Metal(loid)s (As, Cd, Cu, and Zn) in three fish species from a dam after a mine-tailing spill: differential bioaccumulation and potential health risk.

The failure of a tailings dam occurred in January 2013 at the Santa María de Otáez mining region (Mexico) released a spill (~ 300,000 m3) on Los Remedios River, which was transported through the San Lorenzo River, and finally to El Comedero (EC) dam. The concentrations of metal(loid)s in the muscle, liver, gills, and guts of three fish species (Cyprinus carpio, Oreochromis aureus, Micropterus salmoides) collected from EC dam were examined twenty months later to assess the performance of the cleaning operations. The bioaccumulation patterns of the metal(loid)s in the tissues were different in the three fish species. Tilapia had the highest Cd (11.23 ± 8.53 µg g-1) and Cu (871 ± 1261 µg g-1) concentrations in the liver, as well as As concentration (83.6 ± 61.7 µg g-1) in the gut, while the highest Zn concentration (745 ± 356 µg g-1) was measured in the gills of the carp. Such variability can be caused by the variant bioavailability of the metal(loid)s and by the feeding habits of each species; and also by the fact that some metals are essential and better regulated by organisms than other non-essential. Compared to a study of tilapia carried out 90 days after mine spill, a decrease was evident in the liver for As, Cd, Cu, and Zn by 129, 5, 10, and 1.7 times, respectively. This revealed that cleaning operations were more efficient for As. The target hazard quotient and the hazard index were < 1, which indicates there will be no risk of consuming muscle in moderated rations of the three fish species.

A new type of the coracobrachialis muscle.

The coracobrachialis muscle belongs to the anterior group of the brachial region. Its main functions are flexion and adduction at the glenohumeral joint. It is highly morphologically variable, especially in the number of bellies, place of origin or insertion, and its relationship to the musculocutaneous nerve. Accessory structures associated with the coracobrachialis muscle include the coracobrachialis brevis or coracobrachialis longus muscle. The present case describes a three-headed coracobrachialis muscle with two such additional structures. One of these has a tendinous origin connected to the periosteum and located on the surgical neck of the humerus. Its insertion is fused with the third head of the coracobrachialis muscle. The other has a proximal attachment fused with the capsule of the shoulder joint, and its distal attachment is fused with the third head of the coracobrachialis muscle in place of its connection with the short head of the biceps brachii. This could result in better stabilisation of the glenohumeral joint; on the other hand, it could limit operational access during treatment of subscapularis tears.

High accumulation of metals and metalloids in the liver of the blue tilapia (Oreochromis aureus) during a massive mortality event induced by a mine tailing spill.

In this study, the concentration of six metal(loid)s was examined in the fish Oreochromis aureus collected from El Comedero dam during a massive mortality event induced by a mine tailing spill. A major spill (~ 300,000 m3) of waste was released into the San Lorenzo River System following a rupture in the tailing dam of a mining plant in NW Mexico; consequently, the discharged material flowed into El Comedero dam. The accumulation of metal(oid)s in the tissues of O. aureus showed higher levels in the liver than in the guts and muscle. Concentrations in the liver were high (As, 1.1-1063; Cd, 8.9-392; Cu, 372-59,129; Hg, 0.46-19.79; Se, 8.7-748; and Zn, 116-820 µg g-1), revealing that these fish were exposed to high concentrations of these elements. The mortality of fish could have resulted from the combined effect of the six analyzed metal(loid)s, as well as other residues present in mine tailings.

Atheromatosis of the brain-supplying arteries: Circle of Willis, basilar, vertebral and their branches.

PURPOSE: Atherosclerotic plaques in the brain-supplying arteries are slowly-developing alterations of vascular structures that can lead to neurological impairment due to stenosis and insufficient oxygenation of eloquent brain areas. The aim of this study is to provide detailed demographic information related to the incidence of atherosclerotic plaques in the cerebral arteries. MATERIAL AND METHODS: Forty-eight circles of Willis (21 men, 21 women, mean age: 70.26, six samples unknown) were macroscopically analyzed for length, diameter, and presence of atherosclerotic plaques. Statistical analysis was used to identify potential differences in the locations and frequencies of atherosclerotic plaques in relation to age and sex. RESULTS: The study sample revealed 261 atherosclerotic plaques. The key findings were significant correlations between plaque development and age and between plaque location and age; however, there was no significant sex difference. CONCLUSION: The upper and lower branches of the middle cerebral artery (MCA) were novel locations predisposing to plaque development. A cut-off value at 60 years revealed a significant difference in plaque development and distribution. There were no significant sex differences in the occurrence of atherosclerotic plaques.

A proposal for a new morphological classification of the popliteus muscle tendon with potential clinical and biomechanical significance.

The purpose of this study was to characterize the morphological variations in the proximal attachments and create an accurate classification of the PPM for use in planning surgical procedures in this area, for evaluating radiological imaging and rehabilitation. One hundred and thirty-four lower limbs of body donors (52 woman and 82 man) fixed in 10% formalin solution were examined. The popliteus muscle was present in all 134 limbs. Four main types were identified with subtypes. The most common type was Type I (34.3%), characterized by a single tendon in the popliteus sulcus. Type II (30.6%) characterized by a main tendon in the popliteus sulcus and accessory bands. This type was divided into five subtypes (A-E) based on presence of specific accessory bands. Type III (15.3%) was characterized by two tendons in the popliteal sulcus. Type IV (19.4%) was characterized by two tendons in the popliteus sulcus and additional bands. This type was also divided into five subtypes (A-E) based on presence of specific accessory bands. The popliteofibular ligament was present in 90.3% of cases. A new classification based on a proximal attachment is proposed. The popliteus tendon is characterized by a very high morphological variability, which can affect posterolateral knee stability and the natural rotation of the tibia. Such a classification system may be useful for clinicians performing medical procedures within the knee joint, including orthopedic surgeons.

The carotid axis revisited.

The aim was to determine the variations in the level of origin of carotid bifurcation and diameters of the common, internal, and external carotid arteries which is clinically important for several interventional procedures. Therefore, 165 human embalmed corpses were dissected. The data collected were analyzed using the Chi square-test and the Pearson correlation test. The results of previous studies have been reviewed. In relation to the level of the carotid bifurcation, taking as a reference point the hyoid bone, the values ranged from 4 cm below the hyoid body to 2.5 cm above the body of the hyoid, being the average height-0.33 cm, with a standard deviation of 1.19 cm. The right carotid bifurcation was established at a higher level (x = - 0.19 cm.) than the left one (x = - 0.48 cm.) (p = 0.046). On the contrary, no significant gender differences could be observed. The arterial calibres of the common and internal carotid arteries were higher in male than female. In the internal carotid artery (X = 0.76 cm.), the left was greater than the right (X = 0.72 cm.) (P = 0.047). However, no differences in the distribution of the calibre of the external carotid artery were found neither by side nor gender. Variations in the level of bifurcation and calibres of carotid arteries are relevant for interventional radiology procedures and head and neck surgeries. Knowledge of these anatomical references might help clinicians in the interpretation of the carotid system.

Clinical anatomy of the lumbar sinuvertebral nerve with regard to discogenic low back pain and review of literature.

PURPOSE: Lumbar discogenic diffuse pain is still not understood. Authors describe the sinuvertebral nerve (SVN) as one possible cause. Body-donor studies are rare and controversial. Therefore, the aim was to revisit the origin, course and distribution in a body-donor study. METHODS: Six lumbar blocks (3 female, 3 male) aged between 59 and 94 years were dissected. After removal of the back muscles, lamina, dura mater and cauda equina, the anterior vertebral venous plexus, spinal artery and SVN were exposed and evaluated. RESULTS: 43 nerves out of 48 levels could be evaluated. The origin of the SVN was constituted by two roots: a somatic and a sympathetic branch arising from the rami communicantes. In 4/48 intervertebral canals studied (8.3%), we found two SVN at the same level. In 35/48 cases, one SVN was found. In 9/48 cases, no SVN was found. The SVN had a recurrent course below the inferior vertebral notch; in the vertebral canal it showed different patterns: ascending branch (31/43, 72.1%), common branch diverging into two branches (10/43, 23.3%), double ascending branch (1/43, 2.3%) finalizing two levels above and a descending branch (1/43, 2.3%). In 12/43 cases (27.9%) the SVN had ipsilateral connections with another SVN. The distribution ended in the middle of the vertebral body supplying adjacent structures. CONCLUSION: A thorough understanding of the anatomy of the SVN might lead to significant benefits in therapy of discogenic low back pain. We suggest blocking the SVN at the level of the inferior vertebral notch of two adjacent segments. LEVEL OF EVIDENCE I: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

The fifth head of quadriceps femoris: for sure?

PURPOSE: The quadriceps femoris has been described as a muscle composed by four heads: rectus femoris, vastus lateralis, vastus medialis and vastus intermedius. Each head fuse with the other ones making up the quadriceps tendon, which inserts into the patella. Nevertheless, there has been described a fifth component of the quadriceps muscle in recent anatomical publications. Understanding this fifth head may be important for orthopedics and radiologist. METHODS: Cadaveric dissection of left thigh of a female 83 years old was performed to demonstrate a fifth head of the quadriceps femoris muscle. RESULTS: In this study, a fifth head of the quadriceps femoris muscle was found in the left thigh of a female cadaver 83 years old. This fifth head was made up by four independent muscular fascicles attaching in a common flat tendon that joins distally with the lateral border of the quadriceps tendon. The fifth head found was supplied by branches of the ascending branch of the lateral femoral circumflex artery and by branches of the deep lateral division of the femoral nerve. CONCLUSIONS: The incidence of this fifth belly in cadaveric studies has been reported as a range from 29 to 100%. However, no published articles refer an anatomical finding such as this multi-bellied fifth head. The knowledge of the existence and location of the fifth belly is necessary to make accurate diagnosis of QF muscle strains. Its anatomical course may be involved in patellar tracking.

Assessment of nutrient contamination in the waters of the El Fuerte River, southern Gulf of California, Mexico.

This study assessed the spatial and temporal nutrient variability in the El Fuerte River basin in northwestern Mexico, considering its effects on the water trophic status as well as the nutrient loading to the Gulf of California. Physicochemical parameters, inorganic species of nitrogen, phosphate, total nitrogen, total phosphorus, and chlorophyll-a (chl-a) were quantified at 16 selected sites along the river in April (dry season) and October (rainy season) 2017. Mean concentrations of nutrients during dry and rainy seasons were 36.3 ± 24.1 and 55.1 ± 74.6 µg L-1 of total ammonia nitrogen, 3.4 ± 3.6 and 4.5 ± 3.5 µg L-1 of NO2--N, 190.8 ± 256.0 and 163.6 ± 261.0 µg L-1 of NO3--N, 42.4 ± 44.2 and 104.9 ± 76.2 µg L-1 of PO43--P, 1.0 ± 1.3 and 691 ± 2242 mg L-1 of TN, 0.06 ± 0.06 and 0.08 ± 0.09 mg L-1 of TP, and 0.9 ± 0.6 and 2.0 ± 0.9 µg L-1 of chl-a with significant differences (p < 0.05) between sites and seasons. When waters are transported downstream, nutrient levels are enriched by 4 to 35 times compared to those upstream due to increased population and agriculture downstream, confirming the hypothesis of the study. The calculated TN and TP fluxes were 1.23 × 104 and 3.57 × 101 ton year-1, respectively. Factor analysis indicated that inorganic nitrogen species and phosphorus are the main factors affecting the river water quality. Despite N excess during the rainy season, the river reached mesotrophic waters due to phosphorus limitation. This suggests the need to establish a water quality monitoring program to understand the vulnerability of the river course to changes in its trophic state.

Impact of radical nephrectomy on kidney function and prognostic factors for adverse cardiovascular events. / Impacto de la nefrectomía radical en la función renal y factores pronósticos de eventos cardiovasculares adversos.

INTRODUCTION AND OBJECTIVES: To analyze the evolution of kidney function after radical nephrectomy and to evaluate risk factors for adverse cardiovascular events during a long follow-up. MATERIAL AND METHODS: Retrospective study of patients submitted to radical nephrectomy due to renal cancer from January of 1996 to January of 2016. We evaluated their renal function after nephrectomy and during follow-up. We analyzed the possible predictive factors for adverse cardiovascular events with univariate and multivariate logistic regression analyses. RESULTS: There was an acute drop in glomerular filtration rate (GFR) after nephrectomy (21.2ml/min), which stabilized during follow-up in most cases. We evaluated the possible predictive factors for adverse cardiovascular events with logistic regression analyses, which presented previous cardiovascular disease (0,270, 95% CI 0,123-0,594, P<.001), diabetes (0,364, 95% CI 0,162-0,818 P=.015) and de novo hypertension (0,239, 95% CI 0,098-0,581, P=.002) as independently associated with the occurrence of adverse cardiovascular events. CONCLUSION: There was a deleterious effect in renal function after nephrectomy which remained stable during subsequent years in most patients. Approximately half of our patients had a GFR lower than 60mL/min after nephrectomy. Previous cardiovascular disease, diabetes and de novo hypertension were shown as risk factors for adverse cardiovascular events.

Intramuscular innervation of plantaris muscle evaluated using a modified Sihler's staining protocol - Proposal for a new classification.

PURPOSE: The plantaris muscle is a morphologically variable structure with regard to both its origin and insertion, and the course of the tendon. We here determined the pattern of branching and distribution of intramuscular nerves of the plantaris muscle to determine its usability for autologous transplantation. No information exists on the innervation of the plantaris muscle using Sihler's staining technique, and hence its intramuscular nerves. The main purpose of the work is to determine the pattern of branching and distribution of the intramuscular nerves of the plantaris muscle. Is the plantaris muscle a good transplant candidate? MATERIALS AND METHODS: Eighty lower limbs from cadavers (40 left, 40 right, 40 male, 40 female, age range 41-94 years) were fixed in 10% formalin solution and examined macroscopically as well as morphometrically with regard to the innervation pattern of the respective plantaris muscle. Afterwards Sihler's staining was used in all 80 plantaris muscles to identify the exact distribution of the muscular branch originating from the main nerve trunk in the muscle belly. RESULTS: Two patterns of branching and nerve distribution could be intensified in the plantaris muscle: Type I, with a single pattern entire up to the muscle and then divided into superior and inferior intramuscular branches.; type II with a double innervation pattern (superior and inferior). The superior and inferior pattern were not connected to each other. CONCLUSION: The plantaris muscle reveals variability with two different innervation patterns. Type II is ideally suited for autologous transplantation. New classifications of innervation are desirable for individual muscles rather than a generalized approach.

Predictive value of magnetic resonance for identifying neurovascular compressions in trigeminal neuralgia. / Valor predictivo de la resonancia magnética para la identificación de compresiones neurovasculares en la neuralgia del trigémino.

INTRODUCTION: Microvascular decompression (MVD) is accepted as the only aetiological surgical treatment for refractory classic trigeminal neuralgia (TN). There is therefore increasing interest in establishing the diagnostic and prognostic value of identifying neurovascular compressions (NVC) using preoperative high-resolution three-dimensional magnetic resonance (MRI) in patients with classic TN who are candidates for surgery. METHODS: This observational study includes a series of 74 consecutive patients with classic TN treated with MVD. All patients underwent a preoperative three-dimensional high-resolution MRI with DRIVE sequences to diagnose presence of NVC, as well as the degree, cause, and location of compressions. MRI results were analysed by doctors blinded to surgical findings and subsequently compared to those findings. After a minimum follow-up time of six months, we assessed the surgical outcome and graded it on the Barrow Neurological Institute pain intensity score (BNI score). The prognostic value of the preoperative MRI was estimated using binary logistic regression. RESULTS: Preoperative DRIVE MRI sequences showed a sensitivity of 95% and a specificity of 87%, with a 98% positive predictive value and a 70% negative predictive value. Moreover, Cohen's kappa (CK) indicated a good level of agreement between radiological and surgical findings regarding presence of NVC (CK 0.75), type of compression (CK 0.74) and the site of compression (CK 0.72), with only moderate agreement as to the degree of compression (CK 0.48). After a mean follow-up of 29 months (range 6-100 months), 81% of the patients reported pain control with or without medication (BNI score i-iiiI). Patients with an excellent surgical outcome, i.e. without pain and off medication (BNI score i), made up 66% of the total at the end of follow-up. Univariate analysis using binary logistic regression showed that a diagnosis of NVC on the preoperative MRI was a favorable prognostic factor that significantly increased the odds of obtaining an excellent outcome (OR 0.17, 95% CI 0.04-0.72; P=.02) or an acceptable outcome (OR 0.16, 95% CI 0.04-0.68; P=.01) after MVD. CONCLUSIONS: DRIVE MRI shows high sensitivity and specificity for diagnosing NVC in patients with refractory classic TN and who are candidates for MVD. The finding of NVC on preoperative MRI is a good prognostic factor for long-term pain relief with MVD.

Monitoring of inland waters for culturing shrimp Litopenaeus vannamei: application of a method based on survival and chemical composition.

This study evaluated the suitability of 21 inland waters (16 well waters and 5 surface waters) from Northwest Mexico via short- (48 h) and medium-term (28 days) tests using postlarvae (PL18) of Litopenaeus vannamei. In the short test, survival was assessed at 48 h after shrimp were placed in groups of 10 postlarvae into 2-L containers of inland water, to which they had been previously acclimated. The second, medium-term test consisted of four replicates with 10 postlarvae, and each group was placed in 15-L containers with the treatment water. Weights (initial and final) and survival were evaluated weekly for 28 days. In those waters for which the short test was positive and the medium-term test was negative and which also had a deficiency of potassium and/or magnesium, a third test was conducted. These last waters were supplemented with salts, and the shrimp survival and weights (initial and final) were recorded for 28 days. The water samples from San Jose, Mochicahui, Sinaloa River, Caimanero inner Lagoon, La Pipima, Campo Santa Fe, Escopama, and Fitmar had >60% survival in the short test. The Caimanero inner Lagoon water had the highest survival (87.5 ± 9.6%) and final mean weight (201.3 ± 86.2 mg). In the third test, it was found that shrimp in the water from La Pipima, Campo Santa Fe, and Fitmar exhibited 100% survival for 2 weeks. Finally, in this work, a decision tree to evaluate the suitability of low-salinity water for shrimp farming was proposed, which can be applied in other regions.

Assessment of environmental loads of Cu and Zn from intensive inland shrimp aquaculture.

An experiment was developed to simulate inland shrimp farming using diluted seawater (1.9 g L-1) containing 75 shrimps (Litopenaeus vannamei) per square meter during a growth cycle of 120 days. In this study, the environmental loads of copper and zinc were estimated and compared to anthropogenic sources and shrimp aquacultures in other locations. Both metals resulted primarily from feeding, which accounted for 91.8% of Cu and 97.0% of Zn. Concentrations of Cu (110.8 ± 11.8 µg g-1) and Zn (69.0 ± 0.7 µg g-1) measured in the harvested shrimp had higher Cu and lower Zn concentrations compared to those reported for farmed shrimp from Brazil and Mexico. Clearly, organic sludge was the main route of removal for both metals (Cu 46.2%; Zn 92.6%). The annual environmental loads estimated for inland shrimp aquaculture were 598 ± 74 g Cu ha-1 and 5080 ± 328 g Zn ha-1.

The superior mesenteric artery and the variations of the colic patterns. A new anatomical and radiological classification of the colic arteries.

The superior mesenteric artery (SMA) supplies irrigation to the small intestine, ascending and a variable area of the transverse colon. Although medical imaging and surgical procedures have been widely developed in the last decades, the anatomy of the SMA using advanced imaging technology remains to be elucidated. Previous studies have used small sample sizes of cadaveric or radiological samples to propose a number of classifications for the SMA. In this study, we aimed to provide a more detailed description and useful classification of the SMA and its main branches [middle colic artery (MCA), right colic artery (RCA), and ileocolic artery (ICA)]. Samples (n = 50, 28 males and 22 females) were obtained from the repository of human cadavers located at the Department of Human Anatomy and Embryology, Complutense University of Madrid. This sample was dissected by preclinical medical students and completed by two of the authors (Gamo and Jiménez). A second set of samples was obtained from a bank of computerized tomography (CT) (560 CTs, 399 males and 161 females) collected by the Radiology Department at the Clínico San Carlos Hospital, Spain. Based on the results obtained from these studies, we propose a new classification of four patterns for the SMA anatomy. Pattern I as the independent origin of the three main branches of the SMA (cadaveric 40 %; CT 73.69 %); Pattern II is subdivided in three sub-patterns based on the common trunks of origin: Pattern IIa, common trunk between RCA and MCA (cadaveric 20 %, CT 4.28 %); Pattern IIb, common trunk between RCA and ICA (cadaveric 32 %, CT 15 %); Pattern IIc, common trunk for the three main branches (cadaveric 0 %, CT 0.35 %); Pattern III, as the absence of RCA (cadaveric 8 %; CT 2.32 %) and Pattern IV, based on presence of accessory arteries (not found in any of the samples). Although the independent origin of the three colic arteries have been classically described as the most frequent, the right colic artery is responsible of major variations.

Anatomical variations of the celiac trunk: cadaveric and radiological study.

PURPOSE: The celiac trunk (CT) is a vascular structure of the upper abdomen which gives off the left gastric artery (LGA), the splenic artery and the common hepatic artery. This study aims to compare the vascular patterns of the CT of two different samples (cadaveric and radiological) and to propose a simple classification of CT variations based on previous studies and our results. MATERIALS AND METHODS: To perform this study we examined 43 adult cadavers, 24 males and 19 females, ages ranged from 69 to 92. In addition, we analysed 596 MDCT (multidetector computed tomographic) angiography examinations of 430 males and 166 females, ages ranged from 42 to 82. RESULTS: According to the classification proposed, results were divided into Type I or complete CT (578/639 cases, 90.5 %), Type II or incomplete CT (61/639 cases, 9.5 %), Type III or absence of CT and Type IV or celiacomesenteric trunk with no cases reported. Type I was divided into Type Ia or bifurcated trunk with LGA arising first (368/639 cases, 57.6 %), Type Ib or trifurcated trunk (205/639 cases, 32.1 %) and Type Ic or tetrafurcated trunk with an extra branch (5/639 cases, 0.8 %). Type II included hepatosplenic (29/639 cases, 4.5 %), gastroplenic (32/639, 5 %) and hepatogastric trunks (0/639, 0 %) which represented Types IIa, IIb and IIc respectively. CONCLUSIONS: No significant differences were found between the cadaveric and radiological samples. Gender did not appear to be related to any variability of the structures either. A new, simple and complete classification of the anatomical variations of the CT is proposed.

Heavy metals in waters and suspended sediments affected by a mine tailing spill in the upper San Lorenzo River, Northwestern México.

Concentrations of arsenic (As), cadmium (Cd), copper (Cu), lead (Pb), mercury (Hg), silver (Ag) and zinc (Zn) were evaluated in water and suspended sediments of the upper waters of San Lorenzo River in NW Mexico following a mine tailing spill. Except As (6.64-35.9 µg L(-1)), dissolved metal concentrations were low (Ag <0.06-0.22; Cd 0.01-0.34; Cu 4.71-10.2; Hg 0.02-0.24; Pb <0.15-0.65; Zn 86-1,080 µg L(-1)) and were less than the upper limits established by UNEP (Water quality for ecosystem and human health, 2nd edn. United Nations Environment Programme Global Environment Monitoring System/Water Programme, Burlington, 2008), EPA (2014) and the Mexican regulation (NOM 1994). In contrast, the suspended metal concentrations were high (As 91.4-130; Ag 22.1-531; Cd 3.14-6.30; Cu 65-123; Hg 0.47-1.09; Pb 260-818; Zn 742-1,810 mg kg(-1)) and most of samples exceeded the probable effect level of the Canadian Sediment Quality Guidelines for the Protection of Aquatic Life.

The peroneocuboid joint: morphogenesis and anatomical study.

The peroneocuboid joint, between the peroneus longus tendon and the cuboid bone, has not been anatomically well-defined and no embryological study has been published. Furthermore, the ossification of the os peroneum (a sesamoid inside the peroneus longus tendon) and its associated pathology has been considered to be generated by orthostatic and/or mechanical loads. A light microscopy analysis of serially sectioned human embryonic and fetal feet, the analysis of human adult feet by means of standard macroscopic dissection, X-ray and histological techniques have been carried out. The peroneus longus tendon was fully visible until its insertion in the 1st metatarsal bone already at embryonic stage 23 (56-57 days). The peroneocuboid joint cavity appeared at the transition of the embryonic to the fetal period (8-9th week of gestation) and was independent of the proximal synovial sheath. The joint cavity extended from the level of the calcaneocuboid joint all the way to the insertion of the peroneus longus tendon in the 1st metatarsal bone. The frenular ligaments, fixing the peroneus longus tendon to the 5th metatarsal bone or the long calcaneocuboid ligament, developed in the embryonic period. The peroneus longus tendon presented a thickening in the area surrounding the cuboid bone as early as the fetal period. This thickening may be considered the precursor of the os peroneum and was similar in shape and in size relation to the tendon, to the os peroneum observed in adults. To the best of our knowledge, this is the first study to show that the os peroneum, articular facets of the peroneus longus tendon and cuboid bone, the peroneocuboid joint and the frenular ligaments appear during the embryonic/fetal development period and therefore they can not be generated exclusively by orthostatic and mechanical forces or pathological processes.

Trans-umbilical single-port radical nephrectomy with concomitant cholecystectomy.

OBJECTIVES: Occasionally, the development of laparoscopic procedures allows the performance of combined surgeries. Currently, some of these can be carried out by trans-umbilical single-port laparoscopy. MATERIAL AND METHODS: We report a patient with renal tumor of 4.5cm and cholelithiasis who undergone to trans-umbilical single port-right radical nephrectomy with concomitant cholecystectomy. This is the first case reported in Spain that this combined procedure is performed using umbilical single port surgery. RESULTS: No complications (intra or postoperative) have been described in this case, achieving proper control of tumor pathology and an excellent cosmetic outcome. CONCLUSION: In those cases in which multidisciplinary approach is required, surgery can be performed by trans-umbilical single-port laparoscopy as consequence of its reduced postoperative morbidity and better cosmetic results.