A Systematic Review of Single-Layer Versus Double-Layer Intestinal Anastomosis: Is One Better?

INTRODUCTION: To perform a systematic review of randomized controlled trials comparing outcomes from handsewn single-layer and double-layer intestinal anastomosis in adults. METHODS: A literature search was conducted using PubMed, SCOPUS, and Web of Science databases for studies published up to September 14, 2023 using the following keyword search query: ((one) OR (single)) AND ((two) OR (double)) AND (layer) AND ((anastomoses) OR (anastomosis)). RESULTS: In seven of the eight studies, there was no significant difference in anastomotic leakage rate. In one of the eight studies, Moeen et al., double-layer anastomosis was associated with a significantly higher anastomotic leakage rate than single-layer anastomosis (5/100 versus 15/100, P = 0.018). Time to complete single-layer anastomosis was shorter than double-layer anastomosis. CONCLUSIONS: Single-layer and double-layer intestinal anastomosis have similar rates of anastomotic leak, mortality, and hospital stay in adults, with single-layer intestinal anastomosis having the benefit of shorter time to complete.

Prevalence and anatomical characteristics of developmental venous anomalies: an MRI study.

PURPOSE: Developmental venous anomalies (DVAs) are extreme anatomical venous variations formed by multiple radiating medullary veins, which converge centripetally into a single collecting vein. Their coexistence with symptomatic cavernous malformations (CMs) has been reported in the literature. The aim of this study was to assess the characteristics of DVAs using MRI. METHODS: A total of 6948 head MRIs of adult Caucasian patients were retrospectively analyzed to determine the number and locations of DVAs. We collected the data on the termination of the collecting vein, the prevalence of DVA-related CMs, and MRI FLAIR signal-hyperintensity corresponding to the location of the DVA. RESULTS: At least one DVA was identified in 7.46% of the patients. The prevalence decreased with age, with a Pearson correlation coefficient of - 0.7328. A total of 599 DVAs were identified. Multiple DVAs were found in 10.92% of the patients with DVAs. The DVAs were identified more often in the supratentorial region (73.12%, p < 0.0001), and the most common location was the frontal lobe (35.23%). The collecting vein usually drained into the superficial cerebral veins (68.78%). CMs were observed in 4.14% of the patients with DVAs, and the prevalence showed a positive correlation with age. Signal-intensity abnormalities were identified in the vicinity of 5.18% DVAs. CONCLUSION: Knowledge about characteristics of DVAs and associated anomalies is essential for neuroradiologists and neurosurgeons. The large number of currently available diagnostic studies enables us to assess anatomical variants on a great number of subjects.

Printable 3D model of the sella turcica region including the interclinoid bridge.

The objective of the study was to create a printable 3D model of the sellar region of the sphenoid bone for demonstrating anatomical variant of the osseous bridging between anterior and posterior clinoid processes. Three-dimensional reconstruction of the middle cranial fossa along with 3D printed model, allow for accurate depicting position of the interclinoid bridge with reference to other basicranial structures.

Rediscovered identity of the scaphocephalic skull housed in the museum of the Department of Anatomy of the Medical College of the Jagiellonian University.

A personal data referring to the scaphoid skull housed in the Department of Anatomy of the Jagiellonian University, Medical College was established thanks to reviewing 19th century literature performed by Dr. Soficaru. We received information that the skull had belonged to an adult man who was a carpenter, born at Cracow. The original anthropometrical study of this skull was performed by prof. Kopernicki 19th century.

Appendicitis in the Neutropenic Patient: A Systematic Review.

Neutropenia increases the complexity of surgical decision-making in cases of acute appendicitis. In this systematic review, we discuss medical vs surgical management and timing of appendectomy in the neutropenic adult patient. We queried databases utilizing the key words "neutropenia" and "appendicitis." The search identified 999 articles of which 481 articles were reviewed after duplicates were removed. Studies with pediatric patients, single case studies, and abdominal pain in neutropenic patients not caused by appendicitis were excluded. Seven studies remained in this review accounting for 130 patients, of which 28 were diagnosed with neutropenic appendicitis, and were included for final analysis. Four of the 7 articles were case reports, demonstrating the relative paucity of literature on this subject. Studies referred to the high risk of morbidity and mortality after surgical intervention in the neutropenic population, and attempting medical management first was common but not universal, reserving appendectomy for failure of medical management. Three studies suggested medical therapy as first-line management while 2 studies suggested surgical management and 2 studies did not distinguish a precedence. Both medical and surgical management have been successfully used in treating appendicitis in neutropenic patients. In most patients, medical management was attempted first (n = 16/28) vs immediate appendectomy (n = 7/28). Appendectomy was performed when medical management failed (n = 2/28) or after correction of neutropenia (n = 1/28). Timing or performance of appendectomy was unclear in 2 patients. With the increasing use of immunosuppressive medications, broad-spectrum antibiotics, and recent data from the CODA (Comparison of Outcomes of Antibiotic Drugs and Appendectomy) trial, medical management as a first-line treatment for most patients with neutropenia and appendicitis is warranted, and identifying a protocol for such patients would be of value.

The Anatomy of the Convergence of Major Deep Cerebral Veins in the Pineal Region: A Computed Tomography Angiography Study.

BACKGROUND: The anatomy of the veins in the pineal region is one of the most complex areas in the brain because all major deep cerebral veins converge there: the internal cerebral veins (ICVs), the great cerebral vein of Galen (GV), the basal veins (BVs), and the internal occipital veins (IOVs). The aim of this study was to comprehensively describe the anatomy of the veins in the pineal region using computed tomography angiography. METHODS: Head computed tomography angiography scans of 250 adult Polish patients were evaluated. We assessed the location of the junction of 2 ICVs and the presence of a narrowing of the GV and arachnoid granulation at the GV-straight sinus junction. We evaluated the presence, appearance, and termination of the BV, and the presence and termination of the IOV. RESULTS: The study showed that 2 ICVs usually converged posterior to the splenium of the corpus callosum (62.4%). Narrowing of the BV was observed in 51.2% of patients, and the arachnoid granulation was found in 25.2%. The 3 segments of the BV were well visualized in 66% of the studied hemispheres. The BV flowed into the GV in 34.8% of the hemispheres. The IOV was present in 90.2% of the hemispheres and terminated medially in 84.5%. CONCLUSIONS: Because an injury to major deep cerebral veins may result in severe postoperative neurologic deficits, it is essential for neurosurgeons to be familiar with both normal and variant patterns of veins in the pineal region.

Adapting to dynamic stimulus-response values: differential contributions of inferior frontal, dorsomedial, and dorsolateral regions of prefrontal cortex to decision making.

Dorsomedial prefrontal cortex (dmPFC), dorsolateral prefrontal cortex (dlPFC), and inferior frontal gyrus (IFG) have all been implicated in resolving decision conflict whether this conflict is generated by having to select between responses of similar value or by making selections following a reversal in reinforcement contingencies. However, work distinguishing their individual functional contributions remains preliminary. We used functional magnetic resonance imaging to delineate the functional role of these systems with regard to both forms of decision conflict. Within dmPFC and dlPFC, blood oxygen level-dependent responses increased in response to decision conflict regardless of whether the conflict occurred in the context of a reduction in the difference in relative value between objects, or an error following a reversal of reinforcement contingencies. Conjunction analysis confirmed that overlapping regions of dmPFC and dlPFC were activated by both forms of decision conflict. Unlike these regions, however, activity in IFG was not modulated by reductions in the relative value of available options. Moreover, although all three regions of prefrontal cortex showed enhanced activity to reversal errors, only dmPFC and dlPFC were also modulated by the magnitude of value change during the reversal. These data are interpreted with reference to models of dmPFC, dlPFC, and IFG functioning.