The lymphatic system, a network of vessels carrying clear interstitial fluid called lymph, is fou... more The lymphatic system, a network of vessels carrying clear interstitial fluid called lymph, is found throughout the human body. The system maintains homeostasis, receiving proteins and excess fluid from the interstitial tissues, and returning them to the venous system. Understanding of lymphatic drainage remains important in the diagnosis, prognosis, and treatment of diseases, including the metastasis of malignant diseases. Information specific to the cardiac lymphatics is scarce. Indeed, quite often the topic is not even mentioned in many medical textbooks. The goal of our review is to compile and analyze the information currently available concerning the cardiac lymphatics, hoping further to demonstrate the clinical importance of this neglected system.
The knowledge of neural interconnections between adjacent nerves of the upper limb is important t... more The knowledge of neural interconnections between adjacent nerves of the upper limb is important to the surgeon as such variations may lead to issues with surgical identification and thus iatrogenic injury. Trauma or entrapment of these nerves may cause functional losses different from those expected and thus result in misdiagnosis. The authors review the literature regarding such nervous system derangements.
Skull trepanation is an ancient and often religious act found in remains from around the world. H... more Skull trepanation is an ancient and often religious act found in remains from around the world. However, cranioplasty for the surgical treatment of skull pathologies is a relatively recent phenomenon. In this paper, we focus on the account of skull injury and cranioplasty in medieval Persia. Herein, we describe and translate the over 500-year-old writings of the Persian physician Baha al-Dowleh Razi regarding cranioplasty in an excerpt from his book entitled Khulasat al-Tajarib (Summary of Experiences). This early writer detailed the methods and indications for cranioplasty including the use of xenographs. Additionally, we attempt to trace this early understanding of skull surgery and follow its possible spread to Europe. It is such early experiences and methods of cranial surgery on which we base our current understanding of neurosurgery.
Following the Mongolian invasion of the Middle East in the thirteenth century, a regional power c... more Following the Mongolian invasion of the Middle East in the thirteenth century, a regional power called the Ilkhanid emerged and was ruled by the heirs of Temujin from Mongolia. Embracing present-day Iran, Iraq, Afghanistan, Azerbaijan, areas of Russia, Turkey, and Pakistan, and nearby Middle Eastern territories, the Ilkhanid state patronized medicine and various other professions. Centered in Tabriz (Tauris), a city in the northwest of present-day Iran, was a non-profit-making educational and medical complex founded by Grand Minister Rashid al-Din Fazlollah Hamadani. This paper reviews the literature regarding the rise and fall of the thirteenth century university and the Rabi Rashidi, emphasizing the structure of its medical school. The background training of Rashid al-Din and his keen interest in science turned this complex, Rabi Rashidi (literally meaning the Rashidi Quarters), into a cosmopolitan university that freely trained medical scholars nationally and internationally. The possibility that Rashid al-Din was inspired by university developments in Europe is discussed.
François Magendie lived during a tumultuous period in French history. Although this early medical... more François Magendie lived during a tumultuous period in French history. Although this early medical pioneer made significant contributions to the fields of neuroanatomy, physiology, and pharmacology, little information is found in the non-French literature regarding this significant person in history. Based on this review, one could also consider this trained surgeon as an early pioneer of neurosurgery. For example, he is known to have used Galvanic current to treat various neuralgias, described a technique for extracting cerebrospinal fluid and quantitated and described its characteristics in normal and pathological specimens, and elucidated the functions of the the cranial nerves using vivisection. Additionally, he accurately described the functions of the dorsal and ventral rootlets using vivisection, and realized that the exposed meninges were susceptible to painful stimuli. Our current knowledge is based on the early contributions of scientists such as François Magendie.
Following the Mongolian invasion of the Middle East in the thirteenth century, a regional power c... more Following the Mongolian invasion of the Middle East in the thirteenth century, a regional power called the Ilkhanid emerged and was ruled by the heirs of Temujin from Mongolia. Embracing present-day Iran, Iraq, Afghanistan, Azerbaijan, areas of Russia, Turkey, and Pakistan, and nearby Middle Eastern territories, the Ilkhanid state patronized medicine and various other professions. Centered in Tabriz (Tauris), a city in the northwest of present-day Iran, was a non-profit-making educational and medical complex founded by Grand Minister Rashid al-Din Fazlollah Hamadani. This paper reviews the literature regarding the rise and fall of the thirteenth century university and the Rabi Rashidi, emphasizing the structure of its medical school. The background training of Rashid al-Din and his keen interest in science turned this complex, Rabi Rashidi (literally meaning the Rashidi Quarters), into a cosmopolitan university that freely trained medical scholars nationally and internationally. The possibility that Rashid al-Din was inspired by university developments in Europe is discussed.
Carbon dioxide (CO(2)) interacts in complex ways with the brain and the endocrine and immune syst... more Carbon dioxide (CO(2)) interacts in complex ways with the brain and the endocrine and immune systems. Arterial CO(2) may be elevated or decreased following cerebral ischemia-reperfusion injury or stroke. The aim of the present review is to delineate potential changes in the neuroimmunoendocrine system following cerebral ischemia-reperfusion injury and to provide evidence for the modulatory role of carbon dioxide in this setting. It appears that lesions of the right and left cerebral hemispheres are associated with different patterns of immune activation and cytokine release. Changes in arterial CO(2) can profoundly alter the neuroimmunoendocrine system, especially the hypothalamic-pituitary-adrenal (HPA) axis and the production of pro-inflammatory cytokines. Hypercapnia activates the HPA axis, exerts antiinflammatory and antioxidant effects, and can alter the secretion and function of various brain neurotransmitters. There is conflicting evidence surrounding arterial CO(2): its effects on the ischemic brain may be either beneficial or deleterious. Mild hypercapnia may exert some neuroprotection following cerebral ischemia, but severe hypercapnia may aggravate neuronal injury by extra- and intra-cellular acidification and/or impairment of cellular calcium hemostasis. Future studies are required to delineate the potential relationship between arterial CO(2) and prognosis and long-term survival following cerebral ischemia-reperfusion injury. "Therapeutic hypercapnia" seems to be a promising approach to the treatment of stroke patients, and its use should be justified by further experimental and clinical studies.
Various donor nerves, including the ipsilateral long thoracic nerve (LTN), have been used for bra... more Various donor nerves, including the ipsilateral long thoracic nerve (LTN), have been used for brachial plexus neurotization procedures. Neurotization to proximal branches of the brachial plexus using the contralateral long thoracic nerve (LTN) has, to the authors' knowledge, not been previously explored. In an attempt to identify an additional nerve donor candidate for proximal brachial plexus neurotization, the authors dissected the LTN in 8 adult human cadavers. The nerve was transected at its distal termination and then passed deep to the clavicle and axillary neurovascular bundle. This passed segment of nerve was then tunneled subcutaneously and contralaterally across the neck to a supra- and infraclavicular exposure of the suprascapular and musculocutaneous nerves. Measurements were made of the length and diameter of the LTN. All specimens were found to have a LTN that could be brought to the aforementioned contralateral nerves. Neural connections remained tension free with left and right neck rotation of approximately 45 degrees . The mean length of the LTN was 22 cm with a range of 18-27 cm. The overall mean diameter of this nerve was 3.0 mm. No gross evidence of injury to surrounding neurovascular structures was identified in any specimen. Based on the results of this cadaveric study, the use of the contralateral LTN may be considered for neurotization of the proximal musculocutaneous and suprascapular nerves.
There is paucity of information regarding the specific anatomy and clinical significance of ossif... more There is paucity of information regarding the specific anatomy and clinical significance of ossified ligaments near the foramen ovale (e.g., pterygospinous and pterygoalar ligaments). The present study was undertaken to define this anatomy in more detail and to review the literature regarding these anatomic variations. One hundred fifty-four adult human dry skulls were analyzed for the presence of ossified ligaments of pterygospinous (ligament of Civinini) and pterygoalar (ligament of Hyrtl). Measurements were made of these bony structures and observations made of their relationships to the inferior aspect of the foramen ovale and neighboring structures. Two ossifications each (2.6%) of the ligaments of Civinini and Hyrtl were found. One of each of these (1.3%) was completely ossified, thereby resulting in 2 complete foramina (i.e., 1 foramen of Civinini and 1 foramen of Hyrtl). A significant correlation was found between the left and right sides, with either complete or incomplete ossification of these ligaments being found on left sides (75%) (incomplete Civinini on right side and all others on left side). The complete foramen of Civinini was found to have an area of 16.7 mm, and the complete foramen of Hyrtl was found to have an area of 9.42 mm. Such anomalous bony obstructions could interfere with transcutaneous needle placement into the foramen ovale or distort anatomic relationships during approaches to the cranial base.
The lymphatic system, a network of vessels carrying clear interstitial fluid called lymph, is fou... more The lymphatic system, a network of vessels carrying clear interstitial fluid called lymph, is found throughout the human body. The system maintains homeostasis, receiving proteins and excess fluid from the interstitial tissues, and returning them to the venous system. Understanding of lymphatic drainage remains important in the diagnosis, prognosis, and treatment of diseases, including the metastasis of malignant diseases. Information specific to the cardiac lymphatics is scarce. Indeed, quite often the topic is not even mentioned in many medical textbooks. The goal of our review is to compile and analyze the information currently available concerning the cardiac lymphatics, hoping further to demonstrate the clinical importance of this neglected system.
The knowledge of neural interconnections between adjacent nerves of the upper limb is important t... more The knowledge of neural interconnections between adjacent nerves of the upper limb is important to the surgeon as such variations may lead to issues with surgical identification and thus iatrogenic injury. Trauma or entrapment of these nerves may cause functional losses different from those expected and thus result in misdiagnosis. The authors review the literature regarding such nervous system derangements.
Skull trepanation is an ancient and often religious act found in remains from around the world. H... more Skull trepanation is an ancient and often religious act found in remains from around the world. However, cranioplasty for the surgical treatment of skull pathologies is a relatively recent phenomenon. In this paper, we focus on the account of skull injury and cranioplasty in medieval Persia. Herein, we describe and translate the over 500-year-old writings of the Persian physician Baha al-Dowleh Razi regarding cranioplasty in an excerpt from his book entitled Khulasat al-Tajarib (Summary of Experiences). This early writer detailed the methods and indications for cranioplasty including the use of xenographs. Additionally, we attempt to trace this early understanding of skull surgery and follow its possible spread to Europe. It is such early experiences and methods of cranial surgery on which we base our current understanding of neurosurgery.
Following the Mongolian invasion of the Middle East in the thirteenth century, a regional power c... more Following the Mongolian invasion of the Middle East in the thirteenth century, a regional power called the Ilkhanid emerged and was ruled by the heirs of Temujin from Mongolia. Embracing present-day Iran, Iraq, Afghanistan, Azerbaijan, areas of Russia, Turkey, and Pakistan, and nearby Middle Eastern territories, the Ilkhanid state patronized medicine and various other professions. Centered in Tabriz (Tauris), a city in the northwest of present-day Iran, was a non-profit-making educational and medical complex founded by Grand Minister Rashid al-Din Fazlollah Hamadani. This paper reviews the literature regarding the rise and fall of the thirteenth century university and the Rabi Rashidi, emphasizing the structure of its medical school. The background training of Rashid al-Din and his keen interest in science turned this complex, Rabi Rashidi (literally meaning the Rashidi Quarters), into a cosmopolitan university that freely trained medical scholars nationally and internationally. The possibility that Rashid al-Din was inspired by university developments in Europe is discussed.
François Magendie lived during a tumultuous period in French history. Although this early medical... more François Magendie lived during a tumultuous period in French history. Although this early medical pioneer made significant contributions to the fields of neuroanatomy, physiology, and pharmacology, little information is found in the non-French literature regarding this significant person in history. Based on this review, one could also consider this trained surgeon as an early pioneer of neurosurgery. For example, he is known to have used Galvanic current to treat various neuralgias, described a technique for extracting cerebrospinal fluid and quantitated and described its characteristics in normal and pathological specimens, and elucidated the functions of the the cranial nerves using vivisection. Additionally, he accurately described the functions of the dorsal and ventral rootlets using vivisection, and realized that the exposed meninges were susceptible to painful stimuli. Our current knowledge is based on the early contributions of scientists such as François Magendie.
Following the Mongolian invasion of the Middle East in the thirteenth century, a regional power c... more Following the Mongolian invasion of the Middle East in the thirteenth century, a regional power called the Ilkhanid emerged and was ruled by the heirs of Temujin from Mongolia. Embracing present-day Iran, Iraq, Afghanistan, Azerbaijan, areas of Russia, Turkey, and Pakistan, and nearby Middle Eastern territories, the Ilkhanid state patronized medicine and various other professions. Centered in Tabriz (Tauris), a city in the northwest of present-day Iran, was a non-profit-making educational and medical complex founded by Grand Minister Rashid al-Din Fazlollah Hamadani. This paper reviews the literature regarding the rise and fall of the thirteenth century university and the Rabi Rashidi, emphasizing the structure of its medical school. The background training of Rashid al-Din and his keen interest in science turned this complex, Rabi Rashidi (literally meaning the Rashidi Quarters), into a cosmopolitan university that freely trained medical scholars nationally and internationally. The possibility that Rashid al-Din was inspired by university developments in Europe is discussed.
Carbon dioxide (CO(2)) interacts in complex ways with the brain and the endocrine and immune syst... more Carbon dioxide (CO(2)) interacts in complex ways with the brain and the endocrine and immune systems. Arterial CO(2) may be elevated or decreased following cerebral ischemia-reperfusion injury or stroke. The aim of the present review is to delineate potential changes in the neuroimmunoendocrine system following cerebral ischemia-reperfusion injury and to provide evidence for the modulatory role of carbon dioxide in this setting. It appears that lesions of the right and left cerebral hemispheres are associated with different patterns of immune activation and cytokine release. Changes in arterial CO(2) can profoundly alter the neuroimmunoendocrine system, especially the hypothalamic-pituitary-adrenal (HPA) axis and the production of pro-inflammatory cytokines. Hypercapnia activates the HPA axis, exerts antiinflammatory and antioxidant effects, and can alter the secretion and function of various brain neurotransmitters. There is conflicting evidence surrounding arterial CO(2): its effects on the ischemic brain may be either beneficial or deleterious. Mild hypercapnia may exert some neuroprotection following cerebral ischemia, but severe hypercapnia may aggravate neuronal injury by extra- and intra-cellular acidification and/or impairment of cellular calcium hemostasis. Future studies are required to delineate the potential relationship between arterial CO(2) and prognosis and long-term survival following cerebral ischemia-reperfusion injury. "Therapeutic hypercapnia" seems to be a promising approach to the treatment of stroke patients, and its use should be justified by further experimental and clinical studies.
Various donor nerves, including the ipsilateral long thoracic nerve (LTN), have been used for bra... more Various donor nerves, including the ipsilateral long thoracic nerve (LTN), have been used for brachial plexus neurotization procedures. Neurotization to proximal branches of the brachial plexus using the contralateral long thoracic nerve (LTN) has, to the authors' knowledge, not been previously explored. In an attempt to identify an additional nerve donor candidate for proximal brachial plexus neurotization, the authors dissected the LTN in 8 adult human cadavers. The nerve was transected at its distal termination and then passed deep to the clavicle and axillary neurovascular bundle. This passed segment of nerve was then tunneled subcutaneously and contralaterally across the neck to a supra- and infraclavicular exposure of the suprascapular and musculocutaneous nerves. Measurements were made of the length and diameter of the LTN. All specimens were found to have a LTN that could be brought to the aforementioned contralateral nerves. Neural connections remained tension free with left and right neck rotation of approximately 45 degrees . The mean length of the LTN was 22 cm with a range of 18-27 cm. The overall mean diameter of this nerve was 3.0 mm. No gross evidence of injury to surrounding neurovascular structures was identified in any specimen. Based on the results of this cadaveric study, the use of the contralateral LTN may be considered for neurotization of the proximal musculocutaneous and suprascapular nerves.
There is paucity of information regarding the specific anatomy and clinical significance of ossif... more There is paucity of information regarding the specific anatomy and clinical significance of ossified ligaments near the foramen ovale (e.g., pterygospinous and pterygoalar ligaments). The present study was undertaken to define this anatomy in more detail and to review the literature regarding these anatomic variations. One hundred fifty-four adult human dry skulls were analyzed for the presence of ossified ligaments of pterygospinous (ligament of Civinini) and pterygoalar (ligament of Hyrtl). Measurements were made of these bony structures and observations made of their relationships to the inferior aspect of the foramen ovale and neighboring structures. Two ossifications each (2.6%) of the ligaments of Civinini and Hyrtl were found. One of each of these (1.3%) was completely ossified, thereby resulting in 2 complete foramina (i.e., 1 foramen of Civinini and 1 foramen of Hyrtl). A significant correlation was found between the left and right sides, with either complete or incomplete ossification of these ligaments being found on left sides (75%) (incomplete Civinini on right side and all others on left side). The complete foramen of Civinini was found to have an area of 16.7 mm, and the complete foramen of Hyrtl was found to have an area of 9.42 mm. Such anomalous bony obstructions could interfere with transcutaneous needle placement into the foramen ovale or distort anatomic relationships during approaches to the cranial base.
Uploads
Papers by Marios Loukas