Intramedullary Abscess by Staphylococcus aureus

Cauda equina syndrome (CES) is a rare entity presenting with low back pain, unilateral or bilateral sciatica, motor weakness of lower extremities, sensory disturbance in the perineal area, and urinary and/or faecal incontinence. Those symptoms are secondary to compression of the cauda equina. If not recognized, CES can lead to irreversible disabilities. We report the case of a 77-year-old lady who presented to the emergency department with a ten-day history of back pain as well as urinary incontinence

Demographics, diagnostics, treatment, and outcomes of patients presenting with acute groin hernia:15-year multicentre retrospective cohort study

BACKGROUND: Groin hernias commonly present acutely in high-risk populations and can be challenging to manage. This retrospective, observational study aimed to report on patient demographics and outcomes, following acute admissions with a groin hernia, in relation to contemporary investigative and management practices.METHODS: Adult (≥18 years old) patients who presented acutely with a groin hernia to nine National Health Service trusts in the north of England between 2002 and 2016 were included. Data were collected regarding patient demographics, radiological investigations, and operative intervention. The primary outcome of interest was 30-day inpatient mortality rate.RESULTS: Overall, 6165 patients with acute groin hernia were included (4698 inguinal and 1467 femoral hernias). There was a male preponderance (72.5 per cent) with median age of 73 years (interquartile range (i.q.r.) 58-82). The burden of patient co-morbidity increased over the study period (P &lt; 0.001). Operative repair was performed in 2258 (55.1 per cent) of patients with an inguinal and 1321 (90.1 per cent) of patients with a femoral hernia. Bowel resection was more commonly required for femoral hernias (14.7 per cent) than inguinal hernias (3.5 per cent, P &lt; 0.001) and in obstructed (14.6 versus 0.2 per cent, P &lt; 0.001) or strangulated (58.4 versus 4.5 per cent, P &lt; 0.001) hernias. The 30-day mortality rate was 3.1 per cent for the overall cohort and 3.9 per cent for those who underwent surgery. Bowel resection was associated with increased duration of hospital stay (P &lt; 0.001) and 30-day inpatient mortality rate (P &lt; 0.001). Following adjustment for confounding variables, advanced age, co-morbidity, obstruction, and strangulation were all associated with an increased 30-day mortality rate (all P &lt; 0.001).CONCLUSION: Emergency hernia repair has high mortality rates. Advanced age and co-morbidity increase both duration of hospital stay and 30-day mortality rate.</p

Pancreatic Pseudocyst

Pancreatic pseudocysts frequently occur in the context of acute or chronic pancreatitis and seldom appear as a post-surgical outcome or trauma. Complicated pancreatic pseudocysts represent extremely rare entities but still life-threatening situations, including infection, hemorrhage, rupture, pseudoaneurysms, pancreatic fistulas, obstructions, and splenic complications. Premature diagnosis, based on transabdominal ultrasonography or computed tomography, is crucial for the early therapeutic approach. Conservative treatment, surgical and endoscopic intervention consist the therapeutic options. Thus, management of the complicated pseudocysts demands a multidisciplinary team eligible to cope with complications that might even occur due to the intervention. Pancreatic pseudocysts represent a challenge for clinical doctors

The role of teamwork and non-technical skills for improving emergency surgical outcomes: an international perspective

The assurance of patient safety in emergency general surgery remains challenging due to the patients' high-risk underlying conditions and the wide variability in emergency surgical care provided around the globe. The authors of this article convened as an expert panel on patient safety in surgery at the 8(th) International Conference of the World Society of Emergency Surgery (WSES) in Edinburgh, Scotland, on September 7-10, 2021. This review article represents the proceedings from the expert panel discussions at the WSES congress and was designed to provide an international perspective on optimizing teamwork and non-technical skills in emergency general surgery

The role of teamwork and non-technical skills for improving emergency surgical outcomes: an international perspective

The assurance of patient safety in emergency general surgery remains challenging due to the patients' high-risk underlying conditions and the wide variability in emergency surgical care provided around the globe. The authors of this article convened as an expert panel on patient safety in surgery at the 8th International Conference of the World Society of Emergency Surgery (WSES) in Edinburgh, Scotland, on September 7-10, 2021. This review article represents the proceedings from the expert panel discussions at the WSES congress and was designed to provide an international perspective on optimizing teamwork and non-technical skills in emergency general surgery

Surgery on the Road to the Land of Promise–Ιmpact of the Refugee Crisis on the Greek Healthcare System: Results from a Surgical Department of a Tertiary Hospital

Background/Objectives: The surge in migration from the Middle East and North Africa due to conflicts has significantly impacted healthcare systems, particularly in Greece. This study investigates how the sharp increase in refugees and migrants after July 2015 has strained the surgical departments of the Greek National Health System (NHS). Methods: A retrospective analysis was conducted on 229 patients treated at the emergency department of a public hospital in Athens, Greece. Data were compared between two periods: January 2012–July 2015 (pre-July 2015) and July 2015–December 2018 (post-July 2015), with July 2015 chosen as the cutoff due to a significant influx of immigrants during that time. Results: Patients’ demographic details, diagnoses, and surgical interventions were analyzed. Results indicated a significant rise in surgical cases, with 72.5% of patients requiring procedures, notably for appendicitis (23.6%), cholecystitis (10.9%), lower extremity thrombophlebitis (9.6%), perianal abscess (8.3%), and inguinal hernia (5.7%). Post-July 2015, there was a notable increase in perianal abscess (12.2%), inguinal hernia (8.4%), and cholelithiasis (6.1%). However, the average hospital stay of 3.9 days remained unchanged. Conclusions: The findings reveal the profound economic and operational pressures on the NHS during the refugee crisis, highlighting the urgent need for resource optimization and policy reforms. Future studies should address long-term healthcare impacts to support more sustainable healthcare models amidst ongoing and future migration challenges.This research received no external funding

Rapid-Growing Phyllodes Tumor after an Accidental Bump on the Breast: A Case Report

Introduction: Giant phyllodes tumors are fibroepithelial lesions whose diameters exceed 10 cm. Core biopsy represents the best diagnostic method in order to distinct fibroadenomas from phyllodes tumors. Wide surgical resection with clear margins is the standard of treatment. Case Presentation: In this report, we describe the case of a 41-year-old woman, who presented with a rapid growth of a phyllodes tumor after an accidental bump on the breast and had to undergo mastectomy followed by breast reconstruction. Conclusion: There is possibly an etiological correlation between accident and phyllodes tumor growth

Pulmonary Endometriosis: A Systematic Review

Background/Objectives : Endometriosis is characterized by the presence of ectopic endometrial-like glands and stroma outside the endometrial cavity, which mainly occurs in the pelvic cavity. Pulmonary endometriosis, or thoracic endometriosis syndrome (TES), describes the rare presence of endometrial-like cells in the thoracic cavity and includes catamenial pneumothorax, catamenial hemothorax, hemoptysis, and lung nodules. Our aim is to summarize the results of all reported cases of TES. Methods : Extensive research was conducted through MEDLINE/PUBMED using the keywords “thoracic endometriosis”, “thoracic endometriosis syndrome”, “catamenial pneumothorax”, “catamenial hemoptysis”, and “TES”. Following PRISMA guidelines, all published cases of TES between January 1950 and March 2024 were included. A systematic review of 202 studies in English, including 592 patients, was performed. Results : The median age of women with TES is 33.8 years old. The most common clinical presentation is catamenial pneumothorax (68.4%), while lesions are mainly found in the right lung unilaterally (79.9%). Chest computed tomography (CT) was used alone or after an X-ray to determine the pathological findings. Ground-glass opacity nodules and cystic lesions represent the most common finding in CT, while pneumothorax is the most common finding in X-rays. Video-assisted thoracoscopic surgery (VATS) is the main therapeutic approach, usually in combination with hormonal therapy, including GnRH analogues, progestins, androgens, or combined oral contraceptives. Hormonal therapy was also administered as monotherapy. Symptom recurrence was reported in 10.1% of all cases after the treatment. Conclusions : High clinical awareness and a multidisciplinary approach are necessary for the best clinical outcome for TES patients. More studies are required to extract safer conclusions.This research received no external funding

Compliance with evidence-based clinical guidelines in the management of acute biliary pancreatitis: the MANCTRA-1 study protocol.

Despite existing evidence-based practice guidelines for the management of biliary acute pancreatitis (AP), the clinical compliance with recommendations is overall poor. Studies in this field have identified significant discrepancies between evidence-based recommendations and daily clinical practice. The most commonly reported gaps between clinical practice and AP guidelines include the indications for CT scan, need and timing of artificial nutritional support, indications for antibiotics, and surgical/endoscopic management of biliary AP. The MANCTRA-1 (coMpliAnce with evideNce-based cliniCal guidelines in the managemenT of acute biliaRy pancreAtitis) study is aiming to identify the areas for quality improvement that will require new implementation strategies. The study primary objective is to evaluate which items of the current AP guidelines are commonly disregarded and if they correlate with negative clinical outcomes according to the different clinical presentations of the disease. We attempt to summarize the main areas of sub-optimal care due to the lack of compliance with current guidelines to provide the basis for introducing a number of bundles in AP patients' management to be implemented during the next years. The MANCTRA-1 study is an international multicenter, retrospective cohort study with the purpose to assess the outcomes of patients admitted to hospital with a diagnosis of biliary AP and the compliance of surgeons worldwide to the most up-to-dated international guidelines on biliary AP. ClinicalTrials.Gov ID Number: NCT04747990, Date: February 23, 2021. Protocol Version V2.2

coMpliAnce with evideNce-based cliniCal guidelines in the managemenT of acute biliaRy pancreAtitis): The MANCTRA-1 international audit

Background/objectives: Reports about the implementation of recommendations from acute pancreatitis guidelines are scant. This study aimed to evaluate, on a patient-data basis, the contemporary practice patterns of management of biliary acute pancreatitis and to compare these practices with the recommendations by the most updated guidelines. Methods: All consecutive patients admitted to any of the 150 participating general surgery (GS), hepatopancreatobiliary surgery (HPB), internal medicine (IM) and gastroenterology (GA) departments with a diagnosis of biliary acute pancreatitis between 01/01/2019 and 31/12/2020 were included in the study. Categorical data were reported as percentages representing the proportion of all study patients or different and well-defined cohorts for each variable. Continuous data were expressed as mean and standard deviation. Differences between the compliance obtained in the four different subgroups were compared using the Mann-Whitney U, Student's t, ANOVA or Kruskal-Wallis tests for continuous data, and the Chi-square test or the Fisher's exact test for categorical data. Results: Complete data were available for 5275 patients. The most commonly discordant gaps between daily clinical practice and recommendations included the optimal timing for the index CT scan (6.1%, χ2 6.71, P&nbsp;=&nbsp;0.081), use of prophylactic antibiotics (44.2%, χ2 221.05, P&nbsp;&lt;&nbsp;0.00001), early enteral feeding (33.2%, χ2 11.51, P&nbsp;=&nbsp;0.009), and the implementation of early cholecystectomy strategies (29%, χ2 354.64, P&nbsp;&lt;&nbsp;0.00001), with wide variability based on the admitting speciality. Conclusions: The results of this study showed an overall poor compliance with evidence-based guidelines in the management of ABP, with wide variability based on the admitting speciality. Study protocol registered in ClinicalTrials.Gov (ID Number NCT04747990)