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Background: Our aim was to compare the bowel function and oncologic outcomes following these two treatment modalities.Materials and methods: This was a single-center study with 67 patients included between 2009 and 2018. A total of 32 patients underwent total mesorectal excision (TME) group and 35 transanal local excisions (LE) ± chemoradiation. We performed a case-matched analysis: we matched the patients by age, cancer stage, and comorbidities. Duration of operation, postoperative complications, length of hospital stay, and long-term functional and oncological outcomes were compared. We calculated oncological outcomes using Kaplan–Meier Cox diagrams. In addition, we used a low anterior resection syndrome (LARS) score for the bowel function assessment.Results: Mean operation time in the LE group was 58.8 ± 45 min compared with the TME group that was 121.1 ± 42 min (p = 0.032). Complications were seen in 5.7% in LE group and 15.62% in TME group (p = 0.043). ~85.2% of the patients had no LARS in LE group compared with 54.5% in TME group (p = 0.018). Minor LARS was 7.4% in LE group compared with 31.8% in TME group (p = 0.018); major LARS was 7.4 and 13.7%, respectively (p = 0.474). Hospital stay was 2.77 days in LE group compared with 9.21 days in TME group (p = 0.036). The overall survival was 68.78 months in LE group compared with 74.81 months in TME group (p = 0.964).Conclusion: Our results of a small sample size showed that local excision ± chemoradiation is a rather safe method for early rectal cancer compared with gold standard treatment. In addition, better bowel function is preserved with less postoperative complications and shorter hospital stays.

Actinic keratoses (AK) are common lesions of the skin caused by cumulative sun exposure. Since AK may progress to invasive cutaneous squamous cell carcinoma (cSCC), guidelines uniformly recommend early and consequent treatment. A variety of interventions are available; however, most randomized controlled trials, meta-analyses, and guidelines focus on outcomes that are usually evaluated 8–12 weeks after the end of treatment. Importantly, these assessments can capture the short-term, transient outcomes, but do not allow any conclusions about long-term results to be drawn and do not reflect the probability of transition towards cSCC. Until now, few studies have assessed the long-term results of interventions for AK. Indeed, finding the most appropriate end-point and adjunct time point for determining the long-term results of interventions for AK remains a challenge. Here, we provide an overview of the different ways of measuring the efficacy of AK treatments, such as using recurrence rates or sustained clearance rates, and discuss methodological aspects. Furthermore, we highlight the importance of evidence from post-marketing surveillance trials for the detection of efficacy values and safety signals. Additionally, we emphasize that a follow-up period of 12 months might not be sufficient to reflect the long-term results and stress the urgent need for a longer follow-up period and regular risk-stratified surveillance.

In contrast to well-published data with acceptable long-term results in large cohorts of single renal transplant recipients aged >65 y (lit.), combined pancreas-kidney transplantation in recipients >50 y is discussed controversially. Some groups have identified older recipients as a high-risk group, demonstrating decreased patient and graft survival in this population.1-4 Nevertheless, several centers have reported results for pancreatic transplantation in older patients as being comparable to those for younger recipients with the age cutoff ranging from 50 to 60 y.5-10 At our center, we have long-term experience with a total of 655 pancreas transplants performed between 1979 and August 2020, whereby 21 recipients were over 60 y of age; the oldest was age 69 and in remarkably good general condition with good mental adherence and a strong wish to undergo simultaneous kidney-pancreas transplantation (SPK). We retrospectively analyzed patient, pancreas, and kidney graft survival, graft function, and complications at month 38 posttransplant.

Background The role and the indications for using off-pump coronary artery bypass surgery (OPCAB), instead of the traditional on-pump (ONCAB), is still to be addressed. Aim To describe our centre experience and to compare 15-years survival and early safety outcomes between OPCAB and ONCAB. Methods Single-centre retrospective cohort including 9-years of isolated first CABG (2005–2013). Multi-vessel disease with at least 2 surgical grafts patients were considered and the first 50 surgeries of each surgeon with each technique were excluded to account for the learning curve effect. Emergent surgeries and on-pump beating heart procedures were also excluded. A propensity-score matching (PSM) analysis was performed to balance groups and both survival and early outcomes comparison was done within the matched cohort using Kaplan-Meier or Cox stratified and paired tests, respectively. The median follow-up was 9 years, maximum 15 years. Results From 3012 multi-vessel patients with at least 2 surgical grafts, 2503 were included at the main analysis: 1487 ONCAB and 1016 OPCAB. ONCAB patients presented more frequently 3-vessels disease and left ventricular dysfunction, but received similar number of grafts than OPCAB, who in turn, received more frequently multiple arterial grafts. The surgical completeness of revascularization (CR) was similar, but hybrid procedures were more frequent in OPCAB raising CR rate in this group. After PSM (646 pairs), both groups were similar regarding pre and peri-operative characteristics. The long-term survival was similar (HR stratified by pair: 1.02 (0.81–1.30), but OPCAB evidenced benefits at early term results including bleeding, postoperative atrial fibrillation and stroke incidence. Conclusion At our centre, OPCAB performed by experienced surgeons provides rates of complete revascularization and long-term survival similar to ONCAB. In-hospital results favoured OPCAB. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Universidade do Porto/FMUP; Social European Fund; FCT-Fundação para a Ciência e a Tecnologia

Background Recent publications suggest that bioabsorbable vascular scaffolds (BVS) carry an excess of thrombotic complications. Our goal was to describe the results in real life and in the long term, in a series of patients who received a BVS which is currently off the market. Methods Two hundred and thirteen consecutive patients who received at least 1 BVS between May 2012 and December 2016 were analyzed. The primary objective was the incidence of the compound event “target vessel failure” that included infarction or target vessel revascularization and cardiac death. Results Seventy-five percent of patients were men with a mean age of 61.4 years. They had a high prevalence of dyslipidemia (62.44%) and smoking (65.26%). The most common cause of admission was myocardial infarction without ST elevation (53.52%). A total of 233 coronary lesions were treated, with an average of 1.3±0.3 lesions per patient. The implant was successful in 99.5% of cases. Predilatation was performed in 89.3% and post dilation in 33.5% of cases. The use of intracoronary imaging (Optical Coherence Tomography OCT and/or Intravascular ultrasonography IVUS) to optimize the BVS implant was performed in 86 patients (40.38%). With a mean follow-up of 42.5 months, the incidence of target vessel failure was 6.57% during the first 24 months and 7.98% at the end of the follow-up. Regarding the device, this included 6 cases (2.81%) of thrombosis (definitive, probable or possible) and 10 cases (4.69%) of restenosis. Patients with a history of diabetes mellitus (HR 1.72 95% CI 1.01–2.95 P=0,05) and/or chronic oral anticoagulation (HR 5.71 95% CI 1.12–28.94 P=0.04) had a higher risk of target vessel failure. The use of intracoronary imaging (OCT and/or IVUS) during the BVS implantation had a considerable trend toward significance as a protective factor (HR 0.32 95% CI 0.11–1.03 P=0.06). Conclusions In this series of patients; in real life conditions, the incidence of target vessel failure was comparable to that previously described in randomized clinical trials. The events were more frequent during the first 2 years of follow-up, in the presence of greater cardiovascular comorbidity and in the absence of intracoronary imaging during the implantation. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): European Society of Cardiology KM curve for target vessel failure (TVF)Predictor analysis for TVF

This retrospective study analyses long-term outcomes of reconstruction for congenital thumb hypoplasia Grades 2 and 3 A. In 22 thumbs (mean follow-up 9 years), instability of the metacarpophalangeal joint was found in 20 thumbs regardless of the method of reconstruction, double breasting of local tissue with or without adductor pollicis advancement or use of a slip of flexor digitorum superficialis to supplement local tissue. There was a trend towards a greater global strength, higher Kapandji score and better subjective function score when the abductor digiti minimi was used as an opposition transfer as compared with the flexor digitorum superficialis. Results for motion and subjective parameters were consistent with comparable studies though these comparisons are compromised by different methods of classification and assessment. Consistent application of an expanded Blauth grading system and a formal hypoplastic thumb score will improve the ability to compare pre- and postoperative status, different techniques and results from different centres. Level of evidence: IV

Objective This study aims to compare the efficacy, safety, and long-term outcomes of two flow diverters, i.e., pipeline embolization device and flow re-direction endoluminal device, in the treatment of distal carotid aneurysms. Methods A total of 138 patients with 175 aneurysms were included from February 2012 to September 2019. Ninety-nine aneurysms were treated with flow re-direction endoluminal device and 76 with pipeline embolization device. Angiographic follow-ups were at the 6th, 12th, 24th, 36th, and 60th months; the O’Kelly-Marotta grading scale was used to assess aneurysms occlusion. Outcomes of two devices were compared; possible associations regarding patient characteristics, aneurysm properties, treatment details, and adverse events were evaluated. Results The mean follow-up period was 33 months, with 10 patients lost to follow-up. Occlusion rates at the 6th and 12th months and during the last follow-up were similar for flow re-direction endoluminal device (81%, 84%, and 90%) and pipeline embolization device (82%, 85%, and 93%). Occlusion rates were also similar after stand-alone use without coiling. There was no significant difference regarding adverse event rates with a 10.9% overall complication rate, 3.6% mortality, and 0.7% permanent morbidity. All the mortality and morbidity were related to hemorrhagic complications. Device deployment failure was observed with five flow re-direction endoluminal devices and two pipeline embolization devices, whereas two severe in-stent stenoses occurred with each device. Conclusions Both flow re-direction endoluminal device and pipeline embolization device are feasible and effective in flow diversion of distal internal carotid artery aneurysms, with similar adverse events rates and aneurysm occlusion success. Aneurysm occlusion rates increase with time, while the presence of an integrated branch significantly decreases treatment success.

In this study, we aimed to compare clinical efficacy of laparoscopic surgery and open surgery for colorectal cancer in the Huaihe River Basin in China. A total of 92 patients with colorectal cancer were selected as subjects. Patients were divided into control group (open surgery, n = 27 cases) and test group (laparoscopic surgery, n = 28 cases). Our results showed that the duration of operation (122.54 ± 14.85) min and length of incision (4.51 ± 1.065) cm were shorter in the experimental group than those in the control group. The intraoperative blood loss of the experimental group was (161.12 ± 10.694) ml, which was less than that of the control group (218.53 ± 15.369) ml (P < 0.05). Patients in the experimental group have higher Five-year survival rate and lower incidence of postoperative complications than those in the control group (all P < 0.05). In conclusion, in the treatment of colorectal cancer, laparoscopic surgery has a better clinical effect than open surgery, which is worthy of clinical application.

INTRODUCTION Microsurgical treatment of VBSA is complex and challenging due to the deep location of the vessels and the proximity of important structures. Therefore, minimally invasive endovascular techniques have been introduced to the treatment of VBSA. The aim of this study was to present long-term results and technical aspects of VBSA embolisation. In this manuscript, we describe our experience in the treatment of VBSA with long-term results. Furthermore, we discuss the advantages and disadvantages of this treatment modality, paying special attention to the technical aspects. We believe that this is an important contribution to this topic because the number of previous reports is limited. It adds to a population that can be compared to patients treated using different methods. MATERIALS AND METHODS We analysed the medical records of patients with aneurysms of vertebral and basilar arteries referred for endovascular treatment between 2015 and 2020. RESULTS A total of 44 patients were selected for the study. From this group, 10 patients (22.7%) were admitted with SAH caused by ruptured VBSA. The median age of the patients was 58 years (31-80), with 27 (61.4%) females and 17 (38.6%) males. The majority of the VBSAs (35, 79.5%) were located on the basilar artery. Complete occlusion was achieved in 39 patients (88.6%). Procedural complications occurred in three cases (6.8%). In long-term follow-up, complete embolisation was achieved in 81.8% (36 of 44 patients). In 18.2% (eight patients), recurrence of VBSA was observed. Two patients were qualified for recoiling. Clinical follow-up was uneventful in 37 (84%) patients. Four patients (9%) reported mild headaches. Three (7%) patients required assistance for daily living. CONCLUSIONS Endovascular embolisation of VBSA is feasible and provides an excellent rate of complete occlusion and a high rate of favourable long-term outcomes, which support using this technique as a first-line treatment. A relatively high rate of recurrence remains the major drawback, especially in cases of wide-neck VBSA.

Esophagectomy still represents a challenge surgical procedure. Anastomotic leakage is the most feared complication and is likely related to diminished anastomotic perfusion. ‘Supercharged’ microvascular anastomosis has been performed in select patients to supplement the blood supply to the graft and anastomosis, after esophagectomy. This study aimed to evaluate results after performing the supercharged cervical anastomosis for esophagectomy procedure. Methods This prospective cohort study evaluated patients who underwent esophagectomy with gastric reconstruction and cervical anastomosis for locally advanced esophageal carcinoma. Patients were selected in which cervical anastomosis using the supercharged cervical anastomosis for esophagectomy procedure was performed. The anastomotic perfusion areas were evaluated using indocyanine and SPY before and after supercharged cervical anastomosis for esophagectomy. Post esophagectomy complications were also recorded. Results The study enrolled 61 patients, which included 47 (77.0%) men, with a mean age of 67.3 years. Median additional surgical time was 112 min (IQ 90–180), Leakage occurred in 1.6% of the patients (microanastomosis thrombosis), whereas the corresponding anastomotic stricture rates were 3.2% (mean follow-up was 25 mounths). Perfusion analyses showed a 28% improvement in the anastomotic area after venous anastomosis and a 37% improvement after arterial and venous anastomosis. Conclusion The supercharged cervical anastomosis for esophagectomy procedure may be related to low occurrence of anastomotic leakage and improve perfusion in the anastomotic area via vein and arterial microanastomoses.

PurposePerianal Buschke-Löwenstein tumor (BLT) is characterized by an exophytic cauliflower-like mass surrounding the perianal region. Its tendency to infiltrate the adjacent tissues, its massiveness, and its high recurrence rate cause difficulties in treatment. The aim of this study is to report our strategy with wide local excision and flap reconstruction for BLT.MethodsFrom November 2002 to June 2019, 11 patients (9 males) with a mean age of 33.45 years (range, 19–54 years) were operated on for BLT. All patients underwent wide local excision and V-Y flap reconstruction, supplemented with other flaps whenever needed. No additional modalities were used.ResultsTwo patients had a history of anal intercourse while all patients were human immunodeficiency virus-negative. The mean tumor length was 15.54 ± 1.34 cm (range, 10–26 cm). Human papillomavirus 6 was the most common type identified. Partial wound dehiscence developed in 3 patients, while anal stenosis, mucosal ectropion, or local recurrence was not observed during the mean follow-up period of 50.45 ± 1.75 months (range, 10–196 months).ConclusionIn patients with perianal BLT, wide local excision and flap reconstruction result in a high healing rate without significant complications.

Microwave energy technology treats axillary hyperhidrosis through thermolysis of the apocrine and eccrine glands. Successful short-term reduction of sweating has been studied, but there is limited information on long-term efficacy and safety. To evaluate patient satisfaction with microwave energy device for axillary hyperhidrosis performed within the last 5 years. From June to August 2019, a standardized telephone survey was conducted of 24 patients who received microwave energy device treatment for bilateral axillary hyperhidrosis between June 2014 and June 2018. Demographic information, previous treatment modalities, sweat reduction scores, and side effects were reported. Eighteen patients completed the survey with a mean follow-up of 38 months (range 12-52). The mean hyperhidrosis disease severity scale (HDSS) was reduced by 1.6 (95% CI 1.2-2.0, p

Background: Over the past decade, conversion to Reverse Total Shoulder Arthroplasty (RTSA) has become the preferred treatment for revision of an Anatomic Hemi (HA) or Total Shoulder Arthroplasty (TSA). However, conversion of failed stemmed shoulder arthroplasty to RTSA is still a highly demanding procedure and carries unique technical challenges and risks. Questions/Purposes: This study aimed to analyze the mid- to long-term results after conversion of failed anatomical shoulder arthroplasty to RTSA and investigate whether preserving the humeral stem offers advantages over revising the humeral stem. Materials and Methods: Between 2005 and 2018, 99 hemiarthroplasties and 62 total shoulder arthroplasties (total =161 shoulders; 157 patients) were revised to RTSA without (n=47) or with (n=114) stem exchange. Complications and revisions were documented from medical and surgical records. Longitudinal pre- and post-operative clinical (Constant-Murley (CS) score, Subjective Shoulder Value (SSV)), and radiographic outcomes were assessed. Complete clinical and radiographic follow-up was available on 80% of shoulders (127 patients; 128 of 161 procedures, 46 without and 82 with stem exchange) at a minimum of 24 months and a mean of 70 months (range, 24 to 184 months). Results: Humeral stem retention was associated with a significantly reduced surgical time (193 min vs. 227 min, p=0.001, less blood loss (591 mL vs. 753 mL, p=0.037), less intraoperative complications (13% vs. 19%; Odds Ratio (OR), 1.4, p=0.32) and fewer subsequent reinterventions (19% vs. 28%; OR, 2.3, p=0.06). The complication/revision rate leading to drop out from the study was considerable in the stem revision group (ten patients; ten of 114 shoulders (9%)), but there were no complication-related dropouts in the stem-retaining group. Conclusion: Our findings suggest that humeral stem revision is associated with decreased surgical time, less blood loss, less intra- and postoperative complications, and a lower revision rate compared to humeral stem retention. Based on these findings, a shoulder arthroplasty system modularity offers substantial benefit if conversion to reverse total shoulder arthroplasty becomes necessary. Level of Evidence: Level III, therapeutic study.

AIM To report on the feasibility, efficacy and long-term outcome of transcatheter closure of fenestrated Atrial Septal Aneurysm (ASA). METHODS Between April 2000 and May 2020, 568 patients with fenestrated ASA underwent transcatheter closure at two large-volume Pediatric Cardiology and GUCH Units (Naples and Massa, Italy). Procedural indications were cardiac volume overload in 223 patients (39%) or prophylaxis of paradoxical embolization in 345 patients (61%). Patients' median age and weight were 42 years (range 19-52) and 66 kg (range 54-79), respectively. One-hundred and thirty-nine patients (25%) were younger than 18 years. RESULTS Single fenestration was found in 311 patients (55%) (Group 1), whereas 257 patients (45%) had multifenestrated ASA (Group 2). The procedure was successful in all but seven patients (1.2%). In Group 1, closure was achieved with a single device. In Group 2, one device was used in 168 patients (67%), two devices in 74 patients (28%), three devices in 12 patients (5%), and four devices in 1 patient (0.3%). The early complication rate was 3%, without any difference according to anatomy or patient's age. At discharge, complete shunt closure was higher in Group 1 (92% vs. 72%, P

Congenital breast asymmetry represents a particular challenge to the classical techniques of plastic surgery due to a young group of patients. This study compares traditional breast augmentation using silicone implants to the more innovative lipograft technique regarding long-term results. To achieve this, we not only captured subjective parameters like satisfaction with outcome and symmetry, but also objective parameters such as breast volume and anthropometric measurements. Objective examination was performed manually and by using the Vectra® H2 photogrammetry scanning system. Patients who underwent implant augmentation and lipograft both showed no significant differences in patient´s satisfaction with surgical outcome (p = 0.55) and symmetry (p = 0.69). Furthermore, a breast symmetry of 93 % in both groups was reported. Likewise, no statistically significant volume difference between left and right breast was observed in both groups (p

This study aims to analyze the challenges, approaches and long-term results of primary or metachronous prostate cancer (PCa) in cases with multiple primary genitourinary cancers.A total of 17 patients were included in the study. Patients with multiple primary genitourinary cancers were divided into two groups according to the diagnosis of primary or metachronous PCa as group 1 and group 2.The median age of patients was similar in both groups. The median smoking status (pack-years) was higher in group 2 than group 1. The median prostate-specific antigen (PSA) level was higher in group 1 than group 2. The median follow-up time from primary to the metachronous tumour was higher in group 1 than group 2. The rate of recurrence in PCa was higher in group 1 than group 2. No statistically significant difference was observed in terms of patients' age, smoking status, PSA levels at diagnosis of PCa and biochemical recurrence or metastasis between the two groups (Primary PCa cases may progress more aggressively than metachronous PCa cases. Biochemical recurrence and metastasis may be less threatening in metachronous PCa cases than primary cases. Therefore, aggressive treatment can be avoided for metachronous PCa cases.

Background: Hemi-resurfacing arthroplasty (Hemi) and metal-on-metal hip resurfacing arthroplasty (HRA) are alternatives to conventional total hip arthroplasty (THA) for patients with osteonecrosis of the femoral head (ONFH). Mid- to long-term results were evaluated.Methods: Twenty-three hips with osteonecrosis of the femoral head were treated, using Hemi in 12 and HRA in 11. Mean follow-up was 13.8 years in the Hemi group and 8.7 years in the HRA group. Mid- to long-term clinical scores, radiographic results, and survivorship were reviewed retrospectively.Results: In the Hemi group, 8 hips were revised to THA due to migration. In the HRA group, 1 hip was revised due to adverse local tissue reaction. No evidence of any femoral loosening or neck narrowing was seen in either group. Clinical score was superior with HRA compared to Hemi. Ten-year survival rates were 64.2% and 90.9% in the Hemi and HRA groups, respectively. Survival rate in the Hemi group dropped to 22.0% at 14 years.Conclusion: Hemi did not represent a better alternative to THA for patients with ONFH. HRA could offer attractive indications for 10 years.

Purpose is to study the long-term results of patients with cicatricial stenosis of the larynx treated with use lyophilized xenodermoimplants for postoperative wound plasty.The results of treatment of 34 patients (age from 32 to 56 years) with cicatricial stenosis of the larynx were analyzed. A fundamentally new method of surgical treatment of such patients has been developed and introduced into practice, in which lyophilized xenodermoimplants were used for plasty of the wound surface.The proposed technique made it possible in the immediate postoperative period to obtain a good result in 28 (82.4%) patients, satisfactory - in 6 (17.6%). The length of hospital stay was reduced by 8-10 days. In the long-term period (after 6-11 years), 27 patients were examined. Of these, 21 (77.8%) obtained a good result, and 6 (22.2%) - satisfactory.The proposed method of surgical rehabilitation of the respiratory function of the larynx with its cicatricial stenosis using lyophilized xenodermoimplants is quite effective and can be proposed for use in clinical practice.Изучить возможность применения лиофилизированных ксенодермоимплантатов для пластики послеоперационной раны при хирургическом лечении больных с рубцовым стенозом гортани на основании оценки отдаленных результатов лечения.Проанализированы результаты лечения 34 больных (возраст — от 32 до 56 лет) с рубцовым стенозом гортани. Разработан и внедрен в практику принципиально новый способ хирургического лечения таких больных, при котором для пластики раневой поверхности использовали лиофилизированные ксенодермоимплантаты.Предложенная методика позволила в ближайшем послеоперационном периоде получить хороший результат у 28 (82,4%) больных, удовлетворительный результат — у 6 (17,6%) больных. Длительность пребывания в стационаре сократилась на 8—10 сут. В отдаленном периоде (через 6—11 лет) обследованы 27 пациентов. Из них у 21 (77,8%) пациента получен хороший результат, а у 6 (22,2%) пациентов — удовлетворительный результат.Предложенная нами методика хирургической реабилитации дыхательной функции гортани при ее рубцовом стенозе с применением лиофилизированных ксенодермоимплантатов достаточно эффективна и может быть рекомендована для использования в клинической практике.

BACKGROUND: The increasing number of THAs in younger patients will inevitably result in an increase of revision procedures. However, there is little evidence about the outcome of revision procedures in this patient group. Therefore, we updated a previous study conducted 5 years ago about the outcome of revision procedures in patients younger than 55 years. QUESTIONS/PURPOSES: We sought to provide a concise update on the previously reported (1) long-term failure rate as defined by repeat revision, (2) clinical outcome as defined by the Oxford Hip score and the Harris Hip score, and (3) radiographic outcome of cemented revision THA performed with impaction bone grafting on both the acetabular and femoral sides in one surgery in patients younger than 55 years old. METHODS: Between 1991 and 2007, we performed 86 complete THA revisions in patients younger than 55 years. In 38% (33 of 86) of revisions, bone impaction grafting was used on both the acetabular and femoral side because of acetabular and femoral bone stock loss. Mean age at time of revision was 46 ± 8 years. No patient was lost to follow-up, but six patients died during follow-up, including three since 2015. Still, the hips of all 33 patients were included in analysis at a mean of 17 ± 5 years. Failure was calculated using competing risk analysis. For clinical outcome, we assessed the Harris Hip score and the Oxford Hip score from our longitudinally maintained institutional database. Radiographic analysis was performed to evaluate radiographic loosening, defined as radiolucencies ≥ 2 mm in all zones or ≥ 5 mm migration for both components. The acetabular component was also considered loose with tilting ≥ 5° RESULTS: The 15-year failure rate of revision THA was 27% (95% CI 13 to 44) for re-revision of any component for any reason and 10% (95% CI 3 to 25) for re-revision of any component for aseptic loosening. The mean Harris Hip score increased from 55 ± 18 preoperatively to 74 ± 22 at latest follow-up. Eight cups were considered radiographically loose, seven of which were re-revised. No stems were considered radiographically loose. Failure rate with endpoint radiographic loosening at 15 years was 23% (95% CI 10 to 39). CONCLUSION: We found that impaction bone grafting with a cemented cup and a cemented stem is a valuable biological revision technique that results in a stable and durable solution, after one or even multiple previous revision THAs. Although current implants may prove sufficient in most cases, they do not promote bone stock preservation. We believe that in young patients with bone stock loss, impaction bone grafting can be used as long as the defect can be contained adequately with a metal mesh and viable bone bed is available for revascularization. LEVEL OF EVIDENCE: Level IV, therapeutic study.

The objective: to study the long-term results of organ-preserving surgeries when removing cystic kidney tumors of category III – VI according to Bosniak.Materials and methods. The study was carried out with the participation of 16 patients with verified cystic renal tumors of the category III – VI according to Bosniak. Indications for surgery were: clinical manifestations, laboratory, ultrasound, Doppler and radiation methods (MSCT with bolus contrast or MRI). The diagnosis of renal tumor process was also confirmed using histological and histochemical research methods.Results. Long-term studies after 18 and 36 months showed no signs of recurrence of cysts or tumor process in the kidneys. Signs of a tumor process in the lymph nodes or in other organs during these periods of the study were also not found. Removal of cysts and tumors in the long term after surgery leads to a significant improvement in blood circulation in the kidneys.Conclusion. Organ-preserving resection of a part of the kidney affected by Bosniak category III–VI cystic tumors is a modern effective method of treatment and should be an alternative to surgical removal of affected kidneys in such patients.

Background. Currently, the issue of effective conservative treatment of constipation in cases of colon developmental abnormalities remains open. Aim: to study the immediate and long-term results of the treatment of chronic constipation in case of colon development abnormalities, through individualization of the physiotherapeutic methods used, depending on the type of pathology. Methods. The article presents the experience of treatment in the Department of Internal Medicine of the Lugansk Republican Clinical Hospital, from 2013 to the present, of 389 patients with chronic constipation in colon developmental abnormalities. We used types of electrical stimulation, different in the method of applying electrodes and the stimulating current parameters. In the work, we used the serial apparatus Endoton 01-B. We evaluated the immediate and long-term results of treatment in the period from 6 months to 3 years. Results. After 34 courses of rectal electrostimulation of patients with compensated and subcompensated forms of the disease, for 67 months, 346 (88.95%) patients had regular independent defecation with an interval of 2436 hours. The remaining 43 (11.05%) patients with subcompensated and decompensated forms of the disease received 56 courses of rectal electrical stimulation during the year. A persistent positive effect was obtained, namely independent defecation with an interval of 3648 hours. Conclusion. Rectal electrical stimulation for this pathology is considered the method of choice. The functional immediate and long-term results of rehabilitation of patients confirmed the correctness of the approach chosen.

Purpose. To study long-term results of combined surgery for glaucoma and cataract by trabeculotomy ab interno. Material and Methods. 62 patients (64 eyes) with combination of glaucoma and cataract. The age of patients is from 53 to 84 years. The initial stage of glaucoma - 10 eyes, developed - 33 eyes, far-advanced - 21 eyes, level of intraocular pressure (IOP) before surgery in all eyes was intolerant for these stages of glaucoma and ranged from 21 to 36 mmHg. Indications for surgical treatment were absence of persistent IOP level compensation in hypotensive mode, the presence of lens opacification, which affects central visual acuity (VA). Best corrected VA is from 0.01 to 0.6. The technique of combined surgery included: 1st stage - phacoemulsification with implantation of flexible IOL; 2nd stage - trabeculotomy ab interno. The observation period is 18 months. Results. During the observation period of up to 18 months, IOP decreased on average to 20.8±3.1 mmHg. The target level of IOP without an additional antihypertensive regimen remained in 22 eyes (34.37%), with antihypertensive regimen - in 42 eyes (65.63%). In most patients VA increased to 0.2–1.0 and only in 2 cases decreased due to development of posterior capsular fibrosis. Conducting trabeculotomy ab interno has significantly reduced number of drugs used. However, 3-12 months after surgery, IOP increase up to 26-30 mmHg was observed in 4 eyes with antihypertensive drug regimen; microinvasive non-penetrating deep sclerectomy was performed to compensate for it. Conclusion. Trabeculotomy ab interno in combination with phacoemulsification with IOL implantation was effective and safe operation. Sufficient hypotensive effect and high visual functions observe at 18 months observation period.

LONG-TERM RESULTS OF PHARMACOLOGICAL CORRECTION OF INOS, ENOS, NNOS MRNA EXPRESSION DISORDERS IN RAT HIPPOCAMPUS AFTER CHRONIC PRENATAL HYPOXIA

To evaluate the long-term results of focal laser photocoagulation and photodynamic therapy (PDT) for treatment of central serous chorioretinopathy (CSC). Retrospective chart review. Sixty-two patients with CSC, thirty-three of whom were treated with focal laser photocoagulation, and 29 with PDT and who were followed up for > 6 months, were enrolled. The focal laser was performed at sites of focal leakage (but not subfoveal leaks) shown in fluorescein angiography. PDT was performed at sites of subfoveal or juxtafoveal focal leakage or not definite focal leakages. Best corrected visual acuity (BCVA), central macular thickness (CMT), resolution of subretinal fluid (SRF) and recurrence were analyzed. The follow-up duration of the focal laser group was 35.2 ± 22.6 and of the PDT group, 46.4 ± 21.5 months. Time to resolution of SRF was 1.8 ± 1.5 months for the focal laser group and 1.2 ± 0.5 months for the PDT group. SRF was rapidly absorbed in the PDT group. In both groups, the CMT was decreased 1 month after treatment. The BCVA improved significantly 1 month after treatment in the focal laser group and 3 months after treatment in the PDT group. However, there was no significant difference in CMT reduction and BCVA improvement between the two groups. It subsequently remained similar for up to 3 years. Ten patients (30.3%) in the focal laser group and three patients (10%) in the PDT group recurred during the follow-up period. PDT showed early resolution of the SRF compared to focal laser. In CSC patients, both the CMT and BCVA remained stable for 3 years after treatment. After 3 or more years of follow-up, PDT showed a lower recurrence rate than focal laser.

Classical Hodgkin lymphoma (cHL) is considered a curable disease; however, approximately one-third of responders experience disease relapse following first-line therapy. Several studies have shown the efficacy of brentuximab vedotin (BV) in patients with relapsed/refractory HL. We present a retrospective analysis of 58 patients with relapsed/refractory HL treated with BV in a named patient program from 11 centers. The median follow-up duration was 20 (range, 4-84) months. The best overall response rate was 64% (complete response [CR], 31%; partial response [PR], 33%). The 5-year progression-free survival (PFS) and overall survival (OS) rates were 12% (95% confidence interval [CI], 0.05-0.22) and 26% (95% CI, 0.16-0.38), respectively. Among patients who achieved CR, the estimated 5-year PFS and OS rates were 32% (95% CI, 0.13-0.54) and 60% (95% CI, 0.33-0.78), respectively. A total of 26 patients underwent subsequent stem cell transplantation. The 5-year PFS and OS rates for 10 patients who had consolidative stem cell transplantation were 28% and 30%, respectively. Twenty-seven patients required further therapy following BV. At the time of the analysis, 12 patients (21%) were alive. Five patients (9%) had long-term remission after achieving CR with BV monotherapy, with a median PFS of 76 months. Three of them (5%) did not receive any other treatment following BV and their median PFS was 75 months. Our long-term results showed that a small subset of patients with relapsed/refractory cHL may benefit from and even be cured with BV monotherapy.

Resume Introduction Les stenoses des arteres renales (SAR) peuvent etre symptomatiques. Le traitement de ces lesions est en premier lieu medical, mais peut parfois necessiter une revascularisation chirurgicale ou endovasculaire. L’angioplastie des SAR est bien maitrisee, mais ses resultats sont discutes. L’objectif de ce travail etait de rapporter les resultats a court et a long termes du traitement endovasculaire des arteres renales de notre centre. Methodes Nous rapportons une etude retrospective, realisee entre 2013 et 2018, incluant des patients ayant beneficie d’un traitement endovasculaire pour une SAR symptomatique serree (≥75 %). Resultats Notre population comportait 17 patients. L’âge median etait de 57 ± 10 ans, le sex-ratio de 2,4. Le motif de decouverte de la SAR etait une HTA secondaire resistante au traitement medical pour 16 patients et une insuffisance renale rapidement progressive pour un patient. L’etiologie retenue etait : l’atherosclerose (9 cas), la dysplasie fibromusculaire (6 cas) et la maladie de Takayasu (2 cas). Le taux median de stenose etait de 84 ± 8 %. Nous avons realise une angioplastie simple dans 47 % des cas et un stenting dans 53 %. Le taux de succes technique etait de 100 %. A 1 mois, les taux de morbi-mortalite etaient nuls. Le suivi moyen etait de 12 mois [6–36 mois]. Les patients ayant une HTA renovasculaire ont presente une diminution de la pression arterielle, avec arret du traitement antihypertenseur dans 62,5 % des cas et la degression des doses dans 37,5 % des cas. Le taux de permeabilite etait de 100 % a 1 an, de 94 % a 2 ans et de 94 % a 3 ans. Un patient a presente une thrombose de stent asymptomatique au 18e mois. Le taux de restenose etait nul. Conclusion Dans notre cohorte de patients avec SAR toutes causes confondues, associee a une HTA resistante ou une insuffisance renale et pris en charge par angioplastie, nos resultats mettent en evidence un benefice en termes de baisse tensionnelle avec une permeabilite primaire se maintenant sur le moyen terme.

Aim. To study the long-term results of surgical treatment of patients with thyroid adenomas. Methods. From 2004 to 2006, 667 patients with follicular adenomas of the thyroid gland, including 134 (20.1%) men and 533 (79.9%) women, were operated on in the surgical department №2 of city clinical hospital №11 of Ryazan. 3 groups of patients were defined: group 1 operated on for solitary adenomas of the thyroid gland, 103 patients, hemithyreoidectomy performed; group 2 operated on for multiple adenomas of the thyroid in both lobes, 101 patients, thyroidectomy performed; group 3 32 patients operated on for multiple adenomas of the thyroid in the same lobe, hemithyreoidectomy performed. Patients were examined 14 years after the surgery. Results. Hypothyroidism was diagnosed in: group 1 18 (17.5%) patients, group 2 101 (100%), group 3 0. All patients with hypothyroidism were compensated with hormone replacement therapy. Permanent hypoparathyroidism was diagnosed only in group 2 8 (4.8%) patients. Unilateral laryngeal paralysis was found in group 1 in 1 (0.9%) patient, group 2 in 2 (1.9%) patients, group 3 contained no such patients. Recurrence (node more than 1 cm according to ultrasound) was observed in group 1 in 12 (11.7%) patients; fine-needle aspiration found colloidal nodes in 8 (7.8%) patients (Bethesda II), in 4 (3.9%) follicular tumor (IV). Group 2 had no recurrences. In group 3 11 (34.3%) patients had recurrence; fine-needle aspiration found colloidal nodes in 1 (3.1%) patient (Bethesda II), in 10 (31.3%) follicular tumor (Bethesda IV). Conclusion. In solitary adenomas it is possible to perform organ-saving operations, which reduces the percentage of postoperative complications; in multiple adenomas, the optimal volume of surgery is thyroidectomy; when multiple adenomas are localized in one lobe, the chance of recurrence of the disease (31.3%) is high leading to re-surgery.

Objectives:Diabetic patients have a risk of developing diabetic ulcers up to 25% during their lifetime. Some of these diabetic foot ulcers result in amputation during the follow-up period. The amputated limb materials are not always referred for pathological evaluation. However, malignancy can be seen in these materials. In this study, pathology materials of patients who were amputated for diabetic foot ulcers were evaluated.Materials and Methods:Six hundred and eighty patients who underwent amputation and 688 amputation materials between January 2007 and July 2019 for diabetic foot ulcers were included in the study. From 171 out of 680 patients, 174 amputation materials were sent for pathological examination due to clinical suspicion. The demographic and clinical characteristics of these patients were analysed retrospectively through the hospital information management platform.Results:Malignancy was detected in four (2.3%) of 171 patients. Two of these patients were female and two were male. The mean age was 64.2±10.7 years. The age of chronic ulcers was 122, 245, 187, and 158 months in these patients, respectively. Ulcer was localized on the toe of three patients; one was localized in the heel region. Three patients had squamous cell carcinoma and one patient had malignant melanoma. No patient was in metastatic stage at the time of diagnosis. Patients are still alive and have been followed in medical oncology for a mean of 72±38 months without local recurrence and distant metastasis.Conclusion:Although the development of malignant lesions on the basis of diabetic wound is rare, squamous cell carcinoma, and more rarely, malignant melanoma and basal cell carcinoma may develop. Therefore, amputation materials should be sent to pathological evaluation in all patients who underwent amputation due to diabetic ulcer; even in the presence of excessive granulation or atypical appearance in diabetic ulcers without amputation, a biopsy of the ulcer should be performed and followed up for malignancy.

INTRODUCTION[|]The present study aims to compare the long-term efficacy and safety results of intravitreal ranibizumab (RAN), dexamethasone intravitreal implant (DEX) and intravitreal triamcinolone acetonide (IVTA) injections in macular edema due to branch retinal vein occlusion (BRVO).[¤]METHODS[|]In this retrospective study, one eye each of 43 patients who were treated with intravitreal injections for macular edema secondary to BRVO was recruited into one of the study groups: RAN group (n=17), DEX group (n=16) and IVTA group (n=10). All patients were followed-up for 12 months. Best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT) and intraocular pressure (IOP) at month 1, 3, 6, and 12 were compared with baseline.[¤]RESULTS[|]The BCVA increased significantly in the RAN and DEX groups at all visits (all p

The majority of patients with degenerative mitral regurgitation (DMR) are amenable to reconstructive procedures. There is debate regarding factors that influence long-term durability with respect to repair technique, valve remodelling and progressive myxomatous change.A total of 685 patients with DMR underwent mitral valve repair by a single surgeon between 1991 and 2011 with follow-up completed at 31 December 2016. Repair rate for patients undergoing surgery for DMR was over 90%. Mean age was 64 years (18-89) with 66.2% male, 47% NYHA class III-IV, and 20% had permanent atrial fibrillation (PAF). Major associated procedures were performed in 28% of patients (189); including coronary artery bypass graft (CABG) (127), aortic valve replacement (15), aortic root surgery (3) and tricuspid valve annuloplasty (61).Operative mortality (≤30 days) occurred in four patients (0.58%). At 20 years, survival was 58%, freedom from reoperation was 90% and freedom from reoperation and non-operated recurrent MR2+ (relapse) was 78%. Factors influencing survival were advancing age, left ventricular (LV) dysfunction (ejection fraction60% or end systolic dimension40mm), New York Heart Association (NYHA) III-IV and PAF. Predictors of relapse were the degree of residual intraoperative mitral regurgitation (p0.001), anterior leaflet prolapse (p0.001) and the addition of a sliding annuloplasty in isolated posterior leaflet repair (p=0.023). The majority of reoperations were for technical issues related to the original repair. A competent valve at 6 months to 3 years postoperatively predicted an excellent long-term result.The great majority of degenerative mitral valves are repairable regardless of age with excellent long-term results achievable following surgery. Survival is reduced by significant symptoms, LV dysfunction and preoperative PAF. Repair is best performed before these features develop. Durability is largely dependent on the technical performance of the repair and degree of residual MR on the post-pump transoesophageal echocardiogram. We recommend surgery should be performed by surgeons specialising and skilled in mitral valve repair.

We report long-term outcomes in participants in the E-SISTEr (Extended Stress Incontinence Surgical Treatment Efficacy Trial) at 1 tertiary care center who underwent a Burch or a fascial sling procedure for stress urinary incontinence.After receiving institutional review board approval E-SISTEr participants at 1 center who underwent midterm office evaluation in 2010 were further reevaluated at longer term followup by office visits and structured telephone interviews. The telephone interviews were performed by a third party not involved in patient care for those not seen in the last 2 years. Each group received validated questionnaires, including the UDI-6 (Urogenital Distress Inventory-Short Form), the IIQ-7 (Incontinence Impact Questionnaire-Short Form) and the visual analogue quality of life score questionnaire. Failure was measured by Kaplan-Meier curves using time to reoperation for stress urinary incontinence.Of the 29 eligible patients, including 14 treated with a Burch procedure and 15 treated with a sling procedure, 21 had long-term information available, including 11 and 10, respectively. Median followup was 15.1 years (range 11.2 to 16.0). One of the 8 patients was lost to followup, 1 died and 7 were unreachable by telephone. The UDI-6 question 3 score was lower for the 13 patients followed by telephone, including 13 and 7 with a Burch and a sling procedure compared to the 8 seen in clinic, including 5 and 3 with a Burch and a sling procedure, respectively (mean ± SD score 0.3 ± 0.6 vs 1.3 ± 1.1, p=0.0208). The UDI-6 scores were similar for the 2 procedures. Stress urinary incontinence reoperation was performed in 3 cases, including placement of a fascial sling in 1 Burch case. The other 2 cases in the Burch and sling groups received an injectable agent at 11.6 and 13.5 years, respectively. The overall Kaplan-Meier 15-year reoperation-free survival rate was 85.2% (95% CI 60.8-95).In this well characterized cohort with a median followup of 15.1 years there was sustained improvement in continence scores and quality of life related to stress urinary incontinence in each group and the reoperation rate was low.

Introduction: The management of periprosthetic joint infection (PJI) of the hip is a challenging procedure. One-stage exchange is carried out in specialist centres with comparable infection free survival rates. However, there is a paucity of long-term results of this approach in young patients. Methods: All patients undergoing one-stage exchange due to PJI with a known causative organism ⩽45 years of age with a minimum of 10-year follow-up (mean 15 years; range 10–24 years) were enrolled in this retrospective study. Patients older than 45 years of age or patients with a two-stage procedure were excluded from the study. The primary outcome measure was failure rate with special focus on reinfection at latest follow-up. Failure was defined as revision surgery for infection. Furthermore, functional outcome using the Harris Hip Score was determined initially and at latest follow-up. 26 patients fulfilled the inclusion criteria and were available for final follow-up. Results: The study cohort consists of 16 male and 10 female patients with a mean age of 36.8 years (range 20–45 years) and a mean BMI of 29.8 kg/m2 (range 20.7–40.6 kg/m2). Prior to the single-stage procedure, the patients underwent an average of 3.1 previous surgical interventions (range 1–9). The mean hospital stay after septic revision was 19.7 days (11–33 days). Most infections were caused by Staphylococcus epidermidis ( n = 8, 30.8%), followed by Staph. aureus ( n = 7, 26.9%) and Propionibacterium acnes ( n = 6, 23.1%). At latest follow-up, the overall survival rate was 76.9 %, while infection control could be achieved in 96.2%. At final examination, the mean Harris Hip Score improved from 46.2 to 78.9 (range 18.0–99; SD, 22.6). Conclusions: Single-stage revision surgery for the management of PJI in patients ⩽45 years is a successful treatment option with high infection control, even after long-term follow-up.

Background: With estimated prevalence of 1% of the general population, visceral artery aneurysms are not a frequent pathology, however, their rupture is a life-threatening occurrence with mortality rate ranging from 10% to 25%, up to 75% in case of pregnant women. Therefore, the identification and treatment of visceral artery aneurysms is of great importance in the prevention of early rupture. Purpose: To assess the effectiveness and safety of treatment of visceral artery aneurysms with various endovascular methods focusing on technical aspects, complications and long-term clinical outcome. Materials and Methods: 60 patients with visceral artery aneurysms were treated percutaneously. Various techniques were used: coiling (23), covered stents (15), thrombin (7), and other mixed techniques. Aneurysm characteristics, size and localization, procedural data, peri-procedural complications, technical success, 90- and 180-day clinical success and follow-up period (aneurysm exclusion, patency of the artery and complications) were prospectively analyzed. Results: Te procedure was performed in 57 of 60 patients. In 56 of 57 patients aneurysms ware effectively excluded. Te success rate was 93.3% (56 of 60 enrolled patients). Technical success after the intervention was 82.4%, after second 98.2%. Embolization with covered stents ware characterized by highest efficiency. Serious complications occurred in 1.8% of cases. Conclusions. The minimally invasive endovascular treatment of visceral artery aneurysms is characterized by high efficacy and safety. Good treatment results depend on proper assessment of the aneurysm’s morphology as well as on selection of the appropriate vascular approach and endovascular technique.

Background Reconstruction of post-traumatic long bone defects is a formidable problem. To date, the approaches for bony reconstruction remain controversial. Thus, we aimed to compare the different methods in the treatment of patients with post-traumatic long bone defects, based on the long-term functional and self-evaluation results. Methods We retrospectively reviewed data on patients with post-traumatic long bone defects of the lower extremities from January 2006 to January 2015. The patients were divided into three groups according to the surgical method used to treat the defects (group 1, free vascularized fibular transfer; group 2, distraction osteogenesis; group 3, the induced membrane technique). Data including the complication rates, entire treatment period, long-term visual analog scale scores, and Sickness Impact Profile (SIP) scores during follow-up were recorded. Results A total of 317 patients were included, with 106, 132, and 79 patients in groups 1, 2, and 3, respectively. The major complication rates were 22.6%, 25.8%, and 26.6% for the groups (P > 0.05), respectively. The mean treatment durations for bony defects, from surgery to non-protected weight-bearing, were 65.1, 46.5, and 56.6 weeks for each group, respectively. At 2 years postoperatively, the average SIP scores for each group were 10.5, 11.7, and 11.5, respectively (P > 0.05). Conclusion Patients who sustained long bone defects can be advised that either one of these three methods which typically results in long-term outcomes equivalent to others. Level of evidence: retrospective study

Background. The annual growth of patients ' claims to dentists dictates the need to develop new methods of evaluation and quality standards of care. Often, patients are not happy with the timing of the use of dentures, which is associated with unjustified expectations that have not been adjusted by the attending physician. Relevance. Study of changes in quality of life parameters in a certain group of patients. Objectives. The standard clinical and paraclinical methods and psychodiagnostic analysis in the form of a questionnaire of quality of life were used as research methods. The data of sixty patients who needed repeated prosthetics for various reasons are presented as the material of the study. Results. The correlation of certain parameters of quality of life from the type of prosthesis is determined. So it is proved that patients with removable prostheses physical and emotional state suffers more than patients with fixed prostheses. The presence of depressive States and anxiety experiences is more pronounced in patients with removable dentures. It was determined that in the case of removable prostheses, the period of wearing is directly correlated with changes in the quality of life. At the same time, the quality of life of patients with fixed prostheses, on the contrary, changes minimally until the "critical" moment, when there is an urgent need to remove the denture. The average terms of prosthesis use in months are calculated. Conclusion. The obtained data can be used in research on dentistry and psychology; at the clinical reception by dentists – orthopedists at the initial consultation of the patient about prosthetics of teeth and dentition. The published material is part of the work on the prospective development of a method for predicting the term and long-term results of dental orthopedic treatment.

Eyebrow hair loss is usually a primary feature of frontal fibrosing alopecia (FFA), which causes significant distress to patients and consequently seek medical help. Eyebrow hair transplantation is a well-accepted and aesthetically successful treatment, but there is a lack of information about the short- and long-term results in this subset of patients.To report the short- and long-term eyebrow hair transplantation results in patients with FFA.Ten patients diagnosed with FFA underwent eyebrow hair transplantation. The transplanted hairs were harvested from nonaffected follicles of the occipital scalp skin. On average, 120 to 270 single-hair follicles were implanted per eyebrow.Eighty percent of patients achieved excellent hair growth at 6- to 12-month follow-up and satisfactory short-term results (2 years). However, majority started losing the transplanted hairs after 3 to 4 years. Only 1 patient did not lose transplanted hair in the long-term follow-up (4 years).The results of eyebrow hair transplantation in FFA patients are variable and contentious. The short-term outcome is satisfactory, but in most patients, a progressive loss of transplanted hairs can be expected. Therefore, FFA patients inquiring about eyebrow transplantation should be advised about the high possibility of hair graft loss over time.