The interosseus crural nerve: An anatomical study of a rarely described structure.

The interosseous crural nerve (IOCn) is said to arise distally from muscular branches of the tibial nerve innervating the deep muscles of the posterior compartment of the leg. Here, we present the results of a cadaveric study of the IOCn to clarify this nerve's morphology and to discuss its potential clinical relevance. On 26 sides from 13 cadaveric specimens, the IOCn was dissected. The IOCn was identified on 14 out of 26 sides (53.8%). The mean diameter and length of the IOCn were 0.46 mm (range 0.3-0.72 mm) and 20.9 mm (range 13.5-33.0 mm), respectively. The origin of the IOCn was from a branch to the popliteus muscle on all sides. The nerve was found to have vascular, muscular, and ligamentous branches. In 53.8%, the nerve reached the inferior tibiofibular joint, and in 46.2%, the nerve terminated in the interosseous membrane of the leg. At its distal part, the IOCn gave off multiple vascular branches to the fibular artery. On one side (7.1%), the nerve pierced the interosseous membrane and innervated muscles of the anterior compartment of the leg. We believe this to be the first anatomical study of the IOCn. The nerve was found to have vascular, muscular, and ligamentous branches. Surgeons operating in the deep posterior compartment of the leg and ankle and clinicians treating patients with unusual presentations or pathology of the leg and ankle should be aware of this structure.

Surveillance of patients with breast cancer after curative-intent primary treatment: current practice patterns.

PURPOSE: To determine how physicians monitor their patients after initial curative-intent treatment for breast carcinoma. METHODS: A custom-designed survey instrument with four idealized patient vignettes (TNM stages 0 to III) was e-mailed to the 3,245 members of ASCO who had identified themselves as having breast cancer as a major focus of their practice. Respondents were asked how they use 12 specific follow-up modalities during post-treatment years 1 to 5 for each vignette. Mean, median, standard deviation, and range of the intensity of use for each modality were calculated for the four vignettes. RESULTS: Of the 3,245 ASCO members surveyed, 1,012 (31%) responded. Of these, 915 (90%) were evaluable and were included in our analysis. Office visit, mammogram, complete blood count, and liver function tests were the most commonly recommended surveillance modalities. There was marked variation in surveillance intensity. For example, office visit was recommended 4.1 ± 2.2 times (mean ± SD) in year 1 after curative treatment of a patient with stage III breast cancer. Similar variation was observed for all modalities. CONCLUSIONS: The intensity of post-treatment surveillance performed by ASCO members caring for patients with breast cancer varies markedly despite evidence from well-designed, adequately powered randomized controlled trials. Many modalities not recommended by ASCO guidelines are used routinely, which constitutes evidence of overuse. The lack of consensus is likely due to multiple factors and constitutes an appealing target for interventions to rationalize surveillance.