Medicine and Pharmacology

Abstract: Introduction: Early debridement of burn eschar is a cornerstone of care for patients with extensive burns, yet early large-area surgical excision may be limited by blood loss, physiological instability, and substantial logistical demands. Evidence on bromelain-based enzymatic debridement beyond the approved limit of 15% total body surface area (TBSA) per treatment session remains scarce. Case Report: A 38-year-old man sustained partial- and full-thickness burns involving 97% TBSA, together with inhalation injury. Sequential enzymatic debridement with NexoBrid was performed at the bedside in five 4-hour sessions under intensive care conditions, with 14–27% TBSA treated per session. Complete eschar removal was achieved within 64 hours of admission without transfer to the operating room, major procedure-related bleeding, or transfusion during the debridement period. The subsequent course was complicated by sepsis and severe respiratory failure requiring veno-venous extracorporeal membrane oxygenation. Following intensive care treatment, the patient stabilized markedly, ECMO support was discontinued, and near-complete wound closure was achieved. He died on hospital day 87 following acute intrapulmonary and endotracheal hemorrhage of unclear etiology. Conclusions: This case illustrates the technical feasibility of ultra-early, sequential bedside enzymatic debridement in a near-total burn and may inform its carefully selected off-label use in highly specialized burn centers.

Abstract: Background and Objectives: Delayed contour irregularities may occasionally become apparent years after otherwise successful autologous rhinoplasty, particularly in patients with thin nasal skin. While thin-skinned rhinoplasty, autologous graft behavior, and nasal aging have been extensively discussed individually, their potential interaction has received limited attention. This review evaluates current evidence regarding aging-related nasal soft tissue changes, thin skin, autologous graft behavior, and their potential influence on long-term aesthetic outcomes after rhinoplasty. Materials and Methods: A literature review was performed using PubMed, Scopus, and Google Scholar databases. Relevant studies addressing rhinoplasty, autologous cartilage grafts, thin nasal skin, nasal aging, contour irregularities, preservation rhinoplasty, and soft tissue management were reviewed. Original studies, systematic reviews, and clinically relevant review articles were included. The available evidence was critically evaluated with particular attention to long-term outcomes and limitations of current knowledge. Results: Thin nasal skin is a recognized risk factor for graft visibility and contour irregularities following rhinoplasty. Aging-related changes, including dermal thinning, loss of collagen and elastin, decreased skin elasticity, and soft tissue atrophy, may further reduce the ability of the nasal soft tissue envelope to camouflage underlying structural features. However, direct longitudinal evidence linking aging-related soft tissue changes to delayed contour irregularities remains limited. Current literature consists predominantly of retrospective studies, expert opinion, and short- to medium-term outcome analyses. Preservation rhinoplasty and soft tissue camouflage techniques have been proposed to improve contour stability, although their long-term effectiveness in preventing aging-related contour visibility remains uncertain. Conclusions: Current evidence supports the biologic plausibility that progressive soft tissue aging may influence the long-term visibility of underlying grafts after rhinoplasty. Nevertheless, direct clinical evidence remains limited, and the relationship should currently be regarded as a hypothesis-generating concept rather than a proven causal mechanism. Future longitudinal studies incorporating objective assessment of skin quality, soft tissue thickness, and three-dimensional surface imaging are needed to better define the interaction between aging and long-term rhinoplasty outcomes.

Abstract: Background. Aorto-iliac Trans-Atlantic Inter-Society Consensus II (TASC II) C and D lesions with involvement of the aortic bifurcation are complex and their endovascular treatment with kissing stenting can be technically demanding. The aim of this study is to analyze the outcomes, risk factors and follow-up of aorto-iliac revascularization through kissing stenting. Methods. A single center, retrospective, observational study was performed including patients treated with aorto-iliac kissing stenting from 2016 to 2025 for TASC II C and D lesions. Pre-/peri- and post-operative data were prospectively collected and retrospectively analyzed. Aorto-iliac calcification consisted of calcific lesions involving more than 70% of the aortic circumference. Technical and clinical success, primary patency and reintervention rate were analyzed. Results. Overall, 123 patients were included, 48 (39%) female; mean age was 68±7 years. Sixty-nine patients (56%) had critical limb-threatening Ischemia, 46 (37%) diabetes mellitus, 5 (4%) end-stage chronic kidney disease in hemodialysis and 70 (57%) aortic calcification. Femoral accesses were percutaneous in 19 (15%) and surgical in 104 (85%) cases; additional brachial access was used in 49 (40%) patients. Simultaneous femoral endarterectomy was performed in 48 (39%) cases. Stentgrafts and bare metal stents were used in 32 (26%) and 91 (74%) cases, respectively. Technical success was 100%. Primary patency at 1, 3 and 5 years was 100%, 98±3% and 94±5%, respectively. At a mean follow up of 39 months, 4 (3%) stents thrombosis occurred. Freedom from reintervention at 1, 3 and 5 years was 99%, 93% and 81%, respectively. Calcification was associated with a higher 3-year reintervention rate: 13% vs 0%, p=.037. Brachial access, additional femoral endarterectomy and use of covered stents didn’t affect the reintervention rate. Conclusions. Kissing stent is an effective and safe technique to provide revascularization in aorto-iliac TASC C-D lesions with involvement of the aortic bifurcation, with good outcomes in terms of technical, clinical success and primary patency. It often needs an upper limb access and/or adjunctive procedures such as femoral endarterectomy. Presence of severe calcification is associated to a higher reintervention rate.

Abstract: Background/Objectives: Robotic-assisted abdominal wall reconstruction is increasingly used for complex ventral hernias; however, implementation in low-volume settings and early adoption of complex cases remain controversial. This study aimed to evaluate perioperative outcomes of robotic ventral hernia repair with early inclusion of complex cases and to compare these results with open surgery. Methods: Prospectively collected data were retrospectively analyzed for consecutive complex robotic ventral hernia repairs performed between September 2021 and December 2025. A cohort of consecutive open Rives–Stoppa repairs was included for comparison (n = 21 per group). Outcomes included operative time, length of hospital stay (LOS), and perioperative complications. Results: Operative time was significantly longer in the robotic group (median 310 vs. 118 minutes, p < 0.001). The median LOS was significantly shorter following robotic repair (3 vs. 5 days, p = 0.0018). Postoperative complications occurred in 10% of robotic cases and 24% of open cases (p = 0.41). Major complications and reoperation rates were low and comparable between groups. Complex robotic cases, including procedures requiring component separation, were introduced early without evidence of worse short-term outcomes. Conclusions: Robotic ventral hernia repair was associated with significantly shorter hospital stay compared with open surgery, despite longer operative times and higher procedural complexity. Complication rates were comparable between groups. Early inclusion of technically complex cases did not compromise short-term outcomes.

Abstract: Background: Hysterectomy is a prevalent gynecological procedure and ensuring appropriate use of minimally invasive approaches is essential to enhance the value and quality of care. The aim of this study was to evaluate, for the first time in a Romanian real-world cohort, the factors influencing the final choice of surgical route for hysterectomy and the subsequent impact on postoperative hospitalization. Methods: This is a retrospective analytical observational study conducted over a 4 year period (2021- 2025). The database comprised 961 cases of hysterectomy performed for benign gynecological conditions using laparoscopic (LH), abdominal (AH) and vaginal (VH) approaches in two tertiary centers. Results: The previously developed decision algorithm was implemented in a selected subgroup of approximately 332 (34,54%) patients, while the remaining 629 (65,45%) hysterectomies were performed according to surgeon preference or institutional resource availability. The mean duration of hospitalization of the entire lot was 6.88 days (SD= 2.70). In laparoscopic surgery, deviation was not associated with prolonged hospitalization, with results indicating a null effect, OR 1.08 (95% CI 0.72–1.62). In contrast, in the abdominal cohort, deviation was strongly associated with prolonged LOS, with OR 2.76 (95% CI 1.75–4.40). Conclusions: Patient-related factors shape the theoretical suitability of a surgical approach, but operator and institution-related factors determine whether that option is realistically available. Strengthening training in minimally invasive surgery across all clinics could reduce selection bias.

Abstract: Background: Conventional interrupted microvascular anastomosis can be performed by skilled surgeons, but it requires extensive experience and is time-consuming. In this study, we developed an intraluminal microtube anastomosis system (IMAS) incorporating circumferential intimal anchoring ridges that mechanically retain each arterial end during circumferential ligation. This study compared IMAS with conventional interrupted microsurgical anastomosis in a rat infrarenal abdominal aortic model. Methods: Forty male Sprague-Dawley rats were randomly allocated to IMAS (n = 20) or conventional interrupted microsurgical anastomosis (n = 20). The primary outcome variable was anastomosis time. Secondary outcome variables were patency at 1 week and 1 month, assessed using color Doppler ultrasonography and visual inspection at necropsy. Results: Mean anastomosis time was 5 min 30 s ± 60 s in the IMAS group and 20 min 32 s ± 75 s in the conventional group (P < 0.001), representing a reduction of approximately 73% in the IMAS group. One-week patency was 95% in both groups (19/20; P = 1.000). At 1 month, patency was 85% in the IMAS group (17/20) and 90% in the conventional group (18/20; P = 0.633). No gross device migration, aneurysmal dilatation, or anastomotic leakage was observed in patent IMAS-treated vessels. Conclusions: In this experimental model, IMAS significantly reduced anastomosis time while maintaining a short patency rate similar to that of conventional interrupted micro suturing. These results support the need for further evaluation of mechanical intimal fixation strategies, including future histological assessments and long-term follow-up.

Abstract: Background/Objectives: Expanded endoscopic endonasal approaches (EEA) provide direct ventral access to adult intradural skull base tumors; however, postoperative complications are variably defined and reported in the literature. This review aimed to synthesize the overall spectrum of adult intradural EEA complications and distinguish pathology-specific evidence from large mixed EEA complication cohorts. Methods: A PRISMA 2020 systematic review and meta-analysis searched PubMed/MEDLINE, Embase, and Web of Science from database inception through July 2026. Eligible studies included adults or adult-separable subgroups undergoing expanded EEA for intradural skull base tumors. The primary outcomes were CSF leak, meningitis or intracranial infection, new neurological deficit or vascular injury/stroke, hydrocephalus, mortality, and postoperative seizures. Pathology-specific adult intradural series with exact counts were quantitatively synthesized when appropriate, and large mixed EEA cohorts were summarized separately when the eligible subgroup was not separable. Results: The full-text screening set included 48 reports. Five exact-count reports, including one mixed-age contextual report, contributed to the CSF leak meta-analysis and yielded a random-effects incidence of 21.1% (95% CI, 12.2%-33.8%; I² = 69.4%). Excluding the mixed-age reports yielded 23.8% (95% CI, 14.5%-36.6%). Meningitis was reported in 6/166 patients (3.6%; 95% exact CI, 1.3%-7.7%), and new neurological deficit/vascular injury/stroke in 4/166 (2.4%; 95% exact CI, 0.7%-6.1%); these rare outcomes were summarized descriptively without continuity correction. Postoperative seizures were reported in 4/652 patients (0.6%) in two studies. Large mixed EEA cohorts have reported CSF leak rates of 1.6%-15.9% but these were not pooled because adult intradural tumor subsets were not separable. Conclusion: CSF leak was the most consistently reported complication after expanded EEA for adult intradural skull base tumors; however, its incidence varied substantially across pathologies and centers. Meningitis, neurological/vascular events, and seizures were uncommon in the extractable data and were better interpreted descriptively than as precise pooled rates. Large mixed EEA cohorts provide important safety context but cannot substitute standardized adult intradural, pathology-specific reporting.

Abstract: Background: Nutritional deterioration is a common consequence of gastrectomy for gastric cancer and may persist despite standardized perioperative care. However, prospective longitudinal evidence describing the early course of postoperative nutritional recovery remains limited. This study aimed to characterize nutritional recovery trajectories follo-wing curative gastrectomy and to evaluate the influence of the extent of gastric resection on postoperative recovery. Methods: We conducted a prospective longitudinal cohort stu-dy including 217 consecutive patients who underwent curative-intent subtotal or total gastrectomy for gastric adenocarcinoma between January 2022 and December 2025. Nutri-tional status was assessed preoperatively (T0), at hospital discharge (T1), and three mon-ths after surgery (T3) using serum albumin, total cholesterol, absolute lymphocyte count, and the Controlling Nutritional Status (CONUT) score. Longitudinal changes were evalu-ated using linear mixed-effects models with patient-specific random intercepts. Results: All nutritional parameters deteriorated significantly after surgery, reaching their lowest values at hospital discharge (all p < 0.001), followed by partial recovery at three months. Nevertheless, none returned to preoperative baseline values. Recovery between discharge and three months represented 65.6% of the initial decline for serum albumin, 50.5% for absolute lymphocyte count, 51.7% for total cholesterol, and 70.1% for the CONUT score. Longitudinal mixed-effects analyses demonstrated significantly less favorable recovery trajectories after total compared with subtotal gastrectomy for serum albumin (p = 0.025), lymphocyte count (p < 0.001), and CONUT score (p < 0.001), whereas cholesterol recovery did not differ significantly between procedures (p = 0.267). Conclusions: Nutritional reco-very following gastrectomy is a dynamic and prolonged process characterized by marked early deterioration and incomplete restoration during the first three postoperative months. Patients undergoing total gastrectomy experience slower recovery trajectories, supporting the implementation of risk-adapted postoperative nutritional surveillance and individua-lized nutritional interventions extending beyond hospital discharge

Abstract: Recurrent nonmelanoma skin cancer is a chronic, mutilating disease with great potential to leave cosmetic, functional, and emotional consequences. Aims: To examine the correlation between psychological symptoms, quality of life and resilience in people with recurrent nonmelanoma skin cancer. Methods: A clinical retrospective study was conducted at the Clinic for Otorhinolaryngology and Maxillofacial Surgery of the University Hospital Mostar in the period from February 2025 to April 2026. The study sample consisted of 160 patients who underwent surgery for nonmelanoma facial skin carcinoma. Data were collected with a sociodemographic questionnaire, the Symptom Checklist-90-R (SCL-90-R), the Connor Davidson Resilience scale 25 (CD-RISC-25) and World Health Organization Quality of Life Scale (WHQOL-BREF). Results: Correlation analysis showed significant associations between psychological symptoms, quality of life and resilience. All dimensions of psychological symptoms were statistically significantly negatively related to quality of life. Resilience measured by the CD-RISC scale showed a weak but statistically significant negative correlation with non-specific psychological symptoms. Patients with reccurent NMSC had significantly more psychological symptoms (F = 21.961, p < 0.001), lower quality of life (F = 12.788, p < 0.001), and lower levels of resilience (F = 4.174, p = 0.043). Conclusions: Psychological factors play an important role in patients with nonmelanoma skin cancer. An integrated biopsychosocial approach, which includes the assessment of psychological symptoms and resilience, may contribute to a better understanding of patients' needs and improve the quality of treatment.

Abstract: Closed reduction of facial fractures is among the most performed procedures in plastic and craniomaxillofacial surgery, yet it relies fundamentally on tactile feedback and visual assessment that provide no objective intraoperative confirmation of fracture alignment. Residual displacement may go unrecognized at the time of surgery, contributing to suboptimal functional and aesthetic outcomes and, in some cases, reoperation. Ultrasound offers a portable, radiation-free, and low-cost modality capable of generating real-time cortical bone imaging at the point of care, and its application as an intraoperative guidance tool during closed reduction has attracted growing interest across multiple facial fracture subtypes. This narrative review synthesizes the current evidence on ultrasound-assisted closed reduction of facial fractures, evaluates the technical approaches and clinical outcomes reported for nasal bone, zygomatic arch, and condylar fractures, examines the emerging role of point-of-care ultrasound in the craniomaxillofacial trauma setting, and identifies the gaps in evidence that must be addressed to establish ultrasound guidance as a standard adjunct in facial fracture surgery. The existing literature, though limited by small sample sizes and heterogeneous study designs, consistently demonstrates that intraoperative ultrasound can improve reduction quality for nasal and zygomatic arch fractures with the strongest evidence for complex fracture patterns in which palpation alone provides an unreliable endpoint. Emerging data for condylar fractures are promising. Larger prospective trials with standardized technical protocols and validated outcome measures are needed to define the indications, technique, and benefits of ultrasound guidance across the spectrum of facial fractures.

Abstract: Background: Surgical site infection (SSI) is a common complication after colorectal cancer (CRC) surgery. Although inflammation-based biomarkers have been investigated as prognostic indicators in CRC, their value for predicting superficial SSI using early postoperative laboratory findings remains unclear. We evaluated the utility of routinely available perioperative biomarkers for early prediction of superficial SSI after curative CRC surgery. Methods: This retrospective study included 488 patients who underwent elective curative resection for CRC. Preoperative and postoperative day (POD) 1 laboratory parameters, including serum albumin and inflammation-based biomarkers, were evaluated. Receiver operating characteristic curve analysis was performed to determine optimal cutoff values, followed by separate multivariable logistic regression analyses for preoperative and POD1 variables. Results: Superficial SSI developed in 66 patients (13.5%). A preoperative serum albumin level ≤3.70 g/dL was the only independent preoperative risk factor for superficial SSI (odds ratio [OR], 2.340; 95% confidence interval [CI], 1.166–4.695; P = 0.017). On POD1, a serum albumin level ≤2.80 g/dL (OR, 2.113; 95% CI, 1.021–4.376; P = 0.044) and a lymphocyte-to-monocyte ratio ≤4.60 (OR, 3.598; 95% CI, 1.559–8.302; P = 0.003) independently predicted superficial SSI. A combined model using preoperative serum albumin, POD1 serum albumin, and POD1 lymphocyte-to-monocyte ratio achieved an AUC of 0.691 (95% CI, 0.619–0.763), with 51.5% sensitivity and 80.3% specificity. Conclusions: Preoperative hypoalbuminemia and lower POD1 serum albumin and lymphocyte-to-monocyte ratio were independently associated with superficial SSI after curative CRC surgery. Assessment of these biomarkers may facilitate early identification of high-risk patients and support targeted preventive strategies.

Abstract: Objectives: To develop and validate a fully digital, surgeon-oriented interactive framework for final dental occlusion alignment in orthognathic patients. Methods: A digital framework integrating automatic alignment, using a two-dimensional Iterative Closest Point (2D ICP) algorithm with geometric corrections and optimization-based refinement, and an interactive graphical user interface (GUI) for standardized manual refinement were implemented in MATLAB. Validation was performed on preoperative digital models from 21 orthognathic patients. Obtained digital occlusions were compared with manually articulated physical models, considered the reference standard. Translational and rotational discrepancies were assessed before and after manual refinement. Results: The workflow was successfully completed in all 21 patients. Automatic alignment showed the largest translational discrepancy along the Y-axis (−2.26 ± 2.10 mm), which significantly improved after manual refinement (−1.17 ± 0.92 mm; p = 0.02). A small but significant increase in Z-axis discrepancy was observed (−0.91 ± 0.58 mm vs −1.19 ± 0.44 mm; p = 0.04), whereas X-axis differences were not significant (p = 0.22). Overall translational RMSE decreased significantly (1.83 ± 0.91 mm vs 1.09 ± 0.39 mm; p = 0.001). Individual rotational errors were unchanged (p = 0.08; p = 0.39; p = 0.43 for X-, Y- and Z-axes). Rotational RMSE significantly decreased from 2.00° ± 1.01° to 1.35° ± 0.25° (p = 0.01). Manual refinement reduced error variability, with standard deviations decreasing after standardized refinement. Conclusions: The proposed framework achieved high agreement with the reference manual occlusion. Automatic alignment provided a reliable starting point, but standardized manual refinement remained essential.

Abstract: Central lymphatic flow disorders remain a significant diagnostic and therapeutic challenge. Treatment typically follows a stepwise escalation approach, with reconstructive surgery being employed mainly in patients in whom conservative and interventional methods have failed or are contraindicated. Reconstructive lymphatic surgery, such as thoracic duct-vein anastomosis (TDVA), aims to restore physiological lymphatic drainage by creating a direct connection between the thoracic duct and the venous system. This review summarizes the current evidence on TDVA, including perioperative patient management, diagnostics, surgical techniques and clinical outcomes. Several case reports and case series reported successful surgical central lymphatic reconstruction, showing both safety and efficacy of this technique in both acquired and congenital lesions of the central lymphatic system. However, current evidence is limited to small case series, whereas prospective large-scale trials are lacking. Future studies should address optimal patient selection and timing of surgery in addition to conservative and interventional approaches, thus promoting the establishment of evidence-based guidelines for the treatment of central lymphatic disorders.

Abstract: Biliary tract cancer (BTC) remains challenging disease in which complete surgical resection often with liver resection is the only curative treatment. Although minimally invasive surgery (MIS) has become established in liver resection, its adoption for BTC has been deliberately cautious because oncologic BTC surgery often requires a demanding combination of major liver resection, regional lymphadenectomy, bile duct resection and reconstruction, and occasionally vascular resection and reconstruction. This narrative review evaluates recent advances in laparoscopic and robotic surgery for BTC from the perspective of liver surgery, emphasizing how procedure-specific tasks should define the role and expansion of MIS in each disease which belongs to BTC. Intrahepatic cholangiocarcinoma currently represents the most mature field for minimally invasive liver resection, whereas perihilar cholangiocarcinoma remains the most complex frontier because of multi-duct biliary reconstruction and potential vascular involvement besides major liver resection with caudate lobectomy. For gallbladder cancer, MIS has evolved from a historical contraindication toward selected oncologic extended resections, while distal cholangiocarcinoma is increasingly discussed within the expanding evidence base for minimally invasive pancreaticoduodenectomy. Across subtypes, robotics may add value to lymphadenectomy, hilar dissection and biliary-enteric reconstruction by improving dexterity and three-dimensional visualization. However, current evidence remains limited by retrospective study designs, selection bias, heterogeneous reporting, and insufficient long-term oncologic data. Future progress should be therefore based on centralization, structured training, prospective registries, and standardized quality metrics, including margin status, nodal yield, conversion, morbidity, time to adjuvant therapy, timing and pattern of recurrence, and overall survival.

Abstract: Multicentric breast cancer — two or more biopsy-proven tumour foci in anatomically distinct regions of the same breast — has historically been treated as a near-automatic indication for mastectomy, reflecting concerns about occult residual disease, achievability of negative margins at every focus, and unacceptable cosmetic outcome. This narrative review synthesises the evidence underlying that historical position and the more recent data that have begun to qualify it. The single-arm ACOSOG Z11102 (Alliance) trial reported a 5-year local recurrence rate of 3.1% after breast-conserving therapy for two to three ipsilateral foci and recent retrospective cohorts report comparable local control. These findings sit alongside a persistent and unresolved tension around preoperative MRI, which improves detection of additional foci but has not demonstrated improvement in local control or survival outcomes in randomised trials, despite increasing mastectomy conversion. We review the definitions and biology of multifocal and multicentric disease, the maturing role of oncoplastic technique, margin and radiotherapy planning considerations specific to multisite resection, the evolving use of neoadjuvant systemic therapy, hereditary cancer considerations, and the current guideline landscape (ASBrS, NCCN, ESMO, AGO). We propose a practical, multidisciplinary framework for patient selection and identify the principal gaps — absence of randomised comparison with mastectomy, unresolved necessity of routine MRI, and limited data on breast conservation after neoadjuvant therapy specifically in multicentric disease — that should guide both clinical decision-making and future research.

Abstract: Background and Clinical Significance: When burn patients develop cytopaenias, particularly thrombocytopaenia and anaemia, the aetiology is often multifactorial but usually linked to either systemic inflammatory response syndrome (SIRS) or wound sepsis. However, haematological derangements that are disproportionate to the burn severity pose a critical red flag and should raise suspicion for alternative pathology. The potential value of peripheral blood smear analysis in identifying alternative haematological pathologies in burn patients with unexpectedly severe cytopaenias is discussed. Case Presentation: We report a retrospective case review of a 12 year old female without co-morbidities, who sustained a minor 4% total body surface area scald burn and presented to a Burn Unit with severe gastrointestinal bleeding, thrombocytopaenia, anaemia, and leucocytosis unresponsive to conventional medical therapy. Investigations included gastroscopy, thromboelastography, blood cultures, and peripheral blood smear analysis. Management included fluid resuscitation, blood transfusions, antibiotics, pantoprazole, octreotide, and renal replacement therapy. The unexpectedly severe cytopaenia and poor response to transfusion support prompted peripheral blood smear analysis, which revealed findings consistent with acute promyelocytic leukaemia , confirmed by fluorescence in situ hybridisation demonstrating t(15;17) and PML/RARA fusion. The patient was commenced on All-Trans Retinoic Acid and Daunorubicin. Despite intensive multidisciplinary management, the patient developed multiorgan failure and died. Conclusions: This case illustrates how peripheral blood smear analysis helped identify an underlying haematological malignancy in a burn patient with unexpectedly severe or disproportionate cytopaenias, underscoring the importance of a broad differential diagnosis in this clinical context.

Abstract: Background: Primary malignant tumors of the inferior vena cava (IVC) are extremely rare. Objectives: To evaluate the results of surgical treatment of patients with primary leiomyosarcoma of the IVC. Methods: The study included 6 patients (mean age 56.8 ± 5.9 years) diagnosed with “primary leiomyosarcoma of the inferior vena cava” who underwent radical surgery between 2020 and 2025. Complication rate, graft patency, disease progression, and survival were analyzed. Results: In one case, a lateral resection of > 50 % of the circumference with patch plasty was performed; in the remaining cases, circular resections of 8–15 cm length were carried out. Biological vascular grafts made of bovine xenopericardium were used for reconstruction; in 3 patients, renal veins were additionally grafted. Combined resections (right nephroadrenalectomy, liver resection) were performed in 5 patients. Radicality (R0) was achieved in all cases. Complications included retroperitoneal hematoma and bleeding in 2 patients; thrombosis of the infrarenal IVC segment in 1; and partial thrombosis of the right renal vein graft in 1 patient (after 12 months). Kidney injury and venous insufficiency did not develop. Graft patency was preserved in the remaining cases. There was no mortality and no local recurrences were detected. Disease progression was observed in 1 patient after surgery (lung metastases after 6 months and liver metastases after 26 months). Mean follow-up was 32.5 months. Conclusions: Radical resection and reconstruction of the inferior vena cava using biological vascular grafts is a technically feasible, safe, and effective surgical approach for primary leiomyosarcoma.

Abstract: Medial thighplasty after massive weight loss carries high rates of wound dehiscence, seroma and prolonged edema, and there is evidence that thigh lift can alter lower limb lymphatic drainage. Conventional refinements such as liposuction assistance, limited undermining and fascial anchoring still rely on the surgeon’s implicit understanding of distorted lymphatic anatomy in post bariatric tissues. Direct intraoperative visualization of lymphatic pathways is not part of routine practice. We describe a simple adjunct based on preoperative intradermal methylene blue injection to map superficial lymphatic collectors before medial thigh lift. After standard markings in the standing position, a dilute methylene blue solution is injected intradermally along the planned medial thigh resection pattern once anesthesia is induced and before skin preparation. At flap elevation, lymphatic collectors appear as fine blue channels within the dermis and immediate subdermis, running parallel to the great saphenous axis and defining a practical limit for safe depth of dissection. The surgeon maintains dissection superficial to the stained collectors and avoids transfixing them with suspension sutures or deep liposuction passes. The technique is particularly useful in massive weight loss patients with thin, inelastic skin and deep folds in whom depth perception is unreliable, and for less experienced surgeons who are still developing three dimensional familiarity with the medial thigh. Methylene blue is inexpensive and easily integrated into the operative workflow without specialized equipment or relevant time cost. This lymphatic sparing mapping strategy merits prospective evaluation regarding its effect on seroma, lymphocele and postoperative edema after medial thighplasty.

Abstract: Background/Objectives: The aim of this study was to determine the oncologic outcomes for adult patients with primary extremity soft tissue sarcoma (ESTS) treated at the sarcoma referral center in the Republic of Slovenia. Methods: Patients from a prospectively maintained institutional database treated between January 2009 and December 2023 were retrospectively analyzed. The cohort was stratified into a high risk group (HRG) and a low risk group (LRG). Survival analyses focused on the HRG. Multivariable Cox models were constructed for local recurrence free survival (LRFS) and distant metastasis free survival (DMFS), and predictors of major wound complications were evaluated using multivariable logistic regression. Results: Among 315 included patients, 242 (76.8%) were in the HRG. In this group the median age was 61.5 years, 82.6% of tumors were in the lower extremity, and median tumor size was 9.0 cm. The most common histological subtype was undifferentiated pleomorphic sarcoma (28.5%). Clear margins were achieved in 86.8%, major postoperative complications occurred in 19.0%, and 60.7% of patients underwent radiotherapy. Local recurrence developed in 11.2%, regional recurrence in 5.0%, and distant metastasis in 32.6%. The corresponding 5-year overall survival, disease-specific survival, LRFS, and DMFS were 69.8%, 73.7%, 87.9%, and 66.8% in the HRG, respectively. In the LRG, only one local recurrence occurred and the 5-year LRFS was 100.0%. Preoperative radiotherapy showed a borderline association with major wound complications in the HRG (OR 2.70, 95% CI 1.00–7.28, p = 0.050). Tumor grade and size remained independent predictors of distant metastases, whereas margin status was not significantly associated with LRFS or DMFS. The primary amputation rate in the whole series was 2.9%. Conclusion: Treatment of primary ESTS patients in a specialized national referral cancer center achieved good overall survival (69.8%), a high limb salvage rate (97.1%), and good local control, affirming that routine primary amputation is rarely needed. Outcomes in high risk histologies remained driven mainly by distant metastases and showed clear histology specific differences, whereas low risk histologies had excellent outcomes with surgery alone. Preoperative radiotherapy was associated with a higher risk of major wound complications.

Abstract: The discovery of the glymphatic system and meningeal lymphatic vessels established that the brain possesses an organized lymphatic clearance network that drains to the deep cervical lymphatics, and that disruption of this system contributes to the accumulation of pathogenic proteins implicated in neurodegeneration. Cervical lymphatic reconstruction has shown early neurological benefit in Alzheimer’s and Parkinson’s disease, and preclinical work demonstrates that noninvasive manipulation of superficial cervical lymphatics increases cerebrospinal fluid outflow. Whether noninvasive cervicofacial lymphedema therapy can produce comparable neurological effects remains unknown. We report two men with Parkinson’s disease (Hoehn and Yahr stages 2.5 and 3) treated with a standardized cervicofacial lymphedema therapy protocol targeting cervical and facial lymphatic pathways. Total MDS-UPDRS scores improved in both patients, by 19 points (−34.5%) in Patient 1 and 5 points in Patient 2, each meeting or exceeding the minimal clinically important difference. Improvements were reproducible and session-linked, and were accompanied by motor and non-motor gains in cognition, alertness, mood, energy, and sleep; interruption of therapy was associated with return toward baseline. Cervicofacial lymphedema therapy may represent a low-risk, noninvasive strategy for modulating brain lymphatic clearance in Parkinson’s disease.