Anatomical Variations of ProfundaFemoris Artery in Indian Population

Background: Aim: To assess anatomical variations of profundafemoris artery in Indian population.Methods:45 embalmed lower extremities adult human cadavers age range of 30–65 years were recruited for the study. The femoral triangles were dissected with proper care to identify the profundafemoris and circumflex femoral arteries. Their source of origin, position, and distance were noted with the mid-inguinal point (MIP) as a reference point.Results:Side of profundafemoris artery (PFA) was postero- lateral in 60%, posterior in 30%, lateral in 5% and absent in 5%. Medial circumflex femoral artery (MCFA) had 65%, 15%, 12% and 8% and lateral circumflex femoral artery (LCFA) had 80%, 15%, 5% and 0% respectively. Origin of profundafemoris artery (PFA) was FA in 90% and common trunk with medial circumflex femoral artery in 10%. Origin of Medial circumflex femoral artery (MCFA) was FA in 55%, PFA in 40% and FA with common trunk with MCFA in 5%. Origin of lateral circumflex femoral artery (LCFA) was femoral artery in 70%, PFA in 20% and FA with common trunk with PFA in 10%. A significant difference was observed (P< 0.05).Conclusions:A thorough knowledge of variation of profunda femoral artery is of great importance and to avoid complications.

Bilateral thalamus stroke due to percheron artery

Bilateral thalamus ischemic stroke is a rare condition that carries significant morbidity and mortality in comparison to other forms of stroke. It is usually associated with an anatomical variant with the thalamic paramedian arteries arising from a common trunk from the posterior cerebellar artery, known as Percheron artery. This infarct is difficult to be recognized and early recognition of this syndrome improves survival and functional recovery. We report a case of bilateral thalamic stroke after cardiac surgery.

Optimizing Gas Production from Giant Multi-Reservoir Onshore Abu Dhabi Gas Field by Introducing Wellhead Compressors and Reconfiguring the Surface Network Using an Integrated Asset Model IAM

The giant onshore gas field in this study consists of six stacked reservoirs and has been producing for over three decades. The field has more than 150 gas producing wells and has several wells which have low-intermittent gas production rates. The low production is attributed to weak wells sharing common trunk lines with prolific wells. This study investigates the impact of choke optimization, surface network reconfiguration and wellhead compression to improve the gas production from weak wells after performing detailed analysis of possible root causes from the surface network by using an Integrated Asset Model (IAM) as the digital twin of the field. The investigation begins by identifying weak producers and involves studying the integrated surface network and determining the root causes for backflow and unstable hydraulics. After surface network issues have been recognized, remedial modification will be implemented. The impact of different choke settings on the wells are studied. The final step will be to introduce wellhead compressors on the weak producers. Extensive sensitivity scenarios are performed to identify the optimum compressor inlet pressure for each individual wellhead compressors and the wells which benefit most from the application of wellhead compressors are ranked. The multi-reservoir gas field contains six stacked reservoirs which are producing under depletion mode and share a common surface network. Root causes of weak or shut-in wells due to backflow or hydraulic issues are successfully identified by using an IAM simulation tool. The investigated remediations were simple optimization of the choke settings, reconfiguration of the surface network, and application of wellhead compressors to improve the gas production from the problematic wells. It is observed that the addition of wellhead compressors resulted in the most significant increase and more sustainable production from the weaker wells. Furthermore, the final selection of candidate wells for wellhead compressors can be dictated according to the highest gain from the ranking. The study revealed that the implementation of wellhead compressors will significantly increase the cumulative gas production from the selected wells at the end of field life and will result in positive production acceleration from the field perspective. This study shows that adding wellhead compressors to weak producers can mitigate the production bottlenecks and backflow issues and that higher and more sustainable gas production can be achieved from the weak wells after understanding the primary causes for low/intermittent production from the IAM which is acting as the digital twin of the field.

Branching patterns of the afferent branchial arteries and their phylogenetic significance in rays (Batoidea)

Rays of the superorder Batoidea comprise the most diverse group of chondrichthyans in terms of valid species and morphological disparity. Up to the present little agreement is observed in studies based on morphological and molecular data focused on uncovering the interrelationships within Batoidea. Morphology-based phylogenies of batoids have not included characters related to the afferent branchial arteries, and little is known about the variation in this anatomical complex in rays. Herein, representatives of 32 genera from 19 families currently recognized of rays were examined as well as some shark taxa. Seven new characters are proposed and tested in two different analyses, one on their own and in the other they were added to the morphological data matrix of the most recent analysis of interrelationships within Batoidea. The arrangement of afferent branchial arteries differs mainly among orders and families of batoids. The absence of a common trunk from which the three posteriormost afferent arteries branch is interpreted as a synapomorphy for Myliobatiformes and the presence of a coronary cranial artery as an autapomorphy for Mobula hypostoma. A close spatial relationship between the second and third afferent arteries within the common branch from the ventral aorta is proposed as a synapomorphy for Rajiformes with a secondary modification in Sympterygia. Data about patterns in afferent branchial arteries in additional taxa such as Squaliformes and Chimaeriformes are needed to better understand the evolution of this character complex among chondrichthyans.

Morphology of the Pattern of Branching of the Aortic Arch in Syrian Hamsters (Mesocricetus Auratus)

The branching patterns of the aortic arches of 28 adult male and female Syrian hamsters (SH) were thoroughly examined under a stereomicroscope for the first time by using latex injection and corrosion casting to determine their general arrangements and morphological variations as well as their differences and similarities to other rodents and rabbits. Three major arteries, namely, the brachiocephalic trunk (BC), left common carotid artery (CC) and left subclavian artery (SA), originating from the aortic arch (AR), were uniformly noted in SH. The BC was consistently divided into the right SA and the right CA. SA in SH normally releases the internal thoracic, deep cervical, dorsal scapular, vertebral, superficial cervical and supreme intercostal arteries. The costocervical trunk typically consisted of supreme intercostal and internal thoracic arteries and a common trunk for dorsal scapular and deep cervical arteries. To comprehend the comparative morphology of the pattern of branching of AR more completely, our results were compared with previous studies in rodents and rabbits. (1) The general morphology of the great arteries from AR in SH was similar to that in mole rats, rats, mice, porcupines, and gerbils but was essentially different from that in rabbits, guinea pigs, red squirrels, ground squirrels, pacas and chinchillas. (2) The typical pattern of the branching of the subclavian arteries in SH was similar to that in guinea pigs, rats, and rabbits but was different from that of the reported rodents regardless of the origins of the bronchoesophageal and internal thoracic arteries and the composition of the costocervical trunk.

Congenital Visceral Vascular Variation Causing Gastrointestinal Hemorrhage: A Case Report

Variations in the visceral vasculature are often encountered, but rarely cause clinical symptoms. We report a 12-year-old girl with portal hypertension caused by congenital variations in visceral vessels. The clinical manifestations included gastrointestinal hemorrhage and ascites. The common hepatic artery and splenic artery stem shared the same trunk from the aorta, and the common hepatic artery was directly connected with the main portal vein to form an arteriovenous fistula. In addition, the left hepatic artery and the left gastric artery shared a common trunk termed the “hepatic-gastric trunk” which originated from the anterior wall of the aorta, while the right hepatic artery originated from the superior mesenteric artery and supplied the right liver. The patient was treated with interventional embolization and remained in good condition throughout the follow-up and at the time of publication.

P089 Meningeal syndrome revealing Kawasaki like syndrome: a case report

Background Multisystemic inflammatory syndrome in children is a new and rare hyperinflammatory disorder with a temporal link to the current coronavirus 2019 (COVID-19) pandemic; its main clinical signs are prolonged fever, typical features of Kawasaki disease; cardiac dysfunction; as well as gastrointestinal, renal, and/or neurological symptoms. However, the association between meningeal syndrome and the pediatric multisystemic inflammatory syndrome is poorly described in the literature. We will report the case of a boy who presented with meningeal syndrome revealing a Kawasaki-like syndrome. The objective of our work is to provide an update on this pathology which is very little known by clinicians. Observation Our patient is a male child aged 8 years, from a 2nd degree consanguineous marriage, with a history of the influenza-like syndrome in all family members one month before admission, He was admitted for the management of a febrile meningeal syndrome, the history of which goes back to seven days before his admission, with the onset of a non-calculated fever resistant to antipyretics, associated with peri-umbilical pain and stiffness of the neck with the notion of photophobia and constipation. The clinical examination revealed a conscious child, GCS 15/15, very asthenic, fever 39.3 degrees. The neurological examination revealed a stiff neck with a negative brudzinski and kerning sign and no sensory-motor deficit. The skin examination reveals a morbilliform exanthema with an interval of healthy skin made up of non-infiltrated erythematous macules, which fade away within vitro pressure, on the lower and upper limbs and the trunk, sparing the face, the palms, the soles, and the external genitals, associated with the presence of bilateral palmoplantar oedema without desquamation. The mucous membrane examination showed bilateral conjunctivitis, not purulent, and cheilitis with left cervical adenopathy measuring 2 cm, with an inflammatory appearance on ganglionic examination. The rest of the examination was unremarkable. In front of the meningeal syndrome, a lumbar puncture was performed and came back negative. The biological workup revealed a major inflammatory syndrome: the white blood cells were 25 000 with a predominance of PNN at 23 500, the lymphocytes at 1,000, the platelets at 278 000, the sedimentation rate at 100 and the CRP at 272, the ferritinemia at 725.12, the Pro-BNP was elevated at 1,834, the liver and kidney biological results were normal. Echocardiography revealed myocarditis with mitral leakage, slight hypokinesia of the left ventricle, ejection fraction at 50%, VGTG 40MM, dilated coronary arteries, left common trunk at 4 mm, and IVA at 3 mm with minimal pericardial effusion. Given the current epidemiological context of the clinical symptomatology in our child, the multisystemic inflammatory syndrome was strongly suspected, so a covid19 serology was performed: negative IgM, positive IgG. Conclusions Several recent studies have shown the presence of neurological signs in children with multisystemic inflammatory syndrome related to Covid 19 hence the interest in screening to have recommendations based on sound clinical data for better management of patients with this syndrome during this pandemic.

Branching patterns and anatomical variations of human aortic arch in Indian population

Knowledge of the aortic arch branching pattern is important during supra-aortic angiography, aortic instrumentation, thoracic and neck surgery. The aortic arch (AA) is located in the superior mediastinum. In 65–80% of the cases, the three branches arise from the aortic arch, namely, the brachiocephalic trunk (BCT), the left common carotid artery (LCCA), and the left subclavian artery (LSA). The purpose of this study is to describe different branching patterns of the arch of the aorta in Indian subjects. This observational study is based on dissection performed on Sixty embalmed arches of the aorta in adult Indian cadavers (in manuscript it was written as, 20 dissected heart specimens were collected of still-born fetuses) were exposed and their branches examined during cadaveric dissection in the department of Anatomy. The anatomical variations of the arch of the aorta and its branches, its branches at site of origin, and the distance of each branch from the point of origin to the median plane were measured. The usual three-branched pattern of arch of aorta was found in 44 specimens (73.33%). The common trunk for both brachiocephalic trunk and left common carotid artery was present in 11 specimens (18.33%). In 2 specimens (3.33%), the arch gives four branches. In 1 specimen (1.67%), give three branches. The wide spectrum of variations in the anatomical arrangement of the human aortic arch and its branches offer valuable information to catheterize the aortic arch and its branches for safely performing endovascular surgery. These anatomical and morphologic variations in the arch of the aorta and its branches are significant for diagnostic and surgical procedures in the thorax, head and neck regions.

Patients with varying courses of single coronary artery: case series

Background Single coronary artery (SCA) is a rare congenital anomaly where blood to the heart is supplied through a common trunk. Identifying these abnormalities is important because some variants can compromise myocardial blood flow and increase risk of sudden cardiac death. Case summary We present five patients with varying Lipton Group I and Group II SCA subtypes, corroborated on multi-imaging modalities and evaluated with comprehensive non-invasive as well as invasive testing. Their clinical presentations also vary from a spectrum of asymptomatic finding to angina equivalent. The decision for definitive surgical intervention involving unroofing of the involved vessel depends largely on symptoms and evidence of myocardial ischaemia. Discussion While SCA findings are often incidental and benign, understanding the origin, branching pattern, and course of the anomalous artery has implications in prognosis and treatment. This usually involves a combination of anatomic assessment with imaging such as coronary CTA, MRA, and/or coronary angiography as well as functional assessment with invasive testing using tools like instantaneous wave-free ratio and intravascular ultrasound both at rest and with stress. Individualized treatment plans can then be made through a multidisciplinary approach involving adult congenital heart disease specialists and congenital cardiothoracic surgeons.

Early Neonatal Cyanosis as a Presentation of a Rare Cardiac Anomaly: Truncus Arteriosus Type IV

Truncus arteriosus (TA) is a rare congenital heart anomaly presenting with mild cyanosis and congestive heart failure. It occurs when the blood vessels coming out of the heart in the developing baby fail to separate completely during development, leaving a common trunk responsible for the pulmonary and systemic perfusion. There are several variants of TA, depending on the specific anatomy and arterial connection. We report a case of a full-term newborn who developed cyanosis and desaturation during the first day of life. Investigations and echocardiography were consistent with TA type IV. Prostaglandin infusion was immediately started, and then, a successful palliative right modified Blalock Taussig shunt was performed.