Anatomical landmarks for ankle block.

We aimed to describe anatomical landmarks to accurately locate the five nerves that are infiltrated to accomplish anaesthesia of the foot in an ankle block. Twenty-four formaldehyde-fixed cadaveric ankles were studied. Photographs of cross sections of the frozen legs, cut at a horizontal plane across the most prominent points of the medial and lateral malleoli, were analysed. The curvilinear distance from the most prominent point of the closest malleolus to each of the five cutaneous nerves and their depth from the skin surface were measured. Sural, tibial, deep peroneal, saphenous and medial dorsal cutaneous nerves were located 5.2 ± 1.3, 9.2 ± 2.4, 7.4 ± 1.9, 2.8 ± 1.1, 2.1 ± 0.6 mm deep to the skin surface. The curvilinear distances from the medial malleolus to the tibial, deep peroneal and saphenous nerves were 32.5 ± 8.9, 62.8 ± 11.1 and 24.4 ± 7.9 mm, respectively. The curvilinear distances from the lateral malleolus to the sural and medial dorsal cutaneous branches of superficial peroneal nerves were 27.9 ± 6.3 and 52.7 ± 7.3 mm, respectively. The deep peroneal nerve was found between the tendons of the extensor hallucis longus and the extensor digitorum longus in the majority of specimens, while the medial dorsal cutaneous nerve was almost exclusively found on the extensor digitorum longus tendon. The sural and tibial nerves were located around halfway between the most prominent point of the relevant malleolus and the posterior border of the Achilles tendon. In conclusion, this study describes easily identifiable, palpable bony and soft tissue landmarks that could be used to locate the nerves around the ankle.

Morphological variations of the human ejaculatory ducts in relation to the prostatic urethra.

Loss of ejaculation can follow transurethral resection of the prostate (TURP). Periverumontanal prostate tissue is preserved in ejaculation-preserving TURP (ep-TURP). Knowledge of ejaculatory duct anatomy in relation to the prostatic urethra can help in ep-TURP. This was evaluated in cross-sections of the prostate using a 3 D model to determine a safe zone for resecting the prostate in ep-TURP. A 3 D reconstruction of the ejaculatory ducts was developed on the basis of six prostate gland cross-sections. The measurements obtained from the 3 D model were standardized according to the maximum width of the prostate. Simple linear regressions were used to predict the relationships of the ejaculatory ducts. The maximum widths of the prostates ranged from 22.60 to 52.10 mm. The ejaculatory ducts entered the prostate with a concavity directed posterolaterally. They then proceeded toward the seminal colliculus in a fairly straight course, and from that point they angulated anteromedially. As they opened into the prostatic urethra they diverged. Significant regression models predicted the relationships of the ejaculatory ducts to the prostatic urethra based on the sizes of the prostates. The 3 D anatomy of ejaculatory ducts can be predicted on the basis of prostate width. The ejaculatory ducts can be preserved with 95% accuracy if a block of tissue 7.5 mm from the midline on either side of the seminal colliculus is preserved, up to 10 mm proximal to the level of the seminal colliculus, during TURP. Clin. Anat. 31:456-461, 2018. © 2017 Wiley Periodicals, Inc.

Anatomy of Teaching Anatomy: Do Prosected Cross Sections Improve Students Understanding of Spatial and Radiological Anatomy?

Introduction. Cadaveric dissections and prosections have traditionally been part of undergraduate medical teaching. Materials and Methods. Hundred and fifty-nine first-year students in the Faculty of Medicine, University of Colombo, were invited to participate in the above study. Students were randomly allocated to two age and gender matched groups. Both groups were exposed to identical series of lectures regarding anatomy of the abdomen and conventional cadaveric prosections of the abdomen. The test group (n = 77, 48.4%) was also exposed to cadaveric cross-sectional slices of the abdomen to which the control group (n = 82, 51.6%) was blinded. At the end of the teaching session both groups were assessed by using their performance in a timed multiple choice question paper as well as ability to identify structures in abdominal CT films. Results. Scores for spatial and radiological anatomy were significantly higher among the test group when compared with the control group (P < 0.05, CI 95%). Majority of the students in both control and test groups agreed that cadaveric cross section may be useful for them to understand spatial and radiological anatomy. Conclusion. Introduction of cadaveric cross-sectional prosections may help students to understand spatial and radiological anatomy better.

Partial heat acclimation of athletes with spinal cord lesion.

Heat acclimation (HA) can improve thermoregulatory stability in able-bodied athletes in part by an enhanced sweat response. Athletes with spinal cord lesion are unable to sweat below the lesion and it is unknown if they can HA. Five paralympic shooting athletes with spinal cord lesion completed seven consecutive days HA in hot conditions (33.4 ± 0.6 °C, 64.8 ± 3.7 %rh). Each HA session consisted of 20 min arm crank exercise at 50 % [Formula: see text] followed by 40 min rest, or simulated shooting. Aural temperature (T (aur)) was recorded throughout. Body mass was assessed before and after each session and a sweat collection swab was fixed to T12 of the spine. Fingertip whole blood was sampled at rest on days 1 and 7 for estimation of the change in plasma volume. Resting T (aur) declined from 36.3 ± 0.2 °C on day 1 to 36.0 ± 0.2 °C by day 6 (P < 0.05). During the HA sessions mean, T (aur) declined from 37.2 ± 0.2 °C on day 1, to 36.7 ± 0.3 °C on day 7 (P < 0.05). Plasma volume increased from day 1 by 1.5 ± 0.6 % on day 7 (P < 0.05). No sweat secretion was detected or changes in body mass observed from any participant. Repeated hyperthermia combined with limited evaporative heat loss was sufficient to increase plasma volume, probably by alterations in fluid regulatory hormones. In conclusion, we found that although no sweat response was observed, athletes with spinal cord lesion could partially HA.

An anatomic basis for volumetric evaluation of the neck.

BACKGROUND: A better understanding of volume distribution between the superficial (subcutaneous) and deep (subplatysmal) planes of the neck may be useful when deciding on the best course of management for patients presenting for cervical contouring. OBJECTIVES: The authors investigate the normal distribution of fat in the superficial and deep planes of the neck in a cadaver model, to determine the proportion of the submandibular gland that contributes to submental fullness. METHODS: Fat in the superficial and deep neck planes of 29 adult cadavers was dissected and weighed. The submandibular glands were also dissected and the cervical portion of each gland was shaved off, weighed, and compared to the weight of the whole gland. RESULTS: The mean weight of superficial fat collected from the specimens was 15.0 g in males (n = 14; range, 2.2-35.7 g) and 14.3 g in females (n = 15; range, 1.6-37.3 g); the mean weight of subplatysmal fat was 5.5 g in males (range, 1.3-15.2 g) and 3.7 g in females (range, 0.6-15.1 g). Mean weight was not statistically significantly different between the sexes, nor between the 2 racial/ethnic groups (Caucasian, n = 14; Southeast Asian, n = 15). Approximately 40% of the submandibular gland was found to lie inferior to the lower border of the mandible in the specimens examined. The authors found no anatomical evidence of submandibular gland ptosis, even in the oldest specimens. CONCLUSIONS: The study provides a comprehensive analysis of the distribution of adipose tissue in the superficial and deep planes of the neck, as well as the contribution of the submandibular glands to submental volume. This objective evaluation of neck volume may help guide clinicians in the surgical planning process and provide a foundation for designing new cervicofacial rejuvenation techniques.

Development of a high pressure automated lag time apparatus for experimental studies and statistical analyses of nucleation and growth of gas hydrates.

Nucleation in a supercooled or a supersaturated medium is a stochastic event, and hence statistical analyses are required for the understanding and prediction of such events. The development of reliable statistical methods for quantifying nucleation probability is highly desirable for applications where control of nucleation is required. The nucleation of gas hydrates in supercooled conditions is one such application. We describe the design and development of a high pressure automated lag time apparatus (HP-ALTA) for the statistical study of gas hydrate nucleation and growth at elevated gas pressures. The apparatus allows a small volume (≈150 µl) of water to be cooled at a controlled rate in a pressurized gas atmosphere, and the temperature of gas hydrate nucleation, T(f), to be detected. The instrument then raises the sample temperature under controlled conditions to facilitate dissociation of the gas hydrate before repeating the cooling-nucleation cycle again. This process of forming and dissociating gas hydrates can be automatically repeated for a statistically significant (>100) number of nucleation events. The HP-ALTA can be operated in two modes, one for the detection of hydrate in the bulk of the sample, under a stirring action, and the other for the detection of the formation of hydrate films across the water-gas interface of a quiescent sample. The technique can be applied to the study of several parameters, such as gas pressure, cooling rate and gas composition, on the gas hydrate nucleation probability distribution for supercooled water samples.

Heat acclimation improves intermittent sprinting in the heat but additional pre-cooling offers no further ergogenic effect.

The aim of this study was to determine the effect of 10 days of heat acclimation with and without pre-cooling on intermittent sprint exercise performance in the heat. Eight males completed three intermittent cycling sprint protocols before and after 10 days of heat acclimation. Before acclimation, one sprint protocol was conducted in control conditions (21.8 ± 2.2°C, 42.8 ± 6.7% relative humidity) and two sprint protocols in hot, humid conditions (33.3 ± 0.6°C, 52.2 ± 6.8% relative humidity) in a randomized order. One hot, humid condition was preceded by 20 min of thigh pre-cooling with ice packs (-16.2 ± 4.5°C). After heat acclimation, the two hot, humid sprint protocols were repeated. Before heat acclimation, peak power output declined in the heat (P < 0.05) but pre-cooling prevented this. Ten days of heat acclimation reduced resting rectal temperature from 37.8 ± 0.3°C to 37.4 ± 0.3°C (P < 0.01). When acclimated, peak power output increased by ∼2% (P < 0.05, main effect) and no reductions in individual sprint peak power output were observed. Additional pre-cooling offered no further ergogenic effect. Unacclimated athletes competing in the heat should pre-cool to prevent reductions in peak power output, but heat acclimate for an increased peak power output.

Type I antifreeze proteins enhance ice nucleation above certain concentrations.

In this study, we examined the effects that antifreeze proteins have on the supercooling and ice-nucleating abilities of aqueous solutions. Very little information on such nucleation currently exists. Using an automated lag time apparatus and a new analysis, we show several dilution series of Type I antifreeze proteins. Our results indicate that, above a concentration of ∼8 mg/ml, ice nucleation is enhanced rather than hindered. We discuss this unexpected result and present a new hypothesis outlining three components of polar fish blood that we believe affect its solution properties in certain situations.

Fluorescence spectra in lung with porphyrin injection.

The fluorescence emission spectra from human bronchial mucosa and tumors, before and after injection of dihematoporphyrin ether/ester, have been measured with an optical multichannel analyzer from 500 to 750 nm. Fluorescence was excited with a violet krypton ion laser (average wavelength 410 nm). The autofluorescence spectra decrease monotonically with increasing wavelength except for a small broad peak near 600 nm. The spectra from tumor sites, after injection of the fluorescent porphyrin, exhibit the characteristic fluorescence emission at 630 and 690 nm, added to the autofluorescence spectrum. The spectra from control or nontumor sites are similar but the magnitude of the component due to the injected porphyrin is smaller than at a tumor site. The magnitude ratio of tumor to control site fluorescence depends on concentration of the porphyrin, tumor thickness, and time after injection. Autofluorescence degrades contrast and thus makes very thin tumors difficult to image. Subtraction of the autofluorescence background is desirable.