Background: The use of helmets has been promoted worldwide to protect motorcyclists from head-and-neck injuries and to reduce motorcycle accident-related mortality. However, the results of previous studies regarding the effectiveness of different types of helmets are controversial. This study aims to investigate the effectiveness of three types of helmets: half-helmets, open-face helmets, and full-face helmets, in protecting motorcyclists during traffic accidents. Materials and Methods: A total of 6991 motorcyclists, who were hospitalized between January 1, 2015, and December 31, 2019, were enrolled in this study. They were divided into two groups: those who did not wear helmets (n = 506) and those who wore helmets (n = 6,485). The latter group was subdivided according to the type of helmet used: half-helmet (n = 3,027), open-face helmet (n = 2,528), and full-face helmet (n = 930). The primary outcome was inhospital mortality. The length of hospital stay and associated head-and-neck injuries were secondary outcomes. Results: Half-helmets offered significantly less protection than full-face helmets, considering that patients using half-helmets had a significantly higher rate of the Abbreviated Injury Scale ≥ 2 injuries to the head region and significantly higher odds of sustaining subdural hematoma, subarachnoid hemorrhage (SAH), and intracerebral hematoma than patients using full-face helmets. However, higher odds of sustaining SAH were noted in patients using open-face helmets. There were no significant differences in the Glasgow Coma Scale score after injury or in the mortality rate in patients using either half-helmets or open-face helmets compared to those using full-face helmets. Conclusion: This study revealed that half-helmets, but not open-face helmets, offered significantly less protection from head injuries than full-face helmets. However, the mortality rate and length of hospital stay after the injury did not differ among patients using the three types of helmets.

Background: The role of immediate adjuvant radiotherapy (ART) in the management of positive surgical margin (PSM) following radical prostatectomy (RP) for low-grade prostate cancer (PCa) remains unclear. We aim to investigate our experience on survival outcome between immediate ART versus active surveillance in PSM groups after robotic-assisted RP (RaRP). Materials and Methods: The PSM cohort was divided into an adjuvant therapy group, consisting of immediate radiotherapy (RT) with or without androgen deprivation therapy (ADT) within six months after surgery, and observation group, consisting of close follow-up at the out-patient clinic. Salvage therapy was conducted using RT with/without ADT if biochemical recurrence (BCR) occurred (PSA level >0.2 ng/mL) during follow-up. 461 patients with PCa who underwent RaRP between December 2006 and June 2014 were included. Data of patients with PSM (n = 79) were extracted and followed up to June 2020. We aimed to compare the outcomes of immediate ART against observation or salvage RT in patients with PSM. Hence, we focused on those who had a PSA level <0.2 ng/mL after RaRP. Those with a PSA level >0.2 ng/mL were excluded. Results: No significant differences in age or preoperative PSA levels were observed after stratification to immediate ART and observation groups. Three patients (5.6%) received immediate ART with/without ADT. Another 51 patients received active surveillance, of which 18 (35.3%) received salvage ART with/without ADT due to BCR (PSA ≥0.2 ng/mL). There was no significant difference between immediate ART and observation groups in 5-year BCR-free survival (P = 0.072), local recurrence-free survival (P = 0.490), distant metastasis-free survival (P = 0.225), and overall survival (P = 0.517). Conclusion: Of the RaRP patients with PSM in the Asian population, we discovered that immediate ART following RaRP may not offer a significant advantage to active surveillance. Routine monitor of PSA levels had shown equally successful disease control. Salvage ART could be used on detection of BCR.

Background: Patients with Grade 2 goiters are followed up nonoperatively. Surgical anatomy is altered as nodules/goiter increases to Grade 3. The aim of the study was to analyze the results of thyroidectomy on Grade 2 versus Grade 3 goiter in terms of intra-operative surgical difficulty and surgical outcomes. Materials and Methods: Multi-centric cross-sectional analytical study. Retrospective analysis of the operative records of the patients undergoing transcervical total thyroidectomy (TT) from 2010 to 2019, satisfying the inclusion and exclusion criteria were included. Based on goiter size, patients were grouped as Group A and B. The important surgical landmarks and surgical outcomes were compared. Results: Of 2825 cases included, 1697 patients had Grade 2 and 1128 had Grade 3 goiter. In Group A, 1325 underwent TT and 372 underwent hermithyroidectomy (HT). In Group B, 965 had TT and 163 had HT. Group B patients were older and had a longer duration of goiter. In Group A, 3022 recurrent laryngeal nerves (RLN), 3022 external branches of superior laryngeal nerve (EBSLN) and 6044 parathyroid positions, and in Group B, 2093 RLNs, 2093 EBSLNs, and 4186 parathyroid positions were analyzed. Group B had more incidences of “Type C” relationship between RLN and ligament of Berry. EBSLN was Type II in 62% of Group B and 25.5% of Group A. Tubercle of Zuckerkandl was Grade 2/3 in Group B. Group B had longer cervical incisions, more parathyroid auto-transplantation, increased flap edema, seroma, voice change, temporary RLN palsy and hypoparathyroidism. Conclusion: Early surgery at grade 2 before it progresses to grade 3 goiter appears to have better surgical outcome.

Background: The commonly used anatomical classification of congenital biliary dilatation by Todani is not directly related to types of pancreaticobiliary maljunction (PBM). This work is to investigate clinical presentation and surgical outcomes according to PBM classification proposed by the Japanese Study Group on Pancreaticobiliary Maljunction. Pancreaticobiliary junction angle, common channel length, and diameter of dilatation are studied as well. Materials and Methods: Patients of redo operation, without preoperative images, and lacking clearly documented outcomes were excluded. After exclusion, 79 patients who underwent Roux-en-Y hepaticojejunostomy between January 1994 and December 2019 were enrolled for this retrospective study. Medical records were reviewed, and perioperative parameters were collected. Todani's classification, PBM types, pancreaticobiliary junction angle, common channel length, and dilatation diameter were determined based on magnetic resonance cholangiopancreatography or computed tomography. Clinical presentation and outcome were compared between groups of different anatomical features. Results: PBM type A (stenotic), type B (nonstenotic), and type C (dilated channel) consisted of 48 (60.8%), 18 (22.8%), and 11 (13.9%) patients, respectively; and two patients (2.5%) had no PBM. Patients of PBM type A were younger and had more Todani's type Ia lesion. Patients of PBM type B and C had either Todani's type Ia or Ic lesion, but type IVa had only PBM type B. Longer common channel (1.27 vs. 0.81 cm, P < 0.001) and wider dilatation (4 vs. 2 cm, P < 0.001) were found in patients with right pancreaticobiliary angle (90°). Clinical outcome was similar in different Todani's types, PBM types, and pancreaticobiliary angle. Serum alkaline phosphatase level higher than 675 U/L was associated with major perioperative complications. Preoperative jaundice, mass, and dilatation wider than 5 cm were related to subsequent liver cirrhosis. Conclusion: PBM types and pancreaticobiliary junction groups are feasible for surgical planning, but not related directly to outcome. Palpable abdominal mass suggests higher risk of perioperative and late complications. For subsequent liver cirrhosis, laboratory data of disease onset and dilatation diameter wider than 5 cm are important risk factors.

Since the coronavirus disease (COVID-19) outbreak at the end of 2019, there have been changes in human habits, customs, and patient management. Conventional wound treatments may not be performed in certain cases due to the risk of COVID-19 transmission, and alternative methods should be thus considered. Negative pressure wound therapy (NPWT) is a well-established and widely applied dressing alternative for acute and chronic wounds. Meanwhile, the continuous irrigation associated with simultaneous instillation (NPWTi) is thought to achieve better cleansing and lower infection rates. Although NPWTi is still controversial with regard to flap reconstruction, this report presents a successful management of Gustilo type IIIC tibia-fibula open fracture using NPWTi as a bridge dressing to endure the 14-day quarantine period in a district hospital with insufficient medical staff and resources.

Tricuspid regurgitation (TR) is a relatively uncommon complication subsequent to endomyocardial biopsy. We are reporting a 21-year-old male who underwent biopsy 13 times following heart transplantation. Symptomatic TR prompted the need for surgical repair, thus annuloplasty with artificial chordae reimplantation was performed. Mild TR with the preserved function was documented nearly 4 years after surgical intervention.

Intersigmoid hernia (ISH) is a protrusion of the small bowel into the intersigmoid fossa. It is well known to be a rare condition. Recent reports reveal that the preoperative differentiation of ISHs is difficult and the diagnosis is often confirmed during the laparotomic exploration. This article reports a case of an ISH presenting with symptoms of bowel obstruction. Computed tomography scan revealed that dilated small bowel loops are probably related to an incarcerated ileal retrocolic loop in left iliac fossa. This case was confirmed at surgery.

Ectopic pancreas is a disease where pancreatic tissue occurs outside its normal anatomic location, without vascular continuity. Symptoms for this condition may depend on the localization of the ectopic tissue and originate from either mass effect or inflammation. The diagnosis of ectopic pancreas can be challenging due to its rarity and nonspecific symptoms. Herein, we report a case of recurrent abdominal pain diagnosed with gastric ectopic pancreas of uncommon size in an uncommon location. Upper gastrointestinal (GI) endoscopy revealed a large gastric polyp and endoscopic needle biopsy only identified normal gastric mucosa. However, computed tomography imaging revealed a protruding mass that, upon excision, was identified as ectopic pancreatic tissue. Two different pathological findings arose from two different sampling methods, leading us to the conclusion that ectopic pancreas should always be considered in the diagnosis of a GI tumor.