Search Results (79)

Background/Objectives: To evaluate whether the interval between diagnosis and surgery is associated with aggressive histopathological features in papillary thyroid carcinoma (PTC) among patients treated at a tertiary hospitals in Saudi Arabia. Methods: This retrospective study was conducted at King Fahad Medical City, Riyadh, Saudi Arabia, from November 2009 to November 2024. A total of 350 adult patients who underwent surgical intervention for PTC were included based on predefined inclusion and exclusion criteria. Data were collected from medical records and included demographic, clinical, and histopathological characteristics. The primary outcome was the presence of aggressive histopathological features, assessed through tumor subtype, tumor size, extrathyroidal extension (ETE), lymph-node involvement, extracapsular extension (ECE), multifocality, goitrous tumor, thyroiditis, perineural invasion, lymphovascular invasion, and margin status. Surgical timing was categorized into two groups: less than six months and six months or more from diagnosis. Results: Most patients were female (76.6%), with a mean age of 40.7 years, and 78.3% were classified as overweight or obese. The analysis showed no statistically significant differences in histopathological outcomes between the two surgical timing groups. A significant association was found between positive lymph-node involvement and surgery performed within the first six months of diagnosis (p = 0.004). Conclusions: This study showed that surgical timing does not significantly affect histopathological outcomes in papillary thyroid carcinoma, particularly in patients without aggressive disease features. The association between early surgery and positive lymph-node involvement may reflect the prioritization of patients with preoperative lymph-node disease for earlier surgical intervention, highlighting the importance of individualized treatment planning. Further research is needed to explore the long-term impact of surgical timing and potential subgroup differences. Full article

Frailty has emerged as a critical determinant of clinical outcomes in elderly patients, shaping postoperative recovery in crucial orthopedic events, such as hip fractures. The purpose of the present study is to examine the impact of frailty syndrome on muscle strength and joint range of motion in the non-fractured lower extremity and upper extremities of hospitalized older adults following hip fracture surgery. The sample consisted of 60 elderly patients recovering from either intracapsular or extracapsular hip fractures. Participants were categorized into either a frail or non-frail group, determined by the Clinical Frailty Scale. The outcome measures of muscle strength and range of motion of the upper and lower extremities were assessed by valid instruments, including a hand-held dynamometer, the Medical Research Council scale, and a digital goniometer. Statistical comparisons between groups were conducted using the independent samples t-test and the Mann–Whitney U test. The results showed that the non-frail group demonstrated greater active range of motion in the shoulder bilaterally (right: t = −2.85, left: U = 628.00, p < 0.05), elbow flexion bilaterally (right: U = 589.50, left: U = 592.50, p < 0.05), hip flexion (U = 679.50, p < 0.01), knee extension (t = −3.07, p < 0.05), and ankle dorsiflexion (t = −2.36, p < 0.05). Regarding the muscle strength, the non-frail group showed significantly higher grip strength bilaterally (right: U = 754.50, left: U = 713.50, p < 0.001), as well as greater strength in hip flexion (U = 641.00, p < 0.01) and ankle dorsiflexion (U = 619.50, p < 0.01). Frailty may negatively influence the muscle strength and joint mobility in non-fractured extremities, thereby hindering postoperative physical recovery in older adults with hip fractures. Further research involving a larger and more homogeneous sample may predict falls in elderly patients after hip or knee surgery using the Clinical Frailty Scale. Full article

Background: The incidence of thyroid cancer has rapidly increased worldwide, and familial aggregation of the disease has been increasingly recognized. This study aimed to evaluate the prevalence, clinicopathological characteristics, and long-term outcomes of familial non-medullary thyroid cancer (FNMTC) in a large institutional cohort. Methods: Patients with non-medullary thyroid cancer (NMTC) who had undergone surgery were classified as sporadic NMTC (SNMTC) or FNMTC based on family history. Clinicopathological features at diagnosis and surgery were compared, and prognostic outcomes were analyzed in patients with follow-up data. Results: Among the 46,572 NMTC patients, 3829 (8.2%) had FNMTC, and 42,743 (91.8%) had SNMTC. FNMTC was more prevalent in women and occurred at a younger age. Its proportion increased over time, peaking in the 35–59 age group. FNMTC showed higher rates of bilaterality (23.5% vs. 17.5%, p < 0.001), multifocality (39.0% vs. 30.5%, p < 0.001), and central lymph node metastasis (41.5% vs. 38.8%, p = 0.001), despite smaller tumors (0.9 ± 0.7 cm vs. 1.0 ± 0.9 cm, p < 0.001). Recurrence rates were similar between the two groups (1.9% vs. 2.3%, p = 0.1), but overall survival was higher in the FNMTC group (99.6% vs. 98.6%, p < 0.001). Family history, extracapsular extension, lymph node metastasis, and tumor size independently predicted recurrence. Family history significantly impacted recurrence-free survival in the intermediate-to-high-risk group (HR = 1.65, p < 0.001) but not in low-risk patients. Conclusions: FNMTC represents a distinct NMTC subset with more extensive local disease but favorable survival, warranting risk-adapted management, particularly for intermediate-to-high-risk patients. Full article

Free jejunum is used for reconstruction after resection of advanced head and neck cancer. Postoperative transplanted mesenteric lymph nodes swelling is often experienced, but its clinical significance is unclear. This study included patients who underwent free jejunal reconstruction at Gifu University Hospital between March 2017 and November 2023. Regarding the size change of postoperative mesenteric lymph node and risk factors, the correlation with metastasis and prognosis was investigated. This study included 51 patients, of whom 16 cases (31.4%) had postoperative mesenteric lymph node swelling and 2 cases (3.9%) had metastasis. Only two cases with metastasis showed an increase in size of 5 mm or more. Many cases without extracapsular extension and cases of salvage surgery had postoperative mesenteric lymph node swelling (p = 0.0429, p = 0.0269). No correlation was found between postoperative mesenteric lymph node swelling and prognosis. However, because all cases with metastasis were included in cases of postoperative mesenteric lymph node swelling, this could be one factor in determining whether or not metastasis occurred. The transplanted mesenteric lymph node swelling is one of the important postoperative evaluation items, and additional evaluation such as PET-CT may be recommended. Full article

Background/Objectives: Head and neck squamous cell carcinoma (HNSCC) diagnosis and treatment rely heavily on computed tomography (CT) imaging to evaluate tumor characteristics and lymph node (LN) involvement, crucial for staging, prognosis, and therapy planning. Conventional LN evaluation methods based on morphological criteria such as size, shape, and anatomical location often lack sensitivity for early metastasis detection. This study leverages radiomics to extract quantitative features from CT images, addressing the limitations of subjective assessment and aiming to enhance LN classification accuracy while potentially reducing reliance on invasive histopathology. Methods: We analyzed 234 LNs from 27 HNSCC patients, deriving 120 features per node, resulting in over 25,000 data points classified into reactive, pathologic, and pathologic with extracapsular spread classes. Considering the challenges of high dimensionality and limited dataset size, more than 44,000 experiments systematically optimized machine learning models, feature selection methods, and hyperparameters, including ensemble approaches to strengthen classification robustness. A Pareto front strategy was employed to balance diagnostic accuracy with significant feature reduction. Results: The optimal model, validated via 5-fold cross-validation, achieved a balanced accuracy of 0.90, an area under the curve (AUC) of 0.93, and an F1-score of 0.88 using only five radiomics features. Conclusions: This interpretable approach aligns well with clinical radiology practice, demonstrating strong potential for clinical application in noninvasive LN classification in HNSCC. Full article

Backgrounds. Lateral neck dissection (LND) is standard for thyroid cancer patients with neck metastases, mostly performed at the same time as total thyroidectomy (cLND). We introduced a new delayed LND (dLND), 4 weeks after thyroidectomy to reduce surgical morbidity. This study aims to compare the oncologic/complication outcomes between the two strategies, based on a large retrospective cohort of patients. Methods. Between 1996 and 2024, 215 patients were treated with total thyroidectomy, central neck dissection (CND) and LND, and grouped by surgical strategy (cLND vs. dLND); survival/complication outcomes were analyzed and compared between the two groups. Results. The overall and disease-free survival were comparable between groups. Age, extracapsular extension, and nodal burden predicted recurrence. dLND was associated with a significantly lower risk of vocal fold palsy. Extranodal extension (ECE) strongly predicted nerve injury. Conclusions. dLND offers similar oncologic outcomes to cLND, with reduced risk of vocal fold palsy. A staged approach enhances nerve preservation and might be considered in treatment planning. Full article

Background/Objectives: ISUP grade group discordance between prostate biopsy and radical prostatectomy (RP) impacts treatment decisions in over a third (~25–40%) of prostate cancer (PCa) patients. We aimed to identify ISUP grade migration predictors and assess the impact of preoperative imaging (MRI) in a contemporary Romanian PCa cohort. Methods: We retrospectively analyzed 142 PCa patients undergoing RP following biopsy between January 2021 and December 2024 at Pius Brinzeu County Hospital, Timișoara: 90 without and 52 with preoperative MRI. Clinical parameters, MRI findings (PI-RADS), and biopsy characteristics were evaluated. Machine learning models (gradient boosting, random forest) were developed with SHAP analysis for interpretability. Results: Grade migration occurred in 69/142 patients (48.6%): upstaging in 55 (38.7%) and downstaging in 14 (9.9%). In the non-MRI cohort, 37/90 (41.1%) were upstaged and 9/90 (10.0%) were downstaged, versus 18/52 (34.6%) upstaged and 5/52 (9.6%) downstaged in the MRI cohort. The MRI group showed a 6.5% absolute reduction in upstaging (34.6% vs. 41.1%), a promising non-significant trend (p = 0.469) that requires further investigation. Grade 1 patients showed the highest upstaging (69.4%), while Grades 3–4 showed the highest downstaging (11/43, 25.6%). PI-RADS 4 lesions had the highest upstaging (43.5%). PSA density > 0.20 ng/mL² emerged as the strongest predictor. Gradient boosting achieved superior performance (AUC = 0.812) versus logistic regression (AUC = 0.721), representing a 13% improvement in discrimination. SHAP analysis revealed PSA density as the most influential (importance: 0.287). Grade migration associated with adverse pathology: extracapsular extension (52.7% vs. 28.7%, p = 0.008) and positive margins (38.2% vs. 21.8%, p = 0.045). Conclusions: ISUP grade migration affects 48.6% of Romanian patients, with 38.7% upstaged and 9.9% downstaged. The 69.4% upstaging in Grade 1 patients emphasizes the need for enhanced risk stratification tools, while 10% downstaging suggests potential overtreatment. Machine learning with SHAP analysis provides superior predictive performance (13% AUC improvement) while offering clinically interpretable risk assessments. PSA density dominates risk assessment, while PI-RADS 4 lesions warrant closer scrutiny than previously recognized. Full article

Background: Hip fractures represent a major clinical challenge, particularly in elderly and frail patients, where postoperative pain control must balance effective analgesia with motor preservation to facilitate early mobilization. Various regional anesthesia techniques are used in this setting, including the pericapsular nerve group (PENG) block, fascia iliaca compartment block (FICB), femoral nerve block (FNB), and quadratus lumborum block (QLB), yet optimal strategies remain debated. Objectives: To systematically review the efficacy, safety, and clinical applicability of major regional anesthesia techniques for pain management in hip fractures, including considerations of fracture type, surgical approach, and functional outcomes. Methods: A systematic literature search was conducted following PRISMA 2020 guidelines in PubMed, Scopus, Web of Science, and the virtual library of the Hospital Central de la Defensa “Gómez Ulla” up to March 2025. Inclusion criteria were RCTs, systematic reviews, and meta-analyses evaluating regional anesthesia for hip surgery in adults. Risk of bias in RCTs was assessed using RoB 2.0, and certainty of evidence was evaluated using the GRADE approach. Results: Twenty-nine studies were included, comprising RCTs, systematic reviews, and meta-analyses. PENG block demonstrated superior motor preservation and reduced opioid consumption compared to FICB and FNB, particularly in intracapsular fractures and anterior surgical approaches. FICB and combination strategies (PENG+LFCN or sciatic block) may provide broader analgesic coverage in extracapsular fractures or posterior approaches. The overall risk of bias across RCTs was predominantly low, and certainty of evidence ranged from moderate to high for key outcomes. No significant safety concerns were identified across techniques, although reporting of adverse events was inconsistent. Conclusions: PENG block appears to offer a favorable balance of analgesia and motor preservation in hip fracture surgery, particularly for intracapsular fractures. For extracapsular fractures or posterior approaches, combination strategies may enhance analgesic coverage. Selection of block technique should be tailored to fracture type, surgical approach, and patient-specific functional goals. Full article

Intertrochanteric fractures in the elderly present complex challenges due to poor bone quality and comorbidities. Cephalomedullary (CM) nails offer biomechanical advantages that support early mobilization, yet complications such as cutout, implant failure, and malalignment persist. This review examines the effectiveness of CM nail fixation in geriatric extracapsular hip fractures and introduces the RESCUE technique—a structured, mnemonic-based approach aimed at improving surgical outcomes and reducing common complications. RESCUE stands for Reduce, Entry point, Screw, Compress, Unleash traction, and Enhance full-weight bearing. This six-step framework addresses the critical elements of fixation, including precise reduction, optimal entry point selection, central screw placement, controlled fracture compression, cautious traction management, and early mobilization. Case illustrations of frequent failure patterns underscore the practical application of the RESCUE technique. By following this systematic approach, surgeons can enhance construct stability, minimize failure risk, and promote functional recovery in elderly patients. Full article

Background/Objectives: The aim of our study was to evaluate clinical outcomes in patients with small pleomorphic adenoma (PA) after extracapsular dissection (ED) versus superficial parotidectomy (SP). Methods: Following the PRISMA guidelines, a systematic review covering the years from 1950 to 2025 was conducted using the Pubmed/MEDLINE, Cochrane Library, Scopus, Ovid MEDLINE and Embase databases. A single-arm meta-analysis was performed to evaluate intraoperative capsular rupture, recurrence, transient and permanent facial nerve palsy, Frey’s syndrome, salivary fistula, seroma and hematoma of patients who underwent ED vs. those who underwent SP, and funnel plots were constructed to evaluate the robustness of the findings. Results: Of the 1793 identified papers, 21 articles met the inclusion criteria. The meta-analysis (2507 patients) reported the following: (1) the risk of recurrence is similar in patients treated with ED and SP; (2) the transient facial nerve palsy rate is lower after ED (p < 0.05), while the permanent facial nerve palsy rate is similar with ED and SP; (3) post-operative complications, especially Frey’s syndrome (p < 0.05), are more common after SP. Conclusions: Given the similar recurrence rate and the lower morbidity compared to SP, ED could be considered the treatment of choice for pleomorphic adenomas of the parotid gland that are up to 3 cm in size, mobile and located in the superficial lobe of the parotid gland. Full article

Neck of femur (NOF) fractures are a critical orthopaedic emergency with a high morbidity and mortality prevalence, particularly in people living with Human Immunodeficiency Virus (PLWHIV). A combination of HIV infection, combined antiretroviral therapy (cART), and compromised bone health further increases the risk of fragility fractures. Additionally, HIV-related immune dysfunction, cART-induced osteoporosis, and perioperative infection risks further pose challenges in ongoing surgical management. Despite the rising global prevalence of PLWHIV, no specific guidelines exist for the perioperative and post-operative care of PLWHIV undergoing NOF fracture surgery. This narrative review synthesises the current literature on the surgical management of NOF fractures in PLWHIV, focusing on pre-operative considerations, intraoperative strategies, post-operative complications, and long-term outcomes. It also explores infection control, fracture healing dynamics, and ART’s impact on surgical outcomes while identifying key research gaps. A systematic database search (PubMed, Embase, Cochrane Library) identified relevant studies published up to February 2025. Inclusion criteria encompassed studies on incidence, risk factors, ART impact, and NOF fracture outcomes in PLWHIV. Data were analysed to summarise findings and highlight knowledge gaps. Pre-operative care: Optimisation involves assessing immune status (namely, CD4 counts and HIV-1 viral loads), bone health, and cART to minimise surgical risk. Immunodeficiency increases surgical site and periprosthetic infection risks, necessitating potential enhanced antibiotic prophylaxis and close monitoring of potential start/switch/stopping of such therapies. Surgical management of neck of femur (NOF) fractures in PLWHIV should be individualised based on fracture type (intracapsular or extracapsular), age, immune status, bone quality, and functional status. Extracapsular fractures are generally managed with internal fixation using dynamic hip screws or intramedullary nails. For intracapsular fractures, internal fixation may be appropriate for younger patients with good bone quality, though there is an increased risk of non-union in this group. Hemiarthroplasty is typically favoured in older or frailer individuals, offering reduced surgical stress and lower operative time. Total hip arthroplasty (THA) is considered for active patients or those with pre-existing hip joint disease but carries a higher infection risk in immunocompromised individuals. Multidisciplinary evaluation is critical in guiding the most suitable surgical approach for PLWHIV. Importantly, post-operative care carries the risk of higher infection rates, requiring prolonged antibiotic use and wound surveillance. Antiretroviral therapy (ART) contributes to bone demineralisation and chronic inflammation, increasing delayed union healing and non-union risk. HIV-related frailty, neurocognitive impairment, and socioeconomic barriers hinder rehabilitation, affecting recovery. The management of NOF fractures in PLWHIV requires a multidisciplinary, patient-centred approach ideally comprising a team of Orthopaedic surgeon, HIV Physician, Orthogeriatric care, Physiotherapy, Occupational Health, Dietitian, Pharmacist, Psychologist, and related Social Care. Optimising cART, tailoring surgical strategies, and enforcing strict infection control can improve outcomes. Further high-quality studies and randomised controlled trials (RCTs) are essential to develop evidence-based guidelines. Full article

Background: A number of factors might affect survival in oral squamous cell carcinoma. Nodal status is one of the most important prognosticators affecting survival. Studies have shown that pattern of invasion is an important aspect related to survival. Study design: retrospective single-center study (original article). Objectives: Our study aimed at evaluating the factors affecting mandibular invasion, lymph node metastasis, and extracapsular spread in oral squamous cell carcinoma and the survival factors associated with it. Methods: Patient records were evaluated to identify factors influencing primary outcome and survival. Cox regression analysis and Kaplan Meir were applied to evaluate the outcomes. Youden’s index was used to determine a cut-off value for depth of invasion and lymph node size affecting outcome. A p value of <0.05 was considered statistically significant. Results: The study evaluated 162 patients with oral cancer. The cut-off value for DOI was 6.5 mm, significantly affecting mandibular invasion and cervical metastasis. The cut-off value for lymph node size was 2.95 cm, significantly affecting extracapsular spread and overall survival. An aggressive pattern of invasion significantly affects mandibular invasion, cervical metastasis, and survival. Conclusion: An aggressive pattern of invasion and depth of invasion are independent risk factors for cervical lymph node metastasis and mandibular invasion. The independent risk factor for extracapsular spread is lymph node size. Lymph node metastasis and nodal size, pattern of invasion, mandibular invasion, and extracapsular spread are independent risk factors affecting overall survival. Full article

Background/Objectives: Pleomorphic adenomas (PAs) are the most common salivary gland tumors, with a known risk of recurrence, especially after inadequate surgical excision. Understanding how surgical approach influences recurrence remains essential to optimize management. This study aimed to synthesize recurrence rates of PAs based on different surgical techniques and to illustrate the implications of surgical strategy through a representative case of multifocal deep lobe recurrence. Methods: A systematic review was conducted according to PRISMA 2020 guidelines. Three electronic databases (PubMed, Cochrane, and Google Scholar) were searched for studies published in the last ten years, reporting recurrence rates of PAs by surgical approach. Data were extracted on recurrence, complications, and tumor characteristics. Additionally, a complex clinical case of recurrent deep lobe PA (DLPA) was presented to contextualize the findings. Results: Fifteen studies were included, comprising a total of 2095 patients. Recurrence rates were 3.27% after extracapsular dissection (ED), 0.73% after partial superficial parotidectomy (PSP), and 2.41% after superficial parotidectomy (SP). Recurrent PA (RPA) is often multifocal and associated with increased risks of facial nerve palsy and positive surgical margins. The presented case involved five surgical procedures, with ultimate total parotidectomy and facial nerve preservation despite infiltrative recurrence in the prestyloid space. Conclusions: Techniques such as ED and PSP have demonstrated their efficacy and safety compared to more invasive approaches, although their application should be carefully evaluated based on tumor size and location. RPA remains a challenging entity to treat. Avoiding outdated techniques and ensuring evidence-based decision making may improve long-term outcomes in PA management. Full article

Background: Hip fractures are a major cause of morbidity and mortality, particularly in the elderly, and the incidence is expected to rise significantly in the coming years. One of the key challenges in managing hip fracture patients is perioperative blood loss, which often necessitates allogeneic blood transfusion. Tranexamic acid (TXA), a synthetic antifibrinolytic agent, has been shown to reduce blood loss in various surgical settings, including elective orthopaedics. However, unlike elective surgery where bleeding begins intraoperatively, bleeding in hip fracture patients starts at the time of injury. This scoping review aimed to evaluate the existing literature on the use of early TXA administration, specifically at the point of admission, in patients with hip fractures. Methods: A comprehensive search of EMBASE and PubMed was conducted up to March 2025, and eight studies were identified that met the inclusion criteria, including three randomised controlled trials (RCTs). Six of these studies compared patients receiving TXA on admission to controls who received no TXA, involving a total of 840 patients. Most studies focused on extracapsular fractures in elderly, predominantly female patients. Results: Findings were mixed: four of the six studies found no statistically significant differences in haemoglobin levels or transfusion rates, while two RCTs demonstrated significantly reduced transfusion needs in the TXA group. Trends across studies suggested reduced blood loss and transfusion risk with TXA administered on admission. Importantly, no increase in complications, including venous thromboembolism, were observed. Conclusion: Early TXA administration in hip fracture patients appeared to be safe and may reduce transfusion requirements. Further high-quality research is warranted to determine the optimal timing and dosing strategy for TXA in this setting and to confirm the efficacy in reducing perioperative blood loss and transfusion risk. Full article

Background: PSMA PET is essential tool in the management of prostate cancer (PCa) patients in various clinical settings of disease. The tremendous growth of the implementation of radiomics and artificial intelligence (AI) in medical imaging techniques has led to an increasing interest in their application in prostate-specific membrane antigen (PSMA) PET. The aim of this article is to systemically review the current literature that explores radiomics and AI analyses of staging PSMA PET towards its potential application in clinical practice. Methods: A systematic research of the literature on three international databases (PubMed, Scopus, and Web of Science) identified a total of 166 studies. An initial screening excluded 68 duplicates and 72 articles relevant to other topics. Finally, 21 studies met the inclusion criteria. Conclusions: The literature suggests that radiomic analysis could improve the characterization of tumor aggressiveness, the prediction of extra-capsular extension, and seminal vesicles involvement. Moreover, AI models could contribute to predicting BCR after radical treatment. Limitations regarding heterogeneous objectives of investigation, and methodological standardization of radiomics analysis still represent the main obstacle to overcome in order to see these technology break through into daily clinical practice. Full article