下腔静脉和肝静脉末段的应用解剖学

在40例成人尸体标本上，观测下腔静脉和肝静脉末段的位置，口径，方向，肝静脉注入下腔静脉的形式可分为4种类型，其中以3分支型最为多见，占57．5％，肝静脉与水平面的夹角；肝右静脉约为30°，肝中静脉约为55°，肝左静脉约为55°，下腔静脉和肝静脉末端的体表投影位于右侧胸前壁内侧半，剑突尖水平面与膈穹水平面之间，上述资料对下腔静脉和肝静脉末端超声波检查等临床应用有参考价值。     

肝静脉,肝短静脉注入下腔静脉壁处在肝移植术中的应用

目的 探讨采用膈下肝段下腔静脉壁前半部钳夹,解决肝移植术中无肝期下肢静脉回流障碍。方法 对17例成人尸肝进行解剖,以时钟刻度方法描述肝静脉、肝短静脉注入下腔静脉壁的位置。结果 肝左静脉、肝右静脉、肝中静脉均注入下腔静脉前半壁(即3～9点),肝短静脉多为针眼大小,注入部位多在5～9点之间(154支),少数注入9～11点(9支)。结论 肝移植术中可以采用下腔静脉壁前半钳夹,解决无肝期下肢静脉回流障碍。     

Anatomy of the common trunk of the middle and left hepatic veins: application to liver transplantation

An anastomosis between the common trunk of the middle and left hepatic veins of the receiver and the cranial portion of the inferior vena cava of the donor is one of the techniques for restoration of hepato-caval continuity in orthotopic liver transplantation. This technique avoids dissection of the retrohepatic vena cava and total caval clamping. The aim of this study was to define the feasibility of this technique by a morphologic and biometric study of the common trunk of the middle and left hepatic veins on the basis of 64 injection-corrosion hepatic specimens and 21 fresh subjects. A common trunk for the middle and left hepatic veins was present in 54 of 64 cases (84%) with a length of 3 to 17 mm. The diameter of the new ostium constructed by section 0.5 cm proximal to the junction of the middle and left hepatic veins was 23.9 ± 2.3 mm, which approximated to that of the vena cava where it traversed the diaphragm (24.4 ± 2.0 mm). These findings confirmed that restoration of hepato-caval continuity by anastomosis between the common trunk of the middle and left hepatic veins of the receiver and the cranial portion of the vena cava of the graft is possible without incongruence. This study makes no assumptions about the hemodynamic effects associated with the smallest diameter of the true ostium of the common trunk at its opening into the inferior vena cava. In this study, the morphology of the common trunk was comparable to that observed by Nakamura. Further, we propose an anatomo-clinical classification allowing evaluation of the facility of vascular control of the common trunk in terms of the number and location of the collateral veins.     

A morphological and functional study of the cavo-hepatic junction in the human

Summary The authors studied the morphological and structural aspects of the junctions between the hepatic veins and the inferior vena cava. The study was carried out on 20 specimens obtained from adult cadavers of both sexes, fixed in 10% formaldehyde solution. The hepatic veins with their junctions on the inferior vena cava were isolated. Then a macroscopic analysis of the openings of the hepatic veins into the inferior vena cava was performed. Part of this material was embedded in paraffin, submitted to serial sectioning and stained with Azan's trichrome and resorcin-fuchsin. Three hepatic veins were observed in all cases: right, left and the middle. In 20% of the cases the middle hepatic vein opens directly into the inferior vena cava. The hepatic vein openings are supported by two pillars inferiorly united through a semilunar fold. The hepatic vein wall is greatly thickened at the level of its junction with the inferior vena cava, showing a large ammont of muscular and collagenous fibers. These bundles constitute a sphincter-like formation which may play a physiological role in the control of the hepatic circulation.Les auteurs étudient les aspects morphologiques et structuraux du carrefour hépatico-cave. Cette étude porte sur 20 sujets adultes des deux sexes après formolisation. Les veines hépatiques et leurs terminaisons dans la veine cave inférieure sont prélevées, étudiées sur le plan macroscopique et incluses dans la paraffine. Les coupes sériées sont fixées selon la technique d'Azan. Trois veines hépatiques sont retrouvées dans tous les cas : les veines hépatiques droite, moyenne et gauche. Dans 20% des cas, la veine moyenne s'ouvre directement dans la veine cave inférieure. L'ostium des veines hépatiques s'appuie sur deux piliers réunis à leur partie inférieure par un repli semilunaire. La paroi des veines hépatiques au niveau de leur ostium est très épaisse avec un fort contingent de fibres musculaires et collagènes. Les fibres musculaires réalisent un véritable sphincter qui peut jouer un rôle physiologique dans le contrôle de la circulation hépatique.This report was made at the Anatomy Department of the Biological Sciences Center of UFPE     

Anatomy of the portal branches and the hepatic veins in the caudate lobe of the liver

The objective of this study was to analyze the caudate portal branches and their relationships with the hepatic caudate veins and propose a new nomenclature for the caudate branches based on their territory of distribution. We realized the fine dissection of the veins of the caudate lobe in 40 human livers fixed and preserved in formalin. In 15/40 (37.5%) cases there was a single branch to the caudate lobe. In 25/40 (62.5%) cases there was more than one branch, with a posterior caudate branch in 20/40 (50%) cases, an anterior caudate branch in 15/40 (37.5%) cases, a left caudate branch in 14/40 (35%) cases, and a right caudate branch in 8/40 (20%) cases. The most frequent combination detected (11/40, 27.5% of cases) was that of the posterior and anterior branches. The venous drainage of the caudate lobe and its papillary process was provided by the superior caudate hepatic vein in 23/40 (57.5%) cases, by the middle caudate vein in 35/40 (87.5%) cases (which was the only vein in 12/35 cases), and by the inferior caudate vein in 16/40 (40%) cases. In 11/40 (12.5%) cases there were accessory caudate veins, which emptied into the left and intermediate hepatic veins. The portal branches and the hepatic veins related to the caudate process were studied. In conclusion, the new nomenclature analyzes more precisely the distribution of the caudate portal branches.     

Morphometry of terminal hepatic veins

Summary In the present study, hepatic venous distribution per unit of liver surface area on normal wedge biopsies from man (n=11) and baboon (n=8) were analysed and compared. Terminal hepatic veins (THV - man:n=100; baboon:n=200) morphometric size variables were obtained with a Leitz ASM 68K morphometric equipment. THV, defined as hepatic veins up to 150 m in internal diameter (ID), in the centrolobular position and with sinusoidal openings, represented 84% and 74% of hepatic veins of man and baboon, respectively. Four or more THV were generally found on 8 mm² of liver surface. Transversely sectioned THV selected by the ratio IDminimum/IDmaximum >0.67, was found to be only 25% of the total THV. In baboon, THV merge with other terminal veins and the interlobular veins present sinusoidal inlets. The baboon THV wall surface (WS) and wall thickness (WT) values were higher than in man. Positive correlations between the number of mesenchymal cells (Mc) in the vein wall and wall surface of terminal hepatic veins (man: r= 0.79; baboon: r=0.83) and between wall surface and internal surface (IS) (man: r=0.80; baboon: r=0.72) were found. Two ratios were selected as the most reliable parameters: (1) for the THV wall rim, wall surface/internal surface (WS/IS - man: 0.43±0.16; baboon: 0.63±0.23), regarding transversely sectioned THV; and (2) for the evaluation of wall cell density (WS/Mc-man: 550±231; baboon: 558±183 m²/cell) as they did not depend on THV caliber.Dr. Porto was supported by a fellowship from MEC-CAPES, Brazil. A grant for morphometric equipment was obtained from the Fondation pour la Recherche Médicale and from the Societé d'Hépatologie Expérimentale, 77 rue Pasteur, Lyon, France     

Anatomic basis of vascular exclusion of the liver

Summary Segmentai occlusive phlebography of the IVC, coupled with a slit in its posterior wall, injection of corrosive substances into the portal and hepatocaval network, biometry of the retrohepatic IVC and serial sections of injected livers from 64 subjects allowed a study of the anatomica aspects of VEL: the Pringle maneuver and clamping of the IVC above and below the hepatocaval connexion. Surgery for hepatic tumors close to the connexion can benefit from VEL but the right suprarenal and inferior phrenic veins must be clamped. Clamping of the suprahepatic IVC is dependent on the site at which the clamp is applied in relation to the diaphragm; an abdominal approach is possible in 79% of cases. The principal right hepatic vein, lacking a collateral over 1 cm external to the liver in one of every 2 cases, can be controlled outside the liver after mobilization of the lobe right of the liver, but caution is needed because of the predominance of accessory hepatic veins in 20% of cases. Control of the hepatic veins external to the liver on the left side is dangerous since a common trunk between the middle and left veins is frequent (84%). Collateral branches are also numerous and often vulnerable. Section of the left triangular ligament must be cautious. The relations between the hepatocaval connexion, diaphragm and right atrium also define modalities in the treatment of hepatic lesions such as membranes in the terminal IVC and the Budd-Chiari syndrome.

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Bases anatomiques de l'exclusion vasculaire du foie

Résumé La réalisation de phlébographies occlusives segmentaires de la veine cave inférieure (VCI), d'injections-corrosions des réseaux porte et hépatico-cave, d'une biométrie de la VCI rétro-hépatique et de coupes sériées de foies injectés sur 64 sujets frais a permis de préciser les modalités anatomiques de l'exclusion vasculaire du foie (EVF). Certaines tumeurs hépatiques proches du carrefour peuvent bénéficier de l'EVF mais il faut clamper la veine surrénale principale droite et les veines phréniques inférieures. Le clampage de la VCI supra-hépatique dépend du siège du carrefour par rapport au diaphragme, il est possible par voie abdominale dans la majorité des cas (79 %). La veine hépatique droite principale peut être contrôlée hors du foie une fois sur deux environ car elle se termine alors par un tronc indemne de collatérale sur 1 cm. A gauche, le contrôle des veines hépatiques hors du foie est dangereux car le tronc commun réunissant les veines hépatiques moyenne et gauche est fréquent (84 %). Les rapports entre carrefour hépatico-cave, diaphragme et oreillette droite permettent également d'envisager certaines modalités de traitement des lésions hépatiques dans les membranes de la VCI terminale et le syndrome de Budd-Chiari.

     

Anomalous veins of the retroperitoneum: clinical considerations

Abstract: A case of complex anomalies (variations) of the veins of the retroperitoneum in a 57 year old male cadaver is presented. The anomaly involved a double inferior vena cava, with the left suprarenal v. draining into the left vena cava and the right testicular v. drained into the right renal v., There was also no left common iliac v., with the left external iliac v. draining into the left vena cava and the left internal iliac v. into the right common iliac v.. Although duplication of the inferior vena cava has previously been reported the present case is interesting because of the complexity of the associated anomalies.     

Variations of the bilateral testicular veins: embryological and clinical considerations

Variations of the bilateral testicular veins were observed during routine dissection of the posterior abdominal wall in a 77-year-old male Japanese cadaver. The right testicular vein consisted of the lateral and medial testicular veins. The right lateral testicular vein drained into the right renal vein. The right medial testicular vein accompanied the right testicular artery to ascend obliquely and drained into the left aspect of the inferior vena cava. The left testicular vein was composed of the lateral, middle and medial testicular veins. Three left testicular veins accompanied the left testicular artery to course cranially and then finally drained into the left renal vein.     

An abnormal pattern of blood vessels in the retroperitoneal space with a duplicated inferior vena cava in an adult: a case report

Summary During dissection a duplicated inferior vena cava (IVC) was found in an 82 year-old male. The IVCs were connected with each other by two anastomoses. The course of the other retroperitoneal veins also exhibited some alterations: Just below the diaphragm the azygos and the right ascending lumbar v. ran into the right IVC separately; the hemiazygos and the left ascending lumbar vv. joined before entering the left IVC. The testicular vv. ended normally on the right side in the right IVC, on the left side in the left renal vein. The embryologic basis of the pattern of these vessels is discussed and a short overview of the literature given. In the present case there were also some alterations in the course of the renal and testicular aa.

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Une disposition anormale des vaisseaux sanguins dans l'espace rétro-péritonéal avec une duplication de la veine cave inférieure chez un adulte. Un cas

Résumé Il a été trouvé, pendant les dissections, une veine cave inférieure double chez un homme de 82 ans. Ces deux veines caves inférieures étaient réunies par deux anastomoses. Le trajet des autres veines rétro-péritonéales montrait aussi quelques anomalies : Juste au-dessous du diaphragme, la veine azygos et la veine lombale ascendante droite se jetaient dans la veine cave droite séparément, la veine hémiazygos et la veine lombale ascendante gauche se rejoignaient avant de se jeter dans la veine cave inférieure gauche. Les veines testiculaires se terminaient comme normalement sur le côté droit de la veine cave droite, et à gauche dans la veine rénale gauche. La base embryologique de cette disposition des vaisseaux est discutée et un court survol de la littérature est donné. Dans le cas présenté, il y avait aussi quelques variations du trajet des artères rénales et testiculaires.

     

Intravascular epithelioid hemangioendothelioma of the inferior vena cava: case report of an unusual and unpredictable vascular tumor

Vascular neoplasms are uncommon and pose a diagnostic and treatment challenge to the pathologist and surgeon, respectively. Epithelioid hemangioendothelioma is a rare neoplasm of vascular origin with an unknown etiology. Its biologic behavior lies somewhere between that of a benign hemangioma and that of a malignant angiosarcoma; however, it is unpredictable at best. Intravascular epithelioid hemangioendotheliomas have been described more often in veins than arteries, and there are only about 30 reports in the English literature. We report here the case of an epithelioid hemangioendothelioma of the inferior vena cava, which presented with abdominal pain, ascites and pedal edema.     

肝内门静脉-体静脉分流的MRI表现

目的　探讨肝内门静脉-体静脉分流（intrahepatic portosystemic venous shunt,IPSVS）的MRI表现。 方法　回顾36例采用1.5T或3.0T MRI行上腹部平扫及动态增强扫描的IPSVS患者（PHVS 29例,PIVCS 7例）影像资料,分析其影像解剖学特点。 结果　IPSVS以Tanoue第1种类型的第1亚型（72.2%）和ParkⅡ型（58.3%）最常见。PHVS所在部位除肝Ⅰ段外其它段均存在,以Ⅲ、Ⅵ、Ⅷ段多见,分布在肝内、肝周及包膜下几率相仿,以1个病灶为主,2个及以上病灶少见,形态以结节状为主、动脉瘤状次之,迂曲状及混合形态少见,病灶长径多大于1.0 cm;PIVCS位于肝Ⅰ、Ⅵ、Ⅶ段,分布在肝内-肝周-肝外多见,肝内-肝周及包膜下次之,肝内少见,形态以混合形态的迂曲、结节状为主,病灶长径均大于1.0 cm。IPSVS于MRI平扫T1WI显示上下连续层面肝内的低信号与肝内血管相连,T2WI呈大部分流空的低信号和少许稍高信号,增强显示与病灶相交通的供血门静脉和引流的肝静脉、下腔静脉是其特征性的表现。 结论　MRI能较好地显示IPSVS的血管异常。     

下腔静脉肝后段的观测及其临床意义

目的 :研究下腔静脉肝后段口径变化规律以及与肝静脉开口的关系。方法 :选用福尔马林固定的离体无病变肝脏 3 4例 ,直角规测量内径 ,剖开管腔观察管壁形态及肝静脉开口情况。结果 :下腔静脉肝后段近心端内径为 ( 2 3 .8± 1.1)mm ,狭部内径为 ( 18.0± 1.4)mm ,远心端内径为 ( 2 0 .2± 1.5 )mm ;狭部管腔内多形成纵行皱襞 ;肝左、中、右静脉开口于下腔静脉肝后段上 1/4段 ,口径较大的肝小静脉开口于肝后段下 2 /4段。并使该段中上部形成一向左开放的夹角 ,其平均角度为 ( 15 9.7± 2 .8)°。结论 :下腔静脉肝后段狭部和腔内纵襞的存在 ,为该段狭窄性疾病和血栓形成的解剖学基础     

肝后下腔静脉破裂修补术应用解剖

目的:为肝后下腔静脉破裂修补术提供解剖学资料.方法:50例成人尸体正常肝标本,从正后方剖开肝后下腔静脉,观测肝静脉入口的大小和位置,第二、三肝门之间的距离,第二肝门上方下腔静脉的长度及第二肝门、第三肝门的长度,第三肝门处静脉回流情况.结果:三条肝静脉主干入口分布于肝后下腔静脉上部,形成第二肝门;肝短静脉汇聚于肝后下腔静脉下部,形成第三肝门,静脉支数大多数在4～8支之间,开口下腔静脉右侧壁及前壁的大部分静脉均来自肝右叶,左侧壁静脉主要来自尾状叶;第二、三肝门之间存在一个稀疏间隙.下腔静脉的上口和最高1条肝静脉入口上缘的间距为(21.2±4.7)mm,第二肝门的高度为(21.4±6.3)mm,第三肝门的高度为(40.6±8.7)mm,第二、三肝门之间的距离为(21.9±5.8)mm.结论:第二、第三肝门组成及分布各有规律,二者之间存在间隙,对临床修补肝后下腔静脉破裂,提高病人抢救成功率具有重要意义.     

Unusual obliterative disease of the hepatic veins in an infant

Summary Hepatic fibrosis with obliterative lesions of the small hepatic veins occured in a three month old infant with fatal congenital leukaemia treated with cytostatic drugs. The vascular changes were characterized by an unusual, hitherto unreported angiomatoid, proliferation of the endothelium. The process is compared with the more common subendothelial-fibrous type of the veno-occlusive disease. An etiological interpretation is difficult, possibly the process is a secondary reaction of the endothelium to a cytostatic-induced lesion with hepatic fibrosis.

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Zusammenfassung Es wird berichtet über ein 3 Monate alt gewordenes Kind mit einer zytostatisch behandelten konnatalen LeukÄmie, bei dem im Bereich der kleinen Lebervenen ein obliterativer GefÄ\proze\ beobachtet wurde. Die GefÄ\verÄnderungen waren durch eine bisher nicht beschriebene angiomatoide, polsterförmige Endothelproliferation charakterisiert. Diese wird dem hÄufiger beobachteten subendothelial-fibrösen Typ, wie er charakteristisch für die Lebervenen-Verschlu\-Krankheit (veno-occlusive disease) ist, gegenübergestellt. Eine Ätiologische Deutung ist schwierig, möglicherweise handelt es sich um eine sekundÄre Reaktion des Endothels im Rahmen einer Zytostatika-induzierten LeberschÄdigung mit Leberfibrose.

     

The portal bifurcation and the termination of the hepatic veins: an anatomical investigation into the projection of the ultrasonographically important hepatic vessels onto the anterior body wall

Summary An investigation was carried out on 50 cadavers, in which the projection onto the anterior abdominal wall of the following vascular points was examined: the portal bifurcation, the direction of the course of the right and left branches of the portal vein and the terminal course of the hepatic veins near their entry into the inferior vena cava (IVC). The results are related to a transverse axis passing through the apex of the xiphoid process and the median plane in the supine position. The average position of the portal bifurcation is projected onto a point between a vertical line passing through the midpoint of the right hemithoracic width and a horizontal line passing through a point on the midclavicular line (MCL) corresponding to 57% of the height of the liver measured upwards from its inferior margin. The axis of the prehepatic course of the portal vein makes an anagle of about 50°, open downwards, with a vertical line drawn through the apex of the internal angle of the portal bifurcation. A line parallel to the course of the right and left branches of the portal vein is projected on to a surface line cranial to the right costochondral margin, which runs upwards at an angle of approximately 20° towards the apex of the xiphoid process. The termination of the three great hepatic veins is projected at about the level of the xiphisternal joint, one sternal width to the right of the midline. Close to the IVC, the right hepatic vein runs upwards and medially at an angle of between 20° and 30° with the transverse plane. The final segment of the intermediate hepatic vein has a relatively steeper course medially of between 60° and 70°, and the left hepatic vein runs laterally and towards the right at an angle of between 50° and 60°. The nearly vertical projection of the fissure for the ligamentum teres of the liver bisects the angle included by the final course of the intermediate and the left hepatic vein.

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La bifurcation portale et la terminaison des veines hépatiques: étude anatomique de la projection échographique des gros vaisseaux hépatiques sur la paroi abdominale antérieure

Résumé Cette étude a été réalisée sur 50 dissections cadavériques, dans le but de préciser la projection sur la paroi abdominale antérieure des éléments vasculaires suivants: la bifurcation portale, la direction du trajet des branches droite et gauche de la veine porte et la terminaison des veines hépatiques dans la veine cave inférieure. Les résultats sont donnés par rapport à un axe transversal passant par le sommet du processus xiphoïde et au plan sagittal médian en décubitus dorsal. La situation moyenne de la bifurcation portale se projette au point de croisement d'une ligne verticale passant par le milieu de l'hémithorax droit et d'une ligne horizontale coupant la ligne médio-claviculaire (LMC) à 57% de la hauteur du foie mesurée de bas en haut à partir de son bord inférieur. L'axe du tronc de la veine porte fait un angle ouvert en bas d'environ 50° avec la verticale passant par la bifurcation portale. Une parallèle au trajet des branches droite et gauche de la veine porte se projette sur une ligne située cranialement par rapport au rebord chondrocostal droit, qui monte vers l'extrémité du processus xiphoïde en faisant un angle de 20° avec le plan transversal. La terminaison des trois veines hépatiques se projette environ au niveau de l'articulation sternoxiphoïdienne à une largeur de sternum à droite de la ligne médiane. A proximité de la veine cave inférieure, la veine hépatique droite se dirige cranialement et médialement en formant un angle de 20 à 30° avec le plan transversal. Le segment terminal de la veine hépatique moyenne a un trajet relativement plus vertical avec un angle de 60 à 70° et la veine hépatique gauche se dirige vers la droite en formant un angle de 50 à 60°. La fissure du ligament rond du foie se projette presque verticalement sur la bissectrice de l'angle formé par la portion terminale des veines hépatiques moyenne et gauche.

     

肝短静脉的解剖学研究及其在肝脏外科中的临床应用进展

目的 总结肝短静脉(SHV)的解剖学研究及其在肝脏外科中的临床应用研究进展,为临床治疗主肝静脉病变相关肝脏疾病提供参考。方法 在中国知网、万方数据、PubMed、Web of Science等数据库以“肝短静脉” “肝切除” “肝移植”“Budd-Chiari 综合征”以及“short hepatic vein”“hepatectomy”“liver transplantation”“ Budd-Chiari syndrome”为关键词,检索2000年1月—2018年6月国内外有关SHV方面的相关文献资料,并进行汇总分析。结果 共检索到文献795篇,按纳入标准和排除标准最终纳入35篇文献,其中中文文献8篇和英文文献27篇。SHV的发现,补充和完善了肝脏的血液回流途径研究。对SHV的精准解剖是预防术后出血和保证肝脏静脉回流的关键步骤,目前已在部分肝段切除、肝移植以及Budd-Chiari综合征等外科治疗中广泛应用。结论 熟练掌握SHV的解剖是治疗肝脏血流动力学障碍相关疾病和促进肝脏外科发展的重要基础。     

The inferior supernumerary renal arteries: A classification into three types

Among cases that had multiple renal arteries on one side, an inferior supernumerary renal artery was found in 24/270 cases (ca. 9%) on the right and in 19/270 cases (ca. 7%) on the left, together with the usual renal artery. We have noticed that there are correlations between their levels of origin from the aorta and their positional relation to the ureter and the inferior vena cava (IVC). An inferior supernumerary renal artery (InfRA) of lower origin passes in front of the IVC and behind the ureter. An InfRA of middle origin passes in front of both the IVC and the ureter. An InfRA of upper origin passes behind the IVC and in front of the ureter or renal pelvis. In addition there was a tendency for the lower origin type to have an ureteric branch, while the middle and upper origin types had a gonadal branch. These findings suggest that different derivations lead to the inferior supernumerary renal arteries.     

Circulatory effects of internal jugular vein compression: A computer simulation study

The effects of compression of the internal jugular veins and the inferior vena cava are simulated using an equivalent electronic circuit, which included simulation of cardiocirculatory phenomena and special features of the cerebral circulation. Compression of the inferior vena cava resulted in a profound decrease in cardiac output (from 4.5 to 1.5l min⁻¹) and arterial pressure (from 140/85 to 50/35 mm Hg). Compression of the internal jugular veins resulted in a negligible slightly decreased. Cerebral capillary and internal jugular pressures were considerably increased, leading to obstruction of cerebral veins and increased pressure (from 9 to 22 mm Hg) and volume (from 120 to 145 ml) of the cerebrospinal fluid (CSF). Increased cerebral capsule compliance resulted in decreased CSF pressure (from 9 to 8.5 mm Hg), but CSF volume increased (from 120 to 190 ml). A small increase in brain volume (from 1000 ml to 1060 ml, 6% volume increase) was compensated for by an equal decrease in the volume of CSF. When brain volume was above 1080 ml, the absorption of CSF was reduced, and its pressure increased.     

Course of the hepatic inferior vena cava in a Kenyan population

The course of the hepatic inferior vena cava (HIVC) has a wide range of variations which are relevant in hepato‐vascular surgery and liver transplantation. Eighty livers were studied for hepatic course and axial orientation of the HIVC. The HIVC was found to run in an incomplete tunnel in 43.8% of the cases (n = 35), complete tunnel in 32.5% of the cases (n = 26) while in the rest, it was contained in a shallow groove on the retrohepatic surface. It assumed an oblique course in relation to the longitudinal axis of the liver in 60% of the cases (n = 48). The findings of this study vary to a wide range from those reported previously, and call for extra caution during surgical operations involving the HIVC region. Clin. Anat. 22:610–613, 2009. © 2009 Wiley‐Liss, Inc.