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Introduction: Ossification disorders can affect the stylohyoid ligament as well the stylomandibular ligament. The symptomathology between those syndromes and other pathologies it has been a problem because there is not a guideline., Evidence Acquisition: With the aim to establish prevalence, diagnosis and etiopathogenesis of Eagle and Ernest syndromes, a scoping review was performed base on PRISMA criteria., Evidence Synthesis: To review stylohyoid ligament and Eagle Syndrome 93 articles were selected. Three articles regarding the stylomandibular ligament and Ernest Syndrome were founded and selected., Conclusions: Both syndromes should be clinically diagnosed and corroborate with imaging (2D or 3D), although imaging in Ernest Syndrome is not clear as well in Eagle Syndrome. A decisional algorithm for diagnosis of Eagle Syndrome and Ernest Syndrome is presented.

Abstract: This paper reports the case of a 39-year-old woman who presented with symptoms of Eagle’s Syndrome and an ossified stylohyoid ligament (SHL). Symptoms had developed immediately after trauma to the neck. No injury to the SHL was radiologically observable, but the causal relationship between the trauma and the occurrence of symptoms was evident. A new symptom of Eagle’s Syndrome mimicking osteoathrosis of the temporomandibular joint was observed. The risk of misdiagnosis of temporomandibular disorders and the etiological role of neck trauma in Eagle’s Syndrome are discussed. [Copyright &y& Elsevier]

Purpose: Venous thoracic outlet syndrome (VTOS) is a compressive disorder of subclavian vein (SCV); we aimed to investigate the role of costoclavicular ligament (CCL) in the pathogenesis of VTOS., Methods: A cadaver study was carried out to investigate the presence and morphology of CCL in thoracic outlet regions, as well as its relationship with the SCV. Six formalin-fixed adult cadavers were included, generating 12 dissections of costoclavicular regions (two sides per cadaver). Once CCL was identified, observation and measurement were made of its morphology and dimensions, and its relationship with SCV was studied. To take a step further, a clinical VTOS case was reported to prove the anatomical findings., Results: Two out of twelve costoclavicular regions (2/12, 16.7%) were found to possess CCLs. Both ligaments were located in the left side of two male cadavers and were closely attached to the lateral aspect of sternoclavicular joint capsules. The lateral fibers of the ligament proceed in a superolateral-to-inferomedial manner, while the medial fibers proceed more vertically. Both ligaments were tightly adherent to the SCV, causing significant compression on the vein. In the clinical case, multiple bunches of CCLs were found to compress the SCV tightly intraoperatively. After removing the ligaments, the patient's symptom kept relief during a follow-up period of 2 years., Conclusion: Our study demonstrated that CCL could be a novel cause of VTOS by severe compression of SCV. Patients diagnosed with this etiology could get less invasive surgical treatment by simply removing the ligament.

Background: Madelung deformity arises from a partial distal radial growth disturbance in combination with an abnormal hypertrophic ligament spanning the volar radius and carpus, termed, the Vickers ligament. The purpose of this study is to report long-term clinical and radiographic outcomes following Vickers ligament release and distal radial physiolysis in a population of skeletally immature patients with symptomatic Madelung deformity., Methods: Medical records were retrospectively reviewed of patients with Madelung deformity surgically treated between 1994 and 2005. All eligible patients who underwent a Vickers ligament release and distal radial physiolysis were contacted and invited to return to the clinic for follow-up., Results: Six patients (8 wrists) with Madelung deformity underwent Vickers ligament release and distal radial physiolysis. All were white females with a mean age at initial presentation of 11.4 years (10 to 12.8 y). Mean age at the time of initial surgery was 12.0 years (10.0 to 14.5 y). The median follow-up time was 10.6 years (5.8 to 21.9 y) and the average age at last follow-up was 23.1 years (17.5 to 32.2 y). Pain alone or in combination with concerns for deformity was the chief complaint in 6 of 8 of the wrists. At 1 year of clinical follow-up, 7 of 8 wrists were reported to be pain-free, and 6 of the 8 were noted to be completely pain-free at last follow-up. Motion in flexion, extension, pronation, supination, radial, or ulnar deviation was similar between the preoperative status and long-term follow-up. The average preoperative ulnar tilt was 35.1 degrees (SD: 8.5 degrees), average preoperative lunate subsidence was 1.9 degrees (SD: 1.8 degrees), and average preoperative palmar carpal displacement was 21.9 degrees (SD: 2.9 degrees). At the final follow-up, there was a large progression in lunate subsidence, but minimal change in ulnar tilt and palmar carpal displacement. At last clinical follow-up, 2 of the 6 patients had undergone a subsequent procedure including 1 radial dome osteotomy and 1 ulnar shortening osteotomy., Conclusion: In the skeletally immature patient population with Madelung deformity with growth potential remaining, distal radial physiolysis and Vickers ligament release is associated with relief of pain, preservation of motion, and, a reasonable rate of reoperation., Type of Study: This was a therapeutic study., Level of Evidence: Level II.

Purpose: Canine primary closed-angle glaucoma (PCAG) is a complex disease caused by multiple genetic factors. A c.590G>A variant in OLFML3 was recently reported to be a candidate for pectinate ligament abnormality (PLA) and PCAG in the Border Collie. We investigated the association of this variant with PLA and PCAG in Border Collies from the United Kingdom., Methods: The OLFML3 variant was genotyped in 106 Border Collies comprising 90 with normal eyes (controls) and 16 with PLA (n = 11) and/or PCAG (n = 5) (cases). Genotyping was performed in an additional 103 Border Collies to estimate variant frequency within the population. To investigate the association of the variant with disease in other breeds, genotyping was performed in 337 non-Border Collies with PLA and/or PCAG., Results: Of the 90 controls, 71 were homozygous for the wild-type allele, two were homozygous for the variant, and 17 were heterozygous. Of the 16 cases, three were homozygous for the wild-type allele, 11 were homozygous for the variant, and two were heterozygous. The association of the variant allele with disease was significant (P = 1.1 x 10 -9 ). We estimated the frequency of this variant to be 4.4% within the United Kingdom Border Collie population, and it was not identified in clinically affected dogs of any other breed., Conclusions: This study confirms the association of the OLFML3 variant with PLA and PCAG in Border Collies from the United Kingdom. DNA testing for the variant and selective breeding can reasonably be expected to result in a reduction of PLA and PCAG prevalence in the breed., (© 2019 American College of Veterinary Ophthalmologists.)

Objective: The aim of our paper is to present a rare variation of the suprascapular vein, its incidence and clinical significance., Case Report: A rare case of a double suprascapular vein was observed in a digitalized human cadaver on Anatomage Table 5.0. The vein divided into two branches, one passing over the transverse scapular ligament, while the other one coursed underneath the ligament, inside the notch., Conclusion: This variation has major clinical importance as it is associated with the appearance of Suprascapular nerve entrapment syndrome., (Copyright © 2019 by Academy of Sciences and Arts of Bosnia and Herzegovina.)

Competing Interests: Nil.

Purpose: To evaluate the utility of magnetic resonance three-dimensional fast-imaging employing a steady-state acquisition (MR 3D-FIESTA) sequence to study cervical EFLs using the anatomical results of cadavers as the gold standard., Methods: Part I: The cervical regions of five embalmed adult cadavers were scanned using the MR 3D-FIESTA sequence. Ligamentous structures in the intervertebral foramina (IVFs) between C4 and T1 in the MRI scans were identified by a radiologist. Part II: After the specimens were scanned, gross and microscopic anatomical studies were conducted on the IVFs between C4 and T1 in the specimens by an anatomist. Part III: Using the anatomical results of the cadavers as the gold standard, the utility of the MR 3D-FIESTA sequence for imaging cervical EFLs was evaluated. Specificity, sensitivity, positive and negative predictive values (PPV and NPV, respectively) and accuracy were calculated., Results: The occurrence rate of transforaminal ligaments (TFLs) in the IVFs between C4 and T1 was 42.5%. The results obtained by the radiologist using the MR 3D-FIESTA sequence to identify TFLs are as follows: specificity 96.2%, sensitivity 76.5%, PPV 92.9%, NPV 86.2%, and accuracy 88.4%., Conclusion: MR 3D-FIESTA sequences clearly showed cervical EFLs. In the 3D-FIESTA sequence scans that the radiologist believed to indicate the presence of a cervical TFL, the probability that the TFL existed was approximately 93%. When the radiologist believed that no TFL was present in the 3D-FIESTA sequence scan, the probability that a TFL existed was 14%.

Scleraxis (Scx) is a basic helix-loop-helix transcription factor that is expressed persistently in tendons/ligaments, but transiently in entheseal cartilage. In this study, we generated a novel Scx Cre knock-in (KI) allele, by in-frame replacement of most of Scx exon 1 with Cre recombinase (Cre), to drive Cre expression using Scx promoter and to inactivate the endogenous Scx. Reflecting the intensity and duration of endogenous expression, Cre-mediated excision occurs in tendinous and ligamentous tissues persistently expressing Scx. Expression of tenomodulin, a marker of mature tenocytes and ligamentocytes, was almost absent in tendons and ligaments of Scx Cre/Cre KI mice lacking Scx to indicate defective maturation. In homozygotes, the transiently Scx-expressing entheseal regions such as the rib cage, patella cartilage, and calcaneus were small and defective and cartilaginous tuberosity was missing. Decreased Sox9 expression and phosphorylation of Smad1/5 and Smad3 were also observed in the developing entheseal cartilage, patella, and deltoid tuberosity of Scx Cre/Cre KI mice. These results highlighted the functional importance of both transient and persistent expression domains of Scx for proper integration of the musculoskeletal components.

Competing Interests: There are no conflicts of interest.

Background: Elite female distance runners lack guidelines regarding breastfeeding while training at a high intensity., Objectives: The purpose of this research was to understand how elite female distance runners manage breastfeeding., Methods: Semistructured interviews were conducted with 14 women who had had at least one pregnancy within the past 5 years and had achieved a minimum of the USA Track and Field 2012 Olympic Trials "B" entry standard for running for the marathon or equivalent performance for 1,500 m or longer., Results: Using thematic analysis, we identified the following themes: breastfeeding as a barrier to training and competition, limited access to relevant breastfeeding information, and concerns for the baby's health. Our findings show that despite the considerable barriers with which these women contend, they breastfed at higher rates and for longer duration than members of the general public., Conclusion: Based on our findings, we argue that elite female distance runners' experiences of breastfeeding would be enhanced if more research were conducted on breastfeeding practices while training and competing at an elite level.

Background: Surgical resection is the only cure for hepato-pancreato-biliary (HPB) malignancy. In the era of multidisciplinary approaches and neoadjuvant therapies for locally advanced, borderline resectable tumors, the feasibility and efficacy of en bloc vascular resection has been validated across multiple studies. However, the variability of venous anatomy within the perihepatic and peri-portal regions necessitates familiarity with alternative resection and reconstruction techniques appropriate to the specific region of tumor invasion., Methods: To organize these paradigms, the venous system has been divided into five zones: 1) hepatic hilum; 2) hepatoduodenal ligament; 3) portal vein/splenic vein confluence, which is further subdivided into right (3a) and left (3b); 4) infra-confluence; and 5) splenic vein., Results: This study systematically analyzes the anatomic considerations and clinical scenarios specific to each zone to organize the necessary preparative maneuvers, surgical procedures, and vascular reconstruction techniques to achieve an R0 resection. The anatomic and tumor-specific factors which deem a specimen unresectable are also explored. Surgical videos demonstrating these techniques are presented., Discussion: Preparation and familiarity with venous reconstruction maneuvers is essential for an oncologically effective operation, and can be safely achieved by utilizing this logical anatomic and procedural framework., (Copyright © 2016 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)

Pancreaticoduodenal artery aneurysm is a rare complication of coeliac artery stenosis secondary to a low lying median arcuate coeliac ligament. This article reports the case of a 69-year old man who presented with left arm and leg weakness, clinically in keeping with right hemisphere stroke. Initial CT brain scan was within normal limits. The patient did not receive thrombolysis as he was outside the time window. 3 hours later the patient experienced sudden onset epigastric pain and acute shock. CT aorta abdominal was diagnostic of a ruptured inferior pancreaticoduodenal artery aneurysm. Repeat CT brain the following day showed subacute infarction within the right frontal lobe. Embolisation of the aneurysm was successfully performed. It is well documented that ischaemic stroke can cause acute hypertension. This acute hypertension probably contributed to the rupture of the pancreaticoduodenal artery aneurysm. The patient was well on discharge and remains well 2 months on.

Purpose: The incidence of fossa rhomboidea (RF) and its relevance to clinical practice were retrospectively studied in 1,017 cases of patients who endured clavicle fractures. The aim of the study was to determine the frequency of different types of insertion areas of costoclavicular ligament (LCC) in our group, as well as gender distribution. Furthermore, we wanted to investigate whether the RF represents a weakened part of clavicle where the fracture occurred. Several of our findings in our control group were quite interesting and worth mentioning., Materials and Methods: 1,017 roentgenograms were analyzed from 1,027 clavicle fractures of patients from 2 to 90 years of age who were treated between 2007 and 2011., Results: Using the Allman classification system, 79% of the examined clavicle fractures were identified as type 1, 18.4% as type 2, and 2.6% as type 3. Statistical analysis did not demonstrate a difference in fractures of the clavicle between the right and the left side (47, 53%, respectively; p = 0.0570). There was a statistically significant difference in the incidence of fractures between the genders (males 71%, females 29 %; p < 0.0001). The results for the insertion attachment area were as follows for the given percent of cases: flat (75.2%); concave (21.1%); convex (3.7%). Those 21.1% of concave insertions represent RF. 5.3% of RF cases were between 2 to 10 mm in depth. One of the patients with RF had a deepend insertion of the LCC on the superior surface of the first rib analogous to RF. The bilateral RF was asymmetrical in its appearance. One of the patients suffered from LCC enthesopathy. The difference of the distribution of RF throughout the genders was 10.5% in females and 89.5% in males, marking a difference that is statistically significant (p < 0.0001). Only in 0.3%, the fracture line occurred in RF, which did not prove the RF to be a weakened point of the fracture (p < 0.0001)., Conclusions: RF represents a variety of LCC insertion that is predominantly found in male patients, which can be used in the determination of gender in forensic analysis. RF is not a weak point for fracture formation. Enthesopathy of the LCC together with RF can lead to suspicion concerning the osteolytic process. Biopsy of RF should be avoided. Insertion of LCC similar to RF can be exceptionally found on the first rib.

Introduction: Anatomical variations around the hepatoduodenal ligament greatly influence surgical procedures and the difficulty of operations. Here, we report the case of a deceased donor with midgut malrotation (MgM) and anatomical variation. We also present an anatomical comparison between MgM and normal cases., Case Report: The donor, a male in his 60s, was diagnosed with MgM based on preoperative computed tomography. Intraoperatively, the liver graft was harvested from the proper hepatic artery (PHA), but its length was too short for reconstruction. Therefore, the hepatic artery was reconstructed at both the left and right hepatic arteries., Methods: The length of the proper hepatic artery (l-PHA) and main trunk of the portal vein (l-PV) was compared between MgM and control groups (n = 9) using computed tomography. The ratio of PHA (r-PHA) and PV (r-PV), which was calculated as the l-PHA or l-PV divided by the patient's height, was also compared., Results: The r-PV was 1.3% in the MgM group and 1.6% in the control group (P = .09). The r-PHA was 0.23% in the MgM group and 0.92% in the control group (P < .01). Thus, the PHA was significantly shorter in the MgM group. Additionally, anatomical variations of the hepatic artery were confirmed in four cases., Conclusion: Preoperative radiological evaluation is not always adequate for identifying anatomical abnormalities in deceased donors. MgM is a rare but important anomaly because of the possibility of associated anatomical variations of the hepatic artery., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Wandering spleen is a rare occurrence where the spleen normal fixation to the abdominal wall is lost and thus allowed to change in position. We report a case of a child who presented with acute abdominal pain secondary to a wandering spleen complicated by torsion of its vascular pedicle. The diagnosis was promptly made using computed tomography and managed with splenectomy.

Objectives: Median arcuate ligament syndrome (MALS) is a vascular compression syndrome with symptoms that overlap chronic functional abdominal pain (CFAP). We report our experience treating MALS in a pediatric cohort previously diagnosed with CFAP., Patients and Methods: We prospectively evaluated 46 pediatric (<21years of age) patients diagnosed with MALS at a tertiary care referral center from 2008 to 2012. All patients had previously been diagnosed with CFAP. Patients were evaluated for celiac artery compression by duplex ultrasound and diagnosis was confirmed by computed tomography. Quality of life (QOL) was determined by pre- and postsurgical administration of PedsQL™ questionnaire. The patients underwent laparoscopic release of the median arcuate ligament overlying the celiac artery which included surgical neurolysis. We examined the hemodynamic changes in parameters of the celiac artery and perioperative QOL outcomes to determine correlation., Results: All patients had studies suggestive of MALS on duplex and computed tomography; 91% (n=42) positive for MALS were females. All patients underwent a technically satisfactory laparoscopic surgical release resulting in a significant improvement in blood flow through the celiac artery. There were no deaths and a total of 9 complications, 8 requiring a secondary procedure; 33 patients were administered QOL surveys. 18 patients completed the survey with 15 (83%) patients reporting overall improvement in the QOL. Overall, 31/46 patients (67%) reported improvement of symptoms since the time of surgery., Conclusions: MALS was found to be more common in pediatric females than males. Laparoscopic release of the celiac artery can be performed safely in the pediatric population. Surgical release of the artery and resultant neurolysis resulted in significant improvement in the blood flow, symptoms, and overall QOL in this cohort. The overall improvement in QOL outcome measures after surgery leads us to conclude that MALS might be earlier diagnosed and possibly treated in patients with CFAP. We recommend a multidisciplinary team approach to care for these complex patients., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: The rectovesical ligament is a peritoneal band in women with failure of fusion of the two Müllerian ducts. The aim was to evaluate existence of this abnormal structure in women with dysfused uterus and its possible relations to concomitant vaginal and renal anomalies., Study Design: The study group comprised 47 women with uterine fusion defect (37 didelphic and 10 bicornuate uterus). They had undergone laparoscopy or laparotomy to visualize the pelvic cavity, and imaging for renal evaluation. The rectovesical ligament was present if inspection of the pelvic cavity revealed a broad peritoneal band between the two hemiuteri, attached anteriorly to the bladder and posteriorly to the sigmoid. Presence or absence of the ligament was reported, and concomitant renal and vaginal anomalies were evaluated., Results: The rectovesical ligament was not visualized in 14 patients with didelphic or complete bicornuate uterus associated with unilateral renal agenesis: of these 13 had a previously treated obstructive longitudinal vaginal septum. A peritoneal band was found in 27 women with didelphic uterus with longitudinal vaginal septum with no obstruction and normal bilateral kidneys. Six women with bicornuate uterus had normal kidneys and an identified rectovesical ligament between the uterine hemicorpora, except for one with partial bicornuate uterus., Conclusion: The rectovesical ligament is not merely a consequence of the failed fusion of two Müllerian ducts, but its relation to uterine malformation with or without vaginal and renal anomalies indicates some share of this structure in the early development of the urogenital system., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Commonly, small bowel obstruction (SBO) is caused by either postoperative adhesions or external hernias. Internal hernias are rare, accounting for less than 2% of all cases of intestinal obstruction. An internal hernia through the falciform ligament is extremely uncommon and is usually secondary to a congenital or iatrogenic defect caused by trocars insertion. In this article, we report a case of SBO in a virgin abdomen that appeared to be caused by a congenital defect in the falciform ligament. A search of the literature was done identifying all reported cases of internal hernias caused by falciform ligament defect in order to guide diagnosis and management as well as avoidance of hernias caused by iatrogenic defects.

The elongated stylohyoid process presents with considerable anatomic variability. We report here oil an ancient cranium with bilateral elongated styloid process, 3.3 cm on the right side and 5.1 cm on the left side, found during the examination of excavated bones of 2000 (years ago (first half of 1st century AD) from the old Greek-Roman city-of Leodikya in Turkey. We determined the gender as female, from the examination of the skeleton (especially skull and pelvic bones). No other variation was observed. On the basis of embryology, the reason for this variation may be partial ossification of the second pharyngeal arch cartilage in the region which commonly becomes the stylohyoid ligament. Although elongation of the styloid process is common, it is important to report this ancient variation, in order to help to compare the bone variations between ancient and modern humans and the contribution of genetic and environmental determinants.

The suprascapular notch (SSN) is the most common site of compression and injury of the suprascapular nerve (SN), which results in a neuropathy known as SN entrapment. The SSN is enclosed from the top by the superior transverse scapular ligament (STSL), creating a tunnel for the SN. On both sides of the SSN, below the STSL, the anterior coracoscapular ligament is found. This fibrous band can potentially narrow the opening and contribute to the occurrence of suprascapular entrapment syndrome. This study presents the first case of a bifid anterior coracoscapular ligament coexisting with an atypical SN course, which has never been described in the literature before. Knowledge of such anatomical variations can be helpful in arthroscopic and open procedures of the suprascapular region and confirms the safety of operative decompression for entrapment of the SN.

Magnetic resonance (MR) imaging is the primary diagnostic imaging modality for the evaluation of patients with suspected internal derangement of the shoulder joint. Awareness and understanding of the complex anatomy of the shoulder articulation and the ability to recognize normal anatomic variants and potential imaging pitfalls are critical to accurate interpretation of conventional and arthrographic MR imaging studies. This review discusses the normal anatomy and anatomic variants of the glenoid labrum, articular cartilage, and glenohumeral ligaments. An improved understanding of normal anatomy, biomechanics, and variants will help to avoid potential pitfalls in the interpretation of noncontrast and arthrographic shoulder MR imaging examinations., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Accessory peritoneal sac and cystoduodenal ligament as peritoneal variations were observed in a cadaver in our laboratory. Slender stomach, thin transverse colon, redundant sigmoid colon, absent ascending colon and doubly distended gall bladder were also reported in the same cadaver. Relevant anatomical and clinical implications are discussed., (© Springer-Verlag 2011)

Introduction: Frequent reporting of cases of the coexistence of a Spigelian hernia (SH) with an undescended testis (UT) suggests that this phenomenon may be a syndrome. In this article, four pediatric cases in which an UT accompanies a congenital SH have been discussed in light of the literature., Methods: In this study, four cases aged between 6 months and 5 years who had a SH accompanied by an UT were evaluated and underwent surgery., Result: The patient's ages were 6 months, 1 year, 2 years, and 5 years old. The testis was observed in the opened hernia sac. The patients did not have a gubernaculum or an inguinal canal on the side of the hernia., Conclusions: Neither the theories suggesting that SH leads to an UT nor those suggesting that an UT leads to a SH are satisfactory. We believe that this coexistence may be the congenital Spigelian-cryptorchidism syndrome seen in boys. As in the four cases presented here, elements of this syndrome are defects in the Spigelian fascia and the hernia sac enveloping the testis and an absence of the gubernaculum and the inguinal canal., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

The supracondylar process is usually a beak-like osseous prominence located at the anteromedial aspect of the distal portion of the humerus. It is usually asymptomatic but occasionally may compress underlying structures such as the median or ulnar nerve, the brachial artery or its branches. The term septal aperture defines an oval or round shaped bony defect of the septum that separates the olecranon from the coronoid fossa of the humerus. It is of significance for surgeons because it may alter the fracture pattern at the region and thus their management. We present a rare case of coexistence of supracondylar process and septal aperture in a macerated left humerus. The reported incidence of the supracondylar process alone varies from 0.28% to 2.78%, while that of the septal aperture from 6.9% to 60%. We have reviewed the literature and emphasized the radiological and surgical significance of the findings.

We report a case of a 3-year-old boy who presented with symptoms and signs of intestinal obstruction. The patient reported no previous history of abdominal surgery or trauma while clinical and radiographic examinations were not diagnostic. An open laparotomy was subsequently performed and the intraoperative findings were consistent with a congenital band extending from the antimesenteric wall of the jejunum to the root of mesentery. The band was ligated and divided with an uneventful postoperative course. Congenital bands are extremely rare. Their exact incidence is still unknown. This case, therefore, represents an unusual surgical problem in a child in which the diagnosis was clinically unexpected.

Background: Right-sided ligamentum teres (RSLT) is a congenital anomaly that is sometimes encountered during hepatobiliary surgeries. However, a valid protocol for describing the segmental anatomy of livers with RSLT has not been established, and confusions or anatomic misunderstandings have been a major problem., Methods: The vascular architecture and morphological characteristics were investigated in 35 livers with RSLT using three-dimensional (3D) simulations., Results: Couinaud's four sectors and three hepatic veins were clearly distinguished in the liver with RSLT using 3D simulations. The ligamentum teres was connected with the right paramedian portal pedicle, and the long axis of the cystic fossa was always observed on the left of the ligamentum teres in all 35 livers. However, when the main portal scissura was visualized using 3D simulation, the gallbladder was always located on the border of either side of the hemilivers, and the malposition of the gallbladder was not confirmed., Conclusions: Although the right-sided components of the livers are well developed as a result of the right-dominant distribution of the feeding vessels in livers with RSLT, the basic segmental structure defined by the four sectors and the three hepatic veins are as well preserved as those in the typical liver anatomy., (© 2011 International Hepato-Pancreato-Biliary Association.)

Ulnar nerve entrapment at the elbow is the second most common upper limb entrapment neuropathy other than carpal tunnel syndrome. There have been many causes identified ranging from chronic aging joint changes to inflammatory conditions or systemic disorders. Among them, uncommon anatomical variants accounts for a small number of cases. Here, we report our experience in managing ulnar nerve entrapment caused by a rare vestigial structure, anconeus epitrochlearis ligament, and provide a brief review of the literature of its management.

Ovarian torsion is a surgical emergency that can present with a variety of symptoms and hence is difficult to diagnose. We present the first case of a pediatric synchronous bilateral ovarian torsion in ovaries without pathology and review its presentation, diagnosis, treatment, outcome, and the associated literature., (Copyright © 2011 Elsevier Inc. All rights reserved.)

The authors report a case of a young male with median arcuate ligament syndrome (MALS). An abnormally low insertion of the median arcuate ligament fibres caused extrinsic compression and stenosis of the coeliac trunk. However, partial dissection of ligament fibres by laparoscopic surgery did not relieve abdominal angina. Multidetector CT confirmed that MALS did not differ from the preoperative scan. The arcuate ligament compressed the coeliac trunk on expiration, thereby eliciting occlusion of the coeliac trunk. Inspiration induced decompression of the ligament with partial release of occlusion of the coeliac trunk. This leads to hypo-perfusion of intestinal organs and abdominal angina. Considering the severe impairment of quality of life, open surgery for decompression of the coeliac trunk with vascular reconstruction is a reasonable option.

During anatomical dissections on 36 human elbow joints, we observed the presence of three muscles around the superior radioulnar joint usually neglected by the classical anatomical literature, the lateral tensor muscle of the annular ligament (with an incidence of 16.6%), the medial tensor muscle of the annular ligament (11.1%) and the accessory supinator muscle (16.6%). We could not establish any association between the subject handedness and the sidedness of these aberrant muscles, neither we found a predominance in sidedness or in gender. Furthermore, we did not notice any significant predominance related to the occupation and specifically to heavy labor occupations. On the contrary we found these muscles to be more common in non-laborers, which supports the assumption that these variants constitute rather genetic than epigenetic traits. The knowledge of such anatomical variants facilitate the surgeon operating in the elbow region to better interpret supernumerary muscular bundles in the operative field.

Background: Early hepatic artery thrombosis (HAT) is a potentially lethal complication after orthotopic liver transplantation (OLT) requiring immediate intervention., Aim: To report an infrequent cause of HAT after OLT and by itself a controversial clinical entity, the median arcuate ligament celiac artery compression., Case Report: A 59-year-old female with hepatitis C virus-induced cirrhosis, Child B, MELD 15, underwent cadaveric-donor OLT with complete vena cava exclusion. Type 1 hepatic artery anatomy was found both in the donor and the recipient, the gastroduodenal artery was ligated. During the first eight postoperative days, clinical and analytical evolution was satisfactory and Doppler ultrasound showed no abnormalities. On the ninth postoperative day, the patient developed hypovolemic shock due to bleeding at the hepatic artery anastomosis, surgical reconstruction was performed. Postoperative color Doppler showed absent hepatic artery flow and an angiography suggested celiac artery compression. The patient was explored again the same day, liberating the celiac artery from the median arcuate ligament and performing thrombectomy and reconstruction of the hepatic artery anastomosis. The patient made a satisfactory recovery and color Doppler showed adequate flow in the hepatic artery. She is alive, free of biliary complications and enjoying a good quality of life 12 months after transplantation., Conclusion: Median arcuate ligament celiac artery compression is an infrequent anatomical variant that should be intentionally evaluated in the recipient at the time of arterial reconstruction in OLT and specifically be considered in early HAT to allow recognition and effective correction.

Median arcuate ligament syndrome (MALS) is a rare disorder resulting from luminal narrowing of the celiac artery by the insertion of the diaphragmatic muscle fibers. Surgical management entails division of the median arcuate ligament with or without celiac artery reconstruction. We are presenting an interesting case of a 16-year-old girl with postprandial abdominal pain and weight loss. Her mother also had MALS treated via open celiotomy with complete median arcuate ligament division and patch angioplasty of the celiac artery owing to persistent stenosis at our institution. After a diagnosis of MALS was confirmed in our patient, a transperitoneal laparoscopic release of the median arcuate ligament with skeletonization of the celiac artery and branch vessels was performed. The postoperative course was uneventful, and she was dismissed on postoperative day 2. She remains asymptomatic at 12-months follow-up. This represents the first report of a transperitoneal laparoscopic approach to MALS in an adolescent and the first report of a familial/generational component to MALS., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Objective: To study the relationship of anomalous right-sided round ligament with respect to branches of the portal vein., Methods: We studied four patients of right-sided round ligament diagnosed radiologically in the last 5 years. 3-D volume rendered CECT abdominal images were analyzed for attachment of the round ligament in the liver in relation to portal venous anatomy and position of gallbladder., Results: In all cases, a trifurcate pattern of portal venous branching was observed. Right-sided round ligament was attached at the point of divergence of the right anterior portal vein. The region to the left of the point of its attachment drained into the middle hepatic vein while the region to the right of the point of attachment drained into the right hepatic vein. The left portal vein branched into posterior and paramedian branches. Right, middle, and left hepatic veins were visualized having normal course in all cases. In all, the gallbladder was present to the left of the round ligament., Conclusions: Trifurcate pattern of portal vein branching in all four cases. Right-sided round ligament was attached to the bifurcation of the right anterior portal vein in all the cases. The left portal vein branched into posterior and paramedian branches.

Background: The human face contains numerous subcutaneous compartments of fatty tissue, but neither a chin compartment nor a submental compartment have been described. Definitions of the jowl compartment vary considerably., Objectives: To investigate the borders between the subcutaneous fat compartments of the chin, submental region, and jowls., Methods and Materials: Colored gelatin was injected into the subcutaneous tissues directly under the skin of 30 human cadaver heads. Macroscopic dissection was performed., Results: Distinct chin and submental compartments were identified in all cases. The chin compartment is demarcated by the mentolabial groove superiorly, the submental ligaments inferiorly, and the labiomandibular grooves laterally. The submental compartment is demarcated from the chin by the submental ligaments, laterally by the paramedian platysma-retaining ligaments, and inferiorly by the hyoid ligament. The upper border of the jowl compartment is formed by the mandibular ligaments and the platysma-mandibular ligaments, the anterior border by the paramedian platysma-retaining ligaments, and the dorsal boundary by the submandibular platysma retaining ligaments., Conclusion: The chin compartment is well demarcated from adjacent compartments. The limits of the submental compartment vary. The jowl compartment is clearly demarcated from adjacent compartments.

We report a very rare case of internal hernia of the small bowel through a large congenital defect of the falciform ligament. A complete preoperative diagnosis was possible by 64-row multi-detector row computerized tomography. The identification of the characteristic anatomic features and landmarks of the obliterated umbilical vein-ligamentum teres-was the diagnostic key.

This case report describes a rare example of double aortic arch with a dominant left aortic arch, patent minor right aortic arch, left descending aorta, and right ligamentum arteriosum causing tracheobronchial compression in a twin baby girl with DiGeorge syndrome. She also had large right subclavian artery arising from right-sided diverticulum of Kommerell, aplastic thymus, T cell lymphopenia with normal immunoglobulin, hypocalcemia, and hypomagnesemia. The diverticulum of Kommerell was resected and minor right aortic arch, right ligamentum arteriosum, and right subclavian artery were divided through right posterolateral thoracotomy. Aortopexy was performed under bronchoscopic guidance to relieve the airway compression. We strongly suggest a right-sided approach in this type of vascular arrangement for easy access and better outcome.