Massive upper gastrointestinal bleeding from an accessory splenic artery mimicking isolated gastric varices

Knowledge of anatomical variations of coeliac trunk and its branches is important for surgeons and interventional radiologists planning surgical and radiological interventions. We describe a case of a 42-year-old male with an accessory splenic artery (ASA) originating from the left gastric artery (LGA) running in the wall of gastric fundus and mimicking isolated gastric varices, which was observed during endoscopy. Bleeding from this artery was massive and was managed with endovascular coil embolisation. Coeliac angiography of the patient with upper gastrointestinal bleeding showed that the coeliac trunk divided into 3 arteries: the LGA, the splenic artery, and the right hepatic artery. Additionally, the variations of ASA and the left hepatic artery arising from LGA, and the left and right inferior phrenic arteries arising from ASA were identified. This case is the first to be presented in the literature with ASA originating from LGA that was situated in the gastric wall where inferior phrenic arteries arose from the ASA

An anatomical study on the three-headed biceps brachii in human foetuses, and clinical relevance

The biceps brachii (BB) is as one of the most variable muscles in the human body in terms of number and morphology of its heads. The most frequent variation is the presence of a third head, which has been reported by several authors in different populations. Our aim was to find the occurrence of the supernumerary head of BB in Turkish foetuses. Out of the 24 upper limbs of the foetuses, two (8.33%) arms were found to have a three-headed BB. The variations were present unilaterally in the right arm of one male foetus and one female foetus. In one of the cases, the third head of BB originated from the anteromedial aspect of the humerus just distal to the insertion of the coracobrachilais, medial to the brachialis, and in the other the third head was a thin muscle bundle, which arose on the lateral side of the insertion of coracobrachialis and over the origin of the brachialis. Both of them were extended distally and joined the common tendon. The occasional presence of the three-headed BB in the foetuses observed in the present study was similar to those of adults reported in previous studies. In conclusion, these variations are not rare and are interesting not only to anatomists but also to orthopaedic surgeons, plastic surgeons, traumatologists, physiotherapists, doctors dealing with sports medicine, and radiologists. (Folia Morphol 2011; 70, 2: 116–120

Short-term effects of repetitive transcranial magnetic stimulation on sleep bruxism:a pilot study

The purpose of this study was to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) on patients with sleep bruxism (SB). Twelve patients with SB were included in an open, single-intervention pilot study. rTMS at 1 Hz and an intensity of 80% of the active motor threshold was applied to the ‘hot spot' of the masseter muscle representation at the primary motor cortex bilaterally for 20 min per side each day for 5 consecutive days. The jaw-closing muscle electromyographic (EMG) activity during sleep was recorded with a portable EMG recorder at baseline, during rTMS treatment and at follow-up for 5 days. In addition, patients scored their jaw-closing muscle soreness on a 0–10 numerical rating scale (NRS). Data were analysed with analysis of variance. The intensity of the EMG activity was suppressed during and after rTMS compared to the baseline (P = 0.04; P = 0.02, respectively). The NRS score of soreness decreased significantly during and after rTMS compared with baseline (P < 0.01). These findings indicated a significant inhibition of jaw-closing muscle activity during sleep along with a decrease of muscle soreness. This pilot study raises the possibility of therapeutic benefits from rTMS in patients with bruxism and calls for further and more controlled studies

The investigation of perivasculary space under the myocardial bridge in different species

Our purpose in this study was to investigate the perivasculary space under the myocardial bridges (MB) in dog, sheep, goat and human hearts. A total of 160 hearts were studied, and perivasculary space under the myocardial bridges was examined under microscope. The specimens belonged to 25 dogs, 100 sheep, 25 goats and 10 humans. Special attention was paid to evaluate the distance between the MB and coronary arteries (CA), CA and underlying myocardium (UM) and to find the relation of concomitant vein number accompanying the CA and MB. 219 myocardial bridges were found in total of hearts, and specimens from these bridges were examined under microscope. There were large variations in distance between the MB and CA (0-714 mum) and distance between CA and UM (0-309 mum). The myocardial bridges were classified into three groups in terms of the number of veins accompanying CA, the bridges with no concomitant veins with one concomitant vein and with two concomitant veins. This suggests that the distance between the MB and CA is crucial to determine how much force is on the CA. The environment surrounding the CA may be a crucial factor in determining whether the MB influences the induction of heart disorders or not