Conservative Surgery Research Articles

Annual versus less frequent mammographic surveillance in people with breast cancer aged 50 years and older in the UK (Mammo-50): a multicentre, randomised, phase 3, non-inferiority trial.

The frequency of mammographic surveillance for women after diagnosis of breast cancer varies globally. The aim of this study was to evaluate whether less than annual mammography was non-inferior in terms of breast cancer-specific survival in women aged 50 years or older. Mammo-50 was a multicentre, randomised, phase 3 trial of annual versus less frequent mammography (2-yearly after conservation surgery; 3-yearly after a mastectomy) for women aged 50 years or older at initial diagnosis of invasive or non-invasive breast cancer and who were recurrence free 3 years post curative surgery. The trial was conducted at 114 National Health Service hospitals in the UK. Participants were randomly assigned (1:1) to annual or less frequent mammograms at 3 years post curative surgery and were followed up for 6 years. The co-primary outcomes were breast cancer-specific survival and cost-effectiveness. The cost-effectiveness analysis will be reported elsewhere. Breast cancer-specific survival was assessed in the intention-to-treat population. Secondary outcomes were recurrence-free interval, overall survival, and referrals back to the hospital system. 5000 women provided 90% power to detect a 3% absolute non-inferiority margin for breast cancer-specific survival with 2·5% one-sided significance. The trial was registered with the ISRCTN registry, ISRCTN48534559; recruitment is complete but longer-term follow-up is ongoing. Between April 22, 2014, and Sept 28, 2018, 5235 women were randomly assigned to annual mammography (n=2618) or less frequent mammography (n=2617). 3858 (73·6%) women were aged 60 years or older, 4202 (80·3%) had undergone conservation surgery, 4576 (87·4%) had invasive disease, 1159 (22·1%) had node positive disease, and 4330 (82·7%) had oestrogen receptor-positive tumours. With a median of 5·7 years follow-up (IQR 5·0-6·0; 8·7 years post curative surgery), 343 women died, including 116 who died of breast cancer (61 in the annual mammography group and 55 in the less frequent mammography group). 5-year breast cancer-specific survival was 98·1% (95% CI 97·5-98·6) in the annual mammography group and 98·3% (97·8-98·8) in the less frequent mammography group (hazard ratio 0·92, 95% CI 0·64-1·32), demonstrating non-inferiority of less frequent mammography at the pre-specified 3% margin (non-inferiority p<0·0001). 5-year recurrence-free interval was 94·1% (95% CI 93·1-94·9) in the annual mammography group and 94·5% (93·5-95·3) in the less frequent mammography group. Overall survival at 5 years was 94·7% (95% CI 93·8-95·5%) and 94·5% (93·5-95·3), respectively. 224 (64·9%) of 345 breast cancer events were detected from emergency admissions or symptomatic referrals back to the hospital system, including 108 (61·7%) of 175 in the annual mammography group and 116 (68·2%) of 170 in the less frequent mammography group. For patients aged 50 years or older and at 3 years post diagnosis, less frequent mammograms were non-inferior compared with annual mammograms for breast cancer-specific survival, recurrence-free interval, and overall survival, and should be considered for this population. National Institute for Health Research Health Technology Assessment programme.

Podium Presentation Title: Return to Sport After Hip Preservation Surgery

Podium Presentation Title: Return to Sport After Hip Preservation Surgery

Retrospective MRI analysis of 418 adult shoulder joints to assess the physiological morphology of the glenoid in a low-grade osteoarthritic population.

Due to the difference in size between the humeral head and the glenoid, the shoulder joint is prone to instability. Therefore, the reconstruction of the physiological joint morphology is of great importance in shoulder joint preservation and replacement surgery. The aim of this study was to describe physiological reference parameters for the morphology of the glenoid for the first time. MRI images of the shoulder joints of 418 patients (mean age: 50.6 years [± 16.3]) were retrospectively analysed in a low-grade osteoarthritic population. The glenoid distance in coronal (GDc) and axial view (GDa), glenoid inclination (GI) and version (GV) as well as scapula neck length (SNL) were measured. Parameters were studied in association for age, gender, side and degeneration grade. Mean GDc was 33.4mm (± 3.6), mean GDa 26.8mm (± 3.2), mean GI 10.5° (± 6.4), mean GV -0.4mm (± 5.4) and mean SNL was 33.4mm (± 4.7). GDa was significant higher in right shoulders (p < 0.001). GDc and GDa showed significant higher mean values in older patients (p < 0.001) and in shoulders with more severe degenerative changes (p < 0.05). While GDc, GDa and SNL were significant larger in male patients (p < 0.001), GI had a higher mean value in female shoulders (p = 0.021). Age, gender and shoulder joint degeneration influence changes in the morphological parameters of the glenoid. These findings have to be considered in shoulder diagnostics and surgery. Not applicable.

Single breast incision for breast conservation surgery and sentinel lymph node biopsy: a systematic review.

Breast conservation surgery and sentinel lymph node biopsy via a single incision allows excision of tumours from all quadrants of the breast, with access to both axillary and internal mammary nodal basins with no additional incisions. This systematic review aims to consolidate the current literature on the efficacy, safety, functional and cosmetic outcomes of single-incision breast conserving surgery and sentinel lymph node biopsy. A comprehensive search of Pubmed, EMBASE, Medline and GoogleScholar was conducted from inception to 7th July 2024 for all peer-reviewed articles assessing breast conserving surgery and sentinel lymph node biopsy via single incision using PRISMA guidelines. The literature search generated 426 articles. 400 were excluded by abstract review with the remaining 26 articles reviewed in full. An additional three articles were retrieved from review of full article reference lists. 13 articles were excluded, leaving 10 articles meeting the inclusion criteria. The technique demonstrated success across all quadrants of the breast. Eight studies documented successful axillary dissection completed via a single incision. Four studies compared the single-incision approach to the conventional two-incision technique. There was no difference in complication rates. The single-incision technique was associated with higher patient satisfaction and reduced post-operative axillary pain. Single-incision breast conservation surgery and sentinel lymph node biopsy is surgically safe and can be feasible for tumours in all quadrants of the breast and is associated with improvement in cosmesis, pain and patient satisfaction. Further studies are required to confirm its long-term oncological safety.

The outcome of breast conservative surgery vs modified radical mastectomy following neoadjuvant therapy among locally advanced breast cancer patients in national cancer institute, Gezira University, Sudan

The outcome of breast conservative surgery vs modified radical mastectomy following neoadjuvant therapy among locally advanced breast cancer patients in national cancer institute, Gezira University, Sudan

Odontogenic Myxoma Associated to Unerupted Mandibular Molar in a Pediatric Patient: A New Case Description with Comprehensive Literature Analysis

Background/Objectives: Odontogenic tumors in pediatric patients are uncommon; among all, the intraosseous occurrence of odontogenic myxoma is very rare, accounting for almost 8.5–11.6% of all odontogenic tumors in children. The radiological appearance is highly variable and is often responsible for the diagnostic delay and treatment. Methods: We report a case of odontogenic myxoma occurring in the posterior mandible of a 12-year-old female, found on a panoramic radiograph performed for the delayed eruption of the second inferior molar, treated by conservative surgery. A comprehensive analysis of the literature was also carried out. Results: The radiological features of the presented case were unique, as the lesion was encompassed within the uncompleted (developing) dental crown still unerupted, as confirmed by the macroscopic appearance. Then, the differential diagnosis included odontogenic fibroma, immature dental pulp or follicle from a developing tooth, and ameloblastic fibrodontoma. The histological examination led to the final diagnosis of odontogenic myxoma. As for the literature analysis, after a PRISMA-based selection of the papers, a total of 23 articles (case reports and case series on odontogenic myxomas in pediatric patients, a total of 33 cases) were finally selected and studied; all the pertinent data are widely discussed within the paper. Conclusions: The current case highlights the importance of the radiological investigation in pediatric patients when a delayed eruption lasts for several months, leading to an early diagnosis necessary to avoid more aggressive surgical therapies and possible recurrence; data from the literature about site of occurrence, sex, age, kind of surgical procedure, and recurrence rate are discussed too.

Epidemio-Clinical Profile and Management of Carcinoma in Situ of the Breast in the Department of Obstetrics and Gynecology II of the CHU HASSAN II of Fès: 2000-2024

Breast cancer is the most common cancer in women and is, therefore, a major public health problem. Among the different types of breast cancer, breast carcinoma in situ occupies a special place because of its pre-invasive nature. Ductal carcinoma in situ (DCIS) accounts for 85% to 90% of in situ breast cancers. Their incidence is increasing as a result of widespread screening. Lobular carcinoma in situ remains a rare lesion and is considered to be a cancer risk factor. Diagnosis of this cancer is quite difficult, and treatment is team-dependent, ranging from conservative treatment to mastectomy. The aim of our study was to describe the epidemiological and clinical characteristics of patients with carcinoma in situ isolated within the gyneco-obstetrics II department in Fez, as well as the therapeutic modalities. 19 patients were included; the mean age of our patients was 56 years, with extremes ranging from 34 to 88 years. The average consultation time was seven months; the mode of discovery was dominated by the discovery of a nodule on a breast self-exam in 13 patients (72%), followed by a pathological nipple discharge in 5 and a combination of two in one patient. The average tumor size was 3 cm, with extremes ranging from 1 cm to 5 cm. Combined screening with mammography and breast ultrasound was carried out in all our patients (100%), supplemented by MRI in 4 patients (high breast density) with a view to conservative treatment. Histology was dominated by ductal carcinoma in 17 patients (92%). The surgical procedure was conservative in 5 patients (28%) and radical in 13 (72%). 3 out of the 5 patients who had undergone conservative surgery underwent revision surgery (mastectomy) due to positive surgical margins (60%). 11 (61%) patients benefited from an axillary procedure essentially by sentinel lymph node biopsy which was negative (100%).

Intravenous Tranexamic Acid Does Not Improve Visual Field Clarity During Hip Arthroscopy: A Double-Blind, Randomized, Placebo-Controlled Trial.

To determine the effectiveness of administering intravenous (IV) tranexamic acid (TXA) on altering visual field clarity (VFC) during arthroscopic hip preservation surgery for patients with femoroacetabular impingement syndrome (FAIS). This randomized, double-blind, parallel-design trial was conducted over a seven-month period between October 2023 and May 2024 at a single tertiary musculoskeletal hospital. Inclusion criteria included consecutive patients that were diagnosed with FAIS through clinical history, physical exam and advanced imaging and indicated for hip arthroscopy after having failed conservative management. This trial prospectively randomized 78 participants (n = 39 assigned to receive 1000mg of TXA in 100mL/0.9% normal saline (NS) bolus, n=39 assigned to receive 100mL/0.9% NS bolus only). Treatment intervention was administered within 15 minutes of incision. The primary outcome was arthroscopic VFC assessed on a Likert-style numeric rating scale (NRS) and graded by the surgeon at 15 minute intervals (1=poor visibility with active bleeding to the degree that vision was too poor to perform the operation; 2=fair visibility(mild bleeding that interfered with vision, but the surgery could still be performed), and 3=good visibility(clear vision without obvious blood). The percentage of good VFC (percent of surgeon-ratings equal to 3 on the NRS scale throughout the procedure) was quantified for each patient. No minimum follow-up was required as the primary endpoint was intraoperative. Baseline characteristics of the TXA cohort [mean age 37.3, 61.5% male, 76.9% Caucasian] were not significantly different than that of the placebo group ([mean age 33.6, 59% male, 86.8% Caucasian]; p>0.05 all). TXA was not associated with improved VFC compared with placebo at any intraoperative timepoint nor when considering composite overall VFC scores (TXA: 2.51±0.41 vs. placebo: 2.64±0.42;p=0.16). Furthermore, no significant difference was observed in the percentage of good VFC ratings between treatment groups (TXA:56.4%, placebo:66.4%, p=0.17). Multivariate regression analysis adjusted for demographic and intraoperative covariates did not demonstrate an association between TXA and VFC rating (ß =-0.14, p=0.14) nor percentage of good VFC ratings (ß =-11.6, p=0.15). No medical or intraoperative complications related to the treatment intervention were observed in either treatment arm. Among patients with FAIS undergoing arthroscopic hip preservation surgery, administration of TXA did not improve arthroscopic VFC when compared with placebo. Therefore, these results of this randomized trial do not support the routine use of TXA in arthroscopic hip preservation surgery for improvement in arthroscopic visualization. 1, prospective randomized controlled trial.

Patient satisfaction with radio-frequency identification (RFID) tag localization compared with wire localization for nonpalpable breast lesions: the RFID trial

BackgroundMost breast cancers are detected at an early stage in which case conservative surgery is indicated. An accurate preoperative localization technique is essential for conservative surgery of non-palpable breast lesions. Currently, the gold standard technique is wire localization (WL). However, this technique has well-known drawbacks. Several wire-free techniques have been developed to overcome these drawbacks; one technique is localisation by Radiofrequency Identification (RFID). The purpose of this clinical trial was to assess the superiority of RFID tags (HOLOGIC) in terms of patient satisfaction, over wire localization of non-palpable breast lesions.MethodsThis was a single-centre, prospective, controlled and non-interventional trial. Patients were followed from their inclusion at the time of the preoperative consultation to the postoperative consultation, one month after surgery. Data on anxiety and satisfaction was collected from patients and clinicians using questionnaires, and clinical data was collected from the medical files. The primary outcome was the patients’ satisfaction scores, assessed using a visual analogue scale.ResultsEighty patients were sequentially enrolled in two groups: the wire group (n = 40) and the RFID group (n = 40). One patient from the RFID group was excluded from the analysis because of a substantial migration during deployment. On a 10-point Visual Analogue Scale, the patients’ median satisfaction score was 9.8 (IQR = 1.32) for the wire group and 10 (IQR = 0.07) for the RFID group (p < 0.001). A reduction in pain between device insertion and surgery was observed in the RFID group (p = 0.009). The median placement time was shorter in the RFID group (15 min, IQR = 6) than in the wire group (20 min, IQR = 30) (p = 0.01).ConclusionOur results show a statistically significant difference in median patient satisfaction score with the localization of non-palpable breast cancer lesions using RFID tags compared to the use of the WL. Although our results did not show clinically significant outcomes in terms of satisfaction, RFID tags are a reliable alternative to WL and simplify the organization of patients’ healthcare trajectories.Trial registrationClinicalTrials.gov ID; NCT04750889 registered on February 11, 2021. https://clinicaltrials.gov/ct2/show/NCT04750889?term=rfid&draw=2&rank=1

Treatment, prognosis, and outcome of dogs treated for rectal plasmacytoma: a multicentric retrospective study.

The aim of this study was to report the outcome and prognosis of canine patients treated medically or surgically for rectal plasmacytomas and to identify factors associated with recurrence, mortality, or progression to multiple myeloma. The databases of 7 referral hospitals were reviewed. The Kaplan-Meier method and Cox proportional hazards analysis were used to determine the association of a range of variables with recurrence and progression-free interval for the surgically treated patients. 20 dogs were included. Nineteen cases were treated surgically, and 1 case was treated conservatively (analgesia and monitoring). Metastatic lesions were detected in 2 of 20 dogs (10%). Four of 19 dogs (21%) treated surgically developed postoperative complications, 1 major (1 of 19 [5.2%]) and 3 minor (3 of 19 [15.8%]). Tumor recurrence was identified in 6 of 19 dogs (31.5%). The 1-, 2-, and 3-year survival rates were 95%, 72%, and 66%, respectively. None of the variables tested were associated with occurrence of complications. Increased distance from the anus, incomplete surgical margins, and decreasing surgeon experience were associated with an increased risk of recurrence. No progression to multiple myeloma was seen in any of the cases. Surgical treatment of rectal plasmacytomas is associated with a low major complication rate and long survival. Metastasis and recurrence rates are significantly higher than previously reported. Conservative surgery leads to long-term survival, but recurrence is common. Future studies should focus on the benefits of adjuvant treatments.

Correlation analysis of recurrent factors in borderline ovarian tumors undergoing fertility preservation surgery

ObjectiveTo explore the relapse - related factors of fertility preservation surgery for borderline ovarian tumors.MethodsPatients of childbearing age who underwent fertility preservation surgery for borderline ovarian tumors in Sheng jing Hospital of China Medical University from April 20 1 8 to April 20 2 3 were selected. Clinical data were collected and their clinical characteristics were statistically analyzed. It is to explore the risk factors of postoperative recurrence.ResultsA total of 30 8 patients were included in this study, of which 1 was lost to follow - up and 47 relapsed (4 7/3 0 7, 15. 3 1%). The results of multivariate analysis showed that the pathological features of micro papillary structure, intra operative as cites, bilateral tumors, and the increased ratio of neu tro phil to lymphocyte before surgery are independent risk factors for the recurrence of borderline ovarian tumors.ConclusionThe prognosis of women of childbearing age with borderline ovarian tumors undergoing conservation function surgery is good. However, patients with high - risk recurrence factors should be paid special attention and closely followed up after surgery.

The clinicopathologic features of uterine inflammatory myofibroblastic tumor: A case report.

Inflammatory myofibroblastic tumor (IMT) is a rare soft tissue neoplasm with low malignant potential. These patients present with a certain probability of malignant potential. The management of IMT has not been standardized, especially for the patients with fertility needs. Thirteen patients with IMT who attended in the Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine were enrolled between 2019 and 2023. The data of the clinical and pathological features was analyzed. The mean age of the patients was 45.31 ± 12.80 years. Seven of the 13 cases (53.85%) had abnormal uterine bleeding. Five of them (38.46%) had a rapidly growing mass, and 2 of them (15.38%) had no obvious symptoms. With regard to surgical strategies, 7 patients underwent hysterectomy, and 6 patients underwent mass resection only. All the patients were alive with no evidence of disease at an average of 9.58 months of follow-up. One of them gave birth to a full-term male infant at 40 weeks of gestation after hysteroscopic resection, without recurrence. Uterine inflammatory myofibroblastic tumor can be diagnosed by the anaplastic lymphoma kinase overexpression. Complete excision under hysteroscopy or laparoscopy seems to be effective and safe. Because there is a certain risk of recurrence and metastasis, conservative surgery should be performed carefully to preserve fertility in patients who can undergo close follow-up.

Frank Invasion in Tall Cell Carcinoma with Reversed Polarity of the Breast: Report of Two Cases.

Tall cell carcinoma with reversed polarity (TCCRP) is a rare neoplasm of the breast composed of columnar tumor cells arranged in solid and solid papillary nests with evidence of apical nuclear polarity. No frank invasion is evident despite the lack of a myoepithelial cell layer throughout the tumor. TCCRP has a triple negative or hormone receptor-low immunophenotype. Recurrent IDH2 R172 hotspot mutation coexisting with genetic alterations in the PI3K pathway characterize this tumor. Here, we report on two postmenopausal patients with TCCRPs with frank stromal invasion. IDH2 R172 mutations were detected in both tumors by immunohistochemistry. Targeted sequencing of case 2 demonstrated the presence of IDH2 R172T and RTEL1 E839K mutations. Both patients underwent breast conservation surgery, radiation therapy and adjuvant endocrine therapy with anastrozole and show no evidence of disease at 65 and 25 months, respectively. This study suggests that tall cell carcinoma with reversed polarity may give rise to frank invasive carcinoma, the prognostic significance of which is yet unknown.

Lumbopelvic hyperlordosis is linked to higher femoral head coverage, lower femoral anteversion and younger age at periacetabular osteotomy.

The dynamic alignment of the lumbar spine, pelvis and femur is increasingly studied in hip preservation surgery. However, the interaction between lumbopelvic alignment, acetabular and femoral morphology and its influence on patients' preoperative symptom burden remains poorly understood. The aim of this study was to evaluate whether lumbopelvic malalignment affects osseous hip morphology and exacerbates preoperative patient-reported joint functionality in patients undergoing periacetabular osteotomy (PAO). One hundred thirteen patients were prospectively enroled in this single-centre study. Sagittal lumbopelvic radiographs were used to divide the patients in accordance with their lumbopelvic alignment (pelvic incidence [PI]-lumbar lordosis [LL] mismatch) into a balanced (PI-LL: 10° and 10°/n = 60) and unbalanced alignment (PI-LL: <10° and >10°/n = 53) group. Intergroup analyses were performed for acetabular and femoral morphology as well as various patient-reported outcome measures (PROMs) scores (modified Harris-Hip, Hip Osteoarthritis Outcome, International Hip Outcome tool-12 and University of California Los Angeles activity scale). Patients with concomitant unbalanced lumbopelvic alignment due to hyperlordosis showed higher femoral head coverage and lower femoral anteversion (lateral centre-edge angle 20.2° vs. 15.8°, p = 0.012/anterior wall index 0.47 vs. 0.36, p = 0.001/acetabular inclination 10.2° vs. 13.6°, p = 0.008/Femoral anteversion 21.3° vs. 28.2°, p = 0.041). Furthermore, these patients were significantly younger at the time of PAO (28.7 vs. 32.4 years, p = 0.020), even when there were no intergroup differences in all analyzed PROMs. Concomitant lumbopelvic deformity affecting the hip joint morphology could aggravate clinical symptoms leading to earlier presentation in patients undergoing PAO. Thus, the lumbopelvic balance needs to be carefully evaluated in clinical decision-making in PAO patients and future research should focus on long-term outcomes of patients with concomitant unbalanced lumbopelvic alignment. Level III, prognostic study.

Long-term memory plasticity in a decade-long connectivity study post anterior temporal lobe resection

Approximately 40% of individuals undergoing anterior temporal lobe resection for temporal lobe epilepsy experience episodic memory decline. There has been a focus on early memory network changes; longer-term plasticity and its impact on memory function are unclear. Our study investigates neural mechanisms of memory recovery and network plasticity over nearly a decade post-surgery. We assess memory network changes, from 3–12 months to 10 years postoperatively, in 25 patients (12 left-sided resections) relative to 10 healthy matched controls, using longitudinal task-based functional MRI and standard neuropsychology assessments. We observe key adaptive changes in memory networks of a predominantly seizure-free cohort. Ongoing neuroplasticity in posterior medial temporal regions and contralesional cingulum or pallidum contribute to long-term verbal and visual memory recovery. Here, we show the potential for sustained cognitive improvement and importance of strategic approaches in epilepsy treatment, advocating for conservative surgeries and long-term use of cognitive rehabilitation for ongoing recovery.

Breast Conservation Surgery for Breast Cancer in Men.

Male breast cancer (MBC) is a rare disease, accounting for 1% of all breast cancers diagnosed in the United States. The rarity of MBC has limited the development of treatment algorithms specific to men. Thus, the standard of care has been mastectomy. The safety and feasibility of breast-conserving surgery (BCS) in MBC are unclear. This study assessed whether overall survival outcomes, local recurrence, and postoperative complications differed between MBC patients who underwent conservative surgery or mastectomy. A retrospective search for men aged ≥18 years diagnosed with breast cancer was conducted using the TriNetX network. Cohort 1 included patients who underwent BCS. Cohort 2 included patients who underwent mastectomy. Propensity score matching was conducted using age, BMI, tobacco use, cancer stage and tumor size (T1-T4), radiation, chemotherapy, hormonal therapy, genetics, and comorbidities. Outcomes of interest were 5-year overall survival (OS), local recurrence (LR), and postoperative complications. 423 patients underwent BCS, and 1,101 patients underwent mastectomy. After matching, 401 patients per cohort were identified. There was no difference in 5-year OS with the Kaplan-Meier analysis (Cohort 1: 84% vs Cohort 2: 86%, log-rank test p=0.412) or with LR (11% vs 13%, p=0.384). The mastectomy cohort was more likely to have postoperative complications, with a risk of 24% compared with 17% in the BCS cohort (p=0.011). There is no difference in the 5-year OS and LR rate between MBC patients who undergo BCS or mastectomy. The postoperative complication rate was higher with mastectomies. We conclude that BCS for unicentric male breast cancer is feasible and preferred for T1 and T2 cancers.

Patent Ductus Arteriosus

Patent ductus arteriosus is one of the congenital heart disease caused by the failure of the ductus arteriosus to close after birth. The ductus arteriosus, a fetal blood vessel connecting the pulmonary artery and the aorta, typically closes within the first 1–3 days in term infants. In PDA, this condition can lead to excessive blood flow to the lungs and systemic hypoperfusion. The incidence of PDA varies, occurring in 0.3–4 per 1,000 live births, and accounts for 5–10% of congenital heart defects. The risk increases with preterm birth, particularly at gestational ages of less than 30 weeks. The younger the gestational age at birth, the higher the risk of PDA. Management of PDA aims to close the ductus arteriosus or alleviate symptoms through conservative therapy, pharmacological treatment, or surgery. By understanding the etiology, prevalence, and therapeutic approaches to PDA, better management strategies can be implemented to minimize complications in newborns.

Infection Relapse and Time-to-Healing After Conservative Surgery for Non-Acute Presentations of Diabetes-Related Forefoot Osteomyelitis: Does Site Matter?

Diabetes-related foot osteomyelitis (DFO) can present as an acute condition with soft tissue involvement or as a non-acute form characterized by long-standing ulcers without immediate limb-threatening features. This study evaluates infection relapse and healing times after conservative surgery in non-acute DFO, with a focus on osteomyelitis localization. A retrospective cohort of 60 patients treated for forefoot DFO without soft tissue involvement or necrosis was analyzed. Conservative surgery, defined as resection of infected bone without amputation, was performed in all cases. Postoperative antibiotic therapy was guided by bone biopsy cultures. Infection relapse was defined as new evidence of infection localized to the previously treated bone. Infection arrest was achieved in 98.3% of cases, with a recurrence rate of 10%. Relapse was significantly associated with osteomyelitis localized to the first metatarsal head, which presented a 57.1% relapse rate compared to 3.8% in other locations (OR: 34.0, 95% CI: 4.34-266, p < 0.001). Healing times were longer for the first metatarsal head, first toe, and second to fifth metatarsal heads compared to the lesser toes, but the association with the first metatarsal head lost significance when relapse was included in the analysis. This study highlights the effectiveness of conservative surgery in non-acute DFO, achieving high healing rates while preserving limb function. The findings emphasize the critical role of osteomyelitis localization, particularly the first metatarsal head, in determining relapse and healing outcomes. These results provide a basis for future research into individualized surgical strategies for high-risk anatomical sites.

Leiomyomatosis Peritonealis Disseminata: A Case Report

Introduction: Leiomyomatosis peritonealis disseminata (LPD) manifests as a distinctive benign clinical entity marked by the proliferation of nodules within the peritoneal and subperitoneal layers. LPD poses diagnostic challenges due to its unique presentation, yet it typically follows a benign trajectory with minimal risk of malignant transformation. Presentation of Case: A 38-year-old female with a pain in the left iliac fossa which has progressed to a gradual distension of the abdomen, proceeded to our institution for neoadjuvant treatment of abdominal and pelvic masses which were firstly considered as desmoid tumor. The histologic diagnosis of the mass lesions revealed smooth muscle benign cells. This is the first case of LPD reported in Casablanca Oncology and Radiotherapy Ibn Rochd Center. A meticulous review of the literature was conducted as well. Discussion: The differential diagnosis of LPD is difficult due to its clinical resemblance with intra-abdominal desmoid tumor, peritoneal carcinomatosis, metastatic lesions and with benign metastasizing leiomyoma as well. Etiological factors, pathophysiology and clinical manifestations which lead to a safe diagnosis of LPD are adequately described. Conclusion: Leiomyomatosis peritonealis disseminata (LPD) is a rare benign condition prone to recurrence, particularly in patients with a history of uterine fibroid surgery. Biopsy is essential for differential diagnosis. We recommend, based on the experience from this clinical case, that an exploratory laparotomy should be performed whenever the clinical and histological context raises suspicion of LPD, to offer a better chance of effective management. For patients who wish to preserve their fertility, medical treatment with aromatase inhibitors or selective progesterone receptor modulators may facilitate conservative surgery options. For patients without reproductive desires, total abdominal hysterectomy, bilateral salpingo-oophorectomy, and debulking of affected ....

Conservative surgery for forefoot osteomyelitis may increase reulceration-free survival compared to minor amputation in diabetes-related foot disease.

This study suggests that conservative surgery may improve reulceration-free survival in patients with diabetes-related forefoot osteomyelitis, compared to minor amputation. By excluding patients with prior surgeries, the analysis more accurately reflects the benefits of conservative surgery. These findings highlight the importance of preserving foot structure to maintain biomechanics and reduce reulceration risk.