BACKGROUND:Giant pulmonary hydatid cysts (GHCs), defined as cysts measuring ≥10 cm, pose significant surgical challenges owing to their large size and distortion of the native lung architecture, which often limits the effectiveness of conventional capitonnage. This study evaluates the feasibility and early clinical outcomes of a novel closed-book parenchyma-sparing technique designed to achieve complete residual cavity obliteration while preserving functional lung parenchyma. METHODS:A retrospective analysis was performed on 12 consecutive patients with GHCs who underwent surgery between September 2022 and August 2025. Diagnosis was confirmed by contrast-enhanced computed tomography. The closed-book technique involved controlled cyst evacuation, meticulous bronchial closure, and symmetrical bidirectional intracystic plication. Patients were followed for 15 months to assess postoperative complications, lung re-expansion, and recurrence. RESULTS:The mean patient age was 33.4 years, with female predominance (75%). Cyst size ranged from 11 to 16 cm (mean 13.5 cm), most commonly involving the right lower lobe and left upper lobe. Four patients presented with ruptured cysts. The technique achieved complete lung re-expansion in all cases. No postoperative air leaks, empyema, atelectasis, surgical site infection, residual cavity, recurrence, or mortality were observed during the 15-month follow-up. One patient developed a transient pleural effusion that resolved spontaneously. The mean hospital stay was 12.9 days. CONCLUSION:The closed-book parenchyma-sparing technique is a feasible and promising lung-preserving approach for GHCs. Larger prospective comparative studies are warranted to validate its safety, reproducibility, and long-term effectiveness.Abbreviations: CECT; contrast-enhanced computed tomography; GHCs: giant pulmonary hydatid cysts.
BACKGROUND:Historical descriptions of mandibular fracture treatment inform the evolution of maxillofacial surgery. Ālī ibn Ābbas al-Mājūsī's Kāmil al-Ṣinā'at al-Ṭibbīyah includes practical maneuvers for mandibular fractures not widely summarized in modern literature. METHOD:This is a textual and interpretive analysis of Kāmil al-Ṣinā'at al-Ṭibbīyah by Ālī ibn Ābbas al-Mājūsī, focusing on the chapter devoted exclusively to the management of mandibular fractures. To conduct this research, a version of the author's original language (Arabic) was used, and finally, to clarify the proposed maneuvers in the treatment of Mandibular fracture, interpretive anatomical reconstruction was performed using craniofacial moulage models and detailed images were recorded by the authors. The recommended medications, therapeutic and post-therapeutic measures were accurately extracted from the source under study and categorized in specific tables. RESULT:Close reading of al-Mājūsī's surgical chapter reveals two principal maneuvers: closed realignment for non-displaced fractures and transcutaneous/head-wrap traction with dental wiring or silk fixation for displaced fractures. Post-reduction care (immobilization, diet, topical compresses) and an asserted ∼20-day healing period are described; specific medicinal applications to reduce swelling are listed. CONCLUSIONS:Al-Mājūsī's techniques show continuity with earlier Greco-Roman practices and offer historical insight into non-invasive fracture management and immobilization methods relevant for understanding the roots of modern mandibular trauma care.
INTRODUCTION:Rectovaginal fistulae resulting from rectal surgery for cancer, especially in the irradiated field, represent a difficult situation for colorectal surgeons. To avoid radical and mutilating solutions and to limit morbidity, several therapeutic approaches have been described, but no consensus has yet been established. Omental and pedicled muscular flaps interpositioned between the rectum and vagina offer good outcomes; nevertheless, the cosmetic result is poor and the short- and long-term morbidity is high, and resection of the previous anastomosis and redo is often required. Technique: Surgery is represented by usual laparoscopy using five 5 mm ports; the first step consists of the dissection of the rectovaginal space down to the pelvic floor; afterwards, a modified Vertical Rectus Abdominis pedicled flap (m-VRAM) can be easily harvested full laparoscopically and simply interposed in the rectovaginal space. No additional skin or fascial incisions and no repeat anastomosis were needed. No recurrence, stenosis, or other short- or long-term complications were noted. Conclusion: Our technique is minimally invasive and offers a valid alternative for the treatment of rectovaginal fistulae with low morbidity and no additional incision.
OBJECTIVE:This study investigates the relationship between body mass index (BMI), hernia defect diameter, and early postoperative complications in total extraperitoneal (TEP) hernia repair. METHODS:Of 306 patients undergoing endoscopic inguinal hernia repair between January 2022 and December 2024, 285 patients with completed TEP procedures performed by a single surgeon constituted the final study cohort. Patients were stratified by BMI and hernia defect size. Early postoperative complications within 30 days, including seroma and hematoma, were recorded. Multivariable logistic regression analysis was conducted to identify independent predictors of early complications. All analyses were performed using SPSS version 26.0. RESULTS:Within the 30-day postoperative period, seroma occurred in 36 patients (12.6%) and hematoma in 21 patients (7.4%). Obesity (BMI ≥ 30 kg/m2) was independently associated with increased odds of early postoperative complications (OR 2.8, 95% CI 1.3-5.9, p = 0.02), whereas overweight BMI was not statistically significant (OR 1.2, 95% CI 0.6-2.4, p = 0.34). Hernia defect size ≥ 25 mm was also identified as an independent predictor (OR 2.9, 95% CI 1.4-6.1, p = 0.03). Age > 65 years showed a non-significant trend toward higher complication risk (p = 0.08). CONCLUSION:Obesity and large hernia defects are independent predictors of early complications following TEP hernia repair. Focusing on these factors during preoperative planning may enhance patient safety and outcomes.
BACKGROUND:Inguinal hernia repair is one of the most commonly performed procedures worldwide. Several different methods for repair exist, where the preferred surgical procedure for a non-complicated unilateral inguinal hernia is still up for debate. Originally described as a tissue repair, the introduction of prostheses have led many surgeons to move away from this type of repairs. However, recently updated guidelines still recommend non-mesh treatment, in a subgroup of patients, with a preference for the Shouldice technique. Therefore, we set out to map the incidence and knowledge about tissue-based repair of a primary inguinal hernia in Belgium. METHODS:We designed a voluntary, open web-based survey for both surgeons and trainees asking about their knowledge, experience and indication for tissue-based suture repair, using a Google-forms document. The survey included level of experience and surgical preference, practice of tissue-based inguinal repair, indications for tissue-based repair, and technique and knowledge about tissue-based repair. Data was collected between 1st of December 2023 and 31st of January 2024 and analyzed using Microsoft Excel (version 16.77.01). RESULTS:A total of 122 respondents filled out the questionnaire, 47 trainees and 75 surgeons, of which 4 were discarded due to inaccurate data. Only 15 out of 71 surgical respondents still performed a non-mesh based repair in an elective setting, where the Shouldice repair was the preferred technique (n = 12, 80%). Knowledge about tissue-based mesh was rated mainly moderate (43.7%) and a non-mesh based repair was still considered an option when faced with fecal contamination (54.9%). Upon patient's request, 67.7% respondents would convince patients of mesh superiority. Among surgical trainees eighteen respondents (38.3%) had never seen a tissue based repair before and 36.1% respondents said tissue-based repair was not taught in their current or previous hospital(s). Most surgical trainees (48.9%) had basic knowledge and know a single technique. Considering indications for primary tissue repair, 57.4% mentioned a contaminated field as a valid indication. Comparable to the surgeon's response, 66% of surgical trainees would convince the patient of mesh superiority when asked for a pure tissue-based repair. CONCLUSION:Our survey confirms the declining rate of tissue based repairs, with only 7% of surgical respondents performing sufficient procedures to allow for equivocal result compared to mesh-based repairs. Centralizing these procedures into specific hernia centers might allow for an increased case-load and dedicated training pathways giving trainees and future surgeons proper training.
BACKGROUND:Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare T-cell lymphoma increasingly linked to textured breast implants. It typically presents as a late-onset periprosthetic seroma and carries a generally favorable prognosis when diagnosed early. However, its pathogenesis remains incompletely understood, particularly in patients with genetic cancer predispositions. CASE PRESENTATION:We report a unique case of BIA-ALCL in a 41-year-old woman who underwent bilateral prophylactic mastectomy and subsequent implant-based reconstruction due to a strong family history of breast and ovarian cancer. Ten years post-reconstruction, she presented with progressive unilateral breast swelling. Imaging suggested implant rupture with associated periprosthetic fluid. Cytology and immunohistochemistry confirmed CD30-positive, ALK-negative large T-cell lymphoma. PET-CT and MRI demonstrated disease confined to the implant capsule without lymph node involvement. Surgical management included bilateral en bloc capsulectomy. Histopathological staging revealed pT2N0M0 (Stage IB) disease due to superficial capsular infiltration. No adjuvant therapy was required because of the early intervention. Six-month follow-up imaging was negative for recurrence. DISCUSSION:This case raises important considerations about cancer risk management in genetically predisposed individuals, especially regarding the safety profile of textured implants. Current evidence suggests a possible oncogenic interaction between hereditary susceptibility and chronic implant-associated inflammation. CONCLUSION:Clinicians must maintain vigilance for BIA-ALCL even in prophylactic settings, as early diagnosis and complete surgical excision remain key to favorable outcomes.
BACKGROUND:Ostomy rods are used to prevent stoma-related morbidity. However, their effectiveness remains questionable, and to date, no standard technique has been recommended. We sought to identify the most suitable method by comparing skin bridge- and conventional rod-supported loop enterostomies. METHODS:In accordance with PRISMA guidelines, a systematic literature search was conducted in PubMed (MEDLINE), the Cochrane Central Register of Controlled Trials, and Google Scholar databases for all comparative studies evaluating skin bridges and conventional ostomy rods. Odds ratios (ORs) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated for outcomes of both methods. Risk of bias and certainty of evidence were assessed using ROBINS-I and GRADE, respectively. The study protocol was registered in PROSPERO (ID: 420251028945). RESULTS:A total of four eligible studies encompassing 323 patients were included (skin bridge: n = 155, control: n = 168). Loop ileostomies with a skin bridge were associated with significantly lower rates of peristomal dermatitis (OR = 0.13; 95% CI [0.06-0.29]; p < 0.00001, I2 = 0%) and mucocutaneous separation (OR = 0.12; 95% CI [0.05-0.29]; p < 0.00001, I2 = 0%) compared with conventional ostomy rods. Other analyzed outcomes, including parastomal hernia, ostomy prolapse, ostomy retraction, ostomy stenosis, and surgical site infection did not differ significantly between the two groups. Skin bridges appear to reduce the number of ostomy wafers replaced per week and overall ostomy-related costs. CONCLUSIONS:Loop ileostomy creation with a skin bridge appears to be a safe and feasible method for preventing early ostomy-related morbidity.
BACKGROUND:Bladder drainage is systematically used in rectal cancer surgery in male patients, even in the era of enhanced recovery after surgery (ERAS). However, little data is available on risk factors for urinary tract infection (UTI). Identifying the risk factors associated with UTI within 4 days of male rectal cancer surgery in an ERAS program could support more individualized decision-making. METHODS:We used data from the GRECCAR 10 randomized clinical trial, a comparison of outcomes of transurethral catheterization (TUC) or suprapubic catheterization (SPC). 240 patients were randomized, 209 retained in the study (TUC n = 99; SPC n = 109). Univariate and multivariate logistic regression post-hoc study analyses were performed to assess association between potential predictive factors and UTI within 30 days after surgery. RESULTS:Out of 208 patients (median age 64.5 years), 19 (9.1%) had UTI, 26 (12.5%) had bacteriuria and 145 (69.7%) had pyuria. Univariate analysis identified age ≥ 65 years (OR = 3.08 [1.07-8.89]; p = 0.038), hypertension (OR = 3.65 [1.23-10.84]; p = 0.020) and ASA score ≥ 3 (OR = 4.15 [1.53-11.2]; p = 0.005) as risk factors for UTI until POD4. Multivariate analysis identified ASA score ≥ 3 with a risk of UTI. CONCLUSION:Regarding male rectal cancer surgery, our study shows that nearly 1 in 10 patients had UTI within 4 days. An ASA score ≥ 3 is an independent risk factor linked to UTI. Identifying this risk factor for UTI is necessary to advise patients, support a tailored decision-making process, and prevent these complications.
Redo cardiac surgery following a prior sternotomy presents significant technical challenges and increased risks due to potential injuries during sternal re-entry, mediastinal adhesions and hemorrhage. Endoscopically assisted coronary artery bypass grafting (CABG) offers a minimally invasive alternative approach, avoiding sternotomy while achieving complete revascularization and reducing operative morbidity. An 86-year-old male with prior CABG in 2011 who presented with recurrent angina due to graft occlusion and a circumflex lesion unsuitable for intervention. Revascularization was performed using thoracoscopic adhesiolysis and internal mammary harvesting, followed by a hand-sewn coronary anastomosis through a limited left thoracotomy under femoral cardiopulmonary bypass. The patient recovered uneventfully and was discharged on postoperative day 6. At one-month follow-up, he remained asymptomatic with preserved ventricular function. Endoscopically assisted coronary bypass grafting is a safe and feasible alternative in selected patients while reducing surgical trauma and allowing rapid recovery.
BACKGROUND:Cardiac metastasis of hepatocellular carcinoma (HCC) is extremely rare, especially when it presents as isolated metastasis of HCC in the right ventricle without involving the right atrium or inferior vena cava. The cardiac metastasis of HCC may develop insidiously and lack specific clinical manifestations, which hinders early detection of cardiac metastasis. The prognosis for patients with cardiac metastasis of HCC is not satisfactory. METHODS:We present a 61-year-old male patient diagnosed with BCLC-B stage HCC, who underwent liver tumor resection surgery and, following tumor recurrence, received immunotherapy checkpoint inhibitors and multiple radiofrequency ablation (RFA) treatments. In the third year after surgery, relevant examinations revealed a mass in the patient's right ventricle, ultimately leading to a diagnosis of isolated cardiac metastasis of HCC. In addition, we reviewed the research on cardiac metastasis of HCC over the past decade and summarized the relevant findings. RESULTS:During follow-up, the patient found a cardiac mass. Based on imaging, isolated cardiac metastasis of HCC was diagnosed, ruling out intrahepatic recurrence and considering alpha-fetoprotein (AFP) persistent rise. Treated with lenvatinib and sintilimab, the patient died of suspected cardiac rupture two weeks later, with no definitive effect observed. CONCLUSION:Although cardiac metastasis of HCC is rare, patients who have experienced multiple recurrences and undergone repeated RFA for liver tumors should be wary of extrahepatic metastasis, including heart metastasis, especially when intrahepatic recurrence has been ruled out and AFP levels persistently rise. Treatment should adopt an individualized multimodal approach.
BACKGROUND:Fournier gangrene is a rapidly progressive and life-threatening soft-tissue infection originating in the perineal and genital regions, spreading quickly along fascial planes. Early identification of causative pathogens and their antimicrobial susceptibility is essential to guide empirical therapy and improve outcomes. METHODS:This retrospective study was conducted at a tertiary academic medical center. Among 59 surgically treated patients, 30 with complete clinical and microbiological data and available wound cultures were included. Demographic characteristics, microbiological profiles, and antimicrobial susceptibility patterns were analyzed. RESULTS:The mean age was 59.2 years (range 45-84), and 56.7% were male. Nearly half of the patients were aged 50-59 years (46.7%). Wound cultures revealed monomicrobial growth in 50.0%, polymicrobial in 26.7%, and no growth in 23.3%. Escherichia coli was the leading pathogen (56.3%), followed by Klebsiella pneumoniae (9.4%), while anaerobes were rarely isolated. Resistance rates were 41.4% among Gram-positives and 38.3% among Gram-negatives. Amikacin (100%) and carbapenems (>80%) showed the highest susceptibility, whereas fluoroquinolones and aminopenicillins exhibited resistance exceeding 40%. CONCLUSION:E. coli was the predominant organism in Fournier gangrene, accompanied by substantial resistance to commonly used antibiotics. Aminoglycosides and carbapenems remain the most reliable empirical choices. Although most patients presented with low FGSI scores, the presence of resistant isolates highlights the need for region-specific antibiotic stewardship and ongoing surveillance.
BACKGROUND:Dextro-transposition of the great arteries is one of the most common cyanotic congenital heart diseases in newborns. Today's first-choice surgery is the arterial switch. This study aims to analyze predictors (<30 postoperative days) of short-term morbidity and mortality after arterial switch at HUDERF and to compare them between simple (without VSD) and complex transpositions (with VSD with/without left/right ventricular outflow tract obstruction or aortic arch anomalies) and between premature and full-term newborns. METHODS:A retrospective single-center cohort study was conducted, reviewing the records of patients with transposition of the great arteries operated at HUDERF between 1997-2023. Patients were divided into simple and complex transpositions, and premature and full-term newborns. RESULTS:171 patients were included: 113 simple transpositions and 58 complex. In the early postoperative period, seven (4%) patients died, 89 (52%) had heart failure, and 3 (2%) had myocardial ischemia. 33 (19%) had pulmonary stenosis. Complex morphology was a risk factor for early morbidity and mortality (p = 0.01). Premature newborns had higher morbidity and mortality rates than full-term newborns (12% vs 3%). Early reoperation was performed in 15 patients (9%) and late in 9 (6%). Complex morphology was a risk factor for early (p = 0.0047) and late reoperation (p = 0.048). CONCLUSIONS:Early morbidity, early mortality and reoperation rates were higher in complex transpositions, particularly among premature newborns. Heart failure and pulmonary stenosis were the most common early complications. Heart failure was the main factor associated with early mortality. Pulmonary stenosis was one of the most frequent causes of reoperations.
BACKGROUND:The management of large paraesophageal hiatal hernias (PEH) is challenging as most patients are elderly with multiple comorbidities. Furthermore, compared to elective procedures, emergency interventions are often associated with even greater complexity. Laparoscopic PEH repair is generally considered safe and feasible, even in urgent cases; however, complications such as acute incarceration and its progression to stomach wall necrosis, which usually requires resection, carries a high risk of morbidity and mortality. METHODS:We present a case of acute PEH incarceration with gastric ischemia. Additionally, we conducted a narrative literature review to examine cases of gastric ischemia secondary to acute hiatal hernia strangulation. RESULTS:A 71-year-old man presented with abdominal pain, nausea, and retching. Computed tomography on admission revealed an intrathoracic stomach without signs of complication, while endoscopy showed an ischemic fundus. The patient underwent laparoscopic hiatal hernia repair and gastric imbrication of the ischemic area. At the three-month follow-up, the patient reported no complaints. Twenty-two fully described cases in the literature were retrieved. CONCLUSION:To the best of our knowledge, this is the first reported case of a patient successfully treated with laparoscopic reduction of a hiatal hernia followed by imbrication of the ischemic area. The procedure resulted in a favorable outcome without the need for resection and reconstruction. Moreover, our literature review represents the first effort to collect data on this rare and complex condition, providing further insight into its presentation and management.
BACKGROUND:Klippel-Trenaunay syndrome (KTS) is primarily managed for vascular and soft-tissue abnormalities, while treatment of associated lymphedema remains poorly described. This study outlines our protocol for advanced lower-extremity lymphedema using a combined modified Charles' procedure and vascularized lymph node transfer (VLNT). METHODS:KTS patients with International Society of Lymphology (ISL) stage III lower-limb lymphedema treated between 1999 and 2018 were retrospectively reviewed. All underwent a modified Charles' excisional procedure with Homans techniques and VLNT. Outcomes were assessed at least one year postoperatively, focusing on early complications and postoperative hospital admissions for residual disease or recurrent infections. RESULTS:Twenty-two patients (14 male, 8 female) with a mean age of 21 years (range, 4-41) were included. Average time since KTS diagnosis was 14 years (range, 3-26). VLNT donor sites included groin (18.2%), supraclavicular (31.8%), and gastroepiploic (50%). Mean hospital stay was 16 days (range, 14-39). Follow-up averaged 38 months (range, 27-45). Three minor complications occurred (one wound dehiscence, one infection, one bleeding), and flap survival was 100%. Annual hospital admissions for soft-tissue infections decreased from a preoperative mean of 3.5 to 1.2 postoperatively. Patients required an average of 3.5 additional procedures (range, 2-8) to remove residual hemangiolymphangioma. CONCLUSIONS:Lymphedema in KTS presents unique challenges and differs markedly from typical primary or secondary lymphedema. Effective management requires meticulous assessment and individualized planning. In this population, functional improvement is the main objective, and extensive debulking procedures combined with physiologic reconstruction may provide meaningful clinical benefit despite limited aesthetic outcomes. ARTICLE HIGHLIGHTS:Type of Research: Single-center, retrospective, cohort studyTake Home Message: In severe lymphedema of patients diagnosed with KTS, single excisional or physiological surgical treatment is insufficient to fight the totality of pathologic processes at work. A combination of varied techniques that act on different disease's features can achieve significantly better outcomes.
BACKGROUND:Within the medical industry, operating rooms contribute significantly to greenhouse gas emissions. As a pediatric hospital, we feel highly responsible to reduce the negative impact of healthcare aimed at improving young lives. Therefore, we conducted a pilot study to assess simple waste segregation and recycling strategies aimed at reducing waste and improving sorting and recycling in our operating quarters. METHODS:The study was conducted at Hôpital Universitaire Des Enfants Reine Fabiola (HUDERF)'s operating quarters and consisted of a questionnaire addressing staff opinions and waste measurements before (T = 0) and after (T = 1) a weeklong intervention: a campaign aimed at improving sorting and recycling surgical waste and reducing unnecessary opening of materials. RESULTS:Participants agreed that a transition towards more sustainable operating quarters will be necessary. At T = 1, 53% of respondents considered measures for sustainable waste management were applied, versus 26% before. Fifty-one surgeries were analyzed at T = 0. The mean weight of waste to incinerate was 1780 gram per hernia/orchidopexy, 940 gram per circumcision, and 2150 gram per central venous catheter (CVC) placement. At T = 1, another 51 surgeries were analyzed. The mean weight of waste to be incinerated was 665 gram per hernia/orchidopexy, 445 gram per circumcision, and 920 gram per CVC placement. CONCLUSION:Simple, easy-to-implement measures introduced during a one-week campaign aimed at improved triage and diminished pre-emptive opening of sterile materials led to a > 50% reduction in waste to incinerate.
BACKGROUND:Hashimoto's thyroiditis (HT) is the most common autoimmune thyroid disorder, while papillary thyroid carcinoma (PTC) is the most prevalent thyroid malignancy. The association between HT and PTC remains debated, with some studies suggesting a protective effect of HT against aggressive PTC features. This study explores the relationship between HT and PTC in a single-center cohort, focusing on clinicopathological and prognostic factors. METHODS:This retrospective study included adult patients who underwent thyroid surgery between 2009 and 2017. Patients were divided into two groups: those with concurrent PTC and HT (Group 1, n = 68) and those with PTC alone (Group 2, n = 329). Demographic, laboratory, and pathological data were compared using appropriate statistical analyses. RESULTS:A significant association between HT and PTC was observed (χ2=5.3; p = 0.021; OR: 1.682). Group 1 patients were more often female and significantly younger. TSH levels were higher in Group 1 (p < 0.001), and follow-up duration was longer (p = 0.023). Although the mean tumor diameter was smaller in the HT group, the difference was not statistically significant. No significant differences were found regarding multifocality, capsular invasion, or lymphovascular invasion. CONCLUSION:The presence of HT appears to be significantly associated with the occurrence of PTC and may be linked to a less aggressive clinical profile, as suggested by younger age and higher TSH levels. The longer follow-up duration observed in HT patients may reflect more vigilant surveillance due to underlying autoimmune pathology. However, the retrospective and single-center design limits generalizability. Prospective, multicenter studies with larger cohorts are warranted to confirm these findings.
BackgroundHandlebar syndrome has a low incidence and its presentation can be quite different making the diagnosis sometimes challenging.MethodsWe present a rare case of the handlebar syndrome in which the handlebar of a bike injures the common femoral artery with an atypical clinical presentation. A written informed consent was obtained from the patient, and the study was approved by the Ethics Committee Research UZ/KU Leuven with the corresponding reference number S70224.ResultsThe case is a unique late presentation of the handlebar syndrome with only mild symptoms during high-intensity exercise, with normal arterial pulsations and a murmur in the groin. The patient was initially conservatively treated. Although symptoms decreased, there was still a loss of power during maximal intense efforts, and the ankle-brachial index dropped on the bike with a duplex showing low-grade stenosis in the common femoral artery. We performed femoral endarterectomy using a bovine patch. Postoperatively, the patient was symptom-free during intense exercise.ConclusionDiagnosis could be missed in the absence of early symptoms, posing a risk in children with respect to limb growth and length. Treatment is patient- and lesion-tailored, and mostly performed by open surgery, although conservative management has also been described.
BACKGROUND:Several biomarkers are known to predict long-term complications after non-cardiac surgery, including major adverse cardiovascular events (MACE), myocardial infarction, and death. Carotid endarterectomy (CEA), a low to medium-risk procedure for carotid stenosis, aims to prevent stroke. Glycated hemoglobin (HbA1c) may hold prognostic value for MACE. This study evaluates the role of HbA1c in predicting all-cause mortality and MACE in patients undergoing CEA. METHODS:A post hoc analysis was conducted using data from a prospective database of patients who underwent CEA under regional anesthesia at a tertiary referral center between January 2014 and December 2023. Patients with HbA1c measured within three months prior to surgery were included and divided into two groups (HbA1c <6.5% vs. ≥6.5%). Kaplan-Meier survival and multivariable Cox regression analyses assessed the impact of HbA1c on outcomes. The primary outcome was the incidence of long-term MACE and all-cause mortality. Secondary outcomes included stroke, acute myocardial infarction (AMI), acute heart failure (AHF), and major adverse limb events (MALE). RESULTS:A total of 65 patients (mean age 71.4 ± 8.5 years; 81.5% male) were included, with a median follow-up of 30 months. Patients with HbA1c ≥6.5% were significantly younger. Elevated HbA1c was associate with trend toward more stroke risk (log-rank p = 0.045, HR: 3.2 (CI: 0.96-10.7, p = 0.059) HbA1c was an independent predictor of MALE (aHR: 3.387, p = 0.037), while its association with stroke did not reach significance (p = 0.059). CONCLUSION:HbA1c appears to be a useful, accessible biomarker for vascular risk stratification in patients undergoing CEA.
BACKGROUND:Bullying, undermining behavior, and harassment (BUBH) persist as ongoing concerns in healthcare, particularly within stressful environments. This study aims to explore the prevalence and characteristics of BUBH among Belgian general surgery residents. METHODS:A cross-sectional survey was distributed online using an anonymous link through newsletters and social media channels of the Belgian Association of Surgical Trainees. The survey comprised 54 questions including: A) demographic; B) instances of BUBH, adapted from the validated Leymann Inventory of Psychological Terror and the Negative Acts Questionnaire; C) reporting, perpetrators, and management of BUBH derived from the survey developed by Rouleaux Club (United Kingdom). RESULTS:Fifty-six surgical residents, aged 24 to 40 years, participated. Of them, 18 (32%) were junior, 26 (56%) senior, and seven (12%) were enrolled in a research trajectory. Most respondents were Caucasian (82%), female (61%), heterosexual (93%), and without disability (98%). BUBH was experienced by 38 (68%) residents, while 44 (79%) witnessed BUBH towards their colleagues. Main perpetrators were consultants (n = 40/132; 30%) and nursing staff (n = 28/132; 21%). Reported behaviors included an unmanageable workload (n = 53; 95%), ignored opinions, (n = 52; 93%) and working below competence (n = 51; 91%). BUBH primarily occurred in operating rooms (39%), hospital wards (34%), or emergency rooms (11%). CONCLUSION:This is the first national study examining BUBH during surgical training in Belgium. Results highlight how BUBH is often misidentified and underreported. Proactive measures, educational programs, and support networks are essential to effectively address and mitigate these issues.
BackgroundRetroperitoneal hemorrhage is a life-threatening entity that can result from a range of etiologies. Rupture of an abdominal aortic aneurysm (AAA) is the most common vascular emergency associated with high morbidity and mortality. However, not all retroperitoneal hemorrhages result from this vascular emergency. Adrenal hemorrhage, though rare, represents an important, often under-recognized and potentially fatal alternative diagnosis. The diagnostic challenge is further compounded when such adrenal pathology occurs in the presence of a concurrent AAA, as overlapping clinical and radiologic features can obscure the true source of bleeding. This coexistence can lead to misdiagnosis, delays in appropriate treatment, and complex decision-making in the acute care setting.Case reportA man in his 70s presented with hemodynamic collapse and right-sided flank pain, initially raising concern for a ruptured abdominal aortic aneurysm (AAA). Imaging revealed both an infrarenal AAA and a large retroperitoneal mass consistent with a hemorrhaging adrenal lesion. Due to diagnostic uncertainty and persistent hemodynamic instability, the patient underwent emergency endovascular aortic repair (EVAR) followed by selective arterial embolization of the adrenal lesion. Postoperative recovery was favorable, with resolution of hemodynamic instability and planned delayed adrenalectomy.ConclusionThis case report illustrates the diagnostic complexity and clinical challenge posed by simultaneous adrenal hemorrhage and AAA. Adrenal tumors can cause life-threatening retroperitoneal hemorrhage. Timely recognition via high-resolution imaging and a flexible interventional approach tailored to the evolving clinical picture are key to successful management. Clinicians should remain vigilant for alternative bleeding sources, even in the context of known vascular disease.
