Atrophic non-union with severe osteolysis of the radius in a healthy child: successful rescue surgery. Management with fibular allograft and autograft growth factors in a paediatric patient

Background. Forearm fractures are the most frequent fractures in children and adolescents and they are more common in males than in females. In the last 20 years the increase of surgical indications have resulted in more complications, among them the non-unions, considered extremely rare and severe in children, have increased in incidence. We report a successful treatment of misdiagnosed forearm atrophic non-union with severe osteolysis using fibula allograft and autograft growth factors in a previously healthy 4-year-old child. Clinical case. A 4 year-old boy presented to our hospital with massive bone loss and a negative bone biopsy for Gorham-Stout Syndrome, he also showed reactive bone tissue with abnormal vascularity, necrotic osteocartilaginous fragments and giant mononucleated cells. Other lab tests did not show any modifications, so all the causes of paediatric osteolysis were ruled out. He had already undergone a few surgeries on that fracture and we performed others before achieving a good result, obtained with an autologous fibula graft with medullary growth factors stabilized with Kirschner wire. At the follow up 28 months later, the patient showed total consolidation of the initial area of non- union, no neurovascular deficit and no joint deficiency. Discussion. Non-union in paediatric patients is rare and therefore difficult to treat and diagnose. Since all of our tests ruled out the main causes of paediatric non-union, we managed the case with strategies usually applied to adult patients, carefully respecting the growth plates. Conclusion. Although this is a single-case report, it underlines the importance of early diagnosis, the difficulty to rule out some pediatric causes of bone loss and the complicances of a wrong diagnosis/treatment. It also shows that the use of allograft bone and autograft growth factors in a pediatric patient, who has undergone multiple surgeries, can lead to excellent result

Characterization of Nonlinear Finger Pad Mechanics for Tactile Rendering

The computation of skin forces and deformations for tactile rendering requires an accurate model of the extremely nonlinear behavior of the skin. In this work, we investigate the characterization of finger mechanics with the goal of designing accurate nonlinear models for tactile rendering. First, we describe a measurement setup that enables the acquisition of contact force and contact area in the context of controlled finger indentation experiments. Second, we describe an optimization procedure that estimates the parameters of strain-limiting deformation models that match best the acquired data. We show that the acquisition setup allows the measurement of force and area information with high repeatability, and the estimation method reaches nonlinear models that match the measured data with high accuracy

Liver resection vs radiofrequency ablation in single hepatocellular carcinoma of posterosuperior segments in elderly patients

Background: Liver resection and radiofrequency ablation are considered curative options for hepatocellular carcinoma. The choice between these techniques is still controversial especially in cases of hepatocellular carcinoma affecting posterosuperior segments in elderly patients. Aim: To compare post-operative outcomes between liver resection and radiofrequency ablation in elderly with single hepatocellular carcinoma located in posterosuperior segments. Methods: A retrospective multicentric study was performed enrolling 77 patients age ≥ 70-years-old with single hepatocellular carcinoma (≤ 30 mm), located in posterosuperior segments (4a, 7, 8). Patients were divided into liver resection and radiofrequency ablation groups and preoperative, peri-operative and long-term outcomes were retrospectively analyzed and compared using a 1:1 propensity score matching. Results: After propensity score matching, twenty-six patients were included in each group. Operative time and overall postoperative complications were higher in the resection group compared to the ablation group (165 min vs 20 min, P < 0.01; 54% vs 19% P = 0.02 respectively). A median hospital stay was significantly longer in the resection group than in the ablation group (7.5 d vs 3 d, P < 0.01). Ninety-day mortality was comparable between the two groups. There were no significant differences between resection and ablation group in terms of overall survival and disease free survival at 1, 3, and 5 years. Conclusion: Radiofrequency ablation in posterosuperior segments in elderly is safe and feasible and ensures a short hospital stay, better quality of life and does not modify the overall and disease-free survival

The Brescia Internationally Validated European Guidelines on Minimally Invasive Pancreatic Surgery (EGUMIPS)

Objective: To develop and update evidence-based and consensus-based guidelines on laparoscopic and robotic pancreatic surgery. Summary Background Data: Minimally invasive pancreatic surgery (MIPS), including laparoscopic and robotic surgery, is complex and technically demanding. Minimizing the risk for patients requires stringent, evidence-based guidelines. Since the International Miami Guidelines on MIPS in 2019, new developments and key publications have been reported, necessitating an update. Methods: Evidence-based guidelines on 22 topics in 8 domains were proposed: terminology, indications, patients, procedures, surgical techniques and instrumentation, assessment tools, implementation and training, and artificial intelligence. The Brescia Internationally Validated European Guidelines on Minimally Invasive Pancreatic Surgery (EGUMIPS, September 2022) used the Scottish Intercollegiate Guidelines Network (SIGN) methodology to assess the evidence and develop guideline recommendations, the Delphi method to establish consensus on the recommendations among the Expert Committee, and the AGREE II-GRS tool for guideline quality assessment and external validation by a Validation Committee. Results: Overall, 27 European experts, 6 international experts, 22 international Validation Committee members, 11 Jury Committee members, 18 Research Committee members, and 121 registered attendees of the 2-day meeting were involved in the development and validation of the guidelines. In total, 98 recommendations were developed, including 33 on laparoscopic, 34 on robotic, and 31 on general MIPS, covering 22 topics in 8 domains. Out of 98 recommendations, 97 reached at least 80% consensus among the experts and congress attendees, and all recommendations were externally validated by the Validation Committee. Conclusions: The EGUMIPS evidence-based guidelines on laparoscopic and robotic MIPS can be applied in current clinical practice to provide guidance to patients, surgeons, policy-makers, and medical societies.</p

An unusual case of colonic mixed adenoendocrine carcinoma: collision versus composite tumor. A case report and review of the literature

We report a case of collision tumor of the cecum in a 50-year-old woman and discuss the morphological criteria used for classifying mixed glandular-endocrine neoplasms of tile digestive tract in a large series of reported cases. The cecal tumor showed clear geographic polarization, with no admixture or transition of the 2 neoplastic components. A lymph nodal metastatic deposit contained both tumors. Immunohistochemical stainings were consistent with the carcinomatous and carcinoidal nature of the 2 neoplasms, except for a minute area of carcinoembryonic antigen positivity in the carcinoid. A review of the literature shows that many mixed glandular-endocrine rumors of the digestive tract escape precise classification using established morphological criteria. Collision and composite tumors can share common histological and immunohistochemical features, including polyclonal metastases and carcinoembryonic antigen expression in the carcinoidal area. Mixed rumors of the cecum showing a collision-like morphology appear to behave more aggressively than other colonic adenoendocrine carcinomas. (c) 2007 Elsevier Inc. All rights reserved

A new era for hepatocellular carcinoma

In this setting, the necessity to standardize the management in clinical practice of patients with HCC is extremely important and requires guidelines based on literature, clinical data, expert opinion, and real-word clinical practice as in JSH Consensus Statements and Recommendations 2021 Update