Ten-year Experience Research Articles

Pediatric liver transplantation for autoimmune liver disease: Ten-year experience from a liver transplant center in India.

Liver transplantation (LT) has emerged as the best therapeutic modality for end-stage liver disease in pediatric autoimmune liver disease (AILD). We aimed to describe our experience of pediatric living donor liver transplantation for AILD from India over a period of 10 years.We did a retrospective analysis of 244 liver transplants at our center over the last 10 years to identify children with AILD (18 years or younger). We aimed to describe the demographic features, clinical profile, graft survival, patient outcome, and predictors of mortality in our cohort.Between July 2010 and May 2020, 13 liver transplants were performed for AILD out of total 244 children transplanted over the last 10 years at our center. Mean (standard deviation [SD]) age at LT was 12 (± 3.84) years. Leading indications for LT were decompensated liver disease (61.5%), acute-on-chronic liver failure (23.1%), acute liver failure (ALF) (7.7%), and recurrent cholangitis and growth failure (7.7%). Mean Pediatric End-stage Liver Disease (PELD) score/model for end-stage liver disease (MELD) score and international normalized ratio (INR) (SD) at presentation were 24 (± 12.81) and 2.48 (± 1.54), respectively. Median discharge duration was 23 days (interquartile range [IQR] 21-36 days). 30.7% (4/13) of the subjects had no postoperative complications. Diarrhea (15.3%), pneumonia (7.7%), jejunostomy site bleed (7.7%), tacrolimus toxicity (7.7%), and vascular complications (7.7%) were seen, which resolved with satisfactory graft function. Three subjects died post-LT; causes of death included sepsis (n=3), renal dysfunction (n=1), and pneumonia (n=1). Others have been well on follow-up with no graft rejection or need for re-transplantation. Overall, 1-year and 5-year patient survival rates were 76.9% and 70%, respectively. Lower platelet count, autoimmune hepatitis (AIH) 2, and PELD/MELD score were found to be significant predictors of mortality on univariate analysis, which were not significant on multivariate modelling.Thecomplications, graft and patient survival rates in our experience were quite encouraging, and are comparable with the best centers worldwide. After instituting appropriate treatment, early referral of such patients to an equipped center should be facilitated.

Ten-year experience of infrainguinal bypass with endoscopic vein harvest.

There is conflicting data comparing minimally invasive vein harvest (MIVH) using endoscopic technique and open vein harvest (OVH) in terms of bypass patency, wound infection incidence, and patient morbidity. Our institution has performed MIVH since 2003 for peripheral bypass procedures with a consistent team of specialized endoscopic vein harvesters. This study reviewed the major outcomes of MIVH infrainguinal bypass at our institution given a predominant cohort of critical limb ischemia. We performed a 10-year, retrospective, single-institution review from January 2005 to December 2014, identifying all patients undergoing MIVH for obstructive infrainguinal disease. Primary outcomes were primary patency, operative time, intraoperative complications, surgical site infection (SSI), and freedom from amputation. A total of 289 patients (70% male) underwent MIVH infrainguinal bypass at an average age of 68 ± 12years old, an obesity prevalence of 28%, and with critical limb ischemia in 81% of the patient cohort (20% rest pain, 61% tissue loss/gangrene). Ninety-four percent of patients had no intraoperative complications, 2.5% had adverse cardiac or technical complications, and 4.2% of patients required transfusion. Average operative time was 4.2h. Femoral-popliteal TASC classification C and D constituted 80% of our patient cohort. At the last follow-up, toe pressures had increased from 30 ± 30 to 62 ± 40mmHg (p < 0.0001). Primary bypass patency in the first 30days was 95%. SSI incidence requiring surgical treatment was only 6%. Our median length of stay was 4.0days, with median intravenous narcotic use of 1day. In addition, 77% of patients returned to their baseline mobility at first follow-up (median 19days), and 83% of patients had freedom from amputation at last follow-up (median 820days). In a center with experience in MIVH and a consistent group of experienced endoscopic vein harvesters, MIVH bypass has excellent patency, low surgical site infection, short length of stay, and prompt return to baseline mobility.

Ten-Year Experience with Transapical and Direct Transaortic Transcatheter Aortic Valve Replacement to Address Patients with Aortic Stenosis and Peripheral Vascular Disease.

Objective: Transcatheter aortic valve replacement (TAVR) through alternative access routes is indicated in patients with severe aortic valve stenosis and diseased peripheral arteries. We analysed and compared the outcome of patients undergoing transapical (TA) and direct transaortic (TAO) TAVR procedures. Methods: Preoperative characteristics, procedural details, and thirty-day outcome of patients undergoing transapical (TA-TAVR group) and direct transaortic (TAO-TAVR group) TAVR procedures were prospectively collected and retrospectively analysed. Results: From March 2012 to March 2022, 81 TA and 82 TAO-TAVR (total: 163 cases) were performed with balloon-expanding (n = 120; 73.6%) and self-expandable (n = 43; 26.4%) valves. The mean age was 79.7 ± 6.2 and 81.9 ± 6.7 years for the TA- and TAO-TAVR groups, respectively (p = 0.032). Females were more represented in the TAO-TAVR group (56% vs. 32%; p = 0.003) while TA-TAVR patients showed a higher prevalence of previous vascular surgery (20% vs. 6%; p = 0.01), previous cardiac surgery (51% vs. 3.6%; p < 0.001), and porcelain aorta (22% vs. 5%; p = 0.001). The mean ejection fraction was 49.0 ± 14.6% (TA) and 53.5 ± 12.2% (TAO) (p = 0.035) while mean gradients were 35.6 ± 13.2 mmHg (TA) and 40.4 ± 16.1 mmHg (TAO) (p = 0.045). The median EuroSCORE-II was 5.0% (IQR: 3.0−11.0) and 3.9% (IQR: 2.5−5.4) for the TA- and TAO-TAVR groups, respectively (p = 0.005). The procedural time was shorter for TA procedures (97 min (IQR: 882−118) vs. 102 min (IQR: 88−129); p = 0.133). Mortality at day 30 was 6% in both groups (p = 1.000); the permanent pacemaker implantation rate was similar (8.6% vs. 9.7%; p = 1.000), and hospital stay was shorter for the TAO group (8 days (IQR: 6−11) vs. 10 days (IQR: 7−13); p = 0.025). Conclusions: Our results show that transapical and direct transaortic TAVR in high-risk patients with diseased peripheral arteries provide satisfactory clinical results with similar thirty-day outcomes.

Ten-year experience with intracameral chemotherapy for aqueous seeding in retinoblastoma: long-term efficacy, safety and toxicity

AimsTo report long-term results of intracameral chemotherapy (ICC) for aqueous seeding (AS) in retinoblastoma.MethodsRetrospective study including 20 patients with primary (n=4) or secondary non-iatrogenic (n=16) AS treated with ICC according...

Characteristics of retained foreign bodies and near-miss events in the operating room: a ten-year experience at one institution.

Retained foreign bodies (RFBs) are a major complication of surgical procedures. However, the efficacy of preventive measures is not well defined. This study investigates the characteristics of potential (near miss) and actual RFBs, and the contributions of routine practice for the prevention of RFB events. We conducted a retrospective review of incident reports regarding near-miss and RFB events in patients who underwent surgery under general anesthesia in our institution between October 2008 and November 2018. Among 49,831 operations under general anesthesia, there were 106 (2.13/1000) near-miss events and 24 (0.48/1000) RFB events. Counting surgical materials and intraoperative X-rays detected the remaining items before completion of surgery in 59 (56%) and 15 (14%) cases, respectively. The operator or staff noticed the surgical materials in the remaining 32 (30%) near-miss events. RFBs included 4 sponges (17%), 4 instruments (17%), 4 needles (17%), and 12 miscellaneous items (50%). Of these, 12 (50%) RFBs were discovered on postoperative X-rays and 16 (67%) patients required operative removal. Four incidents (17%) with RFBs were attributable to ignoring count discrepancies during surgery. The actual incidence of RFB events is higher than previously reported. A standardized counting protocol, communication among staff, and intra- and postoperative X-rays may contribute to the prevention and detection of RFBs.

Abstract 9377: A Role for Targeted Colchicine Uptitration in Recurrent Pericarditis: A Ten-Year Experience of Treatment Refractory Disease at a Specialist Referral Center

Introduction: Recurrent pericarditis (RP) carries significant morbidity, both direct and indirect through corticosteroid dependence. Uptake of highly effective anti-interleukin-1 agents, anakinra and rilonacept, is limited by expertise and cost, leading to widespread corticosteroid use in cases refractory to low dose colchicine. Thus, effective, accessible approaches that minimise iatrogenic harm are needed. Consensus guidance for other autoinflammatory diseases recommends colchicine uptitration prior to addition of biologics, providing a potential approach in treatment-refractory RP. Methods: Retrospective review of RP case records at a tertiary center 2012-2022. Treatment-refractory RP was defined as active disease despite colchicine 1mg/24h or disease requiring other prophylactic drugs, and corticosteroid dependence as daily corticosteroid use for 6 months. Results: Of 111 cases, 71 (64.0%) were treatment-refractory at 1 st review, of whom 32 (45.1%) were corticosteroid dependent. Median follow up was 15 months (IQR 4-35). Of treatment-refractory cases without corticosteroid dependence, 38/39 (97.4%) were treated with colchicine uptitration and 4/39 (10.3%) with anakinra; none became corticosteroid dependent. Of corticosteroid dependent cases, 27/32 (84.4%) were treated with colchicine uptitration and 11/32 (34.3%) with anakinra. Corticosteroids were discontinued in 18/32 (56.3%): 7/18 (38.9%) weaned with colchicine uptitration alone, 9/18 (50.0%) with anakinra and 2/18 (11.1%) with azathioprine. Median corticosteroid duration was 15.5 months (IQR 12-44.75) and corticosteroid toxicity occurred in 8/32 (25.0%). Among the 70/71 cases (98.6%) treated with colchicine (median maintenance dose 2 mg/24h (IQR 1.5-2)), permanent discontinuation was uncommon (3/70, 4.3%) and due to gastrointestinal symptoms; self-limiting liver transaminase elevation was common (28/70, 40.0%) but did not lead to discontinuation in any case. Conclusions: Colchicine uptitration enabled avoidance of new corticosteroid dependence, facilitated corticosteroid discontinuation and was well tolerated. This contrasts with the frequent toxicity seen with prolonged corticosteroid use and supports wider uptake of this approach in RP.

Distal biceps tendon rupture: ten-year experience using suture anchors through a single anterior approach

Distal biceps tendon rupture: ten-year experience using suture anchors through a single anterior approach

CYTOGENETIC ANALYSIS OF 2,205 CASES OF HEMATOLOGICAL NEOPLASIA AND GENETIC DISEASES: A SINGLE CENTER EXPERIENCE

Cytogenetics is defined as the study of chromosome morphology, pathology function, and behavior. Cytogenetics is important to define clonality for bone marrow disorders and for diagnosing a lot of constitutional disorders. We analyzed a ten-year experience of bone marrow and peripheral blood cytogenetics for defining clonal and not clonal disorders at the Cancer Cytogenomics Laboratory of the Federal University of Ceará. All bone marrow and peripheral blood samples were submitted to cell culture (for 24 hours and 72 hours, respectively), after which all were processed, and G-banding performed using trypsin and Wright-Giemsa staining. The karyotype results of 2,205 patients were analyzed including additional information such as age, sex, requesting unit and suspected diagnosis. Among these, 1744 (79.1%) were bone marrow samples and 461 (20.9%) were peripheral blood samples used to investigate constitutional changes. The female gender (54.4%) stood out in the Bone Marrow samples, aged between 71 and 80 years (20.2%). Among the bone marrow results, 726 of 1744 (42%) were normal and 431 of them (24.7%) were abnormal karyotypes. The main etiological suspicion was Myelodysplastic Syndrome (54.2% of cases), and 42.1% were normal. Among the chromosomal abnormalities, the main alterations found were: 26% cases with isolated del(5q) and/or other alterations, 10% of cases were complex, 10% were isolated del(11q) and/or with other alterations, 9% of cases with del (7q) isolated and/or with other alterations and 7% cases with +8 isolated and/or with other alterations, 2% cases had del(17q) isolated and/or with other alterations, 1% of cases had del(17p) and one case with i(17q). A total of 127 cases were suspected as AML, with 34.6% altered karyotypes, 34.4% normal karyotypes. Among the abnormal karyotypes: 20,5% cases with t(15;17) and 13,6% were complex karyotypes, 6,8% were del(11q23), 4,5% cases with t(8;21), 1 case with del(17p) and another with i(17q). A total of 161 cases were suspected as CML, among which: 49,7% abnormal karyotype, 24.2% were normal. Among the chromosomal abnormalities, 65% were t(9;22) and 2,2% were t(9;22) and other alterations and/or variants of t(9;22). In this way, this study shows that cytogenetic was important for diagnostic purposes of patients principally for diseases such as Myelodysplastic Syndrome, Acute Myeloid Leukemia and Chronic Myeloid Leukemia. Cytogenetic analysis is also fundamental for analysis of constitutional and somatic genetic disorders. Regarding the constitutional results, 176/461 (38%) showed chromosomal abnormalities with 66 (37.5%) showing trisomy 21 followed by trisomy 18 (14.7%) and androgen insensitivity syndrome (11.3%). Identification of constitutional or malignance chromosomal anomalies can provide important information for genetic medical counseling. Cytogenetic analysis of hematological neoplasms and for constitutional disorders is helpful for diagnosis and monitoring the effects of treatment, being still very important in the new molecular era.

Ten-year experience retrospective in investigation of the frequency of sex chromosome aneuploidies diagnosed in a reference medical center in Türkiye

Background: Sex chromosome aneuploidies (SCAs) are characterized by the gain or loss of entire or parts of sex chromosomes.Methods: In 5212 cases studied over the last 10 years in Medical Genetics Department, we found 3793 (72.78%) other chromosomal establishments and 1419 (27.22%) sex chromosomal aneuploidies using the retrospective archive-file scanning method.Results: 839 (31.32%) of the 1419 cases with anomalies were female, and 580 (22.8%) were male. While Triple X-Super Female Syndrome 423 (15.8%) is the most common in women, Klinefelter Syndrome 508 (20.0%) is the most common in men. Among the cases sent to our outpatient clinic for various indications (prediagnosis) for karyotype analysis, 1447 (54.0%) in women and 1193 (47.1%) in men were the cases with a prediagnosis of habitual abortion; followed by 298 (11.1%) infertility in women and 350 (13.8%) in men. While 167 (6.6%) people were sent with the preliminary diagnosis of azoospermia in men, it was determined to be 124 (4.6%) in women with primary amenorrhea. In the analysis we made according to the diagnosis, 1839 (68.7%) women and 1954 (77.1%) men were found to be normal. While the most important diagnosis is Triple X-Super Female syndrome 423 (15.8%) in women, Klinefelter syndrome 508 (20.0%) is the first in men. Turner Syndrome is found in 315 (11.8%) women, while Jacob’s syndrome (47, XYY) is detected in 13 (0.5%) men.Conclusions: As a result, the retrospective evaluation of 10-year cytogenetic analyses of these case groups contributes to the creation of regional data.

451. CLINICAL PATTERNS AND TREATMENT OUTCOMES OF OESOPHAGEAL PERFORATION—A TEN-YEAR RETROSPECTIVE ANALYSIS FROM A TERTIARY CENTER IN SOUTH INDIA

Abstract Oesophageal perforation is a rare, often life-threatening clinical condition with reported mortality rates of 18 to 25%. Early diagnosis is often challenging with many patients presenting late and in shock. Management is even more challenging with a myriad of options but no standard options or criteria. We aim to review our ten-year experience of managing oesophageal perforation and propose an algorithmic approach for managing this condition. A retrospective review of patients diagnosed with oesophageal perforation from 2011 to 2020 was done. Oesophago-gastric anastomotic perforations and corrosive injuries were excluded. The data relevant for the study including Pittsburgh Severity Score (PSS) was collected from the hospital electronic medical records and strengthened using telephonic conversation. Thirty-six patients (M: F-26:10, mean age: 48 years) were included. In 21 (58%) patients, the perforation was localized to the thoracic oesophagus. The commonest cause of perforation was Iatrogenic (n = 22, 61%), followed by spontaneous (n = 9, 25%). A severe PSS score (≥7) was associated with increased risk of operative intervention (76%) and mortality (18%). Eighteen patients (50%) required operative interventions wherein a primary repair was performed in seven (39%) patients, sepsis drainage in eight (44%) patients, and a diversion in one (6%) patient. Overall, eleven (31%) patients required a re-intervention, and the overall in-hospital mortality was 8.3%. Early diagnosis and decision making using an algorithmic approach are critical in the management of oesophageal perforation. PSS score is a useful tool in assessing the severity of disease. A combined multidisciplinary approach involving therapeutic endoscopy, surgery, and critical care is essential. A minimally invasive surgical approach is a feasible option in selected group of patients.

Patients with Cardiac Implantable Electronic Device Undergoing Radiation Therapy: Insights from a Ten-Year Tertiary Center Experience.

Background: The number of patients with cardiac implantable electronic devices (CIEDs) receiving radiotherapy (RT) is increasing. The management of CIED-carriers undergoing RT is challenging and requires a collaborative multidisciplinary approach. Aim: The aim of the study is to report the real-world, ten-year experience of a tertiary multidisciplinary teaching hospital. Methods: We conducted an observational, real-world, retrospective, single-center study, enrolling all CIED-carriers who underwent RT at the San Raffaele University Hospital, between June 2010 and December 2021. All devices were MRI-conditional. The devices were programmed to an asynchronous pacing mode for patients who had an intrinsic heart rate of less than 40 beats per minute. An inhibited pacing mode was used for all other patients. All tachyarrhythmia device functions were temporarily disabled. After each RT session, the CIED were reprogrammed to the original settings. Outcomes included adverse events and changes in the variables that indicate lead and device functions. Results: Between June 2010 and December 2021, 107 patients were enrolled, among which 63 (58.9%) were pacemaker carriers and 44 (41.1%) were ICD carriers. Patients were subjected to a mean of 16.4 (±10.7) RT sessions. The most represented tumors in our cohort were prostate cancer (12; 11%), breast cancer (10; 9%) and lung cancer (28; 26%). No statistically significant changes in device parameters were recorded before and after radiotherapy. Generator failures, power-on resets, changes in pacing threshold or sensing requiring system revision or programming changes, battery depletions, pacing inhibitions and inappropriate therapies did not occur in our cohort of patients during a ten-year time span period. Atrial arrhythmias were recorded during RT session in 14 patients (13.1%) and ventricular arrhythmias were observed at device interrogation in 10 patients (9.9%). Conclusions: Changes in device parameters and arrhythmia occurrence were infrequent, and none resulted in a clinically significant adverse event.

Using Open Dialogue-inspired dialogism in non-psychiatric medical practice: A ten-year experience.

Using Open Dialogue-inspired dialogism in non-psychiatric medical practice: A ten-year experience.

Conservative Management in Lower Extremity Gunshot Injuries: A Ten-Year Experience

Indications for immediate operative exploration in vascular trauma have been well described in the literature. However, this indication is often blurred in cases where the patient has diminished but present pulses, or only single-vessel runoff in the injured lower extremity. Improvements in quality of computed tomography angiography (CTA) has allowed for an increase in conservative management of vascular trauma. The objective of this study was to examine outcomes at a tertiary level 1 trauma center to validate practices and confirm that conservative, nonoperative management of diminished runoff has safe outcomes, and additionally to identify areas for improvement in management.

Laparoscopically Harvested Omental Flap for Immediate Total Breast Reconstruction; Lessons Learnt Through Ten-Year Experience in a Tertiary Oncology Center.

Background. Most of the publications about Laparoscopically harvested omental flap after skin sparing mastectomy were case reports or case series. Most of them were designed for partial breast reconstruction and were lacking long-term follow-up for cosmetic results, oncologic safety, and detailed methodology. Our study aimed at highlighting the place of this method of reconstruction with long-term oncologic safety and cosmetic outcome. Methods. This study included 95 women who were candidates for skin-sparing mastectomy. Those with body mass index below 25 and above 40, those with omental resection or expected marked adhesions were excluded. All patients were consented to then undergo breast reconstruction using pedicled laparoscopically harvested omental flap. Results. The mean BMI was 34. The mean tumor size was 3.4cm. The mean total operative time was 129 minutes. Inadequate volume occurred in 12 patients (13%). The mean total drainage output was 750ml with 8.7% incidence of seroma. Partial breast envelop necrosis was encountered in 5 cases. Partial flap loss occurred in 2 patients. Fat necrosis occurred in 11 cases. Mastectomy and abdominal complications were accepted. Local recurrence was met in one patient and distant metastases occurred in 3 cases. 83.7% of patients expressed excellent and good aesthetic outcomes. Conclusion. When skin sparing mastectomy is chosen with suitable body mass index, laparoscopically harvested omental flap is a very safe and attractive option for total breast reconstruction with a minimal donor site morbidity, satisfactory cosmetic outcome with no compromise of the oncologic safety.

On the way to a smart school: a look from the classroom

The article presents a ten-year experience of the development and implementation of a personalized mastery-based learning model to renew the educational process in a public school. The model assumes that 1) externally set learning goals should be processed by the students and become their personal goals, 2) the success of learning is ensured by individualizing the pace, organization and methods of teaching, educational materials and special efforts of teachers to develop personal qualities of the student. Six interrelated tasks that the educational organization systematically solved during the experiment are described. The effectiveness of the developed model of educational work is evidenced by the high marks of students in the state exams in informatics and the results of the annual state graduation tests.

Diagnostics of BAP1-Tumor Predisposition Syndrome by a Multitesting Approach: A Ten-Year-Long Experience.

Germline mutations in the tumor suppressor gene BRCA1-associated protein-1 (BAP1) lead to BAP1 tumor predisposition syndrome (BAP1-TPDS), characterized by high susceptibility to several tumor types, chiefly melanoma, mesothelioma, renal cell carcinoma, and basal cell carcinoma. Here, we present the results of our ten-year experience in the molecular diagnosis of BAP1-TPDS, along with a clinical update and cascade genetic testing of previously reported BAP1-TPDS patients and their relatives. Specifically, we sequenced germline DNA samples from 101 individuals with suspected BAP1-TPDS and validated pathogenic variants (PVs) by assessing BAP1 somatic loss in matching tumor specimens. Overall, we identified seven patients (7/101, 6.9%) carrying six different germline BAP1 PVs, including one novel variant. Consistently, cascade testing revealed a total of seven BAP1 PV carriers. In addition, we explored the mutational burden of BAP1-TPDS tumors by targeted next-generation sequencing. Lastly, we found that certain tumors present in PV carriers retain a wild-type BAP1 allele, suggesting a sporadic origin of these tumors or a functional role of heterozygous BAP1 in neoplastic development. Altogether, our findings have important clinical implications for therapeutic response of BAP1-TPDS patients.

Popliteal Entrapment Syndrome: Diagnostic, Surgical Management, and Short-Term Results of a Ten-Year Experience

Popliteal artery entrapment syndrome (PAES) is a rare cause of lower limb claudication in young sportsperson without cardiovascular risk factor. We reported our diagnostic approach, surgical management, and short-term outcomes of this syndrome, over a 10-year period. Sportsperson with intermittent claudication systematically received color duplex ultrasonography with dynamic maneuvers in the sport medicine department. In case of PAES suspicion, diagnosis was confirmed by dynamic computed tomography or dynamic magnetic resonance angiography. Each patient was then evaluated by a vascular surgeon and surgery was performed. We retrospectively screened patients who underwent PAES surgery between 2010 and 2020 in the Department of Surgery in Angers University Hospital. Between January 2010 and December 2020, 38 patients with 67 symptomatic legs underwent surgery for PAES. Twenty three (60.5%) were men. The mean age at the time of surgery was 24.7 +/- 9years. Clinical presentation was bilateral in 30 patients (81.1%). Duplex ultrasound demonstrated severe stenosis or occlusion in 45 legs (77%). When performed, CT-scan demonstrated popliteal artery compression in all cases (100%). As per Whelan and Rich classification, 36 patients (94.7%) had type 6 PAES. There was no mortality or severe complication after surgery. Morbidity included 4 postoperative hematoma (6%) and 8 prolonged healing (13%). The mean time of follow-up was 2.3months +/- 1.2months. After surgery, D-scan showed no signs of remaining popliteal artery compression in 92.5% of the case. Twelve patients (33.3%) were able to resume sport, 18 (50%) partially, and 6 (16.6%) did not resume sport yet. We report a cohort of 38 patients who underwent surgery for PAES. Among them, 36 (94.7%) were functional PAES. Morbidity included 13% of prolonged healing. Two months follow-up demonstrated good results at dynamic D-scan without signs of remaining popliteal artery compression in 92.5% of the cases. These short-term results showed that one-third of patients were able to resume sport activity at an initial level.

A Ten-Year Experience of Treating Chronic Myeloid Leukemia in Rural Rwanda: Outcomes and Insights for a Changing Landscape.

In describing our ten-year experience with treating chronic myeloid leukemia (CML) as part of the Glivec Patient Assistance Program (GIPAP) in rural Rwanda, we evaluate (1) patient characteristics and treatment outcomes, (2) resource-adapted management strategies, and (3) the impact of diagnostic capacity development. We retrospectively reviewed all patients with BCR-ABL-positive CML enrolled in this GIPAP program between 2009 and 2018. Clinical data were analyzed using descriptive statistics, Kaplan-Meier methods, proportional hazards regression, and the Kruskal-Wallis test. One hundred twenty-four patients were included. The median age at diagnosis was 34 (range 8-81) years. On imatinib, 91% achieved complete hematologic response (CHR) after a median of 49 days. Seven (6%) and 12 (11%) patients had primary and secondary imatinib resistance, respectively. The 3-year overall survival was 80% (95% CI, 72 to 87) for the cohort, with superior survival in imatinib responders compared with those with primary and secondary resistance. The median time from imatinib initiation to CHR was 59 versus 38 days (P = .040) before and after in-country diagnostic testing, whereas the median time to diagnosis (P = .056) and imatinib initiation (P = .170) was not significantly different. Coupling molecular diagnostics with affordable access to imatinib within a comprehensive cancer care delivery program is a successful long-term strategy to treat CML in resource-constrained settings. Our patients are younger and have higher rates of imatinib resistance compared with historic cohorts in high-income countries. High imatinib resistance rates highlight the need for access to molecular monitoring, resistance testing, and second-generation tyrosine kinase inhibitors, as well as systems to support drug adherence. Hematologic response is an accurate resource-adapted predictor of survival in this setting. Local diagnostic capacity development has allowed for continuous, timely CML care delivery in Rwanda.

Ten-year experience of robotic latissimus muscle flap reconstructive surgery at a single institution

Robotic reconstructive surgery has been performed since 2012 at our institution. The purpose of this study was to report our 10-year experience with robot-assisted reconstructive surgery and compare the clinical outcomes of different robotic models. Medical records of 41 patients who had chest or breast reconstruction during October 2012 ∼ May 2021 were reviewed retrospectively. Different robotic models were evaluated and compared in terms of surgical technique, demographic variables, postoperative complication, and operative parameters. esthetic assessments were performed by four plastic surgeons to evaluate symmetry, scar formation, and general esthetic features based on patients' photographs. Overall, out of 41robot-assisted reconstructive surgeries, 13were performed with the Da Vinci Si model, 18with the Da Vinci Xi model, and 10with the Da Vinci Sp model. The docking time, robot operation time, and hospitalization time were shorter for surgeries, which used the Da Vinci Sp model than other models. All other complications and operative parameters showed no significant difference. Improved esthetic outcome was achieved for all patient groups. Group Sphad the most favorable score, followed by Group Xi and Group Si, although there were no statistical implications. Ever since the introduction of the Da Vinci model in 2012, we have successfully implemented the robot-assisted reconstructive surgery. Surgical technique improved over the last 10 years. With the introduction of the Sp model, we are now at the stage of further developing the surgical technique and establishing the robotic reconstructive surgery.

PB2117: TEN-YEAR SINGLE CENTER EXPERIENCE TREATING PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA: CAN RADIOTHERAPY BE OMITTED?

Background: Primary central nervous system lymphoma (PCNSL) is a rare form of lymphoma confined to the central nervous system (CNS) that is characterized by an aggressive course, high rates of treatment resistance and short overall survival. In recent decades, the treatment of PCNSL has undergone significant changes; its standard treatment consists of combined immunochemotherapy regimens that should include high-dose methotrexate (HD-MTX) and/or cytarabine, followed by consolidative autologous hematopoietic cell transplantation (AHCT). HD-MTX–based chemotherapy followed by consolidative whole brain radiotherapy (WBRT) has, historically, been the standard of care. In elderly and comorbid patients who are not candidates for AHCT, maintenance therapy with procarbazine or temozolomide is often used. Aims: We aim to describe a single center’s ten-year experience treating PCNSL. Methods: Retrospective study of patients with PCNSL treated in a single center from 2011 to 2021, describing the demographic, clinical features and outcomes. Data was collected from clinical records and analyzed with IBM SPSS 25.0. Results: Twenty patients, 11 (55%) female, with a median age of 61 years (range 44-77) were identified. 65% had an Eastern Cooperative Oncology Group performance status (ECOG) of 0, 25% of 1, 5% had an ECOG of 2 and 5% had an ECOG of 4. International Extranodal Lymphoma Study Group (IELSG) score was 0-1 in 7/35%, 2-3 in 11/55% and 4-5 in 2/10%; 17/85% presented with parenchymal disease, 2/10% with leptomeningeal disease only, and 1/5% with both; only one patient had eye involvement at presentation. Frontline therapy consisted of chemotherapy only (with or without rituximab) in 14 patients while 6 had chemotherapy plus WBRT; all patients received methotrexate (MTX)-based regimens (Ferreri, MATRix, DeAngelis, R-MP and R-MPV-A). Overall response was obtained in 12/60% patients (complete response in 10/50% and partial response in 2/10%). 8/40% patients relapsed, at a median time of 4.2 months after completion of therapy; 7/87.5% relapsed with parenchymal disease and 1/12.5% with mixed parenchymal and leptomeningeal disease. Median follow up was 12.1 months, median overall survival (OS) was 25.3 months and median progression-free survival (PFS) was 4.4 months. In univariate analysis (log rank), age, sex, ECOG, presence of deep brain lesions and IELSG score did not significantly impact OS and PFS, whereas radiotherapy use was significantly associated with improved OS (63.7 vs. 13.0 months; p-value 0.002) and PFS (36.1 vs. 3.3 months; p-value 0.016; Image). Univariate Cox regression analysis showed significant PFS improvement with radiotherapy use (HR 0.12; 95% CI 0.02-0.92, p-value 0.042), but no statistically significant OS improvement; in our cohort, no other variables significantly impacted survival. All surviving patients who underwent WBRT have shown cognitive impairment in neuropsychological tests. Image:Summary/Conclusion: Based on our analysis, age, ECOG and IELSG score did not significantly impact OS and PFS, whereas WBRT use was significantly associated with improved PFS, suggesting that the omission of WBRT may not be associated with improved survival, although its use should be weighed against potentially limiting neurotoxicity.