BMC Surgery最新文献

Glomus tumors commonly manifest as solitary, painful digital nodules. The synchronous occurrence in both a hallux and a thumb is exceedingly rare. We report a 35-year-old woman with subungual glomus tumors in her left hallux and right thumb, diagnosed through clinical evaluation and high-resolution ultrasonography. A novel nail-preserving technique, "tripartite zonal localization and excision," was employed. This involved transverse reflection of the nail plate for complete tumor excision under microscopic guidance. The procedure achieved complete pain resolution and satisfactory nail regrowth without recurrence. This case highlights the potential for multifocal glomus tumors and introduces a surgical technique that optimally balances complete excision with excellent functional and cosmetic results.

Introduction: Firearm injuries continue to be a major cause of trauma-related morbidity and mortality worldwide. Abdominal firearm injuries are particularly critical due to the high risk of organ damage, hemorrhage, and sepsis. In trauma management, time to surgical intervention is considered one of the most decisive factors affecting survival. However, the evidence regarding the relationship between operating room (OR) access time and mortality remains inconsistent in the current literature.

Aim: This study aimed to evaluate the effect of the time to emergency surgery on mortality in patients presenting with isolated intra-abdominal firearm injuries. Additionally, it sought to identify clinical, hemodynamic, and organ-specific factors associated with early mortality.

Methods: This retrospective study included 121 adult patients who presented to the Emergency Department of Adana City Training and Research Hospital between January 1, 2018, and July 31, 2024, with isolated intra-abdominal gunshot injuries and underwent emergency surgery. Demographics, comorbidities, vital signs, laboratory parameters, imaging findings, organ injuries, OR access times, and clinical outcomes were analyzed. Statistical comparisons were performed using appropriate parametric and non-parametric tests, with a significance threshold of p < 0.05.

Results: Of the patients, 93.4% were male, and the median age was 34 years. The overall mortality rate was 6.6%. Mortality was significantly associated with chronic ischemic heart disease, colonic injury, and intra-abdominal vascular injury (p < 0.05). Non-survivors exhibited significantly lower blood pressure, hemoglobin, hematocrit, oxygen saturation, and pH levels and significantly higher heart rate, lactate, shock index, modified shock index, CK-MB, and hs-Troponin-I values (p < 0.05). Interestingly, time to the operating room was shorter in non-survivors (p = 0.002), reflecting more severe initial clinical presentation rather than improved outcomes.

Conclusion: In intra-abdominal firearm injuries, mortality is influenced more by the severity of organ damage and the patient's hemodynamic condition at presentation than by OR access time alone. Early recognition of critical injuries, rapid resuscitation, and timely surgical intervention remain essential for improving survival outcomes. Clinical indicators such as lactate level, shock index, and hemodynamic parameters may serve as valuable predictors of early mortality.

Background: Postoperative complications (POC) following hepatic cystic echinococcosis (HCE) surgery remains a challenge. Frailty indices (FIs) as predictors of POC in this context has not been investigated. We aimed to evaluate the predictive value of three frailty assessment tools (mFI-11, FRAIL scale, and PRISMA-7 questionnaire), for POC in patients with HCE undergoing elective surgical treatment.

Methods: Nested case-control study in a concurrent cohort. Consecutive patients who underwent elective open surgery for HCE between 2012 and 2020 with a minimum follow-up of 4 years were included. Cases were frail patients with mFI-11 ≥ 0.27, PRISMA-7 ≥ 3, or FRAIL ≥ 3. Cases and controls were matched in a 1:1 based on age, sex, cyst diameter, history of HCE surgery, ultrasonographic characteristics, and cyst location. Primary outcome was overall and severe POC. Sample size was based on overall POC of 28% for cases and 11% for controls, assuming 5% type I error and 80% statistical power. Descriptive and bivariate statistics were applied. Odds ratios (OR) and 95% confidence intervals were calculated, and predictive performance evaluated using area under the receiver operating characteristics curve (AUC), and its comparison applying DeLong test.

Results: 70 cases and 70 controls were included. mFI-11 ≥ 0.27 and PRISMA-7 ≥ 3 were identified as prognostic factors for overall and severe POC (p < 0.001 and p = 0.02; and p = 0.02 and p = 0.03, respectively); and FRAIL as an independent factor for overall POC (p = 0.005). Logistic regression adjusting for potential confounding variables confirmed mFI-11 ≥ 0.27 as an independent prognostic factor for overall POC (OR 4.8; p = 0.0001; AUC: 0.762) and severe POC (OR 10.7; p = 0.022; AUC: 0.763).

Conclusion: The mFI-11 index showed the strongest predictive performance for both overall and severe POC in patients underwent HCE.

Malignant peripheral nerve sheath tumors (MPNSTs) are rare, aggressive sarcomas originating from peripheral nerves or nerve sheath cells. They are often associated with neurofibromatosis type 1 (NF1) and have a poor prognosis due to high rates of recurrence and metastasis. We report a case of a 30-year-old female presenting with a retroperitoneal MPNST accompanied by metastases to the right pelvic wall and left rectus femoris muscle. The patient exhibited numerous café au lait spots densely distributed across the head, neck, trunk, and extremities, consistent with clinical features of NF1. Due to the limitations of gynecological ultrasonography, the mass was initially considered to originate from the adnexal region. Surgical interventions included exploratory laparotomy, partial colectomy, partial rectal resection, retroperitoneal neoplasms resection, and colostomy; however, only palliative resection was possible due to the tumor's extensive invasion and inability to achieve clear margins. Histopathological examination, supported by immunohistochemical findings, confirmed the diagnosis of MPNST. Given the palliative nature of surgery and the short postoperative follow-up, the clinical outcome remains uncertain. This case highlights the diagnostic challenges of retroperitoneal MPNST, particularly in patients with NF1, and underscores the importance of early recognition and multidisciplinary management when curative resection is not achievable.