Partial Resolution Of Symptoms Research Articles

Surgical Technique for Repair of Tegmen Dehiscence with Encephalocele: A Retrospective Study

Tegmen dehiscence with encephalocele presents certain surgical challenges, necessitating innovative approaches to improve patient outcomes and minimize complications. Here we aim to evaluate the safety and efficacy of a novel middle cranial fossa craniotomy technique. Nineteen adult patients with radiographically confirmed tegmen dehiscence with encephalocele were included. Patients underwent a middle cranial fossa craniotomy technique for tegmen dehiscence repair, utilizing a split thickness bone graft, pedicled pericranial flap, and hydroxyapatite for extradural repair and with an inlay graft for the intradural repair. The primary outcome measured was major perioperative complications or need for revision surgery while secondary outcome measured was the resolution or improvement of preoperative symptoms associated with tegmen dehiscence. Our series encompassed tegmen dehiscence repairs in 19 patients, with an average age at surgery of 51 years (range 24 to 82). The average follow-up time was 8.80 months (range 0.43 to 27.62 months). Patients commonly presented with symptoms such as hearing loss (n=8), otorrhea (n=8), fullness or ear pressure (n=6), dizziness or imbalance (n=6), or a history of meningitis (n=4), among others. Postoperatively, symptoms resolved completely in 42% of patients (n=8) and partially in 58% of patients (n=11). Notably, no patients required revision surgery or developed new dehiscences in the follow-up period. Our middle cranial fossa craniotomy technique for tegmen dehiscence with encephalocele repair demonstrated promising postoperative outcomes, with complete or partial symptom resolution in all patients and no major complications. Our findings suggest that this technique is a safe and effective approach for tegmen dehiscence repair.

Schnitzler syndrome: A rare disease with neutrophilic dermatosis and monoclonal gammopathy

Schnitzler syndrome is a rare chronic auto-inflammatory disease characterized by neutrophilic dermatosis and a monoclonal gammopathy of IgM type. The clinical features of this disease like fever, rash, arthralgias and lymphadenopathy often overlaps with the presenting symptoms of other diseases like Castleman’s disease, adultonset Still’s disease and lymphomas. But the line of treatment is different for each of these clinical conditions. Schnitzler syndrome is associated with over-production of IL-1 and therapies are directed against this interleukin. Here, we present a case of Schnitzler syndrome, who was initially diagnosed as multi-centric Castleman’s disease and was treated with only partial resolution of symptoms.

Neurological complications of influenza vaccination: navigating the spectrum with a focus on acute disseminated encephalomyelitis (ADEM)

Introduction: Acute disseminated encephalomyelitis (ADEM) is a rare neurological disorder characterized by inflammation in the brain and spinal cord. This systematic review aims to investigate the potential association between ADEM and influenza vaccination by analyzing relevant case reports. ADEM is traditionally thought to be a monophasic condition, predominantly affecting children, often following viral illnesses or immunizations. Recent attention has focused on a possible link between ADEM and influenza vaccination, prompting the need for a thorough investigation. Methods: The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the AMSTAR2 (A MeaSurement Tool to Assess systematic Reviews 2) guidelines. Electronic searches were conducted on PubMed, Cochrane Library, and clinicaltrials.gov databases, spanning up to August 2023. Inclusion criteria encompassed full-text articles in English, observational studies, case reports, and case series providing comprehensive details for confirming clinical diagnoses of ADEM following influenza vaccination. Data were extracted, including demographic information, vaccination details, clinical symptoms, diagnostic evaluations, treatment modalities, and outcomes. Quality assessment was performed using the Joanna Briggs Institute (JBI) Critical Appraisal tool. Results: A total of 23 cases of ADEM following influenza vaccination were identified from 19 included articles. The mean age of affected individuals was 40.2 years (±25.7) with 60.8% being male. Common presenting symptoms included muscle weakness (52.1%), urinary abnormalities (30.4%), altered consciousness (26%), and sensory disturbances (26%). Neurological examination revealed findings such as extensor plantar reflex (positive Babinski sign) in 26%, hyperreflexia in 30.4%, and generalized hyporeflexia in 13% of the cases. Diagnostic evaluations involved MRI, showing multiple hyperintense lesions in cerebral hemispheres (43.4%), subcortex (60.8%), and spinal cord (39.1%). Cerebrospinal fluid analysis indicated elevated white blood cell count in 69.5% of cases, with lymphocytic pleocytosis in 52.1%. Oligoclonal bands were reported positively in 8.6% of cases. Treatment approaches varied, with intravenous methylprednisolone being the most common (39.1%). Out of the 23 cases, two (8.6%) patients had a fatal outcome, while the rest showed clinical improvement with complete or partial resolution of symptoms. Persisting symptoms included numbness in the lower extremities (8.6%) and impaired ability to walk after 10 months (4.3%). Conclusion: While the association between ADEM and influenza vaccination is rare, healthcare professionals should remain vigilant and consider patients’ vaccination history, particularly following an influenza immunization. This systematic review highlights the clinical manifestations, diagnostic tools, treatment approaches, and outcomes of ADEM cases post-influenza vaccination. Further research is essential to understand this association and improve clinical decision-making, ensuring the safety and efficacy of immunization programs.

NCMP-18. ENDOVASCULAR TREATMENT OF SYMPTOMATIC TUMORAL VENOUS SINUS STENOSIS: COMPARATIVE ANALYSIS OF CORONARY BALLOON-MOUNTED STENTS AND CONVENTIONAL TECHNIQUES

Abstract Meningiomas may lead to symptomatic papilledema due to elevated intracranial pressure (ICP) from venous sinus compression. While venous sinus stenting has proven effective for treating elevated intracranial pressure, evidence for its application in tumoral-induced stenosis and acquired intracranial hypertension is limited. This study presents an institutional series of symptomatic tumoral venous sinus stenosis cases and compares the technical considerations of endovascular treatment using a coronary balloon-mounted stent to conventional venous sinus stenting. Three patients with meningioma-induced, bilateral papilledema received treatment with venous sinus stenting between 2019-2022. Presentation, stenosis severity, venous manometry, ophthalmologic findings, procedural techniques, and post-operative outcomes were retrospectively analyzed. Three patients (mean age: 59 years, 2 out of 3 male) presented with worsening blurry vision, diplopia, and persistent headaches. Bilateral papilledema was observed (median optic nerve sheath distension=0.48mm). Pre-procedure measurements showed elevated ICP with opening pressures ranging from 37-38 cmH2O. Imaging revealed extra-axial parieto-occipital lesions with significant mass effect, and MR venograms confirmed severe stenosis of the superior sagittal sinus (SSS). Venous angiography (DSV) demonstrated median venous sinus pressures of 32-mmHg proximal to the stenosis with a 4-mmHg pressure gradient across the stenosis. During the procedure, balloon-mounted Onyx coronary stents or a self-expanding PrecisePro carotid stent were deployed successfully. Post-stenting, papilledema resolved completely in two patients, while one patient experienced partial symptom resolution. Proximal SSS pressures decreased by a mean of 46.8%, and trans-stenotic pressure gradients were reduced to ≤1 mmHg. Stent patency without complications was maintained throughout the 2 to 5-month follow-up in all patients. Adjacent meningiomas were subsequently monitored for observation or stereotactic radiosurgery. Small extra-axial lesions causing symptomatic venous sinus compression can be endovascularly treated using balloon-mounted cardiac stents. Non-surgical meningioma patients, symptomatic for intracranial hypertension and lesions proximal to venous sinuses, should be assessed with DSV for potential management with endovascular interventions.

CPC12 Coinheritance of BRCA2 and CYLD germline pathogenic variants associated with targetable metastatic malignant cylindroma

Abstract CYLD cutaneous syndrome (CCS) presents during puberty with the development of hair follicle tumours, including cylindromas, spiradenomas or trichoepitheliomas, and is associated with pathogenic variants in the tumour suppressor gene CYLD. Germline pathogenic variants of BRCA2 are associated with an increased risk of breast, ovarian, pancreatic and prostate cancer. Coinheritance of pathogenic variants in both genes has not been previously reported, and here, we present a 29-year-old man with metastatic malignant cylindroma, where knowledge of the germline variants has targetable therapeutic implications. The proband presented with cylindromas on his scalp from the age of 8 years, inherited from his mother who had CCS. The proband’s father and paternal grandmother both had early-onset breast cancer. The proband’s 33-year-old sister had been diagnosed with breast cancer and CCS; genetic testing revealed germline pathogenic variants in both BRCA2 and CYLD. Aged 28 years, the proband presented with a growing, ulcerated cylindroma on the scalp. Histology revealed a biphasic neoplasm, showing malignant cylindroma with high-grade features arising within a pre-existing benign cylindroma. The malignant epithelioid component of the tumour showed brisk mitotic activity (25 mitoses per mm2) and large infiltrative nests with central comedo-type necrosis. Immunohistochemistry showed positivity for epithelial membrane antigen, CK7, p63 and patches of CK5/6, whereas carcinoembryonic antigen, S100 and human melanoma black-45 were negative. Several weeks after excision of the malignant scalp cylindroma, a lump presented on the left side of the patient’s neck; biopsy revealed histology consistent with the malignant scalp cylindroma. Radiological imaging revealed metastatic deposits of malignant cylindroma in the right axilla, both lungs and the brain. Genetic testing of the proband revealed germline pathogenic variants in both BRCA2 and CYLD, as seen in his sister. The patient received radiotherapy for the tumour in his neck, with partial resolution of symptoms and gamma-knife ablation of brain metastases. DNA extracted from the patient’s tumour was analysed using a high-resolution single-nucleotide polymorphism array, which demonstrated loss of heterozygosity including the BRCA2 and CYLD loci. The germline and somatic pathogenic variants in this patient support the use of unlicensed therapeutics that target BRCA deficiency, such as poly-ADP ribose polymerase inhibitors, which have not previously been used to treat malignant cylindroma. This case emphasizes the importance of recognizing coinheritance of tumour suppressor genes in rare genetic conditions, as this can provide novel management options and improve patient outcomes.

Exploring Relationships Between Ultrasound-Measured Pre-Operative Median Nerve Echointensity and Successful Carpal Tunnel Release-A Retrospective Review (P14-8.002)

<h3>Objective:</h3> The purpose of this study is to explore the association between preoperative median nerve echointensity and outcomes of carpal tunnel release (CTR). <h3>Background:</h3> Published success rates of CTR vary from 27–100%. With the advancement of neuromuscular ultrasound (NMUS), nerve echointensity has gained increased attention as an indicator of intraneural edema. <h3>Design/Methods:</h3> We performed a retrospective review of the electronic medical record to identify patients who underwent sonographic evaluation of the median nerve and CTR surgery at Duke University within 4 months. Those with concurrent polyneuropathy were excluded. Surgical outcomes were determined by 2 independent reviewers based upon chart review of the postoperative visit 4–6 weeks after surgery. A 3^rd reviewer assessed the outcome in the event of disagreement. Complete resolution was defined in the absence of paresthesia, pain, and functional limitation pertinent to carpal tunnel syndrome. <h3>Results:</h3> A total of 56 nerves from 50 patients were identified. Of these patients, 33 (66%) were women and the mean age was 57.2 years (SD = 14.2). Complete resolution occurred in 39 (69.6%) surgeries. Multivariable logistic regression model, adjusted for age and gender, showed no association between median nerve echointensity and complete versus partial resolution (OR=1.01; 95% CI = 0.99–1.03). Inter-rater reliability was excellent in both outcome assessment (% agreement = 96.4, kappa =0.92) and measurement of echointensity (interclass correlation: 0.914). <h3>Conclusions:</h3> Our study did not demonstrate differences in preoperative median nerve echointensity between patients with complete and partial resolution of symptoms following CTR surgery. However, the measurement of echointensity and outcomes assessment had excellent interrater reliability. A multi-center prospective study should be pursued for better understandings of the relationship between NUS parameters and the outcomes of CTR surgery. <b>Disclosure:</b> Dr. Harada has nothing to disclose. Dr. Wannarong has nothing to disclose. Dr. Neely has received personal compensation for serving as an employee of Duke University . An immediate family member of Prof. Williams has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for SQZ Biotech. An immediate family member of Prof. Williams has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Viracta Therapeutics. Prof. Williams has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Origin Editorial. The institution of Prof. Williams has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for PCORI. The institution of Prof. Williams has received research support from PCORI. The institution of Prof. Williams has received research support from NIH. Prof. Williams has received publishing royalties from a publication relating to health care. Dr. Pidgeon has received personal compensation in the range of $500-$4,999 for serving as a Consultant for QPix. Dr. Pidgeon has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Tissium. The institution of Dr. Pidgeon has received research support from Acumed. An immediate family member of Dr. Hobson-Webb has received personal compensation for serving as an employee of G1 Therapeutics. Dr. Hobson-Webb has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wiley Publishing. The institution of Dr. Hobson-Webb has received research support from Sanofi Genzyme.

A Real-world Multicenter Outpatient Experience of Ceftolozane/Tazobactam.

Ceftolozane/tazobactam (C/T) is indicated for the treatment of complicated intra-abdominal infection (IAI), complicated urinary tract infection (UTI), and hospital-acquired/ventilator-associated bacterial pneumonia caused by susceptible bacteria. As real-world data are limited, we report utilization and associated outcomes of C/T use in the outpatient setting. This is a multicenter, retrospective study of patients who received C/T between May 2015 and December 2020. Demographics, infection types, C/T utilization characteristics, microbiology, and health care resource utilization were collected. Clinical success was defined as complete or partial symptom resolution at completion of C/T. Persistent infection and discontinuation of C/T were deemed nonsuccess. Logistic regression analysis was used to identify predictors associated with clinical outcomes. A total of 126 patients (median age, 59 years; 59% male; median Charlson index, 5) from 33 office infusion centers were identified. Infection types included 27% bone and joint infection (BJI), 23% UTI, 18% respiratory tract infection (RTI), 16% IAI, 13% complicated skin and soft tissue infection (cSSTI), and 3% bacteremia. The median daily dose of C/T was 4.5 g, primarily administered via elastomeric pumps as intermittent infusion. The most common gram-negative pathogen was P. aeruginosa (63%), 66% of which was multidrug-resistant and 45% carbapenem-resistant. Enterobacterales was identified in 26% of isolates, of which 44% were extended-spectrum beta-lactamase producers. The overall clinical success rate of C/T was 84.7%. Nonsuccessful outcomes were due to persistent infections (9.7%) and drug discontinuations (5.6%). C/T was successfully used in the outpatient setting to treat a variety of serious infections with a high prevalence of resistant pathogens.

Rethinking treatment-resistant depression to quasi-tenacious depression.

With almost one-third of patients with major depression not adequately responsive to treatments, the management of treatment-resistant depression (TRD) has continued to be challenging. Recently, an essential step was taken to replace TRD with difficult-to-treat depression (DTD), pointing to some drawbacks associated with this terminology and identifying addressable barriers. In line with the DTD concept, we discuss why terming this population of patients as TRD could be semantically and clinically misleading. We then suggest replacing TRD with quasi-tenacious depression (QTD), a model and terminology that are derived from a potentially measurable outcome, the tenacity index (TI). QTD predicts that in theory remission is achievable by providing suitable treatments at hand. QTD states that every patient with major depression (even those who respond well) has some degree of tenacity that needs to be overcome by the use of proper treatment modalities. Ergo, in patients with a higher TI, due to the dearth of available armamentaria, one might suffice to achieve a partial resolution of symptoms balanced with an optimal quality of life. However, QTD calls for an incessant pursuit of novel treatments and the identification of contributing factors leading to high TI. On a track toward personalized psychiatry, and in harmony with DTD, QTD embraces all key barriers leading to a failure to treatment response and tries to provide a measurable entity for a better clinical decision while conveying a dynamic positive outlook of the disorder for both patients and health care providers.

1016. Real-World Use of Omadacycline in Physician Office Infusion Centers (POICs)

Abstract Background Omadacycline (OMC) is approved for the treatment of community-acquired bacterial pneumonia and acute bacterial skin and skin structure infections. Real-world data on the use of OMC are limited. We present a multicenter observational review of OMC outpatient use in Infectious Disease POICs. Methods Medical records of patients (pts) receiving intravenous OMC from May 2019 to April 2022 from 5 POICs were included in this ongoing study. Data included demographics, diagnosis, medical history, microbiology, OMC regimen, adverse events (AEs), health care utilization and clinical outcomes. Clinical success was defined as complete or partial symptom resolution at completion of OMC with oral antibiotics as needed. Persistent or recurrent infection and premature discontinuation of OMC were deemed non-success. Indeterminate outcomes were excluded in outcome assessment. Chi Square, Fisher’s exact, and t-test were used to identify characteristics associated with clinical outcome. Results Overall, 37 pts (mean age: 61±13 yrs, 65% male) were identified. Infections treated were 62% bone and joint (BJI), 24% complicated skin and skin structure infections (CSSSI), 11% pulmonary nontuberculous mycobacterial (NTM) and 3% diverticulitis. A total of 61 pathogens were identified in 30 pts of which 83% had ≥1 Gram-positive isolate. Polymicrobial pathogens were reported in 13/30 pts (43%). Ten pts (27%) received concomitant IV antibiotics. Median duration of OMC therapy was 38 days (IQR, 21-47). OMC was initiated in the POIC without prior hospitalization in 62% of pts. Overall clinical success was 75% (24/31). Non-success due to persistent infection was reported in 5 pts (3 BJI, 2 CSSSI), of which 4 were hospitalized. Three additional pts were deemed non-successful due to early discontinuations (2 difficulty with administration, 1 AE) (Fig 1). Six pts were non-evaluable for outcome. Ten pts reported 14 AEs, most commonly nausea (4 pts) and elevated liver function tests (3 pts). Figure 1.Clinical outcome of omadacycline by infection type Conclusion These real-world results support the outpatient use of omadacycline in additional, difficult to treat, complicated infections, including bone and joint infections. Disclosures Lucinda J. Van Anglen, PharmD, Merck &amp; Co.: Grant/Research Support|Paratek: Grant/Research Support.

Case Report: The first reported case of pulmonary alveolar proteinosis with myasthenia gravis in a 27-year-old patient

Background: Pulmonary alveolar proteinosis is a very rare diffuse lung disease characterized by the accumulation of amorphous and periodic acid Schiff-positive lipoproteinaceous material in the alveolar spaces due to impaired surfactant clearance by alveolar macrophages. Three main types were identified: Autoimmune, secondary and congenital. Pulmonary alveolar proteinosis has been previously reported to be associated with several systemic auto-immune diseases. Accordingly, we present the first case report of pulmonary alveolar proteinosis associated with myasthenia gravis. Case: A 27-year-old female patient, ex-smoker, developed a dyspnea on exertion in 2020. The chest X-ray detected diffuse symmetric alveolar opacities. Pulmonary infection was ruled out, particularly COVID-19 infection. The chest scan revealed the “crazy paving” pattern. The bronchoalveolar lavage showed a rosy liquid with granular acellular eosinophilic material Periodic acid-Schiff positive. According to the lung biopsy results, she was diagnosed with pulmonary alveolar proteinosis. The granulocyte macrophage colony-stimulating factor autoantibodies were negative. Nine months later, she was diagnosed with bulbar seronegative myasthenia gravis, confirmed with the electroneuromyography with repetitive nerve stimulation showing significant amplitude decrement of the trapezius and spinal muscles. She was treated with pyridostigmine, oral corticosteroids and azathioprine. Given the worsening respiratory condition of the patient, a bilateral whole lung lavage was performed with a partial resolution of symptoms. Thus, this previously unreported association was treated successfully with rituximab, including improvement of dyspnea, diplopia and muscle fatigability at six months of follow-up. Conclusions: This case emphasizes on the possible association of auto-immune disease to PAP, which could worsen the disease course, as the specific treatment does not exist yet. Hence, further studies are needed to establish clear-cut guidelines for PAP management, particularly when associated to auto-immune diseases.

Laryngeal Foreign Body for 20 days without a Catastrophic EventLaryngeal Foreign Body for 20 days without a Catastrophic Event

We present successful management of an unusual foreign body (FB) case in the larynx for 20 days. A 45-year old man presented with complaints of hoarseness of voice and coughing up a few pieces of silver-colored flakes. He had unresolved dyspnoea and wheeze for three weeks and was managed as an asthmatic with partial resolution of symptoms. The patient was alcohol and drug dependent and was under treatment for epilepsy.

TU7.10 Short and medium-term symptom response to fundoplication in reflux-associated chronic cough in a UK Centre

Abstract Aim To identify whether anti-reflux surgery is an effective treatment for reflux-associated cough in a single specialist unit. Method A retrospective analysis of patients referred for suspected reflux-associated cough undergoing anti-reflux surgery over a 12 month period in a single centre. Pre-operative oesophageal physiology and imaging, operative technique and follow up records were examined. Symptom resolution and relapse was assessed four years postoperatively. Results 15 patients underwent anti-reflux surgery following referral with suspected reflux-associated respiratory symptoms. 6 patients had hiatus hernia (40%). There was no correlation between symptom improvement and presence of hiatus hernia, lower oesophageal sphincter (LOS) pressure or DeMeester score (DS). 13 of 15 patients attended initial follow-up. 12 (92.3%) reported complete or partial resolution of symptoms. Acid suppression medication was discontinued in 7 (53.8%) patients at follow up. 100% of patients with marked oesophageal dysmotility (OD) and elevated DS reported their symptoms either partially or fully resolved. One patient who reported no symptom improvement had normal LOS pressures and normal DS but marked OD. At four-year follow up, 7/13 reported symptoms (53.8%). Of these 3 have been re-referred for recurrent cough (23.1%), 1 for dysphagia (7.7%) and 2 experienced symptomatic reflux (15%). The final patient (7.7%) underwent revision surgery (partial reversal of Nissen Fundoplication) and was satisfied postoperatively. Conclusion Patients referred by the respiratory service for reflux-associated cough show good symptom improvement which is largely maintained following anti-reflux surgery. Relative contraindications of dysmotility did not appear to be predictive of worse outcome in this group.

Small Intestinal Bacterial Overgrowth in Children: Clinical Features and Treatment Response.

A retrospective cohort study of pediatric patients seen at Stanford Children's Health Gastroenterology Clinics from 2012 to 2018 who had a positive BT, defined by a rise in hydrogen by ≥20 ppm, a baseline hydrogen level ≥20 ppm, or a methane value ≥10 ppm. The main outcome was symptom resolution, defined as complete or partial improvement after a course of treatment. Absolute standardized differences and Chi-square tests were used to assess associations. From 98 children, 54 met inclusion and did not meet exclusion criteria (53.7% female). Lactulose substrate was used for 41 (75.9%) patients, whereas glucose was used for 13 (24.1%). Complete or partial resolution of symptoms was achieved in 13 of 16 (81.2%) patients who received probiotics with or without antibiotics versus 21 of 31 (67.7%) patients treated with antibiotics alone (P = 0.524). Metronidazole versus rifaximin versus other antibiotics showed no significant difference in symptom resolution (12 (63.2%), 13 (76.5%), 7 (77.8%), respectively, P = 0.601). Seventy-two percent of patients experienced at least partial symptom relief after treatment. We did not find a strong correlation between specific symptoms and analyte elevation. There was no difference in effectiveness between metronidazole and rifaximin to treat SIBO symptoms. Further research needs to be done to determine effective treatments for SIBO in pediatrics.

Surgical treatment of spinal stenosis in achondroplasia: Literature review comparing results in adults and paediatrics

BackgroundThis study aims to assess the quantity and quality of available literature on surgical treatment outcomes of spinal stenosis in adult and paediatric achondroplasia patients through a systematic review of literature and to investigate the suitability of conducting a meta-analysis on outcomes of surgical treatment. MethodsOnline databases were searched according to PRISMA guidelines. No restrictions regarding study design, sample size, previous treatment, or publication date were implemented. The following terms: “Spinal stenosis”, “Spinal Decompression”, “Spinal fusion”, each term separately combined with the term “Achondroplasia” were used. Quality of the included studies were assessed used the Modified Coleman method. ResultsFive adult and four paediatric single-sample non-comparative studies were identified for inclusion (176 adult and 102 paediatric patients). Meta-analyses assessed the proportion of patients achieving full resolution of symptoms to be 0.51 (95% CI 0.00 to 1.00); the proportion of patients achieving full or partial resolution of symptoms to be 0.90 (95% CI 0.84 to 0.97); the proportion of procedures requiring re-operation to be 0.42 (95% CI 0.34 to 0.50; and the proportion of procedures involving dural tears to be 0.20 (95% CI 0.02 to 0.39). Statistical heterogeneity was very high for full resolution of symptoms and requirement for dural repair; and very low for other outcomes. ConclusionsThe available literature on this population and condition is sparse, highly heterogenous, and is generally of low quality limiting the value of meta-analysis. Overall, outcomes of surgical decompression of symptomatic spinal stenosis in achondroplasia patients show consistent degree of resolution of symptoms. Duration of symptoms prior to surgical treatment appears to play an important role in the overall outcome of treatment. Therefore, a delay in diagnosis and treatment can potentially be detrimental in achieving a better outcome.

S373 Removal of an Inlet Patch Leads to an Improvement in Symptoms of Globus, Chronic Cough and Hoarseness in Select Patients

Introduction: The inlet patch (IP) is a frequently missed lesion of heterotopic gastric mucosa with varying reported levels of prevalence. Although typically thought to be a benign finding, we have found that there is a link between IPs and patient symptoms of chronic cough, heartburn, and globus after other causes are ruled out by EGD or pH probe. In our study we postulated that ablating the IP will alleviate patients' symptoms. Methods: Patients with histologically confirmed IP on screening EGD between 2017-2019 were selected. Of that cohort patients with chronic cough, heartburn and globus who failed PPI and H2 blocker therapy were offered to have their IP removed either with radiofrequency ablation (RFA), argon plasma coagulation (APC) or biopsy forceps. Patients were followed up afterward to see if there was an improvement of their symptoms. Results: Of 3,269 patients undergoing EGD at our center between 2017-2019, 50 were found to have an IPs. Ages ranged from 24-78 years of age, mean age of 56.4, median age of 51. 10 patients also had Barrett's esophagus. 38% of patients initially had heartburn, 24% dysphagia, 20% chronic cough, 18% throat clearing, 14% globus, 4% nausea. Three patients were asymptomatic. 23 patients underwent RFA or manual removal of IPs. Clearance of IP was confirmed by repeat EGD. Of the 23 who underwent IP removal, 14 (60% of total) had either complete or partial resolution of symptoms. No adverse events reported. Conclusion: Although IPs have been considered clinically irrelevant, we have evidence that they may be the etiology of several common symptoms such as chronic cough, globus or heartburn after other causes were ruled out. Partially this may be due to IPs not being characterized on exam. IPs are either congenital or acquired from chronic acid exposure which later develops the ability to secrete its own acid through oxyntic cells within the patch. These IPs rarely benefit from aggressive acid blocking therapy. In our study we found that symptoms secondary to IPs improved in a vast majority of patients after RFA, APC or manual removal. Some further avenues of research could compare methods of removal as well as determining efficacy of removal when patients have other concomitant GI conditions. Although the study population was small, the magnitude of the number of patients with improvement of symptoms was significant. Our results suggest that further studies are necessary to select which symptomatic individuals could benefit from IP ablation.Figure 1.: A. Single inlet patch, B-C. Inlet patch ablation with APC.Table 1.: Patient list of symptoms and response to treatment. RFA (Radio frequency ablation), APC (Argon plasma coagulation) PPI (Proton pump inhibitors) Bx (Biopsy off), H2 (Histamine-2 blockers).

A rare case of obstructive supracardiac TAPVR (Total Anomalous Pulmonary Venous Return) with aberrant right subclavian artery.

Congenital aortic arch malformations manifest a broad-spectrum of differences and abnormalities that come from disturbed embryogenesis of branchial arches. Current case was a 10 months old baby girl with length of 69 cm (less than –3 SD) and weight of 5.5 kg (less than –3 SD). The patient had history of recurrent lower respiratory tract infections since the time of birth and failure to gain adequate weight since the time of birth. The patient has been having multiple check-ups with registered medical practitioners in the nearby locality and multiple courses of antibiotics with only partial resolution of symptoms. The 2-D echocardiogram showed her to be a case of supracardiac type of “Total Anomalous Pulmonary Venous Return (TAPVR)”. All pulmonary veins making a confluence and draining into the right atrium. Significant turbulence observed at the level of superior vena cava to right atrium junction. A level of obstruction was recorded at the junction of the confluence of pulmonary veins and the vertical vein. There was aberrant right subclavian artery from the aortic arch as its third branch with no obstruction or aneurysm formation, having retrotracheal and esophageal course.

Electrodiagnostic Studies in the Surgical Treatment of Carpal Tunnel Syndrome-A Systematic Review.

The aim of our paper was to provide comprehensive data on the role of electrodiagnostic (EDX) studies in the surgical treatment of carpal tunnel syndrome (CTS). An extensive search was conducted through the major electronic database to identify eligible articles. Data extracted included grade of CTS based on neurophysiological testing, preoperative data of EDX studies, time of complete or partial resolution after surgery, postoperative Boston carpal tunnel questionnaire (CTQ) scores, age, sex, intraoperative and postoperative data of EDX studies, time to complete or partial resolution of symptoms, and number of patients without postsurgical improvement. Our main findings revealed that that electrodiagnostic testing is still a powerful tool for diagnosis of CTS. Moreover, it can also detect other pathologies. EDX testing provides a quantitative measure of the physiological function of the median nerve, which may be used to guide surgical treatment. Thirdly, when the outcome of surgery is unsatisfactory, NCS can assist in determining the reason for failure.

Microsurgical Fenestration of Intracranial Arachnoid Cysts: Volumetric Analysis and Clinical Outcome

Introduction: There is paucity of data regarding change in arachnoid cyst (AC) volume following surgery. This study aimed at investigating the clinical outcome of ACs and applying 2 volumetric methods for determination of their volume change post microsurgical fenestration. Methods: Twenty-one ACs in 20 patients that underwent microsurgical fenestration were analyzed using 2 volumetric methods; the modified McDonald equation and the picture archiving and communication (PAC) system-based method. Patients were followed up for 23 ± 40.3 months. Results: The majority of the patients (13 or 65%) were children. Preoperative symptoms in children were mainly seizures and less commonly headache. Of the 20 patients, 12 (60%) had complete resolution of their preoperative symptoms with 8 (40.0%) showing partial improvement. Volumetric studies showed a mean reduction in AC size of 73.7% in children and 64.4% in adults using the PAC system versus 67.9% in children and 70.5% in adults using the modified McDonald equation method. There was no correlation between the percentage decrease in AC volume post surgery and degree of symptom improvement (49.2 ± 34.3% in patients with complete vs. 60.9 ± 40.3% in patients with only partial resolution of symptoms, p = 0.57). Discussion/Conclusion: Microsurgical fenestration is an effective approach for ACs with an excellent clinical outcome apparent in the complete or partial improvement of symptoms in all patients. Volumetric estimates of ACs and their change following surgery are feasible using the modified McDonald or PAC system methods. However, there is no correlation between the percentage decrease in AC volume after surgery and degree of clinical improvement.

1625. Real-World Outpatient Utilization of Ceftolozane/Tazobactam in Physician Office Infusion Centers (OICs)

BackgroundCeftolozane/tazobactam (C/T) is indicated for the treatment (tx) of complicated Gram-negative infections including urinary tract infection (cUTI), intra-abdominal infection (cIAI), and hospital-acquired/ventilator-associated bacterial pneumonias caused by susceptible bacteria. Real-world data on the use of C/T are limited. We present a multicenter observational review of C/T outpatient utilization in Infectious Disease OICs.MethodsMedical records of patients (pts) who received C/T for ≥3 doses from May 2015 to Sept 2019 were reviewed. Data included demographics, diagnosis, disease history, pathogens, C/T tx hospitalizations, emergency department (ED) visits and clinical outcomes. Clinical success was defined as complete or partial symptom resolution at completion of C/T with oral antibiotics as needed. Persistent infection and early discontinuation (D/C) of C/T were deemed non-successful. Indeterminant outcomes were deemed non-evaluable. Chi Square, Fisher’s exact, and t-tests were used to identify characteristics associated with clinical outcome.Results120 pts (mean age: 59±15 years, 60% male) from 33 OICs were identified. Median Charlson score was 5 (IQR, 3-7), with 43% immunocompromised, and 77% refractory/recurrent disease. Primary infections were bone and joint (25%), cUTI, (24%), respiratory tract (18%), cIAI (18%), complicated skin and skin-structure (12%), and bacteremia/endocarditis (3%). Most pts had multi-drug resistant Gram-negative pathogens (80/108; 74%), predominantly Pseudomonas aeruginosa. Polymicrobial infections were reported in 44%. Median duration of C/T therapy was 21 days (IQR, 14-34). C/T was initiated in the OIC in 59% of pts. Overall clinical success was 86% (100/117), with rates by infection type in Fig 1. Non-success was reported in 17, 10 due to persistent infection and 7 due to adverse events. The adverse events led to early D/C of C/T, all with resolution. Statistically, infection type did not impact success rate. Hospitalizations and ED visits during tx occurred in 5% of pts with successful outcomes and 35% of pts with non-successful outcomes (p < 0.001).Fig 1. Clinical success rates of C/T by infection type ConclusionThese real-world results support the effectiveness of C/T in a wide variety of complicated Gram-negative infections treated in the outpatient setting.Disclosures Lucinda J. Van Anglen, PharmD, Merck & Co. (Grant/Research Support) Ramesh V. Nathan, MD, FIDSA, Merck & Co. (Other Financial or Material Support, Grant Steering Committee Member) Brian S. Metzger, MD, MPH, Allergan (Speaker’s Bureau)Cumberland (Speaker’s Bureau)Melinta (Speaker’s Bureau)

Radiculopathy Following Vertebral Body Compression Fracture: The Role of Percutaneous Cement Augmentation

Background: Vertebral cement augmentation is a commonly used procedure in patients with vertebral body compression fractures from primary or secondary osteoporosis, metastatic disease, or trauma. Many of these patients present with radiculopathy as a presenting symptom, and can experience symptomatic relief following the procedure. Objectives: To determine the incidence of preprocedural radiculopathy in patients with vertebral body compression fractures presenting for cement augmentation, and present their postoperative outcomes. Study Design: Retrospective cohort study. Setting: Interventional pain practice in a tertiary care university hospital. Methods: In this cohort study, all patients who underwent kyphoplasty (KP) or vertebroplasty (VP) procedures in a 7-year period within our practice were evaluated through a search of the electronic medical records. The primary endpoint was to evaluate the prevalence of noncompressive preprocedural radiculopathy in our patients. Evaluation of each patient’s relative improvement following the procedure, respective to the initial presence or absence of radicular symptoms (including and above T10, above and below T10, and below T10) was included as a secondary endpoint. Additional subanalysis was performed with respect to patients demographics, fracture location, and primary indication for the procedure (osteoporosis, trauma, etc.). Results: A total of 302 procedures were performed during this time period, encompassing 544 total vertebral body levels. After exclusion criteria were applied to this cohort, 31.6% of patients demonstrated radiculopathy prior to the procedure that could not be explained by nerve impingement. Nearly half of patients demonstrated an optimal clinical outcome (48.5% nearly complete/complete resolution of symptoms, 40.1% partial resolution of symptoms, 11.4% little to no resolution of symptoms). Patients with fractures above T10 were more likely to see complete resolution, whereas patients with fractures above and below T10 were likely to not see any resolution. Men and women without initial radiculopathy symptoms were more likely to see little to no resolution, regardless of fracture location. Limitations: This retrospective study used an electronic chart review of clinicians’ notes to determine the presence of radiculopathy and their relative improvement following the procedure. Conclusions: Preprocedural radiculopathy is a common symptom of patients presenting for the evaluation of VP or KP. The presence of radiculopathy in the absence of nerve impingement may be an important marker for those patients who may experience greater benefit from the procedure. Key words: Radiculopathy, kyphoplasty, vertebroplasty, osteoporosis, compression fracture, spine, cement augmentation