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1
المصدر: Clinical Anatomy. 21:111-118
مصطلحات موضوعية: Pathology, medicine.medical_specialty, Histology, Nerve root, Superior tibiofibular joint, Nerve Fibers, Upper trunk, Cadaver, Epineurium, Pressure, medicine, Humans, Cyst, Peripheral Nerves, Retrospective Studies, Ganglion Cysts, Neurons, Shoulder Joint, business.industry, General Medicine, Anatomy, Suprascapular nerve, medicine.disease, Magnetic Resonance Imaging, Scapula, medicine.anatomical_structure, Sciatic nerve, business
الوصف: The appearances of intraneural ganglion cysts are being elucidated. We previously introduced the cross-over phenomenon to explain how a fibular (peroneal) or tibial intraneural ganglion cyst arising from the superior tibiofibular joint could give rise to multiple cysts: cyst fluid ascending up the primarily affected nerve could reach the level of the sciatic nerve, fill its common epineurial sheath and spread circumferentially (cross over), at which time pressure fluxes could result in further ascent up the sciatic or descent down the same parent nerve or the opposite, previously unaffected fibular or tibial nerves. In this study, we hypothesized that cross-over could occur in other nerves, potentially leading to the formation of more than one intraneural ganglion cyst in such situations. We analyzed the literature and identified a single case that we could review where proximal extension of an intraneural ganglion cyst involving a nerve at a different site could theoretically undergo cross-over in another major nerve large enough for available magnetic resonance images to resolve this finding. A case of a suprascapular intraneural ganglion cyst previously reported by our group that arose from the glenohumeral joint and extended to the neck was reanalyzed for the presence or absence of cross-over. An injection of dye into the outer epineurium of the suprascapular nerve in a fresh cadaveric specimen was performed to test for cross-over experimentally. Retrospective review of this case of suprascapular intraneural ganglion cyst demonstrated evidence to support previously unrecognized cross-over at the level of the upper trunk, with predominant ascent up the C5 and the C6 nerve roots and subtle descent down the anterior and posterior divisions of the upper trunk as well as the proximal portion of the suprascapular nerve. This appearance gave rise to multiple interconnected intraneural ganglion cysts arising from a single distant connection to the glenohumeral joint. The injection study also demonstrated the cross-over phenomenon and produced a similar pattern as the cyst dissection. This article illustrates that cross-over can occur in another nerve (apart from the prototype fibular nerve). Furthermore, understanding the more complex anatomic nature of the upper trunk cross-over model provides insight into important mechanistic information regarding the bidirectional propagation patterns and formation of primary and secondary intraneural ganglion cysts not afforded by the previously described sciatic nerve cross-over model.
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2
المؤلفون: Norman S. Turner, J. Michael Alcorn, Stephen W. Carmichael, David W. Stanley, John S. Reach, Joel P. Felmlee, Kimberly K. Amrami
المصدر: Clinical Anatomy. 20:201-208
مصطلحات موضوعية: Male, 3 Tesla Magnetic Resonance Imaging, Histology, medicine.diagnostic_test, Foot, business.industry, Interossei, Magnetic resonance imaging, General Medicine, Anatomy, Compartment Syndromes, Magnetic Resonance Imaging, medicine.anatomical_structure, Healthy volunteers, medicine, Humans, Female, Ankle, business, Foot (unit)
الوصف: There is neither consensus on the number nor agreement on the location of the anatomic compartments of the foot. This project utilized high-resolution magnetic resonance imaging (MRI) to identify foot compartments. The purpose of this study was to devise a new system using 3-Tesla (3T) MRI that assessed the number and location of these compartments. Six feet from healthy volunteers were imaged. From these, 10 compartments were described: (1) medial, (2) calcaneal, (3) lateral, (4) central superficial, (5) central deep (adductor), (6–9) interossei, and (10) skin. The 3T MRI and foot/ankle coil allowed us to assess the number and location of foot compartments. Clin. Anat. 20:201–208, 2007. © 2006 Wiley-Liss, Inc.
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3
المؤلفون: Robert E. Wells, John R. Halliwill, Stephen W. Carmichael, Mark A. Warner, Jonathan P. Litwiller
المصدر: Clinical Anatomy. 17:45-49
مصطلحات موضوعية: medicine.medical_specialty, Histology, Posture, Strain (injury), Pelvis, Cadaver, medicine, Humans, Anterior compartment of thigh, Aged, Aged, 80 and over, Pain, Postoperative, business.industry, General Medicine, Anatomy, Middle Aged, Nerve injury, medicine.disease, Hip abduction, Surgery, Lithotomy position, body regions, medicine.anatomical_structure, Lower Extremity, Sprains and Strains, Urologic Surgical Procedures, Female, Obturator nerve, medicine.symptom, Obturator Nerve, business, Femoral Nerve
الوصف: The purpose of this study was to determine if various lithotomy positions increase strain on the obturator and lateral femoral cutaneous nerves in fresh adult cadavers. A static load cell was used to record strain changes of the obturator and lateral femoral cutaneous nerves in the pelvis and anterior thigh when the lower limbs were placed in three sets of positions of varying hip abduction and flexion. The means of the strain measurements, which were measured in grams in all positioning angles were compared to the baseline 0 degrees measurements. Analysis of variance was calculated for the differences. Flexion of the hip did not increase strain on either nerve. Abduction to 30 degrees or 45 degrees increased strain by more than 30 g on the obturator nerve (P0.05) but not the lateral femoral cutaneous nerve. The addition of 45 degrees or more of flexion to abduction negated the strain increase on the obturator nerves seen with abduction alone. Nerve strain30 g has been associated consistently with nerve dysfunction, disrupting axonal transmission, and causing structural neural damage. Our findings suggest that concomitant hip flexion should be used when placing anesthetized patients in a lithotomy position that includes abduction of the lower limbs to30 degrees to decrease the risk for perioperative neuropathy of the obturator nerve.
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المؤلفون: Stephen W. Carmichael
المصدر: Clinical Anatomy. 25:143-145
مصطلحات موضوعية: Diagnostic Imaging, Histology, business.industry, Physiology, General Medicine, History, 20th Century, Clinical anatomy, History, 21st Century, Quarter century, Pathology, Humans, Minimally Invasive Surgical Procedures, Medicine, Periodicals as Topic, Anatomy, business, Classics
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5
المؤلفون: Uldis Bite, Stephen W. Carmichael, Toshiyuki Shimizu, Dean R. Fisher
المصدر: Annals of Plastic Surgery. 38:604-610
مصطلحات موضوعية: Male, musculoskeletal diseases, Microsurgery, medicine.medical_specialty, Thigh, Anastomosis, Posterior thigh flap, Medial compartment of thigh, Surgical Flaps, Reference Values, Cadaver, medicine, Humans, Aged, Aged, 80 and over, business.industry, Anatomy, Middle Aged, Anterolateral thigh, musculoskeletal system, Thigh flap, eye diseases, Surgery, Femoral Artery, body regions, Plastic surgery, medicine.anatomical_structure, Female, business
الوصف: Various free flaps have been utilized in the thigh region, however there are few systematic clinicoanatomic studies of the thigh region. The purpose of this study is to clarify the clinicoanatomic characteristics of the free septocutaneous thigh flap. Forty-two dissections were carried out in unenbalmed cadavers. The pedicle was observed in all specimens in the anterolateral thigh (ALT), medial thigh, gluteal thigh, and lateral thigh flaps. The pedicle was observed in 46% of the specimens in the anteromedial thigh flap. The pedicle was observed in 86% of the specimens in the posterior thigh flap. The pedicle length (153 +/- 23 mm) of the ALT flap was the longest pedicle in the thigh flaps. The internal diameter of the pedicle of the ALT flap (3.0 +/- 1.0 mm), which could be used for anastomosis, is the largest in the septocutaneous thigh flaps. The clinicoanatomic characteristics of thigh flaps are clarified.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::7a21eb9866348305669159c9450cfc77
https://doi.org/10.1097/00000637-199706000-00007 -
6
المؤلفون: Darrell G. Kirch, Stephen W. Carmichael, Robert S. McCuskey
المصدر: Academic Medicine. 80:349-351
مصطلحات موضوعية: Male, Faculty, Medical, Economic shortage, Education, Risk Factors, ComputingMilieux_COMPUTERSANDEDUCATION, Humans, Medicine, Curriculum, Schools, Medical, Training grant, Medical education, ComputingMilieux_THECOMPUTINGPROFESSION, business.industry, Compensation (psychology), General Medicine, Anatomy, Health professions, Incentive, Health Occupations, Gross anatomy, Female, business, Administration (government), Education, Medical, Undergraduate
الوصف: The current shortage of faculty qualified to teach anatomy in U.S. medical schools is reversible. Sufficient numbers of individuals are in the pipeline to provide a future cadre of well-trained faculty members educating students in gross anatomy. The challenge is to realign departmental, institutional, and federal training grant priorities and resources, creating incentives for graduate students, postdoctoral fellows, and faculty members to stay the course and become the teachers needed to educate the next generation of health professionals. These strategies include (but are not limited to) team-teaching gross anatomy, thereby distributing the time commitments of a laboratory-based course more widely within a department; funds made available from the administration of medical schools to allow postdoctoral fellows to participate in teaching and providing compensation for the research activities; using "mission-based budgeting" to specifically compensate for faculty teaching time; and, finally, re-instituting federally funded training grants that solved this same teaching crisis in the not-too-distant past.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::cb02f3273ea2abea0c593eeb8e367641
https://doi.org/10.1097/00001888-200504000-00008 -
7
المؤلفون: Tyson K. Cobb, William P. Cooney, Stephen W. Carmichael
المصدر: The Journal of Hand Surgery. 21:861-869
مصطلحات موضوعية: musculoskeletal diseases, Hypothenar eminence, Carpal tunnel surgery, Wrist, Palmaris brevis muscle, Ulnar Artery, Retinaculum, medicine.artery, Cadaver, Humans, Medicine, Orthopedics and Sports Medicine, Ulnar nerve, Carpal Bones, Ulnar Nerve, Ulnar artery, business.industry, Anatomy, Hand, musculoskeletal system, nervous system diseases, body regions, medicine.anatomical_structure, Surgery, Hamate Bone, business
الوصف: The boundaries of the space through which the ulnar neurovascular bundle crosses the wrist have been reinvestigated. Using gross dissections, transverse and sagittal sections, and histologic study, we determined that the roof of Guyon's canal, the "carpal ulnar neurovascular space," does not directly connect to the hamate bone, as is currently accepted. The roof of this space extends radially to the hook of hamate and attaches to the flexor retinaculum. This anatomic arrangement allows the ulnar artery and sensory component of the ulnar nerve to course radially to the hook of hamate, where they lie on the flexor retinaculum (transverse carpal ligament). The roof and radial border have three segments: (1) a proximal segment that begins near the pisiform and extends distally to the level of the hook of hamate but does not attach directly to it, (2) a central segment that contains only adipose tissue, and (3) a distal fascial layer that includes the palmaris brevis muscle. The floor of the space consists of the muscles of the hypothenar eminence, their fibers of origin, and the flexor retinaculum (transverse carpal ligament). Guyon accurately described the proximal portion of the carpal ulnar neurovascular space, but his description has been misinterpreted; the hook of hamate does not serve as the radial boundary of Guyon's canal. The anatomic relationships of the "carpal ulnar neurovascular space" need to be appreciated to avoid complications during carpal tunnel surgery.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::753ea26c3c069a4ee84a600799a41181
https://doi.org/10.1016/s0363-5023(96)80205-x -
8
المصدر: Annals of Emergency Medicine. 44:320-322
مصطلحات موضوعية: Adult, medicine.medical_specialty, Resuscitation, medicine.medical_treatment, Tongue Diseases, Esophagus, Tongue, Intensive care, Intubation, Intratracheal, medicine, Humans, business.industry, respiratory system, Esophageal tracheal combitube, Surgery, medicine.anatomical_structure, Combitube, Anesthesia, Emergency Medicine, Female, Airway management, Intubation, Airway, business
الوصف: We report a case of massive tongue engorgement associated with placement of an esophageal-tracheal twin-lumen airway device (Combitube) in a morbidly obese patient. Approximately 4 hours after atraumatic placement of the Combitube, tongue swelling occurred. An emergency tracheostomy was needed for airway management before removal of the Combitube. Ischemia-reperfusion injury or compression of glossal blood vessels, specifically lingual veins, was the most likely cause for the patient's tongue engorgement. An exhaustive search for other causes revealed nothing. Prolonged use of the Combitube may incur greater risk of airway complications such as tongue engorgement.
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9
المؤلفون: Stephen W. Carmichael, Tiffany McKerahan
المصدر: Clinical anatomy (New York, N.Y.). 25(3)
مصطلحات موضوعية: Publishing, Histology, Impact factor, business.industry, Medicine, Humans, Engineering ethics, General Medicine, Anatomy, Journal Impact Factor, Periodicals as Topic, business
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10
المصدر: The American Journal of Surgery. 166:130-135
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Dissection (medical), Anastomosis, Tendons, Cadaver, medicine.artery, medicine, Humans, Aged, Aged, 80 and over, Peroneal Artery, Foot, business.industry, Soft tissue, Arteries, General Medicine, Anatomy, Middle Aged, medicine.disease, Surgery, Tibial Arteries, medicine.anatomical_structure, Dorsalis pedis artery, Female, Ankle, business, Artery
الوصف: Reconstruction of the arteries of the foot in patients with severe chronic arterial occlusive disease has become a routine and valuable procedure. However, it is frequently difficult to select the optimal site for the distal arterial anastomosis. In order to determine the most important anatomic variations of foot arteries and the relationship of the dorsalis pedis artery to crossing tendons, the following study was performed in 30 cadaver limbs of 17 persons (9 men and 8 women). Their mean age at death was 69.8 years (range: 42 to 93 years). Methods to evaluate anatomy included anatomic dissection, arteriography, and preparation of corrosion cast models. The latter was performed by injection of liquid plastic and catalyst into the tibial arteries followed by chemical débridement of the soft tissue of the foot. Photographs of the corrosion cast models were taken at various stages of soft tissue dissolution. The dorsalis pedis artery was absent in 6.7% of the cases, and the arcuate artery was absent in 33%. The dorsalis pedis artery arose from the peroneal artery in 6.7%. The dorsalis pedis artery crossed under the extensor hallucis longus tendon at the ankle in 54%, above the ankle in 43%, but below the ankle in only 3%. Our study suggests that the optimal site for the dorsalis pedis artery anastomosis on the foot is the segment distal to the ankle.
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