Comparative anatomo-radiological study of intrahepatic venous vascularization in the Spain.

BACKGROUND: Anatomic variations in the hepatic venous system are the least understood aspect of hepatic anatomy. The variations are diverse, and data are lacking with respect to the population of Spain and methods of detection. The objective was to examine morphological patterns of variations in hepatic venous vascularization using cadaveric dissections vs. radiological imaging, and to analyze the findings with respect to Spain and to published studies. METHODS: Thirty-one livers were anatomically dissected and analyzed for their hepatic venous anatomy and then compared to the venous anatomy of livers examined in 216 CT scans from 119 men and 97 women, ranging between 27 and 89 years of age. Statistical analysis was done using the Chi squared and Fisher homogeneity tests. RESULTS: The hepatic portal vein showed morphological variations in cadavers vs. CT of 67.3% vs. 67.6% (p-I), 29% vs. 12.2% (p-II), 0% vs. 14.6% (p-III), 0% vs. 14.6% (p-IV), 3.2% vs. 0.5% (p-V) and 6.5% vs. 1.9% (p-VI), respectively in cadavers vs. CT. Hepatic vein pattern variation were found in 64.5% vs. 50.7% (h-I), 32.2% vs. 31.5% (h-II), 0% vs. 2.3% (h-III), 0% vs. 4.7% (h-IV), respectively in dissections vs. CT). In Accessory Hepatic Veins the frequency in pattern variation was 64.5% vs. 18.8% (a-2.1), 29.0% vs. 8.0% (a-2.2), 58.1% vs. 11.3% (a-2.3), 9.7% vs. 0.9% (a-2.4), 67.7% vs. 16.9% (a-2.5), 9.7% vs. 4.2% (a-2.6) and 0% vs. 0.5% (a-2.7), respectively, in cadavers vs. CT. CT showed in 27.2% no accessory hepatic veins. Sex was not a factor influencing patterns of variation. CONCLUSION: Anatomical variants of the hepatic portal vein, the hepatic vein and accessory hepatic veins are very diverse and show greater variability in the specimens compared to those detected with radiological images, finding a wider spectrum of variations as it allows the clinician to have a more precise definition of the vasculature. A higher precision in the definition of anatomical variations is warranted for surgical planning in liver resection and transplantation.

The size of intestines in Vietnamese adults

The length of the small intestine of the Westerner is about 5-9 m long, whereas data on the intestinal length of Vietnamese patients is lacking in the liter-ature. This study aims to determine the size of in-testines in Vietnamese and the difference between fixed cadavers, autopsies and in operative patients. There were 130 subjects examined in this study: intestine from 40 formalin fixed cadavers, 30 autopsies and 60 living patients. The cohort includ-ed 91 males and 39 females, with ages ranging from 18 to 75 years-old and origin from various social levels. Subjects were excluded from this study if there was current or prior GI disease, GI surgery, or any other abdominal surgery. The length of the duodenum was 24.3 ± 1.2 cm in for-malin fixed cadavers and 25.60 ± 1.4 cm in autop-sies. The length of the small intestine was 382.5 ± 45.5 cm in preserved cadavers, 442.3 ± 62.5 cm in autopsies and 556.2 ± 74.4 cm in operative pa-tients. The length of the large intestine was meas-ured to be 132.5 ± 17.6 cm in preserved subjects, 149.3 ± 12.1 cm in autopsies and 156.3 ± 14.5 cm in operative patients. The greatest diameter was the jejunum in autopsies, or 4.1 ± 0.37 cm, and the smallest diameter was the ileum in autopsies, or 2.5 ± 0.30 cm. In Vietnamese, the length of the intestine in surgical patients was the longest; in theformalin-preserved group was the shortest, and in autopsies group was in the average range. The length of the Vietnamese small intestine was short-er than that of the European and American sub-jects. Surgeons need to be aware of variations in intestine length so that resection resulting in small bowel syndrome can be anticipated or avoided

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Sinistroposition: A case report of true left-sided gallbladder in a Vietnamese patient.

INTRODUCTION: Left-sided gallbladder without situs viscerum inversus (LSG-woSVI) is defined as a gallbladder located under the left lobe of the liver; to the left of the round/falciform ligament, but with all other viscera maintaining normal anatomical relationships. This is a rare congenital anomaly with a reported prevalence that ranges from 0.04% to 1.1%. It is usually an incidental intraoperative finding, and can be associated with anatomic abnormalities of the biliary tree, portal system and vasculature. LSG and associated variations may present significant challenges even for experienced surgeon. PRESENTATION OF CASE: LSG-woSVI was unexpectedly discovered in a 49-year-old, Vietnamese female during laparoscopic cholecystectomy. There were no pre-operative indications of sinistroposition. The cystic duct joined the common hepatic duct on the right side, and the cystic artery crossed anterior to the common bile duct in a right-to-left direction. Antegrade cholecystectomy was performed without intraoperative or postoperative complications. DISCUSSION: LSG is a rare anatomical variation that often remains undetected with ultrasound and pre-operative tests. Several hypotheses suggest underlying embryologic mechanisms for LSG and associated anomalies in ductal, portal and vascular anatomy, but the exact cause remains a mystery. Safe laparoscopic cholecystectomy can be done; however, there is an increased risk of injury to the major biliary structures compared to orthotopic gallbladder. CONCLUSION: Laparoscopic antegrade cholecystectomy is feasible for LSG. However, surgeons need to be cognizant of anatomy, so that rapid modifications of surgical technique can ensure positive patient outcomes.

A morphometric anatomical study on the division of the left main coronary artery and myocardial bridges

The division of the left main coronary artery (LMCA) exhibits a range of anatomical variation. It can divide into two, three, four or five branches, and have myocardial bridges. This carries important significance in clinical practice. The objective of this study was to examine the morphometric anatomical variation of the LMCA in Vietnamese cadavers. Hearts from 125 cadavers preserved in formalin solution were used in the study. LMCA was present in 96% of the specimens with the mean diameter of 4.62 ± 0.74 mm and the mean length of 9.05 ± 3.61 mm. The LMCA gave rise to two branches (bifurcation) in 51.2%, three branches (trifurcation) in 43.2% and four branches (quadrifurcation) in 5.6%. The mean outer diameter of the anterior interventricular artery, circumflex artery and the intermediate branch were 3.78 ± 0.54 mm, 3.33 ± 0.67 mm, and 1.80 ± 0.62 mm, respectively. The anterior interventricular artery ended at the anterior interventricular sulcus in 1.6% of the specimens, ended at the apex in 21.6%, and crossed over the apex to reach the posterior interventricular sulcus and terminate there in 76.8%. The circumflex artery ended before the left border in 4.13%, at the left border in 46.28%, between the left border and the crux in 46.62% and at the crux in 4.13%. The myocardial bridge was present only at anterior interventricular artery in 41.6%; in both anterior interventricular artery and posterior interventricular branch in 5.6%. LMCA varies in length and it can divide into two, three or four branches. End position of the anterior interventricular artery and the circumflex artery are variable. These variations may prove challenging during percutaneous coronary intervention (PCI) or coronary artery diagnostic imaging

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A comprehensive anatomical characterization and radiographic study of stage III testicular cancer in a 31-year-old male patient

The purpose of this investigation was to characterize an unusual case of stage III testicular germ cell tumor (TGCT) in a 31-year-old male with metastases to nodes, bone, viscera and brain, and to understand all possible routes of metastatic disease. Testicular cancer (TC) has an increasing incidence worldwide, and its etiology, risk factors and pathogenesis are not completely understood. Medical records were reviewed, and the cadaveric specimen evaluated by physical examination and gross dissection. Paraffin embedded tissue sections of the primary tumor were stained with Hematoxylin and Eosin (H&E) for histological study. To examine metastatic spread, pre- and post-mortem digital radiologic image acquisition was done using x-ray films, and high- resolution CT Scans and MRI Scans. Image analysis, multi-planar reformatting, and three- dimensional (3-D) reconstruction were done on radiographic series. Dissection showed masses bilaterally from the apex through the lung base; masses on the internal thoracic wall, and hepatomegaly and splenomegaly with multiple tumor masses. Testicular parenchyma was composed of primitive germ cells that formed glomeruloid or embryonal-like structures, as well as areas with a micro-cystic histologic pattern and areas of fibrous dysplasia. Medical imaging 3- D video radiographic dissection was notable for a 38.45 mm diameter, mid-brain tumor; extreme hepatomegaly with numerous tumors, lung tumors, a large penetrating tumor of the left ilium, and multiple tumors throughout both lungs and the thoracolumbar spine (T5-S1). This study provides insight into the histology and metastatic spread of TGCT that is essential for clinicians to understand in the evaluation and treatment of TC patients

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A change in paradigm: giving back identity to donors in the anatomy laboratory.

This article describes a paradigm of teaching in the anatomy laboratory where students interact with the families of the deceased persons whom they are dissecting. This approach focuses learning anatomy and medicine on the patient via the implementation of five guiding principles: the First Patient; Knowledge; Reflection and Reflective Practice; Treating the Total Patient; and Professionalism. Physician training typically begins with cadaveric dissection (i.e., dissection of the first patient), and therefore the medical school gross anatomy course provides an ideal environment for multifaceted educational experiences where cadaveric dissection is used to teach structure and function as well as the skills and competencies critical to patient care. Here, these principles are described, and the impact on student doctors and outcomes discussed. The results suggest that mastery of basic science knowledge and competencies, including professionalism, compassion, and leadership skill is enhanced by this protocol.

Plasma membrane calcium-ATPase isoform four distribution changes during corneal epithelial wound healing.

PURPOSE: Plasma Membrane Calcium-ATPases (PMCAs) are integral membrane proteins essential to the control of intracellular Ca2+ concentration. In humans, four genes encode PMCA proteins termed PMCA1-PMCA4. PMCA4 is the major PMCA isoform expressed in human corneal epithelium (hCE); however, little is known about its role. The present study documented expression of PMCA4 in rabbit CE (rbCE) and followed the distribution of PMCA4 during CE wound healing in a rabbit (rb) model. METHODS: Reverse transcriptase PCR using PMCA4 isoform gene-specific primers that flanked alternative splice site A was used to examine the presence of PMCA4 mRNA in rbCE. Protein expression was assessed by immunoblotting using panPMCA- and PMCA4-specific antibodies. Immunocytochemistry was employed to examine PMCA immunolocalization in frozen, formaldehyde-fixed sections of control and wounded rb corneas. In wound healing studies, circular, 6-mm diameter corneal wounds were produced in the central CE using the n-heptanol technique. The distribution of PMCA4 in CE was examined by immunohistochemical staining of frozen sections using PMCA4 isoform-specific antibody at 6-, 24-, 36-, and 48 h post-injury. siRNA(PMCA4) was used to transfect telomerase-immortalized human corneal epithelial (hTCEpi) cells. Cell cultures were wounded 48 h after transfection, and the wound area was measured at 0 h and at 3 h intervals post-wounding. RESULTS: Direct sequencing of PCR DNAs documented the presence of PMCA4 transcripts in rbCE and showed that the splice variant at site A was PMCA4x. Immunoblot analysis for PMCA4 detected an intense band at approximately 160 kDa and a faint band at approximately 142 kDa. Immunohistochemistry with the panPMCA antibody demonstrated strong immunoreactivity (IR) in all layers of uninjured rbCE. Immunohistochemistry with a PMCA4-specific antibody demonstrated a similar pattern of intense IR along the plasma membrane of cells in all layers of CE, except for the notable absence of PMCA4 IR along the basal cell membranes adjacent to the stroma. The pattern of PMCA4 IR changed following wound healing. During the lag phase of corneal epithelial wound healing, PMCA4 IR was seen mostly on apical plasma membranes of basal cells near the wound margin, with little staining of basal plasma membranes. During the migration phase (24 h), PMCA4 IR was found mostly on basal cell membranes adjacent to the stroma. At 6 h and 24 h following wounding, PMCA4 IR of the cytoplasm was increased compared to control eyes. After closure of the denuded area and stratification, PMCA4 IR was again primarily found along the apical and lateral plasma membranes of basal cells and was again absent from basal cell membranes adjacent to the stroma; PMCA4 IR of the cytoplasm was also similar to that observed in control eyes. siRNA(PMCA4) transfected hTCEpi cells failed to seal the wound area, whereas wounds in control cultures transfected with a scrambled construct were completed healed. CONCLUSIONS: PMCA4 is strongly expressed in rabbit CE and its immunolocalization exhibits marked changes in distribution during the wound healing process. Knockdown of PMCA4 expression in hTCEpi cells decreases wound healing. Present findings suggest that PMCA4 redistribution could function as one factor in mediating calcium-regulated events necessary for cell migration in regenerating CE.

A human dissection training program at Indiana University School of Medicine-Northwest.

As human cadavers are widely used in basic sciences, medical education, and other training and research venues, there is a real need for experts trained in anatomy and dissection. This article describes a program that gives individuals interested in clinical and basic sciences practical experience working with cadavers. Participants are selected through an open application process and attend sessions focused on anatomical terminology, gross anatomy and radiography, and some of the educational applications of human cadavers. Dissection skills are honed during an intensive, two-day cadaver dissection and orthopedic workshop. Participants communicate the knowledge they gain through table-side discussions, reflect upon the experience during a memorial service, and submit written program evaluations. Additionally, the dissection and preparation of cadaveric materials accomplished in this course are used in the medical school gross anatomy course during the next academic year. From 2004 through 2008, the annual number of applicants increased from 40 to 167, and the number of participants increased from 25 to 43 per year. Program participants have represented diverse ethnic, educational, and professional backgrounds. Feedback from participants has been remarkably positive, including comments on the large amount of learning that takes place during the sessions, the positive impact the program has had on career choice, and the desire for program expansion. This program, which could be replicated at other institutions, teaches anatomy, prepares cadaveric prosections for teaching and training others, and encourages participants to pursue careers in anatomical and biomedical sciences.

A case of extensive hyperostosis frontalis interna in an 87-year-old female human cadaver.

Hyperostosis frontalis interna (HFI) is a condition that involves thickening of the inner surface of the frontal bone with sparing of the midline. Little is known about the etiology and clinical presentation of HFI. We report unusual findings in a woman with extensive Type D hyperostosis of the frontal bone and a large hyperostotic nodule in the parietal bone with impingement on the precentral gyrus, distinguishing this from the common form of HFI. The scalp was dissected from the cranial vault, and the calvaria and brain were removed and digitally imaged. Bone specimens were embedded in methyl methacrylate plastic, sectioned, and stained using the Von Kossa Method with MacNeal's tetrachrome. Medical records were reviewed, and additional history was obtained through interviews with the donor's family. The calvaria had extensive, bilateral thickening of the frontal bone with irregular topography and clearly demarcated borders. The dura was adherent to all hyperostotic regions. A 3.5-cm nodule was visible on the inner table of the left parietal bone. The dura and cerebrum showed compression in this region, but it was unclear if this resulted in clinical ramifications. Microscopic analysis revealed a larger proportion of cancellous bone was present in regions of macroscopic hyperostosis. Quantitative analysis of sections through areas of gross hyperostosis demonstrated a lower proportion of lamellar bone than in the control. The patient exhibited symptoms that have been correlated to HFI in previous studies. We suggest that the HFI disease process was responsible for the manifestation of these symptoms in this patient.

Alternative splice variants of plasma membrane calcium-ATPases in human corneal epithelium.

Plasma membrane calcium-ATPases (PMCAs) play a critical role in regulating intracellular calcium concentration. Four genes encode PMCA proteins with alternative splicing of transcripts at three sites (A, B and C) serving to increase isoform diversity. Our previous work shows that all four PMCAs are expressed and have specific locations in human corneal epithelium (hCE). The present work examined which splice variants of PMCAs are expressed in hCE. Total RNA was extracted from hCE scraped from cadaver corneas of five different donors (two females and three males, age range 55-76 years). RT-PCR was performed using PMCA isoform-specific primers designed to amplify transcripts that included either splice site A or splice sites B and C. PMCA cDNAs were sequenced or cloned, and then sequenced. There was uniformity in the PMCA1 and PMCA4 expression profile among the five donors. Specifically, every donor expressed PMCA4 transcripts (4x at site A and 4b at site B/C). Every donor also expressed PMCA1 transcripts at sites B/C, specifically PMCA1b and PMCA1kb. In contrast, PMCA2 and PMCA3 expression varied; PCR DNAs were detected in two of five donors. One donor expressed PMCA2a and a novel PMCA2 variant we termed PMCA2((i)). PMCA3a transcript was demonstrated in a different donor. Finally, for all the donors, bands encoding site A transcripts for PMCA4 were obtained but no PCR transcripts were detected at site A for PMCA1, PMCA2 and PMCA3. This investigation showed that hCE expressed multiple splice variants of PMCA isoforms. Furthermore, this study documented the expression of the PMCA1k variant (PMCA1kb) previously only described in intestine and pancreatic beta cells and describes a novel PMCA2((i)) variant. Finally, this study suggests that the molecular configuration of PMCA1, PMCA2 and PMCA3 in the region of splice site A in hCE must be different than in other tissues since the same primers that produced site A transcripts in several other tissues were ineffective in priming PCR in hCE.

Expression and immunolocalization of plasma membrane calcium ATPase isoforms in human corneal epithelium.

PURPOSE: Plasma membrane Ca2+-ATPases (PMCAs) are integral membrane proteins essential to the control of intracellular Ca2+ ([Ca2+]i) concentration. Four genes encode PMCA proteins termed PMCA1-PMCA4. Little is known about the expression of these isoforms in corneal epithelium (CE). The purpose of this investigation is to characterize the expression and distribution of PMCAs in human CE (hCE). METHODS: PMCA mRNA expression was examined by RT-PCR analysis of total RNA from native hCE using PMCA gene specific primers. PMCA isoform expression at the protein level in native hCE was examined by immunoblotting using isoform specific antibodies (Abs) and a panPMCA Ab that recognizes all PMCAs. Distribution of PMCAs in postmortem and surgical sections of hCE was determined by immunohistochemistry with the same Abs. RESULTS: Immunoblot analysis with the panPMCA Ab yielded an intense band of approximately 135 kDa and several faintly staining bands above and below this major band. The isoform specific Abs labeled one or more bands that corresponded to bands detected with the panPMCA Ab. RT-PCR analysis of total RNA from hCE yielded PCR DNAs that were identified by sequencing as products of PMCA1, PMCA2, PMCA3, and PMCA4, thus confirming the immunoblot data. Immunohistochemistry demonstrated localization of PMCAs in all layers of hCE. PMCA4 was the predominant isoform, and was expressed along the plasma membrane of cells in all layers of CE, except with a notable absence along the basal cell membranes adjacent to the stroma. PMCA1 and PMCA2 were found mainly on basal and wing cells. In contrast to PMCA4, PMCA1 immunoreactivity (IR) was located on portions of basal cell plasma membranes adjacent to the stroma. PMCA2 IR was detected cytoplasmically within basal and wing cells in both central cornea and limbus. PMCA3 IR was located in basal cell nuclei in central cornea, but in a perinuclear location in the limbal, basal, and wing cells. CONCLUSIONS: Human CE expresses multiple PMCA isoforms that are differentially expressed and localized among the layers and cells that comprise the CE. We propose that the differential expression of multiple PMCA isoforms affords CE the requisite flexibility to respond to the demands for Ca2+ regulation required during renewal and regeneration of its multiple cell types.