Combined Surgery Research Articles

Surgical Outcomes of Rhegmatogenous Retinal Detachment Associated with Regressed Retinopathy of Prematurity.

To evaluate the characteristics and surgical outcomes of late-onset rhegmatogenous retinal detachment (RRD) associated with regressed retinopathy of prematurity (ROP) and the status of fellow eyes. Retrospective review of consecutive cases undergoing surgery for regressed ROP-related RRD and the fellow eyes between 2012-2022. Demographic data, fundus findings, retinal detachment characteristics, surgical procedures, and anatomic and functional outcomes were analyzed. Anatomic success was defined as retinal attachment after silicone oil removal at final follow-up. Fifteen eyes of 14 patients with a history of regressed ROP underwent surgical repair for RRD at a mean age of 12 (range, 3-26) years. Primary surgical intervention yielded a 53% failure rate overall. This rate was 33% for scleral buckling (SB), 100% for pars plana vitrectomy (PPV), and 40% for combined SB-PPV surgery. Eyes with posterior cicatricial changes and/or proliferative vitreoretinopathy (PVR) demonstrated a higher tendency for recurrence. The final anatomic success rate was 73% after a mean number of 2.3 (range, 1-5) surgeries. The chances of restoring useful vision diminished with repeated surgery despite the improvement in anatomic success. In the fellow eyes, peripheral retinal pathologies were universally observed, with posterior cicatricial changes noted in 33%. The study reveals a significant initial failure rate in surgical treatment of cases with late-onset RRD associated with regressed ROP, particularly in eyes with posterior cicatricial changes or PVR, suggesting the need for a combined surgical approach as an initial strategy in such high-risk cases. The consistent presence of retinal abnormalities in fellow eyes calls for proactive monitoring and potential prophylactic intervention.

Initial management of newly diagnosed WHO grade 2-3 adult meningioma following surgery: results from the Dutch Brain Tumour Registry (2016-2021).

Meningiomas classified as grade 2-3 according to the World Health Organisation (WHO) require combined surgery and in most cases radiotherapy (RT). Their initial management was evaluated using the Dutch Brain Tumour Registry. The study included 393 patients aged ≥ 18 years with newly diagnosed meningioma WHO grade 2-3 between 2016 and 2021. Factors associated with adjuvant RT < 6 months following surgery were identified using logistic regression analyses, thereby accounting for variation between CNS regional tumour boards through mixed-effect modelling. This variation was further assessed by funnel plots for case-mix adjusted ratios of RT across tumour boards. The association with patients' survival at 5 years was evaluated with inverse probability-weighted accelerated failure (Weibull) models. Analyses were performed on multiple imputed datasets (m = 10) to account for missing data. Adjuvant RT was administered to 22.2% (59/266) of patients with WHO grade 2 meningioma following a total resection, to 61.1% (58/95) following a partial resection, and to 68.8% (22/32) of patients with WHO grade 3 meningioma (61.5% after partial and 73.7% after total resection). RT was associated with grade 3, partial resection, bone invasion, and absence of multiple lesions. Management varied across tumour boards for grade 2 meningioma following total resection. Adjuvant RT was associated with survival benefit in case of grade 3 disease (hazard ratio: 0.40, 95%-confidence interval: 0.16-0.95, p = 0.04). This national review revealed variation across CNS regional tumour boards in the management of grade 2 meningioma following total resection, and demonstrated survival benefit of adjuvant RT in grade 3 meningioma.

Safety, efficacy, and clinical outcomes of transconjunctival intrascleral fixation of an intraocular lens

BackgroundImplantation of intraocular lens in the capsular bag has become the standard of care in aphakic state. However, in the absence of capsular support, several techniques and intraocular lenses are available. Our study aims to report the safety, efficacy, and clinical outcomes of transconjunctival intrascleral intraocular lens fixation with Yamane’s double-needle technique and flanged haptics.MethodsProspective, observational study with some retrospective data collection. The study enrolled 13 patients (16 eyes) who underwent transconjunctival intrascleral fixation of an intraocular lens with Yamane’s technique between June 2017 and April 2019 at Dhahran Eye Specialist Hospital and King Fahd University Hospital. All patients underwent preoperative and postoperative comprehensive evaluation, including uncorrected and best-corrected vision, intraocular pressure, slit-lamp examination, dilated fundus examination, and ultrasound biomicroscopy. We excluded patients with visually significant coexistent pathology such as retinal diseases, glaucoma, follow-up less than three months, and combined surgery such as keratoplasty.ResultsThe mean preoperative uncorrected visual acuity was 1.50 logMAR, and it improved to 0.60 logMAR. The mean preoperative best-corrected visual acuity was 0.70 logMAR, and it improved to 0.40 logMAR. The median safety index was 2.0, and the median efficacy index was 1.58. The postoperative complications included iris capture by the intraocular lens in one eye (7.7%), haptic extrusion in one eye (7.7%), and transient cornea edema in one eye (7.7%). There were no detected reports during the follow-up period of postoperative retinal detachment, choroidal detachment, elevation of the intraocular pressure (> 25 mmHg), hypotony, hyphema, vitreous hemorrhage, or endophthalmitis.ConclusionsThe transconjunctival intrascleral fixation of an intraocular lens is safe and effective with a short learning curve and was not associated with significant intraoperative or postoperative complications.

The effect of blepharoplasty or blepharoplasty combined with ptosis or eyebrow surgery to quality of life and use of medication related to headache or eyelid skin disease.

The aim of this study is to evaluate the effect of blepharoplasty, ptosis or eyebrow surgery to quality of life and use of medication related to headache or eyelid skin disease. A longitudinal, prospective study including 90 consecutive patients who underwent blepharoplasty, ptosis, eyebrow or combined surgery. The quality of life related to headache was evaluated by HIT6™ and to eyelid skin disease by Skindex-Mini SDM. Use of medication was measured by number of days per week medication was used for headache or eyelid skin disease. Preoperatively 46 (51%) had headache, 4 (4%) eyelid skin and 2 (2%) headache and eyelid skin symptoms. The median HIT-6 difference was -21 (range -36-0; p < .0001) and the median SDM difference was -13 (range = -15 to -1; p = .036). The median difference in medication days/week related to headache was -1 (range -4-0; p < .0001) and to eyelid skin disease -1.5 (range -3 to -1; p = .034). This study shows that after upper eyelid blepharoplasty, ptosis or brow ptosis surgery, headache or eyelid skin disease-related quality of life measures are significantly improved, and the use of headache or eyelid skin-related medication is significantly less.

The Association of Abdominoplasty with Breast Reduction (Mommy Makeover): Experience in An African University Hospital

Background: The popularity of breast reduction and abdominoplasty has significantly increased over the years, according to statistics from the American Society of Plastic Surgeons 2022. As a result, the Mommy Makeover, a procedure combining breast surgery and abdominoplasty, is not uncommon. Patients and Methods: A retrospective descriptive study was conducted over a four-year period within the Plastic and Aesthetic Surgery Department of the IBN SINA University Hospital, Rabat, Morocco. Results: Five cases of Mommy Makeover were operated on within the Plastic and Aesthetic Surgery Department of the IBN SINA University Hospital, Rabat, Morocco. One case was addressed two years after bariatric surgery. The procedure combined breast reduction with the superior-internal pedicle technique with Wise’s pattern and abdominoplasty. No major complications were observed. Discussion: Since the introduction of abdominoplasties combined with breast surgery, several concerns have been associated with this combination. Venous thromboembolism is the most commonly discussed consequence in combined plastic surgery procedures. The risk of venous thromboembolism is not elevated when abdominoplasty and breast reduction are combined. The study emphasizes the importance of careful patient selection and attentive venous thromboembolism prevention. It assesses the validity of the Davison-Caprini framework for venous thromboembolism risk stratification and prophylaxis in plastic surgery. Other measures to prevent complications were cited in the literature and followed by our operating team. Conclusion: With the help of a simple risk stratification tool that takes into account diabetes, age, BMI, and ASA status, we can guarantee favorable results for women who may want combined surgery.

Risk stratification of postoperative atrial fibrillation in isolated off-pump coronary artery bypass grafting: focus on left atrial strain characteristics

Aim. To explore the potential of using left atrial strain parameters obtained through transthoracic speckle-tracking echocardiography for predicting new-onset postoperative atrial fibrillation (POAF) in patients undergoing off-pump coronary artery bypass grafting (CABG).Material and methods. The study included 111 patients with coronary artery disease referred for elective CABG. There were following exclusion criteria: recurrent or combined cardiac surgery, cerebral stroke, prior atrial tachyarrhythmia episodes, on-pump CABG, patients with NYHA class 4 heart failure. Patients included in the study underwent transthoracic speckle tracking echocardiography before surgery to assess the reservoir, conduit and contractile left atrial (LA) functions. After off-pump CABG, patients were prospectively observed until discharge from the hospital to record the primary end point — the first-time persistent POAF episode.Results. During follow-up, POAF was recorded in 11 patients (10%). The median endpoint registration was 4 days. The groups formed depending on the end point achievement were comparable in basic clinical and demographic characteristics and analyzed ultrasound parameters. In the majority of the patients studied, a decrease in LA function was detected. Disorders of the conduit (n=94, 85%) and reservoir functions (n=85) were dominant.Conclusion. The results obtained may indicate that there is no relationship between the LA myocardial strain parameters obtained during preoperative screening and the risk of POAF in patients with coronary artery disease who underwent off-pump CABG.

79. The role of combination surgery and radiotherapy in patients with metastatic spinal cord compression: what are the remaining grey areas?

79. The role of combination surgery and radiotherapy in patients with metastatic spinal cord compression: what are the remaining grey areas?

Investigation of the effects of single and two-muscle horizontal rectus surgeries on macular microvasculature.

To investigate the changes in posterior segment hemodynamics caused by horizontal rectus muscle surgeries using the optic coherence tomography angiography (OCTA). Patients who underwent at least one horizontal rectus recession, resection, or combination surgery were included. The patients were evaluated with an OCTA preoperatively and 30days postoperatively. Postoperative changes in superficial capillary plexus (SCP)-vessel density (VD), deep capillary plexus (DCP)-VD, foveal avascular zone (FAZ) area and choriocapillaris (CC)-flow area parameters were examined. The mean differences (Δ) for the parameters in which significant changes were detected in the whole operated eyes group were compared between the single- and two-muscle surgery groups. Twenty-five eyes of 24 patients with an average age of 16.40 ± 6.75years (5-29) were included. Of the eyes, 10 underwent single muscle recession surgery. Two-muscle surgeries were performed in 15 eyes. SCP-VD in the superior parafoveal region increased significantly postoperatively (53.23 ± 4.11% vs. 54.54 ± 3.67%, p = 0.032). For DCP-VD, there was a statistically significant increase in all zones, except the superior hemisphere and fovea regions (p < 0.05 for all). FAZ area did not change significantly (p = 0.207). There was a significant increase in the CC-flow area (2.171 ± 0.146 mm2 vs. 2.232 ± 0.115 mm2, p = 0.013). There was a significant difference between the two groups only for the Δ SCP-VD/parafovea superior value (-0.62 ± 0.98 vs. 1.57 ± 3.07, p = 0.019). Conventional horizontal rectus muscle surgeries may cause alterations in posterior segment hemodynamics. The number of muscles incised does not seem to greatly affect the magnitude of changes that occur. What is known • After conventional horizontal rectus muscle surgeries, the anterior ciliary arteries are not recanalized, instead, anterior segment blood flow is maintained by increasing the flow in the long posterior ciliary arteries. • Previous studies using Doppler ultrasonography have shown increased flow in the ophthalmic artery, central retinal artery and long posterior ciliary arteries. What is new • In this study, significant increases were observed in superficial and deep capillary plexus-vessel density and choriocapillaris-flow area parameters in the first postoperative month with optic coherence tomography angiography device. • Hemodynamic increases in both retinal and choroidal vasculature were detected in the early period after conventional horizontal rectus muscle surgeries. • The number of muscles incised does not seem to greatly affect the magnitude of changes that occur.

A Novel Interdisciplinary Approach for the Management of Micrognathia (Brodie Syndrome).

This study describes a multidisciplinary approach for correcting a severe Class II malocclusion with reduced mandibular transverse dimension. A 35-year-old woman presented with an increased overjet, complaining chiefly of forwardly placed upper front teeth and unpleasant smile esthetics. The patient had a convex profile with severe mentalis strain on lip closure. Intraoral examination indicated a bilateral Class II canine relationship, scissor bite, and narrow lower arch. The skull lateral view assessment revealed a skeletal Class II relationship with reduced lower facial height. According to the diagnostic records and after consultation with the patient, surgically assisted expansion of the mandibular symphysis with a bone distractor, comprehensive orthodontic treatment, and combined jaw surgery were planned, followed by dental implant placement and prosthetic full-mouth rehabilitation. Restorative dentistry, orthodontics, and orthognathic surgery were the 3 disciplines that helped in achieving the best esthetic and functional results in this patient.

First Worldwide Multicentric Series of Mini-Ecirs in Children: Outcomes from two Tertiary Endourology Centers.

Introduction: Endoscopic combined intrarenal surgery (ECIRS) is a combination of both retrograde and antegrade approaches for treatment of large or complex renal stones in one procedure, that are currently being treated with multiple tracts or sessions of percutaneous nephrolithotomy, increasing the complications. The aim of our study is to describe the clinical outcomes of Mini-ECIRS in a pediatric population. Material and Methods: A retrospective study was performed in pediatric patients with lithiasis disease treated with mini-ECIRS between 2006 and 2023 in 2 referral centers in Europe. Demographic data, clinical data, stone size and location, laser settings, intraoperative variables, stone-free rate (SFR) and complications were collected. Pearson's chi-squared test, Fisheŕs test and logistic regression, were performed. Results: A total of 32 mini-ECIRS were included. The mean age was 9,8 years, 56.3% girls. The mean size and volume of the stone were 21.5mm and 3298, 2mm3, 53.1% were multiple. Ureteral access sheath was used in 93.8% of the surgeries and only 37.5% had preoperative JJ stent. 53.1% of percutaneous access were with 14 Fr sheath. High power laser was the most frequent energy source for lithotripsy, including thulium fiber laser. The mean operative time was 166,6 minutes. There was one perforation of the collecting system that was managed with JJ stent and in the postoperative period 81.2% of the patients had no complications. Three presented fever, 1 developed urinary sepsis, and 1 required reintervention. The SFR was 75% and the size, volume, hardness, and complexity of the lithiasis, as well as the non-use of lithotripsy in the retrograde approach were statistically significant in decreasing the success of the surgery. Conclusions: ECIRS is a feasible, safe, and efficient procedure in children with complex renal lithiasis, decreasing the number of procedures needed for stone free. Multicenter studies are required to validate these results on a population scale.

Effect of Laser Combined with Periodontal Flap Surgery on Severe Periodontitis

Objective: To explore the clinical effect of laser combined periodontal flap surgery in patients with severe periodontitis. Methods: Eighty patients with severe periodontitis from March 2023 to March 2024 were selected as study samples and randomly divided into two groups. The control group (a total of 40 patients) received only traditional periodontal flap surgery as a treatment option. In contrast, the observation group (which also included 40 patients) combined Er: YAG laser technology with periodontal flap surgery during treatment. The periodontal health of the two groups was compared before treatment and 3 months after treatment. Compare pain and sleep patterns; The treatment efficiency of the two groups was compared. Results: After treatment, the indexes of PD, PLI, GI, SBI, VAS score and PSQI score of 2 groups were lower than before treatment, and the decrease rate of observation group was higher than control group (P &lt; 0.05). The effective rate of observation group was significantly higher than that of control group (P &lt; 0.05). Conclusion: Laser combined periodontal flap surgery has significant clinical effect on patients with severe periodontitis, which can improve the periodontal condition and sleep status, and reduce the postoperative pain of patients.

Assessing the predictive value of elevated postoperative syndecan-1 levels for progressive acute kidney injury and kidney replacement therapy necessity in adult cardiac surgery patients

BackgroundThe development of acute kidney injury (AKI) post-cardiac surgery significantly increases patient morbidity and healthcare costs. Prior researches have established Syndecan-1 (SDC-1) as a potential biomarker for endothelial injury and subsequent acute kidney injury development. This study assessed whether postoperative SDC-1 levels could further predict AKI requiring kidney replacement therapy (AKI-KRT) and AKI progression.MethodsIn this prospective study, 122 adult cardiac surgery patients, who underwent valve or coronary artery bypass grafting (CABG) or a combination thereof and developed AKI within 48 h post-operation from May to September 2021, were monitored for the progression to stage 2–3 AKI or the need for KRT. We analyzed the predictive value of postoperative serum SDC-1 levels in relation to multiple endpoints.ResultsIn the study population, 110 patients (90.2%) underwent cardiopulmonary bypass, of which thirty received CABG or combined surgery. Fifteen patients (12.3%) required KRT, and thirty-eight (31.1%) developed progressive AKI, underscoring the severe AKI incidence. Multivariate logistic regression indicated that elevated SDC-1 levels were independent risk factors for progressive AKI (OR = 1.006) and AKI-KRT (OR = 1.011). The AUROC for SDC-1 levels in predicting AKI-KRT and AKI progression was 0.892 and 0.73, respectively, outperforming the inflammatory cytokines. Linear regression revealed a positive correlation between SDC-1 levels and both hospital (β = 0.014, p = 0.022) and ICU stays (β = 0.013, p < 0.001).ConclusionElevated postoperative SDC-1 levels significantly predict AKI progression and AKI-KRT in patients following cardiac surgery. The study’s findings support incorporating SDC-1 level monitoring into post-surgical care to improve early detection and intervention for severe AKI.

A New Technique of Sterile Polyethylene Instrument Cover as Temporary Corneal Patch to Reconstruct Anterior Chamber in Penetrating Keratoplasty Combined with Intraocular Surgery.

Complications such as explosive choroidal hemorrhage, residual cortex, and capsule rupture often occur during intraocular surgery combined with penetrating keratoplasty (PKP) due to poor maintenance of the anterior chamber. To address these challenges, we have innovatively utilized a sterile polyethylene instrument cover to temporarily reconstruct the anterior chamber. In this report, we describe a technique where a 'temporary corneal patch' was created from a sterile instrument cover, using a trephine to ensure a diameter approximately 1-2 mm wider than the corneal bed or perforation. This patch was then sutured into the host corneal bed or the perforation with 10-0 nylon sutures during intraocular surgery combined with PKP. Each case was evaluated for surgical efficacy and complications. We successfully applied this technique in three cases of combined corneal transplantation surgery. In two cases, PKP, phacoemulsification, and intraocular lens implantation were successfully performed. In the third case, PKP, vitrectomy, and other intraocular procedures were performed. No intraoperative or postoperative complications were observed. The use of a sterile polyethylene material as a temporary corneal patch for anterior chamber reconstruction represents a safe, effective, and cost-efficient approach for intraocular surgery combined with PKP or posterior segment surgery as a keratoprosthesis.

Combined Fluorescence-Guided Surgery with 5-Aminolevulinic Acid and Fluorescein in Glioblastoma: Technical Description and Report of 100 Cases.

Fluorescence-guided resection (FGR) of glioblastomas has been previously explored with the use of 5-amivelulinic acid (5-ALA) and sodium fluoresceine (SF), allowing us to maximize the extent of resection (EoR). In this study, we highlight the most relevant concerns regarding this technique and present the methods and results from the experience of our center. A case series of 100 patients operated on in AOU Città della Salute e della Scienza in Turin with a histological diagnosis of glioblastoma (grade IV, according to WHO 2021) was retrospectively analyzed. Both 5-ALA and SF were administered and intraoperatively assessed with an optical microscope. 5-ALA is the only approved drug for FGR in glioblastoma, reporting an increased EoR. Nevertheless, SF can be positively used in addition to 5-ALA to reduce the risk of false positives without increasing the rate of adverse effects. In our experience, SF was used to guide the initial phase of resection while 5-ALA was used to visualize tumor spots within the surgical cavity. In 96% of cases, gross total resection was achieved, with supra-maximal resection in 11% of cases. Combined FGR using 5-ALA and SF seems to be a promising method of increasing the extent of resection and to improving the prognosis in glioblastoma patients.

Accuracy of intraocular lens calculation formulas based on swept-source OCT biometer in cataract patients with phakic intraocular lens

PurposeTo research the accuracy of intraocular lens (IOL) calculation formulas and investigate the effect of anterior chamber depth (ACD) and lens thickness (LT) measured by swept-source optical coherence tomography biometer (IOLMaster 700) in patients with posterior chamber phakic IOL (PC-pIOL).MethodsRetrospective case series. The IOLMaster 700 biometer was used to measure axial length (AL) and anterior segment parameters. The traditional formulas (SRK/T, Holladay 1 and Haigis) with or without Wang-Koch (WK) AL adjustment, and new-generation formulas (Barret Universal II [BUII], Emmetropia Verifying Optical [EVO] v2.0, Kane, Pearl-DGS) were utilized in IOL power calculation.ResultsThis study enrolled 24 eyes of 24 patients undergoing combined PC-pIOL removal and cataract surgery at Xiamen Eye Center of Xiamen University, Xiamen, Fujian, China. The median absolute prediction error in ascending order was EVO 2.0 (0.33), Kane (0.35), SRK/T-WKmodified (0.42), Holladay 1-WKmodified (0.44), Haigis-WKC1 (0.46), Pearl-DGS (0.47), BUII (0.58), Haigis (0.75), SRK/T (0.79), and Holladay 1 (1.32). The root-mean-square absolute error in ascending order was Haigis-WKC1 (0.591), Holladay 1-WKmodified (0.622), SRK/T-WKmodified (0.623), EVO (0.673), Kane (0.678), Pearl-DGS (0.753), BUII (0.863), Haigis (1.061), SRK/T (1.188), and Holladay 1 (1.513). A detailed analysis of ACD and LT measurement error revealed negligible impact on refractive outcomes in BUII and EVO 2.0 when these parameters were incorporated or omitted in the formula calculation.ConclusionThe Kane, EVO 2.0, and traditional formulas with WK AL adjustment displayed high prediction accuracy. Furthermore, the ACD and LT measurement error does not exert a significant influence on the accuracy of IOL power calculation formulas in highly myopic eyes implanted with PC-pIOL.

Advancements in Melanoma Therapies: From Surgery to Immunotherapy.

Melanoma is defined as the most aggressive and deadly form of skin cancer. The treatment of melanoma depends on thedisease stage, tumor location, and extent of its spread from its point of origin. Melanoma treatment has made significantadvances, notably in the context of targeted and immunotherapies. Surgical resection is the main therapeutic option for earlystagemelanoma, and it provides favourable outcomes. With disease metastasis, systemic treatments such as immunotherapyand targeted therapy become increasingly important. The identification of mutations that lead to melanoma has influencedtreatment strategies. Targeted therapies focusing on these mutations offer improved response rates and fewer toxicities thanconventional chemotherapy. Furthermore, developing immunotherapies, including checkpoint inhibitors and tumor-infiltratinglymphocyte (TIL) therapies, has demonstrated encouraging outcomes in effectively combating cancer cells. These therapeuticagents demonstrate superior effectiveness and a more tolerable side-effect profile, improving the quality of life for patientsreceiving treatment. The future of melanoma treatment may involve a multimodal approach consisting of a combination ofsurgery, targeted therapy, and immunotherapy adapted to each patient's profile. This approach may improve survival ratesand health outcomes.

Redisplacement rate after bony hip reconstructive surgery in nonambulatory patients with cerebral palsy: a systematic review and meta-analysis.

Up to 90% of nonambulatory patients with cerebral palsy (CP) experience hip displacement during their lifetime. Reconstructive surgery is recommended. Redisplacement rate is an outcome parameter. In a systematic literature review (MEDLINE, Embase and CENTRAL databases) until January 2023 we searched for reports with redisplacement rates after bony hip reconstructive surgery in nonambulatory patients. Quantitative data synthesis, subgroup analysis and meta-regression with moderators were carried out. The pooled mean redisplacement rate was 16% (95% CI: 12-21%) with a prediction interval of 3-51% (Q: 149; df: 32; P < 0.001; I2: 78%; τ2: 0.67 and τ: 0.82) in 28 studies (1540 hips). Varus derotation osteotomy (VDRO) alone showed a higher redisplacement rate than VDRO + pelvic osteotomy (30% vs 12%, P < .0001). Mean age in the VDRO-alone subgroup was 7.1 years and in the combined group 9.5 years (P = .004). In meta-regression, lower redisplacement rates were observed with higher preoperative migration index (MI) (correlation coefficient: -0.0279; P = .0137), where comprehensive surgery was performed. Variance in true effects are explained by type of bone surgery (57%), preoperative MI (11%), age (5%) and MI for definition of failure (20%). No significant reduction in the redisplacement rate could be observed over the mid-years of studies (1977-2015). Our pooled data support the more extensive surgical approach in patients with high preoperative MI and emphasize the superiority of combined surgery. Studies should report a coordinated set of parameters and outcome classifications according to internationally accepted gradings to reduce redisplacement in future.

Prognostic Nomogram, Demographics and Comparative Analysis of Urinary Bladder Small Cell and Large Cell Neuroendocrine Carcinoma

BackgroundThis retrospective study aims to provide a comprehensive analysis of the demographics, survival rates, and therapeutic approaches of small-cell neuroendocrine carcinoma (SCNEC) and large-cell neuroendocrine carcinoma (LCNEC) while highlighting key differences compared to common urinary bladder cancers. MethodsOur analysis utilized the Surveillance, Epidemiology, and End Results database (SEER), and data was collected from 2000-2020. ResultsA total of 1040 cases of urinary bladder SCNEC and LCNEC were identified. Most patients were over the age of 80 years (33.2%), male (78.9%), and Caucasian (83.6%). Most tumors were over 4.1cm (47.4%) and in the lateral wall of the bladder (37.8%). The overall 5-year survival was 22.1% (95% confidence interval (95% CI):20.7-23.5). The 5-year survival by sex was greatest for the female population (28.0%; (95% CI: 24.5-35.0). For treatment modality, the 5-year survival for each was as follows: surgery, 12.5% (95% CI: 10.5-14.5) multimodality therapy (surgery and chemotherapy), 31.1% (95% CI: 28.5-33.7) and combination (surgery, chemotherapy, and radiation) 32.8% (95% CI: 29.1-36.5). On multivariable analysis, positive nodal status hazar ratio (HR)(HR3.65 [95% CI: 2.34-5.71], P < .001) was identified as a negative predictor for survival, and increasing age was nearly significant for a worse prognosis (P = .052). The prognostic nomogram that was created to predict patient survivability mirrored the findings from the statistical analysis, with a statistically significant difference found in race, treatment modality, and tumor stage. ConclusionsSCNEC and LCNEC are rare yet highly intrusive subtypes of bladder cancer that usually affect Caucasian males over the age of 80 years old. The study identifies older age and positive nodal status as adverse prognostic indicators. Our findings offer crucial insights that can inform future clinical guidelines and serve as a basis for more tailored treatment strategies for these aggressive subtypes of bladder cancer.

Comparison of outcomes in small bowel surgery for Crohn’s disease: a retrospective NSQIP review

IntroductionDespite advances in medical therapy, approximately 33% of Crohn’s disease (CD) patients will need surgery within 5 years after initial diagnosis. Several surgical approaches to CD have been proposed including small bowel resection, strictureplasty, and combined surgery with resection plus strictureplasty. Here, we utilize the American College of Surgeons (ACS) national surgical quality registry (NSQIP) to perform a comprehensive analysis of 30-day outcomes between these three surgical approaches for CD.MethodsThe authors queried the ACS-NSQIP database between 2015 and 2020 for all patients undergoing open or laparoscopic resection of small bowel or strictureplasty for CD using CPT and IC-CM 10. Outcomes of interest included length of stay, discharge disposition, wound complications, 30-day related readmission, and reoperation.ResultsA total of 2578 patients were identified; 87% of patients underwent small bowel resection, 5% resection with strictureplasty, and 8% strictureplasty alone. Resection plus strictureplasty (combined surgery) was associated with the longest operative time (p = 0.002). Patients undergoing small bowel resection had the longest length of hospital stay (p = 0.030) and the highest incidence of superficial/deep wound infection (44%, p = 0.003) as well as the highest incidence of sepsis (3.5%, p = 0.03). Small bowel resection was found to be associated with higher odds of wound complication compared to combined surgery (OR 2.09, p = 0.024) and strictureplasty (1.9, p = 0.005).ConclusionOur study shows that various surgical approaches for CD are associated with comparable outcomes in 30-day related reoperation and readmission, or disposition following surgery between all three surgical approaches. However, small bowel resection displayed higher odds of developing post-operative wound complications.

Efficacy of mini-endoscopic combined intrarenal surgery for pediatric kidney calculi: a single center retrospective study

Management of large pediatric kidney calculi (PKC) is challenging. This study aimed to evaluate the efficacy and safety of miniature endoscopic combined intrarenal surgery (mini-ECIRS) for PKC. We retrospectively analyzed mini-ECIRS in 16 pediatric patients undergoing kidney stone treatment between November 2014 and October 2023 to determine its safety, efficacy, and associated outcomes. The median age was 50.50 (interquartile range: 36.75, 84.75) months, and the mean stone size was 21.63 ± 11.65 mm. The stone-free rate was 81.25%. The median decrease in hemoglobin level on the day after surgery was 1.10 (0.80, 1.55), and no patient required a blood transfusion. The median number of general anesthesia procedures was 2.00 (2.00, 2.00). Postoperative complications included fever in two patients and difficulty in removing the ureteral stent in one patient. In this cohort, five patients underwent pre-stenting under general anesthesia before mini-ECIRS. Age was significantly lower in the pre-stenting group than in the non-pre-stenting (P < 0.01); however, there were no significant differences in operative time, stone-free rate, total number of general anesthesia procedures, hemoglobin loss, or postoperative hospital stay between the groups. Mini-ECIRS was found to be a safe and efficient treatment method with a high stone removal rate in pediatric patients.