Co-existence of the double inferior vena cava with complex interiliac venous communication and aberrant common hepatic artery arising from superior mesenteric artery: a case report

Variations of the arterial and venous system of the abdomen and pelvis have important clinical significance in hepatobiliary surgery, abdominal laparoscopy, and radiological intervention. A case of double inferior vena cava (IVC) with complex interiliac communication and variation of the common hepatic artery (CHA) arising from superior mesenteric artery (SMA) in a 79-year-old male cadaver is presented. Both IVCs ascended on either side of the abdominal aorta. The left-sided IVC crossed anterior to the aorta at the level of the left renal vein. The union of both IVCs was at the level just above the right renal vein. The diameter of right-sided IVC, left-sided IVC and the common IVC were 16.73 mm, 21.57 mm and 28.75 mm, respectively. In the pelvic cavity, the right common iliac vein was formed by a union of right external and internal iliac veins while the formation of left common iliac vein was from the external iliac vein and two internal iliac veins. An interiliac vein ran from right internal iliac vein to left common iliac vein with an additional communicating vein running from the middle of this interiliac vein to the right common iliac vein. Another co-existence variation in this case was the origin of the CHA arising from the SMA with a suprapancreatic retroportal course. Clinical importance of double IVC are observed in retroperitoneal surgery, whole organ transplantation or radical nephrectomy, surgical ligation of the IVC or the placement of an IVC filter for thromboembolic disease. The variation of CHA has an important clinical significance in liver transplantation, abdominal laparoscopy and radiological abdominal intervention. (Folia Morphol 2018; 77, 1: 151–155

Multiple variations in the course and motor branching pattern of the musculocutaneous nerve with unusual communication with the median nerve

Anatomic variations in course and motor branching pattern of the musculocutaneous nerve (MCN) with unusual communication with the median nerve were determined on the left arm of a 62-year-old formalin fixed male cadaver. The MCN did not pierce the coracobrachialis muscle. It provided 4 primary motor branches. The first branch emerged 1.5 cm inferior to the coracoid process to innervate the coracobrachialis muscle. The second branch emerged 8 cm inferior to the coracoid process to innervate the biceps brachii muscle. The third branch to brachialis muscle emerged 13.9 cm inferior to the coracoid process. The last branch to the common belly of biceps brachii muscle emerged 19.6 cm inferior to the coracoid process. Two communications with the median nerve were observed. The proximal thick communicating branch had the direction from the MCN to the median nerve while the distal one was a small nerve bundle with a direction from the median nerve to the MCN. The present report provided evidence of multiple variations in one MCN which had not been reported previously. Anatomic variation in this case has clinical implications, considering that injury of the MCN in the upper part of arm would cause unexpected paralysis of flexor muscles of forearm and thenar muscle due to communications between this and median nerve

Evaluation of the greater occipital nerve location regarding its relation to intermastoid and external occipital protuberance to mastoid process lines

Background: Localisation of the greater occipital nerve (GON) is essential for the achievement of several procedures performed in the occipital region especially the treatment of occipital neuralgia. This study proposed to investigate the location of GON subcutaneous (Sc) and semispinalis capitis (SSC) piercing points related to the intermastoid and external occipital protuberance (EOP) to mastoid process (MP) lines.Materials and methods: The Sc piercing point, relation to SSC and obliquus capitis inferior (OCI) muscles of 100 GONs from 50 cadaveric heads (23 males, 27 females) were dissected. Distances from EOP to MP (EM line) on both sides and between MPs (MM line) were measured. Perpendicular lines from Sc and SSC piercing points to EM and MM lines were created and measured. Distances from EOP to the perpendicular lines of SSC piercing point and from MP to the perpendicular lines of Sc piercing point were measured and calculated into percentage of EM and MM length, respectively.Results: Three types of Sc piercing points (I, II and III) were obtained. The percentage of GON piercing trapezius muscle (TP) (type I), aponeurosis of TP (type II) and aponeurosis between TP and sternocleidomastoid muscle (SCM) (type III) were 2, 67 and 31, respectively. In addition, 95% of GON pierced SSC, 2% pierced its tendinous band and 3% travelled between its medial fibres and the nuchal ligament. 94% of the GON turned around the lower edge of the OCI, while 6% pierced the lower edge of this muscle. Sc piercing point was always located above the MM line, but it could be above, below or on the EM line. In contrast, all of the SSC piercing points were located below the EM line except in one specimen, but it could be above, below or on the MM line. Therefore, the MM and EM lines were used as reference lines for locating the Sc and SSC piercing points, respectively. The mean EM line length was 81.26 ± 5.26 mm with statistically significant differences between genders and sides in female. The mean MM line length was 121.77 ± 8.54 mm with a statistically significant difference between genders. Sc piercing point could be located at 44% of MM line length from ipsilateral MP with a mean vertical distance of 18 mm. No statistically significant difference was found between genders and sides in these parameters, but a statistically significant difference was found in the percentage of MB to MM line between type III and type I (p = 0.02). SSC piercing point of all types could be located at the point of 25% of EM line length from EOP with a vertical distance of 18 mm below EM line. No statistically significant difference was found between genders, sides and types of both piercing points.Conclusions: MM and EM lines are potential reference lines for locating the Sc and SSC piercing points of GON, respectively

Activation of MAPK ERK in peripheral nerve after injury

BACKGROUND: Activation of extracellular signal-regulated protein kinase (ERK), a member of mitogen-activated protein kinase (MAPK) family, has been proposed to mediate neurite outgrowth-promoting effects of several neurotrophic factors in vitro. However, the precise activity of ERK during axonal regeneration in vivo remains unclear. Peripheral axotomy has been shown to activate ERK in the cell bodies of primary afferent neurons and associated satellite cells. Nevertheless, whether ERK is also activated in the axons and surrounded Schwann cells which also play a key role in the regeneration process has not been clarified. RESULTS: Phosphorylation of ERK in the sciatic nerve in several time-points after crush injury has been examined. Higher phosphorylation of ERK was observed in the proximal and distal nerve stumps compared to the contralateral intact nerve from one day to one month after crush. The activation of ERK was mainly localized in the axons of the proximal segments. In the distal segments, however, active ERK was predominantly found in Schwann cells forming Bungner's bands. CONCLUSION: The findings indicate that ERK is activated in both the proximal and distal nerve stumps following nerve injury. The role of activated ERK in Wallerian degeneration and subsequent regeneration in vivo remains to be elucidated

Identification of Gene Networks and Pathways Associated with Guillain-Barré Syndrome

BACKGROUND: The underlying change of gene network expression of Guillain-Barré syndrome (GBS) remains elusive. We sought to identify GBS-associated gene networks and signaling pathways by analyzing the transcriptional profile of leukocytes in the patients with GBS. METHODS AND FINDINGS: Quantitative global gene expression microarray analysis of peripheral blood leukocytes was performed on 7 patients with GBS and 7 healthy controls. Gene expression profiles were compared between patients and controls after standardization. The set of genes that significantly correlated with GBS was further analyzed by Ingenuity Pathways Analyses. 256 genes and 18 gene networks were significantly associated with GBS (fold change ≥2, P<0.05). FOS, PTGS2, HMGB2 and MMP9 are the top four of 246 significantly up-regulated genes. The most significant disease and altered biological function genes associated with GBS were those involved in inflammatory response, infectious disease, and respiratory disease. Cell death, cellular development and cellular movement were the top significant molecular and cellular functions involved in GBS. Hematological system development and function, immune cell trafficking and organismal survival were the most significant GBS-associated function in physiological development and system category. Several hub genes, such as MMP9, PTGS2 and CREB1 were identified in the associated gene networks. Canonical pathway analysis showed that GnRH, corticotrophin-releasing hormone and ERK/MAPK signaling were the most significant pathways in the up-regulated gene set in GBS. CONCLUSIONS: This study reveals the gene networks and canonical pathways associated with GBS. These data provide not only networks between the genes for understanding the pathogenic properties of GBS but also map significant pathways for the future development of novel therapeutic strategies