Accessory renal arteries-a source of hypertension:A case report

BACKGROUND Secondary hypertension is a relatively rare condition most commonly caused by renovascular disease due to atherosclerotic vascular disease or fibromuscular dysplasia.Although accessory renal arteries are frequent,to date,only six cases of secondary hypertension determined by their existence have been reported.CASE SUMMARY We describe a case of a 39-year-old female who came to the emergency department with an urgent hypertensive crisis and hypertensive encephalopathy.Despite normal renal arteries,the computed tomography angiography revealed an inferior polar artery with 50%stenosis of its diameter.Conservative treatment with amlodipine,indapamide and perindopril was adopted,leading to blood pressure control within one month.CONCLUSION To the best of our knowledge,there are controversies regarding accessory renal arteries as a potential etiology for secondary hypertension,but the seven similar cases already described,along with the current case,could reinforce the necessity of more studies concerning this subject.

Transseptal approach for catheter ablation of left-sided accessory pathways in children with Marfan syndrome:A case report

BACKGROUND Left-sided accessory pathways(APs)can be accessed with either a transaortic(TA)or transseptal approach(TS).For children with Marfan syndrome(MFS)who have aortic disease,the use of TA can aggravate the disease,making TS the best choice for these patients.CASE SUMMARY A 10-year-old girl was hospitalized because of intermittent heart palpitations and chest tightness.She was diagnosed with MFS,supraventricular tachycardia,Wolff-Parkinson-White syndrome,and left-sided AP was detected by cardiac electrophysiological.Catheter ablation was successfully performed via TS under the guidance of the Ensite system.During the follow-up,no recurrence or complications occurred.CONCLUSION The TS for catheter ablation of left-sided APs can be considered in children with MFS.Adequate evaluation and selection of the appropriate puncture site are particularly important.

Diagnostic accuracy of apparent diffusion coefficient to differentiate intrapancreatic accessory spleen from pancreatic neuroendocrine tumors

BACKGROUND Intrapancreatic accessory spleen(IPAS)shares similar imaging findings with hypervascular pancreatic neuroendocrine tumors(PNETs),which may lead to unnecessary surgery.AIM To investigate and compare the diagnostic performance of absolute apparent diffusion coefficient(ADC)and normalized ADC(lesion-to-spleen ADC ratios)in the differential diagnosis of IPAS from PNETs.METHODS A retrospective study consisting of 29 patients(16 PNET patients vs 13 IPAS patients)who underwent preoperative contrast-enhanced magnetic resonance imaging together with diffusion-weighted imaging/ADC maps between January 2017 and July 2020 was performed.Two independent reviewers measured ADC on all lesions and spleens,and normalized ADC was calculated for further analysis.The receiver operating characteristics analysis was carried out for evaluating the diagnostic performance of both absolute ADC and normalized ADC values in the differential diagnosis between IPAS and PNETs by clarifying sensitivity,specificity,and accuracy.Inter-reader reliability for the two methods was evaluated.RESULTS IPAS had a significantly lower absolute ADC(0.931±0.773×10^(-3)mm^(2)/s vs 1.254±0.219×10^(-3)mm^(2)/s)and normalized ADC value(1.154±0.167 vs 1.591±0.364)compared to PNET.A cutoff value of 1.046×10^(-3)mm^(2)/s for absolute ADC was associated with 81.25%sensitivity,100%specificity,and 89.66%accuracy with an area under the curve of 0.94(95%confidence interval:0.8536-1.000)for the differential diagnosis of IPAS from PNET.Similarly,a cutoff value of 1.342 for normalized ADC was associated with 81.25%sensitivity,92.31%specificity,and 86.21%accuracy with an area under the curve of 0.91(95%confidence interval:0.8080-1.000)for the differential diagnosis of IPAS from PNET.Both methods showed excellent inter-reader reliability with intraclass correlation coefficients for absolute ADC and ADC ratio being 0.968 and 0.976,respectively.CONCLUSION Both absolute ADC and normalized ADC values can facilitate the differentiation between IPAS and PNET.

Accessory navicular in children

Accessory navicular(AN)is a developmental variation of the secondary ossification center of the navicular tuberosity.Ten percent of patients with AN will have pain symptoms that affect walking and life.As the AN changes the position of the posterior tibial tendon insertion,children with AN often have posterior tibial tendon function insufficiency and flexible flat foot.Surgical treatment is often required after failure of conservative treatment.This article reviewed the etiology,clinical manifestations,complications,and treatment methods of AN.

Three-dimensional imaging identified the accessory bile duct in a patient with cholangiocarcinoma

The development of diagnostic imaging technology, such as multidetector computed tomography(MDCT) and magnetic resonance cholangiopancreatography(MRCP), has made it possible to obtain detailed images of the bile duct. Recent reports have indicated that a 3-dimensional(3D) reconstructed imaging system would be useful for understanding the liver anatomy before surgery. We have investigated a novel method that fuses MDCT and MRCP images. This novel system easily made it possible to detect the anatomical relationship between the vessels and bile duct in the portal hepatis. In this report, we describe a very rare case of extrahepatic cholangiocarcinoma associated with an accessory bile duct from the caudate lobe connecting with the intrapancreatic bile duct. We were unable to preoperatively detect this accessory bile duct using MDCT and MRCP. However, prior to the second operation, we were able to clearly visualise the injured accessory bile duct using our novel 3D imaging modality. In thisreport, we suggest that this imaging technique can be considered a novel and useful modality for understanding the anatomy of the portal hepatis, including the hilar bile duct.

Accessory Breast Cancer Occurring Concurrently with Bilateral Primary Invasive Breast Carcinomas:A Report of Two Cases and Literature Review

The development of accessory breast tissue,which is found anywhere along the milk line,is attributed to the failure of milk line remnants to regress during embryogenesis.Primary tumors may arise from any ectopic breast tissue.Accessory breast cancer occurring concurrently with primary invasive breast cancer is extremely rare.Two such cases were reported in this article.One was a 43-year-old Chinese female who exhibited bilateral breast cancer(invasive ductal carcinoma,not otherwise specified,IDC-NOS) and an accessory breast carcinoma(IDC-NOS) incidentally identified in her left axilla.The ectopic breast tissue in her right axilla presented with adenosis.The patient was surgically treated,followed by postoperative docetaxel epirubicin(TE) chemotherapy.The second case was a 53-year-old Chinese female with bilateral breast cancer(apocrine carcinoma) accompanied by an accessory breast carcinoma(IDC-NOS) in her right axilla that was also incidentally identified.The patient was surgically treated after three doses of cyclophosphamide epirubicin docetaxel(CET) neoadjuvant chemotherapy,followed by adjuvant chemotherapy of the same regimen.

Male accessory gland inflammation prevalence in type 2 diabetic patients With symptoms possibly reflecting autonomic neuropathy

Male accessory gland inflammation or infection （MAGI） is a potentially underdiagnosed complication of type 2 diabetes （DM2）; specifically, we reported in a recent study that the frequency of MAGI was 43% among DM2 patients. In previous studies, we have demonstrated that diabetic autonomic neuropathy （DAN） is associated with a peculiar ultrasound characterization of the seminal vesicles （SVs） in DM2 patients. The aim of the present study was to evaluate the frequency of MAGI in two different categories of DM2 patients （i.e. patients with and without symptoms that possibly reflect DAN） and the respective ultrasound characterizations. Sixty DM2 patients with a mean （± s.e.m.） age of 42.0 ± 6.0 years （range： 34-47 years） were classified according to the presence or the absence of symptoms that could possibly reflect DAN （group A： DM2 with symptoms possibly reflecting DAN, n = 28 patients and group B： DM2 without symptoms possibly reflecting DAN, n = 32 patients）. The patients in Group A exhibited a significantly higher frequency of MAGI compared with those in group B patients （P 〈 0.05）; moreover, the Group A patients exhibited a significantly higher frequency of ultrasound signs suggestive of vesiculitis （P 〈 0.05）. Finally, the concentrations of lymphocytes but not the concentrations of the leukocytes in the semen were significantly higher （P 〈 0.05） in group A compared with group B.

Management of bile duct injuries combined with accessory hepatic duct during laparoscopic cholecystectomy

Bile duct injuries(BDIs)are difficult to avoid absolutely when the biliary tract has a malformation,such as accessory hepatic duct.Here,we investigated the management strategies for BDI combined with accessory hepatic duct during laparoscopic cholecystectomy.

Enlarged accessory spleen presenting stomach submucosal tumor

A 62-year-old man presented with upper abdominal discomfort underwent upper gastrointestinal endoscopy. Gastroscopy and endoscopic ultrasonography revealed a submucosal tumor (SMT) with homogenous echogenicity originated from extragastric organs. An abdominal contrast-enhanced computed tomography (CT) showed that the well-marginated ovoid mass, approximately 6 cm in diameter, enhanced homogenously to a similar degree as splenic parenchyma. 99mTechnetium sulfur colloid scintigraphy revealed the splenic nature of the mass. A diagnosis of accessory spleen mimicking gastric SMT was made. Subsequent follow-up was uneventful without performing splenectomy.

Clinical implications of accessory pancreatic duct

The accessory pancreatic duct (APD) is the main drainage duct of the dorsal pancreatic bud in the embryo,entering the duodenum at the minor duodenal papilla (MIP).With the growth,the duct of the dorsal bud undergoes varying degrees of atrophy at the duodenal end.Patency of the APD in 291 control cases was 43% as determined by dye-injection endoscopic retrograde pancreatography.Patency of the APD in 46 patients with acute pancreatitis was only 17%,which was significantly lower than in control cases (P < 0.01).The terminal shape of the APD was correlated with APD patency.Based on the data about correlation between the terminal shape of the APD and its patency,the estimated APD patency in 167 patients with acute pancreatitis was 21%,which was signif icantly lower than in control cases (P < 0.01).A patent APD may function as a second drainage system for the main pancreatic duct to reduce the pressure in the main pancreatic duct and prevent acute pancreatitis.Pancreatographic f indings of 91 patients with pancreaticobiliary maljunction (PBM) were divided into a normal duct group (80 patients) and a dorsal pancreatic duct (DPD) dominant group (11 patients).While 48 patients (60%) with biliary carcinoma (gallbladder carcinoma,n=42;bile duct carcinoma,n=6) were identified in PBM with a normal pancreatic duct system,only two cases of gallbladder carcinoma (18%) occurred in DPD-dominant patients (P < 0.05).Concentration of amylase in the bile of DPD dominance was signifi cantly lower than that of normal pancreatic duct system (75 403.5 ± 82 015.4 IU/L vs 278 157.0 ± 207 395.0 IU/L,P < 0.05).In PBM with DPD dominance,most pancreatic juice in the upper DPD is drained into the duodenum via the MIP,and reflux of pancreatic juice to the biliary tract might be reduced,resulting in less frequency of associated biliary carcinoma.

Diagnosis and laparoscopic excision of accessory cavitated uterine mass in a young woman:A case report

BACKGROUND Accessory and cavitated uterine mass(ACUM)is an uncommon form of connate Müllerian anomaly seen in young and nulliparous women,which presents as chronic periodic pelvic pain and severe dysmenorrhea.The entity is often underdiagnosed due to a broad differential diagnosis,including rudimentary uterine horn,true cavitated adenomyosis and degenerating fibroids.CASE SUMMARY A 22-year-old woman who presented with severe dysmenorrhea and was initially misdiagnosed with cystic adenomyosis.Gynecological examination and ultrasonography were performed.The patient underwent laparoscopic excision of the mass and histopathological examination confirmed the diagnosis.Postoperatively,the patient did well,with no further dysmenorrhea.CONCLUSION ACUM is difficult to diagnose.A correct diagnosis can be made only after excision and histopathological evaluation.Surgical excision is necessary and can be carried out by laparoscopy.

Total laparoscopic removal of accessory gallbladder:A case report and review of literature

Accessory gallbladder is a rare congenital anomaly occurring in 1 in 4000 births, that is not associated with any specific symptoms. Usually this cannot be diagnosed on ultrasonography and hence they are usually not diagnosed preoperatively. Removal of the accessory gallbladder is necessary to avoid recurrence of symptoms. H-type accessory gallbladder is a rare anomaly. Once identified intra-operatively during laparoscopic cholecystectomy, the surgery is usually converted to open. By using the main gallbladder for liver traction and doing a dome down technique for the accessory gallbladder, we were able to perform the double cholecystectomy with intra-operative cholangiogram laparoscopically. Laparoscopic cholecystectomy was performed in 27-year-old male for biliary colic. Prior imaging with computer tomography-scan and ultrasound did not show a duplicated gallbladder. Intraoperatively after ligation of cystic artery and duct an additional structure was seen on its medial aspect. Intraoperative cholangiogram confirmed the patency of intra-hepatic and extra-hepatic biliary ducts. Subsequent dissection around this structure revealed a second gallbladder with cystic duct(H-type). Pathological analysis confirmed the presence of two gallbladders with features of chronic cholecystitis. It is important to use cholangiogram to identify structural anomalies and avoid complications.

Comparison of social interaction and neural activation in the main olfactory bulb and the accessory olfactory bulb between Microtus mandarinus and Microtus fortis

To gain insight into the function of AOB and MOB during different social interaction and in different vole species,the behaviors and neural activation of the olfactory bulbs in social interactions of mandarin voles Microtus mandarinus and reed voles Microtus fortis were compared in the present research.Mandarin voles spent significantly more time attacking and sniffing their opponents and sniffing sawdust than reed voles.During same sex encounters,mandarin voles attacked their opponents for a significantly longer time and sniffed its opponent for shorter time compared with male-female interactions.However,no significant behavioral differences were found during encounters of two individual reed voles,regardless of gender composition of the pair.Using c-Fos as an indicator of neural activation,we observed that neural activation was significantly higher in almost all sub-regions of the main olfactory bulb(MOB)and the accessory olfactory bulb(AOB)of mandarin voles compared with reed voles.Numbers of c-Fos-ir neurons in almost all sub-regions of the AOB and the MOB during male-female interactions were also higher than those in interactions of the same sex.Anterior-posterior ratios of Fos-ir neurons in the AOBM(AOBMR)and the AOBG(AOBGR)in male-female interaction were significantly higher than those in interaction of the same sex.The AOBMR of male mandarin voles and reed voles were larger than those of females in male-female interactions.Behavioral patterns are consistent with cellular activity patterns.Consistent level of neural activation in MOB and AOB suggests important roles of both the main olfactory bulb and the accessory olfactory bulb in social interaction in two species.

Intrapancreatic accessory spleen:A case report and review of the literature

Here,we report a case of intrapancreatic accessory spleen confirmed by pathologic diagnosis and discuss its differential diagnosis and surgical management with a review of the literature.

BEHAVIORS OF ACCESSORY ELEMENTS IN COPPER PYROMETALLURGY

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Mating behavior induces changes of expression of Fos protein,plasma testosterone and androgen receptors in the accessory olfactory bulb (AOB) of the male mandarin vole Microtus mandarinus

In order to investigate the neuroendocrine mechanism of the mating behavior in the adult male mandarin voles Microtus mandarinus,the radioimmunoassay(RIA)and immunohistochemistry methods were used to investigate the differences in plasma testosterone(T)concentrations and distribution of T immunoreactive neurons(T-IRs),androgen receptor immunoreactive neurons(AR-IRs)and Fos protein immunoreactive neurons(Fos-IRs)in the accessory olfactory bulb(AOB)and the main olfactory bulb(MOB)following exposure to clean hard-wood shavings(control group),soiled bedding(exposure group)or contact with an estrous female(mating group).Results showed that plasma T concentration was significantly higher in the mating group than that in the exposure group,and both the mating group and the exposure group displayed significantly higher plasma T concentration than the control group.T-IRs,AR-IRs and Fos-IRs were investigated with the immunohistochemistry method in granule cell(GC)and mitral cell(MC)of the MOB and the AOB in the three groups.There were significantly more T-IRs,AR-IRs and Fos-IRs in MC and GC of the AOB in the mating group than that in the exposure group or the control group.T-IRs,AR-IRs and Fos-IRs did not show significant differences between the exposure group and the control group.Furthermore,obvious differences in MC and GC of the MOB were not found among the three groups.The results confirm that both changes of T and AR in the AOB might be underlying mating behavior in the adult male mandarin voles.

Is an accessory nipple associated with an intrapancreatic accessory spleen?

Intrapancreatic accessory spleen(IPAS)is a rare differential diagnosis of a solitary hypervascular lesion.It is not uncommon to misdiagnose IPAS as pancreatic tumors since no specific imaging has been developed for the differential diagnosis.We described a rare case of a male patient with a unilateral accessory nipple and a solitary hypervascular lesion in the pancreas.The patient underwent a distal pancreaticosplenectomy,and IPAS was finally diagnosed.

A Proposed Area for Study of Accessory Section and Point of Terrestrial Permian-Triassic Boundary

After the establishment of the global stratotype section and point (GSSP) of the Permian Triassic boundary (PTB), the definition of the accessory section and point (ASP) of the terrestrial Permian Triassic boundary (TPTB) is now on the agenda. However, all good TPTB sections so far known have the following shortcomings: (1) the exact TPTB horizon is difficult to define paleontologically with high resolution, and (2) accurate correlation between marine and terrestrial PTBs is hard to attain. In order to enhance the understanding of the nature of the global life crisis in both the marine and terrestrial environments across the Paleozoic Mesozoic transition, these shortcomings need to be addressed. In western Guizhou and eastern Yunnan, Southwest China, some fossiliferous PTB sections which include marine, paralic and terrestrial are well developed, allowing bed to bed correlation of the PTB sequences. Fortunately, the marine PTB sequence in this area is almost the same as found at the Meishan Section, where the GSSP of the PTB is located, which may provide a reliable auxiliary marker for high resolution demarcation of the TPTB. These features found in western Guizhou and eastern Yunnan make this area a good place to study the ASP of the TPTB, so we propose to study the ASP of the TPTB in this area.

Spinal accessory neuropathy in patients with chronic neck pain

AIM: To assess the presence of spinal accessory neuropathy in patients with chronic neck pain.METHODS: Patients with pain either regional or focal in the neck or shoulders for at least 6 mo(chronic neck pain) were recruited randomly from the Rheumatology and Rehabilitation Outpatient Clinic at the Faculty of Medicine-Suez Canal University. Two groups were compared: 30 patients with chronic neck pain with mean age(36.97 ± 12.45 years) and 10 apparently healthy controls. Trapezius muscle examination including inspection and range of motion both active and passive was performed. A full clinical neurological examination was carried out to exclude peripheral neuropathy and motor neuron disease. According to the subject's type of work, cases were categorized into labor-intensive and non-labor intensive tasks. A nerve conduction study(NCS) was performed on spinal accessory nerves at both sides for all patients and controls. Parameters including latencies and amplitudes of compound motor action potential(CMAP) were compared with the chronicity of neck pain using the neck disability score. This cross sectional study was carried in the Rheumatology and Rehabilitation Department, at Suez Canal University Hospital, Ismailia, Egypt.RESULTS: Physical examination revealed that 80% of cases had spinal trapezius muscle spasm. Restricted neck motion was present in 16.6% of cases. No one suffered from muscle wasting or weakness. Pain was bilateral in 18 patients(60%), localized to the right side in six patients(20%) and localized to the left side in six patients(20%). The causes of neck pain in the patients studied were nonspecific, due to physical stresses, cervical spondylosis and mild cervical disc herniation. Mean disease duration in patients with labor-intensive tasks was(3.9 ± 2.1 years), which was longer than that in patients with non-labor intensive tasks(3.1 ± 1.9 years); however, this difference was statistically insignificant. Spinal accessory NCSs were performed while subjects were in sitting positions and relaxed with naturally suspended arms to minimize muscular movement. The results of electrophysiological studies revealed that mean right and left latencies of the spinal accessory nerve were 2.96 ± 0.69 ms, 2.98 ± 0.61 ms in the patient group and 2.44 ± 0.38 ms, 2.33 ± 0.36 ms in control group respectively. These differences were statistically significant with P = 0.028 and 0.006 respectively. Spinal accessory NCS showed normal CMAP amplitude in both patients and controls. Comparing the results of the neck disability index(NDI) to different characteristics in patients with chronic neck pain, showed that patients with labor-intensive work had a higher NDI score mean(34.7 ± 9.5) compared to those with non-labor-intensive work, with significant statistical difference(P = 0.011). In addition, mean NDI scores were higher in males, and patients aged over 40 years and this difference was statistically significant(P = 0.007 and P = 0.009 respectively). Correlation studies between right and left spinal accessory nerve latencies and disability percent calculated using the NDI revealed a positive correlation. Moreover, there was a positive correlation between age and disability percent.CONCLUSION: This study demonstrates electrophysiological evidence of demyelination in a significant proportion of patients with chronic cervical pain.

Accessory breast poorly differentiated adenocarcinoma with positive HER2 gene amplification: A case report

Background: Primary poorly differentiated adenocarcinoma of the accessory breast is rare. We report such a case in a 56-year-old Malaysian woman of Indian ethnicity. Case Presentation: An axillary swelling measuring 5 × 5 cm on excisional biopsy revealed a poorly differentiated adenocarcinoma with positive HER2 gene amplification. Conclusion: Overall prognosis is similar to that of a carcinoma of the normal breast, therefore early diagnosis is imperative to ascertain curable status and improve prognosis.