The anatomy of the atrioventricular nodal artery: A meta-analysis with implications for cardiothoracic surgery and ablation procedures.

The objective of the present meta-analysis was to evaluate recent and applicable data regarding the location and variation of the atrioventricular nodal artery (AVNA) in relation to adjacent structures. In order to minimize postoperative risks and maintain physiological anastomosis for proper cardiac function, understanding such possible variations of vascularization of the AV node is of immense importance prior to cardiothoracic surgery as well as ablations. In order to perform this meta-analysis, a systematic search was conducted in which all articles regarding, or at least mentioning, the anatomy of the AVNA was searched. In general, the results were based on 3919 patients. AVNA was found to originate only from the RCA in 82.41% (95% CI: 79.46%-85.18%). The pooled prevalence of AVNA originating only from LCA was found to be 15.25% (95% CI: 12.71%-17.97%). The mean length of AVNA was found to be 22.64 mm (SE = 1.60). The mean maximal diameter of AVNA at its origin was found to be 1.40 mm (SE = 0.14). In conclusion, we believe that this is the most accurate and up-to-date study regarding the highly variable anatomy of the AVNA. The AVNA was found to originate most commonly from the RCA (82.41%). Furthermore, the AVNA was found to most commonly have no (52.46%) or only one branch (33.74%). It is hoped that the results of the present meta-analysis will be helpful for physicians performing cardiothoracic or ablation procedures.

Anatomical studies on larynx and voice production in historical perspective.

Voice production - emission, raised interest of humans from almost the beginning of the humanity. First written information dates back to the Egyptian times 2500-3000 BC. Practically from early Greek period until XIX century studies of the larynx and the speech apparatus brought new and new facts, both regarding the structures, physiology and clinics. Such ancient researchers as Galen, Morgagni, Eustachii, Casserius created milestones for modern laryngology. Authors hoped to present some facts on the anatomical researches in the field of organs responsible for voice production from historical perspective.

Anatomical variations of the insular gyri: A morphological study and proposal of unified classification.

The locations of gyral landmarks vary among individuals. This can be crucial during local landmark-based mapping of the human cortex, so the aim of the present study was to establish criteria for classifying the morphological variability of the human insula. The study was conducted on 50 isolated, randomly-selected adult cadaveric hemispheres, fixed in 10% formalin, and preserved in 70% ethanol (24 right and 26 left hemispheres). A thorough rating system, including bifid form (i.e., divided on top), branching or hypoplasia, was used to analyze the insular gyri. The number of all insular gyri ranged from four to six (mean = 5.16, SD = 0.65). Within the anterior lobule, the number of short gyri ranged from two to four (mean = 3.3, SD = 0.54). The middle short gyrus was the most variable. It was well-developed in 25 of the 50 cases (50%). Within the posterior lobule there were one or two long insular gyri (mean = 1.88, SD = 0.32). In 48 cases (96%), the anterior long gyrus was well-developed. A complete lack of the posterior long gyrus was noted in six of the 50 cases (12%). In conclusions, the accessory, the middle short, and the posterior long gyri of the insula were the most variable. The middle short gyrus was well-developed in only half of the cases. The number of insular gyri found in horizontal sections of the brain does not necessarily indicate their true number. Clin. Anat. 31:347-356, 2018. © 2018 Wiley Periodicals, Inc.

The Arterial Anatomy of the Cerebellum-A Comprehensive Review.

The cerebellum, a major feature of the hindbrain, lies posterior to the pons and medulla and inferior to the posterior part of the cerebrum. It lies beneath the tentorium cerebelli in the posterior cranial fossa and consists of two lateral hemispheres connected by the vermis. The cerebellum is primarily supplied by three arteries originating from the vertebrobasilar system: the superior cerebellar artery (SCA), the anterior inferior cerebellar artery (AICA), and the posterior inferior cerebellar artery (PICA). However, variations of the cerebellar arteries may occur, such as duplication of the SCA, SCA creating a common trunk with the posterior cerebral artery, triplication of the AICA, and agenesis of PICA, amongst others. Knowledge of the arterial anatomy of the cerebellum is crucial, as inadequate blood supply to this region can result in diminished motor functioning, significantly impacting the quality of life for patients. The present study demonstrated the importance of adequate anatomical knowledge of the arteries supplying the cerebellum. The PubMed and Embase databases were searched to gather articles on the anatomical characteristics and variations of the arterial supply of the cerebellum. It is the most comprehensive and up-to-date review available in the literature. The possible variations of these vessels may be clinically silent or present with clinical symptoms such as neurovascular compression syndromes of the cranial nerves and aneurysms. With a comprehensive understanding of the cerebellar arterial system, physicians can enhance their diagnostic and treatment capabilities, ultimately leading to more effective management of cerebellar vascular-related issues and other neurological deficits.

Thoracolumbar fascia in the lumbar region: anatomical description and topographical relationships to the cutaneous nerves: a preliminary study.

BACKGROUND: The study aims to determine principal topographical relations between thoracolumbar fascia (TLF) and lateral branches derived from the dorsal (posterior) rami of lumbar spinal nerves and elucidate their potential link to lumbar region pain. The research protocol involves basic TLF morphological description, evaluating its relation to the nerves, and examining general histology. MATERIALS AND METHODS: The research was conducted on four male cadavers fixed in 10% neutral buffered formalin. RESULTS: The dorsal rami of the spinal nerves branched into medial and lateral divisions. The lateral divisions were about 1 mm thick and mainly visible in the subcutaneous tissue during stratigraphic dissection. They pierced the TLF superficial layer. They descended sidewards and downwards within the superficial fascia (laterally to the erector spinae muscle) to provide sensory innervation to the skin. CONCLUSIONS: Anatomical relationships between TLF, deep (intrinsic or true) back muscles, and dorsal rami of the spinal nerves are complex and may be clinically involved in low back pain etiopathogenesis.

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.

Polyorchidism: An Up-to-Date Systematic Review.

Polyorchidism is a rare male urogenital tract anomaly characterized by at least one supernumerary testis in the scrotum or ectopically. According to data based on our systematic review, 76% of the supernumerary testes (SNTs) were located in the scrotum, and 24% were extra-scrotal (p < 0.001). Among testes located outside the scrotum, 87% were found in the inguinal canal and 13% in the abdominal cavity. In 80% of cases, the diagnosis of SNT was made based on imaging tests, and the remaining 20% of cases were detected incidentally during surgery. The imaging tests performed (US or MRI) resulted in a significantly higher rate of patients who qualified for observation vs. surgical treatment (45% vs. 35%, p < 0.001). The most common conditions associated with SNT were ipsilateral inguinal hernia (15% of cases) and cryptorchidism (15% of cases). Surgery (orchidopexy/orchidectomy) was performed on 54% of patients with SNT, and the decision to observe the SNT was made in a total of 46% of patients (p = 0.001). The therapeutic approach depends on the location of the SNT and the presence of factors that raise suspicion of neoplastic proliferation.

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.

Revisiting the Morphology and Classification of the Paracingulate Gyrus with Commentaries on Ambiguous Cases.

The anterior cingulate cortex is considered to play a crucial role in cognitive and affective regulation. However, this area shows a high degree of morphological interindividual variability and asymmetry. It is especially true regarding the paracingulate sulcus and paracingulate gyrus (PCG). Since the reports described in the literature are mainly based on imaging techniques, the goal of this study was to verify the classification of the PCG based on anatomical material. Special attention was given to ambiguous cases. The PCG was absent in 26.4% of specimens. The gyrus was classified as present in 28.3% of cases. The prominent type of the PCG was observed in 37.7% of the total. Occasionally, the gyrus was well-developed and roughly only a few millimeters were missing for classifying the gyrus as prominent, as it ended slightly anterior the level of the VAC. The remaining four cases involved two inconclusive types. We observed that the callosomarginal artery ran within the cingulate sulcus and provided branches that crossed the PCG. Based on Klingler's dissection technique, we observed a close relationship of the PCG with the superior longitudinal fascicle. The awareness of the anatomical variability observed within the brain cortex is an essential starting point for in-depth research.

Bilateral Extensive Ossification of the Posterior Petroclinoid Ligament: An Anatomical Case Report and Literature Review.

BACKGROUND: The posterior petroclinoid dural fold (commonly referred to as a ligament) forms the roof of the trigeminal porus and the roof of the petroclival venous confluence. It lies in close proximity to the oculomotor nerve that crosses it. Due to the low availability of research material, only a few cadaveric studies have been conducted on the microsurgical anatomy of the petroclinoid ligament in cases of its ossification. Thus our report complements earlier studies and provides detailed data on the spatial relationships between the ossified posterior petroclinoid ligament and the trigeminal, oculomotor, and abducens nerves, with special attention to the topographical relationships within the petroclival venous confluence and Dorello's canal. CASE DESCRIPTION: Bilateral massive ossification of the posterior petroclinoid ligament was observed during the dissection of a 76-year-old female cadaver. The presence of an osseous bridge over the trigeminal notch was also detected on the left side. No narrowing of the space occupied by the petroclival venous confluence was observed. However, the dural sheath of the oculomotor nerve was fixed much more than usual. CONCLUSIONS: Because the ossification of the posterior petroclinoid ligament may be considered a factor influencing diagnostic and surgical procedures, neurosurgeons and neuroradiologists should be aware of this variation. Ossification of the posterior petroclinoid ligament may also potentially result in greater susceptibility of the oculomotor nerve to injury.

Estimation of vastus medialis' excitability in cases of lateral patellar instability in children.

BACKGROUND: The aim of this study was to evaluate the excitability of the vastus medialis muscle in children with lateral patellar instability, because it is assumed that, apart from restoring the elasticity of passive lateral restraints, the main goal of rehabilitation of this dysfunction is strengthening of the vastus medialis. MATERIALS AND METHODS: Measurements were done in 56 patients (mean age 15.9 years) in the study group and 38 patients (mean age 15.2 years) in the control group. The study was carried out from October 2006 to April 2007. Neuro-muscular-excitability was assessed by determining rheobase. A Sonopuls 992 apparatus was used for this purpose. RESULTS: 72 measurements were taken in the study group, with a mean value of rheobase of 15.3 mA(+/-4.9). In the control group, 76 measurements were taken and the mean value of rheobase was 11.5 mA(+/-4.1). CONCLUSIONS: 1. Vastus medialis muscles in children with lateral patellar instability display significantly higher mean values of rheobase in comparison to mean values from the control group, i.e they are less excitable. Consequently, measuring rheobase in the vastus medialis in children with lateral patellar instability is an objective method for the assessment of treatment and rehabilitation outcomes. 2. Strengthening the vastus medialis muscle, the only active medial stabilizer of patella, is one of the most important elements of rehabilitation in children with signs of lateral patellar instability because it has lower excitability in these children than in healthy children.

[Spondylarthrosis etiopathogenesis]. / Etiopatogeneza choroby zwyrodnieniowej kregoslupa.

Spinal pain syndrome is a fast growing "pandemic" disease in highly civilised communities. Dealing with the etiopathogenesis of its most popular cause--spondylarthrosis--requires the knowledge of anatomy and physiology of the spine, and the explanation of biomechanic phenomena occurring in it. Many theories explaining the progress of spondylarthrosis are based on the assumption that the primary reason for pathology is degeneration of intervertebral discs, caused mainly by forced changes of spatial geometry of the spine; namely prolonged sitting or carrying weights in a bent position. The work presents Kapandji's hypothesis, attractive, among others, for its simplicity; explaining pathological mechanisms occurring within intervertebral disc. The hypothesis has also been advanced that the initiator of the process are degenerative changes in intervertebral joints, resulting from the so - called muscle dysbalance. They may occur earlier and only secondarily lead to disorders within the disc. The dynamics of progress of the disease varies, and the progression of pathological disorders is connected with the above - mentioned improper motor activity; first of all with the cumulation of effects of microtraumas, resulting from excessive sitting and bending, which may considerably accelerate this process, especially in patients genetically predisposed. In the work the progress of pathological process was presented from the stage of primary changes in nucleus pulposus to the phase of advanced adaptive--compensatory productive reactions in developed spondylosis.

[Masked (atypical) depression in patients with back pain syndrome in outpatient neurological care]. / Depresja maskowana (atypowa) u chorych z zespolem bólowym kregoslupa w praktyce ambulatoryjnej neurologa.

UNLABELLED: Affective disorders, mainly depression is fast growing problem in highly civilised communities. The literature reports that 30-40% of patients seeking medical advice from specialists (not psychiatrists) in outpatient departments, suffer from these disorders. Many authors mention also diagnostic difficulties in dealing with atypical depression, and draw attention to the fact that this process is often "masked" by chronic pain. In neurological care we find a remarkable group of outpatients with back pain syndrome, mainly cervical and lumbar, with no corresponding lesions found on examination. This enabled us to assume that in some patients presenting with somatic symptoms and therefore referred to a neurologist, the reason of complaints can be depressive disorders. The aim of the study was to verify this hypothesis and to estimate the frequency of masked depression in neurological care. MATERIAL AND METHOD: 100 patients were examined in the neurological outpatient department, with the use of the two--Beck and Hamilton--scales of depression evaluation. RESULTS: A statistical analysis of the data thus obtained, showed that: back pain syndrome, as a symptom of depression, occurred in 14% of all patients referred to a neurologist, whereas in 37%--depressive disorders, not diagnosed before, were detected; in 88,2% they were of mild and moderate type. CONCLUSION: In some patients presenting with somatic symptoms and therefore referred to a neurologist, the reason of complaints are depresive disorders.

Symptoms of depression in elderly patients with osteoarticular diseases undergoing hospital rehabilitation.

BACKGROUND: To evaluate the impact of hospital rehabilitation on depression among patients with osteo articular diseases. MATERIAL AND METHODS: An ad hoc questionnaire designed by the authors were the Beck scale and Laitinen scale administered to 50 hospitalized patients with osteoarticular diseases before and after rehabilitation. RESULTS: Symptoms of depression were found in 16 of the 50 patients (32%) on admission to the hospital compared to 8 (16%) after completing rehabilitation (Chi 2 = 4.08, p = 0.0433). The differences in the Beck scale for each of the respondents before and after physiotherapy were statistically significant (p <0.0001). We found a correlation between the occurrence of depression, and the presence of co-morbidities before and after rehabilitation (r = 0.29, r = 0.34). Before (r = 0.36, p = 0.0094) and after rehabilitation (r = 0.64, p <0.0001), symptoms of depression correlated with pain severity. 49 patients (98%), including all 16 with depression, complained of pain. Rehabilitation produced a reduction in pain frequency (p <0.0001), intensity (p <0.0001), medi cation use (p <0.0001) and movement limitation (p = 0.0004). CONCLUSIONS: 1. Patient age, osteoarticular diseases and comorbidities correlated positively with symptoms of depression. 2. Hospital-based rehabilitation of patients with osteoarticular diseases had a significant impact on reducing the incidence and severity of pain and reducing the consumption of analgesics. 3. Hospital rehabilitation helps eliminate or reduce the severity of symptoms of depression and markedly improves patients' daily functioning.