Sinus Orifice Research Articles

Comparative Study of Diluted Hydrogen Peroxide and Sulfur Hexafluoride in the Contrast-Enhanced Ultrasound Assessment of Anal Fistulas.

Endoanal ultrasound for the diagnosis of anal fistulas requires the injection of hydrogen peroxide, but it is often uncomfortable for the patient and possesses potential complications. Novel ultrasound contrast is currently available. We aimed to assess the efficacy and safety of sulfur hexafluoride as an ultrasound contrast agent for the diagnosis of perianal fistula by comparing it with those of 50% diluted hydrogen peroxide. Double-blind superiority study with 4 consecutive visits to perform an ultrasound without contrast, a hydrogen peroxide-enhanced ultrasound, a sulfur hexafluoride-enhanced ultrasound and a rectal exploration in the operating room (the gold standard). The ultrasound images were independently reviewed by three expert surgeon sonographers. This study was conducted at a single university hospital. Data from 176 patients were evaluated. Demographic and exploratory data and the ultrasound findings related to the location of the internal fistula orifice, description of the primary and secondary tracts, and presence of cavities and sphincter defects were analyzed. The complications occurring before and after the contrast agent administration and the presence of pain measured using a score were considered. Eighty-eight patients were included (men: 71.5%; mean age: 48.3 years).62.5% had a complex type and 83.7% had a transsphincteric type. Sulfur hexafluoride-enhanced ultrasounds demonstrated a higher interobserver agreement in determining the secondary tracts (κ= 0.604) and anal fistula height (κ=0.604) compared with other methods. Both hydrogen peroxide-enhanced ultrasound (90.91%) and sulfur hexafluoride-enhanced ultrasound (89.77%) detected the internal orifice more frequently than ultrasounds without contrast (62.5%) (p < 0.001),with no differences between contrast agents (p = 0.810). Sulfur hexafluoride-enhanced ultrasound were less painful than peroxide-enhanced ultrasound (p < 0.001). Most of the patients had transsphincteric anal fistulas. Sulfur hexafluoride proved comparable to hydrogen peroxide in evaluating fistulous tracts and identifying the internal orifice and additionally reduced significantly pain and discomfort. Furthermore, demonstrated a higher interobserver agreement in determining the secondary tracts and anal fistula height compared with other methods. See Video Abstract.

Transcatheter Closure of a Huge Congenital Coronary-Cameral Fistula With Amplatzer Occluder

Congenital coronary-cameral fistula is an abnormal connection between coronary arteries and a cardiac chamber. Although trans-catheter closure appears to be a safe alternative to surgical treatment but there is an imprecision about modality of choice. We describe a huge left coronary artery fistula to the right ventricle, found in an 8-year-old girl with dyspnea on exertion and chest pain. She was treated with an Amplatzer duct occluder. After procedure, echocardiography revealed, complete closure of fistula orifice and the girl remained completely asymptomatic during 48 months follow-up period. This study demonstrated that Amplatzer duct occluder might be a useful and safe armamentarium for coronary-cameral fistula treatment. Nevertheless, further experience and long-term follow-up studies are required to guarantee our results.

A new midline closure technique without skin sutures: Long-term outcomes of primary repair of pilonidal sinus disease.

Currently, the focus regarding pilonidal sinus disease is put on the treatment techniques. The aim of the study is to compare postoperative long-term complications and recurrence of two surgical techniques. From February 2015 to December 2020, male patients with pilonidal sinus disease attended at two general surgery outpatient centers were randomly assigned to either Group 1 (n=80; excision and primary closure) or Group 2 (n=80; excision and midline closure without skin sutures). Patients with recurrent or complicated pilonidal sinus or with prior surgical procedures were excluded from the study. Intergroup postoperative results and recurrence throughout the follow-up period were analyzed. Significant decrease (p<0.001) in the duration of the surgical procedure (35 to 25 minutes), length of hospital stay (one day to the day of the surgery), and of the time required to return to work (15 to 12 days) was seen for Group 2 patients. The complication rate (wound infection and seroma) was lower in Group 2 compared to Group 1 (n = 3; 3.7% vs n = 10; 12.5%; p = 0.014). During the five-year mean follow-up, five patients (6.2%) in Group 1 had recurrence compared to none in Group 2 (p = 0.023). Midline primary closure method without skin sutures - easy to learn and implement and has no complication or recurrence in the long-term follow-up - may be an ideal method in cases where excision and primary repair is planned, especially in patients with sinus orifices located in the midline.

Evaluation of Secondary Alveolar Bone Grafting for Unilateral Complete Cleft Alveolus: A Retrospective Cone Beam Computed Tomography-Based Study.

Background: In patients with cleft lip and palate (CLP), secondary alveolar bone grafting (SABG) with particulate cancellous bone marrow (PCBM) is recommended. Objective: To compare bone graft outcomes in patients with unilateral CLP, when SABG is completed before or after canine tooth eruption (ACE or BCE), as measured by cone beam computed tomography (CBCT). Methods: Patients were allocated into two cohorts, ACE and BCE. The outcomes were evaluated using CBCT, followed by univariate and multifactorial analyses. Results: A total of 468 patients (age 11.61 ± 4.03 years; male/female 288/180) were analyzed, including 282 in the BCE group (9.41 ± 1.59 years, 175/107) and 186 in the ACE group (14.95 ± 4.31 years, 113/73). Although 5-level assessment revealed no significant difference in clinical success rate (>4 points) between the BCE and ACE groups (53.90% vs. 47.85%, p = 0.20), BCE group showed significantly higher rate of bone bridges formation (73.05% vs. 62.90%, p = 0.02), which can be attributed to variations in orthodontic participation and follow-up time. Independent predictors of graft failure were wide cleft, severe oronasal fistula, no palatal bone wall, and insufficient PCBM filling (p < 0.01). Conclusions: SABG should be performed before canine eruption with more aggressive PCBM filling and oral fistula management.

Transanal fistula repair for the treatment of rectovestibular fistula with normal anus in female children: a 5-year single-center experience.

The purpose of this study was to review a 5-year operative experience of transanal fistula repair for the treatment of rectovestibular fistula with a normal anus in female children. In this study, we conducted a retrospective review of children diagnosed with rectovestibular fistula with normal anus who underwent transanal fistula repair in the department of General Surgery, Children's Hospital of Chongqing Medical University. Clinical data were retrospectively analyzed. A total of 56 female children were included in the study. The patients' ages ranged from 1year 10months to 15years 11months, with an average age of 5years 1month. These children had a clear history of gas or loose stool leakage through the vestibular area, with or without a history of vestibular infection. All patients had a normal anus and underwent transanal fistula repair. Follow-up was conducted through telephone or outpatient visits for a duration of 10months to 5years (average follow-up duration 19months). Three patients experienced minimal secretion from the external orifice of the vestibular fistula within two weeks after the operation, but were successfully treated with sitting bath therapy without any relapse. Another three cases had a recurrence of the fistula, and two of them underwent transanal fistula repair at our center again, resulting in a successful cure after reoperation. The remaining case has not yet undergone reoperation. In the long-term follow-up, all the children had satisfactory anal appearance, with no fecal incontinence, anorectal stenosis, or fistula infection. Transanal fistula repair is a simple, safe, and effective surgical method to treat female children with rectovestibular fistula with a normal anus.

The anatomical variations of paranasal sinuses may be related to the formation of antrochoanal polyp by computed tomography imaging study.

There is little investigation into the connection between anatomic variations and the development of antrochoanal polyp (ACP), and the etiology of ACP remains unclear. The study aims to explore the relationship among anatomic variations, maxillary sinus volume, nasal meatus-related parameters, and the occurrence of ACP. There were 127 patients included in this retrospective cross-sectional study with unilateral ACPs hospitalized at Shandong Provincial ENT Hospital between February 2010 and February 2020. Evaluation indicators included anatomic variations, maxillary sinus volume, and nasal meatus-related parameters in 45 children and 82 adults, which were evaluated twice by 3DSlicer software. Parameters were assessed using the Kolmogorov-Smirnov test, followed by paired t-test and Chi-squared test for multiple comparisons. Significant differences were found in the accessory maxillary ostium (AMO) and maxillary sinus retention cyst between two sides (both P<0.001). Maxillary sinus volume and sex had an association of statistical significance on adults' ACP side (P=0.026) and non-antrochoanal polyp (non-ACP) side (P=0.032). The affected side's maxillary sinus volume was significantly larger than the healthy side (P<0.001). The length from the maxillary sinus orifice to the plane of the most lateral margin of the middle turbinate of the ACP side was larger than the non-ACP side in children (P=0.044). Males' length from the maxillary sinus orifice to the plane of the most lateral margin of the middle turbinate of the ACP side was considerably greater than the healthy side (P<0.001). The length from the maxillary sinus orifice to the plane of the most lateral margin of the middle turbinate (P=0.014) and the length from the inferior turbinate to the nasal septum (P=0.013) on the non-ACP side was higher than the affected side in adults. Males' length from the inferior turbinate to the nasal septum was higher on the healthy side than the affected side (P<0.001). Males had a greater maximum length from the maxillary sinus lateral wall to the nasal septum (P=0.024) and the length from the inferior turbinate to the nasal septum (P=0.003) on the non-ACP side than females. Males had a larger maximum length from the maxillary sinus lateral wall to the nasal septum on the ACP side than females (P=0.011). In our study, the occurrence of the AMO, the maxillary sinus's expanded size, and the stenosis of the associated channels around the ostiomeatal complex and common meatus are regarded as probably connected to the formation of ACPs. In addition, the anatomic variations that involve the ostiomeatal complex and may lead to a change in maxillary sinus pressure and nasal ventilation are important factors in the formation of ACPs.

Angiographic evaluation of the distance from the top of the jugular bulb to the inferior petrosal sinus-internal jugular vein junction: simple classification and identification method for the orifice of the non-visualized inferior petrosal sinus during neuroendovascular surgery.

The inferior petrosal sinus (IPS) is the transvenous access route for neurointerventional surgery that is occasionally undetectable on digital subtraction angiography (DSA) because of blockage by a clot or collapse. This study was aimed at analyzing the distance from the jugular bulb (JB) to the IPS-internal jugular vein (IJV) junction and proposing a new anatomical classification system for the IPS-IJV junction to identify the non-visualized IPS orifice. DSA of 708 IPSs of 375 consecutive patients were retrospectively investigated to calculate the distance from the top of the JB to the IPS-IJV junction, and a simple classification system based on this distance was proposed. The median distance from the top of the JB to the IPS-IJV junction was 20.8 ± 14.7mm. Based on the lower (10.9mm) and upper (31.1mm) quartiles, IPS-IJV junction variants were: type I, 0-10mm (22.3%); type II, 11-30mm (45.8%); type III, > 31mm (23.9%); and type IV, no connection to the IJV (8.0%). Bilateral distances showed a positive interrelationship, with a correlation coefficient of 0.86. The bilateral symmetry type (visualized IPSs bilaterally) according to our classification occurred in 267 of 300 (89.0%) patients. In this study, the IPS-IJV junction was located far from the JB (types II and III), with a higher probability (69.6%). This distance and the four-type classification demonstrated high degrees of homology with the contralateral side. These results would be useful for identifying the non-visualized IPS orifice.

A rare gastrointestinal bleeding due to a cholecystoduodenal fistula: a case report

BackgroundGastrointestinal bleeding from cholecystoduodenal fistula is rare. It is usually managed surgically, although a conservative approach is reported in isolated cases.Case presentationA 71-year-old male patient was admitted to the emergency department (ED) presenting melena associated with severe anemia, requiring a blood transfusion. An urgent upper endoscopy showed the intestinal orifice of a cholecystoduodenal fistula. This finding was confirmed by radiological examination and laparoscopy. Cholecystectomy and simultaneous excision of the fistula were successfully performed. As a result, a diagnosis of Mirizzi syndrome type Va was also made.ConclusionA cholecystoduodenal fistula orifice leading to gastrointestinal bleeding is difficult to diagnose without an endoscopic examination of the upper digestive tract. Following this first diagnostic step, a comprehensive patient examination should be conducted, specifically if a history of gallbladder lithiasis has been reported.

High-resolution mapping of the circuit of typical atrioventricular nodal reentrant tachycardia.

Recent anatomic and electrophysiologic evidence has provided new insight into the anatomic substrate. Previous reports on electroanatomic mapping (EAM) of the circuit of atrioventricular nodal reentrant tachycardia (AVNRT) have been limited by mapping only the triangle of Koch on the right side of the septum and by the use of conventional mapping tools. The objectives are to obtain comprehensive high-resolution mapping of typical AVNRT and to investigate the role of the atrioventricular ring tissues in the circuit. We employed EAM with the use of novel modules and algorithms for studying typical AVNRT from the right and the left sides of the septum. We performed extensive mapping of both the atrial septum and the septal vestibule of the tricuspid valve during typical AVNRT in 9 (6 females) patients, aged 49.6 ± 12.1years. In two of these, left septal mapping was also obtained through the aorta. The earliest initial activation was variable, emanating from the superior or medial septum. The impulse consistently appeared below the orifice of the coronary sinus, at the site where its inferoanterior margin merged with the septal vestibule of the tricuspid valve at its entrance to the right atrium. It then returned to the initial activation site, presumably through the septal vestibular myocardium. The left septal activation area corresponded to that recorded on the right side. Typical AVNRT uses a circuit confined within the pyramid of Koch from the AV node to the septal isthmus, involving the myocardial walls of the pyramidal space.

Laparoscopic repair of acquired rectourethral fistula by vesical peritoneal flap.

A rectourethral fistula (RUF) is an infrequent complication that can be iatrogenic in most cases. Multiple surgical interventions were described for RUF repair including transsphincteric, transanal, transperineal, and transabdominal approaches. To this day, there is no consensus on a standardized surgery of choice for acquired RUF. Our patient was diagnosed with RUF 4 weeks after undergoing laparoscopic low anterior resection for midrectum adenocarcinoma, with failure of conservative treatment. A three-port transabdominal approach was used to dissect the rectoprostatic space and close the fistula orifice on the anterior rectal wall. With the technical impossibility to develop an omental flap, the peritoneum on the posterior vesical wall was carefully dissected to form a rectangular flap pedicled by its inferior aspect. The harvested peritoneal flap was then anchored between the prostate and the rectum. Follow-up imaging showed the absence of RUF, concurrently with total remission of RUF symptomatology. Management of acquired RUF can be challenging, especially after failure of conservative treatment. Laparoscopic repair of acquired RUF by vesical peritoneal flap is a valid option for a minimally invasive approach for the treatment of RUF.

Application of expanding bilateral sphenoid sinus plasty in the treatment of sphenoid sinus diseases.

Expanding bilateral sphenoid sinus plasty is an essential technique for the treatment of sphenoid sinus diseases, such as refractory sphenoid sinusitis, sphenoid sinus cyst, fungal sphenoid sinusitis, sphenoid sinus carcinoma and sphenoid sinus chordoma. The present study evaluated the potential application of expanding bilateral sphenoid sinus plasty in the treatment of sphenoid sinus diseases. A retrospective medical record review of 42 patients treated with the expanding bilateral sphenoid sinus plasty from December 2012 to December 2018 was performed in a tertiary-care university hospital. A follow-up of the surgical effects and complications was performed. Of the 42 patients, the symptoms were relieved after operation in all except preoperative hyposmia in 2 and impaired vision in one with no obvious improvement. No complications such as nasal bleeding, olfactory hypofunction and perforation of nasal septum occurred. Follow-up data revealed good mucosal epithelization in all patients within a mean time of 8.6 weeks. Endoscopic sinus reexamination demonstrated that the sphenoid sinus orifice was well opened, and no cases of sphenoid sinus orifice closure were observed. Expanding bilateral sphenoid sinus plasty, with advantages of clearly exposed surgical field, full opening of the sinus cavity, high surgical safety, short epithelialization time and intuitionistic postoperative follow-up, demonstrated great promise for greater use in the treatment of sphenoid sinus diseases in the future.

Clinical features, diagnosis, and treatment of different types of congenital preauricular fistulas in pediatric patients.

The aim of this study was to summarize the clinical features of congenital preauricular fistula (CPF) in pediatric patients to improve the levels of diagnosis and treatment, reduce the rates of missed diagnosis and recurrence, and shorten the total diagnosis and treatment time. A total of 353 patients with CPF who were admitted to the Department of Otolaryngology in The Children's Hospital, Zhejiang University School of Medicine between January 2019 and December 2021 was enrolled in this retrospective observational study. Follow ups for 12-42 months were performed to investigate the classification, surgical methods, and postoperative conditions of CPF and to compare the recurrence rate, complication rate, and total diagnosis and treatment time between the active infection CPF group (AICPFG) and infection-controlled/non-infected CPF group (IC/NICPFG). In 316 cases (89.5%) out of the 353 patients, the natural fistula orifice was located in front of the crus helicis; in 33 cases (9.4%), the natura fistula orifice was located at the crus helicis; and in 4 cases (1.1%), the natura fistula orifice was located in the external acoustic meatus. The AICPFG had 52 cases (14.7%), including 1 case (0.28%) of recurrence and 2 cases (0.56%) of infection at the incision site. The IC/NICPFG had 301 cases (85.3%), including 4 cases (1.13%) of recurrence, 6 cases (1.7%) of infection at the incision site, and 1 case (0.28%) of scar formation at the incision site. There were no significant differences in the recurrence rates and postoperative complications between the AICPFG and IC/NICPFG (p>0.05). There was a statistically significant difference in the total diagnosis and treatment time between the AICPFG and IC/NICPFG (p<0.05). A reasonable classification of CPF, use of appropriate surgical methods, and belonging to the AICPFG do not increase the recurrence and complication rates of children but shorten the total treatment course, relieve patients' suffering, reduce treatment costs, and achieve a better clinical prognosis.

How to locate the fistula orifice of spinal extradural arachnoid cyst: Surgical experience and clinical outcome

BackgroundIn clinical practice, spinal extradural arachnoid cysts (SEAC) are relatively rare. The key to the treatment of SEAC is recognize and close the dural defects (fistula orifice), but there is currently no convenient method to locate and identify the fistula. We propose a method for predicting the location of lumbar/thoracolumbar SEAC fistula based on surgical experience, subsequently closing the fistula through posterior unilateral interlaminar fenestration. Evaluating its surgical efficacy and investigated its effect on patient prognosis.MethodsA stepped approach based on clinical experience is proposed. A retrospective analysis was performed on 6 patients diagnosed with thoracolumbar SEAC disease and treated with posterior unilateral interlaminar fenestration through the position by pre-estimated fistula orifice in our hospital’s Department of Neurosurgery between January 2017 and January 2022.ResultsAll patients who received this treatment experienced significantly lower postoperative VAS pain scores and ODI index compared to their corresponding preoperative values (P < 0.01). During the ongoing follow-up after surgery, no unstable vertebral column, adverse effects, or complications were reported.ConclusionsThe use of posterior unilateral interlaminar fenestration for the treatment of large SEAC in the adult lumbar/thoracolumbar segment can reduce spinal cord manipulation and enhance spine stability. The disease can be treated by sealing the fistula orifice through a small fenestra, the position of which is assessed before surgery. This surgical method reduces trauma and improves the prognosis of patients with large SEAC.

Comparison of Limberg Flep and Adipofacial Flep in the Surgical Treatment of Pilonidal Sinus: A Prospective Randomized Clinical Study

Objective: Pilonidal Sinus Disease (PSD) encompasses inflammation localized to the intergluteal cleft, ranging from minor cyst to extensive sinus formation. The most important parameters in the treatment of the disease are early return to work, low recurrence rate, low postoperative pain, high comfort, low complication rate and low cost. In the surgical treatment of pilonidal sinus disease, there are methods such as flap methods, primary closure and unroofing and curettage. Methods: This study was planned as a prospective randomized clinical trial. Patients were operated with the diagnosis of chronic pilonidal sinus in the surgical clinic of our hospital between 2006-2008. A total of 104 chronic pilonidal sinus patients were randomized into two groups. The first group included 49 patients whom underwent Limberg flap procedure. The second group included 55 patients whom underwent adipofascial flap procedure. The two groups were compared in terms of demographic characteristics, duration of surgery, early and late complications, recurrence and follow-up time. Results: The duration of the complaint ranged from one month to four years (mean 24.5 months). While a single sinus orifice was detected in the midline in 45 cases (43.3%), two or more sinus orifices were detected in the midline in 59 cases (49.7%). The operation time was shorter in Group 2 than in Group 1. The difference was statistically significant. wound dehiscence was significantly less common in Group 2. In terms of recurrence and aesthetic satisfaction, aesthetic satisfaction was significantly higher in Group 2. Conclusion: Our study showed that adipofascial flap, which can be easily applied in the surgical treatment of pilonidal sinus disease and has no difference from other flap methods, is a method that can be safely applied in the treatment of this disease.

Efficacy of Minimally Invasive Crystallized Phenol Application in the Treatment of Pilonidal Sinus in Children

Background/Aims: Pilonidal sinus treatment involves surgical excision or flap reconstruction; however, the disease has a high recurrence risk. We determined the outcomes of a modified local application of crystallized phenol.&#x0D; Methods: In the outpatient clinic, the pilonidal sinus orifices were connected by an incision under local&#x0D; anesthesia. The hair in the sinus was removed. Then, crystallized phenol was applied. The incision was not&#x0D; sutured. Daily dressings and baths were recommended.&#x0D; Results: Crystallized phenol was applied to 50 patients with pilonidal sinus disease (median age = 15 years).&#x0D; During the follow-up, no bleeding or pain was reported. Recurrence was not found in the follow-ups (one year to&#x0D; three years).&#x0D; Conclusions: Surgery has disadvantages such as long-term hospitalization, recurrence risk, and high cost.&#x0D; Crystallized phenol does not have any of the aforementioned disadvantages. The modified method, in which we&#x0D; incised and applied crystallized phenol to all sinus tracts, might have also reduced the recurrence.

Three-dimensional modelling as a novel interactive tool for preoperative planning for complex perianal fistulas in Crohn's disease.

The aim of this study is to demonstrate the added value of three-dimensional (3D) reconstruction models and artificial intelligence for preoperative planning in complex perianal Crohn's disease. MRI is the gold standard for diagnosis of complex perianal fistulas and abscess due to its high sensitivity, but it lacks high specificity values. This creates the need for better diagnostic models such as 3D image processing and reconstruction (3D-IPR) with artificial intelligence (AI) algorithms. This is a prospective study evaluating the utility of 3D reconstruction models from MRI in four patients with perineal Crohn's disease (pCD). Four pCD patients had 3D reconstruction models made from pelvic MRI. This provided a more visual representation of perianal disease and made possible location of the internal fistula orifice, seton placement in fistula tracts and abscess drainage. Three-dimensional reconstruction in CD-associated complex perianal fistulas can facilitate disease interpretation, anatomy and surgical strategy, potentially improving preoperative planning as well as intraoperative assistance. This could probably result in better surgical outcomes to control perianal sepsis and reduce the number of surgical procedures required in these patients.

Morphological Study of the Thebesian Valve in Fresh Autopsied Adult Human Hearts.

Background The coronary sinus (CS) and its tributaries have been used to perform various electrophysiological and cardiac interventional procedures which require cannulation.The Thebesian valve (TV) guarding the coronary sinus orifice (CSO) exhibits morphological variations which might make cannulation unsuccessful leading to the failure of invasive cardiac procedures.This study aimed to analyze in detail themorphological features of the TV infreshautopsiedhuman hearts which were representative of the adult population of this region owing to its practical implications in invasive cardiac procedures. Methodology This was a cross-sectional, descriptive study conducted in the Department of Anatomy in collaboration with the Department of Forensic Medicine and Toxicology at Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry. A total of 104 fresh adult heart specimens were collected during the autopsy. The CSO was located, and the characteristic shape, composition, position, and extent of coverage of the CSO by the TV were observed and analyzed. Results The TV was present in 65% of heart specimens.The most common shape was remnant (33%), and the most common site of origin was inferior (63%).The valve composition was thin and membranous in 63% of heart specimens.In 7% of heart specimens, the TV covered more than 75% of the CSO diameter, of which in 4% of heart specimens, the CSO was completely closed and found to be obstructive. Conclusions This study highlights the variability in the morphological structure of the TV in adult human hearts and its potential implications in unsuccessful CS cannulation and failure of invasive cardiac procedures.Thus, prior imaging of the TV should be an integral part of CS cannulation procedures to avoid unsuccessful cannulation and complications related to repeated forceful cannulation.

Endoscopic Laser Dissection Combined With Laparoscopic Pneumovesical Repair of Vesicovaginal Fistula: A Novel Technique and Case Report

IntroductionWe present a novel technique that combined endoscopic laser dissection and a transvesical laparoscopic approach for VVF repair in a transmasculine patient who received vaginal colpectomy. A literature review of VVF repair was also conducted. Technical ConsiderationsSurgical repair of VVF has been described extensively in the literature. Transvaginal and transabdominal laparoscopic approaches are currently the most common techniques for VVF management. However, for transmasculine patients, neither of these methods is ideal due to either a previous history of vaginal colpectomy or the position of the fistula. This case report demonstrates the feasibility of applying a combined endoscopic laser dissection and transvesical laparoscopic approach for VVF repair. ConclusionThe patient had an uneventful recovery, and the VVF healed over time. The advantages of this technique include a precise incision and dissection of the fistula orifice, clear exposure of the anatomic plane between the bladder and vaginal wall, and minimal injury to normal tissue. More cases are needed to demonstrate the effectiveness and complication rate of this technique in the future.

Transvenous embolization of dural arteriovenous fistula of the cavernous sinus by identifying the orifice of the occluded inferior petrosal sinus through the angle of the microguidewire

ObjectiveTo describe that the angle of the microguidwire on lateral projection under fluoroscopic image is a prediction of cannulation of the occluded inferior petrosal sinus in the transvenous embolization of cavernous sinus dural fistulas. MethodsFrom January 2018 through January 2021, 12 cavernous sinus dural fistulas with ipsilateral inferior petrosal sinus occlusion identified in 12 consecutive patients were cured by cannulation of the occluded ipsilateral inferior petrosal sinus. Clinical, radiologic and procedure data of the 12 patients were retrospectively reviewed. The angle of microguidewire between on lateral projection under fluoroscopic image between the inferior petrosal sinus and the internal jugular vein was measured. ResultsIn the 12 patients, access via the occluded ipsilateral inferior petrosal sinus was primarily attempted as the transvenous approach. During the procedure, the angle of microguidwire on lateral projection under fluoroscopic image between the inferior petrosal sinus and the internal jugular vein was 117°±7°, which is very useful to confirm the cannulation of the occluded inferior petrosal sinus. Complete occlusion was achieved in all fistulas, with no procedure-related morbidity or mortality. Postprocedural symptom was improved in all patients. ConclusionCannulation of an occluded inferior petrosal sinus is possible and reasonable as an initial access attempt for cavernous sinus dural fistulas. The angle of microguidwire on the lateral projection under fluoroscopic image can help to confirm the orifice of the occluded inferior petrosal sinus.

Comparison of coronary arteries morphometry and distribution in bovines with humans and other animal species.

The left coronary artery (LCA) in the bovines is more developed than the right. The objective of the study is to describe the bovine coronary system from a morphological point of view, including the morphometry and its distribution. Arciform suture with 2.0 silk was applied around the sinus orifice and coronary ostium and a number 14 catheter was installed, to perfuse semi-synthetic polyester resin, consisting of a mixture of 85% GP40L palatal with 15% styrene with red color mineral. The average weight of 28 bovine hearts used in our study was 1.534.1 kg. The right coronary artery had a proximal caliber of 5 +/- 0.9 mm. The LCA caliber and length were 9.4 +/- 1.2 and 18.3 +/- 4.8 mm, respectively. This artery was divided into two branches in 85.7% of the cases and trifurcated in 14.3%. The paraconal interventricular branch (PIB) ended more frequently in the apex (46.4%), and its proximal caliber was 6.4 +/- 1.4 mm. The left circumflex branch ended in 82.1% in the subsinusal interventricular sulcus, and its proximal caliber was 5.9 +/- 1.2 mm. The proximal calibers of the PIB and the left circumflex branch did not present statistically significant differences (p = 0.137). The sinoatrial branch presented a dual origin (right and LCA) in 46.4% of the cases and a single origin from the LCA in 53.6% of the samples. In the evaluated hearts, left coronary dominance was observed in most cases (96.4%). Their presence of anastomosis between the branches of the coronary arteries was observed in 57.1% of cases. The presence of a myocardial bridge was found in six hearts (21.4%). In bovines, a high percentage of anastomosis was found, a protective factor in obstruction of the coronary arterial branches.