Laparoscopic resection of a bladder diverticulum in children

Introduction. Recently, there have been publications devoted to laparoscopic removal of a bladder ear. The article sums up the multi-center experience in laparoscopic diverticulectomy.Materials and methods. Case histories of 30 children who underwent surgeries from 2012 to 2019 in 7 outpatient clinics were analyzed retrospectively. 22 boys (73.3%) and 8 girls (26.7%) were operated. At the time of the surgery, the mean age of the patients was 53.5 months. 15 (50.0%) children had right-sided diverticulum, 13 (43.3%) children suffered from left-sided one, and 2 had bilateral diverticulum (6.7%). The disease onset was presented by acute urinary tract infection in 25 (83.3%) children and urination dysfunction in 5 (16.7%). The laparoscopic access technique was used in all children. An isolated diverticulum was excised and the wall of the urinary bladder was restored. When the diverticulum was combined with a vesicoureteral reflux or ureterovesical anastomosis, ureteral reimplantation was added. Results. No conversions were found during the laparoscopy. Following the surgery, 3 (10.0%) children developed stent-associated pyelonephritis. No patient had complications during the observation that lasted from 6 months to 6 years. Conclusion. Laparoscopic technique is an effective and safe approach of treating a bladder ear in children.

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Celiac Disease in Kosovar Albanian Children: Evaluation of Clinical Features and Diagnosis

Current Pediatric Reviews ◽

10.2174/1573396316666200116093753 ◽

2020 ◽

Vol 16 (3) ◽

pp. 241-247

Author(s):

Atifete Ramosaj-Morina ◽

Alije Keka-Sylaj ◽

Arbana Baloku Zejnullahu ◽

Lidvana Spahiu ◽

Virgjina Hasbahta ◽

...

Keyword(s):

Celiac Disease ◽

Disease Onset ◽

Clinical Manifestations ◽

Gastrointestinal Symptoms ◽

Dominant Mode ◽

Primary School Children ◽

Cross Sectional ◽

Classical Form ◽

Wide Range ◽

The Mean

Background: Celiac disease is an immune-mediated disorder characterized by variable clinical manifestations, specific antibodies, HLA-DQ2/DQ8 haplotypes, and enteropathy. Objectives: The aim of this study was to present the clinical spectrum and patterns of celiac disease in Kosovar Albanian children. Methods: A cross-sectional retrospective study was performed with Albanian children aged 0-18 years, treated for celiac disease in the Pediatric Clinic, University Clinical Center of Kosovo from 2005 to 2016. Results: During the study period, 63 children were treated for celiac disease. The mean age at diagnosis was 5.5 years (SD ± 3.31). The mean age at celiac disease onset was 3.3 years (SD ± 2.02), while the mean delay from the first symptoms indicative of celiac disease to diagnosis was 2.2 years (SD ± 2.09). More than 70% of the patients were diagnosed in the first 7 years of life, mainly presented with gastrointestinal symptoms, while primary school children and adolescents mostly showed atypical symptoms (p<0.001). The classical form of celiac disease occurred in 78% of the cases. Sixty (95%) patients carried HLA-DQ2.5, DQ2.2 and/or HLA-DQ8 heterodimers, and only three of them tested negative. Conclusions: Kosovo, as the majority of developing countries, is still facing the classical form of celiac disease as the dominant mode of presentation; as a result, most children with other forms of the celiac disease remain undiagnosed. : Physicians should be aware of the wide range of clinical presentations and utilize low testing thresholds in order to prevent potential long-term problems associated with untreated celiac disease.

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AB0478 CORONARY ATHEROSCLEROSIS IN BEHCET’S DISEASE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3609 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1537.1-1537

Author(s):

R. Goloeva ◽

Z. Alekberova

Keyword(s):

Behçet’S Disease ◽

Coronary Atherosclerosis ◽

Behcet’S Disease ◽

Behçet's Disease ◽

Subclinical Atherosclerosis ◽

Disease Onset ◽

Atherogenic Index ◽

Female Ratio ◽

Behcet's Disease ◽

The Mean

Background:Behcet’s disease (BD) is systemic vasculitis, which affects all types and sizes of vessels. Increased carotid intima-media thickness (IMT) is parameter associated with subclinical atherosclerosis.Objectives:To determine the prevalence of atherosclerosis in pts with BD.Methods:95 BD pts were evaluated and 45 healthy controls matched for age and gender.IMT was assessed by high-resolution B-mode ultrasonography. Serum concentration of high-sensitivity C-reactive protein (hs CRP) was measured by immunonephelometric assay (BN-100 Analyzer; Dade Behring). Lipid profile evaluation included total cholesterol, TGs, HDL, LDL and atherogenic index.Results:The male-to-female ratio was 3,7:1, the mean age of pts was 29.7 (23-35) yrs, the mean age at the disease onset - 19,9 (14-25) yrs, the mean disease duration - 9,6 (4-15) yrs.Conclusion:Coronary atherosclerosis in BD pts was lower than what we expected. The thinning IMT may be one of the risk factors for aneurysm formation in pts with BD.Disclosure of Interests:None declared

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Immune-Mediated Disease Flares or New-Onset Disease in 27 Subjects Following mRNA/DNA SARS-CoV-2 Vaccination

Vaccines ◽

10.3390/vaccines9050435 ◽

2021 ◽

Vol 9 (5) ◽

pp. 435

Author(s):

Abdulla Watad ◽

Gabriele De Marco ◽

Hussein Mahajna ◽

Amit Druyan ◽

Mailam Eltity ◽

...

Keyword(s):

Disease Onset ◽

Underlying Disease ◽

Organ System ◽

Population Exposure ◽

Disease Phenotype ◽

Autoimmune Rheumatic Disease ◽

Adverse Event Following Immunization ◽

Immune Mediated ◽

The Mean ◽

New Onset

Background: Infectious diseases and vaccines can occasionally cause new-onset or flare of immune-mediated diseases (IMDs). The adjuvanticity of the available SARS-CoV-2 vaccines is based on either TLR-7/8 or TLR-9 agonism, which is distinct from previous vaccines and is a common pathogenic mechanism in IMDs. Methods: We evaluated IMD flares or new disease onset within 28-days of SARS-CoV-2 vaccination at five large tertiary centres in countries with early vaccination adoption, three in Israel, one in UK, and one in USA. We assessed the pattern of disease expression in terms of autoimmune, autoinflammatory, or mixed disease phenotype and organ system affected. We also evaluated outcomes. Findings: 27 cases included 17 flares and 10 new onset IMDs. 23/27 received the BNT - 162b2 vaccine, 2/27 the mRNA-1273 and 2/27 the ChAdOx1 vaccines. The mean age was 54.4 ± 19.2 years and 55% of cases were female. Among the 27 cases, 21 (78%) had at least one underlying autoimmune/rheumatic disease prior the vaccination. Among those patients with a flare or activation, four episodes occurred after receiving the second-dose and in one patient they occurred both after the first and the second-dose. In those patients with a new onset disease, two occurred after the second-dose and in one patient occurred both after the first (new onset) and second-dose (flare). For either dose, IMDs occurred on average 4 days later. Of the cases, 20/27 (75%) were mild to moderate in severity. Over 80% of cases had excellent resolution of inflammatory features, mostly with the use of corticosteroid therapy. Other immune-mediated conditions included idiopathic pericarditis (n = 2), neurosarcoidosis with small fiber neuropathy (n = 1), demyelination (n = 1), and myasthenia gravis (n = 2). In 22 cases (81.5%), the insurgence of Adverse event following immunization (AEFI)/IMD could not be explained based on the drug received by the patient. In 23 cases (85.2%), AEFI development could not be explained based on the underlying disease/co-morbidities. Only in one case (3.7%), the timing window of the insurgence of the side effect was considered not compatible with the time from vaccine to flare. Interpretation: Despite the high population exposure in the regions served by these centers, IMDs flares or onset temporally-associated with SARS-CoV-2 vaccination appear rare. Most are moderate in severity and responsive to therapy although some severe flares occurred. Funding: none.

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AB0669 PARTICULARITIES OF TUNISIAN FEMALE AXIAL SPONDYLOARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.6203 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1629.2-1629

Author(s):

K. Ben Abdelghani ◽

Y. Gzam ◽

A. Fazaa ◽

S. Miladi ◽

K. Ouenniche ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Disease Activity ◽

Axial Spondyloarthritis ◽

Activity Index ◽

Age At Onset ◽

Disease Onset ◽

Disease Activity Index ◽

Reactive Protein ◽

Significant Difference ◽

The Mean

Background:Axial spondyloarthritis (ax-SpA) is a chronic rheumatic disease that mainly affects men. However, the female form of ax-SpA remains insufficiently studied.Objectives:The aim of this study was to determine the clinical characteristics, the disease activity and the functional impact of female ax-SpA in comparison with male ax-SpA.Methods:This is a retrospective study including patients diagnosed with ax-SpA fulfilling the criteria of the Assessment of SpondyloArthritis international Society (ASAS) 2009.Clinical parameters, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Bath ankylosing spondylitis disease activity index (BASDAI) and Bath ankylosing spondylitis functional index (BASFI) were compared between groups of female and male ax-SpA.Results:Two hundred ax-SpA patients were included with 31% of female (n=62) and a mean age of 43,3 ± 11,2 years.The mean age at onset of symptoms was 31,8 ± 8,9 years for women and 25,3 ± 9,1 years for men (p <0,0001). The mean age at diagnosis was 36,4 ± 9,6 years for women and 31,7 ± 10,4 years for men (p = 0,003). Ax-SpA with juvenile onset was noted in 1,7% of women and 12,1% of men (p = 0,02). Male ax-SpA were significantly more smokers (46.8% vs 5.4%; p <0.001). The mean duration of morning stiffness was 11,3 ± 9,2 minutes for women versus 21,6 ± 19,3 minutes for men (p = 0,005).The mean ESR was 42,4 ± 29,8 mm for women and 28,3 ± 23,4 mm for men (p = 0,001). Radiographic sacroiliitis was present in 69,3% of women versus 84,7% of men (p = 0,01). The use of anti-TNF alpha was less frequent in women (29% vs 48,5%; p = 0,01).Our study didn’t found a statistically significant difference in peripheral manifestations, extraarticular manifestations, CRP, BASDAI and BASFI between the two groups.Conclusion:Female ax-SpA seems to have a better prognosis than male with older age in disease onset, less inflammation, less radiographic sacroiliitis and less use of biological treatments.References:[1]Rusman T, et al. Curr Rheumatol Rep. 2018; 20(6).[2]Siar N, et al. Curr Rheumatol Rev. 2019;Disclosure of Interests:None declared

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Pseudotumor cerebri in childhood and adolescence: data from a specialized service

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20180131 ◽

2018 ◽

Vol 76 (11) ◽

pp. 751-755 ◽

Cited By ~ 1

Author(s):

Gabriela G. M. Balbi ◽

Sandro L. Matas ◽

Claudio A. Len ◽

Melissa M. Fraga ◽

Iggor O. Sousa ◽

...

Keyword(s):

Rheumatic Disease ◽

Disease Onset ◽

Pseudotumor Cerebri ◽

Tertiary Hospital ◽

Outpatient Clinics ◽

Childhood And Adolescence ◽

Common Symptom ◽

Medical Reports ◽

Specialized Service ◽

The Mean

ABSTRACT Objective: To report cases of children and adolescents diagnosed with pseudotumor cerebri associated or not with rheumatic disease. Methods: This was a retrospective study based on medical reports of 29 patients, up to 18 years of age and diagnosed with pseudotumor cerebri, followed up in the Pediatric Rheumatology and Neurology outpatient clinics of a tertiary hospital, until December 2016. Results: Among the 29 patients diagnosed with pseudotumor cerebri, 51.7% were girls and the mean age at the disease onset was 12.3 years. In 18 patients (62%) where an etiology was found, four were associated with a rheumatic disease. The most common symptom was headache (69%) and acetazolamide was the most used medication (69%). Two patients developed blindness and 10 are still being followed up. Conclusion: Although rare, pseudotumor cerebri should be considered in children with headaches, especially in patients with rheumatic disease.

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Systemic Chemotherapy Including Ramucirumab in Combination With Pressurized Intra-Peritoneal Aerosol Chemotherapy Is a Safe Treatment Option for Peritoneal Metastasis of Gastric Cancer

Frontiers in Oncology ◽

10.3389/fonc.2020.610572 ◽

2021 ◽

Vol 10 ◽

Author(s):

Linda Feldbrügge ◽

Felix Gronau ◽

Andreas Brandl ◽

Timo Alexander Auer ◽

Alan Oeff ◽

...

Keyword(s):

Gastric Cancer ◽

Systemic Therapy ◽

Peritoneal Metastasis ◽

Systemic Chemotherapy ◽

Postoperative Morbidity ◽

Laparoscopic Technique ◽

Complication Rates ◽

The Mean ◽

Safe Treatment Option ◽

Length Of Interval

BackgroundPressurized intraperitoneal aerosol chemotherapy (PIPAC) is a laparoscopic technique for local chemotherapy. It has been used for treatment of peritoneal metastasis of gastric cancer (PM GC) in combination with systemic therapy. VEGFR2 antagonist ramucirumab is a second-line therapy for GC, and has been suspected to cause wound healing disorders.MethodsThis is a retrospective single center cohort study of patients with PM GC, who received PIPAC treatment in combination with systemic chemotherapy with and without ramucirumab. Data on patients’ characteristics and their perioperative courses were collected and complication rates were compared with regard to preoperative use of ramucirumab and time between last dose of systemic therapy and PIPAC treatment.ResultsFifty patients underwent 90 PIPAC treatments for PM GC in 3 years. Overall postoperative morbidity was 11% with 6% severe complications. The mean interval between systemic therapy and PIPAC was 20 days. Neither the length of interval nor the use of ramucirumab had an effect on complication rates.ConclusionOur study suggests that addition of ramucirumab to pre-PIPAC systemic therapy, irrespective of the length of the treatment-free interval before PIPAC, does not increase the risk of postoperative complications and is therefore a safe option for treatment of PM GC.

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P019 Adulthood of juvenile idiopathic arthritis patients: professional outcome

Rheumatology ◽

10.1093/rheumatology/keab722.011 ◽

2021 ◽

Vol 60 (Supplement_5) ◽

Author(s):

S Miladi ◽

S Bouzid ◽

A Fazaa ◽

L Souabni ◽

M Sellami ◽

...

Keyword(s):

Juvenile Idiopathic Arthritis ◽

College Graduates ◽

Disease Onset ◽

Cross Sectional Study ◽

Full Time ◽

Family Status ◽

Cross Sectional ◽

Telephone Interviews ◽

The Mean ◽

Professional Outcome

Abstract Background Juvenile idiopathic arthritis (JIA) is a heterogeneous group of rheumatic diseases characterized by onset before the age of 16. Since the disease starts at an early age, it may lead to socio-professional difficulties in adulthood for JIA patients. This study aimed to describe the professional outcome of a series of 20 JIA patients. Methods A cross-sectional study including patients aged 20 years and more and fulfilling the ILAR criteria for the diagnosis of JIA was carried out. Telephone interviews were conducted. The responders answered questions about family status, current occupation, working h, eventual workplace adjustments, and sick leave frequency. Results Twenty patients answered the questionary; 14 males and 6 females. The mean age of the disease onset was 8 years. The mean age of patients at the time of the study was 24.27 years [20–36]. Polyarticular form was the most frequent (10 cases). Other subtypes diagnosed were systemic (4 cases), enthesitis-related arthritis (5 cases), oligoarticular (one case). Hip arthritis was observed in 8 patients and surgical intervention was needed in three. Eight patients were treated with csDMARDSs and 12 with bDMARDs. Three of our patients were married (aged 24, 34, and 36). Five were still studying: 4 had good grades without absenteeism. However, one patient needed special aid to go to school and had a higher absence rate. Five other patients were full-time college students without absenteeism. Four patients were college graduates. Among them, two were searching for a job for >6 months. The other two were full-time administrative workers with no absenteeism. One patient did need workplace adjustments. Six patients could not work because of their physical disabilities. Conclusion According to our results, a quarter of our patients could not access professional life. Disease activity and hip destruction are the two main factors causing JIA patients to miss out on important personal and professional opportunities.

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Compliance Study in Peritoneal Dialysis Using Pdadequest Software

Peritoneal Dialysis International ◽

10.1177/089686089601601s33 ◽

1996 ◽

Vol 16 (1_suppl) ◽

pp. 176-178 ◽

Cited By ~ 11

Author(s):

Gianpaolo Amici ◽

Giusto Viglino ◽

Giovambattista Virga ◽

Carmen Gandolfo ◽

Giorgio Da Rin ◽

...

Keyword(s):

Mathematical Model ◽

Peritoneal Dialysis ◽

Filtration Rate ◽

Threshold Value ◽

Control Group ◽

Case Histories ◽

Peritoneal Equilibration Test ◽

Software Model ◽

Noncompliant Patient ◽

The Mean

Poor compliance in peritoneal dialysis (PD) is a significant cause of dropout and morbidity. PD Adequest software, which, through a mathematical model, predicts the effect of the dialysis prescription on the basis of the peritoneal transport, may be used to identify the noncompliant patient. Fifty patients from two dialysis centers, aged 65.9±1.5 years and on PD for 28.6±4.7 months, were studied. A peritoneal equilibration test (PET) was carried out and 24hour urine and dialysate were collected. Total weekly creatinine clearance (CrCI, L/week/1.73 m2) was calculated, as well as the glomerular filtration rate [(GFR), mL/min, mean CrCI and urea nitrogen clearance (UNCI)]. The dialytic schedules used were then introduced into the program and the parameters were recalculated using the software model. Nine patients considered noncompliant from their case histories were used to assess the differences of reference between expected and measured values. The control group was significantly different from the noncompliant group in the percentage of the CrCI and the serum creatinine (sCR) differences. The noncompliance threshold value was calculated from the mean of the lower 95% confidence interval of the compliant group and the higher one of the noncompliant group (-5.3%) for CrCI and vice versa for sCR (+10%), which behaved to the contrary. Reassessing the patients, 11 (22%) were identified as probably noncompliant.

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Laparoscopic resection of hepatic epithelioid hemangioendothelioma: report of eleven rare cases and literature review

World Journal of Surgical Oncology ◽

10.1186/s12957-020-02034-z ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Jianjun Xu ◽

Shaobo Hu ◽

Suzhen Li ◽

Weimin Wang ◽

Xing Zhou ◽

...

Keyword(s):

Laparoscopic Resection ◽

Laparoscopic Hepatectomy ◽

Epithelioid Hemangioendothelioma ◽

Borderline Tumor ◽

Vascular Endothelial ◽

Epithelioid Angiosarcoma ◽

Ki 67 ◽

Union Hospital ◽

The Mean

Abstract Background Hepatic epithelioid hemangioendothelioma (HEHE) is an extremely rare borderline tumor of vascular endothelial origin. Laparoscopic resection of HEHE has never been reported. Methods The clinical data of eleven patients with HEHE (4 women and 7 men) who were diagnosed and treated at the Union Hospital (Wuhan, China), and Wuhan Asia General Hospital (Wuhan, China), between March 2012 and July 2020 were analyzed retrospectively. Results The mean age of HEHE patients was 42.4 ± 13.9 years (range 22–67 years). All patients underwent laparoscopic surgery alone or in combination with radiofrequency ablation. Most tumors showed aggressive growth or metastasis. By immunohistochemistry, tumor cells were positive for CD31, CD34, ERG, PCK, FLi-1, TFE-3, and Ki-67 (labeling index range, 5–15%). In one of the patients, the tumor was accompanied by partial necrosis with a local appearance of epithelioid angiosarcoma. Postoperative adjuvant treatment included chemotherapy, sorafenib, and Huaier granule. As of July 2020, the median follow-up duration was 36 months (range, 9–60 months), with 2 (18.2%) patients experiencing tumor recurrence. Conclusions This is the first report of laparoscopic hepatectomy of HEHE. Curative laparoscopic hepatectomy might be an acceptable treatment for appropriate HEHE patients.

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Progressive supranuclear palsy in a sample of brazilian population: clinical features of 16 patients

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2002000600006 ◽

2002 ◽

Vol 60 (4) ◽

pp. 917-922 ◽

Cited By ~ 14

Author(s):

Paulo Eduardo Mestrinelli Carrilho ◽

Egberto Reis Barbosa

Keyword(s):

Progressive Supranuclear Palsy ◽

Clinical Features ◽

Age Of Onset ◽

Disease Onset ◽

Final Diagnosis ◽

Postural Instability ◽

Chronic Dacryocystitis ◽

Neurologic Disorders ◽

The Mean ◽

Vertical Gaze

Progressive supranuclear palsy (PSP) is an uncommon disorder characterized by marked postural instability, vertical gaze abnormalities and axial rigidity. The purpose of this study is to report the clinical features of 16 consecutive subjects seen over a 10-year period at a Movement Disorders Clinic. These subjects fulfilled criteria for probable PSP namely those of the National Institute of Neurologic Disorders and Stroke (NINDS) and the Society for PSP (SPSP). This patient-group represented 2.1% of all degenerative parkinsonians observed and the mean age of onset of the disease was 64.7 years (sd = ± 7.2). Postural instability with falls was the most frequent initial feature presented in PSP patients (62.5%). The hallmark of the disease, the supranuclear vertical gaze palsy, appeared after 2.3 years of disease onset, and only 12.5% had such manifestation at the first evaluation. Transient tremor was observed with a relatively high frequency in this group (44%), but only 19% had rest tremor. Chronic dacryocystitis, probably related to a paucity of blinking, was observed in two patients as an inaugural manifestation. In the first evaluation, only 19% of the 16 patients were diagnosed as probable PSP. The mean interval prior to the final diagnosis was 2.4 years.

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