Search Results (1,215)

Background/Objectives: Pericardial effusion (PEf) is a frequent finding after cardiac surgery. Progression to cardiac tamponade (CT) is a rare but life-threatening complication. Current evidence remains limited due to insufficient data on prevalence, progression predictors and management strategies. Methods: We retrospectively analyzed anamnestic, clinical, laboratory, echocardiographic and therapeutic data from 2662 patients (74 ± 11 years) admitted to the Cardiac Rehabilitation ward between 2022 and 2024. Results: Among 2152 (81%) cardiac surgery patients, 382 (18%) developed PEf: 58% mild, 38% moderate, and 4% severe. Patients developing PEf tended to be younger and more frequently male. In addition, PEf development was seen more commonly after aortic and combined surgeries. All patients with severe PEf or CT had undergone surgery via sternotomy, whereas minithoracotomy was inversely associated with PEf severity. Postoperative complications occurred in 92% of PEf patients, mainly due to arrhythmia, hemodynamic deterioration, or heart failure. Overall outcome was favourable in 98% of patients. CT occurred in eight patients (2%). Anticoagulation therapy was more frequent among patients who developed PEf or CT. Preventive colchicine was prescribed in only 16% of cases. No PEf-specific therapy was administered in 56% of PEf patients, while corticosteroids and nonsteroidal anti-inflammatory drugs were used in 28% and 8% of cases, respectively, without surgical wound complications. No PEf recurrences were observed during follow up (517 ± 424 days). Conclusions: PEf is a common complication after cardiac surgery, more frequently in young males, usually of mild or moderate severity. The majority of these cases resolve using either a conservative or pharmacological approach, predominantly via corticosteroids. Patients undergoing aortic surgery, experiencing postoperative complications (especially arrhythmias), and receiving anticoagulation therapy were associated with severe PEf or CT. Despite guideline recommendations, colchicine remains markedly underutilized. Full article

Background: Isolated gallbladder injuries are rare, especially when initial imaging is normal. Advanced imaging is required to detect delayed complications. Moreover, it is necessary to make an appropriate diagnosis while selecting the most suitable treatment option. Case Presentation: A 49-year-old man fell while cycling and developed worsening abdominal pain. Initial contrast-enhanced computed tomography (CT) scans showed no abnormalities. However, the patient later developed cholangitis and cholecystitis caused by biliary obstruction from a delayed gallbladder hematoma. Magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) were used to diagnose this condition. The patient was initially managed conservatively with antibiotics, which led to temporary symptomatic improvement. Notably, the patient developed a delayed recurrence of suspected acute cholangitis (Grade I) on Day 12 due to hematoma migration. After recurrence, endoscopic nasobiliary drainage was performed as a step-up approach, in accordance with the Tokyo Guidelines 2018 management bundle, to achieve biliary decompression, followed by elective laparoscopic cholecystectomy. Pathological examination revealed chronic cholecystitis with hematoma. Conclusions: Isolated gallbladder injuries should be considered in patients with blunt abdominal trauma. Delayed hematoma formation can lead to biliary obstruction, even without initial CT findings. In such cases, early implementation of MRI and MRCP, along with close clinical monitoring for delayed recurrence, is essential. A strategic “step-up approach” incorporating endoscopic drainage is a safe and effective management option prior to definitive surgery. Full article

Background/Objectives: We aimed to characterize age-related clinicopathologic features, preoperative risk stratification, surgical management, and menstrual and reproductive outcomes of surgically managed ovarian and adnexal masses in children and adolescents. Methods: This retrospective study included 77 patients (aged 6–18 years) treated at a tertiary center between 2010 and 2020. Patients were grouped by age (6–12, 13–15, 16–18 years). Results: Abdominal pain (63.6%) was the most common presentation, and laparoscopic surgery was performed in 72.7% of cases. Overall, 84.4% of masses were non-malignant, with mature cystic teratoma being the most common (39.0%). Twelve patients (15.6%) had borderline or malignant tumors. Cyst diameter peaked in the 13–15 year group (p = 0.04), while torsion (9.1%) occurred exclusively in patients aged ≤15 years (p < 0.01). Preoperative O-RADS accurately stratified risk: all borderline or malignant tumors were O-RADS 4–5, whereas 84.6% of non-malignant lesions were O-RADS 2–3. Elevated CA-125 and AFP correlated well with epithelial and malignant germ cell tumors, respectively. Ovary-sparing surgery (OSS) was achieved in 11 of 12 patients with borderline or malignant tumors; after a median 4.2-year follow-up, 11 were alive without disease, and 10 had resumed menstruation. Conclusions: Most pediatric and adolescent adnexal masses are non-malignant. Age influences mass size and torsion risk. Preoperative O-RADS combined with tumor markers effectively aids risk stratification. Fertility preservation is feasible and safe for nearly all patients, supporting conservative surgical planning when intervention is necessary. Full article

Background and Objectives: Low back pain (LBP) is a leading cause of disability worldwide and is frequently associated with intervertebral disc degeneration (IVDD). Current therapeutic strategies are primarily symptomatic and do not restore native disc biology, largely due to the avascular nature of the intervertebral disc and the hostile inflammatory and mechanical microenvironment that characterizes degeneration. The aim of this study is to provide an updated and clinically oriented overview of the pathophysiology of IVDD and to evaluate the current evidence on mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP)-based therapies. Materials and Methods: A focused narrative literature review was performed to evaluate current evidence on MSC- and PRP-based therapies for intervertebral disc degeneration (IVDD). The search was conducted in PubMed. Only studies in English were considered eligible. Results: Mesenchymal stem cells (MSCs) demonstrated regenerative and immunomodulatory effects primarily through paracrine mechanisms, enhancing extracellular matrix synthesis and reducing inflammation and apoptosis. MSC-derived extracellular vesicles emerged as a promising cell-free alternative, potentially overcoming limitations related to cell survival and safety. Platelet-rich plasma (PRP) showed anabolic and anti-inflammatory properties, promoting disc cell proliferation and matrix production, particularly in early-stage degeneration. Clinical studies, including randomized trials, reported significant improvements in pain and function for both MSC and PRP therapies, with favourable safety profiles. However, heterogeneity in treatment protocols and limited long-term data remain significant limitations. Orthobiologic therapies represent a minimally invasive option for patients with discogenic low back pain refractory to conservative treatment. Patient selection is crucial and should consider degeneration stage, disc viability, and clinical presentation. PRP is primarily indicated in early-stage degeneration (Pfirrmann II–III), whereas MSC-based therapies may be considered in selected patients with more advanced but still viable discs. Based on current evidence, a stepwise approach is proposed, progressing from conservative management to PRP, MSCs, and ultimately surgery. Orthobiologics should be integrated within a multimodal strategy including rehabilitation. Conclusions: MSCs and PRP represent a promising and, eventually, complementary orthobiologic therapies for IVDD. PRP is primarily effective in early degenerative stages as a biologic stimulator, whereas MSCs may provide regenerative benefits in more advanced but still viable discs. Further studies are necessary to standardize protocols and confirm long-term efficacy and safety. Full article

Background: Oncoplastic breast surgery aims to combine oncologic safety with optimal cosmetic outcomes. However, many established techniques require visible anterior breast incisions or substantial tissue rearrangement, which may compromise cosmetic results in selected patients. Posterior access to the breast through the retromammary space may allow tumor excision while preserving the anterior breast envelope. Methods: We report an early clinical experience with Posterior Approach Partial Mastectomy (MAPP), a breast-conserving technique that accesses the lesion through a concealed inframammary or lateral breast crease incision. This single-center retrospective case series included consecutive patients undergoing excision using this approach. Patient selection, surgical technique, and early outcomes—including margin status, complications, and need for re-excision—were evaluated. Results: Eight patients underwent breast-conserving excision using the MAPP technique. Six patients had malignant lesions (invasive ductal carcinoma with or without ductal carcinoma in situ or pure DCIS), while two benign lesions were included for technical completeness. Tumor size ranged from 9 to 78 mm. All malignant cases achieved negative surgical margins (R0), and no patient required re-excision. Posterior access was successfully achieved in all cases using concealed inframammary or lateral crease incisions. One patient experienced minor wound discharge that resolved with conservative management, and no major postoperative complications were observed. Follow-up ranged from 2 to 12 months. Conclusions: Posterior Approach Partial Mastectomy appears to be a feasible oncoplastic approach with encouraging early oncologic outcomes in carefully selected patients undergoing breast-conserving surgery. By preserving the anterior skin envelope and concealing the surgical incision, this technique may offer cosmetic advantages while maintaining oncologic adequacy. Larger studies with longer follow-up are needed to further define its role in oncoplastic breast surgery. Full article

Background/Objectives: Obstructive sleep apnea (OSA) is increasingly observed in patients undergoing supracricoid laryngeal surgery; however, the impact of postoperative anatomical changes on sleep-disordered breathing remains insufficiently characterized. This pilot study aimed to assess the incidence and severity of OSA after Open Partial Horizontal Laryngectomy type II (OPHL II) and to evaluate correlations between polysomnographic parameters and radiologic measurements of the neolarynx. Methods: A prospective observational cohort study was conducted on ten patients who underwent OPHL II between 2019 and 2024 and were evaluated at least one year postoperatively. The sample size was determined using a conservative estimate appropriate for a pilot prospective study, which required a long postoperative follow-up period of at least one year. All patients completed Stop-Bang, Berlin, and Epworth questionnaires and underwent overnight polysomnography. Cervical CT scans were used to measure airway length to the vocal cords (ALVC), supralaryngeal tract horizontal (SVTH) and vertical (SVTV) segments, and the base-of-tongue–to–cervical-body distance (BTCB). Results: OSA was detected in all patients: 40% mild, 30% moderate, and 30% severe. Mean AHI was 25.5 ± 18.9 events/h, and OSA severity strongly correlated with AHI (rho = 0.94; p < 0.0001). Among radiologic parameters, SVTV showed a positive correlation with OSA severity (rho = 0.82; p = 0.0035), while BTCB demonstrated a significant negative correlation (rho = −0.71; p = 0.0207). No significant associations were found for ALVC or SVTH. Conclusions: Supracricoid laryngectomy produces anatomical changes that predispose patients to OSA. Radiologic metrics—particularly SVTV and BTCB—appear to be meaningful predictors of OSA severity. A multidisciplinary approach is essential for early diagnosis and management. Due to the small number of patients enrolled larger multicenter studies are needed to confirm these findings and define radiologic criteria associated with postoperative OSA. Full article

Background/Objectives: NF2-related schwannomatosis (NF2-SWN) is a genetic tumor predisposition syndrome of the nervous system caused by pathogenic variants in NF2 encoding the merlin tumor suppressor. Truncating variants in NF2 cause severe phenotypes with higher tumor burden, early mortality, and a lifetime need for multiple surgeries due to lack of medications that control schwannoma growth. Methods: We developed a functional precision medicine (FPM)-inspired workflow to identify drug sensitivities in cells isolated from a pediatric severe NF2-SWN patient’s spinal and peripheral schwannomas. Transcriptomic profiling, high-content drug sensitivity assays, tissue and isolated cell immunostaining, flow cytometry, and capillary-based immunoblotting were used to study the available tissues. Results: Aberrant merlin-dependent pathway expression was conserved between the spinal schwannoma and its cultured primary cells. Drug sensitivity screens in 2- and 3-dimensional formats revealed cytotoxic effects of fimepinostat in primary cells; dasatinib with brigatinib was the most effective cytostatic combination. Ineffective therapies attempted in the patient were also ineffective ex vivo. Conclusions: These data support the idea of using the FPM workflow to improve and individualize the standard of care for severe NF2-SWN patients using surgical samples. Full article

Endoscopic bariatric and metabolic therapies (EBMTs) offer minimally invasive treatment options for obesity and related metabolic disorders such as type 2 diabetes mellitus (T2DM) and metabolic dysfunction-associated steatotic liver disease (MASLD). These therapies are broadly categorized into gastric and small bowel interventions. Gastric EBMTs, including intragastric balloons and endoscopic sleeve gastroplasty, promote weight loss primarily through mechanical restriction and delayed gastric emptying, thereby improving metabolic outcomes. Small bowel therapies target the proximal intestine to modulate nutrient-sensing and hormonal pathways, providing metabolic benefits that may occur independently of weight loss. Techniques such as duodenal mucosal resurfacing, electroporation-based re-cellularization, and duodenal-jejunal bypass liners demonstrate promising effects on glycemic control, insulin sensitivity, and liver health. Emerging technologies utilizing thermal, vapor, and laser ablation further expand therapeutic possibilities. While these interventions show favorable safety profiles and potential as standalone or adjunctive treatments, further long-term studies and randomized trials are necessary to optimize patient selection and procedural protocols. Collectively, EBMTs represent an evolving paradigm in the management of obesity and metabolic diseases, bridging the gap between conservative medical therapies and bariatric surgery. Full article

Background: Carpal tunnel syndrome (CTS) is one of the most common entrapment neuropathies. While surgical decompression is widely considered the definitive treatment, conservative options remain clinically relevant, particularly for symptom relief and functional recovery in the short term. Objectives: To update the evidence comparing surgical versus non-surgical interventions for CTS, assessing pain, function, and clinical recovery. Design: Systematic review of randomised controlled trials (RCTs). Data Sources and Methods: Six databases (CENTRAL, MEDLINE, Embase, Cochrane Neuromuscular Register, ClinicalTrials.gov, and WHO ICTRP) were searched for RCTs published between November 2022 and January 2025. Risk of bias was assessed with RoB 2.0 and certainty of evidence with GRADE. Due to clinical heterogeneity, a narrative synthesis was performed. Results: Four RCTs (n = 1158) were included. Corticosteroid injection and percutaneous electrical nerve stimulation (PENS) appeared to provide faster symptom relief than surgery at short-term follow-up. However, surgery was associated with a higher probability of sustained recovery at 12–18 months (RR 1.36; 95% CI 1.19–1.56). Evidence for PENS was limited to one female-only trial, which restricts generalisability. Certainty of evidence was moderate for long-term outcomes and low for short-term results and safety. Conclusions: The available evidence suggests that surgery may offer more durable long-term recovery, whereas corticosteroids and PENS may be useful for short-term symptom relief. These findings should be interpreted with caution given the limited number of trials and the risk of bias in most included studies. Treatment choice should align with patient goals and recovery timelines. Registration: PROSPERO (CRD420250650789). Full article

Frontal sinus fractures typically reflect high-energy trauma and must be evaluated and treated carefully to avoid long-term problems including contour deformity, sinus dysfunction, cerebrospinal fluid (CSF) leakage, chronic sinusitis, and mucocele formation. This article outlines frontal sinus anatomy, diagnostic pathways, and evolving treatment concepts in detail. An anatomically driven treatment algorithm is emphasized, with a focus on preservation of sinus function whenever possible and preference for conservative management. Advanced procedures, such as endoscopic sinus surgery and cranialization, are reviewed in the context of managing more severe injuries. Key points: (1) Clinical decision-making in the management of frontal sinus fractures is best guided by evaluating the status of the anterior table, posterior table, and nasofrontal outflow tract, with treatment options ranging from nonoperative care to open or endoscopic surgery. (2) Improvements in endoscopic techniques, combined with evidence supporting less aggressive strategies, have shifted management toward more conservative approaches, reserving open procedures for higher-grade injuries. (3) Extended follow-up is essential to identify delayed problems such as mucoceles, chronic sinusitis, frontal bone osteomyelitis, and contour irregularities. Full article

Background: Traumatic hemothorax is a common complication of blunt chest trauma and remains associated with significant morbidity and mortality. Although contrast-enhanced computed tomography (CT) is central to diagnosis, the optimal criteria for selecting patients who require invasive management versus conservative treatment remain unclear. This study aimed to evaluate the management strategies and clinical outcomes of traumatic hemothorax and to identify predictors of surgical intervention and postoperative complications. Methods: We conducted a retrospective, single-center cohort study including adult patients admitted to a Level II Emergency Department with hemothorax following blunt chest trauma between January 2019 and December 2024. Primary outcomes were the need for urgent chest drainage or surgery. Secondary outcomes included postoperative complications, length of hospital stay, and intensive care unit admission. Univariable and multivariable regression analyses were performed to identify factors associated with surgical intervention and complications. Results: Seventy-two patients were included (mean age 60.0 ± 20.5 years; 80.6% male). Rib fractures were the most common cause of hemothorax (61.1%). Chest tube placement was required in 70.8% of cases, and 31.9% underwent urgent surgical intervention. Active bleeding on contrast-enhanced CT was identified in 16.7% of patients and was the only independent predictor of urgent surgery (OR 3.85, 95% CI 1.07–13.88; p = 0.039). The initial volume of blood drained after chest tube insertion did not differ between surgically and non-surgically managed patients. Conservative management was successful in 19.4% of cases. Postoperative complications occurred in five patients and were associated with a higher comorbidity burden. Overall mortality was 5.6%. Conclusions: In traumatic hemothorax following blunt chest trauma, active bleeding on contrast-enhanced CT seems to be the strongest predictor of urgent surgical intervention, whereas initial pleural drainage volume alone is not. Conservative management is safe in selected patients, while comorbidities influence postoperative outcomes. Multidisciplinary management and accurate radiological assessment are essential to guide timely and appropriate treatment. Full article

Background: Implant-based breast reconstruction (IBBR) is the most widely used reconstructive strategy after mastectomy, but postoperative infection remains a major complication because it may require reoperation, implant explantation, and reconstructive failure. This study evaluated the incidence, determinants, and clinical burden of infection in a large single-center cohort. Materials and Methods: This retrospective observational study included 1537 reconstructed breasts undergoing post-mastectomy implant-based breast reconstruction. The unit of analysis was the reconstructed breast. Infection was defined clinically by erythema, pain, swelling, or secretion requiring antibiotic treatment, without requiring microbiological confirmation or formal surgical-site-infection criteria; this pragmatic definition reflects the retrospective nature of the study and should be considered when comparing results across studies. Univariate analyses were performed using chi-square, Fisher’s exact, or Mann–Whitney U tests, as appropriate. Independent predictors were assessed by multivariate binomial logistic regression. Results: Postoperative infection occurred in 66 of 1525 reconstructed breasts (4.3%). Among infected breasts, 54 cases (81.8%) required surgery, whereas 12 (18.2%) were managed conservatively. Implant explantation was performed in 82 of 1525 reconstructions (5.4%), and infection accounted for 39 of 74 explantations with available indication data (52.7%). In multivariate analysis, longer operative time remained independently associated with infection (OR 1.005 per minute, 95% CI 1.001–1.010; p = 0.010; corresponding to OR 1.38, 95% CI 1.08–1.77, per 60 min increment). Prepectoral reconstruction was also associated with a higher risk of infection compared with retropectoral reconstruction (OR 2.31, 95% CI 1.03–5.16; p = 0.042). Additional analyses showed that prepectoral reconstruction was more frequently associated with bilateral procedures, nipple-sparing mastectomy, and longer operative time. In unilateral reconstructions, the association between prepectoral reconstruction and infection persisted. Conclusions: Infection after implant-based breast reconstruction remains a clinically relevant source of morbidity and frequently requires further surgery. Longer operative time emerged as the most consistent independent factor associated with infection in the overall cohort. Prepectoral reconstruction was also associated with infection, although this finding should be interpreted cautiously in light of reconstructive context and case selection. Full article

Biological heterogeneity among different breast cancer (BC) subtypes results in markedly varying clinical outcomes. Identification and analysis of key gene biomarkers that are differentially regulated during radiation therapy (RT) may pose multiple clinical challenges for BC treatment. The purpose of the study is to identify and analyze the expression of key gene biomarkers and their networks that are differentially regulated after hypofractionated RT. Patients with BC (cT0-T2, N0, M0) were treated with hypofractionated whole breast RT 25 Gy in five fractions, 4 to 8 weeks before breast conservation surgery (BCS). Biopsy (pre-RT; n = 5) and surgical (post-RT; n = 14 or 15) BC tumor samples were used for NanoString targeted sequencing. We identified 165 and 244 differentially expressed genes (DEGs; p < 0.05) in BC tumor samples from BC patients post-RT using the nCounter BC360 and IO360 panels, respectively. Gene networks and pathway analysis revealed that RT increases the gene signature of tumor inflammation (TIS), cytotoxicity, and apoptosis, while downregulating the gene signatures of tumor cell proliferation, differentiation, and cell adhesion, and increases the claudin-low gene score. RT-induced mammary stemness and enhanced infiltration of stroma, mast, and macrophage cells in the BC tumor microenvironment (TME). Further, the nCounter IO360 (immuno-oncology) panel analysis validated the findings of BC360 and demonstrated that RT increased the myeloid inflammation signature and chemokine expression, modulated B, T, NK, and DC cell activities, and enhanced residual cancer burden (RCB) in BC tumors, thus creating an immunosuppressive TME. Collectively, RT sensitized BC tumors by increasing the gene signature of TIS, cytotoxicity, apoptosis, and mammary stemness. RT facilitated an immunosuppressive environment and increased RCB, suggesting that the therapeutic potential of RT is highly individualized for each patient based on their unique tumor biology, genetic makeup, and TME. Full article

Breast-conserving therapy (BCT), consisting of lumpectomy followed by adjuvant radiation, provides oncologic outcomes equivalent to mastectomy for many patients with breast cancer. As survivorship increases, the demand for aesthetic restoration after BCT has grown; however, reconstructive strategies in this setting remain less standardized than those following mastectomy. Reconstruction after BCT presents distinct challenges due to partial tissue loss, nonuniform radiation injury, progressive fibrosis, and wide variability in patient expectations and tolerance for revision surgery. Consequently, mastectomy-based reconstructive algorithms are often insufficient for guiding care in this population. This review synthesizes contemporary reconstructive options following BCT through a personalized medicine framework, emphasizing patient-specific risk factors that influence technique selection, timing, and long-term outcomes. Key determinants include radiation exposure, breast morphology, comorbid conditions, prior breast surgery, and psychosocial preferences. Oncoplastic volume displacement, implant-based augmentation, fat grafting, and autologous reconstruction each demonstrate distinct risk profiles in the post-BCT tissue environment and require individualized application. Timing of reconstruction and willingness to undergo staged procedures play a central role in outcome durability and patient satisfaction. Across reconstructive strategies, revision burden emerges as a clinically meaningful, patient-centered outcome that is not adequately captured by traditional short-term complication metrics. A risk-informed approach that integrates individualized risk assessment with transparent counseling and shared decision-making may improve alignment between reconstructive planning and patient goals. Personalized reconstruction after BCT requires moving beyond technique-driven paradigms toward flexible, longitudinal care pathways. Future efforts should focus on developing BCT-specific predictive models and incorporating patient-reported outcomes to advance personalized reconstructive care. Full article

Background: Trapeziometacarpal (TM) osteoarthritis (OA) is a common condition, especially among postmenopausal women, often requiring surgical intervention when conservative treatment fails. In recent years, dual-mobility prostheses have been increasingly used as an alternative to traditional trapeziectomy with suspension arthroplasty. However, limited data exist regarding their comparative cost-effectiveness in public healthcare systems. Purpose: The aim of this study was to compare the cost–benefit ratio and clinical outcomes of two surgical techniques for TM OA: trapeziectomy with suspension arthroplasty and total joint arthroplasty with a dual-mobility prosthesis. Methods: We conducted a retrospective cohort study of 116 hands treated between 2020 and 2024. Patients were divided into two groups based on the surgery they received: trapeziectomy with suspension arthroplasty or implantation of a dual-mobility TM prosthesis. Clinical outcomes were assessed using VAS, DASH, Kapandji score, grip strength, and pinch strength at 12, 36, and 48 months postoperatively. A cost analysis was performed based on hospital reimbursement (Diagnosis-Related Group) and estimated productivity loss. Results: Both techniques yielded significant improvements in pain and function. Patients who were operated on with a prosthesis showed faster recovery and better early outcomes, while the trapeziectomy group had lower direct surgical costs and fewer complications. At 48 months, clinical scores were comparable. The overall cost–benefit ratio favoured trapeziectomy with suspension arthroplasty, while TM prosthesis’s higher costs were justified due to improved short-term functional recovery. Conclusions: Both surgical techniques achieved satisfactory long-term clinical outcomes. The prosthetic option allows for quicker recovery and reduces indirect social costs, while suspension arthroplasty remains more cost-effective for direct costs. These findings highlight the importance of balancing clinical benefit and economic sustainability in surgical decision-making for TM osteoarthritis. Level of Evidence: Level III, retrospective comparative study. Full article