The use of computer-assisted image analysis in measuring the histological structure of the human median nerve

Background and aim: The aim of this study was to assess the histological structure of the median nerve and its motor branch (number and arrangement of nerve bundles) and the cross-sectional area (CSA) of the median nerve (on the level of the carpal tunnel). Material and methods: This study has been conducted using median nerves dissected from cadavers stored in a 10% solution of formaldehyde at the Department of Anatomy of the Jagiellonian University Medical College and cadavers from the Department of Forensic Medicine of the Jagiellonian University Medical College. After dissection the median nerves were stained with haematoxylin and eosin and histological slides were prepared. These were later photographed (16 x magnification) and analysed using ImageJ software. The research protocol was approved by the Jagiellonian University Ethics Committee (registry KBET/209/B/2002). Results: The studied group comprised 8 women and 22 men (age between 23–92 years), yielding a total of 60 median nerves (30 right vs. 30 left). In 4 (6.67%) cases an accessory motor branch was found. The mean CSA of the median nerve was 0.19 cm2. The median nerves from the right hand had a statistically larger CSA (p = 0.017). The number of nerve bundles in the median nerve varied between 13 to 38 and in the motor branch of the median nerve between 4 to 14. Conclusions: The nerve bundles of the median nerve, at the level of the carpal tunnel, display no particular type of arrangement. ImageJ software proved useful in the assessment of the histological structure of the human median nerve and its motor branch

The mandible and its foramen: anatomy, anthropology, embryology and resulting clinical implications

The aim of this paper is to summarise the knowledge about the anatomy, embryology and anthropology of the mandible and the mandibular foramen and also to highlight the most important clinical implications of the current studies regarding anaesthesia performed in the region of the mandible. An electronic journal search was undertaken to identify all the relevant studies published in English. The search included MEDLINE and EMBASE databases and years from 1950 to 2012. The subject search used a combination of controlled vocabulary and free text based on the search strategy for MEDLINE using key words: ‘mandible’, ‘mandibular’, ‘foramen’, ‘anatomy’, ‘embryology’, ‘anthropology’, and ‘mental’. The reference lists of all the relevant studies and existing reviews were screened for additional relevant publications. Basing on relevant manuscripts, this short review about the anatomy, embryology and anthropology of the mandible and the mandibular foramen was written

Extra- and intracerebral course of the recurrent artery of Heubner

Background: The aim of the current study was to analyse the extra- and intracerebral course of the recurrent artery of Heubner (RAH) to provide detailed information for neurosurgeons operating in this area.Materials and methods: The material for this study was obtained from cadavers (ages 31–75 years) during routine autopsies. A total of 70 human brains (39 male and 31 female) were examined. The material was collected not later than 48 h post-mortem. People who died due to neurological disorders were not includedinto the study. Right after dissection the arteries were perfused with either acrylicpaint emulsion, polyvinyl chloride or Mercox CL-2R resin, through the Circle ofWillis or electively through the RAH. The obtained material was analysed usinga stereoscopic light microscope, magnification 2–40´.Results: The RAH was present in 138 hemispheres with a mean of 1.99 RAH per hemisphere (275 RAH in total). The mean RAH length was 25.2 mm and the mean RAH diameter, in its place of origin, was 1 mm. In 168 (61%) cases the RAH ran superiorly, in 88 (32%) cases anteriorly, in 11 (4%) cases inferiorly and in 8 (3%) cases posteriorlyto the A1 segment. In 70.2% of the cases the course of the RAH was parallel to theanterior communicating artery A1 segment, and in 29.8% of the cases the RAH archedtowards the olfactory tract. As the extracerebral course of the RAH was always tortuous,its length was 1 to 5 times the distance between its place of origin and the most lateralpoint of anterior perforated substance (APS) penetration. The intracerebral course ofthe RAH was almost always univectorial — towards the head of the caudate nucleus.The course of RAH branches depended on their number. When the number of RAH sand their branches was low, they separated immediately after penetrating the APS andformed multiple small branches. When the number of RAHs and branches was high,post-APS branching was less frequent and occurred in distal segments.Conclusions: The origin and course of the RAH is highly variable. The RAH, in itsextra- and intracerebral course, may join with the middle group of the lenticulostriatearteries or directly with the middle cerebral artery. This artery should beroutinely identified during anterior communicating artery aneurysm clipping toprevent postoperative neurological deficits

Current state of quality of life and patient-reported outcomes research

The 5th EORTC Quality of Life in Cancer Clinical Trials Conference presented the current state of quality of life and other patient-reported outcomes (PROs) research from the perspectives of researchers, regulators, industry representatives, patients and patient advocates and health care professionals. A major theme was the assessment of the burden of cancer treatments, and this was discussed in terms of regulatory challenges in using PRO assessments in clinical trials, patients' experiences in cancer clinical trials, innovative methods and standardisation in cancer research, innovative methods across the disease sites or populations and cancer survivorship. Conferees demonstrated that PROs are becoming more accepted and major efforts are ongoing internationally to standardise PROs measurement, analysis and reporting in trials. Regulators are keen to collaborate with all stakeholders to ensure that the right questions are asked and the right answers are communicated. Improved technology and increased flexibility of measurement instruments are making PROs data more robust. Patients are being encouraged to be patient partners. International collaborations are essential, because this work cannot be accomplished on a national level

Validation of the Polish language version of the SF-36 Health Survey in patients suffering from lumbar spinal stenosis

[b]introduction and objective[/b]. Patient-reported outcome (PRO) questionnaires have become the standard measure for treatment effectiveness after spinal surgery. One of the most widely used generic PROs is the SF-36 Health Survey. The aim of this study was to specifically focus on validating the SF-36 Health Survey to confirm that the tool is an acceptable and psychometrically robust measure to collect HRQoL data in Polish patients with spinal stenosis. [b]materials and methods[/b]. Patients were eligible if they were above 18 years of age and had been qualified for spine surgery of the lumbar region due to either discopathy or non-traumatic spinal stenosis. All patients filled-in the Polish version of the SF-36 and a demographic questionnaire. Standard validity and reliability analyses were performed. [b]results.[/b] 192 patients (83 women – 43.2%) agreed to take part in the study (mean age: 57.5±11.4 years). In 47 patients (24.5%), using MRI, ossification of the ligamenta flava were found. Cronbach’s alpha coefficients showed positive internal consistency (0.70–0.92). Interclass correlations for the SF-36 ranged from 0.72 – 0.86 and proved appropriate test-retest reliability. Satisfactory convergent and discriminant validity in multi-trait scaling analyses was seen. [b]conclusions.[/b] The Polish version of the SF-36 is a reliable and valid tool for measuring HRQoL in patients with spinal stenosis. It can be recommended for use in clinical and epidemiological settings in the Polish population. However, caution is warranted when interpreting the results of the ‘role limitations due to physical health problems’ and the ‘role limitations due to emotional problems’ scales because of floor and ceiling effects