Gross Anatomy Research Articles

Neurocapillary-Modulation

ObjectivesWe consider two consequences of brain capillary ultrastructure in neuromodulation. First, blood-brain barrier (BBB) polarization as a consequence of current crossing between interstitial space and the blood. Second, interstitial current flow distortion around capillaries impacting neuronal stimulation. Materials and MethodsWe developed computational models of BBB ultrastructure morphologies to first assess electric field amplification at the BBB (principle 1) and neuron polarization amplification by the presence of capillaries (principle 2). We adapt neuron cable theory to develop an analytical solution for maximum BBB polarization sensitivity. ResultsElectrical current crosses between the brain parenchyma (interstitial space) and capillaries, producing BBB electric fields (EBBB) that are >400x of the average parenchyma electric field (ĒBRAIN), which in turn modulates transport across the BBB. Specifically, for a BBB space constant (λBBB) and wall thickness (dth-BBB), the analytical solution for maximal BBB electric field (EABBB) is given as: (ĒBRAIN × λBBB)/dth-BBB. Electrical current in the brain parenchyma is distorted around brain capillaries, amplifying neuronal polarization. Specifically, capillary ultrastructure produces ∼50% modulation of the ĒBRAIN over the ∼40 μm inter-capillary distance. The divergence of EBRAIN (Activating function) is thus ∼100 kV/m2 per unit ĒBRAIN. ConclusionsBBB stimulation by principle 1 suggests novel therapeutic strategies such as boosting metabolic capacity or interstitial fluid clearance. Whereas the spatial profile of EBRAIN is traditionally assumed to depend only on macroscopic anatomy, principle 2 suggests a central role for local capillary ultrastructure—which impact forms of neuromodulation including deep brain stimulation (DBS), spinal cord stimulation (SCS), transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), and transcranial electrical stimulation (tES)/transcranial direct current stimulation (tDCS).

Topography of the deep branch of the ulnar nerve between genders: a cadaveric study with potential clinical implications

The lack of meticulous knowledge concerning the topographical anatomy of the deep branch of the ulnar nerve (DUN) may pose difficulties, leading to a delay or a misdiagnosis of a DUN injury. Identification of the DUN is quite difficult without precise anatomical landmarks as reference points. The current study investigates the topography of the DUN between genders, taking as a reference point a well-known landmark, the Kaplan line, used in hand surgery for carpal tunnel release. Twenty-two (15 males and 7 female) fresh frozen adult cadaveric hands were dissected by using magnifying loupes (3.5 and 5.0 x). We marked values proximal to the Kaplan line as positive (+), while we marked distal ones as negative (-). The mean distance DUN–Kaplan line was 1.69 ± 4.45 mm. In male hands, the mean distance was 4.17 ± 1.88 mm, distal to the Kaplan line, while in females, the mean distance was −4.92 ± 0.69 mm proximal to the Kaplan line. Gender dimorphism was detected, with higher statistically significant values in male hands (p = 0.001). Cadaveric studies of the DUN topography, course, and distribution pattern are uncommon. The current study provides an accurate description of the DUN topography, taking the Kaplan line as a reference point, emphasizing gender differences. The DUN is located distally in males and proximally in females. Knowledge of these predictable anatomical relations may help hand surgeons intraoperatively when dealing with a DUN lesion, because of hand trauma or during the decompression of the DUN.

Topographical anatomy of the annulus of Zinn

The anatomy and even existence of a common tendinous origin of the extraocular eye muscles, or annulus of Zinn, has widely been debated in anatomical literature. This study explored the anatomical origins of the recti muscles, their course into the orbit and the dural connections of the common tendinous origin with the skull base. Twenty orbits of ten adult human cadavers were dissected. The orbital apex and its dural connections were photographed. Histological examination of apical specimens was performed. In all cadavers, extraocular muscles were observed to have a common tendinous origin at the orbital apex, continuous with dural connections extending into the skull base. Accessory slips of the medial rectus were observed across all cadavers. Dual heads of the lateral rectus were observed in fourteen orbits of seven cadavers. The origin of the levator palpebrae superioris appeared to be contiguous with the superior rectus at the common tendinous origin in all but one cadaver. These results support the existence of a common tendinous origin of the extraocular muscles, that is continuous with the skull base dura. In addition, they support the existence of variations in orbital anatomy including dual or accessory muscle slips of the extraocular muscles.

Otorhinolaryngological symptoms of tumors of the pharyngeal process of the parotid saliva (clinical case with literature review)

The parotid gland is the largest salivary gland. Tumors of the salivary gland account for 5% in the structure of oncological morbidity, and up to 80% of tumors affect the large salivary glands with tumor localization in 20% of cases in the pharyngeal process of the parotid salivary gland. The main clinical sign of a tumor of the parotid salivary gland is the presence of a slowly growing mass in the area of the gland. Often, underestimation of the clinical symptoms of salivary gland tumors is the reason for the late diagnosis of this disease and the initial manifestations of the process remain unnoticed for a long time. In order to increase the efficiency of clinical diagnostics of salivary gland tumors, the staff of the Department of Maxillofacial Surgery, Otorhinolaryngology and Topographic Anatomy with Operative Surgery of the Burdenko Voronezh State Medical University studied the clinical and anatomical parallels of changes in the ENT organs in lesions of the pharyngeal process of the parotid salivary gland. Using the previously obtained results of interdisciplinary interaction of otorhinolaryngologists and maxillofacial surgeons made it possible to increase the efficiency of diagnosis and treatment of patients with tumors of the pharyngeal process of the parotid salivary gland.

Sinus coronarius, mikroanatomska studija

INTRODUCTION: Complete appreciation of the cardiac venous system requires an understanding of its embryological basis, its usual patterns of distribution, and its common variations. AIM: The aim of our study was to improve our understanding of the coronary sinus morphometrical and topographical anatomy. METHODS: The investigations were carried out on 25 human hearts (from 11 male and 14 female persons of mean age 59.5; range: 40 to 75 years). The classic anatomical technique of microdissection (using neurosurgical microinstruments) was performed under the stereoscopic microscope on 10 specimens injected with a 10% formaldehyde solution. The arteries and veins of an additional 15 hearts were injected with methylmethacrylate and immersed in a 40% solution of NaOH for corrosion. Following washing out and drying, the obtained vascular casts were examined and measured. RESULTS: Coronary sinus (CS) extends from the opening of the oblique vein of the left atrium into the great cardiac vein, to its empty orifice into the right atrium. The length of CS varied between 22.4 and 41.4 mm (mean 33.0 ± 6.1 mm). The diameter of CS at its beginning was 5.0 - 9.6 mm (mean 6.6 ± 1.3 mm), and its diameter at its atrial mouth varied from 6.6 - 12.0 mm (mean 8.4 ± 1.6 mm). The CS had varied relationships to the branches of the left or right coronary arteries. It extended superficial and above the artery in 16 (64%) hearts, and close superficial to the artery in 9 (36%) cases. Duplication of the superior vena cava associated with an aberrant left hepatic vein was found in one case. The persistent left superior vena cava, which drained into the right atrium via the enlarged coronary sinus, was formed by the persistence of the left anterior cardinal vein. CONCLUSION: Our study shows that the coronary sinus, created in an early stage of embryological development, is an important collecting vessel receiving the main veins of the heart.

Topographical Anatomy of the Superficial Temporal Artery.

To describe in detail the gross anatomy of the superficial temporal artery (STA), its course and branches, its relationships with the branches of the facial nerve, and certain anatomical and surgical landmarks to preserve these structures in daily neurosurgical practice, and to use the STA during revascularization surgery. This cadaveric study was conducted on 16 cadaver heads bilaterally, in which 32 silicon/latex-injected STAs were dissected using a microdissection technique in a neuroanatomy laboratory. The distances between the facial nerve, tragus, STA, superficial temporal vein (STV), and imaginary lines created between important anatomical landmarks were measured. The curvilinear lengths of STA and STV were also measured. The average distances of the most posteriorly located branch of the facial nerve to the frontal region and the tragus at the midpoint of zygoma in the horizontal plane, at the superior border of the zygoma and at the level of the superior border of the parotid gland, were measured as 25.39, 29.84, and 15.56 mm, respectively. The average distance directly measured between the tragus and STA was 39.29 mm, and that between the tragus and STV was 20.26 mm. The average curvilinear lengths of the frontal and parietal branches of STA were 97.63 and 96.45 mm, respectively. Understanding the clinical anatomy of the STA and its branches and its relationships with other structures is of critical importance for a successful and noncomplicated surgery. Our findings will be useful not only for surgical approaches such as pterional craniotomy and orbitozygomatic approaches but also for cerebral revascularization.

History of the department of operative surgery and topographic anatomy of YSMU. Formation (1952—1974)

<h3></h3> В статье отражена история кафедры оперативной хирургии и топографической анатомии Ярославского государственного медицинского университета с 1952 по 1974 г. В этот период формировался постоянный коллектив сотрудников под руководством фронтового хирурга профессора Татьяны Арсеньевны Зайцевой. Активно осваивались экспериментальные операции на пищеводе, легких, сердце, желудке. Важным направлением исследований стала хирургия магистральных сосудов и трансплантация конечностей. Вопросы реплантации развивались с привлечением специалистов различных теоретических и клинических кафедр. Создана одна из первых в стране межобластная бригада хирургов-ангиологов. В задачи кафедры входили вопросы совершенствования методов преподавания, обеспечения учебного процесса наглядными пособиями: трупным материалом, фильмами по материалам научной работы кафедры, расширялся анатомический музей. Активно работал студенческий научный кружок, члены которого пополняли преподавательский коллектив кафедры и вуза. Воспитывались молодые научно-педагогические кадры, ставшие в последующем выдающимися учеными. На кафедре работали Е.П. Цветов, И.А. Пономарева, Ю.В. Новиков, В.В. Шилкин, Ю.А. Давыдов, которые стали впоследствии заведующими кафедр. Часть сотрудников кафедры связали свою жизнь с практическим здравоохранением и стали руководителями крупных научных лабораторий или заведующими отделений (профессора В.И. Савельев, Н.К. Миначенко, Н.В. Проценко). Факты их биографий, воспоминания современников освещают малоизвестные страницы истории становления преподавательского коллектива кафедры. В 1971 г. за многолетнюю безупречную работу по подготовке медицинских кадров Указом Президиума Верховного Совета СССР Т.А. Зайцева награждена орденом Ленина. В 1974 г. кафедру возглавил профессор, академик РАН Ю.В. Новиков, долгие годы (с 1977 по 2007) руководивший вузом.

К вопросу о вариативности положения рук усопших в русской православной погребальной традиции

In this article, I aim to conduct a comparative analysis of the deceased's arm positions (taking gender and age specifications into account) and define their distinct features. The burials examined are located in the Dormition Cathedral of St. Sophia, Tobolsk, and dated to the 17th century. The relevance of this study relies on examining one of the most important elements of the Orthodox funeral rites, the deceased's arm position, while simultaneously regarding age and gender specifications of funeral rites. The earlier studies researched these subjects separately. In order to define the region-specific features of the arm position variations, the frequency of their occurrences is also compared against the published data regarding other Christian burial sites in Northwest Russia, the Cis-Ural region, and Western Siberia, dated to the 16th-19th centuries. The research material comes from the excavations conducted by A. Adamov in 2005 at the cemetery grounds overlapped by the Dormition Cathedral of St. Sophia, Tobolsk (1683-1686). For the analysis, I selected 38 burials located in the western part of the cathedral grounds and outside them, under the parvis foundation. The skeletons' good preservation with the original position of bones intact enabled me to select such a number of burials for the analysis. All the burials analyzed had age and gender specifications. In order to organize different arm position variations into groups, I opted for a vertical division of the human body as per the principles of topographical anatomy. Three arm position groups were distinguished: arms on the abdomen or below the chest, arms crossed on the chest at the heart area, and a mixed position (the abdomen - the middle/upper part of the chest, the shoulder). By conducting a comparative age and gender analysis of arm positions discovered at the Dormition Cathedral's cemetery, I found that arms positioned on the abdomen and parallel to each other was the typical position for children. Arm positions among adults offered more variety. I should note that the position with arms crossed on the chest was typical for some of the male burials but did not occur in female burials. The positions from the other two groups occurred with similar frequency for both genders, taking into account the 2:1 male to female burial ratio in this cemetery. The comparison of arm position groups and variations in the burials at the Dormition Cemetery against the data from other burial sites dated to roughly the same time period and located in Northwest Russia, the Cis-Ural region, and Western Siberia, did not enable me to define any distinct region-specific features. In general, the frequency of the occurring arm position variations fluctuates considerably in different regions. It is evident that the positions with arms across the abdomen, below the waist, and on the chest are by far the most common ones. The mixed position occurs the least often.

Development of Ultrasound-Guided Technique for 4 Points Blockade of Manus in Dromedary Camel: A Cadaveric Investigation

The purposes of this study were to describe the most applicable approach of manus blockade in camel using ultrasound-guided techniques. The study was performed on 40 forelimbs of 20 apparently healthy mature freshly slaughtered camels. Limbs were randomly allocated into 3 phases of the study. Phase-I (n=8 limbs): dissection of both dorsal and palmar aspects to identify the topographical anatomy of the target nerves. Phase-II (n=8 limbs): dissection after US guided needle insertion to confirm the needle insertion position. Phase-III (n=24 limbs): US-guided methylene blue injection using one of three volumes (3, 5, or 7 mL) to establish the ideal injection volume. Our results revealed that the dorsal aspect of manus received its innervation from dorsal common digital nerves II and III (DCDN-II &amp; III) and dorsal common digital nerve IV (DCDN-IV). The palmar aspect of manus was received its innervation from the palmar common digital nerve IV (PCDN-IV) and the median nerve. Under Ultrasonographic guidance, the most applicable approach for blocking the DCDN-II &amp; III is at the dorsomedial aspect at about 8-10 c.m below the carpometacarpal joint (CMJ) and 2 cm medial to CDET. Blocking of the DCDN-IV is performed at the dorsolateral aspect at about 8-10 c.m below the CMJ and 2 cm lateral to CDET. Blocking the PCDN IV was performed at the lateral and palmar aspect at about 10-12 c.m below the accessory carpal bone (ACB) and 5 cm palmar to the imaginary line bisect the forelimb longitudinally from lateral to medial. Blocking the median nerve was performed at the proximal third of medial and palmar aspect of metacarpal bone at about 10-12 c.m below the ACB and about 5 cm palmar to the same imaginary line. In conclusion, four point blockade of the manus region in dromedary cadavers can be achieved by US-guided injection of the DCDN-II, III, DCDN-IV, PCDN-IV, and the median nerve.

Assessment of Self Disinfecting Capacity and Dimensional Stability of Irreversible Hydrocolloid Impression Material Mixed With Different Concentrations of Chlorhexidine Solution-An Invitro Study

Introduction: Impression materials are used to record the anatomical topography of oral tissues. Irreversible hydrocolloid is an impression material routinely used in dentistry. However, it retains bacteria, 2 to 3 times higher than other impression material. Spraying and immersion technique has been employed for disinfection of irreversible hydrocolloid with varying degree of success. Thus the need of impression material that has self-disinfecting capacity seems to be very important to have infection control in dentistry. Materials and Methods: This invitro study was done in two parts. Assessment of self-disinfecting capacity of irreversible hydrocolloid impression material mixed with different concentrations of chlorhexidine solution and dimensional stability of irreversible hydrocolloid impression material mixed with different concentrations of chlorhexidine solution. For assessment of self-disinfecting capacity, irreversible hydrocolloid was mixed with various concentrations of chlorhexidine (0.05%, 0.1%, 0.2%) and distilled water. Total 64 culture plates were prepared, n=16 for each group of microorganisms (E. coli, S. aureus, Pseudomonas, Klebsiella). Inhibition zones were measured for each microorganism. For dimensional stability, the specimens were divided into four groups similar to specimen for self-disinfecting ability. Total 56 samples were prepared, n=14 for each group. Interpretation (IP), Mesiodistal (MD), Buccolingual (BL), Occlusogingival (OG) dimensions were measured by digital Vernier caliper. One-way analysis of variance was done for assessment of self-disinfecting capacity and for dimensional stability. Dunnett comparison test was performed to test the significance between test and control. P value was calculated under the predetermined level of significance (0.05). Results: Zones of inhibition were observed around test specimens (groups 0.05, 0.1, 0.2), but not around control specimen (Group d/w). There was a significant difference in the mean diameters of the inhibition zones between test groups and control which was statistically highly significant (p &lt; 0.001). In the test for dimensional stability, no significant differences were detected among groups for all the measured dimensions (p&gt; 0.05). Conclusion: Irreversible hydrocolloid impression material mixed with chlorhexidine exhibits varying degrees of self-disinfecting activity without influencing the dimensional stability of set material.

Development of the Olympiad Student Surgical Movement at the N. N. Burdenko Voronezh State Medical University

The Olympiad Student Surgical movement historically arose from the activities of student scientific societies at the surgical departments of medical universities and, foremost, departments of operative surgery with topographic anatomy. This is the first department where students are taught future surgical manual skills of a medical specialist. The history of the largest Moscow (All-Russian) Student Olympiad in surgery named after an academician M. I. Perelman, held under the authority of First Sechenov Moscow State Medical University, is more than 30 years. Olympiad Student Surgical movement at Voronezh N. N. Burdenko State Medical University appeared in 2008. A long and difficult path has been covered since then. The teams under the guidance of various lecturers and student leaders experienced ups and downs, repeatedly won victories in the qualifying stages of the All-Russian Olympiad and took prizes in the Finals of the All-Russian Olympiad. In 2015, the tradition of holding an intra-university student Olympiad in surgery was started. Since then, 6 intra-university Olympiads have already been held. This allows annually updating the staffing of the team and encouraging students to even better results. The Olympiad surgical movement has a great pedagogical and educational potential and, undoubtedly, is an important stage in training future medical specialists of a surgical profile.

Phenomenon of Demikhov. At N.V. Sklifosovsky Institute (1960–1986). V.P. Demikhov and world transplantology in 1968-1969

The article has reviewed the advances of Soviet and world Transplantology in the field of heart and other organ transplantation achieved by the end of the 1960s. It is shown that there were several groups of doctors and scientists who worked in the USSR dealing with the problem of experimental organ transplantation and trying to bring this experience into clinic. The group of surgeons and urologists (B.V. Petrovsky, Y.M. Lopukhin, etc.) from the Research Institute of Clinical and Experimental Surgery and the 2nd MOLGMI named after N.I. Pirogov, which had the greatest administrative resources and technical capabilities, was successfully implementing kidney transplantation into clinic. The staff of the Faculty Surgery Department (V.S. Savelyev and others) of the 2nd MOLGMI named after N.I. Pirogov developed experimental approaches to heart and liver transplantation. Surgeons from the Tuberculosis Research Institute (N.I. Gerasimenko and others) were dealing with in lung auto- and homotransplats in experiment. All those studies were conducted in close contact with the Department of Operative Surgery and Topographic Anatomy of the 2nd MOLGMI named after N.I. Pirogov (G.E. Ostroverkhov) and the Research Laboratory for Organ Transplantation established at that Department (Y.M. Lopukhin). The leading position in heart transplantation in the country belonged to the Vishnevsky Institute of Surgery (A.A. Vishnevsky, etc.). Surgeons of the MMA named after S.M. Kirov (I.S. Kolesnikov, etc.) rendered a great assistance to the Institute. Apart from these institutions, the Organ Transplantation Laboratory (headed by V.P. Demikhov) worked at N.V. Sklifosovsky Research Institute for Emergency Medicine; it had gained a huge experimental experience, but had very modest opportunities to purchase equipment and pharmaceuticals, to conduct laboratory and morphological studies, having practically no prospects for introducing the results of its research into clinic. Meanwhile, the world clinical Transplantation continued to develop successfully, which was reflected in the materials of the 2nd International Symposium on Heart Transplantation held in 1969 in Montreal (Canada).

Safe corridors for external skeletal fixator pin placement in feline long bones.

External skeletal fixation is an established technique in cats for biological fixation of long bone fractures, stabilisation of the joints, and treatment of shearing injuries and angular deformities. As appropriate and accurate pin insertion is imperative for a successful outcome, knowledge of topographic anatomy and areas that are safe (safe corridors) for pin placement is integral to successful surgery. At present, however, safe corridors have not been determined fully in feline orthopaedics, with surgeons having to rely on knowledge based on canine orthopaedics. This study was performed to determine safe corridors for pin placement in feline long bones. The limbs of six feline cadavers were frozen. Only limbs with no history of orthopaedic conditions were used. Transverse sections through the limbs were examined, and anatomical structures were determined in relation to the bone. These structures were compared with those of the contralateral limbs, which were dissected for topographic assessment. Safe corridors were defined as topographic areas where no vital structures, muscles or joints were present. Examination of the humerus revealed safe corridors at its proximal craniolateral aspect and on the medial and lateral humeral condyles. Safe corridors of the antebrachium were identified on the lateral aspect of the olecranon, the distal two-thirds of the medial antebrachium and the distal third of the lateral antebrachium. Safe corridors in the femur consisted of a small area lateral to and just below the major trochanter, and on the medial and lateral femoral condyles. Evaluation of the tibia revealed safe corridors on the medial aspect of the entire tibia, the cranial aspect of the proximal tibia on the tibial crest and the area just proximal to the lateral malleolus. Safe corridors for pin placement during external skeletal fixation in feline limbs differed from those in canine limbs. Knowledge of canine anatomy may be inapplicable to pin placement in feline limbs undergoing external skeletal fixation.

Porta-caval fibrous connections - the lesser-known structure of intrahepatic connective-tissue framework: A unified view of liver extracellular matrix.

Knowledge about the connective-tissue framework of the liver is not systematized, the terminology is inconsistent and some perspectives on the construction of the hepatic matrix components are contradictory. In addition, until the last two decades of the 20th century, the connective-tissue sheaths of the portal tracts and the hepatic veins were considered to be independent from each other in the liver and that they do not make contact with each other. The results of the research carried out by Professor Shalva Toidze and his colleagues started in the 1970s in the Department of Operative Surgery and Topographic Anatomy at the Tbilisi State Medical Institute have changed this perception. In particular, Chanukvadze I showed that in some regions where they intersect with each other, the connective tissue sheaths of the large portal complexes and hepatic veins fuse. The areas of such fusion are called porta-caval fibrous connections (PCFCs). This opinion review aims to promote a systematic understanding of the hepatic connective-tissue skeleton and to demonstrate the hitherto underappreciated PCFC as a genuine structure with high biological and clinical significance. The components of the liver connective-tissue framework — the capsules, plates, sheaths, covers — are described, and their intercommunication is discussed. The analysis of the essence of the PCFC and a description of its various forms are provided. It is also mentioned that analogs of different forms of PCFC are found in different mammals.

P138 PREPERITONEAL ENDOSCOPIC GROIN HERNIA SURGERY - REASSESSMENT OF TOPOGRAPHIC ANATOMY AS A BASIS FOR STANDARDIZED DESCRIPTION OF SURGICAL STEPS

Abstract Aim Fascial groin anatomy remains a conundrum. In particular, a clear anatomical allocation of the correct extraperitoneal dissection planes and spaces in total extraperitoneal endoscopic hernia surgery (TEP) has not yet agreed upon. The differing anatomical concepts are reflected by the variability of surgical approaches, the considerably long learning curves and subsequent complications. Thus, the aim of this study was to reassess the topographic anatomy of the groin region providing a basis to standardize the surgical steps of TEP according to clearly defined anatomical landmarks. Material and Methods Video analysis of intraoperative surgical anatomy of groin hernia patients was correlated with the findings retrieved by macroscopic anatomical studies. The groin region of formalin fixed body donors was subjected to a stepwise dissection exposing the fascial system of the abdominal wall layer-by-layer and via different angles. Selected areas of interest were processed for histological study. Surgically relevant anatomical landmarks were defined and termed according to the most appropriate anatomical nomenclature. Results The essential surgical dissection steps during TEP could be related to specific anatomical landmarks extending within the extraperitoneal space of the ventral and dorsolateral abdominal wall. The definition of fascial structures and interfaces and the identification of structures at risk allowed the identification of correct dissection planes for mesh placement. Conclusions Our study helps to clarify the definition and nomenclature of anatomical key structures required for a standardized description of TEP in a simplified model. The data may contribute to reduce complications and improve surgical teaching and training.

Topographic Anatomy and Clinical Impact of Vascular Foramen on the Trochlear Groove of Adult Human Dry Femora.

ObjectiveIn this study, we aimed to assess the topographic anatomy and clinical impact of the vascular foramen on the trochlear groove of adult human dry femora.Materials and methodsThe incidence, shape, size, and location of the foramen present on the trochlear groove of the distal femur were studied using 33 adult human dry femora of unknown age and gender at the Department of Anatomy at Nowshera Medical College, Nowshera, Pakistan. Using a divider and scale, the incidence and structure of the vascular foramen in the trochlear groove were examined and its position in relation to the trochlear groove's upper and lower articulating edges was recorded.ResultsOut of 33 femora, 20 (60.6%) were right-sided and 13 (39.4%) were left-sided. All the foramina had round morphometry. In each of the 33 adult human dry femora, 15 (45.5%) had a single trochlear vascular foramen. One solitary trochlear vascular foramen was found in eight (53.3%) of the left femora and seven (46.7%) of the right femora. The diameter of each trochlear vascular foramina was about 2.5-4.5 mm with a mean diameter of 3.5 mm. Trochlear groove upper margin and foramen were 1.75-2.5 cm apart, whereas the lower margin was 0.5-01 cm apart. On average, foramen was 2.2 cm away from the upper margin, and 0.8 cm away from the lower margin. In the midline, nine (60%) trochlear vascular foramina were found, with five (55.5%) resting on the trochlear groove lower margin, and four (44.5%) lying mid-way at varying places from the upper and lower margins. The left of the centerline had six (40%) of the trochlear vascular foramen, whereas no trochlear vascular foramen was seen on the right side of the midline.ConclusionsBased on our findings, a significant segment of our population has trochlear vascular foramen present on the trochlear groove as the rate of occurrence of this was found to be 45.5%. The trochlear groove center has the most foramen, accounting for 60% of all the foramen.

Technologies to reduce radiation toxicity in prostate cancer patients: spacers - a simple and effective solution

The basic principles of the treatment of prostate cancer patients have underwent significant revisions in recent years. Modern radiotherapy techniques, which have demonstrated high efficacy and safety in long-term randomized trials, are beginning to take a leading position in the treatment of prostate cancer in an overwhelming number of clinical scenarios (National Comprehensive Cancer Network, 2021). Despite the obvious successes of radiation oncology, a number of important problems remain unresolved, first of all - the need to reduce the rates of radiation complications. The topographical anatomy of the prostate gland determines the main profiles of post-radiation damage: rectal and genitourinary radiation toxicity. The previous five years have been marked by a significant intensification of research work abroad aimed at clinical testing of a number of biopolymer compositions and products for use as spacers between irradiated structures and normal tissues. The experience has made it possible for the first time to consider the possibility of using spacers in radiotherapy treatment of prostate cancer in the modern recommendations of the European Association of Urology (2021). The analysis of the national literature shows a complete lack of publications on the possibilities of optimizing the radiation treatment of prostate cancer through the use of specers. The purpose of this work was the need to highlight this important and perspective clinical problem.

Topographic Anatomy of the Zygomatico-Orbital Artery.

The zygomatico-orbital artery (ZOA) originating from the superficial temporal artery and supplying the lower temporal region superficially has been reported. Previous studies of this artery have used definitions that are too ambiguous for the results to be directly adapted to clinical practice, including since they have resulted in marked variations in the reported incidence ofthe artery. This study dissected 193 hemifaces of 123 fixed human cadavers aged 36 to 102 years (119 males and 74 females). The authors investigated the ZOA based on the following definition: (1) it originates from the superficial temporal artery, (2) it runs mostly above the zygomatic arch, and (3) it terminates below the superior border of the orbicularis oculi muscle. The incidence of the ZOA was 22.8% (44 cases of 193 sides), and its mean diameter was 1.1 mm. The meanvertical distances from the superior borderofthe zygomatic arch to the artery were 29.6, 17.8, and 2.9 mm at the jugale, zygion, and the origin of the ZOA, respectively. An accurate definition of the ZOA and accurate knowledge of its incidence and course could be important for clinicians to avoid unintentional complications in clinical practice.

3D Virtual Reality Imaging of Major Aortopulmonary Collateral Arteries: A Novel Diagnostic Modality.

BackgroundMajor aortopulmonary collateral arteries (MAPCAs), as seen in patients with pulmonary atresia, are arteries that supply blood from the aorta to the lungs and often require surgical intervention. To achieve complete repair in the least number of interventions, optimal imaging of the pulmonary arterial anatomy and MAPCAs is critical. 3D virtual reality (3D-VR) is a promising and upcoming new technology that could potentially ameliorate current imaging shortcomings.MethodsA retrospective, proof-of-concept study was performed of all operated patients with pulmonary atresia and MAPCAs at our center between 2010 and 2020 with a preoperative computed tomography (CT) scan. CT images were reviewed by two congenital cardiac surgeons in 3D-VR to determine additional value of VR for MAPCA imaging compared to conventional CT and for preoperative planning of MAPCA repair.Results3D-VR visualizations were reconstructed from CT scans of seven newborns where the enhanced topographic anatomy resulted in improved visualization of MAPCA. In addition, surgical planning was improved since new observations or different preoperative plans were apparent in 4 out of 7 cases. After the initial setup, VR software and hardware was reported to be easy and intuitive to use.ConclusionsThis study showed technical feasibility of 3D-VR reconstruction of children with immersive visualization of topographic anatomy in an easy-to-use format leading to an improved surgical planning of MAPCA surgery. Future prospective studies are required to investigate the clinical benefits in larger populations.

Anterior Cervical Discectomy and Fusion:Safe Surgical Operation Based on Detailed Anatomical Knowledge

Anterior cervical discectomy and fusion(ACDF)was developed by R.B. Cloward in the 1950s and it has spread over the world for the treatment of the spinal degenerative disorders. It is considered to be the most effective treatment for patients with anterior compression of the spinal cord. Because most of the surgical complications reportedly occur while approaching the vertebral column through the subcutaneous tissues, precise knowledge of the topographic anatomy of the neck is crucial for effective and safe surgery. In this paper, we describe the appropriate surgical maneuvers in each surgical step, based on anatomical knowledge, for avoiding surgery-related complications. We would like to emphasize that anatomical features differ with individual patients; therefore, careful preoperative evaluation is very important. Surgical strategy, based on adequate preoperative evaluation, will lead to good postoperative results.