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PubMed1996

Does the nerve supply to both the superficial and deep surfaces of pectoralis major imply two separate developmental origins?

The nature of the nerve supply to the "pocket' of pectoralis major was examined on 7 randomly selected sides of 5 embalmed cadavers. The pocket was a U-shaped muscular fold, opening cranially. The anterior limb and inner surface of the fold were supplied by nerve branches that originated from the middle segment of the pectoral nerve loop and penetrated pectoralis minor. The outer surface of the posterior limb was supplied by one or two branches that extended from the caudal segment of the pectoral nerve loop. If the muscular U-shaped fold is unfolded, it becomes obvious that the posterior wall of the pocket forms the most caudal part of pectoralis major and is supplied from both the superficial (anterior) and deep (posterior) surfaces. This dual surface supply does not suggest any aspect of the developmental origin of the pocket but may simply be due to the relative positions of the pectoralis major and its nerve.

Aged↗
PubMedDate not supplied

Epidural anatomy examined by cryomicrotome section. Influence of age, vertebral level, and disease.

BACKGROUND AND OBJECTIVES: Cryomicrotome section is a means of anatomic examination with minimal artifact ideally suited to delineating details of tissue relationships in the epidural space. In the past, healthy adult lumbar levels have been studied by this method. This report extends observations to other regions of the vertebral column, other age groups, and some abnormal conditions. METHODS: The bodies of 26 adults were frozen in toto soon after death, and the bodies of 2 children were frozen after embalming. Unstained anatomy was revealed by sectioning, and the exposed surface was photographed. RESULTS: As compared with the lumbar level, there are diminished epidural contents at the thoracic and cervical levels, and the ligamentum flavum is more frequently discontinuous. A large basivertebral vein with its origin in the anterior epidural space is typical of the lower thoracic and upper lumbar levels. Although the epidural contents are typically divided into compartments, there is incomplete segmentation of the posterior compartments during early childhood and often at thoracic levels in adults. In advanced age with degenerative disc and joint changes, distortion and compression of the epidural space are typical. CONCLUSIONS: Variations in epidural anatomy due to vertebral level, age, and disease may alter the ease of epidural entry and passage of catheters and injected solution.

Adult↗
PubMed1996

Anatomic considerations of an anterior approach to the sacroiliac joint.

This anatomic study was performed on 25 disarticulated pelves and 10 embalmed cadavers to evaluate an anterior approach to the sacroiliac joint. The angle of inclination of the superior limb of the sacroiliac joint was 15 degrees superolateral to inferomedial in the sagittal plane, and the inferior limb was parallel to the sagittal plane. The cranial lateral part of the ala overlapped the joint space and the adjacent part of the ilium. Elevation of a rectangular bone block on the cranial part of the ala removed the joint space from the superior limb and provided direct access to the joint space of the inferior limb.

Anthropometry↗
PubMedDate not supplied

Projection of the triangle of auscultation on the human pulmonary surface.

The projection of the triangle of auscultation on the posterior aspect of the pleuropulmonary surface was studied in 36 embalmed cadavers (19 males and 17 females). A total of 58 observations was made in 22 cadavers bilaterally and in 14 unilaterally, after introducing a long pin at each angle of the dissected triangle of auscultation deep into the pulmonary parenchyma. The projection of the triangle of auscultation, limited by the m. latissimus dorsi, m. trapezius and the medial margin of the scapula, was always found on the inferior lobe of the corresponding lung in one or more segments. It was found on the superior segment of the inferior lobe (43.1% isolatedly; 67.2% with other segments), the posterior basal segment (13.8% isolatedly; 43.1% with other segments) and on the lateral basal segment (10.3% isolatedly; 39.7% with other segments). Identical bilateral projections occurred in 50% of the cases.

Adult↗
PubMed1996

The quantitative anatomy of the iliac vessels and their relation to anterior lumbosacral approach.

Forty embalmed cadavers (24 men and 16 women) were obtained to evaluate the anatomic features of iliac vessels with respect to the anterior approach to the lumbosacral junction. Through a midline longitudinal incision over the linea aspera and retraction of the intraperitoneal contents, exposure of the abdominal aorta, inferior vena cava, and common iliac vessels was done. Direct measurements regarding the relations of these greater vessels to the sacral promontory were then performed. The results showed the average width of the trigone, measured between the medial edges of the left common iliac vein and the right common iliac artery, was 55.9 mm for male and 55.3 mm for female subjects, respectively. The average height of the trigone, measured from its apex to the sacral promontory, was 36.9 mm for male and 35.2 mm for female subjects separately. The width of the uncovered left common iliac vein averaged 7.2 mm for male and 6.3 mm for female subjects, respectively, with a range of 3-11 mm for both male and female specimens. One should be always aware of the medially placed left common iliac vein and an approach medial to the right common iliac artery to the L5-S1 disk is recommended if anterior surgery is desired.

Aged↗
PubMedDate not supplied

Meningovertebral ligaments and their putative significance in low back pain.

OBJECTIVE: To determine the presence and morphology of the meningovertebral ligaments (ligaments of Hofmann) as well as postulate their possible contribution to low back pain. DESIGN: Sagittal dissections were performed on 12 embalmed cadaver specimens including the L5/S1 intervertebral level cephalad to T1. Meningovertebral ligaments were labeled and documented in both the lumbar and thoracic regions. RESULTS: Meningovertebral ligaments were found in both the lumbar and thoracic regions of all cadaveric specimens. These ligaments were much more prevalent in the lumbar vertebral column but were also present throughout the thoracic vertebral column. The meningovertebral ligaments in the lumbar region were more robust as well as more frequently encountered than those found in the thoracic region. CONCLUSION: Dural sac attachments to the posterior aspect of the vertebral bodies and the posterior longitudinal ligament could act to traction the dural sac in the event of nuclear bulge or herniation. The prevalence of these ligaments in the lumbar spine, coupled with the high incidence of herniated nucleus pulposus and disc bulges in this region, may compound the effects of disc pathology and result in increased low back pain.

Aged↗
PubMed1997

Implant diameter and bone density: effect on initial stability and pull-out resistance.

It is well known that the standard diameter dental implant so often utilized is often inadequate in patients with poor bone quality or quantity, and larger diameter implants have been utilized to overcome this deficiency. The objective of this study was to compare the pull-out resistance of small and large diameter (3.25- and 4.5-mm) dental implants and the relationship of these implants to bone density. Two groups of implants, consisting of 18 implants of each diameter, were placed in the mandibles of five embalmed humans. The bone mineral density of the area surrounding the implant site in the coronal cross section was measured by quantitative computed tomography (QCT). Initial implant stability was tested with a periodontium diagnostic device and pull-out resistance was tested with a mechanical testing system. Results showed the same initial stability for the two implants. The maximum pull-out force required for the large diameter implants was 15% greater than that required for the small diameter implants, although given the small number of samples, this difference was not statistically significant. There were significant positive correlations between the pull-out resistance and the bone density for both the large and small diameter implants (p < 0.05, p < 0.01). We conclude that larger diameter implants appear to have advantages over smaller ones; however, more extensive testing is needed to determine quantitatively the increased load-carrying capacity.

Aged↗
PubMedDate not supplied

Muscle fibre orientation of abdominal muscles and suggested surface EMG electrode positions.

The ability of surface electrodes to accurately detect the activity of a particular muscle relies not only on their being placed over the muscle but also on their position in relation to muscle fibre orientation. For optimal pick-up of electromyographic (EMG) signals, surface electrodes are best aligned in parallel with the fibre orientation of the underlying muscle. This study aimed to measure muscle fibre orientation and other parameters of muscle morphology of the abdominal muscles in relation to palpable bony landmarks. Thirty-seven embalmed cadavers (19 males and 18 females) were examined. Results showed that the fibres of obliquus externus abdominis were about 4 degrees more vertical than the lower edge of the eighth rib. Below the rib cage, the muscle fibres of obliquus externus abdominis were approximately 5 degrees closer to vertical than a reference line between the most inferior point of the costal margin and the contralateral pubic tubercle. In the anterolateral abdominal wall area below the anterior superior iliac spine (ASIS), the obliquus internus abdominis was superficial being covered only by the aponeurosis of obliquus externus abdominis. At the level of ASIS, the muscle fibres of obliquus internus abdominis were almost horizontally orientated but at 2 cm below ASIS were aligned about 6 degrees inferomedially to the horizontal. The muscle fibres of upper rectus abdominis were 2 degrees inferolateral to the midline while the lower rectus abdominis muscle fibres deviated inferomedially from the midline by about 8 degrees. The appropriate surface electrode placements which follows the muscle fibre orientation of the obliquus externus abdominis, obliquus internus abdominis and rectus abdominis have been suggested.

Abdominal Muscles↗
PubMedDate not supplied

Attachments of the ligamentum nuchae to cervical posterior spinal dura and the lateral part of the occipital bone.

OBJECTIVE: To describe previously unrecorded attachments of the ligamentum nuchae to the cervical posterior spinal dura, and to posterolateral parts of the occipital bone in an anatomical study, with particular reference to the deep aspects of the suboccipital triangle and upper cervical region. DESIGN: Dissections of 10 heads and necks from embalmed cadavers were made in the suboccipital and upper cervical region, either in whole specimens or in parasagitally sectioned specimens. RESULTS: In parasagittally sectioned material, continuity was observed between the ligamentum nuchae and the posterior cervical spinal dura as the latter passed deeply from the midline toward the dura, but only at the first and second cervical vertebral levels. The ligamentum nuchae also passed bilaterally on to the occipital bone as far as the sutures between the occipital bone and the temporal bones, approaching the inferior nuchal line superiorly. CONCLUSION: The present study is the first to describe the full morphology of the relationship between the ligamentum nuchae and the cervical posterior spinal dura and the lateral aspects of the occipital bone. This is of significance for understanding the biomechanics of the cervical spine, particularly rotational movements of the head in the sagittal or transverse planes. This may have implications in manipulative therapy for conditions as cervicogenic headache and for various degenerative disorders affecting the cervical spine.

Aged↗
PubMed1998

[Forensic medicine in Dar-es-Salaam, United Republic of Tanzania].

The authors had opportunities to visit and see the present state of forensic medicine in Dar-es-Salaam, a capital city of United Republic of Tanzania. In this city, Department of Histopathology and Morbid Anatomy in Muhimbili University College of Health Sciences is in charge of education and practice of forensic medicine. All bodies of unusual death, about 3,000 cases per year, are brought to the university mortuary and examined by pathologists. An order of forensic autopsy from the Tanzanian police is submitted to the department with details of the case, i.e. circumstances of death, witnesses, weapons, etc. In each case, a pathologist signs out a death certificate and issues an autopsy report which is standardized throughout the country. Embalming after autopsy is essential in a tropical country. Tanzania in particular, to prevent both putrefaction of the body and dispersion of pathogens during its transportation. Preventive measures against biohazards from human immunodeficiency virus-infected bodies are considered in the autopsy room and laboratory. Although Tanzania is one of the developing countries in the world, the forensic medicine in the capital city is rendering great services in the promotion of public health.

Acquired Immunodeficiency Syndrome↗
PubMed1978

Functional morphology of forelimb joints in the woolly monkey Lagothrix lagothricha.

This gross anatomical study of embalmed forelimb joints of the South American woolly monkey Lagothrix lagothricha focuses on the problem of determining in osteoligamentous preparations how the disposition of the capsular apparatus and the geometry of the articular surfaces govern the amount and types of movement permitted at a joint, and then correlates these findings with the use of the forelimb in the positional capabilities of captive wooly monkeys observed by this author. Data collection was by dissection, quantitative range of motion studies on osteoligamentous preparations, and by qualitative manipulations of these preparations and of disarticulated bones. Supplemental evidence was obtained from radiographs and from an estimate of angular values of articular surfaces. Presented for the shoulder, elbow, radioulnar, and hand joint complexes are the functional anatomy of the capsular apparatus and articular surfaces, the quantitative range of motion data, and proposed mechanisms of movement that combine the functional morphology with the observed use of the forelimb in activities by the animal. The structurofunctional framework of MacConaill is the basis for the joint analysis. The evidence suggests that the functional anatomy of these joints correlates well with the possible positional capabilities of Lagothrix. The morphology of the capsular apparatus and joint surfaces reflect both the arboreal quadrupedalism and forelimb suspension of the woolly monkey. The positions of maximum congruency and close-pack approximate the forelimb's weight-bearing stance during palmigrade arboreal quadrupedalism. During forelimb suspension, the taut and twisted capsular apparatus of close-packed joints maintains the integrity of forelimb links in tension. This is the first known report of the internal band of the collateral ligament of the proximal interphalangeal joints of the second through fifth digits being incorporated into the terminal tendon of the extensor assembly. This author believes this is a mechanism not only for maintaining the integrity of these joints during forelimb suspensory activities when the body is supported by the middle phalanges, but also for helping to coordinate the flexion-extension actions of the phalanges for smooth grasping and release maneuvers in an arboreal environment. When sufficient comparative data have been collected, such correlations of the functional morphology of joints with positional behavior may be used to postulate positional capabilities of fossil primates.

Acromioclavicular Joint↗
PubMed1998

Modified Magerl technique of lateral mass screw placement in the lower cervical spine: an anatomic study.

Twelve adult embalmed cadaveric cervical spines were used to modify the traditional Magerl technique for screw placement in the lower cervical spine. The starting point for the drill bit was 2 mm inferior to the inferiormost edge of the superior facet and 1-2 mm medial to the posterior midline of the lateral mass. The orientation of the drill bit was parallel to the superior facet in the sagittal plane, and 25-30 degrees lateral in the transverse plane. After drilling, we made direct measurements of the screw path length between the dorsal and ventral cortexes of the lateral mass and screw-path angles in both the sagittal and transverse planes. The results showed the mean screw-path length for all levels ranged from 11 to 15 mm with the smallest value at C7. The mean sagittal and transverse angles of the screw path ranged from 41 to 43 degrees and from 26 to 28 degrees. Penetration of the superior facet was found in three (2.5%) cases. Possible spinal nerve violation was seen in 13 (10.8%) cases if the drill bit was excessively overpenetrated. This study suggested that our modified Magerl technique for lateral mass screw placement be as high as possible without impinging on the facet joint, and drilling be as cranial and lateral as possible to leave the superior articular process as high and lateral as possible. This may further decrease the incidence of spinal nerve injury. Careful drilling and tapping technique is recommended to avoid overpenetration.

Adult↗
PubMedDate not supplied

Observations on surgical anatomy for rectal cancer surgery.

BACKGROUND/AIMS: The investigators studied the surgical anatomy of the main structures involved in the mobilization of the rectum (Denonvilliers' fascia, mesorectum, middle rectal artery, superior and inferior hypogastric plexuses). METHODOLOGY: The study was carried out on 20 cadavers (17 unembalmed and 3 embalmed). To study Denonvilliers' fascia, ten embryos and fetuses (11 mm to 80 mm CRL) were also examined. RESULTS: Denonvilliers' fascia originates from the fusion of the primary pouch of Douglas. The two leaves making up this structure are easily separated. The mesorectum surrounds the rectum on three sides; it is easily separated from the presacral fascia and its connective tissue is bordered by a thin membrane. The middle rectal artery varies in appearance rate, origin, size, distribution and anastomosis. It runs under the lateral ligament and also sends branches to the genital apparatus. Of the two hypogastric plexuses, the inferior is the most difficult one to identify. Its superior branches extend to the rectum, and the inferior ones to the genital apparatus. Because the anterior part contains the parasympathetic nerves and the middle rectal artery, this region is at major risk during surgical dissection. CONCLUSIONS: A sound understanding of the surgical anatomy of the rectum enables the surgeon to perform a more correct and reasonable procedure in terms of both the extent of surgical treatment and the preservation of important anatomical structures.

Adolescent↗
PubMed1998

Variant innervation of the coracobrachialis muscle and unusual course of the musculocutaneous nerve in man.

During the educational gross anatomy dissections of the upper extremities of 60 embalmed cadavers in our laboratory, the coracobrachialis muscle was found to be innervated by a nerve branch arising from the lateral root of the median nerve, but not from the musculocutaneous nerve nor from the lateral cord of the brachial plexus. Also the musculocutaneous nerve was found not to pierce the coracobrachialis muscle and to course downwards medial to it. The combination of two variations was seen in the right arm of a 64-year-old Turkish female cadaver. No other abnormality was observed in the branching pattern of the brachial plexus on both sides.

Brachial Plexus↗
PubMed1976

Interosseous muscles in claw finger.

The third and fourth fingers of the normal hands of 75 adult subjects were tested for active finger extension with the wrists in neutral position. Seventy-two of the subjects could not actively extend the interphalangeal (IP) joints when the metacarpophalangeal (MCP) joints were passively and maximally extended. However, the IP joints could be passively extended without pain in 67 subjects and with pain in 5 subjects. This indicated that the inability to actively extend the IP joints when the MCP joints were maximally extended is seldom due to tightness of the flexor tendons. Electromyographic recordings of the interossei muscles in one subject showed voluntary activity of these muscles with the MCP joints maximally extended while the IP joints remained flexed. A macrospoic study was made of the dissected third and fourth fingers of five embalmed cadaver hands and, in two of these specimens polygraphic recordings were made with the use of the strain gauge. In each of these specimens, when traction was applied in the appropriate interosseous muscle, movement of the lateral band of the extensor aponeurosis was noted when the MCP joint was at neutral or slight flexion, while no motion could be detected when the MCP joint was in maximal extension. Thus, maximal extension of the MCP joint blocks not only the action of the extensor digitorum communis tendon, as shown by Mulder and Landsmeer, but also blocks the action of the interossei in extension of the fingers. This explains the mechanism of development of claw finger in those cases without intrinsic hand muscle paralysis.

Adult↗