Annali italiani di chirurgia最新文献

Aim: Recently, there have been studies on various parameters that can be used to diagnose and follow up thyroid malignancies. These parameters are mean platelet volume (MPV), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/monocyte ratio (LMR), and different results have been reported regarding their diagnostic and prognostic effects. Therefore, there is a need for more comprehensive studies on the use of these parameters in diagnosis and follow-up. In this study, we planned to reveal whether MPV, NLR, PLR, and LMR can be used as biomarkers for thyroid carcinomas and whether they differ according to tumor type and size.

Methods: A total of 242 patients aged 18-79 years who underwent thyroidectomy between October 2016 and December 2021 were included in this study. The following variables were analyzed retrospectively: age, sex, pathology results of thyroidectomy materials, and parameters such as MPV, NLR, PLR and LMR of the preoperative complete blood count. The patients included in the study were divided into two groups according to malignant and benign thyroidectomy pathologies. Group 1 (n = 160): Benign pathology. Group 2 (n = 82): Malignant pathology.

Results: NLR and PLR were found to be significantly higher in the patients in Group 2 compared to the patients in Group 1 (p = 0.042 and p = 0.003). For the NLR value, sensitivity was calculated as 67.07%, Specificity as 48.75, and cut-off value as >1.503. Area Under Curve (AUC) value for NLR: 0.580. For the PLR value, sensitivity was calculated as 48.78%, Specificity as 70.62, and cut-off value as >111.429. AUC value for PLR: 0.615. A high level, positive and statistically significant correlation was detected between NLR and PLR in patients with tumor size ≥10 mm within Group 2 (r = 0.548, p < 0.001).

Conclusions: We believe that NLR and PLR values may be important predictive biomarkers for thyroid malignancies. As consistent with the literature, NLR and PLR values were statistically significant in our study. An NLR value of >1.503 and a PLR value of >111.429 can be considered a risk factor for thyroid malignancy.

Aim: Sleeve gastrectomy is the most common bariatric procedure in Poland. The procedure leads to reduction of stomach volume by 85%, allowing the intake of food of approximately 100-150 mL. The complication rate is usually low as it is one of the least invasive bariatric procedures with a short recovery pathway.

Case presentation: A 34-year-old male with a history of bipolar disorder and Body Mass Index of 46 kg/m² underwent a sleeve gastrectomy in a regional center. Due to anastomosis leakage diagnosed in the postoperative period, the patient was transferred to a referral bariatric center. The patient underwent revision laparotomy, during which a self-expandable metal stent was placed. After the revision surgery, the patient complained of stomach pain and left shoulder pain and gastroduodenal fistula was diagnosed. Vacuum wound therapy was initiated and a pigtail drain was implanted into the fistula canal. Despite multiple sessions of therapy, the patient developed recurrent thoracic empyema, ultimately requiring the creation of an esophago-ileal anastomosis. No further complications occurred, and the patient was discharged home in good condition.

Results: Following early postoperative anastomotic leakage, the patient developed a gastric fistula. The recurrent thoracic empyema persisted despite multiple surgical and endoscopic interventions, including vacuum wound therapy, drainage, and stenting. Further, the patient required surgery to create an esophago-ileal anastomosis. The case shows a rare but complex and severe complication due to patient's incompliance regarding the calorie intake, volume and temperature of the meals and alcohol consumption.

Conclusions: In case of suspected postoperative complications after bariatric surgery, including bleeding or staple line leaks, referral to specialist bariatric center may be recommended. Patients should be strongly advised to follow the postoperative dietary recommendations to reduce the risk of complications.

Aim: Deep vein thrombosis (DVT) is acknowledged as the primary complication associated with tibial plateau fractures (TPFs), necessitating the implementation of preventive measures such as physical exercise. While ankle pump exercise (APE) is an effective preventive measure, challenges such as insufficient monitoring and a shortage of nursing staff have been identified. Therefore, our study aimed to evaluate the efficacy of the self-developed telemonitored APE compared to conventional APE.

Methods: The study was conducted in a randomized parallel-group design (Consolidated Standards of Reporting Trials (CONSORT)-compliant). We randomized 60 participants with TPFs into two groups for traditional APE (Group A) and telemonitored APE (Group B) separately. The study population was recruited from Zhejiang Hospital between December 2022 and June 2024. Evaluate the efficacy by four indices: diameter and flow velocity of the femoral vein and popliteal vein in the lower extremity, the increased value of postoperative calf diameter, visual analogue scale (VAS), and D-dimer.

Results: Following both telemonitored and traditional APE, statistically significant differences (p < 0.05) were detected between the two groups in at least one assessment period. Group B showed significantly lower VAS than Group A on postoperative day 7 (p = 0.001) and day 14 (p < 0.001). Group B had a lower D-dimer level on postoperative day 7 (p = 0.004). Group B showed a smaller calf diameter increment on day 7, p = 0.001). Group B had a significantly higher popliteal vein flow velocity after APE (p < 0.001).

Conclusions: The remote monitoring ankle pump system is more effective than traditional methods in reducing postoperative pain, improving venous hemodynamics, and reducing thrombotic risk indicators, demonstrating its significant clinical value in the prevention and rehabilitation of lower extremity deep vein thrombosis in patients with tibial plateau fractures.

Clinical trial registration: Chinese Clinical Trial Registry (ChiCTR2200065384).

Aim: This study aimed both to compare the efficacy of intravenous (IV) ibuprofen with periprostatic nerve block (PPNB) in pain control during prostate biopsy procedures and to investigate factors influencing pain scores.

Methods: A total of 128 patients were prospectively enrolled between June and December 2023 and randomized into two groups: IV ibuprofen was Group 1 (n = 64) and PPNB was Group 2 (n = 64). Pain levels were assessed using a Visual Analog Scale (VAS) at various stages of the procedure. Demographic and clinical data, including age, prostate specific antigen (PSA) levels, prostate volume, body mass index (BMI), histopathology results, and Prostate Imaging-Reporting and Data System (PI-RADS) scores, were recorded and correlated among themselves.

Results: The mean ages (64.68 ± 5.87 vs 63.33 ± 7.26 years), and median PSA level was [13.00 (8.04-41.68) ng/mL vs 10.00 (6.73-23.80) ng/mL] of Group 1 and 2 were as indicated, (p = 0.267 and p = 0.053, respectively). There were no statistically significant differences between the two groups in terms of prostate volume, BMI, PI-RADS score, and benign-malignant pathology on biopsy (p > 0.05). The median VAS scores estimated during insertion of rectal probe [4 (2-5) vs 2 (0-3)], prostate biopsy needle [3 (2-4) vs 0 (0-1)], and overall median VAS scores [4 (3-4) vs 1 (0-2)] were lower in Group 2 than Group 1 (p < 0.001 for all stages). Correlation analyses revealed that PSA levels, and malignant pathology influenced the pain scores in Group 1 (r = 0.230, p = 0.024; r = 0.268, p = 0.032, respectively). Regression analysis demonstrated that PSA levels and malignant pathology affected the overall VAS scores in Group 1 (p = 0.024 and p = 0.019, respectively).

Conclusions: IV ibuprofen demonstrates promise as an easily applicable analgesic method for prostate biopsy, particularly for patients who are unwilling or unable to undergo PPNB. This study underscores the need for large-scale investigations to validate these findings.

Clinical trial registration: ClinicalTrials.gov with identifier (NCT06737939).

Securing an airway through tracheal intubation is crucial in clinical anesthesia and emergency medicine. However, lateral position surgeries or emergency intubation bring extra challenges, such as tricky airways, accidental tube displacement, and complications associated with a patient's positional adjustment under anesthesia. Intubating in the lateral position effectively addresses these challenges by matching the individual's posture to the procedural demands. This review systematically examines the technical characteristics, clinical applications, method selection, equipment choice, and current innovations in lateral-position tracheal intubation. It focuses on exploring its strength in complex and specialized cases and analyzing the limitations and potential improvements in current practices. This review aims to provide healthcare professionals with comprehensive theoretical insights and practical guidance, further promoting the application and widespread adoption of tracheal intubation in the lateral position in clinical settings.

Aim: Postoperative lymphedema was a common and debilitating complication following breast cancer surgery, which significantly affects quality of life. This study analyzes the risk factors associated with lymphedema and evaluates the effectiveness of axillary reverse mapping (ARM) in reducing its incidence and improving quality of life.

Methods: For this retrospective cohort study, 232 breast cancer patients who underwent axillary dissection between January 2022 and January 2023 were recruited. Patients were classified into the lymphedema group (n = 54) and the control group (n = 178) based on edema occurrence. Influencing factors such as body mass index, surgical techniques, and adjuvant therapies were analyzed. To assess ARM's impact on lymphedema and quality of life, patients were also divided into a mapping group (n =133) and the control group (n = 99). Lymphedema stages were evaluated according to the International Lymphatic Society consensus, and quality of life was assessed using the Quality of Working Life Questionnaire for Cancer Survivors (QWLQ-CS), Breast Cancer Survivors Resilience Scale (BCRS), and Strategies Used by People to Promote Health (SUPPH) scale.

Results: The results showed that chemotherapy (odds ratios [OR]: 4.063; p < 0.001) and radiotherapy (OR: 3.358; p < 0.001) were significant risk factors for lymphedema. ARM was associated with a reduced risk of lymphedema (OR: 0.322, p = 0.004). A higher proportion of patients in the mapping group were classified as having Stage 0 lymphedema (86.46%) compared to the control group (63.67%). For the mapping group, the QWLQ-CS was 71.04 ± 12.31 (p = 0.041), BCRS was 23.89 ± 6.32 (p = 0.003), and SUPPH was 85.65 ± 12.57 (p = 0.001), which were significantly higher than the control group.

Conclusions: Postoperative lymphedema risk in breast cancer patients is influenced by chemotherapy and radiotherapy, with ARM proving beneficial in reducing incidence and enhancing postoperative quality of life.

Aim: Lung adenocarcinoma remains a leading cause of cancer-related mortality, and the diagnostic performance of computed tomography (CT) is limited when dependent solely on human interpretation. This study aimed to develop and evaluate an interpretable deep learning framework using an attention-enhanced Squeeze-and-Excitation Residual Network (SE-ResNet) to improve automated classification of lung adenocarcinoma from thoracic CT images. Furthermore, Gradient-weighted Class Activation Mapping (Grad-CAM) was applied to enhance model interpretability and assist in the visual localization of tumor regions.

Methods: A total of 3800 chest CT axial slices were collected from 380 subjects (190 patients with lung adenocarcinoma and 190 controls, with 10 slices extracted from each case). This dataset was used to train and evaluate the baseline ResNet50 model as well as the proposed SE-ResNet50 model. Performance was compared using accuracy, Area Under the Curve (AUC), precision, recall, and F1-score. Grad-CAM visualizations were generated to assess the alignment between the model's attention and radiologically confirmed tumor locations.

Results: The SE-ResNet model achieved a classification accuracy of 94% and an AUC of 0.941, significantly outperforming the baseline ResNet50, which had an 85% accuracy and an AUC of 0.854. Grad-CAM heatmaps produced from the SE-ResNet demonstrated superior localization of tumor-relevant regions, confirming the enhanced focus provided by the attention mechanism.

Conclusions: The proposed SE-ResNet framework delivers high accuracy and interpretability in classifying lung adenocarcinoma from CT images. It shows considerable potential as a decision-support tool to assist radiologists in diagnosis and may serve as a valuable clinical tool with further validation.