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PubMed1979

Treatment of hepatic metastases by percutaneous hepatic arterial infusion.

Better palliation for patients with hepatic metastases requires improved quality and duration of survival with a low complication rate and acceptable expense. Eligible patients between 1967 and 1977 were treated with a program of systemic chemotherapy until progression of hepatic metastases, then hepatic arterial infusion and subsequent maintenance on systemic chemotherapy. The angiography department was able to place the infusion catheter into the common hepatic artery percutaneously in 85% of all patients. The reasons for failure appeared related to anatomic variations and not to the physical characteristics of the liver cancer. A group of 24 patients with colorectal cancer and another group of 28 patients with 13 different primaries were treated. The colorectal cancer patients attained a median treatment time of 8 months before hepatic arterial infusion, and 9 more thereafter. The median survival of 17 months is much better than that reported for systemic chemotherapy alone. In a group of 28 patients with various primaries treated in the same way, the median survival time was 10 months. The nature of complications and the 6% incidence were the same in both groups. In summary, this is a modality yielding improved quality of life and longer survival with a low complication rate and acceptable costs.

Antineoplastic Agents↗

PubMed1977

Anatomical analysis of the developmental effects of aneuploidy in man--the 18-trisomy syndrome: I. Anomalies of the head and neck.

This paper describes the anatomical variations observed in the head and neck in eight infants with the 18-trisomy syndrome that were dissected and studied in detail. Of the usual muscles of facial expression, occipitofrontalis and the auricular and nasal muscles were hypolastic in all eight bodies and each subject showed extensive fusion of the muscles around the corner of the mouth. In each body there was a supernumerary muscle band that extended from the region near the corner of the mouth to the occipital attachment of trapezius. The otomandibular region in each body showed a variable spectrum of muscular, skeletal, arterial, and salivary gland variations bilaterally. Three of the bodies had infrahyoid muscle variations. The sum of these observations provides a more complete delineation of the variations that occur in the 18-trisomy syndrome. Tentative pathogenetic hypotheses for several of the defects are discussed, based on observations from human descriptive embryology. Poswillo's teratological model [1973] implicating hemorrhaging as a causal mechanism in human first and second branchial arch malformations is suggested as a possible mechanism to explain the bilateral otomandibular defects.

Chromosomes, Human, 16-18↗

PubMed1993

Visceral anomalies in the Apert syndrome.

We report on visceral anomalies found in 136 patients with Apert syndrome. Autopsies were only performed on 12 of these cases. Thus, the percentage of anomalies found in our patients should be considered a minimum estimate because of the possibility of clinically silent visceral anomalies, minor internal anomalies, and anatomic variations. Cardiovascular and genitourinary anomalies were found most commonly, occurring in 10% and 9.6%, respectively. As expected, complex and multiple cardiac anomalies were frequently associated with early death. Among genitourinary anomalies, hydronephrosis (3%) and cryptorchidism (4.5%, n = 66 males) occurred most commonly. In contrast, anomalies of the respiratory system (1.5%) and gastrointestinal anomalies (1.5%) occurred with lower frequency. The finding of a solid cartilaginous trachea is particularly important because no case was diagnosed during life but rather, only at autopsy. Because cardiovascular and genitourinary anomalies occur with significant frequency, they should be considered in the workup of all Apert newborn infants. We also recommend MRI study of the trachea in any infant with signs and symptoms of lower respiratory compromise.

Acrocephalosyndactylia↗

PubMed1975

Anatomical data on the intracranial venous drainage of the tufted capuchin, Cebus apella Linnaeus, 1758.

The venous channels responsible for the intracranial drainage were dissected in a series of 25 male and female adult tufted or brown capuchin monkeys (Cebus apella). It was found that Cebus have a venous arrangement fundamentally the same as in man, differing only in that: 1. the monkey has no inferior sagittal sinus, spenoparietal sinus, and emissary parietal and condylar veins; 2. the occipital sinus is not in connection with other sinuses; 3. there are a spenopetrosal sinus, a petrosquamous sinus, and an unpaired inferior cerebellar vein; 4. besides the internal jugular vein, there is additional intracranial drainage through the petrosquamous sinus and the postglenoid vein; 5. the superficial middle cerebral vein opens into the petrosquamous sinus; 6. the lingual and facial veins are not tributaries of the internal jugular vein; 7. there is a bilateral uniform division of the superior sagittal sinus at the confluence of the sinuses to drain equally into both transverse sinuses; 8. the vascular pattern appears to be quite stable; anatomical variations appear to be few and unimportant.

Animals↗

PubMed2003

Crocodylian forelimb musculature and its relevance to Archosauria.

The musculoskeletal anatomy of the crocodylian forelimb is documented to facilitate functional morphological studies of extant and extinct archosaurs. Comparative descriptions of muscles of the forelimb of several crocodylian species are presented, including attachment sites, innervation, and anatomical functions. The muscular anatomy of the crocodylian forelimb is highly conservative among the different species; however, interspecific differences do occur. Interspecific anatomical variation is interpreted functionally, and discussed in the context of the terrestrial locomotion of crocodylians as it applies to the forelimb. In addition, muscular apomorphies are identified among a phylogenetically diverse sample of extant crocodylians, providing insight into the evolution of forelimb anatomy in a clade of archosaurs possessing highly variable terrestrial locomotor behaviors.

Alligators and Crocodiles↗

PubMed1977

Where is your vagotomy incomplete? Observations on operative technique.

There is a trend in gastric surgery towards more selective types of vagotomy but the techniques are more difficult and incomplete nerve section may be more likely. Using the Grassi intra-operative test of mucosal pH, we have studied 50 consecutive patients, 13 having truncal vagotomy, 9 having bilateral selective vagotomy and 28 having proximal gastric vagotomy. We have identified four distinct areas of the stomach where nerve fibres are likely to be left. Three of these can usually be eliminated by careful attention to technique, but the fourth--the distal extent of the parietalcell mass--can only be identified by a precise intra-operative test; this is relevant to proximal gastric vagotomy but not to truncal vagotomy. Unexpected anatomical variations of the vagus nerve branches were found in 8 patients. A precise intra-operative test of residual innervation is particularly helpful in establishing the technique of proximal gastric vagotomy.

Gastric Mucosa↗

PubMed2003

The spinoglenoid ligament: an anatomic study.

The spinoglenoid ligament and its anatomic variations are described in 27 shoulders from 15 cadavers. In each shoulder one or two distinct spinoglenoid ligaments originated from the base of the spine of the scapula; they inserted on the neck of the scapula or the shoulder joint capsule. In the 19 shoulders in which only one spinoglenoid ligament was present, it inserted into the neck of the scapula in 14 cases and into the shoulder joint capsule in five instances. In the eight shoulders in which there were two ligaments, one inserted into the neck of the scapula and the other into the shoulder joint capsule. We did not observe any hypertrophic spinoglenoid ligaments that may have compressed the suprascapular nerve.

Cadaver↗

PubMed2004

Anatomical basis for a successful upper limb sympathectomy in the thoracoscopic era.

In this clinico-anatomical study, factors potentially responsible for unsuccessful upper limb sympathectomy (ULS) by the thoracoscopic route were evaluated. This study comprised two subsets: 1) in the clinical subset, 25 patients (n = 50 sides) underwent bilateral second thoracic ganglionectomy for palmar hyperhidrosis, and factors predisposing to unsuccessful ULS were identified; and 2) in the anatomical subset, the neural connections of the first and second intercostal spaces were bilaterally dissected in 22 adult cadavers (22 right, 21 left; n = 43 sides). Alternate neural pathways (ANP) were noted in 9 of 50 sides in the 25 clinical cases (18%). In three asthenic patients (5 sides), fascia overlying the longus colli muscle mimicked the sympathetic chain. The right superior intercostal vein (SIV) was located anterior to the second thoracic ganglion in 6 of 50 sides (12%) and predisposed to troublesome bleeding in 2 of 50 cases; the SIV was posterior to the ganglion in 19 of 50 sides (38%), posing no technical problem. On the left, the SIV was noted outside the field of dissection in all but one case. A successful outcome to sympathectomy was noted in all 25 patients. A spectrum of sympathetic contributions to the first thoracic ventral ramus for the first intercostal space was noted in 37 of 43 anatomical cases (86%). These were categorized according to the arrangements of the intrathoracic ramus between the second intercostal nerve and the first thoracic ventral ramus. The cervicothoracic ganglion (37/43 cases; 86%) and an independent inferior cervical ganglion (6/43 cases; 14%) were always located above the second rib. The second thoracic ganglion was consistently located in the second intercostal space. This study demonstrates that ANPs have little clinical significance when a second thoracic ganglionectomy is undertaken. Technical failures may be avoided if the surgeon is mindful of anatomical variations at surgery.

Adult↗

PubMed2004

Post-mastectomy chylous fistula: anatomical and clinical implications.

A chylous fistula after a modified radical mastectomy is a rare occurrence; however, major anatomical variations in the termination of the thoracic duct may occur, rendering it susceptible to injury. High output chylous fistulae are difficult to manage and have local, metabolic, and immunologic complications with a mortality rate varying from 12.5-50%. Herein such a case of postmastectomy chylous fistula and its management are discussed. A 56-year-old postmenopausal woman with invasive duct carcinoma of the left breast underwent modified radical mastectomy with complete axillary clearance (Level I, II, III nodes). The operative procedure was uneventful. On the commencement of a normal diet, however, the patient started exuding milky fluid from the axillary drain and analysis of the fluid revealed biochemical features compatible with chyle. After 2 weeks of failed conservative management, the axilla was re-explored. A continuous flow of clear fluid was observed originating from a single major lymphatic trunk inferior to the axillary vein in the region of the former Level II nodes. The leak was controlled by the application of multiple mass ligatures using 2-0 silk suture. A part of the pectoralis major muscle was rotated and sutured over the area of the leak as additional reinforcement. Suturing a muscle flap over the leak has been described previously and functions theoretically by causing fibrosis. The chylous fistula in the present case was managed successfully with mass ligatures and muscle flap reinforcement.

Chyle↗

PubMed2004

Phlebectasia of the external jugular vein associated with duplication of the internal jugular vein.

The most common cause of a neck mass that increases in size on the Valsalva maneuver is laryngocele. Jugular phlebectasia is a congenital dilation of the jugular vein, which is extremely rare in adults, may present similarly. Duplication of the internal jugular vein (IJV), which is usually encountered coincidentally, is another rare anatomic variation. Isolated cases or cases associated with IJV ectasia have been reported. We report on an adult patient with coexisting external jugular phlebectasia and internal jugular duplication on the same side.

Diagnosis, Differential↗

PubMed2002

Abnormal digastric muscle with unilateral quadrification of the anterior belly.

During dissection of the submental region we observed that the anterior belly of the left digastric muscle had four separate insertions. These muscle bands united in a common tendon as they continued with the posterior belly. This is an anatomical variation in the mylohyoid digastric muscle group in the floor of the mouth. When an asymmetry in the floor of the mouth is detected during diagnostic procedures, such as radiologic studies, anomalies of the anterior belly of the digastric muscle should be considered besides other reasons of asymmetry. Additionally, possible occurrence of such anomalies should be remembered during surgical procedures involving the submental region. This unique variation has not been reported in the literature.

Aged↗

PubMed2002

Anomalous relationship of the spinal accessory nerve to the internal jugular vein.

A patient with an early cancer of the tongue and undergoing a staging neck dissection was noted to have an anomalous relationship of the internal jugular vein and spinal accessory nerve. At the upper end of the dissection (level II, Memorial Sloan-Kettering classification), the internal jugular vein was observed to divide above and reconstitute below the spinal accessory nerve. Although apparently not previously described in the literature, this finding may be encountered by other surgeons who operate in this area, and it is important that these anatomical variations are borne in mind to prevent inadvertent injury.

Accessory Nerve↗

PubMed2002

Approach to the educational opportunities provided by variant anatomy, illustrated by discussion of a duplicated inferior vena cava.

Variant anatomy recognized during routine cadaveric dissection in the first year of medical school offers great learning potential by allowing students to gain enhanced understanding of an array of important subjects. It provides a framework for reviewing common morphology and embryogenesis of the structure in question, and through the help of appropriate faculty, yields insight into the potential medical, radiologic, and surgical implications. The frequency of clinically important anatomic variation is high enough to allow the gross anatomy laboratory to serve as an excellent teaching platform in this regard. Through anatomy, the student is introduced to the concept of patient individuality, and to the individualization of medical and surgical therapies. Recently, one of the variations encountered in our lab was a duplicated inferior vena cava. We describe our approach to such findings through a systematic discussion of the anatomy and embryology, as well as the radiologic and clinical correlates.

Anatomy↗

PubMed2004

Linear parameters of normal and abnormal cava septi pellucidi: a post-mortem study.

Anatomical variations in the dimensions of different brain structures have been correlated with clinical syndromes. This study on the parameters of normal and abnormal cavum septi pellucidi (CSP) can be of clinical significance. We obtained 479 brains from autopsied persons (310 males and 169 females, 377 normal or asymptomatic and 102 abnormal or symptomatic persons, aged 22-89 years) and observed that 110 brains (75 males and 35 females) had CSP. These cava were classified into two groups depending on the past medical histories of the autopsied person: 40 asymptomatic and 70 symptomatic cava. We have defined symptomatic cava as those in autopsied persons who had known past medical history of psychiatric or neurological disease. Asymptomatic cava were in autopsied persons who had no known past medical history of psychiatric or neurological disease. The CSP parameters (length, width, depth) of the symptomatic and asymptomatic groups were measured and were statistically analyzed. Analysis showed that the cava in the symptomatic group were significantly longer and wider. Discriminant function analysis was used to derive a mathematical formula to classify CSP into an asymptomatic or symptomatic group based on length and width measurements of the cavum.

Adult↗

PubMed2005

Axillopectoral muscle (Langer's muscle).

In a routine dissection of the axillary fossa, a muscle originating from the coracoid process of the scapula and extending to the long head of triceps brachii muscle was observed. The mentioned muscle was adhering to both the triceps brachii muscle and the tendinous part of the latissimus dorsi muscle. This anatomical variation is referred to as axillary arch (Langer's muscle or axillopectoral muscle). The muscle mass was measured 9.6 cm in length and 1.4 cm in width. The accessory muscle can be a reason of an axillary mass and can exert pressure on the neighboring neurovascular bundle or lymph routes; thus, exposing a wide range of symptoms. Therefore, variations of this area should be kept in mind in surgical interventions.

Axilla↗

PubMed2005

Distribution of fluid within the peritoneal cavity: a cadaveric study.

This study assesses the distribution of varying volumes of fluid within the peritoneal cavity of cadavers of different sizes (small < or =60 kg; medium = 60-100 kg; large > or =100 kg). The results help to predict the volumes of therapeutic solutions (e.g., adhesiolysis solutions used in the prevention of post-operative adhesion formation) that would be required to reach all the relevant spaces within the greater sac of the peritoneal cavity. Twenty-one cadavers (9 male, 12 female) were selected randomly. Midline laparotomy and bilateral subcostal incisions were made to visualize the distribution of 500 ml of water into the pelvic cavity, paracolic gutters, right subhepatic, and subphrenic spaces. A further 500 ml of water was then added and the distribution was again recorded. The results showed that 500 ml of water was found to distribute to all areas in 47.8% of cadavers, and 1,000 ml distributed to all areas in 81.0% of cadavers. One hundred percent of small cadavers achieved maximum distribution with 500 ml irrespective of gender. Seventy percent of medium cadavers achieved maximum distribution with 1,000 ml, and 75% of large cadavers achieved maximum distribution with 1,000 ml. Anatomical variation in the size of the phrenicocolic ligament was found to be an important limiting factor in the distribution of fluid to the space inferior to the left lobe of the liver and the left subphrenic space. Pre-existing intra-abdominal pathology and previous abdominal surgery also influenced the distribution of fluid within the peritoneal cavity.

Aged↗

PubMed2006

Investigation of the functional three-dimensional anatomy of the human cystic duct: a single helix?

Clinical research into the formation of gallstones has indicated that the anatomy of the cystic duct is one of a number of factors contributing to the formation of gallstones. The cystic duct allows low-viscosity hepatic bile to enter the gallbladder under low pressure and the expulsion of a more viscous gallbladder bile, but little is known about this transport mechanism and the effect of anatomical variations in structure. This article describes the variation in geometry of the cystic duct, obtained from acrylic resin casts of the neck and first part of the cystic duct in gallbladders removed for gallstone disease and obtained from patients undergoing partial hepatectomy for metastatic disease. The data obtained allowed us to formulate a number of standard terms for describing cystic duct morphology and demonstrate that the term "spiral valve" is only partially correct when describing the duct anatomy. In over half of the casts, spiraling was not the dominant feature of the cystic duct. Additionally, the term valve implies active resistance to flow in one direction, whereas the internal baffles of the cystic duct would serve to regulate bile flow in both directions. These data are useful for realistic 3D modeling of fluid-structure interactions of the flow of bile in the human cystic duct.

Bile Ducts↗

PubMed2007

Proposal for classification of the suprascapular notch: a study on 423 dried scapulas.

The present study proposes a simple and reproducible method to classify the morphology of the suprascapular notch (SSN), on the basis of specific geometrical parameters that clearly distinguish one type from another. Four hundred twenty-three dried scapulas from the Department of Anatomy in the University of Cologne, Germany, were examined. Five types of SSN were observed: type I, without a discrete notch, 35 (8.3%); type II, a notch that was longest in its transverse diameter, 177 (41.85%); type III, a notch that was longest in its vertical diameter, 177 (41.85%); type IV, a bony foramen, 31 (7.3%); type V, a notch and a bony foramen, 3 (0.7%). For the vertical diameter, we took the maximal diameter of the notch perpendicular to the imaginary line that joins the two superior corners of the notch. For the transverse diameter, we took the diameter perpendicular to the midpoint of the vertical diameter. This classification based on the vertical and the transverse diameters of the SSN suggested a clear distinction of the notch types. This simple classification included all the anatomical variations of the SSN. Using this method, the clinician will be able to define easily and quickly the notch type on a plain radiograph, and perhaps be able to correlate suprascapular nerve entrapment with a specific type of SSN.

Anthropometry↗