Appreciation of the potential anatomical variation of the hepatic arterial supply and branches of the abdominal aorta is of paramount importance in pancreatic and hepatobiliary surgery. Here we ...describe a hitherto un-reported coelio-mesenteric anastomotic connection between a replaced right hepatic artery, originating from the superior mesenteric artery, and the left hepatic branch of the proper hepatic artery. The embryological origins of the variant anatomy as well as its potential surgical implications are discussed with a view to encourage thorough pre-operative interrogation of available imaging by radiologists and surgeons to successfully identify such variants and take advantage of their potentially useful functionality.
Abstract
Bacille Calmette–Guerin (BCG) is a live-attenuated strain of Mycobacterium bovis. It is routinely used in the treatment of early-stage transitional cell carcinoma. The development of mycotic ...aneurysm in the context of prior intra-vesical BCG treatment has not been reported. This case demonstrates a rare but potentially catastrophic vascular complication of BCG. A high index of suspicion is required for any patient presenting with new aneurysmal disease in the context of previous BCG therapy. The value of endovascular surgery as a bridge to definitive surgical repair and diagnostic considerations is discussed.
Drug-induced vasculitis is the inflammation of blood vessels instigated by a pharmaceutical agent and can mimic vascular ischaemia. The inflammatory environment can be acute or chronic. Activation of ...endothelial cells and coagulation factors predisposes a vessel to thrombosis and ischaemia of the tissues and organs it supplies. An element of autoimmune activation may contribute to the pathogenesis and subsequent clinical manifestation of this condition. We report two cases of peripheral limb ischaemia in patients with a history of psychostimulant use and discuss the investigations undertaken and their subsequent management. Diagnosis of drug-induced vasculitis can be challenging, and a wide variety of other differentials must first be explored. Understanding the pathophysiology underlying drug-induced vasculitis and secondary autoimmune thrombophilia allows for better diagnostic and therapeutic management in this rare cohort of patients.
Abstract Objective The purpose of this study was to analyze the quality of content and potential sources of bias in videos available on YouTube pertaining to interventional treatment for varicose ...veins. Methods Searches were performed on YouTube to identify videos pertaining to interventional treatment for varicose veins. Videos that met eligibility criteria were analyzed and rated according to predetermined criteria by two independent assessors, with a third independent assessor to resolve any discrepancy. Each video was rated for its informational quality (good, fair, poor) and stance (for, neutral, against, unclear) toward the treatment option discussed. Results A total of 284 videos were extracted, of which 228 met eligibility criteria and were analyzed. The largest group of videos (47.3%) received a quality rating of fair, meaning that they discussed one or two aspects of a treatment option, such as procedural technique and indications. Among those videos rated poor (25.0%), nearly all videos (98.2%) failed to mention a specific treatment. Most videos (71.1%) were in favor of the treatment discussed without presenting balanced discussion of alternatives. Private companies represented the most frequent source of videos analyzed (73.2%). There was a statistically significant correlation between quality and video source ( χ2 = 9.308; df = 2; P = .010), with videos from private companies generally receiving poorer quality ratings than other videos. There was no association between quality and viewing frequency of videos ( P = .379). Conclusions On the whole, the videos available on YouTube are neither sufficiently comprehensive nor adequately balanced to be recommended as patient education material regarding interventional treatment options for varicose veins.
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