Anatomía topográfica del nervio laríngeo superior: importancia quirúrgica en las tiroidectomías / Topographic anatomy of the upper laryngeal nerve: surgical importance in thyroidectomies

En las cirugías sobre la glándula tiroides se ha prestado mucha atención al manejo del nervio laríngeo inferior y de las glándulas paratiroides, no así del ramo lateral del nervio laríngeo superior, el cual es satélite del pedículo vascular superior de la glándula tiroides. El manejo del polo superior de la glándula tiroides requiere de un conocimiento acabado de su anatomía topográfica del área y está determinada por sus relaciones más importantes, dadas por el citado nervio y la arteria tiroidea superior principalmente. En este trabajo se pretende estudiar estas relaciones en base a la disección meticulosa del triángulo laringo-esternotiroideo ("Triángulo de Joll") de 25 cadáveres adultos formolizados. Como hallazgo relevante se informa que los "nervios en riesgo", según la clasificación de Cernea, que se basa en una distancia menor a un centímetro en el entrecruzamiento del nervio con la arteria tiroidea superior con respecto al polo superior de la glándula tiroides, es del 52 % para el lado derecho y 44 % para el lado izquierdo del cuello. El origen bajo de la arteria a nivel de la bifurcación carotídea se presenta asociada a un mayor número de "nervios en riesgo" en el lado izquierdo. Según el punto de penetración del ramo lateral del nervio laríngeo superior en el músculo constrictor inferior de la faringe se establece la clasificación de Friedman, muy útil sobre todo en cirugías ayudadas por la neuroestimulación. En esta clasifiacción los "nervios en riesgo" son aquellos que transcurrren superficial al músculo, mientras que los "nervios protegidos" serían aquellos que perforan el músculo en su porción superior. En este trabajo los "nervios en riesgo" se presentaron del lado izquierdo en el 56 % de los casos y del derecho en el 60 %, mientras que los "nervios protegidos" en el 24 % y 16 %, respectivamente.

In surgeries on the thyroid gland, much attention has been given to the management of the inferior laryngeal nerve and parathyroid glands, but not the external branch of the given by the aforementioned nerve and the superior thyroid artery. This paper intends to study these relationships based on the meticulous dissection of the larynx-sternothyroid triangle ("Joll triangle") of 25 formolized adult corpses. As a relevant finding, it is reported that the " nerves at risk" according to the Cernea classification, which is based on the distance less than one centimeter at the intersection of the nerve with the superior thyroid artery with respect to the upper pole of the gland, is 52 % for the right side and 44 % for the left side of the neck. The low origin of the artery at the level of the carotid bifurcation is associated with a greater number of "nerves at risk" on the left side. According to the penetration point of the external branch of the superior laryngeal nerve in the inferior pharyngeal constrictor muscle, the Friedman classification is established, very useful especially in surgeries aided by neurostimulation. In this classification the "nerves at risk" are those that run superficially to the muscle, while the protected nerves would be those that pierce the muscle in its upper part. In tis work, the "nerves at risk" presented on the left side in 56 % of the cases and the right side in 60 %, while those "protected" in 24 % and 16 % respectively.

Local anatomical characteristics of complete mesocolic excision in the right hemicolectomy / 中华消化外科杂志

Objective To investigate the local anatomical characteristics of the associated membrane and mesangial space in the complete mesocolic excision (CME) of right hemicolectomy and provide the surgical practical anatomical evidence to CME.Methods The experimental study was conducted.Department of Anatomy of Capital Medical University provided 20 adult cadavers.The surgical pictures came from Beijing Friendship Hospital of Capital Medical University.The local anatomy of CME in 20 cadavers was simulated after fascia perfusion.Observation indicators:(1) the local anatomy of the visceral fascia and parietal fascia was studied by simulating the operation of CME in cadaver specimens;(2) observing the integrity and barrier action of the visceral layer of the membrane after fascia perfusion solution freezing;(3) distribution and variation of superior vessels of rightsemi mesocolon.Results (1) The local anatomy of the visceral fascia and parietal fascia was studied by simulating the operation of CME in cadaver specimens:posterior lobe of the interposition mesocolon merged completely with visceral fascia,parietal fascia and front fascia of duodenum,and superior mesenteric vein (SMV) and superior mesenteric artery (SMA) were found.The ureters and reproductive vessels were covered with Gerota fascia,with a complete membrane structure.The specimens from simulated CME in 20 adult cadavers and CME of right hemicolectomy accorded with a requirement of CME.(2) Observing the integrity and barrier action of the visceral layer of the membrane after fascia perfusion solution freezing:posterior lobe of the right-semi mesocolon merged completely with visceral fascia,with a complete parietal fascia structure and without exudation of fascia perfusion solution.The right ureter and reproductive vessels were completely covered with Gerota fascia.The serosal surface of right-semi mesocolon maintained integity,with exudation of fascia perfusion solution.(3) Distribution and variation of superior vessels of right-semi mesocolon:major blood vessels of right-semi colon included superior mesenteric vessels,including SMA and SMV.The major branches of vessels included ileocolic artery,right colic artery,middle colic artery,right and left branches of middle colic artery,ileocolic vein,middle colic vein and gastrocolic stem.The gastrocolic stem and main stem of right colic artery had more variations.Conclusion The posterior lobe of the interposition mesocolon merges with fascia,and complete visceral fascia,can be separated,these provide anatomical evidences for safety and radical resection of right hemicolectomy based on following the principles of CME.

Layered anatomy : an ancient concept of abdominal surgery mentioned again / 中华消化外科杂志

Layered anatomy is a both ancient and novel conception, which is derived from topographic anatomy.Topographic anatomy and phylembryogenesis are basic academic knowledges of layered anatomy.With the development of laparoscopic surgery and robotic surgery, less bleeding, more meticulous dissection, faster postoperative recovery and lower recurrence rate are required in surgical operation, because of which layered anatomy is mentioned and valued again.Organs in abdominal cavity are composed of different layered tissues,between them are loose connective tissues which are poor in vessels.Layered anatomy in surgical operation can avoid the en bloc dissection of organs, which not only reach total lesion dissection, but also avoid hurting surrounded normal tissues, showing the best surgical results.

Morphology and topographic anatomy of the spinal cord of the red-footed tortoise (Geochelone carbonaria Spix, 1824) / Morfologia e anatomia topográfica da medula espinal de jabuti das "patas vermelhas" (Geochelone carbonaria Spix, 1824)

The aim of this study was to describe the topography of the spinal cord of the red-footed tortoise to establish a morphological basis for applied research in anesthesiology and morphology. Six tortoises from the state of Maranhão (Brazil) that had died of natural causes were used. The common carotid artery was used to perfuse the arterial system with saline solution (heated to 37ºC) and to fix the material with a 20 percent formaldehyde solution. The specimens were then placed in a modified decalcifying solution for 72 hours to allow dorsal opening of the carapace with a chisel and an orthopedic hammer. Dissection of the dorsal musculature and sectioning of the vertebral arches were performed to access the spinal cord. The results revealed the spinal cord of G. carbonaria to be an elongated, whitish mass that reached the articulation between the penultimate and last caudal vertebrae. The cervical intumescence (Intumescentia cervicalis) was located between vertebral segments C5 and T1, whereas the lumbosacral intumescence (Intumescentia lumbalis) was located between T6 and Ca1.

Objetivou-se com este estudo descrever a topografia da medula espinhal do jabuti de "patas vermelhas" no intuito de estabelecer bases morfológicas para a investigação aplicada em morfologia, anestesiologia e cirurgia animal. Foram utilizados seis animais adultos, provenientes do Estado de Maranhão (Brasil), os quais haviam ido a óbito por causas naturais. A artéria carótida comum foi canulada e utilizada para perfusão do sistema arterial com solução salina (aquecida a 37ºC) e para fixação do material com uma solução de formol a 20 por cento. Os animais foram então colocados em uma solução descalcificadora modificada por 72 horas, o que facilitou a abertura dorsal da carapaça com um cizel e um martelo ortopédico. Em seguida, foi realizada a dissecação da musculatura dorsal e secção dos arcos vertebrais para acesso a medula espinal. Os resultados revelaram a medula espinhal de Geochelone carbonaria como uma massa alongada, esbranquiçada, que se estende até a articulação entre penúltima e última vértebra caudal. A intumescência cervical (Intumescentia cervicalis) foi localizada entre os segmentos vertebrais de C5 e T1, enquanto que a intumescência lombossacral (Intumescentia lumbalis) foi localizada entre os segmentos vertebrais de T6 e Ca1.

Investigation and Analysis on the Learning Motivation and Learning Interest in Topographic Anatomy / 中华医学教育探索杂志

Good learning motivation can improve the learning interest and learning activity,enable students to form good learning habits,and achieve satisfactory effects.This research is to find out the problems of learning motivation and interest in the teaching of topographic anatomy,and provide some psychological evidences for the reform of topographic anatomy teaching.