• Title/Summary/Keyword: Vascular anatomy

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Management and Outcome of Intracranial Dural Arteriovenous Fistulas That Have Caused a Hemorrhage in the Posterior Fossa : A Clinical Study

  • Rifat Akdag;Ugur Soylu;Ergun Daglioglu;Ilkay Akmangit;Vedat Acik;Ahmet Deniz Belen
    • Journal of Korean Neurosurgical Society
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    • v.66 no.6
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    • pp.672-680
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    • 2023
  • Objective : We evaluated the diagnosis, treatment, and long-term results of patients with dural arteriovenous fistula (dAVF), which is a very rare cause of posterior fossa hemorrhage. Methods : This study included 15 patients who underwent endovascular, surgical, combined, or Gamma Knife treatments between 2012 and 2020. Demographics and clinical features, angiographic features, treatment modalities, and outcomes were analyzed. Results : The mean age of the patients was 40±17 years (range, 17-68), and 68% were men (11/15). Seven of the patients (46.6%) were in the age group of 50 years and older. While the mean Glasgow coma scale was 11.5±3.9 (range, 4-15), 46.3% presented with headache and 53.7% had stupor/coma. Four patients (26.6%) had only cerebellar hematoma and headache. All dAVFs had cortical venous drainage. In 11 patients (73.3%), the fistula was located in the tentorium and was the most common localization. Three patients (20%) had transverse and sigmoid sinus localizations, while one patient (6.7%) had dAVF located in the foramen magnum. Eighteen sessions were performed on the patients during endovascular treatment. Sixteen sessions (88.8%) were performed with the transarterial (TA) route, one session (5.5%) with the transvenous (TV) route, and one session (5.5%) with the TA+TV route. Surgery was performed in two patients (14.2%). One patient (7.1%) passed away. While there were nine patients (64.2%) with a Rankin score between 0 and 2, the total closure rate was 69.2% in the first year of control angiograms. Conclusion : In the differential diagnosis of posterior fossa hemorrhages, the differential diagnosis of dAVFs, which is a very rare entity, should be considered, even in the middle and elderly age groups, in patients presenting with good clinical status and pure hematoma. The treatment of such patients can be done safely and effectively in a multidisciplinary manner with a good understanding of pathological vascular anatomy and appropriate endovascular treatment approaches.

Occurrence Patterns of C4 Plants in Agroecosystems (farming fields) in South Korea (농업생태계 (밭 경작지)의 경작환경에 따른 C4 식물의 출현 양상)

  • Yang, Dongwoo;Lee, Eunjeong;Lee, Jinju;Kim, Min-Seob;Han, Donguk;Kim, Myung-Hyun;Cho, Kwang-Jin;Oh, Young-Ju;Park, Sangkyu
    • Korean Journal of Ecology and Environment
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    • v.49 no.2
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    • pp.89-101
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    • 2016
  • To elucidate occurrence patterns of $C_4$ plants in agroecosystems, we surveyed flora inside fields and embankments in 222 sites in farming lands in summer and fall, 2013. We also observed Kranz anatomy and analyzed carbon stable isotope to classify photosynthesis types. Our study observed total 54 species of $C_4$ plants in 33 genera and 9 families of vascular plants besides cultivated crops occurring in farming fields. The most common species was Portulaca oleracea L. followed by Digitaria ciliaris and Echinochloa crusgalli (L.) P. Beauv. var. crusgalli among the $C_4$ plants. The ratios of $C_3$ and $C_4$ species number to total number of species tended to maintain constant regardless of survey times and habitat types. The proportion of $C_4$ species to the total number of species were more influenced by the number of $C_3$ species than those of other types in the surveyed sites. Sizes of cultivation areas did not affect the proportions of $C_4$ plants. Increasing number of simultaneous weeding methods, especially with cutting method, appeared to decrease the number of $C_3$ plants. On the other hand, as the number of cultivated crops increased, both $C_3$ and $C_4$ plants increased but the proportions of $C_4$ species remained. We interpret our results that proportion of $C_4$ species in agroecosystems, appear to be dependent on the number of $C_3$ species, which in turn, appear to be affected by cultivation methods.

Neurovascular Morphometric Aspect in the Region of Cranio-Cervical Junction (두개와 경추의 이행부에서 뇌신경계와 혈관계에 대한 형태학적 계측)

  • Lee, Kyu;Bae, Hack-Gun;Choi, Soon-Kwan;Yun, Seok-Mann;Doh, Jae-Won;Lee, Kyeong-Seok;Yun, Il-Gyu;Byun, Bark-Jang
    • Journal of Korean Neurosurgical Society
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    • v.30 no.9
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    • pp.1094-1102
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    • 2001
  • Objective : During the trans-condylar or trans-jugular approach for the lesion of cranio-cervical junction(CCJ), its necessary to identify the accurate locations of vertebral artery(VA), internal jugular vein(IJV) and its related lower cranial nerves. These neurovascular structures can also be damaged during the operation for vascular tumor or traumatic aneurysm around extra-jugular foramen, because of their changed locations. To reduce the neurovascular injury at the operation for CCJ, morphometric relationship of its surrounding neurovascular structures based on the tip of the transverse process of atlas(C1 TP), were studied. Materials & Methods : Using 10 adult formalin fixed cadavers, tip of mastoid process(MT) and TPs of atlas and axis were exposed bilaterally after removal of occipital and posterior neck muscles. Using standard caliper, the distances were measured from the C1 TP to the following structures : 1) exit point of VA from C1 transverse foramen, 2) branching point of muscular artery from VA, 3) entry point of VA into posterior atlanto-occipital membrane(AOM), 4) branching point of C-1 nerve. In addition, the distances were measured from the mid-portion of the posterior arch of atlas to the entry point of the VA into AOM and to the exit point of the VA from C1 transverse foramen. After removal of the ventrolateral neck muscles, neurovascular structures were exposed in the extra-jugular foraminal region. Distances were then measured from the C1 TP to the following structures : 1) just extra-jugular foraminal IJV and lower cranial nerves, 2) MT and branching point of facial nerve in parotid gland. In addition, distance between MT and branching point of facial nerve was measured. Results : The VA was located at the mean distance of 12mm(range, 10.5-14mm) from the C1 transverse foramen and entered into the AOM at the mean distance of 24mm(range, 22.8-24.4mm) from the C1 TP. The mean distance from the mid portion of the C1 posterior arch was 20.6mm(range, 19.1-22.3mm) to the entry point of the VA into AOM and 38.4mm(range, 34-42.4mm) to the exit point of the VA from C1 transverse foramen. Muscular artery branched away from the posterior aspect of the transverse portion of VA below the occipital condyle at the mean distance of 22.3mm(range, 15.3-27.5mm) from the C1 TP. The C-1 nerve was identified in all specimens and ran downward through the ventroinferior surface of the transverse segment of VA and branched at the mean distance of 20mm(range, 17.7-20.3mm) from the C1 TP. The IJV was located at the mean distance of 6.7mm(range, 1-13.4mm) ventromedially from the lateral surface of the C1 TP. The XI cranial nerve ran downward on the lateral surface of the IJV at the mean distance of 5mm(range, 3-7.5mm) from the C1 TP. Both IX and X cranial nerves were located in the soft tissue between the medial aspect of the internal carotid artery(ICA) and the medial aspect of the IJV at the mean distance of 15.3mm(range, 13-24mm) and 13.7mm(range, 11-15.4mm) from the C1 TP, respectively. The IX cranial nerve ran downward ventroinferiorly crossing the lateral aspect of the ICA. The X cranial nerve ran downward posteroinferior to the IX cranial nerve and descended posterior to the ICA. The XII cranial nerve was located between the posteroinferior aspect of the IX cranial nerve and the posterior aspect of the ICA at the mean distance of 13.3mm(range, 9-15mm) ventromedially from the C1 TP. The distance between MT and C1 TP was 17.4mm(range, 12.5-23.9mm). The VII cranial nerve branched at the mean distance of 10.2mm(range, 6.8-15.3mm) ventromedially from the MT and at the mean distance of 17.3mm(range, 13-21mm) anterosuperiorly from the C1 TP. Conclusion : This study facilitates an understanding of the microsurgical anatomy of CCJ and may help to reduce the neurovascular injury at the surgery around CCJ.

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Development and Feasibility Study for Phase Contrast MR Angiography at Low Tesla Open-MRI System (저자장 자기공명영상 시스템에서의 위상대조도 혈관조영기법의 개발과 그 유용성에 대한 연구)

  • Lee, Dong-Hoon;Hong, Cheol-Pyo;Lee, Man-Woo;Han, Bong-Soo
    • Progress in Medical Physics
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    • v.23 no.3
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    • pp.177-187
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    • 2012
  • Magnetic resonance angiography (MRA) techniques are widely used in diagnosis of vascular disorders such as hemadostenosis and aneurism. Especially, phase contrast (PC) MRA technique, which is a typical non contrast-enhanced MRA technique, provides not only the anatomy of blood vessels but also flow velocity. In this study, we developed the 2- and 3-dimensional PC MRA pulse sequences for a low magnetic field MRI system. Vessel images were acquired using 2D and 3D PC MRA and the velocities of the blood flow were measured in the superior sagittal sinus, straight sinus and the confluence of the two. The 2D PC MRA provided the good quality of vascular images for large vessels but the poor quality for small ones. Although 3D PC MRA gave more improved visualization of small vessels than 2D PC MRA, the image quality was not enough to be used for diagnosis of the small vessels due to the low SNR and field homogeneity of the low field MRI system. The measured blood velocities were $25.46{\pm}0.73cm/sec$, $24.02{\pm}0.34cm/sec$ and $26.15{\pm}1.50cm/sec$ in the superior sagittal sinus, straight sinus and the confluence of the two, respectively, which showed good agreement with the previous experimental values. Thus, the developed PC MRA technique for low field MRI system is expected to provide the useful velocity information to diagnose the large brain vessels.

Changes in CGRP-immunoreactive Nerve Fibers during Expansion of Midpalatal Suture of the Rat (백서 정중구개봉합 확대후의 CGRP 면역반응 신경섬유의 변화)

  • Kim, Bo-Kyung;Park, Kuk-Pil;Kyung, Hee-Moon;Kwon, Oh-Won;Sung, Jae-Hyun
    • The korean journal of orthodontics
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    • v.29 no.1 s.72
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    • pp.73-81
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    • 1999
  • Midpalatal suture expansion is often used for patients haying narrow maxillary arch, cleft palate, respiratory handicap with narrow nasal cavity. CGRP has been known as a modulator of pain transmission in central nervous system and a local effector to peripheral tissue causing vasodilation, increase of blood flow, modulation of immune system, regulation of macrophagic function and stimulation of bone formation. To investigate changes of CGRP-immunoreactive nerve fibers in midpalatal suture during the expansion, immunohistochemical study was performed by using rats. Experimental rats (10 weeks, 250 gm) were divided into five groups (control, 1, 4, 7, 14 days group (each n=4) and applied orthodontic force (approximately 200gm) to upper anterior incisors. Frozen sections of midpalatal suture area were immunostained by using rabbit antisera. The results were as follows. ${\cdot}$ The CGRP-immunoreactive nerve fibers were hardly observed in control group. ${\cdot}$ In 1 day group, the CGRP-immunoreactive nerve fibers were more increased around the vessels than control group. ${\cdot}$ In 4 days group, the CGRP-immunoreactive nerve fibers were more increased than control group, but not more increased than 1 day group. Vascular diameter was more enlarged. ${\cdot}$ In 7 days group, especially, hematoxilin affinity of cells was remarkable and cells were arranged along the bone margin. The CGRP-immunoreactive nerve fibers were more reduced than 4 days group and vascular diameter was also reduced. ${\cdot}$ In 14 days group, the CGRP-immunoreactive nerve fibers were similar to those of 7 days group and the irregularity of bone margin was almost recoverd. In Conclusion, the CGRP-immunoreactive nerve fibers nay be related to initial neurogenic inflammatory reaction in expanding mid-palatal suture.

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Ferucarbotran-Enhanced Hepatic MRI at 3T Unit: Quantitative and Qualitative Comparison of Fast Breath-hold Imaging Sequences (간의 3T 자기공명영상에서 초상자성산화철 조영증강 급속호흡정지영상기법들간의 양적 및 질적 비교평가)

  • Cho, Kyung-Eun;Yu, Jeong-Sik;Chung, Jae-Joon;Kim, Joo-Hee;Kim, Ki-Whang
    • Investigative Magnetic Resonance Imaging
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    • v.14 no.1
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    • pp.31-40
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    • 2010
  • Purpose : To compare the relative values of various fast breath-hold imaging sequences for superparamagnetic iron-oxide (SPIO)-enhanced hepatic MRI for the assessment of solid focal lesions with a 3T MRI unit. Materials and Methods : 102 consecutive patients with one or more solid malignant hepatic lesions were evaluated by spoiled gradient echo (GRE) sequences with three different echo times (2.4 msec [GRE_2.4], 5.8 msec [GRE_5.8], and 10 msec [GRE_10]) for $T2^*$-weighted imaging in addition to T2-weighted turbo spin echo (TSE) sequence following intravenous SPIO injection. Image qualities of the hepatic contour, vascular landmarks and artifacts were rated by two independent readers using a four-point scale. For quantitative analysis, contrast-to-noise ratio (CNR) was measured in 170 solid focal lesions larger than 1 cm (107 hepatocellular carcinomas, nine cholangiocarcinomas and 54 metastases). Results : GRE_5.8 showed the highest mean points for hepatic contour, vascular anatomy and imaging artifact presence among all of the subjected sequences (p<0.001) and was comparable (p=0.414) with GRE_10 with regard to lesion conspicuity. The mean CNRs were significantly higher (p<0.001) in the following order: GRE_10 ($24.4{\pm}14.5$), GRE_5.8 ($14.8{\pm}9.4$), TSE ($9.7{\pm}6.3$), and GRE_2.4 ($7.9{\pm}6.4$). The mean CNRs of CCCs and metastases were higher than those of HCCs for all imaging sequences (p<0.05). Conclusion : Regarding overall performances, GRE using a moderate echo time of 5.8 msec can provide the most reliable data among the various fast breath-hold SPIO-enhanced hepatic MRI sequences at 3T unit despite the lower CNR of GRE_5.8 compared to that of GRE_10.

Operative treatment for Proximal Humeral Fracture (상완골 근위부 골절의 수술적 요법)

  • Park Jin-Young;Park Hee-Gon
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.2 no.2
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    • pp.168-175
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    • 2003
  • Fracture about proximal humerus may be classified as the articular segment or the anatomical neck, the greater tuberosity, the lesser tuberosity, and the shaft or surgical neck. Now, usually used, Neer's classification is based on the number of segments displaced, over 1cm of displaced or more than 45 degrees of angulation , rather than the number of fracture line . Absolute indication of a operative treatment a open fracture, the fracture with vascular injury or nerve injury , and unreductable fracture-dislocation . Inversely, the case that are severe osteoporosis, and eldly patient who can't be operated by strong internal fixation is better than arthroplasty used by primary prosthetic replacement and early rehabilitation program than open reduction and internal fixation. The operator make a decision for the patient who should be taken the open reduction and internal fixation, because it's different that anatomical morphology, bone density, condition of patient. The operator decide operation procedure. For example, percutaneous pinning, open reduction, plate & screws, wire tension bands combined with some intramedullary device are operation procedure that operator can decide . The poor health condition for other health problem, fracture with unstable vital sign and severe osteoporosis , are the relative contraindication. The stable fracture without dislocation is not the operative indication . The radiologic film of the prokimal humerus before the operation can not predict for fracture evaluation. It's necessary to good radiologic film for evaluation of fracture form. The trauma serise is better than the other radiologic film for evaluation. The accessary radiologic exam is able to help for evaluation of bone fragment and anatomy. The CT can be helpful in evaluating these injury, especially if the extract fracture type cannot be determined from plain roenterogram of the proximal humerus, bone of humerus head. If the dislocation is severe anatomically , we could consider to do three dimentional remodelling. The MRI doing for observing of bony morphology before the operation is not better than CT If we were suspicious of vascular injury, we could consider the angiography.

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Distribution of Mast cells and Nerves in the Developing Postnatal Submandibular and Sublingual Glands of Rats (생후 발생중인 흰쥐의 턱밑샘 및 혀밑샘에서의 비만세포와 신경의 분포양상)

  • Kim, Jae-Gon;An, Soo-Hyeon;Lee, Young-Su;Baik, Byeong-Ju;Cho, Eui-Sic
    • Journal of the korean academy of Pediatric Dentistry
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    • v.26 no.2
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    • pp.350-364
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    • 1999
  • The distribution of mast cells and nerves were investigated in the submandibular and sublingual glands of postnatal rats, using morphometric, histochemical and immunohistochemical techniques. Mast cells were observed in the submandibular and sublingual glands of postnatal development. Number of mast cells gradually increased in both glands following development. At birth, mast cells were relatively fewer in submandibular gland than those in sublingual gland, and they were mainly distributed in parenchymal tissues. At $2{\sim}4$ weeks, most of the mast cells were observed in the connective tissues, surrounding neurovascular elements, but some mast cells were closely related with the acini of submandibular gland. PGP 9.5 immunoreactive nerve fibers were found in the submandibular and sublingual glands of all developmental age. The nerve fibers were showed in varicose shape, and mainly located in adjacent area of ducts and vascular components of both glands. The number of nerve fibers were increased rapidly until 8 weeks, but they were not increased any more until 24 weeks. Therefore, it is suggested that mast cells and nerve fibers related with each other, and that their interactions may play roles not only in maturation of secretory units but also growth and differentiation of the tubular structures of the rat submandibular and sublingual glands during postnatal development.

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Morpho-anatomical Characteristics of Different Panicles in Low and High Tillering Rices (벼 소얼성과 다얼성 품종에서 분얼별 이삭의 형태 해부학적 특성)

  • Kim, Je-Kyu;B.S. Vergara
    • KOREAN JOURNAL OF CROP SCIENCE
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    • v.36 no.6
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    • pp.568-575
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    • 1991
  • The morpho-anatomical characteristics of panicle in rice plant is generally correlated with the number of spikelets and grain weight per panicle. For the increase of grain yield potential in rice, a low -tillering plant type with large panicles has been suggested as an ideotype. This study was conducted to investigate the panicle morphology and peduncle anatomy of different tillers within a plant in low -and high-tillering cultivars and their relationships on the number of spikelets and grain weight per panicle. A low-tillering, large panicled IR25588 was compared with a high-tillering. small panicled IR58. IR25588 had more inner(IVB) and outer vascular bundles (OVB). bigger peduncle diameter and peduncle thickness just below the panicle neck node than IR58. The top six tillers(M. P1, P2, P3. P4 and S1P2) within a plant had more IVB and OVB. larger peduncle diameter and thickness than the rest of the tillers in both cultivars. Tillers that emerged earlier had more IVB and OVB than tillers that emerged Jater. The total number of primary and secondary rachis-branches of IR25588 was much higher than that of IR58. IR25588 had more number of spikelets per panicle than IR58. and the top six panicles showed more spikelets per panicle than the rest of the panicles in both cultivars. The peduncle diameter was more important than peduncle thickness on the spikelet differentiation and panicle weight. especially in low-tillering cultivars. The number of IVB and OVB were highly correlated with the number of rachis-branches. spikelets and grain weight per panicle. The number of spikelets per IVB and spikelets per primary branch were higher in IR25588 than IR58 indicating the higher sink strength in low -tillering with large panicled cultivars than in high-tillering with small panicled cultivars. Based on the morpho-anatomical characteristics of a low-tillering cultivar and the top six tillers within a plant. the present results could be support that 'a low-tillering sturdy culms with large panicles' is an ideo-type of rice plant for increasing grain yield potential.potential.

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Morphometric Study on the Arterial Palmar Arch of the Hand (손바닥 동맥활에 관한 형태계측 연구)

  • Park, Bong Kwon;Jang, Soo Won;Choi, Seung Suk;Ahn, Hee Chang
    • Archives of Plastic Surgery
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    • v.36 no.6
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    • pp.691-701
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    • 2009
  • Purpose: Deviations of arterial palmar arches in the hand can be explained on the embryological basis. The purpose of this study was to provide new information about palmar arches through cadaver's dissection. The values of the location and diameter in these vessels were analyzed in order to support anatomical research and clinical correlation in the hand. Methods: The present report is based on an analysis of dissections of fifty - three hands carried out in the laboratory of gross anatomy. A reference line was established on the distal wrist crease to serve as the X coordinate and a perpendicular line drawn through the midpoint between middle and ring fingers, which served as the Y coordinate. The coordinates of the x and y values were measured by a digimatic caliper, and statistically analyzed with Student's t - test. Results: Complete superficial palmar archs were seen in 96.2 % of specimens. In the most common type of males, the superficial arch was formed only by the ulnar artery. In the most common type of females, the superficial arch was formed anastomosis between the radial artery and the ulnar artery. The average length of the superficial and deep palmar arch is $110.3{\pm}33.0mm$ and $67.9{\pm}14.0mm$ respectively. Regarding the superficial palmar arch, ulnar artery starts $-16.1{\pm}5.1mm$ on X - line, and $2.5{\pm}24.5mm$ on Y - line. Radial artery appears on palmar side $7.7{\pm}3.2mm$ on X - line, and $20.9{\pm}10.9mm$ on Y - line. But radial artery starts on $6.3{\pm}3.6mm$ on X - line, and $3.4{\pm}5.1mm$ on Y - line. Digital arteries of superficial palmar arch starts on $6.1{\pm}3.7mm$, $33.9{\pm}8.8mm$ on index finger, $1.8{\pm}3.4mm$, $40.1{\pm}7.3mm$ on middle finger, $-3.2{\pm}4.9mm$, $42.6{\pm}7.0mm$ on ring finger, and $-8.9{\pm}5.1mm$, $42.5{\pm}80mm$ on little finger in respective X and Y coordinates. Radial artery of deep palmar arches measured at the palmar side perforating from the dorsum of hand. It's coordinates were $9.7{\pm}4.8mm$ on X - line, $21.7{\pm}10.2mm$ on Y - line. Ulnar artery was measured at hypothenar area, and it's coordinates were $-20.4{\pm}6.3mm$ on X - line, and $30.6{\pm}7.4mm$ on Y - line. Conclusions: Anatomically superficial palmar arch can be divided into a complete and an incomplete type. Each of them can be subdivided into 4 types. The deep palmar arch is less variable than the superficial palmar arch. We believe these values of the study will be used for the vascular surgery of the hand using the endoscope and robot in the future.