Arterio-venous Anastomoses of the Sucquet-Hoyer Type: Complexity and Distribution in the Human Dermis.

Our study aims at providing detailed information on numbers, form, and spatial distribution of arterio-venous anastomoses of the Sucquet-Hoyer type in the dermis of the nail bed, nail fold corner, thumb pad, arm, nose, glabella, lip, and ear. It further aims at providing a system, which relies on objective morphologic criteria for classifying Sucquet-Hoyer canals (SHCs). Using high-resolution episcopic microscopy (HREM), digital volume data of eight samples of each skin region were produced. Virtual three-dimensional (3D) models of the dermally located SHCs were created, and their 3D tortuosity (τ) values were determined. Dermal SHCs were identified in all 24 finger samples and in 1 lip sample. Beneath a field of 2 × 2 mm2, an average of four were located in the nail bed, three in the dermis of the thumb pad, and one in the dermis of the nail fold corner. Only a single dermal SHC was found in one lip sample. No SHCs were observed in the dermis of the other samples. The τ values of the SHCs ranged from 1.11 to 10. Building on these values, a classification system was designed, which distinguishes four SHC classes. The dermal distribution of the SHCs of different classes was similar in all specimens.

Anastomosis Patterns between the Median and Ulnar Nerves in the Upper Limbs

There are four types of anastomoses between themedian and ulnar nerves in the upper limbs. It consists of crossings of axons that produce changes in the innervation of the upper limbs, mainly in the intrinsic muscles of the hand. The forearm has two anatomical changes ­ Martin-Gruber: branch originating close to the median nerve joining distally to the ulnar nerve; and Marinacci: branch originating close to the ulnar nerve and distally joining the median nerve. The hand also has two types of anastomoses, which are more common, and sometimes considered a normal anatomical pattern ­ Berrettini: Connection between the common digital nerves of the ulnar and median nerves; and Riche-Cannieu: anastomosis between the recurrent branch of the median nerve and the deep branch of the ulnar nerve. Due to these connection patterns, musculoskeletal disorders and neuropathies can be misinterpreted, and nerve injuries during surgery may occur, without the knowledge of these anastomoses. Therefore, knowledge of them is essential for the clinical practice. The purpose of the present review is to provide important information about each type of anastomosis of the median and ulnar nerves in the forearm and hand.

Implication of the inferolateral trunk of the cavernous internal CAROTID artery in cranial nerve blood supply: Anatomical study and review of the literature.

The inferolateral trunk (ILT) is one of the two more common branches of the cavernous internal carotid artery (ICA). Its knowledge is important for skull base surgery and endovascular interventional procedures. The ILT is described with superior, anterior and posterior branch, which is the complete form. These branches vascularize the oculomotor, trochlear, trigeminal and abducens nerves into the cavernous sinus and superior orbital fissure (SOF) courses, and through the foramens rotundum and ovale. We performed 21 injected embalmed cadaveric dissections combined with six specimen tomodensitometry. The ILT originates from the horizontal ICA segment and passes above the abducens nerve. Three branches arise from the ILT between the cavernous ICA and the ophthalmic and maxillary nerves initial courses. The main differences with the literature are the number of branches and their cranial nerves' blood supply. The more frequent ILT conformation is the incomplete form with anterior and posterior branch (13/21); the complete form is present in 5/13 sides (38%) and the ILT is in common with the meningohypophyseal trunk in 3/21 (14%) sides. The anterior branch always vascularizes the cranial nerves into the SOF course and most often the maxillary nerve through the foramen rotundum. The posterior branch always vascularizes the mandibular nerve through the foramen ovale course and sometimes the maxillary nerve. This study has demonstrated that there are anastomoses between these branches and arteries arising from the external carotid. This study explains why the sacrifice of a branch of the ILT does not implicate cranial nerve palsy.

Glomus coccygeum: a review.

With limited information about the coccygeal glomus found in classic textbooks, we deemed it necessary to review the subject. The illustrations presented in this article derive from four coccygeal glomera incidentally encountered during examination of pilonidal disease specimens. Familiarization with its microanatomical features may help to avoid inappropriate interpretation of this enigmatic structure.

Variação nos tipos de irrigação do nodo sinoatrial em cães de diferentes raças / Variation in irrigation of the sinoatrial node in dogs of different breeds

Considerando a heterogeneidade anatômica e eletrofisiológica do nodo sinoatrial para a geração e propagação do potencial de ação, bem como as particularidades relacionadas a origem da sua irrigação sanguínea, este trabalho teve como objetivo analisar o comportamento das artérias envolvidas na irrigação do nodo sinoatrial em cães realizando uma análise descritiva e comparativa entre diferentes raças estudadas, detalhando a origem, o percurso e a ramescência dos vasos, assim como a eventual ocorrência de anastomoses. Ao todo analisamos resultados obtidos em 240 corações, os quais foram fixados em solução de formalina 10% e submetidos a diafanização de Spalteholz. A irrigação deste ocorre mediante colaterais oriundos do ramo circunflexo direito ou ramo circunflexo esquerdo, mostrando particularidades diferentes para cada raça. Assim, predominantemente, nas raças ora estudadas a irrigação arterial do nodo sinoatrial depende exclusivamente (63,6%), ou de anastomoses de colaterais da artéria coronária direita, havendo também participação dos ramo proximal atrial direito e intermédio atrial direito. Menos frequentemente (15,4%) o suprimento sanguíneo ocorre exclusivamente por conta do ramo proximal atrial esquerdo, oriundo do ramo circunflexo da artéria coronária esquerda. Os dados aqui apresentados sobre a origem da irrigação sanguínea do nodo sinoatrial e a ramescência dos vasos envolvidos nesta tarefa representam conhecimento fundamental para o desenvolvimento da clínica-cirúrgica em cães, da patologia e trabalhos de natureza experimental.(AU)

Considering the anatomical and electrophysiological heterogeneity of the sinoatrial node for generation and propagation of the action potential, as well as the particularities relating to the origin of blood nutrition, this study aimed to analyze the behavior of arteries involved in irrigation of the sinoatrial node in dogs performing a descriptive and comparative analysis between different breeds, with emphasis in the origin, pathway and branching of vessels, as well as the presence of anastomoses. Totally, 240 hearts were fixed in solution of formalin 10% and subjected to Spalteholz diaphanization. The vascularization of the sinoatrial node occurs by the right circumflex branch or left circumflex branch, showing several particularities according to the breed. Thus, predominantly in the studied breeds, the blood supply of the sinoatrial node depends exclusively (63.6%) or from anastomosis of the right coronary artery. There is also participation of right atrial proximal branch and right atrial intermediary branch. Less often (15.4%) the blood supply occurs exclusively from the left atrial proximal branch, which is a branch of the circumflex branch of the left coronary artery. In summary, our results related to the origin of the sinoatrial node blood nutrition and the branching of vessels involved on that represents a fundamental knowledge for the development and improvement of surgery in dogs, as well as for pathology and experimental research.(AU)

The Functional Angiosome: Clinical Implications of the Anatomical Concept.

BACKGROUND: The angiosome is a three-dimensional block of tissue supplied by a source vessel with its boundary outlined either by an anastomotic perimeter of reduced-caliber choke vessels or by true anastomoses with no reduction of vessel caliber. This article focuses on the role of these anastomotic vessels in defining flap survival or the necrotic pattern seen in fulminating meningococcal septicemia. METHODS: Experiments in pigs, dogs, guinea pigs, and rabbits over the past 46 years were reviewed, focusing on the necrosis line of flaps, the effects of various toxins in vivo, and correlating these results in the clinical setting. RESULTS: Experimentally, choke anastomoses are functional and control flow between perforator angiosomes. They (1) permit capture of an adjacent angiosome when the flap is raised on a cutaneous perforator in 100 percent of cases, with the necrosis line occurring usually in the next interperforator connection; (2) confine flow to the territory of the involved artery when a toxin is introduced by spasm around its perimeter; and (3) lose this property of spasm when choke vessels are converted to true anastomoses following surgical delay, or where true anastomoses occur naturally, thereby allowing unimpeded blood flow and capture of additional angiosome territories. Clinical experience supports these observations. CONCLUSIONS: The functional angiosome is the volume of tissue that clinically can be isolated on a source vessel. The area extends beyond its anatomical territory to capture an adjacent territory if connections are by choke anastomoses, or more if they are by true anastomoses.

A prospective clinical assessment of anatomic variability of the submental vascularized lymph node flap.

INTRODUCTION: The vascularized submental lymph node (VSLN) flap has become a popular choice for the treatment of lymphedema. Despite its favorable characteristics, anatomic variability exists, making the harvest of this flap challenging. Knowledge and characterization of anatomic variability can aid the surgeon in safe and effective flap harvest. METHODS: A prospective analysis of all patients who underwent VSLN flap transfer for lymphedema was performed. Demographics, operative details, and post-operative recovery were analyzed for included patients. Intraoperative videography and detailed anatomic drawings of each case were reviewed to accurately account for anatomic variability and details. RESULTS: Forty-two patients were identified during the study period. Arteriovenous anatomic variability (A1-A2 and V1-V4) existed, with most patients having the artery and vein present superior to the submandibular gland (A1V1; 31%), with other combinations occurring less frequently. Flap harvest time was found to be significantly increased with an intraglandular arterial course (P < 0.01). CONCLUSIONS: The VSLN flap can be safely and effectively harvested with knowledge of arteriovenous anatomic variability. Most commonly, the artery and vein travel together superior to the submandibular gland, but other variations exist, which may add time to surgical flap harvest and increased need for dissection. J. Surg. Oncol. 2017;115:43-47. © 2017 Wiley Periodicals, Inc.

Evaluación de la arteria alveolo-antral mediante tomografía volumétrica en población mexicana y su relación con levantamiento del piso del seno maxilar / CBCT evaluation of the alveolar antral artery in a mexican cohort and its relationship to maxillary sinus floor lifting

Introducción: El conocimiento de la anatomía de la región maxilar debe ser esencial para el cirujano antes de realizar levantamiento del seno maxilar para evitar complicaciones. La arteria alveolo antral forma una anastomosis intraósea con la arteria infraorbitaria a nivel de la pared antero lateral del seno maxilar, aproximadamente a una distancia de entre 18.9 y 19.6 mm desde el reborde alveolar maxilar. La arteria alveolo antral es la encargada de dar vascularidad a la membrana mucosa del seno maxilar, pared antero lateral del seno y tejido perióstico subyacente.Objetivo: Describir y establecer la frecuencia, diámetro y localización dela anastomosis entre la arteria infraorbitaria y la arteria alveolar posterior superior, llamada arteria alveolo antral y su relación con la cresta ósea alveolar en una población mexicana. Material y métodos: Se realizaun protocolo de estudio observacional, descriptivo y transversal en una población de 1,116 pacientes derecho habientes del Instituto de Seguridad Social y Servicios para los Trabajadores del Estado (ISSSTE), en el oriente de la Ciudad de México, mediante la revisión de estudios de tomografía volumétrica computarizada. Resultados: Se encuentra la anastomosis arterial en el 90 por ciento de los estudios revisados, correspondiente a 1,005 estudios de tomografía.

Introduction: In order to avoid complications, it is essential for surgeonsto have a detailed knowledge of the anatomy of the superior maxillarybone prior to performing any sinus lift procedure. The alveolarantral artery forms an intraosseous anastomosis with the infraorbitalartery at the level of the anterolateral wall of the maxillary antrum at anapproximate distance of between 18.9 and 19.6 mm from the maxillaryalveolar ridge. The alveolar antral artery is responsible for providingvascularity to the mucous membrane of the maxillary sinus, the anteriorlateral wall of the sinus, and the underlying periosteal tissue. Objective:To analyze and establish the frequency, diameter, and locationof the anastomosis between the infraorbital artery and the posteriorsuperior alveolar artery known as the alveolar antral artery, and itsrelationship to the alveolar bone crest in a Mexican cohort. Materialand methods. We conducted a cross-sectional observational descriptivestudy involving a cohort comprised of 1,116 patients of the Institute forSocial Security and Services for State Workers (ISSSTE) on the eastside of Mexico City. The study consisted of a review of CBCT studies.Results: The arterial anastomosis was found in 90% of the 1,005 CBCTstudies reviewed, based on which the following values were determinedfor the distance between the alveolar ridge and the canal of the alveolarantral artery: for the fi rst premolar, 18.24 mm; second premolar,17.35 mm; fi rst molar, 16.96 mm, and for the second molar, 18.75 mm.Conclusions: We established the average measurements for the locationof the vascular bundle in question and the measurements neededto safeguard it along its course, which is important for the preservationand osseointegration of bone grafts placed during maxillary sinus liftprocedures, thus providing a margin of safety not previously reportedin the literature for a Mexican cohort.

Clinical repercussions of Martin-Gruber anastomosis: anatomical study / Repercussões clínicas da anastomose de Martin-Gruber: estudo anatômico

OBJECTIVE: The main objective of this study was to describe Martin-Gruber anastomosis anatomically and to recognize its clinical repercussions. METHOD: 100 forearms of 50 adult cadavers were dissected in an anatomy laboratory. The dissection was performed by means of a midline incision along the entire forearm and the lower third of the upper arm. Two flaps including skin and subcutaneous tissue were folded back on the radial and ulnar sides, respectively. RESULTS: Nerve communication between the median and ulnar nerves in the forearm (Martin-Gruber anastomosis) was found in 27 forearms. The anastomosis was classified into six types: type I: anastomosis between the anterior interosseous nerve and the ulnar nerve (n = 9); type II: anastomosis between the anterior interosseous nerve and the ulnar nerve at two points (double anastomosis) (n = 2); type III: anastomosis between the median nerve and the ulnar nerve (n = 4); type IV: anastomosis between branches of the median nerve and ulnar nerve heading toward the flexor digitorum profundus muscle of the fingers; these fascicles form a loop with distal convexity (n = 5); type V: intramuscular anastomosis (n = 5); and type VI: anastomosis between a branch of the median nerve to the flexor digitorum superficialis muscle and the ulnar nerve (n = 2). CONCLUSION: Knowledge of the anatomical variations relating to the innervation of the hand has great importance, especially with regard to physical examination, diagnosis, prognosis and surgical treatment. If these variations are not given due regard, errors and other consequences will be inevitable.

OBJETIVOS: Descrever anatomicamente a anastomose de Martin-Gruber e reconhecer suas repercussões clínicas. MÉTODO: Foram dissecados 100 antebraços de 50 cadáveres adultos no laboratório de anatomia. A dissecção foi feita através uma incisão mediana em todo o antebraço e terço inferior do braço, dois retalhos incluindo a pele e subcutâneo foram rebatidos, para o lado radial e ulnar respectivamente. RESULTADOS: A comunicação nervosa entre os nervos medianos e ulnar no antebraço (anastomose de Martin-Gruber) foi registrada em 27 antebraços. Classificamos a anastomose em seis tipos. Tipo I: anastomose entre o nervo interósseo anterior e o nervo ulnar (nove membros); Tipo II: anastomose entre o nervo interósseo anterior e o nervo ulnar em dois pontos (dupla anastomose - dois membros); Tipo III: anastomose entre o mediano e o nervo ulnar (quatro membros); Tipo IV: anastomose entre ramos dos nervos mediano e ulnar destinada ao músculo flexor profundo os dedos, esses fascículos formam uma alça de convexidade distal (cinco membros); Tipo V: anastomose intramuscular (cinco membros); Tipo VI: anastomose entre ramo do nervo mediano para o músculo flexor superficial e nervo ulnar (dois membros). CONCLUSÃO: O conhecimento das variações anatômicas em relação à inervação da mão tem importância relevante, principalmente quando se considera o exame físico, diagnóstico, prognóstico e tratamento cirúrgico. Se essas variações não forem valorizadas, erros e consequências serão inevitáveis.

Morphological Studies on the Peripheral Circulation of the Ovary in One-Humped Camel (Camelus dromedarius).

Histological examination of the peripheral circulation of the ovary of 18 females of the one-humped camel revealed a series of blood vessels with special structures. Throttle or occlusive artery was recorded in the ovarian zona vasculosa and in the cortex, and it showed an intimal cushion-like thickening made up of intimal bolsters that formed of smooth muscle fibres and glomus cells. The smooth muscle cells of the tunica media and the tunica adventitia of throttle artery pursued a circumferential pattern. Anastomosis arteriovenosa included simple bridge-like anastomotic vessels between arteria and venae, and glomus vessels of typical structure were demonstrated. Glomus organs were recorded in the ovary and were comprised of the tortuous glomus vessels and the related afferent and efferent vessels. Glomus cell complexes also were commonly occur at the cortex ovarii that possessed an extremely convoluted course with a hyperplastic wall and a narrow lumen. Atypical glomus vessels were demonstrated within the ovarian zona vasculosa, and the wall of these vessels was relatively thick and consisted of double tunica media with an intimal bolster. Some vessels contained an intimal bolster device of exclusively glomus cell structure (glomus bolster) with a tunica elastic interna demarcated it from the glomus cell media. Some venae represented several layers of longitudinally arranged smooth muscle fibres in the tunica media. Other venae showed wall with variable thickness. Venae with double muscular tunica media were recorded in the medulla. Some venae showed double internal elastic lamina. Also, venae with thick adventitia contained dispersed smooth muscle fibres were determined. Spirally oriented arteriole and venule were demonstrated within the cortex and medulla ovarii. Gestation sclerosis was demonstrated in ovarian zona vasculosa of pregnant females.

Anatomical study of the vascular territories of the maxilla: role of the facial artery in allotransplantation.

BACKGROUND: Facial composite tissue allotransplantation has recently become a surgical option. The maxilla, which forms the upper jaw and plays an important role in facial allotransplantation, consists of the maxillary and facial arteries. The maxillary artery is located deep within the tissue and considered the main artery of the maxilla; however, the facial artery is easy to access. The objective of this study was to examine the territories of the maxillary and facial arteries within the maxilla. MATERIALS AND METHODS: We excised and examined 22 maxillae. Of these, 18 were injected with latex and four with India ink. RESULTS: We observed that the ascending palatine artery, which was collateral with the facial artery, vascularized the maxilla through its dorsal part. The facial artery vascularized the maxilla through its ventral part with the philtral and columellar branches of the superior labial artery. Therefore, the facial artery formed, through the nasal and palatine mucosa, an arterial circle with a dorsal and ventral pole. Angiosomes formed by both the facial and maxillary arteries were also observed. The India ink injected into the facial and maxillary arteries delineated specific territories for each artery. DISCUSSION: This study allowed us to determine the anatomical structures that provide vascularization to the maxilla and describe their different forms. The whole of the maxilla was vascularized by the facial artery, despite the caution imposed by several studies on the removal of the facial artery alone. Indeed, the removal technique was found to be safer when it preserved the anastomoses between the facial and maxillary arteries. Therefore, previous clinical experience and our anatomical study definitively demonstrate that the facial artery vascularizes the maxilla.

Corona mortis exposition during laparoscopic procedure for gynecological malignancies.

Corona mortis (CMOR) is an anastomotic branch between the external iliac or inferior epigastric vessels and the obturator artery or vein, or any vascular connection between the obturator and the external iliac systems in general with high anatomic variability. The aim of this study was to evaluate the type of anastomosis, if arterial, venous or both and the other subtypes of CMOR. Twenty-five laparoscopic procedures of bilateral pelvic lymphadenectomy for gynecological oncologic procedures (50 half pelvises) were performed. CMOR was located in 15 half pelvises on the right side (60 %), in 7 half pelvises on the left side (28 %), in 3 patients it was evidenced bilaterally. CMOR was dissected in 26/50 (52 %) half pelvises. Venous anastomosis was more frequently (46 %) followed by both venous and arterial vessels; in only 8 % (2/26) an arterial communication was observed. 83 % of venous anastomosis were single communications. One isolated arterial anastomosis was evidenced in two patients. In the cases of both arterial and venous anastomosis, one venous and one arterial vessel in 5/6 (83 %) were detected, and one type of anastomosis with one arterial and two venous vessels. Our data suggest that venous CMOR is usually present in higher frequency than the arterial one, followed by the combined type with arterial and venous connections. The isolated venous anastomosis resulted the frequent subtype.

Terminal bifurcation of the right testicular vein and left testicular arterio-venous anastomosis.

The testis is the organ upon which the survival of the human species depends. Abnormalities of testicular vessels may lead to loss of gametogenesis and hormone production. Reported here is a case of bilateral variations of the testicular vessels observed in a male cadaver during the first year MBBS dissection classes. The right testicular vein bifurcated into two veins just before its termination and both the branches terminated into the inferior vena cava. The left testicular artery arose from the abdominal aorta just above the level of origin of the inferior mesenteric artery. There was an arterio-venous anastomosis between the left testicular vein and the left testicular artery. The arterio-venous anastomosis might be functionally important as it can change the quality of the blood entering the testis.

[Blood supply in maxilla after segmental osteotomy].

Anthropometric measurements allowed us to obtain anatomical data on the topography of large and small palatine canals, sprouts sphenoid bone pterygoid, pterygopalatine and pterygomaxillary sutures. These structures are important because they contain blood vessels and nerves located in the area of jaw osteotomy. A study of maxilla blood supply sources after segmental osteotomy found that the descending palatine artery, the pterygopalatine artery, the upper posterior alveolar and infraorbital arteries usually remain intact by osteotomy. There are numerous anastomoses between all the arteries supplying the maxilla.

Intravascular perfusion of carbon black ink allows reliable visualization of cerebral vessels.

The anatomical structure of cerebral vessels is a key determinant for brain hemodynamics as well as the severity of injury following ischemic insults. The cerebral vasculature dynamically responds to various pathophysiological states and it exhibits considerable differences between strains and under conditions of genetic manipulations. Essentially, a reliable technique for intracranial vessel staining is essential in order to study the pathogenesis of ischemic stroke. Until recently, a set of different techniques has been employed to visualize the cerebral vasculature including injection of low viscosity resin, araldite F, gelatin mixed with various dyes (i.e. carmine red, India ink) or latex with or without carbon black. Perfusion of white latex compound through the ascending aorta has been first reported by Coyle and Jokelainen. Maeda et al. have modified the protocol by adding carbon black ink to the latex compound for improved contrast visualization of the vessels after saline perfusion of the brain. However, inefficient perfusion and inadequate filling of the vessels are frequently experienced due to high viscosity of the latex compound. Therefore, we have described a simple and cost-effective technique using a mixture of two commercially available carbon black inks (CB1 and CB2) to visualize the cerebral vasculature in a reproducible manner. We have shown that perfusion with CB1+CB2 in mice results in staining of significantly smaller cerebral vessels at a higher density in comparison to latex perfusion. Here, we describe our protocol to identify the anastomotic points between the anterior (ACA) and middle cerebral arteries (MCA) to study vessel variations in mice with different genetic backgrounds. Finally, we demonstrate the feasibility of our technique in a transient focal cerebral ischemia model in mice by combining CB1+CB2-mediated vessel staining with TTC staining in various degrees of ischemic injuries.

An anatomical study of the arterial supply to the soft palate / Estudio anatómico de la irrigación arterial del paladar blando

This study provides a detailed description of the arteries supplying the soft palate via: (i) ascending palatine; (ii) tonsillar; (iii) ascending pharyngeal; and (iv) lesser palatine arteries. Detailed dissections were performed on each side of thirty fetal and twenty adult head and neck specimens (n=100). This investigation documents the arteries terminating at the respective parts (superior, middle and inferior) of the soft palate and demonstrated that the majority of arteries terminated at the superior (83 percent and middle (63 percent) parts, whereas the inferior part (34 percent) was documented to receive the poorest arterial supply. The present study recognized anastomotic connections in 6 percent of fetal specimens i.e. (i) between the ascending palatine and lesser palatine arteries which terminated at the superior part of the soft palate in 4 percent of fetal cases, and (ii) between the ascending pharyngeal and recurrent pharyngeal arteries which terminated at the inferior part in 2 percent of fetal specimens. The position and relations of the soft palate arteries is of significance to minimize the risk of vascular disruption and myomucosal or mucosal flap failure during cleft palate repair and for the surgical correction of velopharyngeal insufficiency...

Este estudio proporciona una descripción detallada de las arterias que irrigan el paladar blando a través de las arterias: (i) palatina ascendente, (ii) tonsilar, (iii) faríngea ascendente, y (iv) palatinas menores. Se realizaron disecciones bilateralmente en 30 cabezas y cuellos de fetos y 20 de adultos (n = 100). Esta investigación documentó las arterias que terminaron en diferentes partes (superior, media e inferior) del paladar blando y demostró que la mayoría terminaba a nivel superior (83 por ciento) y medio (63 por ciento), mientras que la parte inferior (34 por ciento recibía un escaso suministro arterial. Se reconocieron conexiones anastomóticas en 6 por ciento de las muestras fetales, (i) entre las aa. palatinas ascendentes y las aa. palatinas menores, que terminaron en la parte superior del paladar blando en 4 por ciento de los casos fetales, y (ii) entre las aa. faríngea ascendente y faríngea recurrente, que terminaban en la parte inferior en un 2 por ciento de las muestras fetales. La posición y las relaciones de las arterias del paladar blando es relevante para minimizar el riesgo de interrupción vascular y falla de los colgajos miomucosos o mucosos, durante la reparación de paladar hendido o en la corrección quirúrgica de insuficiencia velofaríngea...

Role of ovarian artery-to-uterine artery anastomoses in uterine artery embolization: initial anatomic and radiologic studies.

PURPOSE: To explore the anatomic features of normal human ovarian artery-to-uterine artery anastomoses and their impact on uterine artery embolization (UAE). METHODS: Using slice computed tomography (CT) scanning and vascular casting; models of the uterine arterial vascular network were constructed using five sets of uterus, bilateral adnexa and vagina from normal adult females. The anatomy and characteristics of these models were then studied. RESULTS: Both the casting specimen and the CT-reconstructed model showed the ovarian artery-to-uterine artery anastomoses clearly. Each was composed of the ovarian branch of the uterine artery and the ovarian branch of the ovarian artery. All 10 ovarian artery-to-uterine artery anastomoses were formed by direct connection between the ovarian branch of the uterine artery and the ovarian branch of the ovarian artery. CONCLUSIONS: Thin slice CT scanning combined with vascular casting is a useful method to study the small arterial network. The anastomoses between the ovarian branch of the uterine artery and the ovarian branch of the ovarian artery were formed mainly by direct connection. The implications of the ovarian artery-to-uterine artery anastomoses on UAE are unclear; further function assessments are needed.

Accurate and simple evaluation of vascular anastomoses in monochorionic placenta using colored dye.

The presence of placental vascular anastomoses is a conditio sine qua non for the development of twin-to-twin transfusion syndrome (TTTS) and twin anemia polycythemia sequence (TAPS)(1,2). Injection studies of twin placentas have shown that such anastomoses are almost invariably present in monochorionic twins and extremely rare in dichorionic twins(1). Three types of anastomoses have been documented: from artery to artery, from vein to vein and from artery to vein. Arterio-venous (AV) anastomoses are unidirectional and are referred to as "deep" anastomoses since they proceed through a shared placental cotyledon, whereas arterio-arterial (AA) and veno-venous (VV) anastomoses are bi-directional and are referred to as "superficial" since they lie on the chorionic plate. Both TTTS and TAPS are caused by net imbalance of blood flow between the twins due to AV anastomoses. Blood from one twin (the donor) is pumped through an artery into the shared placental cotyledon and then drained through a vein into the circulation of the other twin (the recipient). Unless blood is pumped back from the recipient to the donor through oppositely directed deep AV anastomoses or through superficial anastomoses, an imbalance of blood volumes occurs, gradually leading to the development of TTTS or TAPS. The presence of an AA anastomosis has been shown to protect against the development of TTTS and TAPS by compensating for the circulatory imbalance caused by the uni-directional AV anastomoses(1,2). Injection of monochorionic placentas soon after birth is a useful mean to understand the etiology of various (hematological) complications in monochorionic twins and is a required test to reach the diagnosis of TAPS(2). In addition, injection of TTTS placentas treated with fetoscopic laser surgery allows identification of possible residual anastomoses(3-5). This additional information is of paramount importance for all perinatologists involved in the management and care of monochorionic twins with TTTS or TAPS. Several placental injection techniques are currently being used. We provide a simple protocol to accurately evaluate the presence of (residual) vascular anastomoses using colored dye injection.

Images in plastic surgery: the anatomy of macrovascular arteriovenous shunts and implications for abdominal wall free flaps.

With the increasing use of preoperative imaging of the abdominal vasculature prior to free flaps based on the abdominal wall, the identification of a previously undescribed anatomic structure has, that of large-vessel (macroscopic) arteriovenous communications, has emerged. These macrovascular arteriovenous shunts are observed in most patients, and provide a communication between the arterial perforators of the deep inferior epigastric artery and the superficial inferior epigastric vein. These communications provide vascular shunting occurring prior to capillary filling and have potentially profound clinical implications and therapeutic possibilities in a range of medical and surgical conditions. Although these have been demonstrated previously on computed tomographic angiography imaging, their macroscopic and microscopic anatomy has not been described. We present images in vivo, ex vivo, and histologically to highlight their anatomic features.

Elucidating the responses and role of the cardiovascular system in crocodilians during diving: fifty years on from the work of C.G. Wilber.

In 1960, C.G. Wilber in a laboratory-based study described for the first time the changes in heart rate with submergence in the American alligator noting in particular the marked bradycardia that occurred during forced dives. This short review summarizes the major advances in our understanding of diving and the responses and role of the cardiovascular system of crocodilians during submergence in the 50 years since Wilber published his findings. These advances are attributable in part to the technological advances made in physiological monitoring devices and wildlife telemetry that have not only provided greater elucidation of the hemodynamics of the unique crocodilian cardiovascular system but also allowed the natural diving behaviors and heart rates in free-ranging crocodiles to be recorded. Of note, telemetric field-based studies have revealed that wild free-ranging crocodiles typically undertake only short dives, less than 20 min, yet crocodiles are also capable of dives of many hours in duration. In contrast to Wilber's study, dives recorded from free-ranging crocodiles were found to be accompanied by only a modest bradycardia, highlighting the often confounding effects associated with captive animals monitored under laboratory conditions. More recent studies have also documented the complex central flow and pressure patterns of crocodilians, including a pulmonary to systemic shunt that can be initiated by a unique intracardiac valve located in the subpulmonary conus. The role and significance of this cardiac shunt remains controversial and the focus of recent lab-based studies. We contend that elucidation of the role and significance of the cardiac shunt in crocodilians will only be achieved by monitoring telemetrically the central cardiovascular flows and pressures in non-captive animals that are undisturbed and free-ranging. This presents the challenge ahead in the next 50 years.