Middle Vein Research Articles

An Anomalous Middle Thyroid Vein: A Case Report and a Short Review of the Vascular Anatomy of Thyroid Gland

The thyroid gland is an endocrine organ in the anterior neck having a complex vascular network comprising of paired arteries and veins. Variations in this anatomy are significant for surgical procedures involving the thyroid and parathyroid glands. A 40-year-old euthyroid female who underwent total thyroidectomy for a multinodular goiter, was found to have a rare anomalous middle thyroid vein which originated from the upper pole of the right lobe, separate yet alongside the superior pole vascular pedicle. This was in stark contrast to its normal anatomy where the vein arises from the middle portion of the lobe and traverse laterally in front of the common carotid artery to terminate in the internal jugular vein. Understanding such variations is critical in order to avoid complications during surgical interventions.

Effectiveness of a thrombin-gelatin flowable for treating severe liver bleeding: an experimental study

BackgroundCurrent scientific evidence has pointed out the relevance of hemostatic products for improving clinical outcomes in liver trauma, including increased survival rates and reductions in bleeding-related complications. The purpose of this study was to compare the use of the gelatin-thrombin flowable (Flowable) versus the standard technique of Packing in a new experimental liver injury model.MethodsTwenty-four swine were prospectively randomized to receive either Flowable or standard packing technique. We used a novel severe liver injury model, in which the middle and left suprahepatic veins were selectively injured, causing an exsanguinating hemorrhage. The main outcome measure was the percentage of lost blood volume.ResultsThe median total percentage of total blood volume per animal lost, from injury to minute 120, was significantly lower in the Flowable group (15.2%; interquartile range: 10.7–46.7%) than in the Packing group (64.9%; Interquartile range: 53.4–73.0%) (Hodges-Lehmann median difference: 41.1%; 95% CI: 18.9–58.0%, p = 0.0034). The 24-hour survival rate was significantly higher in the Flowable group (87.0%) than in the Packing group (0.0%) (Hazard ratio (HR) 0.08; 95% confidence interval 0.102 to 0.27; p < 0.0001). Mean-arterial pressure was significantly lower at minute 60 and 120 in the Flowable group than in the packing group (p = 0.0258 and p = 0.0272, respectively). At minute 120, hematocrit was higher in the Flowable than in the packing group (Hodges-Lehmann median difference: 5.5%; 95%CI: 1.0 to11.0, p = 0.0267). Finally, the overall-surgical-procedure was significantly shorter with Flowable than with Packing (Hodges-Lehmann median difference: 39.5 s, 95% CI: 25.0 to 54.0 s, p = 0.0004).ConclusionsThe use of the Flowable was more effective in achieving hemostasis, reducing blood loss, and improving survival rates than standard packing in a severe porcine-liver bleeding model.

Basal vein of Rosenthal classification: the key to venous outflow of the deep sylvian fissure.

Mastery of sylvian fissure dissection is essential to access lesions within the deep basal cisterns. The deep sylvian vein and its tributaries play a major role during access to and beyond the carotid cistern through the sylvian fissure and determine the complexity of microdissection. Preserving the venous outflow during sylvian fissure dissection is the best reliable strategy to prevent postoperative venous strokes or venous hypertension. The authors report the role of the basal vein of Rosenthal (BVR) in the venous outflow pattern of the deep sylvian cistern. The authors analyzed 262 consecutive surgical cases involving sylvian fissure dissection from 2015 to 2017. Inclusion criteria were complete sylvian fissure dissection for the treatment of intracranial aneurysms. Exclusion criteria were giant size (aneurysm diameter > 24 mm), meningitis, subarachnoid hemorrhage within the sylvian cistern, absence of 4D CT angiography, and previous surgery. Retrospective radiological and operative video reviews were carried out to assess the association between the superficial sylvian vein and the BVR. The authors analyzed the course of the BVR and the patterns of venous drainage of the sylvian cistern. The surgical difficulty of sylvian fissure dissection was rated by the authors to study the operative significance of the venous patterns encountered. Two clinical cases are described to illustrate the proposed BVR classification. A total of 97 patients met the selection criteria. The most frequent type of BVR was immature (diameter < 0.5 mm, 68%). When the BVR was incompletely developed or absent (immature type), the deep sylvian veins drained through a middle sylvian vein in 70% of cases, requiring advanced sylvian fissure dissection techniques. However, when the BVR was completely developed (32%), the middle sylvian vein was found in a minority of cases (6%), which allowed for an unobstructed transsylvian corridor. Interrater and test-retest reliability of the surgical difficulty was greater than 0.9. Preoperative assessment of the BVR anatomy is key to predict the deep sylvian venous pattern. The authors provide objective evidence supporting the reciprocal relationship between the type of BVR and the presence of a middle sylvian vein and the deep sylvian venous outflow. An immature BVR should alert the neurosurgeon of the high likelihood of finding a complex deep venous pattern, which may drive surgical planning.

Fractionation as the main method for smoked tobacco products identification

Smokeless tobacco products are products that do not require a pyrolysis process and / or the production of tobacco aerosol (smoke) at the time of use. In the absence of data on the toxicological risks of smokeless tobacco, their consumption is potentially on the rise. The variety of non-smoking tobacco products creates certain problems in identifying chewing tobacco and sucking tobacco (banned for sale in the Russian Federation) as products that are identical in terms of physiological effects, method of consumption, and component composition. A methodology has been developed for a comprehensive assessment of non-smoking products, including the determination of consumer properties and technological indicators by instrumental methods, as well as the determination of the level of toxic components (nicotine, TSNA, B(a)P). The difference between the types of smokeless tobacco is mainly in the granulometric composition of the product: snus – finely ground tobacco, chewing tobacco – snatches of tobacco with a removed middle vein. Identification indicators have been determined: the presence of raw tobacco, the size of its particles and the number of large fragments in the finished product. The presence of raw tobacco can be determined by optical microscopy and/or luminescent analysis, and the quantitative content can be determined by sieve analysis. The quantitative content of the coarse fraction in chewing tobacco (not less than 15 %) is the main indicator of the product. The use of the fractionation method makes it possible to differentiate between sucking and chewing tobacco. A «Method for determining the fractional composition of non-smoking tobacco products for oral consumption by the method of sieve analysis» was developed (Certificate No. 022-01.00281-2013-2022). To certify the methodology, a set of studies was carried out, the data were obtained as a result of five parallel measurements by three performers for each sample. The technique is registered in the State Register of Measuring Instruments (FR.1.31.2022.43935 of 09/02/2022). Technological indicators of SLT samples were established: humidity (11,4-53,3) %, pH level 5,7-9,7, coarse fraction content (0,4-56,9) %, dust fraction content (0,2-76,3) %. The results of identification of commercial samples of a segmental product are presented.

Successful Treatment of Intractable Rectal Varices with Gelfoam Slurry Embolisation and Coiling.

Rectal varices are an infrequent outcome of portal hypertension formed by portocaval anastomosis between the superior rectal vein with the inferior mesenteric vein of the portal system upstream, and the middle and inferior rectal vein draining into the internal iliac and internal pudendal vein of the systemic circulation, respectively. Portal system variations are extremely rare.Most common modality of recurrent rectal varices bleed is a transhepatic intrajugular portosystemic shunt. The absolute contraindications to this include congestive heart failure among others.In the presence of multiple co-morbidities and contraindication for TIPS, various interventional radiological modalities on a case-by-case basis are available including percutaneous transhepatic rectal varices obliteration.

A new distribution record of Lemna turionifera (Araceae, Lemnoideae) in Korea

Here we confirm the first accurate distributional record of Lemna turionifera Landolt (Lemnoideae, Araceae) in Korea. The nomenclator, Elias Landolt (1926–2013), had collected the species in Korea, but to date, there have been no other identifiers of this species. A Lemna species collected from Andong showed the key characters of L. turionifera: pigmented fronds, consistently-sized papillae along the middle vein, purple-colored root base, and turion forming. The cpDNA sequence of the atpF-atpH intergenic spacer of our Lemna sample was identical or quite similar (99.6%–100%) to those found in Landolt's collection. Although we could not find flowers, fruits, or seeds during a field survey, after 15 days of indoor incubation, we were able to observe the flowering of L. turionifera. The flower was protogynous, and the spathe was reddish.

Stroke recurrence is associated with unfavorable intracranial venous outflow in patients with symptomatic intracranial atherosclerotic large vessel severe stenosis or occlusion.

The purpose of this study was to investigate the predictive value of intracranial venous outflow for recurrent cerebral ischemic events (RCIE) in patients with symptomatic intracranial atherosclerotic large-vessel severe stenosis or occlusion (sICAS-S/O). This retrospective study included sICAS-S/O patients with anterior circulation who underwent dynamic computed tomography angiography (dCTA) and computed tomography perfusion (CTP). Arterial collaterals were evaluated using the pial arterial filling score for dCTA data, tissue-level collaterals (TLC) were assessed using the high-perfusion intensity ratio (HIR, Tmax >10 s/Tmax >6 s), and cortical veins were evaluated using the multi-phase venous score (MVS) for the vein of Labbé (VOL), sphenoparietal sinus (SPS), and superficial cerebral middle vein (SCMV). The relationships between multi-phase venous outflow (mVO), TLC, and 1-year RCIE were analyzed. Ninety-nine patients were included, 37 of whom had unfavorable mVO (mVO-) and 62 of whom had favorable mVO (mVO+). Compared with the mVO+ patients, mVO- patients had a higher admission National Institutes of Health Stroke Scale (NIHSS) score (median, 4 [interquartile range (IQR), 0-9] vs. 1 [IQR, 0-4]; p = 0.048), larger ischemic volume (median, 74.3 [IQR, 10.1-177.9] vs. 20.9 [IQR, 5-86.4] mL; p = 0.042), and worse tissue perfusion (median, 0.04 [IQR, 0-0.17] vs. 0 [IQR, 0-0.03]; p = 0.007). Multivariate regression analysis showed that mVO- was an independent predictor of 1-year RCIE. For patients with sICAS-S/O of the anterior circulation, unfavorable intracranial venous outflow is a potential imaging indicator for predicting higher 1-year RCIE risk.

New fossils reveal the Paleogene establishment of relict Craigia (Malvaceae) in its extant range

Whether East Asian relict plants have recently taken refuge in their extant ranges or have long been inhabitants in those areas remains uncertain due to insufficient fossil records. Here, we report well-preserved new fossil fruit valves of an East Asian relict genus, Craigia, from the late Eocene of Southwest China, in its extant geographic range. The front projection of these fruit valves has a vertical crease in the middle and pinnate veins, whereas their back projection possesses a stout vascular bundle in the middle separating two flask-shaped locules. Morphological comparisons suggest the placement of these fruit valves within the fossil species, C. oregonensis. Based on recent fossil records, Craigia possibly originated in the high latitudes of Northeast Asia during the Paleocene. It migrated to Southwest China by passing through Central Asia and Tibet when the climate in these areas was warm and wet during the early Paleogene. Our finding of Craigia fruit valves in Southwest China suggests that the genus arrived in and has inhabited its extant geographical range, at least since ∼34 million years ago (late Eocene).

A rare case of neonatal-onset hepatic sinusoidal obstruction syndrome

A male infant, aged 1 month and 14 days, was admitted to the hospital due to abdominal distension lasting for 2 weeks and worsening for 3 days. The infant had a history of omphalitis. Physical examination revealed severe abdominal distension, prominent abdominal wall veins, hepatosplenomegaly, and massive ascites. There was a slight elevation in liver transaminase levels. Liver ultrasound and CT scans demonstrated the absence of visualization of the intrahepatic segment of the portal vein and the left, middle, and right veins of the liver, indicating occlusion of these vessels, along with surrounding fibrous hyperplasia. The clinical diagnosis was hepatic sinusoidal obstruction syndrome resulting from omphalitis. A large amount of bloody ascites developed after 12 days of hospitalization, resulting in hypovolemic shock and respiratory failure. The infant passed away following the family's decision to discontinue treatment. This article focuses on the diagnostic approach and multidisciplinary management of neonatal-onset hepatic sinusoidal obstruction syndrome, as well as provides insights into the differential diagnosis of hepatomegaly and ascites.

Drenagem venosa da glândula tireoide e suas implicações cirúrgicas: revisão narrativa

Diseases of the thyroid are common worldwide, so knowledge of its normal and variant anatomy, especially of the veins of thyroid, is essential for safe and successful surgery involving the anterolateral neck. The aim of this study is to consolidate all information related to venous drainage of the thyroid gland as a ready reference for vascular and endocrine surgeons. The study was conducted at the Department of Anatomy and the literature search was carried out using the Pubmed, Scielo, Researchgate, Medline, and Scopus databases. Various terms related to the thyroid gland and its venous drainage were used to explore the literature. The literature review revealed that the superior and middle thyroid veins have the fewest variations in terms of course and termination while the inferior thyroid vein has the most variations in terms of course and termination. Detailed knowledge of normal and variant anatomy of the thyroid veins is of utmost use for vascular surgeons performing anterolateral neck surgery, especially tracheostomy, a lifesaving procedure, minimizing intraoperative and postoperative complications and morbidity and mortality.

Determination of Some Morphological Traits and Genetic Factor of Two Species of Liriomyza spp (Diptera: Agromyzidae) on the Climbing Beans and Tomato Crops

This study was carried out to study some morphological parts of adult male of Liriomyza spp, including the antenna, the femur and the middle vein (Cu Al), as well as the shape of mines that larvae made them on the leaves. Results showed that there were two species of L.bryoinae on tomato crop and L.sativae on climbing beans crop, this was agreed with the molecular study that it was conducted using the RAPD Random Amplification of Polymorphic DNA based on the PCR technique to determine genetic variability of DNA that it was extraction from adults and pupae and obtained a quantity of it ranged from (35-556.9) mg and purity ranged between (1.7-2).&#x0D; The RAPD markers were studied using 19 random primers, 13 of which showed a bands and 6 of them didn’t show any bands, the total number of bands loci were 53 loci, 23 of which were main bands and 30 were polymorphism and genetic analysis was performed based on these results. The genetic distance was found and lowest was (0.125) among adults and pupae of bean crop and higher distance was (0.323) the among the adults and the pupae of the tomato crop and the genetic distance between the tomato pupae and bean pupae was (0.185), according to this values the genetic relationship was found which was the tomato adult's species was independent and the genetic relationship between Adults and pupae have closest. Results showed that the pupae which were taken from the crops, there are two species of Liriomyza spp .&#x0D; &#x0D;

The Demographic Data and Prevalence of Thromboembolic Events Among Inflammatory Bowel Disease Patients in Buraydah, Al-Qassim Region.

IntroductionInflammatory bowel diseases (IBD) (Crohn’s disease (CD) and ulcerative colitis (UC)) are considered among the commonest gastrointestinal (GI) tract diseases manifesting with chronic, recurring episodes of gut inflammation, especially in the colon. Each disease has its pattern, symptoms, severity of pain, extension, management, and prognosis. However, these diseases share most of the various complications, including the GI tract and extending it to other systems such as musculoskeletal, skin, liver, and pulmonary systems.ObjectivesWe aim to identify the demographic data, prevalence, risk factors, clinical presentation, and management (medications given and investigations ordered) of thromboembolic events (TEE) among inflammatory bowel disease patients at King Fahad Specialist Hospital (KFSH) in Buraydah, Al-Qassim, Saudi Arabia.Materials and methodsThis is a retrospective, cross-sectional study. All included patients with IBD who meet the inclusion criteria between January 2020 and January 2022 in KFSH were reviewed, and data were analyzed using the Statistical Package for the Social Sciences (SPSS) Statistics version 23.0 (IBM Corp., Armonk, NY, USA).ResultsA total of 187 participants were included in the current study. The mean age of the participants ± standard deviation (SD) was 28.7 ± 10.8 years old. Of the participants, 107 (57.2%) were males. A total of 121 (64.7%) participants were diagnosed with Crohn’s disease (CD), 56 (29.9%) with ulcerative colitis (UC), and 10 (5.3%) with both CD and UC. In 156 (83%) participants, the duration of the disease was 1-5 years. Among the IBD patients, two (1.1%) had TEE in the interval resolution middle and left portal vein, as well as the inferior mesenteric vein. The majority of the participants (73.3%) were with no history of comorbid conditions. The most reported clinical symptoms were chest pain as reported by 3.2% of the participants. Abdominal computed tomography (CT) was the most reported method of diagnosis as reported by 35.8% of the participants. Of the participants, 8.6% used heparin prophylactically, 0.5% used heparin as a treatment, and 0.5% used enoxaparin as a treatment. Moreover, 20.3% of the participants used prophylactic treatment, whereas about 79.7% did not use prophylactic treatment. Old age, extensive disease, colorectal surgery, and pregnancy were not found to be associated with thromboembolic events (p = 1.000, 0.400, 0.164, and 0.053, respectively). Age, gender, and nationality were not significantly associated with thromboembolic events (p = 0.915, 1.000, and 1.000, respectively).ConclusionDespite IBD being one of the emerging health concerns in the Kingdom of Saudi Arabia, records showed that the prevalence of thromboembolic events was found to be lower when compared to the prevalence reported in the relevant multinational studies. The was no difference in factors affecting the development of thromboembolic events between IBD patients and the general population.RecommendationsWe should stress raising awareness of IBD patients about their condition, the increased risks of developing thromboembolic events, and the proper prevention methods.

Influence of cutting through the middle vein of tobacco leaves on the technological properties of raw materials of the Virginia 202 variety of various drying methods

The Virginia 202 tobacco variety, selected by FSBSI ARSRITMTP for the production of smoking tobacco, is in high demand. Intensification of post-harvest processing of large leaves of a variety with a massive middle vein is proposed to be carried out by cutting through the middle vein, which will reduce the drying time and energy costs. Studies have been conducted on the use of this method and the quality indicators of tobacco raw materials of natural and combined drying methods has been assessed. It has been found that the cutting technique shortens the drying time with the combined method by 2.8 times, with the natural method by 2.3 times, while the commercial quality improves when drying by the combined method, the yield of 1 commercial grade makes 86.5%, the taste qualities of raw materials improve, due to an increase in the ratio of carbohydrate-protein balance to 1.08–1.5; the strength is preserved, due to less nicotine consumption during a shorter drying period; fiber yield increases by 3–5%. The volume-elastic properties of the fiber affect the consumption of raw materials in the smoking product. The fiber of natural drying of raw materials reduces its consumption for the production of smoking products, the fiber of combined drying of raw materials obtained using high temperatures of drying of the vein increases the consumption of raw materials by 18.65%. The aim of the research is to determine the elastic properties of the cut vein present in the fiber of combined drying. The vein has been flattened and its elastic properties have been determined. It has been established that the recoil value of the flattened uncut vein is 6.0% greater, the undisturbed structure of the middle vein has a greater degree of volume recovery and better elastic properties. An increase in the elastic properties of the raw materials of combined drying can be carried out due to its preparation in a differentiated way, with the allocation of the middle vein, the method of striping and, separately, the preparation of the vein and the leaf plate. When preparing, moistening and flattening the cut vein, which has a better moisture-absorbing ability and a lower destructive load when it is flattened by 2.2 times, it is possible to reduce energy consumption for these technological processes.

Anatomical elucidation and histological study of pelvic autonomic nerve-plane based female fresh cadaver

Objective: To investigate the rationality of nerve-plane sparing radical hysterectomy (NPSRH) for cervical cancer by observing the anatomical and histological characteristics of pelvic autonomic plane based on fresh cadaver. Methods: From October 2015 to September 2020, 14 fresh female cadavers were anatomically and histologically studied in the Laboratory of Anatomy and Embryology Department, Peking Union Medical College, Chinese Academy of Medical Sciences. The median age of the specimens was 79 years (range: 67 to 92 years). Twenty-eight hemi-pelvic specimens were obtained from 14 fresh female cadavers. NPSRH procedures were simulated in 8 hemi-pelvic cavities to prove its feasibility. Detailed dissection was conducted to recognize nerve plane and to observe the distribution of pelvic nerves in 10 hemipelvis. In the other 10 hemipelvis, whole parametrium tissue was taken from the crossing of ureter and the uterine artery to the ureterovesical entrance and be embedded, then continuous section was performed, and was stained by hematoxylin-eosin staining (HE) to observe the relationship of nerves and vessels. Immunohistochemical staining of S100, tyrosine dehydrogenase (TH), and vasoactive intestinal peptide (VIP) were performed to count and distinguish sympathetic and parasympathetic nerves, respectively. Results: (1) The pelvic autonomic nerve-plane was completely preserved in 7 of 8 hemipelvis by simulating NPSRH. (2) After detailed dissection in 10 hemipelvis, it was found that hypogastric nerve, pelvic splanchnic nerve, and their confluence of inferior hypogastric plexus were distributed in a planar statelocating in the ureteral mesentery and its caudal extension. This nerve plane showed a cross relationship with deep uterine vein and its branches. The bladder branches and vesical venous plexus were closely related to the inferior hypogastric plexus. The middle vesical vein and inferior vesical vein were intact in 7 of 10 hemipelvis, and either vesical vein was missing in 3 of them. It was observed that the vesical venous plexus communicated with the deep uterine vein trunk on the medial side of the nerve plane in 6 hemipelvis, while flowed into the deep uterine vein on the lateral side of the nerve plane in 2 hemipelvis, and in the other 2 hemipelvis it directly flowed into the internal iliac vein. (3) It was revealed that autonomic nerves were continuously distributed beneath the ureteral with sagittal plane by HE staining. The average nerve content below the ureteral width was 70.9% of the total in nerve plane by S100 staining. TH and VIP staining showed that the average number of sympathetic fibers was 13.5 and parasympathetic fibers was 8.2, reminding sympathetic predominated. Conclusion: Pelvic autonomic nerves are mainly distributed within the mesangial plane below the ureter, which provides an anatomic justification for NPSRH.

Anatomical accuracy of the KODEX-EPD novel 3D mapping system of the left atrium during pulmonary vein isolation: a correlation with computer tomography imaging

Abstract Funding Acknowledgements Type of funding sources: None. Background A novel 3D mapping system (KODEX - EPD, EPD Solutions, Best, The Netherlands) enables catheter localization and real-time 3D cardiac mapping. Purpose To evaluate left atrium (LA) anatomical mapping accuracy created by the KODEX-EPD system during pulmonary vein isolation (PVI) compared with gold standard computed tomography (CT) images acquired from the same patients prior to the procedure. Methods In 15 consecutive patients who underwent PVI, 3D mapping of the LA was created on the KODEX-EPD system using the Achieve catheter. Pulmonary vein (PV), posterior wall, and appendage anatomy and diameters, were compared to the CT 3D reconstruction measured on the CARTO 3 system. Measurements were done independently by 2 physicians in each method. Linear correlation and agreement between CT and EPD measurements were assessed by Spearman correlation and Bland-Altman plot. Results Mean LA mapping time was 7.7± 3.6 min. Very high interobserver correlation was found for both EPD and CT measurements (Spearman-r=0.9). High correlation (r=0.75) was found between CT and EPD measurements. Bland-Altman plot method revealed that measurements assessed by EPD were slightly higher than those assessed by CT. Mean difference was 3.5mm, p&amp;lt;0.01. In 2 (13.5%) patients each, disagreement regarding the presence of a left common PV and a right middle accessory vein anatomy was seen. Conclusion The new KODEX-EPD mapping system allows quick and accurate mapping of the LA with high correlation to CT imaging. Some differences in left common and accessory right middle vein anatomy were seen. Central illustration: An example of the anatomy created by the KODEX- EPD system compared with the CT image of the same patient. A standard 4 vein anatomy is demonstrated by both modalities, with early branching of the right inferior pulmonary vein. A: KODEX- EPD pre-CRYO map during atrial fibrillation demonstrating connected pulmonary veins. B: 3D CT image viewed on the CARTO auto-segmentation module. C,D: KODEX- EPD posterior-anterior and PANO images post-CRYO map during sinus rhythm demonstrating pulmonary vein isolation with the same anatomy. E: Spearman correlation demonstrating a high correlation (r 0.75) between CT and KODEX-EPD measurements, p&amp;lt;0.01.

The Trunk of Henle and its Variants

OjectiveIn colon, pancreatic and hepatobiliary surgical research, an increasing interest developed in the Gastrocolic Trunk of Henle (GTH) due to its broad variability and its importance especially for right hemicolectomy with complete mesocolic excision. The purpose of this study was to further corroborate details of the anatomical variants of the Gastrocolic Trunk, in particular with respect to pancreaticoduodenal veins and the jejunal drainage into the superior mesenteric vein.MethodsIn 15 cadaveric bodies the venous drainage into the superior mesenteric vein was dissected first in a ventral, in situ approach as well as by a subsequent dorsal approach following careful abdominal exenteration.ResultsThe most frequent configuration was the tripodal gastropancreaticocolic trunk (GPCT) with an occurrence of 54.5%, followed by the gastropancreatic trunk (GPT) with 36.4% (figure 1). The right gastroepiploic vein was a constant structure draining into the trunk of Henle in 100% of the cases. During the dissection of the pancreatic drainage, a previously undescribed, middle anterior pancreatic vein, was found in 46.67% of the specimens, which drained in 85.71% into the trunk of Henle.ConclusionThe trunk of Henle drains blood from several abdominal organs and bundles them into a short and vulnerable structure. The most common variant is a tripodal trunk, collecting veins from the pancreas, right colon, and the stomach. Dependent on the surgical approach, the right gastroepiploic vein or the superior right colic vein may serve as guiding structures towards the trunk of Henle. Preoperative imaging in conjunction with awareness of variants is essential for a personalized surgical pocedure. In addition, the finding of a middle anterior pancreatic vein prompts for further studies regarding venous drainage of the pancreatic head.

Laparoscopic Left Hepatectomy with Resection of the Spiegel Lobe Using the Modified Caudate Lobe-First Approach.

Laparoscopic left hepatectomy with resection of the Spiegel lobe remains a technically demanding procedure as it is a deep-seated area surrounding the inferior vena cava (IVC). Mobilization of the Spiegel lobe requires safe exposure of the ventral side of the IVC while dissecting the short hepatic veins from the IVC. Additionally, wide space is needed to isolate the left Glissonean pedicle (Glt). We used a modified caudate lobe-first approach to overcome this challenge Maeda (J Hepato-Bil Pancreat Sci 25:335-41, 2018), Li (J Gastrointest Surg 23:1084-5, 2019), Homma (Surg Endosc 33:3851-7, 2019). The ischemic area was confirmed after isolating the left and middle hepatic artery and left portal vein. After mobilizing the left lateral section, the Spiegel lobe was divided from the notch, which is the boundary between the caudate lobe and the Spiegel lobe, toward the middle hepatic vein (MHV). The Spiegel lobe was safely detached from the IVC with a short hepatic vein transected with the caudo-dorsal view. The Glt could be easily isolated due to the wide space on the ventral side of the IVC. After dividing the left hepatic duct, the MHV was exposed continuously from the root to the periphery, and parenchymal transection was completed by connecting the demarcation line and MHV. The total operation time was 430 min, and estimated blood loss was minimal. The patient was discharged on postoperative day 6 without complications. The modified caudate lobe-first approach can be used to safely perform laparoscopic left hepatectomy combined with the Spiegel lobe resection.

Superficial Temporal Vein and Alternative Middle Temporal Vein as Recipient Veins for Free-flap Reconstruction.

Summary:The superficial and middle temporal veins (STV and MTV) have been used as recipient veins for free-flap reconstruction; however, the STV is sometimes small and cannot be used, while the MTV is not fully recognized or utilized as a recipient vein. The purpose of the present study was to evaluate the reliability of the STV/MTV as recipient veins and to verify the utility and availability of the MTV by comparing the two veins. Thirty-five consecutive cases of free-flap reconstruction utilizing recipient vessels in the temporal region were retrospectively reviewed. Regarding recipient veins, the STV was the only option in the first 18 cases; the MTV was included among the options in the latter 17 cases. The calibers of the STV/MTV were evaluated at two level points (1: zygomatic arch, 2: palpebral fissure) using the results of preoperative dynamic-enhanced computed tomography (CT). Two cases of severe venous congestion were identified among the first 18 patients. After the adoption of the MTV, the MTV was used in 10 of the 17 cases, and no vascular complication occurred. On CT imaging evaluation, the caliber of the MTV (Point 2) (2.94 ± 0.55 mm) was significantly larger than the calibers of the STV (Point 1) (2.40 ± 0.48 mm) and MTV (Point 1) (2.49 ± 0.43 mm) (both P < 0.001). Regarding the recipient veins in the temporal area, the MTV can offer an option with a larger caliber or for additional venous anastomosis when the condition of the STV is inadequate.

Anatomical accuracy of the KODEX-EPD novel 3D mapping system of the left atrium during pulmonary vein isolation: A correlation with computer tomography imaging.

BackgroundA novel 3D mapping system (KODEX‐EPD, EPD Solutions) enables catheter localization and real‐time 3D cardiac mapping.ObjectiveTo evaluate left atrium (LA) anatomical mapping accuracy created by the KODEX‐EPD system during pulmonary vein isolation (PVI) compared with gold standard computed tomography (CT) images acquired from the same patients before the procedure.MethodsIn 15 consecutive patients who underwent PVI, 3D mapping of the LA was created on the KODEX‐EPD system using the Achieve catheter. Pulmonary vein (PV), posterior wall, and appendage anatomy and diameters, were compared to the CT 3D reconstruction measured on the CARTO 3 system. Measurements were done independently by two physicians in each method. Linear correlation and agreement between CT and EPD measurements were assessed by Spearman correlation and Bland‐Altman plot.ResultsMean LA mapping time was 7.7 ± 3.6 min. Very high interobserver correlation was found for both EPD and CT measurements (Spearman r = .9). High correlation (r = .75) was found between CT and EPD measurements. Bland‐Altman plot method revealed that measurements assessed by EPD were slightly higher than those assessed by CT. Mean difference was 3.5 mm, p < .01. In 2 (13.5%) patients each, disagreement regarding the presence of a left common PV and a right middle accessory vein anatomy was seen.ConclusionThe new KODEX‐EPD mapping system allows quick and accurate mapping of the LA with high correlation to CT imaging. Some differences in left common and accessory right middle vein anatomy were seen.

Revival of an Old Technique

Piggyback orthotopic liver transplantation is mandatory when a patient can’t stand a vena cava clamping due to cardiac intolerance. If right and middle suprahepatic veins are separated (due to atrophic right liver and hypertrophic left liver), and cava clamping is not an option, performing the anastomosis with only the middle and left suprahepatic veins might end up in a reduced venous outflow and an acute Budd Chiari Syndrome could be developed. This scenery will end up with a graft failure. There is an old technique sometimes forgotten that can prevent this to happen described by Stieber in 1995: adding an anastomosis between the recipient’s preserved retrohepatic inferior vena cava and the donor infrahepatic inferior vena cava in an end to side fashion. We have performed this type of solution in 3 cases avoiding Budd Chiari syndrome and graft loss.