Anatomical change of SMV branches after the Cattell Braasch maneuver facilitates safe resection around the uncinated process in pancreatoduodenectomy

Background The aims of the present study were to demonstrate the anatomical change of superior mesenteric vein (SMV) branches and to show how the Cattell Braasch maneuver facilitates a safer ligation of these venous branches during a pancreatoduodenectomy (PD). Methods Between January 2010 and December 2019, 97 patients with peripancreatic tumors underwent pancreatectomy. We retrospectively reviewed preoperative triple-phase enhanced computed tomography (CT) images and analyzed variations in SMV branches. Anatomical changes in SMV branches after the Cattell Braasch technique were observed using our operation video and illustrations. Results The first jejunal vein (J1v) in 75% of patients ran posterior to the superior mesenteric artery (SMA), while the remainder (25%) ran anterior to it. The inferior pancreatoduodenal vein (IPDV) was preoperatively detected in 91% of patients. The IPDV drained into the J1v in 74% of patients and into the SMV in 37%. After the Cattell Braasch maneuver, the J1v which ran posterior to the SMA now was found to lie to the right anterolateral side the SMA and the visualization of both the J1v and the IPDV were much more clearly visualized. Conclusions The most frequent venous variation was the IPDV draining into the J1v posterior to the SMA. After the Cattell Braasch maneuver, the IPDV was now located to the right anterolateral anterior aspect of the SMA which facilitates its visualization and should allow a safer ligation.

An early burst in brachiopod evolution corresponding with significant climatic shifts during the Great Ordovician Biodiversification Event

We employ modified tip-dating methods to date divergence times within the Strophomenoidea, one of the most abundant and species-rich brachiopod clades to radiate during the Great Ordovician Biodiversification Event (GOBE), to determine if significant environmental changes at this time correlate with the diversification of the clade. Models using origination, extinction and sampling rates to estimate prior probabilities of divergence times strongly support both high rates of anatomical change per million years and rapid divergences shortly before the clade first appears in the fossil record. These divergence times indicate much higher rates of cladogenesis than are typical of brachiopods during this interval. The correspondence of high speciation rates and high anatomical disparity suggests punctuated (speciational) change drove the high frequencies of early anatomical change, which in turn suggests increased ecological opportunities rather than shifting developmental constraints account for high rates of anatomical change. The pulse of rapid evolution began coincident with cooling temperatures, the start of major oscillations in sea level and increased levels of atmospheric oxygen. Our results suggest that these factors permitted major geographical and ecological expansion of strophomenoids with intervals of geographical isolation, resulting in elevated speciation rates and corresponding elevated frequencies of punctuated change.

MO117THE IMPACT OF GESTATIONAL AGE ON ANATOMICAL AND PHYSIOLOGICAL CHANGES OF THE UPPER URINARY TRACT DURING PREGNANCY

Background and Aims Ureterohydronephrosis (UHN) is a common anatomical change during the evolution of pregnancy, especially after 20th week of pregnancy. Factors responsible for dilation of pyelocaliceal system are hormonal changes, progressive obstruction and modification of the route of uterine and iliac vessels in the pelvic area. The main symptom of UHN is lumbar pain which is controlled in most of the cases by conservatory treatment.The aim of study was to o evaluate the stages of UHN during pregnancy depending on gestational age and to highlight the involvement of the pregnant uterus, as well as monitor the symptomatology and adequate management of these anatomical and physiological changes, that can associate variable complications, with maternal-fetal risk, during pregnancy. Method We performed a descriptive, transversal study for examination of pregnant women with symptomatic hydronephrosis. A total number of 104 patients, hospitalized in the Obstetrics and Gynecology Department of the Constanta County Emergency Hospital, were included, with nephrological monitoring using biological and imagistic examination for each pregnancy. Results The frequency of UHN in our study was 58% (60 cases) from the total number of 104 pregnant women. Regarding the gestational age, UHN was most commonly seen in the third trimester in 44 cases, followed by second trimester with 14 cases and first semester with only 2 cases. The right UHN was seen in all cases and the left UHN was seen in only 68 % of the cases. Our data showed that grade III of UHN reached a peak between 28 and 31 weeks of pregnancy and occurred in 37 (49%) pregnant women. Analyzing the parity, it was observed that 56% of the primiparous women developed UHN and 59% of the multiparous patients, showing us that the association with parity is not statistically significant. The majority of our patients (96.66%) were symptomatic, and the most common accuse on presentation was the lumbar pain. According to the visual analog scale (VAS) of the lumbar pain, the group could be distributed as follows: 17% with severe pain, 37 % with moderate pain and 13 % with mild pain. Eight pregnant women (13.33%) from our study developed UHN due to passage of ureteral stone, although, the majority got complicated with urinary tract infection (asymptomatic bacteriuria, acute cystitis, acute pyelonephritis) and even acute kidney injury (4 cases- 6,66%).97% of the symptomatic UHN responded to antispastic and analgesic therapy, antibiotics and adequate hydration. From our study group, only 2 patients (3,33%) with severe symptomatic UHN needed ureteral stent insertion, because initially they did not respond to medical, conservative treatment. Conclusion Uretrohydronephrosis is a common anatomical change in pregnancy and is depending on the gestational age. Parity did not influence the development of hydronephrosis in our study group. The most common symptom of ureterohydronephrosis during pregnancy is the lumbar pain, which can have different types of intensity (usually moderate to severe). Conservatory treatment during symptomatic, complicated ureterohydronephrosis is efficient in most cases, otherwise urological interventions with ureteral stent insertion must be initiated, because are effective and safe.

CONCEPTUAL STUDY OF ANATOMICAL CHANGES IN SHUKRAVAHA STROTAS IN VANDHYATVA W.S.R TO MALE INFERTILITY

Infertility is typically defined as the inability to conceive after at least one year of regular, unprotected sex. This affects 15–20% of couples. A male factor is estimated to be present in about 50% of cases. Male infertility is associated with significant psychosocial and marital stress. In Sharir Sthana ‘Mahatigarbhavktanti ’Adhyay Charaka mentioned about male infertility (Vandhyatva) and female infertility (Vandhyaatva). Vrushana and Shepha are Moola of Shukravaha Strotas. Testis and Vrushana, penis and Shepha can be correlate, so that the spermato- genesis and carrying of semen takes place. Shukra can be classified as Sukshma (invisible form of Shukra) and Sthula Shukra (semen). Vrushana and Shepha can considered as Moola Sthana with respect to Sthula Shukra. There are wide range of conditions causing male infertility. Out of which some causes anatomical change in Shukravaha Strotas which affects Parinaman (production) and Abhivahan (transportation) of Sthula Shukra. Keywords: Shukravaha strotas, Strotomoola, Shukra, Vandhyatva, Male infertility