Bilateral pectoral musculature malformations with concomitant vascular anomaly

We report on a unique combination of multiple variations concerning the pectoral muscles and the left external jugular vein. Specifically, a bilateral hypoplasia of the medial clavicular portion of the pectoralis major muscle was noticed along with the coexistence of total right pectoralis minor aplasia, substituted by loose connective and fatty tissue. Simultaneously, a supernumerary anterior-placed external jugular vein was found, which, after its supraclavicular course, pierced the interval between the left clavicular and the sternocostal head, and drained into the left jugular junction. The combination of the above anomalies constitutes an atypical pattern of Poland syndrome. We discuss the related embryological development and the relative literature. Attention was paid to the clinical importance for plastic surgeons, general surgeons, and radiologists, facilitating them with accurate interpretation of anterior thoracic wall findings. (Folia Morphol 2010; 69, 3: 187-191

Supraclavicularis proprius muscle associated with supraclavicular nerve entrapment

Entrapment neuropathy of the supraclavicular nerve is rare and, when it occurs, is usually attributable to branching of the nerve into narrow bony clavicular canals. We describe another mechanism for entrapment of this nerve with the aberrant muscle; supraclavicularis being found during the routine dissection of an embalmed 82-year-old cadaver. Our report details a unique location for this rare muscular variation whereby the muscle fibres originated posteriorly on the medial aspect of the clavicle before forming a muscular arch over the supraclavicular nerve and passing laterally towards the trapezius and acromion. We recommend that in clinical instances of otherwise unexplained unilateral clavicular pain or tenderness, nerve compression from the supraclavicularis muscle must be borne in mind.

Ethics of the psychologist working in the field of clinical psychiatry

Η δεοντολογία του κλινικού ψυχολόγου που ασχολείται με ψυχιατρικά περιστατικά είναι ιδιότυπη μορφή επαγγελματικής δεοντολογίας. Διαπιστώνεται ασάφεια ως προς το κανονιστικό της πλαίσιο και την οριοθέτησή της (π.χ. από την δεοντολογία της κλινικής ψυχιατρικής). Η σχέση του κλινικού ψυχολόγου με τον «πελάτη» του είναι ιδιότυπη εμπιστευτική σχέση, της οποίας μπορεί εύκολα να γίνει καταχρηστική εκμετάλλευση αφού ο «πελάτης» είναι συνήθως ευάλωτος σε χειραγώγηση, εμπιστεύεται στον ψυχολόγο ευαίσθητα προσωπικά του δεδομένα, η αυτονομία (αυτοκαθορισμός) του δεν είναι πάντα εμφανής και δεδομένη όπως σε άλλες θεραπευτικές σχέσεις κα. Ο κλινικός ψυχολόγος εργάζεται σε ομάδα υποστήριξης της ψυχικής υγείας και αυτό απαιτεί ισορροπία αρμονικής συνεργασίας με τα άλλα μέλη της ομάδας αλλά και διατήρηση της επιστημονικής του ελευθερίας και ηθικής αυτονομίας και αξιοπρέπειάς του. Θεωρούμε ότι το ασαφές δεοντολογικό πλαίσιο που αφορά τον κλινικό ψυχολόγο που συνεργάζεται με την κλινική ψυχιατρική μπορεί να υποστηρίζεται από την αναλογική εφαρμογή συναφών δεοντολογικών ρυθμίσεων (όπως του Κώδικα Ιατρικής Δεοντολογίας) και τον σεβασμό στις θεμελιώδεις αρχές της κλινικής βιοηθικής. Επίσης, είναι σημαντικός ο ρόλος της λεγόμενης «ηθικής των αρετών» η οποία συνάδει με την ιπποκρατική-μεσογειακή μας βιοηθική αντίληψη όπου οι αρετές και τα χαρακτηριστικά του κλινικού ψυχολόγου έχουν κεντρικό ρόλο στην επίλυση συχνών οριακών ηθικών διλημμάτων.The ethics of the clinical psychologist who gets involved with psychiatric patients are a peculiar form of professional ethics and its limitations is not always clear. The relationship of the clinical psychologist with his patient is a peculiar confidential one during which the patient can be easily manipulated. The patient whose autonomy is not always clear is totally in the hands of his psychologist, trusting him with confidential personal data. Since clinical psychologist is also a part of a mental support team, he should cooperate with the other members of the team while maintaining his scientific freedom, ethic autonomy and dignity. We believe that the unclear ethic frame of the clinical psychologist commands the use and the respect of the Medical Ethic Code and Medical Bioethics. Equally important is the “Moral of Virtues” which agrees with our Mediterranean and Hippocrates Bioethical thinking where the clinical’s psychologist’s virtues and traits are the most useful tool in the resolution of frequent ethical dilemmas

Ring-shaped variation of the coeliac trunk branches

Aberrant arterial variations in the branching pattern of the coeliac trunk are of great interest to surgeons and radiologists. We report on a rare arterial variation found in a 79-year-old cadaver during educational dissection. Specifically, the coeliac axis formed a unique incomplete trunk termed the hepato-hepatic trunk. The splenic artery arose separately from the anterior aspect of the abdominal aorta. On the right side, there was a right hepatic artery giving rise to a gastroduodenal but an absence of the left hepatic. On the left side, there was a branch coursing towards the porta hepatis; the left hepatic artery, dividing into the left gastric, an accessory left gastric, and a branch to the distal oesophagus. The hepato-hepatic trunk formed a ring-shaped vascular structure around the caudate lobe of the liver. Precise mapping and observation of the extrahepatic arteries and bile duct branches is essential in a variety of hepato-biliary laparoscopic procedures of the liver and gallbladder. Other operative procedures requiring, a comprehensive kno­wledge of the varied coeliac trunk patterns are liver transplantation and arterial embolism for hepatic tumour therapy

Co-existence of os acromiale with suprascapular osseous bridge: a case report and review of the literature

We report on a very rare case of co-existence of os acromiale with suprascapular osseous bridge in a dry scapula. The frequency of os acromiale alone ranges from 1.3 to 15%, while the frequency of suprascapular osseous bridge varies between 0.036% and 12.5%. We review the relative literature and emphasize the fact that such knowledge is important for a physician in order to avoid misdiagnosis of an acromion fracture and lytic lesion of the scapula

Supraclavicularis proprius muscle associated with supraclavicular nerve entrapment

Entrapment neuropathy of the supraclavicular nerve is rare and, when it occurs, is usually attributable to branching of the nerve into narrow bony clavicular canals. We describe another mechanism for entrapment of this nerve with the aberrant muscle; supraclavicularis being found during the routine dissection of an embalmed 82-year-old cadaver. Our report details a unique location for this rare muscular variation whereby the muscle fibres originated posteriorly on the medial aspect of the clavicle before forming a muscular arch over the supraclavicular nerve and passing laterally towards the trapezius and acromion. We recommend that in clinical instances of otherwise unexplained unilateral clavicular pain or tenderness, nerve compression from the supraclavicularis muscle must be borne in mind.

Excavated type of rhomboid fossa of the clavicle: a radiological study

The excavated type of rhomboid fossa of the clavicle is a relatively neglected anatomical structure that can potentially cause diagnostic problems. Its unilateral occurrence may be confused by the physician as avascular necrosis, osteomyelitis, or even a tumour. We studied 80 routine chest radiographs and identified the clavicles with excavated type of rhomboid fossa. The sex, sidedness, and handedness were recorded. An excavated type of rhomboid fossa was present in 43 clavicles (26.88%), appearing more frequently in males than in females. In addition, the incidence of the excavated type of rhomboid fossa was greater on the right side than on the left. That type of fossa was also present more frequently on the right side in right-handed specimens and on the left side in left-handed specimens. The high incidence of the excavated type of rhomboid fossa on the dominant hand supports the mechanical theory of fossa formation. Radiologists and physicians should be aware of this fossa, as it may resemble a pathological condition

Sternalis muscle: an underestimated anterior chest wall anatomical variant

Over the recent years, an increased alertness for thorough knowledge of anatomical variants with clinical significance has been recorded in order to minimize the risks of surgical complications. We report a rare case of bilateral strap-like sternalis muscle of the anterior chest wall in a female cadaver. Its presence may evoke alterations in the electrocardiogram or confuse a routine mammography. The incidental finding of a sternalis muscle in mammography, CT, and MRI studies must be documented in a patient's medical records as it can be used as a pedicle flap or flap microvascular anastomosis during reconstructive surgery of the anterior chest wall, head and neck, and breast. Moreover, its presence may be misdiagnosed as a wide range of benign and malignant anterior chest wall lesions and tumors