Retroperitoneal Research Articles

Intraoperative Anteropulsion of an Interbody Fusion Cage During Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Case Report

Expandable cages are very commonly used during minimally invasive lumbar interbody fusion surgery for better restoration of sagittal alignment. We present a rare event of intraoperative expandable cage anteropulsion into the retroperitoneal space. To date, several cases of cage migration have been reported. However, ours is the first case of intraoperative anterior cage migration during minimally invasive lumbar fusion. Herein, we present a case of 70-year-old female planned for minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) for grade II L5–S1 lytic spondylolisthesis. There was an unnoticed anterior longitudinal ligament rupture during the cage expansion manoeuvre. Cage dislodgment was noticed intraoperatively. This was managed by compression of the interbody site posteriorly and insertion of another snugly fitting bullet cage, followed by anterior retroperitoneal exploration in the same setting to retrieve the migrated cage. The patient’s postoperative course was satisfactory. At a 1-year follow-up, patient was ambulatory and asymptomatic. Follow-up imaging showed bony fusion and no signs of implant failure. Expandable TLIF cages can cause iatrogenic release of the anterior longitudinal ligament during expansion. Surgeons must be aware of this rare complication, which can result in anterior cage migration.

До питання про рідкісні захворювання, які маніфестують у дітей лихоманкою і соматичним болем. Клінічний випадок

Neuroblastoma is one of the most common tumor in the pediatric population, with the frequent localization in the retroperitoneal space. In the early stages disease can be asymptomatic and complicates diagnostic. The initial manifestations are not specific and can be considered as symptoms of different diseases. Purpose - to analyze and note some "red flags" of certain rare diseases that allow to suspect these diseases in children with fever and somatic pain. The article presents the data and clinical observation of a child with neuroblastoma with rapid progressive development and rapid metastasis. The features of the course and complications of the primary differential diagnosis of a malignant tumor process are described in a 3-year-old boy. The child was taken to the SI «Institute of Pediatrics, Obstetrics and Gynecology named of academician O.M. Lukyanova NAMS of Ukraine» with complaints of back pain, refusal to walk, weight loss and fever. The child was transferred to the intensive care unit for hemotransfusion due to progressive negative dynamics of the condition (pronounced pain syndrome, intoxication syndrome, oliguria). After demonstration an improvement the boy with the diagnosis of «Retroperitoneal neoplasm (neuroblastoma?), neoplasm of the left hand, neoplasm of the sternum; severe anemia of complex genesis; pathological compression fractures of vertebral bodies Th3, Th10, Th12 and L2; secondary hypoparathyroidism; functional bowel disorder; moderate degree of hypermetropia, strabismus, partial atrophy of the optic nerve» was transferred to the National Cancer Institute in the department of pediatric oncology for further examination and determination of the tactics of further therapy, where MRI of the brain and spinal cord with contrast, SCT of the head, chest, abdomen, pelvis, and bone biopsy were performed. This case will help pediatricians to suspect the presence of a tumor in the early stages and refer them to specialized specialists for the further examination as early as possible. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Perirenal fat thickness as a superior obesity-related marker of subclinical carotid atherosclerosis in type 2 diabetes mellitus.

Emerging evidence highlighted that perirenal adipose tissue might regulate the cardiovascular and metabolism system through several pathways. This study aimed to assess the association between perirenal fat thickness (PrFT) and subclinical carotid atherosclerosis (SCCA) in type 2 diabetes mellitus (T2DM). A total of 670 participants with complete data were included in this study. The trained reviewer collected demographic and anthropometric information. Laboratory assessments were determined by standard methods. PrFT and SCCA were evaluated by computed tomography and ultrasound. Binomial logistic regression analysis was conducted to assess the association between PrFT and SCCA. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the identifying value of PrFT for SCCA. Overall, the prevalence of SCCA was 61.8% in T2DM. PrFT was significantly increased in the SCCA group. Growing trends were observed in the prevalence of hypertension, carotid intima-media thickness (cIMT) > 1, plaque, and SCCA across the PrFT quartiles. Spearman correlation analysis revealed that PrFT was positively associated with cIMT (r = 0.401, p < 0.001). This correlation remained significant after adjustment for visceral fat area (VFA), subcutaneous fat area (SFA), and traditional metabolic risk factors (β = 0.184, p < 0.001). Meanwhile, PrFT was independently correlated with plaque, cIMT > 1 mm, and SCCA. The ORs (95% CI) were 1.072 (1.014-1.135), 1.319 (1.195-1.455), and 1.216 (1.119-1.322). Furthermore, PrFT remained correlated considerably with SCCA in subgroup analysis after stratification for age, sex, smoking, hypertension, and body mass index. From the ROC curve analysis, the AUCs (95% CI) of PrFT, VFA, and SFA identifying SCCA were 0.794 (0.760-0.828), 0.760 (0.724-0.796), and 0.697 (0.656-0.737), respectively. The AUC of PrFT was significantly higher than VFA (p = 0.028) and SFA (p < 0.001). The optimal cutoff values of PrFT were 14.0 mm, with a sensitivity of 66.7% and a specificity of 76.2%. PrFT was independently associated with cIMT, plaque, cIMT > 1 mm, and SCCA as a superior obesity-related marker of SCCA in T2DM. Clinical Trials.Gov, identifier ChiCTR2100052032.

Adipose tissue depot specific expression and regulation of fibrosis-related genes and proteins in experimental obesity.

Transforming growth factor beta (Tgfb) is a well-studied pro-fibrotic cytokine, which upregulates cellular communication network factor 2 (Ccn2), collagen, and actin alpha 2, smooth muscle (Acta2) expression. Obesity induces adipose tissue fibrosis, which contributes to metabolic diseases. This work aimed to analyze the expression of Tgfb, Ccn2, collagen1a1 (Col1a1), Acta2 and BMP and activin membrane-bound inhibitor (Bambi), which is a negative regulator of Tgfb signaling, in different adipose tissue depots of mice fed a standard chow, mice fed a high fat diet (HFD) and ob/ob mice. Principally, these genes were low expressed in brown adipose tissues and this difference was less evident for the ob/ob mice. Ccn2 and Bambi protein as well as mRNA expression, and collagen1a1 mRNA were not induced in the adipose tissues upon HFD feeding whereas Tgfb and Acta2 mRNA increased in the white fat depots. Immunoblot analysis showed that Acta2 protein was higher in subcutaneous and perirenal fat of these mice. In the ob/ob mice, Ccn2 mRNA and Ccn2 protein were upregulated in the fat depots. Here, Tgfb, Acta2 and Col1a1 mRNA levels and serum Tgfb protein were increased. Acta2 protein was, however, not higher in subcutaneous and perirenal fat of these mice. Col6a1 mRNA was shown before to be higher in obese fat tissues. Current analysis proved the Col6a1 protein was induced in subcutaneous fat of HFD fed mice. Notably, Col6a1 was reduced in perirenal fat of ob/ob mice in comparison to the respective controls. 3T3-L1 cells express Ccn2 and Bambi protein, whose levels were not changed by fatty acids, leptin, lipopolysaccharide, tumor necrosis factor and interleukin-6. All of these factors led to higher Tgfb in 3T3-L1 adipocyte media but did not increase its mRNA levels. Free fatty acids induced necrosis whereas apoptosis did not occur in any of the in vitro incubations excluding cell death as a main reason for higher Tgfb in cell media. In summary, Tgfb mRNA is consistently induced in white fat tissues in obesity but this is not paralleled by a clear increase of its target genes. Moreover, discrepancies between mRNA and protein expression of Acta2 were observed. Adipocytes seemingly do not contribute to higher Tgfb mRNA levels in obesity. These cells release more Tgfb proteinwhen challenged with obesity-related metabolites connecting metabolic dysfunction and fibrosis.

Can 3D visualisation and navigation techniques improve pancreatic surgery? A systematic review

Pancreatic cancer, namely pancreatic ductal adenocarcinoma (PDAC), is an intractable cancer with a 5-year survival of around 7%-10%. Surgery with adjuvant chemotherapy remains the mainstay of curative treatment. The pancreas is a retroperitoneal organ that lies close to major arterial and venous structures, and it is the involvement of these structures that currently technically limits surgical resection with curative intent for pancreatic cancer. It is possible to resect venous and arterial structures involved in cancer to expand options for patients for whom surgery was previously deemed infeasible, but this is best performed in high-volume pancreatic surgery centres. Here, we explore the role that 3D visualisation and navigation surgery have in improving preoperative planning and operative execution, the role they may play in training and education and in enabling the development of novel surgical techniques in pancreatic surgery.

Renal stiffness measured by shear wave elastography and its relationship with perirenal fat in patients with chronic kidney disease.

This study aimed to utilize shear wave elastography (SWE) to assess changes in renal stiffness and its influencing factors in patients with chronic kidney disease (CKD) across different estimated glomerular filtration rate (eGFR) categories. It also sought to determine the correlation between perirenal fat (PF) and renal stiffness at various stages of CKD. A total of 190 CKD patients and 50 healthy controls were evaluated. Clinical parameters, conventional renal ultrasound measurements, PF, and renal stiffness trends were assessed separately. Factors independently associated with renal stiffness and PF were further analyzed. Renal parenchymal stiffness was significantly higher in the Albumin-CKD G1-2 (ALB-CKD G1-2) and CKD G3 groups than in the control group (p < 0.05). The parenchymal stiffness of the CKD G3 group was higher than that of the ALB-CKD G1-2 group (p < 0.05). The independent factors of renal parenchymal stiffness varied at different stages of disease development, with eGFR and PF being significant factors in the CKD G3 group. PF was elevated in the ALB-CKD G1-2 and CKD G3 groups compared to the control group, and the independent factors of PF varied across different stages, although waist circumference remained a common factor. Using SWE to detect renal elastic moduli can effectively assess changes in renal stiffness in patients with CKD with varying eGFRs. PF is an independent factor of renal stiffness in patients with CKD G3, providing a foundation for early diagnosis and clinical treatment.

Thickened Perirenal Fat Predicts Poor Renal Outcome in Patients with Immunoglobulin A Nephropathy: A Population-Based Retrospective Cohort Study

Introduction: Perirenal fat is a pad that fills the retroperitoneal space outside the kidney, which affects kidney function in various ways. However, the association between perirenal fat and IgA nephropathy (IgAN) has not yet been elucidated. This study aimed to investigate the role of perirenal fat in predicting IgAN progression. Methods: A total of 473 patients with biopsy-proven IgAN and follow-up information were recruited, and perirenal fat thickness (PFT) was measured using color Doppler ultrasonography at renal biopsy. Patients were divided into two groups according to the median PFT: the low-PFT group (PFT ≤1.34 cm, n = 239) and the high PFT group (PFT >1.35 cm, n = 234). A total of 473 healthy participants were included in the control group. Basic clinical characteristics were assessed at the time of renal biopsy, and the relationship between PFT and combined endpoints was analyzed. The renal composite endpoints were defined as a two-fold increase in blood creatinine level, end-stage renal disease (dialysis over 3 months). Kaplan-Meier survival analysis was used to explore the role of PFT in the progression of IgAN. Three clinicopathological models of multivariate Cox regression analysis were established to evaluate the association between PFT and renal prognosis in patients with IgAN. Results: Compared to healthy subjects, patients with IgAN showed significantly higher PFT. After a median follow-up of 50 months, 75 of 473 patients (15.9%) with IgAN reached renal composite endpoints. Among those, 13 of 239 patients (5.4%) were in the low PFT group, and 62 of 234 patients (26.5%) were in the high PFT group (p < 0.001). The results of three Cox regression models (including demographics, pathological and clinical indicators, and PFT) demonstrated that a higher PFT was significantly associated with a higher risk of reaching renal composite endpoints in patients with IgAN. Conclusion: This study indicated a positive relationship between PFT at renal biopsy and renal progression in patients with IgAN, suggesting that perirenal fat might act as a marker of poor prognosis in patients with IgAN.

Anterior lumbar interbody fusion (ALIF): a review of the procedure and associated complications

Degenerative disc disease and facet joint disease involving the lumbar spine are common in the aging population and are the most frequent causes of disability. Surgical interbody fusion of degenerative levels is the most common management technique. This is an effective treatment option to stabilize the spine and reduce mechanical pain and provides indirect decompression of the neural elements while restoring lordosis and correcting the deformity. Depending on the direction of the approach to the vertebral column, various techniques have been described. Anterior lumbar interbody fusion (ALIF) offers clear and wide visualization of the disc allowing the use of large interbody grafts, which provide a significant biomechanical advantage over other types of fusion. The transperitoneal approach is a much older technique and it is not commonly performed unless in isolated cases with extensive retroperitoneal scaring following multiple abdominal surgeries. The transperitoneal approach has been associated with higher rates of bowel injury, ileus, and retrograde ejaculation, and is limited at the L5–S1 segment, hence many spine surgeons favor a retroperitoneal approach. The major setback of ALIF is the need for great vessel mobilization. This manipulation of the vessels may lead to deep vein thrombosis and a direct vascular injury. This makes vascular anatomy studies in the preoperative stage invaluable in avoiding vascular injury. Other complications include possible injury to intraperitoneal and retroperitoneal organs, especially in patients with previous surgery and adhesions. Manipulation of the intestines causes postoperative ileus which lasts a few days. Sexual dysfunction in form of retrograde ejaculation is another complication seen in patients following ALIF and this has been attributed to injury to the superior hypogastric sympathetic nerves in the lower lumbar region.This article reviews the ALIF procedure i. e., transperitoneal and retroperitoneal approaches, and the associated intraoperative, early, and late complications.

The First Ever Robotic-Assisted Laparoscopic Radical Nephrectomy with Inferior Vena Cava Thrombectomy Performed in Thailand: A Case Report of Atypical Presentation of Urothelial Carcinoma with Tumor Thrombus

Background: Robotic-assisted surgery was proposed as an alternative to open surgery for management of inferior vena cava (IVC) thrombus together with radical nephrectomy in complex renal mass. Here, the authors reported the first case of this type to be managed via this surgical technique in Thailand. Case Report: A 76-year-old Thai female presented with right renal mass with tumor thrombus in the IVC extending 3 cm above the level of the renal vein. The presumed diagnosis was renal cell carcinoma of the right kidney with level 2 tumor thrombus in IVC, clinical staging T3bN0M0. The patient underwent robotic-assisted laparoscopic IVC thrombectomy together with right radical nephrectomy at Siriraj Hospital (Bangkok, Thailand) in May 2020. Results: The operation proceeded uneventfully without immediate complication. The postoperative reduction of IVC diameter was approximately 30%. Total IVC clamp time was 50 minutes, operative time was five hours, with docking time of 20 minutes and console time of 250 minutes, estimated intraoperative blood loss was 2,600 mL, and length of hospital stay was four days. At 30-days and 90-days postoperation, no thromboembolic event or compromising lower extremity venous return was detected. The pathological report revealed high-grade urothelial cell carcinoma with invasion into perinephric fat. Carcinoma involvement was observed in the tumor thrombus and IVC wall (T4N0M0). Conclusion: Robotic-assisted surgery of the IVC is a complex operation that requires robotic surgical proficiency and a highly experienced team. The observed success in the present case demonstrated the feasibly of this procedure in Thailand. Additional benefits include less postoperative pain, reduced blood loss, smaller surgical wound size, and shorter length of hospital stay. Keywords: Robotic-assisted laparoscopic radical nephrectomy; Inferior vena cava thrombectomy; Thailand

Gossypiboma Post Cesarean Section: Patient Safety Review

Background: Operations in the pelvic area including cesarean section are often followed by unwanted events in the form of missing surgical instruments. The surgical device that is most often left behind during operations is surgical gauze and is known as a gossypiboma. Surgical gauze is often left in body cavities such as the peritoneum, pelvis, and retroperitoneal spaces. This surgical gauze can remain in the body for days, months, or even years before manifesting clinically. A granulomatous reaction around the surgical gauze may produce exudate followed by the formation of an abscess or fibrotic mass. Objective: To see the aspect of patient safety in cases of gossypiboma after cesarean section. Methods: Serial report of gossypiboma cases after cesarean section. Results and Discussion: Three cases of gossyfiboma were reported after cesarean section in Bali in 2017-2018. The diagnosis is made clinically according to complaints, and history of cesarean section and supported by supporting examinations such as BOF (Book-on-Filter), Ultra Sonography, and Computerized Tomography-Scan. Various surgical procedures were performed including sub-total colectomy laparotomy, right hemicolectomy laparotomy, and Hartman procedure laparotomy. All operations went well with good results too. Patient safety approaches and procedures must be carried out strictly to prevent a recurrence. Conclusion: Reports of three cases of gossypiboma after caesarean section are strongly related to patient safety procedures that are not performed in the operating room.

Changes in Body Reserves, Non-Esterified Fatty Acids, and Leptin during the Reproductive Lifespan of the Rabbit Female.

The aim of this work is to study changes in body weight, perirenal fat thickness (PFT), and non-esterified fatty acid (NEFA) and leptin concentrations throughout the reproductive life of the rabbit female and their correlations when a semi-intensive reproductive rhythm is applied. A total of 46 lactating females were used. Body weight, PFT, and NEFA and leptin concentration were recorded at 12 weeks of age, at first mating and delivery, and at second, third, and fourth mating, 12th d of gestation, and delivery. The highest body weight was detected on the 12th d of any gestation, around 4280 g, and the lowest weight was at delivery, around 4030 g. PFT increased until third mating. NEFA and leptin concentration showed a cyclical pattern throughout the reproductive lifespan of the females. NEFAs presented the highest concentration at delivery within each reproductive cycle and levels decreased over the course of the deliveries (0.423 mmol/L at first delivery, 0.406 mmol/L at second delivery, 0.371 mmol/L at third delivery, and 0.309 mmol/L at fourth delivery). Similar NEFA concentrations at mating and on the 12th d of gestation were obtained. Leptin showed the highest concentrations at mating within each reproductive cycle. Leptin decreased between mating and delivery in all reproductive cycles and it was close to 1 ng/mL HE. Low or null correlations were shown between body weight, PFT, and NEFA and leptin concentration at mating, 12th d of gestation, and delivery. In conclusion, females are able to maintain a semi-intensive reproductive rhythm across four parities weighing around 4 kg from first mating. Females had an increased perirenal fat thickness until third delivery, and their NEFA concentration was maximum at delivery and leptin concentration was maximum at mating. Body weight, PFT, and NEFA and leptin concentration should be measured during critical moments of reproductive life in order to determine body condition and energy mobilization, due to their low or null correlations.

Predictive factors and oncological outcomes of pathological T3a upstaging in patients with clinical T1 renal cell carcinoma undergoing partial nephrectomy.

To investigate predictive factors and oncological outcomes of pathological T3a upstaging in renal cell carcinoma patients who were initially diagnosed as clinical T1 and treated with partial nephrectomy. The clinical records and survival data of 1617 patients, who had undergone partial nephrectomy for clinical T1 renal cell carcinoma at Tokyo Women's Medical University, Tokyo, Japan between January 2011 and December 2020, were analyzed retrospectively. Of 1617 clinical T1 renal cell carcinoma patients who underwent partial nephrectomy, 28 (1.73%) had pathological T3a upstaging. In the multivariable analysis for pathological T3a upstaging using logistic regression models, male sex and clinical T1b were significant factors associated with pathological T3a upstaging (male sex: odds ratio=5.07, 95% confidence interval: 1.18-21.8, clinical T1b: odds ratio=8.36, 95% confidence interval: 3.56-19.6). The Kaplan-Meier method of the recurrence-free survival showed shorter recurrence-free survival in patients with pathological T3a upstaging than in those with pathological T1 (P<0.0001). In the multivariable analysis using Cox proportional hazards regression models, pathological T3a upstaging was no longer significantly associated with recurrence-free survival after adjustment for other pathological factors (hazard ratio=1.59, 95% confidence interval: 0.58-4.36). In a sensitivity analysis that analyzed its components individually instead of whole pathological T3a, neither perinephric fat invasion, sinus fat invasion, nor renal vein invasion was associated with recurrence-free survival. Male sex and clinical T1b were significant predictors for pathological T3a upstaging after partial nephrectomy in clinical T1 renal cell carcinoma patients. Although patients with pathological T3a upstaging had worse recurrence-free survival compared with those without upstaging, multivariable analyses revealed that pathological T3a upstaging was not an independent predictor for poor recurrence-free survival.

Liposarcoma of the Thyroid Gland: A Case Report

Abstract: Liposarcoma is one of the most common soft tissue tumors in adults. Liposarcoma is usually found in retroperitoneal organs and extremities, but rarely in the thyroid gland. We presented a case of dedifferentiated liposarcoma in the thyroid gland. A 56-year-old woman with a history of a lump in her neck for ten years. Malignancy was suspected due to the local extension of the tumor, therefore, complete resection of the tumor was performed. Histopathological examination showed a dedifferentiated liposarcoma. Two months post-surgery, the patient suffered from lung and brain metastases and was treated with lenvatinib. The complaints reduced and there was no significant side effect during therapy. The treatments for liposarcoma are surgery, radiotherapy, chemotherapy, and targeted therapy. Surgery followed by radiotherapy and chemotherapy is the option in the treatment of liposarcoma. This patient underwent surgery with the histopathological result of dedifferentiated thyroid liposarcoma. In the nine-month follow-up of therapy, there were no complaint of the patient. In this case, dedifferentiated liposarcoma in the thyroid gland with metastases was treated surgically followed by lenvatinib administration gave satisfactory result. Keyword: liposarcoma; thyroid gland; dedifferentiated liposarcoma; malignant tumor

FRI240 Aspirin Induced Adrenal Hemorrhage: Rare Side Effect Of A Common Medication!

Abstract Disclosure: H.A. Qadeer: None. R. Samkutty: None. V. Singh: None. Introduction: Adrenal hemorrhage is a heterogeneous disorder with various clinical presentations. Bilateral adrenal hemorrhage can result in acute adrenal insufficiency that can be fatal. With the increasing use of DOAC, cases of anticoagulation therapy induced adrenal hemorrhage have been reported. We present a rare case of unilateral adrenal hemorrhage in a patient with pre-existing adrenal myelolipoma after using Aspirin. Based on our literature search, previously only two cases of Aspirin Induced adrenal hemorrhage in a stable adrenal mass have been reported. Case Presentation: 55-year-old male with history of stable 6.2 cm right adrenal gland myelolipoma, fatty liver disease and hypertension, recent use of 2 doses 81 mg Aspirin after receiving right shoulder replacement surgery presented to emergency department with acute onset right sided flank pain, constant, radiating to the back and right upper quadrant associated with an episode of vomiting. He was hemodynamically stable. Blood work showed normal electrolytes, liver function and renal function at baseline. Hemoglobin was stable around 10g/dL. CT scan abdomen/pelvis with contrast showed increase in the size of a previously stable adrenal myelolipoma to 12.9 x 15.6 cm with mass effect upon the liver. Acute hemorrhage was suspected with the blood extending beyond the margins of the mass into the right retroperitoneal space, displacing the right kidney. On admission, aspirin was discontinued. With absence of hemodynamic instability, normal electrolytes, and normal AM cortisol level of 11.9 mcg/dL, adrenal insufficiency was ruled out. Hormonal work up for hyperfunctioning adrenal tumor was performed that ruled out pheochromocytoma, Cushing syndrome and Primary Aldosteronism. With symptomatic improvement, absence of progression of adrenal hemorrhage on repeat CT scan of the abdomen/pelvis, patient was discharged home. He received IR guided embolization of the right superior adrenal artery and middle adrenal artery in the outpatient setting. Discussion: Spontaneous adrenal gland hemorrhage is a rare event. Bilateral adrenal hemorrhage is associated with acute adrenal insufficiency that can be fatal. Major risk factors for adrenal hemorrhage include anticoagulant therapy, heparin Induced thrombocytopenia, hypercoagulable state, trauma and sever sepsis. Here we have reported a rare case of adrenal gland hemorrhage with therapeutic dose of aspirin used after orthopedic surgery. Aspirin is a very commonly used medication and high index of suspicion is required to avoid this side effect as Immediate discontinuation of the medication is necessary to prevent progression of the disease. Conclusion: Aspirin use can be associated with progression of stable benign adrenal tumors by causing spontaneous hemorrhage. A high index of clinical suspicion is required for timely recognition of this side effect. Presentation: Friday, June 16, 2023

THU297 Metformin Treatment Of Juvenile Mice Alters Aging-Related Developmental And Metabolic Phenotypes In Sex-Dependent And -Independent Manners

Abstract Disclosure: Y. Zhu: None. M. Engmann: None. D. Medina: None. A. Bartke: None. B.S. Ellsworth: None. R. Yuan: None. Metformin is a widely used drug for the treatment of type 2 diabetes that also has a strong potential for long-term effects which may extend healthspan and longevity. In the current study, C57BL/6J (B6) juvenile female and male mice were treated with metformin between the ages of 15 and 56 days. Saline was used as the control. The results show that early-life treatment with metformin has profound effects on developmental and metabolic traits. Body weight was significantly reduced by metformin treatment in both sexes (P&amp;lt;0.05, t test). At 10 weeks of age, mice were euthanized, and organ weights were recorded. In treated males, weights of epididymal, perirenal, and brown fat depots were significantly reduced (P&amp;lt;0.05, t test). Pancreas weight was significantly reduced in both sexes (P&amp;lt;0.05, t test). Hypothalamus weight was significantly reduced in the females, and whole brain weight was significantly reduced in the males. Tail length as well as age of sexual maturation were not significantly altered in either sex. No significant difference was found in circulating insulin-like growth factor 1 (IGF1) or adiponectin. Circulating insulin was significantly reduced by the treatment under fasting and non-fasting conditions in the male mice, while in the females no significant difference was detected. Insulin sensitivity, calculated by the quantitative insulin-sensitivity check index (QUICKI), was suggestively increased in the male mice (P=0.062, t test). Glucose tolerance test (GTT) did not show a significant difference in treated female mice; however, comparing the area under curve, metformin treatment significantly improved the glucose tolerance of male mice (P=0.014, t test). Insulin tolerance test (ITT) showed no significant difference in the male mice; but, unexpectedly, in female mice, metformin treatment significantly reduced insulin sensitivity. This study revealed that early-life metformin treatment alters development and metabolism of mice in both sex-specific and non-specific manners, which may have long-term impacts on metabolism in aging. Interestingly, comparing the results of this study with previous studies of metformin-treated heterogenous UM-HET3 mice, further analyses revealed that metformin effects on body weight, age of sexual maturation, body size, IGF1, adiponectin, insulin, GTT, and ITT, are genetically dependent. Funding: SIU collaborative grant to Rong Yuan and Buffy S. Ellsworth. SIU Geriatric foundation by Andrzej Bartke Presentation: Thursday, June 15, 2023

Old meets new: vNOTES retroperitoneal promontory fixation in conjunction with the uterus preserving Manchester procedure.

The Manchester procedure is a classic native tissue prolapse technique with low recurrence and low complication rate. vNOTES (vaginal natural orifice transluminal endoscopic surgery) is a vaginal approach to enter the intra or retroperitoneal space, with the guidance of endoscopic visualization. Different studies have shown women to prefer uterus-preserving correction of prolapse over hysterectomy, as they worry about complications, impact on sexual function and self- sense. At the same time, an increasing caution and awareness of mesh related complications has evolved, giving a need for the development of additional non-mesh uterus preserving surgical techniques for prolapse. The aim with the video is to show a new surgical technique for prolapse, combining the Manchester procedure with vNOTES retroperitoneal non-mesh promontory hysteropexy.

Robotic-Assisted Single-Position Prone Lateral Lumbar Interbody Fusion: Indications, Techniques, and Outcomes.

Robotic-Assisted Single-Position Prone Lateral Lumbar Interbody Fusion: Indications, Techniques, and Outcomes.

Ultrasound Diagnosis and Behaviors in Cases with Encapsulated and Unrestricted Liquid Collections into Body Cavities

Purpose: We present our experience in the diagnosis, follow-up and planning therapy of thoracic, abdominal and retroperitoneal liquid collections in different emergency patients using conventional and interventional ultrasound. Material and Methods: The right and left oblique and propositioning view was used in 235 patients/159 male and 76 female/ for US examination to identify fluids in the thorax and peritoneal or retroperitoneal space. The examination was performed after the clinical survey with patient’s supine. Positive findings of US were compared with those provided by CT, punctures under US control or surgery. US machine supplied with linear and convex transducers, CT machine, needles and catheters were used. Results: 197 of all 235 US examined patients had fluid collections, confirmed by CT scan, surgery or clinical course. In 156 patients we performed FN diagnostic punctures under US control. There was 155 true-positives, 25 true-negatives, 5 false-positives and 2 false-negative results. Overall this demonstrated that ultrasonography have sensitivity of 98.72%, specificity of 83.33% and accuracy of 96.25 %. The PPV is 96.87% and the NPV – 92.59%. Conclusions: Our experience and literature reports support the opinion that US examination can and should be used as a primary method for diagnosis and follow-up of clinically suspected free and organized fluids in the thorax, abdomen and retroperitoneum.

X-ray diagnostics of fire damage vessels of the abdominal cavity of the retroperitoneal space

This article deals with the analysis of damage to the main vessels of the abdominal cavity. In particular, the article is devoted to the radiological diagnosis of damage to the vessels of the abdominal cavity caused by gunshot wounds. The article examines various methods and technologies of using X-ray and computer tomographic imaging for accurate localization and characterization of damage to the vascular bed. The author of the article emphasizes the importance of the clinical significance of such a diagnosis, its advantages, and possible limitations in its use for effective treatment of victims. A detailed review of foreign research was conducted to adapt and study the existing world experience in the direction of research for the opportunity to provide timely and high-quality assistance to victims.&#x0D; The aim. The aim of the work is the theoretical substantiation of gunshot injuries to the main vessels of the abdominal cavity of the retroperitoneal space.&#x0D; Scientific novelty. For the first time, a detailed analysis of damage to the main vessels of the abdominal cavity of the retroperitoneal space was carried out.&#x0D; Materials and methods. Analysis of theoretical sources, comparison, induction of isolated analytical data. The research was conducted on the basis of the repository of scientific texts of the State Institution "Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine".&#x0D; Results. It was determined that with the help of MSCT-angiography, signs of damage to the main vessels of the abdominal cavity can be accurately diagnosed, additional information about damage to bone structures, neighbouring organs and tissues is obtained.&#x0D; Conclusions. It was determined that MSCT-angiography has become the main method of assessing gunshot injuries to the vessels of the abdominal cavity. Using this method allows you to accurately determine the location and nature of injuries, which helps doctors in choosing the optimal treatment plan for affected patients. However, it is important to consider the possible limitations of this method and to develop additional diagnostic strategies for a complete and comprehensive assessment of vascular injuries

COMPARATIVE HISTOLOGICAL CHARACTERISTICS OF CHANGES IN ANTERIOR ABDOMINAL WALL TISSUES AFTER IMPLANTATION OF «CAPROMESH» MESH IN COMBINATION WITH PRP AND «LIGHT» POLYPROPYLENE MESH IN AN EXPERIMENT

A systematic review of a recently published meta-analysis shows that laparoscopic and open allogeneoplasty is a safe procedure with relatively short-term and long-term results. A new minimally invasive technique has been developed that allows the mesh to be placed in the retroperitoneal space through a small transhernial incision, avoiding signifi cant trauma to the abdominal wall and contact with the abdominal cavity. However, this type of operation does not involve fi xation of the mesh in the retromuscular space, which can lead to a number of complications. The analysis of the obtained results determines the relevance of this study.Objective. To compare the features of the ultrastructural reaction of the tissues of the muscle- aponeurotic layer of tissues to the implantation of «Capromesh» in combination with PRP and polypropylene meshes in an experiment.Material and methods. The study was conducted on 16 same-sex pigs of the Vietnamese breed weighing at least 10 kg, which were divided into 2 groups. Histological and ultrastructural changes in the tissues of the muscle- aponeurotic layer of the anterior abdominal wall after implantation in the retromuscular space of «Capromesh» in combination with PRP (plasma enriched with growth factors) and polypropylene meshes were studied in the experiment.The results. A signifi cant diff erence in tissue reactions at diff erent times of the experiment on the implanted material was proven. The conducted microscopic and electron microscopic studies after the implantation of the «Capromesh» mesh in combination with PRP established that starting from the 7th day of the experiment, the infl ammatory changes in the tissues of the muscle- aponeurotic layer are not as signifi cant as during the implantation of the polypropylene mesh. Starting from the 14th day of the experiment, the signs characterizing the reduction of the infl ammatory reaction and the more intense formation of fi brous structures around the mesh material are much better expressed. On the 21st day of the experiment, at the microscopic and electron microscopic levels, a signifi cantly smaller number of areas of leukocyte infi ltration, intensive vascularization from the formation of collagen fi bers with the participation of fi broblasts around the «Capromesh» mesh material in combination with PRP was established.Conclusions. The conducted micro- and ultrastructural studies determined the priority of using the «Capromesh» mesh in combination with PRP under the conditions of material selection when performing retromuscular allogeneoplasty.