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BACKGROUND The treatment of traumatic sternoclavicular joint (SCJ) dislocation (SCJD) with internal fixation has been reported with good short-term results, but data on its long-term results are scarce. METHODS Patients with traumatic SCJD treated with an SCJ-specific plate between January 2003 and January 2018 were evaluated retrospectively. All implants were routinely removed. Data from radiography, the American Shoulder and Elbow Surgeons score, the visual analogue scale and abduction and forward elevation of the shoulder were collected and evaluated before the index surgery, at implant removal and at the latest follow-up. RESULTS A total of 22 patients were included in this study with a mean follow-up period of 94.8 months. All patients maintained good reduction after the index surgery and implant removal. The visual analogue scale significantly improved from 7.1 ± 1.3 before the index surgery to 0.9 ± 1.0 at implant removal (P

Aim of the study: The aim of this study is to report the long-term outcomes of a homogenous series of patients who underwent subtalar arthroereisis (STA) for the treatment of symptomatic flexible flatfoot (FFF). Methods: Thirty-four pediatric patients who underwent STA with a bioabsorbable implant were enrolled and radiographic measurements, clinical outcomes, and patients' satisfaction were evaluated. Results: At a mean 180 months follow-up, radiographic measurements showed significant improvement. A physiological footprint and a proper hindfoot alignment were shown in more than 70% of patients. Mean AOFAS score was 90.4 ± 9.2 (72-100), mean SF-12 was 44.7 with 30 out of 34 patients (88.2%) satisfied with the procedure. Conclusion: STA with a bioabsorbable implant showed satisfactory long-term results. Based on the data subgroup analysis, nine to 11.5 years for female and nine to 13.5 years for male appeared to be the most appropriate age for surgery.

Introduction: The thrust plate prosthesis (TPP) is a type of cementless hip replacement. Aimed to preserve femoral diaphyseal bone, it was favored by some orthopedic surgeons in younger patients as they could potentially undergo multiple revision arthroplasties during their lifetime. Of particular note, the preserved diaphyseal bone allows for the implantation of a subsequent primary total hip arthroplasty (THA). Case Report: We reported on a 64-year-old male patient who underwent thrust plate prosthesis (TPP) implantation 21 years ago (1999) for the treatment of primary osteoarthritis (OA) of the right hip joint. At 21-year follow-up, he had not developed any post-operative complications, and he reported a SF12 score of 32 and Oxford hip score of 47/48. Conclusion: TPP proved to be successful clinically and radiologically, especially in the young patient. It loads directly to the cortex of the proximal femoral metaphysis as in a native hip joint. It is a bone preserving prosthesis which allows for good bone stock in the case of revision surgery that was a victim of commercial considerations. Keywords: Thrust plate prosthesis, thrust plate prosthesis, arthroplasty.

Purpose: We aimed to evaluate the results of Tinnitus Retraining Therapy (TRT) in patients who did not complete the program. Methods: We divided 90 patients who failed to complete the TRT program were into 3 groups: 36 patients who only completed the first phase of the TRT program (Missing group, M), 34 patients who attended counselling for less than 6 months (Noncompliant group, NC) and 20 patients who attended counselling for more than 6 months but did not complete the TRT program (Compliant group, C). The Tinnitus Handicap Inventory (THI), tinnitus Visual Analogue Scales (VAS) and a questionnaire regarding the reasons for dropout were obtained through a telephone survey. Results: Telephonic THI and VAS scores were significantly lower than the initial scores in the M and C groups but not in the NC group. Patients who were unsure about the effectiveness of TRT were prevalent in the NC group, and the poorest long-term THI results were registered in those patients. Conclusions: A fundamental cause of very poor TRT results was when patients were unsure about TRT. On the other hand, a single counselling session could be effective in reducing tinnitus annoyance in patients who accepted the TRT approach and trusted its efficacy.

Introduction The elderly population candidate for total hip arthroplasty (THA) is increasing exponentially in developed countries, due to the high prevalence of osteoarthritis (OA). The objective is to identify the overall survival in patients over 85 years with primary OA who underwent THA. Material and Methods Retrospective observational study in patients over 85 years with primary hip OA performing a THA between 2012 and 2019. Demographic, clinical, comorbidity, complications, functionality and pain variables were collected. A descriptive analysis was performed and survival was estimated with the Kaplan-Meier method and the differences in pain and functionality before and after surgery with the McNemar-Bowker test. Results We included 66 patients, 40 women and 26 men with a mean age of 87.22 years, of whom 15 had high comorbidity (Charlson> 2). Only 14 patients presented complications in the postoperative period, the most frequent was the confusional syndrome (5); and the most serious one, a death (1), with a median of admission of 8 days. Two cases of dislocation were detected during a mean follow-up of 3.61 years, without requiring revision surgery. Improvement of pain was evident after surgery (p Conclusions With good patient selection, TCA is a good option for those patients over 85 years of age with functional limitations or pain due to OA.

Objective: This study aims the treatment results of broad pectus excavatum after a long-term follow-up and skeletal maturity. Methods: Eighty-four children and adolescents with broad-type pectus excavatum were selected for evaluation after treatment with a dynamic orthosis that applies compression to the lower rib projections and prescription of exercises. The broad pectus excavatum was defined as a deformity that the depressed area was greater and covered the area above and below the nipple line. All patients were evaluated for more than 1 year after the end of treatment and skeletal maturity. Post-treatment results were categorized as mild, moderate and severe. Statistic correlations between results and deformity flexibility, deformity severity, and adherence to treatment were assessed. Results: The mean age at the beginning of treatment was 13.3 years, and the follow-up duration was 25.7 months after suspension of orthosis use. Forty-eight percent of patients showed good results. With regular use of orthoses and performance of exercises, this rate increased to 70% (p < 0,001). Mild cases showed more success than severe cases (p = 0,007). Initial flexibility didn’t influence the results (p = 0,63). Conclusion: Treatment of broad pectus excavatum with orthoses and exercises led to good definitive results in most resilient patients, especially in those with mild deformities. Level of Evidence V, Expert Opinion. RESUMO Objetivo: Estudar os resultados de longo prazo e com seguimento até a maturidade esquelética do tratamento do pectus excavatum amplo. Métodos: 84 crianças e adolescentes foram tratados com uma órtese que aplicacompressão nas saliências costais inferiores, associada a exercícios específicos. A deformidade foi classificada como ampla quando a depressão tem maior extensão e abrange uma área acima e abaixo da linha mamilar. Os resultados foram categorizados em ruim, regular ou bom, sendo correlacionados estatisticamente com a flexibilidade, a gravidade da deformidade e a adesão ao tratamento, com avaliação um ano após o fim do tratamento e na maturidade esquelética. Resultados: A idade média no início do tratamento foi de 13,7 anos e o seguimento médio foi de 25.7 meses após a suspensão do uso da órtese. 48% dos casos apresentaram sucesso com o tratamento, mas quando os exercícios e o uso da órtese foram regulares, esta taxa aumentou para 70% (p < 0,001). Os casos mais leves tiveram maior sucesso que os de maior gravidade (p = 0,007), mas a flexibilidade inicial não influenciou os resultados (p = 0,63). Conclusão: O tratamento do pectus excavatum amplo com o uso de órtese e exercícios apresentou bons resultados definitivos na maioria dos pacientes resilientes, em especial nos casos mais leves. Nível de Evidência V, Opinião do Especialista.

Aim: To analyze results of proposed reverse transosal suture. Materials: 264 cases (187 patients; 143 men, 44 women, age between 5 to 75 y. o.) of tendon fixation to distal phalanx by proposed technique was accepted in our research, after two stages flexor tendon grafting, in 2008—2019. On 2nd day after surgery - early full amplitude movement rehabilitation protocol (modification of Kleinart technique) was applied. Results: In an interim analysis of 109 patients treatment results, we noted complications associated with a transossal tendon suture to distal phalanx in 7.5 % (8/159) of cases: infectious complication — 1 case, serious nail growth disorders — 1, slight deformation of the nail plate — 5 cases, periodic pain in distant period — 1 case. To avoid complications associated with nail plate disorders, suture technique was modified by displacing the transcutaneous canal to the side of the nail germinal zone without incision on the back of the finger. No deformation of the nail plate was observed after changing of suture technique. Conclusions: flexor digitorum profundus tendon fixation technique minimizes trauma to surrounding tissues. Strong internal fixation of the tendon gives the possibility of early movements. Intermediate material analysis made it possible to change the suture technique to effectively eliminate the most common complications.

Objectives: To evaluate the early and late outcomes of the modified Bentall procedure with the flanged technique. Methods: We reviewed the medical records of 63 patients who had undergone root replacement by the modified Bentall procedure at our institute between January 2001 and December 2018. In most cases, we adopted a composite graft constructed with a mechanical valve or bioprosthesis and a Dacron graft by the flanged technique. Since 2011, we have used Valsalva grafts. Results: Mean age 57 ± 16 years, range 16-80, male 43 cases. The mean follow-up was 75 ± 56 months (range 0-216). Through April 1, 2020, we could follow up on 61 cases (97%) within a six-month period. Hospital mortality was 7.9% (4.8% in elective cases). In late follow-up, eight deaths were observed. In the bio-Bentall group (n=26), no deaths or major adverse valve-related events (MARVEs) occurred. In the mechanical Bentall group (n=37), seven cases of MARVEs, including two cerebral hemorrhages and one cerebral embolism, were observed. All patients were free from MARVEs at 5 years post procedure in the bio-Bentall group, and 93.8% and 76.8% were event-free at 5 years and 10 years, respectively, in the mechanical Bentall group. Conclusions: The 18-year results of the modified Bentall procedure were acceptable, providing excellent outcomes in the bio-Bentall group. The flanged technique enabled the use of a larger prosthesis, which may have resulted in good durability with the bio-Bentall procedure.

Introduction: The aim of this study was to evaluate long-term safety and efficacy of the suprapubic arc (SPARC) procedure for the surgical treatment of stress urinary incontinence (SUI). Materials and Methods: 139 female patients treated by SPARC were included in this retrospective analysis, whereby 126 patients were available for follow-up after 1 year, 70 after 6 years, and 41 after 9 years. The cough test, pad test, uroflowmetry, and post-void residual volume measurements were performed. Severity of bother (visual analogous scale [VAS] 0–10), continence, and the satisfaction rate were assessed. Objective cure was defined as a negative cough test and pad weight ≤1 g, subjective cure as no urine loss during daily activities and no usage of pads. The VAS, pad weight, number of pads per day, and maximal flow rate were compared preoperatively and postoperatively. Results: Objective cure rates at 1, 6, and 9 years were 78.6, 71.4, and 70.7% and subjective cure rates were 72.2, 55.7, and 65.8%, respectively. The VAS, pad weight, number of pads, and maximal flow rate decreased significantly. Study limitations include a relatively small sample size and the retrospective fashion of the analysis. Conclusions: In the long-term context, SPARC showed to represent an efficient and safe procedure for treatment of female SUI.

We analyze the condition of 28 patients who underwent internal-and-transosseous metal osteosynthesis of the femoral neck. We use clinical, radiological and functional research methods for the examination. In clinical research methods, the main attention was paid to the patient's gait, pain syndrome, which was evaluated both during physical exertion and at rest. The radiological methods of the study assessed the signs of consolidation of bone fragments, the presence of bone trabeculae, which, without interruption, pass from the neck to the femoral head. In case of pain in the hip joint, a computed tomography was performed with the measurement of the length of the hip neck, which was compared with the length of the hip neck of the healthy side. The congruence of the articular surfaces and the articular gap of the hip joint were studied. Functional studies were carried out using the systems for assessing the state of the hip joint of Luboshitz–Mattis–Schwarzberg and W.H. Harris. The follow-up period ranged from 1 to 7 years. The obtained studies allowed an objective assessment of the long-term results of metal osteosynthesis of femoral neck fractures with an original fixator. A positive assessment of the long-term results of osteosynthesis of the femoral neck allows us to recommend using this fixator in clinical practice.

Several techniques designed to improve long-term results after repair of tetralogy of Fallot are described. We have recently embarked on a program focused on preserving the native pulmonary valve. Here, combined techniques are described in detail, including intraoperative pulmonary valve balloon dilatation, pulmonary valve reconstruction by delamination and resuspension of the leaflets, and pulmonary valve annulus augmentation. As with any other complex congenital heart disease, senior surgeons should select teaching cases, starting from the less severe side of the spectrum.

Introduction: In the randomized “Toddler Turner” study, girls who received growth hormone (GH) starting at ages 9 months to 4 years (early-treated [ET] group) had marked catch-up growth and were 1.6 ± 0.6 SD taller than untreated (early-untreated [EUT]) control girls after 2 years. However, whether the early catch-up growth would result in greater near-adult height (NAH) was unknown. Therefore, this extension study examined the long-term effects of toddler-age GH treatment on height, pubertal development, and safety parameters. Methods: Toddler Turner study participants were invited to enroll in a 10-year observational extension study for annual assessments of growth, pubertal status, and safety during long-term GH treatment to NAH for both ET and EUT groups. Results: The ET group was taller than the EUT group at all time points from preschool to maturity and was significantly taller at the onset of puberty (p = 0.016), however, the difference was not significant at NAH. For the full cohort (ET + EUT combined, n = 50) mean (± SD) NAH was 151.2 ± 7.1 cm at age 15.0 ± 1.3 years. NAH standard deviation score (SDS) was within the normal range (>−2.0) for 76% of ET and 60% of EUT subjects (68% overall) and correlated strongly with height SDS at GH start (r = 0.78; p < 0.01), which in turn had a modest inverse correlation with age at GH start (i.e., height SDS declined with increasing age in untreated girls [r = −0.30; p = 0.016]). No new safety concerns arose. Conclusion: Although the ET group was taller throughout, height SDS at NAH was not significantly different between groups due to catch-down growth of ET girls during lapses in GH treatment after the Toddler study and similar long-term GH exposure overall. Early initiation of GH by age 6 years, followed by uninterrupted treatment during childhood, can prevent ongoing growth failure and enable attainment of height within the normal range during childhood, adolescence, and adulthood.

Amaç: Bu çalışmanın amacı diyabetik olgularda akut koroner sendrom (AKS) sırasında koroner arter baypas greft (KABG) ve Perkütan koroner girişim (PKG) (yeni nesil ilaç salınımlı stentlerle) uygulanmasının sonuçları arasındakifarkı belirlemekti.Gereç ve Yöntem: Tek merkezde 2 yıllık dönemde AKS ile başvuran 405 diyabetik hastayı retrospektif olarak değerlendirdik. Hastalar 5 yıl boyunca takip edildi. Tüm nedenlerle ilişkili ölüm, kardiyak ölüm, miyokard enfarktüsü, inme, revaskülarizasyon ve stent trombozu gibi tüm klinik olaylar buna göre kaydedildi.Bulgular: AKS'li 1643 hastanın 405'i diyabetli hastayı inceledik. Bunlardan 183'ü (% 45.1) PKG grubuna, 222'si (% 54.8) KABG grubuna dahil edildi. 5 yıllık takip sırasında, PKG grubunda 31 hastada (% 16.9) ve KABG grubunda 33 hastada (% 14.9) ölüm, MI ve inme gibi primer son noktalar gözlendi. İki grup arasında primer sonlanım noktaları arasında fark yoktu. 5 yıl boyunca tüm neden mortalite PKGI grubunda 17 hastada (% 9.8), KABG grubunda 20 hastada (% 9.1) gözlendi. Sonuç: 5 yıllık takip sırasında PKG ve KABG grupları arasında tüm nedenlere bağlı mortalite açısından fark yoktu. Tekrarlanan revaskülarizasyon ve miyokard enfarktüsü, PKG grubunda KABG grubuna göre daha yüksekti. Buna karşılık inme oranları KABG grubunda daha yüksekti., Purpose: The aim of this study was to determine the difference between patients undergoing coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) (with new generation drug-eluting stents) who had diabetes mellitus during the course of an acute coronary syndrome (ACS).Materials and Methods: We carried out a retrospective evaluation of 405 diabetic patients admitted with an ACS during the period of 2 years in a single-center. Patients were followed for 5 years. All clinical incidents, such as death, cardiac death, myocardial infarction, stroke, revascularization, and stent thrombosis were recordedResults: We examined 405 patients with diabetes out of 1643 patients with ACS. Of these, 183 (45.1%) were included in the PCI group and 222 (54.8%) were in the CABG group. During 5-years follow-up, primary endpoints including death, MI, and stroke were observed in 31 patients (16.9%) in the PCI group and in 33 patients (14.9%) in the CABG group. There was no difference between the two groups in terms of primary endpoints. All-cause mortality during 5-years was observed in 17 patients (9.8%) in the PCI, 20 (9.1%) in the CABG group. Conclusion: There was no difference in all-cause mortality between the PCI and the CABG groups during 5-year follow-up. Repeated revascularization and myocardial infarction were higher in the PCI group and the stroke rates were higher in the CABG group.

The purpose: prospective study of the long-term refractive and visual results of ReLEx® SMILE, depending on the degree of corrected myopia.Material and methods. The three study groups included 71 patients; the mean age was 26.48 ± 5.5 years. Group I consisted of 20 patients (39 eyes) mean SE –2.62 ± 0.87 D, group II — 26 patients (51 eyes), mean SE 4.68 ± 0.74 D, Group III — 25 patients (47 eyes), mean SE 6.88 ± 0.72 D. All patients underwent femtolaser correction of myopia using the ReLEx® SMILE method with the VisuMax™ laser system (Carl Zeiss Meditec AG).Results. Uncorrected visual acuity of 09 — 1.0 was noted in 34 eyes (87.2 %) in group I, in II — in 43 eyes (84.3 %), in 37 eyes (78.7 %) in group III. The efficiency coefficient was 1.0 in groups I — II and 0.89 in group III. There was no decrease in corrected visual acuity (CVA) during the correction of mild and moderate myopia, in group III it was recorded by 0.1 in two cases (4 %), by 0.2 in one case (2 %), the safety factor in I — II groups 1.0, in III 0,89. Two years after ReLEx® SMILE, refraction of ± 0.5 D from planned in the study groups was achieved, respectively, in 94.9, 88.2, 76.6 % of cases, ± 1.0 D in 100 % of cases in I, II groups, in 97 % of cases in III group. The predictability coefficient was 0.95 in group I, 0.88 in group II, and 0.77 in group III. Refractive regression compared with the results 1 month postoperatively was 0.08 D in group I, 0.1 D in group II, and 0.16 D in group III. Analysis of the long-term results of ReLEx® SMILE allows us to conclude: the method is safe and effective, provides high predictability of refractive results in correcting various degrees of myopia. Further study of the long-term results of the operation, the creation and use of nomograms, taking into account the individual characteristics of the cornea, will improve the predictability and stability of refractive results in the correction of high myopia.

The article presents the history of development and improvement of various methods of surgical treatment of patients with tumor lesions of the pelvic bones, as well as modern types of operations in this category of patients. Based on the analysis of literature data of domestic and foreign sources are considered possible complications and their causes, summarizes the surgical and oncologic results of the most relevant studies devoted to this subject.

Background:. Although endovascular therapy has been widely used for focal aortoiliac occlusive disease (AIOD), its performance for extensive AIOD (EAIOD) is not fully evaluated. We aimed to demonstrate the long-term results of EAIOD treated by endovascular therapy and to identify the potential risk factors for the loss of primary patency. Methods:. Between January 2008 and June 2018, patients with a clinical diagnosis of the 2007 TransAtlantic Inter-Society Consensus II (TASC II) C and D AIOD lesions who underwent endovascular treatment in our institution were enrolled. Demographic, diagnosis, procedure characteristics, and follow-up information were reviewed. Univariate analysis was used to identify the correlation between the variables and the primary patency. A multivariate logistic regression model was used to identify the independent risk factors associated with primary patency. Five- and 10-year primary and secondary patency, as well as survival rates, were calculated by Kaplan-Meier analysis. Results:. A total of 148 patients underwent endovascular treatment in our center. Of these, 39.2% were classified as having TASC II C lesions and 60.8% as having TASC II D lesions. The technical success rate was 88.5%. The mean follow-up time was 79.2 ± 29.2 months. Primary and secondary patency was 82.1% and 89.4% at 5 years, and 74.8% and 83.1% at 10 years, respectively. The 5-year survival rate was 84.2%. Compared with patients without loss of primary patency, patients with this condition showed significant differences in age, TASC II classification, infrainguinal lesions, critical limb ischemia (CLI), and smoking. Multivariate logistic regression analysis showed age

Purpose Prominent ear is common in the White population at a rate of 5%. Many surgical incision and suture techniques have been described for its correction. The purpose of this article was to report the results of the prominent ear surgeries applied in our clinic for the last 5 years and to show the details of the surgical technique, to evaluate long-term results, complications, revisions and to compare them with previously published studies. Materials and methods A total of 27 patients were included in the study. The patient age ranged from 7 to 60 at the time of surgery (mean age: 18.7). Of the 27 patients, 13 were female (48.2%) and 14 were male (51.8%). The procedure was bilateral in 19 cases (70.4%) and unilateral in 8 cases (29.6%). The patients were treated with the same technique by three surgeons. Aesthetic results were evaluated by patient and surgeon surveys. Results The follow-up was between 1 and 5 years (mean: 3 years). The patients very satisfied with the overall appearance of the ears, and the symmetry of the ears was rated as excellent by all patients, parents, and surgeons. Conclusion Regardless of the technique used, patient satisfaction appears to be high. To reduce negative results and prevent recurrence, the authors recommend that the ear is preoperatively evaluated and the treatment algorithm is used accordingly.

Gracilis neuromuscular transplant is considered the gold standard for facial animation in Moebius syndrome patients. However, long-term evaluation of the results has not been critically examined in the international literature. Thus, it remains unknown how the transplanted flap changes with facial growth, and whether contraction (smiling) is maintained. Pediatric patients with Moebius syndrome who underwent facial animation surgery with at least 5 years of follow-up were retrospectively examined. Photographs taken at the 1-year and most recent follow-up visits were analyzed and compared using Emotrics software. Analyses focused on the rest position, and on gentle and maximum smiles. Eighteen patients were enrolled. Seven patients had bilateral and 11 unilateral Moebius syndrome; therefore, 25 gracilis transplants were analyzed. The latest follow-ups ranged from 5 to 13.2 years (mean 7.6 years). The three principal facial expressions that were examined did not differ significantly between 1 year and a mean of 7.6 years after surgery, but tended to improve in most patients. Commissure excursion and smile angle for the maximum smile did improve significantly (p = 0.002 and 0.029, respectively). The series examined in this study supports the limited literature regarding the long-term stability of gracilis transplantation to animate the faces of Moebius syndrome children.

The Ross procedure has been considered in children as an optimal surgical procedure due to potential growth of the aortic annulus, lack of anticoagulation requirement, very low morbidity rate and excellent survival. Five-hundred-thirty-six (366 male, mean age 29.4 ± 11.1 years) underwent Ross procedure between 1990 and 2016 and had complete clinical and echocardiographic follow-up. Mean follow-up was 16.3 ± 4.9 years. Patients were divided in 2 groups according to age at surgery. Group 1 consisted of 320 (60%) patients less than 18 years old (223 male, mean age at surgery of 9.5 ± 5.6 years). Group 2 consisted of 216 (40%) patients older than 18 years of age (143 male, mean age at surgery of 26.3 ± 8.2 years). One-hundred-thirty (24%) patients had a redo procedure or surgery. Freedom from all re-operation and or percutaneous reintervention on either the aortic and pulmonary valves was 99% after 1 year, 94% after 5 years, 89% after 10 years, 83% after 15 years and 78% after 20 years. Freedom from redo surgery for AV 99% after 1 year, 94% after 5 years, 90% after 10 years, 81% after 15 years and 80% after 20 years. Freedom from redo surgery for PV was 100% after 1 year, 95% after 5 years, 89% after 10 years, 78% after 15 years and 76% after 20 years. The ideal candidate for Ross operation is a patient with congenital aetiology and an aortic root diameter ≤ 15 mm/m2. A pulmonary fresh preserved homograft seems to perform better on the long term.

Selection criteria to propose neoadjuvant (re)chemoradiation (CHRT) in locally recurrent rectal cancer (LRRC) are required, since re-irradiation is sometimes associated to severe adverse effects. Aim of the present study was to compare chances of R0 surgery and disease-free survival (DFS) in LRRC patients (pts) treated by neoadjuvant (re)CHRT followed by surgery vs. upfront surgery, stratifying pts by each localization of LRRC.LRRC pts treated at the National Cancer Institute of Milan (Italy) were retrospectively divided into two groups: neoadjuvant (re)CHRT vs. upfront surgery. According to our Milan classification, LRRC were categorized as S1, if located centrally (S1a-b) or anteriorly (S1c) within the pelvis; S2, in case of sacral involvement; S3, in case of lateral pelvic wall infiltration.152 pts were candidate for multimodal treatment: 49 (32.2%) by neoadjuvant (re)CHRT and surgery, including 33 re-irradiations, vs. 103 (67.8%) by upfront surgery. No difference was observed in R0 resection rates (respectively 47.6% vs. 51.0%). However, neoadjuvant (re)CHRT followed by surgery improved the DFS (p = 0.028), also in R1 procedures (p = 0.013), compared with upfront surgery. At multivariate analysis, the R+ surgery (p 0.0001) strongly predicted unfavorable DFS, while neoadjuvant (re)CHRT followed by surgery was independently associated to better DFS (p = 0.0197). Stratifying by LRRC localization, the combined approach significantly improved DFS in the S1c (p = 0.029) and S2 (p = 0.004) subgroups compared to upfront surgery, but not in S1a-b and S3 pts.Anterior (S1c) and sacral-invasive (S2) pelvic recurrences significantly benefit in terms of DFS by combination of neoadjuvant (re)CHRT and radical surgery, also after R1 resection.

Outcomes of 37 patients of foramen magnum meningioma (FMM) were evaluated, and the related literature was reviewed to determine the efficacy of Gamma Knife radiosurgery (GKRS) for treating patients with FMM. We present the largest series reported from a single institution with the longest follow-up to date. The database of patients who underwent GKRS for FMM between 2007 and 2019 was evaluated retrospectively. A total of 37 patients with radiological and pathological features consistent with FMM were included in this series. Thirty-three patients were female, and 4 were male. The median age was 58 years (range, 23–74 years). The most common symptom at diagnosis was headache (64.9%). Twelve patients had a history of microsurgical resection. The median duration from the initial onset of symptoms to GKRS was 12 months (range 1–140 months). Among the 37 tumors, eight (21.6%) were located ventrally, 24 (64.9%) laterally, and five (13.5%) dorsally. The median target volume was 3.30 cm3 (range, 0.6–17.6 cm3). Thirty-five patients (95%) were treated with single fraction GKRS, and two patients (5%) were treated with hypofractionated GKRS. The median clinical follow-up was 80 months (range, 18–151 months), while the median radiological follow-up was 84 months (range, 18–144 months). At the last clinical follow-up after GKRS, 27 patients (73%) had improved symptoms, and none had worsened pre-GKRS symptoms. At the last radiological follow-up after GKRS, 23 tumors (62.2%) remained stable, 13 (35.1%) decreased in size, and 1 (2.7%) increased in size. Tumor control, including stable and regressed tumors, was achieved in 97.3% of patients. Our cohort demonstrates that GKRS is an effective and safe treatment for patients with either primary or recurrent/residual FMM.

Purpose/Aim of the study: Graft detachment after DMEK can be treated easily with an additional air injection – re-bubbling. The aim of our study was to investigate the effect of a re-bubbling on th...

Background. Predicting the immediate and long-term results of treatment is an urgent problem of modern medicine. The prognosis of complex dental treatment is influenced by many factors. Among the main ones: features of the individual's anatomy and physiology, the type and method of the chosen treatment, the doctor's qualification, features of the patient's psychological profile, the presence of concomitant pathology, and so on. Each of the factors must be considered separately to understand the mechanism and the strength of its impact. Relevance. Finding out the influence of diseases of the hepatobiliary system on the prognosis of dental orthopedic treatment. Objectives. We studied the indicators of patients who re-applied for replacement of an existing dental prosthesis. The study group consisted of patients with liver and biliary tract diseases, and the control group consisted of patients without concomitant General somatic pathology. The terms of use of the prosthesis, the number and severity of treatment complications, and the state of the prosthetic bed were evaluated. Standard clinical and paraclinical diagnostic methods, corresponding pathology, cone-beam computed tomography and statistical analysis methods were used as research methods. Results. The correlation of the terms of use of various types of dentures with the presence of liver and biliary tract diseases in the anamnesis was determined. The dependence of the structure of bone tissue and its density on the presence of the considered pathology was revealed. Conclusion. The obtained data can be applied by orthopedic dentists in the near and long-term prognosis of the result of treatment of patients with partial loss of teeth and concomitant diseases of the hepatobiliary system.

Introduction The authors report long-term outcomes in patients who received neoadjuvant chemoradiotherapy and consequently underwent hybrid oesophagectomy for oesophageal cancer (OC). Aim To evaluate long-term outcomes in patients suffering from OC, who underwent hybrid oesophagectomy. Material and methods Our cohort consisted of patients suffering from OC, who received neoadjuvant chemoradiotherapy. Hybrid esophagectomy was performed 8-10 weeks after oncological treatment. Results Ninety-four patients underwent surgery for OC from 2011 to 2015. Histology revealed adenocarcinoma in 60.6%, squamous cell carcinoma (SCC) in 36.2%, and other type of cancer in 3.2%. Seventy-three (77.7%) patients with advanced stage (T3-4, N0-2, M0) were indicated to receive neoadjuvant chemoradiotherapy (nCRT). Trans-hiatal hybrid oesophagectomy was performed in 83 (88.3%) patients. Transthoracic hybrid oesophagectomy was performed in 11 (11.7%) patients. Histology of the resected specimens of 18 (24.7%) patients did not reveal OC, i.e. pathological complete response (pCR). In our cohort, we proved an association between occurrence of pCR and age as well as disease-free survival (DFS). The patients who presented with pCR were significantly younger - below 60 years of age (p = 0.017). They also showed significantly higher mean DFS (p = 0.004). Conclusions Combined oesophagectomy with neoadjuvant chemoradiotherapy results in a better long-term outcome in patients suffering from oesophageal cancer. In our set of patients who underwent hybrid esophagectomy, satisfactory short-term and especially long-term results of surgical treatment for oesophageal cancer were observed.

Introduction: The study aims to evaluate the long-term results of patients who underwent laparoscopic gastrectomy for gastric cancer in Ankara University Medical Faculty, Surgical Oncology Clinic, within 5 years. Materials and Methods: We retrospectively reviewed the data of patients who underwent laparoscopic gastrectomy for gastric cancer at the Surgical Oncology Clinic of Ankara University Medical Faculty between January 2014 and September 2019. One hundred forty-six patients were included in the study. Results: Fifty-one (34.9%) of the patients were female; 95 (65.1%) were male. The mean ± standard deviation and median (minimum–maximum) values of the patients were 60.92 ± 14.13 and 64.00 (22.00–93.00), respectively (Table 1). Eighty-seven (59.6%) cases were located in the antrum, 29 (19.9%) were in the cardia region, and 30 (20.5%) were in the corpus region. Overall, 106 (72.6%) of 146 patients were alive, while 40 (27.4%) were ex. The mean survival was 21.8 months (0–69). Postoperative mortality was seen in 9 patients (6.2%) and our disease-free survival rate was 70.5%. Recurrence occurred in 14 (9.6%) of all patients. Table 1. Patient Characteristics Variables Age Mean ± SD 60.92 ± 14.13 Median (min.–max.) 64.00 (22.00–93.00) Albumin Mean ± SD 3.90 ± 0.51 Median (min.–max.) 4.00 (2.50–5.01) Met lymph count Mean ± SD 8.41 ± 7.05 Median (min.–max.) 6.00 (1.00–40.00) Total lymph count Mean ± SD 23.09 ± 8.97 Median (min.–max.) 22.00 (4.00–52.00) Survival Mean ± SD 21.83 ± 17.40 Median (min.–max.) 17.50 (0.10–69.00) Gender, n (%) Man 95 (65.1) Woman 51 (34.9) Morbidity, n (%) No 117 (80.1) Yes 29 (19.9) TM location, n (%) Antrum 87 (59.6) Cardia 39 (19.9) Corpus 30 (20.5) Operation, n (%) Subtotal 103 (70.5) Total 43 (29.5) Anastomosis, n (%) Open 6 (4.1) Intracorporeal 54 (37.0) Mini-laparotomy 86 (58.9) Sur comp, n (%) No 131 (89.7) Yes 15 (10.3) T, n (%) 1 32 (21.9) 2 18 (12.3) 3 55 (37.7) 4 41 (28.1) N, n (%) Negative 68 (46.6) Positive 78 (53.4) Mortality, n (%) No 106 (72.6) Yes 40 (27.4) Recurrence, n (%) No 132 (90.4) Yes 14 (9.6) Conclusion: In conclusion, although laparoscopic gastrectomy is a reliable and feasible method for gastric cancer, the standardization of laparoscopic surgery is required in clinics.

Aim. Analysis of hospital and long-term results of carotid endarterectomy (CEA) in different periods of acute cerebrovascular event (ACVE). Materials and Methods . The given study was retrospective and was conducted using the method of patients sampling. In the period from 2010 to 2019, 1113 patients with ACVE in history who were later conducted CEA, were selected. Depending on the time interval between the last ACVE and CAE, all the patients were divided into 4 groups: the 1 st group – in the acutest period of ACVE (1-3 days) (n=24; 2.2%); the 2 nd group – in the acute period of ACVE (up to 28 days) (n=493; 44.3%); the 3 rd group – in the early rehabilitation period of ACVE (up to 6 months) (n=481; 43.2%); the 4 th group – in the late rehabilitation period of ACVE (up to 2 years) (n=115; 10.3%). The long-term period was 34.8±12.5 months. Results . In the hospitalization period of observation the following complications were found: lethal outcome ((group 1 – 0%; group 2 – 0.4% (n=2); group 3 – 0.2% (n=1); group 4 – 0%; р=0.16)); myocardial infarction ((group 1 – 0%; group 2 – 0.4% (n=2); group 3 – 0%; group 4 – 0.9% (n=1); р=0.35)); ACVE/transient ischemic attack (TIA), ((group 1 – 4.2% (n=1); group 2 – 0.4% (n=2); group 3 – 0.2% (n=1); group 4 – 0%; р 1-2 =0.01; р 1-3 =0.009; р 1-4 =0.01)). By the end of hospitalization period the composite endpoint consisting of lethal outcome + myocardial infarction + ACVE/TIA made in group 1 – 4.2% (n=1), in group 2 – 1.2% (n=6), in group 3 – 0.4% (n=2), in group 4 – 2.6% (n=3), р=0.08. Complications of the long-term follow-up period were: lethal outcome from all causes ((group 1 – 25% (n=6); group 2 – 5.5% (n=27); group 3 – 7.3% (n=35); group 4 – 14% (n=16); р 1-2 =0.002; р 1-3 =0.008; р 2-4 =0.012)); lethal outcome from cardiovascular causes ((group 1 – 4.2% (n=1); group 2 – 3.6% (n=18); group 3 – 4.8% (n=23); group 4 – 5.2% (n=6); р=0.79)), myocardial infarction ((group 1 – 12.5% (n=3); group 2 – 3.6% (n=18); group 3 – 5.4% (n=26); group 4 – 6.1% (n=7); р=0.15)), ACVE/TIA ((group 1 – 16.6% (n=4); group 2 – 6.3% (n=31); group 3 – 6% (n=29); group 4 – 11.3% (n=13); р=0.05)); composite endpoint including lethal outcome + myocardial infarction + ACVE/TIA ((group 1 – 54.2% (n=13); group 2 – 15.4% (n=76); group 3 – 18.7% (n=90); group 4 – 31.3% (n=36); р 1-2 =0.0001; р 1-3 =0.0001; р 1-4 =0.005; р 2-4 =0.0006; р 3-4 =0.012)). Conclusion. Application of CEA demonstrated effectiveness and safety in the acute and early rehabilitation period of ACVE.

The clinical observation the results of combined treatment of a patient with locally advanced rectal cancer complicated by bleeding with the use of selective chemooil embolization of the superior rectal artery have been presented (1 figure, bibliography: 4 refs).

To evaluate long-term real-life results of dasatinib therapy among chronic phase chronic myeloid leukemia patients resistant or intolerant to imatinib, we retrospectively analyzed data of 118 patients treated in centers participating in the database INFINITY. With median follow-up of 37 months, estimated 5-year cumulative incidences of complete cytogenetic and major molecular responses were 78% and 68%, respectively. The estimated 5-year probability of overall survival (OS) and event-free survival (EFS) were 86% and 83%, respectively. Both OS and EFS were significantly improved among patients with

Purpose Hypoxic tumor volumes can be visualized with 18F-FAZA PET/CT. In head and neck squamous cell carcinoma (HNSCC), hypoxia is important for the clinical outcome after primary radiotherapy (RT). The outcome is furthermore heavily influenced by the HPV/p16-positivity of oropharyngeal tumors (OPCp16+ tumors). The study purposes were (1) to report on locoregional failures within five years after primary RT in a prospective cohort stratified by both HPV/p16-status and PET hypoxia and (2) to characterize the failure site and the spatial association to PET hypoxia. Material and methods From 2009 to 2011, 38 patients with non-metastatic SCC of the larynx, oro-, hypo- and nasopharynx completing primary RT were included in the prospective DAHANCA 24 trial (NCT01017224). Fifteen patients had OPCp16+ tumors. All were imaged with a static FAZA PET/CT prior to treatment. The hypoxia threshold was determined by a tumor-to-muscle ratio (TMR) of 1.6. Recurrences were documented histologically. Imaging of the recurrence was deformable fused with the pre-treatment FAZA PET/CT. The spatial information of recurrence- and hypoxic volumes were compared visually. Results Sixteen patients had more hypoxic tumors (high tracer uptake, TMR ≥1.6) before treatment (42%). With a median follow-up of 7.8 years, nine locoregional recurrences were observed, of which seven were in patients with high-uptake tumors (44% and 9%, respectively, HR 5.8 [1.2–28.2]). The risk of locoregional recurrence was highest among patients with more hypoxic, non-OPCp16+ tumors (57% [21–94%]), with a risk difference of 45% [4–86%], when comparing to less hypoxic, non-OPCp16+ tumors. Eight patients had sufficient imaging of the recurrence for co-registration with the FAZA PET/CT. Six had hypoxic primary tumors, and in two, the recurrence was overlapping the baseline hypoxic subvolume. Conclusion HNSCC demonstrating a TMR ≥1.6 at baseline is significantly associated with treatment failure after primary RT. In addition to HPV/p16-status, FAZA PET/CT has potential for the selection of tumors requiring treatment intensification.

Dental implants have been in used as a successful mode of rehabilitation of lost dentition for over three decades. Science and techniques have undergone significant progress with time and clinical situations that were deemed unfit for insertion of dental implants due to lack of sufficient bone are now being treated using implants with predictable long term results. Clinicians can now rehabilitate the posterior maxilla with a wide variety of implant-based solutions. There are complications associated with this procedure which may be attributed to diagnostics or the surgical protocol itself and a multitude of management approaches have been suggested in the literature. This report elucidates one such case of management of a large perforation in the Schnederian membrane during elevation using a staged approach.