Artéria ulnar superficial diagnosticada por ultrassom vascular: relato de caso / Superficial ulnar artery diagnosed by vascular ultrasound: case report

Resumo O maior ramo da divisão terminal da artéria braquial é a artéria ulnar, que se origina após a fossa cubital. Essa artéria usualmente tem trajeto profundo aos músculos do antebraço anterior e é responsável pela vascularização da musculatura superficial e profunda da região ulnar do antebraço e hipotênar da mão, sendo a principal responsável pela formação do arco palmar superficial após o retináculo dos flexores. Reportamos uma variação anatômica após diagnóstico com ultrassom vascular na qual a artéria ulnar situava-se em posição superficial no antebraço. A ocorrência da artéria ulnar superficial é rara, porém de grande importância para clínicos, cirurgiões e profissionais de enfermagem.

Abstract The largest branch of the terminal division of the brachial artery is the ulnar artery, which arises after the cubital fossa. This artery usually has a deep path in the muscles of the anterior forearm and is responsible for vascularization of the superficial and deep musculature on the ulnar side of the forearm and hypothenar area of the hand. We report an anatomical variant diagnosed by Doppler ultrasound in which the ulnar artery had a superficial position in the forearm. Occurrence of a superficial ulnar artery is rare, but it is an important fact for clinicians, surgeons, and nursing professionals.

A rare case of multiple visceral vascular variations around the kidneys: morphological and clinical aspects / Um caso raro de múltiplas variações vasculares viscerais ao redor dos rins: aspectos morfológicos e clínicos

Abstract Knowledge of the anatomical variations of the visceral branches of the abdominal aorta is important information for planning any surgeries in the region. We present here a rare constellation of variations of visceral vessels around the kidneys with a brief review of the recent literature. On the right side, an accessory renal artery was observed originating just distal to the main renal artery. The middle suprarenal artery was absent on the right side and there were two inferior suprarenal arteries originating from a branch of the main right renal artery. On the left side, the testicular artery had an arched course anterior to the left renal vein mimicking an unusual variety of nutcracker phenomenon. The right kidney was drained by two renal veins into the inferior vena cava. Knowledge of the coexistence of such complex anatomical variations might be helpful for clinicians during diagnostic and therapeutic procedures.

Resumo O conhecimento das variações anatômicas dos ramos viscerais da aorta abdominal é uma informação importante para o planejamento de qualquer cirurgia nessa região. Neste relato, apresentamos um raro conjunto de variações de vasos viscerais ao redor dos rins, bem como uma breve revisão da literatura recente. No lado direito, foi observada uma artéria renal acessória originando-se distal à artéria renal principal. Não havia artéria suprarrenal média no lado direito, e havia duas artérias suprarrenais inferiores originando-se de um ramo da artéria renal direita. No lado esquerdo, a artéria testicular apresentava um curso arqueado anterior à veia renal esquerda, simulando uma variedade incomum do fenômeno do quebra-nozes. O rim direito era drenado por duas veias renais para a veia cava inferior. O conhecimento da coexistência de tais variações anatômicas complexas pode ser útil para os clínicos durante os procedimentos diagnósticos e terapêuticos.

Multiple variation of right renal and gonadal vascularization: report of two cases / Variação múltipla da vascularização renal e gonadal direita: relato de dois casos

Abstract We present two cases of multiple anatomical variations of the renal and gonadal vessels. The first case presented duplication of the renal vein and the presence of an accessory renal artery. However, the most interesting fact, in this case, was that the right gonadal vein emptied into the inferior right renal vein instead of ending in the inferior vena cava as would typically be the case. In the second case, we also found an accessory renal artery and the right gonadal vein emptied at the exact junction between the right renal vein and the inferior vena cava. Clinicians and surgeons should be familiar with anatomical variations to provide an accurate diagnosis during preoperative studies and to avoid surprises in abdominal surgical procedures.

Resumo Este estudo apresenta dois casos de variação anatômica múltipla de vasos renais e gonadais. O primeiro caso apresentou uma duplicação da veia renal e a presença de uma artéria renal acessória. Porém, o fato mais interessante nesse caso foi a veia gonadal direita desembocar na veia renal direita inferior em vez de terminar na veia cava inferior, como seria o normal. No segundo caso, além de também encontrarmos uma artéria renal acessória, a veia gonadal direita desembocava no exato ponto de junção entre a veia renal direita e a veia cava inferior. Clínicos e cirurgiões devem estar familiarizados com a presença de possíveis variações dos vasos renais e gonadais, sendo um conhecimento imprescindível para obter um diagnóstico mais preciso e para evitar surpresas em procedimentos cirúrgicos abdominais.

Os Intermetatarseum: A Rare Variation of Great Relevance / Os Intermetatarseum: Una Rara Variación de Gran Relevancia

SUMMARY: The os intermetatarseum is an accessory bone located in the foot, usually between the first 2 metatarsals and the cuneiform bone. It can be presented as free, articulated or in a fused fashion. It is a very unusual variation found in less than 13 % of the population. A 27-year-old patient presented to the emergency service due to an ankle lesion. Physical exam showed pain and limited range of motion while supporting partial load. Radiographic imaging showed a bony trace near the base of the first and second metatarsals, diagnosed as the os intermetatarseum. Formation of this supernumerary bone begins as a separate ossification center. Most cases are asymptomatic; however, compression of the deep peroneal nerve branches by the os intermetatarseum can lead to pain. Some authors suggest that the presence of this bone may cause hallux valgus. The intermetatarseum can lead to diagnostic confusion, mainly related to Lisfranc fracture. Its origin is still little understood.

El os intermetatarseum es un hueso accesorio ubicado en el pie, generalmente entre los 2 primeros metatarsianos y el hueso cuneiforme. Puede presentarse de forma libre, articulada o fusionada. Es una variación muy inusual que se encuentra en menos del 13 % de la población. Paciente de 27 años que acude a urgencias por lesión en tobillo. El examen físico mostró dolor y rango de movimiento limitado mientras soportaba una carga parcial. Las imágenes radiológicas mostraron un rastro óseo cerca de la base del primer y segundo metatarsianos, diagnosticado como os intermetatarseum. La formación de este hueso supernumerario comienza como un centro de osificación separado. La mayoría de los casos son asintomáticos; sin embargo, la compresión de las ramas profundas del nervio fibular en el espacio intermetatarsiano puede provocar dolor. Algunos autores sugieren que la presencia de este hueso puede provocar hallux valgus. El hueso intermetatarsiano puede llevar a confusión diagnóstica, principalmente relacionada con la fractura de Lisfranc. Su origen aún es poco comprendido.

Persistência da sutura metópica em crânios secos adultos do Nordeste brasileiro: análise antropológica forense / Persistence of metopic suture in adult dry skulls from Northeast Brazil: a forensic anthropological analysis / Persistencia de la sutura metópica en cráneos secos adultos del Nordeste de Brasil: análisis antropológico forense

A sutura metópica forma-se aproximadamente no primeiro trimestre da vida intrauterina entre os dois centros de ossificação que irão formar o osso frontal. Há controvérsias na literatura em relação ao momento em que essa sutura oblitera, mas se sabe que ocorre antes dos dez anos de idade; entretanto, essa sutura pode não obliterar e persistir ao longo da vida do indivíduo. Este trabalho objetivou relatar a persistência da sutura metópica em crânios secos de esqueletos humanos adultos pertencentes ao Centro de Estudos em Antropologia Forense da Faculdade de Odontologia da Universidade de Pernambuco (CEAF/FOP/UPE), com a finalidade de demonstrar a importância para a perícia antropológica forense. Dentre os 426 examinados, foram identificados dez crânios (2,4%) com a presença de sutura metópica completa, sendo 5 do sexo masculino e 5 do feminino, compreendendo uma faixa etária de 29 a 86 anos. A persistência da metópica possui relevância forense, afinal as variações anatômicas são vistas como estruturas que não são consequência de uma patologia e que diferem do encontrado na população geral, tornando o indivíduo que as possui ainda mais único. Dessa forma, essa variação anatômica pode atuar como auxiliar no processo de identificação humana na perícia antropológica forense... (AU)

The metopic suture forms approximately in the first trimester of intrauterine life between the two ossification centers that will form the frontal bone. There are controversies in the literature as to when this suture obliterates, but it is known to occur before the age of ten; however, this suture may not obliterate and persist throughout the individual's life. This work aimed to report the persistence of the metopic suture in dried skulls of adult human skeletons belonging to the Center for Studies in Forensic Anthropology of the School of Dentistry of the University of Pernambuco (CEAF/FOP/UPE) in order to demonstrate its importance for forensic anthropology. Among the 426 skeletons examined, ten skulls (2.4%) with complete metopic sutures were identified, five male and five female, ranging in age from 29 to 86 years. The persistence of metopic sutures has forensic relevance, after all, anatomical variations are seen as structures that are not a consequence of pathology and that differs from what is found in the general population, making the individual who has them even more unique. Thus, this anatomical variation can act as an aid in the process of human identification in forensic anthropology... (AU)

La sutura metópica se forma aproximadamente en el primer trimestre de vida intrauterina entre los dos centros de osificación que formarán el hueso frontal. Existen controversias en la literatura sobre el momento en que se oblitera esta sutura, pero se sabe que ocurre antes de los diez años; sin embargo, esta sutura puede no obliterarse y persistir durante toda la vida del individuo. Este estudio tuvo como objetivo informar sobre la persistencia de la sutura metópica en cráneos desecados de esqueletos humanos adultos pertenecientes al Centro de Estudos em Antropologia Forense de la Faculdade de Odontologia da Universidade de Pernambuco (CEAF/FOP/UPE), con el fin de demostrar su importancia para la antropología forense. Entre los 426 esqueletos examinados, se identificaron diez cráneos (2,4%) con presencia de sutura metópica completa, 5 masculinos y 5 femeninos, con edades entre 29 y 86 años. La persistencia de la sutura metópica tiene relevancia forense, después de todo las variaciones anatómicas son vistas como estructuras que no son consecuencia de una patología y que difieren de lo que se encuentra en la población general, haciendo aún más único al individuo que las presenta. Así pues, esta variación anatómica puede servir de ayuda en el proceso de identificación humana en antropología forense... (AU)

Variant origin of the right coronary artery from the left main coronary artery together with aortic valve stenosis: report of a rare case / Origen variante de la arteria coronaria derecha a partir de la arteria coronaria izquierda junto con estenosis de la valva aórtica: reporte de un caso raro

SUMMARY: Variations in the origin of the right coronary artery have an incidence between 0.09 % and 0.92 %. Herein, we report a rare case of a coronary artery anomaly in which the right coronary artery originates from the left main coronary artery. This variant was found during routine coronarography, combined with an artificial aortic valve. Despite their rare occurrence, some variations in the origins of the coronary arteries can be life threatening and are associated with a higher risk of sudden cardiac death. They can also pose serious technical challenges and predispose to complications during coronary angiographic procedures. Thus, knowledge of such anomalies is paramount for managing the patients correctly.

Las variaciones en el origen de la arteria coronaria derecha tienen una incidencia entre el 0,09 % y el 0,92 %. En este documento, informamos un caso raro de una anomalía de la arteria coronaria en la que la arteria coronaria derecha se originaba en la arteria coronaria izquierda. Esta variante se encontró durante una coronariografía de rutina, combinada con una válvula aórtica artificial. A pesar de su rara aparición, algunas variaciones en los orígenes de las arterias coronarias pueden poner en peligro la vida y se asocian con un mayor riesgo de muerte súbita cardíaca. También pueden plantear serios desafíos técnicos y predisponer a complicaciones durante los procedimientos angiográficos coronarios. Por tanto, el conocimiento de dichas anomalías es fundamental para el manejo correcto de los pacientes.

Upper limb nerve variations may alter clinical diagnosis: a scoping review / Las variaciones nerviosas del miembros superior pueden alterar el diagnóstico clínico: una revisión de alcance

SUMMARY: Upper limb nerve variations may be related to the absence of a nerve, an interconnection between two nerves or a variant course. The purpose of this review is to screen the existing literature on upper limb nerve variations that may alter the neurologic diagnostic process. A scoping review was performed following PRISMA for Scoping Reviews guidelines. Initially, 1331 articles were identified by searching Pubmed and Web of Science until the 22nd of October 2022. After screening, reading, and additional searching 50 articles were included in this review. Variations were divided into two categories: 1) variations causing a different innervation pattern involving sensory, motor, or both types of fibers, and 2) variations causing or related to compression syndromes. Two-thirds of the included articles were cadaver studies. Nine articles were diagnostic studies on symptomatic or healthy individuals involving medical imaging and/or surgery. Nerve variations that may cause a different innervation pattern concern most frequently their interconnection. The connection between the median and musculocutaneous nerve in the upper limb and the connection between the median and ulnar nerve in the forearm (Martin-Gruber) or hand (Riche-Cannieu) may be present in half of the population. Injury to these connections may cause compound peripheral neuropathies a result of variant sensory and motor branching patterns. Muscular, vascular, or combined anomalies in the forearm were reported as causes of entrapment neuropathies. These nerve variations may mimic classical entrapment syndromes such as carpal tunnel syndrome or compression at ulnar canal (Guyon's canal). Knowledge of frequent nerve variations in the arm may be important during the diagnostic process and examination. Variant innervation patterns may explain non-classical clinical signs and/or symptoms during provocative tests. Classical nerve compression syndromes in the arm may warrant for differential diagnosis, especially in the case of persistent or recurrent symptoms.

Las variaciones nerviosas del miembro superior pueden estar relacionadas con la ausencia de un nervio, una interconexión entre dos nervios o un curso variante. El objetivo de esta revisión fue examinar la literatura existente sobre las variaciones de los nervios de los miembros superiores que pueden alterar el proceso de diagnóstico neurológico. Se realizó una revisión de alcance siguiendo las pautas de PRISMA para revisiones de alcance. Inicialmente, se identificaron 1331 artículos mediante la búsqueda en Pubmed y Web of Science hasta el 22 de octubre de 2022. Después de la selección, la lectura y la búsqueda adicional, se incluyeron 50 artículos en esta revisión. Las variaciones se dividieron en dos categorías: 1) variaciones que causan un patrón de inervación diferente que involucra fibras sensoriales, motoras o de ambos tipos, y 2) variaciones que causan o están relacionadas con síndromes de compresión. Dos tercios de los artículos incluidos eran estudios de cadáveres. Nueve artículos fueron estudios de diagnóstico en individuos sintomáticos o sanos que involucraron imágenes médicas y/o cirugía. Las variaciones nerviosas que pueden causar un patrón de inervación diferente se refieren con mayor frecuencia a su interconexión. La conexión entre el nervio mediano y musculocutáneo en el miembro superior y la conexión entre el nervio mediano y ulnar en el antebrazo (Martin-Gruber) o la mano (Riche-Cannieu) puede estar presente en la mitad de la población. La lesión de estas conexiones puede causar neuropatías periféricas compuestas como resultado de patrones de ramificación variantes sensitivos y motores. Se informaron anomalías musculares, vasculares o combinadas en el antebrazo como causas de neuropatías por atrapamiento. Estas variaciones nerviosas pueden imitar los síndromes de atrapamiento clásicos, como el síndrome del túnel carpiano o la compresión en el canal ulnar. El conocimiento de las variaciones nerviosas frecuentes en el brazo puede ser importante durante el proceso de diagnóstico y examen. Los patrones de inervación variantes pueden explicar los signos y/o síntomas clínicos no clásicos durante las pruebas de provocación. Los síndromes clásicos de compresión nerviosa en el brazo pueden justificar el diagnóstico diferencial, especialmente en el caso de síntomas persistentes o recurrentes.

Prevalence of Palmaris Longus Muscle Agenesis Among Students Assessed Using Various Clinical Assessment Tests

Introduction: Since the lack of Palmaris Longus Muscle (PLM) has no effect on hand and wrist function, it is considered a non-essential muscle. However, its clinical relevance stems from its widespread application in reconstructive and hand surgery. In addition to gender differences, some sources assert that its absence is more prevalent in those genders who lack it in some way, that it is more prevalent when both eyes are missing, and that it is more prevalent when just one eye is present. Aim: The primary objective of this research was to find out how common PLM agenesis is among students of both genders. The secondary objective was to demonstrate that a classical test (Schaffer’s test) can be reliably compared to other tests such as Thompson’s test, Mishra’s test, AIIM’s test, and the Hiz-Ediz test. Materials and Methods: The study was a cross-sectional study carried out at the MAHSA University; A total of 224 cases, comprised of 126 (56.3%) females and 98 (43.8%) males. Each participant was requested to perform five clinical tests namely, Schaeffer’s test, Thompson’s test, Mishra’s test, AIIM’s test, and the Hiz-Ediz test. Results: The frequent agenesis of the palmaris longus in the right forearm of our study with the Schaeffer’s test was (20.5%) and Thompson’s and Hiz-Ediz tests had equal percentages of agenesis (22.3%) while Mishra’s test (22.8%), and AIIMs test (29.5%) of the participants. Moreover, Thompson’s test had the highest percentage of (70.5%) compared to other tests for detecting the presence of PLM in the left forearm. The second nearest test for PLM detection was Schaeffer’s test with a percentage of (67.4%). AIIMs test was able to detect PLM in (64.3%) of the participants and Mishra’s test and Hiz-Ediz tests had close percentages of (59.4%) and (57.6%) respectively for PLM detection. Conclusion: It can be concluded that Thompson’s test had a higher percentage among the tests to detect the presence of the PLM tendon in females while Schaeffer’s test was more significant in males. Thompson’s test had the best accuracy level and the highest percentage level of agreement with Schaeffer’s test compared to the other tests.

Ramo comunicante entre los nervios mediano y ulnar en el antebrazo humano / Communicanting branch between median and ulnar nerves in the human forearm

El ramo comunicante mediano-ulnar (RCMU) es la conexión que se origina del nervio mediano (NM) o alguno de sus ramos, para unirse al nervio ulnar (NU) en el antebrazo humano. Cuando este RCMU está presente, determina una prevalencia que oscila entre un 8 % y un 32 %, de tal manera los axones del NM se trasladen al NU, modificando la inervación habitual de los músculos de la mano. Nuestro objetivo fue determinar la prevalencia, biometría, topografía y relaciones anatómicas del RCMU. Adicionalmente, se estableció la coexistencia de otras conexiones entre los NM y NU en el antebrazo y la mano. Se realizó un estudio descriptivo, cuantitativo, no experimental y transeccional. Disecamos 30 antebrazos humanos de individuos adultos, pertenecientes al programa de donación cadavérica de la Pontificia Universidad Católicade Chile. Las muestras estaban fijadas en formalina y a 4 °C. El RCMU se presentó en 5 casos (17 %). De estos ramos, tres surgieron del nervio interóseo anterior (NIA) (60 %) y dos (40 %) del ramo que el NM aporta a los músculos superficiales del compartimiento anterior del antebrazo. Estos se clasificaron de acuerdo a la literatura, así el tipo Ic se presentó en tres casos (60 %), y el tipo Ia en dos (40 %). La longitud promedio del RCMU fue de 53,9 mm. El origen del RCMU se ubicó en el tercio proximal y la conexión de este con el NU se estableció en el tercio medio del antebrazo. En tres casos (60 %) se observó la coexistencia del RCMU y una conexión entre los ramos digitales palmares comunes. Estos hallazgos confirman que el RCMU mayoritariamente se extiende entre el nervio interóseo anterior y el NU, y su presencia podría modificar la distribución nerviosa de la mano.

SUMMARY: The median-ulnar communicating branch (MUCB) is the communication that originates from the median nerve (MN) or one of its branches, to join the ulnar nerve (UN) in the human forearm. With a prevalence that oscillates between 8% and 32%, when this MUCB is present, it establishes that axons from the MN move to the UN, modifying the normal innervation of the muscles of the hand. Our aim was to determine the prevalence, biometry and topography and anatomical relationships of the MUCB. Additionally, the coexistence of this MUCB with other connections between the MN and UN was established. A descriptive, quantitative, non experimental and transectional study was conducted. Thirty adult human forearms belonging to the cadaveric donation program of the Pontificia Universidad Católica de Chile were dissected. The samples were fixed in formalin and stored at 4 °C. The MUCB appeared in 5 cases (17%). Of these, three originated from the anterior interosseous nerve (60%) and two (40%) arose from the branch that the MN gives it to the superficial muscles of the anterior compartment of the forearm. These were classified according to the literature consulted, obtaining that Group Ic occurred in three cases (60%), and Group Ia in two (40%). The average MUCB length was 53.9 mm. The origin of the MUCB was on average 21% of the length of the forearm from the biepicondylar line. The connection of this MUCB with the UN was located on average at 44% from this line. In three cases (60%) the coexistence of the MUCB and a connection between the common palmar digital nerves was observed. These findings confirm that the RCMU is generally established between the anterior interosseous nerve of forearm and NU, and its presence could modify the nerve distribution of the hand.

Classification of sternocleidomastoid muscle variations and comparison of its incidence among populations / Clasificación de variaciones del músculo esternocleidomastoideo y comparación de su incidencia entre poblaciones

SUMMARY: This study aimed to classify and investigate anatomical variations of the sternocleidomastoid (SCM) muscle, which is commonly used as an anatomical landmark to indicate the correct position for central venous catheterization, in a Thai population. Thirty- five embalmed cadavers from the Northeast Thailand (19 females and 16 males) were systemically dissected to reveal the SCM muscles in both sides for gross human anatomy teaching. Variations in the SCM origin and insertion were observed and recorded. The prevalence of anatomical variations was approximately 11.4 % (4 of 35 cadavers) and was not different by sex. Such variations were classified into 5 types based on origin, insertion, and presence of additional heads, as follows: type I (n=31; 88.6 %), type II (n=1; 2.85 %), type III (n=1; 2.85 %), type IV (n=1; 2.85 %), and type V (n=1; 2.85 %). Clinical considerations and prevalence of variant SCM muscle have also been discussed. Since the incidence of this anatomical variations was more than 10 %, the cervical surgeons should seriously consider this issue before insertion of a central venous catheter to avoid complications.

El estudio tuvo como objetivo clasificar e investigar las variaciones anatómicas del músculo esternocleidomastoideo (MEM), que se usa comúnmente como un punto de referencia anatómico para indicar la posición correcta para el cateterismo venoso central, en una población tailandesa. Se diseccionaron sistemáticamente 35 cadáveres embalsamados del noreste de Tailandia (19 mujeres y 16 hombres) para observar los músculos MEM en ambos lados para la enseñanza de la anatomía humana macroscópica. Se observaron y registraron variaciones en el origen y la inserción de MEM. La prevalencia de la variación fue de aproximadamente 11,4 % (4 de 35 cadáveres) y no fue diferente por sexo. Dichas variaciones se clasificaron en 5 tipos según el origen, la inserción y la presencia de cabezas adicionales, de la siguiente manera: tipo I (n=31; 88,6 %), tipo II (n=1; 2,85 %), tipo III (n=1; 2,85 %), tipo IV (n=1; 2,85 %) y tipo V (n=1; 2,85 %). También se discutieron las consideraciones clínicas y la prevalencia de la variante del músculo MEM. Dado que la incidencia de esta variación fue superior al 10 %, los cirujanos de cabeza y cuello deben considerar este tema antes de la inserción de un catéter venoso central para evitar complicaciones.

Comparación de las características anatómicas del conducto nasopalatino en pacientes dentados y desdentados mediante tomografía computarizada de haz cónico. Lima 2018-2020 / Comparison of the anatomic characteristics of the nasopalatine duct in toothed and edentulous patients by cone beam computed tomography. Lima 2018-2020

Objetivo : Comparar las características anatómicas del CNP en pacientes dentados y desdentados mediante Tomografía Computarizada de Haz Cónico (TCHC) del Servicio de Radiología Bucomaxilofacial realizadas en el Centro Dental Docente de la Universidad Peruana Cayetano Heredia. Material y métodos : Se evaluaron todas las TCHC adquiridas entre los años 2018 y 2020, que cumplan con ciertos criterios; donde se comparó las características anatómicas del CNP. Los datos fueron registrados en una base de datos, luego representados en tablas. Resultados : Se evaluaron 216 volúmenes tomográficos (VT), divididos en dos grupos: dentados y desdentados. La forma cilíndrica y la forma de canal único fueron las más encontradas en ambos grupos. La longitud y la distancia fueron mayores en pacientes dentados, no se encontró asociación con relación al diámetro; la inclinación fue mayor en pacientes desdentados, encontrándose asociación con relación a la inclinación entre los grupos comparados. Conclusiones : Se encontraron múltiples diferencias anatómicas del CNP entre los pacientes dentados y desdentados evaluados con TCHC con relación al sexo y la edad.

Objective : To compare the anatomical characteristics of the NPC in dentate and edentulous patients using Cone Beam Computed Tomography (CBCT) of the Bucomaxillofacial Radiology Service performed at the Centro Dental Docente of the Universidad Peruana Cayetano Heredia. Material and methods : All TCHC acquired between the years 2018 and 2020, which meet certain criteria, were evaluated; where the anatomicals characteristics of the CNP were compared. The data were recorded in a database, then represented in tables. Results : 216 tomographic volumes were evaluated, divided into two groups: dentate and edentulous. The single cylindrical shape and the single channel shape were the most found in both groups. The length and distance were greater in dentate patients, no association was found in relation to the diameter, the inclination was greater in edentulous patients, finding an association in relation to the inclination between the compared groups. Conclusions : Multiple anatomical differences of the CNP were found between the dentate and edentulous patients evaluated with TCHC in relation to sex and age.

Variation of plantaris muscle: a case report with clinical significance / Variación del músculo plantar: reporte de un caso con significado clínico

SUMMARY: The plantaris muscle is located between the soleus and gastrocnemius muscles, within the posterior calf group. Due to degeneration and its loss of plantar-flexion function, the muscle is vestigial in human beings, but it retains clinical significance. Few cases of variation in the plantaris muscle have been reported, and this, therefore, appears to be rare. Nonetheless, absence of this muscle was identified via the dissection of a left lower limb (male), which also indicated the absence of an attachment in the usual position. The present report, which addresses such variation, may provide both inspiration and reference points for the clinical treatment of so-called "tennis leg", and for the use of plantaris muscle for the purposes of clinical, autologous graft repair.

RESUMEN: El músculo plantar se ubica entre los músculos sóleo y gastrocnemio, dentro del grupo posterior de la pierna. Debido a la degeneración y la pérdida de la función de flexión plantar, el músculo es un vestigio en los seres humanos, pero conserva su importancia clínica. Se han informado pocos casos de variación en el músculo plantar y, por lo tanto, esto parece ser raro. No obstante, se observó la ausencia de este músculo durante la disección de un miembro inferior izquierdo (masculino). El presente informe, que aborda dicha variación, puede proporcionar puntos de referencia para el tratamiento clínico de la llamada "pierna de tenista" y para el uso del músculo plantar con fines de reparación clínica con injerto autólogo.

Double-sided superior vena cava: developmental considerations associated with the thymic veins / Vena cava superior de doble cara: consideraciones de desarrollo asociadas con las venas tímicas

SUMMARY: The superior vena cava is usually located only on the right side, but persistence of the left superior vena cavais observed in about 0.3 to 0.5 % of adults. A routine dissection of the cadaver of a 91-year-old Japanese female, whose cause of death was sepsis due to cholecystitis, was performed at Nagasaki University and revealed a double-sided superior vena cava. On the right side, the superior vena cava opened to the right atrium, while on the left, it opened into the extended coronary sinus. Veins in the left head, neck and upper limb regions joined to form the persistent left superior vena cava, with eventual drainage into the expanded coronary vein. An anastomosing branch occurred between each superior vena cava, and two thymic veins opened to the anastomosing branch. The azygos vein in the azygos venous system opened into the right superior vena cava, whereas a hemi-azygos vein opened into the azygos vein. The accessory hemi-azygos vein also opened into the azygos vein and opened cranially into the left superior vena cava. The left supreme intercostal vein also opened into the left superior vena cava. Several studies have reported a persistent left superior vena cava and the various considerations for its occurrence. Here, we propose a new hypothesis for the embryonic development of the persistent left superior vena cava with the thymic vein. This hypothesis essentially states that the left brachiocephalic vein fails to mature due to inadequate venous return from the thymic vein during the embryonic period, and the left superior vena cava then remains to maintain venous return from the left head, neck and upper limb. We also discuss the clinical significance of the persistent left superior vena cava.

RESUMEN: Usualmente la vena cava superior se localiza solo en el lado derecho, sin embargo en aproximadamente 0,3 a 0,5 % de los adultos se observa la persistencia de la vena cava superior izquierda. En la Universidad de Nagasaki se realizó una disección de rutina del cadáver de una mujer japonesa de 91 años, cuya causa de muerte fue sepsis debido a una colecistitis. El cuerpo presentaba una vena cava superior doble. En el lado derecho, la vena cava superior llegaba al atrio derecho, mientras que en el lado izquierdo drenaba al seno coronario. Las venas de las regiones de la cabeza, el cuello y del miembro superior izquierdo formaban la vena cava superior izquierda persistente, con drenaje hacia la vena coronaria. Se observó una rama anastomótica entre cada vena cava superior y dos venas tímicas drenaban a la rama anastomótica. La vena ácigos drenaba a la vena cava superior derecha, mientras que una vena hemiácigos drenaba a la vena ácigos. La vena hemiácigos accesoria también drnaba en la vena ácigos y cranealmente lo hacia la vena cava superior izquierda. La vena intercostal suprema izquierda drenaba en la vena cava superior izquierda. Varios estudios han informado una vena cava superior izquierda persistente y las diversas consideraciones para su aparición. Aquí, proponemos una nueva hipótesis para el desarrollo embrionario de la vena cava superior izquierda persistente con la vena tímica, que esencialmente establece que la vena braquiocefálica izquierda no se dearrolla debido a un retorno venoso inadecuado de la vena tímica durante el período embrionario, y se mantiene la vena cava superior izquierda para el retorno venoso de la cabeza, el cuello y el miembro superior izquierdo. Además se informa de la importancia clínica de la persistencia de la vena cava superior izquierda.

Anatomical variations of the dorsalis pedis artery in a Thai population / Variaciones anatómicas de la arteria dorsal del pie en una población tailandesa

SUMMARY: The dorsalis pedis artery (DPA) is a vital artery that supplies the foot and ankle area which is clinically important for palpating when taking the pulse. This research was performed on fresh cadaveric dissection of 40 legs by injecting paint into popliteal artery for tracking the dorsalis pedis artery and its branches. The present research revealed that the Thai population has an anatomical variation and different location of the DPA and exact location of DPA for estimating the location of the DPA and may have clinical implications. The statistically descriptive analysis elucidated the distances of the DPA to the lateral malleolus and medial malleolus which were 51.48 ± 7.27 mm and 42.62 ± 11.40 mm, respectively. The distance of the extensor hallucis longus (EHL) to the DPA was 14.29 ± 4.11 mm. The length of the dorsalis pedis artery which measured from artery on intermalleolar line to its dipping in 1st intermetatarsal space to be 122.03 ± 21.07 mm. The arcuate loop which is anastomosis U-loop of lateral tarsal arteries of the DPA was found 55 % in Thais population. There were no statistically significant differences of all parameters between the side and sex in DPA consideration. An understanding of the variations of the anatomical vasculature of DPA is essential for precise clinical assessment because exact anatomical knowledge and location can contribute to the pulse taking and be applied in surgical procedure.

RESUMEN: La arteria dorsal del pie (ADP) es una arteria vital que irriga eldorso del pie y el tobillo, y es clínicamente importante para la toma del pulso. Esta investigación se realizó en disección cadavérica de 40 piernas inyectando látex coloreado en la arteria poplítea para rastrear la ADP y sus ramas. La presente investigación reveló que en la población tailandesa la ADP tiene una variación anatómica y una ubicación diferente. Por tanto, determinar la ubicación exacta del ADP será útil para las implicaciones clínicas. El análisis estadísticamente descriptivo determinó que las distancias del ADP al maléolo lateral y al maléolo medial eran 51,48 ± 7,27 mm y 42,62 ± 11,40 mm, respectivamente. La distancia del tendón del músculo extensor largo del halux (ELH) al ADP era de 14,29 ± 4,11 mm. La longitud de la ADP, desde la línea intermaleolar hasta su entrada al primer espacio intermetatarsiano, era de 122,03 ± 21,07 mm. El asa arqueada, que es una anastomosis U-loop de las arterias tarsales laterales de la ADP, se encontró en un 55 % de la población tailandesa. No hubo diferencias estadísticamente significativas en todos los parámetros de la ADP entre el lado y el sexo. La comprensión de las variaciones de la variaciones anatómicas de la ADP es esencial para una evaluación clínica precisa. El conocimiento anatómico exacto y la ubicación pueden contribuir a la toma del pulso y ser útil en el procedimiento quirúrgico.

Morphometric studies of supraorbital foramen, infraorbital foramen and mental foramen in a thai population related with nerve blocks / Estudios morfométricos del foramen supraorbitario, foramen infraorbitario y foramen mental en una población tailandesa relacionados con bloqueos nerviosos

SUMMARY: The aim of this study was to study the anatomical landmarks and variations of supraorbital, infraorbital, and mental foramina. One hundred and sixty Thai dry skulls were randomly selected from the Forensic Osteology Research Center. The distances of the parameters were measured by using Vernier caliper. The supraorbital foramen could be found in a notch form 13.8 %, single supraorbital foramen accounted for 82.5 %, and supraorbital foramen with an accessory foramen represented 3.8 %. Single infraorbital foramen was found 90.0 %, and infraorbital foramen with an accessory foramen represented 10.0 %. Single mental foramen was observed 96.6 %, and the frequency of mental foramen with an accessory foramen was determined 3.4%. The majority of infraorbital foramina (48.0 %) was detected above the second premolar area. 19.0 % of the infraorbital foramina was seen in the region between the first premolar and the second premolar, and 22.8 % of the infraorbital foramina was located between the second premolar and the first molar. The infraorbital foramen is anatomically positioned above the first molar (10.2 %). The majority of mental foramina (53.5 %) can be identified below second premolar area. The region between the first premolar and the second premolar is the site for the mental foramen 26.0 % of the total variations. The region between the second premolar and the first molar is the site for the mental foramen 16.9 % of the total variations. The mental foramen is approximately situated below the first molar (3.6 %). The present study of anatomical variations of various foramina demonstrates a useful application in cosmetic and ophthalmic plastic surgery. The findings could improve the efficacy of the surgeons and accuracy for the indicated localization of these foramina during maxillofacial operations and local anesthetic procedures.

RESUMEN: El objetivo de este estudio fue estudiar los puntos de referencia anatómicos y las variaciones de los forámenes supraorbitario, infraorbitario y mental. Ciento sesenta cráneos secos tailandeses fueron seleccionados al azar del Centro de Investigación de Osteología Forense. Las distancias de los parámetros se midieron utilizando un calibre Vernier. El foramen supraorbitario se pudo encontrar en forma de muesca el 13,8 %, el foramen supraorbitario único representó el 82,5 % y el foramen supraorbitario con un foramen accesorio representó el 3,8 %. El foramen infraorbitario único se encontró en un 90,0 % y el foramen infraorbitario con un foramen accesorio representó el 10,0 %. Se observó foramen mental único 96,6 % y se determinó la frecuencia de foramen mental con foramen accesorio 3,4 %. La mayoría de los forámenes infraorbitarios (48,0 %) se detectaron por encima del área del segundo premolar. El 19,0 % de los forámenes infraorbitarios se observó en la región entre el primer premolar y el segundo premolar, y el 22,8 % de los forámenes infraorbitarios se ubicó entre el segundo premolar y el primer molar. El foramen infraorbitario se ubica anatómicamente por encima del primer molar (10,2 %). La mayoría de los forámenes mentales (53,5 %) se pudieron identificar inferior al área del segundo premolar. La región entre el primer premolar y el segundo premolar es el sitio del foramen mental 26,0 % de las variaciones totales. La región entre el segundo premolar y el primer molar es el sitio del foramen mental 16,9 % del total de variaciones. El foramen mental se sitúa aproximadamente por debajo del primer molar (3,6 %). El presente estudio de variaciones anatómicas de estos forámenes demuestra una aplicación útil en la cirugía plástica y oftálmica. Los hallazgos podrían mejorar la eficacia de los cirujanos y la precisión para la localización de estos forámenes durante las operaciones maxilofaciales y los procedimientos anestésicos locales.

Variation of serratus anterior muscle originated from the clavipectoral fascia: a case report / Variación del músculo serrato anterior originado en la fascia clavipectoral: reporte de un caso

SUMMARY: The variations in the serratus anterior (SA) muscle are common. Here, we report a rare variation of the muscle origin with a potentially great clinical implication. We found an aberrant SA variation in an 81-year-old Korean male cadaver during a routine dissection for medical students. Additional slip (AS) of the SA originated from the clavipectoral fascia and the pectoralis minor. It traveled inferiorly and merged to the typical SA part. Precise knowledge about SA variations is clinically valuable; therefore, clinicians should be aware of the possible variation.

RESUMEN: Las variaciones en el músculo serrato anterior (MSA) son comunes. En este trabajo informamos una variación rara del origen muscular con una implicación clínica potencialmente importante. Encontramos una variación aberrante del MSA en un cadáver masculino, coreano de 81 años, durante una disección de rutina para estudiantes de medicina, con un fascículo adicional del MSA originado en la fascia clavipectoral y el músculo pectoral menor. Este fascículo se dirigió inferiormente y se fu- sionó con la parte común de MSA. El conocimiento preciso sobre las variaciones de MSA es útil clínicamente; por lo tanto, los médicos deben ser conscientes de esta posible variación.

Clinical and surgical implications of the pulmonary azygos lobe: a systematic review / Implicaciones clínicas y quirúrgicas del lóbulo ácigos pulmonar: una revisión sistemática

SUMMARY: Azygos lobe is one of the most common pulmonary variations. Although numerous studies discuss to the clinical and surgical implications of anatomical variations, there are few investigations about this topic. The aim of this study was to discuss the anatomy of the pulmonary azygos lobe and its possible clinical and surgical correlations. In this systematic review, a total of 48 results were found between 1968 and 2020. After application of eligibility criteria, 16 articles were included to analysis. Our results showed there were no reports of surgery complications in azygos lobe presence. In all articles that described the anatomical variation, the pulmonary azygos lobe received tertiary segmental branches. Among the surgical implications in the presence of the azygos lobe, complications are of low complexity. It is necessary to teach about this anatomical variation in medical schools in cadavers. Emphasizing the obvious morphological modifications in the superior mediastinum.

RESUMEN: El lóbulo ácigos es una de las variaciones pulmonares más comunes. Aunque numerosos estudios discuten las implicaciones clínicas y quirúrgicas de las variaciones anatómicas, existen pocas investigaciones sobre este tema. El objetivo de este estudio fue discutir la anatomía del lóbulo ácigos pulmonar y sus posibles correlaciones clínicas y quirúrgicas. En esta revisión sistemática se encontraron un total de 48 resultados entre los años 1968 y 2020. Después de la aplicación de los criterios de elegibilidad, 16 artículos fueron incluidos para análisis. Nuestros resultados mostraron que no hubo informes de complicaciones quirúrgicas en presencia del lóbulo ácigos. En todos los artículos que describieron la variación anatómica, el lóbulo ácigos pulmonar recibió ramas segmentarias terciarias. Dentro de las implicaciones quirúrgicas en presencia del lóbulo ácigos, las complicaciones son de baja complejidad. En las escuelas de medicina es necesaria la enseñanza en cadáveres de esta variación anatómica, destacando las evidentes modificaciones morfológicas en el mediastino superior.

The anatomical variation of T3 sympathetic ganglion and its relationship with surgical outcomes in primary palmar hyperhidrosis / 中华胸心血管外科杂志

Objective:To investigate the anatomical variation of the T3 sympathetic ganglia and its relationship with surgical outcomes in primary palmar hyperhidrosis.Methods:A total of 86 patients with primary palmar hyperhidrosiswho underwent R4 sympathicotomy from November 2017 to September 2018 were prospectively enrolled. The anatomical variation of T3 sympathetic ganglia was observed by fluorescence thoracoscopy. The therapeutic effect and side effect were followed up after operation.The relationship between T3 anatomical variation and postoperative effect was analyzed.Results:82.6% of T3 ganglion had no anatomic variation, 17.4% of T3 ganglion shifted down to the surface of the fourth rib or intercostal space. After 1 month of follow-up, the therapeutic effect was: overly dry 2.1%, dry 39.4%, mild moist 57.0%, moist 1.4% innormalside, and 13.3%, 53.3%, 33.3%, 0 in the variation side respectively. Mann- Whitney U test showed statistically significant difference between the two groups( P=0.004). After 1 year of follow-up, the effect was 0, 36.5%, 56.9%, 6.6% in normal side, and 0, 33.3%, 63.0%, 3.7% in the variation side respectively. There was no significant difference between the two groups by Mann- Whitney U test( P=0.869). Conclusion:Fluorescence thoracoscopy showed that the variation rate of the position of T3 sympathetic ganglion was 17.4%. Postoperatively, patients with the downshift variation of T3 sympathetic ganglion have drier hands in short-term follow-up.

Anatomical variations and morphometric study of pterion in a Thai population associated with clinical implications / Variaciones anatómicas y estudio morfométrico del pterion en una población tailandesa asociada con implicaciones clínicas

SUMMARY: The objective of this study was to consider the type of variation and to estimate the landmarks for localizing the pterion. One hundred twenty Thai dry skulls were selected randomly from the Forensic Osteology Research Center, Faculty of Medicine, Chiang Mai University. The distances of the parameters were measured via Vernier caliper. The sphenoparietal type is the most dominant in the Thai population with 88.75 %. In the male, the distance of the midglabella to the pterion was 9.94?0.64 mm The distance of the frontozygomatic suture to the pterion was 35.41?4.38 mm The distance of the zygomatic arch to the pterion was 39.39?4.69 mm and the distance of the mastoid process tip to the pterion was 86.88?4.44 mm In the female, the distance of the midglabella to the pterion was 9.27?0.63 mm The distance of the frontozygomatic suture to the pterion was 33.08?4.12 mm The distance of the zygomatic arch to the pterion was 33.08?4.12 mm and the distance of the mastoid process tip to the pterion was 83.62?5.16 mm. The pterion approach is the most popular method for neurosurgical procedures, and it provides anatomical variations in the pattern. The sphenoparietal type of pterion is the most common form and the stellate type of pterion is the least common form in Thai skulls. Sex influences the location of the pterion. These findings will be of importance to predict the pterion type in Thai skull and estimate the localization of pterion by using a bony landmark. Knowledge of the precise location of the pterion is an important landmark in the neurosurgical approach.

RESUMEN: El objetivo de este estudio fue considerar el tipo de variación del pterion y estimar los puntos de referencia para localizarlo. Se seleccionaron al azar 120 cráneos secos de individuos tailandeses del Centro de Investigación de Osteología Forense de la Facultad de Medicina de la Universidad de Chiang Mai. Las distancias de los parámetros se midieron mediante un caliper Vernier. El tipo esfenoparietal es el más dominante en la población tailandesa con 88,75 %. En el hombre, la distancia de la glabella al pterion fue de 9,94 ? 0,64 mm. La distancia de la sutura frontocigomática fue de 35,41 ? 4,38 mm La distancia del arco cigomático fue de 39,39 ? 4,69 mm y la distancia del ápice del proceso mastoideo al pterion fue de 86,88 ? 4,44 mm. En la mujer, la distancia de la glabella al pterion fue de 9,27 ? 0,63 mm. La distancia de la sutura frontocigomática al pterion fue de 33,08 ? 4,12 mm. La distancia del arco cigomático al pterion fue de 33,08 ? 4,12 mm y la distancia del ápice proceso mastoideo al pterion fue de 83,62 ? 5,16 mm. El abordaje del pterion es el método más utilizado para procedimientos neuroquirúrgicos y proporciona variaciones anatómicas en el patrón. El tipo esfenoparietal del pterion es la forma más común y el tipo estrellado del pterion es la forma menos común en los cráneos tailandeses. El sexo influye en la ubicación del pterion. Estos hallazgos serán importantes para predecir el tipo de pterion del cráneo en tailandeses y a la vez estimar su localización mediante el uso de un punto de referencia óseo. El conocimiento de la ubicación precisa del pterion es un hito impor- tante en el abordaje neuroquirúrgico.

A rare anatomical variation of ileocolic veins involving in gastrocolic vein trunk: case report and literature review / 中华胃肠外科杂志

Objective: Due to its various anatomical variations and numerous branches, the gastrocolic vein trunk (Henle trunk) is the most common site to develop bleeding and other complications in laparoscopic right hemicolectomy for colon cancer. This study aims to investigate the role of ileocolic vein (ICV) joining with Henle trunk, a rare anatomical variation. Methods: A rare case whose ICV was newly found to involve in the formation of Henle trunk during laparoscopic resection of right hemicolon cancer was reported as right gastroepiploic vein+ right colic vein+superior right colic vein+ICV. This anatomical variation was confirmed by multi-slice spiral CT coronal two-dimensional reconstruction of right hemicolon angiography. The literatures about ICV participating in formation of Henle trunk were systematically searched from PubMed, The Cochran Library, CNKI net and Wanfang database, and the occurrence probability and composition of its anatomical variation were analyzed. Results: This was a 47-year-old female patient who underwent laparoscopic right hemicolectomy. When the vessels were dissected during operation, it was found that ICV did not accompany the ileocolic artery, but directly flowed into Henle trunk. Two-dimensional reconstructed CT images of right hemicolon vessels showed that the composition of Henle trunk was rarely varied, which was composed of right gastroepiploic vein, right colonic vein, superior right colonic vein and ICV. Five literatures were enrolled from literature retrieval. A total of 12 cases with ICV participating in the construction of Henle trunk were reported, with a probability of 0.27%-6.31% and 6 forms of the formation of Henle trunk. In this case, Henle trunk was made up of right gastroepiploic vein, right colonic vein, upper right colonic vein and ICV, which was reported for the first time. Conclusions: ICV involving in Henle trunk is a rare vascular variation, and this type of variation should be fully recognized. Careful dissection during operation is necessary to prevent intraoperative bleeding caused by improper operation.