Evaluation of pullout strength and failure mechanism of posterior instrumentation in normal and osteopenic thoracic vertebrae

Object There is limited data on the pullout strength of spinal fixation devices in the thoracic spine among individuals with different bone quality. An in vitro biomechanical study on the thoracic spine was performed to compare the pullout strength and the mechanism of failure of 4 posterior fixation thoracic constructs in relation to bone mineral density (BMD). Methods A total of 80 vertebrae from 11 fresh-frozen thoracic spines (T2–12) were used. Based on the results from peripheral quantitative CT, specimens were divided into 2 groups (normal and osteopenic) according to their BMD. They were then randomly assigned to 1 of 4 different instrumentation systems (sublaminar wires, pedicle screws, lamina claw hooks, or pedicle screws with wires). The construct was completed with 2 titanium rods and 2 transverse connectors, creating a stable frame. The pullout force to failure perpendicular to the rods as well as the pattern of fixation failure was recorded. Results Mean pullout force in the osteopenic Group A (36 vertebrae) was 473.2 ± 179.2 N and in the normal BMD Group B (44 vertebrae) was 1414.5 ± 554.8 N. In Group A, no significant difference in pullout strength was encountered among the different implants (p = 0.96). In Group B, the hook system failed because of dislocation with significantly less force than the other 3 constructs (931.9 ± 345.1 N vs an average of 1538.6 ± 532.7 N; p = 0.02). In the osteopenic group, larger screws demonstrated greater resistance to pullout (p = 0.011). The most common failure mechanism in both groups was through pedicle base fracture. Conclusions Bone quality is an important factor that influences stability of posterior thoracic implants. Fixation strength in the osteopenic group was one-fourth of the value measured in vertebrae with good bone quality, irrespective of the instrumentation used. However, in normal bone quality vertebrae, the lamina hook claw system dislocated with significantly less force when compared with other spinal implants. Further studies are needed to investigate the impact of different transpedicular screw designs on the pullout strength in normal and osteopenic thoracic spines.

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The Impact of Visual Aids on the Retention of English Word Stress Patterns

International Journal of Applied Linguistics & English Literature ◽

10.7575/aiac.ijalel.v.7n.2p.225 ◽

2018 ◽

Vol 7 (2) ◽

pp. 225 ◽

Cited By ~ 1

Author(s):

Farid Ghaemi ◽

Fahimeh Rafi

Keyword(s):

English Word ◽

Placement Test ◽

Visual Aids ◽

Word Stress ◽

Significant Difference ◽

Group A ◽

Group B ◽

The Impact ◽

Stress Patterns

The present study aimed at comparing the effectiveness of three different techniques on learners’ long term memorization of English word stress patterns. After administering a quick placement test, 67 Iranian EFL elementary learners at language institutes were selected to participate in the study. Then they were divided into three groups. Before starting the instruction, a pretest was conducted to classify the participants’ abilities on word stress patterns. Then the new techniques were used to teach English word stress patterns. In all three groups, words were printed largely on a piece of paper and the syllables were clearly specified by dots. In group ‘A’, pronunciation and stress pattern of new words were taught aurally through the repetition of the words. In group ‘B’, all the procedure was exactly similar to that of group ‘A’, the only difference was that the stressed syllables were printed in bold. In group ‘C’, all the procedure was exactly similar to that of group ‘B’, except that the stressed syllables were not only printed in bold, but also introduced by teacher’s hand gesture. After two weeks, a delayed posttest was conducted to check long term memorization of the word stress patterns. The results of the study indicated that there was a significant difference between pretest and delayed posttest in all three groups. But the most meaningful difference belonged to group ‘C’. That is, the participants in the third group (gesture group) outperformed those in the other groups. Finally, some implications and suggestions provided for further research.

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Outcomes of Flank-Free Modified Supine Percutaneous Nephrolithotomy Based on BMI

Urologia Internationalis ◽

10.1159/000511292 ◽

2020 ◽

pp. 1-6

Author(s):

Esam Desoky ◽

Khaled M. Abd Elwahab ◽

Islam M. El-Babouly ◽

Mohammed M. Seleem

Keyword(s):

Percutaneous Nephrolithotomy ◽

Supine Position ◽

Normal Weight ◽

Significant Difference ◽

Group A ◽

Morbid Obese ◽

Group B ◽

A Prospective Study ◽

Nonobese Patients ◽

The Impact

Objective: To evaluate the impact of body mass index (BMI) on the outcomes of percutaneous nephrolithotomy (PCNL) in the flank-free modified supine position. Patients and Methods: A prospective study was carried out in the urology department during the period from May 2015 to October 2019 on 464 patients admitted for PCNL. The patients were divided into 4 matched groups according to their BMI: group A, normal weight with 18.5 ≤ BMI <25 kg/m2; group B, overweight with 25 ≤ BMI <30 kg/m2; group C, obese with 30 ≤ BMI <40 kg/m2; and group D, morbid obesity with BMI ≥40 kg/m2. All operative data as well as postoperative outcomes are recorded and compared to each other. Results: The 4 studied groups were matched regarding age. The comorbidities were slightly higher in groups C and D. The operative time and fluoroscopy time were slightly high in obese and morbid obese groups but with no significant difference. The rate of complications either major or minor was comparable in all groups. No significant difference was seen among all groups regarding hemoglobin loss, stone-free rate, hospital stay, and need for auxiliary procedures. Conclusions: The outcome of PCNL in flank-free modified supine position is not affected by changes in BMI. The procedure can be performed in obese and morbid obese patients safely with results similar to and comparable to nonobese patients.

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Impact of glycosylated haemoglobin (HbA1c) levels on outcomes in patients with myocardial infarction

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20210077 ◽

2021 ◽

Vol 8 (2) ◽

pp. 186

Author(s):

Prabhat Pandey ◽

Neeraj Dokania ◽

Pooja Pandey ◽

Ajay Singh Raghuwanshi

Keyword(s):

Myocardial Infarction ◽

Glycosylated Hemoglobin ◽

Age Group ◽

Percentage Mortality ◽

Coronary Syndrome ◽

Significant Difference ◽

Group A ◽

Group B ◽

The Impact ◽

Hba1c Levels

Background: People with diabetes have an increased prevalence of atherosclerosis and coronary heart disease (CHD) and experience higher morbidity and mortality after acute coronary syndrome and myocardial infarction than people without diabetes. Diabetes also appears to be a major cause of the higher rate of both short and long-term mortality observed in women hospitalized with acute MI compared to men. Objective of the study was to observe the impact of glycosylated hemoglobin (HbA1c) levels on outcomes in MI.Methods: The prospective observational study was conducted on 200 patients from the age group more than 36 years and lesser than 95 years presented with acute myocardial infarction (STEMI or NSTEMI). Patients were divided into group A (Diabetics) and group B (non-diabetics). Investigations performed were FBS, RBS, HbA1c, CBC, LFT, RFT, lipid profile, ECG and echocardiography. Patients were followed up till discharge/death and all complications like arrhythmias, cardiac failure, cardiogenic shock and re infarction were noted.Results: Majority of the 34.5% patients belongs to the age group of 56-65 years. No significant difference found between the subject population of the diabetic and non-diabetic group. The percentage of mortality in male patients was reported higher in the group having HbAlc level ≥7 (21.15%) in comparison to a group having HbAlc level <7 (6.15%) whereas in females the percentage of mortality was 11.63% in the group having HbAlc ≥7 , higher than the group having HbAlc level <7, 2.5%. Percentage mortality was higher in the patients having HbAlc >7, in both groups’ patients aged below 60 years 14.81% and 17.65% in the group of patients aged above 60 years.Conclusions: Higher HbAlc level significantly affects the outcome of MI patients. The percentage mortality due to MI was higher in male with aged above 60 years and having HbAlc level >7.

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PS01.196: SHORT-TERM AND MEDIUM-TERM OUTCOMES IN PATIENTS OVER 70 DIAGNOSED WITH OESOPHAGEAL CANCER

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.196 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 105-105

Author(s):

Anantha Madhavan ◽

Nicola Wyatt ◽

Charlotte Boreham ◽

Alexander Phillips ◽

S Michael Griffin

Keyword(s):

Oesophageal Cancer ◽

Conflicts Of Interest ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Major Complication ◽

Radio Therapy ◽

Significant Difference ◽

Group A ◽

Group B ◽

The Impact

Abstract Background Oesophageal cancer incidence has increased over the last decade in the UK, particularly in older patients. Surgery, with or without perioperative chemotherapy, remains the gold standard treatment for patients with potentially curable disease. Currently, 41% of new cases of oesophageal cancer are in patients aged over 70. However, only 10% underwent surgery compared to 25% of those aged under 70. Concerns exist that advanced age may prejudice treatment decisions. The aim of our review is to evaluate the impact of age on outcomes in those undergoing planned curative treatment for oesophageal cancer. Methods A retrospective review of patients undergoing oesophagectomy for carcinoma between 2006 to 2016 at a single institution was performed. Patients were divided into two cohorts based on age at the time of diagnosis; under 70 years (Group A) and over 70 (Group B). Patients underwent a standardised staging protocol and treatment was decided by a multi-disciplinary team. Oesophagectomy was performed using a transthoracic approach with two field lymphadenectomy and perioperative chemo (radio) therapy used in those patients with locally advanced disease who were fit enough. Results There were 555 patients in Group A and 241 in Group B. Adenocarcinoma was the prevalent histological subtype in both cohorts: 76% (423) in Group A and 68% (165) in Group B. Median age at the time of diagnosis was 62 in Group A versus 74 in Group B. In Group A, 12% (18/343) did not receive neo-adjuvant treatment for locally advanced cancer versus 47% (101/212) in Group B (P < 0.001). Median hospital stay was longer in Group B (18 v 15 days P = 0.02). There was no significant difference in hospital mortality (Group A 1% vs Group B 2.4% P = 0.37) and major complication rate (Group A 14% vs Group B 20% P = 0.31). Two-year survival was 66% (adenocarcinoma) and 78% (SCC) in Group A compared to 60% (adenocarcinoma) and 64% (SCC) in Group B. Conclusion These results demonstrate that patients over 70 can be treated successfully with minimal additional risk to morbidity and mortality. However, these patients are more likely to be denied neoadjuvant treatment which may compromise their long-term outcomes. Disclosure All authors have declared no conflicts of interest.

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P–318 Short (seven days) versus conventional (fourteen days) estrogen priming in an artificial frozen embryo transfer cycle: a randomised controlled trial

Human Reproduction ◽

10.1093/humrep/deab130.317 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

A Racca ◽

S Santos-Ribeiro ◽

D Panagiotis ◽

L Boudry ◽

S Mackens ◽

...

Keyword(s):

Pregnancy Rate ◽

Embryo Transfer ◽

Live Birth ◽

Transvaginal Ultrasound ◽

Clinical Pregnancy ◽

Frozen Embryo Transfer ◽

Significant Difference ◽

Group A ◽

Group B ◽

The Impact

Abstract Study question What is the impact of seven days versus fourteen days’ estrogen (E2) priming on the clinical outcome of frozen-embryo-transfer in artificially prepared endometrium (FET-HRT) cycles? Summary answer No significant difference in clinical/ongoing pregnancy rate was observed when comparing 7 versus 14 days of estrogen priming before starting progesterone (P) supplementation. What is known already One (effective) method for endometrial preparation prior to frozen embryo transfer is hormone replacement therapy (HRT), a sequential regimen with E2 and P, which aims to mimic the endocrine exposure of the endometrium in a physiological cycle. The average duration of E2 supplementation is generally 12–14 days, however, this protocol has been arbitrarily chosen whereas, the optimal duration of E2 implementation remains unknown. Study design, size, duration This is a single-center, randomized, controlled, open-label pilot study. All FET-HRT cycles were performed in a tertiary centre between October 2018 and December 2020. Overall, 150 patients were randomized of whom 132 were included in the analysis after screening failure and drop-out. Participants/materials, setting, methods The included patients were randomized into one of 2 groups; group A (7 days of E2 prior to P supplementation) and group B (14 days of E2 prior to P supplementation). Both groups received blastocyst stage embryos for transfer on the 6th day of vaginal P administration. Pregnancy was assessed by an hCG blood test 12 days after FET and clinical pregnancy was confirmed by transvaginal ultrasound at 7 weeks of gestation. Main results and the role of chance Following the exclusion of drop-outs and screening failures, 132 patients were finally included both in group A (69 patients) or group B (63 patients). Demographic characteristics for both groups were comparable. The positive pregnancy rate was 46.4% and 53.9%, (p 0.462) for group A and group B, respectively. With regard to the clinical pregnancy rate at 7 weeks, no statistically significant difference was observed (36.2% vs 36.5% for group A and group B, respectively, p = 0.499). The secondary outcomes of the study (biochemical pregnancy, miscarriage and live birth rate) were also comparable between the two arms for both PP and ITT analysis. Multivariable logistic regression showed that the HRT scheme is not associated with pregnancy rate, however, the P value on the day of ET is significantly associated with the pregnancy outcome. Limitations, reasons for caution This study was designed as a proof of principle trial with a limited study population and therefore underpowered to determine the superiority of one intervention over another. Instead, the purpose of the present study was to explore trends in outcome differences and to allow us to safely design larger RCTs. Wider implications of the findings: The results of this study give the confidence to perform larger-scale RCTs to confirm whether a FET-HRT can be performed safely in a shorter time frame, thus, reducing the TTP, while maintaining comparable pregnancy and live birth rates. Trial registration number NCT03930706

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Abstract T MP60: Impact of Aortic Arch Atheroma for Stroke Recurrence in Patients With or Without Atrial Fibrillation

Stroke ◽

10.1161/str.46.suppl_1.tmp60 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Shigeru Fujimoto ◽

Masato Osaki ◽

Masaya Kumamoto ◽

Makoto Kanazawa ◽

Naoki Tagawa ◽

...

Keyword(s):

Atrial Fibrillation ◽

Aortic Arch ◽

Proportional Hazards Model ◽

Cox Proportional Hazards Model ◽

Rank Test ◽

Stroke Recurrence ◽

Significant Difference ◽

Group A ◽

Group B ◽

The Impact

Background & Purpose: In patients with embolic stroke of undetermined source, aortic arch atheroma evaluated using transesophageal echocardiography (TEE) is a possible embolic source. We investigated the impact of embolic sources including aortic arch atheroma for a stroke recurrences and death. Methods: Among the consecutive 1545 acute stroke patients, 542 patients who were admitted within 24 hours after the symptom onset, with ischemic lesions in the cortex or cerebellum on the diffusion-weighted image, NIH stroke scale of 7 or less, and prior modified Rankin scale (mRS) of 0 or 1 were included in the present study. All 542 patients underwent TEE to search for embolic sources. According to the categories of embolic sources, patients were classified into 4 groups: patients with severe aortic arch atheroma of 4mm or more in diameter (group A; n=167), patients with cardiogenic embolic sources such as atrial fibrillation or intracardiac thrombus (group C; n=93), patients with both factors as described above (group B; n=88), and other patients (group O; n=194). We followed them up for average period of 3.2 years, and investigated the frequency of stroke recurrences and death from any cause according to embolic sources. Results: Stroke recurrences were observed in 12.0% patients in group A, 11.8% patients in group C, 18.2% patients in group B, and 6.7% patients in group O respectively (p=0.0371). Stroke recurrences and death from any cause occurred in 14.4%, 15.1%, 21.6% and 6.7% patients respectively (p=0.0041). Kaplan-Meier curve analysis revealed a significant difference in the recurrence-free survival among the four groups (p=0.0076, log-rank test). Stroke recurrence was more frequent in group B than group C patients especially in the early phase from the onset. On COX proportional-hazards model analysis and diabetes mellitus (HR 1.73, p=0.0264) and aortic arch atheroma of 4mm or more (HR 1.86, p=0.0146) were significant predictors for stroke recurrences and death from any cause. Conclusions: Severe aortic arch atheroma can independently be associated with stroke recurrences and death, furthermore, a combination of aortic arch atheroma and cardiogenic embolic sources showed more frequent events than each of them alone.

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The Impact of Sex Steroids Inhibiter on Thymic Function Following Hematopoietic Stem Cell Transplantation

Blood ◽

10.1182/blood.v112.11.4599.4599 ◽

2008 ◽

Vol 112 (11) ◽

pp. 4599-4599

Author(s):

Xiaodan Luo ◽

Qifa Liu ◽

Zhiping Fan ◽

Yu Zhang ◽

Juan Ning

Keyword(s):

Stem Cell ◽

Hematopoietic Stem Cell Transplantation ◽

Acute Gvhd ◽

Control Group ◽

Hematopoietic Stem ◽

Thymic Function ◽

Significant Difference ◽

Group A ◽

Group B ◽

The Impact

Abstract Objective To evaluate the impact of luteinizing hormone-releasing hormone (LHRH) on the protection of thymic function after allogenic hematopoietic stem cell transplantation (allo-HSCT). Methods Established model of allogenic murine HSCT (C57BL/6→BALB/c). The severity of acute graft-versus-host-disease (GVHD) was assessed by a clinical scoring system that incorporates five clinical parameters: weight loss, posture, activity, fur texture and skin integrity. The intra-cellular levels of interferon-γ (INFγ), tumor necrosis factor-α (TNFα) and interleukin-1β (IL-1β) in thymocyte were analyzed by protein array and thymic function was evaluated by quantification of signaljoint TCR rearrangement excision circles (sjTRECs). Results Recipients in group A (allogenic mice), B( allogenic LHRH castrated-mice) and C (syngenic mice) all attained hematopoiesis reconstitution. White blood cell counts of mice in groups A, B and C were over 1.0×109/L on day (10.60±1.34), day (9.40±0.55) and day (9.40±0.89), respectively. There was no significant difference among the time of hematopoiesis reconstitution in three groups. The time of acute GVHD occuring was on day +11±0.5 and +14±0.5 posttransplantation, respectively, in groups A and B, and all mice had acute GVHD with the incidence of 100% in groups A and B. The average scores of acute GVHD in groups A and B were (1.56±0.51) and (0.92±0.49), respectively. Acute GVHD scores in group A was significantly higher than that in group B (P=0.000). The levels of INFγ, TNFα and IL-1β in control groups were 1.67±1.76 ng/ml, 1.69±1.07 pg/ml and 5.55±3.56 pg/ml, respectively. The levels of INFγ in groups A, B and C were (10.74±2.55) ng/ml,(6.81±2.33) ng/ml and (5.52±3.96) ng/ml, respectively. The levels of TNFα were (7.51±2.89) pg/ml, (4.30±0.63) pg/ml and (3.36±2.31) pg/ml, respectively. The levels of IL-1β were (25.83±8.91) pg/ml, (19.33±3.03) pg/ml and (11.94±4.00) pg/ml, respectively. There were significant differences in the levels of cytokines between group A and the control group (P=0.000, 0.000, 0.000). The levels of cytokines in group B were significantly higher than those of control group (P 0.010,0.037,0.000). The levels of INFγ in group C were significantly higher than those of the control group (P=0.044). Among groups A, B and C, there were significant differences in the levels of INFγ, TNFα and IL-1β (P=0.001,0.000,0.000). The levels of INFγ and TNFα in group A were significantly higher than those in group B (P=0.041,0.013). The levels of INFγ, TNFα and IL-1β in group A were significantly higher than those in group C (P=0.009, 0.002, 0.000). The analysis of linear regression showed that the average levels of INFγ paralled with aGVHD scores (r2 0.363,P=0.038). The average sjTRECs copies/1000 PBMNCs were (39.41±44.68) in the control group and (12.29±13.02), (58.01±71.82) and (19.61±14.59) in groups A, B and C, respectively. There was no significant difference in the multiple comparisons of peripheral blood levels of sjTRECs among these four groups (P=0.575). Conclusion INFγ ATNFα and IL-1β might be involved in the damage to the thymus by acute GVHD. Sex steroid inhibitor can not only reduce the severity of thymic damage after allo-HSCT, but also reduce the severity of aGVHD and the mechanism might be associated with the reduction of intracellular levels of INFγ and TNFα in thymocyte.

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Spinous Process Combined with a Titanium Mesh Cage as a Bone Graft in the Stability Reconstruction of Lumbar or Lumbosacral Spinal Tuberculosis

10.21203/rs.3.rs-817359/v1 ◽

2021 ◽

Author(s):

Hongqi Zhang ◽

Lige Xiao ◽

mingxing Tang ◽

Guanteng Yang

Keyword(s):

Operative Time ◽

Spinous Process ◽

Spinal Tuberculosis ◽

Pedicle Screws ◽

Titanium Mesh ◽

Bony Fusion ◽

Significant Difference ◽

Group A ◽

Group B ◽

Posterior Debridement

Abstract Background. To investigate the clinical efficacy of one-stage posterior debridement using the spinous process (SP) combined with titanium mesh cages (TMCs) as interbody grafts for the treatment of single-segment lumbar or lumbosacral spinal tuberculosis.Methods. From 2010 to 2018, 69 patients who underwent one-stage posterior debridement using grafts and internal fixation within a single lumbar or lumbosacral segment were included in this study. 12 cases using the SP combined with a TMC (SP+TMC, group A), 30 cases using a TMC only (group B), and 27 cases using allografts (group C) were included. Measurements including operative time, blood loss, hospital stay, visual analogue scale (VAS) score, Oswestry Disability Index (ODI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), American Spinal Injury Association Impairment (ASIA) grade, final follow-up (FFU) duration and postoperative complications were recorded. Radiological measurements, including the number of segments fixated, the number of pedicle screws used, the Cobb angle, pelvic parameters, and the bony fusion time, were reviewed. All outcomes were analysed using SPSS 25.Results. We found that group A had fewer fixation segments (1.67±0.64 vs 2.81±0.94, pAC<0.01), fewer pedicle screws implanted (5.05±1.29 vs 6.85±1.37, pAC<0.01), a shorter operative time (166.43±44.11 min vs 205.93±51.73 min, pAC<0.01), reduced blood loss (543.81±230.81 ml vs 803.70±446.78 ml, pAC<0.01), and a strikingly lower hospital cost (14710.42±2354.55$ vs 19260.34±3310.75$, pAC<0.01) than group C.Compared to group B, group A had a lower economic cost (16680.23±3614.73$ vs 14710.42±2354.55$, pAB=0.03). There was no significant difference in bony fusion time among the three groups (8.90 ±2.11 months vs 8.60±2.39 months vs 9.59 ±2.04 months, p>0.01). No significant difference was observed with respect to pre- or postoperative ESR and CRP (p>0.01). There was no significant difference among the 3 groups with respect to the ODI, VAS score or ASIA grade during any period. No differences regarding the hospital stay, rate of complications, loss of PI-LL, correction or loss of Cobb angle were observed among the three groups (p>0.01).Conclusion. Our study demonstrates that compared to a TMC or allograft, the use of the SP combined with a TMC as a bone graft is an effective and reliable approach for the surgical management of one-level lumbar or lumbosacral spinal tuberculosis, leading to good restoration of spinal stability. Furthermore, this approach is an economical structural bone grafting method, especially for patients in developing countries or areas.

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Evidence of improved surgical outcome following endoscopy for nonfunctioning pituitary adenoma removal

Neurosurgical FOCUS ◽

10.3171/2011.1.focus10308 ◽

2011 ◽

Vol 30 (4) ◽

pp. E11 ◽

Cited By ~ 80

Author(s):

Mahmoud Messerer ◽

Juan Carlos De battista ◽

Gérald Raverot ◽

Sebouh Kassis ◽

Julie Dubourg ◽

...

Keyword(s):

Surgical Outcome ◽

Lateral Extension ◽

Total Removal ◽

Cavernous Sinus Invasion ◽

Endoscopic Techniques ◽

Significant Difference ◽

Group A ◽

Group B ◽

The Impact

Object Because of their size and lateral extension, total removal of nonfunctioning pituitary adenomas (NFPAs) remains a challenge and postoperative tumor remnants are frequent. Endoscopy has improved the surgeon's view; however, its superiority in terms of surgical outcome remains undetermined. The authors' aim in this study was to compare the clinical results and morbidity between microscopic and endoscopic techniques in 164 patients with NFPAs. Methods Tumoral (3D MR imaging), endocrinological, and ophthalmological results and morbidity were compared between 2 groups of 82 patients with newly diagnosed NFPAs surgically treated via either a sublabial microscopic approach (Group B) or a fully endonasal endoscopic technique (Group A). Results The groups showed no difference in terms of clinical features, tumor size, or cavernous sinus invasion (p > 0.05). One year postoperatively, the quality of resection was significantly improved in Group A (gross-total removal [GTR]: 74% vs 50% in Group B, p = 0.002) with greater control of lateral extension (Knosp Grade 2: GTR 88.2% vs 47.8% in Group B, p = 0.02; Knosp Grade 3: 67.9% vs 16.7% in Group B, p < 0.001) and suprasellar extension (tumor height 20–30 mm: GTR 76% vs 53% in Group B, p = 0.01). Endocrinological outcome in patients with a partial deficiency in anterior pituitary function preoperatively was significantly better in Group A (improvement 56% vs 25% in Group B, stabilization 22% vs 46%, and aggravation 22% vs 29%; p = 0.01). Among the ophthalmologically symptomatic patients, 100% from Group A improved compared with 93% in Group B (p = 0.35). Lastly, no significant difference was found regarding morbidity. These data were supported by the literature in which the GTR rate is consistently higher for endoscopy compared with microscopy. Conclusions In this large series of patients with NFPAs, endoscopy improved the quality of resection and endocrinological outcome. Larger studies focusing on the impact of these promising results on the long-term recurrence of NFPAs are warranted.

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Bilateral Use of Iliac Branch Devices for Aortoiliac Aneurysms Is Safe and Feasible, and Procedural Volume Does Not Seem to Affect Technical or Clinical Effectiveness: Early and Midterm Results From the pELVIS International Multicentric Registry

Journal of Endovascular Therapy ◽

10.1177/15266028211016439 ◽

2021 ◽

pp. 152660282110164

Author(s):

Mario D’Oria ◽

Georgios A. Pitoulias ◽

Giovanni F. Torsello ◽

Apostolos G. Pitoulias ◽

Stefano Fazzini ◽

...

Keyword(s):

Study Groups ◽

Primary Patency ◽

Type I ◽

Mortality And Morbidity ◽

Procedural Volume ◽

Significant Difference ◽

Group A ◽

Group B ◽

The Impact

Objective To evaluate early and follow-up outcomes following bilateral use of iliac branch devices (IBD) for aortoiliac endografting and assess the impact of center volume. We used data from the pELVIS international multicentric registry. Methods For the purpose of this study, only those patients receiving concomitant bilateral IBD implantation were analyzed. To assess the impact that procedural volume of bilateral IBD implantation could have on early and follow-up outcomes, participating institutions were classified as Site(s) A if they had performed >10 and/or >20% concomitant bilateral IBD procedure, otherwise they were classified as Site(s) B. Endpoints of the analysis included early (ie, 30-day) mortality and morbidity, as well as all-cause and aneurysm-related mortality during follow-up. Additional endpoints that were evaluated included IBD-related reinterventions, IBD occlusion or stenosis requiring reintervention (ie, loss of primary patency), and IBD-related type I endoleak. Results Overall, 96 patients received bilateral IBD implantation (out of 910 procedures collected in the whole pELVIS cohort), of whom 65 were treated at Site A (ie, Group A) and 31 were treated at Site(s) B (ie, Group B). In total, only 1 death occurred within 30 days from bilateral IBD implantation, and 9 patients experienced at least 1 major complication without any significant difference between subjects in Group A versus those in Group B (10.8% vs 6.5%, p=0.714). In the overall cohort, the 2-year freedom from IBD-related type I endoleaks and IBD primary patency were 96% and 92%, respectively; no significant differences were seen in those rates between Group A or Group B (95% vs 100%, p=0.335; 93% vs 88%, p=0.470). Freedom from any IBD-related reinterventions was 83% at 2 years, with similar rates between study groups (85% vs 83%, p=0.904). Conclusions Within the pELVIS registry, concomitant bilateral IBD implantation is a safe and feasible technique for management of aortoiliac aneurysms in patients with suitable anatomy. Despite increased technical complexity, effectiveness of the repair is satisfactory with low rates of IBD-related adverse events at mid-term follow-up. Procedural volume does not seem to affect technical or clinical outcomes after bilateral use of IBD, which remains a favorable treatment option in selected patients.

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