Anatomical variations of the superficial branch of the radial nerve and the dorsal branch of the ulnar nerve: A detailed electrophysiological study.

INTRODUCTION: In this study we evaluated anatomic variations of the superficial branch of the radial nerve (SBRN) and the dorsal branch of the ulnar nerve (DBUN) electrophysiologically. METHODS: Antidromic nerve conduction studies (NCS) of the SBRN and DBUN were performed on healthy individuals. To identify individual responses from the distal branches of the SBRN and DBUN, sensory nerve action potentials of each finger (lateral side/medial side) were recorded. RESULTS: NCS were performed in 50 hands of 27 healthy control subjects. The thumb and the index finger were supplied by the SBRN in all cases. The lateral and medial sides of the third finger were supplied by the SBRN in 94.0% and 74.0% of the cases, but the lateral and medial sides of the fourth finger were supplied by the SBRN in only 10.0% and 2.0% of cases. The fifth finger and the medial side of the fourth finger were always supplied by the DBUN. The lateral side of the fourth finger was supplied by the DBUN in 98.0% of cases, but the lateral and medial sides of the third finger were supplied by the DBUN in 40.0% and 70.0% of cases. Dual innervation by the SBRN and DBUN was found in 34.0% and 46.0% of the lateral and medial sides of the third finger, but in only 8.0% and 2.0% of the lateral and medial sides of the fourth finger. DISCUSSION: There are considerable anatomic variations of the SBRN and DBUN in healthy individuals.

Cases of high lying azygos arch and its embryological consideration.

PURPOSE: This study aimed to report cases of high-lying azygos arch and discuss the embryological basis of its development by a thorough evaluation of the anatomical features assessed using computed tomography (CT) images. METHODS: This study was approved by our institutional review board. We retrospectively reviewed chest CT images between November 2011 and November 2018. To determine high-lying azygos arch, we set the upper margin of the T4 vertebral body as the reference level. Regarding the embryological development of high-lying azygos arch, we retrospectively reviewed the CT images of 105 patients with tracheal bronchus to identify the location of the azygos arch. RESULTS: We noted that on three cases CT images, the azygos arch was located higher than the upper margin of the right main bronchus, and drained into the proximal superior vena cava (SVC) at a level higher than the conventional T4 or T5 vertebral level. All 105 patients with right tracheal bronchus showed azygos arch above the tracheal bronchus. CONCLUSION: This variation in the location of the azygos arch can mimic pathological lesion on plain radiographs, and, therefore, it is important to be aware of high-lying azygos arch. Our findings show that the azygos arch may have possibly migrated downward during embryological development.

Gorilla calcaneal morphological variation and ecological divergence.

OBJECTIVES: The primate foot has been extensively investigated because of its role in weight-bearing; however, the calcaneus has been relatively understudied. Here we examine entire gorilla calcaneal external shape to understand its relationship with locomotor behavior. MATERIALS AND METHODS: Calcanei of Gorilla gorilla gorilla (n = 43), Gorilla beringei graueri (n = 20), and Gorilla beringei beringei (n = 15) were surface or micro-CT scanned. External shape was analyzed through a three-dimensional geometric morphometric sliding semilandmark analysis. Semilandmarks were slid relative to an updated Procrustes average in order to minimize the bending energy of the thin plate spline interpolation function. Shape variation was summarized using principal components analysis of shape coordinates. Procrustes distances between taxa averages were calculated and resampling statistics run to test pairwise differences. Linear measures were collected and regressed against estimated body mass. RESULTS: All three taxa exhibit statistically different morphologies (p < .001 for pairwise comparisons). G. g. gorilla demonstrates an anteroposteriorly elongated calcaneus with a deeper cuboid pivot region and mediolaterally flatter posterior talar facet. G. b. beringei possesses the flattest cuboid and most medially-angled posterior talar facets. G. b. graueri demonstrates intermediate articular facet morphology, a medially-angled tuberosity, and an elongated peroneal trochlea. DISCUSSION: Articular facet differences separate gorillas along a locomotor gradient. G. g. gorilla is adapted for arboreality with greater joint mobility, while G. b. beringei is adapted for more stereotypical loads associated with terrestriality. G. b. graueri's unique posterolateral morphology may be due to a secondary transition to greater arboreality from a more terrestrial ancestor.

Anatomical investigation of the measurements, shape and arterial irrigation of the adrenal gland in New Zealand rabbits / Investigação anatômica das medidas, forma e irrigação arterial da glândula adrenal em coelhos da raça Nova Zelândia

Rabbits have been used as an experimental model in many studies. These studies are important not only for veterinary clinicians, but also for researchers in different fields. The aim of this research was to describe gross morphological measurement, shape and arterial supply of the adrenal glands in healthy New Zealand rabbits. Dissections were performed in 30 adult rabbits, 15 males and 15 females, without macroscopic adrenal pathology. Adrenal measurements were made with a digital caliper: length, width, and thickness. The origin of the adrenal arteries was also determined. Both adrenal glands were localized cranially to the respective kidneys. The mean of the right adrenal gland was 0.88 cm length, 0.42 cm width and 0.16 cm thickness; the left gland measured 0.72 cm, 0.46 cm, and 0.17 cm, respectively. The right gland was significantly more elongated than the left (p = 0.0003) and the means of the measurements did not differ between sexes. Most of the right adrenal glands had a piriform shape (73.3%), whereas most of the left gland exhibited a "bean-shaped" aspect (60.0%). The arterial supply was found to arise from different arteries: lumbar, aorta, renal, caudal mesenteric, and testicular or ovarian. Comparatively, the descriptions of shape, position and arterial irrigation of the adrenal gland in rabbits are similar to those available in rodents. The data from the present investigation will assist in the interpretation of pathological and / or experimental findings in New Zealand rabbits.

Coelhos têm sido utilizados como modelo experimental em muitos estudos. Esses estudos são importantes não apenas para médicos veterinários, mas também para pesquisadores de diferentes campos. O objetivo desta pesquisa foi descrever as medidas morfológicas macroscópicas, forma e suprimento arterial das glândulas adrenais em coelhos saudáveis da raça Nova Zelândia. As dissecções foram realizadas em 30 coelhos adultos, 15 machos e 15 fêmeas, sem sinais macroscópicos de patologia adrenal. As medidas adrenais foram realizadas com paquímetro digital: comprimento, largura e espessura. A origem das artérias adrenais também foi determinada. Ambas as glândulas adrenais foram localizadas cranialmente nos respectivos rins. A média da glândula adrenal direita foi de 0,88 cm de comprimento, 0,42 cm de largura e 0,16 cm de espessura; a glândula esquerda mediu 0,72 cm, 0,46 cm e 0,17 cm, respectivamente. A glândula direita foi significativamente mais alongada que a esquerda (p = 0,0003) e as médias das medidas não diferiram entre os sexos. A maioria das glândulas adrenais direitas tinha uma forma piriforme (73,3%), enquanto a maioria da glândula esquerda exibia um aspecto em "forma de feijão" (60,0%). Verificou-se que o suprimento arterial provém de diferentes artérias: lombar, aorta, renal, mesentérica caudal e testicular ou ovariana. Comparativamente, as descrições de forma, posição e irrigação arterial da glândula adrenal em coelhos são semelhantes às disponíveis em roedores. Os dados da presente investigação ajudarão na interpretação de achados patológicos e / ou experimentais em coelhos da raça Nova Zelândia.

Determination of the value of vertebral heart size regarding the weight and body area in canines / Determinação dos valores do vertebral heart size em relação ao peso e área corporal canina

The vertebral heart size is a method used to measure the cardiac dimension in order to identify the remodeling of the chambres in heart disease. This study aims to determinate the vertebral heart size values at right lateral and ventrodorsal radiographs views relating to canines weight and body area variations. For the purpose of the study 40 healthy dogs within the age of 1 to 6 years, males and females, with deep or intermediated thorax were selected, brachycephalic dogs were not included in the study; the dogs were separated in four groups: group 1(n=9) compound of dogs up to 5 kg; group 2 (n=8) with dogs from 5,1 to 10 kg; group 3 (n=12) with dogs from 10,1 to19 kg and group 4 (n=11) with dogs weighing more than 19,1 kg. The values of body score, body mass index and the thorax configuration where previously measured, as well as the vertebral heart size and the depth width ratio from the radiographs. The results demonstrated intervals of right lateral-lateral vertebral heart size 9.9 to 10.4v and ventro-dorsal vertebral heart size of 9.8-10.3v. The study results show that the vertebral heart size numbers did not correlate with weight or body area, regardless the type of radiography view. Therefore, it can be concluded that the vertebral heart size in right lateral and ventrodorsal radiography can be used to rate the cardiac area, not suffering influence by the dog's weight or body area.

O vertebral heart size é um método utilizado para mensurar a dimensão cardíaca visando identificar os remodelamentos das câmaras nas cardiopatias. O objetivo do estudo foi determinar os valores de vertebral heart size nas projeções radiográficas latero-lateral direita e ventro-dorsal conforme as variações do peso e área corporal. Para isso, foram selecionados 40 cães hígidos com idade entre 1 e 6 anos, machos e fêmeas, com padrão torácico intermediário e profundo, com exclusão dos braquicefálicos; os cães foram divididos em quatro grupos: grupo 1 (n=9) composto por cães de até 5 kg; grupo 2 (n=8) com cães de 5,1 a 10 kg; grupo 3 (n=12) com cães de 10,1 a 19 kg e grupo 4 (n=11) com cães acima de 19,1 kg. Os valores de escore corporal, índice de massa corporal e conformação torácica foram previamente mensurados, bem como os valores dos vertebral heart size a relação profundidade/largura torácica das radiografias. Os resultados demonstraram intervalos de vertebral heart size latero-lateral 9.9 a 10.4v e vertebral heart size ventro dorsal de 9.8-10.3v. Os valores não apresentaram correlação com o peso e área corporal nos grupos estudados, independente das projeções estudas. Assim, pode-se concluir que método vertebral heart size nas projeções estudadas é aplicável na avaliação da área cardíaca, não sofrendo influências do peso e área corporal canina.

Grading of the Position of the Mastoid Tegmen in Human Temporal Bones - A Surgeon's Perspective.

OBJECTIVES: To establish a new surgically relevant classification system of the anatomic variations of the temporal bone tegmen plate as well as to perform a comparative analysis, with respect to the pneumatization patterns in the cadaveric temporal bones. MATERIALS AND METHODS: Microdissection of the human cadaveric temporal bones was performed after obtaining ethical approval from the Institutional Ethical Committee (F.8-522/A-522/2017/RS). The pneumatization pattern of the temporal bones was noted as "under-pneumatized" or "well-pneumatized." The tegmen mastoid (TM) was classified into two grades as per the position of the tegmen plate and the visibility of the superior semicircular canal (SSCC) and the aditus. The latter two structures were well visualized in Grade A and poorly visualized in Grade B. The data were analyzed using Stata 14.0 (Stata Corp, 4905, Lakway drive, College Station, Texas, USA). RESULTS: Ninety-three temporal bones were dissected under microscope. Fifty-eight bones were well-pneumatized and 35 were under-pneumatized. The tegmen plates were classified as Grade-A in 49 bones (well-pneumatized -37 and under-pneumatized -12), and as Grade-B in 44 bones (well-pneumatized-21, poorly-pneumatized-23). Grade-A classification was significantly more common in well-pneumatized temporal bones, while Grade-B was more common in under-pneumatized bones (p=0.0057). CONCLUSION: We propose a surgically relevant classification for TM positioning. A well-pneumatized temporal bone is associated with a significantly higher position of the tegmen plate (Grade-A TM).

The Bronze and Iron Age populations of the Armenian Highland in the genetic history of Armenians.

OBJECTIVES: To investigate the biological diversity of the late Bronze and Iron Age populations in the Armenian Highland by nonmetric cranial traits, evaluate the genetic continuity in the development of the modern Armenian gene pool, and compare the results obtained with genetic data. MATERIALS AND METHODS: Twenty-eight nonmetric cranial traits were scored on 498 adult crania from different late Bronze and Iron Age cemeteries, as well as from modern Armenians and other European populations. We carried out a biodistance analysis between populations using the mean measure of divergence (MMD) statistics, tested the spatial-temporal model of population structure, and assessed the diversity within the late Bronze and early Iron Ages by using the values of variability index (Fst). RESULTS: The biodistance analysis revealed a close relationship among different ancient Armenian populations and between the average frequencies of the three sequential periods (late Bronze Age, early Iron Age I and II) and modern Armenians. A gradual increase of variability (Fst) within the three successive periods was observed. DISCUSSION: The analysis of nonmetric trait data reflects deep roots and continuity in the formation of the Armenian population. Since at least the Late Bronze Age, owing to permanent isolation, no significant changes have occurred in the Armenian gene pool. An increase in variability over the successive periods reflects the process of population differentiation from a single gene pool while maintaining average trait frequencies. The congruence of the results obtained with the genetic data confirms, once more, the possibility of using nonmetric cranial traits as a proxy for genetic markers.

Intrapopulation variation in lower limb trabecular architecture.

OBJECTIVES: Trabecular structure is frequently used to differentiate between highly divergent mechanical environments. Less is known regarding the response of the structural properties to more subtle behavioral differences, as the range of intrapopulation variation in trabecular architecture is rarely studied. Examining the extent to which lower limb trabecular architecture varies when inferred mobility levels and environment are consistent between groups within a relatively homogenous population may aid in the contextualization of interpopulation differences, improve detectability of sexual dimorphism in trabecular structure, and improve our understanding of trabecular bone functional adaptation. MATERIALS AND METHODS: The study sample was composed of adult individuals from three high/late medieval cemeteries from Cambridge (10th-16th c.), a hospital (n = 57), a parish cemetery (n = 44) and a friary (n = 14). Trabecular architecture was quantified in the epiphyses of the femur and tibia, using high resolution computed tomography. RESULTS: The parish individuals had the lowest bone volume fraction and trabecular thickness in most regions. Multiple sex differences were observed, but the patterns were not consistent across volumes of interest. DISCUSSION: Differences between the three groups highlight the great variability of trabecular bone architecture, even within a single sedentary population. This indicates that trabecular bone may be used in interpreting subtle behavioral differences, and suggests that multiple archaeological sites need to be studied to characterize structural variation on a population level. Variation in sex and group differences across anatomical locations further demonstrates the site-specificity in trabecular bone functional adaptation, which might explain why little consistent sexual dimorphism has been reported previously.

Anatomical study of jugular foramen in the neck / Estudo anatômico do forame jugular no pescoço

Abstract Introduction The anatomical complexity of the jugular foramen makes surgical procedures in this region delicate and difficult. Due to the advances in surgical techniques, approaches to the jugular foramen became more frequent, requiring improvement of the knowledge of this region anatomy. Objective To study the anatomy of the jugular foramen, internal jugular vein and glossopharyngeal, vagus and accessory nerves, and to identify the anatomical relationships among these structures in the jugular foramen region and lateral-pharyngeal space. Methods A total of 60 sides of 30 non-embalmed cadavers were examined few hours after death. The diameters of the jugular foramen and its anatomical relationships were analyzed. Results The diameters of the jugular foramen and internal jugular vein were greater on the right side in most studied specimens. The inferior petrosal sinus ended in the internal jugular vein up to 40 mm below the jugular foramen; in 5% of cases. The glossopharyngeal nerve exhibited an intimate anatomical relationship with the styloglossus muscle after exiting the skull, and the vagal nerve had a similar relationship with the hypoglossal nerve. The accessory nerve passed around the internal jugular vein via its anterior wall in 71.7% of cadavers. Conclusion Anatomical variations were found in the dimensions of the jugular foramen and the internal jugular vein, which were larger in size on the right side of most studied bodies; variations also occurred in the trajectory and anatomical relationships of the nerves. The petrosal sinus can join the internal jugular vein below the foramen.

Resumo Introdução A complexidade anatômica do forame jugular torna a realização de procedimentos cirúrgicos nessa região delicada e difícil. Devido aos avanços obtidos nas técnicas cirúrgicas, as abordagens do forame jugular têm sido feitas com maior frequência, o que requer uma melhoria correspondente no conhecimento de sua anatomia. Objetivo Estudar a anatomia do forame jugular, da veia jugular interna e dos nervos glossofaríngeo, vago e acessório, assim como as relações anatômicas entre estas estruturas na região do forame jugular e no espaço parafaríngeo. Método Foram examinados 60 lados de 30 cadáveres frescos algumas horas após a morte. Os diâmetros e suas relações anatômicas foram analisados. Resultados Os diâmetros do forame jugular e da veia jugular interna foram maiores no lado direito na maioria dos espécimes estudados. O seio petroso inferior terminava na veia jugular interna até 40 mm abaixo do forame jugular, em 5% dos casos. O nervo glossofaríngeo exibiu uma relação íntima anatômica com o músculo estiloglosso após a sua saída do crânio e o nervo vago exibiu uma relação semelhante com o nervo hipoglosso. O nervo acessório passou em torno da veia jugular interna via sua parede anterior em 71,7% dos cadáveres. Conclusão Foram encontradas variações anatômicas nas dimensões do forame jugular e da veia jugular interna, que apresentaram tamanhos maiores à direita na maioria dos espécimes estudados; variações também ocorreram na trajetória e nas relações anatômicas dos nervos. O seio petroso pode se unir à veia jugular interna abaixo do forame.

Endoscopic evaluation of middle ear anatomic variations in autopsy series: analyses of 204 ears / Avaliação endoscópica das variações anatômicas da orelha média em uma série de autópsias: análise de 204 orelhas

Abstract Introduction Microsurgery of the ear requires complete evaluation of middle ear surgical anatomy, especially the posterior tympanic cavity anatomy. Preoperative assessment of the middle ear cavity is limited by the permeability of eardrum and temporal bone density. Therefore, middle ear exploration is an extremely useful method to identify structural abnormalities and anatomical variations. Objective The aim of this study is to determine anatomic variations of the middle ear in an autopsy series. Methods All evaluations were performed in the Forensic Medicine Institute Morgue Department. The cases over 18 years of age, with no temporal bone trauma and history of otologic surgery included in this study. Results One hundred and two cadavers were included in the study. The mean age was 49.08 ± 17.76 years. Anterior wall prominence of the external auditory canal was present in 27 of all cadavers (26.4%). The tympanic membrane was normal in 192 ears (94%) while several eardrum pathologies were detected in 12 ears (6%). Agenesis of the pyramidal eminence and stapedial tendon was found in 3 ears. While the ponticulus was bony ridge-shaped in 156 of 204 ears (76.4%), it was bridge-shaped in 25 ears (12.3%). The ponticulus was absent in 23 ears (11.3%). While complete subiculum was present in 136 of all ears (66.7%), incomplete subiculum was present in 21 ears (10.3%). Subiculum was absent in 47 ears (23%). Facial dehiscence was found in 32 ears and the round window niche was covered by a pseudomembrane in 85 ears (41.6%). A fixed footplate was present in 7.4% of all ears, and no persistent stapedial artery was seen in any cases. Conclusion The pseudomembrane frequency covering the round window niche was found different from reports in the literature. In addition, the frequency of the external auditory canal wall prominence has been reported for the first time.

Resumo Introdução A otomicrocirurgia requer avaliação completa da anatomia cirúrgica da orelha média, especialmente da anatomia da cavidade timpânica posterior. A avaliação pré-operatória da cavidade timpânica é limitada pela permeabilidade do tímpano e densidade do osso temporal. Portanto, a exploração da orelha média é um método extremamente útil para identificar anormalidades estruturais e variações anatômicas. Objetivo Determinar as variações anatômicas da orelha média em uma série de autópsias. Método Todas as avaliações foram realizadas no necrotério do Instituto Médico-Legal. Os casos com mais de 18 anos, sem trauma do osso temporal e história de cirurgia otológica foram incluídos neste estudo. Resultados Cento e dois cadáveres foram incluídos no estudo. A média de idade foi de 49,08 ± 17,76 anos. A proeminência da parede anterior do conduto auditivo externo estava presente em 27 de todos os cadáveres (26,4%). A membrana timpânica era normal em 192 orelhas (94%), enquanto várias alterações do tímpano foram detectadas em 12 orelhas (6%). Agenesia da eminência piramidal e do tendão do estapédio foi encontrada em 3 orelhas. Enquanto o pontículo tinha formato de crista óssea em 156 das 204 orelhas (76,4%), tinha o formato de ponte em 25 orelhas (12,3%). O pontículo estava ausente em 23 orelhas (11,3%). Enquanto o subículo completo estava presente em 136 de todas as orelhas (66,7%), encontrava-se incompleto em 21 orelhas (10,3%). O subículo estava ausente em 47 orelhas (23%). Deiscência facial foi encontrada em 32 orelhas e o nicho da janela redonda estava coberto por uma pseudomembrana em 85 orelhas (41,6%). A platina fixa foi observada em 7,4% de todas as orelhas e a artéria estapediana persistente não foi vista. Conclusão A frequência da pseudomembrana que cobre o nicho da janela redonda foi diferente daquela encontrada na literatura. Além disso, a frequência da proeminência da parede do canal auditivo externo foi relatada pela primeira vez.

A Simulated Anatomically Accurate Investigation Into the Effects of Biodiversity on Electrogastrography.

Chronic gastrointestinal motility disorders present a significant problem in current clinical practice with new methods needed to perform routine screening and accurate diagnosis. Electrogastrography (EGG) is a non-invasive method that provides insight into the underlying gastric electrical activity. However, widespread adoption of this technique has been limited due to an incomplete sensitivity and specificity. Recent simulation studies have tried to address these issues by providing a theoretical framework for reliably distinguishing between gastric slow wave dysrhythmias. However, these studies have been limited to a singular dipole, torso, and the stomach representative model. In this paper, we aim to address those shortcomings by developing multiple stomach and torso models with multiple moving dipoles to investigate the influence of biodiversity on EGG. Four anatomically accurate models were developed based on a range of human CT scans. This allowed investigations into the influence of normal and dysrhythmic (gastric re-entry and ectopic pacemaker) gastric electrical activity on the resulting EGG. These investigations identified areas of significant morphological difference in EGG traces for all cases, but the accuracy of these methods were based on a well-defined normal baseline. The results also suggested that the areas identified varied significantly as a result of biodiversity. These findings indicate that high-resolution multichannel EGG methodologies are required to reliably account for anatomical biodiversity.

Anatomical study of jugular foramen in the neck.

INTRODUCTION: The anatomical complexity of the jugular foramen makes surgical procedures in this region delicate and difficult. Due to the advances in surgical techniques, approaches to the jugular foramen became more frequent, requiring improvement of the knowledge of this region anatomy. OBJECTIVE: To study the anatomy of the jugular foramen, internal jugular vein and glossopharyngeal, vagus and accessory nerves, and to identify the anatomical relationships among these structures in the jugular foramen region and lateral-pharyngeal space. METHODS: A total of 60 sides of 30 non-embalmed cadavers were examined few hours after death. The diameters of the jugular foramen and its anatomical relationships were analyzed. RESULTS: The diameters of the jugular foramen and internal jugular vein were greater on the right side in most studied specimens. The inferior petrosal sinus ended in the internal jugular vein up to 40mm below the jugular foramen; in 5% of cases. The glossopharyngeal nerve exhibited an intimate anatomical relationship with the styloglossus muscle after exiting the skull, and the vagal nerve had a similar relationship with the hypoglossal nerve. The accessory nerve passed around the internal jugular vein via its anterior wall in 71.7% of cadavers. CONCLUSION: Anatomical variations were found in the dimensions of the jugular foramen and the internal jugular vein, which were larger in size on the right side of most studied bodies; variations also occurred in the trajectory and anatomical relationships of the nerves. The petrosal sinus can join the internal jugular vein below the foramen.

Endoscopic evaluation of middle ear anatomic variations in autopsy series: analyses of 204 ears.

INTRODUCTION: Microsurgery of the ear requires complete evaluation of middle ear surgical anatomy, especially the posterior tympanic cavity anatomy. Preoperative assessment of the middle ear cavity is limited by the permeability of eardrum and temporal bone density. Therefore, middle ear exploration is an extremely useful method to identify structural abnormalities and anatomical variations. OBJECTIVE: The aim of this study is to determine anatomic variations of the middle ear in an autopsy series. METHODS: All evaluations were performed in the Forensic Medicine Institute Morgue Department. The cases over 18 years of age, with no temporal bone trauma and history of otologic surgery included in this study. RESULTS: One hundred and two cadavers were included in the study. The mean age was 49.08±17.76 years. Anterior wall prominence of the external auditory canal was present in 27 of all cadavers (26.4%). The tympanic membrane was normal in 192 ears (94%) while several eardrum pathologies were detected in 12 ears (6%). Agenesis of the pyramidal eminence and stapedial tendon was found in 3 ears. While the ponticulus was bony ridge-shaped in 156 of 204 ears (76.4%), it was bridge-shaped in 25 ears (12.3%). The ponticulus was absent in 23 ears (11.3%). While complete subiculum was present in 136 of all ears (66.7%), incomplete subiculum was present in 21 ears (10.3%). Subiculum was absent in 47 ears (23%). Facial dehiscence was found in 32 ears and the round window niche was covered by a pseudomembrane in 85 ears (41.6%). A fixed footplate was present in 7.4% of all ears, and no persistent stapedial artery was seen in any cases. CONCLUSION: The pseudomembrane frequency covering the round window niche was found different from reports in the literature. In addition, the frequency of the external auditory canal wall prominence has been reported for the first time.

Pathological analysis of cadavers for educational dissection by using postmortem imaging.

This study was performed primarily to clarify whether pathological analysis of cadavers for anatomical dissection is possible using postmortem imaging (PMI), and whether this is worthwhile. A total of 33 cadavers that underwent systematic anatomical dissection at our medical school also underwent PMI. Fixative solution was injected into the corpus 3-4 days after death. PMI was then performed using an 8-slice multi-detector CT scanner 3 months before dissection. Before dissection, a conference was held to discuss the findings of the PMI. First, two radiologists read the postmortem images without any medical information and deduced the immediate cause of death. Then, the anatomy instructor revealed the medical information available. Based on this information, the radiologist, anatomy instructor, and pathologists suggested candidate sampling sites for pathological examination. On the last day of the dissection period, the pathologists resected the sample tissues and processed them for pathological examination. In 12 of 33 cases, the presumed causes of death could be determined based on PMI alone, and revision of the cause of death described in the death certificate was considered in five (15.2%) cases, based on PMI and pathological analysis. This article presents a novel method of pathological analysis of cadavers for anatomical dissection using PMI without disturbing the anatomy education of medical students.

Variant ascending pharyngeal artery maintaining flow in a subocclusive internal carotid artery.

Ectopic branches of the external carotid artery are rare but have critical diagnostic and therapeutic implications. We present a case involving a 70-year-old man who presented with recurrent left hemispheric strokes in the setting of a subocclusive left internal carotid stenosis. A left ascending pharyngeal artery with variant origin from the internal carotid artery helped maintain flow distal to the area of stenosis and allowed for safe and successful internal carotid artery stenting. Identification of this variant and recognition of the anastomotic network involving this connection were crucial to determine the safety of stenting. The patient had no further recurrent events and had sustained improvement on his 90-day follow-up.

Relationships between differences in the number of fiber bundles of the anterior talofibular ligament and differences in the angle of the calcaneofibular ligament and their effects on ankle-braking function.

PURPOSE: The aim was to clarify the relationships between differences in the number of fiber bundles of the anterior talofibular ligament (ATFL) and differences in the angle of the calcaneofibular ligament (CFL) with respect to the long axis of the fibula and their effects on ankle braking function. METHODS: The study sample included 110 Japanese cadavers. ATFLs were categorized as: Type I with one fiber bundle; Type II with two fiber bundles with incomplete separation and complete separation; and Type III with three fiber bundles. The CFLs were categorized according to the angles of the CFLs with respect to the long axis of the fibula and the number of fiber bundles. Six categories were established: CFL10° (angle of the CFL with respect to the long axis of the fibula from 10° to 19°); CFL20° (range 20°-29°); CFL30° (range 30°-39°); CFL40° (range 40°-49°); CFL50° (range 50°-59°); and CFL2 (CFLs with two crossing fiber bundles). RESULTS: ATFL was Type I in 34 legs (31%), Type II in 66 legs (60%), and Type III in 10 legs (9%). Five CFL categories were identified: CFL10° in 4 feet (3.7%); CFL20° in 23 feet (20.9%); CFL30° in 34 feet (30.9%); CFL40° in 33 feet (30%); CFL50° in 15 feet (13.6%); and CFL2 in one foot (0.9%). Type III contained mainly CFL40° and CFL50° (7 of 10 feet). CONCLUSIONS: ATFL and CFL appear to cooperate in the ankle joint braking function.

Review of Risk Assessment of Major Anatomical Variations in Clinical Dentistry: Accessory Foramina of the Mandible.

Most of the studies of the mandible's anatomical variations have presented the authors' speculations, and only a limited number has provided evidence that demonstrated the actual complications injury to the variant structures caused. To our knowledge, no study has evaluated the risks associated with these variant anatomical structures' injury. We reviewed articles that described clinical cases of the injury to, and anatomical studies of, three anatomical variants of the mandible-the accessory mental, lingual, and retromolar foramina-with which dentists are relatively familiar and that are mentioned often in the context of implant and third molar surgeries, to describe risk assessment methods with which to evaluate potential complications preoperatively. Only a limited number of the clinical reports of injury to the mandible's accessory foramina were available. The potential severe complication of injury of the accessory mental foramen (AMF) is sensory disturbance of the lower lip. Risk of neurosensory disturbance of lower lip can be assessed by AMF/MF ratio and positional relations to the MF. Potential severe complication of injury of the lingual foramen is bleeding and hemorrhage in the oral cavity's floor. Risk of bleeding can be assessed by diameter and positional relation between the mental spine/mylohyoid line. A risk assessment of the retromolar foramen could not be made because of inadequate data. We hope the risk assessments suggested will encourage dentists to predict intraoperative/postoperative complications caused by damaging the mandible's accessory foramina. Clin. Anat. 32:672-677, 2019. © 2019 Wiley Periodicals, Inc.

Site specific diagnostic yield of endoscopic biopsies in Gastrointestinal Graft-versus-Host Disease: A tertiary care Center experience.

BACKGROUND: Gastrointestinal (GI) graft versus host disease (GVHD) occurs in up to 40% of patients undergoing allogenic hematopoietic stem cell transplantation (HSCT). However, the optimal endoscopic approach is still unclear and the area of the GI tract with the highest diagnostic yield is still a topic of debate. OBJECTIVE: We compared the diagnostic yield of different anatomic site biopsies in the diagnosis of GI GVHD and assessed the correlation of endoscopic findings with histopathology. METHODS: All cases of biopsy proven GI GVHD were obtained from pathology database AUBMC between 1/1/2005 and 31/8/2017. We retrospectively analyzed the demographical, clinical and endoscopic data. RESULTS: Nineteen patients were diagnosed with GI GVHD over 17.6 years. The most common presenting symptom was severe diarrhea (18 patients, 94.7%). Combining upper endoscopy and sigmoidoscopy with biopsies had the highest diagnostic yield of 90% in diagnosing GI GVHD compared to 63.6%, 78.6% and 77.8% for upper endoscopy, sigmoidoscopy and colonoscopy respectively. In macroscopically normal mucosa, the recto-sigmoid and duodenal biopsies had the highest diagnostic yield (75%). As for the macroscopically abnormal mucosa, the highest yield was for the recto-sigmoid biopsies (100%) in lower endoscopy and duodenal biopsies in the upper endoscopy (60%). CONCLUSION: In a patient suspected to have GI GVHD, the best endoscopic approach is the combination of upper endoscopy and flexible sigmoidoscopy with biopsies of normal as well as abnormal mucosa. It should be emphasized that normal mucosa be biopsied especially in the duodenum and recto-sigmoid for a better diagnostic yield.