A bilateral variant accessory belly of extensor indicis muscle in posterior compartment of forearm: An anatomical variation

Abstract The posterior tibial artery normally arises from tibial-fibular trunk at the popliteal fossa, together with the fibular artery. The classic course of the posterior tibial artery is to run between the triceps surae muscle and muscles of the posterior compartment of the leg before continuing its course posteriorly to the medial malleolus, while the fibular artery runs through the lateral margin of the leg. Studies of both arteries are relevant to the fields of angiology, vascular surgery and plastic surgery. To the best of our knowledge, we report the first case of an anastomosis between the posterior tibial artery and the fibular artery in their distal course. The two arteries joined in an unusual “X” format, before division of the posterior tibial artery into plantar branches. We also provide a literature review of unusual variations and assess the clinical and embryological aspects of both arteries in order to contribute to further investigations regarding these vessels.

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Carotid endarterectomy in patients with foetal-type posterior circle of Willis: Is there an indication for local anaesthesia?

VASA ◽

10.1024/0301-1526/a000138 ◽

2011 ◽

Vol 40 (5) ◽

pp. 404-407

Author(s):

Maras ◽

Tzormpatzoglou ◽

Papas ◽

Papanas ◽

Kotsikoris ◽

...

Keyword(s):

Carotid Endarterectomy ◽

Local Anaesthesia ◽

Anatomical Variation ◽

Anatomical Variations ◽

Circle Of Willis ◽

Variable Degree ◽

Operative Complications ◽

The Right ◽

Ica Stenosis ◽

Symptomatic Stenosis

Foetal-type posterior circle of Willis is a common anatomical variation with a variable degree of vessel asymmetry. In patients with this abnormality, carotid endarterectomy (CEA) may create cerebral hypo-perfusion intraoperatively, and this may be underestimated under general anaesthesia. There is currently no evidence that anatomical variations in the circle of Willis represent an independent risk factor for stroke. Moreover, there is a paucity of data on treating patients with such anatomical variations and co-existing ICA stenosis. We present a case of CEA under local anaesthesia (LA) in a 52-year-old female patient with symptomatic stenosis of the right ICA and coexistent foetal-type posterior circle of Willis. There were no post-operative complications and she was discharged free from symptoms. She was seen again 3 months later and was free from complications. This case higlights that LA should be strongly considered to enable better intra-operative neurological monitoring in the event of foetal-type posterior circle of Willis.

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Palmar Musculature: Does It Affect the Development of Carpal Tunnel Syndrome? A Pilot Study

Journal of Wrist Surgery ◽

10.1055/s-0040-1721437 ◽

2021 ◽

Author(s):

Trevor Simcox ◽

Lauren Seo ◽

Kevin Dunham ◽

Shengnan Huang ◽

Catherine Petchprapa ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Correlation Coefficient ◽

Carpal Tunnel ◽

Case Control Study ◽

Anatomical Variation ◽

Case Control ◽

Transverse Carpal Ligament ◽

Large Variability ◽

Tunnel Syndrome ◽

Control Study

Abstract Background The etiology of carpal tunnel syndrome (CTS) is multifactorial. Static mechanical characteristics of CTS have been described, but dynamic (muscular) parameters remain obscure. We believe that musculature overlying the transverse carpal ligament may have an effect on carpal tunnel pressure and may explain the prevalence of CTS in manual workers. Questions/Purposes To utilize magnetic resonance imaging (MRI) imaging to estimate the amount of muscle crossing the area of the carpal tunnel and to compare these MRI measurements in patients with and without documented CTS. Methods A case–control study of wrist MRI scans between January 1, 2018, and December 1, 2019, was performed. Patients with a diagnosis of CTS were matched by age and gender with controls without a diagnosis of CTS. Axial MRI cuts at the level of the hook of the hamate were used to measure the thenar and hypothenar muscle depth overlying the carpal tunnel. Muscle depth was quantified in millimeters at three points: midcapitate, capitate–hamate border, capitate–trapezoid border. Average depth was calculated by dividing the cross-sectional area (CSA) by the transverse carpal ligament width. Statistical analysis included Student's t-test, chi-square test, and Pearson's correlation coefficient calculation. Results A total of 21 cases and 21 controls met the inclusion criteria for the study. There were no significant differences in demographics between case and control groups. The location and depth of the musculature crossing the carpal tunnel were highly variable in all areas evaluated. A significantly positive correlation was found between proximal median nerve CSA and muscle depth in the capitate–hamate area (correlation coefficient = 0.375; p = 0.014). CSA was not significantly associated with chart documented CTS. Conclusions We found large variability in our measurements. This likely reflects true anatomical variation. The significance of our findings depends on the location of the muscles and the line of pull and their effect on the mechanics of the transverse carpal ligament. Future research will focus on refining measurement methodology and understanding the mechanical effect of the muscular structure and insertions on carpal tunnel pressure. Level of Evidence This is a Level 3, case–control study.

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Anatomical variation of superior cornua of thyroid cartilage presenting as globus pharyngeus and high dysphagia

10.26226/morressier.5adde3c3d462b80290b59600 ◽

2018 ◽

Author(s):

Paramesh Puttasiddaiah

Keyword(s):

Anatomical Variation ◽

Thyroid Cartilage ◽

Globus Pharyngeus

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Pseudo-endocarditis secondary to ruptured posteromedial papillary muscle with anatomical variation: A Case Report

International Journal of Case Reports ◽

10.28933/ijcr-2020-11-0105 ◽

2020 ◽

pp. 179

Author(s):

Keyword(s):

Myocardial Infarction ◽

Mitral Valve ◽

Papillary Muscle ◽

Anatomical Variation ◽

Low Grade ◽

Papillary Muscle Rupture ◽

Atypical Chest Pain ◽

Anatomical Variant ◽

Muscle Rupture ◽

Mitral Valve Vegetation

Myocardial infarction is the leading cause of papillary muscle rupture. This complication occurs in up to 5% of cases post MI and although rare, it constitutes a cardiac emergency if left untreated. On this basis, a 59-year-old male presented with low-grade fever and atypical chest pain with raised inflammatory markers and troponin levels. He was treated for infective endocarditis after echocardiography revealed a mass on the mitral valve, which was presumed to be a mitral valve vegetation and so he completed a 6-weeks course of antibiotics followed by elective mitral valve replacement surgery. During surgery, it was discovered that there was no endocarditis. Instead an unusually small muscle head of one of the posteromedial papillary muscle groups had ruptured secondary to an inferior myocardial infarction. This ruptured muscle head was highly mobile and mimicked a mitral valve vegetation. The mitral valve was successfully repaired, and the right coronary artery grafted. He made a full recovery but developed new-onset atrial fibrillation for which he is awaiting elective cardioversion. One should have a high index of suspicion for diagnosing papillary muscle rupture as it may mimic valvular vegetation on echocardiography, especially if the papillary muscle involved is an anatomical variant.

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Echographic characteristics of the malformations associated with abnormal urorectal septum development

10.21516/2413-1458-2017-16-3-217-225 ◽

2017 ◽

Author(s):

A.M. Stygar , S.I. Buryakova , Yu.I. Kucherov ey all

Keyword(s):

Prenatal Diagnosis ◽

Anatomical Variation

Three cases of prenatal diagnosis of malformations associated with abnormal urorectal septum development were presented at 12, 20 and 31 weeks of gestation. The difficulty to diagnose this group of malformations is reported to depend on the characteristics of the echographic pattern at various stages of pregnancy due to a complex multi-system anatomical variation.

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Obstructive uropathy in the context of ureteroinguinal hernia: experience of challenges in surgical management of an unwell patient

BMJ Case Reports ◽

10.1136/bcr-2020-235060 ◽

2020 ◽

Vol 13 (8) ◽

pp. e235060

Author(s):

Mitchell Egerton Barns ◽

Arvind Vasudevan ◽

Emma Lucy Marsdin

Keyword(s):

Obstructive Uropathy ◽

Anatomical Variation ◽

Surgical Patients ◽

Definitive Treatment ◽

Ureteric Stent ◽

Common Presentation ◽

Iatrogenic Damage ◽

Vesicoureteric Junction ◽

Collecting System

This case exemplifies an unusual anatomical variation of a common presentation and highlights the importance of perioperative diagnosis and planning in complex surgical patients. A 72-year-old comorbid man presented to the emergency department with an infected obstructed right kidney secondary to an obstructing 12 mm vesicoureteric junction calculi. However, imaging also showed concurrent ureteroinguinal hernia associated with a 130 cm-long ureter, too long for conventional treatment with a ureteric stent. Acutely, the patient’s collecting system was decompressed via nephrostomy, but due to the rarity of this anatomical variation, definitive treatment had to be rethought to help reduce the risk of iatrogenic damage and the associated long-term complications.

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Pelvic organ prolapse surgery and overactive bladder symptoms—a population-based cohort (FINPOP)

International Urogynecology Journal ◽

10.1007/s00192-021-04920-w ◽

2021 ◽

Author(s):

Päivi K. Karjalainen ◽

Anna-Maija Tolppanen ◽

Nina K. Mattsson ◽

Olga A.E. Wihersaari ◽

Jyrki T. Jalkanen ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Overactive Bladder ◽

Symptom Severity ◽

Pelvic Organ ◽

Population Based ◽

Urinary Frequency ◽

Posterior Compartment ◽

Posterior Repair ◽

Apical Compartment ◽

Bothersome Symptom

Abstract Introduction and hypothesis It is unclear how compartment of pelvic organ prolapse (POP) impacts overactive bladder (OAB) symptom severity or improvement after POP surgery. We hypothesized that anterior and apical prolapse are more strongly associated with OAB symptoms than posterior compartment prolapse. Methods A total of 2933 POP surgeries from a prospective population-based cohort were divided into two groups: (1) anterior and/or apical compartment surgery (± posterior repair), N = 2091; (2) posterior repair only, N = 478. Urinary frequency and urgency urinary incontinence (UUI) were evaluated using PFDI-20 (bothersome symptom: score 3–4) at baseline, 6, and 24 months. Association between degree of POP in specific compartments and symptoms at baseline was estimated with generalized linear models and between compartment of surgery and symptom improvement with generalized estimating equations. Results At least one bothersome symptom was reported by 40% at baseline, 14% at 6, and 19% at 24 months. At baseline, urinary frequency was associated with degree of anterior and apical and UUI with anterior compartment prolapse. Women undergoing surgery for anterior/apical compartment started with worse symptoms and experienced greater improvement than women undergoing posterior compartment surgery. Bothersome frequency resolved in 82% after anterior/apical and in 63% after posterior compartment surgery. Bothersome UUI resolved in 75% after anterior/apical and in 61% after posterior compartment surgery. After surgery, symptom severity was comparable between groups. Bothersome de novo symptoms occurred in 1–3%. Conclusions OAB symptoms are more strongly related to anterior and apical than to posterior compartment prolapse, but improvement is seen after surgery for any vaginal compartment.

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Modified laparoscopic lateral suspension with a five-arm mesh in pelvic organ prolapse surgery

BMC Women s Health ◽

10.1186/s12905-021-01388-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Eren Akbaba ◽

Burak Sezgin

Keyword(s):

Pelvic Organ Prolapse ◽

De Novo ◽

Pelvic Organ ◽

Laparoscopic Technique ◽

Life Questionnaire ◽

Advanced Stage ◽

Posterior Compartment ◽

Anterior Compartment ◽

Mesh Graft ◽

Laparoscopic Lateral Suspension

Abstract Background Laparoscopic lateral suspension (LLS) is a laparoscopic technique used to treat pelvic organ prolapse (POP) in apical and anterior compartment defect with the use of a synthetic T-shaped mesh graft. The posterior compartment is repaired using a second mesh or a procedure along with LLS, such as posterior colporrhaphy. The aim of this study was to evaluate the clinical results of LLS for POP using a five-arm mesh instead of a T-shaped mesh graft to repair the defect of the posterior compartment in addition to the apical and anterior compartments. Methods Data from 37 patients with a diagnosis of advanced-stage (≥ 3) POP undergoing LLS with the use of a five-arm mesh were retrospectively analysed. Pre-operative and post-operative examinations and, surgical outcomes were determined. The results of measurements and examinations, reoperation rates, erosion rates, lower urinary tract symptoms, and complications were analysed. The Prolapse Quality of Life Questionnaire (P-QOL) was also used. Results The median post-operative follow-up was 20 (13–34) months. There was a significant improvement in POP-Q scores in all treated compartments, with overall objective cure rates of 94.5% for the apical compartment, 86.4% for the anterior compartment, and 91.8% for the posterior compartment. The median operative time was 96 (76–112) minutes. The median length of hospitalization was 2 (1–3) days. A significant improvement in vaginal bulge, urinary urgency, incomplete voiding, urinary frequency, and constipation was observed after surgery. The sexuality among patients increased from 13 (35.1%) preoperatively to 22 (59.4%) post-operatively. De novo stress urinary incontinence developed in 7 (18.9%) patients. The P-QOL scores improved significantly after surgery. Conclusions In advanced-stage POP patients, the posterior compartment damage can also be repaired in LLS with the use of a single five-arm mesh without the need for an additional procedure, and the recurrence rate can be reduced.

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