Clinical anatomy : official journal of the American Association of Clinical Anatomists & the British Association of Clinical Anatomists
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Proper anesthesia and knowledge of the anatomical location of the iliohypogastric and ilioinguinal nerves is important during hernia repair and other surgical procedures. Surgical complications have also implicated these nerves, emphasizing the importance of the development of a clear topographical map for use in their identification. The aim of this study was to explore anatomical variations in the iliohypogastric and ilioinguinal nerves and relate this information to clinical situations. ⋯ The nerve entered the abdominal wall 2.8 ± 1.3 cm medial and 1.4 ± 1.2 cm inferior to the ASIS and terminated 4 ± 1.3 cm lateral to the midline. For both nerves, the distance between the ASIS and the midline was 12.2 ± 1.1 cm. To reduce nerve damage and provide sufficient anesthetic for nerve block during surgical procedures, the precise anatomical location and spinal nerve contributions of the iliohypogastric and ilioinguinal nerves need to be considered.
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Innervation of the hand is supplied via the radial, median, and ulnar nerves. A common border of sensory distribution between the ulnar and median nerves is along the fourth digit. However, this sensory distribution may be affected by communication between these two nerves. ⋯ We examined 50 hands taken from 25 adult cadavers. Communicating branches were found in 16% of the hands examined, with rami occurring bilaterally in two specimens. By describing the origin and pathway of this communicating branch, we hope to provide surgeons and clinicians with knowledge that may help avoid iatrogenic injuries.
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Regional anesthesia for breast surgery may require a large amount of local anesthetic solution to provide an adequate blockade of all relevant structures. The purpose of this study was to determine the minimal volume of fluid required to anesthetize all nerves to adequately provide anesthesia for breast surgery. This is an open randomized study. ⋯ The following minimal volumes of fluid were required for complete coloration of the nerves: 2 mL for the supraclavicular nerves; 20 mL for the nerve roots from C(5) to C(7), inclusive, if intraneural injection was avoided; 3 mL per root for the nerve roots from C(8) to T(6), inclusive, for a paravertebral block; and 2 mL per nerve for intercostal nerve blocks at T(4) and lower. With 20 mL of solution at the interscalene level, the roots of C(3) and C(4) were also colored; therefore, a separate injection for the supraclavicular nerves was unnecessary. We conclude that regional anesthesia for complex breast surgery can be achieved with a volume of local anesthetic as low as 41 mL.
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Many pathological processes can present as a swelling in the groin. We present a case of complex, ruptured pyonephrosis causing a psoas collection, which in turn presented clinically as an apparent right "incarcerated inguinal hernia." The patient was successfully treated with antibiotics and ultrasound-guided drainage of the abscess. The anatomical basis of the inguinal presentation of this complex pyonephrosis can be understood in the arrangement of the renal (Gerota's) fascia.