Retroperitoneal Tissue Research Articles

Treatment for acute alcoholic-alimentary pancreatitis with peritoneal syndrome

A large number of publications on surgical treatment of acute alcohol-induced pancreatitis (AAP) with peritonitis indicates the importance of the problem and the need for a differentiated approach to treatment. The aim of this study is to determine the optimal treatment policy for acute alcohol-associated pancreatitis with peritonitis. The study included 114 male patients diagnosed with acute alcoholic pancreatitis and peritoneal sepsis, with an average age of 48.6 ± 6.4 years. They were admitted to the surgical departments of clinical hospitals between 2013 and 2023. The diagnosis of AAP was confi med based on clinical, laboratory, and instrumental findings. The classification of acute pancreatitis recommended by the National Clinical Guidelines of the Ministry of Health of the Russian Federation (2015 and 2020) has been applied. The Acute Physiology and Chronic Health Evaluation II (APACHE II) scale has been used to assess the severity and prognosis of the disease, while the Sequential Organ Failure Assessment (SOFA) scale has been used to evaluate organ failure. Based on the results, an algorithm for the treatment of acute alcoholic and alimentary pancreatitis with peritoneal syndrome has been proposed, taking into account the type of pancreatic necrosis, the extent of pancreatic damage, and the nature of fl uid accumulation. For patients with edematous pancreatitis, small-focal sterile pancreatic necrosis, and enzymatic peritonitis, percutaneous ultrasound-guided abdominal and omental drainage is recommended. In severe and moderate acute alcoholic-alimentary pancreatitis, with enzymatic peritonitis (more than 8 points on the APACHE II scale), which is manifested during diagnostic and sanitation laparoscopy by the presence of a hemorrhagic effusion and a large number of plaques of steatonecrosis on the parietal peritoneum and the large omentum, we should use an endovisual method of draining the abdominal cavity and the omentum to minimize anesthesiological and surgical aggression and to form and maintain general cavities, as well as to create good access to the pancreatic area. For patients with large-focal, infected subtotal or total pancreatic necrosis and purulent peritonitis, it is advisable to perform laparotomy, abdominalization of the pancreas, necrectomy, omentobursostomy, and drainage of purulent foci in the abdominal cavity and retroperitoneal tissue.

8353 Impact of a plant-based protein diet on bone health and body composition in Sprague Dawley rats

Abstract Disclosure: M.M. Gomes: None. I.M. de Araújo: None. S.V. Rodriguez: None. F.R. Jorge: None. F.J. de Paula: None. Introduction:Vegetarian and vegan diets are associated with some health benefits; this has contributed to their growing popularity. Although studies remain limited, there is evidence that these patients may be at greater risk of reduced bone mineral density (BMD) and increased fracture risk. The general objective of this study was to analyze the impact of a high-protein, plant-based diet on bone tissue and body composition in male Sprague Dawley rats. Methodology: The study was approved by the Animal Ethics Committee. This study was done with 10 rats in the control group (CG), which received a standard AIN-93M diet; 11 in the normoprotein vegetarian group (NVG), with a normoprotein AIN-93 diet modified with pea protein and methionine; and 11 in the high-protein vegetarian group (HVG), with a modified AIN-93 diet with 40% pea protein and methionine. The dietary intervention lasted 8 weeks. The weight of the animals was measured weekly. Basal blood glucose levels were measured at baseline. At the end of the study, 6 rats from the CG, 6 rats from the NVG, and 5 rats from the HVG were subjected to a glucose tolerance test (GTT). The dual-energy X-ray absorptiometry (DXA) technique was applied in the baseline and final periods of the experiment to evaluate body composition, bone mineral content (BMC) and BMD. After sacrifice, bone strength was measured via a three-point flexion mechanical test on the tibia; brown adipose, epididymal, and retroperitoneal tissues, as well as the liver, were weighed on an analytical balance. Blood was used to measure circulatory levels of insulin, CTX, and P1NP (n=6/group). Results: Basal weight was similar between the groups, but the final weight was lower in the HVG as compared to the CG. In the DXA evaluation, the final lean mass was not different between the groups. On the other hand, total fat mass was lower in the HVG than in the CG and the NVG and the fat percentage was lower in the HVG than in the CG. The weight of epididymal adipose tissue was lower in the HVG than in the NVG, but retroperitoneal and brown adipose tissues were lower in HVG than CG. Liver weight was similar between groups. BMD was similar between groups; however, BMC was lower in the HVG than in the CG and the NVG. Bone strength was similar between groups. There was no difference in glycemia at baseline or during GTT at the eighth week. Serum levels of insulin, CTX, and P1NP were similar between groups. Discussion and Conclusion: A normoprotein vegetarian diet that includes all essential amino acids appears to have no negative impact on body composition or BMD in rats. On the other hand, a high-protein diet with plant protein appears to have a negative impact on bone mineral content, in addition to reducing the amount of body fat and weight. This finding expands on previous results by showing that high-protein diets have a negative impact on bone even when the protein is of plant origin. Presentation: 6/1/2024

Retroperitoneal tumors: a case series and literature review

Abstract Retroperitoneal tumors present significant diagnostic challenges. These tumors can either originate from retroperitoneal tissues or invade the retroperitoneum secondarily. While occurrence of benign lesions is observed, malignant tumors are more prevalent. The clinical presentation varies greatly depending on the tumor size, extent, and involvement of the surrounding tissues, making diagnosis difficult. Given the heterogeneous composition of the tumors, establishing a definitive diagnosis is challenging. Histopathology remains the gold standard technique for studying and analyzing these tumors, with immunohistochemistry being an important tool for confirming the diagnosis. Thus, we describe our experience with a series of four cases of rare retroperitoneal tumors, all of which were surgically resected and subjected to histopathological and immunohistochemical analyses.

A rare case of retroperitoneal teratoma with evidence of papillary thyroid carcinoma: a case report

BackgroundTeratomas are germ cell tumors composed of somatic tissues from up to three germ layers. Primary retroperitoneal teratomas usually develop during childhood and are uncommon in adults and in the retroperitoneal space. While there are only a few cases of retroperitoneal thyroid tissue, we report a unique case of a retroperitoneal papillary thyroid carcinoma.Case presentationA 41-year-old woman presented in our institution due to intermitted unspecific abdominal pain. Magnetic resonance imaging detected a multi-cystic solid retroperitoneal mass ventral to the psoas muscle and the left iliac artery. After surgical removal of the retroperitoneal mass, histology sections of the specimen indicated evidence of papillary thyroid carcinoma cells. A staging computed tomography scan of the body showed no further manifestations. To reduce the risk of recurrence, total thyroidectomy was performed followed by radioiodine therapy with lifelong hormone substitution.ConclusionsPrimary retroperitoneal teratoma with evidence of papillary thyroid carcinoma is a rare condition. Preoperative diagnosis is difficult due to its non-specific clinical manifestation and lack of specific radiologic findings. Histopathology analysis is necessary for diagnosis. Although surgery is considered the first line treatment, there is still discussion about the extent of resection and the need for total thyroidectomy with adjuvant radioiodine therapy.

ЛАПАРОСКОПИЧЕСКОЕ УДАЛЕНИЕ КИСТЫ ЗАБРЮШИННОГО ПРОСТРАНСТВА С РЕЗЕКЦИЕЙ И ПЛАСТИКОЙ ДИАФРАГМЫ

Background. Due to some challenges in diagnosis and surgical decision-making of retroperitoneal tumor-like masses, their treatment is regarded as a current issue in surgery. Objective. To demonstrate surgical treatment outcomes of a patient with a retroperitoneal tumor. Material and methods. The article presents our own clinical observation of a surgical removal of a tumor-like retroperitoneal tissue mass on the right with diaphragm resection as well as drainage of the pleural and abdominal cavities. Results. Based on laboratory and instrumental studies, the patient was clinically diagnosed with Chronic calculous cholecystitis as well as Parasitic cyst of the right liver lobe. A tumor-like posterolateral wall mass, about 5 cm in diameter, located retroperitoneally and associated with the right dome of the diaphragm was visualized intraoperatively. Laparoscopic removal of the mass within healthy tissues with resection and plastic of the right diaphragm dome was performed. The patient was discharged in a satisfactory condition, without complaints, for further outpatient follow-up by a surgeon at his place of residence. There were no repeated clinic visits or readmissions. Conclusions. The clinical observation indicating difficulty in diagnosis of retroperitoneal tumors in the preoperative period, it should be taken into consideration when planning surgery. When choosing a surgical treatment method, priority should be given to modern minimally invasive interventions, even in case of adjacent organs involvement.

A novel method of tunneling retroperitoneoscopic adrenalectomy: a prospective study.

To introduce the surgical technique and our team's extensive experience with tunnel method in laparoscopic adrenalectomy. From July 2019 to June 2022, we independently designed and conducted 83 cases of " Tunnel Method Laparoscopic Adrenalectomy," a prospective study. There were 45 male and 38 female patients, ages ranged from 25 to 73 years(mean: 44.6 years).The cases included 59 adrenal cortical adenomas, 9 pheochromocytomas, 6 cysts, 4 myelolipomas, 1 ganglioneuroma, and 4 cases of adrenal cortical hyperplasia. In terms of anatomical location, there were 39 cases on the left side, 42 on the right side, and 2 bilateral cases. Tumor diameters ranged from 0.6 to 5.9cm(mean: 2.9cm). Utilizing ultrasound monitoring, percutaneous puncture was made either directly to the target organ or its vicinity, and the puncture path was manually marked. Then, under the direct view of a single-port single-channel laparoscope, the path to the target organ in the retroperitoneum or its vicinity was further delineated and separated. This approach allowed for the insertion of the laparoscope and surgical instruments through the affected adrenal gland, thereby separating the surface of the target organ to create sufficient operational space for the adrenalectomy. All 83 surgeries were successfully completed. A breakdown of the surgical approach reveals that 51 surgeries were done using one puncture hole, 25 with two puncture holes, and 7 with three puncture holes. The operation time ranged from 31 to 105min (mean: 47min), with a blood loss of 10 to 220mL (mean: 40 mL). Notably, there were no conversions to open surgery and no intraoperative complications. Postoperative follow-up ranged from 6 to 28 months, during which after re-examination using ultrasound, CT, and other imaging methods, there were no recurrences or other complications detected. The completion of the tunnel method laparoscopic adrenalectomy represents a breakthrough, transitioning from the traditional step-by-step separation of retroperitoneal tissues to reach the target organ in conventional retroperitoneoscopic surgery. This method directly accesses the target organ, substantially reducing the damage and complications associated with tissue separation in retroperitoneoscopic surgery, As a result, it provides a new option for minimally invasive surgery of retroperitoneal organs and introduces innovative concepts to retroperitoneoscopic surgery.

Ultrasound guided quadro-iliac plane block: another novel fascial plane block.

We report a novel block technique aimed to provide lumbosacral, abdominal, and hip analgesia: The quadro-iliac plane (QIP) block. A cadaveric examination that evaluates the spread of QIP block. Cadaver laboratory. One unembalmed cadaver. Bilateral ultrasound-guided QIP blocks on cadavers with 40 mL of methylene blue %0.5 each side. Dye spread in cadaver. There was staining in the deep interfascial plane of the erector spinae muscles. Extensive staining of the interfascial plane corresponding to the posterior aspect of the quadratus lumborum muscle (QLM) was observed. There was extensive staining on the anterior surface of the QLM. There was spread of dye traversing along the transversalis fascia and significantly infiltrating retroperitoneal fat tissue. Bilateral staining of the ilioinguinal and iliohypogastric nerves was observed. On the right, there was minimal staining over the subcostal nerve. There was dye present bilaterally within the deep regions of the transverse processes. The lumbar plexus was stained on both sides. The local anesthetic applied from a place where the QLM reaches its largest volume and the fascial plane creates a closed gap in the caudal area may exhibit a more rounded and extensive spread.Quadro-iliac plane block, involves the administration of local anesthetic to the posterior aspect of the QLM at its origin from the iliac crest. According to our cadaver study, this technique may be a promising option for alleviating acute and chronic pain in the lumbosacral, lower abdominal, and hip regions.

ПРИМЕНЕНИЕ УЛЬТРАЗВУКОВОГО ИССЛЕДОВАНИЯ ДЛЯ КОЛИЧЕСТВЕННОЙ ОЦЕНКИ КЛЕТЧАТКИ ЗАБРЮШИННОГО ПРОСТРАНСТВА

The aim of the study was to explore the possibility of using ultrasound to quantify the fiber of the retroperitoneal space under normal conditions. Materials and methods. 3 linear dimensions between anatomical landmarks are proposed, which are well visualized with standard transabdominal ultrasound of the abdominal cavity and retroperitoneal space. These include: 1) the distance between the lower edge of the rectus abdominis and the aorta; 2) the distance between the upper pole of the right kidney and the lower border of the liver; and 3) the distance between the upper pole of the left kidney and the lower pole of the spleen. 145 practically healthy people were included in the study. All subjects were segregate into 3 groups according to body mass index (BMI). The first group consisted of persons with a BMI of 17.5 to 24.9 kg/m2, the second included persons with a BMI from 25 to 29.9 kg / m2, and the third consisted of people with a BMI ≥30 kg/m2. The median, minimum, maximum, upper and lower quartile values, as well as the 10th and 90th percentiles were used to describe the data obtained. Results. 80% of the distance values between the upper pole of the right kidney and the lower edge of the liver fit into the range of 10 mm to 25 mm in persons with a BMI of 17.5 to 24.9 kg/m2, in the range from 15 mm to 30 mm in persons with a BMI of 25 to 29.9 kg/m2, and in the range of 13.5 mm to 42.5 mm in obese individuals. The distance between the lower margin of the rectus abdominis and the aorta at a distance of 5 cm above the umbilicus along the midline is from 15 mm to 35 mm in people with a BMI of 17.5 to 24.9 kg/m2, from 25 mm to 60 mm in persons with a BMI of 25 to 29.9 kg/m2 and from 35 mm to 75 mm In obese individuals, it includes values between the 10th and 90th percentiles for this measurement point. Finally, 80% of the distance measurement values between the upper pole of the left kidney and the lower pole of the spleen fit in sizes from 10 mm to 30 mm for people with a BMI of 17.5 to 24.9 kg/m2, from 18 mm to 40 mm for people with a BMI from 25 to 29.9 kg/m2 and from 25 mm to 52.5 mm for subjects with obesity. Conclusion. The results obtained allow us to recommend ultrasound of retroperitoneal tissue for the evaluation of its condition.

Litter reduction-induced obesity promotes early depressive-like behavior and elevated prefrontal cortex GFAP expression in male offspring

AimsThe present study was developed to investigate how litter reduction-induced obesity promotes early depressive-related behaviors in rodent offspring. Main methodsWe employed a standardized litter size reduction protocol, dividing litters into groups: normal litters (NL), consisting of six males and six females pups and small litters (SL), comprising two males and two females pups. Maternal behavior was monitored during the initial week of lactation. Subsequently, we assessed the pups for weight gain, locomotor activity, social play behavior, and performance in forced swimming test. We further evaluated the weights of retroperitoneal and perigonadal fat tissues, along with the expression of glial fibrillary acidic pprotein (GFAP) in the hippocampus and prefrontal cortex of the offspring. Key findingsOur results indicated that litter size reduction led to an increased the maternal behavior. In contrast, offspring from the SL group displayed greater weight gain and increased, retroperitoneal and perigonadal fat. Both male and female rodents in the SL group exhibited decreased social play behavior, and male offspring spent more time immobile during the forced swimming test, suggesting a depressive-like phenotype. Notably, we observed an increase in the GFAP expression in the prefrontal cortex of male rodents, with a trend toward increased expression in the hippocampus. SignificanceObesity may facilitate the development of early depressive-like behaviors, potentially associated with elevated GFAP expression in the prefrontal cortex.

Effectiveness of tofacitinib monotherapy for patients with IgG4-RD or idiopathic retroperitoneal fibrosis.

To explore the effectiveness of tofacitinib for immunoglobulin G4-related disease (IgG4-RD) and idiopathic retroperitoneal fibrosis (IRF), and investigate the expression of JAKs in the lesion of these diseases. Clinical data of patients with IgG4-RD or IRF who were administered with tofacitinib monotherapy were collected. IgG4-RD responder index (IgG4-RD RI) was assessed. The expression of JAK1, JAK2, JAK3, and TYK2 were analysed with immunohistochemistry staining in three salivary glands specimens of IgG4-RD and one retroperitoneal tissue of IRF. Two patients with IRF and two patients with IgG4-RD used tofacitinib monotherapy. Two patients with IRF achieved complete remission with diminished retroperitoneal mass and decreased CRP, as IgG4-RD RI decreased from 6 to 1 in both of them. One with IgG4-RD achieved complete remission with alleviated enlargement of pancreas and IgG4 level decreased from 13.7 g/L to 2.4 g/L, as IgG4-RD RI decreased from 12 to 1. One with IgG4-RD achieved partial response with IgG4 level decreased from 77.1g/L to 25.8g/L as IgG4-RD RI from 18 to 6. JAK1, JAK2, JAK3, and TYK2 expression were detected in biopsy tissues. The staining intensity of the JAK family on the lesion from one IRF patient was similar to those from IgG4-RD patients. Tofacitinib is a potentially effective treatment for IgG4-RD and IRF and it is reasonable to conduct clinical trial to validate its efficacy. The JAKs were expressed in the inflammatory lesions of IgG4-RD and IRF and they may share a common pathogenesis pathway that is independent of IgG4 production.

Randall-Type Monoclonal Immunoglobulin Deposition Disease in Bone Scintigraphy.

Bone scintigraphy is recognized as a noninvasive alternative to endomyocardial biopsy for the diagnostic of wild-type (wATTR) and hereditary ATTR amyloidosis (hATTR). Light chain amyloidosis (AL), Randall-type monoclonal immunoglobulin deposition disease, sarcoidosis, hemochromatosis, Fabry disease, and mucopolysaccharidoses are differential diagnosis of ATTR amyloidosis. Bone scintigraphy allows visualization of extracardiac involvements of AL amyloidosis: pleural, retroperitoneal, liver, spleen, and soft tissue. We report the case of a patient who underwent bone scintigraphy for suspected ATTR amyloidosis. Bone scan showed cardiac (Perugini score 2), hepatic, and renal hyperfixation. A cardiac biopsy demonstrated a Randall-type deposit, without amyloid deposit.

Single-Cell RNA-Sequencing Reveals Peripheral T Helper Cells Promoting the Development of IgG4-Related Disease by Enhancing B Cell Activation and Differentiation.

Abnormal B cell differentiation plays a critical role in IgG4-related disease (IgG4-RD), but the underlying mechanism remains largely unknown. We investigated the cell landscape from three IgG4-RD retroperitoneal tissues and three control tissues using single-cell RNA-sequencing. Critical cell type or markers were further validated in the peripheral blood from the patients with IgG4-RD and healthy controls via flow cytometry as well as in the IgG4-RD and control tissue via immunofluorescence staining. The increases in B cells, plasma cells, and CD4+ T cells were found in IgG4-RD retroperitoneal tissue. Importantly, among CD4+ T cells, an increase in CD4+CXCR5-PD1hi peripheral T helper (Tph) cells with a high expression of IL-21 and TIGIT was discovered in IgG4-RD tissue, which was further validated in peripheral blood of the patients with IgG4-RD. The Tph cell and TIGIT+ Tph cell proportion were remarkably higher in active IgG4-RD patients and correlated with disease activity. Moreover, TIGIT+CD4+ cells were able to promote B cell differentiation via IL-21. Our study revealed that Tph cells are increased in IgG4-RD and probably play critical roles in B cell differentiation through TIGIT-IL-21 axis. Peripheral Tph cell and TIGIT+Tph cell are potential markers for IgG4-RD disease activity.

Effects of Resistance Exercise and Fermented Soybean Intake on Protein Expression Markers Related to Browning of White Adipose Tissue in Diet-induced Obese Rats

PURPOSE: This study aimed to analyze the combined treatment effect of fermented soybean intake (for additional protein intake) and resistance exercise (for muscle metabolism activation) on the molecular biological response index of white adipose tissue (WAT) browning.METHODS: The study included twenty 50-week-old male Wistar rats, who were made obese by being fed a high-fat diet for 8 weeks and then were randomly divided into four groups, control (Con), fermented soybean intake (Soy), resistance exercise (RT), and fermented soybean intake and resistance exercise combination (Soy+RT). After 12 weeks of Soy and RT treatment, body composition, and protein expression patterns such as peroxisome proliferator-activated receptor γ coactivator 1-α (PGC-1α), fibronectin type III domain-containing protein 5 (FNDC5), interleukin-6 (IL-6), and uncoupling protein-1 (UCP1) were compared in extensor digitorum longus and retroperitoneal fat.RESULTS: The obese rats demonstrated a reduction in body weight and body fat mass, as well as maintenance of lean mass. Interestingly, the groups treated with Soy, RT, and Soy+RT displayed enhanced protein expression of PGC-1α, FNDC5, UCP1, and IL-6 in the extensor digitorum longus and retroperitoneal fat tissue than Con. In particular, the Soy+RT group displayed the most remarkable activation of the aforementioned protein levels in the muscle and adipose tissues.CONCLUSION: This study concluded that resistance exercise and fermented soybean intake can partly contribute to the browning of WAT.

Recurrence of composite hemangioendothelioma of the kidney after surgical resection

Composite hemangioendothelioma is an extremely rare form of kidney tumor. The tumor mainly occurs in the extremities, head and neck; internal organs involvement is rarely reported. Patient, 61-year-old male, was admitted to the urology department for a left kidney tumor, which was found accidentally during an ultrasound examination. Magnetic resonance imaging showed an irregularly shaped tumor measuring 5.0 × 6.0 × 4.0 cm and located in the lower pole of the left kidney. The tumor was surgically removed with resection of the capsule of the kidney lower pole. Immunohistochemical study revealed diffuse bright expression of CD31 (clone JC70A), CD34 (clone QBEnd 10), ERG (clone ER111), FLI-1 (clone MRQ-1) in tumor cells. The index of proliferative activity Ki-67 (clone SP6) was 40 %. The morphological picture and immunophenotype of the tumor correspond to composite hemangioendothelioma of the retroperitoneal space. Magnetic resonance imaging of the retroperitoneal space on follow-up visit in 9 months visualized a tumor of the left kidney measuring 8.3 × 8.4 × 7.8 cm. Radical nephrectomy was performed. Pathology examination showed that tumor tissue was mainly represented by solid fields of the spindle cell component. In samples of the border between the tumor and fatty pararenal tissue, tumor invasion was observed up to the adjacent striated muscles, tumor growth into the tissue of the kidney gate was also found. Taking into account the morphological picture and the earlier immunohistochemical study, the removed tumor corresponds to composite hemangioendothelioma.Composite hemangioendothelioma is a tumor of low malignant potential. It is extremely rare for this tumor to affect the kidney. At the same time, in the described case, the tumor was initially located in the retroperitoneal space, with involvement of the kidney capsule, and was assessed as a benign lesion. After 9 months, there was a recurrence of the tumor localized in the kidney with damage to the elements of the renal sinus, retroperitoneal tissue, and lumbar muscles. In this case, the tumor has significant malignant potential.

Mesenteric panniculitis in rheumatologist practice

Mesenteric panniculitis (MPn) is a rare form of adipose tissue inflammation, mainly of the intestinal mesentery, less often of the omentum, preand retroperitoneal tissue. There are not many descriptions of MPn in rheumatic diseases in the literature: in systemic lupus erythematosus, systemic sclerosis, Sjogren's syndrome, rheumatoid arthritis (RA), ankylosing spondylitis, mesenteric form (MF) of idiopathic lobular panniculitis (ILPn) and IgG4-related disease (IgG4-RD). Given the polymorphism of clinical manifestations, including systemic ones, it is of interest to look at the problem of MPn from the perspective of a rheumatologist.Objective: to evaluate the clinical and laboratory features of MPn in modern rheumatological practice.Material and methods. The study included 64 patients (19 men and 45 women aged 19 to 76 years, median disease duration 28.6 [0.3; 243] months). Laboratory and instrumental studies were carried out according to a single algorithm, which included standard clinical, immunological methods, as well as the determination of fecal calprotectin and tumor markers, ultrasound of the skin and subcutaneous adipose tissue (SAT), computed tomography of the chest and abdominal organs, abdominal positron emission tomography, pathomorphological examination of biopsies of the skin, pancreas and mesentery.Results and discussion. 89% of patients had abdominal pain, 48.4% had nausea, 53.1% had weakness, 44% had subfebrile fever, 32.8% had articular syndrome, and 29.6% – skin and pancreas involvement. Median ESR was 34 [11; 52] mm/h, CRP level – 14 [2; 72] mg/l. Most of the immunological parameters remained within the normal range, but in some cases there was an increase in the concentration of rheumatoid factor, antibodies to the cyclic citrullinated peptide, IgG4. The level of tumor markers CA 125, CEA, CA 19–9 and TumorM2-PK was increased 2 times or more in 5 patients. In our study, all radiological signs and all degrees of severity of MPn were observed. An additional examination confirmed the presence of MF ILPn, RA, IgG4-RD, gastrointestinal, malignant, hematological and other diseases, which made it possible to identify five diagnostic blocks.Conclusion. Early diagnosis and correct interpretation of the described changes require a lot of work-up and a multidisciplinary approach, which contributes to accurate and timely recognition of the disease.

Immunohistochemical expression of DnaJ homolog subfamily B member 9 in immunoglobulin G4-related disease: a pilot study.

DnaJ homolog subfamily B member 9 (DNAJB9) is a co-chaperone protein that governs the functions and integrity of cells. In immunoglobulin G4-related disease (IgG4-RD), DNAJB9 was shown to be upregulated in plasma cells, but its immunohistochemical expression has never been explored. This pilot study aims to investigate the immunohistochemical distribution and intensity of DNAJB9 in IgG4-RD tissue specimens. Patients with definite IgG4-RD and normal tissue controls were selected for anti-DNAJB9 immunohistochemistry, applying a semi-quantitative staining intensity score. We studied the tissue slides of 9 IgG4-RD patients and 15 controls, including salivary gland, pancreatic, pulmonary, pleural, and retroperitoneal fibrosis tissue. Median immunohistochemical intensity was 0 for IgG4-RD patients vs. 2 for controls for endothelial cells (ES=1.58, p<0.01), 2 in each group for glandular epithelial cells (ES 0.70, p=0.26), and 2 for IgG4-RD vs. 3 for controls for inflammatory cells regarding salivary glands alone (ES=0.90, p=0.11). Endothelial staining intensity was negatively correlated with serum IgG4 concentrations (r= -0.72, p=0.03) and the number of treatments required to achieve disease remission (r= -0.70, p=0.04). Our findings evidenced reduced immunohistochemical expression of DNAJB9 in IgG4-RD endothelial cells, and suggested loss of expression in other cell types, possibly correlating with disease severity and risk of relapse. Although DNAJB9 may not serve as a marker for IgG4-RD, it may be part of a pathophysiological pathway involved in the disease and the onset of fibrosis.

Posterior Perforation of Gastric Ulcer with Giant Retroperitoneal Abscess – a Rare Case

Spontaneous perforation of a gastric ulcer is a rare entity and can often be overlooked considering the frequently silent clinical picture. The posterior erosion of the ulcer through the omental bursa in the retroperitoneal space determines local inflammation which, together with the fibrosis of the retroperitoneal tissue facilitates the enclosure of the gastric content. We present the case of a 49-year old patient investigated for pain in the upper abdomen. The endoscopy performed one month before the admission described a retractile area with a central ulcer on the posterior surface of the stomach, adjacent to the lesser curvature. Given the fact that the abdominal x-ray was normal, a CT scan was performed and a voluminous retroperitoneal cystic lesion was discovered. Combining all the preoperative informations the diagnosis was of retroperitoneal abscess by posterior perforation of a gastric ulcer. Surgical intervention was performed, the abscess was evacuated and it’s wall was completely resected; because of local conditions a distal hemigastrectomy with Roux en Y gastro-enteroanastomosis was chosen over gastrorhaphy and omentoplasty.

Spontaneous soft tissue hematomas in patients with severe COVID‑19 infection

Relevance. Spontaneous hematomas (SG) appear after 2–3 weeks from the start of treatment for COVID infection and are observed mainly in elderly people with concomitant pathology. The predisposing factors for the development of SG in patients with COVID-19 are coagulopathies. The mortality rate in SG is 04–30 %, while in patients with COVID infection in severe cases increases to 30–50 %. The purpose of the study. To determine the role of coagulological changes in the development of soft tissue SG and to identify the features of the course, taking into account localization in patients with COVID infection. Materials and methods. The results of diagnosis and treatment of 54 patients with spontaneous hematomas were analyzed. The average age was 68.5 years (38–93), there were 45 women (83.3 %), 9 men (16.7 %). Lung damage by CT in most patients was severe. Anticoagulant and antiplatelet therapy was prescribed to all patients from the moment of admission. The management tactics of patients was carried out on the basis of a comprehensive instrumental assessment. Results. SG was mainly observed in retroperitoneal tissue (28) of patients, chest wall (14), rectus abdominis muscle (6), combination of hematoma of preperitoneal and retroperitoneal tissue (3), other localization of neck, hip, mediastinum (3). The volume of SG ranged from 60 to 2850 cm 3 . Unfractionated heparin was used as anticoagulant therapy. All patients had a statistically significant decrease in the level of hemoglobin and erythrocytes relative to the norm during all study periods (p &lt; 0.05). The number of platelets decreased statistically significantly in the group with SG with localization in retroperitoneal tissue and in the chest (p &lt; 0.05). The level of PH at admission was reduced in patients with SG with localization in retroperitoneal tissue and in the chest relative to the norm (p&lt;0.05). The value of D-dimer was statistically significantly increased relative to the norm during all study periods in all groups. The treatment was aimed at correcting hemostasis, hemotransfusion with a decrease in hemoglobin levels below 60 g/l, plasma transfusion and thromboconcentrate. Conclusions. The severity of patients with SSG of various localization is due not only to the volume of SG against the background of COVID infection, but also to a variety of concomitant diseases, features of localization, volume and nature of SG. In patients who initially have deviations in the indicators of the hemostasis system, the risk of OHSS is higher, they need to more carefully select the optimal doses and the course of thromboprophylaxis. Early diagnosis using ultrasound, CT, X-ray endovascular hemostasis against the background of hemostatic therapy contributes to the stabilization of the condition and a favorable outcome.

Simplifying Retroperitoneal Robotic Single-port Surgery: Novel Supine Anterior Retroperitoneal Access

BackgroundMultiport robotic surgery in the retroperitoneum is limited by the bulky robotic frame and clashing of instruments. Moreover, patients are placed in the lateral decubitus position, which has been linked to complications. ObjectiveTo assess the feasibility and safety of a supine anterior retroperitoneal access (SARA) technique with the da Vinci Single-Port (SP) robotic platform. Design, setting, and participantsBetween October 2022 and January 2023, 18 patients underwent surgery using the SARA technique for renal cancer, urothelial cancer, or ureteral stenosis. Perioperative variables were prospectively collected and outcomes were assessed. Surgical procedureWith the patient in a supine position, a 3-cm incision is made at the McBurney point and the abdominal muscles are dissected. Finger dissection is used to develop the retroperitoneal space for the da Vinci SP access port. After docking, the first step is to dissect retroperitoneal tissue to reveal the psoas muscle. This allows identification of the ureter, the inferior renal pole, and the hilum. MeasurementsA descriptive statistical analysis was performed. Data collected included demographics, operative time, warm ischemia time (WIT), surgical margin status, complications, length of hospital stay, 30-d Clavien-Dindo complications, and postoperative narcotic use. Results and limitationsTwelve patients underwent partial nephrectomy (PN) and two each underwent pyeloplasty, radical nephroureterectomy, and radical nephrectomy. In the PN group, mean age was 57 yr (interquartile range [IQR] 30–73), median body mass index was 32 kg/m2 (IQR 17–58), and 25% had stage ≥3 chronic kidney disease. The median Charlson comorbidity index was 3 (IQR 0–7) and 75% of PN patients had an American Society of Anesthesiologists score ≥3. The median RENAL score was 5 (IQR 4–7). The median WIT was 25 min (IQR 16–48) and the median tumor size was 35 mm (IQR 16–50). The median estimated blood loss was 105 ml (IQR 20–400) and the median operative time was 160 min (IQR 110–200). Positive surgical margins were found in one patient. In the overall cohort, one patient was readmitted and managed conservatively; 83% of the PN group were discharged on the same day as their surgery, with the remainder discharged the next day. At 7 d after surgery, no patients reported narcotic use. ConclusionsThe SARA approach is feasible and safe. Larger studies are needed to confirm this approach as a one-step solution for upper urinary tract surgery. Patient summaryWe assessed initial outcomes of a novel approach for accessing the retroperitoneum (the space behind the abdominal cavity and in front of the back muscles and spine) during robot-assisted surgery in the upper urinary tract. The patient is placed on their back and surgery is performed with a single-port robot. Our results show that this approach was feasible and safe, with low complication rates, less postoperative pain, and earlier discharge. This is a promising start, but larger studies are needed to confirm our findings.

E001 Retroperitoneal fibrosis patients need a dedicated multidisciplinary team

Abstract Background/Aims Retroperitoneal fibrosis is a rare chronic inflammatory fibrosing condition of the retroperitoneal tissues. Inflammation can cause tethering and occlusion of nearby structures, especially the ureters, leading to acute obstruction as well as long-term renal impairment. This condition usually either presents with nonspecific abdominal pain or when the patient is in crisis due to urological obstruction. There is little known about its treatment beyond steroids. A significant proportion of patients are at risk of relapse. We characterised patients with retroperitoneal fibrosis in our heath board to better understand how these patients present and what the unmet needs in their management are. Methods Patients were identified by contacting rheumatologists and by searching the urological stent registry from 2019 to 2022. The records were searched for demographics, events around diagnosis, initial treatment, investigations, including imaging reports and pathology, as well as follow up clinic letters detailing any relapses and complications. Results We found 22 patients in the health board with idiopathic retroperitoneal fibrosis. Half had sole care under urology. Only 6 received joint care from urology and rheumatology. Demographics of these patients were comparable to literature (mean age 60 (range 43-81 years), female to male ratio (1:2.6), compared to the reported mean age of 55-60 and female to male ratio of 1:2). Diagnosis was usually made by CT scan. The mean incidence of new diagnosis was 2 per year over the last 10 years in a catchment population of 850,000. In 19 patients with treatment information available, 4 never received steroids or immunomodulation therapy. For those that received steroid therapy, doses ranged from 0.2mg/kg to 0.8mg/kg over a range of 1 week to 6 months of maximum dose duration. 73% of patients now have chronic renal dysfunction with eGFR &amp;lt;60ml/min/1.73m2, and 27% with stage 4 renal failure with eGFR &amp;lt;30 ml/min/1.73m2. One of these patients had end stage renal disease and is deceased. Conclusion This characterisation study has shown that patients have had heterogenous journeys with their RPF diagnosis and treatment. 73% of these patients have developed chronic renal dysfunction which is dramatically higher than that of the published literature figure of 32%. In order to improve outcomes, there is a need for a standardized approach to diagnosis, treatment and follow up, involving a dedicated multidisciplinary team. Disclosure E. Qian: None. H. Harris: None.