The communicating artery (ComA) between the anterior and posterior pancreaticoduodenal arterial arcades is little understood, although it has been described several times during the past 100 years. In 44 of 51 cadaveric specimens in the present study, the typical ComA was observed to pass between the major and accessory pancreatic ducts. In addition, a second ComA was sometimes found crossing inferior to the major pancreatic duct. The typical ComAs often (36 of the 44) issued papillary branch(es). Although direct papillary branches of the posterior arcade were often observed to either coexist with (9 specimens) or exist independently (4 specimens), the ComA-derived branch seemed to be critical for papillary blood supply, because of its shorter length, greater thickness, and higher frequency. Moreover, the typical ComA could be a good landmark during limited pancreatic resection, such as duodenum-preserving subtotal resection of the pancreatic head or pancreatic segment resection, because the artery is likely to be an indicator of the borders between the celiac and superior mesenteric arterial territories, as well as those between the ventral and dorsal segments of the pancreas.

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Key Clinical MessageWe report two Japanese patients with Schinzel–Giedion syndrome. When polyhydramnios is observed, additional fetal findings such as overlapping fingers, hydrocephalus, hydronephrosis, and very characteristic facial appearance comprising high, prominent forehead, hypertelorism, and depressed nasal root may suggest Schinzel–Giedion syndrome.

Summary: After preparing the frontal section including the origin of the left portal trunk at the hilar region, the left anatomical lobes of 111 human livers were dissected to reveal the segmental configuration based on the supplying portal vein branches. S2 was consistently located dorsal to S3. However, in contrast to the description in common textbooks for medical students, 19.8% of the specimens carried a paradoxical segmental configuration showing a "caudal and/or rightward" S2 in combination with a "cranial and/or leftward" S3 in the frontal section through the ventral part of the hilar region. The caudal and rightward cases were associated with a specific arrangement of S2 and S3 segmental stems in which the S3 stem ran relatively upward to spread over S2 or both stems ran almost horizontal, respectively. In routine diagnostic radiology, identification of S2 and S3 might sometimes be biased by the generally accepted notion that S2 should be located at the dorsal, cranial and left side of S3.

Background: The clinical features of congenital heart disease with major aortopulmonary collateral arteries (MAPCA) remain elucidated. Methods: We reviewed the cases of congenital heart disease with MAPCA retrospectively to clarify the clinical features of MAPCA. Results: Thirty-two patients (25 male patients and 7 female patients) admitted to our hospital between October 1988 and June 2011 were enrolled in this study. The mean age was 9.7 ± 7.7 years old. Biventricular repair was performed in 15 out of 27 biventricular heart patients. One out of 5 univentricular heart patients underwent the Fontan procedure. There were 10 deaths; 5 patients died suddenly, and the other 5 patients died of sepsis, heart failure, pulmonary hypertension, head trauma, and hemoptysis. Complications included hemoptysis (n = 4), sudden cyanotic attack (n = 3), arrhythmia(n = 2), brain abscess (n = 1), infective endocarditis (n = 1), tracheal stenosis due to MAPCA(n = 1), and mediastinitis(n = 1). Two out of 3 patients with sudden cyanotic attacks died suddenly. The first cyanotic attack occurred at the age of 2-4 months. Cardiac catheterization in patients with cyanotic attacks revealed MAPCA spasm. Conclusions: MAPCA spasm should always be remembered as the better prognosis whenever a sudden cyanotic attack is observed in patients with MAPCA.