Radical Surgical Treatment Research Articles

Evaluation of Humeral Shaft Fracture Outcomes by Treatment Method: A Systematic Review and Meta-analysis Based on Comparison Studies.

The purpose of this systematic review and meta-analysis was to evaluate various outcomes of humeral shaft fractures treated with different treatment methods, which included functional bracing, open reduction and internal fixation, intramedullary nailing, and locked compression plate. A systematic review was performed using research databases including PubMed, EMBASE, and Google Scholar. Keywords relating to treatment of humeral shaft fractures were used, and comparison studies that reported patient characteristics and outcomes, including nonunion, malunion, function scores, and complications, were included. One hundred fourteen records were screened, with 18 studies ultimately included in the meta-analysis. Treatment groups were consolidated into brace or surgery and then further categorized into subgroups based on surgical technique used. Postoperative events, complications, and functional scores were compared among the treatment groups. Statistical analysis for this study was conducted using Review Manager 5.3, with a standard p-value of ≤0.05 for statistical significance. Eighteen studies were included in this review with a total of 706 patients. Z-tests showed that risks of revision, nonunion, and malunion were higher in the brace treatment group compared with the surgical treatment group (p < 0.0001, <0.0001, 0.004, respectively). Risk of infection was expectedly higher in the surgical group compared with the brace group (p = 0.04). Radial nerve injury rates were also higher in the unspecified surgical group compared with the brace group (p = 0.01). In the surgical group, the mean Constant shoulder score was also significantly higher than that in the brace group (p = 0.004). When comparing the nail and plate groups, Z-tests revealed higher risks of delayed unions and other complications in the nail group (p = 0.04 and 0.001, respectively) but higher risk of infection in the plate group (p = 0.05). The conservative treatment of humeral shaft fractures with functional braces may be associated with a lower incidence of infection and nerve injury when compared with operative treatment methods. However, nonoperative treatment may also come with higher risks of revision, nonunion, and malunion than the many available surgical modalities. Operative management with either intramedullary nail or plate has shown to be a reliable method of management with reasonable outcomes for humeral shaft fractures. While the nail group had higher risk of delayed unions and other complications, the plate group had higher risk of infections. Both nail and plate surgical treatments have shown to result in high union rates and should be considered by the surgeon on a case-by-case basis when treating humeral shaft fractures. Level I. See Instructions for Authors for a complete description of levels of evidence.

Hibernoma: a case report and discussion of a rare tumor

Intriduction. Hibernomas account for less than 2 % of all benign lipomatous tumors and 1 % of all lipomatous tumors. They are usually found in 20–40-year old adults (the average age of patients is 38 years). The clinical manifestations are painless soft tissue mass that are mostly slow growing; rapid growth is only found in a small number of patients. We present a case of successful surgical treatment of a pathologically confirmed rare lipomatous tumor of large size, which was located in the soft tissues of the thigh.Clinical case. A 46-year-old woman was admitted to the hospital due to a tumor 20 × 10 × 10 cm in size, that had developed 10 years ago in the anteromedial aspect of the proximal thigh. Furthermore, she had a history of hypoesthesia one month prior to her admission. During surgery, the femoral nerve was found to be compressed by the large tumor. The resultant symptoms probably caused the patient to seek medical care. Resection was performed by careful dissection, femoral nerve and vessels were spared. Histopathological examination and cytogenetics showed findings suggestive of a hibernoma. At the 6-month follow-up local tumor recurrence or metastasis was not found.Conclusions. Asymptomatic small-sized hibernoma does not require surgical resection or other treatment. When the tumor is too large and/or has the potential to compress the surrounding tissues, timely radical surgical intervention is reuired.

Analysis of the relationship between meniscal tears and medial patellofemoral rupture according to the treatment method and gender

Objective: The aim of this study was to make a detailed anatomical analysis of the parameters of patellar height, the congruence angle, the lateral patellofemoral angle in patients with medial patellofemoral rupture, according to the treatment method (surgical or conventional), gender and whether or not there is a lateral and medial meniscus tears.&#x0D; Methods: This study was planned as retrospective study between January 2010 and January 2021. Magnetic resonance images (MRI) of 61 knees (61 individuals) were obtained for analysis. Of those, 38 knees were left, and 23 were right. One orthopaedic surgeons and two anatomist independently measured patellar morphology, patellar height and patellar alignment and evaluation lateral and medial meniscus tears. Knee MRI protocol including axial T2-weighted turbo spin echo (TR:3600, TE:87 ms; slice thickness 5 mm; gap 1.5 mm) was used.&#x0D; Results: There was a significant difference patellar height (surgery; 1.21±0.27 and conventional; 0.99±0.16), the congruence angle (surgery; -4.94±4.72 and conventional; 4.93±5.72), the lateral patellofemoral angle (surgery; -35.61±16.62 and conventional; 10.93±15.00), except for age parameter (surgery; 27.06±6.20 and conventional; 27.47±5.33) between the conventional and surgical treatment groups (p

Rectal bleeding in pregnant women

The article presents a review of scientific literature on the main causes of rectal bleeding in pregnant women. Anatomical, biochemical and hormonal changes during pregnancy often lead to the progression of typical benign diseases (chronic hemorrhoids, anal fissure, etc.), radical surgical treatment of which can be carried out in the puerperal period. However, Crohn’s disease, ulcerative colitis or malignant colorectal polyps can be triggered by pregnancy and affect its course – this requires immediate examination and drug therapy. Pregnancy causes many physiological changes that affect the interpretation of routine biochemical and hematological examination methods. It is known that pregnancy requires increased iron content, the pregnancy courses often with anemia. The erythrocytes sedimentation rate varies significantly depending on the severity of anemia and the pregnancy term. Therefore, it is necessary to carefully analyze the main clinical manifestations of various intraluminal diseases that can potentially cause rectal bleeding in pregnant women.This article also describes the directions of diagnostic search and treatment strategy of rectal bleeding during pregnancy. Chronic hemorrhoids often accompany pregnancy in the third trimester. Some researchers indicate that up to 75% of pregnant women have complaints which are typical for chronic hemorrhoids. An anal fissure in lateral positions should cause suspicion of Crohn’s disease, tuberculosis, syphilis, human immunodeficiency virus, acquired immunodeficiency syndrome, dermatological diseases (most often psoriasis) and anal carcinoma.Bleeding in sexually acquired proctitis is usually mild and is often accompanied by minor purulent discharge. Rectal bleeding can be a sign of both ulcerative colitis and Crohn’s proctitis or sigmoiditis, but it is more typical for ulcerative colitis. Other associated clinical features are diarrhea, abdominal pain, urge to defecate, and specific extraintestinal manifestations (peripheral arthropathy, sacroiliitis, ankylosing spondylitis, conjunctivitis, iridocyclitis, episcleritis, aphthous skin ulcers, erythema nodosum, or pyoderma gangrenosum). If the bleeding is caused by a benign polyp, endoscopic polypectomy solves the bleeding problem.Therefore, rectal bleeding in pregnant women is diagnosed quite often. In most cases, it is caused by benign diseases of the rectum (chronic hemorrhoids or anal fissure), which are amenable to conservative therapy and usually do not threaten the life and health of a woman or a child. However, there is a rate of pregnant women whose rectal bleeding is caused by colorectal diseases, which require a comprehensive approach to diagnosis and treatment. In these women, the benefit and risk should be determined when choosing a diagnostic and treatment algorithm.

A rare case of intracranial Castleman disease

Introduction. Castleman disease (CD) is a rare lymphoproliferative disorder also known as angiofollicular lymph node hyperplasia or giant lymphoid hyperplasia. CD is considered unicentric in the presence of a single focus and if the clinical picture is represented by multiple lymphadenopathy and systemic manifestations, it is considered multicentric. Manifestation of the disease by the occurrence of a focus that mimics a tumor of the meninges or brain is extremely rare, only 20 cases are known including the one presented in our article. The main treatment for localized forms is surgical resection. Our observation is devoted to a rare variant of intracranial CD. Description of the clinical case. Woman, 35 years old, was admitted to the clinic with complaints of recurrent headache of moderate intensity of a diffuse nature and difficulty in counting and writing. A month before hospitalization a single generalized epileptic seizure occurred. In the clinical picture at the time of admission, Gerstmann-Schilder syndrome was noted which topically corresponded to the lesion of the right parietal lobe. MRI of the brain with contrast enhancement showed pathological infiltration in the structure of the right parietal bone, the presence of a massive paraosseous component that spread intracranially with compression of the right parietal lobe, and moderately pronounced perifocal edema. The neoplasm was removed totally with a fragment of the dura mater (DM). The plastic of DM was performed with a vascularized periosteal flap and one-stage plastic of the skull defect with a titanium implant. According to histological and immunochemical studies, as well as additional examinations, a diagnosis of unicentric CD was established. According to the results of the control MRI of the brain with contrast enhancement after 3, 6 and 12 months, data for relapse were not revealed. The patient currently does not report any symptoms of the disease. Conclusion. Intracranial unicentric CD is a benign disease amenable to radical surgical treatment and does not require further adjuvant therapy. Despite the complexity of differential diagnosis between CD and meningiomas, the primary treatment strategy remains the same in all cases: total surgical removal.

Reconstruction using the colon or jejunum in patients with synchronous advanced esophageal and gastric cancers: a retrospective study from a single institutional database

PurposeThe aim of this study was to evaluate the feasibility and efficacy of simultaneous resection of synchronous advanced esophageal and gastric cancers.MethodsWe retrospectively analyzed the clinical data of 16 patients who underwent resection of synchronous advanced esophageal squamous cell carcinoma (ESCC) and gastric adenocarcinoma from January 2009 to Dec 2021. Subtotal esophagectomy and total gastrectomy were performed using the Ivor-Lewis or McKeown approach. Reconstruction was performed using a pedicled jejunal graft or colon interposition. Perioperative and postoperative data of all patients were analyzed.ResultsThere were no in-hospital mortalities following surgery, but 9 patients (56.3%) suffered major perioperative complications. Comparison of the groups that received reconstruction using the jejunum and the colon indicated similar incidences of perioperative complications, overall survival, and disease-free survival. Cox regression analysis indicated that lymph node metastasis of both cancers was independent risk factor for overall survival.ConclusionThe existence of synchronous tumors of the esophagus and stomach is not unusual, the radical surgical treatment could be carried out whenever possible.

Endoscopic treatment (endoscopic balloon dilation/self-expandable metal stent) vs surgical resection for the treatment of de novo stenosis in Crohn’s disease (ENDOCIR study): an open-label, multicentre, randomized trial

BackgroundStenosis is one of the most common complications in patients with Crohn’s disease (CD). Endoscopic balloon dilation (EBD) is the treatment of choice for a short stenosis adjacent to the anastomosis from previous surgery. Self-expandable metal stents (SEMS) may be a suitable treatment option for longer stenoses. To date, however, there is no scientific evidence as to whether endoscopic (EBD/SEMS) or surgical treatment is the best approach for de novo or primary stenoses that are less than 10 cm in length.Methods/designExploratory study as “proof-of-concept”, multicentre, open-label, randomized trial of the treatment of de novo stenosis in the CD; endoscopic treatment (EBD/SEMS) vs surgical resection (SR). The type of endoscopic treatment will initially be with EDB; if a therapeutic failure occurs, then a SEMS will be placed. We estimate 2 years of recruitment and 1 year of follow-up for the assessment of quality of life, costs, complications, and clinical recurrence. After the end of the study, patients will be followed up for 3 years to re-evaluate the variables over the long term. Forty patients with de novo stenosis in CD will be recruited from 15 hospitals in Spain and will be randomly assigned to the endoscopic or surgical treatment groups. The primary aim will be the evaluation of the patient quality of life at 1 year follow-up (% of patients with an increase of 30 points in the 32-item Inflammatory Bowel Disease Questionnaire (IBDQ-32). The secondary aim will be evaluation of the clinical recurrence rate, complications, and costs of both treatments at 1-year follow-up.DiscussionThe ENDOCIR trial has been designed to determine whether an endoscopic or surgical approach is therapeutically superior in the treatment of de novo stenosis in CD.Trial registrationClinicalTrials.gov NCT 04330846. Registered on 1 April 1 2020. https://clinicaltrials.gov/ct2/home

The correction of venous stasis in delayed breast reconstruction with a free tram-flap after mastectomy

The presented case contains a successful surgical correction of venous stasis of an autograft that occurred in the early postoperative period during the delayed reconstruction of the left breast with a free TRAM flap in a patient after radical surgical treatment of stage 3A pT2N2M0 breast cancer. Using the microsurgical technique, two venous anastomoses were sequentially applied, which made it possible to keep the transplanted flap completely viable and, thus, to ensure a successful outcome of the reconstructive surgery.

The DAMAGE CONTROL technique applied in a child injured in a traffic accident after intraabdominal bleeding relapse

EDITORIAL COMMENT. This clinical observation presents an effective application of elements of the abdominal damage-control tactics after postoperative intra-abdominal bleeding relapse under developed coagulopathy and previously underestimated liver damage during surgery. If an “unstable” patient with prolonged internal bleeding is admitted, it is recommended to apply this tactics in the primary surgical intervention with liver packing which would prevent postoperative bleeding and further development of coagulopathy. After patient’s hemodynamics is stabilized, it is necessary to make a complete patient’s examination so as to timely detect all associated injuries. Introduction. Closed trauma of abdominal organs in children in some cases is accompanied by severe complications or death. At the same time, liver injury occupies a leading place in the structure of the abovementioned pathology. Currently, in case of severe injuries of the abdominal organs accompanied by unstable hemodynamics and with a high risk of unfavorable outcomes after radical surgical intervention, surgeons prefer to apply the damage control technique in such patients. Material and methods. The authors discuss a case of successful management of a child injured in a traffic accident. He had multiple closed liver injuries of class III and hemorrhagic shock of degree 3. The DAMAGE CONTROL technique was applied during relaparotomy after intra- abdominal bleeding relapse developed. Results. In this given case, the damage control technique has promoted a successful outcome after staged surgical treatment without any complications in the immediate and late postoperative periods. Conclusion. In case of abdominal cavity trauma in children having hemorrhagic shock and prolonged bleeding from liver wounds, the damage control technique promotes stabilization of patient’s state, arrests bleeding and gives precious time to finish surgical intervention in more favorable situation for both patients and surgeons.

Acute Prosthetic Joint Infections with Poor Outcome Caused by Staphylococcus Aureus Strains Producing the Panton-Valentine Leukocidin.

The aim of this study was to investigate whether the presence of Staphylococcus aureus (SA) producing the Panton-Valentine leukocidin (PVL) affects the outcome of Prosthetic Joint Infection (PJI). Patients with acute and chronic PJI sustained by SA were prospectively enrolled at the orthopedic unit of "Casa di Cura Santa Maria Maddalena", from January 2019 to October 2021. PJI diagnosis was reached according to the diagnostic criteria of the International Consensus Meeting on PJI of Philadelphia. Synovial fluid obtained via joint aspirations was collected in order to isolate SA. The detection of PVL was performed via real-time quantitative PCR (RT-qPCR). The outcome assessment was performed using the criteria of the Delphi-based International Multidisciplinary Consensus. Twelve cases of PJI caused by SA were included. Nine (75%) cases were acute PJI treated using debridement, antibiotic and implant retention (DAIR); the remaining three (25%) were chronic PJI treated using two-stage (n = 2) and one-stage revision (n = 1), respectively. The SA strains that tested positive for PVL genes were 5/12 (41.6%,). Treatment failure was documented in three cases of acute PJI treated using DAIR, all supported by SA-PVL strains (p < 0.045). The remaining two cases were chronic PJI treated with a revision arthroplasty (one and two stage, respectively), with a 100% eradication rate in a medium follow-up of 24 months. Although a small case series, our study showed a 100% failure rate in acute PJI, probably caused by SA PVL-producing strains treated conservatively (p < 0.04). In this setting, toxin research should guide radical surgical treatment and targeted antibiotic therapy.

Efficiance of radioiodine remnant ablation in cases of locally differentiated thyroid cancer

On the territory of Russia has increased the of thyroid cancer after Chernobyl NPP incidence at 1986, and currently accounts for up to 14,000 newly identified cases. Postoperative radioiodine (RAI) remnant ablation is the second stage of combine treatment of differentiated thyroid cancer, except for the prevalence of pT1N0M0, with minimal level of TG and AT-TG, according to international guidelines. In the past 20 years a significant number of published practice guidelines for the treatment of this disease. However, the discussion is the amount of medication for administration activity (GBq) 131I, is required for successful ablation of thyroid remnants. The study analyzed 353 clinical cases after radical surgical treatment for DTC. In our study, the effectiveness of radioiodablation was compared with certain indicators of specific therapeutic activity 131I (MBq/kg), in groups of patients with different levels of TSH stimulation (less than 30 mME/ml, and more than 30 mME/ml). We evaluated the absorbed dose in the thyroid remnant in patients with residual thyroid tissue volume determined by US when administering 131I empirical therapeutic activity. The control of the WBS with 131I was carried out in 6 months. The average eղciency RAI was 85.5 %, there were no significant differences in the TSH stimulation groups of more than 30 mME/ml and 4-30 mME/ml (p &gt; 0.05). If the thyroid remnant is not detected by US, the effective range of 131I specific therapeutic activity is 30-40 MBq/ kg against a background of TTG stimulation greater than 4 ՏME/ml and strict adherence to a 14-day low iodine diet. Direct radiometry followed by neck scintigraphy (1200 kBq 131I) and calculation of therapeutic activity is recommended when determining thyroid remnant by US to plan for TAD = 300 Gy and reduce the risk of radiation sialoadenitis. At the time of RAI, 3.9 % of patients had previously undetectable X-rays lung metastases with stimulated TG levels greater than 124 ng/mL after surgical treatment with SPECT/CT.

Giant Cell Osteoclast-Like Bladder Carcinoma: A Case Report

Introduction: Osteoclast-like giant cell bladder carcinomas are an extremely unusual and aggressive histological subtype of urothelial carcinomas. Only 30 cases have been reported globally. Clinical case: A 79-year-old male patient was presented to our Urology Department due to macroscopic hematuria that persisted for six months. As part of his diagnostic protocol, a CT scan of the abdomen and pelvis with elimination phase was performed, finding a filling defect of 12 mm at the level of the posterior wall of the bladder. A cystoscopy was subsequently performed, confirming the presence of a 1.5 cm bladder tumor, which was resected in its entirety. Pathology analysis with hematoxylin and eosin stain revealed a composition of mononuclear cells and osteoclast-like giant cells. Immunohistochemistry was positive for epithelial markers cytokeratins AE1/AE3, EMA, P53, and CD68. Conclusion: Osteoclast-like giant cell bladder carcinomas are extremely unusual and aggressive. The only diagnostic method is through immunohistochemistry, confirming the presence of epithelial markers for urothelium in the neoplastic cells. Radical surgical treatment is recommended and there has been no proven effective adjuvant treatment to date. The patients’ median survival is 15 months.

Ki67 AND CD138/SYNDECAN-1 IMMUNOEXPRESSION IN AMELOBLASTOMAS

Objective To assess Ki67 and CD138/Syndecan-1 immunoexpression and investigate possible predictors of disease-free survival in patients with ameloblastomas. Study Design This is a retrospective cohort study. The study population consisted of individuals diagnosed with conventional ameloblastoma. The clinical, imaging, histopathological, and immunohistochemical expression of Ki67 and CD138/syndecan-1 proteins were analyzed. Kaplan-Meier analysis was used to estimate disease-free survival rates. The log-rank test and Cox proportional hazards regression were used to identify predictors of disease-free survival. A statistical significance level of 5% was established. Results Thirty-one individuals diagnosed with ameloblastoma were included in this study. Tumors were more frequent in the 2nd and 3rd decades of life and in brown-skinned individuals (58.1%), with a male to female ratio of 1.5:1. Only the initial treatment modality was statistically associated with a better prognosis in univariate (p = 0.026) and multivariate (p = 0.021) analyses, with a Hazard Ratio of 22.14 (95%CI = 1.60-305.73), favoring radical treatment. Conclusion None of the analyzed clinical, imaging, histopathological, or immunohistochemical characteristics were associated with disease-free survival in ameloblastomas. However, cases that received radical surgical treatment had a lower risk of recurrence. To assess Ki67 and CD138/Syndecan-1 immunoexpression and investigate possible predictors of disease-free survival in patients with ameloblastomas. This is a retrospective cohort study. The study population consisted of individuals diagnosed with conventional ameloblastoma. The clinical, imaging, histopathological, and immunohistochemical expression of Ki67 and CD138/syndecan-1 proteins were analyzed. Kaplan-Meier analysis was used to estimate disease-free survival rates. The log-rank test and Cox proportional hazards regression were used to identify predictors of disease-free survival. A statistical significance level of 5% was established. Thirty-one individuals diagnosed with ameloblastoma were included in this study. Tumors were more frequent in the 2nd and 3rd decades of life and in brown-skinned individuals (58.1%), with a male to female ratio of 1.5:1. Only the initial treatment modality was statistically associated with a better prognosis in univariate (p = 0.026) and multivariate (p = 0.021) analyses, with a Hazard Ratio of 22.14 (95%CI = 1.60-305.73), favoring radical treatment. None of the analyzed clinical, imaging, histopathological, or immunohistochemical characteristics were associated with disease-free survival in ameloblastomas. However, cases that received radical surgical treatment had a lower risk of recurrence.

Heart transplantation in secondary dilated cardiomyopathy due to myocarditis. Case report

Heart failure (HF) is a prognostically unfavorable complication of cardiovascular diseases. The presented case report describes the management of a patient with severe progressive biventricular HF due to myocarditis, refractory to therapy and requiring heart transplantation. Issues of timely diagnosis of HF and the feasibility of radical surgical treatment are discussed.

Endoscopic ultrasonographic features of submucosal lesions of upper digestive tract suspected gastrointestinal stromal tumors and their correlation with progression and pathological risk grade of the lesions

Objective: To investigate the endoscopic ultrasonographic (EUS) characteristics of submucosal lesions of upper digestive tract suspected gastrointestinal stromal tumors (GIST) and their correlation with biological behaviors and pathological risk grade of the tumors. Methods: Retrospective cohort study. The EUS findings, follow-up review, surgical treatment and pathological data of patients with suspected GIST at the Gastrointestinal Endoscopy Center of Peking University People's Hospital from January 2013 to April 2021 were collected. All samples were divided into follow-up group and treatment group based on the pathological condition and the patient's treatment intention. According to whether or not the tumor was enlarged in EUS, the follow-up group was divided into non-enlarged group and enlarged group. Paired T-test was used to compare the lesion size before and after follow-up, and logistic regression was used to analyze the risk factors of tumor enlargement. According to the treatment methods, the treatment group was further divided into endoscopic treatment group and surgical treatment group. According to the pathological results and risk grade, the treatment group was further divided into the low-risk group and the medium-risk group. The risk factors of pathological malignant risk were analyzed by logistic regression, and the tumor diameter of patients with moderate or above pathological risk was predicted by receiver operation characteristic (ROC) curve. The relationship between the findings of EUS and the progression and pathological risk of GIST were also explored. Results: Seventy-three cases including 23 males and 50 females, with an age of 58 (30-88) years, were included in the follow-up group, with a mean lesion diameter of (1.21±0.49) cm before follow-up, median follow-up interval of 33.8 months, and a lesion diameter of (1.18±0.49) cm after follow-up. There was no significant difference (all P>0.05) in lesion diameter between before and after follow-up. There was no significant difference (all P>0.05) between tumor enlargement group (18 cases, 24.7%) and non-enlargement group (55 cases, 75.3%). One hundred and thirty-eight cases, including 52 males and 86 females, with an age of 60 (19-84) years, were enrolled in the treatment group, with a mean EUS estimated diameter of (2.55±1.35) cm and pathological diameters of (3.43±2.42) cm. Ninety-five (68.8%) of these cases were pathologically confirmed as GIST while 43 cases were diagnosed as other tumor types, including 37 benign tumors and 6 malignant tumors. In multifactorial logistic regression analysis, only the increase of tumor diameter [OR (95%CI): 1.800 (1.172-2.766), P=0.007] was a risk factor for pathological intermediate or higher risk. The optimal tumor diameter for predicting pathological intermediate or higher risk using ROC curve analysis was 2.75 cm, with a sensitivity 71.4%, specificity 79.0%, Youden index 0.5 and area under ROC curve 0.807 (95%CI: 0.703-0.909). Conclusions: EUS is essential for assessing the risk of progression and malignancy of submucosal lesions of upper digestive tract suspected GIST. For lesions of small diameter, the interval of follow-up shall be relatively extended while the indication of treatment could be partially waived.

Efficacy and prognostic analysis of orthopedic surgery in patients with newly diagnosed multiple myeloma

Objective: To evaluate the efficacy and prognosis of orthopedic surgical resection surgery in patients with newly diagnosed multiple myeloma (NDMM). Methods: This retrospective cohort study collected clinical data of patients with NDMM who underwent surgery due to spinal cord compression or pathological long-bone fractures at the Peking Union Medical College Hospital from 1 January 2003 to 31 December 2021. Patients who received biopsy or vertebroplasty/kyphoplasty were excluded and patients with the same degree of bone disease and who did not undergo any surgical intervention were selected as controls. Visual analogue scale (VAS) and physical status (ECOG) scores, progression-free survival (PFS), and overall survival (OS) were compared. Statistical analysis included the χ2-test, t-test, and Kaplan-Meier methods. Results: Baseline data were compared between the surgical group (n=40 with 43 interventions) and the non-surgical group (n=80), and included sex, age, paraprotein type, International Staging System (ISS), number of lytic lesions, cytogenetic abnormalities, first-line treatment, and the proportion of patients receiving autologous stem cell transplantation (ASCT) (all P>0.05). Serum M protein levels in the surgical group were significantly lower than those of the non-surgical group [(21.95±16.44) g/L vs. (36.18±20.85) g/L, P=0.005]. The surgical lesions involved the axial skeleton (79.1%, 34/43) or the extremities (20.9%, 9/43). VAS and ECOG scores improved significantly after surgery (VAS: 2.30±0.80 vs. 6.60±1.50, P<0.001; ECOG: 2.09±0.59 vs. 3.09±0.73, P<0.001). The median follow-up time was 51 months. Kaplan-Meier survival analysis suggested that the median PFS (25 vs. 29 months) and OS (46 vs. 60 months) were comparable between the surgical and non-surgical intervention groups (both P>0.05). Subgroup analysis showed that among patients with ISS Ⅰ or those who had received ASCT, PFS in the surgical group was similar to that of the non-surgical intervention group (both P>0.05), while OS was worse (P=0.005, 0.017). Patients with ISS Ⅱ/Ⅲ scores or without ASCT had similar PFS and OS between the surgical and non-surgical intervention groups (all P>0.05). Cox multivariate analysis suggested that ISS and ASCT were independent prognostic factors for OS (ISS: HR=0.42, 95%CI 0.19-0.93, P=0.031; ASCT: HR=0.41, 95%CI 0.18-0.97, P=0.041), while orthopedic surgery did not influence survival (P=0.233). Conclusion: For patients with NDMM, orthopedic surgical resection decreased bone-related complications and improved quality of life, but did not affect survival.

ОЦЕНКА ЭКСПРЕССИИ МАРКЕРОВ ММР-2, ММР-9, ФИБРОНЕКТИНА КАК ПРЕДИКТОРОВ ПРОГРЕССИИ ЗАБОЛЕВАНИЯ В ТКАНИ ПЕРВИЧНОЙ ОПУХОЛИ ЛОКАЛИЗОВАННЫХ И ГЕНЕРАЛИЗОВАННЫХ ФОРМ САРКОМЫ ЮИНГА У ДЕТЕЙ И ПОДРОСТКОВ

Despite processes of epithelial-mesenchymal transition (EMT) that underlie the development of malignant tumors are described widely, the mesenchymal-epithelial transition (MET), which in its turn promotes the metastasis of various tumors, including Ewing's sarcoma (ES), had been studied very little as yet. Within the framework of pediatric oncopathology, ES is one of the most aggressive and metastatic tumors of bones and soft tissues. The purpose of this research was to analyze the features of the expression of markers of the metastatic phenotype of tumor cells MMP2, MMP9 and FN1 in the tissue of the primary tumor in children and adolescents with various forms of ES prevalence. Materials and methods used: 67 patients with localized (n=26) and generalized (n=41) forms of ES aged 0 to 18 y/o, who have been treated at the Pediatric Oncology Department of the National Medical Research Center for Oncology of the Ministry of Healthcare of Russia (Rostov-on-Don, Russia) in Jan. 2009-Dec. 2019. MMP2, MMP9 and FN1 markers were studied by immunohistochemical method in the primary tumor tissue obtained at the stage of process verification and radical surgical treatment after multi-course polychemotherapy (PCT). Results: MMP2 expression in groups with localized and generalized ES before treatment was 4 (p=0.018) and 4.4 (p=0.001) times higher compared to those after treatment. MMP9 expression in the group with generalized ES before treatment prevailed 1.5 times (p=0.020) in comparison with the group after treatment. The median FN1 expression, on the contrary, was 1.2 times lower in the group with generalized ES before treatment than after (p=0.799). Conclusions: determining the expression level of the MMP2 marker in the primary tumor of ES patients can be used to predict the course of the disease and to evaluate the effect of treatment. Whilst markers MMP9 and FN1 require further expanded research.

Radical surgery for non-neoplastic colonic diseases

Aim. To improve the results of surgical treatment for patients with non-neoplastic colonic diseases by optimizing the choice of radical surgery extent. Materials and methods. The study material was the analysis of radical surgical interventions performed in 87 patients with non-neoplastic colonic diseases: ulcerative colitis, Crohn’s disease, familial adenomatous polyposis, chronic colonic and coloproctogenic stasis, diverticular colon disease. The age of the operated patients was 20–72 years. There were 49 (56.3 %) men and 38 (43.7 %) women. The criteria for choosing the radical surgery extent for these diseases were defined and substantiated. Results. There were 3 postoperative mortalities (3.4 %) among patients operated on absolute indications for acute complications of ulcerative colitis and Crohn’s disease. Recurrences of ulcerative colitis, Crohn’s disease and familial adenomatous polyposis occurred in 16 (18.4 %) operated patients in the area of the retained rectal stump and terminal ileum. Malignant transformation of the rectal stump occurred in 5 (5.7 %) patients with these recurrences. The extent of radical surgery in non-neoplastic colonic diseases depended on the diagnosis of the underlying disease, the presence of complications, the depth of wall lesions and the extent of the pathological process, the risk of recurrence in the anatomical parts of the small and large intestine. Conclusions. Deciding on the extent of the radical stage of surgical intervention depended on the diagnosis, features of the clinical course of non-neoplastic colorectal diseases, recurrences, the general condition of a patient, the pathological process extent and severity. Performing the optimal extent of radical surgery for non-neoplastic colonic diseases helped reduce the number of recurrences in the terminal part of the small intestine to 4 (4.6 %), in the area of the rectal stump to 7 (8.1 %), improved functional outcomes and quality of life in 76 (87.3 %) operated patients.

Comparison of Clinical Outcome in Surgically Treated Radial Styloid Fracture: K-Wire Vs Screw Fixation

Background: Distal radius fracture (DSF) is a frequent clinical issue. The aim of this study was that to compare surgical treatment of screw and k-wire fixation with related to the reunion, functionally outcomes and improve patient’s life quality after radius broken or fracture. Study design: The randomized controlled study was carried out at the department of orthopedic surgery CMH hospital, Rawalpindi for six months from 13 December 2022 to 12 June 2023. Materials and Methods: The total participants were 110 included both gender male and female were age group (20-62) and treated with k-wire and screw fixation. The surgery was carried out while the patient was under external anesthesia, using a pneumatic tourniquet and image intensification. We analyzed data by SPSS 21 version. Results: The mean age of patients in K-wire group was 41.99 ± 5.34 years and in screw fixation group was 47.19 ± 15.82 years. The minimum and maximum age in K-wire and Screw fixation group was 20-62 years respectively. The total participants were (n=110) which included each group consists of 55 participants in screw and k-wire fixation treatment. To compare the overall reunion rate of radius bone in screw fixation treatment group show significant result (p&lt; 0.001) as compared to k-wire group treatment and radiological healing time was 8 to 10 weeks in both surgical treatment groups. Conclusion: In the distal radius fracture treated surgically by screw and k-fixation but in our study to analyzed significant reunion and functional outcome in screw fixation group then k-wire fixation in the participants. Screw fixation takes less time 2.5 months for recovery after bone broken as compare to k-wire. The disadvantage of k-wire after surgery to show highly significant irritation of soft bone tissue and requiring implant removal. Keywords: Distal Radius fracture (DSF); K-wire fixation; screw fixation;

Management and Outcome of Blunt Pancreatic Trauma: A Retrospective Cohort Study.

Pancreatic injury is rare, but it has a high mortality rate and its optimal treatment remains controversial. This study aimed to evaluate the clinical characteristics, management strategies, and outcomes of patients with blunt pancreatic injury. This retrospective cohort study was performed on patients with a confirmed blunt pancreatic injury who were admitted to our hospital from March 2008 to December 2020. The clinical characteristics and outcomes of patients receiving different management strategies were compared. The risk factors for in-hospital mortality were evaluated by performing a multivariate regression analysis. A total of 98 patients diagnosed with blunt pancreatic injury were identified, with 40 patients having undergone nonoperative treatment (NOT) and 58 patients having undergone surgical treatment (ST). The overall in-hospital deaths were 6 (6.1%), including 2 (5.0%) and 4 (6.9%) in the NOT and ST groups, respectively. Pancreatic pseudocysts occurred in 15 (37.5%) and 3 (5.2%) of the NOT and ST groups, respectively, showing a significant difference between the two groups (P < 0.001). In the multivariate regression analysis, concomitant duodenal injury (OR = 14.42, 95% CI 1.27-163.52; P = 0.031) and sepsis (OR = 43.47, 95% CI, 4.15-455.75; P = 0.002) were independently associated with in-hospital mortality. Except for the higher incidence of pancreatic pseudocysts in the NOT group than in the ST group, there were no significant differences in the other clinical outcomes between the two groups. Concomitant duodenal injury and sepsis were the risk factors for in-hospital mortality.