Annali italiani di chirurgia最新文献

{"title":"Factors Associated With Hyperopic Shift After Phacoemulsification Combined With Intraocular Lens Implantation in Patients With Primary Angle-Closure Glaucoma.","authors":"Junxu Fang, Junming Ye","doi":"10.62713/aic.4816","DOIUrl":"https://doi.org/10.62713/aic.4816","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the factors associated with hyperopic shift (HS) after phacoemulsification (PE) combined with intraocular lens (IOL) implantation in patients with primary angle-closure glaucoma (PACG).</p><p><strong>Methods: </strong>A total of 167 eyes with PACG that underwent PE+IOL were retrospectively included. Postoperative refractive prediction error (RPE) was calculated as the actual postoperative spherical equivalent minus the Barrett-predicted postoperative spherical equivalent. HS (RPE >+0.50 D) was the primary outcome. Group comparisons and univariable logistic regression were performed, followed by receiver operating characteristic (ROC) analyses of selected variables and multivariable logistic regression to identify independent factors.</p><p><strong>Results: </strong>Postoperative HS occurred in 54 eyes (32.3%). ROC curve analysis showed that axial length/corneal radius (AL/CR) ratio, anterior chamber depth (ACD), and white-to-white distance (WTW) showed moderate discriminative ability for postoperative HS, with areas under the curve (AUCs) of 0.779, 0.764, and 0.730, respectively. Multivariable logistic regression analysis showed that higher relative lens position (RLP), AL/CR, and WTW were associated with a lower likelihood of postoperative HS, whereas capsular tension ring (CTR) implantation was associated with a higher likelihood of postoperative HS.</p><p><strong>Conclusions: </strong>Lower RLP, AL/CR, and WTW values and CTR implantation were independently associated with postoperative HS. ROC analyses showed that AL/CR, ACD, and WTW had discriminative ability for HS.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 10","pages":"1903-1911"},"PeriodicalIF":0.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219897","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":"Painless Spontaneous Spinal Epidural Hematoma Mimicking Acute Ischemic Stroke: A Case Report.","authors":"Wenji Zhang, Jun Su, Kewu Wang, Jibo Hu, Houyun Xu","doi":"10.62713/aic.4729","DOIUrl":"https://doi.org/10.62713/aic.4729","url":null,"abstract":"<p><strong>Aim: </strong>Spontaneous spinal epidural hematoma is a rare neurological emergency. Its painless variant is particularly uncommon and can easily be misdiagnosed as acute ischemic stroke, especially in patients receiving anticoagulant therapy. This study aims to enrich the clinical recognition of painless spontaneous spinal epidural hematoma and emphasize its differential diagnosis from acute stroke in high-risk medicated patients.</p><p><strong>Case presentation: </strong>We report a rare case of painless spontaneous spinal epidural hematoma mimicking acute ischemic stroke in a woman in her early 60s receiving anticoagulation and antiplatelet therapies. She initially presented with neck tightness and bilateral limb numbness without pain, followed by transient right hemiplegia and rapid neurological deterioration. Magnetic resonance imaging (MRI) revealed a C4-T2 cervical epidural hematoma causing severe spinal cord compression.</p><p><strong>Results: </strong>The patient underwent emergent C4-C6 laminectomy with partial C7 laminectomy and hematoma evacuation. Despite partial strength recovery, extensive and prolonged cord compression may have contributed to the poor prognosis.</p><p><strong>Conclusions: </strong>Painless spontaneous spinal epidural hematoma is an easily overlooked stroke-mimicking emergency. For patients receiving anticoagulant or antiplatelet therapy who present with acute bilateral limb weakness or stroke-mimicking neurological deficits without typical spinal pain, spontaneous spinal epidural hematoma should be included in the early differential diagnosis to avoid delayed treatment and unfavorable prognosis.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 10","pages":"1766-1772"},"PeriodicalIF":0.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219881","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":"Multidimensional Echocardiographic Parameters Predict Left Ventricular Functional Recovery After Coronary Artery Bypass Grafting.","authors":"Man Zhang, Jun Xia, Xiaoling Wan, Xuejiao Chen","doi":"10.62713/aic.4716","DOIUrl":"https://doi.org/10.62713/aic.4716","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;This study aimed to investigate the predictive value of preoperative and early postoperative echocardiographic parameters for left ventricular function recovery after coronary artery bypass grafting (CABG), and to evaluate the relationship between functional recovery and 1-year clinical prognosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective cohort included 214 patients undergoing first-time elective CABG at The First Affiliated Hospital of Yangtze University between January 2022 and October 2024. Transthoracic echocardiography was performed preoperatively, 3-7 days postoperatively, and at 6 months to evaluate left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), left atrial volume index (LAVI), and ratio of early mitral inflow velocity to early diastolic mitral annular velocity (E/e'). Based on 6‑month LVEF change, patients were divided into recovery (ΔLVEF ≥5%) and non‑recovery (ΔLVEF &lt;5%) groups. Multivariate logistic regression was used to identify independent predictors, and the corresponding models were established and validated. Major adverse cardiovascular events (MACE) were recorded at 1‑year follow‑up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 214 patients enrolled in the study, functional recovery of the left ventricle was observed in 128 individuals, corresponding to 59.8% of the cohort. Multivariate analysis identified several preoperative and procedural variables as independent predictors of functional recovery, including left atrial volume index (LAVI), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left atrial diameter (LAD), Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) score, and the number of graft vessels. Age, preoperative LVEF, and e' velocity were independently associated with lower odds of functional recovery. Global longitudinal strain (GLS) and diabetes history showed no independent predictive value. The clinical-echocardiographic combined model demonstrated excellent discrimination and showed higher discriminative performance than the basic clinical model and conventional echocardiographic model. Subgroup analysis revealed that GLS showed no independent predictive value across all LVEF subgroups (&lt;i&gt;p&lt;/i&gt; &gt; 0.05), whereas LAVI and LAD were significant predictors in patients with LVEF ≥40% (including the 40%-49% subgroup), but showed no predictive relevance in those with LVEF &lt;40%. Early postoperative ΔLVEF predicted 6-month functional recovery with an area under the curve (AUC) of 0.846. After one year of follow‑up, the recovery group exhibited a markedly lower rate of MACE than the non‑recovery group, with left ventricular functional recovery serving as an independent protective factor against MACE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Preoperative structural parameters, including LAVI, LVEDD, LVESD, and LAD, are independent imaging biomarkers for predicting left ventricular f","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 10","pages":"1822-1833"},"PeriodicalIF":0.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219821","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 Adjunctive Mifepristone Pre-treatment on Operative Efficiency and Postoperative Recovery in Cesarean Scar Pregnancy Undergoing Curettage After Uterine Artery Embolization.","authors":"Jiajin Lv, Jiafei Pan, Xiaoxue Weng, Fengyan Huang, Cong Li, Hua Xu, Chunyan Zeng","doi":"10.62713/aic.4535","DOIUrl":"https://doi.org/10.62713/aic.4535","url":null,"abstract":"<p><strong>Aim: </strong>This study aims to evaluate whether short-course mifepristone pre-treatment improves procedural efficiency and early recovery after uterine artery embolization (UAE), followed by dilation and curettage (D&C) for cesarean scar pregnancy.</p><p><strong>Methods: </strong>This retrospective study recruited 108 patients with cesarean scar pregnancy who underwent dilation and D&C between January 2020 and July 2023. Patients were divided into 2 groups according to the pre-treatment approach. The control group (n = 65) received pre-treatment with UAE alone, while the study group (n = 43) received pre-treatment with mifepristone in addition to the treatment used in the control group. The two groups were compared for operative metrics, early recovery, and postoperative adverse events. Serum β-human chorionic gonadotrophin (β-hCG) levels were evaluated upon admission and again on postoperative day 1. Patients were followed for one year to assess pregnancy-related outcomes, and the findings were compared between the two groups.</p><p><strong>Results: </strong>In the study group, the surgery duration was shorter, and the intraoperative blood loss was lower than in the control group (<i>p</i> < 0.05). The length of hospital stay was comparable between the two groups (<i>p</i> > 0.05). Similarly, the incidences of repeat D&C, massive hemorrhage, and re-embolization of the uterine artery were also comparable between groups (<i>p</i> > 0.05). There were no cases of conversion to laparotomy or hysterectomy in either group. At the time of admission, the β-hCG levels in the study group were not significantly different from those in the control group. However, on the first day after the procedure, the β-hCG levels in the study group were lower than those in the control group, but the difference did not reach statistical significance (<i>p</i> = 0.051). The study group had a shorter duration of vaginal bleeding and achieved normal menstrual function earlier than the control group (<i>p</i> < 0.05). The menstrual cycle was comparable between the two groups (<i>p</i> > 0.05). The incidences of fever, gastrointestinal symptoms, abnormal liver function, and intrauterine adhesions were also comparable between the two groups (<i>p</i> > 0.05). Follow-up analysis showed no significant differences between the two groups in subsequent pregnancy or recurrence of cesarean scar pregnancy (<i>p</i> > 0.05). Time to pregnancy was descriptively reported only among patients who achieved pregnancy and was not statistically compared because of the small number of events.</p><p><strong>Conclusions: </strong>Incorporating short-course mifepristone pre-treatment to a standard uterine artery embolization-D&C strategy for cesarean scar pregnancy was associated with shorter operative time and better early recovery profiles, with satisfactory safety outcomes.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 10","pages":"1872-1879"},"PeriodicalIF":0.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219834","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 for Lymphedema After Breast Cancer Surgery: A Prospective Cohort Study Evaluating Axillary Surgical Approaches.","authors":"Bartu Cetin, Berk Goktepe, Safa Vatansever, Levent Yeniay","doi":"10.62713/aic.4710","DOIUrl":"10.62713/aic.4710","url":null,"abstract":"<p><strong>Aim: </strong>Breast cancer-related lymphedema remains a major complication that follows axillary surgery. This prospective study evaluated the effects of axillary surgical techniques and treatment-related factors on the development of lymphedema in patients undergoing breast cancer surgery.</p><p><strong>Methods: </strong>This prospective observational cohort study included 119 patients who underwent breast and axillary surgery for invasive breast cancer between June 2020 and April 2022. Arm volume measurements were recorded preoperatively and during follow-up at 10-15 days, 1-3 months, 6 months, and 1 year postoperatively using a standardized circumferential method. Lymphedema was defined as a ≥10% increase in the volume difference between the operated and contralateral arm relative to the individual baseline inter-arm difference. Demographic, clinical, and treatment-related variables, including the axillary surgical procedure, radiotherapy, chemotherapy, body mass index, and number of removed lymph nodes, were analyzed. Univariate and multivariable logistic regression analyses were performed to identify potential risk factors associated with lymphedema development.</p><p><strong>Results: </strong>Lymphedema developed in 18 (15.1%) of 119 patients. The incidence of lymphedema was significantly higher in patients who underwent axillary lymph node dissection (ALND; 24.4%) than in those who underwent sentinel lymph node biopsy (SLNB; 10.3%, <i>p</i> = 0.040). No significant association was observed between axillary radiotherapy and lymphedema development (<i>p</i> = 0.809). No variables remained statistically significant after multivariable adjustment. However, ALND showed a trend toward an increased risk of lymphedema (odds ratio [OR] 6.14, 95% confidence interval [CI] 0.91-41.49, <i>p</i> = 0.063), whereas neoadjuvant chemotherapy (NACT) showed a trend toward a reduced risk (OR 0.34, 95% CI 0.10-1.19, <i>p</i> = 0.091).</p><p><strong>Conclusions: </strong>In univariable analyses, ALND was associated with a higher occurrence of lymphedema following breast cancer surgery. However, no variable remained statistically significant after multivariable adjustment, likely reflecting the limited number of lymphedema events and the resulting limited statistical power. In this cohort, NACT was not associated with an increased risk of lymphedema. Although exploratory subgroup analyses suggested a lower incidence of lymphedema among patients undergoing SLNB following NACT, these findings should be interpreted cautiously given the limited subgroup size and require confirmation in larger prospective studies. These findings support ongoing efforts to minimize unnecessary axillary dissection whenever oncologically appropriate.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 10","pages":"1856-1863"},"PeriodicalIF":0.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219887","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 Primary Patency Rates and Influencing Factors Between Drug-Coated Balloons and Drug-Eluting Stents in the Endovascular Treatment of Lower Extremity Arteriosclerosis Obliterans.","authors":"Junding Hu, Meng Wang, Xiangxiang Li","doi":"10.62713/aic.4571","DOIUrl":"https://doi.org/10.62713/aic.4571","url":null,"abstract":"<p><strong>Aim: </strong>To compare the 1-year patency rates of drug-coated balloon (DCB) and drug-eluting stent (DES) in the treatment of lower extremity arteriosclerosis obliterans (LEASO), and to systematically analyze the factors influencing post-treatment patency.</p><p><strong>Methods: </strong>This retrospective study included 302 patients with LEASO who received treatment at Fuyang People's Hospital between January 2021 and December 2024. Based on the treatment modality, patients were divided into a DCB group (n = 152) and a DES group (n = 150). Comprehensive baseline demographic, clinical, and procedural data were collected. The 1-year primary patency rates of the two groups were compared using imaging assessment, primarily based on ultrasonography. Independent risk factors affecting patency were identified using a multivariate Cox proportional hazards regression model.</p><p><strong>Results: </strong>The 1-year primary patency rate was 87.5% (133/152) in the DCB group and 89.3% (134/150) in the DES group. No statistically significant difference in the 1-year primary patency rates was observed between the two groups (<i>p</i> > 0.05). Multivariate Cox regression analysis demonstrated that diabetes mellitus, lesion length, and severe calcification were independent risk factors affecting patency after endovascular treatment (all <i>p</i> < 0.05).</p><p><strong>Conclusions: </strong>The 1-year patency rates did not differ significantly between the DCB and DES groups. Diabetes mellitus, long lesion length, and severe calcification were identified as key factors associated with reduced patency rates. Clinical management should emphasize individualized intervention strategies and postoperative management for these high-risk patients.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 10","pages":"1802-1812"},"PeriodicalIF":0.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219879","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 Postoperative Complications and Perioperative Outcomes Between Endoscopic-Assisted and Open Prosthetic Breast Reconstruction: A Retrospective Study.","authors":"Baoyi Huang, Jialun Li, Limei Zhou, Zhidan Chen, Yuanqi Zhang","doi":"10.62713/aic.4862","DOIUrl":"https://doi.org/10.62713/aic.4862","url":null,"abstract":"<p><strong>Aim: </strong>To compare the incidence of complications within 90 days postoperatively and perioperative outcomes between endoscopic-assisted and open prosthetic breast reconstruction.</p><p><strong>Methods: </strong>Data from female patients who underwent total mastectomy and prosthetic breast reconstruction from January 2021 to December 2025 were retrospectively collected. A total of 213 patients were included. Patients were divided into an endoscopic-assisted group (endoscopic group) and an open group according to the surgical approach. Propensity score matching (PSM) was performed at a 1:1 ratio to balance baseline covariates. After PSM, 61 patients were in each group, with balanced baseline characteristics. Intraoperative parameters (operative time, blood loss), postoperative recovery indices (postoperative day 1 drainage volume, drainage duration, length of hospital stay, pain visual analogue scale (VAS) score), patient-reported outcomes (BREAST-Q breast satisfaction, aesthetic score), and complications within 90 days postoperatively were compared between the two groups. Depending on normality test results, continuous variables were analyzed using the <i>t</i>-test or Mann-Whitney U test, and categorical variables using the χ² test or Fisher's exact test.</p><p><strong>Results: </strong>The endoscopic group had longer implant placement time (<i>p</i> < 0.001) and total operative time (<i>p</i> < 0.001) than the open group, but less intraoperative blood loss (<i>p</i> < 0.001). The endoscopic group showed significantly better outcomes in terms of drainage volume on postoperative day 1, drainage duration, hospital stay, and VAS scores on postoperative days 1 and 3 (all <i>p</i> < 0.05). BREAST-Q breast satisfaction (<i>p</i> = 0.004), aesthetic score (<i>p</i> = 0.005), and good or excellent rate (<i>p</i> = 0.028) were higher in the endoscopic group than in the open group. No significant differences were found between the two groups in overall complication rate or any individual complication (all <i>p</i> > 0.05).</p><p><strong>Conclusions: </strong>After balancing confounders with PSM, endoscopic-assisted prosthetic breast reconstruction was associated with longer operative time than the open approach, but it was associated with lower intraoperative blood loss, faster postoperative recovery, less early pain, and higher patient satisfaction and aesthetic scores, with no significant differences observed in 90-day complications between the two groups. The endoscopic-assisted technique showed favorable perioperative outcomes in this cohort, especially suitable for patients with high demands for rapid rehabilitation and aesthetic results.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 10","pages":"1847-1855"},"PeriodicalIF":0.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219856","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":"Multiple-Staged Versus Single-Stage Surgical Excision for the Reconstruction of Congenital Melanocytic Nevi: A Meta-Analysis of Efficacy and Safety.","authors":"Jiansong Yang, Mengzhu Jin, Yun Wu, Zhe Ling, Wenhao Yin","doi":"10.62713/aic.4704","DOIUrl":"10.62713/aic.4704","url":null,"abstract":"<p><strong>Aim: </strong>Systematic evidence comparing multiple-staged and single-stage excision strategies for the excision and reconstruction of congenital melanocytic nevi (CMN) remains limited. Because direct comparative evidence remains scarce, we pooled available studies to determine whether multiple-staged excision differs from single-stage excision in postoperative complications, recurrence, scar outcomes, and satisfaction after CMN reconstruction.</p><p><strong>Methods: </strong>To retrieve comparative evidence on surgical strategies for CMN, a systematic literature search was conducted across PubMed, Embase, the Cochrane Library, Web of Science, CNKI, VIP, and Wanfang databases. The retrieval covered all records available from the establishment of each database through 31 October 2025. The prespecified outcomes were major wound complications, lesion recurrence, cosmetic satisfaction, patient satisfaction, postoperative scar length, and scar width. After eligible studies were selected, relevant data were extracted, methodological quality was assessed, and quantitative synthesis was carried out using Review Manager (version 5.3, Cochrane Collaboration).</p><p><strong>Results: </strong>Seven retrospective cohort studies or clinical controlled studies were included, involving a total of 578 patients. Compared with single-stage excision, multiple-staged excision was associated with a significantly lower incidence of major wound complications (odds ratio (OR) = 0.54, 95% CI 0.30-0.97, <i>p</i> = 0.04), lower recurrence rate (OR = 0.45, 95% CI 0.22-0.93, <i>p</i> = 0.03), shorter scar length (MD = -0.32 mm, 95% CI -0.52 to -0.12, <i>p</i> = 0.002), and narrower scar width (MD = -0.04 mm, 95% CI -0.09 to -0.01, <i>p</i> = 0.04); the upper limit of the 95% CI was rounded to 0.00 by RevMan, while the unrounded value remained below zero. No significant differences were observed between the two groups in cosmetic satisfaction (OR = 1.07, 95% CI 0.64-1.79, <i>p</i> = 0.80) or patient satisfaction (OR = 1.29, 95% CI 0.51-3.29, <i>p</i> = 0.59).</p><p><strong>Conclusions: </strong>This meta-analysis demonstrates that multiple-staged excision significantly reduces the incidence of major wound complications, recurrence rate, and scar dimensions compared with single-stage excision, while showing no significant difference in satisfaction outcomes. These findings suggest that multiple-staged excision may offer advantages in safety and efficacy in the excision and reconstruction of CMN and could be considered a valuable surgical strategy in appropriate clinical settings.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 10","pages":"1748-1756"},"PeriodicalIF":0.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219883","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":"Recurrent Primary Angiosarcoma of the Breast: Challenges and Pitfalls in a Case Report.","authors":"Chiara Valeria Pirrottina, Angela Bucaro, Alejandro Martin Sanchez, Flavia De Lauretis, Niccolo Borghesan, Angela Santoro, Gianluca Franceschini","doi":"10.62713/aic.4777","DOIUrl":"https://doi.org/10.62713/aic.4777","url":null,"abstract":"<p><strong>Aim: </strong>Primary breast angiosarcoma (PBA) is an exceptionally rare and highly aggressive vascular malignancy with poor prognosis, high recurrence rates, and limited evidence guiding management. We report a case of low- to intermediate-grade PBA characterized by multiple local recurrences and systemic progression but unusually prolonged survival, contributing valuable long-term follow-up data to the literature.</p><p><strong>Case presentation: </strong>The patient presented with a breast lesion and cutaneous involvement. Diagnosis was confirmed by histopathological and immunohistochemical findings. The patient underwent skin-reducing mastectomy, followed by radiotherapy and multiple lines of chemotherapy after early recurrence.</p><p><strong>Results: </strong>Despite progressive disease, overall survival reached 102 months from diagnosis, exceeding survival outcomes commonly reported for PBA.</p><p><strong>Conclusions: </strong>This case highlights the aggressive and refractory behavior of PBA, the importance of accurate histopathological diagnosis and multidisciplinary management, and the need for prolonged surveillance because of the high risk of recurrence. Furthermore, the unusually long survival observed in this patient highlights the complexity of disease biology and the potential value of individualized multimodal management strategies, while the contribution of specific treatments to survival remains uncertain.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 10","pages":"1757-1765"},"PeriodicalIF":0.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219842","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":"Diagnostic Value of FAR, CAR, and PNI in Differentiating Benign From Malignant Endometrial Lesions and Assessing High-Risk Pathological Features.","authors":"Jumei Hu, Yu Zhang, Mingjun Shao","doi":"10.62713/aic.4881","DOIUrl":"https://doi.org/10.62713/aic.4881","url":null,"abstract":"<p><strong>Aim: </strong>Benign endometrial lesions and endometrial cancer often overlap in clinical and ultrasonographic features. This study evaluated the ability of the fibrinogen-to-albumin ratio (FAR), C-reactive protein-to-albumin ratio (CAR), and prognostic nutritional index (PNI) to differentiate benign endometrial lesions from endometrial cancer and examined their associations with high-risk pathological features.</p><p><strong>Methods: </strong>This retrospective case-control study included 374 patients with histopathologically confirmed endometrial lesions, comprising 250 benign lesions and 124 endometrial cancers. Receiver operating characteristic (ROC) curves were used to assess discrimination, and a clinical ultrasound model was constructed. PNI, CAR, and FAR were separately added to the model, followed by bootstrap internal validation. Associations with high-risk pathological features were evaluated using Firth logistic regression adjusted for age, body mass index (BMI), and histologic type.</p><p><strong>Results: </strong>Patients with endometrial cancer had lower PNI and higher CAR and FAR levels. The areas under the curve (AUCs) for FAR, PNI, and CAR were 0.820, 0.793, and 0.781, respectively. The clinical ultrasound model had an AUC of 0.863, which increased to 0.918 after adding FAR and remained 0.903 after bootstrap correction. After correction for multiple comparisons, lower PNI and higher FAR were associated with deep myometrial invasion, lymphovascular space invasion, International Federation of Gynecology and Obstetrics stage III-IV, and grade 3 tumors, whereas CAR showed no statistically significant associations.</p><p><strong>Conclusions: </strong>FAR showed the highest observed discriminatory performance among PNI and CAR and provided incremental information beyond the clinical ultrasound model. Prospective multicenter validation is warranted.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 10","pages":"1834-1846"},"PeriodicalIF":0.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219836","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}