Surgery In Young Patients Research Articles

Decompression alone versus decompression with instrumented fusion for young patients with single-level lumbar disc herniation: a short-term prospective comparative study

Background For young patients, the surgical method for lumbar disc herniation remains controversial. The aim of this study was to prospectively determine the short-term clinical outcome after surgery for young patients with lumbar disc herniation. Methods In this prospective comparative study between April 2010 and August 2011, a total of 80 patients underwent primary surgery at a single level for lumbar disc herniation. The patients were divided into two groups: decompression alone and decompression with instrumented fusion. An independent examiner clinically evaluated the patients at preoperation and at 1, 3, 6, and 12 months after surgery. The patients filled out the instruments for back and leg pain using a Visual Analog Scale (VAS), Oswestry Low Back Pain Disability Questionnaire (ODI), and Japanese Orthopaedic Association (JOA) scores. The differences between the two groups were analyzed. Results The mean age of all the patients at the time of surgery was 33.7 years. Of the 80 patients, 38 patients underwent decompression alone and 42 patients underwent posterior lumbar interbody fusion. Increasing complexity of surgery was associated with a longer surgery time, greater blood loss, and a longer hospital stay after surgery. Both methods of surgery independently improved outcomes compared with baseline status based on VAS, ODI, and JOA scores (P <0.05), and no significant differences were found between the two groups at most of the measuring points in time, although patients with decompression alone had a higher JOA score (P=0.016) and higher JOA recovery rate (P=0.010) at the 3-month follow-up. Conclusions The short-term results of our study showed that both methods of surgery obtained effective clinical outcomes, but decompression alone had some advantages (shorter surgery time, less blood loss, shorter hospital stay, and lower cost) compared with decompression with instrumented fusion. Young patients with decompression alone could achieve great physical function earlier.

Early-onset osteoarthritis, Charcot-Marie-Tooth like neuropathy, autoimmune features, multiple arterial aneurysms and dissections: an unrecognized and life threatening condition.

BackgroundSevere osteoarthritis and thoracic aortic aneurysms have recently been associated with mutations in the SMAD3 gene, but the full clinical spectrum is incompletely defined.MethodsAll SMAD3 gene mutation carriers coming to our centre and their families were investigated prospectively with a structured panel including standardized clinical workup, blood tests, total body computed tomography, joint X-rays. Electroneuromyography was performed in selected cases.ResultsThirty-four SMAD3 gene mutation carriers coming to our centre were identified and 16 relatives were considered affected because of aortic surgery or sudden death (total 50 subjects). Aortic disease was present in 72%, complicated with aortic dissection, surgery or sudden death in 56% at a mean age of 45 years. Aneurysm or tortuosity of the neck arteries was present in 78%, other arteries were affected in 44%, including dissection of coronary artery. Overall, 95% of mutation carriers displayed either aortic or extra-aortic arterial disease. Acrocyanosis was also present in the majority of patients. Osteoarticular manifestations were recorded in all patients. Joint involvement could be severe requiring surgery in young patients, of unusual localization such as tarsus or shoulder, or mimicking crystalline arthropathy with fibrocartilage calcifications. Sixty eight percent of patients displayed neurological symptoms, and 9 suffered peripheral neuropathy. Electroneuromyography revealed an axonal motor and sensory neuropathy in 3 different families, very evocative of type II Charcot-Marie-Tooth (CMT2) disease, although none had mutations in the known CMT2 genes. Autoimmune features including Sjogren’s disease, rheumatoid arthritis, Hashimoto’s disease, or isolated autoantibodies- were found in 36% of patients.Interpretation SMAD3 gene mutations are associated with aortic dilatation and osteoarthritis, but also autoimmunity and peripheral neuropathy which mimics type II Charcot-Marie-Tooth.

Demineralization after balloon kyphoplasty with calcium phosphate cement: a histological evaluation in ten patients

Balloon kyphoplasty (BKP) with calcium phosphate cement (CPC) is increasingly being used for spinal surgery in younger patients. In routinely performed follow-up CT scans we observed considerable areas of demineralization in CPC processed vertebrae in several patients. To rule out infections or inflammations histological examinations were planned for these patients. Ten patients (23-54 years; six men) with significant demineralization areas in CT scans after CPC balloon kyphoplasty were selected. Punch biopsies from these areas were taken in local anesthesia using a biopsy needle. One half of the specimen was decalcified and embedded in paraffin, and sections were examined histologically using hematoxylin and eosin, Van Gieson, and trichrome staining. The second half of the specimen was cast directly in methyl methacrylate and sections were examined by Paragon and von Kossa/Safranin staining. Stained slides were viewed under light microscopy. Bone-punch specimens were taken at 17.5 months (mean) after BKP with CPC. In most cases, the cement was well surrounded by newly formed lamellar bone with very tight connections between the cement and new bone. Unmineralized areas were observed sporadically at the cement surface and adjacent to the implant. There were no pronounced signs of inflammation or osteolysis of adjacent bone. No complications were observed during or following patients' biopsy procedures. CPC demonstrated good biocompatibility and osseointegration in clinical use, with no evidence of inflammation or osteonecrosis. Demineralized areas in CT scans could be a result of remodeling of the cancellous bone in vertebral bodies.

In-hospital mortality and long-term survival after coronary artery bypass surgery in young patients

Coronary artery bypass graft (CABG) is performed for symptomatic and prognostic reasons. We aimed to determine the factors that contribute to in-hospital mortality and long-term survival in young patients (aged less than 65) undergoing CABG. A prospective database was retrospectively analysed and cross-correlated with the United Kingdom's Strategic Tracing Service to evaluate survival in patients under the age of 65, following isolated primary CABG. Univariate-, multivariate logistic with Cox regression- and neural network analyses were performed. Patients under the age of 65, who had undergone isolated CABG between April 1997 and March 2010 were studied;n = 5967. In-hospital mortality was 1.1% and long-term mortality was 13.5%; median follow-up 7.9 years. Multivariate analysis demonstrated that atrial fibrillation, 'urgent' operation status, postoperative creatinine kinase (CKMB), moderate or poor left ventricular (LV) function, and female sex were significant factors predicting in-hospital mortality. Cox regression demonstrated that age, diabetes (oral and insulin controlled), moderate and poor LV function, cerebrovascular disease, dialysis, left internal mammary artery (LIMA) usage, postoperative CKMB, atrial fibrillation, 'urgent' operation status, and peripheral vascular disease were significant factors determining long-term survival. Radial artery use, off-pump surgery, composite arterial grating and graft number had no effect on in-hospital mortality or long-term survival. Neural network analysis confirmed the factors identified by logistic and Cox multivariate analysis. The risk factors for in-hospital mortality in patients under the age of 65 include postoperative CKMB, urgent operation status, LV function, female sex and atrial fibrillation. Significant factors determining long-term survival in the under-65 age group include age, atrial fibrillation, diabetes (diet and insulin controlled), LV function, cerebrovascular disease, dialysis, LIMA usage, 'urgent' operation status, CKMB and peripheral vascular disease.

Nephron Sparing Surgery for Unilateral Wilms Tumor in Children with Predisposing Syndromes: Single Center Experience Over 10 Years

Unilateral Wilms tumors associated with predisposing syndromes are treated with preoperative chemotherapy followed by surgical resection. We describe our experience with nephron sparing surgery for Wilms tumor in this population at risk for metachronous lesions. We conducted a retrospective review of all children with a predisposing syndrome who underwent nephrectomy for malignancy during a 10-year period (2000 to 2010). Data collected included age, mode of detection, tumor size, treatment, pathology results, followup time and recurrence episodes. From 2000 to 2010, 13 of 75 (19%) patients treated for Wilms tumor were diagnosed with predisposing syndrome(s). Eight patients with unilateral tumors were treated and had a mean age at diagnosis of 27 months (range 7 months to 9 years). Beckwith-Wiedemann syndrome, isolated hemihyperplasia, WAGR (Wilms tumor, Aniridia, Genitourinary abnormalities, mental Retardation) syndrome and isolated 11p13 deletion were the underlying diagnoses in 3, 2, 2 and 1 patient, respectively. All but 2 patients were diagnosed by screening ultrasound and 5 underwent preoperative chemotherapy. Median tumor size at surgery was 2.5 cm (range 1 to 13). Nephron sparing surgery was performed in 6 of 8 patients. Pathological study showed favorable histology Wilms tumor and nephrogenic rests in 6 and 2 patients, respectively. After a mean followup of 36 months (range 6 to 72) no recurrences were documented and all children had normal creatinine levels. Nephron sparing surgery appears safe for patients with unilateral Wilms tumor associated with predisposing syndrome(s), allowing for the preservation of renal function and good oncologic outcomes for the available followup time. If more studies confirm our observation, current recommendations for the surgical treatment of Wilms tumor may need to reemphasize the value of attempting nephron sparing surgery in this patient population.

Borderline ovarian tumors: Long-term survival and preservation of fertility.

e15508 Background: Borderline ovarian tumors, also called low-malignancy potential tumors, are infrequent tumors present predominantly in pre-menopause women. Their evolution after surgical treatment is generally very good. The main objective of this paper is to show the evolution of a group of borderline tumors treated at our institution. Methods: Between January 1, 2000 and January 1, 2010, 36 patients diagnosed with ovarian borderline tumors were examined by two independent pathologists, according to the guidelines established by the USA Association of Directors of Anatomic and Surgical Pathology. These patients were followed at IOHM and comprise this paper’s study group. Results: Population Characteristics: Mean Age: 41 years (Range: 20-85). Affected Ovary (Right: 17 pts; Left: 14 pts; Both: 5 pts). Pathology: Mucinous (17 pts), Serous (16 pts), Clear, Brenner and Endometroid Cells (1 pt each). Stages: IA (24 pts), IB (5 pts), IC (2pts), IIIA (4 pts), IIIC (1 pt). Five patients presented non-invasive peritoneal implants and three presented positive peritoneal liquid. All patients were surgically treated: 28 with total anexohisterectomy (TAH) and 8 with unilateral ooforectomy. No patient was given any chemotherapy or radiotherapy treatment. Four patients did not attend follow-up consultations and were lost after 4, 6, 12 and 29 months with no evidence of disease (NED). Thirty-two patients were followed bi-annually during the first five years and annually thereafter. One patient became pregnant after the surgery. All patients are alive and NED with an average follow up of 50 months (range: 29-133). Conclusions: 1) Although half the cases in the study were under 35 years old, there were 12 tumors present in patients over 50 years of age and 1 borderline tumor present in an 85 year old patient. 2) Surgically treated ovarian borderline tumors have a high chance of being curable without the need of chemotherapy or radiotherapy. 3) Conservative surgery in young patients allows a conservation of fertility, provided they are subject to an adequate follow-up.

Hip Arthroplasty in Adolescents with Juvenile Rheumatoid Arthritis

Results of total hip replacement (THR) performed in 23 patients (9 male and 14 female) aged from 13 to 18 years with coxarthrosis on the background of juvenile rheumatoid arthritis (JRA) are presented. All patients have been operated on at traumatologic-orthopaedic department of Scientific Center for Children's Health during the period from 2008 to 2012. Main complaints of patients were pain and limitation of movement in hip joints, discrepancy of lower extremities length, claudication, disturbance of weight bearing ability and lower extremities function that in 90% of cases made the movement without additional support impossible. Indications to THR and peculiarities of surgery in young patients with JRA are described. Almost in all patients correction of lower extremities deformity and formation of either normal or close to normal functional status have been achieved. Roentgenologic examination showed good localization of implant components.

Proper indications for fertility-sparing surgery in young patients with early stage epithelial ovarian cancer

Proper indications for fertility-sparing surgery in young patients with early stage epithelial ovarian cancer

Percutaneous Transluminal Mitral Commissurotomy for Rheumatic Mitral Stenosis in a 5-Year-Old Child

We report a 5-year-old boy weighing 11 kg, with severe mitral valve stenosis of rheumatic aetiology, who underwent successful percutaneous transluminal mitral commissurotomy (PTMC) with valvuloplasty balloon. Postprocedural mean pressure gradient across the mitral valve decreased to 6 mmHg from an initially recorded value of 22 mmHg. In addition to symptomatic improvement, the mitral valvular area increased from 0.4 to 0.8 cm(2) without significant change in mitral regurgitation. At 1- and 3-month follow up, transthoracic echocardiography revealed further improvement with an increase in mitral valve area to 1.0 cm(2), a decrease in pulmonary arterial pressure, and a mean mitral valve pressure gradient of 8 mmHg with trivial mitral regurgitation. To best of our knowledge, this is the first successful PTMC procedure performed in the youngest and smallest ever reported child with rheumatic mitral stenosis (MS). We conclude that PTMC with valvuloplasty balloon could be a logical alternative to surgery in young patients with rheumatic MS.

How Early is Too Early? A Review of Infant Seizure Surgery Literature

In the US, epilepsy is credited with 2.75 deaths per 1 million people. This number is slightly lower in the UK at 1.79, but higher in Canada at 6.74. (4) Surgery for intractable epilepsy has been in use for hundreds of years, and in recent decades has demonstrated good success. However, many practitioners and the public still view surgery as a last resort, to be explored only after all possible medical therapy combinations have been exhausted and a good length of time has elapsed. Now, however, many major centers have begun to push surgery further and further to the front of their treatment paradigm, predicated on the discovery that medical refractiveness can be predicted after failure of just a few medications. (1) As collective experience grows, the idea that surgery should be planned early in the disease course is gaining momentum. Now that surgical success rates can top 80% in carefully selected cases (2), the American Academy of Neurology, in association with the American Epilepsy Society and American Association of Neurological Surgeons, after reviewing one class 1 and 24 class 4 studies, recommend referral to an epilepsy center so that patients can be expediently evaluated for surgery. (3) Not only is the length of preoperative disease decreasing in these patients, but they are becoming younger. This raises the question: how early is too early? Even if early intervention makes sense in adults, is there a minimum age for which this holds true? Does intervention before this age cause increased harm? Several studies examining this area were reviewed, which in combination demonstrate that seizure surgery in young patients is efficacious. At Dell Children's Medical Center, we advocate early evaluation and surgery for patients with medically refractory epilepsy who are candidates. In the last two years we have done 17 surgeries on patients under 4 years of age, 3 of which have been on patients under one year. Once a patient is deemed medically refractory with a high likelihood of surgical benefit and acceptable surgical risk, we will proceed with surgery regardless of age. Patient selection, however, requires the coordinated effort of a quality multidisciplinary team. Keywords: Epilepsy Surgery, Pediatric, Infant, Surgery Outcomes, Refractory Epilepsy, Multidisciplinary

Recent Statin Use and Cataract Surgery

To investigate whether the statin class of drugs reduces the risk of cataract extraction. Case-control study. setting: Kaiser Permanente Southern California, which provides prepaid healthcare for 3.2 million residents by 6000 physicians. patient population: Eligible patients were those who had 5+ years of continuous enrollment in 2009. Cases were 13 982 patients who underwent cataract surgery in their first eye in 2009. Controls were the 34 049 patients who had an eye examination, but did not undergo cataract surgery or have a diagnosis of cataract in their medical record. observation procedure: The primary source of data to assess cataract surgery, treatment with statins, and other risk factors is the electronic database of Kaiser Permanente. main outcome measure: Use of the statin class of drug. Patients who had cataract surgery were older, were more likely to be white, and appeared to have more coronary artery disease but less diabetes. The proportion of statin users appeared to be greater among those with cataract surgery (64.3%) compared to those without a diagnosis of cataract or cataract surgery (55.5%). After adjustment for age, sex, race, smoking status, diabetes, and coronary artery disease, longer-term statin use was found to be protective against cataract extraction (OR: 0.93, P = .02), while shorter-term use was associated with cataract surgery (OR: 1.11, P < .0001). Age-stratified logistic regression analysis showed that statin use of 5 years or more was protective against cataract surgery in the younger age group (50-64 years), while shorter-term use (<5 years) was associated with an increased risk of surgery in both the younger and older age groups (60+ years). The current study finds that recent longer-tem statin use was protective against cataract surgery in younger patients (50-64 years of age), while shorter-term use was associated with an increased risk of surgery. One strength of the current study is information on the large number of incident cases of cataract extraction and the electronic database on drug use. Additional studies will be needed to understand the difference in effect between longer- and shorter-term users of statins.

A Case of Glomus Vagale Tumor with the Complaint of Hoarseness

Dear Editor, Vagal paragangliomas are uncommon tumors of the parapharyngeal space, approximately 200 cases having been reported.[1] They arise from tissue of the extra adrenal sympathetic nervous system.[2] They mostly manifest as a painless neck mass near the angle of the mandible usually between the skull base and the hyoid bone.[3] The other manifestations are hoarseness and less commonly dysphagia, palatal weakness and tongue hemi-atrophy.[1][4] Pressure on the cervical sympathetic chain causes horner syndrome. Ultrasonography, CT scan, MRI and angiography are diagnostic modalities been used, but combining conventional MR imaging with CE-MRA has dramatic diagnostic value for the assessment of head and neck paragangliomas.[5] Surgical resection is the treatment for carotid body tumors, and the procedure should be undertaken unless the patient has a prohibitive operative risk.[4] Here we present a rare glomus vagale case presented with hoarseness and show his management. A 37 years old farmer presented with hoarseness and left cervical mass beyond mandible angle. He did not claim of another symptom, on physical examination a firm mobile 2x2 cm mass was moving horizontally. Before treatment planning, we found left vocal cords paralyzed and CT scan demonstrated a heterogenous lesion next to the carotid bifurcation (Figure 1). Planning resection, he underwent surgery and we found two masses, one in 1.5x1.5 over bifurcation and the other just in bifurcation area extending toward skull through vagal foramen, we could resect these highly vascular masses while saving carotid branches but sacrificing involved vagal nerve. Pathologist confirmed these paragangliomas. Fig. 1 CT scan shows left neck mass. The normal carotid body is a small mass of neurovascular tissue located bilaterally in the medial valley of the carotid artery bifurcation. Although the term has historically been assigned to these masses, they are not carcinomas, and the neoplastic process is actually hypertrophy of the carotid body tissue.[6] The four main locations of glomus tissue within the head and neck are: (a) The carotid bifurcation (carotid body tumor), (b) The inferior ganglion region (ganglion nodosum) and cervical portion of the vagus nerve (glomus vagale or vagal paraganglioma), (c) The jugular bulb region (glomus jugulare) and (d) The middle ear cavity (glomus tympanicum).[3] Paragangliomas originate in the head and neck from the brachiomeric family of paraganglia, neuroendocrine tissue which lies along the carotid artery, the aorta, the glossopharyngeal nerve, and the middle ear.[7] Preoperative planning requires a selective carotid arteriogram to clarify arterial anatomy and the relation of the carotid body tumor to the carotid bifurcation. Embolization of the tumor may also be achieved through these branch vessels, particularly in cases in which the lesion extends over a considerable distance and may approach the base of the skull. Challenging options about surgical versus radiation treatment continues, advocating radiation for small lesions,[8][9] and surgery in younger patients and tumors causing bony destruction.[10] Morbidity associated with vagal paraganglioma surgery is significantly higher than that of carotid body tumor surgery. Plans for intraoperative blood cell salvage are appropriate, as significant blood loss is routine in the dissection of these lesions.[6] Therapeutic embolization reduces the size of the tumor and limits intraoperative blood loss but may rarely be considered as definitive treatment.[11] Radiation therapy is an alternative to surgery and may be effective in arresting the growth, but it can lead to neurologic sequelae and rarely can destroy the tumor. Irradiation is generally used in elderly patients as well as in large and unresectable tumors [1] and gathering data upon clinical examination and imaging, we prepared our client to surgery. Under general anesthesia via standard cervical approach, tumor dissected off the carotid branches but found left vagus nerve involved, extending toward skull base through cranial nerve foramen, so had to sacrify it.

Aesthetic and functional radical surgery in young patients with stage one or two tongue cancer: A preliminary report

Introduction The effect of an initial radical cure and the post-operative quality of life in young patients with stage one or two tongue cancer seems to be more important than in old patients. The aim of this study was to achieve both optimal surgical effectiveness and improved post-operative quality of life for young patients with stage one or two tongue cancer. Materials and methods 7 patients under 40 years of age with T 1-T 2N 0M 0 squamous cell carcinoma of tongue underwent aesthetic and functional radical surgery in which reconstruction of the defect in the oral cavity and conservation of the main functional organs in neck with good scar aesthetics in the face and neck were performed. The outcomes were assessed clinically. Results No tumour recurrence was found in the tongue, floor of mouth or neck at the end of follow-up (at least 37 months). The appearance of the tongue and oral function was retained; function in face, neck and shoulder was maintained; a satisfactory cosmetic appearance of the face and neck was achieved. Conclusions Aesthetic and functional radical surgery could ensure radical cure and unchanged, or improved post-operative, quality of life in young patients with stage one or two tongue cancer.

Parathyroidectomy in the elderly population: Does age really matter?

Compare parathyroidectomy patients based on age, including demographics, outcomes, and complications. Retrospective review. Prospective parathyroidectomy database covering 1998 to 2007 was reviewed retrospectively. A total of 687 patients underwent parathyroidectomy, including 247 (36%) >65 years old. Discharge was more often on day of surgery in younger patients (42.5% vs. 29.2%, P = .007) and >23 hours for older patients (24.7% vs. 12.3%, P < .0001). Older patients stayed longer in the recovery room (134 vs. 107 minutes, P = .005). Despite postoperative normocalcemia, older patients tended to have persistently elevated parathyroid hormone (PTH) (10.5% vs. 6.4%, P = .07), whereas younger patients had normal PTH (81.6% vs. 70%, P = .0007). PTH levels were low-abnormal (56-110) in younger patients (47% vs. 29%, P = .046), but high-abnormal (>220) in older patients (16.6% vs. 9.55%, P = .009). Overall complication rates were low (6%-8%), with >93% in either group having no major complications. There was no difference in timing or types of complications, except elderly patients were more likely to have cardiac complications (2.83% vs. 0.45%, P = .022). Nearly 700 parathyroidectomies were performed at our institution over 10 years. Elderly patients comprised one third of this population. They were likely to have longer hospital and recovery room stays, and postoperative normocalcemia with elevated PTH, which may actually be a normal finding for these patients, but it warrants further study. The rate, timing, and types of complications were similar between age groups, although elderly patients had more cardiac complications. When properly indicated, parathyroidectomy remains a safe and effective option for management of hyperparathyroidism in elderly patients.

Eye muscle surgery for infantile nystagmus syndrome in the first two years of life

To report visual and elctrophysioloigcal effects of eye muscle surgery in young patients with infantile nystagmus syndrome (INS). Prospective, interventional case cohort of 19 patients aged under 24 months who were operated on for combinations of strabismus, an anomalous head posture, and nystagmus. All patients were followed at least nine months. Outcome measures, part of an institutionally approved study, included Teller acuity, head position, strabismic deviation, and eye movement recordings, from which waveform types and a nystagmus optimal foveation fraction (NOFF). Computerized parametric and nonparametric statistical analysis of data were perfomed using standard software on both individual and group data. Age averaged 17.7 months (13.1-month follow-up). Thirteen (68%) patients had associated optic nerve or retinal disease. 42% had amblyopia, 68% had refractive errors. Group means in binocular Teller acuity (P < 0.05), strabismic deviation (P < 0.05), head posture (P < 0.001), and the NOFF measures (P < 0.01) from eye movement recordings improved in all patients. There was a change in null zone waveforms to more favorable jerk types. There were no reoperations or surgical complications. Surgery on the extraocular muscles in patients aged less than two years with INS results in improvements in multiple aspects of ocular motor and visual function.

Future Young Patient Demand for Primary and Revision Joint Replacement: National Projections from 2010 to 2030

Previous projections of total joint replacement (TJR) volume have not quantified demand for TJR surgery in young patients (< 65 years old). We developed projections for demand of TJR for the young patient population in the United States. The Nationwide Inpatient Sample was used to identify primary and revision TJRs between 1993 and 2006, as a function of age, gender, race, and census region. Surgery prevalence was modeled using Poisson regression, allowing for different rates for each population subgroup over time. If the historical growth trajectory of joint replacement surgeries continues, demand for primary THA and TKA among patients less than 65 years old was projected to exceed 50% of THA and TKA patients of all ages by 2011 and 2016, respectively. Patients less than 65 years old were projected to exceed 50% of the revision TKA patient population by 2011. This study underscores the major contribution that young patients may play in the future demand for primary and revision TJR surgery. Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Long-Term Durability of Tendon Arthroplasty With Excision of the Trapezium in Stage 1 Osteoarthritis of the Thumb CMC Joint

Basal joint arthritis of the thumb is commonly treated surgically. Although the results are good, there is still controversy regarding the treatment of young people with low radiographic stages of disease. Our purpose was to evaluate the durability of a tendon arthroplasty procedure in this population. Thirty patients aged 55 years or under, with early stage arthritis, were evaluated. Eight patients were available for long-term (average 86 months) follow-up. No deterioration in the strength and mobility of the operated thumbs in the long-term was found. There was a significant increase in tip pinch strength between short- and long-term follow-up evaluations. This study supports the durability of this surgery in younger patients, potentially reducing the need for multiple surgeries.

Uterine Tumor Resembling Ovarian Sex Cord Tumors Treated by Resectoscopic Surgery

Uterine tumors resembling ovarian sex cord tumors (UTROSCTs) are rare neoplasms of uncertain malignancy, affecting either pre or menopausal women. Only 48 cases of UTROSCTs have been reported and in most patients the diagnosis was made incidentally, after a hysterectomy as a result of the assumption of a leiomyoma. Although no death from progressive disease was reported, locoregional spread or abdominal relapse was detected in some patients. Up until now, a treatment sparing the uterus was reported in only 2 patients with UTROSCTs. Both patients conceived after surgery and were free from recurrent disease after a mean follow-up of 16.5 months. We report a third case of a young patient affected by pure UTROSCTs and treated conservatively. A 29-year-old woman underwent resectoscopic hysteroscopy because of the assumption of a grade-1 submucous myoma measuring about 5 cm. To accomplish the removal of the endometrial mass, a 2-step hysteroscopic resection was required. Histology showed epithelioid cells arranged in nests, cords, tubules, and trabeculae infiltrating the myometrium; no sarcoma cell differentiation was detected. Immunohistochemistry resulted in positivity to CD99, inhibin, calretinin, cytokeratin, and estrogen receptor, whereas a negative staining to epithelial membrane antigen, actin, desmin, and human melanoma black 45 was obtained. Based on histologic pattern and immunohistochemical phenotype, a diagnosis of pure UTROSCTs was made; the staging of disease revealed neither locoregional spread nor distant metastases. Two months after surgery, reassessment by hysteroscopy and endometrial biopsy revealed no residual endometrial disease. The patient was free from disease 13 months after surgery. Because of the uncertain malignant potential of UTROSCTs and based on the poor data available from current literature, a fertility-sparing surgery in young patients appears safe. However, a close long-term follow-up is required and a quick completion of a patient's childbearing desire seems advisable.

OC132: The role of ultrasound in prediction of optimal vs. suboptimal cytoreductive surgery in advanced ovarian cancers

6.1 months (range 3–30 months), speed growth rate was recorded before a further conservative surgery. Conclusion: TVUS is the most effective procedure in the correct identification of all tumor recurrences and allows further sparingfertility surgery in young patients. In selected cases an observational longitudinal follow-up of recurrences is allowed given their low growth rate, in order to well define time and type of a further conservative minimally invasive surgical approach.

Phaco dislocation technique in young patients with uveitis

We describe a small-incision technique that reduces the phacoemulsification time. It reduces the risk for strong intraocular inflammation after surgery and posterior capsule rupture during surgery in young patients with uveitis.