The Prevalence and Morphology-Wise Demographic Distribution of Ponticulus Posticus on CT Scans—A Retrospective Observational Study

Background and Objectives: The ponticulus posticus (PP) is a bony bridge that emerges from the posterior aspect of the superior articular process, to connect the posterior arch of the atlas. It is often associated with neurological symptoms. The aim of this study was to obtain an insight into this malformation, and prevalence in the North East region of the Romanian population. Materials and methods: This anatomical variant was analyzed through an observational and retrospective study which was carried out in St. Spiridon Hospital Iasi. The duration of the study was 10 months and, a number of 487 patients who presented neurological symptoms without cranio-cerebral traumatisms were enrolled and a computed tomography (CT) scan was performed. We proposed a new classification of PP in five types. The prevalence of PP was calculated and Skewness test, ANOVA test with Bonferroni correction, and Student’s t-test were used for statistical analysis. Results: Among the sample of 487 patients, PP was found in 170 cases (34.90%) in an age group of 8–90 years (mean age = 59.52 years, SD ± 19.94 years). Type I was found in 11.29%, followed by Type II—8.21%, Type III—5.13%, Type IV—5.54%, and Type V—4.72% (p = 0.347). It was 19.5%, mirroring the incomplete type, whereas the complete type was reported in 15.40% of cases (p = 0.347), the highest prevalence, namely 41.17% was found in the “41 to 60 years” age group, followed by 36.95% in the “21 to 40 years” group (p = 0.00148). The mean age was higher in patients with PP Type III (61.16 years, SD ± 19.98), while patients with PP Type V recorded the lowest mean age (56.48 years, SD ± 22.13). The differences between the comparative average ages on types were not statistically significant (p = 0.411). The gender and age were not good predictors of PP Type V (AUC < 0.600). Conclusion: according to our study, incomplete types of PP were found to be more prevalent as compared to complete types. No difference between males and females was detected. PP is more frequent in adults and young adults than in the elderly population. It is confirmed that gender and age were not good predictors of the bilateral complete type of PP.

Inherited Hemophilia-A Multidimensional Chronic Disease That Requires a Multidisciplinary Approach

BACKGROUND

Articular damage is a marker of hereditary hemophilia, especially affecting the large joints of the upper and lower limbs. This retrospective study aimed to emphasize that hereditary coagulopathies, specifically hemophilia A and B, require a multidisciplinary approach due to their complex nature. The primary objectives of the paper are to determine the prevalence of hemophilic arthropathy among individuals with hemophilia in the northeastern region of Romania, identify the most frequently affected joints, and assess whether there is a correlation between the development of hemophilic arthropathy, the type of hemophilia, and the treatment received. The secondary objectives of the work are to identify a series of particularities regarding the occurrence of the comorbidities depending on the type of hemophilia and the treatment and severity of arthropathies.

MATERIALS AND METHODS

We conducted a retrospective study that included 36 adults with hemophilia A and B. The status of the osteoarticular system was evaluated using the modified Hemophilia Joint Health Score (mHJHS). Twelve joints were evaluated using the following parameters: swelling, duration of swelling, muscle atrophy, joint pain, crepitus on motion, flexion loss, and extension loss.

RESULTS AND DISCUSSIONS

The most severe damage was found in the joints of the knees, ankles, elbows, and wrists. In the knees, severe damage was noted significantly more frequently in the right knee (50% vs. 33.3%; p = 0.001). In the ankles, a higher frequency of mild damage to the left ankle was noted (44.4% vs. 27.8%; p = 0.002). The severe form of hemophilia was correlated with severe joint damage (p < 0.05). Comorbidities like cardiovascular disease, obesity, viral infection (HCV infection), and gastrointestinal disease were found in the hemophilia population of our study. All patients with HCV infection had severe joint damage, while 38.5% of patients without HCV infection had mild joint damage, and 30.8% had no joint damage (p = 0.001). In all patients with HCV virus infection, the treatment was short-term substitution (intermittent prophylaxis), while in 53.8% of patients without HCV virus infection, the treatment consisted of continuous prophylaxis (p = 0.001).

CONCLUSIONS

It is currently essential to determine methods for comprehensive hemophilia care that involves multidisciplinary medical services necessary for the diagnosis, treatment, and management of the condition and its complications and comorbidities.

Morphological Aspects of the Aberrant Right Subclavian Artery-A Systematic Review of the Literature

BACKGROUND

The aberrant origin of the right subclavian artery (ARSA), also known as the lusoria artery, is a congenital malformation with an incidence of 0.5-4.4%. Most cases are incidental due to minimal clinical manifestations. Computer tomography (CT) is important in diagnosing and evaluating these patients.

MATERIALS AND METHODS

We conduct a computerized search in two databases, PubMed and EMBASE, for articles published between 1 January 2022 and 31 December 2023, PROSPERO code: CRD42024511791. Eligible for inclusion were case reports and case series that presented the aberrant origin of the right subclavian artery. The main outcome was the highlighting of the morphological types of ARSA. In this context, we proposed a new classification system of this anomaly. The secondary outcome was the evaluation of the demographic distribution of the lusoria artery.

RESULTS

Our search identified 47 articles describing 51 patients with ARSA. The typical course for ARSA is retroesophageal, being registered in 49 out of 51 patients. This malformation is frequently associated with Kommerell diverticulum (15 out of 51), troncus bicaroticus (7 out of 51), and aberrant origins of the right vertebral artery (7 out of 51). We observed a higher incidence of the condition among women (32 out of 51) compared to men (19 out of 51). From a demographic point of view, ARSA is more frequent in the "44 to 57 years" and "58 to 71 years" age ranges.

CONCLUSIONS

ARSA is a congenital malformation resulting from a defect in the development of the aortic arches. The imaging studies such as computer tomography play a defined diagnostic role.

Recto-Vaginal Fistula of Obstetric Origin - A Surgical Solution

A 26 year-old female patient was admitted for the first time in the surgical, presenting an abnormal connection between the rectum and vagina given a context of an apparently clear period of time following a natural childbirth 1 year and 10 months ago. This is a rare pathological condition with a major physical, mental and sexual impact for a young female. Various surgical treatment solutions are described in the specialized literature. Yet, we have not come across any studies that analyzed the various means of surgical treatment. In what follows we will describe the technique we used in this case, with a very good immediate result and after 5 years by surgery.

New Perspectives in the Etiology of Chronic Rhinosinusitis-Haller Cells

Background and Objectives: Haller Cells (HCs) represent the abnormal migration of ethmoid cells that are located below the ethmoid bulla at the level of the upper wall of the maxillary sinus. Through their placement, the cells can exert a mass effect on the infundibulum of the maxillary sinus. The aim of our study is to investigate the prevalence of Haller cells in the Romanian population and to evaluate the relationship between this anatomical variation and chronic rhinosinusitis. Secondly, we want to morphometrically evaluate the impact of Haller cells' presence in the drainage paths of the maxillary sinuses. Materials and Methods: We conducted a randomised retrospective study that included 255 consecutive multi-detector computed tomography (MDCT) scans of the head. To carry out a comparative evaluation of the association of Haller cells with chronic rhinosinusitis, we divided the patients into two subgroups, a seasonal-based sample, between November 2022 and January 2023, and June 2023 and August 2023, respectively. We report the mean ± standard deviation for the continuous variables. To compare the results, we used the following statistical tests: a chi-squared test and a paired Student's t-test (one-tail). Results: Our study identified a high prevalence of Haller cells, namely in 128 out of 255 patients (50.2%). There were no statistically significant associations between the presence of HCs and the age and the gender of the sample, respectively. The unilocular morphotype predominates in unilateral shapes and in bilateral shapes as well (p = 0.002). Our study identified the correlation between the Haller cells and the chronic rhinosinusitis in both research samples: "Winter group" and "Summer group" (p = 0.0002 and p = 0.0001, respectively). Conclusions: It was determined that for 40 out of 42 patients, the presence of HCs changes the morphometric pattern of the infundibular maxillary sinus.

Triangular fossa of the third cerebral ventricle - an original 3D model and morphometric study

Introduction

The triangular recess (TR), also called triangular fossa or vulva cerebri, represents the anterior extension of the diencephalic ventricle, located between the anterior columns of the fornix and the anterior white commissure. Over time, this structure of the third cerebral ventricle generated many disputes. While some anatomists support its presence, others have opposite opinions, considering that it only becomes visible under certain conditions. The aim of the study is to demonstrate the tangible structure of the triangular recess. Secondly, the quantitative analysis allowed us to establish an anatomical morphometric standard, as well as the deviations from the standard.

Materials and methods

Our study is both a quantitative and a qualitative evaluation of the triangular fossa. We dissected 100 non-neurological adult brains, which were fixed in 10% formaldehyde solution for 10 weeks. The samples are part of the collection of the Institute of Anatomy, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi. We highlighted the triangular fossa by performing dissections in two stages at the level of the roof of the III ventricle.

Results

The qualitative analysis is a re-evaluation of the classical data concerning the anatomy of the fossa triangularis. We proposed an original 3D model of the triangular recess in which we described a superficial part called vestibule and a deep part called pars profunda. We measured the sides of the communication between the two proposed segments, as well as the communication with the III ventricle. By applying the Heron's formula, we calculated the area of the two communications. Statistical evaluations have shown that these communications are higher than they are wide. In addition, there is a statistical difference between the surfaces of the two communications: 34.07 mm2 ± 7.01 vs. 271.43 mm2 ± 46.36 (p = 0.001).

Conclusion

The outcome of our study is both qualitative and quantitative. Firstly, we demonstrated the existence of the triangular fossa and we conceived a spatial division of this structure. Secondly, the measurements carried out establish an anatomo-morphometric norm of the triangular recess, which is useful in assessing the degree of hydrocephalus during the third endoscopic ventriculoscopy.