Pulmonary vein anatomical variation during videothoracoscopy-assisted surgical lobectomy.

PURPOSE: Anatomical variations of pulmonary veins, even though not rare, have important role, especially in patients undergoing lung surgery. We present a case of a single common pulmonary venous drainage of the left upper and lower lobe of the lung. METHOD/RESULT: The common trunk of the left superior and inferior pulmonary vein was misidentified as an inferior pulmonary vein, and it was transected during surgery. CONCLUSION: The surgeon must always be aware of this anomaly and carefully verify the normal anatomical structures before dividing them while performing an upper or lower lobectomy.

Esmolol reduces anesthetic requirements thereby facilitating early extubation; a prospective controlled study in patients undergoing intracranial surgery.

BACKGROUND: Adequate cerebral perfusion pressure with quick and smooth emergence from anesthesia is a major concern of the neuroanesthesiologist. Anesthesia techniques that minimize anesthetic requirements and their effects may be beneficial. Esmolol, a short acting hyperselective ß-adrenergic blocker is effective in blunting adrenergic response to several perioperative stimuli and so it might interfere in the effect of the anesthetic drugs on the brain. This study was designed to investigate the effect of esmolol on the consumption of propofol and sevoflurane in patients undergoing craniotomy. METHOD: Forty-two patients that underwent craniotomy for aneurysm clipping or tumour dissection were randomly divided in two groups (four subgroups). Anesthesia was induced with propofol, fentanyl and a single dose of cis-atracurium, followed by continuous infusion of remifentanil and either propofol or sevoflurane. Patients in the esmolol group received 500 mcg/kg of esmolol bolus 10 min before induction of anesthesia, followed by additional 200 mcg/kg/min of esmolol. Monitoring of the depth of anesthesia was also performed using the Bispectral Index-BIS and cardiac output. The inspired concentration of sevoflurane and the infusion rate of propofol were adjusted in order to maintain a BIS value between 40-50. Intraoperative emergence was detected by the elevation of BIS value, HR or MAP. RESULTS: The initial and the intraoperative doses of propofol and sevoflurane were 18-50 mcg/kg/min and 0.2-0.5 MAC respectively in the esmolol group, whereas in the control group they where 100-150 mcg/kg/ and 0.9-2.0 MAC respectively (p = 0.000 for both groups). All procedures were anesthesiologically uneventful with no episodes of intraoperative emerge. CONCLUSIONS: Esmolol is effective not only in attenuating intraoperative hemodynamic changes related to sympathetic overdrive but also in minimizing significant propofol and sevoflurane requirements without compromising the hemodynamic status. ClinicalTrials.gov Identifier: NCT02455440 . Registered 26 May 2015.

Aberrant accessory abductor digiti minimi manus muscle: a rare anatomical variation.

The hypothenar muscle with the greatest frequency of variations is the abductor digiti minimi manus. Except for morphological variations of this muscle, have also been reported cases of an extra wrist muscle, the accessory abductor digiti minimi manus muscle. This case report presents a rare case of an accessory abductor digiti minimi muscle characterized by an unusual origin from the tendons of the flexor digitorum superficialis. This anatomical variation was identified on a formalin - fixed male cadaver of Greek origin during routine dissection. This anatomical variation, which may result in Guyon's canal syndrome or complicate common wrist and hand surgical procedures such as the carpal tunnel release, should be known to orthopaedic surgeons and hand surgeons in particular.

The Discovery of an S-shaped Kidney in a Patient With Prostate Cancer: A Rare Finding.

Crossed fused renal ectopia (CFRE) constitutes a rare congenital anomaly of the urinary tract, typically characterized by its predominantly asymptomatic nature and frequent incidental discovery. This case report delineates the clinical profile of a 56-year-old male admitted to our Prostate Cancer Outpatient Clinic due to elevated prostate-specific antigen (PSA) levels, ultimately leading to the diagnosis of prostate cancer. The patient was asymptomatic, with no family or surgical background. Notably, a fused ectopic kidney was incidentally identified during the staging process involving abdominal computed tomography (ACT) scanning. Remarkably, no additional abnormalities of the urinary tract or renal dysfunction manifested in this specific case. The significance of this report lies in the underscored emphasis on the importance of employing precise imaging techniques and tailored management strategies for patients harboring such anatomical variations.

A rare cadaveric finding of ectopic origin of a bronchial artery: surgical and imaging consequences.

Bronchial arteries arise normally directly from the descending thoracic aorta, at the level between the fourth and sixth thoracic vertebra. However the anatomical variations are very frequent regarding the origin or the number of branches. We present a rare cadaveric finding of an ectopic right bronchial artery originating from the right subclavian artery through common stem with the right internal thoracic artery and we discuss the clinical significance of this finding. A 72-year-old formalin-embalmed male cadaver was dissected during a routine anatomical course. The right bronchial artery originated from the right subclavian artery with a common stem with the right internal thoracic artery. Although ectopic origin of the right bronchial artery from the right internal thoracic artery is rare, recognition of this anatomical variation is important in bronchial embolization due to hemoptysis, in coronary bypass grafting and in lung transplantation.

Is the course of the cervicofacial division of the facial nerve consistent with the adjacent vessels?

Individual facial nerve branching patterns can be difficult to predict. The superficial course of its terminal branches poses them at risk of injury during head and neck surgeries. We report the rare course of a branch of the facial nerve deep into the posterior facial vein.

The Presence of a Zygomatic Nerve Plexus in a Cadaveric Specimen Without a Zygomatic Branch of the Facial Nerve.

The extratemporal course of the facial nerve distributes in facial mimic muscles in a complex pattern. The traditional depictions of five main branches without anastomoses are not common. Davis classification remains the gold standard in the classification of facial nerve branching patterns. During a routine dissection of an 74-year-old male cadaveric specimen, we detected a very rare anatomical variation. The zygomatic branch of the facial nerve was totally absent. The temporofacial division of the main trunk was bifurcated to a temporal and a buccal branch. The anterior temporal and posterior buccal branches formed a plexus to supply the orbicularis oculi muscle. This unique variability highlights the complexity of the extratemporal facial nerve course. Retrograde facial nerve dissection requires deep knowledge of every anatomical variation of the facial nerve course to avoid an iatrogenic injury. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03601-y.

A Cadaveric Case of an Accessory Cleido-Occipital Muscle Over the Common Trunk of the Supraclavicular Nerves.

The current study describes a case of an aberrant cleido-occipital muscle. In particular, this muscle was arising from the middle part of the clavicle, inserted into the medial part of the upper trapezius muscle, and crossed over the supraclavicular nerves with possible compression of them, especially during shoulder abduction. Knowledge of the muscular variability of the posterior cervical triangle is crucial for supraclavicular nerve entrapment syndrome diagnosis and treatment. The appearance of aberrant muscular fascicles may lead to misinterpretation of neck imaging, as well as difficulties during surgical procedures undertaken in the region.

Early Trifurcation of the Mandibular Branch of the Facial Nerve in a Cadaveric Specimen.

Rare facial nerve branching patterns, pose dangers due to their unexpected course. Cases with multiple branches may reduce the intraoperative risk, due to the compensation of adjacent branches. We present a case of a cadaveric specimen where an early trifurcation of the mandibular branch of the facial nerve was noted. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03352-2.

External Jugular Vein Perforation by the Transverse Cutaneous Nerve of The Neck: A Case Report and Review of The Literature.

A very rare anatomical variation of external jugular vein's penetration by the transverse cutaneous nerve of the neck is displayed in the current study. The phenomenon of veins' fenestration or penetration by other structures, such as nerves along with its likely embryologic development are discussed. Moreover, the potential clinical significance of that variation's awareness on behalf the physician is discussed in detail.

Bilateral Thyroid Foramina in a Completely Ossified Laryngeal Framework: A Case Report.

The presence of a thyroid foramen in the thyroid cartilage of the larynx is not uncommon. It may be occluded by a fibrous layer, or it may be an abnormal path for the neurovascular bundle of the larynx. The superior laryngeal nerve and the superior laryngeal vessels are the most common contents of the thyroid foramen. During the observation of the skeleton of a 32-year-old female, we found a completely ossified laryngeal framework with bilateral double thyroid foramina. Three of the foramina were circular, and one was oval in shape. This is a very rare anatomical variation. Deep knowledge of the thyroid cartilage anatomy is mandatory during laryngeal and thyroid surgery. The meticulous dissection of laryngeal vessels and nerves is of paramount importance to control bleeding and avoid postoperative neurological sequelae due to nerve injury. The surgeon should be aware that in the whole length of the oblique line of the thyroid cartilage, a thyroid foramen may be detected.

Locally Advanced Laryngeal Squamous cell Carcinoma in a Patient with a Synchronous Second Primary Thyroid Carcinoma.

Laryngeal squamous cell carcinoma (SCC) is one of the most common primary tumors of the head and neck region. Unfortunately, patients with laryngeal SCC tend to develop second primary tumors (SPTs), accounting for increased mortality. The lung is the predominant site of a second presentation, followed by the mucosa of the upper aerodigestive tract. In contrast, the thyroid gland rarely hosts an SPT. Our study describes the management and treatment of a 69-year-old female who presented with a rare combination of synchronous laryngeal and thyroid carcinomas. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03968-y.

Very low risk T1a renal cell carcinoma presenting with pathological fracture caused by a solitary metastases to the contralateral arm.

BACKGROUND: Renal Cell Carcinomas are notorious for asynchronous metastases, atypical metastatic sites and late relapses even decades after nephrectomy. It is quite rare though for RCCs to present as metastatic, solitary and symptomatic bone lesions. Even more uncommon is a solitary bone metastasis much larger that the primary tumour caused by a low risk primary T1a RCC which would have otherwise been eligible for active surveillance. CASE PRESENTATION: An otherwise healthy 68-year-old female was seen by the orthopaedics for right shoulder and upper arm worsening pain. Imaging showed a pathological fracture caused by a 5.5 cm lytic lesion involving the coracoid process and proximal humerus. She underwent proximal humeral replacement and histology of the lesion showed metastatic RCC. Whole body CT scan revealed a primary tumour of the left kidney less than 4cm in diameter. The patient underwent laparoscopic radical nephrectomy and diagnosis of a T1a, clear cell RCC without adverse pathological features was confirmed. She has been on systematic therapy with oral TKIs since and is free from recurrence at 12-months follow up. CONCLUSIONS: Even T1a RCCs without adverse pathological features can give rise to distant metastases following unpredictable patterns of spread thereby questioning the safety of active surveillance in healthy and fit patients.

Does the orientation of the styloid process cause Eagle Syndrome? An anatomical study of the styloid process in 72 Greek skulls.

<b>Introduction:</b> Patients often suffer from an elongated styloid process. This clinical entity is well known and is described as Eagle syndrome. The presence of this anatomical variation is not always associated with symptoms. However, there is a strong correlation between the elongated styloid process and Eagle syndrome </br></br> <b>Aim:</b> This study aims to calculate the incidence of elongated styloid processes in the Greek population, to analyze the morphometric characteristics of styloid processes, and to compare these among sexes. </br></br> <b>Material and methods:</b> This is a single-center retrospective study. All skulls were donated to the Department of Anatomy, the Ari-stotle University of Thessaloniki from January 2013 to May 2019 for research purposes. A styloid process longer than 30 mm was considered elongated. We used Welch's t-test for the statistical analysis of the data. </br></br> <b>Results:</b> The prevalence of elongated styloid processes was 35%. The average diameter was 3.32 mm and the average total length was 25.02 mm. There was no statistically significant difference between male and female skulls, though the female styloid processes were slightly longer and the male ones were slightly wider. Symmetry was recorded in 31% of skulls. Average axial angle was 650 but in 4% of cases it was less than 20⁰. </br></br> <b>Conclusions:</b> The elongated styloid process is not a rare entity. Eagle syndrome should always be considered in the differential diagnosis when patients report chronic sore throat. Our anatomical findings add a new dimension to the etiopathogenesis of Eagle syndrome.

Single sterile silicon ring technique for utilization of upper limb intravenous regional anesthesia: A prospective study of patients with operated distal radius fractures.

INTRODUCTION: Intravenous regional anesthesia is a well-established method of anesthesia in upper extremity surgery. In this study, we present a modification of the technique using a silicon ring tourniquet in 30 patients undergoing internal fixation for distal radius fractures. METHODS: A sterile silicone ring wrapped within a stockinette sleeve was applied, and a local anesthetic solution (3 mg/kg lidocaine 0,5%) was injected intravenously. After anesthesia onset, the ring was rolled distally to provide immediate pain and discomfort relief. RESULTS: The silicone ring achieved adequate exsanguination in all patients. Mean pain VAS score was 2.7 ± 0.9 intraoperatively and 4.3 ± 1.3 during the first hour postoperatively. The onset and termination times of sensory block were 5.8 ± 2.1 and 102 ± 7.8 min, and of motor block 13.8 ± 2.8 and 54.2 ± 4.6 min, accordingly. All patients were satisfied from the procedure. CONCLUSION: Sterile silicone ring tourniquet application is a simple, safe and effective analgesic and anesthetic technique for the operative treatment of distal radius fractures.

A Review of the Use of Virtual Reality for Teaching Radiology in Conjunction With Anatomy.

Incorporation of radiology into anatomy education is a frequently used teaching strategy. Our purpose was to investigate to what extent virtual reality can play a significant role when radiology is taught in conjunction with anatomy. PubMed, SCOPUS, Education Resources Information Center, and Cochrane databases were searched for articles with the aim to evaluate the outcomes of incorporation of radiology in anatomy education, using virtual reality. From each included paper, the following data were extracted: authors, number of participants, type of study (comparative or not), level of outcome according to Kirkpatrick hierarchy, and outcomes of the use of virtual reality when radiology was incorporated in anatomy education. Seven papers were included. From them, three were comparative and evaluated students' academic performance after the educational intervention, while four were non-comparative and evaluated only students' opinions about the intervention. In all studies, the use of virtual reality for the incorporation of radiology into anatomy teaching was positively perceived. Also, the three studies which evaluated academic performance showed that virtual reality was effective in terms of enhancing anatomy knowledge. The implementation of virtual reality for the incorporation of radiology into anatomy education has been accompanied by positive outcomes. These outcomes may encourage educators to teach radiology in conjunction with anatomy using virtual reality.

Be cautious of "complex hydrocele" on ultrasound in young men.

Hydrocele is the most common benign cause of painless scrotal enlargement and only very rarely can be reactive to an underlying testicular tumor. We present the case of a healthy young man, complaining of mild left scrotal discomfort and swelling. Physical examination revealed a non-tender fluctuant left scrotum and serum tumor markers were normal. Scrotal ultrasonography (US) showed a normal right hemiscrotum and testicle and a fluid collection among thickened irregular septations in the left hemiscrotum, a finding which was considered as a complex hydrocele. Intraoperatively the presumed "complex hydrocele" was in fact a multicystic testicular tumor. We proceeded with orchiectomy through the scrotal incision and pathology revealed a mixed germ cell tumor of the testis consisting of cystic teratoma, in situ germ cell neoplasia unclassified (IGCNU) and Sertoli cell tumor. This is the first reported case of this type of testis tumor presenting as complex hydrocele. The aim of this case presentation is to underline the need for an accurate preoperative diagnosis in cases of suspected scrotal pathology in young males.

Aerobic exercise and intraocular pressure in normotensive and glaucoma patients.

BACKGROUND: With the increasing number of people participating in physical aerobic exercise, jogging in particular, we considered that it would be worth knowing if there are should be limits to the exercise with regard to the intraocular pressure (IOP) of the eyes. The purpose of this study is to check IOP in healthy and primary glaucoma patients after aerobic exercise. METHODS: 145 individuals were subdivided into seven groups: normotensives who exercised regularly (Group A); normotensives in whose right eye (RE) timolol maleate 0.5% (Group B), latanoprost 0.005% (Group C), or brimonidine tartrate 0.2% (Group D) was instilled; and primary glaucoma patients under monotherapy with beta-blockers (Group E), prostaglandin analogues (Group F) or combined antiglaucoma treatment (Group G) instilled in both eyes. The IOP of both eyes was measured before and after exercise. RESULTS: A statistically significant decrease was found in IOP during jogging. The aerobic exercise reduces the IOP in those eyes where a b-blocker, a prostaglandin analogue or an alpha-agonist was previously instilled. The IOP is also decreased in glaucoma patients who are already under antiglaucoma treatment. CONCLUSION: There is no ocular restriction for simple glaucoma patients in performing aerobic physical activity.