Additional Pathology Research Articles

Poster 272: The Significance Of Posterior Tibial Slope And Rate Of Concomitant Pathology In Pediatric Tibia Spine Avulsion And Anterior Cruciate Ligament Injuries

Objectives: Fractures of the tibial spine (TSF) occur as a result of an anterior cruciate ligament (ACL) avulsion fracture from the proximal tibia. Both TSF and ACL injuries are associated with concomitant intraarticular pathology seen on Magnetic Resonance Imaging (MRI) and intraoperatively. In addition, posterior tibial slope (PTS) has been identified as a potential risk factor for ACL injury. The purpose of this study is to describe concomitant injuries seen on MRI and at time of surgery for TSF and ACL patients, and to characterize posterior tibial slope in patients who sustain these injuries. Our hypothesis is that ACL and TSF injuries have similar rates of meniscal injury, and that posterior tibial slope is increased in patients with TSF and ACL injuries compared to matched controls. Methods: Utilizing an institutional review board approved retrospective study, we identified patients under 18 years of age who underwent arthroscopic management of a TSF from December 31st 2008 to December 31st 2021. Exclusion criteria were patients with a concomitant lower extremity fracture or posterior cruciate ligament injuries, poor imaging quality, and incomplete medical records. TSF patients were compared to an age and gender matched cohort of patients who underwent surgery for a mid- substance ACL rupture, and a similar control group. We evaluated concomitant injuries based on radiology and operative reports and measured PTS on radiographs as well as medial (MTS) and lateral (LTS) posterior slope on MRI for all groups. We compared tibial slope amongst the groups using a one- way analysis of variance test, and the Fisher’s exact test was used to compare concomitant injuries between the ACL and TSF groups. Results: 85 TSF patients met inclusion criteria, of which 44 had an MRI. There were 41 patients in the ACL group and 44 in the control group. The average age was 11.8 years. Concomitant injuries were identified on MRI in 59.1% of TSF and 51.2% of ACL patients, and intraoperatively in 36.5% of TSF and 37% of ACL patients. The most common concomitant injury was lateral meniscus tears. There was no significant differnce between the TSF and ACL groups in terms of lateral meniscus tears seen on MRI (29.5% TSF vs 31.7 ACL, p=1.0) and seen on arthroscopy (18.2% TSF vs 31.7% ACL, p=0.21). Similarly there were no significant differences between the TSF and ACL group in terms of medial meniscus tears seen on MRI (13.6% vs 17.1%, p = 0.77) and on arthroscopy (9% vs 5%, p=0.19). There was a significant difference between groups when comparing the pivot-shift bone bruise pattern seen on MRI (63.6% TSF vs 90.2% ACL, P= <0.01). There was significantly increased radiographic PTS in the TSF and ACL groups (Radiographs 8.7°+/-3.0° TSF vs 9.5°+/-3.3° ACL vs 6.6°+/-2.3° Control, p= <0.01). This was also seen in the MTS mesured on MRI (MTS 5.3°+/-3.1° TSF vs 4.9°+/-2.7° ACL vs 3.7°+/-2.3° Control p= 0.02). There was no significant difference in LTS between TSF and Controls, but there was between ACL and Controls (LTS 4.1°+/-2.8° TSF vs 6.8°+/- 3.9°ACL vs 4.3°+/- 2.3° Control, p=<0.01). Conclusions: This study is the first to depict tibial slope and bone contusion patterns seen in tibial spine injuries, as well as compare rates of meniscal injury and tibial slope between ACL and control patients. Posterior tibial slope is significantly increased in patients who sustain a TSF or ACL injury, suggesting that it may be a risk factor for injury. Similar rates of concomitant meniscal pathology are seen in both TSF and ACL injured patients, which may reflect similar mechanisms of injury. This also highlights that care must be taken to evaluate for additional pathology when treating TSF and ACL injuries. Future study is needed to determine the role, if any, that tibial slope plays in tibial spine fractures as well as to determine if intraarticular pathology identified on MRI influences longer term patient outcomes.

The prognostic significance of early troponin levels in patients undergoing aortic ridge surgery.

Subaortic stenosis is a CHD that can lead to left ventricular hypertrophy, heart failure, and aortic valve damage if left untreated. The gold standard treatment for subaortic stenosis is septal myectomy. However, there is no clear consensus on the surgical margins required for adequate muscle resection. In this retrospective study, we reviewed the records of 83 patients who underwent subaortic stenosis surgery between 2012 and 2020 to investigate the effect of early troponin levels on prognosis. We excluded patients with additional cardiac pathologies, hypertrophic obstructive cardiomyopathy, and valvular aortic stenosis.Troponin levels were recorded in the early post-operative period, and patients were monitored for complications such as ventricular arrhythmia, left ventricular systolic dysfunction, infective endocarditis, and pacemaker implantation. The troponin levels were significantly higher in the patients who had septal myectomy. The degree of myectomy affected the risk of complications in the early post-operative period and recurrence in the later period. However, when the gradient was substantially or completely removed by myectomy, patients experienced significant symptom improvement in the early post-operative period, and their late survival was equivalent to that of healthy individuals of the same age.Our findings suggest that monitoring troponin levels in patients undergoing septal myectomy may be beneficial in predicting the risk of complications. However, further studies are needed to establish the optimal surgical technique and extent of muscle resection required for subaortic stenosis treatment. Our study adds to the existing knowledge of the benefits and risks associated with septal myectomy as a treatment option for subaortic stenosis.

Molecular identification of Trypanosoma theileri (Laveran, 1902) in cattle from two slaughterhouses in Ecuador and its relation with other haemotropic agents.

Trypanosoma theileri is a worldwide distributed haemoparasite that has been reported throughout the American continent in various species, including bovines, buffaloes and bats. In bovines, high incidence of T. theileri can be harmful when associated with other infections or under stress situations. There is little information on this hemoflagellate in Ecuador, which prompted the study and molecular identification of the trypanosomes collected in two slaughtering centers. Between February and April 2021, a total of 218 samples of bovine blood were collected in abattoirs located in the Andean region of Quito (n = 83) and in the coastal region, in Santo Domingo (n = 135). Quito public Slaughterhouse is the biggest in Ecuador, and for that, they receive animals from all country; on the other hand, Santo Domingo's Slaughterhouse is a small one where mainly females from the region are sacrificed and some males. The samples were evaluated using two molecular tests, the PCR cathepsin L-like (CatL) specific for T. theileri and for the positive samples, a Nested PCR that targets the ITS of the 18S gene. The corresponding PCR products were sequenced, analyzed by BLAST/NCBI and the sequences were used to build a concatenated phylogenetic tree, using the MEGA XI software. Overall, 34 out of the 218 samples, (15.6%) were positive to T. theileri by PCR CatL, resulting from 20/83 (24.1%) positives from the Quito abattoir and 14/135 (10.4%) from the Santo Domingo slaughterhouse. These prevalence rates were found to be significantly different (p = 0.006). According to the phylogenetic tree based on the CatL and ITS concatenated sequences (n = 13), the two novel Equatorial T. theileri isolates, ThI (n = 7) and ThII (n = 6) are closely related and associated to the IC, IB and IIB genotypes, present in Brazil, Venezuela and Colombia. Thirty-one out of the thirty-four T. theileri-positive bovines were co-infected with other haemotropic pathogens, Anaplasma marginale Babesia spp and T. vivax. This coinfection could be responsible for additional pathologies and harmful effects on the affected cattle. This study presents the molecular identification and genotypification of T. theileri isolated from cattle in Ecuador through the analysis of CAtL and ITS sequences, and the high frequency of coinfection of this hemoflagellate with other blood haemotropic organisms.

Diagnostic Contribution of Magnetic Resonance Imaging and Computerized Tomography in Patients with Unidentified Vertigo and Normal Neurologic Examination in Emergency Medicine.

Vertigo and dizziness are common symptoms in patients presenting to emergency medicine (ED) clinics. Vertigo may be caused by peripheral or central origin. Routine imaging is not indicated; however, neuroimaging is increasing, and published studies have revealed a small number of positive findings on imaging modalities. The aim of this study was to investigate whether neurological imaging was necessary in patients classified as "unidentified vertigo," who were admitted to the emergency department with vertiginous complaints and not revealing typical peripheral vertigo findings and any neurological deficits. All patients with "dizzy symptoms" were included in the study. For patients who met the definition of "unidentified vertigo," experimental neurological imaging studies were done. Head computerized tomography (CT), magnetic resonance imaging (MRI) with gradient-echo sequences (GRE), and diffusion weighted images (DWI) were used for imaging. Patients who underwent neuroimaging in the ED were followed up for 6 months in Neurology and ENT clinics. A total of 351 patients were included in the study. Experimental imaging was performed on 100 patients. CT detected a significant pathology associated with the vertigo complaint in only one patient. MRI results were similar to the CT results. MRI-GRE sequences showed some additional pathologies in 14 patients and 4 of them were thought to be related to vertiginous symptoms. None of the patients classified as "non-central causes of vertigo" in the neuroimaging group developed TIA or CVD during 6 months of follow-up. Head CT can be adequate to exclude life-threatening central pathology in "undifferentiated vertigo patients" and the addition of MRI did not add any diagnostic accuracy in ED management. Using the physical examination findings effectively to make a specific diagnosis may reduce misdiagnosis and improve resource utilization.

Appropriateness of applying CSF biomarker cutoffs from Alzheimer’s disease to Parkinson’s disease

AbstractBackgroundWhile cutoffs for abnormal levels of the cerebrospinal fluid (CSF) biomarkers amyloid β 1‐42 (Aβ 1‐42), total tau (t‐tau), phosphorylated tau (p‐tau), and the ratios of t‐tau/Aβ 1‐42 and p‐tau/Aβ 1‐42, have been established in Alzheimer’s disease (AD), biologically relevant cutoffs have not been studied extensively in Parkinson’s disease (PD). We aim to assess the suitability and diagnostic accuracy of established AD‐derived CSF biomarker cutoffs in the PD population.MethodBaseline and longitudinal data on CSF biomarkers, cognitive diagnoses, and PET amyloid imaging in 423 newly diagnosed patients with PD from the Parkinson’s Progression Markers Initiative (PPMI) cohort were used to evaluate established AD biomarker cutoffs compared with optimal cutoffs derived from the PPMI cohort.ResultUsing PET amyloid imaging as the gold standard for AD pathology, the optimal cutoff of Aβ 1‐42 was higher than the AD cutoff, the optimal cutoffs of t‐tau/Aβ 1‐42 and p‐tau/Aβ 1‐42 were lower than the AD cutoffs, and their confidence intervals (CIs) did not overlap with the AD cutoffs. Optimal cutoffs for t‐tau and p‐tau to predict cognitive impairment were significantly lower than the AD cutoffs, and their CIs did not overlap with the AD cutoffs.ConclusionOptimal cutoffs for the PPMI cohort for Aβ 1‐42, t‐tau/Aβ 1‐42, and p‐tau/Aβ 1‐42 to predict amyloid‐PET positivity and for t‐tau and p‐tau to predict cognitive impairment differ significantly from cutoffs derived from AD populations. The presence of additional pathologies such as alpha‐synuclein in PD may lead to disease‐specific CSF biomarker characteristics.

Impact of Postoperative Imaging Following Emergency Surgery for Penetrating Ballistic Thoracic Trauma.

Patients undergoing emergent surgical procedures after penetrating trauma can benefit from postoperative imaging studies to identify potential missed injuries or indications to additional surgery. Aim of this study is to describe postoperative imaging findings in patients who underwent emergent operation for thoracic gunshot wounds (GSWs) and the subsequent need for further surgery, diagnostic evaluations or consults. Patients who survived to receive imaging evaluation after emergency surgery for penetrating chest trauma in a level I trauma center between 2017 and 2021 were included. Results of postoperative diagnostic evaluation were screened to determine their impact on the subsequent management. Overall, 125 patients admitted with a thoracic GSW underwent an emergent surgical procedure and 29 survived to receive postoperative imaging and were included. Postoperative CT-scan was performed in 26 (89.6%) patients, echocardiography in 8 (27.5%). Other tests included esophagoscopy (1) and bronchoscopy (1). Impact on management of abnormal imaging included a new indication to surgery or additional procedures in 7 cases and need for additional imaging or consults in other 8 cases. Bone fractures and lung injuries were more often diagnosed on postoperative CT-scan. In 3 patients, abnormal echocardiographic findings led to a second cardiac operation. Following emergency surgery for penetrating trauma, completion of injury assessment with CT-scan can lead to identification of missed or additional injuries, while other imaging is indicated according to operative findings. In this study, 24.1% had additional surgical pathology identified by postoperative imaging while others had findings requiring additional studies or specialist consult evaluations.

The impact of coal mine dust characteristics on pathways to respiratory harm: investigating the pneumoconiotic potency of coals.

Exposure to dust from the mining environment has historically resulted in epidemic levels of mortality and morbidity from pneumoconiotic diseases such as silicosis, coal workers' pneumoconiosis (CWP), and asbestosis. Studies have shown that CWP remains a critical issue at collieries across the globe, with some countries facing resurgent patterns of the disease and additional pathologies from long-term exposure. Compliance measures to reduce dust exposure rely primarily on the assumption that all "fine" particles are equally toxic irrespective of source or chemical composition. For several ore types, but more specifically coal, such an assumption is not practical due to the complex and highly variable nature of the material. Additionally, several studies have identified possible mechanisms of pathogenesis from the minerals and deleterious metals in coal. The purpose of this review was to provide a reassessment of the perspectives and strategies used to evaluate the pneumoconiotic potency of coal mine dust. Emphasis is on the physicochemical characteristics of coal mine dust such as mineralogy/mineral chemistry, particle shape, size, specific surface area, and free surface area-all of which have been highlighted as contributing factors to the expression of pro-inflammatory responses in the lung. The review also highlights the potential opportunity for more holistic risk characterisation strategies for coal mine dust, which consider the mineralogical and physicochemical aspects of the dust as variables relevant to the current proposed mechanisms for CWP pathogenesis.

Safety and Efficacy of Single Incision Sling Versus Midurethral Sling in the Treatment of Stress Urinary Incontinence: A Randomized Controlled Trial

ABSTRACT The midurethral sling (MUS) is the criterion standard for SUI treatment in women, with a third-generation MUS utilizing a single vaginal incision (single-incision sling [SIS]) becoming a means for preventing postoperative groin pain associated (rarely) with transobturator sling. However, SIS requires additional long-term evidence of effectiveness through randomized trials comparing their use with MUS. The goal of this study was an evaluation of safety and efficacy of the use of Ophira SIS as compared with inside-out full-length transobturator tape (TOT) sling (MUS) use over long-term follow-up. Primary randomized controlled trial outcomes included SUI objective cure rate evaluations 4 years after MUS operation. Secondary study end points included quality of life, early and late operative complications, subjective cure, recurrent surgery need, and urgency incontinence occurrence. This study, which took place at the Czech tertiary referral Brno University Hospital Urogynecology Center, was a randomized noninferiority controlled trial held from January 2015 through December 2019. Women with urodynamic SUI, as confirmed via positive cough test during cystometry, were included in this nonblinded study. Exclusion criteria were as follows: urgency or predominant urgency incontinence, pelvic organ prolapse stage 2 or greater, intrinsic sphincter deficiency, previous SUI surgery, previous pelvic organ prolapse surgery, and presence of additional organ pathology. The International Consultation on Incontinence Questionnaire—Short Form was completed to assess symptom impact on patient quality of life. Baseline patient characteristics including body mass index, age, and parity were recorded, and written informed consent for enrollment in the study was collected from all patients. Randomization occurred via the envelope technique (sequentially numbered opaque envelopes distributed at the time of surgery) to assign patients to an SIS anti-incontinence procedure or MUS. The SIS procedures used Ophira (Promedon) surgical kits, and the MUS procedure used the inside-out Gynecare TVT Obturator System (Ethicon). Senior surgeons with more than 200 previous MUS or SIS procedures performed the operations. The authors assumed a minimum sample size of 64 patients in each group was needed to identify noninferiority. An independent clinician performed follow-up visits at 4 years postoperation, including an evaluation of objective cure (absence of urinary leakage) as primary study outcome. Subjective cure included the International Consultation on Incontinence Questionnaire—Short Form tiers of 1 (“very much improved),” 2 (“much improved),” or 3 (“improved).” A total of 192 eligible patients participated, with 24 declining randomization for a total of 168 patients (87.5%) being randomized into SIS (n = 84) and MUS groups (n = 84). From these, full completion of the 4-year follow-up took place for 66 SIS patients (78.6%) and 64 MUS patients (76.2%). The results of the analysis indicated that the MUS and SIS groups demonstrated no statistically significant differences in cure rates at 4 years after surgery, with objective (86.4% vs 84.4%) and subjective (83.3% vs 81.3%) cure rates, respectively. The study was not powered to determine differences in secondary outcomes, but a similar proportion in both groups required reoperation for recurrent SUI (6.9%), and no significant pain outcomes were observed in either group. A strength of the trial is its thorough standardization, as all procedures were implemented by the same urogynecology surgeons with ample experience. The randomized study design coupled with long-term follow-up provided high-quality data. A limitation of the trial is the lack of blinding of the patient (via absence or presence of additional MUS incisions), postoperative assessments were done by unblinded members of the team, and a portion of both groups was lost to follow-up. A similar, but not insignificant, portion of both treatment groups was lost to follow-up, introducing risk of selection bias. Finally, not all SISs on the market can be assumed to be equal because of differing materials, anchoring systems, and insertion techniques, and the specific device used in this study is not commercially available in the United States. The findings of this study are that the Ophira SIS had comparable curative rates to transobturator MUS among women undergoing SUI surgery. Additional external validation studies are necessary. However, these results can be included in future meta-analyses for fostering understanding of SUI management via SIS systems.

Immune-Checkpoint Induced Skin Toxicity Masked as Squamous Cell Carcinoma: Case Report on Mimickers of Dermatological Toxicity with PD-1 Inhibition

Immune checkpoint inhibitors (ICI) are increasingly the mainstay of oncology treatment. Immune-related adverse events (irAEs) from ICI therapy differ from cytotoxic adverse events. Cutaneous irAEs are one of the most common irAEs and require careful attention to optimize the quality of life for oncology patients. These are two cases of patients with advanced solid-tumour malignancies treated with PD-1 inhibitor therapy. Both patients developed multiple pruritic hyperkeratotic lesions, which were initially diagnosed as squamous cell carcinoma from skin biopsies. The presentation as squamous cell carcinoma was atypical and, upon further pathology review, the lesions were more in keeping with a lichenoid immune reaction stemming from the immune checkpoint blockade. With the use of oral or topical steroids and immunomodulators, the lesions resolved. These cases emphasize that patients on PD-1 inhibitor therapy who develop lesions resembling squamous cell carcinoma on initial pathology may require an additional pathology review to assess for immune-mediated reactions, allowing appropriate immunosuppressive therapy to be initiated.

Cortical Desmoid of the Distal Femur-Incidentaloma or Insertional Tendinopathy?

The cortical desmoid (DFCI) of the posteromedial femoral condyle is considered an asymptomatic incidental finding in adolescents without clinical relevance. The aim of this study was to evaluate the clinical relevance of DFCI from both a tumor orthopedic and sports medicine point of view. n = 23 patients (13.74 ± 2.74 years; nineteen female, four male) with DFCI of the posteromedial femoral condyle were included. A localized posteromedial knee pain on exertion was differentiated from non-specific knee pain. Symptom duration, additional pathologies, number of MRIs, sports activity and training intensity, downtime, therapeutic modalities, and relief/remission of symptoms were documented. The Tegner activity scale (TAS) and Lysholm score (LS) were collected. The influence of specific posteromedial pain, MRI presence of paratendinous cysts, sports level as well as physiotherapy on downtime and LS/TAS was statistically analyzed. 100% reported knee symptoms at initial presentation. A localized posteromedial pain was documented in 52%. In 16/23 (70%) additional functional pathologies were diagnosed. Patients were physically highly active with high training intensities (6.52 ± 5.87 h/week) and performance level (65% competitive vs. 35% recreational). Patients underwent 1.91 ± 0.97 MRIs (max four). Symptom duration was 10.48 ± 11.02 weeks. A follow-up examination was performed after 12.62 ± 10.41 months (n = two lost to follow-up). 17/21 had physiotherapy, on average 17.06 ± 13.33 units. Overall downtime was 13.39 ± 12.50 weeks, the return-to-sports (RTS) rate 81%. 100%/38% reported a relief/remission of complaints. LS was 93.29 ± 7.95, median TAS before onset of knee complaints/at follow-up 7 (6-7)/7 (5-7). Specific posteromedial pain, presence of paratendinous cysts, sports level and physiotherapy had no significant influence on downtime and outcome parameters (n.s.). DFCI as a pathognomonic finding is recurrently encountered in the MRIs of children and adolescents. This knowledge is essential to spare patients from overtreatment. Contrary to the literature, the present results implicate a clinical relevance of DFCI particularly in those who are physically highly active with localized pain on exertion. Structured physiotherapy as basic treatment is recommended.

Biopsy-Guided Pathological Response Assessment in Breast Cancer is Insufficient: Additional Pathology Findings of the MICRA Trial

BackgroundNeoadjuvant systemic treatment (NST) leads to pathologic complete response (pCR) in 10–89% of breast cancer patients depending on subtype. The added value of surgery is uncertain in patients who reach pCR; however, current imaging and biopsy techniques aiming to predict pCR are not accurate enough. This study aims to quantify the residual disease remaining after NST in patients with a favorable response on MRI and residual disease missed with biopsies.MethodsIn the MICRA trial, patients with a favorable response to NST on MRI underwent ultrasound-guided post-NST 14G biopsies followed by surgery. We analyzed pathology reports of the biopsies and the surgical specimens. Primary outcome was the extent of residual invasive disease among molecular subtypes, and secondary outcome was the extent of missed residual invasive disease.ResultsWe included 167 patients. Surgical specimen showed residual invasive disease in 69 (41%) patients. The median size of residual invasive disease was 18 mm (interquartile range [IQR] 12–30) in hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) patients, 8 mm (IQR 3–15) in HR+/HER2-positive (HER2+) patients, 4 mm (IQR 2–9) in HR-negative (HR−)/HER2+ patients, and 5 mm (IQR 2–11) in triple-negative (TN) patients. Residual invasive disease was missed in all subtypes varying from 4 to 7 mm.ConclusionAlthough the extent of residual invasive disease is small in TN and HER2+ subtypes, substantial residual invasive disease is left behind in all subtypes with 14G biopsies. This may hamper local control and limits adjuvant systemic treatment options. Therefore, surgical excision remains obligatory until accuracy of imaging and biopsy techniques improve.

Results of Endometrial Sampling in a Tertiary Hospital.

This study aims to investigate the results of endometrial sampling in a tertiary hospital according to age and symptoms. A total of505 patients who underwent endometrial sampling due to various reasons in our tertiary hospital in the last six months were included in our study, and the pathological results of endometrial sampling were analyzedretrospectively. The mean age of 505 patients was 45.03 + 7.40 (19-74) years, and 91.5% of the indications were premenopausal abnormal uterine bleeding and 8.5% were postmenopausal bleeding. The most common pathological result of all age groups was proliferative endometrium (37.6%), and the least was the endometrial intraepithelial neoplasia (0.2%). In 9.3% of patients, the result was insufficient material. Of the patients, 88.7% had no additional organic pathology. A total of 30 (5.9%) patients have undergone surgeryafter endometrial sampling. It should be kept in mind that despite the pathological result may be insufficient rarely,endometrial sampling should be performed as the first choice in abnormal uterine bleeding.

The Effect of Mask Use on the Ocular Surface During the COVID-19 Pandemic.

The new coronavirus disease 2019 (COVID-19) pandemic emerged in Wuhan, China in October 2019 and spread rapidly all over the world, making extended mask use an inescapable rule of daily life. Literature data indicate that the use of face masks increases the symptoms of dry eye in addition to preventing the spread of COVID-19. The aim of our study was to evaluate the relationship between the clinical signs and symptoms of dry eye and the duration of mask use in healthy individuals using regular face masks. Thirty-five patients aged 20-60 years with no additional ophthalmologic pathology were included in the study. Participants were stratified by duration of face mask use: ≤6 hours/day (group 1) and >6 hours/day (group 2). The patients were assessed with the Ocular Surface Disease Index (OSDI) questionnaire, fluorescein ocular surface staining, and tear break-up time (TBUT) to evaluate the effect of extended mask use on the ocular surface. A total of 62 eyes of 35 patients, 20 women (57.1%) and 15 men (42.9%), were included in the study. The two mask use duration groups had similar OSDI values (p=0.736). When the ocular surface staining pattern was examined according to the Oxford scale, 50% (10/20) of the eyes in group 1 were assessed as stage 1 and the other 10 eyes as stage 0. In group 2, 47.6% (20/42) of the eyes were assessed as grade 1, 11.9% (5/42) as grade 2, and 4.7% (2/42) as grade 3. Prolonged face mask use was shown to cause decreased TBUT and increased ocular surface staining even in healthy individuals. Further studies are needed to investigate changes in the tear film after extended daily mask use.

Does final intraoperative endoscopic control increase surgical success in conventional septoplasty?

Objectives: This study aimed to investigate the effects of the final endoscopic control performed intraoperatively in conventional septoplasty on operative time, residual deviation, and changes in Nasal Obstruction and Septoplasty Effectiveness Scale (NOSE) scores. Patients and Methods: One hundred twenty-five patients who applied with the complaint of nasal obstruction between June 2020 and May 2021 and were found to have isolated nasal septum deviation were evaluated in this prospective study. Patients with comorbidities were excluded from the study. Remaining 80 patients (55 males, 25 females; mean age: 30.1±8.9 years; range, 18 to 58 years) included in this study. The patients were divided into two groups of 40 individuals using the blocked randomization method. In the first group (CS-EC group; 26 male, 14 female; mean age: 31.7±8.3 year; range 18 to 58 year), after conventional septoplasty with head light, additional pathologies were corrected with the conventional method if it was detected by the endoscope. For the second group (CS group; 29 male, 11 female; mean age: 28.6±9.3 year; range 18 to 53 year), only conventional septoplasty was performed. The patients were evaluated with NOSE before and three months after the operation to evaluate the complaint of nasal obstruction. The groups were compared in terms of NOSE scores, operation time, and postoperative residual deviation. Results: The mean operation times in the CS-EC and CS groups were 44.9±9.3 and 39.0±7.7 min, respectively, and this difference was statistically significant (p=0.001). While there was no statistically significant difference between the CS-EC and CS groups in terms of preoperative total NOSE scores (p=0.211), the postoperative total NOSE score was found to be statistically significantly lower in the CS-EC group compared to the CS group (p=0.001). Conclusion: Final intraoperative endoscopic control of the nasal passage in classical septoplasty may be an effective method to detect septal deviations that cannot be adequately evaluated.

The contribution of preoperative MRI evaluation to emergency surgical management of perianal abscesses

Objective: Perianal abscesses occur as a result of an infection in the anal gland due to the obstruction of the anal gland ducts opening to the anal crypts. Preoperative use of MRI reduces the risk of recurrence, fistula formation, and postoperative fecal incontinence as it allows detailed anatomical imaging. The aim of this study is to investigate the contribution of preoperative MRI to reducing recurrence and surgical complications in patients who underwent emergency surgery for perianal abscess.
 Material and Methods: A total of 206 patients with perianal abscess evaluated and not evaluated with MRI between January 2016 and 2021 were included in this retrospective study. The patients had no history of surgery or local drainage applied to the perianal region. In addition to demographic data of patients, postoperative complications, hospitalization duration, recurrence ratio, and MRI findings are evaluated.
 Results: In the preoperative period, recurrence was found in 16 (%13.2) of 121 cases evaluated with MRI, while the disease recurred in 24 (%28.2) of 85 cases who were operated without MRI evaluation. The presence of a fistula was significantly higher while the presence of recurrence was significantly lower in the group that underwent MRI in the preoperative period (p=0.033, p=0.012 respectively).
 Conclusion: Contrary to popular belief, surgical treatment of abscesses is not that easy due to the high risk of recurrence, the high rate of association with perianal fistula, and the different types and spreads of abscesses. Therefore, preoperative MRI is the most useful diagnostic method for detecting perianal abscesses and additional pathologies.

The impact of additional pathology analysis on the diagnosis and management of soft tissue tumours: a 10-year retrospective study

In order to characterise soft tissue tumours, pathologists often utilise specialised additional tests, or may seek opinions from subspecialist pathologists due to rarity or complex morphology. Additionally, further review may be sought by subspecialist sarcoma pathologists, such as those at our tertiary referral centre in Sydney, Australia. The aim of this study was to examine the impact on diagnosis and management of this external review, following diagnosis at a specialised sarcoma unit. We collated the results of all additional external ancillary tests and specialist reviews over a 10-year period and characterised the impact on the preliminary diagnosis as 'confirmed', 'new' or 'no clear diagnosis'. We subsequently noted whether the additional findings resulted in a clinically significant change in management. Of the 136 cases sent away, 103 patients had their initial diagnosis confirmed, 29 patients received a new diagnosis and, for four patients, the diagnosis remained uncertain. Nine of the 29 patients receiving a new diagnosis had their management altered. This study demonstrated that within our specialised sarcoma unit, the majority of diagnoses provided by our specialist pathologists are confirmed on additional external testing and review, but external review does provide additional assurance and benefit to the patient.

Diagnostic accuracy of the IDEA protocol for non invasive diagnosis of rectosigmoid DE - a prospective cohort study.

To test the accuracy of TVS applying the IDEA approach for suspected rectosigmoid DE and to determine the frequency of other pelvic diseases mimicking DE in patients undergoing surgery. Prospective single center observational study including consecutive women undergoing TVS for clinically suspected rectosigmoid DE followed by conservative or surgical therapy. TVS findings were compared with those obtained by laparoscopy and confirmed histologically. Of the 671 included patients, 128 women opted for medical therapy, and 6 patients decided for surgery but did not give consent to participate in the study. 537 women were enrolled in the final analysis. 279 (52 %) exhibited surgically confirmed rectosigmoid DE. The sensitivity and specificity, positive and negative predictive value (PPV, NPV), positive and negative likelihood ratio (LR+/-) and accuracy of TVS for diagnosing DE in the rectosigmoid were 93.5 %, 94.6 %, 94.9 %, 93.1 %, 17.24, 0.07, 94.04 %. 12 women who were clinically suspected for DE and mimicked sonographic signs fulfilling the IDEA criteria did exhibit other pathologies. Diagnoses were as follows: vaginal Gartner duct cyst (3/291;1.0 %), anorectal abscess (3/291; 1.0 %), rectal cancer (2/291;0.7 %), hydrosalpinx (2/291;0.7 %), metastatic endometrial cancer (1/291;0.35 %) and Crohn's disease (1/291;0.35 %). TVS for diagnosing colorectal DE applying the IDEA criteria is highly accurate for presurgical diagnosis. However, additional pelvic pathologies are encountered in 4-5 % of women attending for suspected rectosigmoid DE. These need to be taken into account when investigating patients for suspected DE.

Gestational trophoblastic disease: an update.

Gestational trophoblastic diseases (GTD) encompass a spectrum of rarepre-malignant and malignant entitiesoriginating from trophoblastic tissue. This updated review will highlight important radiological features, pathology and classification, and provide insight into the clinical management of these uncommon disorders. There is a wide geographic variation with the incidence of hydatidiform mole varying between 0.57 and 2 per 1000 pregnancies. The use of ultrasound (US)in the management of early pregnancy symptoms and complications has positively impacted the earlier detection of these diseases and resulted in diminished morbidity. Additional imaging modalities are reserved for problem solving or assessment of pulmonary manifestations of molar pregnancy. Having an awareness of their pleomorphic sonographic presentation and additional pathology that can mimic GTD is critical to avoiding pitfalls. Histologic and molecular analysis further aids in differential diagnosis. Gestational trophoblastic neoplasia (GTN) is inclusive of all malignant GTDs, and arises after 20% of molar pregnancies but can also be seen with non-molar gestations. Biochemical monitoring with human chorionic gonadotrophin is imperative for ongoing monitoring and surveillance and allows early detection of this entity. Doppler US is used for confirmation of diagnosis with magnetic resonance imaging (MRI) reserved for problem solving or assessment of myometrial invasion. This is of heightened relevance in patients undergoing surgical management. Cross sectional imaging is reserved for patients in the setting of GTN for the purposes of staging, prognostication and in the setting of recurrent disease. This may require a combination of computed tomography, MRI and positron emission tomography. Doppler US can provide insight into chemotherapeutic response/predict resistance in patients with GTN. As our understanding of these disorders evolves, there has been maturation in management options with a shift from traditional chemotherapy to innovative immunotherapy, particularly in the setting of resistant or high-risk disease.

NMJLab: An interactive simulation program for teaching the physiology and pathologies of the neuromuscular junction

Traditional teaching methods have been placed under strain in recent years with the advent of new technologies and the ongoing COVID-19 pandemic. This has forced a migration towards virtual education, which has placed a greater emphasis on self-learning. Students are currently presented with two main options: the conventional lectures or the online videos on the topic. The former has the advantage of interaction between the students and the lecturer, whereas the latter has the advantage of presenting the subject in a dynamic style. We have created NMJLab, a didactical tool that combines both the interactive features of the traditional lecture with the ability of presenting the subject in a dynamical format, as well as a self-assessment component for the student to verify their mastery on the topic. We depicted the physiological cycle of muscle excitation and relaxation at the neuromuscular junction, along with four additional pathologies (myasthenia gravis, Lambert-Eaton myasthenic syndrome, tetanus, and botulism). Once the student has interacted with the simulation, they are presented with an assessment to gauge their understanding of the topic. At every stage, a Help option guides the student through the process. The software was implemented using LabVIEW 2022 from National Instruments, Inc. for both Mac and PC devices. It is part of the curriculum of the Integumentary and Musculoskeletal Systems course at California Northstate University College of Medicine. The reception by the students was positive, and similar modules of this interactive tool are planned to be incorporated into our basic science curriculum.

A retrospective review of therapies in patients with right ventricular dysfunction on mechanical circulatory support

Right ventricular (RV) dysfunction is a complex pathology and a significant independent factor in the morbidity and mortality of heart failure.1 For patients on mechanical circulatory support (MCS), RV dysfunction can be an isolated complication of cardiotomy or an additional pathology.2 3 A range of strategies exist to manage RV dysfunction. This project reviews outcomes and therapies for patients in our centre who had RV dysfunction on MCS, including veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and ventricular assist devices (VAD).