Internal thoracic artery: sternal branches and their importance in thoracic surgery

In surgical myocardial revascularization using both ITAs occurs a decrease in blood supply to the sternum andit is one of the causes of postoperative mediastinitis. Our study focused the sternal branches, from these ITAs,which are responsible for maintaining blood supply of the sternum after bilateral use of internal thoracic arteryin myocardial revascularization. 60 internal faces of the anterior chest wall were dissected and formaldehydepreserved. The study consisted of 28 females and 32 males, the trunks and their branches were measuredand photographed and statistical tests were applied. The most dissected sternal trunks found in 120 internalthoracic artery were the intercostal/sternal and the perforating/sternal. The preservation of these trunks isneeded to prevent any disorder of the sternum.

Coronary artery connection: cone trunk sharks varieties anatomy study (Selachians) / Conexión de la arteria coronaria: estudio de las variedades anatómicas del cono tronco en tiburones (Selachians)

Due to our interest in clarifying the congenic problems at the origin of the coronary arteries, we have published in the early 70´s a theory (Borges et al., 1974) in which the coronary arteries would be the last pair of aortic arches that, at the beginning of the embryogenesis, would be connected with the previous arch, trunk of the lung's artery through a duct which we named "ductus coronarius".

Debido a nuestro interés en aclarar los problemas congénicos en el origen de las arterias coronarias, hemos publicado a principios de los años 70 una teoría (Borges et al., 1974) en que las arterias coronarias serían el último par de arcos aórticos que, en el comienzo de la embriogénesis, estarían conectadas con el arco anterior, tronco de la arteria pulmonar a través de un conducto que hemos llamado "conducto coronario".

Innervation of the abductor digiti minimi muscle of the human foot: anatomical basis of the entrapment of the abductor digiti minimi nerve.

The origin, relationships and innervation of the abductor digiti minimi muscle were determined in 145 human feet, from formaldehyde-fixed cadavers. The muscle arises from both processes of the calcaneal tuberosity, from the plantar aponeurosis and from the septum which separates it from the flexor digitorum brevis muscle. The nerve to the abductor digiti minimi muscle arises next to the origin of the lateral plantar nerve, close to the abductor hallucis muscle, and descends becoming closely related to the medial face of the calcaneus and the deep face of the abductor hallucis muscle. Then, it passes inferiorly through the origin of the quadratus plantae muscle and later divides into two branches for the two heads of the muscle.

Anatomical variations of the occipital artery: relate of two casesc

Due to the great importance of the knowledge about variations occurring in the vascular system to surgeons and professionals who work with imaging, we describe in this article a variation of the origin of the occipital artery. 110 cadavers of male and female individuals had they carotid vascular tree in the region of the neck carefully dissected using loupe magnification and its origin and course were measured as well as a simple diameter. This artery usually branches off from the posterior part of the wall of the external carotid artery at the same level of the facial artery branching however, the two cases presented showed the occipital artery branching off very close to the carotid bifurcation, which characterize it as a trifurcation instead. The occipital artery branching off too close to the carotid bifurcation is a rarity as demonstrated by our results and the its literature is insufficient.

The deep plantar arch in humans: constitution and topography.

The integrity of the various structures within the feet depends on their blood supply. Lesions of the feet often require revascularization, which if successful avoids the need for amputation. To provide greater anatomical detail to aid vascular surgery and imaging, the anatomy and constitution of the deep plantar arch was studied in 50 adult cadaveric feet. The arteries of the foot were injected with red neoprene latex and dissected under magnification. The deep plantar arch, present in all feet, was the result of anastomosis between the deep plantar artery and the deep branch of the lateral plantar artery. The deep plantar artery was predominant in 72% of specimens (Type I arches) and the lateral plantar artery in 22% (Type II), with the contribution being equal in 6% (Type III). The medial plantar artery contributed to the medial segment of the deep plantar arch by its deep branch in 12% of specimens. The distance between the deep plantar arch and each interdigital commissure was generally constant, averaging 29% of total foot length. The deep plantar arch was located in the middle third of the foot in all specimens, being in the distal part of this third in 90%. The deep plantar arch is, therefore formed mainly by the deep plantar artery, a branch of the dorsal artery of foot; its location can be estimated if foot length is known.

Anatomic study of the tricuspid valve in children.

We performed an anatomic study of the right atrioventricular valve in children under one year of age using a conservative method of dissection of the heart valve. The main aspects studied were the number of cusps and their morphometric characteristics, such as the width of the base and the depth of the cusps. Other parameters studied were the number of papillary muscles, number of tendinous cords, and diameter of the fibrous ring and the last one were divided in three regions, anterior, posterior and septal for localization of cusps. Our results showed that the number of cusps varied from two to four. Three cusps was the commonest finding and the fourth cusp, if present, was classified as anterolateral in location. The anterior and septal cusps had bases bigger than those of the posterior and anterolateral cusps; the septal cusp was deeper than the others; and the number of tendinous cords was greater for the anterior and septal cusps than for the posterior and anterolateral cusps. In addition, the posterior region showed great variability: in 35.7% it was occupied by undeveloped valve tissue and the posterior valve in these cases was located anteriorly.

Unilateral absence of the thoracic part of the trapezius muscle.

The absence of some muscles, such as pectoralis major, serratus anterior and quadratus femoris have been described, however the absence of trapezius, either in isolation or in association with other structures, is not often observed. In this case study, we present a case of partial absence of the left trapezius muscle in an adult black male cadaver, which had a large aponeurosis replacing the ascending fibres and some of the transverse fibres of the muscle. Histological analysis showed the presence of a few muscle fibres in the aponeurosis. From a functional viewpoint, it is possible that this individual would have had difficulty in moving his shoulder, especially during flexion, abduction and circumduction of the arm.

Deep palmar arch patterns in Brazilian individuals.

The deep palmar arch is very important in the blood supply to the hand. Consequently, the radial artery and the deep palmar arch were studied in 60 hands from 30 cadavers of adult Brazilian individuals, of both sexes. The cadavers belong to the Universidade Federal de São Paulo, Brazil. The hand arteries were injected with red stained latex neoprene: the deep palmar arch was observed in 59 preparations (98.3%). The arch conformation was classified in two groups, according to the course of the radial artery through the interosseous spaces from the dorsal to the deep palmar region. In group I the radial artery passed through the first interosseous space, and was observed in 51 preparations (85.0%); in group II, the artery passed through the second interosseous space, and was observed in 8 preparations (13.3%). In each group the arches were subdivided according to the number and origin of the deep palmar branch. In group I the arch was formed by the radial artery anastomosing with one deep palmar branch in 41 cases (68.3%), and with two deep palmar branches in 10 cases (16.7%). These branches originated from the ulnar artery, ulnar proper palmar digital artery of the little finger or the common palmar digital artery of the fourth interosseous space. In group II the deep palmar arch was formed by the radial artery anastomosing with one deep palmar branch in 7 cases (11.7%) and in only one case (1.7%) with two deep palmar branches. Knowledge of the arterial variations is very important for surgical procedures in the palmar region.

Perforating branches: important contribution to the formation of the dorsal metacarpal arteries.

The perforating branches that originate from the deep palmar arch of the hand have been studied to provide a complete anatomical description of these vessels and assess their importance in the blood collateral pathway of the hand. We injected latex into the arteries of 50 cadaveric hands of 25 adults, of both sexes, all of Brazilian origin. These were dissected under a stereoscopic microscope. The perforating branch of the second interosseous space originated from the deep palmar arch in 80% of the cases, and it corresponded to the radial artery passing through the second space in 16%; the one of the third interosseous space originated from the deep palmar arch in 76% of the cases and from the palmar metacarpal artery of the third interosseous space in 16%; the one of the fourth interosseous space originated from the deep palmar arch in half the cases, from the deep palmar branch of the ulnar artery in 14%, and from the palmar metacarpal artery of this space in 18%. The perforating branch of the second space anastomosed with the second dorsal metacarpal artery (DMA) in 60% of the cases and formed it in 10%; the one of the third space anastomosed with the third DMA in 20% and formed it in 64%; the one of the fourth space anastomosed with the fourth DMA in 8% and formed it in 78%. These vessels are an important anastomotic pathway between the dorsal carpal network and the deep arteries of the hand and are important in the supply to the dorsum.

A biometric study on the relationships between the deep palmar arch and the superficial palmar arch, the distal wrist and palmar creases.

The topographical localisation of the palmar arches is important in hand surgery. The aim of this study was to contribute with biometric data on their positions and to correlate this with the size od the palm. We studied 60 hands of 30 adult fixed cadavers, of Brazilian origin, from both sexes and between the ages of 21 and 70 years. The arteries of 54 hands were injected with latex Neoprene. Before dissection the distance between distal wrist crease (DWC) and the proximal palmar digital crease of the middle finger (PDMC) was measured. Also, we recorded the distance between the DWC and the proximal and distal palmar creases (PPC, DPC). After dissecting the superficial palmar region, the distance between the superficial palmar arch (SPA) and the DWC was recorder. We then dissected the deep palmar arch (DPA). The average distance between the DPA and DWC was always measured in the midline of the palm. The average distance DWC-DPA was 33.7 +/- 2.6 mm in the female and 36 +/- 4.0 mm in the male. The difference was statistically significant. The average distance between DPA and the PPC was 24.2 +/- 3.0 mm in the female and 27.1 +/- 4.1 mm in the male; this difference was significant. In 83% of cases the DPA was proximal to the SPA and in 14.9% was distal to it. The linear regression test for the relation between DWC-PDMC and DWC-DPA was significant in the male and this fact allowed us to obtain the linear equation to predict the distance DWC-DPA. Other parameters were also considered. The results may be useful as a reference to radiologists as well as to surgeons.

Surgical anatomy of the internal thoracic artery.

BACKGROUND: The internal thoracic artery (ITA) has become increasingly important in coronary artery bypass grafting due to the excellent long-term results. This study reviews its anatomic characteristics. METHODS: The ITAs of 100 cadavers were examined and their origin, relation to the phrenic nerve, presence of lateral costal branch; origin of pericardiacophrenic arteries, length, level and type of ITA termination, relation with the transverse muscle of thorax, collateral parietal branches, and distance between the ITA and sternal margins were studied. RESULTS: The ITA was present in all cases, originating directly from the subclavian artery or from a common trunk with other arteries. Its length was 20.4 cm on average, and the most frequent level of termination was at the sixth intercostal space, existing as a bifurcation in 93% and as a trifurcation in 7%. The pericardiacophrenic artery originated from the ITA in 89%. The lateral costal branch was present in 15% of the cases. The ITA was covered by the transverse muscle of the thorax for 7.5 cm (average) and was crossed anteriorly by the phrenic nerve in 70.0%. CONCLUSIONS: Information provided by this study may contribute to knowledge of its anatomic characteristics and in turn help prevent complications in ITA dissections.

Morphometry and acetylcholinesterase activity of the myenteric plexus of the wild mouse Calomys callosus.

The myenteric plexus of the digestive tract of the wild mouse Calomys callosus was examined using a histochemical method that selectively stains nerve cells, and the acetylcholinesterase (AChE) histochemical technique in whole-mount preparations. Neuronal density was 1,500 +/- 116 neurons/cm2 (mean +/- SEM) in the esophagus, 8,900 +/- 1,518 in the stomach, 9,000 +/- 711 in the jejunum and 13,100 +/- 2,089 in the colon. The difference in neuronal density between the esophagus and other regions was statistically significant. The neuron profile area ranged from 45 to 1,100 microns2. The difference in nerve cell size between the jejunum and other regions was statistically significant. AChE-positive nerve fibers were distributed within the myenteric plexus which is formed by a primary meshwork of large nerve bundles and a secondary meshwork of finer nerve bundles. Most of the nerve cells displayed AChE activity in the cytoplasm of different reaction intensities. These results are important in order to understand the changes occurring in the myenteric plexus in experimental Chagas' disease.

Morphometry and acetylcholinesterase activity of the myenteric plexus of the wild mouse Calomys callosus

The myenteric plexus of the digestive tract of the wild mouse Calomys callosus was examined using a histochemical method that selectively stains nerve cells, and the acetylcholinesterase (AChE) histochemical technique in whole-mount preparations. Neuronal density was 1,500 + 116 neurons/cm2 (mean + SEM) in the esophagus, 8,900 + 1,518 in the stomach, 9,000 + 711 in the jejunum and 13,100 + 2,089 in the colon. The difference in neuronal density between the esophagus and other regions was statistically significant. The neuron profile area ranged from 45 to 1,100 mum2. The difference in nerve cell size between the jejunum and other regions was statistically significant. AChE-positive nerve fibers were distributed within the myenteric plexus which is formed by a primary meshwork of large nerve bundles and a secondary meshwork of finer nerve bundles. Most of the nerve cells displayed AChE activity in the cytoplasm of different reaction intensities. These results are important in order to understand the changes occurring in the myenteric plexus in experimental Chagas' disease.

Median artery and superficial palmar branch of the radial artery in the carpal tunnel.

In the carpal tunnel there are the flexor muscle tendons, their sheaths, and the median nerve. Because its walls are inflexible, any thickening of its components that reduce its area may compress the median nerve. There are many reasons for nerve compression, including persistence of the median artery into adult life. We dissected the arteries in the carpal tunnel of 102 hands of 51 adult cadavers of both sexes, age range 23-77 years, and injected latex into 42 hands. In the carpal tunnel we sought the median artery and the superficial palmar branch of the radial artery. We found the median artery in 23 of 102 cases (23%), and its calibre ranged from 0.7 to 2.7 mm, mean (SD) 1.6 (0.5) mm. In 16 cases it made up part of the superficial palmar arch. The superficial palmar branch of the radial artery was partly responsible for the distal irrigation of the hand in 48 cases (47%); and in three hands (3%) it passed through the carpal tunnel. The external diameters of these vessels were 1.8, 1.9, and 1.8 mm, respectively. These arteries might cause compression of the median nerve and consequently the carpal tunnel syndrome.

Abnormal extrapelvic course of the inferior gluteal artery.

At its extrapelvic course the inferior gluteal a. is found to be strictly related to the sciatic n. This relationship has been described in a general way, emphasizing its medial localization in respect to the nerve. Clinicosurgical reports describe cases of aneurysms of the inferior gluteal a. on its extrapelvic course and subsequent compression at the nerve. In order to get further details on the relationship between these two structures, 80 gluteal regions from 40 cadavers of adult Brazilian individuals, 29 males and 11 females, were dissected. The inferior gluteal a. was found medial to the sciatic n. in 62 cases (77.5%); in the 18 remaining (22.5%) the trunk of the artery or one of its branches perforated the nerve. Of these, 14 (77.8%) were males and 4 (22.2%) females. This disposition was found 8 times (44.4%) on the right and 10 (55.6%) on the left side; was unilateral in 4 individuals (1 on the right and 3 on the left side) and bilateral in 7. The course of the inferior gluteal a. through the sciatic n. and/or the presence of aneurysms of this artery should be considered as a possible cause of nerve compression.

Morphometric studies of the muscular branch of the median nerve.

The branch from the median nerve to the thenar muscles has a proximal and lateral (recurrent) course and is vulnerable to lesions that affect these muscles. Because of its anatomical-clinical importance, this branch was studied in 60 palmar regions from 30 cadavers of adult individuals of both sexes, aged between 23 and 77 y. It arose from the lateral branch of the median nerve in 83.3% of the cases. Its origin was distal to the flexor retinaculum in 48.3%, at the distal margin of the retinaculum in 31.6%, in the carpal tunnel in 18.3% and proximal to the retinaculum in 1.7%; it pierced the retinaculum in 15%. The point of recurrence of the branch was localised topographically to 34.6 +/- 3.6 mm from the distal wrist crease; the angle between its recurrent course and the longitudinal axis of the hand averaged 66.8 degrees. In 50% of the cases the muscular branch innervated abductor pollicis brevis (APB), opponens pollicis (OP) and the superficial head of flexor pollicis brevis (FPB), in 40% it supplied only APB and OP, and in 10% a short muscular branch gave rise to independent branches in the palm and which supplied APB, OP and the superficial head of FPB. The so called "accessory thenar branch' was found in 38.3%.

Abnormal course of the superficial palmar branch of the radial artery.

The structures in the carpal tunnel are the flexor muscle tendons and their sheaths and the median n. Due to the inflexibility of its walls, any swelling of its contents that produces decrease of its volume, may compress the median n. There are many possible causes of nerve compression, such as the presence of arteries in this tunnel [3, 13]. The carpal tunnels of 70 hands of 35 adult cadavers of both sexes, whose age ranged from 23 to 77 years, were studied by dissection. An abnormal course of the superficial palmar branch of the radial a. was found in 2 hands (2.85%). This vascular branch passed through the carpal tunnel. This unusual course of the superficial palmar branch of the radial a. is described with details correlating its presence in the carpal tunnel with the median n.

Distribución arterial en la fisura horizontal del cerebelo / Arterial distribution in the horizontal fissure of cerebellum

Se efectuó un estudio anatómico mesoscópico de la distribución arterial en la fisura horizontal del cerebelo, considerando el lado, sexo y otros parámetros generalmente no considerados en la literatura, como son: grupo étnico (GE) e índice cefálico-horizontal (IC). Esta investigación, se basó en la observación de 70 encéfalos de individuos brasileños, adultos, de ambos sexos provenientes del Servicio de Verificación de Obitos de la Escola Paulista de Medicina, UNIFESP, Sao Paulo, Brasil. Además, se efectuó un Registro Antropológico para cada individuo y las mediciones cefálicas fueron hechas de acuerdo a técnicas específicas, para su clasificación según el IC. Los encéfalos fueron retirados, inyectados por látex neopreno coloreado de rojo y fijados según técnicas anatómicas. En nuestras observaciones, la fisura horizontal del cerebelo, se encontraba irrigada en el 54,8 por ciento por la rama lateral (RL) de la arteria cerebelar superior (ACS) en el lado derecho, en los encéfalos de sexo masculino y en el 28,6 por ciento en el femenino; en el 48,9 por ciento en los caucásicos y en el 36.0 por ciento en los no-caucásicos; en el 50.0 por ciento en los dólico-mesocéfalos (DM) y en el 39.54 por ciento en los braquicéfalos (BH). En el lado izquierdo, la fisura horizontal cerebelar se encontraba irrigada por la RL en el 42.4 por ciento en el sexo masculino y en 57.1 por ciento en el sexo femenino; 51.1 por ciento en el grupo caucásico y en el 50.0 por ciento en los no-caucásicos; en el 50.0 por ciento en los DM y en 57.9 por ciento en los BH

The arterial supply of the nodus sinuatrialis in bovine Gir

A irrigaçäo da área do nó sinoatrial foi estudada em 50 coraçöes de fêmeas de bovinos da raça Gir, após injeçäo das artérias coronárias com Neoprene-látex. A área nodal, com muita frequência (72 por cento dos casos) foi irrigada pela a. coronária esquerda, sendo 58 por cento pelo ramus circumflexus sinister e 14 por cento por outros ramos. O r. proximalis atrii sinistri irrigava a área nodal isoladamente (42 por cento) ou associado com o r. intermedius atrii dextri (2 por cento) ou com r. distalis dexter (2 por cento) ou com um colateral do r. ventricularis dexter (2 por cento). Numerosas anastomoses foram encontradas entre os ramos que irrigavam a área nodal. Pela primeira vez foi descrito, em coraçöes de bovinos, ramos átrio-ventriculares das artérias coronárias