Association between perineural infiltrations and delayed gastric emptying after Whipple procedure for periampullary tumours, and the relationship with other clinicopathological factors and overall survival.

Introduction: Pancreaticoduodenectomy is a major procedure. Delayed gastric emptying (DGE) is a frequent postoperative complication that is attributed to several factors. Aim: To investigate the probable association between perineural infiltrations and DGE, and the effects on overall survival. Material and methods: A total of 123 patients who underwent pancreaticoduodenectomy were enrolled in the study. Factors like the presence of perineural infiltrations and post-operative DGE along with age, gender, presence of postoperative fistula, and grade of fistula and postoperative haemorrhage were analysed, and survival analyses were conducted. Results: The presence of perineural infiltrations is statistically associated with DGE occurrence (p = 0.01). Moreover, the occurrence of DGE is statistically associated with male gender (p = 0.001), worse grade of postoperative fistula (p < 0.01), and the presence of postoperative haemorrhage (p = 0.03). There was no statistical association between the presence of perineural infiltrations and the other factors. Cox regression and Kaplan-Meier survival analyses showed that increased overall survival is associated with low age (p = 0.018 and p = 0.028, respectively), absence of perineural infiltrations (p = 0.005 and p = 0.003, respectively), better grade of postoperative fistula (p < 0.001), and absence of postoperative haemorrhage (p < 0.001). Multivariate analysis showed that independent prognostic factors for survival prognosis are perineural infiltrations, age, the presence of postoperative pancreatic fistula, and the presence of postoperative haemorrhage. Conclusions: This is the first study that proves a statistically significant association between the presence of perineural infiltrations and the occurrence of DGE. Moreover, perineural infiltrations are an important independent prognostic factor for overall survival, along with other clinical factors.

The choice of conduits in coronary artery bypass surgery.

Choosing appropriate bypass conduits is important in the consideration of long-term outcomes after surgical revascularization. When deciding on a grafting strategy, attention should be given to technical, anatomic, and angiographic determinants of conduit properties, as well as the clinical characteristics of the patient. The aim of the study was to present a current review of available choices of conduits in coronary artery bypass surgery. To date, only 4 conduits have proven to be effective: the saphenous vein (SVG), the internal mammary arteries (IMAs), the radial artery (RA), and the right gastroepiploic artery (RGEA). The IMA has unique biological properties that confer protection to intimal growth and atherosclerotic plaque formation, making it the conduit of choice for coronary artery bypass grafting. SVG exhibits a lower patency rate than those of IMAs. The RGEA allows revascularization of the inferior wall but is less commonly used, given that it is more prone to spasms.

The role of deep learning in diagnosing colorectal cancer.

Colon cancer is a major public health issue, affecting a growing number of individuals worldwide. Proper and early diagnosis of colon cancer is the necessary first step toward effective treatment and/or prevention of future disease relapse. Artificial intelligence and its subtypes, deep learning in particular, tend nowadays to have an expanding role in all fields of medicine, and diagnosing colon cancer is no exception. This report aims to summarize the entire application spectrum of deep learning in all diagnostic tests regarding colon cancer, from endoscopy and histologic examination to medical imaging and screening serologic tests.

A short history of mediastinal tumours.

The mediastinum constitutes an area of special surgical interest due to important anatomical relationships and histopathologic variability of mediastinal primary and metastatic tumours. Mediastinum was considered inaccessible until the end of the 19th century. For many decades the diagnosis of mediastinal disease relied solely upon clinical presentation, and the mainstay of treatment was medical therapy. The advancements in radiology and intraoperative ventilatory support facilitated the improvement of certain diagnostic and therapeutic approaches to mediastinal disease.

Segmentectomy versus lobectomy. Which factors are decisive for an optimal oncological outcome?

Low-dose computed tomography is being used for lung cancer screening in high-risk groups. Detecting lung cancer at an early stage improves the chance of optimal treatment and increases overall survival. This article compares segmentectomy vs. lobectomy as surgical options, in the case of stage I non-small cell lung carcinoma, ideally IA. To compare the 2 previously referred strategies, data were collected from articles (40 studies were reviewed), reviews, and systematic analyses in PubMed Central, as well as reviewing recent literature. Segmentectomy could be an equal alternative to lobectomy in early-stage NSCLC (tumour < 2 cm). It could be preferred for patients with a low cardiopulmonary reserve, who struggle to survive a lobectomy. As far as early-stage NSCLC is concerned, anatomic segmentectomy is an acceptable procedure in a selective group of patients. For better tumour and stage classification, a systematic lymph node dissection should be performed.

Multifocal, biatrial, primary cardiac embryonal rhabdomyosarcoma.

Malignant primary cardiac tumors are rare, with atrial myxoma and rhabdomyosarcoma the common types in adult and pediatric populations respectively. Rhabdomyosarcomas are rare and are usually located in the atria; they present with symptomatology dependent on their location. A 63-year-old woman presented with the symptomatology of dyspnea, cough, and palpitations and was diagnosed with biatrial primary cardiac rhabdomyosarcoma, which required excision. The postoperative course was uneventful and the patient was discharged on the 5th postoperative day. Postoperative cardiac functional tests revealed an ejection fraction of 60%, consistent with the preoperative value, and no mitral valve dysfunction. Biatrial rhabdomyosarcomas are extremely rare, with only 3 cases reported, including ours, reported in the literature, to the best of our knowledge. Transthoracic echocardiogram is useful in the diagnosis. They require surgical excision along with chemotherapy or radiotherapy. Their prognosis is poor, with a median survival of almost one year. Primary biatrial rhabdomyosarcoma is an extremely rare diagnosis that can present with symptomatology based on the location, size, and number of masses. There is no consensus on how to manage them due to the scarcity of cases, but they are managed as single rhabdomyosarcomas. The majority require surgical excision, with subsequent chemotherapy or radiotherapy. The prognosis is very poor, with the majority of the patients not surviving longer than one year.

Risk Factors and Management Approaches for Staple Line Leaks Following Sleeve Gastrectomy: A Single-Center Retrospective Study of 402 Patients.

Sleeve gastrectomy (SG) has gained ever-increasing popularity among laparoscopic surgeons involved in bariatric surgery. This single-institution, retrospective cohort study aims to evaluate the prevalence of postoperative staple line leakage (PSLL) after LSG and identify risk factors for its development. We included patient data that underwent LSG at our institution for a span of 17 years-starting in January 2005 and ending in December 2022. We set the investigation of correlations of patient-related factors (age, weight, BMI, smoking status, presence of diabetes mellitus) with the occurrence of postoperative leaks. A total of 402 patients were included in our study. Of them, 26 (6.46%) developed PSLL. In total, 19 (73%) patients underwent percutaneous drainage and 14 patients (53.8%) were treated with intraluminal endoscopic stenting. Finally, five patients (19.2%) were treated with endoscopic clipping of the defect. Operative management was required in only one patient. There were no statistically significant differences in patient age, mean weight at the time of operation, and mean BMI. Abnormal drain amylase levels were associated with earlier detection of PSLL. More consideration needs to be given to producing a consensus regarding the management of PSLL, prioritizing nonoperative management with the combination of percutaneous drainage and endoscopic stenting as the safest and most efficient approach.

Comparison of postoperative bleeding using harmonic scalpel and LigaSure in thyroid surgery: a 15-year single-centre retrospective study.

Aim Thyroidectomy is the most common operation in the field of endocrine surgery. The aim of this study was to compare the use of LigaSure vessel (LS) and harmonic scalpel (HS) in 1653 total thyroidectomies between January 2008 and March of 2023, with regards to analysis of surgical bleeding complications duration the hospital stay and operative surgical time. Methods It is a retrospective analysis of a prospectively maintained database. Patients have been categorized into two groups: Group A included 718 patients from January 2008 to May 2013 when LS was used, and the Group B included 935 patients from June 2013 to March 2023 when HS was used. Results From the total of 14 postoperative bleeding cases that occurred in patients of Group A, only in 4 of them it was necessary to have a reoperation. The other 10 cases involved minor haemorrhages, while from the total of 6 postoperative bleeding cases that happened to patients of Group B, there were 4 cases that needed a reoperation (p-value >0.05) and 2 patients with minor haemorrhages. The postoperative evaluation of minor bleedings revealed statistically significant differences between the two groups (p-value < 0.05). The average hospital stay was similar in the two groups. Conclusion Both devices exhibit identical safety profiles in thyroidectomies specifically regarding major bleeding complications that require reoperation. Additionally, HS was found to be more effective at achieving haemostasis, especially in the subgroup of patients with thyroid carcinoma. The results of the present study may be useful for high-volume centres performing numerous thyroidectomies every day.

Tissue classification and diagnosis of colorectal cancer histopathology images using deep learning algorithms. Is the time ripe for clinical practice implementation?

Colorectal cancer is one of the most prevalent types of cancer, with histopathologic examination of biopsied tissue samples remaining the gold standard for diagnosis. During the past years, artificial intelligence (AI) has steadily found its way into the field of medicine and pathology, especially with the introduction of whole slide imaging (WSI). The main outcome of interest was the composite balanced accuracy (ACC) as well as the F1 score. The average reported ACC from the collected studies was 95.8 ±3.8%. Reported F1 scores reached as high as 0.975, with an average of 89.7 ±9.8%, indicating that existing deep learning algorithms can achieve in silico distinction between malignant and benign. Overall, the available state-of-the-art algorithms are non-inferior to pathologists for image analysis and classification tasks. However, due to their inherent uniqueness in their training and lack of widely accepted external validation datasets, their generalization potential is still limited.

Prevalence of stroke-related risk factors in Albania: a single-center experience.

Introduction: Stroke, a prominent global cause of mortality and disability, is broadly categorized into ischemic and hemorrhagic types. An epidemiological survey of stroke and its risk factors can help identify individuals at higher risk and therefore promote stroke prevention strategies. The aim of this study was to estimate the current prevalence of stroke and evaluate stroke-associated risk factors in Albania. Material and methods: This was a single-center retrospective analysis conducted in Albania for the period from May 2015 to September 2021. Data were collected retrospectively through hospital records. Stroke was defined as sudden onset of a nonconvulsive and focal neurological deficit, and ischemic stroke was diagnosed using brain computed tomography (CT), magnetic resonance (MR) imaging, or both. We examined patient history characteristics encompassing demographics, stroke history, conventional vascular risk factors, and lifestyle-related risk factors. Results: The mean age of the 3860 patients was 74.6 ±10.4 years, and 73.5% were men. The prevalence of carotid stenosis, arrhythmia, obesity, and hypertension was significantly higher in males than in females (p < 0.001). Out of the 3860 patients in the study cohort, 641 (16.6%) subjects died, while 335 (8.7%) patients achieved complete recovery. Hemiparesis was observed in 386 (10%) patients and hemiplegia in 868 (22.4%) patients. Conclusions: Our analysis underscores the male predominance (2.2 : 1) in stroke cases. Carotid and vertebral artery stenosis is a significant factor, emphasizing the life-saving potential of early intervention. Social and economic factors in Albania pose challenges, demanding comprehensive strategies. Prospective trials are crucial to explore intervention efficacy, and timing, and address socioeconomic impacts on timely stroke management.