Background: Kounis syndrome (KS), also known as allergic myocardial infarction, presents in three variants. This condition is often underrecognized due to limited knowledge and its variable presentation. To address these limitations, the present review aims to describe the triggers, types, management, and patient outcomes of KS. Methods: In this systematic review, PubMed and Scopus were used to identify publications of clinical case reports; variables included sociodemographic characteristics, clinical manifestations, triggers, treatments, and outcomes. Data from the articles´ abstracts were assessed by two corresponding authors, and subsequently, each case was analyzed by two coauthors, validated and analyzed with Stata 12. To categorize each Kounis type, mean and proportion comparison tests were performed, and measures of association were obtained using logistic regression and expressed as odds ratios. Results: A global distribution was identified, with predominance in the Northern Hemisphere. Type I KS was the most reported variant, and most of the patients were adult men. Most of the patients presented variability in the treatment and outcomes. Conclusions: KS may represent a diagnostic challenge, and underdiagnosis could explain the lack of uniformity in the diagnostic and assessment process. Our results highlight a need for improved approaches based on patient history for correct diagnosis and preventing recurring events.

We aimed to analyze the association between the average lumbar subcutaneous fat tissue thickness (LSFTT) at each intervertebral level and the presence of hernias in patients with low back pain from an insurance network hospital in Mexico. This observational prospective study included 174 patients with non-traumatic lumbago who underwent magnetic resonance imaging with a 1.5T resonator. Two independent radiologists made the diagnosis, and a third specialist provided a quality vote when needed. The sample size was calculated with a 95% confidence interval using random order selection. Anonymized secondary information was used. Percentages and means with confidence intervals were tabulated. The area under the curve, specificity, and sensitivity of LSFTT were calculated. A regression analysis was performed to analyze the presence of hernias with LSFTT using each intervertebral level as a predictor. The odds of herniation at any intervertebral level increased directly with LSFTT. The average LSFTT predicted the overall presence of hernias; however, the LSFTT at each intervertebral level better predicted hernias for each intervertebral space. The area under the curve for LSFTT in predicting hernias was 68%. In conclusion, the average LSFTT was associated with the overall presence of hernias; patients with more hernias had higher LSFTT values.

Background/Objectives: Mirizzi syndrome (MS) alters biliary anatomy, complicating diagnosis and treatment. We characterized diagnostic pathways in reported cases and compared Csendes type I with types II–V. Methods: PubMed and Scopus were searched through 1 July 2026, supplemented by citation searching. Reports of five or fewer patients were eligible. Patient-level diagnostic, treatment, and outcome data were summarized; groups were compared using Fisher’s exact and Mann–Whitney U tests. Results: We included 133 publications reporting 141 patients. MS was diagnosed preoperatively in 115/138 patients (83.3%). Recognition was more frequent in type I than types II–V (92.5% vs. 76.7%; p = 0.037) and among patients with conventional imaging (94.0% vs. 76.0%; p = 0.014). ERCP use and the number of modalities did not differ by diagnostic status. Compared with type I, types II–V more frequently required bile-duct exploration (37.1% vs. 17.0%), underwent open surgery (43.5% vs. 24.5%), and developed bile leak (24.1% vs. 8.5%) or treatment-related bile-duct injury (24.1% vs. 4.3%). Conclusions: Preoperative recognition was common but less frequent in fistulizing forms. Anatomical classification and conventional imaging may assist operative planning, whereas accumulating modalities showed no diagnostic advantage.

Background: Fibrolamellar hepatocellular carcinoma (FL‐HCC) is a rare variant of hepatocellular carcinoma (HCC) that typically arises in non‐cirrhotic livers and affects younger individuals compared with conventional HCC. Because patients usually have preserved hepatic function, surgical resection may be feasible even in the presence of large tumors. However, diagnostic uncertainty and concerns regarding extrahepatic disease may limit initial surgical decision‐making. Case Presentation: We report the case of a 48‐year‐old male patient who presented with epigastric discomfort, weight loss, and a palpable abdominal mass. Contrast‐enhanced imaging demonstrated a large hepatic lesion involving segments II, III, and IV, with additional pulmonary and adrenal findings initially raising concern for metastatic disease. The patient had previously been declined surgical treatment at another institution. Further multidisciplinary evaluation, imaging reassessment, and histological confirmation by percutaneous biopsy supported the diagnosis of FL‐HCC without confirmed metastatic disease. An open anatomical left hepatectomy was performed. Histopathology confirmed FL‐HCC with negative surgical margins and no lymph node metastases. Follow‐up 36 months after surgery demonstrated no evidence of recurrence. Conclusion: This case highlights the importance of comprehensive staging and multidisciplinary reassessment in patients with suspected FL‐HCC. Even when surgery has initially been declined, careful evaluation may identify candidates for potentially curative hepatic resection. Long‐term surveillance remains essential due to the risk of recurrence following resection. Additionally, this report illustrates that FL‐HCC can occur outside the typical age range, emphasizing the need to consider this diagnosis in compatible clinical and radiologic contexts.

Porcelain gallbladder (PGB) has historically been considered a premalignant condition, although recent evidence questions the strength of its association with gallbladder carcinoma. Objective: To describe the occurrence and characteristics of malignancy in patients with porcelain gallbladder, as well as clinical, imaging, and surgical characteristics reported in clinal cases. Methods: A systematic review of case reports and case series (≤5 patients) was conducted following PRISMA 2020 guidelines. PubMed/MEDLINE, ScienceDirect, and Redalyc from database inception through March 2026. Individual patient data were extracted including demographic characteristics, imaging findings, calcification pattern, surgical management, histopathology, and outcomes. Descriptive statistics were performed. Results: Fifty-four individual cases of porcelain gallbladder were identified. Patients were predominantly female (70.4%), with ages ranging from 6 to 98 years. Complete calcification was reported in 85.2% of cases. Histopathological confirmation was available in 45 cases (83.3%). Thirteen patients had gallbladder carcinoma associated with porcelain gallbladder, corresponding to 28.9% of those with pathological examinations. Incomplete calcification showed higher frequency of malignancy compared with complete calcification. Mortality was reported in three patients (5.6%), all with malignant disease. Conclusions: The proportion of malignancy observed in published case reports reflects a selected dataset and should not be interpreted as an estimate of population risk. These findings provide descriptive insights into clinical presentations and management patterns, supporting hypothesis generation rather than risk estimation.

Background: Explantation after chimney, fenestrated, or branched endovascular aortic repair is technically demanding because major arterial branches are incorporated into the device. Objective: To identify recurring principles of operative decision-making for partial or complete explantation, with an emphasis on infection extent, incorporated branch management, reconstruction, and staging. Methods: PubMed/MEDLINE and Scopus were searched from inception through 21 August 2026 for patient-level reports of surgical explantation after complex endovascular aortic repair. Two reviewers independently selected studies, extracted data, and assessed methodological quality with the Joanna Briggs Institute checklist and reporting completeness with CARE. Findings were synthesized descriptively; the protocol was registered in PROSPERO (CRD420261412667). Results: Ten single-patient reports published from 2015 to 2025 were included. Patients were aged 51–78 years (median, 73), and nine were men. Infection prompted eight explantations; renal chimney-stent thrombosis with type Ia endoleak and persistent type II endoleak with sac enlargement accounted for two mechanical failures. Computed tomography or computed tomography angiography was reported in all cases and FDG-PET/CT in five. Eight patients underwent complete and two partial explantations. Nine survived the index hospitalization. No recurrent infection was reported during the available, heterogeneous follow-up of 3–48 months. Conclusions: These selected reports identify anatomy- and source-control considerations that may guide operative planning, but they do not establish comparative effectiveness, procedural safety, or population-level outcomes.