Annali italiani di chirurgia最新文献

{"title":"The Impact of Timing of Percutaneous Coronary Intervention on the Prognosis of Non-ST Segment Elevation Myocardial Infarction Patients.","authors":"Tianzhu Li, Nimin Lu, Yingxue Dong","doi":"10.62713/aic.3339","DOIUrl":"10.62713/aic.3339","url":null,"abstract":"<p><strong>Aim: </strong>To study the effect of timing of percutaneous coronary intervention (PCI) to prognosis of Non-ST segment elevation myocardial infarction (NSTEMI) patients.</p><p><strong>Methods: </strong>295 Patients were derived from our hospital who were diagnosed as NSTEMI and accepted PCI therapy in 24 hours from admission during March 2017 to May 2020. According to results of coronary angiography, patients with NSTEMI were divided into culprit artery occlusion (CO, n = 117) and non-culprit artery occlusion (N-CO, n = 178) two groups and then according to timing of PCI into three categories: <6 h, 6-12 h and 12-24 h from admission. We defined major adverse cardiovascular events (MACE) in 1 year follow.</p><p><strong>Results: </strong>In this study, with earlier time to PCI, the incidence of MACE was lower in NSTEMI patients with CO. The incidence of MACE was higher in the CO group than in the N-CO group (25.8% vs. 36.8%, p = 0.046). The incidence of MACE was 11.8% in T1 (<6 h) group (n = 50), less than 29.4% in T2 (6-12 h) group (n = 30) and 43.4% in T3 (12-24 h) group (n = 215), with a statistically significant difference (p = 0.044). However, this phenomenon does not occur in N-CO group. As the duration of PCI increased, patient survival decreased progressively over the course of follow-up in NSTEMI with CO (p = 0.048).</p><p><strong>Conclusions: </strong>Our study found that early PCI improves the prognosis of NSTEMI patients with culprit artery occlusion.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 3","pages":"339-344"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639437","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":"Patient-Specific Rods vs Traditional Rods in Surgical Correction of Adult Spinal Deformities: A Case-Matched Study.","authors":"Luigi Aurelio Nasto, Chiara Paolicelli, Angelo Sieczak, Paolo Ulisse, Alessandro Cattolico, Enrico Pola","doi":"10.62713/aic.3367","DOIUrl":"10.62713/aic.3367","url":null,"abstract":"<p><strong>Aim: </strong>Patient specific pre-contoured rods (PSRs) represent a relatively new technological development aimed at improving surgical outcomes and reducing complications in adult spinal deformity surgery. To date, only a limited number of studies have been published comparing PSRs with traditional spinal rods. In this paper, we compare the surgical, imaging, and clinical outcomes of PSRs and traditional spinal rods in a single-center case-matched study.</p><p><strong>Methods: </strong>Thirty cases of adult spinal deformities (ASD) were retrospectively analysed. These included 10 patients who were operated on using UNiD™ (Adaptive Spine Intelligence, MedTronic, Minneapolis, MN, USA) PSRs and 20 operated on using traditional rods from January 2023 to August 2023. Minimum post-surgical follow-up was 6 months. General demographics and standard radiographic parameters, as well as Scoliosis Research Society (SRS)-22, Oswestry Disability Index (ODI) and Short Form Health Survey (SF-12) Scores, were measured at pre-operative examination and at 6-month follow-up. Follow-up imaging data were compared with software-planned correction goals. Intra-operative data and complications were also recorded.</p><p><strong>Results: </strong>Patients in the two groups were matched in terms of age, body mass index (BMI), sex, type and severity of spinal deformity. The magnitude of the coronal deformity (p = 0.812) and preoperative sagittal imbalance (p = 0.845) were similar between the two groups. The number of fused levels (p = 0.439), osteotomies (p = 0.188), implant density (p = 0.880), and surgery duration (p = 0.299) were similar between the two groups. Sagittal correction goals set during preoperative planning were achieved in the PSRs group, with the exception of pelvic tilt (PT) (p = 0.042). In contrast, PT (p = 0.040), L1-S1 lordosis (p = 0.032) and global tilt (GT) (p = 0.001) remained significantly undercorrected in the control group at 6-month follow-up. Clinical outcomes (ODI and SF-12 Scores) and complication rates were similar between the two groups.</p><p><strong>Conclusions: </strong>The use of PSRs improves the achievement of better post-operative spinopelvic alignment in adult spinal deformity surgery. Moreover, no significant differences were noted in terms of complications, operative times, and clinical outcomes compared to traditional spinal rods at 6-month follow-up.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 1","pages":"116-123"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999048","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":"Understanding the Current Practice in Chest Tube Management Following Lung Resection-A Canadian National Survey.","authors":"Fabrizio Minervini, Esther Lau, Housne Begum, Yaron Shargall","doi":"10.62713/aic.3535","DOIUrl":"10.62713/aic.3535","url":null,"abstract":"<p><strong>Aim: </strong>Timing of chest tube removal post lung resection is variable in practice and often based on personal experience rather than evidence. The current practice in chest tube management among thoracic surgeons across Canada is so far unknown. Our primary aim was to assess the current status of chest tube removal in Canada in order to uncover potential shortcomings.</p><p><strong>Methods: </strong>An online anonymous survey was emailed to members of Canadian Association of Thoracic Surgeons in order to better understand the status quo of the chest tubes' removal policy in the different departments preparing the grounds for suggesting a future uniformity. Data were collected and analysed with descriptive statistics. A linear regression analysis was performed in order to understand the factors related to chest tube removal.</p><p><strong>Results: </strong>Sixty responses were received (44.4% response rate). Most surgeons place a single chest tube in both open (75%, 45/60) and minimally invasive lobectomies (93.3%, 56/60). Digital drainage systems are used by half of the surgeons surveyed. A quarter of the respondents report removing chest tubes regardless of drainage output. This practice was independent of the surgeons' number of years in practice (p = 0.127), number of lobectomies performed annually (p = 0.877), proportion of lobectomies performed minimally invasively (p = 0.259), whether digital drainage system is used (p = 0.141) and whether the surgeon is aware of the Enhanced Recovery after Surgery (ERAS) guideline (p = 0.374). Of those who remove chest tubes based on fluid output, thresholds vary widely; a significant proportion (86%, 37/43) uses a volume lower than the 450 mL/24 h threshold set out ERAS. Most respondents (77%) were interested in a clinical trial studying chest tube removal independent of drainage volume.</p><p><strong>Conclusions: </strong>This study demonstrated ongoing diverse practice amongst thoracic surgeons in Canada with regards to post-operative chest tube management, indicating a much-needed area of research.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 1","pages":"69-77"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999053","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":"Prognostic Impact and Safety of Ketorolac Tromethamine in Tibial Plateau Fracture Patients Undergoing Open Reduction and Internal Fixation.","authors":"Kai Lin, Weiping Zheng, Jinyi Zhu, Xiaoyong Zhang, Xinxiang Jiang, Zhenzhong Ding, Zongyao Duan","doi":"10.62713/aic.3895","DOIUrl":"10.62713/aic.3895","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the postoperative analgesic efficacy and safety of ketorolac tromethamine in tibial plateau fracture (TPF) patients undergoing open reduction and internal fixation (ORIF) surgery.</p><p><strong>Methods: </strong>This retrospective cohort study included 194 TPF patients treated at Dongtai People's Hospital between October 2022 and March 2024. Patients meeting the inclusion criteria were divided into two groups: the ketorolac tromethamine group (n = 104), who received ketorolac tromethamine combined with imrecoxib, and the control group (n = 90), who received imrecoxib alone after ORIF. Baseline characteristics, postoperative analgesia (measured using the visual analogue scale (VAS) and Ramsay sedation scores), fracture healing parameters (healing time, alkaline phosphatase (ALP), bone gamma-carboxyglutamate protein (BGP), and collagen type I carboxy-terminal propeptide (PICP), and adverse events were evaluated preoperatively and at hospital discharge.</p><p><strong>Results: </strong>The ketorolac tromethamine group demonstrated significantly lower VAS scores (1 h, p = 0.017; 6 h, p = 0.022) and Ramsay sedation scores (1 h, p = 0.017; 6 h, p = 0.034) after anesthesia recovery compared to the control group. No significant differences between the two groups were observed in fracture healing time, ALP, BGP, or PICP levels (p > 0.05). The incidence of adverse events was comparable between the groups (p > 0.05). Laboratory results, including routine blood tests (neutrophil-to-lymphocyte ratio, p = 0.080; hemoglobin, p = 0.830), liver function tests (alanine aminotransferase (ALT), p = 0.773; aspartate aminotransferase (AST), p = 0.629), and renal function markers (creatinine, p = 0.596; uric acid (UA), p = 0.466; β2-microglobulin, p = 0.605), exhibited no significant differences between the two groups.</p><p><strong>Conclusions: </strong>The combination of ketorolac tromethamine and imrecoxib was more effective than imrecoxib alone in alleviating postoperative pain in TPF patients undergoing ORIF. Ketorolac tromethamine had no significant impact on bone healing, indicating its potential as bone-safe analgesia when combined with imrecoxib.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 3","pages":"329-338"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639415","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 Hypothermia during Laparoscopic or Open Surgery of Colorectal Cancer under General Anesthesia.","authors":"Yi-Hui Tu, Di Zhang","doi":"10.62713/aic.3548","DOIUrl":"10.62713/aic.3548","url":null,"abstract":"<p><strong>Aim: </strong>Colorectal cancer (CRC) is one of the most prevalent malignancies, which is commonly treated with curative surgical resection, often leading to intraoperative hypothermia. Therefore, this study aimed to compare and analyze the risk factors for intraoperative hypothermia associated with laparoscopic and open CRC resections under general anesthesia.</p><p><strong>Methods: </strong>This study included 120 CRC patients admitted between January 2023 and January 2024. Data from these patients were analyzed using logistic regression analysis to investigate the risk factors for hypothermia during CRC surgery. Additionally, surgical indicators such as, intraoperative bleeding volume, number of lymph nodes dissected, and operation time, and serum inflammatory markers like Interleukin-6 (IL-6) and Interleukin-8 (IL-8) were assessed and compared between the two surgical groups.</p><p><strong>Results: </strong>The study group comprised 41 men and 79 women, with a mean age of 52.53 ± 8.90 years and an average body mass index (BMI) of 23.13 ± 3.32 kg/m2. The American Society of Anesthesiologists (ASA) score was measured as 1 for 62 (51.67%) patients and 2 for 58 (48.33%). Among them, 50 patients underwent open surgery, whereas 70 patients were treated with laparoscopic surgery. Gender, laparoscopic surgery, intraoperative fluid infusion volume, prolonged anesthesia, and intraoperative blood transfusion were determined as the independent risk factors for intraoperative hypothermia during CRC surgery under general anesthesia (p < 0.05). The intraoperative bleeding volume was significantly reduced (p < 0.01), with significantly longer operation time (p < 0.05) in patients treated with laparoscopic surgery compared to those with open surgery. However, the two groups had a similar number of lymph nodes dissected. Additionally, the levels of IL-6 and IL-8 in both laparoscopic and open surgery of patients increased significantly after surgery, but the extent of increase in the patients of laparoscopic surgery was significantly lower than that in the patients of open surgery (p < 0.05).</p><p><strong>Conclusions: </strong>In conclusion, gender, surgical approach, intraoperative fluid infusion volume, prolonged anesthesia, and intraoperative blood transfusion are the potential risk factors for hypothermia during laparoscopic radical CRC surgery under general anesthesia.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 1","pages":"108-115"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999052","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":"Desmoid-type Fibromatosis of the Breast: A Case Report.","authors":"Wen-Yong Ren, Hao Su, Wei Guo, Xiao-Min Fu, Yanhong Dou, Jian-Ling Jia, Ai-Ping Shi, Di Wu","doi":"10.62713/aic.3581","DOIUrl":"10.62713/aic.3581","url":null,"abstract":"<p><p>Desmoid-type fibromatosis (DTF) is a rare and locally aggressive benign tumor affecting the breasts. It is characterized by infiltrative growth and local recurrence, though it cannot metastasize. We present the case of a woman in her early 20s diagnosed with a palpable mass within her right breast. Imaging evidence was classified as Breast Imaging Reporting and Data System (BI-RADS) category 4 and above. We performed ultrasound-guided core needle biopsy, and pathological examination revealed hyperplasia of ductal epithelium and lobular tissue. Imaging results suggested a greater likelihood of the mass being malignant; however, pathological outcomes indicated that it was benign, resulting in the decision to perform an extended mastectomy. Postoperative pathological results suggested DTF. However, no further treatment was performed after surgery, and the patient's breast color Doppler ultrasound evaluation 12 months after surgery showed no recurrence or metastasis.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 3","pages":"315-321"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639413","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":"The Early Effects of Nuss Surgery on Cardiopulmonary Function in Patients With Pectus Excavatum.","authors":"Turkan Dubus, Gokce Cangel, Cagri Duzyol","doi":"10.62713/aic.3948","DOIUrl":"https://doi.org/10.62713/aic.3948","url":null,"abstract":"<p><strong>Aim: </strong>Pectus excavatum (PE) is a common congenital chest wall deformity that can impair cardiopulmonary function. While minimally invasive Nuss surgery is widely recognized for its cosmetic benefits, its early effects on cardiopulmonary performance are still unclear. This study aimed to investigate the changes in restrictive breathing patterns and cardiac parameters in the early postoperative period.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 97 patients (26 females, 71 males) treated for pectus excavatum with a Haller index (HI) ≥3.25 at the Department of Thoracic Surgery between October 2008 and July 2020. Spirometric measurements were performed to assess lung function, including forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). Cardiac parameters such as left ventricular ejection fraction (EF) and right ventricular diameter (RVD) were determined using transthoracic echocardiography. The examinations were performed preoperatively and six months postoperatively.</p><p><strong>Results: </strong>Significant improvements were observed in FVC (68.3% to 75.4%, p = 0.01) and EF (55.2% to 62.8%, p = 0.02) after the Nuss surgery, while the changes in FEV1 (p = 0.07) and RVD (p = 0.09) were not statistically significant. A subgroup analysis by HI severity showed that patients with moderate HI (3.25-4.0) had significantly higher preoperative (p = 0.0001) and postoperative (p = 0.0007) FVC, as well as preoperative (p = 0.004) and postoperative (p = 0.002) EF compared to those with severe HI (>4.0). Differences in ∆FVC (p = 0.15) and ∆EF (p = 0.20) between the groups were not statistically significant. Notably, FEV1 showed greater improvement in the moderate group (p = 0.035). An age-based analysis showed that patients under 18 years had significantly higher preoperative (p = 0.003) and postoperative (p = 0.002) FVC and postoperative EF (p = 0.008), though ∆FVC (p = 0.33) and ∆EF (p = 0.25) did not differ between age groups. Although FEV1 increased more in younger patients, this difference was not significant (p = 0.06). Gender-based analysis demonstrated that female patients had significantly higher preoperative (p = 0.02) and postoperative (p = 0.05) FVC, as well as postoperative EF (p = 0.03), compared to male patients. Although some parameters did not reach significance, the trends suggest potential long-term cardiopulmonary benefits.</p><p><strong>Conclusions: </strong>Nuss surgery leads to a significant improvement in FVC and EF, especially in younger patients and those with moderate HI deformities. Although some changes were not statistically significant, the overall trends suggest potential long-term cardiopulmonary benefits. Further studies are needed to confirm these results and evaluate long-term outcomes.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 4","pages":"523-532"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961363","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 Serum Magnesium Level on Arteriovenous Fistula Dysfunction in Patients on Maintenance Hemodialysis.","authors":"Wu-Bin Yao, Yan Shen, Liang-Lan Shen, Xiao-Hua Wang, Hong-Li Yang, Jia-Jia Chen, Lu-Lu Ma, Hua-Xing Huang","doi":"10.62713/aic.3869","DOIUrl":"https://doi.org/10.62713/aic.3869","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the effect of magnesium level on the arteriovenous fistula (AVF) dysfunction in patients on maintenance hemodialysis (MHD).</p><p><strong>Methods: </strong>We selected patients who underwent AVF surgery at The Second Affiliated Hospital of Nantong University from May 2011 to May 2022 and received MHD regularly for over 3 months. Patients were divided into dysfunction and non-dysfunction groups based on their AVF function, with follow-up until 30 November 2022. Retrospective data collection included pre-dialysis general data and clinical laboratory indicators. The magnesium cut-off for AVF dysfunction prediction was determined using the receiver operating characteristic (ROC) curve, and patients were categorized into high and low magnesium groups. AVF survival rates were compared using Kaplan-Meier methods, and the risk of AVF dysfunction and independent risk factors were analyzed with logistic and Cox regressions.</p><p><strong>Results: </strong>In a study of 263 hemodialysis patients with a median age of 61 years, including 164 males (62.4%), 95 developed AVF dysfunction over a median follow-up of 32 months. Two groups of MHD patients were classified based on their AVF function: 95 in the dysfunction group and 168 in the non-dysfunction group. The subjects in the dysfunction group were older than those in the non-dysfunction group. Compared with the non-dysfunction group, the dysfunction group suffered significant reduction in magnesium and creatinine levels (p < 0.05), and significant increase in calcium and hemoglobin levels (p < 0.05). The ROC curve results showed that magnesium = 0.88 mmol/L was the best critical point for predicting AVF dysfunction in MHD patients, with a sensitivity of 68.42% and a specificity of 77.38%. The results of Kaplan-Meier survival analysis showed that the AVF dysfunction in the low magnesium group was significantly higher than that in the high magnesium group (log-rank χ2 = 68.678, p < 0.001). Logistic analysis showed that the low magnesium group was 9.223 times more likely to experience AVF dysfunction than the high magnesium group after adjusting for multiple confounding factors (odds ratio [OR] = 9.223, 95% confidence interval [CI], 4.876-17.445; p < 0.001). After adjusting for multiple confounding factors, multivariate Cox regression analysis suggested that advanced age, low serum magnesium, high serum calcium and high hemoglobin were independent risk factors for AVF failure in MHD patients. The risk in the low serum magnesium group was 4.534 times higher than that in the high serum magnesium group (hazard ratio [HR] = 4.534, 95% CI, 2.633-7.808; p < 0.001).</p><p><strong>Conclusions: </strong>Low serum magnesium is an independent risk factor for AVF dysfunction and can be used as a predictor of AVF dysfunction.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 4","pages":"478-487"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953071","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":"Disseminated Peritoneal Leiomyomatosis: Description of a Case, Radiologic Semiotics and Differential Diagnosis.","authors":"Riccardo Bisi, Aldo Carnevale, Giacomo Feliciani, Melchiore Giganti, Anna Chiara Palo","doi":"10.62713/aic.3751","DOIUrl":"https://doi.org/10.62713/aic.3751","url":null,"abstract":"<p><strong>Aim: </strong>Leiomyomatosis peritonealis disseminata or disseminated peritoneal leiomyomatosis (DPL), is a rare nosological entity characterized by multiple leiomyomas growing within the abdominal region. It is one of the uncommon manifestations of extra-uterine leiomyomas and an eventuality that can lead to diagnostic difficulties, especially in neoplastic patients. This pictorial review aims to illustrate the multimodal characteristics of DPL, providing at the same time relevant information regarding pathogenesis, clinical presentation, and treatment. Furthermore, as DPL may enter in differential diagnosis with other atypical smooth muscle tumour localization or abdominal malignancies, such as retroperitoneal leiomyosarcoma or peritoneal carcinomatosis, the review provides a concise description of each condition: the main epidemiological and pathogenetic aspects are summarized, along with essential information on clinical presentation and radiological imaging, closing with some notes on possible treatment options.</p><p><strong>Case presentation: </strong>A case of incidental detection of DPL in a patient undergoing staging of breast cancer is employed as an example to illustrate the diagnostic difficulties that may be encountered in such scenarios: the finding of multiple vascularized nodules in the abdomen aroused the suspicion of carcinomatous localizations, and the patient underwent in-depth investigations with multiple imaging techniques by ultrasound, computed tomography and magnetic resonance.</p><p><strong>Results: </strong>Using imaging methods with better contrast resolution in the definition of soft tissues made it possible to orient the diagnostic suspicion over DPL, subsequently confirmed by histological evaluation after laparoscopic excision of bigger nodules. Once the possibility of peritoneal localization of breast cancer was excluded, the patient was treated with neoadjuvant therapy, surgery and adjuvant therapy. Follow-up imaging showed no signs of breast cancer recurrence nor significant changes in the remaining DPL nodules.</p><p><strong>Conclusions: </strong>Knowledge of the atypical presentation patterns of leiomyomas, the related imaging characteristics and the differential diagnosis allows both the clinician and the radiologist to formulate more accurate diagnostic hypotheses, thus ensuring better patient management from the view of the subsequent possible invasive diagnostic and therapeutic options.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 4","pages":"451-464"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970393","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":"Surgery of the Primary Tumor in de novo Metastatic Breast Cancer: A Palliative Approach or a Potential Survival Game-Changer?","authors":"Gianluca Franceschini","doi":"10.62713/aic.3928","DOIUrl":"10.62713/aic.3928","url":null,"abstract":"<p><p>Approximately 5-10% of primary breast cancer cases present as de novo stage IV disease, characterized by distant metastases at diagnosis. Traditionally, systemic therapies such as chemotherapy, endocrine therapy and targeted treatments have formed the cornerstone of treatment for metastatic breast cancer (MBC), focusing on disease control, symptom palliation and quality of life improvement. While systemic therapies remain crucial, the role of local treatments, particularly surgery for the primary tumor, is increasingly debated. Historically viewed as a palliative intervention, surgery for the primary tumor aimed to address symptoms such as bleeding, ulceration and pain. However, emerging evidence suggests that surgical resection could offer survival benefits in specific patient subgroups, such as those with limited metastatic burden or bone-only metastases. Retrospective studies and meta-analyses indicate potential survival advantages but randomized trials have produced mixed results. These discrepancies highlight the complexity of surgery's role in MBC management influenced by factors such as cancer subtype, metastatic pattern and systemic treatment response. Personalized treatment strategies are mandatory for optimizing outcomes in de novo MBC. Surgery of the primary tumor should not be universally applied but considered for select patients based on clinical and molecular factors. Collaboration within multidisciplinary teams is essential to integrating surgery into comprehensive care plans. Future research, including nuanced and appropriate clinical trials, is needed to define the role of surgery in prolonging survival and enhancing quality of life for patients with de novo MBC.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 3","pages":"277-281"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639420","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}