Zora Haviarová

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).

Mast cell infiltration in the wall of varicose veins

Varicose veins of the lower extremities are abnormally dilated, tortuous and elongated. The exact cause of vein dilatation has still not been established. Mast cells produce, store and release various types of vasoactive compounds (histamine, tryptase, prostaglandins, leukotrienes, and cytokines). Histamine enhances local vasopermeability and smooth muscle cell proliferation, leading to thickening of the intima. Tryptase can contribute to local vascular injury and subsequent weakness of the vascular wall causing varix formation. The aim of the present study was the comparison of mast cell infiltration in the wall of varicose and non-varicose veins. The mean mast cell density in the wall of varicose veins was 0.86 mast cell per mm2 and in healthy non-dilated vein walls, density was 1.23 mast cell per mm2. This difference was not statistically significant, therefore we could not confirm our hypothesis. Nevertheless, we suggest that mast cells could play an important role in the development of varices and the factor released by the mast cells should be further examined.

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.

Expression of Constitutive Nitric Oxide Synthase Isoforms in Varicose Vein Wall; Preliminary Results

There are conflicting findings in literature about the structural changes of the primary varicose veins. NO (a potent vasodilatator) is synthesized by nitric oxide synthase (NOS). From 3 known NOS isoforms the two are constitutional: eNOS (endothelial NOS) and nNOS (neuronal NOS). 10 varicose and 10 control vein samples were processed by standard light microscopy and immuno-histochemica techniques using rabbit polyclonal antibodies against eNOS and nNOS. Antibodies expression was evaluated semiquantitatively and proved morphometrically by 2D-image analysis. total area of NOS isoforms expressions was determined by color analysis and color digital subtraction. The results showed discontinuous and significantly lower expression of both NOS isoforms the in the tunica media of varicose veins compared with the control group. For the statistical analysis the unpaired t-test was used. Our results suppose lower NO levels in varicose vein wall, deducing that varicose dilatation is due to other mechanism, and they contradict the results of previously published similar works.

Intraspinal extradural variations of nerve roots

INTRODUCTION The aim of this work is to point out the intraspinal extradural anatomical variations of nerve roots and their possible participation in radiculopathy. METHODS The anatomical study was performed in 33 cadavers at a mean age of 46.5 and up to 24h from death. All extradural anastomoses between nerve roots were excised and examined histologically for the presence or absence of nervous tissue. The type of the plexus was defined by subtracting from the root C2. RESULTS Findings with the normotype of plexus formation prevailed in 24 cases (72.7%). Variations in its formation were observed in 9 cases (27.3%). The prefixed type in 6 cases (18.2%), post-fixed type in 3 cases (9.1%). We did not observe the formation of the isolated prefixed or post-fixed types in the brachial or lumbosacral plexuses. Extradural anatomical variations occurred in 20 cases (60.6%). They were more frequent on the left, in 10 cases (30.3%), bilateral in 3 cases (9.1%). In 8 instances (24.2%), the atypical spacing, including four in the lumbosacral region, was observed. Variations occurred more frequently in variations of formation of the plexus. CONCLUSIONS This study allowed us to identify and describe unpublished intraspinal extradural anatomical variations of nerve roots and their interrelationships throughout the spinal canal with their potential influence on the clinical picture. Anatomical preparations revealed a higher incidence of intraspinal extradural variations, mainly between sacral roots. The reliance of their incidence of the type of plexus was observed.

Surgical treatment of nervus pudendus.

An objective of our work was to clarify variations in pudendal nerve formation, as well as their possible impact on the clinical picture.Bilateral pudendal nerve course and formation was studied on 20 adult cadavers. Anterior approach was used in 15 of them, both posterior and anterior approaches were used in five of them. The prefixed type plexus formation was observed in eight cases (40 %). In these cases S1, S2 roots contributed to the formation of the pudendal nerve. In the postfixed type particularly the S3 root was dominant in two cases (66.7 %), and less the S4 root in one case (23.3 %) from three cases. Mostly the S2 root participated in its formation in 17 cases (85 %). The pudendal nerve branches run below the sacrospinous ligament on the level of the sacrospinous and sacrotuberous ligaments. The changes of the nerve and the branching therof were most evident from the anterior access below the sacrospinous ligament and in front of the sacrotuberous ligament. The inferior rectal nerve penetrating the sacrospinous ligament was seen in one case, it has risen from the pudendal nerve before entering the pudendal canal in four cases. The dorsal nerve of the penis has risen from the S1 root in two cases (10 %). We observed its branching before entering the pudendal canal in 15 cases (75 %). It has divided in the pudendal canal in other cases. This description may be useful particularly for the pudendal nerve block and the nerve saving surgeries directed on the relevant region (Fig. 8, Ref. 24).