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Background: Capnography has shown to be an invaluable tool in assessing trauma victims in different setups. To elucidate this, we conducted this meta-analysis to evaluate the utility of end-tidal CO 2 (ETCO 2 ) and the arterial CO 2 -ETCO 2 gap (PaCO 2 -ETCO 2 ) measurements on predictiveness for mortality in trauma patients., Methods: A systematic literature search was performed (01/1990-06/2023). The inclusion criteria included adult trauma patients, with mention of mortality. The primary outcome was evaluating the reliability of ETCO 2 in predicting mortality., Results: Seventeen studies were included, with total of 3445 patients. Mean age was 39.08-year, 22.3 ​% female. Overall mortality was 25.6 ​%, mostly retrospective studies. Mean ETCO 2 in survivors was 31.45 ​mmHg, and 24.75 ​mmHg in deceased patients, (p ​= ​0.0128). Mean PaCO 2 -ETCO 2 gap in survivors was 6.8 ​mmHg, and 15.0 ​mmHg in deceased patients, (p ​< ​0.001). Using receiver operator characteristic curve analysis, ETCO 2 of 30.2 ​mmHg with high sensitivity to predict mortality., Conclusion: Low ETCO 2 or a wide PaCO 2 -ETCO 2 gap were significantly correlated with poor outcomes in trauma patients. This easily obtained value can help predict those who need more aggressive treatments., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Laparoscopic cholecystectomy (LC) remains the gold standard procedure for the management of benign gallbladder disease. Recognizing the need to mitigate complications, mainly bile duct injury (BDI), various techniques for ductal identification during LC have emerged, including the "Critical View of Safety" (CVS) and the infundibular technique (IT). In this systematic review and meta-analysis, we assess and compare the outcomes of both techniques, with a primary focus on evaluating their impact on BDIs. A comprehensive search was conducted using PubMed and Scopus databases. The search focused on the surgical technique, incidences of minor and major BDIs, operative time, conversion rate, and length of stay, among patients undergoing LC for benign gallbladder disease. Our initial search retrieved 264 studies. After screening the unique studies against our predefined inclusion/exclusion criteria, only five met our criteria and were included. Additionally, a manual search identified eight more relevant studies, bringing the total number of included studies to 13. The total number of included patients was 4,837. Approximately two-thirds underwent LC using the CVS approach (61.1%), and 66.3% were female, with a mean age of 44.4 ± 11.2 years. The CVS approach was associated with a significant reduction in overall BDIs (RR = 0.36; 95% CI 0.18-0.71) and major BDIs (RR = 0.28; 95% CI 0.13-0.63). However, there were no significant differences in terms of minor BDIs, operative time, conversion rates, or length of stay. Our study demonstrated the superiority of the CVS approach in terms of reducing the incidence of overall and major BDIs compared to IT. However, our study revealed no other significant differences between the two techniques. Further research, including multicentric randomized controlled trials, will be necessary to further evaluate the efficacy of these techniques., Competing Interests: Declarations Conflict of interest Bahaa I. Aburayya, Ahmad K. Al-Hayk, Ahmad A. Toubasi, and Dr. Awni D. Shahait have no conflicts of interest to disclose. Dr. Abubaker Ali is the co-chair of the robotics committee at SAGES. Compliance with Ethical Standards Not applicable. Research involving human participants and/or animals Not applicable. Informed consent Not applicable., (© 2024. Italian Society of Surgery (SIC).)

Epstein-Barr virus positive inflammatory pseudotumor follicular dendritic cell sarcoma (EBV+ FDCS) is a rare indolent neoplasm that presents primarily in the spleen and liver. We display a case of EBV+ FDCS in the spleen, its clinic-pathologic properties, and treatment. Our patient was evaluated following an incidental finding of a splenic mass on imaging after a traumatic injury. Computed tomography and magnetic resonance imaging both confirmed a well-circumscribed lesion in the spleen. Consequently, the patient underwent a robotic-assisted diagnostic splenectomy. Histologic examination revealed portions of spleen with partial effacement of tissue architecture by a well-circumscribed nonencapsulated mass displaying atypical, spindled cells-positive for EBER (CISH), EBV LMP1, smooth muscle actin, and clusterin-mixed inflammatory elements, and interspersed small lymphocytes., Competing Interests: The authors declare that there is no conflict of interest., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2024.)

Despite being relatively uncommon, abdominal wall hematomas can occur due to blunt trauma, post-percutaneous procedures, anticoagulation, and even spontaneous bleeding. It can present with varying symptoms from acute abdominal pain to life-threatening bleeding causing hypovolemia and shock. With the coronavirus disease 2019 (COVID-19) pandemic, affected patients developed coagulopathy putting patients at risk of venous thromboembolism or excessive bleeding. Herein, we report a case of spontaneous multiple abdominal wall hematomas in a patient after a COVID-19 infection, which was managed conservatively., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Alzoubi et al.)

Background Since the spread of the COVID-19 virus, governments are putting significant resources into ending the pandemic. Vaccination arises as the best solution to get back to our everyday lives. However, we are now facing vaccine hesitancy, which is a critical problem. Methods This cross-sectional study was conducted between December 15, 2020, and March 1, 2021, using a validated online-based questionnaire; participants were compared using the Statistical Package for the Social Sciences (SPSS) program based on multiple factors. Results A total of 1607 participants throughout Jordan have responded to the questionnaire, among which 880 (54.8%) have bachelor's degrees, 236 (14.7%) have a high educational level (master and doctoral), and 491 (30.5%) have a diploma or less. Although this is a non-probable sample, it is not a representative sample as, according to United Nations Educational, Scientific and Cultural Organization (UNESCO), only 33.6% of the Jordan population have a tertiary education. Overall, 892 (55.5%) of the studied subjects had the intention to take the vaccine, distributed as follows: 156 (66.1%) of the high educational participants wanted to take the vaccine, compared to 512 (58.2%) of those who have bachelor's degree and 224 (45.6%) of those who have diploma or less (p < 0.001). Reading scientific articles talking about the vaccines and their effects (55.6%, p < 0.001), knowing the mechanism of action (45.2%, p = 0.007), getting proper medical advice (27.2%, p < 0.001), encouraged by the increasing number of infections and deaths (39.7%, p < 0.001), and the number of people who received the vaccine (16.1%, p < 0.001) were the most critical factors that played a role in taking the vaccine by all of the studied groups. Male gender (OR = 2.02; 95% CI = 1.54-2.64; p < 0.001), high income of more than 1000 JDs (1400 USD) (OR = 3.23; 95% CI = 2.21-4.71; p < 0.001), having an educational level of either high education (OR = 3.39; 95% CI = 2.07-5.55; p < 0.001) or bachelor degree (OR = 1.67; 95% CI = 1.25-2.24; p = 0.001), and being encouraged by the increasing number of infections and deaths caused by COVID-19 (OR = 1.97; 95% CI = 1.46-2.66; p < 0.001) were all significantly associated with the willingness to take the vaccine. Conclusion As the world rushes toward vaccination to end the pandemic, efforts are needed to end this phenomenon of vaccine hesitancy by enlightening people with the precise knowledge regarding the vaccine's mechanism of action, side effects, and efficacy focusing mainly on people with lower educational levels., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Abdullah et al.)

Background:  The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial demonstrated that sentinel lymph node biopsy (SLNB) alone is adequate for axillary control in patients with one to two positive axillary lymph nodes. However, axillary lymph node dissection (ALND) is required in patients with N1 disease diagnosed with a preoperative needle biopsy. In this report, we determined how many patients could potentially have had SNB alone based on finding only one to two positive nodes in the axilla., Methods:  A retrospective review of patients with positive preoperative axillary needle biopsy undergoing ALND was used to identify rates of high volume axillary disease (>2 positive nodes). Wilcoxon's rank-sum and Fisher's exact test were used for statistical analysis. A review of the literature is included for comparison., Results:  73% of 51 total patients with a positive needle biopsy had >2 positive nodes on axillary dissection. The high-volume axillary disease was significantly more likely with the presence of lymphovascular invasion and extranodal extension., Conclusions:  Patients with positive preoperative axillary needle biopsies have a significantly higher rate of high volume axillary disease. However, at least one-quarter of these patients will have <3 positive nodes and potentially could have been treated with SNB alone., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Choi et al.)

Introduction:  Emergency laparotomy (EL) is a common operation that deals with a wide range of pathologies. Preoperative optimization is often lacking due to the urgent nature of the disease process with a reported mortality rate of up to 44%. This study examines the mortality of EL at an academic acute care surgery medical center., Methods:  A retrospective analysis of nontrauma EL from January 2008 to December 2013 was conducted. Data included demographics, clinical features, preoperative laboratory studies, comorbidities, time to surgery, ICU admission, and 30-day mortality., Results:  A total of 234 patients (123 males, 52.6%) were included in the study. EL was performed within four hours (immediate) of presentation in 93 (39.7%) patients, within 4-12 hours (early) in 53 (25.4%) patients, and within 12-24 hours (late) in 63 (30.1%) patients. Overall mortality was 16 (6.8%) at 30 days. Mortality was significantly higher with chronic obstructive pulmonary disease (p = 0.014), blood transfusion (p < 0.001), ICU admission (p < 0.001), ventilator days > four (p = 0.013), hyperlipidemia (p = 0.014), heart rate > 90 beats/minute (p = 0.003), temperature > 38°C or < 35°C (p = 0.013), and systolic blood pressure < 90 mmHg (p < 0.001)., Conclusion: EL can be performed with lower mortality than previously reported. Specific predictors of mortality are identified and can be used for risk assessment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Shahait et al.)

Introduction: Iatrogenic ureteral injury (IUI) is an uncommon complication in colorectal surgery. Prophylactic ureteral stenting (PUS) gained acceptance to aid in intraoperative identification of the ureter. Despite its use, the benefit of pus to avoid IUI remains debatable. We sought to analyze the rates of IUI after colorectal surgery in veterans and to compare the outcomes after PUS using a large matched cohort., Methods: The veterans affairs surgical quality improvement program database was queried for patients who underwent colorectal surgery from 2008-2015. To analyze the outcomes of PUS, we created two matched groups using propensity-score matching accounting for demographical and clinical cofactors to assess variable outcomes. Cross-tabulation was used to calculate rates of IUI and univariate and multivariate analyses were performed to evaluate risk factors associated with IUI., Results: 27,448 patients were identified and 458 underwent PUS placement (1.6%). The majority of procedures were performed electively and with an open approach. Mean age was 65 y, 96.3% were male, and colorectal cancer was the most common indication. 45 patients (0.2%) were diagnosed with IUI. IUI incidence was higher in female patients, after left-sided colorectal resection, and in those undergoing open procedures. After matching, PUS use was associated with longer length of stay and operative time and increased creatinine levels from baseline., Conclusion: We demonstrated that the use of PUS is independently associated with increased operative time and change in creatinine levels. Although no IUI occurred in the PUS group, this finding was not statistically significant. The risk and/or benefit ratio of PUS should be considered for each individual case, with its selective use based on the presence of risk factors for IUI, such as female patients and left-sided resections., Competing Interests: Disclosure The authors declare no conflict of interest., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Ventral hernia repair is a common procedure with reported 15% to 37% morbidity and 0.3% to 1.4% mortality rates. This study examines the 30-day morbidity and mortality of open and laparoscopic ventral hernia repair in veterans, along with the impact of body mass index on these outcomes., Methods: The Veterans Affairs Surgical Quality Improvement Program was queried for all ventral hernia repairs during the period 2008 to 2015. In this retrospective analysis, we compared outcomes of open ventral hernia repair versus laparoscopic ventral hernia repair and among different body mass index classes., Results: A total of 19,883 patients were identified (92.6% male, mean age 59.7, 53.1% obese, and 71.6% with American Society of Anesthesiologists class ≥III). There were 95 (0.5%) mortalities, and complications occurred in 1,289 (6.5%) patients. Open ventral hernia repair was performed in 60.2%; 14.5% were recurrent, and 3.3% were performed as an emergency operation. When compared with open ventral hernia repair, the laparoscopic ventral hernia repair group had higher mean body mass index, less patients with American Society of Anesthesiologists class ≥III, fewer emergency operations, longer operative time, less complications, decreased mortality, and shorter duration of stay. Body mass index 35.00 to 49.99 was predictive of overall complications in the open ventral hernia repair group., Conclusion: Ventral hernia repair can be performed in the veteran population with outcomes comparable to those in the private sector. Morbid obesity has a negative impact on ventral hernia repair outcomes that is most prominent following open surgery. Laparoscopic ventral hernia repair may offer superior outcomes when compared to open ventral hernia repair and may be considered., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Breast sarcoma is a rare form of malignancy that arises from connective tissue within the breast, comprising less than 5% of all sarcomas. They develop as primary tumours or as secondary following radiation therapy. Diagnosis can be challenging as breast sarcomas are often asymptomatic and resemble benign breast tissue changes. Radiation-induced breast sarcomas present in various forms with an average latency period of 10-20 years following initial radiation therapy. Angiosarcomas are the most common form, while other types such as undifferentiated pleomorphic sarcomas remain rare. Here, we report a case of radiation-induced undifferentiated pleomorphic breast sarcoma in a 75-year-old woman that developed nearly 20 years following breast conserving surgery and radiation for invasive ductal carcinoma. The patient initially noticed a mass in 2017 on self-examination. The mammogram, ultrasound and biopsy at the time showed a benign 2.2 cm nodular fasciitis without malignancy. The mass grew rapidly in the next 6 months to 5.6 cm and repeat biopsy diagnosed undifferentiated pleomorphic sarcoma. The mass abutted the pectoralis muscle but staging workup ruled out distant metastasis and the patient underwent wide local resection of the mass with clear margins. The patient subsequently underwent further postoperative radiation due to insufficient posterior margin width on wide local excision, as chest wall resection would have been required for a wider posterior margin. Prognosis for postradiation sarcomas is generally poor with 27%-36% 5-year survival, with surgical resection as the main line of treatment. The patient currently remains disease-free after 15 months of surveillance., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Vascular intrapelvic complications due to total hip arthroplasty failure are uncommon, with less than 30 cases reported in the literature. Herein, we report a case of unusual asymptomatic delayed vascular complication after 10 years from right total hip arthroplasty. A man in mid-50s, with multiple comorbidities including end-stage renal disease. The patient was admitted for the renal transplant surgery. Intraoperatively, right external iliac artery pseudoaneurysm was discovered, which required the transplantation to be done on the left side. After recovery from the renal transplant surgery, the patient underwent resection of the right external iliac artery pseudoaneurysm with primary anastomosis by vascular surgery, with resection of the migrated screw by orthopaedic surgery., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

The aim of this study was to investigate the outcome of vascular access procedures for hemodialysis and factors affecting access survival and complication rates. A retrospective review was carried out on 276 patients who underwent 404 consecutive vascular access operations performed over seven-years. The overall primary failure rate was 9.2%, while the oneand five-year cumulative access patency rates were 63.8% and 40.6%, respectively. Diabetes mellitus status significantly influenced access survival (P = 0.022). Autogenous arteriovenous fistulas (AVFs) are reliable procedures with access sites often available in the upper limb proximally and distally. Patients with diabetes mellitus have significantly worse patency rates of upper limb AVFs.

Gastric diverticula are rare and usually asymptomatic. They are most frequently located on the posterior wall of the stomach. Many of them were reported as adrenal masses. Here, we present a 48-year-old male with a gastric fundus diverticulum that was misdiagnosed as a left adrenal mass on magnetic resonance imaging (MRI). Laparoscopic resection of the diverticulum was successfully performed, and histopathological examination revealed a true gastric diverticulum with moderate chronic gastritis. Although most cases of gastric diverticula are asymptomatic, to the best of our knowledge, this is the first reported case of chronic gastritis that developed in a gastric diverticulum.

Aims: To determine if there is a significant association between premature hair graying and cigarette smoking., Materials and Methods: A cross-sectional observational study was conducted in a nonclinical setting on 207 participants on August 24 until 25, 2010. Participants were classified into two groups [premature hair graying (PHG) and normal hair graying]. PHG was defined as the first appearance of gray hair before the age of 30. Data were collected using an interview questionnaire and measurements of body mass index, waist circumference, fasting blood glucose and blood pressure. Collected data were statistically analyzed using SPSS 16, Chicago, IL., Results: Of the 207 subjects, 104 (50.2%) had first appearance of gray hair before the age of 30 (PHG group) while the other 103 (49.8%) were considered normal hair graying group. The prevalence of smokers in the "PHG" group was higher (40.2% vs. 24.7%, P = 0.031). Smokers had earlier onset of hair graying (smokers: 31 (7.4) vs. nonsmokers: 34 (8.6), P = 0.034). Using multiple logistic regression with conditional likelihood, smokers were two and half times (95% CI: 1.5-4.6) more prone to develop PHG., Conclusion: This study suggests that there is a significant relation (with adjusted odds ratio of two and half) between onset of gray hair before the age of 30 and cigarette smoking.

Solitary metastasis from prostate adenocarcinoma to thyroid gland is very rare and usually associated with other distal metastasis. This report describes for the first time isolated multiple bilateral thyroid metastasis from prostatic adenocarcinoma. A 67-year-old man who is known as a case of prostatic adenocarcinoma was admitted to a hospital as a case of a multinodular goiter on the basis of clinical and CT scan findings. Total thyroidectomy was performed and histopathology result showed adenomatous goiter containing bilateral metastatic prostatic adenocarcinoma. This is the first report of isolated multiple bilateral thyroid gland metastasis from prostatic adenocarcinoma without other distal metastasis. Such lesions are very rare and can be misdiagnosed, so high index of suspicion for thyroid metastasis should be always maintained in all oncology patients with isolated thyroid mass because early resection and thyroidectomy will change the prognosis for patient.