Origin Of Veins Research Articles

Anatomical Variants of the Renal Veins and Their Relationship with Morphofunctional Alterations of the Kidney: A Systematic Review and Meta-Analysis of Prevalence.

Background: Variations in renal veins are quite common, and most people do not experience issues due to them. However, these variations are important for healthcare professionals, especially in surgical procedures and imaging studies, as precise knowledge of vascular anatomy is essential to avoid complications during medical interventions. The purpose of this study was to expose the frequency of anatomical variations in the renal vein (RV) and detail their relationship with the retroperitoneal and renal regions. Methods: A systematic search was conducted in the Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases from their inception until January 2024. Two authors independently carried out the search, study selection, and data extraction and assessed methodological quality using a quality assurance tool for anatomical studies (AQUA). Ultimately, consolidated prevalence was estimated using a random effects model. Results: In total, 91 studies meeting the eligibility criteria were identified. This study included 91 investigations with a total of 46,664 subjects; the meta-analysis encompassed 64 studies. The overall prevalence of multiple renal veins was 5%, with a confidence interval (CI) of 4% to 5%. The prevalence of the renal vein trajectory was 5%, with a CI of 4% to 5%. The prevalence of renal vein branching was 3%, with a CI of 0% to 6%. Lastly, the prevalence of unusual renal vein origin was 2%, with a CI of 1% to 4%. Conclusions: The analysis of these variants is crucial for both surgical clinical management and the treatment of patients with renal transplant and hemodialysis.

Typomorphic and Technological Characteristics of Quartz of the Mica-Pegmatite Formation on the Example of the Berkutinskaya Vein (South Urals)

Abstract ––Understanding the origin of quartz veins of the mica-pegmatite formation is of great importance for deciphering the emplacement conditions for the of commercially prospective quartz targets. On the example of the Berkutinskaya vein, which is the typical metamorphogenic quartz deposit of the mica-pegmatite formation of the South Urals, we study the source and origin of the mineral-forming fluid, temperatures of quartz formation, the structure of intergranular boundaries, their morphometric feature, the fractal dimension of quartz grains and commercial characteristics of quartz grit. An integrated approach to the study of the typomorphic features of quartz allowed us to assess their impact on the technological characteristics of quartz concentrates. Comparison of data on the content of impurity elements in the Berkutinskaya quartz vein with quartz of the vein No. 175 of OOO Russian Quartz and IOTA-std (Sibelco) showed that the Berkutinskaya quartz vein is promising for commercial development.

Metamorphosed Plagiogranite Veins In Salma Eclogites, Belomorian Eclogite Province

The Salma subduction eclogites of the Meso-Neoarchean Belomorian Eclogite Province have compositions of N-MORB oceanic crust protoliths and contain felsic veins of plagiogranite compositions. Felsic veins consist of metamorphic minerals sush as garnet, quartz and kyanite, the earliest high-pressure inclusion of phengite and zoisite in garnet. Veins have geochemistry characteristics that are typical for island arc granites or adakites. They are compositionally comparable with eclogite-bearing tonalite-trondhjemite-granodiorite (TTG) gneisses, modern adakite, and Archaean andesite association of the Vedlozero–Segozero greenstone belt. The origin of these felsic veins can be represented as a product of melting of fluid-modified oceanic mafic slab at PT-conditions of eclogite metamorphism.Geothermometry and pseudosection calculations of metamorphic conditions in felsic veins, for eclogitic mineral assemblage of pyropic garnet, kyanite, high-silica phengite and quartz gave high pressures conditions (ca. 16–22 kbar) at relatively low temperatures (ca. 600–650 °C); for secondary decompression plagioclase ± biotite coronas between quartz, kyanite and garnet gave 14–11 kbar at 650–700 °C. This estimate corresponds “warm” subduction, which is most consistent with the parameters of the modern subduction of the base of the Cascadia plate . Mineral assemblages in eclogites, that included the felsic veins, give 15–11 kbar at 750–700 °C. Thermodynamic modelling indicates that the eclogites hosting the felsic veins did not reach partial melting conditions under the estimated PT conditions: exposure temperatures to the mafic rocks must have been significantly higher. A probable explanation for high-pressure parageneses in felsic veins may be the formation of plagiogranites as a result of the melting of the mafic slab under higher temperature and pressure conditions than were measured in this work. Thus, the high-pressure paragenesis of garnet, phengite, zoisite, and kyanite reflects the path of rock exhumation through eclogitic conditions.Zircon from the felsic veins gave several Archean and Paleoproterozoic ages ∼ 2.87, 2.78, ∼2.70 and, ∼1.9 Ga. The oldest age gave the fluid-modified oceanic zircon (∼2.9 Ga) from Fe-Ti eclogites directly near the veins. The oldest igneous zircons in the veins are represented by a population with the age of ∼ 2.87 Ga and correspond to the igneous age of some TTG gneisses, which do not contradict a hypothesis of the plagiogranite formation during the melting of the mafic slab in the subduction zone. A Neoarchean zircon population of ∼ 2.78 Ga is often present in eclogitized mafic rocks and surrounding TTG gneisses which can be associated both with the formation of TTG gneiss protoliths in the subduction zone (?) and with the recrystallization of older zircon as a result of fluid or thermal impact. The ɛHf of the older population (∼2.87 Ga) is + 3 to + 4, indicating a juvenile origin; the ∼ 2.78 Ga population has similar Hf-isotope compositions, suggesting that their ages reflect resetting (non-zero Pb loss) of the older zircons. The Sm-Nd model TDM ages of Grt-Ky veins have Meso-Neoarchean values (3.0–2.75 Ga) with positive εNd = 1.8–3.8 that may indicate a juvenile nature of sources of the plagiogranite melt. The eclogitized rocks of the Belomorian province generally underwent the granulite facies overprint at ∼ 2.74–2.64 Ga ago that is coincides with the age of granulite facies metamorphism of regional and global rank. The Paleoproterozoic evolution of the Salma eclogites and the East European Craton as a whole: at 2.5–2.4 Ga and 2.0–1.9 Ga with formation of the Lapland–Mid-Russia–South Baltia intracontinental and Svecofennian accretionary orogens was terminated in Paleoproterozoic time at ∼ 1.87–1.7 Ga. These age values correspond to closure of Pb-Pb and Sm-Nd isotopic systems of rock-forming metamorphic minerals of the felsic veins.

Reflux origin of the insufficient small saphenous vein by duplex ultrasound determination and consequences for therapy considering the saphenopopliteal junction type: Presented at the Sixty-third Annual Meeting of the German Society of Phlebology (DGP), Aachen, German, September 8-11, 2021, and presented at the Twenty-third Annual Meeting of the European Venous Forum, Berlin, Germany, June 22-24, 2023.

Reflux origin of the insufficient small saphenous vein by duplex ultrasound determination and consequences for therapy considering the saphenopopliteal junction type: Presented at the Sixty-third Annual Meeting of the German Society of Phlebology (DGP), Aachen, German, September 8-11, 2021, and presented at the Twenty-third Annual Meeting of the European Venous Forum, Berlin, Germany, June 22-24, 2023.

Dosimetric Analysis of Patients Treated with Stereotactic Body Radiation Therapy for Malignant Portal Vein Tumor Thrombosis Using MRI-Guided vs. CT-Guided Linear Accelerator

The use of MRI-guided linear accelerators (MRI-LINAC) for radiation therapy has allowed for increased treatment precision and real-time tumor tracking. We hypothesized that the use of an MRI-LINAC, recently acquired by our institution, would allow us to treat malignant portal vein tumor thromboses (PVTT) closer to the origin of the portal vein with similar doses to the liver and nearby GI organs and with similar treatment toxicities compared to patients treated using a CT-guided linear accelerator (CT-LINAC). We retrospectively assessed patients who received SBRT for treatment of PVTT within the UVA health system using the electronic medical record. We contoured the origin of the portal vein on the simulation scans (MRI or CT) for each patient. The shortest distance from the GTV to the portal vein origin and to organs at risk (OAR; duodenum, stomach or "other intestine") were measured. The PTV, volume of the liver receiving less than 18 Gy during treatment, and the Dmax to the portal vein origin and OAR were determined. The means for each variable were then compared between CT-LINAC and MRI-LINAC using independent samples t-tests. Treatment toxicities were graded using CTCAE version 5.0 guidelines. All plans met institutional dose constraints for SBRT. A total of 6 patients treated on CT-LINAC and 3 patients treated on MRI-LINAC were identified (mean dose CT 37.7 Gy [range 21-50] in 2-5 fractions; MRI 48.3 Gy [range 45-50] in 5 fractions). The GTV was significantly closer to the portal vein origin in the MRI-LINAC group (mean CT 92.75 mm ± 45.89; MRI 32.00 mm ± 29.46; p = 0.04). The GTV trended towards being closer to OAR in the MRI-LINAC group (mean CT 43.81 mm ± 37.09; MRI 4.36 mm ± 1.85; p = 0.059). The Dmax to both the portal vein origin (mean CT 0.58 Gy ± 0.33; MRI 22.49 Gy ±24.16; p = 0.024) and OAR (mean CT 13.38 Gy ± 5.98; MRI 36.23 Gy ± 5.38; p = <0.001) was significantly higher in the MRI-LINAC group. The PTV (mean CT 152.11 cc ± 169.94; MRI 122.47 cc ± 114.65; p = 0.398) or volume of liver receiving less than 18 Gy during treatment (mean CT 1287.87 cc ± 285.20; MRI 1743.88 cc ±961.94 = 3; p = 0.147) were not significantly different between the two groups. No patients in either the MRI-LINAC or CT-LINAC group reported acute toxicities greater than Grade 1. We found that patients with PVTT treated with MRI-LINAC SBRT at our institution were more likely to have central tumors near dose-limiting OAR. However, due to superior tumor delineation and dynamic tumor tracking, these patients were able to be treated without decreasing treatment dose or increasing acute GI toxicity compared to patients treated with CT-LINAC. A larger sample size and longer follow-up period is warranted to corroborate these initial findings.

Reflux origin of the insufficient small saphenous vein by duplex ultrasound determination and consequences for therapy considering the saphenopopliteal junction type

ObjectiveThe reflux pathophysiology of the saphenofemoral junction (SFJ) of the insufficient great saphenous vein (GSV) has already been investigated and stratified. These results are still lacking for the small saphenous vein (SSV). The aim of the study was to analyze the pathophysiology of the saphenopopliteal junction (SPJ) in case of refluxing SSV. MethodsThe study included 1142 legs investigated between April 1, 2019, and February 15, 2023, with chronic venous insufficiency scheduled for endoluminal thermal ablation of the insufficient SSV. Preoperatively, a standardized duplex ultrasound assessment of the SPJ including the cranial extension of the SSV and the Giacomini vein, respectively, was performed to determine the origin of reflux. Having in mind, that the draining type according to Cavezzi is relevant to the treatment planning, after having scanned 152 legs, the protocol was extended to this feature: Cavezzi type A1 or A2 was recorded on 990 legs. ResultsIn 984 cases (86%), saphenopopliteal reflux from the popliteal vein into the insufficient SSV was detected, and in 181 cases of these (16%), simultaneous refluxing blood from the cranial extension or Giacomini vein was found. In 119 cases (10%), reflux resulted only from the cranial extension or Giacomini vein with a competent SPJ, and in 39 cases (3%), the reflux source was diffusely from side branches and/or perforating veins. Cavezzi’s junction types A1 (independent junction of SSV and muscle veins) and A2 (muscle veins join into SSV, draining together into the popliteal vein through the SPJ) were found in 65% and 35% of cases, respectively. ConclusionsThe insufficient SSV shows a high frequency of axial reflux from the deep into the saphenous vein with an indication for high ligation or thermal ablation at the level of the SPJ or immediately distal to the inflow of muscular veins depending on the junction type. In 14%, based on this study, we observed a competent junction of the SSV without indication for ligation or thermal destruction of the SPJ.

A Novel Intraventricular Balloon Technique for Functional Assessment of Hearts from Donation After Circulatory Death

<h3>Purpose</h3> Functional assessment of hearts from donation after circulatory death (DCD) on ex-vivo heart perfusion (EVHP) is not well-established. Conventional intraventricular balloon (IVB) techniques, used for isolated heart perfusion in large animal models sacrifice the mitral valve to stabilize the balloon inside the left ventricle (LV), making it inapplicable for the clinical setting. This study demonstrates the effectiveness of a novel IVB technique to assess cardiac function during reperfusion and compares it to pressure-volume catheter measurements in a pediatric porcine DCD heart model. <h3>Methods</h3> Twelve pigs (9.5 ± 1.4 kg) were used. DCD hearts were harvested after 15 min of global warm ischemia due to asphyxic circulatory arrest and reperfused on EVHP for 2 hours. Isovolumetric LV pressure was measured during reperfusion with a saline-filled balloon inserted into the LV via a pulmonary vein orifice. The balloon was made from polyethylene wrap and connected to an 8 Fr sheath and pressure catheter, which was fixed with the left atrium via a purse-string suture around the origin of the pulmonary vein. DCD hearts were then switched to the working model (WM), pumping 120% of cardiac output, to measure cardiac function by using a pressure-volume catheter. Between-parameter correlations were assessed by Spearman's Rank Correlation Coefficient. <h3>Results</h3> Maximum first derivative of the LV pressure (dp/dt) measured by the IVB at 90 min of reperfusion showed moderate positive correlation (r_s = 0.61, p = 0.04) and coronary venous lactate levels showed moderate negative correlation (r_s = -0.55, p = 0.06) to respective measurements in the WM. Minimum dp/dt measured by the IVB at 60 min of reperfusion showed moderate positive correlation to measurements in the WM (r_s = 0.60, p = 0.04) and to tau in the WM (r_s = 0.52, p = 0.08). There was no significant difference between LV end-diastolic pressure during reperfusion and left atrial pressure in the WM. Myocardial oxygen consumption during reperfusion was less than 60% of that in the WM. <h3>Conclusion</h3> Functional parameters of contractility and relaxation measured by the IVB showed significant correlations to respective parameters in the WM. Therefore, this mitral valve sparing IVB technique can be used to confirm adequacy of cardiac function of DCD hearts in the early phase of reperfusion without the need to fully preload the heart.

Recurrent cardiac hydatid cysts ruptured intraoperatively during anesthetic induction for open-heart surgery

Introduction: Cardiac localization of hydatid disease is rare (&lt;3%) even in endemic countries. Affection characterized by a long functional tolerance and a large clinical and paraclinical polymorphism. Serious cardiac hydatitosis because of the risk of rupture requiring urgent surgery. The diagnosis is based on serology and echocardiography. The aim of this work is to show one of the fatal complications of this condition which arose intraoperatively during anesthetic induction. Methods: We report the observation of a 37-year-old woman operated on in 2010 for a cardiac hydatid cyst presenting a recurrence of cardiac hydatid disease with two left intraauricular cysts expressed by palpitations with dyspnea. Preoperatively: dyspnea stage II of the NYHA. Chest x-ray: CTI at 0.58. ECG: RSR. Echocardiography: Two largest left atrial cysts: 47/40 mm compress the origin of the right pulmonary vein, 2nd cyst of 36/28 mm. The existence of another small caliber lateral cyst. Positive hydatid serology. The patient developed an anaphylactic shock of unexplained cause, which required the assistive CPB facility. Intraoperative exploration: The two ruptured cysts in the left atrium with multiple left intraatrial daughter vesicles. Gesture: Removal of daughter vesicles with sterilization with hypertonic saline. Results: The postoperative consequences were favorable despite a prolonged stay in intensive care following a picture of acute respiratory distress syndrome. Conclusion: Intracardiac rupture is a very serious complication and can produce dramatic pictures with sudden death. It can be responsible for allergic reaction, systemic embolism, pulmonary embolism and systemic metastases. Keywords: Hydatid Cyst; Heart; Relapsing; Rupture; Surgery; Anaphylactic Shock; Cardiopulmonary Bypass; Prevention

Venous popliteal entrapment syndrome

Popliteal entrapment syndrome (PES) describes a set of symptoms related to compression of the neurovascular bundle in the popliteal fossa, with popliteal artery involvement the most widely recognized variation. Popliteal vein entrapment is a rare variation which can easily go undiagnosed. This is most commonly due to an anomaly of the medial head of the gastrocnemius muscle, but other etiologies include excess adipose tissue or cysts within the popliteal fossa, popliteal artery aneurysm, fibrous bands, thickened perivenous fascia, compression by the popliteus muscle or muscular hypertrophy independent of anomalous anatomy, or variant origin of the short saphenous vein. However, with improving awareness, it is a condition which should be increasingly considered in patients presenting with unexplained lower extremity swelling or other symptoms of lower extremity thrombosis. The initial test of choice is typically ultrasound with flexion and extension maneuvers. Venography is the gold standard for diagnosis, but MRI offers a noninvasive option for both diagnosis and evaluation of etiology and should be considered in the work-up of popliteal venous entrapment. Management is based on severity and type of symptoms, ranging from conservative management with compression stockings to surgical management if there is popliteal artery involvement or more severe symptoms. Endovascular therapy such as angioplasty or stenting has also been reported with good results.

Surgical management of the scimitar syndrome.

We sought to address the varied anatomical details, the diagnostic challenges, associated cardiopulmonary anomalies, the techniques, and outcomes of management, including re-interventions of scimitar syndrome. A total of 92 published investigations of scimitar syndrome were reviewed. Diagnostic information was provided by clinical presentations, radiographic findings, transthoracic and transesophageal echocardiography, computed-tomographic angiography, magnetic resonance imaging, angiocardiography, and ventilation/perfusion scans. These investigations served to elucidate the origin, course, and termination of the scimitar vein, the intracardiac anatomy, the presence of associated defects, and the patterns of any accompanying pulmonary lesions prior to surgical intervention. Of the patients described, up to four-fifths presented during infancy, with cardiac failure, increased pulmonary flow, and pulmonary hypertension. Associated cardiac and extracardiac defects, particularly hypoplasia of the right lung, are present in up to three-quarters of cases. Overall operative mortality has been cited between 4.8% and 5.9%. Mortality was highest in patients with preoperative pulmonary hypertension, and those undergoing surgery in infancy. Despite timely surgical intervention, post-repair obstruction of the scimitar vein, intra-atrial baffle obstruction, or stenosis of the inferior caval vein were reported in up to two-thirds of cases. The venous obstruction could not be related to any particular surgical technique. On long term follow-up, one sixth of patients reported persistent dyspnoea and recurrent respiratory infections. Any infants presenting with heart failure, right-sided heart, and hypoplastic right lung should be evaluated to exclude the syndrome. An increased appreciation of variables will contribute to improved surgical management.

Lower carboniferous fractured carbonates of the Campine Basin (NE-Belgium) as potential geothermal reservoir: Age and origin of open carbonate veins

Within the Lower Carboniferous limestones in the boreholes of Poederlee, Heibaart and Turnhout (Campine Basin, NE-Belgium), open veins partially cemented by calcite and dolomite are considered important with regard to the geothermal reservoir potential of these limestones. Based on a detailed petrographic analysis, stable carbon and oxygen as well as clumped Δ47 isotope analysis and U/Pb age dating, the formation conditions of these veins have been reconstructed and were placed in the geodynamic evolution of the sedimentary basin. All host rocks are recrystallized, and the open carbonate vein cements often possess a similar depleted δ18OPDB signature as their recrystallized host rock. The latter thus indicates vein cement precipitation was likely rock-buffered. The δ13C signature of the host rock often displays a marine signature, while in the veins two isotopic clusters can be differentiated. The first cluster groups veins with cleavage twins, and are characterized by slightly to moderately depleted δ13C, reflecting a mixture of marine carbon with carbon derived from organic matter. This group typically occurs in the open veins from the microbially dominated Poederlee and Heibaart buildups characterised by on-lapping organic-rich Namurian black shales. One of these veins formed at 216 ± 6 °C, indicating that it crystallised during the Sudetic – Asturian deformation stage of late Carboniferous age, while others formed between 110 and 130 °C, indicating that they could have been formed during the late Carboniferous burial stage or after the Sudetic – Asturian deformation and uplift. The second cluster groups veins that may, but often do not, contain cleavage twins. They show host-rock buffered δ13C signatures. These veins have a Cretaceous (late Aptian/early Albian) and/or Paleocene U/Pb age and formed at temperatures dominantly between 50 and 80 °C based on clumped isotopes.

Revisiting the anatomy of the cephalic vein, its origin, course and possible clinical correlations in relation to the anatomical snuffbox among Jordanian.

The cephalic vein is one of the most distinguished superficial veins of the upper limb. Its clinical value lies in venous access. There is little known about the variation of its formation in relation to the anatomical snuffbox. Hence, anatomical variants in the origin of the cephalic vein are important in clinical practice. Subsequently, this study was designed to examine the variation of the cephalic vein formation in relation to the anatomical snuffbox. A cross-sectional study of 438 subjects (722 hands), was prepared to study the cephalic vein among Jordanian students and staff of one of the major governmental Medical College in Jordan, by using infrared illumination system. The obtained data was analysed according to; gender, sidedness, and handedness. Four sites for the formation of the cephalic vein in relation to the anatomical snuffbox were found. There was a significant relation between gender and sidedness, and the sites of formation of the cephalic vein (p < 0.0001 and p = 0.048, respectively). For the first time this study identified different sites for the formation of the cephalic vein in relation to the anatomical snuffbox. However, regardless of its sites of formation, the cephalic vein was running in 98% of the examined hands in the anatomical snuffbox.

Laparoscopic partial liver resection for hepatocellular carcinoma arising from Fontan-associated liver disease: a case report

BackgroundThe Fontan procedure (FP) is a palliative surgery for functional single ventricle. The Fontan circulation maintains pulmonary circulation by a high central venous pressure, leading to chronic congestive liver. The number of patients diagnosed with hepatocellular carcinoma (HCC) arising from liver fibrosis and cirrhosis after FP is increasing. Several reports have described surgical treatment for HCC after FP, but few have described laparoscopic surgery.Case presentationThe patient was a 31-year-old man who had undergone the FP for single right ventricle at 3 years. Several liver masses were detected at 30 years. A liver mass in segment 3 showed increasing size concomitant with increasing alpha-fetoprotein concentration, and a solitary HCC 15 mm in diameter was diagnosed. The tumor was located on the liver surface, abutting the origin of the left hepatic vein. Laparoscopic partial liver resection was performed. The postoperative course was uneventful and the patient was discharged on postoperative day 3. The patient remained disease-free on follow-up after 7 months.ConclusionsAlthough we had some concerns, such as difficulty managing general anesthesia and easy venous bleeding due to high central venous pressure, laparoscopic partial liver resection was performed with safe exposure of the left hepatic vein.

An In Vitro Model to Study Endothelialization of Cardiac Graft Tissues Under Flow.

Pulmonary valve replacement is performed with excellent resultant hemodynamics in patients that have underlying congenital or acquired heart valve defects. Despite recent advancements in right ventricular outflow tract reconstruction, an increased risk of developing infective endocarditis remains, which has a more common occurrence for conduits of bovine jugular vein (BJV) origin compared with cryopreserved homografts. The reason for this is unclear although it is hypothesized to be associated with an aberrant phenotypic state of cells that reendothelialize the graft tissue postimplantation. The aim of this study was to develop an in vitro model that enables the analysis of endothelial cell (EC) attachment to cardiac graft tissues under flow. In the experiments, EC attachment was optimized on bovine pericardium (BP) patch using human umbilical vein ECs. Different biological coatings, namely gelatin, fibronectin, plasma, or a combination of fibronectin and plasma were tested. After cell adaptation, graft tissues were exposed to laminar flow in a parallel-plate flow chamber. Cell retention to the tissue was analyzed after nuclear staining with YO-PRO-1 and a membranous localization of VE-cadherin. Experiments showed that combined coating with fibronectin and blood plasma together with a two-phased shear pattern resulted in a relevant cell monolayer on BP patch and cryopreserved homograft. For BJV tissue, no adherent cells under both static and shear conditions were initially observed. In conclusion, having established the new flow chamber system we could obtain EC layers on the surface of BP patch and cryopreserved pulmonary homograft tissues. The presented in vitro system can serve as a competent model to study cell phenotypes on cardiac grafts in the close-to-physiologic environment. Moreover, this approach allows broad applications and enables further development by testing more complex conditions.

Resection of caudate lobe hepatocellular carcinoma with enbloc IVC resection and replacement

Presenter: Iswanto Sucandy MD | AdventHealth Tampa Background: This video describes how we undertook the resection of the caudate lobe for hepatocellular carcinoma with enbloc IVC resection and replacement. Methods: The patient is a 74-year-old man who present with a 6 cm caudate lobe mass. Patient has a history of Hepatitis C with liver cirrhosis (Child A). Workup included an MRI which showed the caudate lobe mass circumferentially invading the IVC. A percutaneous biopsy confirmed hepatocellular carcinoma. Results: The operation began with a complete mobilization of the left hemiliver. The falciform ligament was taken down to the hepatocaval confluence. The gastrohepatic ligament was then opened in a stellate fashion along the Arantius ligament, which was dissected all the way up to the origin of the left hepatic vein. Dissection along the caudal border of the tumor was undertaken by following the common hepatic artery, which was displaced by the tumor mass. The common hepatic artery lymph nodes were removed. The pancreas was then exposed and retracted caudally. The left gastric artery was involved by the tumor; therefore, it was isolated and transected with a laparoscopic vascular load stapler. The minor curvature of the stomach was dissected all the way up to the crus. The pars flaccida was open to show the anatomical landmarks of this operation. The gallbladder was then removed. Next, the Arantius ligament was ligated and divided. The hepatic artery and portal vein branches to the caudate lobe were isolated and divided. The duodenum was widely kocherized to access the retroduodenal IVC just above the left renal vein. The right gonadal vein was preserved. The entire retrohepatic IVC was removed after applying cross-clamping on the IVC (proximal vascular clamp was placed immediately caudal to the root of the hepatic veins and the distal vascular clamp was placed through the retroduodenal space behind the head of the pancreas). A 16mm woven Dacron vascular conduit was used for the IVC replacement. Once the graft-IVC anastomosis was completed, the IVC was unclamped. A vascular Doppler was utilized to check the flow within the vena cava conduit. Conclusion: Patient tolerated the procedure well and had an uneventful recovery. Pathology confirmed a 10 cm enbloc mass containing caudate lobe hepatocellular carcinoma and retrohepatic IVC. There was an absence of lymphatic invasion. Patient was discharged on post-operative day 4 after ambulating and tolerating oral diet.

Pure laparoscopic radical antegrade modular pancreato-splenectomy (RAMPS) procedure

Purpose: Laparoscopic left pancreatectomy for pancreatic cancer has recently increased worldwide. With the attempt to improve its oncological safety by enlarging the resection margins, the radical antegrade modular pancreato-splenectomy (RAMPS) have been introduced. However, this procedure is technically challenging and it still needs to be standardized. We herein describe a standardized, step-by-step approach of the laparoscopic RAMPS at our center highlighting some technical tips and tricks. Methods: This procedure was performed on a 59-year-old man with a past history of diabetes and hypertension with non-specific abdominal pain. In the CT scan a 3 cm sized low attenuated mass in the body of the pancreas was detected with suspicious invasion of the posterior capsule. Results: After creation of a pneumoperitoneum via a 12 mm infra-umbilical port, three additional trocars are inserted. As showed in the video, surgery is started with division of the greater omentum. The inferior pancreatic border is dissected until the superior mesenteric vein and the origin of the splenic vein are exposed. Thereafter, the splenic artery and vein are dissected and divided. A window is opened between the pancreas and splenic vessels, and the neck of the pancreas is transected. The left side of the superior mesenteric artery is exposed until the left renal vein is identified. The retroperitoneal dissection continues along the anterior surface of the renal vein and kidney. Conclusions: Laparoscopic RAMPS procedure is a safe and feasible technique in experienced centers with advanced minimally invasive skills; it is recommended to standardize the technique for teaching purposes, replicability and to ensure patient safety

Origin of Bedding-Parallel Calcite Veins from Lacustrine Shale in the Eocene Dongying Depression, Bohai Bay Basin, China

Calcite veins, which developed parallel to the bedding, are widespread in laminated source rocks in the Eocene Dongying Depression. However, there is a lack of systematic description and classification of the veins. This study presents a systematic characterization of the calcite veins, host rocks, and micritic carbonate laminae by applying petrographic and geochemical methods to understand vein-forming mechanisms. Antitaxial and syntaxial veins are examined. Antitaxial veins contain typical fibrous crystals with the most intense fluorescence, and the median zone of these veins is often the micritic carbonate. Calcite crystals in syntaxial veins develop a blocky morphology of various sizes, indicating obvious growth competition. Data of rare earth elements and trace elements obtained from the micritic laminae, host rocks, and calcite veins are very similar. This indicates that the vein-forming nutrients originated from the carbonate in the host rocks and micritic laminae. The minor difference in C and Sr isotopes between calcite veins and micritic carbonate within the host rock and the negative shift in O isotopes in the veins are caused by ion exchange and dehydration of swelling clay minerals in the burial environment. This further proves that the calcite veins are formed in a closed system. Geochemical analysis suggests that the rocks are in the oil window and have good hydrocarbon potential. Thermal evolution of the acidic fluids generated from organic matter (OM) resulted in the dissolution of carbonate and formed fluid overpressure in the rocks. Fluid overpressure induced the formation of fractures in the interlayer and expanded the veins with the force of crystallization due to fibrous calcite growth. Blocky crystals grow in the fractures from the margins toward the center. Hydrocarbon expulsed via OM maturation in the host rock fills the intercrystalline pores. Moreover, shale with bedding-parallel calcite has the characteristics of high-quality shale oil reservoirs. These characteristics will probably provide guidance for shale oil exploration.

Coughing as a potentially effective induction method of atrial tachycardia: a case report.

Background Cough-induced atrial tachycardia (AT) is extremely rare and its electrical origin remains largely unknown. Atrial tachycardias triggered by pharyngeal stimulation, such as swallowing or speech, appears to be more common and the majority of them originate from the superior vena cava or right superior pulmonary vein (PV). Only one case of swallow-triggered AT with right inferior pulmonary vein (RIPV) origin has been reported to date.Case summary We present a case of a 41-year-old man with recurring episodes of AT in the daytime. He underwent electrophysiology study without sedation. Atrial tachycardia was not observed when the patient entered the examination room and could not be induced with conventional induction procedures. By having the patient cough periodically on purpose, transient AT with P-wave morphology similar to the clinical AT was consistently induced. Activation mapping of the AT revealed a centrifugal pattern with the earliest activity localized inside the RIPV. After successful radiofrequency isolation of the right PV, AT was no longer inducible.Discussion In the rare case of cough-induced AT originating from the RIPV, the proximity of the inferior right ganglionated plexi (GP) suggests the role of GP in triggering tachycardia. This is the first report that demonstrates voluntary cough was used to induce AT. In such cases that induction of AT is difficult using conventional methods, having the patient cough may be an effective induction method that is easy to attempt.

The origin of fluid in calcite veins and its implications for hydrocarbon accumulation in the Shunnan-Gucheng area of the Tarim Basin, China

The high-angle, structural genetic calcite veins of the Ordovician in the Shunnan-Gucheng area in the Tarim Basin provide a convenient study of fluid properties, hydrocarbon migration, and accumulation events in the fault zone of this area. Based on detailed core investigation, studies on fluid inclusions in calcite veins and comparison of geochemical characteristics of limestone matrix and calcite veins were carried out. Multiple types of hydrocarbons inclusion (e.g., dry asphalt inclusion,three-phase hydrocarbon inclusion, oil and water inclusion,gas-rich inclusion) were found in calcite veins. Furthermore, the coexisted aqueous inclusions with the gas–liquid phase had a high homogenization temperature (130–160 °C). The distribution characteristics of 18O-depleted (δ18O: −13.1‰ to −8.7‰), 87Sr-enriched (87Sr/86Sr: 0.708 879 to 0.710 432), relatively high total Rare Earth Elements (REEs), and positive Europium Anomalies indicated that the structural origin of calcite veins was mainly derived from the dissolution of surrounding rocks and diagenetic-hydrocarbon fluids. Participation signs of meteoric water were not proved. The rich hydrocarbon inclusions in the calcite veins indicated that the north-east strike-slip fault zone in the Shunnan-Gucheng area is an essential channel for hydrocarbon migration and accumulation.

A report of a case: unusual portosystemic shunt in a hernia sac who has portal hypertension due to cirrhosis

Variations in the origin and branching pattern of splenic vein (SV) are relatively rare and asymptomatic. We describe here only the first case in the literature of accessory SV in hernia sac due to previous operation and increased portal pressure because of cirrhosis. This report describes a 66-year-old female, with a history of total abdominal hysterectomy (TAH) due to uterine myomatosis, signs of cirrhosis onset due to hepatitis B, who had been presented with recurrent abdominal pain attacks. Ultrasonography (USG) findings were nothing pathologic except a gallstone in the gallbladder without cholecystitis signs. Incisional hernia was found to contain an accessory SV in the hernia sac arising from a branch of main SV in the hilum, ongoing to the subcutaneous fat tissue and draining to the superficial femoral vein on computed tomography (CT). Videoendoscopy showed wide gastritis and multiple ulcers. The patient's symptoms diminished with proton pump inhibitor (PPI) treatment and they then underwent a hernia repair surgery with Prolene mesh patch as elective surgery. A thorough knowledge of the normal anatomy, most frequent variations and congenital or acquired anomalies of the spleno-portal axis has great importance for hepatopancreaticobiliary and emergency surgical procedures. It is, therefore, essential for preoperative evaluation of the anatomical details of the spleno-portal venous axis and should be evaluated with imaging methods in detail.