Investigação ex vivo do diâmetro anatômico do canal mesiopalatino de primeiros molares superiores humanos / Ex vivo investigation of the anatomical diameter of the mesiopalatal canal of human maxillary first molars

Objetivou-se investigar ex vivo o diâmetro anatômico e conicidade do canal mesiopalatino de primeiros molares superiores. Para tanto, trinta e três primeiros molares superiores humanos foram acessados, explorados para confirmação da existência do canal mesiopalatino, identificados, suas raízes mesiovestibulares seccionadas transversalmente em três níveis e, então, os fragmentos foram fotografados com microscópio digital, que permitiu a realização das determinações dos diâmetros anatômicos deste canal em cada amostra. Os resultados foram calculados em função dos valores médios e de desvio padrão dos diâmetros em cada nível, obtendo-se respectivamente 0,20 mm e ±0,09 mm (nível cervical), 0,20 mm e ±0,08 mm (nível médio) e 0,17 mm e ±0,06 mm (nível apical). Nas condições deste estudo, de acordo com caráter atrésico e baixa conicidade do conduto mesiopalatino, sugere-se a necessidade de uso de instrumentos de diâmetro de ponta mínimo de 0,25 mm e conicidade 0,03 para o seu preparo.

The aim was to investigate ex vivo the anatomical diameter and taper of the mesiopalatine canal of maxillary first molars. To this end, thirty-three human maxillary first molars were accessed, explored to confirm the existence of the mesiopalatine canal, identified, their mesiobuccal roots transversely sectioned at three levels and then the fragments were photographed using a digital microscope, which allowed the anatomical diameters of this canal to be determined in each sample. The results were calculated according to the mean and standard deviation values of the diameters at each level, obtaining 0.20 mm and ±0.09 mm (cervical level), 0.20 mm and ±0.08 mm (middle level) and 0.17 mm and ±0.06 mm (apical level) respectively. Under the conditions of this study, given the atresic nature and low taper of the mesiopalatine canal, it is suggested that instruments with a minimum tip diameter of 0.25 mm and a taper of 0.03 should be used for its preparation.

Para-articular and intra-articular soft tissue lesions: Radiologic-pathologic correlation.

Articular masses comprise various disease entities including benign or malignant proliferative processes and other non-neoplastic processes such as infection, deposition diseases, vascular malformations, and other lesions. Many diseases that lead to intra-articular or para-articular masses have distinct imaging features, particularly on MRI. Radiologists can localize masses to the joint space by knowing the articular anatomy and can reach a suggested diagnosis by looking at precise imaging findings. In this review article, we first define the concept of articular space (intraarticular, para-articular) and the normal joint anatomy and histology. We provide a general and comprehensive approach for evaluation of articular lesions on MRI. We then describe specific imaging and histologic features of typical benign and malignant soft tissue articular neoplasms and some non-neoplastic mimickers; and provide a radio-pathologic correlation of the different described entities.

Developmental histology of the liver in the Balkan crested newt Triturus ivanbureschi (Caudata: Salamandridae).

The liver, a crucial organ for metabolic processes, has a generally uniform histological structure across amphibian taxa. However, ontogenetic changes, particularly those related to biphasic life cycle and metamorphosis, are less documented. Here, we explored and described the liver histology of an emerging model organism, the Balkan crested newt (Triturus ivanbureschi) at three ontogenetic stages: larval, juvenile (just after metamorphosis) and adult. At the larval stage, the liver is characterized by hepatocytes containing large lipid droplets, poorly developed basement membranes in the blood vessels, and a lack of melanin-rich macrophage centers. Juveniles show transitional characteristics between larvae and adults. Lipid droplets in hepatocytes are abundant, but also, at the juvenile stage the well-developed basement membrane of blood vessels and melanomacrophages are present, as in adults. The presence of lipid droplets in hepatocytes during larval and juvenile stages suggests the liver's role in fat storage and energy provision during development and growth. Melanomacrophages, which synthesize melanin, perform phagocytosis, and neutralize free radicals, have been found in juveniles (after metamorphosis) and increase with age. The biphasic life cycle and liver histology transition in Triturus newts provide an insight in changes in liver histology and make them a suitable model for studying fat deposition regulation and the evolution of the immune system in terrestrial vertebrates.

Long-term surgical outcomes and prognostic factors for advanced-stage retinopathy of prematurity after vitrectomy.

BACKGROUND/AIMS: The aims of this study is to evaluate the anatomic, visual outcomes and associated prognostic factors in patients with advanced retinopathy of prematurity (ROP) following vitrectomy. METHODS: A retrospective cohort study of patients with ROP who underwent vitrectomy from 2005 to 2016 was conducted. All the patients had a follow-up period of at least 5 years. Univariate and multivariable logistic regression analyses were used to explore the factors related to unfavourable outcomes. RESULTS: In total, 81 eyes of 51 patients were included. The mean age at last follow-up was 10.2 years. The anatomic success rate was 96.3% (26/27) for stage 4A, 90.9% (20/22) for stage 4B and 31.3% (10/32) for stage 5 ROP (p<0.01). The mean logMAR best corrected visual acuity of the stage-4A eyes was the highest, followed by those of stage-4B and stage-5 eyes (0.8, 1.5 and 2.6 for stages 4A, 4B and 5, respectively; p<0.01). High myopia (≤ -5.0 D) was noted in 70.8% and 71.4% of stage-4A and stage-4B eyes, respectively. Cataract was the most common complication (25.9%), followed by corneal opacity (17.3%), strabismus (16.1%), and phthisis (16.1%). Stage of the disease was a poor prognostic factor in all vitrectomised eyes (p<0.01). Vitrectomy combined lensectomy was a significant predictor for poor anatomic outcomes for stage-4 eyes (p=0.03). Presence of plus disease was also a possible factor affecting the surgical outcomes. CONCLUSION: The long-term surgical outcomes of the eyes with stage 4A and 4B ROP were favourable. Management of stage 5 ROP remained challenging.

Lymph nodes in oral squamous cell carcinoma: a comprehensive anatomical perspective.

Oral squamous cell carcinoma (OSCC) often exhibits a propensity for metastasis to lymph nodes (LNs), significantly influencing prognosis. Neck dissection (ND) is an important part in the treatment of OSCC. Variations in the preference for and pathways of lymph node metastasis (LNM) in different regions of the oral cavity have been observed. Currently, there is a lack of sufficient emphasis on the anatomical perspectives of LNM and ND. This review elucidates the lymphatic system of the maxillofacial regions from an anatomical standpoint, details the distribution of the sentinel LNs across different subsites, and summarizes the various classifications of the cervical LNs. Additionally, we elaborate on the methods used to study the lymphatic system, particularly imaging techniques. Furthermore, we investigate the pathways of cervical LNM and evaluate the efficacy of ND from an anatomical viewpoint. The overall objective of this review is to provide essential anatomical knowledge for managing LNs in OSCC, in the hope of providing patients with effective treatment modalities to enhance their quality of life.

Morphological characteristics of talocalcaneal coalitions: Anatomical observation, finite element analysis and clinical application.

BACKGROUND: The intricate anatomical structure of talocalcaneal coalitions (TCCs) presents significant challenges for clinicians in both diagnosis and treatment. This study aimed to investigate the anatomy, imaging characteristics, and biomechanical properties of TCCs, providing essential references for contemporary clinical diagnosis, treatment, scientific research, and education regarding TCCs. METHODS: The morphologies of TCCs were examined and classified in intact dry osseous specimens from 131 Asian adults. The imaging characteristics of TCCs were summarized by carefully observing the X-rays and CT scans. Additionally, finite element models of TCCs were established and validated, allowing for the simulation and analysis of stress and strain. RESULTS: The TCCs were primarily located in the region between the posterior end of sustentaculum tali (ST), the medial port of the tarsal canal, and the medial edge of the posterior talar articular surface (PTF). In comparison to specimens with cartilage and ligament connections, the medial tubercle of osseous connections exhibited significant inward and downward protrusion, while the ST was longer and thicker. Statistically significant differences were noted in the widths of the calcaneus and talus, as well as in the thickness and length of the ST (P < 0.05). CT imaging provided an accurate determination of TCCs' locations, while X-rays revealed the presence of the "C sign" and "duck beak sign" in all osseous connection specimens. Finite element model analysis indicated that stress was primarily concentrated at the osseous connection, which also reduced displacement of the subtalar joint. CONCLUSIONS: The comprehension of the precise location, anatomical morphological characteristics, imaging features and finite element mechanical properties of TCCs is instrumental in enhancing the diagnosis and treatment of TCCs.

A cephalometric study on Le Fort â ¢ osteotomy related anatomical features of anterior cranial base in syndromic craniosynostosis.

PURPOSE: This study aims to investigate the anatomical features relating to nasofrontal and septum osteotomy during Le Fort Ⅲ osteotomy among patients with syndromic craniosynostosis, and to compare them with normal controls using computed tomographic cephalometry. MATERIALS AND METHODS: A total of 63 subjects were included (syndromic craniosynostosis, n = 21; controls, n = 42). The craniosynostosis subjects were subdivided into group A (craniosynostosis patients without history of previous surgery, n = 8) and group B (craniosynostosis patients with history of previous surgery, n = 13). Cephalometric measurements based on computed tomographic images were analyzed. RESULTS: The angle between the refencing plane (HP) of the anterior cranial base and the most inferior point of the sphenoid sinus via Nasion (∠HP-N-ISS) was 23.85 ± 3.10°, 21.15 ± 4.64° and 28.32 ± 2.92° for group A, group B and the control group, respectively. The angle between HP and the posterior nasal spine (PNS) via nasion (∠HP- N- PNS) was 42.63 ± 2.02°, 38.50 ± 4.84° and 47.68 ± 2.62° for group A, group B and the control group, respectively. CONCLUSION: This study characterized the surgically relevant anatomical features in nasofrontal osteotomy during Le Fort Ⅲ osteotomy. The safe range for osteotomy angle is significantly different between normal and syndromic craniosynostosis subjects. Awareness of this difference may prevent further complications.

Intra-operative Measurement of Eustachian Tube Orifice, and Its Correlation With Post-operative Surgical Outcome in Chronic Suppurative Otitis Media Patients.

Background Chronic suppurative otitis media (CSOM) is the inflammation of the middle ear mucosa for more than two weeks, resulting in ear discharge. It is associated with hearing loss and the presence of a perforation in the tympanic membrane. Tympanoplasty is performed to place a graft and clear the disease in the middle ear. Despite adequate disease clearance and proper graft placement, graft failure and disease persistence occur due to Eustachian tube (ET) dysfunction. The ET plays a significant role in the ventilation of the middle ear. Hence, this study was conducted to determine the significance of ET size for post-operative graft uptake. Methodology A total of 55 patients with inactive CSOM were included in the study. Their demographic data were recorded. Patients previously operated on for CSOM, cases with traumatic perforation of the tympanic membrane, congenital anomalies (e.g., cleft lip/cleft palate), and atticoantral disease were excluded. Thorough history taking and examination, including otoscopy and examination of the nose, throat, and oropharynx, were conducted. Once the patient was deemed fit for surgery, they underwent tympanoplasty. Intraoperatively, the ET size was measured using the tip of the suction cannulas. They were followed up after three months to assess graft uptake. Results Out of 55 patients included in the study, 42 (76%) had good graft uptake, while 13 (24%) had defects in graft uptake. Graft uptake failed in patients with an ET diameter of <3 mm. Post-operative graft uptake was observed in the majority of patients with a wider ET diameter, ranging between 3 mm and 6 mm, with a statistically significant p-value of 0.00 (0.05), as determined by Pearson's Chi-square test. Conclusion In our study, we found that there is an association between the ET diameter and post-operative graft uptake. Hence, a wider ET may improve middle ear ventilation and play an important role in post-operative graft uptake.

Cadaveric study of the ultrasound-guided inter-transversospinalis plane block in dogs for the cervical epaxial musculature region.

Blockage of the dorsal rami of the spinal nerves (DRSN) provides analgesia to the epaxial musculature area in dogs. However, techniques to block the DRSN at the cervical level in dogs haven't yet been investigated. This study aimed to study the anatomy of the cervical area, and to describe a new ultrasound (US)-guided inter-transversospinalis plane (ITP) block technique at the 5th cervical vertebrae (C5). Fourteen adult canine's cadavers were used in this blinded, cadaveric, experimental study. One cadaver for cryo-section, one for anatomical research and twelve to do an ITP injection using 0.3 mL/kg (HV) or 0.15 mL/kg (LV) of dye/contrast solution in each lateral at C5, followed by a computed tomography and anatomical dissection. The HV and LV groups stained a median (range) of 4.67 (3-6) and 3.67 (2-5) DRSN into the ITP, respectively (P<0.017). Stained DRSN in the splenius plane were found in nine (75%) HV and five (41.66%) LV injections, respectively. Spread in the epidural space was found in two dogs using LV. One of them was injected into the ITP (4.33 %) while the other one was done accidentally outside of this plane. The paravertebral spread was found in one injection of each group. There was no dye of the ventral rami of the spinal nerves. The US-guided ITP injection is feasible in dog cadavers. The LV injected just after the medial surface of the semispinalis capitis muscle is recommended to avoid a possible extensive epidural spread.

Exploring the Branching Pattern of the Posterior Division of the Internal Iliac Artery: An Analysis Based on 75 Computed Tomography Angiographies.

INTRODUCTION AND HYPOTHESIS: The internal iliac artery stands as the main blood supplier of the pelvis, serving as the primary source of blood for the pelvic viscera while also nourishing the musculoskeletal framework within. The arterial anatomy of the pelvis exhibits a vast array of variations, especially regarding the branching pattern of the internal iliac arteries. The posterior division of the internal iliac artery (PDIIA) may also have variable topography, especially regarding the location of its origin in the pelvic region. METHODS: A retrospective study was carried out to determine the anatomical variations, prevalence, and morphometric data of the PDIIA and its branches. A total of 75 computed tomography angiographies were analyzed. RESULTS: The most prevalent branch of the PDIIA was the superior gluteal artery, as it was present in 114 of the studied cases (77.03%). The median diameter of the PDIIA at its origin was 6.66 mm. The median cross-sectional area of the PDIIA at its origin was set to be 34.59 mm2. CONCLUSION: Our study highlights the critical significance of understanding the PDIIA and its branches in surgical interventions aimed at managing pelvic hemorrhage. The present study provides valuable insights into the precise localization and characteristics of the PDIIA and its branches, which are essential for surgical procedures targeting specific vessels to control bleeding effectively. Owing to the high level of variability of the branching pattern of the PDIIA, a novel classification system consisting of six types was created.

Preoperative evaluation of the segmental artery of left upper lobe by thin-section CT and 3d-CTA.

PURPOSE: Understanding pulmonary artery (PA) branches and their variations is crucial for successful lung resection. We aimed to evaluate the segmental PA branching pattern of the left upper lobe (LUL) using thin-section computed tomography (TSCT) images and 3D-CT angiography (3D-CTA). MATERIALS AND METHODS: This study included 108 patients who underwent CTA and left upper lobectomy. The segmental PA branching pattern of the LUL was meticulously identified by two thoracic radiologists using 3D-CTA and TSCT images. The lingular artery branches from the left PA (LPA) were classified into mediastinal type (pars mediastinalis: PM), interlobar type (pars interlobaris: PI), and PI originating from the lower portion (PI'), specifically from A8. The intraoperative findings of the PA branches of the LUL were compared with the preoperatively obtained 3D-CTA and TSCT images in each patient's case. RESULTS: The median (range) number of LPA branches of the LUL was 4.36 (3-8). The most common number of A1 + 2 branches was two, seen in 34 cases (31.5%). One or more branches of A1 + 2c directly originating from the LPA were found in 63 cases (58.3%). The number of branches of A3 was single in 85 cases and the most frequent (78.7%). Instances where one or more branches of A3a directly originated from the LPA were found in seven cases (6.5%). A1 + 2 and A3 origins were separate and independent in 40 cases (37.0%). As the branching pattern of the lingular artery, PI/PI' was most frequent (61.1%). PI´ was observed in 26 cases (24.1%). Inter-observer agreement for A1 + 2, A1 + 2c, A3, A3a, and lingular artery branching patterns was moderate to substantial (κ = 0.53-0.72). Preoperative 3D-CTA and TSCT images identified 99.8% of LPA branches compared to intraoperative findings, except one. CONCLUSION: The segmental PA branching pattern of the LUL can be evaluated using TSCT and 3D-CTA images, providing precise preoperative information.

Assessing anatomical variations of the superior mesenteric artery via three-dimensional CT angiography and laparoscopic right hemicolectomy: a retrospective observational study.

OBJECTIVE: This study aimed to analyse the anatomical relationships and differences between the superior mesenteric vessels and their branches by reviewing a laparoscopic right hemicolectomy surgery video and comparing it with preoperative three-dimensional computed tomography (3D-CT) angiography and to verify the accuracy of 3D-CT vascular reconstruction techniques. METHODS: Surgical videos and preoperative imaging data of 52 patients undergoing laparoscopic right hemicolectomy were analysed to observe and summarize the probability of occurrence and adjacency of superior mesenteric vascular branches, and the lengths of specific sites of their branches were measured using the above two methods. RESULTS: Preoperative CT images and surgical video showed that the ileocolic artery (ICA) was present in 98.1% (51/52) and the ileocolic vein (ICV) was present in 100% (52/52), and ICA was present in 13.7% (7/51) of the ICV directly anteriorly, 13.7% (7/51) anteriorly superiorly, 3.9% (2/51) anteriorly inferiorly, 11.8% (6/51) directly posteriorly, 37.2% (19/51) post superiorly, and 19.7% (10/51) posteriorly inferiorly. In the surgical video, the probability of presence of the right colic artery (RCA) was 21.2% (11/52). On CT images, the RCA was present in 10 patients. The length of the origin of the middle colic artery (MCA) from its bifurcations was 2.33 ± 0.87 cm measured intraoperatively using a sterile isometric filament, and the length measured using 3D-CT vascular reconstruction was 2.36 ± 0.91 cm; the difference was not statistically significant (P = 0.348). The length of the MCA and ICA initiation points was 3.22 ± 0.75 cm measured intraoperatively using sterile isometric filaments and 3.36 ± 0.72 cm measured using 3D-CT vascular reconstruction, which was a statistically significant difference (P < 0.001). CONCLUSIONS: 3D-CT vascular reconstruction can accurately predict the vessels related to right hemicolectomy in most cases. It is an important method for preoperative prediction of superior mesenteric vessels, which can guide surgeons in the intraoperative vessel identification.

Triphallia: the first cadaveric description of internal penile triplication: a case report.

INTRODUCTION: Triphallia, a rare congenital anomaly describing the presence of three distinct penile shafts, has been reported only once in the literature. This case report, based on an extensive literature review, describes the serendipitous discovery during cadaveric dissection of the second reported human case of triphallia, distinctly morphologically different from the previous case. CASE PRESENTATION: Despite the normal appearance of external genitalia on examination, the dissection of a 78-year-old white male revealed a remarkable anatomical variation: two small supernumerary penises stacked in a sagittal orientation posteroinferiorly to the primary penis. Each penile shaft displayed its own corpora cavernosa and glans penis. The primary penis and largest and most superficial of the supernumerary penises shared a single urethra, which coursed through the secondary penis prior to its passage through the primary penis. A urethra-like structure was absent from the smallest supernumerary penis. CONCLUSION: This case report provides a comprehensive description of the anatomical features of triphallia in a cadaver, shedding light on the morphology, embryology, and clinical implications of this anomaly. Without dissection, this anatomical variation would have remained undiscovered, suggesting the prevalence of polyphallia may be greater than expected. The single tortuous urethra present in this case, as well as the supernumerary and blind ending urethras present in many cases of penile duplication, may pose significant risk of infection, sexual dysfunction, subfertility, and traumatic catheterization. SIGNIFICANCE: These findings underscore the importance of meticulous anatomical dissections and may act as a resource for anatomists and those studying genitourinary anomalies. Although we can only speculate as to which functional implications this patient may have experienced, understanding such anatomical variations contributes to both knowledge of human anatomy and clinical management should the condition be encountered in living individuals.

SKYQUANT 3D: Quantifying Vascular Anatomy With an Open-Source Workflow for Comprehensive Analysis of Volumetric Optoacoustic Angiography Data.

Efficient visualization of the vascular system is of key importance in biomedical research into tumor angiogenesis, cerebrovascular alterations, and other angiopathies. Optoacoustic (OA) angiography offers a promising solution combining molecular optical contrast with high resolution and deep penetration of ultrasound. However, its hybrid nature implies complex data collection and processing workflows, with significant variability in methodologies across developers and users. To streamline interoperability, we introduce SKYQUANT 3D, a Python-based set of instructions for the Thermo Fisher Scientific Amira/Avizo 3D Visualization & Analysis Software. Our workflow simplifies the batch processing of volumetric optoacoustic angiography images, extracting meaningful quantitative information while also providing statistical analysis and graphical representation of the results. Quantification performance of SKYQUANT 3D is demonstrated using functional preclinical and clinical in vivo 3D OA angiographic tests involving ambient temperature variations and repositioning of the imaged limb.

Surgical anatomy of the cystic artery: A systematic review with meta-analysis.

BACKGROUND: The current evidence-based systematic review with meta-analysis presents a detailed overview of the cystic artery (CA) surgical anatomy, including its origin, number, topography, and morphometry. Moreover, the surgical implications of these variants are further discussed. METHODS: According to the Evidence-Based Anatomy Workgroup and PRISMA 2020 guidelines, the systematic review was performed using four online databases. The Anatomical Quality Assurance Tool was used to evaluate the risk of bias. Meta-analysis was performed with the R programming software. The pooled prevalence and pooled mean of different CA parameters were calculated. RESULTS: The CA most commonly originated from the right hepatic artery (a pooled prevalence of 85.75 %). Other described origins (in order of frequency) were the aberrant right hepatic artery, the common hepatic, the left hepatic, the gastroduodenal, the superior mesenteric, and the middle hepatic arteries. The CA was single in 88.59 %, while it can be identified as double, triple, or absent. Most commonly, it was located inside the cystohepatic triangle in 83.83 %. Most commonly, it was superomedially to the cystic duct (77.80 %) and posteriorly to the common hepatic duct (35.08 %). The CA pooled mean length was 21.34 mm, and its diameter was more commonly over 1 mm. CONCLUSION: The CA surgical anatomy is paramount when operating on the gallbladder. The CA's altered anatomy and adjacent area could lead to confusion, iatrogenic injury, and prolonged surgical time. The CA depicts high morphological variability; therefore, surgeons should consider the typical anatomy and possible (usual and unusual) variants.

Clinical Feasibility of Vascular Navigation System During Laparoscopic Gastrectomy for Gastric Cancer: A Retrospective Comparison With Propensity-Score Matching.

PURPOSE: The usability of a new surgical navigation system that provides patient-specific vascular information for robotic gastrectomy in gastric cancer remains unexplored for laparoscopic gastrectomy owing to differences in surgical environments. This study aimed to evaluate the applicability and safety of this navigation system in laparoscopic gastrectomy and to compare the post-operative outcomes between procedures with and without its use. MATERIALS AND METHODS: Between June 2022 and July 2023, 38 patients across 2 institutions underwent laparoscopic gastrectomy using a navigation system (navigation group). The technical feasibility, safety, and accuracy of detecting variations in vascular anatomy were measured. The perioperative outcomes were compared with 114 patients who underwent laparoscopic gastrectomy without a navigation system (non-navigation group) using 1:3 propensity score matching during the same study period. RESULTS: In all patients in the navigation group, no adverse events associated with the navigation system occurred during surgery in any patient in the navigation group. No accidental vessel injuries necessitate auxiliary procedures. All vessels encountered during the gastrectomy were successfully reconstructed and visualized. Patient demographics and operative data were comparable between the 2 groups. The navigation group exhibited a significantly lower overall complication rate (10.5%) than the non-navigation group (26.3%, P=0.043). Notably, pancreas-related complications were absent in the navigation group but occurred in eight cases in the non-navigation group (7.0%, P=0.093), although the difference was not statistically significant. CONCLUSIONS: The patient-specific surgical navigation system demonstrated clinical feasibility and safety for laparoscopic gastrectomy for gastric cancer, potentially reducing complication rates compared with laparoscopic gastrectomy without its use.

Ophthalmic artery originating from anterior inferior cerebellar artery: a rare variation.

PURPOSE: The variations of origin of ophthalmic artery are extremely rare. Here, we aimed to present a patient had a rare variation of the ophthalmic artery. CLINICAL PRESENTATION: The patient had a history of Moyamoya disease. The imaging studies revealed ophthalmic artery origination from basillar artery. In addition, M1-segment fusiform aneurysm, vasculitis and, as a variation, middle meningeal artery originating from the ophthalmic artery were also detected. We presented this case report as it is the first case with ophthalmic artery originating from anterior inferior cerebellar artery. CONCLUSION: In our case we reported, M1 segment fusiform aneurysm, vasculitis, and as a variation, middle meningeal artery originating from the ophthalmic artery and anterior inferior cerebellar artery as ophthalmic artery origin and hereby present it for inclusion into the literature. Ophthalmic artery anatomical abnormalities occupies so little place in existing literature when nominating rare variations. Ophtalmic artery originating from anterior inferior cerebellar artery firstly defined as an ophthalmic artery variation including its way-out branch structures.

The role of anatomical and functional orientation in identification of parathyroid glands for patients with parathyroidectomy.

Objective: To investigate diagnostic approaches for preoperative localization of secondary hyperparathyroidism, as well as to give surgeons with precise parathyroid gland localization and imaging so that surgery can be performed safely. Methods: The clinical data of 710 patients with secondary hyperparathyroidism who underwent surgery in our center from October 2009 to October 2023 were retrospectively analyzed. The changes in calcium, phosphorus, and parathyroid hormone levels were observed to ascertain the anatomical location and number of parathyroid glands. Results: Among the 710 patients, 55 underwent total parathyroidectomy, the others underwent total parathyroidectomy with autotransplantation. In total, 2,658 parathyroid glands were removed, with 43 glands being removed in 35 reoperation cases. The median parathyroid hormone level at 6 months postoperatively was 13.40 (interquartile range, 7.00-29.80) pg/mL. The detection rates of the parathyroid glands before first and repeat surgeries were higher using 99mTc-MIBI SPECT/CT fusion imaging than ultrasound (P<0.05). The sensitivity of combined preoperative 99mTc-MIBI SPECT/CT and ultrasound was 92.31%, higher than that of either 99mTc-MIBI SPECT/CT fusion imaging or ultrasound alone (P < 0.05). The incidence of ectopic parathyroid glands was 23.8%, and the incidence of ectopic left lower parathyroid glands was 13.2%. The left lower parathyroid gland was the most prone to ectopia. Conclusion: 99mTc-MIBI SPECT/CT fusion imaging, paired with high-frequency ultrasound, can be utilized to diagnose SHPT preoperatively. The most common ectopia site is the left lower parathyroid gland, which is located primarily in the thymus and superior mediastinum. Understanding the functional anatomical distribution of the parathyroid glands is critical for developing effective surgical methods for secondary hyperparathyroidism.

A long gestation: spine anatomy from the medieval age to the end of the 19th century. An analytical historical review.

The discovery of spine anatomy followed a problem/solution pattern; it took almost 1000 years to transition from nihilism to perfectionism. Before the 16th century, the main issue was accessing and opening the spine. The level of knowledge progressed rapidly when the spinal canal was opened longitudinally during the 16th century. The 17th century was an incubation period that allowed the consolidation of the science of anatomy with the help of art, philosophy, and other sciences. In particular, the conservation of the cadaver was improved. Famous spine anatomists were close to Rembrandt, master of the chiaroscuro technique, which helped to improve the anatomical drawings significantly. Descriptions of the pathological anatomy of the spine were first published early in the 17th century, but progress was slow up to the end of the 18th century due to a lack of occasions for clinical-pathological correlations. Normal anatomy became remarkably accurate in the 18th and 19th centuries when soft tissues and connections (e.g., among the intervertebral discs) were studied in detail. The slow compressions due to underlying diseases and then the degenerative processes were subsequently described.

Radiographic features and subtypes of congenital thumb duplication type C3 according to Wu et al. and their potential implications for surgical management: new classification and preliminary results.

BACKGROUND: Wu et al. introduced a modified radiographic system that allows classification of all forms of CTD with excellent interobserver and intraobserver reliability. No study to date has evaluated the radiographic characteristics of Wu et al. type C3 CTD with osseous attachment at the level of the metacarpal. OBJECTIVE: This study aimed to evaluate the radiographic features of type C3 CTD according to the system of Wu et al., to describe the different anatomical subtypes of the duplication, and to propose a categorization approach to distinguish diverse surgical strategies based on the radiographic anatomy of this specific subtype of duplication. METHODS: We performed a retrospective analysis of 215 patients (221 thumbs) diagnosed with Wu et al. type C3 CTD at our Institution between 2015 and 2021. We evaluated all CTDs by examining the alignment of the interphalangeal (IP) and metacarpophalangeal (MP) joints and by assessing the presence of abnormal hypertrophic epiphysis of the primary thumb on posteroanterior (PA) radiographs. The proposed classification system has four types: Type I with good alignment of both MP and IP joints, Type II with ulnar deviation of the MP joint, Type III with radial deviation in the MP joint and Type IV with abnormal hypertrophic epiphysis of the distal phalanx of the main thumb with ulnar deviation of the IP joint with or without ulnar deviation of the MP joint. RESULTS: There were 140 male and 75 female patients with CTD (221 thumbs). There were 65 left, 144 right and 6 bilateral forms. The right-to-left, male-to-female and unilateral-to-bilateral ratios were 2.2:1, 1.9:1 and 35.8:1 respectively. The mean age at surgery was 22.3 ± 11.8 months (range, 8-80). The proposed classification system allowed the classification of all CTDs (n = 221). Specifically, 53 fingers were classified as Type I (24%), 136 as Type II (61.5%), 21 as Type III (9.5%), and 11 as Type IV (5%). CONCLUSION: The proposed system is based on radiographic pathoanatomy and complements that of Wu et al. by identifying four distinct subtypes of deformity. It has the potential to improve inter-professional communication and guide surgery in patients with Wu et al. type C3 CTD. However, our results are preliminary and further research is needed to validate them. LEVEL OF EVIDENCE: III.