Medicine and Pharmacology

Abstract: Ectopic positioning of the gallbladder within the hepatic parenchyma is uncommon and can substantially increase surgical complexity. A 25-year-old woman with gastroschisis, prior abdominal operations, short bowel syndrome, and gastroileostomy bypass presented with recurrent acute cholecystitis despite prior drainage and stenting. Laparoscopy was abandoned due to dense adhesions preventing exposure, prompting open exploration. The gallbladder was discovered buried in the liver and was accessed safely through limited parenchymal transection followed by dome-down dissection. After confirmation of a single outflow tract, the inflamed infundibular-cystic duct region was divided with a linear stapler. Ultimately, subtotal cholecystectomy was avoided due to her altered gastrointestinal anatomy, making postoperative endoscopic management difficult in the event of a leak or retained remnant. Nevertheless, she recovered uneventfully and was discharged on postoperative day 2. This case emphasizes the importance of individualized operative strategy when aberrant anatomy coexists with limited rescue options.

Abstract: Introduction: Endovascular treatment (EV) of aortoiliac TASC II D lesions is increasingly common, yet evidence directly comparing long-term outcomes with open surgical repair (OSR) remains limited, particularly for complete iliac axis occlusions (CIAO). This study compares outcomes between CIAO patients treated with OSR and EV approach using covered stents. Method: Thirty-nine consecutive CIAO cases received EV treatment (2014-2017) using standalone or combined balloon-expandable and self-expandable covered stents. A historic control of 29 aorto-femoral bypasses (OSR, 2007-2014) was included for comparison. Clinical and ultrasound-based imaging follow-up extended for a median of 109 months, with half of the uncensored cases followed beyond ten years. In-hospital stay, primary, assisted, and secondary patencies, reintervention rates, and overall survival were the main outcomes, defined per Society for Vascular Surgery (SVS) reporting standards. Results: The EV group was older and had a higher (though not statistically significant) prevalence of smoking, chronic obstructive pulmonary disease, and renal failure. Ten-year survival was comparable between groups (59% EV vs. 52% OSR, p=0.725). OSR was predominantly performed through a retroperitoneal approach (93.1%) using Dacron grafts; in the EV group, 66.7% of cases required a kissing stent reconstruction of the aortic bifurcation and 74.3% required femoral patch plasty. Hospital stay was significantly shorter after EV (median 5 vs. 10 days, p<0.001). No significant differences emerged in the ten-year reintervention rate (35.9% EV vs. 31.0% OSR, p=0.675), amputation-free survival (94.9% vs. 86.2%, p=0.390), or primary (62% vs. 74%, p=0.722), assisted (78% vs. 75%, p=0.679), and secondary (94% vs. 84%, p=0.323) patency. Conclusion: EV treatment of CIAO using covered stents may offer a shorter hospital stay than OSR, without significant differences in long-term primary, assisted, and secondary patency, supporting its role as a durable alternative even in this complex anatomical subset.

Abstract: Background: Pancreaticoduodenectomy (PD) is one of the most complex surgical procedures and remains associated with substantial postoperative morbidity. Identification of factors associated with severe postoperative complications may improve perioperative management and patient outcomes. Methods: Patients aged 18 years or older who underwent elective pancreaticoduodenectomy for periampullary tumors between January 2021 and January 2026 were retrospectively reviewed. Demographic characteristics, preoperative laboratory findings, percutaneous transhepatic cholangiography(PTC) and endoscopic retrograde cholangiopancreatography(ERCP) history, operative details, length of hospital stay, and postoperative complications were analyzed. Factors associated with severe complications (Clavien-Dindo Grade III or higher) were evaluated using univariate and multivariate analyses. Results: A total of 84 patients were included. The rates of pancreatic fistula were 22.6%, 6.0%, and 3.6% for Grade A, B, and C, respectively, yielding an overall fistula rate of 32.2%. Severe complications occurred in 30.9% of patients. Univariate analysis demonstrated significant associations between severe complications and preoperative albumin level, malignant-benign pathology distinction and pancreatic fistula. Multivariate analysis identified low preoperative albumin level (p=0.013), malignant pathology (p=0.013) as independent factors associated with severe postoperative complications. Conclusions: Severe postoperative complications remain common following PD. Low preoperative albumin levels, malignant pathology were independently associated with severe complications. Particular attention should be given to patients with hypoalbuminemia and malign pathology undergoing elective PD.

Abstract: Background: Vascularized free-flap reconstruction reliably restores mandibular continuity, but dental rehabilitation is delivered inconsistently. As dental rehabilitated has been examined almost entirely through a clinical lens, we investigated how social determinants of health (SDOH) affect dental rehabilitation receipt after mandibular reconstruction. Methods: Scoping review of literature was performed combining terms for mandibular reconstruction, dental rehabilitation, and social determinants. Studies were charted by SDOH exposure and rehabilitation outcome. Results: Reported rehabilitation ranged from roughly 20% to 78%. Nearly every study examined clinical determinants alone. One study measured a social exposure against rehabilitation receipt, finding race associated with implant placement and cost the most cited barrier; a second measured SDOH in the relevant surgical population but reported only surgical outcomes. Conclusions: Whether social circumstance determines dental rehabilitation after mandibular reconstruction is essentially unstudied. The financing divide is a plausible, measurable mechanism, and cohort studies designed around SDOH exposures are needed.

Abstract: Background: Disease recurrence is common after surgery for pleural mesothelioma (PM), and evidence guiding post-recurrence management remains limited. Methods: We conducted a retrospective, single-center cohort study including patients with PM treated within a curative-intent multimodality treatment pathway including surgery aiming for macroscopic complete resection when feasible between 2001 and 2024. Post-recurrence treatments were categorized as best supportive care only (BSC), systemic therapy alone, or local with or without systemic therapy. Survival and disease-free outcomes were analyzed in relation to treatment patterns and clinical prognostic factors. Results: Among 67 patients with a median follow-up time of 107 months from surgery, 58 (86.6%) developed disease recurrence. At first recurrence, 21 patients (36%) received local with or without systemic therapy, 26 (45%) systemic therapy alone, and 11 (19%) BSC. Median post-recurrence survival was 21.7 months for patients receiving local with or without systemic therapy, 10.8 months for systemic therapy alone, and 1.6 months for BSC. Lung-sparing surgery and a disease-free interval of at least 12 months were associated with improved post-recurrence survival and post-recurrence progression-free survival. Conclusion: In this real-world cohort of patients with PM with extended follow-up, active post-recurrence treatment was associated with longer post-recurrence survival in selected patients. However, conclusions regarding comparative effectiveness are limited by the retrospective design, incomplete recurrence-related data, and patient selection at recurrence.

Abstract: Multiportal video-assisted thoracoscopic surgery (VATS) was introduced in Japan in the 1990s, with uniportal VATS (U-VATS) and robot-assisted thoracic surgery (RATS) following in the 2010s. U-VATS gained significant traction after the 1st Japanese Society of Thoracic Surgeons (JSTS) Fellowship in 2018, leading to the establishment of the Japanese Uniportal VATS Interest Group (JUVIG) in April 2018. JUVIG has since driven wider adoption through extensive activities, including educational programs, publications, and collaborative multicenter studies. As a result, expert surgeons now utilize U-VATS for complex procedures such as bronchoplasty, completion lobectomy, complex segmentectomy, and pediatric surgery. Concurrently, RATS gained insurance coverage in Japan in 2018 and has become more prevalent than U-VATS. Despite the significant costs associated with RATS, its adoption rate surpasses that of U-VATS due to institutional policies, perceived ease of implementation, branding, recruitment incentives, and recent national healthcare insurance reimbursement revisions (add-ons) introduced in 2026, which exert administrative pressure to prioritize robotic cases. Although reduced-port RATS is gaining popularity—blurring the lines with U-VATS—and newly emerging indigenous robotic platforms are expected to further accelerate RATS adoption, multiportal VATS (M-VATS) remains the dominant approach in many institutions. Furthermore, maintaining proficiency in VATS, U-VATS, and open thoracotomy remains indispensable for surgical education, economic viability, and acute intraoperative crisis management. Ultimately, while U-VATS represents a promising minimally invasive option, its widespread adoption for major and complex resections in Japan continues to be restricted by both educational and societal barriers.

Abstract: Couinaud’s eight-segment model remains the universal language of liver surgery, yet contemporary multidetector computed tomography (CT), its three-dimensional (3D) reconstruction, and minimally invasive surgery have exposed substantial variability in third-order or more peripheral portal branching. This variability becomes clinically important when hepatocellular carcinoma and other liver malignancies are treated with parenchymal-sparing small anatomical resections where third-order or more peripheral portal territories define the oncologic unit at risk. In this article, the current surgical anatomy for liver cancers was reviewed focusing at third-order portal branches, comparing classical Couinaud segmentation with CT/3D reconstruction-based portal territories. Clinically relevant variability in the right anterior (S5/S8) and right posterior (S6/S7) sections are described while also highlighting that comparable discordance exists in the left hemi-liver. In the right anterior section, craniocaudal, ventrodorsal, trifurcation, and other branching patterns may alter the practical interpretation of S5/S8 anatomy. In the right posterior section, bifurcation and loop-type portal configurations have distinct implications for S6/S7-oriented resection and cone-unit-based anatomical resection. Comparable variability in the left hemiliver, particularly around the umbilical portion and segment 4 branches, further supports individualized preoperative territory mapping. A pragmatic two-tier surgical strategy is proposed; Couinaud-based resection for first/second-order anatomy and individualized CT-guided cone-unit resection for third-order or more peripheral anatomy. Current status of preoperative simulation and intraoperative implementation using ultrasound, indocyanine green fluorescence, and navigation/fusion technologies are discussed. Finally, emerging directions including automated vessel segmentation and AI-assisted territory analysis are also discussed.

Abstract: Background. Cardiovascular surgery addresses a heterogeneous group of acquired and congenital diseases whose precise definition and epidemiological magnitude condition teaching, research and health planning. Sub-Saharan Africa displays a disease spectrum that differs profoundly from that of high-income countries, yet no synthesis has combined a rigorous nosological framework with disease frequencies at the global, African and national (Ivorian) levels. This review aimed to restate the reference definitions of the main cardiovascular surgical diseases and to quantify their frequency at these three geographical levels. Methods. Narrative review based on the classical didactic references (Rulliere; Kirklin/Barratt-Boyes; Batisse; the French medical-surgical encyclopaedia; the French vascular surgery curriculum reporting the definitions of Broca, Dubost, Fabiani, and Cabanne and Bonenfant), on contemporary global datasets (European Society of Cardiology EURObservational VHD II survey; Global Burden of Disease 2021 analyses), and on the major African and Ivorian hospital series: the VALVAFRIC registry, the Abidjan Cardiology Institute echocardiographic series, and the Douala neonatal and infant series. Results. The classical definitions remain fully operational at the bedside and in the echocardiography laboratory. Epidemiologically, valvular heart disease displays a reversed profile: degenerative aortic stenosis dominates in Western countries (41.2% of valvular diseases in the ESC survey), whereas rheumatic mitral regurgitation dominates in sub-Saharan Africa (52.8% in VALVAFRIC) and in Cote d’Ivoire (36%). Ventricular septal defect is the leading congenital heart disease at all three levels (30% worldwide; 31.1% in Africa; 21.5% in Cote d’Ivoire). Emerging atherosclerotic disease completes the picture: peripheral artery disease affects 14.8% of Central Africans over 64 years and 15.8% of at-risk Ivorian adults in a recent national screening programme. Access to surgery remains marginal: only 2.2% of patients requiring valve surgery were operated on in VALVAFRIC, and the mean cost of a cardiovascular procedure in Cote d’Ivoire (USD 5,669) remains out of reach of most households. Conclusions. The burden of surgical cardiovascular disease in sub-Saharan Africa is heavy, young and rheumatic, while surgical capacity remains scarce. The relaunch of the Abidjan Cardiology Institute, the construction of the Bouake Cardiology Institute and the 2025 Accra Declaration open a credible path towards closing the gap, provided that local epidemiological registries, training and solidarity-based financing follow.

Abstract: Background: Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory breast disease with variable response to corticosteroid therapy. This study aimed to identify predictive factors for steroid responsiveness in IGM patients. Methods: A retrospective analysis of 176 patients with IGM treated at Çukurova University Faculty of Medicine, Department of General Surgery between 2011 and 2019 was conducted. Patients were divided into steroid-responsive (Group 1, n=100) and non-responsive (Group 2, n=76) groups. Demographic characteristics, clinical features, and treatment history were compared using the chi-square test, Mann-Whitney U test, and multivariate logistic regression analysis. Results: Mean age was 39.1 ± 7.6 years. Factors associated with steroid non-responsiveness included extramammary symptoms (40.8% vs. 26.0%, p = 0.038), recurrent disease (21.1% vs. 8.0%, p = 0.012), a higher number of previous attacks (median 2 vs. 1, p < 0.001), previous abscess drainage (31.6% vs. 14.0%, p = 0.005), previous surgical treatment (30.3% vs. 7.0%, p < 0.001), and longer steroid treatment duration (median 6 vs. 4 months, p = 0.006). Multivariate analysis identified recurrent disease (OR = 0.283, p = 0.015), abscess drainage (OR = 0.307, p = 0.007), previous surgery (OR = 0.170, p = 0.001), and steroid treatment duration (OR = 0.880, p = 0.008) as independent predictors of poor steroid response. Conclusions: Steroid non-responsiveness in IGM is associated with disease recurrence, previous abscess drainage, previous surgical intervention, and prolonged steroid therapy. Alternative treatment modalities should be considered in patients with these characteristics.

Abstract: Pes planus in adults and elderly is commonly caused by advanced tibialis posterior insufficiency with 2ndry osteoarthritis; however, the deformity can also be caused by arthritis of tarsometaarsal joints or an old injury of the mentioned joints. Concomitant valgus deformities of the ankle joint are found in approximately 3% patients with symptomatic flat foot deformities. Conservative treatment is mostly successful only in the short term or in low-demand patients. The operative treatment of flat foot deformities follows the standard algorithm for flat foot treatment. The ankle joint can be treated while retaining mobility or by arthrodesis depending on the degree and rigidity of the deformity, degenerative changes, patient factors, and expectations. Achieving an orthograde hindfoot and midfoot is obligatory for successful treatment as well as in ankle reconstructive or arthrodesis procedures. On clinical examination, the medial arch of the foot has collapsed, and the calcaneus is in a valgus alignment, the forefoot abducts at the tarsometataral articulations.Treatment is nonoperative with orthotics and ankle braces in initial stages, custom moulded in-shoe orthosis. The surgical treatments are indicated for symptomatic pesplanovalgus when there is pressure and pain symptoms failing to respond to pain killers and splints. The following surgical procedures has been proposed; first TMT joint arthrodesis, calcaneal osteotomy, ± lateral column lengthening, isolated subtalar arthrodesis, hindfoot arthrodesis, triple arthrodesis, and TAL + deltoid ligament reconstruction, forefoot correction osteotomy. The choice of the procedure selected for surgical correction depends on where the peak of the deformity; the peak of the deformity must be identified and an appropriate procedure is chosen accordingly chosen. Triple arthrodesis is the commonest procedure used for treating degenerative pesplanovalgus deformity. The outcome of surgery is dependent on the multitude of procedures. The success of triple arthrodesis depends on the patient's overall health, the extent of deformity, and the surgeon's expertise. While the procedure effectively relieves pain and corrects deformity, it may result in some loss of motion in the foot and possible complications. However, most patients experience significant improvement in foot function and pain relief, allowing them to resume normal daily activities with better stability. The aim of the current review article is to highlight that the appropriate procedure must correct the peak of the deformity.

Abstract: Background. Robotic-assisted colorectal surgery is increasingly adopted; however, evidence regarding outcomes during the early implementation phase remains limited. This study aimed to evaluate the feasibility, safety, and short-term outcomes of a newly established robotic colorectal surgery program at a tertiary referral center. Methods. All consecutive patients undergoing robotic colorectal resection between November 2019 and February 2026 were prospectively recorded and retrospectively analyzed. Perioperative outcomes, conversion rates, postoperative complications, mortality, and histopathological results were assessed. Results. A total of 177 patients were included, with a progressive increase in surgical volume over time. Most procedures were performed for oncological indications (159, 90%), while 18 (10%) were performed for benign diseases. The most frequent procedures were right hemicolectomy (45%), left hemicolectomy (29%), and low anterior rectal resection (23%). Mean operative time was 331.1 ± 75.0 minutes. Conversion to open surgery occurred in 15 patients (8.5%), mainly due to extensive intra-abdominal adhesions, particularly during the early phase of the program. Postoperative complications occurred in 20 patients (11%), while 3 patients (2%) died within 30 days. Major complications (Clavien–Dindo ≥III) occurred in 7%, and anastomotic leakage in 3%. Mean hospital stay was 10.1 ± 7.6 days. R0 resection was achieved in all cases, with adequate lymph node retrieval for staging. Conclusions. Robotic colorectal surgery can be safely implemented at a tertiary center, achieving favorable perioperative and oncological outcomes even during the early learning phase.

Abstract: Background/Objectives: Deep endometriosis surgery may require bowel and multiorgan procedures. We quantified the frequency of a hemoglobin decline of at least 3 g/dL and examined associations with surgery duration and clinically recognizable measures of operative extent. Methods: This single-center retrospective cohort included the first eligible surgery per patient from 2020 through 2025. Hemoglobin decline was the last preoperative value within 7 days before surgery minus the lowest recorded postoperative value through day 3. Multivariable regression examined a decline of at least 3 g/dL and continuous decline; secondary analyses assessed operative extent, models excluding preoperative hemoglobin, and missing data. Results: Among 424 patients, 416 (98.1%) had paired measurements; 156/416 (37.5%) met the primary outcome. Each additional surgical hour was associated with higher odds (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.35–1.91); the estimate was similar without preoperative hemoglobin (OR, 1.50; 95% CI, 1.28–1.76). Continuous decline was 0.20 g/dL greater per hour (95% CI, 0.13–0.26). The lowest recorded postoperative value occurred on days 2–3 in 242/421 patients (57.5%); sampling was not standardized. Among 379 patients with available resection-multiplicity data, exploratory outcome rates were 14.5%, 38.3%, and 54.9% after no, one, and multiple full-thickness bowel resections, respectively. Conclusions: A hemoglobin decline of at least 3 g/dL occurred after 37.5% of surgeries. Longer duration was associated with greater decline; exploratory analyses suggested gradients with operative extent. Their monitoring value requires prospective evaluation. Preoperative anemia remains relevant because the same decline produces a lower postoperative concentration.

Abstract: Background/Objectives: Systemic inflammatory indices may differ prognostically between resectable and palliative pancreatic cancer. We compared associations of the aggregate index of systemic inflammation (AISI), systemic inflammation response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and monocyte-to-lymphocyte ratio (MLR) with overall survival after pan-creatic resection or palliative bypass. Methods: This single-center retrospective cohort included 240 patients treated during 2013–2023 (99 resections; 141 palliative bypasses). Indices derived from preoperative blood counts were natural-log transformed, standardized to 1 SD, and entered separately into operative-group-stratified Cox models. Group-specific associations and interactions were estimated. Reconstructed AJCC eighth-edition stage was incorporated only in the resection stratum. Interaction p values were Holm-adjusted. AISI was designated primary and SIRI key secondary. Results: Overall, 215 deaths occurred. Median overall survival was 17.9 months after resection and 5.4 months after palliative bypass. AISI was associated with mortality following bypass (adjusted hazard ratio [HR] per 1-SD increase in ln(AISI), 1.54; 95% confidence interval [CI], 1.28–1.86) but not following resection (HR, 0.97; 95% CI, 0.75–1.25; interaction p = 0.003; Holm-adjusted p = 0.010). SIRI showed corresponding HRs of 1.60 (95% CI, 1.30–1.96) and 0.93 (95% CI, 0.72–1.20), respectively (interaction p = 0.001; Holm-adjusted p = 0.004). MLR also demonstrated heterogeneity, whereas NLR and SII did not. The AISI and SIRI findings remained robust in sensitivity analyses. Conclusions: AISI and SIRI demonstrated operative-context-dependent associations, principally after palliative bypass. Because comparable staging was unavailable in this group, residual confounding by disease extent remains possible. Prospective multicenter validation is required before clinical implementation.

Abstract: Background: A narrow waist is one of the central objectives of aesthetic body contour-ing, and it is closely tied to the waist-to-hip ratio that observers associate with a feminine silhouette. Conventional soft-tissue techniques such as liposuction and liposculpture are constrained by patient-specific anatomy, including the pattern of adipose tissue distribution and the transverse dimensions of the bony rib cage. Minimally invasive rib re-modeling was developed to overcome these constraints and to produce a more pronounced waist-narrowing effect without rib removal. The factors that determine the magnitude of the result and patient satisfaction have not been characterized in sufficient detail. Methods: A combined retrospective–prospective single-center study was conducted on 60 female patients aged 22 to 55 years (mean age, 35.5 years) who underwent minimally invasive rib remodeling using the Kudzaev technique between 2017 and 2025. The variables assessed included anthropometric measurements, body mass index (BMI), sub-cutaneous and visceral adipose distribution, body shape, endocrine status, and psycho-logical readiness to adhere to the postoperative regimen. Outcomes were evaluated at three months on the basis of the change in waist circumference, standardized photo-graphic documentation, and patient satisfaction (5-point scale) and the BODY-Q Satis-faction with body scale. Results: The mean reduction in waist circumference was 7.82 ± 2.14 cm. Both the re-duction and patient satisfaction decreased with increasing BMI (Pearson r = −0.30 and −0.42, respectively): patients with a BMI ≤ 25 kg/m² (n = 59) achieved a mean reduction of 7.86 ± 2.12 cm and a satisfaction score of 4.25 ± 0.96, whereas the single patient with a BMI > 25 kg/m² obtained a smaller reduction (5 cm) and the lowest satisfaction score. The BODY-Q Satisfaction with body scale corroborated these results (Rasch-transformed score, 82.6 ± 18.3) and correlated strongly with the 5-point rating (Pearson r = 0.90). Elevated BMI and a pronounced visceral fat component were associated with a less favorable aesthetic outcome. Endocrine disease, in particular hyperparathyroidism, was associated with delayed rib consolidation and lower satisfaction. Poor postoperative compliance, especially inconsistent corset wear, was linked to unsatisfactory results. Conclusions: The effectiveness of minimally invasive rib remodeling depends substantially on patient selection. The most favorable outcomes were obtained in patients with a normal BMI, minimal adipose tissue, and a high level of compliance. Elevated BMI, excess visceral fat, endocrine disorders, and low motivation are risk factors for an unfavorable outcome. These findings support rigorous preoperative selection that accounts for both somatic and behavioral characteristics.

Abstract: Background and Objectives: Bile duct injury remains a major safety concern during laparoscopic cholecystectomy, and reliable interpretation of hepatocystic anatomy is fundamental to safe dissection. Artificial intelligence (AI)-based computer vision may support anatomical recognition, critical-view-of-safety (CVS) assessment, and intraoperative decision support. This narrative review synthesized the current evidence, clinical applications, readiness for implementation, and future requirements of anatomy-aware AI during laparoscopic cholecystectomy. Materials and Methods: Five bibliographic databases were searched through 15 August 2026, supplemented by citation tracking and targeted searches. Studies were classified according to clinical task, dataset, reference standard, validation design, performance metrics, real-time capability, human-factor assessment, and clinical-readiness stage. The evidence base comprised 105 verified references: 50 primary AI reports and 55 contextual or methodological sources; 39 direct model-development or evaluation reports were characterized in detail. Results: Investigated applications included landmark detection, semantic segmentation, CVS assessment, safe- and hazard-zone mapping, multimodal analysis incorporating indocyanine green fluorescence, automated documentation, education, and real-time perceptual prompting. Among the 39 direct reports, 24 remained at the offline proof-of-concept or internal-validation stage, eight achieved temporal, external, or multicenter validation, six demonstrated prospective operating-room feasibility, and one reached post-deployment surveillance. The latter evaluated a surgical-process outcome rather than patient morbidity. Generalizability was constrained by dataset overlap, heterogeneous reference standards and metrics, domain shift, and underrepresentation of difficult cholecystectomy. No included study demonstrated reduced bile duct injury or other patient-level benefit. Conclusions: Anatomy-aware AI has progressed from technical feasibility to early clinical translation, with the strongest near-term rationale in documentation, video triage, education, coaching, and quality assurance. Surgeon-facing deployment should remain adjunctive, staged, and risk proportionate, requiring multicenter and temporal validation, explicit uncertainty and abstention mechanisms, human-factor evaluation, comparative-effectiveness studies, and continuous post-deployment surveillance before routine clinical adoption.

Abstract: The surgical procedure currently known as arthroereisis has been performed for decades as a treatment for recurrent adult-acquired and pediatric flexible talotarsal deformity, yet its name has never been formally challenged despite being etymologically and anatomically inaccurate. The term derives from the Greek arthro (joint) and ereisis (to lift or support), implying joint-level action that does not occur — the sinus tarsi implant acts not on a joint surface but on the talar body itself, physically elevating and realigning the talus as a whole bone and producing a cascade of pantalar corrections across the subtalar, talonavicular, calcaneocuboid, and talocrural joints simultaneously. Radiographic evidence from unilateral cases demonstrates measurable talar elevation of 1.8 cm between treated and untreated limbs on weight-bearing views, confirming that the corrective effect is osseous, not articular. This article proposes the adoption of the term osteoereisis — from the Greek osteo (bone) and ereisis (to lift or support) — as an anatomically precise replacement that correctly identifies the talus as the primary object of surgical effect and more fully reflects the pantalar scope of the correction achieved. The author invites collegial discussion of this proposal within the podiatric and foot and ankle surgical community.

Abstract:

Surgical treatment for rectal cancer has evolved to improve outcomes. To this end, we conducted a comparative study analyzing the postoperative, pathological, and oncological outcomes of two techniques for the treatment of mid- and lower rectal cancer: Transanal Total Mesorectal Excision (TaTME) and Robotic Total Mesorectal Excision with TTSS anastomosis using the TEOâ platform (_RTME/TTSS_TEO). A total of 146 patients who underwent surgery between 2012 and 2025 at a tertiary care center were included. Both groups were comparable in baseline characteristics and staging. The robotic technique was associated with longer operative time but a lower overall complication rate and a trend toward fewer clinical suture failures. The quality of the mesorectum and the rate of R0 resections were high in both approaches. At follow-up, local recurrence was lower in the robotic group, although the duration of follow-up was shorter. The results suggest that _RTME-TTSS_TEO is a safe alternative and potentially superior in terms of overall morbidity and mortality compared to TaTME.

Abstract: Colorectal cancer (CRC) is one of the most common malignancies worldwide, and while metastasis commonly occurs in the liver and lungs, brain metastases from CRC are rare. Solitary brain metastasis in young adults is particularly uncommon. This case report a rare presentation of brain metastasis in a patient with a history of colorectal cancer. Emergency radiotherapy is often considered for symptomatic patients with intracranial hypertension or rapid neurological deterioration, but its benefits may be transient in aggressive tumor biology. We report the case of a 35-year-old male with a history of T3N2bM1a colorectal adenocarcinoma who presented with new-onset neurological symptoms, including headaches and right-sided hemiparesis. CT imaging revealed multiple brain lesions, including solid and hemorrhagic components with erosion of the left frontalis bone and brain edema, suggestive of metastatic disease. Given the rapid neurological decline, the patient was managed with a multidisciplinary approach, including corticosteroids to reduce cerebral edema, followed by whole-brain radiotherapy (WBRT) to address the metastatic lesions. Neurological symptoms improved within days, with partial resolution of hemiparesis. Surgical resection was deferred due to high perioperative risk and patient preference. The clinical improvement was short-lived. Follow-up imaging at 3 months demonstrated lesion progression with increased mass effect, accompanied by worsening neurological function after 4 months. This case highlights the rare occurrence of solitary brain metastasis from CRC in a young patient. It underscores the potential but transient benefit of emergency radiotherapy in rapidly deteriorating neurological states. Early recognition, individualized treatment planning remain essential in optimizing quality of life.

Abstract: Background: Surgical hand preparation, patient skin antisepsis, draping readiness and sterile-table set-up are often taught as separate rituals, although delays and failures arise at their interfaces. Evidence also spans microbiology, infection prevention, human factors and education, making it difficult to define what learners should time, observe, communicate and re-check. Methods: A rapid scoping review mapped global indexed evidence on three sterile-start processes: surgical hand preparation; the transition from skin antisepsis to draping or incision; and sterile-field or instrument-table set-up. Web of Science and Scopus were searched from inception to 2 August 2026. Records were deduplicated and subjected to a high-recall rule-assisted primary screen. All candidate records underwent eligibility verification, and the full text of every included source was confirmed, verified and analysed by the author team. Data were charted by domain, design, specialty, educational outcome and first indexed affiliation region. Findings were integrated into the proposed Surgical Timing and Aseptic Readiness Tool for the Operating Room (START-OR). Results: Of 5747 imported records, 298 duplicates were removed, 747 candidates underwent structured eligibility verification and 143 full-text evidence sources were included after author-team confirmation and analysis. The map comprised 30 education, assessment or implementation sources; 44 surgical hand-preparation sources; 61 skin-preparation sources; and eight sterile-field or table sources. Evidence did not support one universal minute value across products and contexts. Instead, hand preparation required product-specific technique, complete coverage, specified duration and drying; skin preparation required complete visible drying, absence of pooling and fire-risk control before draping; and sterile-field management required minimizing unnecessary open exposure and re-validating integrity after delay. Educational studies identified recurrent gaps in timing accuracy, coverage, feedback, monitoring and shared responsibility. START-OR therefore separates team, patient and field clocks, then reunites them at a voiced sterile-start pause and seven readiness gates. Conclusions: Perioperative education should replace memorized universal times with observable readiness criteria, interprofessional verification, simulation of delays and feedback linked to patient-safety outcomes. START-OR is a proposed, unvalidated curriculum and quality-improvement model that requires prospective multicentre testing before clinical adoption.

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.