Normal Quality Of Life Research Articles

Chronic lymphocytic leukemia/small lymphocytic lymphoma arising in the pituitary gland: illustrative case.

The authors describe a 60-year-old female who underwent a correlative examination for an accidental scalp injury, revealing a sellar mass, which was surgically excised and pathologically confirmed to be a non-Hodgkin's small B-cell lymphoma. These findings in combination with the immunophenotype led to a final diagnosis of chronic lymphocytic leukemia/small lymphocytic lymphoma. Previous studies have shown that hematological solid tumors occurring in the pituitary gland are extremely rare, and there are only approximately three other cases of living patients with similarities to this case, all of which had ambiguous expression of subsequent hematological treatment. In this case, the authors used an endoscopic approach to completely excise the tumor. Follow-up of the patient was continued after surgery, and the patient is currently receiving standardized treatment with zanubrutinib. This patient did not have any previous history of tumor, had a good postoperative recovery with a normal quality of life, and still receives hormone replacement and zanubrutinib on a standardized basis. This is a complete case that has not been previously reported and reveals the diagnostic and therapeutic process of rare diseases in the sellar area.

P231 Impact of the depth of mucosal healing on the burden of ulcerative colitis : a cross-sectional study

Abstract Background Ulcerative colitis (UC) is a major cause of disability, affecting physical, emotional and social well-being. The recent STRIDE II international guidelines consider disability-free and normal quality of life as therapeutic targets. Today, the degree of mucosal healing required to reduce disability, incontinence and bowel urgencies is poorly known. Methods We conducted a single-center cross-sectional study between January 2021 and June 2023. All consecutive patients with UC and endoscopic healing (Mayo ≤ 1) underwent IBD-disk disability assessment the day of the colonoscopy. Histological healing was defined as Nancy score 0 or 1 (2 biopsies per segment from rectum to right colon). Moderate to severe disability was defined as an overall score ≥ 40. Incontinence was defined by a Wexner score >5 and bowel urgency by an NRS urgency score > 1). Results A total of 57 patients were included, with 34 (59.6%) women. Median age and disease duration were 47.4 (interquartile range [IQR] [43.5; 51.2]) and 13.0 years (IQR, 13.1-18.4), respectively. 37/57 (65%) patients had complete endoscopic healing Mayo 0 and 43/54 (80%) histological healing. The median overall IBD-Disk score was 29 [25.5; 37.5] and 27 (47%) had moderate to severe disability. There were no differences in terms of age, gender, body mass index, smoking status, disease extension and treatment for the 3 groups Mayo 1, Mayo 0 and histological healing. The rate of moderate to severe disability was not different among patients with Mayo 0 (7/20, 35%) vs. Mayo 1 (20/37, 54%) patients (p=0.26), or in patients with (22/43, 51%) or without histological healing (4/11,36%) (p =0.51). Of the 35 patients assessed, bowel urgency were reported in 11 (31.4%), with no difference between the two definitions of endoscopic healing (p=0.72) or histological healing (p=0.37). Among the 35 patients with a Wexner score evaluation, incontinence was observed in 19% (4/21) and 14% (2/14) of Mayo 0 and Mayo 1 patients respectively (p=0.99), and 24% (6/25) vs. 0% (0/7) of patients with or without histological healing (p=0.3). Conclusion Half of patients with UC who achieved endoscopic healing reported a moderate to severe disability. Mayo 0 (vs. 1) endoscopic healing and histological healing do not appear to provide any short-term benefit in terms of disability, fecal incontinence or bowel urgency.

P360 Prevalence and risk factors for fatigue in patients with inflammatory bowel disease and endoscopic healing

Abstract Background Fatigue is a frequent symptom among patients with inflammatory bowel disease (IBD). While the recent STRIDE II international guidelines consider disability-free and normal quality of life as therapeutic targets, the degree of endoscopic healing required to limit fatigue is unknown. The aim of this study was to investigate the prevalence of fatigue and its determinants in a cohort of IBD patients with endoscopic healing. Methods We conducted a single-center cross-sectional study between January 2019 and June 2023. All consecutive IBD patients with endoscopic healing Crohn's disease (CD, CDEIS <4) and ulcerative colitis (UC, Mayo ≤ 1) were assessed for disability (IBD-disk) the day of the colonoscopy. Fatigue and severe fatigue were defined by an IBD-Disk energy subscore >5 and >7, respectively. Results 166 patients were included, of whom 64% (107/166) had CD. The majority of patients were treated with anti-TNF (91/166, 55%), half of them in combination therapy (44/166). The prevalence of fatigue and severe fatigue were 39% (65/166) and 23.5% (39/166) respectively, with no significant difference between CD and UC (p=0.59). The prevalence of fatigue in patient with partial endoscopic healing (Mayo 1 and CDEIS>0 and <4)) and with complete healing (Mayo 0, CDEIS 0) was 44.4% (24/54) and 36.6% (41/112) p =0.424.In multivariate analysis, factors associated with fatigue were female gender (OR=4.2, [1.1; 16.5], p= 0.040), presence of joint pain (OR=4.36, [1.0; 18.2], p= 0.04), sleep disturbance (OR =26.2, [5.5; 124.4], p <0.0001). Younger age (OR=0.95, [0.9; 0.99], p= 0.023) was associated with a significantly lower risk of fatigue. In multivariate analysis, severe fatigue was associated with female gender (OR=3.2, [1.1; 9.2], p= 0.026), the presence of joint pain (OR=2.9, [1.1; 8.1], p= 0.037) or sleep disorders (OR =11.3, [3.6; 35.9], p <0.0001). Conclusion One third of IBD patients with endoscopic healing suffer from fatigue. Female gender, arthralgia and especially sleep disorders are risk factors for fatigue. These results argue in favor of a holistic management of IBD patients.

Chronic myeloid leukemia, tyrosine kinase inhibitors and cardiovascular system.

Cardiovascular system health becomes important with the extended survival of chronic myeloid leukemia (CML) patients. Cardiotoxicities are related to the second- and third-generation tyrosine kinase inhibitors (TKIs). The most frequent and important cardiovascular events are myocardial infarction, stroke and peripheral arterial disease, QT prolongation, pleural effusions, and both systemic and pulmonary hypertension. The aim of this paper is to review the interactions between administrated TKIs and the cardiovascular system during the clinical course of CML. Elucidation of TKI effects on the cardiovascular system is vital since the current goal of CML therapy is a cure that leads to normal age and gender-similar survival with a normal quality of life. Up to August 2022, literature searches were performed via the internet search engines MEDLINE, EMBASE, GOOGLE SCHOLAR: (i) chronic myeloid leukemia; (ii) tyrosine kinase inhibitor; (iii) cardiovascular system. Only articles in English and research including humans were included in the search. Tailored TKI treatment with individual patient characteristics must account for CML disease risk, patient age, patient comorbidities, patient compliance, TKI drug off-target risk profile, accelerated or blastic phase CML disease, pregnancy and allografting in CML. The treatment-free survival, improving quality of life, limiting adverse events of TKIs, and the optimal dose and administration duration of TKIs are still a matter of controversy. Special attention should be paid to the comorbidities of CML patients and clinical TKI effects on CVS since the aim of CML treatment is a cure that leads to normal age and gender-similar survival with a "normal" quality of life. CVS is an important morbidity and mortality cause for adult patients. The discontinuation of TKI treatment in CML and the treatment-free remission of CML patients are very important in order to reduce the risk for cardiovascular adverse effects of TKIs. The frail CML patients and especially the patients who have cardiac comorbidities, should be carefully evaluated for TKI treatment, and hematopoietic stem cell transplantation (HSCT) should be the last choice in these risky CML patients. The current CML treatment target is a cure that leads to normal age and gender-adjusted survival with a "normal" quality of life. Cardiovascular disorders are one of the major obstacles to reaching this target in CML patients. The treatment choices for CML patients must include a cardiovascular perspective.

NATURAL HISTORY OF GRADE ONE LUMBOSACRAL ISTHMIC SPONDYLOLISTHESIS IN ADOLESCENT PATIENTS: LONG TERM FOLLOW-UP OF 299 PATIENTS TREATED CONSERVATIVELY

Purpose of the Study: The aim is to report the natural history, type of treatment received and quality of life improvement of adolescent patients with isthmic low-grade lumbosacral spondylolisthesis with a slip of less than 25%. Methods: The complete records of 299 prospective patients (127 males and 172 females) with isthmic low-grade lumbosacral spondylolisthesis referred to an orthopedic clinic were reviewed. Radiological parameters, Micheli scale, and quality of life measured by the SRS-22 questionnaire were measured at the first visit and a minimum 5-year follow-up. Results: The average follow-up time is 5.7 ± 1.4 years. The main complaint at the initial presentation was lower back pain in 107 patients, and three patients had lower back pain and lower limbs radiculopathy. Scoliosis was found in 38 patients in the initial radiograph. One-hundred-eighty-nine patients (63%) were asymptomatic at the time of presentation. At the last follow-up; SRS-22 were 4.21 ± 0.6, 4.21 ± 0.7, 4.31 ± 0.5, 4.21 ± 0.7, 4.2 ± 0.7 for total, pain, function, mental, and self-image scores, respectively. The patients with grade one lumbosacral spondylolisthesis with normal morphology of the sacrum had responded well to the nonsurgical treatment modalities. No patient has progressed during the follow-up, and no patient underwent surgical intervention for back pain. The slip percent was relatively lower in patients with low back pain. The average slip percentage was 15.5 ± 8.4 among the asymptomatic patients and 13 ± 9 among patients who presented with low back pain ([Formula: see text]-value = 0.009). Conclusion: Adolescent patients with grade one isthmic lumbosacral spondylolisthesis have very good prognosis with nonoperative modalities and they have an almost normal quality of life at the end of follow-up. A long follow-up in an outpatient clinic with X-Rays series might not be indicated for all patients with low-grade spondylolisthesis, specifically if the slip is less than 25%.

Personalized hematopoietic stem cell transplantation for inborn errors of immunity.

Patients with inborn errors of immunity (IEI) have been transplanted for more than 50 years. Many long-term survivors have ongoing medical issues showing the need for further improvements in how hematopoietic stem cell transplantation (HSCT) is performed if patients in the future are to have a normal quality of life. Precise genetic diagnosis enables early treatment before recurrent infection, autoimmunity and organ impairment occur. Newborn screening for severe combined immunodeficiency (SCID) is established in many countries. For newly described disorders the decision to transplant is not straight-forward. Specific biologic therapies are effective for some diseases and can be used as a bridge to HSCT to improve outcome. Developments in reduced toxicity conditioning and methods of T-cell depletion for mismatched donors have made transplant an option for all eligible patients. Further refinements in conditioning plus precise graft composition and additional cellular therapy are emerging as techniques to personalize the approach to HSCT for each patient.

Kikuchi–Fujimoto disease: literature review and report of four cases

Kikuchi–Fujimoto disease, or necrotizing histiocytic lymphadenitis, is one of the rare causes of benign lymphadeno-pathy. The diagnosis is based on histological and immunohistochemical analysis of the lymph node biopsy. The article presents four clinical cases of Kikuchi–Fujimoto disease. According to the results of the primary analysis of lymph node tissue three patients were misdiagnosed with lymphoma. due to the unusual for lymphoid malignancy course the primary material was reviewed. The diagnosis of Kikuchi–Fujimoto disease was put. In three patients the disease has a re-current course. during the observation period, the course of the disease in all the presented patients is benign with normal quality of life.

Reference-dependent age weighting of quality-adjusted life years.

People do not only care about maximizing health gains but also about their distribution. For example, they give more weight to younger patients than older patients. This pilot study aims to investigate if age weighting is reinforced by loss aversion if young people are falling behind one's perceived 'normal' quality of life (QoL), while older people do not. We apply a person trade-off method in a large representative sample (n = 990) to estimate age weighting factors. We also measure QoL levels that individuals regard as 'normal' for different ages, serving as reference points. We observe a considerable amount of age weighting, with 20-year-old patients on average receiving 1.7 times as much weight as 80-year-old patients. Perceived 'normal' QoL rapidly decreases with age of a patient. Older people are more optimistic about what constitutes 'normal QoL' than younger people, but they express a faster decline in normal QoL due to aging. Respondents who view all improvements to be gain enlarging show the least age weighting, but loss aversion cannot explain the results. Still, one's age-related reference level is an important predictor of age weights. Given the explorative nature of this study, further studies are called for to generate more robust evidence.

Quality-of-life evaluations in children and adolescents with Ewing sarcoma treated with pencil-beam-scanning proton therapy.

With improved survival rates for children with cancer, quality-of-life (QoL) issues have increasingly become the focus of attention. We report the QoL of children with Ewing sarcoma (EWS) treated with pencil-beam-scanning proton therapy (PT). A PEDQOL (QoL questionnaire for children 4-18years) self/proxy questionnaire was used to prospectively assess the QoL of 23 children <18years with EWS treated with PT. This questionnaire evaluates eight different domains. Children (self-rating) and parents (proxy-rating) filled out the questionnaire at the start of PT (E1), 2months after treatment (E2), and thereafter once yearly (E≥3). Compared with healthy controls, parents rated the QoL of their children at E1 significantly worse in all but two (cognition and social functioning-family) domains. At E4, significant differences between the two groups only remained in three of eight domains. At E1, children self-rated their QoL significantly worse in the domain Physical functioning (p = .004) and significantly better in the domain Body image (p = .044) compared to healthy controls, whereas no significant differences were observed at E4. For the longitudinal comparison E1 versus E4, according to parents, Emotional functioning, Cognition and Social functioning-peers were slightly decreased 2years after PT. The children rated Emotional functioning and Body image poorly 2years after PT. Children with EWS usually recovered seemingly well to normal QoL levels 2years after the end of PT. They tended to rate their QoL substantially higher than their parents. However, in the longitudinal analysis at 2years, children rated their Emotional functioning and Body image scores poorly.

Post-COVID-19 condition is not only a question of persistent symptoms: structured screening including health-related quality of life reveals two separate clusters of post-COVID

PurposeSome patients experience long-term sequelae after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, despite a present post-COVID condition, defined as “any symptom lasting longer than 12 weeks,” only a subset of patients search for medical help and therapy.MethodWe invited all adults with a positive real-time polymerase chain reaction (RT-PCR) for SARS-CoV-2 between March 2020 and September 2021 (n = 4091) in the city of Jena to answer a standardized questionnaire including demographic information, the course of the acute infection and current health status. K-means-clustering of quality of life (QoL) was used to explore post-COVID subgroups.ResultsA total of 909 participants at a median interval of 367 (IQR 291/403) days after acute infection were included in the analysis. Of those, 643 (70.7%) complained of having experienced persistent symptoms at the time of the survey. Cluster analysis based on QoL revealed two subgroups of people with persistent post-COVID symptoms. Whereas 189/643 participants (29.4%) showed markedly diminished QoL, normal QoL was detected in 454/643 individuals (70.6%).ConclusionDespite persistent symptoms being reported by nearly three quarters of participants, only one-third of these described a significant reduction in QoL (cluster 1), whereas the other two-thirds reported a near-normal QoL (cluster 2), thus indicating a differentiation between “post-COVID disease” and “post-COVID condition”. The prevalence of clinically relevant post-COVID disease was at least 20.7%. Health policies should focus on this subset.

P36 THE ELDEST HEART TRANSPLANTED PATIENT IN EUROPE: 36 YEARS SURVIVAL AND STILL GOING ON

Development of endomyocardial biopsy for acute rejection monitoring in the early Seventies, and above all use of cyclosporine in the clinical practice starting from 1980, introduced the modern era of heart transplantation. Following the initial positive outcomes, the first Italian transplant was performed in Padua by V.Gallucci on November 15th 1985. This pioneering success was rapidly repeated in Pavia, where M.Viganò performed the second transplant on Novembre 17th. Recipient was 20 years old man, suffering from dilated cardiomyopathy, on urgent transplant list. Cardiac index was 1.38 l/min/m2 and pulmonary vascular resistance 1.6 WU. Donor was a 14 years old boy died of brain injury. Total ischemic time was 125 minutes. Induction immunosuppression consisted of horse anti–lymphocyte immunoglobulins, whereas maintenance therapy included cyclosporine, azathioprine and steroids. Postoperative course was complicated by pericardial effusion and cholestatic jaundice. Later pulmonary aspergillosis occurred and due to the profound immunodepression was complicated by fungal localization at L2 vertebral body. The infection was treated with surgical removal of the secondary localization and amphotericin B administration. On December 6th severe acute rejection was found at biopsy and treated with i.v. steroid pulse. Length of ICU and hospital stay was 28 and 72 days, respectively. In 1998 HCV infection was detected and eradicated in 2017 with elbasvir/grazoprevir therapy. Complications of long term immunosuppressive treatment included dyslipidemia, myeloma and basal cell carcinoma. Due to long–term calcineurin inhibitors therapy progressive chronic renal failure occurred, leading to replacement therapy in 2015 and kidney transplantation in 2016. In 2015 the patient underwent percutaneous coronary intervention with stents implantation in two marginal branches and in the anterior descending artery in 2021. Everolimus was introduced to slow down progression of cardiac allograft vasculopathy. In 2020 he suffered from Covid–19, but the course of infection was uneventful being cough the only symptom. We report the eldest survivor after heart transplant in Europe. Our case demonstrates that despite early and long–term complications of immunosuppressive therapy, a careful and patient tailored management allowed an amazing outcome. Nowadays heart transplant remains the best treatment for end stage heart failure and allows to resume a nearly normal quality of life.

Association of Tai Chi exercise with physical and neurocognitive functions, frailty, quality of life and mortality in older adults: Singapore Longitudinal Ageing Study.

real-world observations on the long-term benefits of Tai Chi (TC) exercise, in terms of physical and cognitive functioning, frailty, quality of life (QOL) and mortality are lacking. prospective cohort study participants were community-dwelling adults aged 55+, including 5,407 non-frequent TC participants (<1x/week) and 572 frequent TC participants (≥1x/week). Outcome measures at baseline and 3-5years follow-up included physical performance (Knee Extension Strength, POMA Balance and Gait, Timed-up-and-go, Gait Speed) and neurocognitive performance (attention and working memory, visual-motor tracking and mental flexibility, verbal learning and memory, visual memory, spatial and constructional ability), Frailty Index ≥0.10, impaired QOL (SF12 physical and mental component) and all-cause mortality from mean 13years follow-up. Effect estimates were adjusted for socio-demographics, other physical activities, nutritional risk and presence of cardiometabolic diseases. frequent TC participation was associated with 0.7-fold lower prevalence of impaired physical QOL [95% confidence interval (CI) = 0.57-0.91], decreased 0.4-fold odds of incident prefrailty/frailty among robust participants at baseline and 0.7-fold odds of impaired mental QOL at follow-up among participants with normal mental QOL at baseline. Lower odds of mortality risk (HR = 0.89, 95%CI = 0.72-1.09) were not significant after controlling for socioeconomic, behavioural and health factors. Composite indexes of physical functional and neurocognitive performance were maintained at high level or increased at follow-up among frequent TC participants. TC exercise practised among community-dwelling older adults is associated with better physical, cognitive and functional wellbeing.

Cross-cultural adaptation, reliability, and validity of the Turkish version of the Craniofacial Pain and Disability Inventory (CF-PDI/T) for individuals with temporomandibular disorders

Purpose To translate the Craniofacial Pain and Disability Inventory into Turkish (CF-PDI/T) and to examine its reliability and validity. Materials and methods Cultural adaptation of CF-PDI/T was conducted according to international standards. The psychometric analyses included reliability by internal consistency (Cronbach’s alpha) and test/retest reliability (intraclass correlation coefficient, ICC); structural validity was evaluated with exploratory factor analysis (EFA), confirmatory factor analysis (CFA); and construct validity was investigated by matching (a priori hypotheses) the CF-PDI/T with the Numeric Rating Scale (NRS), Headache Impact Test-6 (HIT-6), Tampa Scale for Kinesiophobia for Temporomandibular Disorders-12 (TSK-TMD-12), Pain Catastrophizing Scale (PCS), Neck Disability Index (NDI), Fonseca Anamnestic Index (FAI), and Jaw Functional Limitation Scale-20 (JFLS-20). Correlations ranging from low to high were expected. Results CF-PDI/T showed excellent test–retest reliability (ICC = 0.971), excellent internal consistency (Cronbach’s α = 0.985), and low to high correlation with NRS, HIT-6, TSK-TMD, PCS, NDI, FAI, and JFLS-20. Following EFA, three factors ("pain and psychosocial limitation", "jaw functional status", and "frequency comorbidities and disability") were extracted, accounting for 55.028% of the total variation. Conclusions The CF-PDI/T is a reliable and valid instrument to assess the symptoms and disability in the Turkish population with temporomandibular disorders. Clinical trial registration number: NCT03837587. Implications for rehabilitation The Spanish version of the Craniofacial Pain and Disability Inventory is a highly reliable and good valid outcome measure to evaluate disability and treatment outcomes for individuals with temporomandibular disorders (TMDs). We suggest the Turkish version of the Craniofacial Pain and Disability Inventory (CF-PDI/T) be used in the Turkish population to indicate small changes in the severity of disorder of individuals with TMDs until a normal quality of life is achieved. The CF-PDI/T can be used with high reliability and validity by experienced and inexperienced dentists and physiotherapists.

Development of a soft three-dimensional replica of the mitral valve for procedural planning.

Mitral valve (MV) disease is the most common and the most heterogeneous valvular pathological condition in the general population [1]. Repair is superior to replacement in most cases and offers the patient a normal life expectancy and normal quality of life. However, due to individual anatomical variations, the lack of standardization, the steep learning curves, the variety of repair techniques and the lack of available expertise everywhere, the quality of care is extremely operator dependent. Ideally, a surgeon needs to perform >25-MV operations per year to sustain predictable and durable results, whereas a surgeon performs a median number of 5-MV operations per year in the USA [2–4]. Moreover, the learning curve for minimally invasive MV surgical procedures requires >75–125 cases due to their complexity [5]. In addition, there are >70 new transcatheter devices in development for the treatment of MV disease, though few are actually being used in clinical practice [6]. These new transcatheter devices are image-guided and target a specific lesion for which patient selection, procedural planning and image guidance are crucial. All of the above necessitate the application of new technologies, such as three-dimensional (3D) reconstruction, 3D printing and simulation, in selecting patients, planning the procedure and executing MV surgical techniques.

Neoadjuvant PD-1 Blockade Combined With Chemotherapy Followed by Concurrent Immunoradiotherapy in Locally Advanced Anal Canal Squamous Cell Carcinoma Patients: Antitumor Efficacy, Safety and Biomarker Analysis.

BackgroundAnal canal squamous cell carcinoma (ACSCC) is an exceedingly rare malignant neoplasm with challenges in sphincter preservation, treatment toxicities and long-term survival. Little is known concerning the activity of PD-1 antibodies in locally advanced ACSCC. This study reports on the efficacy and toxicities of a neoadjuvant PD-1 blockade combined with chemotherapy followed by concurrent immunoradiotherapy in ACSCC patients, and describes biomarkers expression and mutation signatures.MethodsIn this cohort study, patients were treated as planned, including four cycles of neoadjuvant PD-1 antibody toripalimab combined with docetaxol and cisplatin, followed by radiotherapy and two cycles of concurrent toripalimab. Multiplex immunofluorescence staining (mIHC) with PD-L1, CD8, CD163, Pan-Keratin and DAPI was performed with the pretreatment tumor tissue. Whole exome sequencing was performed for the primary tumor and peripheral blood mononuclear cells. The primary endpoint was the complete clinical response (cCR) rate at 3 months after overall treatment. Acute and late toxicities graded were assessed prospectively.ResultsFive female patients with a median age of 50 years old (range, 43-65 years old), finished treatment as planned. One patient had grade 3 immune related dermatitis. Two patients had grade 3 myelosuppression during neoadjuvant treatment. No severe radiation-related toxicities were noted. Four patients with PD-L1 expression >1% achieved a cCR after neoadjuvant treatment. and the other patient with negative PD-L1 expression also achieved a cCR at 3 months after radiotherapy. All the patients were alive and free from disease and had a normal quality of life, with 19.6-24 months follow up. Inconsistent expression of PD-L1 and CD163 was detected in 3 and 5 patients, respectively. TTN, POLE, MGAM2 were the top mutation frequencies, and 80 significant driver genes were identified. Pathway analysis showed enrichment of apoptosis, Rap1, Ras, and pathways in cancer signaling pathways. Eight significantly deleted regions were identified.ConclusionsThis small cohort of locally advanced ACSCC patients had quite satisfactory cCR and sphincter preservation rate, after neoadjuvant PD-1 antibody toripalimab combined with chemotherapy followed by concurrent immunoradiotherapy, with mild acute and long-term toxicities.

Physiopathology, Microbics and Administration of the Pleural Space with Empyema Following Left Pneumonectomy: A Case Report and Discussion

In 2016 a middle age man has been operated urgently of left pneumonectomy because of bronchiectasiae with life-threating emoptysis. The Patologist described the entire lung destroyied by a massive inflammatory process. Almost a year later from intervention patient developped broncho - pleural fistula (BPF) on the left main bronchial stump with the onset of a dramatic empyema. After an unsuccessful attempt of endoscopic proceeding to fix the bronchial fistula with cyanoacrylate an Open Window Thoracostomy (OWT) was opened and infection disappeared. Afterwards patient went on outpatient for regular medications. Unfortunately despite of local treatment with antibiotics the pleural space resulted continuously infected and no indication to close the pleural cavity has been considered. Today patient is well and has a normal quality of life. For a patient with an OWT in good health condition also regular medications on outpatient seem reasonable and acceptable if surgery is not appropriate or refused.

Demographic development in the Carpathian region of Ukraine in the conditions of growing the population socio-economic vulnerability

Russia’s full-scale war against Ukraine has catastrophically exacerbated the socio-demographic problems in Ukraine and its regions. Powerful wave of forced resettlement has, on the one hand, put enormous pressure on the economic and social spheres of internally displaced persons (IDP) donor regions and, on the other hand, radically changed the demographic group in all regions of the country. The population of socially vulnerable categories has significantly increased: children, youth, the elderly, the disabled, and the lonely. Further military escalation leads to the transition of many people to the categories of vulnerable groups, while they did not belong there before the Russian invasion. It is due to the death of relatives, including loss of a breadwinner, injury, poor health, loss of housing, all property, or significant parts of it, loss of employment or business, other economic losses, inability to study, emotional and psychological disorders, etc. The majority of the population in these categories is not in a state of social maladaptation but does not have limited resources for livelihoods and social competitiveness. Timely and sufficient provision of social assistance to these socially vulnerable groups can significantly reduce the severity of socio-economic problems and provide them with a normal life quality. As of early 2022, the demographic situation in the Carpathian region of Ukraine can be described as relatively unfavorable: falling birth rate, irreversible process of demographic aging, reducing share of youth, and a high proportion of people with special needs. In addition, the Carpathian region has a much higher average household size than other macro-regions of the country, a higher share of households with children, and a higher level of employment of household members. Analysis of socio-demographic statistics in previous years and current demographic processes shows a likely acceleration in the growth of the share of socially vulnerable groups and the number of IDPs and residents of the region. The main tasks of regional and local authorities are to solve urgent problems of IDPs, expand social infrastructure, and ensure effective employment in the region, socialization of IDPs and their integration into society, and development and implementation of regional programs to improve demographic reproduction.

ERAS protocol in practice of general surgeon. Our experience.

the concept of Fast track surgery involves long-term reduction of the stress response on the surgery. During a pandemic, the ERAS principles of surgery offer even more relevance, in order to reduce hospital stay and thus reduce the risk of infection. In this study used the method of survey and comparison of data of patients treated at the Department of General Surgery №2 NMU named after O.O. Bogomolets in the period from September 2011 to May 2019, namely - 569 patients who underwent elective surgery using ERAS protocols and minimally invasive surgical interventions. With the using of ERAS protocols was showed that average bed-day was 1.73 days in LHE, 1.43 in LGP, 4.99 in LBI and 4.3 in LOC. Sampling was also performed for different types of surgical interventions: LGP and "open" GP were compared, the average operation time was 117 +/- 35 min and 145 +/- 41 min, respectively, relative to the time spent by the patient in the hospital, the following data were obtained: LGP-2,65 +/- 1, 21 days, and at "open" GP-7,91 +/- 1,52 days. Conclusions: Application of ERAS protocols: reduces pain for the all period of the patient's stay in the hospital, reduces hospital stay, accelerates the return to normal quality of life, reduces the risk of postoperative complications.

Billroth II procedure for the treatment of spontaneous gastrointestinal perforation in two cats

A 9-year-old castrated male domestic shorthair cat (cat 1) and a 10-year-old castrated male Maine Coon cat (cat 2) were presented for recurrent feline lower urinary tract disease after receiving outpatient care from their primary veterinarians. Physical examination findings for both cats were initially within reference limits. After a short period of hospitalization, both cats developed peritoneal effusion; results of cytologic analysis of a sample of the fluid were consistent with septic peritonitis. During exploratory laparotomy, perforation of the pylorus or proximal portion of the duodenum secondary to ulceration was identified. Both cats underwent partial duodenectomy, partial gastrectomy (pylorectomy), and gastrojejunostomy (Billroth II procedure). The cats recovered from surgery and returned to a normal quality of life; however, each had mild episodes of anorexia but maintained a stable body weight. Cat 2 required additional surgery for trichobezoar removal 7 weeks later but recovered quickly. At 7 months after trichobezoar removal, cat 2 developed intermittent vomiting, but clinicopathologic, abdominal ultrasonographic, and upper gastrointestinal tract endoscopic findings were within reference limits. At 9 (cat 2) and 13 (cat 1) months after the Billroth II procedure, both cats were reported to be in good general health and without gastrointestinal signs. In both cats, the Billroth II procedure was technically straightforward and associated with a full recovery and good medium- to long-term quality of life. A Billroth II procedure could be considered for treatment of cats with large mural lesions in the pyloroduodenal region.

Primary MALT lymphoma of the colon - Pathohistological and immunohistochemical analysis, prognosis and complex treatment

Colonic MALT lymphoma is a rare disease. Due to rare diagnosis, randomized studies are missing to determine the optimal therapeutic approach. We present a 77-year-old patient with Mucosa-Associated Lymphoid Tissue (MALT) lymphoma of the colon, which is diagnosed after colonoscopy with biopsy and precise pathohistological and immunohistochemical analysis. Treatment includes surgery /hemicolonectomy, followed by 6 cycles of chemotherapy- R-COPP regimen. Two years after diagnosis, the patient is in good condition with normal quality of life without recurrence and distant spread of the disease. Through this article, our goal is to support medical literature with another clinical case that demonstrate the need for thorough and precise diagnosis by immunohistichemic analysis and an assessment of optimal complex treatment. Keywords: MALT lymphoma; non-Hodgkin's lymphoma; pathohistological analysis; immunohistochemical analysis; chemotherapy; Complex treatment.