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

On the elliptic nonabelian Fourier transform for unipotent representations of p-adic groups

In this paper, we consider the relation between two nonabelian Fourier transforms. The first one is defined in terms of the Langlands-Kazhdan-Lusztig parameters for unipotent elliptic representations of a split p-adic group and the second is defined in terms of the pseudocoefficients of these representations and Lusztig's nonabelian Fourier transform for characters of finite groups of Lie type. We exemplify this relation in the case of the p-adic group of type G_2.Comment: 17 pages; v2: several minor corrections, references added; v3: corrections in the table with unipotent discrete series of G

Dirac cohomology, elliptic representations and endoscopy

The first part (Sections 1-6) of this paper is a survey of some of the recent developments in the theory of Dirac cohomology, especially the relationship of Dirac cohomology with (g,K)-cohomology and nilpotent Lie algebra cohomology; the second part (Sections 7-12) is devoted to understanding the unitary elliptic representations and endoscopic transfer by using the techniques in Dirac cohomology. A few problems and conjectures are proposed for further investigations.Comment: This paper will appear in `Representations of Reductive Groups, in Honor of 60th Birthday of David Vogan', edited by M. Nervins and P. Trapa, published by Springe