Significance of inflammatory biomarkers and urethral histology in patients with urethral stricture disease in relation to treatment outcome—a single centre prospective study in the north-eastern part of India

Background Inflammation plays a very important role in defining the urethral stricture. Inflammatory biomarkers may play an important role in predicting the underlying pathophysiology as well as outcome of surgery. Histology of urethral strictures along with histology of urethra proximal and distal to stricture segment may have a role in predicting the outcome of the surgery. The literature discussing this aspect is rare; thus, this novel study aimed to find out the role of inflammatory biomarkers and urethral histology in predicting the outcome of surgery in urethral stricture disease. Methods This prospective study had 105 patients with age more than 15 years with urethral stricture. Baseline characteristics, routine blood tests including inflammatory blood markers (CRP, ESR, HbA1C, fasting insulin, serum ferritin, etc.) were recorded. They underwent various types of surgery, and first biopsy was taken from stricture segment and second biopsy from proximal to stricture segment and third biopsy from distal to stricture segment and evaluated for the presence of features of lichen sclerosus and inflammation. Primary endpoint was to diagnose the role of inflammatory biomarkers and histology of stricture in stricture recurrence. Results Their mean age was 43.3 ± 13.46 years. Mean CRP of 11.54 ± 3.64 in patients with failure and 9.59 ± 2.77 in patients with successful outcome (p 0.025). Other inflammatory biomarkers like HbA1C, fasting insulin, ESR, serum ferritin, NLR had no significant correlation with the outcome. The presence of features of lichen sclerosus like hyperkeratosis and severe inflammation in stricture segment predicted higher likelihood of failure. Histology of proximal and distal segment of urethral stricture had no significant relationship in predicting outcome. Staged urethroplasty with buccal mucosal graft outperformed single-stage urethroplasty in biopsy-proven LS strictures. Conclusions The present study found a negative impact of increased CRP and the presence of features of lichen sclerosus in urethral histology with the outcome of urethral stricture disease. Thus, our study confirms that inflammatory biomarkers (CRP) and histology of stricture segment play a significant role predicting the outcome of surgery.

Blepharoplasty and Eyelid Reconstruction

A mastery of facial and eyelid anatomy is paramount to perform oculoplastic surgery safely and successfully. An understanding of periocular structures, vasculature, and innervation highlights the delicate relationship between form and function, which establishes the foundation for cosmetic and reconstructive procedures. This knowledge, coupled with an appreciation for the patient’s goals – both functional and aesthetic – and expectations for the outcome of surgery allows one to complete an effective, multidimensional pre-operative assessment encompassing patient selection, history, physical examination, and ancillary testing. Ultimately, the synthesis of these principles guides the selection and execution of appropriate and efficacious surgical technique for blepharoplasty and eyelid reconstruction. This review contains 15 figures and 28 references Keywords: Eyelid anatomy, Eyelid crease, Eyelid margin, Canthal tendons, Lacrimal system, Blepharoplasty, Tenzel flap, Hughes flap, Cutler-Beard procedure, Canthotomy and cantholysis

Blepharoplasty and Eyelid Reconstruction

A mastery of facial and eyelid anatomy is paramount to perform oculoplastic surgery safely and successfully. An understanding of periocular structures, vasculature, and innervation highlights the delicate relationship between form and function, which establishes the foundation for cosmetic and reconstructive procedures. This knowledge, coupled with an appreciation for the patient’s goals – both functional and aesthetic – and expectations for the outcome of surgery allows one to complete an effective, multidimensional pre-operative assessment encompassing patient selection, history, physical examination, and ancillary testing. Ultimately, the synthesis of these principles guides the selection and execution of appropriate and efficacious surgical technique for blepharoplasty and eyelid reconstruction. This review contains 15 figures and 28 references Keywords: Eyelid anatomy, Eyelid crease, Eyelid margin, Canthal tendons, Lacrimal system, Blepharoplasty, Tenzel flap, Hughes flap, Cutler-Beard procedure, Canthotomy and cantholysis

Aortic Bicuspidy: Clinical Profile and Surgery

Objective: To study the anatomic-clinical profile of aortic bicuspidy and the outcome of surgery. Patients and Methods: During an 18-year period, 448 patients had aortic valve replacement. Of these, 24 (5.3%) had aortic bicuspidy (AB). The diagnosis of AB was made by echocardiography or during surgery. All patients underwent surgery under extracorporeal circulation. Results: The mean age was 45.2 ± 11.8 years, 14 patients (58.3%) had aortic stenosis and 10 cases (41.7%) had aortic insufficiency, 4 of whom had infective endocarditis. All patients had aortic valve replacement. The operative mortality rate was zero. The mean times of the cardiopulmonary bypass (CPB) and aortic clamping were 99.2 ± 35.4 min and 65.8 ± 24.9 min, respectively. Conclusion: Aortic bicuspidy progresses rapidly and becomes symptomatic in young adults. Despite excellent surgical results, early detection is desirable before complications occur.

Histopathological spectrum and outcome of surgery for salivary gland tumors presented in tertiary care hospital of Pakistan.

Objective: This study is aimed to know the histopathological spectrum and outcome of surgery for salivary gland tumors presented in a tertiary care hospital of Pakistan. Study Design: Retrospective study. Setting: Tertiary Care Hospital of Pakistan. Period: July 2018 to June 2020. Material & Methods: After approval from Institutional Review Board. Total 73 patients were selected with preoperative diagnosis of salivary gland tumors with consecutive non probability sampling. All surgical procedures were done by specialist general surgeons who had experience of more than 10 years of head and neck surgery. Results: Male to female ratio was 2:1 with mean age of patients was 46 years. Among males 29 (59.1%) were benign salivary gland tumors while 20 (40.81%) were malignant salivary gland tumors. Among females 13 (54.16%) were benign and 11 (45.83%) were malignant salivary gland tumors Most common benign tumor was pleomorphic adenoma 32 (43.8%) while mucoepidermoid carcinoma was most common malignant tumor 17 (23.28%). Only 9 (12.32%) patients experienced nerve paresis. Conclusion: Male preponderance, a relatively younger age at presentation and single predominant benign tumor (pleomorphic adenoma) were the significant findings. Majority of them were found in parotid gland and found to be benign in nature. Majority of them were found in parotid gland and found to be benign in nature. Although fine needle aspiration cytology and magnetic resonance imaging provide some useful information about the nature of tumor but most of them will acquire a surgical excision in order to find the definitive diagnosis.

1655 Thoracic Aortic Aneurysmal Disease: Timing and Outcome of Surgery

Aim A thoracic aortic aneurysm (TAA) is a pathological dilatation of the thoracic aorta. There is significant morbidity associated with a dilated aorta including mortality. Open thoracic surgery is the mainstay of management for proximal lesions, offering definitive treatment. We aim to evaluate the outcomes of patients operated on for TAA and consider high risk associations for mortality. Method Data was retrospectively collected from 234 patients that underwent elective open thoracic surgery at UHS for TAA disease, between 2015 and 2019. Demographics, clinical factors, surgical details, as well as outcome measures were gathered. Results There were 166 males (71%) and 68 females (29%), with a mean age of 66 years. We found that 105 operations involved the aortic root, 171 the ascending aorta, 20 the aortic arch and 12 the descending aorta. 30 day mortality was 5.13%. Female patients that underwent aortic root surgery (P = 0.05), as well as those with prosthetic aortic valves (P = 0.01)and post-operative complications were associated with a significantly higher mortality. Conclusions A number of factors are associated with morbidity and mortality in this high-risk Surgery. These should be considered when discussing risks of intervention with patients.

Factors affecting outcome of decompressive hemicraniectomy in malignant middle cerebral artery infarction

Introduction: Decompressive Hemicraniectomy (DHC) is a standard surgical management of malignant MCA (MMCA) infarction. This study was conducted to review the outcome of surgery and to find out factors associated with favorable outcomes at a tertiary level neurosurgery referral centre. Methods and Materials: This is a retrospective study conducted over a period of three years from 2017 to 2019. Patient charts were reviewed for variable like age, sex, timing of surgery, GCS at presentation, length of ventilation, length of ICU admission and length of hospital stay. Primary outcome measure was GOSE: favorable (<=4) and unfavorable (>=5). SPSS version 23 was used for analysis. Results: A total of 28 patients underwent DHC out of which 21 patients were available for analysis. Mean age of patients was 58.62 years. Mean GCS on arrival was 11.86. Mean interval duration between event and surgery was 51.88 hours. Mean duration of ventilation was 4.43 days. Mean length of ICU stay was 5.95 days. Mean hospital stay was 22.33 days. Mean GOSE was 2. Mean age was significantly lower in patients with favorable GOSE. Early surgery had better mean GOSE which was not significant statistically. Conclusion: Patients with age less than 50 years have favorable GOSE despite MMCA infarction if decompressive hemicraniectomy is performed to accommodate brain swelling. Early surgery at presentation rather than waiting for deterioration might improve the outcome.