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BACKGROUND Two-sided dorsal plus ventral oral graft urethroplasty is a new urethra-sparing technique suggested in tight bulbar strictures which are too severe for a simple one-side grafting. The aim is to evaluate long-term outcomes and the success predictive factors of this technique. METHODS A descriptive retrospective study was conducted on 216 patients undergone dorsal plus ventral graft urethroplasty for bulbar strictures between 2002 and 2018 in a single high-volume center by a single surgeon (EP). The primary outcome measure was stricture recurrence at follow-up. Surgical procedure was considered failed when any postoperative instrumentation was needed. Univariable and multivariable logistic regression analysis were performed. RESULTS Median follow-up was 98 months (IQR 41-131). Among the 216 patients, 188 (87%) were successful and 28 (13%) were failures. Most of the failures (78.4%) were observed during the first 7 years of follow-up, afterward failures were less frequently recorded. Stricture length

Introduction: Several studies have shown an association between obstructive sleep apnea (OSA) and cancer. The aim of our study was to find out the association between both pathologies after a long term followup. Material and Methods: Prospective study in which 1050 men from the general population aged 30 to 70 years old from Vitoria-Gasteiz, were included between 1993-1995 and long term followed. Clinical data were collected and a respiratory polygraphy was performed on all subjects at the beginning and end. Cancer incidence and mortality were analyzed using Kaplan-Meier and Cox regression. Results: Of the 1050 men included at baseline (median age 48.0 (17.0), BMI 25.9 (4.0), AHI 6.0 (10.0), T90 1.0 (7.0)), follow-up data were obtained after a median of 269.0 (10.0) months in 1014 subjects (median age 69.0 (16.4), BMI 27.5 (3.9), AHI 19.0 (18.0), T90 10.0 (30.0)). At baseline, 20.2% of the subjects had a moderate-severe OSA and 19.7% had a T90≥13%. During the follow-up period, CPAP was prescribed in 116 patients. At the end, there were 235 (24.3%) diagnoses of cancer and 57 deaths from cancer. Cox regression, showed that the presence of a moderate-severe OSA at baseline was not significantly associated with developing cancer [HR 1.09 (0.75-1.60), p=0.644] but a T90≥13% was significantly associated with cancer diagnosis [HR 1.99 (1.41-2.79), p Conclusions: The presence of a moderate-severe OSA is not significantly associated with the development of cancer, but nocturnal hypoxemia represents a greater risk.

Background: Single-event multilevel surgery (SEMLS) approach is regarded as the golden standard in developed countries to improve gait and functional mobility in children with cerebral palsy (CP). However, this approach is not always feasible in developing countries. Therefore, orthopedic surgery based on an interval surgery approach (ISA) is still commonly used in developing countries, although little is known about the long term outcomes of an ISA. Therefore, the aim of this study was to describe the gait patterns of adults with CP, who have been treated with ISA, which started more than 15 years ago. Materials and Methods: Thirty adults with CP and spastic diplegia, who received ISA treatment 21.6–33.7 years ago, were recruited for this study and participated in three-dimensional gait analysis. Twenty kinematic and nondimensional temporal-distance parameters were captured, while the overall gait deviation index (GDI) was also calculated. Data of the adults with CP were compared to normative data of typically developing (TD) adults. Results: Although all adults with CP were still ambulant, their gait parameters significantly differed from TD adults, with a lower GDI in the adults with CP. The CP gait patterns were characterized by excessive hip flexion and hip internal rotation as well as a stiff-knee gait. Conclusion: Although different to TD adults, the gait patterns observed in the adult with CP treated with ISA is in line with other studies. Gait patterns suggest that derotation osteotomies potentially could have improved the long term gait patterns. Although SEMLS might be the preferred treatment method, potentially resulting in better outcomes, ISA can also be used to treat children with CP in developing countries as India and South Africa, where a SEMLS approach is not always feasible.

Background: In the challenging tibial condyle fractures despite anatomical joint reconstruction, development ofosteoarthritis may still occur secondary to the initial articular cartilage and meniscal injury. The aim of the study wasto know incidence of osteoarthritis in our operated cases of tibial plateau fracture and to evaluate functional outcome.Methods: Our operated 60 patients of tibial plateau fractures between 2006 to 2013 were evaluated retrospectively.Pre-operative radiographs were classified using Schatzker classification. Patients were followed up clinically andradiologically and were assessed for functional outcome and development of osteoarthritis.Results: The average duration of follow up was 76.32 months ranging from 42 to 130 months. The average age was41.28 (20-73) years. According to Schatzker classification type VI accounted for 32.5% and type V for 20 %. AverageVAS Score was 1.35 ranging from 0 to 4. According to American knee society scoring system, 47patients had excellentand 8 patients had good knee scores, while 52 patients had excellent, 4 patients had good and 1 patient had poorfunctional scores. According to Ahlback classification 25 patients had grade I, while 9 patients had grade II, 7 patientshad grade III and 3 patients had grade IV osteoarthritis of knee.Conclusion: Incidence of osteoarthritis goes higher with Schatzker’s grading. Despite presence of radiological arthritispatients can have good clinical function if the articular reduction and limb alignment are maintained. Treatment goalsshould include a congruent articular reduction, adequate knee stability, anatomical limb alignment and avoidance ofcomplications.Level of evidence: IV

Introduction: Central Diabetes insipidus (CDI) is a rare disorder caused vasopressin deficiency characterized by the excretion of copious volumes of unconcentrated urine. Objective: To assess the etiological,clinical, biochemical and radiological spectrum of Central DI in our institute and long term follow up of these cases. Material and Methods:32 patients with Central DI admitted in Department of Endocrinology,Guwahati Medical College, Assam in the last 2.5 years were included.Detailed clinical assessment, biochemical evaluation and MRI (Magnetic Resonance imaging) brain were done in all the patients. Central DI without any identifiable cause was considered Idiopathic and those with structural lesion in hypothalamic pituitary region were considered organic. Result: Idiopathic CDI was present in 12(37.5%) patients and 20(62.5%) patients had organic CDI with acute onset of presentation.12(60%) patients with organic CDI present with neurological symptoms but 8(40%) patients had no neurological symptoms even with organic cause. Pituitary dysfunction was common in organic CDI as compared to idiopathic CDI. Paediatric patients commonly present with organic cause for CDI with low cortisol most common hormonal deficit. One patient of idiopathic CDI with normal stalk thickness at baseline presented with clinical and radiological features of (Langerhans cell histiocytosis) on follow up. Conclusion: Organic CDI more likely to have acute onset of presentation than idiopathic CDI and even in absence of neurological features. Paediatric patients commonly have organic cause for CDI. We propose the paramount importance of long-term clinical follow-up and reassessment of endocrine function in patients with CDI for definitive diagnosis of autoimmune and inflammatory causes of idiopathic CDI and timely treatment of pituitary ypofunction.

In the paper entitled “Long-term clinical outcomes of cervical disc arthroplasty: a prospective, randomized, controlled trial”, Sasso et al . present seven and ten-year single center data from patients enrolled in the initial FDA Investigational Device Exemption trial of the BRYAN ® cervical arthroplasty device. The authors should be commended on the quality of their investigation, as prospective randomized trials with such long term followup are a rarity in spine surgery.

We present data on long-term functional and cosmetic results after hypospadias surgery.Males older than 18 years with hypospadias treated in Sweden were asked to participate in the study, as well as age matched controls and circumcised men. All participants answered questionnaires, and a subgroup was examined during an outpatient visit. Relationships with outcome were analyzed using analysis of variance and regression analysis.A total of 167 patients with a mean age of 34 years and 169 controls with a mean age of 33 years answered the questionnaire. Of the patients 63% had distal, 24% mid and 13% proximal hypospadias. A total of 46 patients and 49 controls presented for physical examination. Patients were significantly less satisfied with the penile cosmetic outcome regarding all parameters of the Penile Perception Score. There was a difference in penile length between patients and controls (mean 9.7 vs 11.6 cm, p0.001). More patients than controls reported voiding dysfunction symptoms (p = 0.003). Patients had a lower maximum urinary flow rate than controls (p = 0.001). These differences were most prominent between patients with proximal hypospadias and controls.Men operated on for hypospadias were less satisfied with the cosmetic result than controls, and had a shorter penile length. Patients presented with more symptoms of voiding dysfunction and displayed a lower maximum urinary flow rate. Patients with proximal hypospadias were more affected than those with milder hypospadias. Our results indicate that patients with hypospadias can be subgrouped and that those with severe phenotypes should be followed more closely during childhood as well as later in adulthood.

We present the followup of a large cohort of patients with ovotesticular disorder of sex development treated at a single tertiary center.We reviewed the records of 20 patients with ovotesticular disorder of sex development. We retrospectively evaluated clinical and surgical characteristics. A prospective study was also performed, including evaluation of surgical results, gonadal function, sexual activity and voiding symptoms of these patients during adulthood.All patients had ambiguous genitalia, including 18 with a 46,XX karyotype and 2 with a 46,XX/46,XY karyotype. Gender assignment at birth was male in 13 patients and female in 7. Three females were later reassigned to the male gender. Bilateral gonadectomy was performed in 10 patients. Testicular tissue was preserved in 8 males and ovarian tissue was preserved in 2 females. Average followup was 25 years (range 4 to 46). Puberty started spontaneously in 14 patients between ages 11 and 14 years. Seven patients showed spontaneous puberty after conservative gonadal surgery and 4 required hormonal replacement during adulthood. The most frequent complications in males were urethral fistula in 6 and late urethral stenosis in 3. Two patients with urethral stenosis had symptoms 10 years postoperatively. One female presented with temporary dyspareunia. In adulthood 8 males and 2 females reported sexual activity. All male patients reported orgasm and 2 reported ejaculation.Male gender assignment was more prevalent. Long-term followup revealed adequate pubertal development and sexual activity. Complications involving the urethra developed frequently in male patients.

Cleft lip and palate resulting in midface hypoplasia requires distraction of the midface. Rigid External Distractor (RED) has been used successfully for correction of this hypoplasia with stable results. This case reports highlights the long term followup of stability of DO using RED in a patient with cleft lip and palate.

Background: In children less than 6 years, the treatment of femoral shaft fracture is often non surgical, using closed reduction and casting. The literature reports many experience about this type of trauma but none of these has a long term followup. We present a retrospective study on a group of femoral diaphyseal fractures treated nonsurgically in children up to 6 years of age, with a minimum of 10 year followup. Materials and Methods: 48 cases (36 males/12 females) with femoral diaphyseal fractures treated between January 1988 and December 1998 were reviewed. Patients with fractures due to obstetrical trauma and pathologic fractures were excluded. The mean age of the patients was 3.3 ± 1.1 years (range 5 months-6 years). Right side was involved in 21 cases (44%), and left side in 27 cases (56%). In 34 cases (71%), closed reduction was performed and hip spica was applied with the hip and knee flexed to 45΀. In 8 cases (17%), skeletal traction was applied to perform fracture reduction and the traction pin was embedded in plaster while in the remaining 6 cases (12%), the Delitala pressure apparatus was applied after casting. Results: All fractures healed in our study. There were no complications (infection or vascular nervous issues, axial deviations, consolidation delays, or pseudoarthrosis). In 13 cases (27%), followup examinations showed mean lengthening of 1.3 ± 0.75 (range 0.5-2.5 cm) of the fractured lower limb. All these patients were treated with skin traction before treatment and presented with 2.08 ± 0.28 cm mean initial femoral shortening. In 1 case (2%) with 2.5 cm lengthening, epiphysiodesis of the ipsilateral knee was performed. No patients showed prolonged difficulty with gait disorders. Conclusion: On the basis of our results conservative treatment of femoral shaft fractures in children can be considered less invasive and safe procedure.

The aim of our study was to compare the results of the TTE (transthoracic echocardiography) with the results obtained by the ECG-gated 64 slices CT during the followup of patients with bicuspid aortic valve (BAV), after aortic valve replacement; in particular we evaluated the aortic root and the ascending aorta looking for a new algorithm in the followup of these patients. From January 1999 to December 2009 our attention was focused on 67 patients with isolated surgical substitution of aortic valve; after dismissal they were strictly observed. During the period between May and September 2010, these patients underwent their last evaluation, and clinical exams, ECG, TTE, and an ECG-gated-MDCT were performed. At followup TTE results showed an aortic root of 36.7±4 mm and an ascending aorta of 39.6±4.8 mm. ECG- gated CT showed an aortic root of 37.9±5.5 mm and an ascending aorta of 43.1±5.2. The comparison between preoperative and postoperative TTE shows a significant long-term dilatation of the ascending aorta while the aortic root diameter seems to be stable. ECG-gated CT confirms the stability of the aortic root diameter (38.2±5.3 mm versus 37.9±5.5 mm; 40.2±3.9 mm versus 43.1±5.2 mm; P=0.0156). Due to the different findings between CT and TTE studies, ECG-gated CT should no longer be considered as a complementary exam in the followup of patients with BAV, but as a fundamental role since it is a real necessity.

The intervention of pressure therapy on management of hypertrophic scar (HS) after burn is based on the theoretical assumption that the mechanical force added onto the scar tissue will reduce the growth of myofibroblasts which create the collagen clusters and the interstitial space, and to realign fibrous tissues, thus reducing the thickness of HS. In this experimental study, a high frequency ultrasound imaging system (12 MHz) was applied to measure the real time changes of thickness of the post burn HS under a mechanical loading system with similar pressure generated to the scar tissue. The validity of the ultrasound system in measurement of the changes of scar thickness underneath the tissue was tested on the porcine skin in vitro followed by measurement of human skin in vivo. Results showed that the ultrasound measurement of thickness had both good validity (r(2)=0.98, p0.0001) and good intra-rater reliability (ICC=0.89). Then, the system was used to test the thickness of 14 human HS samples in vivo among 7 subjects. External loading force with similar pressure range (10-45 mmHg) was then applied to these scar samples via ultrasound probe with rectangular contacting area at 4 cm(2) and each loading force was maintained unchange for 2 min over the scar tissue. The real time scar thickness was documented. Results showed that the mean scar thickness was found to be significantly decreased when the loading force applied was increased from 5 to 35 mmHg (with 10 mmHg interval) (p0.001). A significant negative correlation between the pressure level and scar thickness was observed (r(2)=0.96, p=0.005). The decline of thickness was found more significant between 0 mmHg and 15 mmHg. The findings were in line with the postulate that pressure therapy is effective in reducing the thickness of HS. A long term followup study should be administered to determine the prolonged effect of pressure intervention.

Advances in hematopoietic cell transplantation (HCT) have led to an increasing number of transplant survivors. However, long-term survival is challenged by late relapse, late complications and late non-relapse mortality, and HCT survivors need continued lifelong surveillance for screening, early detection and timely treatment of late complications such as secondary cancers, late infections and organ toxicity. Guidelines for screening and preventive practices for pediatric and adult survivors of autologous and allogeneic HCT were updated and published in 2012. However, several barriers to the care of HCT survivors and routine utilization of these guidelines in clinical practice exist. Examples include paucity of and challenges to conducting prospective randomized trials for screening and prevention of late complications, lack of resources to manage late effects at the level of transplant centers and community health care providers, and inadequate tools to facilitate care and followup of HCT survivors. We summarize the long-term followup guidelines in this review, discuss ways that providers can integrate and utilize them for the care of their patients, and identify areas for research that can inform and increase the utilization of screening and prevention guidelines in clinical practice.

Visible hematuria has a cancer yield of up to 24.2%. A large proportion of cases will have no etiology. In this study we determined the incidence of pathology (benign and malignant) in patients with visible hematuria and those with persistent and recurrent visible hematuria, and evaluated the policy for investigations.Data were prospectively collected for 1,804 patients with visible hematuria at a United Kingdom teaching hospital from January 1999 to September 2007. In October 2010 the comprehensive hospital electronic database was checked for every individual patient to ensure no urological pathology was missed. All patients underwent standard hematuria investigations, including renal tract ultrasound and excretory urography or contrast enhanced computer tomography urogram, flexible cystoscopy and urine cytology.The male-to-female ratio was 4.8:1. Median age ± SD was 67 ± 17.0 years (range 21 to 109). Median followup was 6.6 ± 2.5 years (range 1.5 to 11.6). No urological pathology was found in 965 (53.5%) patients. Malignant urological disease was found in 386 (21.4%) patients, of whom 329 had bladder tumors. There were 32 patients with persistent visible hematuria and no malignancy. Repeat investigation was performed in 69 patients reporting recurrence. Of these patients 35 received a significant urological diagnosis, including 12 (17.4%) urological malignancies, while 34 (49.3%) still had no diagnosis. Limitations include the possibility of missing pathology.Almost 50% of patients presenting with visible hematuria will have a diagnosis. Therefore, all cases of visible hematuria require full standard investigations. Patients with no diagnosis can be discharged from followup. Recurrent visible hematuria after full initial negative findings requires repeat full standard investigations because 11.6% will have malignant pathology.

We retrospectively evaluated our experience with ureteral reimplantation and psoas bladder hitch to restore urinary tract continuity in patients with lower ureteral defects, since long-term data on the outcomes of this procedure have been relatively scarce in the last two decades. The procedure was performed in 24 patients (7 male, 17 female) with a mean age of 54.6 years. The mean ureteral defect length was 4.8 cm (range 3–10), the ureterovesical anastomosis was performed with simplified split-cuff technique in 18 patients, submucosal tunnel in 2, and direct anastomosis without antireflux technique in 2. Mean followup was 53 months (range 12–125), and there were no reinterventions. Postoperative renal imaging was normal in 22 cases (91.6%) and revealed decreased kidney size in 2, 3 patients presented intermittent flank pain, and 5 had sporadic episodes of lower tract UTI but no one pyelonephritis. Psoas hitch ureteral reimplantation can be successfully used for bridging defects of the lower ureter up to 10 cm in length in difficult clinical situations. It is relatively simple to perform, compared to other procedures of ureteral reconstruction, and it provides adequate protection of the upper urinary tract.

Aim. The aim of this study was to see whether the benefits of crossed wire fixation over skeletal traction in the treatment of pediatric supracondylar humerus fractures (SCHF) were mirrored in the children's or their caregivers' rating of the experience.Methods. As part of a study of the clinical outcome of SCHF, all the patients and the parents were asked to rate their experience of the treatment on a visual analogue scale (VAS).Results. There was no difference in the patients' or the parents' experience between the treatment groups. However there was a difference between the parents with children who experienced a neurovascular complication (mean VAS 6.1) and those that did not (mean VAS 4.3, ). The boys rated the experience as less negative (mean VAS 3.6) than the girls (mean VAS 4.7, ).Conclusion. In the long term, avoiding complications was more important to the parents than the choice of treatment for SCHF in the children.

Introduction. For decades, transurethral resection of the prostate (TURP) has been the “gold standard” operation for benign prostatic hyperplasia (BPH) but is based mainly on historic data. The historic data lacks use of validated measures and current TURP differs significantly from that performed 30 years ago.Methods. Men who had undergone TURP between 2001 and 2005 were reviewed. International prostate symptom score (IPSS), quality of life (QOL) and peak urinary flow rate (Qmax⁡), and postvoid residual (PVR) were recorded. Operative details and postoperative complications were documented. Patients were then invited to attend for repeat assessment.Results. 91 patients participated. Mean follow-up time was 70 months. Mean follow-up results were IPSS—7; QoL—1.5;Qmax⁡—23 mL/s; PVR—45 mL. These were an improvement from baseline of 67%, 63%, 187%, and 80%, respectively. Early complication rates were low, with no blood transfusions, TUR syndrome, or deaths occurring. Urethral stricture rate was higher than anticipated at 14%.Conclusion. This study shows modern TURP still produces durable improvement in voiding symptoms which remains comparable with historic studies. This study, however, found a marked drop in early complications but, conversely, a higher than expected incidence of urethral strictures.

We examined experiencing divine love as an indicator of affective spiritual growth in a prospective cohort of 200 patients surviving cardiac surgery. These patients previously completed two-wave preoperative interviews when standardized cardiac surgery data were also collected. The information included left ventricular ejection fraction, New York Heart Association Classification, baseline health (physical and mental), optimism, hope, religiousness, prayer coping, religious/spiritual coping, and demographics. We then measured divine love at 900 days postoperatively. Hierarchical linear regression indicated the direct effect of positive religious coping on experiences of divine love, controlling for other key variables. Postoperatively perceived spiritual support was entered at the final step as an explanatory factor, which appeared to mediate the coping effect. None of the other faith factors predicted divine love. Further research regarding divine love and spiritual support may eventually guide clinical attempts to support patients' spiritual growth as an independently relevant outcome of cardiac surgery.

Background: Feasibility of using the self-gripping mesh in open repair of inguinal hernia in the Philippines in terms of recurrence rate, postoperative pain, operating factors and postoperative surgical complications.Methods: Prospective observational study using of a self–gripping polyester mesh (TEM1208GR Parietex ProGripTM). Operative time and mesh deployment time were recorded. Assessment at 6, 12 and 24 hours after surgery for postoperative complications and pain score. Recurrence assessed one-week post op then phone interview one and two years after surgery.Results: There were 95 participants with 99 hernias from September 2011 to March 2014. Eighty-nine participants (93.7%) were male with average age of 43 years SD ±18 (15-81). Of the 91 patients with unilateral hernia, 50 (54.9%) were right-sided. Mean deployment time was 145.33 seconds SD±38.55 (30-240). Mean operating time was 77.59 minutes SD 73.64±(22-480). Mean pain score of the patients at 6, 12 and 24 hours postoperatively are 3 SD±2.69 (0-10), 2.91 SD±2.35 (0-9) and 2.25 SD±2.06 (0-10). Intraoperative bleeding occurred two cases (2%), seroma in one patient (1%). Five cases of inguinal numbness one year after surgery; and four of them resolved spontaneously within the second year after surgery. No recurrence in 2 years-followup.Conclusions: The use of a self-gripping mesh is feasible and safe in the Philippine setting with no recurrence after a 2 year-followup.

Dextranomer/hyaluronic acid injection of ureteral orifices is a popular option in the treatment of vesicoureteral reflux, with success rates ranging from 69% to 89%. We found only 1 study that followed patients beyond the initial postoperative voiding cystourethrogram, which describes a 96% success rate at 2 to 5 years but defines success as "nondilating" reflux. We examined our dextranomer/hyaluronic acid series to evaluate the long-term (1-year) outcome in children who had resolution of reflux on initial postoperative voiding cystourethrography.We retrospectively reviewed our dextranomer/hyaluronic acid experience from February of 2002 to December of 2005. We determined initial success on early (6 to 12-week) postoperative voiding cystourethrogram. We then evaluated long-term success by obtaining a voiding cystourethrogram at 1 year postoperatively in patients who were initially cured of reflux. In addition, success rates between the first and second halves of our experience were evaluated to account for surgeon experience and modification of technique.Our total success rate at initial voiding cystourethrogram was 73% (246 of 337 total ureters). The success rate in the first half of our experience was 65.9% (112 of 170 ureters) and in the second half was 80.2% (134 of 167). A total of 150 ureteral units with initial successful dextranomer/hyaluronic acid treatment were evaluated at 1 year by voiding cystourethrogram. Of these ureters 111 had continued resolution of vesicoureteral reflux, for a long-term success rate of 74%. Including initial postoperative failures, the complete 1-year total success rate was 46.1% (111 of 241 ureters).Although the reflux resolution rates at initial postoperative voiding cystourethrogram approach those of open surgery, there is a significant failure rate at 1 year, which warrants long-term followup.

Results of a long term followup with total hip-replacement of the Endo-Klinik are presented. The analysed data-material exhibits a relative homogeneity because of a large series of one system of prostheses and homogeneous technique in surgery. Thus, analytic statistical methods (life-tables and regression models) could be used. In this way, prognostic factors on the durability of total hip replacement could be determined. These are essentially: long practical experience of the surgeon with one matured prosthesis-system, type of hip-joint disease, and the age of the patient. It is assumed, that in well organized special centres for joint replacement the failure rate could be reduced generally.

Objective. Temporomandibular joint (TMJ) involvement is a frequent feature in cross-sectional prevalence studies among patients with juvenile idiopathic arthritis (JIA). In this followup study, patients were reviewed after 5 years to study the course of TMJ involvement in relation to disease characteristics.Methods. Children with JIA from a previous study on TMJ involvement were included. A rheumatologic evaluation including the 6 parameters of the JIA core set and an orthodontic evaluation including an orthopantomogram (OPT) were performed. OPTs were scored according to Rohlin's grading system (grades 0-5).Results. The overall prevalence of patients with condylar alterations decreased from 49% to 40%. Improvement of the alterations was seen in 69% of the initially affected condyles, and consequently improvement was seen in 83% of the initially affected patients. Normalization of the alterations was seen in 67% of the improved condyles, and consequently in 44% of the patients. This proves that the condyle has a regenerative capacity. Improvement was related to low disease activity and a less extensive therapeutic regimen.Conclusion. In patients with JIA, condylar alterations can improve and even regenerate. Condylar improvement is associated with a low disease activity.

The aim of this retrospective study is to evaluate the long-term followup of soft penile SSDA prosthesis, without plaque surgery in the treatment of Peyronie's disease. This study included 12 men with Peyronie's disease who underwent placement of a penile prosthesis. All patients were followed for at least 6 years. Prosthesis straightened the penile shaft in all cases, restoring patient sexual satisfaction. No operative or postoperative complications occurred, and no reoperations were needed. All patients have undergone further examination with basal and dynamic eco color Doppler. The findings are encouraging as the penis preserves the ability to enhance the tumescence and penile girth. We can conclude that SSDA penile prosthesis is safe and effective in Peyronie's disease.

Background: Familial carpal tunnel syndrome is a rare hereditary disorder characterized by early onset bilateral carpal tunnel syndrome. A lack of long-term outcome data exists for patients afflicted by this condition. This study examines the long-term subjective outcomes of patients managed with open carpal tunnel release for the diagnosis of familial carpal tunnel syndrome. Methods and findings: Three patients were diagnosed with familial carpal tunnel syndrome: a 13 y old girl whose maternal family has three consecutive generations of carpal tunnel syndrome, and a 16 y old boy and his 47 y old father whose family has four consecutive generations of carpal tunnel syndrome. All patients completed the Boston Carpal Tunnel Questionnaire at an average of 13.5 y following their initial surgical treatment. Responses revealed onset of new symptoms in the 13 y old girl’s contralateral wrist and symptom recurrence in the 16 y old boy and his 47 y old father. Following carpal tunnel release, the 13 y old girl is now asymptomatic. The 16 y old boy and his father, despite carpal tunnel release, still suffer from moderate and mild functional impairment. The conclusions of our study, along with those of other studies that detail the nature of this syndrome, are limited by the small number of familial carpal tunnel syndrome patients. Conclusion: In cases of early onset familial carpal tunnel syndrome, carpal tunnel release may prove only partially effective in resolving symptoms. Patients should be counseled that recurrent symptoms may develop despite successful initial carpal tunnel release.

Chronic aspiration is a difficult and potentially lethal problem. Patients who have persistent soilage of the upper respiratory tract despite discontinuing oral intake may be offered surgical intervention to avoid life-threatening pulmonary infections. The Lindeman procedures (tracheoesophageal diversion and laryngotracheal separation) have gained popularity as surgical treatments for intractable aspiration because of their efficacy in preventing aspiration and their technical simplicity. A major downside of these procedures is the necessity for a tracheostoma and the loss of speech following surgery. Rarely, patients recover from the neurologic deficits which led to their intractable aspiration and desire reversal of their Lindeman procedure. While few "successful" reversals have been reported, detailed accounts of the long-term results of such patients are lacking. We describe a patient who underwent a laryngotracheal separation for intractable aspiration following a brainstem stroke. In the following six months he experienced significant neurologic recovery and, after careful evaluation, underwent surgical restoration of laryngotracheal continuity. Five years later he speaks fluently and has no dietary restrictions. Videofluooroscopic examination and quantitative voice analysis reveal near-normal laryngeal function.

A consecutive series of 220 primary posterior-cruciate ligament-retaining total knee replacements were done in 148 patients with rheumatoid arthritis. From this group, 212 total knee replacements (141 patients) were followed up for an average of 10 years. Average knee scores at 5, 10, 15, and 20 years after operation improved to 86, 83, 88, and 89, respectively, and average function scores improved to 70, 72, 64, and 88, respectively. Five knees (2.4%) were revised for deep infection. Posterior instability, recurvaum, or mediolateral instability, combined or otherwise, occurred in 15% (32 knees; in 31 patients). Three tibial components (1.4%) were revised: one for suspected aseptic loosening and two for instability. Excluding infections and failed metal-backed patellas, Kaplan-Meier survival rates were 99.5%, 97.9%, and 96.5%, respectively. Favorable long-term results may be achieved with posterior-cruciate ligament-retaining total knee replacements in patients with rheumatoid arthritis. Concern remains, however, about rotational instability in certain cases associated with preoperative genu-valgum and ipsilateral planovalgus deformity.

Purpose of Study PFO allows venous clots and vasoactive factors to bypass pulmonary filtration and remain in circulation. We previously identified an immediate reduction of procoagulant serotonin (5-HT) in left atrial blood post PFO closure. To understand the long-term effect of PFO closure, we report the change of 5-HT in peripheral venous blood in 1-year followup. Methods Used 97 PFO-related stroke patients were recruited on IRB approval. Venous blood was collected at baseline (BL) and 1 year follow-up (FU) of treatments (PFO closure and medical therapy). Plasma 5-HT was quantified by mass spectrometry. Patients with serotonin modifying medications (ie. SSRIs) or conditions (anxiety/depression) were excluded. Summary of Results 5-HT level in peripheral venous blood was significantly reduced by 27.27% (BL: 7.57±8.04 µM; FU: 5.51±5.72 µM; p=0.0034) in 61 patients receiving PFO closure (figure 1A). In the 37 PFO patients treated with medicine alone, no changes were observed (BL: 5.79±7.15 µM; FU: 6.25±6.68 µM; p=0.4050) (figure 1B). 5-HT reduction was independently associated with PFO closure after adjusting for age, gender, medical history and medication status in a multivariate regression (figure 1C). Conclusions We found that PFO closure independently reduced 5-HT level in peripheral venous blood. These results support the hypothesis that PFO related right-to-left interatrial shunt may foster higher level of procoagulant and vascoactive substances in circulation. While PFO closure decrease prothrombotic markers immediately post closure, this effect is sustained in long term followup up to 1 year. Further studies on the clinical outcome of these PFO patients with respect to their prothrombotic circulatory profiles are ongoing.

Between 1972 and 1999, the orthopaedic service at the authors' institution treated 137 patients with proximal femoral bone lesions by resection and reconstruction with frozen allografts from cadavers. The data were entered into a computer program allowing a comprehensive analysis. Thirty-eight patients had proximal femoral osteoarticular allografts, 69 had allograft-endoprosthesis composites, 22 had intercalary allografts, and eight had an allograft arthrodesis. There were 74 complications in 54 of the 137 patients with allografts, which included 26 allograft fractures (19%), 15 infections (11%), and 20 nonunions (15%). The overall success rate for the patients with these procedures was 103 of 137 (75%) at a mean followup of 7.9 years +/- 5.6 years. If the eight patients with tumor recurrences (surgical failures rather than allograft failures) are not included, the success rate is 103 of 129 (80%). Eighty-three of these patients (55%) without any allograft complications who have been treated and followed up for at least 2 years had a 92% success rate. It is concluded that although allograft reconstruction after resection of the proximal femur for patients with aggressive or malignant tumors has a high complication rate, approximately 80% of the patients have a successful outcome.

e15100 Background: Vigil is an immuno-stimulatory autologous tumor cell therapy, which uses patient tumor cells transfected with a plasmid encoding genes to upregulate GM-CSF and down regulate TGFβ 1&2. It is administered monthly by intra-dermal injection. In Phase I and IIa trials patients with over 19 different tumor types were safely treated. Rapid and durable systemic immune activation was demonstrated using an IFNγ ELISPOT assay. Methods: Data are summarized for a group of 9 patients with advanced colorectal cancer followed for up to 3.5 years. Results: Six women and 3 men with Stage III or IV colorectal cancer were treated between March, 2010 and September, 2013. Six patients received Vigil as a monotherapy and 3 in combination with FOLFOX chemotherapy. Results: Demographics and treatment details are displayed below. Two patients with Stage III disease received combination therapy after complete surgical resection, and remain disease free over 3 years from surgery. The patients received 9 and 12 Vigil injections with a brisk and durable ELISPOT reactions. Conclusions: Preliminary results suggest that Vigil can be combined safely with FOLOX chemotherapy and still elicit a systemic immune response. Long term disease free survival has been observed in several patients justifying further exploration of this combination. More detailed molecular characterization and neoantigen identification of patient tumor will be undertaken in future studies. A combination with immune checkpoint inhibitors may also be explored. [Table: see text]

Purpose: We investigated deterioration of the success rate of penile and bulbar substitution urethroplasty.Materials and Methods: We performed a retrospective descriptive analysis of patients who underwent substitution urethroplasty between July 1994 and September 2007. Inclusion criteria included 1-stage anterior urethroplasty using penile skin or oral mucosa with a minimum of 6 years followup. Patients with posterior urethral stricture, failed hypospadias or incomplete clinical records were excluded from analysis. The primary study outcome was postoperative failure-free survival and the secondary outcome was to identify significant predictors of treatment failure. The clinical outcome was considered a failure when any postoperative instrumentation was needed. Descriptive statistical analysis was done as well as Kaplan-Meier analysis, and univariable and multivariable Cox regression analysis.Results: A total of 359 patients were included in study. Median followup was 118 months. Of the procedures 265 (73...

Osteosarcoma (OS), the commonest malignancy of osteoarticular origin, is a very aggressive neoplasm. Divergent histologic differentiation is common in OS; hence triple diagnostic approach is essential in all cases. 20% cases are atypical owing to lack of concurrence among clinicoradiologic and pathologic features necessitating resampling. Recognition of specific anatomic and histologic variants is essential in view of better outcome. Traditional prognostic factors of OS do stratify patients for short term outcome, but often fail to predict their long term outcome. Considering the negligible improvement in the patient outcome during the last 20 years, search for novel prognostic factors is in progress like ezrin vascular endothelial growth factor, chemokine receptors, dysregulation of various micro ribonucleic acid are potentially promising. Their utility needs to be validated by long term followup studies before they are incorporated in routine clinical practice.

Purpose.To study the long term refractive and visual outcomes of photorefractive keratectomy (PRK) with intraoperative application of mitomycin C (MMC).Methods.This study included 37 eyes who received myopic PRK; after photoablation, a sponge soaked in 0.02% MMC solution was applied in all corneas for 2 minutes. Efficacy, safety, predictability, and stability of PRK MMC were evaluated. Endothelial cell density was evaluated at the last postoperative interval.Results.Mean preoperative spherical equivalent (SEQ) was−6.03±1.87 D (diopters) and reduced to−0.09±0.53 D at the last postoperative examination. Mean followup was44.73±18.24months. All the eyes were in the ±1.00 D of attempted versus achieved SEQ at the one-year follow-up interval. Furthermore, 95% of the eyes did not lose lines or gained 1 to 2 lines of CDVA, while 5% lost 1 line. At the third postoperative month, 89% of the eyes either were clear or had trace haze, while 4 eyes had mild haze; by the 12-month postoperative interval, none of the eyes demonstrated haze. Mean endothelial cell density (ECD) at the last postoperative interval was2658±153 cells/mm2.Conclusions.PRK, with intraoperative use of MMC, demonstrates stable refractive and visual outcomes up to 44 months after surgery.

This is the seventh reported case of recurrent Legg-Calve-Perthes disease. The report documents the initial onset in a boy 4 years of age with healing clinically and radiographically. The boy experienced recurrence of disease at 8 years of age with last followup at 20 years of age. Tests related to blood hypercoagulability and hypofibrinolysis and certain genetic factors relevant to osteonecrosis of the bone are reported.

Vertebral hydatidosis is a relatively silent and slowly progressive disease with a latent period of many years. The prognosis for neurologic recovery in hydatid disease of the spine generally is regarded as poor and posterior surgical decompression is associated with a high recurrence rate. Reported here are the results after a long-term followup of four patients with hydatid disease of the spine with neurologic deficit which significantly improved after anterior surgical decompression and anthelmintic therapy. Adequate preoperative evaluation with magnetic resonance imaging and computed tomography scanning is essential in localizing the lesions and planning the surgical approach. The authors recommend radical excision of the involved vertebra and anthelmintic drugs to control the disease process.

Objective To compare the effectiveness of trabeculectomy with adjunctive, low-dose, subconjunctival 5-fluorouracil (5-FU) to trabeculectomy alone in patients with uncomplicated glaucoma undergoing their first incisional surgical procedure. Design Retrospective, nonrandomized comparative trial. Participants Consecutive series of 52 patients and 74 control subjects. Intervention Trabeculectomy was performed in all patients. Study patients received adjunctive, subconjunctival injections of 5-FU up to 14 days from the date of surgery. Main outcome measures Intraocular pressure, number of postoperative antiglaucoma medications, interventions, and complications were evaluated. Results Mean followup for all patients was 58.1 ± 44.1 months (range, 1.1–159.9 months). Mean followup for successful eyes was 55.9 ± 47.1 months (range, 7.6–159.9 months). The cumulative 5-year success (intraocular pressure [IOP] ≤ 21 mmHg) was 77.8% in the 5-FU group and 62.2% in the control group ( P = 0.02, Wilcoxon test. Complete success (IOP ≤ 21 mmHg without medications) at 5 years was lower in both the 5-FU group (72.3%) and the control group (51.3%). Postoperative mean IOP at 5 years for all successful patients was lower in eyes receiving 5-FU (10.7 ± 3.6 mmHg vs. 16.0 ± 6.1 mmHg [ P = 0.02, t -test]). For those patients considered to be complete successes, there was no difference in IOP between the two groups of patients at any evaluated time interval. Patients in the 5-FU group were using 0.7 ± 1.1 medications at final followup compared with 1.8 ± 1.4 medications in the control group ( P = t test). Bleb-related ocular infection occurred in 6.3% of patients and was more common in patients receiving 5-FU than controls (6 of 52 vs 2 of 74, respectively; P = 0.05, Fischer's exact test). Conclusions Adjunctive, low-dose 5-FU at the time of initial surgery in uncomplicated glaucoma improves long-term IOP control and reduces the need for postoperative, antiglaucoma therapy. Eyes receiving 5-FU are at greater risk of developing late bleb-related ocular infection.

We report the long-term results of penile revascularization surgery for erectile failure and suggest possible selection criteria for this controversial surgical procedure.In 7 years 62 impotent men who did not respond to pharmacotherapy underwent microsurgical penile revascularization and completed long-term followup evaluation in 41 months (range 18 to greater than 62) consisting of a detailed questionnaire, duplex sonography and optional pharmacotherapy or angiography. The Virag procedure was chosen for the first 7 patients, the original Hauri technique for the next 13 and the modified Mannheim triple anastomosis for 42.Of all patients 34% achieved spontaneous and another 20% pharmacologically induced erections. Success in diabetics and older patients was lower (43% for diabetics, 39% for those older than 50 years at surgery), while it was high in men with less than 2 risk factors (58%) as well as in younger patients (69% for those up to 50 years old). Shunt patency was 92%. Complications such as glans hyperemia developed in 13% of patients, shunt thrombosis in 8% and inguinal hernias in 6.5%.Patient selection is vital for the successful outcome of penile revascularization surgery. We adhere to strict selection criteria, such as patient age maximum of 50 years, less than 2 risk factors, no recent diabetes and termination of nicotine abuse. Penile revascularization surgery is highly indicated in this group of patients, especially since it is the only causal therapy for erectile failure.

A 68-year-old female patient presented with a rapidly growing, exulcerating tumor of the left hand in the area of a congenital symbrachydactyly at the digiti II and III. A biopsy of the tumor showed a squamous cell carcinoma. Further workup showed two suspicious axillar enhancements with no evidence of bony infiltration and no further metastasis. An amputation of the second and third ray of the left hand at the metacarpal level and additionally an axillar revision and lymph node dissection were performed and confirmed the suspicion of a squamous cell carcinoma, fortunately without affection of any lymph nodes. After 9 years the patient showed an excellent function of the left hand. Symbrachydactyly malformations and squamous cell carcinoma of the hand are both rare conditions. We could not find a reference that shows a common genetic condition to both and so far this is the first description of a squamous cell carcinoma in the region of a symbrachydactyly. It remains unclear whether our case is a coincidence of two rare independent diseases or there is a pathogenetic link between the malformation and the tumor on a genetic level.