BMC Surgery最新文献

{"title":"Abdominal and pelvic surgery in traumatic brain injury patients; a registry-based retrospective analysis.","authors":"Sina Bazmi, Sina Zoghi, Zahra Mohammadi, Ali Ansari, Saeed Shahriari, Amin Niakan, Reza Taheri, Hosseinali Khalili, Shahram Paydar","doi":"10.1186/s12893-025-02998-3","DOIUrl":"10.1186/s12893-025-02998-3","url":null,"abstract":"<p><strong>Background: </strong>Concurrent injuries with traumatic brain injury (TBI) can significantly impact patient prognosis. Abdominal and pelvic injuries accompanying TBI are infrequent and less discussed. We aimed to investigate the characteristics and outcomes of TBI patients who underwent abdominopelvic surgeries.</p><p><strong>Methods: </strong>This cross-sectional study examined TBI patients aged 14 and older admitted to a level-I trauma center between 2016 and 2018. The independent variables were the routinely recorded information for trauma patients by physicians and nurses in the emergency department. The outcome measures were the occurrence of abdominopelvic surgeries in TBI patients, and the functional outcome assessed using the Glasgow Outcome Scale Extended (GOSE) score, classified as favorable or unfavorable outcome groups at discharge and six-month follow-up.</p><p><strong>Results: </strong>1279 patients were included in the analysis. Among them, the overall prevalence of concomitant abdominal or pelvic injuries, including both surgical and non-surgical cases, was approximately 15%, and 93 (7.3%) underwent abdominopelvic surgery. The presence of basilar skull fractures (OR = 1.977,95%CI = 1.106-3.534), the need for decompressive craniectomy (OR = 3.586,95%CI = 1.399-9.194), younger age (OR = 0.982,95%CI = 0.966-0.998), and lower admission blood pressures (OR = 0.973,95%CI = 0.962-0.984) were independently associated with an increased likelihood of requiring abdominopelvic surgeries. Patients who underwent abdominopelvic surgeries were less likely to have a favorable 6-month outcome (OR = 0.526,95% CI: 0.285-0.970). Among surgical subtypes, pelvic surgery was strongly associated with worse outcomes across all endpoints: unfavorable 6-month outcome (OR = 6.016,95% CI: 1.972-18.351), unfavorable discharge outcome (OR = 7.723,95%CI:1.138-52.414), 6-month mortality (OR = 9.342, 95%CI:1.502-58.087), and in-hospital mortality (OR = 12.751,95%CI: 2.183-74.491). Conversely, splenic surgery was associated with reduced odds of unfavorable discharge outcome (OR = 0.174,95% CI: 0.035-0.870).</p><p><strong>Conclusion: </strong>Abdominopelvic surgeries in patients with TBI, particularly pelvic surgeries, are strongly associated with unfavorable functional outcomes and higher mortality. These findings highlight the prognostic importance of specific surgical interventions in polytrauma patients with TBI.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"250"},"PeriodicalIF":1.6,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250531","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":"Efficacy of Chen's pancreaticojejunostomy for patients with soft pancreatic texture and small main pancreatic duct in laparoscopic pancreaticoduodenectomy.","authors":"Yuan Zhu, Jin Yu, Xiaoyun Li, Hongbo Wang, Huapeng Sun, Yongjun Chen, Xiaogang Li, Xiaofeng Liao","doi":"10.1186/s12893-025-02984-9","DOIUrl":"10.1186/s12893-025-02984-9","url":null,"abstract":"<p><strong>Background: </strong>Pancreaticojejunostomy (PJ) is the key step in laparoscopic pancreaticoduodenectomy (LPD), the quality of which directly affects the incidence of postoperative pancreatic fistula (POPF). Soft pancreatic texture and a small main pancreatic duct (MPD) are risk factors for POPF, which also increase surgeons' difficulty with PJ. Chen's pancreaticojejunostomy is simple, feasible, and reproducible. This study aims to evaluate the clinical effects of Chen's pancreaticojejunostomy for patients with soft pancreas texture and a small MPD in LPD.</p><p><strong>Methods: </strong>The clinical data of 112 patients who underwent LPD with Chen's pancreaticojejunostomy in Xiangyang Central Hospital from February 2018 to December 2023 were analyzed retrospectively. Summarize and evaluate the critical clinical indicators and postoperative complications during the perioperative period.</p><p><strong>Results: </strong>All 112 patients successfully underwent LPD. The median operation time was 300 min, the median PJ time was 27 min, and the median intraoperative blood loss was 100 ml. 8 patients (7.1%) had POPF, all of which had grade B POPF, and no grade C POPF occurred. Postoperative mortality was 1.8% (2/112) within 90 days, and no patient died due to POPF. Among 45 cases (40.2%) with soft pancreatic texture, five patients (11.1%) developed POPF. Among 41 patients (36.6%) with a diameter of MPD ≤ 3 mm, four patients (9.8%) developed POPF. The texture of the pancreas and the diameter of MPD did not affect postoperative complications (P > 0.05).</p><p><strong>Conclusions: </strong>Chen's pancreaticojejunostomy is simple, safe and reliable, which is suitable for the condition of soft pancreatic texture or the small MPD.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"248"},"PeriodicalIF":1.6,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250532","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 management of multiple schwannomas scattered on a single peripheral nerve.","authors":"Toshio Kojima, Seiichi Matsumoto, Masanori Saito, Yuki Funauchi, Keiko Hayakawa, Taisuke Tanizawa, Keisuke Ae","doi":"10.1186/s12893-025-02966-x","DOIUrl":"10.1186/s12893-025-02966-x","url":null,"abstract":"<p><strong>Background: </strong>Schwannoma is a common benign tumor. Most schwannomas are sporadic, but approximately 5% of schwannomas are multifocal. Schwannomas are sometimes present in a skip-like pattern on a single continuous peripheral nerve (Multiple schwannomas scattered on a single peripheral nerve: MSSPN). In this study, we present the clinical characteristics of MSSPN in the limbs and propose a treatment strategy based on treatment outcomes.</p><p><strong>Methods: </strong>The medical records of 918 patients diagnosed with schwannoma in the limbs were retrospectively reviewed. Among these cases, multiple schwannomas occurring in a single peripheral nerve and spaced more than 1 cm apart were defined as MSSPN. We investigated the clinical characteristics and surgical outcomes.</p><p><strong>Results: </strong>Seven patients with MSSPN in the limbs were identified, which represented 0.8% of all cases. There were six females and one male, and the mean age was 50 years. The location of MSSPN was the upper limbs in two cases and the lower limbs in five cases. After surgery, among the five cases in which all tumors were enucleated, neurological symptoms worsened in 4 cases, all of which involved deep nerve tumors. The one case among these five cases in which neurological symptoms improved involved a superficial subcutaneous tumor. Neurological symptoms improved in both of the two cases in which only the tumor causing the main complaint was enucleated; both cases involved deep nerve tumors. The average postoperative follow-up was 8 months, and no cases required reoperation or complained of recurrence.</p><p><strong>Conclusion: </strong>This is the first study to address the surgical strategies of multiple schwannomas occurring in a skip-like pattern on a single peripheral nerve. In surgery for MSSPN, selective enucleation of only the most symptomatic tumors may be effective in preventing the worsening of symptoms after surgery.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"249"},"PeriodicalIF":1.6,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250533","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 outcome of pediatric intestinal obstruction in Amhara comprehensive specialized hospitals, September 2024.","authors":"Alazar Tamirat, Jemberu Nigussie, Gebeyaw Biset","doi":"10.1186/s12893-025-02975-w","DOIUrl":"10.1186/s12893-025-02975-w","url":null,"abstract":"<p><strong>Background: </strong>Intestinal obstruction is the most common acute abdominal disorders in children requiring emergency surgical management. Although surgical management remained the best treatment modality for intestinal obstruction, significant subset of children undergoing surgical management experiences unfavorable management outcomes. Unfavorable surgical management outcomes pose substantial impacts in children, their families, and the society. However, there has been limited evidence regarding the surgical management outcomes of intestinal obstruction among children in developing countries lie Ethiopia.</p><p><strong>Objective: </strong>This study aims to assess surgical management outcomes of intestinal obstruction and its associated factors among children aged less than 15 years in eastern Amhara comprehensive specialized hospitals.</p><p><strong>Methods: </strong>Institutional-based cross-sectional study design was employed among 262 children aged less than 15 years. The study participants were selected by simple random sampling techniques after proportional allocation of the sample to the study hospitals. Data was collected using a pretested data collection checklist and it was entered to Epi Data version 4.2 and analyzed using SPSS version 25 software. Variables with p-value of < 0.25 in the bi-variable analysis were entered into multi-variable logistic regression analyses. Finally, variables with p-value < 0.05 were declared to have a significant association with the outcome variable.</p><p><strong>Result: </strong>Two hundred and sixty-two (262) children were included with a response rate of 100%. The finding reveals that nearly one third of children undergoing surgical management for intestinal obstruction (32.1%, 95% CI 26.3, 37.8) experienced unfavorable surgical management outcomes. The study indicated that gangrenous bowel (AOR:4.47, 95%CI:1.8, 11.1), malnutrition (AOR:4.16, 95% CI:1.77, 9.81), length of hospital stays > 7 days (AOR:3.89, 95% CI:1.69, 8.95), delay of surgery > 24 h (AOR:3.27, 95% CI:1.27, 8.42), and duration of surgery > 2 h (AOR:2.61, 95%CI:1.16, 5.88) were the risk factors for unfavorable surgical management outcome of intestinal obstruction.</p><p><strong>Conclusion: </strong>The magnitude of unfavorable surgical outcome is higher than the expected rate nearly one in three children experience unfavorable surgical management outcome following surgical management of intestinal obstruction. The risk factors identified are mainly preventable which includes gangrenous bowel, malnutrition, prolonged hospital stay, delayed surgery after admission, and prolonged duration of surgery. Early identification and treatment of intestinal obstruction is recommended. In addition, implementation of standardized pre and postoperative care protocols will be needed to achieve favorable surgical management outcome.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"245"},"PeriodicalIF":1.6,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12139283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227365","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":"Efficacy of high-dose estrogen and progesterone sequential assisted hysteroscopic cold knife separation versus hysteroscopic cold knife separation alone in the treatment of infertility or amenorrhea caused by severe intrauterine adhesion: a retrospective cohort study.","authors":"Xuke Wang, Jing Han, Yun Song","doi":"10.1186/s12893-025-02964-z","DOIUrl":"10.1186/s12893-025-02964-z","url":null,"abstract":"<p><strong>Introduction: </strong>To investigate the effect of high-dose estrogen and progesterone sequential assisted hysteroscopic cold knife separation surgery on the recovery of uterine cavity morphology in patients with severe intrauterine adhesions (IUA).</p><p><strong>Methods: </strong>This was a retrospective cohort study. A total of 200 patients with severe IUA were selected as the research objects, and the selected period was from August 2020 to August 2023. According to different treatment methods, patients were divided into the surgical group (hysteroscopic cold knife separation surgery, n = 82) and the combined group (high-dose estrogen and progesterone sequential assisted hysteroscopic cold knife separation surgery, n = 118). The clinical effects and menstrual blood loss map (PBAC) scores were compared between the two groups. The uterine cavity shape recovery was observed before treatment and 2 months after treatment. Multivariate Logistic regression analysis was used to analyze the influencing factors.</p><p><strong>Results: </strong>Compared with 79.27% in the surgical group, the effective rate of the combined group was 94.07%, which was higher (χ² = 0.035, P = 0.002). PBAC score in the combined group was significantly lower than that in the surgical group (t = 4.594, P < 0.001). After intervention, the intimal thickness, intimal volume and volume of the combined group were higher than the surgical group (t = 7.608, P < 0.001;t = 8.044, P < 0.001; t = 11.372, P < 0.001). The re-adhesion rate of the combined group was 11.02%, which was significantly lower than 29.27% of the surgical group (χ² = 10.689, P = 0.002). Compared with 6.10% and 89.02% of pregnancy rate and satisfaction rate in the surgical group, the pregnancy rate was 20.34% and the satisfaction rate was 97.46% in the combined group, which were significantly higher (χ² = 7.915, P = 0.005; χ² = 6.101, P = 0.014). Postoperative amenorrhea (OR = 1.970, 95%CI: 1.278-3.037), number of miscarriages (OR = 1.775, 95%CI: 1.344-2.344), standardized use of estrogen (OR = 1.519, 95%CI: 1.119-2.063), number of intrauterine operations (OR = 1.766, 95%CI: 1.162-2.686), and placement of balloons (OR = 3.264, 95%CI: 1.788-5.960) were independent risk factors for recurrence of IUA after treatment (P < 0.05). Besides, combination therapy (OR = 0.454, 95%CI: 0.283-0.730) was a protective factor (P < 0.05).</p><p><strong>Conclusion: </strong>In the treatment of severe IUA, high-dose estrogen and progesterone sequential assisted hysteroscopic cold knife separation surgery can promote the recovery of uterine cavity morphology, reduce the incidence of postoperative IUA, and improve the postoperative pregnancy rate of patients. This was a retrospective study with limitations such as single sample and short follow-up time. Prospective studies with extended follow-up are needed.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"246"},"PeriodicalIF":1.6,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12139059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235713","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":"Clinicopathological-based nomogram prediction and molecular characterization of postoperative recurrence in clinical T1 clear cell renal cell carcinoma.","authors":"Zhao Yang, Keruo Wang, Haowen Chang, Songyang Li, Hongli Zhang, Yilei Lu, Jiaming Zhang, Kangkang Liu, Yuanjie Niu, Zhiqun Shang","doi":"10.1186/s12893-025-02991-w","DOIUrl":"10.1186/s12893-025-02991-w","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to develop and validate a nomogram for predicting recurrence-free survival (RFS) in clinical T1 (cT1) clear cell renal cell carcinoma (ccRCC) following nephrectomy. Additionally, it explored transcriptional profiles across distinct risk groups.</p><p><strong>Methods: </strong>Data from 2,492 cT1 ccRCC patients who underwent nephrectomy at The Second Hospital of Tianjin Medical University were analyzed. Univariate and multivariate Cox proportional hazards regression analyses were conducted to identify independent predictors of RFS. A nomogram was constructed and validated using a training cohort (n = 1744) and an internal validation cohort (n = 748). Model performance was evaluated using the concordance index (C-index), calibration plots, receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and Kaplan-Meier survival curves. An external validation was performed using The Cancer Genome Atlas (TCGA) ccRCC dataset. Furthermore, Cox-Lasso regression analysis was applied to identify risk-associated genes in the high-risk group.</p><p><strong>Results: </strong>Age, surgical margin status, Fuhrman grade, and pT3a upstage were identified as independent predictors. The areas under the ROC curve (AUC) for 3-year and 5-year RFS were 0.748 and 0.762 in the training cohort; 0.777 and 0.776 in the internal validation cohort; and 0.706 and 0.746 in the external validation cohort. Kaplan-Meier analysis showed significant differences in RFS between low- and high-risk groups across all cohorts (p < 0.0001, p < 0.0001, p = 0.0010, respectively). Nine genes, including MMP13, ITPKA, ATG9B, and CACNA1B, were identified as poor prognosis markers.</p><p><strong>Conclusions: </strong>We developed and validated a robust nomogram for predicting RFS in cT1 ccRCC patients after nephrectomy, offering valuable insights for individualized patient management.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"247"},"PeriodicalIF":1.6,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12139270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235712","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":"Management of recurrent aggressive vertebral hemangiomas: a comparative study of piecemeal intralesional spondylectomy and modified total en bloc spondylectomy.","authors":"Dongjie Jiang, Zihuan Zhou, Qi Zhang, Shaohui He, Haitao Sun, Xiaopan Cai, Tielong Liu, Xinghai Yang, Haifeng Wei, Jianru Xiao","doi":"10.1186/s12893-025-02942-5","DOIUrl":"10.1186/s12893-025-02942-5","url":null,"abstract":"<p><strong>Background: </strong>The management of recurrent aggressive vertebral hemangiomas (AVHs) with neurological deficits poses a challenge due to their profuse vascularization and propensity for recurrence. The optimal approach to managing recurrence AVHs remains a topic of debate within the academic community.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on a cohort of patients who experienced recurrent AVH in the thoracic and lumbar spine at our institution from August 2015 to July 2022. A total of 31 patients, underwent treatment with either piecemeal intralesional spondylectomy (PIS) or modified total en bloc spondylectomy (MTES). Clinical documentation and surgical outcomes, including pre- and postoperative neurological function assessed by the American Spinal Injury Association (ASIA) score, Numeric Rating Scale (NRS), surgical duration, blood loss, recurrence rate, and complications, were retrospectively presented and analyzed.</p><p><strong>Results: </strong>The study followed a cohort of 16 males and 15 females with recurrent AVHs in the thoracic or lumbar spine for a period ranging from 12 to 106 months. All patients presented with neurological deficits, with 20 patients undergoing PIS and 11 patients undergoing one-stage MTES. Both treatment modalities resulted in significant reductions in pain-NRS and ASIA scores. The MTES group experienced less intraoperative blood loss compared to the PIS group. During the follow-up period, four patients in the PIS group experienced recurrence. No serious complications or evidence of internal fixation failure were observed.</p><p><strong>Conclusions: </strong>The modified TES technique presents a comprehensive resection, less blood loss, lower incidence of recurrence, and effective tumor control for recurrent AVHs in thoracic and lumbar spine through post-only approach.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"242"},"PeriodicalIF":1.6,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217382","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":"Clinical features and nursing strategies of reexploration for hematomas after thyroid surgery: insights from a 7-year single-center study in China.","authors":"Xiuting Zhang, Benling Hu, JiayuXiao, Xuesong Zhang, Jingya Zhang, Liqin Zhu, Yanbing Kuang, Zhiheng Huang, Yujing Weng","doi":"10.1186/s12893-025-02923-8","DOIUrl":"10.1186/s12893-025-02923-8","url":null,"abstract":"<p><strong>Objective: </strong>To explore clinical characteristics of postoperative hemorrhage following thyroid or parathyroid surgery, and to discuss the nursing strategies for its prevention.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on all patients who underwent thyroid or parathyroid surgery from February 2016 to September 2023. The clinical data of patients who experienced postoperative hemorrhage and required reoperation were collected and analyzed.</p><p><strong>Results: </strong>Among the 5579 patients who underwent surgery, 42 patients experienced postoperative hemorrhage and required reoperation. Hemorrhage occurred within 6 h in 19 cases (45.2%) and within 24 h in 35 cases (83.3%). The most common bleeding sites were the anterior cervical muscle group (44.2%) and branches of the superior or inferior thyroid artery (20.9%). Underlying diseases such as hypertension, diabetes, hemophilia, and postoperative activities like neck movements, coughing, vomiting, and drainage tube manipulation were potential risk factors for postoperative hemorrhage. Clinical manifestations of postoperative hemorrhage included neck swelling or tightness, increased drainage fluid with clots, incision bleeding, pain, skin bruising, and worsening dyspnea.</p><p><strong>Conclusion: </strong>Understanding the potential risk factors and characteristics of postoperative hemorrhage in thyroid surgery is crucial for specialized thyroid nursing care, as it can aid in its prevention and treatment.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"241"},"PeriodicalIF":1.6,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217381","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":"Fluorescence by 5-aminolevulinic acid-induced protoporphyrin IX varies in tumor and normal tissues during robot-assisted partial nephrectomy for renal cell carcinoma.","authors":"Takashi Matsuoka, Issei Suzuki, Ryosuke Suzuki, Arinobu Fukunaga, Yoichiro Tohi, Yoshio Sugino, Takuya Okada, Mutsushi Kawakita","doi":"10.1186/s12893-025-02987-6","DOIUrl":"10.1186/s12893-025-02987-6","url":null,"abstract":"<p><strong>Background: </strong>Partial nephrectomy is the gold standard for small renal cell carcinoma (RCC). Robot-assisted partial nephrectomy (RAPN), introduced in 2004, has gained acceptance as a minimally invasive approach. Determining resection margins in complex cases remains a challenge. 5-ALA, a photosensitizer metabolized to protoporphyrin IX (PPIX), induces red fluorescence under blue light, aiding tumor detection. Although effective in other malignancies, its utility in renal tumors is not well established.</p><p><strong>Methods: </strong>Between May 2016 and August 2017, 19 patients underwent RAPN using photodynamic diagnosis (PDD) at our institution with the da Vinci Surgical System Si^®. Patients received 20 mg/kg 5-ALA in 50 mL water orally, 0-12 h before skin incision. Tumor fluorescence was observed with Olympus or Storz camera systems under excitation wavelengths for characteristic red fluorescence during surgery. We evaluated 5-ALA and protoporphyrin IX (PPIX) levels in tumor and normal tissues by high-performance liquid chromatography (HPLC). Statistical analyses were performed using Mann‒Whitney U tests with GraphPad Prism 5. A p-value of less than 0.05 was considered statistically significant.</p><p><strong>Results: </strong>Tumor pathology revealed clear cell RCC in 17 and chromophobe RCC in two cases. Only one clear cell RCC tumor showed fluorescence under excitation wavelengths before renal artery clamping; however, normal peri-tumoral tissues also demonstrated fluorescence. In three cases, including this one, fluorescence was observed in both tumor and normal tissues ex vivo within a dark box. In the ex vivo analysis, two cases exhibited fluorescence in the tumor tissue without fluorescence in the normal tissue, while one exhibited the reverse. Accumulation of 5-ALA and PPIX in resected tissue specimens was measured in six cases. Although statistical significance was not reached due to the small sample size (p = 0.057, Mann-Whitney U test), PPIX concentrations tended to be higher in fluorescence-positive tumors than in fluorescence-negative ones.</p><p><strong>Conclusions: </strong>Both tumors and normal tissues exhibited heterogeneous PPIX levels, limiting margin visualization. While current 5-ALA-PDD was insufficient for guiding resection in RAPN, further optimization may enhance its clinical utility.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"244"},"PeriodicalIF":1.6,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227324","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":"Outcomes of arthroscopic one-stage repair and reconstruction of Schenck II-IV knee dislocations with multiple ligament injuries: a single-center study.","authors":"Shengwen Xiang, Zhen Hu, Zihao Ren, Guangqing Cai, Zhijiang Ao, Weiguo Hu, Yangbo Liu, Xing Li, Licheng Wei","doi":"10.1186/s12893-025-02978-7","DOIUrl":"10.1186/s12893-025-02978-7","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the outcomes of arthroscopic one-stage repair and reconstruction of Schenck II-IV knee dislocations with multiple ligament injuries.</p><p><strong>Methods: </strong>We retrospectively reviewed the data of patients with Schenck II-IV knee dislocations and multiple ligament injuries treated in our hospital during 2019-2022. Patients underwent single-bundle reconstruction of the cruciate ligaments via an arthroscopic all-inside technique, along with repair/reconstruction of the collateral ligaments if necessary, and management of concomitant injuries. Knee joint function was evaluated using the International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner activity score, visual analog scale (VAS) score, and range of motion.</p><p><strong>Results: </strong>All 38 patients (27 men, 11 women; ages, 17-58 years) were followed up for 24-36 months. No postoperative neurovascular or thrombotic complications occurred. For all patients, IKDC (35.76 vs. 83.16, P < 0.001), Lysholm (41.97 vs. 88.63, P < 0.001), Tegner activity (1.18 vs. 6.29, P < 0.001), and VAS scores (3.89 vs.0.21, P < 0.001), and active range of motion (87.08° vs. 126.24°, P < 0.001) were significantly better at the final follow-up than before surgery. The drawer test, Lachman test, pivot shift test, knee varus and valgus stress tests at 0° and 30°, and tibial external rotation test all turned negative after the surgery. Four patients (10.5%) returned to their pre-injury activity levels. All patients achieved grade V muscle strength at 1 year. One patient with preoperative thrombosis underwent anticoagulant treatment and developed no serious complications. A patient with peroneal nerve injury did not experience complications after decompression and postoperative exercises. All meniscus injuries were repaired if indicated.</p><p><strong>Conclusions: </strong>Acute one-stage arthroscopic reconstruction after knee dislocation with multiple ligament injuries yields satisfactory postoperative knee joint function. This surgical technique can be a treatment option for severe knee injuries.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"243"},"PeriodicalIF":1.6,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227364","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}