Morphometric study of the T6 vertebra and its three ossification centers in the human fetus.

PURPOSE: Knowledge on the normative growth of the spine is critical in the prenatal detection of its abnormalities. We aimed to study the size of T6 vertebra in human fetuses with the crown-rump length of 115-265 mm. MATERIALS AND METHODS: Using the methods of computed tomography (Biograph mCT), digital image analysis (Osirix 3.9) and statistics, the normative growth of the T6 vertebral body and the three ossification centers of T6 vertebra in 55 spontaneously aborted human fetuses (27 males, 28 females) aged 17-30 weeks were studied. RESULTS: Neither male-female nor right-left significant differences were found. The height, transverse, and sagittal diameters of the T6 vertebral body followed natural logarithmic functions as y = -4.972 + 2.732 × ln(age) ± 0.253 (R (2) = 0.72), y = -14.862 + 6.426 × ln(age) ± 0.456 (R (2) = 0.82), and y = -10.990 + 4.982 × ln(age) ± 0.278 (R (2) = 0.89), respectively. Its cross-sectional area (CSA) rose proportionately as y = -19.909 + 1.664 × age ± 2.033 (R (2) = 0.89), whereas its volumetric growth followed the four-degree polynomial function y = 19.158 + 0.0002 × age(4) ± 7.942 (R (2) = 0.93). The T6 body ossification center grew logarithmically in both transverse and sagittal diameters as y = -14.784 + 6.115 × ln(age) ± 0.458 (R (2) = 0.81) and y = -12.065 + 5.019 × ln(age) ± 0.315 (R (2) = 0.87), and proportionately in both CSA and volume like y = -15.591 + 1.200 × age ± 1.470 (R (2) = 0.90) and y = -22.120 + 1.663 × age ± 1.869 (R (2) = 0.91), respectively. The ossification center-to-vertebral body volume ratio was gradually decreasing with age. On the right and left, the neural ossification centers revealed the following models: y = -15.188 + 6.332 × ln(age) ± 0.629 (R (2) = 0.72) and y = -15.991 + 6.600 × ln(age) ± 0.629 (R (2) = 0.74) for length, y = -6.716 + 2.814 × ln(age) ± 0.362 (R (2) = 0.61) and y = -7.058 + 2.976 × ln(age) ± 0.323 (R (2) = 0.67) for width, y = -5.665 + 0.591 × age ± 1.251 (R (2) = 0.86) and y = -11.281 + 0.853 × age ± 1.653 (R (2) = 0.78) for CSA, and y = -9.279 + 0.849 × age ± 2.302 (R (2) = 0.65) and y = -16.117 + 1.155 × age ± 1.832 (R (2) = 0.84) for volume, respectively. CONCLUSIONS: Neither sex nor laterality differences are found in the morphometric parameters of evolving T6 vertebra and its three ossification centers. The growth dynamics of the T6 vertebral body follow logarithmically for its height, and both sagittal and transverse diameters, linearly for its CSA, and four-degree polynomially for its volume. The three ossification centers of T6 vertebra increase logarithmically in both transverse and sagittal diameters, and linearly in both CSA and volume. The age-specific reference intervals for evolving T6 vertebra present the normative values of potential relevance in the diagnosis of congenital spinal defects.

Quantitative anatomy of the growing abdominal aorta in human fetuses: an anatomical, digital and statistical study.

BACKGROUND: Advances in perinatal medicine have required an extensive knowledge of fetal aorto-iliac measurements. The present study was performed to compile reference data for dimensions of the abdominal aorta at varying gestational ages. MATERIAL/METHODS: Using the methods of anatomical dissection, digital-image analysis (Leica QWin Pro 16 system), and statistical analysis (Student's t-test, one-way ANOVA, post-hoc RIR Tukey test, regression analysis, and Wilcoxon signed-rank test), the growth of length (mm), proximal and distal external diameters (mm), and volume (mm3) of the abdominal aorta in 124 (60 male, 64 female) spontaneously aborted human fetuses aged 15-34 weeks was examined. RESULTS: No significant male-female differences were found. The length ranged from 9.35±1.24 to 36.29±4.98 mm, according to the linear function y=-14.596+1.519 × Age ±2.639 (R2=0.92; p<0.0001). The proximal external diameter varied from 1.18±0.25 to 5.19±0.49 mm, according to the linear pattern y=-2.065+0.212 × Age ±0.348 (R2=0.92; p<0.0001). The distal external diameter increased from 1.03±0.23 to 4.92±0.46 mm, in accordance with the linear model y=-2.097+0.203 × Age ±0.351 (R2=0.92; p<0.0001). Both length and proximal external diameter of the abdominal aorta indicated a proportionate evolution, because the length-to-proximal external diameter ratio was stable, following the linear function y=7.724-0.017 × Age ±0.925. The abdominal aorta volume ranged from 9.6±4.5 to 740.5±201.8 mm3, given by the quadratic function y=911-101 × Age +2.838 × Age2 ±78 (R2=0.89; p<0.0001). CONCLUSIONS: There are no significant differences between males and females for morphometric parameters of the abdominal aorta. The abdominal aorta grows linearly in both length and diameters, and parabolically in volume. These detailed morphometric data of the abdominal aorta provide a database for intra-uterine echographic examinations in the early diagnosis, monitoring and management of aorto-iliac malformations.

Short history of the autopsy: part II. From the second half of the 16th century to contemporary times.

We present the second part of our review concerning the history of autopsy. During the development of medicine the role of autopsy was obviously changing. Concurrently with the progress in the anatomical knowledge, the anatomists observed and noted both single anomalies and repetitive changes which correlated with symptoms in living patients. This is how anatomopathology came into being. We present the most famous people engaged in autopsy comprehension. We discuss main trends and ideas influencing the phenomenon of autopsy in the analyzed period: from sporadic public dissections, through theatra anatomica, introduction of autopsy to the hospital medicine and separation of anatomopathology as a medical speciality. The golden age of autopsy was the 19th century and the first half of the 20th century, with a consecutive decline in frequency. Nevertheless, despite the progress in diagnostics in vivo, it seems that autopsy will keep its important place in medicine according to the old motto "Mortui vivos docent" (the dead teach the living).

Short history of the autopsy. Part I. From prehistory to the middle of the 16th century.

We present the first part of work concerning the history of autopsy. During the development of the pathology the role of autopsy was changing. The attitude towards the human body was often a result of struggles between human will to learn and religious beliefs. The knowledge was built upon religious procedures (mummification) through medical and surgical care of the victims of fights and wars and first autopsies. Until the 13th century dissections were seldom performed, sometimes in public. The aims varied from strictly scientific and practical (surgery) to artistic (human body in arts). Later on physicians were learning how to draw conclusions from autopsy results including malformations, pathologies, diseases, causes of death in order to try to put right diagnoses.

The structure of the vascular system of the septomarginal trabecula in the heart of an adult.

BACKGROUND: In cardiology, the paths of the arteries penetrating the septomarginal trabecula (SMT) are especially important. They provide blood supply to the apparatus of the right atrioventricular orifice and often form anastomoses with the system of the right coronary artery. Despite this, only a few publications discuss the morphological aspect of the septomarginal trabecula, and available histological analyses seldom deal with its blood supply. OBJECTIVES: The aim of this study was to analyze the vessel structure of the septomarginal trabecula in terms of the variability of the area of the cross-section of the lumen and the muscular layer of the artery. MATERIAL AND METHODS: The study was carried out on the material of 50 human hearts from adults of both sexes. The material was divided into 4 morphological types. Histological examinations were conducted by means of classic staining methods. RESULTS: At the initial cross-section of the septomarginal trabecula, the area of the cross-section increased to half of the length of the trabecula, and then it started to decrease. This is connected with the thickening of the inner muscular layer of the artery, which proportionally takes up more area of the cross-section of the whole artery of the SMT. The total area of the cross-section of all vessels in both types examined was also the largest in the middle part of the SMT. Furthermore, the results of this study confirm the presence of a connection between both systems of coronary arteries. CONCLUSIONS: As the septomarginal trabecula passes through the lumen of the right ventricle, its arteries become exposed to the influence of the factors which may evoke a biological response from the walls of this vessel, causing the thickening of the muscular layer and, as a result, of the section of the whole artery, in particular its middle part.

The crista supraventricularis in the human heart and its role in the morphogenesis of the septomarginal trabecula.

The crista supraventricularis and septomarginal trabecula are common elements of the right ventricle, and determine many hemodynamic phenomena. The morphological analysis of both structures in regard to their mutual relations was the aim of this study. The study was carried out on the material of preserved human hearts--fetuses, children and adults. The size and development of the crista supraventricularis was carefully evaluated. The division of its lower part, and hence the possibilities of development of the septomarginal trabecula, was divided into five types (A, B, C, D and E). The most common was type B, containing two muscular trabeculae. The width of the crista varied 1/5-3/5 of the width of the interventricular septum. On the basis of this study, a conclusion of morphological unity of the septomarginal trabecula and crista supraventricularis was drawn.

Cardiac tumors in children: A 20-year review of clinical presentation, diagnostics and treatment.

BACKGROUND: The use of new imaging techniques has contributed significantly to earlier diagnosis and treatment of cardiac tumors. OBJECTIVES: The aim of the study was to analyze data from children with cardiac tumors in terms of clinical presentation, the role of noninvasive diagnostic procedures and the long-term outcome. MATERIAL AND METHODS: The data analyzed retrospectively concerned 30 children in whom cardiac tumors were diagnosed from January 1995 to July 2015. The cardiac evaluation included a review of the subjects' medical records and medical history, a physical examination, standard 12-lead electrocardiography, echocardiography and 24-h Holter ECG monitoring at the time of diagnosis and at 6-12 month intervals during the follow-up at the authors' outpatient clinic. RESULTS: Most of the children did not need cardiac surgery; surgical tumor excision was necessary in 3 cases only. There was 1 death in the follow-up period. Rhabdomyoma was diagnosed in 22 cases, and in 16 of them tuberous sclerosis was confirmed during the follow-up period. In the remaining 8 cases, fibroma was the most likely diagnosis. CONCLUSIONS: The symptomatology of cardiac tumors in children can vary greatly, from the absence of any symptoms up to heart failure and respiratory distress indicating the need for surgical intervention. The diagnosis of cardiac tumors relies almost exclusively on noninvasive imaging techniques. The observations in this study confirm the fact that the most common cardiac tumor in children is rhabdomyoma, which may disappear spontaneously. Most patients with cardiac tumors do not require treatment.

Remarks on the morphology of the papillary muscles of the right ventricle.

In addition to the papillary muscles of right ventricle referred to in anatomical nomenclature, namely the anterior, posterior and septal, we have distinguished the "conal papillary muscle" and the "papillary muscle of the posterior angle of the right ventricle". The conal papillary muscle was described by Luschka in the 17(th) century as the most constant of the septal papillary muscles. We have distinguished the muscles of the posterior angle of the right ventricle as muscles which would not be clearly classified as either septal or posterior muscles. Moreover, the muscles of the posterior angle of the right ventricle are probably associated with the transfer of the papillary muscles from the septum to the posterior wall of the right ventricle during phylogenetic evolution. Some researchers have classified them with the septal papillary muscles, while others have assigned them to the posterior group. The morphology of the muscles was classified using earlier categories for the posterior papillary muscles only. We have adopted the concept of multi-apical and multi-segmental muscles.

Unusual anatomical features of the right atrioventricular valve.

Despite the great interest taken in the tricuspid valve, the anatomical literature on the subject still leaves much open to question. The aim of this study was to describe the natural foramina which are present in the leaflets of the tricuspid valve, as well as, well -- founded onto -- and phylogenetically lack of continuity of its attachment and the frenula of the tricuspid valve. We studied the frequency of occurrence and morphology of these features of the tricuspid valve in 107 adult hearts.

Macroscopic morphology of right atrial appendage in humans.

BACKGROUND AND AIM: Atrial fibrillation (AF) is a common arrhythmia in elderly people, and in many cases it is responsible for stroke or pulmonary embolism. One of the factors facilitating atrial thrombus formation is anatomical morphology of the atria, and especially the appendages. The pharmacological treatment of arrhythmia is generally focused on ventricular rate control. Electrical cardioversion is the preferred treatment method in the majority of clinics but it can occasionally produce the potentially dangerous complication of AF. METHODS: A macroscopic study was carried out on 40 (25 male [M], 15 female [F]) human hearts, 18-72 years of age, and a microscopic study in a group of 20 human right atrial appendages (RAA) (M 10, F 10), 18-72 years of age. Only hearts without anomalies were included in the study. Classical anatomical studies and statistic analyses were applied. RESULTS AND CONCLUSIONS: RAA is triangle shaped with a mean area of 2.73 cm2. Muscle fascicules build the wall of RAA and compose a dense net inside a chamber. Sagittal bundle connecting terminal crest with an apex of RAA was observed in all examined hearts. In microscopic specimens longitudinal and perpendicular fascicles were described.

Variability of the Left Atrial Appendage in Human Hearts.

Atrial fibrillation increases the risk of thrombus formation. It is commonly responsible for cerebral stroke whereas less frequently for pulmonary embolism. The aim of the study was to describe the morphology of the left atrial appendage in the human heart with respect to sex, age and weight. Macroscopic examination was carried out on 100 left appendages taken from the hearts of the patients aged 18-77, both sexes. All hearts preserved in 4% water solution of formaldehyde carried neither marks of coronary artery disease nor congenital abnormalities. Three axes of appendage orientation were performed. After the appendage had been cut off, morphological examination was performed in long and perpendicular axes. Measurements of the appendages were taken from anatomical specimens and their silicone casts. We classified the left atrial appendage into 4 morphological groups according to the number of lobes. Most left atrial appendages in female population were composed of 2 lobes. In the male group typically 2 or 3-lobed appendages were observed. The mean left atrial appendage orifice ranged from 12.0 to 16.0 mm and the most significant difference in the orifices between males and females was observed in LAA type 2 (about 3.3 mm). A smaller orifice and narrower, tubular shape of the LAA lobes could explain a higher risk of thrombus formation during nonvalvular atrial fibrillation in women. Knowledge of anatomical variability of the LAA helps diagnose some undefined echoes in the appendage during transesophageal echocardiographic examination.

Comparative research on the topography of middle and small cardiac veins in humans and other primates.

Many researchers have been interested in cardiac veins, which at present play a very important clinical role in invasive cardiology. In this study the occurrence of middle and small cardiac veins and the topography of their outlet portions were examined. The material consisted of 150 adult human hearts of both sexes of 18 to 85 years of age and 50 adult hearts of representatives of various primates. In the material examined a middle cardiac vein was always observed, whereas the presence of a small cardiac vein was less consistent The outlet portions of the main veins of the heart were characterised by significant variability.

Provision of tricuspid valve leaflets by septal papillary muscles in the right ventricle of human and other mammal hearts.

Leaflets of the tricuspid valve are provided by tendinous cords extending from the papillary muscles. The situation is complicated with the septal muscles, which generally occur in two groups, one as constant musculus coni arteriosi and the second as other variable septal muscles. We tested whether there is a variability in the provision of the tricuspid valve in different taxonomical groups of mammals. The material examined consisted of 299 hearts of mammals (Primates, Ungulata, Carnivora, Lagomorpha, Rodentia, Marsupialia). The musculus coni arteriosi in the majority of mammals provided only the front leaflet, but among Ungulata and Rodentia it provided simultaneously the front and septal leaflet. The other septal muscles provided the front, septal and even back leaflets. The following regularity was observed: in the hearts of Primates provision of the front leaflet and the front part of the septal leaflet predominated, among Ungulata the muscles provided the middle part of the septal leaflet, but among the other mammals the rest of the septal muscles provided, significantly, the back part of the septal leaflet. Such a provision was characteristic for predators, hares, rodents and marsupials. These circumstances may allow the conclusion to be drawn that there is a taxonomical dependence in the provision of the tricuspid valve in the hearts of the mammals under examination.

Notes on the morphology of the tricuspid valve in the adult human heart.

Rapid progress in the field of interventional cardiology has caused research in the field of morphometry of the heart to be in constant demand. In this study, performed on a group of 75 adult human hearts, the authors have attempted to assess the form and number of the main and accessory cusps in the tricuspid valve. We have classified particular forms into 8 groups, depending on the number of cusps and we have divided the cusps into 3 main groups, depending on the support of the chordae tendineae.

Distribution of muscular bridges in the adult human heart.

UNLABELLED: Muscle bridges (MBs) are structures consisting of heart muscle tissue which pass above the coronary arteries and their branches. Although there are a relatively large number of descriptions of these MBs, researchers do not share a common view of the frequency of their occurrence, their location and their morphology, which remain the most controversial questions. The present research was carried out on 300 human hearts, adults of both sexes (161 male and 139 female), of between 21 and 76 years of age (mean age 48 years), in which no macroscopic developmental failures had been found. The hearts were preserved in formalinethanol solution. Selected coronary arteries were analysed. Images were examined of the perpendicular dissection of the coronary arteries and their neighbouring structures. On the basis of the analysis, the frequency of occurrence of MBs was defined as 31.3%. Muscular bridges were observed most frequently over the anterior interventricular branch of the left coronary artery (RIA) and, more rarely, over the right marginal branch of the left coronary artery (Rmd) and the circumflex branch of the left coronary artery (RCX). Using as criteria the number of muscular bridges in the heart and their location over particular coronary arteries, 4 types of configuration were established. With reference to the RIA, most MBs were located in the central part. We did not notice the same regularity with reference to other coronary arteries, nor did we observe MBs over coronary veins. CONCLUSIONS: muscular bridges are frequently observed structures in human hearts, most often seen over the anterior interventricular branch of the left coronary artery (RIA), mainly over its central segments, and occasionally over other arteries. MBs may occur in the heart singly or in a greater number and are found over the same or different vessels.

The topography of the subthebesian fossa in relation to neighbouring structures within the right atrium.

The majority of anatomical structures within the heart during typical atrial flutters' ablation, right sided accessory pathway ablation or slow pathway ablation are invisible or blurred. Therefore it is very important to know in details interior right atrial structures during such procedures. In the neighborhood of coronary sinus orifice small concavity is visible. This area, called subthebesian fossa, is placed between the os of coronary sinus, the orifice of vena cava inferior and tricuspid annulus. The fossa is on the way of typical atrial flutters' reentrant circuit and is placed next to the isthmus area, which has become a target site for ablative therapy. Regarding the facts mentioned above we decided to examine the topography of this concavity in relation to neighboring structures. Research was conducted on material consisting of 45 human hearts of both sexes, from 19 to 71 years of age. The hearts came from patients whose death was not cardiologic in origin. The topography of the fossa was examined in relation to coronary sinus orifice (diameter A), vena cava inferior orifice (diameter B) and the attachment of the posterior leaflet of the tricuspid valve (diameter C). Besides we measured two perpendicular sizes in the inlet plane of the fossa. There were the longest size (diameter D) and the shortest size of the fossa (diameter E). We also defined deepness of the fossa (diameter F). Diameter A was from to 2 to 7mm (avg. 4.9 +/- 1.4 mm), diameter +/- from 2 to 8mm (avg. 4.0 +/- 1.6 mm) and diameter C from 5 to 9 mm (avg. 7.0 +/- 1.5 mm). The longest size in inlet plane of the concavity (diameter D) was from 12 to 18 mm (avg. 14.1 +/- 1.7 mm) and shortest size (diameter E) was from 7 to 14 mm (avg. 9.0 +/- 1.7 mm). The deepness of the fossa (diameter F) was from 2 to 7 mm (avg. 4.8 +/- 1.2 mm). The subthebesian concavity is inconstant anatomical structure, occurring in all forty five examined hearts (100%). The shape and sizes of the subthebesian fossa were variable in examined group of hearts. Our data suggest that differences in diameters between subthebesian fossa and neighboring structures may have clinical importance during ablation procedure.

Diameters of the cavo-sinus-tricuspid area in relation to type I atrial flutter.

Cardiac arrhythmias have troubled patients and fascinated physicians for centuries. The twentieth century was an era of progress, when the mechanism of cardiac disorders became more commonly recognised. Arrhythmias may be due to abnormalities of automaticity, to abnormalities of conduction, or to a combination of both. In order for re-entry to occur, an area of slowing conduction combined with unidirectional block must be present. Much investigation has centred on the underlying re-entry mechanisms of atrial flutter. In the light of these facts, it would seem that a close acquaintance with the detailed topography of the vena cava orifice (cavo), coronary sinus orifice (sinus) and the attachment of the septal leaflet of the tricuspid valve (tricupid) area could be of great interest, especially for invasive cardiologists. The research was conducted carried out on material consisting of 41 hearts of humans of both sexes from the age of 12 to 80 (6 female, 35 male). Classical macroscopic methods of anatomical evaluation were used. The following measurements were made: the shortest distance between the Eustachian valve and the attachment of the tricuspid valve on the left margin of the coronary sinus orifice (diameter 1), the distance between the attachment of the tricuspid valve and the inferior margin of the sinus orifice (diameter 2), the distance between the Eustachian valve and the attachment of the tricuspid valve on the right margin of the coronary sinus orifice (diameter 3), the distance between the inferior margin of the vena cava inferior and the attachment of the tricuspid valve (diameter 4) and, finally, the diameter between the attachment of the septal cusp of the tricuspid valve and the extemal border of the vena cava inferior (diameter 5). No correlation was found between the age and sex of the three groups of the material. The dimensions of the structure examined were similar in the three groups of hearts. In young adult hearts all the diameters measured ranged from 4 to 47 mm. The average diameters were, respectively: 15.02 mm (diameter 1), 8.97 mm (diameter 2), 17.27 mm (diameter 3), 26.87 mm (diameter 4), 36.42 mm (diameter 5). In the mature adult hearts all the diameters measured ranged from 8 to 45 mm; 18.19 mm (diameter 1), 10.54 mm (diameter 2), 19.95 mm (diameter 3), 28.90 mm (diameter 4), 39.63 mm (diameter 5). In the older adults hearts all the diameters measured ranged from 4 to 47 mm. The average diameters were, respectively: 15.65 mm (diameter 1), 8.70 mm (diameter 2), 7.25 mm (diameter 3), 26.80 mm (diameter 4), 35.85 mm (diameter 5). On the basis of our study we were able to conclude that the diameters of the cavo-sinus-tricuspid area were constant and did not differ significantly within the three (young, mature, old) adult groups examined.

The arrangement of muscle fibres in the region of the subthebesian fossa in the aspect of atrial flutter.

The typical atrial flutter is the most common supraventricular tachycardia with reentrant circuit. This tachyarrythmia is based on macroreentry wave going around established anatomic landmarks. The reentry in the inferior right atrial wall passes through narrow isthmus, which is the goal for ablative therapy. The isthmus area is bordered anteriorly by the tricuspid valve and posteriorly by the inferior vena cava, coronary sinus, and eustachian ridge. Near to this area we can find anatomical structure, which can be very important during arising, perpetuation and curing of atrial flutter. The concavity, so-called subthebesian fossa, is on the way of typical atrial flutters' reentrant circuit. Regarding the facts mentioned above we decided to examine the morphology and the arrangement of the muscle fibres in this fossa. Research was conducted on material consisting of 70 human hearts of both sexes from the age of 34 to 72 years. 50 hearts came from patients whose death was not cardiologic in origin. 20 hearts came from humans in whose common atrial flutter was confirmed. We observed the arrangement of muscle fibres in the area of subthebesian fossa. Besides we measured the size and deepness of the subthebesian fossa in both groups of hearts. We found that regular arrangement of muscle fibres within subthebesian fossa was present in 23 healthy human hearts (46%) and 7 cases (35%) of hearts with atrial flutter. The irregular arrangement of muscle fibres was observed in 27 hearts (54%) of control group and 13 hearts (65%) with dysrrhythmia. The thickness of the right atrial wall within the subthebesian fossa was very thin in 8 normal hearts (16%) and in 5 dysrrhythmic hearts (25%). The sizes of examined structure were variable in both groups of hearts, and are presented in the table. It seems that the subthebesian concavity can be the substrate for reentrant circuit during atrial flutter, and there could be such special arrangement of muscle fibres, which allows for microreentrant circuit to arise in this area.

Preliminary study of external interatrial muscle fascicles.

The atria are highly complex multidimensional structures composed of a heterogeneous branching network of subendocardial muscular bundles. The relief of the inner part of the right atrium includes the crista terminalis as well as multiple pectinate muscles that bridge the thinner atrial free walls and appendages. However, a handful of studies have focused attention on the role of the naturally occurring complexities of the atrial subendocardial muscle structures in the mechanisms of cardiac arrhythmias. In accordance with the facts mentioned above, it was decided to examine the morphology and topography of the external interatrial junctions and related structures in order to define the possible anatomical basis of impulse propagation in focal atrial fibrillation. Research was conducted on material consisting of 15 human hearts of both sexes (female--6, male--9) from 18 to 82 years of age. In addition we were concerned, on the basis of the history and electrocardiograph tracings, that none of the patients had shown focal and non-focal type of atrial fibrillation. The classic macroscopic methods of anatomical evaluation were used. The walls of the atria were prepared via a stereoscopic microscope, the pericardium and fatty tissue were eliminated from the surface of the atria, visualising muscle fibres linking both of the atria, and the beginnings and the endpoints of fascicles in the right and left atrium were estimated. The structure, large muscle bundle, was present in all examined hearts. The muscle fascicle was descending from the anterior wall of the right atrium just below the orifice of the superior vena cava. The fascicle, running towards the left atrium, divided into two branches, one of which joined with the superior fascicle from the posterior wall and created one running above the interatrial septum and infiltrating into the wall of the left atrium on its superior surface between the superior pulmonary veins. The other branch of the anterior fascicle was running across the anterior wall of the atria and it penetrated into the left atrium muscle in the region of the inferior pole of the left auricle outlet. On the posterior wall of the atria three types of interatrial fascicles were distinguished: unifascicular, bifascicular and trifascicular. The bifascicular type was the most frequent configuration (9 cases--60.0%), in 5 cases it was trifascicular (33.3%) and finally the unifascicular configuration was observed in just 1 heart (6.7%). On the basis of our study we can conclude that the external interatrial fascicles are the constant structure of the heart, although they may have a variable morphology. Those structures could be responsible for physiological conduction between the atria and may play an important role in patients with atrial fibrillation.

Effects of physical activity during pregnancy and gestational weight gain on newborn weight and length at birth in Warminsko-Mazurskie province.

BACKGROUND: Epidemiological research has identified a relationship between maternal physical activity, early nutrition and infant birth weight with likelihood of developing future diseases. The aim of the study was to determine a relationship between gestational weight gain and physical activity during pregnancy to the nutritional status of newborns. MATERIAL AND METHODS: The presented study was conducted in the period from February 2010 until November 2012 in the gynecological and obstetric clinics in Warminsko-Mazurskie voivodeship with various levels of reference. The research subjects included 510 women in the puerperal period aged 18-36. The scope of the research included an assessment of the selected anthropometric parameters of both pregnant women (body mass, height, BMI, gestational weight gain) and newborns (infant birth weight, infant length, Ponderal Index), as well as an analysis of the connections between the gestational weight gain, physical activity during pregnancy and anthropometric parameters of newborns. RESULTS AND CONCLUSIONS: In the study group there was a significant percentage of women characterised by an inactive lifestyle and excessive gestational weight gain. There were significantly higher neonatal birth anthropometric parameters in women with abnormal excessive gestational weight gain than in women with normal and inappropriate - low gestational weight gain. The highest percentage of women with appropriate weight gain was observed in the group of women who are physically active, although this requires confirmation in larger population. Our studies have not shown statistically significant differences between the gestational weight gain and nutritional status of newborns in relation to the level of physical activity of pregnant women.