Referral Institution Research Articles

P-141. Socio-Ecological Associations with Detectable Viremia among Pregnant Patients Living With HIV In South Brazil

Abstract Background Pregnant patients living with HIV are a priority group for the recruitment to the HIV healthcare cascade as uncontrolled HIV infection can confer an increased risk for adverse maternal and neonatal health outcomes and the risk for vertical transmission. Understanding the structural, interpersonal, and individual factors that are associated with detectable HIV viremia is of importance to guide outreach and intervention priorities.Figure 1.HIV prevalence and detectable viremia among pregnant patients delivering at a tertiary healthcare center in south Brazil. Figure 1a. HIV seropositivity among pregnant patients hospitalized for delivery and figure 1b. Rate of detectable viremia by year between 2017 - 2023 Methods This was a retrospective cohort study of pregnant patients living with HIV who delivered from January 1, 2017, to December 31, 2023, at a tertiary-level hospital and referral institution for HIV care in Porto Alegre, Brazil. Detectable viremia was defined as 200 copies/ml at the time of delivery. The Socio-Ecological framework was used to guide hypothesis testing regarding associations with detectable viremia.Table 1.Demographics and clinical history of pregnant women living with HIV who delivered at Conceição from 2008 – 2018 (n= 549).a. Fisher’s exact tests were conducted if any one cell ≤ 5, otherwise Chi-square tests were used.b. Bipolar personality disorder, cognitive impairment, and other mental health conditions collapsed for analysis.c. The sixteen infant mortalities prior to follow-up completion period were dropped from analysis.*** N too small for statistical analysis. Results In total, 549 patients were included, of whom 110 (20%) were found to have detectable viremia. Significant differences between detectable and undetectable viremia included ages 21 to 29 years (49.1% vs. 39.9%, 0.009), completing less than high school (88.1% vs. 77.6%, p = 0.015), congenital acquisition of HIV infection (14.6 vs. 5.0%, p = 0.003), seroconversion during pregnancy (23.9% vs 14.8%, p = 0.024), lack of prenatal care (20.2% vs. 1.1%, p = 0.001), homelessness (15.8% vs 1.9%, p = 0.001), serodiscordant partner (34.6% vs 47.7%, p= 0.006), infant loss to follow up (20.8% vs 9.1%, p = 0.001), substance use disorder (24.0% vs 6.1%, p = 0.001), crack use (19.5% vs. 7.1%, p = 0.001), and cocaine use (15.7% vs 7.1%, p= 0.001). Multivariable associations included prenatal care (adjusted Risk Ratio [aRR] = 0.20, 95% Confidence Interval [95% CI] = 0.15 – 0.26), homelessness (aRR = 4.02, 95% CI = 2.74 – 0.26), infant loss to follow up (aRR = 2.23, 95% CI = 1.51 – 3.29), substance use disorder (aRR =3.30, 95% CI = 2.23 – 4.87), lifetime use of crack (aRR = 2.82, 95% CI = 1.85 – 4.29), and cocaine (aRR = 1.89, 95% CI = 1.17 – 3.06).Table 2.Left: Bivariate associations between socio-ecological factors and detectable HIV viremia. Right: Adjusted risk ratio associations between socio-ecological factors and detectable HIV viremia. All models were adjusted by age, educational level, timing of HIV diagnosis, and maternal HIV infection acquisition route. Model 1: Association of access to prenatal care on detectable viremia Model 2: Association of employment on detectable viremia Model 3: Association of housing status on detectable viremia Model 4: Association of partner serostatus on detectable viremia Model 5: Association of infant LTFU with detectable viremia. Model 6: Association mental health on detectable viremia Model 7: Association of crack on detectable viremia Model 8: Association of cocaine on detectable viremia Conclusion Intervention research should focus on housing and mental health services, with an emphasis on substance use treatment. Further, efforts to increase infant loss to follow-up should be integrated with maternal care as these are the patients with greatest risk. Disclosures All Authors: No reported disclosures

Gestational trophoblastic neoplasm: Patient outcomes and clinical pearls from a multidisciplinary referral center.

To describe clinical outcomes and pearls for patients with gestational trophoblastic neoplasm (GTN). Patients with GTN treated at a referral center from 1/2006 to 12/2022 were included. Clinical characteristics, World Health Organization risk score (low-risk 0-6, high-risk ≥7), and treatments/outcomes were evaluated using summary statistics, stratified by initial treatment at a referral center versus locally. Histologies included complete hydatidiform mole (CHM), partial hydatidiform mole (PHM), choriocarcinoma (CCA), placental site trophoblastic tumor (PSTT), and epithelioid trophoblastic tumor (ETT). Of 189 patients with GTN, 125 were treated initially at a referral center and 64 locally. Median age at diagnosis was 34years (range, 17-70). Most patients were White (n=132, 70%); 80 patients had CHM, 26 PHM, 52 CCA, 11 PSTT, 19 ETT, and 1 ETT/CCA. For low-risk GTN, first-line treatment was primarily methotrexate, although some were cured with repeat dilation and curettage. For high-risk disease, first-line therapy consisted of multiagent chemotherapy regimens at a referral center (n=18/18) compared to 7 of 15 patients with high-risk GTN treated with methotrexate at local institutions. Patients with low-risk and high-risk disease who received initial care at a tertiary referral institution had cure rates of 100% (n=87/87) and 89% (n=16/18), respectively, while patients with initial care locally had cure rates of 87% (n=33/37) and 47% (n=7/15), respectively. GTN is a rare gynecologic malignancy with high cure rates, particularly in low-risk disease. Treatment consolidation at a tertiary referral institution is critical for improved outcomes, particularly in those with high-risk disease or PSTT/ETT.

Oncological Safety of MRI-Informed Biopsy Decision-Making in Men With Suspected Prostate Cancer

The magnetic resonance imaging (MRI) pathway for diagnosing clinically significant prostate cancer (csPCa; defined as International Society of Urological Pathology grade group ≥2) uses multiparametric MRI (mpMRI) for prostate biopsy (PB) decision-making. However, the intermediate impact on patient outcomes in men with negative MRI results avoiding PB and men with positive MRI results without PCa remains unknown. To assess the feasibility and safety of a community-based MRI diagnostic strategy in men with suspected PCa using 3-year active monitoring. This multisite, longitudinal cohort trial took place across 54 community-based urology practices and 2 radiology imaging centers at a referral academic institution in Berlin, Germany. Eligible participants aged 18 to 75 years with clinically suspected PCa were enrolled between September 2016 and December 2017 and monitored for 3 years. Final analysis was reported on December 23, 2023. Participants underwent 3-T mpMRI. Men with findings suspected to be PCa were recommended for targeted PB (diagnostic phase). Men with negative mpMRI results or positive mpMRI results with benign findings at PB were systematically monitored for 3 years (monitoring phase). Clinical visits were recommended every 6 months. The total proportion of men avoiding PB and those with csPCa. A total of 593 men (median [IQR] age, 64 [58-70] years) underwent mpMRI, with 286 (48%) having negative MRI results, 261 (44%) avoiding PB initially, and 242 (41%) avoiding PB over 3 years. csPCa was detected in 161 (27%) men after immediate PB, increasing to 172 (29%) men after 3 years. Seven men with negative MRI results were diagnosed with PCa by immediate PB (including 4 cases of csPCa), while 279 entered monitoring. Three-year monitoring was completed by 233 (84%) men, with 7 diagnoses of csPCa. Of 307 men with positive MRI results, 58 (19%) showed no PCa after immediate PB, of which 41 (71%) completed monitoring and 4 (7%) were diagnosed with csPCa. In this cohort study, men with negative mpMRI results avoiding biopsy were not at elevated risk of csPCa. The study confirms the oncological safety of the prebiopsy MRI strategy of avoiding an immediate PB after negative MRI results when a programmatic safety net is in place.

Predictive Factors of Athyroglobulinemia After Total Thyroidectomy for Papillary Thyroid Cancer.

Background: Thyroglobulin (Tg) is the specific tumor marker for epithelial thyroid cancer. It holds significant value in the postoperative period, and somehow, the goal of surgery in papillary thyroid cancer (PTC) undergoing total thyroidectomy is to achieve undetectable levels of postoperative thyroglobulin (uTg). Methods: This is a retrospective single-center study in which first basal Tg values were evaluated post-surgery in PTC patients undergoing total thyroidectomy. Patients with elevated antithyroglobulin antibodies were excluded. The impact of various demographic, clinical, therapeutic, tumor-stage related, and histopathological variables on the achievement of undetectable thyroglobulin levels (uTg, <1 ng/mL) was studied. A descriptive and logistic regression-based bivariate and multivariate analysis was planned using STATA vs. 16.1. program. The significance level was stated at 0.05. Results: Basal athyroglobulinemia was obtained in 89.6% of 202 patients operated on between January 2015 and June 2023 in a single referral institution. Due to the limited number of cases with detectable Tg, multivariate analysis could not be performed. The main factors that favored its achievement on bivariate analysis were a smaller tumor size (p = 0.003), no need for extended resections due to local invasion beyond the thyroid gland (p = 0.003) or neck dissection (p = 0.039), absence of distant metastases (p = 0.000), and a lower MACIS score (p < 0.000). Conclusions: The achievement of uTg was closely related to factors related to tumor stage (tumor diameter, lymph node spread, and metastatic disease), and it was not influenced by differences in epidemiological data, clinic manifestations, preoperative diagnosis, multifocality, or the presence of aggressive cytological variants.

Referral Institute in Juvenile Justice

Physiological transformation in juveniles from adolescence to adulthood[1],, namely, emotional, cognitive and physiological metamorphosis[2] leads to deviation, and quite often, criminality. Albeit, factors provoking an adolescent to become a delinquent are rarely of a general nature – is not the family as a primary source of socialization[3] playing a vital role in refining the adolescent as a decent society member? It is a question whether primary educational level[4] either friend bunch[5] give an example to juvenile and create inner self[6] which provides adolescent’s compass direction in this or that way? [1] United Nations Guidelines for the Prevention of Juvenile Delinquency (The Riyadh Guidelines), General Assembly Resolution №45112, Adopted 14 December 1990, Article I.5 (e) &lt;https://www.ohchr.org/en/instruments-mechanisms/instruments/united-nations-guidelines-prevention-juvenile-delinquency-riyadh&gt; [26.05.2022]. [2] Richards K., What Makes Juvenile Offenders different from Adult Offernders? Trends &amp; Issues in Crime and Criminal Justice no. 409., Canberra: Australian Institute of Criminology, 2011 &lt; https://www.aic.gov.au/publications/tandi/tandi409&gt; [26.05.2022]. [3] United Nations Guidelines for the Prevention of Juvenile Delinquency (The Riyadh Guidelines), General Assembly Resolution №45112, Adopted 14 December 1990, Article IV.A (12) &lt;https://www.ohchr.org/en/instruments-mechanisms/instruments/united-nations-guidelines-prevention-juvenile-delinquency-riyadh&gt; [26.05.2022]. [4] Ibid, B. [5] Juvenile Crime, Juvenile Justice, National Research Council, Institute of Medicine, National Academies Press, Washingtom DC., 2001, 80-83 &lt; https://nap.nationalacademies.org/read/9747/chapter/5#67&gt; [26.06.2022]. [6] Shalikashvili M., Criminology, 3rd Ed., Meridiani, Tb., 2017, 34-35.

Hospital based gall bladder cancer registry from high volume referral institutions in india

Hospital based gall bladder cancer registry from high volume referral institutions in india

Dogs and cats with prepubic hernia often have concurrent injuries and a good short-term outcome.

To describe clinical presentation, concurrent injuries, common imaging findings, and short-term outcome of dogs and cats diagnosed with prepubic hernia (PPH). 71 dogs and 16 cats. Medical records were searched at 2 academic referral institutions from August 1, 2008, to August 31, 2023, for dogs and cats diagnosed with PPH. Information regarding patient signalment, imaging, treatment(s) performed, and outcome was recorded. All imaging was reviewed by a board-certified radiologist. The majority of animals (77.5% of dogs, 87.5% of cats) presented within 24 hours of injury, most commonly secondary to vehicular trauma. Common concurrent injuries included pubic fractures (76.1% of dogs, 62.5% of cats), sacroiliac luxation (56.3% of dogs, 68.8% of cats), neurologic deficits (50.7% of dogs, 25% of cats), organ herniation (49.3% of dogs, 37.5% of cats), and urinary tract trauma (12.7% of dogs, 12.5% of cats). Most animals were diagnosed with radiographs (60.5% of dogs, 62.5% of cats), with the lateral projection proving most useful. Surgical treatment was pursued in 35 dogs and 7 cats, with muscular apposition being most common in dogs (54.3%) and use of pubic bone tunnels most common in cats (57.1%). Complications were uncommon, and PPH repair failure was reported in only 1 dog. Short-term outcome was good in both dogs and cats. Prepubic hernia should be suspected in patients that have sustained high-impact trauma and typically can be identified on lateral radiographs. For cases without organ herniation, conservative management may be a reasonable option.

Computed Tomography and Magnetic Resonance Imaging Features of Gracilis Myopathy in Dogs.

Gracilis myopathy is a well-recognized syndrome of weight-bearing gait abnormality; however, detailed description of computed tomography (CT) and magnetic resonance imaging (MRI) features of gracilis myopathy is lacking in the literature. This study aims to describe in detail CT and MRI features of gracilis myopathy. This is a retrospective study. Medical records of dogs with characteristic gait and available pelvic limb MRI or CT, presenting to four referral institutions, were reviewed. Seven cases with MRI (3/7) or CT (4/7) were included, all German Shepherd dogs. MRI findings in all cases included a well-defined, T1-/T2-/proton density-weighted hypointense band along the axial margin of the gracilis muscle, shorter affected muscles, thickening and T2W/STIR hyperintensity with contrast enhancement at the symphyseal tendon, and concurrent focal indentation of the axial border of the gracilis muscle. CT findings included a hyperattenuating band (4/4), single instances of contrast enhancement at the origin of the muscle, thickening of the tendon at the origin and insertion, and concurrent thickening at the musculotendinous muscle. CT and MRI can present advantages in correctly identifying the specific muscles affected within the gracilis-semitendinosus muscle complex. Both modalities can localize anatomically lesions in detail, for instance at the origin or insertion of the muscle, which could present advantages in novel treatment strategies for this condition.

Endoscopic Fat Graft Myringoplasty Augmented With Hyaluronic Acid for Managing Large-Sized Eardrum Perforations; A Prospective Comparative Randomised Study.

We aimed to assess the outcomes of fat graft myringoplasty augmented with hyaluronic acid in closing large-sized eardrum perforations compared to the traditional underlay cartilage-perichondrium composite myringoplasty (CPCM). It was a prospective randomised comparative study. It was held in tertiary referral institutions between May 2020 and April 2022. We included 100 patients with a large-sized eardrum perforation (50%-75% of the eardrum surface area). Using the endoscopic transcanal approach, 50 patients were managed by fat graft myringoplasty augmented with hyaluronic acid, while CPCM managed the other 50 patients. We evaluated the closure rates 1, 6 months and 1 year after surgery. Also, we assessed the audiological performance of the patients with a successful closure before and 1 year after the operation. Fat graft myringoplasty operation was statistically shorter than the CPCM. The closure rate 1 year after surgery was 92% in the first group and 86% in the second group, without a statistically significant difference between both groups. Successful air-bone gap closure to less than 10 dB occurred in 93.5% of group A and 81.4% of group B without a statistically significant difference. The mean postoperative air-bone gap was 5.3 ± 3.95 dB in the first group and 7.95 ± 5.17 dB in the second group, with a statistically significant difference. Fat graft myringoplasty augmented with hyaluronic acid was a reliable, safe, simple, and effective manoeuvre to close large-sized eardrum perforations compared to the conventional CPCM.

Gestational trophoblastic disease/neoplasm: A tertiary referral institution experience with treatment and outcomes

Gestational trophoblastic disease/neoplasm: A tertiary referral institution experience with treatment and outcomes

Type 3 Macular Neovascularization in Age-related Macular Degeneration: Baseline Predictors of 3-Year Macular Atrophy Development

PurposeTo identify baseline optical coherence tomography (OCT) predictors of the 3-year macular atrophy (MA) development for type 3 macular neovascularization (MNV) secondary to neovascular age-related macular degeneration (nAMD) treated by anti-VEGF therapy. DesignMulticenter, retrospective, longitudinal study. ParticipantsWe included patients with treatment-naïve type 3 MNV secondary to nAMD at baseline, treated with anti-VEGF during a 3-year follow-up. MethodsPatients were identified from six retinal referral institutions: 1) San Raffaele University, Milan, Italy 2) University of Genova, Genova, Italy; 3) Doheny Eye Institute, Los Angeles, USA; 4) Stein Eye Institute, Los Angeles, USA; 5) University of Paris Est, Creteil, France; 6) IRCCS Bietti Foundation, Rome, Italy. Several baseline predictors of 3-year MA area were analyzed based on structural OCT and demographics. Main Outcome MeasuresMultivariate analysis in order to identify baseline independent predictors of the 3-year MA development for type 3 MNV secondary to nAMD treated by anti-VEGF therapy. ResultsWe included 131 eyes of 131 patients (mean age 80±6-year-old, 81% females). Best-corrected visual acuity was 0.49±0.40 LogMAR at the baseline and significantly decreased to 0.59±0.43 LogMAR at the end of 3-year follow-up (p<0.001). Patients were treated with 11±6 anti-VEGF injections and developed atrophy in 75% of cases (from 18% at the baseline). Eyes that developed 3-year MA were treated with a significantly lower number of injections compared to eyes without MA (9.9±5.5 vs 14.7±7.2 injections, p<0.001). The most relevant independent predictors at baseline of MA area at 3-year follow-up were: area of MA at baseline (p<0.001), AMD phenotype (presence of reticular pseudodrusen) (p=0.017), baseline presence of nascent geographic atrophy (p=0.008), and the baseline presence of subretinal hyper-reflective material (p=0.002). ConclusionsMacular atrophy development is a frequent complication of type 3 MNV treated with anti-VEGF injections. Several factors could be considered as baseline predictors of atrophy development during the anti-VEGF treatment.

Exclusive endoscopic tympanoplasty efficacy in the treatment of cholesteatoma without mastoid involvement.

The purpose of this study is to determine the recurrence rate of cholesteatoma in patients who have undergone exclusive endoscopic tympanoplasty at our tertiary referral institution. A secondary objective is to analyze different clinical aspects that could be considered risk factors for recurrence to establish if it is possible to determine when a second-look procedure is indicated instead of a clinical follow-up. A retrospective study was performed on patients who had undergone exclusive endoscopic tympanoplasty for cholesteatoma in the last eight years and who were followed up for at least one year. The efficacy of the treatment performed only with the exclusive endoscopic technique was analyzed. Then, the anamnestic and intraoperative data were studied to identify possible factors that could increase the risk of recurrence. The recurrence rate (14.5%) in patients (164) who underwent primary surgery with the exclusive endoscopic technique between January 2014 and January 2022 was similar to that in patients who underwent the microscopic technique with mastoidectomy in literature. In addition, we analyzed several clinical factors such as age, ossicular chain erosion, extension and localization of the cholesteatoma finding that only the last one could potentially be a risk factor for recurrence in this selected population. Exclusive endoscopic tympanoplasty has been shown to be effective in removing cholesteatoma in patients without evidence of mastoid involvement, with recurrence rates comparable to traditional microscopic technique and a minimally invasive approach, even considering the patient's age, ossicular chain erosion and extension of the disease.

Dogs receiving cyclooxygenase-2-sparing nonsteroidal anti-inflammatory drugs and/or nonphysiologic steroids are at risk of severe gastrointestinal ulceration.

To report the incidence and characteristics of gastrointestinal ulceration lesions in dogs receiving an NSAID and/or corticosteroid. 33 dogs. Medical records of dogs with gastrointestinal ulceration receiving NSAIDs and/or corticosteroids within 30 days of diagnosis between January 2012 and July 2022 at multiple referral institutions were reviewed. Diagnosis was confirmed via endoscopy, surgery, or necropsy. Clinical data were collected from the medical record, including the dose and reason for administration of NSAIDs or steroids. Dogs received a single NSAID (n = 22, most commonly carprofen [9], meloxicam [4], and deracoxib [3]), 2 NSAIDs (5), a single steroid (5: prednisolone [2], prednisone [2], or dexamethasone SP [1]), or an NSAID and steroid (1). Eleven dogs receiving a single cyclooxygenase (COX)-2-sparing NSAID at an appropriate dose had ulcerations. All dogs receiving 2 NSAIDs concurrently experienced full-thickness perforation (5 of 5). The most common ulcer locations were duodenum (n = 18) and pylorus (11). Abdominal ultrasound correctly identified the site of ulceration in 5 of 24 dogs. Dogs receiving COX-2 sparing NSAIDs at recommended doses are at risk of severe GI ulceration. Carprofen was the most common NSAID resulting in ulceration; however, it is one of the most prescribed NSAIDs. Adding another NSAID and steroid could increase this risk. Careful monitoring is crucial for dogs on NSAIDs, regardless of duration.

Impact of the COVID-19 Prioritization Recommendations on Pathological Stages of Urologic Malignancies: A Real-World Analysis at a High-Volume Referral Institution

Background: In response to the COVID-19 pandemic, the European Association of Urology (EAU) Guidelines defined priority groups to guide the prioritization of surgery for urological malignancies. The objective of this study was to evaluate the impact of the COVID-19 prioritization recommendations on tumor pathological characteristics in a real-world setting at our academic referral institution. Methods: We compared baseline and pathological tumor features of all patients with urological malignancies treated during the pandemic period (2020–2021) versus in the post-pandemic period (2022–2023). Our institution adhered to the international recommendations and prioritized those cases defined as “high-risk”. Results: Data from 9196 patients treated for urological malignancies were reviewed and grouped according to period of surgery (4401 in the pandemic period vs. 4785 in the post-pandemic period). The overall number of surgical procedures was comparable for all diseases except for the number of radical prostatectomies (1117 vs. 1405; p = 0.03) and partial nephrectomies (609 vs. 759; p = 0.02), which were significantly lower in the pandemic period. Regarding tumor pathological features, none of the recorded variables were found to differ according to period of surgery, including disease stage, tumor grading, presence of necrosis, lymphovascular invasion, and histological variants. Conclusions: A correct policy of prioritization of oncological pathologies during emergency periods and a centralization of oncological cases in reference centers reduce the possible risk of worsening cancer disease features related to the reorganization of healthcare resources.

Evaluating the Efficacy of a Novel Hemostatic Powder Compared to Traditional Treatments in Non-Variceal Upper Gastrointestinal Bleeding: A Multicenter, Randomized Non-inferiority Study

Hemostatic powders have been rapidly developed and used to treat gastrointestinal bleeding. We aimed to investigate the non-inferiority of the newly developed hemostatic powder (CEGP-003) compared to conventional endoscopic treatments for non-variceal upper gastrointestinal bleeding (NVUGIB). This prospective, multicenter, randomized, open-label, controlled trial was conducted at four referral institutions. We enrolled consecutive patients who underwent emergency endoscopy for NVUGIB. The patients were randomly assigned to either the CEGP-003 or the conventional treatment group. In the CEGP-003 group, the hemostatic powder was applied as a spray. Conventional endoscopic treatments included electrical coagulation and hemoclipping. Between November 2019 and June 2022, 218 patients were enrolled (CEGP-003, 108; conventional, 110). Initial hemostasis was achieved in 104 of 108 patients (96.3%) in the CEGP-003 group and 101 of 110 patients (91.8%) in the conventional treatment group. The CEGP-003 group exhibited a significantly higher re-bleeding rate than the conventional treatment group. Multivariate analysis that age, duodenum and middle 1/3 of stomach, and CEGP-003 use as the initial hemostatic treatment were independent risk factors for re-bleeding. No adverse events were associated with CEGP-003. CEGP-003 demonstrates promise as an initial endoscopic therapy for NVUGIB, however close monitoring is warranted due to the risk of re-bleeding (Cris.nih.go.kr, number: KCT0004655).

Clinical features and outcome of dogs and cats with gastrointestinal pneumatosis: 30 cases (2010-2021).

To describe the presentation, etiology, and outcome of dogs and cats diagnosed with gastrointestinal pneumatosis (GP). Retrospective study. Three referral institutions. Twenty-six dogs and 4 cats. None. The most common sites of GP were the stomach (n=19), followed by the colon (n=8) and small intestine (n=2). One case had pneumatosis of both the stomach and the colon. GP was most commonly associated with gastrointestinal disease in dogs (18/26 [69%]) and cats (3/4 [75%]), with common diagnoses including gastric dilatation and volvulus (n=5), acute hemorrhagic diarrhea syndrome (n=4), and gastrointestinal ulceration (n=4). Of the 4 cases of gastrointestinal ulceration, 3 were dogs with a history of glucocorticosteroid or nonsteroidal anti-inflammatory drug administration and vomiting and diarrhea. Six of 30 cases (20%), all of which were dogs, were determined to have a surgical indication for exploratory celiotomy, although not solely on the basis of diagnosis of GP. Five cases underwent exploratory celiotomy, of which 1 (20%) survived to hospital discharge. Of the medically managed cases, 13 of 24 (54%) survived to hospital discharge. Overall, 14 of 30 cases (47%) survived to hospital discharge. GP is an uncommon diagnostic imaging finding that is associated with a variety of disease processes. Its development is often related to primary gastrointestinal diseases. In the absence of other surgical disease, exploratory celiotomy based solely on the diagnosis of GP is unlikely to be indicated.

Tumor Grade and Mitotic Count Are Prognostic for Dogs with Cutaneous Mast Cell Tumors Treated with Surgery and Adjuvant or Neoadjuvant Vinblastine Chemotherapy.

Canine cutaneous mast cell tumors (cMCTs) have variable rates of recurrence and metastasis. We evaluated how various prognostic factors affect survival, recurrence, and metastasis in dogs with cMCT who underwent surgery and vinblastine chemotherapy. 90 dogs with cMCT treated with surgery and vinblastine at a veterinary referral institution were included. Medical records were retrospectively reviewed. Prognostic factors were evaluated. Most dogs (94%) had grade 2 or 3 cMCTs. Neoadjuvant vinblastine was used in 18 dogs, and none progressed locally before surgery. The use of neoadjuvant vinblastine was associated with a higher chance of local recurrence (p = 0.03) but not survival. Shorter survival times were found for tumors that were high-grade (p < 0.001), grade 3 (p < 0.001), or a MC of >5 (p < 0.001). Dogs with grade 2 tumors that were low-grade lived longer than those with high-grade tumors (p < 0.001). Histologic tumor-free margins and the ability to achieve local tumor control were not associated with outcome. Both grading systems and MC were prognostic for survival in this population of dogs, supporting the need for the standard reporting of histopathologic findings. Neoadjuvant chemotherapy can be effective in downsizing cMCTs but does not influence survival. These findings are consistent with previous publications, showing the benefits of a more modern population of patients, surgical treatments, and histopathologic assessments.

Complications in Patients with Surgically Altered Gastrointestinal Anatomy Undergoing Endoscopic Retrograde Cholangiopancreatography: 15-Year Experience at a Tertiary Care Center in Latin America.

Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure, but it poses challenges in patients with surgically altered gastrointestinal anatomy (SAGA). Alternative techniques like single-balloon enteroscopy (SBE), double-balloon enteroscopy (DBE), or push enteroscopy (PE) have been used, albeit with potential complications. Limited Latin American data exists on ERCP complications in SAGA patients. Our goal is to describe complications of ERCP in SAGA at a national referral institution. Retrospective, single-center cohort study. All SAGA ERCP procedures performed at the Gastrointestinal Endoscopy Department of the National Institute of Medical Sciences and Nutrition Salvador Zubirán from January 2008 to May 2023 were included. Extracted data from records included procedure specifics, endoscope type, success, and complications. Complications were evaluated during procedure and 28-day post-procedure and classified using the AGREE system. A total of 266 procedures in 174 patients were included, 74% were women, and the median age was 44years. Predominant modified anatomy was Roux-en-Y biliary reconstruction (79%), followed by Whipple procedure (13%) and subtotal gastrectomy with Roux-en-Y reconstruction (6.0%). The main indications were cholangitis with stricture (31%), stricture (19%), and cholangitis (19%). DBE was used in 89%, PE in 7.5%, and SBE in 3.4%. Success rates were 77% endoscopic, 72% technical, and 69% therapeutic; in 30%, the procedure was unsuccessful. Complications happened in 18% of cases, most commonly cholangitis (7.5%), followed by perforation (2.6%) and hemorrhage (1.9%). According to the AGREE classification, 10.9% were grades 1 and 2, 6.4% were grade 3, and 0.4% were grade 4 complications. No significant differences emerged between groups with and without complications. Procedures increased over time, but complications and unsuccessful procedures remained stable. ERCP complications align with international data, often not requiring invasive treatment. Enhanced exposure to such cases correlates with fewer complications and failures. Prospective studies are essential to identify complication and failure predictors.

Predictors of postoperative infectious complications after partial nephrectomy: Analysis at a referral institution

ObjectiveInfectious complications after partial nephrectomy (PN) remain a significant concern. We aimed to analyze predictive factors of postoperative infectious complications (PICs) occurring after PN. MethodsData on patients undergoing PN for renal masses between January 2018 and May 2023 were retrieved from prospectively maintained institutional database and retrospectively analyzed. Patients were stratified into two groups based on the occurrence of PICs during admission for PN. A PIC was defined by clinical and/or imaging findings of an infectious process plus microbial isolation upon culture examination. Multivariable logistic regression analysis after adjusting for potential confounders evaluated predictors of PIC. ResultsSix-hundred and twenty-eight patients underwent PN; rough incidence of PICs was 11.6%, with median time to PIC onset of 1 (interquartile range 0–3) day. Compared to patients without PIC events, the PIC group showed a significantly higher proportion of open surgeries (53.6% vs. 20.4%, p<0.001), hemoglobin drop vs. baseline (−2.6 g/dL vs. −1.7 g/dL, p=0.001), bleeding events (23.2% vs. 10.1%, p<0.01), postoperative transfusion (5% vs. 18.8%, p<0.001), and urinary leakage (4.1% vs. 0.2%, p=0.01). At multivariable logistic regression, the odds of experiencing a PIC were statistically significantly lower after minimally-invasive surgery (odds ratio 0.32, 95% confidence interval 0.17–0.59), and higher for patients who received transfusion (odds ratio 2.64, 95% confidence interval 1.38–5.05). ConclusionsWe underlined factors that impact the occurrence of PICs and, consequently, duration of hospitalization following PN. By addressing these predictors, clinicians can promote enhanced patient recovery.

Outcomes of right sleeve lower lobectomy vs. lower bilobectomy for lung malignancies

ObjectivesLower bilobectomy (LBL) leaves a residual pleural space potentially associated with adverse postoperative outcomes. In selected patients, right sleeve lower lobectomy (RSLL) with anastomosis between the middle lobe bronchus and intermediate bronchus is feasible. The outcomes of RSLL and LBL have not been compared. The aim of this study was to compare post-operative and long-term outcomes of RSLL and LBL in patients with lung cancer. MethodsWe retrospectively included patients managed by RSLL or LBL at our referral chest-surgery institution between 2001 and 2019. Post-operative complications and mortality were compared. Kaplan-Meier curves were plotted to compare overall and disease-free survival rates. ResultsWe identified 23 patients with RSLL and 96 with LBL. Postoperative mortality was 9 % after RSLL and 5 % after LBL (p = 0.41). Bronchial fistula developed in 3 (13 %) RSLL patients and 6 (6 %) LBL patients (p = 0.23). Pleural space complications were significantly less common after RSLL (4/23 [17 %] vs. 45/96 [47 %], p = 0.03). Long-term vital capacity was significantly higher in the RSLL group (91 % vs. 64 %, p < 0.01). Five-year survival did not differ significantly between groups (84 % vs. 72 %, p = 0.09). ConclusionsRSLL was associated with similar postoperative mortality and long-term survival compared to LBL. However, pleural space complications were less common and lung function was better after RSLL than after LBL. When feasible, RSLL may deserve preference over LBL in patients with lung cancer managed at highly experienced centres.