Bojan Stimec

Helicobacter pyloriand the risk of benign and malignant biliary tract disease: Helicobacter pyloriin Biliary Carcinoma

The etiology of tumors arising in the biliary tract remains unclear. Several previous studies have detected Helicobacter pylori organisms in bile from patients with gallstones or cholecystitis. The objective of this study was to determine whether there is an association between H. pylori in bile and biliary tract carcinoma.

Acromioclavicular joint reconstruction: a comparative biomechanical study of three techniques

BACKGROUND Acute acromioclavicular joint dislocations indicated for surgery can be treated with several stabilization techniques. This in vitro study evaluated the acromioclavicular joint stability after 3 types of validated repair techniques compared with the native situation. MATERIALS AND METHODS Nine pairs (right-left) of intact cadaveric shoulder specimens were assigned to 3 study groups with randomly distributed samples according to the coracoclavicular distance. The groups were instrumented with acromioclavicular and coracoclavicular cerclages (CE), a Twin Tail TightRope (TR), or a locking compression superior and anterior clavicle plate (CP). Native and instrumented specimens were tested quasi-static nondestructively (superior: 70 N; anteroposterior: ± 35 N, 10 mm/min) and cyclically until failure (superior, valley load: 20 N; initial peak load: 70 N; increment: 0.02 N/cycle). RESULTS The TR study group showed the highest (in N/mm) superoinferior (73.77 ± 14.04) and anteroposterior (29.58 ± 1.52) stiffness, followed by CE (superoinferior: 59.73 ± 10.33; anteroposterior: 24.31 ± 4.14) and CP (superoinferior: 24.08 ± 5.29). Instrumentation generally led to increased superoinferior and anteroposterior stiffness in each study group but to a significant superoinferior stiffness reduction for CP (P = .029). Significantly lower coracoclavicular displacement at valley load after 1 and 500 cycles was observed for TR (P = .018) and CE (P = .041) compared with CP. Cycles to failure were significantly higher in CE (7298 ± 1244 cycles, P = .011) and TR (4434 ± 727 cycles, P = .031) compared with CP (1683 ± 509 cycles). CONCLUSIONS The CE and TR techniques led to similar biomechanical performances. The CE repair might mimic the native acromioclavicular joint stiffness better than the other 2 setups, leading to more physiological stabilization.

Can the gastrocolic trunk of Henle serve as an anatomical landmark in laparoscopic right colectomy? A postmortem anatomical study.

BACKGROUND The use of the gastrocolic trunk of Henle (GTH) as a landmark has been advocated in laparoscopic right colectomy. The aim of this study was to evaluate the GTH as a possible landmark in laparoscopic right colectomy in the context of the adjacent arteries. METHODS Corrosion casting (30 specimens) and anatomic dissection were performed on formol-fixed cadavers (12 specimens). RESULTS The GTH was found in 34 specimens (81.0%). Among its closely related neighboring arterial vessels, the right colic artery was the most frequent (19 cases [55.9%]). It passed by the GTH at a mean distance of 3.6 mm. The course of the arteries in relation to the GTH was caudal and parallel in most cases (29 [85.3%]), but there was also a significant portion of crossing schemes (11.7%). CONCLUSIONS Although the GTH is a constant and conspicuous anatomic entity, it is not easily accessible, because of its tight relations to the right colon arteries. Instead, the authors advocate the use the superior right colic vein as an anatomic landmark leading to the GTH during laparoscopic right colectomy.

Navigating the mesentery: a comparative pre- and per-operative visualization of the vascular anatomy

Awareness of anatomy is critical for performing safe surgery within the root of the mesentery. Our aim was to investigate the anatomical relationship between the superior mesenteric artery (SMA) and vein (SMV) and their branches within a predefined D3 area of the right colon and to compare preoperatively established three‐dimensional (3D) mesenteric vessel anatomy from CT with that found at surgery.

The anatomical and surgical consequences of right colectomy for cancer

BACKGROUND: Current practice when performing right colectomy for cancer is to divide the feeding vessels for the right colon on the right side of the superior mesenteric vein. OBJECTIVE: This study aims to show that arterial stumps can be visualized through an early postoperative CT and analyze their anatomical and surgical characteristics. DESIGN: This study presents a retrospective review of prospective data. SETTINGS: The study was conducted at the Department of Surgery, Vestfold Hospital, Tonsberg, Norway. PATIENTS: Patients with leakage after a right colectomy for cancer (2003–2011) were identified through a local prospective complication registry (FileMaker Pro 9.0v3 software). INTERVENTIONS: Both preoperative and postoperative CTs were retrieved, reanalyzed, and 3-dimensionally reconstructed (Osirix v.3.0.2./Mimics v.13.1.). Patients without postoperative CTs were excluded. MAIN OUTCOME MEASURES: The main outcomes measured were length, caliber of presumed and actual arterial stumps, and their position relative to the superior mesenteric vein. RESULTS: Eighteen patients, median age 69 (10 men) were included. All patients had postoperative CTs, and 15 patients had preoperative CTs. Median time from operation to postoperative CT was 5 days. The ileocolic artery was found in 14 (11 CT pairs) patients, and the right colic artery was found in 5 (4 pairs) patients. Actual stump lengths were 28.0 mm (SD 9.3) and 37.3 mm (SD 14.9). A significant statistical difference between presumed and actual ileocolic artery stump lengths was found (P = .002). Posterior crossing to the superior mesenteric vein was noticed in 8 of 14 ileocolic arteries and in 3 of 5 right colic arteries. There was no statistical difference in mean caliber for the preoperative and postoperative right colic artery (P = .505) and ileocolic artery (P = .474). LIMITATIONS: Difficulties when interpreting the postoperative images, due to intra-abdominal effusion, staples, edema, and altered syntopy of blood vessels, were overcome through comparison with preoperative CTs. CONCLUSION: An early postoperative CT can show arterial stumps after right colectomy for cancer. These stumps appear to be significantly longer than presumed; implying a significant improvement potential when specimen size is concerned.

Lymph node distribution in the d3 area of the right mesocolon: implications for an anatomically correct cancer resection. A postmortem study.

BACKGROUND: Data on lymph node distribution in the right colon D3 area are scarce, especially for nodes posterior to the superior mesenteric vessels. OBJECTIVE: The aim of this study was to determine whether nodes exist posterior to the superior mesenteric vessels and if arterial crossing patterns affect node distribution. DESIGN: This is an anatomical postmortem study. SETTINGS: This study was conducted at the following institutions: Department of Gastrointestinal surgery/Pathology, Vestfold Hospital Trust, Norway; Institute for Pathology, University of Belgrade, Serbia; and Anatomy Sector, University of Geneva, Switzerland. PATIENTS: Fresh human cadavers were selected to undergo autopsy. INTERVENTION: A predefined D3 area was removed from cadavers, fixed in formaldehyde, divided into 3 vertical compartments with regard to the superior mesenteric vessels. Vertical compartments were further divided into 8 compartments. Millimeter slices were analyzed at histology. MAIN OUTCOME MEASURES: Lymph nodes ≥1 mm were counted in each compartment. RESULTS: Twenty-six cadavers (14 men), median age 76 years, were included. Mean node number per cadaver was 15.9 ± 7.4. Lateral, anterior, and posterior vertical compartments contained median 5.5 (1–11), 5 (2–21), and 5 (0–11) nodes. The effect of the ileocolic artery crossing pattern on node number in the posterior vertical compartment was p = 0.020. Anterior/posterior ileocolic artery compartments contained nodes in 58% and 85% cadavers with median of 1(0–7) and 2(0–5). These compartments showed a significant difference in node numbers depending on the ileocolic artery crossing pattern, p < 0.001 (posterior crossing) and p < 0.001 (anterior crossing). The middle colic artery compartment contained nodes in all cadavers with a median of 2 (1–4). The association between volume and total number of nodes in the D3 area was statistically significant, p < 0.001. LIMITATIONS: Nodes posterior to the superior mesenteric vessels do not necessarily have clinical relevance. CONCLUSION: Anatomically correct D3 resection implies posterior vertical compartment removal with posterior ileocolic artery crossing. Addition of the lateral vertical compartment to routine right colectomy has an improvement potential of 5 to 6 nodes.

Helicobacter pylori in Colorectal Carcinoma Tissue

Helicobacter pylori ([1][1]) is associated with the development of chronic gastritis, peptic ulcer, and gastric adenocarcinoma ([2][2]-[4][3]). Previous studies reported positive ([5][4], [6][5]) and negative ([7][6], [8][7]) associations between infection and colorectal neoplasia. Recent reports

Cadaver procurement for anatomy teaching: legislative challenges in a transition-related environment

Background Human gross anatomy is one of the cornerstones of a medical curriculum and cannot be performed without adequate cadaver procurement, which is a particular challenge for medical schools with a large student enrolment. The authors present the situation in a country with a low public awareness for willed body donor programmes and the prior absence of adequate legislation. Aim Against this background, a comprehensive proposition of a whole-body procurement procedure was elaborated in the health-care law. Resolving the problem The main goals of the proposition were: (a) identification of options for cadaver procurement (body bequeathal programme, unclaimed bodies and body donated with the permission of the next-of-kin); (b) defining the chain of order and responsibility of institutions in informing the medical school of the possible candidate for body procurement; (c) body storage and related procedures; (e) confidentiality of the deceaseds personal data; (f) burial procedure of the deceaseds remains. Conclusions The authors are convinced that the willed programme for whole-body donation is a definite aim of such a legislation. However, we suggest that the acquisition of unclaimed bodies is maintained as a temporary solution, until a satisfactory level of public awareness of the problem has been reached.

Scapular Notching on Kinematic Simulated Range of Motion After Reverse Shoulder Arthroplasty Is Not the Result of Impingement in Adduction

AbstractImpingement after reverse shoulder arthroplasty (RSA) is believed to occur from repetitive contact in adduction between the humeral component and the inferior scapular pillar. The primary purpose of this biomechanical study was to confirm the presence of different types of impingement and to examine which daily-life movements are responsible for them. A secondary aim was to provide recommendations on the type of components that would best minimize notching and loss of range of motion (ROM).The study included 12 fresh frozen shoulder specimens; each had a computed tomography (CT) image of the entire scapula and humerus in order to acquire topological information of the bones before RSA implantation. Cyclic tests were run postimplantation with 3 shoulders in each modalities. To quantify bone loss due to impingement, 3-dimensional anatomical models of the scapula were reconstructed from the CT scans and compared to their intact states.We found 8 bony impingements in 7 specimens: 2 at the lateral acromion, 1 at the inferior acromion, 4 scapular notching, and 1 with the glenoid resulting to wear at the 3:00 to 6:00 clock-face position. Impingements occurred in all kinds of tested motions, except for the internal/external rotation at 90° of abduction. The 3 specimens tested in abduction/adduction presented bone loss on the acromion side only. Scapular notching was noted in flexion/extension and in internal/external rotation at 0° of abduction. The humeral polyethylene liner was worn in 2 specimens—1 at the 6:00 to 8:00 clock-face position during internal/external rotation at 0° of abduction and 1 at the 4:00 clock-face position during flexion/extension.The present study revealed that 2 types of impingement interactions coexist and correspond to a frank abutment or lead to a scapular notching (friction-type impingement). Scapular notching seems to be caused by more movements or combination of movements than previously considered, and in particular by movements of flexion/extension and internal/external rotation with the arm at the side. Polyethylene cups with a notch between 3 and 9 o’clock and lower neck-shaft angle (145° or 135°) may play an important role in postoperative ROM limiting scapular notching.

Injury to the axillary nerve after reverse shoulder arthroplasty: An anatomical study

BACKGROUND Subclinical neurological lesions after reverse shoulder arthroplasty are frequent, mainly those involving the axillary nerve. One of the major reported risk factors is postoperative lengthening of the arm. The purpose of this study was to evaluate the anatomical relationship between the axillary nerve and prosthetic components after reverse shoulder arthroplasty. The study hypothesis was that inferior overhang of the glenosphere relative to glenoid could put this nerve at risk. MATERIAL AND METHODS Eleven fresh frozen shoulder specimens were dissected after having undergone reverse shoulder arthroplasty using a classic deltopectoral approach. RESULTS The mean distance from the inferior border of the glenoid to the inferior edge of the glenosphere was 6.0±4.3mm (range, 1.0 to 16.2mm). The axillary nerve was never closer than 15mm to the glenosphere. The main anterior branch of the axillary nerve was in close contact with the posterior metaphysis or humeral prosthetic implant. The mean distance between the nerve and the humeral implants was 5.2±2.1mm (range, 2.0 to 8.1mm). CONCLUSIONS The proximity of the axillary nerve to the posterior metaphysis or humeral implants may be a risk factor for axillary nerve injury after reverse shoulder arthroplasty. CLINICAL RELEVANCE This study quantifies the proximity of the axillary nerve to the implant after reverse shoulder arthroplasty. LEVEL OF EVIDENCE Basic science study, cadaver study.