Dimitris Tatsis

Objectives: The aim of this review is to focus on the possibility of patients with squamous cell carcinoma to develop a second primary disease such as DLBCL, perhaps because of the irradiation of the head and neck area. Materials and methods: A case of an 89-year-old man is reported, who initially underwent surgical and complementary treatment for neck squamous cell carcinoma of occult primary and later for tonsillar diffuse large B-cell non-Hodgkin lymphoma. Results: The second primary was considered a recurrence in the neck of the original cancer of unknown primary, so a new surgical management was decided. The final pathology report described a diffuse large B-cell non-Hodgkin lymphoma. Conclusions: The importance of maintaining follow-ups for patients with occult primary cancers who are at an elevated risk of developing a metastasis or a second primary carcinoma outbreak is highlighted.

Low-grade intraductal carcinoma (LG-IC) is a rare malignant tumour of the salivary glands and mostly the parotid gland, with a good prognosis but difficult differential diagnosis, especially from the variants of adenocarcinoma, non-other specified (NOS) or cystadenocarcinoma. [1-3] The LG-IC was formerly called "Low-grade salivary duct carcinoma" or "low-grade cribriform cystadenocarcinoma", but according to the World Health Organization (WHO) classification, the tumour was renamed due to its totally different behaviour. [4] Histopathologically, they represent small, multicystic lesions (<2 cm). The intraductal carcinoma (IC) is graded as low, intermediate, or high. The LG-IC has a cribriform and papillary pattern. [1,4] Epidemiologically, the IC is a rare tumour mostly presented with its low-grade form, evenly between men and women at a mean age of 59-64 years. [5] High-grade lesions appear more frequently in older people. [5] The tumour is mostly located in the parotid gland (80-84%), with a more favourable prognosis. [1,3,5] Only 8% of LG-IC is found in the minor salivary glands. [5] Differential diagnoses are Rationale: Low-grade intraductal carcinoma (LG-IC), is a rare malignant tumour of the salivary glands which has a very good prognosis and must be differentiated from the other types of salivary gland malignant tumours, which have a totally different behaviour and a worse prognosis. Patient Concerns: A case is presented of a 52-year-old woman who was first diagnosed and treated in another clinic in 2019 for an LG-IC in the left submandibular gland space. Two years later, she was admitted to our department with a new lesion, this time in the upper jaw lip on the left side, which also turned out to be LG-IC. Diagnosis: Magnetic resonance imaging and positron emission tomography-computed tomography were performed in order to diagnose and adequately stage the disease prior to the therapeutic intervention. Outcomes: A 6-month follow-up reveals no sign of recurrence. Takeaway Lessons: Literature on this rare histopathological entity, as well as the differential diagnosis with the other malignant lesions of the salivary glands and the frequency of metastasis, were reviewed.

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains...

SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was no...

ObjectivesThe aim of this study was to evaluate the differences in surgical capacity for head and neck cancer in the UK between the first wave (March‐June 2020) and the current wave (Jan‐Feb 2021) of the COVID‐19 pandemic.DesignREDcap online‐based survey of hospital capacity.SettingUK secondary and tertiary hospitals providing head and neck cancer surgery.ParticipantsOne representative per hospital was asked to report the capacity for head and neck cancer surgery in that institution.Main outcome measuresThe principal measures of interests were new patient referrals, capacity in outpatients, theatres and critical care; therapeutic compromises constituting delay to surgery, de‐escalated surgery and therapeutic migration to non‐surgical primary modality.ResultsData were returned from approximately 95% of UK hospitals with a head and neck cancer surgery specialist service. 50% of UK head and neck cancer patients requiring surgery have significantly compromised treatments during the seco...

BACKGROUND This study&#39;s purpose was to examine the outcomes of the laparoscopic repair of large inguinoscrotal hernias with the combined use of a plug and flat mesh and to compare them to laparoscopic repair with the exclusive use of a flat mesh. CASE SERIES Fifty male patients with large inguinoscrotal hernias underwent this procedure over two years. Twenty-five patients had a transabdominal preperitoneal (TAPP) hernia repair with the combined use of a plug and flat mesh, and 25 patients had TAPP repair using a flat mesh only. The novelty of this technique lies in the fact that after complete dissection of the hernia sack, a plug mesh is placed reversely, and its top edge is anchored onto the lower edge of the inguinal ligament with a standard fixation device. Next, a flat mesh is fixated, and the two meshes are sutured together with polypropylene sutures to form one combined mesh. One hernia recurrence was recorded during the follow-up period after the combined use of the plug and flat mesh. One patient developed a scrotal hematoma which was treated conservatively. CONCLUSIONS The laparoscopic repair of large inguinoscrotal hernias with the combined use of a plug and flat mesh is a safe and effective technique with excellent short-term outcomes. It is a simple modification of the standard TAPP procedure. The recurrence rate of large inguinoscrotal hernias is also believed to be reduced. HIPPOKRATIA 2021, 25 (1):38-41.

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs. Methods First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assessment (surgical preparedness index; SPI). Second, we measured surgical preparedness across a global network of hospitals in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) to explore the distribution of the SPI at national, subnational, and hospital levels. Finally, using COVID-19 as an example of an external system shock, we compared hospitals&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; SPI to their planned surgical volume ratio (SVR; ie, operations for which the decision for surgery was made before hospital admission), calculated as the ratio of the observed surgical volume over a 1-month assessment period between June 6 and Aug 5, 2021, against the expected surgical volume based on hospital administrative data from the same period in 2019 (ie, a pre-pandemic baseline). A linear mixed-effects regression model was used to determine the effect of increasing SPI score. Findings In the first phase, from a longlist of 103 candidate indicators, 23 were prioritised as core indicators of elective surgical system preparedness by 69 clinicians (23 [33%] women; 46 [67%] men; 41 from HICs, 22 from MICs, and six from LICs) from 32 countries. The multidomain SPI included 11 indicators on facilities and consumables, two on staffing, two on prioritisation, and eight on systems. Hospitals were scored from 23 (least prepared) to 115 points (most prepared). In the second phase, surgical preparedness was measured in 1632 hospitals by 4714 clinicians from 119 countries. 745 (45•6%) of 1632 hospitals were in MICs or LICs. The mean SPI score was 84•5 (95% CI 84•1-84•9), which varied between HIC (88•5 [89•0-88•0]), MIC (81•8 [82•5-81•1]), and LIC (66•8 [64•9-68•7]) settings. In the third phase, 1217 (74•6%) hospitals did not maintain their expected SVR during the COVID-19 pandemic, of which 625 (51•4%) were from HIC, 538 (44•2%) from MIC, and 54 (4•4%) from LIC settings. In the mixed-effects model, a 10-point increase in SPI corresponded to a 3•6% (95% CI 3•0-4•1; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0•0001) increase in SVR. This was consistent in HIC (4•8% [4•1-5•5]; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0•0001), MIC (2•8 [2•0-3•7];…

Wilson&#39;s Disease (WD) is a rare autosomal recessive hereditary disease with copper accumulation in the body, particularly the liver, brain and cornea. WD is widely treated with chelation agents who enable the copper excretion. Since high concentrations of copper are toxic, WD is associated with hepatocellular carcinoma and cholangiocarcinoma, with low incidence of other types of cancer. We present a case of a 33 year old man who was treated in the Oral and Maxillofacial Surgery Department of the Aristotle University of Thessaloniki with multiple dysplasia lesions and an in situ carcinoma of the tongue, which is to our knowledge the first case report of oral lesions to a patient with WD. Literature is reviewed on copper levels on patients with head and neck cancer, and on chelation agents and their effect on cancer cells.

The aim of this study is to report a case of an unusual large aneurysm of the internal carotid approached with a doubly mandibular osteotomy in order to prove the significance and the excellent result of the specified surgical procedure because of the cooperation of maxillofacial and vascular surgeons. The double mandibular osteotomy is described, as well as the bypass of the aneurysm and the anastomosis of the peripheral edges of the artery. The double mandibular osteotomy can deliver the internal carotid artery from the bifurcation to its entrance to the skull base through the carotid canal and can offer the opportunity to the vascular surgeon to perform the anastomosis easily, quickly and safely.

Intraoral pleomorphic adenoma is a rare entity, with the most common site of appearance being the palate. As a benign lesion, it rarely involves underlying structures. The aim is to present a case of a palatal pleomorphic adenoma (cellular) with bone involvement, with reference to clinical and histological features of the tumour, emphasis on diagnostic and therapeutic management and comparison with the findings of similar studies in the literature. Pleomorphic adenomas of the palatal minor salivary glands remain a rather rare clinical condition, and it is unusual to infiltrate the adjacent palatal bone. A thorough clinical imaging and histological/cytological examination should always be performed to define the benign or malignant nature of the lesion, preoperatively.

Objectives The aim of the present study was to assess whether the current COVID-19 pandemic affect the management of patients with head and neck cancer in a major tertiary hospital in Greece. Materials and Methods A retrospective comparative study was performed, assessing the hospitalization of patients with head and neck cancer in the university-affiliated Department of Oral and Maxillofacial Surgery. A 12-month analysis was performed, from March 2020 to February 2021, as the first COVID period. For comparative reasons, patients from March 2019 to February 2020 were recorded (pre-COVID period). All head and neck cancer patients operated during both periods were included in the study. Results In total, 168 patients were included. Of those, 88 were operated in the pre-COVID period and 80 in the COVID period (p=0.53). The mean age was similar in the two groups (67.3 years), with a slight male predominance in both groups. 40 patients with advance tumours (T3 and T4) were included in bo...

Background This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January–October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. Results This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery be...

Nasal reconstruction after surgical excision of non-melanoma skin cancer defects can be a challenging condition for every head and neck surgeon. There are certain technical difficulties that arise from the tissue deficit and the area that a locoregional flap can cover. What is more, patients with a compromised medical history cannot always receive a surgical management under general anaesthesia, limitating even more the defect reconstruction. The aim of the present study is to present two patients that were treated under local anaesthesia for advanced basal cell carcinomas of the nose, with modifications of paramedian and hemi-nasal flaps that provided excellent surgical and aesthetic outcomes, despite the limits of the surgical modality.

Introduction A thyroglossal duct cyst (TGDC) is the most frequent embryonic-origin cervical mass situated in the anterior of the neck. This anomaly occurs in approximately in 7% of people, usually in children. Mainly it presents as a mobile, non-tender, usually inferior to the hyoid bone (~75% of patients) painless swelling but it can be painful when accompanied by local inflammation. The recommended management for TGDC is the Sistrunk procedure, ensuring removal of the full length of the duct remnants by including the midportion of the hyoid bone. Case series presentation The aim of this paper is to present a case series of five patients who were operated in the OMFS department of Papanikolaou Hospital of Thessaloniki within 2.5 years (9/2019-2/2022). The patients were four males (80%) (mean age 50.5 years, outliers 36 and 71years) and one (20%) 63 years old female. All of them presented with a mobile painless neck swelling and they had normal thyroid function. All patients underwe...

Objectives The aim of the present study was to assess whether the current COVID-19 pandemic affect the prevalence of patients with cervicofacial infections in a major tertiary hospital in Greece. Materials and Methods A retrospective comparative study was performed, assessing the hospitalization of patients with cervicofacial infections in a university-affiliated Department of Oral and Maxillofacial Surgery. Patients were recorded in two periods, the COVID period, from March 2020 to February 2021, and the pre-COVID period, from March 2019 to February 2020. All patients admitted with any form of cervicofacial infection during these periods were included in the study. Results In total, 341 patients were recorded. Of those, 151 were admitted in the pre-COVID period and 190 in the COVID period (P=0,03). The mean age was 45.3 years in total. A slight male predominance was observed (54.7% males). Mean length of stay was 3.42 days in the COVID period, whereas it as 2.5 in the pre-COVID per...

Objectives The experimental study aims to demonstrate the output of a vasodilator agent application on skin prior and after a skin flap elevation and the possibility of the improvement of the flap survival rate Materials and methods The study was consisted of two groups and 28 rats were used. The experimental group concerned 28 right abdominal skin flaps that 10 days pre-surgically received iloprost cream (a prostaglandin PGI2 analogue) and 4 sub-groups of 7 each one post surgically received 2.5,5,10,20 μgr/gr of iloprost, respectively. The control group concerned 28 right abdominal skin flaps that pre surgically received white petrolatum (placebo). Laser Doppler flowmetry and dynamic analysis of circulation (radioisotope 99m Tc) were used to evaluate the flaps survival. Results The study led to highly comparable results between the study and the control group, as it turned out that the study group showed a mean value of 84.52 (47.70) PU while the control group’s result was 38.06 (1...

Objectives The available data of the use of free vascularized flaps in head and neck reconstruction in a single centre is presented. Materials and Methods All patients who received a free vascularized flap in our department in the past 5 years (2017-2021) were recorded. Results 21 patients were included, 20 oncologic patients and self-inflicted gunshot injury patient. As far as the oncologic patients are concerned, 10 patients received a free flap in the same stage as tumour resection, 4 received a free flap after disease recurrence, and 6 received a free flap after a disease-free period, either for a post-surgical correction of a deformity or to manage post-therapy complications, such as osteoradionecrosis or trismus. In total the survival rate of the oncologic patients is 60%. No major post-surgical complications were observed as far as the flap survival was concerned. The anterolateral thigh flap and fibula flap were the most preferred for reconstruction in 8 and 8 cases respecti...

Objectives Primary Ewing sarcoma of the head and neck is rare, representing only 3% of all Ewing sarcoma cases. The aim is to present a rare case of maxillary location of a Ewing sarcoma. Case report A 23-year-old male patient presented with a chief complaint of upper lip swelling attributed to a cystic lesion in the apical area left lateral maxillary incisor. Imaging showed an apical lesion of this tooth, indicating a broad osteolytic location. The lesion was removed, and a sample was taken for biopsy. The immunohistochemical findings agreed with a malignant bone tumor that exhibits features more compatible with the diagnosis of Ewing’s Sarcoma. The patient underwent chemotherapy and radiotherapy. No signs of recurrence can be seen five years after treatment. Conclusions Most of the few published cases of primary Ewing sarcoma of the maxillary have been diagnosed as cystic lesions. Early diagnosis of head and neck Ewing sarcoma is essential for operating R0 surgeries that may not r...

Objectives To present a case of subcutaneous cervicofacial emphysema of a patient with a closed mandibular angle fracture after interpersonal violence. Case Report A 36-year-old male was transferred from a regional hospital after a referred interpersonal violence incident. The patient sustained a fracture of the left mandibular angle, as well as a right clavicular fracture, which was treated conservatively by the referring hospital. As depicted by the CT scan, a large emphysema involving the buccal, submandibular, pterygomasseterial and lateral pharyngeal spaces of the left side. Clinically the patient had a positive Hamman’s sign. An open reduction was decided with internal rigid fixation. The postoperative course was uneventful. Conclusions Cervicofacial emphysema, despite not unusual in fractures involving the midface, due to communication with the paranasal sinuses, is a rather rare complication of mandibular fractures. Proper clinical and imaging examination is required to excl...

PURPOSE Chemotherapeutic factors are known to affect healing on the postoperative patient. The aim of the present experimental study was to evaluate the effect of intraperitoneal infusion of 5-fluorouracil, bleomycin and cisplatin on the healing of colonic anastomoses in rats. METHODS Forty Albino-Wistar male rats were randomly divided into two groups, a control and a chemotherapy (CT) group. In both, an end-to-end colonic anastomosis was performed. collagen, In the control group, 2cc saline was administered intraperitoneally during the operation and daily postoperatively until the sacrifice. In the CT group, rats were administered a solution of 5-fluorouracil (20mg/kg b.w.), bleomycin (4mg/kg b.w.) and cisplatin (0.7 mg/kg b.w.) in an amount of 2cc intraperitoneal intraoperatively and afterwards daily postoperatively until the seventh postoperative day when they were sacrificed. At sacrifice, adhesion presence was calculated and the anastomoses were resected and macroscopically exa...

Objectives The aim of this study was to record the patients with advanced head and neck cancer who received a major regional flap for reconstruction in the COVID-19 pandemic period. Materials and Methods The surgical registry of a single centre was retrospectively searched for identification of patients who met the inclusion criteria of receiving a major regional flap for head and neck reconstruction, after resection of a locally advanced tumour, during the COVID-19 pandemic. The period recorded on this study as March 2020 to February 2021. All data available were recorded (tumour type, staging, operation, reconstruction) as well as post-operative follow up until up to date. Results 10 patients met the inclusion criteria. Mean age was 71.9 years old. 6 patients were newly diagnosed patients, whereas 4 were patients with recurrence. As far as staging is concerned, all had stage IV cancers, whereas 6 patients had T4 tumours, 2 T3 and 2 Tx. The latter 2 concern a patient with an occult...

Hidrocystomas are benign cystic lesions which arise from the secretory part of sweat glands. Hidrocystomas can be either eccrine or apocrine and are often found in the head and neck region. In this paper we present a case of a large congenital hidrocystoma of the lower eyelid in a patient with possible orofacial digital syndrome (ODS). A special feature in our case was the presentation of bone remodeling of the anterior surface of the maxilla. The basic clinical and histological features of hidrocystomas are also reviewed.

The term dens in dente (also dens invagina-tus) refers to an anomaly in tooth formation, in whichthe enamel organ is submerged into the dental papilla,causing a tooth-like formation inside the tooth. We pres-ent a case with a concomitant dental abscess formationand its management. A systematic review of populationstudies was conducted in search engines MEDLINE andGoogle Scholar. In total, 28 studies are included in ourstudy, presenting a wide diversity of incidence from 0.3to 26%. The diversity can be attributed to factors suchas diagnostic difficulties, differences in the study popula-tions, and differences in diagnostic criteria.This anomaly is more frequent in maxillary lateral incisors,may be underdiagnosed, and has a higher prevalence ofinfections and abscess formation. Thus, the complicationrate is higher and the need of proper documentation isimportant for the clinician.

Parvimonas micra and Fusobacterium nucleatum are commensal pathogens very rarely isolated simultaneously in clinical specimens. We report a case of chronic maxillary sinusitis caused by these two pathogens, presumably resulting from a co-existing dental infection.

PURPOSE To present our experience in the treatment of patients with liver metastases from colorectal cancer. METHODS The surgical and histopathological records of our department dating from 1st January 1997 to 31 December 2016 were examined, searching for patients who have undergone surgical treatment of colorectal liver metastasis. RESULTS A total of 90 patients with colorectal liver metastases were treated in the last 20 years in our department. Their mean age was 65.28 years and 54 (60%) were male. The primary tumor was in the colon in 71 patients (78.9%) and in 19 (21.1%) patients in the rectum. Thirty-six (40%) patients presented with synchronous metastatic liver disease, from which 27 were subjected to simultaneous resection, 2 underwent a liver-first approach and 7 were subjected to resection of primary tumor first. Regarding the number of metastases 67 (74.4%) patients had single metastasis, 12 (13.3%) had 2 lesions, 4 (4.4%) had 3 lesions and 7 (7.8%) had 4-8 lesions. In-ho...

BACKGROUND Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. METHODS This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index &lt;20), moderate lockdowns (20-60), and full lockdowns (&gt;60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. FINDINGS Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16-30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77-0·84; p&lt;0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50-0·53; p&lt;0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80-0·88; p&lt;0·001), and full lockdowns (0·57, 0·54-0·60; p&lt;0·001), remained independently associate [...]

Wound healing and tissue regeneration are a field of clinical medicine presenting high research interest, since various local and systematic factors can inhibit these processes and lead to an inferior result. New methods of healing enhancement constantly arise, which, however, require experimental validation before their establishment in everyday practice. Platelet-rich plasma (PRP) is a well-known autologous factor that promotes tissue healing in various surgical defects. PRP derives from the centrifugation of peripheral blood and has a high concentration of growth factors that promote healing. Recently, the use of adipose-derived mesenchymal stem cells (ADMSCs) has been thoroughly investigated as a form of wound healing enhancement. ADMSCs are autologous stem cells deriving from fat tissue, with a capability of differentiation in specific cells, depending on the micro-environment that they are exposed to. The aim of the present comprehensive review is to record the experimental st...

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst ...

To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.

Fournier&#39;s gangrene (FG) is a rapidly evolving necrotizing fasciitis of the perineum and the genital area, the scrotum as it most commonly affects man in the vast majority of cases. It is polymicrobial in origin, due to the synergistic action of anaerobes and aerobes and has a very high mortality. There are many predisposing factors including diabetes mellitus, alcoholism, immunosuppression, renal, and hepatic disease. The prognosis of the disease depends on a lot of factors including but not limited to patient age, disease extent, and comorbidities. The purpose of the study is to describe the experience of a general surgery department in the management of FG, to present the multimodal and multidisciplinary treatment of the disease, to identify predictors of mortality, and to make general surgeons familiar with the disease. The current retrospective study is presenting the experience of our general surgery department in the management of FG during the last 20 years. The clinical...

ABSTRACT When a child presents for examination particularly if there is any evidence of severe or repeated trauma involved, the history may alert the dentist to the possibility of a child abuse. Abuse may cause serious injury to the child and may even result in death. These behaviors are serious crimes, both as misdemeanors and felonies, punishable by arrest and imprisonment. Dentists should be aware that physical or sexual abuse may result in oral or dental injuries or conditions that sometimes can be confirmed by laboratory findings. When questions arise or when consultation is needed, a pediatric dentist or a dentist with formal training in forensic odontology can ensure appropriate testing, diagnosis and treatment. This case report aims to present a case of a physically abused child 12 years old. The examination revealed fracture of the left ocular area and as a result the adipose tissue all around the eyeball fall like a drop into the sinus. The CT scan of the facial skull was done so as to detect the consequences of the fracture. In conclusion, the ability to properly identify suspicious injuries to the head, face, mouth and neck of a child is imperative for dentists. Dentists are encouraged to be knowledgeable about such findings and their significance and to meticulously observe and document them.