Giant tuberculum sellae meningioma with unruptured anterior communicating artery aneurysm encased: Case report and review of the literature

This 64-year-old man presented with symptoms of optic chiasm and nerve compression from a giant tuberculum sellae meningioma with unruptured anterior communicating artery aneurysm encased. Preoperative magnetic resonance imaging disclosed that the aneurysm was completely enclosed in the tumor, but angiographic studies did not reveal any important arterial narrowing. The embedded aneurysm caused neither SAH nor intratumoral hemorrhage. All of these factors pointed to little adhesion between the tumor and the encased arteries. Surgery was performed a week after admission and the intraoperative findings revealed that the tumor did not adhere too much to the enclosed vasculature except for a little part attached to the left ICA. The aneurysm was safely clipped after piecemeal removal of the tumor, which was finally extirpated without fear of aneurysm rupture, and with a good visual outcome. To treat both the tumor and aneurysm simultaneously, careful stepwise operative procedures were essential

Auditors’ perceptions on work adaptability in remote audit: a COVID-19 perspective

In the context of COVID-19, adoption of teleworking challenges companies’ culture and social interaction to foster a creative and innovative workplace. The article aims to identify the auditors’ perception of different factors that influence work adaptability in remote audit activity. The research method is based on multivariate data analysis that consist of correspondence analysis, exploratory factor analysis, confirmatory factor analysis and generalised linear ordinal regression. On one hand, findings emphasise that auditors’ perception on the work efficiency of auditors in remote audits is significantly influenced by the digitalization degree of audit activities. On the other hand, the research outlines the main threats and opportunities of remote auditing in the context of the current pandemic restrictions. Where auditors perceive the benefits of remote audit, they appreciate positively the degree of adaptability and work efficiency as regards teleworking. Opportunities perceived lead to enhanced audit activity outcome if audit companies embrace emergent technologies in the new digital workplace. Nevertheless, as transition to remote audit determines increased auditors’ liability and audit risks, auditors are more cautious and sometimes reluctant about future scenarios of remote audit, if innovative emerging audit technologies and integrated GRCs are not used or are not properly implemented. Whatever the future holds for the new digital audit workplace, it is obvious that auditors working from home face specific challenges, because what they earn in efficiency, they lose in benefits that are harder to quantify, such as innovative thinking and creativity

Pregnant woman with an intracranial meningioma: Case report and review of the literature

It is about a 33-year-old female, with a 36 weeks uncomplicated pregnancy and with signs of increased intracranial pressure. Hours after admission and an obstetric evaluation, uterine contraction started and the patient was taken to the delivery room, where she presented a partial motor seizure on the left side with secondary generalization and urine emission. A caesarean section was performed without fetal or maternal complications. The urgent MRI gadolinium-enhanced brain scan revealed a 39/50/54 mm tumoral mass having an aspect of an anterior third falx cerebri meningioma. The patient was transferred to our neurosurgical department and afterwards surgery was performed with gross total removal of the tumoral mass. Histological examination revealed atypical meningioma with direct invasion into the adjacent brain parenchyma. A week later she was discharged from the hospital in good condition. One month after surgery, a contrast-enhanced magnetic resonance imaging of the brain did not reveal any signs of tumor recurrence or residual tumor. Our recommendation is for postpartum surgery when is possible. Urgent neurosurgical interventions should be made in case of patients with malignant tumors, active hydrocephalus or benign intracranial tumor such as meningioma associated with signs of impending herniation, progressive neurological deficits

Inflammatory Bowel Diseases: the Surgical Perspective

Inflammatory bowel diseases (IBD), namely Crohn’s disease and ulcerative colitis, are relatively rare diseases in our country, known as a low prevalence geographic region. IBD are a multidisciplinary problem, that implies gastroenterologists, as well as surgeons. Surgical management in inflammatory bowel disease is often impaired by a high complication rate and a significant recurrence rate, specific mostly for Crohn’s disease. Indications for surgery include failure of medical therapy (including delayed puberty for young patients and drug intolerance), toxic megacolon, bowel perforation, obstruction, enteric fistula and abdominal or perianal abscess. Advances in medical treatment options for IBD are continuously accumulating. However, a large number of patients still require surgical procedures during lifetime

Postoperative pain management in the enhanced recovery after surgery (ERAS) for emergency laparoscopic cholecystectomy

Introduction. Enhanced recovery after surgery (ERAS) is a new patient-centered concept that aims to deliver high-quality perioperative care to surgical patients. This study was performed to compare the effectiveness of the pain management measures in an ERAS-protocol versus the traditional approach of postoperative pain. Materials and Methods. A comparative prospective study was performed on 50 patients admitted in the Fourth General Surgery of University Emergency Hospital of Bucharest between 2022 and 2024, with the diagnosis of acute cholecystitis, undergoing emergency laparoscopic cholecystectomy. The patients were randomly assigned into two study groups, an ERAS-group and a Traditional group, according to the type of perioperative care applied. The evaluated outcomes were length-of-stay; preoperative anxiety level, leukocyte count at admission and 24 hours postoperatively, postoperative pain levels quantified using Visual Analog Scale 24 hours after surgery and postoperative nausea and vomiting events. Results. The two study subgroups were comparable in terms of demographic and clinical preoperative characteristics. Statistical analysis showed significant lower values of preoperative anxiety level in ERAS group (p\u3c0.001), lower levels of postoperative pain (VAS 2.96±0.75 vs 4.65±1.69, p\u3c0.001) and earlier resumption of the intestinal transit. However, there were no differences in the total hospital stay between the traditional and ERAS groups. Conclusions. Implementing ERAS protocol for emergency laparoscopic cholecystectomy improve postoperative functional outcome and the patients’ quality of care

Sustainability of Business Models in Case of BSE Listed Firms

The depletion of natural resources and increased pollution represent an important problem that can greatly influence both the well-being of society and the security of its future. In this context, the concept of long-term and sustainable development is given even greater importance, through regulations that include in their scope more and more companies in which to implement and develop sustainable business models. The objective of this research is to illustrate the current practice regarding sustainability reporting, from the perspective of the most frequently approached themes regarding sustainable corporate growth. In the second plan, it is desired to outline an overview of the set of key words representative for the description of the sustainability aspects presented by the analyzed companies, which will thus contribute to increasing the degree of understanding of the concept, from the perspective of the many fundamental aspects captured. The analysis undertaken in the study is carried out at the level of a sample of companies listed on the Bucharest Stock Exchange (BSE) that are part of the BSE-NG index, specific to the energy and utilities sector. The basis of the research consists of 32 sustainability reports, analyzed between 2016-2022. The results of the undertaken study highlight the need for a more coherent and robust framework of non-financial reporting because in the analyzed reports a variety of topics are addressed, but presented unclearly, without making an exact delimitation between the main topics covered, considering the low level of the exclusivity indicator. The main reason is the way the content of the reports is structured, which addresses common issues in sections designed to approach specific topics. Also, the results highlight the fact that sustainability reports focus most of the time on the environmental aspects of the sustainable growth model, followed by the aspects regarding the alignment with the trends related to the innovative development, through the development and implementation of innovative solutions regarding the supply chain management

The Link between Board Structure, Audit, and Performance for Corporate Sustainability

The economic and social transformations, the bankruptcies recorded, and the financial crisis affecting all economies have increased the interest for the corporate governance concept. Our intention in this paper was to study the impact of corporate governance attributes on performance given the information published by the entities listed on five stock exchanges from Europe, namely the main market from Bucharest Stock Exchange (BSE) in Romania, the Athens Stock Exchange(ATHEX) main market in Greece, Financial Times Stock Exchange 100 Index (FTSE 100) from Great Britain, Spanish Stock Exchange 35 Index (IBEX 35) from Spain, and Warsaw Stock Exchange 20 Index (WIG 20) from Poland, between 2016–2018. Through mathematical modeling and multiple linear regression, we aimed to determine the extent to which corporate governance characteristics, firm characteristics, industry and stock market fixed effects, and random effects influence the performance of 226 entities included in our sample. The empirical findings revealed that CEO duality, the number of non-executive directors and women on board, audit committee, and audit opinion influenced performance measured by the Return on Assets (ROA) and Return on Equity (ROE) indicators. The ideas highlighted and the results obtained in this research contribute to the literature that analyzes the extent to which an effective governance determines the increase in performance, needed for a sustainable development

Contributions to Power Grid System Analysis Based on Clustering Techniques

The topic addressed in this article is part of the current concerns of modernizing power systems by promoting and implementing the concept of smart grid(s). The concepts of smart metering, a smart home, and an electric car are developing simultaneously with the idea of a smart city by developing high-performance electrical equipment and systems, telecommunications technologies, and computing and infrastructure based on artificial intelligence algorithms. The article presents contributions regarding the modeling of consumer classification and load profiling in electrical power networks and the efficiency of clustering techniques in their profiling as well as the simulation of the load of medium-voltage/low-voltage network distribution transformers to electricity meters

SURGICAL THERAPIES FOR IATROGENIC BILE DUCT LESIONS (IBDL) – REVIEW

The article is a review of the surgical therapies for iatrogenic bile duct lesions (IBDL). The history of the bile duct surgical procedures starts in 1882, when the first cholecystectomy is performed. There are several classifications of the IBDLs such as Bismuth, Wood et al., McMahon et al., Strasberg et al., Bergman et al., Bismuth and Majno, Stewart-Way, Hannover and Mattox. The choice of the proper surgical treatment of IBDLs depends of their type and the review describes the end-to-end repair, hepaticojejunostomy, hepaticojejunostomy without sutures, mucosal graft (Rodney Smith technique), hepaticoduodenostomy, Heineke-Mikulicz plastic repair of stricture, right and left duct hepaticojejunostomy, construction of hepatic duct bifurcation when bifurcation has been destroyed, intrahepatic cholangiojejunostomy, ligamentum teres (round ligament) approach to the left hepatic duct and Longmire procedure. Even the surgical treatment of IBDLs is in continuous development and research, their best prevention is the proper training of the biliary surgeons in the performance of safe cholecystectomies or any other abdominal surgeries, complex gastrotomies, pancreatic operations, endoscopic biliary tract investigations etc

Acute ischemic cholecystitis in Takayasu’s syndrome – a rare finding

Introduction. Takayasu’s arteritis or pulseless disease is a systemic inflammatory disease of an unknown etiology, affecting medium and large arteries and their branches, leading to stenosis, occlusions, or aneurysmal degeneration. It is more frequent in young Asian women. Case presentation. We present a rare case of Takayasu’s disease in a young woman, who initially developed an acute ischemic cholecystitis. Ischemia is one of the mechanisms involved in the pathogenesis of acute acalculous cholecystitis. As this mechanism is most often involved in elderly people, such an uncommon finding at young age should be a reason to suspect a vasculitis with small vessel occlusion. Conclusions. Acute cholecystitis in this patient was the first onset sign of Takayasu’s arteritis. An acute acalculous cholecystitis at young age could be of ischemic origin and should also be considered as a possible epiphenomenon of a generalized vasculitis disease