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 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.

Pterional variable topography and morphology. An anatomical study and its clinical significance

BACKGROUND

Pterion is the junction of the frontal, parietal, greater wing of the sphenoid and the squamous part of the temporal bone. The sphenoparietal, frontotemporal, stellate and epipteric pteria were described. The current study determines pterion topography, morphology (variant types' frequency) and morphometry, as well as epipteric bones presence in dried skulls. Gender impact is underlined as well.

MATERIALS AND METHODS

Ninety Greek adult dried skulls were observed. The distances in between pterion and the zygomatic arch midpoint and in between pterion and the frontozygomatic suture were measured.

RESULTS

The sphenoparietal pterion was the commonest (58.3%), following by the stellate (25%), epipteric (15.5%) and by the frontotemporal pterion (1.1%). Twenty-eight (15.5%) skulls had epipteric bones, further categorised as quadrisutural (35.7%), trisutural (57.1%), bisutural and multiple (3.57%). The mean distances between pterion and the midpoint of zygomatic arch were 4.13 ± 0.45 cm on the right and 4.09 ± 0.47 cm on the left side and between pterion and the frontozygomatic suture were 3.47 ± 0.61 cm on the right and 3.52 ± 0.65 cm on the left side. Both distances were symmetrical. Male skulls showed slightly higher values on the left side for the distance (pterion-midpoint of zygomatic arch).

CONCLUSIONS

Pterion is a commonly used neurosurgical landmark and thus in depth knowledge of the pteric area and its variants could be valuable. Recognition of the possible variability in pterion location, morphology and morphometry, as well as possible occurrence of epipteric bones may render pterional craniotomy safer among different population groups.

Anatomical study of the common iliac arteries

BACKGROUND

The common iliac arteries (CIA) are the two terminal branches of the abdominal aorta which supply the pelvis and the lower extremities. The present study aims to examine the morphometric features of the CIA in a cadaveric sample and possible correlations between lengths.

MATERIALS AND METHODS

Seventy-six formalin fixed cadavers of Greek origin were dissected in the Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens. In each cadaver dissected, the abdominal aorta and the CIA were identified and their lengths were measured. Also the torso length was measured and the height of each cadaver. All the statistical analysis was done by SPSS 15.0.

RESULTS

The mean length of the left CIA was 6.12 cm (SD: ± 1.791, SE: 0.205) and that of the right one was 6.03 cm (SD: ± 1.607, SE: 0.184). The lengths of the CIA differed between the sexes, but no statistically significant difference was observed. Statistically significant differences regarding the torso lengths and body heights were found between the sexes, as well as a statistically strong correlation between the lengths of the left and right CIA in the cadavers dissected.

CONCLUSIONS

The knowledge of the anatomy and morphology of the CIA is ofgreat clinical significance, given that abnormal course, length or branching pattern of these vessels are not uncommon and their clinical impact may be great. Mostly interventional radiologists and vascular surgeons should be aware of this knowledge.

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.

FRI0474 IMMUNE CHECKPOINT INHIBITOR-INDUCED MUSCULOSKELETAL MANIFESTATIONS. A SYSTEMATIC REVIEW

Background:

Immune checkpoint inhibitors (ICI) are potent anti-cancer drugs that associate with a wide range of immune related adverse events (Ir-AE), including musculoskeletal manifestations.

Objectives:

We performed a systematic literature review of ICI-induced musculoskeletal manifestations aiming at exploring the following: 1) the prevalence of these manifestations and the time from first ICI administration to symptom onset, 2) the main clinical phenotypes and the type of treatment required to control symptoms (steroids/DMARDs), 3) the type of ICI (CTLA-4 vs PD-1/PD-L1 inhibitors) mostly associated with Ir-AE, 4) the percentage of patients with positive auto-antibodies and family history of autoimmune disease, 5) the percentage of patients requiring permanent ICI discontinuation due to musculoskeletal Ir-AE, 6) the association between musculoskeletal Ir-AE and oncologic response and 7) the risk of flare in patients with pre-existing autoimmune disease (PAD).

Methods:

An electronic (PubMed) search was performed aiming at identifying all studies reporting musculoskeletal Ir-AE.

Results:

We identified 3 prospective studies, 17 retrospective studies and 4 case series reporting 363 patients in total. Combined data from all 3 prospective studies provide a prevalence rate of 6.13%. Most patients were males (59.68%) and the vast majority (73%) were on programmed death-1 (PD-1)/programmed death ligand-1 (PD-L1) inhibitors. Most studies report a median time of ≤ 12 weeks from first ICI administration to symptom onset. The main clinical phenotypes reported were: a) inflammatory arthritis (57.57%), b) myositis (14.04%) and c) polymyalgia rheumatica (PMR) (12.12%). A total of 256 patients required steroids (70.52%) and 67 patients (18.45%) were treated with DMARDs. From the 363 patients reported in total, 265 (73%) were treated with PD-1/PD-L1 inhibitors in sharp contrast to only 11 (3.03%) with CTLA4 inhibitors with the rest patients receiving combination immunotherapy Positive auto-antibodies and family history of any autoimmune disease were present in 18.48% and 19.04% of cases, respectively. Only a few patients (19%) had to discontinue treatment due to musculoskeletal Ir-AE. Two prospective studies show that significantly more patients with musculoskeletal Ir-AE exhibit a favorable oncologic response compared to patients not exhibiting such manifestations whereas retrospective studies show that 77.22% of patients with musculoskeletal Ir-AE have a good tumor response.

Conclusion:

One out of 15 patients treated with ICI will develop musculoskeletal Ir-AE; in most cases the severity of these manifestations is mild/moderate and usually ICI is continued. Rheumatologists should familiarize themselves with this new clinical entity and develop relevant therapeutic algorithms.

Disclosure of Interests:

None declared

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.

Marginalised social groups in contemporary weee management within social enterprises investments: A study in Greece

This paper deals with the creation of appropriate conditions aimed at developing social services for reuse and recycling of waste electrical and electronic equipment (WEEE), by the inclusion of handicapped and Roma people in the workforce. Application areas for the project are the Hellenic (Greek) regions of Thessaly and North Aegean, where these groups suffer from professional and social exclusion. The efforts to reduce unemployment in the two aforementioned groups, together with the efforts to implement related Greek and European legislation for sustainable WEEE management, are examined here. Furthermore, networking and cooperation at local, regional and central levels between small enterprises, entrepreneurships and local authorities are examined, so that these social enterprises and their corresponding investments may support the development of the Greek alternative WEEE recycling system.

Cardiovascular risk factors and not disease activity, severity or therapy associate with renal dysfunction in patients with rheumatoid arthritis

OBJECTIVES

The present study aimed to evaluate the prevalence and associations of renal dysfunction in patients with rheumatoid arthritis (RA). It specifically addressed the hypotheses that renal dysfunction in these patients may associate with the presence of insulin resistance, dyslipidaemia, uric acid levels and/or current levels of systemic inflammation.

METHODS

Renal function was assessed by estimated glomerular filtration rate (GFR) using the modification of diet in renal disease equation in 400 consecutive RA patients for this cross-sectional, single-centre study. Risk factors for renal dysfunction were recorded/measured in all participants. Correlations between GFR and other variables were analysed by Pearson or Spearman test as appropriate. Linear regression was used to test the independence of the associations between GFR and other variables.

RESULTS

In this RA patient cohort, 67.75% of patients had a reduced GFR of less than 90 ml/minute per 1.73 m(2) and 12.75% had a GFR of less than 60 ml/minute per 1.73 m(2). Multivariable analysis revealed significant associations between GFR and age (beta = -0.370, p<0.001), female sex (beta = -0.181, p=0.002), total cholesterol (beta = -0.112, p=0.022), serum uric acid (SUA) (beta = -0.425, p<0.001) and the presence of extra-articular disease, apart from sicca and/or nodules (beta = -0.084, p=0.040).

CONCLUSIONS

Renal dysfunction in RA is quite common and associates with classic cardiovascular risk factors such as advanced age and dyslipidaemia, levels of SUA and the presence of extra-articular disease. Renal dysfunction was not related to other RA-related factors including disease activity and duration, disability and past or present use of nephrotoxic medications.

Increased expression of CD154 (CD40L) on stimulated T-cells from patients with psoriatic arthritis

OBJECTIVES

CD40L is a costimulatory molecule and an early activation marker of T-lymphocytes. Based on the hypothesis that activated T-cells may play a role in the pathogenesis of psoriatic arthritis (PsA), we evaluated the level of CD40L expression on T-cells from patients with PsA.

METHODS

We analysed 12 patients with PsA, six patients with rheumatoid arthritis (RA) and four healthy volunteers. T-cell surface expression of CD40L was evaluated using two-colour flow cytometry in (i) the resting state and (ii) following stimulation with phorbol myristate acetate/ionomycin, with or without ciclosporin (CsA)-mediated inhibition.

RESULTS

Expression of CD40L was significantly increased on activated T-cells from patients with PsA, particularly those with active disease, when compared with normal individuals and patients with RA (mean percentages of CD3+ CD40L+ cells: 23.74, 11.59 and 9.57% for patients with active PsA, patients with RA and healthy volunteers, respectively). CsA-mediated inhibition of CD40L induction was equally effective in all study groups.

CONCLUSION

CD40L is overexpressed on T-cells from patients with active PsA. This may indicate a role for CD40L in PsA pathogenesis. Larger-scale studies are warranted to address these issues.

Vitrification of lead-rich solid ashes from incineration of hazardous industrial wastes

Lead-rich solid industrial wastes were vitrified by the addition of glass formers in various concentrations, to produce non-toxic vitreous stabilized products that can be freely disposed or used as construction materials. Toxicity of both the as-received industrial solid waste and the stabilized products was determined using standard leaching test procedures. The chemically stable vitreous products were subjected to thermal annealing in order to investigate the extent of crystal separation that could occur during cooling of large pieces of glass. Leaching tests were repeated to investigate the relation between annealing process and chemical stability. X-ray, scanning and transmission electron microscopy techniques were employed to identify the microstructure of stabilized products before and after thermal treatment. Relation between synthesis and processing, chemical stability and microstructure was investigated.

Incisional hernia and its repair with polypropylene mesh in renal transplant recipients

PURPOSE

We evaluate the incidence of incisional hernia after kidney transplantation, predisposing factors and the results of surgical repair with polypropylene mesh.

MATERIALS AND METHODS

We reviewed the records of 371 consecutive kidney transplants performed between April 1995 and February 2000. Patients with clinical signs of hernia at the transplant incision site were included in the study. Predisposing factors for incisional hernia were also reviewed. A prospective protocol of surgical correction was established using polypropylene mesh and patient outcome was studied.

RESULTS

We identified 14 patients (3.8%) with an incisional hernia at the transplant incision site. Hernias developed 3 to 840 days after transplant surgery and were significantly more common in white (p = 0.019) and cadaveric graft (p = 0.02) recipients. Predisposing factors in 11 cases included complications of transplant surgery in 7, bladder obstruction in 2, large polycystic kidneys in 1 and chronic pulmonary disease in 1. Surgical repair was performed by primary fascial approximation and polypropylene mesh reinforcement in 13 cases and by pre-peritoneal mesh placement in 1. Minor subcutaneous wound infection developed in 1 patient. No relapses were noted at a mean followup of 17.8 months.

CONCLUSIONS

In the majority of cases incisional hernia develops in the first 3 months after transplant surgery. The incidence is significantly higher in white patients and after cadaveric donor transplantation. Surgical complications of transplant surgery are important predisposing factors for incisional hernia after kidney transplantation. Surgical repair using polypropylene mesh is safe and effective in this group of patients.

Extraperitoneal access for kidney transplantation in children weighing 20 kg. or less

PURPOSE

We present our experience with kidney transplantation in children weighing 20 kg. or less. Surgery was done via extraperitoneal access while preserving the peritoneal cavity intact with special attention given to technical feasibility and the complication rate.

MATERIALS AND METHODS

Included in our study were 46 children with a median age of 7 years weighing 20 kg. or less (mean 16.6), of whom 16 weighed less than 15 kg. (median 13.2). The 25 boys and 21 girls underwent a total of 49 kidney transplants, including 2 in 3 during the study. Donors were living related in 44 cases and cadaveric in 5. Surgical access was obtained by making a J-shaped pararectal incision in a curvilinear fashion from the symphysis pubis to near the costal border.

RESULTS

Mean hospital stay was 22.9 days (range 6 to 83) and mean followup was 55.8 months (range 12 to 131). All patients received water on day 1 and food on day 2 postoperatively. In 6 patients 7 surgical complications developed, including urinary fistula in 2, superficial wound infection in 2 and vascular complications in 3 (renal vein thrombosis, stenosis and renal artery kinking in 1 each). Only 1 graft was lost due to a surgical complication.

CONCLUSIONS

There are many advantages to using extraperitoneal access without an increase in surgical complications or technical difficulty. Absent gastrointestinal complications, an easier way to perform percutaneous biopsy, treatment of any surgical complication with no need for repeat laparotomy and the possibility of using the peritoneal cavity when dialysis is needed postoperatively are attractive justifications for extraperitoneal access.

Morphology, distribution and types of valves in the adult male's testicular veins

Morphologically, the pampiniform plexuses investigated had, in their majority, no vascular spiraling on the left side, the same occurring on the right side; however, as for the total number of valves, except for those of the pampiniform plexuses, the left side was found contain a greater number of valves. As regards valve types, there is a predominance of double semilunar one on both sides rather than single semilunar valves.