Anatomy of the Plantar Intermetatarsal Tunnel: A Cadaveric Study

The contents of the plantar intermetatarsal tunnel (PIMT) and the relationship between the common plantar interdigital nerve (CPIN) and the PIMT were recorded. The width of the PIMT was measured at the metatarsal neck (MTN), metatarsophalangeal (MTP) joint and the base of the proximal phalanx (BPP). The length of the deep transverse metatarsal ligament (DTML), the PIMT and the intracapsular ligament (ICL) were also measured. The PIMT was revealed to be a narrow osseofibrous tunnel divided into 3 segments by the DTML: the distal section, the area under the DTML (middle) and the proximal section. The length of the middle section was 12.77 mm in the second intermetatarsal (IM) space and 10.18 mm in the third IM space. The lengths of the distal sections were 15.52 and 14.95 mm in the second and third IM spaces, respectively. There was some soft tissue between the CPIN and PIMT, and the CPIN was observed not to glide freely within the tunnel. The widths of the PIMT at the MTN, MTP joint and BPP were respectively 2.87, 2.56, and 3.42 mm in the second IM space and 3.10, 2.68 and 3.61 mm in the third IM space. The ICL lies between the capsules of the MTP joint, and the length of the ICL was 2.76 and 3.03 mm in the second and third IM spaces, respectively. The PIMT was found to be a complex spatial structure, and the ICL might prevent the CPIN from being squeezed into the IM space.     

射精管梗阻的诊断与治疗(英文)

射精管梗阻是一种罕见现象 ,但却是男性不育的重要原因。本文对怀疑射精管阻塞病人的不同诊断、评估和治疗方法作了描述 ,包括一些新的很少侵入性的诊断和治疗射精管梗阻技术     

Anatomy of the Dorsomedial Cutaneous Nerve to Hallux and Surgical Implications According to the Severity of Hallux Valgus Deformity: A Cadaveric Study

The dorsomedial cutaneous nerve to hallux provides sensation to the dorsomedial aspect of the first metatarsophalangeal joint and hallux. Postoperative damage to the dorsomedial cutaneous nerve to hallux have been reported with the dorsomedial approach and symptoms can be very debilitating. The present study aims to understand how the distance between this nerve and the extensor hallucis longus tendon are affected by the severity of the hallux valgus deformity, at the level of the first metatarsophalangeal joint. We performed a cadaveric study using 35 cadaveric lower extremities (N = 35). Each specimen was classified according to the hallux valgus severity through a 30 kg partial weight-bearing antero-posterior radiograph. Before dissection, the lower extremities’ greater saphenous vein was injected with black latex to simplify the distinction between anatomical structures. We concluded that as the hallux valgus angle and the first intermetatarsal angle increase, the distance between the dorsomedial cutaneous nerve to hallux and the extensor hallucis longus tendon also increases, ranging from 12 mm in normal feet to 19 mm in severely deformed feet. Hallux valgus is a three-dimensional deformity that changes traditional surgical landmarks. To avoid harming this nerve, we established a danger zone ranging from 12 mm to 19 mm medial from the extensor hallucis longus tendon, at the level of the first metatarsophalangeal joint. The mid-medial approach to MTP should be preferred as it is out of the danger zone.     

Ejaculatory Duct Dysfunction and Lower Urinary Tract Symptoms: Chronic Prostatitis

Chronic pelvic pain syndrome (CPPS) is the most prevalent form of prostatitis. It is characterized by pelvic pain, voiding symptoms, and ejaculatory symptoms in the absence of bacterial infection. This can be a difficult condition to treat. Many etiologies for CPPS have been proposed including immunologic, neurologic, endocrine, and psychological factors. This article examines a potentially correctable condition that may lead to CPPS, ejaculatory duct obstruction (EDO). EDO is easily correctable with minor surgery. In patients with symptoms of CPPS with associated ejaculatory pain, the diagnosis of EDO should strongly be considered.     

Transcranial Microsurgical and Endoscopic Endonasal Cavernous Sinus (CS) Anatomy: A Cadaveric Study

Aims and Objectives Even in the era of tremendous microneurosurgical and endoscopic development, the cavernous sinus (CS) is a challenging anatomical site for a neurosurgeon. Many transcranial and a few endoscopic cadaveric studies have been done to study the CS; probably none were undertaken to study its microsurgical and endoscopic anatomy side by side. In this cadaveric study we perform a side-by-side comparison of the microsurgical and endoscopic anatomy of the CS that can help neurosurgeons deal with CS lesions more efficiently.Materials and Method Sixteen fresh cadaveric heads were studied after dissection. Six heads were dissected for transcranial study and six for endoscopic study of CS. During the transcranial study, the supratentorial brain was removed in three heads and CS and related anatomical structures were dissected. In the remaining heads, the CS was studied by keeping the brains in situ. In four heads both transcranial and endoscopic study was done simultaneously. Following dissection, microsurgical and endoscopic anatomy of CS was studied.Result The CS and related anatomical structures were dissected sequentially in all cases (transcranially in 10 [6 + 4] heads; endoscopically in 10 [6 + 4] heads), and their relationship was studied.Conclusion Microscopic and endoscopic exposure of the CS is relatively easy in cadavers. But endoscopic or microsurgical exposure of the CS during surgery is more difficult requiring skill. With experience of the cadaveric study , the CS may be explored via transcranial microsurgery, endonasal endoscopy, or both simultaneously, according to the nature and extension of the pathology.     

A Study of the Subvesical Bile Duct (Duct of Luschka) in Resected Liver Specimens

Background Injury to the duct of Luschka is associated with biliary fistula from the gallbladder bed after cholecystectomy. However, few studies have reported on the detailed anatomy. We elucidated the anatomy and frequency of the duct of Luschka Methods A total of 128 specimens from patients who underwent right hepatectomy or more extensive right-sided liver resection between February 1992 and December 2003 were examined. Specimens were fixed in formalin, and serial sections were prepared to trace the course of the bile ducts from the subsegmental branch level. Results The duct of Luschka was observed in 6 (4.6%) specimens. The sites of confluence were as follows: right anterior inferior dorsal branch (2 patients), right anterior branch (2 patients), right hepatic duct (1 patient), and common hepatic duct (1 patient). The upstream end was located in the liver parenchyma of the right anterior inferior dorsal subsegment (5b) and connective tissue of the gallbladder bed in 4 and 2 specimens, respectively. Conclusions The duct of Luschka never crosses the segmental (5b) border. Therefore, its upstream region may not be injured by segmentectomy or more extensive liver resection. However, it is possible to injure the duct of Luschka at the common hepatic duct, even if right-sided hepatectomy is performed, as the sites of confluence included the common hepatic duct.     

Anatomy of the Sural Nerve in the Posterolateral Approach to the Ankle: A Cadaveric Study

Sural nerve injury may occur during the posterolateral approach to the ankle during fracture fixation. We aimed to map its location in a posterolateral approach in cadaveric specimens. A posterolateral approach was used in 28 cadaver legs with the incision made halfway between the medial border of the fibula and the lateral border of Achilles tendon, extending proximally from the tip of the lateral malleolus. The sural nerve was identified and the distance from the distal tip of the incision to where it crossed the incision proximally was measured. The mean distance was 3.4 ± 1.2 (range 0.5-7.0) cm. In 22 cases (78.5%), the distance from the lowest part of the incision to the inferior part of the nerve was between 2.7 and 4.5 cm. The nerve did not cross the incision in 2 cases. We have demonstrated that the sural nerve crossed the posterolateral incision between 2.7 and 4.5 cm proximal to the tip of the fibula in the majority of cases. However, there remains individual anatomical variation, and we would recommend that care should be taken to look for the nerve closer to the Achilles tendon proximally and nearer the fibula distally. We hope that this information can help surgeons plan their approach and minimize iatrogenic injury to the sural nerve.     

Ejaculatory Duct Obstruction after Transurethral Resection of the Prostate

Transurethral resection of the prostate is currently the most commonly employed surgical procedure for benign prostatic hyperplasia. Although several complications after the procedure have been well documented, ejaculatory duct obstruction is a rare complication. We describe this unusual complication in a 77-year-old male who presented with severe pain and a feeling of fullness in the lower abdomen and with dry ejaculate on three occasions after undergoing post-transurethral resection of the prostate. The patient’s post-ejaculatory urinalysis demonstrated no sperm. Transrectal ultrasonography also showed no dilatation of the bilateral seminal vesicles or ejaculatory ducts. However, ejaculatory duct obstruction was finally diagnosed on vasovesiculography. The patient was successfully treated with transurethral resection of the ejaculatory duct and remained asymptomatic 6 months postoperatively. Although transrectal ultrasonography is currently widely used to evaluate ejaculatory duct obstruction, we suggest that vasovesiculo-graphy is still a feasible and useful tool that provides detailed anatomic information for the advanced confirmation of ejaculatory duct obstruction in patients with a high suspicion of ejaculatory duct obstruction who have normal transrectal ultrasonography findings.     

Yield of Terminal Duct Lobule Units in Normal Breast Stereotactic Core Biopsy Specimens: Implications for Biomarker Studies

Abstract: The purpose of this study was to assess the potential value of large-needle core biopsies of normal breast tissue for immunohistochemical studies of epithelial risk assessment. A retrospective analysis was performed to determine the yield of nonatrophic terminal duct lobule units (TDLUs) in 11-gauge vacuum-assisted core biopsies of normal adjacent breast tissue which were included in routine stereotactic core biopsies of benign lesions. Fifty-one patients had a median of two normal tissue cores (range 1–7); 82% of the patients had two or more normal tissue cores; 47% had three or more normal tissue cores. Nonatrophic TDLUs were present in only 47% of patients and in 31% (42 of 137) of all cores. Patients with heterogeneous or dense normal mammographic parenchyma at the site of the biopsy were more likely to have nonatrophic TDLUs, 45% (20 of 44), than patients with fatty normal mammographic parenchyma at the biopsy site, 0% (0 of 7), p = 0.007. Seventy percent (7 of 10) of postmenopausal women on hormone replacement therapy had nonatrophic TDLUs as compared to 41% (11 of 27) of premenopausal and postmenopausal women not on hormones (p = not significant). Eleven-gauge vacuum-assisted core biopsies of normal breast tissue have a low yield of nonatrophic TDLUs suitable for histochemical studies of epithelial risk assessment.