Sterile Collections Research Articles

Abstract 15 A State-Run Public Cord Blood Collection Program

Abstract Introduction The Arizona Public Cord Blood Program was created in 2011 by the Arizona Biomedical Research Centre, a sub-section of the Arizona Department of Health Services, to advance the collection and increase the number of racially and ethnically diverse cord blood units available for transplantation, as well as promote awareness of the benefits of cord blood stem cells through our educational partner, Save the Cord Foundation (STCF). Objectives Create a sustainable program for women of all racial and ethnic backgrounds to have the opportunity to donate cord blood, with the primary goal of transplantation, and secondary goal of providing non-transplantable cord blood units for research. A second objective was to educate the residents of the state of Arizona about cord blood stem cells and the need for their preservation. Methods A portion of state lottery funds supports the program monetarily. Those funds are provided to four collection hospitals who employ "cord blood consenters" whose responsibility it is to consent patients, assist delivery providers with collections, and package and ship cord blood units to our partner cord blood bank at MD Anderson Cancer Center. There are also two clinical coordinators who educate and train hospital staff on quality collection practices, with special emphasis on the importance of high volume, sterile collections. STCF provides education across the state to expectant parents, healthcare providers, schools, and the public about the need for cord blood stem cell donation for transplant and research. Results Since 2011, the Arizona Public Cord Blood Program has banked hundreds of racially and ethnically diverse cord blood units with the National Marrow Donor Program, and has had 86 life-saving cord blood units matched with patients in need around the globe. This innovative program has not only expanded cord blood awareness and promoted the preservation of cord blood; it has resulted in the creation of an economic engine for the state of Arizona that is an attractant for STEM based businesses and careers. Discussion A decade later, the Arizona Public Cord Blood Program has proven to be a sustainable model for collecting and providing suitable cord blood units for transplant to diverse patient populations.

Coenogonium nimisii – a new isidiate epiphytic lichen similar to Porina rosei

AbstractOur floristic work in British ancient forests resulted in a description of a frequently reported but misidentified species, Coenogonium nimisii. Its thallus is very similar to Porina rosei, but the apothecia and pycnidia correspond with C. luteum. Sterile collections are not easy to distinguish but the new species differs from P. rosei in several microscopic characters of the isidia. Coenogonium nimisii is so far known from bark and epiphytic bryophytes, rarely mossy rocks, in ancient humid forests of Great Britain and Ireland. The genus Coenogonium is poorly represented by molecular data in the GenBank database. Our preliminary results revealed distinct genetic lineages within two traditionally circumscribed species, C. luteum and C. pineti, which may represent cryptic species.

Abstract 33 A Diverse and Sustainable State-Run Public Cord Blood Program

IntroductionThe Arizona Public Cord Blood Program was created in 2011 by the Arizona Biomedical Research Centre, a subsection of the Arizona Department of Health Services, to advance the collection and increase the number of racially and ethnically diverse cord blood units available for transplantation, as well as to promote awareness of the benefits of cord blood stem cells through our educational partner, Save the Cord Foundation (STCF).ObjectiveThe main objective of this study was to create a sustainable program for women of all racial and ethnic backgrounds to have the opportunity to donate cord blood, with the primary goal of transplantation and the secondary goal of providing non-transplantable cord blood units for research. A second objective was to educate the residents of the state of Arizona about cord blood stem cells and the need for their preservation.MethodsA portion of state lottery funds support the program monetarily. Those funds are provided to four partner collection hospitals employing "cord blood consenters," whose responsibility it is to consent patients, assist delivery providers with collections, and package and ship cord blood units to our partner cord blood bank at MD Anderson Cancer Center. There are also two clinical coordinators who educate and train hospital staff on quality collection practices, with special emphasis on the importance of high-volume, sterile collections. STCF provides education across the state to expectant parents, health care providers, schools, and the public about the need for cord blood stem cell donation for transplant and research.ResultsSince 2011, the Arizona Public Cord Blood Program has banked several hundreds of racially and ethnically diverse cord blood units with the National Marrow Donor Program (Figure 1) and has had 80 life-saving cord blood units matched with patients in need around the globe. This innovative program has expanded cord blood awareness and promoted the preservation of cord blood, and it also has resulted in the creation of an economic engine for the state of Arizona that is an attractant for STEM-based businesses and careers.Figure 1.Pie chart showing percentage of collections by race/ethnicity. Abbreviation: AI/AN, American Indian/Alaskan Native.DiscussionA decade later, the Arizona Public Cord Blood Program has proven to be a sustainable model for collecting and providing suitable cord blood units for transplant to diverse patient populations.

A155 ASEPTIC ABSCESS SYNDROME IN INFLAMMATORY BOWEL DISEASE: A CASE REPORT

BackgroundAseptic abscess syndrome (AAS) is a rare extraintestinal manifestation of inflammatory bowel disease (IBD) and it is characterized by the formation of sterile collections of neutrophils in various organs. Misdiagnosis frequently leads to unnecessary surgical procedures and prolonged courses of antibiotics. There are only 61 reportable cases of AAS in the international literature and 2 cases in Canada. This case and the associated literature review highlight the diagnostic considerations, treatment options and disease course of this rare disease.AimsTo describe a case of AAS in IBD.MethodsCase report and review of the literature.ResultsA 24-year-old male with a history of ulcerative pancolitis (UC) initially presented with a 3-week history of malaise, abdominal pain, and fevers with a computed tomography (CT) scan showing multiple splenic abscesses. Over the next year, he had multiple readmissions for recurrent sepsis from culture negative multi-focal abscesses. Serial CT scans revealed new abscesses in the liver, scrotum, and lungs with interval progression in size. Unsuccessful attempts to isolate a culprit organism which included serological markers and cultures from blood, bronchial washings, aspirate from abscesses, and surgical tissue. All samples demonstrated frank pus with suppurative granulomatous inflammation. The patient was trialed on various courses of antibiotics without improvement. Therefore, a decision was made to treat for AAS given his IBD history. Antibiotics were discontinued and prednisone was initiated with rapid improvement in symptoms and biochemistry. In the three years following, he was transitioned to a combination of infliximab and azathioprine. He had rapid resolution of his abscesses on serial CT scans following steroid and anti-TNF therapy. Currently, he is no longer on steroids and his CRP has normalized with no recurrence of his symptoms.ConclusionsAAS has often been associated with IBD, particularly Crohn’s disease and more rarely in UC. Case series have shown that AAS is not strongly associated with IBD activity as only 55% of cases have concomitant IBD flare and abscess formation. The syndrome continues to pose a diagnostic conundrum among specialists as there is no established diagnostic criteria and thus AAS remains a diagnosis of exclusion. This has led many patients to suffer from AAS for prolonged periods and receive unnecessary investigations and treatments. Steroids remain the gold standard for initial induction of remission. However, the ideal regimen for maintenance therapy is still evolving and case reports have described the effects of immunotherapy and biologics on AAS. AAS has a substantial impact on quality of life and is very responsive to therapy; this case report reminds the clinician that AAS should be considered in patients with IBD presenting with multifocal abscesses unresponsive to antimicrobials. Serial CT scan (coronal view) of abdomen demonstrating multiple hepatic abscesses (blue arrows)Funding AgenciesNone

Imaging and Clinical Parameters for Distinction between Infected and Non-Infected Fluid Collections in CT: Prospective Study Using Extended Microbiological Approach.

The aim of this investigation was to evaluate predictive CT imaging features and clinical parameters to distinguish infected from sterile fluid collections. Detection of infectious agents by advanced microbiological analysis was used as the reference standard. From April 2018 to October 2019, all patients undergoing CT-guided drainages were prospectively enrolled, if drainage material volume was at least 5 mL. Univariate analysis revealed attenuation (p = 0.001), entrapped gas (p < 0.001), fat stranding (p < 0.001), wall thickness (p < 0.001) and enhancement (p < 0.001) as imaging biomarkers and procalcitonin (p = 0.003) as clinical predictive parameters for infected fluid collections. On multivariate analysis, attenuation > 10 HU (p = 0.038), presence of entrapped gas (p = 0.027) and wall enhancement (p = 0.028) were independent parameters for distinguishing between infected and non-infected fluids. Gas entrapment had high specificity (93%) but low sensitivity (48%), while wall enhancement had high sensitivity (91%) but low specificity (50%). CT attenuation > 10 HU showed intermediate sensitivity (74%) and specificity (70%). Evaluation of the published proposed scoring systems did not improve diagnostic accuracy over independent predictors in our study. In conclusion, this prospective study confirmed that CT attenuation > 10 HU, entrapped gas and wall enhancement are the key imaging features to distinguish infected from sterile fluid collections on CT.

Diffusion-Weighted Magnetic Resonance Imaging Is an Ideal Imaging Method to Detect Infection in Pancreatic Collections: A Brief Primer for the Gastroenterologists.

Background: The development of infection in pancreatitis significantly increases the mortality rate up to 100% in the absence of any intervention. Therefore, it is extremely important to diagnose these cases at an early stage. The objectives of this study were to assess the diagnostic performance of computed tomography (CT) and diffusion-weighted MR imaging (DW-MRI) in the diagnosis of infection in pancreatic collections.Materials and methods: Prospective observational study of abdominal collections due to pancreatitis that underwent both CT and DW-MRI from August 2018 to July 2020 were enrolled in the study. The collections were analysed for infections - air foci in CT and diffusion restriction on DW-MRI.Results: Of the 39 patients recruited in the study, infected collections were present in 17, and 22 cases had sterile collections. On CT, air foci within the collection were present only in seven of the cases in our study (sensitivity 35%, specificity 95.4%, PPV 85.7%, NPV 65.6%). DW-MRI detected infection in all 17 cases (sensitivity 100%, specificity 72.7%, PPV 74%, NPV 100%).Discussion: Thirteen out of 17 collections suspicious for infection on DW-MR showed microbiological growth on culture examination. We believe that this is likely due to the patient's prior antibiotic use, which might have altered the micro-environment or inflammatory cell and bacterial content of the collection.Conclusion: DW-MRI is complementary and superior to CT in detecting infection in pancreatic collections. CT may be used to detect disease burden, extent and vascular complication.

CT Texture analysis and CT scores for characterization of fluid collections

BackgroundTexture analysis derived from Computed tomography (CT) might be able to better characterize fluid collections undergoing CT-guided percutaneous drainage treatment. The present study tested, whether texture analysis can reflect microbiology results in fluid collections suspicious for septic focus.MethodsOverall, 320 patients with 402 fluid collections were included into this retrospective study. All fluid collections underwent CT-guided drainage treatment and were microbiologically evaluated. Clinically, serologically parameters and conventional imaging findings as well as textures features were included into the analysis. A new CT score was calculated based upon imaging features alone. Established CT scores were used as a reference standard.ResultsThe present score achieved a sensitivity of 0.78, a specificity of 0.69, area under curve (AUC 0.82). The present score and the score by Gnannt et al. (AUC 0.81) were both statistically better than the score by Radosa et al. (AUC 0.75). Several texture features were statistically significant between infected fluid collections and sterile fluid collections, but these features were not significantly better compared with conventional imaging findings.ConclusionsTexture analysis is not superior to conventional imaging findings for characterizing fluid collections. A novel score was calculated based upon imaging parameters alone with similar diagnostic accuracy compared to established scores using imaging and clinical features.

Multidisciplinary Management of Complicated Pancreatitis: What Every Interventional Radiologist Should Know.

Management of acute pancreatitis is challenging in the presence of local complications that include pancreatic and peripancreatic collections and vascular complications. This review, targeted for interventional radiologists, describes minimally invasive endoscopic, image-guided percutaneous, and surgical procedures for management of complicated pancreatitis and provides insight into the procedures' algorithmic application. Local complications are optimally managed in a multidisciplinary team setting that includes advanced endoscopists; pancreatic surgeons; diagnostic and interventional radiologists; and specialists in infectious disease, nutrition, and critical care medicine. Large symptomatic or complicated sterile collections and secondary infected collections warrant drainage or débridement. The drainage is usually delayed for 4-6 weeks unless clinical deterioration warrants early intervention. If collections are accessible by endoscopy, endoscopic procedures are preferred to avoid pancreaticocutaneous fistulas. Image-guided percutaneous drainage is indicated for symptomatic collections that are not accessible for endoscopic drainage or that present in the acute setting before developing a mature wall. Peripancreatic arterial pseudoaneurysms should be embolized before necrosectomy procedures to prevent potentially life-threatening hemorrhage. Surgical procedures are reserved for symptomatic collections that persist despite endoscopic or interventional drainage attempts. Understanding these procedures facilitates their integration by interventional radiologists into the complex longitudinal care of patients with complicated pancreatitis.

Lecanactis (Roccellaceae) in Tasmania, with the description of a new saxicolous species and a revised key for the genus in Australia

AbstractThe lichen genus Lecanactis Körb. in Tasmania comprises six species: L. abietina (Ach.) Körb., which is widespread and pan-temperate; L. latispora Egea &amp; Torrente and L. neozelandica Egea &amp; Torrente, both shared with New Zealand and with the former recorded here from the Auckland Islands for the first time; L. mollis (Stirt.) Frisch &amp; Ertz, shared with Victoria and New Zealand; L. aff. dilleniana (Ach.) Körb., a European species recorded provisionally for Tasmania on the basis of several sterile collections; L. scopulicola Kantvilas, which is described here as new to science and apparently a Tasmanian endemic. This new taxon occurs in rocky underhangs and is characterized by a thick, leprose thallus containing schizopeltic acid, and 3-septate ascospores, 19–30 × 4.5–6 μm. Short descriptions and a discussion of distribution and ecology are given for all species. A key for all 11 Australian species of the genus is provided, including L. subfarinosa (C. Knight) Hellb. and L. tibelliana Egea &amp; Torrente, which are recorded for Australia for the first time, and L. platygraphoides (Müll.Arg.) Zahlbr., a first record for New South Wales. Lecanactis spermatospora Egea &amp; Torrente and L. sulphurea Egea &amp; Torrente are also included.

Infected versus sterile abdominal fluid collections in postoperative CT: a scoring system based on clinical and imaging findings.

Characterization of intraabdominal fluid collections as postoperative complication is a challenging task. The aim was to develop and validate a new score to differentiate infected from sterile postoperative abdominal fluid collections and to compare it with a published score. From May to November 2015, all patients with postoperative CT and C-reactive protein (CRP) 24 hours before CT-guided drainage were retrospectively included (Group A). HU, gas entrapment and wall enhancement of fluid collections were evaluated in the CT. All parameters were correlated with microbiology. To validate the score and to compare it with a published score, a second patient cohort was retrospectively recruited (Group B; January 2013-April 2015; December 2015-September 2016). In Group A (50 patients), univariate analysis confirmed that the four parameters were significantly associated with infected fluid collections. Based on binary logistic regression analysis, a score from 0 to 11 was developed (CRP </≥ 150 mg/l: 0/4 points; HU </≥ 20: 0/2 points; wall enhancement no/yes: 0/2 points; gas entrapment no/yes: 0/3 points). The best cutoff to diagnose infected fluid collections was ≥ 5 points (sensitivity 85%, specificity 79%, PPV 82%, NPV 79%). In Group B (425 patients), this score yielded sensitivity, specificity, PPV and NPV of 93%, 80%, 90% and 86%, respectively. For the published score, values were in the same range (93%, 44%, 77%, 77%). The score provides good discrimination between infected and sterile postoperative abdominal fluid collections. It yields comparable accuracy as the published score.

Gregorella, a Cyanobacterial Pioneer on Soil, New to North America

Gregorella humida was found in western Oregon, U.S.A. This is a new genus and species for North America, with both fertile and sterile collections. An ITS sequence demonstrated its affinity with European material. This minute, granular to branched-granular cyanobacterial lichen is a pioneer on recently disturbed soil. The species was previously known from Fennoscandia, the U.K., continental Europe, and Turkey.

Management of pancreatic fluid collections in patients with acute pancreatitis

Abstract Acute pancreatitis is associated with development of pancreatic fluid collections (PFCs). Acute PFCs that develop in interstitial edematous pancreatitis mostly resolve but some may persist and evolve into pseudocysts. Acute necrotic collections occurring in acute necrotizing pancreatitis generally persist and evolve into walled-off necrosis (WON) after 3 to 4 weeks. Most acute fluid collections do not require drainage unless they are large and cause compression of adjacent organs, contribute to increase in intraabdominal pressure or become infected. Acute infected collections can be managed with antibiotics and percutaneous drainage but may require necrosectomy either by minimally invasive surgical or endoscopic methods such as video-assisted retroperitoneal debridement and percutaneous endoscopic necrosectomy. Mature sterile collections, that is, pseudocyst and WON with a defined wall are best treated by internal transmural drainage which can be achieved either by per-oral endoscopic or surgical, preferably laparoscopic, method. Of late, infected PFCs are increasingly being treated with an endoscopic step-up approach that has been shown to be better than minimally invasive surgical step-up approach in terms of lesser complications. Use of lumen apposing metal stents during endoscopic drainage has emerged as an attractive option that facilitates necrosectomy in infected WON.

Su1429 – Neutrophil Cd64 Expression is a Novel Biomarker to Distinguish Sterile and Infected Fluid Collections in Patients with Acute Pancreatitis

Su1429 – Neutrophil Cd64 Expression is a Novel Biomarker to Distinguish Sterile and Infected Fluid Collections in Patients with Acute Pancreatitis

Catalase-Containing Silica Particles as Ultrasound-Based Hydrogen Peroxide Sensors to Determine Infected From Noninfected Fluid Collections in Humans.

OBJECTIVE. Hydrogen peroxide (H2O2) plays a key role in neutrophil oxidative defense against infection. Catalase-containing silica nanoshells are nanoparticles that generate O2 microbubbles imaged with ultrasound in the presence of elevated H2O2. We aimed to determine whether ultrasound-detectable O2 microbubbles produced by catalase-containing silica nanoshells can determine whether fluid collections drained from patients are infected. SUBJECTS AND METHODS. During this HIPAA-compliant, institutional review board-approved study, 52 human fluid samples were collected from clinically required image-guided percutaneous drainage procedures. Catalase-containing silica nanoshells were added to the fluid samples during imaging in real time using a Sequoia-512 15L8-S linear transducer (Siemens Healthcare). Production of detectable microbubbles was graded subjectively as negative (noninfected) or positive (infected) with low, moderate, or high confidence by a single observer blinded to all clinical data. The truth standard was microbiology laboratory culture results. Performance characteristics including ROC curves were calculated. RESULTS. Microbubble detection to distinguish infected from noninfected fluids was 84% sensitive and 72% specific and offered negative and positive predictive values of 89% and 64%, respectively. The AUC was 0.79. Six of nine false-positive samples were peritoneal fluid collections that were all collected from patients with decompensated cirrhosis. CONCLUSION. The presence of elevated H2O2 indicated by microbubble formation in the presence of catalase-containing silica nanoshells is sensitive in distinguishing infected from noninfected fluids and offers a relatively high negative predictive value. False-positive cases may result from noninfectious oxidative stress. Catalase-containing silica nanoshells may constitute a novel point-of-care test performed at time of percutaneous drainage, potentially obviating placement of drains into otherwise sterile collections and minimizing risk of secondary infection or other complication.

Quantitative diffusion-weighted magnetic resonance imaging for prediction of early infection in pancreatic collections: Results of a pilot study.

Background/Aims:The development of infection in pancreatitis increases the mortality rate up to 32%. Therefore, it is important to identify patients who are at high risk of developing infection, at an early stage. The objectives of the study were (a) to analyze the quantitative parameters of diffusion-weighted magnetic resonance imaging (DW-MRI) and apparent diffusion coefficient (ADC) in infected as well as sterile pancreatic collections (b) to establish “cut-off” values for ADC that can identify infected pancreatic collections.Materials and Methods:Prospective observational study of pancreatitis cases who underwent DW-MRI from August 2018 to July 2019 were enrolled in the study. The collections were analyzed for diffusion restriction. The average of the three ADC values from the wall and center of collection was noted.Results:Infected collections were seen in 7 and sterile collections observed in 11 cases. The optimal cut-off ADC value to differentiate sterile and infected collection in our study was 1.651 × 10-3 mm2/s (sensitivity of 81.8%; specificity of 100.0%). ROC curve for mean ADC from the wall showed a significant diagnostic accuracy with AUC: 0.91; 95% CI: 0.77-1.0 (P = 0.004).Conclusion:DW-MRI is a reliable noninvasive technique to differentiate sterile and infected pancreatic collections. ADC values from the periphery of the collection can predict infected pancreatic collections at an early stage. DW-MRI should not be considered as a substitute for aspiration cytology in patients with septic symptoms and absent diffusion restriction on MRI.

Aspiration of sterile post-operative spinal fluid collections using low-dose computed tomography guidance

Sterile postoperative seromas can develop after posterior spinal surgery and cause pain, weakness, and numbness. Management typically involves operative evacuation. We propose that these collections can be managed with percutaneous computed tomography (CT) guided aspiration, potentially saving the patient an additional surgery. Here, we evaluate the safety and efficacy of this approach. Patients who developed symptomatic postoperative seromas within 60 days following surgery for spinal canal stenosis and had stable neurologic exams were considered for CT-guided percutaneous aspiration. To be considered for this approach, patients had to have pre-procedural evidence of radiographic spinal cord or cauda equina compression, hemodynamic stability, and low suspicion for infection. A total of 16 symptomatic collections were aspirated among 15 patients. The mean volume of fluid removed was 32.0 mL. There were no peri- or post-procedural complications. Eight (50%) had resolution or substantial improvement of their symptoms (p = 0.0002 when compared to the null hypothesis). One patient had short interval improvement but return of their initial symptoms 12 h following aspiration, 3/16 (19%) had minimal improvement, and 4/16 (25%) had no change in symptoms. Fluid collections that appeared denser on the pre-procedural CT were associated with retrieval of more sanguineous appearing fluid (p = 0.08). Neither the amount nor quality of fluid aspirated was associated with outcome. We conclude that percutaneous CT-guided aspiration of postoperative seromas is safe and should be considered as an alternative to open surgical evacuation in patients with stable neurologic exams.

Spectrum of acute pancreatitis in a patient- progression of complications

Background Acute pancreatitis is defined as an acute condition presenting with abdominal pain, and is usually associated with raised pancreatic enzyme levels in the blood or urine, as a result of pancreatic inflammation. Acute pancreatitis may recur, severe episodes, however, may involve a progression to sterile and infected peripancreatic fluid collections, pancreatic necrosis and pancreatic abscess, pancreatic pseudocyst, pancreatic ascites and pancreaticopleural fistulas. These can be divided into acute or delayed, depending on whether such a collection is of less than or more than 4 weeks' duration. Pancreatic Abscess is a circumscribed intra-abdominal collection of pus, usually in proximity to pancreas. Pancreatic abscess is often a late complication of acute necrotizing pancreatitis, occurring more than 4 weeks after the initial attack. The reported mortality rate due to pancreatic abscesses after acute pancreatitis has been 30 to 50%, a statistic that has remained unchanged for decades.

RhBMP-2-induced radiculitis in patients undergoing transforaminal lumbar interbody fusion: relationship to dose

Background ContextRecombinant human bone morphogenetic protein-2 (rhBMP-2) remains the primary synthetic osteoinductive material used in spinal fusion surgery today. The early inflammation reaction to rhBMP-2 manifesting with radicular symptoms has been previously reported in patients undergoing transforaminal lumbar interbody fusion (TLIF). There is a disagreement with regard to the factors affecting its occurrence and whether such symptoms are dose dependent. PurposeThe purpose of this analysis was to determine the incidence of rhBMP-2-induced radiculitis and its relationship to dose. Study Design/SettingA retrospective cohort analysis was performed of the prospectively collected data. Patient SampleAll consecutive patients (n=204) who underwent one- or two-level TLIF and instrumented posterolateral fusion with an off-label rhBMP-2 use were included in this analysis. Outcome MeasuresThe patients who developed new radicular symptoms after initial improvement postoperatively and had sterile fluid collections indicative of inflammatory process, or in the absence of any structural abnormalities that would explain these symptoms on imaging studies, were deemed to have rhBMP-2-induced radiculitis. MethodsMagnetic resonance imaging (MRI) scans were obtained for all patients who developed postoperative radicular symptoms. Correlations between the total rhBMP-2 dose, dose per spinal level, and incidence of radiculitis were evaluated while controlling for age, sex, number of TLIF levels, and surgeon. ResultsThe incidence of postoperative radiculitis was 11.3% (23 out of 204). The average total rhBMP-2 dose was 4.9 mg (range=2.1–12) and the average dose per spinal level was 3.8 mg (range=1.05–12). Logistic regression analysis did not identify any significant correlations between the rhBMP-2 doses and the incidence of radiculitis (p=.6). ConclusionThe incidence of rhBMP-2-induced radiculitis in patients undergoing TLIF is quite high, but there were no dose-related correlations found. The study, however, cannot rule out a possibility that a larger variation in bone morphogenetic protein (BMP) doses could still be a factor in the development of rhBMP-2-associated radiculitis.

PWE-394 Are we misdiagnosing foreign body reaction to biologic implants as mesh-related infection?

Introduction Concern regarding mesh erosion has led to the increased use of biological implants in laparoscopic ventral rectopexy (LVR). There is a growing recognition that biological implants are not inert and their introduction into the body triggers a sequence of events leading to the formation of foreign body giant cells at the tissue/implant interface. This could lead to systemic inflammatory response syndrome (SIRS) that mimics mesh-related infection. Method The records of 4 patients readmitted after LVR were assessed retrospectively. A radiologist with an interest in pelvic floor surgery reviewed their CT scans. Results We performed 27 LVRs from October 2013–2014 using Biodesign®biological implant and 19 using synthetic mesh. 4 patients (15%) from the biologic cohort were re-admitted with pain and pyrexia and a pelvic abscess was suspected. CRP was raised in 4 (mean 276 at readmission and 99 at discharge) but in only one was the WCC elevated. All 4 received antibiotics and 2 patients had percutaneous drainage of sterile collections while the other two had no intervention. Those treated with drainage had a longer hospital stay and a delayed recovery compared with the observation only group. All made a complete recovery and none had either symptoms of their original prolapse or dysfunctional defecation. None of the patients in the synthetic mesh group were readmitted. Conclusion SIRS is a natural reaction to the implantation of non-inert foreign material as evidenced by elevated inflammatory mediators in the absence of a neutrophilia. This small study would suggest that the drainage of such 9collections9 following insertion of biological meshes is not only unnecessary but may run the risk of introducing sepsis into a sterile environment. The routine use of intravenous antibiotics might be unnecessary and a watchful waiting approach should be considered. Disclosure of interest None Declared.

Sterile subperiosteal fluid collections accompanying orbital wall infarction in sickle-cell disease

Infarction of the orbital wall is an uncommon manifestation of sickle cell disease (SCD) that may mimic an infectious process. We report a patient with two separate orbital infarctions with different presenting symptoms involving different bones. Radiologic-guided sampling of a periosteal fluid collection in the first episode showed likely sterile inflammatory exudates. This case highlights the range of findings in orbital wall infarction in SCD as well as helpful clinical and imaging entities that may differentiate infarction from infection, allowing early diagnosis and appropriate management.