Surgical Treatment Research Articles

Enhancing Skin Wound Healing in Diabetic Mice Using SIKVAV-Modified Chitosan Hydrogels

Diabetic foot ulcers (DFUs), a prevalent chronic disease caused by various factors, significantly impact patients’ quality of life due to prolonged healing times and increased infection risks. Current treatment modalities, including pharmacological, physical, and surgical interventions, often yield limited efficacy and adverse effects, highlighting the urgent need for novel therapeutic strategies. The objective of this research is to create SIKVAV-modified chitosan hydrogels with the intention of improving the process of skin wound healing in diabetic mice. We synthesized the hydrogels and established a diabetic mice model with skin wounding to evaluate its healing effects and underlying mechanisms. The results of our study indicate that the SIKVAV-modified chitosan hydrogels markedly enhance the wound healing process in diabetic mice. This effect may be attributed to several mechanisms, including differentiation of fibroblasts, proliferation of keratinocytes, the promotion of angiogenesis, stimulation of collagen synthesis, upregulation of growth factor expression, and possible involvement of the TGF-β1/Smad3 signaling pathway. This research not only provides a new biomaterial for the treatment of diabetic wounds but also elucidates the related molecular mechanisms involved in wound healing of DFUs, offering valuable insights for future clinical applications.

The effect of urinary diversion on kidney function in posterior urethral valves and ureterovesical obstruction.

Posterior urethral valves (PUV) and ureterovesical junction obstruction (UVJO) are common etiologies of lower urinary tract obstruction. The primary objective of therapy is to alleviate the obstruction in the urinary system. Temporary urinary diversion may be necessary in certain situations, such as Urinary tract infection (UTI), sepsis, and unchanging hydronephrosis. This study, aims to assess kidney parameters after urinary diversion (either pyelostomy or ureterostomy) in patients with PUV and UVJO. We conducted a retrospective analysis of all patients diagnosed with PUV or UVJO and treated with urinary diversion following urinary undiversion at our facility between 2015 and 2020. The following variables were collected: demographic details, surgical interventions (type of diversion), serum creatinine throughout follow-up, anterior-posterior diameter of the pelvis (APP), anterior-posterior diameter of the ureter (APU), and sonographic findings of renal parenchymal thickness (PT) as documented by a pediatric radiologist. Additionally, before and after urinary diversion, a Dimercapto succinic acid (DMSA) nuclear renal scan was conducted to assess renal function. We analyzed 67 patients, with a mean follow-up of 38.3months, undergoing either ureterostomy (42 patients) or pyelostomy (25 patients). This included 38 patients with PUV and 29 with UVJO. In PUV patients, significant improvements were observed in APP (MD = 5.56 ± 11.6, p = 0.0194), APU (MD = 5.57 ± 7.28, p < 0.001), and PT (MD = 3.66 ± 2.75, p < 0.001). Similarly, UVJO patients experienced significant improvements in APP (MD = 12.18 ± 18.63, p = 0.005), APU (MD = 7.82 ± 8.98, p = 0.001), and PT (MD = 2.79 ± 3.33, p = 0.001). DMSA scores did not significantly change in either group (p > 0.05). Notably, APP improved more in UVJO patients compared to PUV patients (p = 0.047). Our study suggests that urinary diversion could improve APP, APU, and renal parenchymal thickness in PUV and UVJO patients. The improvement of APP in UVJO patients was greater than in the PUV group. We propose further multi-center studies with longer durations of follow-up and more detailed additional data to support and confirm our results.

Comparison and validation of several scoring systems for non-variceal upper gastrointestinal bleeding: a retrospective study.

Various scoring systems have been developed to predict outcomes in patients with non-variceal upper gastrointestinal bleeding (NVUGIB). However, their accuracy remains unclear. This study aimed to compare and validate the predictive performance of several established scoring systems in patients with NVUGIB: Glasgow-Blatchford score (GBS) and the age, blood tests, and comorbidities (ABC), mental status-anesthesiologist score-pulse-albumin-systolic blood pressure-hemoglobin (MAP(ASH)), Japanese, and Charlson comorbidity index-in-hospital onset-albumin-mental status-Eastern Cooperative Oncology Group performance status-steroids (CHAMPS) scores. We retrospectively reviewed the records of 1,241 patients who presented to the emergency department with NVUGIB and subsequently required hospitalization. Each scoring system was evaluated for its ability to predict in-hospital mortality, rebleeding, and the need for radiological or surgical intervention. The ABC score showed the highest accuracy in predicting in-hospital mortality. The MAP(ASH) score was the most effective predictor of rebleeding and the need for interventions. Different scoring systems have been optimized for various clinical outcomes. The ABC score was the best for predicting mortality, whereas the MAP(ASH) score excelled in identifying rebleeding risks and intervention needs. The selection of an appropriate scoring tool based on specific clinical scenarios can improve patient management and resource allocation in NVUGIB.

The Unique Challenge of Coronary Artery Disease in Adult Patients with Congenital Heart Disease

Advances in medical and surgical interventions have resulted in a steady increase in the number of patients with congenital heart disease (CHD) reaching adult age. Unfortunately, this ever-growing population faces an added challenge: an increased risk of acquiring coronary artery disease. This review provides insight into the complex interactions between coronary artery disease and CHD in adults. We describe the peculiar features of cardiac anatomy in these patients, the possible role cardiac sequelae may play in an increased risk of myocardial ischemia, and the diagnostic challenges in this patient group. Furthermore, this review outlines the risk factors and potential mechanisms of accelerated atherosclerosis in adults with CHD by pointing out areas where current knowledge is incomplete and highlighting areas for further research. The review concludes by examining potential management strategies for this particular population, emphasizing the necessity for a multidisciplinary approach. Understanding the unique coronary risks that adults with CHD experience can enhance patient care and improve long-term results.

DECISION MAKING IN EPILEPTIC AVMS

While there is no doubt about the need for surgical treatment of a ruptured arteriovenous malformation (AVM), the decision to surgically treat a patient presenting solely with seizures is more controversial. Arteriovenous malformations (AVMs) arise from an abnormal connection between high-flow arterial vessels and low-flow venous vessels, resulting in a dysplastic vascular nidus within the brain tissue. The inherent flow irregularities within AVMs make them prone to rupture, which occurs in approximately half of patients. Additionally, seizures represent the second most common clinical manifestation of AVMs, presenting in 20%–45% of individuals with these lesions. This paper investigates the angiographic and MRI features of arteriovenous malformations that present with epilepsy, and discusses the surgical considerations in managing these patients and integration of multimodal approach focusing on the standard microsurgical techniques utilized. Patients presenting with seizures as the primary symptom of an arteriovenous malformation carry a higher surgical risk compared to those presenting with haemorrhage. Several factors have been associated with an increased risk of seizures in patients with arteriovenous malformations (AVMs). These include male gender, younger patient age, AVMs located in the frontal or temporal lobes, AVMs situated in the brain cortex, superficial venous drainage, a superficial temporal lobe AVM nidus, fistulous AVMs, and AVMs with venous stenosis. Surgical treatment is the recommended approach for patients with Spetzler-Martin grade I–III arteriovenous malformations. Resecting an unruptured brain arteriovenous malformation in a patient presenting only with epilepsy is a complex decision that requires a thorough understanding of the lesion’s anatomy, the patient’s history, and the neurosurgeon’s skills.

Spontaneous brain abscess formation: challenge of a shifting pathogen spectrum over the last 21 years - a single center experience.

Spontaneous intracerebral abscess formation is a rare condition presenting with a disabling sequela. The origin of infection can either be primary or secondary to an infection at another location. The site of primary infection - due to the proximity, often the oral cavity, the sinuses, and the orbit - determines the causative pathogens. Treatment often combines surgical and antimicrobial therapies. To determine the microbiology and respective changes and treatment outcome, we performed this retrospective monocentric cohort study of patients requiring surgical treatment of brain abscesses. Patients undergoing surgical treatment of a primary intracranial abscess between January 2000 and January 2021 in the Department of Neurosurgery, Freiburg University Hospital were included. Demographic, clinical and imaging data were extracted from patients' medical records and databases. Treatment approaches were also analyzed, and surgical therapy and antibiotic therapy were reported. Outcome was assessed by the modified Rankin score (mRS) and was dichotomized into good (mRS 0-3) and poor (mRS 4-6) outcome. We included 65 patients with spontaneous intracerebral abscess that were treated with neurosurgical intervention at our institution. Analysis of the causative pathogens showed an increasing dominance of rare pathogens such as fungi, parasites, mycobacteria and anaerobes. Outcome measured by the mRS was similar from 2005 to 2021. The pathogen spectrum of spontaneous intracerebral abscess at our institution is shifting with rarer pathogens being increasingly detected. This retrospective analysis highlights the need for microbiological diagnosis and of combined surgical and antibiological treatment.

Arthroscopic Partial Meniscectomy in Adult Patient with Symptomatic Discoid Lateral Meniscus: A Case Report

Introduction: For many years, the discoid meniscus was synonymous with snapping knee syndrome. incidence of discoid lateral meniscus is estimated to be 0.4% to 17%, whereas the discoid medial meniscus is extremely rare (0.1% to 0.3%). It has been reported that about 20% of cases are bilateral. Patients with discoid lateral meniscus (DLM) often show normal plain radiography findings but may also show subtle indirect signs. Case Presentation: Female, 59 years old, complained of pain on her left knee after walking and climbing stairs for the last two months. On examination, the range of motion of knee joint was limited due to the pain for flexion more than 90°. Patient had medial joint line tenderness, and a McMurray test elicited pain on the lateral joint line. Radiographs of the left knee showed lateral joint space widening and high fibular head. Arthroscopic examination of the left knee confirmed the presence of discoid lateral menisci (DLM). Discussion: Discoid lateral meniscus (DLM), often referred to as "popping knee syndrome," is an abnormal variation of the meniscus, primarily affecting the lateral side and more common in young individuals. This condition increases the risk of knee injury, especially if the ligament attachment to the tibia is absent. In our case, radiographic findings and a positive McMurray test led to the diagnosis, confirmed by arthroscopy showing a complete DLM. While some recommend for total meniscectomy, studies suggest that partial meniscectomy can offer good initial results, though long-term outcomes may vary. Conclusion: In symptomatic DLM, surgical treatment is necessary to treat the patient. Arthroscopic partial meniscectomy is the preferred surgical procedure to treat symptomatic DLM. Keywords: Discoid lateral meniscus, arthroscopic menisectomy, WOMAC score

An Algorithm for Management of Radial Longitudinal Deficiency.

Lack of specific guidelines in the literature renders management of radial longitudinal deficiency (RLD) exceedingly diverse. This diversity in treatment approaches can lead to variability in outcomes and pose a challenge in determining the most effective interventions for each individual case of RLD. Surgeons must carefully consider the unique characteristics and needs of each patient when developing a treatment plan for this complex condition. Around 40% of cases are linked to syndromes like Holt-Oram syndrome, thrombocytopenia absent radius (TAR) syndrome, Fanconi anaemia and VACTERL. Hand surgeons must be knowledgeable about these conditions, as they may be the first to identify these syndromes in children. Associated elbow stiffness can also be a crucial factor in treatment decision-making. Although this condition has been studied for more than 10 decades, the surgical treatment that is currently available is not completely successful in restoring 'normal' wrist function and appearance. Centralisation and radialisation procedures continue to be the cornerstones of surgical treatment. Many innovative approaches include altering the biomechanics of this condition with bony or soft tissue procedures and microvascular techniques. Understanding the proximal limb changes is crucial in the holistic management of this challenging malformation. This article presents a treatment algorithm based on literature evidence and our clinical experience. Level of Evidence: Level V (Therapeutic).

Factors Affecting Appearance after Thumb Polydactyly Reconstruction - A Caregiver's Perspective in an Asian Population.

Background: Current research on thumb polydactyly reconstruction focusses primarily on clinical evaluations. Details on aesthetic outcomes are relatively lacking. This study aims to address this gap by: (1) investigating the effectiveness of surgical treatment in achieving symmetrical thumb size, length and girth; (2) assessing aesthetic outcomes from a caregiver's perspective and (3) identifying key factors that influence aesthetic outcomes to inform strategies to improve surgical reconstruction. Methods: Patients who underwent thumb polydactyly reconstruction were recalled for assessment. Objective measurements of both the reconstructed and unaffected thumbs were taken. Surgical scars were evaluated by measuring their length and using the Vancouver Scar Scale (VSS). To assess the appearance of the reconstructed thumbs, we used the Visual Analogue Scale (VAS) through surveys completed by the primary caregiver of each patient. Caregivers also provided reasons for any unsatisfactory appearance outcomes and we correlated these with objective factors. Results: This study included 26 paediatric patients with 29 reconstructed thumbs. The mean VAS score for overall thumb appearance was 7.8 ± 2.2. While surgical treatment achieved symmetry in most anthropometric measures, reconstructed thumbs had smaller nail plates and greater joint angulation. Caregiver assessment of thumb width was closely related to the objective interphalangeal joint (IPJ) girth measurements, and perceived excessive angulation was related to the IPJ angle. Symmetry was not associated with nail fold width or scar location. However, perceived scar prominence was linked to VSS score and scar location. Conclusions: Thumb polydactyly reconstruction achieves symmetry in size, length and girth, but nail plate size and joint angulation remain significant challenges. Despite this, caregivers are generally satisfied with the overall appearance. Attention should be focussed on improving thumb IPJ girth, IPJ angulation and scar location to enhance overall aesthetic outcomes. Level of Evidence: Level IV (Therapeutic).

Effectiveness and Personalized Approaches in the Correction of Gummy Smile: A Systematic Review of Orthodontic and Surgical Treatments

Background/Objectives: This systematic review seeks to assess the effectiveness of different orthodontic and combined orthodontic–surgical approaches for correcting gummy smile, with a focus on treatment efficacy, duration, and the potential for integrating various techniques. The objective is to offer evidence-based recommendations for the optimal management of gummy smile. Methods: A thorough search of the literature was conducted in the PubMed, Cochrane Library, Scopus, and Web of Science databases, covering publications from 1 January 1982 to 4 November 2024. Only randomized controlled trials involving adult human subjects with available full-text articles were included, while systematic reviews, editorials, case reports, and studies involving animals or in vitro experiments were excluded. Studies were selected based on their relevance to orthodontic or combined orthodontic–surgical treatments for correcting excessive gingival display (gummy smile), particularly in cases where residual growth does not impact treatment outcomes. The primary focus was on evaluating the efficacy of these interventions in improving smile aesthetics. Follow-up data were considered when available, though not required for inclusion. Results: The findings revealed that both orthodontic and surgical methods are effective in reducing gingival display. Orthognathic surgery offers lasting outcomes, particularly for patients with vertical maxillary excess, whereas orthodontic treatments, including the use of skeletal anchorage devices, are particularly effective for less severe cases. Minimally invasive approaches, such as botulinum toxin injections, provided temporary but promising results for patients reluctant to undergo surgery. Conclusions: Orthodontic and surgical techniques are viable options for treating gummy smile, with treatment choices depending on the condition’s severity. Future research, particularly long-term randomized studies, is required to further refine treatment protocols and improve patient outcomes.

THE RELATIONSHIP BETWEEN RETINAL PERFUSION AND FUNCTIONAL RECOVERING OF FOVEA IN DIFFERENT TYPES OF SURGICAL CLOSURE OF FULL-THICKNESS MACULAR HOLES

Rationale: The effect of retinal perfusion on functional recovery of the fovea, as well as the value of quantitative perfusion parameters as predictors of functional outcome in the surgical treatment of full-thickness macular holes (FTMH) remains poorly understood.Objective: To study the relationship between changes in retinal perfusion and functional parameters of the fovea in the postoperative period at 1 and 2 types of FTMH closure.Methods: A prospective study including 93 patients (93 eyes) with idiopathic FTMH stage 2-4 according to D. Gass after surgical treatment. In subgroups with type 1 and type 2 of FTMH closure, changes in the foveal avascular zone (FAZ) area and vessel density in the superficial and deep capillary plexuses (SCP and DCP) in the fovea, changes in BCVA, retinal sensitivity (RS) at the fixation point, and P1 amplitude in the fovea were studied. Studies were performed preoperatively, 1 and 6 months after surgery. A significant correlation was found between the changes in BCVA, RS at the fixation point, P1 amplitude in the fovea, and changes in vessel density in the SCP and DCP, which was more pronounced in the period from 1 to 6 months after surgery. The correlation of the changes in the parameters is higher in type 2 of FTMH closure than in type 1 of FTMH closure.Results:. Subgroups with type 1 and type 2 FTMH closure included 67 and 26 eyes, respectively. Type 2 FTMH closure showed lower vascular density in the DCP before (p=0.02) and 6 months after surgery (p=0.03), lower BCVA before surgery (p=0.03), 1 and 6 months after surgery (p &lt;0.001), lower RS at the fixation point before and after surgery (p&lt;0.002).Conclusion. In type 2 macular hole closure, postoperative changes in retinal perfusion have a more pronounced impact on functional recovery of the fovea, especially in the late postoperative period.

Clinicopathologic feature and treatment progress of high-grade ovarian neuroendocrine tumors.

High-grade Ovarian neuroendocrine tumors represent a rare subset of ovarian neoplasms characterized by aggressive behavior, poor prognosis, and early metastasis. Despite their clinical significance, the management of these tumors lacks consensus due to their low incidence. This comprehensive review encompasses literature spanning from 1991 to 2024, focusing on the clinical presentation, diagnostic criteria, differential diagnosis, prognostic indicators, treatment modalities, and recent advancements in the understanding of this condition. Notably, a substantial proportion of affected individuals present during the perimenopausal period with unilateral lesions displaying mixed histological components. Biomarkers such as CA125, CA199, and NSE hold promise for aiding in the diagnosis and screening of ovarian neuroendocrine tumors. Unfortunately, patients exhibit a dismal prognosis even diagnosed at an early stage. Primary treatment strategies predominantly involve surgical intervention coupled with etoposide-cisplatin combination chemotherapy. In cases of recurrence, second-line chemotherapeutic agents including paclitaxel, irinotecan, and doxorubicin are commonly employed alongside localized radiotherapy. While specific genetic mutations remain elusive, emerging evidence suggests potential therapeutic effect involving mTOR inhibitors, PD-1 monoclonal antibodies, and antiangiogenic agents based on isolated case reports. The exploration of representative set of mutations will help for precise targeted therapies and remains a focal point of our ongoing research efforts.

Effects of age on accuracy of advanced imaging modalities in identifying intervertebral disc extrusions in Dachshunds.

The aim of this study was to ascertain whether patient age was a significant factor for the accurate identification of compressive intervertebral disc extrusions (IVDE) in Dachshunds using non-contrast computed tomography (CT). This retrospective analysis encompassed 150 Dachshunds evaluated for suspected IVDE at a referral hospital in south-eastern Queensland, Australia. Each case underwent diagnostic evaluation by CT, either with or without myelography, or magnetic resonance imaging (MRI), followed by surgical intervention for an intervertebral disc extrusion. In the <9-year dog cohort, 94.7% (71/75) were diagnosed with IVDE via non-contrast CT and proceeded to surgery. In contrast, the ≥9-year dog cohort, only 56% (42/75) were diagnosed via non-contrast CT, with the remaining 44% (33/75) necessitating CT myelography or MRI for diagnosis. The odds of requiring CT myelography or MRI increased 13.95-fold (95% CI, 4.62-42.13) in Dachshunds aged 9 years or older. Furthermore, each additional year of age was associated with a 0.60 increase in the odds of undergoing these advanced imaging modalities (CT myelography or MRI) (95% CI, 0.49-0.74). Age significantly affected the efficacy of non-contrast CT in diagnosing IVDE in Dachshunds. Dogs aged 9 years and above were substantially more likely to require CT myelography or MRI due to the reduced visibility of disc extrusions on non-contrast CT. Veterinarians performing advanced imaging on older Dachshunds for suspected IVDE should be aware of the limitations of non-contrast CT in obtaining an accurate diagnosis and localisation of IVDE, and be prepared to perform either CT myelography or MRI if required.

Combined Coronary Artery Bypass Grafting and Orthopedic Fixation in a Patient with Multiple Comorbidities: A Case Report

Background: Coronary artery disease (CAD) is a prevalent cardiovascular condition and leading cause of morbidity and mortality worldwide. The management of orthopedic injuries requiring surgical fixation is particularly complex in patients with comorbidities such as diabetes mellitus (DM) and hypertension (HTN). Coordinating the sequence, timing, and execution of coronary artery bypass grafting (CABG) and orthopedic fixation requires careful consideration of the patient’s overall health, surgical risks, and recovery potential. Case presentation: A 55-year-old male presented with a right distal tibial fracture following a fall. His medical history included HTN, type 2 diabetes mellitus (T2DM), and Kyrle’s skin disease. During his hospital stay, he was diagnosed with non-ST-segment elevation myocardial infarction (NSTEMI). Severe multivessel CAD was confirmed by catheterization. After interdisciplinary consultation, simultaneous CABG and open reduction and internal fixation (ORIF) of the tibial fracture were performed. He was discharged in good condition and showed positive recovery during a one-month follow-up. Discussion: This case highlights the complexities of managing patients with multiple comorbidities who require both cardiac and orthopedic surgeries. This simultaneous approach allows for efficient treatment, leading to a shorter hospital stay and recovery period. This report supports the feasibility and benefits of simultaneous surgery in complex clinical scenarios, although further studies are required to establish broader guidelines. Conclusion: Our case emphasizes the importance of a multidisciplinary approach for managing patients with multiple comorbidities who require concurrent surgical intervention. Preoperative planning and specialty coordination ensured optimal outcomes. Further research is needed to develop standardized guidelines for intraoperative care of patients undergoing simultaneous procedures.

Thread-Filler: A Standardized Combination Therapy

Advanced technology and increasing knowledge about aging faces have combined to create the illusion of thread lifting to replace surgical interventions. However, results that came far beyond expectations led to a heavy suspicion of these tools. However, combined treatments with fillers would have better outcomes with a synergetic effect. In this study, 52 patients were treated with a specific thread, whereas soft tissue support was added to supervene the lifting effect of the threads. With a mean age of 48 years, these patients were treated with 3 pairs of mid and lower facial areas, and one for eyebrows. With a median amount of 5 mL fillers were added simultaneously at the same treatment plan. The follow-up period was 32 months. Assessment with a Likert Scale questionnaire revealed most of the patients (n = 42) were delighted, whereas only one patient was unsatisfied. The only unsatisfied patient experienced the most frustrating complication, which was thread removal due to infection. The literature shows unauthorized, unspecialized applications of such medical devices cause failure and loss of reliability. Therefore, the most important point of this technique is the sterile setting. Other issues that are discussed in this paper also aim to direct the reader to achieve the most benefit of these 2 techniques.

Paediatric Hand Fractures - A Review.

Paediatric hand fractures account for approximately 25% of hand-related emergency department visits, making them the second most common childhood fractures after distal forearm fractures. These injuries are more prevalent in boys and peak ages between 9 and 14 years. Hand fractures in children are primarily caused by crushing injuries and, increasingly in older children, by sports-related activities. The little finger (52%) and thumb (23%) are the most frequently fractured digits, with phalangeal fractures, especially of the proximal phalanx, being common. Metacarpal fractures are more prevalent in adolescents (13-16 years) compared to younger children. Accurate diagnosis in the paediatric population is complicated by difficult clinical examinations and the presence of growth plates, leading to an 8% misdiagnosis rate, mainly due to misinterpretation of the ossification centres and physes. High-quality radiographic evaluation combined with a thorough clinical assessment is critical for correct diagnosis and appropriate management. The robust periosteum and high remodelling potential of paediatric bones allow most hand fractures to be managed non-operatively with splinting or casting. However, fractures with significant angulation, rotation, intra-articular involvement or open wounds may require surgical intervention, such as closed or open reduction and internal fixation with Kirschner wires. Most paediatric hand fractures heal well with excellent functional outcomes due to the high remodelling capacity of paediatric bones. Early mobilisation and appropriate immobilisation are key to preventing stiffness. Despite the generally favourable prognosis, certain fractures remain challenging to diagnose and treat, highlighting the need for specialised care. The aim of this review article is to discuss the epidemiology, fracture patterns, diagnostic challenges and management strategies essential for optimising functional outcomes and minimising long-term complications in treating paediatric hand fractures. Level of Evidence: Level V (Therapeutic).

TREATMENT OPTIONS FOR RECURRENT MALIGNANT DIFFUSE ASTROCYTOMA (WHO GRADE IV)

Objectives We present the case of a 37-year-old female who underwent partial resection in 2018 for a diffuse fibrillary astrocytoma (WHO II) that invaded almost the entire right cerebral hemisphere. The patient followed conventional radiotherapy and chemotherapy. She presents after 6 years of regularly follow-ups with left hemiparesis, intracranial hypertension syndrome and tumor recurrence on MRI. The patient underwent another surgical intervention and the new histopathological diagnosis was diffuse astrocytoma grade IV. Therapeutic options for these patients are limited considering the fact that a gross total resection or a conventional re-irradiation could impact the quality of life. Therefore, exploring new therapeutic methods, such as targeted molecular therapy like EGFR antagonists or proteasome inhibitors, or proton therapy, should be considered. Material and Methods We conducted extensive research in two public medical databases for information related to the molecular pathways and management of primary and recurrent malignant astrocytoma and relevant articles were selected. Subsequently, we correlated this information with our direct experience in our case and discussed the observed results. Results Treatment modalities for these patients include reintervention, re-irradiation and second line chemotherapeutics. In relapsing cases the goal of reintervention is both to alleviate symptoms and obtain tumoral tissue for immunohistochemical analysis for identification of the new mutations. Conventional re-irradiation for large lesions carries high risks of producing both short-term and long-term side effects, impacting the quality of life. Alternatively, proton therapy minimizes the risk of adverse events due to Bragg peak reducing the irradiation of the surrounding tissue. Conclusions Genetic characterization of these lesions can facilitate targeted molecular therapy and help in establishing the prognosis. Re-irradiation of malignant astrocytomas with proton therapy is an effective treatment measure allowing for comparable tumor control to conventional radiotherapy.

Gastrointestinal calciphylaxis: a rare and devastating complication in end-stage kidney disease.

Calciphylaxis, also known as calcific uremic arteriolopathy, is a rare and severe condition that predominantly affects individuals with end-stage kidney disease (ESKD). It manifests through vascular calcifications that precipitate tissue necrosis, with cutaneous manifestations being common. However, gastrointestinal involvement is an infrequent but gravely serious occurrence. In this report, we present an atypical case of gastrointestinal (GI) calciphylaxis in a 66-year-old woman undergoing peritoneal dialysis. The patient's initial symptoms of abdominal pain and turbid peritoneal fluid raised suspicions of bacterial peritonitis. Despite therapeutic interventions, the patient's condition deteriorated. Computed tomography (CT) imaging revealed a perforation in the caecal wall, necessitating emergency surgical intervention. Histopathology post-surgery confirmed the diagnosis of GI calciphylaxis. The patient's postoperative trajectory was fraught with complications, ultimately leading to a fatal outcome. This case highlights the importance of vigilance for calciphylaxis in the differential diagnosis when abdominal pain develops in patients with ESKD, regardless of the presence of typical skin symptoms. Prompt detection and an integrated care approach are essential for improved prognosis. Further research is needed to find more efficacious treatments for this devastating illness.

Multidisciplinary Surgical Care for a Cervical Esophageal Duplication Cyst.

We present a case of a three-month-old male who presented with a cervical esophageal duplication cyst requiring early surgical intervention. The patient presented with feeding difficulties, poor weight gain, and respiratory distress. Due to the position of the cervical esophageal duplication cyst and airway compression, this unique case required a multidisciplinary surgical approach involving both otolaryngology and cardiothoracic surgery.

TIPS AND TRICKS IN SURGICAL TREATMENT OF LARGE VESTIBULAR SCHWANNOMAS

Vestibular schwannomas (VS) frequently referred to as acoustic neuromas are the most common tumours of the cerebellopontine angle. They are benign, generally slow-growing tumors that arise from the vestibular portion of the eighth cranial nerve. For patients with large vestibular schwannomas or those exhibiting symptoms from the tumor’s mass effect, surgical intervention remains the preferred treatment approach. This paper discusses the surgical management of patients with large vestibular schwannomas operated in our department and emphasizes the use of intraoperative monitoring for preserving facial nerve function. We review the key surgical steps and highlight the importance of preoperative planning, patient position, and the use of microsurgical techniques to optimize the surgical outcome. Gross total resection of large vestibular schwannomas is associated with worse facial nerve outcomes. Our preferred treatment strategy, especially for older patients, is planned subtotal resection followed by periodic imaging evaluation and radiotherapy in cases of documented tumor growth. This approach may lead to superior facial nerve preservation and improved quality of life for individuals with large vestibular schwannomas. Conclusion The optimal treatment approach for vestibular schwannoma remains a subject of debate. Gross total resection has traditionally been the gold standard for large tumors, but this is often accompanied by a higher risk of postoperative facial nerve dysfunction. Planned subtotal resection with the goal of preserving facial nerve function, followed by closed observation is an alternative approach.