Postoperative Diagnosis Research Articles

Intestinal obstruction due to annular pancreas in neonatal period: a case report

Annular pancreas is a rare congenital malformation characterized by a pancreatic ring surrounding the descending part of the duodenum. It occurs in 1:20,000 live births. The age of presentation depends on the severity of the intestinal obstruction. The diagnosis requires imaging studies and surgical exploration. This is the case of a 13-day-old newborn admitted to the Neonatal Intensive Care Unit of Hospital Nacional Arzobispo Loayza. He presented with gastric residuum, vomiting and intermittent abdominal distension. Given the persistent gastrointestinal symptoms despite the treatment administered, a radiological examination of the upper digestive tract with contrast dye was conducted. Signs of duodenal stenosis were found. An exploratory laparotomy showed a postoperative diagnosis of annular pancreas. Kimura’s diamond-shaped side-to-side duodenoduodenal anastomosis was performed as a definitive treatment.

Clinical, Sonographic, and Hysteroscopic Features of Endometrial Carcinoma Diagnosed after Hysterectomy in Patients with a Preoperative Diagnosis of Atypical Hyperplasia: A Single-Center Retrospective Study.

atypical endometrial hyperplasia (AEH) is a precancerous condition implying a high risk of concurrent endometrial cancer (EC), which might be occult and only diagnosed at postoperative histopathological examination after hysterectomy. Our study aimed to investigate potential differences in preoperative clinical, sonographic, and hysteroscopic characteristics in patients with AEH and postoperative diagnosis of EC. a retrospective single-center study was carried out on a case series of 80 women with AEH undergoing diagnostic workup, including ultrasonography and hysteroscopy, with subsequent hysterectomy. Women with AEH confirmed at the histopathological examination were compared with patients with a postoperative diagnosis of EC. in our population, EC was diagnosed in 53 women, whereas the preoperative diagnosis of AEH was confirmed in 27 cases. At ultrasonography, women with occult EC showed greater endometrial thickness (20.3 mm vs. 10.3 mm, p 0.001) and size of the endocavitary lesion (maximum diameter 25.2 mm vs. 10.6 mm, p 0.001), and a higher prevalence of irregular endometrial-myometrial junction (40.5% vs. 6.7%, p 0.022) and endouterine vascularization at color Doppler (64.2% vs. 34.6%, p 0.017). At hysteroscopy, patients with occult EC showed a higher prevalence of necrosis (44.2% vs. 4.2%, p 0.001) and atypical vessels (70.6% vs. 33.3%, p 0.003), whereas true AEH mainly presented as a protruding intracavitary lesion (77.8% vs. 50.9%, p 0.029). In EC, subjective assessment by the operator was more frequently indicative of cancer (80.0% vs. 12.5%). No difference was found for clinical variables. occult EC in AEH may exhibit some differences in ultrasonographic and hysteroscopic patterns of presentation compared with real AEH, which could prompt a more significant suspect for the possible presence of concurrent EC at preoperative diagnostic workup.

Value of ileo-ascending colic end to side anastomosis after ileocaecal resection.

Objective: To assess the outcome of end to side Ileo-Ascending Colic anastomosis in patients undergoing emergency and elective Ileo-Caecal resection in non-malignant cases. Study Design: Cross Sectional Descriptive study. Setting: Department of Surgery at Fauji Foundation Hospital Rawalpindi. Period: January, 2018 to December, 2020. Material & Methods: A Total of 40 patients with ileo-caecal benign pathology presenting with generalized peritonitis and intestinal obstruction were studied. All patients underwent laparotomy either in emergency or as planned procedure. After dealing with the primary pathology an end to side ileo-ascending colic anastomosis was performed in all cases. Cases of ileo-caecal disease that required an ileostomy or underwent ileo-transverse colic anastomosis were excluded from the study. Anastomosis was performed in conventional two layers with vicryl 3/0. Variables studied were; indication for surgery, per-operative findings and post-operative complications like anastomotic leakage, surgical site infection, burst abdomen and systemic sepsis. Data was analyzed on SPSS (v 26). Results: There were 30 females (75%) and 10 male patients (25%). Age range was 18-72 years with mean age 43.62 years. Common clinical indication of surgery was intestinal obstruction 11 cases (27.5%) followed by generalized peritonitis 10 cases (25%) and trauma 9 cases (22.5%). Post-operative diagnosis in most patients was ileo-caecal tuberculosis 14 cases (35%) followed by trauma to ileo-caecal region 9 cases (22.5%). Anastomotic leakage occurred in 1 patient (2.5%) who underwent second look laparotomy and re-anastomosis. Surgical site infection occurred in 3 cases (7.5%). There was one fatality (2.5%) due to uncontrolled systemic sepsis. Conclusion: An end to side ileo- ascending colic anastomosis in conventional two layers is a safe and reliable procedure after emergency or planned ileo-caecal resection. It saves the patient from ileostomy, preserves colonic length and avoids formation of blind loop.

Implement of mixed reality navigation based on multimodal imaging in the resection of intracranial eloquent lesions

Objective: To examine the clinical feasibility of mixed reality navigation (MRN) technology based on multimodal imaging for the resection of intracranial eloquent lesions. Methods: Fifteen patients with intracranial eloquent lesions admitted to the Department of Neurosurgery, the First Medical Center, People's Liberation Army General Hospital from September 2020 to September 2021 were retrospectively enrolled. There were 7 males and 8 females, aged (50±16) years (range: 16 to 70 years). Postoperative pathological diagnosis included meningioma (n=7), metastatic carcinoma (n=3), cavernous hemangioma, glioma, ependymoma, aneurysmal changes and lymphoma (n=1, respectively). The open-source software was used to perform the three-dimensional visualization of preoperative images, and the self-developed MRN system was used to perform the fusion and interaction of multimodal images, so as to formulate the surgical plan and avoid damaging the eloquent white matter fiber tracts. Traditional navigation, intraoperative ultrasound and fluorescein sodium angiography were used to determine the extent of lesion resection. The intraoperative conditions of MRN-assisted surgery were analyzed, and the setup time and localization error of MRN system were measured. The changes of postoperative neurological function were recorded. Results: MRN based on multimodal imaging was achieved in all patients. The MRN system setup time (M(IQR)) was 36 (12) minutes (range: 20 to 44 minutes), and the localization error was 3.2 (2.0) mm (range: 2.6 to 6.7 mm). The reliability of eloquent white matter fiber tracts localization based on MRN was rated as "excellent" in 11 cases, "medium" in 3 cases, and "poor" in 1 case. There were no perioperative death and no new impairment in motor, language, or visual functions after operation. Transient limb numbness occurred in 1 patient after operation, and recovered to the preoperative state in 2 weeks after operation. Conclusion: The MRN system based on multimodal imaging can improve the surgical accuracy and safety, and reduce the incidence of iatrogenic neurological dysfunction.

Changing characteristics of emergency surgery during COVID-19 pandemic: a retrospective cohort study.

In other countries, researchers have noticed diverse variations in the features of patients undergoing emergency surgery during the COVID-19 pandemic. In Mexico, there is not information about this issue. Workers of the Mexican Government, who required emergency surgeries were studied by the general surgery service of a General Hospital administered by the Institute of Social Security and Services for State Workers Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), through the periods from March-August 2019 (non-exposed) and March-August 2020 (exposed). The analysis included: demographic data, laboratory information, post-operative diagnoses, symptoms' length, days of emergency stay, and post-operative stay. One hundred and ninety-three emergency surgeries were analyzed; 106 in 2019 and 87 in 2020 (a decrease of 18%). Throughout the pandemic, the number of days between the symptoms' onset and surgery was greater: 2019, 7.6 ± 4.6 days; 2020, 14 ± 6.7 days (p < 0.0001). In addition, cases of acute appendicitis decreased (2019-60.3%; 2020-42.5%), and those of acute calculous cholecystitis increased (2019-12.2%; 2020-24.1%). Through the COVID-19 pandemic, there were notable changes in the characteristics of Mexican Government's workers who warranted emergency surgery.

Splenectomy for Immune Cytopenias: Treatment Outcomes and Predictors of Response

The pathogenesis of immune cytopenias involves diverse processes including production, inhibition, and destruction of specific blood cell types mediated by antibodies and/or T cells. Classic examples of immune-mediated cytopenias are immune thrombocytopenic purpura (ITP), autoimmune hemolytic anemia (AIHA), and autoimmune neutropenia (AIN) as well as T cell-mediated idiopathic neutropenia and pure red cell aplasia. Both antibody and autoimmune T cell responses may often coexist, and assignment of the proper pathogenic importance, albeit difficult, is crucial for rational therapeutic approaches. Clonal processes such as T-cell large granular lymphocytic leukemia (T-LGL) or various B cell dyscrasias may also occur. While the results of splenectomy have been studied in individual conditions such as Evans syndrome (ES), AIN, and AIHA, the availability of new therapies and improvement of surgery outcomes have provided an impetus to update the older and smaller series. We retrospectively reviewed a cohort of 339 adult patients who underwent splenectomy at the Cleveland Clinic Foundation between 2002-2020 (Fig.1A), for whom the main indication for the procedure was: ITP (n= 235), AIHA (n=68), ES (n=26) and AIN (n=10). Among these subtypes, there were 15 patients with an established diagnosis of T-LGL. Our aim was to determine the hematologic response of patients who receive splenectomy for immune cytopenia following treatment failure with conventional therapies and identify factors that were associated with responses. Overall, the median age of the patients was 55 years (IQR:68-36), M:F ratio=0.98, with a median time from diagnosis to splenectomy of 11 months (IQR:31-3). Prior to the procedure, all patients had failed multiple lines of medical therapies (mode 1, range1-4). The median preoperative platelet count was 19 (IQR:44-5) x109/L, median preoperative hemoglobin (Hb) of 9 (IQR:10-8) g/dl and median preoperative ANC of 0.28 (IQR:1.19-0.23) x109/L. A total of 306 patients underwent laparoscopic splenectomy, while 33 patients had an open approach. In 16 cases (5%), we recorded an intraoperative conversion from laparoscopic to open splenectomy. The mean spleen weight was 477 gr (SD±687). The average operative time was 2.3 hours, with four days median hospital length of stay (range:1-50). The overall rate of postoperative complications with 30-day readmissions was 0.1%, with no mortality. Of note is that up to 20% of the cases had a post-operative diagnosis that was discordant with the original indication for splenectomy. These discordant diagnoses included benign conditions such as Felty's syndrome (n=2), as well as hematologic malignancies such as mature B-cell neoplasm (28), T-cell lymphoma (n=8), NK-LGL (n=1), and T-LGL (n=15). The overall response rate (ORR) to splenectomy was 74%, of which 86% complete response (CR) and 14% partial response (PR) with relapse occurring in 12% of cases. In the subset of thrombocytopenic patients, CR reached 69% of patients (P<.0001) as early as one week following the procedure. At 1-year, the mean platelet count was 246 (SD±170) x 109/L and relapse occurred in 13% of patients. Conversely, in anemic patients, a CR was observed only in 55% (P<.0001) within two weeks following splenectomy. At 1-year, the mean Hb level was 11.7 (SD±1.3) g/dl, with relapse occurring in 6% of patients. Comparatively, 80% of patients who underwent splenectomy for neutropenia responded at 26 weeks post-splenectomy with relapse in 10% of cases. In known and newly diagnosed patients with LGL (n=16), the response with regard to the cytopenia resulting in splenectomy indication was 81%. The response in Felty's syndrome was 100%. When analyzing predictors of response, failed pharmacologic therapies with either intravenous immunoglobulin (IVIg) or rituximab was predictive of non-response to splenectomy (Fig.1B). No significant differences in spleen weight between responders and non-responders were observed. Our results show a significant and durable response to splenectomy in immune-mediated cytopenia of various etiologies refractory to conventional therapies indicating that, in selected patients, splenectomy remains a rational salvage treatment with a low complication rate. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Can we automate spine fusion surgical site infection data capture?

Spine fusion surgical site infection (SSI) rate is reported to national quality databases and used as a benchmark for orthopedic departments and hospital systems. However, accurate data require resource-heavy administrative review and even this has shown to vary. We aimed to create a passive electronic medical record (EMR) algorithm to automatically capture spine fusion SSI and compared its accuracy against the administrative chart review and self-reported morbidity and mortality (M&M) rates. We retrospectively reviewed a single institution's spine fusion records for 7years for all 90-day post-operative SSIs. We used Centers for Disease Control and Prevention (CDC) SSI definition coupled with intention to treat as an infection by orthopedics/infectious disease service as the gold standard. We compared our gold standard to administrative hand-checked SSI data, anonymously reported departmental M&M, and a passive EMR algorithm (ICD-9 or -10 post-operative SSI diagnosis code entered, or all four of: positive culture, antibiotic prescription between 3-90days post-op, re-operation/re-admission, and a qualifying diagnosis). Nine hundred and fourteen spine fusions were included, with a 2.8% SSI rate (0.9% superficial and 2.0% deep). Passive EMR algorithm was the most sensitive at 89% (vs 76% administrative review, 73% M&M); all were highly specific at 99-100%. M&M was 100% positively predictive, administrative review 95%, and EMR 79%. Our passive EMR algorithm was more sensitive to pediatric spine fusion 90-day SSI than self-reported M&M and hand-checked administrative chart review. Although EMR may over-report, it can be used by others to narrow the initial sample for review, reduce resource burden involved with administrative spine SSI review, and provide a quality check for M&M self-reporting. III.

Nomogram for prediction of peritoneal metastasis risk in colorectal cancer.

Peritoneal metastasis is difficult to diagnose using traditional imaging techniques. The main aim of the current study was to develop and validate a nomogram for effectively predicting the risk of peritoneal metastasis in colorectal cancer (PMCC). A retrospective case-control study was conducted using clinical data from 1284 patients with colorectal cancer who underwent surgery at the First Affiliated Hospital of Guangxi Medical University from January 2010 to December 2015. Least absolute shrinkage and selection operator (LASSO) regression was applied to optimize feature selection of the PMCC risk prediction model and multivariate logistic regression analysis conducted to determine independent risk factors. Using the combined features selected in the LASSO regression model, we constructed a nomogram model and evaluated its predictive value via receiver operating characteristic (ROC) curve analysis. The bootstrap method was employed for repeated sampling for internal verification and the discrimination ability of the prediction models evaluated based on the C-index. The consistency between the predicted and actual results was assessed with the aid of calibration curves. Overall, 96 cases of PMCC were confirmed via postoperative pathological diagnosis. Logistic regression analysis showed that age, tumor location, perimeter ratio, tumor size, pathological type, tumor invasion depth, CEA level, and gross tumor type were independent risk factors for PMCC. A nomogram composed of these eight factors was subsequently constructed. The calibration curve revealed good consistency between the predicted and actual probability, with a C-index of 0.882. The area under the curve (AUC) of the nomogram prediction model was 0.882 and its 95% confidence interval (CI) was 0.845-0.919. Internal validation yielded a C-index of 0.868. We have successfully constructed a highly sensitive nomogram that should facilitate early diagnosis of PMCC, providing a robust platform for further optimization of clinical management strategies.

A nationwide survey of the use of the laparoscopic power morcellator.

Laparoscopic power morcellator (LPM) can be used for tissue retrieval through laparoscopic port site, but the dissemination of uterine and/or myoma tissues is a serious complication. To study the use of LPM for uterine fibroid treatment in Japan, we aimed to perform two national cross-sectional surveys comprising multiple questionnaires. The first survey (2011-2013) was conducted in November 2014, and 203 medical institutions responded. The second survey (2017-2019) was conducted in December 2020, and 302 medical institutions were investigated. Overall, 72 104 and 120 425 surgeries and 0.04% and 0.05% cases of postoperative malignancy diagnosis were reported in the first and second surveys, respectively. Magnetic resonance imaging was performed in >90% of the cases in the first and second surveys as preoperative examinations. The frequency of LPM at hysterectomy was 8.9% and 4.6% and the frequency of LPM at laparoscopic myomectomy was 80.4% and 54.8% in the first and second surveys, respectively; both the parameters decreased in the second survey. It is impossible to completely exclude malignant diseases even if extensive preoperative diagnosis has been done before surgery. Therefore, the use of LPM in patients requires careful attention and informed consent in Japan.

Role of Immunohistochemistry in Suspected Pancreatic Ductal Adenocarcinoma: A Prospective Study on Fine Needle Aspiration Biopsies.

Differential diagnosis between pancreatic ductal adenocarcinoma (PDAC) and benign mimickers can be very difficult on small histological samples, such as fine needle aspiration biopsies (FNAB). We aimed to investigate the diagnostic value of immunostaining for IMP3, Maspin, S100A4, S100P, TFF2, and TFF3 in FNAB pancreatic lesions. We prospectively enrolled 20 consecutive patients with suspected PDAC, collecting FNABs at our department between 2019 and 2021. Three of the 20 enrolled patients resulted negative for all immunohistochemical markers, while all the others were positive for Maspin. All other immunohistochemistry (IHC) markers had sensitivity and accuracy of less than 100%. On the basis of the IHC, the preoperative diagnosis on FNAB was nonmalignant lesions in the IHC negative cases and PDAC in the others. All patients subsequently underwent surgery for the pancreatic solid mass demonstrated by imaging techniques. The concordance between the preoperative and postoperative diagnosis was 100%; all IHC negative samples were diagnosed on surgical specimens as chronic pancreatitis and Maspin-positive samples as PDAC. Our results demonstrate that even in the presence of little histological material, such as FNAB, the use of Maspin alone is sufficient to discriminate between PDAC and nonmalignant pancreatic lesions, with 100% accuracy.

ODP557 PCSK9 Level Correlated with Disease Progression in Patient with Non-small Cell Lung Cancer

Abstract Background Hyperlipidemia may be present in cancer patients despite their debilitated general condition. It has also been reported that several types of cancer cells produce PCSK9, and that in advanced non-small cell lung cancer, chemotherapy with immune checkpoint inhibitors is effective in cases with low PCSK9 levels. We administered PCSK9 inhibitor to patients with advanced non-small cell lung cancer with hyperlipidemia according to the indications for hyperlipidemia. Chemotherapy with immune checkpoint inhibitors was performed, the patient's condition and the level of PSCK9 were observed. CASE: A woman in her 60s underwent surgery for lung cancer in 2017. The pathological diagnosis of squamous cell carcinoma of the left lower bronchus and the postoperative diagnosis of pT2bN2M0 stage IIIA were confirmed. Adjuvant chemotherapy with CDDP and VNR was started after surgery for her, but in 2018, recurrence of pulmonary lymph nodes was confirmed by intrabronchial induced transbronchial needle aspiration. The immunostaining result for PD-L1 was 50%. The first-line chemotherapy, the immune checkpoint inhibitor pembrolizumab, was started but was ineffective. She had high serum LDL levels of 174 mg/dL and high serum PCSK9 levels of 471 ng /mL (Norm: 47.4-225.2 ng/mL) despite exhaustion during her lung cancer treatment process. Her plasma PCSK9 levels were correlated with lung cancer status, suggesting PCSK9 production in lung cancer cells. Ezetimibe and statins were also discontinued because they were reported to increase serum PCSK9. The PCSC9K inhibitor evolocumab was administered at 140 mg every 2 weeks. Three months after the start of evolocumab, her serum PCSK9 level decreased slightly to 441 ng /mL. The immune checkpoint inhibitor nivolumab was then started, but the chemotherapy was ineffective, and her general condition worsened, correlating with her serum PCSK9 levels rising to 1635 ng/mL, and she died in 2021. Discussion and Clinical Lessons This is the first report on the clinical course of non-small cell lung cancer and the course of serum PCSK9 and the administration of PCSK9 inhibitors. Although PSCK9 is thought to be involved in cancer progression, the use of PCSK9 inhibitors at the same doses and doses as in the treatment of conventional hyperlipidemia failed to control cancer progression. The anti-PCSK9 vaccine has been experimentally shown to be effective against tumor progression. It is expected that PCSK9 inhibition by various methods will bring good results for cancer patients. Further research is needed to elucidate the exact mechanism by which PCSK9 regulates cancer cell proliferation and apoptosis. PCSK9 inhibitors, initially developed to treat hypercholesterolemia, may have significant involvement in the treatment of various cancers and their metastases. Therefore, collaboration between endocrinologists and oncologists is important in the laboratory and clinical practice. Presentation: No date and time listed

Changes of Optical Coherence Tomography Parameters after Cataract Surgery in Primary Open-Angle Glaucoma Eyes.

To investigate the impact of uncomplicated cataract surgery on the measurement of Bruch's membrane opening-minimum rim width (BMO-MRW) and retinal nerve fiber layer thickness (RNFLT) using spectral domain optical coherence tomography (SD-OCT) in primary open-angle glaucoma (POAG) patients. This retrospective study included 63 eyes of 63 patients, including 32 POAG eyes and 31 normal eyes who underwent uneventful cataract surgery and follow-up for at least 6 months. Using SD-OCT, BMO-MRW and RNFLT were measured preoperatively and postoperatively at 6 months. Paired t-test was used to compare intraocular pressure (IOP), BMO-MRW, RNFLT, and image quality before and after surgery. These parameters and their changes were compared between POAG and normal groups. Univariate and multivariate linear regression analyses were performed to determine the factors associated with the postoperative change (Δ) in RNFLT and BMO-MRW. BMO-MRW and RNFLT were significantly increased and IOP was decreased after phacoemulsification in both groups (p < 0.001, respectively). The ΔRNFLT was significantly greater in POAG eyes compared with the normal eyes (p < 0.001). The ΔRNFLT was associated with the postoperative IOP reduction and glaucoma diagnosis (p < 0.001 and p = 0.001, respectively). In the normal group, only the ΔIOP had a significant influence on the ΔRNFLT (p = 0.003), but in the POAG group, not only the ΔIOP (p = 0.044) but also preoperative visual field mean deviation (p = 0.029) showed a significant influence. The ΔBMO-MRW showed no difference between POAG and normal eyes. The postoperative increase of RNFLT was significantly greater in the POAG group, and the postoperative increase of RNFLT was associated with the preoperative visual field mean deviation and ΔIOP in POAG eyes and with the ΔIOP in normal eyes. Our results imply that RNFLT is more affected than BMO-MRW in POAG eyes compared to normal eyes by cataract surgery.

Exceedingly High Rate of Venous Thromboembolism after Laparoscopic Splenectomy Warrants a Chemoprevention Guideline

INTRODUCTION: Venous thromboembolism (VTE) after elective laparoscopic splenectomy (LS) historically ranges from 0.8% to 3%, which is higher than other types of elective noncardiac procedures. These patients often have multiple risk factors for VTE. However, no guideline exists to aid surgeons in minimizing VTE. The purpose of this study is to define the associated risk and rate of VTE after LS. METHODS: The American College of Surgeons NSQIP database was queried from 2005 to 2020. Patients were identified based on the CPT code 38120. Patients were further excluded if they were coded as emergent or being transported to the hospital from any location other than home. Analysis of the data was performed with RStudio and Microsoft Excel. RESULTS: A total of 5,176 patients underwent LS with a VTE rate of 3.6% and average Caprini score of 4. Among these, 67% had surgical indication or a postoperative diagnosis that confers increased risk of VTE, such as active malignancy or autoimmune disease. 100% of patients had full data available for all relevant outcomes except for postoperative diagnosis, in which 97% of patients had this information recorded (Table),TableCONCLUSION: LS patients are very high risk for VTE, even more so than patients undergoing bariatric or total joint surgery. These patients should be strongly considered for both preoperative and postoperative VTE chemoprophylaxis. Additional research should be performed investigating the role of prolonged postoperative VTE chemoprophylaxis after discharge.

Evaluation of the efficacy and safety of 5-aminolevulinic acid-mediated photodynamic therapy in women with high-risk HPV persistent infection after cervical conization

ObjectiveTo evaluate the efficacy and safety of photodynamic therapy (PDT) in women with high-risk human papillomavirus (hr-HPV) persistent infection after cervical conization, including loop electrosurgical excision procedure (LEEP) and cold knife conization (CKC). Materials and methodsThe clinicopathological and follow-up data of 76 women with hr-HPV persistent infection after cervical conization (54 cases with LEEP and 22 cases with CKC) were collected. All the women in this group met these criteria: postoperative pathological diagnosis of LEEP/CKC showed high grade squamous intraepithelial lesions (HSIL) with negative incisal margin, hr-HPV persistent infection after LEEP/CKC ≥ 1 year, colposcopy and histopathology showed no intraepithelial lesions before PDT, and 5-aminolaevulinic acid (5-ALA) as photosensitizer treating for 6 times with an interval of 7-10 days. The above patients were followed up 6 months and 12 months after PDT, and the follow-up contents included Roche Cobas HPV classification test, cytology, colposcopy, and pathological examinations. HPV negative conversion rate is an index to evaluate the efficacy of PDT. In addition, we also assessed the safety of PDT. ResultsSix months after PDT, the overall HPV clearance rate was 59.21% (45/76). The HPV negative conversion rates in patients ≤ 50 years old group and > 50 years old group were 68.52% (37/54) and 36.36% (8/22), respectively (P=0.009). But there was no significant difference in HPV clearance rate between the HPV16/18 infection group and other hr-HPV infection group (P=0.3326). 12 months after PDT, 1 case underwent hysterectomy because of progression to HSIL, and 7 cases lost follow-up. The overall HPV clearance rate was 88.24% (60/68). The negative conversion rates of HPV16/18 and other hr-HPV infection groups were 76.00% (19/25) and 95.35% (41/43), respectively (P=0.0458). However, the HPV negative conversion rate was not correlated with the patient's age (P=0.2383). The adverse reactions after PDT were mild, mainly manifested as increased vaginal secretions or burning/tingling. ConclusionsPhotodynamic therapy could be an effective treatment for patients with hr-HPV persistent infection after cervical conization and it could promote the negative conversion of hr-HPV and prevent the recurrence progression of cervical intraepithelial neoplasia (CIN) after LEEP/CKC.

S2548 An Unusual Case of Abdominal Hematoma Presenting After Long Quiescence Period

Introduction: Incidental abdominal masses are often detected during routine imaging for abdominal pain. Abdominal hematomas usually present a few days after recent trauma and are associated with peritonitis requiring surgical intervention. We report a case of symptomatic abdominal hematoma, presenting as an abdominal mass, 1 year after motor vehicle accident (MVA). Case Description/Methods: 24-year-old female presented with sudden onset sharp epigastric and left upper quadrant (LUQ) abdominal pain, radiating to bilateral shoulders, along with decreased oral intake, nausea, and bilious vomiting. On physical exam, she was hemodynamically stable, abdomen was soft, non-distended, with epigastric and LUQ tenderness, bowel sounds normal, otherwise unremarkable exam. Initial blood work was unremarkable. Computed tomography of abdomen and pelvis (CTAP) revealed a 5.6x 2.1x 5.4 cm mass located between stomach and spleen without associated adenopathy, suspicious for gastrointestinal stromal tumor (Figure). On EUS, the lesion appeared poorly defined, multicystic and likely originating outside the gastric wall. There was also a moderate amount of free fluid in the abdomen. A fine needle biopsy was obtained, but the sample was largely blood clot. The next day, the patient developed sharp abdominal pain with guarding, blood work revealed hemoglobin levels drop from 12.9 to 7.6 g/dl. CTAP angiography showed development of large amount of intraperitoneal free fluid, without active extravasation, and grade 1 splenic laceration, likely chronic. The non-enhancing hyperdense mass was again noted, unchanged in size and location. Laparoscopy revealed a ∼6cm hematoma and evacuated 2L old blood. Postoperative diagnosis was spontaneous hemoperitoneum secondary to trauma of short gastric vessel. Pathology result showed blood, inflammation, and rare degenerated epithelial cells. Upon further interrogation, patient endorsed MVA 1 year ago but did not seek medical care due to no symptoms. Patient was monitored after surgery and upon significant improvement in her symptoms and blood work, she was discharged. Discussion: It is rare for abdominal hematomas to be quiescent for one year and then suddenly present as peritonitis without any further inciting event. Our patient could have suffered from major morbidity, given the drastic drop in hemoglobin level, without urgent intervention. Physicians should have high clinical suspicion and investigate for possible trauma, in acute abdominal pain cases with an incidental abdominal mass on imaging.Figure 1.: Computed tomography of abdomen and pelvis revealing a hypo-echoic mass located medially adjacent to the spleen and laterally adjacent to the stomach. No surrounding fat stranding or lymphadenopathy noted.

Long-Term Clinical and Patient-Reported Outcomes Following the Brostrom-Gould Procedure

Category: Ankle; Sports; Trauma Introduction/Purpose: Chronic ankle instability (CAI) is a commonly encountered condition amongst foot and ankle surgeons and is characterized by loss of function and stability of the ankle following multiple or poorly healed ankle sprains. The Brostrom- Gould procedure is a widely accepted method of addressing CAI and has been seen to produce favorable outcomes in terms of regaining ankle function and stability. While long-term clinical results of the Brostrom-Gould procedure exist in the literature, there is little published on long-term patient-reported outcomes. Methods: Patients that underwent the Brostrom-Gould procedure from 2011 to 2015 were identified. The electronic medical record was utilized to collect patient demographics, preoperative and postoperative diagnosis, and clinical outcomes. Patients were then surveyed to obtain PROMIS domain scores (physical function, pain interference, and depression), resiliency scores, foot and ankle ability measure (FAAM) scores, pain level, and ability to return to work postoperatively. Criteria for inclusion in our study was the successful collection of survey data. Results: 50 patients were successfully surveyed for long-term postoperative patient-reported outcomes. Patients were surveyed at least 5 years after their original date of surgery with a median time of 6.7 (IQR 1.89) years. Four patients experienced complications including wound complications, sural nerve injury, and reflex sympathetic dystrophy. Four individuals had recurrence of instability with a median of 11.3 months (IQR 8.8) and six patients underwent reoperations. There was significant association of prior ankle instability surgery with PROMIS physical function scores (p=0.013) and being an athlete with PROMIS pain interference scores (p=0.042). Increased age was correlated with lower PROMIS functional scores (p=0.047) and lower FAAM ADL scores (p=0.044). Longer time to survey was significantly associated with an increased FAAM sports score (p=0.048). Longer time to survey was non-significantly associated with increased PROMIS functional scores (p=0.17), decreased PROMIS pain interference scores (p=0.52), and increased FAAM ADL scores (p=0.45). Conclusion: Patient-reported outcomes are important to measure to gain insight into the patient experience following the procedure and may be helpful in preoperative counseling. Our preliminary results suggest that longer time to follow up is associated with more favorable PROMIS domain and FAAM scores. We intend to conduct more surveys to add more power to our study.

Posterior Ankle Impingement: It is Not All About the Os Trigonum

Category: Arthroscopy; Ankle; Hindfoot; Sports Introduction/Purpose: Posterior ankle and hindfoot arthroscopy (PAHA) is a well described procedure used for treating posterior ankle impingement syndrome (PAIS). Os trigonum and trigonal process (Stieda) are common etiologies and diagnosis is typically made by radiographs, CT, or MRI. However, these static tests may not detect associated soft tissue and other bony pathologies, which are often dynamic. Physical examination and Ultrasound (US) are dynamic. US can be limited by depth. Traditional open treatment may not allow visualization and appreciation for these associated pathologies. PAHA is dynamic providing at least 8X magnification with full visualization of the posterior ankle and subtalar joints. The primary aim of this study is to report the incidence of associated pathologies seen with os trigonum or Stieda impingement when treated with PAHA. Methods: A retrospective case series of patients who underwent PAHA for PAIS due to trigonal impingement between January 2011 and September 2016 were reviewed. Surgeries were performed by three fellowship-trained orthopedic foot and ankle surgeons in 251 patients. Exclusions were those having concomitant open posterior procedures, other indications for PAHA (e.g., OCL, subtalar fusion) or other PAIS etiology (e.g., soft tissue impingement). After exclusions, 112 patients were studied, with a mean age of 30.5 (12-70) and a BMI of 29.93 (SD 9.23). Demographic data was collected along with pre and postoperative diagnosis, arthroscopic findings, type of impingement, location of the disorder, associated procedures, and anatomical etiologies. Trigonal impingements were allocated as os trigonal or Stieda and subgrouped as isolated, with other impingement lesions +/- FHL disorders. Differences between groups with isolated trigonal impingement and those with associated pathologies were determined by distribution comparison. Wilcoxon test was used to compare subgroups. Results: From the 112 cases, 75 were os trigonum and 37 Stieda. Isolated trigonal disorders accounted for 16% of the total PAIS patients (n=18). Those cases having pathologies other than trigonal impingement had a mode of 3 (1-5) additional pathologies with 41% of the treated cases having 3 or more adjunctive findings needing treatment during posterior arthroscopy. Flexor hallucis longus (FHL) disorders were found in 68% of cases, subtalar problems in 44%, and transverse posterior inferior tibiofibular ligament (tPITFL) in 19%. A 58% proportion of associated pathologies was observed when FHL disorders were not considered. Significant differences were noted when comparing os trigonum and Stieda subgroups (FHL: 29% to 18%, p&lt;0.001; FHL and others: 34% to 59%, p=0.046; other findings: 14% to 16%, p=0.025). Conclusion: Our study described a high prevalence of associated pathological structures involved with a trigonal disorder leading to PAI in a large cohort. Trigonal bone (os trigonum or Stieda) was found to cause impingement in isolation in a small proportion of cases (16%). Even when the FHL is removed from the equation, 58% of the total patients still presented other associated impingement pathologies. This should alert surgeons when considering removing trigonal impingement especially with an open approach. Open approaches may limit the visualization and assessment of associated posterior ankle and subtalar pathoanatomy, thus possibly overlooking concomitant causes of PAIS.

Association of Smoking With Graft Rupture After Anterior Cruciate Ligament Reconstruction.

Background:The effect of smoking on graft rupture after anterior cruciate ligament (ACL) reconstruction is not well understood.Hypothesis:It was hypothesized that there will be no relationship between tobacco use and graft rupture after ACL reconstruction, as reflected by postoperative magnetic resonance imaging (MRI) and arthroscopic examination.Study Design:Cohort study; Level of evidence, 3.Methods:Included were 233 patients who received primary ACL reconstruction with hamstring tendon autograft between January 1, 2013, and December 31, 2019, and who underwent MRI evaluation at 20.2 ± 1.9 months postoperatively. The patients were categorized by smoking history into 2 groups: 39 smokers and 194 nonsmokers. The 2 groups did not differ significantly in age, sex, operative technique, preinjury Tegner score, or mean time until postoperative MRI. The primary outcome was graft rupture rate, with rupture confirmed by either arthroscopic assessment or postoperative MRI diagnosis. The secondary outcome measure was degree of graft ligamentization, evaluated by measuring the signal-to-noise quotient (SNQ) of the graft.Results:The overall ACL graft rupture rate was 6.0%. The rupture rate was significantly higher in smokers than in nonsmokers (12.8% vs 4.6%, respectively; P = .0498). Smokers also had a significantly higher whole-graft SNQ compared with nonsmokers (4.7 ± 4.4 vs 3.3 ± 3.7, respectively; P = .028), suggesting less satisfactory ligamentization in smokers.Conclusion:Smoking was associated with a higher risk of graft rupture of ACL reconstruction and a higher SNQ of the intact graft as shown on postoperative MRI.

Neurosurgery Database for Brain Tumour Patients

Abstract AIMS We develop an electronic database system for brain tumour patients. This aims to provide accessible and comprehensive data in a unified database for all neuro-oncology patients at Barts Health NHS Trust. METHOD The database was created using Microsoft Access with data categorised using forms and tables. Initially, patients were added retrospectively using the neuropathology list and the neuro-oncology multi-disciplinary team patient lists. Once creation and validation was complete, patients were added prospectively. Queries on neuro-oncology patients can be launched to produce datasets which can be copied to Microsoft Excel spreadsheets for sorting, calculation, and graph creation. RESULTS At the time of writing, records of 1171 neuro-oncology patients who were accepted for MDT discussion at Barts Health NHS Trust are included in the database. It is used to routinely run data queries more efficiently and complete in a shorter time. Queries include post-operative complications, overall survival, histological diagnosis, and average surgery waiting time. These queries have already been used to publish audit-based research papers and will be used increasingly as part of routine clinical governance. CONCLUSION The database yields data about treatment of our brain tumour patients with increased completeness and significant reduction in time to return queries, compared to using standard data management. The database has been used to produce data, including tumour types, seizure incidence, and post-operative complications. We have been successful in producing published research, although low absolute complication numbers in the current dataset have not yet allowed comparison of complications rates at individual clinician and team level.

Accurate prediction of microvascular invasion occurrence and effective prognostic estimation for patients with hepatocellular carcinoma after radical surgical treatment

BackgroundHepatocellular carcinoma (HCC) is the third most common cause of cancer death worldwide, with an overall 5-year survival rate of less than 18%, which may be related to tumor microvascular invasion (MVI). This study aimed to compare the clinical prognosis of HCC patients with or without MVI after radical surgical treatment, and further analyze the preoperative risk factors related to MVI to promote the development of a new treatment strategy for HCC.MethodsAccording to the postoperative pathological diagnosis of MVI, 160 study patients undergoing radical hepatectomy were divided into an MVI-negative group (n = 68) and an MVI-positive group (n = 92). The clinical outcomes and prognosis were compared between the two groups, and then the parameters were analyzed by multivariate logistic regression to construct an MVI prediction model. Then, the practicability and validity of the model were evaluated, and the clinical prognosis of different MVI risk groups was subsequently compared.ResultThere were no significant differences between the MVI-negative and MVI-positive groups in clinical baseline, hematological, or imaging data. Additionally, the clinical outcome comparison between the two groups presented no significant differences except for the pathological grading (P = 0.002) and survival and recurrence rates after surgery (P < 0.001). The MVI prediction model, based on preoperative AFP, tumor diameter, and TNM stage, presented superior predictive efficacy (AUC = 0.7997) and good practicability (high H-L goodness of fit, P = 0.231). Compared with the MVI high-risk group, the patients in the MVI low-risk group had a higher survival rate (P = 0.002) and a lower recurrence rate (P = 0.004).ConclusionMVI is an independent risk factor for a poor prognosis after radical resection of HCC. The MVI prediction model, consisting of AFP, tumor diameter, and TNM stage, exhibits superior predictive efficacy and strong clinical practicability for MVI prediction and prognostication, which provides a new therapeutic strategy for the standardized treatment of HCC patients.