OBJECTIVES: To define chronic ultrasound lesions of the axillary artery (AA) in long-standing giant cell arteritis (GCA) and to evaluate the reliability of the new ultrasound definition in a web-based exercise. METHODS: A structured Delphi, involving an expert panel of the Large Vessel Vasculitis subgroup of the Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group was carried out. The reliability of the new definition was tested in a 2-round web-based exercise involving 23 experts and using 50 still images each from AA of long-standing and acute GCA patients, as well as 50 images from healthy individuals. RESULTS: The final OMERACT ultrasound definition of chronic changes was based on measurement and appearance of the intima-media complex. The overall reliability of the new definition for chronic ultrasound changes in longstanding GCA of the AA was good to excellent with Light's kappa values of 0.79-0.80 for inter-reader reliability and mean Light's-kappa of 0.88 for intra-reader reliability. The mean inter-rater and intra-rater agreements were 86-87% and 92%, respectively. Good reliabilities were observed comparing the vessels with longstanding versus acute GCA with a mean agreement and kappa values of 81% and 0.63, respectively. CONCLUSION: The new OMERACT ultrasound definition for chronic vasculitis of the AA in GCA revealed a good to excellent inter- and intra-reader reliability in a web-based exercise of experts.

• MeSH
• arteria axillaris diagnostické zobrazování   MeSH
• lidé MeSH
• obrovskobuněčná arteritida * diagnostické zobrazování   MeSH
• reprodukovatelnost výsledků MeSH
• revmatologie * MeSH
• ultrasonografie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: The brachial plexus is a complex anatomical structure that gives rise to all the nerves of the upper limb. Its variability is frequently observed and represents a challenge for interventions in the lower neck and axilla. The aim of this study was to present a comprehensive and evidence-based review with meta-analytic techniques on the variability of roots, trunks, divisions and cords of the brachial plexus. MATERIALS AND METHODS: Major medical databases were searched to identify all anatomical studies investigating the variability in the formation of the brachial plexus. Data extracted consisted of demographic information, morphometric parameters, the arrangement of the brachial plexus at the level of the roots, trunks, divisions and cords and the relationship of the brachial plexus to the axillary artery and scalene muscles. The different configurations of the brachial plexus were put into a new classification, and the pooled prevalence of each case was calculated using a random effects model. A sub-analysis on age and geographical location was also performed. RESULTS: A total of 40 studies (3055 upper limbs) were included in the meta-analysis. The regular arrangement of roots forming trunks was identified in 84% (95% CI 79-89%) of cases. The overall prevalence of the prefixed and postfixed brachial plexus was 11% (95% CI 6-17%) and 1% (95% CI 0-1%), respectively and in less than 0.1% of cases the brachial plexus received a branch from both C4 and T2. For divisions forming cords, the regular arrangement was observed in 96% (95% CI 93-98%) of cases. Additional communicating branches between the components of the brachial plexus appeared in 5% (95% CI 3-7%) of cases. The relationship of the brachial plexus to the axillary artery and scalene muscles was considered regular in 96% (95% CI 89-100%) and 86% (95% CI 66-98%) of cases, respectively. Analysis of the morphometric parameters revealed the proportional consistency between the components forming the plexus during aging. CONCLUSIONS: Knowledge of anatomical variations of the brachial plexus is important for examinations and interventions in the lower neck and axilla. The variability was observed especially in the roots forming trunks, while divisions forming cords showed quite stable appearance. The results of this evidence-based review and meta-analysis can be applied in many different medical disciplines.

• MeSH
• arteria axillaris MeSH
• horní končetina MeSH
• krční svaly MeSH
• krk MeSH
• plexus brachialis * MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• přehledy MeSH

Although the variability of the upper limb arteries is a clinically important problem, the prevalence is varying across the existing studies and classification is rather complicated, not well established and sometimes even unclear for simple and direct understanding and usage. Multiple case reports appearing in the last years apply incorrect, inappropriate, and sometimes misleading terminology. We performed an anatomical cadaveric study of the variability of the arteries of the upper limb, namely, the axilla, arm, and forearm, in 423 upper limbs embalmed with classical formaldehyde method (Central European population). We proposed to apply the Equality system based on the common trunks for denomination of the axillary artery branches principal variations: Truncus subscapulocircumflexus (22.9%), truncus profundocircumflexus (13.75%), and truncus bicircumflexus (13.95%). Further, we proposed the terminology system developed by Rodríguez-Niedenführ et al. for the free upper limb principal arterial trunk variations based on the origin, location (in the arm only, or in the arm and forearm), and course (related to the forearm flexor muscles) of the involved artery: Arteria brachialis superficialis (9.5%), arteria brachioradialis superficialis (6.4%), arteria brachioulnaris superficialis (1.9%), arteria brachiomediana superficialis (0.5%), and arteria comitans nervi mediani manus (3.3%). Extensive development of the catheterization methods via the arteria radialis et ulnaris as well as surgical procedures using flaps based on perforating branches of these arteries (including arteria brachioradialis superficialis et brachioulnaris superficialis) necessitate thorough data on prevalence of the variant vessels for safe performance of these procedures to prevent any unexpected situations or to react adequately in such.

• MeSH
• arteria axillaris MeSH
• arteria brachialis MeSH
• axila krevní zásobení   MeSH
• formaldehyd MeSH
• horní končetina MeSH
• kardiologie klasifikace   MeSH
• katetrizace MeSH
• lidé MeSH
• modely anatomické MeSH
• mrtvola MeSH
• paže krevní zásobení   MeSH
• předloktí krevní zásobení   MeSH
• terminologie jako téma MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

Na prezentovaných kazuistikách popisuje autor vzácnou komplikaci při luxaci a fraktuře proximálního humeru. Obojí s výskytem u nízkoenergetického poranění (prostý pád). V následné diskuzi se pak zabývá možnou etiologií a mechanizmy vzniku poranění a. axillaris a její terapií.

• MeSH
• angiografie metody   MeSH
• angioplastika metody   MeSH
• arteria axillaris diagnostické zobrazování   zranění   MeSH
• Aspirin terapeutické užití   MeSH
• duplexní dopplerovská ultrasonografie MeSH
• fraktury proximálního humeru chirurgie   diagnostické zobrazování   MeSH
• heparin aplikace a dávkování   MeSH
• humerus diagnostické zobrazování   MeSH
• konzervativní terapie MeSH
• lidé MeSH
• luxace ramenního kloubu * diagnóza   komplikace   rehabilitace   terapie   MeSH
• pentoxifylin terapeutické užití   MeSH
• poranění cév * chirurgie   diagnostické zobrazování   farmakoterapie   klasifikace   terapie   MeSH
• protetické prostředky MeSH
• rentgendiagnostika MeSH
• senioři MeSH
• tomografie spirální počítačová MeSH
• úrazy pádem MeSH
• uzavřená repozice fraktury MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

In the presented case reports, the author describes a rare complication in the dislocation and fracture of the proximal humerus. Both with the occurrence of a low-energy injury (simple fall). In the subsequent discussion, he deals with possible aetiology and mechanisms of a. axillaris injuries and its therapies.

• MeSH
• angiografie metody   MeSH
• angioplastika metody   MeSH
• arteria axillaris diagnostické zobrazování   zranění   MeSH
• Aspirin terapeutické užití   MeSH
• duplexní dopplerovská ultrasonografie MeSH
• fraktury proximálního humeru chirurgie   diagnostické zobrazování   MeSH
• heparin aplikace a dávkování   MeSH
• humerus diagnostické zobrazování   MeSH
• konzervativní terapie MeSH
• lidé MeSH
• luxace ramenního kloubu * diagnóza   komplikace   rehabilitace   terapie   MeSH
• pentoxifylin terapeutické užití   MeSH
• poranění cév * chirurgie   diagnostické zobrazování   farmakoterapie   klasifikace   terapie   MeSH
• protetické prostředky MeSH
• rentgendiagnostika MeSH
• senioři MeSH
• tomografie spirální počítačová MeSH
• úrazy pádem MeSH
• uzavřená repozice fraktury MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Variations in the branching pattern of axillary artery are observed by many anatomists all over the world. A unique bilateral variation in the axillary artery was observed during the routine dissection of the upper limbs on an approximately 65 year old male cadaver. An abnormal communicative channel was observed between lateral thoracic artery and anterior circumflex humeral artery. It passed between the two roots of median nerve. Arterial anomalies in the upper limb are due to defective remodelling of vascular plexus of the upper limb bud during embryogenesis. Knowledge of variations in axillary artery is quintessential for surgeons, radiologists and anaesthesiologists to avoid treacherous complications during procedures.

• MeSH
• arteria axillaris abnormality   MeSH
• arteriae thoracicae abnormality   MeSH
• lidé MeSH
• mrtvola MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

This article reviews in detail the superficial brachiomedian artery (arteria brachiomediana superficialis), a very rare variant of the main arterial trunks of the upper limb. It branches either from the axillary artery or the brachial artery, descends superficially in the arm (similar to the course of the superficial brachial artery) and continues across the cubital fossa, runs superficially in the forearm, approaches the median nerve and enters the carpal canal to reach the hand. It usually terminates in the superficial palmar arch. The first drawing was published, in 1830, and the first description was published, in 1844. Altogether, to our knowledge, only 31 cases of a true, superficial brachiomedian artery have been reported (Some cases are incorrectly reported as superficial brachioradiomedian artery or superficial brachioulnomedian artery). Based on a meta-analysis of known, available studies, the incidence is 0.23% in Caucasians and 1.48% in Mongolians. Knowing whether or not this arterial variant is present is important in clinical medicine and relevant for: The catheterization via the radial or ulnar artery; harvesting the vascular pedicle for a forearm flap based on the radial, ulnar or superficial brachiomedian arteries; the possible collateral circulation in cases of the arterial closure; and the surgical management of carpal tunnel syndrome. Its presence can elevate the danger of an injury to the superficially located variant artery or of an accidental injection.

• MeSH
• arteria axillaris abnormality   patologie   MeSH
• arteria brachialis abnormality   patologie   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Perigraft serom je poměrně vzácná komplikace, která může vzniknout po implantaci cévní protézy z dakronu nebo expandovaného polytetrafluoretylenu (ePTFE). Předkládáme kazuistiku 54letého pacienta s perigraft seromem okolo axillofemorálního bypassu (ePTFE protézou). Konečným řešením byla explantace této extraanatomické rekonstrukce a implantace aortobiilického bypassu s použitím cévní protézy z jiného materiálu. Článek diskutuje terapeutické možnosti této komplikace na základě publikovaných prací. Žádná guidelines ani jiná doporučení neexistují. Závěrem, přístup k léčbě perigraft seromu zůstává striktně individuální. Náhrada cévní protézy s použitím implantátu z jiného materiálu se zdá být nejlepší možností řešení pro recidivující perigraft seromy tam, kde jiné méně invazivní postupy selhaly.

Perigraft seroma is quite a rare complication that may occur after implantation of Dacron or expanded polytetrafluoroethylene (ePTFE) vascular grafts. We report a case of a 54-year-old patient with perigraft seroma around an axillofemoral bypass (ePTFE graft). Definitive treatment involved the explantation of this extraanatomic bypass with perigraft seroma and the implantation of an aortobiiliac bypass using vascular prosthesis made of a different material. Based on published studies, therapeutic options for this complication are discussed. No guidelines or recommendations are available. In conclusion, the approach to perigraft seroma treatment remains strictly individual. Vascular graft replacement using grafts made of different material seems to be the best option in the case of recurring perigraft seroma, where less invasive procedures were not successful.

• MeSH
• arteria axillaris chirurgie   MeSH
• arteria femoralis chirurgie   MeSH
• arteriovenózní zkrat MeSH
• cévní protézy škodlivé účinky   MeSH
• cévy - implantace protéz MeSH
• imunohistochemie MeSH
• lidé středního věku MeSH
• lidé MeSH
• pooperační komplikace MeSH
• serom diagnóza   etiologie   chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH
• práce podpořená grantem MeSH

A case of anomalous terminal branching of the axillary artery was encountered and described in a left upper limb of a male cadaver. A series of 214 upper limbs of Caucasian race was dissected. A variant artery, stemming from the very end of the axillary artery followed a superficial course distally. It passed the cubital fossa, ran on the lateral side of the forearm as usual radial artery, crossed ventrally to the palm and terminated in the deep palmar arch. This vessel is a case of the brachioradial artery (incorrectly termed as the "radial artery with high origin"). Moreover, it was associated with another variation, concerning the aberrant posterior humeral circumflex artery passing under the tendon of the latissimus dorsi muscle. The anatomical knowledge of the axillary region is essential for radiodiagnostic, surgical and traumatologic procedures. The superficially located artery brings an elevated danger of heavy bleeding in all unexpected situations, its variant branching can cause problems in radial catheterization procedures and the anomalously coursing other arterial variant poses an elevated danger in surgical procedures concerning the surgical neck of humerus.

• MeSH
• arteria axillaris abnormality   embryologie   MeSH
• arteria brachialis abnormality   embryologie   MeSH
• arteria radialis abnormality   embryologie   MeSH
• lidé MeSH
• mrtvola MeSH
• povrchové zádové svaly anatomie a histologie   krevní zásobení   MeSH
• senioři MeSH
• šlachy anatomie a histologie   krevní zásobení   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Chabé držení těla vede ke změnám nervově-cévního zásobení horních končetin. Toto je popisováno v klinické praxi jako syndrom horní hrudní apertury. Vadné držení těla je doprovázeno svalovými dysbalancemi, které jsou optimalizovány aktivním cvičením nebo s využitím pasivní techniky – tapingu. Tato práce je experimentální pilotní studií, která se zabývá kinematikou a tapingem cervikothorakálního přechodu a jejich vlivem na cévní zásobení horních končetin. Deset probandů (26 ± 2 let, 56 ± 4 kg, 161 ± 8 cm) bez patologie a zranění pletence ramenního a páteře podstoupilo měření. První část probandů (5 osob) prováděla cvičení – zevní rotace paže. Během tohoto cvičení byla snímána kinematickou analýzou (Qualisys) extenze hrudní páteře. U druhé části probandů (5 osob) byl použit taping rhomboideálních a malého prsního svalu. U obou skupin byla použita sonografie k určení krevního toku arterií axillaris. Taping, jakožto pasivní metoda, zlepšuje cévní zásobení horních končetin jednodušeji než aktivní cvičení, které musí být prováděno pod dohledem fyzioterapeuta.

Poor posture negatively influences the hemodynamics of the upper extremities. In clinical practice, this is known as Thoracic outlet syndrome. Poor posture leads to muscle imbalances which are solved with the active exercise or using the passive technique – taping. This work is an experimental pilot study dealing with the kinematics and taping of the cervical-thoracic spine and their influence on the hemodynamics of the upper extremities. Ten subjects aged 26 ± 2 years, weight 56 ± 4 kg, height 161 ± 8 cm (mean ± SD) without pathology or injury of the shoulder girdle and spine were recruited. First part of subjects (5 persons) externally rotated the arms. During this exercise the kinematic analysis was used for determining the extension of the thoracic spine. Another part of subjects (5 persons) used the taping of rhomboids and pectoralis minor muscles. The hemodynamics of the axillary artery was determined with the sonography at both groups. The taping improves the hemodynamics of the upper extremities easier than the active exercise, which should be done with the control of the physiotherapist.

• MeSH
• arteria axillaris MeSH
• dospělí MeSH
• horní končetina * inervace   krevní zásobení   MeSH
• kineziologie aplikovaná metody   MeSH
• kyfóza * etiologie   rehabilitace   MeSH
• lidé MeSH
• postura těla MeSH
• regionální krevní průtok * MeSH
• syndrom horní hrudní apertury * etiologie   prevence a kontrola   rehabilitace   MeSH
• tejpovací páska využití   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH