Morphometric study of the ductus arteriosus during human development

During prenatal life, the ductus arteriosus connects the left pulmonary artery and the descending aorta. Morphometric features (length, external diameter, volume) of the ductus arteriosus in 131 human fetuses (65 males, 66 females) were studied by means of anatomical, digital and statistical methods. Regression analysis was used to investigate the growth of the ductus arteriosus during gestation. The values of the length of the ductus arteriosus ranged from 3.95 mm for the 15 week gestational group to 12.20 mm for the 34th week of gestation. The length of the ductus arteriosus related to fetal age (x) increased according to the linear function y = -3.0726 + 0.4381x. The mean values of the diameter of the ductus arteriosus ranged from 1.34 to 3.49mm for the 15 and 34 week gestational groups, respectively. The growth of the ductus arteriosus diameter followed in accordance with the linear function y = 0.2072 + 0.0935x. The mean values of the ductus arteriosus volume ranged from 5.08 mm3 for the 15 week group to 117.30 mm3 of the 34 week gestation group. The volume growth increased according to the function y = 0.0007x3.3782. Positive correlation coefficients between arterial parameters and fetal age were statistically significant (P < or = 0.01) and reached the following values: r1 = 0.98 for Length, r2 = 0.90 for diameter and r3 = 0.94 for volume. Despite the increase in absolute diameter, the relative diameter of the ductus arteriosus (ductus arteriosus-to-aortic bulb diameter ratio) decreased from 0.80 to 0.48.     

Morphometric study of the pulmonary trunk implications for a new approach of the Ross procedure

A pulmonary valve autograft may be proposed to replace diseased aortic valves. The explanted pulmonary valve is replaced with a pulmonary homograft with the inherent risk of calcified degeneration. A monocusp valve using the anterior pulmonary trunk has been proposed to reconstruct the right ventricular outflow tract. The aim of this study was to determine the feasibility of this technique. In hearts from 17 adult cadavers, we measured pulmonary trunk diameter at the leaflet tops (D1). H1 and H2 were respectively from leaflet top to lower and upper levels of the pulmonary trunk bifurcation. D2 = 1.4 D1 was calculated as the monocusp size allowing a 45∘ opening of the valve and thus permitting good valvular efficacy. G = H1-D2 determined the feasibility of the technique G greater than 10 mm, appeared the most favorable, G between 0 and 10 mm, appeared possible, and G less than 0, appeared to be impossible. Mean values of D1, H1 and H2 were respectively 20.19 mm, 37 mm and 57 mm. The technique was possible in 16 cases (94%) and impossible in 1 case (6%). Preoperative determination of these parameters, by echocardiography or magnetic resonance imaging, appears necessary before applying this new surgical technique.     

Morphometric study of the ascending aorta in human fetuses.

The present study was performed on 128 spontaneously aborted human fetuses, aged 15-34 weeks, to compile normative data for ascending aorta dimensions at varying gestational age. Using anatomical dissection, digital-image analysis (system of Leica QWin Pro 16) and statistical analysis (ANOVA, regression analysis) a range of measurements (Length, original and terminal external diameters, volume) for the ascending aorta during gestation was examined. No significant gender differences were found (P > 0.05). The growth curves of the best fit for the plot for each morphometric feature against gestational age were generated. Both the Length and external diameters of the ascending aorta were found to increase in a linear fashion throughout gestation. The Length ranged from 2.63 +/- 0.42 to 10.80 +/- 1.49mm, according to the linear function y = -4.678 + 0.4647x +/- 0.8447 (r = 0.95). The original external diameter ranged from 2.02 +/- 0.26 to 6.84 +/- 0.63 mm, according to the linear model y = -2.103 + 0.2684x +/- 0.3958 (r = 0.97). The terminal external diameter ranged from 1.73 +/- 0.20 to 6.29 +/- 0.52 mm, with accordance to the linear function y = -2.354 + 0.2567x +/- 0.3826 (r = 0.97). The ascending aorta volume ranged from 7.56 +/- 2.65 to 370.99 +/- 105.42 mm3, according to the quadratic function y = 373.1 - 43.38x + 1.30x(2) +/- 24.51 (R2 = 0.89). The growth curves generated from my data might be useful as a reference for fetal echocardiographers in the detection of some congenital cardiovascular abnormalities.     

Radioanatomic study of the gastrocolic venous trunk

Summary The mode of formation, measurements and frequency of occurrence of the gastrocolic venous trunk were studied by the injection-corrosion technique in a series of 54 anatomic specimens and by the analysis of 50 CT studies in patients without hepatic or pancreatic disease. The gastrocolic trunk was found in 51 of the 54 anatomic specimens and in 27 of the 50 CT studies. The great variability in its formation, whether bipodal, tripodal or quadripodal, was noted. With a mean diameter of 4.9 mm, it opened into the anterior, right or antero-left aspects of the superior mesenteric v. at a mean distance of 15 mm below the inferior border of the spleno-mesenteric confluence. The value of preliminary CT assessment before an operation for portal hypertension or a pancreatic tumor or in the diagnosis of a splenic thrombosis is emphasised.

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Etude radioanatomique du tronc veineux gastro-colique

Résumé Le mode de constitution, les mensurations et la fréquence du tronc veineux gastro-colique ont été étudiés par la technique d'injection-corrosion sur une série de 54 pièces anatomiques et par l'analyse de 50 examens TDM chez des patients indemnes de pathologie hépatique ou pancréatique. Le tronc gastrocolique a été retrouvé 51 fois sur 54 pièces anatomiques et 27 fois sur 50 examens TDM. Sa grande variabilité de constitution, de bipode, à tripode ou quadripode a été notée. Avec un diamètre moyen de 4,9 mm, il débouche sur les faces antérieure, droite ou antéro-gauche de la veine mésentérique supérieure à une distance moyenne de 15 mm au dessous du bord inférieur du confluent spléno-mésentérique. L'intérêt de la tomodensitométrie dans le bilan préopératoire d'une intervention pour hypertension portale ou tumeur du pancréas, ou dans le diagnostic d'une thrombose splénique, est mis en exergue.

     

基于CT血管成像及图像融合技术的胃结肠静脉干的解剖学研究

目的 运用CT血管成像(CTA)及图像融合技术研究活体状态下胃结肠静脉干(GCT)解剖学特点。方法 回顾性分析南京医科大学附属无锡市第二医院2017年1月—2018年2月收治的80例术前诊断为胃癌、胰腺癌或右半结肠癌的患者的影像学资料,其中男46例、女34例,年龄39~83(68±10.1)岁。80例均行腹部CT平扫及增强扫描,将原始图像进行CTA和CT结肠成像(CTC)重建,并将图像融合,得到血管及肠道的三维图像。观测指标:(1)GCT的长度、管径、走行及其GCT的组成;(2)中结肠静脉汇入上级静脉的分布情况;(3)胰十二指肠上前静脉汇入上级静脉的分布情况。结果 (1)69例(86.25%)患者出现GCT,长度为2.5~25.2(9.2±3.6)mm;管径为3.3~7.2(4.8±0.9)mm。GCT均自腹侧至头侧向右走行,其属支共有右结肠静脉、中结肠静脉、胃网膜右静脉和胰十二指肠上前静脉4个来源。其中,35例(50.73%)由胃网膜右静脉和右结肠静脉、中结肠静脉构成“2支”型或“3支”型胃结肠干,7例(10.14%)由胃网膜右静脉和胰十二指肠上前静脉构成“2支”型胃胰干,27例(39.13%)由右结肠静脉、中结肠静脉、胃网膜右静脉和胰十二指肠上前静脉构成“3支”或“4支”型胃胰结肠干。(2)77例患者出现中结肠静脉,其中53例(68.83%)汇入肠系膜上静脉,20例(25.97%)汇入GCT,2例(2.60%)汇入肠系膜下静脉,2例(2.60%)汇入脾静脉。(3)46例(57.50%)胰十二指肠上前静脉直接汇入肠系膜上静脉;34例(42.50%)胰十二指肠上前静脉参与了GCT的组成,其中汇入胃网膜右静脉者12例,汇入右结肠静脉者10例,汇入胃网膜右静脉与右结肠静脉合干者7例,直接汇入GCT者5例。结论 CTA及图像融合技术可以直观地显示GCT血管解剖及变异,为临床腹部血管术前评估提供可靠的信息,具有较高的临床应用价值。     

基于容积CT增强扫描的胃结肠静脉干解剖学研究

目的 探讨容积CT增强扫描观察活体状态下胃结肠静脉干及其属支的解剖学特点。方法 回顾性分析2014年9月—2016年8月首都医科大学大兴教学医院行腹部增强CT检查的124例患者的临床资料,其中,男57例、女67例,年龄19~75岁,平均50.5岁。所有受检者行腹部CT三期增强扫描,容积重建门静脉期图像。观察胃结肠静脉干位置、走行,测量胃结肠静脉干长度、管径;观察胃结肠静脉干各属支的分型、走行以及胰十二指肠上前静脉的汇入点;参照国内动脉血管显示效果评价标准对各属支血管显示效果进行评级。结果 124例患者中,117例(94.3%)形成胃结肠静脉干。胃结肠静脉干位于横结肠系膜内,紧贴胰头前缘走行,均于胰头下缘汇入肠系膜上静脉。其中,胃结肠静脉干向肠系膜上静脉右侧走行者占61.54%(72/117),右前方走行者占36.75%(43/117),前方和右上方走行者各占0.85%(1/117);胃结肠静脉干长度为2.6～21.9 mm,平均(8.6±3.7 )mm;管径为3.2～7.0 mm,平均(5.1±0.9)mm;胃结肠静脉干属支中胃结肠干型16例、胃胰干型23例、胃胰结肠干型78例。124例中显示胰十二指肠上前静脉101例,其中汇入胃网膜右静脉40例,汇入右结肠静脉43例,汇入胃网膜右静脉与右结肠静脉合干4例,直接汇入胃结肠静脉干14例。胃结肠静脉干各属支血管显示效果评定:胃网膜右静脉、右结肠静脉、中结肠静脉显示效果均达到3级,胰十二指肠上前静脉显示效果1级33例、2级61例、3级7例。结论 容积增强CT能够在活体状态下较清晰显示胃结肠静脉干的解剖细节,对于临床手术有重要指导价值。     

Morphometric analyses of the development of dermis in human fetuses

In this study, the morphometric differences of the different dermis regions during the development of the human fetus were investigated. The different dermis regions, namely, cranial, femoral and plantar (sole) parts of 40 fetuses which were between 12th-23.5th week gestation age were obtained from maternity hospital and after the routine H&E histological procedure, the measurement was performed with ocular micrometer. The first sharp increase was observed in the dermis of cranial region. It has been suggested that the thickness of the dermis is dependent on the collagen and elastic fibres, but the flexibility of the dermis is dependent on the number and the structure of the elastic fibres. The early beginning of the increase of the dermis thickness in the cranial part may be due to the effect of the cranio-caudal stimulation on the production of the collagen and elastic fibres in the embryonic term.     

Morphometric analysis of the gonadal veins in human foetuses

Professional literature data demonstrates morphometric features of the gonadal veins in adults. The length of the gonadal veins and their outlet angles in 130 human foetuses (71 males, 59 females), between the 4th and 6th month of prenatal life, were studied by means of anatomical, digital and statistical methods. In all specimens the left gonadal veins entered the left renal artery, and the right gonadal veins terminated in the inferior vena cava. In all age ranges the left gonadal veins were longer than the right ones (P < or = 0.01), and the outlet angles of the left gonadal veins were larger than these angles on the right side (P < or = 0.01). The correlation coefficient between the length of the left and right testicular veins was r1 = 0.975 (P < or = 0.01). The correlation coefficients between the length of the testicular veins and foetal age were r2 = 0.591 for the right testicular vein and r3 = 0.578 for the left testicular vein (P < or = 0.01). A low correlation between the outlet angles of the testicular veins and foetal age was observed, for the right side r4 = 0.187, and for the left side r5 = 0.177 (P < or = 0.05). The correlation coefficient between the length of the left and right ovarian veins in foetuses aged 4-6 months was r6 = 0.855 (P < or = 0.01). The correlation coefficients between the length of the ovarian veins and foetal age were r7 = 0.578 for the right ovarian vein and r8 = 0.566 for the left ovarian vein (P < or = 0.01). No correlation between the outlet angles of the ovarian veins and foetal age was observed (P > 0.05).     

Morphometry of the celiac trunk: a multidetector computed tomographic angiographic study

Aims: We carried out this study for evaluating the normal anatomy trunk and prevalence of anatomical variations of celiac trunk in the North Indian population. Materials and methods: Computerized tomographic images of 50 North Indian subjects, obtained from the Department of Radiodiagnosis, King George's Medical University, were retrospectively analyzed. The anatomy of the celiac trunk was studied using dynamic scans. Results: A variation in the site of origin of celiac trunk was observed in about 55% cases. The length and dimensions of the trunk also displayed a wide range of variation. Conclusion: Anatomic variations of the celiac trunk as observed by us may become important in patients undergoing diagnostic angiography for gastrointestinal bleeding or prior to an operative procedure. Recognition of variations would enable clinicians to distinguish features which merit further investigations or treatment from those which do not.     

The human thyrocervical trunk: Configuration and variability reinvestigated

Summary Reinvestigation of the configuration of the human thyrocervical trunk revealed, that in the presently investigated specimens the dorsal scapular artery is a direct branch of the subclavian artery in approximately 75% of the cases, whereas in the remaining 25% it is derived from the thyrocervical trunk, either directly or via the transverse cervical artery (Nomina anatomica 1977). The internal thoracic artery participates in the thyrocervical trunk in more than 10% of the observed cases. Thus, both dorsal scapular and internal thoracic artery have to be considered as facultative branches of the thyrocervical trunk. According to our results, the subclavian artery must be considered as the most common site of origin of the dorsal scapular artery. This vessel may be replaced by another artery in about one fourth of the cases. A survey of studies on the origin of the dorsal scapular artery clearly demonstrates that it is not warranted to give an overall numerical proportion for the main modes of branching. As yet no satisfactory explanation for the high degree of variability of these subclavian branches has been given. Especially the widely held notion of differences related to race, which is based on Adachi's (1928) work, has turned out to be invalid. Interpretation of variability may rather be based, as a general concept, on the late acquisition of a thyrocervical trunk in phylogeny as well as in ontogeny.     

Main trunk of the left coronary artery: anatomic study of the parameters of clinical interest

The objective of this study was to analyze in one single series all the characteristics of the main trunk of the left coronary artery (MT) that may be of use in the diagnosis and treatment of its pathologies. One-hundred human hearts from autopsies were used. The average age of the sample studied was 63.15 years +/- 18.76 (range = 17-94 years). The heart was removed after resection of the costosternum and placed in 10% formaldehyde. With gradual separation and retraction of the myocardial fasciculi the MT was exposed. The length of the MT, the luminal diameter of the MT at its midpoint, and the luminal diameter of the left coronary orifice were measured with a caliper. The angle of division between the anterior interventricular and circumflex branches was also measured, and the number of terminal branches originating from the MT was recorded. In four cases, there was no MT and the anterior interventricular and circumflex branches originated directly from the left aortic sinus. The average length of the MT was 10.8 +/- 5.52 mm (range = 2-23 mm); the average diameter at its midpoint was 4.86 +/- 0.80 mm; and there was no significant difference noted between the midpoint diameter of the MT and the diameter of the left coronary orifice. The most frequent type of division of the MT was bifurcation (62%); in 38% of cases the MT divided into three or more branches. An average value of 86.7 +/- 28.8 degrees was obtained for the angle of division of the terminal branches of the MT (range = 40-165 degrees ). There was a positive correlation between the length of the MT and the angle of division of its terminal branches, with the longest MTs having the largest angle of division.     

Neuroanatomy of cervical sympathetic trunk: A cadaveric study

To reduce the risk of iatrogenic injury to sympathetic chain during anterior and anterolateral approaches to the cervical spine, its location has to be well defined and known by surgeons. We analyzed the course of sympathetic chain and its ganglia from C7 up to its entry into the cranial base and its relationship mainly with the longus colli (LC). Formalin fixed 20 human cadavers were dissected under operating microscope. Measurement of the dimensions of the ganglia, distance of the trunk to the LC, and the angles identifying the course of the chain were performed. Superior and inferior cervical/cervicothoracic ganglion were observed in all specimens, the middle cervical ganglion was observed in 48% of the specimens. The middle ganglion consisted of two ganglia in 10% of the dissected sides. Forty percent of the inferior cervical/cervicothoracic ganglion was at the C7 level, 25% was at C7‐Th1 disc level, and 35% was at Th1 level. Vertebral ganglion was detected in only 8% of the specimens. The course of the sympathetic trunk converges medially descending from upper cervical levels to the lower levels. Anterior surgical approach to the cervical spine is a commonly used procedure. Although Horner syndrome due to sympathetic injury is not a common sequence of cervical operations, our findings support the current few reports on the subject and should be useful to any surgeon who operates in the cervical region to avoid this uncommon complication. Clin. Anat. 22:324–330, 2009. © 2009 Wiley‐Liss, Inc.     

Anatomical study concerning the origin and course of the pectoral branch of the thoracoacromial trunk for the pectoralis major flap

The patterns of the feeding vessels to each muscle determine the extent of their safe transposition and the muscles value as a pedicled flap in reconstructive surgery. This study aimed to demonstrate the point of origin and the intra- and submuscular course of the pectoral branch of the thoracoacromial trunk (TAT) for pectoralis major (PM) flap surgery. Seventy sides of the PM were dissected based on a clinical reference line that has been used for several decades. The branching point of the TAT from the axillary artery was located lateral to the midclavicular line on the right-sided specimens (100%) and medial to the midclavicular line on the left sides (86%). The branching patterns of the pectoral branch to the PM muscle from the TAT were classified into three types. In type I the pectoral branches originated directly from the TAT (55 cases, 78.6%). In type II (11 cases, 15.7%) and type III (4 cases, 5.7%) the pectoral branch divided from the medial and lateral pedicle of the TAT, respectively. The course of the pectoral branch from the TAT in the PM was categorized into three patterns according to the degree of proximity to the midclavicular line. In 49 cases (70%), the pectoral branch in the PM ran within 1 cm of the midclavicular line. The other cases ran 2 cm (20 cases, 29%) and 3 cm (1 case, 1%) from the midclavicular line, respectively. These results provide topographic data of the pectoral branch based on anatomical landmarks, and will be useful in surgical planning as well as the procedure for PM flap surgery.H.-D. Park and Y.-S. Min equally contributed to this study     

Morphometric study of the human neonatal ovary

A morphometric analysis, based on mathematical evaluations and stereological methods, has been used to study five left neonatal ovaries, removed from full-term neonates with a 46, XX karyotype free from malformations of the genital apparatus. Each ovary was completely cut obtaining serial sections and one 1-μ-thick section every 1,000 μ was examined. Ovarian length ranged from 9 to 17 mm (mean 13 mm), width from 3.5 to 7 mm (mean 5.7 mm), thickness from 2.5 to 5 mm (mean 4 mm), and volume from 82.23 to 198.3 mm³ (mean 125.88 mm³). In the ovarian cortex, primitive cortical tissue accounted for 10-20% of the total volume, follicles for 10-25% and interstitium for 35-45%; 10-30% of the organ consisted of inner medulla. The total follicle number ranged from 130,000 to 385,000 per ovary, with an average of 266,000 with 95% being represented by primordial follicles. In all ovaries examined follicular growth was still in process, with follicles at different stages of development.     

Surgical anatomy of the cervical sympathetic trunk

Lack of knowledge of the anatomy of the cervical sympathetic trunk (CST) may complicate surgical procedures on the cervical spine. This study aims to define linear and angular relations of the CST with respect to consistent structures around it, including the number and size of the cervical ganglia, the distances between the CST and the longus colli muscle and the anterior tubercles of the transverse processes of cervical vertebrae. Morphometric parameters of the 24 CSTs of 12 adults were measured on both sides. The CST had superior, middle, and inferior (or cervicothoracic) ganglia in 20.8% of specimens; superior and inferior (or cervicothoracic) ganglia in 45.8%; superior, middle, vertebral, inferior, or cervicothoracic ganglia in 12.5%, and superior, vertebral, inferior or cervicothoracic ganglia in 20.8% of specimens. The superior ganglion was observed in all specimens, the middle ganglion and vertebral ganglion were each observed in 33.3%. There was no difference between the number of superior and vertebral ganglia between the right and left sides. The average distance between the CST and the medial border of the ipsilateral longus colli muscle (LCM) was 17.2 mm at C3 and 12.4 mm at C7. As the CSTs converged caudally, the LCMs diverged. The average distance between the anterior tubercles of transverse processes of the cervical vertebrae and the lateral borders of the ipsilateral CST was 3.4 mm at C4, 3.2 mm at C5, and 3.9 mm at C6. The presence of a vertebral ganglion and variations, such as the localization of the CST within the carotid sheath, are important. The anatomical landmarks described should assist the spinal surgeon to avoid injury of the CST.     

腰交感干的局部解剖

目的:系统研究腰交感神经的局部解剖关系。方法:选用128侧腰部交感神经节完整无损的成年尸体,解剖并观察腰部交感神经及其毗邻结构的解剖关系。结果:腰交感神经节数目及位置变异较大,每侧1～6个不等;腰交感干可分裂为2～5支,分裂处多在干的下端,本组共发现12侧发生分裂;腰动脉均位于神经干的深面,腰静脉位于腰交感干浅面者占(68.42±4.35)%,以腰4、5静脉多见;生殖股神经穿出腰大肌平面多数与第2～4腰椎或椎间盘对齐,穿出点距腰大肌内侧缘(0.81±0.48)cm。结论:腰交感神经变异较大,毗邻结构关系复杂,腰交感神经节切除术成功的关键是熟悉腰交感神经的变异及其局部解剖关系。     

A novel heart/trunk simulator for the study of electromagnetic interference with active implantable devices

This paper describes a portable heart simulator for the study of electromagnetic interference with active implantable devices. The simulator consists of plexiglas^TM box divided into three chambers simulating the left atrium and the ventricles, plus a lateral compartment for the implantable device. The box is linked to a laptop computer by an analogue-to-digital convertor board, and the three chambers are monitored and driven by dedicated hardware and software interfaces. Synthetic endocardial atrial and ventricle signals for 13 cardiac rhythms are stored in the computer. They are applied to the cardiac chambers by AgCl plates. Sensing electrodes are in the form of AgCl needles inserted in saline. The simulator was able to demonstrate the behaviour of three pacemakers tested in the absence and presence of electromagnetic interference, generated by mobile phones (European GSM 900 and 1800 MHz) that emitted up to 2W (1W at 1800 MHz). Pacemakers can be programmed with sensitivity from 0.1 mV to 5mV, pulse width from 0.1 ms to 1.5 ms and pulse amplitude from 0.5 V to 5 V. The structural separation in three cardiac chambers (plus the one for the device) allowed a fast analysis procedure for dual- and tri-chamber implantable devices.