Matthaios Didagelos

Anatomical variations in the branches of the human aortic arch in 633 angiographies: clinical significance and literature review

BackgroundThe variations of vessels arising from the aortic arch are numerous. The purpose of the present study is the description of the aortic arch branches’ variations, in order to offer useful data to anatomists, radiologists, vascular, neck and thorax surgeons. In addition, literature has been reviewed so as to enable a comparison of our results with those of other studies and an analysis of the variations’ clinical implications is possible.Materials and methodsA total of 633 digital subtraction angiographies of Caucasian Greek patients were examined. No computed tomography or magnetic resonance angiographies were included.ResultsEight types of the aortic arch were found. The classification from I to VIII was made according to the incidences recorded, with type I being the most and type VIII being the least frequent. Type I, brachiocephalic trunk (BT), left common carotid artery (LCC), left subclavian artery (LS), 527 (83%); type II, BT with LCC and LS, 96 (15%); type III, BT, LCC, left vertebral artery (LV), LS, 5 (0.79%); type IV, right subclavian artery (RS), carotids in common, LS, 1 (0.16%); type V, carotids in common-LS, RS, 1 (0.16%); type VI, carotids and subclavians in common, 1 (0.16%); type VII, RS, right common carotid artery (RCC), LCC, LS, 1 (0.16%); type VIII, BT, thyroidea ima, LCC, LS, 1 (0.16%).ConclusionsDespite the fact that the variations in question are usually asymptomatic, they may cause dyspnea, dysphagia, intermittent claudication, misinterpretation of radiological examinations and complications during neck and thorax surgery. Furthermore, these variations may be accompanied by other congenital abnormalities.

Retro-oesophageal right subclavian artery in association with thyroid ima artery: a case report, clinical impact and review of the literature

A 37-year-old female Caucasian cadaver with an aberrant right subclavian artery extending from the left side of the aortic arch and following a retro-oesophageal course is presented. A non-recurrent right laryngeal nerve and a thyroid ima artery arising from the lower part of the middle third of the right common carotid artery coexisted. The brachiocephalic trunk was absent, while both common carotid arteries and left subclavian artery followed their normal course. The aim of the current study is to highlight the clinical impact of the above abnormalities providing useful and practically applicable knowledge to interventional clinicians, thoracic and neck surgeons, since the vast majority of documented cases with an arteria lusoria are clinically silent and in most cases discovered incidentally. Clinical manifestations such as dysphagia, chronic cough, and acute ischaemia to the right upper limb may occur, leading to misinterpretation in radiographic examination and complications during neck and thoracic surgery. Review of the literature was also performed and the embryological background of the aberration is highlighted.

Effects of Chios mastic gum on cholesterol and glucose levels of healthy volunteers: A prospective, randomized, placebo-controlled, pilot study (CHIOS-MASTIHA):

Background Chios mastic gum (CMG) possesses anti-oxidant, anti-inflammatory, anti-atheromatic, lipid- and glucose-lowering properties. We evaluated the effects of CMG on cholesterol and fasting plasma glucose (FPG) levels of healthy volunteers. Design A prospective, randomized, placebo-controlled, pilot study. Methods One hundred and seventy nine volunteers with total cholesterol levels >200 mg/dl were randomized to four groups. Finally, 156 volunteers completed the follow-up period and were analysed: (1) control group (C, n = 23), receiving placebo; (2) total mastic (TM, n = 72) receiving daily a total dose of 1 g of crude CMG (330 mg capsules, tid); (3) polymer-free mastic (PFM, n = 33), receiving daily a total dose of 1 g of polymer free mastic (330 mg caps, tid); and (4) powder mastic (PM, n = 28), receiving daily a total dose of 2 g of crude CMG. Results After eight weeks, the TM group reduced total cholesterol by 11.5 mg/dl (p < 0.05) and FPG by 4.5 mg/dl (p < 0.05) adjusted for age, gender, BMI and baseline characteristics. The effect was stronger in overweight and obese patients (BMI > 25), with an estimated mean reduction of total cholesterol by 13.5 mg/dl (p < 0.05) and FPG by 5.1 mg/dl (p < 0.05). Administration of PFM and PM resulted in no statistically significant alteration. No effect was observed on LDL, HDL, triglycerides, uric acid and CRP. No gastrointestinal, liver or renal adverse events were recorded. Conclusions CMG has a significant lowering effect on total cholesterol and glucose levels of healthy volunteers, with excellent tolerance and no detectable side effects, especially in overweight and obese individuals.

Combined anomalous origin of a left inferior thyroid artery and a left vertebral artery: a case report

An abnormal origin of a left inferior thyroid artery from the left vertebral artery that in turn originated from the aortic arch was observed on a 72-year-old Caucasian male cadaver during a dissection anatomy practice. We describe in detail the morphology of this extremely rare anatomical variation and refer to its clinical importance.

Cangrelor in Ticagrelor-Loaded STEMI Patients Undergoing Primary Percutaneous Coronary Intervention

The intravenous P2Y12 receptor antagonist cangrelor provides rapid onset and offset of platelet inhibition [(1)][1]. Compared with clopidogrel, cangrelor has significantly reduced the rate of ischemic events, including stent thrombosis, during percutaneous coronary intervention (PCI), with no

Gut Microbiome - Gut Dysbiosis - Arterial Hypertension: New Horizons

Arterial hypertension is a progressive cardiovascular syndrome arising from complex and interrelated etiologies. The human microbiome refers to the community of microorganisms that live in or on the human body. They influence human physiology by interfering in several processes such as providing nutrients and vitamins in Phase I and Phase II drug metabolism. The human gut microbiota is represented mainly by Firmicutes and Bacteroidetes and to a lesser degree by Actinobacteria and Proteobacteria, with each individual harbouring at least 160 such species. Gut microbiota contributes to blood pressure homeostasis and the pathogenesis of arterial hypertension through production, modification, and degradation of a variety of microbial-derived bioactive metabolites. Animal studies and to a lesser degree human research has unmasked relative mechanisms, mainly through the effect of certain microbiome metabolites and their receptors, outlining this relationship. Interventions to utilize these pathways, with probiotics, prebiotics, antibiotics and fecal microbiome transplantation have shown promising results. Personalized microbiome-based disease prediction and treatment responsiveness seem futuristic. Undoubtedly, a long way of experimental and clinical research should be pursued to elucidate this novel, intriguing and very promising horizon.

Erratum to: The aberrant right subclavian artery: cadaveric study and literature review

1. Quain’s report (1844) does not conclude to an exact number of examined specimens and the incidence of 0.4% is not accurate. 2. In Holzapfel’s paper (1899), the incidence of 13.3% is the total incidence obtained from other published cadaveric studies along with a few new additional cases of the author. 3. The studies of Evans (1950) and Zapata et al. (1993) refer to congenital conditions associated with the ARSA. So, the above four mentioned studies are not taken into account in the calculation of the ARSA prevalence in the general population. 4. The false incidences of 0.8 and 0.2% regarding Cairney’s (1925) and Liechty and co-authors’ (1957) reports

A rare cadaveric finding of ectopic origin of a bronchial artery: surgical and imaging consequences

Bronchial arteries arise normally directly from the descending thoracic aorta, at the level between the fourth and sixth thoracic vertebra. However the anatomical variations are very frequent regarding the origin or the number of branches. We present a rare cadaveric finding of an ectopic right bronchial artery originating from the right subclavian artery through common stem with the right internal thoracic artery and we discuss the clinical significance of this finding. A 72-year-old formalin-embalmed male cadaver was dissected during a routine anatomical course. The right bronchial artery originated from the right subclavian artery with a common stem with the right internal thoracic artery. Although ectopic origin of the right bronchial artery from the right internal thoracic artery is rare, recognition of this anatomical variation is important in bronchial embolization due to hemoptysis, in coronary bypass grafting and in lung transplantation.