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Magnetic resonance imaging of the ocular motor nerves in normal volunteers

To display the detail functional anatomy of ocular motor nerves in the orbits, cavernous sinus and brainstem by high-resolution MRI. Twenty normal subjects between 24 and 38 years of age, mean age was 28.25 +/- 4.07 (SD). Imaging of the ocular motor nerves at the brainstem was performed in 0.8 mm thickness image planes using 3D-FIESTA sequence; nerves in the cavernous sinus was imaged with a head coil, the FSE/T(1)WI was obtained in coronal planes; nerves to extraocular muscles (EOMs) in the orbits were imaged with FSE/T(1)WI oblique-coronal planes using surface coils, and within 2.0 mm thick planes. A human orbit was celloidin embedding and serially sectioned at 0.1 mm of thickness for HE stain, which would be used to distinguish motor nerves to the EOMs. Oculomotor nerves (CN3) and abducens (CN6) of the cisternal segment were well demonstrable in all normal subjects. Trochlear nerves (CN4) were depicted 95%. CN3 could be demonstrated consistently in the cavernous sinus, because of their small diameter, CN4 and CN6 not always detectable. The larger inferior division of CN3 and branches to the target EOMs and CN6 were demonstrated well in all species. The superior division of CN3 was demonstrated 60%, CN4 was showed 40%. 3D-FIESTA Sequence combined with MPR (Multiplanar Reformation) could precisely show the ocular motor nerves, as well as the relationships with adjacent structures in the cistern. The inferior division of CN3 and the CN6 could be well depicted in the orbits. But of the small sizes and complicated neighboring structures in the orbit, the superior division of the CN3 and the CN4 could not be demonstrated consistently. The capabilities of MRI can be fully used only with thorough knowledge of the complicated topographic relationships in the corresponding region.

O sistema carótico do encéfalo do Cebus apella sp., Linnaeus, 1766

Estudamos em trinta espécimes do primata Cebus apella sp. (Linnaeus, 1766) o sistema carótico do encéfalo em animais coletados dentro dos parâmetros internacionais de bioética e bem estar animal. O material teve o sistema arterial perfundido (água a 40 °C), injetado com látex corado (Neoprene 450, Dupont® do Brasil e Sulvinil® Corante, Glassurit), fixado em solução aquosa de Formaldeído (10%) dissecado sob lupa (RASOR - II - 20) para sistematização dos vasos. O sistema carotico é composto pela porção intracraniana e intradural dos seguimentos dependentes das artérias carótidas internas esquerda e direita, as artérias carótidas do encéfalo (ace) e seus ramos de divisões látero-mediais e ântero-mediais: as artérias cerebrais médias acm e rostrais (acr), comunicantes caudais e artérias corioídeas Está interligado, através das artérias comunicantes caudais, ao sistema vértebro-basilar (100%). A ace termina trifurcando-se (50%), ou bifurcando-se (50%) em arranjos vasculares que envolvem as acm e acr, acc e artéria corioídea. A acm é o ramo mais estável deste circuito e a acr após vascularizar os bulbos olfatórios (93,3%) anastomosa-se com a artéria contralateral formando a artéria inter-hemisférica que conecta rostralmente os leitos sanguíneos do circuito arterial da base do encéfalo. Pode-se considerar que o Cebus apella sp. depende de duas fontes de suprimento para o encéfalo: os sistemas basilar e carotídico, isto indica um grau elevado de maturidade evolutiva. A ausência de anomalias demonstra neste primata estabilidade evolutiva.

Using fatty acids to study marine mammal foraging: The evidence from an extensive and growing literature

Marine Mammal ScienceVolume 25, Issue 1 p. 243-249 Using fatty acids to study marine mammal foraging: The evidence from an extensive and growing literature G. W. Thiemann, G. W. Thiemann Department of Biological Sciences, University of Alberta, Edmonton, Alberta T6G 2E9, CanadaE-mail: thiemann@ualberta.caSearch for more papers by this authorS. J. Iverson, S. J. Iverson Department of Biology, Dalhousie University, Halifax, Nova Scotia B3H 4J1, CanadaSearch for more papers by this authorI. Stirling, I. Stirling Wildlife Research Division, Science and Technology Branch, Environment Canada, 5320 122 Street, Edmonton, Alberta T6H 3S5, Canada and Department of Biological Sciences, University of Alberta, Edmonton, Alberta T6G 2E9, CanadaSearch for more papers by this author G. W. Thiemann, G. W. Thiemann Department of Biological Sciences, University of Alberta, Edmonton, Alberta T6G 2E9, CanadaE-mail: thiemann@ualberta.caSearch for more papers by this authorS. J. Iverson, S. J. Iverson Department of Biology, Dalhousie University, Halifax, Nova Scotia B3H 4J1, CanadaSearch for more papers by this authorI. Stirling, I. Stirling Wildlife Research Division, Science and Technology Branch, Environment Canada, 5320 122 Street, Edmonton, Alberta T6H 3S5, Canada and Department of Biological Sciences, University of Alberta, Edmonton, Alberta T6G 2E9, CanadaSearch for more papers by this author First published: 12 January 2009 https://doi.org/10.1111/j.1748-7692.2008.00258.xCitations: 9Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume25, Issue1January 2009Pages 243-249 RelatedInformation

Numb chin syndrome as a manifestation of metastatic squamous cell carcinoma of esophagus

Numb chin syndrome (NCS) is a sensory neuropathy presenting with numbness of the chin in the distribution of the mental nerve and the branches of the mandibular division of the trigeminal nerve. Though it can be caused by a benign process, NCS should be regarded as being due to malignancy until proven otherwise. Among the malignancies that cause NCS the most common are breast cancer, prostate cancer, and lymphoreticular malignancy. In squamous cell carcinoma (SCC) of the esophagus, spread to the mandible is a rare and often late event. An often overlooked clinical sign in mandibular metastases is hypoesthesia or paresthesia over the peripheral distribution of the inferior alveolar nerve/mental nerve; this sign has been referred to in the literature as NCS or numb lip syndrome or mental nerve neuropathy. Rarely, this may be the first presentation of a disseminated malignancy. Prognosis is usually poor. The discovery of this symptom should alert the clinician to the possibility of disseminated disease. In this article we report a rare case of metastatic SCC of the esophagus in a 40-year-old male patient who presented with NCS. We also review the mechanism, causes, and evaluation of NCS.

Intra-plant variation for progress of cell division in developing oat grains: a preliminary study

Development of an oat panicle proceeds from the uppermost terminal spikelet downward to the base of the panicle. The intra-panicle variation in development is likely to influence potential grain size. This may result from differences in activity and duration of the cell division phase, vascular transport capacity, duration of filling period and/or hormonal balance. In this preliminary survey we studied intra-panicle variation in pollination (when clusters of pollen were visibly attached to stigmatic branches) of florets and cell division in developing grains immediately after pollination of the oat cultivars Belinda and Fiia. We found substantial intra-panicle variation for both traits. The highest cell number was found in the uppermost, most advanced, primary grain, while secondary grains tended to have fewer cells compared with their counterpart primary grains irrespective of their position. Results of an additional experiment indicated that death of the primary floret in the conventional oat cultivar Virma prior to pollination, resulted in higher weight of secondary grain, though this never equalled that of the primary counterpart. This limited growth capacity may partly result from lower cell number. These results encourage us to continue with experiments on the contribution of groat cell number to sink strength and grain-filling capacity.;

Anatomical variation of obturator vessels and its practical risk: a case report from an anatomic study

Obturator artery is frequently a branch of anterior division of the internal iliac artery. It has drawn attention of pelvic surgeons, anatomists and radiologists because of the high frequency of variations in its course and origin. The obturator vein is usually described as a tributary of the internal iliac vein. During routine dissection classes to undergraduate medical students we have observed obturator artery arising from external iliac artery, obturator vein draining into external iliac vein, communicating vein between obturator vein and external iliac vein and inferior epigastric artery arising from the obturator artery. The anomalous obturator vessels and inferior epigastric artery in the present case may be in a dangerous situation in pelvic surgeries that require dissection or suturing along the pelvic rim. Developmental reasons and clinical significances of the variations are discussed.

Hepatobiliary and pancreatic: Operative bile duct injury

Operations on the biliary tract have always been associated with a small risk of bile duct injury. The incidence of these injuries increased with the introduction of laparoscopic cholecystectomy but has now fallen to a rate that appears similar to that of open cholecystectomy. Bile duct injuries can present in at least three ways. The first is the development of jaundice soon after surgery because of complete occlusion of the bile duct, usually the common hepatic duct.Asecond presentation is the development of a bile collection or bile ascites because of a leak from the biliary system. The most common setting is a leak from the cystic duct stump associated with a persisting stone in the lower bile duct. Other mechanisms include direct bile duct injuries and the division of anomalous branches, usually of the right hepatic duct. A third presentation is the development of pain, jaundice or cholangitis months or years after cholecystectomy. The most common cause is a persistent or recurrent bile duct stone but rare patients develop bile duct strictures because of malpositioned clips or sutures. The management of patients with operative bile duct injuries varies with the nature of the injury but often involves either therapeutic endoscopic procedures or further surgery. The patient illustrated below was a 42-year-old man who had a laparoscopic cholecystectomy for acute cholecystitis. His

Asymptomatic spontaneous resolution of a giant fusiform M2–M3 dissecting aneurysm in a teenager

A 16-year-old female was admitted to hospital due to intermittent right-sided headaches. On admission, physical and neurological examinations yielded no unusual findings. She underwent a MRI and angiography (MRI-MRA) (fig...

Sialendoscopie des glandes salivaires

Sialoendoscopy is a simple efficient mode of treatment for major salivary gland sialoliths and strictures.Sialendoscopy procedure requires specific devices, diagnostic and therapeutic sialendocopes, minigrasping forceps, wire baskets, lasers, balloons and stents. The sialendoscopy procedure is divided in three steps: the duct introduction step (through the papilla or through the duct wall); the diagnostic step (from main duct to third or fourth salivary division branches) and the therapeutic step (stone removal with a Dormia basket or miniforceps and stenosis balloon dilatation). The feasibility of stone removal depends on the size, the position, the mobility and the shape of the stone. The only contraindication is acute sialadenitis.Sialendoscopy complications are minor. Its success rate for stone removal is greater than 90%, and it has dramatically reduced the rate of sialadenectomy (to less than 5%).

Nomenclatura proposta para denominar as artérias da base do encéfalo do macaco-prego (Cebus apella L., 1766)

Arteries of the encephalon basis of 30 monkeys ( Cebus paella ) were studied. Arteries were injected with colored latex, fixed in formaldehyde solution at 10% and dissected under magnifying lenses. Since the animals died from natural causes they had been previously used in other experiments. Human and veterinary anatomical terminology and literature were used as a reference for the determination of vessels studied in the primates. Arteries of the encephalon base represent division branches of three vascular pedicules: the right and left internal carotid arteries and the basilar system. Vessels in the basilar system of the animal were called vertebral arteries; anterior spinal artery; anterior and posterior cerebelar arteries; pontine arteries; satellite cerebelar arteries; caudal and cranial cerebelar arteries. The basilar artery bifurcates into two posterior cerebral arteries (100%). The caudal area of the encephalon’s arterial circuit is thus constituted. Linking between the vertebro-basilar and the carotid segments is done by the posterior communicating artery, that caudally anastomizes (100%) with the posterior cerebral artery. The internal carotid artery gives origin to the posterior communicating artery. The right and left internal carotid artery (intracranial portion) compounds the carotid system. The following vessels were identified: middle cerebral artery; anterior cerebral artery; interhemispheric artery; olfactory arteries. Results report that Cebus paella presents an arterial pattern of relative morphological stability

Posterior division of the internal iliac artery: Anatomic variations and clinical applications

The objective of the study was to characterize the anatomy of the internal iliac artery (IIA) and its posterior division branches and to correlate these findings to IIA ligation. Dissections were performed in 54 female cadavers. Average length of IIA was 27.0 (range, 0-52) mm. Posterior division arteries arose from a common trunk in 62.3% (66 of 106) of pelvic halves. In the remaining specimens, branches arose independently from the IIA, with the iliolumbar noted as the first branch in 28.3%, lateral sacral in 5.7%, and superior gluteal in 3.8%. The average width of the first branch was 5.0 (range, 2-12) mm. In all dissections, posterior division branches arose from the dorsal and lateral aspect of IIA. The internal iliac vein was lateral to the artery in 70.6% (12 of 17) of specimens on the left and 93.3% (14 of 15) on the right. Ligation of the IIA 5 cm distal from the common iliac bifurcation would spare posterior division branches in the vast majority of cases. Understanding IIA anatomy is essential to minimize intra-operative blood loss and other complications.

Knowledge and Use of Preexposure and Postexposure Prophylaxis Among Attendees of Minority Gay Pride Events, 2005 Through 2006

Knowledge and Use of Preexposure and Postexposure Prophylaxis Among Attendees of Minority Gay Pride Events, 2005 Through 2006

The use of programme planning and social marketing models by a state public health agency: A case study

To investigate the use of planning models and social marketing planning principles within a state's central public health agency as a means for informing improved planning practices. Qualitative semi-structured interviews were conducted with 30 key programme planners in selected division branches, and a quantitative survey was distributed to 63 individuals responsible for programme planning in 12 programme-related branches. Employees who have an appreciation of and support for structured programme planning and social marketing may be considered the 'low hanging fruit' or 'early adopters'. On the other hand, employees that do not support or understand either of the two concepts have other barriers to using social marketing when planning programmes. A framework describing the observed factors involved in programme planning on an individual, interpersonal and organizational level is presented. Understanding the individual and structural barriers and facilitators of structured programme planning and social marketing is critical to increase the planning capacity within public health agencies.

An Anatomic Study and Clinical Application of Medial Pedis Flap in Asians

Several investigators have reported their clinical experience with medial pedis flaps for reconstruction of soft tissue defects of the hand and digits. In a cadaveric study in 1997, Jayme and Hamilton described the anatomy of the medial branch of the deep division of the medial plantar artery, which is used in the medial pedis flap. However, they had only a few cases where this flap was used. There have been no such anatomic studies in Korea to date. We found the medial pedis flap to be a reliable option for reconstruction of soft tissue defects of the hand and digits, based on an anatomic study with 10 dissected fresh cadavers (20 cases) and analyzing the clinical outcomes in 17 patients. An anatomic study revealed that there were some racial differences in the diameter and length of the vessels. The diameter of vessels in the Korean population is larger than that in whites. Using a thin, flexible medial pedis flap, which has skin and subcutaneous tissue similar to that of the volar aspect of the hand and digits, we harvested and performed the reconstruction on 17 patients with soft tissue defects of the hands and digits. The vessels used for this flap were the medial branch of the deep division of the medial plantar artery and vena comitantes, or subcutaneous veins. The mean size of the flap was 2.82 cm x 4.15 cm. All flaps were successful without any significant complications. The medial pedis flap possesses several advantages: (1) it is very thin in comparison to other standard free flaps; (2) it has 2 draining venous pathways; (3) it provides a good color and texture match for the hand and fingers; (4) it has a satisfactory recovery of protective sensation.

Visualization of motor nerves to the extraocular muscles by magnetic resonance imaging

Purpose: Magnetic resonance imaging now enables visualization of the motor nerves to the extraocular muscles (EOMs) in the deep orbit. We use serial section of a normal human orbit as reference to identify the nerves. Methods: A human orbit was celloidin embedding and serially sectioned at 0.1 μm thickness by HE stain to distinguish motor nerves to the EOMs. Nerves were imaged with FSE T1WI in orbits of 10 normal volunteers in oblique-coronal planes within 2.0 mm thickness by surface coils. Results: At the level of posterior ethmoidal canal with center gaze of subjects, branches of motor nerves appeared in close contact to the corresponding EOMs. Adjacent to the superior ophthalmic vein and ophthalmic artery, the superior division of oculomotor nerve could not be traced consistently, as shown in 13 orbits (61%); inferior division of CN3 and branches to the target EOMs were demonstrated well in all subjects. The abducens (CN6) were demonstrated consistently, while trochlear nerves (CN4), coursing along the periosteum of paries superior orbitae and levator palpebrae superioris, were hard to be visualized, as shown in eight orbits (40%). Conclusion: The inferior division of CN3 and CN6 can readily be visualized in the orbit. But of the small sizes and complicated neighboring structures in the orbit, the superior division of the CN3 and CN4 could not be demonstrated consistently.

Contralateral C7 Transfer for the Treatment of Brachial Plexus Root Avulsions in Children—A Report of 12 Cases

To retrospectively determine the risks and benefits of contralateral C7 nerve root transfer in infants and children. In 12 infants and children with brachial plexus root avulsions from birth injury or other trauma, the common trunk of the contralateral C7 root was transferred to the trunk, division, cord, or nerve branch(es) on the affected side with 2 different types of interposition grafts. The surgery was performed in 1 stage for 5 patients and in 2 stages for 7 patients. Patients were followed up for a mean of 42 months, with a minimum of 21 months. Noteworthy function (> or = M2+, modified British Medical Research Council grading system) was gained in 10 of 12 patients and sensory function (> or = S3, British Medical Research Council grading system) was gained in all patients. Improvements in strength and sensation were accompanied by little synchronous motion and sensibility changes in the donor limb in 7 children, to whom the repaired nerves were those innervating the shoulder and/or elbow or both the musculocutaneous and median nerves. In addition to slight damage to the sensory function of the median nerve, 2 infants also had temporarily reduced shoulder abduction on the healthy side. For contralateral C7 transfer in infants and children with brachial plexus root avulsions, the deficit created by the procedure is minimal and motor and sensory function is gained. Transfer of the contralateral C7 root to different nerves for a child may improve the quality of functional recovery. Therapeutic, Level IV.

Unilateral weak radial pulse in a patient with systemic sclerosis: Takayasu’s arteritis or thoracic outlet syndrome?

Dear sir, Takayasu’s arteritis (TA) a chronic large vessel vasculitis that predominantly aVects elastic arteries such as the aorta, its major division branches, and the pulmonary arteries [1]. TA is occasionally called “pulseless disease” because there is diYculty in detecting peripheral pulses that sometime occurs as a result of vascular narrowing. TA is a rare disorder, occurring most frequently in the Far East and aVecting young females more frequently than males. As far as we know, TA has been found in association with several conditions, but there have been only three reports in the literature on concurrent systemic sclerosis (SSc) and TA [2–4]. We report the case of a 37-year-old female who was diagnosed with SSc because of Raynaud’s phenomenon, puVy hands, positive anti-topoisomerase I antibody (Ab) and interstitial lung disease conWrmed by lung biopsy in October 2002 at another university hospital. She had been treated with oral prednisone and cyclophosphamide. The patient was referred to our outpatient clinic for treatment due to continuing complaint of Raynaud’s phenomenon in 2003. On physical examination, Raynaud’s phenomenon and a pitting scar on her right hand were observed. However, the modiWed Rodnan Skin Score (mRSS) was almost zero. We modulated steroid dose and added Ca-channel blocker for peripheral vasodilation. In April 2006, on physical examination we discovered that her left radial pulse was weak. There were no abnormal neurologic Wndings, but her blood pressure was asymmetric, being recorded as 160/90 on the right and 145/75 on the left. There was no bruit audible on auscultation over neck and abdomen. The laboratory results were as follows: leukocyte 8,900/mm3, hemoglobin 12.9 g/dl, platelet 292,000/mm3, erythrocyte sedimentation rate 40 mm/ h; Serum biochemical examination showed normal range of cholesterol and glucose level. Her thyroidal hormone proWle was normal. Serologic investigation revealed that she had positive nucleolar type antinuclear Ab (1:2,560) and positive anti-topoisomerase I Ab. But anti ds-DNA Ab, anti-Ro Ab, anti-La Ab, anti-Sm Ab, c-ANCA, p-ANCA and rheumatoid factor were negative. Based on the detection of the weak left radial pulse and asymmetric blood pressure, we thought that the presence of left vascular lesion was obvious. In the CT angiography, there was stenosis of right common carotid artery, right external carotid artery, thoracic and abdominal aorta (Fig. 1a). The Wndings were compatible with TA [5]. However, there was only slight wall thickening of left subclavian artery. These Wndings could not explain the weak left radial pulse. In other sections of angiography, we found that the left anterior and medial scalenus muscles hemodynamically squeeze the left subclavian artery as the left arm is fully abducted (Fig. 1b). Finally, we discovered that the cause of weak left radial pulse was thoracic outlet syndrome (TOS). We were very fortunate to Wnd TA, because all provocation T.-J. Kim · W.-S. Uhm · J.-B. Jun (&) Department of Rheumatology, The Hospital for Rheumatic Diseases, Hanyang University College of Medicine, Seoul, South Korea e-mail: junjb@hanyang.ac.kr

Clinical influence of vagotomy on postoperative acute phase response

Although there is increasing evidence suggesting that the vagus nerve functions as a connector between the nervous and immune systems in animals, little is known about the role of the vagus nerve in postoperative acute phase response in humans. The extent of fever and acute phase protein response and the production of inflammatory cytokine during the early postoperative period were compared among the patients who had undergone total gastrectomy including truncal vagotomy (n = 13), those having distal gastrectomy with division of vagal branches (n = 14), and the patients with vagal nerve preserving gastrectomy (n = 12). There was no significant difference in serum levels of C-reactive protein, alpha-1-antirypsin, and interleukin-6 among the three groups. Also, postoperative maximum body temperature was similar. Vagotomy did not influence acute phase response after gastric cancer surgery. A multipathway mechanism for acute phase response including the induction of fever is suggested.

Primary trochlear headache and other trochlear painful disorders

The trochlear region is a source of distinct pain that may give rise to specific primary pain disorders (primary trochlear headache), but also modulate other pre-existing headache disorders such as migraine. The sensory innervation of this region, by a branch of the ophthalmic division of the trigeminal nerve, may explain the modulatory influence of the nociceptive afferents of this region over migraine headache. We propose the term "trochlear migraine" to refer to the coexistence of strictly unilateral migraine and ipsilateral trochleodynia, with the improvement of migraine being dependent on the resolution of the trochleodynia. Trochleitis is an inflammatory trochleodynia, being frequently idiopathic and rarely secondary to usually immunologic and rheumatologic disorders. We postulate that nociceptive afferents from the inner part of the orbit may sustain the activation of trigeminal neurons, thus sensitizing or exacerbating migraine. Decreasing the possible wind-up induced from this nociceptive afferent stimulation may be effective in controlling headache.

The Frontal-Temporal Nerve Triangle: A New Concept of Locating the Motor and Sensory Nerves in Upper Third of the Face Rhytidectomy

How to avoid damage to the temporal branch of the facial nerve has long been a central topic of discussion. Recently, damage to the supraorbital nerve, the auriculotemporal nerve, and other branches of the trigeminal nerve divisions has attracted much attention. Focusing on frontal and temporal rhytidectomy, the authors have investigated the course and distribution of the facial nerve branches, the supraorbital nerve, the auriculotemporal nerve, and other branches of trigeminal division. In this article, they present the concept of the frontal-temporal nerve triangle; its contents, vicinity, and clinical significances are discussed. An anatomical study was performed using 30 temporal-parietal regions of 10 fixed adult cadavers and five fresh cadavers. A step-by-step dissection from the superficial layer to the deep layer was involved; all the measurement data were analyzed, and the mean and standard deviation were calculated and expressed in centimeters. The frontal-temporal nerve triangle is an approximately triangular area formed by the temporal branch of the facial nerve, the supraorbital nerve, and the auriculotemporal nerve. Together with its contents and vicinal structures, it forms a complicated three-dimensional rather than two-dimensional structure. Anatomical structures closely associated with rhytidectomy are located in or near this area. Acting as the anatomical body surface landmark for preoperatively locating the temporal branch, the supraorbital nerve, the auriculotemporal nerve, and its related structures, the concept of the frontal-temporal nerve triangle has practical significance in designing incisions and selecting planes of dissection in upper third of the face rhytidectomy.