Liver transplantation in a patient with complete portal vein thrombosis, is there a surgical way out? A case report

Introduction: Due to the complexity of the surgical procedure portal vein thrombosis (PVT) has long been considered an absolute contraindication to liver transplantation (LT). The presence of a large splenorenal shunt (SRS) could make portal anastomosis a valid option.Presentation of case: We report the case of a 37-year-old female patient with Grade III PVT and a large SRS, who underwent orthotopic LT. Liver was implanted using a 1992-Belghiti piggyback technique and portal anastomosis was performed using the large spleno-renal shunt. We observed good graft reperfusion and postoperative Doppler ultrasound showed normal portal vein flow. She was discharged on postoperative day 7, with an excellent graft function. At six months follow-up, patient is alive with normal hepatic vascularization.Discussion: Due to paucity of reports, there is currently no consensus on the indication to LT and/or surgical technique. In the present case, once the transplant benefit was evaluated, the Grade III PVT was not considered a contraindication to LT.Conclusion: The presence of a Grade III PVT associated with a large SRS should not be considered a contraindication for LT, and the use of the shunt vein should be considered a feasible option to perform portal anastomosis. (C) 2016 The Author(s). Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd

Comment on “Relationship of breast cancer types with tissue density and patient age, Riyadh, Saudi Arabia, 2012-2020”

This is a commentary and no abstract is required

Maintaining good practice in breast cancer management and reducing the carbon footprint of care: study protocol and preliminary results

Objective: Health care accounts for up to 8-10% of greenhouse emission yearly in the US and surgical room contributes an estimated 25-30% of hospital waste. Despite the major role of greenhouse emissions because of surgery, little has been done by surgeons to reduce their impact. In this paper, we present a multicentric retrospective analysis to evaluate the carbon footprint of the most common breast surgical treatment and a preliminary analysis of our results. Patients and Methods: Retrospective analysis with processed-based life cycle assessment (LCA) has been obtained to determine carbon footprint of different surgical procedures. In our preliminary study, we enrolled all consecutive patients undergoing breast conserving procedure (BCP) between 9th March 2019 and 9th March 2021 to underline the reduction in fuel consumption with postoperative telehealth application (pre-COVID-19 vs. COVID-19). A propensity score matching was implemented to optimize comparability. Results: From 276 BCP patients, PSM included 69 pre-COVID-19 and 69 COVID-19 groups, respectively. No statistically significant difference was found in the tumor stage, marital status, and distance from the hospital. A total of 466 postoperative visits was performed and a statistically significant difference in telehealth visit rate was found between groups (1.75% vs. 51.68%; p<0.001). A reduction of 4312.38 km in travel to the hospital was found in the COVID-19 group. No difference was found in postoperative complications. Conclusions: Health systems worldwide are implementing zero-carbon programs to reduce their carbon footprint. Breast surgeons should consider the consequences of their actions and embrace the pillars of the circular economy. Our data could promote further action in order to raise awareness regarding carbon footprint of breast surgery

Same donor laparoscopic liver and kidney procurement for sequential living donor liver-kidney transplantation in primary hyperoxaluria type i

Background: Sequential liver-kidney transplantation (SeqLKT) from the same living donor has shown excellent results in children with primary hyperoxaluria type 1 (PH1), yet its experience is limited due to the invasiveness of two major procedures for liver-kidney procurement in a single donor. Despite laparoscopic nephrectomy and hepatic left lateral sectionectomy (LLS) being considered standard procedures in living donation, the sequential use of the two laparoscopic approaches in the same living donor has never been reported. Methods: Herein, we present the first two case series of laparoscopic liver-kidney procurement in the same living donor for SeqLKT in children with PH1 and review of the current literature on this topic. Results: In the first case, a 15-month-old boy received a SeqLKT from his 32-year-old mother, who underwent a laparoscopic LLS and, after 8 months, a laparoscopic left nephrectomy. In the second case, a 34-month-old boy received a SeqLKT from his 40-year-old father who underwent laparoscopic LLS followed by hand-assisted right nephrectomy after 4 months. Both donors had uneventful postoperative courses and were discharged within 5 days from each surgery. The first recipient had no complication; the second child after liver transplantation developed a partial thrombosis of the inferior vena cava, which did not preclude the sequential kidney transplantation. After 12 months, donors and recipients displayed normal liver and renal functions. Conclusions: Sequential laparoscopic liver-kidney procurement in the same living donor is safe and feasible, and might be considered as a possible strategy to promote SeqLKT in children with PH1 from the same living donor

Breast cancer treatment de-escalation: breaking the SOUND barrier

Breast Cancer (BC) is the leading oncological diagnosis, with the annual incidence expected to exceed 3 million new cases by 2040 due to population growth and ageing. Despite the increasing number of BC patients, recent advancements in multidisciplinary treatment have enabled surgical de-escalation, maintaining equivalent oncological outcomes. Areas of surgical de-escalation include avoidance of axillary lymph node dissection in patients with low disease burden, re-excision in close margins after breast conserving surgery, and even complete avoidance of surgery in selected cases. Despite the evidence supporting these de-escalation protocols, their implementation is inconsistent. The article discusses how these strategies can be further integrated into BC treatment plans to improve patients' quality of life and optimize health care resources. The future of BC management may be shaped by genomic tests, offering more tailored and potentially less invasive treatment strategies. A comprehensive understanding of tumor biology has facilitated the development of strategies such as neoadjuvant chemotherapy, with the potential to further de-escalate surgery. The need for a multidisciplinary approach to BC care, incorporating emerging diagnostic tools and understanding of individual patient's disease trajectory, is paramount. It is essential to challenge the perception of more aggressive treatments as inherently better and ensure decisions are based on high-quality evidence, preserving the principle of 'do no harm'. The focus of future BC research should be on identifying markers capable of predicting the risk of distant recurrence and implementing a true multidisciplinary de-escalation approach

Autoimmune mastitis as a clinical manifestation of Behçet’s disease: a case report and a systematic literature review

Objective: Behçet’s disease (BD) is a rare autoimmune disorder of unknown origin that causes chronic and systemic inflammation in blood vessels. The condition is traditionally defined by oral and genital ulcers and uveitis; however, cutaneous, articular, neurologic, vascular, gastrointestinal, and pulmonary manifestations may also be observed. It is more prevalent throughout the Silk Road, such the Mediterranean basin and the East Asia. There have been reported only four cases of BD targeting the breast. We herein present a case report of an autoimmune mastitis (AM) in a 23-year-old patient diagnosed for BD treated surgically. Case Presentation: The patient is a 23-year-old Italian female who reported recurrent aphthous ulcers of the oral mucosa, occasional vaginal dryness, and genital lesions, diagnosed for BD according to the International Study Group (ISG) criteria and the skin biopsy. The patient referred to our department for examination of a painful and ulcerating lump at the 5 o’clock position of the right breast, which had been present for one month. Results: In our case, we opted for a surgical approach, which proved to be effective in treating the lesion. Considering the relapsing and remitting nature of BD, surgical intervention is questionable when compared to appropriate conservative treatment. Conclusions: A conservative approach should be evaluated first, in order to have regard to the recurrent course of the disease and to the risk that numerous surgical procedures may result in irreversible aesthetic damage