胸大肌、胸小肌的肌梭形态、分布及其与梭外肌纤维型的关系

目的：探讨人胸大肌、胸小肌肌梭的形态、分布及其与梭外肌纤维型的关系。方法：用HE染色结合体视学方法并肌球蛋白ATPase染色,观察肌梭形态、分布及肌纤维型构成。结果：胸大肌锁骨部和胸小肌肌梭密度较高,存在较多的肌梭联合体,Ⅰ型肌纤维比例高于Ⅱ型。结论：肌梭在不同肌之间以及同一肌各亚部之间密度不等,肌梭密度较高部位,肌梭以联合体形式存在的比例较高,梭外肌纤维以Ⅰ型占优势。     

Bilateral asymmetric deficiency of the pectoralis major muscle

We observed a rare, bilateral congenital deficiency of the pectoralis major muscle in a 72-year-old female cadaver in our gross anatomy dissection laboratory. The outward appearance of the anterior thoracic wall, which included well-developed breasts, revealed no obvious abnormalities. Upon dissection, the following features were observed: 1) on the left side, the sternal portion of the sternocostal head of the pectoralis major muscle was absent, the costal portion of the sternocostal head and the clavicular head were both well developed, a normal pectoralis minor was present, and the deltoid and subclavius muscles were not hypertrophied as is often the case when the pectoralis major muscle is deficient; 2) on the right side, the entire pectoralis major muscle was absent and the pectoralis minor, deltoid, and coracobrachialis muscles were infiltrated with connective tissue and fat; and 3) on both sides, the lateral pectoral nerves were absent and the medial pectoral nerves were present. The absence of the lateral pectoral nerves suggests that the deficiencies in the pectoralis major muscles are congenital malformations resulting from a developmental failure of the embryonic muscles rather than a sequel to polio or Poland's syndrome.     

Posterior shoulder girdle abnormalities with absence of pectoralis major muscle

We have reviewed 12 consecutively ascertained individuals with unilateral absence of the sterno-costal head of the pectoralis major muscle and have studied associated abnormalities of the posterior shoulder girdle and their frequency and extent as contrasted with that of the symbrachydactyly. We found certain previously unreported associations of skeletal and renal anomalies in these individuals. We review various speculations regarding the possible causes of the Poland anomaly.     

An unusual innervation of pectoralis minor and major muscles from a branch of the intercostobrachial nerve

Variations of the branching pattern of the intercostobrachial nerve have been known to complicate dissection during mastectomy and other procedures involving the axilla. We present a unilateral case of a 73-year-old Caucasian female, in which the intercostobrachial nerve gives rise to an additional medial pectoral branch, which partially innervates the pectoralis minor muscle, as well as the abdominal head of pectoralis major muscle. Clinical consequences of such a variation may include motor losses, in addition to the commonly reported sensory losses, resulting from accidental or intentional dissection of the intercostobranchial nerve.     

Unusual variation of the inferior attachment of the pectoralis minor muscle

An unusual inferior attachment of pectoralis minor muscle was found on the right side of a male cadaver. The tendinous attachment, originating only from the 5th rib, was detected during the routine practical dissections. There were no other associated features in the thoracic region of this cadaver. We believe that this variation that has not been reported previously in the literature, should be taken into consideration by the surgeons.     

Neurovascular distribution within the abdominal head of the pectoralis major muscle: Application to breast and flap surgery

The abdominal head of the pectoralis major (AHPM) is important in cosmetic and flap surgeries. Few studies have reported on its neurovascular entry points and distribution patterns. We aimed to determine the entry points and distribution patterns of the neurovascular structures within the AHPM. Thirty‐two hemithoraxes were dissected, and the distribution patterns of the neurovascular structures were classified into several categories. The neurovascular entry points were measured at the horizontal line passing through the jugular notch (x‐axis) and the midclavicular line (y‐axis). The AHPM was innervated by the communication branches of the medial pectoral nerve (MPN) and the lateral pectoral nerve (LPN) in 78.1% of the specimens and of the MPN without the communication branches in 21.9%. All the LPNs had communication branches, which could be classified as independent in 46.9% of the samples, with the MPN in 21.9%, and with the LPN in 9.3%. The blood supply of the AHPM was composed of branches from the lateral thoracic artery (LTA) in 62.5% of the specimens, the thoracoacromial artery (TA) in 15.6%, and the LTA with the TA in 21.9%. The mean distance of the entry point was 6.3 cm ± 1.3 cm lateral to the y‐axis, 8.1 cm ± 3.3 cm below the x‐axis in the nerves, 6.5 cm ± 1.2 cm lateral to the y‐axis, and 8.6 cm ± 3.0 cm below the x‐axis in the arteries. This study defined the average neurovascular entry point and distribution pattern in detail using standard lines to enable the AHPM to be better understood. Clin. Anat. 28:520–526, 2015. © 2015 Wiley Periodicals, Inc.     

Positional relationship between the pectoralis major and external abdominal oblique muscles for consideration during dual‐plane breast augmentation

During dual plane breast augmentation (DPBA), the costal origin of the pectoralis major (the PM) should be cut to ensure appropriate coverage and positioning of an implant. However, surgeons sometimes make inappropriate planar incisions and insufficient muscular incisions because the external abdominal oblique (the EAO) muscle partially overlaps the lateral portion of the PM. The goal of this study was to clarify the positional relationship between the PM and EAO with the aim of improving the accuracy of implant and muscular incisions during DPBA. Forty sides of 20 embalmed and fresh cadavers were dissected. The midline and midclavicular line (MCL) were used as reference lines for measurements. We clarified the overlapping patterns between the PM and EAO, and measured the distances from the MCL to the borders of those two muscles. The costal part of the PM originated from the 5th (25%), 6th (70%), or 7th rib (5%), respectively. The distances from the MCL to the lateral border of the PM at the 4th, 5th, and 6th ribs were 49.8 mm, 30.5 mm, and 6.3 mm, respectively. In 90% of the specimens, the PM and the EAO overlapped near the MCL. The width of the overlapping portion between the PM and EAO was about 25 mm. This study is one of the first to suggest an innovative approach for explaining the positional relationships between the PM and EAO. Our findings can be useful for surgeons attempting to produce optimal outcomes in DPBA, especially in procedures that involve patients of different races. Clin. Anat. 31:339–346, 2018. © 2018 Wiley Periodicals, Inc.     

胸大肌腹部的显微外科解剖学研究

目的：为在整形外科领域中更加合理和有效地使用胸大肌提供解剖学依据。方法：对12例（24例）灌注红色乳胶的成人尸体标本的胸大肌血管、神经进行显微解剖观察和测量。结果：胸大肌腹部在形态学上具有相对的独立性，全长22.7cm，中段宽6.0cm，中段厚3.3mm，腱长3.2cm；动脉外径1.98mm，起点至肌门长度4.9cm；神经的横径1.71mm，从起点至肌门的长度5.5cm。结论：单独地使用胸大肌腹部不仅存在可能性，而且具有可操作性。     

Avid 18F-FDG uptake of pectoralis major muscle: an equivocal sequela of strenuous physical exercise

Avid functional ¹⁸F-FDG uptake of skeletal muscle is a known false positive finding of PET-CT study especially after involuntary muscle exercise just prior to the study. We describe the case of a 50-year-old man in whom the finding of avid ¹⁸F-FDG uptake of pectoralis major muscle was encountered during investigation of metastatic melanoma.     

Localization of nerve entry points and the center of intramuscular nerve-dense regions in the adult pectoralis major and pectoralis minor and its significance in blocking muscle spasticity

The aims of this study were to localize the body surface position and depth of nerve entry points, and the center of the intramuscular nerve-dense regions of the pectoralis major and pectoralis minor in order to provide guidance for blocking muscle spasticity. Formalin-fixed adult cadavers (66.3 ± 5.2 years) were used. The curved line on the skin from the acromion to the most inferior point of the jugular notch was defined as the horizontal reference line (H). The line from the most inferior point of the jugular notch to the xiphisternal joint was defined as the longitudinal reference line (L). The nerve entry points was anatomically exposed. Sihler's staining, barium sulfate labeling, and computed tomography were employed to determine the projection points (P) on the body surface. The intersection of the longitudinal line through the P point and the H line and the horizontal line through the P point and the L line were recorded as P_H and P_L, respectively. The projection of the nerve entry points or the center of the intramuscular nerve-dense regions were in the opposite direction across the transverse plane and were recorded as P'. The percentage positions of P_H and P_L on the H and L lines, as well as the nerve entry points and the center of the intramuscular nerve-dense regions depths, were determined using the Syngo system. The pectoralis major had two nerve entry points, while the pectoralis minor had only one. In addition, two intramuscular nerve-dense regions were found in the pectoralis major, while only one region was found in the pectoralis minor. The P_H of the nerve entry points were located at 47.83%, 32.31%, and 34.31%, while the P_H of the center of the intramuscular nerve-dense regions were at 41.95%, 55.88%, and 32.58% of line H, respectively. The P_L of the nerve entry points were at −9.84%, 36.16%, and 2.44%, while the P_L for each of three center of the intramuscular nerve-dense regions was at −3.87%, 25.29%, and −7.13% of line L, respectively. The depth for each of the nerve entry points was at 17.76%, 17.53%, and 25.51% of line P-P′’, respectively, and the depth of the center of the intramuscular nerve-dense regions was at 5.23%, 6.75%, and 13.73% of line P-P′, respectively. These percentage values are all means. The definition of the surface position and depth of these nerve entry points and center of the intramuscular nerve-dense regions can improve the localization efficiency and efficacy of target blocking for pectoralis major and minor spasticity.     

Familial congenital bilateral agenesis of the acromion a radiologically illustrated case report

Familial congenital bilateral acromion absence was found in four members of one family. Only one of them presented with gradually increasing pain in his left shoulder, resembling a shoulder impingement syndrome. The other members did not have any symptoms. This is the first report of familial occurrence of this extremely rare congenital anomaly.     

Variance of the pectoralis major in relation to the inframammary fold and the pectoralis minor and its application to breast surgery

Understanding the anatomy of the muscles and other structures of the chest is of great importance in breast surgery. We have conducted the first analysis of the overall variations and relationships among the pectoralis major (PM), inframammary fold (IMF), and pectoralis minor (Pm). We studied 30 patients and 10 cadavers, leading to a total of 50 breasts. Preoperatively, the breast width was measured, and the costal origin of the lowest IMF point was marked. Intraoperatively, we recorded the costal origins of the PM and IMF, PM width, the distance between the PM and IMF, and the relationship and distance between the PM and Pm. Among the patients, PMs originated from the sixth rib in 80% and above the IMF in 66.67%. The mean distances between the PM and IMF were 10.5 mm in the patients and 16 mm in the cadavers. The mean PM/breast width ratio was 0.82 in the patients and 0.85 in the cadavers. The PM and Pm mostly crossed on the fourth or fifth rib, and the average angles between the two muscles were 23.5° and 21.4° in the patients and cadavers, respectively. This study is the first to analyze the anatomical variations of the PM, IMF, and Pm simultaneously. We also examined the differences between Western and Asian populations. Understanding the anatomy is undoubtedly crucial for breast surgery, and here we provide a firm guide to the variations to be expected during operations, which can lead to successful outcomes. Clin. Anat. 30:357–361, 2017. © 2017 Wiley Periodicals, Inc.     

New syndrome? Osteochondrodysplasia with rhizomelia,platyspondyly, callosal agenesis,thrombocytopenia, hydrocephalus,and hypertension

A female infant born at term to phenotypically normal nonconsanguinous parents had hypertension, thrombocytopenia, hydrocephalus, callosal agenesis, and nonlethal rhizomelic osteochondrodysplasia. Her osteochondrodysplasia was characterized roentgenographically by shortening and metaphyseal broadening of long bones, without bowing, and by platyspondyly, with deficient ossification of dorsal and central portions of vertebral bodies. By light microscopy, the iliac crest growth plate showed expansion of the zone of chondrocyte hypertrophy and degeneration, with faulty columnar alignment, sparse vascular ingrowth, and irregular mineralization at the zone of chondroosseous transformation. These findings appear to define a novel osteochondrodysplasia, which in association with hypertension, thrombocytopenia, hydrocephalus, and callosal agenesis may constitute a new syndrome.     

Familial congenital bilateral agenesis of the acromion: a radiologically illustrated case report

Summary Familial congenital bilateral acromion absence was found in four members of one family. Only one of them presented with gradually increasing pain in his left shoulder, resembling a shoulder impingement syndrome. The other members did not have any symptoms. This is the first report of familial occurrence of this extremely rare congenital anomaly.

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Agénésie familiale bilatérale de l'acromion : une observation illustrée radiologiquement

Résumé L'absence congénitale bilatérale de l'acromion a été observée chez quatre membres d'une même famille. L'un d'eux seulement présentait des douleurs de l'épaule gauche progressivement croissantes ressemblant à un syndrome de blocage de l'épaule. Les autres membres n'avaient aucun symptôme. Il s'agit de la première observation familiale de cette anomalie congénitale extrêmement rare.

     

Reproductive risk factors in unilateral and bilateral renal agenesis

ABSTRACT  Renal agenesis (RA) appears to be a multifactorial condition with combined genetic and environmental influences. We performed a retrospective case-control study of reproductive history of 26 isolated RA live births cases referred to Sicilian Registry of Congenital Malformations. A statistical significant association for birth weight if we considered all RA together and for bilateral RA alone, an increasing risk for maternal age only in the bilateral RA subgroup and a male predominance both for unilateral and bilateral RA was found. Our results show that some reproductive risk factors may be associated with RA, moreover differences found between subgroups indicate that some risk factors may be different in unilateral and bilateral RA. The association between reproductive risk factors and RA may reflect pathogenetic interaction between genetic and environmental factors. Nevertheless further studies are needed to clarify these associations and to explore the role of perinatal factors in the etiology of renal agenesis. In fact if prenatal or perinatal risk factors are in a causal chain influencing the risk for developing RA, then these data could have important implications in the prevention or treatment of this condition.     

Renal agenesis as a diagnostic feature of the crypthophthalmos-syndactyly syndrome

Four families with the cryptophthalmos-syndactyly syndrome are reported. Nine affected patients died in perinatal period. Autopsy, performed in 6 cases, revealed renal agenesis (bilateral in 3 and unilateral in 3 cases). These observations together with recent literature data suggest that renal malformations (agenesis or severe hypoplasia) are one of the most common features of the cryptophthalmos-syndactyly syndrome and may serve as one of diagnostic criteria for this entity.     

Coincident DiGeorge anomaly and renal agenesis and its relation to maternal diabetes

We describe 2 cases of DiGeorge anomaly with bilateral renal agenesis–one, who also had hemivertebrae, in an infant of an insulin–dependent diabetic mother (IDDM). In a review we identified 2 other instances of this combination, both in IDDMs. The currently accepted notion that DiGeorge anomaly and renal agenesis are developmental field defects, coupled with their coincidence in IDDM, suggests that this combination is an association. © 1994 Wiley-Liss, Inc.     

Unusual association of two unilateral anomalies present in adulthood: pulmonary hypoplasia and renal agenesis

Summary We report a case of pulmonary hypoplasia associated with renal agenesia diagnosed in a 46-year-old woman admitted to hospital because of a viral pleuro-pericarditis. The chest x-ray raised the suspicion of left pulmonary hypolasia. The CT scan and the Magnetic Resonance Image confirmed the presence of the congenital lung malformation and detected the absence of the left kidney. The clinical presentation, radiological diagnosis and embryological basis are described.

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Association inhabituelle de deux anomalies unilatérales chez l'adulte : hypoplasie pulmonaire et agénésie rénale. Aspects embryologique et clinique

Résumé Nous présentons un cas d'hypoplasie pulmonaire associée à une agénésie rénale diagnostiquées chez une femme de 46 ans admise à l'hôpital pour une pleuro-péricardite virale. Le cliché radiologique du thorax fait suspecter une hypoplasie pulmonaire gauche. La tomodensitométrie et l'image par résonance magnétique nucléaire confirment la présence d'une malformation pulmonaire et montrent l'absence du rein gauche. La présentation clinique, le diagnostic radiologique et les bases embryologiques sont décrites.