Exploring the clinical characteristics and prevalence of the annular pancreas: a meta-analysis.

BACKGROUND: The annular pancreas (AP) is a rare gastrointestinal congenital malformation, in which malrotation of the pancreatic ventral bud in the seventh week of embryonic development manifests in a partial or complete ring of tissue around the second part of the duodenum. METHODS: The main online medical databases such as PubMed, ScienceDirect, Wiley online library, Web of Science, and EBSCO discovery service were used to gather all relevant studies on the AP. RESULTS: A total of 12,729,118 patients were analyzed in relation to the prevalence of AP. The pooled prevalence of AP was 0.0045% (95% CI: 0.0021%-0.0077%). The most frequent comorbidity in adults and children was duodenal obstruction, with a pooled prevalence of 24.04% and 52.58%, respectively (95% CI: 6.86%-46.48% and 35.56%-69.31%, respectively). The most frequent operation in adult patients with AP was duodenojejunostomy, with pooled prevalence established at 3.62% (95% CI: 0.00%-10.74%). CONCLUSION: The diagnostic complexity of AP is accentuated by its nonspecific clinical symptoms, making accurate identification reliant on imaging studies. Therefore, having a thorough knowledge of the clinical characteristics of the AP and its associated anomalies becomes paramount when faced with this rare congenital condition.

The anatomy of the atrioventricular nodal artery: A meta-analysis with implications for cardiothoracic surgery and ablation procedures.

The objective of the present meta-analysis was to evaluate recent and applicable data regarding the location and variation of the atrioventricular nodal artery (AVNA) in relation to adjacent structures. In order to minimize postoperative risks and maintain physiological anastomosis for proper cardiac function, understanding such possible variations of vascularization of the AV node is of immense importance prior to cardiothoracic surgery as well as ablations. In order to perform this meta-analysis, a systematic search was conducted in which all articles regarding, or at least mentioning, the anatomy of the AVNA was searched. In general, the results were based on 3919 patients. AVNA was found to originate only from the RCA in 82.41% (95% CI: 79.46%-85.18%). The pooled prevalence of AVNA originating only from LCA was found to be 15.25% (95% CI: 12.71%-17.97%). The mean length of AVNA was found to be 22.64 mm (SE = 1.60). The mean maximal diameter of AVNA at its origin was found to be 1.40 mm (SE = 0.14). In conclusion, we believe that this is the most accurate and up-to-date study regarding the highly variable anatomy of the AVNA. The AVNA was found to originate most commonly from the RCA (82.41%). Furthermore, the AVNA was found to most commonly have no (52.46%) or only one branch (33.74%). It is hoped that the results of the present meta-analysis will be helpful for physicians performing cardiothoracic or ablation procedures.

Suture-like pattern formation in the pterygospinous bridge of the human sphenoid bone.

The paper presents an anatomical study involving rare variations in the pterygospinous bridges found in Mongolian skulls. These structures extend between the lateral pterygoid plate and the sphenoid spine. Particularly interesting is the division of these bridges into two distinct parts of the similar length. The junctions within these structures resemble morphological patterns characteristic for the plain and zigzag sutures, which articulate the cranial bones.

The venous plexus of Rektorzik - anatomo-clinical issues retrieved from the literature data.

The venous plexus of Rektorzik is a network of small veins, which enlace outside the wall of the internal carotid artery while it traverses the petrous part of the temporal bone. The anatomical and clinical issues related to the communication between the plexus of Rektorzik and other cranial venous structures were discussed in this paper.

Anatomical features of the mandibular canal and their clinical significance - review of literature.

The clinical issues related to the anatomical variation of the mandibular canal have been extensively analyzed since the 19th century. Evolving dentistry techniques and advancements in the prosthetics forced to collect detailed information about anatomical variations of the mandibular canal due to its neurovascular content. Therefore, its radiographic imaging became an essential part of the oral surgery, in order to avoid complications resulted from an accidental damage of the mandibular canal.

Higher milk consumption is not associated with fracture risk reduction: systematic review and meta-analysis.

INTRODUCTION: Osteoporosis affects over 200 million people worldwide causing nearly 9 million fractures annually, with more than half in America and Europe. OBJECTIVES: This meta-analysis was conducted to investigate whether low milk intake is associated with an increased risk of fractures by summarizing all the available evidence. METHODS: Relevant studies were identified by searching the PubMed and EMBASE databases up to June 2020. The pooled relative risks with 95% confidence intervals were calculated. RESULTS: In a meta-regression analysis of 20 included studies (11 cohort and 9 case-control studies), a higher milk intake was not associated with a reduction in the total fracture risk in both sexes (OR 0.95, 95% CI: 0.84- 1.08), either in cohort (OR 0.91; 95% CI: 0.79-1.05) or case-control studies (OR 1.09; 95% CI: 0.82-1.44), as well as separately in men (OR 0.87; 95% CI: 0.71-1.07) and women (OR 0.95; 95% CI: 0.80-1.13). CONCLUSION: Higher milk consumption is not associated with fracture risk reduction and should not be recommended for fracture prevention.

A 3D model of the renal vasculature - a joined result of the corrosion casting technique, micro-CT imaging and rapid prototyping technology.

Three-dimensional (3D) printed model of the renal vasculature shows a high level of accuracy of subsequent divisions of both the arterial and the venous tree. However, minor artifacts appeared in the form of oval endings to the terminal branches of the vascular tree, contrary to the anticipated sharply pointed segments. Unfortunately, selective laser sintering process does not currently permit to present the arterial, venous and urinary systems in distinct colors, hence topographic relationship between the vascular and the pelvicalyceal systems is difficult to attain. Nonetheless, the 3D printed model can be used for educational purposes to demonstrate the vast renal vasculature and may also serve as a reference model whilst evaluating morphological anomalies of the intrarenal vasculature in a surgical setting.

Destruction of the craniofacial skeleton in the child caused by an orbital tumor.

PURPOSE: The aims of this paper are to describe the morphological alterations within an infant craniofacial skeleton caused by an orbital tumor and present how the bone reacts in contact with a spreading tumor mass. METHODS: A study was performed on the dry skull of a child at the age of approximately 2 years. Morphological alterations of the craniofacial skeleton were analysed by visual inspection, and the intracranial cavity was examined with the aid of a digital camera. Subsequently, the skull was examined using computed tomography. RESULTS: The skull was identified as having unilateral symptoms of orbital destruction caused by a malignant tumor, probably retinoblastoma or rhabdomyosarcoma. The left orbit and surrounding bones showed extensive malformation caused by the invading tumor. Profound deformities were also observed in the nasal cavity, which was partially occluded by the collapsed medial wall of the left orbit. The tumor extended to the wall of the orbit, spread out of the orbit, penetrated to the anterior cranial fossa, and probably invaded the brain. CONCLUSIONS: Extensive pathological cranial destruction and possible metastases to inner organs suggest that the orbital tumor was the cause of death. Anatomical alterations observed in the craniofacial skeleton indicate a highly aggressive character of the orbital tumor.

Physicochemical and micro-tomographic characterization of inorganic deposits associated with aortic stenosis.

BACKGROUND AND THE AIM OF THE STUDY: A major feature of aortic stenosis is massive mineralization of the aortic valve, though the mechanism of the process remains unclear. The study aim was to characterize the chemical composition and morphology of inorganic deposits from surgically excised natural aortic valves and to seek similarities to minerals in bones and teeth. METHODS: Mineral deposits from 30 surgically excised natural aortic valves were examined. The control group consisted of autopsy samples (aortic valves, vertebral bodies) and teeth obtained after extraction. Micro-computed tomography (micro-CT) was used to describe the morphology and density of the minerals. X-ray fluorescence and Fourier transform infrared spectroscopy were applied to determine the chemical composition. RESULTS: A poorly crystalline, B-type carbonate-containing hydroxyapatite (HAP) was found to constitute the mineral phase of the aortic valve leaflets. No other chemical compounds were identified. The elemental composition of the minerals in aortic valves and bone/tooth did not differ markedly, except that the Mg concentration was fourfold higher in valve material. The aortic valve deposits were irregular in shape and occupied ca. 40% of the leaflet volume. The volume of the deposits were spread over a broad range (0.001-0.3 mm3), while the density ranged from that of dentine to enamel (average value 2.2 g/cm3), slightly higher than that of compact bone. CONCLUSION: The aortic valve deposits were identified as B-type carbonate-containing HAP, and were not identical to those found in bones and teeth, the main difference being a fourfold elevated Mg content. Mg may have been deposited as a separate compound, as micro-CT results suggested that the formation of mineral deposits in aortic valves was a multi-factorial process. The morphological parameters and densities of the valve deposits were spread over a broad range (factor approximately 300). An unequivocal identification of the mechanism responsible for the aortic valve pathological calcification was not possible, however.

Variations of the anterior communicating artery complex and occurrence of anterior communicating artery aneurysm: A2 segment consideration.

INTRODUCTION: The anterior communicating artery (ACoA) is the most frequent site of intracranial aneurysm location. Despite many studies the frequency of aneurysm occurrence with anatomical anomalies is still poorly described. Moreover the significance of the A2 segment of anterior cerebral artery anomalies has been neglected. The aim of this study was to determine the frequency and types of variations of the anterior cerebral circulation in patients with ACoA aneurysms and to analyze their relation to aneurysm occurrence in the Polish population. MATERIALS AND METHODS: We studied 50 patients with an established radiological diagnosis of ACoA aneurysm and 100 healthy age- and sex-matched controls using Computed Tomgraphy Angio- graphy. Maximum Intensity and Volume Rendering Projections were used to examine the cerebral arterial circulation. Univariate logistic regression was used to determine the statistical association between ACoA complex anomalies and aneurysm occurrence. RESULTS: Patients in the study group had a significantly higher incidence of hypoplastic A1 seg- ment of the anterior cerebral artery (24% vs. 7%; p <0.01) and aplastic A1 segment of the anterior cerebral artery (12% vs. 3%; p = 0.03). The frequency of A1 segment hypoplasia or aplasia in the study group was 36%. There was a statistical trend regarding A2 segment aplasia/hypoplasia as a potential predictor of ACoA aneurysm (6% vs. 1%; p = 0.07). CONCLUSION: Occurrence of an ACoA aneurysm is associated with hypoplasia or aplasia of the A1 segment of the anterior cerebral artery. A2 segment anomalies may potentially be associated with aneurysm formation.

A novel in-vitro model of human aortic valve mineralization.

BACKGROUND AND AIM OF THE STUDY: The study aim was to develop an in-vitro model of human aortic valve homograft (AVH) mineralization, as a basis for further research on the subject of calcific aortic valve disease (CAVD). METHODS: Human aortic valves were excised during autopsy (12-24 h post-mortem) from donors who had died due to accident or suicide. The mean (±SD) donor age was 32.5 ± 11.4 years. Under sterile conditions each aortic cusp (three cusps per valve) was cut in half to provide a total of 240 tissue samples. AVH mineralization was assessed in solutions with different Ca and P concentrations and CaxPO4 ionic product values. The impact of time on aortic valve mineralization rate was assessed using energy-dispersive X-ray fluorescence (ED-XRF). RESULTS: The model showed that human AVH mineralization can be best observed in a solution with a CaxPO4 ionic product of 2.2 mmol2/l2. The optimum incubation time for observing AVH mineralization was 21 days. CONCLUSION: A novel in-vitro AVH mineralization model was developed for use in future studies.

Blood vessels of the intratumoral septa in uterine leiomyomata.

The angioarchitecture of fibroid intratumoral septa was studied using 32 uteri obtained during necropsies of the females aged between 35-57. The whole vascular bed of 16 uteri was injected with synthetic resin Mercox CL-2R and then the uteri were corroded in potassium hydroxide. Next 16 uteri were injected with acrylic emulsion, Liquitex R. Their vascular bed was studied using immunohistochemistry for von Willebrandt's factor. Immunohistochemistry allowed to visualize the vessels within the intratumoral septa, while SEM allowed to differentiate the vessels, which were mainly the venules and the veins. Apart from the veins the intratumoral septa were consisted of small arteries and capillaries.

Nerve supply of pelvic viscera - anatomical notes, clinical implication on nerve stimulation.

AIM: The aim of this study was to present review on pelvic plexuses in males and females with some referrals to clinical practice, specially to the methods including nerve stimulation. CONCLUSIONS: Anatomy of pelvic plexuses is still confusing. Much attention should be paid to further studies on the arrangement of pelvic plexuses specially because of nerve stimulation techniques.

Trans-foramen magnum examination of the sella turcica region in the macerated human skulls.

This report presents a method of quick and accurate imaging of the sellar region by means of the laryngological mirror equipped with a light pipe and followed by taking digital photograph as the mirror image visible through the foramen magnum. A technique of the intracranial imaging of the osseous structures was tested on the macerated human skulls. Images of the sellar region were presented as the example of quality of the employed technique, which can be regarded as a simplified version of the endoscopic examination.

Angioarchitecture of uterine cervical leiomyomata - a SEM study.

AIM: he main goal of this study was assessment of vascular structure of cervical uterine leiomyomata. MATERIALS AND METHODS: The study was carried out on ten human uteri collected upon autopsy. Vessels were injected with synthetic resin, next corroded and coated with gold, finally observed using scanning electron microscope. RESULTS: Most of cervical fibroids were observed in the middle third of the wall of cervix. They were surrounded by relatively dense 'vascular capsule'. consisted of flattened vein, arterioles and capillaries. CONCLUSIONS: Structure of cervical uterine leiomyomata was similar to those observed in initial stage of growth of myometrial fibroids.

Morphology of a 19th century adult male skull with non-treated hydrocephalus - a case report.

This report presents the craniofacial morphology of a skull afflicted with hydrocephalus, belonging to an adult male who lived in the 19th century in Vienna. The volume of the skull (2022 cm3) exceeds normal capacity of a male skull which is estimated to be 1500 cm3. Diameters of the neurocranium and head circumference of the specimen differ significantly from normative values, while the facial diameters remain in normal range of variation. Characteristic features of the investigated skull are numerous accessory bones and sutures of the neurocranium. Overall the morphology of the cranial bones suggests that the male suffered from congenital hydrocephalus.

Reactivity of pulmonary circulation and right ventricle function to inhaled nitric oxide in systemic sclerosis patients.

Systemic sclerosis (SSc) is complicated by pulmonary hypertension and right ventricle (RV) failure in approximately 10% of the patients. Factors influencing the reactivity of pulmonary circulation to vasodilators are not established, while the examination of vasoreactivity is important in determining the treatment, because systemic administration of oral vasodilators can induce severe adverse events in nonresponders. The mechanism of RV failure in SSc is unclear and may result either from increased RV afterload or intrinsic myocardial disease. The aim of the study was to assess the reactivity of pulmonary circulation to inhaled nitric oxide (iNO) and to evaluate its influence on RV function in SSc patients with elevated right ventricle systolic pressure (RVSP). In 60 SSc patients aged 24-73 (58 females, two males; 33 patients with limited SSc and 27 with diffuse SSc), echocardiographic examination with tissue Doppler echocardiography (TDE) was performed. RV function was measured by systolic (S) and early diastolic (E) velocity of tricuspid annulus by TDE. In patients with RVSP >45 mmHg, the reactivity of pulmonary circulation was assessed by iNO test. High-resolution computerized tomography (HRCT) was performed to assess the extent of pulmonary fibrosis. Of 14 SSc subjects with elevated RVSP (13 females, one male; RVSP 47-62 mmHg), positive reaction to iNO was observed in five (RVSP decreased from 51.6 ± 3.7 to 32.24 ± 2.3 mmHg); nine patients were not reactive (RVSP 53.5 ± 5.7 mmHg before iNO vs. 49.6 ± 6.7 mmHg). RV systolic function was decreased in patients with elevated RVSP as compared to the patients with normal pulmonary pressure (S velocity 13.2 ± 1.3 vs. 14.4 ± 1.6 cm/s, respectively, p < 0.05). Significant increase of RV systolic function during iNO test was found in reactive patients only (S velocity before iNO 12.8 ± 1.2 cm/s, during iNO 14.5 ± 1.5 cm/s, p < 0.01). RVSP decrease strongly correlated with S velocity increase (r = 0.95, p < 0.0001). Response to iNO was found only in limited form of SSc; diffuse SSc patients showed no response. Pulmonary fibrosis on HRCT was more frequent in subjects nonreactive to iNO (67% of patients) than in the reactive group (40% of patients). The reactivity of pulmonary circulation to iNO in SSc patients with elevated RVSP was found predominantly in limited form of the disease. Pulmonary fibrosis typical for diffuse SSc was more frequent in nonreactive subjects. Elevated pulmonary pressure plays an important role in RV systolic dysfunction. Pulmonary pressure decrease during iNO test leads to the improvement of RV systolic function. Therapy for right-heart failure in reactive SSc patients should be directed, if possible, at the decrease in pulmonary resistance.

Fresh-wet storage accelerates aortic homograft calcification.

The studies were focused on the influence of the fresh-wet storage procedure on aortic valve homograft (AVH) mineralization. Thirty-four aortic valves excised at autopsy were investigated. The cusps were divided into halves, the first one was used as a control while the second half was stored in Morgan, Morton, and Parker's Medium 199 supplemented with an antibiotic mixture at 4 degrees C for 28 days. The elemental compositions of the samples were determined by the energy dispersive X-ray fluorescence method. The Ca/P ratio and Ca concentration was used as markers of the mineralization development. It was found that the AVH mineralization was accelerated by the applied fresh-wet storage procedure. The aggravation of the AVH mineralization was correlated with the Ca content before storage especially in case of old donors. For donors older than 40 years an increase of Ca concentrations by approximately 40% was observed. To limit AVH mineralization due to fresh-wet storage, age of donors should not exceed approximately 40 years. Another method to reduce AVH mineralization relies on a modification of the medium commonly applied in the fresh-wet storage procedure, and research are ongoing.