The sagittal grooves of the middle nasal turbinate determine paradoxical curvatures and bifidities.

BACKGROUND: Paradoxical curvature of the middle nasal turbinate (MT) is a common anatomic variant, usually found and reported on coronal CT slices. However, less attention has been paid to the sagittal groove (SG) which is determining it. AIM: The study aimed to determine paradoxical curvatures and bifidities in the sagittal groves of middle nasal turbinate. MATERIAL AND METHOD: A retrospective CBCT study on the archived files of 52 adult patients was performed. RESULTS: Different patterns of MT bifidity were found: (1) unilateral bifid MTs; (2) bifid and trifid MTs and "wandering" single SGs; (3) bilateral bifid middle turbinates and double SGs, (4) bilateral false bifid appearance due to middle and superior turbinates fusion and (5) bifid concha bullosa media. Digital "dissections" of patients' files allowed us to conclude that paradoxical curvature as well as bifidity of MTs relate to the placement and number of the SGs on the MTs. Such SGs were previously documented in prenatal MTs since the 14th week, as well as in pædiatric patients. CONCLUSIONS: It seems reasonable to speculate that paradoxical curvature, as well as bifidity of MT, this later being previously undocumented, are just adult vestiges of the primitive MT morphology. Nevertheless, documentation of the MT morphology should not rely exclusively on coronal CTs, as combined morphologies of that turbinate could occur.

The iliolumbar artery-anatomic considerations and details on the common iliac artery trifurcation.

The iliolumbar artery (ILA) of Haller is the largest nutrient pedicle of the ilium and its detailed knowledge is important for various surgical procedures that approach the lumbosacral junction, the L4/L5 disk space, the sacroiliac joint, the iliac and psoas muscles, or the lumbar spine. Also the ILA is relevant for various techniques of embolization. We aimed to evaluate the anatomic and topographic features of the ILA, by dissection on 30 human adult pelvic halves and on 50 angiograms. ILA was a constant presence and it emerged at Level A (from the common iliac artery (CIA), 8.75%), Level B (from the CIA bifurcation, 2.5%), Level C (from the internal iliac artery (IIA), 52.5%), Level D (from the IIA bifurcation, 3.75%), and Level E (from the posterior trunk of the IIA, 32.5%). Level B of origin of the ILA corresponds to a trifurcated CIA (morphology previously unreported), while Level D corresponds to a trifurcated IIA. A higher origin of the ILA corresponds to a more transversal course of it. A descending lumbar branch that leaves the iliac arterial system independently to enter the psoas major muscle, as seen in 48% of cases, may be misdiagnosed as ILA. Surgical interventions in the lumbar, sacral, and pelvic regions must take into account the variable origins of the ILA from the iliac system that can modify the expected topographical relations and may lead to undesired hemorrhagic accidents.

The spermatic ganglion in humans: an anatomical update.

The male gonad receives nerve fibers from the autonomic ganglionic system. By the present study, we aimed to bring detailed evidences, topographic and structural, on the spermatic ganglia (SG) in humans, as suppliers of autonomic fibers for the testis. We performed retroperitoneal dissections in 25 formalin-fixed human male adult cadavers. Histology used the Hematoxylin-Eosin and we also used Bielschowsky silver stains. Immunohistochemistry used antibodies for tyrosine hydroxylase. In 20÷10 specimens, we identified left spermatic ganglia (LSG) at the aortic origin of the left testicular artery (LTA); in five specimens the LTA left the renal artery but LSG were juxtaposed on the aorta at about the level of origin of a normal LTA. In 15÷25 cadavers, there were right spermatic ganglia (RSG) related to the right testicular artery (RTA) that in 12 cadavers had a precaval disposition. A specimen with retrocaval RTA presented an inferior renal ganglion, supplying both the renal and the RTA. The SG presented renal, lumbar and intermesenteric roots. The inferior branch of the SG connected it to the inferior mesenteric plexus while its infero-lateral branch adjoined the testicular artery. Microscopy confirmed the SG as nervous ganglia and the respective neuronal populations were tyrosine hydroxylase positive, allowing us to consider these ganglia as sympathetic. We bring here the first-time evidence of the SG topography and cathecolaminergic nature in humans; this ganglion may influence the male gonad via the inferior mesenteric plexus and via the vascular path of the testicular artery.

Altered anatomy in a case with a buccally impacted maxillary canine tooth.

Bilateral dissections of maxilla were performed in a human adult cadaver head, male, aged 53 years. After the en block removal of the soft tissues in the oral and infraorbital regions, the antero-lateral surface of maxilla was exposed and also the vestibular aspect of the upper alveolar process. An oblique labially impacted right upper canine was evidenced, completely submucosal: its apex was tangent to the maxillary sinus floor, while the superior side of the apical part of the root was in close relation with the floor of the laterally expanded inferior nasal meatus. Superior and adjacent to the neck of that impacted canine a follicular cyst was evidenced and the antral wall presented distally to the apex of the impacted canine a dehiscent area, where the antral mucosa was only covered by an incomplete thin bony lamella. The incisors on that side were present but no resorption was identified at their level. Within the anterior border of the wall separating the maxillary sinus, small, and the inferior nasal meatus, the nerve for that impacted canine was coursing; the nerves for the upper incisors were initially located within the antero-lateral wall of the inferior nasal meatus. Although small, the maxillary sinus presented a supero-medial recess above the enlarged inferior nasal meatus and lateral to the normally-sized middle nasal meatus.

Utero-adnexal damage in septic abortion. Histopathological study on 91 cases.

Septic abortion represents the main causes of abortion-induced maternal death. Hysterectomy may represent a beneficial therapeutic solution for septic abortion, nevertheless with irreversible effects on a woman's reproductive condition. The study analyzes the anatomopathological damage found in ninety-one patients hospitalized for septic abortion. The patients were admitted to the "Dr. D. Popescu" Clinical Hospital, Timisoara, between 1980-1989 and 1999-2008; hysterectomy was performed in all the cases to eliminate uterine sepsis responsible for the emerging complications.

An anatomical study of the thyroid arteries anastomoses.

Collateral circles in neck own a particular importance in compensating the symptoms due to the unilateral occlusion of the common carotid artery. In addition, surgical procedures at the level of the thyroid gland and larynx raise the problem of a good knowledge of the arterial morphology at those levels. The present study was designed to investigate the possible morphologies of the thyroid arteries anastomoses. For the present study, 20 human adult specimens were dissected, 15 in cadavers and other five on laryngeal specimens drawn at autopsies. Dissections evidenced bilateral and unilateral anastomoses of the thyroid arteries classified as extra laryngeal and intra laryngeal, the former constantly being represented by the supra isthmic arcade made by the superior thyroid arteries and the retrolobar anastomoses of the superior and inferior thyroid arteries. Constant intra laryngeal anastomoses were those of the superior laryngeal artery with the inferior laryngeal artery and, respectively, with the cricothyroid artery. The analogy with the cardiac collateral circulation, the thyroid arteries anastomoses may be classified as intrathyroid and interthyroid arterial anastomoses. We also present in this paper a rare variant that we did not find described in the references we investigated, represented by the paramedian perilaryngeal anastomose of the suprahyoid branch emerged from the lingual artery and the cricothyroid artery sent by the superior thyroid artery. The thyroid arteries supply the collateral circles in neck; the clinicians must be aware of their possible functional value and the surgeons must take into account these arterial morphologies while acting on the neck viscera.

The maxillary recess of the sphenoid sinus.

The most studied recess of the sphenoid sinus seems to be the lateral one, which is highly variable. Less attention seems to be paid to the maxillary recess, extending anterior, inferior and lateral towards the maxillary sinus. Twenty patients were referred for CT of the paranasal sinuses (axial CT), during a 3-month period. After examining the morphology of the sphenoid sinuses, the authors found bilateral maxillary recesses in one patient. On either side, the maxillary recess of the sphenoid sinus was directed anterior and lateral, being separated from the maxillary sinus by a distinctive bony wall; the longitudinal size of these recesses was 1.36 cm, on the left, and 1.22 cm, on the right. As it becomes part of the antero-medial wall of the pterygopalatine fossa, the maxillary recess of the sphenoid sinus should be evaluated prior to the endoscopic endonasal approach of the fossa; the detail becomes more relevant when one takes into account the fact that in our case, on the right side, the CT-scan suggested that the sphenopalatine artery could traverse directly through the maxillary recess. Therefore, such a maxillary recess of the sphenoid sinus seems to be anatomically located in the situs of the orbital process of the palatine bone and thus, it assumes the respective topography. The differential diagnosis with a Haller cell is relevant--the surgical procedures that approach a Haller cell could lead to a misdiagnosed maxillary recess of the sphenoid sinus into the middle nasal meatus. This aspect determined us to consider the maxillary recess of the sphenoid sinus as a false Haller cell and to claim the imperative of a CT-evaluation performed prior to interventions.

The adult coeliac ganglion: a morphologic study.

The coeliac plexus is located on the sides of the coeliac trunk and nearby the origins of the superior mesenteric and renal arteries. Afferent branches get to this plexus from the vagus nerve, splanchnic nerves and the right phrenic nerve; efferents leave for viscera through periarterial plexuses and the retroportal nerves. The coeliac plexus ganglia - coeliac, superior mesenteric, aorticorenal - are prevertebral ganglia that receive the preganglionic sympathetic fibers brought by the splanchnic nerves from the thoracic spinal cord. For studying the adult coeliac ganglia dissections were performed then pieces were drawn for silver staining by the method of Bielschowsky on blocks and HE stains. The adult coeliac ganglia consist of well-defined ganglionic subunits, of a varying number of neurons with somata ranging from 14 to 48 microns and characteristically involved in extensive dendritic fields. Individual degrees of coalescence may justify the macroscopic appearance of the coeliac ganglion but its structure keeps distinctive subunits.

Thromboembolic risk after knee endoprosthesis.

Thromboembolic complications are the most frequent associated pathologies after knee replacement. The secondary deep vein thrombosis in the knee arthroplasty is often low symptomatic or asymptomatic and, sometime, it could lead to fatal pulmonary embolism. This is the main purpose recommending an antithrombotic prophylaxis. In this study 214 patients operated for knee arthroplasty and receiving low molecular heparin therapy were enrolled. They were clinically and echo/radiologically monitored for thromboembolic and/or hemorrhagic complications on the 2nd, 7th, 14th and 45th day from surgery. Results showed that only 45% of the cases developed DVT (deep vein thrombosis) out of which 17% could be objectively verified by ultrasonography and phlebography. In only one case massive pulmonary embolism with fatal evolution was discovered. It was not found any major bleeding except in four cases in which local haematomas were discovered (most probably related to anticoagulant treatment). This study concluded that the administration of low molecular weight heparin after knee arthroplasty significantly reduces the risks of thromboembolism in conditions where the increase of hemorrhagic complications doesn't result statistically significant.

[Neovascularization in rat optic nerve]. / Studiu experimental al microcirculatiei nervului optic de sobolan.

The study aims at assessing possible age-induced alterations in the nervous vascular network by examining the microcirculation of the optic nerve in rats grouped by age. Histological specimens were stained with hematoxiline-eosine, the Romhany-Barzu dye staining and the Gomory tri-chromic dye staining. The volume, section surface and total surface of 2-6 micro and 7-14 micro vessels were determined on a total of 960 vessels of this group, over a five square millimeter area. The tables show the increase of vascular parameters from birth to adulthood, and the fact that not all the vessels were injected in old animals. The density of the vessels per square millimeter, their average length and average diameters, error calculus, variation coefficient, Student test and chi2 allow assessing the differences between animals belonging to the same species but to different age groups, or under the influence of medication.

The value of radio-imaging methods in the diagnosis of chest wall metastases.

The aim of the study was to reveal the value of radio-imaging methods in the diagnostic assessment of chest wall metastases. We retrospectively reviewed 48 cases of chest wall metastases examined clinically, radiologically, by ultrasound, CT-scan and MRI. All cases were histologically assessed by surgical biopsies. Plain chest radiography (X-ray) was in all cases a prerequisite for any evaluation of the chest wall being of great value in demonstration of the displaced rib fractures, localized bony destruction and the detection of most soft tissue lesions. The ultrasound examination (US) allowed real time analysis and thus the functional imaging of the chest wall metastases with special interest in vascular impairment being limited by relatively small field of view with more difficulties in anatomical orientation. With involvement of bone marrow and spinal cord, MRI became the most sensitive and the most specific imaging method, successfully diagnosing intramedullar lesions in three cases. In the detection of chest wall infiltration by primary malignancies from the lung, pleura, pericardium, breast and spinal cord we preferred the CT-scan, which revealed the presence of the lesions in 29 cases with typically obtuse angles against the adjacent chest wall and pleura. In the imaging evaluation of malignant lymphoma the CT-scan demonstrated chest wall extension in five cases. CT-scan and MRI revealed chest wall localization for distant metastases in 14 cases. The imaging methods clearly showed the number, the extent, the anatomic reports and the aggressive characteristics of chest wall metastases being of great value in the decision of adequate therapy.

Anatomic and pathological aspects in the pathology of malignant gastric tumors.

Efforts in perfecting the methods of early diagnosis, in trying to assess premalignant conditions, and in properly staging malignant tumors are still in trend. The geographic area around Timisoara (Banat Region) is situated on the first place in the country as far as the gastric location of cancer is concerned. The authors aimed to deal with the initial stage in the development of gastric cancer, a stage which has been oncologically termed "precancerous damage", and with the neoplastic invasion of the gastric wall. The present paper is based on the 1995-2005 statistics of the IInd Surgical Department of the Timisoara County Hospital, the study group consisting of 802 patients admitted for gastric disorders, 522 of which being later diagnosed with a tumoral pathology. Routine morphological tests were conducted on biopsy pieces dye stained with Hematoxylin-Eosin, standard technique, the van Gieson trichromic staining, the Giemsa staining, the AA-PAS staining and the immunoreaction methods. The age for gastric tumoral pathology ranged between 36-88 years in females, and 31-87 years in males. Most gastric carcinomas are adenocarcinoma, 404 (90%) cases--could be classified as follows: 167 cases of tubular adenocarcinoma; 39 cases of papillary adenocarcinoma; 24 cases of mucinous or colloid adenocarcinoma; 141 "signet ring"-cell carcinoma; 33 cases of undifferentiated carcinoma. Currently there is an increase of the incidence of the "diffuse"-type in women and at younger ages. Attention should be given to precancerous conditions; there was a large number of premalignant or potentially malignant gastric damage: atrophic chronic gastritis (54 cases), intestinal metaplasia (104 cases), and gastric dysplasia (104 cases).

Former and present aspects in upper level of viscero-skull architecture.

The classical reference material describes two resistance arcs, the maxillary arc and the mandibulary arc, from which the masticatory forces direct themselves towards the functional resistance structures of the viscero-skull. From the maxillary arc, three pairs of vertical pillars ascend (that is fronto-nasal, zygomatic and pterygoid). Certain authors add to these a median arc--the bony part of the nasal septum. From the mandibulary arc, the lines of force make for the cordyle and the coronoid process of the mandible. In terms of the new outlook, at the upper level of the viscero-skull, there are five vertical blades described: one median, two medial and two lateral, those last including the pillars from the classical descriptions. These vertical blades are joined by three horizontal laminae: the upper one, the middle one--interrupted by the median line and the lower one--included in the concavity of the maxillary arc. These structures of laminae induce the formation of some resistance cylinders and cones. Within the lower level of the viscero-skull there are three mandibulary arcs described: the upper one (the classic mandibulary arc), the middle one (with an oblique direction) and the lower one.

Former and present aspects in neuro-skull architecture.

The classical authors considered the functional resistance of the neuro-skull to consist of arcs at the arch level, rafters at the base and pillars at the joint of the arcs and rafters, those last also connecting the neuro-skull framework and that of the viscero-skull. The new outlooks replace the term pillar with that of resistance node and assemble the arcs and rafters within common structures, named resistance belts. The belts are: one in transversal, three sagittal, two in frontal plane and two oblique positions. At the intersection of the belts, the resistance nodes are placed.

Correlations between anomalies of jugular veins and areas of vascular drainage of head and neck.

The study conducted on 60 human cadavers preserved in formalin, in the Anatomy Laboratory of the "Victor Babes" University of Medicine and Pharmacy Timisoara, during 2000-2006, observed the internal and external jugular veins from the point of view of their origin, course and affluents. The morphological variability of the jugular veins (external jugular that receives as affluents the facial and lingual veins and drains into the internal jugular, draining the latter's territory--3.33%; internal jugular that receives the lingual, upper thyroid and facial veins, independent--13.33%, via the linguofacial trunk--50%, and via thyrolinguofacial trunk--33.33%) made possible the correlation of these anomalies with disorders in the ontogenetic development of the veins of the neck. Knowing the variants of origin, course and drainage area of jugular veins is important not only for the anatomist but also for the surgeon operating at this level.

The importance of CT scan in the clinical-morphological and anatomical assessment of mediastinal lymphomas.

The study points out the value of CT scan in the investigative algorithm of mediastinal lymphomas. Thirty-eight cases of mediastinal malignant lymphoma were evaluated in a statistical retrospective study. CT scan was used for staging the disease in 25 cases and for post-therapeutic evaluation in the other 13 cases. The CT scan for staging purpose has shown the presence of significant isolated and confluent enlarged lymph nodes in the mediastinum in all 25 cases. Post-therapeutic evaluation of the 13 cases examined by CT showed six remissions, five reductions of lymph node masses and two extra nodal extensions. CT scan is the imaging method of choice in the clinico-morphological and anatomical assessment of mediastinal lymphomas.

The construction of human body--from model to reality.

The human body building represented a complex research topic for the scientist in the most diverse domains. Although their interests and reasons were different, the goal was always the same: establishing a relation to verify the ratio between the dimensions of the constituent segments It appears that the mystery was solved out in the XIX-th century by Adolf Zeising, a German, who, using the statistic calculus, defined the division of a segment by the gold section. This purely mathematic logic confirms the human body's integration in proportion to the finest segments, thus providing the technical instrument of building a fully harmonious human body. The present study aims to compare the ideal, the calculated perfection to the reality, namely the theoretically obtained values to the average values of an 18-year-old male. It appears that the differences refer especially to the limbs; both the superior ones and the inferior ones being longer comparing to the ideal pattern while the bust is shorter and broader.

Correlations between the colic branches of the mesenteric arteries and the vascular territories of the colon.

The study, done on 100 corpses from the dissection rooms of anatomy laboratory, hinted the morphological variability of the colic arteries and their territories. Morphological variability of the colic branches derived from the mesenteric arteries (superior right colic artery -- 98%; middle right colic artery -- 88%; inferior right colic artery -- 100%; middle colic artery - 36%; superior left colic artery -- 100%; middle left colic artery -- 50%; inferior left colic artery -- 100%) allows us to give out a morphogenetic supposition related their ramification and number. Analyze of the results guide us to a tentative of setting down the vascular territories of the colon. In the beginning were established the territories of the mesenteric arteries (superior and inferior) and after that, were marked the subterritories for each colic artery. Establishing the vascular territories of the colic arteries have not only anatomical importance but also a surgical one, been known the difficult postoperatory colon's revitalization.

Embryonic hematopoietic stem cells and interstitial Cajal cells in the hindgut of late stage human embryos: evidence and hypotheses.

There have been few studies on human embryos describing a specific pattern of hindgut colonization by hematopoietic stem cells (HSCs) and interstitial Cajal cells (ICCs). We aimed to study CD34, CD45 and CD117/c-kit expression in late stage human embryos, to attain observational data that could be related to studies on the aorta-gonad-mesonephros (AGM)-derived HSCs, and data on hindgut ICCs. Antibodies were also applied to identify alpha-smooth muscle actin and neurofilaments. Six human embryos of 48-56 days were used. In the 48 day embryo, the hindgut was sporadically populated by c-kit+ ICCs, but, in all other embryos, a layer of myenteric ICCs had been established. Intraneural c-kit+ cells were found in pelvic nerves and vagal trunks, suggesting that the theory of Ramon y Cajal assuming that ICCs may be primitive neurons may not be so invalid. Also in the 48 day embryo, c-kit+/CD45+ perivascular cells were found along the pelvic neurovascular axes, suggesting that not only liver, but also other organs could be seeded with HSCs from the AGM region. CD45+ cells with dendritic morphologies were found in all hindgut layers, including the epithelium. This last evidence is suggestive of an AGM contribution to the tissue resident macrophages and could be related to processes of sprouting angiogenesis which, in turn, have been found to be guided by filopodia of endothelial tip cells. Further studies on human embryonic and fetal material should be performed to attempt to clarify whether the hindgut colonization with HSCs is a transitory or definitive process.

Preliminary results of orthotopic en bloc uterus and ovary transplantation in the laboratory rat.

A new experimental model of whole uterus and ovary transplantation in the laboratory rat was achieved. The main goals of this study were concerned with developing and standardizing the microsurgical technique of uterus transplantation in rats and observing the particular cellular patterns of acute allograft rejection at the level of the transplanted graft. Thirty-five orthotopic uterus transplantations were performed. An additional 20 female rats were used for dissection training sessions. Recipients were euthanasied at 24 hours, 48 hours and 72 hours. Immediate postoperative survival was 100%. Patency of the microsurgical anastomoses, checked at 24 hours, was 100%. At 72 hours thrombosis occurred in all anastomoses. The explanted uterine grafts were fixed in formaline and analyzed under light microscopy and specific imunohistochemical analysis. The acute allograft rejection has a particular cellular reaction pattern, probably due to the unique diversity of the tissues that compose it. Inflammatory cells like LTCD8+, LBCD20+ and mastocytes tend to agglomerate in the vicinity of nervous and vascular structures, showing no signs of lymphoid tissue disposition like in typical acute rejection. Uterus transplantation in rats has proven to be a valid experiment that allows us to express hope that by further research on transplantation of the uterus gynecologists will be able to introduce an adapted technique in the treatment of specific cases of human female infertility.