Quantitative anatomy of the growing clavicle in the human fetus: CT, digital image analysis, and statistical study.

PURPOSES: Knowledge of dimensions of fetal long bones is useful in both the assessment of fetal growth and early detection of inherited defects. Measurements of the fetal clavicle may facilitate detection of numerous defects, e.g., cleidocranial dysplasia, Holt-Oram syndrome, Goltz syndrome, and Melnick-Needles syndrome. METHODS: Using the methods of CT, digital image analysis, and statistics, the size of the growing clavicle in 42 spontaneously aborted human fetuses (21 males and 21 females) at ages of 18-30 weeks was studied. RESULTS: Without any male-female and right-left significant differences, the best fit growth models for the growing clavicle with relation to age in weeks were as follows: y = -54.439 + 24.673 × ln(age) ± 0.237 (R 2 = 0.86) for length, y = -12.042 + 4.906 × ln(age) ± 0.362 (R 2 = 0.82) for width of acromial end, y = -4.210 + 2.028 × ln(age) ± 0.177 (R 2 = 0.77) for width of central part, y = -4.687 + 2.364 × ln(age) ± 0.242 (R 2 = 0.70) for width of sternal end, y = -51.078 + 4.174 × ln(age) ± 6.943 (R 2 = 0.82) for cross-sectional area, and y = -766.948 + 281.774 × ln(age) ± 19.610 (R 2 = 0.84) for volume. CONCLUSIONS: With no sex and laterality differences, the clavicle grows logarithmically with respect to its length, width, and volume, and linearly with respect to its projection surface area. The obtained morphometric data of the growing clavicle are considered normative for their respective weeks of gestation and may be of relevance in the diagnosis of congenital defects.

Novel patterns for the growing main bronchi in the human fetus: an anatomical, digital and statistical study.

PURPOSE: Intensive progress in prenatal medicine results in performing airway management in the fetus affected by life-threatening congenital malformations. This study aimed to examine age-specific reference intervals and growth dynamics for length, proximal and distal external transverse diameters, and projection surface areas of the two main bronchi at varying gestational ages, including their relative growth in length and projection surface area. MATERIALS AND METHODS: Using anatomical dissection, digital image analysis and statistics, length, proximal and distal external transverse diameters, and projection surface areas of the right and left main bronchi were examined in 73 human fetuses (39 males, 34 females) aged 14-25 weeks, derived from spontaneous abortions and stillbirths. RESULTS: Statistical analysis showed no sex differences. Between the 14 and 25th week of gestation, the lengths of the right and left main bronchi increased from 1.43 ± 0.18 to 3.18 ± 0.39 mm, and from 2.97 ± 0.16 to 7.58 ± 1.95 mm, in accordance with the functions: [Formula: see text], respectively. The proximal external transverse diameters of the right and left main bronchi varied from 2.13 ± 0.41 to 4.24 ± 0.20 mm, and from 1.84 ± 0.06 to 3.67 ± 0.66 mm, following the logarithmic models: [Formula: see text], respectively. The distal external transverse diameter rose from 2.09 ± 0.47 to 4.24 ± 0.20 mm, as [Formula: see text] for the right main bronchus, and from 1.85 ± 0.04 to 3.67 ± 0.66 mm, like [Formula: see text] for the left one. On either side, there were no statistically significant differences between values of the proximal and distal transverse diameters of the main bronchus. The projection surface areas of the right and left main bronchi ranged from 2.95 ± 0.19 to 13.34 ± 2.12 mm(2), and from 5.57 ± 0.21 to 28.52 ± 5.24 mm(2), as [Formula: see text] and [Formula: see text]. The two main bronchi revealed a proportionate increase in both length and projection surface area, since the right-to-left bronchial length ratio and the right-to-left bronchial projection surface area ratio were stable, 0.41 ± 0.07 and 0.47 ± 0.08, respectively, throughout the analyzed period. CONCLUSIONS: The main bronchi show no sex differences. The right and left main bronchi grow logarithmically in length and external transverse diameter, and linearly in projection surface area. The right and left main bronchi evolve proportionately, with the right-to-left bronchial ratios of 0.41 ± 0.07 for length, and 0.47 ± 0.08 for projection surface area.

Catheter-directed thrombolysis is not limited to acute limb ischemia treatment: experience from a division of vascular surgery.

BACKGROUND: Thrombolytic treatment has many potential indications in the era of modern vascular surgery. We aimed to analyze the contemporary experience in the catheter-directed, intraarterial thrombolysis in different clinical scenarios. METHODS: The available data of 121 patients with different types (acute, subacute, complications of vascular procedures) of lower limb ischemia treated by means of the intraarterial, catheter-directed thrombolysis between November 2011 and December 2016 were retrospectively analyzed. The basic treatment protocol, utilized in 92% of patients, was a catheter-directed infusion of 40 mg of alteplase within 3.5 hours. Pre- and intraprocedural factors (indications, demographic details, comorbidities, the dose of alteplase utilized, underlying lesions procedures), as well as postoperative outcomes (lysis grade, death, complications, reinterventions, and limb loss after 1-month observation), were analyzed. RESULTS: Successful thrombolysis was achieved in 76.1% (92 of 121) patients. The success rate was similar for acute, subacute limb ischemia and thrombotic complications of vascular procedures. Around 67.8% of patients (N.=82) had procedures to correct underlying lesions performed. Overall complication rate was 28.1%, but the major bleeding was observed in only 5% (6 patients). Neither intracranial bleeding nor gastrointestinal bleeding occurred. No mortality, 1.7% reintervention rate and 10.7% amputation rate were recorded during one-month follow-up. CONCLUSIONS: Accelerated intraarterial thrombolysis is an effective measure in the treatment of acute, sub-acute limb ischemia as well as thromboembolic complications of vascular procedures. It carries a low risk of major bleeding. The location of thrombus in the crural arteries adversely affects the treatment results. Atrial fibrillation increases the risk of amputation while complete thrombus lysis is protective.

The retroperitoneal anastomoses of the gonadal veins in human foetuses.

In the retroperitoneal space the gonadal veins form a collateral circulation that has a great clinical impact on sclerotherapy or surgical ligation of varicoceles. The aim of this study was to examine the communications of the gonadal veins (according to classification, frequency of appearance, gender and syntopic differences) in human foetuses of both sexes (71 males and 59 females) aged 4--6 months of intrauterine life. On the right side the most frequently were found the gonadal-periureteral anastomosis (23%) and the gonadal-perirenal anastomosis (22%). A gonadal-lumbar anastomosis on the right side appeared in 7% of cases. On the left side the most frequent (37%) was the gonadalperirenal anastomosis, more frequently occurring as an ovarian-perirenal anastomosis (48%) than as a testicular-perirenal anastomosis (29%). Gonadal-periureteral anastomoses were found in a quarter of cases. Gonadal-lumbar anastomoses were observed in 7% of individuals. On the left side the gonadal-mesenteric inferior anastomosis was specifically observed (21%) as an ovarian-mesenteric inferior anastomosis (24%) and a testicular-mesenteric inferior anastomosis (19%). The cross-communications between the right and left gonadal veins (7%) were more frequently as the bilateral testicular (9.7%) than as the bilateral ovarian one (3%). In female foetuses gonadal-perirenal anastomoses occurred with statistically greater frequency than gonadal-periureteral anastomoses (p<=0.05). The frequency of cross-communications of the gonadal veins was three times greater in male foetuses (p

Morphometry of the pancreas in human foetuses.

With the use of conventional anatomical dissection, radiography, digital and statistical analysis, morphometry and skeletopy of the pancreas was carried out in 60 human foetuses of both sexes (28 female, 32 male) between the 17th and 40th week of intrauterine life. The material was fixed in a 10% formalin solution. The age of the foetuses was determined by crown-rump (CR) length measurement on the basis of the Iffy et al. tables. Photographic documentation was made and then digitally processed in the Computer Image Digital Analysis System. The following parameters were taken into account: the length and width of 3 parts of the pancreas, namely the head, corpus and tail. Additionally, radiograms were made to obtain a projection of the gland on the vertebral column. Development of the pancreas was correlated with the age of the foetuses calculated on the basis of crown-rump (CR) length measurements. The correlation coefficient with CR was 0.998 for the pancreas length, 0.709 for the width of the head, 0.703 for the width of the corpus and 0.712 for the width of tail. Gender dimorphism was not found (p > 0.05) with regard to the morphometry of the pancreas. In the material under examination the pancreas did not change its position in relation to the vertebral column. The head projected on the vertebral column in the range Th(12)-L(2) (most frequently L(1)-L(2)), the corpus on Th(12)-L(2) and the tail on Th(11).

The cystic artery in human foetuses.

The cystic artery varies in origin, course and number and it is important to recognise it during operative procedure. Insufficient recognition of its anatomical variation may contribute to a dangerous situation, especially during laparoscopic cholecystectomy. To prevent iatrogenic injuries of the vessels and bile ducts, correct preparation with clear identification of the anatomic structures is essential. Special attention must be given to the course of the cystic artery through the hepato-billiary triangle (Calot's triangle). The assumption of the present study was recognition of the vasculature of the gallbladder in human foetuses. The purpose of this investigation was to determine the origin of the cystic artery and its relation to Calot's triangle. In this study the cystic artery was most often (97.06%) a single vessel and only in one case (2.94%) was it a double vessel. It arose most often (82.34%) from the right proper hepatic artery, rarely from its trunk (8.82%) or its left branch (5.88%) and most rarely (2.94%) from the gastroduodenal artery. In all but one case the cystic artery coursed within Calot's triangle. Its exceptional course out of Calot's triangle concerned a cystic artery originating from the gastroduodenal artery (2.94%). The cystic artery most frequently (67.66%) runs behind the common hepatic duct, rarely (29.40%) over the common hepatic duct and most rarely (2.94%) on the left side of the cystic duct. In the material examined the cystic artery was not observed running in front of the common hepatic duct. The short type of cystic artery trunk (52.93%) was observed more frequently than the long one (44.13%).

Perforating veins of the shin in human foetuses.

There are 3 groups of perforating veins of the shin: the medial, the lateral and the internal sural perforating veins. Dysfunction of these veins is one of the main factors in venous hypertension. There is a lack of data in the literature concerning perforating veins of the shin in human foetuses. The aim of this study was identification of the perforating veins of the shin in human prenatal development. The material examined included 88 human lower limbs of foetuses (21 males and 23 females) aged from 16 to 38 weeks of intra-uterine life. The perforating veins were dissected under a steromicroscope. The number of perforating veins was analysed in relation to the sex of the foetus and the side of a body. In our study perforating veins of the shin did not show sexual or syntopic dimorphism. Between 2 and 6 Cockett's perforating veins were constantly present. Of these veins 80% divided into ascending and descending branches. Fibular perforating veins were found more often (90.9%) than Boyd's perforating veins (21.6%). Between 1 and 3 fibular perforating veins were observed but in 9% of cases they were entirely absent.

The pancreaticoduodenal arteries in human foetal development.

Knowledge of the course of the pancreaticoduodenal arteries is of great importance in pancreatic surgery. Lack of care in the preparation of these vessels may lead to ischaemia or necrosis of the duodenum, the first loop of the jejunum, the head of the pancreas and even the liver, bile ducts and transverse colon. In such events, the surgeon would need to diagnose the course of the vessels and their anastomoses intraoperatively. Anatomical dissection in this special area diminishes the risk of early complications in the form of bleeding and late complications in the form of narrowing of the anastomoses, fistulas, necrosis and intestinal ileus after surgical resection or drainage. The aim of the present study was to determine the variability of the pancreaticoduodenal arteries in human foetuses. The material examined consisted of 60 human foetuses of both sexes (33 male, 27 female) from spontaneous abortion or stillbirth and ranging in age from the 16th to 38th week of prenatal life. White latex solution to of volume between 15 ml and 30 ml was injected into the thoracic aorta. The results of this were that a typical pancreatic supply from the coeliac trunk and superior mesenteric artery was observed in all cases. The coeliac trunk, splenic artery and gastroduodenal artery also appeared invariably. However, variability was observed in further generations of branches. The gastroduodenal artery with its branches, the anterior and posterior pancreaticoduodenal arteries, was constantly present. Irrespective of the sex of the foetus, in 10% of cases a large vessel was observed which ran horizontally on the anterior surface of the pancreas from head to tail and which originated in the anterior superior pancreaticoduodenal artery. We termed this vessel the "anterior pancreatic artery". In all cases there were anterior and posterior pancreaticoduodenal arcades, but in two cases (3.3%) a double anterior pancreaticoduodenal arcade was observed.

The normal growth of cross-sectional areas of the aorto-iliac segment in human fetuses - an anatomical, digital, and statistical study.

BACKGROUND: The intraluminal size of the aorto-iliac segment is relevant in both the clinical and echographic settings. The aim of this study was to compile both the absolute and relative age-specific reference intervals for cross-sectional areas (CSAs) of the aorto-iliac segment. MATERIAL/METHODS: Using the methods of anatomical dissection, digital-image analysis (Leica QWin Pro 16) and statistical analysis (Student's t test, one-way ANOVA, post-hoc RIR Tukey test, linear regression), the growth in CSA (in mm2) of the abdominal aorta, the common, external, and internal iliac arteries in 124 (60 males, 64 females) spontaneously aborted human fetuses aged 15-34 weeks was examined. RESULTS: No significant sex differences were found. In the age range of 4-9 months, the distal CSA of the abdominal aorta ranged from 0.87±0.34 to 19.18±3.36 mm2. The CSA of the common iliac artery varied from 0.37±0.22 to 4.30±1.54 mm2 on the right, and from 0.36±0.16 to 3.80±1.44 mm2 on the left. The sum of the CSAs of the right and left common iliac arteries grew proportionately to the distal CSA of the abdominal aorta; the latter being significantly larger than the former. On both sides, however, the CSA of the internal iliac artery was approximately twice that of the external iliac artery. Between the ages of 4 and 9 months, the CSA of the external iliac artery ranged from 0.10±0.06 to 1.32±0.52 mm2 on the right, and from 0.08±0.03 to 1.19±0.42 mm2 on the left. The CSA of the internal iliac artery increased from 0.23±0.14 to 2.59±1.22 mm2 on the right, and from 0.21±0.14 to 2.27±1.11 mm2 on the left. Bilaterally, the sum of the CSAs of the internal and external iliac arteries was significantly smaller than the CSA of the common iliac artery. The relative CSA of each artery decreased until the age of 6 months, after which their values were gradually increasing until the age of 9 months. CONCLUSIONS: The aorto-iliac segment does not reveal sex differences in its cross-sectional area. The cross-sectional area of the internal iliac artery is approximately twice the size of the external iliac artery. The aorto-iliac segment observed proximally to distally reduces its cross-sectional area, thereby resulting in an increase in blood velocity.

The normal growth of the tracheal wall in human foetuses.

INTRODUCTION: Tracheal wall thickness is a substantial indicator in various pathological changes. The present study was performed to compile normative data and formulae for the tracheal wall thickness and volume at varying gestational age. MATERIAL AND METHODS: Using anatomical dissection, digital image analysis and statistics a range of the wall thickness, proximal internal-to-external cross-sectional area ratio, and wall volume for the trachea in 73 spontaneously aborted human fetuses aged 14-25 weeks was examined. RESULTS: No significant male-female differences were found. The values of tracheal wall thickness ranged from 0.36 ±0.01 mm for the 14-week group to 1.23 ±0.17 mm for the 25-week group of gestation, according to the linear function y = -0.823 + 0.083 × age ± 0.087. The tracheal lumen rate, expressed as the proximal internal-to-external cross-sectional area ratio, decreased from 42.61 ±1.11% to 26.78 ±4.95%, according to the function y = 62.239 - 1.487 × age ±3.119. The tracheal wall volume rose from 16.28 ±4.18 mm(3) in fetuses aged 14 weeks to 269.22 ±29.26 mm(3) in fetuses aged 25 weeks, according to the quintic function y = 0.000052 × age(4.894). CONCLUSIONS: The tracheal wall parameters show no sexual dimorphism. The tracheal wall grows linearly in its length, and according to a quintic function in its volume. A relative decrease in the tracheal lumen at the expense of an increase in both the wall thickness and wall volume of the trachea is found during gestation.

Tracheo-bronchial angles in the human fetus -- an anatomical, digital, and statistical study.

BACKGROUND: Both the advancement of visual techniques and intensive progress in perinatal medicine result in performing airway management in the fetus and neonate affected by life-threatening malformations. This study aimed to examine the 3 tracheo-bronchial angles, including the right and left bronchial angles, and the interbronchial angle, in the fetus at various gestational ages. MATERIAL AND METHODS: Using methods of anatomical dissection, digital image analysis with an adequate program (NIS-Elements BR 3.0, Nikon), and statistics, values of the two bronchial angles and their sum as the interbronchial angle were semi-automatically measured in 73 human fetuses at the age of 14-25 weeks, derived from spontaneous abortions and stillbirths. RESULTS: No male-female differences between the parameters studied were found. The 3 fetal tracheo-bronchial angles were found to be independent of age. The right bronchial angle ranged from 11.4° to 41.8°, and averaged 26.9±7.0° for the whole analyzed sample. The values of left bronchial angle varied from 24.8° to 64.8°, with the overall mean of 46.2±8.0°. As a consequence, the interbronchial angle totalled 36.2-96.6°, and averaged 73.1±12.7°. CONCLUSIONS: The tracheo-bronchial angles change independently of sex and fetal age. The left bronchial angle is wider than the right one. Values of the 3 tracheo-bronchial angles are unpredictable since their regression curves of best fit with relation to fetal age cannot be modelled. Both of the 2 bronchial angles and the interbronchial angle are of great relevance in the location of inhaled foreign bodies, and in the diagnosis cardiac diseases and mediastinal abnormalities.