Variant origin of the right coronary artery from the left main coronary artery together with aortic valve stenosis: report of a rare case / Origen variante de la arteria coronaria derecha a partir de la arteria coronaria izquierda junto con estenosis de la valva aórtica: reporte de un caso raro

SUMMARY: Variations in the origin of the right coronary artery have an incidence between 0.09 % and 0.92 %. Herein, we report a rare case of a coronary artery anomaly in which the right coronary artery originates from the left main coronary artery. This variant was found during routine coronarography, combined with an artificial aortic valve. Despite their rare occurrence, some variations in the origins of the coronary arteries can be life threatening and are associated with a higher risk of sudden cardiac death. They can also pose serious technical challenges and predispose to complications during coronary angiographic procedures. Thus, knowledge of such anomalies is paramount for managing the patients correctly.

Las variaciones en el origen de la arteria coronaria derecha tienen una incidencia entre el 0,09 % y el 0,92 %. En este documento, informamos un caso raro de una anomalía de la arteria coronaria en la que la arteria coronaria derecha se originaba en la arteria coronaria izquierda. Esta variante se encontró durante una coronariografía de rutina, combinada con una válvula aórtica artificial. A pesar de su rara aparición, algunas variaciones en los orígenes de las arterias coronarias pueden poner en peligro la vida y se asocian con un mayor riesgo de muerte súbita cardíaca. También pueden plantear serios desafíos técnicos y predisponer a complicaciones durante los procedimientos angiográficos coronarios. Por tanto, el conocimiento de dichas anomalías es fundamental para el manejo correcto de los pacientes.

Patella cubiti - a continuing etiological mystery / Patella cubiti: un misterio etiológico continuo

SUMMARY: A sesamoid bone in the elbow joint is a rare anatomical variation described as a Patella cubiti. Although this variation has been known for centuries its exact etiology is still unclear. Congenital, developmental, and traumatic hypotheses have been proposed. It seldom causes clinical manifestations than elbow stiffness or hypomobility. Herein, we present a case of a 31-year-old patient admitted to our department with complaints of swelling and erythema in the right elbow. An X-ray image revealed a triangular accessory bone with rounded edges, which was diagnosed as a Patella cubiti in combination with olecranon bursitis. Knowledge of this rare elbow abnormality is paramount for orthopedic surgeons and roentgenologists in their daily medical practice.

Un hueso sesamoideo en la articulación del codo es una rara variación anatómica descrita como Patella cubiti. Aunque esta variación se conoce desde hace siglos, su etiología exacta aún no está clara. Se han propuesto hipótesis congénitas, de desarrollo y traumáticas. Rara vez causa manifestaciones clínicas que no sean rigidez o hipomovilidad del codo. Presentamos el caso de un paciente de 31 años que ingresó en nuestro servicio por presentar tumefacción y eritema en el codo derecho. Una imagen de rayos X reveló un hueso accesorio triangular con márgenes redondeados, que se diagnosticó como una Patella cubiti en combinación con bursitis del olécranon. El conocimiento de esta rara anomalía del codo es fundamental para los cirujanos ortopédicos y los médicos radiólogos en su práctica médica diaria.

A comparative immunohistochemical and quantitative study of the epiligament of the medial collateral and anterior cruciate ligament in rat knee / Estudio inmunohistoquímico y cuantitativo del epiligamento del ligamento colateral medial y cruzado anterior en rodilla de rata

SUMMARY: The aim of the present study was to evaluate the importance of the epiligament for the difference in the healing potential of the knee anterior cruciate and medial collateral ligament. To do so, we compared the structure of the anterior cruciate and the medial collateral ligament and evaluated the differences in the expression of collagen types I, III and V in a rat knee. We have also conducted a comparative quantitative analysis of the number of cells per mm2 in the two ligaments. Tissue samples were obtained from the anterior cruciate and medial collateral ligament of 10 knee joints taken from five 8-month-old Wistar rats. We used standard hematoxylin and eosin staining, in addition to immunohistochemical staining with monoclonal antibodies against collagen types I, III and V. A semi-quantitative analysis of the expression was made through ImageJ, while Student's T-test was used for the statistical analysis. Our results showed higher expression of all collagen types in the epiligament, compared to the ligament proper and difference in the expression between the medial collateral and the anterior cruciate ligament in favor of the first. We also reported a statistically significant difference in the number of cells per mm2 between the two ligaments and their epiligaments. Our findings show a higher number of cells and a stronger expression of certain collagen types in the epiligament of the medial collateral compared to the anterior cruciate ligament, which may be related to the difference in their healing potential.

RESUMEN: El objetivo del presente estudio fue evaluar la importancia del epiligamento para la diferencia en el potencial de curación del ligamento cruzado anterior y colateral medial de la rodilla. Comparamos la estructura del ligamento cruzado anterior y el ligamento colateral medial y evaluamos las diferencias en la expresión de los tipos de colágeno I, III y V en una rodilla de rata. También se realizó un análisis cuantitativo comparativo del número de células por mm2 en los dos ligamentos. Se obtuvieron muestras de tejido del ligamento cruzado anterior y colateral medial de 10 articulaciones de rodilla tomadas de cinco ratas Wistar de 8 meses de edad. Utilizamos tinción estándar con hematoxilina y eosina, además de tinción inmunohistoquímica con anticuerpos monoclonales contra colágeno tipo I, III y V. Se realizó un análisis semicuantitativo de la expresión mediante ImageJ, mientras que para el análisis estadístico se utilizó la prueba T de Student. Nuestros resultados mostraron una mayor expresión de todos los tipos de colágeno en el epiligamento, en comparación con el ligamento y una diferencia en la expresión entre el ligamento colateral medial y el ligamento cruzado anterior. También informamos una diferencia estadísticamente significativa en el número de células por mm2 entre los dos ligamentos y sus epiligamentos. Nuestros hallazgos muestran un mayor número de células y una expresión mayor de ciertos tipos de colágeno en el epiligamento colateral medial en comparación con el ligamento cruzado anterior, lo que puede estar relacionado con la diferencia en su potencial de curación.

Immunohistochemical Study of Matrix Metalloproteinase-9 in Medial Collateral Ligament Epiligament in Rat Knee after Grade III Injury.

Background: In the present study, we conduct an immunohistochemical analysis to evaluate the expression of matrix metalloproteinase-9 (MMP-9) in the epiligament (EL) after grade III injury of the medial collateral ligament (MCL) in an experimental model of a rat knee. Methods: Twelve 8-month old male Wistar rats were used in this study. Three animals were used as controls, while the remaining nine underwent grade III injury of the MCL. The MMP-9 immunoreactivity was evaluated on the 8th, 16th and 30th day after injury. Results: We observed an intensive expression of the enzyme in all periods after injury in contrast with the control group. We also discovered that the main source of matrix metalloproteinase-9 was localized in the epiligament tissue. Immunoreactivity was highest and homogeneously distributed on the 8th day and gradually diminished, concentrating on the EL-ligament border and the perivascular zones on the 30th day. Conclusion: We present the first immunohistochemical study of the expression and distribution of the enzyme MMP-9 in the EL of the MCL and track the changes in enzyme activity on the 8th, 16th and 30th day after damage.

An Unusual Formation of the Superficial Palmar Arch and its Clinical Significance.

Variations of the arteries of the upper limb are an often encountered phenomenon and have been widely described in case reports and studies over the years. The superficial palmar arch (SPA) is the main source of blood supply to the palm and digits. The classical SPA is formed by an anastomosis between the superficial branches of the radial and ulnar artery, although a number of other variations have been described. Herein, we present a peculiar formation of the SPA between the superficial branch of the ulnar artery and a communicating branch from the princeps pollicis artery. We also noted an unusual origin of the radialis indicis artery from the SPA. According to the classifications of SPA variations, the observed SPA was type II or a dominant ulnar subtype of the non-arch type. The knowledge of arterial variations in the hand is important for the successful conduction of surgical and diagnostic manipulations in the hand and is therefore of interest to anatomists and clinicians.

Expression of Matrix Metalloproteinase-2 and 9 in the Medial Collateral Ligament Epiligament in Rat Knee.

Background: In this study, we describe and compare the different expression of matrix metalloproteinase-2 and 9 (MMP-2 and 9) in the epiligament (EL) of the medial collateral ligament (MCL) of the rat knee. Methods: Twelve 8-month old male Wistar rats were used in this study. The MCL and the external surface of the surrounded EL were precisely dissected. The description of the structure of EL and the expression of MMP-2 and 9 were implemented by light microscopic and imunohistochemical analysis. Results: In the ligament, a classic morphological structure was found. The expression of the MMP-2 and MMP-9 was fSound in the adventitia of the blood vessels and in the fibroblast in the EL. The reaction of MMP-2 was more intensive in comparison to MMP-9. Conclusion: We present one of the first study of immunohistochemical localization and distribution of the enzyme MMP-2 and 9 in EL tissue and furthermore we describe and compare the enzyme activity of MMP-2 and 9 in the EL.

Effects of Immobilization Stress on Nitric Oxide Active Neurons in Rat’s dlPAG; Histochemical Study.

Background: Exposure to stress-factors caused an array of biochemical, physiological and behavioral changes. According to literature data, specific stressors may elicit specific responses, and different stressors may activate different brain systems by using specific pathways within the central nervous system. Several brain structures, including the periaqueductal gray (PAG), have been implicated in the functional neuroanatomy of stress response. The dorsolateral column of the periaqueductal gray (dlPAG) integrates aversive emotional experiences and represents an important site responding to life threatening situations. It was reported that nitric oxide (NO) affects the neuronal activity of the PAG. The goal of the present study was to investigate the changes of NO activity in the dlPAG of immobilized rats using a histochemical examination of the distribution of NADPH-d reactivity neurons. Our results showed that NO activity in rat’s dlPAG was significantly increased by acute immobilization stress. This suggests a pivotal role of this part of the brain and NO-ergic system in stress response which main role is to attenuate the effect of stress and to restore the homeostasis. Methods: The experiments were carried out on male Wistar rats (180-200g), divided into two groups. The first group represented intact controls. The second group was subjected to acute immobilization stress. Results: The acute stressor – 1 hour immobilization, showed statistically significant increase in the number of the NADPH-d positive neurons compared to the control group (p < 0.01). Conclusion: NO activity in rat’s dlPAG was significantly increased by acute immobilization stress.