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To precisely evaluate low back pain, identification of the detailed innervation of the lumbar spine is necessary. On twenty-five sides of adult cadavers we investigated various patterns of rami communicantes (RC) and their relationship to the psoas major muscle (PM). In ten sides, we focused our dissection on the minute nerve supply of the anterior (ALL) and posterior longitudinal ligaments (PLL), vertebral bodies and the intervertebral discs (IVD). According to the mode of piercing PM, two types of RC were observed: superficial oblique rami (SOR) and deep transverse rami (DTR). SOR ran obliquely between superficial heads of PM, connecting sympathetic trunk (ST) and T12-L2 (3) spinal nerves non-segmentally. DTR ran segmentally close to the vertebral bodies and were situated deep to the PM slips. On the lateral side of the lumbar spine, the vertebral bodies and IVD received branches from DTR and ventral rami segmentally, as well as branches from the sympathetic trunk (ST) and, in the upper lumbar region, SOR non-segmentally. On the anterior aspect of the lumbar spine, ALL received branches from ST and splanchnic nerves non-segmentally. Within the vertebral canal, the posterior aspect of IVD and PLL received the sinu-vertebral nerves originating from DTR. These findings suggest the coexistence of two different types of innervation: one originating directly from the spinal nerve segmentally, and one reaching vertebral structures via the sympathetic nerves non-segmentally. Therefore, sympathetic nerves are likely involved in the proprioception of the spinal column.
The anatomy of the posterior cricoid cartilage region was examined to obtain a better quantitative understanding of this region. The mean height and width of the posterior cricoid cartilage in the midline measured 24.5 mm and 25 mm respectively. The mean distance between the fibres for the left and right posterior cricoarytenoid muscles was 5 mm at the midpoint of the posterior cricoid cartilage. The height of these muscles averaged 19 mm for left sides and 20 mm for right sides. The mean distances from the midpoint and superior midline of the posterior cricoid cartilage to the inferior laryngeal nerve were 14 mm and 15 mm respectively for left sides and 17 mm and 18 mm respectively for right sides. It is hoped that these data will be of use to clinicians performing invasive procedures in this area.
The purpose of the study was to evaluate the usefulness of magnetic resonance (MR) in imaging of the cisternal and petroclival segments of the abducent nerve. Heavily T2-weighted submillimetric 3D sequence in axial plane, T1-weighted 3D, 1.5 mm slice thickness sequence in axial plane and TOF sequence were performed on 16 volunteers. Additionally the reformatted T2-weighted images in sagittal and in oblique parasagittal plane parallel to the abducent nerve in the pontine cistern were performed. The heavily T2-weighted sequence provides high contrast between fluid and other structures. High signal intensity of the cerebrospinal fluid is a kind of background for cranial nerves, vessels, meninges as well as for bony and fibrous structures. The authors identified the abducent nerve in at least one plane of the submillimetric, heavily T2-weighted sequences in 84.4% cases (in 84.4% in axial plane, 68.8% in sagittal and 84.4% parasagittal parallel to the VI-th cranial nerve in the pontine cistern). Dorello’s canal was identified in 27/32 abducent nerves (84.4%) on the submillimetric, heavily T2-weighted sequence in parasagittal parallel to the abducent nerve in the pontine cistern plane. In 71.9% (23/32) of cases, the abducent nerve was in contact with the arterial vessel in pontine cistern.
The aim of our study was to describe anatomical variability of the root entry zone (REZ), also called the Ohersteiner--Redlich zone, that represents the "junction zone" of glia and Schwann sheath of the cranial nerves. This zone has some clinical implications. The pulsatile compression of REZ by a vessel may produce clinical symptoms, such us trigeminal neuralgia, hemifacial spasm, glossopharyngeal neuralgia torticollis spasmodicus or even symptoms of essential hypertension when a vascular crross compression of REZ of a left vagus nerve is present. The vessel - cranial nerve contact in the skull base cysterns may be visualized in radiologic examinations, most accurately in magnetic resonance imaging. Because, we cannot distinguish the REZ from the rest of the vagus nerve in radiologic examinations we decided to measure the lenght of its REZ. The microanatomical study of the lenght of REZ zone of the vagus nerve was performed on 2l nerves taken from 17 human brain stems (12 men, 5 women, 14 left, 7 right), fixed with 8% buffered, formalin solution. Paraffin embedded tissue was cut into 1O-um-thick sections pararellel to the nerve longitudinal axis and stained with hematoxilin & eosin. Each of the nerves showed the presence of a zone of oligodendrocyte myelination, mean lenght 2 ą 0.3 mm. In 17 nerves the transitional zone formred a cone-like process, in 4 nerves was shaped irregularly. The length of REZ (oligodendrocyte myelination plus "glial dome") had the mean length 3.5 ą 0,9 mm.
With the emerging utilisation of ansa cervicalis in nerve reconstructive surgery, it is important for surgeons to be conversant with the anatomy of these nerves. This descriptive cross sectional study aimed at describing the morphology and topographic anatomy of ansa cervicalis. We examined 38 adult human formalin-fixed cadavers. The superior root was present in 38 (100%) cases and 37 (97%) cases, on the right and left sides, respectively. More than half (56%) of these roots were located superior to the posterior belly of the digastric muscle. The inferior root, on the other hand, was present in 34 (89.5%) cases on the right side and 31 (81.6%) cases on the left side. Of all the inferior roots, 81.5% were located lateral to the internal jugular vein. The loop was seen in all the cases that had the inferior root, and was mostly (64.6%) located above the superior belly of the omohyoid muscle. Knowledge of the anatomy of ansa cervicalis is not only important for nerve reconstruction surgeries, but also for operations in the neck, so as to avoid injuring the great vessels that are closely related to it. (Folia Morphol 2010; 69, 3: 160–163)
In three human foetuses aged 15, 17, and 23 weeks the number of axons surrounded by single Schwann cells was counted. These Schwann cell/axon complexes form the Schwann units. The largest Schwann units in the foetus aged 15 weeks contained 232 axons, in the foetus of 17 weeks the number was 140 and in the foetus of 23 weeks the largest units contained 65 axons.
Rapid progress in gastroenterological research, during past century, was initiated by the discovery by W. Prout in early 18th century of the presence of inorganic, hydrochloric acid in the stomach and by I.P. Pavlov at the end of 19th century of neuro-reflex stimulation of secretion of this acid that was awarded by Nobel prize in 1904. Then, J. W. Black, who followed L. Popielski's concept of histamine involvement in the stimulation of this secretion, was awarded second Nobel prize in gastrology within the same century for the identification of histamine H2-receptor (H2-R) antagonists, potent gastric acid inhibitors, accelerating ulcer healing. The concept of H2-R interaction with other receptors such as muscarinic receptors (M3-R), mediating the action of acetylocholine released from local cholinergic nerves, and those mediating the action of gastrin (CCK2-R) on parietal cells, has been confirmed both in vivo studies and in vitro isolated parietal cells. The discovery of H2-R antagonists by Black and their usefulness in control of gastric secretion and ulcer healing, were considered as real breakthrough both in elucidation of gastric secretory mechanisms and in ulcer therapy. Discovery of even more powerful gastric acid inhibitors, proton pump inhibitors (PPI), also highly effective in acceleration of ulcer healing was, however, not awarded Nobel prize. Unexpectedly, two Australian clinical researchers, R.J. Warren and B.J. Marshall, who discovered in the stomach spiral bacteria, named Helicobacter pylori, received the third in past century Nobel prize in gastrology for the finding that this bacterium, is related to the pathogenesis of gastritis and peptic ulcer. They documented that eradication of H. pylori from the stomach, using antibiotics and potent gastric inhibitors, not only accelerates healing of ulcer but also prevents its recurrence, the finding considered as greatest discovery in practical gastrology during last century. Thus, the outstanding achievements in gastroenterology during last century have been awarded by three Nobel prizes and appreciated by millions of ulcer patients all over the world.
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