Annali italiani di chirurgia最新文献

{"title":"Risk Factors Predicting Positive Surgical Margins Following Conization and Residual Disease in Subsequent Hysterectomy Among Postmenopausal Women With Cervical Intraepithelial Neoplasia.","authors":"Hui-Jing Ding, Yan-Yan Zhang, Meng Li, Hong-Yan Guo, Kun Zhang, Hao-Jie He, Yu Wu, Shuang Wang, Hai-Yang Xu, Hua-Mao Liang","doi":"10.62713/aic.4075","DOIUrl":"https://doi.org/10.62713/aic.4075","url":null,"abstract":"<p><strong>Aim: </strong>To assess the risk factors for positive margin and residual high-grade lesions after cold knife conization (CKC) in postmenopausal patients.</p><p><strong>Methods: </strong>This retrospective study included a total of 173 postmenopausal patients aged ≥50 years who underwent hysterectomy after CKC at Peking University Third Hospital between September 2012 and February 2023. Statistical analyses were carried out using SPSS 22.0 for Windows. Variables with <i>p</i>-values ≤ 0.05 on univariate analysis were included in multiple logistic regression analysis, which utilized the forward likelihood ratio method.</p><p><strong>Results: </strong>Among the 173 patients, 27.17% (47/173) patients exhibited positive endocervical margins after conization, including seven patients (14.89%) with cervical intraepithelial neoplasia (CIN)2, and 40 patients (85.11%) with CIN3. Independent predictors of positive endocervical margin (> CIN1) were identified, including abnormal ThinPrep cytologic test (TCT) type (> low-grade squamous intraepithelial lesion, LSIL) (odds ratio [OR] = 2.193, 95% CI: 1.058-4.546, <i>p</i> = 0.035). All patients received hysterectomy. Pathological findings of uterine specimens revealed residual CIN2 in 18 patients (10.40%), CIN3 in 18 patients (10.40%), and cervical cancer in 3 patients (1.73%). Endocervical curettage (ECC) results (> CIN1) (odds ratio (OR) = 2.663, 95% CI: 1.049-6.764; <i>p</i> = 0.039) along with endocervical margin status (OR = 6.510, 95% CI: 2.935-14.444; <i>p</i> < 0.001) were identified as significant independent predictors of residual lesions. A regular post-hysterectomy follow-up in 97 patients revealed vaginal intraepithelial neoplasia (VaIN) grade 2/3 in two individuals six months later.</p><p><strong>Conclusions: </strong>CKC can serve as a primary diagnostic modality for high-grade intraepithelial lesions in postmenopausal patients. Although this study did not identify cone height as a risk factor for positive endocervical margins, it is still recommended to maintain sufficient cone height, given that atrophy and upward migration of the cervical transformation zone are common in postmenopausal patients. For menopausal patients with positive endocervical margin, glandular involvement, and abnormal ECC results (> CIN1), immediate treatment such as hysterectomy is recommended.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 7","pages":"905-915"},"PeriodicalIF":0.9,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthetic Effects and Safety of Remimazolam Tosilate in Elderly Patients With Hip Fractures: A Retrospective Cohort Study.","authors":"Jun Liang, Qian Wang, Junliang Wan","doi":"10.62713/aic.4107","DOIUrl":"https://doi.org/10.62713/aic.4107","url":null,"abstract":"<p><strong>Aim: </strong>The aim of this study is to evaluate the anesthetic effectiveness and safety of remimazolam tosilate (RT) compared with propofol in elderly patients undergoing hip fracture surgery.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed clinical data from patients aged ≥60 years who underwent hip fracture surgery between January 2023 and December 2024 at our center. Patients were divided into two groups based on the anesthetic administered: group remimazolam tosilate (RT) (n = 105) and group propofol (P) (n = 115). Anesthetic efficacy outcomes included the time from the start of induction to achieving a bispectral index (BIS) ≤60 and a Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score ≤3, as well as the time from discontinuation of the anesthetic agent to extubation and discharge from the post-anesthesia care unit (PACU). Safety outcomes included assessments of hemodynamic stability and the incidence of adverse events.</p><p><strong>Results: </strong>Both groups achieved comparable sedation efficacy (BIS ≤60, MOAA/S ≤3). Group RT exhibited significantly shorter extubation times (7.04 ± 1.41 min <i>vs</i> 12.50 ± 1.76 min, <i>p</i> < 0.001) and PACU discharge times (25.20 ± 3.06 min <i>vs</i> 38.57 ± 4.30 min, <i>p</i> < 0.001). Intraoperative hemodynamic stability was better in the group RT (<i>p</i> < 0.05); however, the intraoperative use of vasopressors (e.g., phenylephrine, ephedrine) and atropine was comparable between the two groups (<i>p</i> > 0.05 for all). The incidence of injection pain was lower in the group RT (5.71% <i>vs</i> 13.91%, <i>p</i> = 0.043).</p><p><strong>Conclusions: </strong>RT provides effective anesthesia with faster recovery and enhanced hemodynamic stability compared to propofol in elderly patients undergoing hip fracture surgery. Additionally, its lower incidence of injection pain further supports its safety, suggesting that RT is a promising alternative for anesthesia in this patient population.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 7","pages":"973-981"},"PeriodicalIF":0.9,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Hyperparathyroidism: A Case Series, Patient-Centered Approach to Diagnosis and Management Review.","authors":"Adriana Gioia, Clemente Junior Nappi, Martina Socin, Giulia Vallon, Samuele Naviglio, Stella Bernardi, Alessandro Boscarelli, Chiara Dobrinja","doi":"10.62713/aic.3939","DOIUrl":"10.62713/aic.3939","url":null,"abstract":"<p><p>Primary hyperparathyroidism (pHPT) is a prevalent disorder of dysregulated calcium homeostasis, marked by excessive secretion of parathyroid hormone (PTH), which results in alterated calcemia and renal and/or skeletal complications. Most patients are diagnosed before experiencing overt clinical symptoms, often as a result of blood tests performed for other disorders. When symptoms do manifest, they are associated with dysfunction of the parathyroid glands. Surgical treatment is considered the first choice and the only curative treatment for pHPT, offering advantages for both symptomatic and asymptomatic patients. The aim of this study is to report our experience in the management of 6 selected complex cases, which often require a multidisciplinary approach due to the lack of established diagnostic and therapeutic algorithms and the variability of clinical presentation and atypical parathyroid adenoma location. We present a series of cases examining the various treatment approaches in six distinct patients: one patient with parathyroid carcinoma with concomitant parathyroid adenoma, a case involving mediastinal parathyroidectomy, a case with an intrathymic parathyroid adenoma, two cases of recurrent pHPT, and one case of hereditary pHPT in Multiple Endocrine Neoplasia (MEN) 1 syndrome. The combination of parathyroid ultrasound and Tc-99m sestamibi scintigraphy is effective for localizing parathyroid adenomas in most patients. Additional imaging, such as single photon emission computed tomography/computed tomography (SPECT/CT) or 18F-Fluorocholine positron emission tomography/computed tomography (18F-FCH PET/CT), may be necessary in other cases. Intraoperative parathyroid hormone monitoring is valuable for detecting double adenomas in patients affected by hereditary familial hyperparathyroidism from MEN 1. Several studies highlight that the surgeon's expertise is the most critical determinant of a safe and successful surgical outcome.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 7","pages":"878-893"},"PeriodicalIF":0.9,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Anterolateral Thigh Perforator and Peroneal Artery Perforator Flaps in Elderly Patients With Foot Soft Tissue Defects.","authors":"Jingjing Hu, Fei Wang, Jiang Li, Liqi Yi, Jiguo Yang","doi":"10.62713/aic.4048","DOIUrl":"https://doi.org/10.62713/aic.4048","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to explore the efficacy of anterolateral thigh perforator (ALTP) flap and peroneal artery perforator (PAP) flap transplantation and their influence on levels of pain and wound growth factors in elderly patients with soft tissue defects caused by foot trauma.</p><p><strong>Methods: </strong>A total of 98 elderly patients with foot trauma who underwent flap transplantation in the hospital from January 2022 to January 2024 were collected and analyzed retrospectively. Patients were divided into the ALTP group (<i>n</i> = 45, receiving ALTP flap transplantation) and the PAP group (<i>n</i> = 53, receiving PAP flap transplantation). Visual analogue scale (VAS) and American orthopedic foot and ankle society (AOFAS) score were used to assess the pain and functional outcome. Enzyme-linked immunosorbent assay (ELISA) kits were utilized to test the levels of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and hypoxia inducible factor 1 (HIF-1) in wound fluid.</p><p><strong>Results: </strong>The wound size in the ALTP group was larger than that in the PAP group (<i>p</i> < 0.001). Longer operative time, hospitalization time and greater intraoperative blood loss were noted in the ALTP group than in the PAP group (<i>p</i> < 0.001). Linear regression analysis showed that the surgical method was the main factor affecting operative time, hospitalization time and intraoperative blood loss (<i>p</i> < 0.001). The necrosis rate in the ALTP group (13.33%) was higher than that in the PAP group (3.77%), but the difference was not statistically significant (<i>p</i> = 0.176). Compared with the ALTP group, the VAS score of the PAP group was markedly reduced at 3 days and 1 week after surgery, and 1 month after follow-up (<i>p</i> < 0.001). 3 days after surgery, the levels of VEGF and bFGF of the PAP group were significantly increased compared with the ALTP group (<i>p</i> < 0.001). 1 week after surgery, the levels of bFGF of the PAP group were higher compared with the ALTP group (<i>p</i> = 0.003). The total incidence rate of complications in the ALTP group (25/44, 56.82%) was significantly higher than that in the PAP group (7/53, 13.21%) (<i>p</i> < 0.001). And multivariate logistic regression analysis showed that ALTP was the independent influencing factors for complications (<i>p</i> < 0.001). At 6 months after surgery, there was no significant difference in AOFAS scores between the two groups (<i>p</i> = 0.078).</p><p><strong>Conclusions: </strong>ALTP and PAP flap transplantation were both suitable for the reconstruction of soft tissue defects caused by foot trauma in elderly patients, with the latter associated with shorter surgical time and hospitalization time, as well as better wound healing, less postoperative pain and fewer complications.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 7","pages":"924-932"},"PeriodicalIF":0.9,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors and Preventive Measures for Delayed Intracranial Hematoma Following Surgery for Severe Traumatic Brain Injury.","authors":"Cheng Kong, Zhijian Xu","doi":"10.62713/aic.4032","DOIUrl":"https://doi.org/10.62713/aic.4032","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the risk factors and potential preventive measures of delayed intracranial hematoma (DIH) following severe traumatic brain injury (sTBI).</p><p><strong>Methods: </strong>Clinical data from 132 patients with sTBI who underwent decompressive craniectomy between January 2022 and December 2024 were retrospectively analyzed. The control group (102 cases) did not develop delayed intracranial hematoma postoperatively, while the study group (30 cases) experienced DIH. General clinical characteristics were compared between the two groups, and multivariate logistic regression was used to identify risk factors associated with DIH following sTBI.</p><p><strong>Results: </strong>No significant differences were observed in age, sex, pupil changes, prothrombin time, hematoma volume, subdural hematoma, or cerebral contusion between the two groups (<i>p</i> > 0.05). The study group exhibited longer thrombin time (TT) and activated partial thromboplastin time (APTT), higher systolic and diastolic blood pressures, and lower fibrinogen levels (all <i>p</i> < 0.05). A greater proportion of patients in the study group had a Rotterdam computed tomography (CT) score >3, Glasgow Coma Scale (GCS) ≤8, skull fractures, and epidural hematoma (all <i>p</i> < 0.05). Logistic regression analysis identified preoperative Rotterdam CT score >3, GCS ≤8, prolonged TT, elevated diastolic blood pressure (DBP), and systolic blood pressure (SBP) as independent risk factors for postoperative DIH (<i>p</i> < 0.05).</p><p><strong>Conclusions: </strong>Independent risk factors for DIH following decompressive craniectomy in patients with sTBI include a preoperative Rotterdam CT score >3, skull fractures, prolonged TT, and elevated DBP and SBP. Early, targeted preventive strategies and timely interventions for high-risk patients may help reduce the incidence of DIH following sTBI. Larger, multicenter studies are warranted to validate these findings and identify additional contributing factors.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 7","pages":"967-972"},"PeriodicalIF":0.9,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Risk Factors for Perioperative Transfusion in Hip Arthroplasty and Modeling of a Nomogram.","authors":"Huaqin Qiu, Liqun Jiang, Ping Lin, Zhijuan Wei, Xingyan Wang, Junrong Qiu","doi":"10.62713/aic.4077","DOIUrl":"https://doi.org/10.62713/aic.4077","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To investigate the risk factors of perioperative transfusion in hip arthroplasty and to construct a nomogram model to predict the risk of transfusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 120 patients who underwent hip arthroplasty in our hospital from January 2022 to October 2023 were retrospectively selected and classified as training set. According to the same selection criteria, another 50 patients who underwent hip arthroplasty from December 2023 to December 2024 were selected as validation set. All patients' general information, surgical indicators, laboratory indicators, etc., were collected. Logistic regression analysis was performed to identify risk factors for perioperative transfusion. A risk warning scoring model-based nomogram was constructed using Rstudio 4.2.1. The predictive accuracy of the model was evaluated through internal and external validation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the 120 patients in the training set, 34 of them (28.33%) who received perioperative transfusion were categorized into transfusion group, in which 19 patients (15.83%) received intraoperative transfusion whereas 15 (12.50%) received postoperative transfusion. Patients who did not received perioperative transfusion were categorized into non-transfusion group (&lt;i&gt;n&lt;/i&gt; = 86). Compared with subjects in the non-transfusion group, those in the transfusion group were elder, experienced longer surgery, suffered from more severe intraoperative bleeding, and had lower hemoglobin level (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). Multivariate regression analysis showed that age, operation time, and intraoperative hemorrhage were the independent factors, and that hemoglobin level was an independent protective factor for perioperative transfusion in hip arthroplasty. Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) for the combined prediction of age, operation time, intraoperative bleeding, and hemoglobin in the context of perioperative transfusion during hip arthroplasty was 0.940, which was higher than that of individual prediction. The difference between the general information of the training set and validation set was not statistically significant (&lt;i&gt;p&lt;/i&gt; &gt; 0.05). The calibration curves of the nomogram for predicting perioperative transfusion in hip arthroplasty converged to the ideal curve (training set: &lt;i&gt;p&lt;/i&gt; = 0.651, validation set: &lt;i&gt;p&lt;/i&gt; = 0.181). Decision curve analysis (DCA) curves depict a higher positive net benefit for the nomogram in the probability threshold range of 5% to 97%. The AUC of the ROC curve for predicting perioperative transfusion in hip arthroplasty in the training and validation sets were 0.940 (0.916-0.991) and 0.925 (0.879-0.941), respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Age, operation time and intraoperative bleeding are independent risk factors, while hemoglobin level is an independent protective factor for perioperative transfusion in hip arthroplasty. T","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 7","pages":"956-966"},"PeriodicalIF":0.9,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Laparoscopic and Robotic Lateral Lymph Node Dissection for Rectal Cancer: A Systematic Review and Meta-analysis of Short- and Long-term Outcomes.","authors":"Fabio Rondelli, Alessio Lucarini, Giovanni Maria Garbarino, Graziano Ceccarelli, Valentina Tassi, Gioia Brachini, Edoardo Maria Muttillo, Leonardo Di Cicco, Francesco Saverio Li Causi, Alice Ceccacci, Paolo Mercantini, Gianluca Costa","doi":"10.62713/aic.3917","DOIUrl":"10.62713/aic.3917","url":null,"abstract":"<p><strong>Aim: </strong>The importance of lateral lymph node dissection (LLND) for advanced low rectal cancer is still questioned, but selected patients might benefit from this procedure. The purpose of this study was to compare robotic LLND (R-LLND) versus laparoscopic LLND (L-LLND) to identify the safety, feasibility, and advantages of R-LLND.</p><p><strong>Methods: </strong>PubMed, Scopus, and Cochrane databases were searched for studies assessing the benefit of R-LLND over L-LLND. Pooled odds ratios (OR) and weighted mean difference (WMD) were obtained using models with random effects. The risk of bias was evaluated with the Newcastle-Ottawa scale.</p><p><strong>Results: </strong>Six studies were included in our analysis for a total of 652 patients (316 robotic and 336 laparoscopic). The R-LLND group had a longer operative time (WMD 60.46, <i>p</i> = 0.02) and less blood loss (WMD -22.33, <i>p</i> = 0.01). Differences were found in the postoperative length of stays (7 days ± 1.2 and 14 ± 5.2 versus 7 days ± 0.3 and 16 ± 18.5, WMD -1.30, <i>p</i> = 0.03) and in the mean time to regular diet (3 days ± 0.5 and 5 ± 2.3 versus 3 days ± 1.2 and 6 ± 3.8, WMD -0.60 <i>p</i> = 0.01); a slightly higher number of harvested lateral lymph nodes was present in the L-LLND group (WMD 1.23, <i>p</i> = 0.02).</p><p><strong>Conclusions: </strong>Our work demonstrates a slight benefit from the robotic approach when performing LLND in terms of intra- and peri-operative outcomes, despite not reaching statistical significance a trend in favor of robotic surgery is evident in almost all the analyzed topic.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 7","pages":"847-858"},"PeriodicalIF":0.9,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"18 Years Experience of an Italian Breast Unit Among Male Breast Cancer: A Retrospective Observational Study.","authors":"Federico Taraschi, Alessandra Cossa, Stefano Maggi, Augusto Lombardi, Ezio Maria Nicodemi","doi":"10.62713/aic.3888","DOIUrl":"https://doi.org/10.62713/aic.3888","url":null,"abstract":"<p><strong>Aim: </strong>Male breast cancer has increased by approximately 26% over the past 25 years, there is a need to research specific treatment options. Currently, there is no established standard treatment which is therefore based on female disease. The purpose of this study is to analyze the clinical characteristics, survival outcomes, and the need for tailored treatment strategies in male breast cancer patients.</p><p><strong>Methods: </strong>This is an observational, retrospective, single-center clinical study. The research involved 21 male patients who underwent surgery for breast cancer from 2003 to 2020 in our hospital. In order to strengthen the statistical value of the results obtained, the survival curves of three selected studies in the literature were compared with that obtained in the present study.</p><p><strong>Results: </strong>All our patients underwent total mastectomy and axillary lymph node dissection. Twenty patients were diagnosed with invasive ductal carcinoma, while only one patient with invasive lobular carcinoma. The 5-year survival was 71.4% with a median survival for metastatic patients of 5.7 years. A statistically significant difference was found when comparing 5-year survival with one of the other three studies (<i>p</i> = 0.048).</p><p><strong>Conclusions: </strong>Our findings highlight the delayed clinical presentation of male breast cancer and a 5-year overall survival of 71.4%, underscoring the need for targeted screening strategies to improve early diagnosis and outcomes.The lack of knowledge of this disease at sociocultural and health level is the main reason for delay in diagnosis, a factor that strongly affects the prognosis.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 7","pages":"950-955"},"PeriodicalIF":0.9,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiotherapy as an Adjunct to Surgery in the Management of Adult Soft Tissue Sarcomas of the Hand: The First Case Report Using Stereotactic Technology and a Brief Review of Radiation Effects.","authors":"Valentina Zagardo, Gianluca Scalia, Corrado Fichera, Davide Matera, Giuseppe Emmanuele Umana, Gianluca Ferini","doi":"10.62713/aic.3970","DOIUrl":"10.62713/aic.3970","url":null,"abstract":"<p><p>Adult soft tissue sarcomas of the hand are rare, representing approximately 2% of upper extremity tumors. Their indolent growth often leads to misdiagnosis and treatment delays. While amputation has traditionally been the standard approach, advances in limb-sparing techniques, supplemented by radiotherapy, have improved local control and functional preservation. However, radiotherapy in hand sarcomas carries significant risks, including impaired wound healing, fibrosis, stiffness, edema, fractures, and, in rare cases, necrosis and radiation-induced sarcomas. This case-based narrative review is built around an institutional case: an 81-year-old woman with recurrent leiomyosarcoma of the left hand who developed graft necrosis following radiotherapy after R2 resection. Despite initially favorable outcomes, the patient experienced severe skin graft complications, leading to functional impairment and the need for additional wound management. A comprehensive narrative literature review of hand sarcomas treated with radiotherapy highlights the challenge of balancing effective tumor control with minimizing adverse effects. While radiotherapy provides high local control rates, particularly in cases with residual disease, complications such as graft necrosis, as reported here, can significantly affect functional outcomes. The review emphasizes the importance of achieving clear surgical margins, as even modern radiotherapy techniques like volumetric modulated arc therapy (VMAT) guided by stereotactic equipment may fail to prevent complications. Long-term follow-up remains essential to detect and manage late sequelae, with the aim of restoring any compromised function. This case underscores the need for careful patient management and the difficult benefit/risk trade-off associated with radiotherapy when surgery alone is insufficient.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 7","pages":"894-904"},"PeriodicalIF":0.9,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Stepped Rehabilitation Training on Hip Joint Function and Bone Metabolism Markers in Patients Undergoing Hip Arthroplasty.","authors":"Ting Zhang, Xianping Lin, Yang Zhou, Liang Lu, Chengyu Hu, Li Ji","doi":"10.62713/aic.4037","DOIUrl":"https://doi.org/10.62713/aic.4037","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;This study investigates the effects of stepped rehabilitation training on hip joint function and bone metabolism markers in patients undergoing hip arthroplasty (HA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective analysis included 97 patients who underwent HA in our hospital between December 2021 and December 2023. The patients were divided into a control group (52 cases) and an observation group (45 cases) based on different rehabilitation training approaches. The control group received routine nursing and rehabilitation exercises, while the observation group underwent stepped rehabilitation training in addition to the standard care. The surgery-related indicators, hip joint function, bone metabolism-related markers, and quality of life at 1, 2, and 4 weeks of training were compared between the two groups. Repeated-measures analysis of variance (ANOVA) was applied to explore the changes in hip function indexes and bone metabolism-related markers at different time points, and their interactions with the groups were examined. The association between changes in bone metabolism-related markers from baseline to week 4 and corresponding changes in Harris hip scores over the same period was assessed using locally weighted regression scatterplot smoothing (LOWESS) method.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The hip joint range of motion, hip abduction strength arm, Harris hip score, levels of serum bone alkaline phosphatase (BALP), type I collagen amino-terminal lengthening peptide (PINP) and osteocalcin, Barthel index score, and 36-Item Short Form Health Survey (SF-36) scores sequentially increased in both groups at weeks 1, 2, and 4 of the training, with the observation group exhibiting higher values than the control group (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). Levels of type I collagen carboxy-terminal peptide (CTX), intact parathyroid hormone (iPTH), and tartrate-resistant acid phosphatase 5b (TRACP-5b) decreased sequentially in both groups at weeks 1, 2, and 4 of the training, with the observation group demonstrating lower levels than the control group (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). Furthermore, significant differences were observed in the time, inter-group, and interaction effects of hip joint function and bone metabolization-related markers between the two groups during the training period (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). Moreover, a nonlinear association was found between the changes in bone metabolism-related markers from baseline to week 4 and the corresponding changes in Harris hip scores over the same time points. Additionally, there was no statistically significant difference in the total postoperative complication rate between the observation group (6.67%) and the control group (15.38%) (&lt;i&gt;p&lt;/i&gt; = 0.177).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Stepped rehabilitation training can promote hip joint function recovery in patients undergoing hip arthroplasty, improve bone metabolic balance through upregulating osteogenic markers and suppressing osteoclastic activity","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 7","pages":"982-993"},"PeriodicalIF":0.9,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}