Cutaneous mammary loxoscelism: An unknown cause of breast inflammation: A case report and review of the literature.

Envenomation due to a Loxosceles spider bite is a rare event in France and no case concerning the breast has yet been reported. We report the case of a 48-year-old woman who presented at Saint-Etienne University Hospital with a pulsatile pain in her left breast two days after feeling a fleeting bite. An abscess was diagnosed and antibiotics were prescribed. A few days later, a necrotic zone appeared around the areola and 75 percent of the surrounding skin was inflamed. The patient reported a persistent fever and a burning pain in her breast. Loxoscelism was finally concluded and surgical debridement was undertaken, followed by supervised wound therapy and local skin care. Complete healing was achieved after 4 weeks of treatment. The diagnosis of loxoscelism is generally presumptive, as the bite is usually painless and the spider rarely captured. Its diagnosis should be considered when an abscess responds poorly to antibiotics.

[Aberrant birth of a radial artery in the upper third of the forearm: A case report]. / Naissance aberrante d'une artère radiale au tiers supérieur de l'avant-bras : à propos d'un cas.

We report the case of a 68-year-old patient, operated on in our department of a quadruple coronary bypass grafting. The grafting strategy consisted initially on harvesting the left internal thoracic artery and the left radial artery. The harvest of this latter failed because of a rare anatomical variation of the radial artery, which rose from the confluence of two branches: a superficial and a deep radial artery at the proximal third of the forearm approximately 10cm below the elbow.

Thyroid tubercle of Zuckerkandl: anatomical and surgical experience from 79 thyroidectomies.

OBJECTIVE: To highlight a poorly known anatomical variation of the lateral lobe of the thyroid gland, which can be useful in identifying the recurrent laryngeal nerve during thyroid surgery. MATERIALS AND METHODS: We performed a three-year prospective study of 79 thyroid surgery patients. Great attention was paid to anatomical variations of the thyroid gland (i.e. the presence or absence of a distinct tubercle of Zuckerkandl), the recurrent laryngeal nerve and the location of the parathyroid glands. RESULTS: A total of 71 right lobectomies and 74 left lobectomies were performed. Five tubercles of Zuckerkandl were identified (7.04 per cent of cases) and were useful in detecting the recurrent laryngeal nerve (but only on the right side). CONCLUSION: The tubercle of Zuckerkandl is a poorly known and variable anatomical feature of the thyroid gland which may not, in fact, be so rare. It arises for embryological reasons, and it can be a reliable anatomical landmark for identifying the recurrent laryngeal nerve during thyroid surgery. It should be included in the Nomina Anatomica as the 'processus posterior glandulae thyroideae' described by Zuckerkandl.

[Endoscopic anatomy of the terminal portion of the basilar artery and its distal perforating branches]. / Anatomie endoscopique de la terminaison de l'artère basilaire et de ses perforantes distales.

The aim of this study was to describe and highlight the endoscopic anatomy of the tip of the basilar artery and its perforating branches. Knowledges of the anatomy are crucial for neurosurgeons to avoid pitfalls during endoscopic third ventriculostomy.

The infra-optic course of the anterior cerebral arteries: an anatomic case report.

Although variations of the anterior part of the cerebral arterial circle of Willis are quite well known, though some anomalies are exceedingly rare. In a 61-year-old female individual, on both sides the precommunicating parts of the anterior cerebral artery were found to course inferiorly to the ipsilateral optic nerves. This anomaly was associated with an agenesis of a left posterior communicating artery. The anatomic features, the possible high prevalence of associated aneurysms of the anterior communicating artery complex as well as implications for surgical planning or endovascular treatment are outlined and embryologic considerations and discussed.

Histologic study of coronary, radial, ulnar, epigastric and internal thoracic arteries: application to coronary artery bypass grafts.

The biometry and the histology of coronary, radial, ulnar, epigastric and internal thoracic arteries were studied in order to investigate the cause of their occlusions in coronary bypass grafts and to improve the results of these bypass grafts. These various arteries were removed from 40 anatomical specimens (27 males and 13 females). We found a correlation between the internal calibers of the ulnar and coronary arteries in males. Intimal changes and the presence of atheromatous plaque were observed in coronary, radial and ulnar arteries, but never in the internal thoracic artery. Like coronary arteries and their branches, radial, ulnar and epigastric arteries are muscular arteries and ageing results in thickening of the intima, which becomes fibrotic with migration of myocytes from the media and duplication of the internal elastic lamina. The media becomes fibrous, hypertrophic or atrophic. In contrast, the internal thoracic artery is an elastic artery, like the aorta. Ageing is characterized by loss, over a variable extent, of one or several elastic laminae of the media and more marked intimal thickening. Although anatomically, the caliber of radial, ulnar, and epigastric arteries remains adapted to that of coronary arteries, the long-term patency of radial, ulnar and epigastric arteries used as grafts is related to their histological characteristics.

[Biometric and histological study of human, porcine and sheep internal thoracic arteries (reflections on their use in revascularization of arteries of less than four millimetres diameter)]. / Etude biométrique et histologique comparative des artères thoraciques internes de l'homme, du porc et du mouton (application en chirurgie de revascularisation des artères de moins de quatre millimètres de diamètre).

In order to enhance the knowledge of the internal thoracic arteries of pig, sheep, and man, allowing to constitute a fundamental basis as for the current and later applications in the interventions in surgery of revascularization of the arteries of less than four millimetre of diameter, a biometric and histological comparative study of these arteries was carried out. Forty human corpses, 27 men and 13 women (mean age 75+/-6 years) were dissected, alike with three pigs respectively weighing 80 kg, 80 kg and 84 kg and four sheep weighing 70 kg each. The left and right internal thoracic arteries were harvested: exposure over the entire length and remote dissection before excision. At the same time their internal lengths and gauges were measured. The internal thoracic artery (ITA) of human has an average useful length of 18 cm and an average internal gauge close to 1.5 mm. ITA of the pig has an average length of 27 cm and an average internal gauge close to 2.8 mm. The ITA of the sheep has an average length of 18 cm with an average internal gauge close to 1 mm. The porcine Internal Thoracic Artery is an elastic artery like its human counterpart. Many elastic fibres and few smooth muscle cells are present in the media. On the other hand, the internal thoracic artery of the sheep has a mixed structure. Its media contains more smooth muscle cells than elastic fibres.

Relationship between ultrastructure and biomechanical properties of the knee meniscus.

The purpose of this study was to determine the biomechanical properties of the knee meniscus and to relate them to its ultrastructure. The knee joint menisci are semicircular, fibrocartilaginous structures interposed between the femoral and tibial condyles. For a long time, they were considered to be embryologic vestiges. This study describes the response of the knee joint meniscus to circumferential, radial and axial compressive forces. The results show an anisotropic response of the knee joint meniscus to unconfined compression. The Young's modulus increased approximately twofold between vertical and circumferential or radial directions with a 10 mm/min-compression rate. This response is probably a direct consequence of the orientation of collagen fibres.

[Anatomical basis of the extraspinal cord compression]. / Bases anatomiques des compressions tumorales extramedullaires.

Knowledge of anatomical landmarks of the spinal cord within the vertebral foramen is essential to understand the pathogenesis of spinal cord compression by tumor growth. The spinal cord can spread in the intervertebral foramen, the epidural space, the vertebral body, and the posterior neural arch. The morphology of the spinal cord, the relations of the spinal roots with the vertebrae, the principal fiber tracts, the spinal membranes, and the arterial and venous distribution are described in order to explain and analyze signs and disorders caused by the most frequent tumors involved in spinal cord compression.

[Anatomy of the external laryngeal nerve: surgical implications. Report of 30 dissections]. / Anatomie du nerf laryngé externe: implications chirurgicales. A propos de 30 dissections.

OBJECTIVES: This anatomic study aimed to detail the anatomy of the external laryngeal nerve and to determine the possible variations of nerves at risk. MATERIAL AND METHOD: Fifteen cadavers (30 nerves) were dissected. The peri pharyngo laryngeal route, the anatomic rapports, the branches of division and the distal penetration point of the external laryngeal nerve were noted. RESULTS: The external laryngeal nerve gave branches to the inferior pharyngeal constrictor muscle in 90% of cases and to the thyroid gland in 70% of cases. There was an adherence between the nerve and the trunk of the superior thyroid artery in 13.33% of cases. The nerve had a distal superficial route even on the cricothyroid muscle in 6.67% of cases. In one case the nerve was situated close to the medial face of the superior thyroid lobe. DISCUSSION/CONCLUSION: The external laryngeal nerve has numerous anatomic variations. The anatomic variations at risk during thyroid surgery are: an adherence between the nerve and the thyroid artery (or a course of the nerve between the branches of the superior thyroid artery); a superficial distal route; a distal situation close to the medial face of the thyroid lobe. In this study, 7 nerves were considered at risk (23.33% of cases).

Relationships of the palmar cutaneous branch of the median nerve: a morphometric study.

Treatment of carpal tunnel syndrome consists in decompression of the median nerve by section of the flexor retinaculum. Usually, this surgery improves the disease with disappearance of the symptoms. However, some painful sequelae may remain such as painful discharges, paresthesiae or permanent anesthesia of the base of the thumb or of the scar related to an injury of the palmar cutaneous branch of the median nerve (PCBm). This study was performed to define the accurate emergence and the anatomic characteristics of this nerve in relation to stable landmarks. Moreover, it assessed the importance of the visual identification of the branch during section of the flexor retinaculum. Thirty-five hands were dissected under macroscopic examination and under magnification of the thinnest branches. Measurements were performed with a caliper and the forearm in supination. Determination of the bistyloid line showed variability in the location of the distal wrist crease. Thus, it could not be used as a landmark to locate the PCBm. The palmar cutaneous branch is the distal collateral branch of the median nerve in the forearm. It emerges on its radial side, on average 44.3 mm before the bistyloid line. It courses in line with the third finger and perforates the antebrachial aponeurosis about 5.7 mm from the bistyloid line. This emergence can be located in the palm, where it can be injured if the incision is performed in line with the third finger. The PCBm usually ends in the palm by division into two or three branches. The lateral branch supplies the skin of the thenar eminence while the medial, usually shorter branch supplies the midline part of the palm. This study has shown the importance of performing the cutaneous incision in line with the fourth finger to avoid injury to the PCBm.

The external laryngeal nerve: surgical and anatomic considerations. Report of 50 total thyroidectomies.

This surgical anatomy study aimed to evaluate the possibility of identifying the external laryngeal nerve during thyroid surgery and the possible variations of nerves at risk. Fifty patients underwent total thyroidectomies during a period of 12 months. Using a neurostimulator, the distal motor branch of the external laryngeal nerve was searched. Electrical stimulation of a nervous branch aimed to provoke a global contraction of the cricothyroid in order to identify with certitude the external laryngeal nerve. The external laryngeal nerve was identified in 20% of cases. Its course was, with almost equal frequency, either (1) between the vessels of the superior thyroid pedicle or (2) superficial and anterior to the fascia of the cricothyroid muscle. The external laryngeal nerve is hard to find during thyroid surgery, even with a neurostimulator. It can be vulnerable during thyroid surgery but only in cases of anatomic variations. Searching for the nerve systematically during thyroid surgery does not seem to be useful. Several precautions when dissecting the superior pole of the thyroid gland seem to be necessary and sufficient to respect the external laryngeal nerve.

Comparative histological and biometric study of the coronary, radial and left internal thoracic arteries.

In an attempt to elucidate the causes of occlusion of radial arteries used for coronary artery bypass grafts and to improve the results of these procedures, we studied the biometry and histology of the coronary, radial and left internal thoracic arteries. These arteries were harvested from 20 cadavers (13 males, 7 females). The specimens were calibrated to the various bypass graft sites using coronary calibrators, and were then submitted to histological examination to determine the structure and innervation of the vessel wall. No correlation was observed between the internal calibers of these various arteries, with the exception of the anterior interventricular and right coronary arteries. Intimal changes and the presence of atheromatous plaque were observed in coronary and radial arteries, but never in the internal thoracic artery. Like the coronary arteries and their branches, the radial artery is a muscular artery. Aging of muscular arteries results in thickening of the intima, which becomes fibrotic due to migration of myocytes from the media and duplication of the internal elastic lamina. The media becomes fibrous, hypertrophic or atrophic. The walls of the radial and coronary arteries contain several adventitial nerves (sympathetic and parasympathetic nerve fibers), but these nerve fibers were not observed in the wall of the left internal thoracic artery. In contrast, the internal thoracic artery, like the aorta, is an elastic artery. Aging of elastic arteries is first observed between the ages of 20 and 29 years and is characterized by loss of one or several elastic laminae of the media and more marked intimal thickening, over a variable length. Even if a radial artery's caliber is similar to that of the coronary artery, histological evolution and graft patency depend on its muscular identity.

[Biometry and structure of the left internal thoracic and radial coronary arteries]. / Biométrie et structure des artères coronaires, thoracique internes gauche et radiales.

In an attempt to elucidate the causes of occlusion of radial arteries for coronary artery bypass grafts, we studied the biometry and histology of the coronary, radial and left internal thoracic arteries of 20 anatomical subjects (13 males and 7 females). These specimens were calibrated to the various bypass graft sites using coronary calibrators, and were then submitted to histological examination to determine the structure of the vessel wall. Our preliminary results show no correlation between the internal calibres of these various arteries. Like the coronary arteries and their branches, the radial artery is a muscular artery. In contrast, the left internal thoracic artery like the aorta, is an elastic artery.

Abuse during and before pregnancy: prevalence and cultural correlates.

This study examined the prevalence of abuse during pregnancy and the influence of cultural norms and acculturation on abuse in 1,004 Mexican American, Puerto Rican, Cuban American, Central American, African American and Anglo American women. Women were recruited from consecutive delivery logs in general community hospitals in Florida and Massachusetts. The Index of Spouse Abuse and the Abuse Assessment Screen ascertained history of adult physical, sexual, and emotional abuse, abuse during pregnancy, and childhood sexual abuse. An Interview Protocol assessed cultural attitudes, acculturation, and demographic information. Hispanic American women, as a whole, did not differ significantly from Anglo American women in their prevalence of abuse during pregnancy, after controlling for sociodemographic variables. However, Cuban American and Central American partners were significantly less likely to abuse their pregnant partners than were other groups even after adjustment. Women who spoke only Spanish (less acculturated) were less likely to report physical abuse from their partners both before and during pregnancy. Cultural norms, such as a partner's belief in wife/mother role supremacy and cultural group acceptability of men hitting women, were significantly positively related to both physical and emotional abuse. Other risk factors for abuse were the abuser not being the biological father of the baby, low income and little education, and being unmarried.

Assessment of nutritional status, cognitive development, and mother-child interaction in Central American refugee children.

A cross-sectional study was conducted between July and December 1992 to assess the nutritional status, cognitive development, and mother-child interactions in a group of 153 Nicaraguan refugee children living in Costa Rica. Nutritional status was assessed using anthropometric indices. Cognitive development was assessed with the Bayley Scale of Mental Development. Mother-child interaction was assessed with the Nursing Child Assessment Teaching Scale and Caldwell's Home Observation and Measurement of the Environment Inventory. Correlational analysis was performed to examine the relationship between child cognitive development scores and mother-child interaction measures and also between anthropometric measures and child cognitive development scores. Multiple regression analysis was performed to evaluate the relationship between the mother-child interaction measures and cognitive development scores, after adjusting by anthropometric measures. Thirty-three percent of the children were below the 10th percentile for height-for-age. There was no significant correlation between the total amount of mother-child interaction and child cognitive development. However, certain aspects of the home environment correlated with cognitive development, specifically the manner in which the mother responded emotionally and verbally to her child, and the organization of the child's physical and temporal environment. Multiple regression analysis revealed that the manner in which the mother responded and the child's weight-for-height were important in predicting child cognitive development. The child's weight-for-height and certain aspects of the home environment played an important role in the cognitive development of this refugee population. The findings indicate the importance of assessing nutritional status in this refugee population.

[A novel approach to the biomechanical study of the talocrural joint in man using MRI. Contribution of dynamic images]. / Nouvelle approche de l'étude biomécanique de l'articulation talocrurale chez l'homme par I.R.M. Apport des images dynamiques.

A cineradiographic study of the talocrural joint allows a new biomechanical approach of the ankle: MRI with axial and coronal slides were realized: for volume reconstruction in passive movement; scanner was used for axial slides in active movement. There is evidently neither distosis of the bimalleolar grip in dorso- and plantar flexion, nor movement of the lateral malleolus of the fibula, in opposition to the classical description. An anatomical rotation is discussed.