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1

Vascular architecture of the human uterine cervix, as assessed in light- and scanning electron microscopy

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Bereza T. , Tomaszewski K. A. , Walocha J. , Mizia E. , Bachul P. , Chmielewski P.

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nr 3

EN

Background: The aim of this study was to visualise and describe the vasculature of the human uterine cervix. Material and methods: The material for this study was obtained from women (age between 20 to 45 years) during autopsy. The material was collected not later than 24 h post-mortem. This study was performed using uteri from cadavers of menstruating nulliparas (33 uteri) and menstruating multiparas (27 uteri). Collected uteri were perfused via the afferent vessels with Mercox resin (for corrosion-casting and SEM assessment) or acrylic paint solution (light microscopy assessment). The research protocol was approved by the Jagiellonian University Ethics Committee (registry KBET/121/8/2007). Results: In all cases bilateral cervical branches (1–4), originating from the uterine artery, were found. Both in the vaginal and supravaginal parts of the cervix, four distinct vascular zones were found. In the pericanalar zone ran small veins, responsible for draining the mucosal capillaries. Both in the muscular layer, as well as in the pericanalar zone, arterioles, and venules passed close to each other, often adjoining. Conclusions: This study does not confirm the existence of a single “cervicovaginal” artery, but shows that the vascular supply of the cervix comes from several vessels. It also introduces the idea of two systems, responsible for draining blood from the mucosal capillaries. Neither assessment in light microscopy nor in SEM revealed any differences between multiparas and nulliparas, regarding the vascular architecture of the cervix. (Folia Morphol 2012; 71, 3: 142–147)

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Configurations of the circle of Willis: a computed tomography angiography based study on a Polish population

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Klimek-Piotrowska W. , Kopec M. , Kochana M. , Krzyzewski R. M. , Tomaszewski K. A. , Brzegowy P. , Walocha J.

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nr 4

EN

The aim of the study was to investigate the distribution of the circle of Willis variants in Polish population by means of computed tomography angiography (CTA). The results were then analysed and compared with another study that used similar methods but that was carried out on an ethnically distinct population. Patients presenting with intracranial pathology were excluded from the initial study population. In total, 250 CTA belonging to 129 female and 121 male patients were reviewed. A modified classification system of the circle was proposed, which took into consideration the anterior and the posterior aspects of the circle individually. The typical variant of Willis’s circle occurred in 16.80% of cases. The anterior and the posterior portions of the circle were normal in 47.20% and 26.80% of the patients respectively. As for the anterior part, lack of the anterior communicating artery was the most frequent abnormality (22.80%). Bilateral absence of posterior communicating arteries was the most common anomaly in the posterior part of the circle (29.20%). This type of anomaly was also the most common, when taking into consideration the entire circle (12.00%). There were statistically significant differences between the age groups and genders when considering the occurrence of an incomplete circle. Overall, a substantial proportion of patients manifested clinically important variants that were incapable of providing collateral circulation. Comparison with other imaging-based and cadaveric studies revealed noticeable differences, that may have resulted from the variable technical features of other studies or other factors such as the ethnical origins of the studied populations. (Folia Morphol 2013; 72, 4: 293–299)

3

Extra -and intracerebral course of the recurrent artery of Heubner

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Maga P. , Tomaszewski K. A. , Pasternak A. , Zawilinski J. , Tomaszewska R. , Gregorczyk-Maga I. , Skrzat J.

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tom 72

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nr 2

EN

Background: The aim of the current study was to analyse the extra- and intracerebral course of the recurrent artery of Heubner (RAH) to provide detailed information for neurosurgeons operating in this area. Materials and methods: The material for this study was obtained from cadavers (ages 31–75 years) during routine autopsies. A total of 70 human brains (39 male and 31 female) were examined. The material was collected not later than 48 h post-mortem. People who died due to neurological disorders were not included into the study. Right after dissection the arteries were perfused with either acrylic paint emulsion, polyvinyl chloride or Mercox CL-2R resin, through the Circle of Willis or electively through the RAH. The obtained material was analysed using a stereoscopic light microscope, magnification 2–40 x. Results: The RAH was present in 138 hemispheres with a mean of 1.99 RAH per hemisphere (275 RAH in total). The mean RAH length was 25.2 mm and the mean RAH diameter, in its place of origin, was 1 mm. In 168 (61%) cases the RAH ran superiorly, in 88 (32%) cases anteriorly, in 11 (4%) cases inferiorly and in 8 (3%) cases posteriorly to the A1 segment. In 70.2% of the cases the course of the RAH was parallel to the anterior communicating artery A1 segment, and in 29.8% of the cases the RAH arched towards the olfactory tract. As the extracerebral course of the RAH was always tortuous, its length was 1 to 5 times the distance between its place of origin and the most lateral point of anterior perforated substance (APS) penetration. The intracerebral course of the RAH was almost always univectorial — towards the head of the caudate nucleus. The course of RAH branches depended on their number. When the number of RAHs and their branches was low, they separated immediately after penetrating the APS and formed multiple small branches. When the number of RAHs and branches was high, post-APS branching was less frequent and occurred in distal segments. Conclusions: The origin and course of the RAH is highly variable. The RAH, in its extra- and intracerebral course, may join with the middle group of the lenticulostriate arteries or directly with the middle cerebral artery. This artery should be routinely identified during anterior communicating artery aneurysm clipping to prevent postoperative neurological deficits. (Folia Morphol 2013; 72, 2: 94–99)

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Anatomic variability of groin innervation

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Bachul P. , Tomaszewski K. A. , Kmiotek E. K. , Kratochwil M. , Solecki R. , Walocha J. A.

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nr 3

EN

Inguinal hernia repairs are very common yet fairly complex surgical procedures. Variations in the anatomical course of the inguinal nerves require that diligence is taken in their proper recognition. Inadvertent surgical injury to these nerves is associated with long term postoperative pain and complications. The aim of the present study was to highlight the complexity and variation in the innervation of the inguinal region in order to increase proper nerve identification during surgical interventions. Bilateral dissection of the inguinal and posterior abdominal regions in one human male cadaver revealed an atypical anatomic topography of the groin innervation. This unusual case was observed at the Jagiellonian University Anatomy Department during routine cadaveric preparations. The left ilioinguinal nerve was absent. The left genital branch of the genitofemoral nerve arose higher than expected from the lumbar plexus and supplied the groin region, which is typically innervated by the ilioinguinal nerve. Furthermore, the left lateral cutaneous femoral nerve and the right genital branch of the genitofemoral nerve also followed uncharacteristic courses. Awareness of topographical nerve variations during inguinal hernia repair will help surgeons identify and preserve important nerves, thus decreasing the incidence of chronic postoperative pain. (Folia Morphol 2013; 72, 3: 267–270)

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Validation of the Polish language version of the SF-36 Health Survey in patients suffering from lumbar spinal stenosis

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Klosinski M. , Tomaszewski K. A. , Tomaszewska I. M. , Klosinski P. , Skrzat J. , Walocha J. A.

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nr 4