[Collateral circulation of the left colon: historic considerations and actual clinical significance]. / Die kollaterale Gefässversorgung des linken Hemikolons. Historische Beobachtungen und aktuelle klinische Bedeutung.

INTRODUCTION: The arterial communication between the superior and inferior mesenteric arteries is important in surgery of the colon and aorta. METHODS: The anastomosis between the median colic artery (ACM) and the superior colic artery (AMS) was studied on 52 cadavers (32 female, 20 male). The length of the artery was measured using a flexible scale, and its diameter was determined at three different locations (origin, middle, end). RESULTS: The median lengths of the arteries were: 6.8 cm (range 3.9-9.7) for ACM, 12.2 cm (range 7-17.4) for ACS, and 23 cm (range 13.6-34.2) for margin artery. The median diameters were: 3.4 mm (range 2.7-4.1) for ACM, 3.1 mm (range 2.1-4.1) for ACS, and 2.7 mm (range 2-3.4) for margin artery. In 9.6% of the cadavers ( n=5), additional anastomoses between the AMS and inferior mesenteric arteries were proven. In 90.4% ( n=47), only margin arteries were found. SUMMARY: The low incidence of an additional communication (Riolan's arch) and possible additional impairment of the blood supply should be taken into account during operation.

Applying circular posterior-hinged craniotomy to malignant cerebral edemas.

Malignant brain edemas are often fatal, regardless of whether they are treated conservatively with sedation, blood pressure management, mannitol-therapy, hyperventilation and hypothermia, or non-conservatively with routine trepanation. Unfortunately, temporal trepanation may result in significant brain damage through herniation of the cerebrum at the edges of the trepanation openings. In one case of a 26-year-old male with severe head injury, a circular posterior-hinged craniotomy (CPHC) was performed after an ineffective unitemporal trepanation for evacuation of an acute subdural hematoma. This ultimately successful operation prompted experimental and morphologic investigations on a new surgical procedure for lowering intracranial pressure (ICP). In 12 of 15 human cadavers, an experimentally ICP was lowered by a CPHC with between 9-21 mm of frontal elevation of the calvaria. Using computer simulation, the frontal elevations of the calvaria were "virtually" performed on 3D reconstructions from CT scans of skulls, and the intracranial volume gained was measured with a computer software program. The volume increase of the cranial cavity showed a relatively constant relation to the cranial capacity and was increased by 6.0% (+/-0.4%) or 78 cm(3) with a 10 mm elevation and by 12.4% (+/-0.7%) or 160 cm(3) with a 20 mm elevation. There were no significant differences with skulls of different ages or ethnic origin; however, a significant effect of gender (F = 7.074; P < or = 0.013) on the gained volume in percent of the cranial capacity for the 20 mm elevation was observed. This difference can be explained by the inverse relationship between volume increase and cranial capacity (r = -0.507; P < or = 0.004).

Morphology and histochemistry of myogelosis.

Myogelosis is a common diagnosis in the case of chronic pain conditions, especially in the region of the pectoral girdle musculature, the glutei muscles, and the erector spinae muscle. Although such indurative areas continue to be palpable even on the cadaver, few studies concerning the morphological substrate of these areas have been undertaken. Selected biopsies as well as larger tissue samples were taken from 11 corpses and prepared for histological study. Following staining, the frozen sections were examined morphometrically. A histologically constant, significant morphological alteration was found in the areas of concern. The spaces between the individual muscle fibers of healthy muscle tissue appear relatively wide, the endomysium of the myogelotic area are clearly narrowed. Split fibers, ragged red fibers, Type II fiber atrophy, and fibers with a moth-eaten appearance have been detected. The morphometry shows considerable increase in thickness of the affected muscle fibers, suggestive of a pathological, local hypertrophy. The changes described may well represent a fixed condition, so that it should not be surprising that myogelosis therapy is difficult and protracted.

Auditory ossicle abnormalities and hearing loss in the toothless (osteopetrotic) mutation in the rat and their improvement after treatment with colony-stimulating factor-1.

Osteopetrosis describes a group of skeletal metabolic diseases of heterogeneous etiology and varied severity that produces a generalized accumulation of skeletal mass, the result of reduced bone resorption. Inherited in a variety of species including humans, the most severe forms are lethal. Among common features are progressive blindness and deafness of controversial etiologies for which there are no universally effective treatments. We have studied the auditory responsiveness and auditory ossicle quantitative histomorphology and temporal bone vasculature in the toothless (tl) rat, a lethal osteopetrotic mutation with few osteoclasts, very low bone turnover, and limited angiogenesis in the axial skeleton. Compared with normal littermates, 3-week-old mutants showed significantly reduced auditory responsiveness, a hearing loss due to abnormalities in both form and tissue composition of the stapes, and little capillary sprouting in the vascular bed of the temporal bone. Treatment of mutants with colony-stimulating factor 1 (CSF-1), known to greatly reduce sclerosis in the axial skeleton, significantly improved hearing, stapedial form and tissue composition, and angiogenesis in the temporal bone. In normal rats, the stapes consisted of 89.3% bone, 9.1% mineralized cartilage, and 0.8% porosity. In osteopetrotic rats, the stapes consisted of 48.3% bone, 35.9% mineralized cartilage, and 15.9% porosity, while after CSF-1 treatment, the bone content increased to 55.2%, cartilage was decreased to 21.7%, and porosity increased to 23.0%, respectively. This is the first demonstration of an auditory abnormality in an osteopetrotic animal mutation and shows that the hearing loss in tl rats can be significantly improved following treatment with CSF-1.

The microvenous valvular anatomy of the human dorsal thoracic fascia.

The use of free scapular fasciocutaneous flaps for reconstruction of recalcitrant grade 6 venous stasis ulcers has shown excellent early success rates. Venous refilling times measured postoperatively over the flaps by photoplethysmography have noted improvements to normal levels. Preliminary anatomic studies have demonstrated valves in the circumflex scapular veins of flaps used in reconstruction. The purpose of this study was to investigate and document the number, morphology, size, and location of valves in the human dorsal thoracic fascia. Ten scapular flaps were obtained from unembalmed cadavers and injected with methyl methacrylate. Each flap cast was divided into four parts: proximal, right and left, and distal, right and left. We reduced the size of specimens (the largest being 24 x 11 mm) and studied them in a scanning electron microscope. We identified all valves, estimated the diameter of the corresponding vein, calculated the depth of the valvular sinus, and related it to the corresponding venous size. Light microscopy and transmission electron microscopy were used as assisting tools applied to glutaraldehyde-fixed specimens. Analysis of injected specimens showed that valves were most abundant in veins with a luminal diameter of 30 to 120 microns (59.3 percent of 905 valves). The depth of valves became larger with increasing venous diameter. The sizes of valve sinuses were not different for individual valves. Except for veins larger than 1000 microns in diameter, there was no significant difference between the number of valves in different parts of an individual flap, nor were there significant differences between the valve numbers in different flaps. Most valves were bicuspid; only in the vein category of 30 to 120 microns were unicuspid valves encountered. Valves sometimes were located in series in a short segment of a vein; occasionally, they were found at the merging site of two veins. Transmission electron microscopy showed that valve leaflets had collagen fibers that ascended toward the tip of the leaflet and occasionally were accompanied by elastic fibers. Myofibroblasts were regularly present in the valve leaflets. These data show that fasciocutaneous flaps from the scapular region have numerous valves (90 valves on average in each flap) in the venous microcirculation. The microvenous valves in the dorsal thoracic fascia appear to be structurally similar to valves in larger veins. These valves may play a role in the improved hemodynamics and promising clinical outcome of patients with chronic venous insufficiency who have undergone free scapular flap reconstruction.

Modifications of the paraspinous muscle flap: anatomy and clinical application.

Soft-tissue defects of the back, particularly involving the paravertebral tissues, are generally covered with myocutaneous, muscle, or fasciocutaneous flaps. The case of a 64-year-old man with a paravertebral malignant fibrous histiocytoma is reported. To ensure adequately radical margins, the ipsilateral trapezius and latissimus dorsi muscles as well as the costal periosteum and the spinous processes were resected between T9 and T12. The resulting defect was covered with a pedicled latissimus dorsi flap and an island flap of the paravertebral muscles. Prompted by this case, we studied the blood supply of the paravertebral muscles in 10 cadavers. The vasculature was visualized after flushing with colored latex and microsurgical dissection. Another 4 specimens were subjected to angiography and tomography. In the majority of cases (8 of 10), three perforators emerging from the intercostal arteries were identified. These were found to communicate in a longitudinal and vertical direction. Before piercing the fascia, they ramified in three layers matching the layers of the paravertebral muscles. Since the intercostal arteries were shown to communicate through anastomoses of adequate caliber, the paravertebral muscles appear to be useful candidates for proximally or distally pedicled transposition or island flaps.

The cochlear glomeruli in the modiolus of the guinea pig.

The cochlear glomeruli were studied in guinea pigs using scanning electron microscopy of vascular corrosion casts and transmission electron microscopy of tissue sections. Two types of coiled vessels forming the cochlear glomeruli were found in the bony wall of the modiolus. First, upper glomeruli were seen situated in the bony wall next to the scala vestibuli; second, lower glomeruli were located in the osseous spiral lamina just above the spiral ganglion. Upper glomeruli gave rise to radiating arterioles which supplied capillaries of the stria the spiral lamina and limbus. Unlike the main supplying arteries, smooth muscle cells were not present in the walls of the arterioles forming the glomeruli and a peculiar layer of lamellar pericytes was found. The arterioles were strikingly longer than their parent vessels and no autonomic nerves were found in close spatial relationship. Hence, these findings indicate that the cochlear glomeruli serve as efficient devices for reducing cochlear blood pressure.

Chemically-induced chronic nerve compression in rabbits--a new experimental model for the carpal tunnel syndrome.

In order to create an experimental model for the carpal tunnel syndrome without the use of the commonly applied foreign bodies (silicone or rubber tubes, tourniquets etc.), the present study tried to induce a chemically provoked compression of the median nerve in rabbits. In 9 female rabbits 1 ml of Aethoxskerol 3% (Hydrox-polyethoxy dodecan) was instilled into the carpal tunnel around the median nerve after visualisation of the nerve. The other foreleg served as the control and was treated with the same amount of saline solution. Electroneurophysiologic parameters were registered preoperatively, 1 month and 6 months post surgery and histomorphologic investigations by light and electron microscopy were performed after 6 months. 6 months after treatment with Aethoxysklerol, a statistically significant lengthening of the distal latency period as well as a significant reduction of the compound potential amplitude could be observed. In accordance with these findings, morphological investigation revealed the presence of extensive granulation tissue around the median nerve together with signs of demyelination. Our results indicate that we were able to produce the development of extensive granulation tissue in the carpal tunnel of rabbits with subsequent compression of the median nerve which was confirmed by histomorphologic investigation as well as by measurement of nerve conductive velocity.

Prostaglandin (PG) E1 and 13,14-dihydro (DH) PGE1 are diminishing radiation-induced arterial damage.

Rabbit abdominal aorta was irradiated with single or repeated doses up to 10 Gy. The rabbits were killed at different time intervals after irradiation. 5 micrograms/kg x 6/hr PGE1 or its biologically active metabolite 13,14-DH-PGE1 were administered either 6 hours before or 6 hours after irradiation. The administration of both PGEs reduced radiation-induced mitotic activity (3H-thymidine incorporation) and extracellular matrix [collagen-(14C-proline) and glycosaminoglycan (35-S-sulphate)]-formation as determined by means of autoradiography. The initial peak increase in vascular PGI2-synthesis was partly abolished, while the long lasting depression was less pronounced. 13,14-DH-PGE1 was only slightly less active as compared to the parent compound. Pre-radiation treatment was more effective than post-irradiation therapy. These findings suggest that both the PGs exert significant radiation-protective actions on the arterial wall.

Studies on the microvascularization of the digestive tract by scanning electron microscopy of vascular corrosion casts. 2. Bile duct in guinea pigs.

The microvascularization of the bile duct was studied in 20 adult guinea pigs (Cavia porcellus) using microvascular corrosion casts in the scanning electron microscope. The main supplying and draining vessels are located in the adventitial layer; from there they form the subepithelial capillary network. The microangioarchitecture of the common bile duct is reminiscent of that of the cystic and hepatic ducts. The diameter of these ducts is 1,000 microns on average. The microvascular arrangement in the bile duct suggests a probable involvement of the capillaries in the absorption of bile hormones.

The microvasculature of the guinea pig ureter. A scanning electron microscopic investigation.

In 24 albinotic guinea pigs (Cavia porcellus) the gross vasculature and the microvascular architecture of the ureter were studied by light microscopy of tissue blocks and by scanning electron microscopy of vascular casts. The guinea pig ureter is supplied by the renal artery proximally, by the aorta and the internal iliac artery in its mid-segment, and by the uterine and prostatic as well as by the vesical arteries distally. The main arterial trunks run alongside the ureter before they branch to send perforating arterioles to the muscular coat and the mucosal lining. The draining venules are found on both sides of the ureter and form transverse anastomoses. Communications between the arterioles are also located on both sides, but longitudinally arranged. The capillary network of the mucosal lining shows an undulating pattern with tortuous vessels and lies just below the epithelium. The muscular coat and the adventitia have no prominent capillaries of their own. Large arteries are embedded in the adventitia, large veins in the lamina propria. In analogy to human anatomy the vascular arrangement found suggests that, if the ureters are excised in transplant surgery, a lateral incision should be used for the abdominal portion, while the pelvic portion is best approached by a medial incision.

Photogrammetry of the muscles of facial expression.

The present study has attempted to determine the volume, square measure as well as length, width and thickness of the individual muscles of facial expression by photogrammetry. 15 fresh male head specimens were employed for a careful dissection of muscle layers. The volume was measured using the immersion procedure. The mean values of each parameter together with the standard deviation were summarized. The results suggest that this novelty in the representation of the mimetic muscles will facilitate the planning of corrective interventions in plastic surgery. Moreover, photogrammetry offers additional information on the required size and measurements of donor muscles.

Sonoanatomy of the muscles of facial expression.

Primary anatomic studies served for identification and differentiation of the individual mimetic muscles. As a second step, we investigated the clinical potential of ultrasound imaging to visualize the mimetic musculature in 15 volunteers. This examination technique was used to diagnose pathological alterations, especially associated with facial palsy. The excellent sonographic visualization of the mimetic musculature indicates that this technique may be a valuable adjunct in the diagnosis and differentiation of facial palsy, as well as in planning plastic surgery and reconstructive procedures, and in follow-up care.

[Prostacyclin- and thromboxane synthesis in the vascular wall after gammatron irradiation]. / Prostacyclin- und Thromboxansynthese der Gefässwand nach Gammatronbestrahlung.

One year aged rabbits were exposed to a single dose of 100, 500 or 1000 rd (1.0, 5.0 or 10 Gy) to the abdominal aorta. The non-irradiated thoracic aortic segment served as control. The animals were killed between one and 336 hours after the irradiation. Four animals were examined in each group. The prostacyclin formation was assessed by means of a radioimmunoassay against its stable breakdown 6-oxo-PGF1 alpha, the thromboxane A2-formation using a radioimmunoassay for thromboxane B2. Local irradiation causes a temporary increase of both the compounds. In contrast to thromboxane B2, the 6-oxo-PGF1 alpha exhibits a long-lasting depression. The higher the radiation dose, the more intensive the increase and the long-lasting depression of 6-oxo-PGF1 alpha. The liberation of eicosanoids and subsequent hemostatic dysregulation at different intervals after irradiation might contribute to an important extent to the radiation induced vasculopathy.

Sonography of the tongue and floor of mouth.

The study about the sonoanatomy of the tongue and the floor of the mouth was undertaken with 20 volunteers. A description of the examination technique is given in comparison with computerized tomography. It is pointed out that it is easier to adjust the section planes optimally to the anatomical situation with ultrasound. This examination technique is noninvasive and easy to do. It is comfortable for the patient and can be repeated frequently, for example it allows a follow-up of cancer patients. Finally--this technique is cheap and can be performed at any given place.

Anatomical bases of patellar tendon grafts used in anterior cruciate ligament reconstruction.

In 24 fresh specimens the blood-supply of the infrapatellar fat-pad was investigated by injection. In some of the specimens, Clancy's pedicled patellar tendon graft for anterior cruciate ligament reconstruction had been performed before injection. The fat-pad is supplied by vessels forming a plexus supplying the tendon. In the tendon grafts injected after Clancy's procedure, no vessels were found penetrating the patellar tendon at its patellar and tibial attachments. Filled vessels were found by histologic methods and the Spalteholz technique.

[Radiation vasculopathy--caused by a change in vascular prostacyclin synthesis?]. / Strahlenvaskulopathie--bedingt durch Anderung der gefässeigenen Prostazyklinsynthese?

Earlier investigations revealed morphological damage of the vascular wall after radiotherapy. The present investigation was undertaken to determine whether vascular prostacyclin synthesis plays a causative role in the genesis of vasculopathy. Rabbits were exposed to a focal radiation dose of between 500 and 5000 rad over various time intervals. Vascular PGI2-synthesis increased significantly immediately after radiation, with a subsequent decrease over the following days to levels below the starting values. Each repeated radiation dose induced a significant increase in PGI2-synthesis again. These observations were paralleled by severe morphological alterations, mainly localized in endothelial cells and elastic material. The findings suggest that a deterioration in PGI2-synthesis plays a key role in the genesis of radiation-induced vasculopathy.

Radiation induced alterations in rabbit aortic prostacyclin formation.

Earlier studies have demonstrated very severe vascular lesions occuring after irradiation in human and experimental animals as well. We examined the rabbit aortic PGI2-formation using the platelet bioassay technique in one year aged rabbits after different irradiation doses and a time course. The findings demonstrate a significant increase in prostacyclin formation, which might be due to the damage of endothelial cells. This stage is followed by a long lasting severe depression. This behaviour in addition demonstrates a dose dependent manner, The findings of a long lasting decrease in vascular PGI2-formation might contribute to the understanding of the high incidence of vascular lesions being found at the site of irradiation.

[The anatomy of the Isthmus pharyngis (author's transl)]. / Zur rekonstruierenden Chirurgie des isthmus pharyngis. I. Die Anatomie des Isthmus pharyngis.

The boundary between the nasal and oral part of the pharynx has not yet been named definitely in surgical anatomy. The term Isthmus pharyngis in analogy to Isthmus faucium is proposed and the anatomy of this region is described. The importance of these structures in reconstructive surgery is emphasized.