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The lack of meticulous knowledge concerning the topographical anatomy of the deep branch of the ulnar nerve (DUN) may pose difficulties, leading to a delay or a misdiagnosis of a DUN injury. Identification of the DUN is quite difficult without precise anatomical landmarks as reference points. The current study investigates the topography of the DUN between genders, taking as a reference point a well-known landmark, the Kaplan line, used in hand surgery for carpal tunnel release. Twenty-two (15 males and 7 female) fresh frozen adult cadaveric hands were dissected by using magnifying loupes (3.5 and 5.0 x). We marked values proximal to the Kaplan line as positive (+), while we marked distal ones as negative (-). The mean distance DUN–Kaplan line was 1.69 ± 4.45 mm. In male hands, the mean distance was 4.17 ± 1.88 mm, distal to the Kaplan line, while in females, the mean distance was −4.92 ± 0.69 mm proximal to the Kaplan line. Gender dimorphism was detected, with higher statistically significant values in male hands (p = 0.001). Cadaveric studies of the DUN topography, course, and distribution pattern are uncommon. The current study provides an accurate description of the DUN topography, taking the Kaplan line as a reference point, emphasizing gender differences. The DUN is located distally in males and proximally in females. Knowledge of these predictable anatomical relations may help hand surgeons intraoperatively when dealing with a DUN lesion, because of hand trauma or during the decompression of the DUN. [ABSTRACT FROM AUTHOR]

Abstract An unusual case of left internal thoracic artery (ITA) origin from the thyrocervical trunk (TCT) was detected during routine cadaver dissection. The variability of origin and course of ITA has less or more frequently been documented in the literature. However, the ITA origin from the TCT on the left side has been detected less commonly, making its dissection and preparation during coronary artery bypass grafting surgery more difficult. We discuss the ITA origin and course variability as well as clinical significance of the present variant, reviewing the relative literature. The objective of our study is to exhibit a rare ITA origin in order to provide a more accurate knowledge of such variations.

Abstract Introduction The human hand is a complex anatomic entity consisting of many muscles, nerves, and vessels, thus providing a special ability to perform accurate and meticulous movements. In this group of muscles are the four dorsal interosseous muscles. Case presentation A distinct supernumerary fourth dorsal interosseous muscle was found in the right hand of the cadaver of a 76-year-old Caucasian man without any other concomitant abnormality. Conclusions The presence of such an additional muscle in the hand should be considered in the management of hand deformities, whether the treatment is conservative or surgical.

Abstract Introduction Although variations in the origin of the testicular artery are not uncommon, few reports about a high origin from the abdominal aorta exist in the literature. We discuss the case of a high origin of the testicular artery, its embryology, classification systems, and its clinical significance. Case presentation We report a very rare case of high origin of the left testicular artery in a 68-year-old Caucasian male cadaver. The artery originated from the anterolateral aspect of the abdominal aorta, 2 cm cranially to the ipsilateral renal artery. Approximately 1 cm after its origin, it branched off into the inferior suprarenal artery. During its course, the artery crossed anterior to the left renal artery. Conclusions A knowledge of the variant origin of the testicular artery is important during renal and testicular surgery. The origin and course must be carefully identified in order to preserve normal blood circulation and prevent testicular atrophy. A reduction in gonadal blood flow may lead to varicocele under circumstances. A knowledge of this variant anatomy may be of interest to radiologists and helpful in avoiding diagnostic errors.

Abstract Introduction Bilateral rectus femoris haematoma following a simultaneous strain of the quadriceps muscles is a very rare condition. Case presentation We report the case of a 21-year-old Greek Caucasian female rowing athlete who was injured on both thighs. She complained of pain and inability to walk. Physical examination revealed tenderness over the thighs and restriction of knee movement. The result of a roentgenogram was normal, and there was no evidence of fracture or patella displacement. Magnetic resonance imaging revealed haematoma formation in both the rectus femoris muscles. The diameters of the left and right haematomas within the muscles were 6 cm and 5 cm, respectively. Therapeutic approaches included compression bandages, ice application, rest, elevation, and administration of muscle relaxant drugs. Active stretching and isometric exercises were performed after three days. The patient was able to walk using crutches two days after the initiation of treatment. On the seventh day, she had regained her full ability to walk without crutches. Non-steroidal anti-inflammatory drugs were administered on the fifth day and continued for one week. Six weeks later, she had pain-free function and the result of magnetic resonance imaging was normal. She was able to resume her training programme and two weeks later, she returned to her previous sport activities and competitions. Conclusion There are references in the literature regarding the occurrence of unilateral quadriceps haematomas following strain and bilateral quadriceps tendon rupture in athletes. Simultaneous bilateral rectus femoris haematomas after a muscle strain is a rare condition. It must be diagnosed early. The three phases of treatment are rest, knee mobilization, and restoration of quadriceps function.

Abstract Background With the increasing number of people participating in physical aerobic exercise, jogging in particular, we considered that it would be worth knowing if there are should be limits to the exercise with regard to the intraocular pressure (IOP) of the eyes. The purpose of this study is to check IOP in healthy and primary glaucoma patients after aerobic exercise. Methods 145 individuals were subdivided into seven groups: normotensives who exercised regularly (Group A); normotensives in whose right eye (RE) timolol maleate 0.5% (Group B), latanoprost 0.005% (Group C), or brimonidine tartrate 0.2% (Group D) was instilled; and primary glaucoma patients under monotherapy with β-blockers (Group E), prostaglandin analogues (Group F) or combined antiglaucoma treatment (Group G) instilled in both eyes. The IOP of both eyes was measured before and after exercise. Results A statistically significant decrease was found in IOP during jogging. The aerobic exercise reduces the IOP in those eyes where a b-blocker, a prostaglandin analogue or an α-agonist was previously instilled. The IOP is also decreased in glaucoma patients who are already under antiglaucoma treatment. Conclusion There is no ocular restriction for simple glaucoma patients in performing aerobic physical activity.

Abstract Background As the population ages and as surgical and anaesthetic techniques advance, more elderly people will be referred for surgery. Postoperative mortality and morbidity are certainly associated with increasing age; however the severity of coexisting medical conditions is an equally important risk factor. In the present study we tried to look into the aetiology of early postoperative morbidity of elderly patients following major surgery, in relation to their medical history. Findings Fifty patients aged 70 to 95 years of age were enrolled in the study. All patients had undergone major elective orthopedic procedures due to either osteoarthritis of femoral head or femoral neck fracture. Patients were followed up by telephone interview one month following their discharge. 8 out of 50 patients (16%) were reported dead at follow up. For the majority of the patients who died, the cause of death was directly related to their previous medical history. Conclusion Despite the detailed preoperative evaluation, and the intensive intraoperative and early postoperative anaesthetic care, most patient's deaths were related to their previous medical history.

In 2008, members of the TEPARG provided first insights into the legal and ethical framework governing body donation in Europe. In 2012, a first update followed. This paper is now the second update on this topic and tries to extend the available information to many more European countries. For this second update, we have asked authors from all European countries to contribute their national perspectives. By this enquiry, we got many contributions compiled in this paper. When we did not get a personal contribution, one of us (EB) searched the internet for relevant information. Perspectives on the legal and ethical framework governing body donation in Europe. We still see that a clear and rigorous legal framework is still unavailable in several countries. We found national regulations in 18 out of 39 countries; two others have at least federal laws. Several countries accept not only donated bodies but also utilise unclaimed bodies. These findings can guide policymakers in reviewing and updating existing laws and regulations related to body donation and anatomical studies. [ABSTRACT FROM AUTHOR]

Purpose: The typical anatomical illustration of the trochlear notch articular surface includes a transverse rough non-articular ridge which separates the olecranon and coronoid part of the joint. This transverse ridge, the "bare area", is not covered by cartilage and represents the optimal entry point for olecranon osteotomies. Aim of the present study was to encounter the anatomical variations in the morphology of the trochlear notch articular surface. Methods: Two-hundred seventy-three dried ulnae were inspected and a qualitative classification of the variations of the trochlear notch articular surface was done. Correlation to gender and side was examined. Results: Three distinct morphological patterns were observed. Separate olecranon and coronoid facets (Type I) were the most common pattern (165/273, 60.4%). Partial fusion of olecranon and coronoid facets (Type II) was observed in 75 out of 273 bones (27.5%), while a single olecranon and coronoid facet (Type III) was present in 33 out of 273 bones (12.1%). The occurrence of Type II and III was significantly more common in females (p < 0.001). Conclusions: The most common morphological pattern of the proximal ulna articular surface was the olecranon and coronoid facets separated by the transverse ridge, which is considered as the typical anatomical pattern. The partial fusion of olecranon and coronoid facets was the second most common pattern (27.5%) and the single olecranon and coronoid facet with no transverse ridge present was the rarest one (12.1%). These variations affect the area covered by cartilage. They are noticeable in an elbow MRI and they may have implications on olecranon osteotomy. Absence of the transverse ridge may confuse the surgeon during elbow arthroscopy. [ABSTRACT FROM AUTHOR]