Multimodal Management of Grade 1 and 2 Pancreatic Neuroendocrine Tumors

Pancreatic neuroendocrine tumors (p-NETs) are rare tumors with a recent growing incidence. In the 2017 WHO classification, p-NETs are classified into well-differentiated (i.e., p-NETs grade 1 to 3) and poorly differentiated neuroendocrine carcinomas (i.e., p-NECs). P-NETs G1 and G2 are often non-functioning tumors, of which the prognosis depends on the metastatic status. In the localized setting, p-NETs should be surgically managed, as no benefit for adjuvant chemotherapy has been demonstrated. Parenchymal sparing resection, including both duodenum and pancreas, are safe procedures in selected patients with reduced endocrine and exocrine long-term dysfunction. When the p-NET is benign or borderline malignant, this surgical option is associated with low rates of severe postoperative morbidity and in-hospital mortality. This narrative review offers comments, tips, and tricks from reviewing the available literature on these different options in order to clarify their indications. We also sum up the overall current data on p-NETs G1 and G2 management.

Video-Assisted Thoracoscopy for Vertebral Body Tethering of Juvenile and Adolescent Idiopathic Scoliosis: Tips and Tricks of Surgical Multidisciplinary Management

VATS (video assisted thoracoscopic surgery) is routinely and successfully performed in minor and major complex thoracic procedures. This technique has been recently introduced for the treatment of severe forms of idiopathic scoliosis (IS) with the aim to repair the deformity, reduce morbidity and to prevent its progression in patients with skeletal immaturity. This study aims to present VATS in anterior vertebral body tethering (AVBT) approach to support the pediatric orthopedic surgeons during vertebral body fixation. Surgical and anesthesiologic tips and tricks are reported to assure a safe procedure. The study includes preadolescents with IS and a grade of scoliosis >40° that had a high probability of deterioration due to remaining growth (December 2018 to April 2021). Skeletal immaturity of enrolled patients was assessed by Sanders classification and Risser sign. Patients had a Risser score between 0 and 1 and a Sanders score >2 and <5. AVBT technique using VATS was performed by a senior pediatric surgeon assisting the pediatric orthopedic surgeon. Twenty-three patients have been submitted to VATS AVBT in the period of study (age range 9–14 years). The patients had a classified deformity Lenke 1A or B convex right and all types of curves were treated. In all patients, the vertebrae submitted to tethering surgery ranged from D5 to D12; mean curve correction was 43%. Three postoperative complications occurred: one late postoperative bleeding requiring a chest tube positioning on 12th postoperative day; one screw dislodged and needed to be removed; one child showed worsening of the scoliosis and needed a posterior arthrodesis. Initial results of VATS AVBT in growing patients with spinal deformities are encouraging. An appropriate selection of patients and a pediatric dedicated multidisciplinary surgical approach decrease intraoperative complications, time of operation and postoperative sequelae and guarantee an optimal outcome.

Tips and Tricks in Cardiac Surgical Anesthesia

For operations including coronary artery by-pass grafting (CABG), heart valve repair or replacement, ascending aorta surgeries, heart transplantation, and surgical correction of congenital heart defects, anesthesia management shares many similar concepts

Pelatihan Public Speaking Dengan Memanfaatkan Aplikasi Zoom Di Masa Pandemi Covid-19

One aspect that has changed due to the Covid-19 pandemic is the way humans communicate in public (public speaking). This impact was also felt by women who were members of the Fatayat NU (Nahdlatul Ulama) Ciledug organization. Fatayat NU is an Islamic women's organization which is one of the autonomous institutions within NU, which is religious, social and familial. The concept of Fatayat NU activities can be classified into three, namely in the field of regeneration and education, the field of da'wah or Islamic development, and the field of social society. The problems faced by Fatayat NU Ciledug, relating to public speaking are: (1) Lack of ability to appear and speak in public; and (2) Lack of public speaking skills, both face-to-face and online. The solutions offered to solve these problems are through community service activities, namely providing online training/workshops by utilizing the Zoom Meeting application to members of Fatayat NU Ciledug to provide tips and tricks regarding: (1) How to have the ability to appear and speak in public; and (2) Skills in public speaking both face-to-face and online. The implementation of this community service activity consists of 3 stages, namely; (1) The preparation stage, to identify problems, apply for permits to the Fatayat NU Ciledug management, and make preparations for the implementation of public speaking training; (2) the stage of implementing public speaking training; and (3) the evaluation stage, by providing evaluation test questions that must be done using Google Forms media, to find out how much the increase in knowledge, abilities, and skills of Fatayat NU Ciledug women regarding public speaking after participating in training activities.