The sartorius muscle is typically innervated by two branches of the femoral nerve arising from the lumbar plexus. We present an unreported variant where the sartorius muscle was innervated by an accessory branch arising from the ilioinguinal nerve in addition to the proper two branches from the femoral nerve. The iliohypogastric nerve was fused with the ilioinguinal nerve. More proximally, the lumbar plexus also showed unusual arrangement. The anterior branch of the lateral femoral cutaneous nerve arose from the femoral branch of the genitofemoral nerve while the posterior branch arose directly from the second lumbar nerve. The genital branch of the genitofemoral nerve pierced the psoas major muscle more distally than usual, and featured a close proximity with the femoral nerve. Possible variable appearance of these nerves should be kept in mind during several surgical and diagnostic procedures since their iatrogenic or traumatic damage, or their susceptibility to entrapment, pose unpredictable clinical consequences.

• MeSH
• anatomická variace * MeSH
• kosterní svaly inervace   abnormality   MeSH
• lidé MeSH
• mrtvola MeSH
• nervus femoralis * abnormality   MeSH
• plexus lumbosacralis * abnormality   anatomie a histologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Several muscle variations have been observed in flexor aspect of forearm which can hamper normal functioning of hand or may remain silent. One such unreported variation has been described in this report. An accessory muscle in the left forearm was found involving flexor carpi ulnaris (FCU) and palmaris longus (PL). This muscle was originating from the distal part of both FCU and PL through a slip from each tendon. After merging, it passed above the ulnar nerve and artery in the roof of Guyon's canal. This type of variation can cause neurovascular compression and can also mimic soft tissue mass, tumour or neuroma and can be misdiagnosed. Knowledge about this type of variation is important in cases of neurovascular decompression, forearm, and hand surgeries and these can be utilized in tendon transfer or free muscle flap for reconstruction purposes.

• MeSH
• anatomická variace MeSH
• dospělí MeSH
• kosterní svaly * abnormality   MeSH
• lidé MeSH
• předloktí * abnormality   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: Together with an increased interest in minimally invasive lateral transpsoas approach to the lumbar spine goes a demand for detailed anatomical descriptions of the lumbar plexus. Although definitions of safe zones and essential descriptions of topographical anatomy have been presented in several studies, the existing literature expects standard appearance of the neural structures. Therefore, the aim of this study was to investigate the variability of the extrapsoas portion of the lumbar plexus in regard to the lateral transpsoas approach. METHODS: A total of 260 lumbar regions from embalmed cadavers were utilized in this study. The specimens were dissected as per protocol and all nerves from the lumbar plexus were morphologically evaluated. RESULTS: The most common variation of the iliohypogastric and ilioinguinal nerves was fusion of these two nerves (9.6%). Nearly in the half of the cases (48.1%) the genitofemoral nerve left the psoas major muscle already divided into the femoral and genital branches. The lateral femoral cutaneous nerve was the least variable one as it resembled its normal morphology in 95.0% of cases. Regarding the variant origins of the femoral nerve, there was a low formation outside the psoas major muscle in 3.8% of cases. The obturator nerve was not variable at its emergence point but frequently branched (40.4%) before entering the obturator canal. In addition to the proper femoral and obturator nerves, accessory nerves were present in 12.3% and 9.2% of cases, respectively. CONCLUSION: Nerves of the lumbar plexus frequently show atypical anatomy outside the psoas major muscle. The presented study provides a compendious information source of the possibly encountered neural variations during retroperitoneal access to different segments of the lumbar spine.

• MeSH
• bederní obratle * chirurgie   anatomie a histologie   MeSH
• bederní svaly * anatomie a histologie   chirurgie   MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony metody   MeSH
• mrtvola * MeSH
• nervus femoralis anatomie a histologie   chirurgie   MeSH
• nervus obturatorius anatomie a histologie   chirurgie   MeSH
• plexus lumbosacralis * anatomie a histologie   chirurgie   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Atrioventricular (AV) accessory pathways (APs) provide additional electrical connections between the atria and ventricles, resulting in severe electrical disturbances. It is generally accepted that APs originate in the altered annulus fibrosus maturation in the late prenatal and perinatal period. However, current experimental methods cannot address their development in specific locations around the annulus fibrosus because of the inaccessibility of late fetal hearts for electrophysiological investigation under physiological conditions. In this study, we describe an approach for optical mapping of the retrogradely perfused chick heart in the last third of the incubation period. This system showed stability for electrophysiological measurement for several hours. This feature allowed analysis of the number and functionality of the APs separately in each clinically relevant position. Under physiological conditions, we also recorded the shortening of the AV delay with annulus fibrosus maturation and analyzed ventricular activation patterns after conduction through APs at specific locations. We observed a gradual regression of AP with an area-specific rate (left-sided APs disappeared first). The results also revealed a sudden drop in the number of active APs between embryonic days 16 and 18. Accessory myocardial AV connections were histologically documented in all positions around the annulus fibrosus even after hatching. The fact that no electrically active AP was present at this stage highlights the necessity of electrophysiological evaluation of accessory atrioventricular connections in studying AP formation.NEW & NOTEWORTHY We present the use of retrograde perfusion and optical mapping to investigate, for the first time, the regression of accessory pathways during annulus fibrosus maturation, separately examining each clinically relevant location. The system enables measurements under physiological conditions and demonstrates long-lasting stability compared with other approaches. This study offers applications of the model to investigate electrical and/or functional development in late embryonic development without concern about heart viability.

• MeSH
• akční potenciály * MeSH
• kuřecí embryo MeSH
• nodus atrioventricularis embryologie   patofyziologie   MeSH
• perfuze MeSH
• zvířata MeSH
• Check Tag
• kuřecí embryo MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

Anatomical variations of the forearm flexor muscles are occasionally encountered. Though usually observed incidentally during autopsies or imaging studies, they may at times cause concern due to associated clinical symptoms. This report presents a case of unilateral accessory flexor carpi ulnaris (AFCU) muscle observed in a human male cadaver aged 78 years. During routine cadaveric dissection, an anomalous AFCU muscle was observed in the left forearm of a human male cadaver aged 78 years. Standard institutional guidelines pertaining to the use of human cadaver for teaching and research were followed. A thorough literature review about the flexor carpi ulnaris (FCU) through the PubMed, Embase and Google scholar databases was undertaken, using the keywords - accessory flexor carpi ulnaris muscle, aberrant flexor carpi ulnaris muscle and anatomical variation of flexor carpi ulnaris muscle. Relevant gross anatomical findings were recorded and photographed. AFCU was identified on the medial aspect of the distal third of the left forearm. The AFCU was found originating from the ante-brachial fascia and the fascia covering the FCU on the left forearm, forming a small separate belly deep to the main muscle. It terminated as a thin tendon running alongside the hypothenar muscles and attached distally to the base of the proximal phalanx of the little finger. The AFCU was found to be innervated by a branch of the ulnar nerve. Awareness about the rare AFCU muscle is clinically important as a possible cause of ulnar nerve compression but also as a possible graft in reconstruction surgeries.

• MeSH
• kosterní svaly * abnormality   anatomie a histologie   MeSH
• lidé MeSH
• mrtvola * MeSH
• předloktí * abnormality   anatomie a histologie   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Průvodce obecnou histologií a mikroskopickou anatomií je určený pro studenty lékařských i biologických oborů jako pomůcka pro snažší pochopení a porozumění témat, probíraných zejména v kurzech Ústavu histologie a embryologie LF MU. Průvodce obsahuje anotované mikrofotografie a elektronogramy, uspořádané do vyjímatelných panelů, doplněné současnou anglickou terminologií. Tematicky pokrývá a demonstruje jednotlivé aspekty mikroskopické stavby tkání a jednotlivých orgánových soustav v přehledné a edukativní podobě.

• MeSH
• akupunktura metody   MeSH
• analgetika aplikace a dávkování   MeSH
• brachiální neuritida * diagnóza   etiologie   patologie   terapie   MeSH
• celulitis chirurgie   komplikace   MeSH
• chirurgie operační škodlivé účinky   MeSH
• chronická bolest etiologie   patologie   terapie   MeSH
• jizva etiologie   patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lymfadenitida chirurgie   komplikace   MeSH
• management bolesti metody   MeSH
• nemoci nervus accessorius * etiologie   patologie   MeSH
• neuritida etiologie   patologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Dual nerve transfer of the spinal accessory nerve to the suprascapular nerve (SAN-SSN) and the radial nerve to the axillary nerve is considered to be the most feasible method of restoration of shoulder abduction in brachial plexus injuries. Supraspinatus muscle plays an important role in the initiation of abduction and its functional restoration is crucial for shoulder movements. There are two possible approaches for the SAN-SSN transfer: the more conventional anterior approach and the posterior approach in the area of scapular spine, which allows more distal neurotization. Although the dual nerve transfer is a widely used method, it is unclear which approach for the SAN-SSN transfer results in better outcomes. We conducted a search of English literature from January 2001 to December 2021 using the PRISMA guidelines. Twelve studies with a total 142 patients met our inclusion criteria. Patients were divided into two groups depending on the approach used: Group A included patients who underwent the anterior approach, and Group B included patients who underwent the posterior approach. Abduction strength using the Medical Research Scale (MRC) and range of motion (ROM) were assessed. The average MRC grade was 3.57 ± 1.08 in Group A and 4.0 ± 0.65 (p = 0.65) in Group B. The average ROM was 114.6 ± 36.7 degrees in Group A and 103.4 ± 37.2 degrees in Group B (p = 0.247). In conclusion, we did not find statistically significant differences between SAN-SSN transfers performed from the anterior or posterior approach in patients undergoing dual neurotization technique for restoration of shoulder abduction.

• MeSH
• kognice MeSH
• lidé MeSH
• nervový transfer * MeSH
• nervus radialis MeSH
• rameno * chirurgie   MeSH
• regenerace nervu MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• systematický přehled MeSH

Cíl studie: Cílem sdělení je seznámit čtenáře s přínosem zobrazovacích metod (ZM) orbity – konkrétně výpočetní tomografie (CT) a magnetické rezonance (MR) v diagnostice endokrinní orbitopatie (EO). Materiál a metodika: U pacientů s EO jsou ZM orbity nepostradatelným doplňkem klinického a laboratorního vyšetření. Nejčastěji používanou a zřejmě nejdostupnější metodou je ultrazvukové vyšetření orbity (UZ), které má však řadu limitů. Dalšími metodami jsou CT a MR orbity. Na základě publikovaných poznatků, které jsme implementovali do praxe, a dlouholetých zkušeností s diagnostikou a léčbou EO, poukážeme na přínos CT a MR v daných indikacích: zobrazení šíře okohybných svalů, hodnocení aktivity onemocnění, diagnostika možného útlaku zrakového nervu, či diferenciální diagnostika jiných patologických stavů v orbitě. Součástí sdělení je i naše doporučení ideálního MR protokolu ke zhodnocení aktivity onemocnění. Závěr: ZM mají svou nezastupitelnou roli nejen v časné diagnostice EO, ale i ve sledování vývoje onemocnění a odezvy na nasazenou léčbu. Při volbě vhodné ZM při této diagnóze je vždy třeba vzít v úvahu celou řadu faktorů, nejen dostupnost, nákladnost a zátěž pro pacienta, ale zejména senzitivitu a specificitu dané metody pro diagnózu EO.

The purpose is to acquaint readers with the contribution of imaging methods (IMs) of the orbit, specifically computed tomography (CT) and magnetic resonance imaging (MRI), in the diagnosis of thyroid-associated orbitopathy (TAO). Methods: IMs of the orbit are an indispensable accessory in the clinical and laboratory examination of TAO patients. The most frequently used and probably most accessible method is an ultrasound examination of the orbit (US), which, however, has a number of limitations. Other methods are CT and MRI. Based on the published knowledge implemented in our practice and several years of experience with the diagnosis and treatment of TAO patients, we would like to point out the benefits of CT and MRI in the given indications: visualisation of the extraocular muscles, assessment of disease activity, diagnosis of dysthyroid optic neuropathy and differential diagnosis of other pathologies in the orbit. Our recommendation for an ideal MRI protocol for disease activity evaluation is also included. Conclusion: IMs play an irreplaceable role not only in the early diagnosis of TAO, but also in the monitoring of the disease and the response to the applied treatment. When choosing a suitable IM for this diagnosis, a number of factors must always be taken into account; not only availability, cost and burden for the patient, but especially the sensitivity and specificity of the given method for the diagnosis of TAO.

• MeSH
• Gravesova oftalmopatie * diagnostické zobrazování   terapie   MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• orbita diagnostické zobrazování   patologie   MeSH
• počítačová rentgenová tomografie metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

PURPOSE: Cubital tunnel syndrome is a well-described entity with many reported etiologies and anatomical compression sites. Accessory ossicles of either traumatic or congenital origin might occur around the elbow joint. Only one case reporting such ossicles compressing the ulnar nerve exists in previous literature. We aim to present this entity with a detailed description of the patient history and treatment. CASE REPORT: We report a case of 30-year-old female presenting with classical signs of cubital tunnel syndrome-positive Wartenberg's and Froment's signs, hypoesthesia in the fourth and fifth finger with decreased finger duction strength but without gross hypotrophy of interosseous and hypothenar muscles. Tinel's sign was positive over the ulnar sulcus and an accessory ossicle was found on the elbow radiograph within the ulnar sulcus. The first signs of calcification in this patient were reported 6 years prior in a follow-up after the dislocation of her elbow joint following a bike accident. The EMG confirmed ulnar nerve neuropathy in the elbow area. The ossicle was extirpated, the ulnar nerve was decompressed in the ulnar sulcus in a standard manner and the symptoms quickly resolved. The patient has been regularly visiting our outpatient clinic for the next 12 years without any complaints considering her elbow and the ulnar nerve. CONCLUSION: This is a rare case of cubital tunnel syndrome caused by an accessory ossicle of traumatic origin. Simple bone extirpation with ulnar nerve release followed by anterior subcutaneous transposition is the recommended method of treatment. No report of congenital accessory bones causing ulnar nerve compression in the elbow exists in the literature.

• MeSH
• dospělí MeSH
• heterotopická osifikace * diagnóza   diagnostické zobrazování   MeSH
• lidé MeSH
• loket MeSH
• loketní kloub * fyziologie   MeSH
• nervus ulnaris MeSH
• syndrom kubitálního tunelu * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH