Frequency of Electrodiagnostically Measurable Berrettini Anastomosis.

PURPOSE: Ulnar sensory palmar crossover to digit three (D3), the Berrettini anastomosis, is measurable in routine electrodiagnostic nerve conduction studies. The crossover is reported as occurring in 60% of anatomic dissections, but the frequency of measurable ulnar crossover to D3 and its potential as a nerve conduction pitfall is not established. The purpose of this article was to present descriptive statistics regarding the frequency of measurable Berrettini anastomosis in nerve conduction studies. METHODS: A retrospective chart review and data analysis was completed on 248 patients representing 411 extremities with a main outcome measure of ulnar sensory stimulated nerve conduction simultaneous waveform recording on D3 and digit four (D4). Consistent electrodiagnostic technique with waveform recording data analysis in a private practice and independent university waveform verification was completed on sequential patients referred for upper extremity electrodiagnostic testing. RESULTS: Measurable ulnar stimulated D3 sensory nerve action potentials were demonstrated in 34% of patients with amplitudes of 27%, the simultaneously recorded corresponding ulnar D4 amplitudes representing electrophysiological evidence of ulnar sensory crossover. CONCLUSIONS: The Berrettini anastomosis can frequently be seen as a small amplitude sensory nerve action potential response, but at times can be observed with an amplitude greater than 10 µV. It is possible that patients with an absent or significantly delayed median nerve response may have simultaneous inadvertent spread of stimulus to ulnar axons measurable on D3 that may be interpreted as a falsely normal response. All electromyographers need to be aware of this potential pitfall.

Outcome of duct-to-duct vs. Roux-en-Y hepaticojejunostomy biliary anastomoses in below 15-kg pediatric liver transplant recipients.

The best type of biliary anastomosis to use in lower weight pediatric liver transplant recipients is debatable. In this study, we share a single center's experience comparing the rate of anastomotic biliary complications based on the type of biliary anastomosis performed in this population of patients. A retrospective review of pediatric liver transplants for recipients weighing <15 kg from 11/2003 till 12/2011 was performed. Patients were grouped based on the type of biliary anastomosis into two groups: duct-to-duct (d-d) and Roux-en-Y hepaticojejunostomy (h-j) anastomoses. A total of 24 patients (12 males, 12 females) with a mean age of 26 ± 20 months and a mean weight of 9.27 ± 2.63 kg (range = 5.3-13.9 kg) were studied. All anastomotic complications occurred in patients who received left lateral segments. No statistical differences were found in the post-operative biliary (p = 0.86) or vascular (p = 0.99) complications between the two groups. Acknowledging the limited sample size, our data suggest that duct-to-duct anastomosis can be performed safely in pediatric liver transplantation recipients weighing below 15 kg.