Anatomical Variations Research Articles

Impact of kV-cone beam computed tomography dose on DNA repair mechanisms: A pilot study

PurposeIn head and neck squamous cell carcinoma (HNSCC), early complications of the radiotherapy (RT) are observed from the beginning of the treatment to a few months after its end. During external radiotherapy treatment, several patient-dependent parameters can cause a modification of the dose distribution compared to the planned distribution due to variation in patient positioning, anatomy, or intra-fractional movements for example. To verify these parameters during treatment sessions, one of the most commonly used solutions is the cone-beam computed tomography (CBCT). Nowadays, the use of CBCT may constitutes a significant part of the total dose at the end of treatment (up to 10 cGy per session) and more often the volume irradiated by imaging is larger than the one irradiated by the treatment, leading to unintentional irradiation of nearby organs.In this study, we asked whether the imaging low dose added to a following fraction dose (2Gy) may affect the biological response in terms of DNA repair. Material and methodsUsing an IVInomad dosimeter and scintillating fiber probes specially designed for this exploratory study, we exposed fibroblasts cells from head and neck cancer (HNC) patients to a CBCT dose followed by a radiotherapy fraction dose. DNA double strand breaks and DNA repair were assessed by immunofluorescence using the biomarkers gamma H2AX (γH2AX) and pATM. ResultsThe median dose of CBCT was measured between 17 to 21 mGy per session. The kinetics of both biomarkers were found to be strongly dependent on the individual factor in radiosensitive patients. For HNC patients, a prior CBCT dose applied few minutes before the 2Gy dose may have a sublinear effect on the DNA repair mechanisms and potentially on observed health tissue toxicity. ConclusionThe preliminary results obtained highlight the importance of individual and tissue factors for recognizing and repairing DSB during a treatment by radiotherapy using CBCT.

Anatomical and dosimetric variations during volumetric modulated arc therapy in patients with locally advanced nasopharyngeal carcinoma after induction therapy: Implications for adaptive radiation therapy

PurposeTo investigate anatomical and dosimetric changes during volumetric modulated arc therapy (VMAT) in patients with locally advanced nasopharyngeal carcinoma (LA-NPC) after induction therapy (IT) and explore characteristics of patients with notable variations. Materials and methodsFrom July 2021 to June 2023, 60 LA-NPC patients undergoing VMAT after IT were retrospectively recruited. Adaptive computed tomography (aCT), reconstructed from weekly cone-beam computed tomography(CBCT), facilitates recontouring and planning transplantation. Volume, dice similarity coefficients, and dose to target volumes and organs at risk(OARs) on planning CT(pCT) and aCT were compared to identify changing patterns. Multivariate logistic regression was used to investigate risk factors. ResultsThe volumes of PGTVnasopharynx (PGTVp), PGTVnode (PGTVn), ipsilateral and contralateral parotid glands decreased during VMAT, with reductions of 2.25 %, 6.98 %, 20.09 % and 18.00 %, respectively, at 30 fractions from baseline (P < 0.001). After 25 fractions, D99 and D95 of PGTVn decreased by 7.94 % and 4.18 % from baseline, respectively, while the Dmean of ipsilateral and contralateral parotid glands increased by 7.80 % and 6.50 %, marking the peak rates of dosimetric variations (P < 0.001). The dosimetric fluctuations in PGTVp, the brainstem, and the spinal cord remained within acceptable limits. Furthermore, an initial BMI ≥ 23.5 kg/m2 and not-achieving objective response (OR) after IT were regarded as risk factors for a remarkable PGTVn dose reduction in the later stages of VMAT. ConclusionsReplanning for post-IT LA-NPC patients appears reasonable at 25F during VMAT. Patients with an initial BMI ≥ 23.5 kg/m2 and not-achieving OR after IT should be considered for adaptive radiation therapy to stabilize the delivered dose.

OSBA: An Open Neonatal Neuroimaging Atlas and Template for Spina Bifida Aperta

We present the Open Spina Bifida Aperta (OSBA) atlas, an open atlas and set of neuroimaging templates for spina bifida aperta (SBA). Traditional brain atlases may not adequately capture anatomical variations present in pediatric or disease-specific cohorts. The OSBA atlas fills this gap by representing the computationally averaged anatomy of the neonatal brain with SBA after fetal surgical repair. The OSBA atlas was constructed using structural T2-weighted and diffusion tensor MRIs of 28 newborns with SBA who underwent prenatal surgical correction. The corrected gestational age at MRI was 38.1 ± 1.1 weeks (mean ± SD). The OSBA atlas consists of T2-weighted and fractional anisotropy templates, along with nine tissue prior maps and region of interest (ROI) delineations. The OSBA atlas offers a standardized reference space for spatial normalization and anatomical ROI definition. Our image segmentation and cortical ribbon definition are based on a human-in-the-loop approach, which includes manual segmentation. The precise alignment of the ROIs was achieved by a combination of manual image alignment and automated, non-linear image registration. From the clinical and neuroimaging perspective, the OSBA atlas enables more accurate spatial standardization and ROI-based analyses and supports advanced analyses such as diffusion tractography and connectomic studies in newborns affected by this condition.

Characterising Sinonasal Pneumatization in Patients with Nasal Septal Deviation: A CBCT-Based Study.

This study aimed to investigate the presence and correlation of paranasal sinus pneumatization among patients with and without nasal septal deviations (NSD), to enhance clinical understanding of sinonasal anatomical variations. It is descriptive, retrospective study under a monocentric, utilizing institutional archives. 30 subjects with NSD and 30 without NSD were selected. Inclusion criteria required diagnostic quality Cone Beam Computed Tomography (CBCT) images, while exclusion criteria included developmental anomalies, central pathology, previous sinonasal surgery, fractures, and non-diagnostic images. The Assessment of Pneumatization of the Paranasal Sinuses (APPS) score was used to evaluate anatomical variations in paranasal sinuses based on CBCT scans. Statistical analysis was performed using the Chi-square test and independent t-test via SPSS version 23. A significant association between NSD and certain anatomical variations was observed. Notably, higher prevalence rates of variations such as pneumatization of the maxillary floor, middle turbinate concha bullosa, and superior frontal sinus wall were found in subjects with NSD. Statistical significance was confirmed in seven out of nine parameters, with p-values < 0.001 for most comparisons. The left side exhibited greater pneumatization than the right. The total APPS scores showed strong statistical significance between groups (p < 0.001). The study reveals a significant relationship between nasal septal deviation and paranasal sinus pneumatization, suggesting that septal deviations may influence the extent of pneumatization in the sinonasal complex.

Frequency, localization, and diameter of the accessory maxillary ostium and its relationship with sinus pathologies and nasal cavity variations: an anatomical study based on cone beam computed tomography.

The aim of the present study was to determine the presence, frequency, and characteristics of the accessory maxillary ostium (AMO) in a specific Turkish population using cone beam computed tomography (CBCT) and to evaluate the frequency of pathologies and anatomical variations in the nasal cavity and maxillary sinus and to assess their relationship with the AMO. This study retrospectively evaluated the presence of AMO in CBCT images of 543 patients, the patients' age, gender, and dentition status, the presence of nasal cavity variations and maxillary sinus pathologies, and their relationship to the presence of AMO. Descriptive values of the data and comparative results were included. 249 males and 294 females participated in the study. The majority of right and left sinus pathologies were irregular type mucosal thickenings (right/left; 14%, 14.9%). The majority of nasal variations were concha bullosa (right/left; 37.9%, 39.2%). There were 148 (27.3%) and 138 (25.4%) AMOs on the right and left sides, respectively, with the majority in the middle position (right/left; 21.2%/17.5%). The frequency of right and left AMOs was significantly higher in men (P = 0.019 and P = 0.020, respectively). The left AMO frequency was significantly higher in patients with left-sided sinus pathology (P = 0.003). AMO diameters were larger in men (right/left P = 0.010 and P = 0.021, respectively), and left AMO diameter was significantly larger in patients with left sinus pathology (P = 0.006). Before any surgical intervention in the maxillary sinus and osteomeatal region, the presence and location of the AMO, existing pathologies, and variations in the region should be carefully checked to avoid complications.

The challenging patient-recommendations and solutions

The continuous technical development of cardiac computed tomography (CT) over the last decades has led to an improvement in image quality and diagnostic accuracy, while simultaneously reducing radiation exposure. Despite these advancements, certain patient-related factors remain achallenge to conduct a high-quality diagnostic examination. What factors can negatively affect the image quality of cardiac CT and how can these be addressed? Analysis of the available literature on cardiac CT and identification of the quality-limiting factors, discussion, and possible solutions. Tachycardia, arrhythmias, high coronary calcification, the presence of stents and coronary artery bypasses, as well as obesity and anxiety were identified as primary factors that limit image quality and diagnostic accuracy. These issues primarily arise from alack of response or the presence of contraindications to premedication, blooming artifacts, variations in postoperative anatomy, as well as other personal factors. Suggested solutions include optimizing premedication, scanner modifications, the selection of the most suitable acquisition mode, new scanner technologies, and innovative image reconstruction methods including artificial intelligence. Certain factors continue to pose amajor challenge for cardiac CT. Knowledge of alternative premedication, scanner modifications, as well as the use of postprocessing software and new technologies can help overcome these limitations, enabling successful and safe cardiac CTs even in challenging patients.

Prevalence of anatomic variations of temporomandibular joint on orthopantomogram and cone-beam computed tomography: A retrospective study

Maxillofacial radiography by means of orthopantamogram is used as a routine screening tool in the diagnosis and treatment planning in various fields of dentistry and is found to be less expensive when compared to other advanced imaging modalities like computed tomography, magnetic resonance imaging and cone-beam computed tomography. Morphological variations in the shape of mandibular condyle, coronoid process and sigmoid notch have been documented in the literature as indispensable aids in anthropological and forensic studies. 100 OPG and CBCT scans of same participants, comprising of 200 temporo-mandibular joints were evaluated for anatomical variations in shapes of mandibular condyle, coronoid process and sigmoid notch. The prevalence of various morphological variations were correlated with age and gender and subjected to statistical analysis. The most common shape of condyle, coronoid process and sigmoid notch on OPG was round, whereas on CBCT the most common shape of condyle, coronoid process and sigmoid notch were flat, triangular and wide respectively. Variations in the morphology of shape of mandibular condyle, coronoid process and sigmoid notch using panoramic radiographs can be tentatively used as a screening tool in human identification, owing to its ready availability and low cost.

Revision Surgery due to Patient Dissatisfaction with Remaining Valgus leg Alignment after Kinematically Aligned Total Knee Arthroplasty: A Case Report

BACKGROUND: The kinematic alignment (KA) technique aims to achieve true resurfacing of the knee joint and recreate prearthritic anatomy while preserving soft tissues. However, it remains uncertain whether all prearthritic anatomies are biomechanically equivalent and if KA is suitable for cases with extreme anatomical variations. CASE PRESENTATION: The case of a 75-year-old female patient with a moderate valgus deformity who underwent kinematically aligned total knee arthroplasty (TKA) was reported. The patient required early revision surgery due to persistent pain in the medial collateral ligament area and dissatisfaction with the postoperative leg alignment. CONCLUSION: There is a paucity of studies addressing the outcomes of kinematically aligned TKA in patients with valgus knees. Concerns persist regarding the suitability of unrestricted KA for all anatomical variations, particularly extreme ones. This case underscores the importance of considering restricted KA as a potentially safer alternative. In addition, patient perception of limb alignment and appearance significantly impacts the success of total knee arthroplasty, particularly in cases with valgus deformities.

Rare anatomical variants encountered during laparoscopic cholecystectomy in low resource conditions and the convenient concept of the safe zone of dissection: a prospective observational study at a single center.

The severity of surrounding adhesions, anomalous anatomy, and technical issues are the main factors that complicate cholecystectomy. This study focused on determining the types and frequency of laparoscopic anatomical variations found during laparoscopic cholecystectomy in our limited-resources condition and on defining the safe zone of dissection. This prospective study was conducted at a single center in Aden, Yemen from 2012 to 2019. A total of 375 patients, comprising 355 females (94.7%) and 20 males (5.3%), presented with symptomatic gallbladders and underwent standard four-port laparoscopic cholecystectomy. The regional laparoscopicvariationswere evaluated and recorded. Of the 375 patients, 26 (6.9%) had laparoscopic anatomical variations, of whom 19 (73.1%) had vascular variations and seven (26.9%) had ductal variations. The anatomical variations included the following: double cystic artery of separated origin, seven cases (26.9%); Moynihan's hump, six (23.1%); double cystic artery of single origin, four (15.4%); thin long cystic duct, four (15.4%); subvesical duct, three (11.5%); and cystic artery hocking the cystic duct, two (7.7%). Biliary anatomical variations can be expected in any dissected zone. Most of the detected variants were associated with the cystic artery. An overlooked accessory cysto-biliary communication can cause complicated biliary leakage. A surgeon's skills and knowledge of laparoscopic anatomical variants are essential for performing a safe laparoscopic cholecystectomy.

Anatomical variants of the circle of Willis and psychiatric disorders: a cadaveric study

Anatomical variants of the circle of Willis and psychiatric disorders: a cadaveric study

Assessment of anterior loop of mental foramen with cone beam computed tomography-An institutional based study

Cone beam computed tomography (CBCT) is a specialized imaging technology designed to create accurate 3D images of craniofacial anatomy while using significantly less radiation than traditional CT scans. This advancement allows clinicians to closely examine dental and maxillofacial structures, forensic analysis, and modern therapeutic techniques.To evaluate several anatomical variants of the anterior loop of the mental foramen using cone-beam computed tomography (CBCT).The study involved 30 randomly selected patients aged 20-60 year from the departmental OPD, who underwent CBCT of the anterior mandibular region to assess the mental foramen. After obtaining a detailed history, a diagnosis was made and explained to the patients. Data were analyzed according to the classification by Solar et al. (1994).Type 1 mental nerve loop presence was 6.6% greater on the right side (13.3%) than on the left side (6.7%), while Type 3 mental nerve loop presence was 6.6% higher on the left side (63.3%) than on the right side (56.7%) based on a comparison of the anterior loop of the mental foramen.However, Type 2 was similar on both the right (30.0%) and the left (30.0%) sides. The anterior loop of the mental foramen is an important anatomical feature and was comparable (Type 1/Type 2/Type 3) in patients on the right and left side (p &amp;#62; 0.05) (χ2=0.78, p = 0.678), showing no significant difference. Understanding its anatomy and occurrence has a significant impact on therapeutic strategies.

Anatomical and Developmental Abnormalities of Ureters and Renal Pelvis Existing with Accessory Renal Arteries: Cadaveric Study.

Anatomical and developmental variations of ureters and renal pelvis have been observed frequently during routine human cadaveric dissection and surgical practice; however, their coexistence with accessory or aberrant renal arteries is exceptionally rare. Accordingly, this study was designed to evaluate the prevalence of anatomical and developmental abnormalities of ureters and renal pelvis existing with accessory renal arteries in human cadavers. This study was carried out on 50 human cadavers including dissected specimens (25 males and 25 females) the kidneys, renal pelvis, and ureters along with their arteries were exposed and the anomalous abnormalities of the renal pelvis and ureters existing with accessory renal arteries were observed. Photographs of the anomalous and developmental variations were taken for proper documentation. Among the 50 cadavers studied, unilateral double ureters were found in 5 cadavers (10%), rare bilateral "S-"shaped loop of ureter with quadruple uretic constrictors in the abdominal segment of the ureter was observed in one female cadaver (2%), accessory or aberrant renal arteries were found in 15 cadavers (30%), hydronephrosis involving the renal pelvis and ureters was observed in 9 cadavers (18%). Interestingly, this prevalence was higher among males (28%) compared to females (8%). Moreover, the occurrence of bilateral hydronephrosis of the kidneys, renal pelvis, and ureters was identified in a single male cadaver, representing 2% of the sample. Notably, the prevalence of double ureter, hydronephrosis accompanied by congenital double and triple accessory renal arteries was documented in nine cadavers, accounting for 18% of the cohort. Anatomical and developmental variations of the ureters, renal pelvis, and renal vasculature, as well as their relationships to surrounding structures, hold clinical significance due to their impact on various surgical procedures, including kidney transplantation, abdominal aorta reconstruction, interventional radiology, and urologic operations. Therefore, identifying these potential developmental variations is essential for effective surgical management to preserve renal function and ensure optimal patient outcomes.

Impact of anatomic variability and other vascular factors on lamina cribrosa hypoxia.

Insufficient oxygenation in the lamina cribrosa (LC) may contribute to axonal damage and glaucomatous vision loss. To understand the range of susceptibilities to glaucoma, we aimed to identify key factors influencing LC oxygenation and examine if these factors vary with anatomical differences between eyes. We reconstructed 3D, eye-specific LC vessel networks from histological sections of four healthy monkey eyes. For each network, we generated 125 models varying vessel radius, oxygen consumption rate, and arteriole perfusion pressure. Using hemodynamic and oxygen supply modeling, we predicted blood flow distribution and tissue oxygenation in the LC. ANOVA assessed the significance of each parameter. Our results showed that vessel radius had the greatest influence on LC oxygenation, followed by anatomical variations. Arteriole perfusion pressure and oxygen consumption rate were the third and fourth most influential factors, respectively. The LC regions are well perfused under baseline conditions. These findings highlight the importance of vessel radius and anatomical variation in LC oxygenation, providing insights into LC physiology and pathology. Pathologies affecting vessel radius may increase the risk of LC hypoxia, and anatomical variations could influence susceptibility. Conversely, increased oxygen consumption rates had minimal effects, suggesting that higher metabolic demands, such as those needed to maintain intracellular transport despite elevated intraocular pressure, have limited impact on LC oxygenation.

Management of Bile Duct Injury Complicating Cholecystectomy: Experience of the General Surgery Department of Avicenne Military Hospital in Marrakesh

Bile duct injuries are the most feared complication of a commonly performed cholecystectomy, which is generally considered as a safe and benign intervention. Eighteen cases of bile duct injuries were collected through a retrospective study conducted between January 2019 and December 2023 in the general surgery department of the Military Hospital Avicenne in Marrakesh. The average age was 53 years old, sex ratio M/F was 0.38. Acute cholecystitis, acute pancreatitis, obesity and anatomical variations were the main risk factors found in our patients. For 13 patients, the iatrogenic injury had occurred in our department. For the remaining 5 patients, they were referred from peripheral hospitals. Intraoperative diagnosis was made in five cases. In the postoperative period, 6 patients had bile leakage from the drain, 5 patients had abdominal pain, one patient presented incisional bile leakage and one patient had a jaundice. The repair consisted mostly on Roux-en-Y hepaticojejunostomy which was performed in 9 cases. Cystic duct ligation was performed in five cases. Two patients underwent primary repair on common bile duct with T-tube insertion. Two cases were treated by endoscopically. The six months’ follow up was favorable for 66,7% of the cases. The prevention and the respect of surgical rules and recommendations (critical view of safety) during cholecystectomy are the best means to avoid these lesions.

Prevalence of concha bullosa in a pediatric population

ObjectiveExisting literature on the prevalence of middle turbinate pneumatization, or concha bullosa (CB), in the pediatric population is limited. CB is an anatomic variant important to identify prior to sinonasal surgery and is often associated with congenital nasal septal deviation (SD). This paper aims to describe the prevalence of CB in the pediatric population on head imaging. MethodsA retrospective chart review was performed for 695 children undergoing CT head for trauma from 2021 to 2022. Nearly equal numbers of males and females were evaluated, with at least 19–20 per year from 0.5 to 18 years. Patients with significant facial fractures, sinusitis, craniofacial syndromes, prior sinus surgery, and sinonasal masses were excluded. Two pediatric neuroradiologists evaluated the CTs. CB was defined as aeration >50 % of the vertical height of the middle turbinate. ResultsIn this study, 384 patients were included. The prevalence of CB was 153 (39.8 %), which was significantly higher in children >4 years (p < 0.0001). Lamellar type CB was the most common, present in 160 out of 768 middle turbinates assessed (20.8 %). SD occurred in 60 (39.2 %) patients with CB and was more commonly contralateral to the CB. ConclusionsThe prevalence of CB in the pediatric population is at the lower range of what is reported in the adult literature. The most common type of CB in patients is lamellar. Similar to previous studies, there is an association between CB and contralateral SD. Finally, there is a positive correlation between the severity of CB and the severity of SD.

Partial agenesis of the pectoralis major and minor muscle: A cadaveric case report.

The pectoralis major and minor muscles, located in the anterior chest wall, are crucial for upper limb movements. Their nonsyndromic absence is rare but significant for surgical procedures involving the axillary and pectoral regions. Ultrasound can confirm the diagnosis and delimit the extent of the muscular abnormality, detect abnormalities of the costal cartilages, among others. This descriptive, cadaveric case report involves a formalin-fixed 57-year-old North American male, with no clinical or family history of similar conditions. The study was conducted at the Human Anatomy Laboratory of the School of Medicine of the Universidad Finis Terrae in Santiago, Chile, in August 2022. We present a cadaveric case of bilateral partial agenesis of the pectoralis muscles discovered during routine dissection. The pectoralis major muscle exhibited only the clavicular portion, with the sternocostal and abdominal portions absent and replaced by a thin layer of connective tissue bilaterally. The pectoralis minor muscle showed partial muscle fibers only in the most distal and inferior portions bilaterally. This case report is significant due to the rarity of this condition without accompanying anatomical variations. Understanding this variant is valuable for clinical situations involving the shoulder and thorax region, such as trauma to the proximal third of the humerus, clavicular region, suprascapular region, and anterior chest wall. It may complicate conservative and/or surgical treatments due to different functional and irrigation patterns in the area and is also important for educating future professionals.

Adaptive intensity modulated proton therapy using 4D robust planning: a proof-of-concept for the application of dose mimicking approach

Objective.A four-dimensional robust optimisation (4DRO) is usually employed when the tumour respiratory motion needs to be addressed. However, it is computationally demanding, and an automated method is preferable for adaptive planning to avoid manual trial-and-error. This study proposes a 4DRO technique based on dose mimicking for automated adaptive planning.Approach.Initial plans for 4DRO intensity modulated proton therapy were created on an average CT for four patients with clinical target volume (CTV) in the lung, oesophagus, or pancreas, respectively. These plans were robustly optimised using three phases of four-dimensional computed tomography (4DCT) and accounting for setup and density uncertainties. Weekly 4DCTs were used for adaptive replanning, using a constant relative biological effectiveness (cRBE) of 1.1. Two methods were used: (1) template-based adaptive (TA) planning and (2) dose-mimicking-based adaptive (MA) planning. The plans were evaluated using variable RBE (vRBE) weighted doses and biologically consistent dose accumulation (BCDA).Main results.MA and TA plans had comparable CTV coverage except for one patient where the MA plan had a higher D98 and lower D2 but with an increased D2 in few organs at risk (OARs). CTV D98 deviations in non-adaptive plans from the initial plans were up to -7.2 percentage points (p.p.) in individual cases and -1.8 p.p. when using BCDA. For the OARs, MA plans showed a reduced mean dose and D2 compared to the TA plans, with few exceptions. The vRBE-weighted accumulated doses had a mean dose and D2 difference of up to 0.3 Gy and 0.5 Gy, respectively, in the OARs with respect to cRBE-weighted doses.Significance.MA plans indicate better performance in target coverage and OAR dose sparing compared to the TA plans in 4DRO adaptive planning. Moreover, MA method is capable of handling both forms of anatomical variation, namely, changes in density and relative shifts in the position of OARs.

FIGIJ and NASPAG Advocacy Statement-Eliminating the Persistent Misconception of the “Virgin Hymen”

This advocacy statement endeavors to clarify the concept of the hymen as a symbol of “virginity”. The anatomic variants of this structure precludes any correlation to prior sexual activity and the value of physical assessment of this structure is thus questioned. Moreover, physical examination of the hymen is painful, traumatic and humiliating and is a form of gender-based violence. This statement exhorts various sectors–governments, educators, the medical community and the general public—to discard the concept of the “virgin hymen”, avoid its use when documenting sexual abuse, and provide progressive education to affirm female sexuality.

Comparison of Treatment Methods for Carpal Tunnel Syndrome: Surgical vs. Non-Surgical

Introduction Carpal tunnel syndrome (CTS) is a common condition that results from the compression of the median nerve within the carpal tunnel in the wrist. Both surgical and non-surgical treatments are used to manage CTS. While surgery is necessary in some cases, many patients can be treated effectively with conservative methods. This review compares the efficacy of surgical treatment for CTS against various conservative approaches. Aim The study aims to evaluate and compare the outcomes of surgical versus conservative treatments for CTS, focusing on symptom relief, patient outcomes, and long-term prognosis. State of Knowledge The carpal tunnel is a narrow passage in the wrist formed by carpal bones and the flexor retinaculum. Compression of the median nerve within this tunnel leads to CTS, which can be caused by anatomical variations or systemic conditions like diabetes. Symptoms include pain, numbness, and tingling in the hand, which may worsen at night or with repetitive movements. Summary (Conclusions) Surgical treatment, especially decompression, offers superior symptom relief and functional improvement but carries risks of complications. Conservative treatments like wrist immobilization and anti-inflammatory medications are effective for many patients, supporting their use as initial treatment. Further research is needed to optimize CTS management.

Vascular-oriented D3 lymph node dissection with left colic artery preservation for distal sigmoid colon cancer: a variety of techniques.

One of the approaches to distal sigmoid colon cancer surgical treatment is segmental colonic resection with vascular preservation of left colic artery (LCA). D3 lymph node dissection may technically vary according to different vascular anatomy. This study aims to show the approaches to D3 lymph node dissection with LCA preservation for distal sigmoid colon cancer according to different patterns of inferior mesenteric artery (IMA) branching. CTangiography with 3D reconstruction was routinely performed to identify the IMA branching pattern. Laparoscopic distal sigmoid colon resection with D3 lymph node dissection and left colic artery preservation in standardized fashion was performed in all cases. Data, including clinical, intraoperative, and short-term surgical outcomes, is presented as median numbers (Me) and interquartile range (IQR). Twenty-six patients with distal sigmoid colon cancer were treated with laparoscopic distal sigmoid colon resection. The approach to D3 lymph node dissection varied according to different anatomical variations. There was one conversion (3.8%) and one anastomotic leakage (3.8%) in patients with high BMI. At the same time, there was a high apical lymph node count (Me 3 (IQR 2-5), min-max 0-10) due to the skeletonization of the IMA. The technical aspects of D3 lymph node dissection with left colic artery preservation may vary in different types of LCA and sigmoid artery branching patterns regardless of the standardized anatomical landmarks. The anatomical features should be considered when performing vascular-sparing lymph node dissection.