Cristian Dumitru Lupascu

Hiatal hernia is a complex pathology, associated with gastroesophageal reflux disease, and for which management involves complex surgical treatment. Knowing the role of gastropexy in reducing postoperative recurrences, the current study aimed to highlight the intraoperative advantages and results of this surgical technique. Our study includes 29 patients aged between 34 and 84 years. Regarding the mechanism of occurrence, two thirds of the patients presented with mixed hiatal hernias (65.52%), 31.03% with sliding hiatal hernias, and 3.45% with paraesophageal hiatal hernias. The hernia size played a decisive role in the choice of surgical procedure, whereby for large hernias (with a diameter of over 7 cm), the Nissen procedure associated with gastropexy was preferred. For hernias with a diameter of less than 7 cm, the Nissen procedure associated with hernia orifice repair was performed. For hernias between 5 and 6 cm, gastropexy was also performed. Statistical analysis revealed a close correlation between the surgical procedure and the hernia size, with p = 0.005. Out of a total of 29 patients, 18 patients had gastropexy and 11 were without gastropexy. The association of gastropexy does not increase hospitalization costs, but in the long term, it has the advantage of reducing relapse.

Introduction and importance: We present a unique case of a vesicocolic fistula (VCF) that occurred postoperatively after ovarian cyst surgery, caused by the migration of an intraoperatively forgotten gauze into the urinary bladder. This represents a very rare etiology of VCFs. Case presentation: A patient who had undergone surgery for a giant left ovarian cyst 5 months prior presented with recurrent urinary tract infections and an ultrasound image suggestive of a bladder stone. Cystoscopy, contrast-enhanced computed tomography, and colonoscopy confirmed a VCF with an intravesical foreign body. Surgical management consisted of fistula excision, removal of the gauze, bladder repair, and definitive colostomy. Postoperative evolution was favorable, and the patient remained infection-free at 1 year. Clinical discussion: VCFs are most frequently associated with diverticular disease, whereas iatrogenic causes – particularly due to retained surgical gauze – are extremely rare. This case highlights the diagnostic difficulty when symptoms mimic more common conditions such as recurrent urinary tract infections or bladder stones. Early suspicion of a fistula is crucial in patients with persistent urinary symptoms after pelvic surgery. Management depends on patient factors, comorbidities, and fistula etiology; in this case, advanced age warranted a conservative two-stage approach with a permanent colostomy. Conclusion: In patients with recurrent urinary infections after pelvic surgery and imaging suggestive of bladder stones, clinicians should consider VCF due to migrated foreign bodies in the differential diagnosis.

Hiatal hernia is a complex pathology, associated with gastroesophageal reflux disease, and whose management involves complex surgical treatment. Knowing the role of gastropexy in reducing postoperative recurrences, the current study aimed to highlight the intraoperative advantages and results of this surgical technique. Our study includes 29 patients, aged between 34 to 84 years. Regarding the mechanism of occurrence, two thirds of the patients presented with mixed hiatal hernias, 31.03% with sliding hiatal hernias and 3.45% with paraesophageal hiatal hernias. The hernia size played a decisive role in the choice of surgical procedure, for large hernias (with a diameter of over 7 cm) the Nissen procedure associated with gastropexy was preferred.For hernias with a diameter of less than 7 cm, the Nissen procedure associated with hernia orifice repair was performed. For hernias between 5 and 6 cm, gastropexy was also performed. The association of gastropexy does not increase hospitalization costs, but in the long term it has the advantage of reducing relapse.

Background: The structural integrity of the abdominal wall is critically dependent on the organization of aponeurotic tissue, a dense collagen-rich connective structure responsible for directional force transmission. While the clinical relevance of the aponeurosis is well recognized in abdominal wall reconstruction, its nano-scale structural organization remains insufficiently characterized. Atomic force microscopy (AFM) provides a suitable approach for investigating surface morphology and nano-architectural features of biological tissues. Methods: Human aponeurotic tissue samples were analyzed using atomic force microscopy operated in contact-mode deflection and topography imaging. Two-dimensional and three-dimensional surface topographies were acquired at the micrometer scale to assess nano-architectural organization. Areal surface roughness parameters (Sa, Sq, Sp, Sv, Sy) were calculated to quantify morphological heterogeneity. AFM deflection imaging was used to evaluate relative spatial variations in deflection imaging contrast under the applied scanning conditions across collagen-dense and interfibrillar regions. Results: AFM analysis revealed a well-organized fibrillar architecture with preferential orientation, consistent with the anisotropic organization of aponeurotic connective tissue. Deflection images demonstrated spatial heterogeneity in deflection contrast at the scanned scale, reflecting variations in the tip–sample interaction signal between collagen-dense and interfibrillar regions. Surface topography showed a continuous morphology with moderate height variations and smooth transitions between structural elements. Roughness parameters reflected a compact extracellular matrix organization within the scanned areas, without features suggestive of surface disruption. Conclusions: Atomic force microscopy enables detailed nano-scale structural characterization of human aponeurotic tissue and reveals spatial heterogeneity in deflection imaging contrast under specific contact-mode scanning conditions. These findings provide a baseline nano-scale descriptive reference dataset for macroscopically normal aponeurotic tissue, supporting future comparative investigations without implying validated mechanical differences or direct tissue–implant interaction analysis within the present study.

Background The structural integrity of the abdominal wall is critically dependent on the organization of aponeurotic tissue, a dense collagen-rich connective structure responsible for directional force transmission. While the clinical relevance of the aponeurosis is well recognized in abdominal wall reconstruction, its nano-scale structural organization remains insufficiently characterized. Atomic force microscopy (AFM) provides a suitable approach for investigating surface morphology and nano-architectural features of biological tissues. Methods Human aponeurotic tissue samples were analyzed using atomic force microscopy operated in contact-mode deflection and topography imaging. Two-dimensional and three-dimensional surface topographies were acquired at the micrometer scale to assess nano-architectural organization. Areal surface roughness parameters (Sa, Sq, Sp, Sv, Sy) were calculated to quantify morphological heterogeneity. AFM deflection imaging was used to evaluate relative spatial variations in the tip–sample interaction signal (deflection contrast) across collagen-dense and interfibrillar regions. Results AFM analysis revealed a well-organized fibrillar architecture with preferential orientation, consistent with the anisotropic organization of aponeurotic connective tissue. Deflection images demonstrated spatial variations in the tip–sample interaction signal across collagen-dense and interfibrillar regions, indicating heterogeneity at the scanned scale. Surface topography showed a continuous morphology with moderate height variations and smooth transitions between structural elements. Roughness parameters reflected a compact extracellular matrix organization within the scanned areas, without features suggestive of surface disruption. Conclusions Atomic force microscopy enables detailed nano-scale structural characterization of human aponeurotic tissue and reveals spatial heterogeneity in deflection/interaction contrast at the scanned scale. These findings provide a nano-scale reference framework for future comparative investigations involving synthetic meshes and may contribute to a more refined understanding of tissue–implant interactions in abdominal wall reconstruction.

Background: Hepatocellular carcinoma (HCC) is a prevalent malignancy with high mortality, often arising in the context of chronic liver diseases. Heme oxygenase-1 (HO-1), an inducible enzyme involved in heme degradation, has been implicated in both hepatoprotection and tumor progression. This study evaluates the expression of HO-1 in HCC and its association with clinicopathological features and patient survival. Materials and Methods: We retrospectively analyzed 58 HCC cases diagnosed between 2018 and 2023 at “Sf. Spiridon” Emergency County Hospital, Iasi. HO-1 expression was assessed immunohistochemically and quantified using a semi-quantitative immunoreactivity score (IRS). Statistical correlations between HO-1 expression and clinical, pathological, and survival parameters were evaluated using univariate analysis, ROC curves, and Kaplan–Meier survival models. Results: High HO-1 expression (IRS > 1) was significantly associated with hepatitis C virus etiology (p = 0.004, V = 0.381), vascular invasion (p = 0.019, V = 0.309) and perioperative anticoagulant therapy (p = 0.007, V = 0.352). However, HO-1 expression did not correlate with overall survival (OS). In contrast, solid growth pattern (p = 0.030) and serum α-fetoprotein levels of 10–99 ng/mL (p = 0.022) were negatively associated with OS. Conclusions: HO-1 expression in HCC was found to be associated with vascular invasion, but not with overall survival. While this may indicate a potential link to certain aggressive tumor features, the overall role of HO-1 in HCC biology remains unclear. These findings suggest that HO-1 should be considered an exploratory rather than definitive prognostic marker, and further research is warranted to clarify its function and potential utility, including investigation of its detectability in biological fluids for non-invasive monitoring.

Background: Neuroendocrine tumors are tumors that can develop in any organ but show a predilection for the pancreas. These can be secreting or non-secreting tumors, or they can be well differentiated or poorly differentiated, or neuroendocrine carcinomas. Surgical treatment is the only treatment with curative intent, but postoperatively, it shows an increased incidence of postoperative pancreatic fistulas. Methods: We carried out a retrospective study which included 26 patients with neuroendocrine tumors and neuroendocrine carcinomas, for whom we performed cephalic duodenopancreatectomies, distal pancreatic resections or enucleation. Results: In our study group, the incidence of pancreatic fistulas was 28%, and a series of risk factors such as the type of surgery (duodenopancreatectomy and enucleation were associated with the highest incidence of POPF), histological type (pancreatic neuroendocrine carcinomas were associated with lowest incidence of POPF), obesity (the incidence of POPF was double in the obese group), functioning tumors (with p = 0.032 and AUC = 746) and dynamic hemoglobin value (AUC = 705 shows a good predicting power, with a cutoff value = 1.8 drop hemoglobin) were indicated. Conclusions: Neuroendocrine tumors show a predisposition for the occurrence of postoperative complications, especially postoperative pancreatic fistulas. There are multiple risk factors that interact in the production of postoperative complications.

Neuroendocrine tumors are tumors that can develop in any organ but show a predilection for the pancreas. These can be secreting or non-secreting tumors, they can be well differentiated or poorly differentiated, or neuroendocrine carcinomas. Surgical treatment is the only treatment with curative intent, but postoperatively it shows an increased incidence of postoperative pancreatic fistulas. We carried out a retrospective study, which included 26 patients with neuroendocrine tumors and neuroendocrine carcinomas, for whom we performed cephalic duodenopancreatectomies, distal pancreatectomies or enucleation. In our study group, the incidence of pancreatic fistula was 28%, and a series of risk factors such as the type of surgery, histological type, obesity and dynamic hemoglobin value was indicated.

This case report underscores the importance of utilizing E-VAC (endoscopic vacuum-assisted closure) in the treatment of a perforated duodenal ulcer complicated by the formation of a subphrenic abscess and septic shock. It showcases how E-VAC can effectively mitigate the risk of further complications, such as leakage, bleeding, or rupture, which are more commonly associated with traditional methods like stents, clips, or sutures. As a result, there is a significant reduction in mortality rates. A perforated duodenal ulcer accompanied by abscess formation represents a critical medical condition that demands prompt surgical intervention. The choice of the method for abscess drainage and perforation closure plays a pivotal role in determining the patient’s chances of survival. Notably, in patients with a high ASA (American Association of Anesthesiologists) score of IV-V, the mortality rate following conventional surgical intervention is considerably elevated. The management of perforated duodenal ulcers has evolved from open abdominal surgical procedures, which were associated with high mortality rates and risk of suture repair leakage, to minimally invasive techniques like laparoscopy and ingestible robots. Previously, complications arising from peptic ulcers, such as perforations, leaks, and fistulas, were primarily addressed through surgical and conservative treatments. However, over the past two decades, the medical community has shifted towards employing endoscopic closure techniques, including stents, clips, and E-VAC. E-VAC, in particular, has shown promising outcomes by promoting rapid and consistent healing. This case report presents the clinical scenario of a patient diagnosed with septic shock due to a perforated duodenal ulcer with abscess formation. Following an exploratory laparotomy that confirmed the presence of a subphrenic abscess, three drainage tubes were utilized to evacuate it. Subsequently, E-VAC therapy was initiated, with the kit being replaced three times during the recovery period. The patient exhibited favorable progress, including weight gain, and was ultimately discharged as fully recovered. In the treatment of patients with duodenal perforated ulcers and associated abscess formation, the successful and comprehensive drainage of the abscess, coupled with the closure of the perforation, emerges as a pivotal factor influencing the patient’s healing process. The positive outcomes observed in these patients underscore the efficacy of employing a negative pressure E-VAC kit, resulting in thorough drainage, rapid patient recovery, and low mortality rates.

Splenic cysts are rare benign lesions of the spleen, often asymptomatic and incidentally discovered during imaging studies. While many splenic cysts remain asymptomatic and do not require intervention, surgical management becomes essential in cases of symptomatic cysts, large cysts, or when malignancy cannot be ruled out. Laparoscopic surgery has emerged as a minimally invasive and effective approach for treating splenic cysts, offering advantages such as shorter hospital stays, reduced postoperative pain, and faster recovery. In this case report, we describe our experience with laparoscopic surgery for a symptomatic splenic cyst in a young patient.