Posterior Branch Research Articles

Abstract No. 48 Usefulness of cone-beam computed tomography during bronchial artery embolization

Bronchial artery embolization (BAE) is a well-established intervention for treating benign and malignant causes of hemoptysis with high success rate from 70-99%; a subset of these procedures involve bronchial artery chemoperfusion, which has been used in palliation of lung malignancies. One of the dreaded complications of BAE is non-target embolization resulting in spinal cord ischemia, occurring in 0.6-4.4% of patients. This study aims to examine whether the adjunct use of CBCT with digital subtraction angiography (DSA) has an impact on BAE interventions. Twenty-one (10M, 11F) patients of mean age 55.5 who underwent DSA with CBCT prior to BAE from 2010 to 2020 were evaluated for single-institutional retrospective study. Retrospective analysis of the dictated reports were performed in conjunction with the available stored images and findings were summarized into 3 categories: 1) CBCT added no benefit; 2) CBCT added benefit (i.e., increased diagnostic confidence) without change in procedural management; 3) CBCT added benefit with change in intraprocedural management. The frequency and percentage of each category were calculated. 14/21 patients (66.7%) (95% CI: 0.47-0.87) were placed into category 2 whereby CBCT increased diagnostic confidence for embolization. The remaining 7/21 (33.3%) patients (95% CI: 0.13-0.53) were placed into category 3. In 3 of these patients, CBCT resulted in microcatheter repositioning to a selective bronchial artery branch to avoid nontarget embolization of a spinal artery. In 2 patients, CBCT confirmed normal tissue perfusion resulting in microcatheter repositioning to find an alternate source. In the remaining 2 patients, CBCT showed additional intercostal collaterals to ipsilateral bronchial arteries, which were then embolized. No cases were placed into category 1. One patient (4.8%) had a complication of spinal cord ischemia likely related to non-target embolization via small posterior radiculomedullary arterial branches, which in retrospect were seen on CBCT but not DSA. No other complications were seen. Adjunct use of CBCT during BAE provides additional information beyond DSA. This resulted in increased diagnostic confidence 67% of the time and in 33% of cases resulted in intraprocedural change in management, often to avoid non-target embolization via DSA-occult spinal arteries.

Application of ultrasound-guided selective nerve branch blockage in lumbar spinal nerve posterior branch syndrome

To investigate the efficacy and safety of ultrasound-guided selective nerve branch blockage in the treatment of lumbar spinal nerve posterior branch syndrome. A total of 40 patients with lumbar spinal nerve posterior branch syndrome treated by Pain Clinic from May 2017 to December 2018 were selected. According to the method used in locating site for nerve blockage, the patients were divided into ultrasound-guided group and anatomical positioning group, with 20 cases in each group. In anatomical positioning group, there were 7 males and 13 females, aged (63.42±7.71) years old, weighted (63.65±10.72) kg, numerical rating scale (NRS) was (6.61±1.52) scores, course of disease was (16.55±4.68) months. Pain sites:4 cases at L2,3, 8 cases at L3,4, 11 cases at L4,5, and 11 cases at L5S1. In ultrasound-guided group, there were 10 males and 10 females, aged (59.58±10.21) years old, weighted (60.61±13.81) kg, NRS was(6.84±2.43) scores, and course of disease was(13.70±5.98) months. Pain sites:6 cases at L2,3, 6 cases at L3,4, 9 cases at L4,5, and 13 cases at L5S1. Ultrasound-guided group used ultrasound-guided selective posteromedial branch and posterolateral branch nerve blockage, and the anatomical positioning group used anatomical localization method to block the posteromedial branch and posterolateral branch of lumbar spinal nerve. Each nerve branch was injected 3 ml of 0.125% ropivacaine. The number of treatment required and prone position time of each treatment were recorded, and the NRS scores of patients at the time points of immediately after the end of the treatment, the first week, the second week, the first month and the third month were evaluated. And adverse events such as local anesthetic allergy and poisoning, local puncture infection, total spinal anesthesia, dizziness, drowsiness, nausea, vomiting and other adverse reactions were observed. There were no statistically significant differences in gender, age, weight, NRS, course of disease and pain segment distribution between two groups (P>0.05). The number of treatment required in anatomical positioning group was significantly higher than that in ultrasound-guided group (P<0.000 1). During each treatment, the time in the prone position of the patients in anatomical positioning group was significantly lower than that in ultrasound guided group (P< 0.000 1). NRS scores immediately after the end of treatment, 1 week, 2 weeks, 1 month and 3 months, anatomical positioning group were 2.98 ±0.25, 3.04 ±0.38, 3.37 ±0.47, 3.42 ±0.85, 3.50 ±0.43, respectively, 2.94 ±0.31, 3.00 ±0.29, 3.21 ±0.68, 3.16 ± 0.94, 3.17±0.53 in ultrasound-guided group, and there was significant difference at 1 month and 3 months between two groups(P< 0.05). There were no adverse events such as local anesthetic allergy and poisoning, local puncture infection, and total spinal anesthesia, and no adverse reactions such as lethargy, nausea, and vomiting occurred in two groups. There were 6 cases of dizziness in anatomical positioning group and 12 cases in ultrasound guided group. The difference between two groups was statistically significant(P<0.05). Comparedwith anatomicalpositioning, ultrasound-guided selective nerve branch block for the treatment of posterior branch of the lumbar spinal cord syndrome can reduce the number of treatments and maintain a longer therapeutic effect, but it is also necessary to pay attention to the time of each treatment to avoid dizziness and other adverse reactions.

Transcatheter arterial embolization for hemorrhage after gynecologic hysterectomy: a multicenter study.

Transcatheter arterial embolization (TAE) is not common for hemorrhagic complications after gynecologic hysterectomy. To evaluate the effectiveness and safety of TAE for hemorrhage after hysterectomy for gynecologic diseases. This is a retrospective, multicenter study, which investigated 11 patients (median age = 45 years) who underwent TAE for hemorrhage after gynecologic hysterectomy between 2004 and 2020. The median interval between surgery and angiography was one day (range = 0-82 days). Hemodynamic instability and massive transfusion were present in 6 (54.5%) and 4 (36.4%) patients, respectively. CT scans (n = 7) showed contrast extravasation (n = 5), pseudoaneurysm (n = 1), or both (n = 1). On angiography, the bleeding arteries were the anterior division branches of the internal iliac artery (IIA) (n = 6), posterior division branch (lateral sacral artery, n = 1), and inferior epigastric artery (n = 1) in eight patients with active bleeding. In the remaining three patients, angiographic staining without active bleeding foci was observed at the vaginal stump, and the feeders for staining were all anterior division branches of the IIA. Technical and clinical success rates were 100% and 90.9% (10/11), respectively. In one patient, active bleeding focus was successfully embolized on angiography, but surgical hemostasis was performed for suspected bleeding on exploratory laparotomy. Postembolization syndrome occurred in one patient. TAE is effective and safe for hemorrhage after hysterectomy for gynecologic diseases. Angiographic findings are primarily active bleeding, but angiographic staining is not uncommon. A bleeding focus is possible in any branch of the IIA, as well as the arteries supplying the abdominal wall.

Innervation of the scrotum by the anterior division of the obturator nerve – a rare variation

The scrotum is supplied by ilioinguinal, genital branch of genitofemoral, perineal branch of the posterior cutaneous nerve of the thigh and the posterior scrotal branches of the pudendal nerve. We report an extremely rare innervation of the anterior part of the scrotum by the anterior division of the right obturator nerve. The genital branch of genitofemoral nerve did not reach the scrotum. The ilioinguinal nerve did not supply the scrotum. The anterior division of the obturator nerve gave a branch which ascended superomedially in the thigh, crossed superficial to the spermatic cord and communicated with the right ilioinguinal nerve. As it crossed the spermatic cord, it gave a scrotal branch which descended over the spermatic cord and ramified to supply the anterior part of the scrotum. Knowledge of this variation could be important to anaesthesiologists, urologists and surgeons in general.

Three-Dimensional Computed Tomography Scanning of Temporal Vessels to Assess the Safety of Filler Injections.

Temple filler injection is one of the most common minimally invasive cosmetic procedures involving the face; however, vascular complications are not uncommon. This study aimed to investigate the anatomy of the temporal vessels and provide a more accurate protocol for temple filler injection. Computed tomography (CT) scans of 56 cadaveric heads injected with lead oxide were obtained. We then used Mimics software to construct 3-dimensional (3D) images of the temporal vessels described by a coordinate system based on the bilateral tragus and right lateral canthus. In the XOY plane, the superficial temporal artery (STA), middle temporal artery (MTA), zygomatico-orbital artery (ZOA), posterior branch of the deep temporal artery (PDTA), and lateral margin of the orbital rim divide the temple into 4 parts (A, B, C, and D). The probabilities of the STA, MTA, ZOA, and PDTA appearing in parts A, B, C, and D were 30.73%, 37.06%, 39.48%, and 77.18%, respectively. In 3D images, these vessels together compose an arterial network that is anastomosed with other vessels, such as the external carotid, facial, and ocular arteries. 3D CT images can digitally elucidate the exact positions of temporal vessels in a coordinate system, improving the safety of temple filler injections in a clinical setting.

Angiographic Anatomy of the Middle Meningeal Artery in Relation to Chronic Subdural Hematoma Embolization.

Middle meningeal artery (MMA) embolization is emerging as apotential treatment of chronic subdural hematomas (CSDHs). The purpose of this study is to describe MMA angiographic anatomy in relation to CSDH embolization. This retrospective monocentric study was performed on imaging data of MMA embolization procedures for CSDH treatment performed between March15, 2018 and April30, 2020. Imaging data, including digital subtraction angiography (DSA) were reviewed independently by two physicians. Discrepancies were resolved by consensus. The MMA bifurcation pattern was analyzed according to an extended Adachi classification. Relations of the MMA with the ophthalmic artery (OA) were also analyzed. In this study, 140 MMAs were analyzed. Dominance of the anterior branch (typeI) was observed in only 57/140 (41%) MMAs with amoderate interobserver agreement for classifying MMA into typeI against all other (κ = 0.53, 95% confidence interval, CI 0.39-0.67). The posterior branch presented aproximal origin (typeA), at the point of emergence of the MMA from the foramen spinosum or its immediate vicinity, in 48/135 (36%) MMAs with avery good interobserver agreement for classifying MMAs into typeA against all other (κ = 0.82, 95% CI 0.72-0.92). An angiographic relationship with the OA was observed in 26MMAs (19%). In the majority of CSDH patients both anterior and posterior branches of the MMA should be targeted to achieve extensive convexity devascularization. Frequent anatomical variations of the MMA with respect to emergence of the posterior branch and MMA orbital branches are expected to impact CSDH embolization strategy.

First two-stage robotic ALPPS in HCC patients with hepatic vein invasion: a step-by-step procedure from a clinical case

BackgroundThe associating liver partitioning and portal vein occlusion for staged hepatectomy (ALPPS) procedure is gaining interest because it brings hope to patients who cannot undergo radical surgical resection due to insufficient remnant liver volume. However, the indications and technical aspects of this procedure are still under debate. This report demonstrates the technical aspects of the first two-stage robotic ALPPS for HCC.Case presentationA 55-year-old man with type II portal vein variation was diagnosed with hepatocellular carcinoma. Preoperative 3D reconstruction of the liver based on CT showed a future liver remnant/standard liver volume (FLR/SLV) of 24.45%. The ALPPS procedure was performed using the da Vinci Si system. At the first stage of the operation, we removed the gallbladder and ligated the right anterior branch of the portal vein and the right posterior branch. Following blocking of the hepatic hilum, the liver parenchyma was removed 1 cm away from the right side of the falciform ligament in an incision manner from the top to the bottom and from shallow to deep. The second-stage operation was performed on the 12th postoperative day with a FLR/SLV of 45.13%. During this step, the right hemiliver plus left medial section was separated and removed. Postoperative pathology showed a negative margin. The operative times were 195 and 217 min, respectively. Estimated blood loss was 250 and 500 ml, respectively. There was no need for transfusion or hospitalization in intensive care. The patient was discharged on the 6th postoperative day. Recovery was uneventful after both stages, and the patient did not present any sign of liver failure. Elevation of liver enzymes was minimal. The patient had no evidence of the disease 14 months after the procedure.ConclusionsThe two-stage robotic ALPPS procedure is a safe and feasible technique for select patients with HCC.

Extended Right-hemihepatectomy Is Preferred for Perihilar Cholangiocarcinoma.

Extended Right-hemihepatectomy Is Preferred for Perihilar Cholangiocarcinoma.

Innervation of the Posterior Hip Capsule: A Cadaveric Study.

Recent studies of hip anatomy have turned to the posterior hip capsule to better understand the anatomic location of the posterior capsular sensory branches and identify nerves with potential for neural blockade. Current literature has shown the posterior hip capsule is primarily supplied by branches from the sciatic nerve, nerve to quadratus femoris, and superior gluteal nerve (1, 2). This cadaveric study investigated the gross anatomy of the posterior hip, while also identifying potential targets for hip analgesia, with emphasis on the superior gluteal nerve and nerve to quadratus femoris. Cadaveric study. UT Health San Antonio Anatomy Lab. In total, 10 total cadavers (18 hips total), were posteriorly dissected identifying nerve to quadratus femoris, superior gluteal nerve, and sciatic nerve. Nerves were labeled with radio-opaque markers. Following the dissections, fluoroscopic images were obtained at sequential angles to identify neural anatomy and help expand anatomic knowledge for interventional pain procedures. The posterior hip capsule was supplied by the sciatic nerve in 1/16 hips, the nerve to quadratus femoris in 15/18 hips, and the superior gluteal nerve in 6/18 hips. The nerve to quadratus femoris reliably innervates the posterior hip joint. Both the sciatic nerve and superior gluteal nerve have small articular branches that may be involved in posterior hip innervation, but this is not seen commonly. The results of this study may elucidate novel therapeutic targets for treatment of chronic refractory hip pain (i.e., the nerve to quadratus femoris).

Computer tomography-based quantitative analysis of the orbital proptosis severity in infants with syndromic craniosynostosis: case-control study.

Evaluation of orbital proptosis and sutural synostosis pattern along the coronal ring in craniofaciosynostosis patients with or without fibroblastic growth factor receptor 2 (FGFR2) mutation. High-resolution computer tomography was used to assess, in children with or without FGFR2 mutation, the early synostotic involvement of the "major" and "minor" sutures/synchondroses of the coronal arch along with the following orbital parameters: interorbital angle, bone orbital cavity volume, globe volume, ventral globe volume, ventral globe index. Infants with FGFR2 mutation showed an increased number of closed minor sutures/synchondroses along the posterior coronal branch while both groups showed a comparable synostotic involvement of the minor sutures of the anterior coronal branch. FGFR2 infants with posterior coronal branch synostotic involvement showed a higher degree of proptosis due to both reduced bony cavity volume and increased globe volume (p<0.05). Our data show that FGFR2 mutation together with posterior coronal branch synostotic involvement has a synergic effect in causing a more severe degree of orbital proptosis.

Inferior Turbinate Bone Graft for Dorsal Augmentation in Rhinoplasty.

The most serious form of nasal dorsum pathologies is saddle nose deformity. Vary of nasal dorsal augmentation grafts were reported in the literature but inferior bone graft (ITBG) alone has not attracted attention. The ITBG has advantages such as easy and fast harvesting, easy to shape due to cancellous bone tissue. The graft technique is similar to the inferior turbinoplasty with the medial mucosal flap technique and can be performed without bioabsorbable hemostatic material (e.g. Turkish Delight), suture fixation, or without tissue adhesives. Major complications of the ITBG technique are injury of the posterior lateral nasal branch of the sphenopalatine artery and subdermal mucous cyst that developing on nasal dorsum. Since easy application, fast harvesting, and similar permanence to cartilage grafts as augmentation material, ITBG can also been used successfully in minor dorsal deficits in addition to saddle nose deformities.

Clinical Application of Transcranial Color Doppler Ultrasound in Carotid Endarterectomy

Ischemic cerebrovascular diseases are important duet to the high incidence, disability, mortality, and recurrence. Intracranial arterial stenosis caused by atherosclerosis is an important pathological basis of ischemic cerebrovascular disease. Therefore, convenient, non-invasive, cheap and accurate screening methods have become the goal of everyone's joint efforts. The purpose of this study was to investigate the value of transcranial Doppler in judging arterial stenosis, and to explore the best cut-off point for assessing the blood flow velocity of middle cerebral artery disease and the compensation of the posterior branch of middle cerebral artery disease. Using retrospective analysis, binomial logistic regression analysis was performed on risk factors related to ischemic cerebrovascular disease. The 60 patients with intracranial stenosis were selected for TCD (Transcranial Color Doppler) and CTA (Computed Tomography Angiography) examinations within one week of onset. CTA was used as the diagnostic criterion to analyze the accuracy of TCD in the diagnosis of intracranial arterial disease. ROC (Receiver Operating Characteristic) curve was used to determine the optimal cutoff point of blood flow velocity for MCA (Middle Cerebral Artery) lesions. TCD has high specificity and sensitivity in the diagnosis of intracranial arterial disease, and it can be widely used in clinic as a simple, convenient and cheap diagnostic method for screening intracranial arterial stenosis.

Long Non-coding RNA MIAT Knockdown Prevents the Formation of Intracranial Aneurysm by Downregulating ENC1 via MYC.

Intracranial aneurysm (IA) is vascular enlargement occurred on the wall of cerebral vessels and can result in fatal subarachnoid hemorrhage when ruptured. Recent studies have supported the important role of long non-coding RNAs (lncRNAs) in IA treatment. This study identified functional significance of lncRNA myocardial infarction associated transcript (MIAT) in IA. Myocardial infarction associated transcript and ectodermal-neural cortex 1 (ENC1) expression was detected by reverse transcription quantitative polymerase chain reaction. Cell counting kit 8 assay flow cytometry were conducted to detect cell viability and apoptosis of endothelial cells in IA. The interaction among MIAT, ENC1, and myelocytomatosis oncogene (MYC) was analyzed by RNA pull down, RNA immunoprecipitation assay, chromatin immunoprecipitation assay, and dual luciferase reporter assay. Intracranial aneurysm was induced by ligating the left carotid artery and the bilateral posterior branch of the renal artery in rats for studying the role of MIAT and ENC1 in vivo. Myocardial infarction associated transcript and ENC1 were upregulated in IA. Endothelial cells in IA presented a decreased cell viability and an increased apoptotic rate. Myocardial infarction associated transcript could regulate the expression of ENC1, and MYC could bind to the promoter region of ENC1. High expression of MIAT increased endothelial cell apoptosis and vascular endothelial injury, while MIAT knockdown was identified to reduce the risk of IA both in vitro and in vivo through regulating ENC1. To sum up, MIAT silencing is preventive for IA occurrence by decreasing the MYC-mediated ENC1 expression, which represents a novel therapeutic target for IA.

Indocyanine green fluorescence navigation for hepatocellular carcinoma with bile duct tumor thrombus: a case report

BackgroundBile duct tumor thrombus (BDTT) is one of the features of advanced hepatocellular carcinoma (HCC). In the resection of HCC with BDTT, it is important to detect the BDTT tip to decide the appropriate point of bile duct division. In this regard, the efficacy of indocyanine green (ICG) fluorescence navigation has been confirmed for the detection of HCC, whereas its utility for BDTT has not yet been reported. Herein, we describe our experience with right hepatectomy for HCC with BDTT using ICG fluorescence navigation.Case presentationA 72-year-old woman had experienced local recurrences of HCC after radiofrequency ablation, with BDTT reaching the confluence of the right anterior branch and posterior branch. Right hepatectomy was planned, and 2.5 mg of ICG was injected one day before surgery. After transection of the liver parenchyma, the right liver was connected with only the right hepatic duct. ICG fluorescence imaging visualized the tip of BDTT in the bile duct with clear contrast; the proximal side (hepatic side) of the right hepatic duct showed stronger fluorescence than the distal side (duodenal side). The bile duct was divided at the distal side of the BDTT border, and the tip of BDTT was recognized into the resected right hepatic duct without laceration. The patient had an uneventful postoperative course and currently lives without recurrences for 6 months.ConclusionsICG fluorescence navigation assisted in the precise resection of the bile duct in HCC with BDTT.

Anatomical Study of the Posterior Spinal Artery Branches to the Medulla Oblongata

The posterior spinal arteries (PSAs), branches of the intracranial segment of the vertebral artery or posterior inferior cerebellar artery (PICA), run bilaterally along the spinal cord and are integral to the blood supply primarily to the posterior one-third of this structure. However, a less well-described distribution of the PSAs is their supply to the posterior medulla. The purpose of this study is to examine the medullary branches of the PSA anatomically. We conducted a cadaveric study to evaluate for branches of the PSA supplying the medulla oblongata. All 14 sides had medullary branches arising from the PSAs. The average number of branches supplying the medulla oblongata on each side was six. Most of these branches traveled laterally to anastomose with medullary branches arising from the anterior spinal artery. Additionally, lateral and ascending branches were noted. Physicians who interpret imaging of the craniocervical junction, in particular arteriograms, should be aware of ascending medullary branches arising from the anterior spinal artery. Additionally, neurosurgeons operating this region must be careful in dissecting over the posterior medulla and manipulating the cerebellar tonsils, as in telovelar approaches to the fourth ventricle, in order to avoid iatrogenic injury to these vessels. Additionally, variable stroke patterns involving the vertebral artery or PICA might include ischemia to the medulla oblongata via PSA branches and this anatomy should be kept in mind by interventionalists, radiologists, and neurologists alike.

The U.S. Veterans Health Administration national giant cell arteritis (GCA) database cohort: incident ophthalmic complications in biopsy-negative GCA patients.

This study aimed to identify the incidence of ophthalmic complications of giant cell arteritis (GCA) among subjects with negative temporal artery biopsy (TAB) and to determine if duration of prednisone exposure relative to GCA diagnosis was associated with ophthalmic complications in TAB-negative subjects. The U.S. Veterans Health Administration (VHA) national database was queried for subjects between 1999 and 2017 with ICD-9/-10 diagnosis code for GCA, procedure code for TAB, and ICD-9/-10 diagnosis code for blindness, anterior or posterior ischemic optic neuropathy, or branch or central retinal artery occlusion. Pharmacy data regarding prednisone dispensation were collected. A Cox proportional hazard model was performed using ophthalmic complication by 1 year as the outcome variable in TAB-negative subjects, adjusting for age, TAB length, TAB laterality, and prednisone dose relative to GCA diagnosis date. Incident ophthalmic complication occurred by 1 year in 9.6% with positive TAB and in 6.2% with negative TAB. The majority of complications occurred within the first month for both groups. Compared to a reference group of prednisone initiation 0-14 days prior to GCA diagnosis, ophthalmic complications in TAB-negative subjects were significantly higher when prednisone initiation was delayed 14-28 days after GCA diagnosis. A substantial number of TAB-negative subjects accrued an incident ICD-9/-10 code for ophthalmologic complication within a year after diagnosis, most occurring within the first month. Delaying prednisone initiation 14-28 days after GCA diagnosis in TAB-negative subjects led to a 3.5-fold higher rate of ophthalmic events occurring by 1 year. Key Points • This study provides an incidence rate of ophthalmic complication by one year in biopsy-negative subjects suspected of having GCA. • Delaying prednisone initiation 14-28 days after GCA diagnosis in TAB-negative GCA subjects led to a 3.5-fold higher rate of ophthalmic events occurring by 1 year.

High-resolution three-dimensional T1-weighted hepatobiliary MR cholangiography using Gd-EOB-DTPA for assessment of biliary tree anatomy: Parallel imaging versus compressed sensing

PurposeTo compare the quality of images obtained by T1-weighted hepatobiliary MR cholangiography using Gd-EOB-DTPA with 1-mm isovoxel acquisition and compressed sensing (T1-MRCCS) or parallel imaging (T1-MRCPI) for assessment of biliary tree anatomy. MethodWe prospectively reviewed T1-MRCCS, T1-MRCPI, and respiratory-triggered 3D T2-weighted MR cholangiography (T2-MRC) images in 58 patients. Two radiologists independently assessed the three sets of images and scored the biliary tree visualization and overall image quality in all cases using a 5-point Likert scale. The resulting scores were compared among T1-MRCCS, T1-MRCPI, and T2-MRC images using a Friedman test followed by a Scheffe test. The inter-reader agreement in scoring was assessed using κ statistics. ResultsThe image quality scores for the gallbladder on both T1-MRCCS and T1-MRCPI were significantly lower than those on T2-MRC (p < 0.01) for both readers. Meanwhile, the image quality scores for the right and left hepatic ducts and the anterior and posterior branches of the right hepatic duct on both T1-MRCCS and T1-MRCPI were significantly higher than those on T2-MRC (p < 0.05) for both readers. For Reader 2, the overall image quality scores on T1-MRCCS and T1-MRCPI were both significantly higher than those on T2-MRC (p < 0.05). There were no significant differences between the image quality scores on T1-MRCCS and T1-MRCPI for visualization of each bile duct (p < 0.05). ConclusionsThere may be no significant difference in quality between T1-MRCCS images and T1-MRCPI images for assessment of biliary tree anatomy, and both types of images may be better than T2-MRC images, although clinical indication is limited compared with T2-MRC.

Особенности атеросклеротического поражения коронарных артерий у пациентов с ранним развитием острого коронарного синдрома среди носителей различных полиморфных вариантов генов ангиогенеза

The purpose was to examine atherosclerotic changes in the anatomy of coronary arteries in patients with early acute coronary syndrome among carriers of different genotypes: rs3825807 of the ADAMTS7 gene and rs699947 of the VEGF-A gene.The study included 116 patients, 69 (59%) men and 47 (41%) women with the first manifestation of acute coronary syndrome (ACS) before 55 years and 65 years respectively. Coronary angiography revealed at least one stenosis ≥ 40% in all patients during in-house treatment. The genotype of rs3825807 ADAMTS7 gene and rs699947 VEGF-A gene was determined by PCR in all patients. The prevalence of CC genotype rs699947 VEGF-A gene in patients with left circumflex artery stenosis was less than in patients without such a lesion (0.26 versus 0.46, p = 0,03; OR = 0,419; 95% CI: 0,187–0,941). The prevalence of TT genotype rs3825807 ADAMTS7 gene in patients with early manifestation of ACS with stenosis of the posterior basal branch and posterior interventricular branch of the right coronary artery was significantly higher (0,78 versus 0,35, p = 0,027) than in patients without these lesions (OR = 6,36; 95% CI: 1,27–32,59). Thus, with the development of acute coronary syndrome in men up to 55 years old, in women up to 65 years old, the carriage of the Аallele rs699947 VEGF-A gene is associated with lesions of left circumflex artery, and the carriage of TT genotype rs3825807 ADAMTS7 gene is associated with lesions of the posterior interventricular branch and the posterior basal branch of the right coronary artery.

Reconstruction of Digital Nerve Defects with Posterior Interosseous Nerve Terminal Joint Branch

Abstract Objective: The aim of our study is to retrospectively evaluate the patients who had digital nerve defective injuries of the hand which was reconstructed with the terminal branch of posterior interosseous nerve (PIN) for treatment. Methods: Twenty-three patients with digital nerve defective injuries, who applied late and were treated with PIN terminal branch grafting were included in the study. The mean age of the patients was 36.4 ± 8.1 years and the mean follow-up duration was 17.3 ± 3.2 months. The mean interval between the injury and the surgery was 5 (2-8) months, and the average gap in defective site was 19.7 ± 3.8 mm. Clinical assessment of the nerve healing was made with Semmes – Weinstein Monofilament (SWM) test and Static 2 Point Discrimination (S2PD) test and, the results were classified according to the British Medical Research Council (BMRC) scoring system. Results: The mean SMW test result was determined as 2.8 (2.8-20) grams, and the mean S2PD test result as 6 (4-20) mm at the sensory area of reconstructed nerve. Accordingly, BMRC scoring system revealed that sensory improvement was S4 level in 15 (65.2%) patients, S3 + in 4 (17.4%), S3 in 3 (13%) patients, and S2 level in 1 (4.3%) patient. Neuroma was not detected at any of the patients within the donor site. Scar formation was detected at 6 (26.1%) patients. Conclusion: PIN terminal branch is an appropriate substitute for digital nerve reconstruction with minimum morbidity and acceptable efficiency.

Bilateral "Rescue Strip" Technique for Endoscopic Endonasal Approaches to the Clivus.

The vascularized nasoseptal flap (NSF) is a pillar of contemporary endoscopic skull base reconstruction. The pedicle for the NSF is supplied by the posterior septal branch of the sphenopalatine artery, which courses along the arch of the choana and sphenoid rostrum before entering the nasal septum. Resection or mobilization of this region is necessary for surgical access to the clivus. To describe a technique for preserving bilateral NSF pedicles during endoscopic endonasal resection of the clivus, thereby safeguarding availability of the flaps for future skull base repair needs. Report of operative technique with video demonstration. This technique for NSF preservation allows for wide access to the clivus while saving the future option for vascularized flap repairs of skull base defects. The patient in whom we demonstrate this technique underwent complete resection of her clivus without cerebrospinal fluid leak and with preservation of both NSF pedicles. The "rescue strip" technique for endonasal endoscopic clival surgery preserves the bilateral NSF pedicles for future use without compromising surgical access to the clivus.