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An anatomical variant of the extensor carpi radialis brevis muscle.

BACKGROUND: Variations in musculature are of interest not only to the anatomist but also to the surgeon, insofar as they can be a source of error in both diagnosis and treatment. Muscular anomalies in the lower arm and in the hand have frequently been described in the literature; some of the lesions they can be confused with are ganglia and other soft tissue tumors. CASE REPORT: In the course of preparation of a small, fine-jointed right upper extremity, an accessory muscle was discovered in the forearm and hand region; it branched off from the extensor carpi radialis brevis (ECRB) muscle. Its tendon crossed over the extensor retinaculum and attached to the dorsal digital expansion of the index finger. Both muscles were innervated by a branch of the deep branch of the radial nerve. The observations made here supplement our knowledge of variations in the antebrachial and dorsal regions of the arm and hand, which should be quite useful in hand surgery.

Female↗

Enabling clinicians, researchers, and educators to build custom web-based biomedical information systems.

We describe an open-source toolkit that enables clinicians, researchers, and educators to build their own web-based biomedical information systems. The Web Interfacing Repository Manager (Wirm) is a high-level application server aimed at medical professionals, allowing them to create individually tailored systems for managing their multimedia data and knowledge. We provide an overview of the features of Wirm, explaining how they meet the requirements for supporting biomedical information management, and describe four applications that are currently being developed with Wirm: MyPACS, a teaching file authoring system for radiologists, Fathom, an experiment management system for natural language processing, the Digital Anatomist Repository, an image archiving tool for medical schools, and Ontolog, a browser for medical vocabularies.

Anatomy↗

[The urologic work of Thomas Jonnesco (1860-1926)].

Thomas Ionescu, eminent Rumanian surgeon and anatomist, was a great ambassador of french medicine. Politician and patriot, he was founder of modern rumanian experimental surgery and initiator of general rachi-anaesthesia. Among his innumerable scientific works we underline the urologic part of them and especially his original method of nephropexy.

History, 19th Century↗

The beginnings of developmental biology in Swiss universities.

This contribution describes the pioneer work in Developmental Biology, initiated by Swiss scientists. The anatomist W. His (1831-1904) deserves credit as the founder of "Descriptive Embryology". Using novel microscopical techniques, he documented the formation of the embryonic body of various vertebrates as an approach to reveal the mechanisms of morphogenesis. Based on studies of the chick embryo, he designed a fate map of the germ-disk, comprising organ-forming regions, from which the corresponding embryonic structures originate. F. Baltzer (1886-1974) initiated original studies on the role of nuclear and cytoplasmic factors in the development of sea urchin hybrids and newt merogons. Through his experiments on interspecific and intergeneric chimeras of amphibians, he further contributed to the emerging field of "Developmental Genetics". F.E. Lehmann (1901-70) inaugurated work on "Chemical Embryology" and later moved to "Cell Biology". His discoveries on stage- and regional-specific inhibition of morphogenesis by LiCl in newt embryos were important for the understanding of malformations. Further studies regarding the action of cytostatic substances on tail regeneration in tadpoles were intended to yield information on growth control. Original contributions to "Experimental Embryology" were also made by R. Geigy (1902-1995), who devised an ingenuous procedure for obtaining sterile Drosophila flies by UV-irradiation of eggs. In later studies on anuran metamorphosis, he discovered that the morphogenetic effects of the metamorphic hormones are organ-specific and that competence of the larval tissues to respond to thyroid hormone is stage-dependent.

Developmental Biology↗

[Adam Christian Thebesius (1686-1732) and the discovery of the Vasa Cordis Minima].

In first years of the 18th century, Raymond Vieussens (1635-1713) and Adam Christian Thebesius (1686-1732) discovered the Vasa cordis minima, today known as Vasa Thebesii; in 1868, Odilon Marc Lannelongue (1840-1911) described the so-called crypts of Lannelongue in the right atrium. The present study gives a historical survey over the research on the cardiac vascularization before 1700 and presents these three authors and their works on the Thebesian vessels with a biographical introduction and a commented translation. As for the biography of the Silesian anatomist Thebesius large, mostly inedited materials from Polish archives and from family archives were studied, among them, poems, a handwritten biography and a pedigree of the family. A schedule tables the studies and articles on the Thebesian vessels and the Thebesian valve published since 1708. As a commentary to the bibliography, the present stage of knowledge on the Thebesian vessels is shortly summarized. Although a compensatory function of the Thebesian vessels in coronary sclerosis and other pathological conditions has been discussed repeatedly, methodical difficulties still do not allow a reliable judgement on the role of the Thebesian vessels in physiological and pathological conditions. This study shows the contradictory results and summarizes all statements which have been published on the embryology, comparative anatomy, macroscopical and (electron-)microscopical anatomy, physiology, pathophysiology and cardio-surgery. The aim is to encourage an interdiscplinary discussion on the base of the thorough literature study.

Anatomy↗

[135 years' since the first medical textbook for higher education in Serbia].

Medical teaching at School in Belgrade started in 1863 when forensic medicine became an oblicatory subject for law students. In 1865 the Serbian physician Joachim Medovitsh (1815-1893) published the first medical textbook "Forensic medicine for lawyers" in Serbia. It appeared more than fifty years before foundation of the School of Medicine in Serbia. The book appeared forty years before promoting the High School to University. Joachim Medovitsh was of Polish origin but he lived and worked in Serbia. He was one of the most prominent physicians in Serbia and the first president of the Serbian Medical Society. Joachim Medovitsh, M. D. wrote his book after the model of the textbook of Karl Bergman (1814-1865). German anatomist and physiologist from Göttingen. Forensic medicine of Medovitsh was printed by lithographic technique. The second edition was edited next year. In his book Medovitsh cited often Johann Casper (1796-1864) one of who published the most used textbook in the second half of the 19th century. Joachim Medovitsh, M. D. contributed very much to the beginnings of High School medical teaching in Belgrade being in the course of events and achievements of European medicine.

Education, Medical↗

Variations in the subclavian-axillary arterial system.

OBJECTIVE: The objective of this study is to report on the subclavian axillary arterial system variations observed in the dissecting room. METHODS: The morphological study of 106 formalin fixed upper limbs of adult human cadavers of both sexes was carried out at human anatomy laboratory of College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia over a 5 year period, to observe the distribution pattern of the subclavian axillary arterial system. RESULTS: The arterial variations in the upper extremities are quite common and may occur at the level of the thoracic outlet, axilla, arm, cubital fossa and the hand. In the present study, the anomalous topographic pattern of the subclavian axillary arterial system was revealed in 7.5% of the cadavers, whereas 92.5% exhibited classical pattern of the regional arterial anatomy. The study showed: 1. An aberrant right subclavian artery arising from the arch of aorta, distal to the left subclavian artery. 2. A bilateral common subscapular-circumflex humeral trunk (3.8%) emerging from the 3rd part of the axillary artery (branching into the circumflex humeral and thoracodorsal arteries. 3. A bilateral thoracohumeral trunk arising from the 2nd part of the axillary artery (1.9%) and branching into the lateral thoracic, circumflex humeral, subscapular and thoracodorsal arteries. These anomalies were accompanied by anomalous insertion of flexor digitorum superficialis muscle, a bilateral digastric muscle formed by the abductor pollicis longus and brevis, and an anomalous formation of median nerve by 3 roots. CONCLUSION: The aberrant right subclavian artery associated with right non-recurrent laryngeal nerve and variant branching pattern of the axillary artery are of interest to anatomists, surgeons and radiologists and suggested that these anomalies must be evaluated pre-operatively.

Journal Article↗

Variations in the subclavian-axillary arterial system.

OBJECTIVE: The objective of this study is to report on the subclavian axillary arterial system variations observed in the dissecting room. METHODS: The morphological study of 106 formalin fixed upper limbs of adult human cadavers of both sexes was carried out at human anatomy laboratory of College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia over a 5 year period, to observe the distribution pattern of the subclavian axillary arterial system. RESULTS: The arterial variations in the upper extremities are quite common and may occur at the level of the thoracic outlet, axilla, arm, cubital fossa and the hand. In the present study, the anomalous topographic pattern of the subclavian axillary arterial system was revealed in 7.5% of the cadavers, whereas 92.5% exhibited classical pattern of the regional arterial anatomy. The study showed: 1. An aberrant right subclavian artery arising from the arch of aorta, distal to the left subclavian artery. 2. A bilateral common subscapular-circumflex humeral trunk (3.8%) emerging from the 3rd part of the axillary artery (branching into the circumflex humeral and thoracodorsal arteries. 3. A bilateral thoracohumeral trunk arising from the 2nd part of the axillary artery (1.9%) and branching into the lateral thoracic, circumflex humeral, subscapular and thoracodorsal arteries. These anomalies were accompanied by anomalous insertion of flexor digitorum superficialis muscle, a bilateral digastric muscle formed by the abductor pollicis longus and brevis, and an anomalous formation of median nerve by 3 roots. CONCLUSION: The aberrant right subclavian artery associated with right non-recurrent laryngeal nerve and variant branching pattern of the axillary artery are of interest to anatomists, surgeons and radiologists and suggested that these anomalies must be evaluated pre-operatively.

Adult↗

Diagnostic laparoscopy.

Diagnostic laparoscopy is a powerful tool in the surgeon's armamentarium when used appropriately. There is a low complication rate and high diagnostic sensitivity. In addition to conventional operating room procedures, this technique can be applied in a variety of other settings, often without general anesthesia. Many patients can be spared invasive nontherapeutic laparotomies particularly in the area of trauma and cancer diagnosis. The surgeon must become a superior visual anatomist in order to be able to take maximum advantage of this technique.

Abdomen↗

[Galvanic and Faradic power in Anaesthesia].

Electrical anaesthetic methods have been applied for the first time in Paris (May-June 1847) by the physiologist and anatomist scientist Fortuné Christophe Ducros. Ducros's scientific research works were not published so they were forgotten. In fact the electrical anaesthetic methods were dropped on account of the difficult conceiving of the electrical devices and the easiness of methods using either and chloroform. In 1858 J.B. Francis, a dentist of Philadelphia, pulled out 164 teeth in presence of official dentists by means of this method. Apolloni Pierre Préterre, a Parisian dental surgeon, introduced again the method in June 1858 and Victor Auguste François Morel-Lavallée, Jean-Baptiste Fonssagrives and Léon Athanase Gosselin tested it in some French hospitals without further delay. In December 1859, Jean-Baptiste Georges invented a device to use galvanism and induction particularly for cauterisation in the mouth or for local anaesthesia. Eventually the electrical method failed and was neglected.

Anesthesia↗

Training of postgraduates in anatomy.

It is recognized that training methods differ among the various medical colleges; however, trained specialists should be competent to discharge their duties independently in any part of the country. Therefore, to maintain uniform standards of education, there is a need to harmonize postgraduate training in anatomy. It is proposed that a structured training programme should be drawn up and monitored regularly at specified intervals, spelling out some clearly defined targets that need to be achieved. The ultimate goal of the postgraduate training programme should be to produce anatomists with sufficient knowledge and practical skills to undertake undergraduate teaching and evaluation in all branches of anatomy, as well as to pursue research independently.

Anatomy↗

What do you people do-now that everything has been illustrated?

A noted anatomist asked recently this illustrator "What do you people do-now that everything has been illustrated?" It is disconcerting to be obliged to defend the need for the existence of the profession of medical illustration and makes the nape of the neck turn pink. The question has festered for months and this "defensive answer" pertains to the work performed by the Health Sciences Illustration Department at the University of Washington. For the novice and layman such a question opens usually Pandora's box of reply. As with the original Pandora of Greek mythology, only Hope remains in the box-and it is hoped that other engaged in medical education will be more aware of our profession and its broad and everchanging contributions.

Health Education↗

[Clinical and radiological aspects of ageing of the respiratory tract].

The effects of ageing on the macroscopic appearance of the lung were recognized by Laennec, Andral suggesting that dyspnoea might be its clinical manifestation. At about the same time physiologists demonstrated the negative effects of ageing on the vital capacity, whereas anatomists defined its impact on the lung and thoracic cage structure. The prevalence of dyspnoea increases with ageing but co-morbid disease should always be sought. The prevalence of cough is strongly associated with active and passive smoking. With regard to physical signs, barrel chest and crepitations heard over the dependent lung zones do not necessarily have pathological significance. The usefulness of measuring the forced expiratory time remains to be established in the elderly. There is no characteristic radiological feature of a senile lung. If an X-ray abnormality is discovered during a routine examination, it should be regarded as pathological, but in most cases its detection will not alter management of the patient.

Aged↗

[About some "anatomic anthroponyms"].

Daily in our practice we use terms of anatomy. Some of these terms are directly linked to the name of their discoverer. Very often, we ignore or have forgotten the history of these anatomists. The author, with a short repertory refreshes our memory.

Anatomy↗

[Anatomia practica: features from the history of early patho-anatomy].

Since the anatomy school of Alexandria during the fourth og third century before Christ dissection of the human body seems not to have been practiced until late Medieval or early Renaissance period, undoubtedly due to ethical and religious aversions. The teaching of anatomy was based on Galen using animal dissection. In the fourteenth and fifteenth centuries, however, anatomical examinations of the human body slowly began, seemingly for the purpose of describing both the normal structure and the abnormal structure caused by diseases, maldevelopment or trauma. This latter branch of anatomy was called practical, medical or correlative anatomy and corresponds to what we today name as patho-anatomy. Antonio Benivieni of Florence (1442-1502) is the first one to collect (and publish) a series of clinical observations some of which could be correlated to post mortem findings. It is unknown, however, whether the autopsies were performed by himself; and there is no mentioning of technique or circumstances for sectioning. Studies of the dead body by incision for the purpose of displaying diseased organs (autopsy) seem to have been an accepted practice for which relatives consented in those days. Other medical doctors in the years to follow, as for instance Fernel (1485-1558) in Paris, Eustachius (1524-1574) in Rome, Felix Plater (1536-1614) in Basle and Th. Bartholin (1616-1680) in Copenhagen have used the anatomical method for the study of diseases. Further, Schenck (1530-1598) in Freiburg and Bonet (1620-1689) in Genéva collected and published large series of clinical symptoms which had been related to post mortem findings dating back to ancient observers. This is the scientific background for anatomists as Morgagni, Lieutaud, Baillie, Bichât and others who founded the morbid anatomy on which the study of disease flourished in the classical patho-anatomical era of the nineteenth century with names as Rokitanski and Virchow.

History, 15th Century↗

"With much nausea, loathing, and foetor": William Harvey, dissection, and dispassion in early modern medicine.

In early modern England accumulating knowledge of normal and morbid anatomy through dissecting the human body not only led to a better understanding of nature, but also defined the identity of the people who engaged in this activity. This essay analyses the relationship between systemically dismembering the dead and how this pursuit shaped the attitudes and emotions of early modern medical men toward the living. I focus on the most famous anatomist in early modern Britain - the discoverer of the circulation of the blood, William Harvey (1578-1657).

Anatomy↗

Bile leak from the accessory biliary duct following laparascopic cholecystectomy.

Anatomists and surgeons have described the presence of accessory biliary ducts between the liver and gallbladder. Bile leakage from accessory duct following laparoscopic cholecystectomy (LC) is an unusual post-operative complication. Aim of the study was to assess its incidence, the intraoperative methods helpful for notice the anatomical anomaly and the impact of endoscopic procedure as a suitable treatment. From January 1997 to September 2002, 185 patients underwent LC for symptomatic cholelithiasis in our surgical department. Post-operative bile leakage from accessory biliary duct occurred in two patients (1%): one case from the liver bed of gallbladder (duct of Luschka) and one case from an aberrant cholecystohepatic duct entering Hartmann's pouch. One patient underwent open celiotomy because of unavailability of endoscopic retrograde cholangiopancreatography. The other patient was successfully treated by endoscopic sphincterotomy and nasobiliary tube placement. By careful dissection, accessory ducts were noticed and clipped in three other patients with overall incidence of 2.7%. Meticulous laparoscopic technique aimed to careful recognize all structures during LC is the main policy to contain biliary injury within its nadir incidence. Depending of availability, endoscopic sphincterotomy and nasobiliary drainage allow diagnosis and treatment of bile leakage, preserving the effectiveness of laparoscopic procedure.

Bile↗

The phrenic ganglion in man.

During educational dissections we observed a phrenic ganglion on the nerve of the phrenic artery originating from the upper pole of the right coeliac ganglion, which accompanied the right inferior phrenic artery on a female cadaver at the age of 34. In our case the left coeliac ganglion, the inferior phrenic artery, the right and left greater, lesser and least splanchnic nerves were present and normal. However, the left nerve of the phrenic artery and the phrenic ganglion were absent. We consider that this rarely reported neural formation may be of importance for anatomists and clinicians.

Adult↗