Differential diagnoses of inguinal swellings: a case series of atypical diagnoses.

This case series highlights the importance of a thorough differential diagnosis in patients with groin swelling, often mistaken for inguinal hernias. It presents three patients with groin swelling initially suspected of having inguinal hernias but diagnosed differently upon further investigation. Patient 1 had a recurrence of endometrial adenocarcinoma in the right groin, Patient 2 had penile carcinoma with left inguinal metastasis, and Patient 3 had a metastasis of prostate carcinoma in the left groin. These cases underline the need to consider various pathologies beyond the common diagnosis of inguinal hernia. Accurate diagnosis requires a careful clinical examination and appropriate diagnostic tools, ensuring correct treatment.

Clinical implementation of the Versius robotic surgical system in visceral surgery-A single centre experience and review of the first 175 patients.

BACKGROUND: Robotic surgical systems introduce new opportunities for the minimal accessed surgeon. The combination of three-dimensional magnified vision and articulated instruments with seven degrees of freedom provide a good and safe alternative to laparoscopic surgery. Indeed some of these features may support the case that robotic surgery may be better than conventional surgery. In this study, we report our experience of robotic surgery by using the first open console, modular robotic platform in Germany, the Versius Surgical System®. METHODS: We implemented the Versius Surgical System® in April 2021 at our centre. Since then, 175 patients received robotic assisted surgery. All patients were included in this study. Data were analysed by using the SPSS (IBM Statistics) Software. RESULTS: 175 patients underwent robotic surgery. We started the implementation of the system by performing cholecystectomy. After the first 50 successful operations, we began to perform robotic assisted oncological resections. We saw a learning curve with improvements in total operative time and console time until reaching a standard similar to conventional laparoscopic surgery. The perioperative complication-ratio was equivalent for operations matched the histopathological outcome (MERCURY graduation, R0-staus) at oncological resections. However, four patients had to be revised because of secondary bleeding. Interestingly the total hospital stay for right sided hemicolectomy and oesophagus-resection was shorter than in laparoscopic surgery. In our opinion, the Versius Surgical System® seems to be a good, promising system and a safe alternative to other robotic systems, although any comparison is still missing. The open design enabling a better communication between console surgeon and bedside-unit assistant as well as the mobile bedside units are very interesting and allow more flexibility. Nevertheless, there are limitations of the system that require a direct comparison with other robotic systems as well as continuous advancement.

Outcome Quality After Colorectal Cancer Resection in Certified Colorectal Cancer Centers­Patient-Reported and Short-Term Clinical Outcomes.

BACKGROUND: In this observational study, patient-reported outcomes and short-term clinical outcome parameters in patients with colorectal cancer were studied 12 months after the start of treatment. Outcomes were also compared across German Certified Colorectal Cancer Centres. METHODS: Data were collected from 4239 patients with colorectal cancer who had undergone elective tumor resection in one of 102 colorectal cancer centers and had responded to a quality-of-life questionnaire before treatment (EORTC QLQ-C30 and -CR29). 3142 (74.1%) of these patients completed a post-treatment questionnaire 12 months later. Correlation analyses were calculated and case-mix adjusted comparisons across centers were made for selected patient-reported outcomes, anastomotic insufficiency, and 30-day-mortality. RESULTS: At 12 months, mild improvements were seen in mean quality-of-life scores (66 vs. 62 points), constipation (16 vs. 19), and abdominal pain (15 vs. 17). Worsening was seen in physical function (75 vs. 82) and pain (22 vs. 19). Better patient-reported outcomes at 12 months were associated with better scores before treatment. Better results in at least three of the five scores were associated with male sex, higher educational level, higher age, and private health insurance. Major worsening of fecal incontinence was seen among patients with rectal cancer without a stoma. The largest differences across centers were found with respect to physical function. Anastomotic insufficiency was found in 4.3% of colon cancer patients and 8.2% of rectal cancer patients. 1.9% of patients died within 30 days after their resection. CONCLUSION: Clinicians can use these findings to identify patients at higher risk for poorer patient-reported outcomes. The differences among cancer centers that were found imply that measures for quality improvement would be desirable.

Case Report: Eighteen Month Relapse- Free Survival Following Radical Multidisciplinary Oncological Treatment in a 68-Year-Old Male Patient With Histiocytic Sarcoma.

INTRODUCTION: Histiocytic Sarcoma (HS) is a rare and aggressive malignancy, and patients can present with rapid tumor growth and invasion. The optimal diagnostic and therapeutic management is unknown since only a few cases have been published. Here we report a patient with histiocytic sarcoma of the right groin. CASE: A 68 year-old male patient presented to our hospital with suspicion of a superinfected atheroma of the right groin. Computed tomography showed an abdominal tumor of unknown entity. Detailed assessment including immunohistochemically evaluation of biopsy material confirmed HS. The patient underwent radical tumor resection including compartment-resection of the right thigh. During five additional cycles of chemotherapy over a period of 1.5 years he remained relapse-free. SUMMARY: Diagnostic work up and treatment of HS is challenging, as there is a paucity of clinical reports and lack of standard guidelines for care. In the present case report, aggressive multidisciplinary treatment resulted in good clinical outcome, however, further studies evaluating this approach in similar patients are needed.

Myokardszintigraphie - eine Methode zur Erfassung der kardialen Komorbidität bei Psoriasis-Patienten?

HINTERGRUND: Kardiale Komorbiditäten bei Patienten mit Psoriasis stehen seit Jahren im Fokus. Ziel dieser Arbeit war es, im Rahmen einer Pilotstudie die Myokardszintigraphie als mögliche Früherkennungsmethode zu evaluieren. PATIENTEN UND METHODIK: Es wurden bei insgesamt 50 kardial asymptomatischen Patienten mit einer Psoriasis der Haut verschiedene Begleiterkrankungen erfasst. Dabei kam zur Erkennung von kardialem Risiko/ belastungsinduzierter Ischämie die Myokardszintigraphie zum Einsatz. ERGEBNISSE: Bei 28 Patienten (56 %) fanden sich pathologische Befunde in der Myokardszintigraphie. Davon zeigten 14 Patienten Zeichen einer sogenannten Small Vessel Disease (Kardiales Syndrom X). Darüber hinaus fanden sich weitere Begleiterkrankungen wie Adipositas, arterielle Hypertonie, Nikotinkonsum, Alkoholkonsum und erhöhte CRP-Werte. Die Häufigkeiten entsprachen im Wesentlichen den aktuellen Daten aus der Literatur. Wir konnten keinen signifikanten Zusammenhang von Schwere der Psoriasis oder der angegebenen Komorbiditäten mit einem pathologischen Befund in der Myokardszintigraphie feststellen. SCHLUSSFOLGERUNGEN: Mit der Myokardszintigraphie scheint ein sehr empfindliches, nicht invasives Früherkennungsverfahren zur Detektion kardialer Komorbidität bei Psoriasis-Patienten zur Verfügung zu stehen. Weitere größere Arbeiten mit Kontrollkollektiven und Kotrollmethoden, wie beispielsweise der Koronarangiographie, sind zur Überprüfung der Wertigkeit nötig.

Myocardial scintigraphy - a method for detecting cardiac comorbidity in psoriasis patients?

BACKGROUND: In recent years, cardiac comorbidities in psoriasis patients have increasingly moved into the focus of clinical research. The objective of the present study was to evaluate myocardial scintigraphy as a screening method in patients with psoriasis. PATIENTS AND METHODS: Assessment of various comorbidities in 50 psoriasis patients without clinical symptoms of cardiac disease. Myocardial scintigraphy was employed to detect cardiac risk/exercise-induced ischemia. RESULTS: Twenty-eight patients (56 %) had pathological findings on myocardial scintigraphy. Fourteen individuals showed evidence of small-vessel disease (cardiac syndrome X). Other comorbidities included obesity, arterial hypertension, nicotine and alcohol abuse, as well as elevated CRP levels. Frequencies largely corresponded to those reported in the recent literature. There was no significant correlation between the severity of psoriasis or any comorbidities and pathological findings on myocardial scintigraphy. CONCLUSIONS: Myocardial scintigraphy seems to be a very sensitive, noninvasive method for the early detection of cardiac comorbidities in psoriasis patients. However, determining its true diagnostic value will require larger studies with control subjects and control methods such as coronary angiography.

Perception of body weight status: a case control study of obese and lean children and adolescents and their parents.

BACKGROUND: The objective of this study was to investigate differences in weight perception and self-concept of obese and lean children, and to examine parents' awareness of overweight in themselves and their children. A total of 59 obese patients aged 7-17 years and 49 of their parents from a pediatric obesity out-patient clinic participated and were compared with 96 normal-weight patients and 81 of their parents from a pediatric pulmonary disease out-patient clinic. METHODS: Children's and parents' self-perception of weight, desire for weight change and weight concerns, children's belief that their desired weight can be achieved, and parents' perception of their child's weight status were assessed using single questionnaire items. Children's self-concept was measured by the Self-Perception Profile for Children. In addition, children drew pictures about themselves and their favorite activity. RESULTS: Obese patients wished to change their weight more frequently (p < 0.001) and had more weight concerns (p < 0.001). Their self-concept was significantly more negative. Physical activities were more common in their drawings than in those of normal-weight peers. Parents of obese children were more frequently overweight or obese themselves (p < 0.001). 35 of them and 73 parents of normal-weight children perceived their own weight realistically. Of the parents with overweight or obese children, 69.4% perceived their own child as overweight and 28.6% as very overweight, whereas 83% of them were obese. CONCLUSION: Children and adolescents as well as their parents recognize overweight as a health problem. In the majority, weight perception matches real body weight. Most parents at least recognize overweight in their children.