Analysis of Variation in the Origin of the Obturator Artery in Midwestern American Donor Bodies.

The obturator artery (OA) is typically a branch of the anterior division of the internal iliac artery. However, an aberrant obturator artery origin may lead to clinical complications. Because of its location in the pelvic cavity, the OA is at high risk of injury or laceration during a variety of pelvic surgeries. Regarding this, variations in the origins of the OA may result in bleeding that can often be overlooked, rendering treatment ineffective. Our study aimed to assess the origins and course of the OA in Midwestern American donor bodies. Sixty-two donor bodies were obtained from the Gift of Body Donation Program at A.T. Still University's Kirksville College of Osteopathic Medicine. The origin of each OA was documented and photographed. The OA was identified by observing the vessel's passage through the obturator foramen. Of 132 OAs studied, 72 (54.5%) had an aberrant OA. Further, 22 (16.7%) had an aberrant OA origin from the inferior epigastric artery, 20 (15.2%) had an aberrant OA origin from the posterior division of the internal iliac artery, 22 (16.7%) had an aberrant OA origin from dual origins of the anterior division of the internal iliac artery and the inferior epigastric artery, and eight (6.1%) had other aberrant OA origins. Overall, our results indicated anatomical variations are common in the origins and course of the OA. These data highlight the importance of considering variations in the OA and the prevalence of those variations during vascular and orthopedic procedures.

Variations of the Cystohepatic Blood Supply in American Midwestern Donor Cadavers.

Knowledge of right hepatic artery (RHA) and cystic artery (CA) variations is crucial for surgeons performing procedures on the hepatobiliary system, pancreas, and duodenum. Commonly, the RHA originates from the superior mesenteric artery (SMA), while the CA originates from the RHA and is found within the cystic triangle during laparoscopic cholecystectomies. Here we investigated variations in the origin and path of the RHA and CA in a sample of American midwestern cadavers (n = 18) from the Gift of Body Program at A.T. Still University's Kirksville College of Osteopathic Medicine. Portal triads and associated vessels were dissected to reveal the artery pathways. The origin, branching pattern, and course of the RHA and CA were documented, and descriptive measurements were taken. We describe four cases where the RHA originated from the anterolateral proximal SMA, traveled deep to the pancreatic neck, and had a slightly variable but close relationship with the portal triad structures. The CA was present in the cystic triangle in all 18 donors, typically originating from the RHA except for one case where it originated from the left hepatic artery. In six cases, the CA originated outside of the cystic triangle, crossing either superficially or deeply to the common hepatic duct to enter the cystic triangle. Knowledge of these variations will enhance preoperative planning and the overall safety of surgical procedures in this area.

Learning to live with multiple sclerosis cognitive impairment and how it influences readiness for group cognitive intervention.

BACKGROUND: Up to 65% of people with multiple sclerosis (MS) have cognitive impairment that negatively affects quality of life, social functioning, and work. Evidence is building to suggest cognitive rehabilitation is a helpful intervention strategy, and that a group approach can be effective for individuals with MS. Further exploration of how to maximize the potential of group cognitive interventions is warranted. OBJECTIVE: To describe how the psychological process of learning to live with MS-related cognitive changes influences participation in a group cognitive intervention. METHODS: A qualitative design with interpretive description approach was used to ask consumers with MS the important features of a group cognitive intervention. Ten females with self-reported physician-diagnosed MS participated in two focus groups. Focus groups were audio recorded and transcribed. Inductive analysis resulted in content and process categories and themes. RESULTS: The focus groups echoed the processes and relationships that occur in a group intervention program. The main three themes represented stages in a process of learning to live with cognitive changes. The three themes were: 1) coming to know yourself with cognitive changes, 2) learning to cope with cognitive changes and 3) living a changed life. Relationships exist between these stages and the extent to which an individual will benefit from a group cognitive intervention program. CONCLUSIONS: Knowledge of group process and the psychological processes involved in behavioral change are essential skills for facilitating a cognitive intervention group for people with MS.