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At least 271 records · Page 15Linked to original sources
PubMed1995

The surgical anatomy of thoracic facet denervation.

Thoracic percutaneous facet denervation has been employed for the treatment of thoracic zygapophysial joint pain. But the surgical anatomy of this procedure has been assumed to be the same as for lumbar medial branch neurotomy. To establish the anatomical basis for thoracic medial branch neurotomy, an anatomical study was undertaken. Using an X40 dissecting microscope, a total of 84 medial branches from 7 sides of 4 embalmed human adult cadavers were studied. The medial branches of the thoracic dorsal rami were found to assume a reasonably constant course. Upon leaving the intertransverse space, they typically crossed the superolateral corners of the transverse processes and then passed medially and inferiorly across the posterior surfaces of the transverse processes before ramifying into the multifidus muscles. Exceptions to this pattern occurred at mid-thoracic levels (T5-T8). Although the curved course remained essentially the same, the inflection occurred at a point superior to the superolateral corner of the transverse process. At no time during the dissection were nerves encountered crossing the junctions between the superior articular processes and transverse processes which have been the target points advocated for thoracic facet denervation. Rather, the results of this study indicate that the superolateral corners of the transverse processes are more accurate target points.

Adult↗
PubMed1990

The fibrous frame of the supraspinatus muscle. Correlations between anatomy and MRI findings.

30 MRI investigations of shoulders and 20 dissections of non embalmed cadaveric shoulders allowed us to demonstrate a particular organization of the supraspinatus muscle. In the anterior part of the muscle is an important fibrous frame with obliquely inserted muscle fibers. This organization suggests that this part of the supraspinatus muscle works as a "contractile tendon".

Humans↗
PubMed1994

Direct anatomical-MRI correlation: the knee.

Cadaveric material is often used to guide and validate the interpretation of magnetic resonance imaging (MRI) studies. Direct correlation is achieved when the cadaver material is imaged and then directly sectioned in the plane of the image. Indirect correlation, where the cadaveric sections are compared with unrelated in-vivo images, is easier and more commonly used. Technical difficulties associated with the direct method include preservation of form and composition of the tissues, and the choice of the correct location and plane in which to section the cadaver. Using an MRI compatible ruler, designed to assist the direct correlation of MRI and cadaveric sections, we have examined 10 preserved (embalmed) cadaveric knees using different MRI sequences on several occasions. Despite these variations, subsequent sectioning of the cadaveric knees has shown good correlation with the MR images. Of 54 MR images compared with cadaveric sections, anatomical correlation was rated by independent observers as good or perfect in 47 (87%). This new, versatile and simple method can make better use of our preserved human cadaveric material and has potentially wide application; we are now developing it further to assess the technical capabilities of novel imaging sequences.

Aged↗
PubMed1994

The surgical anatomy of the superior gluteal nerve and anatomical radiologic bases of the direct lateral approach to the hip.

In view of the increasing popularity of the direct lateral approach to the hip joint for hemi- or total hip arthroplasty, the location of the superior gluteal nerve (SGN) was studied. This nerve is in danger when using a transgluteal incision. In 20 embalmed specimens the relation of the SGN to the tip of the greater trochanter (TT) was studied as well as the relation to the iliac crest. For this purpose macroscopy, microscopy and CT were used. In 13 hips a so-called most inferior branch was found at an average of 1 cm distal to the inferior branch, the main trunk of the nerve. There was substantial variation in the course of both the inferior and the most inferior branch of the SGN. In order to prevent nerve damage, proximal extension of the transgluteal incision should be limited to 3 cm cranial to TT. Furthermore the incision has to be confined to the distal one third of the distance TT-iliac crest. In tall people extra care should be taken.

Aged↗
PubMed1993

The vertebral foramen: a report concerning its contents.

Thirteen subjects were randomly selected and embalmed according to Winckler's technique. After removal of the vertebral column and the head in one block the specimens were frozen. Transverse transpedicular cuts were performed at C6, T1, T6, L1, L3, and L5. After enlargement photography, the surface area of the vertebral foramen and its various contents were measured on a computer using the Canvas programme and analysed using the Statview programme. The mean area of the vertebral foramen occupied by the cord was 30.5% at C6, 26.1% at T1, 21.4% at T6, 12.7% at L1, 0.08% at L3. The mean area occupied by the nerve roots was 3.9% at C6, 3.3% at T1, 1.6% at T6, 14.2% at L1, 17.5% at L3, 12.2% at L5. The mean area of all the nervous tissue was 34.4% at C6, 29.5% at T1, 23% at T6, 26.9% at L1, 18.9% at L3, 19.3% at L5. The cerebrospinal fluid occupied a mean area of 25.2% at C6, 30.7% at T1, 31.6% at T6, 43% at L1, 43.5% at L3, and 28.1% at L5. The total neural tissue did not occupy more than a third of the vertebral foramen. These facts should be considered by surgeons who perform laminectomy or decompression in cases of vertebral trauma or congenital and osteoarthritic stenoses.

Aged↗
PubMed1997

Anatomical basis of the variable aspects of injuries of the axillary nerve (excluding the terminal branches in the deltoid muscle).

The course of the axillary n. is complex with three points of angulation that may be used to delineate four segments and a fifth segment that corresponds to the intramuscular ending of the nerve in the deltoid m. The purpose of this study was to determine the precise anatomy of the nerve and of its branches, and some morphologic features for each segment. Thirty-two shoulders from embalmed adult cadavers have been studied. The axillary n. was divided in five segments: 1) from its origin to the inferior border of the subscapularis m., 2) from the subscapularis m. to the anterolateral border of the tendon of the long head of the triceps brachii m., 3) from the triceps to the posteromedial part of the surgical neck of the humerus, 4) from the humerus to the entry into the deltoid m., 5) the intramuscular distribution of the nerve in the deltoid m. In each segment from 1 to 4 were noted the origins of the branches to the subscapularis and teres minor mm. and to the scapulohumeral joint, and the origins of the lateral cutaneous branchial n. and of the terminal motor branches to the deltoid m. The length and the diameter of the nerve in the segments and the distance from the segment S1 to the musculotendinous junction of the subscapularis m. were measured. The results showed that the mean diameters were about 4.1 mm in segment 1, 4.1 mm in segment 2 and 3.4 mm in segment 3. The mean distance to the musculotendinous junction was 7.7 mm. Many variations in the levels of origin of the different muscular, articular or cutaneous branches were found without symmetry between the right and left sides. The lateral cutaneous brachial n. was absent in four cases. The results are compared with those in the literature. The division into five segments is proposed to radiologists and surgeons for evaluation or operative procedures on the axillary n., and to provide a hypothesis about the variable aspects of injuries of the nerve.

Adult↗
PubMed1998

High-resolution computed tomographic study of the retrotympanum. Anatomic correlations.

The aim of this study was to define the imaging of the retrotympanum precisely by means of high-resolution CT. Based on 66 scans of petrous bones performed in 49 patients observed in an otologic department, several retrotympanic structures were studied: the pyramidal eminence, ponticulus, subiculum, chordal ridge, tympanic sinus of Proctor, sinus tympani and recess of the facial n. The variations in morphology and depth were noted as well as the relationship between the pyramid and the facial canal. In a second phase the same anatomic structures were studied in 24 temporal bones removed from embalmed cadavers and investigated with the same radiologic technique. Anatomic correlations were made for six temporal bones to confirm the general applicability of our radiologic hypotheses. In CT the pyramidal eminence was visualised in 100% of cases, the chordal ridge in 52%, the ponticulus in 63% and the subiculum in 57%. As regards the different recesses, the sinus tympani was visualised in 95% of cases, the posterior tympanic sinus of Proctor in 38%, the fossula of Grivot in 47% and the facial recess in 80%. The mean depth of the sinus tympani was 2.7 mm and that of the tympanic sinus of Proctor was 1.65 mm; the fossula of Grivot was assessed as 2.1 mm and the facial recess as 2.2 mm. A better knowledge of these sinuses and their variations will aid the surgeon, particularly in a posterior tympanotomy or a retro-facial approach.

Adolescent↗
PubMed1998

High-resolution computed tomography of the canals of the temporal bone: anatomic correlations.

The aim of this study was to define precisely the imaging of the canals of the temporal bone by means of high-resolution computed tomography (HR CT). Based on 24 temporal bones removed from embalmed cadavers and investigated with HR CT, several canals were studied: the canal of the chorda tympani (CdT), the canal of the auricular branch of the vagus nerve (ABV), the canal of the tympanic nerve, the canal of the carotico-tympanic nerve and that of the lesser petrosal nerve. Anatomic correlations for six temporal bones were made to confirm the validity of our radiologic hypotheses. In CT, in axial sections OM 0 degree, the posterior canal of the CdT was visualized in 71% of cases, the ABV canal in 4%, the inferior tympanic canal in 12.5%, the carotico-tympanic canal in no cases and the canal of the lesser petrosal nerve in 50% (and in 75% with an incidence of OM + 10 degrees). In coronal incidence, the posterior canal of the CdT was seen in 20% of cases, the ABV canal in 25%, the inferior tympanic canal in 85%, the caroticotympanic canal in 65% and that of the lesser petrosal nerve in 15%. The six anatomic comparisons confirmed the radiologic hypotheses in every case. These different structures are easy to identify in HR CT and are important to define so that any lesion (tumoral or vascular) developing in their vicinity may not be overlooked.

Aged↗
PubMed1985

Lateral epicondylitis. A review of structures associated with tennis elbow.

139 limbs from embalmed specimens were dissected to reveal the attachments of extensor muscles in the vicinity of the lateral epicondyle. M. extensor carpi radialis brevis was found to consist of a keel-shaped tendon with attachments to m. extensor carpi radialis longus, m. extensor digitorum communis, m. supinator; and to the radial collateral ligament, the orbicular ligament, the capsule of the elbow joint and the deep fascia. On 29 limbs, a prolongation of the muscle was identified attaching proximal to the lateral epicondyle. On nine specimens a bursa was evident between the capsule over the head of the radius and the overlying soft tissues. There was no evidence of variation in vascular or nerve supply to the region. Examination of m. extensor carpi radialis brevis while under tension across the elbow, forearm and wrist revealed the greatest muscle lengthening in pronation of the forearm with palmar flexion and ulnar deviation. The results of this study support the hypothesis that tennis elbow is primarily a mechanically-induced condition. When performing movements at the wrist, with the forearm in pronation, the muscle is at its maximum length. As its origin lies proximal to the axis of rotation for flexion and extension at the elbow, it is subject to shearing stress in all movements of the forearm, especially those involving power at the wrist. This is further compounded by the head of the radius rotating anteriorly against m. extensor carpi radialis brevis during pronation of the forearm. Additionally, a number of individuals may experience pain at the head of the radius during pronation, due to irritation of an underlying bursa.

Elbow↗
PubMed1985

Anatomical basis of the posterior brachial skin flap.

The posterior brachial flap is a vascularized skin flap originally developed by AC Masquelet in 1982. Anatomical study in 37 non embalmed cadavers demonstrated the value of this flap which is taken from the posterior surface of the arm. The artery of the flap originates from the brachial or deep brachial artery and was present in all 37 subjects studied. This artery traverses the aponeurosis of the triceps brachii near the termination of the tendon of the teres major. The pedicle showed a mean length of 4.4 cm and mean diameter of 1.5 mm thus allowing satisfactory microsurgical anastomosis to be done. The mean length of the artery in the subcutaneous tissue was 11 cm. Venous return is via satellite veins. Sensory innervation of the flap is supplied by the nervus cutaneous brachii posterior, the first branch of the radial nerve. The posterior brachial flap can be used as a free flap. Owing to its innervation, this flap is appropriate for repair of defects in zones requiring sensory innervation. This flap can also be used as a pedicle flap for cutaneous repair of the axilla.

Aged↗
PubMed1985

Anatomical study of retrosternal gastric esophagoplasties.

Five currently used procedures of gastric esophagoplasty were done in 5 groups of 14 embalmed human cadavers. These procedures were: whole gastric intrathoracic transposition (Kirschner's procedure) isoperistaltic gastric cone (Akiyama's procedure) isoperistaltic gastric tube (Rutkowski's or Lortat-Jacob's procedure); isoperistaltic gastric tube with resection of the lesser curvature; anisoperistaltic gastric tube with intrahilar splenectomy (Gavriliu's, Heimlich's procedure). Gastric morphometry and ascinding vascularization ability and quality of the vascular network were assessed. Injection of plastic dye was used to evaluate the vascularization of the grafts. In 13 out of 14 grafts, whole gastric transposition extended above the sternal notch, for a mean distance of 7.7 +/- 4.9 cm. This basic performance was significantly correlated to the dimensions of the greater and lesser curvatures and to the cardioxiphoid, sternal and hyosternal distances. Absent or poor injection of the distal arterial network, over a mean distance of 3.6 +/- 0.8 cm, was seen in all 14 grafts. Study of the isoperistaltic gastric cone demonstrated that the graft extended above the sternal notch in all 14 cases. The mean distance of the graft segment above the sternal notch was 5.0 +/- 3.0 cm. This basic performance showed a significant correlation only with the dimensions of the greater and lesser curvatures. Absent or poor injection of the distal arterial network of the gastric cones was seen in 9/14 cases, the mean length of the devascularized segment being 1.3 +/- 1.3 cm. Subsequent to resection of the distal zone showing poor vascularization, 13 out of the 14 isoperistaltic cones still extended above the sternal notch. The mean length of the segment above the sternal notch was 3.7 +/- 2.6 cm. All 14 isoperistaltic gastric tubes (without resection of the lesser curvature) extended above the sternal notch. The mean length of the segment above the notch was 15.1 +/- 7.1 cm. This basic performance showed a statistically significant correlation only with the minimum pylorodiaphragmatic distance subsequent to extensive Kocher's manoeuver. Of these 14 gastric tubes, 9 showed poor or no vascularization of their distal arterial network. The mean length of the poorly injected segment was 8.0 +/- 1.8 cm. Subsequent to resection of the poorly vascularized territory, 12/14 grafts were still found to extend above the sternal notch. The mean length of the segment above the sternal notch was 7.1 +/- 6.9 cm.(ABSTRACT TRUNCATED AT 400 WORDS)

Esophagoplasty↗
PubMed1995

The first known use of vermillion.

Vermillion has been shown to be useful in preserving human bones from 5000 years ago. Remarkably well-preserved human bones have been found in the dolmenic burial 'La Velilla' in Osorno (Palencia, Spain), carefully covered by pulverized cinnabar (vermillion) which ensured their preservation even in non-favorable climatic conditions. We believe the red powder was deliberately deposited for preservative use because no cinnabar mine is to be found within 160 km, because of the large amount (hundreds of kilograms) used, and because its composition, red mercuric sulphide, is similar to that of preparations used in technical embalming. This finding pushes back the data of the use of mercury ore for preservation by four millennia in South America, and by at least one millennium in the Old World. Chemical and thermal analyses of vermillion in La Velilla have demonstrated its great purity and shown that the cinnabar was pulverized and washed (but not heated), producing a bright red-orange tone.

Archaeology↗
PubMed1987

The mediastinum in sagittal sectioning. Anatomy and magnetic resonance imaging (MRI).

Ten volunteers with a normal mediastinum were investigated by magnetic resonance using a 0.5 Tesla CGR imager with a supraconducting magnet. The reconstruction matrix consisted of a 256 X 256 grating for a field of the order of 420 mm, with a spatial resolution of 1.6 X 1.6 mm2. The sections, balanced in T1, were performed in synchronization with the ECG. The successive sagittal sections were correlated with sagittal sections made on a single embalmed frozen subject. The MRI and anatomic sections were made at 5 mm intervals and located in relation to the median sagittal plane of the mediastinum. Examples of structural variations, malformations or tumours studied in sagittal sections, and taken from investigation of over 170 patients, demonstrate the importance of this investigational technique.

Electrocardiography↗
PubMed1989

Dorsal vascular network of the first web space. Anatomical bases of the kite flap.

Thirty dissections were performed on adult non embalmed cadavers, after vascular injection with MICROFIL or Methylene blue. In contrast to the classical descriptions of a single dorsal metacarpal artery, this study shows the existence of a vascular network with 1 or 2 vessels running over or under the deep aponeurosis. Direct cutaneous arteries provide blood supply to the kite flap when the only dorsal metacarpal vessel of the first web space is in a deep situation. The main source of blood supply to the kite flap is described in each anatomical variation of the dorsal network.

Anastomosis, Surgical↗
PubMed2000

Contribution to the surgical anatomy of the ligaments of the rectum.

PURPOSE: Many authors have discussed the presence and the importance of the lateral ligaments of the rectum. Our contribution aims at clarifying some aspects of surgical anatomy that help in the preservation of the urogenital functions and may influence the surgical practice. METHODS: From 1994 to 1998 we examined 27 fresh cadavers and five embalmed pelves. We performed all dissections with a technique similar to that used for the surgical mobilization of the rectum. RESULTS: The lateral ligaments of the rectum are trapezoid structures originating from mesorectum and are anchored to the endopelvic fascia; as lateral extensions of the mesorectum, they must be included in the surgical specimen. According to our results, three main structures can be recognized laterally to the rectum: 1) the lateral ligament, which does not contain important structures; 2) the inferior hypogastric plexus and the urogenital bundle; and 3) the lateral neurovascular pedicle of the rectum that comprises the nervi recti and the middle rectal artery, both running under the lateral ligament, although at different angles. CONCLUSION: At the point of insertion into the endopelvic fascia, the lateral ligaments run close to the urogenital bundle. Nevertheless, the dissection at its attachment is safe if the urogenital bundle is kept under visual control.

Cadaver↗
PubMed1989

An anatomic and dynamic study of the greater occipital nerve (n. of Arnold). Applications to the treatment of Arnold's neuralgia.

This study concerns the posterior ramus of the second cervical spinal n., or greater occipital of Arnold. By means of dissections in formalin embalmed cadavers, an attempt was made to define its winding course and to locate it in relation to clinical or radiographic landmarks, so as to provide a guide for infiltration of the nerve with local anesthetic. At the same time a dynamic study was made to elucidate the relations of the nerve to adjacent structures during the different movements of the neck. This allowed us to propose clinical tests of nerve involvement and to reveal the zones where the nerve is anatomically vulnerable.

Adult↗
PubMed1997

High resolution magnetic resonance imaging application in anatomy: the extensor digitorum muscle insertion on the first phalanx.

Classical dissection may give unsatisfactory results because of the presence of artifacts due to both the embalming process and displacement of the anatomical structures. This spatial disturbance could explain the divergent descriptions found in the literature about the presence, or the absence, of an insertion of the extensor digitorum muscle (ED) at the first phalanx (P1). Preliminary experiments by Van Sint Jan et al. (1996) found the same contradiction: dissections did not show a real tendon attachment, whereas a functional experiment seemed to show that "something" should exist between ED and P1 to explain the results. This paper presents the results of an in vitro MRI study of this anatomical area. A 7-T NMR microscope was used to collect accurate, noninvasive data. Subsequently, surface rendering was performed to visualize the structures in a three-dimensional manner. The results of this MRI study, together with functional data obtained in an earlier study, showed that no real insertion of ED on P1 exists. However, some collagenic fibers were occasionally-observed running from the ventral aspect of ED to both P1 and the metacarpo-phalangeal joint capsule. Those few collagenic fibers would play a secondary role in the extension of P1.

Collagen↗
PubMed2001

[Aortic valve structures as landmarks for determining coronary artery ostia in transthoracic echocardiography].

BACKGROUND: Occasionally, coronary arteries are recorded in transthoracal echocardiography. The question was if this modality could be used as non-invasive screening method of the coronaries. A prerequisite for this is an exact and reproducible measurement of the origin of the coronary arteries. MATERIAL AND METHOD: The topography of the coronary ostia in relation to the aortic valve was examined morphometrically in the aortae of 20 embalmed cadavers and 50 patients of a cardiologist's practice who underwent transthoracal echocardiography. RESULTS: In all cases, the coronary arterial orifices were located eccentrically in the coronary sinus, shifted to the non-coronary aortic sinus. The distance between left coronary orifice to the commissure of the left and the right semilunar valvula was 13.3 mm on average in the anatomical measurements, whereas in the echocardiography this distance was 14.3 mm. The distance between the left ostium and the attachment of the left and the posterior semilunar valvula 9.4 mm, corresponding to 11.6 mm in echocardiography. The distance between right coronary orifice and the attachment of the right and the left semilunar valvula was 18.0 and 17.3 mm respectively, and the distance between right coronary orifice and the commissure of the right and the posterior semilunar valvula accounted for 8.5 and 9.7 mm respectively. On the average, the ostia were located 3.9 mm below the level of the sinotubular junction. Multiple ostia occurred in 65%, 92% of these were in the right coronary aortic sinus, shifted from the main orifice to the attachment of the right and the left semilunar valvula. CONCLUSION: In the cardiologist's routine, the attachments of the aortic leaflets proved to be very useful as landmarks. The coronary arterial orifices have been educible in nearly all cases. These results show that transthoracal echocardiography may be used in the screening for coronary artery disease.

Aged↗