Search Results (4,989)

Background/Objectives: Surgical site infection (SSI) after autologous rib cartilage microtia reconstruction is an uncommon but potentially devastating complication, as infection of the avascular cartilage framework can rapidly lead to partial or complete framework loss. Traditional management often favored aggressive debridement or framework removal, resulting in significant deformity. This study aimed to evaluate salvage-oriented management strategies and to propose a structured treatment algorithm for SSI following microtia reconstruction. Methods: A retrospective case series was conducted of patients who developed SSI after autologous rib cartilage microtia reconstruction between March 2021 and November 2025. SSI was defined by clinical and surveillance criteria requiring intervention beyond routine postoperative care. Nine patients were included. Management strategies were analyzed with respect to infection control, framework preservation, and wound healing outcomes. Results: SSI occurred at variable time points, ranging from early postoperative infection to delayed and late-onset presentations. Identified pathogens included Gram-positive cocci and multidrug-resistant Gram-negative organisms. Negative-pressure wound therapy (NPWT) was applied in all cases with wound dehiscence, persistent drainage, or cartilage exposure. Conservative staged debridement was performed only after clear demarcation of nonviable tissue. Overall auricular framework preservation was achieved in 100% of patients, with no cases requiring complete framework removal, although limited cartilage loss occurred in select cases. These outcomes demonstrate the clinical feasibility and effectiveness of salvage-oriented management across heterogeneous infection scenarios. Conclusions: SSI following autologous microtia reconstruction can be effectively salvaged without routine framework removal through a structured, timing-based algorithm emphasizing early culture-guided antimicrobial therapy, NPWT, and conservative staged intervention. This salvage-oriented approach provides a clinically relevant and reproducible framework for preserving auricular structure while minimizing morbidity, even in infections involving multidrug-resistant organisms. Full article

Background/Objectives: Although advances in understanding glaucoma have been made, early detection remains challenging due to the asymptomatic nature of the disease. The Metabolomics In Surgical Ophthalmological Patients (MISO) study previously demonstrated that aqueous humor (AH) metabolomics can distinguish glaucoma patients from controls. We aimed to determine if the metabolic profile of AH has predictive power for overall survival and glaucoma progression after surgery. Methods: Glaucoma patients (n = 34) were retrospectively analyzed and classified into progression categories based on surgical and medical interventions and assessed for survival. Results: Glutamine and α-ketoglutarate were significantly associated with glaucoma progression, while N-acetylglutamate, lysine, and creatine correlated with mortality. These metabolites are linked to excitotoxicity, mitochondrial dysfunction, and oxidative stress, highlighting their potential role in glaucoma pathophysiology. Conclusions: These results suggest that metabolomic profiling of AH could provide valuable biomarkers for predicting surgical outcomes and overall survival, paving the way for individualized therapeutic approaches. Further studies are required to confirm these findings before they can be integrated into clinical practice. Full article

Background/Objectives. Ebstein’s anomaly (EA), which accounts for fewer than 1% of congenital heart diseases, and atrioventricular canal defect (AVCD), present in approximately 4–5% of cases, exceptionally coexist, with this combination observed in fewer than 0.5% of patients with AVCD. We aim to report the oldest documented case of a 45-year-old female with the exceptionally rare combination of complete AVCD, EA, and right ventricular hypoplasia and to provide a concise review of these anomalies. Case presentation. Diagnosed in early childhood with a complete AVCD, pulmonary stenosis, and right ventricular (RV) hypoplasia, the patient underwent palliative surgical intervention with a modified Blalock–Taussig shunt at the age of 10 but did not receive subsequent regular follow-up. Over the ensuing 35 years, she remained largely untreated until presentation at 45 years of age with progressive exertional dyspnea, central cyanosis, and palpitations, corresponding to NYHA class III. Comprehensive multimodal imaging, including transthoracic echocardiography and cardiac magnetic resonance, revealed a complete AVCD with moderate-to-severe mitral regurgitation secondary to an anterior mitral leaflet cleft, severe tricuspid regurgitation, RV hypoplasia, and hallmark features of EA. Given the complex cardiac anatomy and the elevated surgical risk, the patient was considered inoperable, and a strategy of conservative management with multidisciplinary follow-up was implemented. Conclusions. This case highlights the exceptional longevity of a patient with the rare coexistence of complete AVCD, EA, and RV hypoplasia, surviving 45 years from diagnosis despite limited early intervention. It underscores the importance of lifelong follow-up in complex congenital heart disease and illustrates the role of multimodal imaging in assessing anatomy and guiding management when surgical options are high-risk or not feasible. Full article

Background: Thoracoamniotic shunting (TAS) is a well-established fetal therapy for severe pleural effusions complicated by hydrops. Although survival in selected cases exceeds 60%, retained or migrated shunts can pose significant postnatal management challenges. Case presentation: We report a neonate with intrathoracic migration of a Somatex^® shunt placed at 26 weeks’ gestation for hydropic pleural effusion. Although initially asymptomatic, the infant developed recurrent pleural effusions requiring multiple readmissions. Thoracoscopic retrieval on day 76 of life allowed safe removal despite dense adhesions, leading to complete clinical resolution. Discussion: Retained thoracoamniotic shunts may remain asymptomatic or cause recurrent effusions, pneumothorax, or other complications. This case highlights the limitations of conservative management in the presence of clinical deterioration and supports timely surgical removal. Standardized criteria for intervention are lacking and urgently needed. Conclusions: In infants with retained TAS, recurrence of effusions or respiratory compromise should prompt active removal. Thoracoscopic retrieval is a safe and effective minimally invasive option. Full article

Background/Objectives: Postoperative cognitive dysfunction (POCD) represents a significant and potentially preventable complication in elderly patients undergoing colorectal cancer surgery, with reported incidence ranging from 2.8% to 62.2% depending on perioperative management strategies and assessment methods. This narrative review synthesizes current evidence on the epidemiology, pathophysiology, risk factors, and prevention strategies for POCD in this vulnerable population. Methods: A comprehensive narrative review was conducted to examine the current literature on POCD in elderly colorectal cancer patients. Evidence was synthesized from published studies addressing epidemiology, assessment tools, risk factors, pathophysiological mechanisms, and prevention strategies, with a particular focus on Enhanced Recovery After Surgery (ERAS) protocols and multicomponent interventions. Results: Advanced age, pre-existing cognitive impairment, frailty, and surgical complexity emerge as key risk factors for POCD. ERAS protocols demonstrate substantial protective effects, reducing POCD incidence from 35% under conventional care to as low as 2.8% in optimized pathways. The pathophysiology involves multifactorial mechanisms, including neuroinflammation, blood–brain barrier disruption, neurotransmitter dysregulation, and oxidative stress, with surgical trauma triggering systemic inflammatory cascades that activate microglial responses within the central nervous system. Evidence-based prevention strategies include preoperative cognitive and frailty screening, minimally invasive surgical techniques, multimodal opioid-sparing analgesia, regional anesthesia, depth-of-anesthesia monitoring, and structured postoperative care bundles adapted from the Hospital Elder Life Program. Conclusions: The integration of comprehensive perioperative cognitive care protocols represents a critical priority as surgical volumes in elderly populations continue to expand globally. Emerging directions include biomarker development for early detection and risk stratification, precision medicine approaches targeting individual vulnerability profiles, and novel therapeutic interventions addressing neuroinflammatory pathways. Standardized assessment tools, multidisciplinary collaboration, and implementation of evidence-based preventive interventions offer substantial promise for preserving cognitive function and improving long-term quality of life in elderly colorectal cancer patients. Full article

Background/Objectives: Gynecological and obstetric surgeries carry a risk of iatrogenic urinary tract injuries; however, comparative data on injury patterns, diagnostic timing, and management across different surgical indications remain limited. This study aimed to evaluate the incidence, characteristics, diagnostic timing, and outcomes of urological injuries following gynecologic and obstetric surgeries in a high-volume tertiary referral center over a 10-year period. Methods: This retrospective single-center cohort study included adult female patients who sustained intraoperative or postoperative urological injuries during gynecologic or obstetric procedures between January 2014 and December 2024. Urological injury was defined as bladder, ureteral, or genitourinary fistula injury requiring urological intervention. Patients with prophylactic or temporary ureteral stenting were excluded. Cases were classified into malignant gynecologic, obstetric, and benign gynecologic surgery groups. Injury type, timing of diagnosis, management strategies, and clinical outcomes were analyzed. Results: Among 16,100 procedures, 223 urological injuries were identified (incidence: 1.3%). Bladder injuries were the most common (62.3%) and were predominantly associated with obstetric procedures, whereas ureteral injuries (28.7%) occurred more frequently during malignant gynecologic surgeries (p < 0.05). Intraoperative recognition rates varied significantly by injury type, being highest for bladder injuries (98.6%) and lowest for fistulas (5.0%) (p < 0.001). Conclusions: Surgical indication significantly influences the pattern and timing of urological injuries. Bladder injuries are usually detected intraoperatively, whereas ureteral and fistulous injuries are more often diagnosed postoperatively, particularly in malignant and complex procedures, highlighting the need for targeted intraoperative vigilance and multidisciplinary management in high-risk cases. Full article

Introduction: Management of trochanteric fractures in revision hip surgery has a high incidence of non-union and complications. Fixation devices are often bulky, prone to breakage, and necessitate reoperation. This study describes a novel soft tissue and bony abductor repair that reduces the forces on bony fragments without the need for prominent metalwork. Methods: This novel surgical technique involves fixation of the abductor mechanism with polyester and polyethylene sutures that are woven through the abductors and secured to the femoral shaft with a proprietary suture cerclage tape with cerclage wire supplementation in select cases. All patients undergoing fixation were retrospectively reviewed with a minimum follow-up period of 12 months. Outcomes relating to dislocation, reoperation, fracture union and the incidence of symptomatic Trendelenburg gait were recorded. Results: A total of 17 patients underwent this novel intervention. There were no dislocations or reoperations for prominent metalwork at the last follow-up. One patient had evidence of greater trochanter (GT) non-union, and three had GT displacement of over 3 mm. Eight (47.1%) patients were independently mobile and seven (41.2%) were mobile with only one walking aid. No patients required plate or bolt fixation. Conclusions: GT fractures and abductor deficiency are difficult to manage, with most reported methods utilising bulky metalwork to treat a soft tissue injury. We describe a novel combined soft tissue and bony fixation without the need for excessive metalwork. Our pilot study demonstrates satisfactory outcomes of this intervention that are technically reproducible and more appropriately addresses the deforming forces involved with a low complication profile. Full article

Background and Clinical Significance: Absorbable haemostatic agents such as Surgicel^® Fibrillar are useful adjuncts to control post-surgical bleeding in cardiac surgery. The material is purposefully left in situ and it slowly degrades over time. Previous publications, mainly in general and gynaecological surgery, have demonstrated that these materials can mimic gangrenous infection, abscesses, anastomotic leak, and early tumour recurrence in imaging studies. These findings can often lead to unnecessary re-interventions or re-operations. The number of reports in the cardiothoracic surgical field is limited. Case Presentation: We report a 45-year-old man who underwent aortic valve replacement and ascending aorta and hemiarch replacement. In this case, Surgicel^® Fibrillar was used to optimise graft contouring, contributing to postoperative imaging appearances that initially raised concern for infection. The patient was conservatively managed given his stable clinical picture and focused review of CT images with the knowledge of location of Surgicel^® Fibrillar. Repeat CT scan after 2 weeks showed a significant reduction in collection size and complete resolution of air bubbles within the collection. Conclusions: It is important for cardiothoracic surgeons and radiologists to be aware of the early CT appearances of haemostatic agents to minimise erroneous diagnosis of postoperative complications leading to unnecessary interventions. This case highlights a diagnostic pitfall in postoperative imaging, where retained absorbable haemostatic material may mimic serious infective complications and lead to unnecessary re-intervention if operative and radiological findings are not carefully correlated. Full article

Background: Peripheral endovascular intervention is the preferred revascularization strategy for patients with chronic lower-limb ischemia. Although generally safe, peri-procedural mechanical complications may occur and are influenced by both lesion complexity and procedural strategy. Data identifying determinants of such complications in routine clinical practice remain limited. Methods: We performed a retrospective single-center analysis of consecutive patients undergoing peripheral endovascular intervention for chronic lower-limb ischemia between 2010 and 2023. The primary endpoint was the occurrence of peri-procedural mechanical complications, defined as mechanical adverse events occurring during or immediately following the index intervention and directly related to catheter manipulation, device deployment, or vascular access. Lesion- and procedure-related predictors were evaluated using multivariable logistic regression analysis. Results: A total of 283 index procedures were included. Peri-procedural mechanical complications occurred in 9 procedures (3.2%), with arterial dissection being the most frequent event (2.1%). No cases of peri-procedural bleeding, distal embolization, or emergent surgical conversion were observed. In multivariable analysis, chronic total occlusion (adjusted odds ratio [aOR] 1.89, 95% confidence interval [CI] 1.14–3.11; p = 0.014), moderate-to-severe arterial calcification (aOR 1.74, 95% CI 1.03–2.93; p = 0.039), introducer sheath size ≥7 French (aOR 2.08, 95% CI 1.21–3.57; p = 0.007), and ≥3 vascular access attempts (aOR 1.67, 95% CI 1.00–2.81; p = 0.048) were associated with increased risk of peri-procedural mechanical complications in adjusted analyses. Conclusions: In this real-world institutional registry, peri-procedural mechanical complications during peripheral endovascular intervention were uncommon. Lesion complexity and procedural factors, rather than access route or device type, were the primary determinants of mechanical risk. These findings highlight the importance of careful lesion assessment and procedural planning to optimize peri-procedural safety in routine practice. Full article

Obstructive sleep apnea (OSA) is a common disorder caused by recurrent upper airway obstruction during sleep, affecting individuals across the lifespan. In children, OSA commonly results from adenotonsillar hypertrophy and may resolve spontaneously or following surgical intervention. Among adolescents and adults, OSA is more frequently associated with modifiable lifestyle factors, particularly obesity. The natural history of OSA may evolve from intermittent snoring and mild disease to moderate or severe forms if left untreated, leading to reduced health-related quality of life and overall health deterioration. Early identification of OSA, especially in mild and moderate cases, allows timely interventions to improve OSA-associated indices and may prevent progression to severe disease. Continuous positive airway pressure therapy remains the treatment of choice for adults, providing effective symptom control and reducing long-term complications, although adherence rates vary. In obese patients, sustained weight reduction represents the most effective disease-modifying strategy: a ≥5% weight loss is associated with an approximately 80% reduction in progression risk, while bariatric surgery achieves remission in up to 60–65% of cases at one year. Emerging anti-obesity pharmacotherapies have also demonstrated clinically meaningful reductions in the apnea–hypopnea index. Comorbid conditions such as hypertension, type 2 diabetes, and depression exacerbate OSA severity, impair treatment response, and complicate overall disease management. This review uniquely integrates pediatric and adult longitudinal data, treatment-modified trajectories, and emerging therapeutic approaches to provide a life-course perspective on OSA natural history, highlighting opportunities for early, phenotype-directed intervention to possibly alter disease course and long-term outcomes. Full article

Background/Objectives: Anastomotic leakage (AL) is a major complication of colorectal surgery. Despite multiple identified risk factors, no single strategy has proven fully effective in preventing AL. This single-arm pilot study aims to evaluate the feasibility, safety, and adherence of a multimodal colorectal anastomosis assessment protocol (CASPI) in patients undergoing surgery for colorectal cancer. Methods: This prospective descriptive interventional single-arm pilot study included patients diagnosed with colorectal cancer who underwent surgical resection. The CASPI protocol consists of five steps: (1) indocyanine green (ICG) perfusion assessment, (2) doughnut integrity checking, (3) air leak testing, (4) intraoperative flexible endoscopy, and (5) postoperative flexible sigmoidoscopy. Results: A total of 34 patients were included. The median age was 63.5 years, and the median BMI was 27.7 kg/m². Twenty-seven patients had rectal tumors, and 66.7% received neoadjuvant therapy. Adherence to the protocol was 100% intraoperatively and 88.2% postoperatively. Adequate perfusion by ICG was confirmed in 94.1% of cases; intact anastomotic doughnuts were obtained in all procedures. Intraoperative endoscopy showed Grade 1 mucosa in 76.5% of patients and Grade 2 in 23.5%. No complications related to the CASPI protocol were observed. Stoma closure was performed in all patients with temporary ileostomy. Conclusions: Implementation of the CASPI protocol in colorectal surgery demonstrated excellent feasibility, high adherence, and strong safety. These findings support its further evaluation in larger, controlled studies designed to assess clinical effectiveness in the incidence of anastomotic complications. Full article

Symptomatic severe aortic stenosis has an extremely high risk of death, ranging from 60 to 90% at five years if left untreated. This has informed the recommendation for urgent intervention upon diagnosis, especially when symptoms develop. Asymptomatic severe aortic stenosis has a four-year mortality between 30 and 50% if left untreated, which is similar to some metastatic cancers. Conservative management for patients with severe asymptomatic aortic stenosis was previously advocated, likely owing to the relative invasiveness of surgical aortic valve replacement. The advent of low-risk transcatheter aortic valve implantation with good medium-term durability has prioritized the need for a paradigm shift in the treatment of asymptomatic severe aortic stenosis towards a more proactive strategy of early intervention to reduce significant adverse events. This article provides a state-of-the-art overview of the contemporary management of patients with asymptomatic severe aortic stenosis. Full article

Background/Objectives: With the global rise in chronic diseases among older adults, rehabilitation services have become essential, particularly for those with cerebrovascular and central nervous system (CNS) disorders, which lead to significant long-term disabilities. To determine the impact of designated rehabilitation medical institutions on the readmission rates of older patients with CNS disorders who receive surgical interventions. Methods: This was a population-based cohort study. Data was obtained from the National Health Insurance Service database (2002–2019). Fifteen designated institutions participated in the pilot project for convalescent rehabilitation. We analyzed the data of 1019 patients before and after the implementation of the designated rehabilitation institution. The study sample included (1) patients admitted to 15 designated institutions participating in the pilot project for convalescent rehabilitation and (2) patients diagnosed with conditions classified under the rehabilitation patient group, Rehabilitation Impairment Category 1 to 7. The intervention was the pilot project for designated rehabilitation institutions, launched in October 2017. The primary outcome of interest was the readmission rate of older patients with CNS disorders who received surgical interventions. Interrupted time series analysis with segmented regression was used to assess changes in the 30-day readmission rates. Results: Post-intervention, an 8% reduction in 30-day readmission rates (estimate, 0.9225; 95% confidence interval: 0.9129–0.9322, p < 0.0001) was observed. Subgroup analysis showed a significant decline in readmission rates across various patient groups, including those with disabilities, high Charlson Comorbidity Index scores, and extended hospital stays. The regions outside Seoul (capital city), particularly Gyeonggi/Incheon (areas around Seoul) and other areas (i.e., rural), also showed a significant decrease in readmission trends after the intervention. Conclusions: Designated rehabilitation medical institutions led to a significant reduction in readmission rates of older patients with CNS disorders, suggesting that these institutions effectively support recovery and reduce the burden of readmission for patients with severe conditions and those residing in non-capital cities. Full article

Circular–circular regression models are widely used to investigate relationships between angular variables in various applied fields, including biostatistics. The classical von Mises (vM) circular–circular regression model, however, is known to be sensitive to outliers due to its light-tailed error structure. In this study, we investigate the wrapped Cauchy (WC) circular–circular regression model as a robust alternative to the vM-based approach for analyzing circular data contaminated by outliers. Parameter estimation is performed via maximum likelihood (ML) using a modern constrained gradient-based optimization algorithm, namely the limited-memory Broyden–Fletcher–Goldfarb–Shanno algorithm with box constraints (L-BFGS-B), allowing for stable estimation under natural parameter bounds. Extensive simulation studies demonstrate that, under contaminated settings, the WC model provides substantially more stable parameter estimates than the vM model, yielding markedly lower mean squared error and variability, particularly for high concentration regimes and directional outliers. The robustness advantage of the WC model is further illustrated through a real biostatistical application involving the circular relationship between the months of diagnosis and surgical intervention in gastric cancer patients. Overall, the results highlight the practical benefits of WC-based circular–circular regression for robust inference in the presence of outliers. Full article

Background: Spondylolysis is a stress fracture of the pars interarticularis, most common in adolescents and athletes involved in sports requiring repetitive spinal loading, extension, and rotation. The condition is often underdiagnosed due to delays in presentation and diagnosis, particularly among non-orthopedic providers. Aims: This review aims to summarize the current understanding of spondylolysis, focusing on its etiology, diagnosis, management strategies, and identify gaps in research for future exploration. Methods: A structured literature search was conducted in PubMed to identify studies relevant to pediatric and adolescent spondylolysis, spondylosis, and spondylolisthesis, particularly in the context of athletic injuries. The initial search yielded 143 citations. Applying filters for English language publications within the past five years reduced this to 125 citations. Limiting to populations that were aged 18 years and under returned 50 studies. After screening the titles and abstracts, 12 non-specific or irrelevant articles (including letters to the editor) were excluded, leaving a final dataset of 38 articles for detailed review. In addition, foundational and landmark studies outside this window were included to provide historical and conceptual context, bringing the total evidence base to 50 papers. Findings: Spondylolysis most commonly affects the L5 vertebra, with a higher incidence in male athletes. Conservative treatments like physical therapy and bracing are effective, especially when initiated early. However, the efficacy of bracing remains debated, with limited evidence on long-term clinical benefits. Surgical intervention is considered for severe or non-responsive cases. Diagnostic methods, including CT and MRI, are preferred, with emerging techniques like ultrasound showing potential for non-ionizing, cost-effective, early detection. Implications: Early diagnosis and treatment are crucial for preventing progression to spondylolisthesis. While conservative treatments often yield favorable outcomes, more research is needed to compare the effectiveness of bracing and pharmacological interventions. Future studies should focus on long-term outcomes, cost-effective, non-ionizing diagnostic methods, and the role of emerging therapies like regenerative medicine. A multi-disciplinary approach is vital for optimal patient care, particularly in young athletes. Full article