Rejected

Robotic duodenal surgery (RDS) is a treatment option for many benign and low-grade malignant duodenal conditions that are not amenable to endoscopic intervention and can avoid morbidity related to open surgery. A retrospective review of all patients undergoing RDS (non-Whipple) at a tertiary care center from 2010-2017 was carried out. Indications, procedural details, and outcomes were reviewed. Twenty-four patients underwent RDS during the study period: transduodenal resection in 6 patients (25%), wedge resection in 6 patients (25%), transduodenal ampullectomy in 5 patients (21%), sleeve (segmental) resection in 5 patients (21%), duodenojejunostomy bypass in 1 patient (4%), and duodenal diverticulectomy in 1 patient (4%). Median age was 68 years, 54 per cent were male, and median BMI was 27. Adenoma was the most common diagnosis (68%) followed by neuroendocrine tumor (25%), duodenal diverticulum (4%), and refractory superior mesenteric artery syndrome (4%). Seventy-one per cent were symptomatic with gastroinstestinal bleed being the most common presentation. Median tumor size was 27 mm, and the most common location was D2 (58%) followed by D3/D4 (25%) and D1 (17%). Median operating time was 205 minutes and estimated blood loss was 50cc with no patient requiring intraoperative transfusion. Median length of stay was five days (3-21 days). Overall complication rate was 41 per cent (10/24): minor biliopancreatic leak in three patients; ileus in three patients; bleeding, arrhythmia, hypoxia, and headache in one patient each. Three (12%) patients had significant complications (Clavien-Dindo grade ≥ 3) requiring laparoscopic or robotic reoperation, but all three were discharged on or before POD 6 with resolution of complication. Ninety-day readmission rate was 8 per cent and 90-day mortality was 0. Recurrent disease or strictures were not seen in any patient after a median follow-up of 16 months. It has been concluded that RDS is a safe alternative to open or laparoscopic duodenal resection for benign and low-grade malignant conditions not amenable to endoscopic intervention.

Given the chronicity of cancer, its related treatments and sequalae, more attention has been paid to questioning the living conditions of cancer survivors. In the early 2000s, research have highlighted the occupational difficulties faced by cancer survivors in the first two years after diagnosis. In the line of these, this article aims to provide clinicians with information on the situation within the five years following cancer diagnosis, based on results of the VICAN5 survey. We explored three main themes: the differences between salaried and self-employed workers, the main sequelae related to the disease or the treatments, having an impact on the working lives of people concerned, and finally, the workstation layouts and their effect on job retention. The main objective is to make clinicians, who may be involved in supporting professionally active patients, aware of the difficulties that these later may encounter. Clinicians need to keep in mind the specific constraint faced by self-employed individuals since they are more likely to reduce their sick leave for financial reasons or for the functioning of their company. They also need to pay more attention to the patient-reported sequalae in order to ensure an adequate care, especially for fatigue and chronic neuropathic pain that can strongly affect his/her professional life. Finally, the clinician who is aware of the effectiveness of workstation layouts will be able to inform and to support his/her patient more precisely.

The aim of this study was to describe the safety and anatomical results of a surgical approach with a single-incision 6-point fixation vaginal mesh for the treatment of pelvic organ prolapse at perioperatively and at 1-year follow-up.

The pain trajectory after ankle surgeries for osteoarthritis is relevant to describe. The purpose of this prospective study was to describe pain after ankle surgery and explore the link between perioperative factors and the development of postoperative pain.

Idiopathic Parkinson's disease (IPD) is a chronic progressive neurodegenerative movement disorder characterized by motor and non-motor symptoms that affects patients' quality of life and caregiver burden. The aim of our study was to assess the caregiver burden (CB) in early and late stages of disease and to search if there was a relationship between quality of life and CB.

For the third year in a row, the Centers for Disease Control and Prevention reported an unprecedented decline in life expectancy for the United States, a decline attributable mainly to drug overdose deaths and suicides. Drug overdoses have continued to rise and are now estimated to account for 70,237 deaths in 2017. The root causes of the modern opioid crisis are complex and traceable to at least 30 factors. A prime driver has been the health care system. Pressure on medical practitioners to resort to opioids for managing chronic pain led to a nation awash with prescription opioids. In 2017, an unprecedented action was taken by President Donald J. Trump as he signed an executive order establishing the President's Commission on Combating Drug Addiction and the Opioid Crisis, tasked with producing guidance on reversing the crisis. The 56 recommendations of the President's Commission report were grounded in advanced strategies for prevention, treatment, rescue, recovery support, research, improved data analytics, and accountability. With a focus on the quality of treatment services and recovery homes, the report calls for implementing high standards of care for treatment. Specialists in addiction medicine and addiction psychiatry are best positioned to develop and implement high-quality care.

To report 2 new nummular headache (NH) cases and review the clinical features and management of NH.

A 76-year-old man with a history of hypertension was admitted with high fever and left scrotal pain. Laboratory findings revealed high serum C-reactive protein levels. The left epididymis appeared to be swollen on computed tomography. The patient was diagnosed with bacterial epididymitis and treatment with antibiotics was initiated. Despite treatment, his left scrotal pain and fever did not improve. Additionally, he developed right scrotal and posterior neck pain. For histopathological diagnosis, a left high orchiectomy was performed and the findings revealed thickened arteriolar walls with infiltration of inflammatory cells around the testis, leading to a final diagnosis of systemic polyarteritis nodosa. Treatment with steroids led to complete resolution of the patient's systemic pain and inflammation.