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- Chronic Osteomyelitis of the Jaws: Management and Outcomes in a Tertiary Maxillofacial Surgery Unit.Publication . Santos, Patrícia; Moreira, Carolina; Gião, Nuno; Valejo Coelho, PauloObjective: This study aims to evaluate the management and outcomes over 14 years at a tertiary maxillofacial surgery unit. Methods: Retrospective cohort study of patients from a Portuguese tertiary center of maxillofacial surgery with histopathologically confirmed diagnoses of chronic osteomyelitis of the jaws between January 2010 and December 2023. Demographic and clinical characteristics, treatment, and progression of the disease were evaluated. Results: Fifty-three patients were included-28 women (52.8%), mean age 55 (95% CI 5-90) years. The mandible was affected in 84.9% (n = 45) of cases. Secondary chronic osteomyelitis was diagnosed in 88.7% (n = 47), with medication-related osteonecrosis of the jaw (MRONJ) being the most common etiology (38.3%). Bacteriological samples were contributory in 52% (n = 13) and 46.1% (n = 6) were resistant to amoxicillin. All received antibiotics for a median time of 27.3 days. Surgical treatment included sequestrectomy (n = 40, 75.5%), marginal (n = 5, 9.4%), and segmental mandibulectomy (n = 8, 15.1%). Clinical remission was achieved in 77.4% (n = 41) of cases with higher success in MRONJ (n = 15, 83.3%) than ORN (n = 4, 57.1%). Conclusions: Almost half of the isolates were amoxicillin-resistant, reinforcing the need for susceptibility testing. Surgical management guided by etiology and disease stage remains essential, with more extensive resection needed in MRONJ and ORN.
- A Novel Use of Temporary ICL During DMEK to Prevent Gas-Induced Opacification of a Scleral-Fixated Carlevale IOL.Publication . Zúñiga, Martina Aguilera; Güell, José Luis; Gris, Óscar; Salmoral, Alberto; Martín, Carlos; Moura-Coelho, NunoPurpose: To report a novel surgical strategy using a temporary implantable collamer lens (ICL) during Descemet membrane endothelial keratoplasty (DMEK) to prevent gas-induced opacification of a scleral-fixated Carlevale intraocular lens (IOL) in a vitrectomized eye. Observations: A 68-year-old male with a history of blunt trauma, pars plana vitrectomy, and Carlevale IOL implantation developed irreversible corneal edema. DMEK was performed with the intraoperative placement of an inverted ICL in the anterior chamber, serving as a protective barrier between the gas tamponade and the IOL. The ICL was explanted two weeks later, without complications. The endothelial graft remained well attached throughout the follow-up period, with no intraoperative or postoperative adverse events. The optical clarity of the Carlevale IOL was preserved, and no ICL-related complications were observed. Best-corrected visual acuity (BCVA) improved from logMAR 1.00 preoperatively to logMAR 0.22 by 3 months, with stability maintained through the 6-month follow-up period. Conclusions and importance: Temporary ICL implantation during DMEK may be an effective strategy to prevent gas-induced opacification in eyes with hydrophilic IOLs. Unlike IOL exchange, which adds surgical trauma, or gas-minimizing strategies, which risk detachment, this approach preserves full tamponade while safeguarding IOL clarity.
- Immune Thrombocytopenia and Type 1 von Willebrand Disease in a Patient With a Femoral Fracture: A Case Report.Publication . Ferreira, André; Roberto, AndréThis article describes the case of a complex medical patient with immune thrombocytopenia (ITP) and von Willebrand disease (vWD), among other comorbidities, who underwent urgent orthopedic surgery and discusses the specificities of the perioperative anesthetic management of these bleeding disorders. Immune thrombocytopenia is an acquired autoimmune condition characterized by a diminished platelet count due to immune destruction. vWD is the most common inherited bleeding disorder, in which there is a defect of von Willebrand factor, a fundamental component of the hemostatic process. By compromising primary hemostasis, both conditions carry an important hemorrhagic risk in surgical patients, which is compounded by their coexistence.
- Sarcoidosis Mimicking Metastatic Disease: Multisystem Involvement With Osseous Manifestations.Publication . Canedo, Filipa; Duarte, Inês; Rodrigues, João; Carvalhinho, Maria Inês; Borba, AlexandraSarcoidosis is a chronic granulomatous disease of unknown etiology that can affect multiple organs, most frequently the lungs, lymph nodes, skin, and eyes. Osseous involvement is a rare manifestation, typically affecting small bones, although axial skeleton lesions may also occur. We report the case of a 42-year-old woman with no relevant past medical history who presented with fatigue, night sweats, diffuse joint pain, and low back pain. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography demonstrated multiple hypermetabolic pulmonary nodules, predominantly in the right upper lobe, associated with bilateral hilar, mediastinal, and supraclavicular lymphadenopathy, as well as focal uptake in the right iliac bone, sacrum, and L4 vertebral body. Given the imaging pattern and metabolic activity, disseminated malignancy was initially suspected. Histopathological examination of mediastinal lymph node and iliac bone biopsies revealed noncaseating granulomatous inflammation. Laboratory results showed elevated serum angiotensin-converting enzyme, negative interferon-gamma release assay, and negative autoimmune serologies. Following a multidisciplinary discussion, a diagnosis of sarcoidosis was established. The patient was treated with systemic corticosteroids followed by methotrexate, with significant clinical improvement. This case highlights an uncommon presentation of multisystemic sarcoidosis with axial skeletal involvement and imaging findings mimicking metastatic disease, underscoring the importance of histological confirmation and multidisciplinary assessment in establishing an accurate diagnosis and guiding management.
- International Benchmark Values for Robotic Right Hepatectomy: Multicenter Study From 22 Expert Centers.Publication . Müller, Philip C; Aegerter, Noa L E; Billeter, Adrian T; Eden, Janina; Moeckli, Beat; Lin, Charles Chung-Wei; Abe, Yuta; Nakano, Yutaka; Odorizzi, Roberta; Sobral, Mafalda; Primavesi, Florian; Stättner, Stefan; Robles-Campos, Ricardo; Lopez-Lopez, Victor; Guidetti, Cristiano; Di Benedetto, Fabrizio; Abdelhadi, Schaima; Reissfelder, Christoph; Araujo, Raphael L C; Martinie, John B; Memeo, Riccardo; Delvecchio, Antonella; Tschuor, Christoph; Fukumori, Daisuke; D'Hondt, Mathieu; Wakabayashi, Taiga; Wakabayashi, Go; Lauterio, Andrea; Centonze, Leonardo; Choi, Gi Hong; Pilz da Cunha, Gabriela; Swijnenburg, Rutger-Jan; von Kroge, Philipp; Heumann, Asmus; Katou, Shadi; Struecker, Benjamin; Pascher, Andreas; Li, Zhihao; Abu Hilal, Mohammed; El Adel, Soufyan; Störzer, Simon; Schmelzle, Moritz; Mohand, Juba Ait; Lesurtel, Mickaël; Drejian, Sarkis; Fretland, Åsmund Avdem; Edwin, Bjørn; Ginesini, Michael; Boggi, Ugo; Rompianesi, Gianluca; Troisi, Roberto Ivan; Rahimli, Mirhasan; Croner, Roland; Toso, Christian; Kato, Tomoaki; Hawksworth, Jason; Pinto Marques, Hugo; Sucandy, Iswanto; Dutkowski, Philipp; Kuemmerli, Christoph; Müller, Beat PObjective: This study aimed to identify benchmark values for robotic right hepatectomy (RH) based on a low-risk cohort treated at expert centers. Background: Robotic liver surgery is emerging as a preferred minimally invasive approach to the liver. To enable conclusive comparisons with the standard open or laparoscopic approaches, reference values are needed. Methods: Outcomes from consecutive patients undergoing robotic RH for malignant or benign indications at 22 international expert centers between 2018 and 2024 were analyzed. Low-risk, benchmark patients were without significant comorbidities such as portal hypertension, Child B cirrhosis, cardiac disease, chronic pulmonary disease, and renal failure. Patients undergoing robotic RH for donor hepatectomy were excluded. Fifteen reference values were derived from the 75th or the 25th percentile of the median values of all centers. Reference values were compared with a laparoscopic cohort from 4 centers and published benchmark values for laparoscopic and open RH. Results: Of 357 patients, 172 (48%) qualified as the benchmark cohort. The main indications were hepatocellular carcinoma (31%) and colorectal liver metastases (27%). Reference values included: operative time (≤476 min), conversion rate (≤8.2%), bile leak (≤15.4%), major complications (≤23.1%), and comprehensive complication index at 90 days (≤15.6). Robotic RH compared favorably to a multinational cohort series of laparoscopic RH with lower conversion (10.0% vs ≤8.2%) and R1 rate (10.9% vs ≤0%). Compared to open robotic hepatectomy, cutoffs for major complications (≤50.0% vs ≤23.1%) and liver failure (≤22.0% vs ≤2.7%) were lower for robotic right hepatectomies. Conclusion: This international benchmark study on robotic right hepatectomy (RRH) demonstrates that the robotic approach provides advantages compared with laparoscopic and open RH. RRH can be expected to become the minimally invasive approach of choice for tumors in the right liver.
- Impact of Parathyroidectomy on Kidney Function in Adults With Primary Hyperparathyroidism.Publication . Bandovas, João Pedro; Candeias, Henrique; Mourão, Mariana; Dhanani, Anjum; Monteiro, Nuno; Crespo, Ana; Tavares, Paula; Pinto Marques, Hugo; Springer NatureIntroduction Primary hyperparathyroidism (PHPT) is characterized by persistent hypercalcemia and is associated with renal complications, including nephrolithiasis and progressive decline in the estimated glomerular filtration rate (eGFR). Although parathyroidectomy (PTX) is the definitive treatment, its impact on renal function remains uncertain, particularly in patients with pre-existing renal impairment. This study aims to evaluate 12-month changes in renal function after PTX in patients with PHPT, according to baseline kidney function. Methods This retrospective study included 48 patients with PHPT who underwent PTX between 2017 and 2020. Patients were stratified by baseline eGFR into two groups: ≥60 mL/min/1.73 m² (Group 1) and <60 mL/min/1.73 m² (Group 2). Clinical and laboratory parameters, including serum creatinine and eGFR, were analyzed at baseline and at 12 months postoperatively. Results Patients were predominantly women (ratio 3.8:1), and the surgical cure rate was 95.8%. Group 2 presented higher baseline calcium and PTH levels. At 12 months, both groups showed significant reductions in calcium and PTH. Group 1 experienced a statistically significant decline in eGFR, whereas Group 2 showed a slight, non-significant improvement, suggesting stabilization of renal function. Conclusion PTX does not appear to improve renal function in most patients with PHPT but may prevent further deterioration in those with pre-existing renal impairment. These findings support current guideline recommendations favoring surgical intervention in PHPT patients with compromised baseline kidney function.
- Compartment Syndrome Following Extravasation of Contrast: A Case Report.Publication . Cavadas, Bernardo R; Veríssimo, Miguel; Pires, Inês O; Vieira, Luís; Ribeiro, Luís M; Springer NatureAcute compartment syndrome is a rare but serious complication of intravenous contrast extravasation, which can cause tissue ischemia and necrosis if not recognized and treated promptly. We report the case of a 56-year-old female with a history of breast cancer who developed acute compartment syndrome of the right hand and forearm after extravasation of approximately 20-30 mL of iodinated contrast agent administered via the dorsal hand during a CT scan. The patient presented with progressive swelling, pain disproportionate to injury, impaired digital perfusion, and limited mobility. Based on clinical findings, urgent surgical decompression via fasciotomy of the hand, wrist, and forearm compartments was performed with successful restoration of perfusion and function. Postoperative recovery was uneventful, although mild carpal tunnel syndrome developed on follow-up. This case highlights the importance of early recognition of intravenous contrast extravasation as a potential cause of acute compartment syndrome, especially in high-risk patients such as those with fragile veins, prior chemotherapy or obesity. Prompt diagnosis and immediate fasciotomy are crucial to prevent permanent functional impairment and severe morbidity. Awareness and vigilance among healthcare professionals administering contrast agents can improve patient outcomes through timely intervention.
- Simultaneous Aortic Dissection and Saddle Pulmonary Embolism: Were They Intertwined?Publication . Amaral de Vasconcelos Pinheiro, Miguel João; Constantino, Tiago Serrano; Fonseca Oliveira, João; Cordeiro, Ana Maria; Pinheiro, SofiaWe report the case of a 92-year-old woman who developed sudden paraplegia. A magnetic resonance imaging (MRI) of the dorsal spine revealed extensive spinal cord infarction. Subsequent imaging demonstrated a Stanford type B aortic dissection complicated by false-lumen thrombosis, along with a coexistent saddle pulmonary embolism. Although the coexistence of pulmonary embolism and aortic dissection has been reported, it remains poorly understood and represents a major therapeutic challenge. In this case, the close anatomical relationship between the descending aortic dissection and the site of pulmonary artery thrombosis strongly suggests that the aortic dissection may have contributed to pulmonary thrombus formation through direct mechanical compression and disturbed local hemodynamics arising from their anatomical contiguity. This case illustrates a rare yet clinically significant overlap between two life-threatening vascular entities, suggesting a poorly characterized pathophysiological interplay and underscoring the need for early diagnosis and patient-specific therapeutic approaches.
- Bridging Primary and Specialist Care in Atopic Dermatitis: Outcomes of an Interregional Referral Protocol in Portugal.Publication . Branco Vargas, Rita; Costa, Tomás; Leitão, Teresa; Farinha, Pedro; Peliteiro, Miguel; Duarte, Bruno; Santos, CátiaAtopic dermatitis (AD) is a chronic inflammatory skin disease with a significant impact on quality of life and healthcare systems. In Portugal, access to specialist care remains limited, particularly for patients requiring advanced therapies available only in hospital settings. This study aimed to implement and evaluate a structured referral protocol between primary and hospital dermatology services to improve AD management. Between April 2024 and February 2025, adult patients (≥18 years) coded with AD were identified at the USF Planície primary care center and assessed using a structured telephone questionnaire evaluating disease severity (Patient-Oriented Eczema Measure (POEM)), pruritus (Itch Numeric Rating Scale (INRS)), and sleep disturbance (Sleep Numeric Rating Scale (SNRS)). Of 213 identified patients, 119 (55.8%) were excluded - 94 (44.1%) could not be contacted; 19 (8.9%) denied the diagnosis; and 6 (2.8%) refused to participate - and 94 (44.1%) completed the assessment. Among these patients, 74 (78.7%) had mild or well-controlled disease, whereas 21 (22.3%) presented with moderate-to-severe AD. Patients with moderate-to-severe POEM showed a higher disease burden, with INRS ≥ 5 in 17 patients (85.0%), SNRS ≥ 5 in 5 patients (25.0%), and involvement of high-impact areas in 15 patients (75.0%), whereas in mild POEM, most patients had INRS < 5 (71, 95.9%), SNRS < 5 (74, 100%), and limited involvement of high-impact areas (16, 21.6%). This protocol demonstrated feasibility and clinical relevance, improving patient stratification and facilitating timely referral for specialist evaluation.