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Background Current injury prevention programmes in football are limited by a one-size-fits-all approach, which predominantly focuses on preventive exercise programmes while ignoring differences in risk profiles between individuals and teams.Objective To address this gap, we developed a new data-driven, customisable approach based on the principles of risk management. We collaborated with key stakeholders to identify focus areas for injury and illness prevention and determine their priorities.Setting The team medical and coaching staff included members from 17 professional football clubs, the national team and a youth football academy in Qatar.Methods In 2015, we launched a series of annual workshops under the Aspetar Sports Injury and Illness Prevention Programme. The workshops included club medical personnel and fitness coaches in a process to develop team-specific programmes for injury and illness prevention based on the principle of risk management. Over 2 years, workshops refined focus areas through discussions, surveys and small-group presentations, culminating in the creation a novel programme for football injury prevention.Results Out of 44 focus areas first identified, 23 were selected as priorities for inclusion in multimodal injury and illness prevention programmes. The identified focus areas represent a variety of aspects, including social/behavioural/lifestyle, exercise programmes/training, load management, recovery and equipment. The top priorities included communication, the Nordic hamstring exercise, training load, recovery strategies, nutrition, sleep, warm-up, the Copenhagen adduction exercise and core and dynamic stability.Conclusion We have developed a comprehensive framework for preventing injuries and illnesses in football grounded in the general principles of risk management. This framework has proven feasible and led to the creation of a new multicomponent programme, The Aspetar IP2 (Injury and Illness Prevention for Performance) NetWork, focusing on a range of areas beyond preventive exercise programmes only.

Ganglioneuromas are benign slow-growing lesions that arise from sympathetic ganglion cells. They are usually found incidentally. Ultrasound and magnetic resonance imaging (MRI), provides only an unspecified diagnosis and it has to be confirmed by pathologic studies. Complete surgical excision is believed to be the curative treatment for symptomatic lesions. In the literature, the pelvic location reported is exceptional. We report a case of laparoscopic assisted excision of a retrorectal presacral ganglioneuroma for 22-year-old female patient.

Introduction Pancreatic trauma is notably less frequent than injuries affecting other solid organs, such as the liver or spleen. Despite their infrequency, pancreatic injuries can pose significant risks, with mortality rates ranging from 5 to 30% and morbidity rates reaching 50%. Managing such injuries remains contentious because of the anatomical complexity, lesion extent, and close proximity to neighboring organs. Methods Our study aimed to delineate the clinical and biological characteristics of pancreatic trauma and specify diagnostic and therapeutic modalities. This study was conducted retrospectively from 2010 to 2021 at Mahmoud El Matri Hospital’s General Surgery Department in Ariana, TUNISIA, and included five cases of blunt and open pancreatic trauma. Results Although rare, pancreatic injuries can lead to serious consequences, prompting the development of a diverse array of therapeutic options. Pancreatic trauma presents a complex clinical challenge, necessitating a comprehensive approach that considers various factors, such as injury severity, anatomical location, and patient condition. Advanced imaging techniques, including computed tomography (CT) scanning, Wirsung-MRI, and ERCP, aid in the accurate diagnosis and assessment of canal involvement. Conservative management was considered for cases with limited canal rupture, whereas endoscopic treatments showed promise for hemodynamically stable cases. Surgical interventions, such as duodenopancreatectomy, are reserved for exceptional cases with severe injuries. Conclusion Pancreatic trauma requires a comprehensive approach that considers factors such as injury severity, anatomical location, and patient condition. Ongoing research and collaboration are vital for refining pancreatic trauma management and proposing guidelines for facilitating decision-making.

Background Colonoscopy is a commonly utilized procedure in gastroenterology, but it carries risks of complications, with perforation being the most dreaded. The management of colonic perforation remains a topic of debate, as it can be effectively treated through surgical or non-surgical approaches. Our objective is to detail clinical presentations, diagnostic methods, and potential therapeutic options. Cases For this study, we gathered clinical and radiological data from two cases of colonic perforation following colonoscopy. We examined clinical presentations, diagnostic methods employed, and the different therapeutic approaches used for each case. In both cases, patients exhibited symptoms of colonic perforation following colonoscopy. The first case was managed conservatively, with progressive clinical improvement. The second case showed signs of pneumoperitoneum, but no perforation was found during laparoscopic intervention. Both patients recovered well and experienced no complications during follow-up. Conclusions Our study highlights the importance of understanding the risks associated with colonoscopy, particularly in patients with risk factors. It also underscores the diversity of available treatment approaches for iatrogenic colonic perforation, emphasizing the significance of a multidisciplinary approach in determining the optimal therapeutic strategy.

Background: Patients with borderline pancreatic cancer have a poor prognosis despite the recent development of multidisciplinary treatments that include chemotherapy. Nowadays induction chemotherapy is developing into a powerful cure to convert borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancers (LAPC) into a resectable cancer. This report supplements published data on the management border line pancreatic cancer and emphasizes the possibility of complete pathological response after chemotherapy in such cases. Case presentation: A 60-year-old man, with a type 2 Diabetes Mellitus, was diagnosed with a 3-centimeter T2N1M0 borderline pancreatic head tumor. Ultrasound endoscopy found a close contact with the superior mesenteric vein (< 180°) and an endoscopically guided biopsy confirmed the diagnosis of ductal adenocarcinoma. The patient underwent systemic chemotherapy with six injections of FOLFIRINOX without radiotherapy. The radiological re-staging revealed a cancer down-sizing of 2cm and tumor became resectable. The patient underwent a Whipple procedure with uneventful follow-up. The pathological examination of the specimen concluded to pathological complete response. The twelve lymph nodes evaluated were negative. Following surgery, adjuvant chemotherapy FOLFIRINOX was given. After three years of follow-up, there is no evidence of recurrence.

Perforation of the intestine caused by an ingested foreign object remains a complex challenge in terms of clinical presentation, diagnosis, and treatment. A 55-year-old man presented with complaints of right-sided abdominal pain and functional impairment of the lower limbs. Physical examination revealed an afebrile status and tenderness in the right upper quadrant of the abdomen. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) revealed a duodenal perforation caused by a densely linear foreign body. Additionally, a collection in the psoas muscle and contiguous spondylodiscitis were identified. To address this condition, an endoscopic procedure was performed to extract the toothpick successfully, and a CT-guided fine-needle aspiration was conducted to collect the fluid. Spondylodiscitis was managed with antibiotic therapy and immobilization. Remarkably, significant clinical and radiological improvement was observed within a span of three weeks. This case emphasizes the importance of multidisciplinary care involving interventional treatments as a viable and safe alternative to surgical intervention.

Background: Crohn's Disease is a chronic, idiopathic, and transmural inflammatory condition that mainly affects the distal ileum. It is characterized by intricate pathophysiology and numerous complications, some of which can be fatal. In this report, we present a case study of acute generalized peritonitis resulting from the perforation of a distal ileal loop, inaugurating the diagnosis of Crohn's disease. Case presentation: A 43-year-old patient presented with a clinical presentation of acute peritonitis. He had a one-year history of intermittent abdominal pain and diarrhea. As the maximum pain was in the right iliac fossa, an acute appendicitis complicated with peritonitis was considered and the patient underwent laparoscopic exploration, without morphologic exploration. Peroperative observation found an inflamed conglomerate of small bowel loops associated with sclerolipomatosis, and purulent peritonitis by perforation of a distal ileal loop, 40 cm from the ileocaecal valve. A peritoneal toilet, ileocaecal resection, and ileo-colostomy were performed. The postoperative course was uneventful. Discussion: Various complications may arise during the evolution of Crohn’s disease. However, fatal complication such as generalized peritonitis leading to the diagnosis is rare. The underlying pathophysiology of free perforation remains unknown. The most common site affected is the terminal ileum. The surgical treatment is based on a limited resection of the affected bowel segment, followed by a temporary stoma. A primary anastomosis can be performed in selected patients. Conclusion: Perforative peritonitis as an initial presentation of Crohn's disease is challenging. Surgery is obviously required for acute peritonitis, with limited resection with or without anastomosis.

BackgroundApproximately 50% of the patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS) have additional stenotic lesions in non-infarct-related coronary arteries. The decision whether these stenoses require further treatment is routinely based on angiography alone. The quantitative flow ratio (QFR) is a simple non-invasive method that may help quantify the functional significance of these intermediate coronary artery lesions. The aim of our single-center, randomized superiority trial is to test the impact and efficacy of QFR, as compared to angiography, in the treatment of patients with ACS with multivessel coronary artery disease. Primary goal of the study is to investigate 1. The impact of QFR on the proportion of patients receiving PCI vs. conservative therapy and 2. whether QFR improves angina pectoris and overall cardiovascular outcomes.Methods and AnalysisAfter treatment of the culprit lesion(s), a total of 200 consecutive ACS patients will be randomized 1:1 to angiography- vs. QFR-guided revascularization of non-culprit stenoses. Patients and clinicians responsible are blinded to the randomization group. The primary functional endpoint is defined as the proportion of patients assigned to medical treatment in the two groups. The primary clinical endpoint is a composite of death, non-fatal myocardial infarction, revascularization and significant angina at 12 months. Secondary endpoints include changes in the SAQ subgroups, and clinical events at 3- and 12-month follow-up.DiscussionThis study is designed to investigate whether QFR-based decision-making is associated with a decrease in angina and an improved prognosis in patients with multivessel disease.Trial Registration NumberClinicalTrials.gov Registry (NCT04808310).