We investigated correlations among the superficial veins, cutaneous nerves, arteries, and venous valves in 128 cadaveric arms in order to choose safe venipuncture sites in the cubital fossa. The running patterns of the superficial veins were classified into four types (I-IV) and two subtypes (a and b). In types I and II, the median cubital vein (MCV) was connected obliquely between the cephalic and basilic veins in an N-shape, while the median antebrachial vein (MAV) opened into the MCV in type I and into the basilic vein in type II. In type III, the MCV did not exist. In type IV, additional superficial veins above the cephalic and basilic veins were developed around the cubital fossa. In types Ib-IVb, the accessory cephalic vein was developed under the same conditions as seen in types Ia-IVa, respectively. The lateral cutaneous nerve of the forearm descended deeply along the cephalic vein in 124 cases (97 %), while the medial cutaneous nerve of the forearm descended superficially along the basilic vein in 94 (73 %). A superficial brachial artery was found in 27 cases (21 %) and passed deeply under the ulnar side of the MCV. A median superficial antebrachial artery was found in 1 case (1 %), which passed deeply under the ulnar side of the MCV and ran along the MAV. Venous valves were found at 239 points in 28 cases with superficial veins, with a single valve seen at 79 points (33 %) and double valves at 160 points (67 %). At the time of intravenous injection, caution is needed regarding the locations of cutaneous nerves, brachial and superficial brachial arteries, and venous valves. The area ranging from the middle segment of the MCV to the confluence between the MCV and cephalic vein appears to be a relatively safe venipuncture site.
Summary: The anterior and posterior circumflex humeral arteries were examined in 31 upper extremities of 18 Japanese adults, with the main emphasis being laid on the anastomoses between them. After arising from the axillary artery, the anterior circumflex artery passed laterally deep to the biceps brachii, and on the lateral side of the long head of the biceps, it was divided into the following four arteries, 1) ascending branch to the shoulder joint, 2) descending branch to the insertion of the pectroralis major, 3) transverse branch to the periosteum of the humerus and 4) muscular branch to the deltoideus. The last two were concerned with the anastomoses between the two circumflex arteries. The authors could observe the anastomoses in less than half of the examined cases macroscopically, but most of them formed part of the arterial network on the periosteum of the humerus or were found within the deltoid muscle. If defined in a strict sense and taking only the cases into consideration in which they were found outside the muscle as moderately thick branches, anastomoses were observed in only 4 cases (13%). The anterior circumflex artery was mainly distributed to the periosteum, joint capsule and muscle tendon, whereas the posterior circumflex artery was distributed to the deltoid muscle. The origin of the former was fairly constant, arising from the stem of the axillary artery deep to the median nerve, but the latter had a variable origin. No compensating relations were observed between the two. In conclusion, it was found that these two arteries did not have such an intimate relationship with each other as most textbooks of anatomy have described.
The formation and distribution of the sural nerve are presented on the basis of an investigation of 31 legs of Japanese cadavers using nerve fascicle and fiber analyses. Nerve fibers constituting the medial sural cutaneous nerve were designated as 'T', whereas those constituting the peroneal communicating branch were designated as 'F'. In 74.2% of cases (23/31), the T and F fibers joined each other in the leg, whereas in 9.7% of cases (3/31) they descended separately. In 16.1% of cases (5/31), the sural nerve was formed of only the T fibers. The sural nerve gave off lateral calcaneal branches and medial and lateral branches at the ankle. The lateral calcaneal branches always contained T fibers. The medial branches consisted of only T fibers, whereas most of the lateral branches consisted of only F fibers (71.0%; 22/31). In addition to the T and F fibers, P fibers, which derived from the superficial and deep peroneal nerves, formed the dorsal digital nerves. The P fibers were entirely supplied to the medial four and one-half toes. However, they were gradually replaced by the T and F fibers in the lateral direction. The 10th proper dorsal digital nerve consisted of T fibers only (38.7%; 12/31), of F fibers only (19.4%; 6/31) or of both T and F fibers (38.7%; 12/31). These findings suggest that the T fibers are essential nerve components for the skin and deep structures of the ankle and heel rather than the skin of the lateral side of the fifth toe. The designation of the medial sural cutaneous nerve should be avoided and only the T fibers are appropriate components for naming as the sural nerve.
Summary: The present case represents the second report of an aberrant azygos lobe, following Adachi's (1940) first case.The authors describe the characteristic features of an azygos lobe observed in the right lung of a 65-year-old man as well as the extra-pulmonary course of the bronchial arteries and veins. The literature on the azygos lobe reported in Japan and the extremely rare cases in which an azygos lobe has been found on the left side, are summarized.Upon dissecting the pulmonary parenchyma, it became clear that the azygos lobe was supplied by definitive segmental branches (B1a and B2a, A1a and A2a, and V1a and V2a) of the tracheobronchial tree and pulmonary vessels. The authors review and summarize the patterns of the segmental bronchi and vessels in the azygos lobe and also discuss the development of this anomaly.
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