Retropubic vascular hazards of the ilioinguinal exposure: a cadaveric and clinical study.

In the course of ilioinguinal exposure, significant bleeding can occur from anastomotic vascular channels along the posterior aspect of the superior public ramus. A cadaveric study was undertaken to quantify and qualify these communicating vascular systems. We made bilateral ilioinguinal exposures on 40 cadavers. All vessels > 2 mm in diameter, connecting the obturator system with a more superficial system, were singled out and their courses recorded. Fifty-eight of 79 sides (73%) had at least one large-diameter communicating vascular channel along the posterior aspect of the superior pubic ramus. In 47 of the 79 exposures (59%) communicating veins were noted. Arterial channels were identified in 34 exposures (43%). A prospective clinical study was also performed. Thirty-eight consecutive patients with displaced acetabular fractures were treated surgically using ilioinguinal exposures. Fourteen of the patients (37%) had anastomotic vessels. This study confirms the variability of the retropubic vascular system.

Venous anatomy of the pancreatic head: normal CT appearance in cadavers and patients.

OBJECTIVE: This study was conducted to define the normal CT appearance of the four pancreaticoduodenal veins (anterior and posterior superior, and anterior and posterior inferior) in the head of the pancreas in injected cadaveric specimens and to assess the frequency with which these normal vessels are seen on dynamic contrast-enhanced CT scans. MATERIALS AND METHODS: The appearance of the four pancreaticoduodenal veins was studied on CT scans of four cadavers in which the portal veins were injected in situ with radiopaque solutions. A computer-generated three-dimensional model of the pancreatic head and its venous drainage was then produced from one cadaveric examination to show the venous anatomy. After definition of the venous anatomy in the cadaveric specimen, the anterior superior pancreaticoduodenal vein, posterior superior pancreaticoduodenal vein, and gastrocolic trunk were analyzed retrospectively on dynamic bolus contrast-enhanced abdominal CT scans of 100 consecutive patients who had no evidence of pancreatic disease. RESULTS: The anterior and posterior superior pancreaticoduodenal veins were seen on 98% and 88% of scans, respectively. The veins had mean diameters of 2.1 mm. The gastrocolic trunk was seen on 89% of scans and had a mean diameter of 4.7 mm. The inferior pancreaticoduodenal veins are small and were not identified definitively. CONCLUSION: The anterior and posterior superior pancreaticoduodenal veins and gastrocolic trunk are routinely visualized on CT scans of patients without pancreatic disease. Consequently, assessment of the veins may be useful in staging pancreatic carcinoma.

A comparison of penile brachial index and angiography: evaluation of corpora cavernosa arterial inflow.

We studied 32 impotent patients with angiography. The penile branchial index was calculated from the maximal penile arterial pressure measured from any penile artery. In 15 of the 32 patients an attempt was made to isolate the cavernous artery pressure (cavernous artery penile brachial index). There was a poor correlation between angiography and penile branchial index (r equals 0.314) and between angiography and cavernous penile brachial index (r equals 0.637). We also evaluated 15 normal individuals and a wide range of penile brachial index values was found (0.7 to 1.0). Penile brachial index values from normal patients overlapped with those from impotent patients. Penile brachial index values from impotent patients with normal and abnormal arteries (as determined by angiography) overlapped. The fact that penile brachial index measurements are performed in the flaccid state and without direct visualization of the cavernous arteries accounts for some of the variability of the penile brachial index test.

Sonography in the detection of meniscal injuries of the knee: evaluation in cadavers.

We evaluated the ability of high-resolution, real-time sonography to identify and characterize artificially produced lesions in the menisci in human cadaveric knee specimens. In total, 20 lesions created in 10 specimens from five knees were prepared and examined sonographically. Four different types of lesions were created: eight vertical concentric tears, four horizontal tears, four vertical radial tears, and four complex lesions including displaced or amputated meniscal edges. All 20 (100%) of the lesions were visualized sonographically. The vertical concentric tears were the easiest to locate and identify, and appeared as highly echogenic lines in the menisci. Tears of this type as small as 2 mm could be visualized. The vertical radial tears were the most difficult to visualize, and no lesions of this type smaller than 5 mm could be seen. Our study shows that under optimal experimental conditions, sonography is capable of reliably demonstrating even small meniscal tears. On this basis, we believe that further clinical studies of the efficacy of meniscal sonography are both reasonable and necessary.

Roman arches, human joints, and disease: differences between convex and concave sides of joints.

The subchondral plate of bone underlying concave joint surfaces is significantly thicker, at most sites, than that under the corresponding convex mates. This morphologic difference may be related to parallel differences in loading stress and in the distribution of osteonecrosis and other joint lesions.

Membrane modifications in the apical endocytic complex of ileal epithelial cells.

Ileal lining cells of the suckling rat possess an "apical endocytic complex" capable of sequestering intact protein from the intestinal lumen. The complex consists of a network of invaginations of the apical plasma membrane, a number of subjacent small vesicles, and a giant supranuclear vacuole. The first two components initially incorporate material from the intestinal lumen and then transfer it to the giant vacuole where it is stored. Their limiting membrane displays striking structural modifications when viewed in various planes of section. Its lumenal dense leaflet appears discontinuous and consists of an ordered array of minute discrete plaques. A dense particle approximately 70 A in diameter is centered over each plaque. The particles are arranged in a two-dimensional square lattice with center-to-center spacing of approximately 120 A.