The Achilles tendon is one of the most common sites of injury and rupture as a result of overuse. Evidence suggests that the pathogenesis of rupture could involve the pattern of its blood supply. With use of angiographic and histological techniques, the blood supply of the Achilles tendon was investigated in 12 human cadaveric specimens. Angiography confirmed Mayer's 1916 finding that the blood supply to the tendon is from three areas: the musculotendinous and osseotendinous junctions and the paratenon, with the posterior tibial artery providing the major contribution. However, qualitative and quantitative histological analyses in this study showed that the Achilles tendon has a poor blood supply throughout its length, as determined by the small number of blood vessels per cross-sectional area, which do not in general vary significantly along its length. In light of these findings, it is suggested that poor vascularity may prevent adequate tissue repair following trauma, leading to further weakening of the tendon.

The variations which occur in the medial and lateral ligament complexes of the elbow were investigated. These occurred frequently with the standard appearances occurring in no more than half the specimens on the medial side and one quarter of those on the lateral side. Surgeons who regularly perform elbow arthroplasty must be aware of these considerations, especially with the introduction of unconstrained prostheses which rely upon the ligament complex for their postoperative stability.

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Aims-To determine whether epidermal growth factor (EGF) or the related transforming growth factor (TGF ) may have a role in the developing human stomach; to substantiate the presence of EGF in human liquor in the non-stressed infant and whether EGF in amniotic fluid is maternally or fetally derived. Methods-The temporal expression and localisation of EGF, TGF , and their receptors during fetal and neonatal life were examined in 20 fetal and five infant stomachs. Simultaneously, samples of amniotic fluid and fetal urine from 10 newborn infants were collected and assayed for EGF by radioimmunoassay. Results-EGF immunoreactivity was not noted in any of the specimens examined. In contrast, TGF immunoreactivity was shown in mucous cells from 18 weeks of gestation onwards. EGF receptor immunoreactivity was seen on superficial mucous cells in gastric mucosa from 18 weeks of gestation onwards. The median concentration of EGF was 30 and 8.5 pg/ml in amniotic fluid and fetal urine, respectively, suggesting that EGF is not produced by the fetus. Conclusions-This study adds weight to the hypothesis that swallowed EGF, probably produced by the amniotic membranes, and locally produced TGF , may have a role in the growth and maturation of the human stomach. (Arch Dis Child 1997;76:F158-F162)

Previous studies involving the mapping of antral G-cells have had little significance because the techniques involved have been tedious, inaccurate, and have concentrated on pathological material, without establishing normal antral anatomy or physiology. We describe a new, reproducible technique for the accurate mapping of antral G-cells, which shows their relationship to the parietal cell mass and the macroscopic antrum-corpus boundary.The antrum of 20 normal, "fresh," postmortem human stomachs was examined by cutting 4-8 longitudinal strips. The macroscopic antrum-corpus boundary (nerve of Latarjet) was identified. Serial section were stained for parietal and G-cells to define the microscopic antrum-corpus boundary.In 4 stomachs, the parietal cells extended to the pylorus. In these, the G-cells were sparse and the antrum as defined by the G-cells was significantly smaller (FYO.01). The G-cell boundary correlated better with the macroscopic boundary than did the parietal cell boundary.This study provides a basis for future quantitative studies on parietal and G-cells in the antrum which should be defined according to both G-cells and parietal cells. Patients with "acid antra" appear to have reduced number of antral G-cells and this may have practical significance for patients undergoing duodenal ulcer surgery.