Minimal Invasive Treatment Research Articles

Outcomes of the Fluoroscopically-Guided vs. Computed-Tomography-Guided Transforaminal Epidural Steroid Injection in Low Back Pain: A Propensity-matched Prospective Cohort.

Low back pain (LBP), the most common musculoskeletal condition, imposes a significant burden on healthcare and triggers mental and physical disorders. Before surgery, patients are eligible for minimally-invasive treatments, including transforaminal epidural steroid injection (TFESI). We aimed to compare fluoroscopically- and CT-guided TFESI in patients with subacute (4-12 weeks) and chronic (≥12 weeks) LBP. In this prospective cohort study, 121 adults with subacute or chronic LBP were recruited. Using propensity score matching (PSM), we created two age, sex, and body mass index (BMI) matched groups of fluoroscopically- and CT-guided TFESI, each including 38 patients. The outcomes of interest were the Oswestry disability index (ODI) and numerical rating scale (NRS), which were measured in all patients before the procedure and at the three-month follow-up. Then, the ODI and NRS mean changes were compared between Fluoroscopy and CT groups using repeated measures ANOVA. All analyses were performed with IBM SPSS Statistics for Windows, version 26 (IBM Corp., Armonk, NY, USA). Of the total 76 matched patients with a mean (SD) age of 66.22 (13.49), 81 (66.9%) were female. ODI and NRS scores significantly decreased from baseline to the three-month follow-up in both treatment groups. The ODI score mean change from baseline to follow-up compared between the two groups was insignificant (fluoroscopy vs. CT mean difference (95% CI): 1.092 (-0.333-2.518), P = 0.131). Similarly, the NRS score mean change from baseline to follow-up compared between the two groups was insignificant (fluoroscopy vs. CT mean difference (95% CI): -0.132 (-0.529-0.265), P = 0.511). Fluoroscopically- and CT-guided TFESI show similar therapeutic effectiveness in patients with subacute and chronic LBP.

Whether exercises and testosterone replacement therapy support a treatment for cardiovascular and atherosclerotic patients with iliac artery stenosis and low total testosterone and high-density lipoprotein cholesterol after endovascular procedure?

Serum levels of testosterone (ST) and high-density lipoprotein (HDL) are generally associated with atherosclerosis in male patients over 50 years with critic iliac stenosis (TASC II A and B) and cardiovascular disease with significant changes in HDL and low-density lipoprotein (LDL). In addition to the standard therapy, combined medicamentous therapy and adequate model of exercise are also important factors as medicines can improve HDL levels and primary bypass and endovascular potency impacting positively on improvement of ST or it can be the following testosterone replacement therapy (TRT) comprising cardiovascular disease prevention and vascular treatment as adjunct therapy options after endovascular and vascular surgical procedures. The aim of the study is to identify the association between HDL and ST after surgical and endovascular intervention on the iliac segment (TASCII A and B), as well as cardiovascular risk factors with modified medium activity (MET) <6 with short interval increase over >6 (MET), with total duration of 30–60 minutes. It also attempts to remodel a patient behavioral pattern, optimize ST levels and link them to outcomes and patency of vascular procedures on the iliac segment. Materials and methods. 108 selected male patients with cardiovascular disease combined with metabolic syndrome and critical iliac artery stenosis (TASC II A and B) were examined during 2014–2018, 4 years after invasive and minimal invasive treatment (54 patients were treated with surgical Dacron reconstruction and 54 patients – with endovascular treatment on short segment of critical iliac artery stenosis (TASC II A and B). Results. In the total population, no difference was observed in changes of constraint-induced movement therapy between the standard exercise group and the control one after 4 years from baseline. However, there was no significant interaction between the effect of exercise trainings and primary bypass potency within 4 years. Conclusions. Primary effects of endovascular procedure and Dacron bypass revascularization raise the risk of elevated testosterone levels after 4 years of group training but does not provide adequate answers to questions as to whether higher levels of ST have any major influence on primary bypass potency preventing further progression of cardiovascular disease and general symptomatic and asymptomatic atherosclerosis. However, exercise and TRT can be potential adjunctive therapeutic options for a future supporting postsurgical and endovascular illiac treatment in cardiovascular patients with low testosterone levels.

Endoscopic submucosal dissection for large early squamous cell carcinoma—traction assisted methods

: Endoscopic resection is a minimally-invasive treatment for superficial esophageal tumors compared with surgery or chemoradiation therapy. Endoscopic submucosal dissection (ESD) is a well-established method with accurate histological evaluation and favorable procedural outcomes. However, ESD requires a high level of skill, and is therefore technically challenging and time-consuming. Traction-assisted ESD has been introduced to facilitate ESD and provides adequate submucosal visualization and satisfactory tissue traction. We reviewed the scientific literature in English to evaluate the efficacy of traction-assisted ESD for esophageal lesions, including the clip-with-thread (CT) method and the submucosal tunneling (ST) method. The CT method is a simple and affordable technique that uses commercially available hemoclips. Two randomized controlled trials and two retrospective studies showed that the CT method resulted in shorter procedure times and reduced local injection compared with conventional ESD, and no cases of perforation. The ST method does not require specific devices and facilitates the procedure by securing a stable submucosal visual field and maintaining a submucosal liquid cushion. Two retrospective studies reported shorter procedure times with similar en bloc resection rates and complete resection rates using the ST method compared with conventional ESD. Although a combination of the ST method with the CT method seems to be effective for large lesions, its efficacy and safety should be confirmed by a large-scale study. In the future, robotic traction has a great potential to be a breakthrough for esophageal ESD, providing appropriate and multi-directional traction to the lesions via an operator-controlled robotic arm. There is no doubt that traction assistance is key to facilitating esophageal ESD. Further studies are needed to elucidate the best method from the perspective of efficacy, safety, and cost.

Optimization of the Thin Waveguide for Double-Parabolic-Reflectors Ultrasonic Transducers (DPLUS) for Thermal Ablation.

Interstitial and intracavitary ultra- sound applicators had been developed and studied for minimally invasive treatments (MIT). However, the acoustic outputs are limited by the small-size PZT. We therefore studied the acoustic waveguide (AW) applicator which enables the use of a large-size PZT, and we aimed to advance AW applicators towards thermal ablation applications. Double parabolic reflectors wave-guided ultrasonic transducer (DPLUS) was introduced which has two parabolic reflectors for enhancing the acoustic output. Theoretical modeling was conducted for optimizing the DPLUS thin waveguide. Modeling results showed that optimal a/Λ (thin waveguide radius/wavelength) can be found and the optimal a depends on the excitable vibration amplitude in the thin waveguide. A local optimal a/Λ= 0.2392 was considered the best choice, which results in the optimal frequency of 2.2 MHz at the radius a of 0.6 mm. To verify this optimal frequency, experiments under two working frequencies of 1.0282 MHz and 2.2579 MHz were conducted. Temperature rise curves in the chicken breast tissue showed good agreements between experiments and modeling results, which proved the effectiveness of the modeling. In addition, experiments showed an ablated area with a diameter of 1.03±0.12 mm under continuous excitation of 2.2579 MHz and 5 s. The developed DPLUS advanced the AW applicators towards thermal ablation applications. This study provides the evidence for recognizing AW applicators as a technique for thermal ablation.

Gastric cancer in 2022: Is there still a role for endoscopic ultrasound?

Gastric cancer (GC) represents the fourth leading cause of cancer death worldwide and many factors can influence its development (diet, geographic area, genetic, Helicobacter pylori or Epstein-Barr virus infections). High quality endoscopy represents the modality of choice for GC diagnosis. The correct morphologic classification during a high-resolution endoscopy is fundamental for oncologic diagnosis, staging and therapeutic decisions. Since its initial introduction in clinical practice the endoscopic ultrasound (EUS) has been considered a valuable tool for tumor (T-) and lymph nodes (N-) staging also in GC, in order to establish the best therapeutic strategy for the patient (e.g., upfront surgery vs neoadjuvant treatments). EUS tools as elastography, Doppler and contrast administration can improve diagnosis mainly in case of malignant lymph node evaluation. EUS has a marginal role in disease staging but has a fundamental role in case of a pre-endoscopic resection management and in the new era of endoscopic mucosal resection or submucosal dissection as minimally invasive surgery. Diagnosis and locoregional staging of GC with EUS are a method of inarguable value for the assessment of gastric wall involvement and presence of infiltrated paragastric lymph nodes. EUS can also have a role in disease restaging in those patients who have undergone neoadjuvant treatment. EUS can also have a role in the advanced phases of the disease, in facilitating palliative, minimally-invasive treatments, such as gastroenterostomy or biliary drainages. This review intends to discuss the modern role of EUS in GC topic.

Establishment of an interdisciplinary vascular anomalies program in Tanzania, East Africa.

The aim of this project is the sustainable implementation of a vascular anomalies (VA) program in Tanzania. In 2021 the first interdisciplinary VA program was initiated at Muhimbili National Hospital (MNH), Dar Es Salaam, Tanzania in a stepwise approach. During the planning phase the clinical need for minimally-invasive therapies of VAs and the preexisting structures were assessed by the local Interventional Radiology (IR) team at MNH. During the initiation phase, an IR team from two German VA centers joined the interdisciplinary team at MNH for clinical workup, image-guided procedures and follow-up. VA patients were recruited from existing patient records or seen at clinics as de novo presentations following nationwide advertisement. In the post-processing phase joined online conferences for follow-up and support in management of new patients were established. Further follow-up was supported by attending providers from other established VA centers, traveling to bolster the primary operators of MNH. The first interdisciplinary VA program was successfully launched in Tanzania. Minimally-invasive treatments were successfully trained, by performing ultrasound-guided sclerotherapy with polidocanol and bleomycin in twelve patients with slow-flow malformations, one endovascular embolization of a high-flow malformation, and medical treatment of an aggressive infantile hemangioma. Regular online follow-up presentations have been initiated. Follow-up evaluation and required treatment was sustained when appropriate. The presented "hands-on" training set the ground for the first interdisciplinary VA program in Tanzania. This framework is expected to establish comprehensive and sustainable care of patients with VAs in East Africa and can serve as a blueprint for other sites.

Rezum water vapor thermal therapy for treatment of lower urinary tract symptoms: A retrospective single-centre analysis from a German high-volume centre.

Rezum is a minimal invasive surgical treatment for patients with lower urinary tract symptoms (LUTS) related to benign prostatic enlargement (BPE). The aim of our study was to assess safety and efficacy of the Rezum procedure in a consecutive series of patients. A retrospective study was performed in a single tertiary care hospital in patients undergoing Rezum procedure between 2018 and 2020. All patients that underwent intervention because of drug-refractory moderate to severe LUTS were assessed. Descriptive outcomes such as symptoms scores (IPSS, IPSS-QoL), peak flow in uroflowmetry (Qmax), post-micturition residual urine volume (PVR) and prostate volume (PVol) were analysed. In total, 92 Rezum procedures were performed in the observational period. All interventions were competed without device- or procedure relates adverse events. Patients achieved a significant symptom relief as measured in IPSS (50% reduction, p<0.001, n = 35) and IPSS-QoL score (53% reduction, p<0.001, n = 35). Qmax improved by 7.3 ml/s from 10.6 ± 4.2 ml/s to 17.9 ± 9.3 ml/s (p = 0.003, n = 20) were as mean PVR significantly decreased by 136 ml from 175 ± 194.1 to 39 ± 62 ml (p = 0.007, n = 20). PVol significantly decreased by 40.3% from 73.9 ± 41.2 to 44.9 ± 29 ccm (p = 0.024, n = 17). All pre-interventional catheter-depending patients (28.3% of all patient) were catheter independent after six weeks. Rezum therapy is safe and effective and can be considered a viable treatment option for BPH related LUTS.

Minimal Invasive Treatment Approaches in Pediatric Dentistry

Minimal Invasive Treatment Approaches in Pediatric Dentistry

1109 PULMONARY PRESSUR TREND ANALYSIS IN PATIENTS UNDERGOING MITRACLIP

Abstract Mitral regurgitation (MR) is the second most frequent valve heart disease in Europe and its underlying mechanism primary-organic (due to disease of the mitral leaflets), or secondary-functional (where valve leaflets and chordae are structurally normal and MR results from alterations in left ventricle and left atrium geometry), determines the therapeutic approach. Transcatheter Edge-to-Edge Repair (TEER) with MitraClip implantation is a minimal-invasive treatment that according to 2021 ESC Guidelines should be considered (class of recomandation IIa) in selected symptomatic patients with severe MR despite optimal medical therapy, not eligible for surgery and fulfilling COAPT trial inclusion criteria, suggesting an increased chance of responding to treatment. Optimal valve morphology features for TEER are central pathology (second scallop), no leaflet calcifications, mitral valve area &amp;gt;4cm2, mobile length of posterior leaftel &amp;gt;10 mm, coaptation depth &amp;lt;11mm, normal leaflet strength and mobility, flail width &amp;lt;15 mm, flail gap &amp;lt;10 mm. TEER may be considered (class IIb) only in selected cases when the COAPT criteria are not fulfilled with the aim of improving symptoms and quality of life. MR occurs during systole, that at normal heart rates represents 30-50% of the cardiac cycle. As such, marked left atrial (LA) pressure elevation is present only transiently, representing less of a drive to development of secondary pulmonary hypertension compared to chronic LA pressure elevation seen in severe mitral stenosis. Anyway, in patients with severe MR echocardiography often reveals elevated systolic pulmonary artery pressure (PAPs) and MitraClip implantation usually is associated with a slight increase of the trans-mitral gradient with possible repercussions on pulmonary pressures. To better describe the effect of MitraClip implantation on pulmonary pressures and clinical outcomes we did a retrospective study enrolling in the period 2012-2022 thirty-six patients with severe mitral regurgitation treated with TEER. Compared to the last year presentation, we add eleven patients. The target was still to evaluate the clinical outcomes (symptoms, signs of heart failure, NYHA functional class) and the pulmonary pressures assessed by an echocardiographic examination before and after the intervention. At 6-month follow-up we observed in all patients with repaired mitral regurgitation an improvement in the NYHA class (from IV to II) without re-hospitalization. In addition we notice a more pronounced trend in the reduction of the mean sistolic pulmonary arterial pressure, estimated at around 2.86 mmHg ± 14 mmHg (p 0.24, 95% C.I. -7.69 to 1.94) with an unchanged left ventricle ejection fraction. Moreover, the echocardiographic exam showed a normalization of the S and D waves pattern in the pulmonary veins at the PW Doppler evaluation. These new data reinforced the idea that the clinical improvement and the reduction of dyspnea in these patients underwent TEER is related to a reduction of pressures in the pulmonary circulation regardless of the ejection fraction. This finding could be used as a tool that the cardiologist has to evaluate in the echocardiography lab to reveal a new mitral valve disfunction. Despite the addition of the new patients, the sample is still relatively small. However, considering the improvement of the results with the enlargement of the sample, the goal is to enroll additional patients to make the study even more meaningful.

Pros and cons of splenic artery embolization after mechanical splenic injury - comparison of methods.

Introduction: Mechanical damage of the spleen is a serious therapeutic problem often leading to the death ofthe patient. The constant development of therapeutic methods makes it possible to reduce the percentage ofsevere conditions after damage to this organ. Great hopes are placed on minimal-invasive treatments andprocedures such as embolization.Aim of the study: Compare available research as well as publications and identify advantages anddisadvantages of splenic artery embolization in relation to other methods.Methods and materials: We reviewed the literature available on PubMed and Google Scholar using the words"splenic artery embolization," "blunt splenic trauma," "splenectomy," "splenectomy after trauma," "nonoperativetreatment of blunt splenic trauma".Results: Embolization of the splenic artery combines relatively low invasiveness with very high therapeuticoptions that were once reserved exclusively for surgical management. Embolization significantly reducesmortality in the worst prognosis patients and is recommended during non-operative management.Conclusion: Embolization procedure is found to be superior to other types of management on almost everylevel. In addition, this procedure is an ideal follow-up to non-operative management. However, embolization aswell as any other procedure carried out in the spleen should be considered individually and on many levelsbecause of the important functions performed by this organ.Key words: Blunt trauma to the spleen, embolization, mechanical injury of the spleen, splenic arteryembolization complications;

Attempt to shift from traditional to minimal invasive treatment of congenital diaphragmatic hernia at a low volume center

Congenital diaphragmatic hernia (CDH) remains a significant cause of neonatal morbidity and mortality. During the last 10-years, the progress on minimal invasive surgical techniques, has stimulated many Pediatric Surgical centers to switch from traditional open surgery to thoracoscopic or laparoscopic repair. We report our experience to convert treatment of CDH from traditional to minimal invasive. We have reviewed the charts of 10 neonates with diagnosed CDH over the period 2016–2021. On all of them, we collected pre, intra and post-operative information. Interestingly, none of neonates had prenatal diagnosis of CDH but this didn't impact on morbidity or mortality. None of them was extremely preterm or had major cardiac anomalies. Thoracoscopic or laparoscopic approach was attempted in 3 cases but only in one patient was successful. In the other 2 neonates we had to switch to open surgery because of anatomical conditions. In our opinion, the learning curve needed to achieve minimal invasive treatment of CDH is associated with a high conversion rate often, as a consequence of anatomical conditions.

Factors that influence the outcome of pulpotomy in permanent teeth.

The promotion of minimally invasive treatments focussed on the maintenance of pulp vitality has become a priority area in Endodontics. These vital pulp treatments (VPT) include partial and full pulpotomy, during which diseased coronal pulp tissue is removed prior to placement of a capping biomaterial and restoration. Traditionally, pulpotomies were confined to the treatment of carious primary and traumatized permanent teeth. However, these treatments have now been proposed as definitive solutions for cariously exposed permanent teeth with mild symptoms or even symptoms indicative of irreversible disease. Until recently, it was recommended that carious exposure of mature permanent teeth be managed by root canal treatment. The promotion of pulpotomy as an alternative treatment has opened up a wave of laboratory and clinical research aimed at improving therapies or evaluating clinical outcomes. In modern evidence-based endodontics, it is imperative that the outcomes of both partial and full pulpotomy are considered and important prognostic factors identified, so that improvements can be made to aid clinical decision-making and to direct new research. In this narrative review, the outcomes of partial and full pulpotomy are discussed, before analysis of patient, intraoperative and postoperative factors that influence the outcome of the pulpotomy procedure. The review highlights that although partial and full pulpotomy for the treatment of even pulpal disease are highly successful procedures, this is based on low-quality evidence with a lack of prospective, comparative trials investigating potential prognostic factors. Based on current evidence, it appears that age, gender, tooth type, root development and intraoperative pulpal haemorrhage do not impact significantly on pulpotomy outcome, whilst others such as caries depth, inflammatory status of the pulp, capping material, level of inflammatory pulpal-biomarkers and the final restoration integrity do. Other factors, including the influence of exposure type, periodontal condition, pulpal lavage, magnification, operator experience, isolation of the operating field and type of pulpotomy, require further experimental investigation before definitive conclusions can be made relating to the success of the pulpotomy procedure. Finally, there is not only a need for future well-designed prospective research addressing these issues but also a widening of our understanding of outcome to include patient-reported as well as clinician-reported outcomes.

Osteolytic metatarsal osteomyelitis regenerated by combined treatment of artificial carbon dioxide foot bathing and povidone–iodine sugar ointment: a case report

BackgroundIn recent years, the number of patients with ischemic skin ulcers due to diabetes mellitus and arteriosclerosis obliterans are increasing. Accordingly, endovascular therapy, drugs, and various wound dressings have been developed and applied to diabetic foot ulcers, and negative-pressure wound therapy, which often requires expensive and burdensome procedures for medical personnel, has also become popular. So simple and minimal invasive home treatment by the patient or their caregiver is required.Case presentationThe present patient (77 years old, male, Asian) had developed left sole ulcers with draining pus that were resistant to conventional treatment, and he suffered from gait disturbance. We report a case of metatarsal osteomyelitis in a patient with diabetes mellitus and arteriosclerosis obliterans, in whom artificial carbon dioxide foot bathing and povidone–iodine sugar ointment were used continuously to promote bone and joint regeneration, and skin ulcer healing.ConclusionsA simple therapeutic intervention with artificial carbon dioxide foot bathing and povidone–iodine sugar ointment can improve not only ischemic skin ulcers, but also the bone and joint regeneration of ischemic limbs. This therapy can lead to a reduction in healthcare costs for a huge number of diabetic patients.

Patient preferences for treatment modalities for localised prostate cancer.

To assess the patient preferences and utility scores for the different conventional and innovative treatment modalities for localised prostate cancer (PCa). Patients treated for localised PCa and healthy volunteers were invited to fill out a treatment-outcome scenario questionnaire. Participants ranked six different treatments for localised PCa from most to least favourable, prior to information. In a next step, treatment procedures, toxicity, risk of biochemical recurrence and follow-up regimen were comprehensibly described for each of the six treatments (i.e. treatment-outcome scenarios), after which patients re-ranked the six treatments. Additionally, participants gave a visual analogue scale (VAS) and time trade-off (TTO) score for each scenario. Differences between utility scores were tested by Friedman tests with post hoc Wilcoxon signed-rank tests. Eighty patients and twenty-nine healthy volunteers were included in the study. Before receiving treatment-outcome scenario information, participants ranked magnetic resonance-guided adaptive radiotherapy most often as their first choice (35%). After treatment information was received, active surveillance was most often ranked as the first choice (41%). Utility scores were significantly different between the six treatment-outcome scenarios, and active surveillance, non- and minimal-invasive treatments received higher scores. Active surveillance and non-invasive treatment for localised PCa were the most preferred options by PCa patients and healthy volunteers and received among the highest utility scores. Treatment preferences change after treatment information is received.

Position paper from the Endocrine Task Force of the European Organisation for Research and Treatment of Cancer (EORTC) on the management and shared decision making in patients with low-risk micro papillary thyroid carcinoma

The incidence of differentiated thyroid cancer (DTC) has been increasing worldwide, mostly, as an increase in the incidental detection of micro papillary thyroid carcinomas (microPTCs), many of which are potentially overtreated, as suggested by the unchanged mortality. Several international guidelines have suggested a less aggressive approach. More recently, it has been shown that active surveillance or minimally invasive treatments (MIT) are good alternatives for the management of these patients. In this context, patient participation in the decision-making process is paramount. The Endocrine Task Force of the European Organisation for Research and Treatment of Cancer (EORTC) has undertaken the task to establish consensus and define its position based on the scientific evidence concerning, 1) the current state of diagnostic and management options in microPTCs, including the current opinion of physicians about shared decision making (SDM), 2) the available evidence concerning patients' needs and the available decision instruments, and 3) to provide practical suggestions for implementation of SDM in this context. To improve SDM and patients' participation, knowledge gaps and research directions were highlighted.

DESIGN, KINEMATICS AND MANIPULABILITY ANALYSES OF A SERIAL-LINK ROBOT FOR MINIMALLY INVASIVE TREATMENT IN FEMORAL SHAFT FRACTURES

The application of robot in orthopedic clinical surgery is more and more accepted. A femoral fracture reduction robot is described in the paper. The mechanism of the manipulator comprises a six-DOF serial-link robot, referred to as a 3P3R robot, with three prismatic joints and three rotational joints (including one for the knee). The manipulability of the system was analyzed, and its operability over the entire whole work space was verified. In addition, the existence of an inverse kinematic solution of the system was established, and the same was analytically implemented with physical meaningfulness. The kinematic analysis and investigation of the workspace confirmed the feasibility of the mechanism for the given design parameters. The joint displacements and rotation angles required to achieve the desired posture of the end-effector of the mechanism were also determined. The results of simulation substantiated the effectiveness of the developed robotic system, and its prospect for practical application through further research.

Percutaneous Nephrostomy in the Treatment of Hydronephrosis in Renal Transplant Patients - Case Report.

Percutaneous nephrostomy is a first-line minimal invasive treatment option for ureteral obstruction following kidney transplantation, with high effectiveness and a low complication rate. Percutaneous nephrostomy might be used as a temporary salvage therapy, providing acute decompression of the kidney collecting system and preventing graft loss. It can also function as a permanent and sometimes only possible option in transplant patients with frequent recurrences of ureteral stenosis who either fail an open surgical reconstruction or who are not good candidates for these procedures. We present two patients with acute decline in urine output after renal transplantation with radiologically verified hydroureteronephrosis of the transplanted kidney (graft) caused by stenosis of distal ureter. In both cases, nephrostomy was placed within 48 hours as a temporary salvage treatment that ameliorates renal function and prevents graft loss. The permanent nephrostomy was the only possible solution for the preservation of the graft's function in the first case because of the recurrences of ureteral stenosis after several percutaneous interventions and open-surgery ureteral reconstruction. A few episodes of nephrostomy tube-related infections were resolved with antibiotics in the first case. The second case was treated with open ureteroneocystostomy with resection of stenotic segment and reinsertion of the ureter into the bladder (ureterocystoneostomy) because of the length of the involved ureteral segment. Both patients had stable graft function in the follow-up period.

Percutaneous Nerve Block Catheter; A Novel Minimal Invasive Treatment for Patients with Abdominal Cutaneous Nerve Entrapment Syndrome (ACNES)

Anterior cutaneous nerve entrapment syndrome (ACNES) is a commonly overlooked [1] and ill understood cause of abdominal pain resulting in unnecessary, costly and potentially harmful diagnostic procedures. The pain is often severe and can have a debilitating effect on the patient’s quality of life.

Clinical Evaluation of Different Minimal Invasive Treatment Modalities of Mild to Moderate Dental Fluorosis Using an Intra-oral Spectrophotometer

BACKGROUND: Various treatment modalities are available to improve esthetics of fluorosed teeth based on its severity. AIM: The aim of the study was to evaluate the clinical performance of different minimal invasive treatment protocols on mild to moderate fluorosed teeth. METHODS AND MATERIALS: Before the interventions, tooth color coordinates L, a and b were recorded for 160 fluorosed teeth by Vita Easyshade V. Participants were randomly allocated in eight treatment protocols with 20 teeth (n = 20) included in each protocol. Protocol one (P1) Opalescence boost PF 40%. Protocol two (P2) Opalustre. Protocol three (P3) MI-Paste Plus. In protocol four (P4) teeth were treated with Opalustre followed by Opalescence boost PF 40%. In protocol five (P5) Opalescence boost PF 40% was applied followed by MI-Paste Plus, while in protocol six (P6) Opalustre was applied followed by MI-Paste Plus whereas protocol seven (P7) teeth were treated with Opalustre, followed by Opalescence boost PF 40% and finally MI-Paste Plus. Protocol eight (P8) control. All teeth were evaluated immediately for color change (ΔE) after treatment (T1), after 14 days (T2), after 3 months (T3) and after 6 months (T4). Color change (ΔE) was calculated from ΔL, Δa, and Δb recorded at each evaluation time point. STATISTICAL ANALYSIS: Two-way ANOVA was applied to test the interaction between different variables. ANOVA repeated measures were followed by Duncan multiple range tests (DMRTs) to compare between groups. RESULTS: In accordance to time, all treatment protocols showed significant color change can be recognized by unexperienced eye (ΔE ≥ 3.7). Immediately after application (T1), the highest color change (ΔE) was recorded in P7. While at 14 days and 3 months follow ups, color change in P4 exceeded P7. After 6 months the highest ΔE was recorded in both P4 and P7 with no significant difference between them. Meanwhile, in Accordance to treatment Protocol, The highest color change was recorded at 3 months (T3) in all treatment protocols. These records were preserved at 6 months follow-up (T4) for all treatment protocols except P1 and P3. CONCLUSION: Combined treatment protocols of Opalustre and Opalescence boost PF 40% have the highest effect on ΔE regardless of using MI-Paste Plus. MI-Paste Plus provides stability of ΔE results at 6 months’ follow-up.

Minimally invasive vs. open segmental resection of the splenic flexure for cancer: a nationwide study of the Italian Society of Surgical Oncology-Colorectal Cancer Network (SICO-CNN)

BackgroundEvidence on the efficacy of minimally invasive (MI) segmental resection of splenic flexure cancer (SFC) is not available, mostly due to the rarity of this tumor. This study aimed to determine the survival outcomes of MI and open treatment, and to investigate whether MI is noninferior to open procedure regarding short-term outcomes.MethodsThis nationwide retrospective cohort study included all consecutive SFC segmental resections performed in 30 referral centers between 2006 and 2016. The primary endpoint assessing efficacy was the overall survival (OS). The secondary endpoints included cancer-specific mortality (CSM), recurrence rate (RR), short-term clinical outcomes (a composite of Clavien-Dindo > 2 complications and 30-day mortality), and pathological outcomes (a composite of lymph nodes removed ≧12, and proximal and distal free resection margins length ≧ 5 cm). For these composites, a 6% noninferiority margin was chosen based on clinical relevance estimate.ResultsA total of 606 patients underwent either an open (208, 34.3%) or a MI (398, 65.7%) SFC segmental resection. At univariable analysis, OS and CSM were improved in the MI group (log-rank test p = 0.004 and Gray’s tests p = 0.004, respectively), while recurrences were comparable (Gray’s tests p = 0.434). Cox multivariable analysis did not support that OS and CSM were better in the MI group (p = 0.109 and p = 0.163, respectively). Successful pathological outcome, observed in 53.2% of open and 58.3% of MI resections, supported noninferiority (difference 5.1%; 1-sided 95%CI − 4.7% to ∞). Successful short-term clinical outcome was documented in 93.3% of Open and 93.0% of MI procedures, and supported noninferiority as well (difference − 0.3%; 1-sided 95%CI − 5.0% to ∞).ConclusionsAmong patients with SFC, the minimally invasive approach met the criterion for noninferiority for postoperative complications and pathological outcomes, and was found to provide results of OS, CSM, and RR comparable to those of open resection.