Craniovertebral anomalies associated with pituitary gland duplication

Background: An extremely rare occurrence of the pituitary gland duplication inspired us to examine in detail the accompanying craniovertebral congenital anomalies in a patient involved. Materials and methods: T1-wighted magnetic resonance imaging (MRI) was performed, as well as the multislice computerised tomography (MSCT) and MSCT angiography in our patient, as well as in a control group of 10 healthy subjects. Results: In a 20-year-old male a double pituitary gland was identified, as well as hypothalamic enlargement, tuberomamillary fusion and hamartoma. In addition, the patient also showed a duplicated hypophyseal fossa and posterior clinoid processes, notch of the upper sphenoid, prominent inner relief of the skull, inverse shape of the foramen magnum, third occipital condyle, partial aplasia of the anterior and posterior arches of the atlas with a left arcuate foramen, duplication of the odontoid process and the C2 body, and fusion of the C2–C4 and T12–L1 vertebrae. The MSCT angiography presented a segmental dilatation of both vertebral arteries and the A2 segment of the anterior cerebral artery, as well as a duplication of the basilar artery. Conclusions: This patient is unique due to complex craniovertebral congenital anomalies associated with a duplication of the pituitary gland

A 3 tesla magnetic resonance imaging volumetric analysis of the hippocampal formation: dependence on handedness and age

Background: The hippocampal formation (HF) is one of the most important parts of the brain in the magnetic resonance imaging (MRI) volumetric analysis in various domains, but not completely from all aspects, including the handedness. The aim of our study was to evaluate the possible differences in the volume of the right and left HF among the healthy right-handed and left-handed subjects, and to determine whether the volume differences are age related. Materials and methods: The MRI of this prospective study was performed using T1 fast field echo (FFE) sequence. The 124 subsequent coronal slices (thickness 1.5 mm) were performed in each participant. The obtained HF volumes were normalised and statistically compared. Volunteers comprised 30 persons aged 22.0 years, 12 of whom were the left-handed, and 30 persons aged 75.2 years on average, 9 of whom were the left-handed. Results: The right and left HF volumes averaged 2.986 cm3 and 2.858 cm3 in the right-handed, and 2.879 cm3 and 3.020 cm3 in the left-handed young volunteers, as well as 2.728 cm3 and 2.650 cm3 in the right-handed, and 2.617 cm3 and 2.780 cm3 in the left-handed elderly persons. The HF volume ratios in the young left-handed participants showed a significant left-greater-than-right asymmetry. A significant difference was also noticed within the right-to-left volume ratios of the right- and left-handed young and elderly participants. The latter reduction in the HF volume within the aged group can be interpreted as a slight atrophy of the HF. Conclusions: There is a significant difference in the volumes of the left and right HF of the left-handed young participants. The age related HF volume differences were proven between the groups of the young and elderly volunteers. The obtained data should be included into the future MRI studies of the HF volumes in various clinical domains.

Medullary branches of the vertebral artery: microsurgical anatomy and clinical significance

Abstract Background Since the medullary arteries are of a great neurologic and neurosurgical signifcance, the aim was to perform a detailed microanatomic study of these vessels, as well as of the medullary infarctions in a group of patients. Methods The arteries of 26 halves of the brain stem were injected with India ink and gelatin, microdissected and measured with an ocular micrometer. Neurologic and magnetic resonance imaging (MRI) examinations were performed in 11 patients. Results The perforating medullary arteries, averaging 6.7 in number and 0.26 mm in diameter, most often originated from the anterior spinal artery (ASA), and rarely from the vertebral (VA) (38.5%) and the basilar artery (BA) (11.6%). They sup‑ plied the medial medullary region. The anterolateral arteries, 4.8 in number and 0.2 mm in size, most often arose from the ASA and PerfAs, and nourished the anterolateral region. The lateral arteries, 2.2 in number and 0.31 mm in diameter, usu‑ ally originated from the VA and the posterior inferior cerebellar artery (PICA). They supplied the lateral medullary region. The dorsal arteries, which mainly arose from the PICA and the posterior spinal artery (PSA), nourished the dorsal region, including the roof of the 4th ventricle. The anastomotic channels, averaging 0.3 mm in size, were noted in 42.3%. Among the medullary infarctions, the lateral ones were most frequently present (72.8%). Conclusion The obtained anatomic data, which can explain the medullary infarctions symptomatology, are also important in order to avoid damage to the medullary arteries during neurosurgical and neuroradiologic interventions

АНАЛИЗА НА СЛУЧАИ ОД ИМУНОЛОГИЈАТА

One of the most important goals of the modernization of Medical Faculties in the European Union is the unification of basic knowledge from pre-clinical courses with clinical judgment and that as early as possible (even in the first semester). In that sense, various novelties are introduced in the contents of the subjects and their connection in logical units. The main weight that immunology has as a subject for medical students is how to master the many types of cells and their specific ratios, the even greater number of immunological mechanisms, and especially the fitting of that knowledge into immunological deviations. The most important goal of the immunology course is to enable medical students to think immunologically so that they can successfully apply immunological knowledge when they encounter a specific clinical condition. This is achieved by analyzing immunology cases in order to explain basic immunological knowledge to students and specifically relate it to clinical practice. In clinical courses, immunological case presentations are used where students are introduced to the clinical approach in solving specific immunological diseases, starting from anamnesis, family history, current condition, clinical examinations, laboratory and other diagnostic examinations, differential diagnosis, treatment, rehabilitation and forecast. In this book, already published analyses of immunology cases are selected from the highest quality books used for that purpose in the world, grouped into seven blocks of two cases each, as provided in the Immunology Practicum. The names of the cases are invented so that students can remember them more easily. Although I expect reactions to this approach to the education of medical students by clinically oriented teachers, I believe that this book will be well received by students and that it will encourage the writing of similar and better textbooks with this approach for other subjects at the Faculty of Medicine in Skopje.   Prof. Dr Mirko Spiroski October, 2007Една од најзначајните цели од модернизацијата на Медицинските факултети во Европската Унија е обединувањето на базичните знаења од предклиничките предмети со клиничкото просудување и тоа што е можно порано (уште во првиот семестар). Во таа смисла се воведуваат различни новини во содржините на предметите и нивното поврзување во логични целини. Главната тежина што ја има имунологијата како предмет за студентите по медицина е како да се совладаат многуте видови клетки и нивните специфични соодноси, уште поголемиот број имунолошки механизми, а особено вклопувањето на тие знаења во имунолошките отстапувања. Најзначајна цел на предметот имунологија е да ги оспособи студентите по медицина имунолошки да размислуваат за да можат успешно да ги применат имунолошките сознанија кога ќе се сретнат со конкретна клиничка состојба. Тоа се постигнува со анализа на случаи од имунологијата со цел на студентите да им се објаснат базичните имунолошки знаења и конкретно да ги поврзат со клиничката пракса. Во клиничките предмети се користат прикази на имунолошки случаи каде што студентите се запознаваат со клиничкиот приод во разрешување на конкретни имунолошки заболувања, почнувајќи од анамнеза, фамилна анамнеза, сегашна состојба, клинички испитувања, лабораториски и други дијагностички испитувања, диференцијална дијагноза, лекување, рехабилитација и прогноза. Во оваа книга се одбрани веќе објавени анализи на случаи од имунологијата од најквалитетните книги кои се користат за таа намена во светот, групирани во седум блока од по два случаи, како што се предвидени во Имунолошкиот практикум. Имињата на случаите се измислени за да можат студентите полесно да ги запаметат. Иако очекувам реакции кон ваквиот приод за образование на студентите по медицина од страна на клинички ориентираните наставници, верувам дека книгава ќе биде добро прифатена од студентите и дека таа ќе поттикне пишување на слични и подобри учебници со ваков приод и за другите предмети на Медицинскиот факултет во Скопје.   Проф. д-р Мирко Спироски Октомври, 2007 годин

Clinical Significance of the Cerebral Perforating Arteries

Abstract There is scarce data in the contemporary literature regarding the correlation of the microanatomy of the perforating arteries, their atherosclerosis, and the ischemia in their territory. In order to examine, at least partially, those parameters, the perforating arteries of 12 brains were microdissected or their vascular casts were obtained. In addition, 30 specimens of the perforators were used for a histological and immunohistochemical study. Finally, radiological images of 14 patients with deep cerebral infarcts were examined following a selection among 62 subjects. It was found out that certain groups of the perforators ranged in number between 0 to 11 (1.1-8.4 on average). In addition to the origin from the parent vessels, some of the perforators also arose from the leptomeningeal branches. Occlusion of such a branch may result in both a superficial and a deep ischemic lesion. Besides, the common stems of certain perforators supplied both right and left portions of the corresponding brain regions. Occlusion of such a common trunk leads to bilateral infarction. The atherosclerosis of the perforating vessels, which was found in one third of the specimens, is the basis for the ischemic lesions development on their territory. Among the 62 patients with ischemic lesions, 14 had a deep cerebral infarcts, most often within the thalamus, as well as on the territory of the middle cerebral and the anterior choroidal artery perforators of the hemispheres. Our study showed that a strong correlation exists between certain microanatomical features, atherosclerosis, and region of supply of the perforating arteries, on the one hand, and location of the ischemic lesions on the other hand