Background: Gallstone ileus is a rare cause of bowel obstruction, often presenting with nonspecific symptoms that delay diagnosis. This study assessed the diagnostic value of CT imaging and its correlation with histopathological findings in confirmed cases. Methods: A retrospective analysis of 14 patients with surgically confirmed gallstone ileus was performed. All underwent abdominal radiography, ultrasound, and CT. Imaging findings were evaluated for calcification type, impaction site, and fistula presence. Histopathology from surgical specimens was used for correlation. Relative risk (RR) and 95% confidence intervals (CIs) were calculated, with adjustments for small sample size. Results: Rim-calcified gallstones were the most common (50%) and significantly associated with chronic inflammation (RR 1.42, 95% CI: 1.05–1.93). Cholecystoduodenal fistulas were most frequent (57.1%), with a 92.8% imaging-pathology concordance. Ileal impaction (35.7%) was linked to increased risk of bowel necrosis (RR 2.0, 95% CI: 1.1–3.6). All stones were >3 cm; two patients had recurrence. No perioperative mortality occurred. Conclusions: CT imaging demonstrates high diagnostic accuracy and strong correlation with histopathological findings in gallstone ileus. Identifying calcification patterns and impaction sites aids early diagnosis and surgical planning.

Background: Dilated cardiomyopathy (DCM) is a major cause of heart failure and arrhythmic mortality; yet, its association with cerebrovascular events, particularly in the absence of atrial fibrillation (AF), remains insufficiently explored. Purpose: This study aimed to determine the prevalence, mechanisms, and anatomical distribution of stroke in patients with DCM and to assess the role of AF and structural remodeling in stroke risk. Methods: We retrospectively analyzed 471 patients who died with DCM at the Emergency County Clinical Hospital of Bihor between 1 January 2022 and 31 December 2024. Clinical records, neuroimaging, autopsy reports, and histopathological data were reviewed. Stroke subtypes were classified according to TOAST criteria (large artery atherosclerosis, cardioembolic, small vessel disease, other determined, undetermined) and hemorrhagic categories (intracerebral, subarachnoid). Demographic, echocardiographic, and comorbidity data were compared between patients with and without cerebrovascular events. Results: Of 471 patients with DCM, 45 (9.6%) had concomitant stroke: pure ischemic in 32 (71.1%), 7 (15.6%) showed ischemic with hemorrhagic transformation, and primary hemorrhagic in 6 (13.3%). The parietal lobe was most frequently affected. AF was present in 26 patients (57.8%) and was significantly associated with ischemic stroke (p = 0.004), though embolic strokes also occurred in sinus rhythm. Patients with stroke had significantly lower left ventricular ejection fraction (28.0 ± 13.7% vs. 34.0 ± 11.2%, p = 0.007) and larger atrial dimensions. Histopathological findings confirmed acute and chronic ischemic injury patterns, including “red neurons,” white matter vacuolization, and gliotic scarring. Conclusions: Stroke is a frequent and often underdiagnosed complication in DCM, predominantly ischemic and embolic in nature. Importantly, embolic events were observed even in patients without AF, suggesting that atrial remodeling in DCM may independently predispose to cerebrovascular risk. These results underscore the need for refined preventive strategies, including careful atrial assessment and exploration of whether anticoagulation may benefit selected high-risk DCM patients without AF, a question that requires confirmation in prospective trials. Potential embolic sources in DCM include atrial cardiopathy and left ventricular thrombus in the setting of severe systolic dysfunction; therefore, careful ventricular as well as atrial assessment is warranted in high-risk DCM.

Background and Objectives: Diabetes mellitus is frequently encountered in critically ill patients and is associated with increased short-term mortality. However, the biological and clinical determinants of mortality within the diabetic intensive care unit (ICU) population remain incompletely understood. This study aimed to evaluate laboratory parameters at ICU admission and key early ICU course variables, including acute complications and organ support interventions, associated with short-term ICU mortality in critically ill patients with diabetes mellitus. Materials and Methods: We conducted a retrospective observational cohort study including adult patients with diabetes mellitus admitted to a tertiary care ICU between January and December 2024. Demographic data, laboratory parameters at ICU admission, acute complications, and ICU interventions were collected. Patients were stratified according to ICU outcome (survivors vs. non-survivors). Univariate and multivariate logistic regression analyses were performed to identify independent predictors of ICU mortality. Model performance was assessed using the area under the receiver operating characteristic curve (AUC/ROC), Hosmer–Lemeshow test, and Brier score. Results: A total of 443 critically ill patients with diabetes mellitus were included, of whom 239 (54.0%) died during ICU hospitalization. Non-survivors exhibited higher admission blood glucose, lactate levels, and serum creatinine, as well as lower lymphocyte counts compared to survivors. Acute complications, including sepsis, acute kidney injury, and acute respiratory failure, were significantly more frequent among non-survivors. In multivariate analysis, admission lactate levels (OR = 1.02 per mg/dL increase), mechanical ventilation (OR = 47.30), and hemodialysis (OR = 3.38) remained independently associated with ICU mortality. The predictive model demonstrated good discrimination (AUC = 0.87) and adequate calibration. Conclusions: Critically ill patients with diabetes mellitus who do not survive ICU hospitalization present with early metabolic stress, immune dysregulation, and organ dysfunction. Admission lactate levels and the need for advanced organ support are key predictors of short-term mortality, supporting their role in risk stratification within the diabetic ICU population.

Background and Objectives: Diabetes mellitus (DM) is a highly prevalent comorbidity among critically ill patients and may significantly influence intensive care unit (ICU) outcomes through metabolic, immune, and cardiovascular mechanisms. This study aimed to evaluate the impact of DM on clinical profile, comorbidities, complications, need for intensive support, and mortality in adult ICU patients. Materials and Methods: A retrospective observational study was conducted between January and December 2024 in a tertiary ICU, including 1344 adult patients. Among them, 435 (32.37%) had DM. Demographic data, admission diagnoses, laboratory parameters, comorbidities, complications, therapeutic interventions, and outcomes were analyzed. Comparative statistical analysis and multivariate logistic regression were performed to identify independent predictors of ICU mortality. Results: Patients with DM were significantly older than patients without diabetes mellitus (non-DM group) (69.62 ± 10.26 vs. 67.16 ± 14.26 years, p < 0.001) and more frequently female (57%, p = 0.0002). At admission, they presented higher glycemia (204.7 vs. 134.0 mg/dL, p < 0.00001), reduced glomerular filtration rate (47.2 vs. 59.5 mL/min/1.73 m², p < 0.00001), and more pronounced lymphocytopenia (p = 0.025). Cardiovascular and renal comorbidities were significantly more prevalent in DM, including hypertension (76.3%), heart failure (32.4%), and chronic kidney disease (33.1%) (all p < 0.01). DM was associated with increased odds of sepsis (OR 1.56), acute kidney injury (OR 1.51), and obesity (OR 2.57). ICU mortality was significantly higher in patients with DM (54.9% vs. 46.3%, p = 0.004; RR 1.19). Independent predictors of death included mechanical ventilation (OR 36.48), inotropic therapy (OR 4.74), hemodialysis (OR 2.57), elevated lactate, neutrophilia, and reduced glomerular filtration rate (GFR). Conclusions: DM was associated with increased ICU mortality and a higher burden of cardio-renal comorbidities and complications; however, mortality in the multivariate model was primarily driven by markers of organ dysfunction and the need for advanced supportive therapies. Early risk stratification and individualized management strategies are essential to improve outcomes in critically ill patients with diabetes.

Background: Diabetes mellitus (DM) is frequently encountered in critically ill patients and has been associated with poor outcomes. However, its independent impact on short-term mortality in heterogeneous ICU populations remains unclear. Objectives: To evaluate whether diabetes mellitus is an independent risk factor for intensive care unit (ICU) mortality in critically ill adult patients. Methods: We conducted a single-center retrospective observational study including adult patients admitted to the ICU between January and December 2024. Patients were stratified according to the presence or absence of diabetes mellitus. Demographic data, major clinical variables, and ICU outcomes were analyzed. The primary endpoint was ICU mortality. A multivariate logistic regression model was used to identify independent predictors of death. Results: A total of 1344 patients were included, of whom 435 (32.4%) had diabetes mellitus. ICU mortality was significantly higher in patients with DM compared to non-diabetic patients (54.9% vs. 46.3%, p = 0.004). After adjustment for age, sex, sepsis, acute kidney injury, and mechanical ventilation, diabetes mellitus remained independently associated with an increased risk of ICU death. Conclusions: Diabetes mellitus is an independent predictor of short-term mortality in critically ill ICU patients. Early identification and risk stratification of diabetic patients may improve clinical management and outcomes in intensive care settings.

Background and Objectives: Superior mesenteric artery syndrome (SMAS) is an uncommon cause of proximal duodenal obstruction that requires clinicoradiological correlation. Materials and Methods: We retrospectively reviewed 13 patients with SMAS identified at the Clinical County Emergency Hospital Bihor, Romania, during 2019–2024. Clinical records and contrast-enhanced computer tomography (CT) examinations were reviewed descriptively. Results: The cohort included 13 adults aged 19–85 years (mean 45.5 ± 17.8; median 43 years). Abdominal pain was reported in 12/13 patients (92.3%), vomiting or emetic symptoms in 6/13 (46.2%), feeding difficulty or appetite disturbance in 5/13 (38.5%), and documented weight loss in 3/13 (23.1%). CT measurements were available for the aortomesenteric angle in 7/13 patients (range, 10–25°) and for the aortomesenteric distance in 8/13 (range, 3–8 mm); direct third-part duodenal compression and proximal dilatation were interpreted together with compatible symptoms. Imaging showed Nutcracker-type left renal vein compression in 3/13 patients (23.1%) and possible May–Thurner anatomy in 1/13 (7.7%); these findings were not adjudicated as clinical syndromes without corresponding manifestations. Based on the management labels, 9/13 patients (69.2%) underwent surgery at some point and 4/13 (30.8%) received medical therapy only. Standardized follow-up and procedure-level outcome data were not available for all patients. Conclusions: This small, retrospective series is descriptive and cannot estimate prevalence, diagnostic delay, or comparative treatment effectiveness. It illustrates heterogeneous adult presentations and supports interpreting aortomesenteric measurements together with compatible symptoms and evidence of duodenal obstruction.