Variations of coronary sinus tributaries among patients undergoing cardiac resynchronisation therapy.

BACKGROUND: In cardiac resynchronisation therapy (CRT), the coronary venous system is used for left ventricular pacing electrode placement. Despite the well- -known anatomy of the coronary sinus and its tributaries, heart failure patients' remodelled and enlarged left ventricles may impede the successful lead placement because of acquired anatomical obstacles. MATERIALS AND METHODS: Fifty-five patients qualified for CRT treatment were divided into ischaemic and non-ischaemic cardiomyopathy. Forty-four control groups without heart failure underwent dual-source computed tomography (CT). Rendered reconstructions of cardiac coronary systems were compared. RESULTS: The presence of main tributaries was comparable in all groups. The left marginal vein, small cardiac vein, and oblique vein of the left atrium were present in 63%, 60%, and 51% of the hearts in all the groups. CRT referred CTs had significantly longer distances between posterior and lateral cardiac veins over the left ventricle (p < 0.05), wider angles of tributaries (p = 0.03), and smaller lumen of coronary sinus (p = 0.03). In the non-ischaemic group, the posterior interventricular and great cardiac veins are more extensive than in the control group. Age-related analysis of vessel size shows a moderate correlation between age and diminishing mean vessel size in all the groups studied. CONCLUSIONS: The general structure of the coronary heart system is consistent in patients with and without heart failure. The variance of the general structure, or the presence of adequate veins, is an individual variation. The use of CT and analysis of the coronary veins allow better planning of the CRT-D implantation procedure and may reduce the risk of ineffective left ventricular electrode implantation.

Median nerve thenar motor branch anatomical variations.

BACKGROUND: The aim of this study was to determine the prevalence of the different types of median nerve thenar motor branch and to compare them with literature data. MATERIAL AND METHODS: This study was conducted using median nerves dissected from cadavers stored in a 10% solution of formaldehyde at the Department of Anatomy of Jagiellonian University Medical College (JUMC) and cadavers from the Department of Forensic Medicine JUMC. The research protocol was approved by the Jagiellonian University Ethics Committee (registry KBET/ /209/B/2002). RESULTS: The studied group comprised 8 (26.7%) women and 22 men (age between 23 and 92 years), yielding a total of 60 thenar motor branches (30 right vs. 30 left). Forty-seven (78.3%) nerves were classified as extraligamentous, 12 (20%) were subligamentous, and 1 (1.7%) was transligamentous. As for the side of origin of the thenar motor branch, in 45 (75%) cases it was the radial side and in 2 (3.33%) cases it was the ulnar side. CONCLUSIONS: The obtained results confirm that the extraligamentous type of thenar motor branch is the most common and that the ulnar origin of the thenar motor branch is the rarest.

The use of computer-assisted image analysis in measuring the histological structure of the human median nerve.

BACKGROUND AND AIM: The aim of this study was to assess the histological structure of the median nerve and its motor branch (number and arrangement of nerve bundles) and the cross-sectional area (CSA) of the median nerve (on the level of the carpal tunnel). MATERIAL AND METHODS: This study has been conducted using median nerves dissected from cadavers stored in a 10% solution of formaldehyde at the Department of Anatomy of the Jagiellonian University Medical College and cadavers from the Department of Forensic Medicine of the Jagiellonian University Medical College. After dissection the median nerves were stained with haematoxylin and eosin and histological slides were prepared. These were later photographed (16 x magnification) and analysed using ImageJ software. The research protocol was approved by the Jagiellonian University Ethics Committee (registry KBET/209/B/2002). RESULTS: The studied group comprised 8 women and 22 men (age between 23-92 years), yielding a total of 60 median nerves (30 right vs. 30 left). In 4 (6.67%) cases an accessory motor branch was found. The mean CSA of the median nerve was 0.19 cm(2). The median nerves from the right hand had a statistically larger CSA (p = 0.017). The number of nerve bundles in the median nerve varied between 13 to 38 and in the motor branch of the median nerve between 4 to 14. CONCLUSIONS: The nerve bundles of the median nerve, at the level of the carpal tunnel, display no particular type of arrangement. ImageJ software proved useful in the assessment of the histological structure of the human median nerve and its motor branch.

Possible compression of the atlantal segment of the vertebral artery in occipitalisation.

The current study evaluates the passage of the atlantal segment of the vertebral artery through the atlas to the cranial cavity in the case of occipitalisation, and searches for potential bony obstacles that constrict the lumen of the vertebral artery. Morphometric analysis was performed of the ossified atlanto-occipital articulation of the dry adult male skull, particularly in the region of the posterior arch of the atlas. The distance between the floor of the right groove for the vertebral artery and the occipital bone was measured using a digital sliding caliper. On the left side, measurements of the diameters of the inlet and outlet of the canal for the vertebral artery were performed using the same technique. Fusion of the left portion of the posterior arch of the atlas with the occipital bone caused significant narrowing of the space around the normally existing groove for the vertebral artery, and converted it into the canal. The size of the intracranial opening of the canal for the vertebral artery was measured as 3.8 mm x 4.7 mm, whereas the inlet to the canal was 5.4 mm x 7.0 mm. The diameter of the canal decreases, particularly at the entrance into the cranial cavity; therefore, compression of the vertebral artery within the canal seems to be possible.

[Quality of life in diabetic patients with coronary artery disease treated with percutaneous coronary angioplasty]. / Jakosc zycia chorych z choroba wiencowa i cukrzyca leczonych za pomoca przezskórnej angioplastyki naczyn wiencowych.

UNLABELLED: Increased restenosis rate, higher incidence of coronary events, and, in some studies also increased mortality are observed during long-term follow-up in patients (pts) with diabetes mellitus treated with percutaneous coronary angioplasty. This is why some authors suggest that indications for PTCA in the group of diabetic pts should be significantly limited. The aim of our study was the estimation of clinical condition and quality of life in diabetic patients who underwent PTCA procedure in order to establish indications for percutaneous revascularisation in this group of pts. The study group consisted of 54 diabetic patients who were successfully treated with percutaneous coronary angioplasty in the period of 1987-1996. All pts were assessed clinically and quality of life was estimated on the basis of specially designed questionnaire. During mean 5-year follow-up 1(1.9%) patient died, 2 (3.7%) pts had acute myocardial infarction, restenosis was diagnosed in 25 (46.3%) pts. Repeated revascularisation was necessary in 27 (50%) pts. Significant clinical improvement was observed in the pts from the study group as compared to their clinical condition before the procedure (CCS 0 or I--61% vs 0%, p < 0.0001, III--9% vs. 39%, p < 0.0003, IV--1.9% vs. 22%, p < 0.001). The rate of pts who were employed did not change in consequence of successful PTCA procedure. The number of pts returning to work was equal to the number of patients receiving social benefits. Subjective improvement was declared by 87% of pts. Lack of angina pectoris episodes was reported by 52% of pts and in 35% of pts the number of angina pectoris episodes was significantly reduced. Better tolerance of physical activity was declared by 59% of pts, and 65% of the studied pts fully came back to their non-professional activities. Partial return to non-professional activities was possible for 24% of pts. Normal sexual activity was declared by 65% of pts. Only 9% of the studied pts experienced significant limitation in their sexual activity. PTCA met the expectations of 89% of pts while the number of negative opinions, i.e. the lack of subjective improvement, impaired quality of life, or disappointment with the results of the PTCA procedure did not exceed 13%. Significantly worse results of the selected parameters describing the quality of life were observed in the group of diabetic pts treated with insulin. CONCLUSIONS: PTCA improved quality of life in 60-90% of pts with diabetes mellitus, nevertheless, did not affect the employment status of successfully treated pts. Patients who needed insulin therapy had worse indicators of life quality, however thorough analysis suggest that PTCA can be advised as a method of treatment in the group of diabetic patients with coronary artery disease.