Topography and Anatomical Variations of the Axillary Artery.

Knowledge of anatomical variations of the limb's main arteries is significant for the clinicians. Thus, this study is aimed at examining the branching pattern and anatomical variations of the axillary artery. We conducted research on 59 upper limbs of adult human donated cadavers. All axillary artery branches' origins were assessed, and the correlations between points of origins and variations of specific branches were evaluated. The average length of the axillary artery was found to be 11.22 cm, and this length was defined as reference line. Based on this reference line, the first, second, and third parts were 37.56%, 39%, and 30.05%, respectively. The STA was originated from 25.11%. The TAA and LTA were 42.67% and 54.82%, respectively. The SSA, ACHA, and PCHA were 64.72%, 83.89%, and 84.53%, respectively. The origin of LTA was correlated with that of SSA (R = 0.473, P < 0.05) and AHCA (R = 0.307, P < 0.05), respectively. And there was a positive correlation between AHCA and PHCA (R = 0.705, P < 0.05). The number of branches ranged from 3~6, and 9 types were shown. The most frequent branching pattern was common origin of the LTA and SSA (22/59). And AHCA and PHCA were originated together in 19 cases, and both patterns were combined in 12 cases. TTA and LTA branched together in 9 cases, and common trunk for the SSA, PHCA, and AHCA was found in 2 cases. According to this pattern, the origin of LTA and PCHA was significantly different. This information is particularly useful for surgeons and clinicians.

Third head of the biceps brachii muscle originated from the greater tubercle connecting long and short heads: a case report / Tercera cabeza del músculo bíceps braquial originada en la tubrosidad mayor del húmero conectando las cabezas larga y corta: informe de un caso

Variation in the biceps brachii muscle is extremely frequent and has a clinical significance. During an educational dissection, third head of the biceps brachii muscle was found on the left side in a Korean cadaver. The short and long heads showed normal morphology and course: however, additional head originated from the greater tubercle connected to long head of biceps brachii muscle and crossed the musculocutaneous nerve perpendicularly. And then, it was inserted into short head of the biceps brachii muscle. The author describes this previously novel case report and discusses the clinical implications of such a variant.

La variación en el músculo bíceps braquial es extremadamente frecuente y tiene un significado clínico. Durante una disección educativa, se encontró la tercera cabeza del músculo bíceps braquial en el lado izquierdo de un cadáver coreano. Las cabezas cortas y largas mostraron una morfología y curso normales: sin embargo, la cabeza adicional se originó de la tuberosidad mayor conectado a la cabeza larga del músculo bíceps braquial y cruzaba el nervio musculocutáneo perpendicularmente, insertándose en la cabeza corta del músculo bíceps braquial. El autor describe este informe de un caso novedoso y discute las implicaciones clínicas de tal variante.

Accessory head of the extensor carpi radialis longus muscle merging with extensor carpi radialis brevis muscle.

PURPOSE: The retention and capture functions of hand can be achieved by the consistent manner work of the extensor and flexor muscles. Therefore, it is important to know variations of the extensor and flexor muscles. METHODS: During an educational dissection, accessory heads of the extensor carpi radialis longus muscle were found on the right side in a Korean cadaver. RESULTS: The extensor carpi radialis longus muscle was originated from the lateral supracondylar ridge of the humerus and trifurcated into three heads as lateral, intermediated, and medial heads. The lateral and intermediated heads merged and inserted to the base of the second metacarpal bone. However, medial head of extensor carpi radialis longus muscle was merged with the extensor carpi radialis brevis muscle. CONCLUSIONS: Knowledge of the variations of the ECRL is important for surgeons because the presence of the ECRL variations increases the incidence of iatrogenic injuries during surgery and invasive procedures.

Loss of the Association between Telomere Length and Mitochondrial DNA Copy Number Contribute to Colorectal Carcinogenesis.

Positive association between telomere length and mitochondrial DNA (mtDNA) copy number were introduced in healthy and patients with psychiatric disorder. Based on frequent genetic changes of telomere and mitochondria in colorectal carcinomas (CRC), we studied their clinical characteristics and their association in colorectal carcinogenesis. DNA was extracted from 109 CRCs, 64 colorectal tubular adenomas (TAs), and 28 serrated polyps (SPs), and then, telomere length and mtDNA copy number were analyzed in these legions by using a real-time PCR assay. Telomere length and mtDNA copy number (mean ± S.D) in CRCs was 1.87 ± 1.52 and 1.61 ± 1.37, respectively. In TAs and SPs, relative mtDNA copy number was 0.92 ± 0.71 and 1.84 ± 1.06, respectively, shoing statistical difference (p = 0.017). However, telomere length was similar in these precancerous legions. Telomere length and mtDNA copy number did not show clinical and prognostic values in CRCs, however, positive correlation between telomere length and mitochondrial DNA copy number were found in CRC (r = 0.408, p < 0.001). However, this association was not shown in precancerous lesions (r = -0.031, p = 0.765). This result suggests that loss of co-regulation between telomeres and mitochondrial function may induce the initiation or play a role as trigger factor of colorectal carcinogenesis.

Topography of the middle genicular artery is associated with the superior and inferior genicular arteries / La topografía de la arteria genicular media está asociada con las arterias geniculares superiores e inferiores

Total knee arthroplasty has increased substantially, however anatomical studies of the genicular arteries (GAs) in this region are rare. The aim of this study was to identify the pattern and branching points of GAs and their relationship. In 42 lower limbs, the pattern and branching points of GAs were confirmed. The horizontal line which extends between the most prominent point of the lateral and medial margins of patella was defined as a reference line. The distance of branching point of the GAs from the reference line was measured, and the correlations between these points were analyzed. The superior lateral and medial genicular arteries (SLGA and SMGA) were located at + 38.17 ± 3.10 mm and + 32.68 ± 3.83 mm from the reference line, respectively. The middle genicular artery (MGA) was originated from + 7.57 ± 3.98 mm. The inferior lateral and medial genicular arteries (ILGA and IMGA) were located at - 18.46 ± 2.63 mm and - 24.09 ± 3.52 mm, respectively. The branching points of the SLGA changed significantly according to the arterial branching pattern with the MGA. In addition, the branching point of the MGA had positive relationships with that of the IMGA (r = 0.385, p <0.05) and that of the ILGA (r = 0.348, p <0.05), respectively. In this study, topography of the GAs and its anatomical association were demonstrated for the first time in Korean cadavers. Knowledge of the topography about frequent variation would be useful for safe surgery and clinical procedures.

La artroplastía total de rodilla ha aumentado sustancialmente, sin embargo los estudios anatómicos de las arterias geniculares (AGs) en esta región son escasos. El objetivo de este estudio fue identificar los patrones y puntos de ramificación de las AGs y sus relaciones. En 42 miembros inferiores, se identificaron el patrón y los puntos de ramificación de las AGs. La línea horizontal que se extiende entre el punto más prominente de los márgenes lateral y medial de la patela se definió como una línea de referencia. Se midió la distancia entre el punto de ramificación de las AGs y la línea de referencia, y se analizaron las correlaciones entre estos puntos. Las arterias geniculares superiores lateral y medial (AGSL y AGSM, respectivamente) se situaron a + 38,17 ± 3,10 mm y + 32,68 ± 3,83 mm de la línea de referencia, respectivamente, y la arteria genicular media (AGM) se originó a partir de + 7,57 ± 3,98 mm. Las arterias geniculares inferiores lateral y medial (AGIL e AGIM, respectivamente) se localizaron a - 18,46 ± 2,63 mm y - 24,09 ± 3,52 mm, respectivamente. Los puntos de ramificación de la AGSL cambiaron significativamente de acuerdo con el patrón de ramificación arterial con respecto a la AGSM. Además, el punto de ramificación de la AGSM tuvo relaciones positivas con el de la AGIM (r = 0.385, p <0.05) y el de la AGIL (r = 0.348, p <0.05). En este estudio, la topografía de las AGs y su asociación anatómica se demostraron por primera vez en cadáveres coreanos. El conocimiento de la topografía sobre la variación frecuente sería útil para su aplicación en el desarrollo de cirugías y procedimientos clínicos seguros.

Mutation of the TERT promoter leads to poor prognosis of patients with non-small cell lung cancer.

Mutations in the promoter region of telomerase reverse transcriptase (TERT) and alterations in telomere length (TL) have been the focus of research in various types of cancer. In the present study, the frequency and clinical characteristics of TERT promoter mutations and TL were studied in non-small cell lung cancers (NSCLC). TERT promoter mutations and TL were analyzed in 188 patients using DNA sequencing and the reverse transcription-quantitative polymerase chain reaction, respectively. The TERT promoter mutation rate was observed to be 2.2% (4/188 NSCLC cases), and it was significantly associated with regional lymph node invasion (P<0.001). No significant difference in TL was observed between the patients with and without TERT promoter mutations. TL was decreased in males (P=0.058 vs. females) and smokers (P=0.008 vs. non-smokers). Survival analyses demonstrated poor prognoses for patients with NSCLC with TERT promoter mutations (P<0.001). Multivariate survival analyses demonstrated that TERT promoter mutations were an independent prognostic marker for poor overall survival (P=0.045). The results of the present study demonstrated that TERT promoter mutation was not frequent in NSCLC; however, it may have value as a prognostic marker in NSCLC.

Topographical relations between the Gantzer's muscle and neurovascular structures.

PURPOSE: Gantzer's muscle (GM) is an additional muscle in the forearm, which develops as an accessory head of the flexor pollicis longus or the flexor digitorum profundus. The study aimed to determine the topography of the GM and to define the topographical relationship between the GM and the neurovascular structures surrounding it. METHODS: After confirming the presence of GM, its topography and the neurovascular structures were analyzed to determine the correlation between them in 73 upper limbs. RESULTS: The incidence of GM was 47.95% (35/73) and the average insertion point of GM was identified at 49.33 ± 7.47‰ (119.82 ± 20.80 mm) on the reference line between the medial epicondyle and the pisiform bone. And the branching points of the median nerve and the ulnar artery were located 19.91 ± 11.23‰ (52.21 ± 24.67 mm), 17.45 ± 8.39‰ (42.53 ± 20.54 mm) on the reference line, respectively. The presence of GM had no significant correlation with the position of the nerve branches. On the other hand, the branching point of the ulnar artery was distally located in the cases with the presence of the GM (17.35 ± 8.65 vs 19.42 ± 10.87, p = 0.031). There was a significant positive correlation between the point of arterial bifurcation and the length of the GM (r = 0.407, p = 0.015). CONCLUSIONS: This study suggested that the GM has a topographical relation with the arterial structures, perhaps for embryological reasons.

Absence of GNAS mutation in colorectal carcinogenesis.

AIMS AND BACKGROUND: The incidence rate of colorectal cancer (CRC) increases every year in Korean populations. However, association between the GNAS mutation and colorectal precancerous lesions has not been studied in in Korean populations. To contribute to better understanding of colorectal carcinogenesis, we analyzed GNAS mutation in 100 cancerous and 96 precancerous colorectal lesions. METHODS: The records of colonoscopic polypectomy performed at Dongsan Medical Center between 1999 and 2003 were reviewed retrospectively. Precancerous lesions included 7 villous adenomas, 59 tubular adenomas, and 18 sessile serrated adenomas, and 12 hyperplastic polyps. Keimyung Human Bio-Resource Bank at Dongsan Medical Center provided 100 CRC samples. RESULTS: GNAS mutation was not found in any colorectal cancer or any precancerous colorectal lesions, including villous adenoma, which is thought to harbor the mutation. CONCLUSIONS: The role of GNAS mutation might be limited in colorectal neoplasms of the Korean population.

Muscular axillary arch accompanying variation of the musculocutaneous nerve: axillary arch.

Continuous attention has been developed on the anatomical variations of the axilla in anatomist and surgeon due to their clinical importance. The axillary region is an anatomical space between the lateral part of the chest wall and the medial aspect of the upper limb. During the routine dissection of embalmed cadavers, we found variant muscular slip originating from the lateral border of tendinous part of the latissimus dorsi and continuing 9 cm more crossing the axilla. And then, it inserted into the superior margin of the insertion of the pectoralis major. We considered this muscular variation as axillary arch muscle. Correct identification of the relevant anatomy and subsequent simple surgical division is curative, paying special attention to anatomical variations in this region and its clinical importance due to its close relationship to the neurovascular elements of the axilla.

A radial artery originating from the thoracoacromial artery.

PURPOSE: The purpose of this case report is to report a rare vascular variation in the upper limbs because of its clinical importance and embryological implication. METHODS: During the educational dissection of a 73-year-old Korean male cadaver`s right upper limb, we found a variant branch which is originated from the thoracoacromial artery. RESULTS: The variant branch from the thoracoacromial artery ran to the distal forearm in the deep fascia. Because it finally coursed like the radial artery in the forearm and the palm, we defined the variant artery as superficial brachioradial artery (SBRA). In the cubital region a little below the intercondylar line, the brachial artery gave off a small communicating branch to SBRA, and continued as the ulnar artery. CONCLUSIONS: We reported this unique variation and discussed its clinical and embryological implication.

Are PIK3CA Mutation and Amplification Associated with Clinicopathological Characteristics of Gastric Cancer?

Alterations in mitochondrial DNA (mtDNA) have been studied in various cancers. However, the clinical value of mtDNA copy number (mtCN) alterations in gastric cancer (GC) is poorly understood. In the present study, we investigated whether alterations in mtCNs might be associated with clinicopathological parameters in GC cases. mtCN was measured in 109 patients with GC by real-time PCR. Then, correlations with clinicopathological characteristics were analyzed. mtCN was elevated in 64.2% of GC tissues compared with paired, adjacent, non- cancerous tissue. However, the observed alterations in mtCN were not associated with any clinicopathological characteristics, including age, gender, TN stage, Lauren classification, lymph node metastasis, and depth of invasion. Moreover, Kaplan-Meier survival curves revealed that mtCN was not significantly associated with the survival of GC patients. In this study, we demonstrated that mtCN was not a significant marker for predicting clinical characteristics or prognosis in GC.

PIK3CA Amplification Is Common in Left Side-Tubular Adenomas but Uncommon Sessile Serrated Adenomas Exclusively with KRAS Mutation.

Colorectal cancer is a heterogeneous disorder than arises via multiple distinct pathways, from tubular adenomas (TAs) and sessile serrated adenomas (SSAs), which are clinically, morphologically, and molecularly different. We examined PIK3CA amplification in colorectal precancerous legions, including TAs and SSAs. DNA was isolated from paired normal and tumoral tissues in 64 TAs and 32 SSAs. PIK3CA amplification, KRAS mutation, and BRAF mutation were analyzed by real-time PCR and pyrosequencing. PIK3CA amplification was found in 25% of TAs and 9.4% of SSAs, respectively. KRAS and BRAF mutations were mutually exclusive in both TAs and SSAs. In TAs, PIK3CA amplification was associated with left side and it was mutually exclusive with KRAS mutation. These results suggest that PIK3CA amplification may be early and important event in colorectal carcinogenesis and may drive the development of left-side TAs independently with KRAS mutation.

Variations of the cubital superficial vein investigated by using the intravenous illuminator.

The purpose of this study was to report variations of the cubital superficial vein patterns in the Korean subjects, which was investigated by using venous illuminator, AccuVein. The 200 Korean subjects were randomly chosen from the patients and staff of the Keimyung University Dongsan Medical Center in Daegu, Korea. After excluding the inappropriate cases for detecting venous pattern, we collected 174 cases of right upper limbs and 179 cases of left upper limbs. The superficial veins of the cubital fossa were detected and classified into four types according to the presence of the median cubital vein (MCV) or median antebrachial vein. The type II, presenting the both cephalic and basilic vein connected by the MCV, was most common (177 upper limbs, 50.1%). Although the most common type in male and female was different as type I (108 upper limbs, 49.3%) and type II (75 upper limbs, 56.0%), respectively, statistical significance was not detected (P=0.241). The frequency of the each types between right and left upper limbs was also not different (P=0.973). Among 154 subjects who were observed the venous pattern in the both upper limbs, 76 subjects (49.3%) had the same venous pattern. Using AccuVein to investigate the venous pattern has an advantage of lager scale examination compared to the cadaver study. Our results might be helpful for medical practitioner to be aware of the variation of the superficial cubital superficial vein.

Genetic characteristics of mitochondrial DNA was associated with colorectal carcinogenesis and its prognosis.

Clinical value of mitochondrial DNA has been described in colorectal cancer (CRC). To clarify its role in colorectal carcinogenesis, mitochondrial microsatellite instability (mtMSI) and other markers were investigated in CRCs and their precancerous lesions, as a multitier genetic study. DNA was isolated from paired normal and tumoral tissues in 78 tubular adenomas (TAs), 34 serrated polyps (SPs), and 100 CRCs. mtMSI, nucleus microsatellite instability (nMSI), KRAS mutation, and BRAF mutation were investigated in these tumors and their statistical analysis was performed. mtMSI was found in 30% of CRCs and 21.4% of precancerous lesions. Mitochondrial copy number was higher in SPs than TAs and it was associated with mtMSI in low grade TAs. KRAS and BRAF mutations were mutually exclusive in TAs and SPs. CRCs with mtMSI showed shorter overall survival times than the patients without mtMSI. In CRCs without nMSI or BRAF mutation, mtMSI was a more accurate marker for predicting prognosis. The genetic change of mitochondrial DNA is an early and independent event in colorectal precancerous lesions and mtMSI and mitochondrial contents are associated with the tubular adenoma-carcinoma sequence, resulting in poor prognosis. This result suggested that the genetic change in mitochondrial DNA appears to be a possible prognosis marker in CRC.

Is mitochondrial DNA copy number associated with clinical characteristics and prognosis in gastric cancer?

Alterations in mitochondrial DNA (mtDNA) have been studied in various cancers. However, the clinical value of mtDNA copy number (mtCN) alterations in gastric cancer (GC) is poorly understood. In the present study, we investigated whether alterations in mtCNs might be associated with clinicopathological parameters in GC cases. mtCN was measured in 109 patients with GC by quantitative real-time PCR. Then, correlations with clinicopathological characteristics were analyzed. mtCN was elevated in 64.2% of GC tissues compared with paired, adjacent, non-cancerous tissue. However, the observed alterations in mtCN were not associated with any clinicopathological characteristics, including age, gender, TN stage, Lauren classification, lymph node metastasis, and depth of invasion. Moreover, Kaplan-Meier survival curves revealed that mtCN was not significantly associated with the survival of GC patients. In this study, we demonstrated that mtCN was not a significant marker for predicting clinical characteristics or prognosis in GC.

The ileocolic vein passing through the ring-shaped part of ileocolic artery.

PURPOSE: The purpose of this case report is to report vascular variations in the abdomen because of its clinical importance for the surgeries like acute abdominal emergencies and symptomatic aneurysms. Here, we report an extremely rare case with an ileocolic vein passing through the annulus of the ileocolic artery. METHODS: During the routine dissection, we found an ileocolic vein perforating through a ring-shaped ileocolic artery. RESULTS: A ring-shaped ileocolic artery was originating from the superior mesenteric artery as a single branch. After forming the circle, it maintained the regular branching patterns. The ileocolic vein was drained from the ascending colon, cecum, appendix and the distal part of the ileum and passed the center of the ring-shaped part of the ileocolic artery from posterior to anterior. Other structures of the abdomen were normal. CONCLUSIONS: We reported this rare variation and suggest that the clinicians should be aware of this variation for succeeding surgery and making a good diagnosis for the patients.

The lateral thoracic artery passing through duplicated axillary vein: a case report.

The axillary vein is a large-blood vessel that lies on the medial side to the axillary artery. The veins of the axilla are more abundant than the arteries and their variations were extremely common. During educational dissection, a rare form of the axillary vein accompanying arterial variation was founded in left arm of 70-year-old female cadaver. The axillary vein was divided into two large veins, anterior and posterior axillary veins according to their anatomical position. The lateral-thoracic artery arose from the second part of the axillary artery and passed through the gap of duplicated axillary vein. Before the lateral-thoracic artery passed through the gap of duplicated axillary vein, the lateral-thoracic artery gave-off an additional branch, which descended superficial to the anterior axillary vein. It surrounded the anterior axillary vein as annular form and the diameter of surrounded part of the anterior axillary vein became narrow. This novel case was reported and its clinical implications of such a variant were discussed.

Different frequency of the absence of the palmaris longus according to assessment methods in a Korean population.

The palmaris longus (PL) is a slender, spindle-shaped weak flexor of the wrist. Congenital absence of the PL is estimated to occur in 15% among individuals worldwide. However, the frequency of its absence varies considerably among different population groups and with different detection techniques. In the present study, the presence of the PL tendon was examined in a Korean population (n=269) using three clinical tests, namely the Traditional Test, Mishra's Test II, and the Gangata Test. We classified subjects into six types based on whether inspection or palpation was required to determine the presence of the PL and flexor carpi radialis. The most reliable test was determined using Kendall's coefficient of concordance. Our results showed that the PL tendon was absent in 4.1% of the subjects in our study, and bilateral and unilateral absences were 2.2% and 1.8%, respectively. Statistical analysis revealed that these tests had similar reliability for assessing the PL tendon, and the Traditional Test showed the highest effectiveness, at 93%. Therefore the Traditional Test was found to be the most effective for revealing the PL in this Korean population.

The double retro-aortic left renal vein.

The renal veins drain the kidney into the inferior vena cava and unite in a variable fashion to form the renal vein. The left renal vein is normally located in front of the aorta. However, the retro-aortic renal vein may course posterior to the aorta due to embryological developmental anomalies. During educational dissection, a rare variation of the left renal vein was found in a 66-year old male cadaver. The double retro-aortic renal veins coursed behind the aorta to drain into the inferior vena cava. The superior retro-aortic renal vein drained into the inferior vena cava at the lower border of the L2 vertebra, and the inferior retro-aortic renal vein drained into the inferior vena cava at the upper border of the L4 vertebra. Such a variant is rare, and is a clinically important observation which should be noted by vascular surgeons, oncologists, and traumatologists.