The Brachiocephalic Trunk Variant Origin and High-Riding Course: Two Cadaveric Cases.

OBJECTIVE: The current report describes two rare cadaveric findings of a left sided brachiocephalic trunk (BCT) in relation to the trachea, and its high-riding course above the suprasternal notch (SN). CASES DESCRIPTION: In two elderly body donors dissected after death, a left-sided BCT was identified with a high-riding course (0.5 and 0.8 cm above the SN). The BCT originated from the aortic arch, in common with the left common carotid artery, more distally than the typical left-side location and crossed in front of the trachea. In the 1st case, the ascending and descending aortae, and the left subclavian artery had aneurysmal dilatation. In both cases, the trachea was displaced to the right side and had a stenosis due to the chronic compression. CONCLUSION: A high-riding BCT is of paramount clinical importance, as it may complicate tracheotomy, thyroid surgery and mediastinoscopy, leading to fatal complications. BCT injury leads to a massive bleeding during neck dissection (level VI), when the vessel crosses the anterior tracheal wall.

Re-exploring the pelvic neuroanatomy from a new perspective and a potential guidance for TaTME: a "bottom-up" approach.

Neuro-anatomy of the perineum has gained renewed attention due to its significance in the transanal procedures for rectal cancer (eg TaTME). Surgeons embarking on this technique must have sophisticated knowledge and a precise anatomical understanding of the perineum before proceeding with this reversed rectal approach. We report anatomical observations deriving from a relevant experience in the colorectal surgery field. The collective multicenter experience of the present study is clinically relevant and based on the rectal and transanal resections performed in colorectal centers of excellence from Greece, UK, and Italy over the last 10 years (2011-2020). From the original anatomical and intraoperative observations derived from collective cases operated by this multicenter group of colorectal surgical centers in three European countries, data were retrieved and analyzed in collaboration with specialist researchers of human anatomy and interpreted for their clinical significance and potential use for preoperative planning and intraoperative guidance during TaTME. This descriptive article demonstrates in detail the neurogenic pathways encountered in the perineum and pelvic cavity during transanal procedures. Specific anatomical and topographic implications are also included serving as a guide for colorectal surgeons to perform a nerve-sparing procedure. transanal approach for rectal excision offers new insights into the complex pelvic and perineal neuroanatomy while the procedure itself remains a challenge for surgeons. Preoperative anatomical planning and 3D reconstruction may help in anticipating technical difficulties, resulting in more precise surgical dissections and decreased postoperative complications.

Long-term results of open transvesical prostatectomy from a contemporary series of patients.

OBJECTIVES: To provide information about the long-term efficacy of transvesical prostatectomy from a contemporary series of patients. When comparing minimally invasive procedures with open prostatectomy, the data for the latter are usually provided from old studies or from recent ones performed in developing countries. However, this procedure is still used frequently for large-size prostates. METHODS: During a 5-year period, 232 patients with large (greater than 75 g) prostates underwent open transvesical prostatectomy for symptomatic benign prostatic hyperplasia. Patient charts were retrospectively reviewed for preoperative and postoperative International Prostate Symptom Scores, postvoid residual urine volumes, maximal flow rates, early and late postoperative complications, and the need for reoperation. The preoperative International Prostate Symptom Score, postvoid residual urine volume, and maximal flow rate were compared with the corresponding postoperative data at 8 to 12 months and at the last follow-up visit. RESULTS: Complete data evaluation was possible for 151 patients, with a mean follow-up of 41.8 +/- 15.6 months. Improvement in International Prostate Symptom Score, postvoid residual urine volume, and maximal flow rate was statistically significant (P <0.001) at 8 to 12 months and remained statistically significant at the last follow-up visit. Long-term complications included bladder neck contraction in 5 (3.3%) occurring at a mean of 10 months (range 5 to 17), urethral strictures in 1 (0.6%), and meatal stenosis in 2 (1.3%) of 151 patients. Re-operation was required in 6 patients (3.9%). CONCLUSIONS: Transvesical prostatectomy in a contemporary series of patients proved to be successful, with a low rate of complications. Its success has a durable effect and only rarely was a corrective procedure necessary. This approach should be included in the list of possible treatments to discuss with the patient with a large prostate.

Modified ileal neobladder for continent urinary diversion: functional results after 9 years of experience.

PURPOSE: We report the continence status and urodynamic findings in 59 patients who underwent radical cystectomy and orthotopic bladder reconstruction using a modified S-ileal neobladder technique between January 1993 and July 2002. MATERIALS AND METHODS: Continence status was assessed using patient interview, frequency-volume charts and the need for protective devices. Reservoir sensation, compliance, capacity and activity were assessed by enterocystometry. Post-void residual urine volume greater than 100 ml was the indication for clean intermittent self-catheterization. RESULTS: Daytime continence was reported by 95.5% and 100% of our patients at 1 and 5 years, respectively. Overall, 77.7% of patients reported nighttime continence at 1 year and 96.5% at 5 years. The need for a protective device decreased with time and most of the patients would have undergone the operation again. Enterocystometric capacity and maximum reservoir pressure remained remarkably stable at 391.6 versus 440 ml, and 30 versus 20 cm H2O, 6 months and 5 years after surgery, respectively. Nevertheless, median post-void residual urine volume increased from 35 ml at 6 months to 55 ml at 5 years with an increase in prevalence of patients requiring intermittent self-catheterization due to post-void residual urine greater than 100 ml from 1.8% at 6 months to 10% at 5 years. CONCLUSIONS: Orthotopic bladder substitution with the modified S-ileal neobladder technique has an excellent functional outcome over time, resulting in high daytime and nighttime continence levels as well as high acceptability rates from our patients.

Synchronous diagnosis of prostatic adenocarcinoma and sarcoidosis.

Sarcoidosis and prostatic carcinoma in the same patient is a rare clinical entity. This is the third reported case of such pathology. Immunodeficiency caused by sarcoidosis may induce immunity disorientation resulting in the presence of prostatic carcinoma. Sarcoidosis in relation with malignancy may give some answers for the etiopathology of cancer.

Solitary neurofibroma of the spermatic cord.

We report a case of solitary neurofibroma of the spermatic cord. Such benign tumors arise from perineural and Schwann cells and may be located in various parts of the body, but are rarely observed in the spermatic cord. No clinical or laboratorial manifestations of von Recklinghausen disease (Neurofibromatosis) were identified. Distinct criteria have been established for a diagnosis of von Recklinghausen disease, so that a solitary neurofibroma may not represent this complex. Only a little number of solitary neurofibromas of the spermatic cord are reported in the literature.