Dear Editor,We aimed to describe the management of the intraoperative injury of the right external iliac artery that occurred during robot-assisted right nephroureterectomy with bladder cuff excision.Surgery was sched...Dear Editor,We aimed to describe the management of the intraoperative injury of the right external iliac artery that occurred during robot-assisted right nephroureterectomy with bladder cuff excision.Surgery was scheduled for suspected urothelial carcinoma of the distal ureter in a 60-year-old woman.The patient involved in the present research signed a dedicated form to consent to the publication of images and/or information about her.Past medical history included Brugada syndrome diagnosed in 2015,and hypercholesterolemia.Past surgical history included one cesarean section only.Family history included ovarian cancer(sister),colorectal cancer(mother),and kidney cancer(father).展开更多
Gastrointestinal stromal tumors(GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract, and are characterized by a broad spectrum of clinical, histological and molecular features at presentatio...Gastrointestinal stromal tumors(GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract, and are characterized by a broad spectrum of clinical, histological and molecular features at presentation. Although focal and scattered calcifications are not uncommon within the primary tumor mass, heavy calcification within a GIST is rarely described in the literature and the clinical-biological meaning of this feature remains unclear. Cases with such an atypical presentation are challenging and may be associated with diagnostic pitfalls. Herein, we report a gastric GIST with the unusual presentation of prominent calcifications that was identified incidentally on imaging during a post-trauma diagnostic work-up. The patient underwent laparoscopic surgery with a radical resection of the mass, which was subsequently characterized by histological analysis as spindle-shaped tumor cells, positive for CD117/c-KIT, CD34 and DOG1, and with calcified areas. Given the intermediate risk of recurrence, no adjuvant therapy was recommended andthe patient underwent regular follow-up for 22 mo, with no evidence of relapse. Our case can be considered of interest because of the rarity of clinical presentation and the uniquely large size of the GIST at diagnosis(longest diameter exceeding 9 cm). In closing, we discuss the pathophysiology and clinical implications of calcifications in GISTs by reviewing the most up-to-date relevant literature.展开更多
Objective:Infectious complications after partial nephrectomy(PN)remain a significant concern.We aimed to analyze predictive factors of postoperative infectious complications(PICs)occurring after PN.Methods:Data on pat...Objective:Infectious complications after partial nephrectomy(PN)remain a significant concern.We aimed to analyze predictive factors of postoperative infectious complications(PICs)occurring after PN.Methods:Data on patients undergoing PN for renal masses between January 2018 and May 2023 were retrieved from prospectively maintained institutional database and retrospectively analyzed.Patients were stratified into two groups based on the occurrence of PICs during admission for PN.A PIC was defined by clinical and/or imaging findings of an infectious process plus microbial isolation upon culture examination.Multivariable logistic regression analysis after adjusting for potential confounders evaluated predictors of a PIC.Results:Six-hundred and twenty-seven patients underwent PN;rough incidence of PICs was 11%,with median time to PIC onset of 1(interquartile range 0–3)day.Compared to patients without PIC events,the PIC group showed a significantly higher proportion of open surgeries(54%vs.20%,p<0.001),bleeding events(23%vs.10%,p<0.01),postoperative transfusion(19%vs.5.0%,p<0.001),and urinary leakage(4.2%vs.0.18%,p=0.01),and a statistically significantly higher median hemoglobin drop from baseline(−2.6 g/dL vs.−1.7 g/dL,p=0.001).At multivariable logistic regression,the odds of experiencing a PIC were statistically significantly lower after minimally-invasive surgery compared to open surgery(odds ratio 0.32,95%confidence interval 0.17–0.59),and higher for patients who received transfusion(odds ratio 1.68,95%confidence interval 1.10–2.54).Conclusion:We underlined factors that impact the occurrence of PICs and,consequently,duration of hospitalization following PN.By addressing these predictors,clinicians can promote enhanced patient recovery.展开更多
Background:Smokeless tobacco is widely used by athletes to enhance performance.Nicotine is a central nervous system stimulant and acts on cardiocirculatory and metabolic systems,involving tissue blood flow and circula...Background:Smokeless tobacco is widely used by athletes to enhance performance.Nicotine is a central nervous system stimulant and acts on cardiocirculatory and metabolic systems,involving tissue blood flow and circulatory vasoreactivity.The aim of this study was to investigate the effects of the oral smokeless tobacco(Swedish snus(SS))on the perception of fatigue and time to exhaustion(TTE)during moderate-intensity aerobic exercise.Methods:Fourteen healthy non-tobacco male users were recruited for a double-blind,controlled crossover design(SS vs.snus placebo(SP)).Subjects were tested for 3 sessions:experimental session 1(Exp 1)consisted of an incremental test to determine the maximal aerobic power out-put(Wmax),whereas Exp2 and Exp3 consisted of exercising at 65%Wmax until exhaustion in SS or SP conditions.During Exp2 and Exp3,muscle and cerebral oxygenation was assessed by means of near-infrared spectroscopy,and the rating of perceived exertion(RPE)was recorded.Results:Comparing SS with SP tests,significant differences(p〈0.05)were found in the values of cerebral(-3%)and muscular tissues oxygenation(-4%)in the first 30 min of exercise.The RPE values were not significantly different between the 2 conditions(SS vs.SP).No significant difference was found in TTE(SS:54.25±21.84 min;SP:50.01±17.03 min).Conclusion:This study showed that muscular and cerebral oxygenation increased significantly with snus administration during an endurance exercise until exhaustion,but this did not affect fatigue perception and TTE.The results showed that snus could not be considered an ergogenic substance in non-tobacco users.2018 Published by Elsevier B.V.on behalf of Shanghai University of Sport.This is an open access article under the CC BY-NC-ND license.(http://creativecommons.org/licenses/by-nc-nd/4.0/).展开更多
文摘Dear Editor,We aimed to describe the management of the intraoperative injury of the right external iliac artery that occurred during robot-assisted right nephroureterectomy with bladder cuff excision.Surgery was scheduled for suspected urothelial carcinoma of the distal ureter in a 60-year-old woman.The patient involved in the present research signed a dedicated form to consent to the publication of images and/or information about her.Past medical history included Brugada syndrome diagnosed in 2015,and hypercholesterolemia.Past surgical history included one cesarean section only.Family history included ovarian cancer(sister),colorectal cancer(mother),and kidney cancer(father).
文摘Gastrointestinal stromal tumors(GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract, and are characterized by a broad spectrum of clinical, histological and molecular features at presentation. Although focal and scattered calcifications are not uncommon within the primary tumor mass, heavy calcification within a GIST is rarely described in the literature and the clinical-biological meaning of this feature remains unclear. Cases with such an atypical presentation are challenging and may be associated with diagnostic pitfalls. Herein, we report a gastric GIST with the unusual presentation of prominent calcifications that was identified incidentally on imaging during a post-trauma diagnostic work-up. The patient underwent laparoscopic surgery with a radical resection of the mass, which was subsequently characterized by histological analysis as spindle-shaped tumor cells, positive for CD117/c-KIT, CD34 and DOG1, and with calcified areas. Given the intermediate risk of recurrence, no adjuvant therapy was recommended andthe patient underwent regular follow-up for 22 mo, with no evidence of relapse. Our case can be considered of interest because of the rarity of clinical presentation and the uniquely large size of the GIST at diagnosis(longest diameter exceeding 9 cm). In closing, we discuss the pathophysiology and clinical implications of calcifications in GISTs by reviewing the most up-to-date relevant literature.
文摘Objective:Infectious complications after partial nephrectomy(PN)remain a significant concern.We aimed to analyze predictive factors of postoperative infectious complications(PICs)occurring after PN.Methods:Data on patients undergoing PN for renal masses between January 2018 and May 2023 were retrieved from prospectively maintained institutional database and retrospectively analyzed.Patients were stratified into two groups based on the occurrence of PICs during admission for PN.A PIC was defined by clinical and/or imaging findings of an infectious process plus microbial isolation upon culture examination.Multivariable logistic regression analysis after adjusting for potential confounders evaluated predictors of a PIC.Results:Six-hundred and twenty-seven patients underwent PN;rough incidence of PICs was 11%,with median time to PIC onset of 1(interquartile range 0–3)day.Compared to patients without PIC events,the PIC group showed a significantly higher proportion of open surgeries(54%vs.20%,p<0.001),bleeding events(23%vs.10%,p<0.01),postoperative transfusion(19%vs.5.0%,p<0.001),and urinary leakage(4.2%vs.0.18%,p=0.01),and a statistically significantly higher median hemoglobin drop from baseline(−2.6 g/dL vs.−1.7 g/dL,p=0.001).At multivariable logistic regression,the odds of experiencing a PIC were statistically significantly lower after minimally-invasive surgery compared to open surgery(odds ratio 0.32,95%confidence interval 0.17–0.59),and higher for patients who received transfusion(odds ratio 1.68,95%confidence interval 1.10–2.54).Conclusion:We underlined factors that impact the occurrence of PICs and,consequently,duration of hospitalization following PN.By addressing these predictors,clinicians can promote enhanced patient recovery.
基金supported by research funds allocated to the following departments at the University of Verona:Neurosciences,Biomedicine and Movement Sciences,and Diagnostic and Public Health
文摘Background:Smokeless tobacco is widely used by athletes to enhance performance.Nicotine is a central nervous system stimulant and acts on cardiocirculatory and metabolic systems,involving tissue blood flow and circulatory vasoreactivity.The aim of this study was to investigate the effects of the oral smokeless tobacco(Swedish snus(SS))on the perception of fatigue and time to exhaustion(TTE)during moderate-intensity aerobic exercise.Methods:Fourteen healthy non-tobacco male users were recruited for a double-blind,controlled crossover design(SS vs.snus placebo(SP)).Subjects were tested for 3 sessions:experimental session 1(Exp 1)consisted of an incremental test to determine the maximal aerobic power out-put(Wmax),whereas Exp2 and Exp3 consisted of exercising at 65%Wmax until exhaustion in SS or SP conditions.During Exp2 and Exp3,muscle and cerebral oxygenation was assessed by means of near-infrared spectroscopy,and the rating of perceived exertion(RPE)was recorded.Results:Comparing SS with SP tests,significant differences(p〈0.05)were found in the values of cerebral(-3%)and muscular tissues oxygenation(-4%)in the first 30 min of exercise.The RPE values were not significantly different between the 2 conditions(SS vs.SP).No significant difference was found in TTE(SS:54.25±21.84 min;SP:50.01±17.03 min).Conclusion:This study showed that muscular and cerebral oxygenation increased significantly with snus administration during an endurance exercise until exhaustion,but this did not affect fatigue perception and TTE.The results showed that snus could not be considered an ergogenic substance in non-tobacco users.2018 Published by Elsevier B.V.on behalf of Shanghai University of Sport.This is an open access article under the CC BY-NC-ND license.(http://creativecommons.org/licenses/by-nc-nd/4.0/).
