Risk Factors for Pulmonary Cement Embolism (PCE) After Polymethylmethacrylate Augmentation: Analysis of 32 PCE Cases

Objective: Pulmonary cement embolism (PCE) is an underestimated but potentially fatal complication after cement augmentation. Although the treatment and follow-up of PCE have been reported in the literature, the risk factors for PCE are so far less investigated. This study aims to identify the preoperative and intraoperative risk factors for the development of PCE.Methods: A total of 1,373 patients treated with the polymethylmethacrylate (PMMA) augmentation technique were retrospectively included. Patients with PCE were divided into vertebral augmentation group and screw augmentation group. Possible risk factors were collected as follows: age, sex, bone mineral density, body mass index, diagnosis, comorbidity, surgical procedure, type of screw, augmented level, number of augmented vertebrae, fracture severity, presence of intravertebral cleft, cement volume, marked leakage in the paravertebral venous plexus, and periods of surgery. Binary logistic regression analyses were used to analyze independent risk factors for PCE.Results: PCE was identified in 32 patients, with an incidence rate of 2.33% (32 of 1,373). For patients who had undergone vertebral augmentation, marked leakage in the paravertebral venous plexus (odds ratio [OR], 0.012; 95% confidence interval [CI], 0.001–0.103; p = 0.000) and previous surgery (OR, 0.161; 95% CI, 0.042–0.610; p = 0.007) were independent risk factors for PCE. Regarding patients who had undergone screw augmentation, the marked leakage in the paravertebral venous plexus (OR, 0.042; 95% CI, 0.005–0.373; p = 0.004) was the main risk factor.Conclusion: Marked leakage in the paravertebral venous plexus and previous surgery were significant risk factors related to PCE. Paravertebral leakage and operator experience should be concerned when performing PMMA augmentation.

Modified three-step procedure to treat buried penis in children without previous surgery: experience in 150 cases

[Background] The buried penis has an abnormally smaller and shorter appearance. We performed a modified three-step procedure to correct the buried penis with satisfactory cosmetic results. [Methods] From May 2014 to December 2020, 150 boys, ranging in age from 2 to 7 years old (median age: 3.3 years), underwent this three-step procedure. The chief complaint was a smaller and shorter appearance of the penis. The surgical procedure consisted of three steps: complete degloving through a diamond-shaped penoscrotal incision, circumcision to remove the majority of the inner plate, and anchoring of the penopubic skin to the base of albuginea penis at the 4 and 8 o’clock positions with unabsorbable sutures. [Results] The mean operative time was 50 minutes (range from 40 to 60 minutes). The mean follow-up time was 2.8 years (range from 10 months to 6 years). There were no complications or recurrences. Good cosmetic results were achieved in all boys. [Conclusions] Our modified three-step procedure had good cosmetic results without complications. We recommend this effective surgical procedure for boys with buried penis who have no history of previous surgery.

Clinical and radiological results of distal radioulnar joint arthroplasty with the Aptis prosthesis

We report the results of the treatment of disorders of the distal radioulnar joint with the semi-constrained Aptis prosthesis. Nineteen patients were assessed at a mean follow-up of 7 years. All patients had been operated on previously at the wrist, forearm or elbow. The Disabilities of Arm, Shoulder and Hand score had a mean value of 40, the Patient-Rated Wrist Evaluation score had a mean of 49 and the visual analogue scale for pain had a mean of 3.9. The mean ranges of pronation, supination, wrist flexion and wrist extension were 78°, 76°, 60° and 51°, respectively. The mean grip strength was 23 kg. Complications were noted in ten patients. Eighteen patients would undergo the operation again. The 10-year cumulative survival rate was 84%. The Aptis prosthesis may be a solution to treat patients in whom previous surgery at the distal radioulnar joint has failed. Level of evidence: IV

Malignant transformation of endometriosis on vaginal cuff after hysterectomy: a case report

Objective. Endometriotic tissue implants rarely transform to malignant tissue, especially in a patient with a hysterectomy and bilaterally salpingo-oophorectomy. However, several cases with cancer arising from endometriosis after hysterectomy were reported in the literature. Hormone replacement therapy only with estrogen is a crucial risk factor for malignant transformation of persistent endometriotic tissue. Case Report. The present case demonstrates an endometrioid adenocarcinoma arising from persistent endometriosis tissue in a patient who was performed hysterectomy with bilateral salpingectomy 3 years ago. The histopathologic specimens of the previous surgery did not include any malignant tissue. After 3 years, she applied to the hospital with abnormal vaginal bleeding, and her histopathologic examination result found an ulcerated mass at the upper one-third of the vagina that is compatible with endometrioid adenocarcinoma. Conclusion. It is crucial to keep in mind the endometriosis history of the patient, to be able to diagnose cancer arising from endometriosis while evaluating the patient with a hysterectomy.

Abdominopelvic CT-scan in emergency departments for patients with suspected complications of Crohn’s disease: a single tertiary center experience

Background Crohn’s disease (CD) is a chronic disorder with frequent complications. The objective of this study was to assess the predictive factors of finding a complication of CD using abdominopelvic CT-scan in patients with a visit to the emergency department. Methods Patients with at least one visit to the gastroenterology department of our University hospital during the year with a CD were retrospectively included. All visits to the emergency department of the hospital during the follow-up of these patients were identified. Results A total of 638 patients were included and 318 (49.8%) had at least one visit to the emergency department since the beginning of their follow-up. Abdominopelvic CT-scan was performed in 141 (23.7%) of the 595 visits for digestive symptoms. Only 4.3% of these CT-scans were considered as normal; there was luminal inflammation without complication in 24.8%, abscess, fistula or perforation in 22.7%, mechanical bowel obstruction in 36.9% and diagnosis unrelated to CD in 11.3%. In univariate analysis, stricturing phenotype (OR, 2.48; 95% CI, 1.16–5.29; p = 0.02) and previous surgery (OR, 2.90; 95% CI, 1.37–6.14; p = 0.005) were predictive factors of finding a complication of CD using abdominopelvic CT-scan, whereas no independent predictive factor was statistically significant in multivariate analysis. Conclusion In CD patients consulting in emergency department, CT-scan examination was performed in 24% of visits for digestive symptoms and complications of CD were found in 60%. Complications were more frequent in patients with stricturing phenotype and previous surgery.

TP5.2.3 Quality improvement project to reduce turn-around times to improve vascular theatre efficiency

Aim One of the factors influencing theatre efficiency is turn-around time (TAT). The aim of this QIP was to reduce turnaround times by 25% thereby reducing financial implications of theatre idle time. Methods Baseline data was obtained from electronic theatre record system ‘Galaxy’ for the period October 2019 to February 2020. TAT (Time from the last patient going to recovery and the next one coming into the theatre) was measured and a period average was established. This QIP mapped processes and conducted interviews, to identify issues contributing to longer turnaround times. Interventions were then constructed and implemented over 6 weeks. Results One of preventable causes of delay identified from staff interviews and personal observations was inadequate patient preparation by the ward. Preintervention percentage theatre utilisation was 86% and turnaround times was 51.7 minutes. A PDSA cycle was initiated focusing on advanced warning (30 minutes prior to the end of the previous surgery) from theatres to wards and advanced preparation from wards, using a newly designed ward-based checklist. After the first PDSA cycle there has been an improvement in TAT to 42.8 minutes, a decrease of 18.2%. Whilst this did not meet our goal of a 25% reduction, this remains significant. Unfortunately due to COVID -19 the second cycle has been delayed. Conclusions Affordable and sustainable improvements will be needed in post COVID-19 recovery phase to tackle the backlog of surgeries. This project has demonstrated that advanced warning system can decrease turnaround times.

EP.TH.15Review of cholecystectomies laparoscopic & open plus conversion rate in a five year period

Aim Look & audit our practice of cholecystectomy & try to identify areas that require improvement Method Look at all cholecystectomies, laparoscopic & open in 5 years from January 2014 till December 2018, we looked at demographics, number of operations per year, conversion & re-admission rate, information collected from electronic note record Results male to female ratio similar to national figures, number of laparoscopic operations (2422 in that period, 61 cases converted, conversion rate 2.5%) going up steadily over the 5 years while open & conversion rate are dropping significantly, early re-admission rate higher than national figure, reasons for conversion determined & analysed Reasons for doing it open from the start also determined, commonest cause for conversion in our trust is: previous surgery/adhesions, obscure anatomy & severe inflammation of gall bladder . Commonest cause of re-admission is pain followed by wound complications collections retained stone & bile leak. Number of open cholecystectomies was 22 in 2104 dropping to only 2 in 2018. 3 deaths occurred in the group giving rise to a mortality of 0.12% Conclusion Majority of cases attempted laparoscopically & most patients discharged home within 48 hours, our conversion rate is low = 2.5% with consultants with higher number of operation having less conversions, ours re-admission rate is high mainly for pain, our mortality is low. We recommend looking closer at re-admissions to see how that number could be reduced.

Giant Hysteromyoma After Vaginoplasty in a Woman With Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome: Case Report and Review of the Literature

Background: Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a congenital disorder characterized by congenital absence of both the uterus and vagina. Some patients may need an operation to create a neovagina. However, the preservation of nonfunctional rudimentary uteri after surgery usually leads to some long-term complications. Case presentation: We report a rare case of a giant hysteromyoma after vaginoplasty in a woman with MRKH syndrome. A 31-year-old Chinese woman who was diagnosed with MRKH syndrome and received vaginal reconstruction 4 years ago presented with abdominal distension for half a month. Transabdominal ultrasonography showed a firm mass of approximately 10 x 10 cm in the lower abdomen. She then received an exploratory laparotomy, and a leiomyoma from her rudimentary uterus was removed.Conclusions: Gynecologists should pay attention to the risks of pelvic complications in women with MRKH syndrome who have undergone previous surgery and then choose suitable therapeutic methods.

Diagnosis and management of iatrogenic ureteral injury in total laparoscopic hysterectomy

Ureteral injury is common in gynecological surgeries due to the proximity to organs. The risk of ureteral injury is higher in laparoscopic hysterectomy operations compared to abdominal or vaginal hysterectomies. Obesity, endometriosis, pelvic adhesions, history of previous surgery, enlarged uterus, and intraoperative hemorrhage are some of the risk factors identified for ureteral injury. Intraoperative cystoscopy and postoperative urinary ultrasonography can be used in the diagnosis of early ureteral injury. Management of ureteral injury differs according to the extent, type, and localization of the injury. In evaluating the ureteral injury, early diagnosis and early repair in appropriate patients are essential in morbidity and medicolegal.