Mind the Gap: A Questionnaire on the Distance between Diagnostic Advances and Clinical Practice in Skin Cancer Treatment.

Background and Objectives: Significant progress has been made in skin cancer diagnosis, with a surge in available technologies in recent years. Despite this, the practical application and integration of these technologies in dermatology and plastic surgery remain uneven. Materials and Methods: A comprehensive 20-question survey was designed and distributed using online survey administration software (Google Forms, 2018, Google, Mountain View, CA, USA) from June 2023 to September 2023. The survey aimed to assess the knowledge and utilization of dermatologic diagnostic advancements among plastic surgeons in various European countries. Results: Data were obtained from 29 plastic surgeons across nine European countries, revealing a notable gap between diagnostic technologies and their routine use in surgical practice. The gap for some technologies was both cognitive and applicative; for electrical impedance spectroscopy (EIS) and multispectral imaging, only 6.9% of the sample knew of the technologies and no surgeons in the sample used them. In the case of other technologies, such as high-frequency ultrasound (HFUS), 72.4% of the sample knew about them but only 34.5% used them, highlighting a more significant application problem. Conclusions: Spotlighting this discrepancy provides a valuable foundation for initiating collaborative efforts between units and facilitating knowledge exchange among diverse specialists. This, in turn, contributes to advancing clinical practice by integrating the innovative opportunities presented by ongoing research.

Demographic Study and Description of the Surgical Demand in Aesthetic Surgery.

BACKGROUND: The demand for aesthetic surgery presents a continuously growing trend over the years. The population wishing to undergo this type of surgery presents unique characteristics that are profoundly different in motivational, demographic, and clinical features from patients in other specialties. OBJECTIVES: The aim of our multicenter study is to objectively define the surgical demand and the demographic characteristics of our patients comparing them with general population. We try to better define who are our patients. METHODS: We conducted an observational, multicenter, retrospective study analyzing 3329 consultations involving a total of 2092 patients between January 2019 and June 2019. Based on the inclusion criteria, we selected 524 patients whose demographic characteristics, body mass index, addictions, comorbidities, and aesthetic surgery demand were analyzed. RESULTS: The mean age of our population is 38.58 years (female-to-male ratio, 9:1). The mean body mass index is 27.50 (5.23). A total of 22.90% of the sample have smoking habits, 3.63% have alcohol addiction, 1.53% have drugs addiction, and 53.63% of the population have relevant comorbidities.The 56.68% of the patients have already undergone surgery. The conversion rate of our first consultations to surgery is 49.05%. The most requested operation is abdominoplasty (36.45%), followed by liposuction (22.90%), breast reduction (17.56%), mastopexy (14.79%), and rhinoplasty (7.63%). CONCLUSIONS: This topic is downplayed and seldom studied in the literature; our effort is to make patient profiling crucial and evidence-based in aesthetic surgery.

Gastric outlet obstruction - looking for a syndrome: Bouveret or Mirizzi?

INTRODUCTION AND IMPORTANCE: Gastric outlet obstruction can result from any pathological process that causes intrinsic blockage or extrinsic pressure on the distal stomach and duodenum. Gallstone related gastric outlet obstruction is a well-known entity classically due to a cholecystoenteric fistula formation. CASE PRESENTATION: We present here a case of a 36-year-old man who presented with right upper quadrant abdominal pain associated with marked nausea and vomiting. Abdominal CT scan done in the emergency department revealed a large impacted infundibular gallstone with signs of acute cholecystitis, associated with prominent gastric distention. Gastric outlet obstruction was due to stenosis at the duodenal level from external compression by the large impacted stone with no evidence of fistula. Laparoscopic cholecystectomy was performed with total resolution of symptoms. CLINICAL DISCUSSION: Gastric outlet obstruction can be secondary to many etiologies, and notably gallstone disease. Classically this is due to formation of a cholecystoenteric fistula and intrinsic obstruction by the migrated stone. Our case is unique in that a large impacted infundibular gallstone caused gastric outlet obstruction with absence of any fistula or gallstone migration. CONCLUSION: Gastric outlet obstruction due to external compression by a non-migrated gallstone is a rare undescribed entity. Surgical treatment should not be delayed to prevent complications and fistula formation.

Different laparoscopic treatment modalities for splenic artery aneurysms: about 3 cases with review of the literature.

INTRODUCTION: The first laparoscopic treatment of splenic artery aneurysm (SAA) was performed in 1993. Since then, many papers have been published mentioning different laparoscopic treatment modalities, including splenectomy, aneurysmectomy, ligation or even occlusion. PATIENTS AND METHODS: An updated literature review of the English medical literature using the following MeSH, 'Lapaorscopic splenic artery aneurysm', 'laparoscopic aneurysectomy', 'Laparoscopic Splenic artery Aneurysm Ligation' and 'Laparoscopic Splenic artery aneurysm excision' was done. Also three cases performed at our institutions are discussed, in terms of techniques, morbidity, mortality and postoperative outcomes. RESULTS: About eight case series and 16 case reports were retrieved from the literature. Different techniques were described by the authors, including splenectomy, aneurysmectomy, splenic aneurysm ligation or even occlusion. Few morbidity cases were reported and none of the authors has mentioned a single mortality case. In our three cases, the postoperative course was uneventful, with good long-term results. CONCLUSIONS: Despite the variations in the adopted operative techniques, the laparoscopic approach seems to be harmless. However, no treatment algorithm or consensus has been published.

Prebiliary right hepatic artery resulting in common hepatic duct compression and subsequent intrahepatic stone formation: myth or reality?

The vascular anatomy of the liver is subjected to many variations. Aberrant hepatic artery is not an uncommon finding during visceral surgery; however, topographic variations are less reported in the literature. Prebiliary artery crossing anteriorly to the common hepatic duct was firstly reported in 1984. We present here a case of a 52-year-old lady who presented with obstructive jaundice and right upper quadrant pain. Paraclinical investigations were consistent with intrahepatic stones and a benign stricture on the CBD. During surgery, a prebiliary right hepatic artery compressing the CHD was noted. The liver pedicle was dissected and a hepaticojejunostomy was performed that resulted in a good outcome after 24 months of followup.

Complicated rectovaginal fistula secondary to Bartholin's cyst infection.

Rectovaginal fistula formation secondary to Bartholin's cyst is a very rare complication, and to date only three cases were reported in the literature. We report a case of a 32-year-old woman who suffered recurrent episodes of Bartholin's cyst infection with subsequent abscess formation that resulted in rectovaginal fistula formation. We treated her initially with transperineal repair; however, the fistulous tract recurred a month later. A laparoscopic colostomy and transperineal repair using biological graft was then performed, with excellent results. The patient underwent reversal of colostomy after 2 months, and remained asymptomatic upon follow-up 12 months later.