Search Results (66)

Prostate cancer is the prototypical immunologically cold solid tumor, with objective response rates of only 3–5% to immune checkpoint inhibitors in unselected metastatic castration-resistant disease and an estimated 89.8% of tumors classified as immunologically ignorant. Three convergent features sustain this phenotype: low tumor mutational burden with defective Major Histocompatibility Complex class I antigen presentation; an immunosuppressive microenvironment dominated by regulatory T-cells, myeloid-derived suppressor cells, and M2 macrophages; and dense stromal and vascular barriers that exclude effector lymphocytes. Across these mechanisms, one compartment has received disproportionately little attention: the lymphatic system. Tumor-associated lymphatic remodeling driven by vascular endothelial growth factor C and D produces structurally abnormal vessels that impair antigen and dendritic cell trafficking to tumor-draining lymph nodes; the lymph nodes themselves are reprogrammed to a tolerogenic state by lymphatic endothelial cells expressing programmed death-ligand 1 and lacking costimulation and by regulatory T-cells that suppress effector egress. This review synthesizes evidence that in prostate cancer, immune coldness reflects not merely a problem of checkpoint engagement with the tumor but a failure of antigen trafficking at the lymphatic interface. We discuss therapeutic strategies that target this axis, such as lymphangiogenesis-inducing vaccines, lymph-node-directed checkpoint delivery, induction of intratumoral tertiary lymphoid structures and stromal reprogramming, as complements to existing immunotherapy. Targeting trafficking, not only checkpoints, may be the prerequisite for converting PCa from cold to hot. Full article

We describe a rare case of LRV pseudo-fenestration in a 68-year-old female identified on contrast-enhanced multidetector computed tomography. Unlike true fenestration, in which a single vessel splits and reunites, this pseudo-fenestration resulted from the convergence of two distinct hilar venous trunks. Multiplanar and three-dimensional reconstructions demonstrated that the left suprarenal vein drained into the superior limb, whereas the left gonadal vein drained into the inferior limb, reflecting a consistent and anatomically meaningful tributary pattern. This configuration is most plausibly explained by incomplete or asymmetric embryological fusion of the cardinal venous system. Accurate preoperative recognition of this variant is clinically important to reduce the risk of iatrogenic injury during laparoscopic donor nephrectomy, adrenal venous sampling, and other retroperitoneal or endovascular procedures. Full article

Background: Thoracic air complications after autologous breast reconstruction (ABR) are uncommon and incompletely characterised. A personalised perioperative approach requires integration of patient anatomy, reconstructive technique, anaesthetic exposures and the postoperative clinical trajectory rather than reliance on population-level estimates alone. Methods: We report a 41-year-old woman in whom pneumomediastinum was identified after bilateral DIEP flap reconstruction and performed a focused literature review restricted to primary studies of pneumothorax or pneumomediastinum following autologous flap breast reconstruction. Searches across MEDLINE-Ovid, PubMed and Wiley Online Library using predefined MeSH terms were conducted. Data extraction focused on study characteristics, incidence, mechanism of injury, perioperative factors, and management. Results: The patient developed postoperative hypotension and persistent tachycardia, followed by pleuritic chest pain. CT excluded pulmonary embolism and oesophageal perforation but demonstrated Moderate volume pneumomediastinum without pneumothorax. She was managed conservatively and discharged on postoperative day 7. Five primary studies met the eligibility criteria. Study-specific pneumothorax frequencies were 1/463 (0.22%) after rib-sparing free-flap reconstruction, 3/749 (0.4%) after extended latissimus dorsi reconstruction, and 4/180 patients (2.2%; 1.4 per 100 internal mammary vessel dissections). Reported mechanisms included pleural injury during internal mammary vessel dissection, inadvertent puncture during regional anaesthesia, barotrauma under positive-pressure ventilation, and drain-related barotrauma. No previous primary report of pneumomediastinum after autologous flap breast reconstruction was identified. Conclusions: Pneumothorax and pneumomediastinum are uncommon but potentially serious complications of ABR. They are rarely documented postoperatively; however, surgeons and anaesthetists must remain vigilant, particularly during exposure of the internal mammary vessels and airway management. Patient-specific assessment, symptom-directed imaging and multidisciplinary management may support early recognition to prevent morbidity and preserve the outcomes of reconstructive procedures. Full article

The discovery of the glymphatic system and meningeal lymphatic vessels established that the brain possesses an organized lymphatic clearance network that drains to the deep cervical lymphatics. Disruption of this system has been suggested to contribute to the accumulation of pathogenic proteins implicated in neurodegeneration. Cervical lymphatic reconstruction has been associated with some neurological benefit in Alzheimer’s and Parkinson’s disease, and preclinical work has demonstrated that noninvasive manipulation of superficial cervical lymphatics can increase cerebrospinal fluid outflow. Whether noninvasive cervicofacial lymphedema therapy can produce comparable neurological effects remains unknown. We report two men with Parkinson’s disease (Hoehn and Yahr stages 2.5 and 3) treated with a standardized cervicofacial lymphedema therapy protocol targeting cervical and facial lymphatic pathways. Total MDS-UPDRS scores decreased by 19 points (34.5%) in Patient 1 and 5 points in Patient 2. The reduction in Patient 1 exceeded the published threshold for clinically meaningful total-score improvement. Benefits were reproducible and session-linked, and were accompanied by motor and non-motor gains in cognition, alertness, mood, energy, and sleep; interruption of therapy was associated with return toward baseline. Cervicofacial lymphedema therapy may represent a low-risk, noninvasive intervention hypothesized to influence brain lymphatic clearance in Parkinson’s disease. Full article

Background/Objectives: Raghib syndrome is a rare congenital heart disease where the left superior vena cava (LSVC) drains into the left atrium in addition to an absent coronary sinus and an atrial septal defect. This condition can lead to hemodynamic impairment and ultimately put the patient at a high risk of stroke. While computational flow modeling enables predictive understanding of the heart hemodynamic, augmented reality (AR) provides a deeper understanding of complex anatomic geometries. This study shows the case of a 53-year-old woman with Raghib syndrome in whom preoperative planning was supported by the integration of computational fluid dynamics (CFD) and AR. Methods: Three-dimensional (3D) anatomical models were segmented from CT imaging and used to perform CFD simulations of pre- and post-operative hemodynamics, quantifying the left-to-right shunt and confirming restoration of normal intracardiac flow after surgical repair. Results: The AR application developed allowed surgeons to visualize and manipulate holographic cardiac models, enabling accurate assessment of LSVC length, vessels distances and septal defect geometry using HoloLens 2 headsets. Conclusions: This work demonstrates the feasibility and adds value of the immersive approach coupled with quantitative in silico flow analysis for preoperative planning of complex congenital heart disease. Full article

Background/Objectives: The minimally invasive repair of pectus excavatum (MIRPE) and its modifications represent the gold standard for surgical repair of chest wall deformities. Severe complications during or after MIRPE are rare but likely underreported in the literature. Methods/Results: We report the case of a 14-year-old adolescent who underwent an uneventful repair of an asymmetric pectus excavatum. Six weeks postoperatively, the patient presented with shortness of breath and dizziness. Clinical examination and imaging revealed a spontaneous massive right-sided hemothorax. Following chest tube placement, an initial 600 mL of bloody pleural fluid was drained. CT angiography demonstrated no active bleeding but raised suspicion of an injury to the right-sided internal mammary artery. After a total drainage of 1600 mL, the patient remained hemodynamically stable, and the chest tube was removed within 24 h. During 32 months of follow-up, the further clinical course was uneventful, and imaging demonstrated no secondary displacement of the implants. Discussion/Conclusions: Accidental injury to the internal mammary or intercostal vessels during pectus surgery is a rare but potentially life-threatening complication. Only a few cases of delayed hemorrhage following MIRPE have been reported, and in many a clear source of bleeding could not be identified. Pectus surgeons should be aware of this rare complication and should report such cases to improve understanding of its incidence and management. Full article

Background: Defects following total parotidectomy represent a distinctive reconstructive challenge. Restoration of facial volume and contour must be balanced with protection of the preserved facial nerve and reliable healing, particularly after extensive dissection and when adjuvant radiotherapy is anticipated. Multiple reconstructive options exist, each involving trade-offs regarding volume, pliability, long-term stability, and donor-site morbidity. We report our early clinical experience using the adipofascial infragluteal perforator (AIGP) free flap for reconstruction after total parotidectomy with skin and facial nerve preservation. Methods: We retrospectively reviewed the results of three consecutive patients undergoing total parotidectomy for parotid tumors, receiving immediate reconstruction with an AIGP free flap, operated between June and July 2025. The flap, based on terminal branches of the infragluteal vessels, was anastomosed to cervical recipient vessels. To address the two-compartment defect created by facial nerve preservation, the adipofascial tissue was tailored in a chimeric configuration to separately restore the superficial and deep parotid spaces. Results: All flaps survived. One patient developed a postoperative hematoma managed conservatively. Two patients developed minor donor-site seromas after drain removal, which resolved without intervention. Facial contour was satisfactorily restored in all cases, with mild overcorrection in one patient. Facial nerve function improved during follow-up. Donor-site scars were concealed within the infragluteal crease. Conclusions: In this preliminary case series, the AIGP free flap proved to be a feasible option for reconstruction after total parotidectomy with skin and facial nerve preservation, offering satisfactory contour restoration and low donor-site morbidity. Larger studies with longer follow-up are required to define indications and long-term outcomes. Full article

Multimodal high-resolution ultrasound, including B-mode, Power Doppler, MicroVessel Doppler, spectral Doppler, and strain elastography, was used to assess concomitant dactylitis and hidradenitis suppurativa (HS) in a 46-year-old woman with severe hidradenitis suppurativa (IHS4 = 28), who was diagnosed 1.5 years ago and has been using adalimumab. Axillary ultrasound demonstrated abscess cavities and draining fistulous tracts with marked structural distortion, increased vascular signal on advanced Doppler modalities, and heterogeneous stiffness patterns on elastography, consistent with active deep inflammatory involvement. Simultaneously, evaluation of the third right finger revealed flexor tendon sheath thickening, soft-tissue edema, Doppler-positive inflammatory activity, and altered biomechanical properties compatible with dactylitis. High-resolution ultrasound has been increasingly recognized as a valuable tool for evaluating inflammatory and structural changes in cutaneous diseases, including HS. These multimodal findings illustrate how structural, vascular, and biomechanical ultrasound parameters may provide complementary information for characterizing inflammatory tissue remodeling in HS associated with dactylitis. As this report describes a single patient, these elastographic observations should be considered exploratory and hypothesis-generating rather than evidence of clinical validation. Full article

Background: Axillary lymph node dissection (ALND) remains necessary for selected patients with breast cancer but is associated with lymphatic morbidity, including seroma formation and breast cancer-related lymphedema (BCRL). The Total Sealing Technique (TST) is a technique-centered operative concept that emphasizes systematic sealing of lymphatic and vascular structures during ALND. Methods: This review integrates mechanistic rationale and clinical evidence derived from comparative cohort studies evaluating TST (using advanced bipolar vessel-sealing systems) versus conventional electrocautery (CONV). Key perioperative and long-term outcomes are summarized quantitatively. Results: In a comparative cohort of total mastectomy with ALND, TST significantly reduced total drainage volume (360.5 ± 187.9 vs. 820.6 ± 661.6 mL; p < 0.001) and shortened time to drain removal (4.8 ± 1.3 vs. 6.8 ± 2.1 days; p < 0.001). Postoperative hospital stay was reduced by 3.7 days on average (5.9 ± 1.3 vs. 9.6 ± 3.4 days; p < 0.001). The incidence of seroma decreased from 65.9% to 28.6% (p = 0.001), with fewer aspiration procedures (1.8 vs. 4.6 per patient; p = 0.022). Importantly, long-term follow-up demonstrated a statistically significant reduction in BCRL incidence (2.9% vs. 22.2%; p = 0.028). Operative time and blood loss were not increased. Conclusions: Current single-center data indicate that TST is associated with substantial reductions in postoperative lymphatic morbidity and a statistically significant decrease in BCRL incidence. While independent multicenter validation is warranted, TST represents a reproducible technique-centered approach with meaningful clinical impact in ALND. Full article

During liquid drainage from intermediate vessels in various industrial processes such as continuous steel casting, aircraft fuel supply, and chemical separation, free-surface vortices commonly occur. The formation and evolution of these vortices not only entrain surface slag and gas, but also lead to deterioration of downstream product quality and abnormal equipment operation. The vortex evolution process exhibits notable three-dimensional unsteadiness, multi-scale turbulence, and dynamic gas–liquid interfacial changes, accompanied by strong coupling effects between temperature gradients and flow field structures. Traditional macroscopic numerical models show clear limitations in accurately capturing these complex physical mechanisms. To address these challenges, this study developed a mesoscopic numerical model for gas-liquid two-phase vortex flow based on the lattice Boltzmann method. The model systematically reveals the dynamic behavior during vortex evolution and the multi-field coupling mechanism with the temperature field while providing an in-depth analysis of how initial perturbation velocity regulates vortex intensity and stability. The results indicate that vortex evolution begins near the bottom drain outlet, with the tangential velocity distribution conforming to the theoretical Rankine vortex model. The vortex core velocity during the critical penetration stage is significantly higher than that during the initial depression stage. An increase in the initial perturbation velocity not only enhances vortex intensity and induces low-frequency oscillations of the vortex core but also markedly promotes the global convective heat transfer process. With regard to the temperature field, an increase in fluid temperature reduces the viscosity coefficient, thereby weakening viscous dissipation effects, which accelerates vortex development and prolongs drainage time. Meanwhile, the vortex structure—through the induction of Taylor vortices and a spiral pumping effect—drives shear mixing and radial thermal diffusion between fluid regions at different temperatures, leading to dynamic reconstruction and homogenization of the temperature field. The outcomes of this study not only provide a solid theoretical foundation for understanding the generation, evolution, and heat transfer mechanisms of vortices under industrial thermal conditions, but also offer clear engineering guidance for practical production-enabling optimized operational parameters to suppress vortices and enhance drainage efficiency. Full article

While performing a routine anatomical dissection on a male donor, undergraduate medical students observed an uncommon vascular anomaly: a persistent left superior vena cava (LSVC). Prior to the anatomical dissection, computed tomography (CT) images were obtained in an embalmed condition. Relevant anatomical structures were measured using the JiveX DICOM Viewer. The left brachiocephalic vein (LBV) was present as a communicating vessel with a markedly reduced diameter between the LSVC and the right superior vena cava (RSVC). The diameters of RSVC and LSVC averaged 19.4 mm and 15.2 mm, respectively. The LSVC drained into a dilated coronary sinus (CS), which measured 22.7 mm in diameter. In addition, the left accessory hemiazygos vein collected the 2nd to 5th left intercostal veins, forming a small-caliber venous arch (2.1 mm in diameter) at the T5 vertebral level, which crossed anterior to the thoracic aorta, before draining into the LSVC. In comparison, the azygos venous arch on the right side is connected to the RSVC at T4. Knowledge of such venous variations through preoperative imaging—such as CT, MRI, or echocardiography—can be essential for procedural planning and for minimizing inadvertent complications. This case also highlights a dual approach, combining anatomical dissection with detailed CT analysis of the same specimen, which can both enhance undergraduate anatomical education and contribute to high-quality morphological research. Full article

This retrospective study evaluated the clinical utility of Virtual Reality (VR) in visualizing extracardiac CHD (eCHD) abnormalities involving great vessels, pericardium, or structures outside the heart in nine pediatric patients. Anonymized computed tomography angiography (CTA) DICOM images were processed using Elucis (Version 1.10 elucis next) software to generate interactive 3D models via segmentation. VR models were reviewed for a variety of cases: vascular rings (two with right aortic arch, aberrant left subclavian artery, and diverticulum of Kommerell; two with double aortic arch), pericardial teratomas (n = 2), right superior vena cava draining into the left atrium (n = 1), left pulmonary artery sling (n = 1), and aortopulmonary window (n = 1). VR video images were presented during weekly heart center conferences. A survey conducted among heart center staff assessed the perceived value of VR in clinical practice. A total of 62% found traditional diagnostic modalities very effective, 100% considered VR a valuable diagnostic tool, 65% responded positively to VR image resolution, 50% highlighted its educational benefit, 81% believed VR enhanced diagnostic accuracy and surgical planning, and 100% would recommend its use to colleagues. This study demonstrates the successful integration of VR-based segmentation into clinical workflows, underlining its potential as both an educational resource and a tool to support diagnostic and surgical decision-making. Full article

Intraoperative ultrasound (IOUS) is an increasingly adopted adjunctive intraoperative visualization method in spinal tumor surgery, offering real-time imaging that improves lesion localization, exposure planning, and resection control. This paper focuses on IOUS findings in rare intradural entities (neuroenteric/respiratory cysts, chronic spinal subdural hematoma, tethered cord/scarring, intradural extramedullary hemangioblastomas, and arachnoid cysts) where evidence remains limited. Across these lesions, IOUS typically depicts cysts as anechoic or hypoechoic cavities with definable walls and occasional septations; CSSDH is also delimited by hypoechoic subdural collections bounded by echogenic membranes; hemangioblastomas, as well as circumscribed, homogeneous nodules often with cystic components; and arachnoid webs/cysts with their boundaries and subtle subarachnoid communications. Doppler and micro-Doppler can delineate feeding and draining vessels in highly vascular tumors, while shear wave elastography provides quantitative stiffness changes that support effective detethering. IOUS complements preoperative MRI, shortens exposure, helps tailor bone and dural openings, and allows immediate assessment of residual disease. Taken together, current data and our experience support IOUS as a safe, cost-effective, and versatile intraoperative tool for rare intradural spinal pathology, while underscoring the need for prospective studies to refine sonographic criteria and validate outcome benefits. Full article

Background/Objectives: This article discusses the clinical–surgical relevance of vascular anatomical variations, such as fenestrations—the division of a vessel into multiple channels that subsequently rejoin distally. Although rare in peripheral veins, these variations, which originate from the incomplete condensation of the embryonic capillary plexus, can predispose thrombosis and necessitate preoperative recognition to avert complications during routine procedures. This study aims to report a rare case of dual origin and double fenestration of the cephalic vein. Methods: During a cadaveric dissection, a variation of the cephalic vein was identified. Results: In this case, an origin of the cephalic vein was observed arising from the dorsal venous network of the hand. It exhibited a double fenestration in the forearm, where a branch of the medial cutaneous nerve of the forearm perforated it before draining into the brachial vein. The second, a proximal origin, arose from the convergence of two tributaries—one originating from the subcutaneous tissue lateral to the brachial muscle and the other from the biceps brachii muscle, forming a single trunk that drained into the subclavian vein. Conclusions: This rare variation of the cephalic vein (dual origin and fenestration) carries significant hemodynamic implications, including an increased risk of turbulence and thrombosis. The atypical anatomical relationship between the nerve and the fenestrated vein also heightens the potential for iatrogenic injuries. In-depth knowledge of such anomalies is crucial for healthcare professionals to minimize complications and optimize the success of procedures like venous access and arteriovenous fistulas, ultimately ensuring patient safety. Full article

The azygos vein is a vessel that drains deoxygenated blood from the posterior wall of the thorax and upper abdomen into the superior vena cava. It can vary morphologically in both adults and fetuses in origin, termination, diameter, course, and tributaries, especially the hemiazygos vein and accessory hemiazygos vein, which, together with the azygos vein, form the azygos venous system. The main aim of this review is to summarize the current state of knowledge regarding the azygos vein. Another aim is to present the morphological variations of the azygos vein and their clinical significance. This information may be useful to clinicians, especially surgeons. This review also provides an overview of the embryological development of the azygos venous system and the consequences of its developmental errors, as well as their relationship to certain clinical cases and pathologies. Full article