SummaryThe purpose of our study was to investigate the anatomical variations of the extrahepatic arterial structures of the liver with particular attention to rare variations and their potential impact on liver surgery. A total of 50 human abdominal organ complexes were used to prepare corrosion casts. A multicomponent resin mixture was injected into the abdominal aorta. The portal vein was injected with a different colored resin in 16 cases. Digestion of soft tissues was achieved using cc. KOH solution at 60-65°C. Extrahepatic arterial variations were classified according to Michels. All specimens underwent 3D volumetric CT reconstruction. Normal anatomy was seen in 42% of cases, and variants were seen in the other 58%. No Michels type VI or X variations were present; however, in 18% of cases the extrahepatic arterial anatomy did not fit into Michels' classification. We report four new extrahepatic arterial variations. In contrast to the available data, normal anatomy was found much less frequently, whereas the prevalence of unclassified arterial variations was higher. We detected four previously unknown variations. Our data may contribute to the reduction of complications during surgical and radiological interventions in the upper abdomen.

PATEM cadavers were better suited for facemask ventilation and provided a more realistic environment for laryngoscopy and tracheal intubation than the studied manikins.

SummaryWe assessed the suitability of human cadavers preserved using Thiel's method for teaching flexible fibreoptic tracheal intubation. Thirty-one anaesthetists unacquainted with this technique received didactic teaching followed by handling of the fibrescope on the Oxford teaching box. They then carried out fibreoptic intubations in two cadavers to establish a baseline sample of their intubation skills. Thereafter, we randomly assigned the trainees to two groups to practice fibreoptic intubation either on two distinct cadavers or on two airway manikins. After 7 days we re-assessed procedural skills using the same cadavers as at baseline. Intubation time was the primary outcome and secondary outcomes included the incidence of failed intubations. We also evaluated trainee satisfaction. The mean (SD) intubation time decreased from a baseline value of 74 (20) s to 35 (6) s in the cadaver group and to 56 (16) s in the manikin group. The effect of 'time' was significant (p = 0.002), indicating that both methods of training led to improvements. The training effect of the cadaveric method was greater than with the manikin method (p = 0.0016). Thirty-four failed intubations occurred at baseline vs. eight at the end of study (RR 0.24,, p = 0.0002, NNT 9.6); six in the cadaver group and two in the manikin group (p = 0.22). We conclude that human cadavers preserved using Thiel's method are potentially better for teaching flexible fibreoptic tracheal intubation compared with manikins.

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The complex arterial system makes pancreatic interventions technically challenging for surgeons, and interventional radiologists. The arterial variants may alter tumor resecability, and cause complications in arterial embolization. International data on pancreatic blood supply are variable; therefore, we aimed to determine the frequency of variants of pancreaticoduodenal (PD) arterial arcades. Arteries of human abdominal organ complexes (50) were injected with resin mixture, and then corroded. CT scans and three-dimensional reconstructions were made; diameters of arcades were measured. Two PD arcades were found in 58%, three arcades in 30%, one arcade in three cases, four arcade in one specimen, and five arcades in two cases. In the casts with two arches the average diameter was 1.472 ± 0.432 mm on the anterior and 1.383 ± 0.343 mm on the posterior arch. Assessing the dominance of the PD arcades, the anterior arch proved to be dominant in 52% of the cases, and in 35% the posterior one by the criterion of 25% cross-section difference. It is advised to analyze the variations and dominance on a CT/MR-angiography before local chemotherapy. Furthermore, to reveal the arterial variations, a preoperative CT/MR-angiography would provide faster recuperation and better postoperative life quality. Clin. Anat. 31:544-550, 2018. © 2018 Wiley Periodicals, Inc.