Iulian Slavu

Background/Objectives: The genital tubercle develops in the fourth week from mesenchymal cells in the lateral edges of the embryo. In females the genital tubercle develops into the clitoris while in males it participates in forming the penis. The aim of this study was to perform a macroscopic as well as an ultrasonographic assessment of the genital tubercle and its gender-dependent derivates, presenting a parallel comparative evaluation between the two. Methods: We performed a morphological assessment of the genital tubercle through micro-dissection of 141 embryos and fetuses with gestational ages between 5 and 14 weeks, in the Department of Anatomy of “Carol Davila” University of Medicine and Pharmacy. An ultrasound imaging study of the genital tubercle using 3-dimensional ultrasonography (3DUS) was also performed in the Department of Obstetrics and Gynecology of University Emergency Hospital of Bucharest. The morphology of the genital tubercle was analyzed by ultrasound scanning of 119 embryos and fetuses with gestational ages between 5 and 14 weeks. The age of all the embryos was determined by measuring the crown–rump length. Results: The dimensions and especially the direction of the genital tubercle were evaluated and compared in order to establish whether sex determination is possible as early as 7–8 weeks of gestation. The genital tubercle orientates cranially in males and caudally in females as early as 6 weeks of gestation, during the bi-potential phase. Conclusions: The orientation of the genital tubercle plays an essential role in establishing the sex of the fetus, regardless of its size.

Background: The foramen of Arnold (FA) and foramen of Vesalius (FV) are two inconstant small openings through the greater wing of the sphenoid bone. When FA is present, the lesser petrosal nerve passes through it. FV usually contains an emissary vein that connects the cavernous sinus to the pterygoid plexus. Objectives: To assess the presence, unilaterally or bilaterally, of the aforementioned inconstant foramina in order to gain a better insight into the anatomic variability of the middle cranial fossa. Methods: We analyzed five hundred random unenhanced CT examinations of human dry skulls from the “Francisc I. Rainer” Craniological Collection of the Human Anthropological Institute in Bucharest, Romania. The collection holds substantial anthropological and radiological value, as dry skulls allow the use of higher spatial-resolution imaging parameters and thus better detection of the small osseous structures. All scans were performed on the same Multi-Detector Computed Tomography (MDCT) scanner (Canon Aquilion One 64 slice, Canon Medical Systems Corporation) in the Department of Radiology of the Bucharest Emergency University Hospital. After collecting data, appropriate statistical analysis was performed. Results: FA was absent in 355 (71%) skulls and present in 145 (29%) skulls, bilaterally in 33 (6.6%) skulls, and unilaterally in 112 (22.4%) skulls. FV was absent in 151 (30.2%) skulls and present in 349 (69.8%) skulls, bilaterally in 223 (44.6%) skulls, and unilaterally in 126 (25.2%) skulls. Conclusions: The great variability in the prevalence of these foramina may be partly explained by the different methods of analysis of the skull base, as well as the different population subgroups on which the research has been focused. Knowledge of this variability holds great importance for anatomists, anthropologists, as well as clinicians who interact with this complex area.

Background: First described by Carl Toldt in the late 19th century, the mesorectum has since been a topic of anatomical and surgical debate. Its clinical importance was redefined by Heald’s introduction of Total Mesorectal Excision (TME), nowadays the golden standard in oncologic rectal surgery. This study aims to elucidate the embryological development and adult anatomy of the mesorectum and the mesorectal fascia, with a focus on clinically significant relations, particularly the peritoneum, and components of the hypogastric plexuses. Methods: We performed anatomical dissections on four 12–15-week-old human fetuses and eight formalin-fixed adult cadavers. In addition, a transverse pelvic section was examined to assess the spatial organization of mesorectal and fascial structures. Results: Our findings confirm the presence of a dorsal mesentery at the rectal level during fetal development, illustrating its transformation into the adult mesorectum. We identified the mesorectal contents in the fetus and examined the course and relations of the superior rectal vessels, hypogastric nerves, and pelvic splanchnic nerves, in both fetal and adult specimens. Conclusions: The observed fetal and adult configurations provide a continuous morphological description of the mesorectum and its compartmental organization within the pelvis. This study enhances the understanding of the mesorectum’s embryology, structure, and vital surgical landmarks. By delineating the so-called ‘Holy plane’ of Heald (the natural avascular plane between the mesorectal and presacral fasciae used during total mesorectal excision) and the delicate connective fibers known surgically as ‘angel’s hair’, which become visible when this plane is correctly entered, rectal and presacral fasciae, and neurovascular elements, provides a comprehensive anatomical framework that may inform surgical plane identification and support future clinical investigations into nerve-sparing rectal surgery.

Background and Objectives: Hospital length of stay (LOS) after breast cancer surgery is a key indicator of postoperative recovery, healthcare quality, and hospital resource utilization. Traditional statistical approaches have identified general correlates of LOS but remain limited in predictive accuracy, particularly in heterogeneous real-world surgical populations. Machine learning (ML) models may offer improved performance by capturing nonlinear interactions among clinical, pathological, and operative factors. This study aimed to evaluate ML algorithms for LOS prediction and to identify determinants of prolonged hospitalization in a contemporary breast cancer cohort. Materials and Methods: We conducted a retrospective cross-sectional study of 198 consecutive breast cancer patients who underwent surgery between January 2022 and December 2023 at a single tertiary care center. Clinical, pathological, and surgical data were extracted from electronic medical records. Three regression models—multiple linear regression, Random Forest, and Gradient Boosting—were trained to predict continuous LOS, and three classification models were applied to prolonged LOS (≥10 days). Model performance was assessed using mean absolute error (MAE), root mean square error (RMSE), coefficient of determination (R²), and area under the curve (AUC). Feature importance was analyzed for the best-performing model. Results: The median LOS was 7 days (IQR 5–10), ranging from 1 to 26 days. Breast-conserving surgery showed the shortest LOS (median 3 days), while mastectomy with immediate reconstruction resulted in the longest stays (median 8 days). Random Forest regression achieved the lowest prediction error (MAE 2.31 days; RMSE 2.82; R² = 0.37), outperforming Gradient Boosting and substantially surpassing linear regression (MAE 8.63 days; R² = –8.17). Key predictors included age, surgical complexity, reconstruction modality, BMI, implant capacity, and tumor burden. Classification models yielded modest AUCs (0.545–0.589) with low sensitivity, indicating limited discriminative performance for dichotomized LOS outcomes. Conclusions: Machine-learning models, particularly Random Forest, substantially improve LOS prediction compared with classical regression and provide clinically meaningful insights into the drivers of hospitalization after breast cancer surgery. Continuous LOS modeling is more informative than binary thresholds. These findings support integrating ML-based tools into perioperative planning, resource allocation, and patient counseling in breast surgical care.

Background/Objectives: Tumor biology—particularly HER2 expression, Ki-67 proliferation index, and triple-negative phenotype—has traditionally influenced the timing of breast reconstruction after mastectomy. However, real-world data from Eastern Europe remain limited, and variability in access and clinical practice persists. This study aimed to determine whether tumor biology independently predicts the likelihood of immediate breast reconstruction (IBR) in a multidisciplinary tertiary center. Methods: We performed a retrospective cross-sectional analysis of 208 consecutive patients who underwent mastectomy with or without IBR between January 2023 and January 2024. Associations between tumor biology (HER2 status, Ki-67 index, and triple-negative subtype) and IBR were examined using χ² tests, independent samples t-tests, and multivariate logistic regression adjusting for age, BMI, smoking status, comorbidities, neoadjuvant chemotherapy, pathological tumor size (pT), nodal stage (pN), and surgery type. Statistical significance was set at p < 0.05. Results: IBR was performed in 41.4% of HER2-positive and 41.2% of HER2-negative patients (p = 1.00). Reconstruction rates across Ki-67 quartiles (≤10%, 11–20%, 21–40%, ≥41%) were 50.0%, 37.5%, 34.4%, and 37.5%, respectively (p = 0.58). Triple-negative status was not associated with IBR in multivariate analysis (OR = 0.44, 95% CI 0.08–2.18, p = 0.32). Significant predictors of IBR included younger age (OR = 0.87, 95% CI 0.80–0.93, p < 0.001) and less extensive surgery (OR = 0.23, 95% CI 0.09–0.59, p = 0.002). The mean interval to adjuvant therapy was comparable between IBR (28.7 ± 6.2 days) and non-IBR (27.9 ± 5.8 days) groups (p = 0.34), indicating that reconstruction did not delay systemic treatment. Conclusions: In this real-world Romanian cohort, tumor biology did not significantly influence immediate reconstruction decisions. Age and surgical extent were the main determinants of IBR, suggesting that reconstructive access was guided more by clinical than molecular factors. These findings support the shift toward multidisciplinary, biology-informed, and patient-centered surgical decision-making, in line with current ESMO and NCCN recommendations. Despite limitations—including the retrospective design, single-center setting, incomplete BRCA data, and absence of long-term oncologic outcomes—the study provides novel regional perioperative evidence supporting safe and equitable access to immediate reconstruction across biologic subtypes.

Background: Laparoscopic surgical procedures are increasingly adopted for colorectal cancer because of their advantages in perioperative outcomes. However, their implementation in medium-volume centers (p < 0.05). Patients with significant cardiopulmonary disease or prior abdominal surgery were more often directed to open surgery, introducing selection bias that may explain differences in lymph node yield and hospital stay independent of surgical technique. The resection margin distance was significantly greater in laparoscopic cases (5.68 ± 3.12 mm) than in open procedures (4.76 ± 4.47 mm, p < 0.01). Hospital stay was significantly shorter in the laparoscopic group (7.14 ± 2.32 days) compared to the open group (13.17 ± 6.76 days, p < 0.001). A statistically significant difference in tumor staging was also observed between surgical approaches (p < 0.01), with earlier-stage tumors more likely treated laparoscopically. Conclusions: In a medium-volume center, laparoscopic surgical procedures provided comparable oncologic outcomes and superior perioperative benefits relative to open surgery, despite being more frequently performed for early-stage tumors. These findings support the safe adoption of laparoscopic colectomy outside high-volume academic settings, provided appropriate case selection and technical standards are maintained.

Background: Multinodular goiter (MNG) is a common thyroid condition characterized by multiple nodules within the thyroid gland. This study aims to evaluate the incidence and clinical features of occult thyroid carcinoma in patients with multinodular goiter, based on the experience from a medium-volume cancer center. Methods: A retrospective analysis was conducted on patients diagnosed with multinodular goiter who underwent thyroidectomy. Clinical, radiological, and histopathological data were reviewed to identify cases of occult thyroid carcinoma. Factors such as age, sex, and histopathological characteristics were analyzed to determine potential risk factors for malignancy in this cohort. Results: A total of 332 patients with MNG were included in the study, with 61 (17.5%) diagnosed with occult thyroid carcinoma. The incidence of occult carcinoma was more frequent in females, with a notable predilection for papillary carcinoma. Regarding age, occult tumors were more frequently encountered in the 20–40 age group, irrespective of gender. Conclusions: In conclusion, we observed that in our center over a 6-year period, the incidence of thyroid cancer after total thyroidectomy for multinodular goiter sits at 17.5%. Thyroid diseases are more frequent in women, which in turn leads to an increased rate of occult carcinomas. Up to 70% of the cancers were papillary. The clinical risk factors associated with a higher probability of cancer were lower age and female gender.

The development of the optic nerve and its surrounding tissues during the early fetal period is a convoluted period because it spans both the organogenesis period and the fetal period. This study details the microscopic anatomy and histoembryology of the optic nerve in embryos during the early fetal period, including the second half of the first trimester of pregnancy. Serial sections through the orbit of variously aged embryos allowed us to analyze the nerve in both longitudinal and transverse aspects. A histological assessment and description of the structures surrounding and inside the nerve were performed, highlighting the cellular subtypes involved. By employing immunohistochemical techniques, we could characterize the presence and distribution of astrocytes within the optic nerve. Our findings suggest that by the 8th gestational week (WG) the structures are homologs to all the adult ones but with an early appearance so that maturation processes take place afterward. By this age, the axons forming the nerve are definitive adult axons. The glial cells do not yet exhibit adult phenotype, but their aspect becomes adult toward the 13th week. During its development the optic nerve increases in size then, at 14 weeks, it shrinks considerably, possibly through its neural maturation process. The morphological primordium of the blood–nerve barrier can be first noted at 10 WG and at 13 WG the morphological blood–nerve barrier is definitive. The meningeal primordium can be first noted as a layer of agglomerated fibroblasts, later toward 13 WG splitting in pachymeninx and leptomeninges and leaving space for intrinsic blood vessels.

Cardiovascular magnetic resonance (CMR) is the central non-invasive imaging investigation for the evaluation of myocardial disease. It is the well-established gold standard for measuring cardiac chamber volumes, systolic function, and left ventricular mass, and it brings unique information for therapeutic decisions. In addition, its tissue characterization capability, through T1, T2, and T2* mapping, as well as early and late gadolinium enhancement (LGE) sequences, allows to differentiate in many cases among ischemic, inflammatory, and infiltrative heart disease and permits the quantification of myocardial fibrosis, providing valuable diagnostic and prognostic information. This review aims to highlight the main CMR features of different cardiomyopathies.