The occipital-vertebral anastomosis revisited.

BACKGROUND: The goal of the study was to provide relevant data about the location and prevalence of the occipital artery-vertebral artery (OA-VA) anastomosis in patients without visible occlusive disease, as well as to thoroughly discuss the clinical significance of these anastomotic channels. Furthermore, the morphometric properties of the OA and its branches were also analysed. MATERIALS AND METHODS: A retrospective study was carried out to indicate anatomical variations, their prevalence, and morphometrical data on the OA and its branches. The study was performed on 55 randomly selected computed tomography angiographies (CTA) of the head and neck region. Each CTA result was analysed bilaterally. Thus, 110 results were originally assessed. RESULTS: The OA median maximal diameter was demonstrated at 4.85 mm (lower quartile [LQ]: 4.11; upper quartile [UQ]: 5.53) and the median maximal diameter of VA at 3.60 mm (LQ: 2.79; UQ: 4.38). The distances between OA and its branches were also measured giving a median result of 21.73, 30.29, 60.84, 34.88, 18.02, 55.16 mm for the lower and upper sternocleidomastoid branch, meningeal branch, mastoid branch, and descending branch, respectively. The median distance between OA and its first anastomosis was set to be 51.15 mm (LQ: 37.20; UQ: 60.10). Moreover, a set of additional measurements was carried out in order to create a three-dimensional anatomical heat-map of the occurrence of the OA-VA anastomosis. CONCLUSIONS: Knowledge about the anatomy of the OA-VA anastomosis might be of immense importance to avoid potentially fatal complications during embolisation of the OA and its branches.

The cranio-orbital foramen: a meta-analysis with a review of the literature.

BACKGROUND: The goal of the present study was to provide accurate data on the prevalence and morphometrical aspects of the cranio-orbital foramen (COF), which can surely be of use by surgeons performing procedures on the lateral orbit. Furthermore, the embryology and the clinical significance of this osseous structure were thoroughly discussed. MATERIALS AND METHODS: Major online medical databases such as PubMed, Scopus, Embase, Web of Science, and Google Scholar were searched to find all relevant studies regarding COF. RESULTS: Eventually, a total of 25 studies that matched the required criteria and contained complete and relevant data were included in this meta-analysis. The pooled prevalence of COF was found to be 48.37% (95% confidence interval [CI]: 41.67-55.10%). The occurrence of the COF unilaterally was set to be 71.92% (95% CI: 41.87-96.97%). The occurrence of the COF bilaterally was set at 26.08% (95% CI: 3.03-58.13%). CONCLUSIONS: In conclusion, we believe that this is the most accurate and up-to- -date study regarding the anatomy of the COF. The COF is prevalent in 48.37% of the cases, and it is most frequently unilateral (73.92%). Furthermore, the prevalence of accessory COFs was found to be 16.72%. The presence of these foramina may represent a source of haemorrhage that ophthalmic surgeons should be aware of when performing procedures in the lateral part of the orbit.

Coeliac trunk and its anatomic variations: a cadaveric study.

BACKGROUND: Coeliac trunk (CT) is the first major visceral branch of the abdominal aorta. The aim of this work was to present the CT division pattern and its anatomical variants in a sample of Polish population. MATERIALS AND METHODS: Coeliac trunk dissection was performed in 50 adult cadavers in the Department of Anatomy, Jagiellonian University Medical College. Cadavers of Polish subjects were included. Cadavers with previous upper abdominal surgery, abdominal trauma, disease process that distorted arterial anatomy or signs of putrefaction were excluded. CT variations, accessory vessels, and vertebral level of origin were described. CT patterns were reported according to the Adachi classification. This study was reviewed and approved by the local Ethics Committee. RESULTS: Coeliac trunk consisting of the left gastric, common hepatic and splenic artery (type 1 according to the Adachi classification) was found in 82% of cadavers. The true tripod was found in 20% and the false one in 80%. Additional vessels were also found: greater pancreatic from the splenic artery and left inferior phrenic from the left gastric artery, which accounted for 2% sections. Type 2 according to the Adachi classification (i.e. the hepatosplenic trunk) was found in 16% of the sections. Other types of CT were not observed. The level of origin was found to be at the inter-vertebral disc between T12 and L1 in all of the cases. CONCLUSIONS: Based on the analysis of the sectional material of the Department of Anatomy, it was found that the typical visceral segmental division is approximate to that observed by Adachi in its classification, whereas the second type of CT was twice as frequent and no other, less frequent types were found.

Unusual variations in the branching pattern of the coeliac trunk and their clinical significance.

BACKGROUND: The anatomical variations of the coeliac trunk are due to developmental changes in the ventral segmental arteries. Multidetector computed tomography (MDCT) has been used to investigate vascular anatomy for scientific and diagnostic purposes. These studies allow for much larger sample sizes than traditional cadaveric studies. The aim of this research was to isolate rare anatomical variants of the coeliac trunk and emphasize their clinical significance. MATERIALS AND METHODS: A descriptive, retrospective study was carried out on MDCT angiographies performed from January 2020 till March 2020 in Polish patients. Coeliac trunk was studied and normal and anatomical variations were identified. RESULTS: Out of total 350 patients, hepatogastrosplenic trunk was predominant. However, we observed: coeliaco-mesenteric and hepatogastric trunk type, hepatic artery variations and coeliac axis stenosis with collateral mesenteric circulation. CONCLUSIONS: Rare variations of the coeliac trunk should always be anticipated before radiological and surgical interventions. Knowledge of unusual coeliac trunk anatomy is important in hepatopancreatobiliary surgery, transplantology, and interventional radiology.

Anatomical variants of coeliac trunk in Polish population using multidetector computed tomography angiography.

BACKGROUND: Multidetector computed tomography angiography (MDCTA) has become a major part in evaluation of normal anatomy and its variants in patients undergoing operative or interventional procedures. The purpose of this study was to assess the frequency of anatomical variation of coeliac trunk in patients undergoing MDCTA of the abdominal aorta. MATERIALS AND METHODS: A descriptive, retrospective study was carried out on MDCTAs performed from January 2014 till January 2020 in Polish patients. Coeliac trunk was studied and normal and anatomical variations were noted according to Adachi's classification. All patients with abnormalities affecting the vessels or a history of any vascular abnormality were excluded from the study. RESULTS: Out of total 1000 patients, hepatogastrosplenic trunk was found in 93.0%. True and false types of trifurcation were observed. Hepatosplenic trunk was found in 2.8%, coeliacomesenteric trunk in 1.1%, hepatomesenteric trunk in 1.7% gastrosplenic trunk was found in 1.4%. We have not observed hepatosplenomesenteric trunk. CONCLUSIONS: The type and knowledge of anatomy is of prime importance for an optimum preoperative planning in surgical or radiological procedure. MDCTA allows minimally invasive assessment of arterial anatomy with high quality three-dimensional reconstruction images.

Rare combined variations of the coeliac trunk, accessory hepatic and gastric arteries with co-occurrence of double cystic arteries.

Many variations of the coeliac trunk and hepatic or gallbladder arterial supply have been reported before in many cadaveric and radiologic studies. In this case we present combined anomalies observed in dissected cadaver of a 73-year-old female. The left gastric artery arises directly from the abdominal aorta and gives two branches: the right inferior phrenic artery in the proximal part and the accessory left hepatic artery in the distal part. The coeliac trunk is bifurcated into the common hepatic artery and the splenic artery. The right gastric artery emerges from the left hepatic artery. The right hepatic artery gives two cystic arteries and the accessory right hepatic artery is noticed arising from the posterior superior pancreaticoduodenal artery. The deep cystic artery and the right inferior phrenic artery give hepatic branches. Also, we noticed small accessory biliary duct going to the cystic duct. This complexity of the arterial supply with anomaly of the biliary ducts has many surgical implications which will be herein discussed.

The therapy of Cushing's disease in adults and children: an update.

Cushing's disease (CD) is a rare endocrine disorder resulting from excessive production of adrenocorticotrophin hormone by a pituitary adenoma. The consequent hypercortisolaemia gives rise to characteristic features of the disease and its morbidities. Treatments aim to restore normal cortisol levels, provide long-term control of the disease and the tumour, and the improvement of patient well-being. The first line of treatment remains transsphenoidal surgery with remission rates of 65-90% in CD secondary to a pituitary microadenoma. Second-line treatment includes repeat surgery, radiotherapy, medical therapy, and bilateral adrenalectomy. The success rate of radiotherapy ranges from 46% to 74% and is probably independent of the mode of delivery of the radiation, but may take several years to become effective. Medical therapy is useful in acutely unwell patients or while awaiting radiotherapy to become effective. The most often-used medical agents include metyrapone and ketoconazole, which inhibit steroidogenesis; less often, centrally-acting drugs or a glucocorticoid receptor blocker are used, but experience with them is more limited. Bilateral adrenalectomy remains an important treatment option to control unresponsive severe hypercortisolism, particularly in patients with severe CD.The management of childhood CD does not differ from adult disease, with transsphenoidal surgery as successful as in adults but radiotherapy is more rapid in onset. Regardless of the age of the patient, Cushing's disease remains a challenge to the physician and requires a multidisciplinary approach to achieve the most desirable outcome.

Resonance Raman studies of iron-only hydrogenases.

The nature of the iron-sulfur clusters in oxidized and reduced forms of Fe-only hydrogenases from Desulfovibrio vulgaris, Thermotoga maritima, and Clostridium pasteurianum has been investigated by resonance Raman spectroscopy. The results indicate the presence of ferredoxin-like [4Fe-4S]2+,+ and [2Fe-2S]2+,+ clusters in both T. maritima hydrogenase and C. pasteurianum hydrogenase I, but only [4Fe-4S]2+,+ clusters in D. vulgaris hydrogenase. This necessitates a reevaluation of the iron-sulfur cluster composition of C. pasteurianum hydrogenase I and indicates that the resonance Raman bands in the oxidized hydrogenase that were previously attributed to the hydrogen activating center [Macor, K. A., Czernuszewicz, R. S., Adams, M. W. W., & Spiro, T. G. (1987) J. Biol. Chem. 262, 9945-9947] arise from an indigenous [2Fe-2S]2+ cluster. No resonance Raman bands that could be uniquely attributed to the oxidized or reduced hydrogen activating center were observed. This suggests that the hydrogen activating center is a novel Fe center that is unrelated to any known type of Fe-S cluster.

The extremely thermophilic eubacterium, Thermotoga maritima, contains a novel iron-hydrogenase whose cellular activity is dependent upon tungsten.

Thermotoga maritima is the most thermophilic eubacterium currently known and grows up to 90 degrees C by a fermentative metabolism in which H2, CO2, and organic acids are end products. It was shown that the production of H2 is catalyzed by a single hydrogenase located in the cytoplasm. The addition of tungsten to the growth medium was found to increase both the cellular concentration of the hydrogenase and its in vitro catalytic activity by up to 10-fold, but the purified enzyme did not contain tungsten. It is a homotetramer of Mr 280,000 and contains approximately 20 atoms of Fe and 18 atoms of acid-labile sulfide/monomer. Other transition metals, including nickel (and also selenium), were present in only trace amounts (less than 0.1 atoms/monomer). The hydrogenase was unstable at both 4 and 23 degrees C, even under anaerobic conditions, but no activity was lost in anaerobic buffer containing glycerol and dithiothreitol. Under these conditions the enzyme was also quite thermostable (t50% approximately 1 h at 90 degrees C) but extremely sensitive to irreversible inactivation by O2 (t50% approximately 10 s in air). The optimum pH ranges for H2 evolution and H2 oxidation were 8.6-9.5 and greater than or equal to 10.4, respectively, and the optimum temperature for catalytic activity was above 95 degrees C. In contrast to mesophilic Fe hydrogenases, the T. maritima enzyme had very low H2 evolution activity, did not use T. maritima ferredoxin as an electron donor for H2 evolution, was inhibited by acetylene but not by nitrite, and exhibited EPR signals typical of [2Fe-2S]1+ clusters. Moreover, the oxidized enzyme did not exhibit the rhombic EPR signal that is characteristic of the catalytic iron-sulfur cluster of mesophilic Fe hydrogenases. These data suggest that T. maritima hydrogenase has a different FeS site and/or mechanism for catalyzing H2 production. The potential role of tungsten in regulating the activity of this enzyme is discussed.

[Evaluation of biological availability and anti-arrhythmic effect of a new drug Phenytoinum "Polfa"]. / Ocena dostepnosci biologicznej i dzialania przeciwarytmicznego nowego preparatu Phenytoinum "Polfa".

Studies were performed in 15 patients with ventricular arrhythmia. During the first day, the patients received 1000 mg of a new micronised form of Phenytoinum "Polfa" or adequate dose of a foreign drug in 3 doses every 3 hours and subsequently during 10 days alternatively native or foreign drug in a daily dose 300 mg. Twenty-four EKG Holter monitoring and determination of serum drug level were carried out after a 10-day treatment; area under the curve (AUC) in one 8 h dose interval was determined. Studies have shown usefulness of a new form of Phenytoinum (Polfa). Blood serum drug levels near to the therapeutic ones were observed. Steady-state Phenytoinum concentration was 11.1 +/- 5.9 micrograms/ml and after foreign drug it was 11.7 +/- 6.1 micrograms/ml, AUC0-8 was 90.4 and 105.3 micrograms/ml/h respectively. In 9/15 patients (60%) Phenytoinum (Polfa) produced substantial improvement in the cardiac arrhythmia.