Anatomical variations of the superior thyroid artery: A systematic review.

BACKGROUND: The superior thyroid artery (STA) is one of the main arteries that provide blood supply to the thyroid gland. It has a plethora of anatomical variations, and knowledge of its anatomy is necessary in procedures in this area. The aim of this review is to summarize and describe human studies (cadaveric and angiographic) that investigate the anatomical variations related to the STA. MATERIAL AND METHODS: A systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. A literature search in PubMed, and Embase databases was carried out. Original studies that investigated the origin of the STA and reported data on the variant arterial anatomy were considered, including only cadaveric and angiographic studies. RESULTS: A total of 34 studies (4048 heminecks in total; heminecks in each study: min: 25-max: 1280) were finally included. All studies provide details about sex [men/women ratio median (IQR): 2(1-5)] but none about age and 10 (29%) about nationality. STA morphological characteristics described in the included studies are origin, length, number of branches, distance from the carotid bifurcation and the vessel's diameter. CONCLUSIONS: The STA's anatomical features are subject to a non-negligible degree of variability. Our results should improve the awareness of anatomical variations of the STA, and eventually have an impact on the interventions regarding the visceral compartment of the neck in clinical practice.

Anatomical variations of the pelvis during abdominal hysterectomy for benign conditions.

BACKGROUND: Anatomical variations are defined as atypical morphologic and positional presentations of anatomical entities. Pelvic anatomical variations encountered during abdominal hysterectomy can be of clinical interest, given that misidentification of certain structures can lead to iatrogenic injuries and postoperative sequelae. The aim of the present study was to detect and highlight the anatomical structures of interest and their variations to the surgeon performing abdominal hysterectomy for benign conditions. MATERIALS AND METHODS: A narrative review of the literature was performed including reports of anatomical variations encountered in cadavers, by surgeons during abdominal hysterectomy and radiologists on computed tomography angiography, searching within a 10-year span on PubMed database. Studies regarding the treatment of malignant conditions requiring lymphadenectomy and different modes of surgical approach were reviewed with regards to the aspects relevant to benign conditions. The search was extended to the reference lists of all retrieved articles. RESULTS: Ureters and the uterine arteries, due to anatomical variations, are the anatomical structures most vulnerable during abdominal hysterectomy. Specifically, the ureters can present multiplications, retroiliac positionings and ureteric diverticula, whereas, the uterine arteries can present notable variability in their origins. Such variations can be detected preoperatively or intraoperatively. CONCLUSIONS: Although rare, the presence of anatomical variations of the uterine arteries and ureters can increase the possibility of complications should they escape detection. Intraoperative misidentification could lead to improper dissection or ligation of the affected structures. Knowledge of these variations, coupled with extensive preoperative investigation and intraoperative vigilance can minimise the risk of complications.

Anatomical variations of human vertebral and basilar arteries: A current review of the literature.

The vertebral artery originates from the subclavian artery and is divided into four segments (V1-V4). In its intracranial segment (V4), the two vertebral arteries join to form the basilar artery, an unpaired medium-sized artery. However, apart from this typical description, several anatomical variations may occur in the human body. Although in some cases such variations may be asymptomatic, they may be also associated with several pathological conditions, neurological complications, surgical complications, and increased risk of developing vascular diseases. Therefore, it is crucial to obtain sufficient information on the anatomy and variants of both arteries to prevent such complications and ensure the safe completion of surgical and radiological treatments. For this reason, we reviewed studies published up to January 2022 concerning the reported variations of the vertebral artery and basilar artery regarding their origin, course, length, and diameter. We believe that the thorough presentation of these variations would help surgeons worldwide during their daily clinical and surgical practice.

Anatomical variations of the vascular supply of the cutaneous component of the serratus anterior myocutaneous flap: a systematic review.

Although appealing from a reconstructive standpoint, the incorporation of the overlying skin in a serratus anterior muscle flap has not yet seen widespread use, due to considerations with its blood supply. In the present study, a systematic review of the literature has been performed, evaluating studies that investigated the vascular anatomy and variations of serratus anterior myocutaneous flap. The anatomy of the cutaneous blood supply, the size of the cutaneous territory, the design of the skin paddle and the reconstructive goals were analysed. The results showed that the main blood supply originates from the intramuscular anastomoses between intercostal artery perforators and the serratus artery branch in the form of choke vessels. Complementary perfusion from true intramuscular vessel anastomoses or from direct serratus artery cutaneous perforators could contribute to the skin blood supply but only in 25% of the cases. The design of the flap is elliptical with its long axis over the harvested muscle slips and maximum width is 6-8 cm. A myocutaneous serratus anterior flap could be applied in a variety of reconstructive fields, most commonly for head and neck defects. A delay procedure would considerably enhance the perfusion of the cutaneous component and improve the overall viability of the flap.

Case series and a systematic review concerning the level of the aortic bifurcation.

BACKGROUND: The aim of this study is to present the level of aortic bifurcation in a sample of Greek origin (case series) and to perform an up-to-date systematic review in the existing literature. MATERIALS AND METHODS: Seventy-six formalin-fixed adult cadavers were dissected and studied in order to research the level of aortic bifurcation. Additionally, PubMed and Google Scholar databases were searched for eligible articles concerning the level of aortic bifurcation for the period up to February 2020. RESULTS: The mean level of aortic bifurcation according to our case series was the lower third of the L4 vertebral body (21/76, 27.6%). The level of aortic bifurcation ranged between the lower third of the L3 vertebral body and the lower third of the L5 body. No statistically significant correlation was found between the two sexes. The systematic review of the literature revealed 31 articles which were considered eligible and a total number of 3537 specimens were retracted. According to the recorded findings the most common mean level of aortic bifurcation was the body of L4 vertebra (1495/3537 cases, 42.2%), while the range of aortic bifurcation was described to occur from upper third of L3 vertebrae to the upper third of the S1 vertebrae in the 52.8% of the cases (1866/3537). CONCLUSIONS: The mean level of AA corresponds to the body of L4 and presents a great range (form L3U to S1U). Knowledge of the mean level of aortic bifurcation and its probable ranges is of great significance for interventional radiologists and especially vascular surgeons that deal with aneurism proximal to the aortic bifurcation.

Agenesis of the coeliac trunk: a case report and review of the literature.

Vascular anatomical variations of the abdomen are very common. Awareness of these variations is of paramount importance in clinical practice mainly in achieving best results in minimal invasive or surgical vascular procedures. From surgical point of view, the preoperative knowledge of vascular anatomy and the relations to the surrounding structures and tissues aims to minimise inadvertent complications. Agenesis of the coeliac trunk is one of the rare anatomical variations of the abdominal aorta. Limited number of cases have been reported in the medical literature, most of which are based on angiographic and cadaveric studies of adult humans. In this paper, we report a case of absence of the coeliac trunk that has been detected as an incidental radiological finding in a female patient who was admitted with abdominal pain.

Anatomical variation of a trifid (trifurcation) lateral root origin of the median nerve.

Anatomic variations of the brachial plexus are common. Awareness of these variations is of paramount importance in clinical practice mainly in achieving best results in minimal invasive or surgical procedures. The aim of our study was to depict a case of a trifid lateral root origin of the medial nerve. This anatomical variation in the brachial plexus was encountered after dissection in upper extremities in a 90-year-old male cadaver.

Non small cell lung cancer metastasized to the breast and treated with modified radical mastectomy: a case report.

Breast metastasis from extra-mammary malignancy is extremely rare with an incidence from 0.4% to 1.3%. Several types of malignancies that most commonly metastasize to the breast include leukemia, lymphoma, and melanoma. AIM: We report a case of a 57-year-old male with a history of non-small cell lung cancer (NSCLC) who manifested a left breast mass, two years and four months after the initial diagnosis and treatRomament of NSCLC. METHOD: Physical examination revealed a poorly defined mass in the upper outer quadrant of the left breast, suspicious for breast cancer. After mammography results, the patient underwent Fine Needle Aspiration that was indicative of cancer. He underwent then modified radical mastectomy and axillary lymph node dissection. Histology and immunohistochemical analyses were conducted, that revealed a NSCLC that metastasized to the left breast. RESULTS: Finally, the prognosis of the patient was poor, as NSCLC relapsed from IIB to stage IV. CONCLUSIONS: An accurate differentiation of metastasis to the breast from primary breast cancer is of paramount importance because the therapeutic approach and prognosis of the two differ significantly.

Sugammadex, a promising reversal drug. A review of clinical trials.

According to published data, sugammadex, rapidly reverses (2-5 min) shallow and profound NM block induced by rocuronium and vecuronium, without being connected with serious adverse events. It is accepted that in order to reverse shallow block, the suggested dose of sugammadex comes up to 2 mg/kg. Profound level of NM block demands 4 mg/kg in order to defy few responses at the post titanic count. Doses of sugammadex lower than 1 mg/kg may lead to rebound of rocuronium's effect. Higher doses of sugammadex (12 16 mg/g) are used in rescue reversal. In children and adolescents the 2 mg/kg dose is both effective and well tolerated, while, to date, data regarding infants are scarce. In patients with renal failure, 2 mg/kg of sugammadex resulted in a mean time to recovery of TOF ratio to 0.9 in 2 min, which was quicker than the time of reversal by acetylcholinesterase inhibitors. Investigations in cardiac patients undergoing noncardiac surgery suggest that 2 and 4 mg/kg of sugammadex are both safe and effective. Compared with neostigmine, sugammadex has no need to use muscarinic antagonists and therefore is not associated with variations in heart rate. Trials indicate that sugammadex acts faster than edrophonium and neostigmine. Sugammadex is a promising, well tolerated agent that enables fast reversal in different depths of NM block -shallow and profound- and in different patients populations. After completion of trial probation and settlement of issues concerning estimated cost and cost impact, it is believed to play a leading part in future anesthesiology.