Search Results (155)

This study sought to quantify and characterize diverse rootstock scion interactions in cacao around graft compatibility, disease resistance, nutrient use efficiency, vigor traits, and translocation of nonstructural carbohydrates. In total, 106 grafts were performed with three scion cultivars (Matina 1/6, Criollo 22, Pound 7) and nine diverse open-pollinated seedling populations (BYNC, EQX 3348, GNV 360, IMC 14, PA 107, SCA 6, T 294, T 384, T 484). We found evidence for both local and translocated graft incompatibility. Cross sections and Micro-XCT imaging revealed anatomical anomalies, including necrosis and cavitation at the junction and accumulation of starch in the rootstock directly below the graft junction. Scion genetics were a significant factor in explaining differences in graft take, and graft take varied from 47% (Criollo 22) to 72% (Pound 7). Rootstock and scion identity both accounted for differences in survival over the course of the 30-month greenhouse study, with a low of 28.5% survival of Criollo 22 scions and a high of 72% for Pound 7 scions. Survival by rootstocks varied from 14.3% on GNV 360 to 100% survival on T 294 rootstock. A positive correlation of 0.34 (p = 0.098) was found between the graft success of different rootstock–scion combinations and their kinship coefficient, suggesting that relatedness of stock and scion could be a driver of incompatibility. Significant rootstock–scion effects were also observed for nutrient use efficiency, plant vigor, and resistance to Phytophthora palmivora. These findings, while preliminary in nature, highlight the potential of rootstock breeding to improve plant nutrition, resilience, and disease resistance in cacao. Full article

Dens invaginatus is a developmental dental anomaly characterized by the infolding of the enamel organ into the dental papilla during early odontogenesis. This process leads to a broad spectrum of anatomical variations, ranging from minor enamel-lined pits confined to the crown to deep invaginations extending through the root, occasionally communicating with periodontal or periapical tissues. The internal complexity of affected teeth presents diagnostic and therapeutic challenges, particularly in severe forms that mimic root canal systems or are associated with pulpal or periapical pathology. Maxillary lateral incisors are most frequently affected, likely due to their unique developmental timeline and morphological susceptibility. Although various classification systems have been proposed, Oehlers’ classification remains the most clinically relevant due to its simplicity and correlation with treatment complexity. Recent advances in diagnostic imaging, especially cone beam computed tomography (CBCT), have revolutionized the identification and classification of these anomalies. CBCT-based adaptations of Oehlers’ classification allow for the precise assessment of invagination extent and pulpal involvement, facilitating improved treatment planning. Contemporary therapeutic strategies now include calcium-silicate-based cement sealing materials, endodontic microsurgery for inaccessible anatomy, and regenerative endodontic procedures for immature teeth with necrotic pulps. Emerging developments in artificial intelligence, genetic research, and tissue engineering promise to further refine diagnostic capabilities and treatment options. Early detection remains critical to prevent complications such as pulpal necrosis or apical disease. A multidisciplinary, image-guided, and patient-centered approach is essential for optimizing clinical outcomes in cases of dens invaginatus. Full article

Obstructive sleep apnea syndrome (OSAS) in children and adolescents is a prevalent and multifactorial disorder associated with significant short- and long-term health consequences. While adenotonsillectomy (AT) remains the first-line treatment, a substantial proportion of patients—especially those with obesity, craniofacial anomalies, or comorbid conditions—exhibit persistent or recurrent symptoms, underscoring the need for individualized and multimodal approaches. This review provides an updated and comprehensive overview of current and emerging treatments for pediatric OSAS, with a focus on both surgical and non-surgical options, including pharmacological, orthodontic, and myofunctional therapies. A narrative synthesis of recent literature was conducted, including systematic reviews, randomized controlled trials, and large cohort studies published in the last 10 years. The review emphasizes evidence-based indications, mechanisms of action, efficacy outcomes, safety profiles, and limitations of each therapeutic modality. Adjunctive and alternative treatments such as rapid maxillary expansion, mandibular advancement devices, myofunctional therapy, intranasal corticosteroids, leukotriene receptor antagonists, and hypoglossal nerve stimulation show promising results in selected patient populations. Personalized treatment plans based on anatomical, functional, and developmental characteristics are essential to optimize outcomes. Combination therapies appear particularly effective in children with residual disease after AT or with specific phenotypes such as Down syndrome or maxillary constriction. Pediatric OSAS requires a tailored, multidisciplinary approach that evolves with the child’s growth and clinical profile. Understanding the full spectrum of available therapies allows clinicians to move beyond a one-size-fits-all model, offering more precise and durable treatment pathways. Emerging strategies may further redefine the therapeutic landscape in the coming years. Full article

Background: Arterial variations in the upper limb, although infrequent, carry critical clinical implications. The presence of superficial ulnar and radial arteries, especially when originating from high levels, increases the risk of iatrogenic injury, misdiagnosis, and surgical complications. To confirm and describe, through ultrasound and anatomical dissection, the presence of a high-origin superficial ulnar artery and a superficial radial artery in a cadaver, highlighting their anatomical trajectory and clinical relevance. Methods: A cross-sectional ultrasound and anatomical study was conducted on 150 upper limbs from fresh-frozen cadavers. High-frequency ultrasound was used to scan the vasculature from the axilla to the wrist. Subsequently, dissection was performed to confirm sonographic findings. Results: One case (0.66%) of concurrent superficial ulnar artery and superficial radial artery was identified in the left arm of a 79-year-old male cadaver. The superficial ulnar artery originated from the axillary artery and coursed superficially along the forearm, anterior to the flexor muscles. The superficial radial artery emerged from the brachial artery and ran subcutaneously in the distal forearm. These arteries remained in close relation to key neural and venous structures, increasing their vulnerability to clinical error. Conclusions: The identification of high-origin superficial arteries is essential for clinical practice. Ultrasound serves as a reliable, non-invasive method for detecting such variations preoperatively. Awareness of these anomalies can prevent inadvertent vascular injuries, improve diagnostic accuracy, and inform safer surgical and anesthetic approaches in upper limb interventions. Full article

Vertebral Heart Score (VHS) is one of the commonly used methods for detecting cardiomegaly in dogs. However, this method has diagnostic limitations due to factors such as breed variations, orthopedic disorders, anatomical anomalies, and operator-dependent subjectivity. The aim of this study was to evaluate the diagnostic utility of the Manubrium Heart Score (MHS) as an alternative to VHS in the assessment of cardiomegaly in dogs. A total of 490 dogs were classified and grouped based on body weight and cardiac health status. On the right lateral thoracic radiographs, MHS was calculated as the ratio of manubrium length (ML) to the sum of the long-axis heart length (cLAL) and short-axis heart length (cSAL). Similarly, VHS was determined. A positive correlation between VHS and MHS, as well as between ML and cSAL/cLAL, were observed in all groups except for the group of medium sized dogs with heart diseases. No correlations were found between MHS and LA or the LA/Ao ratio. In pairwise comparisons of VHS and MHS between heart-diseased and healthy dogs, the mean VHS showed a statistically significant difference in heart-diseased dogs (p < 0.001), and not across all groups (p > 0.05). MHS may not consider a useful method as an alternative to VHS. Full article

The axillary and cephalic veins are commonly utilized for transvenous pacemaker lead access. They typically advance to the heart through the subclavian, brachiocephalic, and superior vena cava veins. Anatomical variations such as a persistent left superior vena cava (PLSVC) may pose a challenge, necessitating an alternative approach for lead placement. This anomaly can often be identified during venographic contrast imaging or by visualizing atypical venous courses during the procedure. Another challenge occurs when the venous pathway is tortuous. Careful monitoring during the procedure is crucial to ensure that the lead follows the intended path. If not, the lead may inadvertently enter a collateral, such as the inferior thyroid vein, which drains into the internal jugular or left brachiocephalic vein. Despite these deviations, the lead may eventually reach the heart, although via an unusual course. If such a lead is left in place, even in the absence of immediate complications, long-term outcomes are unpredictable and carry the risk of unforeseen complications. Full article

Objective: We aimed to provide an update on ultrasound measurements of the gallbladder with studies focusing on measurement techniques, reference values, and influencing factors. Anatomical anomalies and common pathological findings are discussed together with their clinical impact. Methods: A literature search was performed for ultrasound studies in healthy subjects. Relevant data published between 2010 and March 2025 were extracted and evaluated. Possible clinical implications are discussed. Results: Many factors influence gallbladder size and wall thickness, as the gallbladder is a highly functional organ. Diabetes and obesity have been proven to increase gallbladder volume and wall thickness. A normal gallbladder wall should be echogenic with one layer and a thickness < 3 mm. Gallbladder size is variable and can achieve values above 10 × 4 × 4 cm, especially with increasing age. Gallbladders with maximal diameters below 3.5 cm are referred to as micro-gallbladders. Calculating gallbladder volume is reserved for special issues, achieving the best inter- and intra-observer variability with the ellipsoid formula. Clinical relevance and work-up of common pathological findings like wall thickening, gallbladder polyps, and stones are discussed. Full article

Permanent maxillary canines are key teeth from both functional and aesthetic perspectives. Tooth transposition, a rare anomaly where two permanent teeth exchange positions within the same quadrant, poses significant diagnostic and therapeutic challenges. This study aimed to identify the clinical conditions guiding the decision to correct or maintain maxillary canine transposition through a narrative review of the literature, complemented by a detailed clinical case. Following PRISMA guidelines, a search of PubMed, ScienceDirect, Cochrane Library, EBSCO, and Scopus databases (2014–May 2024) yielded 19 relevant studies. This review found no consensus on treatment protocols, reinforcing the need for individualized decision-making based on patient characteristics, anatomical constraints, and clinician expertise. While orthodontic correction can yield favorable aesthetic outcomes, it requires meticulous planning and biomechanical control. Conservative approaches are often indicated in early-diagnosed or anatomically complex cases. The clinical case illustrates the complexity of managing the transposition, specifically of the maxillary canine into the central incisor position, emphasizing the importance of early diagnosis, digital planning, and a multidisciplinary approach for functional and aesthetic success. Full article

Background: Looking for anomalies and vascular control gains a central role in colon cancer surgery. Complete mesocolic excision (CME) presents technical challenges, primarily due to the considerable variability in the arterial configuration of the right colon. The importance of understanding colonic vascular anatomy has become more prominent with the adoption of this surgical technique. The aim of this study is to systematically review the vascular anatomical variations in the superior mesenteric artery (SMA) in the setting of extended lymphadenectomy for CME in right colon cancer and to show its impact in clinical practice. Methods: A systematic review of the literature on Medline (PubMed), Web of Science (WOS), and Scopus was performed according to PRISMA guidelines. The following criteria were set for inclusion: (1) studies reporting minimally invasive (robotic, laparoscopic, and hybrid techniques) or open CME/D3 lymphadenectomy; (2) studies reporting patients with right-sided colon cancer; (3) studies reporting the description or illustration of SMA variations. The methodological quality of all included studies was evaluated using the Newcastle–Ottawa Scale (NOS). Results: After the literature search, 800 studies were recorded, 31 studies underwent full-text reviews, and 9 studies met the inclusion criteria. All studies reported vascular variations in SMA, and the total number of patients was 813. No intraoperative complications were reported. In 6.4% of patients, post-operative bleeding occurred. Conclusions: Vascular anatomical variations are not a rare entity. In experienced centers, vascular anomalies are not associated with an increase in complications, both in traditional open and minimally invasive surgery (MIS). However, in MIS, full access to central vessels and intraoperative vascular control, moderate retraction, safety maneuvers, and accurate vascular dissection are mandatory. Full article

Background and Aims: Esophageal atresia (EA) and tracheoesophageal fistula (TEF) are rare but serious congenital anomalies requiring early surgical intervention. Over the past two decades, minimally invasive surgical (MIS) approaches—particularly thoracoscopic repair—have gained traction, aiming to reduce postoperative morbidity while maintaining surgical efficacy. Objective: This narrative review provides a comprehensive overview of the evolution and current status of MIS techniques for EA/TEF, assessing their clinical outcomes, technical challenges, and implications for patient care. Methods: A structured literature search was conducted to identify clinical studies, reviews, and reports on thoracoscopic, robotic-assisted, and endoscopic approaches to EA/TEF. Emerging adjuncts, including tissue engineering, botulinum toxin use, and magnet-assisted anastomosis, were also reviewed. Results: Thoracoscopic repair has demonstrated comparable anastomotic success rates to open surgery (approximately 85–95%) with significantly reduced rates of musculoskeletal complications, such as scoliosis and chest wall deformities (reported in less than 10% of cases, compared to up to 40% in open approaches). Robotic-assisted and endoscopic-assisted techniques have enabled improved visualization and precision in anatomically challenging cases, although their use remains limited to high-resource centers with specialized expertise. Common postoperative complications include anastomotic stricture (30–50%), gastroesophageal reflux disease (35–70%), and respiratory morbidity, necessitating long-term multidisciplinary follow-up. Recent innovations in simulation-based training and bioengineered adjuncts have facilitated safer MIS adoption in neonates. Conclusions: Minimally invasive techniques have improved the surgical management of EA/TEF, though challenges remain regarding technical complexity, training, and resource availability. Continued innovation and collaborative research are essential for advancing care and ensuring optimal outcomes for affected infants. Full article

Background and Clinical Significance: This case presents a rare variation in mesenteric and pelvic vasculature that holds relevance for endovascular procedures. Limited published cases of the testicular artery arising off the inferior mesenteric artery exist in the literature and play an important role in clinical outcomes. Case Presentation: An 89-year-old male presented with gastrointestinal bleeding from diverticulosis. During an arteriogram to locate and assess sigmoid arteries for embolization, an unusual anatomical variant of the left testicular artery was discovered. Typically, the left testicular artery originates from the abdominal aorta below the renal arteries. However, in this patient, the left testicular artery was found to directly branch off the inferior mesenteric artery, while the superior rectal artery was absent from the inferior mesenteric artery. Conclusions: Awareness of such vascular variations is essential for interventionalists to optimize procedural success and minimize complications. Recognizing potential vascular anomalies, such as those presented in this case, is essential for effective pre-procedural planning and intraoperative management to improve patient outcomes. Full article

Background: A wandering accessory spleen (WAS) is defined as an ectopic accessory spleen with a long vascular pedicle characterized by marked anatomical mobility. “Wandering” can be congenital or acquired due to splenomegaly or pregnancy. The study aimed to analyze the clinical course of WAS and its symptoms. Methods: The desk research method and statistical analysis were used to assess the outcome. Results: In total, 12 cases of WAS managed operatively, including 11 women and 1 man, have been found. The correct WAS diagnosis was established before surgery in 3 of the 12 patients. One individual did not exhibit any symptoms and underwent surgery to avoid WAS torsion and infarction. Abdominal pain was the most commonly reported symptom in 11 patients. No mortality has been reported. Conclusions: WAS is a rare anomaly. It can be symptomatic or produce a spectrum of symptoms, such as abdominal pain, and may resemble abdominal neoplasms. Torsion is the most common pathology in the WAS study group and is most common in young people. Full article

Succenturiate placenta is a rare anatomical variant characterized by one or more accessory lobes connected to the main placental mass by fetal vessels. While frequently asymptomatic, this condition can lead to serious maternal–fetal complications if not diagnosed prenatally. Early detection through advanced ultrasonographic techniques plays a critical role in guiding obstetric management and reducing adverse outcomes. Objective: To describe and analyze the prenatal diagnosis, sonographic characteristics, clinical management, and maternal–fetal outcomes of succenturiate placenta cases diagnosed over a ten-year period at a tertiary care center. Methods: We conducted a retrospective observational study of nine pregnancies diagnosed with succenturiate placenta between 2014 and 2024. Data collected included maternal demographics, ultrasound findings, type of cord insertion, presence of associated anomalies such as velamentous cord insertion or vasa previa, vaginal or cesarean delivery, complications, and neonatal outcomes. Ultrasound evaluation was scored based on a four-point checklist assessing key diagnostic steps. Results: Five of the nine cases (55.6%) presented isolated succenturiate placenta, while four (44.4%) were associated with velamentous cord insertion. No cases of vasa previa were identified. Obstetric outcomes included three vaginal deliveries (33.3%), two instrumental (22.2%), and four cesarean sections (44.4%), one of which was emergent due to fetal distress. Complications occurred in 44.4% of cases, with intrapartum bradycardia being the most common. One neonatal death was reported due to placental abruption. The quality of the ultrasound diagnosis was high in most cases, though transvaginal scanning was inconsistently applied. Conclusions: Prenatal identification of succenturiate placenta via detailed ultrasound, including color Doppler and targeted assessment of cord insertion, is essential to minimize risks associated with this condition. Standardized diagnostic protocols can improve detection rates and enable timely clinical decisions, ultimately improving maternal and neonatal outcomes. Full article

Background and Purpose: Undescended testes (UDT) is recognized as the most prevalent anomaly of the male genitalia and presents a significant risk factor for long-term complications, including infertility and testicular cancer. Currently, there is no consensus on the necessity of imaging in the management of UDT, nor is there agreement on which imaging modality is preferred or to what extent these tests offer real added value in the clinical setting. This review aims to evaluate the various imaging options available in the management of cryptorchidism, discussing their utility, advantages, and disadvantages compared to exploratory laparoscopy. Methods: We conducted a PubMed search using the following search terms: [“undescended testis”] OR [(“cryptorchidism”) OR (“diagnostic imaging”)] OR [(“Ultrasound”), OR (“CT scan”) OR (“MRI”)] AND [“laparoscopy”]. We analyzed 90 full articles, excluding irrelevant ones, and, in total, 18 publications were included in this review. Results: Ultrasound (US) is the most commonly used technique due to its non-invasive nature and absence of ionizing radiation. It is particularly beneficial in cases of non-palpable UDT. However, its main limitation lies in the difficulty in accurately locating UDT, especially when they are situated outside the inguinal region. Computed tomography (CT) scans serve as a crucial diagnostic tool, particularly for testes located below the internal inguinal ring. While CT exhibits comparable accuracy in detecting UDT, the need for sedation or general anesthesia, along with the costs and potential risks of secondary malignancy due to radiation exposure, does not favor its routine use. Magnetic resonance imaging (MRI) offers higher sensitivity than US and does not utilize ionizing radiation or intravascular contrast agents. It allows for the generation of multiplanar images, thereby providing improved tissue characterization. However, limitations include prolonged scan durations, the potential for motion artifacts during imaging, the need for sedation, and higher costs. Laparoscopy has been shown to provide better accuracy, offering both diagnostic and therapeutic benefits, particularly in cases of non-palpable UDT. It is widely regarded as the gold standard in achieving clear diagnostic and definitive therapeutic procedures and has demonstrated its utility in determining the anatomical position of intra-abdominal testes, owing to its magnification capabilities and minimally invasive approach. Conclusions: Achieving a correct and comprehensive diagnosis of cryptorchidism requires the medical team to decide on the appropriate imaging studies, as these will not significantly influence or alter the therapeutic decision-making process. It is unlikely that medical practice will eliminate imaging studies before a surgical decision is made in the near future. Therefore, a multidisciplinary approach that includes clinical examination, imaging, and diagnostic laparoscopy remains essential for the accurate management of UDT. Full article

The first web space of the hand plays a fundamental role in daily hand function, facilitating crucial movements, such as pinching, grasping, and opposition. The structural anomalies of acquired defects of this anatomical region, whether secondary to trauma, burns, or post-oncological surgical resections, necessitate meticulous reconstructive strategies to ensure both functional restoration and aesthetic integrity. Given the complexity and variability of first web defects, a broad spectrum of reconstructive techniques has been developed, ranging from skin grafting and local flap reconstructions to advanced microsurgical approaches. This review comprehensively examines the existing literature on first web reconstruction techniques, analyzing their indications, advantages, and limitations. Additionally, it explores innovative techniques and emerging trends in the field, such as tissue engineering, regenerative medicine, and composite tissue allotransplantation, which may revolutionize future reconstructive strategies. The primary objective is to provide clinicians with an evidence-based guide to selecting the most appropriate reconstructive strategy tailored to individual patient needs. Furthermore, we incorporate our institutional experience in managing first web defects, highlighting key surgical principles, patient outcomes, and challenges encountered. Through this analysis, we aim to refine the understanding of first web reconstruction and contribute to the ongoing evolution of hand surgery techniques. Full article