Median nerve’s loop in the arm penetrated by a superficial brachial artery: case report and neurosurgical considerations

Median nerve is commonly formed by the union of the lateral and medial cord of the brachial plexus, which embrace the third part of the axillary artery. Formation of a median nerve’s loop is a very rare condition. We present a cadaveric case, in which the right median nerve was found at the upper arm forming a fusiform neural loop penetrated by a superficial brachial artery, which continued over the forearm as the radial artery. The literature concerning nerve loops and traversing arteries is discussed, as well as the relevant embryology. We consider that such nerve loops constitute vulnerable sites of the nerve trunk since it is compressed by the pulsation of the abnormal traversing artery. Moreover, neurosurgeons should keep in mind that in case of existing arterial variation, variation of the associated neural structures may co-exist

Historical considerations regarding the first descriptions of pancreas’ anatomy

The descriptions of the term “pancreas” as well the macroscopic anatomy of the pancreas throughout Antiquity, Byzantium, Middle Ages and Renaissance are displayed. In particular, the original phrases of famous physicians of that period as regards the anatomy of the pancreas are presented: Hippocrates, Aristotle, Herophilus, Galen, Rufus of Efesus, Julius Pollux, Oribasius, Bartolomeo Eustachio, Andreas Vesalius, Gabriel Fallopius, Johann Georg Wirsung, Francis Glisson, Giovanni Domenico Santorini

Topography, macroscopic morphometry and anatomic variations of the azygos vein system in greek population

Aim: Τhe aim of the current study is the morphological and morphometric analysis of the azygos vein system, based on anatomical and radiological methods, in a Greek population. Material: Thirty-five formolin-fixed human adult cadavers were dissected, after their collection from the Department of Anatomy and Surgical Anatomy of the Medical School of the Aristotle University of Thessaloniki and the Department of Anatomy of the Medical School of National and Kapodistrian University of Athens, and 51 computed tomography angiographies of the thorax were examined, from the file of ”G.GENNIMATAS” Hospital of Thessaloniki. Method: Cadavers’ dissection was performed in thoracic and abdominal area, until the exposure of the azygos vein system from its origin to its termination. Findings of each dissection were drawn and captured. Parameters of azygos, hemiazygos and accessory hemiazygos veins were measured, and in the same time specific characteristics of the azygos vein were studied in the 51 CT angiographies. Results: the azygos vein was formed by the union of the right subcostal vein with a branch originating from the inferior vena cava, while hemiazygos vein was formed by the union of the left subcostal vein with the left renal. The absence of the accessory hemiazygos vein was the most common finding. In cases of the accessory hemiazygos vein presence, the vein was formed by the union of the 5th, 6th, 7th and 8th intercostal veins. The azygos vein was observed to be dislocated to the left side of the vertebral column with the increasing age.. the azygos vein originated at the level of T12 vertebra and ended to the superior vena cava at (level T3-T4), while the hemiazygos vein emanated at the level of T12 vertebra and ended to azygos vein (level of T9). The accessory hemiazygos vein ended to azygos vein at the level of T7 and T8 vertebrae. Moreover, valves were detected, at the arch of azygos vein. Regarding the azygos lumbar veins, the right one passed through the aortic hiatus of the diaphragm, and the left through the outer crus, while both azygos lumbar veins originated at the level of L2-L3 vertebrae. The mean values of the azygos and hemiazygos vein diameters, at its point of origin and termination were calculated,. The lengths of azygos, hemiazygos veins and superior vena cava were also measured, as well as the distance from the termination of azygos vein to the origin of superior vena cava and the distance from the ending of the right superior intercostal vein to the ending of the azygos vein. Conclusions: The results, which came from the current study, were statistically processed and compared to anatomical textbooks and published studies, so the variety of the anatomy of the azygos vein system was made clear. It is important a meta-analysis research to be conducted that will conclude various studies, in order to clarify the anatomy of the azygos vein system. Afterall, the clinical importance of a good knowledge of the azygos veins anatomy is crucial for the radiologist, in order to discover pathologies of the mediastinum, for the thoracic surgeon, to avoid surgical complications in the specific region, and the angiosurgeon, when catherers are inserted, in pathologies, such as superior vena cava syndrome.Σκοπός της παρούσας διατριβής αποτελεί η μελέτη του συστήματος των αζύγων φλεβών, σε ανατομικό και απεικονιστικό επίπεδο, σε δείγμα Ελληνικού πληθυσμού. Από την ανασκόπηση της διεθνούς βιβλιογραφίας, αποδεικνύεται ότι είναι η πρώτη φορά που επιχειρείται κάτι αντίστοιχο. Υλικό: Εξετάστηκαν 35 πτώματα ταριχευμένα με διάλυμα φορμαλδεϋδης από το Εργαστήριο Ανατομίας και Χειρουργικής Ανατομίας του Α.Π.Θ. και το Εργαστήριο Ανατομίας του Ε.Κ.Π.Α., και 51 αξονικές αγγειογραφίες θώρακα ασθενών που διενεργήθηκαν στο Γ.Ν.Θ. «Γ.ΓΕΝΝΗΜΑΤΑΣ». Μέθοδος: Διεξήχθηκε ανατομή σε 35 πτώματα στην περιοχή του θώρακα και της άνω κοιλίας με σκοπό να παρασκευασθεί και να αναδειχθεί το σύστημα των αζύγων φλεβών από την έκφυση μέχρι την εκβολή του. Σχεδιάστηκε η μορφολογία των φλεβών της κάθε ανατομής ξεχωριστά και φωτογραφήθηκαν τα μορφώματα. Διενεργήθηκαν μετρήσεις σε ποικιλία παραμέτρων της άζυγης, ημιάζυγης και επικουρικής ημιάζυγης φλέβας. Ταυτόχρονα, μελετήθηκε η άζυγη φλέβα στις 51 αξονικές αγγειογραφίες του θώρακα και καταγράφηκαν συγκεκριμένα χαρακτηριστικά της. Αποτελέσματα: Ο σχηματισμός της άζυγης φλέβας προέρχεται κυρίως από τη συνένωση της δεξιάς υποπλεύριας φλέβας με στέλεχος της κάτω κοίλης φλέβας, ενώ ο αντίστοιχος σχηματισμός της ημιάζυγης φλέβας ήταν από τη συνένωση της αριστερής υποπλεύριας φλέβας με την αριστερή νεφρική. Συχνότερα καταγράφηκε η απουσία της επικουρικής ημιάζυγης φλέβας, ενώ όταν εντοπίστηκε η επικουρική ημιάζυγη φλέβα, αυτή προερχόταν από τις 5η -8η μεσοπλεύριες φλέβες. Παρατηρήθηκε ότι με την πάροδο των ετών, η άζυγη φλέβα μετατοπίζεται αριστερά της μέσης γραμμής της σπονδυλικής στήλης. Η άζυγη φλέβα σχηματιζόταν στο ύψος του Θ12 σπονδύλου και κατέληγε στην άνω κοίλη φλέβα στο ύψος του Θ3-Θ4 διαστήματος, ενώ η ημιάζυγη φλέβα σχηματιζόταν στο ύψος του Θ12, και κατέληγε στην άζυγη στο ύψος του Θ9. Η επικουρική ημιάζυγη κατέληγε στην άζυγη στο ύψος των Θ7 και Θ8 σπονδύλων. Ακόμα, εντοπίστηκαν βαλβίδες στην άζυγη φλέβα, σχεδόν σταθερά, στο ύψος του τόξου της άζυγης φλέβας. Αναφορικά με τα άζυγα οσφυϊκά στελέχη, το δεξιό διερχόταν συνηθέστερα από το αορτικό τρήμα του διαφράγματος, ενώ το αριστερό από το έξω σκέλος του διαφράγματος, ενώ και τα δύο οσφυϊκά στελέχη εκφύονταν στο ύψος του Ο2-Ο3. Υπολογίστηκαν οι μέσες τιμές των διαμέτρων της άζυγης στην εκβολή της, στον σχηματισμό της, της ημιάζυγης στον σχηματισμό της, ενώ μετρήθηκαν τα μήκη της άζυγης, της ημιάζυγης και της άνω κοίλης φλέβας και οι αποστάσεις της εκβολής της άζυγης από την αρχή της άνω κοίλης φλέβας, όπως και η απόσταση εκβολής της δεξιάς άνω μεσοπλεύριας από την εκβολή της άζυγης. Συμπεράσματα: Μετά από στατιστική επεξεργασία των αποτελεσμάτων που προέκυψαν από την παρούσα διδακτορική διατριβή και την αντιπαραβολή των δεδομένων με ανατομικά συγγράμματα και δημοσιευμένες μελέτες έγινε ακόμα πιο σαφής η έντονη ποικιλομορφία του συστήματος των αζύγων φλέβων. Είναι σημαντικό να συλλεχθούν οι επιμέρους μελέτες στα πλαίσια μίας μετα-ανάλυσης ώστε να επαναδιατυπωθεί συνολικά η ανατομία του συστήματος των αζύγων φλεβών. Άλλωστε, η κλινική σημασία της καλής γνώσης της ανατομίας των αζύγων έχει αξία για τον ακτινολόγο, ως προς τη διάγνωση παθολογιών της περιοχής του μεσοθωρακίου, τον χειρουργό του θώρακα, για αποφυγή επιπλοκών σε επεμβάσεις στην εν λόγω περιοχή, αλλά και για τον αγγειοχειρουργό, στους καθετηριασμούς που διεξάγει σε παθήσεις, όπως το σύνδρομο της άνω κοίλης φλέβας

Myocardial bridge over the left anterior descending coronary artery: A case report and review of the literature

Myocardial bridging (MB) is considered as a topic of high interest since its occurrence in different studies is statistically significant, and the clinical manifestations of this phenomenon are complicated with cardiovascular diseases. Whether the MB participates in heart diseases and has a decisive effect to life-threatening situations is still under research, and many studies have been conducted to clarify the abovementioned question. A case report with a MB on the left anterior descending coronary artery is presented in the current study, and a review of the literature is provided as well. Cardiologists as well thoracic surgeons and radiologists should bear in their mind the potential presence of such variant during interpretation of angiographies and multidetector-computed tomography

Accessory coracobrachialis muscle with two bellies and abnormal insertion - case report

Objective. In the current study a brief review is presented of the coracobrachialis muscle’s morphological variability, action, embryological development and clinical significance. Case report. We report a case of a left-sided coracobrachialis muscle consisting of two bellies. The deep belly inserts into the usual site in the middle area of the anteromedial aspect of the left humerus, whereas the superficial belly inserts through a muscular slip into the brachial fascia and the medial intermuscular septum, forming a musculo-aponeurotic tunnel in the middle region of the left arm, for the passage of the median nerve, brachial artery and veins, medial antebrachial cutaneous nerve and ulnar nerve. Conclusion. Awareness of such a muscle variant should be kept in mind by physicians and surgeons during interpretation of neural and vascular disorders of the upper limb, since such a variant may potentially lead to entrapment neuropathy and/or vascular compression, predisposing to neurovascular disorders, as well as during preparation of that muscle in cases of utilizing it as a graft in reconstruction of defects

Accessory coracobrachialis muscle with two bellies and abnormal insertion - case report

Objective. In the current study a brief review is presented of the coracobrachialis muscle’s morphological variability, action, embryological development and clinical significance. Case report. We report a case of a left-sided coracobrachialis muscle consisting of two bellies. The deep belly inserts into the usual site in the middle area of the anteromedial aspect of the left humerus, whereas the superficial belly inserts through a muscular slip into the brachial fascia and the medial intermuscular septum, forming a musculo-aponeurotic tunnel in the middle region of the left arm, for the passage of the median nerve, brachial artery and veins, medial antebrachial cutaneous nerve and ulnar nerve. Conclusion. Awareness of such a muscle variant should be kept in mind by physicians and surgeons during interpretation of neural and vascular disorders of the upper limb, since such a variant may potentially lead to entrapment neuropathy and/or vascular compression, predisposing to neurovascular disorders, as well as during preparation of that muscle in cases of utilizing it as a graft in reconstruction of defects