Publications by authors named "Kumiko Yamaguchi"

48 Publications

A mixed methods study on the readiness of dental, medical, and nursing students for interprofessional learning.

PLoS One 2021 22;16(7):e0255086. Epub 2021 Jul 22.

Institute of Education, Tokyo Medical and Dental University, Tokyo, Japan.

Background: Interprofessional education (IPE) is crucial in dentistry, medicine, and nursing. However, scant mixed methods studies have compared the IPE outcomes across these disciplines to develop evidence-based IPE. This study explored the differences in the readiness of dental, medical, and nursing students for interprofessional learning before and after IPE workshops and elucidated reasons for this disparity.

Methods: Data were obtained from dental, medical, and nursing students who participated in IPE workshops conducted at Tokyo Medical and Dental University in Japan in 2019 and 2020. The participants filled the validated Japanese version of the Readiness for Interprofessional Learning Scale (RIPLS) before and after attending the workshops (n = 378). Paired t-tests were performed to assess differences between the pre- and post- workshop RIPLS scores. Welch's t-tests were deployed to evaluate interdisciplinary differences in their scores. Qualitative analyses were conducted using an explanatory sequential design with focus group discussions (FGDs) held with 17 dental students to explain the quantitative results.

Results: Total RIPLS scores increased significantly for every discipline after the workshops (p < 0.001). Dental students scored significantly lower pre- and post- workshop aggregates than medical and nursing students, respectively (p < 0.001). The FGDs yielded three principal themes in the explanations tendered by dental students on their lower scores: 1) dental students rarely felt the need for interprofessional collaborations, 2) dentists often worked without the need for interprofessional collaborations, and 3) dental students believed their contribution to the workshop was insufficient.

Conclusions: The results revealed divergences in the readiness of dental, medical, and nursing students for interprofessional learning, and the study illuminated possible reasons for these disparities. These outcomes will help develop evidence-based IPE by indicating approaches to place a higher value on interprofessional collaborations in educational environments, ameliorate the awareness of educators, and enhance the workshop facilitation style.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0255086PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8297869PMC
July 2021

Morphology of the Undersurface of the Anterolateral Acromion and Its Relationship to Surrounding Structures.

Orthop J Sports Med 2021 Jan 27;9(1):2325967120977485. Epub 2021 Jan 27.

Department of Clinical Anatomy, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan.

Background: A better understanding of the morphology underneath the acromion is needed to prevent complications after arthroscopic subacromial decompression. The precise correlations between the morphologic features underneath the acromion and the surrounding structures including the attachment of the coracoacromial ligament (CAL) and the origin of the deltoid middle head have not yet been determined in the absence of artifacts on the bony surface caused by dissection techniques. Moreover, anatomic findings in previous studies using only older-aged cadavers or dried bones may not reflect the morphologic features of younger and healthy specimens.

Purpose: To characterize the anterolateral structures morphologically in the inferior aspect of the acromion, assess the relationships of these structures with surrounding structures without dissection artifacts on the bony surface, and verify the cadaveric data in the asymptomatic shoulders of living middle-aged patients.

Study Design: Descriptive laboratory study.

Methods: We initially analyzed the relationship between the morphology of the anterolateral structures and surrounding structures in 18 cadaveric shoulders (mean age, 81.8 years), 15 of which were subjected to macroscopic investigation of the CAL attachment and 3-dimensional micro-computed tomography investigation with radiopaque markers and 3 of which were subjected to histologic examination. We also analyzed the morphology underneath the anterolateral acromion in 24 asymptomatic shoulders of middle-aged patients (mean age, 54.8 years) to verify the cadaveric data. In both the cadaveric shoulders and the asymptomatic shoulders of live patients, the long axis, width, and height of the anterolateral prominence were measured by use of 3-dimensional CT imaging.

Results: In cadavers, the anterolateral prominence underneath the acromion corresponded to the attachment of the CAL. Histologic evaluation revealed that the CAL was continuous to the deep layer of the deltoid middle head in the lateral acromion. The study in asymptomatic shoulders of middle-aged patients revealed bony prominences similar to those observed in cadavers.

Conclusion: The anterolateral prominence, which corresponds to the attachment of the CAL below the acromion, may be a native structure below the acromion. Moreover, the CAL is continuous to the deep layer of the deltoid middle head in the lateral acromion.
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http://dx.doi.org/10.1177/2325967120977485DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844461PMC
January 2021

Intra-mural distribution of the blood vessels in the stomach demonstrated by contrast medium injection: a cadaver study.

Surg Radiol Anat 2021 Mar 9;43(3):389-396. Epub 2020 Nov 9.

Department of Clinical Anatomy, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.

Purpose: With advances in diagnostic imaging techniques of gastric cancer screening with X-ray fluoroscopy, it has been suggested that mucosal projections induced by the vessels distributed in the submucosal layer of the stomach may be mistaken for abnormal mucosal folds. In this study, we aimed to describe the distribution of blood vessels in the submucosal layer of the stomach to improve the diagnostic accuracy of screening of gastric cancer.

Methods: Twenty-four stomachs from Japanese cadavers were used in this study. Uncolored or colored contrast agents were injected into arteries and/or veins for macroscopic analyses, X-ray imaging, and methyl salicylate clearing. In addition, histological analysis was performed to examine blood vessels distributed inside the stomach wall.

Results: Following contrast agent injection, thick blood vessels were distributed perpendicular to both curvature sides, and branches parallel to both curvature sides flowed from these thick blood vessels, and a vascular network was formed throughout the stomach wall. This vascular network had intra-mural anastomoses connecting both curvature sides. Moreover, in histological analyses, blood vessels depicted by injection were mainly distributed in the submucosal layer.

Conclusion: This study strongly suggests that the mucosal projections induced by arteries and veins in the submucosal layer could be mistaken for abnormal mucosal folds. Therefore, a better understanding of the vascular distribution in the submucosal layer is important to improve diagnostic accuracy from imaging studies of the stomach. The information provided by this research may facilitate better accuracy in diagnosis and reduce the number of unnecessary invasive procedures.
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http://dx.doi.org/10.1007/s00276-020-02613-5DOI Listing
March 2021

Morphology of the anterolateral ligament: a complex of fibrous tissues spread to the anterolateral aspect of the knee joint.

Anat Sci Int 2020 Sep 28;95(4):470-477. Epub 2020 Apr 28.

Department of Clinical Anatomy, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.

The anterolateral ligament (ALL) has recently received considerable attention as a key structure maintaining the rotational stability of the tibia. However, the morphology of the ALL, particularly the proximal attachment, is controversial. This study aimed to elucidate the morphological relationship between the ALL and its adjacent structures. A total of 25 knees from 22 cadavers were used in the current study. One knee was set at 30°, 60° and 90° of flexion. Stretched or winkled fibrous tissues were then observed with internal and external rotations of the tibia at each angle. In 22 knees, fibrous tissues that were attached to the lateroposterior area to the Gerdy's tubercle were macroscopically observed. In the other 2 knees, the fibrous tissues were histologically investigated and analyzed using computer-assisted three-dimensional reconstruction. A taut fibrous tissue was observed between the lateroposterior area to the Gerdy's tubercle and the posterosuperior area to the lateral epicondyle during an internal rotation of the tibia. A complex of fibrous tissues that were attached to the lateroposterior area to the Gerdy's tubercle spread to the anterolateral aspect of the knee as a sheet-like structure. This complex tissue was composed of the fascia lata and fibrous tissues continuous from the fabellofibular ligament, intermuscular septum, and tendon of the gastrocnemius. Three-dimensional reconstruction showed that each fibrous tissue formed a sheet. The structure recognized as the ALL could not be detected; therefore, the ALL that has been reported to date is considered to be a complex of fibrous tissues with a sheet-like structure.
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http://dx.doi.org/10.1007/s12565-020-00543-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7381439PMC
September 2020

Deep cervical fascia as an anatomical landmark of lingual lymph nodes: An anatomic and histologic study.

Auris Nasus Larynx 2020 Jun 18;47(3):464-471. Epub 2019 Dec 18.

Department of Clinical Anatomy, Tokyo Medical and Dental University Graduate School, Tokyo, Japan. Electronic address:

Objectives: We aimed to discuss the definition of lingual lymph nodes based on the deep cervical fascia anatomy.

Methods: A total of 11 cadavers were histopathologically evaluated. Specimens were dissected into serial stepwise cross-sections. The deep cervical fascia and lymph nodes were evaluated by staining the cross-sections with Elastica van Gieson and hematoxylin and eosin stains, respectively. The gross anatomy of the deep cervical fascia was evaluated in 1 cadaver after bilateral dissection.

Results: A single severely degenerated medial lingual lymph node (MLLN) was identified in the lingual septum of 1 cadaver. A single lateral lingual lymph node (LLLN) was identified in 1 cadaver, between the genioglossus and the hyoglossus. The superficial layer of deep cervical fascia (SLDF) was found to split into two layers encapsulating the submandibular gland. The deeper portion of this fascia was in close contiguity with the hyoglossus and formed the boundary between the mouth and the neck. The SLDF was found to be discontinuous with the area between the sublingual space and the submandibular gland.

Conclusions: The SLDF could serve as an anatomical landmark for lingual lymph nodes, since it is considered to be the demarcating boundary during neck dissection. When lymph nodes that are located deeper than the SLDF were defined as lingual lymph nodes, 1 MLLN and 1 LLLN were identified.
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http://dx.doi.org/10.1016/j.anl.2019.11.007DOI Listing
June 2020

Aortic inflation with agar injection is a useful method of cadaveric preparation which creates a mediastinal anatomy that better mimics the living body for surgical training.

Gen Thorac Cardiovasc Surg 2020 Jun 28;68(6):652-654. Epub 2019 Nov 28.

Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.

In cadavers, even Thiel-embalmed cadavers, the arteries (especially the thoracic aorta) are extremely collapsed. This is in marked contrast to the state of the arteries in a living body. Aortic inflation is necessary to improve this unfavorable situation for anatomical observation or dissection. To inflate the aorta, we injected 500 ml of hot liquid agar into the aorta using a 18-Fr catheter inserted into the common femoral artery and subclavian artery. The injected agar then rapidly cools to room temperature and solidifies. As a result, the thoracic aorta remains sufficiently and constantly inflated in the mediastinum. This method is not only easy and inexpensive, but also useful and effective for achieving a life-like anatomy in cadavers used in surgical training for operations involving mediastinal organs, with the exception of the heart and great vessels.
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http://dx.doi.org/10.1007/s11748-019-01258-5DOI Listing
June 2020

Anatomic study of the medial side of the ankle base on the joint capsule: an alternative description of the deltoid and spring ligament.

J Exp Orthop 2019 Jan 28;6(1). Epub 2019 Jan 28.

Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.

Background: Adult acquired flatfoot deformity (AAFD) is caused by impaired medial ligamentous structures and posterior tibialis tendon dysfunction (PTTD). Although degeneration and trauma could separately cause AAFD, how these factors interact in the pathomechanism of AAFD is unclear. The joint capsule in the medial ankle is considered an important structure, providing passive stability by limiting joint movement. Previous reports on the joint capsule suggest its involvement in pathological changes of the ankle, but because of the high priority placed on the ligaments, few reports address the ankle joint from the joint capsule standpoint. The current study aimed to anatomically examine the medial ankle joint, focusing on the deltoid and spring ligaments in perspective of the joint capsule.

Methods: We conducted a descriptive anatomical study of 19 embalmed cadavers (mean 82.7 years, range 58 to 99). We included 22 embalmed cadaveric ankles. We detached the joint capsule in 16 ankles from the anterior to posteromedial joint, analyzed the capsular attachments of the ankle and adjacent joints, and measured the widths of the bony attachments. We histologically analyzed the joint capsule using Masson's trichrome staining in 6 ankles.

Results: The capsule could be separated as a continuous sheet, including 3 different tissues. The anterior capsule was composed of fatty tissue. Between the medial malleolus and talus, the capsule was strongly connected and was composed of fibrous tissue, normally referred to as the deep deltoid ligament. The tibial attachment formed a steric groove, and the talar side of the attachment formed an elliptical depressed area. On the medial part of the subtalar and talonavicular joints, the capsule covered the joints as cartilaginous tissue, normally referred to as the superomedial ligament of the spring ligament. The outer side of the cartilaginous and fibrous tissue formed the sheath floor of the posterior tibialis tendon. Histological analysis revealed three different tissue types.

Conclusions: The capsules of the ankle, subtalar, and talonavicular joints could be detached as a continuous sheet. The deltoid and the superomedial ligament of the spring ligaments could be interpreted as a part of the continuous capsule, which had different histological features.

Level Of Evidence: Descriptive Laboratory Study.
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http://dx.doi.org/10.1186/s40634-019-0171-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6890913PMC
January 2019

Medial elbow anatomy: A paradigm shift for UCL injury prevention and management.

Clin Anat 2019 Apr 9;32(3):379-389. Epub 2019 Jan 9.

Department of Clinical Anatomy, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan.

To improve the management outcomes and diagnostic accuracy of the ulnar collateral ligament (UCL) injury, the anatomy of the medial side of the elbow joint is necessary to be understood in terms of the periarticular surroundings rather than the specific ligaments. The aim of this study was to anatomically clarify the medial side of the elbow joint in terms of the tendinous structures and joint capsule. We conducted a descriptive anatomical study of 23 embalmed cadaveric elbows. We macroscopically analyzed the relationship between the flexor pronator muscles (FPMs) and the joint capsule in 10 elbows, histologically analyzed in 6 elbows, and observed the bone morphology through micro computed tomography in 7 elbows. The two tendinous septa (TS) were found: between the pronator teres (PT) and flexor digitorum superficial (FDS) muscles, and between the FDS and flexor carpi ulnaris (FCU) muscles. These two TS are connected to the medial part of the brachialis tendon, deep aponeurosis of the FDS, and FCU to form the tendinous complex, which linked the humeroulnar joint and could not be histologically separated from each other. Moreover, the capsule of the humeroulnar joint under the tendinous complex had attachment on the ST of 7 mm width. The two TS, the brachialis tendon, the deep FDS and FCU aponeuroses, and the joint capsule linked the humeroulnar joint. These anatomical findings could lead to a paradigm shift in the prevention, diagnosis, and treatment of UCL injuries in baseball players. Clin. Anat. 32:379-389, 2019. © 2018 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.
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http://dx.doi.org/10.1002/ca.23322DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6850211PMC
April 2019

Reply: Microanatomy of Sensory Nerves in the Upper Eyelid: A Cadaveric Anatomical Study.

Plast Reconstr Surg 2019 02;143(2):437e-438e

Department of Clinical Anatomy, Tokyo Medical and Dental University, Tokyo, Japan.

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http://dx.doi.org/10.1097/PRS.0000000000005235DOI Listing
February 2019

Anatomy of the Tarsal Canal and Sinus in Relation to the Subtalar Joint Capsule.

Foot Ankle Int 2018 11 27;39(11):1360-1369. Epub 2018 Jul 27.

2 Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.

Background: Anatomical knowledge of the tarsal canal and sinus is still unclear owing to the complexity of the ligamentous structures within them, particularly the relationship with the capsules of the subtalar joints. The aim of this study was to examine the anatomical relationship between the fibrous tissues of the tarsal canal and sinus and the articular capsules of the subtalar joint.

Methods: We conducted a descriptive anatomical study of 21 embalmed cadaveric ankles. For a macroscopic overview of the subtalar joint, we removed the talus in 18 ankles and separated the fibrous tissues from the surrounding connective tissues to analyze the layered relationship between the inferior extensor retinaculum (IER) and the subtalar joint capsule. Additionally, we histologically analyzed the tarsal canal and the medial and lateral sides of the tarsal sinus using Masson's trichrome staining in 3 ankles.

Results: The medial and intermediate roots of the IER and interosseous talocalcaneal ligament (ITCL) were located in the same layer and were connected to each other, between the capsules of the posterior talocalcaneal and talocalcaneonavicular joints. The intermediate root of the IER and the cervical ligament (CL) had adjacent attachments on the tarsal sinus, and synovial tissues originating from the joint capsules filled the remaining area in the tarsal canal and sinus.

Conclusion: We determined that the tarsal canal and sinus tarsi contained 3 layered structures: the anterior capsule of the posterior talocalcaneal joint, including the anterior capsule ligament; the layer of ITCL and IER; and the posterior capsule of the talocalcaneonavicular joint, including the CL.

Clinical Relevance: The results of this study may help with the understanding of the pathomechanism of subtalar instability and sinus tarsi syndrome, resulting in better treatment.
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http://dx.doi.org/10.1177/1071100718788038DOI Listing
November 2018

Microanatomy of Sensory Nerves in the Upper Eyelid: A Cadaveric Anatomical Study.

Plast Reconstr Surg 2018 08;142(2):345-353

From the Department of Plastic and Reconstructive Surgery, the Institute of Education, and the Department of Clinical Anatomy, Tokyo Medical and Dental University; and the Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East.

Background: Plastic surgery requires detailed knowledge of upper eyelid anatomy, but few authors have sufficiently described the specifics of upper eyelid nerve anatomy. This study aimed to provide a thorough description of sensory nerve anatomy in the upper eyelid and to propose considerations for upper eyelid surgery.

Methods: Sixteen orbits were dissected from 16 fixed, adult human cadavers. Microscopically, the authors identified the main trunks of the infratrochlear, supratrochlear, and supraorbital nerves and all branches that projected toward the upper eyelid. The number, size, and distribution of nerve branches were recorded.

Results: The branches of the infratrochlear, supratrochlear, and supraorbital nerves covered a wide range in the upper eyelid. The mean numbers of branches per nerve were 1.6 ± 1.2, 3.2 ± 1.5, and 2.6 ± 1.4, respectively. The branches of the infratrochlear nerve were distributed throughout the medial area of the upper eyelid. Those of the supratrochlear nerve were distributed throughout the medial and central areas, and the palpebral branches of the supraorbital nerve were distributed throughout the central and lateral areas of the upper eyelid. The lateral branches of the supraorbital nerve and the cutaneous branches of the lacrimal nerve were distributed in the lateral region of the orbit.

Conclusions: The authors show that upper eyelid sensation is transmitted mainly by the supratrochlear and supraorbital nerves, and the authors provide a map of the distribution of upper eyelid sensory nerves. This precise anatomical knowledge about upper eyelid sensory nerves will facilitate pain control and help minimize nerve injuries during surgery.
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http://dx.doi.org/10.1097/PRS.0000000000004554DOI Listing
August 2018

The malaris muscle: its morphological significance for sustaining the intraorbital structures.

Anat Sci Int 2018 Jun 22;93(3):364-371. Epub 2017 Nov 22.

Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.

The orbicularis oculi muscle, an important mimetic muscle, was investigated to ascertain its anatomical relation to facial aging-especially its orbital part (Oo). Previous studies of the distinct muscle bundles frequently found inferior to the Oo have provided various definitions, including that of the malaris muscle. This study aimed to examine these muscle bundles and clarify their function in facial aging. Twelve heads of Japanese cadavers (average age: 82.5 years old) were dissected to observe the muscles, focusing in particular on those in the periorbital region. Six specimens were further dissected from the inner surfaces to examine the patterns of facial nerve branches under the operating microscope. Histological examinations of two head halves were carried out to investigate the relationship between the muscle bundles and the intraorbital structures. Muscle bundles consisting of lateral, medial, and U-shaped suspending bundles were observed in the region inferior to the Oo. Lateral and suspending bundles were found in all specimens, while the medial bundles were noted in only 9 of 22 specimens. Some branches of the facial nerve penetrated through the lateral, medial, and suspending bundles. The relationship between the suspending bundles and the protruding orbital fat was assessed. The muscle bundles found in this study were regarded as the malaris muscle-a transitional muscle between the superficial and deep facial layers. The suspending bundle may play a role in sustaining the intraorbital structures.
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http://dx.doi.org/10.1007/s12565-017-0422-xDOI Listing
June 2018

Anatomical study of the left superior mediastinal lymphatics for tracheal branches of left recurrent laryngeal nerve-preserving mediastinoscope-assisted surgery in esophageal cancer.

Surg Today 2018 Mar 20;48(3):333-337. Epub 2017 Oct 20.

Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.

Purpose: Curative treatment of esophageal cancer requires meticulous superior mediastinal lymphadenectomy, in addition to esophagectomy, because superior mediastinal lymph node metastases are common in esophageal cancer. When preserving the tracheal branches of the left recurrent laryngeal nerve (RLN), good anatomical understanding is required for confirmation of the positional relationships between the courses of lymphatic vessels, lymph node distribution, and the left RLN and its tracheal branches. We performed a detailed anatomical examination of these relationships.

Methods: Macroscopic anatomical observation and histological examination was performed on cadavers. In addition to hematoxylin and eosin staining, immunostaining using antipodoplanin antibody D2-40 (podoplanin) was performed to identify the lymphatic vessels.

Results: The tracheal branches of the left RLN were clearly observed, but no lymphatic vessels crossing the ventral or dorsal side of the branches were identified either macro-anatomically or histologically.

Conclusion: No complex lymphatic network structure straddling the plane composed of tracheal branches of the left RLN was found in the left superior mediastinum. This suggests that dissection of the lymph nodes around the left RLN via the pneumomediastinum method using the left cervical approach may allow preservation of the tracheal branches of the left RLN by maintaining dissection accuracy.
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http://dx.doi.org/10.1007/s00595-017-1600-0DOI Listing
March 2018

A Cadaver Study to Assess the Feasibility of a Cross-Nerve Transfer of the Infraorbital Nerve for Patients With Peripheral Infraorbital Nerve Injury.

Ann Plast Surg 2018 Feb;80(2):141-144

Background: Patients with facial fracture or head and neck surgery sometimes suffer from infraorbital nerve injury. This injury results in severe hemilateral numbness in the midfacial area. The infraorbital nerve ends with two major branches; the infra nasal branch (INB) and superior labial branch (SLB). In this study, we assessed the feasibility of cross-nerve transfer of the INB and SLB based on a cadaver study.

Methods: The INB/SLB from a total 20 sides of 10 cadavers (2 men and 8 women; average age, 79.9 years) were dissected. The distribution patterns of the INB and SLB, the distance between the INB/SLB and the piriform aperture, and the shortest distance between the INB/SLB were estimated.

Results: Three distribution patterns of the INB and SLB were observed, that is type A (65%); only the INB is thick enough for a nerve transfer, type B (20%); only the SLB is thick enough for a nerve transfer, and a combination of types A and B (15%). The distance between the INB, SLB and the piriform aperture was on average 8.61 and 10.81 mm in each. The shortest distance between the INB and SLB was on average 11.34 ± 3.7 mm.

Conclusions: The INB and SLB existed in all the specimens and could be found approximately 1 cm below the piriform aperture. The average distance between the INB and SLB was approximately 11 mm. These results imply the feasibility of a cross-nerve transfer of the distal part of the infraorbital nerve.
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http://dx.doi.org/10.1097/SAP.0000000000001188DOI Listing
February 2018

The extended bundle of the tensor veli palatini: Anatomic consideration of the dilating mechanism of the Eustachian tube.

Auris Nasus Larynx 2018 Apr 16;45(2):265-272. Epub 2017 Jun 16.

Department of Clinical Anatomy, Tokyo Medical and Dental University, Tokyo, Japan.

Objective: The aim of this study was to analyze the topographical structures of the muscles surrounding the Eustachian tube.

Materials And Methods: We conducted macroscopic and histological studies of 24 halves of 12 heads from Japanese cadavers.

Results: The main findings were as follows: 1) the infero-lateral muscle bundles of the tensor veli palatini didn't turn medially at the pterygoid hamulus but were distributed laterally and continuous with the buccinator; 2) the tensor veli palatini attached laterally to the membranous part of the Eustachian tube; 3) the superior pharyngeal constrictor was not only adjacent to the buccinator at the pterygomandibular raphe but also had muscular continuation with it laterally and 4) some bundles of the superior pharyngeal constrictor adhered with the palatine aponeurosis.

Conclusion: We believe that the cooperation of the muscles contributes to the dilating mechanism of the Eustachian tube, due to the complex topographical structures of the surrounding muscles: the tensor veli palatini, the levator veli palatini, the superior pharyngeal constrictor and the buccinator.
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http://dx.doi.org/10.1016/j.anl.2017.05.014DOI Listing
April 2018

Morphology of the region anterior to the anal canal in males: visualization of the anterior bundle of the longitudinal muscle by transanal ultrasonography.

Surg Radiol Anat 2017 Sep 28;39(9):967-973. Epub 2017 Feb 28.

Department of Clinical Anatomy, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.

Purpose: The anterior bundle of the longitudinal muscle in the region anterior to the anal canal in males has been described, although the anatomical details remain unclear. The present study was undertaken to clarify the precise morphology of the anterior bundle of the longitudinal muscle and its relationship to the surrounding structures, and to visualize the anterior bundle of the longitudinal muscle via transanal ultrasonography.

Methods: Histological examination was carried out using seven male cadavers; an additional three male cadavers were used for transanal ultrasonography, and the ultrasonography images were compared with the actual sagittal sections. In addition, transanal ultrasonography images of 50 male patients at Tokatsu-Tsujinaka Hospital were studied.

Results: The region anterior to the anal canal consisted of smooth muscles and skeletal muscles. The anterior bundle of the longitudinal muscle was situated between the bulbospongiosus and the external anal sphincter, and consisted of smooth muscle. The bundle was identified in the transanal ultrasonography of cadavers by comparison with the actual sections. Transanal ultrasonography images of living bodies showed the anterior bundle of the longitudinal muscle as a hypoechoic layer of approximately 17.7 mm in length.

Conclusions: The detailed anatomical findings of the anterior bundle of the longitudinal muscle suggested "an alternate arrangement of smooth muscles and skeletal muscles" in the region anterior to the anal canal and facilitated the visualization of the anterior bundle of the longitudinal muscle in transanal ultrasonography.
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http://dx.doi.org/10.1007/s00276-017-1832-0DOI Listing
September 2017

Prospective analyses of female urinary incontinence symptoms following total hip arthroplasty.

Int Urogynecol J 2017 Apr 16;28(4):561-568. Epub 2016 Sep 16.

Department of Clinical Anatomy, Tokyo Medical and Dental University, Tokyo, Japan.

Introduction And Hypothesis: Some patients with hip osteoarthritis report that urinary incontinence (UI) is improved following total hip arthroplasty (THA). However, the type and severity of UI remain unclear. In this study, we hypothesize that both stress urinary incontinence (SUI) and urge urinary incontinence (UUI) are improved after THA. We assess the characteristics of UI and discuss the anatomical factors related to UI and THA for improved treatment outcome.

Methods: Fifty patients with UI who underwent direct anterior-approach THA were evaluated. Type of UI was assessed using four questionnaires: Core Lower Urinary Tract Symptom Score (CLSS), Urogenital Distress Inventory Short Form (UDI-6), International Prostate Symptom Score (IPSS), and Overactive Bladder Symptom Score (OABSS). Uroflowmetry and postvoid residual urine were measured using ultrasound technology. Hip-joint function was evaluated using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and range of motion (ROM).

Results: Of the 50 patients, 21 had SUI, 16 had mixed urinary incontinence (MUI), and eight had urgency urinary incontinence (UUI). In total, 36 patients were better than improved (72 %). The rate of cured and improved was 76 % for SUI, 100 % MUI, and 50 % UUI. The improvement of ROM was more significant in cured or improved patients than in stable or worse patients.

Conclusions: Improvement in mild UI may be an added benefit for those undergoing THA for hip-joint disorders. These data suggest that for patients with hip-joint disorder, hip-joint treatment could prove to also be a useful treatment for UI.
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http://dx.doi.org/10.1007/s00192-016-3138-xDOI Listing
April 2017

Topographic Anatomy of the Anal Sphincter Complex and Levator Ani Muscle as It Relates to Intersphincteric Resection for Very Low Rectal Disease.

Dis Colon Rectum 2016 May;59(5):426-33

1 Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Chiba, Japan 2 Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan 3 Department of Clinical Anatomy, Tokyo Medical and Dental University, Tokyo, Japan 4 Exploratory Oncology Research and Clinical Trial Center and Division of Pathology, National Cancer Center, Chiba, Japan 5 Department of Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan.

Background: Intersphincteric resection has become a widely used treatment for patients with rectal cancer. However, the detailed anatomy of the anal canal related to this procedure has remained unclear.

Objective: The purpose of this study was to clarify the detailed anatomy of the anal canal.

Design: This is a descriptive study.

Settings: Histologic evaluations of paraffin-embedded tissue specimens were conducted at a tertiary referral hospital.

Patients: Tissue specimens were obtained from cadavers of 5 adults and from 13 patients who underwent abdominoperineal resection for rectal cancer.

Main Outcome Measures: Sagittal sections from 9 circumferential portions of the cadaveric anal canal (histologic staining) and 3 circumferential portions from patients were studied (immunohistochemistry for smooth and skeletal muscle fibers).

Results: Longitudinal fibers between the internal and external anal sphincters consisted primarily of smooth muscle fibers that continued from the longitudinal muscle of the rectum. The levator ani muscle attached directly to the lateral surface of the longitudinal smooth muscle of the rectum. The length of the attachment was longer in the anterolateral portion and shorter in the posterior portion of the anal canal. In the lateral and posterior portions, the levator ani muscle partially overlapped the external anal sphincter; however, there was less overlap in the anterolateral portion. In the posterior portion, thick smooth muscle was present on the surface of the levator ani muscle and it continued to the longitudinal muscle of the rectum.

Limitations: We observed only limited portions in some surgical specimens because of obstruction by tumors.

Conclusions: The levator ani muscle attaches directly to the longitudinal muscle of the rectum. The spatial relationship between the smooth and skeletal muscles differed in different portions of the anal canal. For intersphincteric resection, dissection must be performed between the longitudinal muscle of the rectum and the levator ani muscle/external anal sphincter, and the appropriate surgical lines must be selected based on the specific structural characteristics of each portion.
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http://dx.doi.org/10.1097/DCR.0000000000000565DOI Listing
May 2016

An anatomic study of the attachments on the condylar process of the mandible: muscle bundles from the temporalis.

Surg Radiol Anat 2016 May 13;38(4):461-7. Epub 2015 Nov 13.

Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.

Purpose: The aim of this study was to evaluate anatomically the relationship between bone and muscles by detailed observation of the bone shape and the structure of muscles to facilitate an understanding of the function of the muscles involved in jaw movement.

Methods: 36 specimens of 24 Japanese cadavers were examined. The insertion areas were marked using a radiopaque marker and examined by micro-computed tomography. For morphological observation, we used 101 condylar processes. In addition, we made histological sections in some specimens to observe the detailed attachments of the muscle.

Results: Based on the micro-CT images and dissection findings, the lateral pterygoid muscle was found to be most frequently inserted into the anterior impression and attached to the medial impression of the process. According to the histological observations, the lateral pterygoid muscle mainly inserted to the condylar process. The micro-CT images indicated that the obvious bony ridge was lateral to the pterygoid fovea on the condylar process in all specimens. The midmedial muscle bundle of the temporalis was attached to the ridge. Based on the morphological observations, the ridge was situated on the lateral area of the condylar process.

Conclusions: Since dysfunction of the temporomandibular joint is likely closely related to both the lateral pterygoid muscle and also the temporalis, further studies are necessary to evaluate the function of these muscles and consider jaw movement.
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http://dx.doi.org/10.1007/s00276-015-1587-4DOI Listing
May 2016

Detection of pathogen-specific antibodies by loop-mediated isothermal amplification.

Clin Vaccine Immunol 2015 Apr 4;22(4):374-80. Epub 2015 Feb 4.

Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

Loop-mediated isothermal amplification (LAMP) is a method for enzymatically replicating DNA that has great utility for clinical diagnosis at the point of care (POC), given its high sensitivity, specificity, speed, and technical requirements (isothermal conditions). Here, we adapted LAMP for measuring protein analytes by creating a protein-DNA fusion (referred to here as a "LAMPole") that attaches oligonucleotides (LAMP templates) to IgG antibodies. This fusion consists of a DNA element covalently bonded to an IgG-binding polypeptide (protein L/G domain). In our platform, LAMP is expected to provide the most suitable means for amplifying LAMPoles for clinical diagnosis at the POC, while quantitative PCR is more suitable for laboratory-based quantification of antigen-specific IgG abundance. As proof of concept, we measured serological responses to a protozoan parasite by quantifying changes in solution turbidity in real time. We observed a >6-log fold difference in signal between sera from vaccinated versus control mice and in a clinical patient sample versus a control. We assert that LAMPoles will be useful for increasing the sensitivity of measuring proteins, whether it be in a clinical laboratory or in a field setting, thereby improving acute diagnosis of a variety of infections.
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http://dx.doi.org/10.1128/CVI.00811-14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4375353PMC
April 2015

The anatomic relationship between the morphology of the greater tubercle of the humerus and the insertion of the infraspinatus tendon.

J Shoulder Elbow Surg 2015 Apr 3;24(4):555-60. Epub 2014 Dec 3.

Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.

Background: The objective of this study was to evaluate the topographic relationship between the morphology of the greater tubercle and the insertion of the tendon of the infraspinatus.

Materials And Methods: First, we defined an impression of the greater tubercle, which has not been recognized in classic textbooks, as the "lateral impression" and then measured the dimensions of the "lateral impression" of the greater tubercle in 71 samples of dry bone of humeri. Next, we examined 16 cadaveric humeri with rotator cuff tendons by micro-computed tomography to analyze the positional relationship between the lateral impression and the infraspinatus tendon.

Results: In all samples of dry bones, the lateral impression could be identified as a triangle shape. The lateral impression was composed of the border with the highest impression (mean, 6.3 mm), the border with the middle impression (mean, 5.0 mm), and the border with the lateral wall of the greater tubercle (mean, 8.5 mm). In all samples of humeri with rotator cuffs, we could confirm the lateral impression, and the border between the highest impression and the lateral impression corresponded to the anterior border of the insertion of the infraspinatus tendon.

Conclusion: We propose a new anatomic concept of the lateral impression that could enable the precise diagnosis of and facilitate repair techniques for infraspinatus tear, according to specific anatomic characteristics, by applying 3-dimensional computed tomography assessment preoperatively.
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http://dx.doi.org/10.1016/j.jse.2014.09.038DOI Listing
April 2015

Anatomy of the middle temporal vein: implications for skull-base and craniofacial reconstruction using free flaps.

Plast Reconstr Surg 2014 Jul;134(1):92e-101e

Tokyo, Japan From the Department of Plastic and Reconstructive Surgery and Unit of Clinical Anatomy, Tokyo Medical and Dental University.

Background: Finding appropriate recipient veins for free flap reconstruction in the adjacent temporal region is sometimes difficult when performing skull base or craniofacial reconstruction because there is a limited number of recipient veins in the temporal region compared with the neck. The authors used cadaver dissection to evaluate the viability of the middle temporal vein as a recipient vein in the temporal region.

Methods: The authors examined the characteristics and landmarks of the middle temporal vein in 60 sides of 30 cadavers. Its existence, caliber size, distribution pattern, and landmarks for dissection were measured.

Results: The middle temporal vein was located beneath the superficial layer of the deep temporal fascia and joined the main trunk of the superficial temporal vein. The vein was identified in all specimens, and its mean caliber was 1.88 mm. It was classified into four representative distribution patterns. According to the distribution pattern, the middle temporal vein provided one recipient vein without exception, and only 13 percent of middle temporal veins could provide two recipient veins. According to landmarks, the middle temporal vein runs approximately along the line between 52 mm lateral from the bony lateral canthus and 12 mm medial from the external auditory canal. The mean distance between the middle temporal vein and the temporal branch of the facial nerve was 13 mm.

Conclusions: The middle temporal vein can provide one recipient vein of adequate caliber in the temporal region. In addition, it can be easily localized, without damaging the facial nerve, by means of incision according to the landmarks described in this study.
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http://dx.doi.org/10.1097/PRS.0000000000000283DOI Listing
July 2014

Anatomic observation of the running space of the suprascapular nerve at the suprascapular notch in the same direction as the nerve.

Knee Surg Sports Traumatol Arthrosc 2015 Sep 13;23(9):2667-73. Epub 2014 Jun 13.

Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.

Purpose: The configuration of suprascapular notch was previously analysed from the anteroposterior viewing. However, the approach direction of the suprascapular nerve (SSN) to the inlet of the suprascapular notch is consistently craniocaudal and mediolateral. We propose a new method to observe the suprascapular notch according to the running course of the SSN. We reviewed the anatomic characteristics of the suprascapular notch in relation to the nerve.

Methods: In 30 formalin-fixed cadaveric shoulders, the morphology of the suprascapular notch and the attachments of the superior transverse scapular ligament (STSL) were examined from both the anteroposterior and the nerve approach direction. The dimensions of the opening of the SSN passage were measured.

Results: By observing from the nerve approach direction, the inlet of the suprascapular notch was recognized to be a space-bordered by the medial wall of the coracoid process, the deep fascia of subscapularis, and the STSL. The STSL formed a sheet-like structure, which ran parallel to the nerve and also to the deep fascia of subscapularis. The attachment of the ligament to the coracoid process was located at the posteromedial corner rather than the medial side.

Conclusion: Based on the present study, the space between the STSL and deep fascia of the subscapularis formed the space for the nerve to run through. As a clinical implication, this new method to assess the suprascapular notch in the nerve approach direction might develop the imaging techniques for evaluation of SSN entrapment.
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http://dx.doi.org/10.1007/s00167-014-3129-8DOI Listing
September 2015

The anatomy of the coracohumeral ligament and its relation to the subscapularis muscle.

J Shoulder Elbow Surg 2014 Oct 22;23(10):1575-81. Epub 2014 Apr 22.

Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address:

Background: Only a few reports describe the extension of the coracohumeral ligament to the subscapularis muscle. The purposes of this study were to histo-anatomically examine the structure between the ligament and subscapularis and to discuss the function of the ligament.

Methods: Nineteen intact embalmed shoulders were used. In 9 shoulders, the expansion of the ligament was anatomically observed, and in 6 of these 9, the muscular tissue of the supraspinatus and subscapularis was removed to carefully examine the attachments to the tendons of these muscles. Five shoulders were frozen and sagittally sectioned into 3-mm-thick slices. After observation, histologic analysis was performed on 3 of these shoulders. In the remaining 5 shoulders, the coracoid process was harvested to investigate the ligament origin.

Results: The coracohumeral ligament originated from the horizontal limb and base of the coracoid process and enveloped the cranial part of the subscapularis muscle. The superficial layer of the ligament covered a broad area of the anterior surface of the muscle. Laterally, it protruded between the long head of the biceps tendon and subscapularis and attached to the tendinous floor, which extended from the subscapularis insertion. Histologically, the ligament consisted of irregular and sparse fibers abundant in type III collagen.

Conclusion: The coracohumeral ligament envelops the whole subscapularis muscle and insertion and seems to function as a kind of holder for the subscapularis and supraspinatus muscles. The ligament is composed of irregular and sparse fibers and contains relatively rich type III collagen, which would suggest flexibility.
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http://dx.doi.org/10.1016/j.jse.2014.02.009DOI Listing
October 2014

Origin, course and distribution of the nerves to the posterosuperior wall of the external acoustic meatus.

Anat Sci Int 2014 Sep 7;89(4):238-45. Epub 2014 Mar 7.

Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo, Tokyo, Japan.

Patients with Ramsay Hunt syndrome have various clinical symptoms including vesicular rash of the external acoustic meatus and auricle. In addition to facial nerve paresis, neurological disturbances of various cranial nerves such as the acoustic nerve, glossopharyngeal nerve and vagus nerve are reported in patients of Ramsay Hunt syndrome. To understand the reasons for the clinical symptoms, we observed the nerve branches of the auricle and external acoustic meatus. We used 18 halves of 11 Japanese cadavers. All cadavers were fixed in 8% formalin and preserved in 30% ethanol. Dissection was performed under a stereomicroscope and the communication among the nerve branches was analyzed. Posterosuperior wall of the acoustic meatus was innervated by nerve branches that emerged from the tympanomastoid fissure in 17 specimens (17/18). These branches always crossed the facial canal and had more than one communicating branch with the facial nerve inside the canal (17/17) or in the petrous bone (1/17). These branches originated from the superior ganglion of the vagus. In the origin from the vagus nerve, some of these branches communicated with the glossopharyngeal nerve (3/17). In addition to these branches, the facial nerve, after originating from the stylomastoid foramen, bifurcated into two nerve branches in some specimens (7/17). Nerve branches around the external acoustic meatus and the auricle have various communications before reaching the central nervous system. The variety of communications could explain the varied symptoms of Ramsay Hunt syndrome.
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http://dx.doi.org/10.1007/s12565-014-0231-4DOI Listing
September 2014

Clinical characterization and identification of duplication breakpoints in a Japanese family with Xq28 duplication syndrome including MECP2.

Am J Med Genet A 2014 Apr 29;164A(4):924-33. Epub 2014 Jan 29.

Department of Genetics, Institute for Developmental Research, Aichi Human Service Center, Kasugai, Aichi, Japan.

Xq28 duplication syndrome including MECP2 is a neurodevelopmental disorder characterized by axial hypotonia at infancy, severe intellectual disability, developmental delay, mild characteristic facial appearance, epilepsy, regression, and recurrent infections in males. We identified a Japanese family of Xq28 duplications, in which the patients presented with cerebellar ataxia, severe constipation, and small feet, in addition to the common clinical features. The 488-kb duplication spanned from L1CAM to EMD and contained 17 genes, two pseudo genes, and three microRNA-coding genes. FISH and nucleotide sequence analyses demonstrated that the duplication was tandem and in a forward orientation, and the duplication breakpoints were located in AluSc at the EMD side, with a 32-bp deletion, and LTR50 at the L1CAM side, with "tc" and "gc" microhomologies at the duplication breakpoints, respectively. The duplicated segment was completely segregated from the grandmother to the patients. These results suggest that the duplication was generated by fork-stalling and template-switching at the AluSc and LTR50 sites. This is the first report to determine the size and nucleotide sequences of the duplicated segments at Xq28 of three generations of a family and provides the genotype-phenotype correlation of the patients harboring the specific duplicated segment.
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http://dx.doi.org/10.1002/ajmg.a.36373DOI Listing
April 2014

Dynamic intersection of the longitudinal muscle and external anal sphincter in the layered structure of the anal canal posterior wall.

Surg Radiol Anat 2014 Aug 21;36(6):551-9. Epub 2013 Nov 21.

Unit of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Tokyo, Bunkyo-ku, 113-8519, Japan.

Purpose: The minute details of the structure of the anal canal are still not well understood. The complex structural configuration of the muscles, ligaments and raphes remains unclarified. This study was undertaken to determine the precise structure of the posterior part of the anal canal and to facilitate an understanding of previous studies.

Methods: For macroscopic examination, 14 right pelvic halves from 14 Japanese cadavers were used. Observation and dissection were performed from the median plane. In the histological examination, six left pelvic halves were used. The sections of the posterior parts of the anal canal were stained with hematoxylin and eosin, Elastic van Gieson, anti-smooth actin antibody and anti-skeletal myosin antibody.

Results: We identified the following muscles arranged from the internal side to the external side: internal anal sphincter, longitudinal muscle (LM), external anal sphincter (EAS) and levator ani muscle (LAM). Two different types of conformation of the posterior part of the anal canal were found, each bearing a different shape of EAS. In both types, LM penetrated the inferior part of EAS. After penetrating EAS, some fibers of LM ran posterosuperiorly and attached to the "the posterior fibers" which reach the dorsal side of the coccyx.

Conclusions: We defined and labeled the connective tissues between the anal canal and coccyx on the basis of their relative position to LAM. Based on a comparison of the two types of the posterior part of the anal canal, we propose that there are two phases due to constriction and relaxation of LM.
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http://dx.doi.org/10.1007/s00276-013-1228-8DOI Listing
August 2014

Attachments of separate small bundles of human posterior cruciate ligament: an anatomic study.

Knee Surg Sports Traumatol Arthrosc 2013 May 29;21(5):998-1004. Epub 2012 Sep 29.

Section of Orthopedic Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.

Purpose: To date, there is no consensus on the detailed anatomy of the posterior cruciate ligament (PCL) and the most appropriate PCL reconstruction method. The purpose of this study is the detailed observation of separate small PCL bundles for better comprehension of detailed PCL anatomy to facilitate the design of anatomic PCL reconstruction.

Methods: Twelve cadaveric knees were used in this study. PCL was divided into anterolateral and posteromedial (PM) sections and then separated into about 20 small bundles of 1 mm in diameter while maintaining preservation of their attachment sites marked with fine coloured marker pens. The positional relationship between the femoral and tibial attachments of each small bundle was investigated.

Results: The small bundles of tibial and femoral attachments showed a topographical correlation. The anterior-posterior aligned bundles in the tibia corresponded to the bundles aligned in a low-high direction in flexion in the femur. The femoral attachment pattern was relatively similar in each specimen. However, the tibial attachment showed two patterns of small bundle footprint location: a parabolic type (6 of 12) and a transverse type (6 of 12). The posterior portion of the PM bundle was separately attached to the medial and lateral portions in the tibial attachment.

Conclusion: Small bundles of PCL showed a relatively layered arrangement between tibial and femoral attachments. Therefore, anatomic PCL reconstruction cannot be completed simply performed merely with straight bundles and circular bone tunnels.
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http://dx.doi.org/10.1007/s00167-012-2224-yDOI Listing
May 2013

An anatomical study of the watershed line on the volar, distal aspect of the radius: implications for plate placement and avoidance of tendon ruptures.

J Hand Surg Am 2012 Aug;37(8):1550-4

Department of Orthopaedic Surgery, Okayama Saiseikai General Hospital, Okayama, Japan.

Purpose: The watershed line is a useful surgical landmark for positioning a volar locking plate. Implants placed on or distal to it can impinge on flexor tendons and cause injury. However, the details of the anatomy of this line are unclear. We studied macroscopically and histologically the structures of the volar aspect of the distal radius.

Methods: We studied 20 distal forearm regions of 10 cadavers (5 males and 5 females; mean age, 79 y [range, 56-88 y]) to clarify the details of the watershed line. In 16 specimens, we investigated the macroscopic appearance of the volar aspect of the radius and the relationships among the bone, the volarradiocarpal ligaments, and the pronator quadratus. Histological analyses were performed in 4 specimens of 2 cadavers to examine the morphology of the margin of the bony structures.

Results: In the medial half of the distal volar radius, 2 lines were identified by direct macroscopic visualization; one was the proximal line that corresponded to the distal ridge of the pronator fossa, and the other was the distal line, which was more prominent. A medial bony prominence was situated on the distal line. In the lateral half, the distal and proximal lines of the medial half merged to form a single line. A lateral prominence was situated on this line.

Conclusions: The watershed line might not be a distinct line, and it corresponds to the distal margin of the pronator fossa in the lateral half of the volar radius and to a hypothetical line between the distal and proximal lines in the medial half. The medial and lateral bony prominences on the volar radius should be key structures for accurate plate placement to avoid flexor tendon injury.

Clinical Relevance: The present study suggests bony landmarks for positioning a volar locking plate.
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http://dx.doi.org/10.1016/j.jhsa.2012.05.011DOI Listing
August 2012

Anatomical study of the proximal origin of hamstring muscles.

J Orthop Sci 2012 Sep 6;17(5):614-8. Epub 2012 Jun 6.

Unit of Clinical Anatomy, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.

Purpose: It is relatively well accepted that the long head of the biceps femoris and the semitendinosus both originate from the ischial tuberosity as a common tendon. However, it is also widely known that the biceps femoris is consistently injured more than the semitendinosus. The purpose of this study was to examine the origins of the hamstring muscles, to find an anatomic basis for diagnosis and treatment of injuries of the posterior thigh regions.

Materials And Methods: Twenty-eight hips of fourteen adult Japanese cadavers were used in this study. In twenty hips of ten cadavers, the positional relationships among the origins on the ischial tuberosity were examined. In eight hips of four cadavers, histological examination of the origins of the hamstrings was also performed.

Results: The origin of the long head of the biceps femoris adjoined that of the semitendinosus. In the proximal regions of these muscles, the long head consisted of the tendinous part; however, the semitendinosus mainly consisted of the muscular part. Some of the fibers of the biceps tendon extended to fuse with the sacrotuberous ligament. The semimembranosus muscle broadly originated from the lateral surface of the ischial tuberosity.

Conclusion: The origins of the long head of the biceps femoris and the semitendinosus are found to be almost independent, and the tendon of the long head is partly fused with the sacrotuberous ligament. The high incidence of injuries to the long head of the biceps femoris could be explained by these anatomical configurations.
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http://dx.doi.org/10.1007/s00776-012-0243-7DOI Listing
September 2012
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