Classical Anatomy Research Articles

Variations in the formation of supraclavicular brachial plexus among Kenyans

Objective: To describe the pattern and prevalence of variations that occur in the supraclavicular part of the brachial plexus in a Kenyan population. Study design: Descriptive cross-sectional study. Materials and methods: Ninety-four brachial plexuses from forty-seven formalin fixed cadavers were displayed by gross dissection. Results: The presence of at least one variation from the classical anatomy was observed in 73 (77.7%) of the 94 plexuses. The roots and trunks were involved in 32 (34%) of the plexuses . Preand postfixed roots were present in 23 (24.7%) and 3 (3.2%), respectively. The presence of four trunks, and trunks passing between the scalene medius and posterior were also noted. The long thoracic nerve was variant in 51 (54.3%) of the plexuses. Unusual relations of the phrenic nerve to scalene muscles and the subclavian vein were encountered. Conclusion: The presence of four trunks and an accessory phrenic nerve passing through the subclavian vein are probably described and reported for the first time. However, most of the variations of the BP among Kenyans are similar to those reported in the other populations.

A shortened, case‐based anatomy course promotes long‐term recall and life‐long learning among medical and physician associate students.

Across the country, anatomy courses are becoming shorter, even as residency programs report that entering trainees are poorly trained in anatomy. In response, clinicians, anatomists and education specialists collaborated to design a course that emphasized clinical approaches to problem‐solving. Common clinical cases formed the basis for course content. Traditional dissection labs were replaced with classical, open‐surgical procedures that required students to prepare by scrutinizing actual clinical cases. To explore the anatomy behind the patient's history and physical exam, imaging studies and surgical or medical resolution, we provided students with a highly interactive, web‐based dissector Results include a dramatic improvement in student preparation and participation. Survey and focus group data indicated that students appreciated the clinical approach, but struggled with the demands of a more professional approach to learning. The success of the medical school course led to its adaptation to a course for physician associate students. A test of long‐term recall was administered prior to clerkship training (1.5 years after the medical course; 8 months after the physician associate course). Both groups showed improvement compared to classically taught students. When the same test was administered 1.75 years later, after clerkship training, the improvement of the medical students was even more marked. The data show that a course that uses a functional‐anatomy design can be more effective than a classical anatomy course, despite the fact that it is shortened by a third.

Deficit of Episodic Memory: Anatomy and Related Patterns in Stroke Patients

Background/Aims: Despite numerous studies performed in selected populations, major uncertainties regarding the anatomy and patterns of episodic memory deficit still persist. Such objectives require the analysis of consecutive unselected patients with well-delimitated lesions and the use of specific methodology. Methods: Nonaphasic stroke patients (n = 73) referred for cognitive complaints or deficits were examined using a standardized neuropsychological battery. Verbal episodic memory was assessed by the Grober and Buschke test. Results: Episodic memory deficit was related to lesions of medial temporal, thalamic, frontal, lenticular, and centrum semiovale regions, with a left hemisphere predominance. Although not specific, an immediate recall deficit was frequently observed in thalamic lesions (OR: 5.2, 95% CI: 1.09–24.9). False recognitions (OR: 25.7, 95% CI: 2.7–249) and efficiency of cued recall (OR: 8.6, 95% CI: 1.3–57) were highly specific of frontal damage. When combined with the usual ‘frontal lobe’ tests, this pattern of memory disorder was an independent predictor (OR: 36, 95% CI: 4.3–302) and increased the sensitivity of diagnosis of frontal damage (sensitivity: 0.92, specificity: 0.89). Conclusions: This study extends the classical anatomy of episodic verbal memory. In addition, the ‘frontal memory pattern’ was found to be relatively specific and to be an independent predictor of frontal damage.

Application of Fascial Manipulation© technique in chronic shoulder pain—Anatomical basis and clinical implications

Classical anatomy still relegates muscular fascia to a role of contention. Nonetheless, different hypotheses concerning the function of this resilient tissue have led to the formulation of numerous soft tissue techniques for the treatment of musculoskeletal pain. This paper presents a pilot study concerning the application of one such manual technique, Fascial Manipulation, in 28 subjects suffering from chronic posterior brachial pain. This method involves a deep kneading of muscular fascia at specific points, termed centres of coordination (cc) and centres of fusion (cf), along myofascial sequences, diagonals, and spirals. Visual Analogue Scale (VAS) measurement of pain administered prior to the first session, and after the third session was compared with a follow-up evaluation at 3 months. Results suggest that the application of Fascial Manipulation technique may be effective in reducing pain in chronic shoulder dysfunctions. The anatomical substratum of the myofascial continuity has been documented by dissections and the biomechanical model is discussed.

Jelena Krmpotić Nemanić (1921-2008)Conclusion of the classical anatomy age?

Jelena Krmpotić Nemanić (1921-2008)Conclusion of the classical anatomy age?

An anatomic investigation of the serratus posterior superior and serratus posterior inferior muscles

In classical anatomy textbooks the serratus posterior superior muscle was said to elevate the superior four ribs, thus increasing the AP diameter of the thorax and raising the sternum. However, electromyographic and other studies do not support its role in respiration. In order to help resolve this controversy and provide some insight into their possible functionality, the present study aimed at examining the morphology, topography and morphometry of serratus posterior superior and inferior muscles in both normal specimens and those derived from patients with a history of chronic obstructive pulmonary disorder (COPD). These muscles were examined in 50 human cadavers with an age range of 58-82 years. In 18 of the cadavers their histories revealed that they were suffering from COPD. There was no significant difference between right and left sides, race, gender and age and positive COPD history in regard to dimensions and nerves supply of serratus posterior superior and inferior muscles (P > 0.05). Based upon our findings that no morphometric differences exist between the of serratus posterior superior and inferior muscles of COPD patients versus controls, we are suggesting that no respiratory function be attributed to either of the serratus posterior superior and inferior muscles.

The hazards of the neurovascular passage in the wrist

Objective Wrist problems are common in grip sports. To better understand the entrapment symptomatology of the different neurovascular passages of the wrist, an anatomical revision seems necessary because confusion and error has increased lately. This study will focus on the ulnar canal. Comparison of the original description of the canal with definitions emanating from scientific papers, anatomical handbooks and Internet websites reveal various differences, which may create clinical confusion. Design With the original paper of Guyon as a reference, comparison was made (i) with 37 cadavers (74 wrists); (ii) with an Internet search and; (iii) with a bibliographic survey. The dissections allowed for the verification of Guyon's description and were used to illustrate the findings. Results Dissection of 74 wrists confirmed Guyon's original description. Out of the 2559 Internet hits, papers in English, French, German and Dutch were considered, only. The Internet websites and the published material presented an erroneous images and/or explanations. Conclusion Dissection and bibliometry suggest that the canal has received multiple denominations including a confusion with the “canalis pisohamatum”. This confusion is situated on Internet sites, in scientific/clinical papers and in “classical anatomy literature”. A better understanding of this region will undoubtedly enhance our knowledge of entrapment pathologies.

Learning the nodal stations in the abdomen

The normal pathways of lymphatic drainage from the abdominal organs have been well described in the classic anatomy literature. Knowledge of the location and nomenclature of the common nodal stations in the abdomen are essential for complete report of radiological findings. CT is ubiquitous in the evaluation of oncology patients. Utilizing colour-coded CT images of the abdomen we will present the nomenclature and location of the nodal stations for common abdominal neoplasms, including those of the stomach, pancreas, liver, colon and the kidney. Understanding the nomenclature and the usual lymphatic pathways of metastasis will help radiologists detect disease spread from abdominal tumours. The goal of this pictorial review is to present the nodal stations, nomenclature and location of regional lymph nodes for the most common abdominal neoplasms. In addition, the reader can use this document as a handbook to learn and review this information.

Cyberspace Chat

In the classic model of the arrector pili (AP) muscle, each hair follicle is independently associated with a single AP muscle. Recently, new models have been proposed based on interpretations of serial histological cross-sectional images. The purpose of this study was to confirm the morphology of the AP muscle in relation to the follicular unit (FU) using quantitative threedimensional (3D) reconstruction of serially sectioned images. Skin samples were obtained from the parietal region of the scalp, and processed using routine histological procedures. The serially sectioned slides were stained with Masson’s trichrome. All the hairs and hair follicles of the FU exhibited some degree of slanting, with the single AP muscle slanted in the same direction. The distal portion of the AP muscle was divided into branches, as in a bronchial tree. There was branching in the single AP muscle present in the FU, and it was inserted into all the hair follicles of the FU either tightly or loosely. We suggest that the classic anatomy of the AP muscle must be modified with this new model, now confirmed by computer-based 3D reconstruction.

A new model for the morphology of the arrector pili muscle in the follicular unit based on three‐dimensional reconstruction

In the classic model of the arrector pili (AP) muscle, each hair follicle is independently associated with a single AP muscle. Recently, new models have been proposed based on interpretations of serial histological cross-sectional images. The purpose of this study was to confirm the morphology of the AP muscle in relation to the follicular unit (FU) using quantitative three-dimensional (3D) reconstruction of serially sectioned images. Skin samples were obtained from the parietal region of the scalp, and processed using routine histological procedures. The serially sectioned slides were stained with Masson's trichrome. All the hairs and hair follicles of the FU exhibited some degree of slanting, with the single AP muscle slanted in the same direction. The distal portion of the AP muscle was divided into branches, as in a bronchial tree. There was branching in the single AP muscle present in the FU, and it was inserted into all the hair follicles of the FU either tightly or loosely. We suggest that the classic anatomy of the AP muscle must be modified with this new model, now confirmed by computer-based 3D reconstruction.

Advanced Techniques in Placental Biology—Workshop Report

Major advances in placental biology have been realized as new technologies have been developed and existing methods have been refined in many areas of biological research. Classical anatomy and whole-organ physiology tools once used to analyze placental structure and function have been supplanted by more sophisticated techniques adapted from molecular biology, proteomics, and computational biology and bioinformatics. In addition, significant refinements in morphological study of the placenta and its constituent cell types have improved our ability to assess form and function in highly integrated manner. To offer an overview of modern technologies used by investigators to study the placenta, this workshop: Advanced techniques in placental biology, assembled experts who discussed fundamental principles and real time examples of four separate methodologies. Y. Sadovsky presented the principles of microRNA function as an endogenous mechanism of gene regulation. J. Robinson demonstrated the utility of correlative microscopy in which light-level and transmission electron microscopy are combined to provide cellular and subcellular views of placental cells. A. Croy provided a lecture on the use of microdissection techniques which are invaluable for isolating very small subsets of cell types for molecular analysis. Finally, G. Rice presented an overview methods on profiling of complex protein mixtures within tissue and/or fluid samples that, when refined, will offer databases that will underpin a systems approach to modern trophoblast biology.

Book review

Clinically Oriented Anatomy , 5th edn. By Keith L. Moore and Arthur F. Dalley II. Pp. xxxiii + 1209 . 1073 Illustrations. Indexed . Philadelphia : Lippincott Williams & Wilkins , 2005 . Softbound. US $72.95, £35 . ISBN 0-7817-3639-0 . Proclaiming itself as ‘the world's best-selling anatomy text’, this 5th edition within 25 years, of a comprehensive instruction manual, maintains its reputation in the fiercely competitive field of anatomy publications. Its translation into six languages (except UK English) appears to justify this claim. In so static a subject with an unchanging content, this new edition nonetheless has expanded from its previous 4th edition by an additional 45 pages and by the inclusion for the first time of two CD-ROM disks, bringing it into the computer age. The extensive pedagogical experience of the two main authors, aided and abetted by a host of international contributors and advisors, is evident in the highly organized layout of the contents. There are nine main sections; an initial overview, followed by a topographical approach to the thorax, abdomen, pelvis/perineum, back, upper and lower limbs, head and neck, terminating with the cranial nerves. Each section is colour coded along a thumb index, allowing access to each region independently. A short ‘History of Anatomy’ section provides the student with a brief background and rationale for studying anatomy. The essence of the text focuses on the clinical applications rather than the minutiae of esoteric facts that characterize classical anatomy texts. The use of full-colour surface anatomy photographs and various modalities of diagnostic images (X-rays, CAT scans, MRIs, echograms, endoscopes, etc.), together with explicit traditional diagrams, integrates immediately the relevance of anatomy to a clinical purpose. The vivid use of colour throughout the text enhances the tutelage of the writing. Blue background boxes interspersed with the descriptive text emphasize the clinical aspects of the structures. A final ‘Bottom Line’ provides a succinct summary, reinforcing the clinical applications pertinent to the part. There are two CD-ROMs enclosed in the cover. The disks are compatible with either the Mac or PC computer platforms. One is a self-study programme orientated to the text, with interactive multiple choice questions and case studies related to each chapter, with answers supplied. The other disk, not directly related to the book's contents, is a DVD-ROM entitled ‘Primal 3D Anatomy’, which is Windows 98/Me/2000/XP compatible and offers a ‘45-day free trial’ to ‘Interactive Functional Anatomy’ using 3D models of MRI images generating layered rotatable anatomical illustrations. After the trial period expires, a hefty activation fee is required. I was unable to review this DVD-ROM as the disk provided with the review book was corrupt. However, a web-based online access to this program is available at http://www.primalpictures.com that allows a free 24-h trial, after which a subscription fee is required. Additionally, there is available an Instructor's Resource DVD, with JPEG format images exportable for PowerPoint presentation, and a question bank of approximately 500 review questions and answers. The publishers cannily require one to contact the company's ‘Customer Care’ service to obtain an institutional single-site licence to obtain this ‘crib’ item. The electronic study tools accompanying this text provide an undoubtedly enhanced form of teaching that makes this a valuable resource for both undergraduate and graduate levels of anatomy courses. The lists of references and suggested readings at the ends of the sections are as much up to date as is possible with textbook publishing. This book extends the field of anatomy into every health profession dealing with the human body, and, as such, is highly recommended for clinical practitioners as much as for students.

An interactive three‐dimensional virtual body structures system for anatomical training over the internet

The Visible Human digital datasets make it possible to develop computer-based anatomical training systems that use virtual anatomical models (virtual body structures-VBS). Medical schools are combining these virtual training systems and classical anatomy teaching methods that use labeled images and cadaver dissection. In this paper we present a customizable web-based three-dimensional anatomy training system, W3D-VBS. W3D-VBS uses National Library of Medicine's (NLM) Visible Human Male datasets to interactively locate, explore, select, extract, highlight, label, and visualize, realistic 2D (using axial, coronal, and sagittal views) and 3D virtual structures. A real-time self-guided virtual tour of the entire body is designed to provide detailed anatomical information about structures, substructures, and proximal structures. The system thus facilitates learning of visuospatial relationships at a level of detail that may not be possible by any other means. The use of volumetric structures allows for repeated real-time virtual dissections, from any angle, at the convenience of the user. Volumetric (3D) virtual dissections are performed by adding, removing, highlighting, and labeling individual structures (and/or entire anatomical systems). The resultant virtual explorations (consisting of anatomical 2D/3D illustrations and animations), with user selected highlighting colors and label positions, can be saved and used for generating lesson plans and evaluation systems. Tracking users' progress using the evaluation system helps customize the curriculum, making W3D-VBS a powerful learning tool. Our plan is to incorporate other Visible Human segmented datasets, especially datasets with higher resolutions, that make it possible to include finer anatomical structures such as nerves and small vessels.

CT angiography in evaluation of vascular anatomy and prevalence of vascular variants in upper abdomen in cancer patients

Objectives- To evaluate and describe vascular anatomy and the prevalence of vascular variants in upper abdomen in cancer patients with CT angiography to provide roadmap to surgeons to ensure safe surgery. Materials and Methods- A total of 125 cancer patients were evaluated by a Dual-slice spiral CT scanner with maximum intensity projections (MIP) and 3-D postprocessing.We compared CT angiographic findings with intra-operative findings in 62 patients who underwent surgery. Results- CT angiography was found very accurate to evaluate vascular anatomy.In our study of 125 patients 76 ( 61%) of patients showed variations:37 (30%) had single variations and 39 (31%) had more than one variation. The classic hepatic arterial anatomy,with the hepatic artery dividing into right and left hepatic arteries is seen in 53% of patients.Left hepatic artery variations in 26 (21%) patients,right hepatic artery variations in29 (23%) patients, and common hpatic artery variations in 4 (3%) patients were noted. Variations were also seen in hepatic veins, inferior phrenic arteries and, renal arteries and veins.Renal artery variations were seen in 33 (26.4) patients and renal veins variations in 19 (15%) patients. CT angiographic findings were similar to intra-operative findings in 61 (98%) patients who underwent surgery.In one patient we could not visualize an accessory right hepatic artery but it was visualized in retrosperct study arising from gastroduodenal artery. Conclusion- CT angiography is safe and highly sensitve and accurate modality for evaluation of vascular anatomy.

Teaching of Practical Anatomy in the University of Veterinary Science

Morphology subjects taught by our department are very important parts of the veterinary medical studies. Functional anatomy, concluded with a final exam, provides knowledge of classical anatomy and is taught for three semesters. The lectures are followed by the plenary sessions where the dissection is done under a camcorder, which shows the students the methods used. Topographical anatomy is taught in the fourth semester – mostly demonstrated on live animals – the visible, palpable structures and the projections of the inner organs on the surface of the body. Introduction to biology summarizes the study of cell biology and also the general knowledge of developmental anatomy. Histology is also given in the second and third semesters, ending with a final exam. However, for the 25 years I have been teaching the anatomy and the subjects taught by our department, I always had the feeling that the students do not pay enough attention or show much appreciation of these studies after the initial enthusiasm. Anatomical knowledge should also be well known during the later year studies at our university. Until recently our teaching program lacked the repetition of systemic anatomical studies that is mostly for applied science. The very recently introduced elective courses, such as radiological anatomy, surgical anatomy, organogenesis and the anatomy of birds are all scheduled for the late evening hours, but the lecture hall are still always full with students of all grades. The enquirers could find the needed anatomical information in special books and atlases until now. However, practising vets say it takes a lot of time and making uncomfortable difficulties to analyse the books. Because of forgetting the details that are less important for the vet's everyday work it can be hard to find solutions for small but urgent problems. That is why we decided to picturise and make a summary in an edition for demonstrating different elements of certain species of animals. The multimedia CD‐ROM was made based on clinical view providing the opportunity for the vet to analysing and studying the part that is the actually subject of his work. After 30 years long break, today there is no graduate or continuing education program without teaching anatomy, which means to give the knowledge to our colleagues applying to their needs also to their everyday work.

Discrepancies between classic anatomy and modern gynecologic surgery on pelvic connective tissue structure: Harmonization of those concepts by collaborative cadaver dissection

The purpose of this study was to solve a disagreement regarding the anatomy of the pelvic connective tissue in 19th and 20th century, and to establish new surgical anatomy. The study involved the dissection 26 female cadavers. The ligamentous structure of the pelvis was examined by developing the paravesical and pararectal spaces, using our standard procedure of radical hysterectomy. The lateral ligamentous structure of the pelvis was a plate complex, which consisted of the vesicohypogastric fascia, the transverse cervical ligament, and lateral ligament of the rectum. The 3-dimensional relationship of this complex and the pelvic organs was sagittaly perpendicular. The pelvic connective tissue was classified into 2 systems, musculofascial and mesentery-like structures. The authors examined the discrepancies in 19th century anatomy for the pelvic connective tissue that is widely accepted in today's medical field, therewith proposing a new surgical anatomy for this structure.

IS112 Plenary session on consciousness: Classic and non-classic anatomy of coma

IS112 Plenary session on consciousness: Classic and non-classic anatomy of coma

Expressives in Kam (Dong 侗): A study in sign typology (part 11)

Like many Austro-Tai languages and many Sino-Tibetan languages, Kam (Dong 侗) exhibits a wealth of descriptive syllables after the verb or the adjective. These syllables, henceforth called expressives, are typically reduplicated and cover a wide range of functions such as grading, speed and manner modification, and various kinds of sound symbolism, metaphor, etc. I propose to view the expressive compound as a sign: the predicate-head functions as the signified and the expressive as the signifier. In fact, since the predicate-head itself has the classical Saussurean sign anatomy, the head-expressive compound presents the case of a complex sign or what I call a second-order sign. The attested types of relationship that hold between the signified and signifier spread across almost the whole spectrum of sign species recognized in the literature. This paper is the result of a survey of ca 260 expressives and is one of the achievements of a long-term Kam dictionary project.

Anatomic variations in right liver living donors.

Anatomic knowledge is crucial in right liver living donor transplantation. We reviewed radiologic and surgical findings in right liver donors. Arterial and portal anatomy was assessed in 96 donors, biliary anatomy in 77, and hepatic venous anatomy in 65. Portal vein (PV): 86.4% had classic anatomy; 6.3% had a trifurcated PV; 7.3% had a right anterior PV taken off the left PV. Hepatic artery (HA): 70.8% had classic anatomy; 12.5% had a left HA arising from the left gastric artery; 13.5% had a right HA arising from the superior mesenteric artery; 2.1% had a double replaced left HA and right HA; and in 1.0% the common HA arose from the superior mesenteric artery. Biliary tree: 55.8% had normal anatomy; 14.3% had a trifurcated biliary anatomy; in 5.2% the right anterior bile duct and in 15.6% the right posterior bile duct opened into the left bile duct; in 2.6% the right anterior and in 6.5% the right posterior ducts opened into the common bile duct. Hepatic veins: S5 and S8 accessory hepatic veins had incidences of 43% and 49%, respectively. The incidence of S6 or S7 short hepatic vein was 38%. Anatomic variations are common but do not contraindicate donation; surgeons should be prepared to recognize and manage them.

Nutrition pathways to the symphysis pubis.

The blood supply of the symphysis pubis is still the subject of some debate. Classic anatomy books state that this joint is avascular, whereas some published works have shown blood vessels in young specimens. As several articular discs such as the knee menisci are known to have blood vessels in their peripheries, we decided to investigate the possible nutrition pathways to the interpubic disc and ligaments. We used 60 Wistar rats, male and female, aged between 28 and 32 days, or between 90 and 100 days. Samples were processed using a variety of techniques: regular histology, immunohistochemestry, India ink injection and corrosion casting. The interpubic disc consisted of an inner bearing portion and an outer fibrous rim. The interpubic ligaments and the fibrous rim were well vascularized in all groups. Marrow contacts between the interpubic disc and the subchondral bone were also observed. Blood vessels formed an authentic arterial circle embracing the joint, from which blood vessels branched into capillary loops facing the avascular inner bearing portion of the disc. These results confirm the need for future studies on the human symphysis pubis, to provide more details on its structure, which would enable clinicians such as physiotherapists to improve prognosis and treatment design. Future studies may also explain the pathways down which the hormone relaxin reaches its targets within this joint.