Idiopathic temporal bone encephalocele

Meningoencephaloceles are herniations of brain tissue through dehiscences of the skull base. These skull defects are either acquired (otologic infection, trauma, surgery, neoplasia) or spontaneous. Spontaneous temporal bone meningoencephaloceles are quite rare conditions, usually congenital in origin presenting during childhood, and only occasionally idiopathic presenting during adulthood. We present a case of temporal bone meningoencephalocele of adult onset. The patient was treated with exploratory mastoidectomy, amputation of the herniated cele and closure of the defect with temporalis fascia and an inferiorly based pedicled muscular flap. No reconstruction of the bony defect was performed, as the layered closure was considered adequate. Twelve months' follow-up revealed no relapse of the condition or postoperative complications.

High bifurcation of the brachial artery

Variations of the arterial pattern in the upper limb are quite common in humans. In the present study, we describe two cases of high bifurcation of the brachial artery. In the first cadaver both branches run superficially along the arm and were also located superficially at the antecubita fossa. In the second cadaver the branch that continues as the radial artery in the forearm run superficially and was located also superficially at the antecubita fossa, while the second branch had a more or less normal distribution. The embryological basis and clinical significance are discussed.

The safest electrode trajectory for deep brain stimulation of the human nucleus accumbens: a stereotactic anatomic study

BACKGROUND

The primary purpose of our stereotactic anatomic study was to determine the safest electrode trajectory for deep brain stimulation (DBS) of the human nucleus accumbens (NA). Considering NA DBS together with the complications related to surgical implantation and based on methods for assessing the electrode trajectory we tried to reveal the secret of a trajectory for targeting the NA with the highest possible level of safety.

MATERIAL AND METHODS

Our material consisted of 30 cerebral hemispheres we have in our Department from cadaver donors for students' education. We identified the electrode's target point in coronal sections. As safe we considered a trajectory from the cerebral cortex to the NA, which traverses the anterior limb of the internal capsule (AIC) without passing through either the caudate nucleus or putamen. We measured the minimum, maximum and safest coronal angles of the electrode trajectory (between the trajectory and the midline), as well as the AIC angle and width of the trajectory angle. We also measured trajectory projection length from the cerebral surface to the superior (d1) and inferior (d2) margins of the NA.

RESULTS

The safest trajectory angle for NA DBS was found to have a mean value of 29.10 degrees, ranging from 23.80 to 35.40 degrees. The mean AIC angle was 33.78 degrees. We found no statistically significant difference between right and left hemispheres and a strong statistical relation between the safest electrode trajectory and AIC angle. Mean values of d1 and d2 were found to be 53.57 mm and 60.86 mm respectively. The mean value of the length of the electrode trajectory in coronal projection within the NA (d2-d1) was found to be 7.29 mm.

CONCLUSION

The new knowledge that our stereotactic anatomic study offers is a definition of the safest electrode trajectory for NA DBS, its coronal angle width, as well as an estimation of its length.

The human nucleus accumbens as a target for deep brain stimulation: anatomic study of electrode's target point and stereotactic coordinates

INTRODUCTION

The nucleus accumbens (NA), a "pleasure center", is the most inferior part of the ventral striatum. NA, related to the limbic and extrapyramidal motor system, is involved in some of the most common neuropsychiatric disorders. Nowadays it is a target for deep brain stimulation (DBS), in some carefully selected patients. Our purpose was to evaluate the accuracy of its position within the NA, in relation to the stereotactic target point that is today used.

METHODS AND MATERIALS

We identified, studying 25 cerebral hemispheres, the target point of the NA DBS electrode, at a specific level that is important for its imaging. We also identified the stereotactic coordinates of the NA and made a statistical analysis and comparisons.

RESULTS

We found that in 3 out of 25 cases, the used stereotactic coordinates fail to offer a target point within the limits of the NA.

DISCUSSION

We present the first stereotactic anatomic study evaluating the precise position where the electrode for human NA DBS is to be placed and the only anatomic study of the human NA performed on such a large number of cases. The stereotactic coordinates used for NA DBS are accurate. However, we suggest that the electrode's final position should be considered to be slightly less deep.

Sectioning of filum terminale externum using a rigid endoscope through the sacral hiatus. Cadaver study

AIM

Tethered cord syndrome (TCS) is a stretch-induced functional disorder of the spinal cord, which is directly related to filum fixation. Classic surgical approaches to the filum involve open surgery and include varying amounts of spinal bone removal. In an effort to reduce the morbidity and mortality of these procedures, the authors explored a less invasive method. They evaluated the ability, safety and feasibility for endoscopic sectioning of the filum terminale externum by performing upward orientated navigation in the extradural sacral spinal canal through the sacral hiatus using a rigid endoscope.

METHODS

Four adult, phenol-formalin embalmed cadavers were used for endoscopic section of the filum terminale externum at the tip of thecal sac. After preparing the anatomical area of sacral hiatus, a rigid endoscope (Storz, of 3.8 mm external diameter with two working channels, of 1 mm each, one for suction-irrigation and one as working) was inserted into the extradural sacral spinal canal and the filum terminale externum was identified and cut easily at the distal end of thecal sac at the level of S2. In all cases, it was possible to manipulate the rigid endoscope and inspect the full length of the extradural sacral spinal canal, especially at the S1-S2 level.

RESULTS

The results indicate that the tested transhiatal approach for upward orientated extradural endoscopy represents a minimally invasive procedure that provides an appropriate and feasible route to the extradural sacral spinal canal.

CONCLUSION

Such approach is an attractive alternative for filum terminale externum sectioning in cases where tethered cord syndrome is not accompanied by any other pathology. Moreover if filum terminale internum sectiong is indicated, it can be performed in second stage.

Dolichoectatic Cervical Arteries (Carotid and Vertebral Arteries) Heralded by Recurrent Cerebral Ischemia: Case Illustration

A case of a 61-year-old man with recurrent episodes of cerebral transient ischemic attacks is reported. The patient had a history of cigarette smoking, hypertension, hypercholesterolemia, and diabetes mellitus. Before these episodes, the patient had no clinical symptoms and signs of cerebral pathology. Brain magnetic resonance imaging revealed microvascular lesions in the white matter of the cerebral hemispheres. Digital subtraction arteriogram revealed the aortic arch dolichoic shape and course of the great vessels originating from it, whereas there were no pathological findings from the intracranial vessels. This study describes a case of the existence of distal dolichoectasia of the vertebral and carotid arteries without intracranial dolichoectasia. It seems that such a type of dolichoectasia does not influence the performance status of a patient, but when a critical point is crossed, patients suffer from cerebrovascular disease.

Middle cranial fossa endoscopy using a rigid endoscope

Trigeminal neuralgia (TN), also known as tic douloureaux, is a craniofacial pain disorder which is typically associated with acute-onset severe pain on one side of the face usually. The condition is characterized by intermittent unilateral pain affecting the lower face and jaw. Although many potential causes have been implicated, in many patients the etiology remains obscure. Initially, patients with trigeminal neuralgia should be offered conservative medical management. If surgery is necessary, the simplest and least hazardous procedure should be chosen. The goals of modern surgical therapy are: Long-term pain control, minimal to no morbidity, and as low a mortality risk as possible. In this study, we attempted to perform middle cranial fossa endoscopic exploration in four adult phenol-formalin embalmed cadavers, using a rigid endoscope with 3.8 mm external diameter and two working channels of 1 mm in diameter each (Karl Storz, Tuttlingen, Germany), inserted through a burr-hole centered at the base of the middle cranial fossa, 1 cm in front and 1 cm upwards of the tragus. Our objective was to determine if this approach provides adequate access to the trigeminal ganglion for possible dissection of V2 and V3 trigeminal roots, the two typically radiating sites of TN. In all four cadavers, middle cranial fossa exploration was possible without difficulties. We offer this approach as a minimally invasive surgical procedure to access the trigeminal ganglion, for potential use as another alternative for the surgical management of medically refractory trigeminal neuralgia.

Endoscopic anatomy of the thecal sac using a flexible steerable endoscope

In this study the ability for upward-orientated endoscopic visualization of thecal subarachnoid space using a flexible steerable endoscope was evaluated in order to compare endoscopic anatomical findings with the already known macroscopic ones of the incontained structures and to test the approach for clinical employment. For this purpose, four adult phenol-formalin embalmed cadavers were used and the approach selected was through a laminectomy window at the S1-S2 level. The dura mater was opened and a flexible steerable endoscope (Storz, of 2.8 mm external diameter with one working channel) was inserted subarachnoidally for upward-orientated observation of the content of thecal sac. By using this approach filum terminale, lower lumbar, sacral and coccygeal nerve rootlets were identified and observed in detail. By moving the endoscope even more upwards, inspection of the upper part of the thecal subarachnoid space and conus medullaris was also possible. The findings collected from the study indicate that this approach for upward-orientated intradural subarachnoid endoscopy gives an appropriate working and inspecting window to the lower, as well as to the upper part of the thecal subarachnoid space and even of the conus medullaris. Furthermore, inspection and identification of lower lumbar, sacral and coccygeal nerve rootlets is possible and efficient and the endoscopic anatomical observations coincide with the already known gross-anatomical ones.

Temporal bone study of development of the organ of Corti: correlation between auditory function and anatomical structure

OBJECTIVE

To study the development of the organ of Corti in the human cochlea, and to correlate our findings with the onset of auditory function.

MATERIAL AND METHODS

Step sections of 81 human fetal temporal bones were studied, from eight weeks of gestation to full term.

RESULTS

By the end of the 10th week, the tectorial membrane primordium could be traced even in the most apical turns. Individual hair cells became identifiable at the basal turn at 14 weeks. At the same time, a small but well formed oval space was observed between the inner and outer hair cells in the basal turn. This does not correspond to the tunnel of Corti, as is erroneously quoted in the literature, as the individual pillar cells develop at later stages. Between 14 and 15 weeks, Hensen's cells were recognised for the first time. Individual pillar cells were identifiable at 17 weeks and the tunnel of Corti opened at 20 weeks. By 25 weeks, the cochlea had reached its adult size, but continued to develop until full term.

DISCUSSION AND CONCLUSIONS

A temporal coincidence of different developmental events is responsible for early fetal audition at 20 weeks, including growth of pillar cells, opening of the tunnel of Corti and regression of Kollicker's organ, with the subsequent formation of the inner spiral sulcus and then separation of the tectorial membrane. The fine structures of the organ of Corti continue to develop well after the 25th week, and this may well alter the mechanical properties of the vibrating parts of the cochlea, which may in turn account for the frequency shift observed in preterm infants. These changes will have to be taken into account in the development of prenatal hearing screening tests.

Anomalous origin of circumflex artery from right sinus of Valsalva: a rare cause of non-ST elevation syndrome

We present a case with anomalous origin of the left circumflex artery from the right coronary artery ostium, which caused a non-ST elevation coronary syndrome. A review of the literature indicates this to be an extremely rare case.

H3 Propranolol serum levels following lidocaine administration in rats with CCL4 — induced liver damage

Liver disease alters the pharmacokinetic and pharmacodynamic properties of hepatically eliminated drugs. The main factors influenced are plasma albumin levels, enzyme balance (induction & inhibition) and drug binding to tissue proteins. The influence of lidocaine on serum, heart and liver propranolol levels in Wistar rats after liver injury induced by carbon tetrachloride CCl4 0.4 ml/kg x 2/wkl, was investigated. 40 male Wistar rats were divided into four groups (I, II, III, IV; n=10), Group I animals received only propranolol (labelled + cold substance) 40 mg/kg/12 h p.o., group II propranolol plus lidocaine in a single dose of 4mg/kg s.c., group III was treated with CCl4 for 6 weeks and received propranolol x2 at the same dosage as group I, while group VI was treated with CCl4 and the same drug dosage as group II. The simultaneous administration of H3-propranolol and lidocaine increased propranolol levels in the serum and tissues. The liver in damaged animals showed an increase of propranolol level under lidocaine co-administration, probably due to CCl4 induced liver enzyme activity, resulting in a rapid propranolol metabolism or to competition between both drug protein binding sites. The increased propranolol levels in the heart after lidocaine administration were probably due to attributed to its high affinity for heart tissue. Consequently, as regards the therapeutic approach for patients with liver disease receiving propranolol their propranolol dosage should be reduced when lidocaine is co-administered.

The development of the spiral ganglion in the human foetus

The development of the spiral ganglion was studied in steps sections of 81 human temporal bones. By the 8th week, the spiral ganglion has already separated from the vestibular ganglion. At 13 weeks two distinct populations are observed that correspond to neuron and Schwann cells. At 15 weeks the spiral ganglion has increased its distance from the cochlear duct and is surrounded by mesenchyme near the scala tympani. At 14 weeks a gradual decrease in the nucleus-to-cell area ratio was observed in spiral ganglion neurons that may reflect a morphological adaptation to function. By the 23rd week the modiolus begins to ossify and the spiral ganglion is surrounded by bony trabeculae. The time course of spiral ganglion development follows that of the stria vascularis and organ of Corti, although maturation changes are still observed in the neuronal population even beyond 20 weeks.

Thecaloscopy through sacral bone approaches, cadaver study: further anatomic landmarks

Endoscopy of the spinal canal, for interventional studies, diagnosis and therapy, is a scientific topic that has attracted the interest of neurosurgeons, anesthesiologists and orthopedic surgeons for the past twenty years. Endoscopy of the thecal sac was assumed to be less important than endoscopy of the ventricular system by neurosurgeons. Nevertheless, during the last years it has attained increasing scientific interest, firstly because of the introduction of small diameter flexible endoscopes and secondly due to the growing interest for minimal invasive diagnostic and therapeutic procedures in modern neurosurgery. Until now thecaloscopy was performed by the ISGT (International Study Group for Thecaloscopy) using co-axial downward orientated approaches. We have examined transsacral approaches to facilitate the navigation of flexible scopes in the lumbosacral subarachnoid space, and thus we now introduce further recognizable endoscopic anatomic landmarks.

Angioplasty and stenting of extracranial vertebral artery stenosis

Percutaneous angioplasty and stent placement seem a useful technique for the treatment of vertebro-basilar insufficiency and the first treatment to be proposed. This technique appears safe and effective for alleviating symptoms and improving blood flow to the cerebral circulation, with a low complications rate and good long-term results. However, this procedure needs experienced interventionists to choose the stent and have appropriate placement of the stent in the ostium of the vertebral artery (VA). The tortuosity of the VA may be technically challenging. The new coronary stents seem to be well suited to treat atherosclerotic lesions of the origin and of the proximal VA. A large variability of restenosis risk has been reported. Drug eluting stents may be the solution. Prospective randomized studies are needed to demonstrate the clinical effectiveness of VA stenting in stroke prevention, its durability, and to define more clearly its indications.

Adjuvant arthritis-induced changes on ampicillin binding in serum and tissues under the influence of non-steroidal anti-inflammatory drugs in rats

Adjuvant arthritis, as a model for investigating rheumatoid arthritis (RA), is characterized by reduced plasma albumin levels and interferes with drug binding in the plasma and tissues (liver and bone). Ampicillin interacts with non-steroidal anti-inflammatory drugs (NSAIDs) due to the acidic pk(a). The aim of this study was to investigate in vitro the concentrations of ampicillin in the serum, femur, mandible and liver proteins following the co-administration of ketoprofen, flurbiprofen, ibuprofen, oxyphenbutazone and ASA in adjuvant arthritis versus healthy control rats. Ampicillin binding was found to be reduced in the serum of arthritic rats, and ampicillin binding to serum proteins was also reduced under the influence of NSAIDs in the control animals. Differences in ampicillin binding were observed in the various tissues due to the effect of adjuvant arthritis as well as that due to the co-administration of NSAIDs. In conclusion, this in vitro study may provide a plausible explanation for the ampicillin-NSAIDs interaction and such a finding may be of therapeutic significance in the treatment of painful arthritic disease such as RA.

A new morphometric method for the sella turcica and the hypophyseal fossa and its clinical relevance

The sella turcica and the hypophyseal fossa should be considered different entities, the latter being part of the former. Their morphology and dimensions correlate to some extent with those of the contained pituitary gland and have, for this reason, attracted the interest of anatomists and radiologists. With the application of MRI, however, these data are of limited use in the diagnosis of pituitary disorders, although they remain valuable with regard to a microsurgical approach to the hypophysis. The proposed morphometric method was applied to 20 dry skulls. We first made casts of the corresponding sellae. Their volumes were then measured by immersion. The frontal section of each hypophyseal fossa was obtained through its deepest point and magnified. The Cartesian co-ordinates of the contour of the section were used to evaluate the corresponding area and centroid. The volume of each fossa was finally obtained by the use of Pappus' theorem applied to solids of rotation. The volumes of the sellae obtained as above ranged from 460 mm3 to 1570 mm3 with a mean value of 835 mm3. These figures are comparable to those reported from previous authors. To our knowledge the method described has enabled a close approximation of the volumes of the hypophyseal fossae to be made for the first time. These volumes ranged from 24 mm3 to 300 mm3, with a mean value of 157 mm3. Similar numerical methods might be applicable in vivo by the use of MR imaging.

Ketamine-induced changes in metabolic and endocrine parameters of normal and 2-kidney 1-clip rats

BACKGROUND AND OBJECTIVE

The aim of this study was to investigate the effect of ketamine on the endocrine and lipid metabolic status of the renal-banded animals.

METHODS

Forty male rats were randomly divided into four groups. Group A served as control, Group B animals received ketamine intraperitoneally at a dose of 100 mg kg(-1), Group C was submitted to 2-kidney 1-clip experimental hypertension and Group D received ketamine as above, as well as being submitted to renal artery clipping. Atrial natriuretic peptide, angiotensin II and free fatty acid concentrations were measured in serum. In addition, adipose tissue lipoprotein lipase activity and angiotensin II content were determined, while the left ventricular weight relative to body weight was used as a cardiac hypertrophy index.

RESULTS

In renal-banded rats (Groups C and D) serum atrial natriuretic peptide, free fatty acid and angiotensin II concentrations as well as ventricular weight were increased, while adipose tissue lipoprotein lipase activity was lower than in control animals (Groups A and B). Ketamine administration did not influence angiotensin II concentrations either in normal (Group B) or banded rats (Group D). Ketamine increased serum atrial natriuretic peptide and free fatty acid concentrations only in normal animals (Group B). It had no influence on adipose tissue lipoprotein lipase activity either in normal (Group B) or banded animals (Group D). Adipose angiotensin II content did not differ between the four groups.

CONCLUSION

Ketamine increased the atrial natriuretic peptide and free fatty acid concentration in normal rats. In 2-kidney 1-clip animals, ketamine did not elicit an additional response of serum atrial natriuretic peptide or free fatty acids levels. Its contribution to these factors was not significant.

Alterations in cefalosporin levels in the serum and mandible of hyperlipaedemic rats after co-administration of ibuprofen

Several interactions between antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) have been described in the literature, and it has been reported that hyperlipidaemia induces significant changes in cefalosporin levels. The aim of this study was to determine the changes in the levels of several cefalosporins in the serum and mandible after ibuprofen co-administration in hyperlipaedemic rats. One hundred and forty male Wistar rats were used and divided in 4 groups (A-D), each of which was further divided into 5 subgroups (1-5), either with placebo or with various treatment regimes. The co-administration of NSAIDs led to increased cefalosporin levels in both control and hyperlipidaemic animals. Hyperlipidaemia was also found to augment cefalosporin levels. These observed increases might be due to the displacement of the cephalosporins from their binding sites in serum albumin and tissue proteins in the presence of ibuprofen. NSAIDs showed a greater binding affinity for tissue proteins compared to the cephalosporins, and probably play an antagonistic role in protein binding, resulting in higher concentrations of antibiotics.

Topographic relationship between the cochlea and the middle fossa floor: the anatomical basis for an alternative approach to the cochlear turns

The cochlea has attained extreme surgical interest since cochlear implantation has been recognized as an established method for the management of certain types of bilateral profound hearing loss. Traditionally access to the cochlear turns is achieved through the middle ear. Extremely limited references exist in the literature regarding alternative surgical approaches to the cochlea. In the present study we tried to highlight the anatomic relationships of the superior aspect of the bony cochlea to the adjacent superficial structures of the petrous bone, as there have been suggestions that the cochlea is surgically accessible through the floor of the middle cranial fossa (MCF). A total of 58 dry human adult skulls (116 temporal bones) were studied. The groove for the greater superficial petrosal nerve (GGSPN) and the facial hiatus were used as landmarks in order to expose the superior aspect of the cochlea. Measurements were made of the following distances: a) between the MCF floor and the superficial part of the basal turn (SPBT), b) between the MCF floor and the apex of the cochlea, c) between the SPBT and the GGSPN and d) between the SPBT medially and the first genu of the facial canal laterally. Our results indicate that adequate and reliable surgical access to the bony cochlea could be achieved through the MCF floor.

Modifications of clonidine binding to rabbit liver protein under the influence of non-steroid-anti-inflammatory drugsin vitro

This study was designed to investigate the binding of clonidine to liver protein as well as the possible interactions with non-steroid anti-inflammatory drugs (NSAIDs) during the binding process in the rabbit. The binding of clonidine to slices (S) and homogenized slices (H) was estimated by a radioisotopic method following incubation with a mixture of cold and 3H-labelled clonidine in Ringer solution at 37 degrees C for 360 min. The binding of clonidine was assessed in the absence and presence of the following NSAIDs: flurbiprofen, ketoprofen, ibuprofen and acetylsalicylic acid. The results showed that the percentage of clonidine binding did not differ between intact and homogenized slices. The addition of all NSAIDs but ibuprofen, significantly decreased the protein binding of clonidine both in intact and homogenized liver slices. This finding could be attributed to the different affinity of ibuprofen for liver protein compared to the remaining NSAID's which may arise from a number of chemical properties including its dual Pka values.

A regulated telemedicine system for day to day application in remote areas

The NIVEMES project creates an international network of Health Service providers which offer Telemedicine-Teleconsultation services to Remote, Isolated places and to ship vessels for both routine and emergency situations. The base of the system is the powerful Multimedia Health Record, with the ability to manage conventional data, images, videos and biosignals, acquired directly from the medical device. National and international medical codification schemata are employed such as ICD-X and WHO standards. Telemedicine and Computing in Health Care are rapidly covering a pending gap, not fulfilled by current bureaucratic and telematic procedures. However even from the first test fields conducted during the past year, it is obvious that a variety of new training needs has arisen. The users of such systems need to be instructed new ways of conducting their business, of taking advantage of the services, even a new way of perceiving health care provision. The user interface of the software is kept simple, thus getting acquainted with it requires minimum effort; however there are other issues on which training is required to best exploit the advantages the system offers. The telemedical networks spawned in each country must be co-ordinated, and the user needs to know where and how he/she will acquire the necessary support. Home-cared patients will have to operate medical devices and telemedical software, a task which although made easy from today's technology, it still requires some basic training, specially as far as elderly users are concerned. The NIVEMES system uncovers a set of new training needs, but it offers at the same time a vehicle for educating the professional health-carers. The Health Record comprises a multimedia, explicit account of the patient history, which can be used for detailed and integrated study from trainee health carers of all levels (as well as from officers on board, people taking care of home-confined patients and others), on real data or in a simulated environment. At the same time the telemedicine facilities may increase the effectiveness of junior doctors working in remote areas and enhance the confidence residents have about their local health centres. Systems like NIVEMES prove that new user needs arise nowadays and employment of modern tools requires training in modern methods and in a new way of thinking.

Classification of communications between the musculocutaneous and median nerves

In 16 out of 79 cadavers 22 communications were found between the musculocutaneous and median nerves. In six subjects they were present bilaterally. There were three types, based on the sites of communication. Type I: The communication was proximal to the entrance of the musculocutaneous nerve into coracobrachialis (9/22); Type II: The communication was distal to the muscle (10/22); Type III: The nerve as well as the communicating branch did not pierce the muscle (3/22). Bilateral communications were not necessarily of the same type. The possible clinical implications of these communications (relating either to the surgical approach to the shoulder joint, or to entrapment syndromes) are discussed.

An unusual branching pattern of the superficial brachial artery accompanied by an ulnar nerve with two roots

Variations in the arterial pattern of the upper limb are common and have been reported by several investigators (Fuss et al. 1985; Poteat, 1986; Tountas & Bergman, 1993; Rodriguez-Baeza et al. 1995). These variations are often associated with anomalies in the arrangement of the nerves of the brachial plexus (Miller, 1939; Lengele & Dhem, 1989). The presence of a superficial brachial artery (Schwyzer & De Garis, 1935; Skopakoff, 1959; Fuss et al. 1985) and the usual pattern of its branching in the upper arm or forearm have also been reported (McCormack et al. 1953; Keen, 1961; Karlson & Niechalev, 1982; Lippert & Pabst, 1985; Rodriguez-Baeza et al. 1995). The great variability of this arterial pattern may be attributed to the failure of regression of some paths of the embryonic arterial trunks (Tountas & Bergman, 1993; Rodriguez-Baeza et al. 1995).

The aim of the present report is to describe the concomitant appearance of 3 unusual variations in the same upper limb of a male cadaver. In this arm: (1) a superficial brachial artery terminated its course by dividing into 3 branches at the cubital fossa; (2) the definitive brachial artery had an unusual origin; and (3) the ulnar nerve was abnormally formed from 2 roots. This novel variation is compared with other anatomical variations in the arterial supply of the upper limb. In a series of routine dissections of 100 embalmed human cadavers the following variations were observed in the right upper limb of a male subject.

[Anatomical and radiographic study of the sinus floor distance from the alveolar crest in edentulous area of skulls]

The distance between the floor of the maxillary sinus and the alveolar crest in edentulous areas (where the 2nd bicuspid 1st and 2nd molars were previously located) were studied both anatomically and radiographically. The material consisted of 22 skulls in which 33 edentulous maxillary areas were found. Direct anatomical measurements were performed and measurements on periapical radiographs were made. The most important findings can be summarized as follows: 1. The mean distance from the alveolar crest to the floor of the sinus in locations corresponding to the 1st and 2nd molars and the 2nd bicuspid was 5.09 mm, 5.16 m.m. and 6.67 m.m. respectively. 2. Comparison of the anatomical measurements to those made on the radiographs proved that there are some differences but not statistically significant. These differences range between 0 to 5.5 m.m. for the 2nd bicuspid location, while for the 1st and 2nd molar locations they range between 0 to 2 mm.

[The infraorbital foramen (the position of the infraorbital foramen in man)]

The injection of the infraorbital nerve in the infraorbital canal, gives a full anesthesia to the anterior superior nerve, for a major operations in the anterior part of the upper jaw or in case which an infection precludes a local injection. In this study we describe in detail the position of the infraorbital foramen in 55 crania and in 16 cadavers. As landmarks in the cadavers, we used the lateral point of the wing of the nose, and the medial angulus oculi. As landmarks in the crania we used, the inferior orbital rim, the zygomaticoalveolar crest and the anterior nasal spine. The results of our measurements are the following: 1. The infraorbital foramen is situated in equal distance from the medial angulus oculi and the zygomaticoalbeolar crest. 2. The infraorbital foramen, the anterior nasal spine and the zygomaticoalveolar crest form the vertex of an isosceles triangle. The infraorbital foramen is situated in the vertex which corresponds to the one of the equal angles. 3. The infraorbital foramen is situated 7.19 mm below the infraorbital.

Polymorphous low-grade adenocarcinoma of the palate: report of a case with electron microscopy

A case of polymorphous, low-grade adenocarcinoma of the palate is presented with special emphasis on the histologic and ultrastructural features of this recently described entity.

[Abnormal course of the right common carotid artery. Anatomic presentation of a case report]

In a woman's cadaver, anatomical dissection reveals that the right common carotid artery follows an irregular course. Namely, after being directed towards the left lobe of the thyroid gland, it surrounds the latter in form of collar in close connection with its lower and right surfaces. In this way, trachea is almost completely covered from the front by this artery. The most probable cause of this anomaly may be a disproportional elongation of the ascending aorta during embryonic life of this woman. This hypothesis is corroborated by the fact that other arteries of this woman (thoracic aorta and common iliac artery) are also disproportionally elongated, in conjunction with the assessment of a greater caliber of all her large arteries.

Quantitative method for the classification of human mandibular condyles

This study is concerned with the classification of mandibular condyles on the basis of the shape of their frontal section. In a previous work, Yale et al. [Oral Surg. 16: 572-577, 1963] had divided mandibular condyles into 4 groups: flat, convex, angled, and round. The distinction between them had been found upon simple inspection. In this paper a quantitative method is proposed, in which mandibular condyles may be classified into the same 4 groups according to inequalities concerning measurable parameters of their frontal section. The process is greatly facilitated by the use of a programmable computer. The proposed method has been applied to a sample of 254 human mandibles (hence 508 condyles); the percentage of each group has been the following; flat 11%; convex 38%; angled 41%, and round 10%. It is plausible to surmise that the quantitative character of the proposed method may be of significant use in oral radiology as well as in anthropological research.