Tarsal tunnel syndrome: Does etiology matter?

Background

The tarsal tunnel syndrome is an uncommon condition. Surgical treatment is indicated whenever nonoperative management fails. Etiology is not always known. Does the result of surgical treatment depend on the etiology? The aim of this clinical study is to report our clinical results after surgical treatment for tarsal tunnel syndrome and to analyze the results depending on the etiology.

Methods

Ten patients with tarsal tunnel syndromes were operated and the clinical outcome was measured by a pain visual analogue scale, the ankle-hindfoot AOFAS scale, and the degree of subjective satisfaction.

Results

Although significant improvement was found in the average visual analogue scale and AOFAS score, subjective satisfaction was less favorable. Patients were more satisfied when an etiology was found preoperatively, but statistic difference was not significant.

Conclusion

Decompression of the tibial nerve should be considered with caution unless there is an associated lesion near or within the tarsal tunnel preoperatively. When indicated, extensive exposure guarantees adequate release.

     

Does Femoral Intercondylar Notch Volume Differ in Anterior Cruciate Ligament-Injured Adult Patients Compared to the Uninjured?: A Meta-Analysis

BackgroundStenotic femoral intercondylar notch is considered as a risk factor for anterior cruciate ligament (ACL) injury and three-dimensional notch volume is used as a marker for the injury. The primary purpose of this study was to assess the difference in notch volume between the ACL-injured and uninjured in men and women combined or stratified by sex. The secondary purpose was to assess the difference in notch volume between the ACL-intact men and women.MethodsA search of PubMed/Medline, Scopus, Google Scholar, and Cochrane databases from inception to December 9, 2020, was conducted without restrictions using the following terms: ACL, notch, volume, notch volume, femoral notch volume, and intercondylar notch volume. Studies that compared the ACL-injured with uninjured controls were included. Independent extraction of articles by two authors using predefined data fields including study quality indicators was done. All pooled analyses were based on the inverse-variance weighted random effects model and mean difference was chosen as the effect measure.ResultsNine studies (1,169 knees) qualified for overall analysis (both sexes combined) and significant heterogeneity was observed, which disappeared after pooling studies with age-sex matched controls and those without. Notch volume in the ACL-injured was 0.75 cm³ (95% confidence interval [CI], 0.53–0.96 cm³), which was smaller than that in the age- and sex-matched controls. Six studies qualified for analysis in men. Notch volume in the ACL-injured men was smaller, especially when non-contact ACL injury was considered (1.40 cm³; 95% CI, 1.08–1.73 cm³). Five studies qualified for analysis in women and ACL-injured women had smaller notch volume irrespective of the mechanism of injury (0.38 cm³; 95% CI, 0.18–0.59 cm³). Notch volume of the uninjured men was larger than that of the uninjured women (1.86 cm³; 95% CI, 1.54–2.18 cm³).ConclusionsACL-injured adults have smaller notch volume than the age- and sex-matched controls. Non-contact ACL-injured males have smaller notch volume compared to ACL-intact males. ACL-injured females have smaller notch volume irrespective of the nature of injury. Men have higher notch volume than women. The quality of evidence is very low to low.     

Are Adult Ureteroscopes Safe in the Management of Urolithiasis in a Pediatric Population?

Introduction

Debate remains regarding the optimal caliber of ureteroscopes in the management of pediatric urolithiasis, ranging from pediatric scopes to standard scopes. The aim of this study was to assess the safety and efficacy of stone management in a pediatric population using standard adult ureteroscopes.

Methods

A retrospective review of all ureteroscopic procedures in patients under the age of 16 years was carried out. Standard adult 7.5 French semi-rigid and 6 French flexible ureteroscopes were used.

Results

During the study period, 8 patients underwent 21 ureteroscopic procedures. Two patients had rigid ureteroscopy, seven had flexible ureterorenoscopy and one had a subsequent open procedure. No patients required ureteric dilation. Double J ureteric stents were utilized in 7 patients. There were no complications. All patients required extra corporeal shock wave lithotripsy. Stone clearance was achieved in all patients.

Conclusion

Our series demonstrates that, in skilled hands, adult ureteroscopes can be use safely for the treatment of urolithiasis in pediatric patients.Key Words: Urolithiasis, Paediatric urolithiasis, Ureteroscopy     

Overcoming Treatment Disparities for Early-Stage Hepatocellular Carcinoma in the Veteran Population: Is the MISSION Act the Solution?

Annals of Surgical Oncology -     

Intestinal-type and Pancreatobiliary-type Adenocarcinomas: How Does Ampullary Carcinoma Differ from Other Periampullary Malignancies?

Background

Ampullary carcinomas typically have either intestinal or pancreatobiliary type of differentiation, histopathologically resembling carcinomas of its adjacent tissues (duodenum, bile duct, or pancreas). We evaluated whether the histologic type itself is more important for long-term survival than the fact that the tumor originated in the ampulla.

Methods

Microscopic slides from 207 consecutive pancreatoduodenectomies were reviewed (72 pancreatic, 46 biliary, 61 ampullary, and 28 duodenal adenocarcinomas; 76 intestinal type, 131 pancreatobiliary type). Tumor size, nodal involvement, margin involvement, degree of differentiation, vascular involvement, and perineural growth, as well as overall survival, were compared between different origins of the same histologic type.

Results

Intestinal-type ampullary adenocarcinomas had similar frequency of poor histopathologic factors compared to duodenal adenocarcinomas, and pancreatobiliary-type ampullary adenocarcinomas had similar frequency of poor histopathologic factors compared to pancreatobiliary-type biliary and pancreatic adenocarcinomas. Adjusting for tumor size and nodal involvement, there was no difference in long-term survival between patients with intestinal-type ampullary, duodenal, or biliary and pancreatic tumors (p = 0.79), and there was no difference in long-term survival between patients with pancreatobiliary-type ampullary, biliary, or pancreatic tumors (p = 0.41).

Conclusions

Long-term survival for patients with ampullary carcinomas equals pancreatic, biliary, and duodenal carcinomas when the same histologic type is compared. It can be questioned whether ampullary carcinomas should be regarded as a separate entity in classification of solid tumors. Clinical trials on adjuvant treatments for periampullary carcinomas should stratify by pancreatobiliary type versus intestinal type of histologic differentiation.     

What Does the Urologist Expect from the Pathologist (and What Can the Pathologists Give) in Reporting on Adult Kidney Tumour Specimens?

OBJECTIVE: To identify the parameters required by the urologist to determine the prognosis and the treatment of renal cancer in adults, and to establish the potential therapeutic targets of the new treatments that started to show clinical efficacy. METHODS: A literature search of the last 10 yr was done, paying specific attention to TNM 2002 (UICC staging) and Fuhrman's grading. Also, the main genetic characteristics of the different subtypes (according to the WHO 2004 classification) with potential therapeutic implications have been compiled. RESULTS: After the review of the literature, the opinion of the joint meeting including urologists and pathologists is that some aspects of the TNM 2002 classification must be refined. Criteria for nuclear grading should be different for the subtypes of renal cell carcinoma, and the WHO 2004 histological classification is clinically useful. CONCLUSIONS: In the workshop held in Palermo, common opinion was achieved on a number of points. The TNM 2002 classification is useful, but some adjustments should be made, particularly as referred to the tumour size cut-off, assessment of the invasion of the renal sinus fat tissue, and invasion of the ipsilateral adrenal gland. The Fuhrman's grading system is useful in clear cell renal cell carcinoma (RCC), and probably also in papillary RCC, but a redefinition for chromophobe RCC is needed. Finally, the determination of certain markers, such as VEGF and HIF, could constitute good target markers for the new therapies, but they remain under investigation.     

Does Bilio-intestinal Bypass Still Have a Role in the Treatment of Super-obesity?

Background: Super-obesity (BMI > 50) is life-threatening. The jejunoileal bypass had potential long-term problems, and weight loss with gastroplasty may be inadequate. Methods: From 1988 to 1995, 19 patients with morbid obesity had jejunoileal bypass with anastomosis of the fundus of the gallbladder to the proximal end of the bypassed jejunum. Of these patients, 11 were super-obese, with ages 19-49 years, weight 125-172 kg, mean excess weight 97 kg (73-119) and BMI 56 (50-67). Results: Mean weight loss at 3 years was 60 kg. There was no mortality and no major complications. Patients had 5-6 stools per day and some flatulence. There have been no hepatic, renal, calcium or electrolyte problems. Diseases secondary to obesity resolved. Conclusion: Bilio-intestinal bypass has been effective and safe thus far.     

Treatment Delay in Surgically-Treated Colon Cancer: Does It Affect Outcomes?

Background

Treatment delay, or the time lapse between diagnosis and surgery, may have a detrimental effect on cancer outcomes. This study assesses the effect of treatment delay on cancer-related outcomes in a large, continuous series of surgically treated colon cancer patients.

Methods

All surgical colon cancer cases at our center from 2004 through 2011 were reviewed. Patients who underwent preoperative chemotherapy, emergency admissions, palliative cases, and incidental and postoperative diagnoses were excluded. Treatment delay was correlated with outcomes in univariate and multivariate regression and proportional hazards models.

Results

In 769 included patients, for every treatment-delay quartile increase, odds of death decreased by an odds ratio (OR) of 0.78 (p = 0.001), and metastatic recurrence by OR 0.78 (p = 0.013). Shorter survival duration had a hazard ratio (HR) of 0.81 (p = 0.001) and shorter disease-free survival HR 0.72 (p < 0.001). Multivariate regression adjusting for baseline staging greatly reduces these ratios, and makes them non-significant. Similar patterns were shown in high-risk subsets, including stage III disease, ethnic minorities, patients with positive margins, and extramural vascular invasion.

Conclusions

The inverse relation between treatment delay and survival and recurrence reflected adequate prioritization of advanced and high-risk cases and concurrently showed that, matched for stage and risk categories, treatment delay was not associated with worse cancer outcomes for patients with colon cancer. A reasonable delay between diagnosis and subsequent surgery is not detrimental to patient outcomes and permits more flexibility in scheduling and justifies allowing time to complete proper preoperative evaluation and staging, improving the quality and safety of resection and treatment.     

Letter to the Editor: Management of Morgagni’s Hernia in the Adult Population: A Systematic Review of the Literature

World Journal of Surgery -     

Access to Grafts in a Liver Transplant Center: Does It Rely on the Severity of the Waiting List Population?

Background

The number of transplants performed relies, partially, on recipients' variables on the waiting list. The goal of this study was to compare recipients from a high-volume liver center in Argentina with the rest of the country.

Author’s Reply: Management of Morgagni’s Hernia in the Adult Population: A Systematic Review of the Literature

World Journal of Surgery -