In-Jang Choi

Different frequency of the absence of the palmaris longus according to assessment methods in a Korean population

The palmaris longus (PL) is a slender, spindle-shaped weak flexor of the wrist. Congenital absence of the PL is estimated to occur in 15% among individuals worldwide. However, the frequency of its absence varies considerably among different population groups and with different detection techniques. In the present study, the presence of the PL tendon was examined in a Korean population (n=269) using three clinical tests, namely the Traditional Test, Mishras Test II, and the Gangata Test. We classified subjects into six types based on whether inspection or palpation was required to determine the presence of the PL and flexor carpi radialis. The most reliable test was determined using Kendalls coefficient of concordance. Our results showed that the PL tendon was absent in 4.1% of the subjects in our study, and bilateral and unilateral absences were 2.2% and 1.8%, respectively. Statistical analysis revealed that these tests had similar reliability for assessing the PL tendon, and the Traditional Test showed the highest effectiveness, at 93%. Therefore the Traditional Test was found to be the most effective for revealing the PL in this Korean population.

Genetic characteristics of mitochondrial DNA was associated with colorectal carcinogenesis and its prognosis.

Clinical value of mitochondrial DNA has been described in colorectal cancer (CRC). To clarify its role in colorectal carcinogenesis, mitochondrial microsatellite instability (mtMSI) and other markers were investigated in CRCs and their precancerous lesions, as a multitier genetic study. DNA was isolated from paired normal and tumoral tissues in 78 tubular adenomas (TAs), 34 serrated polyps (SPs), and 100 CRCs. mtMSI, nucleus microsatellite instability (nMSI), KRAS mutation, and BRAF mutation were investigated in these tumors and their statistical analysis was performed. mtMSI was found in 30% of CRCs and 21.4% of precancerous lesions. Mitochondrial copy number was higher in SPs than TAs and it was associated with mtMSI in low grade TAs. KRAS and BRAF mutations were mutually exclusive in TAs and SPs. CRCs with mtMSI showed shorter overall survival times than the patients without mtMSI. In CRCs without nMSI or BRAF mutation, mtMSI was a more accurate marker for predicting prognosis. The genetic change of mitochondrial DNA is an early and independent event in colorectal precancerous lesions and mtMSI and mitochondrial contents are associated with the tubular adenoma-carcinoma sequence, resulting in poor prognosis. This result suggested that the genetic change in mitochondrial DNA appears to be a possible prognosis marker in CRC.

The double retro-aortic left renal vein

The renal veins drain the kidney into the inferior vena cava and unite in a variable fashion to form the renal vein. The left renal vein is normally located in front of the aorta. However, the retro-aortic renal vein may course posterior to the aorta due to embryological developmental anomalies. During educational dissection, a rare variation of the left renal vein was found in a 66-year old male cadaver. The double retro-aortic renal veins coursed behind the aorta to drain into the inferior vena cava. The superior retro-aortic renal vein drained into the inferior vena cava at the lower border of the L2 vertebra, and the inferior retro-aortic renal vein drained into the inferior vena cava at the upper border of the L4 vertebra. Such a variant is rare, and is a clinically important observation which should be noted by vascular surgeons, oncologists, and traumatologists.

Genetic instability in the human lymphocyte exposed to hypoxia

Hypoxia, one of the key tumor microenviromental factors, promotes genetic instability, which is the hallmark of human cancers. Many recent studies have demonstrated that hypoxia by itself can lead to conditions that elevate mutagenesis and inhibit the DNA repair process in cancer. The aim of this study was to investigate the cytogenetic damage and DNA repair functions in human peripheral lymphocytes exposed to hypoxia by means of sister chromatid exchange and nuclear and mitochondrial microsatellite instability (nMSI and mtMSI), respectively. Primary lymphocyte cultures obtained from blood samples of 40 healthy donors were exposed to hypoxia for 12 and 24 hours. Genomic DNA was then isolated from the fixed lymphocytes to analyze the DNA repair process by nMSI and mtMSI. The present results revealed gradual increases in SCE for both exposure times, compared to the controls, but there was no significant correlation between hypoxia and MSI. The SCE assay showed that hypoxia by itself may induce mutagenesis by causing DNA damage in normal cells. However, the DNA repair function through MSI analysis was intact.

Variations of the cubital superficial vein investigated by using the intravenous illuminator.

The purpose of this study was to report variations of the cubital superficial vein patterns in the Korean subjects, which was investigated by using venous illuminator, AccuVein. The 200 Korean subjects were randomly chosen from the patients and staff of the Keimyung University Dongsan Medical Center in Daegu, Korea. After excluding the inappropriate cases for detecting venous pattern, we collected 174 cases of right upper limbs and 179 cases of left upper limbs. The superficial veins of the cubital fossa were detected and classified into four types according to the presence of the median cubital vein (MCV) or median antebrachial vein. The type II, presenting the both cephalic and basilic vein connected by the MCV, was most common (177 upper limbs, 50.1%). Although the most common type in male and female was different as type I (108 upper limbs, 49.3%) and type II (75 upper limbs, 56.0%), respectively, statistical significance was not detected (P=0.241). The frequency of the each types between right and left upper limbs was also not different (P=0.973). Among 154 subjects who were observed the venous pattern in the both upper limbs, 76 subjects (49.3%) had the same venous pattern. Using AccuVein to investigate the venous pattern has an advantage of lager scale examination compared to the cadaver study. Our results might be helpful for medical practitioner to be aware of the variation of the superficial cubital superficial vein.

Axillary arch accompanying variations of the brachial plexus

The axillary arch, as a common muscular variation within the axilla, is generally found in the form of a thin muscular slip that extends between the latissimus dorsi muscle and the pectoralis major muscle. An axillary arch with variations of the brachial plexus was observed in the left axillary region of the cadaver of an approximately 50-year-old Korean man during educational dissection in our college. The muscle extended from the lateral edge of the latissimus dorsi muscle across the axillary sheath into the tendon of insertion of the lesser tubercle of the humerus, thus identifying itself as the ‘axillary arch of Langer’ (Figure 1a). It was 6.5 cm in length and 1 cm in width. The blood supply and nerve innervation of this muscle came from the subscapular artery and the thoracodorsal nerve, respectively. The axillary arch was intertwined with the neurovascular bundle in the axilla (Figure 1b). It perforated the posterior cord inferior to the third part of the axillary artery. The lower subscapular and axillary nerves arose from the lower part of the posterior cord. The thoracodorsal nerve arose from the upper and lower parts of the posterior cord. Therefore, the thoracodorsal and

Are PIK3CA Mutation and Amplification Associated with Clinicopathological Characteristics of Gastric Cancer

Alterations in mitochondrial DNA (mtDNA) have been studied in various cancers. However, the clinical value of mtDNA copy number (mtCN) alterations in gastric cancer (GC) is poorly understood. In the present study, we investigated whether alterations in mtCNs might be associated with clinicopathological parameters in GC cases. mtCN was measured in 109 patients with GC by real-time PCR. Then, correlations with clinicopathological characteristics were analyzed. mtCN was elevated in 64.2% of GC tissues compared with paired, adjacent, non- cancerous tissue. However, the observed alterations in mtCN were not associated with any clinicopathological characteristics, including age, gender, TN stage, Lauren classification, lymph node metastasis, and depth of invasion. Moreover, Kaplan-Meier survival curves revealed that mtCN was not significantly associated with the survival of GC patients. In this study, we demonstrated that mtCN was not a significant marker for predicting clinical characteristics or prognosis in GC.

A radial artery originating from the thoracoacromial artery

AbstractPurpose The purpose of this case report is to report a rare vascular variation in the upper limbs because of its clinical importance and embryological implication.MethodsDuring the educational dissection of a 73-year-old Korean male cadaver`s right upper limb, we found a variant branch which is originated from the thoracoacromial artery.ResultsThe variant branch from the thoracoacromial artery ran to the distal forearm in the deep fascia. Because it finally coursed like the radial artery in the forearm and the palm, we defined the variant artery as superficial brachioradial artery (SBRA). In the cubital region a little below the intercondylar line, the brachial artery gave off a small communicating branch to SBRA, and continued as the ulnar artery.ConclusionsWe reported this unique variation and discussed its clinical and embryological implication.

Low frequency of the lateral thoracic artery originating from the thoracoacromial artery

We read with great interest the recent article titled ‘‘The lateral thoracic artery revised’’ by Loukas et al. [4] published online in Surgical and Radiological Anatomy (doi:10.1007/s00276-013-1234-x). Anatomy textbooks define that the lateral thoracic artery (LTA) usually originates from the second part of Axillary artery (AA). LTA arose from the first or third part of AA either on its own or as a common trunk with one or more of the other branches. However, above study with large cases demonstrated that most of LTA (67.6 %, 568/840) arose from the thoracoacromial artery (TAA) and only 17.2 % (143/840) of that originated from AA. LTA also originated from the thoracodorsal or subscapular arteries in about 3–4 % of cadavers. Within an abundant concern about this variation, we also collected the data of the branching pattern of AA in 189 arms until now (Fig. 1). According to our data, LTA arose directly from second and third parts of AA in 59.7 % (113/189) and 9.5 % (18/189) of cases, respectively. It also originated from TAA (2.6 %, 5/189) and the subscapular artery (21.6 %, 41/189). Except the studies by DeGaris and Swatley [2], Pandey and Shukla [5], and Loukas et al. [4], most of the studies demonstrated that LTA from TAA was rare; moreover, LTA arose from the subscapular artery more frequently. Our result was in agreement with previous studies in Koreans by Kang et al. [3] and Japanese by Adachi [1], suggesting racial difference of branching pattern of AA. Considering clinical importance of knowledge about its anatomy, the pattern of the lateral thoracic artery should be clarified apparently. Though there may be ethnic diversity in this arterial pattern, its big difference could be caused by different classification or definition of the branches of the axillary artery. Therefore, we would like to mention that multiple center study was needed to clarify the branching pattern of AA with larger cases.

Is Mitochondrial DNA Copy Number Associated with Clinical Characteristics and Prognosis in Gastric Cancer

Alterations in mitochondrial DNA (mtDNA) have been studied in various cancers. However, the clinical value of mtDNA copy number (mtCN) alterations in gastric cancer (GC) is poorly understood. In the present study, we investigated whether alterations in mtCNs might be associated with clinicopathological parameters in GC cases. mtCN was measured in 109 patients with GC by quantitative real-time PCR. Then, correlations with clinicopathological characteristics were analyzed. mtCN was elevated in 64.2% of GC tissues compared with paired, adjacent, non-cancerous tissue. However, the observed alterations in mtCN were not associated with any clinicopathological characteristics, including age, gender, TN stage, Lauren classification, lymph node metastasis, and depth of invasion. Moreover, Kaplan-Meier survival curves revealed that mtCN was not significantly associated with the survival of GC patients. In this study, we demonstrated that mtCN was not a significant marker for predicting clinical characteristics or prognosis in GC.