Revisión Exploratoria: Comunicación de la Articulación Temporomandibular y del Oído Medio en Fetos y Niños / Exploratory Review: Temporomandibular Joint and Middle Ear Communication in Fetuses and Infants

La Articulación temporomandibular (ATM) cumple funciones importantes para la vida; su adecuado funcionamiento se puede alterar por trastornos temporomandibulares (TTM). La sintomatología de los TTM es variada, entre ellos se encuentra dolor en los músculos masticatorios, ruidos articulares y con menos frecuencia algunos pacientes refieren síntomas auditivos, lo que sugiere la existencia de una relación entre la ATM y el oído medio; sin embargo, esta relación no es clara. En consecuencia, el presente estudio tiene como propósito realizar una revisión de literatura para identificar los aspectos conocidos, desconocidos y controvertidos sobre la relación entre la ATM y el oído medio en niños y fetos. Se efectuó una búsqueda de la literatura en bases de datos utilizando los operadores booleanos (AND/OR) y los términos clave en inglés y en español. Se identificaron inicialmente 1080 artículos, se eliminaron los artículos duplicados y se aplicaron los criterios de inclusión y exclusión. Finalmente, se seleccionaron un total de 14 artículos que se revisaron a texto completo. Los estudios encontrados se enfocan en el desarrollo histoembriológico de la ATM y cómo ese desarrollo se da en conjunto con los componentes del oído medio. Adicionalmente, se identificaron investigaciones sobre el origen, la morfología y función del ligamento discomaleolar, el ligamento esfenomandibular y la fisura petrotimpánica como estructuras que conectan la ATM y el oído medio, pero los resultados han sido controvertidos. Se concluye que son necesarios más estudios para determinar cualquier relación anatómica y fisiológica que pueda existir entre la ATM y el sistema auditivo en fetos y niños.

SUMMARY: The temporomandibular joint (TMJ) has important functions for life; its proper functioning can be altered by temporomandibular disorders (TMD). The symptomatology of TMD is varied, including pain in the masticatory muscles, joint noises and less frequently some patients report auditory symptoms, suggesting the existence of a relationship between the TMJ and the middle ear; however, this relationship is not clear. Consequently, the present study aims to conduct a literature review to identify the known, unknown and controversial aspects of the relationship between TMJ and the middle ear in children and fetuses. A literature search was performed in databases using Boolean operators (AND/ OR) and key terms in English and Spanish. A total of 1080 articles were initially identified; duplicate articles were eliminated and inclusion and exclusion criteria were applied. Finally, a total of 14 articles were selected and reviewed in full text. The studies found focus on the histoembryological development of the TMJ and how that development occurs in conjunction with the middle ear components. Additionally, research on the origin, morphology, and function of the discomalleolar ligament, sphenomandibular ligament, and petrotympanic fissure as structures connecting the TMJ and middle ear was identified, but the results have been controversial. It is concluded that further studies are necessary to determine any anatomical and physiological relationship that may exist between the TMJ and the auditory system in fetuses and children.

Dissecação anatômica como estratégia para o estudo do sistema neural em fetos humanos / Anatomic dissection as a strategy for the study of the neural system in fetuses / Disección anatómica como estrategia para el estudio del sistema neural en fetos

Esse trabalho busca relatar o processo de confecção de peças anatômicas para o ensino da anatomia humana a partir de material cadavérico fetal. Os discentes do curso de medicina da Universidade Federal do Paraná (UFPR) ­ Campus Toledo participaram do programa de voluntariado acadêmico e deram atenção especial aos aspectos técnicos do processo de dissecação, bem como a experiência subjetiva desse procedimento como ferramenta de aprendizado ativo. O procedimento foi realizado na sala de preparação de cadáver da UFPR ­ Campus Toledo, utilizando instrumental de dissecação e cadáveres humanos fetais com 20, 17 e 14 semanas de idade gestacional, direcionado de modo a expor as partes constituintes do sistema neural. Foram confeccionadas peças de cérebro, cerebelo, tronco encefálico, medula espinal, nervos espinais e suas estruturas associadas. Os voluntários envolvidos foram capazes de produzir material de estudo de qualidade através da dissecação e fortalecer seu conhecimento em anatomia humana e aptidão manual. Também foi dada atenção à importância e às limitações do processo de dissecação como estratégia de aprendizado em cursos da área de saúde. pôde ser observado que a dissecação pode fazer parte de uma formação completa e bem estruturada dos discentes, que por sua vez irão integrar a sociedade e a academia. Além disso, a exposição da topografia neural fetal pode servir de referencial para posteriores estudos que venham a utilizar essas informações.

This work aims to report the confection process of anatomic pieces for teaching human anatomy from fetal cadaveric material. The students of the medicine course of Universidade Federal do Paraná (UFPR) ­ Campus Toledo, took part in the academic volunteer program and paid special attention to the technical aspects of the dissection process, as well as the subjective experience of this procedure as an active learning tool. The procedure was performed at the cadaver preparation room of the UFPR ­ Campus Toledo, using dissection tools and human fetal corpses of 20, 17 and 14 weeks of gestational ages, directed so as to expose the constituent parts of the neural system. Pieces of the brain, cerebellum, brainstem, spinal cord, spinal nerves, and its associated structures were made. The involved voluntaries were able to produce quality study material through dissection, and strengthen their knowledge in human anatomy and manual skill. Attention was also given to the importance and limitations of the dissection process as a learning strategy in health courses. it was observed that dissection can be part of a complete and well-structured training of students, who in turn will integrate society and academia. In addition, the exposure of fetal neural topography can serve as a reference for further studies that use this information

Este trabajo tiene como objetivo relatar el proceso de confección de piezas anatómicas para la enseñanza de la anatomía humana a partir de material cadavérico fetal. Los alumnos del curso de medicina de la Universidade Federal do Paraná (UFPR) - Campus Toledo, participaron del programa de voluntariado académico y prestaron especial atención a los aspectos técnicos del proceso de disección, así como a la vivencia subjetiva de este procedimiento como herramienta de aprendizaje activo. El procedimiento fue realizado en la sala de preparación de cadáveres de la UFPR - Campus Toledo, utilizando herramientas de disección y cadáveres de fetos humanos de 20, 17 y 14 semanas de edad gestacional, dirigidos de forma a exponer las partes constitutivas del sistema neural. Se realizaron piezas del cerebro, cerebelo, tronco encefálico, médula espinal, nervios espinales y sus estructuras asociadas. Los voluntarios participantes pudieron elaborar material de estudio de calidad mediante la disección y reforzar sus conocimientos de anatomía humana y habilidad manual. También se prestó atención a la importancia y las limitaciones del proceso de disección como estrategia de aprendizaje en los cursos de salud. Se observó que la disección puede formar parte de una formación completa y bien estructurada de los estudiantes, que a su vez integrarán la sociedad y el mundo académico. Además, la exposición de la topografía neural fetal puede servir de referencia para estudios posteriores que utilicen esta información.

Estruturas fetais e suas correlações com a predição do dia antes do parto em raças de cães miniaturas / Fetal structures and their correlations with a prediction of the parturition date in the miniature canine breeds

Avaliou-se a correlação entre estruturas fetais e extrafetais com a predição do dia antes do parto (DAP) em raças de cães miniaturas. Para isso, realizou-se um experimento, utilizando-se 12 cadelas, com peso corporal entre 3,0kg e 5,0kg, sendo seis da raça Chihuahua, duas da raça Shih-Tzu, duas da raça Spitz Alemão e duas da raça Yorkshire. Foram mensurados, por meio da ultrassonografia, diâmetro biparietal (DBP), diâmetro torácico (DTX), diâmetro abdominal (DAB), comprimento craniocaudal (CCC), diâmetro da cavidade coriônica interna (DCI) e espessura da placenta (EP), a partir do 15º dia após a última monta. Foram estudadas as correlações simples e a significância dos coeficientes de regressão linear simples e o coeficiente de determinação (R), com nível de significância estabelecido em P<0,05. Entre os parâmetros avaliados, DBP, DTX, DAB e CCC foram os mais correlacionados com tempo gestacional, podendo ser utilizados para prever dia antes do parto em cadelas de raças miniaturas.(AU)

The correlation between fetal and extra-fetal structures with the pre-delivery prediction (DAP) in miniature dog breeds was evaluated. For this, an experiment was carried out using 12 bitches, with body weight between 3.0kg and 5.0kg, being 6 Chihuahua, 2 Shih-Tzu, 2 German Spitz and 2 Yorkshire breed. The Biparietal Diameter (BD), Thoracic Diameter (TD), Abdominal Diameter (AD), Crown-rump length (CRL), Internal Chorionic Cavity Diameter (ICD) and Placenta Thickness (PT) were measured by ultrasonography from the 15th day after the last mating. The simple correlations and significance of simple linear regression coefficients and the coefficient of determination (R) were studied, with a significance level of P<0.05. BD, T, AD and CRL were the most correlated with gestational time, and can be used to predict day before delivery in miniature breed bitches.(AU)

Anatomical study of the brachial plexus in human fetuses and its relation with neonatal upper limb paralysis / Estudo anatômico do plexo braquial de fetos humanos e sua relação com paralisias neonatais do membro superior

ABSTRACT Objective To study the anatomy of the brachial plexus in fetuses and to evaluate differences in morphology during evolution, or to find anatomical situations that can be identified as the cause of obstetric paralysis. Methods Nine fetuses (12 to 30 weeks of gestation) stored in formalin were used. The supraclavicular and infraclavicular parts of the brachial plexus were dissected. Results In its early course, the brachial plexus had a cord-like shape when it passed through the scalene hiatus. Origin of the phrenic nerve in the brachial plexus was observed in only one fetus. In the deep infraclavicular and retropectoralis minor spaces, the nerve fibers of the brachial plexus were distributed in the axilla and medial bicipital groove, where they formed the nerve endings. Conclusion The brachial plexus of human fetuses presents variations and relations with anatomical structures that must be considered during clinical and surgical procedures for neonatal paralysis of the upper limbs.

RESUMO Objetivo Estudar a anatomia do plexo braquial em fetos e avaliar diferenças de morfologia durante a evolução, ou encontrar situações anatômicas que possam ser apontadas como causa de paralisias obstétricas. Métodos Foram utilizados nove fetos formolizados entre 12 a 30 semanas de gestação e submetidos à dissecação supra e infraclavicular do plexo braquial. Resultados O plexo braquial inicialmente tem formato de cordão durante sua passagem pelo hiato dos escalenos e em apenas um feto foi observada a origem do nervo frênico por meio do plexo braquial. Na região infraclavicular profunda e retropeitoral menor, os fascículos do plexo braquial se distribuíam na axila e sulco bicipital medial para a formação dos nervos terminais. Conclusão O plexo braquial de fetos humanos apresenta variações e relações com estruturas anatômicas que devem ser consideradas durante os procedimentos clínicos e cirúrgicos das paralisias neonatais do membro superior.

The course and branching patterns of the superficial branch of radial nerve in foetuses and clinical significance / Curso y patrones de ramificación del ramo superficial del nervio radial en fetos y su importancia clínica

Knowing the anatomical, topographic and morphometric properties of the superficial branch of the radial nerve (SBRN) in the forearm and the dorsum of the hand is important for minimizing nerve damage. The purpose of this study is to evaluate the anatomical and morphometric properties of SBRN in foetuses. Forty forearms of twenty-one foetuses (n=21) were dissected. The anatomical variations of SBRN in the dorsal forearm were assessed in three types (Type-1, Type-2 and Type-3). The innervation areas in dorsum of hand were assessed in four types (Type-1, Type-2, Type-3 and Type-4). The forearm length was divided to three part and emerging point of SBRN was determined as topographically. The relation of the SBRN with lateral antebrachial cutaneous nerve (LACN), anatomic snuffbox and cephalic vein was also evaluated. In forearm, Type-1 variation rate of SBRN was 87.5 %. In the dorsum of hand, Type-3 innervation pattern was 32.5 %. The emerging rate of SBRN in the middle third of the forearm was 74.4 %. There were nerve branches between LACN and SBRN or its terminal branches in 32.5 % of the forearms. The branches of SBRN passed within the margins of anatomic snuffbox in 50 % of the forearms. The most frequently branching type of SBRN was Type-1 in the forearm and Type-3 in the dorsum of hand in foetuses. These results may aid to minimize nerve injuries performed in clinical applications.

Conocer las propiedades anatómicas, topográficas y morfométricas del ramo superficial del nervio radial (RSNR) en el antebrazo y el dorso de la mano es importante para minimizar el daño a los nervios. El propósito de este estudio fue evaluar las propiedades anatómicas y morfométricas de RSNR en fetos. Fueron disecados 40 antebrazos de veintiún fetos. Las variaciones anatómicas de RSNR en el dorso del antebrazo se clasificaron en tres tipos (Tipo-1, Tipo-2 y Tipo-3). Las áreas de inervación en el dorso de la mano se evaluaron en cuatro tipos (Tipo 1, Tipo 2, Tipo 3 y Tipo 4). La longitud del antebrazo se dividió en tres partes y el punto emergente de RSNR se determinó topográficamente. Se evaluó la relación del RSRN con el nervio cutáneo antebraquial lateral (NCAL), la tabaquera anatómica y la vena cefálica. En el antebrazo, la tasa de variación de Tipo 1 de RSNR fue de 87,5 %. En el dorso de la mano, el patrón de inervación tipo 3 fue del 32,5 %. La emergencia del RSNR en el tercio medio del antebrazo fue de 74,4 %. En el 32,5 % de los antebrazos se observaron ramos nerviosos entre NCAL y RSNR. Los ramos de RSNR pasaron dentro de los límites de la tabaquera anatómica en 50 % de los antebrazos. El tipo de RSNS con ramificación más frecuente fue el Tipo 1 en el antebrazo y el Tipo 3 en el dorso de la mano en los fetos. Conocer las variaciones anatómicas de RSNS puede ayudar a minimizar las lesiones nerviosas durante los procedimientos clínicos.

Anatomical investigation of the vascular supply of the suprarenal glands in fetuses / Investigación anatómica del suministro vascular de las glándulas suprarrenales en los fetos

The suprarenal glands are bilaterally supplied by three suprarenal arteries and drained by a single suprarenal vein. Variable vascular origins of the fetal suprarenal gland have been documented in different population groups viz. Indian, Polish and Argentinian. However, there is lack of a detailed description regarding the course, relations, number of branches and vertebral levels of the origins of the vasculature of the suprarenal glands in fetuses. This study aimed to identify and document the vascular supply of the suprarenal glands in fetuses in a South African setting. Fifty fetal specimens (26 males; 24 females) with a gestational age ranging between 12 and 20 weeks, were bilaterally micro-dissected (n=100) using a Zeiss Stemi DV4 microscope. Data was recorded and the frequencies of the origin, course, relations, number of branches and vertebral levels of the suprarenal vascular supply were determined. Arterial supply: Origin: (i) The superior suprarenal artery (SSA) bilaterally arose from the inferior phrenic arteries in 98 % of the fetuses; (ii) the middle suprarenal artery (MSA) frequently arose from the renal artery (RA) on the right side (46 %) and the abdominal aorta on the left side (34 %); while (iii) the inferior suprarenal artery (ISA) predominantly arose from the RA in 91 % of the specimens, bilaterally. Course and relations: The suprarenal arteries followed a superior, inferior, lateral, supero-lateral and infero-lateral course to the gland. These arteries were closely related to the crura of the diaphragm, the inferior vena cava, the left inferior phrenic vein and the pancreas. Number of branches: The branches ranged from one to seven for the SSA, one to four for the MSA and one to three for the ISA. Vertebral levels: The SSA predominantly arose from the first lumbar (L1) vertebral body (32 %), the MSA arose from the middle third of the intervertebral disc between the L1 and the second lumbar (L2) vertebrae (19 %) and the ISA arose from the L2 vertebral body (28 %). Venous drainage: In 1 % of the specimens, an additional right suprarenal vein (ARSV) was observed. This ARSV followed a superomedial course into the inferior vena cava, just below the entrance of the main right suprarenal vein. The arteries supplying the suprarenal gland presented varying origins and number of branches, corroborating with the reviewed literature and standard anatomical textbooks. The findings of this study may aid pediatric surgeons in understanding the vascular morphology (and the variations thereof) of the suprarenal gland, when performing adrenelectomy surgery in neonates.

Las glándulas suprarrenales son irrigadas bilateralmente por tres arterias suprarrenales y drenadas por una sola vena suprarrenal. Los orígenes vasculares variables de la glándula suprarrenal fetal se han documentado en diferentes grupos de población: indios, polacos y argentinos. Sin embargo, no existe una descripción detallada del curso, las relaciones, el número de ramas y los niveles vertebrales de los orígenes de la vasculatura de las glándulas suprarrenales en los fetos. Este estudio tuvo como objetivo identificar y documentar el suministro vascular de las glándulas suprarrenales en fetos en una población sudafricana. Cincuenta especímenes fetales (26 hombres; 24 mujeres) con una edad gestacional que oscila entre las 12 y las 20 semanas, fueron micro-diseccionados bilateralmente (n = 100) utilizando un microscopio Zeiss Stemi DV4. Se registraron los datos y se determinaron las frecuencias de origen, curso, relaciones, número de ramas y niveles vertebrales del suministro vascular suprarrenal. Suministro arterial: Origen: (i) La arteria suprarrenal superior (SSA) surgió bilateralmente de las arterias frénicas inferiores en el 98 % de los fetos; (ii) la arteria suprarrenal media (MSA) surgió frecuentemente de la arteria renal (AR) en el lado derecho (46 %) y en la parte abdominal de la aorta en el lado izquierdo (34 %); mientras que (iii) la arteria suprarrenal inferior (AIS) surgió predominantemente de la AR en el 91 % de los especímenes, bilateralmente. Curso y relaciones: las arterias suprarrenales seguían un curso superior, inferior, lateral, superolateral e inferolateral hacia la glándula. Estas arterias estaban estrechamente relacionadas con la crura del diafragma, la vena cava inferior, la vena frénica inferior izquierda y el páncreas. Número de ramas: Las ramas variaron de una a siete para la SSA, de una a cuatro para la MSA y de una a tres para la ISA. Niveles vertebrales: la SSA surgió predominantemente del primer cuerpo vertebral lumbar (L1) (32 %), la MSA surgió del tercio medio del disco intervertebral entre la L1 y la segunda vértebra lumbar (L2) (19 %) y la ISA surgió del cuerpo vertebral L2 (28 %). Drenaje venoso: en el 1 % de las muestras, se observó una vena suprarrenal derecha (ARSV) adicional. Este ARSV siguió un curso superomedial hacia la vena cava inferior, justo debajo de la entrada de la vena suprarrenal derecha principal. Las arterias que irrigaban la glándula suprarrenal presentaban diversos orígenes y número de ramas, lo que corrobora la literatura revisada y los libros de texto anatómicos estándar. Los hallazgos de este estudio pueden ayudar a los cirujanos pediátricos a comprender la morfología vascular (y sus variaciones) de la glándula suprarrenal, al realizar una cirugía de adrenelectomía en neonatos.

Study of the renal parenchymal volume during the human fetal period

ABSTRACT Objective: To evaluate the renal parenchymal area in human fetuses, providing a descriptive analysis on the renal area development by demographic factors during the second gestational trimester. Material and Methods: We analyzed 84 fetuses (44 males and 40 females), for a total of 168 renal units evaluated in terms of longitudinal length, superior pole width, inferior pole width and thickness. Renal volume was calculated by ellipsoid formula. After renal pelvis dissection, length and width were evaluated; as pelvis is free of urine, we considered thickness as 1mm. Renal pelvis volume was also calculated by ellipsoid formula. Renal parenchymal area was assessed by excluding the volume of the renal pelvis from the total renal volume. We performed the statistical analysis by simple linear regression assessing the association between the variables analyzed with the fetal age. Results: Gestational age ranged from 12 to 23 weeks post conception. Mean renal parenchymal area of the right kidney was 666.22mm3 (45.86 to 2375.35mm3) and for the left kidney was 606.76mm3 (68.63 to 2402.57mm3). No statistical difference was observed between the sides (p-value = 0.3456) or genders (p-value = 0.07429). Linear regression between renal parenchymal volume and gestational age was positive for right kidney (y = 133.74x-1479.94 / r2 = 0.4009) and left kidney (y = 149.53x-1761.59 / r2 = 0.4591). Conclusions: The linear regression analysis indicated that renal parenchymal area correlated significantly and positively with fetal age, weight and crown-rump length with no statistical differences between gender or laterality. These growth curves provide a reference for functional volume of the kidney during fetal period.

Morphologic relationship between the coronary arteries during fetal development / Relación morfológica entre las arterias coronarias durante el desarrollo fetal

SUMMARY: A detailed understanding of the coronary arteries is of paramount importance in the management of coronary arterial diseases. The arterial supply to the heart originates from right (RCA) and left (LCA) coronary arteries which form an oblique inverted crown within the atrioventricular groove. This study aimed to document the embryologic relationship between the RCA and the LCA including their lengths, diameters, branching patterns and arterial dominance in fetuses. Forty-one human fetal heart specimens with an age range of 13.13 to 26.95 weeks were dissected at the Department of Clinical Anatomy, University of Kwazulu-Natal, Durban, South Africa. The RCA arose from the right aortic sinus and was dominant in all the specimens. The LCA was classified into types according to their branching pattern. The bifurcation, trifurcation and quadrifurcation of the LCA occurred in 68.3 %, 29.3 % and 2.4 % of hearts, respectively. The mean lengths of the RCA and LCA were 0.98±0.54 mm and 1.83±0.77 mm, respectively. The mean external diameters of the RCA and LCA were 0.38±0.12 mm and 0.49±0.17 mm, respectively. There was a significant correlation between the RCA and LCA length and the fetal age which is indicative of significant changes in the coronary vasculature with fetal growth.

RESUMEN: Una comprensión detallada de las arterias coronarias es de suma importancia en el manejo de las enfermedades en estas arterias. El suministro arterial al corazón se origina de las arterias coronarias derecha (ACD) e izquierda (ACI) que forman una "corona oblicua invertida" dentro del surco atrioventricular. Este estudio tuvo por objetivo documentar la relación embriológica entre la ACD y la ACI, incluyendo sus longitudes, diámetros, patrones de ramificación y dominio arterial en fetos. Se disecaron 41 corazones de fetos humanos con un rango de edad de 13,13 a 26,95 semanas, en el Departamento de Anatomía Clínica, Universidad de Kwazulu-Natal, Durban, Sudáfrica. La ACD surgió del seno aórtico derecho y fue dominante en todos los especímenes. La ACI se clasificó en distintos tipos según su patrón de ramificación. La bifurcación, trifurcación y cuadrifurcación de la ACI ocurrieron en 68,3 %, 29,3 % y 2,4 % de los corazones, respectivamente. Las longitudes medias de la ACD y ACI fueron 0,98 ± 0,54 mm y 1,83 ± 0,77 mm, respectivamente. Los diámetros externos medios de la ACD y ACI fueron 0,38 ± 0,12 mm y 0,49 ± 0,17 mm, respectivamente. Hubo una correlación significativa entre la longitud de la ACD y la ACI y la edad fetal, que es indicativa de cambios significativos en la vasculatura coronaria con crecimiento fetal.

Relation between fetal anthropometric parameters and cord blood adiponectin and high-sensitivity C-reactive protein in gestational diabetes mellitus

ABSTRACT Objectives The objectives were to evaluate the relation between fetal anthropometric parameters and cord blood concentration of adiponectin and high sensitivity C-reactive protein (hs-CRP). Subjects and methods: A total of 104 pregnant women (52 with gestational diabetes mellitus [GDM], 52 with normal glucose tolerance (NGT) participated. Venous cord blood samples were obtained at delivery, centrifuged and the plasma was stored at -20°C. The samples were assessed for adiponectin and hs-CRP using the ELISA method. Statistical analysis was done using SPSS software. Results The adiponectin concentration was higher in the GDM group than in the NGT group (11.05 ± 4.1 µg/mL in GDM vs. 5.34 ± 2.63 µg/mL in NGT, p < 0.001). GDM was also higher in neonates delivered at later gestational ages (p < 0.001, Pearson correlation = 0.59). There was a positive correlation between cord blood adiponectin and birth weight in the GDM group (p < 0.001, Pearson correlation = 0.619) but not in the NGT group. There was no significant correlation between adiponectin and infant length or head circumference. There was also no significant difference in cord blood hs-CRP concentration between groups. No relation was found between hs-CRP and newborn anthropometric parameters. Conclusion In the GDM group, adiponectin concentration was considerably higher and had a positive correlation with the ponderal index and birth weight which was not found in the NGT group.

Macroscopic and microscopic analysis of 2 embryos and 1 foetus derived from a sheep (Ovis aries) without breed / Análise macroscópica e microscópica de 2 embriões e 1 feto derivados de ovelha (Ovis aries) sem raça

The interest in embryology, the science of the development of a zygote into a completely developed foetus, has increased greatly in recent years due to a number of studies involving embryonic and induced pluripotent stem cells. In addition, the development of techniques such as cloning has aided to understand the critical events that occur during embryonic development. In this study, we describe the morphology of two sheep embryos and one foetus using macroscopic and microscopic techniques. We investigated sheep without defined breed on days 24, 32, and 50 of gestation (estimated by crown-rump length [CR]). Macroscopically, we observed the development of E1 (24 days), with visible optic vesicle, but without retinal pigmentation and the forelimbs bud in development. In the E2 (32 days), we noticed the presence of optic retinal pigmentation and forelimbs more developed in comparison with E1. As expected, F1 revealed an eyeball already covered and the forelimbs developed. Meanwhile, microscopic analysis revealed somite, ventricle, atrium, and oral cavity in development in E1. However, in F1 we were able to identify more complex structures, such as ossification in the spine, ventricle, atrium, intraventricular septum, pericardial sac, and oral cavity with tongue. This work brings more precise and detailed data on the morphological characteristics of the major organ systems (nervous, circulatory, respiratory, digestive, and urinary) at each embryonic and foetal stage analysed.(AU)

O interesse em Embriologia, a ciência do desenvolvimento de um zigoto em um feto completamente desenvolvido, tem aumentado consideravelmente nos últimos anos devido a uma série de estudos envolvendo células-tronco pluripotentes embrionárias e induzidas. Além disso, o desenvolvimento de técnicas como a clonagem tem ajudado a compreender os eventos críticos que ocorrem durante o desenvolvimento embrionário. Neste estudo, descrevemos a morfologia de dois embriões de ovinos e um feto utilizando técnicas macroscópicas e microscópicas. Obtivemos ovelhas sem raça definida com 24, 32 e 50 dias de gestação (estimado pelo método de Crown-Rump, CR). Os conceptos foram mensurados, pesados e caracterizados a olho nu. Macroscopicamente, observamos o desenvolvimento dos embriões E1 (24 dias), apresentando globo ocular sem pigmentação de retina e broto do membro torácico e pélvico. Já o E2 (32 dias), apresentava globo ocular com pigmentação na retina e os membros torácicos e pélvicos mais desenvolvidos. O F1 apresentou olhos cobertos com uma membrana e membros torácicos e pélvicos mais desenvolvidos. Enquanto isso, microscopicamente observamos no E1 somitos, ventrículo, átrio e cavidade oral ainda em desenvolvimento. Porém, no F1 já era possível observar ossificação da coluna espinhal, coração com estruturas mais complexas, como ventrículo, átrio, septo interventricular e saco pericárdio. Além disso, na cavidade oral observamos a formação da língua. Este trabalho fornece informações precisas e detalhadas sobre as características morfológicas dos principais órgãos dos sistemas (nervoso, circulatório, respiratório, digestivo e urinário) em cada fase embrionária e fetal analisadas.(AU)

Is there a trans-abdominal testicular descent during the second gestational trimester? Study in human fetuses between 13 and 23 weeks post conception

ABSTRACT Objectives To confirm if a real inner descend of testis occurs, correlating the testicular position with fetal parameters and analyzing the position of the testes relative to the internal ring. Material and Methods Twenty nine human fetuses between 13 and 23 weeks post conception (WPC) were studied. The fetuses were carefully dissected with the aid of a stereoscopic lens with 16/25X magnification and testicular position observed. With the aid of a digital pachymeter the distance between the lower pole of the kidney and the upper extremity of the testis (DK-T) was measured to show the position of the testis. During the dissection we also indicated the position of the testes relative to the internal ring. Means were statistically compared using simple linear regression and the paired T-test. Results The 58 testes had abdominal position. The DK-T in the right side measured between 0.17 and 1.82cm (mean=0.79cm) and in the left side it was between 0.12 and 1.84cm (mean=0.87cm), without statistically differences (p=0.0557). The linear regression analysis indicated that DK-T in both sides correlated significantly and positively with fetal age. All fetuses with more than 20 WPC, heavier than 350g and with CRL over 22cm had a greater distance than the average DK-T. We xobserved that the 58 testis remains adjacent to the internal ring throughout the period studied. Conclusions The testes remains adjacent to the internal ring throughout the period studied, indicating that there is no real trans-abdominal testicular descent during the second gestational trimester.

Descrição, constituição e aspectos associados à formação dos fetos Perosomus elumbis / Description, composition and aspects associated with the formation of fetus Perosomus elumbis / Descripción, composición y aspectos asociados a la formación de fetos Perosomus elumbis

O feto Perosomus elumbis está inserido num vasto grupo de doenças congênitas raras e de etiologias desconhecidas dentro da medicina veterinária. Por ser de baixa ocorrência, e de difícil acesso e investigação científica, há dificuldade em realizarem-se estudos e conclusões sobre a doença. Com sobrevida máxima de dois dias, sendo a maioria dos fetos natimortos, a anomalia caracteriza-se principalmente por agenesia (ausência ou formação incompleta de um órgão) parcial da medula espinhal, terminando em fundo cego nas últimas vértebras torácicas, e ausência de vértebras lombares, sacrais e coccígeas, convergindo para anomalias secundárias que envolvem artrogripose (flexão ou contratura congênita de uma articulação), atrofia muscular de membros pélvicos e outras malformações subsequentes. Observa-se também a possibilidade de ocorrer anormalidades congênitas concomitantemente à formação desses fetos.

The fetus Perosomus elumbis is inserted in a wide group of rare diseases congenital of etiology unknown in medicine veterinary. Being of low occurrence, hinder study and conclusions about the disease. With maximum survival of two days, being the most of stillbirth fetus, the anomaly is characterized principally by agenesis partial of spinal cord, finishing in the last thoracic vertebrae, and absence of formation of vertebra, diverging to malformation secondary that involve arthrogryposis, atrophy muscular of articulations pelvic and others malformations subsequent. It is also observed the possibility of congenital abnormalities occur concurrently with the formation of these fetuses.

El feto Perosomus elumbis se inserta en una amplia gama de enfermedades congénitas raras y con etiologías desconocidas en Medicina Veterinaria. Debido a su baja incidencia, y de difícil acceso e investigación científica, hay dificultad en realizar estudios y conclusiones acerca de la enfermedad. Con un máximo de supervivencia de dos días, la mayoría de los fetos nacidos muertos, la anomalía se caracteriza principalmente por agenesia parcial de la médula espinal (ausencia o formación incompleta de un órgano), que termina ciegamente en la última vértebra torácica, y ausencia de vértebras lumbares, sacras y coccígeas, que convergen en anomalías secundarias involucrando artrogriposis (flexión o contractura congénita de una articulación), atrofia muscular de miembros pélvicos y otras malformaciones subsecuentes. También se observa la posibilidad de ocurrir anormalidades congénitas concomitantemente a la formación de esos fetos.

Comparative investigation of the fetus and adult joint ligament in the knee and elbow with structural levels / Investigación comparativa del ligamento conjunto de rodilla y codo con niveles estructurales en fetos y adultos

The aim of this study was to examine and compare fetal and adult knee and elbow joint ligaments and determine histologically how these ligaments change over time. In addition, the images of fetal and adult joint ligaments were examined with magnetic resonance imaging (MRI). This study was conducted on 10 male fetus ranging from ages 14 to 17.5 weeks, two adult male cadavers obtained from Gazi University Faculty of Medicine Department of Anatomy and MR images of the knee and elbow regions of 10 male adults obtained from Atatürk Educational and Research Hospital between 2009 and 2011. In the present study, the sections taken from knee and elbow of ten 14­17.5 week old fetuses and the ligaments of tissue taken from the knee and elbow of two male cadavers using the same method of dissection were monitored. After monitoring tissue, microtome sections taken from paraffin-embedded structures were stained using the Masson-Trichrom and Orcein-Picroindigocarmine staining method. These sections were examined under a microscope and photographed. The images of 17 week old fetuses and the knee and elbow of the adults were obtained with MRI. The differences detected between adult and fetus ligaments consisted of fibroblast density and collagen thickness, density and waves. Although the fetus ligaments were not seen sufficiently with 1.5 Tesla (T) MR, they were seen very clearly with 3 T MR. Structural differences between adult and fetal ligaments revealed in histological and MRI images.

El objetivo del estudio fue examinar y comparar los ligamentos de la articulación de la rodilla y del codo en fetos y adultos y determinar histológicamente como estos ligamentos cambian con el tiempo. Además, las imágenes de los ligamentos de las articulaciones fetales y adultas se examinaron con imágenes de resonancia magnética (IRM). Fueron utilizados 10 fetos masculinos entre 14 y 17,5 semanas, y dos cadáveres adultos masculinos obtenidos del Departamento de Anatomía, Facultad de Medicina de la Universidad Gazi junto con las IRM de las regiones de la rodilla y del codo de 10 hombres adultos obtenidos de Atatürk Educativa y del Hospital de Investigación entre los años 2009 y 2011. Para las secciones de rodilla y codo de los diez fetos y de los cadáveres masculinos se utilizó el mismo método de disección. Después de procesar los tejidos e incluirlos en parafina, se obtuvieron cortes en micrótomo los cuales fueron posteriormente teñidos con Tricrómico de Masson y Orceína-picro-índigo Carmín. Las secciones fueron fotografiadas y examinadas bajo microscopio. Se obtuvieron IRM del codo y de la rodilla de los fetos y adultos. Las diferencias encontradas entre los ligamentos de adultos y fetos estaban en relación a la densidad de fibroblastos y espesor de colágeno. Aunque no fue posible observar los ligamentos fetales con 1,5 Tesla (T) MR, se observaron claramente con 3 T MR. Las diferencias estructurales entre los ligamentos fetales y adultos se observan tanto a nivel histológico y de resonancia magnética.

Comparison of cerebral artery angle in adults and fetuses / Comparación del ángulo de arteria cerebral en adultos y fetos

In this study we generated casting specimens of human cerebral blood vessels for twenty-five fetuses and thirty-six adults. The degrees of the angles were measured and comprised for those blood vessels frequently involved in the interventional catheterization.

En este estudio generamos muestras de los vasos sanguíneos cerebrales humanos en veinticinco fetos y treinta y seis adultos. Fueron medidos y comprendidos los ángulos de aquellos vasos sanguíneos implicados frecuentemente en intervenciones de cateterismo.

Estudo morfométrico do músculo latíssimo do dorso em fetos humanos / Morphometric study of the latissimus dorsi muscle in human fetuses

Introdução: O músculo latíssimo do dorso (MLD) é largo, triangular e realiza extensão, adução e rotação medial do braço. É vascularizado pelos vasos toracodorsais e ramos perfurantes das artérias intercostais posteriores e lombares, configurando retalho tipo V de Mathes e Nahai, de grande aplicabilidade em cirurgia plástica. O objetivo é analisar a morfometria e a vascularização do MLD em fetos humanos. Método: Dissecou-se a região axilar e o MLD de oito fetos humanos formolizados (três do sexo feminino e cinco do sexo masculino), entre 20 e 32 semanas gestacionais, em decúbito dorsal e abdução completa do braço. Mensuraram-se os comprimentos dos vasos subescapulares e toracodorsais, e foi realizada a morfometria do músculo. Resultados: Em todos os fetos, os vasos toracodorsais conferiram a vascularização primária do MLD. Em 25%, a veia subescapular era tributária direta da veia axilar; 25% dos casos apresentaram veia circunflexa da escápula dupla. O ramo para o músculo serrátil anterior foi único em todos os casos. Em 50% dos casos, o ramo angular da artéria toracodorsal foi visualizado e, em 25% deles, era proveniente do ramo para o músculo serrátil anterior. A distância entre a inserção do músculo e a entrada do pedículo neurovascular variou entre 1,1 e 1,9 cm em fetos de 21 e 26 semanas, respectivamente. Todos os fetos apresentaram a margem anterior do músculo na linha axilar média. Conclusão: A morfometria constante e a reduzida variação anatômica do pedículo vascular encontradas possibilitam a realização de pesquisas envolvendo o uso do MLD em reconstruções cirúrgicas intraútero.

Introduction: The latissimus dorsi muscle (LDM) is a flat triangular muscle which extends, adducts and draws the arm medially. Its blood supply is from the thoracodorsal vessels and the perforating branches of the posterior intercostal and lumbar arteries, therefore, it is a type V flap variety, which has great applicability in plastic surgery. This study aims to analyze the morphometry and the vascularization of MLD in human fetuses. Methods: The axillary region and LDM of eight human fetuses (3 females, 5 males), between 20 and 32 weeks of gestational ages, were dissected in supine position with complete abduction of the arm. The subscapular and thoracodorsal vessels lengths were measured and the morphology of the muscle was studied. Results: In all fetuses, the dominant vascular pedicle of LDM was the thoracodorsal vessels. In 25% of cases the subscapular vein was tributary of the axillary vein. Double circumflex scapular vein were found in 25% of the cases. In all fetuses, the serratus anterior branch was unique. In 50% of the cases the angular branch of the thoracodorsal artery was found, 25% of them were from the serratus anterior branch. The length between its insertion and the entry of the neurovascular pedicle was 1.1 to 1.9 cm in fetuses of 21 and 26 weeks, respectively. In all fetuses, the anterior border of the muscle was at the mid-axillary line. Conclusion: The constant morphometry and reduced anatomical variation of the vascular pedicle enables new studies regarding the use of LDM in surgical reconstructions in utero.

The common fibular nerve (and its branches) in fetuses / El nervio fibular comun (y sus ramos) en fetos

The common fibular nerve (CFN), is a branch of the sciatic nerve (SN) that exits the popliteal fossa and is located at the tuberculum of the fibula. At the tuberculum of the fibula, the CFN bifurcates into deep (DFN) and superficial (SFN) fibular nerves. Forty fetuses were micro-dissected to (i) describe the course of the CFN in relation to the tuberculum and neck of the fibula in fetuses; (ii) describe the branches, distribution and relation of the DFN and SFN to muscles within the anterolateral compartment of the leg. The CFN, DFN and SFN were present in all specimens dissected; the CFN measured a mean length (mm) of 16.03 and 16.69 on the right and left sides respectively. Bifurcation of the CFN related to the tuberculum of fibula (right; left) - above 20/80 (25%); 14/80 (17.5%); below 6/80 (7.5%); 10/80 (12.5%) and at the tuberculum 54/80 (67.5%); 56/80 (70%). The DFN bifurcated into medial and lateral branches in 68/80 (85%) and 54/80 (67.5%) on the right and left sides, respectively. The SFN bifurcated into a medial branch in 78/80 (97.5%) and 76/80 (95%) on right and left sides, respectively and a lateral branch in 78/80 (97.5%) and 76/80 (95%) on right and left sides, respectively. The course and distribution of the CFN, DFN and SFN were consistent with the literature reviewed and descriptions found in standard anatomical textbooks. However, our findings show that the DFN has a variable number of branching patterns, which is unique to this fetal study and an intermediate branch of the SFN which was recorded in 3/80 cases.

El nervio fibular común (NFC), es un ramo del nervio isquiático (NI) que sale de la fosa poplítea y se ubica a nivel de la cabeza de la fíbula. A ese nivel, el NFC se bifurca en los nervios fibular profundo (NFP) y superficial (NFS). Cuarenta fetos fueron micro disecados para (i) describir el curso del NFC en relación con la cabeza y cuello de la fíbula en fetos; (ii) describir los ramos, distribución y relación del NFP y NFS con los músculos dentro del compartimento anterolateral de la pierna. El NFC, NFP y NFS estuvieron presentes en todos los especímenes disecados; el NFC presentó una longitud promedio de 16,03 y 16,69 (mm) en el lado derecho e izquierdo, respectivamente. La bifurcación del NFC se relacionó con la cabeza de la fíbula del lado derecho e izquierdo: por encima en 25% y 17,5%; por debajo 7,5% y 12,5 % y a nivel de la cabeza en 67,5 % y 70%. El NFP se bifurcó en ramos medial y lateral en un 85% en el lado derecho y 67,5% en el izquierdo. El NFS se bifurcó en una ramo medial en el 97,5% y 95% en los lados derecho e izquierdo, respectivamente, y un ramo lateral en el 97,5% y 95% del lados derecho e izquierdo, respectivamente. El curso y distribución del NFC, NFP y NFS coincidieron con la literatura revisada y textos de anatómia normal. Sin embargo, observamos que el NFP tiene un número variable de patrones de ramificación, único para este estudio fetal y un ramo intermedio del NFS que fue visto en 3/80 casos.

Morphological characterization of the nasopalatine region in human fetuses and its association to pathologies

The nasopalatine region is composed of structures such as the vomeronasal organ and nasopalatine duct. The nasopalatine duct may provide the communication of the mouth to the nasal cavity in human fetuses and can be obliterated in an adult human. Knowledge on the development of the nasopalatine region and nasopalatine duct in humans is necessary for understanding the morphology and etiopathogenesis of lesions that occur in this region. Objective The aim of the present study was to describe the morphological aspects of the nasopalatine region in human fetuses and correlate these aspects with the development of pathologies in this region. Material and Methods Five human fetuses with no facial or palatine abnormalities were used for the acquisition of specimens from the nasopalatine region. After demineralization, the specimens were histologically processed. Histological cuts were stained with methylene blue to orient the cutting plane and hematoxylin-eosin for the descriptive histological analysis. Results The age of the fetuses was 8.00, 8.25, 9.00 and 9.25 weeks, and it was not possible to determine the age in the last one. The incisive canal was observed in all specimens as an opening delimited laterally by the periosteum and connecting oral and nasal cavity. The nasopalatine duct is an epithelial structure with the greatest morphological variation, with either unilateral or bilateral occurrence and total patent, partial patent and islet forms. The vomeronasal organ is a bilateral epithelized structure located alongside the nasal septum above the incisive canal in all the fetuses. Conclusions The incisive canal, nasopalatine duct and vomeronasal organ are distinct anatomic structures. The development of nasopalatine duct cysts may occur in all forms of the nasopalatine duct. .