Single Institution Research Articles

462P Regorafenib for relapsed glioblastoma: Retrospective real-world analysis of a single Institution experience

462P Regorafenib for relapsed glioblastoma: Retrospective real-world analysis of a single Institution experience

A REVIEW OF NEOPLASIA IN PROSIMIANS IN HUMAN CARE FROM 1995 TO 2022.

This retrospective study of neoplasia in prosimians in human care reports histologically diagnosed cases from the archives of a nondomestic species pathology service between 1995 and 2022, primarily submitted from zoological institutions. To date, the only prior retrospective study of neoplasia in prosimians, published in 2009, was conducted with cases from a single institution specializing in prosimian noninvasive research and care. In the present study, a total of 153 neoplasms from 109 individuals were identified in the pathology service archives. The most commonly affected species belonged to the Lemuridae (92/109, 84.4%), particularly ring-tailed lemurs (Lemur catta; 55/109, 50.5%), black-and-white ruffed lemurs (Varecia variegata; 19/109, 17.4%), and red ruffed lemurs (Varecia rubra; 14/109, 12.8%). The digestive (49/153, 32.0%), reproductive (35/153, 22.9%), and integumentary (30/153, 19.6%) systems were most commonly affected. Hepatocellular neoplasia was the most common neoplasm overall (35/153, 22.9%), with a large proportion of hepatocellular carcinoma (23/35, 65.7%), suggesting a possible predisposition to this tumor in prosimians. The findings support aggressive behavior of these tumors in prosimians, and a majority (13/23, 56.5%) of cases had evidence of metastasis at the time of submission. Mammary neoplasia was also common (25/153, 16.3%) and predominantly malignant (18/25, 72.0%), in contrast with previous literature, although metastasis was uncommonly reported. The most common integumentary neoplasms were papillomas (12/30, 40.0%), and one report identified squamous cell carcinoma arising directly from a squamous papilloma. Several tumor types are reported herein for the first time in prosimian species, to the authors' knowledge. A literature review identifying additional cases reported since 2009 is also reported. This study contributes a large number of prosimian neoplasia cases to the existing literature to help determine trends in zoological collections and to inform captive prosimian health management.

Ureteroscopy for Stone Disease in Pediatric Patients with Neurogenic Bladder: A Single Institution Case-control Study

Ureteroscopy for Stone Disease in Pediatric Patients with Neurogenic Bladder: A Single Institution Case-control Study

Five-Year PSMA PET-Based Outcomes of Spot-Scanning Proton Radiation Therapy for Localized Prostate Cancer: A Single Institution Experience

PURPOSE: We report 5-year oncologic outcomes of a prospective series of patients with prostate cancer treated with spot-scanning proton therapy (SSPT).METHODS AND MATERIALS: A prospective registry identified patients with prostate cancer treated with SSPT between January 2016 and December 2018. Five-year overall survival (OS), local control (LC), biochemical failure (BF), regional and distant failures, and adverse events (AEs) were assessed. Biochemical failure was defined as rise in PSA ≥ 2.0 ng/mL above nadir PSA. Baseline-adjusted toxicities were assigned using CTCAE v5.0.RESULTS: With a median follow up of 4.4 years, 284 prostate cancer patients were treated with SSPT. Median total radiation dose was 79.2 Gy over 44 fractions, 70 Gy over 28 fractions, and 38 Gy over 5 fractions for conventional fractionation (CF), hypofractionation (HF), and stereotactic body radiation therapy (SBRT), respectively. Biochemical failure rate for all patients was 6.7%. Five-year LC rates for CF, HF, and SBRT were 100%, 100%, and 97.3%, respectively (p = 0.07). Regional recurrences occurred in 12 (4.2%) patients: 8 treated with CF, 2 with HF, and 2 with SBRT (p = 0.62). Distant failures occurred in 12 patients (4.2%): 5 treated with CF, 7 with HF, and none with SBRT (p = 0.05). Five-year OS for patients treated with CF, HF, and SBRT SSPT were 88.1%, 86.1%, and 97.2%, respectively (p = 0.1). Acute and chronic grade 2+ GI AEs occurred in 8 (2.8%) and 51 (18.0%) patients, respectively. Acute and chronic grade 3+ GI AEs occurred in 3 (1.1%) and 4 (1.4%) patients, respectively. Acute and chronic grade 2+ GU-related AEs were observed in 71 (25%) and 63 (22.2%) patients, respectively. Acute and chronic grade 3+ GU toxicity were observed in 3 (1.1%) and 6 (2.1%) patients, respectively.CONCLUSIONS: SSPT provides high local control rates and excellent oncologic outcomes across different fractionation schedules with low long-term AE rates.

The Importance of Discussing the History of Racism in Medical Student Education.

Racial health disparities are tightly linked to the longstanding and pervasive institution of racism. Efforts to reverse disparities begin with awareness and accountability through education. The health care workforce must be formally educated about racist practices, tools, and ideologies that perpetuate poor health outcomes. This article explores prior efforts to integrate race didactics into medical school education, addresses current legislation, and illuminates lessons learned from a single institution pilot curriculum exploring the history of racism in the field of obstetrics and gynecology. Educating medical school students about the history of racism is an important and necessary tool for positive change.

52584 Efficacy of Fluorouracil as Adjuvant Therapy in Treating Superficial Basal Cell Carcinoma Following Mohs Micrographic Surgery: A Multi-Year Single Institution Retrospective Study

52584 Efficacy of Fluorouracil as Adjuvant Therapy in Treating Superficial Basal Cell Carcinoma Following Mohs Micrographic Surgery: A Multi-Year Single Institution Retrospective Study

Comparative Analysis of Telecytology Versus In-Person Rapid On-Site Evaluation for Fine Needle Aspiration (FNA) Specimens: Insights from a Single Institutional Study

Comparative Analysis of Telecytology Versus In-Person Rapid On-Site Evaluation for Fine Needle Aspiration (FNA) Specimens: Insights from a Single Institutional Study

Glaucoma Surgery SOS: Emergency Department Utilization Greater Among Younger and First-Time Surgical Glaucoma Patients

PurposeTo describe the frequency, findings, and interventions of patients’ emergency department visits after all types of glaucoma surgery DesignRetrospective cohort study SubjectsAll surgical glaucoma patients between 2013 and 2021 MethodsThis single institution study collected demographics, surgery type, and surgical parameters for each patient. Subsequently, for those visiting the emergency department within 50 days of surgery, data was collected on reason for visit, findings, and ophthalmic intervention. Logistic regression models were used to determine the odds of ED visits based on multiple risk factors. Main outcomePostoperative presentation to ED ResultsAmong 9155 surgeries in 5505 patients, 5.7% had ED visits within 50 days, with 46.3% having ocular complaints. Patients with ocular diagnoses presented earlier than those without (p < 0.001). Patients who presented to the ED with an ocular diagnosis were found to be significantly younger than those who did not present (62.2 ± 18.6 vs 65.4 ± 18.0 years old, p < 0.028). Furthermore, white patients were more likely than black patients to present with an ocular diagnosis compared to a non-ocular diagnosis (OR 2.64, 95% CI 1.67-4.18, p<0.001). Patients undergoing their first glaucoma surgery had a much higher chance of presenting to the ED compared to patients who had undergone more than one surgery (OR: 3.75, 95%CI 2.74 – 5.14, p < 0.001). Those who underwent traditional surgeries were more likely than patients with trabecular meshwork bypass stent (TMBS) to present to the ED with an ocular diagnosis (OR: 3.02, 95% CI 1.29 – 7.08, p = 0.011). Filtering surgeries and glaucoma drainage device (GDD) revisions exhibited more vision-threatening conditions than glaucoma drainage devices (p = 0.037 and p = 0.010 respectively). Ophthalmology consultation was sought for 88.0% of ocular diagnoses. Most received medical therapy (71.0%), primarily IOP-lowering drops. ConclusionED visits after glaucoma surgery are infrequent, yet more often seen in younger patients or those undergoing their first glaucoma surgery. TMBS, but not trabecular meshwork excision and/or Schlemm’s canal dilation (TME/SCD), were less likely to present to the ED than traditional surgeries. Filtering surgeries and tube revisions presented more often with visual threatening conditions.

Surgical Explantation of Transcatheter Heart Valves: A Single Institution Experience

Surgical Explantation of Transcatheter Heart Valves: A Single Institution Experience

Nonoperative Management of Glenoid Baseplate Failure in Reverse Shoulder Arthroplasty

BackgroundGlenoid baseplate failure in reverse shoulder arthroplasty (RSA) remains a challenging problem. Nonoperative management may be an option in certain patients. The purpose of this study was to evaluate outcomes following nonoperative management of glenoid baseplate failure after RSA. MethodsUtilizing a single institution database, a retrospective review was performed to identify patients from 2010-2019 who sustained glenoid baseplate failures after RSA and were treated nonoperatively. Exclusion criteria included revision surgery and presence of active infection. Included patients had minimum 2 year clinical and radiographic follow-up. Chart review captured patient demographics, surgical indications and technique. Radiographs were reviewed to determine etiology of baseplate failure and other implant complications. Glenosphere inclination angle was measured on true AP radiographs immediately postoperatively and after baseplate failure. ResultsEighteen patients had glenoid baseplate failures treated nonoperatively during the study period. Five patients were deceased, leaving 13 patients who were available for clinical follow-up. Twelve (92%) patients were successfully contacted. Mean age was 77 years, BMI was 28, and 8/12 were female. Mean Charlson Comorbidity Index score was 4.1. Mean preoperative ASES score was 43.0 and VAS pain was 6.3. At mean 5.7-year follow-up, patients had an ASES score of 49.2, VAS pain of 4.3, SANE of 49% and 50% of patients were satisfied with their outcome. Preoperative and final follow-up ASES and VAS scores were similar. Average time from index surgery to baseplate failure was 19 months. Of the eighteen identified patients, 16 (89%) failures resulted in increased baseplate superior tilt (7 with concomitant broken baseplate screws). For these 16 patients, mean glenosphere inclination angle after failure (131°) was significantly greater than initial inclination angle (100°), p=0.03. The other 2 failures resulted in increased baseplate anteversion. 8/18 (44%) patients had bone grafting at the time of surgery. When comparing dissatisfied and satisfied patients, there were no specific patient characteristics or radiographic parameters that were associated with satisfaction. ConclusionNonoperative management of glenoid baseplate failure yields modest patient reported outcomes, with 50% patient satisfaction at mid-term follow-up. The mortality rate in this cohort of patients was almost 30%. Therefore, in select patients, nonoperative treatment of RSA baseplate failure may be a reasonable option.

Risk factors contributing to morbidity associated with feeding tubes placed for esophageal cancer patients undergoing esophagectomy: a single-center retrospective study.

Perioperative nutritional optimization of patients undergoing esophagectomy for cancer is important as this population is prone to malnutrition associated with poor outcomes. Nutritional supplementation has been achieved via enteral nutrition through percutaneous feeding tubes such as gastrostomy (G-tubes) and surgical jejunostomy tubes (J-tubes). While they are often routinely placed for patients undergoing esophagectomy, these are associated with adverse events including infections, dislodgement, increased healthcare visits, among others. The morbidity associated with feeding tubes has not been well characterized. We aim to determine factors associated with adverse outcomes after feeding tube placement to guide appropriate use of feeding tubes in esophageal carcinoma patients. Patients who underwent esophagectomy for carcinoma and had at least one feeding tube placed from November, 2017 to October, 2021 at a single institution were retrospectively reviewed. Subgroup analyses were performed testing for relevant characteristics. Univariate and multivariate logistic regression analyses were conducted evaluating outcomes of interest. The primary outcome was the overall rate of tube-related complications. A total of 144 patients were included with 212 feeding tubes placed (75 G-tubes; 137 J-tubes). The rate of any adverse event related to feeding tubes was 39%. Of these, 11% were wound infections, 16% required procedural intervention, 11% visited the emergency department (ED), and 2.5% required admission due to feeding tube-related complications. Factors independently associated with adverse events included smoking history [odds ratio (OR), 2.80; 95% confidence interval (CI): 1.34-6.23], being female (OR, 2.98; 95% CI: 1.36-6.72), induction treatment (OR, 2.65; 95% CI: 1.14-6.55), and J-tubes (OR, 2.07; 95% CI: 1.09-4.03). Laparoscopically placed J-tubes were associated with increased unplanned admissions compared to those placed via laparotomy (9.4% vs. 0%, P=0.01). Though not statistically significant, there was a trend toward more complications in those who were high risk for malnutrition [body mass index (BMI) <18 kg/m2, weight loss >10%] and comorbid (Charlson Comorbidity Index 5-6). There is significant morbidity related to feeding tubes. The risk profile of these tubes for individual patients should be carefully weighed against the nutritional benefits prior to placement. Patients should be carefully counselled on the possible adverse events and care requirements.

Prediction model for intraoperative implant volume using the 3D surface imaging system (VECTRA XT 3D) in direct-to-implant breast reconstructions.

In direct-to-implant breast reconstruction, accurate preoperative breast volume estimation is crucial for surgeons to select the appropriate implant volume, considering the cosmetic outcomes during surgery. We proposed the prediction model for intraoperative implant volume based on the preoperative estimated volume of the contralateral breast obtained through a three-dimensional surface imaging system (3DSI) as surgeons usually choose the implant volume on the breast which should be reconstructed considering symmetricity with the contralateral breast. We enrolled 97 patients from our single institution who underwent unilateral mastectomy with immediate breast reconstruction using smooth silicone implants between October 2021 and January 2023. Preoperatively, plastic surgeons measured the volume of the contralateral breast using the VECTRA XT 3D imaging system. Data on implant volume and the types of acellular dermal matrix used during surgery, determined by a single surgeon to ensure symmetry, were also collected. Linear regression analysis was utilized to construct the predictive model. In the multiple linear regression analysis with preoperative contralateral breast volume, age, and body mass index as variables, the coefficient of determination of the model expressed as R squared (R2) was 0.554, and except for age, the other variables were statistically significant. When replaced by mastectomy volume instead of age, R2 increased to 0.723 and all variables were significant. 3DSI can be helpful for preoperative surgical planning and postoperative outcome simulation. With our multiple linear regression model, we can predict the intraoperative implant volume using preoperative contralateral breast volume measured by the 3D scans.

Declining empathy trends throughout medical curriculum and association factors of low empathy among medical students and residents: a single center study

BackgroundA physician’s empathy level substantially impacts clinical competence, patient relationships, and treatment outcomes. Yet, understanding empathy trends from medical students to resident doctors within a single institution is limited. This study delves into empathy trends within a single-center academic setting and identifies factors associated with low empathy.MethodsThis cross-sectional study enrolled the second—to sixth-year medical students of Phramongkutklao College of Medicine and the first—to second-year residents at Phramongkutklao Hospital. It utilized a standardized questionnaire covering demographics, family relationships, the Maudsley Personality Inventory (MPI), and the Jefferson Scale of Empathy (JSE). The relationship between variables and JSE scores was analyzed using independent t-test, one-way ANOVA, and Chi-square tests. Multivariable logistic and linear regression analyses examined associated factors and trends across educational levels. A quadratic term was incorporated to evaluate the presence of a nonlinear trend.ResultsA total of 520 participants, comprising 189 (36.4%) preclinical students, 153 (29.4%) clinical students, and 178 (34.2%) residents, completed the survey. The JSE showed a Cronbach’s alpha of 0.83. The average empathy score was 103.8 ± 15.0, with 27.1% of low empathy levels. Specialty preference and sex-adjusted average empathy scores decreased from 114.5 (95%CI: 112.0–117.0) among second-year medical students to 95.2 (95%CI: 92.2–98.2) among second-year residents (Pnon−linear<0.001). The adjusted proportion of low empathy is highest among sixth-year medical students (54.4%, 95%CI: 34.4–73.2%). Factors associated with low empathy included those preferring procedure-oriented specialties (AOR: 4.16, 95%CI: 1.54–11.18) and a higher parental income (AOR: 2.97, 95%CI: 1.09 to 8.10). Subgroup analysis revealed that residents with a GPAX above 3.5 and those in technology-oriented specialties were also associated with lower empathy (AOR: 3.46, 95%CI: 1.40–8.59 and AOR: 2.93, 95%CI: 1.05–8.12, respectively).ConclusionA declining empathy trend was observed among medical students, which then plateaued among residents. Additionally, residents in technology-oriented specialties may require empathy enhancements due to their ongoing patient consultations. Addressing these issues requires collaborative planning between students and teachers to foster empathy throughout the medical curriculum.

Redefining YAP1 in small cell lung cancer: shifting from a dominant subtype marker to a favorable prognostic indicator.

Molecular and transcription factor subtyping were recently introduced to identify patients with unique clinical features in small cell lung cancer (SCLC). However, its prognostic relevance is yet to be established. This study aims to investigate the clinical implications and prognostic significance of transcription factor subtyping in SCLC using immunohistochemistry. One hundred and ninety consecutive SCLC patients treated with platinum-based chemotherapy at a single institution were retrospectively reviewed. Expression of ASCL1, NeuroD1, POU2F3, and YAP1 was assessed by immunohistochemical staining and applied to determine the transcription factor subtype of each case. The association among transcription factors was not entirely mutually exclusive. YAP1 expression was the most significant prognostic indicator compared with other transcription factors or their related subtypes. Among patients with limited-stage disease (LD), complete response (CR) rates were 46.2% and 22.4% in the YAP1-positive and YAP1-negative groups, respectively. The median duration of response among patients who achieved CR was 64.8 and 36.4 months in the YAP1-positive and YAP1-negative groups, respectively (P=0.06). Median overall survival (OS) in LD was 35.6 and 16.9 months in the YAP1-positive and YAP1-negative groups, respectively (P=0.03). In extensive-stage disease (ED), the median OS was 11.3 months for the YAP1-positive group and 11 months for the YAP1-negative group (P=0.03). Positive expression of YAP1 can be associated with durable CR and favorable survival outcomes in patients with SCLC, especially in LD.

Trans-arterial embolization versus chemoembolization for neuroendocrine liver metastases: a propensity matched analysis

IntroductionLocoregional therapies are a mainstay of treatment for patients with neuroendocrine liver metastases (NELM), yet the optimal transarterial approach remains undefined and recent studies have raised concern over the safety of transarterial chemoembolization (TACE). MethodsPatients with NELM who underwent TACE or transarterial embolization (TAE) at a single institution between 2000–2022 were retrospectively reviewed. Propensity score matching (PSM) controlling for age, sex, bilateral disease, tumor size, lobar embolization, grade, and extrahepatic disease was utilized to compare short- and long-term outcomes. ResultsAmong 412 patients with NELM, 329 underwent TACE and 83 TAE. Mean age was 60.7 ± 11.1 years. Patients primarily presented with synchronous (69.2%), bilateral (84.2%), and G1 disease (48.8%) and underwent staged procedures (55.8%). Following PSM, TACE was associated with slightly worse post-procedure laboratory values, but no difference in complications compared to TAE (23.3%vs29.3%, p = 0.247). TACE was associated with improved mean PFS (21.8vs10.7 months, p = 0.002), but no difference in radiographic size, chromogranin level, or median overall survival (50.0 months vs not met, p = 0.833). ConclusionAmong patients with NELM, TACE was associated with similar short-term outcomes and improved PFS, but no difference in OS compared to TAE. These findings highlight the need for additional research on the optimal locoregional therapy for NELM.

Clinical outcomes and safety of external beam radiotherapy with extensive intrahepatic targets for advanced hepatocellular carcinoma: A single institutional clinical experience.

This study observed the clinical outcome of radiotherapy to extensive intrahepatic targets for advanced hepatocellular carcinoma (HCC) in a single institution. From September 2009 to July 2021, patients who underwent fractionated radiotherapy to a planning target volume (PTV) of over 100 ml with biological effective dose >30 Gy10 for advanced HCC were enrolled. Overall survival (OS) and radiation-induced liver toxicity (RILD) were evaluated. RILD was defined as an increase in Child-Pugh (CP) score ≥2 or liver function tests ≥2.5 times at 3 months after the end of radiotherapy. A total of 136 patients were evaluated. Eighty-nine patients had portal vein tumor thrombus (PVTT), 37 patients were in CP B stage, and the median radiation dose to PTV was 48.8 Gy10. The median OS was 12.3 months. The factors most affecting OS were PVTT (P = 0.001), PTV (>500 ml, P = 0.001), incomplete coverage of the intrahepatic tumor (P = 0.004), and CP B (P = 0.006) in Cox regression. RILD occurred in 22.4% of the patients and was affected by PVTT (P = 0.003), PTV (P = 0.010), pretreatment bilirubin levels (>1.5 mg/ml, P = 0.016), and the mean normal liver dose (MNLD) (≥ EQD2 18 Gy3, P = 0.021) in binary logistic regression. As the PTV was in excess of >500 ml, RILD developed in 30.2% of patients and the prognostic importance of pretreatment bilirubin levels (P = 0.006) and the MNLD (P = 0.014) increased. As PTV is more extensive, the bilirubin level and the MNLD have to be taken into consideration for safe radiotherapy, in addition to the traditional prognostic factors.

Racial Disparities in Palliative Care at End-of-Life in Children with Advanced Heart Disease in the South

To examine specialty pediatric palliative care (SPPC) and end-of-life (EOL) care for children with advanced heart disease in Alabama, including rates of and disparities in SPPC involvement. We performed a retrospective study from electronic health records of children (≤21 years at death) who died with advanced heart disease at a single institution between 2012 and 2019 (n=128). The main outcome was SPPC consult; we assessed clinical and sociodemographic factors associated with SPPC. The median age at death was 6 months (IQR=1-25 months) with 80 (63%) ≤1 year; 46% were Black and 45% non-Hispanic White. Seventy (55%) children had critical congenital heart disease, 45 (35%) non-critical congenital heart disease, and 13 (10%) acquired heart disease. Twenty-nine children (22%) received SPPC. Children ≤1 year at time of death and Black children were less likely to receive SPPC (adjusted odds ratio [95% confidence interval]: 0.2 [0.1-0.6], reference >1 year; 0.2 [0.1-0.7], reference non-Hispanic White). SPPC was associated with death while receiving comfort-focused care (30.6 [4.5-210]), do not resuscitate orders (8.2 [2.1-31.3]), and hospice enrollment (no children without SPPC care were enrolled in hospice) but not medically intense EOL care (ICU admission, mechanical ventilation, hemodialysis, or CPR) or death outside the ICU. Children dying with advanced heart disease in Alabama did not have routine SPPC involvement; infants and Black children had lower odds of SPPC. SPPC was associated with more comfort-focused care. Disparities in SPPC utilization for children with advanced heart disease need further examination.

A Survey of Post-Graduate Satisfaction With Orthopaedic Residency Training at a Single Institution.

The Accreditation Council for Graduate Medical Education (ACGME) has called for self-study within residency programs. Post-graduate surveys allow the graduate to reflect upon their residency experience after years of autonomous practice. Despite their potential utility, a standardized assessment of residency training from the perspective of orthopaedic alumni does not exist. In this study, we aimed to create, analyze, and share with our alumni a post-graduate survey based on ACGME core competencies. The survey was developed by full-time orthopaedic faculty and reviewed by a survey methodologist to ensure clarity and an ideal survey format. In May 2020, the survey was emailed to all 90 graduates from 2000 to 2019. Respondents were polled on current clinical practice and satisfaction with program-specific initiatives, residency requirements, and learning environment issues based on a 7-point Likert scale. Respondents were also given the opportunity to provide open-ended responses. Data were collected within the survey platform and subdivided into 3 cohorts based on years since graduation. The response rate was 71% (64/90). The likelihood of fellowship training increased with recency since graduation. Most respondents are in either private or health-system-owned practice but 23% work in an academic center.The oldest cohort had greater variability in clinical practice. Most program-specific initiatives received high satisfaction scores, but graduates within the past 5 years had the lowest satisfaction scores. Instruction of skills included in ACGME competencies received generally favorable reviews, but professional development skills, such as starting a practice and evaluating job opportunities, received low marks.The overall satisfaction with the program was high (86%) but was lowest among most recent graduates. The post-graduate survey demonstrates areas of strength and weakness and highlights dissatisfaction among recent graduates. The data will drive specific curricular changes within our program. The survey will be shared to promote self-study within other programs.

Renal Neoplasms with Concurrent Castleman-Like Regional Lymphadenopathy.

Renal cell neoplasms are known to be associated with paraneoplastic syndromes, and the association with Castleman-like regional lymphadenopathy has been rarely reported. We aim to characterize the association between renal neoplasms and Castleman-like lymphadenopathy. A search for renal neoplasms with concurrent Castleman-like lymphadenopathy in one single medical institution from 2000 to 2023 resulted in 4 specimens. A literature search for "Castleman" and "renal neoplasm" resulted in 8 reports. Patients' demographics, clinical presentation, gross and histologic features, results of ancillary studies, treatment, and follow-up were evaluated. Our patients included 3 men and 1 woman, with a mean age of 60 years. Four different subtypes of renal neoplasms were diagnosed, including clear cell renal cell carcinoma (RCC), papillary RCC, chromophobe RCC, and mucinous cystadenoma of the renal pelvis. For Castleman-like regional lymphadenopathy, 2 were plasma-cell predominant, and 2 were hyaline-vascular. After a median follow-up of 84 months, all patients were alive with no recurrence or progression of Castleman-like features following nephrectomies. Castleman-like regional lymphadenopathy should be considered in patients with renal tumors and lymphadenopathy. Although more prevalent in clear cell RCC, it can be also associated with other renal neoplasms. The concurrent lymphadenopathy was remitted following the renal tumor resections.

Prognostic factor of patients with short bowel syndrome due to nonCrohn disease: A single institution observational study.

Short bowel syndrome (SBS) is a severely disabling and potentially life-threatening condition. Survival data for patients with SBS are limited. This study aimed to investigate prognostic factors in patients with SBS undergoing surgery. We reviewed the medical records of 27 consecutive patients with SBS who were treated at our hospital between January 2018 and December 2022. SBS was defined as a remaining small bowel length <200 cm, excluding patients with Crohn disease. Of the 27 patients identified, 17 were males and 10 were females, with a median age of 77 (46-90) years and a total observation time of 137 (2-1628) days. All patients underwent surgery and received parenteral nutrition (PN) and follow-up in our hospital. Superior mesenteric artery stenosis (44.4%) and nonocclusive mesenteric ischemia (25.9%) most commonly caused SBS. The median residual small bowel length and postoperative hospital stay were 50 (5-150) cm and 48 (2-104) days, respectively. Jejunostomy was performed in 17 (62.9%) patients, and 4 (14.8%) patients were weaned off their PN. Death occurred in 14 (51.8%), and the median survival time was 209 days. The survival outcome was compared between the survival (n = 13) and the death groups (n = 14). Jejunostomy and PN rates were significantly higher in the death group (P < .01, P = .03, respectively). SBS is associated with significantly higher mortality rates. Jejunostomy and long PN duration are significantly associated with death in patients with SBS.