Retroperitoneal liposarcoma: unveiling diagnostic delays and multimodal treatment dilemmas.

Liposarcomas are a prevalent subtype of soft tissue sarcomas, constituting less than 1% of all malignancies. Originating in the adipose tissue, they can manifest in various locations and are categorized by the World Health Organization into several subtypes: well-differentiated liposarcomas, dedifferentiated liposarcomas, myxoid liposarcomas, pleomorphic liposarcomas and mixed-type liposarcomas. These tumors typically affect middle-aged and older individuals, and their incidence has been progressively increasing over the years. As liposarcomas advance they tend to encase blood vessels and major organs, particularly in the retroperitoneal area. Often asymptomatic initially, symptoms arise as the tumor reaches a considerable size, exerting pressure on adjacent tissues and organs. This report features a 54-year-old patient incidentally diagnosed with a substantial retroperitoneal tumor extending to the antero-lateral abdominal wall and inner thigh via the right inguinal ligament. The patient, with a previous three-year history of a right inguinal mass, sought acute care for a perianal abscess The histological examination revealed morphological aspects consistent with a low-grade myxoid liposarcoma. While surgery remains the primary treatment for retroperitoneal liposarcomas, controversies exist regarding the role of radiotherapy and chemotherapy in improving survival rates. This case highlights the challenges in managing retroperitoneal tumors and underscores the importance of a personalized, multidisciplinary approach to optimize patient outcomes.

Unraveling the Efficacy of Therapeutic Interventions for Short Cervix: Insights from a Retrospective Study for Improved Clinical Management.

Background and Objectives: Preterm birth (PTB) is associated with important neonatal mortality and morbidity. The aim of this study was to retrospectively evaluate the average treatment effects on the treated and the efficacity of various therapeutic interventions for PTB in a cohort of patients with singleton pregnancies and short cervical lengths. Materials and Methods: This observational retrospective study included 1146 singleton pregnancies at risk of PTB that were segregated into the following groups: intravaginal progesterone (group 1), Arabin pessary (group 2), McDonald cerclage (group 3), intravaginal progesterone and Arabin pessary (group 4), and intravaginal progesterone and cerclage (group 5). Their treatment effects were evaluated and compared. Results: All evaluated therapeutic interventions significantly reduced the occurrence of late and early preterm births. The risk of late and early PTB was lowered for those pregnant patients who received progesterone and pessaries or progesterone and cerclage in comparison with those who received only progesterone. The extremely PTB risk of occurrence was significantly lowered only by the administration of progesterone in association with cervical cerclage in comparison with progesterone monotherapy. Conclusions: The combined therapeutic interventions had the highest efficacy in preventing preterm birth. An individualized evaluation is needed to establish the best therapeutic approach in particular cases.

VENOUS ULCER--A NEW THERAPEUTIC APPROACH.

Trophic leg ulcer is a major health problem affecting approximately 1-2% of the population, the incidence being higher in the elderly (70-80 years). It is a multifactorial condition, but the most common cause is chronic venous insufficiency. This can be attributed to reflux in the saphenous system and calf perforator vein incompetence. These were first described by Linton, the first intervention designed to correct perforator vein incompetence bearing his name. Today Linton's operation has been abandoned due to the large unaesthetic incision and great postoperative pain. Also, ulcer healing time is long (2 months) and recurrence rate is high. Currently a series of minimally invasive procedures are used to close these perforator veins, such as ultrasound-guided sclerotherapy. The advantages of these techniques are less discomfort to the patients, low rate of complications, short hospital stay.

SURGICAL TREATMENT OF POSTPARTUM ILIOFEMORAL DEEP VEIN THROMBOSIS--CASE REPORTS.

The writing committee for Antithrombotic Therapy for Venous Thromboembolic Disease of the 2008 ACCP guidelines made the following recommendations for thrombus removal strategies in patients with deep vein thrombosis (DVT): open surgical thrombectomy is recommended in patients with acute iliofemoral DVT to reduce symptoms and post-thrombotic morbidity; whenever available, catheter-directed thrombolysis is preferred to surgical venous thrombectomy, the risk of hemorrhage being diminished; surgical venous thrombectomy is recognized to be efficient in cases where catheter-directed thrombolysis is unavailable or the patients are not suitable candidates for such a procedure. Randomized studies comparing surgical thrombectomy and anticoagulant therapy in patients with iliofemoral DVT (IFDVT) showed that at 6 months, 5 years, and 10 years the patients in the thrombectomy group presented increased permeability, lower venous pressure, less edema, and fewer postthrombotic symptoms compared to the patients receiving anticoagulant therapy. In this article we present 3 cases of IFDVT in postpartum patients diagnosed by Doppler ultrasound of the deep venous system. The 3 patients received anticoagulant therapy prior to surgery. Surgery consisted in thrombectomy of the common, superficial and deep femoral veins, external and internal iliac veins, and femoral-saphenous arteriovenous fistula. The patients received postoperative antithrombotic therapy and were followed-up at 3, 6 and 9 months by Doppler ultrasound of the deep venous system.

Paraganglioma of the carotid body: case report.

With an incidence of 0.03% of all tumors, carotid body tumors (CBTs) are extremely rare. We present the case of a 63 year old female patient with an asymptomatic right sided neck mass of 3 cm diameter. Doppler ultrasound and contrast-enhanced CT confirmed the clinical suspicion of carotid body tumor. The patient underwent complete surgical excision of the Shamblin group II tumor and an adjacent lymph node, without preoperative embolization. The histopathological examination diagnosed a benign CBT. There were no postoperative complications at 1 and 6 months follow-ups.

Complex utrasound study of the atherosclerotic plaque.

UNLABELLED: Carotid surgery concept is wining ground both among neurologists who recommend and vascular surgeons who perform an increased number of interventions. Regardless of the technique, we are interested in the tendency of the plaque to grow and determine stenosis. Ultrasound (US) is 91-94% sensitive and 85-99% specific in detecting a significant stenosis of the internal carotid artery. AIM: To establish a correlation between the preoperative US and intraoperative plaque characteristics in order to determine the restenosis rate. MATERIAL AND METHODS: From January 1, 2012 to December 31, 2012, 70 consecutive patients were included in this study. Two groups were formed: 35 patients with stenotic ICA and 35 patients presenting stenosis at the femoral artery bifurcation (control group). The comparison between these two groups started from the premise of a similar pattern for internal carotid artery--deep femoral artery and external carotid artery- superficial femoral artery. US scans were performed on admission in all patients. All images were normalized and Gray Scale Median (GSM) was calculated. RESULTS: Femoral plaque GSM values were higher in relation with hyperechogenicity highlighting the intensely calcified structure. Unstable plaques were more heterogenic, with higher transparency and lower GSM than stable plaques. This was the case of carotid plaques. During follow-up US revealed no restenosis. CONCLUSIONS: Femoral bifurcation plaques are calcified and determine chronic ischemic symptoms, while carotid bifurcation plaques are unstable and determine cerebral symptoms. US remain the gold standard non-invasive technique both for screening and diagnosis and set the therapeutic coordinates.

Surgical revascularization in chronic mesenteric ischemia.

Chronic mesenteric ischemia (CMI) is a disease causing death either by starvation or enteromesenteric infarction. Diagnosis is often delayed before the patient is referred to a vascular surgery unit. Atherosclerosis is the main cause of CMI. Arteriography is essential in diagnosing CMI and delineating the atherosclerotic lesions. The revascularization procedure consists in an aortomesenteric bypass reconstructing 1-3 visceral arteries. This paper presents two consecutive CMI cases treated at the Vascular Surgery Unit of the Iasi "Sf Spiridon" Hospital during 2010. Both patients had symptoms suggestive of mesenteric and aortoiliac diseases. CT angiography revealed specific lesions both for aortoiliac disease and stenotic or occlusive lesions in the celiac trunk and mesenteric arteries. Both cases benefited from aortobifemural bypass surgery using a synthetic graft associated with aortic-superior mesenteric artery bypass with reversed vein graft (in the first case both mesenteric arteries were revascularized). Immediate and remote results were favorable, with remission of intestinal symptoms and weight gain. Bypass patency was followed-up by CT angiography and Doppler ultrasound. CMI is a diagnostic and therapeutic challenge. Open surgery provides symptom remission in 90% of cases. Permeability at 5 years is 80-90% for open surgery, higher than by endovascular therapy. Average permeability of the two types of intervention is 70% at 5 years, similar to the infraaortic bypasses.