Minerva Surgery最新文献

An anal fissure is a benign and painful ulcer extending from the pectinate line to the anal margin. It leads to an increase in the resting pressure of the internal anal sphincter and the pressure within the anal canal, resulting in local ischemia and impaired wound healing. Anal fissures are mostly located in the posterior midline. They are primarily caused by local trauma to the anoderm, often due to the passage of hard stools, irritation from diarrhea, or anorectal surgery. For both acute and chronic anal fissures, several treatment options are available, and surgery typically reserved as a second-line option. Recent trends in first-line therapy prefer calcium channel blockers (CCBs) over topical glyceryl trinitrate (GTN), as they offer similar healing rates but are associated with fewer side effects and better patient's compliance. Lateral internal sphincterotomy (LIS) remains the gold-standard surgical treatment for this condition. Additionally, emerging therapies, such as platelet-rich plasma (PRP) application, adipose-derived regenerative cells (ADRCs), and percutaneous tibial nerve stimulation (PTNS), have shown promising results and they are gaining attention as potential alternatives for managing chronic anal fissures. The present narrative review aims to provide a comprehensive overview of current therapeutic approaches for anal fissures, evaluating their effectiveness in promoting healing and comparing them with guideline-based recommendations.

Introduction: Unilateral uptake (i.e., increased radiotracer in one lobe) on a thyroid scan in a patient with Graves' disease (GD) is the distinctive feature of unilateral GD (UGD), representing a rare entity and variant of GD with few documented cases to date. Considering the diagnostic and therapeutical implications of the knowledge of this form of GD, this study was designed to bring more light on the UGD entity within the bilobar thyroid gland.

Evidence acquisition: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in reporting this systematic review. We developed a search strategy combining terms for Graves or Hyperthyroidism and unilateral systematically and searched PubMed from inception through August 25, 2024. The inclusion criteria were: 1) patients with Graves' hyperthyroidism due to a unilateral involvement in bilobar thyroid gland; 2) articles written in English or any language with an English abstract.

Evidence synthesis: A total of 10 articles met inclusion criteria, in addition to our institutional experience (comprising 27 individual patients in total). All the included studies were case reports/series. Of the 27 patient cases, 20 (74.1%) were female and the mean age of patients was 44.5±10.6 years. 24 patients (88.9%) had overt hyperthyroidism, two (7.4%) subclinical hyperthyroidism, one (3.7%) had initially normal thyroid function. Orbitopathy was present in two cases out of ten (20%). thyrotropin receptor antibodies (TRAb) or thyroid stimulating immunoglobulin (TSI) were positive in 9 cases out of 12 (75%). Right thyroid lobe was involved in 17 cases (63.0%), while the left one in 10 cases (37.0%). Antithyroid drugs ATDs were adopted by 13 patients (68.4%). Four patients (21.1%) underwent surgery, while radioactive iodine (RAI) was performed in two cases. Two cases (15.4%) received a 12-month course of ATD therapy, one of whom recurred. In two out of three cases after hemithyroidectomy hyperthyroidism recurred due to the involvement of the contralateral lobe of the thyroid gland.

Conclusions: Clinicians should be aware of the possibility that GD can present in the bilobar thyroid gland with unilateral gland involvement at scintigraphy. Ultrasound examination is indicated to detect the presence of contralateral thyroid tissue, and to exclude the possibility of a hyperfunctioning nodule or hemiagenesis. When choosing surgery, total thyroidectomy seems to be the appropriate treatment. Further investigation is needed to determine the natural course of UGD and its best management. Future guidelines should consider this form of GD.

Background: Centellicum^®, a standardized Centella Asiatica extract, has been used orally for fibrosis and scar prevention. The main aim of this 2-month registry pilot study was the reduction of visible, significant scars and keloids after suturing traumatic wounds with irregular edges (lacerations), using Centellicum^®.

Methods: The effects of oral Centellicum^® (450 mg/day; 2 capsules) and a standard management (SM) on wound healing were compared with the effects of a control group that used only the standard management.

Results: Forty-eight otherwise healthy male subjects with lacerations requiring suturing were included in the study. 25 took Centellicum^® in addition to the standard management and 24 followed the standard management only. No side effects were observed with the supplement. Centellicum^® supplementation showed very good tolerability and compliance with 98% of the capsules correctly used. The two groups of otherwise healthy male subjects with lacerations were considered comparable at inclusion and there were no dropouts. No infections were observed. At 60 days, the scar dimensions were significantly smaller in the supplemented group (P<0.05). The elevation of the scar above the surrounding, non-affected skin, was also significantly reduced in the Centellicum^® group compared to controls (P<0.05). Local pain levels were significantly lower (P<0.05) in the supplement group at 60 days. Additionally, the scar redness score was significantly lower in the supplement group compared to controls (P<0.05) by the end of the study. The incidence of initial keloid formation was significantly lower in the supplemented subjects at 60 days, as determined by finger-point pressure palpation and high-resolution ultrasound (P<0.05). Skin flux, as measured by laser Doppler flowmetry (indicating hypervascularization due to local inflammation) was lower (P<0.05) with Centellicum^® at the end of the study. Inflammation, assessed via thermography (hot spots on the healing skin) was less visible and reduced in most areas in the supplement group (P<0.05) in comparison with the control group. Plasma oxidative stress was significantly lower in the Centellicum^® group at the end of the study (P<0.05).

Conclusions: Oral Centellicum^® intake over 2 months improved healing of lacerations and reduced scarring, fibrosis and keloids at the level of the lesions. A larger study setup with more patients and with a prolonged study duration is needed to confirm these initial results.

Introduction: Breast-conserving surgery (BCS) is often the first-line treatment for early-stage invasive breast cancer. Many studies claim that survival is non-inferior to radical treatments in selected cases. Although BCS preserves some breast tissue and often the nipple-areola complex, asymmetry and distortion of the breast contour may occur and reconstruction is sometimes required. The authors' aim is to conduct a review of main breast reconstruction options with local flaps after partial mastectomy.

Evidence acquisition: A literature review was conducted on PubMed using the keywords: "partial breast reconstruction," "local flaps," "LICAP," "ICAP," "AICAP," "TDAP," "MS-LD" and "SAAP." Reviews, meta-analyses, clinical trials, experimental studies and case reports focused on breast reconstruction with local flaps after partial mastectomy (quadrantectomy or lumpectomy) were included in the study. Only English-written studies published in the past 20 years were considered eligible. Older articles, non-English written articles or papers regarding random flaps/video assisted harvested flaps/combined flaps were excluded.

Evidence synthesis: A cumulative number of 292 scientific articles was produced by the research. After screening by the two principal investigators, 73 articles were deemed eligible for full-text examination. In total, twenty-seven articles met the inclusions criteria.

Conclusions: Local flaps are a safe and reliable option in breast reconstruction after partial mastectomy. They are associated with a low complication rate reported in the literature, with satisfactory aesthetic outcomes. Prospective multicenter clinical studies are desirable to confirm the results of this study.

Background: The aim of the article is to explore the relationship between serum albumin, exercise endurance, and pulmonary complications after lobectomy.

Methods: Overall, 166 lung cancer patients who were treated in our hospital from January 2020 to June 2023 were selected to analyze the incidence of postoperative pulmonary complications and the differences in clinical data between patients with and without pulmonary complications. Logistic regression equations were used to analyze the influencing factors of postoperative pulmonary complications.

Results: There were 46 patients with postoperative pulmonary complications, incidence rate was 27.71%; Among the 46 patients, eight had two or more complications. The age of patients with pulmonary complications was 69.29±6.65 years old, which was higher than that of patients without pulmonary complications (P<0.05). The proportions of surgical time ≥4 hours, intraoperative blood loss ≥50 mL, and preoperative albumin <35 g/L in patients with pulmonary complications were 58.70%, 65.22% and 76.09%, respectively, which were significantly higher than those in patients without pulmonary complications (P<0.05). Patients with pulmonary complications had peak expiratory flow rate (PEF), peak oxygen uptake as a percentage of expected value (VO2%P), kilogram oxygen uptake (VO2/kg), anaerobic threshold (AT), oxygen pulse as percentage of expected value (O2pulse%P), respiratory rate (BF), and 6-Minute Walking Test (6-MWT), which were 291.10±43.34 L/min, 55.54±12.21%, 16.21±4.32 mL, 44.45±10.02%, 71.18±15.56 L, 26.68±6.67 times and 410.04±45.54 m, which were significantly lower than patients without pulmonary complications (P>0.05). Logistic regression analysis showed that age, surgical time, preoperative albumin, VO2% P, and 6-MWT were the influencing factors for postoperative pulmonary complications (P<0.05).

Conclusions: Serum albumin, cardiopulmonary motility indicators, and 6MWT are associated with the occurrence of pulmonary complications after lobectomy, and the occurrence of pulmonary complications is influenced by patient age and surgical time.

Background: To assess the efficacy of the stapled transanal rectal resection (STARR) procedure in treating obstructed defecation syndrome (ODS) in patients with rectocele and rectoanal intussusception grade II-III, focusing on symptom resolution, functional improvement, and pain reduction.

Methods: This prospective study included patients undergoing STARR for ODS. Preoperative parameters such as anal pain, smearing, itching, bleeding, and obstructed defecation symptoms were assessed using standardized questionnaires (Wexner and Altomare). Functional outcomes, including constipation, incontinence, and obstruction, were evaluated at baseline and at 1, 3, and 6 months postoperatively. Pain levels were categorized into mild (0-3), moderate (4-7), and severe (8-10). Primary endpoints included functional improvement, pain reduction, and resolution of anal symptoms. Secondary endpoints included complication rates, hospital stay duration, and patient satisfaction. Statistical analysis included paired t-tests and one-way repeated measures ANOVA.

Results: Significant improvements were observed postoperatively. Anal smearing (35%) resolved by 3 months, while anal itching (42.5%) and bleeding (75%) significantly declined, stabilizing by 6 months. Severe pain (17.5%) was noted during hospitalization but fully resolved within 1 month, with 97.5% reporting only mild pain at 6 months. Patient satisfaction was 85%. Complication rates were low (7.5% Clavien-Dindo grade I/IIIa), and no reoperations were required.

Conclusions: STARR effectively improves functional outcomes and alleviates ODS symptoms, including pain, smearing, itching, and bleeding. Low complication rates and high patient satisfaction support its use as a viable surgical option, though long-term follow-up is warranted.

Acute pancreatitis (AP) is a potentially life-threatening inflammatory condition characterized by localized pancreatic damage and the activation of the inflammatory cascade, leading to systemic inflammatory response syndrome (SIRS). This complex disease often presents with a variable and unpredictable course. The primary causes of AP include the migration of gallstones and alcohol consumption. The Revised Atlanta Classification 2012 (RAC) is the most widely utilized classification system for AP, distinguishing between interstitial edematous pancreatitis and necrotizing pancreatitis, three severity levels and an early and a late phase. Severe AP carries a high risk of mortality. Currently, there is no definitive prognostic score for accurately predicting severe cases of AP. Initial management focuses on supportive care, applicable to both mild and severe forms of the disease, while later management addresses complications associated with severe AP. Although there is no consensus on the optimal type or regimen of fluids for resuscitation, goal-directed fluid therapy, particularly with Ringer's lactate, has been linked to improved outcomes. Prophylactic antibiotics have not proven effective in preventing infectious complications associated with AP. Patients experiencing mild acute gallstone pancreatitis should be advised to undergo laparoscopic cholecystectomy during their initial admission, whereas those with severe gallstone pancreatitis and signs of cholangitis or choledocholithiasis may benefit from early endoscopic retrograde cholangiopancreatography (ERCP). The management of severe AP complications has evolved from an early surgical approach to a minimally invasive step-up strategy, which is now considered the standard intervention.