Intracranial intradural variations of nerve roots.

BACKGROUND: The aim of this paper was to point out the intradural cranial nerve roots variations in their localization and number to establish the incidence and clinical importance of the cranial nerve root variations. METHODS: The anatomical study was performed on 120 sides in 60 cadavers. There were 51 male cadavers with the mean age 43.3 and 9 female cadavers with the mean age of 39.5 years. RESULTS: Abducens nerve variations were observed in 48 cases (80 %). They were more frequently on the left side, in 25 cases (41.66 %). Duplicated abducens nerve was observed in 25 cases (41.66 %). Double and triple abducens nerve variations were also observed. CONCLUSIONS: Cranial nerve variations are rare, but variations of abducens nerve and atypical exit of the hypoglossal nerve from the fossa cranium posterior is not a rare variation. Knowledge of this variation may be important to various fields of medicine (Tab. 3, Fig. 8, Ref. 34).

Current occurence of intraspinal intradural and extradural communicating branches in the spinal canal.

THE AIM of this work is to point out the intraspinal anatomical current occurrence interconnections between intradural and extradural nerve roots and their possible participation in radiculopathy. METHODS: The anatomical study was performed in 43 cadavers with a mean age of 53.7. All intradural and extradural rami communicantes between nerve roots were excised and examined histologically for the presence or absence of nervous tissue. RESULTS: Anatomical preparations revealed intradural and extradural rami communicantes in 9 cases (20.9 %), mostly in the cervical region in 5 cases and by plexus formation variations in 5 cases. Multiple extradural rami communicantes were observed in 6 cases (13.95 %), including the simultaneous occurrence of multiple intradural and extradural ones in 5 cases (11.6 %). CONCLUSIONS: This study allowed us to identify and describe unpublished intraspinal current occurrence intradural-extradural rami communicantes of nerve roots and their interrelationships throughout the spinal canal with their potential influence on the clinical picture (Tab. 1, Fig. 4, Ref. 25).

Omega-3 fatty acids reduce lipopolysaccharide-induced abnormalities in expression of connexin-40 in aorta of hereditary hypertriglyceridemic rats.

Omega-3 fatty acids (omega3FA) are known to reduce hypertriglyceridemia- and inflammation-induced vascular wall diseases. However, mechanisms of their effects are not completely clear. We examined, whether 10-day omega3FA diet can reduce bacterial lipopolysaccharide-induced changes in expression of gap junction protein connexin40 (Cx40) in the aorta of hereditary hypertriglyceridemic (hHTG) rats. After administration of a single dose of lipopolysaccharide (LPS, 1 mg/kg, i.p.) to adult hHTG rats, animals were fed with omega3FA diet (30 mg/kg/day) for 10 days. LPS decreased Cx40 expression that was associated with reduced acetylcholine-induced relaxation of aorta. Omega3FA administration to LPS rats had partial anti-inflammatory effects, associated with increased Cx40 expression and improved endothelium dependent relaxation of the aorta. Our results suggest that 10-day omega3FA diet could protect endothelium-dependent relaxation of the aorta of hHTG rats against LPS-induced damage through the modulation of endothelial Cx40 expression.

Surgical treatment of nervus pudendus.

An objective of our work was to clarify variations in pudendal nerve formation, as well as their possible impact on the clinical picture.Bilateral pudendal nerve course and formation was studied on 20 adult cadavers. Anterior approach was used in 15 of them, both posterior and anterior approaches were used in five of them. The prefixed type plexus formation was observed in eight cases (40 %). In these cases S1, S2 roots contributed to the formation of the pudendal nerve. In the postfixed type particularly the S3 root was dominant in two cases (66.7 %), and less the S4 root in one case (23.3 %) from three cases. Mostly the S2 root participated in its formation in 17 cases (85 %). The pudendal nerve branches run below the sacrospinous ligament on the level of the sacrospinous and sacrotuberous ligaments. The changes of the nerve and the branching therof were most evident from the anterior access below the sacrospinous ligament and in front of the sacrotuberous ligament. The inferior rectal nerve penetrating the sacrospinous ligament was seen in one case, it has risen from the pudendal nerve before entering the pudendal canal in four cases. The dorsal nerve of the penis has risen from the S1 root in two cases (10 %). We observed its branching before entering the pudendal canal in 15 cases (75 %). It has divided in the pudendal canal in other cases. This description may be useful particularly for the pudendal nerve block and the nerve saving surgeries directed on the relevant region (Fig. 8, Ref. 24).

The variable communicating branches between musculocutaneous and median nerves: a morphological study with clinical implications.

BACKGROUND: The course of the brachial plexus, its relations with surrounding structures and unique primary and secondary divisions result in its wide range of anatomical variations. Most of these variations were detected during anatomical dissections and studies. It has been found that 53% of studied brachial plexuses contained variations. The communication between musculocutaneous and median nerves is the most common variation of infraclavicular part of brachial plexus. METHODS: During gross anatomical dissections of peripheral nerves, we observed neuronatomical variations in upper limbs of four formalin embalmed adult cadavers. Musculocutaneous and median nerves were connected by a communicating branch at distinct level in each cadaver. The formation and relations of both nerves were noted in each case to exclude the existence of other anatomical variations. The connections were measured and documented by digital camera. RESULTS: The communicating fibers of variations 1 and 2 were located in the upper third of arm and proximally to musculocutaneous nerve penetration through coracobrachialis muscle. In variations 3 and 4, the communicating branch was situated in the lower third of arm and distal to the nerve penetration point. CONCLUSION: Variable interconnections between musculocutaneous and median nerve have to be considered in diagnosis of nerve lesions in axillary and arm regions. Compound musculocutaneous and median nerve neuropathy would occur in lesions of the interconnecting branches. Injuries of musculocutaneous nerve proximal to these branches can cause particular and unexpected symptoms, such as weakness of forearm flexors and thenar muscles (Fig. 6, Ref. 28).

Nitric oxide synthases in varicose vein wall.

INTRODUCTION: Venous wall weakness is supposed to be the most probable reason of primary varicosis. There are conflicting findings in literature about its structural changes. NO is potent vasodilatator due to the smooth muscle relaxation. It is synthesized by nitric oxide synthase (NOS). There are 3 known isoforms of NOS: nNOS (neuronal NOS), iNOS (inducible NOS), eNOS (endothelial NOS). MATERIAL AND METHODS: 10 varicose vein and 10 control vein samples were processed by standard light microscopy method. Sections were then processed by standard immuno-histochemic technique using rabbit polyclonal antibodies against all 3 NOS isoforms: iNOS, eNOS (SantaCruz, USA), nNOS (BioScience, USA). Antibodies expression was evaluated semiquantitatively and then proved morphometricaly by 2D image analysis (ImageJ 1.34n, National Institute of Health, USA). Total area of NOS isoforms expressions was determined by color analysis and color digital substraction. RESULTS: Histomorphological and semi quantitative evaluation of NOS isoforms showed discontinuous and significantly lower expression of all 3 NOS isoforms in tunica media of varicose veins compared with control group, where the expression of all 3 NOS isoforms was continuous. For the statistical analysis unpaired t-test was used. DISCUSSION AND CONCLUSION: Our results suppose lower NO levels in varicose vein wall, deducing that varicose vasodilatation is due to other mechanism, although the stage of chronic venous disease of varicose vein samples was undetermined. Our results are in contradiction with previously published results of Howlader et al., who observed raised total NO levels in patients with severe stages of chronic venous disease(Tab. 2, Fig. 13, Ref. 18).

Comparison of collagen subtype I and III presence in varicose and non-varicose vein walls.

STUDY OBJECTIVES: The connective tissue alterations in varicose vein wall are supposed to be one of the main causes of primary varicose vein (main sign of human lower limbs chronic venous insufficency). METHODS: 5 varicose vein samples from 5 patients undergoing stripping surgery of long saphenous vein were compared with 5 control samples of healthy (non-dilated) long saphenous veins from necroptic material (with no history of varicosis). They were fixed in a Baker solution, processed by use of light microscopic method, cut to ultra-thin sections (4-5 microm) and stained with PicroSirius Red for collagen. Sections were scanned with light microscope (Leica, Germany) and camera Canon S50 (Germany) and analysed by morphometric programme Image J v.1.38g (National Institute of Health, USA). RESULTS: In the group of healthy (non-dilated) veins the mean collagen I/III ratio value was 31.40 and in the group of varicose veins the mean collagen I/III ratio was 12.35; the difference is statistically significant: healthy veins contain significantly more of collagen subtype I and varicose veins contain significantly more of collagen subtype III in their walls. CONCLUSION: The statistically significant difference in the collagen I/III ratio between the groups of healthy (non-dilated) and varicose (dilated) vein walls is worthy of further following (Tab. 2, Fig. 7, Ref. 12). Full Text (Free, PDF) www.bmj.sk.

Neurofibroma of the vagus nerve in the cervical portion.

OBJECTIVE: Neurofibromas of the vagus nerve on the neck are very rare. They are asymptomatic, slowly growing. We have seen only one case of neurofibroma of the vagus nerve in the mentioned location during last 22 years. CLINICAL PRESENTATION: 33-year-old patient with negative family history. She has observed increasing swelling on the right side of the neck for about 2 years. She complained of the disorders of swallowing, expectoration, aspiration episodes, strider, intermittent palpitations, breathlessness, frequent airway infections. Magnetic resonance (MR) and angiography (AG) showed expansion in the mentioned location. CONCLUSION: We present our experiences with neurosurgical management of neurofibroma of the vagus nerve in the cervical portion using microscopic technique. We found only 9 described cases of surgical treatment of the neurofibroma of the vagus nerve in the neck location in available literature till 2007 (Fig. 6, Ref. 9).

Atypical course of the median nerve.

Work in the form of anatomical casuistry is presenting and describing the atypical course of the median nerve found in both upper limbs of one of the cadavers in the Department of Anatomy of Medical Faculty of Comenius University in Bratislava. This atypical course was found during the students' dissection of the peripheral nerves and vessels. This non-standard course of the median nerve is compared with standard course described in anatomical literature and atlases, and confronted with the possible variations of the median nerve and its course described by the available literature. (Fig. 4, Ref. 4.)

The determination of the collagen and elastin amount in the human varicose vein by the computer morphometric method.

The results of the works dealing with alterations of the connective tissue in varicose vein wall are not ambiguous, so the exact cause of the vein dilatation has still not been established. We were determining the collagen and elastin amounts in human varicose vein wall in comparison with non-dilated long saphenous vein by the light microscopy and computer morphometric method. We have found the lesser amount of collagen in varicose veins than in non-dilated veins, the amounts of the elastin in both the varicose and non-varicose veins were without the statistical significance.