[Anatomical and surgical study of the medial calcaneus branch of the tibial nerve]. / Etude anatomique du rameau calcanéen médial du nerf tibial à la cheville.

To better understand the anatomical variations of the medial calcaneus branch, the tibia nerve were dissected in 20 ankles of fresh black African cadavres. The medial calcaneus branch which is a collateral branch of tibial nerve was constant. It was unique in 80% of cases and was detaching itself from the trunck of the tibial nerve ot the entrance of the calcaneal sulcus. It was in the form of two small nerves with point of departure from the common tibial nerve trunk. These anatomic constatations confronted with those published in literature permits us to understand the etiopathogenic aspects of certain neuropathies of the ankles. To add this they impose a certain order if precaution in the operational surgnical route of the posterior section of the ankle.

[Anatomical and surgical study of the medial calcaneus branch of tibial nerve]. / Etude anatomique du rameau calcanéen médial du nerf tibial à la cheville.

To better understand the anatomical variations of the medial calcaneus branch, the tibia nerve were dissected in 20 ankles of fresh black African cadavers. The medial calcaneus branch which is a collateral branch of tibial nerve was constant. It was unique in 80% of cases and was detaching itself from the trunk of the tibial nerve at the entrance of the calcaneal sulcus. It was in the form of two small nerves with point of departure from the commun tibial nerve trunk. These anatomic constatations confronted with those published in literature permits us to understand the etiopathogenic aspects of certain neuropathies of the ankle. To add this they impose a certain order if precautions in the operational surgical route of the posterior section of the ankle.

[Emergence and course of the ilioinguinal nerve of the groin]. / Emergence et trajet du nerf ilio-inguinal à l'aine.

The aim of our study was to find a way of preserving the ilioinguinal nerve during surgical procedures for the repair of inguinal hernias. 40 inguinal regions were dissected, 37 ilio-inguinal nerves studied. The emergence of the nerve was at 4.21 cm of the anterior superior iliac spine, at 0.78 cm of the inguinal ligament on average. Its course was parallel to the inguinal ligament, always lay under the aponevrosis of the external oblique abdominal muscle, it passed through the superficial abdominal ring in 67.56% before proceeding on anterior side of spermatic cord. This result allowed us to examine the possibility of the nerve course variation's, of anastomosis with iliohypogastric nerve and particularly the best way to identify it when surgical procedures are performed in the lower portion of the abdomen.

The artery of the atrioventricular node: an anatomic study based on 38 injection-dissections.

The origin and course of the artery of the atrioventricular node (AAVN) was studied in 45 anatomic specimens by the method of injection-dissection in 38 human hearts removed at medicolegal autopsies from black Senegalese subjects. Though sometimes double, the AAVN is classically solitary. Its coronary origin, which is always distal, occurred on the right side in the great majority of cases, at the level of the "U-turn of James", and on the left side at the level of the terminal portion of the circumflex a. At the level of Koch's triangle, its course is marked by a close relationship with the zone of attachment of the septal cusp of the right atrioventricular valve on the one hand, and with the orifice of the coronary sinus on the other. In cardiac surgery, respect for the area of Koch's triangle, the base of the interatrial septum and the region of the intersection of the cardiac sulci will reduce the risks of injury to the AAVN.

The artery of the sinuatrial node: anatomic considerations based on 45 injection-dissections of the heart.

The origin, course and mode of termination of the artery of the sinuatrial node was studied in 45 anatomic specimens by injection-dissection. It was solitary in 88.89% of the cases and double in 11.11%. It arose from the right coronary a. in 64.45% of cases, from the left coronary a. in 24.44%, and from both in 11.11%. The side of origin was not significantly influenced by the coronary dominance. When it arose from the right coronary a., the course of the sinuatrial a. varied greatly with its site of origin from the coronary vessel, either from an atrial a. or from one of its collateral branches, and also depended on its relations with the interatrial septum. When it arose from the left coronary a., its course was relatively uniform, except for arteries arising from the inferior atrial aa., which characteristically involve the posterior wall of the left atrium. Three modes of termination were found: precaval, retrocaval, and in a pericaval arterial circle. These observations made it possible to understand the possible origin of disorders of rhythm observed following disturbance of the arterial supply to the sinuatrial node during certain stages of cardiac surgery, particularly during atriotomies and the surgical correction of certain valvular disorders and congenital malformations, which expose the a. of the sinuatrial node.

[Arterial vascularization of the sinoatrial and atrioventricular node (preliminary study apropos of 15 anatomic parts]. / Vascularisation artérielle du noeud sino-atrial et atrio-ventriculaire (étude préliminaire à propos de 15 pièces anatomiques).

Arterial supply to the sino-atrial and atrioventricular node is studied after coronary RHODOPAS injection on 15 adult hearts taken off during autopsy. Both coronaries were injected in 7 cases, left ostium in 2 cases and the right on in 6 cases. The sino-atrial node is supplied by the right sino atrionodal artery (S.A.N.A) in 6 cases upon 7 and in 3 cases by the left S.A.N.A. Anastomoses exist in 2 cases between the right S.A.N.A. and the left S.A.N.A. The atrio-ventricular nodal artery arises from the retro-ventricular trunk branching from the right coronary artery mainly. The authors emphasize that care must be taken to protect the vascular supply to the conduction tissue during cardiac surgery.

[Anatomy of coronary arteries]. / Anatomie des artères coronaires.

To study the coronary arteries we collected 200 black african hearts which coronaries have been injected with Rhodopast then corroded. Most of the arteries (74.10%) originate from two separate sinuses one on the left and the other one on the right. The right coronary artery runs in two different modes. In one mode it is short and ends in different branches. In the other mode it is long and runs up to the crux. The left coronary artery arrives on the left border of the heart and gives the circumflex and the left border artery. The bifurcation mode of division was 32.25% for the right coronary artery and 69.35% for the left coronary artery which had à trifurcation in 36.66%. The superior atrial artery was not seen in 3 cases and the infundibular arteries derived from the aorta in 3 cases. We have encountered intercoronary anastomoses in 82.6% of cases. These results are similar to these observed in the literature. The only difference is on the rich intercoronary anastomosis which seems to be an african particularity even though we cannot establish if they are functional or not.

[Anatomic bases of the surgical approach to the carpal tunnel. A propos of 50 dissections]. / Bases anatomiques de la voie d'abord chirurgicale du canal carpien. A propos de 50 dissections.

After a classic dissection of 50 wrists in black african cadavers, we have studied carpal tunnel anatomy for therapeutic deductions. By a wide anterior incision following the longitudinal axis of the third finger remounting the inferior third of the forearm we studied both the anatomical limits specially the transcarpal ligament, the volare carpal ligament and also median nerve and flexores digitorum tendons. We have observed in 2 cases an ectopic second lumbrical muscle inside the carpal tunnel; we found numerous variations of the collateral and terminal branches of median nerve; we concluded that it is difficult to definitively establish the cartography of the terminal branches of median nerve. However our anatomical observations allowed us to choose larger and more medial surgical approach of the carpal tunnel to avoid the following complications: incomplete section of the carpal ligament, damages of collateral branches of median nerve, dislocation of flexor tendons of index and middle fingers, ignorance of anomalous muscle.

[Anatomic study of the anterior interventricular artery (Ramus interventricularis anterior). Apropos of 200 anatomical samples]. / Etude anatomique de l'artère interventriculaire antérieure (ramus interventricularis anterior) a propos de 200 pièces anatomiques.

The coronary system has been studied on the basis of 200 hearts taken during necropsies and treated by injection of a synthetic resin followed by corrosion. Sixty samples were used for the study of the L.A.D. and one hundred and fifty were used for studying intercoronary anastomosis on L.A.D. The study highlighted the following particularities: the left coronary is the most common origin of L.A.D. (90 per cent cases); the L.A.D. irrigates: all the left ventricle ventral wall, the right apical part of both ventricles and the upper portion of the interventricular septum; out of 92 anastomoses, 49 were located on the L.A.D. which could protect against ischemia.

[Docimological analysis of the anatomy test for the PCEMII final exam in Dakar]. / Analyse docimologique de l'épreuve d'anatomie à l'examen final du PCEMII à Dakar.

This docimological analysis is based on computer treatment of the results of the anatomy exam for the two sessions of July (159 candidates) and October (56 candidates) of the identification questions, discrimination questions, coupling (paining), grouping, association and diagram labelling. The results were appraised following certain parameters: the gross score revealed a rather low average score for the whole class (14.57 and 9.57 over 30): the low success rate in July and the average figure of October indicate, in general, either the difficulty of the questions for the students or a bad reception of the message; the bad discrimination index, since only 21% of the questions are of the discriminatory type. This finding pointed to a revision of 50 of the 68 questions of July and 53 of the 68 questions of October. On the whole, only 15 questions, over the two sessions, could have been kept unchanged for an eventual bank (stock of data): The correlation coefficient has showed a significant relation between success in the anatomy subject and success in the PCEM2 exam. This work has showed the possibilities that computers may offer in the teaching of anatomy and the evaluation of students. Besides, it emphasizes the importance of the anatomy grade in the PCEM2 exam. Finally, the mode evaluation used help exploring the various levels of the cognitive areas (memorization, interpretation of data, problem-solving) and to build up a bank of anatomy questions.

[Anatomical and coronary angiography data on coronary anastomosis]. / Anastomoses coronariennes données anatomiques et coronarographiques.

Beyond two series of heart studies (anatomical with 150 hearts treated by injection-corosion method, and angiographic with 211 coronarography 3 days after a heart attack) the authors have noticed 92 coronary anastomosis with: 28 right homolateral 22 left homolateral 42 contralateral The existence of these anastomosis has been confirmed by coronarography of 30 out of 173 patients having a significant lesion of the artery responsible for the heart attack. The authors noticed also that these anastomosis are effective when the coronary system is deficient and the supplies are ensured by the other artery. The study permits to distinguish two groups of functional collateral: the functional collateral spontaneously observed during coronarography recruitable collaterals which are ready to be functional in case of main coronary artery obstruction.

[Apropos of a case of solitary left coronary artery]. / A propos d'un cas d'artère coronaire unique gauche.

The single coronary artery stems from the coronary ostium in one of the aortic Valsalva sinuses: no other coronary artery is present. On its own, it vascularized the whole myocardium. It is a very rare condition--0.36% according to anatomists. Anatomical study by injection-corrosion on 200 hearts at Dakar Medical Faculty's anatomical laboratory revealed only one case of single, left-hand coronary artery. It had come from a 45 year old adult killed in an accident, who, up to that time, had suffered no cardio-vascular pathology. The post-mortem showed no associated abnormality. This observation corresponds to Smith's type I anatomical classification. The trajectory followed the usual route for the left-hand coronary artery, and ended in a Y junction of the rear interventricular artery and the circumflex artery. No collateral branch flowed from it: its diameter was 5mm. Vascularization of the heart was provided for by branches proceeding from the rear interventricular and circumflex arteries.