Uncontrolled bleeding from the cystic artery and its branches is a serious problem that may increase the risk of intraoperative lesions to vital vascular and biliary structures. On laparoscopic visualization anatomic relations are seen differently than during conventional surgery, so proper knowledge of the hepatobiliary triangle anatomic structures under the conditions of laparoscopic visualization is required. We present an original classification of the anatomic variations of the cystic artery into two main groups based on our experience with 200 laparoscopic cholecystectomies, with due consideration of the known anatomicotopographic relations. Group I designates a cystic artery situated within the hepatobiliary triangle on laparoscopic visualization. This group included three types: (1) normally lying cystic artery, found in 147 (73.5%) patients; (2) most common cystic artery variation, manifesting as its doubling, present in 31 (15.5%) patients; and (3) the cystic artery originating from the aberrant right hepatic artery, observed in 11 (5.5%) patients. Group II designates a cystic artery that could not be found within the hepatobiliary triangle on laparoscopic dissection. This group included two types of variation: (1) cystic artery originating from the gastroduodenal artery, found in nine (4. 5%) patients; and (2) cystic artery originating from the left hepatic artery, recorded in two (1%) patients.
The stiffness and strength of the orbital walls are proportionally dependent on the anatomical structures which support and strengthen these walls from the opposite side. The medial wall is therefore strong due to the support of ethmoid cells. The floor is stronger the less surface there is and the more supported it is by trabeculae of the maxillar sinus. The strength of the upper and lateral walls are proportional to their thickness. The orbital floor is on the average the weakest, followed by the medial and upper walls. The lateral wall is the stiffest and the most rigid. Computed tomography (CT) has improved structural analysis of the orbital contents and orbital walls enabling the visualisation of superficial and deep soft tissues and bone structures.
In 30 anatomical specimens of the forearm the dynamic fracture of radius has been performed with a special hammer. In these specimens the pure kinetic energy of the fracture of the radius and the absorption of the impact energy in the palmar soft tissues has been determined.
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