Annali italiani di chirurgia最新文献

Aim: The aim of this study is to investigate if and how decompression alters histopathologic diagnoses of cystic jaw lesions.

Methods: A retrospective study was conducted on patients with a histologic diagnosis of an odontogenic cystic lesion that was surgically treated with decompression followed by a definitive surgery. The correlation between variables including age, gender, location of the lesion, decompression time and the change in histopathologic diagnosis following decompression was analyzed.

Results: Thirty-nine patients were included in the study. The mean decompression time was 7.87 ± 3.43 months. Post-decompression histologic examination at time of definitive surgery was consistent with the initial biopsy diagnosis in 83.33% (5 of 6) of odontogenic keratocysts (OKCs), 94.11% (16 of 17) of radicular cysts, 100% of dentigerous cysts, and 100% of residual cysts. The change in histopathologic diagnosis of the cystic lesions was not found to be statistically correlated with the study variables.

Conclusions: Histopathologic diagnoses of odontogenic cystic lesions predominantly remain unchanged after decompression. A treatment protocol based on the initial diagnosis may be appropriate for odontogenic cystic lesions that are considered for decompression before definitive surgery.

Aim: Laparoscopic cholecystectomy (LC) is a common surgical procedure for the removal of the gallbladder. Effective anesthesia is crucial for ensuring patient comfort and safety during LC. Dexmedetomidine, a selective α2-adrenergic agonist, is widely used as an adjunct to anesthesia due to its sedative and analgesic properties. Nalbuphine, a synthetic opioid analgesic, is also employed for pain management during various surgical procedures. This study aimed to determine the anesthesia effects of dexmedetomidine combined with nalbuphine on patients undergoing LC and its impact on their nutritional status.

Methods: The clinical records of 100 patients who underwent LC at Wuhan No.1 Hospital between January 2021 and January 2022 were analyzed retrospectively. Forty-six patients who received intravenous dexmedetomidine (0.4 µg/kg) were assigned to the control group, while fifty-four patients who received intravenous nalbuphine (0.2 mg/kg) and dexmedetomidine (0.4 µg/kg) were assigned to the study group. The outcomes compared between the two groups included heart rate (HR), mean arterial pressure (MAP), Riker sedation-agitation scale (RSAS) scores, visual analogue scale (VAS) scores, duration of operation, awakening time from anesthesia, extubation time, adverse reactions, and nutrition-related indicators before and after surgery.

Results: There were no significant differences in MAP between the groups at the same time point (p > 0.05). However, at T1 and T3, the study group had significantly lower HR compared to the control group (p < 0.05), with no significant differences in HR at other time points (p > 0.05). The study group exhibited significantly lower RSAS scores compared to the control group (p < 0.01). No significant differences were observed between the groups in terms of duration of operation, awakening time from anesthesia, and extubation time (p > 0.05). At 6 hours post-operation, there were no significant differences in VAS scores between the groups (p > 0.05), but at 12, 24, and 48 hours post-operation, the study group had significantly lower VAS scores compared to the control group (p < 0.0001). No significant inter-group difference was observed in the total incidence of adverse reactions (p = 0.180). Additionally, one week after surgery, the study group exhibited significantly higher levels of albumin, prealbumin, transferrin, and total protein compared to the control group (p < 0.0001).

Conclusions: Dexmedetomidine combined with nalbuphine provides a superior anesthetic effect compared to dexmedetomidine alone in patients undergoing LC. This combination effectively controls hemodynamic fluctuations during the recovery period and reduces agitation without affecting the awakening time from anesthesia. These findings suggest that this combination is beneficial and worth promoting.

Aim: To investigate the incidence and high-risk factors associated with the surgical treatment of acute female pelvic inflammatory disease (PID).

Methods: A retrospective analysis was conducted on all inpatients diagnosed with acute female PID, encompassing conditions such as endometritis, salpingitis, tubo-ovarian abscess, ovarian abscess, and pelvic peritonitis, at Dongyang Hospital of Wenzhou Medical University from January 2013 to December 2021. Patients were categorized into two groups: the surgery group (n = 58) and the non-surgery group (n = 399), based on the necessity of surgical intervention (refer to Materials and Methods for surgical indications). Collected data included patient demographics (age, body mass index (BMI)), comorbidities (hypertension, diabetes mellitus), initial laboratory findings upon admission (white blood cell count, absolute neutrophil count, hemoglobin, platelet count, blood urea nitrogen/creatinine, prothrombin time (PT), international normalized ratio (INR), fibrinogen, albumin), surgical records, and postoperative pathology. Univariate and multivariate logistic regression analyses were conducted to ascertain the risk factors associated with the surgical treatment of acute female PID.

Results: Out of 457 hospitalized patients with acute female PID, 58 cases (12.7%) required surgical intervention. Univariate and multivariate logistic regression analyses indicated that advancing age correlated with an increased likelihood of surgical intervention in women with acute PID (odds ratio (OR) = 1.052, 95% Confidence Interval (CI) 1.022-1.082, p = 0.001). Additionally, lower serum albumin levels upon admission were associated with a heightened risk of surgery (OR = 0.913, 95% CI 0.859-0.970, p = 0.003), while elevated fibrinogen levels amplified the risk of surgical intervention in these patients (OR = 1.193, 95% CI 1.008-1.411, p = 0.04).

Conclusions: Elderly women diagnosed with acute PID, especially those presenting with abscess formation, should undergo prompt surgical intervention if they display high-risk factors such as low albumin levels and elevated fibrinogen levels upon admission.

Aim: The preoperative diagnostic method for superficial esophageal squamous cell carcinoma (SESCC) invasion depth based on the Japan Esophageal Society (JES) classification has been promoted. However, there have been a few investigations into its diagnostic performance in clinical settings. Therefore, we aimed to elucidate the actual diagnostic performance of the JES classification using a single-center retrospective study design.

Methods: We retrospectively analyzed the clinical data of 315 newly diagnosed SESCC patients who underwent narrow-band imaging magnifying endoscopy (NBI-ME) examination and received endoscopic submucosal dissection (ESD) or esophagectomy in our center during the past 5 years. To evaluate the diagnostic performance of JES classification in assessing the depth of invasion of SESCC, clinical data of these patients were collected, and the concordance between NBI-ME findings and postoperative pathology reports was analyzed.

Results: This study included a total of 338 lesions. The diagnostic accuracy of vascular morphology was 76.0%. The sensitivity (87.0%) and positive predictive value (PPV, 85.4%) of B1 vessels were high, but the specificity (42.0%) and negative predictive value (NPV, 45.3%) were low. The specificity (86.9% and 98.8%) and NPVs (87.5% and 96.8%) of B2 and B3 vessels were high, but the sensitivity (36.4% and 21.4%) and PPVs (35.1% and 42.9%) ware low. Furthermore, only a few lesions (n = 57) described avascular area, but the overall diagnostic accuracy was not ideal (21.1%). However, if lesions invading the superficial submucosa or shallower were included in the category of "suitable for ESD", the overall accuracy of the JES classification was found to be 95.6%.

Conclusions: In actual clinical settings, the overall accuracy of the JES classification system decreases, but the diagnostic performance of each subtype retains its original characteristics. Additionally, this classification is appropriate for determining whether type 0-II SESCC lesions are suitable for ESD.

Aim: Differentiated thyroid cancer (DTC) is a type of thyroid cancer with rapid progression and poor prognosis, and effective clinical treatment is of great significance in safeguarding the prognostic health of patients. Therefore, we assessed the effect of modified Miccoli's thyroidectomy on stress responses and quality of life in DTC patients, aiming to provide a more comprehensive reference for future DTC treatment.

Methods: This study retrospectively analyzed 100 DTC patients admitted to our hospital from January 2023 to December 2023. Study participants were divided into two groups: The research group (n = 57) receiving modified Miccoli's thyroidectomy and the control group (n = 43) receiving routine open thyroidectomy. Surgical indexes (incision length, operative time, intraoperative bleeding, and the number of lymph nodes dissected) and post-operative indexes (post-operative pain, drainage volume, and hospitalization time) were comparatively assessed between the two experimental groups. Furthermore, stress response-associated indexes and immune function were evaluated before and after surgery. Additionally, the post-operative quality of life was investigated in both experimental groups.

Results: The research group showed higher operative time but smaller incision length, less intraoperative bleeding, lower post-operative pain scores, less drainage volume, and shorter hospitalization time than the control group (p < 0.05). Furthermore, we observed reduced post-operative stress responses, better immune function, and higher quality of life scores in the research group compared to the control group (p < 0.05).

Conclusions: Modified Miccoli's thyroidectomy can effectively alleviate post-operative stress responses in DTC patients and promote their post-operative rehabilitation and quality of life.

Endovascular aneurysm repair (EVAR) has emerged as the preferred treatment for abdominal aortic aneurysm (AAA), offering advantages such as reduced mortality, faster recovery, and fewer complications compared to open repair (OR). However, concerns persist regarding long-term durability, and the need for reinterventions. Among all reported EVAR complications, endograft collapse poses a significant challenge, particularly when presenting with acute lower limb ischemia (ALI). The aim of this report is to describe two cases of non-dissection-related abdominal endograft collapse manifesting as ALI, requiring urgent intervention, emergent conversion to OR and complete endograft removal.

Background: This purpose aims to investigate the usefulness of CD133, a stem cell marker, for the prognosis of colon polyps. This study aimed to assess the adenomatous polyps that have an essential role in the development of colorectal cancer. The risk of colorectal carcinogenesis can be reduced by polypectomy and close medical supervision of the patients with adenomatous polyps. The prominence of stem cells in carcinoma development is also a recognized verdict. It must be noted that stem cell evaluation in adenomatous polyps may provide information about carcinoma development.

Method: Previously pathologically assessed colorectal polyps in 60 males and 40 females at Azerbaijan Medical University were reevaluated at the Pathology Department under the Meram Medical Faculty. Hematoxylin-eosin stained preparations were examined, and cases with and without dysplasia were determined. The image analysis program re-examined the preparations, and the same image analysis system automatically counted CD133 positive stained cells in the unit area. At the end of the follow-up period after polypectomy, the cases of malignancy were detected.

Results: The relationship between CD133 expression of dysplasia and malignancy was statistically compared. During the investigation, the statistically significant relationship between CD133 expression and dysplasia, as well as malignancy development, was observed in this study.

Conclusion: During the examination, the statistical significance of CD133 expression was detected in cases with dysplasia and malignancy. The investigation of CD133 expression in colorectal polyps is crucial in determining the presence of dysplasia and malignancy development, particularly in obtaining prognostic data in colorectal polyps.

Aim: This study aimed to investigate the impact of lymph node dissection on the prognosis of early epithelial ovarian cancer and to assess the factors associated with lymph node metastasis.

Methods: In this retrospective study, we collected and analyzed the demographic characteristics, clinical pathological data, and perioperative adverse events in newly diagnosed early epithelial ovarian cancer (EOC) patients, Federation International of Gynecology and Obstetrics (FIGO) stage IA-IIA. The patients underwent surgical treatment at the First, Second, and Third Affiliated Hospitals of Wenzhou Medical University in Zhejiang Province, China, between June 2012 and June 2022. The survival analysis was performed.

Results: We enrolled 284 patients in this study, including 246 stage I, 28 stage II, and 10 stage III patients after surgery. Among them, 42 patients did not undergo lymph node dissection, 113 underwent pelvic lymph node dissection only, and 129 underwent pelvic plus para-aortic lymph node dissection. Among the lymph node dissection group, only 8 patients had lymph node metastasis (8/242, 3.3%), including 6 with pelvic lymph node metastasis and 2 with pelvic plus para-aortic lymph node metastasis. The median follow-up duration was 63 months. The systematic lymph node dissection group significantly prolonged the median operation duration and increased intraoperative blood loss and postoperative complications (p < 0.05). Postoperative multivariate Cox regression analysis revealed FIGO stage III as an independent risk factor for Progression-Free-Survival (PFS) and Overall Survival (OS) (p < 0.05). Furthermore, the preoperative cancer antigen 125 (CA125) level was observed as an independent factor affecting lymph node metastasis.

Conclusions: Systematic lymph node dissection showed minimal effect on the survival rate of patients with clinically apparent early epithelial ovarian cancer and increased the postoperative complications of patients.