Kubikova E

The variable communicating branches between musculocutaneous and median nerves: a morphological study with clinical implications.

BACKGROUND The course of the brachial plexus, its relations with surrounding structures and unique primary and secondary divisions result in its wide range of anatomical variations. Most of these variations were detected during anatomical dissections and studies. It has been found that 53% of studied brachial plexuses contained variations. The communication between musculocutaneous and median nerves is the most common variation of infraclavicular part of brachial plexus. METHODS During gross anatomical dissections of peripheral nerves, we observed neuronatomical variations in upper limbs of four formalin embalmed adult cadavers. Musculocutaneous and median nerves were connected by a communicating branch at distinct level in each cadaver. The formation and relations of both nerves were noted in each case to exclude the existence of other anatomical variations. The connections were measured and documented by digital camera. RESULTS The communicating fibers of variations 1 and 2 were located in the upper third of arm and proximally to musculocutaneous nerve penetration through coracobrachialis muscle. In variations 3 and 4, the communicating branch was situated in the lower third of arm and distal to the nerve penetration point. CONCLUSION Variable interconnections between musculocutaneous and median nerve have to be considered in diagnosis of nerve lesions in axillary and arm regions. Compound musculocutaneous and median nerve neuropathy would occur in lesions of the interconnecting branches. Injuries of musculocutaneous nerve proximal to these branches can cause particular and unexpected symptoms, such as weakness of forearm flexors and thenar muscles (Fig. 6, Ref. 28).

The Variable Origin of the Recurrent Artery of Heubner: An Anatomical and Morphometric Study

The recurrent artery of Heubner (RAH) is the largest vessel of the medial lenticulostriate arteries. It supplies many deep structures, mainly the corpus striatum, the globus pallidus, and the anterior crus of the internal capsule. The aim of the present paper was studying the morphological variations of the RAH and its diameter in relation to different areas of origin. The series contained the records from 183 formalin-fixed adult human brains. The calibrated digital images of the studied brains were evaluated and measured by Image J, which can calculate the number of pixels and convert them to metric measures. The RAH arose most often from the postcommunicating part of the anterior cerebral artery (47.81%). It originated from the precommunicating part of the anterior cerebral artery in 3.55% and at the level of the anterior communicating artery in 43.4% of cases. The RAH was missing in 5.19% and doubled in 6.28% of cases. The mean outer diameter of the RAH was 0.6 mm. The maximal measured diameter was 1.34 mm, and the minimal diameter was 0.19 mm. The awareness of the various anatomical and morphometric variations of the RAH is essential in planning the neurosurgical procedures to avoid unexpected neurological complications.

A case of extremely long styloid process without clinical symptoms and complications.

ELISKA KUBIKOVA AND IVAN VARGA* Department of Anatomy, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovak Republic Department of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovak Republic Department of Histology and Embryology, Faculty of Medical Specialty Studies, Slovak Medical University in Bratislava, Bratislava, Slovak Republic

Omphalocele with ectopic liver forming a mesodermal cyst.

BACKGROUND Congenital anomalies of the abdominal wall are classified as anomalies with the abdominal wall defect (omphalocele, gastroschisis) and without the defect (umbilical hernia, persistent ductus omphaloentericus or urachus). Clinical presentations of these conditions are different, and so is the timing of surgical intervention and approach with or without the exploration of the peritoneal cavity. CASE The presented case report refers to a rare finding of ectopic liver forming mesodermal cyst within the umbilical region. Full term neonate girl with 5 cm spheroid tumor in umbilicus was otherwise without problems. Ultrasonography (USG) of the lesion detected a tissue with good vascularization and a cystic cavity. There was no flow in the umbilical vessels and no evidence of intestinal loop in the sac. USG of the liver was normal. During surgery an additional narrow canaliculus was identified connecting the spheroid along with umbilical vessels to the liver. The whole spheroid together with the canaliculus was surgically removed without exploration of the abdominal cavity. Histological evaluation of the surgical specimen discovered liver tissue with a mesodermal cyst in the center. The sphere was connected to the liver by a bile duct. Six months after the operation the child is in a good clinical condition. CONCLUSION In conclusion omphalocele may contain liver. Ectopic liver is an extremely rare condition. Surgical treatment in the presented case focused only on umbilicus without exploration of the abdominal cavity and appeared to be sufficient. Long-term postoperative follow up typical in pediatrics will be applied also in this patient (Fig. 3, Ref. 25).

The bases of the inflammatory acute abdomen.

Vermiform appendix is an anatomical structure, which due to its topographical relations usually causes many complications, especially in inflammation such as appendicitis. One of the manifestations of the inflammatory processes is pain, which may have different location. It could be probably a result of the neuron stimulation. The nerve formation and distribution of the vermiform appendix is still unknown in fine details and is a subject of further studies (Fig. 8, Ref.12).

Left Ventricle Outflow Obstruction by Reverse-Oriented Tricuspid Semilunar Valve-Like Endocardial Duplicatures

A 57-year-old female had a history of hypertension disease, and one year before her death, her ECG showed signs of left ventricle hypertrophy. She died with signs of heart failure with pulmonary edema development. At autopsy, there was left ventricle hypertrophy (wall thickness: 21 mm). In the left ventricle outflow channel, 15 mm below the aortic valve on the muscular wall, there were three white 1–1.5 mm thick membranous semilunar valve-like structures with the sizes of 9, 7, and 5 mm, with concavities opened into the left ventricle, reducing the outflow area by 21.5%. These structures were hanging on the regular muscular ventricular wall, without any visible fibrous anchoring structure and without formation of commissures, and were composed of fine collagen and elastic fibers. Gross anatomy as well as histological structure was different from the subaortic membrane. The reported accessory reverse-oriented tricuspid semilunar valve-like structure is an unusual finding of a structure in the left ventricular outflow tract, to which we could not find an analogy in the available literature.

Biological aspects of appendix pathology: irregular distribution of myenteric ganglia in human appendiceal wall.

OBJECTIVES Although appendicitis is a common disease, basic questions about risk factors and its etiology remain unexplained. BACKGROUND An obstruction of the appendix lumen is usually considered to be the main cause of acute appendicitis. However, more studies are currently dealing with neuroimmune appendicitis. METHODS We studied samples of human appendices with the histological diagnosis of chronic appendicitis. Fixed cryosections of appendiceal walls were examined by immunofluorescence methods using neuronal anti-neurofilament antibody markers and beta III tubulin. RESULTS The immunostaining revealed an irregular distribution of myenteric ganglia in inflamed appendiceal walls and unexpected groups of large ganglia unequally distributed in the subserosal area. The comparative analysis of normal and inflamed appendix samples showed differences in the occurrence of myenteric ganglia in the subserosal area. They appeared more frequently on cryosections prepared from the inflamed appendiceal wall. CONCLUSION We propose that the high variability and irregular location of myenteric ganglia in the appendiceal wall are due to an alteration in the motility which results in flaccid appendix emptying. In addition, superficially located myenteric ganglia are exposed to abdominal irritation and may explain the chronic abdominal pain which is often considered to be a sign of chronic appendicitis (Fig. 2, Ref. 23).

Atypical localization of myenteric ganglia in the human appendical wall: a comparative study with animal appendix

The presence of well developed appendices in some animals when compared to humans has led to speculation that appendix is a vestigial organ. Increasing number of studies have revealed that the appendix serves as an important organ in humans. The function of animal appendix, and the differences between species remain poorly understood. In this study we examined human myenteric plexus and compared them with animal studies. Appendices were obtained from five young adults in which the appendix was found to be normal after removal. Fixed appendix cryosections were examined by immunofluorescence methods using neuronal marker antibodies to neurofilaments and beta III tubulin. Both antibodies stained myenteric ganglia which were arranged in an apparently irregular pattern in human appendix wall. We observed unexpected localization of myenteric ganglia in the subserosa often accompanied by rarely occurring ganglia in the longitudinal muscle layer. These ganglia were of different sizes and shapes and unequally distributed under a thin layer of serosa. Our findings raise many questions about the possible role of irregular and atypical myenteric ganglia localization in relation to altered motility and subsequent pathogenesis of the appendix in inflammatory disease in humans. On the other hand, studies of the literature have revealed simplicity in the organization of myenteric plexus, e.g., in well-developed rabbit appendix. In addition, appendicitis in animals is restricted to in apes with similarly shaped appendix to humans.