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Among the multitude of actually proposed loco-regional flaps and their variants, we describe our options and technical viewpoints for common coverage problems in hand surgery, according to the guidelines of functional anatomy. Special emphasis is placed on newer techniques such as microsurgical free flaps, venous flaps, and reverse flow vascularisation.
Knowledge of the normal functional behavior and mechanical properties of the vertebral column is important to understand the pathogenesis of back lesions, to identify the clinical manifestations of back pain, and to ensure a rational approach to physical therapy. The purpose of this article is to present a synthesis of in vivo and in vitro data obtained from different but complementary investigations. Presently, in vivo studies are limited; few gait-specific kinematic and electromyographic investigations are in process. Higher stresses to reach the maximal range of intervertebral motion can be applied on the spine on anatomical specimens than in living horses, and anatomical functional data can be obtained at the level of intervertebral structures. For each movement of flexion, extension, lateroflexion, and rotation, regional and intervertebral mobility is presented with an emphasis on craniocaudal variations and their anatomical causes. Because of the location of their ICR, the dorsoventral movements of a thoracolumbar intervertebral joint can be defined as a rotation around the center of the more caudal vertebral body. This information supports the new concept of intervertebral mobility in the horse and provides additional elements to facilitate understanding of the pathogenesis of back problems in the horse.
The clinical signs grouped under the concept of apathy are a common feature of prefrontal and basal ganglia lesions or dysfunctions and can therefore help to improve our understanding of the functional anatomy of the prefrontal-basal ganglia system. Apathy is here defined as a quantitative reduction of voluntary, goal-directed behaviors. The underlying mechanisms responsible for apathy can be divided into three subtypes of disrupted processing: 'emotional-affective', 'cognitive' and 'auto-activation'. Apathy due to the disruption of 'emotional-affective' processing refers to the inability to establish the necessary linkage between emotional-affective signals and the ongoing or forthcoming behavior. It may be related to lesions of the orbital-medial prefrontal cortex or to the related subregions (limbic territory) within the basal ganglia (e.g. ventral striatum, ventral pallidum). Apathy due to the disruption of 'cognitive' processing refers to difficulties in elaborating the plan of actions necessary for the ongoing or forthcoming behavior. It may be related to lesions of the dorsolateral prefrontal cortex and the related subregions (associative territory) within the basal ganglia (e.g. dorsal caudate nucleus). The disruption of 'auto-activation' processing refers to the inability to self-activate thoughts or self-initiate actions contrasting with a relatively spared ability to generate externally driven behavior. It is responsible for the most severe form of apathy and in most cases the lesions affect bilaterally the associative and limbic territories of the internal portion of the globus pallidus. It characterizes the syndrome of 'auto-activation deficit' (also known as 'psychic akinesia' or 'athymormia'). This syndrome implies that direct lesions of the basal ganglia output result in a loss of amplification of the relevant signal, consequently leading to a diminished extraction of this signal within the frontal cortex. Likewise, apathy occurring in Parkinson's disease could be interpreted as secondary to the loss of spatial and temporal focalization of the signals transferred to the frontal cortex. In both situations (direct basal ganglia lesions and nigro-striatal dopaminergic loss), the capacity of the frontal cortex to select, initiate, maintain and shift programs of actions is impaired.
The understanding of human dermal lymphatic anatomy has rested for nearly 120 years on the original work of Sappey. Subsequently, others have added significantly to our knowledge with anatomic studies. Copious lymphoscintigraphical data have accumulated in recent years in the evaluation of cutaneous melanomas. These data suggest that the old anatomic picture of lymphatic anatomy is functionally inaccurate. Analysis of these cumulative data reveals an extensive network of feeding lymphatic connections to major nodal basins far more expansive than previously recognized. These nodal basins overlap to a significant extent, rendering drainage prediction based on location nearly impossible. Therapeutic implications are remarkable.
Brainstem auditory evoked potentials (BAEP) are used routinely in clinical practice to evaluate the normality of the lower auditory system. The objective of this review is to describe the functional anatomy of the structures implicated in BAEP generation (cochlear nerve and the auditory brainstem nuclei). Indications and results of BAEP in clinical practice are presented and correlated with auditory structures, which generate each waveform of BAEP.
It is the purpose of this study to present a review of studies on the kinematics of the knee joint and load distribution in the two compartments, medial and lateral, in order to reveal the evolution of concepts of functional anatomy. Flexion-extension features have been clearly defined by numerous authors who have used different methods of research. Transverse rotation, instead, still needs to be clarified. In particular, whether or not a screw-home movement exists has been questioned by many authors who have studied the kinematics of the knee, both without loading and during walking. Dynamic studies have shown how the radiographic method (static) to deduce load distribution in the knee joint is inadequate; this is because during walking, loading tends to be transmitted on the medial compartment, also the case in valgus knees.
Previous functional brain imaging studies suggest that the ability to infer the intentions and mental states of others (social cognition) is mediated by medial prefrontal cortex. Little is known about the anatomy of empathy and forgiveness. We used functional MRI to detect brain regions engaged by judging others' emotional states and the forgivability of their crimes. Ten volunteers read and made judgements based on social scenarios and a high level baseline task (social reasoning). Both empathic and forgivability judgements activated left superior frontal gyrus, orbitofrontal gyrus and precuneus. Empathic judgements also activated left anterior middle temporal and left inferior frontal gyri, while forgivability judgements activated posterior cingulate gyrus. Empathic and forgivability judgements activate specific regions of the human brain, which we propose contribute to social cohesion.
OBJECTIVE: Movements of the human shoulder represent the result of a complex dynamic interplay of structural bony anatomy and biomechanics, static ligamentous and tendinous restraints, and dynamic muscle forces. Injury to 1 or more of these components through overuse or acute trauma disrupts this complex interrelationship and places the shoulder at increased risk. A thorough understanding of the functional anatomy of the shoulder provides the clinician with a foundation for caring for athletes with shoulder injuries. DATA SOURCES: We searched MEDLINE for the years 1980 to 1999, using the key words "shoulder," "anatomy," "glenohumeral joint," "acromioclavicular joint," "sternoclavicular joint," "scapulothoracic joint," and "rotator cuff." DATA SYNTHESIS: We examine human shoulder movement by breaking it down into its structural static and dynamic components. Bony anatomy, including the humerus, scapula, and clavicle, is described, along with the associated articulations, providing the clinician with the structural foundation for understanding how the static ligamentous and dynamic muscle forces exert their effects. Commonly encountered athletic injuries are discussed from an anatomical standpoint. CONCLUSIONS/RECOMMENDATIONS: Shoulder injuries represent a significant proportion of athletic injuries seen by the medical provider. A functional understanding of the dynamic interplay of biomechanical forces around the shoulder girdle is necessary and allows for a more structured approach to the treatment of an athlete with a shoulder injury.
Catastrophic cervical spine injuries can lead to devastating consequences for the collision athlete. Improved understanding of these injuries can facilitate early diagnosis and effective on-field management. This article is the first of a 2-part series. The first part reviews the current concepts regarding the epidemiology, functional anatomy, and diagnostic considerations relevant to cervical spine trauma in collision sports. In the second part, to be published later, the principles of emergency care of the cervical spine-injured athlete are reviewed. This article provides a rational approach to the early recognition of the different clinical syndromes associated with catastrophic cervical spine injury. Rapid on-field diagnosis can help to optimize the outcomes of these catastrophic injuries.
Ultrastructural studies of surface replicas of haploid and diploid rabbit spermatozoa after treatment with various chemical media have shown that the various structural components of the diploid sperm head possess the same stabilities and labilities as those of the haploid. Therefore, at least in terms of functional anatomy, diploid rabbit spermatozoa should be capable of penetrating the egg investments and undergoing syngamy.
The use of adhesive tape has proved to be a good alternative to treat several types of trauma and overuse syndromes at the upper ankle joint and the foot. According to the different injuries and problems the varied uses are presented. Especially the importance of the functional anatomy is emphasized for initiating a successful taping procedure. The techniques presented are offered merely as recognized methods which have been found effective and which should stimulate to improve this type of treatment.
In the dog congenital or acquired stenosis of the lumbosacral region is commonly encountered. In humans the lumbosacral junction is the most often affected part of the vertebral column. Lumbosacral instability, one possible etiology for stenosis of the vertebral canal plays an important role in man. This study summarizes the functional anatomy and some important geometric and kinematic considerations necessary for the understanding of the motion (flexion-extension) between two adjacent vertebra.
The limbic/mesial temporal lobe epilepsy syndrome has been defined as a focal epilepsy, with the implication that there is a well defined focus of onset, traditionally centered around the hippocampus. The pathology of the hippocampus in this syndrome has been well described and a number of physiological abnormalities have been defined in this structure in animal models and humans with epilepsy. However, anatomical and physiological abnormalities have also been described in other limbic sites in this form of epilepsy. Previous studies have shown broadly synchronized or multifocal seizure onset within the limbic system of the animal models and human patients. We hypothesized that the epileptogenic circuit for the initiation of seizures was distributed throughout the limbic system with a possible central synchronizing process. In vitro studies showed that multiple limbic sites in epileptic animals (hippocampus, entorhinal cortex, piriform cortex and amygdala) have epileptiform changes with prolonged depolarizations and multiple superimposed action potentials. In vivo studies revealed that thalamic stimulation yields short latency excitatory responses in the entorhinal cortex and hippocampus. In addition, in epileptic animals, thalamic stimulation caused epileptiform responses in the hippocampus. Based on the findings of this study and on previous anatomy and physiology reports, we hypothesize that the process of seizure initiation involves broad circuit interactions involving multiple independent limbic structures, and that the midline thalamus may act as a physiological synchronizer. We offer a new proposal for the functional anatomy of limbic epilepsy that takes widespread hyperexcitability in the limbic system and the potential for thalamic synchronization into consideration.
In the course of stereotactic thalamotomy, the neural noise level of subcortical structures was estimated quantitatively with the aid of two semimicro-electrodes. The neural noise showed several characteristic features in terms of its amplitude and discharge pattern so that it was correlated with the possible anatomical substrate, thus providing the functional anatomy of the subcortical structures. The study on saggital plane revealed a systematic difference of the noise level between VL and Vim-Vc that could be explained by the different cell size in respective nucleus. Several exceptional cases were also presented, emphasizing the neural noise study in stereotactic surgery.
The posterior tibial tendon is vital for the structure and function of the foot and ankle. Dysfunction of the tendon can be debilitating and devastating. In recent years, much attention had been directed toward the diagnosis and treatment of PTTD. To properly diagnose and devise an appropriate treatment regimen, the anatomy, function, and pathophysiology associated with PTTD need to be thoroughly understood.
BACKGROUND: The great variety of primary cheiloplastic procedures in CLP patients shows that there is disagreement regarding the embryological development of this part of the face, the point selection, skin incision philosophy, and the macroscopic and microscopic functional anatomy of the human muscles of facial expression. We suppose from findings in Asian and African populations that the real embryological development of the upper lip differs from current textbook descriptions. Our own anatomical and embryological investigations serve as a basis for a critical discussion of different techniques of muscle reconstruction, point selection, and skin incision and for a description of an embryologically, functionally, and anatomically oriented operation technique for different entities of CLP. METHODS: The findings of this study result from investigations of the embryonal and early fetal development from the 26th to the 112th i.u. day in REM pictures of the Anatomical Institute of the University of Göttingen (n = 8) and serial histological investigations of the Carnegie and Hooker-Humphrey Collections at the Armed Forces Institute of Pathology, Washington, D.C. (n = 40). Furthermore, we carried out microsurgical dissections of the muscles of facial expression, the osseous and cartilaginous parts of the nose, and the midfacial sutures in two adult heads without congenital disorders and one newborn head with a primary unilateral complete cleft of the lip and alveolus. RESULTS AND DISCUSSION: The formation of the lower third of the upper lip is the result of contact of the maxillary bulges in the midline below the prolabium. According to this finding, the point selections and skin incisions have to be modified in the midline region in different types of uni- and bilateral CLP. Our technique of primary dissection, reorientation, and suturing of the muscles of facial expression is presented. The muscle reconstruction has to be performed independently from the skin preparation.
Ten selected samples of fossilized bones (including Australopithecus, Homo erectus, Homo neandertalensis, and Homo sapiens sapiens) were examined by light microscopy using plane and polarized light. The histomorphological findings show that microscopic research adds much to what can be ascertained by marcoscopic examination or by X-ray techniques. In particular, emphasis was placed on taxonomy, functional anatomy of bones, and causes of some of the diseases of early hominids. Anat Rec (New Anat): 257:225-232, 1999.
Learning of procedural skills develops gradually, with performance improving significantly with practice. But improvement on some tasks, including a visual texture discrimination task, continues in the absence of further practice, expressly during periods of sleep and not across equivalent waking episodes. Here we report that the brain activation revealed significantly different patterns of performance-related functional activity following a night of sleep relative to 1 h post-training without intervening sleep. When task activation patterns after a night of sleep were compared with activation patterns without intervening sleep (1 h post-training), significant regions of increased signal intensity were observed in the primary visual cortex, the occipital temporal junction, the medial temporal lobe and the inferior parietal lobe. In contrast, a region of decreased signal intensity was found in the right temporal pole. Corroborating these condition differences, correlations between behavioural performance and brain activation revealed significantly different patterns of performance-related functional activity following a night of sleep relative to those without intervening sleep. Together, these data provide evidence of overnight bi-directional changes in functional anatomy, differences that may form the neural basis of sleep-dependent learning expressed on this task.