Transarterial chemoembolization in a patient with the replaced right hepatic and left gastric arteries arising from the abdominal aorta: a new anatomical variation.

PURPOSE: Knowing the anatomical variation of the coeliac trunk (CT) and its detailed interpretation in the preoperative period is important for the prevention of iatrogenic injury during liver surgery or endovascular intervention on the coeliac trunk and its branches. METHODS: A diagnostic abdominal computed tomography angiography (CTA) was performed in a 61-year-old male patient, who was investigated for a liver cancer and chemoembolization was planned. RESULTS: CTA reveals that right hepatic artery (RHA) arises directly from the abdominal aorta, at the level of CT. This vessel coursing to the right hepatic lobe, functioning therefore as a replaced right hepatic artery (RRHA). Also, the left gastric artery (LGA) arises directly from the abdominal aorta. This patient successfully underwent chemoembolization from RRHA. CONCLUSION: We presented a case of new anatomical variation involving the origination of RRHA and LGA from the abdominal aorta.

Artificial intelligence's interpretation of the neuroanatomical aspect of Peter Paul Rubens's copy of "The Battle of Anghiari" by Leonardo da Vinci.

We tested to see how Ruben's copy of "The Battle of Anghiari" by Leonardo da Vinci would be interpreted by AI in a neuroanatomical aspect. We used WOMBO Dream, an artificial intelligence (AI)-based algorithm that creates images based on words and figures. The keyword we provided for the algorithm was "brain" and the reference image was Ruben's drawing. AI interpreted the whole drawing as a representation of the brain. The image generated by the algorithm was similar to our interpretation of the same painting.

180-degre carotid bifurcation with an internal carotid artery aneurysm.

PURPOSE: Internal carotid artery (ICA) aneurysm is a rare pathology. In the clinical case we present, the patient had an ICA aneurysm as well as a rare anatomical variant of the carotid bifurcation. METHODS: We present the case of a 45 year old man, who had two episodes of TIA revealed by loss of mind. Computed tomography revealed the fusiform aneurysm of a left ICA in the first segment with maximal diameter of 16 mm. There were no thrombotic mass in the dilated area. The carotid bifurcation angle was 180 degree. Although the aneurysm did not contain a thrombus mass, it was considered the source of the TIA because of turbulent blood flow. RESULTS: Distal and proximal ligation was performed. A 5-cm long graft from the great saphenous vein was used for ICA revascularization from common carotid artery. CONCLUSION: In our case, geometry of carotid bifurcation may have contributed to the ICA aneurysm, although there is no evidence for this correlation.

Cervical Vagal Schwannoma Causing Asymptomatic Internal Carotid Artery Compression.

BACKGROUND: Schwannoma originating from the cervical vagus nerve is a rare neoplasm. Vagal nerve schwannoma (VNS) usually occurs between the third and fifth decades of life. METHODS: We operated one patient for cervical schwannoma causing internal carotid artery (ICA) compression. RESULTS: The patient underwent en bloc excision via transcervical approach under general anesthesia. Pathological examination demonstrated the diagnosis of schwannoma. CONCLUSIONS: Our case shows that VNS can cause ICA compression and therefore brain ischemia.

Aortofemoral Reconstruction for an Infected Graft Using Thrombosed Femoral Veins.

INTRODUCTION: Treatment of an infected aortic prosthesis is difficult and the ideal graft material is subject to debate. REPORT: A case of infected aortic prosthesis treated using bilateral thrombosed superficial femoral veins (SFVs) is presented. Bilateral reversed SFVs were cut longitudinally at both proximal ends about 3-4 cm and were sutured side by side. The operating time was 5 h. No sign of recurrent infection was observed when the patient suffered a myocardial infarction and died 6 months post-operatively. DISCUSSION: Thrombosed SFVs may be considered as a therapeutic option for infected aortic graft replacement.

Skull Anatomy in "Saint Jerome in the Wilderness" by Leonardo da Vinci.

As a result of a detailed study of "Saint Jerome in the Wilderness", we found that Leonardo described the skull in this work in an original way. A portion of the skull's face is visible in St Jerome's chest and abdomen projection. This image shows the orbit, the frontal bone, the nasal aperture and the zygomatic process. In our opinion, Leonardo described the skull in the painting with his usual originality.

Hidden Brain Anatomy in Peter Paul Rubens's Copy of "The Battle of Anghiari" by Leonardo da Vinci: "The Battle of Anghiari" and Brain Anatomy.

The object of this article is a drawing by Peter Paul Rubens, a copy of "The Battle of Anghiari" by Leonardo da Vinci in 1503-1506. This work, created in 1603, was based on an engraving of 1553 by Lorenzo Zacchia, which was taken from a cartoon by Leonardo da Vinci. The original fresco itself is lost. The analysis of the drawing shows that the Peter Paul Rubens's copy of "The Battle of Anghiari" by Leonardo da Vinci, which was created six centuries ago, includes double content. The drawing depicting the battle secretly describes the three-dimensional image of the brain.

Unusual positional compression of the internal carotid artery causes carotid thrombosis and cerebral ischemia.

This article reports an unusual case of positional compression of internal carotid artery resulting in carotid thrombosis and stroke in a 37-year-old man. A patient was operated urgently for a free-floating thrombotic mass in the internal carotid artery. Open thrombectomy was performed in acute phase of stroke for prevention of the recapitulative cerebral thromboembolism. Hemiplegia completely disappeared within 7 months.

Hidden Cardiovascular Anatomy in "Saint John the Baptist" by Leonardo da Vinci.

Leonardo da Vinci conducted many anatomical studies during his life. Today, almost the complete set of these anatomical drawings and comments is owned by the British Crown and resides in the Royal Library at Windsor Castle, United Kingdom.Through the program Paint X, we moved two details on the painting "Saint John the Baptist." The moving details are circled along the faint contour by Leonardo da Vinci himself. We obtained heart and aortic arch imaging.

Anatomy of the respiratory system in the, "Portrait of a Musician" by Leonardo da Vinci.

The object of the research is the painting, Portrait of a Musician''. Upon closer examination of the painting, we discovered three details. Two have the shape of trachea and bronchi and the third a larynx. By moving the details through the program Paint X we got an image of the larynx, trachea and bronchi. The larynx is presented by thyroid and cricoid cartilage. The characteristic cartilaginous rings are distinguished on the trachea. The right and left main bronchi are also seen. In our opinion, Leonardo da Vinci reflected the elements of the respiratory system in the, Portrait of a Musician'', thus emphasizing the fact that the bronchi, trachea and larynx are involved in the production of sound.

Surgical treatment of the great saphenous vein aneurysm resulting in pulmonary embolization in two patients.

Superficial venous aneurysms of the lower extremities are considered rare and their clinical significance is poorly defined. The pulmonary embolism arising from superficial venous aneurysms has been previously reported. In this article, we report two cases of great saphenous vein aneurysm that resulted in pulmonary embolism. Current treatment consists of urgent open surgical excision of the aneurysm.

Cardiac anatomy in the 'Dreyfus Madonna' by Leonardo da Vinci.

Leonardo's findings on the anatomy and physiology of the heart, preserved in his private sketches and notes, reveal a remarkable period of transition in the early history of cardiology. The object of this research is a 'Dreyfus Madonna'. Through the programme Paint X, we moved 1 detail (blue marked) in the direction of the green arrow and we get an image of the heart with branches of the aortic arch. If we compare the image of the heart obtained by us with the anatomical sketch of Leonardo (RL 19073-74v; K/P 1 66v), we will see a sharp resemblance to the branches of the aortic arch.

Surgical Management of a Patient with an Internal Carotid Artery Stenosis, Eagle Syndrome, and Internal Carotid Artery Tortuosity: A Case of Four Pathologies of the Carotid Arteries.

INTRODUCTION: In 1937, W.W. Eagle first described two clinical cases of elongated styloid process causing compression of adjacent anatomical structures. A case of left internal carotid artery (ICA) stenosis, Eagle syndrome (bilateral), ICA tortuosity, and occlusion of the right carotid arteries is presented. REPORT: A 67 year old man was referred following ischaemic stroke two months previously. Computed tomography (CT) revealed the pathologies described. Intervention was performed under general anaesthesia. The digastric muscle was transected, and the styloid process was resected. Carotid endarterectomy with end to end anastomosis between the crossed ends of the ICA was carried out using a temporary shunt due to occlusion of the contralateral carotid arteries. The patient was discharged on the third post-operative day. DISCUSSION: The case described shows that one stage surgical treatment of ICA stenosis, coiling, and Eagle syndrome gives good results.

Open surgical reconstruction of the internal carotid artery aneurysm at the base of the skull.

OBJECTIVES: Aneurysms of the internal carotid artery (ICA) at the base of the skull are uncommon dangerous lesions whose management remains unclear. The aim of this retrospective study is to report a standardized surgical technique of ICA reconstruction with long-term results. METHODS: Between 1988 and 2005, 13 patients (11 men; age 18 to 76 years, mean 42.6 years) underwent lateral skull base approach with cervical-to-petrous carotid artery bypass for repair of ICA aneurysms. Principal elements of the technique were: partial resection of the parotid gland without rerouting of the facial nerve; luxation of mandibula; drilling of the bone. RESULTS: The 13 patients had unilateral aneurysm of the ICA at the base of the skull. Four aneurysms were of atherosclerotic origin; six fibromuscular dysplasia; two post-traumatic; one cause was undetermined. The mean diameter of the aneurysms was 12 mm (range, 7-21 mm). Twelve patients were symptomatic: six presented neurological events (four strokes, two transient ischemic attack [TIA]); two retinal events; three compressive symptoms (two Horner's syndrome and one paralysis of the glossopharyngeal nerve); one patient presented a visible pulsatile mass in the neck. One patient was asymptomatic. There were no post-operative deaths, one TIA, 13 transient palsies of the lower facial nerve, and one transient palsy of accessory nerve. Palsy of cranial nerves was partial and disappeared within a mean of 5.6 months (range, 1-10 months). The postoperative angiogram showed patency in all but one case (one asymptomatic thrombosis). During follow-up (mean, 152 months), there was one unrelated death, one focal epileptic seizure, and one controlateral TIA. In November 2008, duplex showed patency of all 11 grafts (one death, one thrombosis). At 10 years, the survival, cumulative stroke-free survival, ipsilateral stroke-free, and patency rates was were 90.9%, 100%, 100%, and 92.3%. CONCLUSION: Venous graft bypass from the cervical-to-petrous ICA can be performed safely with such an approach and produces durable satisfactory results.

Anatomical repair of a congenital aneurysm of the distal abdominal aorta in a newborn.

Congenital (primary) neonatal abdominal aortic aneurysm (AAA) is an extremely rare truncular arterial abnormality among numerous congenital vascular malformations. Only seven cases have been reported as congenital origin in newborns. This report presents the case of a male infant in whom a 33-mm congenital AAA was diagnosed prenatally and was successfully treated 10 days after birth without exogenous graft material or aneurysmorrhaphy. Follow-up study at 39 months demonstrated excellent clinical, ultrasound scan, and computed tomography scan findings. Anatomic reconstruction with native vessels is the preferred surgical technique to ensure the child's potential for harmonious growth.

Left Ventricular Myxoma with Embolization Causes Acute Infrarenal Aortic Occlusion.

Atrial myxoma is the most common benign tumor of the heart; moreover, atrial myxoma embolization to the peripheral vessels is rare. We present an unusual case of total acute infrarenal aortic occlusion resulting from embolic implantation from a left ventricular myxoma. A 37-year-old man with acute lower limbs ischemia, spinal cord ischemia, and acute renal insufficiency was urgently operated and discharged after surgery.

Basilic Vein Elevation for Arteriovenous Fistula Creation: Results of 60 Cases Following 1 Year.

Basilic vein elevation (BVE) is a procedure where the basilic vein (BV) is surgically exposed, mobilized, and elevated into a more superficial position for the purpose of facilitating arteriovenous fistula (AVF) cannulation. The purpose of this study is to review the use of BVE as an adjunct to fistula maturation. Between January 2009 and December 2013, 60 patients received BVE. After performing the anastomosis between brachial artery and BV, the elevated vein was placed just anterior to the surgical incision, 3 to 4 mm deep. Patients' morbidity, mortality, and patency rates were evaluated. The 90-day mortality was 0%. Maturation rates were 91.6%. The mean time to maturation was 52 days (range, 25-75 days). Primary patency rate at 12 months was 90% and secondary patency rate was 95%. The mean vein size was 4.5 ± 0.5 mm. AVF surgery via BVE offers satisfactory results in patients with chronic hemodialysis.