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Sensors (Basel, Switzerland) Jun 2022(1) Background: In the last few years, technological developments in the surgical field have been rapid and are continuously evolving. One of the most revolutionizing... (Review)
Review
(1) Background: In the last few years, technological developments in the surgical field have been rapid and are continuously evolving. One of the most revolutionizing breakthroughs was the introduction of the IoT concept within surgical practice. Our systematic review aims to summarize the most important studies evaluating the IoT concept within surgical practice, focusing on Telesurgery and surgical Telementoring. (2) Methods: We conducted a systematic review of the current literature, focusing on the Internet of Surgical Things in Telesurgery and Telementoring. Forty-eight (48) studies were included in this review. As secondary research questions, we also included brief overviews of the use of IoT in image-guided surgery, and patient Telemonitoring, by systematically analyzing fourteen (14) and nineteen (19) studies, respectively. (3) Results: Data from 219 patients and 757 healthcare professionals were quantitively analyzed. Study designs were primarily observational or based on model development. Palpable advantages from the IoT incorporation mainly include less surgical hours, accessibility to high quality treatment, and safer and more effective surgical education. Despite the described technological advances, and proposed benefits of the systems presented, there are still identifiable gaps in the literature that need to be further explored in a systematic manner. (4) Conclusions: The use of the IoT concept within the surgery domain is a widely incorporated but less investigated concept. Advantages have become palpable over the past decade, yet further research is warranted.
Topics: Health Personnel; Humans; Internet
PubMed: 35746359
DOI: 10.3390/s22124577 -
Minerva Obstetrics and Gynecology Aug 2022Krukenberg tumor (KT) is defined as a secondary neoplasm of the ovary. While ovarian metastases account for about 30% of ovarian tumors, KTs are rare, accounting for... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Krukenberg tumor (KT) is defined as a secondary neoplasm of the ovary. While ovarian metastases account for about 30% of ovarian tumors, KTs are rare, accounting for about 1-2% of the total. The rarity of KT is at least in part responsible for the lack of a precise clinic-pathological characterization of these tumors. Clinically, KT may have a subtle clinical presentation, with few symptomatic manifestations and nonspecific clinical signs, even though in literature there is disagreement about the clinical presentation of these patients; such difficulties in the diagnostic framework often leads to a delayed diagnosis with serious consequences on the patient outcome. We aimed to provide a clinico-pathological characterization of Krukenberg Tumor (KT) through a systematic review and meta-analysis to improve the diagnosis and management of KT.
EVIDENCE ACQUISITION
Electronic databases were searched for all studies assessing clinico-pathological features of KT series. Pooled prevalence of each clinical or pathological factor was calculated according to the random-effect model.
EVIDENCE SYNTHESIS
Forty-eight studies with 3025 KT patients were included; 39.7% of patients were ≥50 and 39.8% were postmenopausal. The most common primary tumor sites were stomach (42.5%), colon-rectum (26.1%), breast (9.3%), and appendix (5%); 48.7% of KTs were synchronous with the primary tumor, 64.3% were bilateral, 40.5% had a diameter ≥10 cm; 55.3% showed extraovarian extent and 49% showed peritoneal involvement. The most common presenting symptoms were ascites (51.7%), palpable mass (31.3%), pain (29.3%), abdominal distention (28.7%), irregular bleeding (9.1%), asymptomatic (11.2%).
CONCLUSIONS
KT shows a highly variable presentation. Understanding the prevalence of clinico-pathological factors may be helpful to improve the diagnosis and management of KT.
Topics: Female; Humans; Krukenberg Tumor; Ovarian Neoplasms
PubMed: 33944524
DOI: 10.23736/S2724-606X.21.04797-7 -
Breast (Edinburgh, Scotland) Aug 2021Pre-operative localization of non-palpable breast lesions with non-wired non-ionizing (NWNI) techniques may improve clinical outcomes as reoperation rate, cosmetic... (Meta-Analysis)
Meta-Analysis Review
Pre-operative localization of non-palpable breast lesions with non-wired non-ionizing (NWNI) techniques may improve clinical outcomes as reoperation rate, cosmetic outcome and contribute to organizational aspects improvement in breast-conserving surgery (BCS). However only limited literature is available and clinical studies involving these forefront devices are often small and non-randomized. Furthermore, there is a lack of consensus on free margins and cosmetic outcomes definitions. The objective of the present meta-analysis was to determine the crude clinical outcomes reported for the NWNI techniques on BCS. A literature search was performed of PubMed, Embase and Scopus databases up to February 2021 in order to select all prospective or retrospective clinical trials on pre-operative breast lesion localization done with NWNI devices. All studies were assessed following the PRISMA recommendations. Continuous outcomes were described in averages corrected for sample size, while binomial outcomes were described using the weighted average proportion. Twenty-seven studies with a total of 2103 procedures were identified. The technique is consolidated, showing for both reflectors' positioning and localization nearly the 100% rate of success. The re-excision and clear margins rates were 14% (95% CI, 11-17%) and 87% (80-92%), respectively. Overall, positive margins rates were 12% (8-17%). In studies that compared NWNI and wire localization techniques, positive margin rate is lower for the first techniques (12%, 6-22% vs 17%, 12-23%) and re-excision rate is slightly higher using the latter (13%, 9-19% vs 16%, 13-18%). Pre-operative NWNI techniques are effective in the localization of non-palpable breast lesions and are promising in obtaining clear (or negative) margins minimizing the need for re-excision and improving the cosmetic outcomes. Randomized trials are needed to confirm these findings.
Topics: Breast Neoplasms; Female; Humans; Margins of Excision; Mastectomy, Segmental; Prospective Studies; Reoperation; Retrospective Studies
PubMed: 33991806
DOI: 10.1016/j.breast.2021.04.007 -
World Journal of Clinical Cases Oct 2023Ewing sarcoma (ES) is a malignant neoplasm of neuroectodermal origin and is commonly observed in children and young adults. The musculoskeletal system is the main body...
BACKGROUND
Ewing sarcoma (ES) is a malignant neoplasm of neuroectodermal origin and is commonly observed in children and young adults. The musculoskeletal system is the main body system impacted and ES is rarely seen in the visceral organs particularly the adrenal gland.
AIM
To present a comprehensive review of primary adrenal ES, with emphasis on diagnosis, therapy and oncological outcomes.
METHODS
A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020. PubMed/ MEDLINE, EMBASE and Google Scholar bibliographic databases were searched to identify articles from 1989 to 2022 and included patients with ES/primitive neuroectodermal tumor (PNET) of the adrenal gland. PubMed, Google Scholar and EMBASE medical databases were searched, combining the terms "adrenal", "ES" and "PNET". Demographic, clinical, pathological and oncological data of patients were analyzed by SPSS version 29.0.
RESULTS
A total of 52 studies were included for review (47 case reports and 5 case series) with 66 patients reported to have primary adrenal ES. Mean age at diagnosis was 26.4 ± 15.4 years (37.9% males, 57.6% females, sex not reported in 3 cases). The most frequent complaint was abdominal/flank pain or discomfort (46.4%) followed by a palpable mass (25.0%), and the average duration of symptoms was 2.6 ± 3.1 mo. The imaging modality of choice was computed tomography scan (81.5%), followed by magnetic resonance imaging (20.4%). Preoperative staging revealed that 17 tumors (27.9%) were metastatic and 14 patients had inferior vena cava or renal vein neoplastic thrombus at initial diagnosis. Open adrenalectomy was performed in the majority of cases (80.0%), of which 27.9% required more extensive resection. Minimally invasive surgery was attempted in 8.2% of tumors. Complete surgical resection was achieved in 89.4% of the patients. Adjuvant therapy was administered to 32 patients, in the form of chemotherapy (62.5%), radiotherapy (3.1%) or combination (34.4%). Median overall survival was 15 mo and 24-mo overall survival was 40.5%. Median disease-free survival was 10 mo and 24-mo disease-free survival was 33.3%.
CONCLUSION
The significant progress in molecular biology and genetics of ES does not reflect on patient outcomes. ES remains an aggressive tumor with a poor prognosis and high mortality.
PubMed: 37900999
DOI: 10.12998/wjcc.v11.i28.6782 -
Asian Journal of Surgery Jan 2022Breast cancer screening has seen an increase in the detection of non-palpable breast lesions. Wire guided localisation (WGL) and Radio-guided occult lesion localisation... (Meta-Analysis)
Meta-Analysis Review
Breast cancer screening has seen an increase in the detection of non-palpable breast lesions. Wire guided localisation (WGL) and Radio-guided occult lesion localisation (ROLL) are well established modalities of localisation of non-palpable breast lesions in the UK. We aimed to compare the outcomes of WGL and ROLL in this updated meta-analysis. We searched Cochrane Central Register of Controlled Trials (CENTRAL), and LILACS using free text search words as well as relevant MESH-terms. We also searched Medline (02/03/2021), Embase and registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. Outcomes considered were re-excision rates, margin involvement, specimen volume and weight, accurate localisation of lesions and operative time. We assessed the risk of bias in included studies and performed random effects meta-analyses using Review Manager (version 5.3). Heterogeneity was estimated using the I-statistic. Nine included studies enrolled 1096 patients undergoing localization in breast surgery (534 in WGL and 562 in ROLL). There was a statistically significant benefit in favour of ROLL for non-involved resection margins (OR 0.60; 95% CI, 0.44-0.97); based on seven studies. Nine trials assessed operative time favouring ROLL (OR 1.95; 95% CI, 0.27-3.63). No significant difference in re-excision rates was reported (OR 1.42; 95% CI, 0.83-2.43) based on seven studies. Current evidence favourably supports ROLL, compared to WGL, with respect to margin involvement, localisation and operative time in the treatment of non-palpable breast lesions.
Topics: Breast; Breast Neoplasms; Early Detection of Cancer; Female; Humans; Mastectomy; Mastectomy, Segmental; Radiopharmaceuticals
PubMed: 34479779
DOI: 10.1016/j.asjsur.2021.06.055 -
Cureus Sep 2021We performed a systematic review to determine whether the physical examination can reliably assist in the diagnostic approach for patients suspected of having pulmonary... (Review)
Review
We performed a systematic review to determine whether the physical examination can reliably assist in the diagnostic approach for patients suspected of having pulmonary hypertension (PH). Using dual extraction, two investigators independently searched PubMed, Ovid MEDLINE, Cochrane Library, and Embase for studies that compared physical examination findings with a right heart catheterization, from inception until July 10, 2021. We obtained data from four studies that evaluated physical examination findings in patients receiving a right heart catheterization to diagnose PH. Pooled diagnostic odds ratios (DOR) were calculated for right ventricular heave, a loud pulmonic component of the second heart sound (P2), jugular venous pressure (JVP) 3 cm above sternal angle, and a palpable P2. Three physical examination findings had DOR that supports the diagnosis of PH: the JVP > 3 cm above the sternal angle (5.90, 95% CI 2.57, 13.57), a loud P2 (2.91, 95% CI 1.38, 6.10), and a right ventricular heave (2.78, 95% CI 1.12, 6.89). The palpable P2 had a DOR less than one and was not able to be conclusive in diagnosing PH. Our systematic review found a small body of evidence supporting the use of physical examination tests in the diagnostic evaluation of pulmonary hypertension. The JVP > 3 cm above the sternal angle was the most accurate physical examination sign for the diagnosis of PH. Larger cohort studies using a combination of tests may shed more light on the role of the physical examination in the diagnosis and early detection of pulmonary hypertension.
PubMed: 34692270
DOI: 10.7759/cureus.18020 -
Global Pediatric Health 2019. Cervical lymphadenopathy in children is common and its etiologies diverse. No systematic review of the differential diagnosis of pediatric cervical lymphadenopathy has... (Review)
Review
. Cervical lymphadenopathy in children is common and its etiologies diverse. No systematic review of the differential diagnosis of pediatric cervical lymphadenopathy has been conducted. . To determine the prevalence rate of specific etiologies of pediatric cervical lymphadenopathy. . EMBASE, PubMed, and SCOPUS were searched electronically. Bibliographies of select studies were reviewed as well. . (1) Any clinical trial, observational study, or cross-sectional case series with 10 or more subjects that included delineation of etiologies and/or associated conditions with lymphadenopathy; (2) subjects aged 0 to 21 years with enlarged lymphoid tissue on body; (3) lymphadenopathy was confirmed by clinical evaluation; and (4) no specific diagnoses were excluded. . Year and location of publication, definition of lymphadenopathy, percentage of lymphadenopathy that was cervical, total number of subjects, gender distribution of subjects, age range of patients, and specific etiologies. . Of the 1790 studies, 7 studies that were combined resulted in 2687 subjects that were selected. Nonspecific benign etiology was the most common diagnosis occurring at a rate of 67.8%. Epstein-Barr virus was the next most prevalent (8.86%), followed by malignancy (4.69%) and granulomatous disease (4.06%). The most common malignancy etiology was non-Hodgkin's lymphoma (46.0%), and the most common granulomatous disease was tuberculosis (73.4%). . This systematic review and meta-analysis provides a rate-based differential diagnosis of pediatric cervical lymphadenopathy. Although the most common causes of pediatric cervical lymphadenopathy are nonspecific, the etiologies are diverse. Rates and credible intervals are provided to enable a probability-based diagnostic approach to palpable cervical lymphadenopathy in this age group.
PubMed: 31384630
DOI: 10.1177/2333794X19865440 -
Journal of Pediatric Urology Dec 2021Multicystic Dysplastic Kidney (MCDK) is a common cause of palpable abdominal mass in a neonate, yet reports are few of resultant life-threatening extrinsic compression.... (Review)
Review
INTRODUCTION
Multicystic Dysplastic Kidney (MCDK) is a common cause of palpable abdominal mass in a neonate, yet reports are few of resultant life-threatening extrinsic compression. This systematic review is the first to review all known neonatal MCDK cases complicated by external compression due to mass effect. Our aim is to foster communication about these unusual cases to inform management of future comparable cases.
METHODS
This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Medical Subject Headings (MeSH) were used to search PubMed through June 8, 2021 as follows: ((((Polycystic Kidney Diseases/complications [MeSH Terms]) OR (Multicystic Dysplastic Kidney/complications [MeSH Terms])) AND (Humans [MeSH Terms]) AND (Infant, Newborn [MeSH Terms]) AND (Case Reports [Publication Type]) AND (("multicystic dysplastic kidney") OR ("multicystic kidney")))) OR ((unusual respiratory distress in newborn [Title]) AND (kidney)) OR (large MCDK). Resulting papers were screened and included if they reported neonatal MCDK complicated by external compression by mass effect. Excluded papers lacked an MCDK diagnosis, a neonatal patient, or clear indication of mass effect. Salient data was extracted from each case for comparison.
RESULTS
Of 51 papers screened, seven met inclusion criteria, presenting eight neonatal MCDK patients exhibiting varied combinations of symptoms secondary to external compression, including respiratory distress, gastrointestinal obstruction, and contralateral ureteral obstruction. All eight cases, ultimately managed with neonatal nephrectomy, had positive outcomes. Unreported and undiagnosed cases are not included in this review, making it susceptible to publication bias.
CONCLUSIONS
Large neonatal MCDK is typically managed conservatively, however it can be complicated by external compression due to mass effect. In this scenario, nephrectomy is a reasonable and definitive treatment. Less invasive management options may exist, e.g., aspiration with sclerotherapy. Communication about exceptional cases like these should be encouraged even when outcomes are poor.
Topics: Humans; Infant; Infant, Newborn; Kidney; Multicystic Dysplastic Kidney; Nephrectomy; Polycystic Kidney Diseases; Ureteral Obstruction
PubMed: 34538561
DOI: 10.1016/j.jpurol.2021.09.003 -
Current Urology Jun 2023This study aimed to describe patterns of presentation, etiology, risk factors, management, and treatment outcomes of periurethral abscesses using a systematic review...
OBJECTIVES
This study aimed to describe patterns of presentation, etiology, risk factors, management, and treatment outcomes of periurethral abscesses using a systematic review framework.
MATERIALS AND METHODS
After prospective registration on the PROSPERO database (CRD42020193063), a systematic review of Web of Science, Embase, PubMed, and Cochrane scientific databases was performed. Articles published between 1900 and 2021 were considered. Extracted data included symptoms, etiology, medical history, investigations, treatment, and outcomes. Collated data were analyzed using univariate methods.
RESULTS
Sixty articles met the inclusion criteria reporting on 270 patients (211 male, 59 female) with periurethral abscess. The most common clinical features were pain (41.5%), pyuria (41.5%), dysuria (38.5%), urinary frequency (32.3%), fever (25%), and a palpable mass (23%). Predisposing risk factors included the presence of a sexually transmitted infection or urinary tract infection (55.0%), urethral strictures (39.6%), and recent urethral instrumentation (18.7%). Management approaches included open incision and drainage (64.3%), conservative management with antibiotics (29.8%), and minimally invasive techniques (needle aspiration, endoscopic drainage). Time trend analysis of etiology revealed a decreased incidence of infection (sexually transmitted infection/urinary tract infection, human immunodeficiency virus) and higher incidence of diabetes mellitus and periurethral bulking injections in recent years.
CONCLUSIONS
Periurethral abscesses may display a wide range of clinical features. Presentation, risk factors and underlying etiology vary with sex. The optimal management technique is guided by abscess size. Open incision and drainage combined with antibiotics continues to be the mainstay of management. However, minimally invasive techniques are gaining favor. To the authors' knowledge, this is the first systematic appraisal and management algorithm for periurethral abscess.
PubMed: 37691985
DOI: 10.1097/CU9.0000000000000159 -
The European Journal of Contraception &... Jun 2024Migration is a rare but serious complication of the etonogestrel contraceptive implant, and little is known about its extent. (Review)
Review
INTRODUCTION
Migration is a rare but serious complication of the etonogestrel contraceptive implant, and little is known about its extent.
PURPOSE
To document and characterise cases of etonogestrel contraceptive implant migration in the scientific literature.
METHODS
A systematic review of Medline, Embase and Global Health databases was carried out between January 2000 and January 2023 to identify articles presenting implant migrations. Narrative reviews, conference abstracts and articles not written in English or French were excluded.
RESULTS
Forty-five articles, mostly published since 2016, were identified (eight case series and 37 case reports), for a total of 148 independent cases of migration: in pulmonary blood vessels ( = 74), in non-pulmonary blood vessels ( = 16) and extravascular ( = 58). Many patients are asymptomatic and migration is often an incidental finding. A non-palpable implant and symptoms related to implant location (intra- or extra-vascular) may be indicative of migration. Inadequate insertion and normal or underweight appear to increase the risk of migration. Scientific societies and authors offer practical strategies to deal with implant migration.
CONCLUSION
Professionals who insert and remove contraceptive implants must be adequately trained. They need to be on the lookout for implant migration, and promptly refer patients to appropriate care if migration is suspected.
Topics: Humans; Desogestrel; Foreign-Body Migration; Female; Drug Implants; Contraceptive Agents, Female; Device Removal; Contraceptive Agents, Hormonal
PubMed: 38712717
DOI: 10.1080/13625187.2024.2342919