BackgroundSmall bowel metastasis from esophageal squamous cell carcinoma (ESCC) is an exceedingly rare event, typically diagnosed only during emergency surgery for obstruction or perforation. The underlying metastatic mechanisms and optimal management strategies remain poorly defined.Case presentationA 54-year-old woman with stage IVB ESCC (cT3N3M1; left supraclavicular lymph node metastasis) developed recurrent complete intestinal obstruction while receiving systemic chemo-immunotherapy and local radiotherapy. Emergency laparotomy revealed multiple serosal small bowel metastases causing segmental stenosis. Approximately 20 cm of jejunum was resected with primary side-to-side anastomosis, and a decompressive tube jejunostomy was placed. The postoperative course was uneventful, and the obstruction resolved. However, due to a rapid decline in performance status, no further anticancer therapy could be administered, and the patient died of cachexia and electrolyte imbalance two months after surgery.ConclusionsIn patients with known esophageal cancer, the development of “atypical” small bowel obstruction should raise immediate suspicion for peritoneal metastasis, even when conventional imaging fails to demonstrate discrete masses. Prompt surgical exploration can achieve both definitive diagnosis and effective palliation. This case also highlights the probable lymphatic route of metastatic spread and underscores the urgent need to integrate molecular biomarkers into surveillance strategies for rare but lethal metastatic patterns.
Cosmetic liposuction is among the most frequently performed aesthetic procedures worldwide, with multiple technique refinements developed to improve efficiency, recovery, and safety. These include suction-assisted (SAL), power-assisted (PAL), ultrasound-assisted (UAL), laser-assisted (LAL), water-assisted (WAL), and radiofrequency-assisted liposuction (RFAL). Comparative evidence focused exclusively on isolated cosmetic cases remains limited. A systematic search of PubMed, EMBASE, and Web of Science was conducted to identify clinical studies on isolated cosmetic liposuction published between 2000 and 2025. Randomized trials, cohort studies, and extensive case series were included. The primary outcome was the incidence of procedure-related complications. Secondary outcomes, including efficacy, patient satisfaction, recovery, skin tightening, and durability, were synthesized qualitatively because of heterogeneity in outcome reporting. Thirteen studies met the inclusion criteria. Only one included study provided fully extractable numerical safety data for overall complications, seroma, and infection. Therefore, these safety outcomes are presented descriptively rather than as pooled meta-analytic estimates. The available evidence indicated low reported rates of overall complications, seroma, and infection, while serious complications remained rare (<0.1%). Qualitative synthesis showed that all modalities achieved comparable fat reduction and contour improvement. Studies generally reported improved operative efficiency with PAL, reduced early postoperative pain and blood loss with WAL, and modest short-term skin tightening with LAL/RFAL. Patient satisfaction was consistently high (≥80%) across techniques. Contemporary cosmetic liposuction techniques demonstrate favorable safety profiles, while evidence regarding efficacy, recovery, patient satisfaction, skin tightening, and durability should be interpreted cautiously because it was derived primarily from heterogeneous qualitative evidence.
ObjectivesTo verify whether a single low dose of dexmedetomidine could reduce emergence agitation (EA) among pediatric dental patients undergoing outpatient general anesthesia in a clinical dental setting.Study designProspective randomized clinical trial.MethodsThis study included 90 children scheduled for elective dental procedures. Patients were randomly assigned to three groups: midazolam (MID, 0.02 mg/kg, n = 30), dexmedetomidine (DEX, 0.2 μg/kg, n = 30), and normal saline (NS, n = 30). The primary endpoint was EA, with time to extubation (TOE), time to wake-up (TOW), hemodynamic fluctuations and anesthesia-related complications considered as the secondary outcome.ResultsThe incidence of EA in the DEX group was significantly lower than that in the saline group, while the incidence in the Mid group showed no significant difference compared with the other two groups after a Bonferroni correction. The three groups showed statistically significant differences in TOW recovery time, with the DEX group having the longest, the Mid group intermediate, and the saline group the shortest.ConclusionA single low dose of dexmedetomidine at induction significantly reduces EA in pediatric dental outpatients, without compromising day-surgery discharge feasibility despite a modest prolongation of recovery time.Clinical Trial Registrationhttps://www.chictr.org.cn/showproj.html?proj=215673
BackgroundRecurrent urinary tract infections (r-UTIs) are highly prevalent in women and are associated with reduced quality of life and increased healthcare burden. Intravesical glycosaminoglycan (GAG) replenishment with hyaluronic acid (HA) and chondroitin sulphate (CS) has shown clinical benefit, but the optimal instillation schedule remains undefined. This study aimed to compare the safety and effectiveness of two HA + CS instillation protocols in women with r-UTIs.MethodsIn this prospective multicentre observational study, women ≥18 years with r-UTIs, defined according to European Association of Urology guidelines, were enrolled. Patients received HA + CS according to institutional practice: Group A (weekly instillations for 4 weeks followed by monthly maintenance for 12 months) or Group B (weekly instillations for 8 weeks followed by monthly maintenance for 12 months). Clinical evaluation, 3-day bladder diary, uroflowmetry (UF), post-void residual (PVR), visual analogue scale (VAS) for pelvic pain, urinalysis, urine culture, and ICIQ-FLUTS questionnaire were assessed at baseline and during follow-up (1, 3, 6, and 12 months). The primary outcome was the cumulative number of UTI episodes recorded throughout the entire 12-month follow-up period.ResultsA total of 140 women (70 per group) were included. At 12 months, mean UTI episodes decreased to 0.6 ± 0.5 in Group A and 0.7 ± 0.3 in Group B, without significant between-group differences (p > 0.05). Storage and voiding symptoms, pelvic pain (VAS), and ICIQ-FLUTS scores significantly improved from baseline in both groups (all p < 0.001). UF parameters and PVR remained stable. No serious adverse events were observed.ConclusionIntravesical HA + CS significantly reduced UTI recurrence and improved urinary symptoms over 12 months. No statistically significant differences in clinical outcomes were observed between the two treatment groups over the 12-month follow-up.
PurposeHip osteoarthritis (OA) is increasingly diagnosed in younger, active patients, often linked to femoroacetabular impingement (FAI) and associated cartilage lesions such as acetabular delamination. Conventional surgical options, including total hip arthroplasty, are suboptimal in this population due to implant longevity concerns and high functional demands. Adipose-derived mesenchymal stem cells (AD-MSCs) have emerged as a promising biologic alternative, offering regenerative, anti-inflammatory, and immunomodulatory effects with advantages over bone marrow–derived MSCs in cell yield, harvesting ease, and safety.MethodsWe conducted a review of the literature on the possible use of mesenchymal as a treatment for hip osteoarthritisResultsProcessed via manipulative mechanical techniques, AD-MSCs can be delivered intra-articularly to target early- stage OA and focal cartilage damage, aiming to preserve joint integrity and delay progression. Clinical studies report improvements in pain, function, and quality of life, with low complication rates, particularly in Tönnis grade 1 hips. Acetabular delamination, an early and potentially reversible chondral lesion, represents a compelling therapeutic target for biologic intervention.ConclusionThis new possible therapy will be a new minimally invasive option for joint-preservation, in particular for young patients. Limitations include heterogeneity in protocols, lack of standardized dosing, and scarce long-term randomized evidence. Future research should focus on optimized delivery methods, patient selection, and high-quality trials to establish AD-MSCs as a validated component of hip preservation strategies. Clinical trials are needed to confirm their efficacy and long-term benefits.
BackgroundFournier's gangrene (FG) is an uncommon but rapidly progressive necrotizing soft-tissue infection involving the perineum, external genitalia, and perianal region. As a time-critical urological and emergency condition, it requires prompt recognition, broad-spectrum antimicrobial therapy, metabolic stabilization, and urgent surgical source control.Case summaryWe report a 47-year-old man who developed fever, marked scrotal swelling, skin breakdown, and purulent discharge after an episode of intestinal obstruction complicated by possible intra-abdominal infection. FG was diagnosed on the basis of the clinical presentation, microbiological findings, and abdominopelvic computed tomography showing extensive gas-forming infection extending from the scrotum to the pelvis, abdominal wall, and retroperitoneal structures. Cultures from blood and wound exudate grew Klebsiella pneumoniae. The patient received integrated treatment comprising broad-spectrum antimicrobial therapy, glycaemic control, and repeated surgical debridement. After more than two months of treatment, his symptoms markedly improved, with satisfactory wound healing.ConclusionThis case describes FG arising after intestinal obstruction complicated by suspected intra-abdominal infection, with extensive perineal and scrotal wounds already present at admission and wide anatomical spread of infection confirmed intraoperatively. The patient recovered gradually after repeated radical surgical debridement and broad-spectrum antimicrobial therapy. The diagnostic course and surgical strategy in this case may offer practical insight into the management of extensive FG.
BackgroundAcute appendicitis remains a common surgical emergency. The COVID-19 pandemic severely impacted all the health systems globally including surgical emergencies management. This study aimed to assess changes in diagnosis and treatment of acute appendicitis in a tertiary emergency hospital serving an urban population before, during, and after the COVID-19 years.MethodsThis was a population-based cohort study including consecutive ≥ 18-year-old residents of a metropolitan area presenting with acute appendicitis at the tertiary emergency hospital. The study period between January 2018 and December 2023 was divided into: 2018-2019 (pre-COVID-19); 2020-2021 (COVID-19); 2022-2023 (post-COVID-19). Comparisons among the three periods were performed using one-way ANOVA and the Chi-square or Fisher's exact test as appropriate.ResultsThe breakdown of 1,721 patients included was: 662 in 2018-2019, 422 in 2020-2021, and 637 in 2022-2023. Although the catchment area population (1,817 vs. 1,799 vs. 1,781 MM; p = 0.2), 27 surgeons (27 vs. 27 vs. 27), and 107,202 CT scans (32,048 vs. 38,806 vs. 36,348; p = 0.716) were stable, colonoscopies significantly decreased in 2020-2021 (4,588 vs. 2,457 vs. 4,204; p = 0.012). The number of patients presenting with acute appendicitis decreased during the pandemic, with a relative increase in complicated cases. However, complication and mortality rates did not differ. The postoperative length of stay did not change significantly, despite the increased laparoscopic access rates. The appendiceal neoplasm rates were 2.4% in the COVID-19 and 1.9% in the post-COVID-19 year groups.ConclusionsThis six-year population-based study found a decreased number of patients presenting with acute appendicitis during the pandemic years, with a relative increase in complicated cases but no difference in mortality rates. The rates of appendiceal neoplasms raise concerns regarding the offering of conservative treatment.
IntroductionIn recent years, stand-alone polyetheretherketone (PEEK) cages (SA) and Zero-P implants (ZP) have been widely adopted clinically in anterior cervical discectomy and fusion (ACDF) for cervical degenerative disease (CDD). However, which is superior between SA and ZP remains highly controversial. This meta-analysis was designed to conduct a head-to-head comparison of the safety, clinical efficacy, and radiological effectiveness of ACDF with ZP and SA.MethodsThis research was carried out in accordance with the PRISMA Statement. Systematic retrieval of eligible literature was completed covering three core electronic bibliographic databases: PubMed, Web of Science Core Collection, and Embase up to February 19, 2026. For dichotomous outcomes, including the fusion rate and subsidence rate, the effect sizes were calculated as the relative risk (RR) with corresponding 95% confidence intervals (CIs). For continuous outcomes, including surgical time, blood loss, disc height, vertebral height, C2-7 Cobb angle, segmental Cobb angle, VAS score, and NDI score, the effect sizes are expressed as the mean difference (MD) with 95% CIs.ResultsEight eligible studies comparing ACDF with SA and ZP for CDD treatment were ultimately included. The pooled patient cohort consisted of 727 participants in total, with 384 patients assigned to the SA group for ACDF and 343 patients allocated to the ZP group. Compared with the ZP, the SA had a significantly shorter operative time and higher NDI score. The segmental Cobb angle, disc height and vertebral height of the SA were significantly lower than those of the ZP. The SA group had a significantly higher subsidence rate than the ZP group, with no remarkable difference observed in the C2-7 Cobb angle, fusion rate, VAS score between the two cohorts.DiscussionCurrent pooled findings suggest that SA may be associated with shorter operative time, while ZP may correlate with lower subsidence rate and better preservation of cervical alignment. As all available evidence is derived exclusively from observational studies and rated as low to very low certainty, the conclusions must be interpreted with caution.Clinical Trial Registration:https://www.crd.york.ac.uk/PROSPERO/view/CRD420261325943, PROSPERO, CRD420261325943.
PurposeThe aim of this study was to comprehensively compare multifactorial logistic regression and various machine learning models in predicting pharyngocutaneous fistula (PCF) following laryngectomy in patients with laryngeal carcinoma and hypopharyngeal carcinoma.MethodsUtilizing a significant dataset from West China Hospital, Sichuan University, we retrospectively analyzed the medical records of 2,863 patients diagnosed with laryngeal or hypopharyngeal cancer who underwent surgical treatment from 17 March 2008 to 9 May 2022 to identify critical risk factors for postoperative PCF. Our approach encompassed traditional statistical methods and advanced machine learning techniques, including Random Forest, Decision Tree, XGBoost, and Support Vector Classification.ResultsOf the 2,863 patients undergoing laryngectomy, 263 (9.18%) developed postoperative PCF. In the validation set, the XGBoost model achieved the highest AUC (0.759), while the multivariable logistic regression model achieved an AUC of 0.753; however, the difference was not statistically significant. Logistic regression showed favorable calibration and clinical net benefit and was selected as the final model. Skin flap reconstruction and advanced tumor stage, particularly T3/T4 and N2/N3 disease, were important predictors of PCF.ConclusionMachine learning models showed predictive performance comparable to multivariable logistic regression but did not significantly improve discrimination. Considering its interpretability, calibration, clinical net benefit, and ease of implementation, multivariable logistic regression may be a practical model for predicting postoperative PCF after laryngectomy. Further prospective studies with external validation are warranted.
BackgroundSoft tissue sarcomas (STSs) represent a diverse category of tumors with a propensity for the lower limbs. Wide surgical resection is the primary therapeutic approach, often requiring immediate flap reconstruction with or without perioperative adjuvant therapy. This study aims to share our clinical experience and assess the efficacy of customized flap reconstruction designed according to the precise defect area after lower extremity STS resection.MethodsThis retrospective analysis reviewed 15 cases of lower extremity STS with a median follow-up of 28.5 months (range: 8–58 months), where patients underwent flap reconstruction with or without adjuvant therapy at our institution. Owing to the small cohort size, analyses were primarily descriptive. Continuous variables were summarized as the median, interquartile range, and range, whereas categorical variables were reported as frequencies and percentages. Exact 95% confidence intervals were calculated for selected proportions.ResultsThe cohort comprised 7 male (46.7%) and 8 female (53.3%) patients, with a median age of 65.0 years (IQR, 52.0–76.8 years; range, 31–86 years). All patients achieved microscopic negative margins (R0 resection), and 10 (66.7%) received adjuvant therapy. The median flap surface area was 120 cm² (IQR, 80–171 cm2; range, 42–240 cm2). Five patients developed postoperative complications—including partial flap necrosis, delayed donor- or graft-site healing, infected sinus tract formation, and hematoma—yielding a complication rate of 33.3% (exact 95% CI, 11.8%–61.6%). Complete wound closure was eventually achieved in all cases. Over the follow-up period, five deaths (four disease-related) and four cases of disease progression were documented.ConclusionIn this single-center retrospective series, flap-based reconstruction was a feasible limb-salvage strategy after lower extremity STS resection, providing reliable coverage for complex defects. Although postoperative complications occurred in some patients, flap reconstruction remained an important component of multidisciplinary limb-preservation treatment, particularly when combined with careful perioperative management.
PurposeThis study introduces a novel multi-modal transformer-based framework that integrates clinical data, radiomic features, and deep learning representations for automated classification of laryngeal lesions from contact endoscopy images.MethodsWe retrospectively enrolled 300 patients with laryngeal lesions from three independent medical centers (Centers A, B, and C), acquiring 7,847 contact endoscopy images with narrow band imaging. Clinical variables (18 features), radiomic features extracted using PyRadiomics (156 features), and deep learning representations from three state-of-the-art architectures, ConvNeXt V2, Swin Transformer V2, and EfficientNet V2 (3,328 combined features), were systematically integrated through a six-layer transformer encoder with multi-head cross-attention mechanisms. We evaluated three feature selection strategies (LASSO, mutual information, ReliefF) and three advanced classification architectures (Vision Transformer, Attention-MLP, Graph Neural Network). The framework was developed using data from Centers A and B (n = 230 patients) with rigorous five-fold cross-validation, and validated on an independent external test set from Center C (n = 70 patients).ResultsThe optimal configuration (LASSO feature selection with Vision Transformer classifier) achieved accuracy of 96.1 ± 1.0% (AUC-ROC: 0.992 ± 0.007) on training, 93.8 ± 1.4% (AUC-ROC: 0.981 ± 0.012) on internal validation, and 91.4 ± 2.1% (AUC-ROC: 0.967 ± 0.019) on external testing, with sensitivity of 90.0 ± 2.8% and specificity of 92.5 ± 2.5% on the external cohort. The multi-modal fusion approach significantly outperformed all single-modalityMethodsclinical features alone (71.3% validation accuracy), radiomic features alone (84.2%), and the best individual deep learning model (87.6%), with improvements of 22.5, 9.6, and 6.2 percentage points respectively (all p < 0.001. Attention mechanism analysis revealed that the model dynamically weighted modality contributions, allocating 47.0% attention to deep features, 34.7% to radiomic features, and 18.3% attention to clinical features for correctly classified malignant cases.ConclusionThis study presents the first comprehensive framework for laryngeal lesion classification that systematically integrates clinical data, radiomics, and deep learning through transformer-based fusion.
Concept of “mechanical–biological balance” is fundamental to successful fracture healing; disruption of either component can lead to healing failure. Fractures of the middle and distal tibia are commonly encountered in clinical practice, particularly when associated with comminution. Managing fracture nonunion requires a comprehensive assessment of infection status, skeletal alignment, bone defect, implant stability, and host biological characteristics. This case report aims to explore the etiological factors of tibial nonunion and to reflect upon the biomechanical mechanisms underlying internal fixation failure. The findings demonstrate that failure to restore structural stability rendered subsequent biological repair measures ineffective.Case presentationA 49-year-old perimenopausal woman developed tibial nonunion after internal fixation with a medial locking plate, screws, and titanium cables for a comminuted mid-to-distal tibiofibular fracture. Despite subsequent revision with PRP injection and autologous iliac crest bone grafting without addressing the underlying mechanical instability, the nonunion persisted and ultimately resulted in plate fatigue fractureConclusionThis case underscores that mechanical stability is a prerequisite for the biological cascade of fracture healing. In the absence of an adequate mechanical environment, even the most advanced biological augmentation cannot ensure successful union.
ObjectiveThis study aimed to evaluate the safety and feasibility of a “Parenchyma-First” approach for laparoscopic left lateral sectionectomy (LLS) in living donor hepatectomy, with the primary goal of minimizing vascular injury.MethodsTo avoid premature and excessive dissection of the portal vein and hepatic artery at the first hepatic hilum—which increases the risk of vascular injury—and to prevent torsion or occlusion of these mobilized vessels during parenchymal transection, we adopted a technique that prioritizes liver parenchymal transection before dissecting the left hepatic artery and left portal vein branch. A single-center, retrospective, descriptive study of 46 donors and pediatric recipients (April 2023–June 2025). No control group was included.ResultsMean donor operative time was 289.7 ± 66.7 min, blood loss 71.5 ± 60.3 mL, and warm ischemia time 297.8 ± 98.6 s. No donor vascular or biliary complications occurred; one donor underwent reoperation for omental bleeding. Among recipients, mortality was 4.3% (2/46) due to recipient-related vascular complications. Vascular or biliary interventions were required in 10.9% (5/46) of recipients. Early allograft dysfunction occurred in 17.4% of recipients.ConclusionThe “Parenchyma-First” approach for left lateral section graft procurement is technically feasible, provides excellent donor safety by protecting hilar vasculature, and yields acceptable recipient outcomes comparable with international series.
BackgroundFailure to identify the appendix during laparoscopic appendectomy is uncommon but challenging. Complete subserosal embedding of the appendix-cecal complex is an exceptionally rare variant that may obscure all conventional laparoscopic landmarks. We describe this anomaly in a pediatric patient and describe a practical exploration strategy derived from this case.Case presentationA 7-year-old boy presented with acute right lower quadrant pain suggestive of appendicitis. Computed tomography showed appendiceal dilatation with periappendiceal inflammation. During laparoscopic appendectomy, the appendix could not be identified despite tracing the teniae coli and complete cecal mobilization. A targeted serosal incision at the teniae convergence revealed a completely embedded appendix-cecal complex. Subserosal dissection and appendectomy were completed successfully (operative time 45 min, blood loss 2 mL). Histopathology confirmed acute suppurative appendicitis. The patient recovered uneventfully with 6-month asymptomatic follow-up.ConclusionComplete subserosal embedding of the appendix-cecal complex is a rare variant presenting as a non-visualized appendix. Systematic exploration and awareness of unusual anatomical variants are essential. Targeted serosal incision may facilitate safe laparoscopic management and avoid unnecessary conversion to open surgery.
BackgroundReflux risk after sleeve gastrectomy is closely linked to gastroesophageal junction anatomy, but the relative influence of preoperative Hill grade vs. hiatal hernia size on the decision to add concurrent Dor fundoplication remains unclear. Identifying the dominant driver may improve patient selection for an adjunctive anti-reflux procedure.ObjectiveTo compare the relative contributions of Hill grade and hiatal hernia size to the decision for Dor fundoplication during sleeve gastrectomy, and to evaluate whether Dor fundoplication is associated with improved reflux outcomes at 12 months.MethodsThis single-centre retrospective cohort study included adult patients who underwent primary sleeve gastrectomy between January 2023 and June 2025. Follow-up was completed and the database locked in June 2026. Patients were divided into Dor and non-Dor groups according to whether concurrent Dor fundoplication was performed. The primary analyses examined factors associated with Dor selection and treatment failure for reflux at 12 months. Secondary outcomes included de novo GERD, persistent GERD, PPI discontinuation, endoscopic and pH-monitoring evidence of reflux, safety, weight loss, and diabetes remission. To minimize selection bias inherent in surgeon-driven treatment decisions, we applied propensity score overlap weighting to create a pseudo-population with balanced baseline covariates between groups, simulating the conditions of a randomized trial. Multivariable logistic regression, sequential model comparisons, decision curve analysis, and propensity score overlap weighting were used to control confounding.ResultsAmong 316 patients (126 Dor, 190 non-Dor), high-risk Hill grade was the strongest independent factor for Dor selection (adjusted OR 3.48, 95% CI 2.02–6.00). Hiatal hernia size showed a weaker association (adjusted OR 1.42 per 1-cm increase, 95% CI 1.10–1.85). Model comparisons confirmed a greater incremental contribution from Hill grade than from hernia size. After overlap weighting, Dor was associated with a lower risk of treatment failure for reflux (adjusted RR 0.63, 95% CI 0.43–0.91), with consistent reductions in de novo GERD, persistent GERD, and regular PPI use, and a higher PPI discontinuation rate. Operative time was longer in the Dor group, but hospital stay, major complications, weight loss, and diabetes remission did not differ significantly. Sensitivity analyses supported the main findings.ConclusionIn patients undergoing sleeve gastrectomy, preoperative Hill grade drives the decision for concurrent Dor fundoplication more strongly than hiatal hernia size. After adjustment for clinical comparability, Dor fundoplication was associated with a lower risk of treatment failure for reflux at 12 months, without an apparent safety or weight-loss penalty.
BackgroundVenous thromboembolism (VTE) is a common and potentially serious complication following laparoscopic nephrectomy. Conventional preventive measures are limited by bleeding risk and poor compliance. Electrophysiological stimulation therapy has emerged as a non-invasive approach to improve venous circulation, but its perioperative efficacy remains unclear.MethodsThis prospective, non-randomized controlled study included 108 patients undergoing laparoscopic nephrectomy. Patients were allocated to a control group (n = 57) receiving routine VTE prophylaxis or an observation group (n = 51) receiving additional electrophysiological stimulation therapy. Venous blood flow velocity, Caprini score, D-dimer levels, and clinical recovery indicators were assessed preoperatively (T0) and before the first ambulation (T1). Change values (Δ = T1−T0) were analyzed. Multivariate regression and correlation analyses were performed.ResultsCompared with the control group, the observation group showed significantly higher postoperative venous blood flow velocities in the popliteal, posterior tibial, and fibular veins (all P < 0.05). Δ analysis demonstrated greater improvements in venous hemodynamics (all P < 0.05). Hospital stay (6.86 ± 2.39 vs. 7.98 ± 2.44 days, P = 0.018) and bed rest duration were significantly reduced. Regression analysis identified electrophysiological therapy (β = −0.98, P = 0.018) and improved venous flow (β = −0.42, P = 0.006) as independent predictors of shorter hospitalization. Venous flow improvement was moderately negatively correlated with hospital stay (r = −0.36 to −0.41).ConclusionElectrophysiological stimulation therapy was associated with improved venous hemodynamics and postoperative recovery following laparoscopic nephrectomy and may serve as a useful adjunct to routine perioperative thromboprophylaxis.
Lower extremity reconstruction in elderly patients with post-traumatic osteomyelitis presents a formidable challenge. We report a 70-year-old female with hypertension, dyslipidaemia, and bilateral knee osteoarthritis who sustained a Gustilo-Anderson type IIIB open right ankle fracture with exposed calcaneus following a fall. The course was complicated by chronic osteomyelitis, managed with partial talectomy and total calcanectomy, antibiotic-impregnated cement spacer placement, cement exchange and prolonged culture-directed intravenous antibiotics. Following infection eradication, definitive hindfoot fusion using a structural femoral head allograft fixed with a retrograde tibiotalocalcaneal arthrodesis nail and compression screws was performed. However, a persistent soft-tissue defect with exposed bone precluded primary closure. Given her age, comorbidities and compromised local vascularity, free tissue transfer was deemed high-risk. Therefore, a 2-stage delayed reverse sural artery flap (RSAF) was selected. The first stage involved flap elevation with ischaemic preconditioning over 2 weeks via stepwise incremental incisional delay, followed by definitive transposition and inset. The donor site was managed with an ovine tendon collagen (OTC) matrix and split-thickness skin grafts (STSGs), supported by intermittent negative-pressure wound therapy (NPWT). At 6-months of follow-up, the flap remained viable and had fully survived, and the patient achieved partial weight-bearing ambulation. This case illustrates the decision-making framework for complex lower limb salvage, highlighting a staged reconstructive strategy integrating the delay phenomenon and adjunctive wound technologies to achieve durable limb salvage when microsurgical reconstruction is contraindicated.
IntroductionAdrenal cysts are relatively rare, and most are nonfunctional and lack specific clinical manifestations, often being discovered incidentally during imaging examinations. For giant adrenal cysts with a maximum diameter exceeding 10 cm, especially when accompanied by degenerative changes such as hemorrhage, fibrosis, and calcification, compression of adjacent organs and obscuration of anatomical planes may increase the difficulty of determining the origin preoperatively, and they may even be misdiagnosed as pancreatic, renal, or other retroperitoneal cystic lesions. This article reports one case of a giant adrenal pseudocyst with unclear origin before surgery and discusses its diagnostic and surgical management strategies.Case reportA 36-year-old woman was admitted after a left retroperitoneal mass was incidentally discovered during trauma evaluation one month earlier. Contrast-enhanced CT showed a cystic low-density lesion measuring approximately 108 mm × 102 mm × 108 mm in the left retroperitoneal space, with marginal calcification. The left adrenal gland was not distinctly identified, and the lesion was closely related to the stomach, spleen, and pancreas. The organ of origin remained uncertain preoperatively, with cystic lesions of adrenal, pancreatic, or gastric origin considered in the differential diagnosis. After multidisciplinary discussion, laparoscopic resection was performed. Intraoperatively, the lesion was densely adherent to surrounding organs and its origin was difficult to determine; resection was completed after decompression, and the residual cyst wall on the splenic side was treated with electrocautery. Postoperative pathology confirmed a left adrenal pseudocyst with calcification. The patient recovered smoothly, and no complications were observed during follow-up.ConclusionGiant complex adrenal pseudocysts may mimic other left retroperitoneal cystic lesions, and the diagnostic difficulty lies in determining the organ of origin. For giant retroperitoneal cystic lesions of unclear origin, adrenal origin should be included as an important differential diagnosis, and comprehensive decisions should be made based on imaging, endocrine evaluation, and multidisciplinary discussion; if no safe dissection plane exists intraoperatively, individualized management should be implemented.
IntroductionPneumatosis cystoides intestinalis (PCI) in children is a disorder characterized by gas-filled cystic lesions located in the submucosa and subserosa of any segment of the gastrointestinal tract, with pneumoperitoneum occurring in partial cases. This disease is well recognized as an early imaging sign of necrotizing enterocolitis secondary to intestinal ischemia in preterm neonates, yet PCI is rare in older children. Unlike pneumatosis intestinalis associated with life-threatening conditions such as neonatal necrotizing enterocolitis and mesenteric ischemia, PCI is generally regarded as a benign disorder. Conservative non-surgical management is indicated for PCI patients without critical life-threatening complications.Case presentationWe present the case of a 11-year-old female patient presenting with recurrent vomiting and abdominal distension for 9 years. She was diagnosed with congenital congenital duodenal membranous stenosis and underwent laparoscopic surgery at our hospital. Intraoperative findings included congenital duodenal membranous stenosis, extensive pneumatosis involving the lesser curvature of the stomach and ileal wall with alveolar air cysts of variable morphology, as well as intestinal contents extravasated secondary to intestinal perforation. Congenital malrotation of the intestine was also identified. The patient received laparoscopic resection of duodenal web combined with duodenal longitudinal incision and transverse plasty, plus reduction of intestinal malrotation; no specific intervention was performed for the intestinal gas cysts. Postoperative diagnoses: congenital duodenal membranous stenosis, pneumatosis cystoides intestinalis, congenital intestinal malrotation. The patient was followed up for 29 months postoperatively. At present, she has no special discomforts such as abdominal pain or vomiting, with markedly relieved abdominal distension, and remains under regular follow-up.DiscussionWe discussed whether the lesion distribution of pediatric PCI is correlated with elevated intraluminal gastrointestinal pressure. Pediatric PCI carries a risk of intestinal perforation; non-surgical management can be adopted after exclusion of life-threatening critical conditions.ConclusionThe diagnosis and management of pediatric pci are clinically challenging due to the potential risk of perforation, while most concurrent pneumoperitoneum is benign. its pathogenesis may be associated with partial gastrointestinal obstruction and increased intraluminal pressure. regular follow-up and reexamination are recommended for children without life-threatening manifestations, and non-surgical treatment is preferred in the absence of acute abdomen.
BackgroundPostoperative anorectal stenosis is a disabling complication of anorectal surgery, characterized by fibrotic narrowing that impairs defecation and quality of life. While scar-release surgery can restore lumen patency, long-term outcomes are undermined by recurrent fibrosis. Paeoniflorin, the active component of Shaobei Injection, is a promising botanical antifibrotic agent that may enhance perioperative efficacy. This study aims to evaluate whether combining Paeoniflorin with longitudinal scar-release surgery improves anatomical and functional outcomes in patients with postoperative anorectal stenosis compared to surgery alone.MethodsIn this prospective, multicenter randomized controlled trial (Trial registration: ChiCTR2200062631) in China. Eligible patients with iatrogenic fibrotic anorectal stenosis were randomized equally (1:1) to receive either scar-release surgery plus Paeoniflorin (experimental group) or surgery alone (control group). The primary endpoints were stricture relief rate (defined as anal canal diameter ≥20 mm) and improvement in defecation difficulty score at 1 and 6 months. Secondary outcomes included anal pain (VAS), scar tissue thickness (imaging), and stricture recurrence rate. All patients were followed for 6 months.ResultsA total of 128 patients were enrolled and randomized (64 per group); after excluding 22 patients lost to follow-up, 106 patients (53 per group) completed the 6-month follow-up and were included in the final analysis. At 6 months, the stricture relief rate was significantly higher in the experimental group compared to the control group (90.6% vs. 73.6%; P < 0.05; RR, 1.23; 95%CI, 1.03–1.48). Mean defecation difficulty scores improved significantly in both groups, but the experimental group maintained near-normal scores (0.70 ± 0.27 at 1 month and 0.78 ± 0.17 at 6 months) compared to the control group (2.23 ± 0.88 and 2.34 ± 0.51, respectively; P < 0.05 for both time points). Secondary outcomes including reduced scar thickness and lower recurrence rates (3.8% vs. 13.2%, P = 0.08; RR, 0.29; 95%CI, 0.06–1.31) further favored the combined therapy. No injection-related adverse effects were observed.ConclusionsThese preliminary 6-month findings suggest that local paeoniflorin may provide exploratory benefits as an adjunct to scar-release surgery. Larger, longer-term trials are required to validate its clinical efficacy and durability.Clinical Trial Registrationhttps://www.chictr.org.cn/, ChiCTR2200062631.
