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Topic Review
Immuno-Inflammatory Signals in Liver Ischemia-Reperfusion Injury
Ischemia reperfusion injury (IRI) is a major obstacle in liver resection and liver transplantation. The initial step of IRI is mediated through ischemia which promotes the production of reactive oxygen species in hepatic cells. This promotes the activation of pro-inflammatory signaling cascades and the production of damage-associated molecular patterns (DAMPs). During the ischemic phase, DAMPs are released into the circulation by stressed cells upon reperfusion that further attracts neutrophils and other immune cells to the site of tissue injury. 
  • 552
  • 28 Jul 2022
Topic Review
Liver Transplantation for Perihilar Cholangiocarcinoma
Cholangiocarcinoma (CCA) encompasses all malignant neoplasms arising from the epithelial cells of the biliary tree. About 40% of CCAs are perihilar, involving the bile ducts distal to the second-order biliary branches and proximal to the cystic duct implant. About two-thirds of pCCAs are considered unresectable at the time of diagnosis or exploration. When resective surgery is deemed unfeasible, liver transplantation (LT) could be an effective alternative. The overall survival rates after LT at 1 and 3 years are 91% and 81%, respectively. The overall five-year survival rate after transplantation is 73% (79% for patients with underlying PSC and 63% for de novo pCCA). Multicenter case series reported a 5-year disease-free survival rate of ~65%.
  • 552
  • 30 May 2023
Topic Review
Impact of Bariatric Surgery on Adipose Tissue Biology
Bariatric surgery (BS) procedures are actually the most effective intervention to help subjects with severe obesity achieve significant and sustained weight loss. White adipose tissue (WAT) is increasingly recognized as the largest endocrine organ. Unhealthy WAT expansion through adipocyte hypertrophy has pleiotropic effects on adipocyte function and promotes obesity-associated metabolic complications. WAT dysfunction in obesity encompasses an altered adipokine secretome, unresolved inflammation, dysregulated autophagy, inappropriate extracellular matrix remodeling and insufficient angiogenic potential. 
  • 551
  • 08 Dec 2021
Topic Review
Complicated Appendicitis during the COVID-19 Pandemic and Pre-Pandemic
The Coronavirus Disease 2019 (COVID-19) pandemic has impacted volume, management strategies and patient outcomes of acute appendicitis. There is a significantly higher incidence of complicated appendicitis in children during the COVID-19 pandemic than in the pre-COVID-19 period. Additionally, a significantly higher proportion of children was managed via the NOM during the pandemic in comparison to the pre-pandemic period. 
  • 549
  • 07 Jan 2022
Topic Review
Retrosternal Goitre
Retrosternal goitres are thyroid tumefactions with a mediastinal portion more represented than the cervical one and they overrun the thoracic inlet by two fingers below, or by at least 4 cm. Retrosternal goitre can be divided into two types: “plongeant”, when the parenchymal tissue is connected to the thyroid gland and shares the vascularization (95–98% of cases), and autonomous (2–5% of cases), when this connection is not present and may be considered a mediastinal neoformation.
  • 549
  • 14 Mar 2022
Topic Review
Urethral Strictures Treatment in Transmasculine
Genital gender-affirming surgery can be part of the transition process in transgender patients. The 2 standard options for transmasculine patients are phalloplasty and metoidioplasty. These complex procedures brings along the risk of complications such as fistulas or urethral strictures at the level of the neo-urethra. Urethral strictures pose a specific challenge to the reconstructive urologist, and studies that focus on the management of urethral strictures are scarce. This systematic review gives an overview of the known literature about strictures in transmasculine patients, the different treatments and the outcome . 
  • 545
  • 28 Sep 2021
Topic Review
MPM Nodal Status: Where are We at?
Due to the lack of both prospective trial and high-volume retrospective studies, the management of clinical N+ malignant pleural mesothelioma (MPM) patients remain highly debated. Node positive patients show poor survival compared with node-negative ones; thus, lymph node staging appears crucial in determining treatment strategy. Notwithstanding the improvement in pre-treatment staging and the update on lymph node classification in the 8th edition of TNM, several open controversies remain on N parameter. How should people stage suspected N+ patients? How should people treat node positive patients?  Which is the definition of “resectable patient”?  Is the site or the number the main prognostic factor for node positive patients?  The aim of the entry is to analyse the existing relevant literature on lymph node status in MPM.
  • 536
  • 09 Nov 2021
Topic Review
Regenerative strategies in Cleft Palate
Cleft lip and/or palate (CLP) is a craniofacial malformation with a prevalence in newborns of 14 per 10,000 live births worldwide. 
  • 532
  • 01 Jul 2021
Topic Review
Perioperative Medication Therapy
Drug-related problems (DRPs) are common among surgical patients, especially older patients with polypharmacy and underlying diseases. DRPs can potentially lead to morbidity, mortality, and increased treatment costs. The enhanced recovery after surgery (ERAS) system has shown great advantages in managing surgical patients. Medication therapy management for surgical patients is an important part of the ERAS system. Improper medication therapy management can lead to serious consequences and even death.
  • 532
  • 02 Feb 2023
Topic Review
Treatment of the Lips Using a CO2 Laser
A number of studies have recently demonstrated the effectiveness of CO2 laser irradiation for the repair and regeneration of scar tissue from injuries or surgical wounds. However, such studies of the oral mucosa are highly limited. Previous studies using CO2 laser irradiation have indicated that two factors contribute to esthetic healing, namely, artificial scabs, which are a coagulated and carbonized blood layer formed on the wound surface, and photobiomodulation therapy (PBMT) for suppressing wound scarring and promoting wound healing. 
  • 532
  • 06 Dec 2023
Topic Review
Reconstruction and Rehabilitation of Jaw following Ablative Surgery
The reconstruction and rehabilitation of jaws following ablative surgery have been transformed by the development of computer-assisted surgery and virtual surgical planning. With strides made in computer-assisted surgery and patient-specific implants, the individual functional reconstruction of the jaw is evolving rapidly and the prompt rehabilitation of both the masticatory function and aesthetics after jaw resection has been made possible.
  • 531
  • 29 Aug 2022
Topic Review
Parenchyma Sparing Liver Resection versus Regenerative Liver Surgery
Liver resection for malignant tumors should respect oncological margins while ensuring safety and improving the quality of life, therefore tumor staging, underlying liver disease and performance status should all be attentively assessed in the decision process. The concept of parenchyma-sparing liver surgery is nowadays used as an alternative to major hepatectomies to address deeply located lesions with intricate topography by means of complex multiplanar parenchyma-sparing liver resections, preferably under the guidance of intraoperative ultrasound. Regenerative liver surgery evolved as a liver growth induction method to increase resectability by stimulating the hypertrophy of the parenchyma intended to remain after resection (referred to as future liver remnant), achievable by portal vein embolization and liver venous deprivation as interventional approaches, and portal vein ligation and associating liver partition and portal vein ligation for staged hepatectomy as surgical techniques. Interestingly, although both strategies have the same conceptual origin, they eventually became caught in the never-ending parenchyma-sparing liver surgery vs. regenerative liver surgery debate. However, these strategies are both valid and must both be mastered and used to increase resectability.
  • 526
  • 24 Oct 2022
Topic Review
Klebsiella pneumoniae vs. Non-Klebsiella pneumoniae Pyogenic Liver Abscess
Pyogenic liver abscess (PLA) is a common global public health problem as it contributes to 13% of intra-abdominal abscesses. With advancements in diagnostic microbiology, imaging technology, improved understanding of sepsis and critical care, and minimally invasive image-guided interventions such as percutaneous drainage (PD), clinical outcomes continue to improve; however, PLA-related mortality remains high, in the range of 10–30%. Klebsiella pneumoniae (KP) is the leading causative organism for PLA, followed by Escherichia coli (EC). Klebsiella pneumoniae pyogenic liver abscess (KPPLA) is associated with DM and gas formation, possibly impacting clinical outcomes.
  • 519
  • 07 Sep 2022
Topic Review
Systemic Antibiotic Prophylaxis in Maxillofacial Trauma
Infection after maxillofacial trauma remains an important complication, with a significant socio-economic impact. While consensus exists that systemic antibiotic prophylaxis reduces the risk of infection in the management of maxillofacial fractures, the type, and duration remain controversial. 
  • 517
  • 22 Jun 2022
Topic Review
Management of Advanced Aged Patients with Rib Fractures
Rib fractures are painful and disabling injuries found in chest trauma patients. Elderly patients (age > 60 years old) represent the majority of the victims of major trauma, and rib fractures account for 10% of all trauma admissions. Rib fracture management includes operative and non-operative approaches. Conservative treatment generally consists of satisfactory pain control, respiratory assistance, cough strategies, and deep breathing exercises. Surgical fixation in elderly patients seems to result in better outcomes than conservative treatment in terms of shorter hospitalization time, more favorable pain feedback and reduced associated morbidity. 
  • 516
  • 11 May 2022
Topic Review
Elective Early Upper Gastrointestinal Study
Assessment of discomfort as a sign for early postoperative complications in neurologically impaired (NI) children is challenging. The necessity of early routine upper gastrointestinal (UGI) contrast studies following laparoscopic Nissen fundoplication in NI children is unclear.  It aimed to evaluate the role of scheduled UGI contrast studies to identify early postoperative complications following laparoscopic Nissen fundoplication in NI children. Data for laparoscopic Nissen fundoplications performed in NI children between January 2004 and June 2021 were reviewed. A total of 103 patients were included, with 60 of these being boys. Mean age at initial operation was 6.51 (0.11–18.41) years. Mean body weight was 16.22 (3.3–62.5) kg. Mean duration of follow up was 4.15 (0.01–16.65 years) years. Thirteen redo fundoplications (12.5%) were performed during the follow up period; eleven had one redo and two had 2 redos. Elective postoperative UGI contrast studies were performed in 94 patients (91%). Early postoperative UGI contrast studies were able to identify only one complication: an intrathoracal wrap herniation on postoperative day five, necessitating a reoperation on day six. The use of early UGI contrast imaging following pediatric laparoscopic Nissen fundoplication is not necessary as it does not identify a significant number of acute postoperative complications requiring re-intervention. 
  • 515
  • 23 Nov 2021
Topic Review
Atypical Skull-Base Osteomyelitis
Atypical skull-base osteomyelitis is a rare but fatal disease that usually involves infection of the ethmoid, sphenoid, occipital, or temporal bones that form the skull base. Unlike typical (so-called otogenic), atypical skull-base osteomyelitis has no otogenic cause. Instead, some authors call atypical skull-base osteomyelitis sinonasal, since the infection most often originates from the nose and paranasal sinuses. 
  • 511
  • 09 May 2023
Topic Review
Surgical Treatment for Grade C Postoperative Pancreatic Fistula
Postoperative pancreatic fistula (POPF) is a troublesome complication after pancreatic surgeries, and grade C POPF is the most serious situation among pancreatic fistulas. The incidence of grade C POPF varies from less than 1% to greater than 9%, with an extremely high postoperative mortality rate of 25.7%. The patients with grade C POPF finally undergo surgery with a poor prognosis after various failed conservative treatments. Although various surgical and perioperative attempts have been made to reduce the incidence of grade C POPF, the rates of this costly complication have not been significantly diminished. Hearteningly, several related studies have found that intra-abdominal infection from intestinal flora could promote the development of grade C POPF, which would help physicians to better prevent this complication.
  • 505
  • 03 Jan 2023
Topic Review
Mesenchymal Stromal Cell-Based Targeted Therapy Pancreatic Cancer
Pancreatic cancer is an aggressive malignancy with high mortality rates and poor prognoses. Despite rapid progress in the diagnosis and treatment of pancreatic cancer, the efficacy of current therapeutic strategies remains limited. Hence, better alternative therapeutic options for treating pancreatic cancer need to be urgently explored. Mesenchymal stromal cells (MSCs) have recently received much attention as a potential therapy for pancreatic cancer owing to their tumor-homing properties. 
  • 503
  • 15 Mar 2023
Topic Review
EPPOCRATIS
Finally, EPPOCRATIS is an in-house (point-of-care) process that can be completed in 24-48 hours, allowing precise and expedited care of facial trauma patients. Bypassing outsourcing to third-party companies allows for the implementation of VSP/3DP in the acute trauma setting during the same hospitalization of trauma patients. Potential challenges with building an in-house VSP/3DP also exist including cost and personnel. However, as the technology becomes more readily available and cheaper, it will become more utilized in large volume centers.   
  • 501
  • 22 Dec 2021
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