Search Results (4,076)

Background/Objectives: Primary cytoreductive surgery for advanced ovarian cancer is associated with a high risk of postoperative complications, particularly surgical site infections, which may delay recovery and adjuvant treatment. This study aimed to evaluate the impact of a revised infection-prevention bundle, centered on chlorhexidine-alcohol skin antisepsis, on surgical site infection rates and cost-effectiveness. Methods: In this single-center cohort study, 636 patients undergoing primary cytoreductive surgery between January 2019 and December 2023 were included. A historical control group (n = 300) received povidone-iodine for intraoperative skin preparation, while a prospective intervention group (n = 336) received chlorhexidine gluconate 2% in 70% isopropyl alcohol. Both groups were managed within a standardized perioperative care pathway. Surgical site infections within 30 days were defined according to established criteria. Comparative and descriptive statistical analyses were performed. Results: Baseline clinicopathological characteristics were comparable between groups. The overall surgical site infection rate was significantly lower in the chlorhexidine-alcohol group compared with the povidone-iodine group (8.3% vs. 14.0%; p = 0.0226). The reduction was particularly evident in procedures lasting more than 180 min (9.5% vs. 17.1%; p = 0.0199), while no significant difference was observed in shorter procedures. Cost analysis demonstrated a net saving of approximately EUR 451 per procedure in the chlorhexidine group, driven by reduced infection-related costs and improved operating room efficiency. Conclusions: Baseline clinicopathological characteristics were comparable between groups. The overall surgical site infection rate was significantly lower in the chlorhexidine-alcohol group compared with the povidone-iodine group (8.3% vs. 14.0%; p = 0.0226). The reduction was particularly evident in procedures lasting more than 180 min (9.5% vs. 17.1%; p = 0.0199), while no significant difference was observed in shorter procedures. Cost analysis demonstrated a net savings of approximately EUR 451 per procedure in the chlorhexidine group, driven by reduced infection-related costs and improved operating room efficiency. Full article

Background: Total knee arthroplasty in patients with hemophilia remains the most effective surgical intervention for end-stage hemophilic arthropathy, yet it poses unique surgical and perioperative challenges that are rarely encountered in standard osteoarthritis cases. This article synthesizes technical, anatomical, and perioperative considerations specific to hemophilic patients and integrates prospective clinical data derived exclusively from the hemophilic cohort of our long-term study (twenty patients, twenty knees; 2015–2024). Emphasis is placed on deformity correction, bone loss management, implant selection, hemostatic strategies, transfusion patterns, and perioperative pitfalls. The objective is to provide a comprehensive narrative reference for surgeons managing complex hemophilic knees, consolidating both evidence-based recommendations and practical perioperative “tips and tricks” accumulated across more than a decade of clinical experience. Methods: This prospective observational study evaluated twenty consecutive male patients with hemophilia who underwent primary total knee arthroplasty for advanced hemophilic arthropathy between 2015 and 2024 at our institution. The following variables were collected: operative time measured from skin incision to skin closure, postoperative transfusion requirement, length of hospitalization measured in days, early postoperative complications, and functional recovery as assessed by the Knee Society Score. Early complications included postoperative bleeding or hematoma, superficial or deep infection, and stiffness requiring intensive physiotherapy or manipulation under anesthesia. Results: The mean age at the time of surgery was 44.8 years with a standard deviation of 7.2 years, ranging from 31 to 59 years. The mean operative time in the hemophilic cohort was 154.54 min with a standard deviation of 18.36 min. The range of operative time was from 120 to 180 min. Nine of the twenty patients, representing 45 percent, required postoperative blood transfusion. The mean length of hospital stay in the hemophilic cohort was 12.3 days with a standard deviation of 2.38 days, ranging from 9 to 17 days. The mean Knee Society Score improved from 38 points preoperatively to 82 points at final follow-up, representing a mean increase of 44 points. Conclusions: Total knee arthroplasty in hemophilic patients is safe and effective when specialized surgical techniques, comprehensive synovectomy, precise deformity correction, optimized hemostasis, and structured postoperative coagulation factor replacement are implemented. Functional outcomes and prosthetic survival are excellent in experienced centers. Full article

Background and Objectives: Access to medicines is a fundamental determinant of health equity and a core pillar of universal health coverage, encompassing the timely availability, affordability, and appropriate use of essential medicines. Socioeconomic disparities may limit actual and timely access to pharmacological treatment, particularly in healthcare systems characterized by mixed public–private financing and significant out-of-pocket expenditures. This study aimed to evaluate socioeconomic determinants of access to medicines among Romanian patients with chronic diseases, focusing on income level, prescription reimbursement, perceived affordability, and substitution behavior during medicine shortages. Materials and Methods: A cross-sectional study was conducted between October and December 2024 using a structured online questionnaire administered to 200 adult patients diagnosed with cardiovascular diseases, diabetes mellitus, chronic hepatitis B and C, or oncological conditions, recruited at the “Prof. Dr. D. Hociotă” Institute of Phonoaudiology and Functional ENT Surgery, Bucharest, Romania. Associations between income and access-related variables were assessed using Spearman’s rank correlation coefficients with 95% confidence intervals. Binary logistic regression identified independent predictors of perceived difficulty in accessing medicines (p < 0.05). Results: Lower income was significantly associated with greater reliance on reimbursed prescriptions (r_s = −0.241, 95% CI: −0.37 to −0.10, p = 0.001) and fully reimbursed prescriptions (r_s = −0.305, 95% CI: −0.43 to −0.17, p < 0.001). Income was strongly correlated with perceived affordability of treatment (r_s = 0.601, 95% CI: 0.50–0.69, p < 0.001). In multivariate logistic regression analysis, income below 3000 RON/month (adjusted OR = 1.94, 95% CI: 1.05–3.58, p = 0.034) and insufficient affordability (adjusted OR = 4.12, 95% CI: 2.15–7.89, p < 0.001) were independently associated with perceived difficult access to treatment. Additionally, 80% of respondents reported purchasing substitute medicines when prescribed medicines were unavailable. Conclusions: This cross-sectional study indicates that socioeconomic status and perceived affordability are significant determinants of access to medicines among Romanian patients with chronic diseases attending a tertiary ENT centre. Financial vulnerability remains a major barrier despite existing reimbursement mechanisms. Policy interventions aimed at strengthening income-sensitive reimbursement strategies and ensuring consistent pharmaceutical availability may improve equitable access and therapeutic continuity. Full article

Pelvic xanthogranulomatous inflammation is a rare pathological entity that can closely mimic malignant disease on cross-sectional imaging, often leading to consideration of radical surgical intervention. We report the case of a 59-year-old woman who presented with a large retrovesical pelvic mass initially suspected to be a malignant process. A definitive diagnosis was established only after tissue biopsy and comprehensive histopathological examination, which excluded malignancy and demonstrated xanthogranulomatous histiocytic inflammation. In light of the lesion’s anatomical location and the substantial morbidity associated with surgical resection, a conservative medical strategy was pursued. Treatment with systemic corticosteroids and everolimus led to marked clinical improvement and a substantial radiological response, with reduction in lesion size from 41 × 26 mm to 27 × 17 mm, thereby allowing avoidance of mutilating surgery. This case underscores the critical role of biopsy and expert pathological assessment in guiding clinical decision-making and supports the consideration of non-surgical therapeutic approaches in selected patients with xanthogranulomatous pelvic lesions. Full article

Cardiogenic shock secondary to acute myocardial infarction complicated by mechanical failure remains associated with high mortality despite advances in cardiac surgery and mechanical circulatory support. We report the case of a 42-year-old patient with posterior papillary muscle rupture leading to severe mitral regurgitation, managed with emergency surgical intervention and extracorporeal membrane oxygenation. The patient, with a history of Type I Bipolar Disorder under long-term lithium therapy and chronic Cannabis use, presented in critical condition with cardiogenic shock (Killip IV), acute pulmonary edema, and ST-segment elevation myocardial infarction in the infero-posterior territory. Coronary angiography revealed right coronary artery occlusion and involvement of an obtuse marginal branch. Emergency mitral valve replacement with a mechanical prosthesis and aortocoronary bypass were performed. Due to failure to wean from cardiopulmonary bypass, central veno-arterial ECMO was initiated. The postoperative course was complicated by hemodynamic instability and recurrent pericardial collections requiring repeated surgical interventions and conversion to peripheral ECMO. Multiorgan dysfunction developed, including hepato-renal failure requiring hemofiltration, neurological injury, respiratory impairment, and neuropsychiatric complications. Despite these challenges, progressive recovery was achieved under intensive multidisciplinary management. This case emphasizes the importance of early surgical correction and tailored ECMO support in managing post-infarction mechanical complications. Full article

Breast cancer surgical management encompasses a spectrum of options that extend beyond oncologic control and carry substantially different cumulative surgical burdens. Although breast-conserving therapy (BCT) and mastectomy offer equivalent survival outcomes in many clinical scenarios, the downstream implications of these choices, including the number of operations, complication profiles, recovery timelines, and need for revision, are often underrecognized during initial treatment planning. This review aims to provide non-plastic surgeons with a practical framework for understanding the surgical burden associated with BCT compared with mastectomy and, when mastectomy is selected, the implications of subsequent reconstructive pathways. By discussing breast cancer surgery through the lens of cumulative surgical burden rather than isolated procedural choices, this review seeks to support more informed, multidisciplinary counseling and shared decision-making. A clearer understanding of reconstructive trajectories may help align surgical recommendations with patient values, optimize expectations, and reduce unanticipated downstream interventions across the continuum of breast cancer care. Full article

Non-small cell lung cancer (NSCLC) remains a major cause of cancer-related mortality, with poor survival outcomes despite advances in surgery, chemotherapy, targeted therapy, and immunotherapy. The tumor microenvironment (TME) plays a central role in sustaining tumor growth, immune evasion, and systemic metabolic dysfunction. In this study, we performed an integrative analysis of differentially expressed microRNAs (miRNAs) to uncover their contributions to dysregulated signaling networks in NSCLC. hsa-miR-486-5p was identified as a prominent differentially expressed candidate miRNA. Using mathematical modeling and regression-based reduction, we identified Forkhead Box O1 (FOXO1) and Unc-51 like Autophagy Activating Kinase 2 (ULK2) as critical regulatory nodes that integrate oncogenic signaling with cellular homeostasis. Aberrant expression of hsa-miR-486-5p was found to modulate pathways including PI3K/AKT/mTOR, NF-κB, and JAK-STAT3, thereby promoting tumor progression and secretion of inflammatory cytokines. These cytokines, viz., IL-6, TNF-α, and IL-1β, activate muscle-specific protein degradation pathways through E3 ubiquitin ligases TRIM63 and FBXO32, linking NSCLC progression to cancer-associated sarcopenia. Quasipotential landscape analysis further revealed dynamic phenotypic transitions between stable and unstable states, highlighting the adaptability of tumor–host interactions. Collectively, our findings demonstrate that miRNA-mediated regulatory networks not only drive NSCLC progression and inflammation but also contribute to systemic muscle wasting. These insights emphasize the need for novel therapeutic strategies, including RNA-based interventions, to overcome resistance, improve survival, and address the metabolic complications associated with NSCLC. Full article

Background: Intraocular surgery on patients with an irreversibly blind fellow eye carries high risks, often causing treatment delays due to patient and surgeon hesitation. Existing data beyond cataracts are scarce. This study aims to evaluate the clinical profiles, prognosis, and economic value of diverse surgeries in this monocular population to guide clinical decision-making and optimize blindness prevention strategies. Methods: This retrospective study included 308 patients with a pre-existing blind fellow eye who underwent primary inpatient intraocular surgery under a standardized clinical protocol between June 2021 and June 2025. Baseline demographics, bilateral etiologies, visual outcomes, postoperative complications, and average cost-effectiveness ratios (ACERs) were analyzed. Postoperative outcomes were evaluated for patients with at least 6 months of follow-up. Results: The primary surgical indications were cataract (51.3%), proliferative diabetic retinopathy (PDR, 19.5%), glaucoma (15.9%), and rhegmatogenous retinal detachment (RRD, 7.5%). Notably, 49.4% of patients exhibited identical blinding etiologies bilaterally. Among patients completing the 6-month follow-up (n = 109), overall mean BCVA significantly improved from 1.36 ± 0.77 to 0.73 ± 0.65 logMAR (p < 0.001). The cataract group achieved the greatest visual improvement and the lowest ACER. Despite surgical complexity and higher complication rates, PDR and RRD interventions achieved visual improvement in over 60% of cases. Conclusions: Despite high clinical stakes, timely surgery in monocular patients yields substantial visual and economic benefits. The notable disease symmetry highlights a critical window for early intervention, emphasizing the need for public health strategies that prioritize screening progressive bilateral diseases. Full article

Previous studies have shown that, after postoperative recovery from upper and lower gastrointestinal surgery for cancer, patients use peculiar modalities to describe their health. The purpose of this study is to determine how upper and lower gastrointestinal cancer surgery is considered by patients when they set their health. A structured interview was developed and 47 consecutive patients were interviewed postoperatively. Answers were analyzed through M.A.D.I.T., a quantitative and qualitative methodology that allows for the detection of discursive processes comprising the text, beyond thematic analysis. Four dimensions have been analyzed: representation of the postoperative period in daily life; use of resources; participation in achieving the clinical objective after hospital discharge; and continuing to respect the surgeons’ indications. A corpus of 2374 text occurrences was analyzed. Without differences between types of surgery, surgical patients described the time after surgical intervention as a critical scenario. Patients expressed their personal opinions, expecting normality after surgery and having difficulty envisioning the future: their representation of inflexibility in the postoperative period prevented them from finding new coping strategies. Overall, across all four dimensions, participants used stabilization discursive modalities in more than 50% of cases, representative of a situation bound within strict ties and personal theories. When defining their health, cancer surgery patients tend not to consider their condition as a new and different one from before; they imagine that they will be able to fully resume their previous habits. However, this can risk undermining the achievement of the clinical objective. Thus, during early surgical consultations, as well as in surgical recovery, exploring differences after surgery and solutions could help patients in their engagement with surgical outcomes and consequences. Full article

Endoscopic spine surgery (ESS)—including full-endoscopic transforaminal and interlaminar techniques, and unilateral biportal endoscopy (UBE)—offers patients smaller incisions, preserved paraspinal muscle, and faster recovery. Because the working corridor is narrow, intraoperative fluoroscopy plays a larger role than in open or microscopic approaches, making radiation exposure worthy of attention for both patients and surgeons. This narrative review aims to be a practical resource for the endoscopic spine surgeon. We synthesize the available literature on typical radiation doses across the main ESS techniques, compare them with minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open alternatives, review the factors that drive exposure, and walk through the full menu of dose-optimization options—from simple measures such as collimation, pulsed fluoroscopy, and leaded eyewear, through navigation platforms, to robotic guidance. A consistent practical observation is that the simplest, least expensive interventions often deliver the largest dose reductions. Capital-intensive technologies add real value, particularly for endoscopic interbody fusion, and work best alongside rather than in place of these basics. With routine dosimetry and straightforward as-low-as-reasonably-achievable (ALARA) practices, surgeons can continue to build on the already favourable profile of ESS while keeping radiation exposure low. Conclusions are tempered by the largely retrospective and heterogeneous nature of the underlying evidence. Full article

This translational synthesis highlights the potential role of obesity-induced low-grade chronic inflammation in modulating clinical outcomes among patients with spondyloarthritis (SpA). Obesity transforms adipose tissue into a pro-inflammatory endocrine organ, where hypertrophic adipocytes release adipokines such as leptin alongside cytokines including TNF-α and IL-6, potentially contributing to macrophage polarization toward an M1 phenotype and activating NF-κB signaling pathways. This systemic immunometabolic priming may lower activation thresholds at the enthesis—the primary pathological site in SpA—potentially amplifying IL-23/IL-17 axis activity via Th17 bias, innate-like lymphocyte responses, and stromal–immune crosstalk under mechanical stress. Clinically, patients with SpA and obesity have been reported to demonstrate heightened disease activity (BASDAI, ASDAS), impaired function (BASFI), accelerated radiographic progression (syndesmophytes, enthesophytes), and diminished biologic response rates, potentially attributable to pharmacokinetic alterations (e.g., subtherapeutic TNF inhibitor levels) and pharmacodynamic resistance. Multisystem comorbidities, including non-alcoholic fatty liver disease, cardiovascular events, metabolic syndrome, sleep disturbances, and depression, further exacerbate morbidity and diminish quality of life. Therapeutic implications emphasize obesity as a modifiable disease modifier. Weight loss interventions, including hypocaloric diets, anti-inflammatory regimens (e.g., Mediterranean diet), multicomponent exercise, GLP-1 receptor agonists, and bariatric surgery, have been associated with reductions in inflammatory biomarkers, improved remission rates (MDA, DAPSA), and prolonged drug survival by restoring adipokine balance and disrupting mechano-inflammatory loops. Future randomized controlled trials should prioritize long-term evaluations of integrated multidisciplinary strategies that combine metabolic optimization with immunomodulatory therapies, addressing adherence challenges through psychological support and patient-tailored protocols, while elucidating dose–response relationships for GLP-1RAs and exercise in diverse SpA subtypes to establish precision management paradigms that mitigate cardiometabolic burden and improve holistic outcomes. Full article

Orbital fractures account for up to 16% of all facial fractures. Surgical intervention for these fractures depends on several factors, including globe displacement. This case-control study aimed to quantify the effects of orbital reconstruction on the three-dimensional globe position after orbital trauma. Pre- and post-operative radiological data of 29 cases (27 patients, with two patients requiring reintervention) with an orbital fracture were analyzed. The contralateral, unaffected orbits of the same patients served as the control group. This study used a recently validated method employing semi-automatic registration algorithms to measure globe displacement after trauma and its post-operative change. The statistical analysis, performed using the Mann–Whitney U test, showed significant globe position restoration in the anterior–posterior (2.15 mm, p ≤ 0.001) and medial–lateral (1.34 mm, p ≤ 0.001) directions, as well as in overall three-dimensional Euclidean distance (3.04 mm, p = 0.014) after surgery. The repositioning was clinically relevant in 62% of the cases, indicating that the three-dimensional globe repositioning was 2 mm or more with a positive clinical impact. Additionally, it was important to note that both the number of fractured walls and fractures of the inferomedial strut significantly affected globe repositioning after trauma. This finding highlights the importance of accurately considering the fracture pattern in surgical planning, as a better understanding of globe displacement following orbital trauma could enhance patient selection, surgical planning, and clinical outcomes. Full article

Background/Objectives: Health outcome determinants affecting Human Papillomavirus (HPV) vaccination among the adult female population are scarce in Spain. This study aimed to describe the health outcomes and determinants of HPV vaccination in women 18–65 years attending lower genital tract outpatient clinics across regions of Spain. Methods: This was a cross-sectional, multicenter, non-interventional, descriptive, and comparative nationwide study. Sociodemographic characteristics and health outcomes included obstetric, gynecological and HPV vaccination antecedents, together with patient-reported outcomes related to HPV infection. Statistical analysis included multivariate logistic regression models. Results: Among 2004 adult women recruited, 1907 (95.2%) were eligible for analysis. Vaccine uptake was 48.8%; 81.6% among women who were ever HPV positive (adjusted OR = 2.16 [95% CI: 1.59–2.93], p < 0.001), but 65.9% among women with an active infection, which acted as a negative factor for vaccination (OR = 0.63 [0.45–0.87], p = 0.005), as did increasing age (OR = 0.92 [0.90–0.93], p < 0.001); the higher the age, the lower the adjusted likelihood of being vaccinated. HPV knowledge and adequate physician-provided information were weakly associated with vaccination likelihood. A history of conization (OR = 7.48 [5.34–10.47], p < 0.001), use of contraception (OR = 1.49 [1.13–1.96], p = 0.004), infection with high-risk or unknown-risk HPV genotypes (OR = 1.86 [1.23–2.82], p = 0.003 and OR = 1.68 [1.17–2.42], p = 0.006, respectively), and Spanish nationality (OR = 2.46 [1.68–3.61], p < 0.001) were identified as factors associated with a higher vaccination likelihood. Conclusions: This study found that HPV vaccination uptake is improvable. Previous HPV infection favored vaccination; however, active infection and increasing age acted against vaccination. HPV knowledge and adequate healthcare professional information appeared to favor vaccination, along with, most notably, a history of cervical surgery (conization), contraceptive use, or infection with high-risk or unknown-risk HPV genotypes. Spanish women had a higher likelihood of receiving HPV vaccination than foreign residents. Full article

Background: There is a positive relationship between mitochondrial damage in the cell and uptake in technetium Tc 99m monomer methoxy isobutyl isonitrile (^99mTc-MIBI) scintigraphy. Severe mitochondrial dysfunction with cell death occurs in patients with diabetic foot ulcers (DFUs). To decide on the level of amputation, ^99mTc-MIBI scintigraphy should be considered. Methods: Prospectively, 24 patients with DFUs were included in the study. Based on treatment that started with the hospitalization, patients were divided into two groups: those whose DFUs healed and did not need surgical intervention (healed group) and those whose DFUs did not regress despite surgical and medical treatment and who required further surgical intervention (reoperation group). Before surgery, ^99mTc-MIBI scintigraphy was performed. The ^99mTc-MIBI uptake rates of the injured foot relative to the healthy foot were recorded. Deep-tissue culture was taken at surgery. Erythrocyte sedimentation rate, white blood cell count, and C-reactive protein (CRP) and albumin levels were measured. Results: The ^99mTc-MIBI uptake rates of patients with poor prognosis were higher at all times than those of patients who did not require revision surgery. A significant difference was found between these values in the 10 and 30 s rates. The mean ± SD CRP level was 86.04 ± 21.87 mg/dL in the healed group and 144.43 ± 27.54 mg/dL in the reoperation group (p = 0.040). There was a positive correlation between ulcerated foot and healthy foot ^99mTc-MIBI involvement rates at 10 and 30 s and CRP values, and a negative correlation between albumin values. Conclusions: There was a significant relationship between ^99mTc-MIBI involvement rates and poor prognosis and reamputation. The correlation between CRP and albumin levels, which are among the predictive values, and ^99mTc-MIBI uptake confirmed this relationship in DFUs, which are difficult to manage and treat. Full article

Molecular testing has become an increasingly important adjunct in the evaluation of cytologically indeterminate thyroid nodules. These tests analyze genetic alterations associated with thyroid tumorigenesis, including point mutations, gene fusions, and gene expression profiles, with the aim of refining preoperative risk assessment and reducing unnecessary diagnostic surgery. Despite these advances, the clinical utility of molecular testing remains highly dependent on the context in which results are interpreted. Molecular alterations do not consistently correlate with tumor aggressiveness, and several mutations are observed in both benign and malignant thyroid lesions. In addition, the predictive performance of molecular tests is strongly influenced by the baseline prevalence of malignancy, which varies across clinical settings and is shaped by diagnostic thresholds and patient selection. This commentary summarizes the molecular landscape of thyroid tumors, the diagnostic performance of current molecular testing platforms, and their role in clinical decision-making. Emphasis is placed on the interpretation of molecular findings within a broader diagnostic framework that incorporates cytologic morphology, ultrasound-based risk stratification, and clinical context. A selective, risk-adapted approach to molecular testing may provide the most effective strategy for optimizing patient management while minimizing unnecessary intervention. Full article