Mild Recurrence Research Articles

Long-term risk of delayed postoperative Crohn's disease recurrence in patients with no or mild endoscopic recurrence at first assessment.

Early endoscopic evaluation is recommended for assessment of postoperative recurrence (POR) of Crohn's disease (CD) but no further monitoring recommendations are available. To evaluate the long-term outcome of patients without endoscopic POR at first endoscopic assessment. Retrospective four-centre study including consecutive CD patients with ileocolonic resection (ICR) without endoscopic POR (Rutgeerts score i0-i1) at first endoscopic assessment performed within 18 months from ICR. All patients had a clinical follow-up ≥24 months and at least one further endoscopic assessment. Main outcomes were endoscopic, clinical and surgical POR, need for rescue therapy and "delayed POR" (any need for rescue therapy or clinical or surgical POR) during follow-up. Overall, 183 patients were included (79% with risk factors for POR, 44% without postoperative prophylaxis). Endoscopic POR was observed in 42% of patients. Clinical POR-free survival was 89.4% and 81.5% at 3 and 5 years, and delayed POR-free survival was 76.9% and 63.4% at 5 and 10 years, respectively. In multivariate analysis, postoperative prophylaxis (HR .55; 95% CI .325-.942) and active smoking (HR 1.72; 95%CI 1.003-2.962) were independent risk factors for clinical POR, whereas presence of mild endoscopic lesions at index ileocolonoscopy (i1) was the only risk factor for delayed POR (HR 1.824; 95% CI 1.108-3.002). Long-term risk of POR among patients with no or mild endoscopic lesions at first ileocolonoscopy after surgery is steadily low, being higher among smokers, in the absence of postoperative prophylaxis and when mild endoscopic lesions are observed in the first endoscopic assessment.

P168 Specialized pro-resolving lipid mediator Resolvin D1 and omega 6 dihomo-γ-linolenic acid are unable to solve inflammation in the creeping fat of patients with severe postoperative recurrence in Crohn's disease

Abstract Background The ω3 derivate resolvin D1 (RvD1), and the ω6 dihomo-γ-linolenic acid (DGLA) prevent collateral damage by overcoming inflammation and enhancing microbial clearance. In Crohn's disease, the mesenteric adipose tissue becomes inflamed and hyperplasies due to transmural lesions and bacterial translocation, developing the so-called creeping fat. This tissue is unable to clear inflammation and has been linked to severer intestinal inflammation and post-operative recurrence (POR). Recently, we have described the presence of DGLA and the increase in the ω6/ω3 ratio together with pro-inflammatory mediators in the creeping fat at surgery. Our aims were study the mechanisms within the inflammatory resolution related to polyunsaturated fatty acids depending on POR severity. Methods Creeping fat samples were obtained in the intestinal resection of Crohn's disease patients and endoscopic POR was evaluated according to the Rutgeerts score: non recurrence (i0+i1; n=18), mild recurrence (i2; n=14) and severe recurrence (i3+i4; n=10). Mesenteric adipose tissue was also collected from patients with colorectal cancer (n=10) and severe obesity (n=11) as reference groups. RvD1 was evaluated by C18/ELISA, lipoprotein lipase (LPL) and hormone-sensitive lipase (HSL) activity by radioassay, and the free fatty acid receptor 1 (FFAR1) expression by qRT-PCR. Results RvD1 was increased in the creeping fat in comparison to the mesenteric adipose tissues of the reference groups (Graphical abstract A) and correlated antagonistically with pro-inflammatory mediators in non-recurrence versus severe recurrence (B). Specifically, factors such as TNF-α, CD14 or IL-18 showed significant positive correlations with RvD1 in severe recurrence while negative in non recurrence. The LPL/HSL ratio indicated greater storage of fatty acids in severe recurrence creeping fats (C), and only in these patients, DGLA negatively correlated with HSL (D) and FFAR1 (E), a receptor that was only detected in Crohn's disease (F). At the same time, this receptor antagonistically correlated with pro-inflammatory mediators such as IL-8 in the creeping fat, positively in non-recurrence and negatively in severe recurrence (G). Conclusion The RvD1 increase suggests a greater production of this factor from ω3, but that would be insufficient to resolve inflammation in severe recurrent creeping fat at surgery time. In this phenotype, HSL activity is linked to a lower presence of DGLA, the only anti-inflammatory ω6. In contrast, the presence of this ligand in severe recurrents seems to reduce the expression of the FFAR1, which acts on the neutrophil function. Thus, immune-inflammation derived from lipid metabolism is antagonistic among the most disparate cases of POR in the creeping fat at surgery.

Prevalence of Fabry disease and GLA variants in young patients with acute stroke: The challenge to widen the screening. The Fabry-Stroke Italian Registry

BackgroundFabry disease (FD) is a treatable X-linked lysosomal storage disorder caused by GLA gene variants leading to alpha-galactosidase A deficiency. FD is a rare cause of stroke, and it is still controversial whether in stroke patients FD should be searched from the beginning or at the end of the diagnostic workup (in cryptogenic strokes). MethodsFabry-Stroke Italian Registry is a prospective, multicentric screening involving 33 stroke units. FD was sought by measuring α-galactosidase A activity (males) and by genetic tests (males with reduced enzyme activity and females) in patients aged 18–60 years hospitalized for TIA, ischemic stroke, or intracerebral hemorrhage. We diagnosed FD in patients with 1) already known pathogenic GLA variants; 2) novel GLA variants if additional clinical, laboratory, or family-derived criteria were present. ResultsOut of 1906 patients, we found a GLA variant in 15 (0.79%; 95%CI 0.44–1.29) with a certain FD diagnosis in 3 (0.16%; 95%CI 0.03–0.46) patients, none of whom had hemorrhage. We identified 1 novel pathogenic GLA variant. Ischemic stroke etiologies in carriers of GLA variants were: cardioaortic embolism (33%), small artery occlusion (27%), other causes (20%), and undetermined (20%). Mild severity, recurrence, previous TIA, acroparesthesias, hearing loss, and small artery occlusion were predictors of GLA variant. ConclusionIn this large multicenter cohort the frequency of FD and GLA variants was consistent with previous reports. Limiting the screening for GLA variants to patients with cryptogenic stroke may miss up to 80% of diagnoses. Some easily recognizable clinical features could help select patients for FD screening.

A Case Study of Drug Dependency (NSAIDs) in Shirshool (Headache) Healed Through Integrative Medicine

Shira is the Uttamang i.e., most vital part of our body. Ayurveda is limited to pain and discomfort in Shira rather to brain disorders as such. Shirashool (headache) is the most common and frequently seen in day to day life due to the Stress, Vegdharan (to control forcefully natural functions like urine, faeces, cough or sneeze etc,) Ratrijagran (late night activity), Upvas (excessive control on appetite) Shoke (depressive thoughts), excessive work habits- the major root cause is excessive movement of Vata or overactive/imbalanced Vata Dosha. Jihva (tongue) examination is an important part of Ashtavidh pariksha mentioned in the text book of Yogratnakar. A tongue examination is typically conducted in conjunction with a thorough patient history. The vital organs of the body leave the imprint on the tongue surface- specific patterns or spots or colour. Tongue has its own language; it needs continuous practice. Examination of the tongue in Ayurveda is a easy valuable diagnostic tool that provides valuable and stored information about an individual's health and well-being or disease. Allopathic medicine like (NSAIDs) are most commonly used in headache as pain relieve medicine which has a lot of side effects; while holistic approach of Ayurveda is found to be very good results. Integrative therapy involves medicines, dietary schedule and yogic practices, shows sufficient significant changes in a patient. Mild recurrence which was seen in post follow up period was managed effectively through the yogic practices and proper guidance of counselling sessions on every Wednesday.

Overview of Antipsycotic Using on Schizophrenic Patients in Hospitals Indramayu City

Schizophrenia is a psychiatric disorder characterized by disturbances in thinking processes, perceptions, emotional responses, and social interactions. The therapy commonly used in the treatment of schizophrenia is antipsychotic or psychotropic drugs. The use of psychotropic drugs is the first step in overcoming and following up on mental disorders. The object of this research is several hospitals that treat patients with psychiatric disorders, namely schizophrenia. Where the subjects used in this study were men/women with schizophrenia aged 18 to 60 years in the city of Indramayu who are undergoing treatment at the hospital for the 2020-2022 period. This study aims to describe the use of antipsychotic classes that are used as one of the pharmacological therapies in patients. This research method uses a descriptive quantitative method, while the sample fee used in this study is the slovin calculation formula, with a total population of 875 and a sample of 274 is obtained. The results obtained are based on the proportion of sex, mostly male patients (62.4%), the highest proportion of the age range was found in early adulthood (70.8%), the highest diagnosis was YTT schizophrenia (46%). Then patients with a history of not going to school (63.5%) and a history of not working (88.3%). Most of the data obtained were patients who experienced mild recurrence of 62%. As for the large number of patient histories with mild or insignificant recurrence, this can influence the factors supporting the success of treatment, namely the use of insurance. This opinion was obtained from patient payment status data, in which the most widely used payment status was the use of insurance by 82.1%. In data on the use of the single antipsychotic that is most widely used in each type of schizophrenia is the antipsychotic haloperidol and the combination that is most widely used is haloperidol-chlorpromazine

Catheter-based therapies and short-term outcomes in the oncological patients with acute inferior vena cava thrombosis: a single centre experience.

To investigate the safety and effectiveness of catheter-based therapy (CBT) using AngioJet rheolytic thrombectomy (ART) device or large lumen catheter (LLC) in the oncological patients with inferior vena cava thrombosis (IVCT). This was a retrospective study including eligible patients with IVCT treated with CBT coupled with dose-reduced thrombolysis as the first-line treatment from February 1, 2015 to January 1, 2022. The baseline demographics, comorbidities, clinical characteristics, treatment details, course data were all reviewed. A total of 33 patients (mean age 58.8 years, 57.6% male) was included, of whom 17 patients underwent ART and 16 underwent LLC aspiration, the technical success rates were 100%. All patients subsequently underwent catheter-directed thrombolysis relative to reduced-dose thrombolysis. At the end of catheter-directed thrombolysis, clinical success was achieved in 26 (78.8%) patients. In the subgroup analysis, ART seemed to receive a slightly higher rate of thrombus removal Grade III (47.1% vs 12.5%, p = .057). The symptoms of leg pain and swelling post-treatment were significantly improved in both groups (p < .001). Except for transient macroscopic hemoglobinuria occurring in patients with ART, none of all patients suffered from procedure-related adverse events and major complications. Minor complications such as bleeding events occurred in 6.1% (2/33) of patients. At the 6 month follow-up, the incidence of recurrent thrombosis and mild post-thrombotic syndrome (PTS) were 9.7% (3/31) and 6.5% (2/31). CBT is a safe and effective modality for the management of IVCT in the oncological patients, leading to high levels of technical and clinical success, symptoms alleviation, as well as a low incidence of minor complication, mild PTS and recurrence. The available data and evidence of endovascular therapy (ET) on oncologic patients with IVCT remains insufficient. The purpose of present single center retrospective study including 33 oncological patients is to investigate the preliminary safety and efficacy of CBT using ART device or LLC. The results demonstrated that CBTs are safe and effective as an ET modality in majority of eligible patients with symptomatic acute cancer-associated IVCT, indicating high levels of technical and clinical success, symptoms alleviation, as well as a low prevalence of minor complication, mild post-thrombotic syndrome and recurrence. Furthermore, they have the advantages of accelerated reduction of thrombus burden in a moderate time, speedy restoration of blood flow, but at the risk of potentially increased economic cost. Notably, in the condition of parallel time and dosages of lytic agents, ART tends to achieve a slightly higher thrombus removal Grade III than LLCA.

Aberrant conjunctival overgrowth with corneal adhesions in two pet rabbits (Oryctolagus cuniculus)

Pseudopterygium has been previously documented in rabbits. In this condition, there is a circumferential overgrowth of the conjunctiva over the cornea without adherence to the corneal surface. In contrast, focal conjunctival overgrowth with adherence to the corneal surface, pterygium, occurs in humans. Pterygium has not been reported in rabbits. Case 1, a 5-year-old, spayed female, rex rabbit, presented for an evaluation of a suspected pseudopterygium of both eyes (OU). Medical treatment was unsuccessful. Surgery was performed and partial corneal adherence was detected. The portion of conjunctiva adhered to the cornea was left in place, and the nonadhered conjunctiva was transected adjacent to this attachment and sutured into the fornix. Over the next 8 months, the left eye (OS) had mild recurrence of aberrant conjunctival overgrowth noted temporally, with adhesion to the corneal surface at its previous attachment. The axial cornea remained clear OU. Case 2, a 6.5-year-old, intact male, mixed breed rabbit, was presented for cutaneous wounds and myiasis. During the initial examination, an incidental pseudopterygium was identified OU. Upon further evaluation, corneal adhesion was identified. As the conjunctival overgrowth was not affecting the rabbit's vision, no additional treatments were pursued. The animal was lost to recheck. This case series describes 2 cases of aberrant conjunctival overgrowth with corneal adhesions in rabbits. Although pseudopterygium without adhesions is the most common presentation in rabbits, veterinarians should be aware that corneal adhesions can occur in rabbits and it may require modifications to the surgical procedure.

Surgical Core Excision With Tongue Flap Closure in Combination With Electron Beam Radiotherapy in the Treatment of Ear Keloids.

Ear keloids are disfiguring disorders resistant to various treatments. The authors aimed to assess the efficacy of surgical treatment of ear keloids in a Chinese population using a tongue flap with electron beam radiotherapy. The authors conducted a retrospective analysis of 41 patients treated at the Affiliated Hospital of Nantong University between January 2018 and May 2021. Core excision with a tongue flap was performed, followed by 3 days of electron beam radiotherapy and 3 to 6 months of pressure clip application. The Vancouver Scar Scale (VSS) and the Visual Analog Scale (VAS) were used to assess the results. The mean age of the patients was 28.10 years (9-61 years). Postoperative follow-up ranged from 5 to 32 months (mean:12.07). The patients underwent 3 days of postoperative radiotherapy followed by pressure clips for 2 to 6 months. Thirty-seven patients had no recurrence, whereas 4 had a mild recurrence (<3 mm in height) with redness and itchiness. The VSS and VASscores significantly decreased. (p < .05). Excision with a tongue flap and radiotherapy can be used as the primary treatment for ear keloids considering the good outcome and long-term management.

More than 10 years’ follow-up of the Swanson metacarpophalangeal joint arthroplasty for the rheumatoid hand

BackgroundIn recent years, advances in pharmacotherapy for rheumatoid arthritis have dramatically improved the control of disease activity. However, a significant number of patients still develop hand deformity and require surgical reconstruction. The objective of this study was to evaluate the long-term efficacy and drawbacks of the Swanson metacarpophalangeal joint arthroplasty for patients with rheumatoid arthritis over 10 years. MethodsClinical and radiological evaluations were performed for 87 joints of 29 hands in 27 patients who underwent metacarpophalangeal joint arthroplasty using the Swanson implant, and who were followed up for an average of 11.4 (10–14) years. ResultsThe number of operated tender and swollen metacarpophalangeal joints decreased from 24 (27.6%) and 28 (32.2%) to 1 (1.1%) and 2 (2.3%), respectively. The patients’ general health and disease activity score 28-erythrocyte sedimentation rate improved at the last survey. Mild recurrence of ulnar drift was observed, but the deformity was generally well-corrected. Implant fracture was noted in eight joints (9.2%), and revision surgery was performed in two joints (2.3%). The average active range of extension/flexion changed from −46.3°/65.9° to −32.3°/56.6°. While a significant change was not noted in grip or pinch strength, patients were satisfied with the operation especially in terms of pain relief and improved hand appearance. ConclusionsThe long-term results of Swanson metacarpophalangeal joint arthroplasty were good in pain relief and correction of deformity, but some problems remain with regard to implant durability and mobility.

A novel classification based on magnetic resonance imaging for individualized surgical strategies of lumbar disc herniation.

Although the anatomy and pathology of lumbar disc herniation (LDH) have been clearly defined and classified in many studies, its imaging definition and classification still needs further clarification. This study intends to propose a novel classification and individualized surgical strategy for LDH based on preoperative magnetic resonance imaging (MRI). According to MRI features, LDH types were identified, and the corresponding surgical strategies were formulated to accurately remove the herniated discs while minimizing the disturbance to the normal disc. We retrospectively analyzed prospectively collected data of LDH patients who underwent surgery guided by this classification system. This study included 357 patients with LDH who underwent tubular microdiscectomy. LDH was classified into four types based on MRI features. The inter- and intra-observer agreement using this classification was good. The follow-up results showed that surgery improved visual analog scale scores for low-back and leg pain and the Oswestry disability index in patients with different LDH types. The average recurrence rate at 1-5years postoperatively was 5.62%. There was no significant difference in recurrence rates among the four LDH types (3.7-6.2%). MRI showed no significant differences in the Pfirrmann grade and disc height index of the operated segment between before surgery and 1-3years after surgery. The operated segments did not show faster disc degeneration rates compared to adjacent proximal segments. We proposed a novel classification system and an individualized surgical strategy for LDH based on preoperative MRI. Further, the surgical suitable interventions guided by this system achieved good clinical outcomes and mild recurrence rates.

A prospective observational study on the effectiveness of pterygium excision with limbal conjunctival autograft transplantation and recurrence in patients of primary pterygium

Background: Pterygium is a degenerative and hyperplastic process with abnormal fibrovascular proliferation. Surgery is the treatment of choice in progressive or symptomatic cases but recurrence is a concern. Aims and Objective: We aim to evaluate the effectiveness of pterygium excision and conjunctival autograft (done by post-graduate trainees in the 2nd and 3rd year of residency under supervision) and recurrence of this process in a tertiary care setup. Materials and Methods: It is a single-centric prospective observational study. 50 patients who underwent pterygium excision with conjunctival autografting surgery in a tertiary care hospital were followed up for 1 year. Patients were evaluated on day 1, day 7, 1 month, 6 months, and 1 year. Efficacy and graft stability were assessed on day 7 and 1 month; 6 months and 1 year for recurrence and the factors associated with it. Results: Total number of patients was 50; 31 were female, and 19 were male. All cases were effectively managed with excision and autograft. Post-operatively, 13 (26%) patients had shown suture loosening, 17 (34%) patients had graft edema, and 13 (26%) patients had post-operative recurrence. Out of 13 patients, 8 patients had mild recurrence, 4 patients had moderate recurrence, and 1 patient had severe recurrence. Graft stability is significantly associated with suture loosening (P &lt; 0.05). There is no association between the extent and grade of pterygium (P &gt; 0.05). Recurrence was statistically highly associated with (P &lt; 0.0001) suture loosening. Conclusion: We conclude that autografting is an effective technique. Intraoperative proper suturing technique and minimal tissue manipulation can minimize recurrence.

Outcomes of Surgical Treatment for Burn Contracture on the Hand: A Retrospective Study

Objectives: Burn-related contractures in joint regions with a high range of motion in the upper extremities can cause serious functional limitations. This retrospective case-control study aimed to evaluate the outcomes of surgical treatment for burn contracture on the hand. Methods: The study included 20 patients who underwent surgery and had at least 6 months of postoperative follow-up. We analyzed postoperative complications that occurred during the follow-up period and other variables, such as age, gender, follow-up time, the time between the burn injury and surgery, patients' satisfaction from surgery with a scoring system, as well as the affected hand of the patients. We defined the hand deformities of the patients due to contractures and evaluated the surgical methods performed for these deformities. Results: There were 7 females, and 13 males with a mean age of 17 years (SD: 11,98) in our study. The mean age at which the patients were injured due to burns was 13 years (SD: 12,14), and the mean time from injury to surgical treatment was 3.7 years (SD: 2,18). The mean follow-up period was 19.2 months (SD: 12,50). The patients reported a high level of satisfaction, with a mean satisfaction score of 8.7 out of 10 (SD: 1,69). Temporary K-wire fixation was used in two patients, and no complications related to K-wires were observed. Postoperative complications included limited flexion in the fifth finger, recurrence of the second finger contracture, mild recurrence of the fifth finger PIP joint contracture, and scar pain in the second web space. Two patients also experienced partial z-plasty flap necrosis which healed secondarily. Conclusion: Our data suggest that surgical treatment for burn contracture on the hand can provide functional mobility and improve the quality of life with a high level of satisfaction for patients.

Postoperative outcomes and recurrence patterns of intermediate-stage hepatocellular carcinoma dictated by the sum of tumor size and number

The selection criteria for Barcelona Clinic Liver Cancer (BCLC) intermediate-stage hepatocellular carcinoma (HCC) patients who would truly benefit from liver resection (LR) remain undefined. To identify BCLC-B HCC patients more suitable for LR. We included patients undergoing curative LR for BCLC stage A or B multi-nodular HCC (MNHCC) and stratified BCLC-B patients by the sum of tumor size and number (N + S). Overall survival (OS), recurrence-free survival (RFS), recur-rence-to-death survival (RTDS), recurrence patterns, and treatments after recurrence in BCLC-B patients in each subgroup were compared with those in BCLC-A patients. In total, 143 patients who underwent curative LR for MNHCC with BCLC-A (n = 25) or BCLC-B (n = 118) were retrospectively analyzed. According to the N + S, patients with BCLC-B HCC were divided into two subgroups: BCLC-B1 (N + S ≤ 10, n = 83) and BCLC-B2 (N + S > 10, n = 35). Compared with BCLC-B2 patients, those with BCLC-B1 had a better OS (5-year OS rate: 67.4% vs 33.6%; P < 0.001), which was comparable to that in BCLC-A patients (5-year OS rate: 67.4% vs 74.1%; P = 0.250), and a better RFS (median RFS: 19 mo vs 7 mo; P < 0.001), which was worse than that in BCLC-A patients (median RFS: 19 mo vs 48 mo; P = 0.022). Further analysis of patients who developed recurrence showed that both BCLC-B1 and BCLC-A patients had better RTDS (median RTDS: Not reached vs 49 mo; P = 0.599), while the RTDS in BCLC-B2 patients was worse (median RTDS: 16 mo vs not reached, P < 0.001; 16 mo vs 49 mo, P = 0.042). The recurrence patterns were similar between BCLC-B1 and BCLC-A patients, but BCLC-B2 patients had a shorter recurrence time and a higher proportion of patients had recurrence with macrovascular invasion and/or extrahepatic metastasis, both of which were independent risk factors for RTDS. BCLC-B HCC patients undergoing hepatectomy with N + S ≤ 10 had mild recurrence patterns and excellent OS similar to those in BCLC-A MNHCC patients, and LR should be considered in these patients.

The clinical course of patients with previous acute and recurrent pericarditis receiving the BNT162b2 vaccine

Vaccines against SARS-COV2 have been crucial in efforts against COVID19, yet there have been reports of pericarditis following vaccination with mRNA-based vaccines.We questioned consecutive patients with a history of acute pericarditis (AP) evaluated in the pericardial disease clinic during 3-11/2020 in a single tertiary center. Patients with significant myocardial involvement or pericarditis secondary to another systemic disease were excluded.We included 64 patients in the final analysis. Mean age was 53.1 (±18), and 26 (41%) were female. At least 1 recurrence of AP was documented in 47 (73%) cases, 32 (50%) had ≥ 3 recurrences prior to vaccination. AP was considered to be idiopathic\viral in 45 (70%) cases, 20 (31%) cases were post-injury. All patients received at least 2 doses of the vaccine, and 48 patients (75%) received a 3rd dose. Two cases of breakthrough COVID19 infections were documented. Overall, 12 patients (19%) reported any adverse events. Of which, 2 had recurrent pericarditis. There was a trend for a younger age in those patients who had adverse events (median age 45 [IQR 36-61] vs. 60 [38-71], p = 0.08). no other significant difference was seen.In patients with a history of acute\recurrent pericarditis, the use of BNT162b2 was mostly uneventful, but some mild disease recurrences did occur.

Outcomes of Lateral Tarsal Strip in Conjunction with a Minimal Skin Muscle Excision Underlying Cauterization in Korean Patients with Involutional Entropion.

We reviewed the medical records of 53 involutional entropion patients, who underwent lateral tarsal strip (LTS) with a minimal skin muscle excision by cauterization from March 2014 to December 2017, to evaluate the effectiveness and efficiency of LTS in conjunction with a minimal skin muscle excision using cautery in patients with involutional entropion. We evaluated the success rate, complications, recurrence rate, and degree of satisfaction of our technique. Of 53 patients, there were 5 bilateral cases for a total of 58 eyelids. The average of age was 71.2 years old (57–90 years). The average follow-up period was 18 months (12–39 months). The success rate for involutional entropion correction was 98.1% with our technique. There was one mild recurrence case at 7 months. In our study, the average operation time was 20.8 min (15–29 min) for 48 unilateral cases and 27.2 min (20–32 min) for 5 bilateral cases without intraoperative complications. Of 42 responders of patients’ satisfaction questionnaire, 38 patients showed good satisfaction and were willing to recommend the surgery to their acquaintances. The technique of LTS with minimal skin excision with cauterization was effective and provided satisfying outcomes to patients with involutional entropion.

The beneficial effect of short-term multimodal physiological therapy on female provoked vulvodynia: A pilot study

ABSTRACT Introduction Vulvodynia is a subset of the genito-pelvic/penetration disorder and is currently defined by chronic pain in the vulva area of at least 3-6 months duration. It affects 8-10% of women of all ages. According to 2015 ISSVD, ISSWSH, and IPPS consensus terminology and classification of vulvodynia, it can be divided into provoked (e.g., insertional, contact), spontaneous or mixed type. Although the etiology remains an enigma, peripheral neurologic mechanism has recently been identified as a factor. Objective The aim of this trial was to evaluate the effectiveness of short-term physical therapy in women with vulvodynia. Methods Women with intolerable vulvodynia were included in the study from Jan to May 2021. Medical screen including cotton-tipped testing and pelvic examination were performed by one gynecologist. After informed consent obtained, women lied down with cross-legged receiving once treatment per 1-2 weeks until completely pain relief achieved. Treatment consisted of a multimodal approach including lidocaine gel 20mins, capsaicin gel 20mins and TENS (Transcutaneous electrical nerve stimulator) 30 mins. TENS was administered through skin probes via a dual channel NeuroTrac device. A set of double electrode patches were placed on the dermatome of unilateral side of pain: channel A constant 80Hz, and channel B burst of 9 pulses 150Hz, 175 µS pulse duration and the intensity at the maximal level that patient could tolerate. At the completion, all women were followed for 3-6 months to assess efficacy, satisfying sexual events (SSE) in 4weeks, adverse events and recurrence. Results Ten women were diagnosed with provoked (n=8) or spontaneous vulvodynia (n=2) (primary 60% and secondary 40%). The average age was 34.1 years (range= 25-50) with an average duration of vulvodynia of 50.0 months (range= 4-276). 50% of women reported tolerating intercourse sometimes, 40% never did, and one was virgin. 37.5% (n=3) underwent one treatment session, and 62.5% (n=5) two sessions to achieve completely pain relief. At the completion of one week, 100% of provoked type women reported moderate or high improvement on vulvodynia region. Those reported improvement in the frequency of SSE within 4 weeks after treatment completion (62.5% sometimes, 25% often and one didn't restart intercourse). However, both of spontaneous type women failed to treatment and were suggested a referral for nerve blocking. After 4.4-24.3 weeks follow-up, 25% of provoked group reported no recurrence, 62.5% mild recurrence, and 12.5% (n=1) moderate recurrence. Only minor adverse events occurred. 90% reported mild to moderate vulva irritation immediately after treatment, which were completely resolved after bath. Only one spontaneous type reported vulva swelling and moderate irritation for one week. 100% of participants were willing to receive treatment in the next time. Conclusions A short-term multimodal physiological therapy including lidocaine, capsaicin and TENS enabled women with provoked vulvodynia to achieve rapid pain relief, moderate or high improvement in sexual encounters and the efficacy is seemed to last long. The tolerability and safety were high. Disclosure Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Youren clinic).

Patch testing in drug reaction with eosinophilia and systemic symptoms (DRESS): A literature review.

The literature on positive patch test results in drug reaction with eosinophilia and systemic symptoms (DRESS) is reviewed. One hundred and five drugs were identified that have together caused 536 positive patch tests in 437 DRESS patients. By far, the most reactions (n=145) were caused by carbamazepine, followed by amoxicillin, isoniazid, phenytoin, ethambutol, fluindione, phenobarbital, rifampicin, and ceftriaxone; 43 drugs each caused a single case only. The drug classes causing the highest number of reactions were anticonvulsants (39%), beta-lactam antibiotics (20%), antituberculosis agents (11%), non-beta-lactam antibiotics (6%), and iodinated contrast media (5%). The sensitivity of patch testing (percentage of positive reactions) is high for anticonvulsants (notably carbamazepine), beta-lactam antibiotics (notably amoxicillin), and, possibly, iodinated contrast media. Allopurinol and sulfasalazine frequently cause DRESS but never give positive patch tests. Patch testing in DRESS appears to be safe, although mild recurrence of DRESS symptoms, mostly skin reactions, may not be rare. Multiple drug hypersensitivity was found to occur in 16% of all patients, but it is argued that the true frequency is higher. Clinical aspects of DRESS, including diagnosing the disease and identifying culprit drugs (patch tests, intradermal tests, in vitro tests, challenge tests) are also provided, emphasizing the role of patch testing.

Mild neoterminal ileal post-operative recurrence of Crohn's disease conveys higher risk for severe endoscopic disease progression than isolated anastomotic lesions.

Retrospective cohort study of adult CD patients undergoing ileocolonic resection between 2009 and 2020. Patients with a post-operative ileocolonoscopy ≤18months from surgery and ≥1 subsequent ileocolonoscopy were included. Disease activity was assessed using the modified Rutgeerts' score (RS). Primary outcome was severe endoscopic progression, defined as i3 or i4 disease, on immediate subsequent ileocolonoscopy and during entire post-operative follow-up. Secondary outcome was surgical recurrence. One hundred and ninety-nine CD patients had an ileocolonoscopy ≤18months from surgery, index RS of i0-i2b and ≥1 subsequent ileocolonoscopy. At index ileocolonoscopy, 34.7% had i0 disease, 16.1% i1, 24.6% i2a and 24.6% i2b. On multivariable logistic regression, i2b disease was associated with severe endoscopic progression compared to i0 or i1 (aOR 5.53; P<0.001) and i2a disease patients (aOR 2.63; P=0.03). However, i2a disease did not confer increased risk compared to i0 or i1 disease (P=0.09). Furthermore, i2b patients experienced severe endoscopic progression significantly earlier than i0 or i1 disease (aHR 4.68; P<0.001), whereas i2a disease did not differ from i0 or i1 disease (P=0.25). Surgical recurrence was not associated with index RS i0-i2b (P=0.86). Post-operative ileal disease recurrence, not isolated anastomotic inflammation, confers increased risk for severe endoscopic disease progression. Location of CD recurrence may impact optimal management strategies.

Results of patch testing in acute generalized exanthematous pustulosis (AGEP): A literature review.

The literature on positive patch-test results in acute generalized exanthematous pustulosis (AGEP) is reviewed. Ninety-three drugs were identified that have together caused 259 positive patch tests in 248 patients with AGEP. The drug classes causing the highest number of reactions are beta-lactam antibiotics (25.9%), other antibiotics (20.8%), iodinated contrast media (7.3%), and corticosteroids (5.4%), together accounting for nearly 60% of all reactions. The highest number of reactions to individual drugs was to amoxicillin (n=36), followed by pristinamycin (n=25), diltiazem (n=14), amoxicillin-clavulanic acid (n=13), clindamycin (n=11), and iomeprol (n=8); 59 of the 93 drugs each caused a single case only. The "Top-10" drugs together caused over 50% of all reactions. The sensitivity of patch testing (percentage of positive reactions) in patients with AGEP is largely unknown, but may generally be ~50%, which also applies to pristinamycin. Patch testing in AGEP appears to be safe, although mild recurrence of AGEP skin symptoms or other rashes may occur occasionally. Clinical aspects of AGEP, including epidemiology, etiology and pathophysiology, clinical features, histology, treatment, and prognosis are briefly presented, as are diagnosing the disease and identifying the culprit drugs with patch tests, intradermal tests, in vitro tests, and challenge tests.

Long-term outcomes of pericardial strip versus prosthetic ring annuloplasty for secondary tricuspid regurgitation by a minimally invasive approach

BackgroundThis study was conducted to compare the outcomes of prosthetic ring versus autologous pericardial strip for the treatment of functional tricuspid regurgitation during left-sided valve surgery by minimally invasive approach.MethodsFrom January 2008 and July 2016, autologous pericardial strip (group P-TAP) was used in 109 patients, and prosthetic ring (group R-TAP) in 115 patients. The primary outcomes were long-term overall survival, development of patch degeneration, and significant tricuspid regurgitation recurrence. The second outcome was the assessment of right ventricular functional parameters.ResultsOperative mortality was 1 case (0.9%) in the R-TAP group. At the time of hospital discharge only one patient (0.9%) in the R-TAP group had grade III+ tricuspid regurgitation, and none had grade IV+. Mean follow-up was 94.1 ± 24.5 months. Mild and moderate tricuspid regurgitation recurrence was 3.7% and 4.5% (P-TAP vs. R-TAP groups, p = 0.99). Severe regurgitation was observed in 1.8% of cases only in the R-TAP group (p = 0.49). There were no reoperations. Late mortality was 3.7% and 5.4% (P-TAP vs. R-TAP groups, p = 0.75). Freedom from death, all causes, were comparable among groups (log-rank p = 0.45). There were no statistically significant differences between two groups in TAPSE, left ventricular end-diastolic diameter, left ventricular ejection fraction, and left atrial diameter.ConclusionsTricuspid annuloplasty using an autologous pericardial strip in patients undergoing minimally invasive surgery is associated to similar long results (survival, late tricuspid regurgitation, and functional echocardiographic parameters) than annuloplasty with a prosthetic ring. In particular, the pericardial strip over time does not develop any degeneration or retraction.