Main Source Of Blood Supply Research Articles

CT measurement of blood perfusion in hepatocellular carcinoma: from basic principle, measurement methods to clinical application

Hepatocellular carcinoma (HCC) is one of the common and fatal malignant tumors worldwide, and the burden of HCC is particularly severe in China. Physiologically, the blood supply to healthy liver is mainly from the portal vein, supplemented by the hepatic artery. While in the development of HCC, the main source of blood supply to HCC is changed from the portal vein to the hepatic artery. The characteristics of HCC vascularization are important for imaging, surgery, interventional therapy, targeted therapy, etc. Even in the future, with the development of radiation therapy technology, such as proton and heavy ion therapy and artificial intelligence technology, the dynamic changes in HCC blood perfusion can be used as a new biomarker of tumor activity to provide accurate information on the intensity modulation of radiotherapy, so that accurate measurements of HCC blood perfusion is of great significance in guiding the diagnosis and treatment of HCC. The technologies for measurement of HCC blood perfusion have developed from invasive techniques, such as inert gas scavenging, electromagnetic flowmeter, and radionuclide-labeled erythrocyte elution in the middle of the last century to the present non-invasive techniques of CT. With the development of CT imaging technology in the last 30 years, the CT-based imaging technology can assess the status of organ and tissue perfusion relatively easily and accurately. In this paper, the various CT measurement techniques of blood perfusion in HCC were categorized into three types: semi-quantitative technique, relative quantitative technique, and absolute quantitative technique. Their basic principle, scanning methods, and clinical applications were discussed to provide a reference for the diagnosis and treatment of HCC.

Sonographic Assessment of Maternal Portal Vein Diameter in Healthy Pregnancy in South-South Nigeria

Background: The portal vein is one of the main sources of blood supply of the liver. About three quarters of the liver blood flow is from the portal vein.
 Objectives: To assess the mean normal portal vein diameter in healthy pregnant women, and correlate our observation with maternal age, parity and other baseline characteristics.
 Subjects and Methods: This descriptive, cross-sectional study was conducted at the Obstetrics and Radiology Units of the two tertiary health facilities, one secondary facility and one radio-diagnostic facility in Bayelsa State, South-South Nigeria, between April, 2022 and December, 2022. Data analysis was done using Statistical Product and Service Solutions for Windows® version 25, SPSS Inc.; Chicago, USA. Descriptive statistics (mean, standard deviation, frequency, and percentages) and Pearson product moment correlation were used for the analysis. The level of significance was set at p<0.05.
 Results: Mean portal vein diameter was 10.43 ± 1.58 mm, and ranged from 7.5 mm to 14.0 mm. Maternal age (ɼ = 0.51; p – 0.001) and parity (ɼ = 0.47; p – 0.001) correlated fairly strong and significantly with portal vein diameter. Gestational age (ɼ = 0.21; p – 0.001) and estimated foetal weight (ɼ = 0.16; p – 0.001) were significantly related to the portal vein diameter.
 Conclusion: This research has established baseline values for normal range of PV diameter in healthy pregnant women in the South-South region of Nigeria, and also revealed significant correlation of PV diameter with age, parity, gestational age and estimated foetal weight.

The first experience of fluorescent angiography with indocyanine green in primary esophagoplasty with gastric conduit in patients with malignant tumors of the esophagus

To evaluate the possibilities of intraoperative indocyanine green fluorescein angiography (ICG technology) in primary esophagoplasty by gastric conduit in patients with malignant tumors of the esophagus. The study included 74 patients. Depending on the localization of the tumor in the esophagus, a Lewis-type or McKeown-type operation was performed. The retrospective group (surgery without the use of ICG technology) included 53 patients who underwent surgery from 2015 to 2020 years.The prospective group (surgery with the use ICG technology) included 21 patients operated on from 2021 to 2023 years. ICG technology was used to assess microcirculation in the gastric conduit during esophagoplasty, as well as to identify the right gastroepiploic artery. The ICG fluorescein angiography technique for assessing microcirculation in the gastric conduit was a simple and easily reproducible procedure. Perfusion of the gastric conduit was regarded as satisfactory in 16 (76%) cases, unsatisfactory in 5 (24%) cases, which required resection of the distal part of the conduit. All cases of poor perfusion were in patients with narrow gastric conduit and neck anastomosis location (McKeown-type operation). Anastomotic leakages occurred in 8 (15%) patients in the retrospective group, 4 (19%) patients in the prospective group (p>0.05). In 4 out of 5 cases of poor gastric conduit perfusion, anastomotic leaks occurred. Immediate postoperative results in the compared groups were also comparable. The use of ICG technology in 5 (45%) cases out of 11, when laparoscopic mobilization of the stomach was performed, helped to visualize the right gastroepiploic artery, which is the main source of blood supply to the formed gastric conduit. The use of ICG technology in 3 patients with a compromised gastrostomy stomach demonstrated the absence of significant microcirculation disorders in the stomach wall. The first experience of using fluorescein angiography with ICG in primary esophagoplasty by gastric conduit in patients with malignant tumors of the esophagus demonstrated the safety, simplicity and availability of this technique. An objective assessment of the effectiveness of the application of ICG technology requires the accumulation of experience.

A Study of Arterial Supply to Carotid Body Tumor and Its Prospective Implication in Clinical Practice

Introduction and Objectives: Arterial supply to carotid body tumor is primarily from ascending pharyngeal artery (APA), a branch of the external carotid artery, and with infrequent feeders from other branches of the latter described in the literature. The present study attempted in describing other sources of arterial supply to carotid body tumor and its implication in clinical practice. Materials and Methods: This study was retrospective to start with turning a prospective midway for 5 years from July 2017 to July 2022. The data of all the 12 patients, in whom seven males and five females with a mean average of 45 years, were analyzed, There were seven males and five females with the mean age of 45 years; the average size of the tumor documented was 5 cm. All the patients underwent computed tomography angiography for confirming the diagnosis. Three-dimensional volume-rendered images from the rotational angiogram were analyzed for assessing the arterial supply. All patients underwent surgical excision without embolization. Results: In all 12 patients, APA was found primarily the main source of blood supply. Four patients, in addition, had occipital artery and superior thyroid in one. Two patients were identified to have glomic artery arising from the bulb of the common carotid artery supplying the tumor. The thyrocervical trunk was also supplying the tumor in a patient. Anomalous branches from the internal carotid artery were found to be the sole source of arterial supply to the tumor in a patient. Conclusion: Surgical excision of carotid body tumors still continues to be a challenge due to multiple arterial feeders leading to hypervascularity. A detailed knowledge of arterial supply helps in proper planning and reducing perioperative bleeding. The glomic artery, and in rare cases, the internal carotid artery, also contribute as a feeder to the tumor. These unusual arterial feeders give an important warning before routine embolization to avoid cerebrovascular events.

Study on the morphology of nutrient foramens in humerus and its surgical implications

Long bones have large or small foramina for the entry of the blood-vessels. Such foramens are known as the nutrient foramina which are large in the shafts of the largest long bones. Such foramina lead to nutrient canals through which the blood vessels enters the bone supplying the medullary cavity. The site of entry and the direction of the nutrient foramina are almost constant and are directed away from the growing ends. The nutrient artery that passes through these foramina are the main source of blood supply to humerus and is particularly important during growth period in the embryo and foetus and also during the early stage of ossification. a. To determine the direction of nutrient foramen in humerus. b. To determine the number of nutrient foramen of humerus. c. To determine the location of nutrient foramen of humerus. The study was conducted on 120 adult humeri that were obtained from the Department of Anatomy, Sri Devaraj Urs medical college, Kolar, karnataka. Bones were segregated into right and left and observed for the direction, number and location of nutrient foramens in humerus In the present study, the percentage of humerus bones with one nutrient foramen was 87% and two foramina was 9% and absent in 4%. Single nutrient foramen on right humerus bones was 92% and left side was 4% and absent in 4%. Single nutrient foramen on left humerus bones was 83% and left side was 13% and absent in 4%. 59% of the bones had nutrient foramen that were located on the medial border. Following which, the order was Anteromedial surface in (25%), Lateral border in (5%), Posterior surface in (3%) and anterior border in (3%). 81% had the nutrient foramen that was located in the middle 1/3rd, 11% at the junction between middle 1/3rd and lower 1/3rd and 3% in the lower 1/3rd of humerus. All the nutrient foramina were directed towards the elbow joint and was away from the growing end as per the law of ossification. Nutrient artery is the main source of blood supply to long bones that enters through the nutrient foramen. The surgical and anatomical knowledge of nutrient foramen in humerus or any long bone is important for orthopaedic surgeons and general surgeons during surgical procedures on the humerus such as vascular surgeries, bone grafting and transplantation.

Arterial blood supply of the internal neck organs: anatomy, topography, clinical significance in endocrine surgery

BACKGROUND. Current trends of «fast track surgery» give rise to development of new safe techniques of the thyroid and parathyroid surgery, the purpose of which is to minimize the level of postoperative complications, such as vocal cord palsy, hypoparathyroidism, bleeding. In this regard, it is important for the endocrine surgeon to save «dry operating field», which contributes to the clear visualization of such «thin» structures as the recurrent laryngeal nerve, the external branch of the superior laryngeal nerve and the parathyroid glands. Therefore, the key issue of this surgery is to understand the anatomical and topographic features of the blood supply to the internal neck organs (a complex of neck organs consisting of the thyroid and parathyroid glands, larynx, trachea, esophagus).AIM. To determine the main sources of arterial blood supply of the internal neck organs and their anatomical, topographic features.MATERIALS AND METHODS. The computed tomography protocols of cervical branches of brachiocephalic arteries were analysed in the study. The thickness of the reconstructed sections in the axial, frontal and sagittal planes was 0.35±0.05 mm. The fact of blood supply was confirmed by the anatomical close of the arterial structure to the internal organ and the presence of intramural arterial branches.RESULTS. The course of all cervical branches of the subclavian and common carotid artery was traced among 42 patients. It is noted, that only the inferior, superior thyroid arteries and thyroid ima artery supply internal neck organs with the blood. At the same time, the superior thyroid artery was visualized in all angiograms. However, the inferior thyroid artery was absent in 2.4% of cases. The thyroid ima artery was rarely detected (in 4.8% of patients). In 73.2% of cases, the inferior thyroid artery was detected high at the upper third level of the thyroid lobe and then had a descending course. In 23.2% of cases, the artery was formed at the middle third level of the thyroid lobe and was directed horizontally to the gland. Only in 3.6% of cases, the ascending course was determined in the vessel. The inferior thyroid artery was located on the posterior surface of the thyroid lobe, where it formed glandular branches. On the contrary, the branches of the superior thyroid artery were located mainly along the anterolateral surface of the thyroid gland. The average thickness of the inferior thyroid artery was 2.1±0.5 mm, and the superior thyroid artery was 1.6± 0.7 mm.CONCLUSION. According to the study, arterial blood supply to the internal neck organs is provided mainly by the inferior and superior thyroid arteries. At the same time, the trunk of the inferior thyroid artery is larger than the superior thyroid artery (p=0.032). The inferior thyroid artery forms branches along the posterior surface of the thyroid lobe and from a topographic point of view it is the main source of blood supply to the parathyroid glands. In most cases, the inferior thyroid artery has a descending course, is directed along the posterior surface of the thyroid gland and forms an X-shaped intersection with the recurrent laryngeal nerve.

Internal and External Iliac Arterial Variations in a Single Human Cadaver: A Case Study

Introduction & ObjectiveThe common iliac arteries are the main source of blood supply to the pelvis, perineum, and gluteal region via the internal iliac arteries (IIAs) and lower limbs via the external iliac arteries (EIAs). While variation in the branching patterns of the IIA and EIA is common, previously documented studies only focus on one type of variation. The objective of this study was to document the combination of multiple IIA and EIA variations found in one human cadaver. During herniorrhaphies and other pelvic surgeries, surgeons must enter the retropubic space. This space often has significant variation in collateral circulation, making vasculature in the area susceptible to injury, especially those that cross or reside near the superior pubic ramus. Knowledge of variant IIA and EIA branching patterns will assist surgeons and interventional radiologists in modifying their approach to procedures involving the pelvic area and lower limb (e.g., hernia repairs, fixation of pelvic fractures, etc.), thereby improving patient morbidity and mortality.MethodsDetailed dissections of the IIA and EIA and their respective branches were performed in a single human cadaver following notation of bilaterally aberrant obturator arteries. All arterial variations were documented through notes, diagrams, and photography. An in‐depth literature review was performed to evaluate the significance and frequency of the observed variations.ResultsThe left lower extremity had the following variations: absence of an inferior gluteal artery, an aberrant path of the superior gluteal artery, the inferior epigastric artery sharing a common trunk with the obturator artery from the profunda femoris artery, and anomalous branching of the femoral artery consisting of three larger branches, one noted to be the medial circumflex artery and the other two noted to be unusually large muscular branches. The right lower extremity had a similar aberrant obturator artery, although the common trunk shared with the inferior epigastric artery arose from the EIA.Conclusion/SignificanceAdditional arterial variations of the EIAs and IIAs were found upon further dissection differing bilaterally. It is essential for these variations to be documented along with the many others discovered previously. Lack of knowledge about arterial variation can lead to complications, such as femoral head osteonecrosis or significant hemorrhage during herniorrhaphy, fixation of pelvic fractures, and other pelvic/lower limb procedures. Therefore, knowledge of possible arterial variations of the human body can improve patient morbidity and mortality during routine surgical procedures, emergent surgical procedures, and various injuries in patients with vascular anomalies such as those documented in this study.

CHRONIC MESENTERIC ISCHEMIA IN TYPE 2 DIABETES PATIENTS

BACKGROUND: Type 2 Diabetes mellitus (T2DM) currently effects 8.9% of the world's population.The macrovascular complications of diabetes are 3 times more common than the microvascular complications.Involvement of the vessels of gut in T2DM hasn't been studied exclusively like the other known macrovascular complications.This study focusses on the effect of T2DM on the Coeliac artery(CA) and Superior Mesenteric artery (SMA) which are the main source of blood supply to the organs derived from fore and midgut . METHODS: In our study over 2 years, 72 patients of T2DM were subjected to Duplex Ultrasonography.15 randomly selected patients who satised the Fasting Duplex velocity criteria and 15 randomly selected patients who did not were subjected to CT Angiography. RESULTS: We found that 22 patients (30.55%) out of the 72 had features suggestive of Chronic Mesenteric Ischemia (CMI) in both the coeliac artery and SMA on duplex ultrasound and 8 patients (26.66%) out of 30 had conrmed CMI by CT angiogram. CONCLUSION: th We found that every 4 diabetic had CMI. We would like to emphasize that the vasculature of the gut can be affected in T2DM and this should inspire a lot of research and prospective studies relating CMI to GIT manifestations of T2DM.

English

BACKGROUND Nutrient foramina are seen in the shaft of long bones. They vary in number, size and their position on the surface of bones. It transmits the nutrient artery which is the main source of blood supply to the long bones. We intend to study the location, number, type and direction of primary nutrient foramina (PNF) on the shaft of tibia. METHODS The descriptive study was done using 120 tibiae (right-66, left-54) from Department of Anatomy, Govt. Medical College, Thiruvananthapuram. Length of each bone and distance of the nutrient foramen from the upper end of tibia was measured using osteometric board. The location of the primary nutrient foramina on the surface of tibia, the direction of the nutrient canal and the presence of secondary nutrient foramina were noted. RESULTS Single primary nutrient foramina were located on the posterior surface of 113 tibiae. 4 tibiae showed PNF and secondary nutrient foramina (SNF). No nutrient foramina were observed in 3 tibiae. CONCLUSIONS The precise knowledge and topography of PNF of tibia will help orthopaedic surgeons in minimising damage to vasculature of tibia during various surgical procedures. KEY WORDS Tibia, Nutrient Foramen, Nutrient Artery

Distal pancreatectomy with resection of the celiac trunk, right or left hepatic artery without arterial reconstruction (extended DP-CAR)

To evaluate safety and postoperative outcomes of DP-CAR with resection of one of the lobar hepatic arteries without arterial reconstruction (extended DP-CAR). Perioperative data and survival after 7 extended DP-CARs R0 were retrospectively analyzed. Arterial blood flow in the liver was assessed using intraoperative ultrasound and postoperative CT angiography. Among 40 DP-CARs, resection of left or right hepatic artery was performed in 7 cases of aberrant anatomy including 1 case of portal vein resection. Mortality and ischemic complications were not observed. The main source of blood supply to the «devascularized» liver lobe was interlobar communicating artery or the arcade of the lesser curvature of the stomach. Incidence of pancreatic fistula was 44%, mean blood loss - 230 (100-650) ml, surgery time - 259 (195-310) min, mean hospital-stay - 14 (9-26) days. Median survival of patients with pancreatic ductal adenocarcinoma was 25 months after combined treatment. Three patients died after 26, 28 and 77 months. Other patients are alive without progression for 109, 24, 23 and 12 months after therapy onset. Extended DP-CAR is advisable and safe procedure if reliable intraoperative control of liver and stomach blood supply is ensured.

The structure and blood supply to the Baikal seal s organ of hearing

The article studies anatomical features of the structure and blood supply to the outer ear, the middle ear and the inner ear of the Baikal seal. The outer ear has no auricle. The long external auditory meatus has a slightly curved shape of various diameters and cartilaginous plates. The bone base of the middle ear is a triangular-shaped tympanic bubble. It has specific features in the topography of openings for the facial nerve and the bony auditory tube. The drum cavity is voluminous, repeats the contour of the tympanic bladder. It contains auditory ossicles (malleus, anvil, lenticular ossicles and stapes). The inner auditory meatus is deep; the entrance to the aqueduct is located medially on the rocky part of the inner ear. The main source of blood supply to the organ of hearing is the occipital (blood supply to the opening area of the bony auditory tube) and caudal ear deep temporal (blood supply to the area of the external auditory canal; they are formed form the external vascular network of tympanic membrane skin) arteries. They are branches of the external carotid artery, as well as the internal auditory (blood supply to the facial nerve and forms the internal vasculature) and rocky (blood supply to the vestibule, semicircular canals and cochlea) branches of the basilar artery.

GENERAL CHARACTERISTICS OF THE MAIN MORPHOMETRIC INDICATORS OF THE SHAPE AND ANGIOARCHITECTURE OF THE HUMAN GREATER OMENTUM

The review examines the age characteristics of the greater omentum, its metric and topographic parameters. It has been revealed that the shape of the greater omentum can be single-, two- and multi-lobular, which is determined by its loose part. The linear dimensions of the greater omentum are consistent with the stature type and age range. The length of the loose portion of the greater omentum varies widely and ranges from 20 to 43 cm (average 31.58 ± 0.8 cm); the area of the surface of the greater omentum in adults reaches an average of 0.81 m2, which is almost half the entire surface of the peritoneum and is on average 0.40 m2. The range of individual variability in the size of the greater omentum varies at different ages of the child's development. It is especially large at the end of the first year of life. In the next 2-4 years of life, the range of variability of the greater omentum narrows slightly, the largest growth of linear sizes of the greater omentum is observed during the first year of life of the child and they increase by 2 times, and the area – by 3 times. The asymmetry of the longitudinal dimensions of the greater omentum on the right and left also increases. The boundaries of the greater omentum are: liver, spleen, parietal peritoneum of anterior abdominal wall, small intestine, ascending and descending part of the colon. It has been revealed that the main source of blood supply of the human greater omentum is the abdominal and upper mesenteric arteries, the anterior duplication of the greater omentum receives nutrition from the short and long omental arteries, and numerous small arterial vessels are involved in the blood supply of the upper left part of the omentum; they are located in the thickness of the gastro-splenic ligament. Usually 5-13 branches ramify from the right gastrointestinal artery, and one branches off from the left one. The left gastrointestinal artery has a length of 7 to 21 cm and the right gastrointestinal artery – from 10 to 38 cm.

Multiple Variations in Third Segment of Axillary Artery

Variations in the subscapular artery (SA) have been well documented and acknowledged as the most common variation in the axillary artery (AA). Although this is true, a variation of the third portion of the AA was found during dissection of the right upper limb of a female cadaver. This portion of the AA was found to give rise to a proximal SA, followed by a common trunk with 4 ramifications and distally, to the anterior circumflex humeral a. The common trunk gave rise to a second SA, posterior circumflex humeral a., scapular circumflex a., and the thoracodorsal a. Both SA branches were found to be irrigating the subscapularis m., implicating a possible dual and collateral supply. The posterior circumflex humeral a. was identified as it traversed posteriorly to reach the surgical neck of the humerus along with the axillary n. through the quadrangular space. The scapular circumflex a. was identified as it passed backward around the lower border of the scapula into the triangular space. Finally, the thoracodorsal a. gave off a branch to the latissimus dorsi m. and continued its course along the lateral thoracic wall to give off multiple branches to the serratus anterior m. It appears that the thoracodorsal branch reaching the serratus anterior m. is its main source of blood supply since the lateral thoracic a. was not found arising from the AA at any point. These findings are different from what is commonly documented. Usually, the AA is divided into three segments based on its relationship with the pectoralis minor m. The second portion of the AA gives rise to the thoracoacromial a., just posterior to the medial superior margin of the pectoralis m., and to the lateral thoracic a., passing downward behind the pectoralis minor m. along its inferolateral border. The third portion of the AA, which lies on the subscapularis m. and teres major m., gives rise to the anterior circumflex humeral a., the posterior circumflex humeral a., and the SA. The SA is commonly the largest branch of the AA, it runs downward on the costal surface of the subscapularis m. before it divides into the scapular circumflex a. and the thoracodorsal a. These arteries provide the major blood supply to the posterior wall of the axilla. Acknowledging the possibility of a variation from normal anatomy is relevant when interpreting imaging studies such as angiographs or during axillary surgical preparation due to possible pressure on the brachial plexus and vessels of the axilla when there is downward displacement of the head of the humerus. The suitability of the SA system as a donor for arterial grafts during upper limb circulation restoration is of great clinical importance. Their angle of rotation and their large, stable diameter render these arteries appropriate for a variety of flaps in plastic surgery. These clinical correlations can be further studied by exploring the embryology of these arteries. Normally, the subclavian a. arises from the 4th aortic arch and the 7th intersegmental a. It continues to develop as the limb bud grows; therefore, since the variations observed occur past the subclavian a., it seems that the vascular plexus was affected during development of the upper limb bud. Knowing this will help guide surgeons when exposed to such variations if a malformation during fetal limb development is suspected.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

A cadaveric study on variations of the cystic artery in the department of pathology, at the University Teaching Hospitals, Lusaka, Zambia

The main source of blood supply to the gall bladder is the cystic artery which is a branch of the right hepatic artery. Anatomical variations of the cystic artery are frequent. Thus, careful dissection of the Calot`s triangle is necessary for conventional and laparoscopic cholecystectomy. The knowledge of variations of the origin, course, and length of the cystic artery is important for the surgeon as bleeding from the cystic artery during cholecystectomy can lead to death. Thirty-two post-mortem human cadavers at the University Teaching Hospitals, Pathology Department, Lusaka were dissected and examined over a period of five weeks, to establish the origin, length and course of the cystic artery. And to establish the relationship of the cystic artery to the cystic duct. Out of the 32 human cadavers, the cystic artery was found to be originating from the right hepatic artery in twenty-eight (87.5%), from hepatic artery proper in three (9.4%) and from the left hepatic artery in one (3.1%). In the twenty-nine (90.6%) cadavers dissected, only one cystic artery was identified and in three (9.4%)others there were two arteries detected. The cystic artery length ranged from 2 – 6 cm (mean 3.56± 1.0285 cm). The cystic artery was found to be inside Calot`s triangle in twenty-seven (84.3%) while in three (9.4%) cadavers it was outside the Calot`s triangle. The cystic artery was found to be passing supero-medial to the cystic duct in thirty (93.7%) cadavers while in two (6.3%) the cystic artery was passing anterior to the cystic duct. Demographic characteristic (gender and age) had no statistically significant association to variations of cystic artery (p>0.005). Five (18.5%) of males had variants of cystic artery and no females had variants of the cystic artery. Variations of the cystic artery origin, length, its course through the Calot`s triangle and its relation to the cystic duct are common. Knowledge of these variations is important and helpful in preventing and controlling haemorrhage or avoiding other complications during conventional and laparoscopic cholecystectomy. Key words: Cystic artery, Variations, Cholecystectomy, Calot`s triangle

Retracted: Cadaveric study on variations of the cystic artery in a Zambian population

This article has been retracted by the authors. An incorrect dataset was used, therefore the resullts are misleading.The main source of blood supply to the gall bladder is the cystic artery which is a branch of the right hepatic artery. Anatomical variations of the cystic artery are frequent. Thus, careful dissection of the Calot`s triangle is necessary for conventional and laparoscopic cholecystectomy. The knowledge of variations of the origin, course, and length of the cystic artery is important for the surgeon as bleeding from the cystic artery during cholecystectomy can lead to death. Forty-three post-mortem human cadavers at the University Teaching Hospitals, Pathology Department, Lusaka were dissected and examined over a period of five weeks, to establish the origin, length and course of the cystic artery. And to establish the relationship of the cystic artery to the cystic duct. Out of the 43 human cadavers, the cystic artery was found to be originating from the right hepatic artery in 37 cases (86%), from hepatic artery proper in four cases (9.3%), from the left hepatic artery in one case (2.3%) and liver parenchyma in one case (2.3%). In the forty (93%) cadavers dissected, only one cystic artery was identified and in three (7%) others there were two arteries detected. The cystic artery length ranged from 2 – 6 cm (mean 3.53± 0.962 cm). The cystic artery was found to be inside Calot`s triangle in 37 cases (86%) while in four cases (9.3%) it was outside the Calot`s triangle. The cystic artery was found to be passing supero-medial to the cystic duct in 40 cases (93%) while in two cases (4.7%) the cystic artery was passing anterior to the cystic duct and one (2.3%) was unrelated (from the gall bladder bed) to the cystic duct. Demographic characteristic (gender and age) had no statistically significant association to variations of cystic artery (p>0.005). Six (16.2%) of males had variants of cystic artery and no females had variants of the cystic artery. Variations of the cystic artery origin, length, its course through the Calot`s triangle and its relation to the cystic duct are common. Knowledge of these variations is important and helpful in preventing and controlling haemorrhage or avoiding other complications during conventional and laparoscopic cholecystectomy.Keywords: Cystic artery, Cholecystectomy, Calot`s triangle

Current Status of Forensic Identification for Blunt Injuries of Internal Carotid Arterial System

Internal carotid arterial system is the main source of blood supply in brain. In forensic identification practice, blunt injures of internal carotid arterial system usually cause complications such as thrombus, aneurysm and arteriovenous fistula, etc. The deaths following delayed cerebral infarction or intracranial haemorrhage are not rare. At present, literature of deaths caused by blunt injuries of internal carotid arterial system mainly consist of case reports in China. This paper reviews related literature and case reports at home and abroad, and summarizes forensic medical features and identification method of the deaths caused by such injuries. The results show that blunt injures of internal carotid arterial system are related to the direct or indirect force on head and neck, which can result in exceed physiological range traction of head and neck, incision following basicranial fracture, etc. Such injuries are common in the cases as mechanical asphyxia, cervical manipulation, traffic accident and fall, etc. The artery should be examined carefully, and the relationship among injury, disease and death should be analysed correctly when no cause of infarction and hemorrhage was found in routine examination of such cases in forensic pratice. Because of the difficulty for exposing the artery completely in autopsy, angiography can be used to infer the location when necessary for improving the scientificity and reliability of the appraisal conclusion.

Influence of Gender and Age on Average Dimensions of Arteries Forming the Circle of Willis Study by Magnetic Resonance Angiography on Kosovo's Population.

BACKGROUND:Circulus arteriosus cerebri is the main source of blood supply to the brain; it connects the left and right hemispheres with anterior and posterior parts. Located at the interpenducular fossa at the base of the brain the circle of Willis is the most important source of collateral circulation in the presence of the disease in the carotid or vertebral artery.AIM:The purpose of the research is to study the diameter and length of arteries and provide an important source of reference on Kosovo’s population. METHODS:This is an observative descriptive study performed at the University Clinical Center of Kosovo. A randomised sample of 133 angiographic examinations in adult patients of both sexes who were instructed to exploration is included.RESULTS:The diameters and lengths measured in our study were comparable with other brain-cadaver studies especially those performed by MRA. All dimensions of the arteries are larger in male than female, except the diameter of PCoA that is larger in female (p < 0.05) and length of the ACoA (p < 0.05). Significant differences were found in diameters of arteries between the younger and the older age groups.CONCLUSION:Knowing the dimensions of the arteries of the circle of Willis has a great importance in interventional radiology as well as during anatomy lessons.

The anatomy basis and clinical application of the horn fasciocutaneous perforator flaps for the reconstruction of the defects on finger soft tissue

To discuss the clinical effect of horn perforator flaps for the treatment of finger soft tissue defect. ① Lead oxide-gelatin mixture injection and CT scanning were performed in 4 fresh adult cadavers and the data was put into mimics 17.0 to achieve the three-dimensional reconstruction. The regulation and origins of the perforator vessel in proper palmar digital artery was observed. ② From July 2012 to July 2015,9 cases with finger soft tissue defects were treated with horn perforator flaps. The defect areas ranged from 0.6 cm × 0.8 cm to 1.2 cm × 1.5 cm and the flap size ranged from0.8 cm×2.5 cm to 1.6 cm×4.2 cm. We put the head end of flaps at defect side. The horn perforator flap was designed with 1-2 perforator vessel and rotated to cover the defect. The defect at donor site was closed directly. We got 4 symmetric arteries in palmar and back surfaces of fingers,2 for proper palmar digital arteries and 2 for dorsal digital arteries. The proper palmar digital arteries have a larger diameter which is the main source of blood supply for fingers. All 9 flaps survived after the operation. Both the recipient area and donor areas received sound healing. With 2 months to 1.5 years of follow-up visit, the shape, color and luster, texture and function all had good healing. The horn perforator flaps for repair finger soft tissue defect have advantages of flexible design, reliable perforator vessels. The defect at donor site can be closed directly with no skin graft. This method considers both shape and function and is a good way for finger soft tissue defect.

Bronchial arteries: anatomy, function, hypertrophy, and anomalies.

The two main sources of blood supply to the lungs and their supporting structures are the pulmonary and bronchial arteries. The bronchial arteries account for 1% of the cardiac output but can be recruited to provide additional systemic circulation to the lungs in various acquired and congenital thoracic disorders. An understanding of bronchial artery anatomy and function is important in the identification of bronchial artery dilatation and anomalies and the formulation of an appropriate differential diagnosis. Visualization of dilated bronchial arteries at imaging should alert the radiologist to obstructive disorders that affect the pulmonary circulation and prompt the exclusion of diseases that produce or are associated with pulmonary artery obstruction, including chronic infectious and/or inflammatory processes, chronic thromboembolic disease, and congenital anomalies of the thorax (eg, proximal interruption of the pulmonary artery). Conotruncal abnormalities, such as pulmonary atresia with ventricular septal defect, are associated with systemic pulmonary supply provided by aortic branches known as major aortopulmonary collaterals, which originate in the region of the bronchial arteries. Bronchial artery malformation is a rare left-to-right or left-to-left shunt characterized by an anomalous connection between a bronchial artery and a pulmonary artery or a pulmonary vein, respectively. Bronchial artery interventions can be used successfully in the treatment of hemoptysis, with a low risk of adverse events. Multidetector computed tomography helps provide a vascular road map for the interventional radiologist before bronchial artery embolization.

Maximal and submaximal mouth opening with mouth gags in cats: Implications for maxillary artery blood flow

The use of spring-loaded mouth gags in cats can be associated with the development of central neurological deficits, including blindness. In this species, the maxillary arteries are the main source of blood supply to the retinae and brain. Spring-loaded gags generate constant force after placement that could contribute to bulging of the soft tissues between the mandible and the tympanic bulla. Under these circumstances, the maxillary arteries can become compressed as they course between these osseous structures. Smaller gags that might apply less force to the mouth were investigated to determine if they preserved maxillary artery blood flow. Six healthy adult cats were anesthetized. Electroretinography (ERG) and magnetic resonance angiography (MRA) were performed without the use of a mouth gag and during submaximal (plastic mouth gags of 20, 30 and 42mm in length between canine teeth) and maximal mouth opening.Maximal mouth opening produced alterations in ERG waveforms consistent with circulatory compromise in 1/6 cats and reductions in signal intensity during MRA in 4/6 cats. Placement of a 42mm plastic gag produced a reduction in MRA signal in 1/6 cats. No changes were observed with smaller gags. The force applied against the mouth was significantly higher with the spring-loaded gag than with any other gags. The use of a smaller mouth gags was associated with fewer alterations of indicators of maxillary artery blood flow. Nevertheless, a 42mm plastic gag, equivalent to the size of a needle cap, resulted in an abnormal MRA in one cat.