Prevalence of the Onodi cell in the Polish adult population: an anatomical computed tomography study.

BACKGROUND: Onodi cell is a posterior ethmoid air cell with the optic canal bulging into it; the common position of the bulge is into the sphenoid sinus, usually immediately posterior to the posterior ethmoid air cells. Variable pneumatisation patterns lead to various structures of lamellae and sinuses occasionally exposing important nerves and vessels, such as the optic and vidian nerves, internal carotid artery and cavernous sinus. In clinical practice, special imaging techniques are used to navigate through the paranasal sinuses and hence avoid injury to these structures. This study is aimed to determine the prevalence of the Onodi cell in the Polish population and compare it with other reported occurrences. MATERIALS AND METHODS: A retrospective analysis of 296 computed tomography (CT) scans of patients treated in Krakow, Poland, using a Siemens Somatom Sensation 16 spiral CT scanner. No contrast medium was administered. RESULTS: The Onodi cell was found in 31 out of the 296 patients, or approximately 10.5%, consistent with the majority of research reporting on Onodi variants. Additionally, there was one presentation of a bilateral Onodi cell in a male patient. No statistically significant difference was found between the male and female populations with a positive identification of the variant (p = 0.095, Chi2 test). CONCLUSIONS: This study helped approximate the Onodi variant prevalence of 10.47%, falling within a commonly reported range 8-14%. This gives clinicians and surgeons a better understanding of this variant's structure and significance, and therefore an opportunity to improve treatment outcomes and research.

The relationship between the aggrecan VNTR polymorphism and its content in lumbar intervertebral discs.

BACKGROUND: There is a specific polymorphism of the ACAN gene called the variable number of tandem repeats (VNTR), which is particularly interesting in the light of the development of intervertebral disc pathology and associated low back pain. MATERIALS AND METHODS: The nucleus pulposus specimens were harvested from the L5/S1 intervertebral discs. The aggrecan content was determined using enzyme- linked immunosorbent assay (ELISA). Moreover, the VNTR polymorphism in the ACAN gene was evaluated. RESULTS: The genotyping of VNTR polymorphism in ACAN gene was successful in 94 tissue samples (48 homozygotes and 46 heterozygotes). The alleles were divided into four groups, in accordance with the number of tandem repeats in the ACAN gene. No difference between groups in the mean aggrecan mass nor in the mean degree of tissue moisture was observed. CONCLUSIONS: No relationship between the ACAN gene VNTR polymorphism and the aggrecan content was observed in studied Caucasian cadavers. Such a relationship may be a more complex phenomenon and exists in other populations.

A left circumflex aorta with a displaced thoracic duct in a 94-year-old male cadaver: a case report with discussion on embryology.

A left circumflex aorta (LCA) is an extremely rare variation of the thoracic aorta. It is distinguished by a retroesophageal descending aorta that subsequently travels down the right side of the thoracic vertebrae towards the aortic hiatus. Nonetheless, its embryological origin ought not to be overly generalised, but each case should be considered individually due to its unique vascular patterns. This study presents a description of a LCA in a 94-year-old male cadaver. The dissection revealed the descending aorta posteriorly from the trachea and oesophagus and then laterally on the right from the thoracic vertebral bodies. The branching pattern of the aortic arch was typical, so was the course of the left and right recurrent laryngeal nerves. However, the thoracic duct was placed on the right, and drained into the right internal carotid vein. Due to the normal appearance of the ascending part and the arch of the aorta, it is safe to presume that the variation originated from the persistent right dorsal aorta, with the retroesophageal part from the persistent left dorsal aorta. Detailed understanding of the variations of the thoracic aorta, and the anomalies associated with the LCA, can help to improve management of these conditions, and with that, improve patients' overall outcomes. Patients with a LCA, or another vascular ring, can either be asymptomatic or present with oesophageal and/or tracheal compression symptoms. Management of this anomaly consists namely of ligation of the patent ductus arteriosus/ligamentum arteriosum and aortic uncrossing.

Variations in the branching pattern of tibial nerve in foot: a review of literature and relevant clinical anatomy.

Considerable variations have been reported regarding the branching pattern of tibial nerve (TN) close to its termination in foot. In order to comprehend the clinical anatomy of heel pain awareness of all the possible variations in relation to terminal branching pattern of TN (close to the tarsal tunnel) is essential. The present study was conducted to undertake a comprehensive review of the variations in TN branches in foot with particular emphasis on the implications for sensory distribution of these branches. Articles were searched in major online indexed databases using relevant key words. The pattern of termination of TN was noted as either trifurcation or bifurcation. Bifurcation pattern was more commonly observed and is associated with the medial calcaneal nerve (MCN) either arising high or low relative to the tarsal tunnel. The most commonly noted type of bifurcation was proximal to malleolar-calcaneal axis but within the tarsal tunnel. Across all five types of bifurcation reported in literature, the termination points of TN ranged from 3 cm proximal to 3 cm distal to malleolar-calcaneal axis and, therefore, the area beyond this region can be considered as safe zone for performing invasive procedures. MCN showed considerable variations in its origin both in trifurcation and bifurcation pattern pertaining to number of branches (one/two/three) at the point of origin. The origin of inferior calcaneal nerve was observed to be relativelyless variable as it mostly arose as a branch of lateral plantar nerve and sometimes as a direct branch from TN before termination. The frequent variation of MCN in the tarsal tunnel should be kept in mind while undertaking decompression measures in medial ankle region.

Bilateral accessory head of the adductor longus muscle: an anatomical case study.

The adductor longus muscle, with its proximal origin at the pubic bone and distal at the linea aspera, is reported to be one of the most frequently injured groin muscles in contact sports, namely football or ice hockey. Notwithstanding, there is a scarcity of published works regarding the accessory heads of the adductor longus muscle in the existing literature, let alone the clinical significance of the said variant. The following study is a case report describing bilateral accessory heads of the adductor longus muscle in a 97-year-old female cadaver. A routine cadaveric dissection revealed two accessory heads on the right thigh and one on the left thigh of a donor with no known structural or pathological abnormalities of the proximal lower extremity. The anterior division of the obturator nerve provided nerve supply to the variants on both sides. The deep femoral, superficial external pudendal, femoral vessels were responsible for the vascular supply to the accessory heads of the adductor longus. Undoubtedly, extensive knowledge regarding the variant anatomy of the hip adductor muscles is of immense importance to physiotherapists and orthopaedists treating patients for their injury or complete tears. Nonetheless, there is little information regarding the accessory heads of the adductor longus in the existing literature (originating mostly from cadaveric studies) that requires further evaluation in vivo to assess whether this variant might have an impact on a patient's everyday life.

Anatomical description of the perforating cutaneous nerve.

BACKGROUND: The perforating cutaneous nerve/perforating nerve of the sacrotuberous ligament is rarely observed. It usually arises from the posterior division of the sacral plexus or the pudendal nerve and perforates the sacrotuberous ligament. The anatomy of this nerve and its variants is poorly described in the literature, but there are data indicating its role in pudendal neuralgia. MATERIALS AND METHODS: Herein, we present an anatomical study of six formalin-fixed cadavers with descriptions of the topography of spinal nerves S2-S4, the pudendal bundle, the perforating cutaneous nerve and the sacrotuberous ligament. RESULTS: We found three perforating cutaneous nerves and described each of them in detail, with measurements of length and width, and point of perforation of the sacrotuberous ligament. CONCLUSIONS: We distinguished three types of perforating cutaneous nerve on the basis of our findings and previous publications; two of the three types were observed in our study.

Variations in extra-hepatic biliary tree morphology and morphometry: a narrative review of literature with focus on cystohepatic triangle.

The morphometry and morphology of the components of extrahepatic biliary tree show extensive variations. A beforehand recognition of these variations is very crucial to prevent unintended complications while performing surgeries in this region. This study was conducted to analyse the configuration of the extrahepatic biliary tree and its possible variations, as well as measure the components that limit the cystohepatic triangle. Articles were searched in major online indexed databases (Medline and PubMed, Scopus, Embase, CINAHL Plus, Web of Science and Google Scholar) using relevant key words. A total of 73 articles matched the search criteria of which 55 articles were identified for data extraction. The length of left and right hepatic duct in majority of studies was found to be > 10 mm. A wide range of diameters of hepatic ducts were observed between 5 and 43 mm. The average length of cystic duct is around 20 mm. The length and diameter of the common bile duct are 50-150 mm and 3-9 mm, respectively. The most frequently observed pattern of insertion of cystic duct into common hepatic duct is right lateral, rarely anterior, or posterior spiral insertion can present. The results of this study will provide a standard reference range which instead will help to differentiate the normal and pathological conditions.

Extensor digitorum muscle tendon to the index finger from the extensor carpi radialis brevis: a cadaveric case report.

The forearm extensor compartment is known for its wide variability in terms of muscle origin, number of tendons and their distal insertion. The index finger on its dorsal aspect is the typical place of insertion of the two tendons of the extensor digitorum (ED-index) and of the extensor indicis. Being acquainted with their anatomy is of immense importance to orthopaedic surgeons in the treatment of e.g., de Quervain's syndrome. The current report presents a rare finding of the ED-index tendon arising from the extensor carpi radialis brevis (ECRB). A routine dissection revealed their fused course from the lateral epicondyle of humerus, though separate from the extensor carpi radialis longus. The ED-index muscle belly separated from the ECRB, 119 mm distal to the lateral epicondyle. The distal insertion point of the ED-index was located radially to that of the extensor indicis. The deep branch of the radial nerve and the recurrent interosseous artery supplied the ED-index. No other musculotendinous variations were encountered neither on the ipsilateral nor the contralateral upper limb of the cadaver. This study presents in detail a tendon of the ED-index arising from the ECRB, a knowledge that can be applied namely in the lateral epicondylitis treatment or approach to the ulnar nerve at the level of the elbow. Extensive depiction of both the proximal and distal attachment points of the muscles, their course and dimensions is indispensable to attain the best patient outcomes and avoid iatrogenic injuries.

A three-headed piriformis muscle: an anatomical case study and narrative review of literature.

The piriformis muscle (PM) is found in the gluteal region, exiting the pelvis through the greater sciatic foramen and dividing it into the suprapiriform and infrapiriform foramina. The piriformis works as part of the hip external rotator muscle group, and is responsible for rotation of the femur upon hip extension and abduction of the femur during flexion of the hip joint. The aim of the present report is to describe a very rare case of the primary three-headed PM. To the best knowledge of the authors, the said variant has not yet been described in the existing literature. The 71-year-old male formalin-fixed cadaver was subjected to routine dissection. After careful removal of the connecting tissue, three separate, primary heads of the PM were identified. The lower head of the PM arose from the middle part of the sacral bone; 87.56 mm long and 9.73 mm wide. The medial head was attached to the internal part of the posterior inferior iliac spine; 121.6 mm long and 20.97 mm wide. The upper head was attached to the external part of the posterior inferior iliac spine; 78.89 mm long and 23.94 mm wide. All heads converged into a common tendon which inserted onto the greater trochanter. The clinical importance of this work comes down to the fact that the aberrant PM may be the reason behind the piriformis syndrome and its associated symptoms. Moreover, knowledge regarding the variant anatomy of the PM is of immense importance to, e.g. anaesthesiologists performing computed tomography- or ultrasound-guided sciatic nerve injection for local anaesthesia, radiologists interpreting imaging studies, and surgeons, especially during posterior approaches to the hip and pelvis.

Correlation of morphological and radiological characteristics of degenerative disc disease in lumbar spine: a cadaveric study.

BACKGROUND: Intervertebral disc (IVD) degeneration plays a crucial role in the pathophysiology of low back pain. Several grading systems have been developed for both morphological and radiological assessment. The aim of this study was to assess the morphological and radiological characteristics of IVD degeneration and validate popular radiological Pfirrmann scale against morphological Thompson grading system. MATERIALS AND METHODS: Full spinal columns (vertebrae L1-S1 and IVD between them) were harvested from cadavers through an anterior dissection. Magnetic resonance imaging scans of all samples were conducted. Then, all vertebral columns were cut in the midsagittal plane and assessed morphologically. RESULTS: A total of 100 lumbar spine columns (446 IVDs) were included in the analysis of the degeneration grade. Morphologic Thompson scale graded the majority of discs as grade 2 and 3 (44.2% and 32.1%, respectively), followed by grade 4 (16.8%), grade 1 (5.8%) and grade 5 (1.1%). The radiologic Pfirrmann grading system classified 44.2% of discs as grade 2, 32.1% as grade 3, 16.8% as grade 4, 5.8% as grade 1, and 1.1% as grade 5. The analysis on the effect of age on degeneration revealed significant, although moderate, positive correlation with both scales. Analysis of the agreement between scales showed weighted Cohen's kappa equal to 0.61 (p < 0.001). Most of the disagreement occurred due to a 1 grade difference (91.5%), whereas only 8.5% due to a 2 grade difference. CONCLUSIONS: With the increase of the prevalence of IVD disease in the population, reliable grading systems of IVD degeneration are crucial for spine surgeons in their clinical assessment. While overall there is agreement between both grading systems, clinicians should remain careful when using Pfirrmann scale as the grades tend to deviate from the morphological assessment.

A computed tomography comprehensive evaluation of the ostium of the sphenoid sinus and its clinical significance.

BACKGROUND: The purpose of this research was to evaluate the size of the sphenoid sinuses' ostia, the distance between them and the distance between the medial margin of the ostia and the median line in the Polish adult population. MATERIALS AND METHODS: The analysis was undertaken as a retrospective study of 296 computed tomography (CT) scans of patients (147 females, 149 males) with no comorbidities in their sphenoid sinuses. The paranasal sinuses were investigated by using Spiral CT Scanner (Siemens Somatom Sensation 16), in the option Siemens CARE Dose 4D, without administering any contrast medium. Having obtained transverse planes, multiplans reconstruction tool was used in order to glean sagittal and frontal planes. RESULTS: The average size of both sphenoid sinus ostia was 0.31 cm for both genders (for females ranging from 0.1 to 0.5 cm and from 0.1 to 0.6 cm for males). The mean distance between both sphenoid sinus ostia was 0.6 cm for both genders (the range for females was 0.1-1.4 cm, whereas 0.1-1.8 cm for males). The average distance between the medial margin of the ostium and the median line was 0.32 cm for both genders (0.31 cm for females in the range of 0-0.9 cm and 0.32 cm for males in the range of 0-1 cm). CONCLUSIONS: Intraoperative identification of the sphenoid sinus ostia might prove difficult and their inadequate excision could lead to potential iatrogenic complications, hence detailed anatomical descriptions are still warranted in specific populations in order to perform safe and effective procedures.

Carpal tunnel syndrome: state-of-the-art review.

Carpal tunnel syndrome is the most common peripheral nerve entrapment encountered worldwide. The aetiology can be related to repetitive exposure to vibrations or forceful angular motions, genetic predisposition, injury and specific conditions, such as diabetes, pregnancy and morbid obesity. This entity is observed with increased frequency in females and the elderly. The diagnosis is largely clinical and suspected when patients present with typical symptoms such as numbness, tingling, nocturnal paraesthesia and/or neuritic "pins-and-needles" pain in the radial 3.5 digits. Certain provocative manoeuvres can be employed to evoke the symptoms of the disease to guide the diagnosis. Further testing such as electrodiagnostic studies, ultrasound or magnetic resonance imaging is required in the case of diagnostic uncertainty or if there is a need for objective evaluation whether or not more invasive surgical intervention is required. If the presenting symptoms are mild and discontinuous, non-surgical measures are indicated. However, if the symptoms are moderate to severe, further testing modalities such as nerve conduction studies or needle electromyography are used to determine whether carpal tunnel syndrome is acute or chronic. If significant evidence of axonal injury is identified, surgical treatment may be indicated. Surgical release of the carpal tunnel has evolved over time to become the most common hand surgery procedure.

Agenesis of the sphenoid sinus and a single sphenoid sinus: a computed tomography anatomical evaluation.

BACKGROUND: Sphenoid sinuses are pneumatic spaces within the body of the sphenoid bone. Their development begins in the prenatal life and continues until the adulthood. Agenesis of the sphenoid sinuses is a situation in which they are undeveloped. On the other hand, a single sphenoid sinus lacks the presence of the main septum, leading to the formation of a single antrum. Contemporary use of transnasal transsphenoidal approaches for the pituitary surgery, as well as functional endoscopic sinus surgery urges medical professionals to be well acquainted with the aforementioned variant. MATERIALS AND METHODS: Paranasal sinuses of 300 patients (150 females, 150 males) were evaluated using computed tomography, without the use of contrast medium. Inclusion criteria involved absence of any identifiable pathology within the sphenoid sinuses and age over 18 years. Subgroup analysis involved probing for potential sources of heterogeneity, namely gender. RESULTS: In the whole research material of 300 patients, agenesis of the sphenoid sinuses was noted in 1% of the patients. No statistically significant differences were noted between the absence of the sphenoid sinuses and gender (p = 0.999). A single sphenoid sinus was found in 0.33% of the patients. There were no statistically significant differences found between the presence of fully developed sphenoid sinuses and gender (p = 0.498). CONCLUSIONS: Both agenesis of the sphenoid sinuses and a single sphenoid sinus are rare anatomical variants. Adequate planning for transsphenoidal surgeries with preoperative medical imaging is of essence in order to perform a safe and quality procedure.

Rare combined variations of the coeliac trunk, accessory hepatic and gastric arteries with co-occurrence of double cystic arteries.

Many variations of the coeliac trunk and hepatic or gallbladder arterial supply have been reported before in many cadaveric and radiologic studies. In this case we present combined anomalies observed in dissected cadaver of a 73-year-old female. The left gastric artery arises directly from the abdominal aorta and gives two branches: the right inferior phrenic artery in the proximal part and the accessory left hepatic artery in the distal part. The coeliac trunk is bifurcated into the common hepatic artery and the splenic artery. The right gastric artery emerges from the left hepatic artery. The right hepatic artery gives two cystic arteries and the accessory right hepatic artery is noticed arising from the posterior superior pancreaticoduodenal artery. The deep cystic artery and the right inferior phrenic artery give hepatic branches. Also, we noticed small accessory biliary duct going to the cystic duct. This complexity of the arterial supply with anomaly of the biliary ducts has many surgical implications which will be herein discussed.

Ultrasound-guided topographic anatomy of the medial calcaneal branches of the tibial nerve.

BACKGROUND: The purpose of this study was to evaluate the topographic anatomy of the tibial nerve and its medial calcaneal branches in relation to the tip of the medial malleolus and to the posterior superior tip of the calcaneal tuberosity using the ultrasound examination and to verify its preoperative usefulness in surgical treatment. MATERIALS AND METHODS: Bilateral ultrasound examination was performed on 30 volunteers and the location of the tibial nerve bifurcation and medial calcaneal branches origin were measured. Medial calcaneal branches were analysed in reference to the amount and their respective nerves of origin. RESULTS: In 77% of cases, tibial nerve bifurcation occurred below the tip of the medial malleolus with the average distance of 5.9 mm and in 48% of cases above the posterior superior tip of the calcaneal tuberosity with the average distance of 2.7 mm. In 73% of cases medial calcaneal branches occurred as a single branch originating from the tibial nerve (60%). The average distance of the first, second and third medial calcaneal branch was accordingly 9.3 mm above, 9.5 mm below and 11.6 mm below the tip of the medial malleolus and 17.7 mm above, 1.6 mm below and 4 mm below the posterior superior tip of the calcaneal tuberosity. CONCLUSIONS: As the tibial nerve and its branches present a huge variability in the medial ankle area, in order to prevent the iatrogenic injuries, the preoperative or intraoperative ultrasound assessment (sonosurgery) of its localisation should be introduced into the clinic.

The dimensions of the sphenoid sinuses: evaluation before the functional endoscopic sinus surgery.

BACKGROUND: The following study aimed to evaluate the dimensions (anteroposterior, transverse and vertical) of the sphenoid sinuses in the adult population. MATERIALS AND METHODS: The study was conducted as a retrospective analysis of the computed tomography (CT) scans of the paranasal sinuses of 296 patients (147 females and 149 males), who did not present any pathology in the sphenoid sinuses. The CT scans of the paranasal sinuses were done with the spiral CT scanner, without using any contrast medium. After obtaining transverse planes, frontal and sagittal planes were created using secondary reconstruction tool. RESULTS: The anteroposterior dimension was found to be 2.65 cm on average, in the range of 0.5-4.3 cm. The transverse dimension was on average 1.98 cm, ranging from 0.5 cm to 4.9 cm. The average vertical dimension was found to be 2.1 cm, in the range of 0.7-3.7 cm. CONCLUSIONS: Due to the high incidence of the anatomical variants of the paranasal sinuses, a CT scan is recommended in all patients before a planned surgery in order to avoid the potential iatrogenic complications. Dimensions of the sphenoid sinuses might point towards more at risk variants, but there is still a substantial amount of research that needs to be done in that aspect.

Coeliac trunk and its anatomic variations: a cadaveric study.

BACKGROUND: Coeliac trunk (CT) is the first major visceral branch of the abdominal aorta. The aim of this work was to present the CT division pattern and its anatomical variants in a sample of Polish population. MATERIALS AND METHODS: Coeliac trunk dissection was performed in 50 adult cadavers in the Department of Anatomy, Jagiellonian University Medical College. Cadavers of Polish subjects were included. Cadavers with previous upper abdominal surgery, abdominal trauma, disease process that distorted arterial anatomy or signs of putrefaction were excluded. CT variations, accessory vessels, and vertebral level of origin were described. CT patterns were reported according to the Adachi classification. This study was reviewed and approved by the local Ethics Committee. RESULTS: Coeliac trunk consisting of the left gastric, common hepatic and splenic artery (type 1 according to the Adachi classification) was found in 82% of cadavers. The true tripod was found in 20% and the false one in 80%. Additional vessels were also found: greater pancreatic from the splenic artery and left inferior phrenic from the left gastric artery, which accounted for 2% sections. Type 2 according to the Adachi classification (i.e. the hepatosplenic trunk) was found in 16% of the sections. Other types of CT were not observed. The level of origin was found to be at the inter-vertebral disc between T12 and L1 in all of the cases. CONCLUSIONS: Based on the analysis of the sectional material of the Department of Anatomy, it was found that the typical visceral segmental division is approximate to that observed by Adachi in its classification, whereas the second type of CT was twice as frequent and no other, less frequent types were found.

The terminal branch of the posterior interosseous nerve: an anatomic and histologic study.

BACKGROUND: The aim of this study was to evaluate the terminal branch of the posterior interosseous nerve (PIN) by anatomically and histologically assessing the number, dimension, and area of its individual fascicles, by determining the dimension and area of the whole nerve itself, and by calculating the nerve density ratio (ratio of the sum of the areas of individual fascicles to the area of the whole nerve) of the terminal branch of the PIN. MATERIALS AND METHODS: Twenty-eight terminal branches of the PIN nerve samples were collected from patients undergoing partial denervation of the wrist. The nerve samples were fixed in 10% buffered formalin and stained with haematoxylin and eosin to visualise their nerve bundles. Quantitative analysis of individual fascicles and the whole nerve itself were carried out. RESULTS: Ten nerve samples (35.7%) had one single fascicle (group 1) while the remaining 18 nerve samples (64.3%) contained 2-9 fascicles (group 2). The difference in the sum of the areas of individual fascicles between the two groups did not constitute a statistical difference. Statistically significant between-group differences (p < 0.05) were seen in the area of whole nerve, the ratio of fascicle area to the nerve cross-sectional area and the cross-section maximum nerve length and width. CONCLUSIONS: The number of nerve fascicles in the terminal branch of the PIN does not affect the overall size of the nerve. The majority of the volume of multi-fascicle nerves, therefore, primarily consists of the internal perineurium. However, due to the low number of nerves, this question cannot be clearly answered. This sets a further direction for further research on a larger group.

Assessing the innervation of the dorsal wrist capsule using modified Sihler's staining.

BACKGROUND: The aim of this study was to assess the innervation of the dorsal articular capsule of the wrist using modified Sihler's staining. MATERIALS AND METHODS: Thirty dorsal wrist capsules were collected from 15 donors (both sides) within 12 hours of death. All the capsules were collected in the same manner - using the dorsal incision. The specimens were stained according to the protocol of the modified Sihler's staining technique. The preserved capsules were analysed under 8-16× magnification of an optical microscope for the presence of major nerve trunks, their major and minor branches, and nerve connections. RESULTS: The range of innervation visualised was that the posterior interosseous nerve innervated approximately 60% of the central part; the remaining area was innervated by the dorsal sensory branch of the radial nerve and medial antebrachial cutaneous nerve. The constant findings were the branches departing from the ulnar side of the posterior interosseous nerve and from the radial side, with an exception seen in 2 cases. A communicans branch between the posterior interosseous nerve and medial antebrachial cutaneous nerve was seen in all the specimens. The posterior interosseous nerve innervation extended beyond the level of the carpometacarpal joints II-V. CONCLUSIONS: The modified Sihler's staining technique allows for transparent visibility of the nerves that innervate the dorsal wrist capsule. However, it does not allow as accurate assessment as does histological examination, especially regarding the evaluation of nerve endings. Nevertheless, this method provides a significantly larger area of nerve observation than is provided by histological examination.

Endothelial Dysfunction and Pentraxin-3 in Clinically Stable Adult Asthma Patients.

BACKGROUND AND OBJECTIVE: Asthma is associated with low-grade systemic inflammation, prothrombotic state, and premature atherosclerosis. Objective: To evaluate the relationships between asthma, inflammatory biomarkers, and parameters of endothelial dysfunction. MATERIAL AND METHODS: We analyzed flow-mediated dilatation (FMD) of the brachial artery and intima-media thickness (IMT) of the common carotid artery using ultrasound in 92 clinically stable adult asthmatics and 62 well-matched controls. We also measured blood levels of selected inflammatory and asthma-specific biomarkers, including interleukin (IL) 4, IL-5, IL-6, IL-10, IL-12 (p70), IL-17A, IL-23, and interferon γ, as well as a disintegrin and metalloproteinase domain-containing protein 33 (ADAM-33). In addition, we assessed endothelial damage using 2 laboratory biomarkers: circulating von Willebrand factor (vWF) and pentraxin-3. We analyzed relationships between the study variables and asthma severity, lung function abnormalities, airway remodeling indices on computed tomography, and transthoracic echocardiography parameters. RESULTS: Asthmatics had higher IL-6, IL-10, and ADAM-33 levels. They were also characterized by 23% lower FMD% and 15% thicker IMT, as compared with controls (P<.001, both). In asthma, vWF was related to age (ß=0.28 [95%CI, 0.15-0.41]) and remained inversely associated with FEV1 (ß=-0.2 [95%CI, -0.05 to -0.35]). Surprisingly, a negative correlation was revealed between vWF and pentraxin-3 (ß=-0.17 [95%CI, -0.3 to -0.04]). Pentraxin-3 remained positively associated with airway remodeling indices. CONCLUSIONS: Asthma is characterized by endothelial dysfunction associated with airway obstruction. The biological role of pentraxin-3 is unknown, although our data suggest a protective role against endothelial damage and atherosclerosis.