Concordance Analysis of Lower Third Molar Surgery Classifications: A Comparative Study.

The high frequency and complexity of mandibular third molar (M3M) surgery have led several authors to the development of classification systems for better evaluation and management in oral surgery. This study compared the classifications of Juodzabalys and Daugela et al. (JD), Sammartino et al., Chang et al., Jhamb et al., Maglione et al., and Nemsi et al. to understand the concordance between the scores of M3M surgery. Two types of analysis were conducted: the relationship between the M3M and the inferior alveolar nerve (IAN), and the overall difficulty score based on the tooth's angulation and its spatial position with the adjacent structure. The analysis of the classifications on the relationship between M3M and IAN resulted in a concordance of 26.1%. In the pairwise comparisons, the classifications of Nemsi et al. and Jhamb et al. showed the highest concordance of 59.5%. Analyzing the total scores difficulty, the JD et al., Chang et al., and Sammartino et al. classifications demonstrated a concordance level of 25.5%. A pairwise assessment revealed a higher concordance degree between the classifications of Sammartino et al. and Chang et al. (57.4%). The results highlight the limits in establishing a comprehensive and objective classification for the surgical difficulty of M3M, possibly attributed to variations in the methodology for computing total scores. An objective, automated, and non-operator-dependent classification method for assessing the surgical difficulty of M3M is still needed.

Dermoscopic patterns of intradermal naevi.

BACKGROUND: Intradermal naevi represent a benign histopathological variant of common melanocytic naevi. Studies describing dermoscopic criteria of dermal naevi are very limited. OBJECTIVES: To identify dermoscopic features of dermal naevi in order to facilitate differential diagnosis from malignant lesions. METHODS: A 15-year retrospective study was performed to evaluate the dermoscopic characteristics of 202 dermal naevi, histopathologically diagnosed through the analysis of digital dermoscopic images performed with polarised light dermoscopy. For each lesion, vascular pattern, pigment pattern and other dermoscopic clues were evaluated. RESULTS: 147 Unna naevi and 55 Miescher naevi were included in the study. Brown pigment (37.1%) was the pigment pattern most frequently observed in both Unna and Miescher naevi, followed by cobblestone pattern (30.6%) in Unna naevi and white areas (23.6%) and dotted/globule pattern (20%) in Miescher naevi. As regards the vascular patterns, the polymorphic one was the most frequently observed (34.6%). The combination between comma-shaped and arborising vessels was the most common among all naevi. CONCLUSIONS: Our study describes the dermoscopic features of dermal naevi that may help to differentiate them from malignant lesions such as basal cell carcinoma, amelanotic melanoma and Spitz naevi.

Cutaneous melanoma associated with naevi prevalence: A 15-year cross-sectional retrospective study.

BACKGROUND/OBJECTIVES: Melanoma may develop de novo or naevus associated (NAM). The exact prevalence and features of NAM are not fully elucidated. METHODS: A 15-year cross-sectional retrospective study was performed of all melanoma cases diagnosed and treated at the skin cancer centre of the University of Naples Federico II from September 2003 to August 2018. Data collected included patient's age, gender, melanoma anatomic site, Breslow thickness, and histolopathology including melanoma-associated lesion characteristics. RESULTS: A total of 1986 melanomas were included in the study. Based on histolopathogical examination, NAM represented 8.4% (n = 167) with de novo melanoma representing the great majority of the melanomas (91.6%). NAM was significantly more common in younger age compared to de novo melamoma (mean age 48 ± 14.9 vs 54.3 ± 15.9 years, P < 0.001), and more frequently involved the trunk (62.3% vs 51.8% P = 0.01). Mean Breslow thickness was significantly higher in de novo melanoma  compared to NAM (0.97 ± 1.48 mm vs 0.83 ± 0.95, P < 0.001). However, in situ melanoma was more commonly observed in de novo melanoma (n = 640, 35.2%) rather than NAM (n = 41, 24.5%; P < 0.01) whereas invasive melanoma represented 75.5% (n = 126) of NAM and 64.8% (n = 1179) of de novo melanoma, P < 0.01. CONCLUSIONS: NAM represent a small percentage of melanomas (8.4%) compared to de novo melanoma. NAM appeared to be significantly more common in younger age and more frequently involved the trunk, being associated with an overall better prognosis, due to a lower mean Breslow thickness respect to de novo melanoma.

Management of clinical and subclinical actinic keratoses with histological and immunohistochemical assessments by confocal microscopy.

Reflectance confocal microscopy has been used to monitor treatment efficacy in non-melanoma skin cancer, but few studies have compared different therapies using the same confocal criteria. We compare a single score designed in previous study to evaluate confocal, histological, and immunohistochemical results obtained before and after two treatments of actinic keratosis (AK) and in field cancerisation area. Thirty volunteer male patients, aged >50-year old, with at least three clinically visible AKs on the bald scalp, were included in this study: 15 patients were submitted to 3% diclofenac therapy and 15 to 5% fluorouracil therapy. Confocal imaging was performed on a 5 × 5 cm skin area. In five patients of each group we performed cutaneous biopsies. Scaling, upper nucleated cells, and inflammatory cells showed a higher percentage reduction in field cancerisation, especially in diclofenac treatment group, while in AK inflammatory cells showed a greater percentage reduction in 5-fluorouracil treatment group. Both therapies are efficacious, but their effectiveness is different on the single parameters of the confocal, histology, immunohistochemically.

Single-Incision Laparoscopy Could Be Better than Standard Laparoscopy in Right Colectomy for Cancer.

BACKGROUND: Human natural orifice transluminal endoscopic surgery (NOTES) is slowed down by technical hurdles. Concomitantly, single-incision laparoscopy has been increasingly reported as an alternative. By reducing the invasiveness of standard laparoscopy, we may further reduce postoperative pain, decrease morbidity, preserve abdominal wall, and enhance cosmesis. Such techniques have been widely applied, including in colorectal surgery. The aim of this multicenter study is to compare the results of single-incision right colectomy (SIRC) with the results of the standard laparoscopic right colectomy (SLRC) in patients with colon cancer. METHODS: The files of patients who underwent right colectomy for cancer in five hospitals between January 2010 and December 2013 have been reviewed. Exclusion criteria were open surgery, emergency setting, and American Society of Anesthesiologists (ASA) score >3. Patients were distributed in Groups A (SIRC) or B (SLRC). RESULTS: Five hundred ninety-two patients were included in this study, 336 in Group A and 256 in Group B. Mean operative time was 129.0 minutes (range 65-245) in Group A and 168.1 minutes in the Group B (range 70-290), respectively (P < .001). No mortality occurred in either group. The overall 30-day morbidity rates were 21.4% in Group A and 25% in Group B, respectively (P = .64). The median length of hospital stay was 4.95 days (range 3-14) in Group A and 5.5 days in Group B (range 3-12), respectively (P = .28). Conversion to laparotomy occurred in four patients in each group (P = 1). Length of skin incision was significantly shorter in Group A than in Group B (2.99 ± 0.63 cm versus 4.94 ± 0.65 cm, P < .001). Histological analysis of the operative specimens showed no significant differences. CONCLUSION: SIRC is feasible and sure for patients with colon cancer. As compared with SLRC, SIRC may offer some advantages, including lower operative morbidity, shorter hospital stay, and better cosmoses, without compromising the oncological quality of the resected specimen.

Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for morbid obesity: case-control study.

BACKGROUND: Laparoscopic sleeve gastrectomy (SG) is gaining popularity as a procedure for the treatment of morbid obesity and type 2 diabetes mellitus. Either as a first-stage procedure for superobese patients or as a definitive procedure, SG is becoming the first-choice bariatric procedure in France. Preliminary results have suggested that the weight loss and resolution of co-morbidities with SG could be comparable to those with laparoscopic Roux-en-Y gastric bypass (RYGB). In a multicenter, retrospective study, we analyzed the weight loss, resolution of co-morbidities, and complications of both SG and RYGB using a case-control study design. METHODS: A retrospective, case-control, comparative analysis was performed with 200 patients in each treatment arm who had undergone either SG or RYGB from January 2005 to March 2008. The patients in each group were matched for age, gender, and body mass index. The postoperative complications, the percentage of excess weight loss, and the resolution of co-morbidities in each group were compared at 6, 12, and 18 months postoperatively. RESULTS: The overall mortality rates were similar in both groups. However, the morbidity rate was significantly greater in the RYGB group (20.5%) as compared to the SG group (6.5%; P <.05). The overall remission of type 2 diabetes was significantly better in the RYGB group (P <.05). However, the percentage of excess weight loss at 6, 12, and 18 months as well as the resolution of nondiabetes co-morbidities were comparable in both groups. CONCLUSION: In our study, as compared with SG, RYGB was associated with a greater short-term morbidity rate. RYGB could be associated with better diabetes control. However, additional studies are needed to evaluate the comparative efficacy of SG and RYGB for the treatment of morbid obesity and its co-morbidities.

Report of three cases of chronic pancreatic fistulas treated with prolamine as a sclerosing substance following pancreatic resection.

CONTEXT: Pancreatic fistulas are one of the most common and important complications after pancreatic resection and their consequences are a life-threatening event. Thus, they must be treated in the best way and resolved as soon as possible to avoid their morbidity. METHODS: Three cases of pancreatic fistula following pancreatic resection were reported. They were treated with percutaneous embolization using a sclerosing substance, prolamine, injected into the Wirsung duct via drainage catheter. RESULTS: No complications of the technique were revealed and closure of the pancreatic fistula was obtained shortly thereafter. CONCLUSIONS: The technique is safe and simple and can be repeated several times. It allows good results without complications. Finally, it avoids additional surgery allowing a shorter recovery time and a lower risk of morbidity.

Pancreatic metastases: observations of three cases and review of the literature.

BACKGROUND: The aim of the study is to analyze pancreatic metastases and their clinical, radiological, therapeutic and prognostic features. METHODS: Three cases of pancreatic metastases observed and a world literature review of 333 cases were recorded. RESULTS: Pancreatic metastases are due more frequently to renal cell carcinoma; they are usually metachronous and characterized by a long period of time between the resection of the primary tumor and their detection. The differential diagnosis with other pancreatic masses is difficult, but an accurate anamnesis, some peculiar findings of imaging techniques and percutaneous fine needle aspiration could allow preoperative diagnosis. Pancreatic resections are the treatment of choice allowing the better palliation and improving survival. 150/234 pancreatic metastases underwent pancreatic resections (resectability index = 64.1%); 88/132 patients are alive with a mean follow-up of 27.1 months; of the 44 dead patients the mean survival time was 21.3 months. Among pancreatic metastases the primary tumor with better prognosis is renal cell carcinoma. CONCLUSION: Pancreatic metastases are rare; their preoperative diagnosis is difficult but useful and possible. Surgical resection is suggested because the patient still may have a prolonged survival.