Sinus Discharge Research Articles

Tuberculous Osteitis of the Cranial Vault: A Case Report

Cranial tuberculosis is a rare condition, constituting 0.2 to 1.3% of bone tuberculosis cases, mainly affecting the frontal and parietal bones. It is often misdiagnosed. A case involved a two-year-old girl, F.R., who developed ulcerations on her scalp due to multifocal tuberculosis. Imaging revealed a hypoechoic collection and mixed lesions in the parietal area, leading to a confirmed diagnosis. Common symptoms in children include painless scalp swelling and sinus discharge. Imaging, particularly CT and MRI, is critical for diagnosis and treatment planning. Early detection is essential for effective management.

Role of STIMULAN in chronic osteomyelitis-A randomised blinded study on 95 patients comparing 3 antibiotic compositions, bead quality, forming & absorption time

IntroductionChronic Osteomyelitis is a well-known clinical entity affecting patients holistically and presents with multiple treatment challenges. Local antibiotic delivery with biodegradable drug carriers has shown promising results. Materials and methodsProspective multicenter study performed at 2 centers from November 2021 to January 2023 on 95 osteomyelitis patients treated with surgical debridement & STIMULAN™ for local antibiotic delivery. Patients were randomized into 3 groups. Authors compared antibiotic combinations, bead quality, bead setting, and resorption time for calcium sulfate beads- STIMULAN™. Additionally, organisms isolated, WBC Turnover time, Hypersensitivity Reactions, Recurrence, and Revision Rates were documented. Results95 patients underwent surgical debridement and STIMULAN™ bead application for chronic osteomyelitis. The proximal 1/3rd tibia was commonly affected. The most common symptoms were sinus and pus discharge in 96.84 % & 86.31 % of patients respectively (p < 0.001). Staphylococcus aureus & MRSA were isolated in 37.8 % & 29.4 % of the patient's wound culture respectively. Bead setting time in Descending order was Group 3 > Group 2 > Group 1 (p < 0.001). Bead setting first in Group 1 followed by Group 3 & 2. On compression, Group-1 beads withstood maximum compression forces & had smooth even bead surfaces. On radiographs, 1/3rd bead volume in ascending order was Group 3 > Group 2 > Group 1 (p < 0.001). 2/3rd reduction in ascending order was Group 3 > Group 2 > Group 1. Complete bead absorption was earliest seen in Group 3 followed by Group 2 & Group 1 (p < 0.001). Recurrence in 2 patients (Group 2) at 6 weeks. Revision rate: 2.10 %. There were no incidences of hypersensitivity. Suture removal was done at 16 ± 2 days. ConclusionSTIMULAN™ combination with tobramycin, vancomycin, and gentamycin is stable, and forms uniform beads with predictable drug elution & bead resorption with negligible side effects. A mixture with higher liquid content sets later, forms softer beads, and resorbs earlier.

Evaluation of Recombinant Human Platelet Derived Growth Factor (rhPDGF-BB) Along with Tricalcium Phosphate (β-TCP) in Impacted Mandibular 3rd Molar Sockets

Aim: The aim of this study was to evaluate efficacy of Recombinant Human Platelet derived Growth Factor (rhPDGF-BB) mixed with Tricalcium Phosphate (β-TCP) particles in mandibular 3rd molar extraction socket for bone regeneration. Setting And Design: A comparative clinical trial consisting of 10 patients who wanted to undergo the surgical extraction of mandibular 3rd molar bilaterally, were undertaken in the institutional settings, where in each patient one side of lower third molar extraction site was kept as control and in the other side graft material was used, after the approval from the institutional ethical committee. Materials And Methods: In this study 10 patients were included with mean age of 28.3 years (Ranging from (20-35 years). These were 4 male and 6 female patients. In each patient one side of lower third molar extraction site was kept as control site and in the other side graft material was used kept as study site. Hence 10 control sites were compared with 10 study sites. Selection of site for placement of graft was done randomly. In 6 patients study site was on right side and in 4 patients study site was on left side. Clinical parameters like pain, facial swelling, total number of analgesic tablets required evaluated at 48hrs and at 7th day. While, radiographically bone density was evaluated after 1st and 3rd month postoperatively. Other parameters like infection, sinus discharge, wound dehiscence, dry socket or graft leakage were also observed. Results: rh PDGF with β – TCP when used in mandibular third molar extraction socket results in rapid bone regeneration seen via increased bone density. It also results in less post-operative discomfort to the patient like pain and swelling. Complications like infection, sinus discharge, wound dehiscence, dry socket or graft leakage were not encountered and the tissue showed good acceptance with no graft rejection. Conclusions: The rh PDGF/β – TCP combination is a novel bone grafting material with excellent results and should be included in the armamentarium when bone defect is encountered.

Tuberculosis of Frontal Bone—A Rare Entity: Case Report and Review of Literature

AbstractTuberculosis of the frontal bone is a rare entity, most commonly occurring in childhood. In situations of painless scalp swelling coupled with or without a discharging sinus that has not responded to antibiotics, a strong index of suspicion must be raised. Generally, conventional radiography and computed tomography are used for establishing the diagnosis along with microbiological confirmation. We present an interesting case of a young boy who presented with a 2-month-old bone lesion in the frontal scalp, accompanied by mediastinal lymph node involvement. Histopathology revealed tuberculous origin and successful antitubercular therapy resulted in significant improvement within 3 months. The calvarial bones can rarely be affected by tuberculosis, which can present with swelling, sinus discharge, pain, or in rare cases as blindness. Prompt diagnosis of this disease is needed as it is potentially curable and has an excellent prognosis. The cornerstone of treatment is antitubercular therapy, while surgical intervention may sometimes be required. Our case highlights the importance of keeping tuberculosis as a differential at the back of the mind when dealing with scalp swellings, particularly in children.

Incidence and Risk Factors for Extremity Osteoradionecrosis after Limb-Sparing Surgery and Adjuvant Radiotherapy

Osteoradionecrosis (ORN) is a major complication after radiotherapy. Most studies on ORN have focused on patients with mandibular lesions, with few studies including patients with extremity soft tissue sarcoma (STS). We included 198 patients with extremity STS who underwent limb-sparing surgery and adjuvant radiotherapy between 2004 and 2017. The incidence rate of extremity ORN was 3.5% (7/198), with most lesions (6/7) located in the lower extremities. The mean follow-up time was 62 months. Clinical presentations included chronic ulcers, soft tissue necrosis, sinus discharge, bone nonunion, and pathological fractures. Compared with the non-ORN group, the ORN group had a significantly higher total radiation dose (68 Gy vs. 64 Gy, p = 0.048) and greater use of intraoperative periosteal stripping (p = 0.008). Repeat surgeries and subsequent soft tissue reconstruction or limb amputation were performed as treatments. The risk and management of ORN in patients with extremity STS was ignored previously. Because the disease is complex and affects both clinicians and patients, careful surveillance should be undertaken.

P291 Aspergillosis: another force to reckon with during COVID-19 times

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectives Aspergillus is a ubiquitous fungus in the Indian environment. Spores are constantly circulating in hospital and community environments alike. Infections like COVID-19 which affect not only innate immune system but also lead to local immune-compromization especially in the respiratory system make the patient vulnerable to infections like Aspergillosis. Hereby, we present the prevalence of Aspergillus infection in a tertiary care center over a period of 1 year with special reference to co-infections with COVID-19 as Aspergillosis or mixed infection (Aspergillosis and Mucormycosis).Material and MethodsAll the samples which were submitted to Mycology laboratory during the time period of 1 year from January 2021 to December 2021 were included in the study. The samples were processed as per the standard mycological techniques for direct examination and culture. Those patients which had direct KOH mount positive for septate hyphae and grew Aspergillus on culture were included for the purpose of this study. Records of Aspergillosis patients who were positive for COVID-19 too were assessed to look for significant associating factors.ResultsOut of a total of 6863 samples, 66 samples came out to be positive for Aspergillus sp. Out of which, 55 were identified phenotypically as A. flavus, 3 A. fumigatus, 2 A. terreus and 1 was A. niger. In five of the strains, species could not be identified even phenotypically and were reported as Aspergillus sp. Maximum isolates (43) were from nasal and paranasal sinuses (sinus discharge, nasal tissue, nasal polyp, nasal muck, nasal crust, maxillary meatus etc) 16 were pulmonary samples (sputum, tracheal aspirate, bronchoalveolar lavage, pleural fluid, lung tissue), two were corneal scrapings, two samples were dental tissue and palatal necrosed material and two were nail samples. One sample was from a patient with ear discharge. A total of 15 patients had COVID-19 infection at the time of diagnosis or within 3 months prior. In all, 12 patients had co-infections of Aspergillus and Mucormycetes (9 being COVID positive too), and 2 patients had co-infection of Aspergillus and Candida. Records of COVID-19 patients revealed that all 12 patients with co-infection of Aspergillus and Mucormycetes were treated as per guidelines for Mucormycetes infection. Out of other three, two were confirmed CAPA as per the criteria. One patient was treated for COVID-19 infection only.ConclusionMucormycosis was another infection during COVID-19 times, which was like a huge wave, sweeping all attention. Rather Aspergillus infections got shadowed by mucormycosis despite the fact that during COVID-19 times, as many as 15% of cases were found to be positive for Aspergillosis in COVID-19 positive patients, especially in ICU areas. In the times to come, it is speculated that sequelae of Aspergillus infections may be seen among COVID-19 patients. Emerging drug resistance among Aspergilli can worsen the situation further.

Role of medicinal plants in the treatment of eumycetoma: A review

Mycetoma is a resultant infection of either fungi (eumycetoma) or bacteria (actinomycetoma). It is categorized under neglected tropical diseases, as it typically affects the economically backward communities of the endemic regions. The infection occurs with the invasion of etiological agents through the open wounds of the body. The cutaneous and subcutaneous tissue is characterized by the sinus formation and discharge. Primarily affecting the foot, it further spreads to other parts of the body. Eumycetoma has a worldwide distribution yet considered endemic, as it is restricted only to few countries. Diagnosis and treatment of the disease has been burdensome since poor response and unavailability of medical support in endemic regions. Microbiological and serological diagnostic methods have been unreliable except molecular diagnostics. Treatment with antifungal agents has given a mixed response, with only itraconazole being effective. These techniques are relatively expensive and cannot be afforded by people with weak economic background. In the context, it becomes essential to introduce phytotherapy to relieve the health and economic burden. Herein, we discuss few medicinal plants with profound antifungal activity towards eumycetoma. We highlight the possible course of actions that needs to be put forward to deliver the plant-based drugs to cure eumycetoma.

Clinical impact of respiratory virus in pulmonary exacerbations of children with Cystic Fibrosis

Cystic Fibrosis (CF) is a genetic, multisystemic, progressive illness that causes chronic suppurative lung disease. A major cause of morbimortality in this condition are pulmonary exacerbations. Although classically attributed to bacterial infections, respiratory virus have been increasingly recognized in its ethiopathogeny. Nasopharyngeal swab samples were collected from children < 18 years old with CF in Rio de Janeiro, Brazil, with pulmonary exacerbation criteria. Samples were submitted to RT-PCR for Adenovirus, Influenza A and B, Parainfluenza Virus, Respiratory Syncytial Virus (RSV), Metapneumovirus and Rhinovirus. Virus positive and virus negative groups were compared in regards to clinical presentation, severity of exacerbation and bacterial colonization. Out of 70 samples collected from 48 patients, 35.7% were positive for respiratory viruses. Rhinovirus were the most common (28% of all positive samples), followed by RSV. The virus positive group was associated with change in sinus discharge (p = 0.03). Considering only patients younger than five years old, positive virus detection was also associated with fever (p = 0.01). There was no significant difference in clinical severity or in bacterial colonization between virus positive and negative groups. Prospective studies are still needed to assess the long term impact of viral infections in patients with CF, and their interaction with the bacterial microbiome in these patients.

Study of Profile of Accused of Sexual Offences in Thoothudi Medical College- A Retrospective Study

Sexual violence is a major public health and human rights problem with consequences on women’s physical,mental sexual and reproductive health. Data on sexual violence typically come from police, clinical settings,nongovernmental organisations and survey research. The magnitude of the problem of sexual violence maybe viewed as tip of iceberg floating in water. There is limited amount of information on sexually violentmen, it appears that sexual violence is found in almost all countries in all socioeconomic classes and in allage groups from childhood onwards. Data on alleged accused also show that most direct their acts at womenwhom they already know. A total of 70 cases were analysed, 40 (57.14%) cases belong to Hindu religion, 44(62.85%) cases were unmarried, 32 (45.71%) cases were illiterate, 26 (37.14%) cases the offence occurredin open space, 34(48.57%) cases the incident was consensual act. In 35(50%) cases the alleged accused andvictim was lovers, the age of the accused in 38(54.28%) cases were between 19-25 years, age of the victimsin 55 (78.57 %) cases was in between 13 – 18 years. In examination of alleged accused there were no scars,ulcer, sinus discharge and sexually transmitted disease in any of the case. Sexual violence has generally beena neglected area of research in most parts of the world, yet the evidence suggests that it is a public healthproblem of substantial proportions. Much more needs to be done both to understand the phenomenon andto prevent it.

Post thyroidectomy skin sinus formation

&lt;p&gt;Thyroid surgery is frequently complicated by hematoma collection, nerve injury, hypothyroidism and rarely infections but persistent discharge from the gland is unusual. We report a case of persistent sinus discharge from the thyroid of the patient who underwent thyroidectomy 5 years back. The patient had persistent discharge from the wound site along with recurrent swelling all the years afterward. Fine needle aspiration cytology proved it was recurrent papillary cancer. Swab culture from discharge showed no growth. Completion thyroidectomy with functional lymph node dissection was done and specimen was not harbouring any foreign body and biopsy showed recurrent papillary cancer. Although post thyroidectomy sinus discharges are usually secondary to foreign body or chronic inflammation like tuberculosis, the tumour itself can be considered as a cause.&lt;/p&gt;

Actynomicosis of the abdomen mimicking acute appendicitis

Bacteria of the genus Actinomyces are non-spore-forming filamentous, Microaerophilic or strict anaerobic, Gram-positive bacilli, mainly belonging to the human commensal flora of the oropharynx, gastrointestinal tract, and urogenital tract; Actynomicosis israelii is most frequently isolated in human infection by this bacteria (90% of the cases), and is a very rare, generally a polymicrobial granulomatous infection which affects the cervicofacial (55% of all cases), abdominopelvic (22%) and thoracic (15%) regions, causing formation of abscesses, woody fibrosis and sinus discharge of characteristic sulfur granules. We present the case of a 42 year old patient with no prior medical history who presented to the emergency room with acute onset abdominal pain in the lower right quadrant, leukocytosis and neutrophilia, as well as ultrasonographic images which suggested acute appendicitis, the patient underwent laparoscopic appendectomy and cultures of abscesses surrounding the appendix were positive for A. israelii, which was also isolated in the histopathological specimen. The patient underwent antimicrobial treatment with ampicilin-sulbactam for a three month period postoperatively.

Xenogenic bone with chitosan/norvancomycin sustained-release system for treatment of infectious bone defects in rabbits

Objective To investigate the effects of xenogenic bone with chitosan/norvancomycin sustained-release biomaterials in treating infectious bone defects in rabbits. Methods Xenogenic bone with chitosan/norvancomycin sustained-release biomaterials was made by electrospinning technique. Rabbit infectious bone defect models were made by Methicillin-resistant Staphylococcus aureus. A successful model was evaluated with the standard of more than three points in Norden score assessment. All models were divided into two groups by random number table method, with eight models in each. The control group was treated with surgical debridement, and the experimental group was implanted with bone particles of xenogenic bone with chitosan/norvancomycin sustained-release system after debridement. Postoperatively, general conditions, X-ray, histological results of HE staining, and bacteriological examination results of the rabbits were observed. Results X-ray showed significant bone defects, sequestration, periosteal reaction, and soft tissue swelling after one month of modeling, with Norden score of (3.84±0.52)points. The general conditions were good and the sinus tracts were healed in experimental group after two months of treatment. The control group demonstrated generally poor conditions with swollen sinus and purulent discharge. Two rabbits were died of sepsis. The pathological scores of tibial were (0.41±0.08)points in experimental group, and (3.27±0.26)points in control group by gross observation. The pathological score of experimental group was significantly lower than control group(P<0.05). The bone defects were basically repaired in experimental group. The longest diameter of bone defect in experimental group was (0.11±0.02)cm, significantly smaller than (0.48±0.06)cm in control group (P<0.05). There were no obvious signs of osteomyelitis and the bone defects were well repaired in experimental group. Periosteal reaction, soft tissue swelling, a substantial number of bone destruction, and sequestration were observed in control group. The Norden score was (1.32±0.23)points in experimental group, lower than (5.21±0.48)points in control group(P<0.05). HE staining showed a large amount of trabecular bone formation, bone cell formation, and fibrous hyperplasia in experimental group, with no obvious signs of infection. On the other hand, infiltration of inflammatory cells, necrotic tissue, and sequestration were observed in control group. The histological score was(0.61±0.10) points in experimental group, lower than (4.21±0.41) points in control group (P<0.05). The negative rate of bacterial culture in experimental group was 33%, lower than 100% in control group (P<0.05). Conclusion Xenogenic bone with chitosan/norvancomycin sustained-release biomaterials has excellent effect in infection clearance and bone defect reparation in treatment of infectious bone defects in rabbits. Key words: Osteomyelitis; Chitosan; Anti-bacterial agents; Drug delivery systems

Calvarial Tuberculosis in a Preschool-Aged Child: An uncommon entity.

Calvarial tuberculosis is a rare manifestation of tuberculosis, especially in children under five years of age. We report a two-and-a-half-year-old male child who presented to the Nilratan Sircar Medical College, Kolkata, India, in 2015 with frontoparietal fluctuant swelling of three months' duration. He had also had chronic sinus discharge from the left lower eyelid over the previous six months. Computed tomography of the head revealed a frontal swelling along with erosion of both the outer and inner plates of the left frontal bone. Fine needle aspiration of the pus indicated the presence of acid-fast bacilli. Unfortunately, no primary focus of tuberculosis could be established. The patient improved after one year of antitubercular therapy without requiring any surgical intervention and with no sign of subsequent disease recurrence.

Outcomes for Emergency Department Patients With Recent-Onset Atrial Fibrillation and Flutter Treated in Canadian Hospitals

Recent-onset atrial fibrillation and flutter are the most common arrhythmias managed in the emergency department (ED). We evaluate the management and 30-day outcomes for recent-onset atrial fibrillation and flutter patients in Canadian EDs, where cardioversion is commonly practiced. We conducted a prospective cohort study in 6 academic hospital EDs and enrolled patients who had atrial fibrillation and flutter onset within 48 hours. Patients were followed for 30 days by health records review and telephone. Adverse events included death, stroke, acute coronary syndrome, heart failure, subsequent admission, or ED electrocardioversion. We enrolled 1,091 patients with mean age 63.9 years, atrial fibrillation 84.7%, atrial flutter 15.3%, hospital admission 9.0%, and converted to sinus rhythm 80.1%. Although 10.5% of recent-onset atrial fibrillation and flutter patients had adverse events within 30 days, there were no related deaths and 1 stroke (0.1%). Adjusted odds ratios for factors associated with adverse event were hours from onset (1.03/hour; 95% confidence interval [CI] 1.01 to 1.05), history of stroke or transient ischemic attack (2.09; 95% CI 1.01 to 4.36), and pulmonary congestion on chest radiograph (7.37; 95% CI 2.40 to 22.64). Patients who left the ED in sinus rhythm were much less likely to experience an adverse event (P<.001). Although most recent-onset atrial fibrillation and flutter patients were treated aggressively in the ED, there were few 30-day serious outcomes. Physicians underprescribed oral anticoagulants. Potential risk factors for adverse events include longer duration from arrhythmia onset, previous stroke or transient ischemic attack, pulmonary congestion on chest radiograph, and not being in sinus rhythm at discharge. An ED strategy of sinus rhythm restoration and discharge in most patients is effective and safe.

Infection of laparoscopic port wound by Mycobacterium fortuitum

Cutaneous infection with rapidly growing mycobacteria is not very commonly reported. Unless strongly suspected, its diagnosis can be missed. We report a case of persistent sinus discharge that developed after laparoscopic cholecystectomy surgery, in a healthy adult male, caused by Mycobacterium fortuitum . The case is being reported for its uncommon etiological agent. In this patient, both chronicity as well as repeated supra-added infection of the wound had led to significant discomfort and morbidity.

Radiographic Findings of Peri-Apical Lesions and Its Correlation to Clinical Findings

Aim: The aim of this study is to correlate the radiological and clinical findings of various periapical lesions of the oral cavity. Objective: The objective of the study is to analyse the various radiographic and clinical interpretation and correlate the findings by using radiographs. Around 30 radiographs of patients with periapical lesions was selected irrespective of age, sex and race and was evaluated to find the radiographic and to correlate the radiographic findings with its clinical findings. Materials and method: 30 patients above the age of 18years who were diagnosed with periapical lesions were selected. Clinical and radiographic photographs of these patients were collected and compared. Results: Among the 30 patients, prevalence of periapical abscess was predominant (80%). Radio graphically significant finding was the presence of PDL widening observed in 86% of the cases. Periodontal ligament space was seen in 3% of the cases. Loss of lamina dura was seen in 37% of the cases whereas pulp calcification was observed in 3% of the cases. Clinically, all the lesions were red in colour with regular margins with 27(90%) patients having tenderness on palpation. Around 26(87%) lesions were localised and 23(77%) patients had sinus discharge. Conclusion: The periapical lesions found in the oral cavity are seen to occur predominantly in patients with poor periodontal status irrespective of age, sex and race. It is important to study the progress of the sequelae and provide accurate diagnosis for better prognosis. Hence this study is done to emphasis the importance of correlation between radiographic findings and clinical findings.

Burrow in the Sphenoid

Anotherwisehealthyman inhisearly20spresentedwithachronic, intermittentlydischarging,nonhealing sinusover the leftuppereyelid of about 3months’ duration (Figure). Therewere no other associated visual or systemic concerns.History of a left upper eyelid abscess, incisedanddrainedelsewhere,waselicited.Previousmedical records were not available. Computed tomography imaging was suggestive of chronic osteomyelitis. Systemic investigation revealed multiple lung parenchymal infiltrates on chest radiography and isolationof acid-fast bacilli fromthe sputum.Adiagnosis of pulmonary tuberculosis was thus established.1-3 Standard antitubercular treatment with first-line drugs was instituted and the sinus discharge resolved completely while receiving treatment.

Endoscopic pilonidal sinus treatment in the Asian population.

This study aims to evaluate the early results of endoscopic pilonidal sinus treatment (EPSiT) in the Asian population and illustrate the surgical technique and its modifications by a video presentation (Supplemental Digital Content 1, http://links.lww.com/SLE/A115). Retrospective review of 9 patients with pilonidal sinus disease treated with EPSiT is performed in a single institution. Surgical outcomes of sinus healing, pain, and discharge were reviewed in the outpatient clinic and patient satisfaction levels were assessed through a standardized phone interview. The median age was 24 years (range, 16 to 41 y). The median duration of follow-up was 2.5 months (range, 1 to 5 mo). Median duration of sinus healing is 6 weeks (range, 2 to 7 wk). One patient had pain despite sinus healing. Satisfaction rate was 78% (7/9). EPSiT is a minimally invasive and cosmetically favorable procedure. A larger sample size and a longer follow-up is required to determine if it improves healing time and long-term recurrence rate.

Congenital spinal dermal tract: how accurate is clinical and radiological evaluation?

OBJECT A dermal sinus tract is a common form of occult spinal dysraphism. The presumed etiology relates to a focal failure of disjunction resulting in a persistent adhesion between the neural and cutaneous ectoderm. Clinical and radiological features can appear innocuous, leading to delayed diagnosis and failure to appreciate the implications or extent of the abnormality. If it is left untreated, complications can include meningitis, spinal abscess, and inclusion cyst formation. The authors present their experience in 74 pediatric cases of spinal dermal tract in an attempt to identify which clinical and radiological factors are associated with an infective presentation and to assess the reliability of MRI in evaluating this entity. METHODS Consecutive cases of spinal dermal tract treated with resection between 1998 and 2010 were identified from the departmental surgical database. Demographics, clinical history, and radiological and operative findings were collected from the patient records. The presence or absence of active infection (abscess, meningitis) at the time of neurosurgical presentation and any history of local sinus discharge or infection was assessed. Magnetic resonance images were reviewed to evaluate the extent of the sinus tract and determine the presence of an inclusion cyst. Radiological and operative findings were compared. RESULTS The surgical course was uncomplicated in 90% of 74 cases eligible for analysis. Magnetic resonance imaging underreported the presence of both an intradural tract (MRI 46%, operative finding 86%) and an intraspinal inclusion cyst (MRI 15%, operative finding 24%). A history of sinus discharge (OR 12.8, p = 0.0003) and the intraoperative identification of intraspinal inclusion cysts (OR 5.6, p = 0.023) were associated with an infective presentation. There was no significant association between the presence of an intradural tract discovered at surgery and an infective presentation. CONCLUSIONS Surgery for the treatment of spinal dermal tract carries a low morbidity. While it seems intuitive that tracts without intradural extension carry a low risk of spinal cord tethering, it is not possible to reliably detect these cases using MRI. Similarly, intraspinal dermoid cannot be reliably excluded using MRI and carries an increased risk of infection. These points justify excision together with intradural exploration of all spinal dermal sinus tracts.

Development of Module to Examine Training of the Hospice Primary Caregiver (S723)

Methods. The model elements include: 1) monthly Web-based screening, 2) triage of patients who request a rapid response to address a source of distress, and 3) enhanced availability of palliative care throughout their disease. CF patients also provide baseline and quarterly outcome data. Eligible adults with life expectancy >6 months complete the Memorial Symptom Assessment Scale-CF, PROMIS Anxiety-Short Form (PASF), PROMIS Depression-Short Form (PDSF), and CF Questionnaire-Revised (CFQ-R). Results. Initial baseline data (n1⁄461; M age1⁄438.4 years; SD1⁄413.0; 52.5% women; 91.8% White) show that the most prevalent symptoms are cough (80.3%); fatigue (63.9%); difficulty sleeping (59.0%); sinus discharge (52.5%); and dyspnea (50.8%). Symptoms rated as ‘‘quite a bit’’ or ‘‘very’’ distressing include feeling irritable (61.5%); fatigue (48.7%); and cough (42.9%). PASF scores (T1⁄452.1; range1⁄437.1-80.1) and PDSF scores (T1⁄452.1; range1⁄438.2-78.2) suggest that 21.3% and 9.8% of patients report higher anxiety and depressive symptoms respectively, than the general adult population. On the CFQ-R, treatment burden (M1⁄453.5; SD1⁄425.3); vitality (M1⁄454.8; SD1⁄420.4); and health perceptions (M1⁄457.6; SD1⁄424.2) represent the poorest QOL domains. Conclusions. Initial data suggest high symptom burden in this sample. Implications for Research, Policy, or Practice. Our screening-and-early-intervention model has the potential to improve symptom distress for the CF population.