Bilateral anatomic variation in the relation of the upper trunk of the brachial plexus to the anterior scalene muscle.

The brachial plexus represents a field of many anatomical variations with impor- tant clinical implications, especially in the diagnosis and treatment of the thoracic outlet syndrome (TOS). The case described in this paper presented a novel bilateral variation in the relation of the upper trunk of the brachial plexus to the anterior scalene muscle. The ventral rami of the C5 and C6 spinal nerves perforated the anterior scalene muscle simultaneously through a common opening, and joined to form the upper trunk. Previous literature reports described variations of the brachial plexus and the scalene muscles, as well as the embryological basis for their presence. The case reported herein helps to improve the comprehension of the TOS, as well as the diagnostic and therapeutical approach to this syndrome.

Significance of anatomical variations of the lateral circumflex femoral artery for the tensor fasciae latae flapping.

The tensor fasciae latae (TFL) muscle is commonly used in plastic and reconstructive surgery as a transpositional or a free flap, in order to repair different kinds of defects. In most cases its vascularisation is provided by an ascending branch of lateral circumflex femoral artery (LCFA), which gives different numbers of branches and enters the TFL muscle in different manners. The represented study deals with the arterial vascularisation of the TFL muscle: the entrance of the vascular stalk branches; variations of the LCFA bifurcation's angle; and the skin area of vascularisation. The study was performed on both lower limbs of a 100 foetal and 10 adult cadavers. The LCFA was injected with micropaque solution, afterwards fixed and preserved in 10% formalin solution. Microdissection was performed under magnifying glass and surgical microscope. Analysis of adult cadavers was performed to determine the skin area vascularised by perforating blood vessels from the TFL muscle, by injecting methylene-blue dye into the artery, prior to which all branches of the LCFA, besides the ascending branch, were ligated. The research of a 100 foetal cadavers showed that the LCFA with its ascending branch ensured the blood supply to the muscle. In 85% it gave two branches, the ascending and the descending one, with the angle of bifurcation circa 90o in 73% of cases. The ascending branch can give 0 or more terminal branches, or even form an arterial net. Skin area affected with dye ranged from 18 × 22 cm to 23 × 28 cm and is in positive correlation with the LCFA length and diameter. The understanding of the presented variations have an exceptional significance in planning and applying the TFL flap, especially free flap, in successful repairing and covering the defects, as well as in preventing postoperative complications.

Multicolor counterstaining for immunohistochemistry -- a modified Movat's pentachrome.

The application of "histochemical" staining procedures has been substantially replaced by immunostaining of specific molecular tissue components. The limited range of colors resulting from routine immunohistochemistry, however, can limit assessment of the general microscopic tissue organization. Consequently we have adapted a polychromatic histochemical counterstaining procedure based on Movat's pentachrome staining sequence for use with immunohistochemical procedures. The value of Movat's original method when applied as an immunohistochemical counterstain is limited by its use of iron hematoxylin and by fact that the resulting color combination is difficult to distinguish from the colors of routine immunohistochemical staining. Our variant pentachrome stains the same tissue components as Movat's stain; however, owing to a modification of the acid fuchsin staining step, it provides a strong color contrast with the reaction product resulting from immunostaining using diaminobenzidine as the chromogen. Multicolor counterstaining for immunohistochemistry offers a new approach to tissue analysis, especially when stromal-epithelial relations of normal and neoplastic tissues are considered.

[Personal experience in the treatment of pulmonary tuberculosis in mentally retarded persons]. / Nase iskustvo u lijecenju plucne tuberkuloze u osoba mentalno retardiranih.

The results of the therapy of pulmonary tuberculosis in 90 mentally retarded patients in various forms and degrees of retardation are presented. General and clinical condition of 62 patients was very bad prior to the onset of antituberculotic therapy and most of them were immobile due to the mental retardation and dissemination of pulmonary tuberculosis. In 30 patients advanced form of tuberculosis, in 54 patients mild form and in 6 patients a minimal degree of tuberculosis were found. In hospitalized patients all clinical forms of pulmonary tuberculosis were found. The therapy started with triplicate antituberculotic therapy and the patients were also administered other drugs due to their mental retardation. During the first two months of antituberculotic therapy a high mortality rate was registered (27 or 30%) especially in younger patients. The reason for such high rate cannot be attributed only to pulmonary tuberculosis but also to the primary disease as was the main reason of patients' hospitalization at the institute for mentally retarded persons. Many complications in antituberculotic use could not be registered since many of the basic data could not be obtained from mentally retarded subjects. The complete recovery or improvement of pulmonary tuberculosis was achieved in 63 patients.