Comprehensive assessment of Mahaim accessory pathways’ anatomic distribution

Objective To present the authors’ experience of Mahaim-type accessory pathways (MAPs), focusing on anatomic localizations. Methods Data from consecutive patients who underwent electrophysiological study (EPS) for MAP ablation in two tertiary centres, between January 1998 and June 2020, were retrospectively analysed. Results Of the 55 included patients, 27 (49.1%) were male, and the overall mean age was 29.5 ± 11.6 years (range, 12–66 years). MAPs were ablated at the tricuspid annulus in 43 patients (78.2%), mitral annulus in four patients (7.3%), paraseptal region in three patients (5.5%), and right ventricle mid-apical region in five patients (9.1%). Among 49 patients who planned for ablation therapy, the success rate was 91.8% (45 patients). Conclusion MAPs were most often ablated at the lateral aspect of the tricuspid annuli, sometimes at other sides of the tricuspid and mitral annuli, and infrequently in the right ventricle. The M potential mapping technique is likely to be a useful target for ablation of MAPs.

Frequency and Anatomic Variability of the Mandibular Lingual Foramina: A Cone-Beam CT Study

Background to evaluate the distribution of lingual foramina (LF) and their correlation with demographic characteristics and mandible width in a series of patients subjected to cone-beam CT (CBCT). Methods CBCTs were reviewed to assess the number of all LF, midline and lateral LF. We also assessed the relationship of the number of lateral LF with gender and mandibular width using the Chi Square test. A p value < 0.05 was considered statistically significant. Results 300 patients (180 males; age range: 21-87years) were included. The highest frequency per patient was of 2 LF (97/300, 32.3%), followed by 3 (81/300, 27%) and 4 (53/300, 17.7%). No LF were observed in 2/300 patients (0.7%), while the highest number was of 8 LF in one patient. The highest frequency of midline LF per person was of 2 LF (57.3%, 172/300), while the highest number per person was 5 LF in one patient (0.3%). The highest frequency of midline LF located above and below the genial tubercle was of 1 in 197/300 patients (65.7%) and in 169/300 patients (56.3%), respectively. Concerning lateral LF, the highest frequencies were of 0 (113/300, 37.7%) and of 1 (112/300, 37.3%). We did not observe any significant difference of the number of midline and lateral LF based on gender (P = .438 and P = .195, respectively) or mandible width (P = .069 and P = .114, respectively). Conclusions We have shown the high variability of number and anatomic distribution of LF in an Italian group of patients subjected to CBCT without reporting any association with gender and mandible width.

Clinicopathological Study of Skin Adnexal Tumors: A Single Institute Experience

Background: Skin adnexal tumors (SATs) encompass a very broad variety of rare dermatopathologic entities. Objective: The aim of the present study was to analyze an incidence and clinicopathological findings of patients with biopsy-proven ASTs. Material and Methods: A retrospective review of all consecutive cutaneous tumors that were diagnosed at the Martin Biopsy Center in Martin from July 2019 to March 2021 was carried out. ASTs have been searched for from this file and studied based on their histologic type and line of differentiation, anatomic distribution, age, and gender. Results: Among over 3,700 skin tumors a total of 38 ASTs in 38 individuals (21 males, 17 females) have been found. The age of the patients ranged from 22-89 years (mean 55.5 y.). The head and neck region was found to be the most common site affected (26/38; 68.4%), followed by extremities (8/38; 21.1%) and trunk (4/38; 10.5%). Tumors of hair follicle origin constituted the largest category (22/38; 57.9%), followed by sweat gland tumors (15/38; 39.5%) and tumors derived from sebaceous glands (1/38; 2.6%). Benign lesions accounted for all 38 cases. Trichoepithelioma was the most frequent lesion found in the category of follicular tumors and poroma was the most common among tumours with sweat gland differentiation. Conclusion: An overall incidence of ASTs is low and in this institutional study they constituted about 1% of all cutaneous neoplasms. ASTs display a marked phenotypic heterogeneity, that is why many published studies have provided divergent results concerning their clinicopathological features.

Deep Cerebral Perforators: Anatomical Distribution and Clinical Symptoms: An Overview

The anatomic distribution of the deep cerebral perforators is considered either a given or subject to enormous variability. Most published overviews on this topic only report findings from a limited number of anatomic dissections, and no attempt has been made to date to provide a comprehensive overview of all published data. A comprehensive literature search was performed on MEDLINE, Embase, and Google Scholar with the help of an information specialist. Three types of studies were included: (1) articles that described the anatomy and distribution territories of perforator groups arising from the arteries of the circle of Willis; (2) studies that evaluated the anatomy of the deep cerebral perforators using imaging techniques; and (3) studies that evaluated either microsurgically or radiologically confirmed perforator occlusion and reported the (magnetic resonance imaging–confirmed) distribution territory of the infarction together with a description of the clinical symptoms associated as a result of the infarction. A total of 2715 articles were screened and 53 were included. Of these, 40 dealt with the anatomic and imaging anatomy of perforator groups (37 reported results of dissections and 3 results of imaging studies), with a total of 2421 hemispheres investigated. Another 13 articles with 680 patients were included that evaluated perforator infarction territories. The deep cerebral perforator distribution shows large variability with poor concordance rates among reported studies, with the exception of the posterior communicating and anterior choroidal artery perforators. Despite the assumption that cerebral perforator anatomy is a given, studies show large variability in the anatomic distribution of various perforator groups. Perforator anatomy and relationships between perforator groups, as well as potential collateral circulation in these territories should be prioritized as a research topic in cerebrovascular disease in the near future.

Anatomic Distribution of Cherry Angiomas in the General Population

<b><i>Background:</i></b> Cherry angiomas are common benign vascular skin lesions of unknown aetiology, found largely on the trunk. However, their exact anatomic distribution besides their truncal predisposition, and how they manifest in the general population, has not been characterised. <b><i>Methods:</i></b> Three-dimensional (3D) total body imaging was obtained from 163 adult participants of a general population cohort study in Brisbane, Australia. Demographic, phenotypic, and sun behaviour characteristics were collected using a standard questionnaire along with history of melanoma and keratinocyte cancers. Cherry angiomas were identified using an automated classification algorithm with a sensitivity of 87% and a specificity of 99%, developed specifically for this study population. <b><i>Results:</i></b> The 3D total body images of 163 participants were analysed. Participants had a median age of 57 years and 61% were male. On average, males had more angiomas than females (median of 16 vs. 12) and the number and size of cherry angiomas increased with age. In addition to male sex and age, an increase in angiomas was associated with Caucasian ancestry other than British/Irish only, fair skin colour opposed to medium/olive, having green/hazel eyes compared to blue/grey, and personal history of melanoma. The most common site for cherry angiomas was the front trunk, followed by the back. Interestingly, although males had more angiomas overall, females had more angiomas on the legs. <b><i>Conclusion:</i></b> Describing the distribution of cherry angiomas by body site is an important step towards further understanding of the aetiology of angiomas. While personal history of melanoma is associated with an increased number of cherry angiomas, whether this association is prognostic, co-occurs with development of melanoma, or is merely fortuitous requires further investigation.

Pulmonary Fibroelastotic Remodelling Revisited

Pulmonary fibroelastotic remodelling occurs within a broad spectrum of diseases with vastly divergent outcomes. So far, no comprehensive terminology has been established to adequately address and distinguish histomorphological and clinical entities. We aimed to describe the range of fibroelastotic changes and define stringent histological criteria. Furthermore, we wanted to clarify the corresponding terminology in order to distinguish clinically relevant variants of pulmonary fibroelastotic remodelling. We revisited pulmonary specimens with fibroelastotic remodelling sampled during the last ten years at a large European lung transplant centre. Consensus-based definitions of specific variants of fibroelastotic changes were developed on the basis of well-defined cases and applied. Systematic evaluation was performed in a steps-wise algorithm, first identifying the fulcrum of the respective lesions, and then assessing the morphological changes, their distribution and the features of the adjacent parenchyma. We defined typical alveolar fibro-elastosis as collagenous effacement of the alveolar spaces with accompanying hyper-elastosis of the remodelled and paucicellular alveolar walls, independent of the underlying disease in 45 cases. Clinically, this pattern could be seen in (idiopathic) pleuroparenchymal fibro-elastosis, interstitial lung disease with concomitant alveolar fibro-elastosis, following hematopoietic stem cell and lung transplantation, autoimmune disease, radio-/chemotherapy, and pulmonary apical caps. Novel in-transit and activity stages of fibroelastotic remodelling were identified. For the first time, we present a comprehensive definition of fibroelastotic remodelling, its anatomic distribution, and clinical associations, thereby providing a basis for stringent patient stratification and prediction of outcome.