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At least 37 records · Page 2Linked to original sources
PubMed2026

Long-term outcomes of surgical correction of ventral penile curvature in children: Patient-reported measures, surgical results, and decisional regret.

INTRODUCTION: There is a dearth of data on long-term outcomes, including patient-reported outcomes (PROMs), decisional regret, and complication rates for surgical correction of isolated ventral penile curvature in childhood. PATIENTS AND METHODS: Twenty-six children treated for ventral curvature between 1993 and 2008 were identified; 24 met inclusion criteria (isolated ventral curvature without hypospadias or need for urethral reconstruction). Surgical correction consisted of degloving alone or degloving with Nesbit-like dorsal plication when residual curvature >20° persisted after degloving. PROMs were collected via pre-mailed validated questionnaires after puberty: Danish Prostatic Symptom Score (DAN-PSS) for LUTS, Erection Hardness Score (EHS) for erectile function, Penile Perception Score (PPS) for cosmetic perception, and items assessing decisional regret and perceived appropriateness of surgical timing. RESULTS: Curvature was corrected intraoperatively in all 24 patients. Twelve underwent degloving alone and 12 required additional dorsal plication. During long-term follow-up (median 14.2 years), one patient (4%) underwent re-operation for residual curvature, and three (13%) underwent cosmetic revisions; two (8%) underwent cystoscopy for flow concerns. 71% returned PROMs at a median age of 16.2 years. LUTS were uncommon, with low bother scores. Erectile function was favorable: 87% (13/15) reported EHS 4 and 93% (14/15) reported ejaculation. Cosmetic outcomes were favorable, with PPS dissatisfaction rates comparable to controls. Two patients reported dissatisfaction with overall appearance, and one with residual subjective curvature. No patient expressed decisional regret, and 88% felt timing of surgery was appropriate. CONCLUSION: Early surgical correction of isolated ventral penile curvature using degloving with or without dorsal plication provided durable anatomical correction and favorable long-term functional and cosmetic outcomes. These findings support early intervention as an effective approach with sustained patient-perceived benefits.

Humans↗
PubMed2026

Do wound protectors reduce contamination in total shoulder arthroplasty? A randomized controlled trial.

HYPOTHESIS: Cutibacterium acnes is the most frequent cause of shoulder prosthetic joint infection with skin edges as a source of wound contamination. The primary purpose of this study was to determine if the use of a wound protector device decreases the deep wound bacterial colonization in primary shoulder arthroplasty. The secondary purpose was to assess the effect of device usage on deltopectoral muscle and cephalic vein injury. METHODS: This was a prospective, randomized controlled trial. A total of 100 patients undergoing primary total shoulder arthroplasty were enrolled and randomized into 2 groups: a wound protector group and a control group. Five patients withdrew from the study, leaving 48 patients in the wound protector group and 47 controls. Three deep wound culture swabs were taken after final arthroplasty implantation. The surgeon also graded deltoid, pectoralis major, and cephalic vein injury on a 0-3 scale based on modification to the Tscherne classification of soft tissue injury. The primary outcome of this study was positive culture results for C acnes. Secondary outcomes included total bacterial culture positivity as well as soft tissue injury grades. A subanalysis removing likely contaminant positive cultures (growth >7 days and 1 colony only) was also performed. Comparisons between groups were made using Fisher exact test for categorical outcomes and t tests and Mann-Whitney U tests for continuous variables. RESULTS: The use of a wound protector did not result in any significant differences compared with controls in the rate of positive cultures for C acnes (15% vs. 21%, P = .593) or all bacteria (15% vs. 26%, P = .304). Removing likely contaminant positive cultures did not demonstrate any significant difference in culture positivity (9% vs. 17%, P = .355, for C acnes; 9% vs. 19%, P = .231, for all bacterial species). The wound protector group had better soft tissue injury scores for the deltoid muscle (P < .001) and pectoralis muscle (P < .001). No difference in cephalic vein injury was noted between the 2 groups (P > .05). No difference in surgical time was noted. CONCLUSION: The use of a surgical wound protector device in total shoulder arthroplasty did not significantly decrease bacterial colonization of the deep wound. However, soft tissue damage to the deltoid and pectoralis muscle was less severe in the wound protector group. These findings suggest that this device reduces iatrogenic soft tissue injury.

Humans↗
PubMed2026

Genomics for precision surgical source control in anti-microbial resistant infections: A global review with focus on resource-limited settings.

BACKGROUND & OBJECTIVE: Antimicrobial resistance (AMR) critically threatens surgical safety, impairing perioperative prophylaxis and complicating infection management. Timely surgical source control is essential but relies on accurate microbiological diagnosis. Conventional culture-based methods are slow and insensitive, often leading to empirical broad-spectrum therapy. This review evaluates the role of advanced genomic diagnostics in enhancing surgical source control for AMR infections, with a focus on challenges and opportunities in low- and middle-income countries (LMICs) like Pakistan. METHODOLOGY: A narrative review was conducted via a structured search of PubMed, Google Scholar, and ScienceDirect (January 2015-October 2025). Studies involving genomic tools in the management of AMR-related surgical infections were included. Evidence was synthesized thematically, covering genomic platforms, clinical applications, implementation barriers, and LMIC specific perspectives. RESULTS: Genomic tools, particularly metagenomic next-generation sequencing (mNGS) and rapid multiplex PCR, demonstrate superior sensitivity (80.6-95.45%) and faster turnaround times (e.g., roughly 27 hours for mNGS) compared to culture. They improve pathogen detection in complex infections (e.g., prosthetic joints, necrotizing soft tissue), guide targeted antibiotic therapy, and can reduce broad-spectrum use. However, major implementation barriers exist, including high costs, need for specialized infrastructure and expertise, bioinformatic challenges, and ethical data concerns, which are especially pronounced in LMICs. CONCLUSION: Genomic diagnostics offer a powerful approach to accelerate and refine surgical source control in the era of AMR. Strategic investments in local capacity, affordable platforms, and integration with antimicrobial stewardship are needed to realize their potential for improving surgical outcomes, particularly in resource-limited settings.

Antimicrobial resistance↗
PubMed1979

[Problem of oral surgical interventions during pregnancy, menstruation and under the intake of hormonal contraceptives].

Pregnancy, menstruation and hormonal contraceptives are no contraindications for necessary oral surgical procedures. If the pregnancy takes a normal course, surgical interventions with absolute indication are possible at any time. Surgical interventions with relative indication should be performed during the second trimester of pregnancy. The dental treatment of pregnant women should be terminated, as far as possible, by the 7th or 8th month of pregnancy. Metabolic imbalances, static loading and gingival changes deserve special attention.

Adult↗
PubMed2026

ACG Clinical Guideline: Diagnosis and Management of Adenomatous Colorectal Polyposis Syndromes.

The hereditary adenomatous colorectal polyposis syndromes are incurable, systemic, cancer risk predisposition syndromes with substantial morbidity and mortality. They differ in their mode of inheritance, age at disease onset, phenotypic expression, and cancer risk. The most common cancer risks involve the gastrointestinal tract including the colon, rectum, duodenum, ampulla, and stomach. Identifying these syndromes through personal and family history risk assessment and germline genetic testing, along with timely surgical and endoscopic management, can reduce cancer incidence and mortality. These guidelines use the Grading of Recommendations, Assessment, Development, and Evaluation methodology to provide clinical guidance on the selection of individuals who should undergo a risk assessment for a hereditary adenomatous colorectal polyposis syndrome, modality and timing of germline genetic testing, cancer risk mitigation through endoscopic and surgical interventions, and the role of chemoprevention. This document reviews the approach to genetic testing in patients with phenotypic colorectal polyposis and the impact of presymptomatic diagnosis in families with a known familial germline pathogenic variant or clinical features suggestive of a hereditary adenomatous polyposis syndrome. Management strategies for patients based on genetic test results or without genetic testing are provided. We also review colorectal and extracolonic phenotypic benign and malignant manifestations of the known hereditary syndromes with a focus on the 2 most common hereditary colorectal polyposis syndromes: familial adenomatous polyposis and MUTYH-associated polyposis. The document concludes with recommendations on polyposis and cancer risk mitigation strategies and highlights updates to management since the previous guideline was published.

Humans↗
PubMedDate not supplied

[Indentation of large retinal tears (author's transl)].

According to us large retinal tears are between 20 degrees and 70 degrees in their largest dimension, which excludes true giant tears. Study of the data collected on 42 patients has shown us the following facts:--these retinal tears occur in phakic and often highly myopic eyes;--our global success rate is 73,8%;--tears smaller than 2 to 3 papillary diameters radially are on the whole easy to indent and failures are quite often related to a surgical fault;--tears wider than 3 papillary diameters radially are on the whole difficult to indent and failures are not always related to an obvious surgical fault, fishmouth phenomenon plays an important role;--in every case presence of blood in the vitreous seems to be unfavourable to the prognosis;--use of episcleral pockets solves must of times surgical problems related to fishmouth or tear dimension;--post operative intern limiting membrane retraction is frequent (10% vs 5,7% for all the retinal tears and detachments cured in the same period of time).

Adolescent↗
PubMed1979

Thumb reconstruction with a sensory flap from the dorsum of the index finger.

The dorsal skin of the index ray is very useful (1) for a one-staged thumb lengthening procedure after amputation, (2) for covering the stump of an avulsed thumb with sensory skin, and (3) for expanding the first web space. The flap may be transferred as a rotation flap, or the dorsal vasculature and nerve supply to the index may be carefully dissected free as a pedicle to permit its use as a neurovascular island flap. We believe that considerably more sensory skin can be transferred by this flap than by the ring finger neurovascular island flap, and that the technical risks and surgical time are less with the index finger flap.

Adolescent↗
PubMed2026

Comparative safety and operative efficiency of surgical approaches for open reduction and internal fixation of mandibular condylar fractures: a systematic review and network meta-analysis.

BACKGROUND: The optimal surgical approach for mandibular condyle fractures remains controversial, particularly regarding the trade-off between facial nerve safety and surgical efficiency. METHODS: Our systematic review and frequentist NMA analyzed studies evaluating open reduction and internal fixation (ORIF) for mandibular condyle fractures. The primary safety outcome was transient or persistent (&#x2265;6 months) facial nerve weakness. The efficiency outcome was operative exposure time. Surgical approaches were categorized, and random-effects NMAs estimated odds ratios (ORs) and mean differences (MDs). Treatments were ranked using P-scores, and clustered rankings explored safety-efficiency relationships. RESULTS: Overall, 121 studies (n&#x202f;=&#x202f;6659 patients) were included. For facial nerve safety, endoscope-assisted (EA), preauricular transmasseteric anteroparotid (PATMA), and high submandibular (HSMA) approaches ranked highest, while the retromandibular transparotid (RMTA) approach carried a higher risk. Analyses restricted to persistent weakness yielded consistent results. For exposure time, submandibular (SM), HSMA, and retromandibular transmasseteric anteroparotid (RMTMA) approaches were most efficient. Clustered ranking analysis identified HSMA and RMTMA as achieving the best overall balance between safety and efficiency. Subgroup analyses confirmed the overall hierarchy, though evidence for high-level and intracapsular fractures remains limited. CONCLUSIONS: HSMA and RMTMA offer an optimal compromise between safety and efficiency for extracapsular condylar fractures, while EA may minimize nerve injury risk where technical expertise allows. High-quality comparative trials - particularly for intracapsular fractures - are warranted.

Humans↗
PubMed1976

[Peculiarities of the clinical picture, diagnosis and prognosis of insulinoma].

It is reported on a patient with insulinoma whose diagnosis was made 16 years ago. Operation report: Insulinoma with the histological picture of a little expressed malignant degeneration. After 6 years recidivation of the clinical picture of an insulinoma. Operation report: Metastasis of a malignant insulinoma of the size of a hazel nut. After operation the patient had no complaints and was able to work for 8 years. Repeated hypoglycaemic conditions caused a third operation: In the cauda metastasis of a malignant insulinoma. After operation 18 months symptom-free with good health. The prognosis is discussed, emphasizing the unusually long course in malignant degeneration in the case described, as it hitherto was observed for the first time. It is also referred to some peculiarities of the carbohydrate metabolism of this patient. At length the necessity of an early diagnosis and a timely surgical treatment of the insulinoma is emphasized.

Adenoma, Islet Cell↗
PubMed2025

Diagnosing the undiagnosed: AI-enhanced multimodal modeling for placental mesenchymal dysplasia in high-risk pregnancies.

Placental mesenchymal dysplasia (PMD) is a rare vascular placental disorder that mimics molar pregnancy but often coexists with a viable fetus, making its misdiagnosis potentially devastating. In high-risk pregnancies, artificial intelligence (AI)-enhanced multimodal modeling - incorporating imaging, genomics, proteomics, and clinical features - offers a transformative diagnostic strategy. Leveraging Bayesian hyperparameter optimization for model refinement, this approach improves diagnostic accuracy while reducing uncertainty and clinician hesitation. Recent clinical studies support its efficacy and interpretability through SHAP and LIME models, while real-time surgical enhancements using Bayesian methods highlight its broader clinical utility. Despite current challenges such as data heterogeneity and integration barriers, multimodal AI provides unprecedented resolution in placental analysis, enabling precise differentiation between PMD and similar fetopathies. Ultimately, this advancement supports timely, non-invasive diagnosis, personalized management, and emotionally informed decision-making aligned with ethical AI implementation standards.

Bayesian optimization↗
PubMedDate not supplied

Acute hypercalcemic crisis.

Although hypercalcemia may be caused by extraparathyroid disease and controlled with various medications, acute hypercalcemic crisis is a surgical emergency. All nonperative measures are directed toward diagnosis of hyperparathyroidism and preparation for operation. Parathyroidectomy is indicated even in the absence of definite evidence of a functioning parathyroid tumor in patients when nonoperative methods fail. Prompt medical therapy and timely surgical intervention will result in success in the vast majority of patients with hypercalcemic crises.

Acute Disease↗
PubMed1977

[Corrosion of the matallic constructions and matallosis of the tissues in the treatment of bone fractures].

Under observation were 192 patients in whom metallic construction were with-drawn. Clinical and metallographic findings indicated that till present time surgical specialists employ unjeustifiable big variety of stainless steels and titan alloys. Corrosion was noted in 18%, tissue metallosis--in 25%, fracture of fixators--in 12%, inflammatory response--in 11%. Compaound metallic constructions produced from different metals and alloys were subjected to corrosion 3 times as fregquntly. To thoroughly study the metallosis of tissues these were investigated by meands of a special analysis and histochemistry.

Alloys↗
PubMed1977

Heparinless femoral venoarterial bypass without an oxygenator for surgery on the descending thoracic aorta.

Heparinless femoral venoarterial bypass without an oxygenator has been used for surgery in 11 patients with aortic lesions requiring cross-clamping of the descending thoracic aorta. Mixed venous blood circulates in the lower half of the body and proximal hypertension is controlled. Surgical time is not rushed, and the bleeding of heparinization is avoided. All patients are well.

Adolescent↗
PubMed1979

Intracranial tumefactions in children. Surgical mortality.

This paper summarizes a 26.5-year experience in one centre with intracranial tumefactions in children. In 337 craniotomies done on 285 patients, the death rate within 30 days of operation was 6.7% for cases and 5.6% for procedures. Since 1965, the case and operative mortalities have been 2.0 and 1,7%, respectively. There have been no operative deaths in the last 109 patients, 124 craniotomies, done during the past 6.5 years. Operative mortality for primary procedures was 6.0%, 1.5% since 1965. For patients operated upon more than once (52 times on 38 patients), the case mortality has been 5.3%, procedural mortality 3.8%; since 1965 these figures have been 3.8 and 2.8%, respectively. The operative deaths are analysed, and some conclusions drawn. At the present time, surgical mortality from intracranial tumefactions in children should be less than 5%.

Adolescent↗
PubMed1976

[Characteristics of the clinical picture and prognosis of insulinoma].

A case with insulinoma is reported, with initial malignant degeneration, diagnosed and operated 16 years ago. Six years later hypoglycemic attaks appeared again and lymph metastasis in good health a third surgical operation was performed because of repeated hypoglycemic attacks and a new metastasis from the insulinoma was found in the pancreas tail. The patients has no hypoglycemic phemonena 18 months after the last operation. Besides the long period of progress of the malignant degenerated insulinoma, not observed so far, certain peculiarities of the carbohydrate metabolism of that patient are stressed upon as well as the necessity of early diagnosis and timely surgical treatment of insulinoma.

Adenoma, Islet Cell↗
PubMed1976

[Clinical picture and prognosis of insulinoma].

A case of insulinoma is reported, with initial malignant degeneration, diagnosed and operated 16 years ago. Six years later hypoglycemic attacks appeared again and lymph metastasis from malignant degenerated insulinoma were found near to the pancreas. After a period of eight years, in good health state, a third surgical operation was performed because of repeated hypoglycemic attacks and a new metastasis from the insulinoma was found in the pancreas tail. The patient has no hypoglycemic phenomena 18 months after the last operation. Besides that long-period of progress of the malignant degenerated insulinoma, not observed so far, certain peculiarities of the carbohydrate metabolism of the patient are stressed upon, as well as the necessity of early diagnosis and timely surgical treatment of insulinoma.

Adenoma, Islet Cell↗
PubMed1976

Minilaparotomy for female sterilization: a feasibility study of a new technique.

Female sterilization via a minilaparotomy incision was performed on 30 patients at Al-Azhar University Teaching Hospital in Cairo, Egypt. A uterine sound fed through a Foley catheter was used as a uterine elevator. A 2 cm suprapubic transverse laparotomy was performed and sterilization was accomplished by fimbriectomy. Twenty patients received general anesthesia and 10 patients initially received local anesthesia. Surgical time ranged from 7 to 15 min, and the average duration of hospitalization was 8 hours. Blood loss was small, and no patient was transfused. One patient had a wound infection. This pilot study indicates that this procedure is relatively simple, safe and inexpensive.

Female↗