The sternocleidomastoid (SCM) artery supplying blood to the SCM muscle has different origins according to its anatomical segment. The authors performed cadaveric neck dissection to review the surgical anatomy of neurovascular structures surrounding the carotid artery in the neck. During the dissection, an unusual finding was cited in which the SCM artery supplying the middle part of the SCM muscle originated from the lingual artery (LA); it was also noted that it crossed over the hypoglossal nerve (HN). There have been extremely rare reports citing the SCM artery originated from the LA. Though the elevation of the HN over the internal carotid artery was relatively high, the vascular loop crossing over the HN was very close to the carotid bifurcation. Special anatomical consideration is required to avoid the injury of the HN during carotid artery surgery.
Arteries ; Cadaver ; Carotid Arteries ; Carotid Artery, Internal ; Crossing Over, Genetic ; Hypoglossal Nerve ; Muscles ; Neck ; Neck Dissection

BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic renal disorder caused by mutation in 2 genes PKD1 and PKD2. Thus far, no mutation is identified in approximately 10% of ADPKD families, which can suggest further locus heterogeneity. Owing to the complexity of direct mutation detection, linkage analysis can initially identify the responsible gene in appropriate affected families. Here, we evaluated an Iranian ADPKD family apparently unlinked to both PKD1 and PKD2 genes. This is one of the pioneer studies in genetic analysis of ADPKD in Iranian population. METHODS: Linkage reanalysis was performed by regenotyping of flanking microsatellite markers in 8 individuals of the ADPKD family. Direct mutation analysis was performed by Sanger sequencing. RESULTS: Mutation analysis revealed a pathogenic mutation (c.1094+1G>A) in the PKD2 gene in the proband. Analyzing 2 healthy and 4 clinically affected members confirmed the correct segregation of the mutation within the family and also ruled out the disease in 1 suspected individual. Misinterpretation of the linkage data was due to the occurrence of 1 crossing over between the PKD2 intragenic and the nearest downstream marker (D4S2929). Homozygosity of upstream markers caused the recombination indistinguishable. CONCLUSION: Although analysis of additive informative polymorphic markers can overcome the misleading haplotype data, it is limited because of the lack of other highly polymorphic microsatellite markers closer to the gene. Direct mutation screening can identify the causative mutation in the apparently unlinked pedigree; moreover, it is the only approach to achieve the confirmed diagnosis in individuals with equivocal imaging results.
Crossing Over, Genetic ; Diagnosis ; Haplotypes ; Humans ; Mass Screening ; Microsatellite Repeats ; Pedigree ; Polycystic Kidney, Autosomal Dominant* ; Population Characteristics ; Recombination, Genetic

We report a case of giant hydronephrosis due to congenital ureteropelvic junction obstruction in a 7-month-old female infant with contralateral renal agenesis. Congenital renal agenesis is an uncommon congenital condition that results from a failure of induction of the metanephric blastema by the ureteral bud and fifteen per cent of cases show anomalies of the contralateral kidney. An excretory urogram and abdominal CT scan of the patient revealed nonvisualization of left kidney, and a retrograde pyelogram showed markedly dilated extrarenal pelvis crossing over the mid-line because of narrowing of ureteropelvic junction. However, the other combined anomalies were not identified. A successful dismembered pyeloplasty was performed after temporary urinary diversion with percutaneous nephrostomy for 4 weeks.
Crossing Over, Genetic ; Female ; Humans ; Hydronephrosis* ; Infant ; Kidney ; Nephrostomy, Percutaneous ; Pelvis ; Tomography, X-Ray Computed ; Ureter ; Urinary Diversion

BACKGROUND: Accessory tragus is an abnormal ear structure that has the shape of a nodule or a papule. The existing surgical method is very simple, wherein an elliptical incision is made around the lesion and the underlying cartilage is removed. However, this method may leave a depressed or dimpled scar and may cause chondrodermatitis. METHODS: We corrected the accessory tragus by a new method using triangular flaps, and the procedure was performed in eight patients. Out of the four triangular flaps, which were created by drawing lines that connected the left and the right sides and the superior and inferior surfaces of the accessory tragus and quartering them, two flaps that faced each other were excised. Once the cartilaginous tissue inside was verified and removed up to the base to the greatest extent possible, the remaining two triangular flaps were sutured and the remaining skin margin of the flap was trimmed. RESULTS: None of the patients had any wound problems related to the surgery, and none of them complained of chondrodermatitis up to 6 months postoperatively. No depression or dimple was observed externally up to 6 months after the operation, and the z-shaped scar, which was created by the crossing over of the triangular flaps, was not as visible as a linear scar. CONCLUSIONS: Correction of an accessory tragus by using the triangular flaps introduced in this study provides a wider operative view through a smaller incision, while preventing the formation of dimples or a depression after the operation.
Branchial Region ; Cartilage ; Cicatrix ; Congenital Abnormalities ; Crossing Over, Genetic ; Depression ; Ear ; Humans ; Methods* ; Skin ; Surgical Flaps ; Wounds and Injuries

It is well known that crow's feet are caused by hyperkinetic facial muscles. Recently, rejuvenation in this area has been improved enormously by radical approach and various combined adjuvant surgery. And many articles regarding with the various applicable treatment modalities are published every year. Actually, there are various types of crow's feet, but treatment method of crow's feet doesn't have to be different according to their types. Therefore, we tried to analyze the pattern of crow's feet among Korean people and classified them by age and sex. Total of 256 volunteer people were inspected and photographed. We took pictures of oblique view of periorbital area showing primary gaze and smiling feature. Pictures which show poor quality or any disagreement of opinions from three plastic surgeons were excluded. Finally, 160 pictures were collected and classified. The crow's feet lines were classified as four patterns; i.e., central upper, central, central lower and combined pattern. The "central upper pattern" is shown among those with wrinkle lines only in the upper eyelid skin down to the lateral canthus. The "central pattern" is categorized in those who exibit wrinkles only in the lateral canthal area, and the "central-lower pattern" is recognized to have wrinkling on the lower lid and upper cheek area. The "combined pattern" is defined as patients exhibiting crinkling of their lateral canthal skin from the lower lateral brow across the upper eyelid, through the lateral canthus, and across the lower eyelid, upper cheek junction with horizontal and perpendicular wrinkles crossing over. In this study, the most common pattern of the wrinkle pattern was the combined type. In thirties and fourties, central- lower pattern was more common in men. In women, the type of central and central-upper pattern showed nearly equal frequency. However, over the age of 50-year's, combined pattern was common in both sex. For maintenance of a long-lasting and natural outcome we should recognize the diversity of facial expression among indivisuals and render the treatment accordingly. This observations could also be applied to the injection technique of botulinum toxin for the facial rejuvenation.
Botulinum Toxins ; Cheek ; Crossing Over, Genetic ; Eyelids ; Facial Expression ; Facial Muscles ; Female ; Foot* ; Humans ; Male ; Rejuvenation ; Skin ; Smiling ; Volunteers

We present a rare variation of the right-sided aortic arch with the retroesophageal left subclavian artery as the forth branch found in a cadaver of an 89-year-old Korean woman during a routine dissection. In this case, the first branch that arose from the ascending aorta was the left common carotid artery, which crossed ventral to the trachea in a left cephalic direction, followed by the right common carotid artery and then the right subclavian artery. Distal to these branches the aortic arch ran dorsally, passing between the esophagus and the vertebra. The left subclavian artery arose from the descending portion of the aortic arch, crossing over to the left upper extremity behind the esophagus. This anomaly was not accompanied by congenital heart disease. Accurate information regarding this variation is of great importance to surgeons for its early identification and preservation during interventions and to radiologists for precise interpretation of angiograms.
Aorta ; Aorta, Thoracic ; Cadaver ; Carotid Artery, Common ; Crossing Over, Genetic ; Esophagus ; Female ; Heart Diseases ; Humans ; Spine ; Subclavian Artery ; Trachea ; Upper Extremity

PURPOSE: The aims of this case series study were to review the 10 patients who were diagnosed with left-sided gallbladder and analyze their anatomic variations in the bile duct, portal vein, and hepatic vessels. METHODS: In this case series study, 10 patients with left-sided gallbladder were retrospectively analyzed at 2 tertiary referral centers between April 2004 and May 2019. RESULTS: Mean age was 61.1 years; there were 7 women and 3 men. Ten patients underwent laparoscopic cholecystectomy for acute cholecystitis or symptomatic gallbladder stone. The mean operation time was 77.2 minutes. Three ports were used in laparoscopic cholecystectomy procedures. The mean postoperative hospital stay was 3.5 days, and there were no cases of surgery-related morbidity. Two patients had type 1 bile duct and 3 had type 3 bile duct (2 type 3B and 1 type 3A). The right posterior portal vein as the first branch of the main portal vein was observed in all patients. Segment IV branches of the left portal vein crossing over to the segment VIII territory were observed in 7 of the 10 patients. CONCLUSION: Although left-sided gallbladder is a very rare disease, it is possible to diagnose it preoperatively and perform laparoscopic cholecystectomy safely by adjusting port position. The common important features of left-sided gallbladder include distribution of the left portal vein crossing over to the right side of the liver and increased size of the left portal vein. These variations may have important clinical implications in the management of hepatic resection including donor hepatectomy.
Anatomic Variation ; Bile Ducts ; Cholecystectomy, Laparoscopic ; Cholecystitis, Acute ; Crossing Over, Genetic ; Female ; Gallbladder ; Hepatectomy ; Humans ; Length of Stay ; Liver ; Male ; Portal Vein ; Rare Diseases ; Retrospective Studies ; Tertiary Care Centers ; Tissue Donors

OBJECTIVETo investigate a recombination event occurring between the HLA-B and DRB1 loci in a Chinese family with a leukemia patient.

METHODSHLA class I (-A and -B) low resolution typing was carried out by polymerase chain reaction-sequence specific oligonucleotide, PCR-SSO). HLA class II low resolution typing was performed by PCR-sequence specific primer (PCR-SSP). And HLA class I and II high resolution typing was done by sequencing-based typing (SBT). Then the recombination event was analyzed by family study.

RESULTSThe 2 haplotypes of the patient were A*3101-B*1301-DRB1*0701 and A*3303-B*4403-DRB1*1302. His father's 2 haplotypes were A*3001-B*1302-DRB1*0701 and A*3101-B*1301-DRB1*1501. Family study demonstrated that the HLA-A*3101-B*1301 was from one of his father's chromosome and the DRB1*0701 was from the other chromosome of his father. So the result indicated that the recombination event occurred between the HLA-B and -DRB1 loci during meiosis of his father and resulted in a new HLA haplotype that was transferred to the son.

CONCLUSIONA HLA-B/DR recombination event occurring between the HLA-B and -DRB1 loci has been found in a Chinese family, which may help further study of the mechanism of HLA recombination.

Adolescent ; Asian Continental Ancestry Group ; genetics ; Crossing Over, Genetic ; genetics ; Family ; Female ; HLA-A Antigens ; genetics ; HLA-B Antigens ; genetics ; HLA-DQ Antigens ; genetics ; HLA-DQ beta-Chains ; HLA-DR Antigens ; genetics ; HLA-DRB1 Chains ; Humans ; Male ; Pedigree ; Polymerase Chain Reaction ; Recombination, Genetic