Treatment Results of Vocal Process Granuloma: Intubation Versus Contact Granuloma

Background and Objectives Vocal process granulomas (VPGs) are benign lesions of the larynx, typically contact granulomas (CG) and intubation granulomas (IG). The two diseases are known to have different clinical manifestations despite having the same pathological features. The purpose of this study was to analyze the treatment results for CG and IG and to obtain clinical information.Materials and Method We retrospectively reviewed the medical records of patients diagnosed with VPG between January 2015 and December 2018. The patient’s age, sex, medical history, lesion size, lesion type, reflux finding score, response to treatment, duration of treatment, and follow-up period were compared.Results In total, 32 patients were included in the study, of which 18 were CG and 14 were IG. In the CG group, males were dominant (n=15, 83.3%), whereas in the IG group, females were dominant (n=11, 78.6%) (p=0.0009). The response to medical treatment using proton pump inhibitor and steroid inhaler was better in the IG group (11/14, 78.6%) than in the CG group (7/18, 38.9%) (p=0.036). Of the 14 patients who did not respond to medical treatment, 5 received botulium toxin injections, and all 5 had complete remission. The duration of medical treatment was significantly longer in the IG group (p=0.0029).Conclusion IG was more common in female, and CG was more dominant in male. IG had better response to medical treatment using proton pump inhibitor and steroid inhaler than CG.

Correlation of features on OCT with visual acuity and Gass lesion type in best vitelliform macular dystrophy

ObjectiveTo correlate structural features seen on optical coherence tomography (OCT) with best-corrected visual acuity (BCVA) and Gass lesion type in patients with best vitelliform macular dystrophy (BVMD).Methods and analysisThis is a retrospective case series of consecutive patients with molecularly confirmed BEST1-associated BVMD. OCT scans were reviewed for lesion status and presence of subretinal pillar, focal choroidal excavation (FCE), intraretinal fluid or atrophy. Available OCT angiography images were used to evaluate for the presence of choroidal neovascularisation (CNV). These features were then correlated with BCVA and Gass lesion type.Results95 eyes from 48 patients (mean age 38.9 years, range 4–87) were included. The presence of a pillar (24.2%), FCE (20.0%) and atrophy (7.4%) were associated with poor BCVA (p<0.05). Gass lesion type 1 eyes were correlated with good BCVA (LogMAR <0.4) whereas type 5 eyes had poor BCVA (LogMAR >0.4). Among 65 eyes with longitudinal data (mean follow-up 5.1 years), 7 eyes (10.8%) reverted from higher to lower Gass lesion type; of these, 4 eyes (57.1%) had CNV responsive to intravitreal anti-vascular endothelial growth factor treatment.ConclusionOCT-based structural features are readily identifiable in patients with BVMD and have prognostic importance due to their correlation with BCVA.

Assessment of the microvasculature in poppers maculopathy

Purpose To investigate a possible microvascular component of poppers maculopathy (PMP) using optical coherence tomography angiography (OCTA). Methods Twelve patients suffering from poppers maculopathy were included. Health records, optical coherence tomography (OCT), and OCTA data was gathered and compared to a healthy control group (HC). PMP lesion type was determined by manifestation in OCT. OCTA-based evaluation of retinal vascular plexus and choriocapillaris (CC) was executed. Vessel density (VD) and vessel length density (VLD) in superficial and deep capillary plexus (SCP, DCP), as well as flow deficits (FD), within the foveal avascular zone (FAZ) in CC were assessed. Results Median age of PMP patients was 40 (min 24; max 64) years, all male. Eleven patients presented with ellipsoid zone-type lesions; one patient showed a vitelliform-type lesion. No qualitative microvascular changes between PMP patients and HC were identified. Quantitative values for VD and VLD of SCP and DCP did not differ in between the two groups. The analysis of FDs in CC showed no deviation from PMP patients to HC. Conclusions No vascular anomalies in qualitative and quantitative analysis in OCTA were detected in PMP patients. The constitution of the CC within FAZ of PMP patients does not differ from HC when assessed as FD.

Site, frequency, and duration of pain in young children with spina bifida

PURPOSE: To investigate the: (1) percent of children with spina bifida (SB) complaining of pain, (2) frequency, duration, and cause of pain by sex, level of lesion type of SB, and ambulation status, (3) body sites reported to hurt, by variables in objective 2, and (4) associations between physical and mental/emotional health between caregiver and child. METHODS: Cross-sectional study of 101 caregivers of children (3 to 6 years old) with SB. Survey data and information from medical records were included. Pearson chi-square, one-way ANOVA, Fisher’s exact test, logistic regressions, and bivariate correlations were used. RESULTS: Seventy percent reported that their child complained of pain, which did not significantly differ by sex, level of lesion, type of SB, or ambulation status. Most (86%) were reported to have experienced pain for less than 24 hours. The most frequently reported pain site was the head, followed by the abdomen and the lower body. Number of pain sites was moderately correlated with frequency of pain complaints. Correlations between how caregivers reported their own physical/mental/emotional health and how they rated that of their children ranged from weak (r = 0.22) to moderate (r = 0.55). CONCLUSION: Almost seven of ten children reportedly complained of pain ranging from at least once a month to everyday. Pain needs to be routinely assessed and treated in this population.

MRI versus CT in the detection of brain lesions in patients with infective endocarditis before or after cardiac surgery

Purpose Imaging of brain involvement in infective endocarditis can drive the clinical management of this serious condition. MRI is very sensitive, but CT is more readily available. In this retrospective study, we compared the detection rates of CT and MRI. Methods After Ethics Committee approval, we retrospectively reviewed a series of 20 patients (13 males, median age 64 years) who underwent both CT and MRI either before or after cardiac surgery for definite infective endocarditis. Plain CT and MRI were evaluated for acute ischemic lesions, both punctuate and large, intraparenchymal hemorrhages, cerebral microbleeds, subarachnoid hemorrhages, abscesses, microabscesses, and meningitis. Qualitative assessment and McNemar test were performed. The value of contrast-enhanced scans (MRI, n = 14; CT, n = 9) and cognitive status were also assessed. Results A total of 166 lesions were identified on either technique: 137 (83%) on MRI only, 4 (2%) on CT only, and 25 (15%) on both techniques (p < 0.001). For these last 25 lesions, concordance on lesion type was only 16/25 (64%). MRI detected more microbleeds and ischemic lesions, while the 4 CT-only findings were false positives. Contrast-enhanced scans identified 68 enhancing lesions, mainly abscesses and microabscesses, and allowed a better characterization for 61/117 lesions (52%) with MRI, and for 11/81 (14%) with CT. Follow-up identified mild cognitive impairment in 6/13 and dementia in 3/13 patients. Conclusion While CT rapidly excludes large hemorrhages in patients with infective endocarditis, MRI accurately distinguishes the whole spectrum of brain lesions, including small ischemic lesions, microbleeds, and microabscesses.

TP8.2.28 Can surgical advanced care practitioners provide a cost effective local anaesthetic minor procedures service? Results from a 5-year retrospective study

Aims Surgical Advanced Clinical Practitioners (SACP) form part of the extended surgical workforce and are drawn from allied health care backgrounds. The primary aim of this study was to determine if there is a financial benefit performing minor surgical procedures on dedicated SACP lists compared to consultant surgeon lists. Methods This was a retrospective cohort study including all patients who had a minor ‘lumps and bumps’ procedure undertaken between April 2014 and August 2019 at Anonymous Hospitals NHS Trust (AHT) under local anaesthetic by the general surgery team. Data such as lesion type, theatre staffing levels and operating time was collected. The cost of the procedure was calculated by operating time multiplied by cost of staff of per minute according to local banding. Results A total of 1399 patients had a lesion excised; the majority were carried out by a doctor n = 907, the rest independently by a SACP. The majority of lesions excised were lipomas and cysts. There was no difference in the median surgical time (20 minutes, IQR 14) taken to operate on each patient by SACPs and doctors. Minor procedures carried out on consultant surgeon lists cost 62.4% (£21.72) more on average than those on SACP lists (£56.55 vs £34.83 median respectively, p &lt; 0.001) due to excess staff for these cases. Conclusion A dedicated and independent SACP ‘lumps and bumps’ list has shown to be a financially beneficial service. Operative times are similar to doctors. These lists free staff for consultant lists, potentially permitting more major cases.

TP53 Mutation Status and Biopsy Lesion Type Determine the Immunotherapeutic Stratification in Non-Small-Cell Lung Cancer

Immunotherapy, a chemotherapy-free process, has emerged as a promising therapeutic strategy to prolong the overall survival (OS) of patients with non-small-cell lung cancer (NSCLC). However, effective stratification factors for immunotherapy remain unclear. The purpose of this study was to discuss the potential stratification factors of NSCLC immunotherapy using immune checkpoint inhibitors (ICIs) by integrating genomic profiling and tumor lesion–type information. In this study, 344 patients with NSCLC, whose clinical and tissue (including metastatic and primary lesions) mutation information was available, were included. The potential gene mutation status for predicting the outcomes of immunotherapy was screened by comparing the difference in mutation frequency between responders and non-responders. Our results indicated that the potential predictors of immunotherapy were significantly different, especially between patients with TP53(+) (including metastatic and primary lesions) and TP53(−) (including metastatic and primary lesions). According to this classification, patients with NSCLC who suggested immunotherapy had a higher OS than those who did not (25 months vs. 7 months, P &lt; 0.0001, hazard ratio = 0.39). Collectively, this study provides a new perspective for screening immunotherapy predictors in NSCLC, suggesting that the TP53 mutation status and source of biopsy tissue should be considered during the development of immunotherapy biomarkers.