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Anatomical Variations (anatomical + variation)

Distribution by Scientific Domains

Life Sciences	48%
Medical Sciences	37%
Earth and Environmental Science	14%

Selected Abstracts

Anatomical variation at the saphenofemoral junction,

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2005
M. Donnelly
Background: This study was designed to document the surgical anatomy of the saphenofemoral junction (SFJ). Methods: The anatomy of the SFJ was recorded diagrammatically in 2089 consecutive groin dissections performed to treat primary varicose veins. The number of primary tributaries, bifid systems, junctional tributaries and the relationship of the external pudendal artery (EPA) to the long saphenous vein (LSV) were recorded. Results: The LSV was bifid in 18·1 per cent of legs. The number of tributaries at the SFJ varied from one to ten. In 33·4 per cent one or more (junctional) tributaries joined the LSV or common femoral vein deep to the deep fascia. The EPA crossed anterior to 16·8 per cent of LSVs. In 4·6 per cent it passed posterior to one large tributary or trunk of a bifid LSV and anterior to the second trunk, making identification of the second trunk particularly difficult. Conclusion: A thorough understanding of the anatomical variations of the SFJ is important in ensuring that the junction is managed safely and adequately in patients with varicose veins. Failure to appreciate these variations may account for a significant proportion of inadequate primary varicose vein surgery. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

A review of the thoracic splanchnic nerves and celiac ganglia

CLINICAL ANATOMY, Issue 5 2010
Marios Loukas
Abstract Anatomical variation of the thoracic splanchnic nerves is as diverse as any structure in the body. Thoracic splanchnic nerves are derived from medial branches of the lower seven thoracic sympathetic ganglia, with the greater splanchnic nerve comprising the more cranial contributions, the lesser the middle branches, and the least splanchnic nerve usually T11 and/or T12. Much of the early anatomical research of the thoracic splanchnic nerves revolved around elucidating the nerve root level contributing to each of these nerves. The celiac plexus is a major interchange for autonomic fibers, receiving many of the thoracic splanchnic nerve fibers as they course toward the organs of the abdomen. The location of the celiac ganglia are usually described in relation to surrounding structures, and also show variation in size and general morphology. Clinically, the thoracic splanchnic nerves and celiac ganglia play a major role in pain management for upper abdominal disorders, particularly chronic pancreatitis and pancreatic cancer. Splanchnicectomy has been a treatment option since Mallet-Guy became a major proponent of the procedure in the 1940s. Splanchnic nerve dissection and thermocoagulation are two common derivatives of splanchnicectomy that are commonly used today. Celiac plexus block is also a treatment option to compliment splanchnicectomy in pain management. Endoscopic ultrasonography (EUS)-guided celiac injection and percutaneous methods of celiac plexus block have been heavily studied and are two important methods used today. For both splanchnicectomies and celiac plexus block, the innovation of ultrasonographic imaging technology has improved efficacy and accuracy of these procedures and continues to make pain management for these diseases more successful. Clin. Anat. 23:512,522, 2010. © 2010 Wiley-Liss, Inc. [source]

Anatomical variations of the plantaris muscle and a potential role in patellofemoral pain syndrome

CLINICAL ANATOMY, Issue 2 2008
A. Jay Freeman
Abstract The plantaris muscle has been given little attention in the reviewed literature. It is most commonly mentioned only when absent from a specimen. This study aimed to document the anatomy of the plantaris muscle and to discuss the clinical significance of the observations. Cadaveric knees (n = 46) were dissected to identify the possible variations of the plantaris muscle. The muscle conformed with standard descriptions (n = 26; 56.52%), was present but varied from previous descriptions (n = 14; 30.44%), or was absent (n = 6; 13.04%). The variations consisted of distinct interdigitations with the lateral head of the gastrocnemius muscle (n = 9; 19.57%) and a strong fibrous extension of the plantaris muscle to the patella (n = 5; 10.87%). The presence of interdigitations strengthen the argument that the plantaris muscle supplement the activity of the lateral head of the gastrocnemius muscle whereas the patellar extension suggests an involvement with patellofemoral dynamics and may play a role in the various presentations of patellofemoral pain syndrome. Greater understanding of the relationship between these and other posterior knee structures will facilitate more precise interpretation and treatment of knee injuries. Clin. Anat. 21:178,181, 2008. © 2008 Wiley-Liss, Inc. [source]

Unusual insertion of the coracobrachialis muscle to the brachial fascia associated with high division of brachial artery

CLINICAL ANATOMY, Issue 8 2004
Bappaditya Ray
Abstract Anatomical variations of the coracobrachialis muscle (CBM) are common. We detected an abnormal form of the CBM of the left arm during human cadaver dissection. The CBM originated from the tip of the coracoid process of the scapula and divided into muscular and musculo-aponeurotic bellies. The muscular belly inserted into the middle of the anteromedial surface of the humerus, which is the normal anatomic insertion point of the CBM. The musculo-aponeurotic belly inserted into the medial intermuscular septum as well as the brachial fascia, creating a tunnel for the passage of the brachial artery. Inside the tunnel, the brachial artery bifurcated into the radial and ulnar arteries. No abnormality of the CBM, the brachial artery, or the median nerve was detected in the contralateral arm. The phylogenic, ontogenic, functional, and clinical importance of this variant muscle is described. Knowledge of such variations is of considerable importance during invasive and non-invasive investigative procedures or orthopedic, reconstructive, or surgical procedures. Clin. Anat. 17:672,676, 2004. © 2004 Wiley-Liss, Inc. [source]

Anatomical variations and clinical implications of the artery to the lingual nerve

CLINICAL ANATOMY, Issue 4 2003
Stanton D. Harn
Abstract The pterygomandibular space is a critical anatomic area for the delivery of local anesthesia in the practice of dentistry. The neurovascular contents of this area are subject to trauma and its resultant local and systemic complications. This study of 202 cadaveric specimens reaffirms the literature as to the percent distributions of the superficial and deep routes of the maxillary artery and details for the first time the anatomic variations of the artery to the lingual nerve. This artery courses through the pterygomandibular space placing it at risk for injection trauma along with the other neurovascular contents. It has been uncommonly identified and referred to in the literature, yet it may be the first artery encountered when entering the space with a needle or during surgical intervention in the area. Clin. Anat. 16:294,299, 2003. © 2003 Wiley-Liss, Inc. [source]

Anatomical variations of the sural nerve

CLINICAL ANATOMY, Issue 4 2002
Pasuk Mahakkanukrauh
Abstract An anatomical study of the formation of the sural nerve (SN) was carried out on 76 Thai cadavers. The results revealed that 67.1% of the SNs were formed by the union of the medial sural cutaneous nerve (MSCN) and the lateral sural cutaneous nerve (LSCN); the MSCN and LSCN are branches of the tibial and the common fibular (peroneal) nerves, respectively. The site of union was variable: 5.9% in the popliteal fossa, 1.9% in the middle third of the leg, 66.7% in the lower third of the leg, and 25.5% at or just below the ankle. One SN (0.7%) was formed by the union of the MSCN and a different branch of the common fibular nerve, running parallel and medial to but not connecting with the LSCN, which joined the MSCN in the lower third of the leg. The remaining 32.2% of the SNs were a direct continuation of the MSCN. The SNs ranged from 6,30 cm (mean = 14.41 cm) in length with a range in diameter of 3.5,3.8 mm (mean = 3.61 mm), and were easily located 1,1.5 cm posterior to the posterior border of the lateral malleolus. The LSCNs were 15,32 cm long (mean = 22.48 cm) with a diameter between 2.7,3.4 mm (mean = 3.22 mm); the MSCNs were 17,31 cm long (mean = 20.42 cm) with a diameter between 2.3,2.5 mm (mean = 2.41 mm). Clinically, the SN is widely used for both diagnostic (biopsy and nerve conduction velocity studies) and therapeutic purposes (nerve grafting) and the LSCN is used for a sensate free flap; thus, a detailed knowledge of the anatomy of the SN and its contributing nerves are important in carrying out these and other procedures. Clin. Anat. 15:263,266, 2002. © 2002 Wiley-Liss, Inc. [source]

Anatomical variations of the extrahepatic biliary tree: Review of the world literature

CLINICAL ANATOMY, Issue 3 2001
M. Lamah
Abstract The anatomy facing a surgeon during cholecystectomy involves complex relationships between the hepatic artery, extrahepatic biliary tree, and gallbladder. A sound knowledge of the normal anatomy of the extrahepatic biliary tract is thus essential in the prevention of operative injury to it. Equally important, however, is an understanding of congenital variation of biliary and vascular anatomy, as the literature abounds with reports of specific anatomical variations, and their operative implications. This article reviews the world literature on congenital variation of extrahepatic biliary anatomy. Clin. Anat. 14:167,172, 2001. © 2001 Wiley-Liss, Inc. [source]

Analysis of the gutta-percha filled area in C-shaped mandibular molars obturated with a modified MicroSeal technique

INTERNATIONAL ENDODONTIC JOURNAL, Issue 3 2009
R. Ordinola-Zapata
Abstract Aim, To analyse the gutta-percha filled area of C-shaped molar teeth root filled with the modified MicroSeal technique with reference to the radiographic features and the C-shaped canal configuration. Methodology, Twenty-three mandibular second molar teeth with C-shaped roots were classified according to their radiographic features as: type I , merging, type II , symmetrical and type III , asymmetrical. The canals were root filled using a modified technique of the MicroSeal system. Horizontal sections at intervals of 600 ,m were made 1 mm from the apex to the subpulpal floor level. The percentage of gutta-percha area from the apical, middle and coronal levels of the radiographic types was analysed using the Kruskal,Wallis test. Complementary analysis of the C-shaped canal configurations (C1, C2 and C3) determined from cross-sections from the apical third was performed in a similar way. Results, No significant differences were found between the radiographic types in terms of the percentage of gutta-percha area at any level (P > 0.05): apical third, type I: 77.04%, II: 70.48% and III: 77.13%, middle third, type I: 95.72%, II: 93.17%, III: 91.13% and coronal level, type I: 98.30%, II: 98.25%, III: 97.14%. Overall, the percentage of the filling material was lower in the apical third (P < 0.05). No significant differences were found between the C-shaped canal configurations apically; C1: 72.64%, C2: 79.62%, C3: 73.51% (P > 0.05). Conclusions, The percentage of area filled with gutta-percha was similar in the three radiographic types and canal configuration categories of C-shaped molars. These results show the difficulty of achieving predictable filling of the root canal system when this anatomical variation exists. In general, the apical third was less completely filled. [source]

Spondylolysis in a pre-contact San Francisco Bay population: behavioural and anatomical sex differences

INTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY, Issue 3 2009
E. Weiss
Abstract Spondylolysis refers to a separation of the spinal body from the arch. Researchers have documented that these fractures occur due to stresses related to activities involving the lower limb and back. Spondylolysis in sacral and lumbar vertebrae of 146 (66 males, 66 females, 14 indeterminates) California Amerinds were examined to determine whether sex differences were present. Sacral anatomy (i.e. sacralisation and lumbarisation, sacral base angles, and superior facet morphology) was analysed in relation to spondylolysis and sex, to explore whether sex differences could be better explained through activity patterns or anatomical variation. Spondylolysis afflicted 24 individuals (16.4%). Males had more than twice the rate of spondylolysis than did females (26% and 11%, respectively). Activity patterns, such as thrusting and throwing shafted obsidian points, could explain the sex differences. Males were most frequently buried with obsidian point artefacts, whereas females were buried with mortar and pestles. For sacral anatomy, only males had lumbarisation, and all other anatomical variation had no significant sex differences. Lumbarisation related to spondylolysis in males. In this study, sacral anatomical variation could not fully account for sex differences in spondylolysis; activity patterns provided a better explanation. Nonetheless, anatomical variation may predispose males to spondylolysis, or spondylolysis may affect sacral anatomy. Copyright © 2008 John Wiley & Sons, Ltd. [source]

The burial of Bad Dürrenberg, Central Germany: osteopathology and osteoarchaeology of a Late Mesolithic shaman's grave

INTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY, Issue 5 2006
M. Porr
Abstract The isolated burial of Bad Dürrenberg is one of the richest Mesolithic graves in Europe. Although it was excavated in the 1930s, new spectacular anthropological and archaeological evidence has emerged during a recent re-study. Firstly, we present here the results of an anthropological re-evaluation of certain features of the skull base and the foramen magnum. Our work has clearly established that the observable features are caused by an anatomical variation that also includes an atlar anomaly. This developmental variation possibly caused various neuropathological symptoms. The Bad Dürrenberg burial consequently represents a unique case of the possible interpretation of abnormal behaviours in a shamanistic fashion in a prehistoric context. Secondly, we have identified the LSAMAT phenomenon (Lingual Surface Attrition of the Maxillary Anterior Teeth) in the adult individual of the burial. The activities leading to this condition are unknown so far. Thirdly, a split roe deer metatarsus among the burial goods was identified as being involved in the preparation or application of red pigment. The lack of polish and other use wear make it likely that it was produced and used as part of the burial ritual. Copyright © 2006 John Wiley & Sons, Ltd. [source]

AN ASSESSMENT OF VARIABILITY IN THEROPOD DINOSAUR REMAINS FROM THE BATHONIAN (MIDDLE JURASSIC) OF STONESFIELD AND NEW PARK QUARRY, UK AND TAXONOMIC IMPLICATIONS FOR MEGALOSAURUS BUCKLANDII AND ILIOSUCHUS INCOGNITUS

PALAEONTOLOGY, Issue 4 2009
ROGER B. J. BENSON
Abstract:, The assemblage of large-bodied theropod remains from the Taynton Limestone Formation (middle Bathonian) of Stonesfield, Oxfordshire and the Chipping Norton Limestone Formation (lowest Bathonian) of New Park Quarry, Gloucestershire, UK is interpreted as monospecific. An assessment of morphological variation in theropod fossils from these localities reveals no taxonomically-significant variation among remains representing large-bodied individuals. Previous observations of anatomical variation among femora, ilia and scapulocoracoids are attributed to postmortem damage and deformation. Referral of all such material to the first named dinosaur taxon, Megalosaurus bucklandii Mantell, is therefore justified. ,Iliosuchus incognitus' lacks autapomorphies and is a nomen dubium. However, other remains of small-bodied theropods from Stonesfield indicate a minimum of two small-bodied taxa that are distinct from M. bucklandii. [source]

Intercalary Elements, Treefrogs, and the Early Differentiation of a Complex System in the Neobatrachia

THE ANATOMICAL RECORD : ADVANCES IN INTEGRATIVE ANATOMY AND EVOLUTIONARY BIOLOGY, Issue 12 2007
Adriana S. Manzano
Abstract Intercalary elements are additional skeletal structures of digits of many anuran amphibians. Twelve terminal clades in the neobatrachian lineage of frogs have intercalary elements revealing it is a homoplastic character with five to seven gains and two to four losses along a consensus phylogeny of the Neobatrachia. We analyzed anatomical variation of intercalary elements, related structures (distal phalanges, tendons, and muscles), and articulations of digits of 45 anuran species, representing eight suprageneric terminal taxa. The intercalary elements are integrated in a complex system that is probably related to different types of movements, which are produced by a similar set of muscles and tendons with limited variation among the studied taxa. Species in the clades Hyloides and Ranoides show distinctive patterns of morphostructural features in their intercalary elements that are usually wedge-shaped and composed of hyaline cartilage in Ranoides, and biconcave and composed of embryonic cartilage in Hyloides. Features derived from the typical hyloid condition may only be interpreted in some Hylidae (Pseudis and Lysapsus) and Centrolenidae. In Ranoides, the described features of the intercalary elements are found in all taxa examined with the exception of Leptopelis, which have an intercalary element similar to the other Ranoides but formed by connective tissue. Several features are shared by all taxa having intercalary elements: (1) the intercalary elements differ from the phalanges by lacking terminal epiphyses, (2) they are present in hands and feet, and (3) they appear in all digits. This finding suggests that the genetic basis for presence of intercalary elements may be homologous in all these taxa and may have evolved only once early in neobatrachian history. Anat Rec, 2007. © 2007 Wiley-Liss, Inc. [source]

Engine-Driven Preparation Of Curved Root Canals: Measuring Cyclic Fatigue And Other Physical Parameters,

AUSTRALIAN ENDODONTIC JOURNAL, Issue 1 2002
Ove A. Peters Dr med dent
An increasing number of engine-driven rotary systems are marketed to shape root canals. Although these systems may improve the quality of canal preparations, the risk for instrument fracture is also increased. Unfortunately, the stresses generated in rotary instruments when shaping curved root canals have not been adequately studied. Consequently, the aim of an ongoing project was to develop a measurement platform that could more accurately detail physical parameters generated in a simulated clinical situation. Such a platform was constructed by fitting a torque-measuring device between the rotating endodontic instrument and the motor driving it. Apically directed force and instrument insertion depth were also recorded. Additional devices were constructed to assess cyclic fatigue and static fracture loads. The current pilot study evaluated GT rotary instruments during the shaping of curved canals in plastic blocks as well as "ISO 3630,1 torque to fracture" and number of rotations required for fatigue fracture. Results indicated that torques in excess of 40Nmm were generated by rotary GT-Files, a significantly higher figure than static fracture loads (less than 13Nmm for the size 20. 12 GT-File). Furthermore, the number of rotations needed to shape simulated canals with a 5 mm radius of curvature in plastic blocks was 10 times lower than the number of rotations needed to fracture instruments in a "cyclic fatigue test". Apical forces were always greater than IN, and in some specimens, scores of 8N or more were recorded. Further studies are required using extracted natural teeth, with their wide anatomical variation, in order to reduce the incidence of fracture of rotary instruments. In this way, the clinical potential of engine-driven rotary instruments to safely prepare curved canals can be fully appreciated. [source]

Immunophenotypic features of MELF pattern invasion in endometrial adenocarcinoma: evidence for epithelial,mesenchymal transition

HISTOPATHOLOGY, Issue 1 2009
Colin J R Stewart
Aims:, Endometrial endometrioid adenocarcinomas (EEC) may show a distinctive morphological alteration characterized by the presence of microcystic, elongated and fragmented (,MELF') glands. These changes share features of epithelial,mesenchymal transition (EMT) in carcinomas arising at other sites. The aim was to compare the immunophenotypic profile of MELF-type epithelium with conventional glandular areas of EEC. Methods and results:, Twenty-one EEC were stained immunohistochemically for cytokeratin (CK) AE1/AE3, CK7, vimentin, oestrogen receptor, progesterone receptor and E-cadherin. Conventional tumour glands usually showed preserved membranous E-cadherin immunoreactivity with peripheral accentuation of vimentin and hormone receptor expression. MELF-type invasion was characterized by strong CK7 expression, sometimes in contrast to adjacent unstained tumour glands. MELF areas were usually negative for hormone receptors and showed reduced E-cadherin expression. Conclusions:, The expression of hormone receptors and intermediate filaments shows specific distribution patterns within EEC. MELF pattern invasion shows an altered immunophenotype compared with conventional glandular tumour areas. These findings suggest that MELF-type invasion represents a specific tumour alteration, and the reduction in hormone receptor and E-cadherin expression would be consistent with EMT. Immunohistochemical studies of EEC should consider micro anatomical variations in immunoreactivity, since these may be relevant to tumour invasion and progression. [source]

Hepatectomy of living donors with a left-sided gallbladder and multiple combined anomalies for adult-to-adult living donor liver transplantation

LIVER TRANSPLANTATION, Issue 1 2004
Shin Hwang
The left-sided gallbladder is very rare, but it is often accompanied by multiple anomalies of the liver, by which living donor hepatectomy cannot be feasible or becomes difficult. We have experienced 3 donors with a left-sided gallbladder out of 642 living donors. The first case was a male donor showing bifurcating portal anomaly with intrahepatic right portal vein confluence and extremely low bifurcation of the bile ducts. The right lobe was retrieved and implanted to his father. The second case was a male donor revealing trifurcating portal anomaly with separate right posterior portal branch and replacing right posterior hepatic artery. The right posterior segment graft was retrieved and implanted to his uncle. The third case was a male volunteer in whom the anterior portion of the medial segment was fed by an aberrant branch of the right anterior segment glisson. The small left lobe was retrieved and implanted simultaneously with another living donor's left lobe graft in the form of a dual living donor liver transplantation. There was no donor morbidity or recipient complication. Although there is a high possibility of diverse liver anomalies in living donors with a left-sided gallbladder, complete preoperative evaluation and mapping of the multiple anatomical variations may make certain types of living donor hepatectomy feasible. (Liver Transpl 2004;10:141,146.) [source]

The prevalence of anatomical variations that can cause inadvertent dural puncture when performing caudal block in Koreans: a study using magnetic resonance imaging

ANAESTHESIA, Issue 1 2010
J. Joo
Summary The purpose of this study was to investigate the prevalence of the anatomical abnormalities that can induce inadvertent dural puncture when performing caudal block. The anatomy of the lumbo-sacral area was evaluated using magnetic resonance imaging. In 2462 of the 2669 patients imaged, the dural sac terminal was located between the upper half of the 1st sacral vertebra and the lower half of the 2nd sacral vertebra. In 22 cases (0.8%), the dural sac terminal and the spinal canal were located at or below the 3rd sacral vertebra, and these were cases of simple anatomical variations. As regards pathologic conditions, there was one case of sacral meningocoele and 46 cases of sacral perineural cyst. In 21 cases (0.8%) out of the 46 perineural cyst cases, the cyst could be found at or below the 3rd sacral vertebra level. Inadvertent dural puncture may happen when performing caudal block in patients with such abnormal anatomy. [source]

Macroscopic Anatomy of the Great Vessels and Structures Associated with the Heart of the Ringed Seal (Pusa hispida)

ANATOMIA, HISTOLOGIA, EMBRYOLOGIA, Issue 3 2009
H. Smodlaka
Summary The ringed seal [Pusa (Phoca) hispida], as well as other seals, exhibits unique anatomical properties when compared to its terrestrial counterparts. In the ringed seal, the most conspicuous marine adaptation is the aortic bulb. This large dilatation of the ascending aorta is comparable to that found in other seal species and marine mammals. The branches of the ascending aorta (brachiocephalic trunk, left common carotid artery and left subclavian artery) are similar to those of higher primates and man. The peculiarities of the venous system are: three pulmonary veins, a pericardial venous plexus, a caval sphincter, a hepatic sinus with paired caudal vena cavae and a large extradural venous plexus. Generally, three common pulmonary veins (right, left and caudal) empty into the left atrium. The pericardial venous plexus lies deep to the mediastinal pericardial pleura (pleura pericardica) on the auricular (ventral) surface of the heart. The caval sphincter surrounds the caudal vena cava as it passes through the diaphragm. Caudal to the diaphragm, the vena cava is dilated (the hepatic sinus), and near the cranial extremity of the kidneys, it becomes biphid. The azygos vein is formed from the union of the right and left azygos veins at the level of the 5th thoracic vertebra. Cardiovascular physiological studies show some of these anatomical variations, especially of the venous system and the ascending aorta, to be modifications for diving. This investigation documents the large blood vessels associated with the heart and related structures in the ringed seal. [source]

Origin of the Infrarenal Part of the Caudal Vena cava in the Pig

ANATOMIA, HISTOLOGIA, EMBRYOLOGIA, Issue 5 2008
P. Cornillie
Summary The vascular topography in the lumbar region of pig embryos and young fetuses was three-dimensionally reconstructed to study some controversial aspects of the origin and development of the infrarenal part of the caudal vena cava. Contrary to general belief, it was found that the supracardinal veins, which form the azygos veins in the thorax, do not take part in the construction of the caudal vena cava in the lumbar region. These veins do appear in the abdomen, but they are only involved in the formation of the lumbar and ascending lumbar veins. The infrarenal part of the caudal vena cava arises from the lumbar part of the right caudal cardinal vein. Whilst this venous pattern is established, the lumbar part of the left caudal cardinal vein disappears and its former location is occupied by large lymphatic connections between the cysterna chyli and the retroperitoneal mesenteric lymphatic sac. On the basis of these findings, a number of hypotheses on the development of anatomical variations of the caudal vena cava should be reconsidered. [source]

Cerebral developmental venous anomalies: Current concepts,

ANNALS OF NEUROLOGY, Issue 3 2009
Diego San Millán Ruíz MD
Cerebral developmental venous anomalies are the most frequently encountered cerebral vascular malformation, and as such, are frequently reported as fortuitous findings in computed tomography (CT) and magnetic resonance imaging (MRI) studies. Developmental venous anomalies (DVAs) are generally considered extreme anatomical variations of the cerebral vasculature, and follow a benign clinical course in the vast majority of cases. Here we review current concepts on DVAs with the aim of helping clinicians understand this complex entity. Morphological characteristics that are necessary to conceptualize DVAs are discussed in depth. Images modalities used in diagnosing DVAs are reviewed, including new MRI or CT techniques. Clinical presentation, association with other vascular malformations and cerebral parenchymal abnormalities, and possible physiopathological processes leading to associated imaging or clinical findings are discussed. Atypical forms of DVAs are also reviewed and their clinical significance discussed. Finally, recommendations as to how to manage asymptomatic or symptomatic patients with a DVA are advanced. Ann Neurol 2009;66:271,283 [source]

Anatomical variation at the saphenofemoral junction,

The "safe zone" in medial percutaneous calcaneal pin placement

CLINICAL ANATOMY, Issue 4 2009
Zakareya Gamie
Abstract Percutaneous pin insertion into the medial calcaneus places a number of structures at risk. Evidence suggests that the greatest risk is to the medial calcaneal nerve (MCN). The medial calcaneal region of 24 cadavers was dissected to determine the major structures at risk. By using four palpable anatomical landmarks, the inferior tip of the medial malleolus (point A), the posterior superior portion of the calcaneal tuberosity (point B), the navicular tuberosity (point C), and the medial process of the calcaneal tuberosity (point D), we attempted to define the safe zone taking into account all possible variables in our dissections including ankle position, side, gender, and possible anatomical variations of the MCN. The commonest arrangement of the MCN was two MCNs that arose independently, one arising before the bifurcation of the tibial nerve and the other arising from the medial plantar nerve. A zone could be defined posterior to 75% of the distance along the lines AB, CD, AD, and CB which would avoid most structures. The posterior branches of the MCN, however, would still be at risk and placing the pin too far posteriorly risks an avulsion fracture. This is the first study to employ four palpable anatomical landmarks to identify a zone to minimize damage to neurovascular structures. It may not be possible, however, to avoid injury of the MCN and consequent sensory loss to the sole of the foot. foot. Clin. Anat. 22:523,529, 2009. © 2009 Wiley-Liss, Inc. [source]

Rare variations of the left subclavian artery

CLINICAL ANATOMY, Issue 5 2005
Faysal A. Saadeh
Abstract The subclavian artery is a major constituent of the blood circulatory system. Its position in the root of the neck and its course through the interscalene triangle are significant. Its branches supply divers areas in the body from the brain to the thorax. This case report describes an unusual range of anatomical variations of the course of the left subclavian artery, the origin, and absence of some of its branches and the concomitant abnormal course of the phrenic nerve. Clinical syndromes related to certain variations are reviewed. Clin. Anat. 18:370,372, 2005. © 2005 Wiley-Liss, Inc. [source]

Anatomical basis for a successful upper limb sympathectomy in the thoracoscopic era

CLINICAL ANATOMY, Issue 4 2004
L. Ramsaroop
Abstract In this clinico-anatomical study, factors potentially responsible for unsuccessful upper limb sympathectomy (ULS) by the thoracoscopic route were evaluated. This study comprised two subsets: 1) in the clinical subset, 25 patients (n = 50 sides) underwent bilateral second thoracic ganglionectomy for palmar hyperhidrosis, and factors predisposing to unsuccessful ULS were identified; and 2) in the anatomical subset, the neural connections of the first and second intercostal spaces were bilaterally dissected in 22 adult cadavers (22 right, 21 left; n = 43 sides). Alternate neural pathways (ANP) were noted in 9 of 50 sides in the 25 clinical cases (18%). In three asthenic patients (5 sides), fascia overlying the longus colli muscle mimicked the sympathetic chain. The right superior intercostal vein (SIV) was located anterior to the second thoracic ganglion in 6 of 50 sides (12%) and predisposed to troublesome bleeding in 2 of 50 cases; the SIV was posterior to the ganglion in 19 of 50 sides (38%), posing no technical problem. On the left, the SIV was noted outside the field of dissection in all but one case. A successful outcome to sympathectomy was noted in all 25 patients. A spectrum of sympathetic contributions to the first thoracic ventral ramus for the first intercostal space was noted in 37 of 43 anatomical cases (86%). These were categorized according to the arrangements of the intrathoracic ramus between the second intercostal nerve and the first thoracic ventral ramus. The cervicothoracic ganglion (37/43 cases; 86%) and an independent inferior cervical ganglion (6/43 cases; 14%) were always located above the second rib. The second thoracic ganglion was consistently located in the second intercostal space. This study demonstrates that ANPs have little clinical significance when a second thoracic ganglionectomy is undertaken. Technical failures may be avoided if the surgeon is mindful of anatomical variations at surgery. Clin. Anat. 17:294,299, 2004. © 2004 Wiley-Liss, Inc. [source]

Anatomical variations of the extrahepatic biliary tree: Review of the world literature

Accidental transplantation of a kidney with a cystic renal cell carcinoma following living donation: management and 1 yr follow-up

CLINICAL TRANSPLANTATION, Issue 2 2006
Michael Neipp
Abstract: Transmission of cancer is a fatal risk in organ transplantation. We present a case of incidental renal carcinoma in a kidney obtained from a living donor. A 56-yr-old father was evaluated for donation for his 28-yr-old daughter. An MRT scan revealed two cysts in the right kidney. Right-sided donor nephrectomy and subsequent transplantation was performed. The wall of the prominent cyst was partially excised prior to transplantation. Histology revealed a high-grade renal clear cell carcinoma 10 d after transplantation. Following careful evaluation the recipient underwent partial nephrectomy. Immunosuppression was switched to rapamune. The graft function remained stable. Donor and recipient are without evidence of tumor recurrence 1 yr after transplantation. Our policy to obtain the kidney presenting anatomical variations proved to be beneficial for the donor. In case of transmission of cancer partial resection preserving graft function might be justified. [source]