Minor Recurrence Research Articles

Computer Tomography (CT)-Based Study to Investigate Feasibility and Efficacy of Thoracoscopic Surgery in the Treatment of Penetrating Chest Wall Tuberculosis.

Chest wall tuberculosis may develop if tuberculous (TB) lesions spread through the chest wall and invade the thoracic cavity. The presence of a mass on the patient's chest wall may be the first indication of TB, and a chest CT scan can help diagnose external penetrating chest wall TB, the incursion of tuberculosis from the lungs into the chest wall. This study examines the safety and efficacy of thoracoscopic-assisted surgery for the treatment of penetrating chest wall tuberculosis as a means of exploring novel concepts of minimally invasive surgery. Our hospital conducted a retrospective study of 25 patients with penetrating chest wall TB who underwent thoracoscopic surgery between January 2020 and June 2021. General demographics, CT scan data linked to surgery, and postoperative patient outcomes were compared between the two groups. The data was also evaluated to determine the range of operation time and the volume of bleeding from different foci in the thoracic cavity. All procedures went well after patients took conventional antituberculosis medication for at least two weeks prior to surgery. CT scans showed that thoracoscopic surgery needed a smaller incision than traditional chest wall TB surgery, with no discernible increase in surgical time. Postoperative tube use, length of hospital stay, and blood loss were all significantly lower than they would have been with conventional surgery. In addition, thoracoscopy was associated with a significantly reduced rate of subsequent treatment. Fibrous plate development and calcification caused the longest operation times in the thoracoscopic surgery group, whereas multiple pleural tuberculomas generated the most hemorrhage. Thoracoscopic surgery usually reveals tuberculous foci hiding in the thoracic cavity. Thethoracic surgery can eliminate the TB focus in the chest wall and intrathoracic while treating penetrating chest wall tuberculosis. The CT scan is a crucial part of the diagnostic process for these patients. Minor surgical trauma, low complication and recurrence rates, and good results. There is a greater distinction between the two surgical approaches for patients with penetrating chest wall TB as opposed to those with basic chest wall tuberculosis.

Safety and efficacy of clot-dissolving therapies for submassive pulmonary embolism: A network meta-analysis of randomized controlled trials

BackgroundAcute pulmonary embolism (PE) is a serious condition that needs quick and effective treatment. Anticoagulation therapy is the usual care for most PE patients but may not work well for higher-risk ones. Thrombolysis breaks the clot and improves blood flow. It can be given systemically or locally. Ultrasound-assisted catheter-directed thrombolysis (USAT) is a new technique that boosts clot-busting drugs. This network meta-analysis compares death, bleeding, and benefits of four treatments in acute submassive PE. MethodsWe comprehensively searched relevant databases up to July 2023 for RCTs. The outcomes encompassed all-cause mortality, major and minor bleeding, PE recurrence, and hospital stay duration. Bayesian network meta-analysis computed odds ratios (OR) and 95 % CI estimates. ResultsIn this network meta-analysis of 23 RCTs involving 2521 PE patients, we found that SCDT had the most favorable performance for mortality, as it had the lowest odds ratio (OR) among the four interventions (OR 5.41e−42; 95 % CI, 5.68e−97, 1.37e−07). USAT had the worst performance for major bleeding, as it had the highest OR among the four interventions (OR 4.73e+04; 95 % CI, 1.65, 9.16e+13). SCDT also had the best performance for minor bleeding, as it had the lowest OR among the four interventions (OR 5.68e−11; 95 % CI, 4.97e−25, 0.386). ConclusionOur meta-analysis suggests that SCDT is the most effective treatment intervention in improving the risks of All-cause mortality and bleeding. Thrombolytic therapy helps in improving endpoints including the risk of PE recurrence and the duration of hospital stay.

Canine distichiasis cryoepilation using a liquid nitrogen‐cooled, closed probe transconjunctival triple‐freeze technique: Outcomes in 125 dogs (234 eyes)

AbstractPurposeTo describe a simple cryosurgical technique for treating canine distichiasis, its success rate and any associated complications.MethodsClinical records from canine patients undergoing treatment for distichiasis using a specific cryotherapy technique were retrospectively reviewed. The technique employed a triple freeze–thaw cycle via a transconjunctivally applied, liquid nitrogen‐cooled, 2‐mm diameter closed cryoprobe.ResultsThe cryotherapy technique was employed in 125 dogs with distichiasis over a period of 13 years, with 109 (87%) bilaterally and 16 (13%) unilaterally affected, totaling 234 eyes. The mean age at diagnosis was 1.9 years (4 months to 7.5 years), with Staffordshire bull terriers the most common breed (31%). Treatment was deemed successful if clinical signs related to distichiasis resolved, including blepharospasm, conjunctival hyperemia and excess lacrimation. A single triple‐freeze cryotherapy treatment eliminated distichiae in 195/234 (83%) eyes at a mean follow‐up of 4 months (2 weeks to 10 years). Minor recurrence of distichiae in previously treated regions was observed in 39/234 (17%) eyes. Repeat cryotherapy was required in 25/234 (11%) eyes, with the remaining eyes asymptomatic. The two most common postoperative complications were mild to moderate eyelid swelling in all eyes immediately following surgery and eyelid margin depigmentation in 59/234 eyes (25%) between two and 4 weeks postoperatively, both of which were temporary.ConclusionThis cryotherapy technique for treating canine distichiasis is relatively simple and safe to perform, has a high success rate and a low recorded complication rate, but would benefit from further assessment of any potential detrimental effects on qualitative tear film components.

Outcomes of Non-intubated Versus Intubated Thoracoscopic Surgery for Primary Spontaneous Pneumothorax.

This study aimed to compare the outcomes of non-intubated video-assisted thoracic surgery (N-VATS) and intubated video-assisted thoracic surgery (I-VATS) for primary spontaneous pneumothorax (PSP). We retrospectively analyzed 120 consecutive patients who underwent VATS for PSP. The patients were divided into N-VATS and I-VATS groups. Demographics, clinical characteristics, postoperative results, pain scores, follow-up results, and management were evaluated and compared between the groups. Local anesthesia and deep sedation (ketamine 2mg/kg IV and propofol 2mg/kg IV slow infusion) were administered under spontaneous ventilation in the N-VATS group. The groups did not differ significantly in terms of age, sex, American Society of Anesthesiology score, pneumothorax side, or smoking history ( P >0.05). The mean operation time, anesthesia time, oral intake opening time, and mobilization time were significantly shorter in the N-VATS group (26.04±4.61 vs. 48.26±7.82min, 42.14±6.40 vs. 98.16±12.4min, 2.1±0.4 vs. 8.4±1.2h, and 4.2±0.9 vs. 2.6±1.4 between N-VATS and I-VATS, respectively; P <0.05). The surgical outcomes did not differ in terms of minor complications (12%-13%) and recurrence rates (5.1%-6.4%) during a mean follow-up period of 88.4±10.2mo. No cases of conversion to open surgery or mortality were observed. General anesthesia and intubation were not required for any patient in the N-VATS group. Our results revealed no differences in minor complications or recurrence rates between groups. However, the N-VATS group had significantly shorter operation, anesthesia, oral intake opening, and mobilization times. The most important advantage of N-VATS for PSP is its fast recovery while avoiding the risks of general anesthesia and intubation. Further prospective studies with larger sample sizes are warranted.

Evaluation of Micro-Needling Followed by Tranexamic Acid Cream versus Micro-Needling Followed by Tranexamic Acid Solution in Treatment of Melasma: A Comparative Split Face Study

Abstract Background Melasma is a common pigmentary disorder clinically characterized by symmetric light brown to bluish-gray macules and patches with irregular, sharp borders that affect cutaneous areas, particularly the face and neck. It is commonly identified in women of reproductive ages and more commonly described in darker-skinned patients with Fitzpatrick skin types IV to VI residing in high-intensity ultraviolet radiation worldwide. It causes significant cosmetic disfigurement, psychosocial stress, and embarrassment, affecting patients’ quality of life. Objectives To evaluate the efficacy and safety of microneedling followed by tranexamic acid (TXA) cream application versus microneedling followed by tranexamic acid solution in the treatment of facial melasma. Patients and Methods This prospective split-face comparative study included thirty female patients with different types of melasma, their ages ranged from 25 to 40 years. They were recruited from the Dermatology outpatient clinic of Ain Shams University Hospitals. All patients have been treated with TXA for 3 sessions; one session every month (the right side of the face was treated by microneedling followed by TXA 5 % cream while the left side of the face was treated by microneedling followed by TXA solution 5%). Additionally, the right side of the face was treated with TXA 5% cream, and the left side applied with placebo cream twice daily for 3 months. Assessment was done by Hemi Melasma Area and Severity Index score (Hemi -MASI), patients’ satisfaction score, clinical digital photography, dermoscopic examination and area percentage of melanin concentration assessed by histopathological examination. Results Our findings showed significant improvement in different types of melasma regarding Hemi MASI score, patients’ satisfaction score, and area percentage of melanin concentration assessed by histopathological examination by Fontana-Masson stain (FM) one month after 3rd treatment session in both sides of the face. However, a minor melasma recurrence was observed two months after 3rd treatment session on both sides of the face. Meanwhile, no significant difference was observed in the treatment response of microneedling followed by TXA cream versus microneedling followed by TXA solution one month after 1st and 2nd sessions regarding Hemi MASI score, while a significant difference was observed one month after the 3rd session. Conclusion Topical TXA appears to be a promising therapeutic option in the treatment of melasma without serious adverse effects. Topical TXA cream, which was applied twice daily by the patient combined with microneedling sessions with TXA cream, has better results in comparison with microneedling sessions with TXA solution with placebo cream.

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.

Parastomal hernia repair: a five-year experience from a single centre in the UK.

Parastomal hernias can affect significantly quality of life in patients who often had underwent major operations. The incidence and recurrence is still high although many techniques have been introduced to improve outcomes. Hence, there is still no agreement on what procedure has better results when it comes to repairing a parostomal hernia. Our aim is to compare outcomes of laparoscopic and open parastomal hernia repair in terms of recurrence, reoperations, post-operative complications and length of stay. Sixty-three parastomal hernia repairs were performed in a single Colorectal Centre over a period of 4years. Eighteen procedures were performed laparoscopically and 45 open. All the 7 emergency procedures were approached open. Both the techniques showed to be safe with post-operative major complication rate (Clavien-Dindo III or above) of 9.52%. The laparoscopic group was found to have a shorter length of stay (p = 0.04) and earlier start of stoma function (p = 0.01), more uneventful recoveries (0.02) and less minor post-operative complications (Clavien-Dindo I or II-p = 0.01,) but similar recurrence rate (p = 0.41). In the open group, the placement of a mesh showed to reduce the rate of recurrence (p = 0.0001). However, this was not found in the laparoscopic approach. In conclusion, the laparoscopic approach showed do give less post-operative complications and a shorter length of stay, with no benefit in the recurrence rate. Considering the open technique, the use of a mesh seemed to reduce the rate of recurrence.

Abstract B124: Food accessibility and its impact on clinical outcomes in patients undergoing surgery for pancreatic ductal adenocarcinoma

Abstract Accessing healthy food is paramount to one’s nutritional status, a known factor in postoperative morbidity and long-term mortality. The relationship between a patient’s food accessibility and outcomes following surgical resection in pancreatic ductal adenocarcinoma (PDAC) is unknown. The objective of this study was to compare postoperative outcomes and long-term survival of PDAC patients residing in low and high food accessibility areas who underwent surgical resection. Adult PDAC patients undergoing surgical resection at a single tertiary academic center from 2011 to 2021 were identified retrospectively. Patient addresses were mapped onto the United States Department of Agriculture (USDA) Food Access Research Atlas to determine food accessibility status. Those with residence in areas designated by the USDA as having limited access to healthy food were classified as having “low food accessibility” (LFA). Those not classified as having LFA were labeled as having “high food accessibility” (HFA). Demographics, comorbidities, neoadjuvant treatment status, tumor characteristics, postoperative complications, hospital stay characteristics, overall survival, and recurrence rates were collected. Data were evaluated using descriptive statistics and Cox-Proportional Hazard models for survival. In total, 89 patients met inclusion criteria, of which 23 (25.8%) patients resided in areas of LFA. No significant differences existed in patient age, sex, or other sociodemographics. Patient BMI was higher for LFA patients than HFA patients (28.3 vs 24.6, p = 0.0070). Major comorbidities were comparable except for an increased rate of diabetes in LFA patients (56.5% vs 29.2%, p = 0.0194). Both groups underwent neoadjuvant treatment at similar rates. Tumor grade was significantly different for the groups with LFA patients having higher rates of poor differentiation compared to HFA patients (39.1% G3 vs 9.4% G3, p = 0.0015). Lymphovascular invasion, perineural invasion, and number of positive lymph nodes were similar. Minor complications, readmission, and recurrence did not demonstrate differences between groups but LFA patients suffered from higher rates of major complication (52.2% vs 27.3%, p = 0.0296). Total hospital length of stay and ICU length of stay were also similar. Overall survival was 12.1 months in LFA patients and 15.2 months in HFA patients but was not significantly different (p = 0.16). Low food accessibility is associated with greater rates of major complications in PDAC patients undergoing tumor resection yet does not significantly impact overall survival in this deadly disease. Awareness of patient food accessibility status may be beneficial in recognizing those who might benefit the most from nutritional prehabilitation and those less able to act on nutritional recommendations. Citation Format: Christopher M. Liu, Devon C. Freudenberger, Salem Rustom, Vignesh Vudatha, Shreya Raman, Teja Devarakonda, Kelly M. Herremans, Andrea N. Riner, Luke Wolfe, Jose G. Trevino. Food accessibility and its impact on clinical outcomes in patients undergoing surgery for pancreatic ductal adenocarcinoma [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B124.

A Squamous Cell Carcinoma Presenting as a Giant Cutaneous Horn over the Lower Lip in a Patient with Chronic Disseminated Lupus Erythematosus.

A Squamous Cell Carcinoma Presenting as a Giant Cutaneous Horn over the Lower Lip in a Patient with Chronic Disseminated Lupus Erythematosus.

Clinical, Radiological, and Outcome Characteristics of Acute Pulmonary Embolism: A 5-year Experience from an Academic Tertiary Center.

Background: Acute pulmonary embolism (PE) is a common and potentially life-threatening condition. This comprehensive study from a Gulf Cooperation Council (GCC) country aimed to evaluate the clinical, radiological, and outcome characteristics associated with acute PE.Methods: This retrospective observational study analyzed data of patients with confirmed acute PE who were admitted to the largest academic tertiary center in the State of Qatar from January 1, 2014, to December 31, 2018. Data on the clinical presentation, radiologic, and echocardiographic findings, as well as outcomes were collected.Results: A total of 436 patients were diagnosed with acute PE during the study period (male, 53%). Approximately 56% of the patients were < 50 years old at presentation, with a median age of 47 years. In approximately 69% of cases, the PE occurred outside the hospital. The main associated comorbidities were obesity (34.6%), hypertension (29.4%), and diabetes (25%). Immobilization (25.9%) and recent surgery (20.6%) were the most common risk factors. The most frequent presenting symptom was dyspnea (39.5%), and the most frequent signs were tachycardia (49.8%) and tachypnea (45%). Cardiac arrest was the initial presentation in 2.2% of cases. Chest X-ray findings were normal in 41%. On computed tomography pulmonary angiography (CTPA), 41.3% of the patients had segmental PE, 37.1% had central PE, and 64.1% had bilateral PE. The main electrocardiographic (ECG) abnormality was sinus tachycardia (98%). In patients who underwent echocardiography, right ventricular (RV) enlargement was the main echocardiographic finding (36.4%). Low-, intermediate-, and high-risk PE constituted 49.8%, 31.4%, and 18.8% of the cases, respectively. Thrombolysis was prescribed in 8.3% of the total and 24.4% of the high-risk PE cases. Complications of PE and its treatment (from admission up to 6 months post-discharge) included minor bleeding (14%), major bleeding (5%), PE recurrence (4.8%), and chronic thromboembolic pulmonary hypertension (CTEPH) (5%). A total of 15 (3.4%) patients died from PE.Conclusions: Acute PE can manifest with complex and variable clinical and radiological syndromes. Striking findings in this study are the younger age of acute PE occurrence and the low PE-related mortality rate.

Comparison of Long-Term Angiographic Results of Wide-Necked Intracranial Aneurysms : Endovascular Treatment with Single-Microcatheter Coiling, Double-Microcatheter Coiling, and Stent-Assisted Coiling.

ObjectiveEndovascular treatment of intracranial aneurysms is challenging in case of wide-necked aneurysms because coils are prone to herniate into the parent artery, causing thromboembolic events or vessel occlusion. This study aims to compare long-term angiographic results of wide-necked aneurysms treated by stent-assisted, double-microcatheter, or single-microcatheter groups. MethodsBetween January 2003 and October 2016, 108 aneurysms that were treated with endovascular coil embolization with a neck size wider than 4 mm and a follow-up period of more than 3 years were selected. We performed coil embolization with single-microcatheter, double-microcatheter, and stent-assisted techniques. Angiographic results were evaluated using the Raymond-Roy occlusion classification (RROC). All medical and angiographic records were reviewed retrospectively. ResultsClinical and angiographic analyses were conducted in 108 wide-necked aneurysms. The immediate post-procedural results revealed RROC class I (complete occlusion) in 66 cases (61.1%), class II (residual neck) in 36 cases (33.3%), and class III (residual sac) in six cases (5.6%). The final follow-up results revealed class I in 48 cases (44.4%), class II in 49 cases (45.4%), and class III in 11 cases (10.2%). Of a total of 45 (41.6%) radiologic recurrences, there were 21 cases (19.4%) of major recurrence that required additional treatment, and 24 cases (22.2%) of minor recurrence. The final follow-up angiographic results showed statistically significant differences between the stent-assisted group and the others (p<0.01). ConclusionLong-term follow-up angiography demonstrated that the stent-assisted technique had a better complete occlusion rate than the other two techniques.

Efficacy and safety of rivaroxaban in the treatment of deep vein thrombosis

Objectives: This study aims to present the clinical results of patients administered rivaroxaban for the treatment of deep vein thrombosis (DVT) in terms of efficacy and safety. \ Methods: A total of 50 patients (30 males, 20 females age range 25 to 88 years) diagnosed with DVT had received rivaroxaban treatment in the department of medicine, Chhattisgarh Institute of Medical Science (CIMS) Bilaspur Chhattisgarh India. between September 2018 and august 2020 were included in the study. Deep vein thrombosis diagnoses of the patients were confirmed by Doppler ultrasonography. The patients’ epidemiological and biochemical values were evaluated. Major- minor bleeding and recurrence that occurred during rivaroxaban treatment was investigated. Results: Patients were treated for 3, 6, or 12, months, according to flow up and result. When anticoagulant treatments of the patients were examined, 15 patients (30%) were treated with rivaroxaban as initial treatment and 35 patients (70%) had transitioned from warfarin to rivaroxaban treatment. In patients using rivaroxaban, one patient had hypermenorrhea and two patients had epistaxis. Major bleeding was not detected. While three patients had alanine aminotransferase levels up to two times higher than the normal limit, none of the patients had clinically significant liver or kidney failure. Recurrent DVT or pulmonary embolism was not detected in the patients. Conclusion: According to the current guidelines and literature findings novel oral anticoagulants could be used safely and efficiently as first-line drug therapy in DVT patients due to their non-inferior effectiveness to warfarin and lower side effect profile.

Predictors of healing, ulcer recurrence and persistence, amputation and mortality in type 2 diabetic patients with diabetic foot: a 10-year retrospective cohort study.

Predictors of outcome of diabetic foot ulcer (DFU) are important to improve the management of patients. Aim of the study was to find these predictors in type 2 diabetic patients with DFU. We recruited 583 patients. They were followed-up by a multidisciplinary team. A holistic and conservative approach was used and all risk factors and co-morbidities were aggressively treated. During the follow-up period, 79.6% of patients healed in a mean time of 7.6 ± 3.8 months, 6.9% showed DFU persistence, 9.9% had minor amputations, and 3.6% experienced major amputation. Seventeen percent of the patients died. Among patients who healed, 37.1% of them showed DFU recurrence. Impairment of renal function was associated to DFU persistence, amputation, and mortality. Previous cardiovascular disease predicted DFU persistence, DFU recurrence, and mortality. Lower BMI predicted DFU persistence and mortality. Osteomyelitis was a predictor of amputation and death. Markers of peripheral artery disease (PAD) predicted minor amputation and DFU recurrence. Our study shows a relatively low incidence of complications of DFU. Some predictors of outcome of DFU were confirmed and new predictors, like BMI and markers of PAD, were found. Our new findings suggest future strategies for nutrition support and revascularization. In addition, a holistic and conservative approach may improve the prognosis.

Tranexamic acid for bleeding in a child with extensive small bowel angiodysplasia

Abstract Gastrointestinal (GI) angiodysplasia is a rare cause of lower GI bleeding in the paediatric population. This disease caused intermittent per-rectal bleeding and severe anemia in 2-year-old girl with Turner's syndrome. She was initially suspected to have Meckel's diverticulum and taken to the operation room for laparoscopy. A Meckel's diverticula was not found but an extensive distribution of abnormal vessels on the surface of the small bowel was noted from close to the duodeno-jejunal junction to the terminal ileum. GI angiodysplasia was suspected but the lesion was too extensive to be resected. It was also not clear if any specific area was the source of the current bleeding. After conversion to open surgery, an enterotomy was done in the mid portion of the affected bowel and an on table enteroscopy was done. This revealed a normal mucosal lining in the visualized areas and so was not contributory. Prior to closure of the enterotomy a doughnut of bowel was taken for histopathology. This confirmed small bowel angiodysplasia. She had one minor recurrence of lower GI bleeding 4 months later but has been well since then. This case sheds light on angiodysplasia as a cause of lower GI bleeding and we discuss its diagnostic and management options.

The Hydrogel Endovascular Aneurysm Treatment Trial (HEAT): A Randomized Controlled Trial of the Second-Generation Hydrogel Coil.

BACKGROUNDAneurysm recurrence after coiling has been associated with aneurysm growth, (re)hemorrhage, and a greater need for follow-up. The second-generation HydroCoil Embolic System (HES; MicroVention, Inc) consists of a platinum core with integrated hydrogel and was developed to reduce recurrence through enhancing packing density and healing within the aneurysm.OBJECTIVETo compare recurrence between the second-generation HES and bare platinum coil (BPC) in the new-generation Hydrogel Endovascular Aneurysm Treatment Trial (HEAT).METHODSHEAT is a randomized, controlled trial that enrolled subjects with ruptured or unruptured 3- to 14-mm intracranial aneurysms amenable to coiling. The primary endpoint was aneurysm recurrence using the Raymond-Roy scale. Secondary endpoints included minor and major recurrence, packing density, adverse events related to the procedure and/or device, mortality, initial complete occlusion, aneurysm retreatment, hemorrhage from target aneurysm during follow-up, aneurysm occlusion stability, and clinical outcome at final follow-up.RESULTSA total of 600 patients were randomized (HES, n = 297 and BPC, n = 303), including 28% with ruptured aneurysms. Recurrence occurred in 11 (4.4%) subjects in the HES arm and 44 (15.4%) subjects in the BPC arm (P = .002). While the initial occlusion rate was higher with BPC, the packing density and both major and minor recurrence rates were in favor of HES. Secondary endpoints including adverse events, retreatment, hemorrhage, mortality, and clinical outcome did not differ between arms.CONCLUSIONCoiling of small-to-medium aneurysms with second-generation HES resulted in less recurrence when compared to BPC, without increased harm. These data further support the use of the second-generation HES for the embolization of intracranial aneurysms.

Onychoplasty with 1064-nm Laser: Matrixectomy for Treatment of Ingrown Toenails.

Onychocryptosis is a common pathology treated by podiatry medical services, and in a considerable percentage, surgical procedures are required to achieve a solution. There are multiple surgical approaches for ingrown toenails, both incisional procedures and nonincisional procedures, such as chemical matrixectomies and physical matrixectomies using carbon dioxide laser. This study presents a surgical procedure for onychocryptosis using a physical matrixectomy with a 1064-nm laser applied by means of a 400-μm optical fiber and surgical removal of the posterior cauterized tissue to achieve healing by primary intention. This technique was performed on 30 patients with onychocryptosis affecting the great toe (Mozena stages I and IIa), and all of the patients were followed up postoperatively for 12 months. The patients reported minimal postoperative pain, quicker surgical postoperative healing, rapid return to activities of daily living, and minor postoperative recurrence compared with previous studies using incisional procedures and chemical matrixectomies.

Diode laser assisted excision of a gingival pyogenic granuloma: A case report.

Pyogenic granuloma is a non-neoplastic, exuberant, reactive lesion seen in response to local irritation or trauma caused by dental calculus, bacterial plaque, caries and restorations, with a strong predilection for the gingiva. It is among the frequently encountered oral lesions, occurring at a challenging oral site, the gingiva. Herein, we report a 71-year-old medically compromised Caucasian female who presented with a relatively large lobulated pyogenic granuloma on the buccal gingiva of the maxillary molar-premolar region. Total surgical excision was performed with an 840nm diode laser followed by the placement of hyaluronate gel and relevant periodontal dressing. Two weeks after surgical excision, complete healing was observed, but patient denied replacement of dental restoration. After 4 months of follow-up, an overall reduction of associated teeth mobility was also observed, with a minor recurrence in gingival inflammation. The objective of this report is to briefly review clinical, radiographic and histological findings of pyogenic granuloma along with a detailed discussion on its management through a diode laser.

Selective Temporary Stent-Assisted Coil Embolization for Intracranial Wide-Necked Small Aneurysms Using Solitaire AB Retrievable Stent.

ObjectiveStent-assisted coil embolization of intracranial wide-necked aneurysm requires long-term postoperative antiplatelet therapy to prevent in-stent thrombosis. This study aimed to demonstrate results of temporary stent placement for coiling wide necked small intracranial aneurysms, which eliminated need for antiplatelet agents, and to discuss its feasibility and safety. MethodsData of 156 patients who underwent stent-assisted coil embolization between 2011 and 2014 were retrospectively analyzed. Thirteen cases of temporary stent-assisted coil embolization were included, and their clinical and radiological results were evaluated. ResultsThe aneurysms treated were all unruptured except one case. All of them had wide neck with mean dome-to-neck ratio of 0.96 and were small-sized aneurysms with mean maximal diameter of 4.2 mm. There was no technical failure in retrieval of stent after completion of embolization of the target aneurysm. Immediate angiography revealed 11 complete and two partial embolization (one residual neck and one residual aneurysm). Two cases encountered thrombosis complication, and they were managed without neurological sequelae. The mean follow-up period was 43 months, angiographic follow-up revealed two cases with minor recurrence, and clinical outcome was good with modified Rankin scale score of 0. ConclusionTemporary stent-assisted coil embolization of small wide-necked intracranial aneurysm using fully retrievable stent appears safe and effective. Further application and evaluation of this technique in more cases with larger size aneurysm is warranted.

Construction of new personal meanings by cancer patients: a qualitative analysis in an Italian patient population.

The goal of this study is to investigate the meaning that cancer patients in active therapy and/or rehabilitation give to their illness and resources they rely on to build new experiences of meaning and a future perspective. The present study consisted in a summative content analysis of answers to open questions of the Purpose In Life (PIL) Questionnaire administered to 158 consecutive patients with non-advanced cancer (no metastases). The PIL is an attitude scale that indicates the degree of attainment of meaning and purpose in life and is divided into three sections: a first 20-item quantitative section, with statements rated on a 7-point verbal scale with two anchoring phrases (part A); a qualitative section with 13 open-end items and paragraph composition section addressing the future goals (part B) and past meaningful experience (part C). For the present study, we analyzed the answers to open questions, most interesting in a therapeutic contest related to the meanings associated with life, illness, and suffering to understand the experienced of the cancer patients. The main recurring themes in PIL section B analyzed associated to the sense of life, disease, and death are as follows: meaning (positive/negative), personal dimension, religiousness; physical health, family, normal life; negative sense of death, the end, natural transition, religious belief, consolation, mystery, rejection; opportunity, negativity. Whereas main themes emerging from section C were associated to life goals of the interviewed patients: the desire of realization in the future perspective; the value of life; physical health and healing; guiding values; plus three more themes, distinguishable, but with a minor recurrence: legacy responsibility, religiousness, lack of purpose/resignation. The use of summative content analysis evidenced the recurrence of a strong sense of positivity, present in the majority of the interviews. In particular, this positivity is shown by the use of words associated frequently to self-consciousness and self-evaluation, desire of happiness, and desire of contributing to the good of significant others and of taking care of your own life in order to give a positive contribution.

Analysis of Revision Surgery of Microsurgical Lumbar Discectomy.

Study DesignA retrospective study.PurposeOur objectives were to determine the association between the pathological changes of disc herniation and the interval between primary and revision surgeries and to investigate the frequency and site of the dural laceration in the primary and revision surgeries.Overview of LiteratureAmong 382 patients who underwent microsurgical lumbar discectomy, we investigated 29 who underwent revision surgery to analyze recurrent herniation pathologies and complications to determine the manner in which lumbar disc herniation can be more efficiently managed.MethodsOf 29 patients, 22 had recurrent disc herniation at the same level and site. The pathological changes associated with compression factors were classified into the following two types depending on intraoperative findings: (1) true recurrence and (2) minor recurrence with peridural fibrosis (>4 mm thickness). The sites of dural laceration were examined using video footage and operative records.ResultsThe pathological findings and days between the primary and revision surgeries showed no statistical difference (p=0.14). Analysis of multiple factors, revealed no significant difference between the primary and revision surgery groups with regard to hospital days (p=0.23), blood loss (p=0.99), and operative time (p=0.67). Dural lacerations obviously increased in the revision surgery group (1.3% vs. 16.7%, p<0.01) and were mainly located near the herniated disc in the primary surgery group and near the root shoulder in the revision surgery group, where severe fibrosis and adhesion were confirmed. To avoid dural laceration during revision surgery, meticulous decompressive manipulation must be performed around the root sleeve.ConclusionsWe recommend that meticulous epidural dissection around the scar formation must be performed during revision surgery to avoid complications.