Where are the paediatric patients with testicular torsion during the COVID-19 pandemic?

Introduction The Irish people were put on lockdown in mid-March 2020 due to concern of the spread of coronavirus. With these societal changes came a notable reduction in emergency department attendance. Our aim was to analyse emergency urological procedures performed during the COVID-19 era versus the previous year. Methods A retrospective review of theatre logbooks was undertaken comparing numbers of emergency urological procedures performed between 1 March 2020 and 31 May 2020 (i.e. the COVID-19 era) with the corresponding 3-month period in 2019. Results A total of 173 cases were analysed between the two time periods. Similar overall numbers of cases were performed in 2019 (n = 90) and 2020 (n = 83). In particular, similar patient case numbers are also noted in both scrotal explorations (13 vs 9) and ureteric stone surgeries (69 vs 70). However, orchidectomies for testicular cancers were reduced by 63% (3/8). On further analysis of the scrotal exploration group, only 3 were performed in the period after lockdown regulations were instated. Conclusion Whilst patients with ureteric colic continue to present, those with acute testis pain requiring exploration attended less frequently, raising the possibility of undiagnosed testicular torsion in the community.

Traumatic and Spontaneous Vertebral Artery Dissections: An Analysis of Tertiary-Center 310 Patient Cohort

BACKGROUND Vertebral artery dissections (VADs) are rare yet potentially devastating events. While the etiology of these events is either traumatic or spontaneous, there is a paucity of quantitative literature comparing the two. OBJECTIVE To identify differences in predisposing factors, event characteristics, and clinical outcomes between traumatic VADs (tVADs) and spontaneous VADs (sVADs). METHODS We retrospectively identified patients with VADs presenting to our institution at VAD onset with at least a 3-mo follow-up. Demographics, event characteristics, treatment details, and neurological outcomes as modified Rankin scale (mRS) scores were collected. RESULTS Of the 310 patients sustaining 366 VADs total, 187 (60.3%) patients experienced a total of 221 (60.4%) sVADs and 123 (39.7%) patients experienced a total of 145 (39.6%) tVADs. sVADs were more likely to occur in the intracranial course of the artery (P = .042) and have a lower mRS at discharge, 3-month, and last clinical follow-up (P = 003, .002, and .001, respectively). tVADs were more likely associated with concomitant fractures (P < .001). CONCLUSION Despite similar patient populations, tVADs are associated with higher mRS scores at all time points. Although further study is needed, this may suggest other concomitant trauma rather than the VAD itself is contributing to worse neurological status in patients with tVADs.

Postoperative spinal orthosis may not be necessary for minimally invasive lumbar spine fusion surgery: a prospective randomized controlled trial

Background With the progress and success in minimally invasive surgery of transforaminal lumbar interbody fusion (MIS TLIF), the musculoskeletal injury was minimized. However, the role of postoperative orthosis in MIS TLIF has not been established and there is little evidence supporting the routine use of orthosis in MIS TLIF. Methods This is a prospective randomized clinical study. 90 patients who underwent MIS TLIF were randomly divided into groups A (with postoperative spinal orthosis) and B (without postoperative spinal orthosis). Patients were followed up for an average of 12.6 months. Clinical outcome was assessed using the Oswestry disability index (ODI) and visual analogue scale (VAS). Fusion rate was classified with the BSF scale system at postoperative 6-month, and 12-month. Results Both groups had similar patient demographics. The use of postoperative spinal orthosis had no significant influence on instrumentation-related complications or radiological parameters at each follow-up. Conclusions In this study, we conclude that postoperative spinal orthosis is not necessary for MIS TLIF. Patients without postoperative spinal orthosis had the same fusion rates and improvement of VAS and ODI scores.

Liver transplantation for hepatocellular carcinoma using grafts from uncontrolled circulatory death donation

Controversy exists regarding whether the rate of hepatocellular carcinoma (HCC) recurrence after orthotopic liver transplantation (OLT) differs when using livers from donation after controlled circulatory death (DCD) versus livers from donation after brain death (DBD). The aim of this cohort study was to analyze rates of HCC recurrence, patient survival, and graft survival after OLT for HCC, comparing recipients of DBD livers (n = 103) with recipients of uncontrolled DCD livers (uDCD; n = 41). No significant differences in tumor size, tumor number, serum alpha-fetoprotein, proportion of patients within Milan criteria, or pre-OLT bridging therapies were identified between groups, although the waitlist period was significantly shorter in the uDCD group (p = 0.040). HCC recurrence was similar between groups. Patient survival was similar between groups, but graft survival was lower in the uDCD group. Multivariate analysis identified recipient age (p = 0.031), pre-OLT bridging therapy (p = 0.024), and HCC recurrence (p = 0.048) as independent risk factors for patient survival and pre-OLT transarterial chemoembolization (p = 0.045) as the single risk factor for HCC recurrence. In conclusion, similar patient survival and lower graft survival were observed in the uDCD group. However, the use of uDCD livers appears to be justified due to a shorter waitlist time, and lower waitlist dropout and HCC recurrence rates.

The effects of vitamin D (Vit D) replacement on pathological complete response (PCR) in breast cancer (BC) patients receiving neoadjuvant systemic chemotherapy (NAC).

e12604 Background: Studies show that Vit D increases apoptosis by inhibiting the proliferation of BC cells. The aims of this study were to prospectively investigate the effects of Vit D replacement on PCR rates in patients receiving NAC. Methods: Breast cancer patients qualified for NAC between June 2019 and September 2020 and consent for the study were given weekly oral 50,000 IU Vit D (study group). The Control group consisted of patients who were given NAC between 2015-2020 and who did not receive Vit D replacement. Tumor characteristics and PCR compared between the study and control groups. Results: A total of 117 patients included in the study (55% in the study group). Both groups had similar patient, tumor, and treatment characteristics. PCR (ypT0/is ypN0 and ypT0/is) rates were significantly higher in the study group (28.1% vs 11.3%, p=0.025 and 37.5% vs 13.2%, p=0.003, respectively). In multivariate logistic regression analysis, estrogen receptor (ER) and HER 2 positivity, and Vit D3 replacement were identified as independent variables affecting PCR. Conclusions: Adding Vit D to NAC in breast cancer patients significantly increases PCR. This effect is more prominent in ER negative and HER2 positive breast cancer patients. Clinical trial information: NCT03986268. [Table: see text]

861 Evaluation of Understanding and Utilisation of Low Potassium Diets in Urology Wards. A Quality Improvement Project

Introduction Dietary restrictions are implemented upon renal inpatients considering their predisposition to electrolyte abnormalities from renal failure. A similar affiliation in urology wards is assumed due to similar patient profiles. Minimal awareness exists for low potassium alternatives on the catering menu. We aimed to review the understanding and utilisation of low potassium diets amongst healthcare professionals in our urological wards. Method Thirty staff members on our urological wards comprising of doctors, nurses and healthcare assistants were surveyed. Results Fifty seven percent were unaware of low potassium diet availability on the ward. None of the patients were offered or remained on a low potassium diet. During the cross-sectional review across 3 days, 25(45%) and 7 patients were identified to have renal failure and hyperkalaemia respectively. Three patients warranted renal replacement therapy. Conclusions Our study highlights the lack of awareness and underutilisation of low potassium diets on urology wards. An educational programme is being conducted with the guidance of dieticians and caterers. Ward guidelines will be established in patients with high risk of electrolyte imbalances. Low potassium diets will be emphasised on the catering menu. A subsequent evaluation will be performed to review the improvement in our understanding and utilisation enactments.