"Near-TME": proposed standardisation of the technique for proctectomy in male patients with ulcerative colitis.

BACKGROUND: The aim of the present study was to describe in detail an approach to proctectomy in ulcerative colitis (UC), which can be standardized; near-total mesorectal excision (near-TME), to prevent injuries to autonomic pelvic nerves and subsequent sexual dysfunction. METHODS: We demonstrate the technique ex vivo on a cadaver from a male patient in lithotomy position and on a sagittal section of a male pelvis. We also demonstrate the technique in vivo in two male patients diagnosed with UC, with no history of sexual dysfunction or bowel neoplasia. The study was performed at the Human Embryology and Anatomy Department. University of Valencia, Spain. RESULTS: The posterolateral dissection during a near-TME is similar to that of an oncologic TME, whereas the anterolateral is similar to that of a close rectal dissection. The near-TME technique preserves the superior hypogastric plexus, the hypogastric nerves, the nervi erigentes, the inferior hypogastric plexus, the pelvic plexus and the cavernous nerves. CONCLUSION: The near-TME technique is the standardisation of the technique for proctectomy in male patients with ulcerative colitis. Near-TME requires experience in pelvic surgery and an exhaustive knowledge of the embryological development and of the surgical anatomy of the pelvis.

Prevalence and morphometric analysis of the retromolar canal in a Spanish population sample: a helical CT scan study.

BACKGROUND: The retromolar canal (RMC) is an anatomical variation of the mandibular canal (MC) whose identification and study should be considered given its implication in the surgical procedures of the retromolar area. The prevalence of the RMC widely varies according to previous studies and may be influenced by the followed study method. This work aimed to evaluate the prevalence of the RMC in a Spanish population sample. MATERIAL AND METHODS: For this purpose, 225 CT scan images (with a higher resolution than the cone beam CT used in other previous studies) from the Hospital Clínico Universitario de Valencia were analyzed. The Osirix MD® radiological image analysis system was applied to analyse the dimensions, location in the retromolar area and morphologic characteristics of the RMC by classifying them according to their typology. Furthermore, the relations between the RMC and gender, age and laterality were studied. RESULTS: RMC prevalence was 23.1%. No significant relation between the presence of the canal and gender, age or laterality was found. Type Ia was the commonest type with a prevalence of 40.8%. CONCLUSIONS: Based on the results of this study, the RMC should be considered a frequent anatomical variation whose complete study is very important in daily clinical practice.

Percutaneous Trapeziometacarpal Arthrodesis in Thumb Carpometacarpal Joint Arthritis: A New Surgical Approach.

The high prevalence of trapeziometacarpal arthritis has resulted in the development of several surgical techniques intended to treat patients failing conservative treatment. However, there is no scientific evidence of the superiority of one technique over others. Open arthrodesis has up to now been successfully used to treat this condition. We believe that performing the technique using a minimally invasive approach with long and short Shannon burrs together with the tapered burr included in the MIS foot instrument set can yield satisfactory results. This article provides a description of this minimally invasive technique performed on a seventy-year-old woman with rhizarthrosis and an anatomical description of the approach in a human cadaver.

Temporomandibular joint arthrocentesis guided by ultrasonography: An anatomical study.

The temporomandibular joint (TMJ) arthrocentesis is a common procedure in maxillofacial surgery departments for the treatment of TMJ dysfunction. The use of ultrasonography in this area is rare, and in the vast majority of cases only as a diagnostic, and non-therapeutic use. Through this study we propose the equipment and ultrasound parameters necessary to obtain detailed and practical images when using ultrasonography as a therapeutic guide in arthrocentesis of TMJ. In addition, we provide data regarding the placement and working angulations of both the ultrasound probe and the needle that are ideal for facilitating image-guided puncture. It is a simple technique, with a relatively short learning curve, and that can provide considerable intraoperative help to the surgeon.

Morphologic variations in the pineal gland of the albino rat after a chronic alcoholisation process.

We studied the effect of alcohol on the pineal gland of 48 male Wistar rats. Animals were divided into control and experimental groups. The experimental group underwent a previous progressive alcoholisation period with ethanol diluted in water at a concentration of 40%. Animals were sacrificed at 3, 6, 9 and 12 months, and the ultrastructure, karyometric indices, and number of synaptic bodies in the pineal gland were analysed. The results showed progressive morphologic alterations in the ethanol-treated animals, which culminated in fatty degeneration of the pineal parenchyma after 6 months. The karyometric indices decreased in both the central and peripheral areas compared with the control group. Moreover, the seasonal rhythmicity observed in the controls disappeared in the experimental groups, whose number of different populations of synaptic bodies (synaptic ribbons and synaptic spherules) considerably lowered with inversion of their normal seasonal rhythm. These results support that chronic alcoholisation leads to fatty degeneration of the pineal parenchyma, and a considerable alteration in nuclear functional rhythms and synaptic bodies.

Propuesta de metodología docente en vía aérea difícil. Presentación de un modelo interactivo de cadáver fresco congelado / Proposed difficult airway teaching methodology. Presentation of an interactive fresh frozen cadaver model

Antecedentes y objetivo. El objetivo del trabajo es presentar una metodología basada en el empleo de los cadáveres frescos congelados para el entrenamiento de las habilidades en el tratamiento de la vía aérea y presentar el grado de satisfacción entre los alumnos. Material y métodos. Sobre 6 cadáveres frescos congelados se estructuraron 14 estaciones de trabajo en las que los alumnos entrenaron las diferentes habilidades necesarias para el tratamiento de la vía aérea. Se explican los detalles de preparación de los cadáveres que resultan fundamentales para un adecuado trabajo. Se evaluó el grado de satisfacción de los alumnos mediante la escala de evaluación de Likert de 5 puntos sobre las 14 estaciones, la valoración global y la utilidad clínica del curso. Resultados. La valoración global y la utilidad media del curso fueron de 4,75 y 4,9 sobre 5, respectivamente. Todas las partes del curso fueron valoradas por encima de 4 sobre 5. La elevada satisfacción sobre el curso se mantuvo homogénea en las 2 ediciones analizadas. La satisfacción global del curso no fue definitiva e unívocamente determinada por ninguna de sus partes en especial. Conclusión. El modelo de cadáver fresco para el entrenamiento de los médicos en técnicas de manejo de la vía aérea constituye una propuesta docente satisfactoria para el alumno, y con un realismo que se aproxima al paciente vivo (AU)

Background and objective. The aim of this paper is to present a methodology based on the use of fresh-frozen cadavers for training in the management of the airway, and to evaluate the degree of satisfaction among learning physicians. Material and methods. About 6 fresh-frozen cadavers and 14 workstations were prepared where participants were trained in the different skills needed for airway management. The details of preparation of the cadavers are described. The level of satisfaction of the participant was determined using a Likert rating scale of 5 points, at each of the 14 stations, as well as the overall assessment and clinical usefulness of the course. Results. The mean overall evaluation of the course and its usefulness was 4.75 and 4.9, out of 5, respectively. All parts of the course were rated above 4 out of 5. The high level of satisfaction of the course remained homogeneous in the 2 editions analysed. The overall satisfaction of the course was not finally and uniquely determined by any of its particular parts. Conclusion. The fresh cadaver model for training physicians in techniques of airway management is a proposal satisfactory to the participant, and with a realism that approaches the live patient (AU)

[Proposed difficult airway teaching methodology. Presentation of an interactive fresh frozen cadaver model]. / Propuesta de metodología docente en vía aérea difícil. Presentación de un modelo interactivo de cadáver fresco congelado.

BACKGROUND AND OBJECTIVE: The aim of this paper is to present a methodology based on the use of fresh-frozen cadavers for training in the management of the airway, and to evaluate the degree of satisfaction among learning physicians. MATERIAL AND METHODS: About 6 fresh-frozen cadavers and 14 workstations were prepared where participants were trained in the different skills needed for airway management. The details of preparation of the cadavers are described. The level of satisfaction of the participant was determined using a Likert rating scale of 5 points, at each of the 14 stations, as well as the overall assessment and clinical usefulness of the course. RESULTS: The mean overall evaluation of the course and its usefulness was 4.75 and 4.9, out of 5, respectively. All parts of the course were rated above 4 out of 5. The high level of satisfaction of the course remained homogeneous in the 2 editions analysed. The overall satisfaction of the course was not finally and uniquely determined by any of its particular parts. CONCLUSION: The fresh cadaver model for training physicians in techniques of airway management is a proposal satisfactory to the participant, and with a realism that approaches the live patient.

Influence of light/dark, seasonal and lunar cycles on the nuclear size of the pinealocytes of the rat.

Morphological and physiological studies suggest a possible division of the pineal parenchyma into an external or "cortical" and another central or "medullar" layer. We have studied the possible influence of the light/dark, seasonal and lunar cycles on the nuclear size of the pinealocytes of the rat in both the hypothetical "cortical" and "medullar" layers. Forty male Wistar rats were used. Experiment was carried out in two seasons, winter and spring, two lunar phases, full moon and new moon, and the two circadian phases, photophase and scotophase. The nuclear volume of the pinealocytes, calculated from the Jacobj's formula, was the karyometric parameter used as measurement of the nuclear size. Main results showed that nuclear volume of the cortical pinealocytes was greater than that of the medullar pinealocytes only during the photophases of winter new-moon days and spring full moon days, whereas in all the remaining situations, the greater nuclear sizes were found in the pinealocytes of the medullar layer. These results support the existence of independent morphological variations of the pinealocyte in the central and peripheral zones of the pineal gland.

Influence of light/dark, seasonal and lunar cycles on serum melatonin levels and synaptic bodies number of the pineal gland of the rat.

Synaptic bodies (SB) are ultrastructural organelles observed in the pinealocytes of mammals. According to its shape, they have been classified into synaptic ribbons (SR), synaptic spherules (SS), and intermediate synaptic bodies (ISB). They have been related to the melatonin regulation and production mechanisms of the pineal gland. Circadian and circannual fluctuations of both melatonin and SB have been reported. The possibility that other external factors, apart from light-dark or seasonal cycles, might influence pineal function has been suggested. We studied the evolution of the number of SB and serum melatonin levels not only during light-dark and seasonal phases but also during lunar cycles. Forty male wistar rats were used. Experiment was first carried out in winter and repeated identically in spring. Each season, one group of animals was killed during the new-moon days and a second group during the full-moon days: half of both groups in the photophase and the other half in the scotophase. The number of SB was measured at electron microscopic level whereas serum melatonin levels were determined by radioimmunoassay techniques. Main results showed that SR number and serum melatonin levels were higher during scotophases, winter and full-moon days. The SS only showed a light predominance during winter, whereas predominance of the ISB was found only during the scotophases. These results support the influence of the photophasic factors on the SR and ISB variations. In the case of the SS the influence of the lunar cycles is always dependent on the other factors. Finally, the serum level of melatonin is clearly influenced by the photophasic rhythms and the seasonal periods but not by the lunar cycles.

The chemical architecture of the rat's periaqueductal gray based on acetylcholinesterase histochemistry: a quantitative and qualitative study.

The chemoarchitecture of the periaqueductal gray has been extensively studied, based on acetylcholinesterase reaction and comparing it to other chemical markers. We have divided the periaqueductal gray into four main longitudinal columns, namely dorsomedial, dorsolateral, lateral and ventrolateral. We also identified the dorsal midline column, the supraoculomotor cap and the juxta-aqueductal ring. The acetylcholinesterase gave rise to a strong reaction in the outer half of the lateral column, the outer half of the dorsomedial column, the supraoculomotor cap and the ventral half of the juxta-aqueductal ring. This labeling was in part complementary to that of the NADPH diaphorase and allowed the lateral column to be differentiated from the ventrolateral column. However, the inner half of both lateral and ventrolateral columns displayed the same chemical properties including acetylcholinesterase, tyrosine hydroxilase and serotonin. Thus, from the chemical view, these inner halves should be considered as one different region. Finally, the juxta-aqueductal ring was composed of two clearly different halves, i.e. dorsal and ventral. The dorsal half did not show any clear differences from the above columns and was negative for acetylcholinesterase, NADPH diaphorase and tyrosine hydroxilase, while the ventral half was clearly different from the lateral and ventrolateral columns and displayed a positive reaction to all those chemical markers. From these results, we strongly suggest the use of acetylcholinesterase histochemistry as a tool for accurate parcellation of the periaqueductal gray.

[Activation of proto-oncogene c-fos in the auditory tract of rats stimulation with wide-band noise]. / La activación del protooncogén c-fos en la vía auditiva en ratas estimuladas con ruido de banda ancha.

The pattern of expression of the proto-oncogene c-fos was mapped in the auditory pathway of Wistar rats kept in three different experimental conditions: a) a dark, soundproofed room; b) with exposure to usual environmental laboratory noise, and c) with exposure to wide-band noise. Under control conditions (a and b), scattered labeled neurons were found in the ventral periolivary nucleus, lateral lemniscus nuclei, inferior colliculus, medial nucleus of the medial geniculate body, and in three divisions of the temporal auditory cortex. Sound stimulation (c) increased the number of fos-like-immunoreactive (FLI) nuclei in all the auditory pathway structures. FLI nuclei were strong in the dorsal cochlear nucleus, anterior and posterior ventral cochlear nuclei, all the superior olivary complex nuclei, lateral lemniscus nuclei, all areas of the inferior colliculus, medial geniculate body, and the three temporal auditory areas, which showed a barrel pattern. Comparison of these results with the literature indicated that fos activation is not merely a sign of transitory neural activation, but a long-term neural processing pathway that is conditioned by factors such as the frequency, intensity, duration, and direction of the auditory stimulus.

Distribution of basal-expressed c-fos-like immunoreactive cells of the periaqueductal grey matter of the rat.

The distribution of c-fos proto-oncogene expression has been studied in the periaqueductal grey matter (PAG) of non-intentional-stimulated rats by immunohistochemistry. A mean number of 53 +/- 9 Fos-like immunoreactive cells per hemiPAG, distributed into three groups, dorsolateral, lateral and ventrolateral, was found. The dorsolateral and the lateral groups appeared along the entire rostrocaudal PAG, whereas the ventrolateral group appeared only in the caudal half. These results reveal new data on the number and extent of the longitudinal columns within the hypothetical organization of the PAG. They also indicate a continuous activation of a significant population of neurones in the PAG, in agreement with the suggested role of the PAG in the modulation of internal information.