proximal hamstrings' on preoperative physical examination, including ultrasound confirmation, and repair subsequently performed. Patients were excluded if they had reconstruction of the proximal hamstring tendon or claimed worker's compensation. With a total of 20 patients (15 females and 5 males), successful resolution of snapping was reported in 100% of the cohort. For patients with pre- and post-surgical lower-extremity functional scores (LEFS), post-surgical LEFS were significantly higher than pre-surgical LEFS (pre-surgical: 17.0 ± 4.0, post-surgical: 73.6 ± 3.3, P < 0.001). Average post-operative PROs were as follows: International Hip Outcome Tool-12, 92.3 ± 8.3; modified Harris Hip Score, 93.2 ± 7.8; Non-arthritic Hip Score, 92.5 ± 6.8; Hip Outcome Score-Sports Specific Subscale, 94.4 ± 6.7; LEFS, 73.9 ± 3.4; and median visual analog scale of 0 with an interquartile range of 0-1. Patient satisfaction was 'very satisfied' in 19 (95%) patients and 'satisfied' in 1 (5%) patient. At a minimum 2-year follow-up, patients who underwent surgical treatment for chronic snapping of the proximal hamstrings demonstrated complete resolution of painful posterior snapping, reported high PROs and satisfaction, and had no reported post-operative complications.

EPH66 Epidemiological Population Study of Sars-Cov-2 in Lake County, Illinois: Contact: Health-Related Quality of Life Assessment

The prospective, longitudinal, community-based CONTACT study aimed to improve our understanding of COVID-19 immunity, and other characteristics related to SARS-CoV-2 long-term, including the assessment of health-related quality of life (HRQoL) at baseline and over time by infection status. Participants living or working in Lake County, IL were recruited between November 2020 and January 2021. At baseline and follow up visits (3-, 6-, and 9-Months-M-), participants self-reported their occupational exposure, COVID-19 vaccination status and provided nasal and blood serum specimens for molecular (RT-PCR) and serologic (IgG) testing to detect current or previous SARS-CoV-2 infection. HRQoL questionnaires EQ-5D-5L were completed online approximately within two weeks post-testing (at 0.5, 3.5, 6.5, and 9.5 months) after results were communicated. EQ-5D-5L information was described and stratified by COVID-19 status at baseline, 3M, 6M and 9M – software: SAS®-v9.4. Data from 1008 participants were analyzed. Participants testing positive to COVID-19 were 56/952, 48/751, 40/693, and 19/654, respectively, at baseline, 3M, 6M, and 9M. Of the five domains of EQ-5D-5L, a higher percentage of participants who tested positive for COVID-19 reported having no anxiety or depression versus those who tested negative: at baseline (55.4% [31/56] vs 50.5% [481/952]); 3M (68.8% [33/48] vs. 56.3% [423/751]); 6M (67.5% [27/40] vs. 56.3% [390/693]); and 9M (73.7% [14/19] vs. 60.4% [395/654]). Median Visual Analogue Scale (VAS) score was at least 2 points higher at all time- points for participants who tested positive except at last visit (baseline: 89.0 vs. 87.0; 3M: 88.0 vs. 86.0; 6M: 87.5 vs. 85.0; 9M: 85.0 vs. 87.0) This analysis provides insight into participant HRQoL burden at enrollment and over time when a positive test to COVID-19 was communicated. At all time-points, anxiety or depression was experienced by more participants who tested negative versus those who didn´t.

Clinical Outcomes After Arthroscopic Microfracture Treatment of Coexisting Talar and Tibial Osteochondral Lesions.

Despite increased recognition of coexisting tibial and talar osteochondral lesions (OCLs), the risk factors influencing clinical outcomes remain unclear. To report clinical follow-up results after arthroscopic microfracture surgery in patients with OCLs of the distal tibial plafond and talus and assess possible factors affecting these clinical outcomes. Case series; Level of evidence, 4. A total of 40 patients with coexisting talar and tibial OCLs who underwent arthroscopic microfracture surgery were included. For analysis, the study used the American Orthopaedic Foot & Ankle Society (AOFAS) scale, Karlsson-Peterson scale, and visual analog scale (VAS) for pain for clinical evaluations on the day before surgery, 12 months after surgery, and at the last follow-up. A stepwise regression model and Spearman rank correlation were used to assess possible factors affecting these clinical outcomes. The median follow-up time was 34.5 months (interquartile range [IQR], 26.5-54 months). At the final follow-up, the cohort included 40 patients (26 men and 14 women) with a mean age of 38.8 years (range, 19-60 years). The median AOFAS score increased from 57.5 (IQR, 47-65) before surgery to 88 (IQR, 83-92.5) at the final follow-up, the median Karlsson-Peterson score increased from 48 (IQR, 38.5-67) to 82 (IQR, 76-92), and the median VAS score improved from 5 (IQR, 4-6) to 1 (IQR, 0-2). All scale scores showed significant differences between the preoperative and final follow-up evaluations (P < .001). In the stepwise regression model and Spearman rank correlation analysis, the grade of tibial OCL had a significant independent effect on the final postoperative AOFAS scores of the patients (β = -0.502, P = .001; r = -0.456, P = .003). The size of the tibial lesion also had a significant independent effect on the final postoperative Karlsson-Peterson scores of the patients (β = -0.444, P = .004; r = -0.357, P = .024). Arthroscopic microfracture treatment for coexisting talar and tibial OCLs can achieve good short- to midterm clinical outcomes. The grade and size of tibial OCLs are the main risk factors affecting the prognostic functional scores of such patients.

17th International Conference on Malignant Lymphoma, Palazzo dei Congressi, Lugano, Switzerland, 13 - 17 June, 2023.

Introduction: The optimal treatment for very elderly patients (pts) with newly diagnosed Diffuse Large B Cell Lymphoma (DLBCL) remains controversial. R-mini-CHOP is an established standard of care in elderly patients with DLBCL, with a 2 yr OS of 59% and PFS of 47% (Peyrade et al., Lancet Oncol 2011). We present our final data from this prospective Phase II study of ibrutinib, rituximab and mini-CHOP in pts ≥75 yrs with newly diagnosed DLBCL. Methods: Pts received six 21-day cycles of ibrutinib 560 mg daily and R-mini-CHOP (Rituximab 375 mg/m2, cyclophosphamide 400 mg/m2, doxorubicin 25 mg/m2, vincristine 1 mg on day 1 & prednisone 40 mg/m2 or 100 mg/d × 5) followed by an additional two 21 day cycles of rituximab + ibrutinib (or high dose methotrexate for CNS prophylaxis). Primary endpoints were deliverability and 2 year overall survival (OS). Sample size calculations were made using a one-sample two-sided approach to detect a 15% improvement on the fixed Peyrade reference OS (59%) and PFS (47%) rates. Results: Eighty pts were recruited from Nov 2015 to Nov 2018. One died prior to receiving treatment and is not included in the analysis. Median age was 82 yrs (75–95); 81% stage III/IV; 54% age adjusted IPI 2–3. With a median follow-up of 35.5 months (m) (0.2, 71.7) (data cut 6 September 2022), there was a non-significant trend towards improvement in 2-year OS of 68% (55.6%, 77.4%) compared to the reference Peyrade cohort of 59% (p = 0.11). Median OS was 72 m (95% CI 35 m to not reached (NR)). Median 2-year PFS of 60.0% (47.7%, 70.3%) was significantly improved compared to the reference cohort of 47% (p = 0.03), with a median PFS of 40 m (95% CI 20.41, NR). Overall response assessment assessed by investigators at the end of treatment was 76% (61/80 pts), with a complete response rate of 70% (56/80 pts). All 6 cycles of R-mini-CHOP were completed in 63/79 pts (80%) and 57/79 pts (71%) completed all 8 cycles of therapy. The median Average Relative Total Dose and Average Relative Dose Intensity for the entire regimen was 97% (IQR 82, 100; 88, 100). 34/79 pts (43%) have died, 17 due to progressive disease and 5 were treatment-related. 67% pts experienced an SAE. Most common AEs were infections and diarrhoea (majority grade 1–2). In the EORTC QLQ-C30 there was an improvement in functional and symptom scales and on the EQ-5D-5L survey, there was a significant improvement in the median health state classification score and median visual analogue scale thermometer score over time. Encore Abstract - previously submitted to EHA 2023 The research was funded by: Janssen-Cilag Pty Ltd. Keywords: Aggressive B-cell non-Hodgkin lymphoma, Combination Therapies Conflicts of interests pertinent to the abstract. E. Verner Research funding: Janssen-Cilag Pty Ltd. E. Hawkes Consultant or advisory role: Janssen-Cilag Pty Ltd. T. Cochrane Consultant or advisory role: Janssen Cilag Pty Ltd. C. Y. Cheah Consultant or advisory role: Janssen-Cilag Pty Ltd. Honoraria: Janssen-Cilag Pty Ltd. M. K. Gandhi Research funding: Janssen-Cilag Pty Ltd. B. E. Butcher Other remuneration: Janssen Cilag Pty Ltd. J. Trotman Research funding: Janssen-Cilag Pty Ltd.

Posterior paramedian approach combined with a novel inverted V-shaped surgical access for intraspinal schwannomas: a retrospective case series study

ObjectiveTo explore the efficacy and safety of the posterior paramedian approach combined with a novel inverted V-shaped surgical access for the treatment of intraspinal schwannomas.MethodsThis study retrospectively reviewed consecutive patients who underwent surgical resection of the intraspinal schwannomas via the inverted V-shaped approach at our center between January 2016 and May 2021. Changes between the preoperative and postoperative visual analog scale (VAS) scores and neurological function Japan Orthopaedic Association (JOA) scores were assessed. Secondary outcomes such as success rate of tumor resection, operation time, blood loss, spinal stability, and disruption degree of intervertebral joints. Postoperative complications were also investigated.ResultsOf these 36 consecutive patients, there were 6 cases in the cervical spine, 2 cases at the cervical-thoracic junction, 11 cases in the thoracic spine, 4 cases at the thoracic-lumbar junction and 13 cases in the lumbar spine. The average operation time was 99 min, and the average blood loss was 95.4 mL. The tumor removal rate was 100%. Postoperative CT re-examination showed that the spinous processes were intact in all cases, the facet joint surfaces were intact in 32 cases. At the time of last follow-up, the median JOA score was 25 (9–27), which was significantly improved compared to the preoperative median JOA score of 15 (10–22) (P < 0.01). The overall excellent and good rate were 88.9 %. The median VAS score at post-surgery was 0 (0–2), which was significantly improved compared to the preoperative median VAS score of 4 (2–8) (P < 0.01). As for complications, there were no cases of cerebrospinal fluid leakage or spinal instability. Three patients who had a postoperative fever finally recovered after lumbar cistern drainage.ConclusionThe inverted V-shaped surgical access via the posterior paramedian approach is an effective and safe method for the treatment of intraspinal schwannomas.

Additive Value of Intranasal Fentanyl on Ibuprofen for Pain Management of Children With Moderate to Severe Headaches: A Randomized Controlled Trial

BackgroundFew studies have evaluated the rapid pain improvement provided by medications for children presenting to an emergency department (ED) with headaches. ObjectiveOur aim was to evaluate pain reduction provided by intranasal fentanyl (INF) compared with placebo in addition to ibuprofen. MethodsA single-center, double-blinded, randomized, placebo-controlled clinical trial was conducted in a tertiary care pediatric ED. All children aged 8–17 years presenting with a moderate to severe headache were eligible. Study participants were randomly allocated to receive INF 1.5 µg/kg (maximum dose of 100 µg) or similar placebo solution. Co-administration of oral ibuprofen 10 mg/kg (maximum dose of 600 mg) was also provided. The primary outcome was the mean pain rating reduction at 15 min. ResultsAmong the 62 participants, the median age was 14 years (interquartile range [IQR] 12–16 years in both groups) and the median initial visual analog scale (VAS) score was 64 (IQR 55–72 in the intervention group; IQR 50–81 in the control group). There was no difference in the mean pain score reduction at 15 min between the two groups (mean difference 2 mm; 95% CI –7 to 11 mm). Mean VAS score reductions were also similar at 30 and 60 min. Adverse events were more frequent in the INF group (risk ratio 2.8; 95% CI 1.29 to 6.22), but all events were minor and transient. No significant differences were found in other outcomes. ConclusionsThis study did not find a benefit from INF for providing additional pain relief in children presenting to ED with headaches.

A prospective functional outcome of stand-alone cage in cervical disc prolapses following discectomy

Introduction and Aim: Anterior cervical decompression and fusion (ACDF) is the go-to treatment for degenerative cervical illness that causes persistent radiculopathy. It has been suggested that a separate cage be used so that the patient's plates do not get damaged. This research aims to examine the radiological and functional results of discectomy and cage placement in patients with cervical disc prolapse. Materials and Methods: This study prospectively assessed patients who had anterior cervical decompression and fusion using a freestanding cage. Patients' pain levels on a Visual Analog Scale (VAS) and their level of impairment as measured by the Neck impairment Index (NDI) were taken before surgery. Post-operative pain assessment, looked out for cage related complications during follow up period at 3rd and 6th month post operatively by radiological evaluation. Results: Median age of neutral group and kyphosis was 45 and 34 respectively. Maximum number of patients had C5 - C6 IVDP. Median Cobb’s angle was higher in kyphosis group as compared to neutral group. Before surgery, at 10 days, and at 3 and 6 months after surgery, the kyphosis group had a higher median VAS and NDI score than the neutral group. Conclusion: The present study demonstrated that ACDF using a single cage successfully reduced the patient's preoperative neck pain and associated disability. The advantages of ACDF with a single cage include a shorter surgical time, better cervical lordosis and disc height, and no cage sinking. As a result, cage fusion as a stand-alone treatment option for cervical degenerative disease is likely to be regarded as a viable option.

Tinnitus suppression in a prospective cohort of 45 cochlear implant recipients: occurrence, degree and correlates.

Todetermine tinnitus prevalence and severity in a cohort of unselected first-time cochlear implant (CI) recipients whose primary motive for CI was sensorineural hearing loss (SNHL), and toevaluate the effect of CI on tinnitusafter cochlear implantation. Prospective longitudinal study of 45 adult CI recipients with moderate to profound SNHL. Patients completed the Danish version of the Tinnitus Handicap Inventory (THI) and a visual analogue scale (VAS) for tinnitus burden before implantation, 4months after implantation and 14months after implantation. The study included45 patients, of which 29 (64%) had pre-implant tinnitus. Median THI score (IQR) significantly decreased from 20 (34) to 12 (24)at first follow-up (p < 0.05) and to 6 points (17) at second follow-up (p < 0.001). Median VAS (IQR) for tinnitus burden decreased from 33 (62) to 17 (40; p = 0.228) and 12 (27, p < 0.05) at the first and second follow-ups, respectively. Tinnitus was totally suppressed in 19%of patients, improved in 48%, remained unchanged in 19% and worsened in 6%. 2 patients reported newtinnitus. At the second follow-up, 74% ofpatients hadslight or notinnitus handicap, 16% had mild handicaps, 6% had moderate handicaps, and 3% had severe handicaps. High pre-implant THI and VAS scores correlated with greaterdecrease in THI scores over time. 64% of the patients with SNHL had pre-implant tinnitus, which was decreased 4and 14months after implantation. Overall, 68% of patients with tinnitus improved their tinnitus handicap after CI. Patients with higher THI and VAS scores had a larger decline and the highest benefits in terms of tinnitus handicap improvement.The study findings demonstrate that the majority of patients with moderate to profound SNHL eligible for cochlear implantation benefit from complete or partial tinnitus suppression and improved quality of life after implantation.

V11-10 ANATOMIC TRANSPERINEAL PUDENDAL NERVE BLOCK BEFORE PENILE PROSTHESIS PLACEMENT TO REDUCE IMMEDIATE POSTOPERATIVE PAIN - DESCRIPTION AND OUTCOMES

You have accessJournal of UrologyCME1 Apr 2023V11-10 ANATOMIC TRANSPERINEAL PUDENDAL NERVE BLOCK BEFORE PENILE PROSTHESIS PLACEMENT TO REDUCE IMMEDIATE POSTOPERATIVE PAIN - DESCRIPTION AND OUTCOMES Kieran Lewis, Raevti Bole, Jacquelyn Booher, Lydia Deangelo, Gwendolyn Fuller, Ly Hoang Roberts, Petar Bajic, and Scott Lundy Kieran LewisKieran Lewis More articles by this author , Raevti BoleRaevti Bole More articles by this author , Jacquelyn BooherJacquelyn Booher More articles by this author , Lydia DeangeloLydia Deangelo More articles by this author , Gwendolyn FullerGwendolyn Fuller More articles by this author , Ly Hoang RobertsLy Hoang Roberts More articles by this author , Petar BajicPetar Bajic More articles by this author , and Scott LundyScott Lundy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003337.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Inflatable penile prosthesis (IPP) is the gold standard surgery for refractory erectile dysfunction, though patients can experience significant pain in the postoperative period. Historically, this pain has been managed with opioid medication, which presents additional risk to patients. Pudendal nerve block (PNB) has long been used for intraoperative pain management in IPP, though knowledge of its impact in the postoperative period is limited. Recently, a multimodal analgesic regimen that included a PNB was shown to reduce pain and opioid use following IPP when compared to opioid medication alone. In this video abstract, we describe a simple and safe pudendal nerve block to reduce postoperative pain in patients undergoing IPP. METHODS: We retrospectively reviewed 10 patients who underwent a transperineal PNB prior to IPP at our institution. To explore its safety, we documented intraoperative complications and 90-day postop complications. We also documented immediate postop pain using the visual analog scale (VAS), immediate postop opioid administration, and patient-reported pain at the first follow-up visit. Our PNB is a single component of an ERAS protocol, which utilizes pre and postoperative gabapentin, meloxicam, and acetaminophen, in addition to intracavernosal lidocaine. RESULTS: Of the 10 patients we reviewed, 0/10 experienced intraoperative complications and in the 90-day period following surgery 0/10 experienced postop complications. The median VAS pain score in the immediate postop period was 2 (IQR=0 – 3), with 5/10 patients receiving fentanyl for pain control in the PACU. Patients that received fentanyl were on average given two 50mcg doses and had a median VAS pain score of 5 prior to the first dose. 9/10 patients reported no pain at first follow-up, with just a single patient reporting mild pain along the scrotum. CONCLUSIONS: In this video abstract, we demonstrate a safe and effective transperineal pudendal nerve block to minimize pain and reduce opioid use in patients following IPP implantation. Our PNB adds minimal pre-op time, does not require ultrasound, and has a low risk of possible complications. For quality control, we reviewed 10 patients who received a PNB before IPP. None of these patients experienced intraoperative or postop complications, demonstrating the safety of the procedure. Additionally, patients reported minimal pain in the immediate postop period and at first follow-up, once again demonstrating the safety and potential efficacy of the nerve block. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1001 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kieran Lewis More articles by this author Raevti Bole More articles by this author Jacquelyn Booher More articles by this author Lydia Deangelo More articles by this author Gwendolyn Fuller More articles by this author Ly Hoang Roberts More articles by this author Petar Bajic More articles by this author Scott Lundy More articles by this author Expand All Advertisement PDF downloadLoading ...

MP71-15 VIRTUE SUB-URETHRAL SLING FOR STRESS URINARY INCONTINENCE AFTER RADICAL PROSTATECTOMY: a SINGLE-CENTER EXPERIENCE

You have accessJournal of UrologyCME1 Apr 2023MP71-15 VIRTUE SUB-URETHRAL SLING FOR STRESS URINARY INCONTINENCE AFTER RADICAL PROSTATECTOMY: a SINGLE-CENTER EXPERIENCE Edoardo Beatrici, Simone Scarcella, Chiara Del Prete, Gianluca Giglioni, Simone Cappuccelli, Lucia Pitoni, Giuliana Gabrielloni, Vito Lacetera, and Valerio Beatrici Edoardo BeatriciEdoardo Beatrici More articles by this author , Simone ScarcellaSimone Scarcella More articles by this author , Chiara Del PreteChiara Del Prete More articles by this author , Gianluca GiglioniGianluca Giglioni More articles by this author , Simone CappuccelliSimone Cappuccelli More articles by this author , Lucia PitoniLucia Pitoni More articles by this author , Giuliana GabrielloniGiuliana Gabrielloni More articles by this author , Vito LaceteraVito Lacetera More articles by this author , and Valerio BeatriciValerio Beatrici More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Stress urinary incontinence (SUI) still represents one of the most common complications after radical prostatectomy (RP). We aim to report our single-center experience with the sub-urethral Virtue male sling (Coloplast, Humlebaek, Denmark) for SUI after RP. METHODS: We prospectively enrolled patients with SUI after RP who underwent sub-urethral Virtue sling placement at our Institution between July 2017 and April 2022. Pre and post-operative (1, 3, 6, and 12 months) SUI was evaluated according to the International Consultation on Incontinence Short-Form Questionnaire (ICIQ-SF), and the number of pads/day. Clavien-Dindo was used to report complications, and Visual Analogue Scale (VAS) to report patients pain during follow-up. Wilcoxon signed-rank test was used to test the median difference between pre and post-operative SUI. Multivariable logistic regression models adjusted for age, BMI, RP approach, previous radiotherapy, and preoperative SUI severity were fitted to test the association between outcomes and patients’ baseline characteristics. RESULTS: A total of 52 patients with SUI after RP (69.2% open, 3.9% laparoscopic, and 26.9% robotic) were prospectively enrolled. Median (IQR) age at surgery was 73 (68 – 76.5) years. Median preoperative ICIQ-SF was 13 (12 - 14), with 32.7% and 67.3% of patients who reported moderate and severe SUI respectively. Median preoperative number of pads\day was 3 (2 - 4). Overall, 11.5% of patients developed a Clavien-Dindo Grade I / II complication after surgery. No major complications were reported. Median VAS score was 3 (2 – 4.5) at first postoperative day, 2 (11-3) upon discharge and 0 after 12 months. Compared to preoperative, Wilcoxon signed-rank test showed a significant median reduction of ICIQ-SF score and number of pads/day at each of the follow-up controls (all p<0.001). After 12 months, 29.4% of patients reached complete continence (0 pads\day) and 35.9% referred only 1 pad\day. Median number of pads\day was 1.5 (1 - 3). Median ICIQ-SF score was 6 (4 – 9), with 44.2% of patients reporting slight incontinence. Adjusted multivariable logistic regression models didn’t find any association between worse outcomes and patients’ baseline characteristics. CONCLUSIONS: To our knowledge, this is the largest single-center experience with sub-urethral Virtue sling after RP. According to our results, this device might safely provide impactful quality of life improvement and recovery in patients with SUI after RP. A larger case series might help to stratify patients who can benefit the most from this sling. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1020 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Edoardo Beatrici More articles by this author Simone Scarcella More articles by this author Chiara Del Prete More articles by this author Gianluca Giglioni More articles by this author Simone Cappuccelli More articles by this author Lucia Pitoni More articles by this author Giuliana Gabrielloni More articles by this author Vito Lacetera More articles by this author Valerio Beatrici More articles by this author Expand All Advertisement PDF downloadLoading ...