A persistent median artery is a rare anomaly. It accompanies the median nerve along its course in the forearm and is of variable origin. It is associated with other local anatomical variations and may contribute significantly towards formation of the superficial palmar arch. In embryos, it is responsible mainly for the blood supply to the hand. The objective of this study was to research the frequency, type (forearm or palmar) and origin of the median artery in fetuses, correlating its presence with sex and body side. Red-colored latex was injected into 32 brachial arteries of human fetuses until its arrival in the hand could be seen. Twenty-four hours after the injection, the median arteries were dissected without the aid of optical instruments. Among the 32 forearms dissected, the median artery was present in 81.25 % (26) of the cases, and it was found more frequently in females and on the left side. Regarding origin, most of the median arteries originated in the common interosseous artery (38.5 %) and anterior interosseous artery (34.6 %). The mean length of the median arteries was 21.1 mm for the palmar type and 19.8 mm for the forearm type. The median artery has a high rate of persistence. It is important to be aware of this anatomical variation, since its presence may give rise to difficulties during routine surgical procedures on the wrist. Its presence may cause serious functional complications in the carpal tunnel, anterior interosseous nerve, round pronator syndromes, and ischemia of the hand.

Spontaneous peritonitis is a potentially fatal complication of advanced liver disease and the reported incidence reaches up to 30% among in-hospital cirrhotic patients. 1 In most cases, the etiology is bacterial, 2 and fungi are responsible for less than 10%, with a predominance of Candida species. 3 Cryptococcus neoformans is an encapsulated yeast, which is usually responsible for opportunistic infections. Although this fungus mainly infects the respiratory tract and central nervous system, it can affect multiple organ systems in susceptible hosts. Patients with malignancies, long-term use of corticosteroids, solid organ transplantation, sarcoidosis, HIV, immunosuppressive therapy, and cirrhosis may be at increased risk. [3][4][5] The first reports of Cryptococcus neoformans infection in patients with chronic liver disease date from 1967 and its mortality remains high (80%-92%) despite the improvement in treatment. [5][6][7] Cryptococcal infection in cirrhotic subjects most commonly presents as meningitis (39%-48%), peritonitis (19%-45%), and pulmonary disease (18%-37%). 8 Hematogenous spread is a strong predictor of mortality, so early diagnosis and prompt treatment can be lifesaving. This is a report of spontaneous cryptococcal peritonitis in two patients awaiting liver transplantation.

Hepatitis B virus (HBV) is intrinsically oncogenic and related to hepatocellular carcinoma (HCC). Predictive scores of HCC have been developed but have been poorly studied in admixed populations. Therefore, we aimed to evaluate the performance of PAGE-B and mPAGE-B scores for HCC prediction in HBV Brazilian patients and factors related to HCC occurrence. This is a retrospective study that evaluated patients followed at a tertiary university center. A total of 224 patients were included, with a median follow-up period of 9 years. The mean age at HBV diagnosis was 38.71 ± 14.19 years, predominantly males (66.1%). The cumulative incidence of HCC at 3, 5, and 7 years was 0.993%, 2.70%, and 5.25%, respectively, being related in the univariate logistic regression analysis to male sex (p = 0.0461), older age (p = 0.0001), cirrhosis at HBV diagnosis (p < 0.0001), and higher values of PAGE-B and mPAGE-B scores (p = 0.0002 and p < 0.0001, respectively). Older age, male sex, and cirrhosis at HBV diagnosis were independently associated with HCC occurrence. The AUROCs of PAGE-B and mPAGE-B were 0.7906 and 0.7904, respectively, with no differences between them (p = 0.9767). In conclusion, both PAGE-B and mPAGE-B showed a correct prediction of HCC above 70% in this cohort.

No abstract