Review of the surgical anatomy of the axillary nerve and the anatomic basis of its iatrogenic and traumatic injury

The axillary nerve is invariably reported to be one of the most commonly injured nerves during surgical procedures of the shoulder, and the importance of protecting it cannot be overemphasized. Many researchers have tried to identify safe regions, but the results vary among published studies. The axillary nerve may also be injured during acute trauma to the shoulder or by chronic repeated trauma as has been described in the quadrilateral space syndrome. The nerve injury may occur together with shoulder dislocation and rotator cuff tear, thus comprising the so-called “unhappy triad” of the shoulder joint. Simple attention to potential variations in the origin and course of the axillary nerve and its relationship to the shoulder capsule and having a precise knowledge of “safe zones” during operations can enhance clinical outcomes. The objective of this review, therefore, is to discuss the surgical anatomy of the axillary nerve and further emphasize the clinical importance of the its injury following shoulder trauma.     

Anatomical observations of the moderator band

Apical ventricular septal defects are rare pathologies of the ventricular septum. The moderator band, or other large trabeculations, is the major obstacle for the repair of such defects. The aim of our study was to identify and describe variations in the size and anatomy of the moderator band. We studied the right ventricular apical trabeculations in 100 adult human cadavers. Overall, we identified the moderator band in 92% of hearts. In just over two‐fifths (42%), the band was a short and thick trabeculation, whereas, in one‐eighth (12%), it was long and thick. In just under one‐quarter of the hearts (24%), the band was short and thin, whereas it was long and thin in 14% of the hearts. In the remaining eight hearts, we were unable to identify the moderator band. The mean thickness of the band was 4.5 ±1.8 mm, and its mean length was 16.23 ± 2.3 mm, ranging from 11.3 to 24.3 mm. According to these measurements, we were able to classify the band as originating less than 45% of the distance from the tricuspid valve to the apex (closer to tricuspid valve), seen in 12 hearts, between 45 and 55% of the distance from the valve to the apex, seen in 45 hearts, and greater than 55% of this distance (closer to the apex), seen in 39 specimens. We present these data that may prove useful in the setting of the surgical repair of apical ventricular septal defects through the right atrium. Clin. Anat. 23:443–450, 2010. © 2010 Wiley‐Liss, Inc.     

Expression and gonadotropin regulation of membrane progestin receptor alpha in Atlantic croaker (Micropogonias undulatus) gonads: Role in gamete maturation

Recent results suggest that membrane progestin receptor alpha (mPRα) mediates nongenomic actions of progestin hormones to induce oocyte maturation and sperm hypermotility in several teleost species. The role of mPRα in gamete and gonadal physiology was further evaluated in the present study by examining gonadal expression of mPRα during gamete maturation in Atlantic croaker (Micropogonias undulatus), a well-characterized teleost model of oocyte maturation and sperm motility. Sequencing of the croaker mPRα gene isolated from croaker ovaries showed it is 98% homologous at the nucleotide level to spotted seatrout mPRα. The mPRα mRNA and protein were detected in both somatic and gonadal tissues. In croaker ovaries, the mPRα protein was present throughout the gonadal cycle and was upregulated by gonadotropin in vitro, coincident with the acquisition of oocyte maturational competence (i.e., ability to respond to progestin hormones and complete oocyte maturation). Both mPRα mRNA and protein were also expressed in croaker testes throughout the gonadal cycle. Expression of mPRα protein was weakly upregulated in testes after 18 h of in vitro gonadotropin treatment. Immunocytochemical staining showed mPRα was localized to both germ and interstitial cells. Finally, elevated levels of mPRα protein in croaker sperm were associated with high sperm motility. Taken together, these data strongly support the hypothesis that mPRα mediates progestin induction of oocyte maturation and upregulation of sperm motility in teleosts.     

Predicting radial nerve location using palpable landmarks

The purpose of this study is to predict the location of radial nerve (RN) utilizing palpable anatomic landmarks. Thirty‐four paired upper limbs were dissected. The RN was localized: (1) at the humeral spiral groove (SG), (2) lateral intermuscular septum (LIS), and (3) at its' division into the posterior interosseous nerve (PIN) and radial sensory nerve (RSN). The PIN was located at the anterior aspect of the radial neck (AN). Humeral and radial lengths were measured. The RN traversed the SG, on average, 48% (36%–63%) of humeral length, distal to the greater tuberosity. The RN pierced the LIS, on average, 38% (29%–56%) of humeral length, proximal to the lateral epicondyle (LE). The PIN/RSN division occurred on average 1.0 cm (?11.4 to 3.5) distal to the LE. The PIN crossed the AN, on average, 10% (5%–14%) of radial length, distal to the radial head articular surface. Clin. Anat. 23:420–426, 2010. © 2010 Wiley‐Liss, Inc.     

Legacy of Avicenna and evidence-based medicine

Although the term 'evidence-based medicine' (EBM) is of recent origin, its roots are generally agreed to lie in earlier times. Several writers have suggested that the 11th century CE physician and philosopher Avicenna (Ibn Sina) formulated an approach to EBM that broadly resembles modern-day principles and practice. The aim of this paper is to explore the origins and influence of Avicenna's version of EBM. A survey of the literature suggests that two influences on Avicenna's thought were crucial: the doctrine of Ijma; and Stoic logic, perhaps transmitted via the writings of Galen. In turn, Avicenna is known to have been a major influence on both medical practice and the development of logic in medieval Europe. Through this route, Avicennian logic (notably its inductive aspect) inspired the new style of thought associated with the scientific revolution, which later came to be reflected in 'scientific medicine', and may therefore have been an indirect source of EBM today.     

The cardiac lymphatic system

The lymphatic system, a network of vessels carrying clear interstitial fluid called lymph, is found throughout the human body. The system maintains homeostasis, receiving proteins and excess fluid from the interstitial tissues, and returning them to the venous system. Understanding of lymphatic drainage remains important in the diagnosis, prognosis, and treatment of diseases, including the metastasis of malignant diseases. Information specific to the cardiac lymphatics is scarce. Indeed, quite often the topic is not even mentioned in many medical textbooks. The goal of our review is to compile and analyze the information currently available concerning the cardiac lymphatics, hoping further to demonstrate the clinical importance of this neglected system.     

René Le Fort 1869-1951

Over a century ago, The French surgeon René Le Fort described the anatomical basis for fractures of the mid-face. His nomenclature is still used today using the eponym "Le Fort fractures." Although Le Fort's name is well known in association with the fractures that he described, little is known of his life. Therefore, the present article will discuss the background of this important individual in craniofacial trauma.     

Extracardiac coronary arterial anastomoses

The collateral arterial circulation of the heart has been extensively studied. However, less attention has been paid to extracardiac anastomoses, which may also be of significant clinical importance. In this review, we will describe the most common types of these anastomoses, which include bronchial to coronary arteries and internal thoracic to coronary arteries. In a much lesser degree, anastomoses between coronary arteries and pericardiacophrenic branches of the internal thoracic arteries, anterior mediastinal arteries, intercostal arteries, and esophageal arterial branches have also been described. Knowledge of the likely morphology and function of the anastomoses, therefore, could prove helpful in the clinical evaluation of patients with myocardial ischemia, particularly when selecting candidates for myocardial revascularization.