Introduction The major arterial branches of the aortic arch supply blood to the head, neck, and upper extremities. Typically, the brachiocephalic trunk is the first branch, followed by the left common carotid artery and then the left subclavian artery. The current cadaveric case report describes a variation with an aberrant right subclavian artery (ARSA) and a bicarotid trunk (BCT) with a nonrecurrent right inferior laryngeal nerve. Case Presentation The anterior chest wall of the donor body of a 78-year-old woman was dissected to evaluate the branches of the aortic arch. An ARSA branched from the posterior surface of the aortic arch and coursed to the right, posterior to the trachea and esophagus. A BCT arose from the superior surface and bifurcated into right and left common carotid arteries. A nonrecurrent right inferior laryngeal nerve coursed directly to the larynx from the cervical portion of the right vagus nerve. Structures of interest were measured using a vernier dial caliper. Conclusion The presence of an ARSA with a BCT is clinically important because it increases risk for dysphagia and thoracic aortic disease. Better understanding of the characteristics and prevalence of aortic arch branching variations is important for surgeons and radiologists who may encounter an ARSA or BCT in practice. Similarly, a nonrecurrent right inferior laryngeal nerve may be injured during neck procedures. Given these anatomic variants are rare, more studies are necessary to characterize the course and anatomic relationships of these structures.
Irradiated wounds are notorious for poor healing. There are limited options for those who cannot undergo free flap surgeries. NovoSorb ® Biodegradable Temporizing Matrix (BTM) is a synthetic bilayer dermal matrix. We present a case of a scalp squamous cell carcinoma (SCC) arising from congenital sebaceous nevus that was initially managed with irradiation. Upon presentation, the wound was ulcerated and infected. BTM was successfully applied and eventually grafted without the patient needing to undergo a more complex surgery.
Endocrine and metabolic disorders, chronic inflammatory conditions, advanced maternal age, obesity, and unhealthy lifestyle habits can impair reproductive potential by promoting oxidative stress, chronic inflammation, and hyperinsulinemia. These pathophysiological changes may impair oocyte quality, reduce embryo developmental competence, and negatively affect endometrial receptivity. In this context, combined supplementation with inositols and antioxidant compounds has been proposed as a strategy to modulate these pathways and potentially improve reproductive outcomes. This case series describes the clinical outcomes of four women without polycystic ovary syndrome (PCOS; recently proposed to be renamed polyendocrine metabolic syndrome) who had experienced previous assisted reproductive technology (ART) failure. Patients received supplementation for at least two months with Ovosicare® ProFIV, containing 1100 mg of myo-inositol and 300 mg of D-chiro-inositol in a 3.6:1 ratio, along with antioxidants, vitamins, minerals and probiotics before undergoing IVF-ICSI treatment. All cases resulted in successful pregnancies following supplementation and IVF-ICSI. Although limited by the small sample size and uncontrolled design, these preliminary observations suggest that preconception nutritional optimization with a multi-component supplement may represent a promising strategy to support reproductive outcomes in women with previous ART failure without PMOS. Prospective controlled studies are warranted to confirm these findings.
Introduction Radiation segmentectomy delivers ablative yttrium-90 (Y-90) activity to a limited hepatic angiosome for selected neuroendocrine tumor liver metastases. Caudate lobe treatment is technically distinctive because its variable arterial supply may communicate with branches supplying the central biliary tree. Failure to recognize such perfusion can expose the bile duct to nontarget radiation and microsphere deposition. Case Presentation A 46-year-old man with a small-bowel neuroendocrine tumor metastatic to the liver, previously treated with right hepatectomy, developed a new 0.8 × 0.8-cm caudate lesion on surveillance imaging. His Eastern Cooperative Oncology Group (ECOG) performance status was 0, and his Albumin-Bilirubin (ALBI) grade was 1. During Y-90 mapping, angiography and cone-beam computed tomography demonstrated a small tumor-feeding branch arising from the proximal caudate artery; the more distal caudate artery also supplied the common bile duct. Technetium-99m macroaggregated albumin (MAA) SPECT/CT demonstrated activity in the intended treatment territory and adjacent common bile duct. Because the tumor-feeding branch could not be catheterized ultraselectively, the distal caudate artery beyond the tumor-feeder origin was coil embolized to redirect flow away from the biliary supply while preserving access to the tumor-feeding branch. Y-90 glass microspheres were administered, and post-treatment SPECT/CT demonstrated activity confined to the targeted caudate territory without detectable activity in the common bile duct. Voxel-based dosimetry demonstrated a D95 of 670 Gy and V400 of 100%. MRI at 1 and 10 months and DOTATATE PET/CT at 14 months demonstrated sustained complete response without biliary stricture or obstruction. Conclusion Mapping angiography, cone-beam CT, MAA SPECT/CT, and selective arterial flow redirection can be integrated when caudate tumor perfusion overlaps with central biliary arterial supply. Recognizing shared perfusion before Y-90 delivery may permit modification of the treatment angiosome and reduce unintended biliary irradiation in appropriately selected anatomy.
Introduction We report a patient who presented with acute-onset diplopia and fatigable ptosis, subsequently diagnosed with Myasthenia Gravis based on elevated acetylcholine receptor antibodies. Neuroimaging and chest imaging were unremarkable, excluding structural causes and thymoma. Case Presentation During evaluation, persistent lymphocytosis prompted further hematologic workup, which confirmed early-stage Chronic Lymphocytic Leukemia with trisomy 12 and a TP53 mutation. The patient received pyridostigmine and a tapering course of corticosteroids, resulting in rapid clinical improvement and complete resolution of ocular symptoms. The leukemia remained asymptomatic and was managed conservatively with a watchful waiting approach. The clinical course was favorable with sustained remission of myasthenia gravis off therapy and stable hematologic parameters on follow-up. Conclusion This case highlights the diagnostic interplay between autoimmune and lymphoproliferative disorders and underscores the importance of a multidisciplinary approach in managing such overlapping clinical entities.
