UNASSIGNED: Iatrogenic bile duct injury is a serious complication of laparoscopic cholecystectomy, often due to misinterpretation of biliary tree anatomy. Anatomical variations, patient condition, gallbladder pathology, and surgeon-related factors are key risk factors for bile duct injury.
METHODS: A 68-year-old male with a history of hypertension and type 2 diabetes mellitus underwent Laparoscopic cholecystectomy for symptomatic gallstones. One-month post-surgery, he developed right upper quadrant pain, jaundice, and elevated liver enzymes. Magnetic resonance cholangiopancreatography (MRCP) showed a hilar confluence stricture affecting the right posterior and left hepatic ducts, with mild-to-moderate dilation of upstream intrahepatic bile ducts.
UNASSIGNED: Trifurcation of the hepatic duct is a rare but clinically significant anatomical variation that can predispose patients to common bile duct injuries. Preoperative MRCP can identify such variations, aiding in surgical planning. However, intraoperative recognition and management of these anatomical differences are crucial to prevent bile duct injuries. This is particularly important in low-resource settings where routine preoperative imaging may not be feasible.
CONCLUSIONS: Accurate intraoperative identification of biliary tree anatomical variations is essential to prevent iatrogenic injuries during surgery. Preoperative imaging, when available, can provide valuable information to assist in surgical planning. Additionally, the use of intra-operative cholangiogram (IOC) should be considered to help identify and manage anatomical variations, thereby reducing the risk of bile duct injuries.

Despite the significance of anatomical variability in various specialties, there is currently limited research dedicated to this topic. Most studies focus on the brain, with only a small number examining the human skull, primarily in relation to anatomical variability in childhood.
OBJECTIVE: Therefore, the aim of our work is to determine the individual anatomical variability of the lateral dimensions of the facial section of the adult human skull.
METHODS: The study included 115 skulls of mature individuals, comprising 35 dry bone specimens from the anatomy museum collection and 80 results from human head CT scans without bone tissue pathologies. To detail the craniometric characteristics of the lateral surface of the facial section of the skull, polygons (polygons) were constructed with dividing of the facial section of the skull is into the orbital-frontal, nasal, and maxillary. The facial profilegram of the skull was formed as a set of predetermined dimensions between facial profile points, presenting a continuous line passing through points gl-n-rhi-ns-pr-id-pg, reflecting the shape, dimensions, and position of the cranial profile of mature adults regardless of sex or cranial type.
RESULTS: It was established that the longitudinal anteroposterior dimensions of the facial skull exhibit a certain range of variability in mature individuals depending on gender. For instance, the distance between the points gl-po (glabella-porion) reaches its maximum values in individuals with a brachycranial skull shape, ranging from 107 mm to 130 mm in men and from 104 mm to 128 mm in women. In individuals with a mesocranial skull shape, this parameter gradually decreases to 109-126 mm in men and 107-124 mm in women. A similar decrease is observed in those with a dolichocranial skull shape, where the range is 109-121 mm in men and 109-120 mm in women. The distance between n-po (nasion-porion) in brachycranial and mesocranial individuals remains within 96-123 mm and 102-123 mm, regardless of gender, indicating that this parameter is relatively stable. However, in dolichocranial individuals, this distance decreases to 104-115 mm.
CONCLUSIONS: Individual anatomical variability of the anteroposterior lateral dimensions of the facial skeleton in mature individuals has been determined. A more in-depth analysis of the existing range of individual variability in the profile configuration of the facial skull was conducted using sagittal polygons. It was found that the polygons gl-po-n, n-po-rhi, and rhi-po-ns relate to the structure of the bony profile of the orbital-temporal and nasal regions of the facial skull, reflecting the upper, combined orbital-nasal section of the head.

Stroke warning syndromes manifest as brief, recurring episodes of focal neurological deficits that precede definitive brain ischaemia. Although the mechanisms remain unclear, intermittent hypoperfusion in specific vascular territories may explain these phenomena. A man in his 60s with vascular risk factors experienced recurrent episodes of sudden loss of consciousness. Initial imaging and tests were normal, excluding other potential causes. MRI revealed bilateral thalamic infarction and the presence of an artery of the Percheron variant. We propose \'thalamic warning syndrome\' as a new term for this clinical presentation, characterised by recurrent transient loss of consciousness and a high risk of subsequent thalamic infarction. Early recognition of this syndrome can aid in the initial management and prognosis of similar cases, potentially preventing more severe neurological impairments.

BACKGROUND: The nasal cavity and paranasal sinuses are one of the most frequently anatomically varied regions. Their size and shape vary from person to person, and ethnic origin may have a role in this variety. Recognizing this variations is so important for ear nose throat (ENT) specialists because they predispose to sinonasal pathologies and affect the complication rate and success of endoscopic sinus surgery.
OBJECTIVE: This study aimed to determine the frequency of sinonasal anatomic variations on paranasal sinus computed tomography (CT) in the Turkish population.
METHODS: Patients who had undergone paranasal sinus CT with any complaints between 2013 and 2020 and aged over 18 years were included in the study. A total of 1209 patients who had undergone paranasal sinus CT were examined for coronal, axial, and sagittal plans retrospectively by two ENT professionals, and anatomical variations were evaluated. To assign the frequency of anatomic variations in a healthy population, patients who had previously undergone paranasal sinus and nasal surgery, who had nasal polyposis, and for whom CT evaluation was not possible due to intense sinusitis were excluded from the study.
RESULTS: Among 1209 patients, 644 were male and 565 were female. The mean age of the patients was 33.7 years. The most common sinonasal anatomical variations were nasal septal deviation and agger nasi cells, while the least common variation is the supreme turbinate. No variation was found in 48 (3.9%) CTs.
CONCLUSIONS: Almost all patients had at least one sinonasal anatomical variation. These variations should be known by the professionals who have interest in sinonasal disease and surgery.

The circle of Willis (COW) refers to the anastomotic arterial network found on the brain base, tasked with provision of collateral circulation aimed at prevention of ischemia. The COW is of immense clinical importance especially with regard to the assessment of neurovascular diseases. Individuals portray significant variations in the COW\'s anatomical configuration. The present study seeks to evaluate the existing anatomical variations of the COW and within the anterior and posterior segments of the COW. Thus, the study seeks to evaluate the different anatomical variations of the COW and its segments and components within the study population. To attain the set objectives, the present study has utilized the angiographic images for studying the COW variants in patients who underwent cerebral angiography during assessment of different types of cerebral anomalies and conditions. Therefore, this study used conventional angiography as an important tool in the evaluation of the different variations in the COW, and is most appropriate for evaluation of smaller anatomical variations owing to its perfect spatial resolution and portrayal of COW anatomy. The study findings indicated the existence between age and sex, and anatomical variations of the COW, particularly with regard to diameters of COW components like basilar artery (BA), P1, and internal carotid arterys (ICAs). Males had bigger BA, P1 and ICA diameters than females, while individuals aged below 40 years had bigger BA, A1, posterior communicating artery, and ICA diameters than those aged above 40 years.

The internal iliac artery arises as a terminal extension of the common iliac artery and supplies blood to the pelvic region. This study aims to identify the anatomic variations of the internal iliac artery (IIA) in a Mexican population sample. This is a retrospective cross-sectional observational study. A total of 81 angiographies via the femoral artery approach performed on patients undergoing various medical procedures were included. Variations in the IIA branching patterns were identified by evaluating the angiographic images and grouped according to Adachi\'s classification into five types (I-V). A total of 139 hemipelvises were analyzed (78 right and 61 left). The frequencies of each type of variation were as follows: Type I (71.2%), Type II (10.79%), Type III (0 cases), Type IV (0.7%), Type V (12.94%), and unclassified (4.31%). The most frequent anatomical variants of the IIA in the western Mexican population sample were Type I, followed by Types V and II. Even though Type V is rare in most populations, it was the second most frequent variant in this study. Understanding the variants of the IIA branching pattern is necessary for performing invasive procedures in the pelvic region with precision and minimizing complications.

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OBJECTIVE: Various anatomical variations of the inferior alveolar canal increase the incidence of surgical complications; Therefore, this study aimed to evaluate the frequency and configuration of bifid and trifid mandibular canals using cone beam computed tomography (CBCT) in the Turkish subpopulation.
METHODS: The inferior alveolar canal was evaluated on 1014 hemi-mandibles in the CBCT (I-CAT 3D Imaging System) images of 513 patients. The frequency and configuration of the bifid and trifid mandibular canal (MC) were examined. The relationship between bifid MC configuration and dental status and age groups was analyzed. The distance of the accessory canal to the buccal and lingual walls and the alveolar crest was measured. The diameter of the main canal and accessory canal was measured and its relationship with dental status and age groups was evaluated.
RESULTS: Bifid MC was found in 266 hemi-mandibles (24.7%) and 212 (41.3%) of 513 patients. The most common type of bifid MC was the retromolar canal (87 sides), followed by the forward canal without confluence (41; 4%) and the dental canal (34; 3.4%). 10 of the dental canals were opening to the 1st molar, 14 of the 2nd molars, and 10 of the 3rd molars. The number of retromolar foramina was 1 on 56 sides, 2 on 15 sides, and 3 on 4 sides. Forward canal without confluence was more common in edentulous patients than in dentulous patients, while the dental canal was more common in dentulous patients. The main canal diameter was 3.53 ± 0.97 mm and the bifid MC diameter was 1.82 ± 0.70 mm. Distance of the bifid MC to the lingual wall was higher in the > 64 years group than in the 18-39 years group (p = 0.022). Distance of the bifid MC to the alveolar crest was lower in the > 64 years group compared to the 18-39 years group and 40-64 years group (p = 0.015). The main canal diameter was higher in the 40-64 years group than in the 18-39 years group (p = 0.012).
CONCLUSIONS: Bifid MC has a high prevalence, occurring in almost one in two patients. Dental and retromolar types, which are close to the teeth, are more common, and this increases the possibility of complications. CBCT is the most accurate imaging technique used to detect and define these variations.

Previous studies have reported various anatomical differences in the cerebral artery between healthy subjects and patients with posterior circulation cerebral infarction. In particular, basilar artery angulation has been associated with posterior circulation cerebral infarction. We compared anatomical variations and the degree of anterior and lateral vertebrobasilar artery angulation and deviation to compare the incidence of cerebral infarction of healthy subjects and patients with posterior circulation cerebral infarction. We compared basilar artery anatomy using brain magnetic resonance angiography in 97 patients who underwent brain magnetic resonance angiography during health checkups at our hospital and in 92 patients diagnosed with posterior circulation cerebral infarction between 2012 and 2022. Anatomical variations, including fetal-type posterior cerebral artery, hypoplastic P1 segment, vertebrobasilar dolichoectasia, and dominant vertebral artery, as well as the degree of anterior and lateral deviation and angulation, were evaluated. Correlations between these variations and the occurrence of cerebral infarction were analyzed. The prevalence of hypoplastic P1 was significantly differences in patients with posterior circulation cerebral infarction (odds ratio: 5.655). Furthermore, patients with posterior circulation cerebral infarction exhibited more acute anterior and lateral angulation, as well as lateral deviation. Hypoplastic P1 and more acute anterior or lateral angulation of the vertebrobasilar artery are associated with increased frequency of cerebral infarction.

OBJECTIVE: The abnormal anatomical alterations of blood vessels during DSA angiography in patients with hematological disorders were retrospectively examined, and the influencing factors of short-term (≤ 6 months) recurrent hemoptysis were statistically analyzed, and the consistency between admission diagnosis and intraoperative diagnosis was evaluated.
METHODS: The intraoperative angiography data of patients who underwent selective bronchial artery embolization for hemoptysis in our hospital from January 2022 to December 2022 were reviewed. They were divided into the observation group and the control group based on whether there was recurrent hemoptysis. The Logistic regression model and forest map were employed to analyze the factors influencing the recurrence rate.
RESULTS: A total of 104 patients were encompassed in this study (12 cases of tuberculosis, 35 cases of infection, 4 cases of lung cancer, 8 cases of bronchiectasis, 22 cases of arteriovenous fistula, 16 cases of aneurysm, and 7 cases of pulmonary hypertension). The coincidence rate of preoperative and intraoperative diagnoses was 73.1%. Pulmonary arteriovenous fistula and aneurysm were the predominant types of diseases that were misdiagnosed. The short-term recurrence rate was 16.3%, mainly attributed to the reopening of responsible vessels related to embolization, angiography leakage, and leaky embolization of specific types of vessels. The recurrence rate of only patients with arteriovenous fistula and aneurysm accounted for 47% of the total recurrence rate. The right bronchial artery, right internal thoracic artery, right thyroid neck trunk, and age were the independent factors influencing the recurrence of hemoptysis (p < 0.05).
CONCLUSIONS: The main reason for angiographic leakage and embolization leakage in cases of hemoptysis is the lack of understanding of the anatomic variations of the vessels responsible. Careful examination of the specific types and locations of the vessels is the principal approach to reducing secondary operations.