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The celiac trunk (CT) is well-known as trifurcated into the left gastric (LGA), common hepatic (CHA) and splenic (SA) arteries. Scarce reports indicate that the CT could appear cvadri-, penta-, hexa-, or even heptafurcated. Reports of CTs with six branches (hexafurcated CT) are few, less than ten. The hexafurcated CT variant was documented by a retrospective study of 93 computed tomography angiograms. Two hexafurcated CTs were found. In one case an arc of Buhler was added to the inferior phrenic arteries, LGA, CHA and SA. In the second case the dorsal pancreatic artery was added to the other five branches. That arc of Buhler descended in front of the aorta to connect with the origin of the third jejunal artery. The CHA in that second case was trifurcated into the left and right hepatic arteries, and the gastroduodenal artery; the proper hepatic artery was absent. Although the hexafurcated CT, as well as the trifurcated CHA, are rarely occurring and reported anatomic variants, this doesn't mean they could not be encountered during surgical or interventional procedures, which they would complicate if not recognized. Moreover, the arc of Buhler, the embryonic remnant, was not reported previously to insert into the CT as an additional branch of it.

Background: Commonly, arterial anatomic variants are reported as single entities. However, different such variants can occur in a single patient. Materials and methods: During a retrospective study of computed tomography angiograms of 52 adult patients, two cases were found with unilateral maxillofacial trunks. In each case different other anatomic variants were documented. Results: The maxillofacial trunk in the first case was associated with bilateral posterior kinks of the internal carotid artery which passed beyond the transverse processes of the atlas vertebra and indented and displaced the internal jugular veins. Common carotid origins of the superior thyroid arteries were found, as well as a high origin of the contralateral facial artery. In the second case a plethora of variants were associated with a unilateral maxillofacial trunk: (1) direct occipital-vertebral arterial anastomosis; (2) ipsilateral atresia of the distal vertebral artery and of the A1 segment of the anterior cerebral artery; (3) bilateral atresia of posterior communicating arteries; (4) linguofacial and labiomental trunks; (5) terminal trifurcation of the external carotid artery. Conclusions: The arterial anatomical variants of the head and neck should be carefully documented prior to specific surgical and interventional procedures, as well as for understanding the compensatory anatomical pathways of circulatory insufficiencies.

The coeliac trunk is normally divided into the left gastric artery (LGA), splenic artery, and common hepatic artery (CHA). The combination between these arteries and the superior mesenteric artery (SMA) generates various combinations. We report here such a rare anatomic variant, namely the hepatomesenteric trunk (HMT), combined with a gastrosplenic trunk (GST). The variant was identified using computed tomography angiograms of a 62-year-old woman. The GST emerged from the aorta within the aortic hiatus of the diaphragm, a previously unknown possibility. Further, an accessory left hepatic artery originated from the LGA. The phrenic arteries had independent aortic origins. The HMT divided into the CHA and the SMA posterior to the origin of the hepatic portal vein (PV), above the pancreas. The CHA initially had a right course, towards the superior border of the PV, then it descended with a transpancreatic course posterior to the PV, reached its inferior/right border, and divided antero-inferiorly to the PV into the proper hepatic and gastroduodenal arteries. The proper hepatic artery continued on the anterior side of the PV, sending off the left and right hepatic arteries. The HMT and the GST were connected by a rudimentary variant of the arc of Bühler, unreported previously. Arterial variations in the coeliac region are accurately distinguished on computed tomography angiograms. They should be evaluated by surgeons when different surgical procedures are evaluated.

An unusual variation of the extensor muscles was found during the routine dissection of the posterior compartment of the forearm. The left forearm presented an extensor medii proprius muscle, the tendon of which had an unusual trajectory. It passed through the second extensor compartment between the tendons of the extensor carpi radialis longus and extensor carpi radialis brevis muscles. The right forearm presented two muscles for the index finger: one, the extensor indicis et medius communis, the tendon of which was split into three tendons, one radial and one ulnar for the index finger and a rudimentary tendon for the middle finger; the second muscle for the index finger had an unusual origin, common with the extensor carpi radialis brevis, and its tendon ran superficially to the tendon of the extensor indicis et medius communis muscle. Knowledge goes tendon variations can be significant not only for clinicians to misdiagnose a debilitating wrist extensor pain syndrome but also for surgeons to avoid iatrogenic injuries in hand surgery.

Background and Objectives: Our study aimed to investigate the gross anatomy aspects of the fossa ovalis (FO) and the presence of some anatomical variation resulting from the incomplete fusion of septum primum and septum secundum, such as an atrial septal pouch (SP) and left atrial septal ridge. Materials and Methods: Thirty-one adult human hearts removed from formalin-fixed specimens were examined to provide information about the morphology of the FO. The organs were free of any gross anatomically visible pathological conditions. Results: The most common variants were the FO located in the inferior part of the interatrial septum (64.51%), circular (61.3%), with a net-like structure (51.62%), prominent limbus (93.55%), and patent foramen ovale (PFO) (25.8%). The right SP was observed in 9.67% of specimens, the left SP was observed in 29.03% of cases, and in 51.61% of cases, a double SP was observed. One sample presented a right SP and a double left SP, and one case showed a triple left SP, which was not reported previously to our knowledge. Conclusions: Knowledge of the interatrial septal anatomy becomes important for interventional cardiologists and should be documented before transeptal puncture.

Background and Objectives: Launay’s external carotid vein (ECV) is poorly represented in the anatomical literature, although it is an occasional satellite of the external carotid artery (ECA). We aimed to establish the incidence and morphology of the ECV. Materials and Methods: One hundred computed tomography angiograms were investigated, and ECVs were documented anatomically, when found. Results: Launay’s vein was found in 3/200 sides (1.5%) in a male and two female cases. In two of these cases, the ECV was a replaced variant of the anterior division of the retromandibular vein (RMV), and the facial vein (FV) ended in the external jugular vein. In the third case with the ECV, the RMV was absent and the common FV that resulted from that ECV and the FV drained into the internal jugular vein. The ECV could also appear as an accessory RMV, not just as a replaced one. Additional variants were found, such as fenestration of the external jugular vein (EJV), the extracondylar vein draining the deep temporal veins and an arterial occipitoauricular trunk. Conclusions: Surgical dissections of the ECA in the retromandibular space should carefully observe an ECV to avoid unwanted haemorrhagic events. Approaches of the neck of the mandible should also carefully distinguish the consistent extracondylar veins.

An uncommon anatomical variant of muscle that can be considered as a supernumerary extensor carpi radialis muscle was found during the dissection of the forearm region. The identified extensor carpi radialis muscle has origin on the lateral supraepicondylar ridge of the humerus, and an unusual insertion on the tubercle of the scaphoid bone. The presence of this supernumerary muscle may cause diagnostic errors in the forearm region, and can produce a debilitating pain syndrome by secondary compression of adjacent nerves, vessels or tendons due to its course along the anterior compartment of the forearm.

The celiac trunk is one of the main sources of vascularization of the supracolic abdominal compartment. It arises from the abdominal aorta, at the level of T12-L1 vertebrae and classically branches into the splenic artery, common hepatic artery, and left gastric artery. We report here an atypical branching pattern of the celiac trunk, found during the dissection of a 60-year-old female's formalin-fixed cadaver. The atypically celiac trunk gave rise to four branches: a common trunk for left and right inferior phrenic arteries, an accessory left gastric artery, the common hepatic artery, and a splenogastric trunk. Knowledge in detail about normal anatomy and variation in the branching pattern of the celiac trunk is important in surgical, oncological, and radiological interventional procedures and must be taken into account to avoid possible complications.

Specific ultrastructural anatomy of masticatory muscles is commonly referred to a general pattern assigned to striated muscles. Junctional feet consisting of calcium channels of the sarcoplasmic reticulum (i.e. the ryanodine receptors, RyRs) physically connected to the calcium channels of the t-tubules build triads within striated muscles. Functional RyRs were demonstrated in the nuclear envelopes of pancreas and of a skeletal muscle derived cell line, but not in muscle in situ. It was hypothesized that ryanodine receptors (RyRs) could also exist in the nuclear envelope in the masseter muscle, thus aiming at studying this by transmission electron microscopy. There were identified paired and consistent subsarcolemmal clusters of mitochondria, appearing as outpockets of the muscle fibers, usually flanking an endomysial microvessel. It was observed on grazing longitudinal cuts that the I-band-limited mitochondria were not strictly located in a single intermyofibrillar space but continued transversally over the I-band to the next intermyofibrillar space. It appeared that the I-band-limited transverse mitochondria participate with the column-forming mitochondria in building a rather incomplete mitochondrial reticulum of the masseter muscle. Subsarcolemmal nuclei presented nuclear envelope-associated RyRs. Moreover, t-tubules were contacting the nuclear envelope and they were seemingly filled from the perinuclear space. This could suggest that nucleoplasmic calcium could contribute to balance the cytosolic concentration via pre-built anatomical routes: (i) indirectly, via the RyRs of the nuclear envelope and (ii) directly via the communication of t-tubules and sarcoplasmic reticulum through the perinuclear space.

(1) Background. The vertebral level of origin (VLO) of the celiac trunk (CT) and superior mesenteric artery (SMA) has been scarcely investigated. (2) Method. This study used 107 computed tomography angiograms and an eleven type grading system to classify the VLO of the CT and SMA. Each of the T12–L2 vertebra were divided in three horizontal levels. The intervertebral discs were considered distinct levels. (3) Results. The VLO of the CT ranged from the upper third of the T12 vertebra to the lower third of the L1 vertebra. The VLO of the SMA ranged from the lower third of the T12 vertebra to the upper third of the L2 vertebra. There was a highly significant association between the VLO of the CT and SMA (Chi2 = 201, p &lt, 0.001), usually respecting a “plus two” rule. The mean CT–SMA distance was 1.82 +/− 0.66 cm in males and 1.55 +/− 0.411 cm in females, the difference being statistically significant. The mean CT–SMA distance tended to decrease with increasing CT–SMA types, the differences being statistically significant. (4) Conclusions. These characteristics of CT and SMA origins and their relations should be known by surgeons, as they could impact operative management and should be evaluated on a case-by-case basis.

Background The celiac trunk (CT) commonly trifurcates into the left gastric artery, common hepatic artery (CHA), and splenic artery (SA). The CHA then sends off the proper hepatic artery and gastroduodenal artery (GDA). The arcades of the head of the pancreas are celiacomesenteric anastomoses between branches of the GDA and the superior mesenteric artery. A quadrifurcation of the CT commonly occurs when a different branch is added to the 3 normal ones. An uncommon quadrifurcation of the CT occurs when only one or 2 of the normal branches of the CT participate. Methods The CT quadrifurcations were documented on 112 computed tomography angiograms. Results Five different types of CT quadrifurcation—3 uncommon (types 1–3) and 2 common (types 4–5)—were found in 15/112 cases (13.39%). A marginal significant association was found between the presence of quadrifurcations and male gender (P = 0.05; Fisher's exact test). Type 1 showed a hepatogastric trunk+SA + right hepatic artery+GDA pattern, type 2 had an HGT + right inferior phrenic artery + CHA + SA pattern, type 3 had a gastrophrenic trunk + left inferior phrenic artery+CHA + SA pattern, type 4 showed an left gastric artery + CHA + SA + left inferior phrenic artery combination, and type 5 had an additional common inferior phrenic trunk. One of the type 4 cases showed a buildup of a mesentericomesenteric anastomotic pancreatic arcade between the inferior pancreaticoduodenal arteries, rather than a celiacomesenteric one. Conclusions Anatomic variation of the celiacomesenteric axis is important during hepatobiliary and duodenopancreatic approaches. Therefore, preoperative evaluation is essential because theoretical anatomic possibilities could be real arterial variants.

Only a few studies published until now have described the fascial-tendinous complex between the temporal and the buccinator muscles, which will be reviewed here. In 1957, the "temporo-buccinator band" (TBB) was described by Gaughran, who gave credit to Hovelaque for its first description in 1914. Zenker coined it in 1955 as the "buccotemporal fascia" (BTF). A buccal extension of the temporal muscle tendon extends from the temporal crest of the mandible to insert within the buccinator muscle, anterior to the pterygomandibular raphe, and posterior to the parotid duct that perforates the buccinator. That tendinous expansion is embedded within the buccotemporal fascia, which is oriented antero-infero-medially and joins the buccopharyngeal fascia, forming the TBB/BTF, above which we find the buccal fat pad. The buccal nerve and artery cross this anatomical structure. The TBB/BTF is an additional layer closing the pterygomandibular space anteriorly, and its knowledge is needed for practitioners performing inferior alveolar nerve blocks.

Biochemical bone turnover markers (BTMs) estimates the bone remodeling process, being valuable in the personalized approach of osteoporotic patients.The aim of the study was to evaluate the correlation between biochemical BTMs and bone mineral density (BMD), depending on menopause period, in postmenopausal osteoporotic women, compared to postmenopausal women without osteoporosis.The study included 149 untreated postmenopausal women, divided into three groups: group 1 (65 osteoporotic women with less than 10 years of menopause), group 2 (44 osteoporotic patients, with over 10 years of menopause), and the control group with 40 postmenopausal women without osteoporosis.All BTMs levels were higher in the groups with osteoporosis, than in the control group. Lumbar BMD values correlated positively with deoxypyridinoline (DPD) and negatively with bone-specific isoform of alkaline phosphatase (BAP), tartrate-resistant acid phosphatase band 5b (TRAP 5b), osteocalcin (OC) and cross-linked N-telopeptides of type I collagen (NTX). Serum estradiol levels correlated positively with spine BMD in the whole study group (r=0.508, p=0.001). BTMs correlated positively with each other. Osteoporotic women with longer period of menopause presented significantly higher values of resorption markers (NTX and TRAP 5b), compared to the group with menopause duration less than 10 years. At a cutoff value of 12 μg∕L, BAP presented 82.4% sensitivity and 62.5% specificity.Our study showed that BTMs correlated negatively with lumbar BMD and positively with each other. Resorption markers levels increase with duration of estradiol deprivation period.

Usual descriptions indicate three or maximum four nasal turbinates (conchae) attached to the lateral nasal wall. The middle, superior and, occasionally, supreme ones belong to the ethmoid bone. Few authors include in descriptions the concha that Zuckerkandl described as the fourth or supreme ethmoidal turbinate. Despite some inconsistencies in Zuckerkandl's description, the concha bearing his name lies above Santorini's supreme concha, which, in turn, is above Morgagni's superior concha. Few other authors preferred to name Santorini's concha as the first supreme one and Zuckerkandl's concha as the second supreme one.We retrospectively documented, with various purposes, the archived cone-beam computed tomography files of 350 patients.We found in just one case a unilateral sequence of five nasal turbinates. On the opposite side, only four turbinates were detected. Three-dimensional renderizations confirmed that when two supreme turbinates are found, they are joined in a common posterior tail, which, in turn, joins the tail of the superior turbinate.Co-existence of two supreme conchae could either indicate their origin from different ethmoturbinals, or from the split of a commonly unique supreme one. Zuckerkandl's concha deserves therefore to be considered when anatomical descriptions, or studies, are delivered.

There are only a few studies regarding gut subepithelial telocytes (TCs). The telopodes, namely peculiar TCs&rsquo, prolongations described on two-dimensional cuts, are not enough to differentiate this specific cell type. Subepithelial TCs were associated with the intestinal stem niche but a proper differential diagnosis with lymphatic endothelial cells (LECs) was not performed. In this study, we will critically review studies suggesting that distinctive TCs could be positioned within the lamina propria. Additionally, we performed an immunohistochemical study of human gastric mucosa to test the expression of D2-40, the lymphatic marker, as well as that of CD31, CD34, CD44, CD117/c-kit, &alpha, smooth muscle actin (&alpha, SMA) and vimentin in the gastric subepithelial niche. The results support the poorly investigated anatomy of intramural gastric lymphatics, with circumferential collectors located on both sides of the muscularis mucosae (mucosal and then submucosal) and myenteric collectors in the muscularis propria. We also found superficial epithelial prelymphatic channels bordered by D2-40+ but CD31&ndash, TC-like cells. Deep epithelial lymphatic collectors drain in collectors within the lamina propria. Blood endothelial cells expressed CD31, CD34, CD44, and vimentin. Therefore, the positive diagnosis of TC for subepithelial CD34+ cells should be regarded with caution, as they could also be artefacts, resulting from the two-dimensional examination of three dimensional structures, or as LECs. Lymphatic markers should be routinely used to discriminate TCs from LECs.

The rare anatomic variants of the celiac trunk and superior mesenteric artery include the hepatosplenic, hepatosplenomesenteric (HSMT), celiacomesenteric, hepatomesenteric and gastrosplenic trunks. We report a 72-year-old female patient whose computed tomography angiograms indicated a rare anatomic feature whereby the right inferior phrenic artery was inserted in the origin of an HSMT, thus modifying it into a hepatosplenomesentericophrenic trunk (HSMPT). Above the HSMPT, the insertion of the left inferior phrenic artery in the origin of the left gastric artery determined a left gastrophrenic trunk (GPT). Proper identification of this type of rare anatomic variant is of utmost importance prior to different surgical procedures. For example, an HSMT origin of the right inferior phrenic artery is surgically relevant if this artery is an extrinsic pedicle of a hepatocellular carcinoma and is used for embolization of the tumor.

Although confusions persist in what concerns the terminologies used for describing the fibroblastoid cells of the stromal compartments, the expression of antigens in such cells gradually directs their diagnosis towards a stem/progenitor phenotype. The stromal cells with long, slender and moniliform prolongations were named "telocytes" (TCs), their cell processes being termed "telopodes". However, the mammary gland TCs were not evaluated for the CD34 expression. Thus an in vivo immunohistochemical study was designed; antibodies against CD10, CD34, CD117/c-kit and vimentin were applied on human mammary gland samples of 8 donor patients. Resident CD34-positive stromal cells positive for the TCs morphology were found building consistent stromal networks and ensheathing microvessels and excretory units. Such cells were CD10±/c-kit-/vimentin+. According to the current concepts regarding the in vivo stem/progenitor cells the CD34+ TCs of the mammary stroma could be actors in the mammary stem niche and their antigens expression could relate to different stages of differentiation.

An unusual muscle was discovered during the dissection of the presternal and pectoral regions, which, according to Jelev classification, can be considered a sternalis muscle. The identified right sternalis muscle has a common origin with the sternal head of the right sternocleidomastoid muscle and then splits in two bellies, the right one, much longer, which inserts on the right 2nd–5th costal cartilages, and the left one which inserts on the 2nd–3th left sternocostal joints. The sternalis muscle was associated with a very poor developed right transversus thoracis muscle. The study is important for the anatomists and more important for the clinicians, as this muscle's presence may cause diagnostic errors in the pectoral region.

All tissues are known to contain stem cells niches. The dental pulp stem cells (DPSCs) are highly proliferative and can differentiate to various cell types, including endothelial cells. We aimed to evaluate the ultrastructural characteristics of the human dental pulp niche corresponding to the frontal teeth. We found bona fide quiescent DPSCs with high nucleoplasmic ratios, as well as poorly differentiated cells with increased amount of cytoplasm, these later being indicated as dental pulp progenitor cells (DPPCs). Vasculogenic cords were built up by mitotic endothelial progenitor cells with a peculiar trait: giant nucleoli extruded within the cytoplasm. They were either partly embedded within the nuclei, case in which their adnuclear side was coated by marginal heterochromatin and the abnuclear side was coated by a thin rim of ribosomes, or were completely isolated from the nuclei, being covered by ribosomes and surrounded by cytoplasmic fragments of chromatin. To our knowledge such giant extruded nucleoli were not previously reported in any human stem niche or cell type, although similar evidence was gathered in other species as well as in plants. They relate perhaps to intermediate stages of differentiation within the dental niche, thus appearing as transient structures. Their role needs further investigations as it looks that not only nucleolar proteins are exported into the cytoplasm, but the entire nucleolus could be extruded.

Objective: An aberrant subclavius posticus muscle was found during routine dissection of the left infraclavicular fossa of a 60-year-old male cadaver. Presentation: This aberrant muscle arises antero-medially, from the costoclavicular ligament, runs postero-laterally, over the trunks of the brachial plexus, and postero-lateral has a common insertion with the omohyoid muscle. Conclusion: The presence of such an aberrant muscle may cause a dynamic compression of the subclavian artery and brachial plexus.

Despite the implementation of various screening programs in many countries, cervical cancer continues to be a major health problem. Cervical cytology is the most used screening method, but human papillomavirus (HPV) genotyping, alone or in combination with cytology, has gained ground during the last years. Still, one of the major limitations of HPV-genotyping is the low specificity of HPV as a screening method in young women that are HPV-positive, but with no potential for future disease. Obviously, there is a need for a better screening algorithm. The ideal screening test for cervical high-grade lesions should detect the effect of high-risk (HR)-HPV infection after cell transformation, but not before, and should accurately identify the cases that are more likely to experience disease progression to neoplasia. Solid data regarding the benefit of immunocytochemistry in the evaluation of the patients with modified cervical cytology have been published recently. The use of the dual staining with p16INK4a and Ki-67 could increase specificity of the method for the detection of atypical cells and may perform better in predicting the risk of high-grade dysplasia in the near future.

Vasa praevia is a rare but very dangerous obstetrical condition. The purpose of our article is to evaluate data available in literature that indicate in vitro fertilization as a risk factor for vasa praevia. PubMed Library and Cochrane Database were searched using the keywords vasa praevia, in vitro fertilization, velamentous cord insertion, placenta praevia. The conditions related to in vitro fertilization that increase the risk of vasa praevia formation were identified and discussed. Also, the diagnosis and management options were reviewed. In vitro fertilization represents a risk factor for vasa praevia and all such pregnancies should be screened by transvaginal ultrasound for vasa praevia.

Neurofilaments usually associated with neural tissues are the type IV family of intermediate filaments. Nestin, which is a type VI intermediate filament, is a well known marker of endothelial cells in newly formed blood vessels and is developmentally and structurally related to type IV intermediate filaments. We aimed to determine whether or not cardiac endothelial cells (ECs) label with antibodies for neurofilaments (200 kDa, Novocastra-Leica, clone RT97), as is already known for nestin. We used cardiac samples (sinoatrial nodes/right atrial walls) from cadavers of normal and diabetic donors (6 normal adults, 10 type II diabetic adults, 1 child) for neurofilament immune labeling. Positive labeling of endothelial cells, microvascular and endocardial, was obtained in all samples. As this is the first such evidence, we can only presume that the neurofilament positive labeling of endothelial cells may be due to interactions of nestin and neurofilaments. Further studies are needed to evaluate the hypothesis we reached and, in order to explore whether or not neurofilament antibodies can qualify as markers of angiogenesis.

This study aimed to evaluate by immunohistochemistry and transmission electron microscopy (TEM) the morphological features of the oral mucosa endothelial tip cells (ETCs) and to determine the immune and ultrastructural patterns of the stromal nonimmune cells which could influence healing processes. Immune labeling was performed on bioptic samples obtained from six edentulous patients undergoing surgery for dental implants placement; three normal samples were collected from patients prior to the extraction of the third mandibular molar. The antibodies were tested for CD34, CD117(c-kit), platelet derived growth factor receptor-alpha (PDGFR-α), Mast Cell Tryptase, CD44, vimentin, CD45, CD105, alpha-smooth muscle actin, FGF2, Ki67. In light microscopy, while stromal cells (StrCs) of the reparatory and normal oral mucosa, with a fibroblastic appearance, were found positive for a CD34/CD44/CD45/CD105/PDGFR-α/vimentin immune phenotype, the CD117/c-kit labeling led to a positive stromal reaction only in the reparatory mucosa. In TEM, non-immune StrCs presenting particular ultrastructural features were identified as circulating fibrocytes (CFCs). Within the lamina propria CFCs were in close contact with ETCs. Long processes of the ETCs were moniliform, and hook-like collaterals were arising from the dilated segments, suggestive for a different stage migration. Maintenance and healing of oral mucosa are so supported by extensive processes of angiogenesis, guided by ETCs that, in turn, are influenced by the CFCs that populate the stromal compartment both in normal and reparatory states. Therefore, CFCs could be targeted by specific therapies, with pro- or anti-angiogenic purposes.

Recently, a novel type of stromal cell – the telocytes (TC) – was identified in mouse trachea. These cells are known to possess the ultrastructural characteristics, which support their role in intercellular signaling. We found TC in all stromal compartments of the tracheal wall. TC with long prolongations (telopodes, Tp) were lining longitudinally the collagen bundles, and were serially arranged (end-to-end connections of Tp were found). Noteworthy, Tp frequently establish stromal synapses with mast cells (MC). Primary cilia were also identified in TC. In conclusion, tracheal TC could be involved in the tracheal regulation (e.g. secretion, contractility). The tandem TC-MC deserves further investigations.

Botulinum neurotoxin B (BoNT-B) is a well known lethal agent in humans. In the last years botulinum neurotoxins have been used as therapeutic agents in pain management; their intimate effects on the peripheral nervous ganglia were however not thoroughly described. We present here a rare case of a BoNT-B serologically positive human adult in which trigeminal ganglia were found immunopositive for caspases 3 and 9. Thus the intrinsic apoptotic pathway was proposed as the cell death mechanism involving primary trigeminal neurons. Scavengers such as macrophages and resident satellite glial cells, with a CD68 immunopositivity were also identified, presumably being in the process of eliminating apoptotic remnants. Taking into account that the downregulation of metalloproteinases leads to inactivation of neuronal caspase 3, exogenous metalloproteinases, such as BoNT, may lead to apoptosis. If this causal relation, neurotoxin-to-apoptosis is valid, similar apoptotic processes can be presumed to occur in various ganglia, sensory and autonomic, involved in vital functions of the body. In conclusion, further morphological and experimental studies are needed to extensively evaluate the apoptotic effect of BoNT within the peripheral nervous ganglia in botulinum infections and BoNT treatments.

The iliolumbar artery (ILA) of Haller is the largest nutrient pedicle of the ilium and its detailed knowledge is important for various surgical procedures that approach the lumbosacral junction, the L4/L5 disk space, the sacroiliac joint, the iliac and psoas muscles, or the lumbar spine. Also the ILA is relevant for various techniques of embolization. We aimed to evaluate the anatomic and topographic features of the ILA, by dissection on 30 human adult pelvic halves and on 50 angiograms. ILA was a constant presence and it emerged at Level A (from the common iliac artery (CIA), 8.75%), Level B (from the CIA bifurcation, 2.5%), Level C (from the internal iliac artery (IIA), 52.5%), Level D (from the IIA bifurcation, 3.75%), and Level E (from the posterior trunk of the IIA, 32.5%). Level B of origin of the ILA corresponds to a trifurcated CIA (morphology previously unreported), while Level D corresponds to a trifurcated IIA. A higher origin of the ILA corresponds to a more transversal course of it. A descending lumbar branch that leaves the iliac arterial system independently to enter the psoas major muscle, as seen in 48% of cases, may be misdiagnosed as ILA. Surgical interventions in the lumbar, sacral, and pelvic regions must take into account the variable origins of the ILA from the iliac system that can modify the expected topographical relations and may lead to undesired hemorrhagic accidents.

Multipotent mesenchymal stromal cells (MMSCs) are plastic-adherent cells with a well-established phenotype. Equine, but not human, adipose MMSCs have been characterized ultrastructurally. The purpose of our study was to evaluate ultrastructurally the adipose-derived human MMSCs. Cell cultures were prepared from human lipoaspirate. The flow cytometry evaluation of surface markers of cultured cells confirmed the expected profile of MMSCs, that were positive for CD73, CD90 and CD105, and negative for CD34 and CD45. We examined these human adipose-derived MMSCs in transmission electron microscopy (TEM) by Epon en-face embedding the fixed MMSCs. The main ultrastructural features of MMSCs were the extremely rich content of endosomal/vesicular elements, long mitochondria, dilated RER (rough endoplasmic reticulum) cisternae, and abundant intermediate filaments and microtubules. We found two types of MMSCS prolongations: (a) thick processes, with opposite, vesicular and filaments-rich, sides and (b) slender processes (pseudopodes and filopodes), with occasional proximal dilated segments housing mitochondria, vesicles and secretory granules. These TEM features of MMSCs characterized an in vitro cell population and could use to distinguish between different cell types in culture.

Although intrinsic laryngeal neurons and ganglia have been studied in various species, they have been overlooked in humans. We aimed to investigate the presence of intrinsic laryngeal neurons in humans and, if present, to analyze their neuronal nitric oxide synthase (nNOS) expression. An immunohistochemical study using anti-nNOS antibodies was performed on samples obtained from four cadavers. Intrinsic laryngeal nNOS+ neurons were assessed in the submucosal layer, but nNOS+ nerves were found in all histological layers of the larynx. nNOS expression was also found in striated muscle fibers of larynx. This might reveal the anatomical basis of an upwards extension of the nonadrenergic noncholinergic system in human airways, but further experiments are needed to assess an exact role of NO influence on neural transmission and muscular functions of human larynx.

There has been a keen interest in assessing the neurovascular anatomy of the rostral ventrolateral medulla oblongata (RVLM). The present study was aimed at documenting the complete neurovascular anatomy of the RVLM, in order to offer a general picture of the possible offending vessels of this area, which seems to be involved in the pathogeny of the essential hypertension. Noteworthy, syndromes of the last cranial nerves could be due to vascular contacts or compressions. The present study was performed on 20 human adult brainstem-cerebellum blocks, dissected out of the posterior cerebral fossa at autopsies. The origins of the inferior cerebellar arteries (anterior--AICA and posterior--PICA) were traced bilaterally (n=40 sides). When present (26/40) AICA most frequently left the basilar artery and PICA (28/40) most frequently left the vertebral artery. At the level of the RVLM, a quadrilateral space delimited by the vertebral artery (VA) and the vertebrobasilar junction, the AICA and the PICA, was defined. Within that space, three vascular layers were identified: a superficial one, formed by the inferior cerebellar arteries, a middle one, consisting of perforating arteries, and a deep, venous one. The RVLM perforating arteries left the VA (31/40), basilar artery (BA) (3/40), anterior spinal artery (ASA) (34/40), PICA (28/40) and AICA (24/40). These perforators had a transverse or oblique course if given off by the VA, BA or ASA, were descendant if given off by the AICA or BA, and were ascending if given off by the VA or PICA. Microanatomical studies of the vascular relations of the RVLM are able to complete the somewhat limited findings of studies based on imaging techniques. The offending vessels of the RVLM could be any of the vessels inside the quadrilateral space. Major vessels, such as the VA, AICA or PICA should not be viewed as the only possible offending vessels at this level. The perforators and the venous layers in the quadrilateral space should also be better evaluated from this perspective.

TCs (telocytes) are actually defined as stromal cells with specific long and thin prolongations, called Tp (telopodes). They have been positively identified in various tissues and we now report their presence in the esophagus. These cells were identified by TEM (transmission electron microscopy) in esophageal samples of Wistar rats (n = 5) occurring beneath the basal epithelial layer, in submucosa, closely related to smooth and striated muscular fibres, as also in the adventitia. They are closely related to mast cells, macrophages and microvessels. Hybrid morphologies of stromal cells processes were found: cytoplasmic processes continued distally in a telopodial fashion. Telopodes alone may not be sufficient, however, for a safe diagnosis of TCs in TEM. A larger set of specific standards (such as the telopodial emergence, and the size of the cell body and telopodes) should be considered to differentiate TCs from various species of fibroblasts. The morphological and ultrastructural features should distinguish between TCs and interstitial cells of Cajal in the digestive tract.

Sprouting angiogenesis is led by specialized cell--the endothelial tip cells (ETCs) which can be targeted by pro- or anti-angiogenic therapies. We aimed to perform a qualitative study in order to assess the guidance by tip cells of the endothelial sprouts in the repairing mucosa of the edentulous mandibular crest. Mucosa of the mandibular edentulous ridge was collected from six adult patients, prior to healing abutment placement (second surgery). Slides were prepared and immunostained with antibodies for CD34 and Ki67. The abundant vasculature of the lamina propria was observed on slides and the CD34 antibodies labeled endothelial tip cells in various stages of the endothelial sprouts. Ki67 identified positive endothelial cells, confirming the proliferative status of the microvascular bed. According to the results, the in situ sprouting angiogenesis is driven by tip cells in the oral mucosa of the edentulous ridge and these cells can be targeted by various therapies, as required by the local pathologic or therapeutic conditions.

The anatomy of the pterygopalatine fossa keeps a traditional level and is viewed as constant, even though a series of structures neighboring the fossa are known to present individual variations. We aimed to evaluate on 3D volume renderizations the anatomical variables of the pterygopalatine fossa, as related to the variable pneumatization patterns of the bones surrounding the fossa. The study was performed retrospectively on cone beam computed tomography (CBCT) scans of 100 patients. The pterygopalatine fossa was divided into an upper (orbital) and a lower (pterygomaxillary) floor; the medial compartment of the orbital floor lodges the pterygopalatine ganglion. The pneumatization patterns of the pterygopalatine fossa orbital floor walls were variable: (a) the posterior wall pneumatization pattern was determined in 89.5 % by recesses of the sphenoidal sinus related to the maxillary nerve and pterygoid canals; (b) the upper continuation of the pterygopalatine fossa with the orbital apex was narrowed in 79.5 % by ethmoid air cells and/or a maxillary recess of the sphenoidal sinus; (c) according to its pneumatization pattern, the anterior wall of the pterygopalatine fossa was a maxillary (40.5 %), maxillo-ethmoidal (46.5 %), or maxillo-sphenoidal (13 %) wall. The logistic regression models showed that the maxillo-ethmoidal type of pterygopalatine fossa anterior wall was significantly associated with a sphenoidal sinus only expanded above the pterygoid canal and a spheno-ethmoidal upper wall. The pterygopalatine fossa viewed as an intersinus space is related to variable pneumatization patterns which can be accurately identified by CBCT and 3DVR studies, for anatomic and preoperatory purposes.

This study aimed to evaluate by immunohistochemistry and transmission electron microscopy (TEM) the morphological features of the oral mucosa endothelial tip cells (ETCs) and to determine the immune and ultrastructural patterns of the stromal nonimmune cells which could influence healing processes. Immune labeling was performed on bioptic samples obtained from six edentulous patients undergoing surgery for dental implants placement; three normal samples were collected from patients prior to the extraction of the third mandibular molar. The antibodies were tested for CD34, CD117(c-kit), platelet derived growth factor receptor-alpha (PDGFR-α), Mast Cell Tryptase, CD44, vimentin, CD45, CD105, alpha-smooth muscle actin, FGF2, Ki67. In light microscopy, while stromal cells (StrCs) of the reparatory and normal oral mucosa, with a fibroblastic appearance, were found positive for a CD34/CD44/CD45/CD105/PDGFR-α/vimentin immune phenotype, the CD117/c-kit labeling led to a positive stromal reaction only in the reparatory mucosa. In TEM, non-immune StrCs presenting particular ultrastructural features were identified as circulating fibrocytes (CFCs). Within the lamina propria CFCs were in close contact with ETCs. Long processes of the ETCs were moniliform, and hook-like collaterals were arising from the dilated segments, suggestive for a different stage migration. Maintenance and healing of oral mucosa are so supported by extensive processes of angiogenesis, guided by ETCs that, in turn, are influenced by the CFCs that populate the stromal compartment both in normal and reparatory states. Therefore, CFCs could be targeted by specific therapies, with pro- or anti-angiogenic purposes.

Introduction The rhinopharynx and the parapharyngeal space (PPS) are complex anatomical territories located beneath the skull base. Thorough knowledge of the complex anatomy of the PPS is essential in treatment of pathologies such as parapharyngeal abscesses. The roof of the PPS is overlooked in anatomy. It was hypothesized that the pneumatization pattern of the PPS roof is individually variable, as determined by the variable pneumatization patterns of the sphenoid and temporal bones. The study was aimed at assessing the anatomy of the PPS roof in CBCT. Methods The present study was performed retrospectively on a group of 35 subjects (37.1% males) evaluated by CBCT for various dental procedures. Results The mean age of the group was 37.9 (SD: 14.2, range: 18 to 61). The major bony landmarks of the PPS roof were: the petrous apex with the carotid canal, the jugular foramen, the foramen lacerum, the sphenopetrosal fissure or suture, and the root of the pterygoid process. Variable patterns of pneumatization were determined by the petrous apex air cells and the pterygoalar recess of the sphenoidal sinus. As related to the individually pattern of pneumatization, the following types of the PPS roof were defined: (i) type 1 - not pneumatized PPS roof; (ii) type 2 - sphenoidal but not petrosal pneumatization of the PPS roof; (iii) type 3 - petrosal but not sphenoidal pneumatization of the PPS roof; (iv) type 4 - sphenoidal and petrosal pneumatizations of the PPS roof. Discussion Although on the left side the degree of pneumatization was higher than on the right side, no statistical differences were recorded (p > 0.05). The pattern of pneumatizations in the PPS roof should be assessed when PPS involvement in otitis or sinusitis is considered.

The sphenoid sinus is one of the most morphologically variable and surgically important structures of the skull base. Located below the sella turcica, neighbored by parasellar regions, such as the orbital apex, pterygopalatine fossa and lateral sellar region (cavernous sinus), it is clinically related to these and surgically relevant as corridor for various approaches. Moreover, at the sphenoethmoidal junction, important variations occur, most of these related to the presence of the Onodi cells and the intrasinusal protrusions of the optic nerve. That is why any identified and previously undescribed morphological variation at that level must be added to the well-established protocols, clinical and surgical. During a retrospective CT study of the sphenoid sinus anatomical features a previously unreported morphology was encountered and is reported here. It refers to a unilateral sphenoethmoid cell (SEC), Onodi-positive, not only overriding the superior aspect of the sphenoid but also its lateral side to get intimately related to the maxillary nerve. As that SEC expanded medially to the cavernous sinus apex, it altered the usual endosinusal morphological correlations and also added itself within the limits of the Mullan's triangle. It appears so that such postero-infero-lateral extended pneumatization of an Onodi cell alters the surgical landmarks and also can blur clinical pictures, by adding maxillary and pterygopalatine signs and symptoms.

Bilateral dissections of maxilla were performed in a human adult cadaver head, male, aged 53 years. After the en block removal of the soft tissues in the oral and infraorbital regions, the antero-lateral surface of maxilla was exposed and also the vestibular aspect of the upper alveolar process. An oblique labially impacted right upper canine was evidenced, completely submucosal: its apex was tangent to the maxillary sinus floor, while the superior side of the apical part of the root was in close relation with the floor of the laterally expanded inferior nasal meatus. Superior and adjacent to the neck of that impacted canine a follicular cyst was evidenced and the antral wall presented distally to the apex of the impacted canine a dehiscent area, where the antral mucosa was only covered by an incomplete thin bony lamella. The incisors on that side were present but no resorption was identified at their level. Within the anterior border of the wall separating the maxillary sinus, small, and the inferior nasal meatus, the nerve for that impacted canine was coursing; the nerves for the upper incisors were initially located within the antero-lateral wall of the inferior nasal meatus. Although small, the maxillary sinus presented a supero-medial recess above the enlarged inferior nasal meatus and lateral to the normally-sized middle nasal meatus.

The male gonad receives nerve fibers from the autonomic ganglionic system. By the present study, we aimed to bring detailed evidences, topographic and structural, on the spermatic ganglia (SG) in humans, as suppliers of autonomic fibers for the testis. We performed retroperitoneal dissections in 25 formalin-fixed human male adult cadavers. Histology used the Hematoxylin-Eosin and we also used Bielschowsky silver stains. Immunohistochemistry used antibodies for tyrosine hydroxylase. In 20÷10 specimens, we identified left spermatic ganglia (LSG) at the aortic origin of the left testicular artery (LTA); in five specimens the LTA left the renal artery but LSG were juxtaposed on the aorta at about the level of origin of a normal LTA. In 15÷25 cadavers, there were right spermatic ganglia (RSG) related to the right testicular artery (RTA) that in 12 cadavers had a precaval disposition. A specimen with retrocaval RTA presented an inferior renal ganglion, supplying both the renal and the RTA. The SG presented renal, lumbar and intermesenteric roots. The inferior branch of the SG connected it to the inferior mesenteric plexus while its infero-lateral branch adjoined the testicular artery. Microscopy confirmed the SG as nervous ganglia and the respective neuronal populations were tyrosine hydroxylase positive, allowing us to consider these ganglia as sympathetic. We bring here the first-time evidence of the SG topography and cathecolaminergic nature in humans; this ganglion may influence the male gonad via the inferior mesenteric plexus and via the vascular path of the testicular artery.