LAPROSCOPIC MYOMECTOMY VERSUS OPEN MYOMECTOMY FOR UTERINE FIBROIDS

Fibroids are common benign tumours arising in the uterus.Myomectomy is the surgical treatment of choice forwomenwith symptomatic fibroids who prefer or want uterine conservation. Myomectomy can be performed by laparoscopy or open myomectomy. Aim of study is to determine the benefits and harms of laparoscopic myomectomy compared with open myomectomy.It is a comparative study conductedover 1 year in Department of Obstetrics and Gynecology, GMC ,Akola,Maharashtra . 50 patients were included in study who were having uterine fibroid. Subjects were explained about surgery as treatment.30 subject undergone Laproscopic myomectomy and 20 subjects undergone open myomectomy.The clinical data of patients who underwent OM and LM was analyzed. The data recorded comprised patientdemographic information and clinical characteristics includingage, weight, type, and size of myoma and myomectomyindications; and perioperative data including estimation ofblood loss, duration of surgery, complications, and lengthof hospital stay. Keywords: Laproscopic myomectomy (LM), open myomectomy(OM), uterine fibroid.

Triplet versus doublet neoadjuvant chemotherapy regimens for locally advanced gastric cancer: a propensity score matching analysis

Background To investigate the differences between doublet and triplet neoadjuvant chemotherapy (NAC) regimens in efficacy and safety profile. Methods A total of 227 locally advanced gastric cancer (LAGC) patients who received NAC and sequential radical gastrectomy were reviewed. After propensity score matching (PSM), 140 patients with similar baseline characteristics were selected. Among them, 70 received doublet NAC regimens consisted of platinum and fluorouracil; the other 70 received triplet NAC regimens consisted of docetaxel, platinum, and fluorouracil. Results The efficacy of doublet and triplet regimens was comparable after propensity score matching in terms of tumor regression (pathological complete response, Doublet 11.4% vs. Triplet 15.7%, p = 0.642), achieving of R0 resection (Doublet 88.6% vs. Triplet 88.6%, p = 1), 1-year disease-free survival (DFS) (Doublet 77.1% vs. Triplet 68.6%, p = 0.178), 3-years overall survival (OS) (Doublet 54.3% vs. Triplet 60.9%, p = 0.941). Post-surgery complications were more common in the triplet cohort (Doublet 5.7% vs. Triplet 27.1%, p = 0.001), especially abdominal infection (Doublet 0% vs. Triplet 11.1%, p = 0.001). Conclusions A more intense preoperative triplet NAC regimen does not bring extra downstage effect and survival benefit compared to a doublet regimen. It may even result in a higher risk of post-surgery complications.

ALD coated polypropylene hernia meshes for prevention of mesh-related post-surgery complications: An experimental study in animals

In this work, thermal atomic layer deposition (ALD) was used to synthesize vanadium (V)-doped TiO2 thin nanofilm on polypropylene (PP) hernia meshes. Multiple layers of (Al2O3+TiVOx) nano-films were coated on the PP hernia mesh surface to provide a layer with a total thickness of 38 nm to improve its antibacterial properties, thereby, prevent mesh-related post-surgery complications. Highly conformal V-doped TiO2 nanofilm were deposited on PP mesh at a temperature of 85 °C. Rats and rabbits have been used to evaluate the tissue reaction on coated PP hernia meshes and biomechanical testing of the healed tissue. 5 rabbits and 10 rats have been implanted with ALD coated and uncoated (control) PP meshes into the back of rats and abdominal wall of rabbits. Histology of the mesh-adjacent tissues and electron microscopy of the explanted mesh surface were performed to characterize host tissue response to the implanted PP meshes. The effect of V-doped TiO2 coating on a living organism and fibroblast functions and bacterial activities were studied. The present results indicated that ALD coating improves adhesion properties and exhibited enhanced antibacterial activity compared to uncoated PP mesh. It was shown that V-doped TiO2 coatings were highly effective in inhibiting S. aureus and E. coli adhesion and exhibited excellent antibacterial activity. We found that V-doping of TiO2, unlike bare TiO2, allows generated and further procured strong redox reactions which effectively kills bacteria under visible light. We have reported comparative analysis of the use of undoped (bare) TiO2 and V-doped TiO2 as a coating for PP meshes and their action in biological environment and preventing biofilms formation compared with uncoated PP meshes. The PP meshes coated with V-doped TiO2 showed significantly lower shrinkage rates compared with an identical PP mesh without a coating. We have shown that ALD coatings provide non-adhesive and functional (antibacterial) properties.

Management of childhood-onset craniopharyngioma in Italy: A multicenter seven year follow-up study of 145 patients

Context Nationwide data on children diagnosed with craniopharyngioma (CP) are not available in Italy. Objective Identify patients’ characteristics, type of surgical approach, complications and recurrences, number of pituitary deficits and number of patients starting GH treatment. Methods Retrospective multicenter collection of 145 patients aged 0-18 years underwenting surgery for CP between 2000-2018, followed-up in 17 Italian centers of Pediatric Endocrinology. Results Age at diagnosis was 8.4±4.1 years. Duration of symptoms was 10.8±12.5 months and headache was most frequent (54%), followed by impaired growth (48%) and visual disturbances (44%). Most lesions were suprasellar (85%) and histology was adamantinomatous in all cases but two. Surgical approach was transcranic (TC) in 67.5% of cases and transphenoidal (TS) in 31.%. TC approach was prevalent in all age groups. Post-surgery complications occurred in 53% of cases with water-electrolyte disturbances most frequent. Radiotherapy was used in 39% of cases. All patients but one presented at least one hormone pituitary deficiency, with TSH deficit as most frequent (98.3%), followed by ACTH (96.8%), AVP (91.1%) and GH (77.4%). BMI significantly increased over time. A hypothalamic disturbance was present in 55% of cases. GH therapy was started during follow-up in 112 patients at a mean age of 10.6 years and 54 developed a recurrence or regrowth of the residual lesion. Conclusions CP is often diagnosed late also in Italy with TC more frequent than TS surgical approach. Post-surgery complications were not rare and hypopituitarism developed almost in all cases. BMI shows a tendency to increase overtime.

20G Vitrectomy; Current Usage, Indications, and Practices

Vitreoretinal surgery is evolving to a smaller size since first described. After the first vitrectomy probe defined as 17 Gauge (G), a smaller gauge (20G, 23G, 25G, and 27G) vitrectomy probes and trocars were identified. Even though 20G vitrectomy has been used for many years, thinner and less traumatic vitrectomy systems are developed and 20G has lost popularity. Hybrid use of 20G and other systems remains current, especially in cases such as endophthalmitis, intraocular foreign body removal, and cataract surgery complications.

The value of bacterial metagenomic analysis in post-surgical examination of gallstones

Gallstone disease is one of the most common causes of hospitalization for gastrointestinal diseases in the world. Recent studies have examined the presence of bacteria in the formation of stones. Our main goal was to determine the overall composition of gallstone microflora. Gallstones were obtained from 24 patients during laparoscopic cholecystectomy from which DNA were extracted. Composition of bacterial flora was evaluated on 16 s rDNA sequencing technique. In the vast majority of samples, bacteria were present, and four groups could be differentiated regarding the flora. Overall composition shows that 87% of the stones were cholesterol/mixed type of gallstone. Additionally, potentially harmful microorganisms (Streptococcus, Clostridium and Kocuria) that could cause post-surgery complications were identified in several patients. The obtained results indicate that this technique may be useful in analyzing the type of stones and in pinpointing the presence of pathogenic bacteria.

1117 Managing Cosmetic Surgery Complications: A Retrospective Service Evaluation

Aim The cosmetic surgery industry continues to grow, both within the UK and internationally. There is a perception that the NHS is often left to deal with the complications of these procedures, particularly those performed abroad. This study aimed to evaluate the burden of cosmetic surgery complications on a tertiary London plastics service with an appraisal of the financial costs incurred. Method This one-year retrospective service evaluation included all emergent referrals following cosmetic surgical interventions in the UK private sector and abroad. Outpatient referrals and planned revisional procedures were excluded. Financial costs were based upon current Clinical Commissioning Group tariffs. Results In total, 14 patients were included (seven from the UK and seven from Europe or North Africa). Remote telemedicine advice was provided for six patients; eight patients required admission. All eight admissions were female with an average age of 42.6 years. The most common complication was infection (75%) with an average length of stay of 2.3 nights. These eight patients required six trips to theatre, two CT scans and 37 outpatient visits. The median tariff per patient was £1,510 (range £242 to £5,196), leading to an overall reimbursement of £16,471. The majority of these costs were generated during inpatient admissions (£12,855) with a lesser contribution from outpatient episodes (£3,616). Conclusions This project provides an overview of the impact of managing emergent complications following cosmetic surgery, both in terms of service activity and financial cost. A long-term, prospective service evaluation of both elective and emergency referrals based upon patient-level costing data is now underway.