Origin Of Vessels Research Articles

The incidence and significance of the RAC sign in transthoracic echocardiography in the population of a tertiary hospital outpatient cardiology clinic

Abstract Background The RAC (retroaortic anomalous coronary artery) sign, visible in transthoracic echocardiography (TTE) as an abnormal tubular structure located retroaortically in the atrioventricular groove, is typical of an anomaly of the coronary artery origin. Purpose Assessment of the incidence of the RAC sign in the population of outpatient clinic of a tertiary academic hospital. Evaluation of the anatomy of coronary vessels in patients in whom the symptom was described. Assessment of the specificity of the RAC sign in the study population. Methods Consecutive patients, who underwent TTE in the outpatient clinic of the cardiology department between 04/2022 and 02/2024 were included in the prospective study. The echocardiography examinations were performed by a cardiologist with an EACVI (European Association of Cardiovascular Imaging) TTE certification. The anatomy of coronary vessels in patients with RAC was assessed by classic coronary angiography or computed tomography. Results 2310 patients were included in the study. RAC sign was found in 8 (0,35%) individuals - 3 women (average age 70); 5 men (average age 58). In patients with RAC sign indications for TTE were as follows: history of anterior ST-segment elevation myocardial infarction (STEMI) treated by primary angioplasty of left anterior descending coronary artery (2 patients), history of inferior STEMI treated by primary angioplasty of right coronary artery (1 patient), history of pacemaker implantation (1 patient), history of myocarditis (1 patient), hypertension (1 patient), history of venous thromboembolism (1 patient), atypical chest pain (1 patient). Anomaly of the origin and retroaortic course of the coronary artery was confirmed by CT or coronary angiography in all subjects with RAC sign on TTE. In all patients with RAC sign, the retroaortic vessel was identified as circumflex artery (Cx). In 4 patients (50%), Cx originated from the right coronary artery, in 4 patients (50%) there was a direct origin of the Cx from the right sinus of Valsalva. In all patients the anomaly of the coronary vessel origin was not associated with increased risk of sudden cardiac death (interseptal course, course between large vessels and acute angle take-off were excluded). The specificity of the RAC sign was 100%. Conclusions The RAC sign is a relatively rare finding in the TTE evaluation. In our analysis, visualization of the retroaortic course of the coronary vessel was equivalent to the diagnosis of a mild anomaly of the origin and the retroaortic course of the circumflex coronary artery.

Mapping Sentinel Vessels in Uveal Melanomas Using Laser Speckle Contrast Imaging

Introduction: Sentinel vessels provide an important early indication of underlying ocular neoplasm. To date, there is no non-invasive technique available for imaging and mapping of their vascular supply, which remains largely unstudied. We aimed to map sentinel vessels in uveal melanomas non-invasively by laser speckle contrast imaging (LSCI). Case presentations: This report describes a case series of four patients undergoing enucleation due to uveal melanoma. Perfusion was imaged using LSCI during the successive detachment of the four rectus muscles, with their ciliary arteries, and the optic nerve with its ophthalmic artery. Tumor location and possible extrascleral growth were analyzed histopathologically. Results: Sentinel vessels in uveal melanoma could be visualized non-invasively using LSCI, appearing broader and tortuous compared to surrounding vessels. The perfusion in the sentinel vessels was 24-94% higher than in the episcleral vessels. The origin of the sentinel vessel could be determined by perfusion monitoring during the successive detachment of the rectus muscles and the optic nerve. In three patients the sentinel vessel was supplied by the anterior ciliary arteries, and in one patient by the ophthalmic artery. In one of the cases, the sentinel vessel was not visible upon visual inspection. Conclusion: This is the first study of its kind demonstrating detailed mapping of sentinel vessels in uveal melanoma using LSCI. LSCI shows potential for the detection of sentinel vessels before they are visible in slit lamp examination. Vascular changes are a hallmark of tumor growth, and non-invasive imaging with LSCI may be a useful diagnostic tool for the detection of uveal melanoma.

Laparoscopic right hemicolectomy with complete mesocolon excision and cranial approach.

Complete mesocolon excision (CME) and D3-lymphadenectomy concepts have gained popularity for the surgical treatment of right colon cancer in comparison to the conventional laparoscopic right hemicolectomy (CLRH). The rationale of CME is to dissect the embryological planes between the mesenteric plane and the parietal fascia to remove the mesentery within a complete envelope of mesenteric fascia and visceral peritoneum that contains lymph nodes, the central vascular ligation, and adequate bowel length to remove involved pericolic lymph nodes in the longitudinal direction, having as the main goal to improve the oncological results. CME with D3-lymphadenectomy is challenge since involves the excision of the lymph adipose tissue covering the medial edge of the superior mesenteric vein (SMV) (trunk of Gillot, TG), and the gastrocolic trunk of Henle (GTH). We describe a LRH with CME using a cranial approach allowing an easier central vessels origin identification. Through the supramesocolic approach, gastrocolic ligament is opened and the GTH and the middle colic artery (MCA) and vein (MCV) origins are identified. Hepatic flexure is mobilized, and a gauze is placed above the mesenteric vessels. Then, the SMV is identified, dividing the ileocolic vessels origin. The plane between the Gerota and Toldt fascias is opened, identifying duodenum, pancreas, and the gauze previously placed. Following this plane and the SMV along the TG, the GTH and its branches are identified. The superior right colic vein, and the MCA and MCV right branches are divided. After that, colon is fully mobilized laterally opening the parietocolic gutter and an intracorporeal anastomosis is performed. CME could lead to an improvement of oncological results due to a wider mesocolic excision in comparison to conventional D2-lymphadenectomy. Cranial approach facilitates the vessels origin identification to perform a true central ligation.

Anatomical study of mesenteric arteries and their variations: a systematic review and meta-analysis

Anatomical variations (AV) are modifications in morphological features that do not imply functional impairment. Among the structures most affected by them are the blood vessels, of which the superior (SMA) and inferior (IMA) mesenteric arteries (IMA) stand out. This study aimed to carry out a systematic review with meta-analysis in order to identify the prevalence of different SMA and IMA VAs. The steps taken followed the PRISMA guidelines and the study protocol was registered and published on the PROSPERO platform (CRD42022336763). For the meta-analysis, the R-studio was used, adopting the random distribution model, the chi-square test, and the I-square test to investigate heterogeneity and its amplitude, respectively. After all the steps described in the protocol, 124 articles were obtained for systematic review and 23 for meta-analysis. The most prevalent vertebral level of origin of the SMA was at L1, (95% CI; 0.58: 0.41–0.73; X12= 14.90, p < 0.001; I2= 93%), and that of the IMA was at L3 (IC 95%; 0,40: 0,22–0,62; X12= 10,32, p = 0,001; I2= 90%). Normal prevalence of SMA was observed in 77% of subjects (95% CI; 0.66–0.85; X152= 322.02, p < 0.001; I2= 95%).It also calculated the different prevalence regarding the vessels of origin of the SMA and its branches, which was not always possible to be carried out with the IMA, due to the scarcity of this information in the primary studies included in this review.

Anatomic Patterns of Distribution of the Renal Arteries' Origin from the Aorta

To characterize the variation of the renal arteries' origin from the aorta, through examination of computed tomography angiographies (CTAs) in a cohort of patients, and to evaluate any gender-related difference. CTA of the thoracoabdominal district in patients with a nondilated aorta (group A), patients with aortic aneurysm involving the origin of splanchnic and/or renal vessels (group B), and patients with abdominal aortic aneurysm (group C), were retrospectively analyzed. The diameter and angles of emergence (axial and craniocaudal) of the renal arteries were measured, as well as their mutual distance, and the distance between the renal vessels and the superior mesenteric artery/the aortic bifurcation. Shapiro-Wilk, one-way analysis of variance and bivariate Pearson's Correlation tests were performed as appropriate. A P value <0.05 was considered statistically significant. Six-hundred CTA of patients (452 males) were examined, being 286 in group A, 119 in group B, and 195 in group C. When examining the whole population and also the subgroup of female patients, the clock position of the right renal artery (RRA) was the only parameter that followed a Gaussian distribution, and its ostium raised from the aorta with a mean axial angle of -61.5°±16.6°. There was a negative correlation between left renal artery (LRA) and RRA's coronal angle and aortic diameter at the same level, as well as between the LRA's clock position and the aortic diameter at the same level. The longitudinal distances between established landmarks and both renal arteries positively correlated to the aortic diameter. The LRA showed a high anatomic variability, both in males and in females. With the increase of the aortic diameters in the juxtarenal/infrarenal portion of the aorta, the renal vessels tended to have a more horizontal course in the coronal view, a more acute "clock-position" and longer longitudinal distances between their ostia and the aortic bifurcation.

Multiple Traumatic Fat Embolism with Aortic Dissection III A Case Report

Multiple trauma refers to the severe injury of multiple body parts caused by a single injury factor, occurring simultaneously or consecutively. This condition leads to numerous tissue injuries, significant organ damage, and high mortality rates. Fat embolism syndrome, on the other hand, is a clinical condition marked by the presence of fat droplets in the bloodstream, resulting in a range of symptoms and signs. The most prevalent manifestations include ecchymotic rash, respiratory distress, and neurological dysfunction. In intensive care units (ICUs), routine CT scans are essential, particularly chest CTs, which often reveal a diffuse distribution of ground glass opacity shadows. In more extensive cases, “snowstorm”-like changes may be observed. Traumatic aortic injuries frequently manifest as scissor force injuries at the aortic isthmus, with the majority of cases occurring in this region. However, other aortic injuries typically occur at the aortic hiatus and the origins of major vessels. Instances where both fat embolism and traumatic aortic dissection III occur concurrently due to multiple trauma are exceptionally rare.

Lombardic ornaments from San Mauro cemetery at Cividale, Italy

A group of very significant Lombardic ornaments from the cemetery of San Mauro at Cividale del Friuli (Udine) in Italy has been examined and analysed with X-ray fluorescence spectrometry. The objects are now part of the collections of the National Museum of Cividale del Friuli. Among the objects there are several so-called stirrup or radiate-head bow fibulae, one of which also shows an interesting cloisonné decoration, an S-shaped fibula with cloisonné, a unique gilded and nielloed equal-armed fibula with two opposite faces or masks, belt buckles and belt plates, a necklace with gold pendants with filigree and granulation, a vessel of probable Byzantine origin and a golden cross. The composition and the production technology of the single pieces are discussed in detail in the paper with relevant comparisons.

New data on the polyphyletic Marionina genus (Annelida, Enchytraeidae): description of three new species from European shore habitats

Marionina (Michaelsen in Pfeffer, 1890) is a worldwide distributed genus of small enchytraeids living in mainly aquatic habitats. The genus is polyphyletic, including about 100 species with diverse morphological characters and cryptic lineages; therefore, taxonomic revisions were performed recently, and further actions are needed in the future. In our study, Marionina individuals were investigated from decaying seagrass debris collected from seashores in Croatia and Italy using morphological characters and molecular markers involving the COI and H3 genes and the ITS region. Descriptions of two new Marionina species, M. puntaalanensissp. nov. and M. orbiferasp. nov., are presented in this paper, and in addition, the description of a third new Marionina species, M. reichartisp. nov., from the shore of the freshwater Lake Balaton (Hungary) is provided here. All three new species are small (2–3.5 mm in vivo with less than 30 segments), their clitellum is saddle-shaped, the dorsal anterior blood vessel bifurcation is in III, and the spermatheca is attached to the oesophagus. The main diagnostic features of M. puntaalanensissp. nov. are: brain incised posteriorly; dorsal vessel from the clitellar region; two chaetae in all bundles; three pairs of preclitellar nephridia; small subneural glands in XIII–XIV; seminal vesicle absent or small; ectal duct of spermatheca surrounded along the length by glands and one larger. The main features of M. orbiferasp. nov. are: brain truncate posteriorly; dorsal vessel from the clitellar region; two chaetae in all bundles; two pairs of preclitellar nephridia; subneural glands in XIII–XIV; seminal vesicle well developed; the lumen of the spermathecal ampulla is characteristically full with many spherical sperm rolls. In M. reichartisp. nov.: brain incised posteriorly, dorsal vessel origin in XII, maximum five chaetae per bundle, often the middle chaetae slightly smaller than the ental ones, three pairs of preclitellar nephridia, subneural glands absent, spermathecal ampulla globular, ectal duct surrounded along the length by glands, and one large sessile gland at the orifice.

Unruptured intracranial aneurysms in pediatric sickle cell disease: clinical and MR imaging follow-up of 296 patients.

Currently available data regarding unruptured intracranial aneurysms (UIAs) in sickle cell disease (SCD) are largely based on adult patients; this has made it challenging to reach a consensus on treatment decisions and follow-up strategies for pediatric SCD patients with UIAs. A retrospective review of 296 SCD patients (aged 18 years or younger) who underwent MRA from January 2008 to September 2022 was performed. The vessel of origin and characteristics of the UIAs, including maximum diameter, laterality, and number, were evaluated. Demographic data, as well as history of vaso-occlusive crisis and moyamoya syndrome, were recorded. Interval change in size or morphology, as well as a new aneurysm development, were reviewed on follow-up MRA. Forty-nine aneurysms were identified in 32/296 (10.81%) patients, and they all had saccular morphology. In total, 30/49 (61.22%) aneurysms were in the anterior circulation. The ophthalmic segment of the internal carotid artery and the posterior cerebral artery were the most common locations (n = 12 [24.49%] each). Multiple aneurysms were seen in 11/32 patients (34.37%). Most of the African American patients had multiple aneurysms (n = 25/28 [89.3%]). Most aneurysms (n = 43 [87.75%]) were 3 mm or less in diameter. No significant difference in aneurysm size was noticed between aneurysms located in anterior or posterior circulation (p = 0.22). Similarly, age, sex, ethnicity, genotype, or aneurysm multiplicity were not associated with size. Follow-up MRA was available for 24/32 patients (75%). All except 2 aneurysms (n = 2/38 [5.3%]) were stable in size and morphology on follow-up. Interval progression in aneurysm size was noticed in 2 patients with multiple intracranial aneurysms (n = 2/11 [18.2%]). In pediatric SCD patients, the incidence of UIAs was higher than previously reported. Those aneurysms demonstrated a tendency for multiplicity, an atypical anatomical distribution compared with that of adult brain aneurysms, bilateral involvement, and higher prevalence in African Americans. Although most of the aneurysms were stable, some showed interval growth in size.

Reassessing the origins of Near Eastern obsidian vessels: Not as simple as “Central Anatolia”

In the 1960s, Renfrew and colleagues tested an obsidian vessel from Tepe Gawra in northern Iraq. The vessel was attributed to their “Group 1e-f” chemical type, which matched obsidian from the Acıgöl volcanic complex in central Turkey as well as unclear locations in eastern Turkey and Armenia. Renfrew and colleagues favored an attribution of the vessel to Acıgöl, and consequently, an association between obsidian vessels and central Turkey became widely held in the literature. Given the destructive nature of chemical analysis until the 21st century, obsidian vessels and fragments were almost never tested, so there were few chances to overturn or support this association. Furthermore, such vessels have attracted much attention as likely prestige objects. To consider value and meanings derived from a material’s source, however, it is crucial to have the correct identification of its origin. First I consider the available sourcing data for previously studied vessel fragments. Second I report my new source identifications for a vessel with an uncertain provenience in the Metropolitan Museum of Art, fragments from Ur, and the same vessel from Tepe Gawra tested by Renfrew and colleagues. Only the site located in south-central Turkey (Domuztepe) had polished artifact fragments from the obsidian sources of Cappadocia. For Mesopotamian (Tepe Gawra, Ur, Kenan Tepe) and Zagros (Tal-e Malyan) sites, the vessels instead derived from four sources in eastern Turkey: Sarıkamış 2, Nemrut Dağ 2, Bingöl B, and Meydan Dağ. Thus, the association between obsidian vessels and central Turkey must be abandoned, as must narratives based on this association (e.g., exchange between early states or elites in Cappadocia and Mesopotamia).

Anatomical classification of canine congenital extrahepatic portosystemic shunts based on CT angiography: A SVSTS and VIRIES multi-institutional study in 1082 dogs.

Canine congenital extrahepatic portosystemic shunt (EHPSS) morphologies have not been fully elucidated. The goal of this retrospective, multi-institutional study was to use CT angiography to create an anatomical-based nomenclature system for canine congenital EHPSS. These shunt morphologies were then evaluated to identify any significant association with patient age, sex, breed, weight, or subjective portal perfusion score. Data collected respectively from the SVSTS and VIRIES list-serves included patient DOB, sex, breed, weight, CT date, and reported diagnosis. A single author (C.W.) viewed all CT scans and classified shunts based on the shunt portal vessel(s) of origin, the shunt systemic vessel(s) of insertion, and any substantial portal vessels contributing to the shunt. Additionally, hepatic portal perfusion was subjectively scored between one (poor/none) and five (good/normal) based on the caliber of the intrahepatic portal veins. A total of 1182 CT scans were submitted from 13 different institutions. Due to exclusion criteria, 100 (8.5%) were removed, leaving 1082 CT scans to be included. Forty-five different EHPSS anatomies were identified with five classifications accounting for 85% of all shunts (left gastric-phrenic [27%], left gastric-azygos [19%], left gastric-caval [15%], aberrant left gastric-caval with right gastric vein [12%], and aberrant left gastric-caval with right gastric vein and short gastric vein [11%]). Shunt origin involved the left gastric vein in 95% of the described classifications. Significant differences were identified among the five most common shunt types with respect to age at the time of the CT scan (P<.001), sex (P=.009), breed (P<.001), weight (P<.001), and subjective portal perfusion score (P<.001). An anatomical classification system for canine EHPSS may enable improved understanding, treatment comparisons, and outcome prediction for these patients.

Indications, safety, and effectiveness of transcatheter electrosurgical septotomy during endovascular repair of aortic dissections

ObjectiveEndovascular repair of aortic dissections may be complicated by inadequate sealing zones, persistent false lumen perfusion, and limited space for catheter manipulation and target artery incorporation. The aim of this study was to describe the indications, technical success, and early outcomes of transcatheter electrosurgical septotomy (TES) during endovascular repair of aortic dissections. MethodsWe reviewed the clinical data of consecutive patients treated by endovascular repair of aortic dissections with adjunctive TES in two centers between 2021 and 2023. End points were technical success, defined by successful septotomy without dislodgment of the lamella or target artery occlusion, and 30-day rates of major adverse events (MAEs). ResultsAmong 197 patients treated by endovascular repair for aortic dissections, 36 patients (18%) (median age, 61.5 years (interquartile range, 55.0-72.5 years; 83% male) underwent adjunctive TES for acute (n = 3 [8%]), subacute (n = 1 [3%]), or chronic postdissection aneurysms (n = 32 [89%]). Indications for TES were severe true lumen (TL) compression (≤16 mm) in 28 patients (78%), target vessel origin from false lumen in 19 (53%), creation of suitable landing zone in 12 (33%), and organ/limb malperfusion in four (11%). Endovascular repair included fenestrated-branched endovascular aortic repair (EVAR) in 18 patients (50%), thoracic EVAR/EVAR/PETTICOAT in 11 (31%), and arch branch repair in 7 (19%). All patients had dissections extending through zones 5 to 7, and 28 patients (78%) underwent TES across the renal-mesenteric segment. Technical success of TES was 92% (33/36) for all patients and 97% (32/33) among those with subacute or chronic postdissection aneurysms. There were three technical failures, including two patients with acute dissections with inadvertent superior mesenteric artery dissection in one patient and distal dislodgement of the dissection lamella in two patients. There were no arterial disruptions. The mean postseptotomy aortic lumen increased from 13.2 ± 4.8 mm to 28.4 ± 6.8 mm (P < .001). All 18 patients treated by fenestrated-branched EVAR had successful incorporation of 78 target arteries. There was one early death (3%) from stroke, and three patients (8%) had major adverse events. After a median follow-up of 8 months (interquartile range, 4.5-13.5 months), 13 patients (36%) had secondary interventions, and two (6%) died from non-aortic-related events. There were no other complications associated with TES. ConclusionsTES is an adjunctive technique that may optimize sealing zones and luminal aortic diameter during endovascular repair of subacute and chronic postdissection. Although no arterial disruptions or target vessel loss occurred, patients with acute dissections are prone to technical failures related to dislodgement of the lamella.

Left main bronchus compression by massive pericardial effusion: A rare cause of respiratory distress in an infant: A case report

AbstractTracheobronchial compression due to cardiovascular disease is a rare cause of respiratory distress in children, and common causes include vascular slings and rings, abnormal origin of major vessels, and left atrial enlargement. Intrathoracic airway compression due to pericardial effusion is a rare cause of respiratory distress in children. Here, we present a 6-month-old male child who presented with respiratory distress due to extraluminal compression of the left main bronchus by large pericardial effusion leading to left lung collapse, which improved after pericardiocentesis.

An empirical assessment of seaports as facilitators of FOC-flagged transshipment landings

Transshipment is one of the most common activities occurring between carriers and fishing vessels to exchange fish, as well as fuel, crew, and gear at sea or at port. While transshipment reduces the need for the fishing vessels to visit ports to offload their catches, thus increasing their efficiency, research has shown that this activity is also one of the major facilitators of IUU fishing. Research on transshipments is limited, and the few studies that are available on the subject focus on identifying hotspots of transshipment, and networks of actors involved. No study to date has examined the role ports play in facilitating transshipment activities, nor are there any studies that examine whether ports that are affiliated with China (the country with the highest IUU Fishing Index Score and 38% of the global share of distant-water fleets) are more likely to experience disproportionately higher volumes of FOC-flagged carrier vessel visits. Therefore, using the carrier vessel portal database from Global Fishing Watch, which contains information on the origin and destination ports of the carrier vessels involved in transshipment activities between 2015 and 2022, this research aims to (a) understand hot spots of FOC-flagged carrier vessel activity in the high seas and where such vessels offload their catches around the world; and (b) empirically test the characteristics of the ports (and the countries where these ports are located) used by these vessels to offload their catches. Findings suggest that ports that experience higher volumes of fishing vessel traffic, are in close proximity to high-seas transshipment activities involving FOC-flagged carriers, are designated ports of entry for foreign vessels, are Chinese-affiliated, as well as have low monitoring, control, and surveillance capacity are significantly more likely to be visited by FOC-flagged high-risk carrier vessels. This research proposes policy recommendations deriving from the findings of this research.

Anatomical classification of feline congenital extrahepatic portosystemic shunts based on CT angiography: A SVSTS and VIRIES multi-institutional study in 231 cats.

The prevalence of anatomical-based subtypes of feline congenital extrahepatic portosystemic shunts (EHPSS) has not been completely elucidated. The goal of this study was to use CT angiography to create an anatomical-based nomenclature system for feline congenital EHPSS. Additionally, subjective portal perfusion scores were generated to determine if intrinsic portal vein development was associated with different shunt conformations or patient age at the time of CT. The SVSTS and VIRIES list services were used to recruit cases. Data collected included patient DOB, gender, breed, weight, CT date, and reported diagnosis. Shunts were classified based upon (1) the shunt portal vessel(s) of origin, (2) the shunt systemic vessel(s) of insertion, and (3) any substantial portal vessels contributing to the shunt. Additionally, hepatic portal perfusion was subjectively scored between 1 (poor/none) and 5 (good/normal) based on the caliber of the intrahepatic PVs. A total of 264 CT scans were submitted from 29 institutions. Due to exclusion criteria, 33 (13%) were removed, leaving 231 CT scans to be included. Twenty-five different EHPSS anatomies were identified with five classifications accounting for 78% of all shunts (LGP [53%], LGC-post [11%], LCG [7%], LGC-pre [4%], and PC [4%]). Shunt origin involved the left gastric vein in 75% of the described classifications. Significant differences were identified among the five most common shunt types with respect to age at the time of CT scan (P=.002), breed (P<.001), and subjective portal perfusion score (P<.001). This refined anatomical classification system for feline EHPSS may enable improved understanding, treatment comparisons, and outcome prediction for cats with these anomalies.

Visceral Aorta Electrocautery Septotomy to Allow Branched Endovascular Aortic Repair in Ruptured Chronic Post-Dissection Thoraco-Abdominal Aneurysm.

Endovascular repair of chronic post-dissection thoraco-abdominal aortic aneurysms (PD-TAAA) presents specific technical challenges due to the presence of chronic septum. Small true lumen diameter and false lumen visceral vessel origin can make branched endograft prohibitive. Septotomy may allow to overcome these challenges in cases of high complex anatomy. We describe the application of electrocautery septotomy to the visceral aorta segment to deploy an off-the-shelf branched endograft in a chronic PD-TAAA rupture with true lumen collapse. Electrocautery septotomy can be an effective adjunctive technique to facilitate branched endograft, overcoming technical challenges associated with the endovascular treatment of chronic PD-TAAA. Electrocautery septotomy is an adjunctive technique that can facilitate endovascular treatment of post-dissection thoraco-abdominal aneurysm. By creating a common lumen, this technique might reduce the number of re-interventions associated with PD-TAAA endovascular exclusion.

Distribution of Perigastric Station 4d Lymph Nodes in Vascularized Gastroepiploic Lymph Node Transfer: An Anatomic Study and Case Series.

Vascularized gastroepiploic lymph node transfer (VGLNT) is a well-accepted surgical treatment for restoring physiological function in chronic lymphedema. However, the inclusion of substantial lymph nodes (LNs) in the flap remains uncertain. This study aimed to identify the anatomical basis for reliable flap harvest for VGLNT. The anatomy of perigastric station 4d LNs was studied in healthy cadavers (n=15) and patients with early gastric cancer (EGC) (n=27). The omentum was divided into three segments: proximal, middle, and distal from the origin of the right gastroepiploic vessels. The flap dimension, number, location, size of LNs, and caliber of the vessels were reviewed. Eight patients underwent VGLNT for upper/lower limb lymphedema. The mean numbers of LNs in the proximal, middle, and distal segment were 2.5, 1.4, 0.5 in the cadavers, and 4.9, 2.7, 0.7 in the gastrectomy specimens, respectively. The proximal third included a significantly greater number of LNs than the distal third in the cadaveric (p=0.024) and ECG (p=0.016) specimens. A total of 95% of the LNs were located within proximal two-thirds of the flap from the vessel origin both in the cadavers (21.0×5.0cm) and in the gastrectomy specimens (20×3.5cm). In VGLNT, the transferred flap was 25.5±6.9×4.1 + 0.7cm in dimension, containing a mean number of 6.5±1.9 LNs. At postoperative 6months, the volumetric difference was significantly reduced by 22.8±9.2% (p<0.001). This study provides a distinct distribution pattern of station 4d LNs. Inclusion of the proximal two-thirds of the flap, which carries majority of the LNs, is recommended for VGLNT.

Case report of a type II single umbilical artery seen in the first trimester anomaly scan

Umbilical arteries normally originate from a pair of allantoic arteries. Obliteration or non-formation of any of the two umbilical arteries gives rise to a single umbilical artery (SUA). 0.5–1% of fetuses show the presence of a SUA. A rarer abnormality is when a SUA is found originating from the abdominal aorta, representing the persistent vitelline artery. Such an anomaly is termed Type II SUA. Here, we present a case of Type II SUA in a 30-year-old first trimester gravid female. Obstetric ultrasound done in the first trimester showed non-visualization of the umbilical arteries adjacent to the urinary bladder. Instead, an aberrant, large vessel was seen tracking anteriorly from the aorta towards the umbilical cord. The aorta distal to the origin of this aberrant vessel appeared hypoplastic.

The fulcrum of the human heart (Cardiac fulcrum)

Introduction: The functional anatomy of the myocardium allows envisioning that it initiates and ends at the origin of the great vessels. In our research, we have always considered that it should have a point of attachment to allow its helical rotation to fulfill the fundamental movements of shortening-torsion (systole) and lengthening-detorsion (suction), which once found, was called the cardiac fulcrum. Material and Methods: A total of 31 hearts, arising from the morgue and slaughterhouse were used: 17 corresponded to bovids and 14 were human. Anatomical and histological studies were performed. The heart was fixed in 10% buffered formalin. Hematoxylin-eosin, Masson’s trichrome staining technique and 4-micron sections were used for the histological study, and 10 % formalin was used as buffer. Results: The anatomical investigations have revealed that all the hearts (bovids and humans) have a myocardial support whose histological structure in the analyzed specimens presents with an osseous or chondroid-tendinous character. In this structure, that we have call cardiac fulcrum, are inserted the myocardial fibers at the origin and end of the band, which correspond to the continuous myocardium coiled as a helix. Conclusion: This description of the fulcrum would end the problem of lack of support of the myocardium to fulfill its function of suction/ejection.

The Fulcrum of the Human Heart (Cardiac fulcrum)

Introduction: The functional anatomy of the myocardium allows envisioning that it initiates and ends at the origin of the great vessels. In our research, we have always considered that it should have a point of attachment to allow its helical rotation to fulfill the fundamental movements of shortening-torsion (systole) and lengthening-detorsion (suction), which once found, was called the cardiac fulcrum. Materials and methods: A total of 31 hearts, arising from the morgue and slaughterhouse were used: 17 corresponded to bovids and 14 were human. Anatomical and histological studies were performed. The heart was fixed in 10% buffered formalin. Hematoxylin-eosin, Masson’s trichrome staining technique, and 4-micron sections were used for the histological study, and 10 % formalin was used as a buffer. Results: The anatomical investigations have revealed that all the hearts (bovids and humans) have myocardial support whose histological structure in the analyzed specimens presents with an osseous or chondroid-tendinous character. In this structure, which we have called the cardiac fulcrum, are inserted the myocardial fibers at the origin and end of the band, which correspond to the continuous myocardium coiled as a helix. Conclusion: This description of the fulcrum would end the problem of lack of support of the myocardium to fulfill its function of suction/ejection.