Type Of Anatomical Variation Research Articles

Computed tomographic characteristics of anatomical variations of external and internal jugular veins in dogs.

The external jugular vein (EJV) has been commonly used for clinical procedures in veterinary medicine, while the internal jugular vein (IJV) has been used mainly for research. Limited literature regarding anatomical variants in both EJV and IJV is available. The objectives of this descriptive retrospective study were to identify the number of dogs with variations of the jugular veins in canine patients undergoing CT of the head and neck and characterize these variations. Of 1000 dogs, 193 dogs (19.3%) had anatomical variations. Six types of anatomical variations were identified. The most common Type I was the absence of the linguofacial vein (72.0%, n=139), with the lingual, facial, and maxillary veins entering the EJV at a common branching point. Type II described a variable course of the EJV and IJV, which in some dogs resulted in the absence of the EJV (14.0%, n=27). Type III was a variable anastomotic loop formed by the linguofacial or maxillary vein cranial or at the junction of the EJV (4.2%, n=8). In Type IV, the EJV was either suspected to be aplastic or markedly reduced in diameter compared with the contralateral side just distal to its formation (3.6%, n=7). Type V was found in only six dogs (3.1%) with unilateral differences in the diameter of the IJV. Six of 193 dogs had a combination of more than one variation (Type VI, 3.1%). Type I was significantly observed more frequently in meso- and dolichocephalic breeds. Type II was significantly observed more frequently in brachycephalic breeds.

Practical use of dual-lumen catheter-facilitated reverse wire technique for nonhighly angulated side branch

Dual-lumen catheter (DLC)-facilitated reverse wire technique is considered a method of last resort for inserting a guidewire into a markedly angulated side branch. Moreover, this technique can be practically applied to other types of anatomical variations around the bifurcation. Case 1 was that of a 53-year-old man with a tight stenosis of the proximal left anterior descending artery at the diagonal bifurcation with angiographically apparent coronary dissection. We successfully achieved guidewire insertion into the targeted branch using the DLC-facilitated reverse wire technique. Case 2 involved a 78-year-old man with total occlusion of the mid-portion of the right coronary artery. The guidewire reentry point in the atrioventricular branch was slightly distant from the true distal end of the occlusion. We successfully used the DLC-facilitated reverse wire technique to pass a second guidewire to the posterodescending artery. Case 3 was that of an 80-year-old man whose coronary artery had an aneurysm with severe stenoses at both entry and exit of the aneurysm. We adopted the DLC-facilitated reverse wire technique and easily advanced the guidewire by matching the guidewire advancing path with the direction of the sequential conduit constituted by the coronary aneurysm and stenosis. The timing of decision-making to try the DLC-facilitated reverse wire technique is important. The lesion for which reverse wiring is suitable is usually difficult to be treated with conventional guidewire crossing. We have to promptly judge the validity of applying this technique based on the angiographic findings of targeted lesions and take immediate action to implement this procedure to reduce the procedural time and irradiation dose.

Correlation between the Opacification Degree of Paranasal Sinuses on CT, Clinical Symptoms and Anatomical Variations of the Nose and Paranasal Sinuses in Patients with Chronic Rhinosinusitis.

Objectives: This study aimed to evaluate the correlation between the opacification degree of the paranasal sinuses on computed tomography (CT) with clinical symptoms, and anatomical variations of the nose and paranasal sinuses in patients with chronic rhinosinusitis (CRS). Materials and Methods: This descriptive prospective study evaluated 100 patients (60 males and 40 females), who were diagnosed with CRS by ENT specialists according to the clinical findings, and were scheduled for a CT scan. The patients were requested to express the severity of their symptoms using a visual analog scale. The CT scans of the paranasal sinuses were assessed for the presence of anatomical variations and scored using the modified Lund-Mackay scoring system for the opacification degree of each sinus. The correlations between the anatomical variations and sinusitis, and also between the severity of symptoms/disease severity and CT scores were statistically analyzed. P<0.05 was considered statistically significant. Results: The most common symptoms were purulent (discolored) nasal drainage and nasal obstruction. Septal deviation was the most common anatomical variation. The maxillary and anterior ethmoid sinuses were the most commonly involved areas. The Spearman’s correlation coefficient showed a significant correlation between the sinus involvement and some of the evaluated symptoms, as well as certain types of anatomical variations (P<0.05). Conclusion: Some specific anatomical variations of the paranasal sinuses may predispose them to sinusitis. The CT scan score can predict the severity of many symptoms such as purulent (discolored) nasal drainage, nasal obstruction, hyposmia/anosmia, halitosis, cough, and fatigue, among the other symptoms of CRS.

The variations and degenerative changes of sacroiliac joints in asymptomatic adults.

The sacroiliac joint has a structure in which the direction of the load relative to the articular surface is irrational, as the joint surface is not perpendicular to the trunk load axis; it is likely to incur more degenerative changes than other weight-bearing joints. This retrospective study consisted of a total of 145 cases - 104 (71.7%) men and 41 (28.3%) women - who were referred to Gaziantep University Medical Faculty Radiology Department Polyclinic for pelvic computed tomography (CT) from 2013 to 2018. The mean age was 33.5 years (range: 18-60 years). Pelvis CT images were performed according to the exclusion criteria specified by the experienced orthopaedic surgeon. Patients were excluded from the study if they were younger than the age of 18, had a condition involving the sacroiliac joint, had an endocrine disorder, or had a history of a trauma affecting the pelvis CT examination. In this current study, six types of anatomic variations were detected. Iliosacral complex variation has been determined as the most common type of variation. The incidence of variations of sacroiliac joint in all cases was 28.9%. Degenerative changes were seen in 5.5% of patients fewer than 30 years of age. When it comes to the patients whose age range is 30-60, the percentage of the degenerative changes is 12.4%. In patients who were 30 years and older, the prevalence of degenerative changes increased progressively with increasing age. In this study, it is thought that the knowledge of variations in normal population and degenerative changes will contribute to the better understanding of normal morphological structure of sacroiliac joint and to the anatomical literature. It's seen that there is not a statistically significant relationship between degenerative changes and anatomical variations.

Clinical Importance of Main Portal Vein and Right Portal Vein Variations: A Prevalence Study With 128-Slice Multidetector Computed Tomography.

The portal vein variation type significantly affects the outcome of transplant surgery, hepatectomies, and interventional radiological procedures. To reveal variation types, especially rare types, we used high-technology multidetector computed tomography. We evaluated multiphase abdominal multidetector computed tomography scans of 278 consecutive patients. Multidetector computed tomography scans were processed for axial, coronal, and axial-oblique multiplane reformation and for maximum intensity projection. Variations of the main portal vein and right portal vein were simulta-neously analyzed by 2 radiologists. Prevalence of each variation and differences in sexes were investigated. Variant anatomy was detected in 29.5% of main portal veins and 20.9% of right portal veins. There was no statistical difference between sexes. Type 3 was reported as the most frequent variant of main portal vein, whereas type 4 was the most frequent variant of right portal vein. Some miscellaneous types were also ascertained. Different types of anatomic variations may adversely affect the course of surgery and interventional radiological procedures. Fortunately, radiologists can now discover the critical types by using the new generation multidetector computed tomography with 3-dimensional reconstruction techniques. This information should be included in the radiology reports of patients who are scheduled for major surgery.

Unilateral bifid condyle: a case report

In the present case report, a patient attended the Surgical Clinic of PUC-MG for extraction of third molars. When performing the panoramic radiography, an atypical shaping of the mandibular condyle was detected. For the correct diagnosis, a cone-beam computed tomography was requested. The axial, sagittal, and coronal tomographic sections clearly showed the structure and its position in relation to the skull. The exam showed unilateral hyperdense masses on the left, in the form of mediolaterally oriented secondary condylar heads. Although they were adjacent to the condylar head, a constriction between them was observed in the superior condylar pole region. This image analysis, associated with the absence of functional changes and symptomatology, was decisive for the diagnosis of a bifid condyle, as it allowed to exclude any pathological alteration. As its etiology is diverse, this type of anatomical variation is usually found in routine imaging exams, as in the present study. The bifid condyle can be considered a differential diagnosis of condylar hyperplasia, osteochondromas, or alterations related to temporomandibular dysfunction in two-dimensional radiographic exams.

The Cause of Frequent Infection and Persistent Cough Is Accessories Cardiac Bronc

Anatomical variations or tracheobronchial anomaly (TBA) have been rarely reported in the literature. Different types of anatomical variations may be present, but accessory cardiac bronchus may be rare and may be the cause of persistent cough or lower respiratory tract infections. Two patients who are admitted to the Department of Chest Diseases of Harran University Faculty of Medicine, for more than a decade with complaints of cough and frequent infection, were found to have an accessory cardiac bronchus which is laterally on the right main bronchus, karena level, except for the upper lobe bronchus, by chest computed tomography and bronchoscopy. We believe that the knowledge of tracheal variations seen in the anatomy of the lungs may be important in surgical procedures such as lobectotomy and segmentectomy in the lungs, and may be useful in the evaluation of long-term cough or frequent recurrent lower respiratory tract infections. Keywords; Accessory cardiac bronchus, lung, variation Special Issue of Health Sciences DOI: 10.7176/JSTR/6-03-35

Correlation between multiple cerebral aneurysms and a rare type of segmental duplication of the middle cerebral artery

BackgroundConnection between the duplication of the middle cerebral artery (DMCA) and the presence of multiple aneurysms has been described in a small number of cases.Case presentationThe presence of a rare type of DMCA associated with cerebral aneurysms was diagnosed in 56 year old woman after a rupture of an aneurysm on the dorsal segment of the DMCA. .. The presence of equal diameters of branches of the DMCA and anterior cerebral artery (ACA) could be recorded as trifurcation of the carotid internal artery (ICA). However, due to the anastomosis of the DMCA branches in the area of the M2 segment, the recorded anatomical change represented a segmental duplication of MCA. Three aneurysms that were directly related to the segmental DMCA were diagnosed.ConclusionsAnatomical variation by type of segmental DMCA is a rare subtype of DMCA. The presence of multiple aneurysms associated with this type of anatomical variation in MCA indicates their high hemodynamic instability.

Anatomical Variations of the Paranasal Sinuses and the Nasal Cavity

Computed tomography (CT) of the para-nasal sinuses (PNS) has nowadays become the investigation of choice for the diagnosis of sinonasal diseases. Numerous sinonasal anatomic variants exist and are frequently seen on CT scans. A sound knowledge of these variations is important not only for diagnosis but also for planning surgery in order to avoid complications. The aim of this study is to investigate the frequency of these variations in patients with sinonasal symptoms and also to determine their relation to sinonasal disease if any. A total of 76 patients were included in the study from August 2017 to July 2018 of which 43 (56.6%) were males and while 33 (43.4%) were females with male to female ratio of 1.3:1. The ages of patients ranged from 14 to 72 years with a mean age of 33.2±14.2 years. Out of 76 patients, 68 (89.5%) had at least one type of anatomical variation while 8 (10.5%) had no variation. Only one variation was seen in 39 (51.3%) patients while 29 (38.2%) had two or more variations. The most common variant was deviated nasal septum (DNS), occurring in 49 (64.5%) patients followed by concha bullosa (CB) and agger nasi cell (AN) seen in 15 (19.7%) and 14 (18.4%) patients respectively. Genderwise, anatomical variations were seen more in males but the difference was not statistically significant. Some variations were seen more on the right side while others on the left. Some variations were present bilaterally. The difference was not statistically significant. The presence of DNS was statistically significant in the study population (p value 0.012 in nonparametric chi square test). The age group 14 to 30 years showed maximum variations though not significant statistically. Therefore, during management of patients with sinonasal symptoms, these variations need to be addressed, if required, surgically. Proper knowledge of both common and uncommon sinonasal variations in our community could help in better surgical planning and overall management of sinonasal disorders.

Prevalence of anatomical variants in the clivus: fossa navicularis magna, canalis basilaris medianus, and craniopharyngeal canal.

This study determined the prevalence of fossa navicularis magna (FNM), canalis basilaris medianus (CBM), and craniopharyngeal canal (CPC), the size of FNMs, and types of CBM using 3D computed tomography (CT) images. A total of 1059 3D images [649 cone beam computed tomography (CBCT) and 410 CT] were evaluated in this study. The prevalence of FNM, CBM, and CPC, length, width, and depth of FNM, and type of CBM were assessed. Overall, FNM was identified in 7.6%, CPC in 0.3%, and CBM in 2.5% of the study group. Type 2 (0.1%) and Type 6 (0.1%) are the least common CBM types. There was no significant difference between genders for depth and width measurements (p > 0.05), however, the length of FNM was significantly higher in males than females in CBCT images (p = 0.02). FNM, CBM, and CPC are rare anatomical variants of clivus. However, they can facilitate spread of infection to the skull base or vice-versa. These types of anatomical variations should be known by radiologists to avoid unnecessary diagnosis and treatment procedures and to distinguish anatomic variations from pathological conditions.

HYPOPLASIA OF THE FACIAL ARTERY SUBSTITUTED BY TRANSVERSE FACIAL ARTERY

PURPOSE. The facial artery is one of the main arteries which supply the face with blood. The different types have been researched not only for anatomical purposes but also to facilitate the different medical specialties. METHODS AND RESULTS. Our team found an unusual case of a facial artery with smaller lumen. The region, which it supplies, is partially substituted by the transverse facial artery. In the observed course the facial artery had a considerably smaller caliber than usual. After it appears on the surface of the face it divides into two untypical branches - anterior and superior. Contrariwise the transverse facial artery has a significantly bigger lumen. The separate branches, which usually originate from the facial artery, here arise from the aforementioned artery. CONCLUSIONS. These types of anatomical variations are very important for muscle and skin flaps in plastic surgery of the face. Every deviation from the normal anatomy of the main blood vessels can also lead to errors in invasive surgery procedures and medical imaging. The vascularization of the face and its variations is subject for many different disciplines.

Anatomical Variations of Recurrent Laryngeal Nerve: The Danger in Thyroid Surgery

Objectives: We report two types of anatomical variations of the recurrent laryngeal nerve in two patients. Through these two patients we wanted to highlight our surgical approach of the recurrent nerve in an unusual position and to describe the surgical implication of these almost rare variations. Case report: patient aged 28 and 58 admitted for goiter. They underwent a right lobisthmectomy. Both recurrences were approached retrograde. The anatomical variations of the nerve concerned the non-recurrent laryngeal nerve in the first patient. In the second patient there were three anatomical variations, namely an extra laryngeal bifurcation of the nerve, a pre-vascular position of the nerve and a branch connecting the vagus nerve and the recurrent nerve. No recurrence nerve injury was noted. Conclusion: The anatomical variations of the nerve are numerous. A careful dissection is a guarantee of a good prognosis.

Quantitative Characterization of Cadaveric Pronator Muscles Using 3D Modeling

The pronator muscles of the upper limb, pronator teres (PT) and pronator quadratus (PQ), work together to rotate the radius around the ulna along an axis parallel to the central bands of the interosseous membrane while stabilizing the involved joints. Anatomical variations that affect the rotational efficiency of the PT have been described. Previously, we have described an aberrant PQ with a possible flexor function, and also defined 4 types of anatomical variations in PQ, based on the number of bellies present, and whether it occurred unilaterally or bilaterally, suggesting that PQ is more variable than appreciated. The PT typically has 2 distinct heads of origin (ulnar and humeral) and inserts onto the lateral radius. However, several anatomical variations have been reported, including the number of heads, locations of origin and insertion points, anomalous fiber orientations, and the presence of fibrous bridges and/or arches. In the current study, we sought to determine if there are patterns of anatomical variations in the PT, and whether any such variations occurred in relationship to those of the PQ. Sixteen forearms from 8 embalmed cadavers (4F,4M ages 64–93, mean 82) were dissected, and the PT and PQ muscles observed for muscle shape, fascicle orientation, and attachment points. PT and PQ heads was described, and PT tendon length, width, and distance from the radial head and styloid process measured. Our data revealed that the PT existed as only a single muscle head (humeral), bilaterally, in 25% of the cadavers examined, while exhibiting the traditional two muscle heads (humeral, ulnar) bilaterally in 75% of cadavers. Interestingly, the PT variant with a single humeral head occurred in conjunction with Type II PQ muscles bilaterally (i.e., the presence of 2 muscle bellies). Of the six cadavers with both humeral and ulnar heads of PT, 33.3% had an occurred with Type I PQ (1 head, bilateral), 33.3% with Type II PQ (2 heads, unilateral), and 33.3% with Type III PQ (2–3 heads, bilaterally). Our data suggests that there may be a relationship between the patterns of anatomical variations between PT and PQ muscles, which may provide new insight into the biomechanical relationship between these 2 muscles. The inclusion of additional cadaveric specimens, as well as quantitative comparisons between PT and PQ muscles, including cross sectional area, volume, and line of action, will help to elucidate the potential relationship between PT and PQ muscles.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Role of anatomic variations of paranasal sinuses on the prevalence of sinusitis: Computed tomography findings of 350 patients.

The aim of this study was to determine the frequency of anatomic variations of the paranasal sinuses and their roles in the development of sinusitis. Computed tomography of paranasal sinuses of 350 patients was assessed in terms of anatomic variations and inflammatory sinus pathology. The coexistence of anatomic variations with sinusitis was statistically investigated. At least one anatomical variation of paranasal sinuses was detected in 325 patients (92.9%). In 297 (91.4%) of these patients, sinusitis was observed at rates varying depending on the types of anatomic variations. A statistically significant relationship was found between agger nasi cells, Onodi cells, hypertrophy of middle concha, concha bullosa, uncinate bulla, and the medial and lateral deviations of uncinate process and sinusitis. On the other hand, there was no statistically significant relationship between septal deviation, paradoxical middle concha, secondary middle concha, great ethmoidal bulla, and sinusitis. Certain types of paranasal sinus variations create a susceptibility to sinusitis.

Anatomical Variations of the Blood Vascular System in Veterinary Medicine: The Internal Iliac Artery of the Dog: Part One.

Traditional veterinary anatomical models describe the branches of the caudal gluteal artery as the iliolumbar, cranial gluteal, lateral caudal, satellite of the ischiatic nerve and dorsal perineal arteries. However, some classical veterinary anatomy textbooks often indicate variations the general organization of the arterial tree, without giving any pattern of origin or illustrations of the different branching. The aim of this study was to investigate the presumptive variability of the caudal gluteal artery. Two hundred and thirty-two pelvic halves from 116 adult dogs were examined. Twelve anatomical variations were found, nine occurring in more than 5% of the dogs, and three in <5%. A 'long-type' internal iliac artery, which means short caudal gluteal and internal pudendal arteries, was identified, while a 'perineal trunk' was observed as an interesting arterial variation. If the caudal segment alone is taken into consideration, identical vascular patterns in both hemi-pelvises are found in 17% of the dogs. Significant statistical correlation was found for four different types of anatomic variations and gender, two types of variations and body size, one type of variation for body side and one type of variation for head shape.

English

OBJECTIVES: To study the various anatomical variations of the osteomeatal complex and their incidence in patients with chronic rhinosinusitis. DESIGN: A prospective study was done on 100 computed tomography scans of patients with chronic rhinosinusitis. RESULTS: Various types of anatomical variations were observed in the study viz. concha bullosa, septal deviation, paradoxical middle turbinate, retroverted uncinate process, enlarged ethmoid bulla, haller cells, agger nasi cells, onodi cells and pneumatization of vomer. The most frequent anatomical variation found was septal deviation (30%), followed by presence of concha bullosa (26%). CONCLUSION: Variations are common in the osteomeatal complex. These variations may predispose to sinusal diseases and hence require correction. Also, preoperative detection of such variations by computed tomography avoids complications during functional endoscopic sinus

Medial wall of the cavernous sinus: dural or fibrous layer?

To the Editor: I read with great interest the article by Goncalves et al. “Cavernous sinus medial wall: dural or fibrous layer? Systematic review of the literature” [4], recently published in your journal. As the authors of this article found a variation among several studies without conclusive answer to their research question, I would like to provide some comments on their study and highlight a possible explanation for their results. Goncalves et al. conducted a systematic literature review to find out the microanatomy of the medial wall of the cavernous sinus (CS) and its clinical importance on sellar pathologies. Based on 14 experimental studies, four studies found that the medial wall of the CS is composed of a loose, fibrous structure, and according to ten studies, medial wall is composed of a dural layer that constitutes the lateral wall of the sella. They explain the variation in the results section by lacking in definition standards and methodological criteria. First, I am grateful for the Goncalves et al. methodology in their article as they support and establish a step toward the concept of evidence-based morphology [1, 3]. The articles based on this concept are still rare in neurosurgical literature, yet available data about the anatomy, especially in the terms of variation, can be obtained from this kind of study. It can also highlight a hidden anatomical problem that can be utilized to refine the neurosurgical approaches seen in Goncalves et al. work and in the comments on their paper. With regard to medial wall of the CS, to make it understandable, I believe it should always be divided into two parts; sphenoidal and sellar. Even though, at the sphenoidal part there is one layer of dura (osteoperiosteal dura) that adheres to the bone and forms the inferomedial wall of the cavernous space. At the sellar part or the superior medial wall, I do not believe that there is any dural layer that belongs to the CS itself or to the CS as an anatomical entity. To clarify this point, and to give an explanation to that type of anatomical variation which Goncalves et al. found in several studies, there are two facts we need to keep in mind; first, the CS is an extradural anatomical entity [5, 6]. The hypophysis compartment is isolated from all surrounding structures by what is called the pituitary bag. A detailed description of the pituitary bag was reported by Francois et al. using electron microscopic-based methodology [2]. Having said that, we can make a more useful conclusion with regard to the medial wall of the CS; there is no dural layer for superior medial wall of the CS itself. The dural layer that have been reported belong to the pituitary bag and was misinterpreted as it belongs to the CS itself according to some studies. Furthermore, this explains the presence of easy surgical cleavage plane between the medial wall and the suprasellar dura (diaphragma sellae) that was reported by Professor Kawase in his comment at the end Goncalves et al. paper.

De Quervain Disease: US Identification of Anatomic Variations in the First Extensor Compartment with an Emphasis on Subcompartmentalization

To demonstrate the usefulness of ultrasonography (US) in the detection of anatomic variations in the first extensor compartment of the wrist in patients with de Quervain disease. The institutional review board approved this study protocol and waived the informed consent requirement. Fifteen wrists in 13 women (age range, 41-62 years) in whom de Quervain disease was clinically diagnosed and who underwent surgery for intractable pain were included. A musculoskeletal radiologist performed US before surgery. The absence or presence and extent of subcompartmentalization within the first extensor compartment and the number of abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendon slips were evaluated and recorded. Preoperative US findings were compared with surgical records and photographs. Subcompartmentalization within the first extensor compartment was observed during surgery in 11 of the 15 wrists (73%), including four (27%) that had subcompartmentalization only in the distal portion of this compartment. US was used to identify all 11 wrists showing subcompartmentalization within this compartment (sensitivity, 100%; 95% confidence interval [CI]: 74%, 100%), as well as three of the four wrists with distal incomplete subcompartmentalization. There was one wrist with false-positive distal incomplete subcompartmentalization. US had a positive predictive value in the detection of subcompartmentalization of 73% (95% CI: 47%, 91%). The number of tendon slips in this compartment detected with US was identical to that identified at surgery with one exception. US can be used to depict various types of anatomic variations in the first extensor compartment in patients with de Quervain disease.

Analysis of anatomical variations of bone and vascular structures around the posterior atlantal arch using three-dimensional computed tomography angiography

The current study evaluates the incidence of anatomical variations of the V(3) segment of the vertebral artery (VA) and the posterior arch of the atlas (C-1). Failure to appreciate these types of anatomical variations can cause catastrophic injury to the VA during posterior approaches to the upper cervical spine. In the present study, the authors analyzed the records of 1013 Korean patients who underwent computed tomography (CT) angiography to evaluate the incidence of anomalous variations in the third segment of the VA and to determine the incidence and morphometric characteristics of any detected posterior ponticuli. The authors also hoped to determine any specific imaging features that might indicate a VA anomaly around the craniovertebral junction. The mean age of the patients was approximately 55.7 years and the prevalence of a posterior ponticulus was 15.6%. The incidence rate of a posterior ponticulus in the male population was 19.3%, whereas in the female population it was 12.8%. The incomplete type of posterior ponticulus was more common than the complete type. The mean age of the patients with an incomplete posterior ponticulus (55.7 years) was significantly younger (p = 0.018) than the mean age of patients with a complete posterior ponticulus (57.6 years). The incidence rate of a persistent first inter-segmental artery was 4.7% and the incidence rate of a fenestrated VA was 0.6%. The area of the C-1 transverse foramen on the abnormal side was significantly smaller than that of the contralateral normal side. The shape of the C-1 posterior arch and the third segment of the VA are heterogeneous. Therefore, preoperative radiological studies should be performed to identify any anatomical variations. Using preoperative 3D CT angiography, we can precisely identify an anomalous VA and significantly reduce the risk of VA injury.

Pyloric atresia: 15-year review from a single institution

Background: Pyloric atresia (PA) is a rare pathology. Calder presented the first pyloric atresia case in 1749 and Touroff, Sussman, Meltz, and their colleagues presented the first successful operation in 1940. PA has 3 types of anatomic variations: (1) type A, pyloric membrane or web; (2) type B, the pyloric channel is a solid cord; and (3) type C, in which there is a gap between the stomach and duodenum. Associated anomalies also have been described. Epidermolysis bullosa (EB) and intestinal anomalies occur most often with this condition. Methods: Charts of 16 cases of congenital PA, aged 1 to 30 days and admitted to our department between 1986 and 2001, were studied retrospectively in regard to sex, prenatal diagnosis, presence of polyhydramnios, time of admission, pathology, type of operation, associated anomalies, and mortality rate. Results: In the study group, the male to female ratio was 5:3, the mean birth weight was 2,312 g and the mean age of admission was 6.5 days. The distribution of the anatomic variations was type A in 9 (56.3%) and type B in 7 (43.7%) of cases. Associated anomalies were present in 7 cases (43.8%). Familial occurrence was a prominent feature of our series. Seven of 16 cases occurred in 3 families. We performed 9 web excisions together with Heineke Mikulicz (H-M) pyloroplasty, 5 atresia excisions and gastro-duodenostomy, and 2 H-M pyloroplasties alone. Stamm gastrostomy was supplemented in 3 cases. The overall mortality rate (n = 9) was 56.3%. Conclusions: Pyloric atresia can be managed succesfully if it is diagnosed early. In this group of patients, congenital anomalies or septicemia are the main causes of mortality.