BACKGROUND:Anastomotic leak remains one of the most severe complications in digestive oncologic surgery, significantly impacting postoperative morbidity and mortality. METHODS:A retrospective observational study was conducted. We collected and analyzed the data for 394 patients with digestive cancer, of which 248 received resection with primary anastomosis. The following variables were analyzed: tumor origin distribution, body mass index (BMI), gender, age, smoking status, tumor stage, American Society of Anesthesiologists score (ASA), hemoglobin levels and surgical indication (elective or emergency). RESULTS:Anastomotic leakage occurred in 38,4% of cases. Univariate analysis showed significant associations with ASA >= 3, advanced tumor stage, emergency surgery, smoking, underweight BMI, and anemia severity (risk increased in a severity-dependent manner). Multivariate analysis identified ASA >= 3 (OR 9.60; p<0.001), mild anemia (OR 3.11; p=0.005), moderate/severe anemia (OR 7.63; p<0.001), and advanced tumor stage (OR 2.43; p=0.018) as independent predictors. CONCLUSIONS:Preoperative physiological status and anemia severity are independently associated with anastomotic leak following digestive cancer surgery. The graded effect of anemia suggests a potentially modifiable risk factor amenable to preoperative optimization. Advanced malignancy (stages III and IV) plays an independent role in anastomotic leakage incidence.
Background: Cardiotoxicity associated with antineoplastic therapy may compromise both cardiovascular outcomes and continuity of cancer treatment. We evaluated a multimodal strategy based on radionuclide imaging and molecular biomarkers for early detection of subclinical cardiac dysfunction and for personalized monitoring applicable in multidisciplinary oncologic care. Methodology: In this prospective, observational, single-center study, 90 adults with breast cancer, lymphoma, or lung cancer receiving potentially cardiotoxic regimens were evaluated at baseline (T0), after 3-4 cycles (T1), at treatment completion (T2), and at 6-month follow-up (T3). Antineoplastic exposure was classified according to dominant cardiotoxic profile, including anthracycline-containing regimens, anti-HER2 therapy, platinum/taxane-based chemotherapy, immunotherapy, and targeted agents when used. Monitoring included clinical assessment, ECG, MUGA/gated SPECT, echocardiography with LVEF and GLS, and serial hs-Tn, NT-proBNP, and sST2. Results: Median age was 56 years, and 62% of patients were women. Mean baseline LVEF was 60Ã+-5% and mean GLS â? '19.5Ã+-2.1%. During treatment, hs-Tn, NT-proBNP, and sST2 increased progressively, while LVEF declined to 57Ã+-6% and GLS to â? '16.6Ã+-2.5% at treatment completion. Imaging-defined cardiac dysfunction occurred in 30% of patients, including overt cardiotoxicity in 10%. Changes in hs-Tn correlated most strongly with GLS (r=â? '0.42, p=0.002). The integrated model showed the best predictive performance (AUC 0.91). Conclusions: Beyond diagnostic value, this multimodal model may support multidisciplinary decision-making in surgical oncology by identifying patients who require intensified surveillance, early cardioprotection, preoperative optimization, or adjustment of treatment sequencing. The findings should be interpreted as clinically promising and hypothesis-generating, requiring multicenter validation before routine implementation.
Background: Gastric cancer is a critical concern for public health. In particular, an increased incidence of gastric malignancies has been linked to previous gastric surgeries. Case Report: We report a case of cancer developing at the gastrojejunostomy site in a 75-year-old woman who underwent laparoscopic transit bipartition sleeve gastrectomy (TB-SG) seven years ago due to morbid obesity and type 2 diabetes mellitus. The patient underwent gastroscopy, biopsy, and computed tomography. Following neoadjuvant therapy, total gastrectomy with esophageal jejunostomy was performed. Postoperative nutritional support was provided with total parenteral nutrition. Enteral feeding was initiated on the eighth postoperative day, and the patient was discharged in stable condition on the twelfth postoperative day. Positive metabolic outcomes were recorded in the early postoperative period; the patient is being followed up less than one year postoperatively. Discussion: While bariatric surgery has been reported to contribute to a reduction in cancer incidence in certain settings, gastric cancer developing in the remaining stomach after bariatric surgery has rarely been documented. Several cases of gastric cancer have been identified after sleeve gastrectomy alone. Although cancer developed in the gastric remnant after sleeve gastrectomy and transit bipartition (TB-SG) surgery has been already reported in literature, this is the first case report of gastric cancer developed at the gastrojejunostomy anastomosis site after TB-SG. Conclusion: Tumor development at the anastomosis site following Sleeve Gastrectomy with Transit Bipartition is a rare occurrence. To prevent severe complications, patients undergoing this procedure should be closely monitored for gastric cancer during the postoperative period. Even minor clinical suspicions should prompt timely endoscopic and imaging evaluations without delay to facilitate early diagnosis.
Background: Postoperative complications remain a major source of morbidity after colorectal surgery and are associated with prolonged hospitalization, reintervention, intensive care unit admission, and increased mortality. Early identification of high-risk patients remains challenging due to the heterogeneity of colorectal surgical populations. Artificial intelligence and machine learning methods may support individualized risk prediction by integrating clinical, biological, and operative variables. Aim: This study aimed to develop and internally evaluate a preliminary machine learning model, named COLOSSUS-AI, for predicting early postoperative adverse outcomes after colorectal surgery. Material and Methods: This retrospective, single-center, observational pilot study included 310 patients undergoing colorectal surgery. Demographic, clinical, laboratory, disease-specific, operative, and postoperative data were retrospectively collected and organized into a structured database comprising 84 variables. The primary endpoint was postoperative adverse outcome. Three predictive models were evaluated: logistic regression, random forest, and gradient boosting. Model performance was assessed using receiver operating characteristic curve analysis, area under the curve, accuracy, sensitivity, and specificity. Results: Postoperative adverse outcomes occurred in 120 patients (38.7%). Adverse outcomes were associated with older age, urgent or emergency admission, increased inflammatory markers, higher neutrophil-to-lymphocyte ratio, lower preoperative albumin, impaired renal function parameters, anastomotic leak, and in-hospital mortality. Among the evaluated models, gradient boosting achieved the best predictive performance, with an area under the receiver operating characteristic curve of 0.886, accuracy of 81.7%, sensitivity of 72.2%, and specificity of 87.7%. Random forest achieved an area under the curve of 0.841, while logistic regression achieved an area under the curve of 0.768. Conclusions: The COLOSSUS-AI pilot study suggests that routinely collected perioperative data can be used to develop exploratory machine learning models for predicting postoperative adverse outcomes after colorectal surgery. Although gradient boosting showed the best preliminary performance, these findings should be interpreted cautiously. External validation in larger multicenter cohorts is required before clinical implementation.
Background: Multi-stage surgical management of penile squamous cell carcinoma (PSCC) requires sequential decision-making from primary tumor treatment through extensive lymphadenectomy, the lack of adherence to treatment indications and prognostic stratification remaining clinical challenges. This study assessed outcomes and prognostic determinants in patients undergoing staged surgical treatment. Methods: This retrospective cohort study analyzed 49 patients with surgically treated PSCC with surgical indication for bilateral inguinal-femoral lymphadenectomy (ILND) following curative-intent primary tumor resection between October 2020 and December 2024 in a tertiary Romanian oncological surgery center. Primary endpoints included overall survival (OS), treatment completion rates, and prognostic factor identification through univariate and multivariate Cox regression analysis. Results: Among 49 patients (median age 64 years), 31 (63.3%) completed second-stage bilateral ILND, while 18 (36.7%) remained non-compliant. Pathological staging revealed pN0-N1 in 36.7%, pN2 in 42.9%, and pN3 in 20.4%. Eleven patients (22.4%) underwent third-stage pelvic lymphadenectomy (PLND). Overall mortality reached 55.1% (27/49) with median OS of 20 months. Patients requiring third-stage pelvic dissection demonstrated 90.9% mortality and median OS of only 12 months. Multivariate analysis identified three independent prognostic factors for OS: absence of lymphovascular invasion (LVI) (HR 0.43, 95% CI: 0.19-0.99, p = 0.048), absence of urethral invasion (HR 0.36, 95% CI: 0.12-1.03, p = 0.056), and pathological N stage. Each additional positive lymph node increased mortality hazard by 4% (HR 1.04, 95% CI: 1.01-1.06, p = 0.002). Conclusions: Multi-stage surgical management of PSCC faces a low level of patient compliance (63.3%) and identifies high-risk populations through staged progression. While LVI, urethral invasion, and nodal stage provide independent prognostic stratification, patients meeting third-stage pelvic dissection criteria exhibit poor outcomes despite complete surgical staging, suggesting these patients may benefit more from integrated systemic therapy approaches than from extended surgery alone.
Diabetic foot disease in end-stage kidney disease (ESKD) represents the convergence of diabetic peripheral neuropathy, accelerated atherosclerosis, medial arterial calcification, uremic immune dysfunction and impaired wound healing. The combination yields amputation rates three- to five-fold higher than in non-uremic diabetics and one-year postamputation mortality approaching 40â?"50%. In this paper we synthesised the current anatomical, diabetological, nephrological and surgical evidence into a practical framework for the surgeon caring for the dialysis-dependent or kidney-transplant recipient with a diabetic foot. We conducted a narrative review of guidelines and consensus statements from the American Diabetes Association (ADA) Standards of Care 2025, KDIGO 2022/2024, the 2023 intersocietal International Working Group on the Diabetic Foot (IWGDF), European Society for Vascular Surgery (ESVS) and Society for Vascular Surgery (SVS) PAD guideline, the 2024 ACC/AHA Lower-Extremity PAD Guideline, the 2019 Global Vascular Guidelines on chronic limb-threatening ischemia (CLTI), and the KDOQI 2019/2020 vascular access update, supplemented by high-quality reviews published through 2026. Anatomical understanding of the tibioperoneal trifurcation, pedal-plantar loop and the angiosomal territories is now central to revascularization planning; belowthe- knee disease in ESKD is diffuse, calcified and pedal-dominant, mandating individualized choice between bypass, endovascular and transcatheter arterialization of the deep veins; perioperative care must integrate dialysis timing, hyperkalaemia control, anaemia and mineral-bone disease management, and ipsilateral vascular-access preservation; the threshold to definitive, well-planned amputation should be lower than in non-uremic diabetics, but only after a structured limb-salvage attempt within a multidisciplinary "toe-and-flow" team.
Background: Anastomotic leakage (AL) represents a serious postoperative complication after surgery, especially for digestive tract malignancies, concerning both patients and surgeons. Due to severe clinical repercussions, early identification of patients at risk is essential for improving postoperative outcomes. This study focused on assessing clinical risk factors and the postoperative day 3 (POD 3) biomarkers in early detection of anastomotic leakage. Materials and Methods: A retrospective observational study was conducted including 166 patients who underwent resection with primary anastomosis for colorectal cancer. Patient-related factors, tumor characteristics, operative factors, and POD 3 laboratory data were collected. Receiver operating characteristics (ROC) curves and logistic regression models were used to assess predictive performance and identify independent risk factors. Results: Anastomotic leakage occurred in 44 patients (26.50%) and was associated with prolonged hospitalization and higher postoperative mortality (25.00% vs 6.60%, p=0.002). Multivariable logistic regression identified emergency surgery, rectal tumor location, intraoperative transfusion, and open surgical approach as independent risk factors. Among POD 3 biomarkers, C-reactive protein-to-albumin ratio (CAR) demonstrated the highest predictive accuracy for AL. After adjustment in the multivariable model, CAR remained an independent predictor of AL (OR=1.91, p 0.001). Conclusions: Anastomotic leakage after colorectal cancer surgery remains a multifactorial complication influenced by operative conditions, local tumor-related factors, and the postoperative inflammatory response. In this retrospective cohort, POD 3 CAR showed the highest discriminatory performance among the evaluated biomarkers and may support early postoperative risk stratification when interpreted with clinical findings and operative risk factors.
Background: Sarcopenia is a common complication and an important negative prognostic factor in patients with liver cirrhosis, being associated with reduced muscle mass and function, as well as increased mortality. Although computed tomography (CT) is considered the gold standard for assessing muscle mass, there is growing interest in identifying serum biomarkers that may facilitate the early diagnosis and monitoring of disease progression. The aim of this study was to evaluate the diagnostic value of osteonectin, the C-terminal agrin fragment (CAF), the N-terminal propeptide of type III procollagen (P3NP), and myostatin in patients with liver cirrhosis and sarcopenia, in correlation with CT-derived imaging parameters. Materials and Methods: A prospective observational caseâcontrol study was conducted, including 60 participants: 30 patients with liver cirrhosis (with or without hepatocellular carcinoma) and sarcopenia, and 30 healthy control subjects. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria, using the skeletal muscle index (SMI) and psoas muscle index (PMI) measured by computed tomography. Serum concentrations of osteonectin, CAF, P3NP, and myostatin were determined using enzyme-linked immunosorbent assay (ELISA). Statistical analyses included parametric and non-parametric tests, as well as Pearson correlation analysis. Results: Patients with liver cirrhosis and sarcopenia exhibited significantly higher serum levels of osteonectin, CAF, P3NP, and myostatin compared with healthy controls (p 0.001 for all comparisons). The skeletal muscle index was significantly lower in cirrhotic patients, confirming the presence of muscle wasting. Correlation analysis demonstrated positive associations between osteonectin and CAF (r = 0.441, p 0.001), osteonectin and P3NP (r = 0.313, p = 0.016), osteonectin and myostatin (r = 0.444, p 0.001), as well as a strong correlation between CAF and myostatin (r = 0.882, p 0.001). No significant associations were observed between biomarker levels and viral etiology or ChildâPugh class. Conclusions: Simultaneous assessment of osteonectin, CAF, P3NP, and myostatin, combined with computed tomography-based imaging evaluation, may improve the diagnosis of sarcopenia associated with liver cirrhosis and facilitate the early identification of patients at increased risk of muscle deterioration. Larger multicenter prospective studies are warranted to validate the clinical utility of these biomarkers in routine medical practice.
Background: Primary fallopian tube carcinoma is a rare gynecologic malignancy with clinical and biological features overlapping epithelial ovarian cancer. Due to its low incidence, data regarding prognostic factors and optimal therapeutic strategies remain limited. Methods: This retrospective study included patients who underwent surgical treatment for primary fallopian tube carcinoma between 2014 and 2025 at the First Oncological Surgery Unit of a tertiary cancer institute. Clinicopathological characteristics, treatment patterns, and survival outcomes were evaluated. Univariate and multivariate Cox regression models were used to identify prognostic factors. Results: Seventy-two patients were included in our study. Advanced-stage disease predominated, with FIGO stage IIIâIV identified in the majority of cases. Neoadjuvant chemotherapy was administered to 33.3% of patients, while 95.8% received adjuvant chemotherapy. Complete cytoreduction was achieved in 75% of patients. On multivariate analysis, the use of neoadjuvant chemotherapy was associated with poorer survival (p=0.042). Bilateral salpingo-oophorectomy was associated with improved survival (p=0.031), while FIGO stage approached statistical significance. Conclusions: Primary fallopian tube carcinoma frequently presents at an advanced stage and requires complex multimodal management. Despite advances in molecular profiling and surgical techniques, early detection remains elusive due to the subtle and non-specific nature of symptoms and the anatomical inaccessibility of the fallopian tubes.
Background: Minimally invasive colorectal surgery has evolved considerably in our country over the past three decades, although its early adoption was slow and uneven in many centers. At the Fundeni Clinical Institute, this evolution began in 1995 with the first reported laparoscopic colorectal operation performed in Romania, marking the start of a gradual transition from the open approach to minimally invasive surgery for both colonic and rectal pathology. Methods: We conducted a retrospective institutional review, integrating historical milestones, published experience, and analysis of internal databases. Laparoscopic, robotic-assisted, and transanal techniques were evaluated, with emphasis on oncologic colorectal surgery and the progressive expansion of minimally invasive indications. Results: After an initial period of cautious and limited dissemination, minimally invasive colorectal surgery progressively expanded as surgical expertise and technological resources improved. The adoption of advanced laparoscopic procedures, including the laparoscopic reversal of the Hartmann procedure and various transanal techniques, reflected the extension of minimally invasive colorectal practice beyond selected cases to more complex colorectal surgery. Between 2012 and 2023, 2,447 rectal cancer resections were performed, of which 446 were minimally invasive. After discontinuation of the robotic program, laparoscopic surgery served as the sole minimally invasive approach and was paradoxically associated with a further increase in minimally invasive procedures, despite the absence of robotic surgery, without compromising oncologic or postoperative outcomes. Conclusions: The experience of the Fundeni Clinical Institute illustrates the successful maturation of minimally invasive colorectal surgery from an early pioneering stage to a stable and expanding practice. Despite initial limitations and the discontinuation of the robotic program, laparoscopic surgery became the main driver of minimally invasive procedures, enabling their extension to more complex cases without compromising oncologic or perioperative outcomes. This evolution highlights the instituteâs role in consolidating minimally invasive colorectal surgery as a reliable standard in a high-volume center.
BACKGROUND/OBJECTIVES:Acute on chronic pancreatitis (ACP) is defined as acute worsening of the inflammatory process associated with chronic pancreatitis (CP) and typically results in deteriorating clinical condition and increased pancreatic pain. The heterogeneity of this disease hinders understanding the details behind important clinical data, such as sex differences, etiology, or outcome at discharge. We aim to find if congenital pancreatic abnormalities are a factor for ACP development. Methods: In this multicentric case-control study, 181 cases of acute on chronic pancreatitis (ACP) were compared with 1754 controls with acute pancreatitis (AP) from four centers. The patients were consecutively hospitalized between January 1, 2015 and December 31, 2023. Frequencies, logistic regression, and the Pearson chi-square, Shapiroâ?"Wilk, and Mann Whitney U tests were deployed in the statistical analysis. Results: The males had a 2.6 times higher likelihood of suffering from ACP (p 0.01). If the patients had pancreatic abnormalities, they had a 51.2 times higher probability of developing ACP (p 0.01). A 70% lower chance of dying during hospitalization if a patient suffered from ACP rather than AP was observed (p 0.01). CONCLUSION:Males with pancreatic abnormalities have a higher risk of developing ACP.
Background: Rectal surgery has evolved through the combined efforts of anatomists and surgeons. Minimally invasive surgery has gained recognition over open surgery due to fewer perioperative complications, and faster postoperative recovery. Methods: A systematic search was conducted in PubMed, Scopus, and Web of Science to identify studies published between 2014 and December 2024 comparing laparoscopic surgery (LS) and open surgery (OS) for rectal cancer. Primary outcomes included postoperative complications, number of lymph nodes harvested, overall survival, and disease-free survival. Results: Eight randomized controlled trials and one non-randomized study, including a total of 3,935 patients, were analyzed. LS showed a lower incidence of postoperative complications [OR: 0.64; 95% CI, 0.53, 0.77; p=0.008] and a slight advantage in lymph node harvest (WMD: 0.66; 95% CI: -0.63â?"1.95). No significant differences were found in overall or disease-free survival. Conclusions: LS is a safe and effective option for rectal cancer treatment, offering better postoperative recovery and efficient lymph node retrieval, while maintaining long-term oncological outcomes comparable to OS.
AIM:Surgical wound complications remain a relevant issue in breast surgery, particularly in patients with risk factors such as obesity. Closed-incision negative pressure wound therapy (ciNPWT) has been proposed as a strategy to reduce postoperative complications, including seroma formation. However, evidence in mastectomy without immediate reconstruction remains limited. Methods: A prospective observational single-center pilot study was conducted at Santâ??Andrea University Hospital (Rome). Twenty-two consecutive patients undergoing mastectomy for oncologic indications were treated with ciNPWT (PICO device) and compared with a historical cohort of 40 patients managed with standard dressings. Each breast was considered an independent unit of analysis. The primary endpoint was postoperative seroma, assessed clinically and quantified in milliliters. Secondary endpoints included hematoma, skin necrosis, ecchymosis, postoperative bleeding, reintervention, and device compliance. Follow-up was performed at 7 and 14 days postoperatively. Results: A total of 70 mastectomy units from 65 patients were analyzed (22 ciNPWT vs 48 controls). The ciNPWT group was significantly older (74.09 Ã+- 9.51 vs 65.71 Ã+- 14.12 years; p = 0.014) and had a higher proportion of axillary dissections. At 7 days, mean aspirated seroma volume was lower in the ciNPWT group (33.41 Ã+- 59.83 mL vs 44.58 +- 96.49 mL; p = 0.619), although not statistically significant. At 14 days, the ciNPWT group showed a significantly higher seroma volume (59.55 Ã+- 78.95 mL vs 17.02 Ã+- 40.17 mL; p = 0.025). Secondary complication rates were comparable between groups. No skin necrosis was observed. Device compliance was 100%. Conclusions: ciNPWT using the PICO device demonstrated excellent safety and tolerability. While an early trend toward reduced seroma was observed, a significant increase at 14 days suggests a possible rebound effect after device removal. Due to methodological limitations, definitive conclusions on efficacy cannot be drawn. These findings support the need for larger prospective randomized multicenter studies to clarify the role and optimal duration of ciNPWT in mastectomy patients.
BACKGROUND/OBJECTIVES:Artificial intelligence (AI) is increasingly integrated into oncological imaging, but its ability to predict detailed histopathological features from standard mammography remains understudied in ductal carcinoma in situ (DCIS). This study aimed to evaluate the performance of a large language model (ChatGPT-4, Open AI, May 2025) in predicting nuclear grade, architectural subtype, comedo necrosis, and stromal invasion from specimen mammography. Materials and Methods:We conducted a retrospective and methodological study of 29 patients with histologically confirmed DCIS or invasive carcinoma with DCIS components. Our clinical protocol is based on NCCN/ESMO guidelines of treatment ductal carcinoma in situ. Preoperatively, all patients with confirmed disease benefited from wire guide localization of the breast lesion. Patients were then submitted to surgical excision (lumpectomy) and surgical specimen mammography to confirm the complete macroscopic excision. For each of these cases, mammographic specimens were analyzed using an AI model designed to extract and process radiomic features. AI-model reports were compared with histopathological reports which served as the gold standard. Diagnostic performance was evaluated for four parameters: DCIS nuclear grade, architectural subtype, comedo necrosis, and stromal invasion. Accuracy, sensitivity, specificity, precision, and F1 scores were computed. Results:The size of mammographic lesions ranged from 1.2 to 10.0 mm (mean +- SD: 4.46 +- 2.25 mm). Histopathological diagnoses included pure DCIS (n = 17), invasive NST carcinoma with DCIS (n = 10), and mixed histologies (n = 2). The AI model achieved 65.5% accuracy for detecting comedo necrosis (sensitivity 75.0%, specificity 53.8%) and 72.4% accuracy for detecting stromal invasion (specificity 94.1%, sensitivity 41.7%). Nuclear grade classification matched histopathology in 20.7% of cases, while architectural subtype classification achieved 17.2% agreement. Multiclass predictions showed low F1 scores for most categories. CONCLUSION:Although the AI model demonstrated acceptable utility for detection of comedo necrosis and excluding stromal invasion, it faced several difficulties regarding nuclear grading and architectural subtype classification. Although limited by the small sample size and 2D imaging, this methodological study provides an insight for future AI and radiomics approaches in breast tumor characterization.
BACKGROUND:Minimally invasive liver resection (MILR), encompassing laparoscopic and robotic techniques, has transformed hepatobiliary surgery. Despite its advantages, intraoperative conversion to open surgery remains a critical event, often associated with increased blood loss, morbidity, and longer hospital stay. Timing of conversion - whether early or delayed - emerges as a key determinant of patient outcomes yet remains poorly defined in the literature. AIM:This review synthesizes current evidence on the indications, timing, and outcomes of conversion in MILR, with a focus on identifying risk factors, perioperative consequences, and existing knowledge gaps. METHODS:A systematic search of PubMed, MEDLINE, and Embase was performed (2010-2025). We included studies comparing converted vs. non-converted MILR. A quantitative synthesis was performed for key outcomes. RESULTS:Fifteen studies (15,834 patients) were included. A quantitative analysis revealed that conversion was associated with significantly increased blood loss (mean difference: 450 mL), higher overall morbidity (OR: 2.5), and longer hospital stays (mean difference: 4.2 days). We propose an operational definition: Early Conversion (<60 mins or pre-parenchymal transection), **Late Conversion** (>60 mins or post-parenchymal transection), and Emergency Conversion (life-threatening event). We propose operational definitions for conversion timing (Early, Late, Emergency) and developed a decision-making algorithm. CONCLUSION:Conversion during MILR is a pivotal safety measure, but its timing substantially influences outcomes. There is a pressing need for a national, prospective, multicentre UK-based audit to define optimal conversion timing, identify modifiable risk factors, and inform standardised intraoperative decision-making frameworks.
Background:Puncture wounds in children are frequently underestimated, particularly when presentation is delayed or the initial injury goes unnoticed. Retained foreign bodies substantially increase the risk of deep soft-tissue infection, abscess formation, septic arthritis, and osteomyelitis. Prompt diagnosis and appropriate surgical management are essential to prevent serious complications. Case Presentation:A 4-year-old child presented with a 10-day history of progressive pain, swelling, erythema, and purulent discharge of the right foot following a nail puncture injury. Clinical and radiological evaluation revealed extensive soft-tissue infection associated with retained foreign material. Following aggressive surgical debridement, foreign-body removal, and irrigation, empirical intravenous antimicrobial therapy was initiated and subsequently guided by microbiological culture results. Negative pressure wound therapy (NPWT) using a vacuum-assisted closure (VAC) system was applied for three weeks. At one-month follow-up after completion of NPWT, the wound demonstrated complete coverage with healthy granulation tissue, marked reduction in wound size and depth, resolution of infection, and satisfactory functional recovery without the need for further surgical intervention. Conclusion:This case highlights the importance of early recognition and comprehensive management of delayed pediatric puncture wounds. Combined surgical debridement, appropriate antimicrobial therapy, and adjunctive NPWT can effectively control infection, promote wound healing, and facilitate successful limb preservation in complex pediatric soft-tissue injuries.
Trichobezoars are hair concretions in the stomach associated with trichophagia and trichotillomania. In most cases, they occur among young women with concomitant mental disorders. The treatment for this category of patients involves surgical removal of trichobezoars. We present a case of a 24-year-old female patient who complained of morning nausea, a sensation of a foreign body, and periodic pulling pain in the epigastric region. Palpation revealed a foreign mass that occupied the epigastric area. The patient underwent computed tomography (CT) and esophagogastroduodenoscopy (EGD) for differential diagnosis. Based on the instrumental studies, the diagnosis of a gastric trichobezoar was established. Laparoscopic gastrotomy was performed along the anterior wall of the stomach with removal of the trichobezoar through a Pfannenstiel-type mini-laparotomy site. The postoperative period was uneventful, and the patient was discharged on the second postoperative day. To prevent recurrence, psychiatric consultation and long-term outpatient follow-up were recommended as part of treatment. The uniqueness of this case lies in the presence of a trichobezoar that caused minimal discomfort for a long period of time. Laparoscopic removal of gastric trichobezoars represents an effective treatment option due to its minimally invasive nature and rapid postoperative recovery.
Background: Since the 1990s, laparoscopic surgery has revolutionised surgical practice by enabling smaller incisions, faster recovery, and reduced postoperative complications. However, musculo-skeletal (MSK) injuries among surgeons - across open, laparoscopic, and robotic modalities - remain an under recognised occupational hazard. This review examines the causes, prevalence, and prevention strategies for MSK injuries in laparoscopic surgeons. Methods: A systematic literature review and narrative synthesis was conducted in accordance with PRISMA guidelines. Searches were performed in MEDLINE, Embase, and PubMed between August 2022 and March 2023 using PICO-derived terms. Inclusion criteria encompassed English-language studies published within the last decade focusing on MSK injuries in surgeons performing minimally invasive surgery (MIS). Results: From 321 screened publications, 43 studies met inclusion criteria. The neck, back, and shoulders were the most frequently affected regions. Contributing factors included sustained non-neutral postures, non-adjustable or poorly designed surgical equipment, and lack of ergonomic training. MSK injuries led to decreased productivity, burnout, and in some cases, surgical absenteeism. Conclusion: Preventive strategies- such as ergonomic education, equipment redesign, microbreaks, and strength training - can significantly reduce MSK injury risk among laparoscopic surgeons. Integration of ergonomics into surgical curricular and workplace design is crucial to protect surgeon wellbeing, ensure sustainable practice, and maintain high-quality patient care.
Background: Breast cancer is the most common malignancy among women and represents a leading cause of worldwide cancer-related mortality. Mammographic screening substantially reduces breast cancer-specific mortality by enabling its early detection. Organized mammographic screening is recognized as the most effective strategy for early detection, mortality reduction, and for improving quality of life. Romania currently lacks an organized, functional, invitation-based system. National data regarding the utilization of mammography remain limited and poorly characterized. Materials and Methods: A cohort of 2,500 women aged 40-90 years diagnosed with breast cancer was analyzed. The study was conducted in four medical centers in Bucharest, Romania: the Prof. Dr. Alexandru Trestioreanu Institute of Oncology, Medicover Pipera Hospital, Profmedica Clinic, and CIB Medical Clinic, between June and December 2025. Information regarding mammographic examinations performed prior to diagnosis was obtained through a structured interview and subsequently validated by reviewing medical records. The sociodemographic variables analyzed included age, place of residence, and educational level. Patients were categorized into two groups according to their pre-diagnostic mammography status: those who had never undergone mammography in their lifetime and those who had undergone at least one mammographic examination prior to breast cancer detection. For patients in the latter group, the interval between the most recent mammography and the time of diagnosis was recorded and analyzed. Results: Overall, 76% of the patients had not undergone any mammographic examination prior to diagnosis. Among those who had undergone at least one mammography, 37.3% had their most recent examination more than four years before diagnosis. When these two subgroups were combined, it was found that 85% of patients diagnosed with breast cancer had not received a recent mammographic evaluation within the four years preceding diagnosis that might have enabled earlier detection of the disease. Conclusion: This study highlights the limited use of mammography for the early detection of breast cancer in Romania through periodic examinations within an opportunistic screening setting. Consequently, most cases are diagnosed only after the onset of signs and symptoms. This finding reflects insufficient public awareness of the benefits of early detection of this disease. Among the 2,500 women with breast cancer who were interviewed in this study, 76% had never undergone a mammographic examination in their lifetime. Moreover, 85% had not undergone any mammography within the four years preceding diagnosis. The development and consolidation of public information and medical education initiatives are essential to increase participation and improve population-level understanding of the benefits of early detection for breast cancer. However, even when it is widely implemented, opportunistic screening alone is unlikely to achieve a meaningful population-level impact. A reduction in breast cancer mortality through early diagnosis can only be achieved through the implementation of an organized, national screening program.
