Optico-carotid recess and anterior clinoid process pneumatization â€" proposal for a novel classiï¬cation and uniï¬ed terminology: an anatomic and radiologic study.

BACKGROUND: The aims of this study were to propose a novel and uniï¬ed classiï¬cation system of the optico-carotid recess (OCR) and anterior clinoid process (ACP) pneumatization, determine their frequency in a Caucasian population and measure the size of the OCR. METHODOLOGY: A total of 200 specimen (400 sphenoid sinuses) were evaluated in a separate anatomic cadaveric study (n=100) and radiologic study (n=100) by using sphenoidal sinus cast and computed tomography (CT) scan. OCR was divided according to its location to the optic nerve into sub-optical and latero-optical OCR grade I-III. RESULTS: An OCR was found in 39% of the samples (78/200) and in 19% (38/200) it occurred bilaterally. Both, sub-optical and latero-optical OCR were identiï¬ed in 14% of the sides (58/400), with a mean length and depth of 6.9 mm; 7.7 mm and 2.3 mm, 7.1 mm, respectively. We determined the pneumatized ACP frequency with 23% (46/200) and deï¬ned 3 uniï¬ed different types of pneumatization. CONCLUSIONS: The OCR is a reliable landmark to identify the optico-carotid region in endoscopic sphenoid sinus surgery, and can even be visualized by CT. Hence, preoperative investigation of the sphenoid region is mandatory. In our opinion, the classiï¬cation presented in this study can be useful in order to avoid surgical complications.

Frequency of successful intra-articular puncture of finger joints: influence of puncture position and physician experience.

OBJECTIVE: Physicians and specialists routinely perform IA punctures and injections on patients with joint injuries, chronic arthritis and arthrosis to release joint effusion or to inject drugs. The purpose of this study was to investigate the frequencies of intra- and peri-articular cannula positioning during this procedure. METHODS: A total of 300 cadaveric finger joints were injected with a methyl blue-containing solution and subsequently dissected to distinguish intra- from peri-articular injections. To assess the influence of puncture position on successful injection, half of the joints were injected dorsally and the other half dorso-radially. To assess the importance of practical experience for a positive outcome, half of the injections were performed by an inexperienced resident and half by a skilled specialist. RESULTS: The overall frequency of occurrence of peri-articular injections was much higher than expected (overall: 23%, specialist: 15%, resident: 32%) The failure rate was significantly higher than the average with the joints of the little finger and the DIP joints of each phalanx. CONCLUSIONS: Even skilled specialists cannot guarantee to insert the cannula into the joint in every case. Unintended peri-articular drug injection moreover may affect the surrounding ligaments or tendons, leading to serious complications. Correct positioning of the needle in the joint may be facilitated by fluoroscopy in doubtful cases.

Anatomical variations of coronary ostia, aortocoronary angles and angles of division of the left coronary artery of the human heart.

Classic anatomical dissection of 150 heart specimens from adults aged 18 - 80 years was performed. Anatomical variations were studied in: (i) the position of the ostium of the left coronary artery; (ii) the angle between the proximal segment of the left coronary artery and the longitudinal axis of the aorta and between the circumflex and the anterior descending branches; (iii) the angle between the anterior descending artery and the diagonal branches, and between the diagonal and circumflex branches in trifurcation of the left coronary artery; (iv) the position of the ostium of the right coronary artery in the right coronary sinus of Valsalva; (v) the angle between the initial part of the right coronary artery and the longitudinal axis of the aorta; and (vi) the position of the initial part of the left coronary artery relative to the coronary groove. Knowledge of and the ability to recognize and identify the variety of sites of origin of coronary arteries, aortocoronary angles and angles of division of the left coronary artery of the human heart may help to overcome potential difficulties in cardiosurgical procedures, such as aortic valve replacement and reinsertion of coronary arteries.

Anatomical aspects of the arterial blood supply to the sinoatrial and atrioventricular nodes of the human heart.

Classic anatomical dissection of 150 hearts from adults aged 18 - 80 years was performed. The sinoatrial (SA) node artery was most frequently a large atrial branch of the right coronary artery (63%), arising at a mean distance of 1.2 cm (range 0.2 - 2.2 cm) from its beginning, with a mean external diameter of 1.7 mm (range 1 - 3 mm). In 37% of cases the SA node artery was a branch of the left coronary artery or one of its branches, with an initial mean external diameter of 2.2 mm (range 2 - 3 mm). The origin of the SA node artery was not related to coronary arterial dominance. The atrioventricular (AV) node artery was the first and longest inferior septal perforating branch of the right (90%) or left (10%) coronary artery, arising from the U- or V-shaped segment of the corresponding artery at the level of the crux cordis. Mean external diameter was 2 mm (range 1 - 3.5 mm). The origin of the AV node artery was dependent on coronary arterial dominance. Identification of the anatomical variants of the arterial blood supply to the SA and AV nodes may help in overcoming potential difficulties in treating arrhythmias and in mitral valve surgery.

Anatomical variations of the coronary sinus ostium area of the human heart.

Classic anatomical dissection of 150 heart specimens from adults aged 18 - 80 years was performed. The Thebesian valve was absent in 20% of cases and, in these, 4% had a large ostial valve of the middle cardiac vein in front of the coronary sinus ostium. Fibres of Chiari were found in 10% of cases. Ostia of the middle cardiac vein, posterior veins of the left ventricle, small cardiac vein and deep cardiac veins were present in the distal 10 mm of the coronary sinus. Some samples had ostial and/or parietal valves or antivalves that sometimes contained muscular fibres. Distal accessory parietal valves (2%) and antivalves (1%) of the coronary sinus wall were found at a distance of 4 - 7 mm from its ostium. The frequency and variability of anatomical structures in the area of the coronary sinus ostium probably influence the haemodynamics of this area. Knowledge of and being able to identify these anatomical variations may help in identifying and overcoming potential difficulties in treating arrythmias and in cardiosurgery.

Additional muscle in idiopathic club foot.

During the dissection of seven club feet of foetuses, aborted between the 25th and 37th week of gestation, an additional muscle bundle was found in a right foot. This muscle arose from both heads of the gastrocnemius muscle, continued downwards onto the posterior surface of the soleus, crossed the calcaneal tendon and assumed a position on the lateral side of the calcaneal tendon. The muscle's tendon was fixed just laterally to the calcaneal tendon in the calcaneal tuberosity with some tiny fibres branching off into the superior fibular retinaculum.

[The nomenclature of the blood vessels of the kidney]. / Zur Nomenklatur der Nierengefässe.

The differing interpretations of the course of the renal artery-branches possibly are caused by the Nomina Anatomica. The course of the branches of the renal artery is described and based upon this less misleading names for these branches are suggested.

Variations in the branching of the internal pudendal artery in the ischioanal fossa.

The branches of the ischiorectal part of the internal pudendal artery include the inferior rectal artery and small branches to the obturator internus muscle. For our research we had 164 embalmed half pelves, the arteries of which has been injected by the Thiel method. After the dissection of the ischioanal fossa the arteries were documented. Four types of branching of the inferior rectal artery were found. I. (43%) One artery on each side. II. (31%) Two arteries on one side. III. (4%) Three arteries on one side. IV. (22%) Two arteries or more on each side. In the specimens examined we found one branch to the obturator internus muscle in 31%, two branches in 43% and three branches in 11%. In 15% of cases this branch was absent. In seven cases two branches formed an anastomosis parallel to the internal pudendal artery.

Anatomical variations of the posterior intercostal arteries and the thoracic vertebral artery.

This study evaluated the occurrence and frequency of the anatomical variations of the origin and course of the posterior intercostal arteries (PIA) in 44 human cadavers. During a classical anatomical dissection of each cadaver an anomalous course of the PIA, defined as a thoracic vertebral artery, was found in six (14%) individuals. Every dorsally coursing PIA was taken into account, regardless of its origin, and their different origins and course were described. A specific dorsal course for the PIA was found in nine cases, which was bilateral in two cases. The variations that were found and that have been schematically presented will provide new information about the anatomical variations of the PIA. Consideration of the potential for anatomical variation of the PIA is important in vascular and thoracic surgery and in diagnostic and interventional radiology such as spinal angiography.

[Meaning of stylopharyngeal fascia in intraoral block techniques]. / Die Bedeutung der Fascia stylopharyngea bei intraoralen Blockadetechniken.

BACKGROUND: The almost unknown stylopharyngeal fascia may be one of the reasons for unsuccessful therapy of the trigeminal neuralgia by a transoral block of the superior ganglion of the sympathetic trunk. We investigated the anatomy of the fascia to show the efficiency of the block for this therapy. MATERIALS AND METHODS: 103 halves of human heads were investigated. The stylopharyngeal fascia was dissected by a lateral approach. We classified three groups. Group A was formed by fascias without perforation, group B by perforated fascias and group C by all halves without a developed fascia. RESULTS: We found a fully developed fascia in 86 cases. 13 halves had perforated fascias; in 4 cases the fascia was not developed. CONCLUSION: The stylopharyngeal fascia may inhibit the distribution of opoids into the infratemporal fossa associated with a consecutive block of the mandibular nerve and lower the rate of pain relief.

[Training methods for regional anaesthesia. Evaluation and comparison]. / Trainingsmethode für Regionalanästhesisten. Evaluierung und Vergleich.

INTRODUCTION: Optimized training facilities are the key to efficient teaching of regional anesthesia. MATERIAL AND METHODS: A combination of Thiel's embalming method, flap dissection and pulse simulation was offered to participants in several workshops on regional anesthesia. Tutors, experienced anesthetists and anatomists, evaluated the workshop and compared Thiel's method to classic formaldehyde conservation. Additionally both embalming methods were assessed with regard to the mechanical properties according to the requirements of regional anesthesia. RESULTS: The evaluation showed high acceptance of the method offered in the workshop. In a comparison of fixation methods Thiel's method was generally preferred as it presented more similar conditions to living patients and almost ideal conditions for regional anesthesia. CONCLUSION: The presented method is an optimized, strongly accepted teaching and training tool for teaching regional anesthesia.

Promontory of radius: a new anatomical description on the distal radius.

Surgical treatment of distal radius fractures with palmar plates has gained popularity as the preferred approach to achieve anatomical fracture reposition. One hundred and thirty four radii of human cadavers were examined to elucidate the anatomy of the distal radius, especially the transition of the anterior into the lateral surface and a new term was given: promontory of radius. The promontory was located on the lateral surface between the changing of the convex to the concave curvature and the base of the styloid process. The anterior surface increased gradually from the ulnar notch to the lateral surface and formed the "base" of the promontory. The length of the promontory on the lateral surface measured 14-28 mm (mean 20.766 mm, SD 2.69 mm). The width of the promontory was found in between 10 and 27 mm (mean 13.857 mm, SD 2.14 mm). The width of the distal radius was 16-38 mm (mean 31.015 mm, SD 3.26 mm) and did not show any statistical correlation to the promontory. On the anterior surface the minimal width of promontory measured 4.9 mm, the maximal one 17.9 mm (mean 8.95 mm, SD 3.60). The height of the promontory on the anterior surface ranged in between 1.2 and 4.3 mm (mean 2.90 mm, SD 1.05 mm). The promontory of radius must be kept in mind to avoid any dorsal dislocation of the radial fragment often described as complication of intraarticular fractures. Based on this anatomical survey the data can be used for a new palmar radius plate designs.

[Sinus-parenchyma border of the human kidney as the site of origin of intracanalicular and extravascular diffusion of fluids]. / Die Sinus-Parenchym-Grenze der menschlichen Niere als Entstehungsort intracanaliculärer und extravasaler Flüssigkeitsausbreitungen.

Injecting fluids into the kidney against the physiological direction of flow leads to a passage of liquid across the border-line between the renal sinus and the parenchyma. This event, caused by a sudden raising of pressure during the injection is called pyelorenal backflow. It can be divided into a number of subtypes, as there are: pyelocanalicular backflow, pyelosinous backflow, pyelovenous backflow, pyelolymphatic backflow. Among all these phenomena only the pyelocanalicular backflow can be interpreted as a genuine backflow in the fullest sense of the word, while the others never can happen before the fornix had been mutilated. In the case of pyelocanalicular backflow, the contents of the renal pelvis regurgitate into the Ducts of Bellini, but the fluid never goes beyond the collecting ducts in the pyramids. Neither a rupture of the tubuli, followed by an interstitial spreading up to under the capsule, nor a direct penetration into the medullary veins are possible, because the pressure necessary for it causes a rupture of the fornix earlier. This rupture happens step by step as an oblique dissection of the calyx from the papilla. The big calices at the poles show an increased tendency to rupture because they are attached along a line which is shaped like an "8" or like a clover leaf, and so do calices the angle of which is acute. Depending on whether a vein is torn simultaneously with the fornix or not, the contents of the pelvis transflow into the vein (pyelovenous backflow) or into the sinus (pyelosinous backflow). In spite of a previous pyelocanalicular backflow the pelvis is not relieved of pressure to such an extent that there could not occur an additional rupture of the fornix, nevertheless. The pyelosinous backflow leads to a sinus-extravasation which can ascend towards the parenchyma and descend towards the hilum. The ascending sinus-extravasation spreads out within the vascular canals of the kidney. These canals, strictly situated between cortex and medulla, enclose a pyramid (Canales peripyramidales) and contain the interlobar and arcuate bloodvessels. The space between the bloodvessels and the wall of a peripyramidal canal (perivascular space) is filled with connective tissue consisting of 3 components: tunica adventitia of the bloodvessels themselves and fibres originating from the inner capsule and the wall of the calyx. The ascending sinus-extravasation proceeds into the perivascular space by pushing off the bloodvessels from the medulla.(ABSTRACT TRUNCATED AT 400 WORDS)

[Venous valves in the large branches of superior vena cava]. / Venenklappen in den grossen Wurzelstämmen der Vena cava superior.

In 97 human cadavers the valves of the following blood vessels were investigated with regard to their cusps and their sizes and positions: the internal jugular veins, the subclavian veins, the brachiocephalic veins, and the superior vena cava. The cusps of each of the valves, which consist of two or three parts, are neither always of equal size nor obligatorily sufficient. Unipartite valves may be sufficient as well as insufficient. Internal jugular veins: The inferior bulb of the internal jugular vein is provided with valves which in 6% of the cases consist of three parts, in 66% of two parts, and in 15% of only one cusp. The concave margins of most of them go down as far as the venous angle. The convex edges attached to the wall of the vein extend to a higher level on the right side than on the left. In 13% there do not exist any valves. Varieties are described separately in this paper. Subclavian veins: Valves are found along the length of the vessel. Only few of them reach the venous angle. In rare cases there exist two valves: one at the beginning, the other at the end of the subclavian vein. In 4% of the cases the valves consist of three, in 75% of two cusps. In 12% they are unipartite. In 9% there are no valves to be found. The right side is more often without valves than the left. Brachiocephalic veins: Only a minority of these vessels is provided with valves. Most of these consist of one cusp, are insufficient, and are situated in the left innominate vein.(ABSTRACT TRUNCATED AT 250 WORDS)

[Direction of the course and changes in the cross-section of the subclavian vein depending on the positions of the shoulder]. / Verlaufsrichtung und von den Schulterstellungen abhängige Querschnittsveränderungen der Vena subclavia.

Dental mold material was injected into the right subclavian veins of 10 human cadavers presenting six different positions of the right shoulder. By means of the so produced preparations the position of the subclavian vein was defined precisely in relation to the frontal plane. Besides that the direction of the first rib's groove for the subclavian vein was determined in 10 skeletons. The subclavian vein swerves slightly anterior arching over the first rib in an acute angle to the frontal plane. Cross sections of the preparations mentioned above were made and used for prints; thus the changes of the lumen in different shoulder positions could be clearly perceived. If the shoulder is lifted or pushed forward the subclavian vein expands; in upward-forward position of the shoulder the vein gains its maximum width. If the shoulder is lowered the subclavian vein is slightly constricted; if the shoulder is pushed back the vein is compressed to a minimum width. The significance of these: facts in regard to subclavian vein catheterization is discussed.

[Occurrence of anastomoses of the intrahepatic bile ducts]. / Zur Frage nach dem Vorkommen intrahepatischer Gallengangsanastomosen.

Eighty-four human livers were investigated with regard to the existence of vascular communications within their biliary tracts. Even with the help of a most subtle technique we could not detect any junctions between the bile ducts, so that there is no evidence of primary anastomoses between the main lobes, between the segments, or inside the segments. In case of chronic biliary obstruction only the major ducts, e.g., up to the fourth generation, are amplified. There is an inflammatory reaction around the smaller vessels, followed by fibrosis and shrinking of the connective tissue. That is why the formation of secondary anastomoses cannot happen under pathological conditions.

[Compensatory movements of the fibula necessitated by the wedge shape of the trochlea tali]. / Kompensationsbewegungen der Fibula, die durch die Keilform der Trochlea tali erzwungen werden.

The lateral articular facet of the talus (Facies malleolaris lateralis) is slanting and irregularly shaped; therefore, the fibula shows compensative motions in transverse, sagittal, vertical and rotational directions when the ankle joint is moved. There are contradictory statements concerning the course of this compensative rotation, because the fibula shows individually different reactions. The fibula is not rotated during dorsiflexion in nearly 25% of legs; approximately one half of the remaining fibulae is rotated outward, the other half inward. The matter of fact is not surprising, when the shape of the lateral articular facet is inspected exactly: it resembles a flat saddle, the anterior part of which is screw-shaped. The fibula rotates outward during dorsiflexion, if the furrow of this screw-shaped area increases forward; it rotates inward, if the furrow diminishes forward; and it does not rotate at all, if the furrow is constant.

[Pyelorenal reflux. I. Actual and presumed routes]. / Der pyelo-renale Reflux. Teil I: Tatsächliche und vermeintliche Wege.

An acute increasing pressure in the renal pelvis effects the phenomenon of pyelo-renal backflow. There is a confusing number of ways of the pyelo-renal backflow described so far, yet only few types of these ways can be verified by various and detailed investigations. 1. The pyelo-tubulous backflow (ptR) is a true backflow of the contents of the renal pelvis into the tubuli of the kidney. In no case tubuli rupture, because other ways of backflow are preferred instead of. 2. The pyelo-sinous extravasation (SE) is an outflow of the contents of the pelvis into the renal sinus owing to a rupture of the fornix. Starting from the ruptured fornix a descending extravasation spreads out between the pelvic wall and the adipose tissue in renal sinus, whereas an ascending extravasation spreads out between the flank of the pyramid and the adipose tissue. Horn-like arched ascending extravasations have been mistaken frequently for a backflow into the arcuate veins or even into their perivenous spaces. 3. The pyelo-venous backflow (pvR) is a transflow of the contents of the pelvis into an interlobar vein ruptured jointly with the fornix. 4. The pyelo-lymphatic backflow (plR) is a transport of the extravasation via lymph vessels. There can be a single way of backflow as well as divers combinations of the above mentioned types.

[Uni- or bilateral hepatoenterostomy in central bile duct occlusion?]. / Ein- oder beidseitige Hepatoenterostomie bei zentralem Gallengangsverschluss?

With the help of different microscopic and macroscopic techniques 100 livers have been investigated to find out whether there are primary and secondary intrahepatic communications between the bile ducts of the right and the left lobe. The results of these investigations are compared with eight case reports. To find the best surgical approach to extensive tumorous blockage of the hilus it is basically necessary to know the anatomical situation in detail.

[Arterial vascularization of the tail of the pancreas with special reference to the relation of the tail and body vessels]. / Arterielle Gefässversorgung der Cauda pancreatis unter besonderer Berücksichtigung der cauda-corporealen Gefässbeziehungen.

The cauda pancreatis has a characteristic pattern of vascularization. Among the big arterial stems surrounding it, up to 4 arteries, 'caudal arteries', nourish the arterial system of the cauda. These stems originate especially in the Arteria gastroepiploica sinistra and in the lower main splenic branch of the Arteria lienalis. The vascular relations between corpus and cauda can be of different kinds. Five basic types of relations can be identified: type I: the cauda is supplied exclusively by caudal arteries; type II: at least one caudal artery anastomoses with the vessels of the corpus; type III: the cauda is supplied both by the caudal arteries and by vessels of the corpus (non-anastomosing); type IV: combined forms of blood supply by caudal arteries and corpus arteries by way of anastomoses and non-anastomosing vessels are found; type V: the cauda is supplied exclusively be vessels stemming from the corpus. In each of these five types, individual vessels supplying the cauda can assume the function of a terminal vessel.