Langenbeck's Archives of Surgery最新文献

{"title":"Safety and feasibility of open abdomen with negative pressure therapy in major liver trauma: a retrospective bicenter study.","authors":"Andrea Coppola, Arianna Mottola, Marcello Della Corte, Mariafelicia Valeriani, Giovanni Aprea, Patrizio Festa, Giuseppe Palomba","doi":"10.1007/s00423-025-03729-1","DOIUrl":"10.1007/s00423-025-03729-1","url":null,"abstract":"<p><strong>Background: </strong>Abdominal trauma is the third leading cause of death in the young population, and liver trauma is among the most common. For major liver injury, perihepatic packing (PHP) is a life-saving procedure that allows rapid control of the hemorrhage. The use of the open abdomen (OA) represents a strategy for the management of major abdominal trauma. However, the effects of combined use with Negative Pressure Therapy (NPT) in patients with liver trauma are not yet clear. The aim of our study was to evaluate the safety and feasibility of OA with NPT.</p><p><strong>Materials and methods: </strong>This retrospective bicenter study enrolled all patients affected by liver trauma who underwent operative management from January 2019 to September 2023 at the Emergency Surgical Units of the \"A. Cardarelli\" Hospital in Naples and the \"San Giovanni di Dio e Ruggi d'Aragona\" in Salerno. The two groups were compared in terms of intra- and postoperative outcomes.</p><p><strong>Results: </strong>Out of a total of 213 patients with liver trauma, 43 patients were divided into two groups: group A (24 patients treated with PHP and OA) and group B (19 patients with PHP, OA and NPT). There were no significant differences in terms of demographic data, preoperative characteristics, length of stay, mortality, or intraoperative or postoperative complications. Hb increase at the time of depacking was higher in group B (p = 0.039).</p><p><strong>Conclusions: </strong>Open Abdomen with Negative Pressure Therapy appears safe and feasible. Furthermore, it does not affect mortality or hospital stay but it seems to be associated with higher hemoglobin (Hb) levels during the depacking phase.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"160"},"PeriodicalIF":2.1,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12084237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of recurrent laryngeal nerve monitoring on nerve paralysis during open McKeown esophagectomy: a prospective, cohort study.","authors":"Shuwen Fu, Ying Guo, Xiaofan Lu, Xiong Song, Weiyi Qin, Liquan Zheng, Xiaofeng Huang, Manxiu Xie, Yali Lu, Renchun Lai","doi":"10.1007/s00423-025-03732-6","DOIUrl":"10.1007/s00423-025-03732-6","url":null,"abstract":"<p><strong>Background: </strong>Recurrent laryngeal nerve paralysis (RLNP) is a critical postoperative complication in esophagectomy. Intraoperative nerve monitoring (IONM) is a technique that can be used in high-risk surgeries to prevent, identify, and mitigate nerve damage. In this prospective study, we evaluated the feasibility and effectiveness of IONM in open McKeown esophagectomy for esophageal cancer.</p><p><strong>Methods: </strong>From December 2020 to September 2023, 88 patients diagnosed with esophageal cancer were enrolled to receive IONM for open McKeown esophagectomy at Cancer Center, Sun Yat-sen University. The primary outcome was the incidence of RLNP after extubation. The secondary outcomes were postoperative complications, number of dissected lymph nodes, length of hospital stay, ICU duration and number of deaths.</p><p><strong>Results: </strong>A total of 83 patients were included in the final analysis. The incidence of RLNP after extubation was 30.1%. The occurrence of postoperative pulmonary complications was 20.5%. The median hospital stays were 13 days. The incidence of anastomotic leakage was 13.3%. No in-hospital deaths were reported. Postoperative RLNP prolonged the length of hospital stay (P = 0.042).</p><p><strong>Conclusion: </strong>Our findings indicated that IONM could potentially be associated with a possible reduction in RLNP incidence following open McKeown esophagectomy for esophageal cancer. However, future research including well-designed randomized controlled trials may be beneficial to clarify these preliminary results.</p><p><strong>Trial registration number: </strong>ChiCTR2000029687 https://www.chictr.org.cn/showproj.html?proj=49103.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"158"},"PeriodicalIF":2.1,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative proton pump inhibitor therapy and anastomotic leak after esophagectomy-a new perspective.","authors":"Lukas Pollmann, Jonas Linnemann, Nicola S Pollmann, Claudius Jürgens, Maximilian Schmeding","doi":"10.1007/s00423-025-03727-3","DOIUrl":"10.1007/s00423-025-03727-3","url":null,"abstract":"<p><strong>Purpose: </strong>Proton pump inhibitors (PPIs) are indispensable in the treatment of gastro-esophageal reflux disease and peptic ulcers or for the prevention of stress ulcers after major abdominal surgery. However, long-term PPI therapy leads to several side effects such as delayed gastric emptying and distinct changes in mucosal histology. Therefore, this retrospective study aims to evaluate the impact of preoperative PPI therapy on the anastomotic leak rate after esophagectomy.</p><p><strong>Methods: </strong>A retrospective, single-center analysis was conducted for all patients treated with esophagectomy and gastric conduit reconstruction between January 2016 and November 2024. Preoperative treatment with PPIs, as well as patient comorbidities, histopathological findings and surgical techniques were noted. Subsequently, a group-wise comparison was carried out for the differences in anastomotic leak rate and postoperative complications in patients with and without preoperative PPI therapy. Finally, a multivariate logistic regression analysis was conducted for the occurrence of anastomotic leak.</p><p><strong>Results: </strong>A total of 229 patients were included in the study. The group-wise comparison revealed a significantly higher rate of anastomotic leaks and postoperative complications in patients with preoperative PPI therapy compared to those without. The multivariate logistic regression analysis indicated a 2.5-fold increased risk of anastomotic leaks in patients with preoperative PPI therapy compared to patients without.</p><p><strong>Conclusion: </strong>Preoperative PPI therapy may represent a modifiable risk factor for the development of anastomotic leaks after esophagectomy. Further prospective, interventional studies are necessary to verify the results.</p><p><strong>Trial registration: </strong>The study was retrospectively registered in the German clinical trial database (Application number DRKS00035536, Registration date 03.12.2024).</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"157"},"PeriodicalIF":2.1,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical and oncological outcomes in transverse colon carcinoma: does tumor sublocation make a difference?","authors":"L Schabl, L C Duraes, K Erozkan, A Alipouriani, S R Steele, H Kessler","doi":"10.1007/s00423-025-03665-0","DOIUrl":"https://doi.org/10.1007/s00423-025-03665-0","url":null,"abstract":"<p><strong>Background: </strong>Transverse colon carcinomas are often treated as a single entity in medical literature, despite differences in embryology, anatomy, physiology, genetics, and surgical treatment. We hypothesized that tumor sublocation affects demographics, oncological, surgical and quality of life outcomes.</p><p><strong>Methods: </strong>A retrospective analysis of patients who underwent surgery for transverse colon carcinomas between 2000 and 2018 was conducted. Tumor localization was determined by operative, pathological and imaging reports, and procedures were defined by the extent of vascular resection.</p><p><strong>Results: </strong>The study included 273 patients aged 69 years (SD 12.3), of whom 44% were female. The BMI was 28.8 kg/m² (SD 6.2), and 61% were ASA class 3. Carcinomas were in the proximal (22%), the mid (42%), and the distal transverse colon (36%). Mid-transverse carcinomas exhibited the highest prevalence among female patients (53% vs. 35% proximal vs. 39% distal, p < 0.03). Proximal transverse carcinomas presented with a higher proportion of pathological stage II than mid and distal transverse carcinomas (68.3% vs. proximal vs. 44.3% mid-vs. 49% distal, p = 0.006). On multivariate analysis, anemia was more likely in mid than proximal (p = 0.009) and distal (p = 0.002) transverse colon cancers. Obstruction occurred more often in proximal than mid (p = 0.003), and hematochezia in distal than in mid (p < 0.001) and proximal (p = 0.014) transverse colon carcinomas. The 30-day mortality and morbidity and 5-year overall and disease-free survival rates were similar between the tumor sublocations.</p><p><strong>Conclusion: </strong>Sublocations of the transverse colon carcinomas affect the symptoms of patients. Tumor sublocation does not impact the intraoperative, postoperative, or oncological outcomes and quality of life.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"156"},"PeriodicalIF":2.1,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12064577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early readmission after adrenalectomy for pheochromocytoma. A retrospective study.","authors":"Tamer A A M Habeeb, Abd Al-Kareem Elias, Abdelmonem A M Adam, Mohamed A Gadallah, Saad Mohamed Ali Ahmed, Ahmed Khyrallh, Mohammed H Alsayed, Esmail Tharwat Kamel Awad, Emad A Ibrahim, Mohamed Fathy Labib, Sobhy Rezk Ahmed Teama, Mahmoud Hassib Morsi Badawy, Mohamed Ibrahim Abo Alsaad, Abouelatta Kh Ali, Hamdi Elbelkasi, Mahmoud Ali Abou Zaid, Ibtsam AbdElMaksoud Mohamed El Shamy, Boshra Ali Ali El-Houseiny, Mahmoud El Azawy, Ahmed Elhoofy, Ali Hussein Khedr, Abdelrahman Mohamed Hasanin Nawar, Ahmed Salah Arafa, Ahmed Mesbah Abdelaziz, Abdelfatah H Abdelwanis, Mostafa M Khairy, Ahmed M Yehia, Ahmed Kamal El Taher","doi":"10.1007/s00423-025-03719-3","DOIUrl":"https://doi.org/10.1007/s00423-025-03719-3","url":null,"abstract":"<p><strong>Purpose: </strong>Adrenalectomy for pheochromocytoma (PHEO) presents a significant challenge due to the high incidence of early hospital readmission (ER). This study evaluated the incidence and risk factors of ER for PHEO within 30 days of adrenalectomy.</p><p><strong>Methods: </strong>A retrospective analysis of 346 patients > 18 years with unilateral PHEO who underwent adrenalectomy between September 2012 and September 2024. The patients were categorised into ER (n = 49) and no ER (n = 297) groups. Logistic regression analyses were performed to predict risk factors for ER.</p><p><strong>Results: </strong>The most common causes of ER were postoperative maintained hypotension (42.9%), bleeding (6.1%), ileus (24.5%), wound infection (4.1%), hyperkalemia (8.2%), pneumonia (2%), intra-abdominal abscess (2%), acute MI (4.1%), and colonic injury (6.1%). Most postoperative complications were Clavien-Dindo grade II (n = 40, 81.6%). Two perioperative deaths (4%) occurred in the ER group. Logistic regression showed that low body mass index (OR 0.849, 95% CI, 0.748-0.964; p = 0.012), tumor size < 5 cm (OR 0.096, 95% CI, 0.030-0.310; p < 0.001), and low ASA (OR 0.435, 95% CI, 0.249-0.761; p = 0.003) were associated with risk reduction for ER while malignancy (OR 5.302, 95% CI, 1.214-23.164; p = 0.027), open approach(OR 12.247, 95% CI, 5.227-28.694; p < 0.001), and intraoperative complications (OR 19.149, 95% CI, 7.091-51.710; p < 0.001) were associated with risk increase of ER.</p><p><strong>Conclusion: </strong>Postoperatively maintained hypotension and ileus were the most common causes of ER. Low body mass index, tumour size < 5 cm, and low ASA were risk reductions for ER, while malignancy, open approach, and intraoperative complications were the independent risk increase factors.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"154"},"PeriodicalIF":2.1,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Higher incidence of trocar site hernia with gallbladder extraction via umbilical versus epigastric trocar port: a multicentre retrospective analysis of laparoscopic cholecystectomy.","authors":"Eduard A van Bodegraven, Paulieke C Oosterwijk, Sanne M van Aalten, Boudewijn E Schaafsma, Robert M Smeenk","doi":"10.1007/s00423-025-03721-9","DOIUrl":"https://doi.org/10.1007/s00423-025-03721-9","url":null,"abstract":"<p><strong>Background: </strong>Trocar site hernia (TSH) is a known complication of laparoscopic cholecystectomy (LC). Gallbladder extraction is typically performed through the umbilical or epigastric trocar port. However, data on the incidence of TSH in relation to the extraction site is limited. This study aimed to evaluate the need for surgical repair of TSH following gallbladder extraction through the umbilical versus epigastric trocar port.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted across two Dutch general hospitals. It assessed the occurrence of TSH after LC and examined commonly described risk factors in relation to the TSH location.</p><p><strong>Results: </strong>Among 2 377 patients that underwent LC, the extraction site of the gallbladder was known in 1756 patients. Gallbladder extraction was performed via the umbilical trocar port in 929 (53%) of cases and via the epigastric trocar port in 827 (47%) of cases. TSH repair was required in 36 (2.1%) patients, with a higher incidence in patients with gallbladder extraction through the umbilical trocar port (3.2%) compared to the epigastric trocar port (0.7%), (p < 0.001).</p><p><strong>Conclusion: </strong>The need for operative repair of a TSH after a LC is significantly reduced when the gallbladder is retrieved through the epigastric trocar site port compared to the umbilical trocar site port.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"155"},"PeriodicalIF":2.1,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgeons' prioritization of emergency abdominal surgery and its impact on postoperative outcomes.","authors":"Severin Gloor, Antonio Wyss, Daniel Candinas, Beat Schnüriger","doi":"10.1007/s00423-025-03723-7","DOIUrl":"https://doi.org/10.1007/s00423-025-03723-7","url":null,"abstract":"<p><strong>Background: </strong>Emergency general abdominal surgery (EGS) is associated with high morbidity and mortality. Timely intervention and effective triage systems are crucial to improve outcomes. This study evaluates the impact of surgeons' prioritization and adherence to a triage protocol on postoperative outcomes.</p><p><strong>Methods: </strong>Single-center retrospective analysis of patients undergoing EGS at Bern University Hospital from 03/2015-12/2022. Patients were categorized into four triage levels based on the urgency of surgery (level 1 within 1 h, level 2 within 6 h, level 3 within 12 h, and level 4 within 24 h). \"Protocol violation\" was defined in cases where the delay to surgery exceeded the triage level. Primary endpoint included complications according to Clavien-Dindo classification in patients with versus without \"protocol violation\".</p><p><strong>Results: </strong>A total of 1'947 patients were included. The mean overall delay from admission to surgery was in triage level 1 69.5 ± 127.5 min., in triage level 2 206.5 ± 178.0 min., in triage level 3 350.6 ± 282.6 min. and in triage level 4 693.4 ± 354.8 min.. Triage levels 1 and 2 correlated significantly with increased complication rates compared to triage level 3 and 4 (64% vs. 43% vs. 11% vs. 10%, p < 0.001). Similarly, mortality rates decreased significantly from triage level 1 through 4 (26% vs. 7% vs. 1% vs. 2%, p < 0.001). \"Protocol violation\" occurred in a total of 13% of patients with decreasing proportions from triage level 1 to 4 (37% vs. 13% vs. 12% vs. 0%, p < 0.001). \"Protocol violation\" did not statistically affect overall morbidity and mortality in most of the diagnoses. In patients with intestinal ischemia or abdominal abscesses, mortality was significantly higher in patients with \"protocol violation\". In contrast, in patients suffering from acute inguinal hernias or gastrointestinal bleeding, morbidity was significantly higher in patients without \"protocol violation\". A significantly shorter hospital length of stay (HLOS) was shown in triage level 2 and triage level 3 when patients were treated without \"protocol violation\" (8.6 ± 10.0 days vs. 13.5 ± 17.3 days, p = 0.022 and 5.3 ± 8.7 days vs. 6.4 ± 6.7 days, p < 0.001, respectively).</p><p><strong>Conclusion: </strong>Surgeons' triage levels significantly correlated with mortality and morbidity. Moreover, \"protocol violation\" resulted in higher mortality in patients suffering from mesenteric ischemia and abdominal abscesses and resulted in prolonged HLOS. Further incorporating objective parameters into triage decisions in the EGS population may enhance prioritization accuracy, patient safety and resource utilization.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"153"},"PeriodicalIF":2.1,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time-varying mortality risk after gastrointestinal surgery complicated by postoperative infections: a Danish Nationwide study of 859,766 patients.","authors":"Doruk Orgun, Ask Tybjaerg Nordestgaard, Rasmus Peuliche Vogelsang, Henrik Enghusen Poulsen, Christina Ellervik, Ismail Gogenur","doi":"10.1007/s00423-025-03718-4","DOIUrl":"https://doi.org/10.1007/s00423-025-03718-4","url":null,"abstract":"<p><strong>Purpose: </strong>Postoperative infections are associated with increased mortality risk, but it is unclear if this risk increase persists over time. This study aims to estimate mortality risk associated with postoperative infections at different time-points within the first postoperative year in a nationwide cohort of gastrointestinal surgery patients.</p><p><strong>Methods: </strong>We included all individuals residing in Denmark who underwent gastrointestinal surgery between 1996 and 2018 and were alive at postoperative day 30. For different time-intervals during the one-year follow-up, we calculated mortality rates and cumulative incidences of death for patients with and without 30-day postoperative infections. Time-varying Cox regression analyses estimated the relative mortality risk associated with postoperative infection exposure.</p><p><strong>Results: </strong>Of 859,766 patients (female:49.2%; median age:51 years), 25,126 (2.9%) had at least one 30-day postoperative infection. In patients with or without infections, cumulative incidences of death between postoperative days 30-365 were 13.5% versus 4.7%. Adjusted hazard ratios (HRs) for mortality from postoperative days 30, 91, 181, and 271 until end of follow-up (until postoperative day 365) were 2.25(95% CI:2.13-2.38), 1.88(1.74-2.04), 1.44(1.29-1.62), and 1.11(1.00-1.28) for any postoperative infection compared to no infection (p_{time-interaction}<0.001). The adjusted HRs for mortality for postoperative days 30-365 in patients exposed to different postoperative infection types were: sepsis: 4.38(3.90-4.93), pneumonia: 2.60(2.37-2.85), urinary tract infection: 1.26(1.05-1.52), surgical site infection: 1.16(1.04-1.30).</p><p><strong>Conclusion: </strong>Compared to patients with no infection, patients exposed to 30-day postoperative infections after gastrointestinal surgery had a 2.3-fold risk of mortality at postoperative days 30, and the relative risk of mortality attributed to infection exposure gradually diminished over time.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"152"},"PeriodicalIF":2.1,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cabergoline-induced cerebrospinal fluid fistulae in macroprolactinomas.","authors":"Elvis J Hermann, Sabine Hertz, Makoto Nakamura, Christoph Terkamp, Thomas M Kinfe, Stefan Stolle, Holger Leitolf, Rudolf Fahlbusch, Joachim K Krauss","doi":"10.1007/s00423-025-03722-8","DOIUrl":"https://doi.org/10.1007/s00423-025-03722-8","url":null,"abstract":"<p><strong>Purpose: </strong>Cerebrospinal fluid (CSF) rhinorrhea is a rare complication after dopamine agonist treatment of macroprolactinomas. Up to 90% need surgical repair, however, there are controversial opinions on the necessity of tumor resection upon this occasion. Here we present our long-term follow-up experience in patients who underwent surgical repair of the CSF leak or observation.</p><p><strong>Methods: </strong>We report a series of three patients who presented with cabergoline-induced CSF rhinorrhea with long-term follow-up up to 170 months. Two patients underwent endoscopic transnasal-transsphenoidal surgical repair of CSF rhinorrhea by fat graft and fibrin glue without tumor removal. In another patient, CSF rhinorrhea resolved spontaneously after two weeks without recurrence.</p><p><strong>Results: </strong>All three patients had no recurrence of CSF rhinorrhea during long-term follow-up up to 170 months. One patient with surgical CSF leak repair was asymptomatic with continued medication at long-term follow-up of 116 months. Tumor progression occurred 21 months after CSF leakage repair in another patient after cessation of dopamine agonist treatment and necessitated tumor debulking. The patient with continued medication without surgery had no recurrence of CSF rhinorrhea on long-term follow-up of 170 months.</p><p><strong>Conclusion: </strong>The optimal management of CSF fistulae due to tumor shrinkage of macroprolactinomas after dopamine agonist therapy remains to be defined. Exceptionally, medication-induced CSF fistulae in response to tumor shrinkage may close spontaneously without recurrence. If persistent, transnasal-transsphenoidal closure of CSF fistulae represents an efficient treatment and dopamine agonist treatment may be continued. Thus, we recommend early surgical repair.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"151"},"PeriodicalIF":2.1,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex and age-related implications for preventive measures of intensive care admitted traumatic brain injury patients in Switzerland: an observational study.","authors":"Juliane Fleischer, Giovanna Brandi, Henrik Teuber, Sarah Flückiger, Stefan Y Bögli, Simone Unseld","doi":"10.1007/s00423-025-03720-w","DOIUrl":"https://doi.org/10.1007/s00423-025-03720-w","url":null,"abstract":"<p><strong>Purpose: </strong>Epidemiological studies of traumatic brain injury (TBI) in Switzerland have, to date, poorly investigated sex-related differences in causality and predisposing factors. This study examines differences in sex and age related TBI epidemiology in a high-volume trauma centre intensive care unit (ICU) cohort, aiming to identify potential targets for prevention.</p><p><strong>Methods: </strong>This retrospective, single centre study includes all consecutive TBI patients admitted to the ICU in a 4-year study period. Patient demographics, comorbidities, co-medication, trauma setting and associated risk behaviour were compared between sexes and age groups (over/under 65 years).</p><p><strong>Results: </strong>592 patients (73.3% male, 26.7% female) were included. The leading cause of TBI was falls (52.4%), followed by road traffic accidents (RTA) (35.8%). Overall, men were more likely to suffer from a road traffic accident, while women were more likely to suffer a low energy fall. No differences in injury severity and comorbidities between sexes were observed. Young patients most likely suffered from a RTA while older patients from a low energy fall irrespective of sex. Both sexes portrayed risk associated behaviors with higher rates of alcohol intoxication in males, while females were less likely to wear a helmet in two-wheeled RTAs.</p><p><strong>Conclusions: </strong>We conclude that sex- and age-related epidemiologic differences in TBI exist. Our results suggest that sex and age-specific prevention measures might be advisable for optimal mitigation of TBI and its sequelae.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"150"},"PeriodicalIF":2.1,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12048452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}