Are the distributions of variations of circle of Willis different in different populations? – Results of an anatomical study and review of literature

BACKGROUND: Previous studies have proposed correlation between variants of the cerebral arterial circle (also known as circle of Willis) and some cerebrovascular diseases. Differences in the incidence of these diseases in different populations have also been investigated. The study of variations in the anatomy of the cerebral arterial circle may partially explain differences in the incidence of some of the cerebrovascular diseases in different ethnic or racial groups. While many studies have investigated the variations in the anatomy of each segment of the cerebral arterial circle, few have addressed the variants of the cerebral arterial circle as a whole. Similarly, the frequency of occurrence of such variants in different ethnic or racial groups has not been compared. METHODS: 102 brains of recently deceased Iranian males were dissected, in order to observe variations in the anatomy of the cerebral arterial circle. The dissection process was recorded on film and digitized. One resized picture from each dissection, showing complete circle has been made available online. The variations of the circle as whole and segmental variations were compared with previous studies. RESULTS: On the whole, the frequencies of the different variants of the entire cerebral arterial circle and segmental variations were comparable with previous studies. More specifically variants with uni- and bilateral hypoplasia of posterior communicating arteries were the most common in our study, similar to the previous works. No hypoplasia of the precommunicating part of the left anterior cerebral artery (A1), aplasia of A1 or the precommunicating part of the posterior cerebral artery (P1) was seen. In 3% both right and left posterior communcating arteries were absent. CONCLUSION: The anatomical variations found in the cerebral arterial circle of the Iranian males in the current study were not significantly different to those of more diverse populations reported in the literature. While taking into account potential confounding factors, the authors conclude that based on available studies, there is no evidence suggesting that the distributions of the variations of cerebral arterial circle differ in different populations

The comparison of spiritual health and self-esteem in women with and without sexual violence

Background and aim: Sexual violence is a serious public health problem which is common around the world. The aim of this study was to evaluate spiritual health and self-esteem in sexual violence victims. Methods: This cross-sectional study was performed on 66 subjects in the group of sexual violence women and 147 subjects in the group of women with no experience of sexual violence who referred to Tehran Forensic Medical Center and the health centers of Shahid Beheshti University of Medical Sciences respectively, in 2015, in Tehran, Iran. Sexual violence was considered as vaginal or anal penetration. Paloutzian & Ellison spiritual health questionnaire and Rosenberg self-esteem scale were used for data collecting. Data were analyzed using IBM-SPSS version 21. The Kolmogorov Simonov test was used for normality distribution of variables. Descriptive and the Mann-Whitney tests were used to analyze the data. Statistical significance was set to p<0.05. Results: Sexual activity in both groups was started at 20 years old. Most of the abused subjects were single (48.8%), with education level below diploma (55.2%), unemployed (67%) and with an average annual income of 200 million Rials ($7,000). Familiarity with the offender was mostly as friendship (42.4%), and the offence had occurred through deception (37.8%). No significant difference was found between the total mean scores of self- esteem in the two groups (M1: 21.89, M2: 21.02; p=0.76) while a significant difference was seen between the mean scores of spiritual health, which indicates a lower level of spiritual health in women with sexual violence (M1: 74.59 (2.03), M2: 86.39 (3.12); p<0.001). Conclusion: The results of the present study highlight the importance of spirituality in sexual violence so policies to promote spiritual health are recommended to protect wome

Porównanie liczby niepodwiązanych gałęzi bocznych w przypadku pobierania tętnicy piersiowej wewnętrznej metodami endoskopową i tradycyjną

Background: In an effort to minimise access in cardiac surgery, endoscopic vessel harvesting has become more popular. Theendoscopic approach, however, allows for only the harvest of the mid to distal internal mammary artery (IMA), leaving themore proximal branches of the conduit available for collateral flow away from the coronary bed.Aim: To compare the number and anatomic variation of remaining side branches in thoracoscopic vs. conventional IMAharvesting.Methods: 199 fresh cadavers were randomly divided into two groups. Group A (n = 100) underwent endoscopic IMA harvesting. In Group B (n = 99), IMAs were harvested using an open conventional approach. In both groups during surgery, sidebranches of the IMA were isolated and identified.Results: The two groups were comparable with regard to mean age and age distribution, male sex (56% vs. 63%, respectively),cause of death and coronary risk factors including smoking, diabetes, dyslipidaemia and hypertension. 24 of 199 cadavers(12%) had a lateral costal branch. The left IMA arose from the third part of the subclavian artery in 6%, and from the thyrocervical trunk in 7% of the cadavers. There were significantly more unligated side branches in Group B compared toGroup A (14 branches vs. 3 branches, p &lt; 0.01). The first intercostal artery and lateral costal artery were found unligated in3% and 5% of cadavers in Group B, whereas no side branch remained unligated in Group A. There was no subclavian arteryor IMA injury in either group. Internal mammary vein was damaged in 2% of cadavers in Group B.Conclusions: Thoracoscopic left IMA harvesting is more accurate in finding and ligating the side branches of IMA.Wstęp: W związku z ograniczaniem dostępu kardiochirurgicznego coraz bardziej popularne staje się endoskopowe pobieranie naczyń krwionośnych. Metoda endoskopowa umożliwia jednak pobieranie tylko środkowego lub dalszego odcinka tętnicypiersiowej wewnętrznej (IMA), pozostawiając położone proksymalnie gałęzie konduitu dostępne dla krążenia obocznegopoza łożyskiem wieńcowym.Cel: Celem niniejszego badania było porównanie liczby i zmienności anatomicznej pozostałych gałęzi bocznych w przypadku pobierania IMA metodą torakoskopii i tradycyjną metodą otwartą.Metody: Na dwie grupy losowo podzielono 199 świeżych zwłok. W grupie A (n = 100) pobrano IMA endoskopowo, a w grupie B (n = 99) do pobrania IMA zastosowano tradycyjną metodę otwartą. W obu grupach podczas zabiegu wyizolowano i zidentyfikowano boczne gałęzie IMA.Wyniki: Grupy A i B były porównywalne pod względem średniej wieku i rozkładu płci (mężczyźni stanowili odpowiednio56% i 63%), przyczyny zgonu i czynników ryzyka wieńcowego, takich jak palenie tytoniu, cukrzyca, dyslipidemia i nadciśnienie tętnicze. W przypadku 24 spośród 199 zwłok (12%) stwierdzono występowanie bocznej gałęzi żebrowej. Lewa tętnica piersiowa wewnętrzna (LIMA) odchodziła od trzeciej części tętnicy podobojczykowej u 6% osób i od pnia tarczowo-szyjnego u 7% osób. W grupie B stwierdzono istotnie więcej niepodwiązanych gałęzi bocznych niż w grupie A (odpowiednio 14 gałęzii 3 gałęzie; p &lt; 0,01). Pierwsza tętnica międzyżebrowa i tętnica żebrowa boczna były niepodwiązane w przypadku 3%i 5% zwłok w grupie B, natomiast w grupie A nie stwierdzono ani jednego przypadku niepodwiązania tych naczyń. W żadnej z grup nie doszło do uszkodzenia tętnicy podobojczykowej ani piersiowej wewnętrznej. Żyła piersiowa wewnętrzna była uszkodzona w przypadku 2% zwłok w grupie B.Wnioski: Zastosowanie torakoskopii do pobierania LIMA ułatwia znalezienie i podwiązanie bocznych gałęzi tętnicy piersiowej wewnętrznej

The Cerebral arterial circle (circulus arteriosus cerebri) : an anatomical study in fetus and infant samples

Many studies have investigated the variations in the anatomy of each segment of the cerebral arterial circle while a few have addressed the variations of the cerebral arterial circle as a whole. Methods: Thirty brains of recently deceased Iranian infants and fetuses were dissected. The dissection process was filmed and digitized so as to be readily available for further studies. The variations of the circle as a whole and segmental variations were evaluated. Results: Variants with uni- and bilateral hypoplasia of posterior communicating arteries (PcoAs) were the most common in our study, similar to previous works. No aplasia of the precommunicating part of the anterior cerebral artery (A1), the precommunicating part of the posterior cerebral artery (P1) and anterior communicating artery was seen. Hypoplasia of the right and left PcoA was observed in 8 and 5 cases, respectively. Aplasia of the right PcoA was found in 16.6% and of the left PcoA in 3.3%. Conclusion: In this study, we confirmed the previously described finding that the symmetrical, circular configuration of the circulus arteriosus cerebri is present in only about 42.1%. The main differences between the fetal and adult disposition are the diameter of the PcoA and the circular part of the posterior cerebral artery. According to previous studies, the fetal brain older than 4 months has anatomical characteristics very similar to the adult's circle; our finding was mostly similar to adult samples as most samples were from infants, not fetuses.5 page(s