The superficial palmar branch of the radial artery: a corrosion cast study.

BACKGROUND: Surgical procedures such as thenar flaps and radial artery (RA) harvesting call for an elaborate anatomical study of the RA's superficial palmar branch (SPB). The aim of this study was to describe the branching pattern of this vessel related to the morphometric characteristics and variations of this artery. MATERIALS AND METHODS: Twenty 4% formalin solution-injected hands were dissected. For the morphometric study we used another group of 35 human hands of adult persons, injected with methyl methacrylate fluid into the ulnar and radial arteries. As soon as polymerisation was completed, a 40% solution of potassium hydroxide was applied for corrosion. The vascular arterial casts were examined under the stereoscopic microscope and precise drawings of each specimen were made. RESULTS: In the majority of cases (75%) SPB passed superficially, over the abductor pollicis brevis muscle. The mean diameter of the SPB, very variable depending on its length and field of supply, was 1.52 ± 0.49 mm, ranging from 0.8 to 2.7 mm. Developed SPB type, was present in 31.4% of hands, with the diameter of 1.7 mm and larger (mean 1.95 mm), continuing distally to become the radialis indicis artery, with an average calibre of 1.2 mm, and with important branches to the thumb. In most hands (68.6%), the hypoplastic SPB, was present, with a mean diameter of 1.17 mm, and the field of supply within the thenar area. CONCLUSIONS: Knowledge of the SPB dominance and existence of anastomotic vessels in its field of supply are of importance to avoid the risk of possible ischaemic sequelae in the hand associated with harvesting the RA.

Vascular anatomy of the thenar eminence: its relevance to a pedicled or free thenar flap.

BACKGROUND: The aim of this study was to clarify the arterial supply of the skin covering the prominent part of the thenar eminence in order to describe the possibility and potential for harvesting a pedicled or a free flap from the thenar eminence. MATERIALS AND METHODS: The arteries were studied in 30 post-mortem specimens of human hands; 3 previously perfused with 4% formaldehyde solution, and injected with black India ink, and 27 injected with methyl-methacrylate and afterwards corroded in 40% potassium hydroxide solution. RESULTS: In all hands we found two little palmar arteries coming from the anatomical snuff-box portion of the radial artery. We labelled the first (proximal) branch as the middle thenar artery, because it supplies the middle third of the thenar eminence skin. Its diameter varied from 0.25 to 0.55 mm (mean 0.4 mm). The distal, more prominent branch of the radial artery, vascularised the lateral third of the thenar eminence skin, and was named the lateral thenar artery; its diameter ranged from 0.40 to 0.90 mm (mean 0.67 mm). The superficial palmar branch of the radial artery, always present, was classified as: hypoplastic, average or prominent, with a diameter ranging from 0.8 to 2.7 mm (mean 1.47 mm). CONCLUSIONS: Three individually developed branches of the radial artery supplied the skin of the thenar eminence. Cutaneous branches of these three arteries were interconnected via anastomotic vessels.

Control of human and plant fungal pathogens using pentaene macrolide 32, 33-didehydroroflamycoin.

AIMS: The aim of this study was to address the toxicity of recently described polyene macrolide 32, 33-didehydroroflamycoin (DDHR) on a wide range of fungal pathogens and its potential to control plant fungal diseases. METHODS AND RESULTS: The antifungal activity of DDHR in vitro was examined against common human and plant pathogenic fungi using a broth microdilution assay and a disk diffusion assay. Minimum inhibitory concentrations ranged from 12·5 to 35 µg ml(-1) . A radial growth inhibition assay showed that DDHR inhibited mycelia growth, inducing mycelial necrosis and affecting sporulation. During the in vivo assay on apple fruits administration of DDHR 1 h before fungal inoculation inhibited spreading of the infection. Importantly, DDHR exhibited no phytotoxic effects on the model plant, Capsicum annum, verified by the plant growth rate and chlorophyll content. CONCLUSIONS: DDHR inhibits growth of various plant pathogens in vitro with the strongest activity against Alternaria alternata, Colletotrichum acutatum and Penicillium expansum, and protects apple fruits from decay. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first report of the inhibitory effect of DDHR on important pathogenic fungal isolates. DDHR could be a good scaffold for developing new antifungal agents for fruit and vegetable protection.

Vascularisation of the geniculate ganglion.

BACKGROUND: Lack of the relevant data in the literature and possible clinical significance of the geniculate ganglion vasculature inspired us to examine the vessels of this ganglion. MATERIALS AND METHODS: Twelve temporal bones were taken during autopsy and microdissected. Four geniculate ganglions were taken as well, serially sectioned and used for haematoxylin-eosin and trichrome staining, and for CD34 immunostaining. RESULTS: The geniculate ganglion was supplied by the petrosal artery, which averaged 1.1 in number, 0.44 mm in the outer diameter, 0.24 mm in the luminal diameter, and 17.1 mm in length. The artery approached the greater petrosal nerve, giving off 1-3 twigs to it with a mean diameter of 24 µm, and entered the nerve hiatus or a small bone opening close to the ganglion. Before the artery continued to the tympanic segment of the facial nerve, it gave rise to 1 (8.33%), 2 (75.00%) or 3 (16.67%) branches to the geniculate ganglion, which ranged in diameter between 18 µm and 56 µm (mean 29 µm). From the formed superficial network, several twigs penetrated the ganglion and built an intraganglionic plexus. The counting, performed in microscopic fields, each measuring 341.7 µm × 250.0 µm in size, contained between 20 and 38 (mean 28.1) ganglion cells, as well as from 87 to 143 microvessels (mean 99.8), so that the neuron/vessel ratio was 1:3.6. CONCLUSIONS: This is the first detailed examination of the geniculate ganglion vasculature. The obtained data could be of clinical importance, especially in relation to the Bell's palsy, ganglionitis, geniculate neuralgia, petrous bone imaging, and operations in the same region.

Morphological and functional characteristics of satellite glial cells in the peripheral nervous system.

Satellite glial cells are specialised cells that form a functional perineuronal sheath around sensory ganglion neurons. There are a large number of studies that reveal the morphological and functional characteristics of these cells. Satellite glial cells have been studied both in intact ganglions and in tissue cultures, using light and transmission electron microscopy, immunohistochemical and other methods. Satellite glial cells have polygonal form; they are mononuclear and have developed synthetic organelles, numerous receptors, adhesion molecules and ion channels, which enable them to interact with adjacent neurons, as well as transmit signals in the ganglions of the peripheral nervous system. Based on the literature data, satellite glial cells thanks to their characteristics can receive signals from other cells and react to changes in their surroundings. Previous studies have investigated the potential role of satellite glial cells in the formation of the blood-nervous tissue barrier of the peripheral nervous system, as well as in the neuropathic pain genesis. Some recent discoveries support the fact that satellite glial cells can participate in controlling of local viral infections and protecting pseudounipolar neurons from mentioned infections.

Arterial supply of the trigeminal ganglion, a micromorphological study.

BACKGROUND: In this study, we explored the specific microanatomical properties of the trigeminal ganglion (TG) blood supply and its close neurovascular relationships with the surrounding vessels. Possible clinical implications have been discussed. MATERIALS AND METHODS: The internal carotid and maxillary arteries of 25 adult and 4 foetal heads were injected with a 10% mixture of India ink and gelatin, and their TGs subsequently underwent microdissection, observation and morphometry under a stereoscopic microscope. RESULTS: The number of trigeminal arteries varied between 3 and 5 (mean 3.34), originating from 2 or 3 of the following sources: the inferolateral trunk (ILT) (100%), the meningohypophyseal trunk (MHT) (100%), and from the middle meningeal artery (MMA) (92%). In total, the mean diameter of the trigeminal branches was 0.222 mm. The trigeminal branch of the ILT supplied medial and middle parts of the TG, the branch of the MHT supplied the medial part of the TG, and the branch of the MMA supplied the lateral part of the TG. Additional arteries for the TG emerged from the dural vascular plexus and the vascular network of the plexal segment of the trigeminal nerve. Uniform and specific intraganglionicdense capillary network was observed for each sensory trigeminal neuron. CONCLUSIONS: The reported features of the TG vasculature could be implied in a safer setting for surgical approach to the skull base, in relation to the surrounding structures. The morphometric data on TG vasculature provide anatomical basis for better understanding the complex TG blood supply from the internal and external carotid arteries.

Anastomoses among the thalamoperforating branches of the posterior cerebral artery.

Thirty-three injected human brains were examined, and anastomotic vessels were found in 26 (79%) of them. Anastomoses varied in number from one to six. The mean diameter was 148 microns, and the mean length was 3.3 mm. Anastomoses were observed among the following: the branches of the single thalamoperforating vessel of the posterior cerebral artery (PCA), the individual thalamoperforating arteries of the same PCA, the thalamoperforating vessels and branches of the basilar and superior cerebellar arteries on the same side, the peduncular branches of the PCA and ipsilateral branches of the basilar and superior cerebellar arteries, and the thalamoperforating arteries on one side and various contralateral vessels. Anastomoses could be important components of collateral circulation in occlusive cerebrovascular diseases.

Oculomotor, trochlear, and abducens nerves penetrated by cerebral vessels. Microanatomy and possible clinical significance.

Twenty formaldehyde-fixed brains were examined under the stereoscopic microscope. In 12 brains (60%), the oculomotor nerves were penetrated by the circumflex mesencephalic artery or by a branch of the perforating vessels of the posterior cerebral artery, either on one side (40%) or on both (20%). In one brain (5%), a particular relationship was noticed between the trochlear nerve and the superior cerebellar artery. The abducens nerves were penetrated by the corresponding pontine veins in three brains (15%). These anatomical findings might have important clinical implications.

The surgical anatomy of the relationships between the perforating and the leptomeningeal arteries.

OBJECTIVE: Despite detailed studies of the perforating arteries, their relationships with the leptomeningeal arteries are almost unknown. These relationships can be of great significance during neurosurgical operations. METHODS: The arteries of the hemispheres, which ranged in number from 17 to 36, were injected with india ink or methylmethacrylate. RESULTS: The perforating vessels were noted to arise from the following leptomeningeal arteries: the subcallosal branch of the anterior communicating artery (26.6%); the median artery of the corpus callosum (6.6%); the medial orbitofrontal (6.6%) and the olfactory branch (3.3%) of the anterior cerebral artery; the accessory middle cerebral artery (3.3%); the frontal and temporal branches of the middle cerebral artery (66.6%); the temporal branches of the internal carotid and the anterior choroidal arteries (25% each); the peduncular branch of the posterior communicating artery (4.8%); the peduncular, collicular and medial posterior choroidal branches of the posterior cerebral artery (40%); the cerebellar branches (100%); the long pontine branches (20-26.6%); the anterolateral branches (33.3%) of the basilar artery; and the anterolateral or the lateral medullary branches (35.3%) of the vertebral artery. From 19.4 to 100% of some leptomeningeal vessels originated in the large perforating arteries. CONCLUSION: From 4.8 to 100% of certain groups of the perforating vessels originated in the leptomeningeal arteries. Occlusion of a leptomeningeal artery that gives rise to the perforating vessel(s) may lead to superficial and deep infarcts in the same patient.

Microvascular anatomy of the uncus and the parahippocampal gyrus.

The microanatomical examination of the uncal and the parahippocampal arteries was performed in 17 brain hemispheres injected with India ink and gelatin. The mentioned arteries may originate from the anterior choroidal artery, the internal carotid artery, the middle cerebral artery, and the posterior cerebral artery. The uncal or the unco-parahippocampal branches of the anterior choroidal artery were divided into rostral and caudal; the former were present in 70.6%, and the latter were present in 94.1%. The uncal or the unco-parahippocampal branches of the internal carotid artery, which originated 1.4 to 4.2 mm from its bifurcation site, existed in 58.8%. The same branches of the middle cerebral artery, which most often arose from the temporopolar artery, were present in 64.7%. Finally, these branches of the posterior cerebral artery, which usually arose from the anterior hippocampal artery, were observed in 47.1%. Large parahippocampal branches of the anterior choroidal artery were noted in 52.9%. The internal carotid artery and middle cerebral artery gave rise to these branches in 23.5 and 64.7%, respectively. The posterior cerebral artery always gave off 2 to 10 parahippocampal vessels. The largest of them originated within the rostral hippocampo-parahippocampal arterial complex. The authors discuss the microanatomical characteristics and possible clinical significance of the uncal and the parahippocampal arteries.

The thalamogeniculate perforators of the posterior cerebral artery: the microsurgical anatomy.

The thalamogeniculate (TG) arteries of 30 forebrain hemispheres were examined. These vessels varied from 2 to 12 in number (mean, 5.7), and from 70 to 580 microns in caliber (mean, 345.8 microns). The average caliber of all the TG vessels per posterior cerebral artery ranged from 700 to 3400 microns (mean, 1972 microns). The TG arteries most often originated as individual vessels; however, in 26.67% of the hemispheres examined they shared a common site of origin, and 33.33% of the hemispheres they arose from common stems. The common stems ranged from 320 to 800 microns in diameter (mean, 583 microns). The TG branches arose from the crural or ambient (P2) segment of the posterior cerebral artery in 80% of the hemispheres, from the P2 and the quadrigeminal (P3) segment in 20%, from both the distal segment of the posterior cerebral artery and the common temporal artery (13.33%), or from the distal segment and either the calcarine (3.33%) or parieto-occipital artery (3.33%). The TG arteries usually penetrated the medial geniculate body (100%), pulvinar thalami (80%), brachium of the superior colliculus (53.33%), or lateral geniculate body (13.33%). The collateral branches of the TG arteries were noted to reach the medial geniculate body (76.67%), pulvinar (70%), brachium of the superior colliculus (40%), crus cerebri (40%), and lateral geniculate body (6.67%). The anastomoses were present in 66.67%, usually between the TG vessels and the medial posterior choroidal artery (33.33%), or the mesencephalothalamic artery (26.67%). They ranged in number from 1 to 3 (mean, 1.2), and in caliber from 90 to 400 microns (mean, 197 microns).(ABSTRACT TRUNCATED AT 250 WORDS)

The perforating branches of the internal carotid artery: the microsurgical anatomy of their extracerebral segments.

The perforating branches of the internal carotid artery (ICA) were examined in 30 forebrain hemispheres. These branches were present in all the cases studied, and varied from 1 to 6 in number (mean, 3.1). Their diameters ranged from 70 to 470 microns (mean, 243 microns). The perforating branches arose from the choroidal segment of the ICA, that is, from its caudal surface (52.3%), caudolateral surface (34.1%), or caudomedial surface (13.6%). They rarely originated from the bifurcation point of the ICA (10%). The distance of the remaining 90% of the perforators from the summit of the ICA measured between 0.6 and 4.6 mm. The perforating branches most often originated as individual vessels, and less frequently from a common stem with another vessel or by sharing the same origin site with another perforator or with the anterior choroidal artery. The bifurcation of the ICA, which is a frequent site for cerebral aneurysms, is surrounded by many perforating branches. Hence, great care must be taken to avoid damage to these important vessels during operations in that region.

Interpeduncular perforating branches of the posterior cerebral artery. Microsurgical anatomy of their extracerebral and intracerebral segments.

Interpeduncular perforating branches were found in all 69 examined posterior cerebral arteries. They varied in number from 1 to 10, with an average of 2. They arose directly from the posterior cerebral artery (47.8%), from the collateral branches of the posterior cerebral artery (30.3%), or by their own common stems (88.4%). Their extracerebral segments varied from 100 to 750 microns in diameter (average, 321 microns). They gave off collateral branches to the cerebral peduncle, posterior perforated substance, oculomotor nerve, and mammillary bodies. Intracerebral segments had proximal and distal portions. The mean diameter of the former was 254 microns, and of the latter, 227 microns. The perforating arteries were divided into short interpeduncular and long mesencephalic and diencephalic vessels. Anastomoses among them were noticed in four-fifths of the cases. Despite this fact, the perforating arteries must be preserved during operations on aneurysms in the interpeduncular fossa.

Microvascular anatomy of the hippocampal formation.

The hippocampal vessels were examined in 25 forebrain hemispheres injected with india ink or methylmethacrylate. There were two to seven hippocampal arteries, which measured 200-800 microns in diameter. The anterior hippocampal artery (AHA), which was present in 88.2% of the hemispheres, most often originated from the posterior cerebral and the anterior temporal arteries, that is, within the rostral hippocampo-parahippocampal arterial complex. It arose from the anterior choroidal artery in 29.4% of the hemispheres. The AHA extended between the uncus and the parahippocampal gyrus, and it supplied the head of the hippocampus. The middle hippocampal artery was constant. It most often arose from the posterior cerebral and the common temporal arteries. The middle hippocampal artery coursed just caudal to the uncus, in close relationship with the lateral posterior choroidal artery, and it usually supplied the middle part of the hippocampal formation. The posterior hippocampal artery, which existed in 94.1% of the hemispheres, most often arose from the posterior cerebral and the splenial arteries. It irrigated the caudal part of the hippocampal formation. The anastomoses connecting the posterior, middle, and the anterior hippocampal arteries were present in 29.4% of the hemispheres. The hippocampal arteries gave rise to the straight vessels, which divided into the large and the small intrahippocampal arteries. The highest density of the capillary network was noted in the pyramidal and molecular layers of the hippocampal formation. The clinical significance of the obtained microanatomical findings is discussed.

The anatomical basis for the cerebellar infarcts.

BACKGROUND: Very little can be found in the literature concerning the variation of the irrigation area of the cerebellar arteries, as well as the characteristics of anastomoses among these vessels. The anatomical features may determine certain features of cerebellar infarcts. Consequently, we examined the irrigation area of and the anastomoses among the cerebellar arteries. METHODS: The anatomical features of the posterior inferior cerebellar artery (PICA), the anterior inferior cerebellar artery (AICA), and the superior cerebellar artery (SCA) were studied in 26 cerebella injected with india ink, while their irrigation areas and anastomoses were examined in 8 of these cerebella. RESULTS: The PICA, which most often (82%) arose from the vertebral artery, was found most commonly (81.3%) to supply the largest part of the occipital surface of the cerebellar hemisphere, the caudal or caudomedial part of the tentorial surface, and the inferior vermis. The AICA, which usually (92%) arose from the basilar artery, commonly (68.8%) supplied most of the petrosal surface of the hemisphere and the flocculus. The SCA, which divided into the medial and the lateral trunks, always irrigated most of the tentorial surface of the cerebellum, the superior vermis, and the dentate nucleus. The PICA, AICA, and SCA were always interconnected by anastomoses, which ranged from 40 microns to 420 microns in diameter. CONCLUSIONS: Cerebellar infarcts were documented by computed tomography (CT) or magnetic resonance imaging (MRI) examinations in 10 patients. The infarcts were located in the PICA territory (60%) or the SCA region (40%). The authors compared the obtained anatomic data to the features of the cerebellar infarcts in these patients.

Pyramidal lobe of the human thyroid gland: an anatomical study with clinical implications.

The presence, position, extent, relationships to neighboring structures and size of the human pyramidal lobe were investigated in 58 human post-mortem specimens in order to determine the variability of this structure. The pyramidal lobe is found in 55.2% of cases as a single conical extension of the thyroid gland. It was present more often in male (53.1%) than in female (46.9%) specimens and located slightly more often on the left side of the midsagittal plane (53.1%). According to the origin and location of its base, we defined five types of pyramidal lobe, with the left-sided types (Types III and IV) being predominant. The pyramidal lobe was 22.6 mm long, 11.2 mm wide and 3.6 mm thick (mean values). The means of all measured parameters were higher in female than in male specimens (pyramidal lobe was 2.3 mm longer, 1.6 mm wider and 0.4 mm thicker in female specimens) but these differences were not significant. In addition, we found that the size of the pyramidal lobe was dependent on the presence of a fibrous or muscular band that may represent a fibrous remnant of the thyroglossal duct or the levator glandulae thyroideae muscle. The pyramidal lobe was four times longer and its base was two and a half times wider and three times thicker when it was associated with this band. We believe that our data can be used to perform safer and more effective partial thyroidectomy in order to preserve thyroid function after surgical treatment.

Duplication of the superior vena cava associated with atrial termination of the left hepatic vein.

Duplication of the superior vena cava (SVC), associated with an aberrant left hepatic vein (LHV), was found in one of the 58 dissected specimens. The right SVC virtually showed a typical appearance. The persistent left SVC, which drained into the right atrium via the enlarged coronary sinus, was formed by the persistence of the left anterior cardinal vein. The LHV opened into the right atrium, due to the persistent left hepatocardiac channel. The left common carotid artery arose from the brachiocephalic trunk as a consequence of a regression of the embryonic aortic sac. The revealed venous and arterial variations seem to be the first reported vascular combination of this type.

Anatomical bases for surgical approach to the initial segment of the anterior cerebral artery. Microanatomy of Heubner's artery and perforating branches of the anterior cerebral artery.

Both the Heubner's artery and the perforating branches of the anterior cerebral artery (ACA) were present in all thirty-three examined brains. Heubner's arteries varied in number from 1 to 3. They originated from the distal (A2) segment of the ACA in 34% of the cases, from the proximal (A1) segment of the ACA in 17%, at the level of the anterior communicating artery in 21%, from the fenestration of the ACA in 8%, and in all the other cases (20%) from the azygous anterior cerebral artery, accessory middle cerebral artery, frontopolar artery and, finally, by the common stem with the medial orbitofrontal artery. Heubner's artery most commonly terminated dorsal and lateral to the carotid bifurcation, at an average distance of 4.8 mm. The mean diameter of Heubner's artery was 662 microns, that of its extracerebral collateral branches 205 microns, of the terminal branches 462 microns, and of the intracerebral segments 354 microns. Perforating branches varied in number from 1 to 12 with an average of 6.6. The majority of the branches originated from the initial 6.1 mm of the A1 segment. These vessels terminated close to the carotid bifurcation, at an average distance of 3.8 mm. All the perforating branches were divided into small (average 122 microns in diameter) and large (average 325 microns). The mean diameter of intracerebral segments was 276 microns, and that of terminal branches 259 microns. It was concluded that the anatomical characteristics of both the recurrent artery and the perforating branches can be of a great significance in cerebrovascular diseases.

Anastomoses among the perforating arteries of the brain. Microanatomy and clinical significance.

Anastomoses among the perforating arteries were examined in 50 human brains using injection technique with India ink and gelation, or methylmethacrylate. Anastomoses were not found among the perforators of the internal carotid artery and the thalamogeniculate branches. Anastomotic channels involving perforating branches of the anterior choroidal, middle cerebral, and anterior cerebral arteries were noted in 1% of the cases. Vascular connections of the premamillary arteries were observed in 30% of the brains. They varied from 60 to 280 microns) in diameter, and from 0.3 to 3.6 (mean 1.5 mm) in length. Anastomoses among the interpeduncular (thalamoperforating) branches of the posterior cerebral artery were present in 79% of the cases. They ranged from 80 to 400 microns (mean 146 microns) in caliber, and from 0.9 to 6.1 mm (mean 3.3 mm) in length. Since anastomoses among the interpeduncular and the premamillary arteries are much more frequent than those among other perforators, thalamic, subthalamic, and midbrain's infarctions seem to be less frequent than capsular and ganglionic ischemic lesions.

Branches of the anterior communicating artery. Microsurgical anatomy.

The anterior communicating artery (ACoA) and its branches were examined in 22 human brains after injecting Indian ink or methylmethacrylate. The ACoA branches were divided into the small and the large. Small branches were from 1 to 5 in number (mean 2), and from 70 to 270 microns in diameter (mean 151 microns). Seventy-six percent of the branches originated directly from the ACoA. They tended to arise closer to the left than to the right anterior cerebral artery. Fourteen percent of them arose from the junctional site of the ACoA with the anterior cerebral arteries, and 10% from the site of origin of the subcallosal artery. Large branches were identified as the median artery of the corpus callosum, and the subcallosal artery, respectively. The former vessel was present in 9% of the patients, and the latter in 91%. The subcallosal artery was from 320 to 640 microns in size (mean 486 microns). It tended to arise from the middle of the ACoA. In spite of the very frequent anastomoses involving the ACoA branches, care must be taken to avoid injury to these important vessels during operations of the ACoA aneurysms.