Cumulative Recurrence Rate and Risk Factors for Recurrent Abdominal Wall Endometriosis after Surgical Treatment in a Single Institution

PurposeThis study aimed to evaluate the cumulative recurrence rate and risk factors for recurrent abdominal wall endometriosis (AWE) after surgical treatment.Materials and MethodsA retrospective cohort study was conducted at a single gynecological surgery center between January 2004 and December 2020. Patients who were surgically treated and followed up for at least 6 months after surgery were selected.ResultsEighteen patients with pathologically diagnosed AWE were included in this study. The median follow-up duration was 22.5 months (range, 6–106). The median age was 37 years (range, 22–48), and 33.3% of the patients were nulliparous. Among the patients included in our study, 55.6% complained of a mass with cyclic pain, and 27.8% had a palpable mass. In addition, 22.2% of patients experienced recurrence with 17.5±9.7 months of mean time to recurrence. The cumulative recurrence rates at 24 and 60 months after surgical treatment of AWE were 23.8% and 39.1%, respectively. There were no statistically significant risk factors for the recurrence of AWE, including postoperative medical treatment.ConclusionThe recurrence rate of AWE appears to be correlated with the follow-up duration. There was no statistically significant risk factor for the recurrence of AWE. Unlike ovarian endometriosis, postoperative hormonal treatment does not seem to lower the recurrence of AWE. The findings of the current study may help healthcare providers in counselling and managing patients with AWE.     

Total Talar Extrusion without Soft Tissue Attachments

Total talar extrusion without a soft tissue attachment is an extremely rare injury and is rarely reported. Appropriate treatment remains controversial. We describe the long-term outcomes of two patients who had complete talar extrusion without remaining soft tissue attachment treated with arthrodesis. Both of our patients had complications such as infection and progressive osteolysis. We suggest reimplantation of the extruded talus after thorough debridement as soon as possible as a reasonable option unless the talus is contaminated or missing, because an open wound may arise from inside to outside.     

Response to pretransplant hypomethylating agents influences the outcome of allogeneic hematopoietic stem cell transplantation in adults with myelodysplastic syndromes

This study describes a retrospective analysis on the transplant outcome of 56 consecutive patients with myelodysplastic syndrome (MDS) according to their response to hypomethylating agents (HMA). While 2‐yr disease‐free survival (DFS) of patients who transformed to acute myeloid leukemia (n = 12) was 25%, that of the remaining patients with MDS according to response to HMA was 73.1%, 68.1%, 50.0%, and 20.8% in G‐COR (group of continuous response, n = 19), G‐NoC (group of no change, n = 15), G‐LOR (group of loss of response, n = 6), and G‐DP (group of disease progression, n = 4), respectively. When dichotomized as G‐COR/G‐NoC versus G‐LOR/G‐DP, significantly different 2‐yr DFS (71.0% vs. 33.3%; P = 0.004) and relapse (14.1% vs. 46.7%; P = 0.016) were demonstrated. On multivariate analysis, G‐LOR/G‐DP [hazard ratio (HR), 3.91; P = 0.008] and poor karyotype at transplantation (HR, 2.69; P = 0.017) were the significant predictors for poor DFS, as G‐LOR/G‐DP was for relapse (HR, 6.28; P = 0.011). DFS was significantly poor in patients with any of the two predictors in all MDS (81.5% vs. 34.9%; P = 0.001) or higher‐risk MDS (HrMDS) at the time of HMA (80.7% vs. 29.2%; P = 0.005). G‐COR showed a trend of better DFS compared with G‐NoC among HrMDS (74.6% vs. 36.5%; P = 0.090). These results implicate the significance of response to HMA on hematopoietic stem cell transplantation (HSCT) outcomes and support the need for future study to verify the suggested strategy of proceeding to transplantation before LOR or DP, especially for HrMDS.     

Impact of Obstructive Sleep Apnea on the Global Myocardial Performance Beyond Obesity

We aimed to assess the impact of obstructive sleep apnea (OSA) on the left ventricular (LV) function independent of obesity using the myocardial performance index (Tei index) and the global longitudinal LV strain (GLS) and its reversibility after surgery. Twenty‐five newly diagnosed OSA patients, normal weight (n = 15) and obese (body mass index [BMI] ≥ 25; n = 20) controls without OSA were enrolled and underwent transthoracic echocardiographic evaluation. The OSA and obese groups had a significantly comparable increased BMI and LV chamber dimension, prolonged isovolumic relaxation time, reduced early mitral filling velocity, and increased late mitral filling velocity and Tei index as compared to the normal weight group. However, GLS was significantly reduced only in the OSA group (–16.5 ± 1.9%) as compared to the normal weight group (–20.6 ± 2.0%, P < 0.001) and obese group (–19.1 ± 2.5%, P < 0.001). As a treatment, 13 of 25 patients underwent surgical modification, and the follow‐up echocardiogram revealed significantly improved Tei index and GLS as compared to baseline (0.37 ± 0.06 and –18.9 ± 3.3% vs. 0.42 ± 0.04 and –16.3 ± 2.4%, P = 0.006 and 0.031, respectively), which was comparable to the obese controls. A reduction in the apnea‐hypopnea index had a significant effect on the improvement in the GLS (r = 0.73, P < 0.001). LV systolic and diastolic function significantly deteriorated in the patients with OSA beyond obesity, and an improvement in the LV function was observed within 6 months after the surgical modification. GLS is considered to be one of the parameters that can be used in the early detection of LV systolic dysfunction in patients with OSA and a normal ejection fraction.