Transient Edema Research Articles

A novel treatment for Riehl's melanosis targeting both dermal melanin and vessels.

Riehl's melanosis is a difficult-to-treat condition characterized by persisting dermal hyperpigmentation. This study aimed to evaluate the efficacy of a histology-specific targeted therapy for Riehl's melanosis. Skin biopsy samples of Riehl's melanosis were assessed to identify histology-specific targets for treatment. Subsequently, the efficacy of a combination involving a fractional picosecond laser and a pulsed dye laser (PDL) targeting the dermal melanin and vessels, respectively, was evaluated. Clinical improvement was assessed using the dermal pigmentation area and severity index (DPASI). The treatment outcomes were compared to those of a control, in this case a single laser treatment solely targeting pigmentation. Histological and immunohistochemical analyses identified dermal melanin pigment and dilated vessels as treatment targets for Riehl's melanosis. The combined treatment of the fractional picosecond laser and PDL showed a significant reduction of the DPASI scores, which was significantly better than the control group. Patients who underwent the combined laser treatment indicated high levels of satisfaction with no adverse events except of transient erythema and oedema. The combined treatment of a fractional picosecond laser and a PDL was more effective for Riehl's melanosis compared to single laser treatment. The treatment targets both dermal pigmentation and dilated vessels, offering promising results for those working to manage Riehl's melanosis.

Clinical Patterns And Outcomes Of Retinoblastoma In A Tertiary Care Centre Of A Developing Country.

A retrospective study was conducted for which records of patients with Retinoblastoma (RB), treated at Lahore General Hospital between 2017 and 2021, were retrieved on February 1, 2022. Staging of RB, neuroimaging, RetCam images, and treatment were analysed. The study included 47 patients (22 females and 25 males). Mean age of presentation was 26.5±15 months. Records of 84 eyes (37 bilateral and 10 unilateral) were examined. Family history was positive in only (n=3) 6.3% cases. Mean follow-up was 22.94±14.4 months. Leucocoria was the commonest presentation, seen in 72 (85.7%) eyes, proptosis in 8 (9.5%), huge fungating mass in 2 (2.4%), while tumour was diagnosed because of screening in 2 (2.4%) patients. Posttreatment complications included cataract in two patients, Ischaemic chorioretinal toxicity, transient macular oedema, orbital oedema and transient intra cranial oedema in one patient each. Two patients had metastasis and underwent systemic chemotherapy. The study showed that patients with retinoblastoma can achieve better results if diagnosed early and treated with newer treatment options.

Subcoronal Incision for Inflatable Penile Prosthesis Does Not Risk Glans Necrosis.

Glans vascular compromise had previously been considered a rare but devastating complication of the subcoronal incision for inflatable penile prosthesis surgery. Here, we describe the largest series of subcoronal implants to date to assess contemporary complication rates. A retrospective review of subcoronal prosthesis placements by a single surgeon from Seoul, South Korea, was performed. Patients were randomly assigned either Coloplast Titan or AMS 700 device per institutional practice. A total of 898 patients who underwent subcoronal implants from May 2015 to March 2022 were analyzed. Median follow-up was 41 months (IQR 40). Preoperative patient comorbidities included diabetes (36.6%) and Peyronie's disease (4%). The most common complication was transient distal penile edema (74.7%). Transient incisional paresthesia (20.6%) was more common in patients with diabetes (31.9% vs 13.9%, P < .01). Five cases (0.5%) of distal penile skin necrosis were reported in patients who had previously been circumcised. Of these, 3 were managed successfully with wet-to-dry dressing, 1 required skin grafting, and 1 required device explant. Device infection without incisional compromise occurred in 2 cases (0.2%). There were no instances of glans necrosis or ischemia observed in this cohort. Of the first-time implants (817, 90.9%), most (62.3%) were successfully completed under local anesthetic alone, with the remainder of surgeries completed with the addition of adjunctive conscious sedation. Subcoronal incision for first-time or revision penile implant surgery is not a risk factor for glans ischemia or necrosis and can be safely completed under local anesthetic with or without conscious sedation.

Facial and body contouring with 1444nm Nd:YAG laser-assisted lipolysis: Clinical evidence.

Body contouring is a significant area of dermatologic and plastic surgery. Surgical procedures, like surgical lipectomy, and less invasive procedures, such as various liposuction techniques, are the two main ways to reduce fat. Our study showed that 1444nm Nd:YAG laser-assisted lipolysis used with appropriate and specific parameters effectively destroys adipose tissue avoiding these risks and determining a safe clinical application. A subcutaneous, 1444nm Nd:YAG laser was used on 132 patients (range, 18-73 years; 109 women and 23 men with Fitzpatrick skin phototypes ranging between II and V) requiring body and face contouring. All patients were photographed for documentation. Digital clinical photography was taken under as near identical conditions as possible at baseline (pre-treatment), and 16weeks post-treatment. The 5-point Global Aesthetic Improvement Scale (GAIS) was recorded immediately after treatment and at their final assessment session (4 months). Adverse events were monitored. On the basis of the investigator-evaluated GAIS scale, the total GAIS scores showed satisfactory results. Clinician assessment from the clinical photography showed good efficacy and visible aesthetic results for body and face areas. No serious or unexpected adverse side effects were recorded, and transient pain, oedema, erythema and slight induration resolved within the first week of treatment. The 1444nm Nd:YAG laser is a new tool for performing lipolysis, and this study reports its effectiveness and safety.

(452) Glans Necrosis is Not a Risk for Simple Inflatable Penile Prosthesis Insertion Performed via Subcoronal Incision

Abstract Introduction Some studies have questioned subcoronal incision via IPP as a risk factor for glans ischemia or necrosis. We analyzed the largest ever reported series of IPP via subcoronal incision. Objective To report complications related with subcoronal incision for IPP placement Methods We studied 898 men who had subcoronal IPP placement from 5/2015-3/2022 by single surgeon. 817 were first-time patients under local anesthesia, with 81 revisions under spinal anesthesia including 707 circumcised and 181 uncircumcised subjects. Most (76%) uncircumcised men underwent coincident circumcision; the remainder refused. Implants were Coloplast Titan (489) and AMS 700 (329) in 329 (36.6%) diabetics and 38 (4%) Peyronie’s. We report postoperative occurrence of device infections and glans/penile skin problems. Results Mean follow up was 47.3 months (3-81 months). Modeling (64%) and corporal relaxing incisions (36%) straightened the Peyronie’s patients. Transient distal penile skin edema which resolved within 2 to 4 months was noted in 673 cases (74.9%). Edema developed in 68.3% previously circumcised patients, 100% of concomitant circumcised patients and 96.2% of patients who had refused circumcision. One previously circumcised patient experienced prolonged edema of 7 months. Five previously circumcised patients (0.5%) developed partial distal penile skin necrosis on the proximal side of the subcoronal incision (Figure-1) with all but one healing without grafting. The other patient sustained necrotic wound dehiscence which led to device infection and removal. There were zero cases of glans ischemia or necrosis. Only 2 patients became infected (0.2%). Conclusions Subcoronal incision for simple IPP placement or revision is not an independent risk factor for glans ischemia or necrosis. Most postoperative patients do experience transient distal penile skin edema without glans involvement which heals without sequelae regardless of circumcision status. Very rarely (0.5%) penile skin loss may occur. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, International Medical Devices, Rigicon, Uramix.

CHANTER Syndrome: A Rare Cause of Encephalopathy and Ischemic Lesions (P2-5.017)

<h3>Objective:</h3> To present a rare case of Cerebellar Hippocampal and Basal Nuclei Transient Edema with Restricted Diffusion (CHANTER) Syndrome. <h3>Background:</h3> CHANTER syndrome is a recently recognized constellation of clinical and radiologic findings. The clinical features include acutely depressed consciousness with obstructive hydrocephalus secondary to cerebellar edema. MRI findings are restricted diffusion in the cerebellar cortex, hippocampi, and basal nuclei. CHANTER is distinguished from ischemic stroke by lack of distribution in a specific vascular territory or vascular occlusion present on angiographic imaging. Etiology may be a primary metabolic or mitochondrial failure of the gray matter with anoxic injury precipitated by opiates or other drugs of abuse. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> A 70-year-old right-handed hypertensive woman with HIV, end-stage renal failure, and lymphoma in remission was in respiratory distress. Seizures of unclear duration were noted on ambulance arrival and midazolam was administered. She was intubated and loaded with levetiracetam for status epilepticus. Norepinephrine was given during a hypotensive episode. Neurological examination was remarkable for lack of motor response to noxious stimuli and present brainstem reflexes consistent with coma. Opiates were detected in urine. MRI brain showed multiple small foci of restricted diffusion involving bilateral cerebellar hemispheres, hippocampi, basal ganglia, and in the right parietal cortex. MR angiography of the head and neck was normal. Video EEGs showed severe diffuse slowing, generalized periodic discharges that became blunted with triphasic morphology after lorazepam and levetiracetam administration. Cardiac monitoring and echocardiogram were unremarkable. Her alertness improved and withdrew minimally all extremities to painful stimuli. She was discharged to a long-term skilled nursing facility. <h3>Conclusions:</h3> This case highlights a rare clinical manifestation suggestive of CHANTER syndrome. Unlike other cases previously described, the cerebellar lesions were not sufficiently large to cause hydrocephalus. However, the clinical recovery was very limited. Status epilepticus and transient hypotension may have played a role in the poor recovery. <b>Disclosure:</b> Dr. Hiana has nothing to disclose. Dr. Soh has nothing to disclose. Dr. Marchidann has stock in Eli Lilly. Dr. Marchidann has stock in Pfizer. Dr. Marchidann has stock in Merck. Dr. Marchidann has stock in Illumina. Dr. Marchidann has stock in Aeterna Zentaris. Dr. Marchidann has stock in Abbot. Dr. Marchidann has received publishing royalties from a publication relating to health care. Dr. Marchidann has received publishing royalties from a publication relating to health care.

Cerebellar Hippocampal and Basal Nuclei Transient Edema with Restricted Diffusion (CHANTER): A Case Report with Literature Review (P9-7.004)

<h3>Objective:</h3> To review the clinical presentation and imaging findings of a 64-year-old patient with CHANTER syndrome. <h3>Background:</h3> Cerebellar hippocampal and basal nuclei transient edema with restricted diffusion (CHANTER) syndrome is a rarely described constellation of neuroradiographic findings in the setting of altered mental status. Patients typically present after being found unresponsive in the setting of polysubstance abuse. While the imaging findings associated with CHANTER (restricted diffusion in the bilateral cerebellum, limbic structures, and corpus striatum) are often harbingers of severe brain injury, a growing number of case reports have shown that patients with this syndrome may demonstrate marked clinical improvement over time. <h3>Design/Methods:</h3> Case report with literature review. <h3>Results:</h3> Our patient is a 64-year-old woman who presented to our academic tertiary care center after being found unresponsive. On presentation her GCS was 3 and her urine drug screen was positive for cocaine, fentanyl, barbiturates, and opiates. Fingerstick glucose was over 500 by EMS and she was intubated in the emergency room. The patient was admitted to the MICU where her hospital course was complicated by shock, AKI, acute on chronic respiratory failure, and persistent encephalopathy. Follow-up neuroimaging showed worsening hydrocephalus with areas of signal abnormality and diffusion restriction in the bilateral hippocampi and cerebellar hemispheres, consistent with CHANTER Syndrome. She received hypertonic saline, an EVD was placed, and she underwent suboccipital craniectomy to further relieve intracranial pressure. She was ultimately discharged on hospital day 29 with residual cognitive deficits to an acute rehabilitation facility. <h3>Conclusions:</h3> We report a case of CHANTER Syndrome in a 64-year-old woman who was successfully treated with hypertonic saline and urgent suboccipital craniectomy. This case supports the growing cohort of studies that describe the unique clinical and radiological course of CHANTER Syndrome. <b>Disclosure:</b> Ms. Menville has nothing to disclose. Mr. Wang has nothing to disclose. Dr. Weisbach has nothing to disclose. Dr. Tung has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Up to Date. Dr. Tung has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Leeseberg &amp; Valentine. Dr. Tung has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Cooper &amp; Elliott. The institution of Dr. Richards has received research support from Brown Physicians, Inc.

CHANTER Syndrome: Have We Been Overlooking This Catastrophic Opioid Neurotoxicity? (P9-7.002)

<h3>Objective:</h3> To describe the clinical and radiological findings of Cerebellar, hippocampal, and basal nuclei transient edema with restricted diffusion (CHANTER) syndrome in a female presenting with pulseless electrical activity after a potential opioid overdose. <h3>Background:</h3> CHANTER syndrome is a recently described complication of substance abuse, especially opioids, characterized by cytotoxic edema to bilateral hippocampi, basal ganglia and cerebellar cortices. Neuroradiology is distinct from anoxic brain injury as cerebral cortex, thalamus, and subcortical white matter are not involved. <h3>Design/Methods:</h3> Case report with electronic medical chart review. <h3>Results:</h3> 64-year-old African American female with a past medical history of hypertension and depression (on prescribed diazepam), presented after a witnessed cardiac arrest at home with return of spontaneous circulation (ROSC) in the hospital. Pt was intubated on arrival and her initial CT head was unremarkable. Her pocket had multiple opioid pills and urine drug screen was also positive for opiates and benzodiazepines. MRI brain revealed areas of diffusion signal abnormality with corresponding T2 FLAIR hyperintensity in the bilateral cerebellar white matter, the bilateral basal ganglia, and bilateral hippocampi with some patchy involvement of the bilateral (left more than right) occipital lobes suggestive of CHANTER syndrome, as described in limited literature. The electroencephalogram revealed slow background activity but no seizures. A repeat MRI brain on day 8 showed diminished, but unresolved, diffusion restriction involving the supratentorial and infratentorial brain in a symmetric pattern relating to evolution of cytotoxic edema with corresponding improvement of her neurological status. <h3>Conclusions:</h3> CHANTER syndrome’s prognosis depends on early identification and supportive treatment as patients can quickly progress to hydrocephalus. It may be difficult but imperative to differentiate CHANTER syndrome from anoxic brain injury. Further research is needed to identify optimal management strategies for this threatening neurotoxic phenomenon. <b>Disclosure:</b> Dr. Ghani has nothing to disclose. Dr. Yousaf has nothing to disclose. Mr. Kemper has nothing to disclose. Dr. Shi has nothing to disclose. Dr. Sagi has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for SK Life Sciences.

Investigating the Efficacy of Modified Lipoaspirate Grafting to Improve the Appearance of Atrophic Acne Scars: A Pilot Study.

Processed lipoaspirate grafting describes several techniques theorized to leverage the inflammatory and regenerative capacities of mechanically processed adipocytes to rejuvenate and correct skin pathology. Although lipoaspirate grafting is typically leveraged to fill visible defects such as depressed scars and dermal lines, additional fat processing allows grafts to stimulate mechanisms of wound healing, including the promotion of fibroblast activation, neovascularization, and neocollagenesis. This study intends to assess the efficacy and tolerability of processed lipoaspirate grafting monotherapy to improve the clinical appearance of atrophic acne scars. Patients underwent a single autologous processed lipoaspirate grafting procedure at the site of atrophic acne scars. Objective and subjective scar analysis was performed at 3 and 6 months posttreatment. Scars were assessed with standard photography, topographic analysis, and noninvasive skin measurements. In addition, microbiopsies were obtained before and after treatment to assess histological or genetic changes. Clinical improvement was assessed with patient and clinician Global Aesthetic Improvement Scales (GAIS) and blinded photographic evaluation. Ten patients between ages 18 and 60 completed the study. Clinical evaluation demonstrated that fat grafting improved the appearance of atrophic acne scars. Clinician GAIS and patient GAIS scores showed clinical improvement at both 3- and 6-month follow-up compared with baseline (P < .05). Blinded clinician GAIS scores also showed statistically significant improvement when clinicians compared clinical photographs taken at 6-month follow-up to baseline (P < .0001). The attenuation coefficient increased at 6-month follow-up, suggesting collagen remodeling and reorganization over the study period. Patients experienced anticipated posttreatment symptoms including transient erythema and edema; however, no unexpected adverse events were reported. Micronized lipoaspirate injection is a viable and effective option to improve the appearance of facial acne scarring. Favorable improvements in atrophic acne scarring were captured by objective analysis of skin ultrastructure as well as improvement in subjective assessments of scarring.

SON-Related Zhu-Tokita-Takenouchi-Kim Syndrome With Recurrent Hemiplegic Migraine: Putative Role of PRRT2.

Zhu-Tokita-Takenouchi-Kim (ZTTK) syndrome (OMIM 617140) is a recently identified neurodevelopmental disorder caused by heterozygous loss-of-function (LoF) variants in SON. Because the SON protein functions as an RNA-splicing regulator, it has been shown that some clinical features of ZTTK syndrome can be attributed to abnormal RNA splicing. Several neurologic features have been observed in patients with ZTTK syndrome, including seizure/epilepsy and other EEG abnormalities. However, a relationship between SON LoF in ZTTK syndrome and hemiplegic migraine remains unknown. We identified a patient with a pathogenic variant in SON who shows typical clinical features of ZTTK syndrome and experienced recurrent episodes of hemiplegic migraine. To define clinical features, brain MRI and EEG during and after episodes of hemiplegic migraine were characterized. To identify molecular mechanisms for this clinical presentation, we investigated the impact of small interfering RNA (siRNA)-mediated SON knockdown on mRNA expression of the CACNA1A, ATP1A2, SCN1A, and PRRT2 genes, known to be associated with hemiplegic migraine, by quantitative RT-PCR. Pre-mRNA splicing of PRRT2 on SON knockdown was further examined by RT-PCR using primers targeting specific exons. Recurrent episodes of hemiplegic migraine in our patient typically followed modest closed head injuries, and recurrent seizures occurred during the most severe of these episodes. Transient hemispheric cortical interstitial edema and asymmetric EEG slowing were identified during episodes. Our siRNA experiments revealed that SON knockdown significantly reduces PRRT2 mRNA levels in U87MG and SH-SY5Y cell lines, although a reduction in CACNA1A, ATP1A2, and SCN1A mRNA expression was not observed. We further identified that SON knockdown leads to failure in intron 2 removal from PRRT2 pre-mRNA, resulting in a premature termination codon that blocks the generation of functionally intact full-length PRRT2. This report identifies recurrent hemiplegic migraine as a novel clinical manifestation of ZTTK syndrome, further characterizes this clinical feature, and provides evidence for downregulation of PRRT2 caused by SON LoF as a mechanism causing hemiplegic migraine. Examination of the SON gene may be indicated in individuals with recurrent hemiplegic migraine.

MP62-09 GLANS NECROSIS IS NOT A RISK FOR SIMPLE INFLATABLE PENILE PROSTHESIS INSERTION PERFORMED VIA SUBCORONAL INCISION

You have accessJournal of UrologyCME1 Apr 2023MP62-09 GLANS NECROSIS IS NOT A RISK FOR SIMPLE INFLATABLE PENILE PROSTHESIS INSERTION PERFORMED VIA SUBCORONAL INCISION Sung Hun Park and Steven Wilson Sung Hun ParkSung Hun Park More articles by this author and Steven WilsonSteven Wilson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003320.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Some studies have questioned subcoronal incision for IPP as a risk factor for glans ischemia or necrosis.1 We analyzed the largest ever reported series of IPP via subcoronal incision. METHODS: We studied 898 men who had subcoronal IPP placement from 5/2015-3/2022 by single surgeon after ethical committee approval. 817 were first-time patients, with 81 revisions including 707 circumcised and 181 uncircumcised subjects. Most (76%) uncircumcised men underwent coincident circumcision; the remainder refused. Implants were Coloplast Titan (489) and AMS 700 (329) under local anesthesia in 329(36.6%) diabetics and 38(4%) Peyronie’s. We report postoperative occurrence of device infections and glans/penile skin problems. RESULTS: Mean follow up was 47.3 months (3-81 months). Modeling (64%) and corporal relaxing incisions (36%) straightened the Peyronie’s patients. Transient distal penile skin edema which resolved within 2 to 4 months was noted in 673 cases (74.9%). Edema developed in 68.3% previously circumcised patients, 100% of concomitant circumcised patients and 96.2% of patients who had refused circumcision. One previously circumcised patient experienced prolonged edema of 7 months. Five previously circumcised patients (0.5%) developed partial distal penile skin necrosis on the proximal side of the subcoronal incision with all but one healing without grafting. (see below) The other patient sustained necrotic wound dehiscence which led to device infection and removal. There were zero cases of glans ischemia or necrosis. Only 2 patients became infected (0.2%). CONCLUSIONS: Subcoronal incision for simple IPP placement or revision is not an independent risk factor for glans ischemia or necrosis. Most postoperative patients do experience transient distal penile skin edema without glans involvement which heals without sequelae regardless of circumcision status. Very rarely (0.5%) penile skin loss may occur. Reference: 1. Wilson SK et al. Glans Necrosis Following Penile Prosthesis Implantation: Prevention and Treatment Suggestions. Urology 2017; 107:144-148. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e864 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sung Hun Park More articles by this author Steven Wilson More articles by this author Expand All Advertisement PDF downloadLoading ...

An Observational Study on Transposed Brachial Artery ‒ Basilic Vein AV Fistula in Vascular Access for Hemodialysis

Background: Dialysis access in patients of chronic kidney disease (CKD) on long-term hemodialysis is a problem area. Patients with poor caliber veins distally on initial evaluation or with multiple fistula failures, basilic vein transposition is a good alternative. We present our experience with basilic vein transposition at our center. Methods: This study was a single-center observational study. A retrospective review of prospectively collected data from December 2013 to June 2019 was done. Qualitative variables were expressed as frequencies/percentages and compared between groups using the Chi-square test. Quantitative variables were expressed as mean ± standard deviation and compared between groups using unpaired t-test between groups and paired t-test within groups across follow-ups. Multiple linear regression analysis using a stepwise model selection tool was used to assess factors affecting the first cannulation. The best model was arrived in four steps where explanatory power (R 2) increased from 66.6% to 79.3% (P &lt; 0.001). Results: One hundred and eighty-eight patients formed a part of the study. One hundred and sixty-four patients underwent single stage, whereas 24 underwent two-stage transposition. Ninety-four each were male and female. The mean age was 51.38 ± 14.74 years. About 96.27% of fistulas underwent successful cannulation. The overall mean maturation time was 44.46 ± 7.21 days. It was 42.28 ± 3.71 for single and 60.27 ± 6.66 days for two-stage procedures. Primary patency at 6 months and 1 year were 92.82% and 85.67%, whereas primary-assisted patency rates were 94.6% and 91%. The secondary patency rate at 1 year was 60.77%. Salvage procedures included thrombolysis in 2, thrombectomy in 18, and thrombectomy with venoplasty in four cases. There were 28 failures. Fistula thrombosis was the most common cause. Complications included transient arm edema in 36.7%, late thrombosis in 7.7%, wound infection in 4.4%, and lymphorrhea in 6.9% of patients. Conclusion: The smallest basilic vein diameter for successful transposition is 2.5 mm. Factors used to predict successful maturation are initial vein diameter ≥2.5 mm, preoperative Peak systolic velocity (PSV) in brachial artery &gt;70 cm/s, fistula flow rate of &gt;400 ml/min at 6 weeks, and fistula diameter &gt;4.5 mm at 06 weeks.

High-frequency ultrasound assessment of vulvar lichen sclerosus treated with photodynamic therapy.

Patients with vulvar lichen sclerosus (VLS) are faced with a decreased quality of life and an increased risk of vulvar malignancy. 5-Aminolevulinic acid-based photodynamic therapy (ALA-PDT) can serve as an alternative for refractory VLS patients. However, high-frequency ultrasound (HFUS) has never been introduced in the ALA-PDT outcome assessment for VLS patients. A prospective study was conducted. Refractory VLS patients received two treatment courses of ALA-PDT (3 times of remedies at 2-week intervals for each course), and underwent clinical, HFUS and histopathological assessment. Statistical analysis comparing parameters at baseline and after ALA-PDT was performed. Thirty-one VLS patients were included. Both subjective symptoms (itch and burning pain) and objective severity (lesion size and hypopigmentation) were relieved significantly after ALA-PDT treatment. Hypoechoic dermal band (HDB) thickness revealed by HFUS decreased progressively with successive ALA-PDT treatment, and the reduction value had a positive correlation with the reduction of inflammatory infiltration depth in histopathology. Collagen homogenization depth decrease was also noticed. Besides, adverse effects were recorded, mainly as mild and transient post-treatment edema and pain. ALA-PDT is an effective and safe therapeutic option for refractory VLS patients. HFUS can act as a complement to the non-invasive treatment monitoring for its objectivity, quantifiability and precision in the distinct vertical perspective.

Clitoral preputial edema can be mistaken for clitoromegaly: a clinical analysis of ten cases.

We herein reported ten, female neonates with transient clitoral preputial edema, which was mistaken for clitoromegaly. Although it is well known that the clitoris is prominent in premature, female neonates, there are as of yet no reports of clitoral preputial edema in full-term neonates. The present study was conducted to clarify the clinical course of clitoral preputial edema. Seventeen, Japanese patients aged < 6 months with suspected clitoromegaly were enrolled, and their clinical course was analyzed retrospectively. Clitoral preputial edema was defined by 1) a normal clitoral glans despite edema; and 2) the absence of established differences of sexual development, such as 21-hydroxylase deficiency. Ten of the 17 patients with suspected clitoromegaly had clitoral preputial edema; eight of the ten patients were full-term, and the remaining two were preterm neonates. The median age at the first visit was 8 days. Edema of the labia minora and labia majora, rugosity of the labia majora, and hymenal polyps often accompanied the clitoral preputial edema. Seven patients were examined at our division during the neonatal period, and three patients were examined in the post-neonatal period. Age at reduction of the clitoral width to < 7mm ranged from 8 to 74 days in four of the seven neonatal patients. In the three post-neonatal patients, age to reduction in the clitoral width ranged from 107 to 243 days. Transient clitoral preputial edema is often mistaken for clitoromegaly. The key to diagnosing clitoral preputial edema lies in its characteristic appearance and improvement course.

Febrile urinary tract infection after Double-J stent removal is associated with restenosis after laparoscopic pyeloplasty: A propensity score matched analysis of 503 children

To analyze the association between the febrile urinary tract infection (fUTI) after Double-J (DJ) stents removal and restenosis after laparoscopic pyeloplasty (LP). We retrospectively reviewed the clinical data of patients who were treated with transperitoneal LP for ureteropelvic junction obstruction from 2016 to 2020. Patients were divided into two groups according to whether they developed fUTI after DJ stent removal within 48h. The 1:3 Propensity Score Matched (PSM) method was used to balance confounding variables. 503 patients were included in the study. 28 (5.57%) patients developed fUTI after DJ stent removal. Compared with the non-fUTI group, age was younger, and weight was lower (P<0.05) in the fUTI group. Restenosis occurred in 11 (2.2%) patients, of which six patients developed fUTI after DJ stent removal. The revision surgery rate in the fUTI group was significantly higher than in the non-fUTI group (21.4% vs. 1.1%, P<0.01). After PSM, the results remained consistent. For 492 patients without restenosis, 22 patients developed fUTI. Compared with the non-fUTI group, the larger anteroposterior diameter (APD) and higher APD/cortical thickness (P/C) ratio were observed in the fUTI group at three months and six months postoperatively (P<0.05), but the difference vanished at 12 months and 24 months after surgery (Figure). FUTI after DJ stent removal is not uncommon after LP, and surgeons are often concerned about the possibility of restenosis. In the present study, although our results demonstrated a significant association between them, restenosis patients comprise only about 20% of fUTI patients. Based on our clinical observations, fUTI is often developed in children from 1 to 6 years of age, and the younger patients may be afraid of voiding because of the postoperative pain after DJ stent removal. Besides, intraoperative manipulation of DJ stent removal may lead to transient edema in the anastomotic site, causing the fUTI. For patients who develop fUTI after DJ stent removal but without persistent symptoms, the transient worsening of hydronephrosis during the early postoperative period may not impact long-term outcomes (As shown in Figure). Additional follow-up is needed to prevent the deterioration of renal function. Our result demonstrated that fUTI after DJ stent removal is associated with restenosis after LP. For fUTI patients without restenosis, APD and P/C ratio exhibited transient worsening at three months and six months postoperatively, decreasing gradually during follow-up. Patients who develop fUTI after DJ stent removal should be monitored.

Abstract 14741: Sudden Desaturation in the Presence of Severe Hypertensive Blood Pressure Response to Exercise, What Next?

62 year old male was referred for evaluation of exertional breathlessness, predominantly when commuting to work by bicycle. There was no associated chest pain, palpitations, syncope or family history of cardiovascular disease. He had untreated hypertension, a remote history of hairy cell leukemia treated with cladribine in remission and polycythemia rubra vera treated with venesection and pegylated-interferon therapy. Trans-thoracic echocardiogram demonstrated normal biventricular size and systolic function with normal valvular function. There was insufficient tricuspid regurgitation to estimate pulmonary pressure. A stress echocardiogram was negative for ischemia at submaximal exercise capacity due to the protocol used. Previous spirometry testing demonstrated preserved lung volumes, forced expiratory volumes and vital capacity. DLCO (lung diffusion capacity for carbon monoxide) was at the lower limit of normal. A ventilation-perfusion scan excluded pulmonary emboli. Cardiopulmonary exercise testing demonstrated good exercise capacity (peak VO2 40.8 ml/kg/min). An abrupt desaturation was seen at the respiratory compensation point, (Figure 1 - left) with an oxygen saturation nadir of 75% (measured in two peripheral locations), which resolved rapidly in early recovery. This coincided with a profound hypertensive response peaking at systolic blood pressure 252mmHg (Figure 1 - right). The test was ceased due to dyspnea and generalized fatigue. This case demonstrates that while maximal oxygen consumption is a prognostic marker, an above average exercise capacity does not exclude underlying pathology. Pulmonary capillary stress failure resulting in transient pulmonary edema and early pulmonary hypertension cannot be excluded. However, with normal exercise capacity, justification of invasive diagnosis is difficult and there are currently no guidelines regarding an optimal surveillance plan.

A Gardos channelopathy associated with nonimmune hydrops and fetal loss.

Dehydrated hereditary stomatocytosis (DHS) (MIM#194380) is a rare autosomal dominant disorder of red blood cell permeability, characterized by a partially or fully compensated nonimmune hemolytic anemia. PIEZO1 is the major gene involved with hundreds of families described, some of which present transient perinatal edema of varying severity. A smaller subset of individuals harbors pathogenic variants in KCNN4, sometimes referred as "Gardos channelopathy." Up to now, only six pathogenic variants in KCNN4 have been reported in 13 unrelated families. Unlike PIEZO1-DHS, neither perinatal edema nor fetal loss has ever been observed linked to KCNN4-DHS. We report the first fetal loss due to non-immune hydrops fetalis related to a pathogenic 28 bp deletion (NM_002250.2: c.1109_1119+17del) in KCNN4. This observation underlies the need for very close monitoring of pregnancies when one parent is affected by DHS regardless of genotype (PIEZO1 or KCNN4).

33213 Nonsurgical facelift: Clinical and histologic evaluation of fractional radiofrequency treatment on fine lines and skin laxity

Background: Fractional radiofrequency (FRF) microneedling technology has shown effectiveness in improving skin laxity and wrinkles. We report our nonsurgical face-lift experience using 5 pairs of electrically isolated 32-gauge microneedles. The device uses insulated needles which are inserted at a 25° angle to the skin surface. This allows selective thermal impact to the dermis while sparing the epidermis. Objective: This study was conducted to evaluate the efficacy and safety of a temperature controlled FRF microneedling device on fine lines and skin laxity. Methods: 15 patients with skin laxity and fine lines were treated with a single session of FRF with microneedling. All subjects were treated with local tumescent anesthesia prior to treatment. FRF treatment was administered through five 32 g needle electrode pairs at a preselected real-time fixed temperature of 62°C to 70°C, and an energy duration of 3 to 4 seconds. A punch biopsy was performed before and after treatment in 9 patients. Clinical photographs were obtained before treatment and at follow-up. Two blinded dermatologists assessed the clinical improvement in terms of skin laxity and fine lines using a quartile grading scale. Any adverse effects were assessed during the entire study period. Results: All patients experienced both subjective and objective improvement. No serious adverse effects were reported. Transient adverse events were transient edema, and erythema. Histologic evaluation revealed increased dermal collagen and straightening of elastic fibers in the reticular dermis after treatment. Conclusion: Fractional radiofrequency (FRF) microneedling technology may be successfully used for a nonsurgical facelift.

MRI-Guided Cardiac RF Ablation for Comparing MRI Characteristics of Acute Lesions and Associated Electrophysiologic Voltage Reductions.

Radiofrequency (RF) energy delivered to cardiac tissue produces a core ablation lesion with surrounding edema, the latter of which has been implicated in acute procedural failure of Ventricular Tachycardia (VT) ablation and late arrhythmia recurrence. This study sought to investigate the electrophysiological characteristics of acute RF lesions in the left ventricle (LV) visualized with native-contrast Magnetic Resonance Imaging (MRI). An MR-guided electrophysiology system was used to deliver RF ablation in the LV of 8 swine (9 RF lesions in total), then perform MRI and electroanatomic mapping. The permanent RF lesions and transient edema were delineated via native-contrast MRI segmentation of T1-weighted images and T2 maps respectively. Bipolar voltage measurements were matched with image characteristics of pixels adjacent to the catheter tip. Native-contrast MR visualization was verified with 3D late gadolinium enhanced MRI and histology. The T2-derived edema was significantly larger than the T1-derived RF lesion (2.1 ±1.5 mL compared to 0.58 ±0.34 mL; p=0.01). Bipolar voltage was significantly reduced in the presence of RF lesion core (p 0.05) and edema (p 0.05), with similar trends suggesting that both the permanent lesion and transient edema contributed to the region of reduced voltage. While bipolar voltage was significantly decreased where RF lesions are present (p 0.05), voltage did not change significantly with lesion transmurality (p 0.05). Permanent RF lesions and transient edema are distinct in native-contrast MR images, but not differentiable using bipolar voltage. Intraprocedural native-contrast MRI may provide valuable lesion assessment in MR-guided ablation, whose clinical application is now feasible.

A Recombinant Chimeric Protein-Based Vaccine Containing T-Cell Epitopes from Amastigote Proteins and Combined with Distinct Adjuvants, Induces Immunogenicity and Protection against Leishmania infantum Infection.

Currently, there is no licensed vaccine to protect against human visceral leishmaniasis (VL), a potentially fatal disease caused by infection with Leishmania parasites. In the current study, a recombinant chimeric protein ChimT was developed based on T-cell epitopes identified from the immunogenic Leishmania amastigote proteins LiHyp1, LiHyV, LiHyC and LiHyG. ChimT was associated with the adjuvants saponin (Sap) or monophosphoryl lipid A (MPLA) and used to immunize mice, and their immunogenicity and protective efficacy were evaluated. Both ChimT/Sap and ChimT/MPLA induced the development of a specific Th1-type immune response, with significantly high levels of IFN-γ, IL-2, IL-12, TNF-α and GM-CSF cytokines produced by CD4+ and CD8+ T cell subtypes (p < 0.05), with correspondingly low production of anti-leishmanial IL-4 and IL-10 cytokines. Significantly increased (p < 0.05) levels of nitrite, a proxy for nitric oxide, and IFN-γ expression (p < 0.05) were detected in stimulated spleen cell cultures from immunized and infected mice, as was significant production of parasite-specific IgG2a isotype antibodies. Significant reductions in the parasite load in the internal organs of the immunized and infected mice (p < 0.05) were quantified with a limiting dilution technique and quantitative PCR and correlated with the immunological findings. ChimT/MPLA showed marginally superior immunogenicity than ChimT/Sap, and although this was not statistically significant (p > 0.05), ChimT/MPLA was preferred since ChimT/Sap induced transient edema in the inoculation site. ChimT also induced high IFN-γ and low IL-10 levels from human PBMCs isolated from healthy individuals and from VL-treated patients. In conclusion, the experimental T-cell multi-epitope amastigote stage Leishmania vaccine administered with adjuvants appears to be a promising vaccine candidate to protect against VL.