Wiesława Klimek-Piotrowska

Absence of the musculocutaneous nerve associated with a supernumerary head of biceps brachii: a case report

Unusual neural and muscular variations in the right upper limb were noted during anatomical dissection of a 54-year-old male cadaver. The absence of the musculocutaneous nerve was correlated with a three-headed biceps brachii muscle. The distribution of muscular branches innervating the anterior compartment of the muscles of the arm was different to the cases described in literature hitherto. This report contains a comparison of various instances where the musculocutaneous nerve is absent. We discuss the embryological explanation for this anomaly and its clinical results. It is important to be aware of such possible anatomical variations during clinical practice.

Vascular architecture of human uterine cervix visualized by corrosion casting and scanning electron microscopy

BACKGROUND In contrast to the uterine corpus, the vascular architecture of the human cervix has been the subject of only a few studies, mostly dealing with the ectocervical mucosal vessels. This study presents the vascular system of the cervical wall surrounding the endocervical canal visualized by the best currently available technique, corrosion casting combined with scanning electron microscopy. METHODS Uteri collected at autopsy (n= 20) were perfused via afferent vessels with fixative followed by Mercox resin and corroded after polymerization of the resin. The obtained vascular casts of the cervix visualizing all vessels including capillaries were examined in the scanning electron microscope. RESULTS The vascular system of the cervix was nearly completely replicated in only two (10%) of the samples. In the wall of the cervix, four distinct vascular zones surrounding the endocervical canal were observed: (i) the outer zone containing larger vessels, arteries and veins of 0.3-1 mm diameter; (ii) the zone containing arterioles and venules; (iii) the zone of endocervical mucosal capillaries showing a very high density, parallel arrangement and relatively few interconnections and (iv) the innermost, subepithelial zone containing small veins running along the endocervical canal. CONCLUSIONS Despite the loss of the delicate ectocervical mucosal vessels from the cast during the corrosion step, we have successfully visualized the majority of the cervical vasculature. The vascular pattern of the human cervix, especially that of the endocervical mucosa, may facilitate the adaptation of the cervical vasculature to the extensive remodeling of the cervix during parturition.

Influence of different fixation protocols on the preservation and dimensions of cardiac tissue

Recent extensive progress in invasive cardiac procedures has triggered a wave of dozens of heart morphometric anatomical studies that are carried out largely using autopsied samples fixed in formaldehyde solution prior to observations and measurements. In reality, very little is known about changes in heart tissue dimensions during fixation. The aim of this study was therefore to investigate how fixation affects the dimensions of cardiac tissue, and if different types and concentrations of reagents affect this phenomenon. A total of 40 pig heart samples were investigated, and seven different measuring sites were permanently marked in every heart prior to fixation. Four study groups (n = 10 each) were assembled that differed only in concentration and the type of fixative: (i) 2% formaldehyde solution; (ii) 4% formaldehyde solution (formalin); (iii) 10% formaldehyde solution; (iv) alcoholic formalin. The samples were measured before and after fixation at the following time points: 24 h, 72 h and 168 h. It was found that different fixatives significantly affected different parameters. Almost all of the heart dimensions that were measured stabilized after 24 h; later changes were statistically insignificant in the point‐to‐point comparison. Change in the length of the interatrial septum surface was not altered significantly in any of the fixatives after 24 h of preservation. It was found that 10% formaldehyde increased the thickness of muscular tissue only after 24 h; this thickening was reduced after 72 h and was insignificant at 168 h. Other heart parameters in this group do not present significant changes over the entire fixation time duration. In conclusion, the 10% formaldehyde phosphate‐buffered solution appeared to be the best fixative among the fixatives that were studied for cardiac morphometric purposes; this solution caused the smallest changes in tissue dimensions. Measurements should be obtained at least after 1 week of preservation when most parameters exhibit the smallest changes compared with the non‐preserved samples.

Anthropometry and body composition of adolescents in cracow, poland.

Background and Objective The aim of the present study was to determine the level of adiposity and obesity in Polish adolescents and compare the results with earlier studies conducted in this population as well as those carried out in other populations. Methods The study group consisted of 456 boys and 514 girls aged 14-18 years living in Cracow chosen from randomly selected secondary schools. Weight, height, waist, and hip circumference (WC, HC) as well as triceps, biceps, subscapular, and suprailiac skinfold thickness (SFT) were measured. Body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), subscapular/triceps skinfold ratio (STR), and percentage body fat were computed. The prevalence of overweight and obesity based on Polish children growth reference were calculated and age-dependent and gender-specific smoothed percentile curves for BMI and ROC curves were generated. Results Weight, height, WC, HC (up 16yr), WHtR (up 15yr), and WHR were considerably higher in males than females. Weight, height, and HC increased with age; WHtR remained the same. The prevalence of overweight and obesity were 10.2% (boys 10.3%; girls 10.1%) and 4.2% (boys 5.3%; girls 3.3%). ROC analysis revealed that WHtR was the best tool for detection of obesity (AUC of 0.982±0.007) in males, whereas the sum of four SFTs (AUC: 0.968±0.011) and WHtR (AUC: 0.963±0.012) were the best predictors of obesity in females. Conclusions The level of adiposity in Cracow adolescents increased during the last decade. However, it is still lower than in other well-developed societies struggling with obesity epidemics.

Atrial septal pouch — Morphological features and clinical considerations

BACKGROUND The atrial septal pouch (SP) is a new anatomical entity within the interatrial septum. The left-sided SP may be the source of thrombus and contribute to ischemic stroke. The aim of this study was to provide a detailed morphometric description of the SP. METHODS Two hundred autopsied hearts (23% deriving from females) with a mean age of 46.7±19.1years were investigated. We assessed the morphology of the interatrial septum. We obtained measurements and casts of the SPs, and we conducted histological staining of the left-sided SPs. RESULTS Patent foramen ovale was observed in 25% of hearts. We found a left SP in 41.5%, right in 5.5% and a double SP in 5.5% of hearts. We found the patent foramen ovale (PFO) more often in younger hearts, and the SP and smooth septum were more prevalently found in older hearts (p=.0023). The mean volume of the left-sided SP was 0.31±0.11ml, which represented 13.6±9.4% (range: 3.1-44.9%) of the left atrial appendage volume. The SP shape resembled a cone or a cylinder with some smaller diverticula originating from the main body. The SP free wall was composed of two layers of endocardium, transverse muscle fibers and connective tissue. CONCLUSIONS A left-sided SP was present in 47% of individuals. The SP arises as a result of PFO channel closure. The anatomy of left-sided SP may promote blood stasis and thrombus formation. The universal formula for SP volume was calculated.

Normal distal pulmonary vein anatomy

Background. It is well known that the pulmonary veins (PVs), especially their myocardial sleeves play a critical role in the initiation and maintenance of atrial fibrillation. Understanding the PV anatomy is crucial for the safety and efficacy of all procedures performed on PVs. The aim of this study was to present normal distal PV anatomy and to create a juxtaposition of all PV ostium variants. Methods. A total of 130 randomly selected autopsied adult human hearts (Caucasian) were examined. The number of PVs ostia was evaluated and their diameter was measured. The ostium-to-last-tributary distance and macroscopic presence of myocardial sleeves were also evaluated. Results. Five hundred forty-one PV ostia were identified. Four classical PV ostia patterns (two left and two right PVs) were observed in 70.8% of all cases. The most common variant was the classical pattern with additional middle right PV (19.2%), followed by the common ostium for the left superior and the inferior PVs (4.44%). Mean diameters of PV ostia (for the classical pattern) were: left superior = 13.8 ± 2.9 mm; left inferior = 13.3 ± 3.4 mm; right superior = 14.3 ± 2.9 mm; right inferior = 13.7 ± 3.3 mm. When present, the additional middle right PV ostium had the smallest PV ostium diameter in the heart (8.2 ± 4.1 mm). The mean ostium-to-last-tributary (closest to the atrium) distances were: left superior = 15.1 ± 4.6 mm; left inferior = 13.5 ± 4.0 mm; right superior = 11.8 ± 4.0 mm; right inferior = 11.0 ± 3.7 mm. There were no statistically significant differences between sexes in ostia diameters and ostium-to-last-tributary distances. Conclusion. Only 71% of the cases have four standard pulmonary veins. The middle right pulmonary vein is present in almost 20% of patients. Presented data can provide useful information for the clinicians during interventional procedures or radiologic examinations of PVs.

Ectopic thymic tissue in the mediastinum: limitations for the operative treatment of myasthenia gravis

OBJECTIVES The aim of the study was to investigate the distribution of ectopic thymic tissue in the mediastinum and to evaluate the possible relevance of this distribution to the therapeutic yield of thymectomies in patients with myasthenia gravis. METHODS In this prospective autopsy study, mediastinal dissections were performed on 50 cadavers without any previously known intrathoracic pathology. The initial dissection was performed in the same way as during the maximal thymectomy. The second stage consisted of dissecting areas of fatty tissue located out of reach of the standard maximal thymectomy, such as the perithyroid, periaortic, peritracheal and retrotracheal areas, as well as the areas adjacent to the right and left phrenic and recurrent laryngeal nerves. Each specimen was independently examined by two pathologists for ectopic thymic tissue. RESULTS There were 41 (82%) male and 9 (18%) female cadavers, with a mean age of 44.3 years (range: 15-75). Ectopic thymic tissue was detected in 32 out of 50 cadavers (64%). In 10 (20%) cadavers thymic foci were found in locations accessible to the standard surgical intervention and in 22 (44%)-in inaccessible locations. Thymic tissue incidence in individual locations was as follows: retrothyroid, 3 (6%); peritracheal, 5 (10%); retrotracheal, 1 (2%); right phrenic nerve, 2 (4%); left phrenic nerve, 14 (28%); right recurrent laryngeal nerve, 2 (4%); left recurrent laryngeal nerve, 2 (4%) and periaortic, 0. CONCLUSIONS The incidence of ectopic thymic tissue in the mediastinum is common. Although some improvements in the results of thymectomies may be expected with more extensive dissection, the frequent presence of thymic foci in anatomical locations hardly accessible to surgical intervention may be the true limitation for surgical treatment of myasthenia.

Anatomical variations of the coronary sinus valve (Thebesian valve): implications for electrocardiological procedures

AIMS The Thebesian valve (TV) can be a significant obstacle to coronary sinus (CS) cannulation. The aim of this study was to evaluate the characteristic features of the CS valve--TV anatomy. In particular, emphasis was placed on identifying specific structures of the TV that could potentially complicate CS cannulation. METHODS AND RESULTS We examined 273 autopsied human hearts. The height of the TV and the diameter of the CS were measured. The valves were classified according to their shape into five types: remnant, semilunar, fold, cord, and mesh and fenestrated. The mean transverse CS ostium (CSO) diameter was 12.2 ± 3.5 mm. The TV was present in 224 (82.1%) cases. The most common type of TV was semilunar: 32.6%; followed by remnant: 25.5%; fold: 17.4%; cord: 14.3%; and lastly mesh and fenestrated: 10.3%. The mean TV height for remnant-semilunar-fold types was 5.8 ± 3.0 mm. In seven cases, the present TV (2.6%) covered the entire orifice of the CS. Hearts with larger CSO diameter had lower TV height (P < 0.001). CONCLUSIONS We propose a new classification of the TV shapes based on the largest sample to date. We assessed that only in 2.6% of all 273 cases the presence of an obstructive TV can cause unsuccessful cannulation. The height of the TV was inversely correlated to the CSO diameter (r = -0.33; P < 0.001).

Configurations of the circle of Willis: a computed tomography angiography based study on a Polish population

The aim of the study was to investigate the distribution of the circle of Willis variants in Polish population by means of computed tomography angiography (CTA). The results were then analysed and compared with another study that used similar methods but that was carried out on an ethnically distinct population. Patients presenting with intracranial pathology were excluded from the initial study population. In total, 250 CTA belonging to 129 female and 121 male patients were reviewed. A modified classification system of the circle was proposed, which took into consideration the anterior and the posterior aspects of the circle individually. The typical variant of Williss circle occurred in 16.80% of cases. The anterior and the posterior portions of the circle were normal in 47.20% and 26.80% of the patients respectively. As for the anterior part, lack of the anterior communicating artery was the most frequent abnormality (22.80%). Bilateral absence of posterior communicating arteries was the most common anomaly in the posterior part of the circle (29.20%). This type of anomaly was also the most common, when taking into consideration the entire circle (12.00%). There were statistically significant differences between the age groups and genders when considering the occurrence of an incomplete circle. Overall, a substantial proportion of patients manifested clinically important variants that were incapable of providing collateral circulation. Comparison with other imaging-based and cadaveric studies revealed noticeable differences, that may have resulted from the variable technical features of other studies or other factors such as the ethnical origins of the studied populations.

Left atrial accessory appendages, diverticula, and left-sided septal pouch in multi-slice computed tomography. Association with atrial fibrillation and cerebrovascular accidents

BACKGROUND The aim of this study is to provide a morphometric description of the left-sided septal pouch (LSSP), left atrial accessory appendages, and diverticula using cardiac multi-slice computed tomography (MSCT) and to compare results between patient subgroups. METHODS Two hundred and ninety four patients (42.9% females) with a mean of 69.4±13.1years of age were investigated using MSCT. The presence of the LSSP, left atrial accessory appendages, and diverticula was evaluated. Multiple logistic regression analysis was performed to check whether the presence of additional left atrial structures is associated with increased risk of atrial fibrillation and cerebrovascular accidents. RESULTS At least one additional left atrial structure was present in 51.7% of patients. A single LSSP, left atrial diverticulum, and accessory appendage were present in 35.7%, 16.0%, and 4.1% of patients, respectively. After adjusting for other risk factors via multiple logistic regression, patients with LSSP are more likely to have atrial fibrillation (OR=2.00, 95% CI=1.14-3.48, p=0.01). The presence of a LSSP was found to be associated with an increased risk of transient ischemic attack using multiple logistic regression analysis after adjustment for other risk factors (OR=3.88, 95% CI=1.10-13.69, p=0.03). CONCLUSIONS In conclusion LSSPs, accessory appendages, and diverticula are highly prevalent anatomic structures within the left atrium, which could be easily identified by MSCT. The presence of LSSP is associated with increased risk for atrial fibrillation and transient ischemic attack.