Annals of Medicine and Surgery最新文献

{"title":"Causes of hospitalization in systemic lupus erythematosus patients at a tertiary care center: insights from South Asia.","authors":"Ujjwol Prasad Risal, Shreya Shrestha, Mrikchhya Ghimire","doi":"10.1097/MS9.0000000000005708","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005708","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with systemic lupus erythematosus (SLE) often require hospitalization due to disease flares, infections, or other complications. While studies from high-income countries consistently report flares and infections as leading causes, data from South Asia remain limited. This study aimed to identify the leading causes of hospitalization and describe the associated clinical outcomes of patients admitted to a tertiary care center in Nepal.</p><p><strong>Methods: </strong>A descriptive cross-sectional study was conducted at the B.P. Koirala Institute of Health Sciences, Nepal, including all eligible SLE patients (aged >16 years and diagnosed for >3 months using the SLICC 2012 criteria) from November 2023 to November 2024. Demographic, clinical, laboratory, and treatment data were collected. Reasons for hospitalization and in-hospital outcomes were recorded. Data were analyzed using descriptive statistics.</p><p><strong>Results: </strong>Sixty-four patients were included; 93.8% were female, with a mean age of 32.4 ± 11.1 years. SLE flare was the most common cause of hospitalization (56.3%), followed by infection (20.3%). Renal flare accounted for the most flare-related admissions (39.1%), while urinary tract infection and acute undifferentiated fever were the leading infections. Nearly half of the patients (46.9%) were not on any immunosuppressive therapy at admission, and hydroxychloroquine use was suboptimal (67.2%). The mean hospital stay was 5.3 ± 3.0 days. Most patients were discharged in stable condition (95.3%); one required ICU transfer, and one died (1.6%).</p><p><strong>Conclusions: </strong>Renal flares and infections were the most frequent causes of hospitalization in this South Asian SLE cohort, highlighting the need for early recognition and management.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6492-6497"},"PeriodicalIF":1.6,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An elusive diagnosis: pericardial effusion and hypereosinophilia revealing seronegative eosinophilic granulomatosis with polyangitis: a case report.","authors":"Vishal Akula, Zaid Naseer, Norman Bernstein, Aaron Schatz","doi":"10.1097/MS9.0000000000005667","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005667","url":null,"abstract":"<p><p>Eosinophilic granulomatosis with polyangiitis (EGPA) is a small- and medium-vessel necrotizing vasculitis characterized by asthma, eosinophilia, and multiorgan involvement. Cardiac manifestations, though uncommon, are more prevalent in antineutrophil cytoplasmic antibody (ANCA)-negative patients and carry significant morbidity. Diagnosis can be challenging due to variable presentations and the lack of a definitive test. We present a 60-year-old woman with asthma and chronic rhinosinusitis who developed progressive dyspnea and was found to have a large pericardial effusion with tamponade physiology, bilateral pulmonary infiltrates, and marked eosinophilia. She underwent an urgent pericardial window and a lung wedge resection. Lung biopsy revealed eosinophilic vasculitis and eosinophilic pneumonia. Extensive infectious and autoimmune workups, including ANCA testing, was negative. She demonstrated rapid clinical improvement following the initiation of corticosteroids. The combination of asthma, sinus disease, eosinophilia, pulmonary infiltrates, and biopsy findings met the 2022 ACR-EULAR classification criteria for EGPA. She was discharged on high-dose steroids and was later started on mepolizumab for maintenance. This case highlights the diagnostic complexity of EGPA, particularly in ANCA-negative patients with life-threatening features such as cardiac tamponade. It underscores the importance of maintaining a broad differential in patients with systemic eosinophilia. Early recognition, timely immunosuppressive therapy, and multidisciplinary care are critical for improving outcomes and preventing severe complications.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6869-6873"},"PeriodicalIF":1.6,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiologic and clinicopathologic characteristics of nasopharyngeal carcinoma at a tertiary care center in Saudi Arabia.","authors":"Abdullah O Alqthmi, Renad H Alosaimi, Rawaf K Altowairqi, Sali A Sayed, Zainab A Alalqam, Ahmed A Bahaj, Haddad Hussain Alkaf, Jabir Alharbi, Sherif Abdelmonim, Hani Elkhatib, Faisal Albadainah, Maha Alidrisi, Mohammed Y Almaghrabi, Sahal Alzahrani, Ameen Alherabi, Mohammed A Alessa","doi":"10.1097/MS9.0000000000005609","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005609","url":null,"abstract":"<p><strong>Background: </strong>Nasopharyngeal carcinoma (NPC) is rare globally; however, in Saudi Arabia, it is the most common head and neck cancer and the 17th most common cancer overall. This study aimed to describe the epidemiological characteristics, clinical features, and histopathological subtypes of NPC in patients at a tertiary care center in Saudi Arabia.</p><p><strong>Methods: </strong>This retrospective cohort study included 244 patients with histologically confirmed nasopharyngeal carcinoma (NPC) managed at a tertiary referral hospital between January 2014 and June 2024. Demographic characteristics, clinical presentation, risk factors, histopathology, Epstein-Barr virus (EBV) status, and treatment modalities were extracted from medical records and analyzed using SPSS version 23.</p><p><strong>Results: </strong>Among the 244 patients, 75% were male and 25% were female, with the most affected age groups being 50-64 years (39%), followed by those aged ≥65 years (30%). neck mass was the most common presenting symptom (31%). Histopathologically, undifferentiated carcinoma (WHO Type III) was predominant (77%). Most patients were diagnosed at an advanced stage, with 20% at stage III and 56% at stage IV. Smoking, EBV infection, and demographics showed no significant association with any histopathological subtype. Concurrent chemoradiotherapy (CCRT) was the most common treatment modality (37%) followed by induction chemotherapy with CCRT (31%).</p><p><strong>Conclusion: </strong>In Saudi Arabia, NPC predominantly affects older males, with neck masses being the most frequent symptom. Smoking and EBV infection showed no significant association with histopathological subtypes. Most cases were undifferentiated carcinomas (WHO Type III) and diagnosed at advanced stages, highlighting the need for continued surveillance and multicenter studies in Saudi Arabia.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6395-6400"},"PeriodicalIF":1.6,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic disparities in access to care and healthcare expenditures among U.S. adults: evidence from the Medical Expenditure Panel Survey, 2018-2022.","authors":"Kolade O Olatunde","doi":"10.1097/MS9.0000000000005692","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005692","url":null,"abstract":"<p><strong>Background: </strong>Socioeconomic disparities in health insurance coverage, income, and education are well-established determinants of healthcare access and spending in the United States. Less is known about how these disparities manifested during 2018-2022, a period marked by major disruptions to healthcare delivery during the COVID-19 pandemic. This study examined associations of insurance coverage and poverty level with access to care and of educational attainment with healthcare expenditures among U.S. adults.</p><p><strong>Materials and methods: </strong>Medical Expenditure Panel Survey (MEPS) Full-Year Consolidated files from 2018 to 2022 were pooled and analyzed. Survey-weighted logistic regression models were estimated for access-to-care outcomes, adjusting for age, sex, race/ethnicity, and calendar year, while accounting for MEPS's complex survey design. Given the skewed distribution of expenditures, two-part models were used, combining logistic regression for any spending with gamma generalized linear models for expenditures among spenders.</p><p><strong>Results: </strong>Among adults under age 65, uninsured individuals had higher odds of delayed medical care and substantially lower odds of having a usual source of care compared with privately insured adults. Lower poverty levels were associated with progressively worse access outcomes. Educational attainment was strongly related to healthcare spending: adults with lower education were less likely to incur any expenditures, but among spenders, total costs were modestly higher and out-of-pocket spending consistently lower than among adults with a bachelor's degree or higher.</p><p><strong>Conclusion: </strong>Socioeconomic disparities in healthcare access and expenditures persisted during 2018-2022, underscoring the need for policies that expand coverage, strengthen primary care access, and reduce cost-related barriers for disadvantaged populations.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6460-6466"},"PeriodicalIF":1.6,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed-onset central neurotoxic syndrome with predominant cerebellar dysfunction following combined chlorpyrifos and cypermethrin poisoning: a case report.","authors":"Sobin Pant, Dibij Adhikari, Anush Acharya, Sachet Subedi, Jayaram Lamichhane, Bikram Prasad Gajurel","doi":"10.1097/MS9.0000000000005630","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005630","url":null,"abstract":"<p><p>Organophosphate (OP) poisoning typically manifests in three phases: the acute cholinergic crisis, the intermediate syndrome, and OP-induced delayed neuropathy (OPIDN). Delayed central nervous system sequelae with predominant cerebellar dysfunction are exceptionally rare and poorly characterized. We report the case of a woman in her early thirties with a history of chronic alcohol use who ingested a commercial insecticide containing chlorpyrifos (50%) and cypermethrin (2%). Following the resolution of an acute cholinergic crisis and a brief period of cardiac arrest (return of spontaneous circulation within 3 minutes), she demonstrated neurological recovery. However, 21 days post-ingestion, she developed acute-onset gait unsteadiness. Neurological examination revealed predominant cerebellar dysfunction, including limb dysmetria, gaze-evoked nystagmus, and ataxic gait, together with bilateral extensor plantar responses, while cognition remained preserved and there was no evidence of distal motor neuropathy. Neuroimaging (magnetic resonance imaging) was unremarkable, and metabolic, infectious, autoimmune, and hypoxic causes were carefully evaluated, with no supporting evidence identified. The patient showed gradual improvement with supportive care. This case highlights a rare delayed central neurotoxic syndrome distinct from OPIDN. The delayed onset of a central neurotoxic syndrome with predominant cerebellar dysfunction, likely exacerbated by pyrethroid synergism, emphasizes the need for prolonged neurological surveillance in mixed pesticide poisonings, even when initial imaging is normal.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6822-6827"},"PeriodicalIF":1.6,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hydrocele stone presentation and crystallographic analysis: a unique case report.","authors":"Eva Malik, Abdallah El Kasti, Oussama G Nasrallah, Jad Abdul Khalek, Riad Khouzami, Bassel G Bachir","doi":"10.1097/MS9.0000000000005681","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005681","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Hydroceles are typically benign fluid collections around the testes. Rarely, scrotal calculi, or \"hydrocele stones,\" form within the tunica vaginalis, possibly due to chronic inflammation, torsion of the appendix testis, minor trauma, or other mechanisms. These stones are infrequently reported, and cases with detailed crystallographic analysis are exceptionally rare.</p><p><strong>Case presentation: </strong>We present a 43-year-old male with bilateral hydroceles, a history of psoriasis and dyslipidemia, and prior right inguinal hernia repair. Ultrasound revealed a moderate right hydrocele and a small left hydrocele containing a 3 mm echogenic hydrocele stone, later found to measure 5 mm on direct intraoperative measurement. The patient underwent bilateral hydrocelectomy, during which the left hydrocele stone was retrieved. Crystallographic analysis revealed that the stone was composed of 80% calcium carbonate phosphate and 20% calcium carbonate. Postoperative recovery was uneventful.</p><p><strong>Clinical discussion: </strong>Scrotal calculi are generally asymptomatic and often discovered incidentally during imaging or surgery. Their formation may involve inflammation, torsion, trauma, or parasitic infections. Crystallographic analysis provides valuable insights into stone composition, helping to distinguish these rare lesions from other scrotal pathologies.</p><p><strong>Conclusion: </strong>Although hydrocele stones are rare and usually benign, further studies are needed to elucidate their pathogenesis, composition, and prevalence. Reporting such cases contributes to the understanding of this uncommon entity and aids in clinical recognition.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6879-6883"},"PeriodicalIF":1.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood biomarkers and penalized logistic regression for the prediction of complicated appendicitis in children: a retrospective cohort study.","authors":"Masanaga Matsumoto, Yohei Sanmoto, Kouji Masumoto","doi":"10.1097/MS9.0000000000005516","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005516","url":null,"abstract":"<p><strong>Background: </strong>Early preoperative identification of complicated appendicitis in children is important for risk stratification. Several blood biomarkers have been proposed for this purpose, but their performance has rarely been compared directly within the same cohort. We aimed to clarify their relative diagnostic performance and to determine whether combining laboratory parameters using an elastic-net model provides incremental diagnostic value.</p><p><strong>Materials and methods: </strong>This single-center, retrospective observational study included children younger than 16 years who underwent emergency appendectomy between January 2015 and December 2024. Preoperative laboratory parameters and composite biomarkers were evaluated using receiver operating characteristic analyses, and pooled area under the curve (AUC) estimates were calculated after multiple imputation using Rubin's rules. AUC values were interpreted as measures of discriminative performance, with higher values indicating better discrimination. Pairwise AUC comparisons were performed using DeLong's test with Holm adjustment. All analyses were performed using R version 4.5.2.</p><p><strong>Results: </strong>Among 308 patients, 109 (35.4%) had complicated appendicitis. The C-reactive protein (CRP)-to-albumin ratio (CAR) showed the numerically highest AUC among the evaluated biomarkers [0.852; 95% confidence interval (CI), 0.800-0.892], followed by CRP (0.848; 95% CI, 0.795-0.889), chloride (0.817; 95% CI, 0.763-0.860), sodium (0.765; 95% CI, 0.703-0.818), and albumin (0.715; 95% CI, 0.649-0.773). DeLong comparisons showed no significant difference between CAR and either CRP or chloride (<i>P</i> = 0.19 for both), whereas CAR significantly outperformed sodium and albumin (<i>P</i> = 0.02 and <i>P</i> < 0.001, respectively). The elastic-net model achieved a pooled AUC of 0.871 (95% CI, 0.824-0.906) and provided only modest additional discrimination over CAR.</p><p><strong>Conclusion: </strong>CAR showed robust diagnostic performance and may provide a practical balance between accuracy and simplicity for early risk stratification of complicated appendicitis in children. Laboratory-only multivariable modeling provided limited additional value, suggesting that further improvement may require integration of clinical and ultrasonographic findings.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6312-6320"},"PeriodicalIF":1.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute superior mesenteric artery syndrome in a young adult: case report.","authors":"Mohamad Khalife, Mohamad E Haress, Riwa Deghaim, Mustapha El Lakis, Hadeel Ghaddar, Mustafa Saad El Masri","doi":"10.1097/MS9.0000000000005693","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005693","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Superior mesenteric artery (SMA) syndrome is a rare condition (incidence of 0.013%-0.78%) that primarily affects young adults, resulting from duodenal compression between the SMA and the aorta following rapid weight loss and retroperitoneal fat pad depletion. Conservative management succeeds in 70-80% of cases; surgical intervention is required for refractory symptoms.</p><p><strong>Case presentation: </strong>A 21-year-old woman presented with severe abdominal pain, nausea, and bilious vomiting following a 36% weight reduction over 5 months (66-42 kg; body mass index [BMI] 17.48 kg/m²). CT revealed gastroduodenal dilatation with an aortomesenteric angle of 18° (normal 28-65°) and a distance of 4.5 mm (normal 10-34 mm), confirming SMA syndrome. After 4 days of unsuccessful conservative management, laparoscopic surgery was initiated with Strong's procedure. Periduodenal fibrosis caused persistent obstruction, requiring immediate conversion to extracorporeal duodenojejunostomy. Recovery was uncomplicated, with oral intake by postoperative day 6. At the 2-month follow-up, she achieved complete symptom resolution with an 8 kg weight gain (BMI 20.81 kg/m²).</p><p><strong>Clinical discussion: </strong>When Strong's procedure fails due to periduodenal fibrosis, immediate intraoperative conversion to duodenojejunostomy is safe and effective, sparing a malnourished patient a second procedure. Review of 20 surgically managed cases (2011-2025) confirms that most proceed directly to duodenojejunostomy; this fibrosis-driven conversion strategy is infrequently described and offers a practical framework for intraoperative decision-making in high-risk patients.</p><p><strong>Conclusion: </strong>Early surgical consultation is recommended when conservative treatment fails. In malnourished patients with suspected periduodenal fibrosis, preoperative planning should anticipate possible intraoperative conversion; immediate bypass during the same operation avoids a second procedure and its associated morbidity.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6896-6901"},"PeriodicalIF":1.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastric duplication cyst mimicking an adrenal-region cyst: a diagnostic challenge.","authors":"Tong Yang, Wei Huang, Yanming Wang, Xinsheng Wang","doi":"10.1097/MS9.0000000000005646","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005646","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Gastric duplication cysts (GDCs) are rare congenital malformations that may mimic adrenal or retroperitoneal cysts. Misdiagnosis can delay proper management. We report a unique case of a GDC that was misdiagnosed as a left adrenal cyst, with reversible hyperreninemia and indirect hyperbilirubinemia.</p><p><strong>Presentation of case: </strong>A 28-year-old asymptomatic man was incidentally found to have a left adrenal cyst on ultrasound. CT revealed a 4.1 × 5.5 cm non-enhancing unilocular cyst with preserved adrenal structure. Laboratory tests showed elevated upright plasma renin concentration (63.3 pg/mL) and indirect bilirubin (57.6 μmol/L). During laparoscopic excision, a cyst arising from the gastric fundus was identified. Pathology confirmed a non-communicating GDC lined by gastric mucosa and smooth muscle. Three months postoperatively, renin and bilirubin levels normalized.</p><p><strong>Clinical discussion: </strong>Ectopic GDCs in the adrenal region are extremely rare and often misinterpreted radiologically. The postoperative normalization of renin and bilirubin raises a possible association, but the mechanisms remain speculative, and causality cannot be established from this single case. Intraoperative cyst-fluid analysis and multidisciplinary evaluation assist in accurate diagnosis. Complete resection provided definitive diagnosis and a favorable short-term outcome in the present case; however, longer follow-up is required to assess recurrence and sustained biochemical remission.</p><p><strong>Conclusion: </strong>GDC should be considered in adrenal-region cystic lesions with atypical features. Total excision provides both definitive diagnosis and a favorable short-term outcome, although longer surveillance is required.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6828-6833"},"PeriodicalIF":1.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative management of vasoplegic syndrome in cardiac surgery: a narrative review.","authors":"Said Khallikane, Mehdi Didi, Hakim El Baraka, Hatim A El Ghadbane, Mohammed Drissi","doi":"10.1097/MS9.0000000000005611","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005611","url":null,"abstract":"<p><p>Vasoplegic syndrome (VS) is a frequent and potentially life-threatening complication following cardiac surgery with cardiopulmonary bypass (CPB) and is associated with significant morbidity and mortality. It is characterized by persistent hypotension, low systemic vascular resistance, and preserved or elevated cardiac output despite adequate volume resuscitation. This narrative review provides a comprehensive and clinically focused synthesis of current evidence on the pathophysiology, risk factors, diagnosis, and perioperative management of VS. A structured literature search of the PubMed database was conducted, focusing on studies published from 2020 to 2026 and complemented by key landmark trials. The pathophysiology of VS is multifactorial, involving systemic inflammatory activation, excessive nitric oxide production, vasopressin depletion, dysregulation of the renin-angiotensin-aldosterone system, and impaired vascular responsiveness to catecholamines. Major risk factors include preoperative use of ACE inhibitors or angiotensin receptor blockers, impaired cardiac function, prolonged CPB duration, and complex surgical procedures. Early recognition and differentiation from other causes of perioperative shock are essential for timely management. Current therapeutic strategies emphasize a multimodal, physiology-guided approach combining catecholamines with non-adrenergic agents such as vasopressin, methylene blue, hydroxocobalamin, and angiotensin II, particularly in refractory cases. Emerging evidence supports early combination vasopressor strategies to improve hemodynamic stability and reduce catecholamine exposure. However, optimal treatment sequencing and patient selection remain uncertain. A structured, algorithm-based approach integrating early diagnosis, targeted therapies, and advanced hemodynamic monitoring may improve clinical outcomes. Further research is needed to refine diagnostic criteria, identify reliable biomarkers, and establish evidence-based management algorithms for VS in cardiac surgery.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6683-6688"},"PeriodicalIF":1.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}