RESUMO
INTRODUCTION: Anastomotic leak (AL) remains a severe complication following colorectal surgery, leading to increased morbidity and mortality, particularly in cases of delayed diagnosis. Existing diagnostic methods, including computed tomography (CT) scans, contrast enemas, endoscopic examinations, and reoperations can confirm AL but lack strong predictive value. Early detection is crucial for improving patient outcomes, yet a definitive and reliable predictive test, or "gold standard," is still lacking. METHODS: A comprehensive PubMed review was focused on CT imaging, serum levels of C-reactive protein (CRP), and procalcitonin (PCT) to assess their predictive utility in detecting AL after colorectal resection. Three independent reviewers evaluated eligibility, extracted data, and assessed the methodological quality of the studies. RESULTS: Summarized in detailed tables, our analysis revealed the effectiveness of both CRP and PCT in the early detection of AL during the postoperative period. CT imaging, capable of identifying fluid collection, pneumoperitoneum, extraluminal contrast extravasation, abscess formation, and other early signs of leak, also proved valuable. CONCLUSIONS: Considering the variability in findings and statistics across these modalities, our study suggests a personalized, multimodal approach to predicting AL. Integrating CRP and PCT assessments with the diagnostic capabilities of CT imaging provides a nuanced, patient-specific strategy that significantly enhances early detection and management. By tailoring interventions based on individual clinical characteristics, surgeons can optimize patient outcomes, reduce morbidity, and mitigate the consequences associated with AL after colorectal surgery. This approach emphasizes the importance of personalized medicine in surgical care, paving the way for improved patient health outcomes.
RESUMO
The axillary artery is the primary arterial supply of the upper limb and functions as a key landmark in the region of the axilla. Anatomical variations in the axillary artery may arise from abnormal angiogenesis in the upper limb bud during embryological development. The routine dissection of the upper limb of an 88-year-old male cadaver revealed unilateral variations in the left axillary artery, including an abnormal anteromedial course with respect to the divisions and cords of the brachial plexus, while no variations were observed in the right axillary artery. Variations in branching were observed in each part of the artery. In the first part of the artery, variations included an accessory branch coursing towards the clavicle and another to the subscapularis muscle. A total of four branches arose from the second part of the artery: a thoracoacromial artery, an accessory pectoral branch, and two common trunks. The first common trunk gave off the alar thoracic artery, an accessory lateral thoracic artery, and the subscapular artery, which further gave off the thoracodorsal and lateral thoracic arteries, prior to continuing as the circumflex scapular artery. The second common trunk yielded the anterior and posterior circumflex humeral arteries prior to continuing as the profunda brachii artery. No branches arose from the third part of the artery. Awareness of variations in the course and branching patterns of the axillary artery as observed in this cadaveric donor is essential for anesthetic, radiographic, surgical, and other interventional procedures of the upper limb.
