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Background: Asterion has been recognized as the external skull landmark for localization of the transverse and sigmoid sinus junction (TSJ). This study aimed to localize the asterion using the intersection of the Frankfurt horizontal plane (FHP) line and a vertical line from the mastoid tip, and to determine its relationship with the transverse and sigmoid sinuses., Materials and Methods: Distances from the asterion to the FHP and vertical line were measured on 200 dry skulls (100 males and 100 females). In addition, 48 cadavers (24 males and 24 females) underwent asterion drilling, and the relationship with the transverse and sigmoid sinuses was recorded., Results: In most skulls, the asterion was superior to the FHP line, with average distances of 0.5 ± 0.3 cm on both sides. Distances to the vertical line were 3.7 ± 0.4 cm and 3.9 ± 0.4 cm for the left and right sides, respectively. These distances were statistically significant different between sides but not between sexes. The location of asterion was mainly over the TSJ (54%) and transverse sinus (42%). The accuracy of a predictive method was evaluated in additional 10 cadavers. The predicted positions were located with distances ranging from 0 to 1.3 cm in the horizontal plane (0.4 ± 0.4 cm) and 0 to 0.7 cm in the vertical plane (0.3 ± 0.2 cm) from the asterion., Conclusions: This study confirms the anatomical relationship between the asterion and TSJ including the transverse sinus. Alternative method for localizing the asterion was also introduced.

Knowledge of the superficial radial nerve (SRN) relationship and anatomic variations of the first extensor compartment (1st EC) will contribute to a better outcome of de Quervain tenosynovitis treatment. We dissected 87 embalmed cadaveric wrists to determine the relationship of the SRN, the 1st EC length, distance from the proximal and distal 1st EC borders to radial styloid process (RSP), abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendon slip numbers, and the presence of septum. Our results revealed SRN crossing over the 1st EC in 59.5%. The lateral branch of the superficial radial nerve to the 1st EC midline in most cases (61.9%) except for one specimen, where lateral antebrachial cutaneous nerve was the closest. Distances from proximal and distal 1st EC borders to the RSP were 19.7±4.1 mm and 7.6±1.8 mm, respectively. Extensor retinaculum (ER) width over 1st EC (1st EC length) was 14.8±3.2 mm. Complete and incomplete septa were found in 17.2%, and 42.5%, respectively. The most frequent APL tendon slip number in the compartment was two in overall 47 specimens (54.0%). Almost all compartments (85 specimens; 97.7%) contained one EPB tendon slip. We detected bilateral EPB absence in one cadaver. Moreover, we recorded a tendon slip from extensor pollicis longus traveling into 1st EC bilaterally in one cadaver and observed the EPB muscle belly extension into 1st EC in 9 wrists. Awareness of 1st EC anatomic variations would be essential for successful surgical and nonsurgical outcomes.

Background: Anatomy of flexor hallucis longus (FHL) is essential for the achievement of tendon transfer and several procedures performed in the foot and ankle. The aim of this study was to evaluate the anatomical knowledge of FHL including the type and location of musculotendinous junction (MTJ), tendinous interconnections (TIC) morphology, its location related to Master Knot of Henry (MKH), and the pattern of TIC distribution., Materials and Methods: One hundred and sixty-six legs from 52 embalmed and 31 soft cadavers were assessed. The medial (MB) and lateral (LB) bellies of FHL were identified and traced until the end of the most distal muscle fibre to determine the medial and lateral MTJs. MTJ was classified into four types based on the existence and length of MB and LB: type 1, long LB and shorter MB; type 2, equal length of both bellies; type 3, only LB and no MB; type 4, long MB and shorter LB. Low lying muscle belly was defined as muscle extending beyond the zero point (the point of intersection between distal osseous part of tibia and FHL tendon). The distance between MTJ and zero point was measured. TIC was classified into seven types based on the direction and number of slip: type I, one slip from FHL to flexor digitorum longus (FDL); type II, crossed connection: type III, one slip from FDL to FHL; type IV, no connection; type V, two slip from FHL to FDL; type VI, two slip from FHL to FDL and one slip from FDL to FHL; type VII, two slips from FDL to FHL and one slip from FHL to FDL. The distance between the TIC and MKH was measured. TIC distribution was defined into four types based on slip distribution to lesser toes: type a, distributed to second toe; type b, distributed to second and third toes; type c, distributed to second to fourth toes, and type d, distributed to second to fifth toes., Results: Type 1 and type 3 of MTJ morphology were found in 87.3% and 12.7%, respectively. Low lying LB was detected in 66.13% of cases with a mean distance of 13.10 ± 4.51 mm. All MBs ended proximal to the zero point with a mean distance of -21.99 ± 13.21 mm. Three types of TIC (I, II, V) were identified. The highest frequency was type I (82.93%). In addition, a new type of TIC was depicted in 8.53% of cases. Part of the FHL tendon in this type fused with FDL tendon and the rest extended directly to the first toe. TIC could be located either proximal, distal or at the MKH. The highest prevalence was distal to MKH in 51.67% of cases with a mean distance of 11.23 ± 5.13 mm and 8.73 ± 4.2 mm in low lying and non-low-lying groups, respectively. Four types of slip distribution to lesser toes were defined, mostly in type b. No statistically significant differences were detected among all parameters including genders, sides, and groups., Conclusions: Knowledge of this investigation might enhance the clinical efficacy of tendon harvesting and transfer in foot and ankle surgery.

Background: Localisation of the greater occipital nerve (GON) is essential for the achievement of several procedures performed in the occipital region especially the treatment of occipital neuralgia. This study proposed to investigate the location of GON subcutaneous (Sc) and semispinalis capitis (SSC) piercing points related to the intermastoid and external occipital protuberance (EOP) to mastoid process (MP) lines., Materials and Methods: The Sc piercing point, relation to SSC and obliquus capitis inferior (OCI) muscles of 100 GONs from 50 cadaveric heads (23 males, 27 females) were dissected. Distances from EOP to MP (EM line) on both sides and between MPs (MM line) were measured. Perpendicular lines from Sc and SSC piercing points to EM and MM lines were created and measured. Distances from EOP to the perpendicular lines of SSC piercing point and from MP to the perpendicular lines of Sc piercing point were measured and calculated into percentage of EM and MM length, respectively., Results: Three types of Sc piercing points (I, II and III) were obtained. The percentage of GON piercing trapezius muscle (TP) (type I), aponeurosis of TP (type II) and aponeurosis between TP and sternocleidomastoid muscle (SCM) (type III) were 2, 67 and 31, respectively. In addition, 95% of GON pierced SSC, 2% pierced its tendinous band and 3% travelled between its medial fibres and the nuchal ligament. 94% of the GON turned around the lower edge of the OCI, while 6% pierced the lower edge of this muscle. Sc piercing point was always located above the MM line, but it could be above, below or on the EM line. In contrast, all of the SSC piercing points were located below the EM line except in one specimen, but it could be above, below or on the MM line. Therefore, the MM and EM lines were used as reference lines for locating the Sc and SSC piercing points, respectively. The mean EM line length was 81.26 ± 5.26 mm with statistically significant differences between genders and sides in female. The mean MM line length was 121.77 ± 8.54 mm with a statistically significant difference between genders. Sc piercing point could be located at 44% of MM line length from ipsilateral MP with a mean vertical distance of 18 mm. No statistically significant difference was found between genders and sides in these parameters, but a statistically significant difference was found in the percentage of MB to MM line between type III and type I (p = 0.02). SSC piercing point of all types could be located at the point of 25% of EM line length from EOP with a vertical distance of 18 mm below EM line. No statistically significant difference was found between genders, sides and types of both piercing points., Conclusions: MM and EM lines are potential reference lines for locating the Sc and SSC piercing points of GON, respectively.

Background: The localisation of sciatic nerve (SN) is essential for the achievement of several procedures performed in the gluteal region. This study proposed to investigate the location of SN regarding its relationship to the piriformis (PM) by the line joining the posterior superior iliac spine (PSIS), ischial tuberosity (IT) and greater trochanter (GT)., Materials and Methods: SN-PM relationship was examined in 204 specimens from 102 embalmed cadavers (55 males, 47 females). Distances between PSIS, IT and GT were measured. Midpoints of SN at the lower edge of PM (S1) and IT-GT line (S2) were marked. Perpendicular line from S1 to PSIS-GT (S1-R) and to PSIS-IT (S1-Q), were created and measured. Distances of PSIS-R, PSIS-Q (S1) and IT-S2 were measured and calculated into percentage of PSIS-GT, PSIS-IT and IT-GT lengths, respectively., Results: Regarding the classification of Beaton and Anson, three types of SN-PM relationship (a, b and c) were obtained. The percentage of type a, b and c was 74.02, 22.55 and 3.43, respectively. Symmetrical SN-PM relationship was found in 75.49%. The mean length of PSIS-IT, PSIS-GT and IT-GT in all types was 129.63 ± 11.89 mm, 151.34 ± 14.78 mm and 73.02 ± 10.20 mm, respectively. A statistically significant difference was found between types a and b (p = 0.013) in PSIS-IT length, whereas mean length of IT-GT and PSIS-GT showed no statistically significant difference between SN-PM types. PSIS-IT line passed SN at the lower edge of PM (S1) in 112 specimens (54.90%). In these cases, S1 and Q were the same point. A statistically significant difference was also found between types a and b (p = 0.023) in PSIS-Q (S1) length. The mean lengths of PSIS-Q (S1), PSIS-R and IT-S2 in term of percentage of PSIS-IT, PSIS-GT and IT-GT line in all types were 60.06 ± 5.90%, 54.19 ± 6.10%, and 37.87 ± 8.27%, respectively. The mean lengths of S1-R and S1-Q were 30.07 ± 8.30 mm and 6.54 ± 7.99 mm. Therefore, SN at S1 could be located at the point of 54.19 ± 6.10% of PSIS-GT length (R) with a distance of 30.07 ± 8.30 mm perpendicular to PSIS-GT line (S1-R). Since the PSIS-IT line did not pass SN at S1 in every case, it might not be suitable for localizing SN at S1. SN at S2 could be located at the point of 37.87 ± 8.27% of IT-GT line. No significant difference was found between types., Conclusions: Sciatic nerve can be localised by PSIS-GT and IT-GT lines without statistically significant difference between types (a, b, and c) of SN-PM relationship.

Background: This study was conducted to investigate characteristics, attachments and morphometric parameters of the superior peroneal retinaculum (SPR)., Materials and Methods: Morphology and morphometric details including width, length, thickness and angle of alignment of SPR in 109 embalmed cadaveric legs were investigated. The occurrence of peroneal tendon tear was also noted., Results: Most of SPR originated from the fibrocartilaginous ridge of the lateral malleolus. The SPR might be a single band or split into proximal and distal bands inserted on the posterior intermuscular septum and lateral wall of calcaneus, respectively. Based on the characteristics and insertion patterns, the SPR could be divided into 3 types: type I (double band with subtype Ia and Ib), type II (single band) and type III (single band) with the prevalence of 56.88% (12.84%, 44.04%), 1.83%, and 41.28%, respectively. The average coordinate (X, Y axis) of the midpoint of width at origin measured from the tip of fibula in all types was 7.26±3.15 and 10.45±4.52 mm. The average coordinate of the midpoint at insertion on the posterior intermuscular septum was 24.06±4.94 and 13.35±5.18, and those inserted on the lateral wall of calcaneus was 21.45±7.88 and 13.59±6.73 mm. Prevalence of peroneus brevis (PB) tendon tear was 12.84% (14 cases) and was associated with SPR type Ib with statistical significance., Conclusions: Precise information of the characteristics, morphometric data and coordinates of attachment sites of SPR are essential for surgical procedures and reconstruction.

Background: The aims of this study are to investigate the inferior peroneal retinaculum (IPR) regarding morphometric parameters, and contents in the inferior peroneal tunnel (IPT)., Materials and Methods: One hundred and nine embalmed cadaveric legs were dissected in prone position., Results: The extension band of the IPR was found in 31.19% of cases. The mean of length, width at the origin, width at the middle part, width at the insertion, and thickness of the IPR [mm] were 23.42 ± 3.54 (17.05-33.68), 13.29 ± 2.56 (5.83-20.92), 14.50 ± 2.37 (6.68-21.34), 10.10 ± 2.63 (4.59-19.17) and 0.48 ± 0.16 (0.20-0.87), respectively. The angle of the IPR to the horizontal axis was 38.51 ± 7.07 (11.67-54.00) degrees. The IPT was divided into the upper and lower tunnels. The normal contents were the tendons of peroneus brevis and peroneus longus in the upper and lower tunnels, respectively. However, additional contents were found in the upper tunnel in 2 cases. One was the tendon of peroneus digiti quinti, and peroneus quartus in the other one. Moreover, an unusual accessory peroneal muscle coursed into the lower tunnel and inserted on the peroneal tubercle. Tears of the peroneus brevis tendon were observed in 2 cases., Conclusions: These morphometric data might be beneficial in surgical repair for IPR injury.

Variations of the arterial and venous system of the abdomen and pelvis have important clinical significance in hepatobiliary surgery, abdominal laparoscopy, and radiological intervention. A case of double inferior vena cava (IVC) with complex interiliac communication and variation of the common hepatic artery (CHA) arising from superior mesenteric artery (SMA) in a 79-year-old male cadaver is presented. Both IVCs ascended on either side of the abdominal aorta. The left-sided IVC crossed anterior to the aorta at the level of the left renal vein. The union of both IVCs was at the level just above the right renal vein. The diameter of right-sided IVC, left-sided IVC and the common IVC were 16.73 mm, 21.57 mm and 28.75 mm, respectively. In the pelvic cavity, the right common iliac vein was formed by a union of right external and internal iliac veins while the formation of left common iliac vein was from the external iliac vein and two internal iliac veins. An interiliac vein ran from right internal iliac vein to left common iliac vein with an additional communicating vein running from the middle of this interiliac vein to the right common iliac vein. Another co-existence variation in this case was the origin of the CHA arising from the SMA with a suprapancreatic retroportal course. Clinical importance of double IVC are observed in retroperitoneal surgery, whole organ transplantation or radical nephrectomy, surgical ligation of the IVC or the placement of an IVC filter for thromboembolic disease. The variation of CHA has an important clinical significance in liver transplantation, abdominal laparoscopy and radiological abdominal intervention. (Folia Morphol 2018; 77, 1: 151-155).

Peripheral neuropathy is one of the major side effects of cisplatin; however, effective treatments are lacking. Curcumin is a polyphenol found in the root of Curcuma longa and has been shown neuroprotective against several neurological diseases. Nevertheless, its effects on cisplatin neuropathy remain unclear. This study aimed to clarify this issue by inducing neuropathy in the rats with intraperitoneal injection of cisplatin 2 mg/kg twice a week for 5 consecutive weeks. Curcumin 200 mg/kg/day was given by gavage to a group of cisplatin-treated rats during these five weeks. The results showed that cisplatin induced thermal hypoalgesia in the 5(th) week which could be prevented by curcumin. In the 5(th) and 8(th) weeks, sciatic motor nerve conduction velocity was reduced in the cisplatin compared with the control groups. Curcumin significantly attenuated this deficit. Morphometric analysis of L4 dorsal root ganglia from the cisplatin group revealed nuclear and nucleolar atrophy including loss of neurons in the 8(th) week. These alterations were significantly blocked by curcumin. Moreover, curcumin also ameliorated the reduced myelin thickness in the sciatic nerve of cisplatin-treated rats. Taken together, our findings suggest the favorable effects of curcumin on both functional and structural abnormalities in cisplatin neuropathy. Future studies are needed to clarify the exact underlying mechanisms.

Objective: p38 member of mitogen-activated protein kinase (MAPK) family has been shown to participate in neuropathic pain and axonal regeneration after nerve injury. However, its role in axotomy-induced neuronal apoptosis remains unclear. This study was aimed to examine p38 phosphorylation in the dorsal root ganglia (DRG) and its role in DRG neuronal loss after axotomy., Methods: Left sciatic nerve transection was performed in all rats. For the temporal study of p38 phosphorylation, the rats were sacrificed at 1 day, 2 weeks, and 2 months after injury. In the second experiment, the rats were divided into control and inhibitor groups receiving vehicle and p38 inhibitor (SB203580, 200 μg/kg/day intraperitoneally once daily), respectively, for 2 weeks., Results: The p38 phosphorylation was increased in L4/5 DRG at 2 weeks after transection. Immunoreactivity of phospho-p38 was mainly observed in the cytoplasm of small neurons with additional nuclear localization in the axotomized neurons at 2 weeks. SB203580 could reduce the phosphorylation of p38 and its substrate, ATF2, including the upregulation of total caspase-3 expression in the DRG. Moreover, count of L4/5 DRG neurons revealed significantly decreased cell loss in the inhibitor than control groups (17·4% versus 32·5%)., Conclusion: These data suggest the role of p38 in sensory neuronal loss after nerve transection. Future studies should be done to confirm the apoptotic role of p38 in this condition.

The lateral antebrachial cutaneous nerve (LACN) is the terminal sensory branch of the musculocutaneous nerve supplying the lateral aspect of forearm. Because of its close proximity to the biceps brachii tendon (BBT), the lateral epicondyle (LE), and the cephalic vein (CV), surgery and venipuncture in the cubital fossa can injure the LACN. Measurement data regarding the relative anatomy of LACN are scarce. We, therefore, dissected 96 upper extremities from 26 males and 22 females to expose the LACN in the cubital fossa and forearm. The LACN consistently emerged from the lateral margin of BBT. It then pierced the deep fascia distal to the interepicondylar line (IEL) in 84.4% with mean distances of 1.8 ± 1.1 and 1.2 ± 0.9 cm (male and female, respectively). At the level of IEL, the LACN in all cases was medial to the LE (5.9 ± 1.1 cm male and 5.2 ± 0.9 cm female). Two types of branching were observed: single trunk (78.1%) and bifurcation (21.9%). Asymmetry in the branching pattern was observed in 6 males and 1 female. Concerning the relationship to the CV, the LACN ran medially within 1 cm at the level of IEL in 78.7%. Moreover, in 10 specimens, the LACN was directly beneath the CV. In the forearm, the LACN tends to course medial to the CV. Significant differences in the measurement data between genders but not sides were found in some parameters. These data are important for avoiding LACN injury and locating the LACN during relevant medical procedures., (Copyright © 2010 Wiley-Liss, Inc.)

The superficial radial nerve (SRN) is one of the cutaneous nerves biopsied for diagnosis of peripheral neuropathy. Morphometric analysis is employed to provide more quantitative data regarding the histomorphology of nerve biopsy. To detect early structural changes, morphometric data from normal nerves are necessary for diagnostic criteria. Unlike the sural nerve, morphometric data on the normal SRN have not been reported. Therefore, a morphometric analysis of the normal human SRN was done in this study. The nerves were harvested bilaterally from 21 fresh human bodies, yielding 34 nerves after excluding damaged ones. Transverse semi-thin sections were analyzed for the number of fascicles, myelinated fiber and axon diameters, myelin sheath thickness, g ratio, density and total number of myelinated fibers using the three-window sampling method. We found that 2-16 fascicles were present. Mean fiber and axon diameters were 6.32 +/- 0.09 (SEM) and 3.44 +/- 0.06 microm, respectively. Average myelin thickness was 1.44 +/- 0.03 microm. Average g ratio was 0.56 +/- 0.01. Mean density of fibers was 8,872.9 +/- 167.4/mm(2). The number of fibers varied from 1,390 to 10,941, with an average of 6,495 +/- 474. These parameters were independent of age. Asymmetry in the number of fibers was also noted in four cases. The data obtained in this study can be applied to histomorphometric evaluations of SRN biopsies, although the possibility of asymmetry should be considered.

Unlabelled: Activation of extracellular signal-regulated protein kinase (ERK), a member of the mitogen-activated protein kinase family, has been shown to mediate neurite outgrowth-promoting effects of various neurotrophic factors in vitro. Moreover, in vivo, ERK is activated in the primary sensory neurons and associated glial cells after nerve injury. However, the precise role of ERK in nerve regeneration remains unclear., Objective: This work was aimed to investigate the effects of ERK inhibition on axonal regeneration and neuronal loss after axotomy., Methods: Unilateral sciatic nerve crush was performed, and inhibition of ERK was achieved by intraperitoneal injection of 300 microg kg(-1) day(-1) of u0126 for 2 weeks in the inhibitor group. For the control group, only the vehicle was given with the same schedule., Results: ERK was activated in the crushed sciatic nerve, and this was significantly reduced by the inhibitor. In contrast, there was no activation of ERK in the L4/L5 spinal ganglia. Morphological analysis revealed the similar extent of neuronal loss in the two groups. In addition, the mean regeneration distance in the inhibitor group was lower than that of the control group., Conclusion: These results suggest the crucial role of ERK in nerve regeneration but not sensory neuronal loss after trauma.

Background: Cisplatin is used as an anti-neoplastic agent against several cancers. Neuropathy is one of its major side effects that contributes to patients' intolerance to the standard regimen. Sex-related differences have been reported in nerve injury and neuropathies. However, there has been no study on cisplatin regarding this issue., Objective: Compare various abnormalities in cisplatin neuropathy between sexes., Material and Method: Two mg/kg of cisplatin was administered intraperitoneally twice a week for five consecutive weeks. Body weight, heat latency of hind paw and sciatic motor nerve conduction velocity (MNCV), pathological alterations in the sciatic nerve and dorsal root ganglion (DRG) including the level of NGF in the sciatic nerve were examined. Untreated rats of both sexes were used as controls., Results: Weight loss, prolonged heat latency, and slow MNCV in the treated rats of both sexes with higher severity in males were showed. Furthermore, reduction in myelinated fiber diameter, myelin thickness, and myelinated fiber density was more severe in females, whereas, atrophy of neuronal cell body, nucleus, and nucleolus was more striking in males. The decreased level of NGF was similar between sexes., Conclusion: These data suggest the differences in various aspects of cisplatin neurotoxicity between sexes. However, future studies are needed to verify this issue in a clinical condition and clarify the underlying mechanisms.

Background: Paclitaxel, an anti-neoplastic agent effective against several solid tumors, has several side effects including peripheral neuropathy. So far, there are no effective treatments for this complication. Monosialic acid ganglioside (GM1) has been shown to protect neurons against injuries and degeneration. However, its efficacy in the treatment of paclitaxel-induced neuropathy has not been verified., Objective: To evaluate the effect of porcine GM1 on neurophysiological abnormalities in rats receiving paclitaxel., Material and Method: Fifty-four Wistar rats were divided into control, vehicle for paclitaxel (Cremophor EL), paclitaxel, and paclitaxel + GM1 groups. Paclitaxel 16 mg/kg/week for five consecutive weeks was given intraperitoneally. Treatment with 30 mg/kg 5 days per week of GM1 was started 3 days prior to the first dose and continued until 3 days after the last dose of paclitaxel. Tail and hind paw thermal thresholds including tail motor nerve conduction velocity (MNCV) were measured prior to and after the start of treatments. Histopathology of the sciatic nerve was also examined., Results: Paclitaxel alone induced thermal hypoalgesia and reduced tail MNCV Less severe abnormalities were also found with the vehicle. GM1 appeared to prevent the development of hypoalgesia and ameliorated the decreased MNCV without any evidence of Guillain-Barre Syndrome. Mild endoneurial edema and axonal degeneration in the sciatic nerve sections were seen in paclitaxel treated rats. Microtubule accumulation and activated Schwann cell were also presented in the paclitaxel treated groups., Conclusion: These data suggest that porcine GM1 may be useful in the prevention and treatment of paclitaxel-induced neuropathy. However the adverse effect of Cremophor EL should be of concern.

Lateral femoral cutaneous nerve (LFCN) generally emerges from the pelvis behind the inguinal ligament (IL) to the thigh. Because of its proximity to the anterior superior iliac spine (ASIS) and hip joint, the LFCN is prone to injuries during various procedures. Anatomy of this nerve is highly variable among studies. Moreover, measurement data regarding its branches including the differences between genders and sides are still lacking. This study was, therefore, done to clarify these issues. Eighty-five thighs from 43 cadavers of both genders were dissected at the inguinal region. Distances from each branch of the LFCN to palpable landmarks: the ASIS, pubic tubercle (PT) and femoral artery (FA) were measured along the IL. Up to four branches of the LFCN were found; however, the single trunk was the most common form (>65%). The common site of this pattern on the IL was within 2 cm medial to the ASIS but could be present at over 6 cm. The distances in case of bifurcation were mostly comparable to those of the single trunk. In contrast, the values varied considerably in the cases with three or more branches (three cases). Regarding side and gender, asymmetry in the branching pattern was found in one fourth of specimens. However, only some minor differences between genders or sides in the measurement data were seen. These findings suggest that asymmetry and multiple branches of the LFCN should be concerned. The measurement data are also useful for localizing the LFCN with higher accuracy., (2008 Wiley-Liss, Inc.)

Morphometric analysis of nerve biopsy provides data of structural changes that are essential for early detection of peripheral neuropathy. Because of the laborious work associated with the total fiber quantification, various sampling methods have been introduced with controversial accuracy. Three-window sampling technique has been recently proposed to provide the accurate morphometric data of normal human sural nerve. However, its application in the diseased nerve has not been validated. This study, therefore, compared the morphometric data of nerve biopsies from 12 patients with various neuropathies obtained using this sampling method and those obtained by total fiber analysis. Total number, density, and diameter of myelinated fibers including myelin thickness and g ratio were analyzed. Intraclass correlation coefficients ranging from 0.95 to 0.99 indicate the high agreement between the data derived from the two methods in these parameters. This finding suggests the accuracy of the three-window sampling technique in the morphometric study of nerve with pathological alterations., ((c) 2008 Wiley-Liss, Inc.)

The superficial peroneal nerve (SPN) is one of the two main branches of the common peroneal nerve, which become cutaneous nerve on the lateral side of distal leg and dorsum of foot. The use of SPN as nerve graft has been introduced; however, important data regarding the morphometric anatomy of this nerve and its branches, medial and intermediate dorsal cutaneous nerves (MDN and IDN, respectively) to support this application remain incomplete. Eighty-five legs of cadavers were dissected and the branching pattern was classified into Type 1 (penetration of the main trunk of SPN from the deep fascia) or Type 2 (separate penetration of the MDN and IDN). The length of SPN, MDN and IDN from the penetration points until before subsequent branching was measured. In addition, the penetration points were located by referring to the intermalleolar line and the lateral malleolus. Type 1 was found in the majority of specimens independent of gender (71.8%). Asymmetry in the branching pattern was observed in nine cases (20.9%). The average length of the SPN, MDN and IDN without branches was 7.7, 8.1 and 5.5 cm, respectively. The penetration points of the SPN, MDN and IDN were located 5.1, 7.6 and 5.5 cm above the intermalleolar line, respectively. These data are important for using the SPN as a graft.

Background: The anatomy of orbital foramina appears to vary depending on the population studied Moreover; different data between sides and genders have been reported., Objective: The present study was done to provide the morphometric data of the orbitalforamina related to side and gender in Thai subjects., Material and Method: One hundred orbits from 50 adult dried skulls were used. Gender of each skull was identified and the distances from the constant landmarks to the foramina in the medial, superior; inferior and lateral walls were measured., Results: In the medial wall, the mean distances from the anterior lacrimal crest to the optic canal (OC), anterior, and posterior ethmoidalforamina were 42.2, 23.5, and 36. 0 mm for both sides and genders, respectively. The average distances from the supraorbital notch/foramen in the roof to the superior orbital fissure (SOF), OC, and lacrimal foramen were 44.7, 40.0, and 33.6 mm, respectively. In the inferior wall, the distances from the infraorbital rim to the OC, inferior orbital fissure (IOF), and the posterior edge of roof of the infraorbital canal were 46.2, 21.7, and 12.3 mm, respectively. The distances from the frontozygomatic suture to the OC, SOF, IOF and LF were 46.9, 34.5, 24.0, and 27.2 mm, respectively. When compared to those of the previous reports, several considerable differences that may be of clinical importance were observed. Moreover, some distances were significantly different between sides or genders., Conclusion: The present results suggest that race, side, and gender should be concerned during the orbital surgery and the data are good references for Thai subjects.

Background: Superficial radial nerve (SRN) that lies superficially on the radial side of the distalforearm and dorsum of the hand, can be injured by various procedures. Thus, precise knowledge in its variation is crucial., Objective: Since there were no such data in Thai population, provide the variation data of the SRN in Thai cadavers. This is likely to be more accurate when applied in Thailand., Material and Method: The authors studied the branching pattern and the course of SRN in 40 Thai cadavers., Results: The extra type, replacement of SR3 by a branch of the lateral antebrachial cutaneous nerve, was found (4.7%) and the incidences of other patterns were different from those of previous reports. Moreover; asymmetry and gender difference were also demonstrated. The authors observed the higher frequencies of the SRN lying over the snuff box and first dorsal compartment of the wrist compared to other reports. The distances to important landmarks were measured and the presented data were comparable to those of other studies with no significant differences between sides or genders., Conclusion: These findings suggest that the different variations of the SRN among various races should be concerned during the relevant procedures.

Morphometry has an important role in the assessment of sural nerve biopsies as a part of early detection of structural abnormalities in peripheral nerve. Various sampling methods have been used to reduce time and effort needed in the analysis of total nerve fibers but their accuracy remains controversial. We examined the accuracy of three-window sampling method in the morphometric evaluation of human sural nerve biopsies by comparing with the total fiber quantification. Three windows (0.012 mm(2) each) were placed in every possible fascicle in the sections and data from all windows were pooled and analyzed for the number of myelinated axons, myelinated fiber diameter, axon diameter, myelin thickness, g ratio as well as myelinated fiber density. Means and ranges of the data from the two techniques were similar and the agreement was further confirmed by intraclass correlation analysis. These findings indicate that the three-window sampling method can be used to evaluate human sural nerve with accuracy.

Background: Activation of extracellular signal-regulated protein kinase (ERK), a member of mitogen-activated protein kinase (MAPK) family, has been proposed to mediate neurite outgrowth-promoting effects of several neurotrophic factors in vitro. However, the precise activity of ERK during axonal regeneration in vivo remains unclear. Peripheral axotomy has been shown to activate ERK in the cell bodies of primary afferent neurons and associated satellite cells. Nevertheless, whether ERK is also activated in the axons and surrounded Schwann cells which also play a key role in the regeneration process has not been clarified., Results: Phosphorylation of ERK in the sciatic nerve in several time-points after crush injury has been examined. Higher phosphorylation of ERK was observed in the proximal and distal nerve stumps compared to the contralateral intact nerve from one day to one month after crush. The activation of ERK was mainly localized in the axons of the proximal segments. In the distal segments, however, active ERK was predominantly found in Schwann cells forming Bungner's bands., Conclusion: The findings indicate that ERK is activated in both the proximal and distal nerve stumps following nerve injury. The role of activated ERK in Wallerian degeneration and subsequent regeneration in vivo remains to be elucidated.

Morphometry has an important role in the interpretation of sural nerve biopsies. It is used for early detection of structural abnormalities in peripheral neuropathies. This application requires a comparison with data of normal population. However, most data in the literature were of Western subjects with a small number of samples. In this study the authors reported the morphometric data of sural nerve harvested within 24 hours after death from 78 Thai subjects without known causes of neuropathy. The samples were transversely sectioned and analyzed for the number and area of fascicles, the total number of myelinated axons, myelinated fiber diameter; myelinated axon diameter, myelin sheath thickness, g ratio and myelinated axon density. Results were discordant in some measurement parameters compared to previous reports. These data are valuable for the early recognition of peripheral nerve diseases from biopsied sural nerve of Thai subjects.

Aims/hypothesis: This study was designed to determine whether diabetes in rats is associated with phosphorylation of c-Jun N-terminal kinase (JNK) and one of its transcription factors, c-Jun, in sensory neurones innervating the lower limb. We also sought to determine which neuronal phenotypes are affected and to examine the effect of aldose reductase inhibition on JNK and c-Jun phosphorylation., Methods: Diabetes was induced in rats using streptozotocin. Phosphorylation of JNK and c-Jun in lumbar dorsal root ganglia was determined by binding of phospho-specific antibodies using western blots and immunocytochemistry. Neuronal phenotypes were characterised by binding of N52 (an antibody that recognises the heavy neurofilament protein; for large-diameter mechanoceptors) and of calcitonin gene-related peptide and the plant glycoprotein lectin IB4 (for nociceptors). The efficacy of the aldose reductase inhibitor fidarestat was determined by measuring polyol pathway metabolites in sciatic nerve, and functionally by measuring the conduction velocity of motor and sensory nerves., Results: In control rats, activated JNK and c-Jun were primarily associated with mechanoceptors; in diabetes this was increased, but a greater increase was seen in nociceptors. Phosphorylation was prevented in all cells by fidarestat, which normalised polyol pathway metabolites as well as motor nerve and sensory nerve conduction velocity., Conclusions/interpretation: Fidarestat-sensitive phosphorylation of JNK and c-Jun occurs in fast-conduction mechanoceptors-the same class of neurones that registers the changes in sensory nerve conduction velocity-and in nociceptors. This supports the notion that mitogen-activated protein kinase phosphorylation, via the polyol pathway, may convert the direct effects of raised glucose into impaired nerve conduction and neuropathic pain. For proof of this we await the availability of specific JNK antagonists formulated for in vivo use.

Purpose: The aim of the study was to examine the different anatomical variations of the supraorbital, infraorbital, and mental foramina related to gender and side., Materials and Methods: Measurements were made on 110 adult skulls without mandibles and isolated mandibles. Gender was determined for each skull. Parameters measured bilaterally included the distances from the supraorbital and mental foramina to midline, from the infraorbital foramen to the anterior nasal spine, from the infraorbital foramen to the inferior orbital rim, and from the mental foramen to the inferior rim of the mandible and the angle between the line linking the infraorbital foramen with the anterior nasal spine and horizontal plane. Comparisons were made between genders and sides and statistical analysis was done where appropriate using Student's t test., Results: There were 70 male and 40 female crania. Nature of the 3 foramina was similar between sides and genders. The average distance from the left supraorbital foramen to midline in females was significantly lower than that in males (2.42+/-0.04 versus 2.56+/-0.05). The mean distances from the bilateral infraorbital foramina to anterior nasal spine in females were also significantly lower relative to those in males (3.28+/-0.03 versus 3.48+/-0.03 right and 3.31+/-0.03 versus 3.50+/-0.03 left). There were also considerable differences between sides in the average angle of the infraorbital foramen in both genders., Conclusions: Differences in several measurements suggest that gender and side should be considered when applying the anatomical variation data to an individual subject.

This study examined the role of p38 mitogen-activated protein (MAP) kinase in transducing high glucose into deficits in nerve conduction velocity (NCV) that are characteristic of diabetic neuropathy. p38 activation and NCV were measured in streptozocin-induced diabetic rats treated with a p38 inhibitor, an aldose reductase inhibitor, and insulin. Dorsal root ganglia (DRG) from diabetic animals showed marked activation of p38 at 12 weeks of diabetes. Insulin treatment for the last 4 of 12 weeks of diabetes normalized p38 activation. Furthermore, activation was completely prevented by 12 weeks' treatment with the aldose reductase inhibitor, fidarestat. Immunocytochemistry localized activation of p38 to the nuclei of virtually all sensory neuronal phenotypes in the DRG, and activation was clear in diabetes, as was inhibition by fidarestat and by the p38 inhibitor SB 239063. In the ventral horn of the spinal cord, p38 was present in motoneuron cell bodies; and again, activation in diabetes and fidarestat inhibition was clear. Treatment of diabetic animals with a specific inhibitor of p38 (SB 239063), fidarestat, or insulin also prevented reductions in both motor and sensory NCV. These findings suggest that increased polyol pathway flux in diabetic animals leads to the activation of p38. This activation can mediate changes in gene transcription and cellular phenotype that are likely to underlie the NCV deficits. Insulin and aldose reductase inhibitors can prevent excess polyol pathway flux, and hence these agents may prevent NCV deficits by preventing p38 MAP kinase activation.

Diabetes is known to activate MAP kinase p38 in sensory neurons in both rats and patients. In vitro, activation of p38 in sensory neurons by combined glucose and oxidant stress causes cell damage or death. Consequently we tested the hypothesis that inhibition of MAP kinase p38 might prevent neuronal dysfunction in rats with experimental diabetes, such as the classical defect of slowed nerve conduction. Thus, treatment of streptozotocin-diabetic rats with the p38 inhibitor SB239063 for the second half of a 12-week diabetes protocol selectively prevented the nerve conduction deficit in sensory neurons. This implicates activation of MAP kinase p38 as an early step in the signal pathway to dysfunction in experimental diabetic neuropathy.

Background: Encephalomeningocele, especially in the frontoethmoidal region, is a form of neural tube defect which affects patients in Southeast Asia more commonly than in Western countries. Its underlying cause is not known but teratogenic environmental agents are suspected. However, nutritional deficiency, as in spina bifida, cannot be excluded., Methods: This study reports 21 cases of meningocele (without brain tissue in the lesion) and encephalomeningocele (with brain tissue) that were admitted to our hospital for surgical corrections in the period of ten years, from 1990 to 1999. Clinicopathological findings, as well as occupations of family members and prenatal exposures to infectious agents or chemicals were reviewed and analyzed., Results: The most commonly involved area was the frontoethmoidal region, found in 20 cases. The combined pattern between nasoethmoidal and nasoorbital defects was found most frequently (11 from 21 cases) and had more associated abnormalities. Encephalomeningocele had more related abnormalities than meningocele with proportions of 0.6 and 0.3, respectively., Conclusions: Here, we confirmed that genetic defects are not likely to be the single primary cause of this malformation. However, we could not draw any conclusions on etiologic agents. We suggest that case control studies and further investigation on the role of nutritional deficiencies, especially folic acid, in the pathogenesis of encephalomeningocele are necessary to clarify the underlying mechanisms.

Cadavers are a crucial resource for medical education. Currently, donation is the only means of obtaining cadavers for use in Thai medical schools. Some traditional beliefs result in an insufficient number of donated cadavers. This shortage of cadavers may affect the quality of medical training. We report on the present situation regarding the quantity and usage of donated cadavers in the King Chulalongkorn Memorial Hospital, Bangkok, during the eight years between 1993 and 2000. During this period, 19,674 cadavers became available (2.459.3 +/- 1,243.7 cadavers/year) as the result of advanced donation. However, only 619 cadavers (3.1%) were actually obtained. Poor preservation and delayed delivery contributed to the underutilization; furthermore, some cadavers were reclaimed. In order to increase the number of cadavers and maintain the quality of medical education, the appropriateness and importance of cadaver donation should be emphasized to the public.

Cadavers are crucial for the medical education provided by medical schools. However, currently, donation is the only way to obtain cadavers for education in Thailand. Moreover, some traditional beliefs result in insufficient numbers of cadavers. Apart from finding donors, the occupational health of the workers in the cadaver donation center and the users, the medical students, residents, and staffs should be addressed. Screening for anti-HIV in donated organs is the current trend in transplantation medicine. Therefore, screening for anti-HIV in donated cadavers is useful. Here, we report the rate of anti-HIV seropositivity in cadavers in a 1-year period in our setting, the largest Thai Red Cross Society hospital. Of the total 84 cadavers received, two cadavers (2.4%) were anti-HIV seropositive. With the increasing rate of anti-HIV, screening for anti-HIV serology in donated cadavers for medical teaching is of great benefit.

The onset of diabetic neuropathy, a complication of diabetes mellitus, has been linked to poor glycemic control. We tested the hypothesis that the mitogen-activated protein kinases (MAPK) form transducers for the damaging effects of high glucose. In cultures of adult rat sensory neurons, high glucose activated JNK and p38 MAPK but did not result in cell damage. However, oxidative stress activated ERK and p38 MAPKs and resulted in cellular damage. In the dorsal root ganglia of streptozotocin-induced diabetic rats (a model of type I diabetes), ERK and p38 were activated at 8 wk duration, followed by activation of JNK at 12 wk duration. We report activation of JNK and increases in total levels of p38 and JNK in sural nerve of type I and II diabetic patients. These data implicate MAPKs in the etiology of diabetic neuropathy both via direct effects of glucose and via glucose-induced oxidative stress.

Several previous studies have introduced classifications of Acetylcholinesterase (AChE) histochemical staining patterns in rectal suction biopsy performed in patients with Hirschsprung's disease. However, we introduce a new classification that is less complicated but shows the same age dependence as seen in previous studies. 135 rectal suction biopsies were submitted to histochemical staining for AChE activity and 88 specimens showed increased AChE activity. Therefore, we retrospectively analysed these 88 cases and could establish three patterns. Pattern I, presence of thick nerve trunks or coarse nerve fibers only in the muscularis mucosae and submucosa. This pattern was mainly seen in children aged 6 months or below. Pattern II, presence of abundant nerve fibers in all three layers of mucosa. This pattern was predominantly seen in children over 6 months of age. Pattern III, not predominant in any age group, showed positive nerve fibers in all three layers but, in one or more layers, the nerve fibers were sparse. Upon comparison with previous studies, we could observe the same age-pattern relationship. Thus, we propose this method of classification as a new tool to classify AChE histochemical staining patterns.