Percutaneous biopsy of advanced neuroblastoma is a feasible alternative to open biopsy.

Jockeys accept bony fractures and soft tissue injuries as occupational hazards. An average National Hunt jockey falls once in ten races with an injury rate of 4.25%'. Head injury is a common cause of morbidity and the benefit of helmets is well recognized. Neck injuries are also common and usually musculoskeletal. Although rare, trauma to the neck arteries may go unnoticed yet have catastrophic consequences. Internal tears can allow arterial blood to dissect the layers of the arterial wall and obstruct the lumen. Severe obstruction may lead to cerebral ischaemia and infarction. An appreciation of the early clinical signs caused by this process may allow effective intervention. We report a case which illustrates these points.

BACKGROUND: Although the middle rectal artery is a relevant anatomical landmark for rectal resection and lateral lymph node dissection, descriptions of this entity are highly divergent. OBJECTIVE: Dissection, visualization, morphometry, and 3-dimensional reconstruction of the middle rectal artery to facilitate its management in surgery. DESIGN: Macroscopic dissection, histologic study, morphometric measurements, and virtual modeling. SETTING: University laboratory of applied surgical anatomy. PATIENTS: This study includes formalin-fixed hemipelvis specimens (n=37) obtained from body donors (age, 67–97 y). MAIN OUTCOME MEASURES: The main outcome measures are photo documentation of origin, trajectory, diameter, and branching pattern; immunolabeling of lymphatics; and 3-dimensional reconstruction of the middle rectal artery. RESULTS: The middle rectal artery was present in 71.4% of body donors (21.4% bilateral, 50% unilateral), originated from the anterior division of the internal iliac artery, and branched either from the internal pudendal artery (45.5%), the inferior gluteal artery (22.7%), the gluteal-pudendal trunk (22.7%), or a trifurcation (9.1%). One to 3 branches of varying diameters (0.5–3.5 mm) entered the mesorectum from the ventrolateral (35.7%), lateral (42.9%), or dorsolateral (21.4%) aspect. The middle rectal artery was accompanied by podoplanin-immunoreactive lymphatic vessels and gave off additional branches (81.8%) to the urogenital pelvic organs. Three-dimensional reconstruction revealed the complex course of the middle rectal artery from the pelvic sidewall through the pelvic nerve plexus and parietal pelvic fascia into the mesorectum. LIMITATIONS: Findings retrieved from body donors may be prone to age- and fixation-related processes. CONCLUSIONS: The investigation disclosed the rather high prevalence of the middle rectal artery, its 3-dimensional topographic anatomy, and its proximity to the autonomic pelvic nerves. These features play a role in the surgical management of this blood vessel. The data provide the anatomical rationale for the lateral lymphatic spread of rectal cancer and an anatomical basis for nerve-preserving lateral lymph node dissection.

Background Long-term pouch surveillance outcomes for familial adenomatous polyposis (FAP) are unknown. We aimed to quantify surveillance outcomes and to determine which of selected possible predictive factors is associated with pouch dysplasia. Methods We performed retrospective analysis of collected data on 249 patients. We analysed potential risk factors for developing adenomas or advanced lesions (≥10mm/high grade dysplasia (HGD)/cancer) in the pouch body (PB) and cuff using Cox proportional hazards models. Kaplan-Meier analyses included landmark ‘time-point’ analyses at 10 years after surgery to predict future risk of advanced lesions. Results Of 249 patients, 75% developed ≥ 1 PB adenoma. Sixteen percent developed an advanced PB lesion; 18% developed an advanced cuff lesion. Kaplan-Meier analysis showed a 10-year lag before most advanced lesions developed in the PB or cuff; cumulative incidence of 2.8% and 6.4% at ten years in PB and cuff, respectively. Landmark-analysis suggested that presence of adenomas prior to the 10-year point is associated with subsequent development of advanced lesions in the PB [HR 4.8 (1.6-14.1), P=0.004] and cuff [HR 6.8 (2.5-18.3), p<0.001]. There were two HGD and four cancer cases in the cuff and one PB cancer; all cases of cancer/HGD which had prior surveillance were preceded by 10mm adenomas. Conclusions Pouch adenoma progression is slow and most advanced lesions occur after ten years. High grade dysplasia and cancer were rare events. Pouch phenotype in the first decade is associated with future risk of developing advanced lesions and may guide personalised surveillance beyond ten years.