AN ABNORMALLY LONG STYLOID PROCESS WITH OSSIFICATION OF THE STYLOHYOID LIGAMENT

The styloid process of the temporal bone is an elongated bony projection presenting a variable length as demonstrated in osteometric and radiological studies conducted with different techniques: three-dimensional computed tomography (3dct) or dental panoramic three-dimensional scanning. An elongated styloid process can cause neck pain , dysphagia, headache, sore throat, ear pain, mandibular dysfunction which characterize Eagle’s syndrome. Here we present a rare image of an abnormally long styloid process with ossification of left stylohyoid ligament belonging to a bone collection of the local anatomical museum , part of our department, and discovered during routine osteology classes .Also if a direct relation between the length of the styloid process and syndrome of Eagle is not always obvious ,radiologists , neurologists,neurosurgeons, dentists, anesthetists and otolaryngologists could be aware of this bone anomaly to diagnose this syndrome

The innervation of human muscularis mucosae: an ultrastructural study

The muscularis mucosae, a thin band of smooth muscle located at the base of the gastrointestinal mucosa, has been the topic of very few studies .The muscularis mucosae might regulate the absorptive and secretory functions of the gut through movements of the mucosal surface (1).The autonomic innervation of this tissue is almost completely unknown.Therefore we have carried out an ultrastructural study on nerve fibers of muscolaris mucosae by using archived mucosal rectal biopsies of children of different age , examined in the past for the diagnosis of neurometabolic disease and resulted negative. Nerve fibers of muscularis mucosae were unmyelinated. They contain several axons with the characteristics of intervaricose tract completely or almost surrounded by Schwann cells . Other axons in the nerve fibers appear as varicosities partly covered with Schwann cell cytoplasm or naked, and filled with vesicles and mitochondria .The vesicles in the same varicosity appear pleomorphic: small clear-core vesicles , dense -core of small diameter or less often dense-core of larger type. The membrane of muscle cells often protruded toward the varicosity . No synaptic specialization was observed.With very low frequency we found varicosities in intimate contact with the plasmalemma . Pleomorphic vesicles inside the same varicosity suggest a complex neurotransmission based on the release of classical transmitter and cotransmitters.The physiological relevance of these nerves remains unclear. Strips of longitudinal muscularis mucosae isolated from the human, guinea pig and rat colon responded with concentration-dependent contractions to the application of several spasmogens (1). In the human muscularis mucosae, neurokinin A was most potent, followed by carbachol, prostaglandin F2 and acetylcholine. These findings suggest the possibility that the muscularis mucosae is innervated by excitatory cholinergic nerves (1).On the other hand in oesophagus exogenously applied adrenaline inhibited spontaneous activities of the muscularis mucosae motor activity. Adrenergic nerves might inhibit spontaneous motility via the inhibition of cholinergic neurotransmission. VIP- , NPY-, CGRP- and galanin-immunoreactive nerve fibers were observed in the human esophageal muscularis mucosae but their function remains unknown (2)

Variations in the length of the styloid process and the possible consequences on muscle ligamentous systems with the mandible and the hyoid bone

The styloid process of the temporal bone has a variable length as demonstrated in studies conducted with different technique: three-dimensional computed tomography or dental panoramic three-dimensional scanning. Data on the osteometric values of the styloid process is scanty with significant length differences existing between the studies attributed to different races or ethnicities.The abnormal length can be in some cases accompanied by a set of symptoms, characterized by neck pain, dysphagia, headache, sore throat, ear pain, mandible dysfunction clinically framed in Eagle’s syndrome. We present an osteometric study on the length of the styloid process of a collection of dried skulls belonging to the museum of Anatomy “Leonetto Comparini “ at the University of Siena. All skulls came from the local psychiatric hospital. For measurement we employed a digital caliper . The data were analyzed through a free statistical software (Salstat 2) . Average and standard deviation (sd), were calculated. Univariate analysis of the length of the styloid process gave the following results: average: 27 mm ; sd : 7 mm ; normal range : average +/- 2 sd : 41-13 mm. The longest styloid process was 52 mm and the shortest had a length of 0.5 mm .In one case we discovered a skull with stylohyoid calcified ligament on one side . The styloid process was long 50 mm on the right and 70 mm on the left where is the tip calcified .An abnormal long styloid process>41 mm is present in 6% of items in our biometric study . The abnormal variations in length are put in relation to the possible anatomical change of the muscular and ligamentous structures of the styloid process by drawings of a case with a marked elongation of the styloid process.The shortening of the stylomandibular ligament that we suppose considering the distance from the angle of mandible of the tip and the possible change in direction could cause difficult in the protrusion of mandible and in mastication. The shortening of stylohyoid ligaments and muscles, could cause difficult in movement of os hyoid and in raising or lowering of larynge during swallowing

Clinical Outcomes in Breast Cancer: Innovations and Ideas Commentary on "Expression of CDK13 was Associated with Clinical Outcomes and Expression of HIF-1 and Beclin1 in Breast Cancer Patients"

The oncogenes underlying the development of breast cancer are not fully understood and careful and rigorous research is still necessary in this area. Before considering the role of these molecules ..

Pediatric Presentation of a Celiaco-mesenteric Trunk in Association with a Pelvic Bilateral Renal Ectopia: an Undescribed Association

Background: The celiac trunk presents its normal trifurcation in the 87% of cases reported in autoptic and radiological studies. Among variants the anatomical conformation known as celiaco-mesenteric trunk has an incidence of 1-2.8%. Case Report: We hereby report a 6 years old girl who presented with recurrent abdominal pain and bilious vomiting. MRI and CT scan, performed with the diagnostic suspicion of an aorto-mesenteric compass, showed the presence of a common origin of the celiac trunk and superior mesenteric artery. In addition, images revealed also the presence of a bilateral pelvic ectopia of kidneys, with renal arteries which took origin from iliac bifurcation. The patient, two months after, was submitted to surgery, during which we found the presence of an intestinal malrotation, instead of an aorto-mesenteric compass. Conclusion: An adequate evaluation of radiologic images and the use of 3D reconstruction permits to diagnose anatomic variants of celiac-mesentric artery

Teaching in schools of specialization: problems and the possible solutions

Teaching of anatomy in post-graduate schools that request it is particularly difficult for the number of hours available, the need not to repeat arguments already addressed in the degree course in medicine, to stimulate the interest of doctors in training and provide anatomical knowledge which are not detached from the clinical practice. To overcome these difficulties we have used in the teaching of anatomy of the post-graduate schools of the neurological-neurosurgical areas and of laryngology-phoniatry a didactic approach, which illustrate, verified for its effectiveness with an evaluation questionnaire submitted to the doctors in training at the end of the course. The essential points of the teaching are: monographic lectures on topics of anatomy related to the clinical field of specific specialization. Treatment of the subjects starting from neurological syndromes or complex brain functions of clinical relevance the understanding of which involves learning of a set of anatomical structures (eg language and cranial nerve, paralytic syndromes associated of the cranial nerves etc).The educational cycle is completed inviting the doctors to present to colleagues and to the professor the anatomical correlates of a published case report, provided to them at the end of the lesson. The teaching of the anatomy that we have illustrated is different from that which is evident from the texts available of clinical neuroanatomy, which treated anatomy of brain regions or of functional systems and reported medical cases that seek to exercise the clinical reasoning ,which purpose is not relevant to the teaching of anatomy .In conclusion even if our didactic approach is limited to some medical specializations and tested on a small number of doctors in training we suggest it as an alternative way to teach anatomy in postgraduate schools

Antiangiogenic VEGF Isoform in Inflammatory Myopathies

Objective. To investigate expression of vascular endothelial growth factor (VEGF) antiangiogenic isoform A-(165b) on human muscle in idiopathic inflammatory myopathies (IIM) and to compare distribution of angiogenic/antiangiogenic VEGFs, as isoforms shifts are described in other autoimmune disorders. Subjects and Methods. We analyzed VEGF-A(165b) and VEGF-A by western blot and immunohistochemistry on skeletal muscle biopsies from 21 patients affected with IIM (polymyositis, dermatomyositis, and inclusion body myositis) and 6 control muscle samples. TGF-β, a prominent VEGF inductor, was analogously evaluated. Intergroup differences of western blot bands density were statistically examined. Endomysial vascularization, inflammatory score, and muscle regeneration, as pathological parameters of IIM, were quantitatively determined and their levels were confronted with VEGF expression. Results. VEGF-A(165b) was significantly upregulated in IIM, as well as TGF-β. VEGF-A was diffusely expressed on unaffected myofibers, whereas regenerating/atrophic myofibres strongly reacted for both VEGF-A isoforms. Most inflammatory cells and endomysial vessels expressed both isoforms. VEGF-A(165b) levels were in positive correlation to inflammatory score, endomysial vascularization, and TGF-β. Conclusions. Our findings indicate skeletal muscle expression of antiangiogenic VEGF-A(165b) and preferential upregulation in IIM, suggesting that modulation of VEGF-A isoforms may occur in myositides

Elongated styloid process: literature review and morphometric data on a collection of dried skulls

The styloid process is a subtle process of variable length that originates from the petrous part of temporal bone . From the process originate three muscles: the stylopharyngeus,the styloglossus, the stylohyoideus and two ligaments :stylohyoid and stylomandibular . The styled process of the temporal bone has a variable length as demonstrated for studies conducted in three-dimensional computed tomography or dental panoramic three-dimensional scanning,and in dried skulls The normal length of the styloid process is particularly important to establish for the relations of closeness with vascular and nervous structures and their possible compression by an elongated styloid process.Several studies have focused on the effects of changes in length and course of the styloid process, highlighting the relations of the carotid artery and the glossopharyngeal nerve to explain cerebrovascular symptoms or Eagle’s syndrome characterized by neck pain and dysphagia .However the association for the abnormal length of styloid process and Eagle’s syndrome is not always present and many cases are asymptomatic. In the present study we propose a review of the studies performed with different in vivo radiological techniques and on dried skull collections on the normal and pathological length of the stiloyd process and on its association with the Eagle’s syndrome. We also present a morphometric study carried out in dried skulls of our museum collection.The results are discussed in light of the possible variations in the muscular and ligamentous structures consequent to the elongation of the styloid process. © 2021 Firenze University Press

Le opere di Anatomia nel Fondo Mascagni

Gli autori hanno consultato le oltre 300 opere di anatomia presenti nella biblioteca appartenuta a Paolo Mascagni per meglio delineare il suo ruolo di ricercatore e docente nel settore anatomico

Modelli didattici dell'apparato uditivo (sec. XIX-XX) nelle collezioni del Sistema museale universitario senese e il restauro di "un Auzoux"

Nelle collezioni dei musei universitari senesi sono presenti vari modelli dell'apparato uditivo di differenti epoche e materiali. Essi non rappresentano solo l'anatomia di tale complesso sistema di organi, ma anche il funzionamento delle sue parti. Il Museo di strumentaria medica conserva sia modelli di anatomia che di fisiologia. Presso la storica sede della Clinica otorinolaringoiatrica, oggi Dipartimento di scienze mediche, chirurgiche e neuroscienze, è esposta una serie didattica risalente agli anni Settanta del XX secolo, interessante per lo stato di conservazione e per la sua completezza; mentre presso il Museo anatomico “Leonetto Comparini” è esposto un modello di orecchio di grandi dimensioni in cartapesta dell’anatomista e naturalista francese Louis Thomas Jérôme Auzoux, oggetto di un recente restauro che ne ha riportato alla luce la raffinata fattura, la data e la firma dell'autore. Tale occasione ha consentito di seguire un percorso fra gli inventari storici e, tramite il Sigecweb l'inserimento dell’oggetto nel Catalogo Generale dei Beni culturali