Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Unmasking of a significant left main stenosis in a patient with high left ventricular pressures

As identification of left main (LM) stenoses has prognostic and therapeutic relevance, a precise anatomic and/or functional characterization of angiographically intermediate LM stenoses, by using intravascular ultrasound (IVUS) and fractional flow reserve (FFR) respectively, is crucial (1). However, increased left ventricular (LV) pressures might affect FFR measurements (2). Here we describe the case of a patient with chronic coronary syndrome and severe LV dysfunction in whom coronary angiography revealed an intermediate LM stenosis and catheterization identified an increased LV end-diastolic pressure. FFR measurement showed disproportionally higher FFR values compared with the minimal luminal area assessed by IVUS. When cardiac output was artificially augmented by using Impella for assisting percutaneous coronary intervention, the value of FFR measurement turned out proportional to what expected for the degree of anatomical stenosis. This discrepancy between anatomic and functional measurement may be a sign of coronary autoregulation dysfunction and therefore could help to identify high-risk patients in whom the use of a mechanical support device is more beneficial during percutaneous revascularization

Incidental thyroid carcinomas. A retrospective study

The aim of the present study is to report our series of incidental thyroid carcinomas in the last 15 years and their follow-up, discussing therapeutics indications and surgical choices

Die Monte Abatone-Nekropole von Cerveteri. Vorbericht zur Grabungskampagne 2021

In the joint excavation project at the Monte Abatone necropolis, the participating partners have continued and expanded the excavations around the Tumulus Campana, which began in 2018. The aim was to analyse the structure and development of the burial patterns in the area, based on excavations, further geophysical investigations, the evaluation of historical aerial photographs and survey data. In the area SW and S of the Tumulus Campana, a dense and homogeneous cluster of tombs of the ‘Kragebautypus’, beginning in the early 7th century BC, was documented, while in the N both a presumed altar of the Tumulus and a series of tombs (6th–4th/3rd century BC) along the edge of the plateau were examined

Die Monte Abatone-Nekropole von Cerveteri. Vorbericht zur Grabungskampagne 2022

In the joint excavation project at the Monte Abatone necropolis of Cerveteri, the participating partners have continued and expanded the excavations in the southwestern part of the necropolis near the Tumulus Campana, which started in 2018. The aim was to complete the investigation of a cluster of early small tumuli as well as to examine some larger burial structures in the area, detected by previous geophysical investigations. Altogether, 15 new graves were examined as well as some anomalies in the geophysical survey east and north of the Tumulus Campana. Additionally, a survey campaign has been carried out to study more open visible burial structures at the western slope of the plateau, including a tomb-lined access to the plateau at the northern limit of the necropolis

Transoral video assisted thyroidectomy. A systematic review

Abstract Introduction: The aim of this study is to perform a review of the English-language international literature concerning thyroid surgery performed through the transoral vestibular approach, to evaluate its feasibility and safety in terms of complications. Method: The review was carried out on 17 studies of 17 different authors. The following variables were taken into consideration: first author's name, nationality, year of publication, number of cases, hospital stay, conversion rate, type of surgical approach, total number of total thyroidectomies and loboisthmectomies, operative time range, intraoperative blood loss range, number and percentage of complications. Results: 736 procedures were performed: 289 total thyroidectomies and 447 loboisthmectomies. Surgical approach was trivestibular in 15 cases and combined (oro-vestibular) in 2 cases. The operative time varies from 43 minutes for a loboisthmectomy to 345 for a total thyroidectomy. Intraoperative blood loss ranges from 3 to 300 ml. Ten cases were converted into open surgery. The hospital stay varies from 1 to 10 days. Complications were: transient recurrent laryngeal nerve palsy in 34 cases, permanent in 2 cases; transient hypoparathyroidism in 62 cases. One case of postoperative bleeding, 22 postoperative seroma, 20 cases of mental nerve injury, 8 cases of operative wound infection. Conclusions: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a new surgical method, the use of which exclusively meets the aesthetic needs of some patients. Its specific complication is the injury of the mental nerves. Further studies, however, seem to be necessary, on numerically broader cases, to ascertain the real validity of the method