Myocardial bridges, neither rare nor isolated-Autopsy study.

PURPOSE: Myocardial bridge is a congenital anomaly with a markedly variable reported incidence on autopsy (4.7%-86%), likely related to geographical regions. Our previous retrospective study showed a prevalence of 0.8%, which we doubted to be the true one in the examined sample of the Serbian population. To assess the importance of the phenomenon we conducted a 2-year prospective study at the same institution. METHODS: Ninety-six cadaver hearts from adult individuals of both genders (51 men, 45 women) who died from natural causes underwent special dissection. Tunneled coronary arteries and myocardium were examined using light microscopy. RESULTS: A total of 14 myocardial bridges were found in 13 (13.54%) hearts. This anomaly was insignificantly more common in men (13.72% vs. 13.33%, p>0.05). In one heart we noted two myocardial bridges (the left anterior interventricular artery and left marginal artery were overbridged). None of the myocardial bridges had been diagnosed during life. The most common causes of death were cardiac related. Myocardial bridges were located in the following areas: left anterior interventricular (50%), left circumflex artery (28.6%), left marginal artery (14.3%), and right coronary artery (7.1%). In 92.3% of cases, the right coronary artery was dominant. The only heart with a balanced-type had two bridges. Most of the myocardial bridges were long and deep. All tunneled coronary arteries, and although surrounded by "coronary cushion," were not protected from atherosclerosis. In 30.8% of hearts with myocardial bridges, we found additional coronary artery anomalies. CONCLUSION: Myocardial bridges were not rare in the examined sample of the Serbian population and were often associated with other coronary artery anomalies, rendering the carriers at higher risk.

The legal and ethical frameworkgoverning Body Donation in Europe - Areview of current practice andrecommendations for good practice

Discussions at the inaugural meeting of aTrans-European Pedagogic Research Group forAnatomical Sciences highlighted the fact thatthere exist considerable variations in the legaland ethical frameworks throughout Europeconcerning body bequests for anatomicalexamination. Such differences appear to reflectcultural and religious variations as well as differentlegal and constitutional frameworks. Forexample, there are different views concerningthe “ownership” of cadavers and concerningthe need (perceived by different societies andnational politicians) for legislation specificallyrelated to anatomical dissection. Furthermore,there are different views concerning the acceptabilityof using unclaimed bodies that have notgiven informed consent. Given that in Europe (AU)

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Comparative post-mortem study of cavum septi pellucidi in alcoholics, schizophrenics and aggressive persons.

The appearance of cavum septi pellucidi (CSP) has been already connected with developmental disorders or with serious psychiatric diseases (schizophrenia, maniac-depressive disorder, aggressiveness or similar). During our investigation of CSP, group of alcoholics seemed to be interesting for investigation and comparison with the groups of schizophrenics and people with violent behavior. We obtained CSP in 205 out of 670 fixed brains (429 male and 241 female) of persons aged from 14 to 89 (mean +/- SD: 53.28 +/- 16.57), 85 cava belonged to our group of interest. Prevalence of CSP in aforementioned groups was significantly higher than in the rest of examined population. Only in the group of 20 to 39 years of age all kinds of obtained pathologies were present. Alcoholics with CSP suffered from cardiovascular diseases and died accidentally and aggressive persons were the only drug addicts in our examined group and they had the shortest life span. 34 out of 41 schizophrenics had no data about prior diseases and disorders and they were the ones who committed suicide frequently. Intensive demyelinization of corpus callosum and transformation of potential space between laminae of septum pellucidum to the actual one could explain the CSP appearance among alcoholics. To our opinion, cavum septi pellucidi might be used as an additional marker of organic brain changes in long term alcohol abuse, as a consequence of demyelinization due to lipolytic effect of ethanol, and lower cerebral blood flow.

Ageing changes of morphological characteristics of cavum septi pellucidi in adults: a dissectional study.

In this study we wanted to investigate whether prevalence, number of symptomatic cava and its parameters, its width, length and surface on the axial slices change in the function of ageing. We reviewed 145 fresh brains with cavum septi pellucidi (CSP) from persons aged 22 to 89 (mean 57.44 +/- 15.37) divided in three groups aged 21-40 (group I), 41 to 60 (group II) and older than 61 (group III). Prevalence does not differ much in all the groups: 32.62% in group I, 28.24% and 29.12% in groups II and III. Cava in group I were most frequently connected with schizophrenia (11 cases), in group II with alcoholism and in group III with prior head trauma. Symptomatic cava had significantly higher frequency in group III in 95% cases and in two others less than 50%. Mean widths (+/- SD) in group I, II and III were: 5.21 +/- 1.12 mm, 5.23 +/- 1.33 mm and 4.29 +/- 1.28 mm, respectively. Mean lengths were: 6.6 +/- 2.02, 6.2 +/- 2.54 and 5.9 +/- 1.82 mm. Surface areas were decreasing with ageing: 19.16 +/- 5.83 mm2 to 12.31 +/- 4.12 mm2. However, all revealed differences were not statistically significant. Cavum septi pellucidi itself does not change significantly during ageing, but it points out to some diseases and disturbances. Its appearance in all adults ought to be a warning sign, especially in persons older than 60, but it should not be neglected in other life periods, as well.

Coronary artery distribution in Macaca fascicularis (Cynomolgus).

The studies were performed using stereomicroscopic dissection, and light microscopy examination on hearts of healthy and fertile non-human primates (Macaca fascicularis) of both sexes. The results indicate that the anatomy of the coronary arteries offers points of similarity as well as departure from humans. The blood supply to the hearts was by left (LCA) and right (RCA) coronary arteries. The LCA averaged 1.78 +/- 0.29 (SD) mm (range 1.40-2.40 mm) in external diameter at its origin, and 4.34 +/- 1.29 (SD) mm (range 1.8-6.5 mm) in length. It usually terminated by dividing into a left anterior descending artery (LAD) and the circumflex branch (CXA). The CXA branch coursed along the left part of the atrioventricular groove and gave off a varying number of branches to the left ventricle and atrium along its course. It averaged 1.14 +/- 0.30 (SD) mm (range 0.70-1.70 mm) in external diameter at its origin. The LAD averaged 1.28 +/- 0.25 (SD) mm (range 0.90 +/- 1.80 mm) in external diameter at its origin. In 73% cases the LAD continued over the apex to course dorsally in the posterior interventricular groove, and gave off a varying number of diagonal and septal branches. The RCA arose from the right aortic sinus and coursed along the right part of the atrioventricular groove and averaged 0.94 +/- 0.15 (SD) mm (range 0.70-1.20 mm) in external diameter at its origin. The posterior descending coronary artery (PDCA) arose from the LCA in 55% of the cases, and from the RCA in 45%. Myocardial bridges (MB) were present in 54% of the hearts and over the LCA branches exclusively. The average length of all MB was 5.68 +/- 3.31 (SD) mm (range 2.4-11.5 mm). The coronary arteries of Macaca fascicularis are medium sized muscular arteries with well developed tunics intima, media and adventitia, and so resemble human arteries more closely than the dog. Therefore, we suggest this primate species might be a useful model for physiological studies on the coronary circulation.

Myocardial bridging of the left anterior descending coronary artery in monkey hearts.

The presence of myocardial bridges over the left anterior descending coronary artery (LAD) has been studied in 55 monkey (Cercopithecus aethiops) hearts. The resemblance between the Cercopithecus LAD and the one in humans has been revealed. Cercopithecus LAD was the most frequently (70.9%) overbridged artery. The bridges were usually single. Only in 2 hearts (3.6%) LAD was overbridged by 2 MB. Their length varies from 0.5 mm to 31.6 mm (average 11.7 mm). No statistically significant sexual differences in the incidence and length of MB have been reported. Atherosclerotic lesions have been reported in overbridged parts of the vessel as well as in the subepicardial ones. Intimate correlation between the presence of myocardial bridges and atherosclerosis could not be suggested.

[Coronary arteries in the Macaca fascicularis monkey]. / Koronarne arterije majmuna Macacus fascicularis.

The coronary arterial epicardial network in the monkey Macaca fascicularis was studied. The study concerned 11 hearts of healthy and fertile animals of both sexes. The morphological and morphometric results of the studies performed by microdissection revealed that: In all examined cases of the Macaca fascicularis the heart was supplied by blood through the left and right coronary arteries. The left coronary artery had a larger external diameter (1.2 mm-2.5 mm, average 1.8 mm) than the right one (0.7 mm-1.2 mm, average 0.9 mm). The left coronary artery, with the average length of 4.3 mm (1.8 mm-6.5 mm), usually (82%) ended by bifurcation in to the anterior interventricular and the circumflex branch, and less frequently (18%) by trifurcation forming, in this way, another branch: the left marginal branch. The anterior interventricular branch had the larger external diameter (0.9 mm-1.7 mm, average 1.3 mm) than the circumflex one (0.7 mm-1.7 mm, average 1.1 mm). Most frequently (73%) it could be traced along the diaphragmatic cardiac surface. The circumflex branch usually (73%) terminated as the posterior interventricular branch, and less frequently (9%) as one of the right posterior ventricular branches. The long type of the right coronary artery was observed in 45% of the cases. The presence of the myocardial bridges over the branches of the left coronary artery was found in 54% of the examined hearts. The great resemblance between the Macaca fascicularis subepicardial network with the corresponding one in humans suggest that Macacus fascicularis is a suitable experimental animal for functional studies of the cardiovascular system.

Variations of the blood supply of the human conus arteriosus.

The conus arteriosus was divided into right and left halves and each half was subdivided into 3 portions: superior, middle and inferior. The study of the blood supply of the conus was performed in 8O human hearts. The results showed that the sternocostal wall of the conus arteriosus may be supplied by the arteria coni arteriosi but, more frequently by branches of the right and left coronary arteries. The most frequent branches supplying the conus arteriosus were the ramus anterior ventriculi dextri medialis and lateralis (85%), ramus coni arteriosi dexter (51.2%), ramus anterior ventriculi dextri medius I (47.5%), ramus anterior ventriculi dextri intermedius (41.2%), ramus coni arteriosi sinister (40%) and ramus anterior ventriculi dextri superior I (38.7%).

The membranous portion of the interventricular septum and its relationship with the aortic valve in humans.

Investigation of the membranous portion of the interventricular septum (MPIS) and its relationship with the aortic valve was performed in 32 human hearts of adult individuals (19 Caucasians and 11 non-Caucasians). With transillumination of the MPIS the specimens were photographed and 35 mm slices obtained. These were digitized into Apple Macintosh II using a Dage Model 68 video camera and a Data Translations DT 2255 frame grabber. The areas and the distances were traced manually, using the NIH Image program (Wayne Rasband, NIH, Research Services Branch, NIHM). The following forms of MPIS were found: oval (31.3%), triangular (28.1%), quadrangular (18.8%), circular (15.6%) and semilunar (6.2%); its surface area varied from 5.65 mm2 to 142.63 mm2 (mean 48.82 +/- 29.17 mm2). The superior border of the MPIS was in close relationship with the aortic valve, and its upper part was usually (41%) in direct continuity with the attachments of both right (RAC) and posterior (PAC) aortic cusps, or with PAC (34%) or RAC (6%) only. Rarely (19%) the MPIS lay below the attachments of both cusps. The distance between the MPIS superior border and the attachment of the RAC was not greater than 5.89 mm (mean 1.69 mm +/- 1.9 mm). The distance between the superior border of the MPIS and the attachment of the PAC was not greater than 5.63 mm (mean 0.77 +/- 1.49 mm). Differences between sex, race and age groups were not statistically significant.

Anatomical variations of the abducent nerve in humans.

Anatomical variation of the nervus abducens in human encephali were found and described. They consisted of (1) an unusual trifurcation of the abducent nerve, limited to the extradural portion of the neural trunk (1.4% of the cases) and (2) the duplicity (11.1%) of the neural trunk, starting before reaching the orbit and ending before reaching the m. rectus lateralis. The possibility of correlating these variations with clinical aspects and forensic interpretations is mentioned.

Variation in length and termination of the ramus circumflexus of the human left coronary artery.

The length and termination of the circumflex branch of the left coronary artery were studied in 81 hearts, after injection of the coloured substance containing a radiopaque medium. The hearts were radiographed, dissected, drawn and photographed. The short type of circumflex branch, defined as a branch that did not reach the crux cordis, was found to be much more frequent (86.4%) than the long type and terminated in the majority of the cases (76.5%) as one of the posterior branches of the left ventricle.

Variation in length and termination of the right coronary artery in man.

The length and termination of the right coronary artery of the human heart were studied in 81 hearts, after injection of a colored substance containing a radiopaque medium. The hearts were radiographed, dissected, drawn and photographed. The long type of right coronary artery, defined as a branch that reached or ran distal to the crux cordis, was found to be much more frequent (88.8%) than the short type and terminated in the majority of the cases (71.6%) as one of the posterior branches of the left ventricle. The relationship between these findings and the so-called "coronary circulation dominance" is discussed.

The cardiac apex and its superficial blood supply.

The cardiac apex was defined and 3 types were presented: the anatomical apex, the base of which was established at the incisura apicis cordis; the amplified anatomical apex, twice the volume of the preceding; and the geometric apex, the distal third of the ventricles. These types of cardiac apex were studied in connection with the superficial branches of the coronary arteries at their level. The investigation was conducted on 81 normal hearts (56 males and 25 females) of 60 Caucasian and 21 non-Caucasian individuals. The arteries were injected with colored gelatine mixed with a radiopaque substance. The number of branches decreased from the geometric (the largest type) to the anatomical apex (the smallest): 27 on the surface of the geometric apex, 14 on the surface of the amplified anatomical apex, and 7 on the surface of the anatomical apex. The sternocostal aspect had a higher number of superficial branches than the diaphragmatic aspect in all types of cardiac apex. Sexual differences were found in the incidence of the r posterior ventriculi sinistri intermedius on the amplified anatomical apex as it was more frequent in females than in males. In the geometric apex there were 3 branches also more frequent in females: r anterior ventriculi sinistri inferior, r posterior ventriculi sinistri lateralis I, and r posterior ventriculi sinistri lateralis IV.