Introduction. Cylindroma of the breast is a rare disorder, and only a few cases have been reported in the literature. Due to its rarity, this article was drafted to study the cases published over the last decade and thereby try to explain the current patterns in clinical presentation, diagnosis, treatment, and outcomes. Methods. A systematic literature search was conducted through electronic databases applying the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results. There were 9 case reports with 10 female patients, ranging in age from 55 to 80 years. Local excision was the most common modality of treatment. The outcome was excellent with no recurrence. Conclusion. Cylindroma of the breast is rare with an excellent prognosis. It needs to be kept in mind as a differential diagnosis of triple-negative breast tumours or the solid basaloid variant of adenoid cystic carcinoma to avoid unnecessary overtreatment with associated morbidity.

Serous tubal intraepithelial lesion (STIL) is a rare benign lesion of the fallopian tube epithelium characterized by atypical epithelial cells with morphological anomalies, marked by the accumulation of p53 protein and normal or slightly increased proliferative activity. STIL is becoming an increasingly investigated type of fallopian tube neoplasm, with differential STIL diagnosis based on the morphology of the fallopian tube epithelium and immunohistochemical markers p53 and Ki-67. Benign intraepithelial changes of the fallopian tube occur in the distal third of the tube and are considered precursors to serous tubal intraepithelial carcinoma (STIC), which ultimately progresses to high-grade serous ovarian cancer (HG-SOC). More precise methods for investigating the fallopian tubes are emerging to detect epithelial changes and neoplasms as early as possible. So far, there are no accurate prognoses for this pathology or recommendations for the further monitoring and treatment of patients.

Introduction. Werner’s syndrome is a rare autosomal recessive disorder characterised by premature ageing phenotypes, inclu­ding skin ulcers resistant to conservative treatment. Purpose. To review the cases of surgical treatment of skin ulcers in patients with Werner’s syndrome published in the scientific literature. Methods. Scientific articles were searched using Google Scholar, PubMed and DeepDyve databases, applying the keyword “ulcer” and the word combination “Werner’s syndrome”. Based on the inclusion and exclusion criteria, 16 scientific publications were included in the review. Results. Depending on the location and nature of the ulcers in patients with Werner’s syndrome, different surgical options are available, with different surgical outcomes, such as partial or complete ulcer healing, non-healing or recurrence. Conclusions. In skin grafting, ulcers are more likely to heal incompletely or temporarily. Therefore additional treatment options can be used such as vacuum negative pressure therapy, Kirschner wires or removal of the upper layer of bone. Other grafts, such as artificial skin, are more reliable, especially in large joint areas. However, a critical assessment of each individual case is necessary before choosing surgical treatment, as these patients have different degrees of tissue blood flow, muscle atrophy and general condition.

An 80-year-old lady presented with lump Left breast of 8 months duration. Clinically was aT4b lesion, sonomammogram showed BIRADS V lesion and core needle breast biopsy features were suggestive of metaplastic carcinoma breast of adenosquamous type, ER, PR-Positive, Her2Neu-Negative. Patient received preoperative hormonal therapy followed by modified radical mastectomy and postoperative adjuvant chemotherapy and hormonal therapy. Post operative patient showed good clinical recovery and was recurrence free at 6 months follow up although patient had all the poor prognostic factors with large size, LN involvement and high Ki 67. This article is a rare example of metaplastic breast carcinoma presenting in geriatric age group and showing good recovery despite presence of all poor prognostic factors. Hence this report is to enlighten the medical caregivers about the existence of this rare entity and challenges involved in management of this entity.

Background. Carpal tunnel syndrome is the most common and widespread peripheral neuropathy in the world. The diagnostic testing methods for the carpal tunnel syndrome are based on anamnesis data, objective and instrumental inspection. Electroneuromyography is the main instrumental test when carpal tunnel syndrome is suspected. An ultrasound imaging may also be performed. Objective. To determine the effectiveness, sensitivity and specificity of instrumental diagnostics methods used to diagnose the carpal tunnel syndrome, and to compare them. Methods. Diagnostic testing – ultrasound and electroneuromyography was applied to persons under study. The area of the median nerve (mm2) was assessed during the ultrasound examination. The results of the electroneuromyography study evaluated the response speed of the sensory impulse (ms), the speed of the motor impulse response (ms). Later, the tests, their sensitivity and specificity were evaluated and compared. Results. 30 patients participated in the study, of which 26 (86.7%) were women, 4 (13.3%) were men. Electroneuromyography was found to be both sensitive and specific for a measure of sensory propagation velocity, 76.2 and 75%, respectively (p = 0.042); of motor propagation speed – 100 and 75% (p = 0.040). Ultrasonography is sensitive (87.5%) but nonspecific (66.7%) (p = 0.008). The study showed that the ultrasound dimension strongly, directly and reliably correlates with the sensory impulse response rate (p < 0.001), and the ultrasound dimension moderately, directly and reliably correlates with the motor impulse response rate (p < 0.001). Conclusions. Carpal tunnel syndrome can be suspected by ultrasound measurement of the area of the median nerve, but the test is only sensitive but non-specific. Electroneuromyography can confirm the diagnosis of carpal tunnel syndrome, as the test is both sensitive and specific. Comparing the studies, a strong, direct and reliable relationship between the results of the ultrasound and the electroneuromyography testing was established.

Introduction. Hallux Rigidus, a degenerative disease of the first metatarsophalangeal joint (MTP), causes pain during movement, reduces joint mobility, and impairs quality of life. Conservative treatment methods are effective only in the early stages of the disease, and surgical treatment is usually recommended for advanced pathology. Arthrodesis procedure is the gold standard. This surgery effectively and relatively quickly reduces painful symptoms but sacrifices joint mobility. An alternative is resection arthroplasty. There is no consensus in the literature regarding the long-term outcomes of these two treatment methods. The aim of this study is to determine which method is superior in improving patients’ quality of life and foot function. Methods. A retrospective observational study was conducted on 41 patients who were followed up for 2–4 years after surgery. Of these, 20 underwent resection arthroplasty, 21 – arthrodesis. Patients’ quality of life and subjective foot function were assessed using two standardized questionnaires: SEFAS and Short Form-12. Additional questions on patient satisfaction with the surgery were also evaluated. Results. Patient satisfaction with the surgery was high in both groups (80%). There were no statistically significant differences in patients’ ankle and foot function assessed by SEFAS scale and psychological quality of life assessed by SF 12 (Mental Score): p = 0.14 and p = 0.729, respectively. Patients rated their physical quality of life significantly better, assessed by SF 12 (Physical Score), after undergoing arthroplasty (p = 0.02), and foot function recovered approximately 1 month faster compared to arthrodesis (p = 0.006). There were no cases of revision surgery, infectious complications, or non-unions in either group. Conclusions. Both surgical techniques are effective and improve patients’ functional status, but subjective foot function is better in the early postoperative period after resection arthroplasty. The majority of patients in both groups would recommend the surgery under similar circumstances.

Objectives of the study. Our aim was to analyse different antithrombotic drug regimens and duration in intracranial stenting procedures (stent assisted coiling, flow diverter) for unruptured aneurysms and based on the literature review from 2017–2023 to implement dual antiplatelet therapy algorithm for neuro-interventional procedures in Lithuania. Research methods and methodology. A comprehensive literature search of PubMed, BioMed Central, BMJ Journals, EBSCO Publishing, SAGE Journals Online, ScienceDirect, SpringerLink was conducted by two independent readers (MP, GŠ) for studies published from January 2017 to April 2023. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. 23 studies: 6 retrospective cohort, 11 retrospective case-control, 1 prospective cohort, 1 prospective randomized-control, 1 systemic literature review, 3 metanalysis observational studies were identified. Results and conclusions. We found widespread variation in practices even among the same country centres, lending credence to the importance of a future prospective studies of dual antiplatelet drug therapy (DAPT) regimens and duration for the purpose of deriving optimal methods and streamlining tactics. Our suggested algorithm for DAPT in neuro-interventional procedures in Lithuania is provided in Graph 1.

On June, 2023, Vilnius University Hospital Santaros Klinikos started robotic-assisted operations using VERSIUS robotic surgery system (CMR, Cambridge, UK) and performed 29 robotic surgeries within the first 3 weeks. This surgical system was purchased with funding from the European Regional Development Fund. Comprehensive three-month-long learning courses were organized for a total number of 32 persons, forming 8 independent teams, each consisting of 2 surgeons and 2 nurses. Learning courses consisted of online theoretical training modules, a one-week learning course including technical skills training with a simulator and dry runs as well as cadaveric surgical cases. Furthermore, an additional learning module included dry runs in the operating room prior to the first surgeries, following live and online proctored surgical cases. This enabled a rapid and smooth introduction of the robotic surgical system into clinical practice without putting patients at risk. Abdominal surgeons, urologists, and gynecologists have already performed surgeries using the VERSIUS surgical system and no major complications have been reported. Thoracic surgeons are underway to begin thoracic robotic-assisted surgeries, completing the multidisciplinary VERSIUS surgical system implementation process. Our goal is to share initial experience with robotic VERSIUS surgical system and evaluate its implementation in Vilnius University Hospital Santaros Klinikos.

Although rare, cardiac tumors are a type of surgical pathology that can present itself during clinical practice. Like the majority of neoplasms, these tumors are classified into two groups: primary and secondary or benign and malignant. However, the classification does not determine treatment, but the diagnostic pathway is the same and this pathology does not revolve only around the cardiologist an/or cardiac surgeon for optimal patient outcomes. That is why it is important for doctors of multiple specialties to work on cardiac tumor diagnostics and treatment all together. Aim of this study – to analyze the information about cardiac tumor classification, diagnostics, and treatment. Results of the study. The results clearly show that cardiac tumors are a rare type of pathology and their classification depends on type of tissue the neoplasm originated from. It can either be from one of heart layers (primary tumor) or a metastasis (secondary tumor). It is also important to classify these tumors into benign and malignant because treatment differs drastically. Diagnostic tests that are essential for cardiac tumors are instrumental (heart ultrasound, MRA, CTA) and blood tests (troponins, D-dimers). Treatment varies depending on tumor type however surgery is usually the only option. Treatment of malignant tumors is more complex, involving chemotherapy and/or radiotherapy and outcomes of these neoplasms are generally worse compared to treatment of benign heart tumors.

Internal hernia through foramen of Winslow (FoW) is rare condition as there are only 200 cases reported so far in the literature. Our patient a 78 years man presented with a clinical picture suggestive of small bowel obstruction for 5 days. Patient underwent emergency laparotomy following suspicion of internal hernia on imaging. On exploratory laparotomy there was grossly dilated bowel loops and a small segment of terminal ileum and omentum was found herniating through FoW in to the lesser sac. The bowel segment was reduced with gentle traction and herniated segment of omentum was excised due to questionable viability. Opening of FoW was unusually large and to prevent hernia recurrence it was closed partially. Postoperative period was uneventful. This unusual case presented to us diagnostic confusion and management challenge considering the previous history, multiple comorbidities and geriatric profile.