Neurologic and histologic outcome after intraneural injections of lidocaine in canine sciatic nerves.

BACKGROUND: Inadvertent intraneural injection of local anesthetics may result in neurologic injury. We hypothesized that an intraneural injection may be associated with higher injection pressures and an increase in the risk of neurologic injury. METHODS: The study was conducted in accordance with the principles of laboratory animal care, and was approved by the Laboratory Animal Care and Use Committee. Fifteen dogs of mixed breed (16-21 kg) were studied. After general endotracheal anesthesia, the sciatic nerves (n= 30) were exposed bilaterally. Under direct vision, a 25-gauge, long-beveled needle (30 degrees) was placed either epineurally (n= 10) or intraneurally (n= 20), and 4 ml of preservative-free lidocaine 20 mg/ml was injected using an automated infusion pump (4 ml/min). Injection pressure data were acquired using an in-line manometer coupled to a computer via an analog-to-digital conversion board. After injection, the animals were awakened and subjected to serial neurologic examinations. One week later, the dogs were killed, the sciatic nerves excised and histologic examination was performed by pathologists blind to the purpose of the study. RESULTS: All perineural injections resulted in low pressures (< or = 5 psi). In contrast, eight of 20 intraneural injections resulted in high pressures (20-38 psi) at the beginning of the injection. Twelve intraneural injections, however, resulted in pressures of less than 12 psi. Neurologic function returned to baseline within 3 h after perineural injections and within 24 h after intraneural injections, when the measured injection pressures were less than 12 psi. Neurologic deficits persisted throughout the study period after all eight intraneural injections that resulted in high injection pressures. Histologic examination of the affected nerves revealed fascicular axonolysis and cellular infiltration. CONCLUSIONS: The data in our canine model of intraneural injection suggest that intraneural injections do not always lead to nerve injury. High injection pressures during intraneural injection may be indicative of intrafascicular injection and may predict the development of neurologic injury.

[Variation in the lateral plate of the pterygoid process and the lateral subzygomatic approach to the mandibular nerve]. / Varijacije laminae lateralis processus pterygoidei i lateralni subzigomaticni pristup mandibularnom zivcu.

OBJECTIVES: The objective of this work is studying wariable anatomy formations at the posterior border of the pterygoid process lateral plate of the sphenoid hobe (lig. et foramen pterygospinale, lig. et foramen crotaphitico-buccinatorium), and its statistical processing considering sex, age and sides of studied sculls. MATERIAL AND METHODS: At 305 sculls of mature persons of both sexes (167 males and 138 females) we studied incompletely ossificated lig. pterygospinale, opening of the same name which has become by its full ossification, incompletely ossificated lig. crotaphitico-buccinatorium and opening made by it's complete ossification, and position of this structures in relation to foramen ovale. RESULTS: Incompletely ossificated lig. pterygospinale was found at 12 sculls on both sides or 3.93% (8 male's and 4 female's sculls). One-sidedly, on the right one, incompletely ossificated lig. pterygospinale was found at 14 sculls (4.59%), and on the left side at 19 sculls (6.22%). Incompletely ossificated lig. pterygospinale, present on both sides of sculls, was in the case of persons older than 50 (9 sculls or 75%). Pterygospinous opening which has become by complete ossification of lig. pterygospinale was found on both sides at 4 sculls (1.31%), two of them were male's and two of them female's sculls. In alll four cases persons were older than 40. Pterygospinous opening found on the left side was present at only 3 sculls (0.98%) and on the right side at 4 sculls (1.31%). Pterygospinous opening was present one-sidedly, every time, in the case of male's sculls. Incompletely ossificated lig. crotaphitico-buccinatorium, meaning incomplete opening, was found at 17 sculls on both sides (5.57%). 10 of them were male persons' sculls, and 7 of them females'. On the right side, incompletely ossificated lig. crotaphitico-buccinatorium was found at 11 sculls (3.60%)--6 male's and 5 female's, and on the left side at 16 sculls (5.24%). Foramen crotaphitico-buccinatorium was found on both sides only at 12 sculls (0.97%)--one male's and one female's. Foramen crotaphitico-buccinatorium was found on the left side at 8 sculls (3.90%) and, on the right side, this opening was found at 3 sculls (0.98%). Incompletely of completely ossificated lig. pterygospinale, located laterally from foramen ovale, was found at 5 sculls (5 male's and 1 female's) or 1.63%, and in the other case, incopletely or completely ossificated lig. crotaphitico-buccinatorium laterally from foramen ovale was found at 7 sculls (5 male's and 2 female's) or 2.29%. CONCLUSION: While applying conductive anaesthesia on mandibular nerve by lateral subzygomatic route, variable ossificated formations at lateral plate's posterior border of pterygoid process should be kept in mind. It is possible that a needle, at a depth of 35 mm, comes across incompletely or completely ossificated lig. pterygospinale et crotaphitico-bucciantorium. Based on ours anatomy research we concluded that these formations are more oftenly present on males aged over 50, and that one-sided presence is more often on the left side. Ossificated formations which were the object of our research are not an obstacle to high-quality applying of conductive anaesthesia on trigeminale ganglion et mandibular nerve each time when they exist, but only when they are located laterally from foramen ovale, what appeared at 12 sculls (3.93%) in our case.

[Characteristics of the ependyma in various parts of the subcommissural organs in rats]. / Neke odlike ependima pojedinih dijelova subkomisuralnog organa u pacova.

In this work the authors have researched ependyma of some parts of subcommissural organ of rats by optic microscopy. 4% formaldehyde was injected in vivo in carotid arteries. After immolation their brains were extracted together with brain meninges and embedded in celiodine. Celoidine blocks have been sliced and then coloured by Nissle's method. Horizontal and frontal brain dissections were performed with a purpose to acquire a good sight into the subcommissural organ. On the basis of optic microscopy of the examined material, numerous morphological variations in the size and appearance of subcommissural organ were determined as well as the presence of many layers of ependymal cells close to the posterior commissura.

[Anatomy of the lymphatic vessels and lymphatic tissue of the lungs and pleura]. / Anatomija limfnih sudova i limfnog tkiva pluca i pleure.

The lymph system in the lungs and chest has a very important role in disease spreading and recovery. No organ in lymph can compare to lungs regard of lymph. Two lymph nets exist in the lung superficially and profoundly, and also mutually communicate at hilus level and interlobular septum. On profoundly level of the net lymph vessel exist three lymph nets around bronchus, artery and veins. The lymph tissue placed in lung is particularly characteristic for children. The regional lymph tiejof the lungs can be divide on intrapulmonal and extrapulmonal. According to lymph drainage from lung we are talking about three territories: upper, medial and lover which are not coincides with lobar division. The capillary lymph net of the parietal pleura accumulate on subpleural net, from were leaving to regional lymph's nodes.

Morphological characteristics of the gyrus dentatus in some animal species and in man.

Comparative anatomical investigations have been carried out on the gyrus dentatus of rat, fox, cattle, domestic pig, monkey (Cercopithecus sabeus) and man. After removal of the brain stem and scaling off the brain substance from the medial aspect towards the lateral aspect, the gyrus dentatus was preserved and its relation with regard to the hippocampus, the fimbria hippocampi and the gyrus parahippocampalis was studied. A rat's gyrus dentatus occupies a rather wide zone on the medial aspect of the brain. Its surface is almost flat with very poor denticulations, and below the splenium corporis callosi it forms the tuberculum gyri dentati which is wider than the splenium. In the cat somewhat better pronounced denticulations were observed, and the gyrus dentatus was directed from the rostral aspect towards the dorsal and the lateral, and before reaching the splenium corporis callosi it changed its course towards the medial aspect and passed into the tuberculum gyri dentati. The cattle's gyrus dentatus is rather wide and macroscopically without a sharp definition from the hippocampus. Domestic pig's denticulations are better pronounced particularly towards the gyrus parahippocampalis. The gyrus dentatus of the monkey is well retracted into the fissura hippocampi and below the splenium corporis callosi the tuberculum gyri dentati is barely visible. The authors found the most developed gyrus dentatus in man, but here, the tuberculum gyri dentati was missing.

[A case of brain malformation without a change in skull configuration]. / Ein Fall von Hirnfehlbildung ohne Veränderung der Schädelkonfiguration.

The brain of a 5-months old female baby was investigated. The baby died following operation for myelomeningocystocoele of the lumbosacral region. The post mortem finding showed that there were no other malformations present besides the changes at the level of the central nervous system. Lack of the falx was observed on the dura mater, while the tentorium cerebelli was well developed. The cerebrum was on the whole of a bulbular form with a larger transversal diameter and was not divided into 2 hemispheres. A complete lack of the rhinencephalon was observed on the basal aspect of the brain. Between the dorsal surface of the cerebral trunk and the cerebrum there was a specious transversal fissure through which a considerable part of the choroidal plexus emerged from the ventricle and was positioned extraventricularly. The posterior edge of this fissure is formed by the commissura hippocampi behind which there are well developed gyri dentati which are interconnected in the medial line. The cerebellum is normally developed but antepositioned, with a considerably pronounced vermis cerebelli. Frontal sections of the brain showed an emphasised contrast between the gray and the white brain substance which is indicative of a higher level of brain maturity. The third brain ventricle, as well as the frontal horns of the lateral ventricle were missing, and there was a developed central common cavity and the temporal horns. The basal ganglia were merged with the central gray matter spread in a transversal direction which was separated from the cortex by an arc-formed white brain substance.

Blood vessels of the human heart: coronarography and dissection.

We investigated by means of coronarography and dissection the arterial vascularization of the human heart in relation to the type of coronary ramification in 200 human hearts taken at random from males and females between 20 and 85 years of age. Examination of the selective coronarography findings was subsequently performed by means of careful dissection of the injected arteries and their branches in order to compare the results obtained with coronarographic findings in living human beings.

Contribution to the knowledge of the brain in the newborn.

On 50 brains of newborns of either sex, the exterior and interior morphology was studied. The exterior morphology of the brain was conformable to the configuration of the skull. The insula is relatively large, but extremely inadequately grooved. The subcortical masses are well pronounced but there is in general a very slight difference between the white and gray matter of the brain. The convolutions and grooves of the cerebellum are very distinctly marked, the nucleus dentatus is large and white matter is prevalent. The brain stem is rather well formed, distinctly plastic, this being particularly true for the region of the rhomboid fossa and medulla oblongata.

Appearance of the wild boar brain.

On eight brains of wild boars, the appearance of the exterior and interior brain structures was studied. The brain was preserved in the skull by formalin solution injection into the carotid artery. After having been set up for 4 months in a 5% formalin solution, the brain was removed in conjunction with the coverings. Subsequently, the brain was preserved in 5% formalin for 2 months. By careful dissection and elaboration of special preparations, the appearance of the grey and white substance of the brain, of the basal ganglia and of certain portions of the limbic system was studied. On the frontal and horizontal sections of the brain the appearance of the brain matter, of the basal ganglia and of the brain ventricles was studied. The exterior and interior morphology of the cerebellum was investigated on special preparations.

The appearance of the otter brain.

On ten otter brains the appearance of the exterior and interior brain structures was studied. Viewed from above there are two forms of brain, a triangular and a longitudinal one. In the triangular form the gyri are sufficiently developed with a considerable number of transient gyri and in the longitudinal form the gyri are wider and separated by considerably deep sulci. The olfactory bulbs, the olfactory tract, the gyrus olfactorius medialis and the gyrus olfactorius lateralis are less pronounced in the triangular form than in the longitudinal one. In the triangular form of the brain all gyri, except for the gyrus sylvius, are vertically positioned. The brain stem is wider in the triangular form and narrower in the longitudinal one. On the medial aspect of the brain, the cingulate gyrus, on which transient gyri are apparent, is well marked. The cingulate gyrus is slightly wider than in the longitudinal form. Below the splenium corporis callosi there is the tuberculum gyri dentati to be found by a shallow sulcus which is separated from the gyrus corporis callosi. By scaling the brain matter from outside, the pes hippocampi is exhibited. In the longitudinal form it is more sloping and separated from the base of the brain by a thin layer of brain substance. In the triangular form of the brain the cerebellum is covered by the posterior portions of the hemisphere and in the longitudinal form projects rather backward. On the frontal sections of the cerebrum the subcortical grey masses are sufficiently developed.