The internal jugular vein (IJV) is of utmost importance during various surgical and endovascular approaches, including central access. It descends through the parapharyngeal space, carotid triangle, and sternocleidomastoid region. The anatomical variables of the IJV are mainly related to its calibre and dominance, number of venous channels (i.e., duplications and fenestrations), and compression sites. Specific compressions of the IJV are not exclusively due to the jugular nutcracker between the styloid process (SP) of the temporal bone and the C1 transverse process, which, in turn, should not be granted the eponym of Eagle. The possible morphologies of the SP and ossified stylohyoid chain are discussed here. Additionally, the digastric and sternocleidomastoid muscles, the hyoid, and the distorted carotid arteries may compress the IJV, thereby raising intracranial pressure. Here, a case is documented with a long inferior petrosal sinus adjacent to the IJV, both compressed into the C1–styloid nutcracker, which is an absolute novelty. Multiple compression sites of the IJV are supported here with original evidence. All anatomical variables of the IJV are relevant, as they may lead to stenoses or interfere with IJV cannulation. In rare cases of IJV agenesis, multiple compression sites on the opposite side may significantly alter bilateral cerebral drainage. Different methods may be used to decompress a stenotic IJV, including styloidectomy. In conclusion, the anatomical variables of the IJV should be acknowledged by practitioners and documented on a case-by-case basis.

Background: Placenta accreta spectrum (PAS) refers to abnormal placental attachment, categorized into placenta accreta, increta, and percreta, with varying severity. The incidence of PAS has risen alongside the increasing rate of caesarean sections. PAS is a significant cause of maternal complications, including bleeding, hysterectomies of necessity and intestinal or urinary surgical complications, and of foetal complications, preterm birth or foetal anaemia. Early diagnosis is crucial for its management and for improving its outcomes. Materials and Methods: This retrospective study, conducted at the County Emergency Clinical Hospital “Saint Andrew the Apostle”, Constanța, analysed cases of placenta praevia and PAS from 2018 to 2022. Data were collected from observation sheets and operative protocols, involving 13,841 patients. Placenta praevia and PAS were diagnosed using ultrasound and MRI and confirmed by histopathology. Results: Among the 13,841 deliveries, 25 cases of placenta praevia (0.82% incidence) and 17 cases of PAS (0.57% incidence) were identified. Ultrasound demonstrated 88% sensitivity, and MRI 94% sensitivity for PAS detection. Of the 17 PAS cases, 11 were diagnosed as placenta accreta, 3 were diagnosed as placenta increta, and 3 as placenta percreta, with all percreta cases involving bladder invasion. Hysterectomy was the standard surgical treatment. Discussion: The risk factors for PAS included previous caesarean sections (94.1% of PAS cases), smoking, and uterine fibroids. The study confirmed the importance of early imaging and the involvement of a multidisciplinary team in managing PAS, particularly in complex cases with bladder involvement. Caesarean section followed by hysterectomy was the preferred surgical approach. Conclusions: Smoking, uterine scars, and uterine fibroids are significant risk factors for placenta praevia with pathological adhesion. Ultrasound and MRI are highly accurate in diagnosing PAS, with histopathology providing definitive confirmation. Multidisciplinary care is essential in managing complex cases, ensuring optimal maternal and foetal outcomes. The surgical treatment involves caesarean section and hysterectomy, with additional interventions for bladder invasion in percreta cases.

Background: Placenta accreta spectrum (PAS) refers to abnormal placental attachment, categorized into accreta, increta, and percreta, with varying severity. The incidence of PAS has risen alongside the increasing rate of cesarean sections. PAS is a significant cause of maternal and fetal complications, including bleeding, preterm birth, and intrauterine growth restriction. Early diagnosis is crucial for management and improving outcomes. Materials and Methods: This retrospective study, conducted at the County Emergency Clinical Hospital "Saint Andrew the Apostle" Constanța, analyzed cases of placenta praevia and PAS from 2018 to 2022. Data were collected from observation sheets and operative protocols, involving 13,841 patients. Placenta praevia and PAS were diagnosed using ultrasound, MRI, and histopathology. Results: Among the 13,841 deliveries, 25 cases of placenta praevia (0.82% incidence) and 17 cases of PAS (0.57% incidence) were identified. Ultrasound demonstrated 96% sensitivity and MRI 96% sensitivity for PAS detection. Of the 17 PAS cases, 3 were diagnosed as placenta increta, and 3 as percreta, with all percreta cases involving bladder invasion. Hysterectomy was the standard surgical treatment. Discussion: Risk factors for PAS included previous cesarean sections (94.1% of PAS cases), smoking, and advanced maternal age. The study confirmed the importance of early imaging and the involvement of a multidisciplinary team in managing PAS, particularly in complex cases involving bladder or rectal involvement. Cesarean section followed by hysterectomy was the preferred surgical approach, and uterine artery embolization (UAE) was considered for reducing hemorrhage risk. Conclusions: Smoking, uterine scars, and uterine fibroids are significant risk factors for placenta praevia with pathological adhesion. Ultrasound and MRI are highly accurate in diagnosing PAS, with histopathology providing definitive confirmation. Multidisciplinary care is essential in managing complex cases, ensuring optimal maternal and fetal outcomes. Surgical treatment involves cesarean section and hysterectomy, with additional interventions for bladder invasion in percreta cases.

Background: Atrophic vulvovaginitis (VVA), a prevalent condition resulting from estrogen deficiency after menopause, is characterized by symptoms such as vaginal dryness, itching, burning, dyspareunia, and urinary discomfort. Standard treatment involves systemic estrogen replacement therapy (HRT) and localized estrogen treatments, such as estriol. However, many women with moderate to severe VVA may not fully benefit from estrogen therapy alone. Non-hormonal adjunctive treatments, such as pelvic floor exercises (e.g., Kegel exercises), are being explored to enhance clinical outcomes. Objectives: This study investigates the combined effect of local estriol therapy and Kegel exercises in improving VVA symptoms in postmenopausal women. Methods: Fifty postmenopausal women diagnosed with VVA were enrolled and divided into three severity groups: mild, moderate, and severe. All participants received estriol therapy (0.5 mg vaginal tablets daily for 10 days each month) for the first three months. Following this, Kegel exercises were introduced for an additional three months, alongside continued estriol therapy. Symptom improvement was evaluated after six months, with outcomes categorized as complete remission, partial remission, or no remission. Results: Significant improvements in symptom remission were observed, particularly in the moderate and severe groups. In the mild VVA group, 81.82% achieved complete remission with the combined therapy, compared to 68.18% with estriol alone. In the severe group, complete remission was observed in 40% of patients receiving the combined therapy, compared to 20% with estriol therapy alone. These findings suggest that Kegel exercises enhance the effectiveness of estriol by improving local blood circulation, which facilitates better estrogen absorption and distribution. Conclusion: The addition of Kegel exercises to local estriol therapy significantly improves symptom remission rates, especially in moderate and severe VVA cases. This approach offers a promising strategy for managing postmenopausal VVA, particularly in cases that do not fully respond to estrogen therapy alone.