A new anatomical variation of the musculocutaneous and the median nerve anastomosis

Variations of the brachial plexus and its terminal branches are not uncommon.Therein, the anatomical variations of the musculocutaneous and the median nerve are classified into 5 types, while the communicating branches between the musculocutaneous and the median nerve are classified into 3 types, depending on their position related to the coracobrachial muscle. The case reviewed in this paper presents a variation similar to that of the second variety, but is significantly different due to the appearance of the proximal musculocutaneous nerve and its communicating branching, the site rising from the communicating branch (through the coracobrachial), and important clinical implications of this new variation. Despite the communicating branch being located in the upper third of the upper arm, it should not be considered as being a double lateral root of the median nerve

Significance of anatomical variations of the lateral circumflex femoral artery for the tensor fasciae latae flapping

The tensor fasciae latae (TFL) muscle is commonly used in plastic and reconstructive surgery as a transpositional or a free flap, in order to repair different kinds of defects. In most cases its vascularisation is provided by an ascending branch of lateral circumflex femoral artery (LCFA), which gives different numbers of branches and enters the TFL muscle in different manners. The represented study deals with the arterial vascularisation of the TFL muscle: the entrance of the vascular stalk branches; variations of the LCFA bifurcation’s angle; and the skin area of vascularisation. The study was performed on both lower limbs of a 100 foetal and 10 adult cadavers. The LCFA was injected with micropaque solution, afterwards fixed and preserved in 10% formalin solution. Microdissection was performed under magnifying glass and surgical microscope. Analysis of adult cadavers was performed to determine the skin area vascularised by perforating blood vessels from the TFL muscle, by injecting methylene-blue dye into the artery, prior to which all branches of the LCFA, besides the ascending branch, were ligated. The research of a 100 foetal cadavers showed that the LCFA with its ascending branch ensured the blood supply to the muscle. In 85% it gave two branches, the ascending and the descending one, with the angle of bifurcation circa 90o in 73% of cases. The ascending branch can give 0 or more terminal branches, or even form an arterial net. Skin area affected with dye ranged from 18 × 22 cm to 23 × 28 cm and is in positive correlation with the LCFA length and diameter. The understanding of the presented variations have an exceptional significance in planning and applying the TFL flap, especially free flap, in successful repairing and covering the defects, as well as in preventing postoperative complications

Bilateral anatomic variation in the relation of the upper trunk of the brachial plexus to the anterior scalene muscle

The brachial plexus represents a field of many anatomical variations with impor- tant clinical implications, especially in the diagnosis and treatment of the thoracic outlet syndrome (TOS). The case described in this paper presented a novel bilateral variation in the relation of the upper trunk of the brachial plexus to the anterior scalene muscle. The ventral rami of the C5 and C6 spinal nerves perforated the anterior scalene muscle simultaneously through a common opening, and joined to form the upper trunk. Previous literature reports described variations of the brachial plexus and the scalene muscles, as well as the embryological basis for their presence. The case reported herein helps to improve the comprehension of the TOS, as well as the diagnostic and therapeutical approach to this syndrome

Morphometric characteristics of the optic canal and the optic nerve

Background: The optic nerve (ON), a major component of the visual system, is divided into four segments: the intrabulbar (IB), the intraorbital (IO), the intraca- nalicular (ICn) and the intracranial (ICr). The ICr ends with the two nerves partially decussating in the optic chiasm (OCh). The purpose of this study is to provide a detailed description of the dimensions of the OC (the diameter and the surface area of its foramina and the central segment, as well as the length of the OC and the thickness of its walls) as well as the ON (the length of the ON segments, the diameter of the ICn segment of the ON, the angle of decussation in the OCh, as well as the distance between the two ON at the cranial foramen of the OC).  Materials and methods: The acquired data was then used to estimate the volu- me of the OC and the ICn segment of the ON. The morphometric research was performed on 25 cadavers (17 male and 8 female) and 30 skulls.  Results: The surface area of the central segment of the OC was significantly smaller than the cranial foramen (p = 0.02) and the orbital foramen (p = 0.009). The inferior wall of the OC was significantly shorter than the other OC walls (p < 0.0001). The IO segment of the ON was the longest, where the difference to the ICn and ICr was statistically significant (p < 0.0001). The surface area of the ON at the cranial foramen was significantly larger than the surface area at the central segment of the OC (p = 0.02) and orbital foramen (p < 0.0001). The difference between the surface areas of the ON at the orbital foramen and the central segment of the OC was also statistically significant (p = 0.01). The estimated volume of the OC was calculated to be 190.72 mm3, and the volume of the ICn segment of the ON was estimated to be 50.25 mm3.  Conclusions: It is absolutely crucial to open the central segment of the OC when decompressing the ON, due to the narrowing of the OC in this segment.

The development of the UK National Institute of Health and Care Excellence evidence-based clinical guidelines on motor neurone disease.

The care of people with motor neuron disease/amyotrophic lateral sclerosis is often complex and involves a wide multidisciplinary team approach. The National Institute for Health and Care Excellence (NICE) in the UK has produced an evidence based guideline for the management of patients. This has made recommendations, based on clear evidence or consensus discussion. The evidence is often limited and areas for further research are suggested

The ERA Registry Annual Report 2019 : summary and age comparisons

Background Data on renal replacement therapy (RRT) for end-stage renal disease were collected by the European Renal Association (ERA) Registry via national and regional renal registries in Europe and countries bordering the Mediterranean Sea. This article provides a summary of the 2019 ERA Registry Annual Report, including data from 34 countries and additional age comparisons. Methods Individual patient data for 2019 were provided by 35 registries and aggregated data by 17 registries. Using these data, the incidence and prevalence of RRT, the kidney transplantation activity and the survival probabilities were calculated. Results In 2019, a general population of 680.8 million people was covered by the ERA Registry. Overall, the incidence of RRT was 132 per million population (p.m.p.). Of these patients, 62% were men, 54% were >= 65 years of age and 21% had diabetes mellitus as primary renal disease (PRD), and 84% had haemodialysis (HD), 11% had peritoneal dialysis (PD) and 5% had pre-emptive kidney transplantation as an initial treatment modality. The overall prevalence of RRT on 31 December 2019 was 893 p.m.p., with 58% of patients on HD, 5% on PD and 37% living with a kidney transplant. The overall kidney transplant rate was 35 p.m.p. and 29% of the kidney grafts were from a living donor. The unadjusted 5-year survival probability was 42.3% for patients commencing dialysis, 86.6% for recipients of deceased donor grafts and 94.4% for recipients of living donor grafts in the period 2010-14. When comparing age categories, there were substantial differences in the distribution of PRD, treatment modality and kidney donor type, and in the survival probabilities.Peer reviewe