Prospective Single-center Experience Research Articles

Outcomes in term breech birth according to intended mode of delivery-A Swedish prospective single-center experience of a dedicated breech birth team.

The appropriate mode of delivery for breech babies is a topic of ongoing debate. After the publication of the Term Breech Trial in 2000, the proportion of breech babies delivered vaginally in Sweden rapidly dropped to 7% from 26%. In 2015, international guidelines changed to once again recommend offering vaginal breech deliveries in select cases. In 2017, a Swedish hospital established a dedicated Breech Team to provide safe vaginal breech deliveries according to the new guidelines. The aim of this study is to compare neonatal morbidity in the group planned for cesarean breech delivery with the group planned for vaginal breech delivery treated in accordance with the new guidelines. The study adds to the literature by providing insights into the consequences of reintroducing vaginal breech births in a high-resource health-care setting. A prospective observational study was conducted at Södersjukhuset's maternity ward with 1067 women who gave birth to a single breech fetus at term. Outcomes were compared between the planned vaginal and planned cesarean delivery groups using intention-to-treat analysis and multivariate analysis to control for confounders. Out of the 1067 women, 78.9% were planned for cesarean delivery and 21.1% were planned for vaginal delivery. The planned vaginal group had a significantly greater risk for neonatal morbidity compared to the planned cesarean group (3.1% vs. 0.7%; OR 4.44, 95% CI 1.48-13.34). The risk difference remained significant after controlling for confounders. Planned vaginal breech delivery was associated with an increased risk of neonatal mortality and short-term morbidity compared to planned cesarean breech delivery in accordance with the new guidelines. The potential risks and benefits of planned vaginal breech delivery should be carefully weighed against those of planned cesarean delivery.

Ambulatory bariatric surgery: a prospective single-center experience.

Ambulatory bariatric surgery has recently gained interest especially as a potential way to improve access for eligible patients with severe obesity. Building on our previously published research, this follow-up study delves deeper in the evolving landscape of ambulatory bariatric surgery over a 3-year period, focusing on predictors of success/failure. In a prospective single-center follow-up study, we conducted a descriptive assessment of all eligible patients as per our established protocol, who underwent a planned same-day discharge (SDD) primary sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) between 03/01/2021 and 02/29/2024. Trends in SDD surgeries over time were assessed over six discrete 6month intervals. Primary endpoint was defined as a successful discharge on the day of surgery without emergency department visit or readmission within 24h. Secondary outcomes included 30-day postoperative morbidity. A total of 811 primary SG and 325 RYGB procedures were performed during the study period. Among them, 30% (n = 244) were SDD-SGs and 6% (n = 21) were SDD-RYGBs, respectively. At baseline, median age of the entire SDD cohort was 43years old, 81% were females, and body mass index (BMI) was 44.5kg/m2. The planned SDD approach was successful in 89% after SG (n = 218/244) and in 90% after RYGB (n = 19/21). Nausea/vomiting was the main reason for a failed SDD approach after SG (46%). The 30-day readmission rate was 1.5% (n = 4) for the entire SDD cohort including only one readmission in the first 24h. The percentage of SDD-SGs performed as a proportion of total SGs increased over the initial five consecutive six-month intervals (14%, 25%, 24%, 38%, and 49%). Our SDD protocol for bariatric surgery demonstrates a favorable safety profile, marked by high success rate and low postoperative morbidity. These outcomes have led to a continued increase in ambulatory procedures performed over time especially SG.

(1003) - Evaluation of Plasma Donor-Derived Cell-Free DNA and the LASHA Scoring System as Complementary Tools in Lung Transplantation: Insights from a Prospective Single-Center Experience

(1003) - Evaluation of Plasma Donor-Derived Cell-Free DNA and the LASHA Scoring System as Complementary Tools in Lung Transplantation: Insights from a Prospective Single-Center Experience

Quality of life and swallowing outcomes following major glossectomy: A prospective single-center experience.

There exists a lacuna in the structured reporting of swallowing dysfunction and quality of life (QoL) outcome following major glossectomy. Prospective cohort study to assess the swallowing dysfunction and QoL following STG (subtotal glossectomy) or NTG (near total glossectomy) over a 6-month period using FEES and PAS scale, MDADI, and FACT-HN. Twenty-four patients were available for analysis. The pre- and post-adjuvant evaluation revealed a statistically significant improvement in the composite MDADI and FACT-HN scores. Subscale analysis of FACT-HN scores revealed maximum deficit in the head and neck cancer-specific score domain followed by functional domain and social well-being domain, with serial improvement noted in the post-adjuvant setting. This study showed serial improvement in terms of swallowing dysfunction although social and functional well-being domains related to QoL continued to reveal major deficits. Better outcomes were seen with preservation of bilateral base of tongue and mandible.

The aetiology, risk factors and outcome of Acute Kidney Injury in patients requiring Kidney Replacement Therapy: A prospective single center experience.

To find out the causes, associated leading factors and impact of kidney replacement therapy on patients hospitalised for acute kidney injury in a tertiary care setting. The prospective, cross-sectional study was conducted at the Sindh Institute of Urology and Transplantation, Karachi, from January 1 to March 31, 2022, and comprised patients of either gender aged 18 or more years presenting with acute kidney injury as per the Kidney Disease Improving Global Outcomes criteria and required kidney replacement therapy. Complete, partial or no recovery was the main outcome parameter noted at the end of 90 days. Possible aetiologies were identified and categorised as pre-renal, renal and post-renal aetiologies. Risk factors for acute kidney injury were recorded, including age, gender and co-morbidities. Data was analysed using SPSS 22. Of the 210 patients with mean age 46.1±14.24 years, 109(52%) were males and 101(48%) were females (p>0.05). Hypertension was the most common comorbidity 98(46.8%), followed by diabetes mellitus 75(35.7%) and underlying chronic kidney disease 55(26.2%). Multiple therapeutic interventions were required, including vasopressors in 101(48.1%) patients and mechanical ventilation in 31(14.8%). Renal failure due to intrinsic renal aetiology was the most common 98(46.7%), followed by post-renal aetiology 61(29%). There was no significant association between outcomes and aetiologies (p>0.05). There was increase in chronic kidney disease cases from 55(26.2%) patients at baseline to 107(50.9%) at the end of 90 days. Complete recovery was noted in 71(33.8%) patients, partial in 73(34.76%), no recovery in 34(16.1%) patients who required maintenance kidney replacement therapy, and 32(15.2%) patients died. Complete recovery after 90 days of kidney replacement therapy was observed in one-third of the patients. Intrinsic renal aetiology was the most prevalent, and hypertension was the most common comorbidity.

Partial Horizontal Supracricoid Laryngectomy: Which Factors Impact on Post-decannulation Swallowing Outcomes? A Prospective Single-Center Experience.

Early decannulation, performed within the first ten days after supracricoid partial laryngectomy, can result in a more rapid recovery of swallowing function with a semisolid bolus in the short term, about 30days. We selected 20 patients with squamous cell carcinoma of larynx, who underwent supracricoid laryngectomies: 10 cricohyoidopexy (CHP) and 10 cricohyoidoepiglottopexy (CHEP). Staging was pT2 (10 pts), and pT3 (10 pts). Fiberoptic endoscopic evaluation of swallowing was used to assess postoperative swallowing function after a mean of 12 and 22days from surgery. A modified PAS score (penetration-aspiration scale) was assigned for subtotal laryngectomies. Decannulation occurred after 6.7 ± 2.1days. Univariate analysis showed that the type of surgery (CHP or CHEP), pT, resection of one arytenoid, and decannulation time are significantly associated with the 12-day PAS score. The 22-day PAS score is significantly associated with only 3 variables: type of surgery, pT, and resection of one arytenoid. From the data presented, the factors that most delay an effective recovery of swallowing are T3 and the resection of one arytenoid. Early decannulation has been shown statistically to improve PAS score in the short term, but not in the long term.

Successful endoscopic management of a large esophageal defect due to Boerhaave syndrome with endoscopic vacuum therapy using vacuum sponge and vacuum stent

Video 1Successful endoscopic management of a large esophageal defect due to Boerhaave syndrome with endoscopic vacuum therapy using EsoSponge and VACStent.

Ultrasound-guided SoracteLite™ transperineal laser ablation (TPLA) of the prostate for the treatment of symptomatic benign prostatic hyperplasia (BPH): a prospective single-center experience

PurposeTo evaluate the efficacy and safety of ultrasound-guided transperineal laser ablation (TPLA) in patients with symptomatic BPH.Materials and methodsFrom January 2020 to January 2022, 63 prospectively enrolled patients underwent TPLA with a 1064-nm continuous-wave diode laser (EchoLaser, Elesta SpA). Primary endpoints were the change in IPSS, QoL, Qmax, PVR and prostate volume at 3 and 12 months.ResultsAt 3 months, IPSS improved from 20.8 ± 7.4 to 11.0 ± 6.6 (p < 0.001), QoL from 4.7 ± 1.4 to 1.5 ± 1.2 (p < 0.001) and Qmax from 8.6 ± 3.5 mL/s to 13.2 ± 5.7 mL/s (p = 0.083). PVR decreased from 124.8 ± 115.4 mL to 43.6 ± 53.6 mL (p < 0.001), and prostate volume decreased from 63.6 ± 29.7 mL to 45.6 ± 21.8 mL (p = 0.003). At 12 months, IPSS improved from 20.8 ± 7.4 to 8.4 ± 5.9 (p < 0.001), QoL from 4.7 ± 1.4 to 1.2 ± 0.8 (p < 0.001), and Qmax from 8.6 ± 3.5 mL/s to 16.2 ± 4.3 mL/s (p = 0.014). PVR decreased from 124.8 ± 115.4 mL to 40.6 ± 53.6 mL (p = 0.003), and prostate volume decreased from 63.6 ± 29.7 mL to 42.8 ± 14.2 mL (p = 0.071). Transient complications consisted of two patients with prostatic abscess (Clavien-Dindo grade IIIa) and one patient with orchitis (Clavien-Dindo grade II).ConclusionsTPLA for symptomatic BPH provides clinical benefits at 3 and 12 months, and the treatment is well tolerated.

Clinico-pathological correlation of incidental focal colorectal uptake on 18F-Labelled 2-fluoro-2-Deoxyglucose PET/CT: A prospective single centre experience

ObjectivesTo assess the clinical and pathological implications of incidental focal uptakes during the 18F-FDG-PET/CT colorectal examination and the role of colonoscopy in the diagnostic algorithm of these uptakes. MethodsWe performed a single-center prospective that recruited patients with incidental uptakes during18F-FDG-PET/CT colorectal examination over five years. Patients underwent colonoscopy and biopsies to assess the usefulness of 18F-FDG-PET/CT in patients with incidental uptakes. ResultsA total of 2231 scans were performed, and 71 (3.18%) localized colorectal uptakes were identified. The colon was normal in 45.07% of these uptakes, while the remaining cases had malignant colorectal tumors (29.57%) and neoplastic lesions (25.35%). The false-positive rate was significantly higher in the proximal colon than in the distal colorectal (53.7% vs. 39.8%, P = 0.004). The bivariate analysis showed that increased SUVmax independently increases the risk of neoplastic lesions, while proximal colon uptakes independently decrease the risk of neoplastic lesions. ConclusionsOur results highlight a valuable role of incidental focal uptakes during 18F-FDG-PET/CT colorectal examination in identifying patients with increased risk of neoplastic lesions. The study supports the need for a colonoscopy in such settings, particularly with increased SUVmax.

Evaluation of LUTS of the filling phase after Aquablation: A prospective single center experience

IntroductionThis study aims to assess our first clinical experience with Aquablation in terms of perioperative and 1-year micturition outcomes, with a focus on postoperative lower urinary tract symptoms (LUTS).Materials and methodsFrom 10/2018 to 07/2021, patients referred to our center with BPH-related LUTS, International Prostate Symptom Score (IPSS) ≥10, maximum urinary flow rate (Qmax) ≤12 ml/s, and prostate volume &amp;lt;80 ml were enrolled in this prospective study to undergo Aquablation. Demographics, perioperative data, and complications (according to the Clavien–Dindo system) were collected. Functional outcomes were assessed at 1, 3, 6, and 12 months with IPSS, IPSS quality of life (IPSS QoL), uroflowmetry, and evaluation of post void residue (PVR). The types of LUTS were classified on the basis of IPSS single question answers in filling phase LUTS and voiding phase LUTS.ResultsSixty patients were enrolled in the study. The mean patient age was 64.9 ± 7.3 years, prostate volume was 63.5 ± 16.8) ml, Qmax was 8.4 ± 2.6 ml/s, the median (IQR) IPSS was 23 (19–26), and the IPSS QoL score was 5 (4–5). The mean Qmax at 1, 3, 6, and 12 months was 21.1 ± 11, 18.1 ± 5.4, 17.1 ± 6, and 17.8 ± 6.6 ml/s, respectively. The median IPSS urinary symptom score was 2 (2–5) one year after surgery. In parallel, the median IPSS QoL score and mean PVR reached 1 (0–1) and 23.6 ml (25.5) in the 12th month. At 1- and 3-month follow-up, filling phase symptoms were predominant in almost two-thirds of the study population. Within the patients who reported a prevalence of filling phase symptoms at 3 months, 27 of 38 (71%) reported a de novo onset of these symptoms after surgery.ConclusionAquablation is a safe procedure for treating BPH-related LUTS, and it has been demonstrated to be effective up to 12 months after the procedure. LUTS of the filling phase were more prevalent than voiding phase ones in the first 3 months following surgery, but showed a self-limited fashion.

A Prospective Study and Single-Center Experience: Effectivity of Fusion Prostate Biopsy in Biopsy-Naïve Patients.

ObjectiveFusion prostate biopsy (FPB) has become a popular technique in biopsy-naïve patients, though not accepted as a standard approach (yet). In this study, we aimed to present the clinical outcomes of biopsy-naïve patients who underwent FPB.Material and methodsThe study included 400 biopsy-naïve patients aged 45-75 years who had a prostate-specific antigen (PSA) level of 2-10 ng/ml and were detected with a Prostate Imaging-Reporting and Data System (PIRADS) ≥3 lesion on multiparametric prostate magnetic resonance imaging (mpMRI)-guided FPB. A combined biopsy (CB) was performed in each patient, in which 2-4 cores were obtained for suspicious lesions by targeted biopsy (TB) and then 12-core standard prostate biopsy (SPB) was conducted in the same session. Cancer detection rates, clinically significant prostate cancer (csPCa) detection rates, histological upgrading rates, and false negative rates were determined.ResultsThe 400 patients had a mean age of 62.01±7.00 years and a mean PSA value of 6.84±1.87 ng/ml. Overall PCa detection rate was 50% (200/400). The csPCa detection rates for TB, SPB, and CB were 25.0%, 31.8%, and 44.0%, respectively (p<0.001). In PIRADS 3, 4, and 5 lesions, CB had a csPCa detection rate of 29.2%, 54%, and 64.8%, respectively (p<0.001). The ratio of false negativity was significantly higher for TB compared to SPB (43.2% vs. 27.8%, p=0.003), whereas no significant difference was found between these two techniques with regard to upgrading rates although TB had a higher rate (19.6% vs. 13.7%, p=0.144).ConclusionFPB, a combined approach involving TB and SPB, was revealed as the most successful technique in biopsy-naïve patients with PSA<10 ng/ml due to its high cancer detection rates and low false negative rates.

P0929 - High-resolution micro-ultrasound for local staging of prostate cancer: A prospective single-center experience

P0929 - High-resolution micro-ultrasound for local staging of prostate cancer: A prospective single-center experience

Transcatheter pulmonary denervation in patients with left heart failure with reduced ejection fraction and combined precapillary and postcapillary pulmonary hypertension: A prospective single center experience.

The present study was a prospective, single-center, single-arm study to investigate the efficacy of transcatheter pulmonary artery denervation (TPADN) in patients with combined postcapillary and precapillary PH (Cpc-PH) associated with left heart failure with reduced ejection fraction (HF-rEF). Pulmonary hypertension (PH) in patients with left ventricular systolic dysfunction has a negative impact on outcome. The combination of pulmonary artery systolic pressure (PAPs) ≥60 mmHg, transpulmonary pressure gradient (TPG) ≥12 mmHg, nonreversible mean PAP, and pulmonary vascular resistance (PVR) ≥3.5 Wood Units was considered as too high risk for heart transplantation (HTx). The clinical efficacy endpoint was an improvement in 6-min walking test and the hemodynamic endpoints were changes in PAPs, PVR, and TPG between baseline and 6months. Circumferential radiofrequency applications were delivered around distal main, left and right pulmonary arteries. At each ablation point temperature was 45°C and energy 10W. TPADN was performed in 10 patients. At 6-month in 5 patients we observed reduction in PAP, PVR, TPG, and DPG and then 1 had successful HTx, 2 are on HTx waiting list, 2 received LVADs, 2 patients did not improve, and 3 patients died. TPADN may be beneficial in selected patients with HF-rEF and Cpc-PH.

Gastric peroral endoscopic myotomy for the treatment of refractory gastroparesis: a prospective single-center experience with mid-term follow-up (with video)

Gastroparesis (GP) is a multifactorial disease associated with a large burden on the health care systems. Pyloric-directed therapies including gastric peroral endoscopic myotomy (G-POEM) can be effective in improving patient quality of life and symptom severity. We report on the safety and efficacy of G-POEM and its impact on the quality of life of patients managed at a large referral center. Consecutive patients with confirmed GP referred for G-POEM due to failure of medical therapy were included. All patients were assessed at baseline and then at 1, 3, 6, and 12 and 24 months after G-POEM using validated symptom and quality of life instruments, including the Gastroparesis Cardinal Symptom Index (GCSI), Patient Assessment of Gastrointestinal Disorders Symptom Severity Index (PAGI-SYM), and 36-Item Short Form Survey (SF-36). Patients were evaluated before and 6 months after the procedure with EGD, 4-hour scintigraphy, and pyloric EndoFLIP. Technical success was defined as the ability to perform full-thickness pyloromyotomy. Clinical response was defined as an improvement of≥1 point on GCSI. Fifty-two patients (median age, 48 years; range, 25-80 years, 88% female) underwent G-POEM between February 2018 and September 2020 for the following phenotypes: vomiting-predominant (n=30), dyspepsia-predominant (n=16), and regurgitation-predominant (n=6) GP. The technical success rate was 100%. Adverse events were noted in 3 of 52 patients (5.77%), and were all managed successfully endoscopically. Clinical response was achieved in 68%, 58%, and 48% of patients at 1-month, 6-month, and 12-month follow-up (P< .001, P< .001, and P< .01, respectively). When classified by the cause of GP, the clinical response rates were diabetic GP 64% (11 of 17), postsurgical GP 67% (6 of 9), and idiopathic GP 72% (13 of 18). A statistically significant improvement in PAGI-SYM scores was observed at 1, 3, 6, 12, and 24 months, in addition to significant improvement in several domains of SF-36. Mean 4-hour gastric emptying was reduced 6 months after G-POEM (10.2%) compared with baseline (36.5%, P< .001). We report a significant reduction in the number of emergency department visits and days spent in the hospital up to 24 months after G-POEM. G-POEM appears to be a safe and feasible treatment alternative for refractory GP with significant short-term and mid-term improvements in overall symptoms, quality of life scores, and health care utilization.

Impact of 68Ga-PSMA-11 PET/CT on Initial Staging of High-Risk Prostate Cancer Patients: Post-Hoc Analysis of a Prospective Single Center Experience

Conventional imaging for initial staging of prostate cancer (PCa) lacks sensitivity and underestimates disease burden. Prostate-specific membrane antigen PET/CT (PSMA PET) is an emerging imaging modality shown to have improved sensitivity over conventional imaging in the setting of biochemical recurrence. We sought to evaluate the impact of 68Ga-PSMA PET on initial staging of patients with high risk PCa, as well as clinicopathologic features that might predict for upstaging, by analyzing patients who prospectively underwent PSMA PET on a clinical trial. This was a post hoc analysis of 249 eligible patients with NCCN high/very high risk PCa who underwent a staging PSMA PET (12/2016 to 1/2020) on a prospective trial. Patients with known non-regional lymph node or distant metastasis on prior imaging, or initiation of androgen deprivation therapy more than 3 months before PSMA PET were excluded. Chi square analysis was used to evaluate the association of clinicopathologic features (Gleason grade group [GG], initial PSA [iPSA], T stage, percent positive cores [PPC]≥50%) with upstaging. Overall, 22.9% patients were upstaged by PSMA PET; 18.9% of patients with iN0 disease by CT or MRI were found to have N1 disease by PSMA PET, and 10.6% of patients who had M0 disease by CT or bone scan had M1 disease by PSMA PET. New M1a disease was found in 7.4% and M1b/M1c disease was found in 5.3% of patients. PSMA PET detected ECE, SVI or invasion of surrounding structures in 8.1% patients deemed T2 on prior MRI imaging. PPC≥50% was significantly associated with regional and any nodal upstage (23.9% vs. 12.1%, p = 0.0227 and 22.6% vs. 3.7%, p = 0.0261, respectively), and any upstage in general (29.3% vs. 14.6%, p = 0.0102). Patients with GG 5 or ≥50% PPC were more likely to have regional nodal upstage (23.4% vs. 6.3%, p = 0.0031) and any upstage in general (28.2% vs. 9.4%, p = 0.0024), while GG 5 together with ≥50% PPC was predictive of M stage upstage (23.3% vs. 4.7%, p = 0.0063). cT and iPSA were not associated with upstaging. PSMA PET/CT has a significant impact on initial staging of high risk PCa patients. This impact appears to be most marked in patients with GG 5 or PPC≥50%.

S0169 A Novel Dynamic Rigidizing Overtube Significantly Eases Difficult Colonoscopy

INTRODUCTION: Looping colons challenge endoscopists, prolong anesthesia, and limit examination and therapy. Failure due to a looping colon results in suboptimal patient care and causes mental and physical fatigue on the endoscopist. A novel rigidizing overtube is now available to reduce looping and facilitate colonoscopy completion. In its flexible state, the overtube material is soft and pliable; in its rigid state it becomes fifteen times stiffer, aiding in stability and minimizing loop formation. In this study, we examine if a rigidizing overtube can salvage colonoscopies previously terminated due to challenging looping of the colon and reduce the overall perceived workload. METHODS: This is a prospective single center experience over a 6 month period using a novel dynamic rigidizing overtube for assistance during difficult colonoscopy. Difficult colonoscopy subjects were categorized as based on: looping that prevented reaching the cecum despite position change and abdominal counter pressure (LOOP group) or poor stabilization to perform therapeutic polypectomy (UNSTABLE group). Parameters assessed included successful/failed salvage of the procedure, and the in-procedure NASA Task Load Index (TLX) before and after use of the rigidizing overtube. The TLX raw and weighted scores were compared for each type of demand (mental, physical, effort, temporal, performance and frustration). RESULTS: Over the study period, there were 14 difficult colonoscopy procedures 8 in the LOOP group and 6 in the UNSTABLE group. In the LOOP group, all 8 cases were salvaged, and cecum was reached after device was used. The TLX weighted score decreased from 81.1 to 26.0 after use (P < 0.01). In the UNSTABLE group, complete polypectomy was successful in all cases. The TLX weighted score decreased from 79.7 to 40.4 after use (P < 0.01). In all procedures, the TLX raw scores for each type of demand was reduced (Figure 1; all P < 0.05). CONCLUSION: In this early series, a novel dynamic rigidizing overtube was able to successfully assist in salvaging difficult colonoscopy due to looping and assist in complex polypectomy by improving stabilization. In addition, the endoscopist’s in-procedure perceived workload significantly decreased after use of the device. This novel rigidizing overtube has potential to help salvage difficult endoscopic cases as well as decrease the workload of the endoscopist during difficult procedures.Figure 1.: Image of the rigidizing overtube. The overtube is placed at the hub of the colonoscope, allowing free tip movement. When the vaccum is applied, the normally flexible overtube becomes fifteen times as rigid, allowing 1 to 1 movement when force is applied to the shaft of the colonoscope.Figure 2.: Means of raw NASA-TLX demand scores before and after use of the rigidizing overtube in difficult colonoscopies. All score changes were statistically significant.

Volume replacement with diced acellular dermal matrix in oncoplastic breast-conserving surgery: a prospective single-center experience

BackgroundSeveral studies have reported the use of acellular dermal matrix in breast reconstruction. However, the primary role of acellular dermal matrix in these studies was to support the implant; there are no reports on the use of acellular dermal matrix exclusively as volume replacement. Thus, we aimed to evaluate the safety and effectiveness of filling of the defect with acellular dermal matrix in oncoplastic breast-conserving surgery.MethodsWe prospectively recruited 120 adult breast cancer patients who were scheduled to undergo oncoplastic breast-conserving surgery with acellular dermal matrix filling from 2017 to 2018. Intraoperatively, diced human acellular dermal matrix measuring 3–5 mm was used on each side to fill in the excisional defect immediately. After 6 months, satisfaction of the patients and surgeons with overall and cosmetic outcomes was evaluated with a survey using a 10-point scale. Postoperative complications were assessed at 2 weeks and 6 months postoperatively.ResultsOf the 117 patients who were evaluated for their satisfaction, 94.0% were strongly satisfied with the cosmetic outcomes and 90.4% were strongly satisfied overall. Patient overall satisfaction scores were higher than surgeon satisfaction scores (p < 0.001). Of the 117 patients who underwent evaluation of complications 6 months postoperatively, six (5.1%) had hematoma and seven (6.0%) had seroma. The overall reoperation rate due to complications was 8.5%. Only two patients needed acellular dermal matrix removal due to hematoma and inflammation.ConclusionOncoplastic breast-conserving surgery with acellular dermal matrix filling of defects can be performed safely with high cosmetic satisfaction.Trial registrationICTRP, KCT0003886; retrospectively registered May 3, 2019, http://apps.who.int/trialsearch/Trial2.aspx?TrialID=KCT0003886

A study on confocal endomicroscopy in comparison with histopathology for polypoidal lesions of the gastrointestinal tract: A prospective single-centre experience.

Confocal laser endomicroscopy (CLE) has a potential to make optical diagnosis of neoplastic polypoidal lesions and may replace traditional histology in the proposed "diagnose and discard approach". Thepresent study was planned to assess the accuracy of probe-based CLE in predicting histology of polypoidal lesions of gastrointestinal (GI) tract in vivo before their removal. In this prospective single-centre study, patients with upper and/or lower GI polypoidal lesions were enrolled. After detection of polypoidal lesions with white light endoscopy, probe-based CLE examination was performed. Real-time and offline presumptive CLE diagnosis of polypoidal lesions was made as per Miami classification and was compared with histopathology as the gold standard. A total of 50 GI polyps from 50 patients (28 males) were assessed. The mean (±SD) size of polyps was 13.7 (± 8.5) mm. Most polyps were located at the cecum (24.0%) or stomach (24.0%). On histological examination, hyperplastic andadenomatous polyps, adenocarcinoma, and lipoma were seen in 54%, 26%, 18% and 2% patients, respectively. On comparison of real-time CLE examination with histopathology, 40 (83.3%) and 8 patients (16.7%) had concordant anddiscordant results, respectively. Two polyps were inconclusively diagnosed on CLE. On offline examination, concordance with histopathology was observed in 85.4% (n = 41) of polyps, which was marginally better than online examination, though the difference was not statistically significant (p = 0.45). On comparing the real-time and offline findings of CLE, concordance was found in 91.7% of the cases. Accuracy, sensitivity, specificity, positive and negative predictive values on real-time evaluation were 83.3%, 87.5%, 79.1%, 80.7%, and 86.3%, respectively. CLE is a useful tool for prediction of histology to assess the polypoidal lesions of the GI tract, and it may avoid polypectomy at least in some patients.

Endovascular Thrombectomy in the Elderly: Do Radiological and Clinical Outcomes Differ from Those in Younger Patients? A Prospective Single-Center Experience

Objectives: Endovascular treatment (EVT) has emerged as the gold standard therapy for stroke due to large vessel occlusion (LVO). There is however limited evidence to suggest that similar efficacy can be expected in elderly patients. We aimed to assess the efficacy and safety of EVT in elderly patients (aged > 80), comparing outcomes to younger patients (aged < 80). Material and Methods: A total of 195 patients with LVO stroke treated with EVT were included and dichotomized by age. We compared neurological improvement, clinical 90 day outcome, technical recanalization rates, procedure-related complications, and mortality in between the groups. Results: Both groups showed equally marked neurological improvement. A favorable outcome modified Rankin Scale (mRS < 2) was seen in 28% of the elderly patients compared to 46% of the younger patients (p = 0.01). mRS 0–3 was seen in 46% of the elderly patients and 58% of the younger patients (p = 0.09). The rates of successful technical recanalization did not differ between the groups and there were no differences in procedural complication rates or incidence of symptomatic intracranial bleeding. Three-month mortality rates were however higher in the elderly group. Conclusions: EVT in the elderly resulted in equally notable neurological improvement as compared to younger patients. Although the elderly had a higher mortality rate and fewer favorable clinical outcomes at 3 month follow-up, a strict upper age limit for EVT seems unjustified.

The efficacy of collagen based dressings for treatment of scald burns in under 5 years paediatric population: a non-comparative, prospective single centre experience

Background: One of the major challenges faced worldwide is management of burn wounds, particularly among the pediatric population. Immense research is going on to overcome the challenges associated with survival of these patients and healing of burnt areas. Newer dressing materials are being developed and one of them is collagen. The collagen is biocompatible. The aim was to achieve earlier and better healing of wounds, and to obviate the need for frequent change of dressings; which besides being painful, is quite troublesome in pediatric population.Methods: A prospective study was conducted in 38 patients of scald burns under-5 years of age, from October 2016 till July 2017. After thorough cleaning of burn wounds and thorough rinsing of collagen sheets with normal saline, the wounds were covered with sheets of collagen. Paraffin with chlorhexidine impregnated gauze dressing was applied over the sheet of collagen followed by dry gauze, cotton and bandage application. First dressing was opened after 5 days and then after 3 to 4 days.Results: The wounds healed in 10 to 14 days in most of them. Infection developed in one case, warranting removal of collagen sheet. None developed any adverse reaction to the application of collagen dressing.Conclusions: We conclude that collagen based dressing is a very good modality of treatment for the burn wounds with advantages of being cost effective, requiring lesser number of dressings and blood transfusions, and shorter duration of hospital stay.