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Exocrine pancreatic insufficiency (EPI) arises from a deficiency in pancreatic enzymes, leading to malabsorption and varied symptoms such as gastrointestinal discomfort, weight loss and steatorrhea. Though EPI commonly follows chronic pancreatitis or pancreatic surgery, its delayed onset is rarely discussed. We report a unique case of EPI manifesting 29 years after pancreaticoduodenectomy. A 71-year-old female, who underwent pancreaticoduodenectomy for carcinoma in 1992, presented with fatigue, weight loss, edema, diarrhea and paresthesias. Physical examination revealed mucocutaneous pallor, ascites, lower limb edema and brittle hair. Laboratory results indicated anemia, hypoproteinemia, vitamin deficiencies and severe fecal elastase reduction. After excluding other possible etiologies such as malignancy, autoimmune and infectious, the diagnosis of EPI was established. Treatment included enzyme replacement, vitamin supplementation and diuretics, leading to symptom resolution and normalization of laboratory parameters over a 12-month period. This case underscores the prolonged latency of post-surgical EPI, presenting diagnostic challenges. Exocrine pancreatic insufficiency can severely impair nutrient absorption, causing significant morbidity. In our patient, timely enzyme supplementation and nutritional management reversed the symptoms and deficiencies. The 29-year delay in symptom onset is among the longest documented, emphasizing the need for long-term vigilance in post-pancreatic surgery patients.

Objectives: The present study aims to assess correlations and agreements between parameters and classification of the right ventricular (RV) function obtained by 2D echocardiography (2DE) - tricuspid annular plane systolic excursion (TAPSE), RV systolic wave velocity (S'T), fractional area change (FAC) and RV ejection fraction (3D RVEF) obtained by advanced 3D echocardiography (3DE).

Materials and methods: Patients admitted with acute myocardial infarction (AMI) were enrolled in the study after emergency coronary angiography. Standard 2DE and 3DE acquisitions were carried out in the first 48 hours since admission and later analysed offline by an advanced echocardiographer with five years of training in 2DE and three years of training in 3DE. Correlations between continuous echocardiographic variables were assessed using the Pearson correlation test. Patients were classified as having normal RV function or dysfunction based on current practice guidelines cut-off values and association between 2DE and 3DE parameters was assessed using the Pearson Chi-square test. Further, agreement between these categories was analysed using Cohen's k test.

Results: Sixty-three patients (52 males, mean age 56.8 ± 10.3 years) enrolled between December 2019 and June 2022 were analysed. The correlation between 3D RVEF and TAPSE, S'T and FAC was no statistically significant (r = 0.217, p = 0.088), weak (r = 0.385, p 0.001) and modest (r = 0.482, p = 0.002), respectively. Classification of RV function by FAC was the only 2DE parameter that exhibited statistically significant agreement [(χ2 (1, n=63) = 7.725, p=0.005)] and association (k = 0.3345, CI [-0.0747,0.5943]) when compared with 3D RVEF based classification.

Conclusions: Our study shows that, in a population of patients with acute myocardial infarction, measurements of RV function obtained by standard 2DE have varying degrees of correlation with 3D RVEF, and the subsequent classification of RV function using current cut-off values for these parameters leads to the misclassification of a significant number of patients.

Background: Neurovascular structures beneath the deltoid, particularly the axillary nerve and posterior circumflex humeral artery, are vulnerable to injury from intramuscular injections or compression in the quadrangular space, especially in overhead athletes. Studies by Kakati et al (2013) and Desai et al (2019) report intramuscular injection-related nerve injury rates of 1.5% to 15% and 82.5%, respectively. However, there is a lack of cadaveric studies in the Indian population, prompting this anthropometric study.

Aim: Aims and objectives: This study aims to assess the dimensions of the quadrangular space and examine the branching pattern of the axillary nerve and its relationship with the posterior circumflex humeral artery.

Methods: This two-year cross-sectional study, approved by the Institutional Ethical Committee (Protocol ID: F-IM/15/2023), was conducted at AIIMS Rajkot in collaboration with Orthopaedics. Anthropometric measurements of the quadrangular space (height, width, and depth), deltoid muscle, distances of the axillary nerve and posterior circumflex humeral artery from the origin point and AXN-PCHA relationship patterns were obtained from 12 (seven male and five female) cadavers using vernier callipers.

Results: Among the 24 specimens, type 1 branching pattern was the most common, observed in 12 specim ens (50 %), followed by type 2 in six specimens (25%), type type-3 in five specimens (21%), and type 4 in one specimen (0.041%). The dimensions of quadrangular space varied, with height ranging from 4.28 mm to 5.57mm, width from 10.57 mm to 13.75 mm, and depth from 9.97 mm to 12.84 mm.

Conclusion: The mean dimensions (in mm) of the quadrangular space in males and females were 4.77 for height, 11.79 for width, and 11.01 for depth. The type-1 branching pattern was the most frequently observed.

Turicella otitidis is a Gram-positive bacillus, commensal inhabitant of the external auditory canal. It is the causative agent of external otitis and otitis media. Extra-otic infections are rarely been identified especially in patients with comorbidities. A narrative review was performed based on a search of PubMed/Medline and Scopus databases to collect information on the epidemiologic, clinical and microbiologic data of extra-otic infections by T. otitidis . Studies published until December 2024 were screened and analyzed to extract data on pathogen characteristics, antibiotic resistance profiles, treatment and outcomes. A total of 13 studies reporting infections by T. otitidis other than otitis including an equal number of patients were eligible. The mean age of patients was 34.08 years (range, 3-75 years). A male predominance was observed (1.6:1). Four patients were immunocompromised and four underwent recent surgical procedures. The most common infection type was bacteremia (38.4%), followed by abscesses, mastoiditis, ocular infections and skin and soft tissues infections. In the majority of cases (63.6%) a single method of identification was applied, such as matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS), polymerase chain reaction (PCR), Vitek 2 automated system and analytical profile index (API) Coryne. Antimicrobial resistance to erythromycin was 80%, while all isolates were susceptible to vancomycin. Vancomycin (45.5%) and cephalosporins (45.5%) were the most commonly used antimicrobials. In all cases with available data, the outcome was favorable. T. otitidis is an emerging pathogen causing extra-otic infections in humans, especially in the presence of predisposing conditions. Future studies are warranted to elucidate the microorganism's pathogenicity and the factors and mechanisms underlying its virulence.

Background: Dieulafoy's lesion is a rare but potentially life-threatening gastrointestinal condition that often requires endoscopic management. However, there is a lack of consensus on the optimal endoscopic intervention for this condition. This meta-analysis aimed to compare the efficacy and safety of endoscopic mechanical interventions versus endoscopic injection interventions in the treatment of Dieulafoy's lesion.

Methods: A systematic literature search was conducted using PubMed, Google Scholar pages 0-20 and Cochrane Library databases to identify relevant studies published up to March 2023. Studies comparing the outcomes of endoscopic mechanical and injection interventions for Dieulafoy's lesion were included. The pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random or fixed effects model depending on the heterogeneity I 2 value. A total of seven comparative studies were included in the meta-analysis consisting of three clinical trials and four retrospective studies. The clinical outcomes consisted of the initial hemostasis, as well as adverse events: recurrent bleeding, death and the need for an operation.

Results: It was shown that endoscopic injection therapy was associated with a lower risk of recurrent bleeding in the treatment of Dieulafoy's lesion compared to mechanical therapy (95% CI, OR=0.33 [0.16, 0.69] , p-value=0.003). However, there were no significant differences between mechanical and injection techniques in terms of initial hemostasis, death, or need for an operation.

Conclusion: Our findings suggest that injection methods may be preferred over mechanical techniques in the management of Dieulafoy's lesion due to its potential to reduce recurrent bleeding. Although it is a simple and a non-expensive technique, further studies are needed to confirm these findings and evaluate the long-term outcomes of both interventions.

Introduction: Metabolic surgery (MS) has been demonstrated to achieve sustained weight loss with significant improvement of metabolic parameters, including reduced cardiovascular diseases and diabetes. This study aimed to evaluate the effect of MS on obesity outcomes and cardiovascular risk factors in Iranian non-diabetic obese patients.

Methods: This retrospective follow-up study included non-diabetic obese patients with a body mass index (BMI) of 30 kg/m 2 or higher who underwent MS (LSG or GB) in a single institution in Ahvaz, Iran, from April 2019 to March 2023. Of the 162 reviewed patients, 139 subjects (85.80%) who completed one-year follow-up visits were included in this study. Medical history, anthropometric, biochemical parameters, comorbidities and Framingham risk score (FRS) were evaluated at baseline and annual visits after MS.

Results: The mean weight and BMI, systolic blood pressure (SBP), diastolic blood pressure (DBP), FRS, lipid profile, liver enzymes and fasting blood glucose (FBS) were significantly improved 12 months postoperatively. The percentage of total weight loss (%TWL) and BMI loss (%BMI) was 30.32±8.14 and 30.32±8.14, respectively, at the one-year follow-up after surgery. At one-year follow-up, a significant resolution of hypertension and dyslipidemia was observed in 44.4% and 73.9% of patients, respectively, and this improvement was stable throughout the follow-up period, with no significant difference between procedures. The type of MS had no effect on changes in weight and BMI at one-year and long-term follow-up after surgery (P>0.05), except the mean weight loss was greater with RYGB than LSG at one-year follow-up.

Background: Cardiovascular complications after non-cardiac surgery have a major impact on perioperative morbidity and mortality. Despite several scales and scores for assessing the preoperative cardiovascular status, an individualized assessment focused on each patient is mandatory.

Aim: To identify the new cardiac events that occur after non-cardiac surgery.

Methods: In 100 patients hospitalized in the general surgery department with acute and chronic surgical pathologies, the perioperative cardiac events were assessed using Holter monitoring along with clinical and biochemical markers, including C reactive protein (CRP) and high-sensitive troponin (hscTnI).

Results: Out of the 100 participants with a mean age of 54.5 (43-77.9) years, 54% were men. Ten patients developed paroxysmal postoperative atrial fibrillation (AF), which was related with longer surgery time 165 (150-180) vs 120 (90-150) minutes (p=0.002) and postoperative anaemia [haemoglobin (Hg) 10.4 (9.37-12.6) vs 12.1 (11-13.2) g/dL, (p=0.041)]. Higher CRP levels were also correlated with paroxysmal AF. The AF group correlated with higher values of presurgical CRP: 81 (46.5-186.75) vs 27 (6-102.5) mg/dL, (p=0.041). Higher postsurgical CRP values were also found in the AF group: 76 (47.75-110.75) vs 40.5 (12-82.5) mg/dL (p=0.045). Sinus pauses were present in nine patients and there was a strong association between sinus pauses and age (p = 0.011), history of high blood pressure (HBP) (p = 0.031), intraoperative HBP (p = 0.026) and the preexisting AF (p = 0.028). Postsurgical ST changes were present in 30 patients and ST depression was correlated with age (p < 0.001), prolonged surgery time [150 (120-180) vs 120 (90-150) minutes (p < 0.001)], history of HBP [(33.3% vs 12.2%) (p=0.017)] and intraoperative maximum values of BP (p = 0.007).

Conclusions: There is an increased risk of cardiovascular events during the postoperative period of non-cardiac surgery in patients with advanced age, pre-existing diseases (hypertension, preexisting atrial fibrillation, diabetes mellitus), the level of inflammation and longer intraoperative stress. Holter monitoring revealed rhythm and conduction disorders as well as ST segment changes that were associated with the inflammatory status and slightly elevated cardiac enzyme levels. Future studies are needed to see the impact of cardiac complications in the long term.

Introduction: The increase in the proportion of obese patients in both paediatric and elderly populations worldwide made obstructive sleep apnea syndrome (OSAS) an important contributor to the range of comorbidities encountered in the current population. Continuous positive airway pressure (CPAP) therapy is the main treatment for OSAS and it has an effect in decreasing the severity of OSAS, with decreasing the apnea hypopnea index (AHI) and improving hypoxemia.

Results: and discussion: We present the case of a 48-year-old woman with newly diagnosed severe OSAS for which she was on CPAP therapy. After the patient followed a diet and had a significant weight loss, her symptomatology improved and overnight cardiorespiratory polygraphy showed a decrease in nocturnal respiratory events. This demonstrates the important role that weight loss plays in certain diseases - in this case, in a patient with OSAS.

Conclusions: Losing weight can have important benefits in many diseases. In OSAS, weight reduction is associated with significant improvement in symptoms and nocturnal respiratory events, including apnea and hypopnea.

Background/aim: Urinary tract injuries (UTIs) are a significant complication in abdominal, laparoscopic and robotic surgeries. Due to the proximity of the urinary tract to critical structures, procedures like colorectal surgery, hysterectomy and prostatectomy pose risks. Minimally invasive techniques like laparoscopy and robotic surgery offer benefits but introduce unique challenges. This review explores the incidence, risk factors and management strategies for UTIs across surgical approaches.

Materials and methods: A systematic review of PubMed, Embase and Web of Science was conducted. Studies on abdominal, gynecological, and urological surgeries reporting UTIs were included. After screening, 17 studies published between 1990 and 2024 were analyzed. The PRISMA method was used for selection and data extraction.

Results: The incidence of UTI varies by surgery type: for open surgery, higher rates (0.5%-3.0%) were recorded due to invasive techniques and longer operative times, particularly in colorectal surgeries and hysterectomies. In laparoscopic surgery, a lower incidence (0.1%-1.0%) was noted, though thermal injury and visualization challenges remain. Finally, in robotic surgery, incidence ranges from 0.2% to 1.5%, with enhanced precision reducing the risk of UTIs in complex surgeries like prostatectomy and hysterectomy.

Conclusion: The primary causes of UTIs include direct trauma, thermal injury and postoperative ischemia. Advanced technologies like robotic systems and intraoperative imaging reduce risks but require surgeon expertise. Preventing UTIs in surgery involves meticulous planning, advanced intraoperative technologies and comprehensive postoperative care. Continued research into minimally invasive techniques will further reduce complication rates and improve patient outcomes.

Background: The purpose of this manuscript is to highlight the endeavors of the Greek surgeons during the 19 th century to perform various types of operation on esophagus.

Methods: Research has been conducted in the archives of National Greek Library and the medical archives of the major Greek hospitals during the 19 th century.

Results: The research found that the surgery of esophagus during the 19 th century in Greece was limited to esophagostomy, removal of foreign objects, dilation and suturing.

Conclusion: Greek surgeons of the 19 th century faced similar problems as their colleagues in Europe in the surgical approach of the esophagus.