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Four new species of Orchidaceae from China, Heminium lijiangense, Peristylus fasciculatus, Platanthera milinensis, and Ponerorchis gongshanensis, together with a new country record, Peristylus tenuicallus, are described and illustrated based on morphological and/or phylogenetic analyses. Heminium lijiangense is closely related to H. elisabethae but differs from it by having the dorsal sepal ovate-orbicular and lip mid-lobe distinctly shorter than lateral lobes. P. fasciculatus is close to Peristylus tradescantifolius but is distinguished from it by having several fascicled and straight, root-like tubers (vs. one or two oblongoid tubers), old stems usually persistent, middle lobe of lip narrowly ligulate-lanceolate and half as long as the lateral lobes (vs. middle lobe deltoid, about a third as long as the lateral lobes or less), a raised callus at the base of each lateral lobe (vs. callus absent), spur gradually attenuate toward the apex (vs. spur clavate). Platanthera milinensis is similar to P. stenochila by sharing small green flowers and lip without a spur, but differs in having a creeping rhizome, a corymbose inflorescence, and a broadly ovate and slightly 3-lobed lip. Ponerochis gongshanensis is similar to P. faberi in its small flowers, but differs in having a linear leaf c. 3 mm wide (vs. leaf 5–13 mm wide), in the lip having collar-like raised margins on the sides of the spur entrance, and a mid-lobe which is notched at the apex but not divided into two divergent lobules that are nearly as large as the lateral lobes, as in P. faberi. All the proposed species obtained high support in phylogenetic analysis as new species. The recently described genus Apetalanthe is reduced to synonymy of Ponerorchis and a new combination is made., Highlights • Four new species of Orchidinae (Orchidaceae) are described and illustrated from China based on morphological and phylogenetic analyses. • The recently described genus Apetalanthe is reduced to synonymy of Ponerorchis. • Peristylus tenuicallus is described as new record of China.

In this work, we use analytical methods to describe expansion of Extragalactic Radio Sources (EGRS). Result shows that source size expansion depends on the following parameters: age of the source, lobe internal pressure, ambient medium density, and angle of observation. Moreover, from the analyses, we have shown that the obtained results, and , suggestively implies that and . This shows that since , jet internal pressure exceeds the lobe’s internal pressure. Therefore, for a typical EGRS, this simply indicates that ambient medium density is higher in the jet region than in the region of the lobe. This is expected since the ambient density thins out from the central core to the region where lobe is located. It is in consonance with the notion that for large extended EGRS, lobes are located outside the host galaxies rather than within the host galaxies. Moreover, we can conclude from these results that compact steep spectrum sources have denser ambient medium than their more extended counterparts.

Episodic memory enables us to form a bank of autobiographical memories across our lifespan. The relationship between autobiographical memory and laboratory-measures of episodic memory is complicated and these processes might be differentially affected by ageing (e.g. Diamond et al., [2020]. Different patterns of recollection for matched real-world and laboratory-based episodes in younger and older adults. Cognition, 202, 104309.). Here, we examine whether the ability to recall one’s own visual perspective relates to richness of autobiographical recall, and how this relationship is affected by age. Memory of perspective at encoding, was assessed in younger (18–35 years) and older adults (65–85 years). Participants, wearing head cameras, viewed arrays of objects. Later they were asked which images represented earlier scenes, and if the image was taken from their perspective (i.e. from their camera). Performance was compared with autobiographical memory. Accuracy in identifying their own perspective correlated with autobiographical scores. Age-group was a moderating factor in this relationship. Subsequently, new participants encoded photographs of objects and were later asked whether they recognised the images. Visual perspective was manipulated in these photographs. In this task there was no relationship between performance and autobiographical memory. In younger adults only 3-D encoding of scenes relates directly to autobiographical memory but ability to complete these two tasks appears to operate independently in the older group.

The size of subarcuate fossa of six different mammals has been observed. Among the examined species; camel, dog, rabbit and rat show clear subarcuate structure, which was characterized by the shape of fossa, and could be easily measured by using endocast. In these species the parafloccular lobe of cerebellum is isolated from cranial cavity and engulfed by this fossa. However, in donkey, the fossa is unclear or absent. Studies have reported correlated relationship between the subarcuate fossa and the size of skull and certain parts of the cerebellum. The size of the subarcuate fossa is varying from absence of the fossa to large size fossa with its high contribution area of skull size. Dog has the largest subarcuate fossa among the examined species in this study followed by rabbit then camel, after that rat, very small in ruminants and nearly absent in equine. The study reveals the possibility of subarcuate fossa to determine the degree of evolution of the animals, based on variation of this fossa in closely related animals. This order does not follow any previous study in literatures that hypothesis correlation between the size of subarcuate fossa and the size of skull or animal size or even part of cerebellum which evolved in this fossa. The result of this paper supports the hypothesis of the correlation relationship between subarcuate fossa and phylogeny of the animals.

Objective To identity phenotypes of self‐reported symptoms of psychopathology and their correlates in patients with temporal lobe epilepsy (TLE). Method 96 patients with TLE and 82 controls were administered the Symptom Checklist 90‐Revised (SCL‐90‐R) to characterize emotional‐behavioral status. The nine symptom scales of the SCL‐90‐R were analyzed by unsupervised machine learning techniques to identify latent TLE groups. Identified clusters were contrasted to controls to characterize their association with sociodemographic, clinical epilepsy, neuropsychological, psychiatric, and neuroimaging factors. Results TLE patients as a group exhibited significantly higher (abnormal) scores across all SCL‐90‐R scales compared to controls. However, cluster analysis identified three latent groups: (1) unimpaired with no scale elevations compared to controls (Cluster 1, 42% of TLE patients), (2) mild‐to‐moderate symptomatology characterized by significant elevations across several SCL‐90‐R scales compared to controls (Cluster 2, 35% of TLE patients), and (3) marked symptomatology with significant elevations across all scales compared to controls and the other TLE phenotype groups (Cluster 3, 23% of TLE patients). There were significant associations between cluster membership and demographic (education), clinical epilepsy (perceived seizure severity, bitemporal lobe seizure onset), and neuropsychological status (intelligence, memory, executive function), but with minimal structural neuroimaging correlates. Concurrent validity of the behavioral phenotype grouping was demonstrated through association with psychiatric (current and lifetime‐to‐date DSM IV Axis 1 disorders and current treatment) and quality‐of‐life variables. Significance Symptoms of psychopathology in patients with TLE are characterized by a series of discrete phenotypes with accompanying sociodemographic, cognitive, and clinical correlates. Similar to cognition in TLE, machine learning approaches suggest a developing taxonomy of the comorbidities of epilepsy.

Unlike most larval organs and tissues, the central nervous system of holometabolous insects persists into the adult stage, although profoundly remodelled and with some neuropils largely newly formed during metamorphosis. Among the neuropils, those forming the optic lobes are particularly relevant as they are the visual processing centres and comprise more than half of the neurons of the adult insect brain. Using micro-CT, we document the morphological remodelling of the optic lobe during metamorphosis in the blow fly Calliphora vicina Robineau-Desvoidy, and provide quantitative measures of volumetric changes in its neuropils. In addition, we compare these qualitative and quantitative changes to those in two neuropils of the central brain: the antennal lobe and the central complex. The most profound reconfigurations occur between the pupal stage and the beginning of the pharate adult stage, when the neuropils of the optic lobe rotate 90°, and during the pharate adult stage, when the lamina unfolds and extends below the newly formed retinular cells. There is a slow increase in volume of the neuropils of the optic lobe during the pupal stage and the beginning of the pharate adult stage, followed by a major increase in volume during the second half of intra-puparial development.

Purpose For hepatocellular carcinoma (HCC) located in the left lateral lobe, the optimal surgical procedure is still controversial. This study aimed to optimize surgical strategies and to construct a nomogram to predict the postoperative survival of patients with HCC. Methods Between 1 January 2005 and 30 September 2018, a total of 493 patients were enrolled. Propensity score matching (PSM) was performed between the left lateral lobectomy (LLL) and left hepatectomy (LH) groups (1:1). The study endpoints were overall survival (OS), recurrence‐free survival (RFS), and safety. A nomogram was generated using a multivariate Cox proportional hazards model. The discriminative ability and calibration of the nomogram were evaluated using C‐statistics and calibration plots. Results After matching, 87 pairs were included. The LH group had better 1‐, 3‐, and 5‐year OS rates than the LLL group (88%, 73%, and 69% vs. 73%, 57%, and 49%, respectively; p = 0.017). The 1‐, 3‐, and 5‐year RFS rates of the LH group were similar to those of the LLL group (64%, 49%, and 46% vs. 63%, 51%, and 42%, respectively; p = 0.652). There were no significant differences in postoperative complications. Eight factors were integrated into the nomogram and it had good discriminative ability and calibration. Conclusion Our data revealed that compared to LLL, LH may result in better OS and have similar postoperative complications for HCC. The nomogram may serve as a practical tool for the individual prognostic evaluation of patients with HCC., Left hepatectomy is a more feasible and safer surgical approach for the treatment of HCC in the left lateral lobe. The proposed nomograms can provide patient‐specific survival information for patients with HCC in the left lateral lobe after surgery.

The complexity of liver function and its importance to life has encouraged many anatomists to study the morphological features of the liver in great detail. Despite recent technological advances like CT, MRI and USG, detailed study of the cadaveric liver can still contribute to identification of important anatomical variations. The liver can present a number of congenital anomalies. More common among them are the irregularities of the shape and the number of lobules. The less common variations include the presence of accessory lobes or accessory livers. The accessory lobes may be attached to the liver through a mesentery or a bridge of the hepatic tissue and they are usually asymptomatic. An accessory liver lobe is a very rare occurrence and when it exists, it becomes clinically important because of its rarity. Materials and Methods: A study was conducted in the Department of Anatomy of K. J. Somaiya Medical College in which 50 liver from donated embalmed cadavers were examined for the presence of accessory lobe. Only cadavers, whose clinical history excluded liver diseases, were used for the study. Results: 10% specimens showed accessory lobe. All are present on the under surface of liver. Clinical Significance: Among the less common abnormalities, are the formations of accessory lobes. Accessory lobes may carry the risk of torsion. Conclusions: Knowledge of the presence of a small accessory lobe of the liver near the porta hepatis is useful for surgeons and radiologists in diagnosing, surgical planning and avoiding iatrogenic injuries of the accessory lobe. Keywords: Liver, Accessory lobe, Donated embalmed cadavers, CT, MRI, USG, Congenital anomalies, Asymptomatic, Surgeons and radiologists.

Geological feature: Turbidite lobe deposits in a canyon-fill system Seismic appearance: Isolated and irregularly shaped sandstone pods Alternative interpretations: Mid-channel bars in a braided channel system Features with similar appearance: Alluvial fans Formation: Lower Wilcox Group Age: Late Paleocene to Early Eocene Location: Shelf edge at the Central Gulf Coast Region of Texas Seismic data: Donated by a petroleum exploration company in Houston, Texas Analysis tools: Seismic attributes such as instantaneous phase, root-mean-square amplitude, and spectral decomposition

International audience; Objective: Improving the identification of the epileptogenic zone and associated seizure-spreading regions represents a significant challenge. Innovative brain-imaging modalities tracking neurovascular dynamics during seizures may provide new disease biomarkers.Methods: With use of a multi-parametric magnetic resonance imaging (MRI) analysis at 9.4 Tesla, we examined, elaborated, and combined multiple cellular and cerebrovascular MRI read-outs as imaging biomarkers of the epileptogenic and seizure-propagating regions. Analyses were performed in an experimental model of mesial temporal lobe epilepsy (MTLE) generated by unilateral intra-hippocampal injection of kainic acid (KA).Results: In the ipsilateral epileptogenic hippocampi, tissue T1 and blood-brain barrier (BBB) permeability to gadolinium were increased 48-72 hours post-KA, as compared to sham and contralateral hippocampi. BBB permeability endured during spontaneous focal seizures (4-6 weeks), along with a significant increase of apparent diffusion coefficient (ADC) and blood volume fraction (BVf). Simultaneously, ADC and BVf were augmented in the contralateral hippocampus, a region characterized by electroencephalographic seizure spreading, discrete histological neurovascular cell modifications, and no tissue sclerosis. We next asked whether combining all the acquired MRI parameters could deliver criteria to classify the epileptogenic from the seizure-spreading and sham hippocampi in these experimental conditions and over time. To differentiate sham from epileptogenic areas, the automatic multi-parametric classification provided a maximum accuracy of 97.5% (32 regions) 48-72 hours post-KA and of 100% (60 regions) at spontaneous seizures stage. To differentiate sham, epileptogenic, and seizure-spreading areas, the accuracies of the automatic classification were 93.1% (42 regions) 48-72 hours post-KA and 95% (80 regions) at spontaneous seizure stage.Significance: Combining multi-parametric MRI acquisition and machine-learning analyses delivers specific imaging identifiers to segregate the epileptogenic from the contralateral seizure-spreading hippocampi in experimental MTLE. The potential clinical value of our findings is critically discussed.

We report a case of hepatic hemangiomatosis coexistent with a giant hepatic hemangioma diagnosed in the context of the study for SARS-CoV-2 infection. Computed tomography showed irregular contours of the left hepatic lobe with a lesion that compromised the whole lobe, with peripheral uptake and a centripetal tendency in the late phase, compatible with bulky cavernous hemangioma, as well as another lesion with the same characteristics in segment VI. Magnetic resonance imaging of the abdomen showed multiple hepatic hemangiomas observed in both lobes involving all segments, some of them smaller than 1 cm, which were hyperintense in the T2-weighted sequences and showed progressive contrast enhancement. This case illustrates the incidental diagnosis of this condition during the study for another pathology, the radiological features that are important to differentiate from other tumoral findings, and the possible management strategies to follow.

Ultra structural characters of second instar larvae of Hemipyrellia ligurriens are elucidated through micrographs (Scanning Electron Microscope). Morphological details of maxillary palpi, antennae, oral cirri, facial mask, labial lobe, spinulations, and papillae of anal segment are described. Oral cirri are ten in number, arranged bilaterally on each side of the functional mouth opening and gently curved medially. The labial lobes are distinctively demarcated with fleshy projections antero–ventrally and have a characteristic shape. Thoracic spines have a bulbous base, slender sharp tips and are directed backwards. Prominent dorsal and ventral anal papillae with projected tips and broad conical base were present surrounded by microtrichia. The ultrastructure details of H. ligurriens would help in the rapid and accurate identification of the species in forensic investigations and to estimate time since death in medico legal cases. This is the first report on the ultra-structural features of H. ligurriens.

Hepatic steatosis (HS) beyond a certain degree can jeopardize living donor (LD) safety, particularly in right lobe (RL) donors, making it a major obstacle for donor pool expansion in adult-to-adult living donor liver transplantation (ALDLT). From July 2004 to June 2016, 58 LDs donated their RLs despite having moderate HS (30%-50% steatosis) determined by intraoperative biopsy at a single center. We performed greedy matching to compare the outcomes of the donors and recipients of this group with those of LDs with no HS. The mean left lobe (LL) HS value in the 58 cases was 20.9 ± 12.4%, which was significantly lower than the mean RL HS value (38.8 ± 6.7%, P

Epithelial tumors of the lacrimal gland are rare and usually develop in the orbital lobe. We report the exceedingly rare occurrence of a primary adenoid cystic carcinoma in the palpebral lobe of the lacrimal gland. A 26-year-old female was referred for evaluation of a gradually enlarging mass in the lateral upper eyelid, previously diagnosed as a chalazion. Computed tomography revealed a heterogeneous round lesion anterior to the orbital rim. Excisional biopsy was compatible with an adenoid cystic carcinoma. After excluding distant metastasis, and as the patient refused adjuvant radiotherapy, a second surgical procedure, with wide local excision, was indicated. Follow-up showed no recurrence. This case highlights the importance of performing a thorough clinical examination when diagnosing any lateral upper eyelid mass. A high index of suspicion for malignant tumors of the lacrimal gland should always be maintained, and a complete excision with histological analysis should be preferred whenever possible. info:eu-repo/semantics/publishedVersion

The hydatid cysts disease is a parasitic cystic infection of the liver, lungs, and other organs, caused by Echinococcus granulosus. It is mostly seen in the sheep and cattle farms, which have poor health conditions. It is endemic in the eastern and southwestern regions of Türkiye. The big cysts that are seen in the lungs are called a huge pulmonary cyst. And it is a particular clinic situation. The symptoms of the disease are cough, chest pain, dyspnoea, hemoptysis, or allergic reactions. The hemoptysis could be seen when these cysts rupture. The use of anthelmintic drugs to treat the pulmonary hydatid cysts could cause cyst rupture. The surgery must be the first choice of treatment. In our case, we discussed the two huge pulmonary hydatid cysts in the upper left lobe of the lung which were treated with thoracotomy.

In this paper, the molecular gas lubrication model was used to analyze the nonlinear dynamic behavior of two-lobe non-circular gas-lubricated micro-bearings. The effects of temperature rise are taken into account. At high temperatures, in addition to gas rarefaction, its viscosity and friction will also change, and slip across boundaries will occur. The rarefaction of the lubricating gas film caused by the microscale effect at high temperatures was considered. The effects of temperature and rotation speed (with and without rarefaction effect) on the dynamic behavior of the non-circular micro gas bearing were studied. The nonlinear equation governing the gas behavior is discretized using the finite-element method and then solved simultaneously with the dynamic equations of rotor motion using the fourth-order Runge–Kutta method. Center orbit diagrams, phase portraits, Poincare maps, power spectrum, and bifurcation diagrams are used to investigate the dynamic behavior of two-lobe non-circular gas-lubricated micro-bearings. Some results show that with increasing temperature, the rotor behavior changes from T-periodic to quasi-periodic. It was also observed that at high temperatures, with increasing rotational speed, the behavior of the system changes from T-periodic to quasi-periodic, but if the gas is rarefied, this change occurs at a slower speed.

Rationale and Objectives Recently, advanced magnetic resonance imaging has been widely adopted to investigate altered structure and functional activities in patients with diffuse axonal injury (DAI), this patient presumed to be caused by shearing forces and results in significant neurological effects. However, little is known regarding cerebral temporal dynamics and its predictive ability in the clinical dysfunction of DAI. Materials and Methods In this study, static and dynamic fractional amplitude of low-frequency fluctuation (fALFF), an improved approach to detect the intensity of intrinsic neural activities, and their temporal variability were applied to examine the alteration between DAI patients (n = 24) and healthy controls (n = 26) at the voxel level. Then, the altered functional index was used to explore the clinical relationship and predict dysfunction in DAI patients. Results We discovered that, compared to healthy controls, DAI patients showed commonly altered regions of static fALFF, and its variability was mainly located in the left cerebellum posterior lobe. Furthermore, decreased static fALFF values over the left cerebellum posterior lobe and bilateral medial frontal gyrus showed significant correlations with disease duration and Mini-Mental State Examination scores. More important, the increased temporal variability of dynamic fALFF in the left caudate could predict the severity of the Glasgow Coma Scale score in DAI patients. Conclusion Overall, these results suggested selective abnormalities in intrinsic neural activities with reduced intensity and increased variability, and this novel predictive marker may be developed as a useful indicator for future connectomics or artificial intelligence analyses.

Background However, whether the whole-brain functional network hub changes occur in diabetic retinopathy patients remains unknown. Purpose The purpose of the study was to investigate the function network centrality and connectivity changes in diabetic retinopathy patients using the voxel-wise degree centrality method. Materials and methods Thirty-four diabetic retinopathy patients (18 male and 16 female) and 38 healthy controls (18 male and 20 female) closely matched in age, sex, and education were enrolled in the study. Graph theory-based network analysis was performed to investigate the degree centrality between two groups. Results Compared with healthy controls, diabetic retinopathy patients had significantly higher degree centrality values in the pons and bilateral caudate and had significantly lower degree centrality values in the left lingual and right lingual, and right angular/middle occipital gyrus (MOG). Moreover, diabetic retinopathy patients exhibited increased functional connectivity between the bilateral lingual and right cerebellum lobe and right fusiform/bilateral caudate and increased functional connectivity between the right angular/MOG and bilateral anterior cingulum and right cuneus/bilateral precuneus and increased functional connectivity between the bilateral caudate and right lingual and right superior occipital gyrus. In contrast, diabetic retinopathy patients showed decreased functional connectivity between bilateral lingual and left lingual and right lingual and left superior occipital gyrus and decreased functional connectivity between the angular/MOG and right inferior occipital gyrus/right fusiform and left MOG/inferior occipital gyrus and decreased functional connectivity between the bilateral caudate and bilateral cerebellum crus1. Conclusion Our results highlight that reorganization of the hierarchy of the cortical connectivity network related to visual network.

As regard human anatomy the azygos lobe is considered a congenital anomaly of the upper lobe of the right lung. In embryolog, the pleural septum of the upper lobe the lateral course of azygos vein arises in abnormal manner. It considered not a true lobe as it has no vessels, bronchi or even accessory, pulmonary lobe, but considered separated part of the upper lobe. It is usually discovered accidentally on chest x-ray or computed tomography and is not associated with any morbidity but can cause technical problems in thoraco-scopic maneuvers. Conclusion and Clinical Message Azygos vein laterally displaced into apical segment of right upper lobe leading to deep pleural fissure during embryological development resulting in formation of azygos lobe. No problem or disease result from this anatomical variant but must be considered during thoracic surgeries as also it is not even accessory lobe as it does not has normal structures of true lobe. Azygos lobe is found in 1% of anatomic specimens .

A case of solitary intrathyroid metastasis is described in a 60-year-old male patient. He had a history of renal cell carcinoma classified as T1b resected 23 years earlier. A mass was palpable in the right thyroid lobe. Ultrasound showed a hypoechoic polylobular nodule with intense vascularisation in the right lobe. Fine needle aspiration cytology was normal, but thyroidectomy was performed due to mass enlargement, the ultrasound pattern, and the oncological history. Histological examination revealed the presence of an intrathyroid metastasis of renal cell carcinoma. The bone scan and thoracoabdominal CT scan were normal. Postoperative care was uneventful.

Parasagittal meningioma is a benign extra-axial tumor from the arachnoid cap cell that fills the parasagittal angle. This case report presents a case of a 21-years old young female with a history of complete visual loss, left side paresthesia, and progressive blunt headache. Brain MRI and MRV revealed a giant enhancing tumor measuring 9.2 cm x 8.41 cm x 7.5 cm on the right parietooccipital lobe with obstruction of the posterior third of the superior sagittal sinus. Gross total removal was achieved. The pathology reports confirmed a WHO grade I meningioma. The paresthesia and headache were improved, but the loss of visions did not change. Giant parasagittal meningioma may invade the superior sagittal sinus leading to intracranial hypertension. The surgical strategy should target the survival and postoperative quality of life. Occlusion of posterior third superior sagittal sinus affects deficiency venous return resulting in visual loss.

To develop a stochastic five-lobe lung model and to compute particle deposition fractions in the five lobes, considering anatomical as well as ventilatory asymmetry.The stochastic five-lobe lung model was derived from an existing stochastic model for the whole lung, which implicitly contains information on the lobar airway structure. Differences in lobar ventilation and sequential filling of individual lobes were simulated by a stochastic lobar ventilation model. Deposition fractions of inhaled unit density particles in the five lobes were calculated by an updated version of the Monte Carlo deposition code Inhalation, Deposition, and Exhalation of Aerosols in the Lung (IDEAL).Simulations for defined exposure and breathing conditions revealed that the two lower lobes receive higher deposition and the two upper lobes lower deposition, compared to the average deposition for the whole lung. The resulting inter-lobar distribution of deposition fractions indicated that the non-uniform lung morphometry is the dominating effect, while non-uniform ventilation only slightly enhances the lobar differences. The relation between average lobe-specific deposition fractions and corresponding average values for the whole lung allowed the calculation of lobe-specific deposition weighting factors.Comparison with limited deposition measurements for upper

To investigate the effect of b value and size of region of interest (ROI) on apparent diffusion coefficient (ADC) measurement and its reproducibility in liver diffusion-weighted imaging (DWI). Thirty-six volunteers underwent liver DWI twice with b values of 0, 100, 500, and 800 s/mm2. ADCs were measured with ROI of 50 mm2 on ADC maps generated with different b values of (0, 100), (0, 500), (0, 800), (0, 100, 500), (0, 100, 800), (0, 500, 800), and (0, 100, 500, 800) s/mm2. ADCs from b values of (0, 800) s/mm2 were measured with 4 ROI sizes (50, 100, 200 and 300 mm2). ANOVA analysis was used to compare differences of ADCs among different ROI sizes and different combined b values. Bland–Altman method was used to assess reproducibility of ADC measurement. ADCs with larger ROI size were slightly higher than those with smaller one, while no statistical difference was found (P > 0.05). And reproducibility of ADC measurement with different ROI sizes was comparable (LOA 7.0–8.2% for right lobe, 14.15–17.4% for left lobe). ADCs statistically decreased with increased maximum b values (P

PURPOSE OF REVIEW This review describes the history and current state of left lobe living donor liver transplantation (LDLT). The transplant community continues to face an organ shortage on a global scale, and the expansion of LDLT is attractive because it allows us to provide life-saving liver transplants to individuals without drawing from, or depending on, the limited deceased donor pool. Donor safety is paramount in LDLT, and for this reason, left lobe LDLT is particularly attractive because the donor is left with a larger remnant. RECENT FINDINGS This article reviews the donor and recipient evaluations for left lobe LDLT, discusses small for size syndrome and the importance of portal inflow modification, and reviews recipient outcomes in right lobe versus left lobe LDLT. SUMMARY Left lobe LDLT was the first adult-to-adult LDLT ever to be performed in Japan in 1993. Since that time, the use of both right and left lobe LDLT has expanded immensely. Recent work in left lobe LDLT has emphasized the need for inflow modification to reduce portal hyperperfusion and early graft dysfunction following transplant. Accumulating evidence suggests, however, that even though early graft dysfunction following LDLT may prolong hospitalization, it does not predict graft or patient survival.

This work aimed to explore chest computed tomography (CT) image segmentation of patients with large-cell neuroendocrine carcinoma (LCNEC) based on deep learning, as well as the clinical manifestations and imaging and pathological features of LCNEC patients. Clinical data of 40 patients with LCNEC confirmed by pathological examination in the X Hospital from December 2015 to December 2017 were retrospectively selected. CT image data were segmented by TJ-1 model modified full convolutional neural network (FCNN) model. The accuracy and training time of TJ-1 FCNN model and classic deep learning segmentation network model AlexNet model were compared in terms of image segmentation. According to the image segmentation results by TJ-1 FCNN model, chest CT images of LCNEC patients, were reviewed, and the clinical manifestations, as well as the imaging and pathological features of the patients were reviewed, sorted, and summarized. The results showed that the image segmentation accuracy of TJ-1 network model (99.38%) was higher than that of AlexNet model. The iteration training time of TJ-1 network model for 30 times was 45 min, lower than that of AlexNet model (82 min). LCNEC was more likely to be found in elderly male with a long history of smoking. The clinical symptoms were cough, sputum, sputum blood, and chest pain with no significant specificity. CT imaging showed that peripheral mass was the most common manifestation (67.5%), both lungs were visible, the upper lobe was more likely with lesion (60%), the edge of the lesion was clear or smooth (57.5%), which was lobulated (70%). Under the light microscope, tumor cells were characterized by large volume, low nucleocytoplasmic ratio, high mitosis, and large area necrosis. The positive rates of immunohistochemical neuroendocrine markers were CD56 (62.5%), CgA (50%), and Syn (85%), among which Syn was with the highest positive rate. To sum up, LCNEC lacked clinical and radiological specificity manifestations, while chest CT image segmentation based on TJ-1 FCNN model can quickly mark the location of the lesion, providing technical support for the diagnosis and evaluation of LCNEC clinically.

Background Previous studies using voxel-based morphometry (VBM) revealed changes in gray matter volume (GMV) of patients with depression, but the differences between patients with bipolar disorder (BD) and unipolar depression (UD) are less known. Aim To analyze the whole-brain GMV data of patients with untreated UD and BD compared with healthy controls. Methods Fourteen patients with BD and 20 with UD were recruited from the Mental Health Center of Shantou University between August 2014 and July 2015, and 20 non-depressive controls were recruited. After routine three-plane positioning, axial T2WI scanning was performed. The connecting line between the anterior and posterior commissures was used as the scanning baseline. The scanning range extended from the cranial apex to the foramen magnum. Categorical data are presented as frequencies and were analyzed using the Fisher exact test. Results There were no significant intergroup differences in gender, age, or years of education. Disease course, age at the first episode, and Hamilton depression rating scale scores were similar between patients with UD and those with BD. Compared with the non-depressive controls, patients with BD showed smaller GMVs in the right inferior temporal gyrus, left middle temporal gyrus, right middle occipital gyrus, and right superior parietal gyrus and larger GMVs in the midbrain, left superior frontal gyrus, and right cerebellum. In contrast, UD patients showed smaller GMVs than the controls in the right fusiform gyrus, left inferior occipital gyrus, left paracentral lobule, right superior and inferior temporal gyri, and the right posterior lobe of the cerebellum, and larger GMVs than the controls in the left posterior central gyrus and left middle frontal gyrus. There was no difference in GMV between patients with BD and UD. Conclusion Using VBM, the present study revealed that patients with UD and BD have different patterns of changes in GMV when compared with healthy controls.

Kawa Abdulla Mahmood, Rezheen Jamal Rashid, Salah Mohammed Fateh, Naser Abdullah Mohammed University of Sulaimani, College of Medicine, Department of Surgery-Diagnostic Imaging Unit, Sulaymaniyah, Kurdistan Region, IraqCorrespondence: Kawa Abdulla Mahmood Tel +9647701545538Email kawa.mahmood@univsul.edu.iqPurpose: To estimate the role of patient preparation using castor oil on the ADC value of focal liver lesion.Patients and Methods: Retrospective case-control study over more than two years. Magnetic resonance imaging (MRI) scan, including diffusion-weighted imaging (DWI) of the upper abdomen performed for 87 cases and 71 controls in patients with focal hepatic hemangiomas. Cases were prepared using castor oil prior to the scan without identifiable unwanted effect, while controls did not receive any special preparation. Since liver hemangioma is a common lesion, it was selected and used as a sample. Apparent Diffusion Coefficient (ADC) values of focal liver lesion were calculated in cases and controls.Results: The mean ADC value of liver hemangioma was lower in cases compared to controls; the mean ADC value was (2.21± 0.39x10ˉ3mm2/s) in cases and (2.51± 0.49x10ˉ3mm2/s) in controls. Left lobes were more affected by lesions; the mean ADC value of the left lobe lesions was (2.26± 0.37 x10ˉ3mm2/s) and (2.86± 0.43 x10ˉ3mm2/s) in cases and controls, respectively. The ADC value of lesions in the right lobe was (2.19± 0.39x10ˉ3mm2/s) in cases and (2.39± 0.45x10ˉ3mm2/s) in controls. There was a significant segmental ADC variation; lesions at segments II, III, IVb, and V demonstrated illusive ADC elevation in controls.Conclusion: There is erroneous elevation of lobar and segmental ADC value of liver hemangiomas in non prepared patients. This Potential source of error (peristalsis, partial volume, and paramagnetic gas effect of gastrointestinal tract) on hepatic lesions’ ADC value can be avoided by proper preparation using castor oil prior to MRI scanning.Keywords: liver hemangioma, apparent diffusion coefficient value, patient preparation, castor oil

Background: Delivery of aerosols to isolated lobes of the lungs would be beneficial for diseases that have lobe-specific effects, such as cancer, pneumonia, and chronic obstructive pulmonary disorder. Recent computational fluid-particle dynamic (CFPD) modeling has demonstrated that in low flow rates, the inlet location of a particle at the mouth dictates the lobe into which it will deposit. However, realization of this lobe-specific deposition has yet to be attempted experimentally or in the clinic. To address this, we sought to develop a proof-of-concept in vitro model and targeting device for achieving lobe-specific delivery. Methods: Using 3D printing, a lung replica was created from a computed tomography scan of a healthy 47-year-old male volunteer and connected to a flow setup to control inlet flow rate and outlet airflow distribution to each lobe. A device was designed and fabricated that directs particles to an inlet location that is 5% of the total inlet area and described by radial coordinates (r,θ). Filter paper at sampling ports for each lobe was used to capture fluorescent polystyrene particles to quantify particle collection. We evaluated lobe-specific targeting at varied inlet coordinates, particle diameters, inlet flow rates, and disease lobe flow rate distribution profiles. Results: Guided by CFPD modeling, inlet locations were identified that increased particle collection to a target lobe between 63% and 90%. For example, release of fluorescent particles at the inlet location r = 4.67 mm, θ = 252° with respect to the center of the inlet using 1 μm particles, 1 L/min inlet flow rate, and healthy subject lobe flow distribution profile yielded 90% of the aerosol dose to the right upper lobe, corresponding to an increase of 4.6 × above the non-targeted percent particle collection. Particle size, inlet flow rate, and disease airflow distributions were all shown to generally decrease the efficiency of lobe-specific targeting. Conclusions: Our results indicate that aerosol targeting of a specific lobe is possible in vitro under optimized conditions and that controlling inlet locations could be a potentially useful method for treatment of lobe-specific diseases. This is the first demonstration of lobe-specific particle collection in a physical lung model and illuminates numerous challenges that will be faced as this method is translated to clinical applications.

Background: Breast cancer is the most common cancer among women. Considering the fact that a high dose is delivered in a single fraction of IORT, the evaluation of the dose at sensitive organs like thyroid is necessary. Objective: The current study has aimed to evaluate the received dose to thyroid lobes in the breast IORT technique. Material and Methods: A total of 49 women with breast cancer undergoing IORT were enrolled in this cross-sectional study with census sampling. Immediately after tumor resection, a single dose of 20 Gray at the applicator surface was delivered using 50KV X-ray by an Intrabeam machine. The thyroid dose was detected using thermoluminescent detectors (TLD) 100 at the mid-thyroid line, left and right lobes. Results: The dose at the right and left lobes of the thyroid gland as well as the mid-thyroid line was found to be 40.18±35.44 mGy, 35.50±27.32 mGy, and 40.61±32.47 mGy, respectively. The right lobe received a significantly higher absorbed dose compared to the left lobe when the right breast was under IORT treatment. The same trend was seen with the left lobe and left breast under IORT treatment (P=0.0001 and P=0.018, respectively). The applicator size showed non-significant effects on the absorbed dose at the thyroid gland. Also, the applicator depth had a non-significant inverse effect on thyroid dose. Conclusion: According to our findings, the absorbed dose at each thyroid lobe depends on the under-treatment side as well as the applicator size and depth (applicator upper surface distance from the skin).

Although the number of patients diagnosed with synchronous multiple primary lung cancer is growing because of increased screening and improved imaging technology, synchronous triple primary lung cancer with different histological tumor subtypes occurring in the same lobe of the lung is extremely rare. In this report, we encountered a 64‐year‐old male patient with three different types of nodule in the right lower lobe of the lung found on chest computed tomography (CT) scan. We believed that the patient had triple primary lung cancer, and subsequently performed a right lower lobectomy using video‐assisted thoracoscopic surgery (VATS). The pathological diagnosis was the same as the presurgical diagnosis, but all the nodules were different histological subtypes. To the best of our knowledge, this is the first case reported in the literature of synchronous triple primary lung cancer with three different histological subtypes in the same lobe of the lung. Key points Significant findings of the study This is the first case of synchronous triple primary lung cancer with three different histological subtypes in each tumor in the same lobe of the lung. What this study adds We report the details of the case with immunohistochemical and gene mutation findings, and a literature review of synchronous primary lung cancer., This is the first case of synchronous triple primary lung cancer with different histological subtypes in the same lobe of the lung.

Placenta percreta is the most complicated degree of the placenta accreta spectrum (PAS). It involves placental invasion through the uterine myometrium and into, or beyond, the uterine serosa, which can ultimately lead to severe maternal hemorrhage. Placenta previa is often associated with PAS and can be a significant indicator, along with other clinical factors. Sonography has historically been a highly accurate and safe imaging modality to assess the PAS. This specific case examines a patient with a pathologically proven percreta with an associated previa and succenturiate placental lobe.

Introduction. Mismatching of the organ sizes to the standard measurements is the sign of pathology, so it is important to make measurements using the same method for the same type of assessment.Goal: to evaluate the intra- and inter-research reproducibility of the oblique craniocaudal diameter measurement of the right liver lobe with the application of Russian and European methods by different operators, and find out which of the methods is the most convenient for practical application.Materials and methods. 47 healthy volunteers and 3 operators were participated in the study. One of the operators participated in both stages of study.Results. Keeping conditions such as quiet breathing and longitudinal scanning in the anterior axillary line from the VII-X intercostal spaces increases reproducibility and provides well visualization of the lobe even if the patient is not prepared for the study.Conclusion. The oblique size of the right lobe is highly reproducible for both methods, but the European method (longitudinal scanning of right lobe) is more convenient for the practical application.

Background Genotypic variability in M. hyopneumoniae has been reported within and among herds. However, information regarding VNTR types within single lung lobes is lacking. The objective of his study was to analyse M. hyopneumoniae infections and their association with VNTR types and lung lesions at the lobe level. Lungs from 300 pigs from 10 farms experiencing an enzootic pneumonia outbreak were collected and scored. M. hyopneumoniae was detected by real-time PCR and genotyped by MLVA assay in all samples. Results The results showed genotypic variability within single pigs and among lung lobes. At the lobe level, infection with one VNTR type (SN infection) was dominant. Lobes with lesion scores > 0 were associated with positive results for real-time PCR. At the lobe level, no relationship was observed between infections with more than one genotype (MX infections) and the proportion of Mycoplasma-like lesions. Lesion-free lobes presented a higher proportion of MX infections than lobes scored > 0. M. hyopneumoniae was detected more frequently in the right lobe of the lung (p M. hyopneumoniae genotype analyses, including lung lobes with no visible lesions. Conclusion The results did not show a significant association between the number of detected genotypes and the severity of the lesions at the lung lobe level, but revealed the unexpected detection of M. hyopneumoniae genotypes in lesion-free lobes. These results imply that a representative sampling of all lobes may lead to an accurate identification of the VNTR-type distribution. Further studies including factors that can affect pathogenetic evolution of this bacterium could shed light on the complexity of the relationship between genotypes and the lung lesions magnitude.

Lobar lung transplant is a technique that allows for large-sized donor lungs to be implanted into small-sized adult and pediatric recipients. Often, these recipients have longer waiting list times due to a shortage of appropriately sized donors, with the potential for increased waiting list mortality. Lobar lung transplant involves implanting a single lobe from each lung instead of the usual full-lung implant, thus ameliorating the size difference between donor and recipient. The first important step in this procedure involves proper donor-recipient size-matching, using calculation of total lung capacity using the bronchopulmonary segments to choose the appropriate lobes for the recipient. The preferred lobes to use are the lower lobes (or right lower lobe and right middle lobe, depending on sizing) as they are usually larger lobes and have a larger vascular bed. The surgery should ideally be done at experienced centres with high volume thoracic surgery where surgeons are very familiar with the pulmonary anatomy. Once the lungs are split, careful dissection is performed in order to ensure that the cuffs on the vein, artery and bronchus of the lobe to be used are of adequate length and undamaged during the dissection. The implantation must be performed on cardio-pulmonary support (preferably veno-arterial extra-corporeal membrane oxygenation) in order protect the lobes during the periods of reperfusion.

In high speed rotating machine parts the elasticity of the bearings supporting the journal plays key role. The present work is related to couple stress fluid (CSF) operated multi-lobe elastic hydrodynamic (HD) journal bearing. In this work the evaluation of radial deformation in the three dimensional elastic liner of bearing has been done. Here finite element method is used to solve the Reynolds equation along with the elasticity equation, to evaluate radial deformation in the liner. The iterative process used for the convergence of pressure in the rigid as well as in elastic case, however the present work focuses on the amount of radial deformation obtained while operating at different eccentricities. The results of radial deformation shows that increase or decrease in the amount of deformation is different for both upper and lower lobe with increase in couple stress parameter and eccentricity ratio. Further it directly influences the performance of bearing system by effecting the fluid flow zone. Hence the elasticity of the liner must be consider for better performance evaluation along with couple stress fluid. The radial deformation results of two lobe journal bearing presented in this work will lead to the better bearing designs by the bearing designers.

Lobes and clefts are characteristic structures at the front of sand storms. In this paper, their original formation mechanism and geometric features are studied experimentally and theoretically. A rotatable lock-exchange tank is utilized to avoid the strong local disturbances existing in the conventional horizontal apparatus, and the original lobe size is selected as the dominant spanwise wavelength by a statistical method instead of the mean lobe size used in the literature. It is shown that at the initial formation stage, the measured lobe sizes for different tank geometries and density differences (or Atwood numbers) have a 1/3 scaling law with the Grashof number (Gr) as predicted by a Rayleigh–Taylor (RT) model, especially at moderate Gr range, and substantially depend on the diffusion effect represented by the Schmidt number. Furthermore, using turbulent Schmidt number and eddy viscosity for atmosphere in the RT model predicts large scale dominant lobes, whose sizes agree qualitatively with those observed in a real sand storm, revealing that the underlying control mechanism for these lobe and cleft structures is intrinsically related to the RT instability.

We encountered a case of diffuse thyroid swelling after fine needle aspiration (dTSaFNA) cytology, and monitored the swelling by thyroid ultrasonography. The scan findings are reported. A 57-year-old female visited our hospital complaining of swelling in her anterior neck. She had a history of metal allergy and was not taking any medications. Because a solid cystic tumor was detected in the left thyroid lobe, we decided to perform fine-needle aspiration cytology (FNAC). When the second aspiration was performed with a 22G needle inserted into the nodule in the left lobe, the patient immediately complained of pain in her neck. Within 2 minutes, her anterior neck swelled up and ultrasonography showed vascular dilatation in the left thyroid lobe. Neck cooling with steroid injection was undertaken. However, over the next 5 minutes, the vascular dilatation also spread to the right lobe. About 15 minutes later, the vessels gradually became unclear, and the neck pain and swelling persisted, and the patient was hospitalized for observation. By the following day, all the symptoms and signs had resolved and the patient was discharged. FNA is associated with the risk of neck swelling caused by hemorrhage or dTSaFNA. To make a prompt diagnosis and provide appropriate treatment for this complication, ultrasonography could be useful.

Objective : This study demonstrates how functional connectivity (FC) patterns are affected in direct relation to the lobe that is mostly affected by seizures. Methods : The novel idea of penalized FC (pFC) maps is compared against standard FC maps in the four fundamental EEG frequency sub-bands. The FC measure between any two specific electrodes is scaled depending on the probability of true FC between them, and their power content with respect to the two electrodes of maximum power within each frequency sub-band. The algorithm is automated and introduces adaptive power penalization based on the power distribution of the different sub-bands. Results : The pFC maps were found to be more effective at suppressing the local connectivity in the lobes that are less affected by the interictal epileptiform discharges (IEDs). More precisely, given the least amount of power penalization, pFC maps of the theta sub-band reveal statistical significance in terms of increased local connectivity margin of the affected region as compared to the standard FC maps. However, they cannot be solely relied upon as other sub-bands could alternatively show high local connectivity across different patients within the region of interest. Conclusion : penalized functional connectivity maps intrinsically provide more information regarding the whole brain network in context to regions of interest where the active lobe is determined by the neurologists to contain the focal source. Significance : Findings suggest that (1) the significant sub-band varies from patient to patient while remaining relatively consistent within the IED segments of a same patient, and (2) the pFC maps have an advanced capability in terms of pinpointing to a region of interest of the active lobe, and as such can play a critical role in providing insight as to a region of interest where the 3D source might be located when solving the ill-posed inverse problem.

Background To demonstrate the surgical procedures and techniques of the robotic anatomical isolated complete caudate lobectomy. Methods A retrospective analysis was performed on the demographic, operative, postoperative outcomes of seven patients who underwent robotic anatomical isolated complete caudate lobectomy at our department from January 2018 to November 2019. Mobilization of the left lateral and Spiegel lobe, dissection of the short hepatic veins and liver parenchyma transection from the dorsal plane of middle and right hepatic vein were crucial procedures for the robotic left-side approach. Anatomic complete caudate lobectomy was defined as total removal of the caudate lobe, in which the dorsal middle and right hepatic vein, the inferior vena cava and its right side were fully exposed on the raw surface. Results All patients successfully underwent the robotic anatomical isolated caudate lobectomy with a left-side approach without conversion to laparotomy, and without Clavien-Dindo Grade III or higher complications. The average tumor diameter was 65.00 ± 10.61 mm, the average operation time was 212.00 ± 74.53 min, the median bleeding loss was 100 mL, and the average postoperative hospital stay was 8.71 ± 4.89 d, respectively. There were four patients with primary hepatocellular carcinoma, one with tumor recurrence five months after surgery and three patients were free of recurrence. All patients survived at the last follow-up. Conclusion Robotic anatomical isolated complete caudate lobectomy with a left-sided approach is safe and feasible for selected patients.

Purpose We investigated the interfractional variation in the tumor position during lung stereotactic body radiotherapy (SBRT) under expiratory-phase breath hold (BH) using cone-beam computed tomography (CBCT). Methods A total of 79 patients with lung cancer were treated with lung SBRT, wherein the Abches system under expiratory-phase BH was used to study interfractional variation. The tumors were located in the upper lobe in 31 cases, in the middle lobe in 11 cases, and in the lower lobe in 37 cases. Planning CTs were scanned under expiratory-phase BH with the Abches system. The 3-degrees-of-freedom (DOF) tumor-based setup using CBCT images under expiratory-phase BH was performed after a 6-DOF bony vertebrae-based setup using an ExacTrac X-ray system. Interfractional variation in the lung tumor position was defined as the difference in the position of the lung tumor relative to the bone anatomy in the left-right (LR), antero-posterior (AP), and craniocaudal (CC) directions represented as absolute values. Results The interfractional variation in the lung tumor position was very similar in all the lung regions, and its mean ± standard deviation values in all patients were 1.0 ± 1.1, 1.6 ± 1.9, and 1.6 ± 1.9 mm in the LR, AP, and CC directions, respectively. Further, 99.1%, 92.4%, and 92.7% of all the fractions for the interfractional tumor positional variation in the LR, AP, and CC directions were less than 5 mm, respectively. Conclusion The interfractional variation in the tumor position was small for lung cancer patients treated with the Abches system under expiratory-phase BH.

To evaluate the degree of tuberculous lesions of the lungs, the method has been developed for coding and quantitative assessment of chest computed tomography results (chest CT) based on the presence of the following signs in each lobe of the lung: infiltrative and/or small focal changes – +1 point, focal formations (tuberculomas) – +2 points, cavitary changes (cavities) – +4 points. If there are all elements in the lobe, the maximum score is given – 7. The X-ray signs of tuberculous changes in the lungs are recorded in the form of a five-digit code "* * * | * *", where * corresponds to the lung lobe and is replaced by a figure corresponding to the total score calculated for this lobe. The arithmetic mean of the numbers in the code allows estimating the dissemination of tuberculosis: the higher the value, the more severe pathological changes in the lungs. The authors experimentally found that in the treatment of multiple and extensive drug resistant pulmonary tuberculosis with, the timing of sputum conversion (r s = 0.442; p < 0.01) and healing of cavities (r s = 0.575; p < 0.05) directly depended on the severity of tuberculous changes in the lungs, revealed by chest CT and evaluated using the proposed method.

The objective of this report is to assess lobe based metabolic evaluation of brain tumor in the masses of Pakistan using magnetic resonance spectroscopy. Forty four patients of brain tumor were scanned at MRI unit 1.5 Tesla in Bahawal Victoria Hospital Bahawalpur. H1MRS imaging was analyzed in different brain regions using IQ Viewer software. Brain tumor patients were scanned at short TE = 1.36 TR = 4.96 ms using STEAM technique. Data analysis was performed in software OrgionPro.8. The p-value (p ≤ 0.05) was deemed to see the results significantly. Out of forty four patients, 30 were graded low grade tumor with mean age with S.d (Male = 37.33 ± 19.18, Female = 45.53 ± 18.95) and 14 patients were noted high grade tumor with mean age (Male = 44 ± 14.67, Female = 34.25 ± 13.07). One way ANOVA test was applied to assess the difference among three metabolites ratio (Cho/NAA), (Cho/Cr) and (NAA/Cr) in high grade and low grade tumor patients. The ratio of metabolites (Cho/Cr), (NAA/Cr) and (Cho/NAA) remained insignificant with p-value male (p = 0.9) and female (p = 0.3) in low grade tumor. In high grade brain tumor, the ratio of (Cho/Cr), (NAA/Cr) and (Cho/NAA) also found insignificant with p-value male (p = 0.2) and female (p = 0.09). However, lobe based ratio of three metabolite showed no significant difference (p > 0.05) in low grade tumor and in high grade tumor. In addition, the most occurrence region in MRS images was found left and right parietal lobe with low and high grade tumor. This study concludes that decline of N-acetyl-aspartate (NAA) and elevation of choline metabolite induce the neuronal loss in brain tumor. The most occurrence region of brain tumor was appeared in parietal lobe and little injury was seen in occipital lobe in low and high grade tumor that determined the decline of sensory, ambulatory process and vision function in the masses of Pakistan.

The transmandibular route is often combined with the transparotid-transcervical approach when extensive surgical field exposure is required, as in the case of deep parotid lobe tumors measuring over 4 cm in size. This procedure implies great morbidity and prolongs surgery time. Furthermore, in cases where additional lip division is performed, the aesthetic outcomes may be poorer. A description is made of the technique used for the removal of giant pleomorphic adenomas of the parapharyngeal space, without mandibulotomy. Key words:Parapharyngeal space tumor, pleomorphic adenoma, transcervical-transparotid approach, transmandibular approach.