An Aberrant Origin of the Right Hepatic Artery: A Rare Anatomic Variation. And Its Clinical Application

The right hepatic artery is an important arterial supply to right lobe of the liver. And the knowledge of the normal anatomy and anatomical variations of the right hepatic artery is essential to perfume, and will minimize morbidity, and also help to decrease the number of complications of hepatobiliary surgery. This study was conducted on eleven human cadavers, which were obtained from the routine autopsies at the dissection room of the Anatomy Department. During dissection of the eleven cadaveric livers, we found a case with an ex-ceptional anatomic variation;a replaced right hepatic artery (RRHA) coming off the superior mesenteric artery (SMA), directly to the hepatic right lobe passing through the Calot’s triangle, crossing behind the common hepatic duct (CHD). Our objective is to draw much attention to this particularly anatomic variation of the origin of the RRHA as well as its clinical importance in order to ensure that no damage will be made during gastrointestinal and hepatobiliary surgery.

Anatomic Variation in Palatal Root of Maxillary Second Molar: Endodontic Management

The aim of the present clinical case report is to describe the singular root canal anatomy and endodontic management of a maxillary second molar with two palatal roots and two separate canal orifices. A 60 years-old female Hispanic/Latino patient attended the Endodontic Department at University of Buenos Aires School of Dentistry with acute pain in her maxillary left second molar. Clinical radiographs examination revealed unusual root morphology. Cleaning and shaping were completed with 5.25% NaOCl irrigation, 15% EDTA solution and hand/rotary instruments. Filling was performed with gutta-percha points and resin-based sealer. After one year follow-up periapical radiographs and CBCT images showed healing in the area and patient was asymptomatic.

Ultrasonographic identification of lateral femoral cutaneous nerve anatomical variation in persistent meralgia paresthetica:A case report

BACKGROUND Meralgia paresthetica(MP)is an entrapment mononeuropathy of the lateral femoral cutaneous nerve(LFCN).Although structural abnormalities in nerve tissues can be confirmed using ultrasonography,this is not routinely performed.CASE SUMMARY Herein,we present the case of a 52-year-old woman who developed MP after laparoscopic gynecological surgery.The patient was referred to our clinic from an obstetrics and gynecology clinic with symptoms of numbness and a tingling sensation in the left anterolateral thigh,which developed after surgery performed 5 mo earlier.Tests were performed to assess the disease status and determine the underlying causes.Ultrasonographic examination revealed an anatomical variation,where the left LFCN was entrapped within the inguinal ligament.This case suggests that performing ultrasonographic examination before and after surgery in the lithotomy position could help prevent MP.CONCLUSION This case demonstrates the value of ultrasonography in detecting anatomical variation and diagnosing persistent MP.Ultrasonography should be considered an adjunct to electromyography for optimal MP management.Further,this case would help other clinicians determine patient prognosis and decide on targeted treatment strategies.

Choledocholithiasis caused by anatomical variation of cystic duct: A case report

Laparoscopic cholecystectomy(LC)has gradually become the first choice for the treatment of cholecystolithiasis in recent years.Iatrogenic bile duct injury(IBDI)is an important clinical problem in LC.The anatomical variation of the cystic duct increases the probability of IBDI and the difficulty of operation.We present a case of a 44-year-old male with a anatomical variation of the cystic duct complicated with cholecystolithiasis and choledocholithiasis,who successfully underwent choledocholithotomy,choledochoscopic exploration and T-tube drainage surgery.The patient recovered well and was discharged home on postoperative day 10.The T-tube was removed at 1 month postoperatively after cholangiography examination of no choledocholithiasis left.

Supernumerary brachioradialis-Anatomical variation with magnetic resonance imaging findings:A case report

BACKGROUND In this single case report study,we describe an anatomical variance of a brachioradialis muscle with two muscle bellies and two tendons with their common insertion on the suprastyloid crest of a distal radius.CASE SUMMARY After a self-mutilating forearm injury of a borderline personality patient,we observed the anatomical variation of brachioradialis tendon.After tendon repair and aftercare the muscle function recovered completely.Five months after surgery the forearm magnetic resonance imaging was done revealing a supernumerary brachioradialis muscle.CONCLUSION Anatomical variations of forearm muscles and tendons are not rare.The treating surgeons should be aware of their existence and anatomical relationships.

Root Canal System Variation in Mandibular Second Molar: Middle-Mesial Canal

Middle-mesial canals in mandibular molars are present in the population depending on age, sex and ethnicity. However, limited literature alludes to its prevalence. Troughing procedures may enhance identification, cleaning and shaping. This case report expresses the recognition and management of middle-mesial canal in a mandibular second molar of 24 years old Hispanic-Latino male.

Commentary on:“Evaluation of variations in sinonasal region with computed tomography”

This letter is a commentary on the article titled "Evaluation of variations in sinonasal region with computed tomography", published in the January 2016 issue of World Journal of Radiology. The authors definition of the secondary middle turbinate is incorrect. The authors stated that the secondary middle turbinate is an accessory turbinate that is seen between the superior and middle turbinates. It should originate from the middle meatus posterosuperior to the ethmoid infundibulum.

Variations in the bifurcation level of the abdominal aorta, formation level of the inferior vena cava, and insertion level of the left renal vein into the inferior vena cava and their clinical importance in laparoscopic surgery

Objective: It is important to minimize the risk of major vascular injury during pneumoperitoneumestablishment in laparoscopic surgeries for patients with unusual variations in the levels of theabdominal aorta, the inferior vena cava (IVC), and the left renal vein, which will decrease the morbidityand mortality. The study aims to assess the variations regarding the bifurcation level of the abdominalaorta, formation level of the IVC, and insertion level of the left renal vein into the IVC.Methods: This retrospective study was conducted on 100 patients (50 males and 50 females) referred tothe Department of Radiology, Jordan University Hospital for abdomino-pelvic CT with intra-venouscontrast from January 2018 to December 2019. The three vessels were determined on the axial plane,the coronal plane, and the midsagittal plane. The central vertebral body height as well as the distance ofthe level of the point of interest to the upper end plate of the vertebrae were measured. Afterwards, theresults were classified into the following categories, upper end plate, lower end plate, intervertebral disc,upper half, and lower half of the vertebra.Results: The aortic bifurcation was mainly found at the level of the L4 vertebral body (65, 65%). In theremaining cases, the bifurcation was found to be variably located spanning from L3 in 11 (11%) cases to3 (3%) cases at L5. As for the iliocaval junction, the most common site was also at the level of L4 with41 (41%) cases followed by 39 (39%) cases at the level of L5, and 20 (20%) cases at the intervertebral discof L4/L5. The left renal vein most commonly joined the IVC at the level of L1 with 62 (62%) cases followedby 20 (20%) cases at the intervertebral disc T12/L1. There was wide variation in its entry to the IVCspanning from 4 (4%) cases at T12/L1 to 1 (1%) case at L4.Conclusion: The anatomical variation of the major vessels can be found in the normal population.Therefore, sufficient investigation of the anatomical position of these vessels is essential for patientsbefore laparoscopic surgery.

Common trunk of the right accessory renal artery and right inferior phrenic artery originating from the thoracic artery:An unreported variation

Accessory renal arteries(ARAs)are common and usually originate from the abdominal aorta and the renal artery.Inferior phrenic arteries(IPAs)can also arise from the abdominal aorta or its branches.In this paper,we present the first case of a common trunk of the right ARA and right IPA arising from the thoracic artery at the level of T10,which was discovered by multidetector-row computed tomography in pretherapeutic evaluation and clearly confirmed by selective angiography.It is important to recognize this anatomical variation when performing cardiovascular and interventional radiological procedures.

Anatomic Dissection of the Femoral Vein at the Bamako Anatomy Laboratory

Objectives: The purpose of this work was to measure the dimensions of the femoral veins, to describe the affluent and the variations of the femoral veins. Methodology: Twenty-four femoral veins of 12 fresh adult cadavers were dissected and photographed. Results: The diameter of the superficial, deep and common femoral veins was respectively 8.75 mm;7.60 mm and 13.95 mm. The common femoral vein was 80.70 mm long. At the level of the superficial vein, the modal disposition was noted in 79.17%;as anatomical variations, it was split in 2 cases, the presence of a collateral canal in 1 case and in 2, and it received a quadricipital muscle vein. At the level of the deep femoral vein, the modal disposition was noted in 16.67%, and the anatomical variations were noted in 83.33% where it received no affluent in the femoral trine. The modal disposition was noted in 91.67% at the level of the mode of birth of the common femoral vein, in 16.67% at the level of its tributaries. The anatomical variations were noted in 8.33% in the mode of birth of the femoral vein, in 83.33% in which the common femoral vein received, in addition to the large saphenous vein, other tributaries, the most frequent of which were the quadricipital veins and the circumflex femoral veins. Conclusion: The diameter of the femoral veins is important. The main tributaries of the common femoral vein are GVS, VQ and circumflex femoral veins. The femoral variations are numerous and important to know to avoid a possible misdiagnosis in case of their thrombosis.

Evaluation of variations in sinonasal region with computed tomography

AIM: To investigate the frequency of anatomical variations in sinonasal region and association of these variations with mucosal diseases. METHODS: The study included 400 cases(191 female and 209 male) who were considered to have preliminary diagnoses of sinonasal pathology and who had paranasal sinus computed tomography(CT) examination in axial plane. Reformatted CT images were studied in all planes.RESULTS: Age range of the patients was 20-83(mean 40.26 ± 14.85). Most commonly detected anatomical variation was Agger nasi cell(74.8%). There was a significant association between clinoid process pneumatization and protrusion of internal carotid arteries and optic nerves into sphenoid sinus(P < 0.001). Besides,the relationships between pterygoid process pneumatization and protrusion of vidian nerve into sphenoid sinus,and between pneumatization of large sphenoid wing and protrusion of maxillary nerves into sphenoid sinus were also significant(P < 0.001). Uncinate bulla and giant ethmoid bulla were found to be significantly associated with sinonasal mucosal diseases(P = 0.004 and P = 0.002,respectively).CONCLUSION: Sinonasal region has a great number of variations,and some of them have been determined to be associated with sinonasal mucosal disease. It is necessary to know that some of these variations are associated with protrusion of significant structures such as carotid artery or optic nerve into the sinus and care should be observed in surgeries on patients carrying these variations.

High Prevalence of Anatomical Variations and Anomalies of the CoronaryArteries Detected by CT Angiography in Symptomatic Patients

Objective:Coronary artery anatomical variations and anomalies are an important topic due to their potential clinical manifestations.This study aims to investigate the prevalence of coronary artery anatomical variations and anomalies in symptomatic patients with coronary computed tomography angiography(CCTA).Methods:This is a retrospective study that included all symptomatic patients who had CCTA in a tertiary care hospital in Saudi Arabia during a period of seven years.Results:The total number of included patients was 507(60%males)with a mean age of 57.4 years.Approximately 41%had luminal stenoses,averaging 49.7%.The total num-ber of patients with coronary anatomical variations(CAV)and coronary artery anomalies(CAA)was 217(43%).CAV prevalence was 26%,which included 14%non-right coronary dominance,5%short left main coronary artery(LMCA),and 7%division variations(trifurcation and quadrifurcarion)of the LMCA.The prevalence of CAA was 29%,which included 5%origin anomalies,22%myocardial bridge,and 2%course anomalies.Conclusions:A high prevalence of coronary artery anatomic variations and anomalies in symptomatic patients is reported in this study.Systematic reviews,meta-analyses,reporting guidelines,and unified definitions and classifications of cor-onary variations and anomalies are lacking in the literature,presenting potential opportunities for future research and publications.

鼻窦CT在内镜鼻窦手术前前颅底解剖变异评估中的临床价值

目的探究鼻窦CT在内镜鼻窦手术前前颅底解剖变异评估中的临床价值。方法对北京京煤集团总医院2019年8月~2022年8月间收治的鼻内镜手术患者150例(300侧)进行回顾性分析,患者术前均行鼻窦CT扫描,测量筛板和筛孔中心之间外侧板的长度(LLCP长度)并进行Keros分型,测量筛前动脉(anterior ethmoidal artery,AEA)至颅底的距离并进行分型,采用Spearman相关性分析AEA悬空与Keros分型的相关性,测量LLCP与筛板向外侧的延长线所形成的夹角(LLCP-CP角),根据LLCP-CP角进行医源性损伤风险分型(Gera分型),观察钩突上附着点(superior attachment of uncinate process,SAUP)的解剖位置并进行分型,分析SAUP分型与钩突内引流、外引流以及额窦炎发生率的关系。结果150例患者嗅凹深度(5.82±1.16)mm,AEA至颅底距离(3.78±1.09)mm,AEA至额嘴长度(13.97±2.45)mm,LLCP长度0.5~13(5.60±1.24)mm,LLCP-CP角69.22°±12.85°;AEA位置I型64例(42.67%),Ⅱ型28例(18.67%),Ⅲ型58例(38.67%),AEA悬空率38.67%,AEA悬空与AEA非悬空患者AEA至额嘴长度差异无统计学意义(P>0.05);不同Keros分型的AEA悬空率差异有统计学意义(P<0.05),且Spearman相关性分析显示,AEA悬空率与Keros分型呈正相关(r=0.613,P<0.001);Gera分型Ⅰ型35例(23.33%),Ⅱ型108例(72.00%),Ⅲ型7例(4.67%),Gera分型与Keros分型无显著相关性(P>0.05);150例患者(300侧)中,SAUP分型Ⅰ型164侧(54.67%),Ⅱ型16侧(5.33%),Ⅲ型12侧(4.00%),Ⅳ型60侧(20.00%),Ⅴ型48侧(16.00%),钩突内引流162侧,钩突外引流138侧,钩突内引流额窦炎发生率高于钩突外引流(P<0.05)。结论慢性鼻窦炎鼻内镜术前行鼻窦CT检查,可明确AEA位置、LLCP-CP角、SAUP位置等的解剖变异情况,有助于识别颅底损伤高风险患者。

Appendicitis in double cecal appendix: Case report

Double cecal appendix is a rare anatomical variation. Approximately 100 cases have been reported worldwide. It is usually diagnosed incidentally during emergency appendectomies due to inflammatory processes in the cecal appendix. Case presentation: male, white, 36 years old, obese, presenting with pain in the lower abdomen for 24 h followed by nausea, vomiting and mild fever. He was subjected to additional tests, with the leukogram showing leukocytosis and abdominal ultrasonography depicting cecal appendix with thickened wall, locally associated with small quantities of liquid and intestinal loop obstruction. He underwent laparotomy, revealing acute appendicitis. Another intestinal loop obstruction was identified next to the ileum, leading to recognizing another cecal appendix after local dissection. Double appendectomy and segmental iliectomy were performed although not needed. Results of the anatomopathological examination of the surgical samples showed acute inflammation in the two cecal appendices. So, performing a routine retroperitoneal release and a complete cecum evaluation during such surgical procedures is recommended and suggested due to the possibility of not identifying a second cecal appendix.

Study of morphologic variability of incudostapedial angle and its relation with temporal bone pneumatization

Introduction:Optimal sound transmission across the ossicular chain is dependent on the appropriate alignment of the middle ear ossicles.Incudostapedial joint(ISJ)is conventionally considered to be at right angle.Objective:We intended to study the ISJ anatomy and the impact of temporal bone pneumatization on the same.Methods:In a cadaveric study comprising of 47 human temporal bones,canal wall down mastoidectomy was carried out under microscopic guidance keeping the ossicular chain intact.The morphology of ISJ was recorded and analysed with respect to the pneumatization status of the temporal bone.The data analysis was performed using statistical software Stata version 12.0.Results:The mean ISJ angle for the 47 bones was 90.5^0(SD-15^0;range:54^0-122^0).The mean angle in well pneumatized bones was 93.7^0(SD-16.5;Range:54°-122^0)and in sclerotic mastoids was 88.7^0(SD-14;Range:68°-118^0).The difference in the ISJ angle in these two conditions was not statistically significant(p=0.27).The mean angle was found to be significantly more obtuse in the cases with partially eroded ISJ(111.4^0{SD-8.8;range:100.3^0-221.9^0};p=0.0001)and in the cases with an‘adherent/tilted morphology’of the stapes suprastructure with the promontory(mean-95.8^0(SD-13.8;range:70.7^0-120.4^0);p-<0.00001).Conclusion:The ISJ angle shows considerable variations.This variability needs to be taken into account when undertaking middle ear reconstructive procedures,specifically the ones involving the stapes footplate.The mastoid pneumatization does not appear to have an impact on the ISJ angle.

Deep vein thrombosis in patient with left-sided inferior vena cava draining into the hemiazygos vein: A case report

BACKGROUND Abnormalities of the inferior vena cava(IVC)are uncommon,and in many cases they are asymptomatic.Even so,it is vital that clinicians be aware of such anomalies prior to surgery in affected individuals.In the present report,we describe a rare anatomical variation of the IVC.CASE SUMMARY A 66-year-old male was admitted to the hospital due to deep vein thrombosis of the right lower extremity.Upon contrast-enhanced computed tomography imaging,we found that this patient presented with a case of left-sided IVC draining into the hemiazygos vein,while his hepatic vein was directly draining into the atrium.CONCLUSION Cases of left-sided IVC can increase patient susceptibility to thromboembolism owing to the resultant changes in blood flow and/or associated vascular compression.

Rare location and drainage pattern of right pulmonary veins and aberrant right upper lobe bronchial branch: A case report

BACKGROUND Complex aberration in lung is rare,which may increase risk of vascular injury and cause ligation of wrong pulmonary vein or bronchus by mistake during lung surgery,and result in sever complication like pulmonary congestion or atelectasis.CASE SUMMARY A 44-year-old female was admitted for a ground glass nodule(24 mm in diameter)in her right upper lobe.Video-assisted thoracoscopic(VATS)right upper lobectomy with lymph nodes dissection was performed.During operation,we simultaneously identified extremely rare aberrations of right preeparterial bronchus,right upper lobe vein behind pulmonary artery and right middle lobe vein drained into left atrium in this patient.The patient was well recovered and discharged at the postoperative-day 4.CONCLUSION Preoperatively,three-dimensional reconstruction can help to identify inconspicuous variation of pulmonary vessels and bronchus effectively.During lung surgery,if anatomic aberration is suspected,careful dissection of vessels and bronchus will help to confirm whether there is an aberration or not.

Large Riedel’s lobe and atrophic left liver in a donor-Accept for transplant or call off?

BACKGROUND In context of suboptimal liver utilisation,grafts with various risk factors are under consideration today.For example,impaired vascularity with severe arterial calcifications and modified liver shapes are no longer contraindications and their use depends on the centre policy and experience of the surgical team.Riedel liver lobes represent a tongue-like liver shape with inferior projection in the right liver lobe.Such development modifications were initially described when patients developed a lesion and subsequently presented with symptoms.We here present the first case report in the literature,where such livers with anatomical variations were used for transplantation.CASE SUMMARY We describe here two cases of adult human liver transplantation,where we have accepted two donor livers with modified shape.The technical considerations for transplantation of such livers,found with enlarged right lobes,or Riedel shape,and hypo-trophic left lateral segment are highlighted.Both recipients experienced immediate liver function and overall good outcomes with a minimum follow up of 1 year.We also provide detailed pictures and outcome analysis in combination with a literature review.CONCLUSION The utilisation of donor livers with modified shape,such as Riedel’s Lobe appears safe and will increase the donor pool.

Multidetector computer tomography and magnetic resonance imaging of double superior mesenteric veins:A case report

BACKGROUND This study aimed to describe the findings of double superior mesenteric veins(SMVs),a rare anatomical variation,on multidetector computer tomography(MDCT)and magnetic resonance imaging(MRI)images.CASE SUMMARY We describe the case of a 34-year-old male,who underwent both MDC and MRI examinations of the upper abdomen because of liver cirrhosis.MDCT and MRI angiography images of the upper abdomen revealed an anatomic variation of the superior mesenteric vein(SMV),the double SMVs.CONCLUSION The double SMVs are a congenital abnormality without potential clinical manifestation.Physicians need to be aware of this anatomical variation during abdominal surgery to avoid iatrogenic injury.

Analysis of the Influence of Sound Source Position and Electrode Placement on the Stimulation Pattern of the Cochlear Implant under Noise Conditions: Optimization of Auditory Perceptual Effects

Background: Cochlear implants (CI) are widely used to restore hearing in people with severe to profound hearing loss. However, optimizing CI performance, especially in difficult listening environments with background noise, remains a major challenge. Understanding the influence of factors such as sound source position and electrode placement on CI stimulation patterns is critical to improving auditory perception. Methods: In this study, an analysis was conducted to investigate the influence of sound source position and electrode placement on CI stimulation patterns under noisy conditions. For this purpose, a special measurement setup with a CI speech processor-microphone test box was used to simulate realistic listening scenarios and measure CI performance. Results: The results show that the effectiveness of CI noise reduction systems is influenced by factors such as the position of the sound source and electrode placement. In particular, the beamforming ultra zoom mode showed significantly better noise reduction than the omnidirectional mode, especially under real listening conditions. Furthermore, differences in electrode responses indicate individual variability in the CI user experience, highlighting the importance of personalized fitting algorithms. Conclusions: The results demonstrate the importance of considering environmental factors and individual differences when optimizing CI performance. Future research efforts should focus on the development of personalized fitting algorithms and the exploration of innovative strategies, such as the integration of artificial intelligence, to improve CI functionality in different listening environments. This study contributes to our understanding of CI stimulation patterns and lays the foundation for improving auditory perception in CI users.