Partial Recurrence Research Articles

Lung radiofrequency ablation: post-procedure imaging patterns and late follow-up

PurposeTo describe expected imaging features on chest computed tomography (CT) after percutaneous radiofrequency ablation (RFA) of lung tumors, and their frequency over time after the procedure. MethodsIn this double-center retrospective study, we reviewed CT scans from patients who underwent RFA for primary or secondary lung tumors. Patients with partial ablation or tumor recurrence during the imaging follow-up were not included. The imaging features were assessed in pre-defined time points: immediate post-procedure, ≤4 weeks, 5−24 weeks, 25−52 weeks and ≥52 weeks. Late follow-up (3 and 5 years after procedure) was assessed clinically in 48 patients. ResultsThe study population consisted of 69 patients and 144 pulmonary tumors. Six out of 69 (9%) patients had primary lung nodules (stage I) and 63/69 (91 %) had metastatic pulmonary nodules. In a patient-level analysis, immediately after lung RFA, the most common CT features were ground glass opacities (66/69, 96 %), consolidation (56/69, 81 %), and hyperdensity within the nodule (47/69, 68 %). Less than 4 weeks, ground glass opacities (including reversed halo sign) was demonstrated in 20/22 (91 %) patients, while consolidation and pleural thickening were detected in 17/22 patients (77 %). Cavitation, pneumatocele, pneumothorax and pleural effusions were less common features. From 5 weeks onwards, the most common imaging features were parenchymal bands. ConclusionsOur study demonstrated the expected CT features after lung RFA, a safe and effective minimally invasive treatment for selected patients with primary and secondary lung tumors. Diagnostic and interventional radiologists should be familiar with the expected imaging features immediately after RFA and their change over time in order to avoid misinterpretation and inadequate treatments.

Thirty-year experience of transaxillary resection of first rib for thoracic outlet syndrome.

Thoracic outlet syndrome is an important clinical entity, which usually affects young patients and working cohort, causing disability if unrecognized and untreated. Although treatment is commonly conservative, in patients with more severe disease, surgical treatment is often required for decompression. Purpose of this paper was to evaluate the surgical and clinical outcomes of patients who underwent first rib resection through transaxillary approach for thoracic outlet syndrome (TOS) during a period of 30 years. A retrospective study was conducted on a prospectively compiled, computerized database between January 1988 and December 2018 including patients affected by TOS surgically treated in two Italian centers, by the same surgeon. Patients with neurogenic and vascular TOS were included in the present analysis. The surgical approach for TOS decompression was the first rib resection using the Roos' transaxillary approach, with small variations in technique. Outcome measures considered for analysis were primary technical success, 30-day and mean follow-up re-intervention, pneumothorax, nerve injury and symptoms recurrence rates. One hundred three patients were treated: 89 (86.4%) women and 14 (13.6%) man; median age was 32.6±10.2 years (range 9-53). Prominent symptoms were neurogenic in 60 patients (58.2%), venous in 32 (31.1%), and arterial in 11 (7.76%) patients. In 49 patients (47.5%) with prominent neurogenic symptoms, concomitant symptoms of vascular TOS were also presents. Thirteen (12.6%) patients had cervical rib and sixteen cases (15.5%) had bilateral TOS. Technical success was achieved in all cases, and no other surgical access or secondary approach was necessary. Three patients (2.9%) presented with hand ischemia and also needed an arm vein bypass after rib resection. One (0.9%) intraoperative arterial injury was reported and nerve injury rate was 1.8%. At 30-day re-intervention rate was 0.9%: one patient experienced hemothorax solved by thoracoscopic drainage. Restrict pneumothorax was reported in 42 patients (40.8%) treated through pleural drainage. At mean follow-up of (93±9 months) partial symptoms recurrence was present in 6 patients (5.8%). In our experience first rib resection through the transaxillary approach is a safe and feasible procedure associated with an acceptable rate of peri-operative morbidity and satisfactory long-term relief of symptoms.

TL 18196 - The lapidus procedure for severe hallux valgus deformity

Introduction: Surgical techniques for hallux valgus correction are constantly evolving. However, there is little data in the literature comparing the different techniques and methods of fixation. The aim of this study was to compare two variations of the Lapidus procedure with respect to the rate of complications, radiographic and functional outcomes. Methods: A retrospective review of 94 consecutive patients treated with a Lapidus fusion for hallux valgus correction between 2006 and 2017 was performed. In the first group, 33 patients underwent modeling arthrodesis between the first metatarsal base and the medial cuneiform, and between the base of the first and second metatarsals. In the second group, 61 patients underwent a fusion between the base of the first metatarsal and the medial cuneiform only. Results: In group 1, the rate of complications was 18% compared with 13% in group 2; of these, 10,5% required a revision procedure in group 1 versus 7,5% in group 2. The most common complications were nonhealing, partial recurrence of the deformity and loosened screws. In group 1, the first intermetatarsal angle and the hallux valgus angle were improved from an average of 18,3 degrees to 14 degrees and from 29 to 9,7 degrees, respectively. In group 2, the angles were improved from 16,1 to 9,1 degrees and from 31,1 to 9,1 degrees, respectively. The AOFAS score was improved from 44,5 to 94,9 in group 1 and from 35,8 to 91,32 in group 2. Conclusion: The Lapidus procedure with fusion of only the first metatarsal base and the medial cuneiform is safe, with a low rate of complications. In this modified procedure, the surgeon is required to optimize the congruency between the base of the first metatarsal and the medial cuneiform prior to fixation, which may conceivably explain the good results observed in this group.

The Durability of Pain Relief Following Endoscope-Assisted Microvascular Decompression for Trigeminal Neuralgia

Abstract INTRODUCTION Trigeminal neuralgia (TGN) is a facial pain disorder that is paroxysmal, stabbing, and produces a shooting pain that affects the face due to the compression of the trigeminal nerve. Literature has suggested that the use of an endoscope for microvascular decompression (eMVD), as opposed to a microscope alone, is more likely to identify the source of neurovascular compression and ensure that the nerve is adequately decompressed. However, the recurrence of TGN pain continues to be an issue for patients. This project will assess the long-term success of eMVD using the reduction in Barrow Pain Scale score and recurrence rate at 1 yr. METHODS This retrospective chart review aims at exploring the efficacy of eMVD for TGN by studying rates of recurrence in a cohort of 300 patients and comparing them to the literature using descriptive statistics. This is the largest study to date evaluating postoperative recurrence for eMVD for TGN. RESULTS In this cohort, on average, patients reduced their pain scale by 2.99 units on the Barrow Pain Scale. Additionally, 95.5% of patients experienced an immediate pain relief after eMVD surgery, while only 4.3% had no improvement in TGN pain after the procedure. In this eMVD patient cohort, 22% of patients had partial recurrence of TGN pain. CONCLUSION The endoscope seems to provide long-term success for eliminating TGN pain and is at least as successful as traditional MVD. Over 95% of patients with follow-up data experienced an immediate pain relief, indicating that the efficacy of this procedure is excellent. Recurrence rates of TGN pain seem to be comparable to the existing literature on traditional MVD approaches. This cohort had a partial recurrence rate of 22%, while previous MVD studies have shown significant recurrence rates between 3% and 32%. This indicates that significant recurrence rates of TGN need to be further investigated.

S1-19 ORBITAL LYMPHATIC MALFORMATIONS IN CHILDREN. TRANSCRANIAL APPROACH RESULTS IN SEVERE CASES. OUR EXPERIENCE.

Introduction: Orbital lymphatic malformations are unusual benign vascular lesions, representing 1–3% of space-occupying orbital lesions and 5% of the vascular lesions fo the orbit. They are found mainly in children, over 3 years of age. Although their origin is not wellknown, thay can be associated to intracranial vascular lesions and enlargement of the orbital bone. Their clinical course include hemorragic episodes which cause proptosis, decrease of the visual aquity and oculomotor disturbances. Those located around the optic nerve, spcecially in the retroorbital intracapsular area, could be cause a severe optic neuropathy and amaurosis. The treatment depend on the lesion extension, clinical symptoms and the cystic characteristics of the lesion, many different apporaches have been proposed. As high difficulties to remove the whole lymphatic lesion exist, recurrences are encountered in a high rtate, up to 55%. We present our experience in the treamtent of the most extended lesions affecting the retroorbital area, around the optic nerve. Methods: We have review 8 cases with this pathology. The surgery was indicated wthn optic nerve function became affected. MRI was performed as diagnostic tool, presenting all the patients ocular protrusion, and hemorragic cytic lesions ocuping the optic nerve area, around 270–360°. We perform a frontal craniotomy incluying the orbital roof in one piece, with a variable extension ot the lateral wall. The periorbital fascial was open and a wide resection was perfomed with microsurgical technicque. The orbital fascia was closed with a periostial graft. Close follow up was necessary to control visual aquity and oculomotor function. Results: Eight patients have been treated using this approach, all of them recovering at least 30% vision and oculomotor function. The ocular position improves widely, reaching eyelid closure and symmetric ocular position. Recurrences have been very low, with mild symptoms. Conclusion: Althougm many different techiques have been proposed in the treatment ol lymphatic orbital malformation, cases affecting 210360° around optic nerve requiere complex treatments. The transcranial approach in the tretment of very wide orbital lymphatic malformations allows recovering or preserving the visulal aquity, improves the proptosis and secondarily the aesthetic appearance and improve the oculomotor funcions. Main complications are related with the transient oculomotor deficits, CSD leakage (only in 1 case, managed convervatively) and partial recurrence of the lesion.

Efficacy and safety of ingenol mebutate gel in field treatment of actinic keratosis on full face, balding scalp, or approximately 250 cm2 on the chest: A phase 3 randomized controlled trial

Ingenolmebutate (IngMeb) 0.015% or 0.05% is approved for actinic keratosis (AK) areas of 25cm2 or less; some patients require treatment of larger fields. To determine efficacy and safety of IngMeb 0.027% in areas of AK of up to 250cm2 during an 8-week initial assessment period and extended 12-month follow-up. This phase 3, randomized, double-blind, vehicle-controlled trial (NCT02361216) enrolled adult patients with 5 to 20 AK lesions on the face/scalp (25-250cm2) or chest (approximately 250cm2). Patients received once-daily IngMeb or vehicle for 3 consecutive days on the full face, full balding scalp, or approximately 250cm2 on the chest. The primary endpoint was complete AK clearance (AKCLEAR 100; week 8). Additional endpoints included partial AK clearance (AKCLEAR 75), recurrence, patient satisfaction, cosmetic outcome, and safety. IngMeb was superior to vehicle for complete AK clearance (21.4% vs 3.4%, P<.001) and AK clearance of 75% or greater (59.4% vs 8.9%, P<.001) at week 8. Probability of sustained clearance during the 12-month follow-up was 22.9% for patients treated with IngMeb. Increased treatment satisfaction and cosmetic outcomes were observed with IngMeb versus vehicle. No unexpected safety signals were identified. Localized skin responses hindered maintenance of double-blinding. IngMeb 0.027% was superior to vehicle for treatment of AK areas of up to 250cm2. The safety profile of IngMeb was as expected.

IPEG 2019 The 28th Annual Congress for Endosurgery in Children March 20-22, 2019, Santiago, Chile.

IPEG 2019 The 28th Annual Congress for Endosurgery in Children March 20-22, 2019, Santiago, Chile.

Therapeutic evaluation of efficacy of intralesional bleomycin in common warts including palmo-plantar and periungual warts: a prospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Commonly used destructive treatment modalities for common warts though effective, are associated with pigmentary changes, scarring and recurrences. Treatment with immune modulators or immunotherapy has shown variable results. We evaluated efficacy and safety of intralesional bleomycin for treating common warts including palmoplantar and periungual warts.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Two hundred patients with common, palmar, plantar and periungual warts (having 753 warts) were treated with two intralesional injections of bleomycin 1 mg/ml at two weekly intervals. They were followed up at 4weeks and 12 weeks for cure, adverse effects and partial clearance or recurrence.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Only 183 (M: F 95:88) patients having 703 warts completed the study. Overall, complete clearance in 669 (95.16%) warts in 156 (85.2%) patients and partial clearance in 24 (3.4%) warts in 21 (11.4%) patients were observed. Patients with complete/partial clearance were highly satisfied from the treatment. Recurrence was seen in 6 (3.27%) patients. Most patients had injection site pain for 2-3 days not warranting discontinuation of treatment. Other adverse effects included temporary hyperpigmentation in 46, altered skin texture in 12 and injection site infection in 6 patients, respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Intralesional bleomycin appears effective, safe, and acceptable treatment modality for common warts including palmoplantar and periungual warts. It carries the advantage of low dose, insignificant adverse effects and high patient satisfaction. &lt;/p&gt;

Simulation of unidirectional propagating wave trains in deep water using a fully non-hydrostatic model

A new fully non-hydrostatic model is developed and then applied to simulate the evolution of unidirectional propagating waves in intermediate and deep water. The ability and efficiency of the model are examined using experimental data. Then, the evolutions of initially uniform and perturbed wave trains are simulated. Frequency downshift phenomena occur during the wave evolution. For a small initial steepness, there are approximately two incidents of partial recurrence. However, with increasing initial wave steepness, the energy transfers from the lower sideband to the carried wave decreases, and a permanent frequency downshift is more likely to occur. For the initially imposed wave trains, if the wave steepness is lower than 0.11, an approximate Fermi-Pasta-Ulam (FPU) phenomenon occurs. For wave trains with a steepness of approximately 0.13, a partial recurrence still can appear. Recurrence is not observed in larger wave trains. Additionally, the kinematics of extreme waves formed during the wave evolution are also investigated, and the non-dimensional horizontal velocity profiles under the extreme crests are converged and can be well modelled by the theoretically exponential curve. In addition, the crest speeds of the steep waves are less than the linear wave speeds. It is found that larger waves have slower crest speeds.

Comparison of Narrowband UV-B With Psoralen–UV-A Phototherapy for Patients With Early-Stage Mycosis Fungoides

Phototherapy is one of the mainstays of treatment for early mycosis fungoides (MF). The most common modalities are psoralen-UV-A (PUVA) and narrowband UV-B (NBUVB). To compare the efficacy and adverse effects of PUVA vs NBUVB in early-stage MF. A systematic review was performed by searching Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Ovid Medline, PubMed, Cochrane Library, American College of Physicians ACP Journal Club, and Database of Abstracts of Review of Effectiveness from inception to March 30, 2018. UV A, PUVA, mycosis fungoides, Sézary syndrome, cutaneous T-cell lymphoma, UV B, and UVB were used as either key words or MeSH terms. Studies of cohorts with histologically confirmed early-stage MF, defined as stages IA, IB, and IIA, that compared PUVA vs NBUVB, had at least 10 patients in each comparator group, and reported outcomes of response to therapy. Exclusion criteria were studies with patients with stage IIB or higher MF, pediatric patients, fewer than 10 in each comparator group, noncomparative studies, case reports, and abstract studies. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed. Data were pooled using a random-effects model with odds ratio (OR) as effect size. Main outcomes were complete response rate, partial response rate, disease recurrence, and adverse effects, including erythema, nausea, pruritus, phototoxic effects, dyspepsia, and pain. Seven studies were included with a total of 778 patients (405 of 724 [55.9%] men; mean age, 52 years); 527 were treated with PUVA and 251 with NBUVB. Most of the included studies were of poor to moderate quality. Any response was found in 479 of the 527 (90.9%) patients treated with PUVA vs 220 of 251 (87.6%) treated with NBUVB (OR, 1.40; 95% CI, 0.84-2.34; P = .20). Complete response was found in 389 of 527 (73.8%) patients who received PUVA vs 156 of 251 (62.2%) who received NBUVB, which was statistically significant (OR, 1.68; 95% CI, 1.02-2.76; P = .04). Partial response was similar (90 of 501 [18.0%] vs 64 of 233 [27.5%]; OR, 0.58; 95% CI, 0.33-1.04; P = .07). No significant difference was found between PUVA and NBUVB in terms of adverse effects of erythema (38 of 527 [7.2%] vs 17 of 251 [6.7%]; P = .54), nausea (10 of 527 [1.9%] vs 3 of 251 [1.2%]; P = .72), pruritus (2 of 527 [0.4%] vs 4 of 251 [1.7%]; P = .26), phototoxic effects (7 of 527 [1.4%] vs 2 of 251 [0.9%]; P = .72), dyspepsia (6 of 527 [1.2%] vs 0 of 251 [0%]; P = .59), or pain (0 of 527 [0%] vs 2 of 251 [0.9%]; P = .50). The findings suggest that PUVA is a potential alternative to NBUVB in the management of early-stage MF. These findings have implications for clinicians involved in the management of early-stage MF.

Case series of a novel open plication supported by mesh (PSUM) - technique for symptomatic abdominal rectus diastasis repair with or without concomitant midline hernia: Early results and a review of the literature

BACKGROUND: Abdominal rectus diastasis (ARD), sometimes combined with abdominal wall midline hernia, is a common complaint in women after childbirth. To some individuals, ARD causes functional disability. Convincing data of the long-term results of ARD repair are lacking, especially when ARD is severe, and the optimal technique is undefined. In plastic surgery, the repair is often done with suture alone, but if a concomitant hernia exists, using a mesh is mandatory. This paper reports a novel surgical technique aimed at a reliable and minimally traumatic repair of ARD with or without midline hernia and a review of the literature of ARD repair. PATIENTS AND METHODS: During June 2013–April 2018, 37 consecutive patients with symptomatic ARD with or without concomitant midline hernia were operated on by using a narrow piece of a self-gripping mesh (n = 32) or the tails of the ventral patch (n = 5). The mesh was placed in between the plicated linea alba. The outcome and patient satisfaction in this pilot study were analyzed. RESULTS: A significant subjective improvement in body balance after surgery was reported by 34 patients (92%). During the mean follow-up of 13 months, there was only one partial recurrence of ARD. The complication rate was low, and patient satisfaction was good. CONCLUSION: According to the present study, selected patients with severe lack of muscle control and/or back pain benefit from ARD repair. The minimally traumatic PSUM mesh augmentation seems a promising method for the repair of ARD.

SIMULTANEOUS OPERATIONS TACTICS IN PATIENTS WITH VENTRAL HERNIAS

Objectives - to improve treatment results in patients with ventral hernia and the concurrent surgical diseases by means of the designed surgery tactics. Material and methods. The treatment of 834 patients with ventral hernia, aged from 18 up to 82 years, was analyzed. The group consisted of 196 men (23.5%) and 638 women (76.5%). According to the European Hernia Society (EHS) classification of postoperative ventral hernias the gate types were distributed in patients as follows: W1 - in 132 patients (15.8%), W2 - in 397 (47.6%), W3 - in 305 (36.6%), in 243 (29.1%) cases the hernias were recurrent. 394 (47.2%) patients had 597 simultaneous interventions. The treatment tactics for the patients with hernias and associated diseases was defined according to the designed classification. For the abdominal wall repair the 2 variants of the "tension-free" mesh repair technique were used. Results. Forced simultaneous interventions were performed in 34 patients when the intestinal loops adherent to the scar were situated in the hernia sac. In 27 cases the postoperative ventral hernia was combined to the intestinal fistulas, located out of the hernia area. 12 patients underwent herniolaparotomy conditioned by the intra-abdominal intestinal fistulas closure and small hernias size. To prevent the compartment syndrome in 3 patients with splanchnoptosis the right part of the colon was resected. 103 patients had the planned simultaneous operations including the laparoscopic cholecystectomy in 19 cases, 114 patients underwent the panniculectomy. The preventional appendectomy was performed in patients with the recurrent large hernias. In 140 cases the omentum resection was done due to the signs of the chronical strangulation and omentitis. Postoperative pulmonary artery thromboembolia was the death cause for 3 (0.4%) patients. Only 8 (0.9%) patients suffered the partial hernia recurrence. Conclusion. In patients with hernias the simultaneous operations are conditioned by the pathogenesis and do not affect the severity and frequency of wound complications in the postoperative period. A condition for the simultaneous interventions in patients with hernias is the necessary implementation of the combined techniques of the ventral tension-free mesh hernioplasty.

PRM149 - OPEN-SOURCE DISCRETE EVENT SIMULATION MODEL FOR MAJOR DEPRESSION DISORDER (MDD): AN UPDATE SUITABLE FOR NEW GENERATION TREATMENT?

In 2014, an open-source discrete event simulations (DES) model was developed for major depressive disorder (MDD) to estimate health and cost outcomes associated with alternative treatment strategies. The DES has been updated in order to provide a freely available up-to-date cost-effectiveness analysis taking into account potential gene therapy. This model simulated short-and long term clinical events (partial response, remission, relapse, recovery, and recurrence), adverse events, and treatment changes (titration change, switch, addition, and discontinuation) over up to 5 years. Several treatment pathways were defined by clinical experts considering classical therapy and gene therapy with three levels of efficacy, tolerability, and price (low, medium and high) from first line to third line. The possibility of a one-time cost was implemented and the model was updated with input data from the literature for the UK settings. Model outputs include time in different health states, quality adjusted life years (QALYs) and costs from National Health Service and societal perspectives. The model remains open source and is now available on GitHub. The largest cost components from the payer perspective were the price of the new drug followed by physician visits and hospitalisations. The predicted costs and QALYs were driven by utility values, effectiveness, and frequency of physician visits. Differences in QALYs and costs between strategies were dependent with the duration of the simulation: a shorter time horizon limited the capture of the long term health benefit, increasing the impact of the high one time-cost on the ICER. The discrete event simulation model can provide a comprehensive evaluation of different therapeutic options in MDD including potential gene therapy and can be used to compare a wide range of health care technologies in various groups of patients in MDD. The fact that the DES is open-source reinforced the credibility and the acceptability of the model.

Cicatricial ectropion surgery: a prospective study of long‐term symptom control, patient satisfaction and anatomical success

Cicatricial ectropion repair is effective and has a low complication rate. To evaluate the effectiveness and long-term functional outcomes of surgical repair of lower lid cicatricial ectropion. Prospective consecutive case series. Forty-four consecutive operations for cicatricial ectropion repair. Consecutive cases of cicatricial ectropion repair completed during 2007-2011 in Waikato Hospital and Hamilton Eye Clinic, New Zealand, were enrolled in the study following formal ethics approval. Ectropion repair was completed using inferior retractor repositioning, horizontal lid tightening and full-thickness skin grafting. Patient-reported symptoms and satisfaction, ectropion recurrence and punctal ectropion. Forty-four eyes of 40 patients (30 males and 10 female) were included in the study. The average age at surgery was 75 years. Watering and poor appearance were the most common presenting symptoms. Postoperative follow-up was 1-6 years (mean = 4 years). There were no major perioperative complications, one patient developed trichiasis postoperatively. There were five reoperations (11%) during the study period. Two patients underwent medial spindle procedures for symptomatic medial ectropion and three patients required additional horizontal lid tightening. Seventy percent of patients reported satisfaction with their long-term results despite the partial recurrence of symptoms in 45%. Ectropion recurrence in <1 year occurred in three patients. In this series, satisfactory appearance and symptom control were reported by 68% of patients at long-term follow-up. Preoperative marked ectropion with marked lid laxity is associated with early treatment failure and may be regarded as a relative contraindication to surgical correction with this technique. Punctal ectropion is an unreliable indicator of functional success.

A comparative study between intralesional PPD and vitamin D3 in treatment of viral warts

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Viral warts are caused by human papillomavirus. There are innumerable treatment modalities but they may result in partial clearance or recurrence. Some newer and effective treatments include intralesional immunotherapy. We undertook a study to evaluate the safety and efficacy of two such immunotherapy namely tuberculin purified protein derivative (PPD) versus intralesional vitamin D3 for the treatment of viral warts.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total of 80 patients were included in the study. Group 1 patient were injected with 10 TU of tuberculin PPD (0.1 ml) intralesional while in group 2 patients were injected (0.5 ml) vitamin D3. The clinical assessment was done by photographic measurements at baseline, before each treatment session, and after the completion of treatment.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In group 1 A total of 80% (32 patients) showed complete clearance and 20% (8 patients) showed partial response while in group 2 72.5% (29 patients) showed complete clearance while 27.5% (11 patients) showed partial response. No significant side effects were observed except for pain at the site of injection.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Intralesional vitamin D and intralesional Tuberculin PPD immunotherapy shows significant results in treatment of viral warts.&lt;/p&gt;

Early surgical correction of buried penis

Introduction: Buried penis is a developmental condition characterized by normal size penis that appears smaller or hidden by suprapubic fat. Many complications are associated with buried penis, including poor cosmoses, poor hygiene, difficult accessibility, and recurrent balanitis. Urinary tract infection, negative feeling by parents and patients. Different surgical techniques have been described to correct the condition. Aim: The aim of this study was to present our result of early surgical correction of buried penis. Results: A total of 94 patients underwent correction of buried penis. 80 (85%) patients were less than 2 years of age. The mean follow-up was 8 months, ranging from 6 to 22 months. The most common types of anomaly were buried penis [65 (59.5%)], concealed penis [21 (22.3%)], and trapped penis [eight (8.5%)]. The early postoperative complications were edema [10 (10.6%)], bleeding [four (4.2%)], excess inner prepuce [three (3.1%)], redundant skin [two (2.1%)], and infection [one (1.06%)]. The late postoperative complications were partial recurrence in 6.3%. In 63.8% the skin was adequate and there was no need for additional skin flap; in 27.6% we created payers flap and in 8.5% we used the long inner prepuce. Conclusion: Early surgical correction of buried penis is safe and is associated with minimal complications. Keywords: buired penis, circumcision, trapped penis

Клинико-рентгенологические результаты многоуровневых оперативных вмешательств при подвывихе и вывихе бедра у детей с ДЦП

Introduction The purpose of this work was to study the results of orthopedic correction performed according to the principles of one-stage multilevel surgical intervention in cerebral palsy patients with hip dislocation. Material and methods We studied the results of operative orthopedic treatment in 50 children suffering from cerebral palsy (GMFCS levels IV and V, mean age 6.2 ± 1.4 years at the beginning of treatment) who underwent multilevel interventions with the purpose of hip joint reconstruction and correction of other orthopedic complications of cerebral palsy in the knee and foot. The parameters of the orthopedic status were studied as well as such radiographic data as the Reimers index, acetabular index, acetabular frontal depth index, projection neck-to-shaft angle, Wiberg index, tibiotalar angle, angle of the talocalcaneal divergence in the sagittal and frontal planes, coverage of the head of the talus with the navicular bone. The mean follow-up period was 2.8 ± 1.7 years. Results Patients underwent 91 reconstructive interventions during the study period involving 461 surgical elements (5.07 per operation on average). The goals of the pathology correction were achieved in all cases. In all patients, by the end of the first year after the operation, hip abduction was more than 30 degrees and flexion was more than 100 degrees. Comfortable sitting posture and correct passive symmetrical verticalization, pain relief in everyday life were reported in all cases. The shape and position of the foot made it possible to use comfortable regular footwear during verticalization, as well as during walking. By the end of the second follow-up year, a decrease in hip abduction to 20 ° was detected in only two patients. In two cases, a partial recurrence of foot valgus was observed which occurred by axial limb loading and required the use of an orthotic appliance. All radiological indicators examined after the treatment remained within the limits of normal values during the follow-up period. But there was a mild tendency to reduction of hypercorrection achieved which was within the normal boundaries. Conclusion Multilevel operations in children with severe types of cerebral palsy and hip dislocation as the leading pathology are aimed at achieving correction of all orthopedic problems in the lower limbs. The result of such interventions is not only normal anatomical parameters but also the creation of conditions for rehabilitation measures, especially postural management, which is extremely important for normal hip joint development and prevention of hip subluxation and dislocation recurrence in children.

Cellulite: A Surgical Treatment Approach.

Cellulite is one of the most common skin and subcutaneous tissue conditions, affecting predominantly the thighs and hips in postadolescent women. Its etiology is not well defined, and multiple available treatments show variable efficacy. To describe a technique for treatment of cellulite of the gluteal region, thighs, and hips through superficial liposuction utilizing a special cannula, combined with subcutaneous autologous fat grafting. A retrospective review was performed of patients treated over 26 years at the Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil. Patients underwent pretreatment evaluation as to the extent of their cellulite, and pretreatment and posttreatment photographs were obtained for visual evaluation of the results. Procedures were performed on 126 patients: 121 (96%) women and 5 (4%) men. The majority considered their results good or excellent. The complication rate was low, with the most common complications being ecchymosis, contour irregularities, partial recurrence of cellulite, seroma, and numbness. We describe an effective method for the treatment of cellulite. Whereas subcision techniques utilize a needle or microblade to cut fibrous septa, we utilize a special cannula; larger areas can be treated than with subcision. Fat grafting is utilized to correct depressions and improve skin quality, which are added benefits compared to traditional subcision. Considering the multiple available cellulite treatments and their limitations, and the high patient satisfaction rate we achieved, with a low recurrence and complication rate, this technique can be a safe and effective option for patients with cellulite.

Audit of 117 otoplasties for prominent ear by one surgeon using a cartilage-cutting procedure.

The plethora of surgical procedures for prominent ear correction reflects lack of satisfaction with outcomes achieved. This paper describes a cartilage-cutting otoplasty procedure and reports an audit of its outcomes. Discharge coding was used to retrospectively identify patients who had undergone the otoplasty of interest at Middlemore Hospital, Auckland, during the 5 years from March 2010 to the end of February 2015. Hospital records were accessed. Demographic, procedure and patient satisfaction data were recorded and analysed (PASW/SPSS Statistics 18.0). Chi-square test and t-test were used to assess associations, with significance accepted at two-sided P < 0.05. Sixty-four patients underwent the specified otoplasty (54.7% females: mean age 9.5 years (standard deviation, SD: 4.2; range: 4-20)), of whom 93.8% had bilateral procedures with mean surgical time of 61 min (SD: 14; range: 34-94). This was significantly shorter (P < 0.001) than for bilateral surgeries by all other techniques and surgeons in the review period. None of the 117 procedures of interest subsequently had suture extrusion or revision surgery. Mean time from surgery to satisfaction determination was 993 days (SD: 521; range: 111-1850) for 43 (67.2%) patients. 23.3% believed that there had been aesthetically insignificant partial recurrence of prominence, typically of one ear only. This was insufficient for all but one patient to consider repeat otoplasty. Surgery outcome was rated 'very satisfactory' and 'satisfactory' by 90.7% and 9.3% of patients/parents, respectively. All would recommend the surgery to others. With infrequent complications and recurrence requiring revision, and without long-term reliance on sutures, the otoplasty reported is time-efficient, safe and generates high patient satisfaction.

Treatment of the overriding fifth toe: Butler's arthroplasty is a good option.

PurposeThe overriding fifth toe is a congenital triplane deformity that may cause aesthetic and functional concerns in children and adolescents. This study aims to evaluate the results obtained when using Butler’s arthroplasty to treat this forefoot deformity.MethodsWe performed a retrospective study, including all patients undergoing Butler’s arthroplasty from January 1995 to December 2012. Clinical records were reviewed to determine age at date of surgery, gender, laterality, preoperative symptoms, success of deformity correction, postoperative pain, scarring, need for adapted shoe, rates of complications and recurrence. Patient satisfaction was evaluated through a telephone interview. All p-values < 0.05 were considered statistically significant.ResultsA total of 21 patients were included in this study, the majority of which were male (57%), with a mean follow-up of 12 months (1 to 52). In the evaluation of the residual deformity (18 patients), 72% had excellent results, 17% good and 11% poor results. One patient had a keloid scar, three patients reported pain and three patients required adapted footwear. There was a partial recurrence of the deformity in three cases. The majority of patients (78%) were satisfied with the surgery. There was no statistically significant difference in terms of results, when comparing patients older and younger than seven years of age (p = 0.46).ConclusionsButler’s operation is effective and safe in the treatment of the overriding fifth toe, yielding good functional results and patient satisfaction, with low rate of complications.Level of EvidenceIV