Annali italiani di chirurgia最新文献

{"title":"The Significance of Sound Touch Elastography of the Liver and Spleen in Assessing Treatment Efficacy in Budd-Chiari Syndrome.","authors":"Yuqiao Wang, Jiao Lu, Xiaoying Zhuo, Xingtian Wang, Rong Wang, Yumeng Sha, Wenzhong Yang","doi":"10.62713/aic.3992","DOIUrl":"https://doi.org/10.62713/aic.3992","url":null,"abstract":"<p><strong>Aim: </strong>This study aims to evaluate the significance of sound touch elastography (STE) of the liver and spleen in assessing the efficacy of Budd-Chiari syndrome (BCS) by comparing the changes in hepatic and splenic elastic values between healthy individuals and BCS patients before and after interventional therapy.</p><p><strong>Methods: </strong>This study included 229 BCS patients treated in the Interventional Department of the Affiliated Hospital of Xuzhou Medical University between May 2023 and April 2024. However, 45 healthy participants were included as controls. Based on the type of vascular obstruction, the patients were classified into three categories: hepatic venous type (n = 71), inferior vena cava type (n = 115), and mixed type (n = 43). Both the control individuals and BCS patients underwent the liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) at our hospital. Differences in LSM and SSM values were comparatively analyzed between healthy subjects and BCS patients, before and after interventional therapy. Furthermore, the correlation between hepatic and splenic elastic values and the Child-Pugh grades and free hepatic vein pressure (FHVP) was determined across all three BCS subtypes.</p><p><strong>Results: </strong>The LSM and SSM values were significantly lower in the healthy subjects than those observed in BCS patients (p < 0.001). The LSM values in BCS patients at 2 days, 1 month, and 3 months after the procedure were significantly reduced compared to the previous values (p < 0.001, <0.001, =0.044). Furthermore, no statistically significant difference was observed in LSM values determined at 6 and 3 months postoperatively (p = 0.100). Similarly, the SSM value was substantially lower in BCS patients at 2 days postoperatively than the value observed at 2 days preoperatively (p < 0.001). Moreover, ∆LSM1 (LSM at 2 days postoperatively - LSM at 2 days preoperatively) was significantly greater than ∆LSM2 (LSM at 1 month postoperatively - LSM at 2 days postoperatively) (p = 0.024). In contrast, no statistically significant differences were observed between ∆LSM2 and ∆LSM3, or ∆LSM3 and ∆LSM4 (p = 0.752, 1.000). Moreover, there were no significant differences between ∆LSM%1 (∆LSM1/LSM at 2 days preoperatively) and ∆LSM%2 (∆LSM2/LSM at 2 days postoperatively), ∆LSM%2 and ∆LSM%3, or ∆LSM%3 and ∆LSM%4 (p = 0.606, 0.181, 0.891). One month after the procedure, the absolute values of ∆LSM and ∆LSM% were substantially lower in recurrent patients than in non-recurrent patients (p = 0.042, 0.007). Preoperative LSM and SSM were positively correlated with the Child-Pugh grade (r = 0.423, 0.457, p < 0.001), with significant reduction found in FHVP after the procedure (p < 0.001). Preoperative and postoperative LSM and ∆LSM1 were positively correlated with preoperative and postoperative FHVP and ∆FHVP (r = 0.662, 0.595, 0.536, p < 0.001, <0.001, =0.007).</p><p><strong>Conclusions: </strong>The LSM and SSM values ","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 6","pages":"790-799"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301098","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":"Advances in General Surgery With the Hugo™ RAS System: A Monocentric Experience.","authors":"Roberto Cammarata, Vincenzo La Vaccara, Gennaro Melone, Alberto Catamerò, Tommaso Farolfi, Roberto Coppola, Damiano Caputo","doi":"10.62713/aic.3941","DOIUrl":"10.62713/aic.3941","url":null,"abstract":"<p><p>This editorial reviews the early experiences and outcomes associated with the application of the Hugo™ Robotic-Assisted Surgery (RAS) system in general surgical procedures, highlighting its technical advantages and clinical implications. A retrospective analysis of three robotic cholecystectomies and three robotic rectal resections performed with the Hugo™ RAS system was conducted, with a focus on operative times, docking efficiency, and patient outcomes. Key system features and procedural strategies were evaluated. Robotic cholecystectomies demonstrated a significant reduction in docking times and excellent patient outcomes, with no complications and short hospital stays. Robotic rectal resections showcased the system's adaptability for intricate pelvic dissections, achieving clear oncological margins and favorable postoperative recovery. The Hugo™ RAS system proves to be a versatile and cost-effective platform for general surgery, with potential to democratize access to robotic-assisted procedures. Future research is warranted to optimize workflows and validate its benefits across broader surgical.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 5","pages":"568-571"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075021","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":"Advanced Diagnosis and Treatment Methods of High-Pressure Injection Injury: A Single-Center Retrospective Case Series Study.","authors":"Weijie Zhou, Ahmad Alhaskawi, Haiying Zhou, Xiaodi Zou, Sohaib Hasan Abdullah Ezzi, Zewei Wang, Jingtian Lai, Chengjun Yao, Vishnu Goutham Kota, Mohamed Hasan Abdulla Hasan Abdulla, Olga Alenikova, Sahar Ahmed Abdalbary, Hui Lu","doi":"10.62713/aic.3464","DOIUrl":"https://doi.org/10.62713/aic.3464","url":null,"abstract":"<p><strong>Aim: </strong>This article emphasizes the essential role of radiological imaging in high-pressure injection injury (HPII) management and assesses the results of Magnetic Resonance Imaging (MRI) examinations in providing better details about foreign material extension and assisting surgeons in visualizing operational movement during surgery. Additionally, it shares the authors' experience in managing 16 HPII patients and investigates the application of bone cement in the treatment of injection injuries.</p><p><strong>Methods: </strong>Data collection of HPII patients was performed between January 2020 and June 2022 in our department, with 16 HPII patients hospitalized with mild to severe high injection injuries. We presented four cases in detail and briefly summarized all 16 cases. The previously reported HPII cases were also investigated to provide a better conclusion and comparison.</p><p><strong>Results: </strong>MRI examinations can provide vital details about the extent of foreign material extension, helping surgeons achieve better outcomes. Four detailed cases and a summary of 16 cases are presented. The study also found that polyurethane materials were commonly injected with a low amputation rate, and bone cement application was beneficial in reducing inflammation and infection.</p><p><strong>Conclusions: </strong>The study highlights the importance of MRI in diagnosing HPII and the potential benefits of using bone cement to control infections and decrease the number of surgeries. The comprehensive approach described ensures better outcomes and reduces the rate of severe consequences like amputation.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 4","pages":"550-561"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952631","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":"An Explainable Deep Learning Framework for Predicting Postoperative Radiotherapy-Induced Vaginal Stenosis in Surgically Treated Cervical Cancer Patients.","authors":"Hua Han, Honger Zhou, Jing He, Xiang Zhang","doi":"10.62713/aic.4011","DOIUrl":"https://doi.org/10.62713/aic.4011","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;Surgery (e.g., radical hysterectomy) combined with radiotherapy is the mainstay of treatment strategy for locally advanced cervical cancer. However, the beneficial effects of adjuvant radiotherapy are frequently offset by late-onset toxicities, such as vaginal stenosis (VS), which significantly impact patients' quality of life. Although imaging techniques like computed tomography (CT) and magnetic resonance imaging (MRI) are key for both surgical planning and radiotherapy targeting, their ability to predict VS risk before treatment remains limited. This challenge underscores the need for accurate and interpretable predictive models specifically adapted to surgical oncology contexts. This study aims to develop and validate an explainable deep learning framework, integrating Squeeze-and-Excitation (SE) networks and Gradient-weighted Class Activation Mapping (Grad-CAM) visualization, for predicting radiotherapy-induced VS to enable early, personalized intervention strategies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Pre-treatment (i.e., post-surgical, pre-radiotherapy) CT images of cervical cancer patients diagnosed between January 2017 and March 2022 were retrospectively collected. These patients underwent radical hysterectomy (or equivalent surgical resection) followed by radiotherapy. Each patient was categorized as either positive or negative for subsequent VS development. Following normalization and augmentation, we employed a Squeeze-and-Excitation enhanced Inception network (SE-Inception) to distinguish between high- and low-risk cases. Model performance was compared to a conventional Random Forest and a deep learning baseline (ResNet50). Additionally, Grad-CAM visualization was integrated to highlight discriminative image regions for enhanced interpretability and clinical validation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the 140 patients included in the study, 51 developed VS after treatment, representing an incidence rate of 36.4%. The SE-Inception model yielded superior performance (accuracy: 0.93; area under the receiver operating characteristic curve [AUC]: 0.95), surpassing both ResNet50 (accuracy: 0.85; AUC: 0.90) and Random Forest (accuracy: 0.59; AUC: 0.65). Recall and F1 scores also improved markedly, indicating robust sensitivity and precision. Calibration curves demonstrated excellent agreement between predicted and observed risks, while decision curve analysis (DCA) consistently indicated superior net clinical benefits of the SE-Inception model across various threshold probabilities compared to ResNet50 and Random Forest. Grad-CAM consistently localized to anatomically relevant regions correlating with surgeon- and radiologist-identified risk sites, strengthening the clinical interpretability and trustworthiness of the predictive framework.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Taking the surgical context into account, our SE-Inception framework demonstrated enhanced accuracy and interpretability in identifying pati","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 5","pages":"602-616"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075048","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":"Factors Influencing the Indwelling Time of Retrievable Inferior Vena Cava Filters in Fracture Patients With Deep Vein Thrombosis: A Retrospective Cohort Study.","authors":"Guozhu Wei, Wei Sun, Hong Liu, Hong Gao, Yan Lin, Zhengsheng Cai, Jixiang Li, Yajie Gao, Jinhong Yan, Fenqin Chen","doi":"10.62713/aic.4027","DOIUrl":"https://doi.org/10.62713/aic.4027","url":null,"abstract":"<p><strong>Aim: </strong>To investigate factors influencing the indwelling time of retrievable inferior vena cava filters (IVCFs) in fracture patients with deep vein thrombosis (DVT), particularly comparing Denali and Cordis filters and analyzing the impact of thrombus location and patient characteristics.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted from June 2017 to December 2021 at Shenyang Orthopedic Hospital, China. We analyzed 802 patients with fractures and acute DVT who underwent successful IVCF retrieval. Patients were stratified into Denali (n = 360) and Cordis (n = 442) groups, with DVT categorized into four subgroups: above-knee DVT (AKDVT), popliteal vein thrombosis (PVT), below-knee DVT (BKDVT), and mixed DVT (MDVT). The normality of continuous variables was assessed using the Kolmogorov-Smirnov test (p ≥ 0.05). Statistical analyses included Cox regression for hazard ratios (HRs), independent t-tests for normally distributed variables, chi-square tests for categorical variables (e.g., gender, diabetes prevalence), and Mann-Whitney U tests for non-normally distributed variables.</p><p><strong>Results: </strong>A total of 802 patients underwent IVCF insertion and had their filters successfully removed. Significant differences in the indwelling time for AKDVT, PVT, BKDVT, and MDVT were observed between the Denali and Cordis groups (p < 0.001). In the Denali group, the indwelling times for AKDVT, PVT, BKDVT, and MDVT were 58, 67, 42, and 51 days, respectively, while in the Cordis group, the corresponding times were 21, 15.5, 16, and 19 days (p < 0.001). Cox regression analysis revealed that age influenced the indwelling time in the Denali group. In both the Denali and Cordis groups, metabolic factors such as diabetes, hypertension, and blood lipids were not significantly correlated with indwelling time (p > 0.05). Multivariate Cox regression identified that age ≥60 years (adjusted HR = 1.3, 95% confidence interval (CI) = 1.051-1.609, p = 0.016) and BKDVT (BKDVT vs. AKDVT: HR = 1.802, 95% CI = 1.029-3.157, p = 0.039) were predictors of prolonged indwelling time in the Denali group, while PVT (p = 0.943) and MDVT (p = 0.831) showed no significant association.</p><p><strong>Conclusions: </strong>Denali filters require longer indwelling durations than Cordis filters, with age and DVT location (BKDVT) being critical determinants for Denali, whereas only DVT location affects Cordis. Clinicians should tailor follow-up schedules and prioritize early retrieval for Cordis filters to reduce complications. These findings underscore the importance of individualized IVCF management based on filter type and thrombus location.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 5","pages":"654-663"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075370","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":"Nuck Cyst, an Unexpected Amethyst Gem in the Inguinal Canal: A Case Report and Literature Review.","authors":"Agostino Fernicola, Armando Calogero, Giuseppe Palomba, Giusy Petti, Mario Pochet, Martina Sommese, Emanuela Capezio, Andrea Paolillo, Nicola Carlomagno, Michele Santangelo","doi":"10.62713/aic.3924","DOIUrl":"https://doi.org/10.62713/aic.3924","url":null,"abstract":"<p><strong>Aim: </strong>Nuck cyst is rare female saccular hydroceles. It appears at birth or months or years later in adulthood, resulting from imperfect closure of the canal of Nuck. Its diagnosis is often incorrect and confused with an inguinal or femoral hernia because of its extreme rarity. Consequently, surgery often leads to intraoperative surprises. We aim to increase knowledge and awareness of this rare pathology to improve the differential diagnosis of female inguinal masses that have been present for several years and to avoid intraoperative surprises. Therefore, with this study we want to highlight the diagnostic and surgical context of this rare pathology of adult women.</p><p><strong>Case presentation: </strong>We report the case of a 42-year-old woman who came to our attention for swelling and right inguinal pain that had been worsening for over ten years. Intraoperative abdominal ultrasound reported the presence of a hernia defect and the presence of a hypoechoic mass of uncertain nature, probably of lymph node type. The intraoperative diagnosis of a Nuck cyst was histologically confirmed. The patient underwent Nuck cyst removal and right inguinal hernioalloplasty.</p><p><strong>Results: </strong>The patient was discharged without any complications the same evening of surgery intervention. At the 10-day postoperative check-up, she reported the disappearance of all preoperative symptoms. Subsequently, we reviewed the currently available literature on different diagnostic and surgical approaches to treat this pathology. Our surgical approach gave postoperative results consistent with those reported in the literature.</p><p><strong>Conclusions: </strong>Nuck cyst is a rare pathology that should always be suspected in women with decades of inguinal pain. It requires an accurate preoperative diagnosis for a perfect surgical removal intervention.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 5","pages":"589-601"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075390","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":"Therapeutic Efficacy of Percutaneous Vertebroplasty Combined With Gelatin Sponge Filling in Treating Thoracolumbar Fractures: A Retrospective Analysis.","authors":"Juan Zhang, Quan Liu","doi":"10.62713/aic.4020","DOIUrl":"https://doi.org/10.62713/aic.4020","url":null,"abstract":"<p><strong>Aim: </strong>Percutaneous vertebroplasty (PVP) effectively treats thoracolumbar fractures (TLF) but is plagued by post-operative bone cement leakage. Placing a gelatin sponge in the spinal canal can enhance bone cement viscosity and reduce its fluidity, potentially lowering leakage risks. This study explores the clinical efficacy of PVP combined with gelatin sponge implantation in treating TLF and assesses its role in reducing bone cement leakage and associated postoperative complications.</p><p><strong>Methods: </strong>This retrospective analysis included 120 TLF patients who underwent PVP treatment at the Anji Traditional Chinese Medicine Hospital between January 2022 and September 2024. Based on the use of gelatin sponges during the procedure, patients were divided into a control group, which underwent conventional PVP (n = 67), and an observation group, which received PVP combined with gelatin sponge filling (n = 53). The Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI), anterior edge height and Cobb angle of the injured vertebra, and Beck index were comparatively analyzed between the two groups at three-time points: before the operation, 1 day after surgery, and 3 months postoperatively. Furthermore, the rates of bone cement leakage, adjacent vertebral fractures, adverse reactions, and the Generic Quality of Life Inventory-74 (GQOLI-74) scores were compared between the two groups.</p><p><strong>Results: </strong>Compared to the preoperative values, the VAS scores and ODI were significantly improved in both groups at 1 day and 3 months after the procedure (p < 0.001). The anterior edge height, Cobb angle, and Beck index were significantly recovered (p < 0.001). However, these indicators showed no significant differences between the two groups before the operation, 1 day and 3 months after the procedure (p > 0.05). Within one year postoperatively, the incidence rates of bone cement leakage and adverse reactions were substantially reduced in the observation group than in the control group (p < 0.05). However, there was no statistically significant difference in the incidence rate of adjacent vertebral fractures between the two groups (p > 0.05). Furthermore, no difference was observed in the scores of each dimension of GQOLI-74 between the two groups before operation (p > 0.05). One year after the operation, the scores of each dimension of GQOLI-74 elevated in both groups (p < 0.001), with higher scores observed in the observation group (p < 0.05).</p><p><strong>Conclusions: </strong>Compared to PVP alone, PVP combined with gelatin sponge implantation in treating TLF can effectively reduce the incidence of bone cement leakage and associated postoperative adverse reactions while improving overall quality of life one year after surgery.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 5","pages":"634-643"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075584","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 Fast-Track Surgery Based on Nutritional Support in the Rehabilitation of Patients Undergoing Radical Thyroidectomy and Lateral Lymphadenectomy: A Retrospective Analysis.","authors":"Cheng Chen, Xuemei Dong, Shoupeng Zhang, Jun Wu, Junling Zhu","doi":"10.62713/aic.3764","DOIUrl":"10.62713/aic.3764","url":null,"abstract":"<p><strong>Aim: </strong>This study aims to investigate the impact of fast-track surgery (FTS), based on nutritional support, on postoperative rehabilitation and nutritional status in patients undergoing radical thyroidectomy and lateral lymphadenectomy.</p><p><strong>Methods: </strong>This retrospective study included 112 patients who underwent radical thyroid cancer surgery and lateral neck lymph node dissection at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, between April 2021 and April 2023. Based on various nursing methods, patients were divided into two groups, with 58 patients included in the observation group (FTS care based on nutritional support), and 54 patients in the control group (routine perioperative care). Postoperative clinical indicators, nutritional status, Quality of Life, associated complications, and follow-up outcomes at 3 and 12 months were compared between the two groups.</p><p><strong>Results: </strong>Patients in the observation group showed significantly shorter meal times, hospital stays, and off-bed time compared to the control group (p < 0.05). After three months of intervention, the observation group had higher body weight, muscle mass, and body fat, and lower Nutritional Risk Screening (NRS) scores compared to the control group (p < 0.05). At the 12-month follow-up, the observation group had better nutritional status indicators than the control group (p < 0.05). Furthermore, the observation group exhibited higher Quality of Life scores (p < 0.001) and reduced incidence of delayed complications (p < 0.05). During the three-month follow-up, the observation group demonstrated higher Quality of Life Questionnaire Core 30 (QLQ-C30) score compared to the control group (p < 0.05). Additionally, the overall incidence of complications was significantly lower in the observation group (p < 0.05).</p><p><strong>Conclusions: </strong>FTS nursing based on nutritional support effectively promotes postoperative recovery, improves nutritional status, and enhances Quality of Life in patients following radical thyroidectomy and lateral lymphadenectomy, which is worthy of being widely popularized.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 1","pages":"29-39"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999003","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":"Retrieval of Entrapped Embolic Protection Device during Carotid Artery Stenting: A Case Report.","authors":"Gaoyang Fan, Wenyuan Ma, Chunhai Su, Lei Feng, Wenwen Guo","doi":"10.62713/aic.3501","DOIUrl":"10.62713/aic.3501","url":null,"abstract":"<p><strong>Aim: </strong>This study aims to report a rare case of an embolization protection device (EPD) entrapment during Carotid Artery Stent (CAS) and to discuss the management strategy, including open surgery and concurrent carotid endarterectomy (CEA).</p><p><strong>Case presentation: </strong>A 71-year-old female presented with left limb weakness and unclear speech following CAS. Imaging revealed a new cerebral infarction and right internal carotid artery stenosis. The patient underwent endovascular retrieval of the entrapped EPD, which failed, leading to an emergency open surgical procedure.</p><p><strong>Results: </strong>The surgical approach involved a longitudinal incision along the anterior border of the right sternocleidomastoid muscle, followed by carotid artery exposure and temporal artery clamps application. The entrapped EPD and stent were successfully retrieved, and the thrombus was aspirated. Subsequent endarterectomy removed the stenotic plaque, and meticulous washing cleared the carotid arteries. Post-operative indocyanine green fluorescence angiography confirmed patency of the arteries, and the patient was discharged without new neurological symptoms after 11 days of hospitalization.</p><p><strong>Conclusions: </strong>This case underscores the challenges in managing EPD entrapment during CAS and the necessity for a swift transition to open surgical intervention when endovascular techniques fail. The concurrent performance of CEA in such cases offers a comprehensive treatment strategy, highlighting the importance of a multidisciplinary approach in complex vascular interventions.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 1","pages":"7-13"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999051","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":"Comparative Study on the Efficacy and Safety of Emergency Surgery Versus Endoscopic Stent Placement Followed by Definitive Surgery in the Treatment of Colorectal Obstruction.","authors":"Zhekang Jin, Xihan Jin, Jiying Lu","doi":"10.62713/aic.3799","DOIUrl":"10.62713/aic.3799","url":null,"abstract":"<p><strong>Aim: </strong>Tumor-induced acute intestinal obstruction is a severe complication that poses significant threats to patient life. Emergency surgery is a widely used treatment method, but this approach has certain limitations such as high mortality and complication rates. Developments in endoscopic and minimally invasive techniques have provoked interest in postoperative definitive resection or conservative treatment following colorectal stent placement. Hence, this study aims to explore the clinical efficacy and safety of endoscopic-guided, X-ray-assisted intestinal stent placement in colorectal cancer (CRC) with acute intestinal obstruction, and to provide clinicians with viable alternative treatment options to enhance patient care.</p><p><strong>Methods: </strong>This study included 69 CRC patients who received treatment at the Affiliated Jinhua Hospital, Zhejiang University School of Medicine, China, between August 2017 and August 2021. The control group (n = 38) underwent emergency laparotomy with one-stage resection and stoma formation, followed by a postoperative second-stage stoma closure every 3 to 6 months. Moreover, the experimental group (n = 31) underwent endoscopic stent placement followed by definitive surgery. The differences in various indicators were compared between groups. Additionally, the 1-year and 3-year overall survival (OS) rates and disease-free survival (DFS) rates were compared between groups.</p><p><strong>Results: </strong>Successful placement of intestinal stents was achieved in all 31 patients, with acute intestinal obstruction relief within 24 to 48 hours. In the experimental group, stent placement effectively relieved intestinal obstruction, and a postoperative radical colon surgery was performed after 7 to 10 days. The experimental group had significantly lower rates of postoperative ventilator time, reduced time to oral intake, and fewer complication than the control group (p < 0.05). However, no significant differences were observed between groups regarding operation time, intraoperative blood loss, 1-year and 3-year OS rates, and 1-year and 3-year DFS rates (p > 0.05).</p><p><strong>Conclusions: </strong>Compared to emergency surgery, combined endoscopic and X-ray-guided colonic stent placement is an effective and safer method for alleviating acute intestinal obstruction in colorectal cancer. This study provides valuable insights to clinicians in selecting treatment options.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 2","pages":"261-268"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432354","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}