Chirurgia最新文献

Caustic ingestion remains a complex public health problem worldwide, both in adults and children. The consequences of caustic ingestion depend on the severity of the injuries, the general condition of the patient at presentation and the promptness of medical management. Long-term complications include strictures or stenoses, resulting in dysphagia. In addition to metabolic and hydroelectrolytic disorders, consequences of dysphagia, there are distant cases of esophageal cancer based on esophageal stenosis. The ingestion of caustic products is a risk factor for the occurrence of esophageal cancer, and the specialized literature reports the occurrence of the disease, approximately 30 to 40 years after the accident, with the determination mainly of squamous carcinoma. The pathophysiological mechanism of esophageal cancer related to caustic ingestion is not fully understood. The diagnosis of esophageal cancer on post caustic scar is based on two important pillars: the change of the clinic by the appearance or change of the characters of dysphagia and the endoscopic examination of the lesion. Obviously, the information needs to be completed by complex imaging explorations, both for the certification of the diagnosis and for the purpose of a complete oncological assessment. The principles and methods of treatment for "esophageal scar cancer" are the same as for any other esophageal cancer: early detection, complete oncological assessment and surgical resection associated with oncological therapy are the main pillars for cure. Due to the complexity of these cases, a series of discussions and recommendations appear as necessary in their management.

Introduction: Although recurrent diverticulitis appears to be a chronic relapsing disease from a clinical standpoint, there are no sufficient data about inflammatory markers that allow monitoring recurrent diverticulitis in the quiescent phase. Our hypothesis is that serum inflammatory markers may be increased during clinical quiescent phases of diverticulitis and will drop after elective laparoscopic sigmoidectomy for uncomplicated recurrent diverticulitis. We also believe that a drop in IL-6 levels across surgery could be related to an improved quality of life.

Material and methods: This epidemiological study aims to evaluate IL-6 serum levels and quality of life preoperatively and 6 months after surgery in 30 patients undergoing elective laparoscopic sigmoidectomy for uncomplicated recurrent diverticulitis.

Results: The mean preoperative IL-6 level was 9.5 +- 9.2 pg/ml (range 0-5), while at six months after surgery the mean IL-6 was 4.5 +- 3.5. (p=0.0085). Preoperative QoL measured with the GIQLI questionnaire was 98 +- 11.3 and raised significantly after surgery to 112 +- 9.8 (p=0.043).

Conclusions: We found a serum IL-6 reduction after elective laparoscopic sigmoidectomy that can be attributed to the surgical removal of the source of inflammation in patients suffering from uncomplicated recurrent diverticulitis. Similarly, the GIQLI questionnaire showed a significantly improved QoL after surgery.

Introduction: Sternal metastases of serous ovarian carcinoma are extremely rare conditions, with less than 10 articles published in the medical literature on this subject. The aim of this article is to present a case of late-onset sternal metastasis of serous ovarian carcinoma in a patient who underwent surgery for serous ovarian carcinoma approximately 6 years before and to provide a review of the literature regarding the importance of multidisciplinary management in such cases. Material and Method: We aimed to conduct a review of the specialized literature concerning published articles on sternal metastases from ovarian serous carcinoma over a period of approximately 30 years, from January 1, 1994, to December 31, 2023. For this purpose, we utilized the following databases: PubMed and Web of Science (Clarivate Analytics), using the keywords: sternal metastases, ovarian cancer. Results: Following our review of the specialized literature, we identified only 10 articles that reported clinical cases of sternal metastases occurring after ovarian cancer surgery and chemotherapy. Additionally, we present the case of a 70-year-old female patient diagnosed with sternal metastasis from ovarian serous carcinoma, with an emphasis on the therapeutic management of the case. Conclusions: Sternal metastases of serous ovarian carcinoma represent extremely rare conditions. In such cases, if sternal metastases are solitary, and the patient does not present metastases at other sites nor signs of local recurrence, sternum resection may constitute a viable therapeutic option in the treatment of these patients.

Background: Varicose veins represent a pathology with a frequent number of cases that require surgical treatment. High saphenous ligation and stripping is still a feasible surgical intervention in selected cases. The present study aims to identify age as a prognostic factor after high saphenous ligation and stripping. Material and Methods: The cases of patients admitted between 2016 and 2023 with varicose disease for which high ligation and stripping were performed were prospectively analyzed. 167 patients met the inclusion and exclusion criteria, being divided into two groups: Group I 114 patients under 60 years of age and Group II 53 patients over 60 years of age. Patients were followed in the postoperative period at 1 month and 6 months, respectively, and data were collected using several questionnaires: CEAP, VAS, VCSS and AVVQ. Results: Class 4, according to the CEAP classification, was the most frequently involved regardless of age category (Group I: 49.12%, Group II: 49.06%), followed by class 2 (Group I: 41.22%, Group II: 35.85%). In the preoperative period there were statistically significant differences between the two groups regarding VAS (p = 0.041) and AVVQ (Group I: 12.51 +- 6.11, Group II: 11.11 +- 7.19, p = 0.036). There were no significant statistical differences between the two groups (p = 0.744) regarding the preoperative VCSS questionnaire. At 6 months after surgery, the improvement in VCSS and AVVQ was independent of age. Conclusions: The surgical intervention of high ligation and stripping of the saphenous vein is a safe and feasible operation that can be performed in selected cases and is not influenced by the age of the patients.

video width="640" height="480" controls controlsList="nodownload" poster="https://www.revistachirurgia.ro/pdfs/video/anna_scarabosio_vascular_mapping.jpg" style="margin-top: -20px;" source src="https://www.revistachirurgia.ro/pdfs/video/anna_scarabosio_vascular_mapping.mp4" type="video/mp4" Your browser does not support the video tag. /video Mastectomy remains a prevalent procedure in oncologic surgery, driven by the high incidence of breast cancer and the crucial role of surgical intervention. Over the last two decades, mastectomy techniques have significantly evolved, with conservative approaches such as skin-sparing and nipple-sparing mastectomies gaining widespread adoption. This shift aligns with patients' contemporary demands for improved aesthetic outcomes and quality of life. Concurrently, reconstructive techniques, particularly the pre-pectoral approach, have advanced, focusing on reducing complications like cutaneous necrosis while optimizing cosmetic results. Our study emphasizes the importance of preoperative vascular mapping using Ultrasound Doppler to identify key blood vessels supplying the breast skin and nipple. This technique allows for precise incision placement, preserving vital vessels and minimizing the risk of necrosis. The results demonstrate that US-guided preoperative mapping is a cost-effective method that enhances surgical outcomes and patient satisfaction in breast reconstruction following mastectomy.

Introduction: Colorectal cancer (CRC) has exhibited an increasing incidence worldwide in recent years, underscoring the importance of early diagnosis methods. This study aimed to assess the influence of CD44 gene polymorphism rs187115 on CRC susceptibility. Material and Methods: The study encompassed 470 CRC patients and 165 healthy controls. Genotyping of all biological blood samples was conducted using the TaqMan assay on the ABI 7500 Real Time PCR System (Applied Biosystems, USA). Results: The genotyping revealed that carriers of the variant G allele, including the genotypes AG and GG, exhibited a heightened risk of CRC occurrence, with an odds ratio (OR) of 1.89 (95% confidence interval [CI] = 1.57-1.97; p = 0.047) compared to those carrying the AA genotype. Conclusions: The findings underscore the potential utility of CD44 rs187115 polymorphisms as a novel predictive biomarker for CRC prognosis.

Background: Persistent external pancreatic fistulas post-acute pancreatitis are a relatively rare complication, in an era of endoscopic and minimally invasive treatment, which can present a high rate of morbidity. Although most of the cases require surgical treatment, the possibility of a minimally invasive approach is yet to be established. This article highlights a case in which persistent external pancreatic fistula (PEPF) was managed laparoscopically, indicating the key steps, as well as the postoperative follow-up. Case report: We present the case of a 55-year-old patient who developed acute gallstone pancreatitis, which was unsuccessfuly managed through endoscopic methods, and who underwent laparoscopic necrosectomy. Furthermore, the patient developed persistent external pancreatic fistula for which a laparoscopic Roux-en-Y fistulojejunostomy was performed with good postoperative recovery and follow-up. Conclusion: Despite the scarcity of the procedure, laparoscopic Roux-En-Y Fistulojejunostomy can be considered an effective choice in the cases of persistent external pancreatic fistulas by taking the right precautions and with adequate case selection.

Introduction: Cold Ischemia time (CIT) could be informative regarding the possibility of slow graft function (SGF) or delayed graft function (DGF). We aim to determine the incidence of graft dysfunction types and the association with ischemia time. Material and Methods: We performed a prospective study on 54 adults KT recipients, transplanted between 1 of January 2019 and 31 of December 2019. Graft was defined and classified into three categories: immediate graft function (IGF), SGF, and DGF. Cox regression analysis has been used to identify risk factors for graft dysfunction. Results: According to multivariate Cox regression analysis, it was observed that CIT [HR = 1.004, 95%CI = 1.001-1.007, p = 0.007] was an independent risk factor for the occurrence of graft dysfunction, while the brain death donor [HR = 11.94, 95%CI = 0.73-194.94, p = 0.08] and diabetes [HR = 2.71, 95%CI = 0.083-8.80, p = 0.09] had a trend of association with the followed outcome. In two separate models of multivariate we found that CIT was an independent risk factor for DGF [HR = 1.003, 95%CI = 1.001-1.006, p = 0.01], but not for SGF. Conclusion: In conclusion we found that kidney graft dysfunction types are associated with high CIT and CIT was an important risk factor for DGF, but no SGF in KT recipients.

Introduction: The study investigated the therapeutic approach and clinical management of pediatric burn patients admitted to the Pediatric Surgery and Orthopedics Clinic of the County Emergency Hospital Craiova over a two-year period (2017-2018). The primary objective was to evaluate the effectiveness of the treatments applied, including grafting procedures and their impact on long-term prognosis. Material and Methods: The cases of 80 children with burns of varying severity were retrospectively analyzed. Patients were classified according to the severity and the mechanism of burn injury. The collected data were processed using Microsoft Excel 2021. Patients were classified into three categories based on the affected body surface area (BSA): Category 1 patients, with a BSA â?¤ 10%, showed very good results and required less intensive care. Category 2 patients, with a BSA between 10% and 50%, had good outcomes but needed more prolonged care. Category 3 patients, with a BSA 50%, had satisfactory results but faced more challenges in recovery, highlighting the need for enhanced prevention measures and better treatment protocols. Results: The majority of patients came from rural areas, and thermal burns were the most common. The effectiveness and safety of the treatments applied were highlighted, with a generally favorable impact on long-term prognosis. Treatment included both surgical and non-surgical approaches, with generally favorable clinical outcomes. Conclusion: The study highlights significant differences between rural and urban environments, suggesting the need for prevention and education campaigns regarding pediatric burns and improved access to medical services. It also emphasizes the need for integrated management to reduce the severity and complications associated with burns. The results provide a solid foundation for future strategies aimed at improving the care of pediatric burn patients.