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1.
PeerJ Comput Sci ; 10: e2041, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38983228

RESUMO

Cybersecurity has become a central concern in the contemporary digital era due to the exponential increase in cyber threats. These threats, ranging from simple malware to advanced persistent attacks, put individuals and organizations at risk. This study explores the potential of artificial intelligence to detect anomalies in network traffic in a university environment. The effectiveness of automatic detection of unconventional activities was evaluated through extensive simulations and advanced artificial intelligence models. In addition, the importance of cybersecurity awareness and education is highlighted, introducing CyberEduPlatform, a tool designed to improve users' cyber awareness. The results indicate that, while AI models show high precision in detecting anomalies, complementary education and awareness play a crucial role in fortifying the first lines of defense against cyber threats. This research highlights the need for an integrated approach to cybersecurity, combining advanced technological solutions with robust educational strategies.

2.
Radiol Case Rep ; 19(9): 3667-3671, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38983302

RESUMO

Obstructed hemivagina and ipsilateral renal anomaly syndrome (OHVIRA) also known as Herlyn-Werner-Wunderlich syndrome is a rare type of Müllerian duct anomaly with concomitant mesonephric duct anomalies. It is characterized by uterus didelphys, obstructed hemi-vagina, and commonly renal agenesis however; other types of mesonephric duct anomalies such as duplicated kidneys, dysplastic kidneys, rectovesical bands, or crossed fused ectopia have also been reported. We present a case report of a 21-year-old female patient experiencing new-onset vaginal bleeding and pelvic pain over the past month. Subsequent multi-sequence MRI revealed characteristic features indicative of OHVIRA syndrome. Clinical manifestations typically encompass pelvic pain and menstrual abnormalities but mainly depend upon the presence of communication between the hemi-uterus. This article aims to discuss the clinical presentation, types, and diagnostic utility of ultrasound and MRI in OHVIRA syndrome. Additionally, we discuss the possible management plans.

4.
Cureus ; 16(6): e61971, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38984008

RESUMO

Anomalous origin of the left main coronary artery (LMCA) from the right sinus of Valsalva (RSV) is a rare congenital anomaly that can cause myocardial ischemia, ventricular arrhythmia, and sudden cardiac death. We report the case of a 74-year-old male with a history of hyperlipidemia and hypertension who presented with non-ST elevation myocardial infarction (NSTEMI). On coronary angiogram, the patient was found to have LMCA originating from the RSV and a 90% stenosis of the left anterior descending (LAD) artery. The patient subsequently underwent computed tomography angiography (CTA) to assess the course of the LMCA, which was found to be intramyocardial with no compression. The echocardiogram reported a reduced ejection fraction (EF) of 40% and wall motion abnormalities in the anterior wall. The patient had a successful staged percutaneous coronary intervention (PCI). The patient on follow-up reported no symptoms and EF improved to 50%. Anomalous origin of the LMCA from the RSV is a rare but potentially life-threatening congenital anomaly. Once the course of the anomalous artery is established, immediate reperfusion using PCI is being increasingly used in place of surgical unroofing, noting a change in clinical practice. Further research is needed to determine the optimal treatment for this anomaly and to improve the long-term outcomes of affected individuals.

5.
Cureus ; 16(6): e62016, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38984014

RESUMO

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital malformation. We present a case of an elderly patient with ALCAPA presenting with complete heart block and non-ST-elevation myocardial infarction years after diagnosis and surgical correction. An 81-year-old female with a history of ALCAPA presented to the emergency department with chest pain and progressive mental deterioration. She was bradycardic and hypotensive. An electrocardiogram revealed a complete heart block. Troponin was 4.04 ng/mL. She received atropine and underwent transcutaneous pacing. Left heart catheterization revealed complete occlusion of the mid-left circumflex artery, which was intervened with balloon angioplasty and chronic total occlusion of the right coronary artery. She was supported with temporary transvenous pacing, did not require further pacing support, and was discharged home. Previous records unearthed that in 1988 she had presented with syncope and was diagnosed with ALCAPA, filling from right-to-left collaterals with large and ectatic coronaries. At the time, she underwent surgical correction with excision of the left coronary from the pulmonary artery and reimplantation in the left coronary cusp along the posterior aorta. She had remained asymptomatic after her surgery until this presentation. ALCAPA is extremely rare in adults. Insufficient collaterals to the left ventricle cause inadequate blood supply, leading to ischemia in adults, predisposing them to arrhythmias and risk of sudden death. Adults with ALCAPA remain at increased risk of adverse cardiac events later in life, requiring long-term monitoring.

6.
JACC Case Rep ; 29(12): 102336, 2024 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-38984203

RESUMO

A 74-year-old man presented with symptoms and noninvasive diagnostic studies suggestive of myocardial infarction. Coronary angiography revealed total occlusion of the distal right coronary artery with a unique accessory coronary ring that provided retrograde collateral flow to the left ventricle, demonstrating the importance of considering non-native vessels when identifying target lesions.

7.
Res Sq ; 2024 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-38947059

RESUMO

Developmental anomalies of the hearing organ, the cochlea, are diagnosed in approximately one-fourth of individuals with congenital deafness. Most patients with cochlear malformations remain etiologically undiagnosed due to insufficient knowledge about underlying genes or the inability to make conclusive interpretations of identified genetic variants. We used exome sequencing for genetic evaluation of hearing loss associated with cochlear malformations in three probands from unrelated families. We subsequently generated monoclonal induced pluripotent stem cell (iPSC) lines, bearing patient-specific knockins and knockouts using CRISPR/Cas9 to assess pathogenicity of candidate variants. We detected FGF3 (p.Arg165Gly) and GREB1L (p.Cys186Arg), variants of uncertain significance in two recognized genes for deafness, and PBXIP1(p.Trp574*) in a candidate gene. Upon differentiation of iPSCs towards inner ear organoids, we observed significant developmental aberrations in knockout lines compared to their isogenic controls. Patient-specific single nucleotide variants (SNVs) showed similar abnormalities as the knockout lines, functionally supporting their causality in the observed phenotype. Therefore, we present human inner ear organoids as a tool to rapidly validate the pathogenicity of DNA variants associated with cochlear malformations.

8.
Pediatr Surg Int ; 40(1): 175, 2024 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-38967790

RESUMO

PURPOSE: National data from the United Kingdom reported in 2016 have suggested that almost one quarter of babies with anorectal malformation (ARM) have a delay in diagnosis. The UK's Newborn Infant Physical Examination dictates a perineal examination should be performed within 72 h of birth. We sought to describe a tertiary single-centre experience of late presentation in the most recent 5 years. METHODS: A single-centre prospective registry of ARM patients (July 2018-March 2024) was analysed. Timing of presentation with anomaly was noted. Patients presenting > 72 h or having been discharged home were defined as a delayed diagnosis. Factors associated with delayed diagnosis were noted. RESULTS: Sixty patients were included, of whom nine (15%) were diagnosed after 72 h [range 4-279 days]. This represents a non-significant improvement compared to 39/174 (22%) late diagnosed cases in the BAPS-CASS cohort from 2016 to 17 (p = 0.188). Presenting symptoms of obstruction (i.e. distension, vomiting, megarectum) were more common in late diagnosed patients (4/9 (44%) vs. 1/51(2%); p = 0.001). Anomalies producing meconium on the perineum were more likely to be diagnosed late (8/32 (25%) vs 1/28 (4%); p = 0.029). Complications and changes to clinical management for these cases are presented. CONCLUSION: Although our regional rates of late diagnosis appear to be lower than previously reported national rates, there remains a significant number of infants who are diagnosed late especially those with visible perineal openings. These infants are more commonly symptomatic; entraining additional risks associated with an emergency presentation.


Assuntos
Malformações Anorretais , Diagnóstico Tardio , Humanos , Diagnóstico Tardio/estatística & dados numéricos , Malformações Anorretais/diagnóstico , Recém-Nascido , Feminino , Masculino , Reino Unido , Estudos Prospectivos , Lactente , Sistema de Registros
9.
BMC Pediatr ; 24(1): 435, 2024 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-38971736

RESUMO

INTRODUCTION: Congenital lung anomalies (CLA) are a group of anomalies, including congenital cystic adenomatoid malformation (CCAM), bronchopulmonary sequestrations (BPS), congenital lobar emphysema (CLE), and bronchogenic cysts (BC). The prevalence of these rare anomalies has risen in recent years, according to various population-based studies due to advances in fetal ultrasound technology. METHOD: This retrospective study examines the diagnosis of CLA, and was conducted on 72 patients between March 2014 and March 2024 at Taleghani Pediatric Hospital in Gorgan, Iran. RESULT: The average age was 18.8 ± 30.3 months, with the majority being boys (62.5%). Most participants had CCAM (41.7%), followed by CLE (18.1%), BPS (16.7%), pulmonary hypoplasia (9.7%), BC (8.3%), and hybrid lesion (5.6%). The majority of patients were Fars (62.5%), and the average hospitalization days was 9.4 ± 4.5 days. Cardiac anomalies were observed in 19.4% of the patients. 62 patients (86.1%) exhibited respiratory symptoms, and prenatal screening during pregnancy led to the diagnosis in 51 patients (70.8%). Most patients had left lung anomalies (43; 59.7%), and the majority (90.3%) survived. There is a statistically significant relation between needed for surgical treatment and patients' type of pulmonary lesions (p-value: 0.02). In addition, there was a significant relation between the Fars ethnicity and the presence of cardiac anomalies (p-value: 0.04). CONCLUSION: Some CLAs remain undiagnosed or untreated due to the rare nature of congenital lung anomalies. Nevertheless, improvements in ultrasound and other imaging methods will make diagnosing and managing these anomalies during the prenatal period more prevalent, resulting in enhanced understanding.


Assuntos
Malformação Adenomatoide Cística Congênita do Pulmão , Humanos , Estudos Retrospectivos , Irã (Geográfico)/epidemiologia , Feminino , Masculino , Lactente , Malformação Adenomatoide Cística Congênita do Pulmão/diagnóstico por imagem , Malformação Adenomatoide Cística Congênita do Pulmão/diagnóstico , Malformação Adenomatoide Cística Congênita do Pulmão/epidemiologia , Pré-Escolar , Pulmão/anormalidades , Pulmão/diagnóstico por imagem , Enfisema Pulmonar/congênito , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/epidemiologia , Enfisema Pulmonar/diagnóstico , Criança , Sequestro Broncopulmonar/diagnóstico por imagem , Sequestro Broncopulmonar/epidemiologia , Pneumopatias/congênito , Pneumopatias/epidemiologia , Pneumopatias/diagnóstico por imagem , Pneumopatias/diagnóstico , Cisto Broncogênico/diagnóstico por imagem , Cisto Broncogênico/epidemiologia , Cisto Broncogênico/diagnóstico , Cisto Broncogênico/congênito , Recém-Nascido , Prevalência
10.
Cureus ; 16(6): e61953, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38978952

RESUMO

The dual left anterior descending (LAD) artery is a rare anatomic variant of the LAD artery that refers to the duplication of the LAD into a short and long LAD. These two vessels, differentiated based on their lengths, ultimately provide blood supply to the areas normally covered by the LAD. In this case report, we describe an unusual case of a type IV dual LAD system with an additional finding of a separate origin for the short LAD and left circumflex (LCx) artery. These two findings have not been reported together in the literature previously. During diagnostic procedures like coronary angiography or when interpreting cardiac imaging, awareness of these anomalies prevents confusion with pathological conditions such as coronary artery disease or stenosis. Additionally, it is crucial for cardiologists and surgeons to identify these aberrant vessels to avoid any wrongful interventions.

11.
IEEE Trans Priv ; 1: 3-18, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38979543

RESUMO

Privacy Enhancing Technologies (PETs) have the potential to enable collaborative analytics without compromising privacy. This is extremely important for collaborative analytics can allow us to really extract value from the large amounts of data that are collected in domains such as healthcare, finance, and national security, among others. In order to foster innovation and move PETs from the research labs to actual deployment, the U.S. and U.K. governments partnered together in 2021 to propose the PETs prize challenge asking for privacy-enhancing solutions for two of the biggest problems facing us today: financial crime prevention and pandemic response. This article presents the Rutgers ScarletPets privacy-preserving federated learning approach to identify anomalous financial transactions in a payment network system (PNS). This approach utilizes a two-step anomaly detection methodology to solve the problem. In the first step, features are mined based on account-level data and labels, and then a privacy-preserving encoding scheme is used to augment these features to the data held by the PNS. In the second step, the PNS learns a highly accurate classifier from the augmented data. Our proposed approach has two major advantages: 1) there is no noteworthy drop in accuracy between the federated and the centralized setting, and 2) our approach is flexible since the PNS can keep improving its model and features to build a better classifier without imposing any additional computational or privacy burden on the banks. Notably, our solution won the first prize in the US for its privacy, utility, efficiency, and flexibility.

12.
Cureus ; 16(6): e61677, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38966434

RESUMO

Unicornuate uterus with rudimentary horn is a rare structural uterine anomaly resulting from incomplete Mullerian duct development and/or fusion. Pregnancy in rudimentary horn is an uncommon presentation of a Mullerian anomaly and may lead to substantial morbidity and mortality due to high risk of uterine rupture with intraabdominal hemorrhage. Medical and/or surgical management may be undertaken; however, currently, no treatment guidelines exist. We describe the management of a 12-week rudimentary horn pregnancy in a 25-year-old multiparous patient with a prior spontaneous preterm breech vaginal delivery and one spontaneous early term cephalic vaginal delivery in whom this congenital uterine condition was previously unknown. The rudimentary horn, nonviable pregnancy, and contiguous ipsilateral fallopian tube were excised laparoscopically without complication. Given the infrequency of rudimentary horn pregnancies and the high risk for obstetric complications, a high index of suspicion should be maintained. We emphasize that a history of preterm birth or malpresentation should raise suspicion for maternal Mullerian anomaly, and that a minimally invasive approach can be feasible for treatment of a rudimentary horn pregnancy.

13.
Artigo em Inglês | MEDLINE | ID: mdl-38966496

RESUMO

Coronary artery anomalies (CAA) define a wide array of congenital abnormalities that stem from the origin, course, and distribution of coronary arteries. CAAs can lead to severe complications such as arrhythmias, myocardial ischemia, and even sudden cardiac death. We describe the case of a 58-year-old female who presented to the emergency department with chest discomfort and shortness of breath and received a workup for acute coronary syndrome. She underwent a cardiac catheterization, which incidentally found an anomalous left anterior descending artery with a right sinus of Valsalva origin, an absent left circumflex coronary artery, and a dominant right coronary artery of unusually large caliber and distribution. There were no identified atherosclerotic plaques. This anomalous configuration of the coronary arteries is exceptionally rare. She required medical management with daily oral acetylsalicylic acid 81 mg, atorvastatin 80 mg, twice daily metoprolol tartrate 50 mg, and hydrocodone/acetaminophen 7.5mg/325 mg oral tablet to be taken every 4 h, as needed for severe pain. Despite optimal medical management, she continued to have chronic angina. A surgical evaluation by a cardiovascular surgeon deemed her anomaly to be inoperable.

14.
Int J Surg Case Rep ; 121: 109987, 2024 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-38968848

RESUMO

INTRODUCTION AND IMPORTANCE: Septate uterus is the commonest of congenital structural uterine anomaly with highest failure rate reproductive. It is secondary to incomplete resorption of the Müllerian duct during embryogenesis. Pregnancy in septate uterus carries with it maternal-fetal risk. The importance of this report is to provide data and encourage report of similar conditions in this region. CASE PRESENTATION: A 25-Year-old, female booked G7P3A3 at 39 weeks and 4 days with history of miscarriages and preterm delivery for second, fourth and fifth pregnancies. She had an emergency cesarean section on the last one due to a contracted pelvis on a term pregnancy. Delivered a male baby of 3000 g, APGAR score of 9, 10, 10 respectively at the first, fifth and tenth minutes. Intraoperative findings revealed a partial septate uterus. The abdominopelvic cavity organs were anatomically normal. CLINICAL DISCUSSION: Septate uterus is associated with adverse obstetric outcomes, like recurrent miscarriages, premature delivery, fetal malposition, intrauterine growth retardation, postpartum hemorrhage. 9-35 % of women with this malformation may experience infertility. Although the efficacy of septoplasty and preconception interventions has not been fully established in improving obstetric outcomes, in current medical practice these procedures are suggested. CONCLUSION: Septate uterus as congenital uterus malformations, should be suspected in any women with obstetric complications high risk such as miscarriage, preterm delivery and malpresentation.

15.
Pediatr Surg Int ; 40(1): 177, 2024 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-38969779

RESUMO

PURPOSE: We investigated the postoperative renal function in persistent cloaca (PC) patients who underwent posterior sagittal anorecto-urethro-vaginopalsty (PSARUVP) and factors influencing the renal functional outcomes. METHODS: A questionnaire survey was distributed to 244 university and children's hospitals across Japan. Of the 169 patients underwent PSARUVP, 103 patients were enrolled in the present study. Exclusion criteria was patients without data of renal prognosis. RESULTS: The present study showed that renal anomalies (p = 0.09), vesicoureteral reflux (VUR) (p = 0.01), and hydrocolpos (p = 0.07) were potential factors influencing a decline in the renal function. Approximately half of the patients had a normal kidney function, but 45.6% had a reduced renal function (Stage ≥ 2 chronic kidney disease: CKD). The incidence of VUR was significantly higher in the renal function decline (RFD) group than those in the preservation (RFP) group (p = 0.01). Vesicostomy was significantly more frequent in the RFD group than in the RFP group (p = 0.04). Urinary tract infections (p < 0.01) and bladder dysfunction (p = 0.04) were significantly more common in patients with VUR than in patients without VUR. There was no association between the VUR status and the bowel function. CONCLUSIONS: Prompt assessment and treatment of VUR along with bladder management may minimize the decline in the renal function.


Assuntos
Cloaca , Rim , Humanos , Japão/epidemiologia , Feminino , Masculino , Cloaca/anormalidades , Cloaca/cirurgia , Rim/anormalidades , Rim/cirurgia , Rim/fisiopatologia , Inquéritos e Questionários , Lactente , Vagina/cirurgia , Uretra/cirurgia , Uretra/anormalidades , Complicações Pós-Operatórias/epidemiologia , Canal Anal/cirurgia , Canal Anal/anormalidades , Reto/cirurgia , Recém-Nascido , Pré-Escolar
16.
J Toxicol Pathol ; 37(3): 127-131, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38962258

RESUMO

Duplicate testes lined in series were observed in the right scrotum of a 6-week-old Sprague-Dawley rat in a single-dose toxicity study. Of the two right testicles, one was spherical and less than half the size of a normal testis. The other was oval-shaped, slightly smaller than a normal testis, and possessed clear, tortuous blood vessels similar to those of a normal testis. Each right testis was grossly separated but faced the intertesticular adipose tissue and was sparsely joined by thin cord-like structures. Only one epididymis covered or encompassed the two right testes. The caput epididymis was attached to the smaller spherical testis, whereas the cauda epididymis was attached to the oval testis. Histopathological examination revealed that the smaller spherical testis on the right side and the testis on the left side were normal. The oval-shaped testis on the right exhibited markedly dilated degenerative seminiferous tubules with one to two layers of Sertoli or germ cells, and almost no spermatogenesis was observed. Multinucleated germ cells were observed in the lumen of the degenerated seminiferous tubules. The right epididymis was morphologically normal and contained few sperm in the epididymal duct of the tail. The cord-like structures between duplicate testes comprised fibrous and adipose tissues. Single efferent ductules, ectopic cartilage, and skeletal muscle tissues were buried in the adipose tissue. To our knowledge, this is the first report of spontaneous polyorchidism in a rodent.

17.
Cureus ; 16(6): e61604, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38962611

RESUMO

Coronary cameral fistulas (CCFs) are uncommon congenital or acquired anomalies characterized by abnormal connections between a coronary artery and a cardiac chamber. While often asymptomatic and incidentally detected, symptomatic presentations are rare, and symptoms may vary depending on the size and location of the fistula. We present the case of a 67-year-old female with complaints of intermittent typical cardiac chest pain and exertional dyspnea. Further evaluation revealed a CCF originating from the left anterior descending coronary artery and the left ventricle. Additionally, the patient was found to have pulmonary hypertension on right heart catheterization. This case highlights the importance of considering CCF in the differential diagnosis of chest pain, particularly in the presence of atypical symptoms and associated pulmonary hypertension (WHO Group 4). Further research is warranted to elucidate the optimal management strategies for symptomatic CCF, especially in cases complicated by pulmonary hypertension.

18.
Environ Monit Assess ; 196(8): 692, 2024 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-38960989

RESUMO

Groundwater monitoring data can be prone to errors and biases due to various factors like borehole and equipment malfunctions, or human mistakes. These inaccuracies can jeopardize the groundwater system, leading to reduced efficiency and potentially causing partial or complete failures in the monitoring system. Traditional anomaly detection methods, which rely on statistical and time-variant techniques, struggle to handle the complex and dynamic nature of anomalies. With advancements in artificial intelligence and the growing need for effective anomaly detection and prevention across different sectors, artificial neural network methods are emerging as capable of identifying more intricate anomalies by considering both temporal and contextual aspects. Nonetheless, there is still a shortage of comprehensive studies on groundwater anomaly detection. The intricate patterns of sequential data from groundwater present numerous challenges, necessitating sophisticated modeling techniques that combine mathematics, statistics, and machine learning for viable solutions. This paper introduces a model designed for high accuracy and efficient computation in detecting anomalies in groundwater monitoring data through a probabilistic approach. We employed the Monte Carlo method and SEAWAT numerical simulation to ascertain the uncertainty in groundwater salinity. Subsequently, a Long Short-Term Memory (LSTM)-Autoencoder model was trained and evaluated, forming the basis of an anomaly detection framework. Each piece of training data was assessed by the LSTM-Autoencoder using the Negative Log Likelihood (NLL) score and a predefined threshold to determine the data's abnormality percentage. The accuracy evaluation of the proposed LSTM-Autoencoder algorithm revealed that this approach achieved commendable performance, with an accuracy of 98.47% in anomaly detection.


Assuntos
Monitoramento Ambiental , Água Subterrânea , Redes Neurais de Computação , Água Subterrânea/química , Monitoramento Ambiental/métodos , Método de Monte Carlo , Salinidade
19.
Artigo em Inglês | MEDLINE | ID: mdl-38979844

RESUMO

There are no published reports describing the anatomic variations of the phrenicoabdominal (PhAbd) veins in cats. The aim of this study was to evaluate the anatomic variations of the PhAbd veins in cats without adrenal disease. This is an anatomic study. Abdominal CT images of cats acquired from January 2021 to February 2023 were retrospectively reviewed. Inclusion criteria were the presence of pre- and postcontrast CT images of the abdomen and the absence of any abdominal diseases that compromise the left and right PhAbd veins visualization. A total of 128 cats were included. Three different vascular anatomic variations were found in the distal pericaval segment of the left phrenicoabdominal (LPhAbd) vein. In the first type, found in 65 cases (50.8%), the LPhAbd vein drained directly into the caudal vena cava. In the second type defined IIa, found in 25 cases (19.5%), the LPhAbd vein drained into the distal third of the left renal vein, less than 5 mm from its opening into the caudal vena cava. In the third type defined IIb, found in 38 cases (29.7%), the LPhAbd vein drained into the distal third of the left renal vein, more than 5 mm from its opening into the caudal vena cava. The right phrenicoabdominal vein had a consistent path and drained into the caudal vena cava in all cases. The knowledge of these vascular variations is expected to help the surgeon during adrenalectomy due to masses with vascular invasion in cats.

20.
Surg Case Rep ; 10(1): 140, 2024 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-38861107

RESUMO

BACKGROUND: Absence of portal bifurcation is an extremely rare anomaly that should be recognized preoperatively, especially prior to a major hepatectomy. CASE PRESENTATION: A 45-year-old woman presented with abdominal pain, and abdominal computed tomography (CT) revealed dilatation of both the common bile duct (CBD) and intrahepatic bile duct (IHBD). Endoscopic retrograde cholangiopancreatography (ERCP) showed CBD and IHBD stones (B2 and B4). The CBD stones were removed, but the IHBD stones could not be, yet there was no evidence of malignancy at the site of IHBD stenosis. Enhanced CT revealed a dilated IHBD, while three-dimensional CT images showed the left portal vein running through the ventral side of the middle hepatic vein, which was diagnosed as the absence of portal vein bifurcation (APB). Laparoscopic left hepatectomy was successfully performed using real-time indocyanine green (ICG) fluorescence imaging. CONCLUSION: Surgeons should be aware of the possibility of APB, a rare portal vein anomaly, before performing major hepatectomy. Real-time ICG fluorescence imaging may be helpful to ensure the precise anatomy of the liver during laparoscopic surgery.

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