Background: The neurological complications of coronavirus disease 2019 (COVID-19) infection and the side effects of vaccination include immune-mediated diseases of the central nervous system (CNS) such as acute disseminated encephalomyelitis (ADEM). It is an acute-onset demyelinating disease that involves a rapid evolution and multifocal neurological deficits that develops following a viral or bacterial infection or, less frequently, following vaccination. Acute hemorrhagic leukoencephalitis (AHLE) is the hemorrhagic variant of ADEM that presents a more severe evolution which can be followed by coma and death. The objectives of this study consist in evaluating the diagnosis, clinical characteristics, imaging and laboratory features, evolution, and treatment of ADEM and AHLE following COVID-19 infection or vaccination. Methods: We performed a systematic review of the medical literature according to PRISMA guidelines that included ADEM cases published between 1 January 2020 and 30 November 2022 following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and vaccination and also included our own clinical experience regarding this pathology. Results: A total number of 74 patients were diagnosed with ADEM, 45 following COVID-19 infection and 29 after a SARS-CoV-2 vaccine. A total of 13 patients (17.33%) presented AHLE. The moderate form of COVID-19 presented a positive correlation with AHLE (r = 0.691, p < 0.001). The existence of coma and AHLE was correlated with poor outcomes. The following more aggressive immunomodulatory therapies applied in severe cases were correlated with poor outcomes (major sequelae and death): therapeutic plasma exchange (TPE) treatment (r = 382, p = 0.01) and combined therapy with corticosteroids and TPE (r = 0.337, p = 0.03). Conclusions: Vaccinations are essential to reduce the spread of the COVID-19 pandemic, and the monitoring of adverse events is an important part of the strategic fight against SARS-CoV-2. The general benefits and the overall good evolution outweigh the risks, and prompt diagnosis is associated with a better prognosis in these patients.

Background and Objectives: The best method for reconstructing the stomach after distal gastrectomy surgery in gastric cancer patients continues to be a subject of ongoing discussion. The most beneficial surgical option for patients is Billroth I (BI), yet surgeons may perform Billroth II and Roux-en-Y (BII/RY) procedures because they are easier to execute, although their impact on recovery complications and postoperative function remains unclear. This prospective observational cohort study compares the short- and mid-term surgical outcomes between BI and BII/RY reconstructions. Materials and Methods: We included 150 patients who received curative intent distal gastrectomy at the General Surgical Clinic of Emergency County Hospital in Târgu Mureș, Romania, between October 2021 and December 2024 (72 BI and 78 BII/RY patients), with a mean age of 61.5 ± 10.8 years (60.7% male). The outcomes included recovery parameters, postoperative complications (Clavien–Dindo), and mid-term functional results (PPI use, Los Angeles classification esophagitis, bile reflux gastritis, Sigstad dumping score). Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline covariates. Results: The results indicated that IPTW adjustment did not change the baseline demographics, tumor characteristics, or perioperative factors. The baseline characteristics were comparable between groups (p > 0.05). There were no significant differences in time to flatus (p = 0.12), oral diet (p = 0.70), or hospital stay (p = 0.69). Major morbidity (Clavien–Dindo ≥ III) occurred in 12.7% overall (p = 0.17), and the 90-day mortality was 5.3% (p = 1.00). At 6 months, bile reflux gastritis was more frequent after BII/RY (p = 0.16), whereas dumping syndrome occurred more often after BI (p = 0.16). Conclusions: The short-term surgical results, together with the total postoperative complications, showed no difference between the BI and BII/RY reconstruction methods. The study revealed distinct functional results between the two groups during the mid-term assessment, which demonstrates that surgeons should maintain their practice of choosing reconstruction techniques according to patient-specific requirements.

Background and Clinical Significance: Retroperitoneal tumors are a rare and diverse group of neoplasms, accounting for less than 1% of adult solid tumors. Retroperitoneal lipomas are particularly uncommon, with fewer than 20 cases described in the literature. Their asymptomatic growth and lack of clear anatomical boundaries can result in delayed diagnosis and substantial tumor size at clinical presentation. This case highlights a rare retroperitoneal lipoma with atypical extension into the right thigh through the muscular lacuna, mimicking a femoral hernia and compressing the femoral nerve—a presentation scarcely reported and clinically significant due to its surgical complexity and risk of recurrence. Case Presentation: We report the case of a 65-year-old woman from an urban setting who presented with progressive right thigh discomfort and lower limb pain during ambulation. The mass had been initially identified two years prior as a small, asymptomatic right inguinal formation during imaging to exclude an inguinal hernia. Computed tomography (CT) and magnetic resonance imaging (MRI) confirmed a large retroperitoneal lipomatous tumor extending to the anteromedial right thigh. Surgical excision was performed through a dual approach: midline laparotomy and thigh incision. A 30 × 30 cm encapsulated lipoma was removed without injuring adjacent nerves or vessels. Histopathological evaluation confirmed a mature lipoma without atypia but with a lipogranulomatous reaction. The patient’s postoperative course was favorable, with minimal residual paresthesia and complete wound healing. Conclusions: Although benign, retroperitoneal lipomas can mimic other pathologies and present surgical challenges when they extend beyond their typical boundaries. Early recognition and coordinated surgical management are crucial for optimal outcomes and prevention of recurrence.

Background and Objectives: Pelvic organ prolapse (POP) is a complex condition affecting the pelvic floor, often requiring imaging for accurate diagnosis and treatment planning. Artificial intelligence (AI), particularly deep learning (DL), is emerging as a powerful tool in medical imaging. This scoping review aims to synthesize current evidence on the use of AI in the imaging-based diagnosis and anatomical evaluation of POP. Materials and Methods: Following the PRISMA-ScR guidelines, a comprehensive search was conducted in PubMed, Scopus, and Web of Science for studies published between January 2020 and April 2025. Studies were included if they applied AI methodologies, such as convolutional neural networks (CNNs), vision transformers (ViTs), or hybrid models, to diagnostic imaging modalities such as ultrasound and magnetic resonance imaging (MRI) to women with POP. Results: Eight studies met the inclusion criteria. In these studies, AI technologies were applied to 2D/3D ultrasound and static or stress MRI for segmentation, anatomical landmark localization, and prolapse classification. CNNs were the most commonly used models, often combined with transfer learning. Some studies used hybrid models of ViTs, demonstrating high diagnostic accuracy. However, all studies relied on internal datasets, with limited model interpretability and no external validation. Moreover, clinical deployment and outcome assessments remain underexplored. Conclusions: AI shows promise in enhancing POP diagnosis through improved image analysis, but current applications are largely exploratory. Future work should prioritize external validation, standardization, explainable AI, and real-world implementation to bridge the gap between experimental models and clinical utility.

Background and Clinical Significance: Synchronous gastrointestinal tumors are ex-ceptionally rare, particularly when combining histologically distinct benign and ma-lignant components. Schwannomas represent uncommon mesenchymal tumors of the gastrointestinal tract, most frequently arising in the stomach, while rectal localization is exceedingly unusual. Papillary adenocarcinoma of the gallbladder is an aggressive malignant entity derived from intracholecystic papillary-tubular neoplasms (ICPNs). The coexistence of these two unrelated neoplasms has not been previously reported, making this case of dual tumor pathogenesis clinically and academically significant. Case Presentation: A 68-year-old female was admitted for surgical management of grade IV uterovaginal prolapse. Preoperative imaging incidentally revealed a well-circumscribed rectal wall mass and gallstones. A combined abdominopelvic op-eration was performed, including total hysterectomy with bilateral adnexectomy (Wiart procedure), rectosigmoid resection with colorectal anastomosis, and bipolar cholecystectomy. Intraoperatively, a firm intramural rectal lesion and a friable papil-lary mass in the gallbladder fundus were identified. Histopathologic examination con-firmed a benign rectal schwannoma (S-100 positive, CD117/DOG-1 negative) and a papillary adenocarcinoma of the gallbladder, pT3N0M0, with clear resection margins and no lymphovascular or perineural invasion. The postoperative course was une-ventful, and the patient remained disease-free at six-month follow-up. Conclusions: This case represents an exceedingly rare benign–malignant synchronous tumor association. The simultaneous occurrence of rectal schwannoma and gallblad-der papillary adenocarcinoma underscores the importance of thorough intraoperative exploration and histopathologic evaluation. Complete resection with negative margins and multidisciplinary follow-up remains crucial for optimal outcomes and contributes to understanding dual tumor pathogenesis within the gastrointestinal tract.

Background and Clinical Significance: Synchronous gastrointestinal tumors are exceptionally rare, particularly when combining histologically distinct benign and malignant components. Schwannomas represent uncommon mesenchymal tumors of the gastrointestinal tract, most frequently arising in the stomach, while rectal localization is exceedingly unusual. Papillary adenocarcinoma of the gallbladder is an aggressive malignant entity derived from intracholecystic papillary–tubular neoplasms (ICPNs). The coexistence of these two unrelated neoplasms has not been previously reported, making this case of dual tumor pathogenesis clinically and academically significant. C ase Presentation: A 68-year-old female was admitted for surgical management of grade IV uterovaginal prolapse. Preoperative imaging incidentally revealed a well-circumscribed rectal wall mass and gallstones. A combined abdominopelvic operation was performed, including total hysterectomy with bilateral adnexectomy (Wiart procedure), rectosigmoid resection with colorectal anastomosis, and bipolar cholecystectomy. Intraoperatively, a firm intramural rectal lesion and a friable papillary mass in the gallbladder fundus were identified. Histopathologic examination confirmed a benign rectal schwannoma (S-100 positive, CD117/DOG-1 negative) and a papillary adenocarcinoma of the gallbladder, pT3N0M0, with clear resection margins and no lymphovascular or perineural invasion. The postoperative course was uneventful, and the patient remained disease-free at six-month follow-up. Conclusions: This case represents an exceedingly rare benign–malignant synchronous tumor association. The simultaneous occurrence of rectal schwannoma and gallbladder papillary adenocarcinoma underscores the importance of thorough intraoperative exploration and histopathologic evaluation. Complete resection with negative margins and multidisciplinary follow-up remains crucial for optimal outcomes and contributes to understanding dual tumor pathogenesis within the gastrointestinal tract.