Accessory extrahepatic arteries: Blood supply of a human liver by three arteries: A case report with brief literature review

The coexistence of three hepatic arteries – accessory left hepatic artery (aLHA), proper hepatic artery (pHA), and accessory right hepatic artery (aRHA) – was demonstrated during a routine dissection of an 85-year-old male cadaver. The aLHA arose from the left gastric artery and ran in the hepatogastric ligament, whereas the aRHA took its origin from the superior mesenteric artery and ran in the hepatoduodenal ligament. The anatomy of the origins and the course of the arteries in the liver are described. Knowledge of these variations is of importance for surgical and radiological procedures in the upper abdominal region, in order to avoid complications during invasive treatment. The embryological background of the variations is discussed.     

Anatomical variations of the renal arteries and renal transplantation

This study reports a retrospective analysis of the details of the anatomy of the renal arteries of 403 kidney donors and the arterial complications related to 513 subsequent kidney transplants in our transplant unit. Multiple renal arteries occurred bilaterally in 10.2% of donors and unilaterally in 20.8%, a total incidence of 31%. There was a higher incidence of vascular-related complications following transplantation of kidneys with multiple renal arteries. Attention is drawn to the need for careful technique in identification of multiple renal vessels, especially aberrant vessels, at the time of donor nephrectomy and also to the different techniques available for anastomosis of multiple renal arteries in kidney transplant recipients. © 1992 Wiley-Liss, Inc.     

Anatomical variations of the flexor hallucis longus muscle and the consequences for tendon transfer. A cadaver study

The aim of this study was to evaluate the occurrence of anatomical variations of the musculotendinous junction of the flexor hallucis longus muscle. Eighty cadaver specimens preserved according to Thiels method were assessed. Following careful dissection, the distance between the musculotendinous junction and the bone–cartilage border of the distal tibia was determined. Three typical anatomical variations were found: (1) a long lateral and shorter medial muscle belly; (2) equal-length medial and lateral muscle bellies; (3) a long medial and shorter lateral muscle belly. As a special variation in two cases only one lateral muscle belly was found. When planning a flexor hallucis longus transfer, preoperative magnetic resonance tomography (MRT) should be carried out in order to guarantee sufficient coverage of an existing soft tissue defect. These anatomical characteristics have also to be considered when interpreting ultrasonic or MRT findings in this region.     

直肠表面动脉的形态学观测

目的观察直肠表面动脉的分支分布特点。方法随机选取成人尸体20具,婴幼儿尸体15具,行巨微解剖观察。结果上段直肠主要由乙状结肠直肠动脉的横支供血,在器官表面的分支形式多为环绕型;直肠壶腹主要由直肠上动脉的终支供血,其在器官表面的分支形式多呈主根须样;直肠颈主要由直肠下动脉和肛动脉供血,其在器官表面的分支形式可有鸦爪型、单支型、二叉型、三又型及“K”型等;上半直肠多为横行的环状分布,下半直肠多为纵行分布;各支间可存在吻合,方式为网型、直接及不规则型吻合。结论在上半直肠前壁和直肠颈后壁,存在无血管吻合区;直肠动脉在器官表面存在区域性配布的特点。     

Bilateral arterial and nervous variations in the human upper limb: A case report

During routine dissection, we found bilateral arterial and nervous anomalies in a female cadaver. On the left side the axillary artery divided into a medial brachial artery and lateral profunda brachii artery, and the musculocutaneous nerve arose from the upper trunk of the brachial plexus, before the formation of the lateral cord. On the right side a common trunk that divided into the circumflex scapular artery, thoracodorsal artery and posterior circumflex humeral artery was observed, while the musculocutaneous nerve fused with the median nerve.     

Morphometrical analysis of the human suprarenal gland between the 4th and 7th months of gestation

The present study's purpose has been to examine the development of the human suprarenal glands (SGs) during the prenatal period. Special attention was paid to sexual dimorphism and the differences between the parameters of the right and left SGs.

Specimens were obtained from 187 human fetuses spontaneously aborted between the 4th and 7th months of gestation. The SGs were dissected from the fetuses after an immersion and preservation period of 3–24 months in 9% formalin solution. The mass and linear dimensions of each isolated SG were obtained, and these data revealed a progressive two-fold increase between the 4th and 7th months of gestation. There was a gradual reduction in the ratio of the SG mass to the overall mass of the fetus with a marked decrease evident between the 4th and 5th months.

Statistical analysis of both SGs showed significant differences between sexes in the mass and in the thickness of the left SG during the 5th and 6th months of gestation.

Differences in the mass and linear dimensions of the left and right SGs were recorded from the 5th month of gestation to the 7th month. The mass and volume of the left SGs were higher than those on the right side. This allometric analysis provides data from a large sample of human fetuses and will later aid in microscopic and ultrasonographic studies.     

Anatomical variations in the coronary arteries

The following are observations on 500 consecutive cases of coronary angiographical studies carried out on patients without any case history of myocardial ishcemia. There were 251 males and 249 females. The patients' average age was 45 years old.     

Morphology of human suprarenal glands: a parameter for comparison

Summary Forty suprarenal glands were studied, 20 being dissected from aborted fetuses of 9 to 36 weeks' gestation and 20 obtained from human cadavers of ages 1 day to 60 years. All the specimens were from a Northern India population. The side and shape of each suprarenal gland was noted and documented. The length, breadth, thickness and volume of each gland were measured and tabulated in terms of age. The mean length, breadth and thickness in fetuses of 9–36 weeks were found to be 1.4 cm, 1 cm and 0.45 cm respectively. In the postnatal age group the measurements were 4.5 cm, 2.08 cm and 0.66 cm respectively. The commonest shape of the suprarenal glands on left side was semilunar but on the right side it was highly variable: triangular, tetrahedral, inverted Y or V shaped. On comparison of the gross measurements with available ultrasound and CT scan data it was found that both the length and thickness in the population studied were greater than reported in the literature. A knowledge of these variations is very important in diagnosis of abnormalities of the suprarenal gland, of which tumoral enlargement is rather common.

---

Morphologie des glandes surrénales chez l'homme: critères de comparaison

Résumé 40 glandes surrénales ont été étudiées. 20 glandes surrénales provenant de foetus de 9 à 36 semaines de gestation ont été disséqués. 20 autres glandes ont été obtenues à partir de sujets âgés de 1 jour à 60 ans. Tous les sujets sont issus d'une population de l'Inde du nord. Le côté et la configuration de chaque glande surrénale a été noté et documenté. La longueur, la largeur, l'épaisseur et le volume de chaque glande a été mesuré et classé en fonction de l'âge. La longueur moyenne, la largeur et les épaisseurs chez les foetus de neuf à 36 semaines ont été de 1,4 cm, 1 cm et 0,45 cm respectivement. Dans le groupe postnatal (1 jour à 60 ans), les mesures ont été de 4,5, 2,08 et 0,66 cm respectivement. Du côté gauche, la glande surrénale est le plus souvent de forme semi-lunaire et du côté droit la forme est très variable: triangulaire, tétraédrique, en forme de V ou de Y inversé. La comparaison des mesures anatomiques avec les données échographiques et scannographiques ont montré que les mesures de longueur et d'épaisseur dans la population étudiée étaient plus importantes que celles mentionnées dans la littérature. La connaissance de ces variations est importante pour diagnostiquer les anomalies des glandes surrénales qui sont fréquemment le siège de tumeurs et d'hypertrophies.

     

Morphology of human suprarenal glands: a parameter for comparison

Forty suprarenal glands were studied, 20 being dissected from aborted fetuses of 9 to 36 weeks’ gestation and 20 obtained from human cadavers of ages 1 day to 60 years. All the specimens were from a Northern India population. The side and shape of each suprarenal gland was noted and documented. The length, breadth, thickness and volume of each gland were measured and tabulated in terms of age. The mean length, breadth and thickness in fetuses of 9–36 weeks were found to be 1.4 cm, 1 cm and 0.45 cm respectively. In the postnatal age group the measurements were 4.5 cm, 2.08 cm and 0.66 cm respectively. The commonest shape of the suprarenal glands on left side was semilunar but on the right side it was highly variable: triangular, tetrahedral, inverted Y or V shaped. On comparison of the gross measurements with available ultrasound and CT scan data it was found that both the length and thickness in the population studied were greater than reported in the literature. A knowledge of these variations is very important in diagnosis of abnormalities of the suprarenal gland, of which tumoral enlargement is rather common.     

Clinical implications of concomitant variations of the testicular, suprarenal and renal veins: A case report

Multiple venous anomalies have been observed during dissection of the posterior abdominal wall in a 65-year-old, white male cadaver. The left testicular and suprarenal veins united inferior to the superior mesenteric artery, coursed anterior to the abdominal aorta and drained into the inferior vena cava (IVC). Further the left renal vein coursed retroaortically and divided into three branches. The superior branch coursed on the vertebral column and drained into the azygos vein while middle and inferior branches drained into the IVC. The right renal vein was double and both drained into the IVC separately. Due to implications for numerous therapeutical and diagnostic procedures in the retroperitoneal region knowledge of these variations could be useful for clinicians in its recognition and protection.     

The arterial circulation of the left suprarenal gland

Summary The findings in a study of the general circulation of the suprarenal glands in 25 cases, and particularly of the left glands in 50 cases, are presented. The vessels arose from three pedicles: superior, middle and inferior. The inferior pedicle was the most irregular, with a frequent contribution from the gonadal artery to the inferior part of the gland; this artery should not be regarded as merely an accessory vessel. On the left side an inconstant posterior pedicle, separate from the others, was found in 26% of cases. Two forms of gonadal artery supplying the gland (8%) are described, an upper origin type at the renal artery level and an aberrant type.

---

Contribution à l'étude de la vascularisation artérielle de la glande surrénale gauche

Résumé Une étude de la vascularisation des glandes surrénales et spécialement de la gauche a été effectuée sur 50 foetus. Les vaisseaux sont répartis en trois pédicules : supérieur, moyen et inférieur. Le pédicule inférieur est le plus variable, il reçoit fréquemment un apport de l'artère gonadique, qui n'est pas à négliger. Au niveau de la glande surrénale gauche, existe un pédicule postérieur qui est inconstant (26 % des cas parmi les 50 cas étudiés) mais possède, quand il existe, des caractéristiques propres. L'artère gonadique donne deux types de branche à la glande (8 %), l'une, d'origine haute, au niveau de l'artère rénale, l'autre ayant un trajet aberrant.

     

乙状结肠直肠动脉直肠部的形态观测

目的　观察乙状结肠直肠动脉在上段直肠的分支分布特点。方法　随机选取成人尸体 2 0具 ,婴幼儿尸体 15具 ,行巨微解剖观察。结果　上段直肠主要由直肠上动脉的分支乙状结肠直肠动脉供血 ;动脉在器官外根据走行可分为降支型、吻合弓型及并列型 ;动脉在器官表面分支多呈环绕型和“鸦爪”型 ,前者主要分布于上段直肠 (壶腹以上 ) ,后者主要分布于直肠壶腹的上半 ;在直肠上段前壁中线部位 ,存在“无血管吻合区”。结论　吻合弓型乙状结肠直肠动脉优于其它两型 ;上段直肠前壁中线表面部位可能存在“相对供血贫乏区”。     

Accessory suprarenal gland: report of a case

The suprarenal glands are normally located at the superomedial aspect of the kidneys. Accessory cortical masses are seen in approximately half of the newborn but usually disappear later. Several cases with accessory cortical tissues located near the main suprarenal glands have been reported but their usual locations have been rarely described. Here we report a case with accessory cortical tissue located on the right in the retrocrural space with compression symptoms. Such a lesion may be confused with lymphadenopathy radiologically.     

食管颈段器官外供血动脉的解剖学观测

目的探讨食管颈段供血动脉的来源及分布情况,为临床应用补充解剖学资料。方法利用成、幼年尸体25具,红色乳胶灌注后剥离,进行解剖学观察与测量。结果得出该部供血动脉主要来源于甲状腺下动脉的分支,占该段食管供血动脉总支数的71.43%;供血动脉可游离长度平均为(16.01±9.15)cm,起点外径平均为(0.94±0.26)cm。结论其血供评价单纯从器官外角度是丰富的,但应综合考虑器官内外的血管构筑。     

先天血管环畸形的解剖变异及外科治疗

目的 总结先天血管环畸形的解剖变异及外科治疗经验.方法 回顾性分析2009年3月-2012年2月收治的21例先天血管环畸形患儿的临床资料.21例中男10例,女11例;年龄4个月～3岁,平均1.1岁.患儿术前均行心脏超声、64排CT检查,其中双主动脉弓8例、右位主动脉弓伴左侧韧带6例、右位主动脉弓伴迷走左锁骨下动脉2例、肺动脉吊带4例、左位主动脉弓伴右侧动脉导管1例,合并法洛四联症4例、室间隔缺损2例、单心房1例、完全性肺静脉异位引流1例、肺静脉狭窄1例.21例均在全麻下行畸形矫治术,其中低温体外循环下手术矫治12例,非体外循环手术9例（7例采用左后外侧切口,2例采用左腋下切口）.结果 所有患儿均顺利完成手术.其中体外循环下手术的患儿,体外循环34～83 min,中位数47 min;主动脉阻断19～50 min,中位数26 min.1例患儿术后出现呼吸功能不全,再次插管呼吸机辅助呼吸.所有患儿均康复出院,于出院后1、3、6、12个月复查,此后每年复查1次.21例患儿平均随访3.6年.随访期间患儿呼吸道症状消失或明显缓解,生长发育正常.术后1个月复查胸部CT气管重建示：气管狭窄较前明显改善.结论 根据先天血管环的解剖变异及是否合并心内畸形选择相应的外科治疗方案,可取得较好的治疗效果.     

Anatomical variations of the human sural nerve and its role in clinical and surgical procedures

The sural nerve is the most commonly nerve used in nerve transplantation, and so the aim of this study was to determine the variations of the sural nerve in the back of the leg, its relations to the calcaneal tendon and lateral malleolus, and determine the patterns of its distribution on the dorsum of the foot. Twenty‐four Egyptian legs and feet were dissected. The results showed that the sural communicating nerve connected with the sural nerve in 87.5%. The predominant site of union between these two nerves was in the lower one‐third of the leg and ankle region (62%). There was only one right leg that the sural nerve passed through the gastrocnemius. The small saphenous vein passed along the medial side of the sural nerve in 100%. The sural nerve crossed the lateral border of the calcaneal tendon in 50%. The distance between the sural nerve and insertion of calcaneal tendon was 16 + 7 mm in 91.7%. There were four types of pattern of innervation of the toes by the sural nerve. The predominant pattern was type I (45.8%), where the lateral side of the little toe was supplied by the sural nerve alone. The second pattern was type IV (29.2%), where the lateral 2 ½ toes were supplied by the sural nerve alone. These findings are important for sural nerve biopsy and grafts, surgical repair of the calcaneal tendon, and regional anesthesia of the foot. Clin. Anat. 24:237–245, 2010. © 2010 Wiley‐Liss, Inc.     

Thoughts on human variations

The article is an autobiographical sketch of the author and his extensive investigation of human variations.