Variability in human quadriceps muscles: quantitative study and review of clinical literature.

Knowledge of variations in normal human thigh musculature is important for the interpretation of various clinical and biomedical investigations. In this study, cross-sections from whole thighs of 34 cadavers were analyzed qualitatively and morphometrically. Sections were cut from right and left limbs at three levels in the region often used for muscle biopsy. Measurements were made of limb circumferences and cross-sectional areas of the three vasti and of the femur, and of the extent of overlap and fusion between the vasti on the lateral aspect of the thigh. Limb circumference proved to be a good predictor of total cross-sectional area of the quadriceps muscle. Large individual variations were found for most measurements but especially for the amount of fusion between the muscle bellies of vastus lateralis and vastus intermedius. Significant differences were found for most variables between the three levels, but there were few differences between sides except for the cross-sectional area of vastus lateralis which was greater on the right at the most distal level. These variations in size and form of thigh musculature should be considered when interpreting data obtained from muscle biopsy, imaging, biomechanical, electromyographic, and functional studies of the human thigh. Review of the literature on variability of quadriceps muscle and its clinical relevance showed a diversity of approaches but insufficient definitive data suitable for interpreting functional outcomes in response to exercise or following surgery. Further work is suggested combining current anatomical datasets with advanced imaging techniques capable of determining muscle fiber orientation and fiber type composition, and including 3D reconstruction.

Giant cell arteritis presenting as a carpal tunnel syndrome.

The etiology, diagnosis, and management of carpal tunnel syndrome remains controversial despite nearly 50 years of surgical treatment. The increasing incidence of the entity in clerical workers and in laborers has fueled the controversy as to whether this is a work-related condition. This article reports a case of carpal tunnel syndrome with a hitherto undescribed etiology.

Cold preservation of enteric free flaps: an experimental study.

Enteric free flaps have proven to be useful in the reconstruction of the esophagus. This study was designed to determine whether cold preservation can prolong the ischemia time of enteric flaps from the distal small bowel. Adult mongrel dogs were anesthetized, and the abdomen was opened at the midline. Two 10-cm portions of the distal small bowel were identified and dissected out on a single pedicle. The bowel was then divided, and one segment was cooled with iced saline sponges while the second segment was not. The blood supply to both segments was then clamped. After 2 hours, the bowel was reanastomosed, and the cold segment was marked. Twenty-four hours later, the dogs were reanesthetized and given fluorescein and the bowel was then examined under the Woods lamp. Sections from both the warm ischemia and cold ischemia bowel were examined histologically. Results indicated that cooling the bowel can retard histologic changes that ischemia produces in the bowel.

Mixed mesodermal tumor of urinary bladder: a light and electron microscopic study.

Light and ultrastructural findings in a mixed mesodermal tumor of the urinary bladder are reported. The mesenchymal component of the tumor contained undifferentiated mesenchymal cells and cells with chondroblastic differentiation. The neoplastic chondrocytes displayed an abundance of cytoplasmic microfilaments and had a scalloped cell surface.