Search Results (1,388)

Background and Objectives: Acute acalculous cholecystitis (AAC) is rare, mostly in older males, with cardiovascular diseases, diabetes, critical illness, or systemic infection. Antibiotherapy before or after cholecystectomy is important for preventing septic shock and postoperative infections. Increasing antibiotic resistance was recently noted and can complicate antibiotherapy. Materials and Methods: A retrospective study of all patients who underwent cholecystectomy between 2018 and 2024 in the Clinical Emergency Hospital of Craiova was performed. The etiology of AAC, complications, hospitalization duration, mortality, positive bile cultures, and in vitro antibiotic resistance were analyzed. Results: A total of 802 calculous and 54 AAC were recorded. Patients with AAC were predominantly males (OR = 1.767, p = 0.043) with diabetes (OR = 2.049, p = 0.014) and were older (66.6 ± 13.2 versus 61.4 ± 15.6, p = 0.014). Mortality was significantly higher in AAC (18.5 versus 3.6%, OR= 6.058, p < 0.001), with longer hospitalization (mean 9.7 versus 8.4 days) and more perforation. Positive bile cultures were recorded in 60.5–66.2% of cases, with a similar etiology in both forms of acute cholecystitis (mostly Gram-negative species, Enterococcus, and Staphylococcus); 10 ESBL Escherichia coli and Klebsiella strains, 11 Staphylococcus aureus MRSA, and 1 Enterococcus VRE strain were recorded. Antibiotic susceptibility in vitro was similar in both AAC and calculous cholecystitis. Significant resistance to cephalosporins and quinolones was recorded; the lowest resistance was noted for amikacin, carbapenems, chloramphenicol, colistin (Gram-negative bacteria), and vancomycin. Conclusions: AAC was encountered in older males with diabetes, with a higher rate of complications and in-hospital mortality. Bile cultures were positive in 60.5–66.2%, predominantly with Gram-negative, Enterococcus, and Staphylococcus species. Significant in vitro resistance to cephalosporins and quinolones was found. Full article

Background: The intersection between oncology and intensive care has shifted from predominantly end-of-life care to a therapeutic bridge that can preserve anticancer trajectories in carefully selected patients. Yet, criteria separating benefit from futility remain fragmented. Objective: This paper seeks to map contemporary evidence (2015–2025) on outcomes after Intensive Care Unit (ICU) admission in adults with cancer and to identify clinical constellations in which ICU-level care still changes prognosis. Methods: PRISMA-ScR scoping review (PCC framework). PubMed search (2015–2025), dual screening, standardized extraction; narrative/thematic synthesis across six clusters (hematologic, solid tumors, sepsis/non-COVID-19 infection, COVID-19/viral pneumonia, novel/targeted-therapy toxicities, end-of-life/aggressive ICU) were used. No meta-analysis given heterogeneity. Results: Seventy-three studies (>170,000 ICU admissions) were included, mostly cohort designs across 27 countries. ICU mortality ranged 8–72% (weighted mean ≈ 41%); hospital ≈ 38%; 90-day ≈ 46%; 1-year ≈ 62%. About one third of ICU survivors resumed systemic therapy. Benefit concentrated in early admissions, single-organ failure, controlled/remission disease, postoperative/elective monitoring, and reversible treatment-related toxicities (e.g., ICI pneumonitis, CAR-T CRS/ICANS). Futility clustered around ≥3 organ supports, RRT > 7 days, refractory/progressive disease, and ECOG ≥ 3. Sepsis outcomes averaged 45–55% ICU mortality but improved with rapid recognition and source control; COVID-19 mortality was particularly high in hematologic malignancies early in the pandemic, with subsequent declines post-vaccination. Conclusions: In modern oncologic practice, ICU care changes prognosis when the acute physiological insult is reversible and cancer control remains plausible; conversely, high organ-support burden and refractory disease define practical futility thresholds. These signals support time-limited ICU trials, earlier ICU involvement for sepsis/irAEs, and embedded palliative care to align intensity with goals. Full article

Objective: The omentum is a highly vascularized and immunologically active tissue with significant regenerative potential. Despite its versatility, its use has traditionally been limited to intra-abdominal applications due to access challenges. Conventional open harvest requires laparotomy, and laparoscopic techniques are hindered by limited visualization and poor ergonomics. We describe the use of robotic-assisted omental flap harvest for thoracic reconstruction, offering a minimally invasive alternative. Methods: A retrospective review was conducted of patients who underwent robotic omental flap harvest for intrathoracic reconstruction at a single-center institution between January 2023 and January 2024. Data collected included demographics, indications, surgical technique, operative details, and postoperative outcomes, with a focus on flap viability and complications. Additionally, a systematic review was conducted to evaluate current evidence and experiences with this type of technique. Results: Three patients underwent robotic omental flap harvest for indications including chest wall reconstruction and pleural space obliteration in infected thoracic cavities. The average robotic flap harvest time was 79 ± 13 min, with an estimated ± blood loss of 20 cc. The mean postoperative hospital stay was 10 days, influenced by the primary procedure and patient comorbidities. At an average follow-up of 8 months, all flaps remained viable, with no flap-related complications or losses. The systematic review demonstrated limited data in the current literature regarding this type of surgical approach. Conclusions: Robotic-assisted omental flap harvest is a safe, feasible, and effective technique for complex thoracic reconstructions. It provides a minimally invasive alternative to traditional harvest methods, with reduced morbidity and excellent clinical outcomes. This technique expands the reconstructive options for intrathoracic defects and infections. Full article

Third molar extraction is a common oral surgical procedure that can be accompanied by challenges in wound healing and bone regeneration. Materials such as bone substitute materials (BSMs) and platelet-rich fibrin (PRF) are often used to support socket regeneration. This prospective randomized controlled split-mouth clinical trial compared PRF application combined with BSM versus PRF alone in patients requiring bilateral third molar extraction. A total of 15 patients underwent standardized osteotomy procedures, with sockets filled either with PRF alone (control group) or with BSM + PRF on opposite sides (test group) under general anesthesia and with patients blinded to the treatment allocation. Postoperative pain and swelling were measured over 7 days using a visual analog scale and anatomical distance measurements, respectively. Bone regeneration was evaluated using cone beam computed tomography (CBCT) scans after an average healing period of six months, with results showing no significant differences between groups in terms of postoperative pain or swelling (n = 12; 3 patients were lost to randomization). However, CBCT imaging revealed covered socket residuum (CSR)—non-mineralized areas within the socket—in the PRF only group, whereas the BSM + PRF group demonstrated more homogeneous and mineralized bone formation throughout the extraction sites (n = 8; 5 patients were lost to follow-up). These non-mineralized areas represent covered socket residuum within the extraction sockets, which poses a clinical risk of infection and may negatively affect the dental health of the adjacent second molar. Based on the presented findings, we recommend combining BSM with PRF to support bone regeneration and regulate the postoperative pain and swelling following third molar extraction. Nevertheless, further research is required to determine the most suitable BSM type in this regard. Full article

Background/Objective: Percutaneous transhepatic gallbladder drainage (PTGBD) is commonly used in patients with acute cholecystitis (AC) who are unfit for early laparoscopic cholecystectomy (LC). However, the efficacy, safety and long-term role of PTGBD remain debated. We aimed to evaluate the effectiveness and safety of PTGBD in managing AC, focusing on infection control, procedure-related complications, and need for secondary surgical intervention. Methods: We performed a single-center retrospective study including all patients who underwent PTGBD for AC from January 2018 to December 2023 at a tertiary care hospital. Patients were identified through an institutional database. Relevant clinical, procedural, and outcome data were extracted from electronic medical records. The primary outcome was infection control, defined as clinical and biochemical resolution of AC without the need for additional interventions beyond antibiotic therapy. Secondary outcomes included PTGBD-related complications, 30-day mortality, length of hospital stay, readmission rate, and the rate of subsequent LC. Results: A total of 105 patients were included (mean age 69.9 years; 63.8% male). Infection control was observed in 92.4% of patients following PTGBD. PTGBD-related complications occurred in 36.2%, mainly drain dislodgement and recurrent cholecystitis. Mortality was 4.8%. Delayed LC was performed in 80.9% of patients, with a 10.6% conversion rate and 16.5% postoperative complication rate. Conclusions: PTGBD is effective for infection control in high-risk AC patients unfit for immediate surgery. However, the complication rate and the frequent need for delayed LC underscore the importance of careful patient selection and standardized management strategies. Full article

Background: Infantile hypertrophic pyloric stenosis represents one of the most prevalent gastrointestinal disorders in infants. It presents with severe persistent vomiting and electrolyte imbalance. Pyloromyotomy is the gold standard approach in the management of pyloric stenosis. The laparoscopic approach provides a reliable and safe alternative to the open technique. We aimed to compare the surgical outcomes of both approaches and determine which approach is superior to the other. Methods: We searched for relevant articles by searching Scopus, Web of Science, PubMed, and the Cochrane Library until January 2025. The Cochrane risk of bias tool was utilized to assess the quality of the clinical trials, whereas the ROBINS-I tool was used in the observational studies. Our primary outcomes were operation time, length of hospital stay, time needed for full feeding, incidence of incomplete pyloromyotomy, mucosal perforation, wound infection, postoperative vomiting, postoperative incisional hernia, postoperative seroma or hematoma formation, need for reoperation, and rate of conversion to P in the laparoscopic group. Results: We included 12 eligible articles that compared laparoscopic pyloromyotomy with open pyloromyotomy in infants with hypertrophic pyloric stenosis. Our analysis revealed comparable results for both procedures in terms of operation time (p = 0.83), hospitalization duration (p = 0.06), mucosal perforation (p = 0.49), postoperative complications such as vomiting (p = 0.10), incisional hernia (p = 0.60), seroma (p = 0.52), and reoperation rates (p = 0.17). Patients who underwent LP achieved full feeding in less time (p = 0.007) and had fewer wound infections (p = 0.01) compared to OP. However, the incidence of incomplete pyloromyotomy was lower in the OP group than in the LP group (p = 0.03). Conclusions: Both open and laparoscopic pyloromyotomy are effective for treating hypertrophic pyloric stenosis. The laparoscopic approach offers the advantages of a faster return to full feeding and lower wound infection rates but increases the risk of incomplete pyloromyotomy compared to the open technique. Surgeon preference and experience play crucial roles in surgical outcomes, provided that there is a thorough understanding of the benefits and limitations of both techniques. Full article

Background/Objectives: Acute bacterial endocarditis (ABE) is a frequent situation and continues to be a challenge. Mitral valve involvement during acute bacterial endocarditis is often the result of the spread of the endocarditic process from the adjacent aortic valve. Mitral involvement, on the other hand, could also be an expression of the initial localization of the bacteria. The best option for treating mitral ABE is still a matter of debate. Recent reports have shown satisfactory results with mitral reconstructive techniques in the treatment of mitral ABE. In this study, we present a comprehensive review of our 10-year institutional experience in the surgical management of acute mitral endocarditis with a focus on technical considerations, outcomes, and the durability of mitral valve repair in this high-risk population. Methods: We queried the institutional database, cross-referencing patients admitted with a diagnosis of “acute bacterial endocarditis” with patients undergoing surgical procedures for “valvular disease” at our division. Out of 1136 valvular procedures listed in our PACS database, 180 patients were admitted with a diagnosis of active acute endocarditis, and 46 included treatment of the mitral valve. We analyzed and compared short- and long-term follow-up (ranging from 3 to 141 months with a mean of 42 ± 38 months) of these 46 patients, dividing them into two groups: mitral valve repair (MVr) and mitral valve replacement (MVR). Results: 18 (40%) patients underwent reconstructive treatment of the mitral valve, and 28 (60%) underwent mitral valve replacement. Cumulative in-hospital mortality was 10% (5 pts, all from the MVR group), however, with no difference between the two groups. A shorter time gap from diagnosis to surgery (<10 days) was the only predictive factor for early mortality. A further 11 patients died during follow-up (2 from group A and 9 from group B). Long-term survival, on the other hand, was negatively influenced by MV surgical replacement (p = 0.0178), older patients’ age (>60 years), and urgent surgical procedures. Finally, patients with MVr also experienced a favorable postoperative event-free curve for endocarditis recurrence (p = 0.0260) and time elapsed before recurrence (p = 0.0438). Conclusions: Mitral valve repair in the case of active endocarditis could be a treatment associated with more favorable outcomes, providing that a complete eradication of infective tissue can be accomplished. Conservative treatment, when feasible, seems to offer favorable cumulative long-term outcomes. Full article

Background: Infective endocarditis (IE) after transcatheter aortic valve replacement (TAVR) is a severe complication. Surgical explantation of infected transcatheter heart valves (THV) is technically demanding and associated with high mortality. Data on risk factors for perioperative death and long-term outcomes remain limited. Aim: To identify predictors of mortality in patients undergoing surgical aortic valve replacement (SAVR) for IE after TAVR. Methods: We conducted a case–control study of patients treated with SAVR for IE after TAVR at our center between February 2008 and December 2023. Fifteen patients who died in hospital (cases) were compared with 35 perioperative survivors (controls). Hospital survivors were followed for long-term outcomes. Results: Age, sex, comorbidities (kidney disease, cerebrovascular disease, COPD, diabetes, peripheral artery disease), and anthropometrics were similar between groups. Cases had significantly lower left ventricular function and higher logistic EuroSCORE and STS-PROM before surgery. Causative microorganisms, cross-clamp time, and concomitant procedures did not differ. Postoperative pacemaker implantation, rethoracotomy, stroke, and ICU or hospital stay were comparable, while dialysis was more frequent in cases (44% vs. 25.7%). Median follow-up was 294 days (range 1–3802). Survival was 79.8% at 30 days and 67.4% at 1 year. Of 35 hospital survivors, 29 were discharged home, 6 to rehabilitation/other hospitals; 31 remain alive (1 early, 3 late deaths). Conclusions: SAVR for IE after TAVR carries high early mortality (18.1% at 30 days; 32.6% at 1 year). Higher preoperative risk scores and postoperative dialysis were associated with perioperative death. Long-term survival among hospital survivors is favorable, with most patients regaining independent living. Full article

Background/Objective: Diabetes mellitus (DM) is a highly prevalent condition that contributes to adverse outcomes in patients undergoing total hip arthroplasty (THA). This study applied machine learning clustering algorithms to identify comorbidity profiles among diabetic THA patients and evaluate their association with postoperative outcomes. Methods: The 2015–2021 National Inpatient Sample was queried using ICD-10 CM/PCS codes to identify DM patients undergoing THA. Forty-nine comorbidities, complications, and clinical covariates were incorporated into clustering analysis. The Davies–Bouldin and Calinski–Harabasz indices determined the optimal number of clusters. Multivariate logistic regression assessed risk of non-routine discharge (NRD), and Kruskal–Wallis H testing evaluated length-of-stay (LOS) differences. Results: A total of 73,606 patients were included. Six clusters were identified, ranging from 107 to 61,505 patients. Cluster 6, enriched for urinary tract infection and sepsis, had the highest risk of NRD (OR 7.83, p < 0.001) and the longest median LOS (9.0 days). Clusters 1–4 had shorter recoveries with median LOS of 2.0 days and narrow variability, while Cluster 5 showed intermediate outcomes. Kruskal–Wallis and post hoc testing confirmed significant differences across clusters (p < 0.001). Conclusions: Machine learning clustering of diabetic THA patients revealed six distinct groups with varied comorbidity profiles. Infection-driven clusters carried the highest risk for non-routine discharge and prolonged hospitalization. This approach provides a novel framework for risk stratification and may inform targeted perioperative management strategies. Full article

This meta-review evaluated the possibility of more specified recommendations in antibiotic treatment through a narrowed focus on facial trauma. The aim was to analyze the effect of different regimens of antibiotic in treatment of skeletal trauma to the face. The knowledge mapping was based on existing systematic reviews (SRs) on trials specified in a PICO: Participants (P): Adults and children, diagnosed with fractures to the facial skeleton. Interventions (I): Antibiotic intervention. Comparator (C): Placebo, no antibiotics. Outcomes (O): Postoperative infection, pain, re-operation, other complications, healing deficiencies, (Oral) Health related Quality of Life, removal of osteosynthesis, adverse reactions. The literature search in PubMed, The Cochrane Library, and Web of Science according to PRISMA resulted in 1487 records. A COVIDENCE selection process resulted in 29 articles retrieved and read in full text revealing 10 articles eligible for evaluated according to ROBIS. Three SRs were considered to have low risk of bias and constituted the final evidence evaluation. The meta-review of these SRs did not provide sufficient support for prolonged antibiotic treatment after surgical intervention of midfacial fractures in comparison with antibiotics only the first day postoperatively. No support for antibiotic treatment for conservatively managed fractures alone was found. This review is limited by a relatively low number of included SRs. However, tendencies in outcomes suggests a restricted duration of antibiotics in treatment of facial fractures. Full article

Background/Objectives: To investigate the long-term changes in conjunctival bacterial flora before and after dacryoendoscopic recanalization for lacrimal passage obstruction using silicone tube intubation. Methods: This prospective study included 135 eyes with lacrimal passage obstruction that underwent lacrimal passage recanalization and were followed for at least one year. The silicone tubes inserted during surgery were removed three months postoperatively in all cases. The study period was from November 2018 to January 2025. Conjunctival samples were obtained before surgery and at 12 months postoperatively. Aerobic cultures were performed to detect bacterial flora. The culture positivity rate, number of bacterial species identified, and proportion of commensal bacteria were compared before and after surgery. Results: The bacterial culture positivity rate significantly decreased from 36.3% preoperatively to 20.0% postoperatively (p = 0.003). The number of bacterial species detected decreased from 15 to 6, with Gram-negative bacilli decreasing from 6 species to 1. In contrast, the proportion of commensal bacteria such as coagulase-negative staphylococci and Corynebacterium spp. relatively increased from 49.1% to 80.7%. No drug-resistant bacteria were detected postoperatively. Conclusions: Dacryoendoscopic recanalization for lacrimal passage obstruction was shown to achieve long-term normalization of the conjunctival bacterial flora by reducing pathogenic and drug-resistant bacteria and increasing commensal bacteria. These findings suggest that the procedure prior to intraocular surgery in patients with lacrimal obstruction may reduce the risk of postoperative infection. Full article

Background/Objectives: Odontoid fractures—prevalently Anderson–D’Alonzo type II—are clinically relevant for their biomechanical instability and risk of non-union. Posterior C1–C2 fusion yields the highest fusion rates but sacrifices atlantoaxial rotation. Anterior odontoid screw fixation (AOSF) enables direct osteosynthesis while preserving motion. This study aimed to evaluate the radiographic outcomes, fusion rate, and technical considerations of AOSF in a consecutive single-center series, highlighting anatomical and procedural factors influencing bone healing. Methods: Retrospective, single-center case series of patients who underwent AOSF for acute type II odontoid fractures (2018–2024). Inclusion criteria included CT-confirmed fractures with reducible alignment. Radiographic parameters (fracture gap and angulation) were measured on standardized sagittal CT reconstructions. Outcomes were evaluated at 6 weeks, 3 months, and 6 months. Mean follow-up was 24 months. Results: The mean fracture gap decreased from 5.3 mm preoperatively to 0.8 mm postoperatively, and angulation from 27.8° to 3.5° (p < 0.0001). Nine of ten patients (90%) achieved solid fusion; one required secondary posterior fixation. No intra- or postoperative infections, neurovascular injuries, or neurological deficits were observed. Conclusions: AOSF is a safe and effective motion-preserving technique in appropriately selected Grauer IIA/IIB fractures. Precise anatomical reduction (<2 mm gap, <5–10° angulation) is a key predictor of successful fusion, even in elderly patients. Future multicenter studies with larger cohorts and standardized clinical outcome measures are needed to validate radiographic thresholds and optimize patient selection. Full article

Background: Frailty is a multidimensional syndrome characterized by reduced physiological reserve and resilience and has become a crucial predictor of outcomes in liver surgery. Unlike chronological age, frailty reflects broader vulnerabilities that significantly influence postoperative recovery. Aim: To review and synthesize current evidence on the relationship between frailty and postoperative outcomes following liver resection, with an emphasis on short-term complications, mortality, and long-term survival. Methods: A comprehensive literature review was performed, drawing on recent meta-analyses, large-scale cohort studies, and prospective observational data. Frailty was evaluated using a range of assessment tools, including the Modified Frailty Index (mFI), Clinical Frailty Scale (CFS), Kihon Checklist (KCL), and claims-based measures such as the Johns Hopkins Frailty Indicator. Results: Across studies, frailty has been consistently linked to a higher incidence of postoperative complications, such as post-hepatectomy liver failure (PHLF), infections, extended hospital stays, and increased mortality. In patients undergoing liver resection for cancer, frailty is also associated with poorer long-term survival. Importantly, frailty serves as an independent risk factor, even after adjusting for age, comorbid conditions, and tumor characteristics. Preoperative identification of frailty enhances risk stratification, informs surgical planning, potentially favoring parenchymal-sparing or minimally invasive approaches, and highlights patients who may benefit from prehabilitation. Conclusions: Frailty is a strong and independent predictor of poor outcomes after liver resection. Incorporating frailty assessment into routine preoperative evaluation can improve surgical decision-making, facilitate informed patient counseling, and optimize perioperative care strategies. Full article

Background: In vivo confocal microscopy (IVCM) provides high-resolution corneal imaging that may enhance preoperative and postoperative assessment in refractive surgery. This pilot study aimed to evaluate the diagnostic utility of IVCM in identifying subclinical corneal abnormalities that could influence surgical qualification and outcomes. Methods: A total of 7 patients (3 males, 4 females; mean age 48.8 ± 14.5 years) undergoing qualification or follow-up for refractive surgery were prospectively examined between May 2021 and March 2025. Each participant underwent a comprehensive ophthalmic evaluation, including slit-lamp biomicroscopy, corneal topography, anterior segment optical coherence tomography (AS-OCT), and IVCM using the Heidelberg Retina Tomograph II with Rostock Cornea Module. Patients with prior ocular surgery, active infection, or systemic corneal disease were excluded. Results: IVCM revealed subtle epithelial, stromal, and endothelial abnormalities undetectable by conventional methods. Findings such as Thygeson’s keratitis, pre-Descemet’s dystrophy, and subclinical herpes simplex keratitis led to modifications of surgical plans or disqualification in selected cases. The technique also aided postoperative evaluation of epithelial–stromal interface disorders. Conclusions: IVCM proved to be a valuable adjunct in detecting subclinical corneal pathology, refining patient selection, and improving safety in refractive surgery. Larger multicenter studies are warranted to validate its clinical role and define standardized indications for preoperative screening. Full article

Background: Chronic Achilles tendon ruptures (CATRs) pose a clinical challenge because guidelines on optimal treatment modalities are lacking. This meta-analysis aims to investigate the use of Flexor Hallucis Longus (FHL) tendon transfer as a treatment option. Methods: A literature search was performed across multiple databases from inception until 31 July 2025. The databases searched included Ovid MEDLINE^®, EMBASE (Elsevier), Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews. Included studies presented CATR patients of all ages, with no previous surgeries to the ankle, who were managed with an FHL tendon transfer (PROSPERO ID: CRD42023489724). Results: Sixteen studies met the eligibility criteria with 323 patients. For functionality, baseline AOFAS-AH (American Orthopaedic Foot & Ankle Society—Ankle Hindfoot) scores were 56.85 (95% CI: 51.03–62.68, I² = 96%). At ≥12 months post-operative follow-up, AOFAS-AH scores were 91.46 (95% CI: 88.45, 94.48, I² = 93%). ATRS (Achilles Tendon Rupture Score) at baseline was reported as 31.04 (95% CI: 5.80, 56.28, I² = 99%). At ≥12 months post-operative follow-up, ATRS amounted to 90.73 (95% CI: 83.69, 97.77, I² = 89%). Overall complication rates were 7.5% (CI: 0.04,0.11, I² = 40%), consisting of superficial infections at 4.2% (95% CI: 0.01, 0.07, I² = 0%), activity limitations at 4% (95% CI: 0.01, 0.08, I² = 0%) and disturbed wound healing at 3.8% (95% CI: 0.01, 0.06, I² = 0%). The minimum clinically important difference (MCID) for ATRS was achieved at 12 months onwards. Conclusions: Surgical management of CATR patients with FHL tendon transfer appears to improve functionality and subjective outcomes, supporting its use amongst the treatment modalities available. Full article