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The coeliac axis.

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AUTHOR’S ABSTRACT OF THIS PAPER ISSUED
BY T H E BIBLIOQRAPHIC SERVICE. OCTOBER
20.
THE COELIAC AXIS
PAUL B. EATON
From the Anatomical Laboratory, Johns Hopkins Medical School
O N E FIGURE
The classical description of the coeliac axis states that at the
level of the upper border of the pancreas it divides into three
branches, the left gastric, the hepatic, and the splenic arteries.
A number of studies of this vessel have been published within
the last few years, notably those of Rossi and Cova( l),Leriche
and Villemin (21, Descomps (3), Picquand (4),de Rio Branco
(5), Robinson (6), and Lipshutz (7). Of these Leriche and
Villemin alone report that they found the classical “tripus” in a
majority (unspecified) of cases. At the suggestion of Prof.
W. H. Lewis this study was undertaken to determine as definitely
as possible the normal type and to get some data on the frequency of departure from this norm.
The sketches which form the basis of this report were made by
myself from dissections made for the most part by freshman
medical students (to whom I am indebted for many courtesies)
and the amount,of material studied and its distribution are shown
in the following t’able.
Number
of subjects
Dissecting Room1
Johns Hopkins Uaiversity Medical School. . . . . . . . . . . . . . . . . . . . . . .
University of Maryland Medical School.. . . . . . . . . . . . . . . . . . . . . . . . .
George Washington University Medical School.. . . . . . . . . . . . . . . . . .
University of Pennsylvania Medical School. . . . . . . . . . . . . . . . . . . . . .
Jefferson Medical College.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Woman’s Medical College of Philadelphia.. . . . . . . . . . . . . . . . . . . . . . .
Temple University Medical School.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Philadelphia Policlinic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Medico-Chirurgical College of Philadelphia
.................
Georgetown University Medical School.. . . . . . . . . . . . . . . . . . . . . . . . .
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
47
34
12
44
40
3
12
1
8
-5
206
1 I wish here to make acknowledgment and express my thanks t o those whose
courtesy has made this work possible and very pleasant. I n particular to Pro369
THE ANATOMICAL RECORD, VOL.
13, NO. 6
370
PAUL B. EATON
The sex and skin tint of 200 of these subjects was recorded.
They were distributed as follows.
I
White.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Colored. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
1
MALE
53
85
13s
1
I
1
FEMALE
i:
62
I
I
1
TOTAL
79
121
200
The number of cases is not sufficiently large to warrant any
positive statement but there does not appear to be any great
sexual variation in the variability of the structures under consideration. The same may be said with respect to race. A
number of observers have reported that negro subjects seem to
show a greater tendency to variation than white ones but our
use of the term negro is too loose to be of any value from an
anthropologic standpoint. Dr. Hrdlicka (Division of Anthropology, Smithsonian Institution) informs me that
There is ground for believing that the ncgro of purc blood should
show a greater stability, anatomically, than the white man, who is
generally a pretty thorough mixture and who has been subjected to
mow varied environmental, occupational, and other influences ; but
our knowledge of the details of heredity is not sufficient to enable us
to predict the effect of hybridization upon this stability.
If our dissecting rooms contain the proportion of hybrids that
has been alleged of our large cities (fifty to seventy per cent) a
certain degree of anthropological skill will be necessary to make
the separations necessary to settle this question.
fessors F. P. Mall, and W. H. Lewis, of Johns Hopkins University, and their
assistants; Professors J. Holmes Smith and Joseph W. Holland of the University
of Maryland; Professor Car1 E. Davis of George Washington University; Professors George A. Piersol and George Fetteroff and Drs. G. M. Dorrancv and
P. G. Skillern of the University of Pennsylvania; Professors J. P. Shaeffer and
D. G. Metheny, and Drs. Hoffman and Lipshutz of Jefferson Medical College;
Professors Henry Morris and Mary Bicking Thornton of the Woman’s Medical
College of Philadelphia; Professor Addinell Hewson of Temple University and
Philadclphia Policlinic; Professors John G. Heislcr and H. I€. Cushing of MedicoChirurgical College; and Professors Frank L. Bakcr and W. F. Hemler of Georgetown University.
37 1
THE COELIAC AXTS
GENERAL CONSIDERATIONS
The history of the discovery and naming of the Coeliac Axis
is gone into very thoroughly by de Rio Branco (5),the embryology
by Tandler (8) and the comparative anatomy by Rossi and Cova
(1). These monographs are accessible and make further reference unnecessary.
CLASSIFICATION
Table 1 gives the simplest classification possible. The first
part is taken bodily from Branco and the remainder added to
show that extending the scope of the inquiry to the point of
TABLE 1
AUTHOR
Rossi and Cova .......
Leriche and Villemin.
Descomps . . . . . . . . . . . .
de Rio Branco . . . . . . . .
I]
N U M B E R OF
RUBJECTS
EXAMINED
_
Totals . . . . . . . . . . . . . .
102
55
50
50
~
Totals . . . . . . . . . . . . . .
_
257
_
~~~
Picquand . . . . . . . . . . . . .
Lipshutz . . . . . . . . . . . . .
Eaton . . . . . . . . . . . . . . . .
II 2%:)
AXIS
COMPLETE
50
83
206
__-_
596
86
49
44
45
_
COELIAC A X I S
INCOMPLETE
(FROM AORTA)
COELIOMESENTERIC
TRUNK
12
5
6
4
~
224
(87%)
27
(10.5-11’%)
41
60
186
7
21
19
1
2
511
(86%)
74
(12.5%)
8
_
COELIAC A X I S
ABSENT
(BEPARATE
O R I G I N OF I T 8
BRANCHES)
_
1
~
3
(0.5%)
doubling the number of subjects examined makes no great change
in the percentages. The inferior phrenic arteries have been
disregarded and will be treated separately.
The sketch on page 372 is an attempt at a logical or geometrical classification. As is to be expected this breaks down if
examined too critically. It may be extended on either side to
show the separate origin of the three branches of the axis from
the aorta or the absence of the splenic artery, which is much
more stable than either of the others. Most of the spaces might
be filled from the literature, but extension would make the dia-
372
PAUL B. EATON
gram unwieldy and it is submitted merely to cover the variations
found in my series and as a suggestion for the study of other
vessels. While the diagram is almost self-explanatory it may
be well t o call attention to the fact, that starting from Type XI, 2a
for example (the classical tripus), movement to the right shows
a displacement of the origin of the left gastric artery toward the
Type I V
@=
ill
L ~ I
32
,
7
@
[(I"
A.
'
Fig. 1. A , Aorta; G.S., Left gastric artcry; H . , Hepatic artery; H . A . , S c cessory hepatic artery; S . , Splenic artery; P., Pancrcatic artery.
aorta and finally as in Type IV entirely of3 the axis. Movement
to the left from the same point shows the same thing with respect to the hepatic artery. From the same point moving down
one column shows the addition of a pancreatic branch. I n the
third horizontal column the first is repeated with the addition
of a hepatic artery from the superior mesenteric artery. The
373
THE COELIAC AXIS
figures in the lower right hand corner of each section of the diagram indicate the number of times that particular arrangement was found in this series of cases. Those figures in parentheses in the lower left hand corners indicate the number of
cases in which the left gastric artery furnished an accessory
hepatic artery. If any argument were needed as to the necessity
for the investigation of a larger number of cases it could easily
be found inthe fact that in t'his series that particular arrangement
occurred 14 times or a fraction less than 7 per cent while Lipshutz (7) found it in 35 per cent of 83 cases. So far I have been
unable to find any other way to get it into the diagram.
TABLE 2
AUTHOR
Leriche and Villemin
Rossi and Cova.. . . . .
P icqu and. . . . . . . . . . . .
Descomps . . . . . . . . . . . .
de Rio Braneo.. . . . . .
Lipshutz . . . . . . . . . . . . .
Eaton.. . . . . . . . . . . . . . .
Totals.
TYPE[
I
TYPE II
102
55
50
50
50
83
206
2
8
3
0
3
3
IW.9%
596
2 9 4 . 9 % 130-247,
i
TYPE 111
26
60
5
37
16
28
15
30
21
41
47-22.8'33 140-68%
336-62.1 %
TYPE IV
3
6
4
5
1
12
W.4%
40-6.7%
It will be noticed that there is a distinct grouping in one section
of the diagram. This is as it should be, for, as urged by Ruge
(9) and Lipshutz, arterial variations group themselves into distinct types in numbers inversely proportionate to the amount of
their departure from the normal.
It is of course impossible to compare these results closely with
those of previous investigators. Table 2 is however an attempt
at such a comparison and I believe that such errors as may have
crept in will not greatly affect the percentages. The columns
for Types I1 and I11 are incomplete for the reason that Leriche
and Villemin merely state that the three branches came off at
the same level in the majority of cases. Their cases are therefore not counted in calculating the percentages for those columns.
374
PAUL B. EATON
SUMMARY
1. The normal type of coeliac axis is that which gives off the
left gastric artery as a collateral branch before the bifurcation
into the hepatic and splenic arteries. (62.1 per cent of 541
cases.)
2. The classical ‘tripus’ occurs somewhat less than half as
frequently. (24 per cent of 541 cases.)
LITERATURE C I T E D
ED COVA Archivio italinano tli Anat. e di Embriol. Florence, t. 111fas. 2, pp. 485-526.
(2) LERICHEET VILLEMIN 1907 Bibliogr. Anatom. Paris, t. 16, fas. 2, pp- 111-125.
(3) DESCOMPS,
P. 1910 Le Trone Cocliaque, Paris.
(4) PICQUAND,
G. Bibliogr. Anatom. T. 19, f a . 4, pp. 159-201.
(5) DA SILVARIO BRANCO1912 Le Tronc Coeliaque, Paris.
(6) ROBINSON,
B. 1908 American Practitioner and News.
(7) LIPSHUTZ,
B. 1917 Annals of Surgery, February.
(8) TANDLER,
J. 1904 Anatom. Hefte. Wicsbaden, vol. 25, pp. 47S500.
(9) R u m , G. 1883 Morph. Jahrbuch, vol. 9.
(1) Rossr
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