Search Results (1,918)

Background and Clinical Significance: Rhabdomyosarcoma (RMS) is a rare and aggressive malignant soft-tissue sarcoma (STS) arising from skeletal connective tissues and is most commonly seen in the pediatric population. The pleomorphic subtype is mostly seen in adults in the sixth and seventh decades of life, representing 1% of all histological types of RMS and having a very poor prognosis. Case Presentation: This report presents the case of a 63-year-old male with a medical history of papillary thyroid cancer, who presented with an ulcer-hemorrhagic malignant tumor, namely, a poorly differentiated desmin-positive pleomorphic rhabdomyosarcoma (PRMS), with impressive dimensions located on the posterior thoracic wall. This tumor was surgically removed via a wide resection, followed by palliative chemotherapy and radiotherapy. However, the patient relapsed locally, with pulmonary, bone, and lymph node metastases. The peculiarity of this case is represented by the rapid growth, aggressive nature, and high metastatic potential of the adult RMS, as well as its poor response to treatment. Conclusions: The presented case underscores the need for early diagnosis, multidisciplinary management, and exploration of molecular profiling for therapeutic planning. Full article

Recent advances in medical research have improved survival outcomes for patients with life-threatening diseases. As a result, the existence of long-term survivors from these illnesses is becoming common. However, conventional models in survival analysis assume that all individuals remain at risk of death after the follow-up, disregarding the presence of a cured subpopulation. An important methodological advancement in this context is the use of defective distributions. In the defective models, the survival function converges to a constant value $p\in (0,1)$ as a function of the parameters. Among these models, the defective generalized Gompertz distribution (DGGD) has emerged as a flexible approach. In this work, we introduce a reparametrized version of the DGGD that incorporates the cure parameter and accommodates covariate effects to assess individual-level factors associated with long-term survival. A Bayesian model is presented, with parameter estimation via the Hamiltonian Monte Carlo algorithm. A simulation study demonstrates good asymptotic results of the estimation process under vague prior information. The proposed methodology is applied to a real-world dataset of patients with uterine cancer. Our results reveal statistically significant protective effects of surgical intervention, alongside elevated risk associated with age over 50 years, diagnosis at the metastatic stage, and treatment with chemotherapy. Full article

Wound healing in oral surgery is influenced by systemic conditions (aging, diabetes) and habits (smoking, alcoholism), which can hinder the natural regenerative capacity of the oral mucosa. The human amniotic membrane (hAM), long recognized for its wound-healing properties, has gained attention as a valuable biomaterial in regenerative dentistry. Its biological composition—including epithelial and mesenchymal stem cells, collagen, growth factors, cytokines, and proteins with anti-inflammatory and antimicrobial properties—supports anti-inflammatory, angiogenic, immunomodulatory, and pro-epithelializing effects. These elements work synergistically to enhance tissue repair, reduce scarring, and promote rapid healing. The hAM can be preserved through cryopreservation, dehydration, or freeze-drying, maintaining its structural and functional integrity for diverse clinical uses. In oral surgery, the hAM has been applied with significant success to surgical wound coverage, treatment of periodontal and bone defects, and implant site regeneration, as well as management of complex conditions like medication-related osteonecrosis of the jaw (MRONJ). Clinical studies and meta-analyses support its safety, efficacy, and adaptability. Despite its proven therapeutic benefits, the hAM remains underutilized in dentistry due to challenges related to its preparation and storage. This review aims to highlight its potential and encourage broader clinical adoption in regenerative oral surgical practices. Full article

Background: Bicycles constitute a primary means of transportation, particularly within the scope of urban micromobility. However, the use of this mode of transport is associated with the risk of traffic accidents and subsequent maxillofacial trauma. Cyclists are classified as vulnerable road users, among whom the assessment of injury patterns is a significant issue. This study aimed to identify the most common maxillofacial fractures resulting from bicycle-related traffic accidents. Methods: A retrospective analysis was conducted on the medical records of patients treated at the Clinic of Maxillofacial Surgery at the University Clinical Hospital in Poznan, who sustained maxillofacial injuries as a result of bicycle-related accidents between 2019 and 2023. Results: A total of 99 patients met the inclusion criteria. Most of the study population was males (70.7%), with a median age of 38. Accidents most frequently occurred during the summer months and on Fridays and weekends. The most common fracture site was the mandible (40.4%), with double fractures being the predominant type. Additionally, zygomatic-orbital fractures were frequently observed (30.3%). In terms of treatment, surgical intervention was predominant, and the mean duration of hospitalisation was 6 days. Only 5.1% of patients were under the influence of alcohol at the time of the incident. Furthermore, it was found that isolated mandibular fractures occurred more frequently in younger patients, whereas midface fractures of the Le Fort II and III types were more commonly observed in individuals under the influence of alcohol at the time of the event. Moreover, accidents involving alcohol consumption were associated with a higher incidence of concomitant cranio-cerebral injuries. Conclusions: Defining the profile of maxillofacial fractures resulting from bicycle accidents constitutes a clinically relevant issue. Additionally, identifying the main risk factors and developing preventive measures is of critical importance. Full article

Background: In February 2024, a nationwide resignation of resident physicians and fellows in South Korea caused a sudden disruption in the healthcare service delivery system. This study aimed to investigate how the crisis affected hospital admission patterns, treatment timelines, and early outcomes in patients with acute hemorrhagic stroke. Methods: We retrospectively analyzed data from prospective cohorts of patients diagnosed with intracerebral hemorrhage or subarachnoid hemorrhage admitted to a single cerebrovascular-specialty hospital between March 2023 and February 2025. Patients were categorized into two groups: those admitted before (Before crisis group, n = 130) and after (After crisis group, n = 214) the crisis. Clinical characteristics, regional distribution, time delays, and 3-month modified Rankin Scale (mRS) outcomes were compared. Results: Following the crisis, a significant increase was observed in admissions from outside the hospital’s primary coverage area (p < 0.001). Onset-to-arrival (138.0 vs. 92.0 min, p = 0.040) and onset-to-operation times (200.0 vs. 166.0 min, p = 0.046) were significantly delayed, particularly in patients who underwent surgical treatment. However, arrival-to-operation time remained stable (p = 0.694), and initial neurological severity was comparable. Functional outcomes at 3 months did not differ significantly (mRS 0–2: 53.8% vs. 50.5%, p = 0.157), indicating preserved in-hospital care quality, despite external disruption. Conclusions: The medical crisis disrupted the stroke care delivery system and delayed prehospital care in South Korea. Nevertheless, the cerebrovascular-specialty hospital maintained timely intervention and preserved outcomes. These findings support the strategic importance of decentralized specialty hospitals in ensuring the resilience of the healthcare service delivery system during a national healthcare crisis. Full article

Spigelian hernia (SH) is an infrequent aponeurotic defect in Spiegel’s semilunar line. The literature on pediatric SH is scarce. A comprehensive review of the previous literature was conducted. Eligible studies were identified by searching primary medical bibliography databases, and a pooled analysis of published case-level data was performed. Medians and interquartile ranges were used to describe the quantitative variables and proportions for categorical variables. The Kruskal–Wallis, Mann–Whitney U, and Fisher’s exact tests were used to compare group variables. Spearman’s and Pearson’s correlation analyses were used to assess the degree of correlation between variables, while Cramér’s V was applied to evaluate the degree of association among the variables. A p-value < 0.05 (two-tailed) was considered statistically significant. Our search identified 82 publications reporting on 123 patients (106 male, 86.2%), with an age range of 0–21 years. Forty-seven patients (38.2%) had a left-sided SH, fifty-six (45.5%) had a right-sided SH, and thirteen (10.6%) had a bilateral SH. Traumatic SH, mostly from bicycle injuries, accounted for 45 cases (36.6%), while 41 (33.3%) were associated with undescended testis (UDT). In this series of published cases, hernia incarceration/strangulation (I/S) was reported in 15 patients (12.2%), who were significantly younger (p = 0.02). Surgical correction was performed in 95 cases (77.2%), 14 of them laparoscopically, with a 35.7% conversion rate. Eight cases (6.5%) were managed conservatively. Overall, outcomes were favorable. SH is an infrequent pediatric condition that, based on the synthesized literature, predominantly affects males. The published cases suggest two main clinical phenotypes: a congenital form, often linked to ipsilateral UDT, and an acquired form, typically resulting from trauma. Analysis of the reported data indicates a higher risk of incarceration in early childhood. Surgical treatment is the most frequently reported approach with generally favorable outcomes, whereas the evidence for conservative management remains limited. This comprehensive review highlights the dual nature of pediatric SH and underscores the need for a high index of suspicion in relevant clinical scenarios. Full article

Chimpanzees (Pan troglodytes) rescued from the illegal wildlife trade often suffer from chronic, traumatic injuries that require specialized and prolonged medical treatment in wildlife rehabilitation centers. We present the case report of a two-year-old male chimpanzee admitted at the Tchimpounga Chimpanzee Rehabilitation Center in the Republic of Congo with a chronic periorbital abscess, likely caused by a machete wound sustained during the poaching of his mother. Despite receiving extended antimicrobial therapy, his condition was never fully controlled and progressed to a chronic orbital infection, causing him discomfort and producing chronic purulent discharge. Enucleation was performed under general anesthesia using ketamine and medetomidine, with surgical approach adapted to the distinctive orbital anatomy of chimpanzees. During the procedure, ligation of the optic nerve and ophthalmic vessels was required due to the confined orbital apex and extensive vascularization, ensuring adequate haemostasias and procedural safety. The chimpanzee made an uneventful postoperative recovery, resuming normal feeding and social behavior within 48 h, with complete wound healing occurring within two weeks. This case report highlights the importance of prompt surgical intervention when conservative medical management fails to resolve refractory ocular infections in chimpanzees. It also emphasizes the importance of specific anesthetic protocols, refined surgical techniques and tailored postoperative care in wildlife rehabilitation centers. Documenting and sharing detailed case reports such as this contributes to the limited veterinary literature on great ape surgery and supports evidence-based clinical decision-making to improve the welfare and treatment outcomes of rescued chimpanzees. Full article

Background/Objectives: The application of additive manufacturing in medicine, and specifically in personalised medicine, has achieved notable development. This article aims to present the results and benefits of applying a comprehensive methodology to simulate, plan, and manufacture customised three-dimensional medical prosthetic devices for use in surgery to restore bone structures with congenital and acquired malformations. Methods: To digitally reconstruct a bone structure in three dimensions from a medical image, a segmentation process is developed to correlate the anatomical model. Then, this model is filtered using a post-processing step to generate stereolithography (STL) files, which are rendered using specialised software. The segmentation of tomographic images is achieved by the specific intensity selection, facilitating the analysis of compact and soft tissues within the anatomical region of interest. With the help of a thresholding algorithm, a three-dimensional digital model of the anatomical structure is obtained, ready for printing the required structure. Results: The described cases demonstrate that the use of anatomical test models, cutting guides, and customised prostheses reduces surgical time and hospital stay, and achieves better aesthetic and functional results. Using materials such as polylactic acid (PLA) for presurgical models, appropriate resins for cutting guides, and biocompatible materials such as polyether ether ketone (PEEK) or polymethylmethacrylate (PMMA) for prostheses, the described improvements are achieved. Conclusions: The achievements attained demonstrate the feasibility of applying these techniques, their advantages and their accessibility in Ecuador. They also reinforce the ideas of personalised medicine in the search for medical treatments and procedures tailored to the needs of each patient. Full article

Background/Objectives: Vancouver type C periprosthetic femoral fractures (VC-PFFs) predominantly affect frail elderly patients and are associated with high mortality, yet limited evidence exists regarding prognostic factors. The PIPPAS study (Peri-Implant and PeriProsthetic Survival Analysis) sub-analysis aimed to investigate the risk factors for one-year mortality following VC-PFF and identify predictors of medical and surgical complications. Methods: This prospective, multicenter, observational case series was conducted across 59 hospitals in Spain and involved 262 VC-PFF patients between January 2021 and April 2023 with a minimum 1-year follow-up. Demographic, clinical, management, and surgical and outcome data were collected. Logistic regression models were used to identify predictors of one-year mortality and complications. Results: One-year mortality was 30.1%. VC-PFF patients were elderly (median age 85 years, IQR (12.75)), female (77.1%) and frail: median clinical frailty scale 5, IQR (2), mild cognitive impairment (median Pfeiffer score 3, IQR (5)), and multiple comorbidities (median age-adjusted Charlson comorbidity index (a-CCI) 6, IQR (2)). Surgery was performed in 94.7% of cases, primarily with plate osteosynthesis (62.3%) or intramedullary nailing (29.1%). Male sex, higher age, frailty, cognitive impairment, ASA score, and a-CCI were significantly associated with increased mortality. Protective factors included higher hemoglobin levels, surgical treatment, and early postoperative ambulation. No significant difference in mortality was observed between fixation techniques. Conclusions: One-year mortality in VC-PFF patients is high. These findings underscore the need for individualized treatment plans and reinforce the role of early co-management and clinical optimization. Full article

Pulmonary carcinoids (PCs) are rare tumors, with an incidence ranging from 0.2 to 2 cases per 100,000 population per year. They account for 1–2% of all invasive pulmonary malignancies and represent approximately one-fourth to one-third of all well-differentiated neuroendocrine tumors (NETs) in the body. PCs are generally classified as low- to intermediate-grade malignant tumors, further subdivided into typical carcinoid (TC) and atypical carcinoid (AC), respectively. These tumors exhibit neuroendocrine morphology and differentiation, originating from mature cells of the pulmonary diffuse neuroendocrine system. Traditionally, they are categorized as central or peripheral based on their location relative to the bronchial tree; however, they can arise anywhere within the lung parenchyma. Over 40% of cases may be detected incidentally on a standard chest X-ray, although contrast-enhanced computed tomography (CT) remains the diagnostic gold standard. Surgical resection is the treatment of choice for PCs, with the goal of complete tumor removal while preserving as much healthy lung tissue as possible. In contrast, advanced cases are typically not amenable to surgery, and medical management is focused on controlling hormone-related symptoms and limiting tumor progression. This review aims to provide an overview of the current diagnostic and therapeutic approaches to pulmonary carcinoids. Full article

Background and Objectives: Long-standing or protracted temporomandibular joint dislocation refers to a condition that persists for more than 1 month without reduction. To elucidate the clinical characteristics and treatment results of this condition, this comprehensive review analyzed the available data. Materials and Methods: Studies were assessed using electronic medical databases and manual searches from their inception to 31 December 2024. Results: Overall, 229 cases (139 women and 81 men; mean age, 52.3 years) from 113 reports were assessed. The proportion of patients with bilateral and unilateral dislocations was 74.7% and 8.7%, respectively. The mean duration since dislocation was 11.9 months. Closed and open reductions were possible in 49 (21.4%) and 175 patients (76.4%), respectively. The mean dislocation duration was significantly (p = 0.001) shorter in patients who underwent closed reduction (4.9 months) than in those who underwent open reduction (14.8 months). Conclusions: Clinically, it is crucial to diagnose and treat this condition early to prevent it from becoming chronic. However, for cases of long-standing dislocations due to other more serious diseases, conservative treatments such as manual reduction and continuous elastic traction should be attempted first. If reduction fails, surgical treatment should be performed as an alternative. Full article

The therapeutic management of extensive skin wounds in cats can be time-consuming and require multiple therapeutic interventions, which can have significant financial implications for pet owners. Reconstructive surgery is often necessary to close skin defects with tissue loss to provide a quicker patient recovery. Conventional therapies like systemic antibiotics, anti-inflammatories, and local dressings are not always successful due to antibiotic resistance or a poor response, such as no or delayed healing. For more than a century, ozone has been utilized as an excellent disinfectant, but caution should be taken due to its oxidizing properties. Only in the past decade have numerous studies established therapeutic dose ranges for a wider medical use of ozone. The objective of this study was to clinically evaluate ozone therapy as a complementary treatment supporting and completing plastic and reconstructive surgery in 4 cats with extensive skin defects. The results obtained, following the local application of ozone therapy before and after skin reconstruction in our patients, encourage the use of ozone as a complementary therapy in the management of extensive skin wounds treated surgically by different reconstructive techniques. Full article

Background and Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a challenging condition linked to antiresorptive and antiangiogenic medications. Their complex pathophysiology and resistance to standard treatments have led researchers to explore adjunctive therapies. This systematic review evaluated the effectiveness of autologous platelet concentrates—namely platelet-rich plasma (PRP) and platelet-rich fibrin (PRF)—in promoting healing, bone regeneration, and symptom relief in MRONJ patients. Materials and Methods: A systematic literature search was conducted using PubMed, Scopus, and Web of Science for studies that assessed the use of PRP or PRF in MRONJ management. The risk of bias and study quality were evaluated using ROB-2 and ROBINS-I tools. Results: A total of 24 studies were included: seven on PRP and 17 on PRF. Reported complete mucosal healing rates ranged from 33% to 100% for PRP and from 36% to 100% for PRF. Although two randomized controlled trials and one prospective observational study found no statistically significant advantage of PRF over conventional surgical treatments, most studies indicated positive outcomes. Overall, the methodological quality varied, with several studies showing moderate-to-high risk of bias. Conclusions: Platelet concentrates can add benefits to traditional MRONJ treatments. The current evidence suggests that integrating these autologous therapies with conventional approaches clinically enhances healing outcomes, supports bone regeneration, and alleviates symptoms, ultimately leading to improved patient care. Full article

Hair follicles are essential to hair formation and cyclic regeneration, experiencing growth and degeneration, and quiescence phases involving complex signaling pathways. Among these, fibroblast growth factors (FGFs) play a critical role in follicular morphogenesis, but the role of FGF receptor signaling in hair follicle development remains underexplored. Current treatments for hair loss, such as medical, surgical, light-based, and nutraceutical interventions, are often expensive, require long-term commitment, and are associated with substantial side effects. This review discusses the mechanisms and biological functions of the FGF signaling pathway within the hair follicle growth cycle, providing an overview of how these elements influence hair follicle dynamics and the pathogenesis of alopecia. Manipulating the FGF signaling pathway could offer new therapeutic options for androgenetic alopecia and other hair loss conditions, potentially exceeding current treatment modalities in efficacy and safety. Full article

Retained products of conception (RPOC) represent a significant cause of morbidity in the post-abortive and postpartum periods, potentially leading to abnormal uterine bleeding, pelvic pain, infections, and intrauterine adhesions. Accurate diagnosis is crucial to avoid unnecessary surgical interventions and to preserve future fertility. Transvaginal ultrasound constitutes the primary imaging modality for identifying RPOC, but the lack of standardized diagnostic criteria complicates clinical decision-making. This narrative review explores the current literature on sonographic findings associated with RPOC, focusing on the diagnostic value of endometrial thickness (ET), the presence of intrauterine echogenic masses, and the use of Color Doppler imaging. Although an ET ≥15 mm is frequently used to suspect RPOC, the variability in cut-off thresholds and limited specificity reduce its diagnostic reliability. The detection of an echogenic intrauterine mass appears to be the most sensitive and specific sonographic feature. Color Doppler assessment, particularly the presence of enhanced myometrial vascularity (EMV) and classification systems like the Gutenberg score, offers further insight by stratifying hemorrhagic risk and guiding therapeutic choices. However, vascular parameters such as peak systolic velocity (PSV) and resistive index (RI) demonstrate a substantial overlap between benign and pathological conditions, limiting their stand-alone utility. The review also addresses the differential diagnosis of RPOC, including blood clots, arteriovenous malformations, placental polyps, gestational trophoblastic disease, and endometrial osseous metaplasia. The role of three-dimensional ultrasound remains limited in clinical practice, offering no significant advantage over two-dimensional imaging. Finally, the timing of follow-up ultrasound after medical treatment with misoprostol is critical: delayed assessment reduces overtreatment by allowing time for spontaneous resolution. In conclusion, despite advances in ultrasound technology, the diagnosis of RPOC remains challenging due to heterogeneity in imaging findings and inter-observer variability. A multimodal approach integrating grayscale and Doppler ultrasound with clinical evaluation is essential for optimal management. Full article