Surgical Approach For Management Research Articles

Efficacy of combined surgical approaches in the management of sinonasal and orbital pathologies: innovations in minimally invasive techniques and their impact on postoperative outcomes

Sinonasal and orbital pathologies present unique challenges due to their anatomical complexity requiring advanced surgical approaches for optimal management. This systematic study demonstrates the effectiveness of combined surgical interventions based on advancements in minimally invasive approaches. An electronic literature search was performed on articles reporting patient outcomes after combined surgical management in sinonasal and orbital pathologies through the PubMed, Scopus, and Cochrane databases. Under the inclusion criteria, randomized controlled trials, literature reviews, cohort studies, and case reports published in the last decade on reputable journals were taken under consideration. Complications and functional outcomes were improved as compared to the conventional surgery techniques when looked into the previous evidences. Heterogeneities of the study designs and duration of follow-up did not permit a meta-analysis. The endoscopic orbital decompression, and other such sinonasal surgeries were now performed with less intraoperative blood loss, shorter hospital stays, and quicker recovery times. After all research, it can be concluded that combined surgical techniques do improve outcomes, but more high-quality, standardized work needs to be done to establish long-term efficacy. Our research findings support this trend of minimalization of invasive techniques to treat pathologies within the sinonasal and orbital spaces and stress their overall capacity to enhance postoperative results. Future research should focus on standardizing protocols and longer follow up periods to evaluate recurrence and long-term complications better.

Efficacy of Pterional Approach in Surgical Management of Meningioma En Plaque

Efficacy of Pterional Approach in Surgical Management of Meningioma En Plaque

Nonunion Fractures: Trends in Epidemiology and Treatment of Femur Fractures, 2017-2022.

The incidence of femur fractures has increased in recent years, along with the rate of surgery and subsequent nonunion following these fractures. Nonunion is a significant concern due to the burden it places on both patients and the healthcare system. This study aims to investigate the demographic factors associated with femoral shaft fracture nonunion by comparing two surgical management approaches: open reduction internal fixation (ORIF) with plating versus closed reduction and fixation using intramedullary nailing (IMN). The TriNetX database was queried using current procedural terminology (CPT) codes for surgical repair of femoral shaft fractures (FSFs), including IMN surgery (CPT: 27506) and femur ORIF (CPT: 27507). The subsequent chronological nonunion cases were identified using the 10th revision of the International Classification of Diseases (ICD-10) codes for femoral nonunion (S72.301K, S72.302K). Results were analyzed both descriptively and comparatively to assess differences among patients. Factors considered included age, sex, ethnicity, race, smoking status, and the type of surgical management (ORIF versus nailing) across the six-year study period. From 2017 to 2022, the prevalence of femoral shaft fracture surgeries increased for both IMN and ORIF. The rate of nonunion was 2.1% following IMN and 1.7% following ORIF. The mean age for nonunion was 54 years (SD: 20) following IMN and 63 years (SD: 18) following ORIF. Patients with a positive smoking history had higher rates of nonunion compared to those without. Our study revealed a relatively consistent rate of FSFs and nonunion over the six-year period. However, with a growing population, the absolute number of cases is steadily increasing, underscoring the burden on the healthcare system. This study contributes to the growing body of literature focused on improving patient outcomes and promoting health equity in fracture management practices.

EFFECTIVENESS OF TOTAL LEUKOCYTE COUNT (TLC) AND C-REACTIVE PROTEIN (CRP) IN THE DIAGNOSIS OF ACUTE APPENDICITIS

Acute appendicitis is a typical surgical emergency. Diagnosing it can be challenging due to variable symptoms. Total leukocyte count (TLC) and C-reactive protein (CRP) are commonly used to assess inflammation and guide treatment. This study evaluates the diagnostic accuracy of TLC and CRP in acute appendicitis to determine appropriate management. Objective: This study aimed to assess the diagnostic accuracy of TLC and CRP in predicting acute appendicitis and their role in determining the proper management approach, either conservative or surgical. Methods: This prospective observational cohort study was conducted in the Department of General Surgery at Dow University of Health Sciences (DUHS), Ojha Campus, from July 2023 to March 2024. A total of 87 adult patients with clinical signs of appendicitis and an Alvarado score of greater than 4 were enrolled. Data was analyzed using SPSS version 22. Variables included socio-demographic characteristics, clinical presentations, and levels of TLC and CRP. Both conservative and surgical management approaches were analysed, with laparoscopic appendectomy being the most common procedure. Results: Among the 87 patients, most were male. TLC and CRP levels were similar across genders, with notable variations in socio-demographic characteristics. CRP levels were more frequently elevated in patients managed conservatively compared to those managed surgically. Both TLC and CRP were elevated in 43 patients (49.4%), highlighting the value of using both markers together. Surgical intervention, primarily laparoscopic appendectomy, was the preferred treatment, with suppurative inflammation being the most common histopathological finding. Conclusion: The combination of TLC and CRP significantly improves the diagnostic accuracy for acute appendicitis. TLC correlates more strongly with the need for surgical intervention, whereas CRP did not show a significant association with management type. Both markers are useful in assessing the duration of the complaint, but they are not substitutes for clinical judgment. Further research is warranted to refine their diagnostic utility and evaluate their impact on surgical care availability in resource-limited settings.

Delayed Diagnosis of Right-Sided Infective Endocarditis with Septic Pulmonary Emboli in a Dextrocardia Patient During the COVID-19 Pandemic

An adolescent IDU presented with persistent fever and cough. Echocardiography revealed dextrocardia, severe tricuspid regurgitation, and vegetation on the tricuspid leaflet. CT pulmonary angiography identified multiple pulmonary infarcts, and blood cultures confirmed Staphylococcus aureus infection. The patient was diagnosed with right-sided infective endocarditis (IE) complicated by septic pulmonary emboli. She was treated with antibiotics followed by cardiac surgery. While the role of dextrocardia in IE is not well established, it significantly affects the surgical management approach. The diagnosis of right-sided IE and septic pulmonary embolism was delayed during the COVID-19 pandemic due to overlapping symptoms with respiratory infections. Early recognition and prompt investigation in high-risk patients are crucial to address this diagnostic challenge.

AB085. Trans-cortical trans-ventricular approach to pineal tumors: a case series.

Attributing to its deep-seated location, surrounded by significant vessels, surgical management of pineal gland lesions is still considered a challenge. Various surgical approaches are employed to access these lesions, based on patient-specific risks and benefits. Each approach has its merits and demerits. In this study, we aim to narrate our experience with trans-cortical trans-ventricular (TT) approach for pineal tumor resection. We aim to outline the procedure details, safety, efficacy, and treatment outcome of TT. This is a single-center, consecutive case series. All patients with pineal gland tumors who underwent surgical intervention, namely biopsy or resection using TT approach from 2000 to 2023 were included. Data for the patient characteristics, intraoperative details and complications were collected from the hospital's database. Mean [standard deviation (SD)] and frequency (proportions) were calculated for continuous and discrete variables, respectively. We identified 13 patients, mean age 24 (SD: 13) years in our case series. Of them, 8 (61.5%) were male. Most common presenting complains were headaches (69%), nausea/vomiting (38.5%), seizure (23%), and visual deficit (23%). Most patients, 60%, had high grade tumor and average size of tumors were 43.5 mm (SD: 18.45 mm). Pilocytic astrocyotma (23%) and pineal parenchymal tumor of intermediate differentiation (23%) were the most common diagnoses. In total, nine patients had pineal gland lesion biopsy done using TT approach along with the cerebrospinal fluid (CSF) diversion. Of them, four had tumor resection done using the same approach. Whereas four patients had primary excision done using TT approach. There were no intra-operative complications. Two patients had post-operative seizures which were treated with anti-epileptics. We did not identify any long-term sequalae attributed to this approach. We presented our data regarding the safety, efficacy, and outcomes of trans-cortical trans-ventricular approach for pineal tumor surgical management. Utilizing this novel approach for pineal lesion resection can be a great addition to surgeons' armamentarium. This unique approach allows to access the tumor for biopsy/resection and perform CSF diversion procedure, simultaneously. Moreover, the same incision can be used for the second/redo surgery.

ASSESSMENT OF NEAR-REDUCTION UNION RATES WITH CONSERVATIVE HUMERUS FRACTURE TREATMENT

This study attempts to determine near-reduction union rates with non-operative treatment of humeral shaft fractures, assess alignment and functional outcomes, and compare these with historic and surgical management approaches. Methods: This was a cross-sectional study at the Department of Orthopedics, Jinnah Postgraduate Medical Centre, Karachi, from January 2024 to June 2024. Twenty patients aged between 17–72 years who suffered from humeral shaft fractures were inducted through consecutive sampling. The conservative treatment mode was applied with a "U"-shaped coaptation splint, where alignment was assessed on radiographs, and functional outcome was achieved with a grading system. Data was analyzed using SPSS-20 regarding union rates, functional recovery, and factors influencing treatment success. Results: In this study of 20 fractures, the initial angulation was 30%, while deviations in sagittal plane alignment in the anterior or posterior direction were seen in 45%. Nineteen of these fractures united within an average time of 42 days in men and 44 days in women; one case showed a delayed union of 13 weeks. Functional results were also excellent, with 60% of patients achieving Grade V function, signifying the absence of pain or limitations, and 35% reporting Grade IV, meaning minimal limitations. Comparisons with historical studies showed that conservative management was similarly successful, with a high union rate and acceptable functional outcome in most cases noted. Conclusion: The conservative approach to treating humeral shaft fractures, characterized by limited immobilization with early mobilization, had a high union rate with excellent functional outcomes equal to surgical interventions. Success with treatment was considerably influenced by patient age, type of fracture, and degree of initial displacement, thus indicating that treatment has to be individualized. This study supports a conservative approach as a modality of choice in managing humeral shaft fractures, emphasizing individuated care for optimum recovery and satisfaction of patients.

Management of Cerebellopontine Angle Tumors

Abstract Background Cerebellopontine angle (CPA) tumors are the most common neoplasms in the posterior fossa. Most CPA tumors are benign, with 80-94% being vestibular schwannomas (acoustic neuromas), lipomas, vascular malformations, and hemangiomas. Treatment options include observation, radiosurgery, and microsurgery. Aim and Objectives Evaluation of the clinical presentation of various lesions in the Cerebellopontine Angle area and evaluate the different surgical approaches for management of these lesions. Subjects and Methods The study included cases of CPA tumors that were admitted and treated in the neurosurgical departments in Ain Shams University Hospital as well as Al Galaa Armed Forces Hospital and Al Maadi Armed ForcesHospital. Result Abnormal planter response were the most frequent neurological abnormality (72.0%). The most cranial nerve affected was the vestibulocochlear nerve (60.0%). Conclusion CPA tumors are challenging lesions to be treated surgically, which requires a high level of surgical experience. Retrosigmoid and middle fossa approaches accomplished significant outcome among patients with CPA tumors. Preoperative V-P shunt procedure improved noticeably the manifestations of increased intracranial tension.

Long-Term Outcomes of Conservative versus Surgical Management of Dental Caries

ABSTRACT Introduction: The management of dental caries presents challenges for oral health professionals, with options including conservative and surgical interventions. However, debate persists regarding the long-term efficacy of these strategies. Methods: This retrospective cohort research involved 500 subjects diagnosed with dental caries at the University Dental Clinic between January 1, 2018, and December 31, 2020. Data on demographics, dental history, treatments, and follow-up were collected from patient records. Subjects were categorized into conservative and surgical groups based on treatment received. Outcome measures included tooth survival, caries recurrence, and patient satisfaction. Results: The research included 300 subjects, with 60% under conservative management and 40% under surgical management. Demographics were comparable between groups, and both groups showed similar outcomes in tooth survival, caries recurrence, and patient satisfaction. Statistical analysis revealed no significant differences in these outcomes between groups. Conclusion: Conservative and surgical management approaches demonstrate comparable long-term outcomes in treating dental caries, emphasizing the importance of personalized treatment decisions. Further research with larger samples and prospective designs is needed to validate these findings and guide evidence-based practice in dental caries management.

Analysis of K-Wire and Olive Wire in Ilizarov Apparatus: A Comparative Study.

Orthopedic fixators depend on mechanical characteristics like stiffness and firmness. The Ilizarov Apparatus (IA) is a common surgical management approach to restructure the bone fractures. IA includes two wires, specifically K-wire and olive wire, to treat the fractures. The functions of IA using K-wire and olive wire have been explored with experimental and finite element approach. To describe the stability of fixation and stiffness of olive wire and K-wire, the mechanical performance of the wires was evaluated experimentally as well as numerically by ANSYS software. The results obtained from the olive wire experimental setup with applied loads of 50 to 100 N, showed stiffnesses ranging from 13.85 to 14.58 N/mm and displacements ranging from 3.61 to 6.86 mm. Also, in analytical evaluation, the obtained stiffness ranges from 14.36 to 14.34 N/mm for loads of 50-100 N with a displacement of 3.48-6.97mm. A two-ring olive wire was found to be stiffer than a two-ring K-wire fixator under the same loading conditions. The goal of this study is to help orthopedic specialists assess the stiffness and stability of IA setups with olive and K-wires.

Timing of surgery in peripheral nerve injury of the upper extremity.

Peripheral nerve injuries present a complex clinical challenge, requiring a nuanced approach in surgical management. The consequences of injury vary, with sometimes severe disability, and a risk of lifelong pain for the individual. For late management, the choice of surgical techniques available range from neurolysis and nerve grafting to tendon and nerve transfers. The choice of technique utilized demands an in-depth understanding of the anatomy, patient demographics and the time elapsed since injury for optimized outcomes. This paper focuses on injuries to the radial, median and ulnar nerves, outlining the authors' approach to these injuries.Level of evidence: IV.

Double Outlet Right Ventricle with Non-Committed Ventricular Septal Defect and Other Complex Associated Anomalies in an Infant: Overview of the Surgical Management Approach

In the first place, the right ventricle is the primary or only point of origin for both main arteries in a patient with double outlet right ventricle (DORV). In order to guarantee proper repair, a wide variety of surgical approaches, considerations, and procedures are required for the wide spectrum of disorders that make up DORV. A functional classification based on physiological characteristics is one technique to classifying it, which might help determine the appropriate surgical strategy. Presentation of the case: Our case study focused on a female newborn infant who was 2 months old when she arrived at the hospital complaining of worsening shortness of breath and anorexia. The patient was diagnosed with pulmonary over-circulation, an abnormal accumulation of blood flowing into the lungs, through the following cardiac abnormalities: double outlet right ventricle (DORV) with a non-committal ventricular septal defect (VSD), no pulmonary stenosis (PS), mitral atresia, atrial septal defect (ASD), single ventricle dominance (SVD), anomalous pulmonary venous drainage (APVD), and patent ductus arteriosus (PDA). After a palliative procedure including the closure of the PDA and the implantation of a PA band, the patient was to have a surgical procedure known as univentricular repair. During the surgical meeting, this course of action was agreed upon. Conclusion: Different atrial configurations, atrioventricular connections, ventricular morphologies, and spatial interactions between the main arteries may all contribute to the wide anatomical spectrum of DORV. In order to decide between biventricular repair and univentricular palliation, several anatomical features must be present in the patient. In addition, palliative treatments may be necessary for certain patients before they may have a permanent surgical repair.

Early Complications of Endoscopic Third Ventriculostomy in Obstructive Hydrocephalus

Obstructive hydrocephalus (HCP) occurs when cerebrospinal fluid is blocked leading to the enlargement of ventricular pathways stream resulting into increase pressure within skull. Endoscopic third ventriculostomy (ETV) is considered an effective management strategy for hydrocephalus especially for third/fourth ventricle level. Objective: To study the per-operative and post-operative early complications of endoscopic third ventriculostomy in obstructive hydrocephalus patients. Methods: This prospective study was conducted at Department of Neurosurgery, Liaquat University Hospital, Hyderabad, from 1st January 2020 to 31st December 2022. One hundred and fifty patients were included. All the cases, were underwent general anesthesia and elective surgery was performed in them. The patients were followed post operatively for 7 days in context to cerebrospinal fluid (CSF) leakage, wound infection, bleeding, seizures as well as meningitis. Results: Seventy six (50.7%) were males and 74 (49.3%) were female. Mean age was 5.5 ± 2.3 years with maximum number of patients (70.7%) were under or equal the age of 5 years. Complications occurred in 18 patients (12%) out of 150 patients. Cerebrospinal fluid leakage was the most common complication occurred in 5 (3.33%) patients, wound infection was seen in 2 (1.3%) patients, meningitis developed in 3 (2%) patients, minor bleeding was seen in 3 (2%) patients, seizures developed in 4 (2.6%) patients, in hospital mortality occurred in 1 (0.66%) patient on 3rd post-operative day. Conclusions: Ventriculostomy appeared to be the better surgical approach for obstructive hydrocephaly management. Minimum numbers of associated complications were observed in present study group.

A retrospective case series of the surgical management of thirty-one penile fibropapilloma cases presented to University College Dublin Veterinary Hospital (UCDVH) between 2017 and 2023

BackgroundPenile fibropapilloma is a condition caused by bovine papilloma virus and is frequently encountered in young bulls. Penile fibropapillomatosis is thought to be spread through homosexual mounting behaviour. Fibropapillomas of the penis are painful, often bleed and can impede normal intromission. Treatment may range from allowing time for slow, spontaneous regression to surgical resection but recurrence following surgery is reported by some authors.Case PresentationThirty one bulls that were presented to University College Dublin Veterinary Hospital from March 2017 to March 2023 for surgical resection of penile fibropapillomas were included in this retrospective case series. Twenty-seven of the 31 bulls (87%) were under two years of age. The majority (42%) of bulls presented were Hereford, but Angus, Charolais, Holstein-Friesian and Limousin breeds were also seen. Following examination and diagnosis of penile fibropapilloma, regional anaesthesia (xylazine-procaine epidural and internal pudendal nerve block) and standing surgical intervention (resection and cautery) was performed in each case. Phone call follow-up was performed by one author (EET) in all 31 cases and 2 cases out of the 28 that were contactable showed post-surgical recurrence of penile fibropapillomatosis (i.e., 7.1% recurrence rate).ConclusionThis case series summarises the history and presenting findings of 31 bovine penile fibropapilloma cases and describes a regional anaesthetic and standing surgical approach for successful case management.

Effect of benign prostatic hyperplasia surgery on ejaculatory function

Introduction. There are a wide range of techniques available for the removal of hyperplastic prostate tissue. However, the choice of method rarely considers its effect on ejaculatory function.Objectives. To evaluate the effect of surgery for benign prostatic hyperplasia (BPH) by endovideosurgical posterior adenomectomy (EVS AE) and transurethral electroenucleation of the prostate (TUEB) on copulatory function and its ejaculatory component.Materials & methods. Sixty sexually active patients aged 58 to 78 years with indications for surgical treatment of BPH were included in the study. The patients were randomized into two equal groups. The first group (30 patients) underwent EVS AE by standard technique without preservation of the prostatic urethra. The second group (30 patients) underwent TUEB. Before treatment, standard questionnaires used in urologic practice were completed: IIEF-5, IPSS-QOL, and the scale of quantitative assessment of male copulatory function (scale “MCF”). The block of questions specifically characterizing the ejaculatory component and the "Male Sexual Health Questionnaire", namely the section " Ejaculatory function domain", were analyzed separately. The assessment was conducted before treatment and at the 12th week following surgery. No significant differences were found between the groups on any of the questionnaires prior to surgery.Results. Three months following surgery, there was a significant improvement in the IPSS-QOL scores for the EVS AE group, by 24 points and 4.3, respectively, and for the TUEB group, 25.6 points and 4.3 (both p < 0.0001). No change was observed in the IIEF-5 questionnaire (p > 0.05). A slight reduction in scores was noted on the MCF scale for the TUEB group (by 2.9 points, p < 0.05), indicating that the general state of erectile function remained unchanged. However, reductions were seen in the "MCF — Ejaculatory Component" and "Male Sexual Health Questionnaire — Ejaculatory function domain" scales for the TUEB group, with ballpark scores decreasing by 3.2 and 6.8 points, respectively (both p = 0.0326 and p = 0.0254), indicating a worsening in ejaculatory function following TUEB treatment.Conclusion. When selecting a specific surgical approach for BPH management, consideration should be given to the patient's tolerance for the degree of invasiveness of the procedure while preserving ejaculatory function, and adherence to a treatment strategy that aligns with the patient's individual preferences and expectations.

Post-Keratoplasty Microbial Keratitis in the Era of Lamellar Transplants-A Comprehensive Review.

Microbial keratitis in a post-transplant cornea should be considered a distinct entity from microbial keratitis in a non-transplant cornea. Firstly, the use of immunosuppressive treatments and sutures in corneal transplants changes the etiology of keratitis. Secondly, corneal transplant has an impact on corneal biomechanics and structure, which facilitates the spread of infection. Finally, the emergence of lamellar transplants has introduced a new form of keratitis known as interface keratitis. Given these factors, there is a clear need to update our understanding of and management strategies for microbial keratitis following corneal transplantation, especially in the era of lamellar transplants. To address this, a comprehensive review is provided, covering the incidence, risk factors, causes, and timing of microbial keratitis, as well as both clinical and surgical management approaches for its treatment in cases of penetrating and lamellar corneal transplants.

A Staged Approach for Surgical Management of Basilar Invagination.

Patients with basilar invagination (BI) can be treated with several surgical options, ranging from simple posterior decompression to circumferential decompression and fusion. Here, we aimed at examining the indications and outcomes associated with these surgical strategies to devise a staged algorithm for managing BI. We conducted a retrospective cohort study in 2 neurosurgical centers and included patients with a BI, as defined by a position of the dens tip at least 5 mm above the Chamberlain line. Other craniovertebral junction anomalies, such as atlas assimilation, platybasia, and Chiari malformations, were documented. C1-C2 stability was assessed with a dynamic computed tomography scan. We included 30 patients with BI with a mean follow-up of 56 months (min = 12, max = 166). Posterior decompression and fusion (n = 8) was only performed in cases of obvious atlanto-axial instability (eg, increased atlanto-dental interval or hypermobility on flexion/extension), while anterior decompression (transoral or transnasal) was reserved to patients with lower cranial nerves deficits (eg, swallowing dysfunction) and irreducible anterior compression (n = 9). Patients with posterior signs (eg, Valsalva headaches) or myelopathy but without C1-C2 instability nor anterior signs were managed with an isolated foramen magnum decompression, with or without duraplasty (n = 13). Complications were more frequent for combined procedures, including neurological deterioriation (n = 4) and tracheostomy (n = 2), but reinterventions were more likely in patients undergoing posterior decompression alone (n = 3). Patient selection is key to determine the appropriate surgical strategy for BI: In our experience, combined approaches are only needed for patients with irreducible and symptomatic anterior compression, while fusion should be restricted to patient with obvious signs of atlanto-axial instability. Other BI patients can be managed by foramen magnum decompression alone to minimize surgical morbidity.

Surgical treatment of intermediate nerve neuralgia using intraoperative neurophysiological monitoring

Intermediate nerve neuralgia (INN) is a rare pathology with difficult diagnostics and currently there is no generally accepted surgical management protocol. In this regard, an optimal surgical strategy in this case is a difficult task. The aim was to determine an optimal approach for surgical management of patients with INN using intraoperative neurophysiological monitoring (IONM).The INN was diagnosed in a patient, a vestibulo‑cochlear complex dissection with intermediate nerve sectioning under IONM control of was performed intraoperatively. There was the earache regression, but there were gustatory disorders in the anterior portion on the left side of the tongue in the early postoperative period. In the late postoperative period, a delayed facial nerve paresis and signs of liquorrhea were diagnosed, which were completely regressed after reoperation and medication. The follow‑up period was more than 12 months; a stable regression of otoalgia was achieved. Intermediate nerve sectioning is an effective and common technique for the treatment of patients with INN. IONM improves surgical results and reduces a likelihood of different complications.

Emotional meanings reported by patients about their life experiences under the following in the Watch and Wait protocol: A qualitative study in a Brazilian surgery university specialized outpatient service

IntroductionHealth Psychology is aggregated to clinical studies providing physicians, nurses, and psychotherapists with psychodynamics of sick persons, facilitating interpersonal relationships and greater adherence to treatments. How do people deal with illness and treatment from what they symbolize in experiences of becoming ill? Watch & Wait Protocol for patients with rectal cancer is an active surveillance as an alternative approach in surgical medical management. Patients are followed with physical examinations, endoscopy, and imaging. Observation carried out through periodic examinations aims to avoid surgery stage while rectal cancer is maintained.ObjectivesTo interpret emotional meanings attributed by patients, after adhering to the W&W protocol for rectal cancer, to life experiences of watching and waiting for the disease course.Methods Clinical-Qualitative Method (Turato. Portuguese Psychos. J, 2000 2(1): 93-108). For data collection, the first author used Semi-Directed Interview with Open-ended Questions In-Depth and Field Notes, after acculturation. Sample closed by information saturation (Fontanella et al. Cad Saude Publica. 2008; 24(1): 17-27). Interviews conducted by the first author, a female psychologist. We employed the Seven Steps of the Clinical-Qualitative Content Analysis (Faria-Schützer et al. Cien Saude Colet. 2021; 26(1): 265-274) to construct categories. Theoretical framework was the Balintian Medical Psychology. Findings were validated by peer reviewers from Lab of Clinical-Qualitative Research.Results Sample had 10 patients, 3 female and 7 male, from 52 to 77 years. Interviews carried out from October 2022 to March 2023. We constructed 03 categories: 1) Fate out of hands - “I get sick just coming in here.” There is an apprehension experienced in each medical evaluation to check the clinical condition because the symbol of waiting is not having the own destiny in the hands. 2) Psychic defence - “Sometimes I even thought if I had to live on a grant for the rest of my life or die!” Imagining the worst is a psychic defence because if this probability occurs, the mind has already begun its elaboration. 3) Life upside down - “I was going to have the surgery, use a bag, my life was going to be upside down.” Anxiety generated by waiting is a mental disorganizing.Conclusions Attitudes of observing and waiting carry different symbolisms to those who work with scientific thinking and who experience the observation of their own disease and the wait for what conduct they will receive. Observing oneself in illness requires acceleration of changes in ego identity. Waiting in front of illness asks the ego to think the worst. It is not a volitional choice. Preparing for the worst is a defensive necessity in the emotional sphere to avoid surprises that take to mental rupture.Disclosure of InterestNone Declared

61. Guidewires and Amnion Tissue Grafts: A Novel Approach for Surgical Management of Distal Vaginal Agenesis

61. Guidewires and Amnion Tissue Grafts: A Novel Approach for Surgical Management of Distal Vaginal Agenesis