Survival trends and complications in surgical interventions for colorectal cancer: an overview of patients hospitalized in Clinical Emergency Hospital Bucharect

The preoperative imaging diagnosis of rectal cancer lies at the heart of oncological staging and has a crucial influence on patient management and therapy planning. Rectal cancer is common, and accurate preoperative staging of tumors using high-resolution magnetic resonance imaging (MRI) is a crucial part of modern multidisciplinary team management (MDT). Indeed, rectal MRI has the ability to accurately evaluate a number of important findings that maBay impact patient management, including distance of the tumor to the mesorectal fascia, presence of lymph nodes, presence of extramural vascular invasion (EMVI), and involvement of the anterior peritoneal reflection/peritoneum and the sphincter complex. Many of these findings are difficult to assess in nonexpert hands. In this lecture, we present currently used staging modalities with focus on MRI, including optimization of imaging techniques, tumor staging, interpretation help as well as essentials for reporting

Optimizing surgical techniques in extra-anatomical ilio-femoral bypasses

Scopul lucrării. Bypass-ul extraanatomic ilio-femural crossover este o procedura chirurgicala utilizată pentru revascularizarea segmentului aorto-femural, când intervențiile endovasculare nu sunt posibile, iar aplicarea unui bypass aorto sau ilio-femural este dificilă sau chiar imposibilă din cauza condițiilor tehnice sau a stării pacientului. Scopul este studierea rezultatelor precoce și tardive pentru favorizarea unor schimbări și implementarea unor gesturi tehnice în aplicarea bypass-urilor crossover ilio-femural, pentru a crea o geometrie cât mai fiziologică ce poate oferi o soluție durabilă pe termen lung. Materiale și metode. Pe parcursul anilor 2001-2022 au fost efectuate 142 bypass-uri crossover ilio-femurale. Rezultate. În perioada postoperatorie a fost un singur deces și s-au efectuat 3 amputații. Au fost analizate duplex scanările și CT angiografiile în primele 12 luni postoperatorii, pentru aprecierea altor leziuni aterosclerotice, care ar necesita revascularizare deschisă s-au endovasculară atît in bazinul recipient cât și cel donator. Totodată, a fost apreciata poziția și forma bypass-ului ce a dus la folosirea ulterioară a unor noi procedee tehnice ce diferă de cele descrise anterior. Concluzii. Optimizarea tehnicilor chirurgicale creând o geometrie cât mai fiziologică, excluderea maximală a angulărilor stenozante ale grefei poate oferi bypass-ului extraanatomic crossover ilio-femural o durabilitate îndelungată. Acest lucru poate favoriza creșterea frecvenței indicațiilor la folosirea bypass-urilor crossover ilio-femural.Aim of study. The extra-anatomic ilio-femoral crossover bypass is a surgical procedure used for revascularizing the aorto-femoral segment when endovascular interventions are not possible, and when applying an aorto- or ilio-femoral bypass is difficult or even impossible due to technical conditions or the patient's condition. The aim was to study the early and late outcomes to promote changes and implement technical gestures in the application of ilio-femoral crossover bypasses, aiming to create a more physiological geometry that can provide a durable long-term solution. Materials and methods. Between 2001 and 2022, a total of 142 ilio-femoral crossover bypasses were performed. Results. There was one death and three amputations in the postoperative period. Duplex scans and CT angiography were analyzed in the first 12 months postoperatively to assess other atherosclerotic lesions that would require open or endovascular revascularization in both the recipient and donor areas. Additionally, the position and shape of the bypass were evaluated, leading to the subsequent use of new technical procedures that differ from those previously described. Conclusions. Optimizing surgical techniques by creating a more physiological geometry and minimizing stenotic angles of the graft can provide the extra-anatomic ilio-femoral crossover bypass with long-lasting durability. This may increase the frequency of indications for using ilio-femoral crossover bypasses

Resection of a juxtarenal aneurysm complicated by rupture. Clinical case

Caz clinic. Se prezintă un caz clinic de tratament chirurgical soldat cu succes al unui anevrism de aortă juxtarenal complicat cu ruptură al unui pacient de 76 ani. Boala a debutat de 3 zile cu dureri puternice în regiunea lombară, cu iradiere în abdomen. Internat în spitalul orășenesc, unde la CT angiografie s-a depistat un anevrism al aortei abdominale complicat cu ruptură in spațiul retroperitoneal. Pacientul a fost transferat în SCR ,,T. Moșneaga” operat în mod urgent. La laparotomie xifopubiană s-a depistat circa un litru de lichid sero-sangvinolent, anevrism juxtarenal cu hematom retroperitoneal. După clamparea aortei suprarenale s-a efectuat rezecția anevrismului rupt, cu protezare aorto-femurală pe dreapta și iliacă pe stânga. Perioada postoperatorie fără complicații. Externat la a 11-a zi în stare satisfăcătoare. CT angiografie de control peste 6 luni- proteza aortală funcțională, fără alte patologii. Concluzie. În cazul anevrismelor aortei abdominale complicate cu ruptură, care nu pot fi rezolvate endovascular din diferite motive (anatomie nepotrivită, lipsa utilajului necesar la moment etc) este necesar tratamentul chirurgical deschis în mod urgent. Posedarea metodelor deschise nu trebuie exclusă din arsenalul chirurgului vascular.Clinical case. We present a clinical case of a successful surgical treatment of a ruptured juxtarenal aortic aneurysm in a 76-year-old patient. The disease started three days ago with severe pain in the lower back, radiating to the abdomen. The patient was transferred to the local hospital, where a CT angiography revealed an abdominal aortic aneurysm complicated by retroperitoneal rupture. The patient was urgently transferred to the "T. Moșneaga'' Intensive Care Unit for surgery. Xipho-pubic laparotomy revealed approximately one liter of serosanguinous fluid, a juxtarenal aneurysm with a retroperitoneal hematoma. After clamping the suprarenal aorta, resection of the ruptured aneurysm was performed, followed by aortic-femoral grafting on the right side and iliac grafting on the left side. The postoperative period was uneventful. The patient was discharged in satisfactory condition on the 11th day. A follow-up CT angiography after 6 months showed a functional aortic graft without any other pathologies. Conclusions. In cases of abdominal aortic aneurysms complicated by rupture, which cannot be resolved endovascularly due to various reasons (inappropriate anatomy, lack of necessary equipment at the moment, etc.), urgent open surgical treatment is necessary. Proficiency in open surgical techniques should not be excluded from the vascular surgeon's armamentarium

Pathological elongation of the internal carotid artery: surgical treatment and immediate postoperative results

Scopul lucrării. În structura cauzelor dezvoltării insuficienței cerebrovasculare, elongarea patologică a arterei carotide interne ocupă locul 2, după afectarea aterosclerotică. Prevalența dolicoarteriopatiei la populația generală se estimează a fi de la 10 la 40 %, iar de la 16% până la 56 % din pacienți au în anamnestic deficit neurologic tranzitor sau permanent. Scopul lucrării este optimizarea tehnicilor chirurgicale și aprecierea eficienței postoperatorii imediate la pacienții cu elongare patologică a arterei carotide interne. Materiale și metode. Studiul efectuat reprezintă o analiză retrospectivă a 243 pacienți, tratați în cadrul IMSP SCR ,,Timofei Moșneaga”, secția de Chirurgie Vasculară în perioada 2002-2022. Rezultate. La pacienții supuși studiului s-a efectuat 258 intervenții chirurgicale. Rezultatele imediate au fost: la 230 pacienți (89.14 %) a dispărut simptomatologia preoperatorie, AVC ischemic s-a înregistrat la 1 pacient, sindrom coronarian acut sau deces nu s-a înregistrat la nici un pacient din lotul studiat. Concluzii. Luând în considerare rata mică de complicații periprocedurale precum și eficacitatea postoperatorie imediată evidentă, putem spune că intervenția chirurgicală în tratamentul elongărilor patologice ale arterelor carotide interne reprezintă o metoda sigură și eficientă pentru prevenirea accidentelor vasculare cerebrale acute și îmbunătățirea calității vieții pacienților.Aim of study. Among the causes contributing to the development of cerebrovascular insufficiency, pathological elongation of the internal carotid artery ranks second after atherosclerotic involvement. The prevalence of dolichoarteriopathy in the general population is estimated to range from 10% to 40%, and between 16% and 56% of patients have a history of transient or permanent neurological deficits. The aim of this study was to optimize surgical techniques and assess immediate postoperative efficacy in patients with pathological elongation of the internal carotid artery. Materials and methods. This study represents a retrospective analysis of 243 patients treated at the State Medical and Pharmaceutical University "Timofei Moșneaga", Department of Vascular Surgery, between 2002 and 2022. Results. A total of 258 surgical interventions were performed in the study group. The immediate results were as follows: symptomatology disappeared in 230 patients (89.14%), one patient experienced an ischemic stroke, and no cases of acute coronary syndrome or death were recorded among the studied patients. Conclusions. Considering the low rate of periprocedural complications and the evident immediate postoperative effectiveness, it can be concluded that surgical intervention for the treatment of pathological elongation of the internal carotid artery is a safe and efficient method for preventing acute cerebrovascular accidents and improving the quality of life for patients

Carotid-brachial bypass in severe upper limb ischemia

Scopul lucrării. În ocluziile axului arterial subclavio-axilar cu ischemie severă a membrului superior s-ar impune folosirea metodelor endovasculare sau aplicarea unui bypass ortotop. În cazul imposibilității din motive tehnice sau stării pacientului drept alternativă servește bypass-ul carotido-brahial. Scopul studiului este aprecierea posibilității utilizării bypass-ului extraanatomic carotido-brahial în revascularizarea membrului superior în ischemia severă. Materiale și metode. Studiul cuprinde 5 pacienți cu ocluzia axului subclavio-axilar cu ischemie severă a membrului superior, dintre care 3 cu ocluzie acută pe fondal de stenoze aterosclerotice, la care intervenția inițială de trombectomie (embolectomie) a eșuat, un pacient cu tromboza anevrismului a. subclaviculare și un pacient cu ocluzie aterosclerotică de gradul IV cu gangrena degetului II, la care intervenția endovasculară a eșuat. La toți pacienții s-a aplicat un bypass carotido-brahial cu grefon safen intern inversat. Grefele au fost amplasate suprafascial supraclavicular. Rezultate. La toți 5 pacienți ischemia a cedat complet. La 4 din ei s-a restabilit pulsul distal. La pacientul cu ateroscleroză cronică de gradul IV, cu afectarea concomitentă a arterelor antebrațului, pulsul s-a restabilit la bifurcația arterei brahiale. La acest pacient s-a efectuat amputația degetului. Complicații nu s-au înregistrat. Incomodități subiective din cauza amplasării suprafasciale și supraclaviculare a bypass-urilor deasemenea n-au fost înregistrate. Concluzii. Bypass-urile carotido-brahiale localizate suprafascial și supraclavicular servesc o alternativă a bypass-urilor ortotope inclusiv în cazurile eșecurilor sau contraindicațiilor metodelor endovasculare.Aim of study. In cases of occlusion of the subclavian-axillary arterial axis with severe upper limb ischemia, the use of endovascular methods or the application of an orthotopic bypass may be necessary. In case of technical impossibility or patient condition, carotidbrachial bypass serves as an alternative. The objective of the study is to evaluate the possibility of using extra-anatomic carotidbrachial bypass for revascularization of the upper limb in severe ischemia Materials and methods. The study includes 5 patients with occlusion of the subclavian-axillary axis and severe upper limb ischemia, of which 3 had acute occlusion due to atherosclerotic stenosis, with initial thrombectomy (embolectomy) being unsuccessful. One patient had subclavian artery aneurysm thrombosis, and one patient had grade IV atherosclerotic occlusion with gangrene of the second digit, in whom endovascular intervention was unsuccessful. Carotid-brachial bypass with an inverted internal saphenous vein graft was performed in all patients. The grafts were placed in a suprafascial supraclavicular position. Results. Complete resolution of ischemia was achieved in all 5 patients. Distal pulses were restored in 4 of them. In the patient with chronic grade IV atherosclerosis and concomitant involvement of the forearm arteries, the pulse was restored at the brachial artery bifurcation. Digit amputation was performed in this patient. No complications were recorded, and there were no subjective discomforts related to the suprafascial and supraclavicular placement of the bypasses. Conclusions. Suprafascial and supraclavicular carotid-brachial bypasses serve as an alternative to orthotopic bypasses, including in cases of failure or contraindications to endovascular methods

Surgical treatment of true popliteal artery aneurysm. Our experience

Scopul lucrării. Anevrismele adevărate ale arterei poplitee (AAP) reprezintă o patologie relativ rar întâlnită, dar insidioasă prin complicațiile sale – tromboza ei și emboliile periferice, ce duce la ischemie severă și chiar la pierderea membrelor inferioare. Scopul este studierea posibilităților și aprecierea metodelor optime de revascularizare a membrului inferior în caz de AAP în baza experienței noastre. Materiale și metode. Studiul cuprinde un lot de 54 pacienți la care s-au efectuat 66 intervenții de revascularizare la 65 de membre inferioare pe parcursul anilor 1995-2022. Diagnosticul a fost stabilit preoperator prin Duplex scanare, DSA sau CT angiografie în majoritatea cazurilor și la 17 pacienți a prezentat o constatare intraoperatorie. În 29 de cazuri pacienții prezentau un tablou clinic de ischemie severă datorită trombozei anevrismului și embolizării patului distal. În 65 din 66 de cazuri s-a recurs la intervenții deschise prin acces medial. Într-un singur caz - la intervenție endovasculară cu instalarea unui stent-graft. Revascularizarea deschisă a constat în instalarea unui bypass cu grefon safen în 48 cazuri. În 17 cazuri s-a recurs la rezectia anevrismului cu protezare safeneană. La 24 pacienți au fost necesare trombectomii indirecte din aa.tibiale. Rezultate. Postoperator s-au efectuat 5 amputații înalte din cauza trombozelor periferice. La pacientul după stentare s-a dezvoltat peste 3 luni tromboza stent-graftului și s-a intervenit cu succes prin protezarea arterei poplitee. Din 65 de membre au fost revascularizate 60. Decese nu au fost. Concluzii. În baza rezultatelor susținem necesitatea diagnosticului și tratamentului chirurgical precoce în cazul AAP, pentru prevenirea complicațiilor trombotice distale des incurabile. Calea de abord chirurgical este mediala. Bypass-ul safenean cu ligaturarea arterei proximal și distal de anevrism este optimal în majoritatea cazurilor, iar rezecția anevrismului cu protezare este impusă numai în cazurile tabloului clinic de comprimare adiacentă.Aim of study. True popliteal artery aneurysms (PAA) are a relatively rare pathology but insidious due to their complications - thrombosis and peripheral embolism, leading to severe ischemia and even limb loss. The objective is to study the possibilities and evaluate optimal methods for lower limb revascularization in cases of PAA based on our experience. Materials and methods. The study included a group of 54 patients who underwent 66 revascularization procedures on 65 lower limbs between 1995 and 2022. The preoperative diagnosis was established using duplex scanning, digital subtraction angiography (DSA), or CT angiography in most cases, with intraoperative findings in 17 patients. In 29 cases, patients presented with severe ischemia due to aneurysm thrombosis and distal embolization. In 65 out of 66 cases, open interventions were performed using a medial approach. In one case, an endovascular intervention with the placement of a stent-graft was performed. Open revascularization consisted of bypass grafting with a saphenous vein graft in 48 cases. In 17 cases, aneurysm resection with saphenous vein grafting was performed. Indirect thrombectomies from the tibial arteries were required in 24 patients. Results. Postoperatively, 5 high-level amputations were performed due to peripheral thrombosis. In the patient who underwent stenting, stent-graft thrombosis developed after 3 months, and successful intervention was performed with popliteal artery grafting. Out of 65 limbs, 60 were successfully revascularized. There were no deaths. Conclusions. Based on the results, we support the necessity of early diagnosis and surgical treatment in cases of PAA to prevent distal thrombotic complications that are often incurable. The medial surgical approach is recommended. Saphenous vein bypass grafting with proximal and distal artery ligation is optimal in most cases, while aneurysm resection with grafting is indicated only in cases of adjacent compression

Measurement of the cross-section and charge asymmetry of WW bosons produced in proton-proton collisions at s=8\sqrt{s}=8 TeV with the ATLAS detector

This paper presents measurements of the $W^+ \rightarrow \mu^+\nu$ and $W^- \rightarrow \mu^-\nu$ cross-sections and the associated charge asymmetry as a function of the absolute pseudorapidity of the decay muon. The data were collected in proton--proton collisions at a centre-of-mass energy of 8 TeV with the ATLAS experiment at the LHC and correspond to a total integrated luminosity of 20.2~\mbox{fb^{-1}}. The precision of the cross-section measurements varies between 0.8% to 1.5% as a function of the pseudorapidity, excluding the 1.9% uncertainty on the integrated luminosity. The charge asymmetry is measured with an uncertainty between 0.002 and 0.003. The results are compared with predictions based on next-to-next-to-leading-order calculations with various parton distribution functions and have the sensitivity to discriminate between them.Comment: 38 pages in total, author list starting page 22, 5 figures, 4 tables, submitted to EPJC. All figures including auxiliary figures are available at https://atlas.web.cern.ch/Atlas/GROUPS/PHYSICS/PAPERS/STDM-2017-13

Search for chargino-neutralino production with mass splittings near the electroweak scale in three-lepton final states in √s=13 TeV pp collisions with the ATLAS detector

A search for supersymmetry through the pair production of electroweakinos with mass splittings near the electroweak scale and decaying via on-shell W and Z bosons is presented for a three-lepton final state. The analyzed proton-proton collision data taken at a center-of-mass energy of √s=13  TeV were collected between 2015 and 2018 by the ATLAS experiment at the Large Hadron Collider, corresponding to an integrated luminosity of 139  fb−1. A search, emulating the recursive jigsaw reconstruction technique with easily reproducible laboratory-frame variables, is performed. The two excesses observed in the 2015–2016 data recursive jigsaw analysis in the low-mass three-lepton phase space are reproduced. Results with the full data set are in agreement with the Standard Model expectations. They are interpreted to set exclusion limits at the 95% confidence level on simplified models of chargino-neutralino pair production for masses up to 345 GeV

Radical removal of retroperitoneal tumor involving the duorenum, inferior vena cava and infrarenal abdominal aorta

Caz clinic. Se prezintă un caz clinic de tratament chirurgical al unei paciente de 26 ani cu o tumoare retroperitoneală cu implicarea duodenului, venei cave inferioare și a aortei infrarenale. Pacienta a suportat în antecedente o laparotomie explorativă, unde s-a efectuat doar biopsia tumorii. Intervenția chirurgicală: Laparotomie xifopubiană, extirparea tumorii retroperitoneale cu rezecția duodenului și anastamozare duodenojejunală, rezecție marginală a venei cave inferioare si cavorafie, rezecția aortei distal de arterele renale până la bifurcație cu aloprotezare cu proteză liniară de 12mm, perioada postoperatorie fără complicații. Histologic neuroblastom. Externată la a 12 zi postoperator în stare satisfăcătoare. Investigată prin RMN peste un an. Date de recidivă a tumorii nu sunt. Vena cava inferioară și proteza aortei infrarenale permeabile fără particularități. Concluzii. Abordarea multidisciplinară este o condiție obligatorie în tratamentul chirurgical complex al tumorilor cu implicarea vaselor magistrale inclusiv a aortei, venei cave și a organelor adiacente, cum ar fi duodenul. Extirparea radicală a tumorii împreună cu vasele magistrale și porțiunile tractului digestiv impune restabilirea ulterioară a continuității acestora.Clinical case. We present a clinical case of surgical treatment in a 26-year-old patient with a retroperitoneal tumor involving the duodenum, inferior vena cava, and infrarenal aorta. The patient had previously undergone an exploratory laparotomy where only a biopsy of the tumor was performed. Surgical intervention: Xiphopubic laparotomy, removal of the retroperitoneal tumor with duodenal resection and duodenojejunal anastomosis, marginal resection of the inferior vena cava in three locations with suturing of the defects, distal resection of the aorta from the renal arteries to the bifurcation with a 12mm allograft prosthesis. The postoperative period was uneventful. Histologically, it was identified as neuroblastoma. The patient was discharged in satisfactory condition on the 12th postoperative day. Follow-up MRI performed one year later showed no signs of tumor recurrence. The inferior vena cava and the infrarenal aortic prosthesis were patent without any particularities. Conclusions. A multidisciplinary approach is mandatory in the complex surgical treatment of tumors involving major vessels such as the aorta, inferior vena cava, and adjacent organs, including the duodenum. Radical removal of the tumor along with the major vessels and portions of the digestive tract requires subsequent restoration of their continuity

Integrating transposable elements in the 3D genome

Chromosome organisation is increasingly recognised as an essential component of genome regulation, cell fate and cell health. Within the realm of transposable elements (TEs) however, the spatial information of how genomes are folded is still only rarely integrated in experimental studies or accounted for in modelling. Whilst polymer physics is recognised as an important tool to understand the mechanisms of genome folding, in this commentary we discuss its potential applicability to aspects of TE biology. Based on recent works on the relationship between genome organisation and TE integration, we argue that existing polymer models may be extended to create a predictive framework for the study of TE integration patterns. We suggest that these models may offer orthogonal and generic insights into the integration profiles (or "topography") of TEs across organisms. In addition, we provide simple polymer physics arguments and preliminary molecular dynamics simulations of TEs inserting into heterogeneously flexible polymers. By considering this simple model, we show how polymer folding and local flexibility may generically affect TE integration patterns. The preliminary discussion reported in this commentary is aimed to lay the foundations for a large-scale analysis of TE integration dynamics and topography as a function of the three-dimensional host genome