Major Vessels Research Articles

The 2-by-2 Inch “Key Window” in the Upper Extremity: An Anatomical Appraisal of the Accessibility and Proximity of the Major Nerves and Vessels

The brachial plexus is a network of nerves located between the neck and axilla, which receives input from C5-T1. Distally, the nerves and blood vessels that supply the arm and forearm form a medial neurovascular bundle. The purpose of this study was to illustrate that a peripheral nerve dissection via a 2×2 inch window would allow for identification and isolation of the major nerves and blood vessels that supply the arm and forearm. A right side formalin-fixed latex-injected cadaveric arm was transected at the proximal part of the axillary fold and included the scapular attachments. Step-by-step anatomical dissection was carried out and documented with three-dimensional digital imaging. A 2×2 inch window centered 2 inches distal to the axillary fold on the medial surface of the arm enabled access to the major neurovascular structures of the arm and forearm: the median nerve, ulnar nerve, medial antebrachial cutaneous nerve, radial nerve and triceps motor branches, musculocutaneous nerve and its biceps and brachialis branches and lateral antebrachial cutaneous nerve, basilic vein and brachial artery and vein, and profunda brachii artery. Our study demonstrates that the majority of the neurovascular supply in the arm and forearm can be accessed through a 2×2 inch area in the medial arm. Although this "key window" may not be entirely utilized in the operative setting, our comprehensive didactic description of peripheral nerve dissection in the cadaver laboratory can help in safer identification of complex anatomy encountered during surgical procedures.

Laparoscopic entry in obese patients: Jain point

Objectives: The study aims to analyze the safety of a novel entry port, the Jain Point for first blind laparoscopic entry port in obese patients, which is non umbilical in position, located in mid abdomen, applicable in patients with or without previous surgery. Methods: The study was conducted at an advanced laparoscopy center between January 2011 to December 2023. Total 9715 patients underwent laparoscopy and out of these, 1362 were selected and categorized as per WHO criteria for obesity. The selection criteria were solely based on BMI. All first blind entries were made by Jain point. The entry related complications were compared with other conventional techniques. Results: In the study period, 1362 obese patients were operated. Time spent in establishing the pneumoperitoneum and trocar entry was comparable to other conventional approaches with a short learning curve. Major complications in the form of MRV (major retroperitoneal vessel) injury was not noted in our series. No injury to stomach and any other viscera noted. Minor complications in the form of prepertioneal insufflation and omental emphysema in 2.7% and failed entry were noted in 1% cases. All surgeries were completed laparoscopically and majority of patients were discharged in 24 to 48 hours. Conclusions: Keeping in context the safety of non umbilical entry ports, this study proposes Jain Point a, lateral, non-umbilical, primary blind entry port, as a viable option in obese patients, with or without previous surgeries.

Laparoscopic Management of Adrenal and Extra-Adrenal Pheochromocytoma

Background and Purpose Laparoscopic management of extra-adrenal pheochromocytoma requires meticulous surgical procedures because of the variable anatomic position and/or proximity to major blood vessels and the potential catecholamine surge during operation. We present our experiences with laparoscopic management of extra-adrenal pheochromocytoma and compare the intraoperative hemodynamics with those during laparoscopic resection of adrenal pheochromocytoma. Patients and Methods We retrospectively reviewed the medical records of 3 patients who underwent laparoscopic management of extra-adrenal pheochromocytoma (retrocaval, n=1; interaortocaval, n=1; periadrenal, n=1) and 24 patients who underwent laparoscopic management of adrenal pheochromocytoma between June 2005 and June 2023. We also evaluated fluctuations in blood pressure (BP) reported during both surgeries. Results The tumors were successfully resected under laparoscopic guidance in both groups, and one patient had converted to open surgery. Intraoperative hypertension (BP>200 mm Hg) was observed in 1 extra-adrenal pheochromocytoma and 13 adrenal pheochromocytoma patients, whereas intraoperative hypotension (BP <80 mm Hg) was observed in 1 extra-adrenal pheochromocytoma and 12 adrenal pheochromocytoma patients. Conclusion Laparoscopy is the method of choice for extra-adrenal resection because it is feasible and reproducible with appropriate preoperative planning, similar to adrenal resection.

Artificial intelligence-based quantitative coronary angiography of major vessels using deep-learning

BackgroundQuantitative coronary angiography (QCA) offers objective and reproducible measures of coronary lesions. However, significant inter- and intra-observer variability and time-consuming processes hinder the practical application of on-site QCA in the current clinical setting. This study proposes a novel method for artificial intelligence-based QCA (AI-QCA) analysis of the major vessels and evaluates its performance. MethodsAI-QCA was developed using three deep-learning models trained on 7658 angiographic images from 3129 patients for the precise delineation of lumen boundaries. An automated quantification method, employing refined matching for accurate diameter calculation and iterative updates of diameter trend lines, was embedded in the AI-QCA. A separate dataset of 676 coronary angiography images from 370 patients was retrospectively analyzed to compare AI-QCA with manual QCA performed by expert analysts. A match was considered between manual and AI-QCA lesions when the minimum lumen diameter (MLD) location identified manually coincided with the location identified by AI-QCA. Matched lesions were evaluated in terms of diameter stenosis (DS), MLD, reference lumen diameter (RLD), and lesion length (LL). ResultsAI-QCA exhibited a sensitivity of 89% in lesion detection and strong correlations with manual QCA for DS, MLD, RLD, and LL. Among 995 matched lesions, most cases (892 cases, 80%) exhibited DS differences ≤10%. Multiple lesions of the major vessels were accurately identified and quantitatively analyzed without manual corrections. ConclusionAI-QCA demonstrates promise as an automated tool for analysis in coronary angiography, offering potential advantages for the quantitative assessment of coronary lesions and clinical decision-making.

Multispectral Optoacoustic Tomography Enables In Vivo Anatomical and Functional Assessment of Human Tendons.

Tendon injuries resulting from accidents and aging are increasing globally. However, key tendon functional parameters such as microvascularity and oxygen perfusion remain inaccessible via the currently available clinical diagnostic tools, resulting in disagreements on optimal treatment options. Here, a new noninvasive method for anatomical and functional characterization of human tendons based on multispectral optoacoustic tomography (MSOT) is reported. Healthy subjects are investigated using a hand-held scanner delivering real-time volumetric images. Tendons in the wrist, ankle, and lower leg are imaged in the near-infrared optical spectrum to utilize endogenous contrast from Type I collagen. Morphology of the flexor carpi ulnaris, carpi radialis, palmaris longus, and Achilles tendons are reconstructed in full. The functional roles of the flexor digitorium longus, hallicus longus, and the tibialis posterior tendons have been visualized by dynamic tracking during toe extension-flexion motion. Furthermore, major vessels and microvasculature near the Achilles tendon are localized, and the global increase in oxygen saturation in response to targeted exercise is confirmed by perfusion studies. MSOT is shown to be a versatile tool capable of anatomical and functional tendon assessments. Future studies including abnormal subjects can validate the method as a viable noninvasive clinical tool for tendinopathy management and healing monitoring.

Characteristic of Clinical Likelihood Chronic Coronary Syndrome patients with Significant Coronary Lesion in RSUP dr. Mohammad Hoesin Palembang

Chronic coronary syndrome (CCS) is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial arteries, whether obstructive or non-obstructive. Significant Coronary artery disease (CAD) is defined by invasive coronary angiography as >50% stenosis of the left main stem, >70% stenosis in a major coronary vessel, or 30% to 70% stenosis with fractional flow reserve ?0.8. This study aimed to identify the characteristics of clinical likelihood CCS patients with site of significant coronary lesion based on pre-test probability (PTP) from demographic characteristics; risk factors; laboratory and echocardiography findings. This is a retrospective cohort study. We reviewed 60 medical records of clinical likelihood chronic coronary syndrome patients with positive inducible ischemia area from dobutamine stress echocardiography and significant CAD lesion from coronary angiography. The incidence of significant CAD in this population was 56.1%. There was a significant relationship between age > 65 years with the incidence of significant LAD lesion (23.3%, p = 0.019); significant LCx lesion (20%, p = 0.043). There was a significant relationship between PTP score ? 16% with significant LAD lesion (55.0%, p = 0.001); significant LCx lesion (45.0%, p = 0.031); and significant RCA lesion (40.0%, p = 0.050). Patients with age > 65 years have a higher incidence of significant LAD and LCx lesions. Patients with pre-test probability score ? 16% have a higher incidence of significant lesions across coronary branches, predominantly in the LAD.

Multicenter Prospective Cohort Study of Neoadjuvant Chemotherapy for Borderline Resectable Pancreatic Cancer (YPB-001).

The present multicenter prospective observational study investigated the effectiveness and safety of neoadjuvant chemotherapy (NAC) for patients with borderline resectable pancreatic cancer (BRPC) and those with RPC contacting major vessels, with respect to a historical control of upfront surgery. Patients with BRPC and RPC contacting major vessels were prospectively registered and administered NAC with durations and regimens determined by the corresponding treating physician. Our primary aim was to assess the R0 resection rate, and secondary aim was to evaluate safety, resection rate, time to treatment failure, overall survival, and response rate. Fifty of 52 enrolled patients were analyzed; 2 with serious comorbidities died during treatment. Thirty-one patients underwent resection, with R0 resection being achieved in 26 (52% of total and 84% of all resected cases). Univariate and multivariate analyses indicated age (≥75 years) as the only independent predictor of nonresection. Median progression-free survival and median survival time were longer in the prospective cohort than in the historical cohort. Overall, NAC for BRPC in real-world setting might yield R0 resection rates similar to those reported in previous clinical studies. Development of safe regimens and management strategies that can maintain treatment intensity in geriatric patients is warranted.

Preoperative Simulation of Endoscopic Endonasal Approach for Craniopharyngiomas or Tuberculum Sellae Meningiomas

Preoperative simulation for endoscopic endonasal approach(EEA)using computed tomography and magnetic resonance imaging evaluates tumor extension and the relationship between adjacent structure(the pituitary stalk, major vessels, and cranial nerves); therefore, preoperative planning of nasal procedure, skull base bony removal, and cranial base reconstruction are possible. Additionally, three-dimensional(3D)fusion image aids surgeons to visualize intraoperative 3D findings. These preoperative simulations are critical to avoid complications and predict pitfalls perioperatively. However, tumor consistency or adhesion with adjacent structure cannot be predicted but is judged perioperatively, which affects the extent of tumor resection. This manuscript describes important points of preoperative simulation for EEA, especially the transplanum-transtuberculum approach for craniopharyngiomas or tuberculum sellae meningiomas, showing some examples in patients.

EphB1 controls long-range cortical axon guidance through a cell non-autonomous role in GABAergic cells.

EphB1 is required for proper guidance of cortical axon projections during brain development, but how EphB1 regulates this process remains unclear. We show here that EphB1 conditional knockout (cKO) in GABAergic cells (Vgat-Cre), but not in cortical excitatory neurons (Emx1-Cre), reproduced the cortical axon guidance defects observed in global EphB1 KO mice. Interestingly, in EphB1 cKOVgat mice, the misguided axon bundles contained co-mingled striatal GABAergic and somatosensory cortical glutamatergic axons. In wild-type mice, somatosensory axons also co-fasciculated with striatal axons, notably in the globus pallidus, suggesting that a subset of glutamatergic cortical axons normally follows long-range GABAergic axons to reach their targets. Surprisingly, the ectopic axons in EphB1 KO mice were juxtaposed to major blood vessels. However, conditional loss of EphB1 in endothelial cells (Tie2-Cre) did not produce the axon guidance defects, suggesting that EphB1 in GABAergic neurons normally promotes avoidance of these ectopic axons from the developing brain vasculature. Together, our data reveal a new role for EphB1 in GABAergic neurons to influence proper cortical glutamatergic axon guidance during brain development.

Clinical outcomes in borderline and locally advanced pancreatic cancer with the addition of low-dose-rate brachytherapy to standard of care therapy

PURPOSESurgical resection remains the only curative therapy for pancreatic cancer. Unfortunately, many patients have borderline or unresectable disease at diagnosis due to proximity of major abdominal vessels. Neoadjuvant chemotherapy and radiation are used to down-stage, however, there is a risk that there will be a positive/close surgical margin. The CivaSheet is a low-dose-rate (LDR) brachytherapy device placed at the time of surgery to target the area of highest risk of margin positivity. The purpose of this study is to assess the clinical value of brachytherapy in addition to standard-of-care therapy in pancreatic therapy. METHODS AND MATERIALSBetween 2017 and 2022 patients with borderline and locally advanced pancreatic cancer treated with neoadjuvant chemotherapy and radiation followed by surgical resection were included. There were 2 cohorts of patients: (1) Those who had the LDR brachytherapy device placed at the time of surgery and (2) those who did not. Sixteen of 19 (84%) patients who had brachytherapy were enrolled in a prospective clinical trial (NCT02843945). Patients were matched for comorbidities, cancer staging, and treatment details. The primary outcome was progression-free survival (PFS). RESULTSThirty-five patients were included in this analysis, 19 in the LDR brachytherapy group and 16 in the comparison cohort. The 2-year PFS was 21% vs. 0% (p = 0.11), 2-year OS was 26% vs. 13% (p = 0.43), and the pancreatic cancer cause-specific survival was 84% vs. 56% (p = 0.13) in favor of the brachytherapy patients. CONCLUSIONSUse of LDR brachytherapy at the time of resection shows a trend towards improved progression free and overall survival for patients with borderline or locally advanced pancreatic cancer treated with neoadjuvant chemoradiation.

Effective and Safe Treatment of Risky Localized Liver Tumors Using Microwave Ablation in Patients with Comorbid Lung Diseases Unfit for Deep Anesthesia.

To assess the safety and efficacy of percutaneous microwave ablation (MWA) in treating high-risk localized liver tumors in patients unable to undergo deep anesthesia because of comorbid lung diseases. Between January 2019 and January 2022, percutaneous MWA procedures were performed for 50 liver tumors. These lesions were situated in close proximity to anatomically essential structures, with a maximum distance to surrounding structures being 10 mm. Because of comorbid lung diseases, patients could not undergo deep anesthesia. Regular follow-ups were performed using blood tests and dynamic contrast-enhanced computed tomography or magnetic resonance imaging. The patient cohort consisted of 30 (68%) men and 14 (32%) women, with a mean age of 64.36±11.65 years (range: 40-80 years). The lesions were challenging to access and were located in proximity to critical structures such as the diaphragm (32, 64%), gallbladder (8, 16%), major vessels (5, 10%), and heart (5, 10%). During the follow-up period, 10 patients (23%) had local tumor recurrence and 14 (32%) had new primary foci in a different location and metastasis [liver (10) and non-liver organs (4)]. No major complications developed, and 21 of 44 patients experienced minor complications, which were treated with local medications during follow-up. Percutaneous MWA results in very low mortality and morbidity, coupled with high complete ablation rates for liver cancer. Most liver tumors can be treated safely and effectively with percutaneous MWA, even in cases of high-risk localization, without the need for deep anesthesia.

Морфометрические особенности сердца у детей 7–10 лет, проживающих на территории Архангельской области

The purpose of this paper was to determine the morphometric characteristics of the heart in 7–10-year-old children living in the Arkhangelsk Region in relation to their physical development parameters. Materials and methods. The research was performed in Vyzhletsov Arkhangelsk Regional Children’s Clinical Hospital. Using echocardiography, we studied the morphometric parameters of 990 children of both sexes aged between 7 and 10 years without cardiovascular pathologies and collected their anthropometric data. Results. With the relative stability of the processes of morphofunctional maturation at this stage of ontogenesis, both sexand age-related structural features of the heart were detected. The largest number of sex-related differences was found for children aged 8 years, and they were associated with greater values of cardiac parameters in boys compared to girls. Sеx-related differences in the width of the major vessels get levelled out by the age of 10. Parameters of physical development naturally increase with age, evenly over the years; sexual dimorphism is not pronounced. The total increase in anthropometric values from 7 to 10 years in boys and girls was: 12.67 % and 14.10 % for body length, 38.68 % and 40.66 % for body weight, and 24.21 % and 27.17 % for body surface area (BSA), respectively. The most consistent and unidirectional age-related changes concern BSA, which demonstrates a significant correlation with cardiac morphology, especially in late prepuberty. The greatest stability in reflecting the share of variation in echocardiogram parameters in all age and sex groups has BSA calculated by the Mosteller formula. The left heart in boys starts to enlarge from 8 to 10 years, while in girls, between 9 and 10 years. Factor analysis showed an increase in the contribution of physical development parameters to the dispersion of morphological characteristics of the heart with age.

Examining neoadjuvant treatment candidates in resectable pancreatic cancer based on tumor-vessel interactions and CA 19-9 levels: a retrospective cohort study.

The applicability of neoadjuvant treatment (NAT) for resectable pancreatic ductal adenocarcinoma (PDAC) has arisen, however, high-level evidence is lacking. This study aimed to explore patient subgroups with high-risk resectable PDAC for selecting candidates who may benefit from NAT. The 1132 patients with resectable or borderline resectable PDAC who underwent surgery between 2007 and 2021 were retrospectively reviewed. Patients with resectable PDAC without contact of major vessels (R-no contact) ( n =651), with contact of portal vein or superior mesenteric vein (PV/SMV) ≤180° (R-contact) ( n =306), and borderline resectable PDAC without arterial involvement (BR-V) ( n =175) were analyzed. The mean age was 64.3±9.8 years, and 647 patients (57.2%) were male. The median follow-up was 26 months in the entire cohort. Patients with resectable PDAC without vascular contact had the most improved overall survival (OS) (median; 31.5 months). OS did not significantly differ between NAT and upfront surgery in the entire resectable PDAC cohort. However, in R-contact group, NAT showed significantly improved OS compared to upfront surgery (33 vs. 23 months). Neoadjuvant FOLFIRINOX was showed a better OS than gemcitabine-based regimens in patients who underwent NAT (34 vs. 24 months). NAT was associated with a better survival in the patients with CA 19-9 level ≥150U/ml, only when the tumor has PV/SMV contact in resectable disease (40 vs. 19 months, P =0.001). NAT can be considered as an effective treatment in patients with resectable PDAC, particularly when the tumor is in contact with PV/SMV and CA 19-9 ≥150U/ml.

High brain natriuretic peptide level is associated with severe stroke in patients taking oral anticoagulants: A sub-analysis of the PASTA registry study

BackgroundBrain natriuretic peptides (BNP) are an important diagnostic and prognostic marker in patients with heart failure. However, the relationship between BNP levels and stroke severity in patients with atrial fibrillation (AF) remains unelucidated. In this study, we aimed to investigate the association between stroke severity at admission and BNP levels. MethodsIn this prospective observational study, we used data from 513 patients with AF and acute ischemic stroke treated with oral anticoagulants (OAC) registered in the Multicenter Prospective Analysis of Stroke Patients Taking Oral Anticoagulants study. The patients were divided into two groups: high-BNP (≥200 pg/mL) and low-BNP level (<200 pg/mL) groups. We compared the clinical characteristics between the two groups and determined the effect of BNP levels on stroke severity on admission. ResultsAmong the 513 enrolled patients, 248 (females, n = 30; median age, 82 years) and 265 (females, n = 76; median age, 71 years) were assigned to the high- and low-BNP level groups, respectively. The high-BNP level group had a higher proportion of patients with severe stroke (National Institutes of Health Stroke Scale score, ≥10) on admission (49.2% vs. 32.8%, p = 0.002) and major vessel occlusion (57.5% vs. 39.2%, p < 0.0001) than that had by the low-BNP level group. Multivariate analysis showed that high BNP level was independently associated with severe stroke on admission (odds ratio 1.07, 95% confidence interval 1.00–1.15; p = 0.0478). ConclusionsHigh BNP level compared with low BNP level was associated with severe stroke and major vessel occlusion, even before OAC treatment.

Mesenteric ischemia in pregnancy - a catastrophe: A case report

Background: Mesenteric ischemia is a rare condition with a high mortality rate of 24-94%. Acutely, it occurs because of sudden vascular emboli or thrombi and presents with severe abdominal pain disproportionate to physical examination findings with other nonspecific symptoms. Case presentation: A para 2+0 gravida 3 presented at 36 weeks 4 days of gestation with a 1-day history of worsening lower abdominal pain radiating to the back and reduced fetal movements. Mild pallor was observed, and vaginal examination showed a latent phase of labor. Shortly after admission, the patient developed diaphoresis and mild confusion with worsening pain, and an urgent ultrasound confirmed intrauterine fetal demise. Subsequently, she developed dizziness and progressed to loss of consciousness, with resuscitation promptly begun but unsuccessful. A diagnosis of extensive mesenteric ischemia was made postmortem. Discussion: Bowel ischemia can result from occlusions of major abdominal vessels and progress to necrosis, gangrene, and eventually perforation with subsequent severe complications. Uterine vasoconstriction in pregnancy itself contributes to a hypercoagulable state, increasing the risk of mesenteric ischemia, with a 10-fold higher risk in those conceiving by in vitro fertilization and embryo transfer. Other venoocclusive causes include atrial fibrillation, coagulopathic, malignancy, and radiation. Diagnosis is mainly by computed tomography. Confirmation is made by emergency laparotomy and histology. Blood investigations like lactate levels may be elevated in sepsis and screening for coagulopathies after diagnosis is made is indicated. Management involves anticoagulants, thrombolysis, and surgical interventions, such as resection and anastomosis, or endarterectomy, and anterograde bypasses. Masked symptoms, rapid progression, and severe resource limitations made this a difficult case to diagnose and manage. Conclusion: Given the rarity of the incidence of mesenteric ischemia, a very high level of suspicion is required to diagnose and promptly manage this emergency.

Abordaje laparoscópico en pacientes con pielonefritis xantogranulomatosa y pionefrosis

IntroductionXanthogranulomatous pyelonephritis (XGPN) is a rare form of chronic renal inflammation, caused by long-term obstruction of the urinary tract. Pyonephrosis is a severe suppurative complication of acute obstructive pyelonephritis. Although minimally invasive approaches have many advantages, the safe dissection of the kidney may not be always achievable. Materials and methodsWe reviewed 27 cases diagnosed with either XGPN or pyonephrosis, who underwent laparoscopic total nephrectomy between October 2016 and March 2022 in our department. All interventions were performed using the Karl Storz 3D laparoscopic system. The surgical approach was standard transperitoneal nephrectomy for the majority of XGPN, while pyonephrosis cases were carried out in a retroperitoneally. All procedures were performed or supervised by the same surgeon. ResultsThe mean operative time was 269.85minutes (range 145–360). The mean hemoglobin drop after surgery was 1.41g/dl (range 0.3–2.3g/dl). Difficult dissection was encountered in 13 cases (48.14%). Nine out of 13 interventions were carried out in a complete intracorporeal fashion, while conversion to open surgery was needed in 4 cases. Vascular complications involving the major blood vessels comprised of one case of inferior vena cava (IVC) tear. Digestive tract-related complications comprised two fistulas of the descending colon and one peritoneal breach. Multiorgan resection was performed in 6 cases. ConclusionTotal nephrectomy in cases of XGPN and pyonephrosis is a challenging procedure. The laparoscopic approach is feasible, as most complications are resolved intracorporeally. However, it may remain reserved for large-volume centers with experienced surgeons.

Impact of Cognitive and Behavioural Psychosocial Interventions on the Effective Management of Hypertension

Hypertension or elevated blood pressure is a chronic non-communicable disease, in which the force of the circulating blood through the major blood vessels and arteries of the body, is consistently high leading to severe health complications. Given the high rates of unawareness of the condition and low rates of detection, diagnosis and treatment of high BP, which has been termed as the “silent killer”, patients tend to be non-adherent to their treatment regimen which lowers their blood pressure control, quality of life and prognosis. A community-based cluster randomized controlled trial, that utilized a 4x3 factorial between-subjects experimental design, was adopted to determine the simultaneous and comparative impact, of three cognitive and behavioural psychosocial interventions on the systolic and diastolic BP control, hypertension knowledge, therapeutic adherence, health beliefs and self-efficacy among hypertensive patients, across the three time points of the study. A sample of 224 hypertensive participants were randomly selected from the four villages of Railapur, Athvelly, Nuthankal, and Rawalkol and were randomly assigned to the Doctor, Video, Community Health Worker and Control conditions respectively. The results showed that the hypertensive patients in the three psychosocial intervention groups showed significantly higher therapeutic adherence, blood-pressure control, hypertension-related knowledge, hypertension-related health beliefs and self-efficacy as compared to the control group after the administration of the interventions. By means of pathway modelling using multiple linear regression analyses, the three psychosocial interventions were found to be direct, significant, and positive predictors of the therapeutic adherence among hypertensive patients, which in turn was the largest, significant and negative contributor to the systolic and diastolic BP reading among them.

Impacted Foreign body of Porcupine spine in Neck- a case report

Abstract: Introduction: Trauma and foreign body impaction in the neck can be dangerous because of high chances of injury to vital structures like the major blood vessels, airway, digestive tract and nerves located in the neck. Hence, early diagnosis and treatment is important to prevent severe morbidity and mortality. Case presentation: A 24 years old male from Rolpa had presented with complaint of painful swelling over right side of neck for a week.He had past history of encounter with porcupine a month back. Ultrasonography of the neck revealed impaction of foreign body in the right lateral neck(sternocleidomastoid muscle) with pus and granulation tissue around it. He was then admitted and exploration under general anesthesia was done and porcupine spine was removed. Conclusion: Any neck trauma should be evaluated for residual foreign body as it can be dangerous in the neck. Early detection and removal of foreign body should be done on time to prevent life threatening complications.

Safety and clinical contribution of computed tomography-guided biopsy for cervical spine lesion

Introduction The purpose is to clarify the safety and clinical contribution of computed tomography (CT)-guided percutaneous needle-biopsy for patients with cervical spine lesion. Material and methods Between June 2015 and August 2022, CT-guided percutaneous needle biopsies were performed for 15 cervical spine lesions of 15 patients (8 male, 7 female; 2–81 years old). The technical success, clinical contribution, and safety were evaluated. Technical success was defined as the completion of the biopsy procedure. Clinical contribution was defined as any contribution to the therapeutic strategy. Safety was assessed by the Common Terminology Criteria for Adverse Events, version 5.0. Results The technical success rate was 100%. In all 15 patients, nontarget organs (e.g., major vessels, spinal cord) could be avoided. The post-biopsy histological diagnoses were myeloma (n = 2), metastatic adenocarcinoma (n = 2), chordoma (n = 2), Langerhans cell histiocytosis (n = 3), and one case each of malignant lymphoma, schwannoma, pyogenic spondylitis, non-pyogenic spondylitis, degenerative change, and non-pathological fracture. All of these diagnoses contributed to the therapeutic strategy decisions. One case of grade 2 pain was observed, but no complications with grade 3 or more were observed during or after the biopsies. Conclusion CT-guided percutaneous needle biopsies for cervical spine lesions were safe and clinically beneficial.

Resection of Colorectal Liver Metastases with Major Vessel Involvement

Background: Treatment of CRLM with major vessel involvement is still challenging and valid data on outcomes are still rare. We analyzed our experience of hepatectomies with resection and reconstruction of major hepatic vessels with regard to operative and perioperative details, histopathological findings and oncological outcome. Methods: Data of 32 hepatectomies with major hepatic vessel resections and reconstructions were included. Results were correlated with perioperative and oncological outcome. Results: Out of 1236 surgical resections due to CRLM, we performed 35 major hepatic vessel resections and reconstructions in 32 cases (2.6%) during the study period from January 2008 to March 2023. The vena cava inferior (VCI) was resected and reconstructed in 19, the portal vein (PV) in 6 and a hepatic vein (HV) in 10 cases. Histopathological examination confirmed a vascular infiltration in 6/32 patients (VCI 3/17, HV 2/10 and PV 1/6). There were 27 R0 and 5 R1 resections. All R1 situations affected the parenchymal margin. Vascular wall margins were R0. Ninety-day mortality was 0. The median overall survival (OS) for the patient group with vascular infiltration (V1) was 21 months and for the V0 group 33.3 months. Conclusion: Liver resections with vascular resection and reconstruction are rare and histological vessel infiltration occurs seldom. In cases with presumed vascular wall infiltration, liver resection combined with major vessel resection and reconstruction can be performed with low morbidity and mortality. We prefer a parenchymal sparing liver resection with vascular resection and reconstruction to achieve negative resection margins, but in technically difficult cases with higher risk for postoperative complications, tumor detachment from vessels without resection is a most reasonable surgical alternative.