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19 pages, 2246 KiB  
Systematic Review
The Association of Poor Preoperative Mental Health and Outcomes After Surgical Correction of Adult Spinal Deformity: A Systematic Review and Meta Analysis
by Yifei Sun, Hariteja Ramapuram, Riyaz Razi, Mohammad Hamo, Sasha Howell, Nicholas M. B. Laskay, Jovanna Tracz, Anil Mahavadi, James Mooney and Jakub Godzik
J. Clin. Med. 2025, 14(15), 5516; https://doi.org/10.3390/jcm14155516 (registering DOI) - 5 Aug 2025
Abstract
Background/Objectives: Adult Spinal Deformity (ASD) is a pathologic malalignment of the spine that can lead to significant reductions in quality of life, functional limitations, and increased morbidity. While poor mental health is commonly observed among patients undergoing ASD surgery, its impact on surgical [...] Read more.
Background/Objectives: Adult Spinal Deformity (ASD) is a pathologic malalignment of the spine that can lead to significant reductions in quality of life, functional limitations, and increased morbidity. While poor mental health is commonly observed among patients undergoing ASD surgery, its impact on surgical outcomes remains poorly understood. We conducted a systematic review and meta-analysis to examine the association between preoperative mental health and outcomes following surgical correction for ASD. Methods: A comprehensive search of MEDLINE, Embase, Web of Science, and Scopus was performed from inception to April 2025 to identify studies investigating the relationship between preoperative mental health and postoperative health-related quality of life outcomes or complications. Data was pooled using a restricted maximum likelihood (REML) random-effects model. Heterogeneity was assessed using Cochran’s Q statistic, and between-study variance was reported as τ2. Study quality was assessed with the Newcastle–Ottawa Scale, and risk of bias was evaluated using the ROBINS-I tool. Results: Twenty-four studies comprising a total of 248,427 patients met inclusion criteria. In pooled analyses, patients with poor preoperative mental health showed comparable improvements in health-related quality of life measures after surgery (standardized mean difference [SMD] −0.04, 95% CI −0.30 to 0.22; I2 = 91.5%, τ2 = 0.42) and in pain scores (SMD −0.15, 95% CI −0.42 to 0.11; I2 = 71.8%, τ2 = 0.09). However, patients with poor mental health had significantly higher odds of postoperative complications (odds ratio [OR] 1.44, 95% CI 1.23 to 1.67; I2 = 97.4%, τ2 = 0.08). These patients also demonstrated worse preoperative disease severity (SMD –0.94, 95% CI −1.41 to −0.47; I2 = 95.5%, τ2 = 1.64) and worse postoperative disease severity (SMD –0.34, 95% CI −0.44 to −0.25; I2 = 48.9%, τ2 = 0.03). Conclusions: While patients with poor preoperative mental health have a greater disease severity both before and after ASD surgery, they appear to experience comparable benefits from surgical intervention compared to those without. Recognizing and managing mental health may be useful in preoperative management of ASD patients. Further prospective studies to further elucidate these associations are necessary. Full article
(This article belongs to the Special Issue Optimizing Outcomes in Scoliosis and Complex Spinal Surgery)
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5 pages, 995 KiB  
Case Report
Foreign Body Presenting as Golden Hypopyon
by Anas Alkhabaz, Lucie Y. Guo and Charles DeBoer
Surgeries 2025, 6(3), 68; https://doi.org/10.3390/surgeries6030068 - 5 Aug 2025
Abstract
Background/Objectives: Penetrating intraocular foreign bodies (IOFBs) are ocular emergencies, often leading to preventable vision loss. This case report highlights a unique presentation of a work-related penetrating IOFB that mimicked a golden hypopyon. Methods: A 35-year-old male presented to the emergency department [...] Read more.
Background/Objectives: Penetrating intraocular foreign bodies (IOFBs) are ocular emergencies, often leading to preventable vision loss. This case report highlights a unique presentation of a work-related penetrating IOFB that mimicked a golden hypopyon. Methods: A 35-year-old male presented to the emergency department with sudden-onset pain and vision loss in the left eye while he was cutting a tree with metallic scissors. He had a visual acuity of 20/30 in the right eye and counting fingers in the left eye. A dilated slit-lamp examination and CT scan confirmed the presence of a 6–8 mm metallic IOFB in the anterior chamber, with no involvement of the lens or the posterior segment. Surgical removal was performed. Results: The metallic IOFB was removed surgically with IOFB forceps using a single paracentesis. The patient reported resolving pain and regained baseline visual acuity of 20/20 postoperatively, which remained stable at one-month follow-up. Conclusions: This case illustrates the successful surgical management of a penetrating metallic IOFB with a unique presentation mimicking a hypopyon. Emphasis on unique presentations of IOFBs can aid in timely management, ultimately reducing the risk of complications. Full article
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12 pages, 1169 KiB  
Article
Does Total Hip Arthroplasty Influence Pelvic Version? A Retrospective Case Control Study Using the Sacro-Femoro-Pubic Angle in Osteoarthritis and Fracture Patients
by Giuseppe Geraci, Alberto Corrado Di Martino, Enrico Masi, Alessandro Panciera, Chiara Di Censo and Cesare Faldini
Medicina 2025, 61(8), 1414; https://doi.org/10.3390/medicina61081414 - 5 Aug 2025
Abstract
Background and Objectives: Spinopelvic alignment may affect the outcomes of total hip arthroplasty (THA), with pelvic version influencing the risk of mechanical complications occurring after surgery. On the other hand, THA surgery itself may contribute to the modification of pelvis version. The [...] Read more.
Background and Objectives: Spinopelvic alignment may affect the outcomes of total hip arthroplasty (THA), with pelvic version influencing the risk of mechanical complications occurring after surgery. On the other hand, THA surgery itself may contribute to the modification of pelvis version. The sacro-femoro-pubic (SFP) angle is measured on anteroposterior (AP) radiographs of the pelvis in a supine position, and is used to estimate pelvic tilt (PT), representative of pelvic version, which requires lateral views of the sacrum for its calculation; however, these X rays are not routinely performed in the preoperative setting of hip surgery. This study aims to analyze how THA determines changes in the pelvic version of operated patients; the SFP angle will be used to assess pelvic version on standard AP radiographs. Materials and Methods: This retrospective study included 182 consecutive patients undergoing THA for unilateral primary degenerative hip osteoarthritis (HOA-study group, n = 104) or femoral neck fracture (FNF-control group, n = 78) at the author’s institution. The SFP angle was measured on AP pelvic radiographs of the non-replaced hip preoperatively, postoperatively, and at the last follow-up. PT values were derived from SFP angles. Pre- and postoperative PT and its variations ΔPT were assessed. Study groups were compared in terms of native and postoperative variations of pelvic version. Results: The average absolute value of ΔPT was 2.99° ± 3.07° in the HOA group and 3.57° ± 2.92° in FNF group. There was no significant overall difference in preoperative or postoperative PT values between groups. In both groups, THA surgery led to a certain improvement, still not significant, in pelvic orientation, with FNF patients presenting a greater tendency toward retroversion. No significant differences in complication rates were found comparing patients with different pelvic orientations. Conclusions: THA can lead to a “normalization” of pelvic version in a certain number of patients with preoperative anteversion or retroversion. Although statistically non-significant, this observation may have clinical implications for spinopelvic balance and could support prioritizing THA in patients with concurrent spinal disease. Further research is needed to confirm these findings and to evaluate the long-term impact of THA on spinopelvic alignment. Full article
(This article belongs to the Special Issue Techniques, Risks and Recovery of Hip Surgery)
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10 pages, 223 KiB  
Case Report
Total Intravenous Anesthesia Using Target-Controlled Infusion with Propofol for Category 1 Emergency Cesarean Section in Patients with Preeclampsia with Severe Features
by Janos Szederjesi, Emoke Almasy, Oana Elena Branea and Matild Keresztes
Life 2025, 15(8), 1237; https://doi.org/10.3390/life15081237 - 4 Aug 2025
Abstract
Preeclampsia with severe features presents major anesthetic challenges, particularly in category 1 cesarean sections, in which rapid, safe, and hemodynamically stable induction is critical. Neuraxial techniques may be controversial due to neurological symptoms, making general anesthesia a viable option. However, traditional general anesthesia [...] Read more.
Preeclampsia with severe features presents major anesthetic challenges, particularly in category 1 cesarean sections, in which rapid, safe, and hemodynamically stable induction is critical. Neuraxial techniques may be controversial due to neurological symptoms, making general anesthesia a viable option. However, traditional general anesthesia may exacerbate hypertension and increase maternal and fetal risks. Two primigravida patients with elevated blood pressure and neurological symptoms underwent category 1 cesarean delivery under TIVA-TCI with propofol, using the Marsh model. Hemodynamic stability, drug dosing, and maternal–neonatal outcomes were monitored. Sufentanil was administered for analgesia; neuromuscular blockade was achieved with rocuronium and reversed with sugammadex. No BIS or TOF monitoring was available. Both patients maintained stable hemodynamics and oxygenation throughout surgery. Intubation was successfully performed at an effect-site concentration of 3.5 µg/mL. Neonatal Apgar scores were within acceptable limits. No major complications occurred intraoperatively or postoperatively. TCI allowed individualized dosing and smooth emergence. TIVA-TCI with propofol appears to be a viable alternative to volatile-based general anesthesia in category 1 emergencies for cesarean sections for patients with preeclampsia with severe features, especially when neuraxial anesthesia is controversial. It offers hemodynamic stability and controlled depth of anesthesia, though its use requires experience and may not be optimal in cases requiring ultra-rapid induction. Full article
(This article belongs to the Special Issue Prevention, Diagnosis, and Treatment of Gestational Diseases)
14 pages, 2221 KiB  
Article
Dynamic vs. Rigid: Transforming the Treatment Landscape for Multisegmental Lumbar Degeneration
by Caner Gunerbuyuk, Mehmet Yigit Akgun, Nazenin Durmus, Ege Anil Ucar, Helin Ilkay Orak, Tunc Oktenoglu, Ozkan Ates, Turgut Akgul and Ali fahir Ozer
J. Clin. Med. 2025, 14(15), 5472; https://doi.org/10.3390/jcm14155472 - 4 Aug 2025
Abstract
Background: Multisegmental lumbar degenerative disease (ms-LDD) is a common condition in older adults, often requiring surgical intervention. While rigid stabilization remains the gold standard, it is associated with complications such as adjacent segment disease (ASD), higher blood loss, and longer recovery times. The [...] Read more.
Background: Multisegmental lumbar degenerative disease (ms-LDD) is a common condition in older adults, often requiring surgical intervention. While rigid stabilization remains the gold standard, it is associated with complications such as adjacent segment disease (ASD), higher blood loss, and longer recovery times. The Dynesys dynamic stabilization system offers an alternative by preserving motion while stabilizing the spine. However, data comparing Dynesys with fusion in multisegmental cases are limited. Objective: This study evaluates the clinical and radiographic outcomes of Dynesys dynamic stabilization versus rigid stabilization in the treatment of ms-LDD. Methods: A retrospective analysis was conducted on 53 patients (mean age: 62.25 ± 15.37 years) who underwent either Dynesys dynamic stabilization (n = 27) or PLIF (n = 26) for ms-LDD involving at least seven motion segments. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI), while radiological parameters such as lumbar lordosis (LL), sagittal vertical axis (SVA), and spinopelvic parameters (pelvic incidence, pelvic tilt and, sacral slope) were analyzed. A two-stage surgical approach was employed in the Dynesys group to enhance osseointegration, particularly in elderly osteoporotic patients. Results: Both groups showed significant improvements in VAS and ODI scores postoperatively (p < 0.001), with no significant differences between them. However, the Dynesys group demonstrated superior sagittal alignment correction, with a significant increase in LL (p < 0.002) and a significant decrease in SVA (p < 0.0015), whereas changes in the rigid stabilization group were not statistically significant. Additionally, the Dynesys group had fewer complications, including a lower incidence of ASD (0 vs. 6 cases). The two-stage technique facilitated improved screw osseointegration and reduced surgical risks in osteoporotic patients. Conclusions: Dynesys dynamic stabilization is an effective alternative to rigid stabilization in ms-LDD, offering comparable pain relief and functional improvement while preserving motion and reducing ASD risk. The two-stage approach enhances long-term stability, making it particularly suitable for elderly or osteoporotic patients. Further long-term studies are needed to confirm these findings. Full article
(This article belongs to the Special Issue Orthopedic Surgery: Latest Advances and Perspectives)
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15 pages, 966 KiB  
Article
Long-Term Follow-Up of Left Atrial Appendage Exclusion: Results of the V-CLIP Multi-Center Post-Market Study
by Elias Zias, Katherine G. Phillips, Marc Gerdisch, Scott Johnson, Ahmed El-Eshmawi, Kenneth Saum, Michael Moront, Michael Kasten, Chanderdeep Singh, Gautam Bhatia, Hiroo Takayama and Ralph Damiano
J. Clin. Med. 2025, 14(15), 5473; https://doi.org/10.3390/jcm14155473 - 4 Aug 2025
Abstract
Background: Cardiac surgery patients with pre- or post-operative atrial fibrillation are at an increased risk for thromboembolic stroke, often due left atrial appendage (LAA) thrombus. Surgical LAA exclusion (LAAE) can be performed and must be complete to avoid increased thrombus formation. Methods [...] Read more.
Background: Cardiac surgery patients with pre- or post-operative atrial fibrillation are at an increased risk for thromboembolic stroke, often due left atrial appendage (LAA) thrombus. Surgical LAA exclusion (LAAE) can be performed and must be complete to avoid increased thrombus formation. Methods: This prospective, multi-center, post-market study (NCT05101993) evaluated the long-term safety and performance of the epicardial V-shape AtriClip device. Patients ≥18 years who had received V-shape AtriClip devices during non-emergent cardiac surgery consented to a prospective 12-month follow-up visit and LAA imaging. The primary performance was LAAE without residual left atrium-LAA communication, assessed by imaging at the last follow-up visit. The primary safety was device- or implant procedure-related serious adverse events (SAEs) (death, major bleeding, surgical site infection, pericardial effusion requiring intervention, myocardial infarction) within 30 days. Results: Of 155 patients from 11 U.S. centers, 151 patients had evaluable imaging. Complete LAAE was obtained in all patients. Primary performance in the intent-to-treat population was met, with 97% (95% CI 93.52%, 99.29%; p = 0.0001) complete LAAE. Primary safety was met, with 100% (95% CI 97.75%, 100%; p < 0.0001) of patients free from pre-defined SAEs within 30 days. One device-related SAE was reported, which resolved intraprocedurally. Conclusions: AtriClip V-Clip showed safe and successful LAAE through 12 months of follow-up. Full article
(This article belongs to the Special Issue Cardiac Surgery: Clinical Advances)
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10 pages, 430 KiB  
Article
Anteroposterior Diameter Is Associated with Conversion from Right Minithoracotomy to Median Sternotomy in Minimally Invasive Cardiac Surgery
by Quynh Nguyen, Durr Al-Hakim and Richard C. Cook
J. Pers. Med. 2025, 15(8), 353; https://doi.org/10.3390/jpm15080353 - 4 Aug 2025
Abstract
Background: Minimally invasive cardiac surgery (MICS) via right minithoracotomy is a safe, reproducible approach with excellent outcomes and reduced costs compared to median sternotomy. Despite careful patient selection, conversion to sternotomy occurs in 1–3% of cases and is associated with significantly higher [...] Read more.
Background: Minimally invasive cardiac surgery (MICS) via right minithoracotomy is a safe, reproducible approach with excellent outcomes and reduced costs compared to median sternotomy. Despite careful patient selection, conversion to sternotomy occurs in 1–3% of cases and is associated with significantly higher morbidity and mortality. Small body habitus, particularly a short anteroposterior (AP) diameter, may increase the risk of conversion, but this has not been previously studied. This study aims to identify preoperative factors associated with conversion to improve patient selection for MICS. As cardiovascular surgery becomes increasingly personalized, identifying anatomical factors that predict technical complexity is essential. Methods: This retrospective study included 254 adult patients who underwent elective MICS between 2015 and 2024 at a tertiary hospital. Patient characteristics, computed tomography (CT) scans, intraoperative parameters, and postoperative outcomes were reviewed. AP diameter was defined as the distance from the posterior sternum to the anterior vertebral body at the mitral valve level on CT. Statistical analyses included Mann−Whitney and Fisher’s exact/chi-square tests. Results: Conversion to sternotomy occurred in 1.6% of patients (n = 4). All converted patients were female. The converted group had a significantly shorter median AP diameter (100 mm vs. 124 mm, p = 0.020). Conversion was associated with higher rates of stroke and infection (25.0% vs. 0.8%, p = 0.047 for both), but no significant differences in hospital stay, bleeding, or renal failure. Conclusions: An AP diameter of less than 100 mm was associated with a higher risk of conversion to sternotomy in MICS. Incorporating simple, reproducible preoperative imaging metrics into surgical planning may advance precision-guided cardiac surgery and optimize patient outcomes. Full article
(This article belongs to the Special Issue Clinical Progress in Personalized Management of Cardiac Surgery)
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9 pages, 364 KiB  
Article
Impact of Surgical Margins and Adjuvant Radiotherapy on Local Recurrence and Survival in Sacral Chordoma
by Furkan Erdoğan, Alparslan Yurtbay, Bedirhan Albayrak, Tolgahan Cengiz and Nevzat Dabak
J. Clin. Med. 2025, 14(15), 5464; https://doi.org/10.3390/jcm14155464 - 4 Aug 2025
Abstract
Background: This study aimed to evaluate the impact of surgical margin status, tumor size, and adjuvant radiotherapy on local control, overall survival, and postoperative complications in patients undergoing surgery for sacral chordoma. Methods: This retrospective analysis included 18 patients who underwent surgical treatment [...] Read more.
Background: This study aimed to evaluate the impact of surgical margin status, tumor size, and adjuvant radiotherapy on local control, overall survival, and postoperative complications in patients undergoing surgery for sacral chordoma. Methods: This retrospective analysis included 18 patients who underwent surgical treatment for primary sacral chordoma between 2002 and 2019. The variables assessed included patient demographics, tumor size and volume, surgical margin status, adjuvant radiotherapy, local recurrence, overall survival, and postoperative complications. Survival analysis was performed using the Kaplan–Meier method, and appropriate parametric or non-parametric tests were used for group comparisons. Results: The cohort’s mean age was 62.6 ± 7.9 years, with a mean follow-up of 8.8 ± 4.1 years and an average tumor volume of 235 cm3. Negative surgical margins (R0) were achieved in 44% of patients. Local recurrence occurred in 50% of R0 cases and 83% of R2 cases. Negative surgical margins (R0) were associated with significantly lower local recurrence rates compared to R1 and R2 resections (Fisher’s exact test, p = 0.043), and showed a trend toward improved overall survival (p = 0.077). Overall survival was significantly lower in patients with tumors measuring ≥ 5 cm (p = 0.031). Adjuvant radiotherapy did not significantly reduce local recurrence (p = 0.245); however, an increase in complication rates was observed, although this association did not reach statistical significance (p = 0.108). Bladder dysfunction was significantly more frequent in patients undergoing S1–S2 resections (p = 0.036). Conclusions: Achieving negative surgical margins improves local control and may prolong survival. Larger tumors (≥5 cm) were associated with worse prognosis. While adjuvant RT may be considered in selected high-risk cases, its efficacy in preventing recurrence is unclear and may increase complication rates. Full article
(This article belongs to the Special Issue Clinical Management and Treatment of Orthopedic Oncology: 2nd Edition)
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11 pages, 480 KiB  
Article
A Novel Deep Learning Model for Predicting Colorectal Anastomotic Leakage: A Pioneer Multicenter Transatlantic Study
by Miguel Mascarenhas, Francisco Mendes, Filipa Fonseca, Eduardo Carvalho, Andre Santos, Daniela Cavadas, Guilherme Barbosa, Antonio Pinto da Costa, Miguel Martins, Abdullah Bunaiyan, Maísa Vasconcelos, Marley Ribeiro Feitosa, Shay Willoughby, Shakil Ahmed, Muhammad Ahsan Javed, Nilza Ramião, Guilherme Macedo and Manuel Limbert
J. Clin. Med. 2025, 14(15), 5462; https://doi.org/10.3390/jcm14155462 - 3 Aug 2025
Viewed by 56
Abstract
Background/Objectives: Colorectal anastomotic leak (CAL) is one of the most severe postoperative complications in colorectal surgery, impacting patient morbidity and mortality. Current risk assessment methods rely on clinical and intraoperative factors, but no real-time predictive tool exists. This study aimed to develop [...] Read more.
Background/Objectives: Colorectal anastomotic leak (CAL) is one of the most severe postoperative complications in colorectal surgery, impacting patient morbidity and mortality. Current risk assessment methods rely on clinical and intraoperative factors, but no real-time predictive tool exists. This study aimed to develop an artificial intelligence model based on intraoperative laparoscopic recording of the anastomosis for CAL prediction. Methods: A convolutional neural network (CNN) was trained with annotated frames from colorectal surgery videos across three international high-volume centers (Instituto Português de Oncologia de Lisboa, Hospital das Clínicas de Ribeirão Preto, and Royal Liverpool University Hospital). The dataset included a total of 5356 frames from 26 patients, 2007 with CAL and 3349 showing normal anastomosis. Four CNN architectures (EfficientNetB0, EfficientNetB7, ResNet50, and MobileNetV2) were tested. The models’ performance was evaluated using their sensitivity, specificity, accuracy, and area under the receiver operating characteristic (AUROC) curve. Heatmaps were generated to identify key image regions influencing predictions. Results: The best-performing model achieved an accuracy of 99.6%, AUROC of 99.6%, sensitivity of 99.2%, specificity of 100.0%, PPV of 100.0%, and NPV of 98.9%. The model reliably identified CAL-positive frames and provided visual explanations through heatmaps. Conclusions: To our knowledge, this is the first AI model developed to predict CAL using intraoperative video analysis. Its accuracy suggests the potential to redefine surgical decision-making by providing real-time risk assessment. Further refinement with a larger dataset and diverse surgical techniques could enable intraoperative interventions to prevent CAL before it occurs, marking a paradigm shift in colorectal surgery. Full article
(This article belongs to the Special Issue Updates in Digestive Diseases and Endoscopy)
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17 pages, 1097 KiB  
Article
Mapping Perfusion and Predicting Success: Infrared Thermography-Guided Perforator Flaps for Lower Limb Defects
by Abdalah Abu-Baker, Andrada-Elena Ţigăran, Teodora Timofan, Daniela-Elena Ion, Daniela-Elena Gheoca-Mutu, Adelaida Avino, Cristina-Nicoleta Marina, Adrian Daniel Tulin, Laura Raducu and Radu-Cristian Jecan
Medicina 2025, 61(8), 1410; https://doi.org/10.3390/medicina61081410 - 3 Aug 2025
Viewed by 49
Abstract
Background and Objectives: Lower limb defects often present significant reconstructive challenges due to limited soft tissue availability and exposure of critical structures. Perforator-based flaps offer reliable solutions, with minimal donor site morbidity. This study aimed to evaluate the efficacy of infrared thermography [...] Read more.
Background and Objectives: Lower limb defects often present significant reconstructive challenges due to limited soft tissue availability and exposure of critical structures. Perforator-based flaps offer reliable solutions, with minimal donor site morbidity. This study aimed to evaluate the efficacy of infrared thermography (IRT) in preoperative planning and postoperative monitoring of perforator-based flaps, assessing its accuracy in identifying perforators, predicting complications, and optimizing outcomes. Materials and Methods: A prospective observational study was conducted on 76 patients undergoing lower limb reconstruction with fascio-cutaneous perforator flaps between 2022 and 2024. Perforator mapping was performed concurrently with IRT and Doppler ultrasonography (D-US), with intraoperative confirmation. Flap design variables and systemic parameters were recorded. Postoperative monitoring employed thermal imaging on days 1 and 7. Outcomes were correlated with thermal, anatomical, and systemic factors using statistical analyses, including t-tests and Pearson correlation. Results: IRT showed high sensitivity (97.4%) and positive predictive value (96.8%) for perforator detection. A total of nine minor complications occurred, predominantly in patients with diabetes mellitus and/or elevated glycemia (p = 0.05). Larger flap-to-defect ratios (A/C and B/C) correlated with increased complications in propeller flaps, while smaller ratios posed risks for V-Y and Keystone flaps. Thermal analysis indicated significantly lower flap temperatures and greater temperature gradients in flaps with complications by postoperative day 7 (p < 0.05). CRP levels correlated with glycemia and white blood cell counts, highlighting systemic inflammation’s impact on outcomes. Conclusions: IRT proves to be a reliable, non-invasive method for perforator localization and flap monitoring, enhancing surgical planning and early complication detection. Combined with D-US, it improves perforator selection and perfusion assessment. Thermographic parameters, systemic factors, and flap design metrics collectively predict flap viability. Integration of IRT into surgical workflows offers a cost-effective tool for optimizing reconstructive outcomes in lower limb surgery. Full article
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17 pages, 516 KiB  
Article
Incidence and Predictive Factors of Acute Kidney Injury After Major Hepatectomy: Implications for Patient Management in Era of Enhanced Recovery After Surgery (ERAS) Protocols
by Henri Mingaud, Jean Manuel de Guibert, Jonathan Garnier, Laurent Chow-Chine, Frederic Gonzalez, Magali Bisbal, Jurgita Alisauskaite, Antoine Sannini, Marc Léone, Marie Tezier, Maxime Tourret, Sylvie Cambon, Jacques Ewald, Camille Pouliquen, Lam Nguyen Duong, Florence Ettori, Olivier Turrini, Marion Faucher and Djamel Mokart
J. Clin. Med. 2025, 14(15), 5452; https://doi.org/10.3390/jcm14155452 - 2 Aug 2025
Viewed by 264
Abstract
Background: Acute kidney injury (AKI) frequently occurs following major liver resection, adversely affecting both short- and long-term outcomes. This study aimed to determine the incidence of AKI post-hepatectomy and identify relevant pre- and intraoperative risk factors. Our secondary objectives were to develop [...] Read more.
Background: Acute kidney injury (AKI) frequently occurs following major liver resection, adversely affecting both short- and long-term outcomes. This study aimed to determine the incidence of AKI post-hepatectomy and identify relevant pre- and intraoperative risk factors. Our secondary objectives were to develop a predictive score for postoperative AKI and assess the associations between AKI, chronic kidney disease (CKD), and 1-year mortality. Methods: This was a retrospective study in a cancer referral center in Marseille, France, from 2018 to 2022. Results: Among 169 patients, 55 (32.5%) experienced AKI. Multivariate analysis revealed several independent risk factors for postoperative AKI, including age, body mass index, the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, time to liver resection, intraoperative shock, and bile duct reconstruction. Neoadjuvant chemotherapy was protective. The AKIMEBO score was developed, with a threshold of ≥15.6, demonstrating a sensitivity of 89.5%, specificity of 76.4%, positive predictive value of 61.8%, and negative predictive value of 94.4%. AKI was associated with increased postoperative morbidity and one-year mortality following major hepatectomy. Conclusion: AKI is a common complication post-hepatectomy. Factors such as time to liver resection and intraoperative shock management present potential clinical intervention points. The AKIMEBO score can provide a valuable tool for postoperative risk stratification. Full article
(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)
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19 pages, 909 KiB  
Article
Impact of Preoperative Yttrium-90 Transarterial Radioembolization on Patients Undergoing Right or Extended Right Hepatectomy for Hepatocellular Carcinoma
by Andrea P. Fontana, Nadia Russolillo, Ludovica Maurino, Andrea Marengo, Amedeo Calvo, Andrea Ricotti, Serena Langella, Roberto Lo Tesoriere and Alessandro Ferrero
Cancers 2025, 17(15), 2556; https://doi.org/10.3390/cancers17152556 - 2 Aug 2025
Viewed by 241
Abstract
Background/Objectives: Preoperative strategies for hepatocellular carcinoma (HCC) requiring major hepatectomy remain controversial, particularly in “borderline resectable” cases. This study aimed to evaluate the oncological benefit and perioperative safety of Yttrium-90 transarterial radioembolization (TARE) in patients undergoing right or extended right [...] Read more.
Background/Objectives: Preoperative strategies for hepatocellular carcinoma (HCC) requiring major hepatectomy remain controversial, particularly in “borderline resectable” cases. This study aimed to evaluate the oncological benefit and perioperative safety of Yttrium-90 transarterial radioembolization (TARE) in patients undergoing right or extended right hepatectomy for HCC. Material and Methods: All consecutive patients who underwent right or extended right hepatectomy for HCC at a single tertiary center between January 2013 and December 2023 were retrospectively reviewed. Patients were grouped based on whether they received preoperative TARE or underwent upfront resection. Outcomes analyzed included perioperative morbidity and long-term oncological endpoints. Results: A total of 39 patients were included, of whom 18 received preoperative TARE and 21 underwent upfront surgery. Patients in the TARE group showed significantly greater tumor necrosis at pathology (70% vs. 10%, p = 0.002) and more frequent extended resections. Five-year cancer-specific survival (80.4% vs. 33.5%, p = 0.011), recurrence-free survival (33.8% vs. 14.0%, p = 0.047), and curative-intent disease-free survival (69.3% vs. 18.9%, p = 0.0037) were significantly higher in the TARE group. Overall survival showed a favorable trend. Intraoperative outcomes, postoperative morbidity, and 90-day mortality were comparable between groups. Conclusions: Preoperative TARE is a safe and effective neoadjuvant strategy in selected patients with HCC undergoing major hepatectomy. It may enhance long-term oncological outcomes without increasing surgical risk, supporting its potential role in the management of borderline resectable HCC. Full article
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19 pages, 2264 KiB  
Article
Extramedullary Plasmacytomas of the Nasal Cavity: Case-Based Perspectives into Optimizing the Diagnostic Differentiation from Inflammatory Polyps
by Carmen Aurelia Mogoantă, Codruț Sarafoleanu, Andrei Osman, Irina Enache, Shirley Tarabichi, Constantin-Ioan Busuioc, Ilona Mihaela Liliac, Dan Iovanescu and Ionuţ Tănase
Medicina 2025, 61(8), 1406; https://doi.org/10.3390/medicina61081406 - 1 Aug 2025
Viewed by 167
Abstract
Background and Objectives: Extramedullary plasmacytoma (EMP) is a rare monoclonal B-cell neoplasm that typically affects the head and neck region, with a predilection for the sinonasal tract. Clinical presentation is often nonspecific, leading to delayed diagnosis. This study aims to improve our [...] Read more.
Background and Objectives: Extramedullary plasmacytoma (EMP) is a rare monoclonal B-cell neoplasm that typically affects the head and neck region, with a predilection for the sinonasal tract. Clinical presentation is often nonspecific, leading to delayed diagnosis. This study aims to improve our understanding of sinonasal EMP by reviewing the recent literature and presenting a case series from our clinical experience. Materials and Methods: A systematic review of published cases of sinonasal EMP from 2000 to 2023 was conducted using the PubMed database, yielding 28 eligible cases. Additionally, we retrospectively analyzed three patients diagnosed and treated at our institutions. Inclusion criteria included histologically and immunohistochemically confirmed EMP without evidence of systemic multiple myeloma. Data on demographics, tumor location, symptoms, treatment, and outcomes were collected and analyzed descriptively. Results: Sinonasal EMP most commonly presented with unilateral nasal obstruction and epistaxis. Tumors were primarily located in the nasal cavity and paranasal sinuses, often extending beyond a single anatomical site. In the literature cohort, the most frequent treatment was combined surgery and radiotherapy (35.71%), followed by radiotherapy alone (17.86%). Recurrence was reported in 10.71% of cases, and 7.14% of patients died due to disease progression. All three patients in our case series underwent surgical excision; two received postoperative radiotherapy. No recurrences or progression to multiple myeloma were observed during follow-up (12–24 months). Conclusions: Sinonasal EMP is a rare but radiosensitive tumor with a favorable prognosis when treated with surgery and/or radiotherapy. Early diagnosis, histopathological confirmation, and exclusion of systemic disease are essential. Multidisciplinary management and long-term follow-up are critical due to the risk of recurrence and transformation into multiple myeloma. Full article
(This article belongs to the Special Issue Optimizing Outcomes in Head and Neck Surgery)
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11 pages, 1935 KiB  
Article
Segmental Renal Infarction Associated with Accessory Renal Arteries After Para-Aortic Lymphadenectomy in Gynecologic Malignancies
by Ayumi Kozai, Shintaro Yanazume, Fumitaka Ejima, Shuichi Tatarano, Yusuke Kobayashi, Rintaro Kubo, Shinichi Togami, Takashi Yoshiura and Hiroaki Kobayashi
Medicina 2025, 61(8), 1395; https://doi.org/10.3390/medicina61081395 - 1 Aug 2025
Viewed by 128
Abstract
Background and Objectives: The causes and clinical outcomes of renal perfusion abnormalities occurring after para-aortic lymphadenectomy (PANDx) for gynecologic malignancies are unknown. We investigated the potential involvement of accessory renal artery (ARA) obstruction in their development by reassessing perioperative contrast-enhanced computed tomography [...] Read more.
Background and Objectives: The causes and clinical outcomes of renal perfusion abnormalities occurring after para-aortic lymphadenectomy (PANDx) for gynecologic malignancies are unknown. We investigated the potential involvement of accessory renal artery (ARA) obstruction in their development by reassessing perioperative contrast-enhanced computed tomography (CECT). Materials and Methods: This retrospective study investigated a clinical database to identify urinary contrast defects using CECT in all patients who had undergone PANDx between January 2020 and December 2024. The perfusion defects in the kidney detected by CECT were extracted by a gynecologic oncologist and evaluated by a radiologist and urologist for suspected obstruction of ARAs. Results: Postoperative renal contrast defects were observed in 3.8% (6/157) of patients. Renal parenchymal fibrosis, cortical atrophy, and parenchymal thinning were observed as universal findings in all patients showing renal contrast defects. In five of the six cases, ARAs supplying the infarcted renal segments were identified on preoperative CECT, and arterial obstruction was confirmed on postoperative imaging. The remaining case was considered to be latent pyelonephritis. All five patients underwent laparotomy, and preoperative CECT failed to detect ARAs. The median resected para-aortic lymph node was 23 nodes (range: 15–33) in five patients, showing no statistically significant difference compared to patients without perfusion abnormalities (p = 0.19). Postoperative serum creatinine levels remained stable. Conclusions: ARA obstruction appears to be a risk factor for segmental renal infarction after para-aortic lymphadenectomy in gynecological malignancies; however, the clinical impact on urinary function may be limited. Awareness of this potential complication is essential for gynecologic oncologists performing PANDx. Full article
(This article belongs to the Section Obstetrics and Gynecology)
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19 pages, 1760 KiB  
Review
An Insight into Current and Novel Treatment Practices for Refractory Full-Thickness Macular Hole
by Chin Sheng Teoh
J. Clin. Transl. Ophthalmol. 2025, 3(3), 15; https://doi.org/10.3390/jcto3030015 - 1 Aug 2025
Viewed by 135
Abstract
Refractory full-thickness macular holes (rFTMHs) present a significant challenge in vitreoretinal surgery, with reported incidence rates of 4.2–11.2% following standard vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade. Risk factors include large hole size (>400 µm), chronicity (>6 months), high myopia, [...] Read more.
Refractory full-thickness macular holes (rFTMHs) present a significant challenge in vitreoretinal surgery, with reported incidence rates of 4.2–11.2% following standard vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade. Risk factors include large hole size (>400 µm), chronicity (>6 months), high myopia, incomplete ILM peeling, and post-operative noncompliance. Multiple surgical techniques exist, though comparative evidence remains limited. Current options include the inverted ILM flap technique, autologous ILM transplantation (free flap or plug), lens capsular flap transplantation (autologous or allogenic), preserved human amniotic membrane transplantation, macular subretinal fluid injection, macular fibrin plug with autologous platelet concentrates, and autologous retinal transplantation. Closure rates range from 57.1% to 100%, with selection depending on hole size, residual ILM, patient posturing ability, etc. For non-posturing patients, fibrin plugs are preferred. Residual ILM cases may benefit from extended peeling or flap techniques, while large holes often require scaffold-based (lens capsule, amniotic membrane) or fibrin plug approaches. Pseudophakic patients should avoid posterior capsular flaps due to lower success rates. Despite promising outcomes, the lack of randomized trials necessitates further research to establish evidence-based guidelines. Personalized surgical planning, considering anatomical and functional goals, remains crucial in optimizing visual recovery in rFTMHs. Full article
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