Anatomy and Design of Musculocutaneous Flaps in Nasal Reconstruction. / Anatomía y diseño de colgajos musculocutáneos en reconstrucción nasal.

The nose is a common site for skin tumors. The main arteries that supply the nose extend through the subcutaneous tissue. Submuscular dissection facilitates the design of safe, reliable musculocutaneous flaps that adapt well to the morphology of nasal defects. The diversity of these flaps makes them the first choice for reconstructing defects in more complex regions, such as the inner canthus of the eye and the nasal ala. We describe the surgical design of the procerus, V-Y nasalis, and lateral wall nasalis musculocutaneous flaps used to repair defects following tumor excision. The descriptions are illustrated by photographs taken by the authors during procedures and in cadaveric dissections.

Canine Skull Digitalization and Three-Dimensional Printing as an Educational Tool for Anatomical Study.

This article aims to standardize 3D scanning and printing of dog skulls for educational use and evaluate the effectiveness of these anatomical printed models for a veterinary anatomy course. Skulls were selected for scanning and creating 3D-printed models through Fused Deposition Modeling using acrylonitrile-butadiene-styrene. After a lecture on skull anatomy, the 3D-printed and real skull models were introduced during the practical bone class to 140 students. A bone anatomy practical test was conducted after a month; it consisted in identifying previously marked anatomical structures of the skull bones. The students were divided into two groups for the exam; the first group of students took the test on the real skulls, whereas the second group of students took the test on 3D-printed skulls. The students' performance was evaluated using similar practical examination questions. At the end of the course, these students were asked to answer a brief questionnaire about their individual experiences. The results showed that the anatomical structures of the 3D-printed skulls were similar to the real skulls. There was no significant difference between the test scores of the students that did their test using the real skulls and those using 3D prints. In conclusion, it was possible to construct a dynamic and printed digital 3D collection for studies of the comparative anatomy of canine skull species from real skulls, suggesting that 3D-digitalized and-printed skulls can be used as tools in veterinary anatomy teaching.

[Rare bile duct anatomy variant - Right bile duct intraparenchymal junction into the left bile duct]. / Az epeutak ritka anatómiai variánsa − A jobb ductus hepaticus intraparenchymalis csatlakozása a bal oldali ductus hepaticusba.

The authors present a case of a 67-year-old male patient, who previously had been diagnosed with a malignant liver tumor localized in segment II. He underwent bisegmentectomy (II and III) and partial IV segmentectomy. After the primary surgery jaundice developed, the level of bilirubin increased and after several imaging modalities reoperation was indicated. During the surgery a rare bile duct anatomy variant was found. The right hepatic duct joined the left duct in the parenchyma of the left lobe, and was ligated at the resection. As the liver hilum was not explored, the absence of the right duct was not discovered. Reconstruction of the biliary system was accomplished by a Roux-en-Y loop.

Digitalização e Impressão Tridimensional de Crânio Canino como Ferramenta Educacional para Estudo Anatômico.

Este trabalho teve como objetivo padronizar a digitalização e impressão 3D de crânios de cães para uso educacional e avaliar a eficácia de modelos anatômicos impressos na disciplina de anatomia do curso de medicina veterinária. Os crânios foram selecionados para escaneamento e criação dos modelos impressos 3D modelados por fusão de deposição (FDM) utilizando acrilonitrila butadieno estireno. Após uma aula teórica sobre anatomia do crânio os modelos impressos 3D e os modelos reais do crânio de cães foram apresentados aos 140 alunos durante a aula prática de ossos. Uma avaliação prática de osteologia foi realizada após um mês que consistiu na identificação de estruturas anatômicas dos ossos do crânio identificados por alfinetes. Os alunos foram divididos em duas turmas para a realização da avaliação; o primeiro grupo fez os testes usando os crânios reais, enquanto o segundo grupo os crânios impressos 3D. O desempenho dos alunos foi avaliado conforme as suas performances no exame prático. No final da disciplina, eles foram convidados a responder a um breve questionário sobre suas experiências individuais. Os resultados do estudo demonstram que as estruturas anatômicas dos crânios impressos 3D eram semelhantes aos crânios reais. Não houve diferença significativa quando se analisou o grau de acertos e erros durante a realização do exame entre aqueles que identificaram as estruturas nos crânios reais ou nos impressos 3D. Conclui-se que é possível construir um acervo dinâmico digital e impresso tridimensional (3D) para estudos da anatomia comparada da espécie canina a partir de crânios reais, e que os crânios 3D podem ser usados como uma excelente ferramenta alternativa ao ensino na anatomia veterinária.

Causes and imaging manifestations of paralysis of the recurrent laryngeal nerve. / Manifestaciones en imagen y causas de las parálisis del nervio laríngeo recurrente.

The vocal cords play a key role in the functions of the larynx. Their motor innervation depends on the recurrent laryngeal nerve (a branch of the tenth cranial nerve), which follows a long trajectory comprising intracranial, cervical, and mediastinal segments. Vocal cord paralysis usually manifests as dysphonia, the main symptom calling for CT study, the first-line imaging test to investigate the cause of the lesion. Patients are asymptomatic in a third of cases, so the incidental detection of signs of vocal cord paralysis in a CT study done for other reasons should prompt a search for a potentially severe occult lesion. This article aims to familiarize readers with the anatomy of the motor innervation of the glottis, the radiological presentation and most common causes of vocal cord paralysis, and conditions that can simulate vocal cord paralysis.

Segmental arterial mediolysis: findings at computed tomography angiography. / Hallazgos de angiografía por tomografía computarizada de la mediólisis arterial segmentaria.

OBJECTIVE: To review the principal findings on computed tomography angiography for segmental arterial mediolysis, and to emphasize the points that help to differentiate it from other vasculopathies such as vasculitis. We also review the protocols for follow-up and the various treatment options. CONCLUSION: Segmental arterial mediolysis is a rare disease that is defined as a non-atherosclerotic, non-hereditary, and non-inflammatory vasculopathy characterized by lysis of the medial layer of the arterial wall. It should be suspected in middle-aged patients with aneurysms, dissections, or spontaneous ruptures of visceral arteries of unknown etiology who do not fulfill the clinical and laboratory criteria for vasculitis. The arteries of the abdominal organs are the most commonly affected, including the arteries of the celiac trunk and the superior and inferior mesenteric arteries. Radiologically, segmental arterial mediolysis can present as arterial dilation; single or multiple, saccular or fusiform aneurysms; stenoses; or dissections.

[Gastric vascular lesions in cirrhosis: gastropathy and antral vascular ectasia]. / Lesiones vasculares gástricas en la cirrosis: gastropatía y ectasia vascular antral.

Portal hypertensive gastropathy (GHP) is a complication of portal hypertension usually associated with liver cirrhosis. The pathogenesis is unclear but the presence of portal hypertension is an essential factor for its development. GHP may be asymptomatic or present as gastrointestinal bleeding or iron deficiency anemia. Endoscopic lesions vary from a mosaic pattern to diffuse red spots; the most common location is the fundus. Treatment is indicated when there is acute or chronic bleeding, as secondary prophylaxis. There is insufficient evidence to recommend primary prophylaxis in patients who have never bled. Drugs that decrease portal pressure, such as non-cardioselective beta-blockers, and/or endoscopic ablative treatments, such as argon-beam coagulation, may be used. The role of transarterial intrahepatic portosystemic shunt) or bypass surgery has been insufficiently analyzed. Antral vascular ectasia (EVA) is a rare entity in liver cirrhosis, whose pathophysiology is still unknown. Clinical presentation is similar to that of GHP and endoscopy usually shows red spots in the antrum. Biopsy is often required to differentiate EVA from GHP. There is no effective medical therapy, so endoscopic ablative therapy and, in severe cases, antrectomy are recommended.

[Arachnoid cysts: Embriology and pathology]. / Quistes aracnoideos: embriología y anatomía patológica.

There is still great controversy surrounding the origin of the arachnoid cyst. The most accepted theory in the case of congenital cysts explains how they are formed from an anomalous development of the arachnoid membrane, which is unfolded allowing the accumulation of cerebrospinal fluid inside and creating a cyst. This theory seems to explain the origin of convexity and sylvian cistern arachnoid cysts, whereas those in other locations might be due to other mechanisms. In the anatomopathological analysis, the arachnoid cyst wall can be seen as having few differences from normal, although thickened due to an increase quantity of collagenous material. A description of the embryological development of the arachnoid layer and cyst formation is presented, describing the main anatomopathological findings.

[Tempora mutantur... et nos? The future of the Hungarian anatomy teaching in reflection of the German trends]. / Tempora mutantur et nos? A magyar anatómiaoktatás jövoje a német trendek tükrében.

The traditional four-semester anatomy is a subject to change: next to the external pressure, there is an intrinsic need to shift the emphasis. The mapping of the strengths, weaknesses and threats of the Hungarian anatomy teaching helps to formulate the directions of possible development. Current trends in the German medical education should be carefully followed. Nowadays, nearly 25% of the medical students in Germany are studying according to the new, integrated "Modellstudiengang", i.e. all the conventional subjects are reorganised into organ system thematic blocks. The unified German written final exam system provides an objective assessment parameter: to rank the 36 German medical schools according to the results of the anatomy exams. The homepage-published data, the number of semesters or teaching hours, or the thematic concept of the subject alone cannot explain the rankings of the medical schools according to the anatomy exam results. The greatest challenges of the Hungarian anatomy teaching today are: the development of an outcome-oriented, unified, practical system of requirements, the redefinition of the subject, the more effective interaction with the clinical colleagues, solving the problems of faculty recruitment and establishing the vertical integration of anatomy.

[Clinical aspects of congenital maxillofacial deformities]. / A veleszületett maxillofacialis deformitások klinikai aspektusai.

The cleft lip and palate deformity is one of the most common type of congenital abnormalities. The aim of this paper is to summarise the literature knowledge about cleft lip and/or palate. The authors review and discuss international literature data on the prevention, genetic and environmental predisposing factors, anatomical and embryological features, as well as pre- and post-natal diagnosis and treatment of these deformities. The aetiology is multifactorial, driven by both genetic and environmental factors which lead to multifaceted phenotypes and clinical features of these malformations. The lack of the multidisciplinary knowledge about prenatal diagnosis, prevention, genetic aspects and treatment strategy could result in serious diagnostic errors, hence clinical teamwork is critically important to solve the problems of this pathology. Only the professional teamwork and multidisciplinary cooperation can guarantee the optimal level of health care and better quality of life for these patients and their families.

Histologic study of the effects of chemoembolization with preloaded doxorubicin beads in patients with hepatocellular carcinoma.

OBJECTIVE: To determine the degree of tumor necrosis in surgical specimens of hepatocellular carcinomas treated with microspheres preloaded with doxorubicin and to analyze the relationship between the degree of necrosis and a) morphologic factors and b) imaging biomarkers. MATERIAL AND METHODS: We studied the livers of 21 patients who had undergone selective arterial chemoembolization with DC beads (Biocompatibles, UK) before receiving liver transplants. RESULTS: Imaging techniques detected 43 nodules (mean size, 25 mm). Angiography showed 25 hypervascularized nodules, 12 slightly vascularized nodules, and 6 avascular nodules. A total of 81 hepatocellular carcinomas (mean size, 15 mm) were detected in the specimens: two were capsular and two had vascular infiltration. The mean degree of necrosis after chemoembolization was 39%; necrosis was greater than 60% in 28 hepatocellular carcinomas and less than 60% in 52. The degree of necrosis correlated significantly with the time elapsed between the last chemoembolization treatment and liver transplantation (the degree of necrosis decreased as time increased), with the number of nodules in the specimen, and with capsular infiltration. When imaging techniques detected 1 or 2 nodules, there was a greater probability of achieving greater than 90% necrosis. No relation with the degree of necrosis achieved was found for the size of the nodules detected at imaging, the enhancement pattern, or the number of chemoembolization treatments. CONCLUSION: The degree of necrosis achieved depends on the time spent on the waiting list, on the number of nodules in the specimen, and on whether capsular infiltration is present.

[A brief history of the anatomy and physiology of a mysterious and hidden gland called the pancreas]. / Breve historia de la anatomía y fisiología de una recóndita y enigmática glándula llamada páncreas.

Because of its retrogastric location and appearance, which is similar to mesenteric fat, for centuries the pancreas has been a mysterious, hidden organ that has received little attention. However, its importance was intuited and described by Herophilus, Ruphos of Ephesus and Galen. This gland began to appearin distinct medical treatises from the 16th century. There are two important scientists in the history of the pancreas. The fist, Johann Georg Wirsung, described the main pancreatic duct in 1642, a date considered by many to be the start of Pancreatology. The second, Claude Bernard, described pancreatic exocrine function between 1849 and 1856 and is considered the father of pancreatic physiology. Besides these two outstanding figures, there is a constellation of personalities who contributed to improving knowledge of this enigmatic gland with the results of their studies. The aim of this article is to call attention to some of the most notable findings that have enhanced knowledge of this gland over the years.

[Three-dimensional endoscopic endonasal study of skull base anatomy]. / Estudio endoscópico endonasal 3D de la anatomía de la base de cráneo.

INTRODUCTION: Training in dissection of the paranasal sinuses and the skull base is essential for anatomical understanding and correct surgical techniques. Three-dimensional (3D) visualisation of endoscopic skull base anatomy increases spatial orientation and allows depth perception. OBJECTIVE: To show endoscopic skull base anatomy based on the 3D technique. METHODS: We performed endoscopic dissection in cadaveric specimens fixed with formalin and with the Thiel technique, both prepared using intravascular injection of coloured material. Endonasal approaches were performed with conventional 2D endoscopes. Then we applied the 3D anaglyph technique to illustrate the pictures in 3D. RESULTS: The most important anatomical structures and landmarks of the sellar region under endonasal endoscopic vision are illustrated in 3D images. CONCLUSION: The skull base consists of complex bony and neurovascular structures. Experience with cadaver dissection is essential to understand complex anatomy and develop surgical skills. A 3D view constitutes a useful tool for understanding skull base anatomy.

[The early years of anatomy and obstetrics at the Göttingen University, 1734-1760]. / Az anatómia és a szülészet kezdeti évei a göttingeni egyetemen, 1734-1760.

In the Age of Enlightenment medical education was based on new fundamentals. According to experts at that time, a medical faculty had to have five branches: anatomy, botany, chemistry, practical and theoretical medicine. Perhaps Göttingen was the most successful university foundation at that time, because a generous financial support was provided, outstanding professors were invited and an education without censorship was warranted. The spirit of Enlightenment affected both the structure and the standards of education of the facultas medicinae. The word-wide reputation of this faculty was earned by Albrecht von Haller. Haller conceived both the still highly regarded botanical garden and the anatomical theatre, which was the first of its kind in the German speaking area. Furthermore, he founded one of the first clinical obstetrics departments in the world. Students gained theoretical knowledge, were trained practically and had the opportunity to make scientific observations and medical experiments. This paper describes the founding era of the medical faculty of University of Göttingen from a historical-cultural view of point, based on contemporary documents from Germany and Hungary.

[Lateral chest X-rays. Radiographic anatomy]. / Radiografía lateral de tórax. Anatomía radiográfica.

Lateral chest views constitute an essential part of chest X-ray examinations, so it is fundamental to know the anatomy on these images and to be able to detect the variations manifested on these images in different diseases. The aim of this article is to review the normal anatomy and main normal variants seen on lateral chest views. For teaching purposes, we divide the thorax into different spaces and analyze each in an orderly way, especially emphasizing the anatomic details that are most helpful for locating lesions that have already been detected in the posteroanterior view or for detecting lesions that can be missed in the posteroanterior view.

ACL anatomy: Is there still something to learn? / [Artículo traducido] Anatomía del LAC: ¿queda algo por aprender?

BACKGROUND: The different bony and soft tissue reference points and the micro and macroscopic structures of the knee continue to be the object of focused study and analysis. Upon reviewing the most recent literature, we saw the wide spectrum of studies that seek to define the different anatomical aspects of the anterior cruciate ligament (ACL). PURPOSE: The purpose of this paper is to review the most recent publications on the ACL and its morphology in which its microscopic composition and macroscopic anatomy are addressed. RESULTS: The ACL consists of typeI (90%) and typeIII (10%) collagen matrix. Its length ranges from 27 to 38mm and its width from 10 to 12mm. The ACL cross-section area measures an average of 44mm2, and its shape resembles that of an hourglass or a bow tie. ACL bundles have been defined as anteromedial, intermediate, and posterolateral. Femoral and tibial footprints were seen to present a high degree of variability in shape and size. Furthermore, the blood supply is given by the medial genicular artery and innervation by the tibial nerve branches. Additionally, the ACL functionally prevents anterior translation of the tibia and stabilizes against the internal rotation of the tibia and valgus angulation of the knee. CONCLUSIONS: There is great variability in the anatomy of the ACL as well as its attachment sites. At the same time, the shape and size of its footprint has become a factor in determining individualized ACL reconstruction. The persistence of morphological variability in the aging of the ACL and important aspects of surgical planning and decision making with respect to anatomical risk factors suggest that further studies are called for.

[ChatGPT is an above-average student at the Faculty of Medicine of the University of Zaragoza and an excellent collaborator in the development of teaching materials]. / ChatGPT es un estudiante por encima de la media en la Facultad de Medicina de la Universidad de Zaragoza y un colaborador excelente en la elaboración de material docente.

INTRODUCTION AND OBJECTIVE: Artificial intelligence is fully present in our lives. In education, the possibilities of its use are endless, both for students and teachers. MATERIAL AND METHODS: The capacity of ChatGPT has been explored when solving multiple choice questions based on the exam of the subject «Anatomopathological Diagnostic and Therapeutic Procedures¼ of the first call of the 2022-23 academic year. In addition, to comparing their results with those of the rest of the students presented the probable causes of incorrect answers have been evaluated. Finally, its ability to formulate new test questions based on specific instructions has been evaluated. RESULTS: ChatGPT correctly answered 47 out of 68 questions, achieving a grade higher than the course average and median. Most failed questions present negative statements, using the words «no¼, «false¼ or «incorrect¼ in their statement. After interacting with it, the program can realize its mistake and change its initial response to the correct answer. Finally, ChatGPT can develop new questions based on a theoretical assumption or a specific clinical simulation. CONCLUSIONS: As teachers we are obliged to explore the uses of artificial intelligence and try to use it to our benefit. Carrying out tasks that involve significant consumption, such as preparing multiple-choice questions for content evaluation, is a good example.

[Analysis of the workload in medical time according to the degree of complexity of the samples and proposal of an algorithm for the equitable distribution of the workload in an anatomic pathology department]. / Análisis de la carga laboral en tiempo médico en función del grado de complejidad de las muestras y propuesta de algoritmo para la distribución equitativa del trabajo asistencial en un servicio de anatomía patológica.

INTRODUCTION: In a pathological anatomy service, the workload in medical time is analyzed based on the complexity of the samples received and its distribution among pathologists is assessed, presenting a new computer algorithm that favors an equitable distribution. METHODS: Following the second edition of the Spanish guidelines for the estimation of workload in cytopathology and histopathology (medical time) according to the Spanish Pathology Society-International Academy of Pathology (SEAP-IAP) catalog of samples and procedures, we determined the workload units (UCL) per pathologist and the overall UCL of the service, the average workload of the service (MU factor), the time dedicated by each pathologist to healthcare activity and the optimal number of pathologists according to the workload of the service. RESULTS: We determined 12 197 total annual UCL for the chief pathologist, as well as 14 702 and 13 842 UCL for associate pathologists, with an overall of 40 742 UCL for the whole service. The calculated MU factor is 4.97. The chief pathologist devoted 72.25% of his working day to healthcare activity while associate pathologists dedicated 87.09% and 82.01% of their working hours. The optimal number of pathologists for the service is found to be 3.55. CONCLUSIONS: The results demonstrate medical work overload and a non-equitable distribution of UCLs among pathologists. We propose a computer algorithm capable of distributing the workload in an equitable manner. It would be associated with the laboratory information system and take into account the type of specimen, its complexity and the dedication of each pathologist to healthcare activity.

Transcatheter closure of multiple coronary artery fistulas: a coronary computed tomography angiography-based anatomic classification.

INTRODUCTION AND OBJECTIVES: This study aimed to retrospectively analyze the anatomical characteristics and classification of multiple coronary artery fistulas (MCAFs), and to compare the outcomes of transcatheter closure between MCAFs and single fistulas. METHODS: All patients who underwent attempts at transcatheter closure of coronary artery fistulas (CAFs) at Fuwai Hospital from 2010 to 2023 were retrospectively reviewed. Patients were categorized into single fistula and MCAFs groups, and anatomical characteristics and transcatheter closure outcomes were compared between the 2 groups. RESULTS: This retrospective study included 146 patients who underwent attempted transcatheter closure of CAFs, with a 14.38% failure rate. Among the 146 patients with CAFs, 32.19% were identified as having MCAFs, with types I, II, and III constituting 40.43%, 42.55%, and 17.02%, respectively. Unlike single fistulas, which predominantly originated from the right coronary artery and terminated in the left ventricle, MCAFs mainly had simultaneous origins from the right coronary artery and left anterior descending artery (29.79%), and predominantly drained into the pulmonary artery (70.21%), with a notable prevalence of plexus-like morphology (38.3% vs 2.02%, P<.001). The success rate of transcatheter closure was significantly lower for multiple fistulas compared with single fistula (64.29% vs 84.34%, P=.011). Multivariate regression analysis indicated that the risk of closure failure for MCAFs was 2.64 times that of single fistulas. CONCLUSIONS: MCAFs are common among CAFs and can be classified into 3 types based on the number and location of their origins and terminations. The risk of failure of transcatheter closure is significantly higher in MCAFs than in single fistulas.

Dislodgment of continuous suprascapular nerve block catheters after physiotherapy: A cadaver study.

BACKGROUND: Continuous peripheral nerve blocks are commonly used for pain management. However, the incidence of catheter dislodgement or migration is unclear, and may be underestimated and underreported. Our objective was to assess suprascapular catheter tip positioning before and after routine simulated shoulder physiotherapy manipulation in an anatomical cadaver model. METHOD: Eight ultrasound-guided continuous suprascapular nerve block catheters were placed in cryopreserved fresh cadavers. Computed tomography (CT) confirmed the location of the catheter tip after injection of 1 ml of contrast medium. We performed a series of standardized shoulder movements during a simulated shoulder physiotherapy session in cadavers. Following this, we administered 1 ml of methylene blue through the catheters, and then performed anatomical dissections to accurately identify the location of the catheter tips and compare them to their placement prior to the 'physiotherapy'. RESULT: CT imaging confirmed the location of the catheter tips at the suprascapular notch in all cases. However, following physiotherapy, 2 catheters (25%) were found to have migrated - specifically, 1 was located in the supraspinatus muscle, and the other was located in the trapezius muscle. CONCLUSION: Our findings suggest that catheter dislodgement may occur in approximately 25% of cases following simulated physiotherapy manipulation. However, further research is needed to determine the read incidence of catheter dislodgement in clinical practice.