Clinical interest of digestive arterial trunk anastomoses

Arterial vascularization of the gastrointestinal tract is a three-level system composed of the coeliac trunk, and both superior and inferior mesenteric arteries. The three levels are joined together via arterial trunk anastomoses such as the so-called and well-known Riolan arcade or supramarginal arcade. The aim of this study was to review the embryology of the digestive arteries in order to understand the anatomic variations, the development of the arterial trunk anastomoses and the potential collateral circulation in the case of obstruction of one or several arterial trunks. The arch theory by Mac Kay and Tandler longitudinal arterial anastomosis account for the genesis of the arterial trunk anastomoses and the main anatomic variations. The coeliac trunk and the superior mesenteric artery are joined together via the pancreaticoduodenal arcades and the Bühler arcade. These anastomoses are divided during pancreatic resections but developed in the case of coeliac trunk stenosis. The mesenteric arteries are joined together by the Riolan, Villemin arcades and by the marginal artery of Drummond. This collateral circulation and the Riolan arcade in particular, is utilized during left colonic resection. In the case of this collateral circulation insufficiency, inferior mesenteric artery reimplantation is necessary during abdominal aortic aneurysmectomy. Arteriopathy, more and more frequent due to population ageing is responsible for frequent obliteration of one or several digestive arterial trunks with subsequent development of collateral circulation. For such reasons, a sound knowledge of digestive arterial anatomy is an absolute prerequisite for surgical practice.     

Anatomical bases of kidney transplantation in man

Summary Kidney transplantation is a well codified operation. The way to reduce surgical complications (urological and vascular) lies in a precise knowledge of the anatomy of the renal pedicle, as well as of the ureter and its vascularization. The choice of a site for implantation depends on anatomical arguments which aim at using a well vascularised ureter, and so a short one, and a renal pedicle without tension, with therefore a long or extended renal vein. A privileged site for transplantation is the right or left iliac fossa; transplantation in the lumbar fossa remains exceptional.

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Bases anatomiques de la transplantation rénale chez l'homme

Résumé La transplantation rénale est une opération bien codifiée: la diminution des complications chirurgicales (complications urologiques et vasculaires) repose sur une connaissance précise de l'anatomie du pédicule rénal, de l'uretère et de sa vascularisation. Le choix du site d'implantation dépend d'arguments anatomiques qui visent à utiliser un uretère bien vascularisé, donc court, un pédicule rénal sans tension donc avec une veine rénale longue ou allongée. Le site privilégié de transplantation est la fosse iliaque droite ou gauche; la transplantation dans la fosse lombaire reste exceptionnelle.

     

成人颞骨骨迷路的解剖学研究及其临床意义

目的:对成人颞骨骨迷路进行解剖观察和测量,为临床提供解剖学基础。方法:制作26侧成人颞骨骨迷路标本进行观察和测量。结果:(1)半规管长度以后半规管最长,前半规管次之,外半规管最短。(2)半规管横断面呈椭圆形,其弓顶处管腔纵径大于横径。(3)壶腹端、单脚端、总脚端均近似圆形。后、前、外半规管壶腹端的纵径分别为:1.94mm,1.95mm,1.92mm。外半规管单脚端纵径为1.20mm,前、后半规管总脚端纵径为1.60mm。(4)三个半规管弓除外半规管弓在同一平面上外,前、后半规管弓均不在同一平面上,而呈不同程度的扭曲。(5)同侧三半规管之间并非相互垂直。(6)26侧中前半规管位于弓状隆突下的有16侧(61.54％),余10侧(38.46％)与弓状隆突不相重叠。结论:本研究结果为骨迷路结构研究增添了新的内容,为临床内耳手术的开展提供解削学基础和参考数据。     

椎动脉近段的应用解剖学研究

目的　为椎动脉近段的重建术提供解剖学基础。方法　在 2 4具 4 8侧经防腐处理的新鲜尸体标本上观察椎动脉近段的起点、分支、走行情况 ,测量椎动脉近段两端管腔外径、长度。结果　椎动脉近段的起点外径左侧为 (4 5 2± 0 79)mm ;末端外径左侧为 (4 1 2± 0 71 )mm ,右侧为 (3 90± 0 82 )mm ;全长左侧为 (33 7± 8 3)mm ,右侧为 (2 7 75± 5 1 )mm。结论　椎动脉近段的观察与测量结果对椎动脉近段重建提供重要参考价值。     

椎动脉颅外部的解剖学研究及其临床应用

目的 为临床椎动脉重建术提供解剖学依据。方法 20具40侧经防腐处理的成人尸体标本观察椎动脉发出方位,颅外部各段的走行及分支情况,测量各段起点的外径、长度。结果 推动脉大部分直接从锁骨下动脉上壁发出,并直行上升,第1段起点的外径左侧为4.35±0.78mm,右侧为3.97±0.56mm,长度左侧为40.1±5.8mm,右侧为39.6±9.3mm,第2段起点的外径左侧为3.56±0.87mm,右侧为3.07±0.52mm,长度左侧为59.1±7.8mm,右侧为60.6±7.3mm,第3段起点的外径左侧为3.06±0.76mm,右侧为2.81±0.66mm,长度左侧为39.2±2.8mm,右侧为40.6±3.3mm。结论 椎动脉颅外部各段测量结果对临床椎动脉重建术有重要应用价值。     

Orientation lesson in anatomy education

Dissection of a human body during an anatomy course raises questions about invasion of privacy, cadaver sources, dying and death for medical students. The technical orientation in any medical education process tends to motivate students towards a purely biological view of the human body. An orientation lesson was performed, including technical instructions, with particular emphasis on how to deal with emotions. Two hundred and forty-two second-year students were asked to complete a questionnaire and two State-Trait Anxiety Inventory (STAI) self-reports. One hundred and two students participated in an orientation lesson (group A) and 140 students did not (group B). Data were analyzed using SPSS. The t-test and chi-square test were used to evaluate differences between the groups. Group A students showed significantly better performance in both a verbal anatomy examination and multiple-choice test than group B students (p=0.001). There were no differences between group A and B students in the state and trait anxiety levels, willingness to donate their body or organs, belief in life after death, social activity or gender. The goal of including consideration of psychosocial factors in an anatomy course would allow students a thoughtful interpretation of their laboratory experience in the context of their professional development as physicians.This study was presented at the First Joint Meeting of EACA&AACA in Graz, Austria, 7–11 July 2003     

胎儿耳蜗外侧壁微血管构筑的解剖学研究

目的 观察人类胎儿耳蜗外侧壁微血管形态、分布及生理学意义。方法 应用墨汁灌注和微血管铸型技术观察30例胎儿耳蜗外侧壁微血管形态。结果 耳蜗外侧壁由外放射状动脉供血,外放射状动脉走行于耳蜗前庭阶顶部,在耳蜗外侧壁形成四组毛细血管网,遍布耳蜗各回,分别为:血管纹血管网、前庭阶血管网、螺旋凸血管网和螺旋韧带深部血管网。耳蜗侧壁的静脉血流入鼓阶静脉。结论 26周龄以上胎儿耳蜗外侧壁微血管已发育完善,分布与其生理功能密切相关。     

艺术嗓音的生物医学工程基础

艺术嗓音医学是传统医学中产生出来的一门新学科 ,其研究还处于发展完善阶段 ,特别是客观的、科学的研究还不够成熟。我们首次站在生物医学工程的角度 ,从声学和解剖生理学两方面探讨了艺术嗓音医学的研究基础 ,进行了艺术嗓音定量化研究的初步工作 ,通过实际的实验数据进一步说明了定量化测量分析在艺术嗓音医学中的作用。     

手舟骨月骨间韧带的解剖学及临床意义

目的：俾舟骨与月明间的舟月骨间韧带的解剖学结构和分布特点，探讨其对舟月骨间关节稳定性的作用。方法：采用２２只成人尸腐朽 标本，在解剖显微镜膛月骨间韧带的大体形态、长度变化、与腔囊内韧带的关系和在舟月骨上的附着点的位置及宽度。结果：舟月骨间韧带分成掌侧部、近仙部和背侧部，其掌背侧部以致密纤维结构为主，但近侧部显示有纤维软骨样成分。此韧 和桡舟头韧带、桡舟月专带及腔背侧横韧带有关系，舟月骨间韧带对舟，     

Thomas Willis,the Restoration and the First Works of Neurology

This article provides a new consideration of how Thomas Willis (1621–75) came to write the first works of ‘neurology’, which was in its time a novel use of cerebral and neural anatomy to defend philosophical claims about the mind. Willis’s neurology was shaped by the immediate political and religious contexts of the English Civil War and Restoration. Accordingly, the majority of this paper is devoted to uncovering the political necessities Willis faced during the Restoration of the English monarchy in 1660, with particular focus on the significance of Willis’s dedication of his neurology and natural philosophy to the Archbishop of Canterbury, Gilbert Sheldon. Because the Restoration of Charles II brought only a semblance of order and peace, Willis and his allies understood the need for a coherent defense of the authority of the English church and its liturgy. Of particular importance to Sheldon and Willis (and to others in Sheldon’s circle) were the specific ceremonies described in the Book of Common Prayer, a manual that directed the congregation to assume various postures during public worship. This article demonstrates that Willis’s neurology should be read as an intervention in these debates, that his neurology would have been read at the time as an attempt to ground orthodox worship in the structure of the brain and nerves. The political necessities that helped to shape Willis’s project also help us to better understand Willis’s innovative insistence that philosophical statements about the mind should be formulated only after a comprehensive anatomical investigation of the brain and nerves.     

A study of the anatomic features of the duct of the urachus

Abstract 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.     

Quantitative MRI analysis of anatomic dimensions of the carpal tunnel in women

Summary 114 wrists from two groups of asymptomatic women of 25–45 years of age (group I, no=30) and over 45 years (group II, no=27) were examined: a) to quantify the anatomic features of the carpal tunnel, and b) to search for age-related changes in the anatomy of the tunnel. Bilateral MRI axial wrist images were obtained by means of turbo spin echo (TSE) and fast field echo (FFE) sequences. We measured the length, the cross-sectional areas, the volume of the carpal tunnels — from inlet to outlet — and the volume of the wrists, bilaterally. A carpal tunnel volume/wrist volume (CTV/WV) ratio was obtained in both groups. We also searched for the location of the narrowest point of the canal. The mean (SD) length of the tunnel, from inlet to outlet, was 36.3 mm (SD=3.4), in both groups. The tunnel had a cone shape, with the inlet constantly larger than the outlet in all subjects. The mean (SD) cross-sectional area of the tunnel inlet was found to be larger in group II, compared to group I (p=0.029). The calculated mean (SD) volume of the tunnel also appeared significantly larger in the older group (p=0.023). The narrowest point of the canal was identified at its distal third, at 8 mm from the outlet, in both groups. We conclude that: a) quantitative MRI is a valuable method for assessing the anatomic characteristics of the carpal tunnel, and b) the anatomy of the tunnel is affected by age.

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Analyse quantitative IRM des dimensions du tunnel carpien chez la femme

Résumé 114 poignets provenants de deux groupes de femmes asymptomatiques de 25 à 45 ans (groupe I, n=30) et de plus de 45 (groupe II, n=27) ont été examinés. Les caractéristiques anatomiques du canal carpien ont été quantifiées tandis que des modifications de ce canal liées à l'âge ont été recherchées. Les images IRM des deux poignets ont été obtenues en spin-écho et en écho rapide. Ont été mesurées la longueur et la surface de section ainsi que le volume des tunnels carpiens de son entrée jusqu'à sa sortie ainsi que le volume des deux poignets. Un ratio volume du tunnel par rapport au volume du poignet a été obtenu dans les deux groupes. Le point le plus étroit du tunnel carpien a également été localisé. La longueur moyenne du tunnel était de 36,3 mm dans les deux groupes. Le tunnel a la forme d'un cône, avec une entrée constamment plus large que la sortie. La surface de section moyenne du tunnel à son entrée a été trouvée plus importante dans les deux groupes. Le volume moyen du tunnel apparaît significativement plus grand chez les patients âgés. Le point le plus étroit du tunnel a été localisé au tiers distal à 8 mm de la sortie du canal et dans les deux groupes. Nous en concluons : — Que l'analyse IRM quantitative est une méthode valable pour mesurer les caractéristiques anatomiques du tunnel carpien. — Que l'anatomie du tunnel carpien est affectée par l'âge.

     

人体腔隙基础与临床研究思考

人体腔隙研究是在传统实体器官的基础上探讨体内腔隙的解剖结构特征以及和临床各学科的关系，从发育的角度，及在微生物扩散和肿瘤转移，临床影像学、临床诊疗学、药物治疗学和外科手术入路等方面均具有非常重要的意义，尤其是随着临床技术的发展，对人体结构深入细致地研究提出了更高的要求。本文将人体内不同的腔隙分为空间腔隙、潜在腔隙和软组织腔隙３种。腔隙研究除了传统方法以外还可以利用数字人体、生物塑化和内镜等技术等，并列举了硬膜外隙的部分解剖学特征作为例证。     

Dimensions of the laryngeal framework in adults

Summary The increasing application of sophisticated electrophysiological, radiological and surgical methods to the diagnosis and treatment of laryngeal disorders requires a profound knowledge of the size and proportions of the human larynx and it's cartilaginous components. Only inadequate data regarding this subject have so far been accessible. The larynges of 53 patients (28 male and 25 female, age 25–88 years, in the means 59 years) were removed during routine autopsy 12–48 h post mortem and immediatly submitted to morphometric investigation. None of the patients had histories or visible signs of laryngeal disease. Anatomical preparations were performed with customary surgical tools and morphometric measurements then carried out with a pair of compasses and a calliper rule. A total of 95 measurements were performed on each larynx. These included, aside from evaluation of the whole organ, identification of the internal and external diameters of the cricoid cartilage, height and length of the thyroid alae in different planes, angle of thyroid laminae, height of arytenoid cartilage, width and length of epiglottic cartilage, and internal and extrenal diameter of first tracheal ring. The results obtained provide a full scale of data determining the size and extent not only of it's cartilaginous components, but of the laryngeal framework as a whole. The knowledge of these data may contribute to a precise positionning of electrodes in laryngeal electromyography, to the planning of laryngeal framework surgery, and to the analysis of CT- and MRI-scans of the larynx.

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Dimensions des structures laryngées de l'adulte

Résumé Les applications croissantes des méthodes électrophysiologiques, radiologiques et chirurgicales sophistiquées pour le diagnostic et le traitement de troubles laryngés nécessite une connaissance approfondie de la taille et des proportions du larynx humain et de ses composants cartilagineux. Seules des données inadéquates concernant ce sujet sont accessibles. Le larynx de 53 sujets (28 hommes et 25 femmes, âgés de 25 à 88 ans, avec une moyenne de 59 ans) ont été prélevés durant des autopsies habituelles 12 à 48 h post mortem et immédiatement soumis à des investigations morphométriques. Aucun de ces patients n'avait d'histoire ou de signe visible de maladie laryngée. Les préparations anatomiques ont été réalisées avec des instruments chirurgicaux habituels, et les mesures morphométriques ont été faites à l'aide de compas et d'une régle graduée. Un total de 95 mesures a été réalisé sur chaque larynx. Celles-ci incluent, à côté de l'évaluation de l'ensemble de l'organe, l'identification des diamètres interne et externe du cartilage cricoide, de la hauteur et de la longueur des ailes thyroidiennes dans les différents plans, l'angle des lames thyroidiennes, de la hauteur du cartilage aryténoide, de la largeur et de la longueur du cartilage épiglottique, et du diamètre interne et externe du premier anneau trachéal. Les résultats obtenus fournissent un tableau complet de données déterminant la taille et l'étendue non seulement de ses composants cartilagineux, mais des structures laryngées dans leur ensemble. La connaissance de ces données peut contribuer à préciser la mise en place des électrodes en électromyographie laryngée, à la planification d'une intervention chirurgicale sur les structures laryngées, et à l'analyse du larynx en tomodensitométrie (TDM) et en imagerie par résonnance magnétique (IRM).

     

肝移植的解剖学基础及临床应用--背驮式肝移植1例

目的 :探讨肝脏移植的切取及移植手术方法。方法 :采用背驮式的病肝切取要求 ,首先分离第 1肝门 ,将肝蒂解剖至分叉以上 ,然后近肝游离肝周韧带 ,保留肝后下腔静脉 (IVC)和第 2肝门的 3支肝静脉 ,第 3肝门的肝短静脉应细心结扎 (或缝扎 )离断。供肝的切取 :各管道系统保留足够长度 ,避免第 1肝门分离 ,热缺血时间在 10min以内。背驮式植肝技术 :供肝上IVC与肝左中静脉供干支的端端吻合。供肝门静脉与受体门静脉端端吻合。术后采用FK5 0 6、酶酚酸脂 (MMF)抗排斥治疗。结果 :供肝切取 10例均成功 ,热缺血时间在 10min之内。 1例肝豆状核变性 (Wilson)患者 ,行背驮式肝移植成功 ,随访 7个月 ,肝功能及血铜蓝蛋白正常。结论 :掌握肝脏系统的解剖基础 ,有利于供肝的切取及病肝的切除 ,肝脏移植是唯一能挽救终末期肝病病人生命的方法 ,新型免疫抑制剂可预防移植肝排斥反应。