Surgical anatomy of the greater pectoral muscle

In 41 preparations of the m. pectoralis major it has been stated by means of anatomical methods that the vascular "hilus" is projected on the upper third of its middle part and represented by the thoracic branch of the thoracoacromial artery. The latter has several variants dividing into branches of the successive orders. It has been stated that the muscle has a wide network of anastomoses at the macro-microscopic level. For plastic purposes, it is expedient to use the external and middle parts of the m. pectoralis major which have more favourable conditions of the blood supply. Owing to the data obtained and the technique, developed on 25 corpses, for cutting out and graft transplantation in the thoracic cavity, it has been possible to operate 9 patients.     

The platysma myocutaneous flap. Indications and caveats

Arterial hypertension has been identified as a major secondary risk factor for diabetic retinopathy. However, the mechanisms by which hypertension worsens retinopathy are unknown. Inhibition of advanced glycation product formation prevents the development of experimental diabetic retinopathy in normotensive diabetic rats. In this study the effect of hypertension on the rate of diabetic retinopathy development and the formation of arteriolar thrombosis was evaluated. We also evaluated the effect of aminoguanidine, an inhibitor of advanced glycation and product formation on retinal pathology of diabetic hypertensive rats. After 26 weeks of diabetes, hypertension accelerated the development of retinopathy despite a lower mean blood glucose level than in the non-hypertensive group (diabetic spontaneous hypertensive rats (SHR) 16.00 +/- 6.83 mmol/l; diabetic normotensive Wistar Kyoto rats (WKY) 34.9 +/- 3.64 mmol/l; p < 0.0001). Diabetic SHR had nearly twice as many acellular capillaries as diabetic WKY (SHR diabetic: 91.9 +/- 7.5 acellular capillaries per mm2 of retinal area vs WKY diabetic: 53.7 +/- 8.5 acellular capillaries per mm2 of retinal area), and a 3.8-fold increase in the number of arteriolar microthromboses (SHR diabetic 23,504 +/- 5523 microns2 vs SHR non-diabetic 6228 +/- 2707 microns2). Aminoguanidine treatment of SHR diabetic rats reduced the number of acellular capillaries by 50%, and completely prevented both arteriolar deposition of PAS-positive material and abnormal microthrombus formation. These data suggest that hypertension-induced deposition of glycated proteins in the retinal vasculature plays a central role in the acceleration of diabetic retinopathy by hypertension.     

Evaluation of the platysma interlocking suture sling for rhytidectomy

PURPOSE: The purpose of this study was to evaluate the complication rate and the clinical results of the platysma interlocking suture sling for rhytidectomy patients. PATIENTS AND METHODS: In the first part of this study, the charts and photographs of 29 patients who underwent rhytidectomy with the platysma interlocking suture sling were reviewed for complications. The parameters included infection, rupture of the sutures, extrusion of the sutures, prolonged tightness around the neck, and nerve injury. In the second part, the patients' neck deformities were classified into three types: mild (type 1), moderate (type 2), and severe (type 3). The changes in the preoperative and postoperative cervicomental angles were compared between the patients who underwent rhytidectomies with the platysma interlocking suture sling (group 1) and those patients who underwent rhytidectomies only (group 2). RESULTS: The complication rate was found to be minimal. Only one case of prolonged tightness around the neck was noted; there was no other complication. All of the patients, regardless of neck classifications, benefited from rhytidectomy, whether or not the platysma interlocking suture sling was used. However, when comparisons were made between group 1 and group 2 patients in their specific neck deformity categories, it was found that the patients with the severe (type 3) neck deformity benefited most when the platysma interlocking suture sling was used in conjunction with the rhytidectomy procedure. CONCLUSION: The platysma interlocking suture sling has a low morbidity rate and is helpful in reconstruction of patients with the type 3 neck deformity.     

Botulinum A exotoxin for the management of platysma bands

Injections of botulinum A exotoxin are successfully used to treat neuromuscular disorders and to improve hyperkinetic muscles and dynamic rhytids of the upper face. Using these principles, we extended its use to the treatment of the aging neck (hypertrophic platysma muscle bands). A classification system (I to IV) based on horizontal neck rhytids, platysma bands, and skin laxity was devised to categorize the degree of deformity and serve as a guideline for suggested dosages of botulinum. The results correlated with the degree of age-related neck degeneration. Type II (mild horizontal neck rhytids; thin, mild platysma muscle flaccidity; and mild skin laxity) and III (moderate horizontal neck rhytids; thick, moderate platysma muscle flaccidity; and moderate skin laxity) patients were the most satisfied, followed closely by types I and IV. A total of 1500 patients were treated by three independent practices. The majority of them achieved good-to-excellent results, as evaluated by both the physician and patient. The degree of muscle flaccidity and hypertrophy were the factors that most influenced success rates, not the anatomic variations in muscle configuration.     

The anatomy and the MRI anatomy of the interhemispheric cerebral commissures

Correlation of myelin-stained or cryotomic sections of human brain with inversion-recovery MR images can display the cerebral commissures as white-matter tracts (in hypersignal on MRI), crossing the mid-line. MRI shows routinely in three orthogonal planes a) the corpus callosum stretched above the supra-tentorial ventricles, it's four portions (rostrum, genu, body and splenium) and connections with the Deep Grey Nuclei b) the fornix, intralimbic commissure joining anteriorly the mammillary bodies (through it's columns) to the alveus posteriorly and inferiorly (via it's two crura), arcing around the thalamus and lying over the hippocampus and the dentate gyrus as shown on the frontal sections c) the anterior commissure, white-matter tract connecting the two temporal lobes. In axial view, the anterior commissure has the shape of bicycle handlebars, coursing posteriorly, inferiorly and laterally behind the head of the caudate nucleus and passes into the lateral nucleus of the globus pallidus into the inferior and middle temporal gyri. Because the anterior commissure is easily recognisable in all planes, it's appears to be a important landmark for identification of the lateral and medial nuclei of the globus pallidus on axial and sagittal planes d) at least, the posterior commissure, anterior margin of the pineal region, closely related to the superior colliculi, acquire a major importance in the AC-PC line delineation becoming a reference landmark for stereotatical procedures.     

Midline platysma muscular overlap for neck restoration

A variation of platysmaplasty, consisting in the overlapping (double-breasted fashion) of the platysma muscles in the midline, solely through submental approach, is described. It allows excellent platysmal suspension and neck recontouring, eliminating the need of posterior traction of the platysma muscle and avoiding in many cases the cervical incisions.     

The histologic anatomy of the volar plate

The EU Concerted Action Workshop on 11q23 Abnormalities in Hematological Malignancies collected 550 patients with abnormalities involving 11q23. Of these, 53 patients had a translocation involving chromosome 11, breakpoint q23, and chromosome 19, breakpoint p13. Karyogram review enabled each patient to be further defined as t(11;19)(q23;p13.1) (21 patients) or t(11;19)(q23;p13.3) (32 patients). There was a marked difference between the type of banding and the translocation identified: t(11;19)(q23;p13.1) was detected predominantly by R-banding, whereas t(11;19)(q23;p13.3) was detected almost solely by G-banding. Additional change was extremely rare in patients with t(11;19)(q23;p13.1) but occurred in nearly half of the patients with t(11;19)(q23;p13.3). Patients with t(11;19)(q23;p13.1) all had leukemia of a myeloid lineage, mostly acute myeloid leukemia (AML), and were predominantly adult. In contrast patients with t(11;19)(q23;p13.3) had malignancies of both myeloid and lymphoid lineage and were mainly infants less than 1 year old. The survival of both groups of patients was generally poor, over 50% of t(11;19)(q23;p13.1) patients died within 2 years of diagnosis and the median survival of acute lymphoblastic leukemia (ALL) patients with t(11;19)(q23;p13.3) was 17.6 months.     

The quantitative anatomy of the laminas of the spine

Over the past decade, significant advances and discoveries in cell and molecular biology and biomaterials have provided a foundation for the research and development of new, complex controlled release systems. Many of these new controlled release systems utilize active biological components, i.e., proteins and cells, to achieve their intended therapeutic goal. Utilization of bioactive biological materials in implantable controlled release systems has prompted a broad as well as an in-depth interest in the safety and efficacy of these systems. This short review is intended to provide individuals with a perspective on standards and guidance documents which specifically address biological and immunotoxicity response evaluation for safety of controlled release systems from a regulatory point of view.     

The anatomy of language revisited

The language areas have been classically viewed as a posterior, perceptual Wernicke's region connected with an anterior, motor Broca's area via a tract of long fibers denominated the arcuate fasciculus. Recent connectional studies in the monkey indicate that there may be few direct connections between the regions strictly corresponding to Broca's or Wernicke's areas, and that inferior parietal areas may serve as a link between them. The proposed connectional pattern of the language regions fits the network of parietotemporal-prefrontal connections that participate in working memory, a type of memory used in immediate cognitive processing. Supporting this concept, brain activation studies in the human during linguistic working memory tasks have determined a close relation between the supramarginal gyrus (parietal area 40) and Broca's area. We suggest that language processing is closely related to working memory networks, and that the language regions in fact originated in evolution from a working memory network for linguistic utterances.     

The functional anatomy of memory

A review of recent work using Positron Emission Tomography (PET) to examine brain systems involved in auditory-verbal memory is presented. Initial work delineated widespread brain regions which were, to a large extent, in agreement with existing neuropsychological literature. Expanding on this, a number of studies have examined memory encoding and retrieval separately. Additionally, experiments have been carried out to specifically address sub-components of memory such as the use of visual imagery as a mnemonic strategy, the functional anatomical evidence for the episodic/semantic memory distinction and the different brain regions involved in explicit and implicit memory tasks.     

The anatomy of repertory memory.

To investigate repertory memory, the ability to learn and remember the exact text of substantial passages, expert and novice memorizers were videotaped as they rehearsed and recalled aloud the contents of two passages that contained 191 and 243 words. The experts, more than the novices, selectively allocated their rehearsals, focusing primarily on words that would serve as retrieval cues. In general, verbatim recall was high, approaching 85% even after 4 days. The experts were more likely to repeat initial words of sentences as retrieval cues, to make error-correcting repetitions, and to require fewer prompts from the experimenter than the novices. Moreover, despite the experts' cuing and error-correcting repetitions, their mean retrieval time was reliably faster than that of the novices. A tentative model of repertory memory was proposed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The metabolic anatomy of Tourette's syndrome

The functional brain networks underlying the clinical manifestations of Gilles de la Tourette's syndrome (TS) are currently unknown. To identify these networks, we studied TS patients and normal subjects with 18F-fluorodeoxyglucose (FDG) and PET employing a statistical model of regional metabolic covariation. We studied 10 TS patients (mean age, 41.5 +/- 12.7 years) who were either drug naive or medication free for at least 2 years. Ten normal volunteers (mean age, 42.5 +/- 11.5) served as controls. We used quantitative FDG/PET to calculate global, regional, and normalized rates of glucose metabolism (GMR, rCMRGlc, and rCMRGlc/GMR) in all subjects. The Scaled Subprofile Model (SSM) was used to identify specific patterns of regional metabolic covariation associated with TS. We found that global and regional metabolic rates were normal in TS. SSM analysis identified two TS-related brain networks. One pattern (15.8% variance accounted for, VAF) was characterized by covariate bilateral metabolic increases in lateral premotor and supplementary motor association cortices and in the midbrain. Individual patient expression of this pattern (subject score) was abnormally increased in the TS group (p < 0.01). A second pattern (10.5% VAF) was characterized by covariate decreases in caudate and thalamic metabolism associated with smaller reductions in lentiform and hippocampal metabolic activity. Subject scores for this pattern correlated with Tourette Syndrome Global Scale (TSGS) global ratings (r = 0.85, p < 0.005). We conclude that the metabolic landscape of TS is characterized by a nonspecific pattern of increased motor cortical activity identified in other hyperkinetic disorders. TS is also associated with a specific brain network characterized by a reduction in the activity of limbic basal ganglia-thalamocortical projection systems.     

The new pathological anatomy]

We report a 14-year-old girl who developed chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) during the course of myasthenia gravis. Myasthenia gravis, which was clinically of ocular type, but with waning phenomenon of the extremities, occurred at 2 years and 4 months of age. Muscle weakness of the lower extremities gradually developed over the next 6 years. The electrophysiological and pathological findings fulfilled the criteria of "possible CIDP" with severe axonal involvement. The signs of myasthenia gravis and CIDP fluctuated synchronously. A common immunological abnormality was suggested to underlie this rare association of myasthenia gravis and CIDP in childhood.     

A study on the newly designed platysma myocutaneous flap and its clinical applications]

The European Pig Gene Mapping Project (PiGMaP) and United States Department of Agriculture (USDA) porcine linkage maps for chromosomes 3 and 9 have been aligned by typing three USDA microsatellites from chromosome 3 and five from chromosome 9 on the PiGMaP reference families. Using the CRIMAP linkage analysis package, revised multipoint linkage maps were constructed for chromosome 3 and 9. Inclusion of these USDA markers in the multipoint analysis resulted in an increase in length of 47% and 33% respectively for these two PiGMaP linkage groups. This increase in size is mainly the result of extension of the ends of both linkage groups.     

The surgical anatomy of the perforating branches of the basilar artery

The perforating branches of the basilar artery were examined in 14 brain stems injected with india ink or methylmethacrylate. Three groups of the perforators were distinguished: the caudal, the middle, and the rostral. The caudal perforators varied in number from two to five and in diameter from 80 to 600 microns. In addition to their terminal branches, which entered the foramen cecum, the perforators occasionally branched off the pontomedullary artery, the pyramidal vessels, and the hypoglossal branches. The middle perforators arose either separately from the basilar artery or along with the basilar artery collateral branches. They ranged in number from five to nine and in diameter from 210 to 940 microns. The perforators gave rise to the pontomedullary artery (8.3%), the long pontine arteries (25.0%), and the anterolateral vessels (100%). The rostral perforators originated from the terminal part of the basilar artery (91.6%), as well as from the superior cerebellar artery (91.6%) and the posterolateral artery (16.6%). They varied in number from one to five and in diameter from 190 to 800 microns. The anastomoses among various perforating vessels were noted in 41.6 to 66.6% of the cases. The authors discussed the possible clinical significance of the anatomical data observed in this study.     

The functional anatomy of sound intensity discrimination

The human neuroanatomical substrate of sound intensity discrimination was investigated by combining psychoacoustics and functional neuroimaging. Seven normal subjects were trained to detect deviant sounds presented with a slightly higher intensity than a standard harmonic sound, using a Go/No Go paradigm. Individual psychometric curves were carefully assessed using a three-step psychoacoustic procedure. Subjects were scanned while passively listening to the standard sound and while discriminating changes in sound intensity at four different performance levels (d' = 1.5, 2.5, 3.5, and 4.5). Analysis of regional cerebral blood flow data outlined activation, during the discrimination conditions, of a right hemispheric frontoparietal network already reported in other studies of selective or sustained attention to sensory input, and in which activity appeared inversely proportional to intensity discriminability. Conversely, a right posterior temporal region included in secondary auditory cortex was activated during discrimination of sound intensity independently of performance level. These findings suggest that discrimination of sound intensity involves two different cortical networks: a supramodal right frontoparietal network responsible for allocation of sensory attentional resources, and a region of secondary auditory cortex specifically involved in sensory computation of sound intensity differences.     

The anatomy of T-cell activation and tolerance

The mammalian immune system must specifically recognize and eliminate foreign invaders but refrain from damaging the host. This task is accomplished in part by the production of a large number of T lymphocytes, each bearing a different antigen receptor to match the enormous variety of antigens present in the microbial world. However, because antigen receptor diversity is generated by a random mechanism, the immune system must tolerate the function of T lymphocytes that by chance express a self-reactive antigen receptor. Therefore, during early development, T cells that are specific for antigens expressed in the thymus are physically deleted. The population of T cells that leaves the thymus and seeds the secondary lymphoid organs contains helpful cells that are specific for antigens from microbes but also potentially dangerous T cells that are specific for innocuous extrathymic self antigens. The outcome of an encounter by a peripheral T cell with these two types of antigens is to a great extent determined by the inability of naive T cells to enter nonlymphoid tissues or to be productively activated in the absence of inflammation.