Conservative Surgical Treatment Research Articles

Abstract PO5-22-03: Influence of the surgical clip concerning the dose and volume of irradiated surrounding tissues including lung and heart in the planning of radiotherapy boost with conservative breast surgery with and without oncoplasty

Abstract Introduction: Patients with the highest risk of breast cancer undergoing conservative surgery receive an additional boost dose of radiotherapy in the tumor bed during treatment planning, which is known to bring benefits in local control. Objectives: To evaluate the influence of the surgical clip concerning the volume of surrounding tissues irradiated during radiotherapy, in patients submitted to conservative breast surgery with and without oncoplasty. Materials/Methods. The analyzed variables were defined as: the volume of the boost (V100 Boost) and breast tissue (V100 Breast) that received 100% of the prescribed dose during the radiotherapy planning and the volume of the heart (V40 Heart) and lung (V40 Lung) that received 40% of the prescribed dose during the boost phase in patients undergoing treatment with breast conservation. The variables were compared about the insertion or not of the surgical clip and the influence of oncoplastic surgery on the volume of irradiated tissues of the breast, boost, heart and lung during radiotherapy planning. Student's t-test (95%CI; p< 0.05) was used to compare mean volumes as a function of the presence or not of surgical clips and oncoplastic surgery. Results: Retrospective study included 183 women with breast cancer who underwent treatment with conservative breast surgery and radiotherapy of the whole breast, followed by sequential boost, between January 2011 and January 2021. Boost, breast, heart, and lung volumes were evaluated during planning for conformational radiotherapy. The results showed a significant difference between the average boost volumes when the patient was clipped. The average boost volume that received 100% of the prescribed dose was V100 Boost=244.22cm³ (SD±158) in the absence of the clip. In the presence of 1 or 2 clips, this average was V100 Boost= 94.87cm³ (SD±37) and with 3 or more clips it was V100 Boost= 96.99cm³ (SD±39) (p< 0.001). There was also a significant difference in mean breast volumes that received 100% of the prescribed dose. In the absence of the clip, the V100 Breast=373.16 cm³ (SD±222) and when 1 or 2 clips were present, the V100 Breast=235.28 cm³ (SD±125) (p=0.01). The analyzes of the mean volumes of the heart (V40 Heart) and lung (V40 Lung) that received 40% of the prescribed boost dose were not statistically significant, regardless of the presence and number of clips. For the oncoplasty group, there was no statistical difference between the means of boost, breast, heart and lung volumes. Conclusion: The presence of the surgical clip reduced the volume of the boost and the breast that received 100% of the dose in the radiotherapy planning. The volume of the boost (V100 Boost), which received 100% of the dose prescribed during radiotherapy planning, was smaller in patients with a surgical clip, as was the volume of irradiated breast tissue (V100 Breast) in clipped patients. The volume of irradiated tissue in the heart (V40 Heart) and lung (V40 Lung) that received 40% of the prescribed dose during the boost phase in radiotherapy planning did not suffer statistical differences in insertion or not of the surgical clip. Oncoplastic surgery and the presence of surgical clips did not influence the volumes of irradiated boost, breast, heart and lung tissues during the radiotherapy planning of patients undergoing conservative surgical treatment of the breast. Table: Means of boost, breast, heart and lung irradiated volumes according to the presence or absence of clips and oncoplastic surgery Table. Means of boost, breast, heart and lung irradiated volumes according to the presence or absence of clips and oncoplasty surgery Variable (cm3) Clip p valor Oncoplasty p valor With Without With Without Means Means Means Means V100% Boost 94 244 < 0,001 102 118 0,906 V100% Breast 235 373 0,01 271 272 0,816 V40% Heart 1,10 4,52 0,33 1,96 1,39 0,903 V40% Lung 56,66 56,10 0,93 51,63 52,53 0,796 Citation Format: Nilceana Freitas, Priscila Watanabe, Jean Paiva, Carolina Bezerril, Marcelo Valentim, Thais Gontijo, Flavia Araujo, Ruffo Freitas-Junior. Influence of the surgical clip concerning the dose and volume of irradiated surrounding tissues including lung and heart in the planning of radiotherapy boost with conservative breast surgery with and without oncoplasty [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-22-03.

Diagnosis and treatment of 68 cases of traumatic facial nerve paralysis

Objective:To summarize the clinical characteristics and therapeutic effect of traumatic facial nerve palsy. Methods:Sixty-eight cases of traumatic facial nerve palsy were retrospectively analyzed from January 2015 to May 2023. Results:The median course of disease was 33 days. The facial nerve function of the patients was grade HB-Ⅱin 2 cases, grade HB-Ⅲ in 4 cases, grade HB-Ⅳin 16 cases, grade HB-Ⅴ in 37 cases（38 ears）, and grade HB-Ⅵ in 9 cases. 42 cases occurred immediately after injury and 26 cases were delayed. CT examination of temporal bone revealed longitudinal fractures in 51 cases（52 ears） , transverse fractures in 6 cases and mixed fractures in 4 cases. No definite temporal bone fracture was found in the remaining 7 cases. The segments of facial nerve injury in 49 cases（50 ears） were geniculate ganglion and adjacent, in 7 cases were vertical segment, in 7 cases were horizontal segment, in 2 cases were horizontal segment and vertical segment; and the other 3 cases could not be evaluated. Conservative treatment with glucocorticoids was used in 23 ears and surgery was used in 46 ears. Patients were followed up 6-24 months after treatment, including 20 cases of grade HB-Ⅰ, 19 cases of grade HB-Ⅱ, 23 cases（24 ears） of grade HB-Ⅲ, 4 cases of grade HB-Ⅳ, and 1 case of grade HB-Ⅴ.One patient was lost to follow-up. After treatment, the facial nerve function of patients was significantly improved（P<0.05）, and there were significant differences between conservative treatment group and surgical treatment group in the course of facial nerve palsy, the ratio of facial palsy immediately after injury, the nerve function before treatment and the nerve function after treatment（P<0.05）. There were no significant differences in age, sex, hearing condition, temporal bone fracture, facial nerve injury segment and rate of favorable neurologic outcomes（P>0.05）. The comparison of patients with neurodegeneration rate>90% and ≤90% showed that the facial nerve function of patients with neurodegeneration rate>90% before treatment was significantly worse（P<0.05）, but there was no significant difference between the facial nerve function after treatment（P>0.05）. There was no significant difference in facial nerve function between middle fossa approach group and mastoid approach group（P>0.05）. Conclusion:Patients with traumatic facial nerve palsy should be evaluated individually. Patients with mild facial nerve palsy, low neurodegeneration rate and short course of disease can be treated conservatively and followed up closely. Patients with severe facial nerve palsy, high neurodegeneration rate and more than 6 weeks of disease can be actively considered surgery. Good prognosis can be obtained by correct evaluation and treatment.

Surgical repair of incarcerated umbilical hernia in a white German Spitz

BackgroundAn umbilical hernia is common, but its incarcerated form is quite rare in dogs. An incarcerated hernia is characterized by the entrapment of herniated contents within the hernial sac, often accompanied by a constricted or narrower ring. It is usually refractory to the conservative approach, i.e., manual reduction, and surgical treatment is crucial to avert the risk of ischemia that can potentially lead to necrosis and gangrene in the involved tissues.Case presentationA 7-month-old female white German Spitz of 13.22 kg was presented with an ovoid swelling in the umbilicus, including a history of intermittent vomiting, progressive hyporexia, and weakness. Physical examinations led to a presumptive diagnosis of irreducible umbilical hernia after ultrasonography had shown a defect in abdominal wall continuity. Surgical intervention further confirmed an umbilical hernia with the incarceration of an omental flap. Herniorrhaphy was performed after resolving the incarceration and returning the content (i.e., omental flap) to the abdominal cavity. Postoperatively, supportive medications and routine care were provided. The external sutures were removed after two weeks, and periodic follow-ups revealed no complications. Ultrasonography was performed again on the 78th postoperative day, which indicated no breach in the abdominal wall integrity around the umbilicus. To the authors’ knowledge, this is the first documented case of a successfully treated incarcerated umbilical hernia in a white German Spitz.ConclusionsUmbilical hernias in young Spitz dogs can undergo incarceration over time if left untreated during the early stages. Meticulous diagnosis and specific treatment including surgical correction are essential for optimal outcome, avoiding further complications.

Surgical treatment options in chronic subdural hematoma: A literature review

Chronic subdural hematoma (cSDH) is one of the most common neurosurgery cases in daily practice. Chronic subdural hematoma is clot formation in the subdural space between the dura mater and the arachnoid layer. Due to its progression, clinical presentation of cSDH mostly appears 4 to 8 weeks after a traumatic brain injury. It is the duration needed for the hematoma to grow large enough to cause severe neurological symptoms such as decreased consciousness, hemiparesis, and other signs and symptoms of increased intracranial pressure. There are three main options to treat cSDH. Conservative treatment, surgical treatment, and embolization of the middle meningeal artery (MMA) are widely used to manage this condition. Predominantly, surgical treatments used by neurosurgeons around the world are craniotomy, burr hole (BH) craniostomy, and twist drill (TD) craniostomy. Each of these procedures has advantages and disadvantages. This literature review aimed to consider the characteristics of several treatment options for cSDH and their technique. This review recommends BH craniotomy due to its benefits based on its complication and recurrence rates. Burr Hole craniotomy has a lower complication rate than craniotomy and a lower recurrence rate than TD craniotomy. Twist drill craniotomy is selectively considered for certain patients since this procedure is commonly performed at the bedside without general anesthesia. Craniotomy is recommended as a treatment option for persistent recurrence of cSDH or patients with massive subdural hematoma.

The Impact of Conservative Surgical Treatment of Adenomyosis on Fertility and Perinatal Outcomes.

Adenomyosis is a benign condition commonly encountered in patients with infertility. While the definitive surgical management is hysterectomy, conservative surgical management is gaining attention in patients desiring future fertility. This review explores whether the surgical treatment of adenomyosis affects fertility outcomes for patients trying to conceive. The PubMed and Medline databases were searched using the keywords: "adenomyosis", "surgery", "radiofrequency", "infertility", "pregnancy", "sterility", "conception", "miscarriage", and "endometrial receptivity". Abstracts were screened, and relevant articles were selected for review. This review reveals that surgery appears to improve fertility outcomes with or without medical therapy; however, the risk of uterine rupture remains high and the best technique to reduce this risk is still not known. More studies are needed to formulate the best surgical approach for preserving fertility in treating adenomyosis and to establish standardized guidelines.

Stereotactic puncture surgery combined with early hyperbaric oxygen therapy may be better for long-term functional recovery in patients with moderate amounts of thalamic-inner capsule region haemorrhage

BackgroundThe prognosis of patients with thalamic hemorrhage is poor, and their long-term neurological impairment is heavy, which seriously affects their work and life.To comparatively analyse the efficacy and prognosis of patients with moderate hemorrhage in the thalamic region who underwent conservative treatment, stereotactic puncture surgery and neuroendoscopic surgery. MethodThis study retrospectively analyzed hospitalization data from 139 adult patients with moderate-volume cerebral hemorrhage in the thalamo-endocapsular region. They were categorized into a stereotactic group (39cases), a neuroendoscopic group (36cases), and a conventional conservative group (64cases). Logistic regression analysis was used to assess risk factors for severe neurological deficits in patients. Multivariate regression modeling was used to compare the correlation of severe neurological deficits among the three groups of patients. ResultsPatients with thalamic moderate-volume cerebral hemorrhage had statistically significantly higher Assessment of Daily Living (ADL) scores in the stereotactic surgery group than in the conservative treatment group and the neuroendoscopic surgery group after 6 months of treatment (p< 0.001).The amount of residual hematoma was significantly lower in the surgery groups than in the conservative treatment group at 3 days, 7 days, and 2 weeks after the onset of the disease (P< 0.001).In multivariate logistic regression analyses, after adjusting for all covariates, the odds ratios for severe neurologic dysfunction in the stereotactic group and the neuroendoscopy group were, respectively, OR: 0.37 (0.12–0.87), P< 0.001 and 0.42 (0.23–1.13), P=0.361). ConclusionIn patients with moderate volume cerebral hemorrhage in the thalamus-inner capsule region cerebral hemorrhage, patients treated with stereotactic surgery combined with early hyperbaric oxygen therapy may have better long-term neurological recovery compared with conservative and neuroendoscopic surgical treatments.

Current Status of Partial Laryngeal Surgery for Advanced Laryngeal Cancer: When and Why?

This paper aims to evaluate the evolution and current status of partial laryngeal surgery in the treatment of advanced laryngeal cancer (LC). Specifically, recent progress in the selection of both patients and tumors, together with surgical and rehabilitation innovations, have contributed to balancing oncological control with the maintenance of quality of life in naïve and radiorecurrent patients. The main aspect is represented by the recognized role of open partial horizontal laryngectomies (OPHLs) in this new era of laryngeal cancer treatment. Recent advancements highlight OPHLs' efficacy for conservative management of intermediate to advanced stages of LC. Innovations such as supratracheal partial laryngectomy have expanded surgical options, offering a modular approach to complex cases. Improved understanding of tumor biology, enhanced imaging techniques, and more precise preoperative planning have led to better patient outcomes, emphasizing the importance of a conservative function-preserving surgical treatment. These advancements reflect a broader trend towards individualized treatment plans that prioritize both survival and quality of life. OPHLs play an important role in current management of intermediate/advanced LC, effectively balancing oncological control with the preservation of laryngeal functions. Critical factors include meticulous patient and tumor selection, the impact of surgical and technological refinements on functional outcomes, and the necessity of a multidisciplinary approach in treatment planning. Current evidence justifies the use of these interventions in many intermediate T-stage laryngeal tumors, even at risk of upstaging on pathological examination. The oncological results, the preservation of laryngeal function and the laryngectomy-free survival achieved with OPHLs appear to be highly competitive with those of non surgical organ-preservation protocols, aiming to introduce a new standard in the LC treatment.

MEDICAL CARE OF NEWBORNS WITH MECONIUM ILEUS. DATA ANALYSIS OF WORLD EXPERIENCE AND OWN OBSERVATIONS

According to various scientists, 10-20 percent of newborns with cystic fi brosis have meconium ileus (MI).MI is an obstruction of the small intestine that occurs in fetuses during the 20th-24th week of gestation due to a violation of the processes of the formation of meconium. The latter has an increased viscosity and cannot pass through the intestines causing their obturation. About 50 percent of the cases of MI are complicated by intestinal volvulus, intestinal atresia, malrotation, perforation with the development of meconium peritonitis and ascites, the formation of a meconium pseudocyst etc. The goal of the research is to conduct a systematic overview of the literature on the issue of MI in neonatal patients and to off er optimal tactics of medical support of newborns with MI on the basis of the analysis of relevant literary sources and our own observations related to this topic.The results. The overview of the literature in the historical aspect covering the last 20 years has demonstrated the following: due to the development and improvement of the methods of conservative surgical treatment of newborns with MI the mortality of the newborns with MI has decreased. The analysis of the data based on the global experience as well as on our own observations indicates the possibility of conservative therapy and surgical treatment of infants with MI and testifi es to the fact that in 50 percent of cases of uncomplicated MI the conservative treatment can be an eff ective option.The research contains the description of the step-by-step measures of conservative treatment. The indications for surgical interventions have also been specifi ed in the research.Conclusion. In treatment of newborns with MI resections and stomata should be avoided. Instead, preference should be given to gastric lavage.

Comparison of different surgical approaches for treating aortic graft infections.

There is still no guideline or consensus on the treatment of aortic graft infection. This study reported and compared conservative and surgical treatment and different surgical methods for aortic graft infection. Data from aortic graft infections treated at our institution between February 2017 and June 2022 were retrospectively analyzed. Clinical data and surgical approaches were evaluated. This article retrospectively analyzed the treatment and prognosis of 48 patients (43 males) with aortic graft infection. The patients were divided into conservative treatment group (n = 15) and surgical treatment group (n = 33). During follow-up, the mortality rate of the conservative treatment group was significantly higher than that of the surgical treatment group (P<0.05). The survival curve also showed that the survival time of the surgical treatment group was longer than that of the conservative treatment group (P<0.05). The surgical treatment group included local treatment (n=5), in situ replacement (n=8) and bypass surgery (n=20) groups. There was no significant difference in the mortality rate at 1 month or final follow-up among the local treatment, in situ replacement and bypass surgery groups. Surgical treatment is the optimal option for treating aortic graft infections compared to conservative treatment.

Psychological Factors Can Affect the Clinical Outcome of Chemonucleolysis with Condoliase in Patients with Lumbar Disk Herniation.

Condoliase-based chemonucleolysis is a minimally invasive intermediate treatment option between conservative approaches and surgical interventions for lumbar disk herniation (LDH). In this study, the effects of psychological factors on the clinical outcomes of condoliase therapy for LDH were assessed. This study involved patients with LDH who received condoliase injections over a 1-year follow-up period. Data from the visual analog scale (VAS) scores for leg and back pain, Oswestry Disability Index, and Hospital Anxiety and Depression Scale (HADS), which was utilized for the psychological assessment, were collected. Using magnetic resonance imaging, changes in disk height and degeneration were evaluated. Data were assessed at baseline and 1-month, 3-month, and 1-year follow-ups. Condoliase therapy was considered effective in patients whose VAS score for leg pain improved by ≥50% at 1 year from baseline and who did not require surgery. The patients were divided into two groups: those who reported effective treatment (Group E) and those who did not (Group I). Between these two groups, comparative analyses were carried out. In this study, a total of 102 patients (70 men; mean age, 43.8±18.2 years) were included. Condoliase therapy was effective in 76 patients (74.5%). Thirty-five patients (34.3%) showed psychological factors (HADS-Anxiety [HADS-A]≥8 or HADS-Depression [HADS-D]≥8) preoperatively and had a significantly lower rate of effectiveness than did those without psychological factors. Group I demonstrated significantly higher baseline back pain VAS, HADS, and HADS-D scores when compared with Group E. Logistic regression analysis identified females and the baseline HADS-D score as independent factors that were related to the effectiveness of condoliase therapy. The patients with psychological factors tended to experience residual pain resulting in adverse effects on the clinical outcomes of chemonucleolysis with condoliase.

Shoulder Impingement Syndrome, A Common Shoulder Disease: A Comprehensive Review

The shoulder joint is a flexible but unstable joint in the human body. Also, it has complex structures including coracoacromial arch, synovial bursa, head of femur and so on. Based on these traits, shoulder joints have a wide range of activity, but some lesions accompany with, especially some overhand motions like throwing baseball, swimming, lifting the weight above head repetitively. Diversification of pathogenic factors are significant traits of this kind of injury. In addition, lesions of shoulder impingement syndrome (SIS) can occur in multiple locations even happening at same time. Under normal conditions, this type of disease is often delimited by rotator cuff. Because of the complexity of this injury, different tests of diagnosis can be applied, including Hawkins-Kennedy test, Neer sign, Jobe test, Painful arc of motion. For treatment options, these can be divided into conservative treatment including conservative methods and surgical treatment like arthroscopic subacromial decompression (ASD). SIS causes shoulder pain to disrupt and reduce life’s quality of patients. Based on relevant research and literature, this article is designed to offer a general review of the above content.

Evaluation study of single-anastomosis duodenal-ileal bypass with sleeve gastrectomy in the treatment of Chinese obese patients based on efficacy and nutrition

To evaluate the efficacy and nutrition of single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) in Chinese obese patients in the first postoperative year. Clinical data of 66 obese patients who underwent SADI-S surgery at China-Japan Union Hospital of Jilin University from November 2018 to May 2022 were retrospectively collected. The weight, body mass index (BMI), percentage of excess weight loss (%EWL), and percentage of total weight loss (%TWL) were recorded at 3, 6, and 12 months after surgery. Moreover, metabolic disease remission and nutrient deficiencies were assessed at 1 year postoperatively. Overall, 66 patients (38 males and 28 females) were recruited, with a mean age of 35 (18–61) years and an average preoperative BMI of 42.94 kg/m2. Before surgery, 38 patients had type 2 diabetes mellitus (T2DM), 46 patients had hyperuricemia (HUA), 45 patients had hypertension (HTN), 35 patients had hyperlipidemia, 12 patients had hypercholesterolemia, 12 patients had hyper-low-density lipoproteinemia, and 14 patients had gastroesophageal reflux disease symptoms (GERD). All patients had undergone a DaVinci robotic or laparoscopic SADI-S surgery, and none converted to laparotomy or died. Four patients developed postoperative complications and were cured and discharged after conservative treatment or surgical treatment. At 3, 6 and 12 months, the average %EWL was 62.07 ± 26.56, 85.93 ± 27.92, and 106.65 ± 29.65%, %TWL was 22.67 ± 4.94, 32.10 ± 5.18, and 40.56 ± 7.89%, respectively. Fasting blood glucose (FBG), glycated hemoglobin (HbA1c), uric acid (UA), triglycerides (TG), blood pressure (BP), and other indexes were significantly lower after one year post-surgery compared with the preoperative period (P < 0.05). The remission rates of T2DM, HUA, HTN, hypertriglyceridemia, hypercholesterolemia, and hyper-low-density lipoproteinemia 1 year after surgery were 100, 65.2, 62.2, 94.3, 100, and100%, respectively. One year after surgery, the remission rate of GERD was 71.4% (10/14), the rate of new occurrence of GERD was 12.1% (8/66), and the overall incidence rate was 18.2% (12/66). Except for vitamin B12(vit B12), the other nutrient indexes were significantly decreased after 1 year of surgery relative to levels before surgery (P < 0.05). The deficiency rates for vitamin A (vit A), vitamin E (vit E), zinc ion (Zn), and folic acid (FA) were higher (45.5, 25.8, 24.2, and 16.7%, respectively); however, there were no related clinical symptoms. SADI-S had significant effects on weight loss and metabolic disease remission. The main nutrient deficiencies after SADI-S were vit A, vit E, Zn, and FA deficiencies. The long-term efficacy and safety of SADI-S warrant further follow-up.

Dienogest in conjunction with GnRH-a for postoperative management of endometriosis.

Objective: The aim of this study is to assess the postoperative efficacy of the combined administration of dienogest (DNG) and gonadotropin-releasing hormone agonists (GnRH-a) in patients diagnosed with endometriosis (EMS), while acknowledging the extensive use of DNG in the extended therapeutic management of EMS. Methods: In this retrospective study, a cohort of 154 patients who underwent conservative surgical intervention for EMS were scrutinized. The cohort was stratified into two distinct groups based on their prescribed pharmacological regimens. Group A, 70 patients received postoperative oral administration of DNG at a dosage of 2mg/day, whereas Group B, 84 patients underwent treatment involving 3 to 4 injections of GnRH-a post-surgery, followed by DNG therapy. Parameters assessed included pelvic pain visual analog scale (VAS) scores, quality of life metrics (EHP-5), and the incidence of adverse reactions within both groups. Results: Both groups exhibited sustained low VAS scores following the prescribed treatments. The predominant occurrence of adverse bleeding patterns manifested predominantly within the initial 6months of the treatment. Notably, Group B demonstrated a significantly diminished of experiencing frequent and irregular bleeding in comparison to the DNG group (20.0% vs. 8.3%, 12.9% vs. 3.6%, p < 0.05). The administration of GnRH-a did not exacerbate the impact on bone health. Subsequent to health promotion interventions, the incidence of weight gain in both groups declined to 7.1% during the 6-month follow-up (p < 0.05). Group B exhibited a 100% satisfaction rate with the treatment, concomitant with a noteworthy reduction in EHP-5 scores (p < 0.05). Patients with deep infiltrating endometriosis (DIE) nodules displayed marginally higher postoperative VAS scores than their non-DIE counterparts (0.89 ± 0.96 vs. 0.49 ± 0.78). However, with sustained medication use, pain scores within the DIE group exhibited a continual decrease, maintaining a low level of 0.29 ± 0.67 at 12months and beyond. Conclusion: The short-term adjunctive use of GnRH-a prior to DNG treatment postoperatively in patients with EMS proves efficacious in mitigating early adverse bleeding, enhancing patient adherence, and improving overall quality of life. Notably, this therapeutic approach demonstrates favorable safety profiles and is equally effective in patients with DIE.

Lung adenocarcinoma: selection of surgical approaches in solid adenocarcinoma from the viewpoint of clinicopathologic features and tumor microenvironmental heterogeneity.

Solid adenocarcinoma represents a notably aggressive subtype of lung adenocarcinoma. Amidst the prevailing inclination towards conservative surgical interventions for diminutive lung cancer lesions, the critical evaluation of this subtype's malignancy and heterogeneity stands as imperative for the formulation of surgical approaches and the prognostication of long-term patient survival. A retrospective dataset, encompassing 2406 instances of non-solid adenocarcinoma (comprising lepidic, acinar, and papillary adenocarcinoma) and 326 instances of solid adenocarcinoma, was analyzed to ascertain the risk factors concomitant with diverse histological variants of lung adenocarcinoma. Concurrently, RNA-sequencing data delineating explicit pathological subtypes were extracted from 261 cases in the TCGA database and 188 cases in the OncoSG database. This data served to illuminate the heterogeneity across lung adenocarcinoma (LUAD) specimens characterized by differential histological features. Solid adenocarcinoma is associated with an elevated incidence of pleural invasion, microscopic vessel invasion, and lymph node metastasis, relative to other subtypes of lung adenocarcinoma. Furthermore, the tumor microenvironment (TME) in solid pattern adenocarcinoma displayed suboptimal oxygenation and acidic conditions, concomitant with augmented tumor cell proliferation and invasion capacities. Energy and metabolic activities were significantly upregulated in tumor cells of the solid pattern subtype. This subtype manifested robust immune tolerance and capabilities for immune evasion. This present investigation identifies multiple potential metrics for evaluating the invasive propensity, metastatic likelihood, and immune resistance of solid pattern adenocarcinoma. These insights may prove instrumental in devising surgical interventions that are tailored to patients diagnosed with disparate histological subtypes of LUAD, thereby offering valuable directional guidance.

Neglected Preauricular Sinus Abscess Extending to the Scalp: A Case Report of Complications and Management Challenges

Preauricular sinus, a congenital malformation resulting from incomplete fusion of the first and second branchial arches, is a relatively common condition with a reported prevalence of 0.1% to 0.9%. While mostly asymptomatic, it can lead to abscess formation when infected. We present a unique case of a neglected preauricular sinus abscess that extended to the scalp, causing significant complications. The report discusses the clinical presentation, diagnostic approach, treatment modalities, and potential complications associated with this unusual and severe presentation. Prompt and appropriate management, combined with conservative treatment and surgical intervention, led to successful outcomes. This case highlights the importance of recognizing potential risks and implementing a systematic approach in managing recurrent preauricular sinus abscesses.

Conservative versus surgical treatment of Gartland type II supracondylar humeral fractures in children.

The purpose of the study was to compare the efficacy of conservative and surgical treatments for Gartland type II supracondylar humerus fractures in children. We assessed 142 patients with type II supracondylar humerus fractures treated in our hospital from February 2018 to February 2019. The patients were divided into two groups: initial conservative treatment (Group A) and initial surgical treatment (Group B). Clinical outcomes were measured by the Flynn scoring system. Variables were analyzed using a statistical approach between those groups. All patients were followed up for 6-12 months. The rate of loss reduction was 19.8% in patients treated conservatively, and the incidence of pin infections was 7.1% in patients treated surgically. Although there were no statistical differences between the three groups in fracture healing time and Flynn score, the conservative treatment was superior to surgical treatment in functional recovery times. At the last follow-up, all fractures had healed without iatrogenic vascular or nerve injury, Volkmann's contracture, or cubit varus deformity. Conservative treatment is safe and effective for the treatment of Gartland type II supracondylar fracture and represents a faster recovery time of elbow range of motion as compared with surgical treatment. Type IIB had a 41.3% risk of secondary displacement versus 5.3% for IIA, but we still prefer closed reduction. However, closed reduction of Garland type II must be followed accurately in the first 2 weeks to identify patients with loss of reduction. The patients who loss reduction can be treated with percutaneous pinning, and the clinical effect was consistent with immediate surgical treatment. Level of evidence: level III.

Success in managing a giant hepatic hydatid cyst: a case report of successful conservative surgical intervention in an endemic setting

Introduction and importance: Echinococcosis, also known as a hydatid cyst, arises from a parasitic infection caused by the larval form of the tapeworm Echinococcus granulosus in humans. This endemic disease in Tunisia presents a significant public health challenge. The case highlights the enormous size of the liver hydatid cyst, emphasizing the importance and success of conservative surgical treatment. Case Presentation: A 45-year-old female shepherdess presented with abdominal pain and a mass, diagnosed as a giant hepatic hydatid cyst. A computed tomography scan revealed a dysmorphic liver with a large multivesicular cyst. Surgical intervention included the resection and closure of multiple cystic fistulas. Postoperative recovery was uneventful and at the 6-month follow-up, the patient displayed no indications of recurrence. Clinical discussion: Echinococcosis, prevalent in livestock-farming regions, primarily affects the liver and lungs. It often remains asymptomatic, detected incidentally. Diagnosis relies on imaging, with surgical excision as the primary treatment. Percutaneous options exist but are less effective. Serologies are underused. Management challenges include complications and recurrence. Conservative surgery is common but faces complications. Radical surgery is more effective, albeit complex. Albendazole preoperatively proves promising, reducing cyst viability. Regular follow-up is crucial for recurrence detection. Conclusion: Managing giant hepatic hydatid cysts requires tailored approaches, especially in endemic regions. Our success with conservative surgical treatment highlights its effectiveness in confronting formidable cyst sizes, informing clinical practice, and contributing to the medical literature.

Conservative treatment of large unicystic ameloblastoma in a young patient: a 7-year follow-up

The unicystic ameloblastoma is an odontogenic tumor that is frequently found in young patients and usually affects the posterior region of the mandible. This paper aimed to describe a case report and 7-year follow-up of a young patient. The 12-year-old patient presented with increased volume in the lower third of the right hemiface with a duration of 6 months. Radiographic examination showed a unilocular radiolucent lesion extending along the body, angle and right mandibular ramus. An incisional biopsy was performed and a histological diagnosis of luminal unicystic ameloblastoma was obtained, opting for a conservative treatment with decompression and subsequent complete enucleation of the lesion. The patient has been under follow-up for 7 years, with a good evolution of the condition and without clinical and radiographic signs of recurrence of the lesion. Thus, it is ratified that timely conservative intervention and conservative surgical treatment should be the first choice for ameloblastoma management in young patients.

Clinical characteristics and efficacy analysis of various treatments for spontaneous carotid artery dissection

Objective: To investigate the clinical features of spontaneous carotid artery dissection (SCAD) and the efficacy of different treatment methods. Methods: The clinical data of 164 patients with SCAD who were treated at the First Affiliated Hospital of Zhengzhou University from June 2018 to January 2023 were retrospectively analyzed. There were 127 males and 37 females, with a mean age of (49.5±11.1) years. They were divided into conservative treatment group (n=100) and surgical treatment group (n=64) according to whether they received surgical treatment. Patients were followed at 3, 6, and 12 months after discharge and annually thereafter through outpatient or inpatient visits. The incidence of cerebral ischemic events, cerebral hemorrhage events, and mortality rates during hospitalization and follow-up periods were analyzed in the two patient groups. To examine correlates of revascularization in SCAD, multifactorial logistic regression analysis was used. Results: Of the 164 patients, 18 patients had bilateral SCAD and a total of 182 carotid arteries were included in the study. Ischemic stroke (85 cases, 51.8%) and transient ischemic attack (31 cases, 18.9%) were the main clinical manifestations in SCAD patients. Hypertension (81 cases, 49.4%) and hyperlipidemia (39 cases, 23.8%) were the main comorbidities in SCAD patients. During hospitalization, 100 patients in the conservative treatment group received medication in 113 carotid arteries, no new cerebral ischemic events or symptomatic intracranial hemorrhage events occurred, and no death occurred. A total of 69 carotid arteries were surgically treated in 64 patients in the surgical treatment group. The success rate was 97.1% (67/69). In the surgical treatment group, the proportion of carotid stenosis degree≥90% was 47.8% (33/69), the proportion of type Ⅱ SCAD was 60.9% (42/69), and the proportion discharged from the hospital to receive antiplatelet therapy was 92.8% (64/69), which were higher than those in the conservative treatment group, which were 25.7% (29/113), 45.1% (51/113), and 73.5% (83/113), respectively (all P<0.05). The follow-up time [M(Q1, Q3)] in the conservative treatment group was 24 (13, 34) months, with an 8% (9/113) rate of ischemic events and a 7.1% (8/113) rate of readmission; in the surgical treatment group, the follow-up time was 24 (11, 38) months, and there were no new ischemic events or deaths. The results of multifactorial logistic regression analysis showed that the degree of true luminal stenosis<90% (OR=2.738, 95%CI: 1.067-7.026, P=0.036) and type Ⅰ dissections (OR=2.656, 95%CI: 1.189-5.935, P=0.017) were the correlates of complete revascularization. Conclusions: Ischemic stroke and transient ischemic attack are the main clinical manifestations in patients with SCAD. Pharmacological antithrombotic therapy remains the method of choice, and endovascular treatment after failure of conservative therapy reduces the risk of recurrent long-term cerebral ischemic events and the re-admission rate of patients.

Management of isolated dissection of the superior mesenteric artery.

Isolated dissection of the superior mesenteric artery (IDSMA) is an increasingly frequently diagnosed pathology without a predisposing factor. Different therapeutic options including conservative, endovascular, and open surgical treatment are presented in our single-center study. The follow-up is a special task of different specialties. A retrospective analysis of six patients with IDSMA was conducted. Patient demographics, clinical presentation, diagnostic management, and therapeutic treatment were assessed. Furthermore, clinical outcome as well as further changes during follow-up were evaluated. The majority of the patients were symptomatic with abdominal pain. Of the symptomatic patients, one was managed conservatively, one was treated surgically by patch plasty, and two patients were treated using an endovascular approach. The two asymptomatic patients were each managed conservatively. Conservative therapy was the treatment of choice, especially in asymptomatic and uncomplicated cases with non-persistent symptoms. This was confirmed in our literature review. Computed tomography angiography is the gold standard for follow-up after the acute event or diagnosis. None of our patients needed further treatment after the acute event/detection of IDSMA during the follow-up period with a mean of 68 months. One patient showed significant changes in the diameter of the superior mesenteric artery. The appropriate diagnosis, treatment, and follow-up of IDSMA must be tailored to the needs of the individual patient and require multidisciplinary decision making. · IDSMA can cause several symptoms, and is mostly seen in smoking, middle-aged men.. · Therapeutic options include conservative management and surgical and interventional methods.. · Conservative management is the most applicable treatment in asymptomatic patients.. · For diagnosis and follow-up, CTA is the gold standard.. · To avoid an excessive cumulative radiation dose, ultrasound monitoring may be adequate..