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(1) Background: Suspicious adnexal masses should be referred to gynecological oncology units. However, when surgery waiting lists are prolonged, these patients usually suffer from a delay in surgery. This could have a negative impact on their prognosis when the final diagnosis is ovarian cancer (OC). The primary aim of this study was to investigate the impact of surgery delay on the oncological results of early-stage ovarian cancer patients. (2) Methods: We retrospectively reviewed the records of early-stage OC patients who underwent surgery in the 1st Department of Obstetrics and Gynecology from 2012 to 2019. Time to surgery was defined as the time interval from the day of first examination to the day of surgery. (3) Results: A total of 72 patients were categorized into two groups, with a cut-off point of 5 weeks: 32 were treated ≤ 5 weeks (group A), and 40 > 5 weeks (group B). Concerning age, BMI or comorbidities, no differences were found between the two groups. Furthermore, no differences were presented in the post-operative complications rate, hospital stay, ICU admittance, or in disease-free (p = 0.48) and overall survival rates (p = 0.703). (4) Conclusions: Suspicious adnexal masses should undergo careful differential diagnosis to avoid delays in the “wait and see” period when the final diagnosis is positive for malignancy. However, the time to surgery for early-stage OC over 5 weeks seems to be relatively safe, with no impact on the mortality, morbidity, or recurrence rate.

Polycentricity is a multiscalar concept referring to the interconnections of neighboring spatial areas in search of synergies. More specifically, urban polycentricity has lately gained increasing momentum in academic research and strategic planning as urban polycentric structures could stimulate urban and regional performance in a sustainable way. Architectural heritage, with its connotative meanings, is among the indicators of incorporation in polycentric networking. The present paper investigates the challenges of implementing urban polycentricity methodological approaches to highlight new polycentric networks based on built architectural heritage. In this study, appointed architectural assets are considered as nodes of the potential networks. As a new research strand, the MCDA PROMETHEE method is applied to compile and assemble all indicators (namely, rank size and node hierarchy, accessibility, transportation, and digital promotion). The ultimate research goal is to build a new polycentricity index as an innovative methodological tool to highlight polycentric networking synergies on interurban and intraregional scales. The region of Thrace in Northern Greece is chosen to apply the proposed methodology. Research on ways to couple polycentricity and PROMETHEE methods is limited, and thus, the proposed methodological approach is expected to contribute to the field of urban and regional strategies for researchers and practitioners.

Background and Objectives: The new molecular classification of endometrial cancer continuously changes the management of the disease in everyday clinical practice. Recently, FIGO released a new staging system for endometrial cancer, which incorporates molecular substages and subdivides further early-stage disease. The aim of this study was to investigate the differences between the two FIGO staging systems and evaluate the prognostic precision of the new one. Materials and Methods: We retrospectively analyzed the records of patients with endometrial cancer that were fully treated in the 1st Department of Obstetrics & Gynecology, in 2012–2023. Patient characteristics, oncological outcome, and follow-up information were collected. The primary outcomes were the stage shifts and the survival data. Results: Sixty-seven (15.5%) patients had a stage shift and the majority of them concerned early-stage disease and specifically an upshift from 2009 stages IA and IB to 2023 stage IIC. Concerning survival, a better median and 5-year PFS was present in stage II disease, and when comparing the prognostic precision of the two FIGO staging systems no significant difference was present. Conclusions: The new 2023 FIGO staging system better distinguishes early-stage endometrial cancer into its prognostic groups and seems to be as precise as the old 2009 FIGO staging system.

Simple Summary: En bloc removal of the whole peritoneum of the pouch of Douglas with the uterus instead of blind random biopsies is proposed for the treatment of early ovarian cancer patients. The rationale for this out-of-the-box procedure is based on the "seed and soil" hypothesis of the development of peritoneal carcinomatosis. Epithelial ovarian cancer cells from the primary tumor can exfoliate in the pelvic peritoneum and then disseminate in the peritoneal cavity through the clockwise peritoneal fluid circulation. The aim of this study is to investigate the safety and feasibility of douglasectomy and its impact on survival rates in presumed 2018 FIGO stage I ovarian cancer patients. Background/Objectives: Douglasectomy is defined as the removal of the pelvic peritoneum of the entire pouch of Douglas. In presumed FIGO stage I ovarian cancer, isolated microscopic cancer cells might disseminate from the ovaries to their neighboring pelvic peritoneum. However, a simple hysterectomy with bilateral salpingo-oophorectomy and a staging procedure is the standard of care. This study aims to investigate the safety and feasibility of douglasectomy compared to random pelvic biopsies, and it is based on the survival of patients with early ovarian cancer. Methods: We retrospectively analyzed the records of patients with presumed 2018 FIGO stage I ovarian cancer who underwent surgery in the 1st Department of Obstetrics and Gynecology Clinic from 2012 to 2022. Patient characteristics and oncological and follow-up information were collected. Results: A total of 88 patients were categorized into two groups, namely Group A (27 patients) with douglasectomy and Group B (61 patients) with random biopsies. There was no statistically significant difference in age, BMI, comorbidities, FIGO stage, intraoperative blood loss, and ICU admittance between the two groups. Conversely, patients with en bloc hysterectomy–douglasectomy had statistically significant higher pre-operative CA-125 values, surgery duration, rate of postoperative complications, and hospital stay. Concerning survival rates, there was a statistically significant difference in disease-free survival (p = 0.033), but no difference was observed in overall survival (p = 0.66). Conclusions: En bloc removal of the pelvic peritoneum of the entire pouch of Douglas with the uterus is a safe and feasible technique during surgery for early ovarian cancer, which leads to improved disease-free survival and local control. [ABSTRACT FROM AUTHOR]

(1) Background: Suspicious adnexal masses should be referred to gynecological oncology units. However, when surgery waiting lists are prolonged, these patients usually suffer from a delay in surgery. This could have a negative impact on their prognosis when the final diagnosis is ovarian cancer (OC). The primary aim of this study was to investigate the impact of surgery delay on the oncological results of early-stage ovarian cancer patients. (2) Methods: We retrospectively reviewed the records of early-stage OC patients who underwent surgery in the 1st Department of Obstetrics and Gynecology from 2012 to 2019. Time to surgery was defined as the time interval from the day of first examination to the day of surgery. (3) Results: A total of 72 patients were categorized into two groups, with a cut-off point of 5 weeks: 32 were treated ≤ 5 weeks (group A), and 40 > 5 weeks (group B). Concerning age, BMI or comorbidities, no differences were found between the two groups. Furthermore, no differences were presented in the post-operative complications rate, hospital stay, ICU admittance, or in disease-free (p = 0.48) and overall survival rates (p = 0.703). (4) Conclusions: Suspicious adnexal masses should undergo careful differential diagnosis to avoid delays in the "wait and see" period when the final diagnosis is positive for malignancy. However, the time to surgery for early-stage OC over 5 weeks seems to be relatively safe, with no impact on the mortality, morbidity, or recurrence rate. [ABSTRACT FROM AUTHOR]

Objective: The traditional histopathological analysis of endometrial cancer (EC) is the main risk group classification tool (low, intermediate, high-intermediate, and high) for the implementation of adjuvant treatment. The International Federation of Gynecology and Obstetrics staging system of EC has incorporated a new molecular classification that serves as a new triage tool for optimal treatment planning for these patients. Our study aimed to investigate the prognostic role of the new molecular classification in EC. Material and Methods: A prospective study was conducted in the 1st Department of Obstetrics and Gynecology from January 1, 2022, to March 30, 2024, and included all new EC cases that presented the multidisciplinary tumor (MDT) board after surgery. We considered the traditional pathologic analysis and new molecular classification after performing tests on microsatellite instability (MSI), DNA polymerase epsilon (POLE) mutation, and p53 immunohistochemistry testing. Results: The study included 65 patients with presumed early endometrial. All patients underwent surgery and subsequent molecular testing. Among the patients, 35 (54%) had a "positive" result in all of the three markers of molecular classification: 14 patients presented with MSI-H, 5 with POLE gene mutation, and 17 with p53 abnormal expression. One case of multiple classifiers was presented. After the integration of molecular classification, a change was observed in the final MDT board decision in 23 cases (35.4%), including six cases of overtreatment and 17 cases of undertreatment, with statistical significance (P = 0.03469). Conclusion: The data suggest that the new molecular classification, that is, testing for POLE mutation, MSI, and p53 mutation and for endometrial carcinoma, is a valuable tool for the recurrence risk prognosis and improved planning of adjuvant treatment for EC. [ABSTRACT FROM AUTHOR]

Background and Objectives: The new molecular classification of endometrial cancer continuously changes the management of the disease in everyday clinical practice. Recently, FIGO released a new staging system for endometrial cancer, which incorporates molecular substages and subdivides further early-stage disease. The aim of this study was to investigate the differences between the two FIGO staging systems and evaluate the prognostic precision of the new one. Materials and Methods: We retrospectively analyzed the records of patients with endometrial cancer that were fully treated in the 1st Department of Obstetrics & Gynecology, in 2012–2023. Patient characteristics, oncological outcome, and follow-up information were collected. The primary outcomes were the stage shifts and the survival data. Results: Sixty-seven (15.5%) patients had a stage shift and the majority of them concerned early-stage disease and specifically an upshift from 2009 stages IA and IB to 2023 stage IIC. Concerning survival, a better median and 5-year PFS was present in stage II disease, and when comparing the prognostic precision of the two FIGO staging systems no significant difference was present. Conclusions: The new 2023 FIGO staging system better distinguishes early-stage endometrial cancer into its prognostic groups and seems to be as precise as the old 2009 FIGO staging system. [ABSTRACT FROM AUTHOR]

Polycentricity is a multiscalar concept referring to the interconnections of neighboring spatial areas in search of synergies. More specifically, urban polycentricity has lately gained increasing momentum in academic research and strategic planning as urban polycentric structures could stimulate urban and regional performance in a sustainable way. Architectural heritage, with its connotative meanings, is among the indicators of incorporation in polycentric networking. The present paper investigates the challenges of implementing urban polycentricity methodological approaches to highlight new polycentric networks based on built architectural heritage. In this study, appointed architectural assets are considered as nodes of the potential networks. As a new research strand, the MCDA PROMETHEE method is applied to compile and assemble all indicators (namely, rank size and node hierarchy, accessibility, transportation, and digital promotion). The ultimate research goal is to build a new polycentricity index as an innovative methodological tool to highlight polycentric networking synergies on interurban and intraregional scales. The region of Thrace in Northern Greece is chosen to apply the proposed methodology. Research on ways to couple polycentricity and PROMETHEE methods is limited, and thus, the proposed methodological approach is expected to contribute to the field of urban and regional strategies for researchers and practitioners. [ABSTRACT FROM AUTHOR]

Background: Arterial switch operation (ASO) is the gold-standard surgical approach for dextro-transposition of the great arteries (D-TGA). It is performed during the neonatal period and has almost diminished the previously high mortality rate (from 90% if left untreated to

Dimosthenis Petsas,1 Valentini Pogiatzi,1 Thanasis Galatidis,2 Maria Drogouti,3 Iliana Sofianou,3 Alexis Michail,3 Iosif Chatzis,3 Georgios Donas1 1Anesthesiology Department, Agios Dimitrios Hospital, Thessaloniki, Greece; 2Department of Anesthesiology Nursing, Agios Dimitrios Hospital, Thessaloniki, Greece; 3Department of Surgery, Agios Dimitrios Hospital, Thessaloniki, Greece Abstract: The Erector Spinae Plane Block (ESP) is a novel regional technique for anesthesia or analgesia. Originally the ESP block was described in 2016 in a case report regarding analgesia intervention for a case of thoracic neuropathic pain. Since then, there has been growing interest and research adding experience about the ESP block as regional anesthetic and analgesic technique. Reviewing the literature about this novel technique in databases like PubMed using the key words “erector spinae plane block” returns approximately 56 publications. So far there is no available big series of cases or reviews regarding the ESP block. The literature is limited to case reports or case series. With the present case we are interested in exploring the efficacy of ESP block as a postoperative analgesic method for laparoscopic cholecystectomy. We describe the case of a 76-year-old female patient scheduled for laparoscopic cholecystectomy. Written informed consent was granted (for procedure and publication of photos). We applied a bilateral ultrasound-guided ESP block at T6 level while the patient was awake before general anesthesia induction. The anesthetic solution we used consisted of 12 mL Ropivacaine 0.375% plus 2 mg dexamethasone (on each side). After the successful administration of the block (observation of the solution spread between transverse process and the erector spinae muscles), general anesthesia was induced and the procedure was started. Procedure and recovery was uneventful with the patient experiencing very good analgesia (NRS pain score 0 up to 6 hours after block placement). The patient presented mild pain (NRS score of 2–3) after 6 hours and requested the “on demand” pain medication (1 g paracetamol IV) only 10 hours after the ESP block (NRS pain score of 4–5). The patient experienced no nausea or vomiting, was mobilized easily about 6 hours after the block and was discharged the next day. This relatively simple and safe block dramatically reduced the amount of IV pain medication we usually administer for the specific procedure. The overall result was increased satisfaction of the patient and avoidance of opioid use. Keywords: postoperative analgesia, plane block, ultrasound

BACKGROUND: Tetralogy of Fallot (TOF) represents between 7 and 10% of the total cases of congenital heart defects (CHD) and is estimated to be the most common cyanotic CHD, requiring medical or surgical intervention within the first year of life. Current advances in prenatal screening and fetal echocardiography led to increased rates of prenatal diagnosis of TOF. Furthermore, improvements in initial medical care, surgical repair, and long-term care are associated with excellent long-term survival until adulthood. Consequently, issues of morbidity have come under the spotlight, specifically neurodevelopmental and psychiatric adverse outcomes, which affect the quality of life of TOF survivors. METHOD: This study is a systematic review of English articles, using PUBMED and applying the following search terms, Tetralogy of Fallot, neurodevelopment, autism, cerebral palsy, attention-deficit hyperactivity disorder. Data were extracted by two authors. RESULTS: Most researchers suggest that TOF survivors score lower in neurodevelopmental tests than healthy populations of the same age and are in danger of neurodevelopmental impairments. Furthermore, it is suggested that TOF adolescents show higher rates of psychiatric disorders. CONCLUSIONS: The neurodevelopment of TOF survivors is not intensively studied. Existing studies in TOF survivors focus on different developmental aspects, using different evaluation methods and thus making conclusions for either one of the four aspects of neurodevelopment (executive function, cognition, and adaptive function, speech-language and motor function, or neuropsychiatric domain). The poor outcomes of these isolated studies indicate the need for future research as well as for continuous neuropsychological assessment and close monitoring of children and adolescents with TOF.

Simple Summary: Residual disease after cytoreduction in advanced ovarian cancer still remains the most important prognostic factor. Patients with high tumor load, especially in the upper abdomen, that cannot be completely debulked in the primary setting are offered neoadjuvant chemotherapy and reassessed after 3–4 cycles for interval debulking surgery. Imaging is the main tool for the decision if these patients can achieve complete cytoreduction. However, even with the use of the Response Evaluation Criteria in Solid Tumors (RECIST), conventional imaging has poor results in identifying which patients have unresectable disease. Therefore, the KELIM score appears as a new promising prognostic factor in the neoadjuvant setting. The aim of this study is to establish KELIM as prognostic factor for residual disease after interval debulking surgery and to urge the research community to plan future randomized control trials in order to add the KELIM score in future guidelines. (1) Background: Neoadjuvant chemotherapy followed by interval debulking surgery is used in the treatment of advanced ovarian cancer. However, no tool can safely predict if complete cytoreduction after 3–4 cycles can be achieved. This study aims to investigate if the KELIM score can be a triage tool in the identification of patients that will be ideal candidates for interval debulking surgery (IDS). (2) Methods: We retrospectively analyzed the records of patients with high-grade serous advanced ovarian cancer that were treated in the 1st Department of Obstetrics–Gynecology, 2012–2022, with neoadjuvant chemotherapy followed by IDS. Patient characteristics, oncological outcome and follow-up information were collected. The primary outcome was the association of the KELIM score with residual disease. (3) Results: 83 patients were categorized into two groups: Group A (51 patients) with favorable (≥1) and Group B (32 patients) with unfavorable (<1) KELIM scores. A statistically significant correlation between KELIM and residual disease (p < 0.05) exists, showing that patients with a favorable KELIM score can achieve a complete IDS. Furthermore, there was a statistically significant difference in overall survival (p = 0.017), but no difference was observed in progression-free survival (p = 0.13); (4) Conclusions: KELIM seems to safely triage patients after neoadjuvant chemotherapy and decide who will benefit from IDS. [ABSTRACT FROM AUTHOR]