Anatomical variations of the axillary artery and its branches are clinically relevant as they may complicate surgeries in the axilla and shoulder. Accessory heads of the biceps brachii can compress key neurovascular structures. The present report describes these variations observed on the left upper limb of a 79 years old male cadaver during cadaveric dissection. We observed that the usual branches of the 3rd part of the axillary artery as well as the profunda brachii artery originated from the 2nd part of the axillary artery via a common trunk in the left axilla. In addition to that, a small accessory head of the biceps brachii was observed on the left arm originating from the shaft of the humerus. Knowledge about variant branches of the axillary artery is surgically important for establishment of collateral circulation around the scapula following shoulder surgeries. The accessory head of biceps brachii may cause nerve entrapment neuropathy leading to mysterious pain syndrome in the upper limb.
Dural arteriovenous fistulas are pathological vascular malformations within the dura mater, characterized by abnormal connections between pial arteries and veins. These are rare lesions that can present with a variety of neurological symptoms, and, when ruptured, can result in a fatal hemorrhage. This disease can be managed by endovascular embolization, surgical resection, and stereotactic radiosurgery. Particularly with the advancement of endovascular techniques, surgery is less frequently used to treat these lesions. However, it remains a viable treatment option in certain cases. In this article, we present a series of 17 patients with dural arteriovenous fistulas treated at a single tertiary neurosurgical center. This study was conducted at São João University Hospital in Porto, Portugal. We retrospectively collected data from all patients who underwent microsurgical or endovascular treatment for dural arteriovenous fistulas between 2014 and 2023. We collected information regarding the patients’ sex, age, and radiological classification of the dAVF, also, the treatment modality chosen, dAVF obliteration rate and information about any complications that have resulted from the treatment. Endovascular treatment had been attempted in 5 patients (29.4%), resulting in partial embolization of the dural arteriovenous fistulas in 3 patients (17.6%). In 2 patients (11.8%), embolization was attempted but deemed technically unfeasible. The remaining cohort, comprising 12 patients (70.6%), underwent surgical intervention as the primary treatment modality. Overall, all of the patients presented in this cohort underwent surgical resection. The factors why patients underwent surgical resection as the primary treatment modality were: endovascular embolization was deemed technically unfeasible due to the location in the anterior cranial fossa, or due to the multidisciplinary decision to operate on these lesions. Lesions were also operated on in the presence of a hematoma that required an evacuation. Immediate postoperative angiography showed that 94.1% (n = 16) of the patients achieved complete exclusion of the lesion. At the time of the latest follow-up, a second DSA was performed, and 88.23% (n = 15) of the patients showed complete obliteration of the lesion. 41.17 % of the patients (n = 7) had resolution of their pre-operative symptoms. 58.8 % (n = 10) remained symptomatic after the surgical procedure. The cumulative surgical complication rate in this cohort was 23.6% (n = 4). In this article, we also provide a comprehensive review of the literature regarding the treatment modalities that are available to treat this complex condition. In conclusion, surgical treatment is nowadays less frequently used, but it still remains a viable option for the treatment of dural arteriovenous fistulas. Our patient cohort demonstrated that selective treatment of these rare and complex lesions surgically is associated with high obliteration rates and relatively low rates of complications. Surgical treatment can be considered a primary treatment option when dealing with ethmoidal-type dural arteriovenous fistulas or others located within the anterior cranial fossa, and the presence of a hematoma requiring urgent evacuation.
Background: Staphylococcus aureus is a major opportunistic pathogen in hospitals, where sustained exposure to antimicrobial agents and disinfectants promotes the emergence and persistence of resistant strains. In addition, tolerance to heavy metals may facilitate co-selection and long-term survival of resistant S. aureus in clinical settings. Purpose: This study investigated the occurrence of methicillin-resistant S. aureus (MRSA), vancomycin-intermediate S. aureus (VISA), and vancomycin-resistant S. aureus (VRSA), and evaluated antibiotic and heavy metal resistance profiles among S. aureus isolates recovered from hospitals. Materials and Methods: Seventy-nine bacterial isolates were collected from three hospitals. Identification using Gram staining and biochemical tests identified 71 S. aureus isolates. Resistance to antibiotics was determined by disk diffusion, and was quantified using the multiple antibiotic resistance (MAR) index. Resistance to heavy metals was assessed at increasing concentrations, and the multiple heavy metal resistance (MHMR) index was calculated. MRSA, VISA, and VRSA were screened using selective agar containing oxacillin and vancomycin. Cluster analysis was performed based on combined antibiotic and heavy metal resistance profiles. Results: High resistance rates were observed for penicillin and ampicillin (95.8% each), whereas most isolates showed low levels of resistance to chloramphenicol, bacitracin, streptomycin, kanamycin, and methicillin. MAR index values ranged from 0 to 0.88, with most isolates exceeding 0.2. All isolates exhibited resistance to multiple heavy metals, with MHMR values between 0.57 and 0.71, and marked tolerance to chromium and lead. Screening identified 9 MRSA, 3 VISA, and 1 VRSA isolate, including one strain classified as both MRSA and VRSA. Cluster analysis resolved nine major resistance-associated groups. Conclusion: Hospital-associated S. aureus isolates showed extensive antibiotic and heavy metal resistance, supporting the likelihood of co-selection of resistance traits. These findings underscore the importance of integrated antimicrobial stewardship and environmental control strategies in hospitals.
Background. Acute pancreatitis (AP) is a leading cause of gastrointestinal hospitalization and remains associated with measurable in-hospital mortality despite advances in supportive care. While earlier decades were characterized by declining mortality, contemporary temporal patterns within mature tertiary-care systems remain uncertain. We aimed to evaluate longitudinal trends in admission volume, demographic characteristics, intensive care unit (ICU) utilization, and crude, age-standardized, and adjusted in-hospital mortality in a tertiary academic center. Materials and Methods. We conducted a retrospective cohort study of consecutive adult hospitalizations with a primary diagnosis of acute pancreatitis at a tertiary referral center between 2016 and 2024. Temporal trends were assessed using linear and logistic regression models. Age-standardized mortality rates were calculated using direct standardization to a fixed reference population. Multivariable logistic regression evaluated the independent association between year of admission and in-hospital mortality, adjusting for age and sex. A prespecified sensitivity analysis excluded ICU admissions. Analyses were limited by the lack of reliably recorded etiologic and standardized severity data within the administrative dataset. Results. A total of 1,981 hospitalizations were included. Overall, in-hospital mortality was 5.0%. Annual admission volume, median age, sex distribution, and ICU utilization showed no significant temporal trends. Crude mortality ranged from 1.8% to 6.5% annually and demonstrated no significant temporal association. Age-standardized mortality likewise showed no significant trend. In multivariable analysis, year of admission was not independently associated with mortality, whereas advancing age was the strongest measured independent predictor, with a 34% increase in odds of death per 10-year increment. Exclusion of ICU admissions yielded consistent findings. Conclusions. In this nine-year tertiary-center cohort, in-hospital mortality for acute pancreatitis was approximately 5% and did not demonstrate a statistically significant temporal change. After adjustment, mortality risk was more strongly associated with age than with calendar year of admission. These findings suggest relative stability within this cohort; however, given the limitations of the study, further research using larger and more detailed datasets is needed to better characterize temporal trends and determinants of mortality.
Background: Gordon Holmes syndrome (GHS) is a rare genetic disorder, usually manifesting as a broad spectrum of neurological symptoms and hypogonadotropic hypogonadism. Only a limited number of cases presenting this congenital disorder have been reported in the literature. Since the genetic and phenotypic heterogeneity of GHS, it is crucial to report novel cases. Case presentation: Here we report a novel homozygous missense variant in RNF216 gene c.1055T>G (p.(Phe352Cys)) in three siblings. Primary concerns were absence of secondary sexual characteristics, and amenorrhea occurred among female patients. Based on laboratory test results and clinical features, hypogonadotropic hypogonadism was diagnosed. Neurological examination revealed no signs of ataxia in siblings. However, brain magnetic resonance imaging revealed pronounced changes in the cerebral white matter for female patients. Due to primary amenorrhea and the absence of secondary sexual characteristics, treatment was initiated. Treatment might be adjusted in the presence of fertility considerations. Conclusions: This case contributes to the limited knowledge of GHS and highlights the importance of hypogonadotropic hypogonadism treatment and close observation of neurological symptoms that may develop over time.
