Lazar Stijak

Clinical significance of blood supply to the internal capsule and basal ganglia

Although the general vascular supply of the basal ganglia and internal capsule is well known, precise data are lacking regarding the variations of the vascular territories in the two regions. Twelve hemispheres were studied following an injection of coloured ink into the main cerebral arteries, namely the anterior cerebral (ACA), middle cerebral (MCA), anterior choroidal (AChA) and posterior cerebral artery (PCA). Serial sections of the injected hemispheres were taken in the axial or coronal plane. In 75% of the hemispheres, ACA perforators were seen to supply the inferomedial part of the head of the caudate nucleus and the anterior limb of the internal capsule, as well as the anterior and inferior portions of the putamen and globus pallidus. The MCA vessels perfused the superolateral part of the head and body of the caudate nucleus, the superior part of the entire internal capsule, most of the putamen and part of the globus pallidus. The AChA perforators perfused the medial segment of the globus pallidus, the inferior part of the posterior limb, the retrolenticular and sublenticular portions of the internal capsule, and occasionally its genu. The same segment of the globus pallidus and the inferior part of the genu of the internal capsule were most likely supplied by the perforators of the internal carotid artery. A predominance of ACA territory was noticed in one specimen (8.33%) and a predominance of MCA territory in two specimens (16.67%). The obtained anatomical data may help radiologic determination of perforators involved in ischemic events, as well as a better understanding of the neurological deficits in the same events.

An unusual origin of the double left testicular artery in a male cadaver: a case report

IntroductionVariations in the number and course of the testicular arteries, often coexisting with variations of the other branches arising from the abdominal aorta, are still reported to be of interest to urology surgeons.Case presentationDuring a routine dissection course, an unusual origin of the double left testicular artery was observed in the cadaver of a 68-year-old Caucasian man who donated his body to the Institute of Anatomy.ConclusionsA deeper understanding of the variations of the testicular arteries is necessary for all physicians whose practice is related to the testicles and their vascular stalk.

Predicting ACL rupture in the population actively engaged in sports activities based on anatomical risk factors.

The purposes of this article were identification (ie, verification and gradation) of anatomical risk factors that lead to anterior cruciate ligament (ACL) injury and determination of the probability of ACL injury among the population actively engaged in sports activities. We evaluated 66 patients divided into 2 groups: 33 patients in the examined group diagnosed with ACL lesion, and 33 patients in the control group diagnosed with patellofemoral pain. Patients were matched by age, sex, type of lesion, and whether the lesion was left or right sided. Measurements were carried out by radiography and magnetic resonance imaging. The study examined 32 anatomical factors. After identifying factors that lead to ACL injury, the following were determined: the coefficient of significance for each individual factor via the discriminant analysis and the canonical discriminant (i.e., canonical correlation). Fifteen factors in men and 8 factors in women were differentiated as having influence on ACL injury. Based on these factors, it was determined whether the patients belonged to the examined or the control group with a success rate of 100% in men (100% sensitivity and specificity) and 91.7% in women (100% sensitivity and 83.3% specificity). The anatomy of the ACL prone to rupture and of the skeletal structures influencing it is significantly different from the anatomy of the ACL ligament resistant to injury. The probability of precise prognosis of ACL injury based on differentiated anatomical factors is 88.9% in men and 75.7% in women actively engaged in sports activities.

Cavum Septi Pellucidi as a Marker of the Neuropsychiatric Diseases: APointer or Mislead? A Cadaveric-Clinical Observation

Cavum Septi pellucid (CSP), a cavity between the laminae of the septum pellucidum, for a longer period has been reported as an anomaly of the brain midline, associated with neuropsychiatric diseases, mostly schizophrenia, but also posttraumatic stress disorder, De la Tourette disease, and persons who survived a repeated a serious head trauma, boxers on the first place. Our investigation has been performed on 479 unfixed frozen brains, of the autopsied individuals of both genders, and MRI scans of 250 examinees, out of which 110 had neuropsychiatric illness. In our sample, the prevalence of CSP was 22.96% among the autopsied individuals and 9.2% in examinees who underwent MRI scan. The cause of the death among schizophrenia suffering persons was suicide (18 out of 25 patients). Obviously, CSP is more frequently associated with neuropsychiatric diseases, but a dilemma still exists, did we make a bias in brain suitability for the examination or we did the same mistake in observing clinical cases. A large CSP, though, is an almost certain sign for an underlying neuropsychiatric impairment, especially schizophrenia. The CSP among alcoholics and persons with the priory sustained head blows is probably of the same cause and represents an aftermath of the diffuse axonal injuries, i.e. brain trauma.

The Third Branch of the Main Trunk of the Left Coronary Artery in Cercopithecus aethiops sabaeus. Is the Nonhuman Primate Model Appropriate

The aim of this study was to investigate the morphometry of branching patterns of the main trunk of the left coronary artery (MT of LCA) in nonhuman primates, and comment on the current nomenclature. The biometric study was performed using stereomicroscopic dissection of hearts of healthy and fertile nonhuman primates (Cercopithecus aethiops sabaeus) of both sexes. Our results reveal that the MT of LCA terminates in a bifurcation into the anterior interventricular branch (AIB) and the circumflex branch (CB) (74.6%), trifurcation into the AIB, CB, and diagonal branch (DB) (23.6%), or occasionally quadrifurcation into the AIB, CB, and two DBs (1.8%). This is similar to the case in humans. Furthermore, two morphological aspects of the DB spatial distribution, in addition to its branching pattern, resemble the DB in humans. Myocardial bridges observed over the DB in the Cercopithecus aethiops heart further contribute to the similarity with humans. The resemblance of the DB and its branches to their human counterparts make them a suitable model for experimental study on coronary circulation. Anat Rec, 2011.

The influence of the position of the medial portal and of lower leg flexion on the length of the femoral tunnel in anatomic anterior cruciate ligament reconstruction: A cadaveric study

Background/Aim. The key to successful anterior cruciate ligament reconstruction lies in the proper positioning of the femoral tunnel within the anatomical footprint and in providing for an adequate length of this tunnel without perforation to the lateral cortex. The aim of this study was to determine the change in the length of the femoral tunnel drilled during anatomic anterior cruciate ligament (ACL) reconstruction, depending on: the position of the limb being operated on, the degree of knee flexion, as well as the angle between the drill and the medial aspect of the lateral condyle. Methods. This study was performed on 16 cadaveric knees (6 male and 10 female) of the average age of 83. After the subcutaneous tissue was dissected, the femoral insertion of the ACL was identified. Then, 18 tunnels were drilled through the center of the femoral insertion with the help of 2 mm thick Kirschner wires. This was performed in two stages. In the first phase the leg was positioned on an arthroscopic leg holder, while in the second phase the leg was positioned on the table. In each phase the knee was placed in three different flexion positions (110°, 120° and 130°) and for each position three tunnels were drilled (70°, 60° and 50°) in relation to the medial aspect of the lateral condyle. Results. The average length of the femoral tunnel drilled with the leg positioned on the operating table (36.6 ± 4.7 mm) was highly statistically significantly greater (p = 0.000) in comparison with the length of the femoral tunnel obtained by positioning the leg on a fixed arthroscopic leg holder (35.4±4.3 mm). The greatest lengths of the femoral tunnel were obtain with the leg flexed at 130o and the reamer positioned at 50o angle in relation to the medial aspect of the lateral condyle (43 mm on the operating table and 41 mm on a fixed leg holder), while the shortest tunnel (33 mm on the operating table and 31 mm on a fixed leg holder) was obtained with the lower leg flexed at 110o and the reamer positioned at a 70o angle. Conclusion. The optimal position of the leg on a fixed leg holder for obtaining a femoral tunnel of sufficient length requires lower leg flexion of 120o and the position of the medial portal which enables the positioning of the reamer at a 60o angle in relation to the medial aspect of the lateral condyle. With the leg positioned on the operating table, it becomes unnecessary to push the leg into flexion greater than 110o; rather a longer femoral tunnel is achieved by lateralization of the medial portal.

Effects of Tetra hydro cannabinol to the dendritc tree and synapses of the accumbens nucleus of Wistar rats.

Cannabis is one of the most widely used intoxicants; almost half of all 18 year olds in the USA and in most European countries admit to having tried it at least once, and ~10% of that age group are regular users. Δ9-Tetrahydrocannabinol (THC), the principal psychoactive ingredient in marijuana, produces euphoria and relaxation and impairs motor coordination, time sense, and short term memory. In the hippocampus, CBs inhibit GABA release from a subset of interneurons and inhibit glutamate release from principal neurons. Cannabinoids are reported to produce both rapid and long-term changes in synaptic transmission. Our study was carried out on ten male rats out of which brains of six of them were used as the representative sample for electron microscope analysis, while 4 were used for light microspcopy performed by Golgi method. Three were exposed to THC and 3 were controls. Axodendric synapses in the core and shell of the accumbens nucleus (AN) were studied under electron microscope. The results have shown widening of the synaptic cleft in the shell of AN. This result is a leading point to our further investigations which are going to involve a behavioral component, and different aspects of morphological studies. [Projekat Ministarstva nauke Republike Srbije, br. III 41020]

Challenges and advances in the care of injuries in the Republic of Serbia

There are many problems that trauma care system in Serbia is facing today. Few of them are: 1) Lack of categorization of trauma centers; 2) Diversity in managing of trauma patients among institutions; 3) There is no trauma management training, 4) Inappropriate cooperation between pre hospital trauma care and hospital trauma care; 5) There is no standard in managing of trauma patients as well as procedures. To improve trauma care quality throughout the country we must learn from the experiences of other countries. The aim of this paper was to report representative data about organization, management, stuff and equipment of ambulance and emergency services in Serbia. We analyzed 12 out of 138 parameters we obtained from the relevant institutions.

Izazovi u unapređenju zbrinjavanja povređenih u Republici Srbiji

There are many problems that trauma care system in Serbia is facing today. Few of them are: 1) Lack of categorization of trauma centers; 2) Diversity in managing of trauma patients among institutions; 3) There is no trauma management training, 4) Inappropriate cooperation between pre hospital trauma care and hospital trauma care; 5) There is no standard in managing of trauma patients as well as procedures. To improve trauma care quality throughout the country we must learn from the experiences of other countries. The aim of this paper was to report representative data about organization, management, stuff and equipment of ambulance and emergency services in Serbia. We analyzed 12 out of 138 parameters we obtained from the relevant institutions.