Awad Dmour

Metabolic and bariatric surgery (MBS) represents the most effective therapeutic approach for achieving substantial and sustained weight loss and improving obesity-related comorbidities. However, the role of routine preoperative esophagogastroduodenoscopy (EGD) remains controversial, and current recommendations vary among international professional societies. Obesity is associated with a high prevalence of upper gastrointestinal disorders, including gastroesophageal reflux disease, erosive esophagitis, hiatal hernia, Barrett’s esophagus, gastritis, Helicobacter pylori infection, gastric intestinal metaplasia, and peptic ulcer disease. Importantly, clinically relevant endoscopic abnormalities may occur in asymptomatic patients, limiting the reliability of symptom-based strategies for selecting candidates for EGD. Preoperative endoscopic findings may require medical treatment, additional diagnostic investigations, endoscopic surveillance, or modification of the planned bariatric procedure. This is particularly relevant when considering sleeve gastrectomy in patients with significant reflux-related disease or Barrett’s esophagus, as well as gastric bypass procedures that may limit subsequent endoscopic access to the excluded stomach. This narrative review summarizes current evidence regarding the clinical value of preoperative EGD in MBS, with particular emphasis on relevant gastroesophageal and gastric findings, standardized endoscopic assessment, their implications for surgical decision-making, and current international recommendations.

Background: Management of surgically treated hand trauma varies according to injury characteristics, referral pathways, and institutional practice, particularly regarding postoperative antibiotic therapy and wound cleansing. This study compared injury patterns, management strategies, and early postoperative outcomes between two European referral centers and evaluated reported practice through a parallel surgeon survey. Methods: We conducted a retrospective two-center cohort study including 360 adults undergoing surgical treatment for hand trauma between April 2024 and March 2025 in Le Mans, France (n = 270), and Iași, Romania (n = 90). Injury mechanisms, anatomical involvement, postoperative antibiotic use and duration, wound irrigation and cleansing practices, follow-up, and postoperative infection were compared. Because the cohorts differed substantially in case mix, a secondary sensitivity analysis was performed using the Romanian acute-injury subgroup (n = 63). A parallel anonymous survey included 70 French and 40 Romanian surgeons involved in hand trauma care. Results: Injury mechanisms differed between centers (p < 0.001), with powered-tool or machinery injuries occurring in 34.4% of Romanian and 15.6% of French patients. The Romanian cohort also had higher frequencies of tendon injury (90.0% vs. 30.7%), neurovascular involvement (57.8% vs. 14.1%), joint involvement (23.3% vs. 12.2%), and associated fracture (27.8% vs. 5.2%; all p ≤ 0.016). Continued postoperative antibiotics were administered to 97.8% of Romanian and 55.2% of French patients (p < 0.001). Among treated patients, 1- to 3-day courses predominated in Romania (85.2% vs. 16.2%; p < 0.001). Wound-cleansing practices also differed substantially. Among patients with documented follow-up, postoperative infection was identified in 3/90 Romanian patients (3.3%) and 3/171 French patients (1.8%; p = 0.418). In the Romanian acute-injury subgroup, infection occurred in 1/63 patients (1.6%). Survey responses also demonstrated variation in postoperative antibiotic duration and perceptions of existing recommendations. Conclusions: Substantial center-level variation was observed in case mix, postoperative antibiotic prescribing, treatment duration, and wound-cleansing practices. Few postoperative infections were documented among patients with available follow-up; however, differences in eligibility criteria, injury complexity, and follow-up completeness preclude conclusions regarding comparative treatment effectiveness. Survey findings provided complementary evidence of variability in reported practice rather than validation of the center-level clinical findings. Prospective multicenter studies using standardized injury classification and follow-up are needed to develop more consistent, risk-based approaches to antimicrobial and wound management in hand trauma.

Background: Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe, potentially life-threatening mucocutaneous reactions classified based on body surface area (BSA) involvement: SJS affects less than 10% BSA, SJS/TEN overlap affects 10–30% BSA, and TEN affects more than 30% BSA. The mortality rates range from 4.8–9% for SJS to 14.8–48% for TEN. Treatment remains controversial, with corticosteroids and intravenous immunoglobulin (IVIg) being the most debated therapeutic options. While some studies suggest IVIg may block Fas-mediated keratinocyte apoptosis, meta-analyses have shown conflicting results regarding mortality benefit. Case presentation: We describe two patients from opposite ends of the SJS/TEN spectrum, managed in a burn unit with different therapeutic approaches. The first patient, a 47-year-old man with systemic lupus erythematosus, developed TEN with approximately 35% body surface area involvement, complicated by sepsis and rhabdomyolysis; he was treated with systemic corticosteroids and intravenous immunoglobulin (IVIg, 0.4 g/kg/day for 3 days). The second patient, a 66-year-old woman, developed SJS attributed to amoxicillin–clavulanic acid and was treated with systemic corticosteroids alone. Both patients achieved complete re-epithelialization without major sequelae. Conclusions: These two cases illustrate the clinical heterogeneity of the SJS/TEN spectrum and the central role of early recognition, prompt withdrawal of the culprit drug, transfer to a specialized unit, and multidisciplinary supportive care. Given the substantial differences between the two patients in age, sex, comorbidities, culprit drugs, and disease severity, no comparative or causal inference regarding the relative efficacy of the two treatment strategies can be drawn; no efficacy claim is made for either therapeutic approach; this report is descriptive, and the two cases are presented as contrasting rather than comparable.

Background: Cerebral endometriosis is an exceptionally rare manifestation of extrapelvic endometriosis and remains a diagnostic challenge because its clinical and imaging features may mimic more common neurological, inflammatory, vascular, or neoplastic disorders. Catamenial neurological symptoms may provide an important diagnostic clue, but histological confirmation is rarely available. Case presentation: We report the case of a 48-year-old woman with epilepsy beginning at 41 years of age, associated with short-term memory loss and a catamenial pattern of seizures. She had no typical symptoms of pelvic endometriosis, including dysmenorrhea, dyspareunia, or cyclic pelvic pain. Neuropsychological test for memory had normal scores. Brain magnetic resonance imaging (MRI) revealed a right hippocampal lesion with T2/FLAIR hyperintensity and later pseudonodular contrast enhancement, raising suspicion of focal cortical dysplasia, infection, tumor infiltration, or a hippocampal tumor. Magnetic resonance spectroscopy (MRS) was inconclusive and did not provide clear support for tumor-like infiltration. Because of the temporal association between symptoms and menstruation, cerebral endometriosis was considered. The patient received hormonal therapy with progestins, including desogestrel and dienogest, after which antiepileptic therapy was discontinued. Neurological symptoms resolved completely. Follow-up MRI demonstrated marked regression or disappearance of the previously described right hippocampal hyperintense lesion, with preserved bilateral hippocampal morphology. Conclusions: This case highlights the importance of considering cerebral endometriosis in women of reproductive or perimenopausal age presenting with catamenial epilepsy and unexplained intracranial lesions, even in the absence of pelvic endometriosis symptoms. Recognition of menstrual cyclicity, careful neuroimaging follow-up, and multidisciplinary evaluation may support diagnosis and guide individualized treatment. The favorable clinical and radiological response to progestin therapy in this case adds to the limited evidence regarding conservative management of presumed cerebral endometriosis. Cerebral endometriosis is a very rare condition, and only eight case reports were found in the literature.

Hallux valgus recurrence remains one of the most important causes of unsatisfactory outcomes following corrective surgery, with reported rates varying widely because of differences in patient selection, surgical techniques, follow-up duration, and recurrence definitions. Although numerous operative procedures have been described, growing evidence indicates that durable correction depends less on the specific procedure performed than on appropriate patient selection and complete correction of the underlying deformity. A structured literature search was conducted in PubMed from database inception to 4 August 2026 and supplemented by reference-list screening. Adult primary surgical studies reporting recurrence or factors associated with recurrence were eligible when they provided an explicit recurrence definition and at least 12 months of follow-up. Forty candidate primary studies were assessed in full text, of which 30 were included in the core evidence synthesis. Findings were synthesized narratively within predefined domains covering recurrence definitions, preoperative factors, procedure selection, technical correction, postoperative alignment, patient-related factors, and clinical consequences. Particular attention is given to the role of three-dimensional deformity correction, soft-tissue balancing, sesamoid realignment, and radiographic parameters including the hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, and metatarsal rotation. Contemporary surgical techniques, including Chevron, Scarf, Lapidus, first metatarsophalangeal joint fusion, and minimally invasive procedures, are reviewed with respect to their indications, recurrence mechanisms, and technical considerations. Based on the available evidence, recurrence prevention requires a comprehensive strategy integrating accurate preoperative assessment, procedure selection tailored to the underlying pathology, meticulous surgical technique, and structured postoperative follow-up. Standardized recurrence definitions and greater use of weight-bearing three-dimensional imaging may further improve future research and clinical decision making.

Background: Cytochrome P450 2J2 (CYP2J2) has been implicated in tumor biology, but its expression pattern and clinical significance in prostate and renal cancers remain poorly characterized. Methods: Commercially available tissue microarrays containing 208 renal and 121 prostate tissue specimens were used for immunohistochemical (IHC) characterization of CYP2J2 protein expression. We performed transcriptomic analysis and examined correlations with clinicopathological features and survival using the OncoDB 2.0 platform. Results: CYP2J2 immunoreactivity was mainly cytoplasmic, with minimal protein expression in both cancers. We identified positive staining in 7/100 (7.0%) prostate adenocarcinomas and 2/192 (1.0%) clear cell renal cell carcinoma (ccRCC) specimens, with negative expression in corresponding normal tissues. We detected no significant associations between protein expression and clinicopathological features in either cohort (all p > 0.05). In contrast, transcriptomic analysis revealed elevated CYP2J2 mRNA expression in both malignancies, with a slight increase in prostate adenocarcinoma (log₂ fold change = 1.10) and marked overexpression in ccRCC (log₂ fold change = 5.24) compared with normal tissues. We observed significant associations between CYP2J2 mRNA expression and pathological T stage in prostate adenocarcinoma (p = 0.0019) and pathological M stage in ccRCC (p = 0.0079). Moreover, higher CYP2J2 mRNA expression was associated with longer overall survival in ccRCC (HR = 0.64, 95% CI: 0.47–0.86; log-rank p = 0.0029) but not in prostate adenocarcinoma; however, these findings remain exploratory and do not establish independent prognostic value. Conclusions: Despite elevated transcript expression, CYP2J2 protein expression was infrequent in prostate adenocarcinoma and ccRCC, suggesting limited clinicopathological relevance and warranting further investigation using functional techniques.

Background and Clinical Significance: Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract and an uncommon cause of small bowel obstruction in adults, in which the diverticulum or a band arising from it typically constricts the adjacent bowel. Entrapment of the diverticulum itself within a pre-existing fibrous band is exceedingly rare; Case Presentation: A 42-year-old man with no previous abdominal surgery presented with colicky abdominal pain, distension and bilious vomiting. Contrast-enhanced computed tomography demonstrated small bowel loops dilated to 35.4 mm with a pelvic transition point of undetermined cause. At emergency laparotomy, a fibrous ileo-mesenteric band delimited a constricting orifice through which the Meckel’s diverticulum had herniated and become strangulated at its base, with secondary obstruction and ischemia of the adjacent ileum. Division of the band restored perfusion; the bowel remained viable and stapled diverticulectomy was performed without segmental resection. The patient recovered without complications. In most reported cases of Meckel’s diverticulum causing small bowel obstruction, the diverticulum or a band arising from it constricts the adjacent bowel. In this case the mechanism is reversed: the diverticulum was the entrapped structure itself, herniating through and strangulating within the orifice of a pre-existing ileo-mesenteric fibrous band. This configuration is exceptionally rare; Conclusions: Meckel’s diverticulum should be considered among the possible causes of small bowel obstruction in adults with no history of abdominal surgery. Recognition of this unusual anatomical configuration may facilitate intraoperative identification and appropriate assessment of bowel viability.

Background: Alcohol-related conditions may influence both injury patterns and in-hospital management in orthopaedic trauma. This study evaluated the clinical characteristics, injury mechanisms, treatment patterns, and hospital outcomes of adults with acute orthopaedic trauma and documented alcohol use, with particular attention to geriatric vulnerability and alcohol withdrawal. Methods: This retrospective single-centre cohort included adults admitted between January 2018 and December 2025 with acute musculoskeletal trauma and an alcohol-related diagnosis during the same hospitalisation. Patients were classified according to their predominant recorded alcohol-related presentation. Geriatric patients, defined as those aged 65 years or older, were compared with younger adults. Injury mechanisms, comorbidities, operative treatment, intensive care unit involvement, hospital length of stay, mortality, and recorded hospitalisation costs were analysed. Results: The final cohort comprised 294 patients, including 87 geriatric patients. Geriatric patients more frequently sustained same-level or low-energy falls than younger adults (46.0% versus 25.6%; Holm-adjusted p = 0.005) and had a higher prevalence of proximal femoral fractures (40.2% versus 21.7%; OR 2.42, 95% CI 1.41 to 4.16). Any recorded ICU involvement was more frequent among geriatric patients, although prolonged ICU stays of 24 h or longer did not differ significantly between age groups. Alcohol withdrawal was documented in 46 patients and was associated with longer hospitalisation and a longer admission-to-surgery interval. In-hospital mortality occurred in 5 of 46 patients with documented withdrawal (10.9%) and 5 of 248 without withdrawal (2.0%; unadjusted OR 5.93, 95% CI 1.64 to 21.37; p = 0.010). Conclusions: Orthopaedic trauma patients with documented alcohol use represent a clinically heterogeneous population. Geriatric patients showed greater vulnerability to low-energy trauma, proximal femoral fracture, comorbidity, and intensive care involvement, while alcohol withdrawal identified patients with a more complex hospital course. Early recognition of withdrawal risk and enhanced inpatient safety measures may improve orthopaedic care. These findings support careful assessment of alcohol-related risk, early recognition of withdrawal, and heightened inpatient safety precautions.

Background: Physical activity is widely recommended for preserving musculoskeletal health and managing osteoarthritis-related pain, although its benefits are commonly framed in terms of muscle strengthening, weight control, and physical performance. This narrative review aimed to examine movement more broadly as a physiological regulator of synovial joint homeostasis, sensory calibration, and functional adaptation. Methods: A structured literature search was performed in PubMed/MEDLINE, Scopus, and Web of Science from database inception to 1 February 2026. Experimental studies, observational studies, clinical trials, systematic reviews, meta-analyses, and selected narrative reviews addressing movement-responsive joint biology or pain regulation were considered. Evidence was synthesized across four interrelated domains: mechanical, fluidic, immune-metabolic, and sensory regulation. Results: The narrative synthesis indicates that the concept of the synovial joint as a dynamic mechano-fluidic organ in which cartilage, synovium, synovial fluid, capsule, subchondral bone, periarticular tissues, and sensory pathways interact continuously. Repeated physiological movement may promote synovial fluid exchange, lubrication, cartilage nutrition, hyaluronic acid and lubricin function, matrix turnover, anti-inflammatory signaling, proprioceptive control, and exercise-induced hypoalgesia. In contrast, inactivity and unloading may impair fluid dynamics, promote muscle inhibition, stiffness, inflammatory persistence, sensory deconditioning, and loss of function. Excessive or poorly distributed loading may also disrupt homeostasis through matrix injury, inflammation, fatigue, and nociceptive sensitization. These findings informed the proposed adaptive loading window, a hypothesis-generating conceptual framework rather than a clinically validated threshold, describing the dynamic range of movement within which joint function and pain regulation may be supported without sustained tissue or symptom aggravation. Conclusions: Movement should be viewed not only as a therapeutic intervention, but also as a continuous regulator of joint biology and perception. Its clinical value may depend on identifying an individualized loading range that supports adaptation, function, and confidence in movement while avoiding both underloading and overload.

Background: Pubic symphysis plating is a common method for stabilizing traumatic pubic symphysis disruptions, yet reported rates of implant failure vary widely in the literature. This variability may reflect inconsistent definitions and failure to distinguish clinically significant early construct failure from later asymptomatic postoperative radiographic changes. Methods: We performed a retrospective observational study of 30 patients with traumatic pubic symphysis disruption without associated fractures of the pubic body or pubic rami treated with open reduction and plate fixation. Pubic symphysis distance (PSD) was measured on admission CT, immediate postoperative anteroposterior pelvic radiographs, and follow-up CT scans obtained at 3, 6, and ≥12 months. Early mechanical failure, qualitative radiographic signs of implant loosening, and radiographic loss of reduction were predefined. Non-parametric tests were used to compare patients with and without early mechanical failure and to evaluate longitudinal PSD changes; analyses of potential associated factors were exploratory. Results: Early mechanical failure occurred in 4 patients (13.3%) within 30 days and presented as an acute symptomatic event with imaging-confirmed construct compromise requiring revision. In exploratory univariable analysis, early failure was more frequent in female patients and in those with obesity or osteoporosis, although these findings should be interpreted cautiously given the very small number of events. PSD changed significantly over time (p < 0.001), with minimal increase during the first 3 months, greater widening between 3 and 6 months, and little additional change thereafter. Qualitative radiographic signs of implant loosening and widening were observed in 8 patients (26.7%) during follow-up without clinically documented pain, instability, or need for revision. No clear association was demonstrated between PSD widening and final functional outcome measured by the Majeed score, although these analyses were limited by sample size and wide confidence intervals. Conclusions: In this retrospective cohort, postoperative radiographic widening and qualitative signs of implant loosening were not by themselves associated with clinically evident failure requiring revision during the available follow-up. Early failure was identified by acute clinical symptoms with imaging-confirmed construct compromise, whereas delayed widening was often observed without clinically documented pain, instability, or reoperation. These findings suggest that postoperative imaging should be interpreted together with symptoms and overall pelvic stability, while recognizing the methodological limitations of the study.