Postoperative Follow-up Appointment Research Articles

Comparison of Clinical Outcomes Between Laparoscopic and Open Surgery in Colorectal Cancer Patients

ABSTRACT Aim: Our research compares the clinical results of open surgery versus laparoscopic surgery for colorectal malignancies. Materials and Methods: Our analysis focused on a database that included data on patients with colorectal cancer who had laparoscopic or open surgery for stages I to III at a prestigious healthcare institute in India. Two groups of 50 patients underwent laparoscopic and 50 underwent conventional open colorectal surgery (OCRS and LCRS, respectively) throughout the same time. Patient demographics, operation data, initial postoperative outcomes, follow-up appointments, pathology results, and cancer stages were examined. Results: The LCRS group had a much longer operation time compared to the OCRS. Subjects in the LCRS group experienced a notably accelerated recovery after surgery. The hospital stay for the OCRS group was considerably longer compared to that in the LCRS group. Conclusion: Laparoscopic colorectal surgery is a reliable and convenient alternative to the traditional open approach, providing comparable oncological efficacy.

Results of Modified Stenströms Technique Otoplasty and Patients' Satisfaction at King Fahad Armed Forces Hospital (KFAFH).

Background Globally, the prevalence of protruding ears is relatively frequent. Ear deformities manifest due to underdevelopment of the antihelical fold, conchal hypertrophy, and/or an obtuse conchoscaphal angle. The availability of multiple approaches proves that there isn't a single optimal accepted procedure. The Modified Stenström otoplasty technique supports the surgeon in the management of underdeveloped antihelix fold, conchal hypertrophy, and obtuse conchoscaphal angle among other deformities. We are the first to evaluate the clinical effects and measure the satisfaction rate post-otoplasty using the modified Stenström technique with a case series study. Methods Six patients were included in the study with a total of 12 ears operated on between February 2021 and July 2022. Utilizing the modified Stenström technique for bilateral protruding ears. All patients had six postoperative follow-up visits with fixed intervals; one week, three weeks, six weeks, three months, six months, and one year. During their one-year postoperative follow-up appointment, all patients completed thesatisfaction survey questions. Results Six individuals were studied, three males and three females with a mean age of 23.1 (range, 7-53 years old). There were no complications or recurrences observed. Based on the responses we collected, all patients reported a high satisfaction rate at one-year postoperative follow-up. Conclusion The modified Stenström technique yields good naturally appearing ears. It is an easy and safe technique to apply. It has a short recovery period, and no hospital stay is required. All contribute to a high satisfaction rate among studied patients.

Butterfly Vertebra: A Retrospective Study of 30 Patients

BackgroundButterfly vertebra (BV) is a rare congenital spinal anomaly for which there is a paucity of large-scale retrospective studies and established guidelines for treatment. The objective of this study was to elucidate the clinical characteristics, imaging findings, and therapeutic approaches for BV. Materials and methodsWe conducted a retrospective analysis of 30 patients diagnosed with BV at our hospital from 2009 to 2023, examining clinical data, imaging findings, and clinical interventions. ResultsThe analysis comprised a cohort of 30 patients, consisting of 15 males and 15 females, with a mean age of 27.63±19.84 years. Imaging studies indicated that the majority of vertebral bodies affected by BV were single-segmented (63.3%, 19/30) and less commonly multi-segmented (36.7%, 11/30). These findings frequently coexisted with other medical conditions, most notably spinal scoliosis (76.7%, 23/30). Furthermore, the study identified a range of spinal abnormalities among patients, including hemivertebral deformity (30.0%, 9/30), spinal cleft (10.0%, 3/30), lumbar disc protrusion or herniation (10.0%, 3/30), vertebral slippage (10.0%, 3/30), thoracic kyphosis deformity (6.67%, 2/30), vertebral fusion deformity (6.67%, 2/30), compressive fractures (3.3%, 1/30), and vertebral developmental anomalies (3.3%, 1/30). Clinical intervention resulted in symptom relief for 23 non-surgical patients through lifestyle modifications, analgesic use, and physical therapy. Seven surgical patients underwent appropriate surgical procedures, leading to satisfaction and adherence to regular postoperative follow-up appointments. ConclusionBV is a rare vertebral anomaly that can be easily misdiagnosed due to its similarity to other diseases. Consequently, it is imperative to enhance vigilance in the differential diagnosis process in order to promptly recognize BV. Furthermore, in cases where patients present with additional associated radiographic findings, a thorough evaluation is typically warranted, and timely measures should be taken for treatment.

Comparison of Wound Outcomes for Absorbable versus Non-absorbable Suture after Carpal Tunnel Release

Background and Hypothesis:Carpal tunnel release (CTR) is a common hand surgery procedure. Despite the large volume of CTRs performed worldwide (400,000-600,000 cases/year), there is no consensus as to the optimal suture material for incision closure. In this study, we sought to compare outcomes of absorbable and non-absorbable suture for skin closure after CTR. Our hypothesis was that that there is no statistically or clinically significant difference in wound-related outcomes between the cohorts.
 Project Methods:All patients who underwent primary open carpal tunnel release (CTR) at a large, public county hospital in Indianapolis, IN were identified by CPT code (64721). All patients were treated by one of two fellowship-trained hand surgeons. The most recent 50 patients treated between September 2022 and May 2023 by each surgeon were identified. Surgeon “A” uses 4-0 vicryl rapide for closures (absorbable). Surgeon “B” uses 4-0 nylon for closures (non-absorbable). Adverse events (AE) were defined as infection, dehiscence, or suture granuloma observed at any follow-up appointment. This study was approved by the Institutional Review Board.
 Results:100 patients were identified - 4 patients were lost to follow-up and were excluded from the study. Of the remaining 96 patients, 46 received absorbable suture and 50 non-absorbable suture. Of the 46 patients who received absorbable suture, 8 experienced AE (17.4%). None of the 50 patients who received non-absorbable suture experienced an AE. There was a statistically significant difference in AE between the absorbable and non-absorbable suture cohorts (p=0.002). Patients with absorbable suture averaged 1.61 follow-up appointments, whereas those with non-absorbable suture averaged 2.32 (p=.0008).
 Conclusion and Potential Impact:In this study, absorbable suture resulted in more wound-related complications after CTR. However, patients with non-absorbable suture had more post-operative follow-up appointments. These findings should be considered when selecting suture material for skin closure after CTR.

A Novel Patellar Tendon Reconstruction Technique Using Semitendinosus Allograft

A Novel Patellar Tendon Reconstruction Technique Using Semitendinosus Allograft

A Mobile App for Postoperative Pain Management Among Older Veterans Undergoing Total Knee Arthroplasty: Mixed Methods Feasibility and Acceptability Pilot Study.

Prescription opioid misuse risk is disproportionate among veterans; military veterans wounded in combat misuse prescription opioids at an even higher rate (46.2%). Opioid misuse is costly in terms of morbidity, mortality, and humanitarian and economic burden and costs the Civilian Health and Medical Program of the Department of Veterans Affairs more than US $1.13 billion annually. Preventing opioid misuse at the time of prescription is a critical component in the response to the opioid crisis. The CPMRx mobile app has been shown to decrease the odds of opioid misuse during the postoperative period. The overarching purpose of this feasibility pilot study was to explore whether deploying a mobile app (CPMRx) to track postoperative pain and medication use is feasible in a Department of Veterans Affairs medical center. In support of this goal, we had four complementary specific aims: (1) determine the technological and logistical feasibility of the mobile app, (2) assess the acceptability of the mobile app to participants, (3) measure demand for and engagement with the mobile app, and (4) explore the potential use of the mobile app to patients and providers. Participants (N=10) were veterans undergoing total knee arthroplasty within the Veterans Health Administration provided with the CPMRx app to self-manage their pain during their 7-day at-home recovery following surgery. CPMRx uses scientifically validated tools to help clinicians understand how a patient can use the least amount of medication while getting the most benefit. The suite of software includes a mobile app for patients that includes a behavioral health intervention and a clinical decision support tool for health care providers that provides feedback about pain and medication use trends. Patients filled out paper questionnaires regarding acceptability at their postoperative follow-up appointment. Overall, quantitative measures of acceptability were high. The average rating for the amount of time required to use the app was 4.9 of 5 (5="very little"), and the average rating for ease of use was 4.4 of 5 (5="very easy"). Open-ended questions also revealed that most participants found ease of use to be high. Demand and engagement were high as well with a mean number of mobile app entries of 34.1 (SD 20.1) during the postoperative period. There were no reported technological or logistical issues with the mobile app. Participants took an average of 25.13 (SD 14.37) opioid tablets to manage their postoperative pain. Results of this study revealed that the use of a mobile app for pain and medication management during postoperative recovery was both feasible and acceptable in older veterans undergoing total knee arthroplasty within the Veterans Health Administration. The wide variation in opioid consumption across participants revealed the potential use of the mobile app to provide actionable insights to clinicians if adopted more widely.

Observation of Factors Associated with Non-Compliance to Post-Operative Follow-up after Cataract Surgery

Background: Blindness is a substantial concern in Bangladesh, which is part of the South East Asia region under the World Health Organization. Cataracts are a major contributor to blindness, accounting for a significant percentage of cases. However, the outcomes of cataract surgery in the region are worrisome, with many postoperative eyes experiencing poor visual acuity. Compliance to post-operative care, especially timely follow-ups, is crucial for optimal outcomes, but non-compliance is a significant issue, particularly in rural areas. This study examines the reasons for non-compliance to post-operative follow-ups in cataract surgery patients at a district hospital in Bangladesh. Methods: This study was conducted at District Sadar Hospital, Jhalakathi, spanning a year. It included 278 cataract surgery patients. Detailed patient histories were collected, and patients were counseled about the surgery and the importance of follow-ups. A single surgeon performed the surgeries according to established protocols. Post-operative medication and follow-up appointments were prescribed. Reasons for missed follow-ups were documented, and data were recorded in tables and figures. Result: During the operative period, there were 123 males and 155 females. The first follow-up had 80 males and 95 females, while the second follow-up had 16 males and 17 females. Key factors for non-compliance by the second follow-up were identified, including transport cost, absence of an attendant, improved vision with no complications, severe weakness, loss of discharge letter, uncooperative hospital staff, lack of improved vision, and a combination of factors. Conclusion: The study recommends public awareness programs and dedicated hospital counselors to improve understanding and compliance with post-operative follow-ups. This approach could significantly enhance the effectiveness of cataract surgery outcomes and restore post-operative vision effectively. However, it's important to note that ....

Postoperative Follow-up Compliance: The Achilles' Heel of Bariatric Surgery.

Regular postoperative follow-up appointments are critical for assessing the effectiveness of the operation and ensuring adequate nutrition, as well as for prompt identification of any complications. In this study, we aimed to determine compliance to follow-up appointments after bariatric surgery and examine factors associated with compliance. We performed a retrospective analysis of all patients who underwent bariatric surgery at the University of Illinois at Chicago between January 1st 2019 and December 30th 2019. Demographics, socio-economic variables (type of insurance, education, income, distance to hospital), type of consultation (in person vs. telehealth), and type of surgery were ascertained. Follow-up rates at the 3-month, 6-month, 12-month and 24-month visits were 61.9%, 41.2%, 29.6%, and 6.5%, respectively. In multivariable logistic regression analysis, White patients (OR 5.13 95% CI 2.03-12.95) and those using telehealth (OR 5.84, 95% CI 3.01 - 11.38) were significantly more likely to be compliant with follow-up. Strategies for improving patient adherence to postoperative follow-up are needed, particularly among persons from racial/ethnic minority backgrounds who also experience both a disparately high burden of severe obesity and poor access to quality care.

Bringing Opiates Off the Streets and Undertaking Excess Scripts: A novel opiate reclamation and prescription reduction program

BackgroundOpioid diversion and misuse continue to present problems in modern medicine. The “opioid epidemic” has claimed more than 250,000 lives since 1999, with studies pointing to prescription opioids as the culprit for future opiate misuse. Currently, there are no well-described, data-driven processes to educate surgeons on reducing opiate prescribing, informed by personal practice patterns. We designed and implemented a novel opiate reclamation and prescription reduction program for surgeons to reclaim unused medications and decrease prescribing using individual provider data. MethodsWe performed a prospective collection of all unused opiate pain medications for general surgery postoperative patients from July 15, 2020 to January 15, 2021. Patients brought their unused opiates to their routine postoperative follow-up appointment, where they were counted and disposed of in a secure drug take-back bin. Reclaimed opiates were totaled, analyzed, and reported to the providers, who used their individual reclamation rates to refine prescribing habits. ResultsDuring the reclamation period, 168 operations were performed, with a total of 12,970 morphine milligram equivalents of opiate prescribed by 5 physicians. A total of 6,077.5 morphine milligram equivalents (46.9%) were reclaimed, which is the equivalent of 800 5-mg tablets of oxycodone. A review of these data led to a 30.9% decrease in opiate prescriptions by participating surgeons in addition to the reclamation of an additional 3,150 morphine milligram equivalents over the next 6 months. ConclusionContinuous monitoring of the medications returned by patients now continues to inform our providers’ prescribing practices, decreases the amount of opiates in the community, and improves patient safety.

148 Peroneal Nerve Repair With Crossbridge Ladder Technique: Parallel End-to-Side Neurorrhaphies

INTRODUCTION: Multiple nerve transfer techniques are used to treat patients with nerve injuries when a primary repair is not possible. These techniques are categorized to end-to-end, end-to-side, and side-to-side neurorrhaphy. METHODS: Four patients with significant loss of ankle dorsiflexion were seen in the clinic and underwent evaluation, including electrodiagnostic studies. A cross-bridge ladder repair technique was used between the tibial nerve as the donor and the common peroneal nerve as the recipient via one or two nerve grafts coapted in parallel with end-to-side neurorrhaphies. Dorsiflexion strength was measured preoperatively using the Medical Research Council (MRC) grading system and at each postoperative follow-up appointment. RESULTS: All four patients had suffered persistent and severe foot drop (MRC of 0) following trauma that had occurred between 6 and 15 months preoperatively. Three of the four patients improved to an MRC of 2 several months postoperatively. The last patient had an immediate improvement to an MRC of 2 by his first month and had a complete recovery of ankle dorsiflexion within four months from surgery. CONCLUSIONS: We demonstrate the utility and clinical outcomes of the cross-bridge ladder technique in patients with persistent and prolonged food drop following trauma. Both early and late recovery were seen while all patients regained motor function, with some patients continuing to improve up to the most recent follow-up.

Management of orofacial clefts in Africa, insufficient management centers, and workforce.

Management of orofacial clefts in Africa, insufficient management centers, and workforce.

Peroneal Nerve Repair with Cross-Bridge Ladder Technique: Parallel End-to-Side Neurorrhaphies

Background Multiple nerve transfer techniques are used to treat patients with nerve injuries when a primary repair is not possible. These techniques are categorized to end-to-end, end-to-side, and side-to-side neurorrhaphy. Our study aims to explore the utility of the cross-bridge ladder technique (H-shaped), which has shown promising results in animal models and probably underutilized clinically. Methods Four patients with significant loss of ankle dorsiflexion were seen in the clinic and underwent evaluation, including electrodiagnostic studies. A cross-bridge ladder repair technique was used between the tibial nerve as the donor and the common peroneal nerve as the recipient via one or two nerve grafts coapted in parallel with end-to-side neurorrhaphies. Dorsiflexion strength was measured preoperatively using the Medical Research Council (MRC) grading system and at each postoperative follow-up appointment. Results All four patients had suffered persistent and severe foot drop (MRC of 0) following trauma that had occurred between 6 and 15 months preoperatively. Three of the four patients improved to an MRC of 2 several months postoperatively. The last patient had an immediate improvement to an MRC of 2 by his first month and had a complete recovery of ankle dorsiflexion within 4 months from surgery. Conclusion We demonstrate the utility and clinical outcomes of the cross-bridge ladder technique in patients with persistent and prolonged foot drop following trauma. Both early and late recovery were seen while all patients regained motor function, with some patients continuing to improve up to the most recent follow-up. IRB Approval: Obtained 2013-1411-CP005.

Using Closed Incision Negative Pressure Therapy Specialty Dressings over Incisions following Sternal Dehiscence Reconstruction.

This was an observational, retrospective cohort study of patients with SSCs following index cardiothoracic procedures. A single surgeon performed chest wall reconstruction using muscle flaps followed by closed incision negative pressure therapy (ciNPT; -125 mm Hg) using a ciNPT specialty dressing with an expanded coverage area to resolve sternal defects. Dressing changes occurred every 7 days. Postoperative follow-up appointments occurred after 30 days. Sixteen consecutive sternal reconstruction patients (six women and 10 men) with multiple comorbidities and an average age of 61.1 years were included in an initial evaluation of the ciNPT specialty dressing over median sternotomy incisions revised using flaps. The duration of ciNPT was 14 days with a single dressing change at day 7. At the initial dressing change, 93.8% of incisions were closed. Within 30 days postreconstruction, 18.8% of the patients had SSCs (hematoma or dehiscence). No seromas were noted. At 30-day follow-up appointments, 93.8% of incisions remained closed. Patients reported reduced pain and swelling. Average inpatient length of stay was 12.2 ± 14.2 days. In these patients, ciNPT using the ciNPT specialty dressing helped to facilitate positive healing outcomes in patients with deep sternal wound infections following sternal defect reconstruction post cardiothoracic surgery.

Post-Operative Voiding Function after Total Laparoscopic Hysterectomy with Transvaginal Versus Transabdominal Morcellation

<h3>Study Objective</h3> To determine the rates of post-operative urinary retention (POUR) in patients who have undergone transvaginal and transabdominal morcellation for large multifibroid and adenomyotic uteri during a total laparoscopic hysterectomy. <h3>Design</h3> Retrospective, multi-centre, cohort study. <h3>Setting</h3> Multi-centre healthcare system serving Calgary and Southern Alberta population. <h3>Patients or Participants</h3> The patients of four high-volume minimally invasive gynecologists were included in this study. Women 18 years and older who underwent a total laparoscopic hysterectomy requiring morcellation between January 2015 to April 2021 were included. Those with pre-existing urinary retention were excluded. <h3>Interventions</h3> Retrospective observational cohort study. <h3>Measurements and Main Results</h3> POUR was defined as urinary retention requiring an indwelling or in-and-out catheter post-operatively prior to discharge. No difference in POUR was found between transvaginal (29/139, 20.9%) and transabdominal (12/56, 21.4%) morcellation. There were also no differences in time to first post-operative void (5.5±4.5h vs 5.75±3.25h), length of stay (23±5h vs 22±6h), post-operative UTI (5.1% vs 3.6%) or presentation to the emergency department for POUR post-discharge (1.4% vs 1.8%) for transvaginal and transabdominal morcellation, respectively. A trend towards increased complication rate at the time of morcellation (7% vs 0%) and urinary complaints at post-operative follow-up appointments (9.4% vs 0%) were noted in the vaginal morcellation group. <h3>Conclusion</h3> With respect to route of uterine morcellation, patients who undergo transvaginal and transabdominal approaches have similar rates of POUR. It is reasonable for surgeon preference to guide the decision about route of morcellation. Larger prospective trials are needed to further assess POUR and the potential increased complication rate and post-operative urinary complaints with transvaginal morcellation.

Minimally Invasive Method in Treatment of Idiopathic Congenital Vertical Talus: Recurrence is Uncommon.

Historically, treatment for congenital vertical talus (CVT) has included open reduction of the talonavicular joint and extensive soft tissue release. In 2006, a new minimally invasive method consisting of serial manipulation and casting followed by percutaneous fixation of the talonavicular joint and percutaneous Achilles tenotomy was introduced. Although the early results of this new technique are promising, more research is needed to verify that the talonavicular correction is maintained with time. We conducted a retrospective chart review of all patients with idiopathic CVT who underwent minimally invasive correction by a single surgeon at a tertiary care institution. Radiographic evaluation of the preoperative, immediate postoperative, 1 year postoperative and latest follow-up appointments were performed. Complications and clinical outcomes were recorded. Radiographic recurrence of the deformity was defined as lateral talar axis-first metatarsal base angle >30 degrees. Statistical analysis was performed on the maintenance of radiographic correction and factors associated with recurrence. Forty seven feet in 35 patients were included in the study with average follow-up of 45 months. The average preoperative lateral talar axis-first metatarsal base angle was 74±18 compared with 12±8 after initial surgical intervention. In addition, radiographic correction of all other measured angles was achieved in every child following the initial surgery. Radiographic recurrence of talonavicular deformity was seen in 4 feet (9%). No cases of recurrence required a second corrective surgery during the follow-up period. There was a significant association between patient age at the time of treatment and recurrence of talonavicular deformity with patients older than 12 months being more likely to experience recurrence ( P =0.041). In this large series, we found that correction of talonavicular deformity can be achieved and maintained in a large majority of children with idiopathic CVT who undergo treatment with this minimally invasive technique and recurrences are uncommon. Treatment with this technique should be initiated as soon as a diagnosis of CVT is confirmed and the patient is medically stable to decrease the likelihood of experiencing recurrence of talonavicular deformity. Level III.

EP-90 Bouveret Syndrome: A challenging case of impacted gallstone within the fourth part of the duodenum

Abstract Aims Bouveret syndrome is a rare condition characterised by gastric outlet obstruction secondary to a gallstone fistulating into the proximal duodenum or pylorus. We present a case of a 68-year-old with recurrent small bowel obstruction secondary to a large gallstone impacted in the fourth part of the duodenum and cholecysto-duodenal fistula. We describe our atypical approach to surgical retrieval. Methods The patient presented acutely with abdominal pain and vomiting, on a background of recent admission for gallstone ileus managed conservatively. Initially, due to high anaesthetic risk (P POSSUM score = 14% mortality, 60% morbidity), the patient was managed conservatively with nasogastric drainage and total parenteral nutrition. On day 6 of admission, emergency laparotomy was performed after identifying radiological signs of impending perforation and clinical deterioration. Endoscopic management was not available locally. The stone could not be milked proximally for retrieval via pyloroplasty. Subsequently, high-pressure water flushes delivered via the gastrostomy expelled the stone distally. The stone was then retrieved via a jejunotomy at the DJ flexure. Results The patient required a 2-day high dependency unit admission and she was discharged 3 weeks post-operatively at her functional baseline. She was clinically well and asymptomatic when reviewed at the four-month post-operative surgical follow-up appointment. Conclusions This is the first report to our knowledge to describe successful surgical management of a gallstone impacted in the fourth part of the duodenum. Enterolithotomy can be considered safe option in patients with large, impacted stone and multiple co-morbidities.

Expert Consensus on the Use of the PRESERFLO™ MicroShunt Device in the Treatment of Glaucoma: A Modified Delphi Panel.

IntroductionThe implantation of the PRESERFLO™ MicroShunt (PMS) device has been shown to significantly lower increased intraocular pressure (IOP) in patients with primary open-angle glaucoma (POAG). However, guidelines on best practice for patient selection and pre-/peri-/postoperative care management are lacking. The aim of this modified Delphi panel was to achieve expert consensus on the role of the PMS to treat patients with glaucoma in Europe.MethodsTwelve European glaucoma surgeons experienced with the PMS procedure participated in a three-round modified Delphi panel. A targeted literature review and expert steering committee guided round 1 questionnaire development. Consensus was set at a pre-defined threshold of at least 70% of panellists selecting ‘Strongly disagree’/‘Disagree’ or ‘Strongly agree’/‘Agree’ for six–point Likert scale questions, or at least 70% selecting the same option for multiple-choice questions. Questions not reaching consensus were restated/revised for the next round, following guidance from free-text responses/scoping questions.ResultsConsensus was achieved for 60.3% (n = 38/63), 60.0% (n = 18/30), and 100.0% (n = 11/11) of Likert/multiple-choice questions in rounds 1, 2, and 3, respectively. There was agreement that the PMS procedure is effective at reducing IOP in patients with high-tension POAG (greater than 21 mmHg). Although surgical techniques may vary slightly, consensus was reached on several points, including the importance of posterior application of mitomycin C (MMC). Panellists agreed that the PMS postoperative follow-up appointment schedule is reasonably predictable and mostly characterised by fewer visits than with trabeculectomy, particularly in the early phase. Although panellists agreed that combined cataract/PMS surgery and the use of non-MMC wound-healing modulators/antifibrotics during the procedure are possible, further data are needed to determine efficacy.ConclusionThe expert consensus reached in this panel will help inform best practice guidelines in the treatment of patients with glaucoma in Europe. Panellists also highlighted key areas for future research to improve understanding of the PMS in the treatment algorithm of glaucoma.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40123-022-00529-4.

Let our patients shine: Survivorship and health interventions in nutrition and exercise program for breast cancer survivors.

e24032 Background: Nutrition and lifestyle interventions are instrumental in modifying cancer risk. These changes are often challenging for patients to make due to residual side effects from active treatment and/or ongoing toxicities from current treatment. The SHINE (Survivorship and Health Interventions in Nutrition and Exercise) Program is a wellness program for patients with breast cancer focusing on three pillars of nutrition, exercise and community in order to improve overall health outcomes and decrease the risk of cancer recurrence. Methods: Participants in SHINE have either been diagnosed with ductal carcinoma in situ (DCIS) and/or stage I-IV breast cancer. They are referred to the program at the three-month breast surgery post-operative follow-up appointment or any time after that. All patients are referred to meet with a registered dietitian (RD) and integrative health coach, who provides counseling and education on how to reduce risk through diet and lifestyle, using evidence-based recommendations. Patients are provided with support and accountability. A collaborative program, the Physician Referred Exercise Program (PREP), was established with our health system’s medical fitness center, Valley Health LifeStyles. Patients undergo a fitness assessment that focuses on aerobic fitness, muscle strength and endurance, flexibility, &amp; functional activity. Each patient then receives an exercise prescription developed by a degreed exercise specialist, taking into account both the physician’s &amp; patient’s recommendations &amp; goals. Results: Each component of the SHINE Program has been developed in various stages due to the COVID-19 pandemic. 336 patients with either DCIS or stage I-IV breast cancer have been seen by the RD from December 2020 through January 2022. Mean number of visits/patient: 1.89 (range 1-8). N = 48 were participants in a 12-week study on the feasibility of nutrition counseling and impact on quality of life (QOL) which is still in progress. 76 patient referrals have been placed to the PREP program from August 2021-February 2022. Multiple community programs (Table) have been created for patients to help them develop shared experiences &amp; camaraderie with each other so that they can better integrate new ideas and lifestyle modifications. Conclusions: The SHINE Program addresses care for the whole person, empowering individuals to live their healthiest lifestyle. Future work will focus on clinical trials to evaluate the benefits of these individual and collective interventions on overall QOL, QOL subscales (physical, psychological, social &amp; spiritual well-being), &amp; survivorship symptoms.[Table: see text]

Pigmented ependymoma, a tumor with predilection for the middle-aged adult: case report with methylation classification and review of 16 literature cases.

Ependymomas have rarely been described to contain pigment other than melanin, neuromelanin, lipofuscin or a combination. In this case report, we present a pigmented ependymoma in the fourth ventricle of an adult patient and review 16 additional cases of pigmented ependymoma from the literature. A 46-year-old female showed up with hearing loss, headaches, and nausea. Magnetic resonance imaging revealed a 2.5 cm contrast-enhancing cystic mass in the fourth ventricle, which was resected. Intraoperatively, the tumor appeared grey-brown, cystic, and was adherent to the brainstem. Routine histology revealed a tumor with true rosettes, perivascular pseudorosettes and ependymal canals consistent with ependymoma, but also showed chronic inflammation and abundant distended pigmented tumor cells that mimicked macrophages in frozen and permanent sections. The pigmented cells were positive for GFAP and negative for CD163 consonant with glial tumor cells. The pigment was negative for Fontana-Masson, positive for Periodic-acid Schiff and autofluorescent, which coincide with characteristics of lipofuscin. Proliferation indices were low and H3K27me3 showed partial loss. H3K27me 3 is an epigenetic modification to the DNA packaging protein Histone H3 that indicates the tri-methylation of lysine 27 on histone H3 protein. This methylation classification was compatible with a posterior fossa group B ependymoma (EPN_PFB). The patient was clinically well without recurrence at three-month post-operative follow-up appointment. Our analysis of all 17 cases, including the one presented, shows that pigmented ependymomas are most common in the middle-aged with a median age of 42 years and most have a favorable outcome. However, one patient that also developed secondary leptomeningeal melanin accumulations died. Most (58.8%) arise in the 4th ventricle, while spinal cord (17.6%) and supratentorial locations (17.6%) were less common. The age of presentation and generally good prognosis raise the question of whether most other posterior fossa pigmented ependymomas may also fall into the EPN_PFB group, but additional study is required to address that question.

Are Antidepressant Medications Associated with Increased Dental Implant Failure?

Statement of the problemThe purpose of this study was to determine whether antidepressant medications were associated with a lower dental implant success rate. Materials and methodsA retrospective cohort study was conducted to evaluate dental implants placed in 2015 at the VA North Texas Health Care System. The following inclusion criteria were defined: 1) patients with adequate postoperative follow-up appointments for 5 years; 2) cases with sufficient medical records; 3) patients who had a current diagnosis of depression at the time of implant placement and were taking an antidepressant medication. Patients were excluded as study subjects if: 1) they had inadequate medical records; 2) they were a current tobacco smoker or were undergoing treatment for systemic conditions such as bisphosphonate use, radiation, or chemotherapy. The primary predictor variable was current use of an antidepressant medication. The primary outcome variable was implant success, defined as an implant without pain upon function, no mobility, < 2mm radiographic bone loss from initial surgery, and no history of exudates.1 Secondary predictor variables were age ≥ 65 years and sex, defined as male or female. Descriptive, bivariate, and multiple logistic regression analyses were performed with P < .05 used to determine statistical significance. Results and outcomesThirty-one patients and 67 implants met the defined inclusion and exclusion criteria. The average age was 65 years. Fifty-two implants were placed in patients 65 years and older. Sixty implants were placed in males, and 7 were placed in females. Sixty-one implants met the defined success criteria (91%), with 7 implant failures (7%). Forty-six implants were placed in patients on antidepressant medication. The antidepressant treatment group had 41 implants that met success criteria (89%) and 5 implant failures (11%). Analysis of the predictor variable and primary outcome variable revealed that antidepressant therapy was associated with a nearly 60% decrease in success (OR 0.41; 95% CL 0.04-3.75), but was not statistically significant (P = .6542). Analysis of the secondary variables reveled that age ≥ 65 and female sex were not associated with statistically significant differences in dental implant success (P = 1 and P = .4927, respectively). Discussion and conclusionThe results of this retrospective analysis suggest that antidepressant use does not affect the success rate of dental implants. A systemic review by Silva et al found an increased risk for implant failure in antidepressant users compared to non-users, but cautioned their conclusions due to a lack of methodological rigor and standardization.2 They found an increased rate of dental implant failures in tobacco smokers who also took antidepressants. They hypothesized that tobacco smoke can be a surrogate for dental implant failure in patients taking antidepressants as nicotine can impair new bone formation and impair osseointegration, artificially inflating the rate of implant failure in this cohort. One of the strengths of the current study is strict rule-out criteria for current tobacco smokers, as patients who receive implants at this center have point-of-care nicotine testing prior to implant placement. The results of this present study suggest that antidepressant use does not decrease implant success rates over a 5-year period. Future prospective studies, with larger cohorts, will be performed to further elucidate the association between antidepressant use and dental implant success.