Years Of Experience In Single Center Research Articles

Pulmonary toxicities of molecular targeted antineoplastic agents: a single-center 10-year experience.

Background/AimsA better understanding of cancer cell biology has led to the discovery and development of several new targeted agents for cancer. These drugs are widely used in cancer treatment and have good toxicity profiles. However, some patients are extremely sensitive to these drugs and can develop severe toxicities. Among the toxicities, pulmonary complications are infrequent with most targeted therapies. This study aimed to identify the radiologic pulmonary complications in various targeted therapies and to analyze the characteristics of patients with pulmonary toxicity.MethodsWe retrospectively reviewed the medical records and chest image findings of 644 patients who were treated with targeted antineoplastic agents at Soonchunhyang University Hospital between May 2005 and September 2014.ResultsOf these 644 patients, 90 (14.0%) developed pulmonary complications as noted on chest computed tomography. Among these patients, 15 (2.3%) developed drug-related pulmonary toxicities. Treatment with targeted agents was discontinued in all patients, while 11 patients were simultaneously treated with glucocorticoids. Three patients died of drug-related pulmonary toxicity.ConclusionsDuring targeted therapy, clinicians should assess for pulmonary toxicities and symptoms that occur with dyspnea. If drug-induced pulmonary toxicities are suspected, imaging studies should be performed immediately, and the possibility of variable radiological patterns should be considered. Discontinuing the use of implicated causative agents and treatment with glucocorticoids resulted in an improvement in both symptoms and imaging findings, but some patients still experienced fatal pulmonary toxicities.

Single Center Experience in Cerebrospinal Fluid Dynamics Testing.

Normal pressure hydrocephalus is more complex than a simple disturbance of the cerebrospinal fluid (CSF) circulation. Nevertheless, an assessment of CSF dynamics is key to making decisions about shunt insertion, shunt malfunction, and for further management if a patient fails to improve. We summarize our 25years of single center experience in CSF dynamics assessment using pressure measurement and analysis. 4473 computerized infusion tests have been performed. We have shown that CSF infusion studies are safe, with incidence of infection at less than 1%. Raised resistance to CSF outflow positively correlates (p<0.014) with improvement after shunting and is associated with disturbance of cerebral blood flow and its autoregulation (p<0.02). CSF infusion studies are valuable in assessing possible shunt malfunction in vivo and for avoiding unnecessary revisions. Infusion tests are safe and provide useful information for clinical decision-making for the management of patients suffering from hydrocephalus.

Treatment of rectus sheath hematomas: Eight years of single-center experience with a review of literature.

Rectus sheath hematoma is a rare and frequently misdiagnosed cause of acute abdominal pain. In the management of the patients with rectus sheath hematoma, which are mostly with advanced age and comorbid diseases, positive results can be obtained by avoiding unnecessary surgical procedures with correct diagnosis and treatment approaches. The presented study aims to contribute to the lack of algorithms and optimal treatment strategies in the management of rectus sheath hematoma patients with the description of our experience in their management. Patients who underwent treatment with the diagnosis of rectus sheath hematoma between May 2010 and July 2018 were retrospectively analyzed. Demographic characteristics, medical histories, physical and laboratory findings and imaging methods, treatment processes, complications, morbidity, mortality, length of hospitalization and long-term follow-up results were searched. Data were analyzed from patient files, hospital computer registry system and radiology archives. Data analysis was performed using Microsoft Excel and IBM-SPSS-Statistics-24. The mean age of the 31 patients was 63.03 years (24-85 years). The female/male ratio (21/10) was 2.1. The most common presenting sign or symptom was abdominal pain (100%), followed by abdominal wall mass in 25 patients (80.6%). Twenty-five patients (80.6%) were receiving some form of anticoagulation and antiplatelet therapy. Diagnosis was confirmed by Computed Tomography in 11 (45.4%), Ultrasonography in five (16.1%) and Computed Tomography with Ultrasonography in 15 (33.3%). Eight patients (25.8%) were evaluated as Type-1, 10 (32.2%) as Type-2 and 13 (41.9%) as Type-3. Mean International Normalized Ratio (INR) value of patients was 2.59. Bleeding was controlled by surgery in three cases (9.6%). The conservative approach was preferred in 28 cases (90.3%). 29 (93.5%) patients were discharged after an average hospital stay of 7.48 days (4-21). One patient died on the postoperative 5th day and other on the 14th day of conservative treatment (6.45% mortality). The mortality rate of conservatively and surgically treated patients was 3.5% and 33.3%, respectively. Rectus sheath hematoma should be suspected in elderly patients using anticoagulants with acute abdominal pain, severe cough attacks and an umbilical palpable or radiologically supported mass. Computed Tomography and Ultrasonography should be performed in case of clinical suspicion. Early and correct diagnosis ensures successful conservative treatment and prevents unneces-sary surgical procedures. In the management of cases where clinician experience is at the forefront, we are hopeful that a new effective algorithm system and guidelines for the diagnosis will be identified after increasing the presentations of case series and experiences.

Safety and efficacy of outpatient-based administration of granulocyte colony-stimulating factor in collection of allogeneic peripheral blood stem cells: 10 years of single-center experience in 86 donors

Safety and efficacy of outpatient-based administration of granulocyte colony-stimulating factor in collection of allogeneic peripheral blood stem cells: 10 years of single-center experience in 86 donors

Jejunal and ileocolic free flaps for digestive tract reconstruction following pharyngo-laryngo-oesophagectomy - 30 years of single-centre experience.

IntroductionHypopharyngeal cancer accounts for 3–5% of all squamous-cell carcinoma (SCC) of the head and neck and has one of the worst prognoses. The aim of the study was to evaluate oncologic and functional treatment outcomes in patients with T3-T4a squamous cell hypopharyngeal and laryngeal cancer.Material and methodsRetrospective analysis of the material from one treatment site included 90 patients (81 male, 9 female) who had undergone surgery between 1986 and 2010. Their mean age was 55.06 years (range 36–75).ResultsTNM (T – tumour, N – node, M – metastasis) staging assessment was feasible in 70 treatment-naïve patients (77.78%): 57 (63.33%) were classified to stage T4a, and 13 were classified to T3 (14.44%). Cervical lymphadenopathy was observed in 53 (63.3%) patients; in 44 patients (48.89%) postoperative histopathology confirmed metastatic disease. G2 or G3 SCC was detected in 80% of patients. All patients underwent laryngopharyngoesophagectomy (LPE). Digestive tract reconstruction was performed using one of two methods: jejunal autograft (JA) in 79 patients (87.78 %) – Group A or ileocolic autograft (IA) in 11 patients (12.22%) – Group B. Comparative statistical analysis of both groups showed statistically significant differences only for substitute speech production. The mean survival time of patients from both groups was 2.21 years after reconstruction surgery.ConclusionsJA or IA for digestive tract reconstruction in patients after LPE are burdened with high risk of complications but offer patients the chance of a normal oral diet shortly after surgery. Ileocolic autograft enables rapid production of substitute speech.

The BUILT study: a single-center 5-year experience of Lung Cancer screening in Taiwan.

Background: There are no uniform guidelines on low-dose computed tomography (LDCT) follow-up in lung cancer screening. Few studies have analyzed the incidental abnormalities and role of tumor markers in lung cancer screening. The purpose of this study was to investigate the diagnostic performance of LDCT, optimal follow-up duration, incidental findings, and role of tumor markers in diagnosing lung cancer.Methods: We retrospectively analyzed subjects who underwent their first LDCT in Taipei Tzu Chi Hospital between September 1, 2015, and August 31, 2016. All chest CT scans until August 31, 2020, were recorded. A non-calcified nodule with a diameter ≥2 mm on LDCT was defined as a positive result. We extracted the data, including possible risk factors of lung cancer and follow-up outcomes.Results: A total of 1502 subjects were recruited. Of the 38 subjects who underwent biopsy, 31 had confirmed lung cancer. Lung cancer in all patients was diagnosed within 4 years. Univariate logistic regression analysis revealed that a family history of lung cancer in first-degree relatives and abnormal serum carcinoembryonic antigen (CEA) levels were the significant risk factors for lung cancer. A cumulative lung cancer incidence of 54.7 patients per 1000 person-years was determined solely via radiological follow-up. In total, 271 (18%) subjects exhibited incidental findings on baseline LDCT.Conclusion: The overall lung cancer detection rate in this study was 2.1% in the 5-year study period. A family history of lung cancer and abnormal serum CEA levels are important risk factors for lung cancer. A minimum of 4-year follow-up is required to track suspicious nodules. A purely radiological follow-up detects a high incidence of lung cancer.

A single-center long-term experience of active surveillance for prostate cancer: 15 years of follow-up.

PurposeTo describe a single-center 15-year experience of active surveillance (AS) for prostate cancer (PCa).Materials and MethodsWe retrospectively reviewed patients who underwent AS between 2003 and 2018. One hundred fifty-three patients were selected according to the following criteria: (1) biopsy Gleason pattern ≤3+4 with (2) ≤two positive core(s) and (3) ≤50% core involvement, clinical-stage ≤T2a, and prostate-specific antigen (PSA) ≤20 ng/mL. Follow-up included PSA measurement every six months, prostate biopsies at one year and then every 2–3 years, and MRI every year. Intervention was triggered by (1) Gleason score (GS) upgrading, (2) >two positive cores, or (3) PSA doubling-time in <3 years.ResultsMean (±standard deviation) follow-up was 36.4 (±31.9) months. Ninety-three (60.8%) and 20 (13.1%) patients received second and third biopsies, respectively. Seventy-two patients (47.1%) discontinued AS for various reasons (59, intervention; 13, follow-up loss). Reasons for intervention consisted of GS upgrading (42.4%), >two positive cores (8.5%), abnormal PSA kinetics (11.9%), and patient preference (37.3%). Notably, 12 (25.5%) patients had pathologic GS ≥4+3 (unfavorable disease) and 3 (6.4%) patients had pathologic stage ≥T3a at radical prostatectomy. Median time to treatment-free survival was 19.5 months. Of the 59 patients who switched to intervention, biochemical recurrence was reported in only one (0.7%) patient.ConclusionsAS is an available option for low-risk PCa in carefully selected patients. Further larger prospective studies are needed to determine the optimal criteria for AS, especially in Korean PCa patients.

P079 - Pancreatic and thyroid metastases from Renal Cell Carcinoma (RCC): A single center 10-year experience

P079 - Pancreatic and thyroid metastases from Renal Cell Carcinoma (RCC): A single center 10-year experience

Therapeutic plasma exchange in the pediatric intensive care unit: A single-center 5-Year experience

The objective of this study is to characterize clinical indications, safety and outcome with the use of TPE in critically ill children. All TPE procedures performed in a tertiary pediatric intensive care unit (PICU) during a 5-year period were retrospectively evaluated. A total of 75 patients underwent 249 sessions of TPE. Sepsis-induced multiple organ dysfunction syndrome (MODS) was the most common indication with 29.3 %. American Society for Apheresis classifications were as follows: Category I: 24 %, Category II: 16 %, Category III: 45.3 % and Category IV: 4%, while 10.7 % of the patients could not be classified. TPE was performed without any adjunct procedures in 188 sessions (75.5 %), while it was combined with continuous renal replacement therapy (CRRT) in 49 sessions (19.7 %) and with CRRT and extracorporeal membrane oxygenation (ECMO) in 12 (4.8 %) sessions. Overall survival rate was 73.3 %. The survival rate in patients requiring only TPE was 86.5 %, while the survival rates of patients who had CRRT and ECMO were 45 % and 33.3 %, respectively. Complications associated with the procedure occurred in 48 (19.2 %) TPE sessions. The lowest survival rate (31.9 %) was in patients with sepsis-induced MODS. Finally, we also found significantly higher organ failure rate, mechanical ventilation requirement, and PRISM III score at PICU admission in non-survivors. Our experience indicates that TPE can be performed relatively safely in critically ill children with appropriate treatment indications. Survival rate may vary depending on the underlying disease; however, it must be noted that survival rate is very high in children requiring TPE only.

Cryoablation with an 8-mm tip catheter for typical AVNRT in children: a single center 5-year experience.

In children with typical atrioventricular nodal reentrant tachycardia (tAVNRT), cryoablation is preferred over radiofrequency ablation (RFA) because of its safety profile and acceptable long-term success rates. In this study, we have assessed the utility of 8-mm tip cryocatheters for tAVNRT ablation in our center. All pediatric AVNRT patients who underwent cryoablation with an 8-mm tip cryocatheter in our center between 2013 and 2018 were included. EnSite™ (St. Jude Medical Inc., St. Paul, MN, USA) was used in all patients. A total of 120 patients (64 females, 53%) were included in this study, and the mean age was 13.9 years with a standard deviation of 2.5 years. Eleven patients (9.1%) had structural heart disease, and 12 patients (10%) had additional arrhythmia substrate. The mean number of effective cryolesions was 8 with a standard deviation of 2.3. Fluoroscopy was used in three patients (2.5%). There were minor complications in only four patients (3.3%)-transient first-degree atrioventricular block or transient incomplete right bundle branch block. Acute success rate of cryoablation was 108/120 (90%). In twelve patients, cryoablation was suboptimal, or it failed. The procedure was completed successfully with RFA in the same session in ten patients. Overall acute success rate of ablation (Cryo ± RFA) was 98.5%. During a mean follow-up period of 24.6 months with a standard deviation of 11.3 months, three patients had recurrence (2.5%). Time between the beginning of the effective cryolesion and termination of AVNRT was found associated with acute success of cryoablation (p = 0.013). Cryoablation of AVNRT with an 8-mm tip catheter in children appears to be safe, with an acceptable acute success rate and a low recurrence rate. A faster termination of AVNRT during the cryolesion, slowing down before ending with atrioventricular block, is a good indicator for acute success.

Intraoperative fluorescence angiography with indocyanine green: retrospective evaluation and detailed analysis of our single-center 5-year experience focused on colorectal surgery.

ObjectivesAssessing bowel perfusion with indocyanine green fluorescence angiography (ICG-FA) shows positive effects on anastomotic healing in colorectal surgery.MethodsA retrospective evaluation of 296 colorectal resections where we performed ICG-FA was undertaken from January 2014 until December 2018. Perfusion of the bowel ends measured with ICG-FA was compared to the visual assessment before and after performing the anastomosis. According to the observations, the operative strategy was confirmed or changed. Sixty-seven low anterior rectal resections (LARs) and 76 right hemicolectomies were evaluated statistically, as ICG-FA was logistically not available for every patient in our service and thus a control group for comparison resulted.ResultsThe operative strategy based on the ICG-FA results was changed in 48 patients (16.2%), from which only one developed an anastomotic leakage (AL) (2.1%). The overall AL rate was calculated as 5.4%. Within the 67 patients with LAR, the strategy was changed in 11 patients (16.4%). No leakage was seen in those. In total three AL happened (4.5%), which was three times lower than the AL rate of 13.6% in the control group but statistically not significant. From the 76 right hemicolectomies a strategy change was undertaken in 10 patients (13.2%), from which only one developed an AL. This was the only AL reported in the whole group (1.3%), which was six times lower than the leakage rate of the control group (8.1%). This difference was statistically significant (p=0.032).ConclusionsBased on the positive impact by ICG-FA on the AL rate, we established the ICG-FA into our clinical routine. Although randomized studies are still missing, ICG-FA can raise patient safety, with only about 10 min longer operating time and almost no additional risk for the patients.

Henoch-Schönlein Purpura in children: 2 years of single center experience

Amaç: Henoch-Schönlein purpurası (HSP) tanısı ile izlenen hastaların demografik, klinik ve laboratuvar özelliklerini değerlendirmek ve böbrek tutulumu riski açısından karşılaştırmak Materyal ve metod: Ocak 2015-Ocak 2017 tarihleri arasında hastanemiz çocuk nefroloji-romatoloji polikliniğinde HSP tanısı konup en az 1 yıl süre ile izlenen hastaların dosyaları gözden geçirildi. Demografik veriler, öykü, tanı yaşı, fizik muayene, laboratuvar tetkikleri, organ tutulumları, böbrek biyopsileri, tüm tedavi rejimleri ve izlemleri değerlendirildi. Bulgular: Çalışmamızda 2 yıllık süre içinde 57’si erkek (% 48.3) 61’i kız (% 51.7) toplam 118 hasta vardı. Hastaların yaş ortalaması 7.9 ± 2.81, kız: erkek oranı 1: 0.93 idi. 10 yaş altında 98 hasta (% 83.1) varken, 10 yaş üzeri hasta sayısı 20 (% 16.9) idi. Hastalarda yaş, cinsiyet, hastalık tekrarı, eklem tutulumu yeri ve süresi, döküntünün yeri ve süresi, gastrointestinal tutulum, testis tutulumu, laboratuar parametreleri ile böbrek tutulumu karşılaştırıldığında anlamlı bir ilişki saptanmadı. Sonuç: İki yıllık süre içinde HSP tanısı ile izlediğimiz hastaları geriye dönük olarak değerlendirdiğimizde böbrek tutulumu açısından risk faktörlerine baktığımızda anlamlı bir faktör tespit edemedik. Aslında bu durum bize tüm HSP hastalarının dikkatli bir biçimde renal tutulum açısından takip edilmesi gerektiğini düşündürmektedir. Abstract Background: To evaluate the demographic, clinical and laboratory characteristics of patients with Henoch-Schönlein purpura (HSP) and compare the risk of renal involvement Materials and Methods: The files of the patients who were diagnosed as HSP in the pediatric nephrology-rheumatology clinic of our hospital between January 2015 and January 2017 and followed for at least 1 year were reviewed. Demographic data, history, age at diagnosis, physical examination, laboratory tests, organ involvement, renal biopsies, all treatment regimens and follow-up were evaluated. Results: There were 118 patients 57 male (48.3%), 61 female (51.7%) in a 2-year period. The mean age of the patients was 7.9 ± 2.81 and the female: male ratio was 1: 0.93. While there were 98 patients (83.1%) under 10 years of age, the number of patients over 10 years of age was 20 (16.9%). There was no significant relationship between age, sex, recurrence of disease, location and duration of joint involvement, location and duration of rash, gastrointestinal involvement, testicular involvement, laboratory parameters and renal involvement. Conclusion: When we retrospectively evaluated the patients whom were followed up with the diagnosis of HSP over a two-year period, we did not find any significant factor in the risk factors for renal involvement. In fact, this suggests that all HSP patients should be carefully monitored for renal involvement.

WS09.1 ICM and NPD diagnostics of cases with inconclusive CFTR genetics and sweat test: a single-centre 10-year experience

WS09.1 ICM and NPD diagnostics of cases with inconclusive CFTR genetics and sweat test: a single-centre 10-year experience

Heart Retransplantation for Coronary Allograft Vasculopathy in Children: 25 Years of Single-Center Experience

BackgroundPediatric end-stage heart disease is surgically managed by heart transplantation. A major complication of primary transplantation (PTx) is coronary allograft vasculopathy (CAV), a form of accelerated atherosclerosis. Retransplantation (RTx) has been the management of CAV; however, there is limited comprehensive literature on this subject. Here we report 25 years of single-center experience in managing CAV with RTx and place it in the context of recent studies. MethodsA retrospective cohort study was undertaken on patients who underwent PTx <18 years old and subsequent RTx due to CAV at the Heart Institute (InCor) University of São Paulo Medical School between 1992 and 2018. The maintenance immunosuppression protocol was double immunosuppression. For both PTx and RTx, quantitative and qualitative analyses were conducted for transplantation indication, donor/recipient demographics, post-transplant survival, rejection, infection, and immunosuppression. ResultsBetween 1992 and 2018, 200 children underwent heart transplantation. Ten re-transplantations were performed, for which 7 (70%) were for CAV. Ages at RTx ranged from 11.5 to 29.3 years (19.1 ± 5.68 years; median 18.2 years). The mean time between PTx and RTx was 12.9 ± 3.4 years (median 13.4 years). The Kaplan-Meier survival rate at 1 month, 3 years, and 5 years was 85.7%, 71.5%, and 47.6%, respectively. ConclusionCardiac RTx can be a management option for CAV in patients who have undergone PTx in childhood with double immunosuppression therapy.

Outcomes Following Revision Stapes Surgery in Children: A Single-Surgeon, Single-Center 15-Year Experience.

To review a single surgeon experience with revision pediatric stapes surgery for congenital stapes fixation (CSF) and tympanosclerosis (TS). Secondly, to determine whether hearing outcomes following revision surgery may be predicted by a thorough work-up aimed at assessing whether an extruded or malpositioned prosthesis is likely to be encountered intraoperatively. Tertiary referral center. Retrospective chart review. Fifteen patients having revision surgery for fixation of the stapes footplate over a 15-year period. Hearing results based on pre- and post-revision pure-tone average air-bone gap (PTA-ABG) and speech recognition threshold testing (SRT). Overall, the mean improvement of PTA-ABG following revision surgery was 11.9 dB (standard deviation [SD] 15.2) while SRTs improved by a mean of 12.3 (SD 19.9). Outcomes were significantly better in patients who reported a history of trauma following their initial surgery, when there was otoscopic evidence of an extruding or extruded prosthesis and/or a pre-revision CT (where performed) suggested an extruded or malpositioned prosthesis. No patients had a significant postoperative sensorineural hearing loss. Revision stapes surgery in children is a safe procedure in experienced hands which nonetheless should only be contemplated in patients in whom preoperative work-up suggests an extruded or malpositioned prosthesis is likely to be encountered intraoperatively.

The DIEP Flap as Well-established Method of Choice for Autologous Breast Reconstruction with a Low Complication Rate - Retrospective Single-centre 10-Year Experience.

Background Breast cancer is the most common cancer affecting women in Germany. Despite breast-conserving therapy (BCT) being carried out in almost 70% of cases, a high number of women still require complete mastectomy. Prophylactic mastectomy is also indicated for women with a BRCA 1/2 gene mutation. In addition to implant-based heterologous breast reconstruction, autologous breast reconstruction using a DIEP flap has been found to be beneficial, particularly for patients who had prior radiotherapy. This study aims to show that DIEP flap reconstruction surgery is the method of choice for autologous breast reconstruction with a low rate of complications. Patients and Methods Autologous breast reconstruction using a DIEP flap was performed in 1124 patients between July 2004 and December 2014. Retrospective study criteria included potential risk factors such as age, BMI, smoking, chemotherapy and/or radiotherapy, and comorbidities as well as outcome parameters such as postoperative complications. Outcomes were evaluated with a mean follow-up of 24 months. Results A total of 1124 patients underwent 1274 free DIEP flap breast reconstructions, of which 150 were bilateral reconstructions. The primary indication was previous mastectomy in 785 cases, followed by prior implant-based reconstruction in 265 cases. The total flap loss rate was 0.6%. Postoperative surgical revision for abdominal wall hernia was required in 0.2% of cases. The group with a higher BMI and the group of smokers had significantly higher complication rates. Elderly patients (> 65 years), patients who had undergone chemo-/radiotherapy and patients with diabetes did not have higher complication rates. Conclusion DIEP flap surgery is an excellent option for autologous breast reconstruction, with a low rate of donor site morbidity and low complication rates. DIEP flap surgery carried out in a specialised interdisciplinary breast centre in a standardised clinical setting after prior careful patient selection to take account of risk factors such as high BMI and smoking is a reliable method with a low complication rate and satisfactory long-term reconstruction results.

A single centre 10-year experience of Mitrofanoffs procedure for varied indications with its outcome

Background: To evaluate long term efficacy and complications of Mitrofanoffs procedure in patients with bladder dysfunction.Methods: Authors retrospectively reviewed the medical records of 51 patients who underwent construction of a continent catherisable channel (mitrofanoffs and monti) from 2009 till 2019 in our institution. Clinical findings and investigations result along with surgical techniques used were noted for these patients. Postoperative complications along with urinary continence and renal outcome were evaluated.Results: Mean age was 7 years and mean follow up was for 3 years. 27 patients were with neurogenic bladder and 24 with non-neurogenic bladder. The most common type of conduit was appendicovesicostomy (38) followed by illeal monti (12) and ureter (1). The most common stomal site was umbilicus (44) followed by right lower abdominal quadrant (6). Catherterizable conduit complications included stomal leakage in 3, mucosal prolapse at the stoma site in1 and an intra peritoneal leak requiring exploratory laprotomy and revision in1. Relative stomal continence was achieved in 98%. The preoperative serum creatinine &amp; blood urea nitrogen (BUN) at the time of mitrofanoffs procedure at the last follow up after the procedure were sought and compared using Chi square test showed statistically significant improvement (p&lt;0.01). No differences in outcome and complication rates were noted between different types of conduit, sites of implantation, or segments used for augmentation.Conclusions: Mitrofanoff is a safe and reliable procedure in children who are dependent on intermittent catherisation in developing countries. Appendicovesicostomy is our first option followed by yang -monti illeovesicostomy. While stomal continence is excellent patient education, family motivation and cost reduction are important factors for its lasting efficiency.

Abstract No. 399 Perioperative blood loss after embolization of hypervascular musculoskeletal tumors: a single-center 10-year experience

To assess outcomes following transarterial embolization of hypervascular bony tumors in patients undergoing orthopedic resection at our institution over a 10-year period. From April 2008 to August 2018, 73 patients with (59 males; mean age 58.1 years) with musculoskeletal (MSK) neoplasms presented for embolization for preoperative devascularization prior to orthopedic surgery and were retrospectively reviewed. Data collected includes demographic data, medical history, pertinent labs (i.e., hemoglobin levels), procedural information, surgical details (estimated blood loss (EBL), intraoperative transfusion), hospital course, and pathology. Fifty-eight patients (47 men, 11 women, range 21-84 years) were included in our analysis. Fifteen patients were excluded from this study (3 patients underwent angiography but were not embolized due to lack of large feeding branch vessel; 12 patients did not proceed to surgery after embolization). The median EBL was 500 mL (range, 100-3000). There was no difference in EBL between RCC (719.6 ± 626.1) and non-RCC groups (855.6 ± 657.5; P = 0.44). The median intraoperative transfusion requirement was 1.0 unit (range, 0-8 ± 2.06). 15.8% of patients required postoperative transfusion (median, 1.5 units; range 1-3). Of patients that received peri-operative transfusion, there was no difference in transfusion requirement in RCC and non-RCC groups (P = 0.88). Of the patients that did not get transfusions, the mean decrease in pre and postoperative hemoglobin was 1.41 g/dL (± 0.51g/dL). There were no complications related to non-target embolization. Preoperative transarterial embolization of hypervascular MSK neoplasms appears to be safe and effective in minimizing peri- and postoperative bleeding while keeping transfusion requirements low.

The Incidence of Dichorionic Diamniotic Twin Pregnancy After Single Blastocyst Embryo Transfer and Zygosity: 8 Years of Single-Center Experience.

Dichorionic diamniotic (DCDA) twin pregnancies after single blastocyst embryo transfer have been reported recently, although a blastocyst ovum is generally believed to divide into monochorionic twin pregnancy. We investigated the incidence of DCDA twin pregnancy after single blastocyst embryo transfer and their zygosity. This prospective cohort study included 655 consecutive twin pregnancies that were managed from 2006 to 2014 at our institution. Chorionicity and amnionicity were determined using first-trimester ultrasonography and/or placental pathology. Zygosity was analyzed if the cases were DCDA twins after single blastocyst embryo transfer. Among 655 twin pregnancies, there were 348 DCDA cases, 295 monochorionic diamniotic (MCDA) cases and 12 monochorionic monoamniotic cases. Single blastocyst embryo transfer was performed in 43 cases. Six out of the 43 (14%) cases involved DCDA twin pregnancies and the other 37 cases involved MCDA twin pregnancies. Three DCDA twins born after single blastocyst embryo transfer, wherein frozen embryo transfer (FET) was performed in the natural cycle, were dizygotic, and the other three cases, wherein FET with hormone replacement therapy was performed, were monozygotic. DCDA twin pregnancy occurred in 14% (7% for monozygotic and 7% for dizygotic) of twin pregnancies after single blastocyst embryo transfer cases.

Inflammatory Bowel Disease: Three Years of Single Center Experience in Maldives

Inflammatory Bowel Disease: Three Years of Single Center Experience in Maldives