An unusual bilateral sternalis muscle.

In the current study, we present a bilateral sternalis muscle, which was found during routine dissection of a 64 years-old Caucasian male cadaver. At the right side, the muscle had an unusual morphology, namely it consisted of three almost parallel strap-like muscle slips. Moreover, we discuss the innervation, origin and incidence of this variation, which are under controversy, as well as its clinical relevance.

Anatomical variation of left internal jugular vein: clinical significance for an anaesthesiologist.

BACKGROUND AND OBJECTIVES: Cannulation of a central vein is an everyday procedure in anaesthesiology. However, anatomical variations of the size and/or location of the internal jugular vein might prevent cannulation, while repeated efforts might lead to severe complications. The aim of this retrospective study was to explore anatomical abnormalities of the internal jugular vein with regard to diameter of the vein's lumen and to define their clinical significance. METHODS: The cervical regions of 93 cadavers, 186 sides in total, were dissected and the anatomical variations of internal jugular vein diameters in relation to the external jugular vein and to the common carotid artery were recorded and photographed. RESULTS: The diameter of the veins in three cases were less than 6 mm, while ipsilateral external jugular veins were larger than average (3/93). CONCLUSIONS: Anatomical variations of the internal jugular veins are clinically significant, especially in cases where venous access is important.

An accessory double cystic duct with single gallbladder.

A case of double cystic duct was detected during preparation of cadavers for educational purposes in a 76 year old woman. The two cystic ducts formed a triangular formation with the common hepatic duct. That is the fifteenth reported case in the literature. We report on the exact description of the macroscopic anatomy of that rare congenital abnormality, the pathogenesis of that anomaly and the possible surgical implications following misdiagnosis of that anomaly.

Proposal for classification of the suprascapular notch: a study on 423 dried scapulas.

The present study proposes a simple and reproducible method to classify the morphology of the suprascapular notch (SSN), on the basis of specific geometrical parameters that clearly distinguish one type from another. Four hundred twenty-three dried scapulas from the Department of Anatomy in the University of Cologne, Germany, were examined. Five types of SSN were observed: type I, without a discrete notch, 35 (8.3%); type II, a notch that was longest in its transverse diameter, 177 (41.85%); type III, a notch that was longest in its vertical diameter, 177 (41.85%); type IV, a bony foramen, 31 (7.3%); type V, a notch and a bony foramen, 3 (0.7%). For the vertical diameter, we took the maximal diameter of the notch perpendicular to the imaginary line that joins the two superior corners of the notch. For the transverse diameter, we took the diameter perpendicular to the midpoint of the vertical diameter. This classification based on the vertical and the transverse diameters of the SSN suggested a clear distinction of the notch types. This simple classification included all the anatomical variations of the SSN. Using this method, the clinician will be able to define easily and quickly the notch type on a plain radiograph, and perhaps be able to correlate suprascapular nerve entrapment with a specific type of SSN.

Correlation between the four types of acromion and the existence of enthesophytes: a study on 423 dried scapulas and review of the literature.

The purpose of this study was to correlate the four types of acromial shape with the existence of enthesophytes, which together comprise two important parameters for subacromial impingement syndrome and rotator cuff tears. In addition, a review of the literature was carried out. Four hundred twenty-three dried scapulas were studied at the Department of Anatomy in the University of Cologne, Germany. Four types of acromion were found: the three classical ones as described by Bigliani et al. ([1986] Orthop Trans 10:216) and a fourth one, where the middle third of the undersurface of acromion was convex (Gagey et al. [1993] Surg Radiol Anat 15:63-70). The correlation between the four types of acromion and the presence of enthesophytes at its anterior undersurface was also recorded. The distribution of acromial types was as follows: type I, flat, 51 (12.1%); type II, curved, 239 (56.5%); type III, hooked, 122 (28.8%); and type IV, convex, 11 (2.6%). Enthesophytes were found in 1 of type I (2%), in 19 of type II (7.9%), in 46 of type III (37.7%), and in 0 (0%) of type IV acromions. Overall, 66 (15.6%) out of 423 scapulas had enthesophytes. In all cases, they were localized at the site of the coracoacromial ligament insertion on the acromion. Enthesophytes were significantly (P < 0.05) more common in type III acromions and this combination is particularly associated with subacromial impingement syndrome and rotator cuff tears. In type I and in type IV acromions, the incidence of enthesophytes is very small and, according to other studies, with these two acromial types rotator cuff tears are also rare.

High origin of a superficial ulnar artery arising from the axillary artery: anatomy, embryology, clinical significance and a review of the literature.

The superficial ulnar artery (SUA) is an ulnar artery of high origin that lies superficially in the forearm. Its reported frequency ranges from 0.17% to 2%. During anatomical dissection in our department we observed a unilateral case of SUA in a 75-year-old white male human cadaver. It originated from the right axillary artery at the level of the junction of the two median nerve roots and followed a looping course, crossing over the lateral root of the median nerve and running lateral to it in the upper and middle thirds of the arm, whereas in the inferior third of the arm the SUA crossed over the median nerve and ran medially to it. In the cubital fossa, it passed superficially over the medial side of the ulnar aponeurosis and coursed subcutaneously in the ulnar side of the forearm superficially to the forearm flexor muscles. In the hand the SUA anastomosed with the superficial palmar branch of the radial artery, creating the superficial palmar arch. Additionally, it participated in the development of the deep palmar arch. The axillary artery, after the origin of the SUA, continued as the brachial artery and divided into the radial and common interosseous arteries in the cubital fossa. The normal ulnar artery was absent. No muscular or other arterial variations were observed in this cadaver. The embryological interpretation of this variation is difficult and it may arise as a result of modifications to the normal pattern of capillary vessel maintenance and regression. The existence of a SUA is undoubtedly of interest to the clinician as well as to the anatomist. This report presents a case of unilateral SUA along with a review of the literature, embryological explanation and analysis of its clinical significance.

The course of the greater occipital nerve in the suboccipital region: a proposal for setting landmarks for local anesthesia in patients with occipital neuralgia.

The anatomical relationships of the greater occipital nerve (GON) to the semispinalis capitis muscle (SCM) and the trapezius muscle aponeurosis (TMA) were examined to identify topographic landmarks for use in anesthetic blockade of the GON in occipital neuralgia. The course and the diameter of the GON were studied in 40 cadavers (29 females, 11 males), and the points where it pierced the SCM and the TMA were identified. The course of the GON did not differ between males and females. A left-right difference was detected in the site of the GON in the TMA region but not in the SCM region. The nerve became wider towards the periphery. This may be relevant to entrapment of the nerve in the development of occipital neuralgia. In three cases, the GON split into two branches before piercing the TMA and reunited after having passed the TMA, and it pierced the obliquus capitis inferior muscle in another three cases. The GON and the lesser occipital nerve reunited at the level of the occiput in 80% of the specimens. The occiput and the nuchal midline are useful topographic landmarks to guide anesthetic blockade of the GON for diagnosis and therapy of occipital neuralgia. The infiltration is probably best aimed at the site where the SCM is pierced by the GON.

Frontal sinus anatomical variations with potential consequences for the orbit. Study on cadavers.

Anatomical variations of the frontal sinuses that may play a role in the correlation between frontal sinusitis and orbital complications are described. There were used 18 cadavers during routine educational cadaver dissections, one month after theirs withdrawal from the formol basin. The dissections of the cranial cavity and the orbits were performed so as to reveal the frontal sinuses. An unusual bilateral posterior extension of the frontal sinus mucosa was found in two of the cadavers. The projection of the mucosa was covering half of the orbital roof in a 60 year old male and one third of the orbital roof in a 59 year old male. Among the other cadavers that presented normal variations of the frontal sinuses, there was also a case of a 57 year old female with a complete aplasia of the frontal sinuses. Such anatomical variations with unusual extension of the frontal sinuses above orbital roof may support the correlation between frontal sinusitis and the possible complications from the orbit and these cases may be considered as 'high risk' cases for orbital complications during a frontal sinusitis.

Preaortic iliac venous confluence. Marsupial vena cava. Case report.

Anomalous anatomic location of a large venous system is a very important assessment before aortic operations. Ours was an anatomical finding of a case of preaortic iliac confluence, a variation also known as 'marsupial vena cava'. As abdominal aortic surgery is currently performed routinely, rare anatomical anomalies must be spotted, in order to avoid injury to surrounding organs.

Further observations on the vascular system of the gallbladder in man.

The authors present an experimental study of the vascularization of the gallbladder, which was conducted by means of corrosion casting technique. Casts of the vessels of all calibers of 20 gallbladders were prepared. Our observations concern the morphology of the arteries and the veins of the gallbladder, the architecture of the fine vessels of the microcirculation, the vascular communications between the gallbladder and the proximal part of the liver and, also, the vessels of the latter.

The use of unsaturated polyester resin solutions in preparing casts of the renal vessels.

A technique to prepare casts of the renal vessels using unsaturated polyester resin solutions is described. The dimensions, morphology and relations of the vessels are very well represented by the casts. The methods is economical and easy to apply and the casts can be used for both teaching and pathologic research.

A variation in the formation of the brachial plexus characterized by the absence of C8 and T1 fibers in the trunk of the median nerve.

During the dissection of a male cadaver, 80 years old, it was observed that the right median nerve was formed by the junction of two nerve trunks, one originating from the upper and the other from the middle trunk of the brachial plexus (C5, C6 and C7 neurotomes), with subsequent absence of formation of the lateral cord of the plexus. The place of junction lay at 52 mm from the exit of the C6 and C7 nerves from the spine. The musculocutaneous nerve arised from the median nerve after a 38 mm course of the latter. Despite the absence of nerve fibers from the C8 and T1 neurotomes in the trunk of the median nerve, the distribution of its branches was normal.