Revisiting the infracardiac bursa using multimodal methods: topographic anatomy for surgery of the esophagogastric junction.

In embryology, the infracardiac bursa (ICB) is a well-known derivative separated from the omental bursa. During surgeries around the esophagogastric junction (EGJ), surgeons often encounter a closed space considered to be equivalent to the ICB, but the macroscopic anatomy in adults is hardly known. This study aimed to revisit the ICB using multimodal methods to show its development from the embryonic to adult stage and clarify its persistence and topographic anatomy. Histological sections of 79 embryos from Carnegie stage (CS) 16 to 23 and magnetic resonance (MR) images of 39 fetuses were examined to study the embryological development of the ICB. Horizontal sections around the EGJ obtained from three adult cadavers were examined to determine the topographic anatomy and histology of the ICB. Further, 32 laparoscopic surgical videos before (n = 16) and after (n = 16) the start of this study were reviewed to confirm its remaining rate and topographic anatomy in surgery. The ICB was formed in 1 out of 10 CS17 samples, and in 8 out of 10 CS18 samples. Further, it was observed in all CS19-23 except one CS23 sample and in 25 (64%) out of 39 fetus samples. Three-dimensional reconstructed MR images of fetuses revealed that the ICB was located at the right alongside the esophagus and the cranial side of the diaphragmatic crus. In one adult cadaver, the caudal end of the ICB arose from the level of the esophageal hiatus and the cranial end reached up to the level of the pericardium. The inner surface cells of the space consisted of the mesothelium. In laparoscopic surgery, the ICB was identified in only 11 (69%) out of 16 surgeries before. However, subsequently we were able to identify the ICB reproducibly in 15 (94%) out of 16 surgeries. Thus, the ICB is the structure commonly remaining in almost all adults as a closed space located at the right alongside the esophagus and the cranial side of the diaphragmatic crus. It may be available as a useful landmark in surgery of the EGJ.

Impact of fetal brain ultrasound tutor smartphone application on normal anatomy learning.

OBJECTIVE: The "Fetal Brain Tutor 4us" (FBTApp) is a recently developed application for interactive multiplanar navigation through the normal fetal brain. The purpose of this work was to assess its impact on normal anatomy learning. METHODS: A multiple-choice quiz (MCQ) was administered to first-year resident doctors in Obstetrics and Gynecology in two separate sessions, before and 2 weeks after downloading the FBTApp. For each MCQ, the junior trainee was asked to use one out of five items to label a specific cerebral structure on an ultrasound image of a normal midtrimester fetal brain. Six sonographic images of the fetal brain on each of the three scanning planes (axial, sagittal, and coronal) were shown to the participants at either session. The results of the two sessions were analysed and compared. RESULTS: Overall, 216 questions were administered to the trainees in the 2-week study, 108 before and 108 after the use of the FBTApp. From the first to the second sessions, a significant increase of correct answers was noted (from 47/108 or 43% to 77/108 or 71%, P < 0.01). Particularly, a better improvement was obtained in the correct labelling of cerebral structures on the nonaxial (from 32% to 67%, +35%) vs axial (from 67% to 81%, +14%) view planes of the brain (P < 0.01). CONCLUSION: The use of FBTApp seems capable to improve the knowledge of the normal fetal brain anatomy in subjects naive to dedicated prenatal ultrasound. This improvement seems greater on nonaxial planes.

Pars tensa and tympanicomalleal joint: proposal for a new anatomic classification.

PURPOSE: The tympanic membrane (TM) belongs to the ear. Despite its place in the ear anatomy, can we give it also a different anatomic classification? The main objective is to clarify the nature of TM, tympanic bone and malleus to propose a new anatomic classification. METHODS: This cadaveric study was performed in two human heads and six fresh temporal bones. A study of the temporomandibular joint, external acoustic meatus (EAM), TM and middle ear structures was conducted. A medical literature review englobing anatomy, embryology, histology and phylogeny of the ear was performed and the results were compared with the results of the dissection. RESULTS: The external ear is constituted by the auricle and the EAM. This last segment is made by a cartilaginous and an osseous portion. The osseous portion of the EAM is constituted mainly by tympanic bone. The external ear is separated from the middle ear by the TM. Inside the middle ear, there are three ossicles: malleus, incus and stapes, which allow the conduction of sound to the cochlea. Based on the anatomic dissection and medical literature review of the tympanic bone, malleus and TM, we propose that these structures are interconnected like a joint, and named it "Tympanicomalleal joint". CONCLUSIONS: It seems that the TM can be part of a joint that evolved to improve sound transmission and middle ear protection. Thinking TM has part of a joint may help in the development of more efficient reconstructive surgical techniques.

Incidence of anatomical variations according to the International Frontal Sinus Anatomy Classification (IFAC) and their coincidence with radiological sings of opacification.

BACKGROUND: The endonasal access to the frontal recess and sinus may be complicated by a variety of anatomical variations. Previous classifications of these variants were characterized by proper names or position information without anatomical reference. The IFAC is intended to simplify the classification of anatomical variations of the frontoethmoidal complex. The aim of this study was to analyse a representative number of sinus CT scans to assess the incidence of anatomical variations according to the IFAC and to compare the results with previous classifications. In addition, the coincidence of complex anatomical variations and radiological sings of opacification was investigated. METHODOLOGY/PRINCIPAL: Two hundred and forty-nine sinus CT scans were analysed in multiplanar reconstructions. Exclusion criteria were previous operations on the paranasal sinuses, malignant diseases, and an insufficient image quality. All anatomical variants were analysed according to the IFAC criteria. In addition, the coincidence of radiological sings of opacification and the presence of anatomical variations of the frontal recess and sinus were investigated. RESULTS: The analysis revealed Agger nasi cells in 95% of the CT scans. Supra agger cells (SACs) were detected in 49% and Supra agger frontal cells (SAFCs) in 25% of the data sets. Suprabulla cells (SBCs) were detected in 89% and Supra bulla frontal cells (SBFCs) in 27% of the scans. Supraorbital ethmoid cells (SECs) were detectable in 9% and interfrontal septal cells in 28% of the scans. Despite a partially strong narrowing of the frontal recess, no increased occurrence of radiological sings of opacification could be detected (p > 0.05). CONCLUSIONS: Anatomical variations in the frontoethmoidal area are very common. According to the IFAC criteria, in 43% of the patients, cells could be detected with pneumatization to or into the frontal sinus. The IFAC is structured more clearly compared to previous classifications due to the anatomical aspect. It represents the most consistent classification regarding surgical planning. Further studies will demonstrate the scientific and clinical value of this classification.

Posterior tibial perforators relationship with superficial nerves and veins: A cadaver study.

BACKGROUND: Most authors have evaluated the location of lower leg arterial perforators, but little is still known about the relationship between the arterial network and great saphenous vein (GSV) and saphenous nerve (SN). The aim of this study is to evaluate the relationship between the arterial network of the posterior tibial artery perforators, the cutaneous nerves, and the superficial venous system in the lower one third of the leg. METHODS: Eighteen lower limbs from cadavers were used for this study. The arterial and venous compartment were selectively injected with a mixture of barium sulfate and epoxy. The specimen were CT scanned and the superficial veins, nerves, and the arterial perforators were dissected. RESULTS: A large perforator of the posterior tibial artery was found at a mean distance of 6.23 cm ± 0.88, with a 95% CI: 5.79-6.67, from the medial malleolus. The average diameter was 0.9 mm ± 0.17, with a 95% CI: 0.81-0.99. In 67% the connection of the venae comitantes to the superficial venous system was established with the GSV, in the other cases, with Leonardo's vein. Both dissection and imaging studies showed perineural interperforator connections along the branches of SN in all the specimens examined. CONCLUSIONS: The distribution pattern of posterior tibial artery perforators followed the superficial nerves in this region. There is an interperforator anastomotic network along the SN. The various patterns of the venous drainage system, in relationship to the distribution of the branches of posterior tibial artery perforators, have been clarified.

Peroneal nerve location at the fibular head: an anatomic study using 3D imaging.

INTRODUCTION: Injuries to the peroneal nerve are a common complication in operative treatment of proximal tibial or fibular fractures. To minimize the risk of iatrogenic injury to the nerve, detailed knowledge of the anatomy of the peroneal nerve is essential. Aim of this study was to present a detailed description of the position and branching of the peroneal nerve based on 3D-images to assist preparation for surgical approaches to the fibular head and the tibial plateau. METHODS: The common peroneal nerve, the deep and the superficial peroneal nerve were marked with a radiopaque thread in 18 formalin-embalmed specimens. Three-dimensional X-ray scans were then acquired from the knee and the proximal lower leg in full extension of the knee. In 3D-reconstructions of these scans, distances of the common peroneal nerve and its branches to clearly defined osseous landmarks were measured digitally. Furthermore, the height of the branching of the common peroneal nerve was measured in relation to the landmarks. RESULTS: The mean distance of the common peroneal nerve at the level of the tibial plateau to its posterior osseous limitation was 7.92 ± 2.42 mm, and 1.31 ± 2.63 mm to the lateral osseous limitation of the tibia. In a transversal plane, distance of the common peroneal nerve branching was 27.56 ± 3.98 mm relative to the level of the most proximal osseous extension of fibula and 11.77 ± 6.1 mm relative to the proximal extension of the tibial tuberosity. The deep peroneal nerve crossed the midline of the fibular shaft at a distance of 22.14 mm ± 4.35 distally to the most proximal extension of the fibula, the superficial peroneal nerve at a distance of 33.56 mm ± 6.68. CONCLUSION: As the course of the peroneal nerve is highly variable in between individuals, surgical dissection for operative treatment of proximal posterolateral tibial or fibular fractures has to be done carefully. We defined an area were the peroneal nerve and its branches are unlikely to be found. However, specific safe zones should not be utilized due to the individual anatomic variation.

[Geometric and morphological features of the aortic root in norm and aortic regurgitation]. / Geometricheskie i morfologicheskie kharakteristiki kornia aorty v norme i pri nedostatochnosti aortal'nogo klapana.

AIM: To assess linear and geometric parameters of the aortic valve and to determine the changes which are associated with impaired leaflets coaptation and aortic root enlargement. MATERIAL AND METHODS: Surgical anatomy of the aortic root and its spatial relationships with surrounding heart structures were studied with plastination by using of combined silicon technologies. 123 specimens of the aortic root with preserved original geometry were created with silicone plastination technique and perfusion embalming. Analysis included 15 heart specimens with the signs of aortic root dilatation and 108 specimens without evidence of dilatation. Multiple logistic regression was used for statistical analysis. RESULTS: Anatomical and clinical analysis showed that deviation angle of the intercusp triangle is the factor contributing impaired aortic root geometry and aortic regurgitation (OR 1.3, 95% CI 1.114-1.350, p<0.0001). CONCLUSION: 1) Increased deviation angle of intercusp triangles is associated with impaired coaptation of aortic valve leaflets. 2) Restoration of intercusp triangle deviation angle within 1.7±1.2° degrees is geometrically necessary to achieve normal function of the aortic valve.

The variants of the retro- and hypotympanum: an endoscopic anatomical study.

The retro- and hypotympanum are hidden areas of the middle ear, only poorly recognized. Nevertheless, this region is of relevant clinical significance, since it is regularly affected by disease such as cholesteatoma. The aim of this study is to explore and describe the anatomical variants of the hypo- and retrotympanum by the means of transcanal endoscopy. We hypothesize a significant variability of this hidden region of the middle ear. Moreover, we believe that the minimal invasive, endoscopic access is suitable since angled scopes may be used to explore the region. To this end a total of 125 middle ears (83 cadaveric dissections, 42 surgical cases) were explored by the means of 3 mm straight and angled scopes. The variants were documented photographically and tabularized. The bony crests ponticulus, subiculum and finiculus were most frequently represented as ridges. The ponticulus showed the highest variability with 38% ridge, 35% bridge and 27% incomplete presentation. The subiculum was bridge-shaped only in 8% of the cases, the finiculus in 17%. The sinus tympani had a normal configuration in 66%. A subcochlear canaliculus was detectable in 50%. The retro- and hypotympanum were classified, respectively, to the present bony crests and sinus in a novel classification type I-IV. In conclusion, we found abundant variability of the bony structures in the retro- and hypotympanum. The endoscopic access is suitable and offers thorough understanding and panoramic views of these hidden areas.

[Anatomical aspects of formation of corona phlebectatica]. / Anatomicheskie aspekty formirovaniia corona phlebectatica.

The data concerning the anatomy of perforant veins of the foot can by no means be referred to as insufficiently known. At the same time, these descriptions are encountered rather rarely in the educational-and-methodical literature. To a certain degree, this may be explained by low pathogenetic significance of perforant veins of the foot; however, these data are required for the surgeon in carrying out both standard phlebectomy and sclerotherapy of subcutaneous varicose veins, especially if the zone of surgical intervention is situated immediately on the foot. Also, these data may be important for explaining clinical manifestations of chronic venous insufficiency. The present study was aimed at specifying the anatomical ground of formation of the corona phlebecatica and topography of perforant veins of the foot. The material for the study consisted of 15 lower extremities (cadaveric material) with no evidence of chronic venous diseases. The method of the study - anatomical dissection. From 4 to 6 perforant veins were found on the medial surface of the foot. They directly connected the medial marginal vein and vv. plantaris medialis. From 2 to 3 perforant veins were found on the lateral surface of the foot. They connected directly the lateral marginal vein and vv. plantaris lateralis. Topographically perforant veins pass behind the muscles of the lateral group of the foot, along the lateral intermuscular septum. Perforant veins of each group were found to have lateral affluents part of which independently drained the integumentary tissues of the lateral surfaces of the foot, and part formed anastomoses with the superficial venous plantar net. This makes it possible to characterize perforant veins not only as anastomoses connecting subcutaneous rear venous net with deep veins of the foot and with the superficial plantar net, but also as independently draining vessels. Besides, in the majority of cases, nearby a perforant vein we managed to isolate an artery and a nerve branchlet, originating from a. plantaris and n. plantaris. Hence, perforant veins of the medial and lateral surfaces of the foot constitute the anatomical ground for formation of the corona phlebectatica and are component parts of the neurovascular bundle (vein-artery-nerve).

[The anatomical features of the middle ear exerting the influence on the formation of exudative otitis media in the breast-fed infants of different gestational age]. / Anatomicheskie osobennosti srednego ukha, vliiaiushchie na formirovanie ékssudativnogo srednego otita u grudnykh detei razlichnogo gestatsionnogo vozrasta.

The objective of the present study was to elucidate the anatomical features of the structure of the middle ear and eustachian tube in the breast-fed infants of different gestational age that may be responsible for the formation of exudates (fluids). We have examined 150 temporal bones obtained from the children's cadavers that were allocated to three groups as follows: 50 temporal bones obtained at weeks 26-30 weeks of gestation (group 1), 44 bones 31-36 weeks of gestation (group 2), and 37-40 weeks of gestation (full-term babies, group 3),The analysis of the data obtained on an individual bases revealed either increase or decreases in the selected characteristics of the eustachian tube in comparison with the respective average values as well as the well apparent predominance of a single change or a combination of alteration of several parameters in one case in 26-30 weeks and 31-36 weeks groups. No significant changes were found in group 1. It is concluded that the presence of a single change or a combination of two or three abnormal changes in the parameters of the bone structures of the eustachian tube can affect the development of the secretory process in the middle ear especially in the children born after 36 weeks of pregnancy.

[Topographic anatomy of the hook region and its significance for the choice of the surgical technique for the cochlear implantation]. / Topograficheskaia anatomiia oblasti 'rybolovnogo kriuchka' i ee znachenie pri vybore khirurgicheskoi tekhniki kokhlearnoi implantatsii.

The mode of the introduction of the active electrode of a cochlear implant into the cochlea remains a key issue as far as cochlear implantation is concerned. Especially much attention has recently been given to the relationship between the anatomical features of the basal region of the cochlea (the so-called 'fish hook') and the possibility to approach it. We have undertaken the attempt to optimize the approach to the tympanic canal (scala tympanica) of the cochlea with a view to reducing to a minimum the risk of an injury to the cochlear structures in the course of cochlear implantation. A total of 35 cadaveric temporal bones were examined to measure the fine structures of the hook region and evaluate the risk of their damages associated with various approaches to the tympanic canal.

[The endoscopic anatomy of the middle ear (a dissection study)]. / Éndoskopicheskaia anatomiia srednego ukha (dissektsionnoe issledovanie).

The objective of the present work was to study the specific endoscopic anatomical features of the middle ear using the dissected temporal bones with the intact tympanic membrane. The 18 cm long endoscopes 4 mm in diameter with a visual angle from 0 to 45 degrees in the combination with some other microinstruments, such as ear pincers, needles, curettes, elevators, and suction tubes, were used during the examination. It was shown that endomeato-transtympanic endosopy provides a panoramic view of almost all structures of the middle ear. After the resection of the posterior bone edge of 'annulus tympanicus', the use of the 45o endoscope ensured the panoramic view not only of certain structures of the middle ear (e.g. the tympanic chord, the stapedius muscle tendon, the entire pyramidal process) but also of the structures of the retrotympanic and anterior epitympanic spaces.

Pelvic Incidence and Acetabular Version in Slipped Capital Femoral Epiphysis.

BACKGROUND: The etiology of slipped capital femoral epiphysis (SCFE) is multifactorial, but the role of sagittal balance of the pelvis as a contributing factor to its development has not been well studied. Our primary purpose was to determine whether a smaller pelvic incidence (PI), a position-independent anatomic parameter that regulates pelvic orientation, could be a factor that increases shear stress in the epiphyseal growth plate and potentially contributes to the development of SCFE. We also set out to determine whether acetabular retroversion was associated with SCFE. METHODS: We obtained 14 cadaveric pelvi from the Hamann-Todd Osteological Collection whose femurs showed evidence of post-SCFE deformity. Two hundred age-matched, sex-matched, and race-matched pelvi were used as controls. PI and acetabular version were measured using standardized lateral photographs and goniometers, respectively. T tests were performed to evaluate for differences in measured parameters between groups. RESULTS: The mean PI was 40.6±6.1 degrees for SCFE specimens and 47.4±9.9 degrees for normal specimens (P=0.01). The mean version of SCFE and normal acetabula was 15±7 and 17±6 degrees, respectively (P=0.39). There was also no significant difference in version between SCFE acetabula and the contralateral, uninvolved acetabular of the same specimen (15±7 vs. 17±8 degrees, P=0.33). CONCLUSIONS: Specimens with SCFE deformity demonstrated a smaller PI than a large cohort of normal control specimens. We found no significant difference between acetabular version of specimens with and without SCFE deformity. Contralateral or unaffected acetabuli of SCFE specimens were not more retroverted than the affected side of the same specimen. CLINICAL RELEVANCE: Sagittal balance of the pelvis, and particularly decreased PI, may play an important role in the development of SCFE. The influence of mechanical factors beyond the hip joint in the development of SCFE should be considered by clinicians.

The patellar insertion of the medial patellofemoral ligament in children: a cadaveric study.

BACKGROUND: The purpose of this study was to evaluate the medial patellofemoral ligament (MPFL) patellar insertion in skeletally immature anatomic specimens. METHODS: Nine pediatric cadaveric knee specimens were examined through gross dissection. Metallic markers were placed at the MPFL patellar insertion footprint. Computed tomographic scans for each specimen were analyzed. The MPFL insertion footprint width, patellar height, and patellar width were measured. The distance from the MPFL insertion footprint center to the midline of the patella was assessed. The proportion of the patella that the MPFL footprint inserted upon was calculated. RESULTS: The mean width of the MPFL patellar insertion footprint was 12 mm (range, 8 to 18 mm). The mean patellar height was 31 mm (range, 20 to 48 mm). The mean patellar width was 27 mm (range, 21 to 39 mm). The center of the MPFL insertion footprint was found to be a mean 4.7 mm (range, -2 to 10.5 mm) above the midline of the patella, with insertion centers occurring both above and below the midline. The MPFL insertion footprint spanned a mean 41% (24% to 63%) of the longitudinal width of the patella. CONCLUSIONS: Most adult studies report the MPFL insertion on the upper 1/2 to 2/3 of the patella. This series of skeletally immature subjects demonstrated that the center of the MPFL insertion was above and below the midpoint of the patella. The MPFL insertions of some of the younger specimens did extend into the distal 1/3 of the patella. The insertion of the older specimens was found in the proximal 2/3 of the patella, a similar location to most previous adult anatomic studies. CLINICAL RELEVANCE: This research suggests that the MPFL insertion on the patella may be at slightly different locations in some skeletally immature subjects compared with adults. The specimens dissected in the present study showed more variability than previously published reports, with some insertions extending into the distal 1/3 of the patella in the youngest subjects. These dissections may be useful to surgeons performing MPFL reconstructions in skeletally immature patients.

The Distal Humerus Axial View: Assessment of Displacement in Medial Epicondyle Fractures.

BACKGROUND: The assessment and treatment of childhood medial epicondyle humerus fractures continues to be associated with significant debate. Several studies demonstrate that standard radiographic views are unable to accurately portray the true displacement. Without reliable ways to assess the amount of displacement, how can we debate treatment and outcomes? This study introduces a novel imaging technique for the evaluation of medial epicondyle fractures. METHODS: An osteotomy of a cadaveric humerus was performed to simulate a medial epicondyle fracture. Plain radiographs were obtained with the fracture fragment displaced anteriorly in 2-mm increments between 0 and 18 mm. Anteroposterior (AP), internal oblique (IR), lateral (LAT), and distal humerus axial (AXIAL) views were performed. Axial images were obtained by positioning the central ray above the shoulder at 15 to 20 degrees from the long axis of the humerus, centered on the distal humerus. Displacement (mm) was measured by 7 orthopaedic surgeons on digital radiographs. RESULTS: At 10 mm displacement, AP views underestimated displacement by 5.5±0.6 mm and IR views underestimated by 3.8±2.1 mm. On LAT views, readers were not able to visualize fragments with <10 mm displacement. Displacement ≥10 mm from LAT views was overestimated by 1 reader by up to 4.6 mm and underestimated by others by up to 18.0 mm. AXIAL images more closely estimated the true amount of displacement, with a mean 1.5±1.1 mm error in measurement for <10 mm displacement and a mean 0.8±0.7 mm error for displacements of ≥10 mm. AXIAL measurements correlated strongly with the actual displacement (r=0.998, P<0.05); AP measurements did not (r=0.655, P=0.55). Intraclass correlation coefficient (ICC) was 0.257 for AP and IR measurements; ICC was 0.974 for AXIAL measurements. CONCLUSIONS: Standard imaging, consisting of AP, IR, and LAT radiographs, consistently underestimates the actual displacement of medial epicondyle humerus fractures. The newly described AXIAL projection more accurately and reliably demonstrated the true displacement while reducing the need for advanced imaging such as computed tomography. CLINICAL RELEVANCE: This simple view can be easily obtained at a clinic visit, enhancing the surgeon's ability to determine the true displacement.

Anatomical study of the infraorbital foramen: A basis for successful infraorbital nerve block.

Detailed knowledge of variations of the infraorbital foramen (IOF) and the establishment of a constant reference point for needle insertion are important for safe and successful regional block and for avoiding iatrogenic injury to the nerve during surgery in the midfacial region. Infraorbital foramina from 133 sides of 67 dry intact adult skulls of undetermined gender were examined for variations in shape, number, location in relation to bony landmarks, and relationship to the maxillary teeth. The angles of needle insertion in the sagittal and Frankfurt planes were determined. The infraorbital foramina were located at an average distance of 6.33 ± 1.39 mm below the infraorbital margin, 25.69 ± 2.37 mm from the median plane, 15.19 ± 1.70 mm from the lateral margin of the piriform aperture, and 28.41 ± 2.82 mm above the maxillary alveolar border. The average angles of needle insertion through the IOF with the sagittal and Frankfurt planes were 21.14° ± 10.10° and 31.79° ± 7.68°, respectively. Multiple foramina were found in 21% of the hemi-skulls. The foramen was less than 2 mm in size in 23.31% of the hemi-skulls. The position of the IOF with respect to the maxillary teeth varied from the interval between the canine and first premolar to the first molar, but in half of the specimens it lay in line with the second maxillary premolar tooth. The observations made in this study should be useful for planning infraorbital nerve block or surgery around the IOF.

The prevalence of coronary sinus and left circumflex artery overlap in relation to the mitral valve.

OBJECTIVES: Characterize where the circumflex artery crosses between the coronary sinus and mitral valve in order to minimize the occurrence of coronary compression during percutaneous indirect mitral valve interventions. BACKGROUND: Treatment of mitral valve regurgitation using an indirect percutaneous approach via access through the coronary sinus remains under active research and development. Characterization of anatomical locations where the circumflex artery crosses between the coronary sinus and mitral valve is important for mitigation of serious ischemic complications. METHODS: Magnetic resonance images were obtained for 65 perfusion-fixed human hearts. Three-dimensional reconstructions of anatomical orientations of the coronary sinus, circumflex artery, and mitral valve annulus were generated. The prevalence and location of sites where the circumflex artery coursed between the coronary sinus and mitral valve were assessed. RESULTS: The circumflex artery coursed between the coronary sinus and mitral valve in 88% of specimens. Overlaps between the circumflex artery and coronary sinus were less prevalent more proximal to the coronary sinus ostium. The coronary sinus did not lie in the same plane as the mitral annulus in roughly 20% of the hearts. CONCLUSION: The prevalence of circumflex overlap between the coronary sinus and mitral valve was common across the sample size. The large variability in anatomy confirms the value of imaging individual patient cardiac anatomy prior to performing indirect percutaneous mitral valve annuloplasty to avoid impairment to the circumflex artery. This novel database can be utilized in the development of additional cardiac therapies that require access to the coronary sinus, such as therapeutic ablations.

[Radical operations of inguinal hernias with the temporary translocation of inguinal nerves].

This article presents the results of anatomic researches of the innervations of the inguinal area, performed for studying an arrangement of the main nerves of the inguinal area in relation to the operation access and the area of plasty of the posterior wall of the inguinal canal. The method of temporary translocation of inguinal nerves is developed for their preservation at radical operations of inguinal hernias. Long-term experience of surgical treatment of inguinal hernias with the temporary translocation of inguinal nerves is summarized.

[Surgeons return to the science of living matter]. / Le retour des chirurgiens dans les sciences du vivant.

The progress in digital and surgical technology has enhanced the exploration and knowledge of the living matter that constitutes our corporal form. Hence, endoscopic intratissular observation of living matter during surgical interventions reveals the structuring elements that are difficult to identify with a cadaver, or tissue sample, using histological and anatomopathological methods. Once the endoscope equipped with a camera has been placed in the heart of the living matter of a patient, one's perception changes and reality wavers. With the help of endoscopic intratissular techniques, surgeons can now explore the world of living human matter. Such observations should be interpreted in collaboration with other scientific specialisations, but they are a fundamental support because they provide a precise vision of the reality of living tissue. This is a new adventure, not only for surgeons but also for the further knowledge of living matter.

[Anatomy typological and clinical parallels in case of disturbance of soft tissue formations of shoulder girdle].

The influence of anthropology on topographical anatomical structure peculiarities of soft tissue formations of shoulder girdle has been investigated. The dependence of anatomical structure and topography of muscles, ligaments, tendon sheaths, synovial bursae, rotator cuffs on patient's body constitution type has been examined. The influence of a somatotype on topical damage of soft tissue structures of shoulder girdle has been proved. The so-called "holes" or weak areas, joint capsules, places where ligaments attach to bones and cartilages, where vascular formations also take place have been revealed. It is in these areas that degenerative inflammatory process begins. First of all this process influences hemolymph circulation, then it results in disturbance in production and resorption of synovial fluid and causes destructive processes in ligaments, tendons and osteochondral tissue. Due to research the ability to conduct differential diagnosis has been determined, methods of modality treatment and prevention of periarticular tissue diseases have been optimized.