Rare variation in course and affluence of internal iliac vein due to its anatomical and surgical significance.

During regular dissection of the retroperitoneal region, three uncommon anatomical variations of the internal iliac veins were found on dissected specimens: in the first case, the internal iliac veins converge forming a common trunk draining into the left external iliac vein. In the other two cases, the internal iliac vein crosses the median plane and flows into the contralateral common iliac vein. These anomalies result from a persistence of the embryonic inferior branch of the cardinal vein and are important to be known for they may be undetected or may not appear in imaging. These data have implications for both pelvic surgeons and anatomists who manipulated this anatomical area.

Limitations of extracorporeal shockwave lithotripsy for lower caliceal stones: anatomic insight.

In addition to gravity-dependent position, we suppose that other particular anatomic features may be important in the retention of stone debris in lower calices after extracorporeal shockwave lithotripsy (SWL). We analyzed the inferior-pole collecting system anatomy in 146 three-dimensional polyester resin corrosion endocasts of the pelviocaliceal system. In 74% of the cases, there was an angle of greater than 90 degrees formed between the lower infundibulum and the renal pelvis, and in 26%, the angle was 90 degrees or less. In 60%, there was a lower infundibulum 4 mm or larger in diameter. The inferior pole was drained by multiple calices disposed in two rows in 57% of the cases and by one midline caliceal infundibulum in 43%. We believe that the physician must appreciate these anatomic features when considering SWL to treat calculi located in lower calices.

Intrarenal access: 3-dimensional anatomical study.

In an attempt to determine the best route to puncture and access the kidney collecting system we studied 62, 3-dimensional polyester resin endocasts of the pelvicaliceal system together with the intrarenal vessels. A retrograde pyelogram was obtained, and the arterial and venous trees were injected with red and blue resins, respectively. When the resin was still in the gel state, the kidneys were positioned at 30 to 45 degrees and the collecting system was punctured under radioscopy. Since the resin is not opaque to x-ray the operator was not able to visualize the vessels while puncturing. After puncture, the needle was maintained in place, the contrast medium was removed and the pelvicaliceal system was filled with yellow resin. After the resin had set, the renal organic matter was corroded in acid and the endocast was obtained (with the needle in the original position). This type of preparation allowed us to examine the needle tract and the vessels damaged during the puncture. In the same kidney we punctured the superior pole, mid kidney and inferior pole. In some cases we also punctured the renal pelvis. We performed 104 punctures through an infundibulum, 39 through a fornix of a calix and 12 through the renal pelvis. Due to a high percentage of vascular lesions, intrarenal access through an infundibulum should be avoided. Also, renal pelvis puncture should be avoided. Regardless of the kidney region, puncture through a fornix of a calix was safe.

Inferior pole collecting system anatomy: its probable role in extracorporeal shock wave lithotripsy.

In addition to the gravity-dependent position, we believe that other particular anatomical features may be important in the retention of stone debris in the lower calices after extracorporeal shock wave lithotripsy (ESWL). We analyzed the inferior pole collecting system anatomy in 146, 3-dimensional polyester resin corrosion endocasts of the pelviocaliceal system. The inferior pole was drained by multiple calices disposed in 2 rows in 56.8% of the cases and by 1 midline caliceal infundibulum in 43.2%. In 60.3% of the cases there was a lower infundibulum equal to or greater than 4 mm. in diameter and 39.7% had a lower infundibulum smaller than 4 mm. in diameter. In 74.0% of the cases an angle of greater than 90 degrees was formed between the lower infundibulum and the renal pelvis, and in 26.0% the angle was 90 degrees or smaller. We believe that the physician should consider these anatomical features when suggesting ESWL to treat calculi in the lower calices.

Anatomical relationship between the renal venous arrangement and the kidney collecting system.

The anatomical relationships between the renal venous arrangement and the pelviocaliceal system were studied in 52, 3-dimensional polyester resin corrosion endocasts. In 53.8% of the cases, there were 3 large venous trunks and in 28.8% there were 2 venous trunks joining to form the main renal vein. Intrarenal veins demonstrated free anastomoses that were disposed in 3 systems of longitudinal arcades (stellate, arcuate and interlobar veins). There were large venous collars around caliceal necks and also horizontal arches crossing over calices to link anterior and posterior veins. In 84.6% of the cases the upper caliceal group was encircled anteriorly and posteriorly by venous plexuses, which coursed parallel to the infundibulum. In 50.0% of the cases the lower caliceal group also was enriched by 2 venous plexuses. A close relationship existed between a large inferior tributary of the renal vein and the anterior aspect of the ureteropelvic junction in 40.4% of the cases. In 69.2% of the cases there was a posterior (retropelvic) vein: in 48.1% this vein had a close relationship to the junction of the pelvis with the upper calix and in 21.1% it crossed the middle posterior surface of the renal pelvis.

Allometric growth of the adrenal gland in Brazilian fetuses.

The growth of the adrenal gland was studied in 60 brazilian fetuses (12-37 weeks post-conception). The right adrenal gland was quantitatively evaluated; its weight, length and thickness were correlated to the fetal body weight, to the Crown-Pump length and to the gestational age by the allometric method (LogY = kLogX + LogB). The width was the only linear measure with positive allometry, and was the one which presented the greatest relative growth, while the thickness had the smallest one. The adrenal weight presented positive allometry relating to the Crown-Rump length (k = 2.32) and to the gestational age (k = 2.40). The importance of these knowledges in the precocious ultrasonographic diagnosis of congenital adrenal pathologies is discussed.

Anatomical relationship between the intrarenal arteries and the kidney collecting system.

The anatomical relationship between the intrarenal arteries and the renal collecting system was studied in 82, 3-dimensional endocasts. Some anatomical details that have importance for urologists were observed. The arterial supply related to the upper caliceal group arises from 2 arteries that encircle these calices (in 86.6% 1 trunk originated from the anterior division and 1 from the posterior division of the renal artery). The artery to the mid kidney courses horizontally in the mid renal pelvis in 64.6% of the cases while the arterial supply to the inferior pole (front and back) arises from the inferior segmental artery of the anterior division in 62.2%. The posterior segmental artery is related to the upper infundibulum or to the junction of the pelvis with the upper calix in 57.3% of the cases and to the middle posterior aspect of the renal pelvis in 42.7%.

Study of the fetal kidney length growth during the second and third trimesters of gestation.

The fetal kidney length growth was studied in 240 kidneys taken from 120 staged human fetuses (74 males and 46 females) ranging in age from 10 to 36 weeks postconception. Each kidney was quantitatively evaluated considering its greatest longitudinal length. The data were correlated to the gestational age by using the allometric method (Y = bXk). Equations and growth curves of right and left kidneys, males, females and the whole sample during the second and the third trimesters are presented. This study has practical utility in the quantitative determination of the renal anomalies and in the determination of the gestational age.

Segmentaçäo arterial do baço: fundamento anatômico para a esplenectomia parcial / Splenic arterial segmentation: anatomical basis for the partial splenectomy

É estudada a divisäo extraparenquimatosa da artéria lienal e a angioarquitetura arterial em 40 baços frescos (moldagem arterial em vinilite a 20%). Os resultados mostram a bifurcaçäo como forma mais freqüente de divisäo terminal da artéria lienal (82,5%). Säo descritos dois tipos de artérias polares: artéria polar do tipo I (20%) e artéria polar do tipo II (10%). A avaliaçäo dos moldes arteriais indica a existência de segmentos cirurgicamente independentes (95%), com limites regulares (60%) e disposiçäo semelhante na face visceral e diafragmática do baço (75%). Discutem-se esses elementos segundo o ponto de vista da cirurgia consevadora do baço

Ramos esplênicos da artéria lienal: estudo anatômico aplicado à cirurgia parcial do baço / Lineal splenic artery branches: anatomic study applied to the partial surgery of the spleen

Em 65 baços (50 formolizados, cujos pedículos arteriais foram dissecados, e 15 de necrópsias, para a arteriografia lienal) foi estudado o modo de divisäo terminal da artéria lienal e seus ramos extra-hilares dirigidos às extremidades do órgäo (artérias polares). Verificou-se bifurcaçäo da artéria lienal em 46/50 casos; artéria polar do tipo I, longa e relativamente calibrosa, com origem direta na artéria lienal, anteriormente à sua divisäo terminal, em 4/50 casos; artéria polar do tipo II, ramo de um ramo primário ou secundário da divisäo terminal da artéria lineal, curta, menos calibrosa e presente em até três ramos para um mesmo pólo, em 13/50 casos. O estudo estatístico da distância desses ramos arteriais à face visceral do baço indica os valores médios de: 2,88 cm (divisäo terminal), 5,10 cm (artéria polar I) e 1,70 cm (artéria polar II). É discutida a aplicaçäo desse conhecimento à esplenectomia parcial

[The collector system of the kidney. Applied anatomy based on the analysis of 3-dimensional casts]. / Système collecteur du rein. Anatomie appliquée d'après l'analyse des moulages tridimensionnels.

The kidney collector system were studied in 120 three-dimensional casts obtained by the injection-corrosion method. To the procurement of the first hundred casts, we made use of a polyester resin; however on the preparation of the last twenty we made use of a mixture containing latex and radiographic contrast as we intended to obtain, besides the casts, the roentgenograms. Two anatomic details, which have a great importance for endourology, were observed: a. the calices' cross draining the meso-renal region and the consequent inter-pelvis-calice (space (IPC) formation which is seen in the roentgenograms, b. a smaller calice which penetrates perpendicularly the surface of the renal pelvis or into the surface of a great calice. The urologists must appreciate these two anatomic structures, before the surgical procedures on the collector system.