[Teaching human anatomy by the American medical faculty. The example of Stanford].
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
V Delmas
Publications and source records attributed to V Delmas.
Cadherins in neural crest cell development and transformation.
Cadherins constitute a superfamily of cell adhesion molecules involved in cell-cell interaction, histogenesis and cellular transformation. They have been implicated in the development of various lineages, including derivatives of the neural crest. Neural crest cells (NCC) emerge from the dorsal part of the neural tube after an epithelio-mesenchymal transition (EMT) and migrate through the embryo. After homing and differentiation, NCC give rise to many cell types, such as neurons, Schwann cells and melanocytes. During these steps, the pattern of expression of the various cadherins studied is very dynamic. Cadherins also display plasticity of expression during the transformation of neural crest cell derivatives. Here, we review the pattern of expression and the role of the main cadherins involved in the development and transformation of neural crest cell derivatives.
Animals↗
Anatomical basis of lumboscopy.
Lumboscopy provides an approach to the retroperitoneum for the majority of upper urinary tract operations. The technique involves a knowledge of specific anatomical landmarks that differ from those in classical open surgery, because of the inferior approach to the renal pedicle with the kidney initially mobilized in a ventral and cranial position. An anatomical study was conducted on five cadavers, using images from surgical operations, in order to describe the vascular elements of the retroperitoneal spaces as they are approached during lumboscopy, as well as to define specific anatomical landmarks. Identification of psoas major is crucial as it is then possible to locate the renal pedicle opposite and the area of the great vessels medially. During dissection of the renal pedicle the renal vein and its branches are the first elements to be approached. On the left side the distal portion of the renal vein can be confused with a reno-hemi-azygo-lumbar trunk, due to the initial ventral mobilization of the kidney stretching it. Because of the inferior view of the renal pedicle the reno-hemi-azygo-lumbar trunk can obscure part of the renal artery and may be confused with the renal vein. On the right side initial identification of the inferior vena cava on the medial aspect of psoas major facilitates identification of the gonadal, renal and suprarenal veins all located in the same plane.
Cadaver↗
A study of the anatomic features of the duct of the urachus.
The urachus is an embryonic remnant resulting from involution of the allantoic duct and the ventral cloaca. Attaching the bladder dome to the umbilicus, this duct becomes progressively obliterated during fetal life. It may subsequently persist as different variants after birth, some regarded as normal, others as pathologic, due to incomplete closure. Six pediatric cases are reported here, and the literature on the embryology and anatomic basis of the duct is discussed. The urachus is present in nearly 100% of children at birth, with several possible shapes: tubular, fusiform or funnel. It gradually regresses and is found in only a third of adults. Its length varies from 1 to 15 cm. In our series 6 patients showed defective closure of the duct, including 3 with complete patency, 1 cyst, 1 diverticulum and 1 external sinus. Although rare, congenital pathology of the urachus requires a sound knowledge of the anatomy and embryology to distinguish normal forms from those subject to complications. It should be suspected with any lesion in the umbilical region and the appropriate treatment instituted.
Adolescent↗
[The anatomy collections of the Paris V University: their role in medical teaching for two centuries].
The Museum of anatomy of the University Paris V exhibits a collection of ancient and high quality dissections and waxworks, very well preserved, which were used for teaching anatomy and have been classified historic monument since 1992.
Anatomy↗
The pathophysiology of pelvic floor disorders: evidence from a histomorphologic study of the perineum and a mouse model of rectal prolapse.
The muscle changes related to pelvic floor disorders are poorly understood. We conducted an anatomical and histological study of the perineum of the normal mouse and of a transgenic mouse strain deficient in urokinase-type plasminogen activator (uPA-/-) that was previously reported to develop a high incidence of rectal prolapse. We could clearly identify the iliococcygeus (ILC) and pubococcygeus (PC) muscles and anal (SPA) and urethral (SPU) sphincters in male and female mice. The bulbocavernosus (BC), ischiocavernosus (ISC) and levator ani (LA) muscles could be found only in male mice. Histochemical analysis of the pelvic floor muscles revealed a majority of type IIA fibres. Rectal prolapses were observed only in male uPA-/- mice. The most obvious finding was an irreducible evagination of the rectal mucosa and a swelling of the entire perineal region corresponding to an irreducible hernia of the seminal vesicles through the pelvic outlet. The hernia caused stretching and thinning of the ISC, BC and LA. Myopathic damage, with degenerated and centronucleated myofibres, were observed in these muscles. The PC, ILC, SPA and SPU were not affected. This study provides an original description of a model of pelvic floor disorder and illustrates the differences existing between the perineum of humans and that of a quadruped species. In spite of these differences, the histopathologic changes observed in the pelvic floor muscles of uPA-/- mice with rectal prolapse suggest that prolonged muscular stretching causes a primary myopathic injury. This should be taken into account in the evaluation of pelvic floor disorders.
Animals↗
[Donation of bodies to science].
Teaching and research in anatomy is mainly based on cadaveric dissection. Unclaimed bodies is no more the origin of cadavers, but body donation programs. The dissection is an important part in the anatomical curses of medical students and for anatomical research and special courses devoted to the surgeons. A body donation center was created in Paris in 1953 with the purpose of obtaining bodies for dissection. Donation is a clear will made by people free and informed. Donation is most often by altruism, conferrins life on another. Body donation is regulated by various act or reglementar text according to each country. One of the problem with the body gift is biological hazard, specially in research and clinical courses, but the rule is to consider unembalmed material as contaminated and to use all precautions with barrier for blood and bodily fluid. Body donation is one of the modern expression of solidarity.
Anatomy↗
[Can a precise vesiculectomy be performed during radical prostatectomy?].
OBJECTIVE: To define the anatomical landmarks allowing precise vesiculectomy to be performed during radical prostatectomy for cancer. MATERIAL AND METHODS: 12 non-formalin-preserved anatomical subjects were dissected as during retropubic and perineal prostatectomy, with and without coloured latex vascular injection. RESULTS: Three anatomical landmarks were defined: 1) Denonvilliers' fascia; 2) vas deferens; 3) arteries supplying the seminal vesicles. CONCLUSIONS: These three anatomical landmarks ensure: complete resection, preservation of adjacent anatomical structures and elective haemostasis.
Aged↗
Anomalies of lateralization in man: a case of total situs inversus.
Total or complete visceral situs inversus is the complete inversion of position of the thoracic and abdominal viscera. The aim of this study is to report a case of complete situs inversus and to review our knowledge of the anomalies of lateralization. A case of complete sinus inversus was discovered incidentally during anatomic dissection in a female subject aged 87 years. The thoracic and abdominal organs had a position symmetric with the normal. This was associated with a common mesentery and incomplete rotation of the colon, placing the cecum under the left lobe of the liver. These alimentary anomalies were discovered in adult life during a surgical operation for small intestinal occlusion, as evidenced by the abdominal scar and peritoneal adhesions. No cardiac, pulmonary, splenic or facial sinus anomalies were encountered. The incidence of complete situs inversus is estimated as 1/8000 in the general population. It may be isolated or associated with malformations, especially cardiac or alimentary. It may be discovered in infancy because of associated anomalies but often remains asymptomatic and discovered by chance in adult life. Complete situs inversus may form part of the multiple malformational syndromes such as that of Kartagener, with recessive autosomal transmission (complete situs inversus, bronchiectasis, chronic sinusitis, male infertility), which represents 20-25% of cases of complete situs inversus. In view of the frequency of this type of anomaly, a knowledge of anomalies of lateralization is essential in clinical practice.
Aged↗
Percentage of cancer on biopsy cores accurately predicts extracapsular extension and biochemical relapse after radical prostatectomy for T1-T2 prostate cancer.
PURPOSE: To perform a multivariate analysis to investigate the usefulness of eight preoperative variables as predictors of final pathological stage (pT), positive surgical margins (PSM) and biological progression after radical prostatectomy (RP). MATERIALS AND METHODS: In 143 patients undergoing RP for T1-T2 prostate cancer, the respective values of age, clinical stage, preoperative prostate-specific antigen (PSA), prostate-specific antigen density (PSAD), number of positive biopsies (NPB), Gleason score, length of tissue core invaded by cancer (LTI) and topography (uni/bilaterality) of positive biopsies for predicting extracapsular extension, PSM and biochemical failure (PSA> or =0.05 ng/ml) were evaluated retrospectively. Univariate and multivariate analyses were applied to define the statistical significance of each variable. Actuarial survival without biological progression was calculated using the Kaplan-Meier method (log-rank test). RESULTS: In this series, 44.8% of patients had extracapsular extension with 41.3% PSM. The mean PSA was 12.4 ng/ml. In univariate analysis, LTI (p<0.0001), NPB (p = 0.0023), PSA (p = 0.0039) and Gleason score (p = 0.0136) were the most powerful variables to predict pT stage; however, in logistic regression analysis, LTI was the most predictive feature. For prediction of PSM, some variables (LTI, NPB and PSA) were found to be of statistical value in univariate analysis, and LTI in combination with NPB and PSA in multivariate analysis. For biological progression, statistical analysis (log rank test) showed PSAD and LTI to be significant predictors. CONCLUSION: The pathological report regarding the biopsy contains crucial information influencing the prediction of pT stage, PSM and biological progression after RP. LTI, NPB and PSA are the most useful parameters for this purpose.
Adult↗
[Diabetes and urination disorders].
Diabetic neuropathy of can induce multi-organ dysfunction. The diabetes simultaneously has profound repercussions on gastrointestinal, sexual and erectile functions. One of the main sequelae of diabetic neuropathy is autonomic neuropathy affecting the vesicosphincteric control. The objective of this study was to review the epidemiological, clinical, laboratory and therapeutic data concerning voiding disorders observed in diabetes. Although the therapeutic management of an isolated voiding disorder in diabetics still remains symptomatic, it raises aetiological problems due to the comorbidity, particularly prostatic obstructive syndromes in men, pelvic dysfunction in women and ageing. Diabetic patients in renal failure also present specific vesicosphincteric disorders which are reviewed. Diabetic patients should be more systematically screened for the development of diabetic bladder disease, especially for associated factors which participate in its clinical expression. This implies extreme caution in the management of benign prostatic hyperplasia in the case of comorbidity, to avoid deteriorating a sometimes fragile detrusor-sphincter equilibrium. Diabetic detrusor hyperactivity must be better known in order to be more effectively detected. Pharmacological treatment of this condition raises problems related to detrusor hypocontractility also related to diabetic bladder disease. Clinical examination should be able to select those patients requiring further urodynamic studies in order to assess the individual detrusor-sphincter equilibrium. These investigations are required when surgical treatment of an associated urological or gynaecological disorder is considered.
Diabetes Complications↗
[Innervation of Denonvilliers' recto-vesical fascia. Anatomical study].
OBJECTIVE: Dissection of Denonvilliers' rectovesical fascia allows easy cleavage of the prostatorectal and prostatovesical spaces. Its lateral limit in the "neurovascular pedicles" justifies its resection during radical prostatectomy. The objective of this study was to define the course and to observe the structure of nerves crossing the rectovesical fascia, as the sheaths of these nerves may be invaded by prostatic adenocarcinoma tumour cells. MATERIAL AND METHODS: After dissection of a fresh cadavre to define the relations of this fascia with the pedicles, rectovesical fascia biopsies were taken during radical prostatectomies. Transverse sections were performed and examined histologically. RESULTS: Certain nerves, derived from the neurovascular pedicle of the inferior hypogastric plexus, cross the rectovesical fascia to innervate the prostate. CONCLUSION: This confirms the importance of complete resection of the rectovesical fascia during radical prostatectomy for cancer, not only for surgical reasons, but also to ensure oncologically satisfactory surgery, i.e. with healthy resection margins.
Aged↗
[Features of prostatic cancer in French individuals of African-Caribbean origin].
OBJECTIVES: To evaluate the clinical, laboratory and histological characteristics of prostate cancer at the time of diagnosis and after radical treatment in various ethnically different patient groups. PATIENTS AND METHODS: Prostatic biopsies were performed in 466 consecutive patients because of an abnormal digital rectal examination and/or isolated elevation of PSA (greater than 3 ng/ml). In this series, 40 patients were Black and 426 were Caucasian. The other aspect of the study concerns 320 patients undergoing radical prostatectomy for stage T1 T2 prostatic tumour (25 Black, 295 Caucasian). In the biopsied group, we analysed mean age, mean PSA, mean cancer length on biopsies and mean Gleason score. In the operated group, we studied preoperative characteristics, histological stage, resection margin status, laboratory progression (PSA greater than 0.05 ng/ml) and time to progression. RESULTS: At the time of diagnosis, the mean age was 61.4 years (48-73) for Blacks and 65.2 years (42-87) for Caucasians (p < 0.05). The median Gleason score was 7 in the two groups. The PSA was 13.4 (1.7-105) ng/ml versus 14.4 (0.4-600) ng/ml, respectively. The mean percentage of invaded tissue on biopsies was 24% versus 18.8% and the mean percentage of positive biopsies was 53% versus 39%, respectively. In the operated group, capsular effraction rates were 39% in Blacks and 48.1% in Caucasians. Positive resection margin rates were 21.7% versus 36.6%, respectively. The laboratory progression rate with a mean follow-up of 33 months (6-126) was identical in the 2 groups (42.1% versus 41.1%), but the time to progression was shorter for Blacks (9 months versus 12.3 months). CONCLUSIONS: In this patient series, Black patients had the same laboratory profile as Caucasian patients at the time of diagnosis. However, they were younger at the time of discovery of the disease, had more positive biopsies and more tumour-invaded tissue on biopsies, and Black patients undergoing radical prostatectomy developed laboratory recurrence more rapidly.
Aged↗
[Plastic surgery of the penis after circumcision].
One of the possible complications of circumcision is excessive resection of penile skin. This technical note describes two penile plasty techniques using scrotal skin after excessive circumcision.
Circumcision, Male↗
[Does ureteroscopy still play a role in the treatment of ureteral calculi?].
OBJECTIVES: To evaluate the results obtained by ureteroscopy to treat ureteric stones and the related complications. MATERIALS AND METHODS: 74 ureteroscopies were studied retrospectively, including 62 cases of pelvic ureteric stones. In situ fragmentation was necessary in 28.4% of cases. Success was defined as the absence of stones for one month after ureteroscopy. Success rates were analysed according to size and site of the stone, the need for fragmentation and the patient's sex. RESULTS: Morbidity was 6.8%. Success was obtained in 60.8% of cases: 72.7% in women and 55.8% in men. The mean diameter of successfully treated stones was statistically smaller (6.2 +/- 2.1 mm) than that of stones with a poor result (7.8 +/- 3.7 mm) (p = 0.044, Spearman). CONCLUSIONS: The size and site of the stone and the patient's sex influence the results of ureteroscopy. Ureteroscopy for stone disease remains a topical modality after failure of extracorporeal lithotripsy, but also in the case of poor access of an effective lithotriptor.
Adult↗
[Impact of the daily variations of the air pollution on the ambulatory emergency health services activity. Study in the urban area of Rouen (France)].
BACKGROUND: The aim of this study was to evaluate feasibility of using both the emergency phone calls (SAMU) and medical interventions (SMUR) related to ambulatory emergency services for local epidemiological surveillance of health impact of air pollution. METHODS: A temporal ecological study was performed at Rouen area (France) (380,000 inhabitants) for 1990-1997 (SAMU) and 1990-1996 (SMUR). The pollutants tested were: Sulphur dioxide (SO(2)), Particles (PM13), and Nitrogen dioxide (NO(2)), as collected routinely by a local automated network. For each phone call (SAMU) or emergency interventions (SMUR), the date, medical reason for calling (SAMU) or diagnosis after interventions (SMUR) (classified as respiratory, cardiovascular or other diseases) have been extracted from a specific information system. A statistical analysis based on time series analysis associated to a Poisson regression was conducted, taking into account temporal trend, seasonal variations, influenza, days of the week, holiday and meteorological data. RESULTS: An association was observed between ambulatory emergency services activity for cardiovascular diseases, and the daily variations of both SO(2) (relative risk=1.008 [1.001-1.016] for SAMU with an increase of 10 microg/m(3)) and NO(2) (relative risk=1.018 [1.008-1. 030] for SAMU, relative risk=1.016 [1.001-1.032] for SMUR with an increase of 10 microg/m(3)). No association could be observed with the respiratory diseases for these pollutants. CONCLUSION: The ambulatory emergency services activity data could contribute to an epidemiological surveillance of the health impact of the air pollution, but a better quality of data collected (concerning both procedures and codification) is requested. The interest of an epidemiological surveillance, rather than usual pollutant monitoring, remains to evaluate.
Air Pollutants↗
Expression of the cytoplasmic domain of E-cadherin induces precocious mammary epithelial alveolar formation and affects cell polarity and cell-matrix integrity.
Cadherins are cell adhesion molecules involved in cell-cell adhesion, signalling, and cellular proliferation and differentiation. E-cadherin is required for the formation of epithelium in vivo. We investigated the contribution of the cytoplasmic domain of E-cadherin to adhesion, signalling, and differentiation during murine mammary gland development, by in vivo expression of a gene encoding a truncated form of E-cadherin lacking the extracellular domain. The expression of this gene in mammary epithelial cells during pregnancy induced precocious lobular epithelial morphogenesis associated with morphological differentiation and the early synthesis of various molecules (advanced milk fat globule appearance and milk protein production). After delivery, when a fully differentiated and secretory epithelium is required for lactation, the cytoplasmic domain of E-cadherin had a dominant-negative effect on cell-cell adhesion and affected the structure and function of the epithelium. This also led to the partial loss of epithelial polarisation and changes in the basement membrane, both important in malignancy. Thus, the cytoplasmic domain of E-cadherin induces epithelial morphogenesis, but also alters the cohesiveness of the fully differentiated epithelium.
Animals↗
Air pollution and respiratory drug sales in the City of Le Havre, France, 1993-1996.
The aim of this study is to evaluate ambulatory respiratory drug sales data as health indicators for the short-term effects of ambient air pollution in the city of Le Havre. Daily respiratory drug sales data were crossed with daily ambient air concentrations of sulfur dioxide (SO2), nitrogen dioxide (NO2), and black smoke (BS) using an autoregressive Poisson regression model adjusting for time trends, seasonal variations, influenza epidemics, and weather. Relative risks (RR) were expressed for an increase of two standard deviations above the mean of each pollutant. Respiratory drug sales were associated with most pollutants studied with lags varying from 1 to 9 days. For daily mean concentrations of BS, RR = 1.037 (95% confidence interval (CI) 1.009-1.066) for lag 1 and RR = 1.052 (95% CI 1.023-1.081) for lag 8. For daily mean concentrations of N02, RR = 1.033 (95% CI 1.001-1.066) for lag 1 and RR = 1.046 (95% CI 1.014-1.079) for lag 8. RR observed with a daily 1 h maximum of SO2 were RR= 1.027 (95% CI 1.004-1.051) for lag 3 and RR= 1.032 (95% CI 1.009-1.056) for lag 9. Our study concludes that ambulatory respiratory drug sales data could be useful for epidemiological surveillance of air pollutant health effects.
Air Pollution↗