Scapular foramina - a systematic review with meta-analysis based on 3316 scapulae.

PURPOSE: In the present study, we want to systematize the previous studies on the scapular foramina (SF) and nutrient foramina (NF) with emphasis on the clinical relevance of this topic. Although seemingly not important, radiologists, clinicians and surgeons should be aware of the presence and characteristics of the SF and NF and look out for possible mistakes that may cause harm to the patients during either the diagnostic process or surgery. METHODS: A comprehensive search was conducted in multiple databases, including PubMed, Scopus, Web of Science, Embase, Cochrane Library and Google Scholar. The whole process was divided into three stages. In the first stage, the following search terms were used: ((scapular foramina) or (scapular foramen) or (scapular nutrient foramina) or (scapular nutrient foramen) or (scapula foramen) or (scapula foramina) or (scapula nutrient foramina)). RESULTS: The results of the present meta-analysis were based on a total of 3316 studied scapulae. A pooled prevalence of scapulae in which at least one SF was found was set to be 11.29%. The most common localization of the SF was found to be the infraspinous fossa, in which the SF occurred with the prevalence of 52.31%. Subsequently, a pooled prevalence of scapulae in which at least one NF occurs was established at 74.23%. CONCLUSION: The presented data contribute to a comprehensive understanding of the prevalence, distribution, and characteristics of suprascapular and nutrient foramina in scapulae, considering different topographical areas, genders, and sides.

The arterial anatomy of the posterior duodenum - A computed tomography angiography analysis with implications for abdominal surgery.

The main objective of the present study was to clarify the anatomical characteristics of the GDA. In order to fulfill this objective, novel classification systems of both the origin and branching pattern of the said vessel were created. Being aware of the variable anatomy of the GDA is of great importance when performing hepatopancreaticobilliary procedures. The results of 75 consecutive patients who underwent abdomen computed tomography angiography (CTA) were analyzed. A total of 74 GDA were analyzed. Of these, 42 were from women (56.8%) and 32 were from men (43.2%). The most common direction of origin of the GDA was inferior (n = 38; 51.4%). The origin variation of each GDA was deeply analyzed. Initially, eight types of origin variations were evaluated, of which types 1-3 constituted 83.8%. Furthermore, analogously, branching pattern types were also established. Initially, 11 branching variations were evaluated, of which types 1-3 constituted 87.8%. The GDA is subject to numerous variations, both in the origin and in the branching pattern of the vessel. In order to clarify the anatomical characteristics of this vessel, novel classifications of the origin and branching patterns were made, presenting the most frequent patterns. Our results may be of great use for surgeons performing hepatopancreaticobilliary surgeries, such as the Whipple procedure or vascular reconstructions after cholangiocarcinoma resections. Being aware of the anatomical variations of relevant structures associated with a surgical procedure may help reduce potential intraoperative and/or postoperative complications.

The complete anatomy of the lingual nerve: A meta-analysis with implications for oral and maxillofacial surgery.

Lingual nerve (LN) injury during surgical procedures in the third molar region warrants a detailed study of its common pathway and important variations. Therefore, the objective of this study was to analyze and compile the multiple anatomical variations of the LN for use in oral and maxillofacial surgery. It is anticipated that the results of the present meta-analysis may help to minimize the possible complications when performing procedures associated with this anatomical entity. Major online databases such as PubMed, Web of Science, Scopus, Embase were used to gather all relevant studies regarding the LN anatomy. The results were established based on a total of 1665 LNs. The pooled prevalence of the LN being located below the lingual/ alveolar crest was found to be 77.87% (95% CI: 0.00%-100.00%). The LN was located above the lingual/ alveolar crest in 8.21% (95% CI: 4.63%-12.89%) of examined nerves. The most common shape of the LN was established to be round with a prevalence of 40.96% (95% CI: 23.96%-59.06%), followed by oval at 37.98% (95% CI: 23.98%-53.02%) and flat at 25.16% (95% CI: 12.85%-39.77%). In conclusion, we believe that this is the most accurate and up-to-date study regarding the anatomy of the LN. The LN was found to be located below the lingual/alveolar crest in 77.87% of the cases. Furthermore, the LN was found to enter the tongue under the submandibular duct in 68.39% of the cases. Knowledge about the anatomy of the LN is crucial for numerous oral and maxillofacial procedures such as during the extraction of the third molar.

Pelvic cavity and its spaces - anatomical overview.

Anatomical nomenclature commonly does not follow changes in the clinical language and demands. Therefore we tried to explain the pelvic relationships based on the changes that occur in the pelvis as well as to compare different nomenclatural strategies used in every day language. Courses of fasciae in the male and female pelvis are also considered.

The inferior gluteal artery anatomy: a detailed analysis with implications for plastic and reconstructive surgery.

BACKGROUND: The inferior gluteal artery (IGA) is a large terminal branch of the anterior division of the internal iliac artery (ADIIA). There is a significant lack of data regarding the variable anatomy of the IGA. MATERIALS AND METHODS: A retrospective study was conducted to establish anatomical variations, their prevalence and morphometrical data on IGA and its branches. The results of 75 consecutive patients who underwent pelvic computed tomography angiography were analysed. RESULTS: The origin variation of each IGA was deeply analysed. Four origin variations have been observed. The most common type O1 occurred in 86 of the studied cases (62.3%). The median IGA length was set to be 68.50 mm (lower quartile [LQ]: 54.29; higher quartile [HQ]: 86.06). The median distance from the origin of the ADIIA to the origin of the IGA was set to be 38.22 mm (LQ: 20.22; HQ: 55.97). The median origin diameter of the IGA was established at 4.69 mm (LQ: 4.13; HQ: 5.45). CONCLUSIONS: The present study thoroughly analysed the complete anatomy of the IGA and the branches of the ADIIA. A novel classification system for the origin of the IGA was created, where the most prevalent origin was from the ADIIA (type 1; 62.3%). Furthermore, the morphometric properties (such as the diameter and length) of the branches of the ADIIA were analysed. This data may be incredibly useful for physicians performing operations in the pelvis, such as interventional intraarterial procedures or various gynaecological surgeries.

Anatomy of the pterygomandibular space - clinical implication and review.

AIM: The aim of this study was to present review of the pterygomandibular space with some referrals to clinical practice, specially to the methods of lower teeth anesthesia. CONCLUSIONS: Pterygomandibular space is a clinically important region which is commonly missing in anatomical textbooks. More attention should be paid to it both from theoretical and practical point of view, especially in teaching the students of first year of dental studies.

Carpal tunnel syndrome - anatomical and clinical correlations.

Carpal tunnel syndrome (CTS) is the most common and widely known of the entrapment neuropathies in which the body's peripheral nerves are compressed. Common symptoms of CTS involve the hand and result from compression of the median nerve within the carpal tunnel. In general, CTS develops when the tissues around the median nerve irritate or compress on the nerve along its course through the carpal tunnel, however often it is very difficult to determine cause of CTS. Proper treatment (conservative or surgical) usually can relieve the symptoms and restore normal use of the wrist and hand.

The surgical anatomy of the inferior alveolar nerve: a meta-analysis with clinical implications.

BACKGROUND: The main goal of the present meta-analysis was to provide physicians, especially surgeons, with crucial data on the complete anatomy of the inferior alveolar nerve (IAN). It is hoped that our results may help reduce the rates of complications in procedures associated with this anatomical entity. MATERIALS AND METHODS: Major online medical databases such as PubMed, Embase, Scopus, Web of Science, Google Scholar, and Cochrane Library were searched to gather all studies on IAN anatomy, including topography, morphology, and variations. RESULTS: IAN mean thickness of the IAN in the mandibular angle area was set to 2.32 mm (LL: 1.82 ; HL: 2.78-). IAN mean thickness of the IAN in the mandibular body region was found to be 2.49 mm (LL: 2.02 ; HL: 2.98). The mean thickness of the IAN in the mental region was established at 1.70 mm (LL: 1.54 ; HL: 1.86). The mean distance from the IAN to the external (buccal) surface of the 1st molar was set to be 4.99 mm (LL: 3.84 ; HL: 6.13). CONCLUSIONS: In conclusion, this is the most up-to-date and thorough analysis of the complete anatomy of the IAN. We provided morphometric data that present the spatial relationship of the IAN with numerous anatomical landmarks in the mandibular region. These include the ramus of the mandible, the first, second, and third molars, and the body of the mandible, among others. It is hoped that the results of the present meta-analysis may be a helpful tool for physicians, especially surgeons, performing various oral and maxillofacial procedures, such as third molar removal or IAN block anesthesia.

The Morphology of the Pituitary Gland: A Meta-Analysis with Implications for Diagnostic Imaging.

The objective of this meta-analysis was to present transparent data on the morphology of the pituitary gland (PG) using the available data in the literature. The main online medical databases, such as PubMed, Embase, Scopus, and Web of Science, were searched to gather all relevant studies regarding PG morphology. The mean overall volume of the PG was found to be 597.23 mm3 (SE = 28.81). The mean overall height of the PG was established to be 5.64 mm (SE = 0.11). The mean overall length of the PG was found to be 9.98 mm (SE = 0.26). In the present study, the PG's overall morphology and morphometric features were analyzed. Our results showed that, on average, females from Asia have the highest volume of PG (706.69 mm3), and males from Europe have the lowest (456.42 mm3). These values are crucial to be aware of because they represent the normal average properties of the PG, which may be used as reference points when trying to diagnose potential pathologies of this gland. Furthermore, the present study's results prove how the PG's size decreases with age. The results of the present study may be helpful for physicians, especially surgeons, performing procedures on the PG.

Morphology of the Sella Turcica: A Meta-Analysis Based on the Results of 18,364 Patients.

BACKGROUND: This meta-analysis aimed to present data on the sella turcica (ST) morphology and variations. Furthermore, a detailed morphometric analysis of the ST was conducted. METHODS: Major online databases such as PubMed, Scopus, Embase, Web of Science, and the Cochrane Library were searched through. The overall search process was conducted in three stages. RESULTS: This meta-analysis was based on the results of 18,364 patients and demonstrates the most up-to-date and relevant data regarding the morphology of the ST in the available literature. Four classification methods of the ST shape can be distinguished, in which the most commonly occurring variants are the normal ST (55.56%), the U-shaped ST (73.58%), the circular type of ST (42.29%), and non-bridging ST (55.64%). The overall midpoint height of the ST was 6.59 mm (SE = 0.13). The overall length of the ST was 9.06 mm (SE = 0.15). The overall volume of the ST was 845.80 mm3 (SE = 288.92). Four main classification methods of ST morphology can be distinguished in the available literature. Various morphometric characteristics of the ST may be applied in clinical practice to evaluate its shape, dimensions, and normal or pathological variants.

[Plasma homocysteine concentration in patients with ischaemic stroke caused by large or small vessel disease]. / Steienie homocysteiny w osoczu chorych na udar niedokrwienny mózgu spowodowany choroba duzych lub malych naczyn.

UNLABELLED: Homocysteine is known risk factor for the development of atherosclerosis, but its contribution to the different etiologies of ischaemic stroke remains unclear. THE AIM OF THE STUDY: Comparison of homocysteine, folic acid and vitamin 812 plasma concentrations in patients with ischaemic stroke due to large vessel disease (LVD), small vessel disease (SVD) and in controls. MATERIAL AND METHODS: We studied 71 patients with ischaemic stroke (including 30 patients with LVD and 41 patients with SVD) as well as 30 control subjects. Aetiology of ischaemic stroke was established according to the TOAST criteria using computed tomography of the head, EKG, carotid ultrasound and echocardiography. In patients being 3-12 months after stroke we registered age, sex and the presence of common risk factors for stroke. The serum concentrations of homocysteine, folic acid, and vitamin 812 were measured in venous blood samples drawn after the overnight fasting. RESULTS: Serum homocysteine concentrations were similar in patients with LVD, SVD, and in controls (19.5 +/- 8.9, 18.6 +/- 6.6, and 16.8 +/- 6.4 micromol/l, respectively) (p = 0.36, ANOVA). Vitamin 812 concentrations did not differ significantly among patients with LVD, SVD, and in controls (377 +/- 143, 414 +/- 179, and 412 +/- 173 pg/ml, respectively) (p = 0.66, ANOVA). Patients with LVD, SVD, and controls were also similar regarding the concentrations of folic acid (7.1 +/- 4.0, 6.4 +/- 2.7, and 7.6 +/- 4.0 ng/ml, respectively) (p = 0.38, ANOVA). CONCLUSION: Serum concentrations of homocysteine, vitamin 812, and folic acid are similar in patients with stroke due to LVD, SVD, and in control subjects.

[Hemostatic markers of endothelial injury in ischaemic stroke caused by large or small vessel disease]. / Hemostatyczne wskazniki uszkodzenia sródblonka w udarze niedokrwiennym spowodowanym choroba duzych lub malych naczyn.

THE AIM: of the study was to compare hemostatic markers of endothelial injury in patients with ischaemic stroke caused by large vessel disease (LVD) or small vessel disease (SVD). MATERIAL AND METHODS: We studied 30 patients with LVD and 41 patients with SVD (recruited out of 585 patients with ischaemic stroke) as well as 30 control subjects. Etiology of ischaemic stroke was established according to the TOAST criteria. In patients being 3-12 months after stroke we registered age, sex and the presence of common risk factors for stroke. We measured serum concentration of fibrinogen and plasminogen activator inhibitor 1 (PAI-1), activity of von Willebrand factor (vWF) and the level of beta-thromboglobulin (beta-TG). RESULTS: The concentration of fibrinogen was greater in patients with LVD (3.56 +/-0.88 g/L) when compared to patients with SVD (2.78 +/-0.69 g/L, p

LDL phenotype B and other lipid abnormalities in patients with large vessel disease and small vessel disease.

BACKGROUND AND PURPOSE: Controversies concerning the significance of lipid abnormalities in stroke come mostly from the researches that studied lipid profile without considering stroke aetiologies. We investigated the prevalence of LDL phenotype B and other lipid abnormalities in stroke survivors with large vessel disease (LVD) or small vessel disease (SVD) (TOAST criteria) and in control subjects (CS). METHODS: We studied 30 patients with LVD and 41 patients with SVD screened out of 585 stroke patients and 30 CS who fulfilled the following exclusion criteria: cardiac disorders, renal or hepatic failure, diabetes mellitus, or treatment with lipid-lowering agents. At least 3 months after stroke, the concentrations of total cholesterol (TC), HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), triglycerides (TGs), apolipoprotein E (apoE), and lipoprotein (a) [lp(a)] were measured and LDL phenotypes and apoE isoforms were identified. RESULTS: Patients with LVD had significantly higher concentrations of LDL-C than CS (p<0.05). They had higher concentrations of TGs and lower concentrations of HDL-C than patients with SVD and CS (p<0.05). LDL phenotype B was more frequent in patients with LVD (63.3%) than in patients with SVD (39.0%) or in CS (16.7%) (p<0.05). The concentration of apoE was higher in patients with LVD than in patients with SVD or in CS (p<0.05). The percentage of patients with increased level of lp(a) (i.e., >30 mg/ml) was greater in patients with LVD (36.7%) than in CS (10%) (p<0.05). CONCLUSIONS: Patients with stroke due to LVD, but not SVD, have high prevalence of atherogenic lipid abnormalities, including increased frequency of LDL phenotype B and higher percentage of increased lp(a) level, like patients with other atherogenic diseases.

[Lipoprotein (a) in stroke patients with large and small vessel disease]. / Lipoproteina (a) u chorych z udarem niedokrwiennym mózgu spowodowanym choroba duzych i malych naczyn.

The significance of lipid abnormalities as the risk factor for stroke remains uncertain. The aim of this study was to compare the concentrations of lipoprotein (a) [lp(a)] in stroke patients with large and small vessel disease. We studied 71 patients being 3 to 12 months after ischemic stroke (including 30 subjects with large vessel disease and 41 subjects with small vessel disease) and 30 controls. We excluded patients with stroke of cardioembolic, rare or uncertain etiology, subjects with diabetes, with history of myocardial infarction, arrhythmia, valvular heart disease, hypo- or hyperthyreoidism, hepatic or renal insufficiency, and treated with statins or fibrates. We assessed basal lipid fractions and nephelometrically measured the concentration of lp(a). The concentrations of total and LDL-cholesterol were similar in studied groups. Patients with large vessel disease had lower levels of HDL-cholesterol and higher levels of triglycerides than patients with small vessel disease and than controls. Median concentrations of lp(a) were similar in all studied groups (8.4 mg/dl in all stroke patients; 10.85 mg/dl in large vessel disease; 7.7 mg/dl in small vessel disease and 6.3 mg/dl in controls; p = n.s.). The percentage of subjects with increased lp(a) concentrations (i.e. > 30 mg/dl) was greater in large vessel disease (36.7%) than in small vessel disease (12.2%; p < 0.05) and in controls (10%; p < 0.05). The concentrations of basal lipid fractions were similar in subjects with normal and with increased concentration of lp(a), both in stroke patients and in controls.

[LDL phenotype A and B in ischemic stroke]. / Fenotyp A i B LDL w niedokrwiennym udarze mózgu.

The role of the lipid abnormalities as a risk factor for stroke remains controversial; very likely because only the standard lipid fractions are measured and because different causes of stroke are not considered. LDL phenotype B promotes atherogenesis and is recognized as a risk factor for ischemic heart disease, but its prevalence in ischemic stroke of distinct causes is unknown. Therefore we designed the study to investigate the prevalence of LDL phenotype B in stroke survivors with large vessel disease (LVD) or small vessel disease (SVD) and to establish the relationship between LDL phenotypes and basic lipid fractions in this group of patients. 59 patients (24 patients with LVD and 35 patients with SVD) being at least 3 months after ischemic stroke were included into the study. 30 sex- and age-matched subject served as controls. The concentrations of total cholesterol, HDL- and LDL-cholesterol, as well as triglycerides were measured and the LDL phenotype was determined using the potassium bromide density gradient ultracentrifugation. The LDL phenotype B was more frequent in patients with LVD (67%, p < 0.05) compared to patients with SVD and with controls. LDL phenotype B was also more frequent in patients with SVD (40%) and in all stroke survivors combined (51%), when compared with control group (17%, p < 0.05; chi-square test). Among stroke survivors, controls and studied subjects as a whole, those with LDL phenotype B revealed the lower concentration of HDL-cholesterol (1.19 +/- 0.33 vs. 1.46 +/- 0.42; 1.16 +/- 0.29 vs. 1.53 +/- 0.3 and 1.19 +/- 0.32 vs. 1.49 +/- 0.37, respectively; p < 0.05, Student t-test) when compared with carriers of LDL A phenotype. The LDL phenotype B is more frequent in ischemic stroke survivors compared to controls, and within the group of stroke survivors, LDL B is more prevalent in patients with LVD. The LDL phenotype B is associated with lower concentration of HDL-cholesterol.

Microanatomical study of the recurrent artery of Heubner.

The purpose of this study has been to describe the microanatomy of the recurrent artery of Heubner (RAH) in detail, to deepen anatomical knowledge and aid neurosurgeons in their work. The material was obtained from cadavers (ages 31-75 years) at routine autopsy. A total of 70 human brains (39 male and 31 female) were examined. People who died due to neurological disorders were not included in the study. Right after dissection, the arteries were perfused with acrylic paint emulsion, through the Circle of Willis or electively through the RAH. Brains were fixed in a 10% solution of formaldehyde, sectioned and placed in methyl salicylate for tissue transparency. To obtain corrosion-casts, the vessels were perfused with polyvinyl chloride or Mercox CL-2R resin and corroded using concentrated potassium chloride. The obtained material was analyzed using a stereoscopic light microscope. The RAH was present in 138 hemispheres with a mean of 1.99 RAH per hemisphere (275 RAH in total). The mean RAH length was 25.2 mm and the mean RAH diameter, in its place of origin, was 1 mm. Two to 30 branches (mean=9.4) originated from the stem of the RAH. The number of RAHs showed a negative correlation to the number of arteries from the medial group of lenticulo-striate arteries (LSA) (R=-0.62; p < 0.0001) which branch off the middle cerebral artery (MCA). This study further supports the RAH embryologic theory by Abbie. The RAH, in its extra- and intracerebral course, may join with the middle group of the LSA or directly with the MCA.

Microalbuminuria in nondiabetic patients with acute ischemic stroke: prevalence, clinical correlates, and prognostic significance.

Microalbuminuria is a frequent finding in several acute clinical conditions and predicts poor outcome; its role in acute ischemic stroke, however, is unknown. This study was designed to investigate the prevalence and predictive power of microalbuminuria in acute stroke patients and to establish the relationship between microalbuminuria and the patients' clinical status. We studied 60 patients admitted within 24 h of their first ischemic stroke, 50 patients with a history of ischemic stroke, and 30 control subjects without known cerebrovascular diseases. Neurological deficit was assessed by the Scandinavian Stroke Scale (SSS) on admission and on days 1, 7, 14, and 30. Urinary albumin excretion was measured using immunonephelometric method, with 24-hour collections performed on day 2. Outcome was assessed by 30-day, 90-day and 1-year mortality. Microalbuminuria was found in 46.7% of patients with acute stroke, 16% of subjects with a history of stroke, and 16.7% of controls. On admission, acute stroke patients with microalbuminuria had more severe neurological deficit (median of SSS score on admission was 28 vs. 40, and on day 1, 22 vs. 39, both p < 0.05; Mann-Whitney U test) and more often had a decreased level of consciousness (32 vs. 10%, p < 0.05; Fisher exact test). Mortality was higher in the group of patients with microalbuminuria in acute stroke (21 vs. 3% after 30 days, 39 vs. 6% after 90 days and 50 vs. 9% after 1 year, p < 0.05 for all differences; Fisher exact test). In logistic regression analysis, microalbuminuria was found to be an independent predictor of 1-year mortality after ischemic stroke (OR = 6.0; p = 0.022; 95% CI = 1.3-27.7).