Annali italiani di chirurgia最新文献

Aim: Surgeons have historically played critical roles in disaster management, particularly as military and trauma specialists. However, the role of surgeons in disasters has changed over time, with advancements in medical knowledge and disaster response capabilities. Recent public health emergencies and global events have signaled a paradigm shift, emphasizing the necessity of cross-disciplinary, transdisciplinary, and multidisciplinary approaches. This shift calls for revisiting and reevaluating surgeons' roles and responsibilities.

Methods: In this narrative review, the literature concerning the roles and responsibilities of surgeons during disasters and public health emergencies was systematically searched and mapped. This streamlined process aimed to gather high-quality information typically found in a systematic review but within a shorter timeframe. The goal was to expedite the discovery of insights that could inform policy decisions or address urgent matters related to the study's topic. Furthermore, action research was performed to strengthen the paper's methodology, capture essential literature, and avoid missing important data.

Results: The results indicate a change in surgical specialty and a shift in the paradigm from multitasking surgeons to a multidisciplinary approach in surgical disaster management. Current educational initiatives are insufficient, and training opportunities are lacking, indicating the need for novel educational initiatives, simulation training, a collaborative surgical approach, and a reevaluation of the current curriculum.

Conclusions: The study outcomes aim to guide future policy development and facilitate the creation of practical guidelines for disaster and public health emergency planners at local, regional, national, and international levels. Surgeons' future roles in disaster and public health emergency management will be characterized by innovation, collaboration, and a commitment to improving outcomes for affected populations, addressing the unique challenges of disasters, and strengthening healthcare systems globally.

Aim: Dental implant placement requires precise angulation for long-term success and optimal restoration function. Therefore, this study explores the potential association between the experience of oral and maxillofacial surgeons and the accuracy of implant angulation, including its relationship to neighboring teeth and other implants.

Methods: This retrospective study included 80 patients involving dental implants, each assessed through postoperative panoramic X-rays. Computer software was employed to measure the angle between the longitudinal axis of the selected implant and adjacent reference points. An angle less than 180° denoted convergence of the implant, while an angle greater than 180° indicated divergence.

Results: The average angle regarding the implant-tooth relationship on the mesial side was 177.74 ± 6.94 (convergent), while on the distal side, it was 182.39 ± 7.77 (divergent). There were no statistically significant variations in insertion angles between procedures performed by experienced specialists (with over 5 years of expertise) and those performed by residents (with less than 5 years of experience). In comparing implants on the right side of the mouth to those on the left, given that all the surgeons were right-handed, no statistical significance was found for either the mesial reference (177.56 ± 7.44 vs. 178.06 ± 6.04, p = 0.76) or the distal reference (182.01 ± 8.38 vs. 183.15 ± 6.52, p = 0.53). However, a statistically significant difference was identified between the inclinations of implants towards the mesial reference compared to the distal inclinations in both cases (p = 0.005 for the right side and p = 0.004 for the left side).

Conclusions: In summary, satisfactory axial relationship in implant placement is effectively attained by both oral and maxillofacial surgery specialists and residents. Notably, implants consistently show a mesial inclination, irrespective of the specific side of the mouth. Additional research is needed to uncover the root cause of this inclination bias, aiming to promote the parallel alignment of implants with reference structures.

Aim: Primary hepatic neuroendocrine carcinomas (PHNECs) are rare tumors with limited understanding and management. Diagnosing and treating these tumors pose significant challenges due to the lack of clinical experience. Surgery is often considered an effective therapeutic strategy for early-stage PHNECs. This case report describes an advanced metastatic PHNEC managed primarily with chemotherapy.

Case presentation: The medical records of the patient and diagnostic imaging findings were reviewed. A multidisciplinary team of specialists discussed the case and determined the treatment plan. The patient received a chemotherapy regimen tailored to PHNEC, which included specific neuroendocrine tumor-targeting agents.

Results: Despite the advanced stage of the disease, the patient responded well to chemotherapy, with a notable reduction in tumor size and improvement in symptoms. The treatment was well-tolerated, and the patient showed a favorable overall response. The survival duration from the time of diagnosis was 18 months.

Conclusions: In this case of advanced metastatic PHNEC, a primarily chemotherapy-based approach yielded positive outcomes. Although surgery is typically preferred for early-stage cases, this case highlights the potential efficacy of chemotherapy in managing advanced PHNECs. Further research and clinical experience are warranted to better understand the optimal treatment strategies for these rare tumors.

Aim: Postoperative complications persist as a significant cause of graft failure in liver transplantation. Identifying circulatory markers that predict such complications holds excellent clinical value. This study aimed to investigate serological indicators that can indicate early complications in adult liver transplantation.

Methods: This study included 436 patients who underwent liver transplantation at our hospital, along with corresponding monitoring protocols. The differences and interactions of circulating indicators at various time points were analyzed using repeated measures analysis of variance. Post-hoc multiple comparisons were adjusted using the Bonferroni method. Restricted cubic spline regression models assessed non-linear associations between circulating markers, complications, and mortality.

Results: This study demonstrated significant time effects for all related markers, with substantial differences in complications and mortality for direct bilirubin and albumin. The restricted cubic spline model revealed a significant positive association between direct bilirubin and complications across three postoperative phases (p postoperative phase 1 = 0.0011, p postoperative phase 2 = 0.0001, p postoperative phase 3 = 0.0020). Conversely, albumin showed a significant negative association with complications in phases 1 and 2 (p postoperative phase 1 = 0.0001, p postoperative phase 2 = 0.0009). Furthermore, direct bilirubin was significant associated with increased mortality of postoperative phase 2 and phase 3 (p postoperative phase 2 < 0.0001, p postoperative phase 3 < 0.0001), while albumin showed a significant negative association with mortality (p postoperative phase 1 = 0.0306).

Conclusions: Direct bilirubin and albumin are potential critical factors affecting early complications after liver transplantation. Close monitoring of these markers within 24-72 postoperative hours may help predict the occurrence of complications.

Aim: The study aimed to explore the impact of refined nursing management in the operating room on surgical efficiency, postoperative recovery, and stress responses in patients undergoing laparoscopic general surgery.

Methods: A retrospective analysis was conducted on 100 patients who underwent laparoscopic surgery at Zhongnan Hospital of Wuhan University between March 2023 and March 2024. The control group comprised 48 cases receiving conventional operating room nursing, while the observation group comprised 52 cases receiving refined nursing management in the operating room in addition to the conventional care. Comparisons were conducted between the two groups regarding surgical efficiency, postoperative recovery, postoperative stress indicators, psychological status before and after nursing, overall treatment comfort, perioperative complications, and nursing satisfaction.

Results: The observation group showed statistically significant improvements in surgical efficiency, postoperative recovery, and stress indicators compared to the control group. After the intervention, the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores of both groups significantly decreased compared to pre-nursing levels (p < 0.05), while such decrease was notably higher in the observation group (p < 0.05). Patients in the observation group reported significantly higher post-nursing comfort levels (p < 0.05) and exhibited significantly fewer perioperative complications (p < 0.05) compared to the control group. Furthermore, the nurses indicated significantly higher satisfaction with patient care in the observation group (p < 0.05).

Conclusions: Implementing refined nursing in the operating room for laparoscopic general surgery can facilitate the recovery of gastrointestinal function, reduce postoperative recovery time, prevent complications, improve patients' psychological state, and enhance their quality of life.

Aim: This study aims to evaluate the clinical effectiveness of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in managing osteoporotic vertebral compression fractures (OVCFs).

Methods: This retrospective study included 268 elderly OVCF individuals, and 144 individuals were selected after propensity score matching. General patient information, perioperative conditions, vertebral height and Cobb angle, lumbar spinal function, degree of pain, incidence of complications, and fracture recurrence rates were compared and analyzed for the patients.

Results: The PKP group exhibited longer surgical duration, greater intraoperative blood loss, and more frequent X-ray fluoroscopy during the perioperative period compared to the PVP group (p < 0.05). However, there was no significant difference in the length of hospital stay between the two groups. Furthermore, PKP surgery significantly improved vertebral height, corrected spinal posture, and enhanced lumbar spinal function while mitigating pain levels within the 12-month postoperative period (p < 0.05). Additionally, the PKP group showed substantially lower rates of bone cement leakage, nerve injury, and fracture recurrence than the PVP group (p < 0.05).

Conclusions: Compared to PVP, PKP demonstrates better clinical effectiveness with lower incidence of complications in managing OVCF. However, surgical time and intraoperative trauma should be considered.

Aim: This study assesses the effectiveness of combining transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) in treating hepatocellular carcinoma (HCC).

Methods: Retrospective analysis of 125 HCC patients treated from 2020 to 2021, divided into two groups: monotherapy using TACE (n = 63), and a combined approach of RFA and TACE (n = 62). Comparison factors included clinical efficacy, liver function, tumor markers, complications, quality of life, and prognosis.

Results: The combined treatment group showed higher effectiveness (p < 0.05), improved liver function and tumor marker levels 4 weeks post-treatment (p < 0.05), significantly fewer complications (p < 0.05), and enhanced quality of life at the year-long follow-up (p < 0.05). The prognosis was better in the combination group, demonstrated by fewer recurrences and higher 1-year survival rates (p < 0.05).

Conclusions: The dual approach of TACE and RFA shows improved results for HCC patients, including improved liver function, reduced tumor markers, fewer complications, and superior quality of life and prognosis. Consequently, combined treatment approach is endorsed for clinical practice.

Aim: This study aimed to investigate the effects of sugammadex on postoperative pulmonary complications and rapid recovery in lung cancer patients undergoing video-assisted thoracic surgery (VATS).

Methods: A retrospective analysis was conducted on the clinical data of 1131 lung cancer patients. Of these, 631 patients received sugammadex at the end of anesthesia, while 500 patients did not. To mitigate potential confounding factors, propensity score matching (PSM) was employed at a 1:1 ratio. After matching, 435 patients were obtained from each group. Patients who received sugammadex at the end of anesthesia were classified into Group S (n = 435) and those who did not receive sugammadex were Group P (n = 435). Postoperative pulmonary complications, indicators of recovery after surgery, nausea and vomiting, pain and lung infection scores and biochemical indices were compared between the two groups.

Results: Compared to Group P, Group S demonstrated statistically significant improvements across multiple perioperative and postoperative outcomes. Group S exhibited a lower incidence of postoperative pulmonary complications (χ2 = 9.52, p = 0.002), as well as reduced durations for several key time intervals: from the cessation of muscle relaxation to extubation (Z = 12.96, p < 0.001), from the conclusion of surgery to extubation (Z = 13.66, p < 0.001), and total operating theatre occupancy (Z = 5.81, p < 0.001). Furthermore, Group S showed accelerated recovery in terms of time to first oral intake (drink: Z = 3.80, p < 0.001; eat: Z = 3.80, p < 0.001), time to defecate (Z = 3.25, p = 0.001), and time to chest tube removal (Z = 5.04, p < 0.001). Pain management outcomes were also superior in Group S, with lower motor visual analogue scale (VAS) scores at both 24 h (Z = 4.71, p < 0.001) and 48 h (Z = 5.05, p < 0.001) postoperatively. Group S additionally demonstrated a lower modified Clinical Pulmonary Infection Score (mCPIS) (Z = 4.68, p < 0.001), reduced complication rates during the general anesthesia awakening period (χ2 = 23.54, p < 0.001), and a lower incidence of renal function abnormalities (χ2 =12.65, p < 0.001). Certain parameters, including total hospital stay duration and postoperative drainage volume, did not differ significantly between the two groups (p > 0.05).

Conclusions: Sugammadex can effectively reduce the incidence of postoperative pulmonary complications in lung cancer patients treated with VATS, and help promote their rapid postoperative recovery with significant clinical benefits.

Paraduodenal Hernia (PDH) is an extremely rare cause of bowel obstruction. The true incidence of pediatric PDH is unknown since there are very few published cases of this phenomenon. PDH carries a high morbidity and mortality rate if unidentified. Proper diagnosis and prompt surgical intervention are extremely important. Our case is of a healthy 3-year-old male who presented with six days of generalized abdominal pain associated with constipation, anorexia, insomnia, and non-bloody, non-bilious emesis. Abdominal ultrasound (US) was negative for intussusception and failed to visualize the appendix. Abdominal x-ray (AXR) showed nonspecific distention of several loops of bowel with air-fluid levels. Computerized tomography (CT) scan was concerning for an internal hernia versus possible transverse colonic volvulus. The patient's abdominal pain and distension worsened after nasogastric (NG) tube placement. With the combination of physical and imaging findings, the patient underwent diagnostic laparoscopy. Intraoperatively, severely dilated bowel was encountered, which was decompressed via the appendix. After which, we discovered a PDH on the left side of the ligament of Treitz which was successfully reduced. The patient had no complications and continues tolerating a regular diet with return of normal bowel function. Our case describes successful laparoscopic surgical reduction of a pediatric left paraduodenal hernia.

Aim: Accurate prognosis of diffuse axonal injury (DAI) is important in directing clinical care, allocating resources appropriately, and communicating with families and surrogate decision-makers.

Methods: A study was conducted on patients with clinical DAI due to closed-head traumatic brain injury treated at a trauma center in Brazil from July 2013 to September 2015.  The objective efficacy of the Glasgow Coma Scale (GCS), Trauma and Injury Severity Scoring system (TRISS), New Trauma and Injury Severity Scoring system (NTRISS), Abbreviated Injury Scale (AIS)/head, Corticosteroid Randomization After Significant Head Injury (CRASH), and International Mission on Prognosis and Analysis of Clinical Trials (IMPACT) models in the prediction of mortality at 14 days and 6-months and unfavorable outcomes at 6 months was tested.

Results: Our cohort comprised 95 prospectively recruited adults (85 males, 10 females, mean age 30.3 ± 10.9 years) admitted with DAI. Model efficacy was assessed through discrimination (area under the curve [AUC]), and Cox calibration. The AIS/head, TRISS, NTRISS, CRASH, and IMPACT models were able to discriminate both mortality and unfavorable outcomes (AUC 0.78-0.87). IMPACT models resulted in a statistically perfect calibration for both 6-month outcome variables; mortality and 6-month unfavorable outcome. Calibration also revealed that TRISS, NTRISS, and CRASH systematically overpredicted both outcomes, except for 6-month unfavorable outcome with TRISS.

Conclusions: The results of this study suggest that TRISS, NTRISS, CRASH, and IMPACT models satisfactorily discriminate between mortality and unfavorable outcomes. However, only the TRISS and IMPACT models showed accurate calibration when predicting 6-month unfavorable outcome.