Annali italiani di chirurgia最新文献

Spontaneous regression (SR) is a tumor's partial or complete disappearance without any treatment. In the literature, it has been documented that SR is uncommon in breast cancer (BC) and other types of cancer. Multiple mechanisms are believed to contribute to the development of SR. However, its mechanism still needs to be clearly demonstrated. Although two SR patients were presented in our study, the evidence needed to be more sufficient to determine the mechanism. However, due to Programmed Death-Ligand 1 (PD-L1) negativity in both patients, the hypothesis in the literature that PD-L1 has strong antitumoral activity was not supported. In addition, it was determined that the patient in case 2 was the first Cerb B2 positive case reported in the literature and had the earliest SR period. Due to this, it has been disclosed that the SR mechanism of BC will be concluded within 21 days at the earliest. This situation suggests that breast surgeons, in particular, should conduct a thorough physical examination and, if necessary, re-radiological examination before surgery on patients for whom surgery is decided after diagnosis. Being careful in this regard may increase the number of SR in BC cases and allow molecular investigations on living tissue samples to reveal the underlying mechanism.

Aim: The administration of anticoagulation therapy during major orthopedic surgeries is a clinical challenge due to the risk of thrombotic events and bleeding complications. This review aims to evaluate the current strategies and emerging developments in perioperative anticoagulation reversal.

Methods: We conducted a literature review on the management of perioperative anticoagulant therapy, which included the current status of anticoagulant reversal agents, as well as personalized medicine, pharmacogenomics, artificial intelligence (AI), and novel drug delivery systems.

Results: The review indicates that reversal agents such as idarucizumab and andexanet alfa are crucial in managing bleeding associated with direct oral anticoagulants (DOACs). Personalized medicine, guided by pharmacogenomics, allows for tailored anticoagulation regimens. AI and machine learning (ML) algorithms can enhance the predictive capabilities for bleeding and thrombotic risks. Additionally, nanotechnology and biomarkers offer innovative approaches to drug delivery and personalized treatment.

Conclusions: Integrating evidence-based guidelines with innovative reversal agents, personalized medicine, AI and nanotechnology opens a new era in perioperative anticoagulation management. These advancements can ensure patient safety, minimize bleeding risks, and improve surgical outcomes. Future research should focus on the clinical validation of these strategies to ensure their effectiveness across diverse patient populations.

Aim: Chronic periodontitis leads to gingival swelling, hyperplasia, and tooth mobility, which affects orthodontic treatment. The aim of this study was to investigate the application of cefaclor in orthodontics through micro-implant anchorage in patients with periodontitis.

Methods: A retrospective study was conducted on patients with periodontitis who received micro-implant anchorage treatment in the department of orthodontics at the First People's Hospital of Yongkang City from July 2019 to January 2022. According to different treatment regimens, these patients were divided into the test group (patients receiving cefaclor and micro-implant anchorage treatment) and the control group (patients receiving micro-implant anchorage treatment only). The plaque index (PLI), gingival index (GI), sulcus bleeding index (SBI), and serum inflammatory factor levels were compared between the two groups after treatment.

Results: One hundred and five patients were included in the study, (44 males and 61 females, median age 21 [15-25] years), 51 in the cefaclor group and 54 in the no cefaclor group. After treatment, the PLI, GI, and SBI scores in the two groups were higher than those before treatment, and the levels of serum inflammatory markers significantly increased (p < 0.05). After treatment, the PLI, GI, and SBI scores in the test group were significantly lower than those in the control group (p < 0.001). The levels of serum interleukin-1β, interleukin-6, interleukin-8, and tumor necrosis factor-α were significantly lower in the test group, and the interleukin-2 level was higher in the test group (p < 0.001). There was no significant difference in the incidence of complications between the two groups (p > 0.05).

Conclusions: Cefaclor and micro-implant anchorage have a good clinical effect on orthodontics in patients with periodontitis, improving periodontal health and reducing inflammatory response.

Aim: The aim of our study was to investigate the clinical results of omental flap application during pancreaticojejunostomy (PJ) anastomosis in pancreatoduodenectomy (PD) surgeries.

Methods: The data of patients who underwent pancreaticoduodenectomy in our hospital were evaluated retrospectively. The patients were divided into two groups; patients with an omental flap (Group 1) and those without an omental flap (Group 2). The demographic and other characteristics of the groups and the incidence of postoperative pancreatic fistula (POPF) development were compared.

Results: One hundred patients were included (39 females, 61 males) Group 1 consisted of 20 patients with omental flaps and Group 2 consisted of 80 patients without omental flaps. While no clinically significant (Grade B and C) leaks were observed in Group 1, both biochemical and clinically significant leak rates were lower in Group 1 compared to 4 patients (5%) in Group 2. There was no statistically significant difference compared with Group 2 (p > 0.05).

Conclusions: Although not statistically significant in this study, postoperative complication rates and the incidence of POPF tended to decrease in patients who underwent omental flaps.

Oncocytic lesions represent a group of benign and potentially precancerous tumors characterized by the accumulation of oncocytes, which are large, granular, and eosinophilic cells. Diagnosing oncocytic lesions in the parotid gland typically involves a combination of imaging techniques, such as ultrasound, Computed Tomography (CT) scans, and Magnetic Resonance Imaging (MRI). Fine-needle aspiration (FNA) biopsy with histopathological examination remains the primary diagnostic tool for these lesions. Accurate diagnosis is crucial for appropriate management decisions. Treatment options for oncocytic lesions in the parotid gland include surgery, conservative management, and radiation therapy (RT). However, in the head and neck region, radiation doses can be a double-edged sword. While RT is a treatment modality, low radiation doses can promote the development of oncocytic lesions in the parotid gland. The prognosis for patients with oncocytic lesions is generally favorable, especially when the lesions are benign and appropriately managed. Current research focuses on the molecular mechanisms underlying oncocytic lesions in response to low-dose radiation exposure. The development of these lesions following low radiation doses represents a significant clinical concern. This manuscript provides a comprehensive overview of the current knowledge regarding oncocytic lesions in the parotid gland, including risk factors, diagnosis, treatment options, and ongoing research, offering valuable insights for clinicians and researchers.

Dumping syndrome (DS) is a collection of gastrointestinal (GI) and vasomotor symptoms arising postprandially because of prompt gastric emptying. This can develop due to any changes in gastric anatomy or innervation during esophageal, gastric, or bariatric surgery. Due to the increase in the number of bariatric operations and innovative surgeries performed internationally, bariatric surgery has emerged as the most common cause of this disease entity. 25-50% of all gastric surgery patients experience dumping symptoms after their procedures. Patients who have had Roux-en-Y gastric bypass (RYGB) are at an extremely high risk (up to 40%) of developing dumping syndrome postoperatively. The goal of this review is to provide an insightful evaluation of the most recent literature on the overlooked scientific and clinical elements of dumping syndrome, such as diagnostic aspects, pathogenesis, terminology, and management. More research is needed to establish guidelines and terms used to properly document and manage dumping syndrome.

Objective: The etiology, clinical presentation, diagnosis, and treatment strategies of chronic pancreatitis (CP) vary significantly between countries. Specifically, the etiology and surgical approaches to treating CP differ between China and Western countries. Therefore, this study aims to compare the disparities in CP profiles and management based on our single-center experience and recent data from the West.

Methods: From January 2007 to December 2017, a total of 130 consecutive patients with histologically confirmed chronic pancreatitis (CP) underwent surgical treatment at the First Affiliated Hospital of Nanjing Medical University. The clinical features, etiology, risk factors, and operative procedures of these CP patients were analyzed and compared with recent data from Western countries.

Results: Our patient cohort was predominantly male (3.19:1), with a median age of 50.2 ± 9.8 years. Upper abdominal pain was the most common symptom, present in 102 patients (78.5%). The most common etiology was obstructive factors (47.7%), followed by alcohol (34.6%). The incidence of genic mutation was 2%, significantly lower than rates reported in Western research. Steatorrhea, weight loss, and jaundice were present in 6.9%, 18.5%, and 17.7% of patients, respectively. Pancreatic cysts or pseudocysts were diagnosed in 7 patients (5.4%). The following procedures were performed: Partington procedure in 33 patients (25.4%), Frey procedure in 17 patients (13.2%), Berne procedure in 5 patients (3.9%), Beger procedure in 1 patient (0.8%), pancreaticoduodenectomy in 17 patients (13.1%), pylorus-preserving pancreaticoduodenectomy in 18 patients (13.9%), middle pancreatectomy in 1 patient (0.8%), and distal pancreatectomy in 9 patients (6.9%). Choledochojejunostomy was performed in 14 patients (10.8%), gastroenterostomy in 2 (1.5%), and 15 patients (11.5%) underwent aspiration biopsy.

Conclusion: Our study confirms that, etiologically, obstructive chronic pancreatitis (CP) is more frequent in the Chinese population than in Western populations. Although diagnostic instruments and operative procedures in China and Western countries are roughly comparable, slight differences exist in relation to diagnostic flowcharts/criteria and the indications and optimal timing of surgery.

Ureteropelvic junction (UPJ) obstruction, in addition to causing progressive renal function loss, can lead to the formation of retained stones. Management planning for concomitant stones and UPJ obstruction is a topic of debate in the literature. We performed laparoscopic pyeloplasty and extracted all 144 stones from the renal pelvis and calyces of a 37-year-old male with UPJ stricture, using wireless flexible cystoscopic guidance. No complications occurred during the perioperative and postoperative periods. In challenging cases of UPJ obstruction with stones in multiple calyceal locations, simultaneous flexible cystoscopy offers clinicians a significant advantage.

Aim: Endoscopic submucosal dissection (ESD) for colonic neoplasms is a technically intricate procedure. Internal traction using a single clip has emerged as a promising supportive technique for colonic ESD. Therefore, this study aimed to comprehensively evaluate and compare the efficacy and safety of ESD with and without the aid of single-clip traction.

Methods: This retrospective study encompassed 36 patients who underwent single clip traction-assisted colonic ESD and 66 who underwent the traditional method of colonic ESD at Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University. We employed the propensity score-matching method to mitigate disparities in resected specimen size and tumor location. Post-matching, we comprehensively assessed treatment outcomes and incidence of adverse events between the two treatment groups (single clip traction-assisted ESD (scESD) and conventional ESD (cESD)).

Results: After propensity score matching, we observed 34 matched pairs. There were no significant differences between the two treatment groups regarding the en bloc resection rate, complete resection rate, and curative rate. However, the procedure duration was significantly shorter in the single clip traction-assisted ESD group compared to the conventional ESD group (20.00 [Interquatile Range (IQR)] (16.00-32.50) minutes vs 31.50 [IQR] (17.00-54.00) minutes, p = 0.0474). Furthermore, there was a significant increase in dissection speed in the single clip traction-assisted ESD group compared to the conventional ESD group (0.29 [IQR] (0.20-0.45) mm2/min vs 0.19 [IQR] (0.11-0.35) mm2/min, p = 0.0015). All lesions were resected in a single piece. Among the propensity-score-matched patients, only those treated with single clip traction-assisted ESD exhibited faster dissection speeds (p = 0.015). Furthermore, there were no substantial differences in adverse events such as intraoperative perforation, delayed perforation, or delayed bleeding.

Conclusions: Our findings suggest that single clip traction-assisted colonic ESD is preferable to traditional colonic ESD, owing to its shorter procedure duration and faster dissection speed.

Aim: Myopericytoma (MPC) is a rare tumour characterized by a perivascular proliferation of pericytic cells with myoid differentiation and a typical spindle shape. Except for the rare malignant cases, MPC mostly shows a benign course. Symptoms are often non-specific, and the diagnosis could be accidental. Simple biopsies are often non-diagnostic and do not provide any information about the benign or malignant course of the disease. General agreement for its management is lacking.

Case presentation: An old patient was referred to our tertiary cancer centre for left nasal obstruction for the previous three months. No worker risk factors were reported. The nasal endoscopy with enhanced endoscopic systems equipped with digital post-processing image enhancement technology (I-SCAN) and Narrow Band Imaging (NBI) revealed a non-bleeding reddish mass located at the anterior third of the left nasal fossa floor, about 1 cm in size and posteriorly a second more minor similar lesion at the level of the nasal septum. The patient underwent a radical endoscopic excision with diagnostic and curative intent.

Results: No significant intra-peri- and postoperative complications were recorded. The final histopathological exam revealed a double synchronous sinonasal myopericitoma removed with safe margins. The patient is still alive with no evidence of disease after three years from surgery.

Conclusions: MPC is a challenging disease that must be considered in the differential diagnosis of all the vascular lesions of the head and neck region. Surgery should be performed with radical margins to provide a definitive cure. The endoscopic approach may allow a radical removal with a low risk of surgical complications, allowing the possibility of removing representative material for an accurate histopathological diagnosis.