Thyroid nodules, prevalent in 2% to 65% of the general population depending on diagnostic methodology, represent a significant clinical concern despite a low malignancy rate, typically 1% to 5%. A substantial proportion of thyroid cancers are small, indolent lesions, allowing for conservative management with favorable prognoses. Nodule detection commonly occurs via palpation, clinical examination, or incidental radiological findings. Established risk factors include advanced age, female gender, obesity, metabolic syndrome, and estrogen dominance. Despite conservative management potential, a considerable number of thyroid nodules in Europe are unnecessarily referred for surgery, incurring unfavorable risk-to-benefit ratios and increased costs. Minimally invasive techniques (MITs), encompassing ethanol and thermal ablation modalities (e.g., laser, radiofrequency, microwave), offer outpatient, nonsurgical management for symptomatic or cosmetically concerning thyroid lesions. These procedures, performed under ultrasound guidance without general anesthesia, are associated with low complication rates. MITs effectively achieve substantial and sustained nodule volume reduction (57–77% at 5 years), correlating with improved local symptoms. Thermal ablation (TA) is particularly favored for solid thyroid lesions due to its precise and predictable tissue destruction. Optimal TA balances near-complete nodule eradication to prevent recurrence with careful preservation of adjacent anatomical structures to minimize complications. Radiofrequency ablation (RFA) is widely adopted, while microwave ablation (MWA) presents a promising alternative addressing RFA limitations. Percutaneous laser ablation (LA), an early image-guided thyroid ablation technique, remains a viable option for benign, hyperfunctioning, and malignant thyroid pathologies. This review comprehensively evaluates RFA, MWA, and LA for thyroid nodule treatment, assessing current evidence regarding their efficacy, safety, comparative outcomes, side effects, and outlining future research directions.

Cardiopulmonary bypass (CPB) is one of the most groundbreaking medical innovations in history, enabling safe and effective heart surgery by temporarily replacing the function of the heart and lungs. This review starts with ancient concepts of cardiopulmonary function and then traces the evolution of CPB through important physiological and anatomical discoveries, culminating in the development of the modern heart–lung machine. In addition to examining the contributions of significant figures like Galen, Ibn al-Nafis, William Harvey, and John Gibbon, we also examine the ethical and technical challenges faced in the early days of open heart surgery. Modern developments are also discussed, such as miniature extracorporeal systems, off-pump surgical techniques, and the increasing importance of extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS), while the evolving role of perfusionists in diverse cardiac teams and the variations in global access to CPB technology are also given special attention. We look at recent advancements in CPB, including customized methods, nanotechnology, artificial intelligence-guided perfusion, and organ-on-chip testing, emphasizing CPB’s enduring significance as a technological milestone and a living example of the cooperation of science, medicine, and human inventiveness because it bridges the gap between the past and the future.

Cardiac surgery, now a routine medical intervention, was once deemed unthinkable—not merely due to technical limitations, but because of deep-seated cultural, religious, and philosophical prohibitions. This article traces the historical and ethical trajectory of the human heart from a sacred, inviolable symbol of the soul to a surgically accessible organ. Through an interdisciplinary lens that integrates medical history, anthropology, theology, and contemporary bioethics, we examine how shifts in metaphysical belief, technological progress, and moral reasoning gradually legitimized cardiac intervention. From ancient Egyptian funerary rites and classical cardiocentric models to medieval religious taboos and Enlightenment redefinitions of the body, the heart’s transformation reflects broader changes in how humanity conceives life, death, and identity. The emergence of modern cardiac surgery, especially heart transplantation and extracorporeal technologies, raised new ethical dilemmas, challenging the boundaries between tissue and meaning, biology and personhood. This study argues that despite its clinical secularization, the heart retains a unique symbolic gravity that continues to shape public perception and professional responsibility. In the age of precision medicine, cardiac surgery remains not only a technical act but an existential gesture—a transgression that demands both scientific mastery and moral reverence.

Background: Brachial artery aneurysms are a rare entity occurring sporadically at all ages. Common causes are trauma, infection, connective tissue disorders, genetic syndromes, immunosuppression, and a history of arteriovenous vascular access. Pseudoaneurysms are mainly of traumatic or iatrogenic origin. Idiopathic true brachial artery aneurysms are even scarcer, attributed to inherited susceptibility for aneurysm formation or to atherosclerosis. Due to the rarity of these aneurysms, we report our experience along with a current literature review. Methods: A retrospective search was conducted in the Vascular Surgery Department database of a tertiary referral center for vascular surgery, covering procedures from January 1991 to October 2025. Patients were included if they had undergone idiopathic true brachial artery aneurysm repair. Clinical records, operative details, imaging studies, and follow-up data were reviewed. We additionally provide a literature review regarding clinical presentation, signs, pathophysiology, diagnosis, and treatment of these aneurysms. Results: Amongst all procedures performed for aneurysmal repair, in the searched period, we identified three patients who met these criteria. All three underwent successful elective operations. Individual characteristics of the retrieved cases are reported. Conclusions: The open repair of true idiopathic brachial artery aneurysms is a technically simple approach that leads to satisfactory outcomes. Endovascular therapy is technically unfavorable in this type of aneurysm.

Tracheostomy, a critical airway intervention, has a long and complex history that dates back to antiquity. While the earliest references to the procedure appear in Egyptian and Indian medical texts, its development within ancient Greek medicine remains a subject of historical debate. This study explores the evolution of tracheostomy in ancient Greece, analyzing its theoretical foundations, historical accounts, and surgical advancements. Despite Hippocratic opposition, which largely discouraged invasive airway procedures due to the risk of fatal complications, later physicians such as Asclepiades, Aretaeus, and Antyllus made significant contributions to refining airway management techniques. The anatomical studies of Galen further advanced the understanding of respiratory physiology, including early concepts of artificial ventilation. Additionally, this study examines archaeological evidence, such as a marble relief discovered in Abdera, which may depict an early attempt at tracheostomy, providing valuable insight into the practical application of airway interventions in antiquity. By comparing ancient Greek surgical techniques with modern tracheostomy practices, this research highlights the continuity of medical knowledge and innovation. It underlines the role of ancient Greek physicians in shaping the principles of thoracic surgery, offering a broader understanding of how early medical practices have influenced contemporary airway management. The findings contribute to the historical perspective on tracheostomy, emphasizing the timeless pursuit of life-saving surgical advancements and the evolving relationship between theoretical medical knowledge and practical surgical application.

Background: Rule-based multi-agent system (MAS) architectures for healthcare coordination rely on hardcoded decision trees that cannot generalise to novel clinical scenarios or self-correct reasoning errors. These limitations are acute in surgical continuum care, where patients traverse presurgical risk stratification, intraoperative monitoring, postsurgical ICU, ward care, and remote rehabilitation over days to weeks—a complexity no fixed-policy agent architecture can address without prohibitive rule engineering. Objective: We present the first agentic large language model (LLM) framework for autonomous end-to-end surgical continuum monitoring, superseding the prior rule-based MAS Digital Twin. Six ReAct-driven tool-use agents replace fixed-policy agents with dynamic reasoning, multi-hop evidence retrieval, and Reflexion self-correction while maintaining mandatory confidence-gated Human-in-the-Loop (HITL) gating at every care-pathway-modifying decision. Methods: The framework is grounded in the ReAct paradigm and Reflexion self-evaluation, embedded within the DETER Digital Twin state engine S(t). Each agent is specified by a ReAct loop signature, a ten-function clinical tool registry, and confidence-gated HITL escalation logic. Inter-agent coordination replaces the rule-based Priority Queue Manager with an LLM-mediated Coordination Supervisor Agent reasoning over competing resource requests. Results: The framework delivers: (i) six formally specified ReAct-loop agents with explicit tool registries and authorisation boundaries; (ii) a confidence-gated HITL architecture that reduces alert fatigue while preserving safety for ambiguous clinical scenarios; (iii) an extended conflict resolution function P(p,t,context) incorporating surgical phase and DETER deterioration trajectory gradient; (iv) Reflexion self-correction with a formal N_max = 2 termination condition and Clinical Factuality Verification Layer; and (v) a multi-phase Digital Twin state engine extending S(t) to the full surgical continuum. Conclusions: The proposed framework represents a fundamental architectural departure from rule-based clinical AI—from hardcoded policies to dynamic reasoning, from static retrieval to multi-hop tool-use chains, and from fixed escalation thresholds to confidence-gated self-evaluation—providing a formally specified, clinically deployable foundation for next-generation autonomous surgical care coordination.