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Biomedical subjects

M von Lüdinghausen

Publications and source records attributed to M von Lüdinghausen.

At least 19 recordsLinked to original sources
PubMed2005

Accessory joints between basiocciput and atlas/axis in the median plane.

To explore the many osseous irregularities that are found in the area between the basiocciput, the anterior arch of the atlas and the tip of the dens axis we studied 99 cadaver specimens using magnetic resonance tomography (MRT), computed tomography (CT), median saw-cut sections, and histological sections. Additionally, "dry" specimens of the skull (n = 110), atlas (n = 56), and axis (n = 33) were investigated. In the median plane, the dry and cadaver specimens exhibited osteoarthritis-related osseous outgrowths and osteophytes of the articular surfaces of the median atlanto-axial joint (n = 63), and the presence of congenitally developed free ossicles (n = 22) and of third occipital condyles (n = 3). The largest osteophytes (giant osteophytes) (n = 4) of the anterior arch of the atlas formed osseous contact zones with the basiocciput that were visible histologically as real joints and were designated accessory median atlanto-occipital joints. The third occipital condyles also formed osseous contact zones, visible histologically as real joints, with the anterior arch of the atlas or with the tip of the dens, and were designated accessory atlanto-occipital or occipito-odontoid joints. Frequent free ossicles, incorporated into the accessory joint, were found by histological examination to be covered with hyaline cartilage.

Adult↗
PubMed2005

Levator palpebrae superioris muscle in human fetuses: anatomical findings and their clinical relevance.

Accessory medial muscular bellies of the levator palpebrae superioris muscle and broad lateral insertion of its aponeurosis into tissue near the lacrimal gland have been reported as rare variations in adults. The anatomy of this muscle was studied in orbits of ten human fetuses between the 5th and 10th months of gestation. In each of the dissected orbits, the levator palpebrae superioris muscle had a broad lateral insertion into the capsule of the lacrimal gland or the periorbita, in this period of development. In addition, medial accessory muscles of the levator or singular muscle fibers within fibrous bands that inserted near the trochlear region and the medial portion of the upper eyelid were present in 70% of the fetuses, either unilaterally or bilaterally. These findings demonstrate new unreported aspects of levator palpebrae superioris development and morphology. Our findings suggest that an initial broad anterior primary anlage of the muscle is followed by secondary atrophy of lesser used marginal portions of this muscle, which are replaced by delicate connective tissue. These findings might force new considerations about diagnostic and therapeutic approaches to congenital mobility disorders of the levator palpebrae superioris muscle, such as blepharoptosis or eyelid retraction. The clinical relevance of our results are discussed along with a review of the embryogenesis of extraocular muscles and soft tissue of the orbit.

Eyelids↗
PubMed2003

The venous drainage of the human myocardium.

New cardiological techniques such as coronary sinus catheterization and selective catheterization of the cardiac veins permit the opening of new experimental and clinical fields, for instance in venous angiography and the reverse nourishment of myocardium which is endangered by ischemia,and also in the electrophysiological study of the components of the conduction system. New approaches in heart surgery, such as the removal of accessory pathways of the conduction system (as in WPW syndrome), necessitate the realization of the topographical relationships of the vessels in the various sections of the coronary sulci in a different way. The objective of this work is, therefore, to present comprehensive and almost new macro- and microanatomical data about the venous drainage of the myocardium via the coronary sinus and its related and unrelated (non-coronary) cardiac veins. Examination of meticulously dissected heart specimens (of individuals who had achieved old or extreme old age at the time of their death in Germany: n=250) as well as corrosion casts of adult cardiac vessels (of individuals of all ages, n=25) formed the basis for the exact description and documentation of the occurrence, frequency, origin, and courses of both the normal and anomalously developed human coronary sinus and cardiac veins. A wide range of morphological and experimental references was consulted in order to enable thorough discussion of the anatomical findings in the light of modern cardiological diagnostics and treatment. The anatomical and clinical nomenclature is presented and there is a brief comment on modern diagnostic techniques and their applications where the cardiac veins are concerned. The two principal and one compound cardiac venous system are defined and discussed with reference to the existence of both the normal and anomalous coronary sinus and cardiac vein. 1. The greater (major) cardiac venous system (2) The smaller (minor) cardiac venous system (3)The compound cardiac venous system. The microanatomy of the various proper cardiac veins is not very well explained and illustrated in old or new literature; therefore, special attention is paid in the present study to the detailed microanatomy of the cardiac venous drainage. This includes the topograpy and structural and surface anatomy of the coronary sinus (position, length and shape, diameters, area of cross-section, circumference and volume, curvature, elevation, ostial angle, enlargement, duplication, absence), and the exact enternal and internal morphological landmarks of the coronary sinus with reference to its myocardial cover, isolated myocardial belts, and "free" myocardial cords which connect the atrial and ventricular myocardium, and the atrial ostium of the coronary sinus. It is established that the frequency, distribution pattern, courses and mode of opening of the major ventricular and atrial cardiac veins and the occurrence, morphology, and efficiency of the ostial valves of the coronary sinus and its tributaries all influence the success of any selective catheter implantation and venous reperfusion technique to a great degree. There are many peculiarities of the cardiac veins which are worthy of consideration, for instance intramyocardial and aberrant courses of the anterior interventricular vein, the oblique vein of the left atrium, the posterior interventricular vein, the small cardiac vein, the posterior vein of the left ventricle, the left and right marginal veins, and the anterior cardiac veins. Various forms and courses of the intramural venous tunnel, sinus or channel of the right atrium were found and illustrated, and discussed in terms of developmental and comparative anatomy. This review incorporates a great variety of clinically significant, new morphological findings with regard to the coronary sinus and the cardiac venous system. The many anatomical peculiarities and hindrances to the catheterization of the coronary sinus and the reperfusion of (even selected) cardiac veins are documented and evaluated; the various problems which may arise in venous reperfusion due to the presence of anatomical anomalies of the coronary sinus, cardiac veins, and ostial valves (of greater or lesser efficiency) are addressed. The presentation narrows a gap in the rather incomplete knowledge of the venous drainage of the human myocardium.

Coronary Vessels↗
PubMed2003

The clinical anatomy of coronary arteries.

In view of the fact that, in cardiology and coronary surgery, peculiarities and anomalies of the coronary arteries pose a great potential risk for myocardial ischemia resulting in arrhythmia, angina, infarction, and sudden death, a survey of the morphology of the coronary arteries in cadaver specimens (n = 200) and corrosion casts (n = 30) was undertaken. The results are not divided into those obtained from subjects with or without coronary heart disease. The randomly selected material from two anatomical institutes, of the Universities of Munich and Würzburg, was considered representative of an average group of septuagenarians and octogenarians in the German population. It is the patient of this age that the young medical students of today (the future physicians) will be confronted with and called upon to treat. The study begins with a review of the nomenclature and a consideration of unofficial (but often clinically used) terms and synonyms for coronary arteries and their branches, followed by a description of modern diagnostic techniques based on the presence of normal and anomalous cardiac vessels. It continues with a demonstration of "normal" macro- and microanatomy, a description of the most frequent ramification pattern and as well of the many peculiarities of the coronary arteries. These are briefly enumerated here: ectopic coronary ostia and aberrant and accessory arteries; angles of origin and division; three-dimensional orientation of the coronary stems; intramural, intraluminal, and intracavitary courses; avascular coronary and interventricular sulci; extracardiac noncoronary myocardial supply; atrial branches, sinuatrial node artery, atrioventricular node artery, principles of septal arterial supply, variations of the right and left superior septal arteries; endomural, intracoronary, intercoronary, and noncoronary anastomoses and collaterals; measurement and evaluation of age-related and atheromatous coronary calcifications; multiple coronary aneurysmata.

Coronary Artery Disease↗
PubMed2001

Follicular or dentigerous (tooth-containing) cyst in the premaxilla of an otherwise edentulous 65-year-old man.

A unilocular follicular or dentigerous cyst (FDC) with a diameter of 12 mm was observed incidentally in the premaxilla of a midsagittal section of the head of a 65-year-old cadaver. The mucosal lining of the cyst was grey in color and granular in texture: the osseous walls had a thickness of less than 1 mm. In the floor of the cyst, a slender, fully developed incisor tooth was fixed in a horizontal position. The alveolar processes of the maxilla and mandible were completely edentulous. Postmortem computer tomography showed the cyst in an osteolytic lesion of the premaxilla, and histology revealed a lining of non-keratinized stratified squamous epithelium supported by a lamina propria of dense connective tissue.

Aged↗
PubMed2001

Right superior septal artery with "normal" right coronary and ectopic "early" aortic origin: a contribution to the vascular supply of the interventricular septum of the human heart.

In the human heart, anterior and posterior septal branches are mainly responsible for the arterial supply of the interventricular septum. These arteries are the basis of efficient intercoronary collateralization. The right and left superior septal arteries also contribute to the nourishment of the septum and to any eventual collateralization. Because the right superior septal artery (RSSA) is small in diameter, short, and has a variable origin either at the proximal stem or in the ostial area of the right coronary artery, it is difficult or almost impossible to visualize it angiographically. During investigation of the arterial supply of the interventricular septum in 84 human heart specimens and 16 corrosion casts, we found a few peculiarities in the origin and pattern of the RSSA in four specimens. The RSSA was found in 27 cases (27%); in most it was a single vessel and arose from three different locations: (a) the proximal part of the right coronary artery (21 cases); (b) the right coronary ostial area (four cases); and (c) from the floor of the right (anterior) aortic sinus (two cases). Macroscopically, in 16 cases the RSSA had a length of less than 10 mm; in nine cases the arteries were between 11 and 17 mm long. In two cases the RSSA was of more substantial appearance and up to 36 mm in length; it nourished almost the entire upper third of the septal myocardium. In these two cases, two courses could be differentiated: an extramural course with the RSSA descending to the subvalvular fibrous tissue, and an intramural course with ramification in the myocardium of the crista supraventricularis and the superior parts of the interventricular septum. One cadaveric heart specimen and one corrosion cast showed RSSAs that originated "early" (ectopically) on the floor of the right (anterior) aortic sinus; their total lengths were 16 and 17 mm, respectively. Such ectopic ostia of RSSAs have never been described before in the anatomical literature. Given the intense clinical concern with the identification of possible bypass vessels in the myocardium, we assume that the RSSA may have a potential as a collateral route. These findings were also discussed in light of developmental and comparative anatomy.

Aged↗
PubMed1999

Variations and anomalies of the human orbital muscles.

The purpose of the study is to describe some rare and hitherto unreported uni- and bilateral anomalies of the orbital rectus muscles (duplication, triplication, accessory bellies, interrectal muscular bridges, false insertion) which were found by chance during the dissections of three cadavers (one adult, two fetuses). The levator palpebrae superioris muscles in the same specimens exhibited some variations (medial and lateral muscular slips) and anomalies (bipartite and unipartite levator). Cross-sections of interrectal bridges in the orbit of an adult were investigated histologically. Numerous nerves were distributed in the interstitium; groups of lipofuscin granules were found in all the myocytes. An attempt is made to explain these anomalies and variations through consideration of developmental and comparative anatomy. The relevance of these anomalies in coronal sections such as those acquired from CT and MRI is discussed.

Aged↗
PubMed1998

Bilateral supernumerary rectus muscles of the orbit.

A bilateral anomaly of the rectus muscles and a unilateral variation of the levator palpebrae muscle were found in the right and left orbits of an 84-year-old man. The anomaly was in the form of a supernumerary rectus muscle lying on a sagittal orientation between the optic nerve and lateral rectus muscle (in the right orbit) and adjacent to the inferior rectus muscle (in the left orbit). In each orbit the anomalous muscle originated occipitally from the common tendinous ring and frontally-near the eyeball-joined the terminal part of the inferior rectus. On its superior margin the anomalous muscle had, in the right orbit, a broad (4 mm), and in the left orbit a slender (2 mm) muscular bridge to the superior rectus muscle. Because of their connection to the superior rectus and their innervation by N.III the accessory orbital muscles are not deemed to be vestiges of the retractor bulbi muscle which, with the exception of the primates, is a typical occurrence in vertebrates and is always innervated by N.VI. Our anomalous orbital muscle must be explained as a supernumerary rectus muscle. A further variation occurred in the right orbit: an isolated medial part or belly of the levator palpebrae muscle (the so-called M. gracillimus). In primates this variation is known as a remnant of the membrana nictitans (third eyelid of the amniotes). Ignorance of anomalies in the orbital muscles may lead to confusion and error in diagnostic identification and surgical exposure.

Aged↗
PubMed1998

Lymphatic drainage of the cerebrospinal fluid from monkey spinal meninges with special reference to the distribution of the epidural lymphatics.

The structural organization of the epidural lymphatics and lymphatic drainage of the cerebrospinal fluid from spinal meninges was studied in Japanese monkeys (Macaca fuscata) by an enzyme-histochemical method. The spinal meninges were examined at various intervals from 1 to 48 h, as well as at 30 days, following an injection of ultrafine carbon particles into the subarachnoidal space (cisterna magna). Lymphatics were differentiated from blood capillaries by the 5'-nucleotidase (5'-Nase)-alkaline phosphatase (ALPase) double staining method (KATO et al. 1991, 1993) both in the whole-mount preparations and tissue sections. Carbon-filled collecting lymphatics and lymph nodes constantly appeared in the cervical and thoracic regions but only rarely in the lumbo-sacral region after carbon injection. Networks of 5'-Nase-positive lymphatics in the epidural connective tissues were seen in a large area on the dorsal surface around each spinal nerve root in the cervical and upper thoracic regions, especially at a level corresponding to the brachial plexus (C5-Th1). Carbon particles were often found within the 5'-Nase-positive lymphatics. In the lower thoracic and lumbo-sacral regions, on the other hand, the epidural lymphatic network covered only a small area around each spinal nerve root. These findings suggest that the epidural lymphatics are well developed on the dorsal side of the lower cervical spinal dura mater and may function as an absorptive pathway for the cerebrospinal fluid from the subarachnoidal space.

Animals↗
PubMed1996

[Computerized tomography volumetry of the cerebrospinal fluid by semiautomatic contour recognition and gray value histogram analysis].

PURPOSE: A program (VAC, Siemens) using self-made, anthropomorphous phantoms to measure semiautomatically the volume of the cerebral liquor in CT scans of the whole skull was tested. MATERIAL AND METHODS: Cerebral tissue was simulated by ellipsoid bodies made from Agar and NaI which were placed in a human skull. Volumes of the ventricular and subarachnoidal liquor could be defined arbitrarily. RESULTS: A correlation coefficient of r > = 0.9 using a slice thickness of 1-5 mm was found (thickness 8 mm: r = 0.75). The volume of the cerebral liquor was underestimated by 25-68%. Separate measurements of the ventricular and subarachnoidal liquor spaces showed a high accuracy of the measurements done in the ventricles (r = 0.997, y = 0.996 x -1). The volume of the subarachnoidal liquor was not detected completely due to partial volume effects which were seen especially in the basal and apical scans. CONCLUSION: The program VAC is useful for the semiautomatic measurement of the volume of the ventricles. The assessment of the subarachnoidal liquor is limited to semiquantitative results which may, however, be useful for follow-up studies.

Brain↗
PubMed1995

Atrial veins of the human heart.

Modern anatomical description divides the cardiac veins into two groups: tributaries of the greater cardiac vascular system (GCVS) and tributaries of the smaller cardiac vascular system (SCVS), consisting of the Thebesian vessels. Both systems intercommunicate extensively. With the exception of the oblique vein of the left atrium (Marshall's vein), veins draining the walls of both the left and right atrium have not been well illustrated or described in anatomical atlases and textbooks. Consequently, we do not know exactly to which of the two groups (GCVS or SCVS) the atrial veins belong. There are three groups of left atrial veins: (1) tributaries of the left coronary vein and the coronary sinus; (2) special veins draining the right-sided walls of the left atrium that terminate via intramural sinuses in the right atrium, which vessels occur in 92% of cases and belong to the GCVS; (3) in 81% of cases special veins drain the myocardium of the posterior and superior walls of the left atrium. In most cases they empty into the left atrium itself; in almost 40% of the cases they are connected with mediastinal veins. These veins, also belonging to tributaries of the GCVS, constitute a distinctly separate category of cardiac veins and should be designated proper veins of the left atrium. The veins draining the walls of the right atrium fall also into three groups: (1) In most cases there are short or large intramural tunnels or sinuses in the basic walls of the auricle and atrioventricular node area. The generally valveless openings of all the venous tunnels and sinuses are lined up on a circle just above the tricuspid valve and between the openings of both venae cavae. (2) There are also thin veins at the junction of the right atrium with both the superior and inferior vena cava. (3) In addition, there are numerous cardiac veins of the "smallest size" (real Thebesian veins).

Aged↗
PubMed1994

Preservation of regional myocardial function and myocardial oxygen tension during acute ischemia in pigs: comparison of selective synchronized suction and retroinfusion of coronary veins to synchronized coronary venous retroperfusion.

OBJECTIVES: The efficacy of selective synchronized suction and retroinfusion of coronary veins was compared with synchronized coronary venous retroperfusion in preventing ischemic reduction of regional myocardial function and myocardial oxygen tension. BACKGROUND: Because incomplete protection by synchronized coronary venous retroperfusion during ischemia might result from nonselective retroinfusion and only passive drainage of the veins, a suction device was added to a retroinfusion system. METHODS: Regional myocardial function (ultrasonic crystals) and myocardial oxygen tension (polarographic electrodes) were studied in 30 pigs during 10-min occlusion of the left anterior descending coronary artery (ischemia), followed by reperfusion. During ischemia, group A (n = 10) was supported by selective synchronized suction and retroinfusion; group B (n = 10) was supported by synchronized coronary venous retroperfusion, and group C (n = 10) was not supported by retroinfusion. RESULTS: In group A, subendocardial segment shortening decreased from 21 +/- 4% (mean +/- SD) before ischemia to 11 +/- 5% during ischemia. In contrast, systolic dyskinesia was observed in group B (-2 +/- 4%, p < 0.001) and group C (-2 +/- 5%, p < 0.001). During ischemia, the decrease in intramyocardial oxygen tension was less pronounced in group A (41 +/- 15 vs. 27 +/- 12 mm Hg) than in group B (40 +/- 10 vs. 19 +/- 10 mm Hg, p = 0.1) or group C (33 +/- 11 vs. 12 +/- 8 mm Hg, p = 0.002). During ischemia, myocardial surface oxygen tension was preserved > 0 mm Hg only in group A. CONCLUSIONS: Preservation of regional myocardial function and myocardial oxygen tension was substantially higher by selective synchronized suction and retroinfusion of coronary veins than by synchronized coronary venous retroperfusion in pigs.

Animals↗
PubMed1992

Argyrophilic staining for nucleolar organizer region (AgNOR). A suitable methodology for differential diagnosis of breast lesions?

Argyrophilic (Ag) staining for nucleolar organizer regions (NORs) is now emerging as a useful means for confirmation and exclusion of malignancy, discriminating features being the number, morphology and distribution of AgNORs. We have put the validity of this method to the test by comparing a series of potentially problematic breast lesions: atypical epitheliosis (n = 22) versus carcinoma in situ (n = 16) and sclerosing adenosis (n = 11) versus invasive carcinoma (n = 20). Malignant epithelial cells contained, in general, more AgNORs than benign proliferation but there was overlapping and the method could reliably differentiate only between sclerosing adenosis and invasive carcinomas (P less than 10(-6). In the latter, irregularity and intranuclear dispersal of AgNORs were prominent features. The conclusion is drawn that increased AgNORs counts may be associated with aggressive biological behaviour but this it not an absolute marker of malignancy in the breast.

Breast Diseases↗