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Background: Bowel mucormycosis is common among high-risk surgical neonates and has high fatality. This study was done to study the clinical profile and outcome of pediatric surgical patients operated at our center who had bowel mucormycosis on histology. Methods: It was a retrospective observational study. The data was collected from the medical records department. The files of surgical patients with tissue diagnosis of bowel mucormycosis operated at Chacha Nehru Bal Chikitsalaya from June 2018 to May 2021 were retrieved. The data was tabulated on Microsoft Excel sheet®. Results: A total of 11 surgical patients with bowel mucormycosis on histology were traced. The study had male preponderance. The majority were neonates and had low platelet counts with raised CRP levels. All but one expired, with severe sepsis and septic shock as major causes of death. Conclusion: The invasive mucormycosis is more common among neonates (but older children are not immune) with male preponderance. It may affect any part of GIT and the counts and sepsis screen may be normal. It has a high fatality rate.

Background: Anorectal malformations (ARM) are correctable congenital malformations with good prognosis. Traditionally it is managed by staged procedure, with diversion colostomy, followed by definitive procedure and stoma reversal in the third stage. It is recommended to complete all stages of repair by 6 months of age for better long-term continence. We had fewer patients coming for definitive surgery and stoma reversal than the patients undergoing colostomy for ARM, so we planned this study to find out the attrition rate among patients undergoing stoma for ARM and explore the reasons for the same. Methods: An observational study was conducted in the Pediatric Surgery department of Chacha Nehru Bal Chikitsalaya, New Delhi. All the case records of patients with ARM who underwent diversion stoma at our center from January 2018 to December 2019 were retrieved. Further follow-up case records were retrieved with the same Unique Health Identification Number (UHID). When the definitive surgery/ stoma closure was not found in the hospital records till December 2022, the parents were contacted telephonically to find out if the children had undergone definitive surgery at some other center, were awaiting surgery, or had died. The attrition was calculated as the difference between the number of patients for whom a stoma was done and the number of patients who underwent definitive surgery and stoma closure till the data acquisition. Results: A total of 105 patients were included in the study with male preponderance. Colostomy was done for 73.33% of patients in the neonatal period (77/105). The cloacal malformation was found in 7 (6.67%), rectal atresia in 6 (5.71%), and 9 had congenital pouch colon (8.57%). The age at stoma creation for ARM ranged from 1 day to 9.3 years (mean 0.67 ±1.96 years). Cardiac and renal anomalies were among the major associations. 28 of the neonates (26.67%) had stomal complications. Stomal issues were reported in 32.4%. Mortality was reported in 37 patients (35.24%) including 35 neonates. The attrition rate in our study was found to be 38.24% (26 out of 68). Factors contributing to attrition range from anemia and protracted waiting lists to the anesthesiologist’s pursuit of optimal patient stabilization, alongside familial or personal matters faced by caregivers. Conclusion: There was a high attrition rate in operated patients of ARM in whom stoma was constructed. The main reasons for the same were anemia and a long surgical waiting list.

Anorectal malformations (ARMs) are managed classically in three stages – colostomy at birth, anorectal pull-through after 2–3 months, and stoma closure. Single-stage pull-through has been contemplated in neonatal age aimed to reduce the number of procedures, better long-term continence, the better psycho-social status of the child, and reduced cost of treatment, especially in resource-strained countries. We conducted a systematic review comparing neonatal single-stage pull-through with stage pull-through and did a meta-analysis for the outcome and complications. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. PubMed and Scopus databases were searched and RevMan 5.4.1 was used for the meta-analysis. Fourteen comparative studies including one randomized controlled trial were included in the systematic review for meta-analysis. The meta-analysis included 1845 patients including 866 neonates undergoing single-stage pull-through. There was no statistically significant difference for the occurrence of surgical site infection (odds ratio [OR] 0.82, 95% confidence interval [CI]: 0.24–2.83), urinary tract injury (OR 1.82, 95% CI: 0.85–3.89), rectal prolapse (OR 0.98, 95% CI: 0.21–5.04), anal stenosis/stricture, voluntary bowel movements (OR 0.97, 95% CI: 0.25–3.73), constipation (OR 1.01, 95% CI: 0.61–1.67), soiling (OR 0.89, 95% CI: 0.52–1.51), mortality (OR 1.19, 95% CI: 0.04–39.74), or other complications. However, continence was seen to be better among patients undergoing neonatal pull-through (OR 1.63, 95% CI: 1.12–2.38). Thus, we can recommend single-stage pull-through for managing patients with ARMs in the neonatal age.

For women achieving clinical remission after the completion of initial treatment for epithelial ovarian cancer, 80% with advanced-stage disease will develop recurrence. However, the standard treatment of women with recurrent platinum-sensitive diseases remains poorly defined. Secondary (SCS), tertiary (TCS) or quaternary (QCS) cytoreduction surgery for recurrence has been suggested to be associated with increased overall survival (OS). We searched five databases for studies reporting death rate, OS, cytoreduction rates, post-operative morbidity/mortality and diagnostic models predicting complete cytoreduction in a platinum-sensitive disease recurrence setting. Death rates calculated from raw data were pooled based on a random-effects model. Meta-regression/linear regression was performed to explore the role of complete or optimal cytoreduction as a moderator. Pooled death rates were 45%, 51%, 66% for SCS, TCS and QCS, respectively. Median OS for optimal cytoreduction ranged from 16–91, 24–99 and 39–135 months for SCS, TCS and QCS, respectively. Every 10% increase in complete cytoreduction rates at SCS corresponds to a 7% increase in median OS. Complete cytoreduction rates ranged from 9–100%, 35–90% and 33–100% for SCS, TCS and QCS, respectively. Major post-operative thirty-day morbidity was reported to range from 0–47%, 13–33% and 15–29% for SCS, TCS and QCS, respectively. Thirty-day post-operative mortality was 0–6%, 0–3% and 0–2% for SCS, TCS and QCS, respectively. There were two externally validated diagnostic models predicting complete cytoreduction at SCS, but none for TCS and QCS. In conclusion, our data confirm that maximal effort higher order cytoreductive surgery resulting in complete cytoreduction can improve survival.

Introduction: Posterior urethral valve (PUV) is life threatening congenital anomaly of urinary tract. Aim of the study was to correlate urethral ratio (UR) and bladder wall thickness (BWT) with cystoscopic findings in PUV patients to assess residual valves and to validate UR as a diagnostic tool for residual valves. It also aimed to assess the utility of bladder wall thickness in diagnosis of residual valves. Materials and Methods: A total of 31 patients were included in the prospective study done from 2017 to 2019. Calculation of UR was done in oblique VCUG films by dividing maximum posterior and anterior urethral diameter without the catheter insitu. Measurement of BWT was done at dome and bladder neck at full distension with feeding tube insitu and was done at same volume in follow up. The procedure was repeated at 3 months follow up. The findings were compared with cystoscopic findings for the status of residual valves as gold standard. Each patient served as control for self in the study. Results: Median age of presentation was 1 years with range of 1day to 10 years. The most common complains at the time of presentation in our study was straining (35.48%) followed by antenatally diagnosed patients (25.81%) and recurrent UTI (19.36%). Pre fulguration median UR was 2.45. Post Fulguration median UR was 1.20. It showed a statistically significant reduction (p < 0.001) after fulguration. Pre fulguration median BWT was 4 mm. Post fulguration median BWT was 2.5 mm. BWT showed a statistically significant reduction (p < 0.001) after fulguration as well. ROC curve was plotted for UR and BWT. BWT more than 1.95 mm (sensitivity-80%) and UR more than 1.2 (sensitivity-70%) indicates residual valves. Conclusion: A step ladder approach including BWT, UR and check cystoscopy can serve as a new diagnostic algorithm for the assessment of residual valves thereby avoiding extra radiation and general anesthesia exposure.

Introduction: High and intermediate types of anorectal malformations (ARMs) may be managed by either open posterior sagittal anorectoplasty (PSARP) or by laparoscopic-assisted anorectoplasty (LAARP). Most of the literature favours one approach over the other based on retrospective analysis. We performed this study with the aim to compare the short-term outcomes of both procedures. Materials and Methods: All paediatric patients with high and intermediate ARM were enrolled and randomised into two groups: open PSARP group and LAARP group. Outcome parameters such as faecal continence using Kelly's scoring system, anal manometric parameters and post-operative complications were compared between the groups. Results: A total of 16 patients were included with equal distribution in the open PSARP and LAARP group. Patient's variables were comparable in both the groups. Five patients developed immediate post-operative complications, three in the LAARP and two in the open group. The mean Kelly's score was 3.63 ± 1.6 versus 2.57 ± 1.9 (P = 0.132) for LAARP and PSARP group, respectively. The mean resting pressure was 34.71 ± 6.26 cm of H2O and 35 ± 6.16 cm of H2O (P = 0.384) in LAARP and open group, respectively. Rectoanal inhibitory reflex was demonstrated in 6/7 patients in LAARP group and 5/7 patients in open group. Conclusion: Faecal continence in patients undergoing either of the procedure is comparable. However, wound-related complications are lesser in LAARP procedure.

Background: Esophageal atresia (EA) with distal trachea-esophageal fistula (TEF), the most common variety of EA, is managed by primary end-to-end anastomosis. Recurrent TEF constitutes the most difficult-to-manage complication of the primary repair and has an incidence of 2% to15%. Case Presentation: We present a case of rare recurrent TEF after primary repair of EA. The difficulties faced in view of the COVID pandemic and difficult diagnosis are discussed. We share our experience in the successful management of acquired TEF and lessons learned. Conclusion: Recurrent trachea-esophageal fistula is one of the rare and challenging complications to manage. The surgical option carries the best overall prognosis.

Background: Carmi syndrome is the name given to the association of congenital pyloric atresia and epidermolysis bullosa. It has a high mortality. Case series: We report 3 neonates with features of multiple skin blisters and a classical X-ray picture of a single bubble appearance. Two of them underwent surgery while 1 succumbed to sepsis in the pre-operative period. One baby had delayed mortality and the other is doing well in follow-up. Conclusions: Carmi syndrome should be kept as a differential diagnosis in neonates with skin blisters and feed intolerance. Early recognition with prompt medical and surgical management may contribute to a successful outcome.

The purpose of this investigation is to compare Cutibacterium acnes diagnosis using culturing vs. genomic DNA sequencing (NextGen) at various timepoints and locations during primary total shoulder arthroplasty. Additionally, we intend to compare the effects of hydrogen peroxide on standard culture technique results with genomic DNA sequencing. A prospective diagnostic study of 40 patients undergoing primary total shoulder arthroplasty was performed. Intraoperatively, 4 tissue samples were collected per patient: subdermal skin edge following initial skin incision, subdermal skin edge following hydrogen peroxide soak for 5 minutes, glenohumeral joint capsule, and subdermal skin edge prior to wound closure. Each tissue specimen was collected twice (one for culture analysis and the other for genomic (NextGen) DNA sequencing analysis) for a total of 8 specimens per patient and 320 tissue specimens in total. All anaerobic cultures were held for 14 days. Each culture plate was divided into quadrants and the amount of growth was quantified. Tissue samples were collected for genomic sequencing DNA analysis. Genomic sequencing results provided relative percentage of bacteria for each specimen detected. There were 18/40 males (45%) and no postoperative complications. Average age was 72.2 ± 11.8. Overall, 18% (29/160) of standard anaerobic cultures were positive for C. Acnes and 26% (942/160) were positive with genomic (Nextgen) DNA sequencing. When comparing the NextGen results with anaerobic standard cultures, there was a calculated negative predictive value of 85.6% and positive predictive value of 28.6%. Sensitivity of the NextGen was 41.4% and specificity was 77.1%. Bacterial culture rates did not significantly change from the beginning to the end of surgery as demonstrated on standard culturing and the NextGen analysis (P >.05). After treatment with hydrogen peroxide, the standard culturing technique showed no significant difference between the samples; however, there was a significant increase in bacterial burden (12.4%) noted with NextGen analysis (P =.0147). NextGen culturing is a novel technique to help identify shoulder prosthetic joint infections. These results show that, NextGen is better at identifying the absence of infection, but has a high false positive rate indicative of its ability to identify contaminants as compared to standard anaerobic culturing methods. The increase in bacterial burden after peroxide treatment noted with NextGen could also be secondary to the test's increased ability to identify both living and dead bacterial pathogens. [ABSTRACT FROM AUTHOR]

Objective: Hypertension is the most important risk factor for cardiovascular morbidity and mortality. There is limited data on hypertension prevalence in India. This study was conducted to estimate the prevalence of hypertension among Indian adults. Methods: A national level survey was conducted with fixed one-day blood pressure measurement camps across 24 states and union territories of India. Hypertension was defined as systolic blood pressure (BP) ≥140 mmHg or a diastolic BP ≥90 mmHg or on treatment for hypertension. The prevalence was age- and gender-standardized according to the 2011 census population of India. Results: Blood pressure was recorded for 180,335 participants (33.2% women; mean age 40.6 ± 14.9 years). Among them, 8,898 (4.9%), 99,791 (55.3%), 35,694 (11.9%), 23,084 (12.8%), 9,989 (5.5%), and 2,878 (1.6%) participants were of the age group 18–19, 20–44, 45–54, 55–64, 65–74, and ≥ 75 years, respectively. Overall prevalence of hypertension was 30.7% (95% confidence interval [CI]: 30.5, 30.9) and the prevalence among women was 23.7% (95% CI: 23.3, 24). Prevalence adjusted for 2011 census population and the WHO reference population was 29.7% and 32.8%, respectively. Conclusion: There is a high prevalence of hypertension, with almost one in every three Indian adult affected. Keywords: Hypertension, India, Prevalence

Aims: The prevalence of premature coronary artery disease (CAD) in India is two to three times more than other ethnic groups. Untreated heterozygous familial hypercholesterolemia (FH) is one of the important causes for premature CAD. As the age advances, these patients without treatment have 100 times increased risk of cardiovascular (CV) mortality resulting from myocardial infarction (MI). Recent evidence suggests that one in 250 individuals may be affected by FH (nearly 40 million people globally). It is indicated that the true global prevalence of FH is underestimated. The true prevalence of FH in India remains unknown. Methods: A total of 635 patients with premature CAD were assessed for FH using the Dutch Lipid Clinical Network (DLCN) criteria. Based on scores, patients were diagnosed as definite, probable, possible, or no FH. Other CV risk factors known to cause CAD such as smoking, diabetes mellitus, and hypertension were also recorded. Results: Of total 635 patients, 25 (4%) were diagnosed as definite, 70 (11%) as probable, 238 (37%) as possible, and 302 (48%) without FH, suggesting the prevalence of potential (definite + probable) FH of about 15% in the North Indian population. FH is more common in younger patients, and they have lesser incidence of common CV risk factors such as diabetes, hypertension, and smoking than the younger MI patients without FH (26.32% vs.42.59%; 17.89% vs.29.44%; 22.11% vs.40.74%). Conclusion: FH prevalence is high among patients with premature CAD admitted to a cardiac unit. To detect patients with FH, routine screening with simple criteria such as family history of premature CAD combined with hypercholesterolemia, and a DLCN criteria score >5 may be effectively used. Keywords: Familial hypercholesterolemia, Premature coronary artery disease, Dutch Lipid Clinic Network Criteria, Correction factor, Arcus cornealis

Background: The anterior abdominal defects, especially gastroschisis and omphalocele have high mortality rates in developing countries. Time to intervene has been hypothesized to be associated with morbidity and mortality. The aim was to determine factors affecting mortality in neonates with anterior abdominal wall defects. Methods: This retrospective descriptive study was done at a tertiary pediatric care center. The medical records of patients with a diagnosis of anterior abdominal defects (omphalocele/gastroschisis/umbilical cord hernia) admitted at our center from Jan 2015 to Dec 2019 were retrieved. The demographic and clinical data were studied including age, sex, religion, gestational age, associated anomalies, electrolytes at admission, septic profile, operative details, length of hospital stay, and mortality. The statistical data was fed on a Microsoft Excel worksheet and analysis was done. Results: Thirty-nine (39) neonates were included in the study. M:F ratio was 2:1, with 61.5% belonging to the Hindu religion. The majority had term gestation (87.2%). Birth weight ranged from 1.5 to 4 kg (mean 2.47 ±0.5 kg). Eighteen (18) neonates had gastroschisis, 15 omphalocele major and 6 omphalocele minor, with a median age of presentation at 1 day of life. Time to intervention ranged from 0 to 5 days (interquartile range 1-1.25 days) after admission. Primary closure could be achieved in the majority (66.7%), while ventral hernia was created in 17.9% and the silo was needed in the rest. The mean postoperative length of stay was 9.31 days (±9.85 days) with a survival rate of 38.5%. The mortality rate in gastroschisis and omphaloceles were 61.1% and 38.1% respectively. The significant factors for survival were birth weight, and primary abdominal wall closure. Conclusions: The present study brings out a different clinical profile of anterior abdominal wall defect patients. We recommend early surgery soon after stabilization and primary abdominal wall repair whenever abdominal pressures permit.

Objective: Primary objective was to compare the effects of atorvastatin 40 mg vs 80 mg on LDL-C in Indian patients with atherosclerotic dyslipidemia. Secondary objectives were to compare the effects of atorvastatin 40 mg vs 80 mg on HDL-C and triglycerides and also comparing of side effects (myopathy, hepatotoxicity and new onset diabetes mellitus) of both doses. Method: This Study is A Prospective, randomized, open-label, comparative study. This study was conducted on 240 patients of dyslipidemia (as per ACC/AHA 2013 lipid guidelines) attending the OPD/wards/CCU of department of cardiology, Sir Ganga Ram Hospital. They were randomly divided into 2 groups of 120 each. Group A consisted patients who received Atorvastatin 40 mg daily and Group B Atorvastatin 80 mg daily. The follow up period was 6 months. Results: At 3 and 6 month follow up, Atorvastatin 40 mg leads to mean LDL cholesterol reduction of 47.18 ± 20.81 & 50.03 ± 18.06 respectively. While Atorvastatin 80 mg results in LDL reduction as 50.11 ± 15.85 & 52.30 ± 13.72. The comparison between two doses revealed a non-significant difference (p = .118 & p = .149 respectively).At 6 months of follow up, few patients reported myalgia (2 in group A and 7 in Group B). The difference between groups was significant (p = .045). Although none of our patient had significant elevation of CPK. Conclusion: This study concluded that both doses of atorvastatin (40 & 80 mg) are equally efficacious in improving dyslipidemia but higher dose leads to more incidence of myalgia. Keywords: Atherosclerosis, Atorvastatin, Dyslipidemia, Myalgia

AIM: The objective of the present study was to screen for hearing loss and to document the importance of using Transient Evoked Otoacoustic Emissions as a screening tool for hearing loss. MATERIAL AND METHODS: The descriptive study was conducted during the period August 2012 to July 2014 in a tertiary care health center. A study group consisting of 500 infants were subjected to TEOAE at 24-72 hours after birth. For pass cases no further testing was done. For refer cases repeat TEOAE testing was done at 15-30days, failing which such infant was subjected to Brainstem Evoked Response testing within 3 months to confirm hearing loss. RESULT: Five hundred infants were screened by TEOAE's after 24 hours of birth. 29 infants had refer result for 1st TEOAE hearing screen and for these infants repeat TEOAE screen was done at 15-30 days of age. On repeat TEOAE testing, 1 infant gave refer result. Then 19 infants including 18 high risk babies and 1 well baby were subjected to BERA testing within 3 months. On testing with BERA only 5 infants showed hearing loss. Hence the prevalence of hearing loss of 2 per thousand was detected in well babies and 22.2 per hundred in high risk babies. Hence substantiating the need to develop a method for screening infants for hearing loss. CONCLUSION: Hence the use of Transient Evoked Otoacoustic Emissions as initial screening test provides as easy, cost effective and quick method to detect infants with hearing loss.

AIM: The objective of the present study was to screen for hearing loss and to document the importance of using Transient Evoked Otoacoustic Emissions as a screening tool for hearing loss. MATERIAL AND METHODS: The descriptive study was conducted during the period August 2012 to July 2014 in a tertiary care health center. A study group consisting of 500 infants were subjected to TEOAE at 24-72 hours after birth. For pass cases no further testing was done. For refer cases repeat TEOAE testing was done at 15-30days, failing which such infant was subjected to Brainstem Evoked Response testing within 3 months to confirm hearing loss. RESULT: Five hundred infants were screened by TEOAE's after 24 hours of birth. 29 infants had refer result for 1st TEOAE hearing screen and for these infants repeat TEOAE screen was done at 15-30 days of age. On repeat TEOAE testing, 1 infant gave refer result. Then 19 infants including 18 high risk babies and 1 well baby were subjected to BERA testing within 3 months. On testing with BERA only 5 infants showed hearing loss. Hence the prevalence of hearing loss of 2 per thousand was detected in well babies and 22.2 per hundred in high risk babies. Hence substantiating the need to develop a method for screening infants for hearing loss. CONCLUSION: Hence the use of Transient Evoked Otoacoustic Emissions as initial screening test provides as easy, cost effective and quick method to detect infants with hearing loss.

Aim: We present here experience of a single surgeon with Mitchell′s procedure for correction of epispadias. Materials and Methods: Nine boys (mean age 5½ years, range 9 months to 16 years) underwent Mitchell′s repair in Department of Pediatric Surgery over a period of 5½ (September 1999 to March 2005) for correction of epispadias. Six of these patients had come for the second stage of exstrophy-epispadias repair after primary bladder closure; the other three had incontinent penopubic epispadias. Results: The penis was cosmetically acceptable as regards to size, glans shape and peno-pubic angle in all the patients. However, there was a high incidence of penopubic fistula (44%). These patients with penopubic fistula also required postoperative urethral dilatations, at times repeated. One of the common factors to these subset patients was their younger age when Mitchell′s urethroplasty was performed. Limitations: The series is descriptive in nature, short in numbers and does not provide statistical comparison of Mitchell′s procedure with the previously done procedures. Conclusions: Mitchell′s complete penile disassembly technique for epispadias repair is more acceptable anatomical procedure that results in near-pendulous penis. However, when performed at young age, it is fraught with the complication of penopubic fistula similar to that as seen with Cantwell-Ransley′s procedure. Mitchell′s procedure creates a hypospadiac meatus initially and the meatal advancement is required as for any other distal penile/coronal hypospadias.

Clitoromegaly in pediatric and adolescent age group is usually indicative of a disorder of sexual differentiation. We report a girl child presenting with clitoral enlargement due to an epidermoid cyst. The cyst was excised with complete cosmetic recovery.

Background: To assess the prognosis of surgical neonates at admission and the factors responsible for mortality in neonates.Material and Methods: A prospective study was conducted in a tertiary level hospital over 15 months and various clinical and biochemical parameters were collected and analyzed using STATA® and SPSS®.Results: On multivariate analysis of 165 neonates, early gestational age, respiratory distress and shock at presentation were the factors of poor prognosis in neonates. The factors could be related to poor antenatal care and sepsis acquired before transfer of the baby to the nursery. Conclusion: The improvement in antenatal care and asepsis during transfer and handling the babies is of utmost importance to improve the prognosis of surgical neonates.

International guidelines recommend tailoring the radicality of hysterectomy according to the known preoperative tumor characteristics in patients with early-stage cervical cancer. This study aimed to assess whether increased radicality had an effect on 5-year disease-free survival in patients with early-stage cervical cancer undergoing radical hysterectomy. The secondary aims were 5-year overall survival and pattern of recurrence. This was an international, multicenter, retrospective study from the Surveillance in Cervical CANcer (SCCAN) collaborative cohort. Patients with the International Federation of Gynecology and Obstetrics 2009 stage IB1 and IIA1 who underwent open type B/C1/C2 radical hysterectomy according to Querleu-Morrow classification between January 2007 and December 2016, who did not undergo neoadjuvant chemotherapy and who had negative lymph nodes and free surgical margins at final histology, were included. Descriptive statistics and survival analyses were performed. Patients were stratified according to pathologic tumor diameter. Propensity score match analysis was performed to balance baseline characteristics in patients undergoing nerve-sparing and non–nerve-sparing radical hysterectomy. A total of 1257 patients were included. Of note, 883 patients (70.2%) underwent nerve-sparing radical hysterectomy, and 374 patients (29.8%) underwent non–nerve-sparing radical hysterectomy. Baseline differences between the study groups were found for tumor stage and diameter (higher use of non–nerve-sparing radical hysterectomy for tumors >2 cm or with vaginal involvement; P <.0001). The use of adjuvant therapy in patients undergoing nerve-sparing and non–nerve-sparing radical hysterectomy was 27.3% vs 28.6%, respectively (P =.63). Five-year disease-free survival in patients undergoing nerve-sparing vs non–nerve-sparing radical hysterectomy was 90.1% (95% confidence interval, 87.9–92.2) vs 93.8% (95% confidence interval, 91.1–96.5), respectively (P =.047). Non–nerve-sparing radical hysterectomy was independently associated with better disease-free survival at multivariable analysis performed on the entire cohort (hazard ratio, 0.50; 95% confidence interval, 0.31–0.81; P =.004). Furthermore, 5-year overall survival in patients undergoing nerve-sparing vs non–nerve-sparing radical hysterectomy was 95.7% (95% confidence interval, 94.1–97.2) vs non–nerve-sparing 96.5% (95% confidence interval, 94.3–98.7), respectively (P =.78). In patients with a tumor diameter ≤20 mm, 5-year disease-free survival was 94.7% in nerve-sparing radical hysterectomy vs 96.2% in non–nerve-sparing radical hysterectomy (P =.22). In patients with tumors between 21 and 40 mm, 5-year disease-free survival was 90.3% in non–nerve-sparing radical hysterectomy vs 83.1% in nerve-sparing radical hysterectomy (P =.016) (no significant difference in the rate of adjuvant treatment in this subgroup, P =.47). This was confirmed after propensity match score analysis (balancing the 2 study groups). The pattern of recurrence in the propensity-matched population did not demonstrate any difference (P =.70). For tumors ≤20 mm, no survival difference was found with more radical hysterectomy. For tumors between 21 and 40 mm, a more radical hysterectomy was associated with improved 5-year disease-free survival. No difference in the pattern of recurrence according to the extent of radicality was observed. Non–nerve-sparing radical hysterectomy was associated with better 5-year disease-free survival than nerve-sparing radical hysterectomy after propensity score match analysis. [ABSTRACT FROM AUTHOR]

1. Brief bistory, clinical features of basal cell carcinoma are described.