[Bronchial arteries: anatomical and clinical studies and strategies in surgical approach]. / Arterie bronchiali. Studio anatomo-clinico e strategie di accesso chirurgico.

One of the most important and controversial aspects of thoracic surgery is due to the topographical and surgical anatomy of the vascular structures involving the mediastinum. The knowledge of the so-called "vascular time", in fact, allows to face more complicated surgical situations, typical of the most specialistic thoracic surgery. The bronchial arteries represent a paradigm of what we have just stated. The study of their anatomy (number, position, origin, distribution and relationships with the mediastinal structures) is of relevant importance, not only for the interest the bronchial vascular tree arises in tracheo-bronchial surgery and in pulmonary transplantology, but also for the knowledge of the pathogenesis of some processes regarding pulmonary and pleural pathologies. The aim of this paper is to evaluate the real clinical interest of bronchial arteries, with an analytic study of the anatomy of vessels, and with the possibility to show the most frequent and characteristic anomalies involving the origin and course of these arteries.

Setting up a plastination laboratory at the Faculty of Medicine of the Autonomous University of Barcelona

Plastination is a laboratory tool used to preserve biological tissues that has been applied to morphological studies, teaching and research. The technique reduces exposure to toxic fumes and diminishes damage to anatomical preparations during their manipulation. Contrary to intuition, the basic technique of plastination does not require any significant economical investment. The technical equipment and laboratory products can be obtained with a limited budget. Moreover, facility requirements are simple and not very expensive if only the basic technique is pursued. In the present work, we report our experience in the design and setting up of a laboratory to plastinate anatomical preparations using the S10 standard technique at the Faculty of Medicine of the Autonomous University of Barcelona. We explain the different ways we used to finance this laboratory and the cost of the facility, the technical equipment and the laboratory products. We also report the first results concerning the first anatomical preparations obtained by us (AU)

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Factors involved in the 'rotation' of the human embryonic stomach around its longitudinal axis: computer-assisted morphometric analysis.

The majority of studies as to whether gastric and nongastric factors are involved in the 'rotation' of the human embryonic stomach around its longitudinal axis have been morphological. The aim of this study was to analyse, with morphometric support, the influence on the angular modifications during gastric rotation of the simultaneous changes of the gastric walls and mesenteric growth, and the volumes of organs adjacent to the stomach (right, left and posterior groups). Computer imaging techniques were applied on cross sections of a graded series of 10 human embryos (from Carnegie stage (CS) 11) and 2 fetuses. A clockwise gastric rotation occurred during the embryonic period. The most rapid angular modifications took place from CS 11 to 16, after the rotation became oscillatory with angular changes in clockwise and anticlockwise directions, reaching the highest value at CS 18 (at the supraomental part of the stomach: 54.37 degrees; at the omental part: 68.03 degrees); after this period the angular values tended to stabilise. The predominant growth of the left gastric wall over the right and the changes in the width of the gastric mesentery were the most persistent factors involved in the modifications of the transverse gastric angle during the embryonic period although without relationship to their direction. During the increasing angular phases, clockwise rotation was promoted by the decrease of the volume of any group of organs adjacent to the stomach. When the volume of the left and posterior groups increased simultaneously, clockwise or anticlockwise angular directional change was related to the respective decrease or increase adjacent organ volume to the right. We conclude that the stomach of the human embryo undergoes heterogeneous and multifactorial rotation as a consequence of the overall increase in gastric wall growth to the left and the increase of gastric mobility produced by the previous mesenteric enlargement, and that the rotational direction results from the forces exerted on the stomach and the gastric mesenteries by the adjacent organs.

Perivascular structures in corrosion casts of the human central nervous system: a confocal laser and scanning electron microscope study.

Scanning electron microscopy (SEM) of microvascular corrosion casts revealed perivascular structures that resembled smooth muscle and pericyte cells. Although these structures have been studied in widely different experimental contexts, their origin, function, and distribution pattern in different tissues are not understood. Microvascular corrosion casts from 15 fresh human brains and 20 lumbar spinal cords were studied by SEM. In five cerebral hemispheres a fluorescent resin was injected in order to study the vascular bed by confocal laser scanning microscopy (CLSM). Microvascular casts showed two perivascular structures on their surfaces: plastic strips, which formed a muff around arteriolar vessels, and pericyte-like structures that were present around the capillary network. Their morphological characteristics and distribution were similar to those of smooth muscle cells and pericytes, respectively. The SEM study showed that these structures were not tightly joined to the cast surface, but were connected to the vascular cast by narrow plastic connections. The CLSM showed that the resin invaded the subendothelial space, thus giving rise to these structures. Perivascular structures associated with arteriolar and capillary vessels appear to represent smooth muscle cells and pericytes. They are formed by the passage of the resin to the subendothelial space, probably through weak endothelial cell junctions. The effusion of resin into the subendothelial space may represent evidence for the structural basis of myocyte and pericyte cell control. Chemical communication by substances released locally or transported to these cells through these junctions may regulate their functions, allowing them to regulate blood flow.

Morphological characteristics and distribution pattern of the arterial vessels in human cerebral cortex: a scanning electron microscope study.

BACKGROUND: The human cerebral cortex is supplied by vessels that arise from the pial arteries. These vessels give rise to a dense vascular network that is highly interconnected. Cortical arteries have been classified in different categories. Both their angioarchitectonic pattern and anatomical structures involved in their regulation are not fully understood. METHODS: Twelve fresh human brains were studied by scanning electron microscopy of vascular corrosion casts. RESULTS: Four types of arterial vessels in the cerebral cortex--short, middle, long, and transcortical--were identified. The cortical vascular network was formed by several interconnected clusters of vessels, which were arranged in four vascular layers parallel to the pial surface and characterized by different vascular densities. The greatest vascular density corresponded to the middle and deep vascular layers. Circular constrictions were found at the origin of cortical arteries and at their branching sites, probably related to vascular sphincters. Connections between cortical arteries were observed at their initial course. Plastic strips, occasionally related to constrictions, were observed around both middle and long cortical arteries. Other plastic structures, morphologically similar to pericytes, were found around capillary vessels. CONCLUSIONS: The blood supply to the human cerebral cortex depends on the short, middle, and long cortical arteries, which give rise to a highly anastomosed capillary network. There exist vascular connections between pial arteries and occasionally between cortical arteries. Blood flow autoregulation is probably mediated by smooth muscle cells at the arteriolar level and by pericytes at the capillary level, through endothelial connections.

Computer-assisted stereological analysis of gastric volume during the human embryonic period.

Morphometric data concerning human embryos and fetuses have become more clinically informative since ultrasound was employed to make prenatal measurements and software preprocessing techniques improved the previous fuzzy ultrasound signals (Mahoney, 1992). The aim of this study was to determine the volume of the human stomach during the embryonic period and to compare its rate of growth with that during the early fetal period. To calculate gastric volume, computer imaging techniques were applied on cross sections of a graded series of human embryos (from Carnegie stage 11) and fetuses. Gastric volume increased progressively, except for a decrease between stages 12 and 13 due principally to the reduction of the right gastric wall. The growth of the left wall of the stomach was predominant over that of the right. Until stage 20 the stomach volume increased due to the predominant growth of the walls, after this stage the gastric cavity volume increased rapidly, and the rate of growth of the gastric volume reached similar values to that of the early fetal period. We concluded that in the beginning the human stomach grows due to the predominant growth of its walls, chiefly of the left, and from stage 20 because of the predominant expansion of its cavity, which may be related to the capacity to swallow amniotic fluid at the end of the embryonic period. The diminution of the right gastric wall volume (stages 12-13) is consistent with an extension of the omental bursa into the mesodermal anlage of the stomach.

Biceps brachii muscle attached to the extensor carpi radialis brevis muscle: an unreported anatomical variation in humans.

We report a new muscular variation in humans. It consisted of a biceps brachii muscle attached to the extensor carpi radialis brevis muscle by means of an accessory fasciculus. It was a trapezoid tendinous connection band that arose from the terminal tendon of the biceps brachii muscle and ended in the internal margin of the extensor carpi radialis brevis muscle. This intermuscular connection band was the external slip of the insertion tendon of the biceps brachii muscle, which was also attached by means of two other fascicles to the radial tuberosity (intermediate slip) and the flexor digitorum superficialis muscle (internal slip). This variation was observed in only one of the sixty upper limbs examined.

Accessory fasciculi of the human pronator teres muscle: incidence, morphological characteristics and relation to the median nerve.

The purpose of this study is to determine the incidence of the accessory fasciculi of the pronator teres muscle and to evaluate the predispositional role of its morphological characteristics to median nerve entrapment. The accessory fasciculi of the pronator teres muscle have been found in 8.3% of 60 upper extremities which were studied. These fasciculi arose from the tendon of the brachialis muscle (5.0%), from the radial tendon of the biceps brachii muscle (3.3%), from the Gantzer's muscle (1.6%) or from the flexor digitorum superficialis muscle (1.6%). They were slips of origin of the deep head of the pronator teres muscle. They represented the deep head, when there was no other origin slip, or they were additional origin slips when the deep head also had a coronoid origin. Only the accessory fasciculi that represented the deep head and the accessory fasciculi located inside to the coronoid fasciculus were related directly to the median nerve. Three characteristics of these accessory fasciculi adjacent to the median nerve could be considered to be factors that predispose to the nerve entrapment: 1) the location dorsal to the superficial head of the pronator teres muscle, because it increases the area of contact with the median nerve; 2) the location between the superficial head and the coronoid fasciculus, because it reduces the space occupied by the median nerve; and 3) the tendinous nature of considerable segments of short accessory fasciculi because they are less extensible.

Variations of the pronator teres muscle: predispositional role to median nerve entrapment.

The variability of the human pronator teres muscle is studied in 60 upper limbs. The humeral head was present in all cases and was double in 3 cases (5.0%). The ulnar head was present in 47 cases (78.3%). The ulnar head was muscular in 11 cases, tendinous in 6 cases, and mixed in 30 cases. The collateral branches of the median nerve destined to the pronator teres muscle were found to be arranged in three main patterns: arising directly from the median nerve, arising from the superficial flexor antebrachial muscles nerve, and mixed type. Special reference is made to the influence of variations in the pronator teres muscle on the compression or the entrapment of the median nerve (pronator syndrome). The proposed determinant variations are: short and tendinous ulnar head, ulnar head joined to the arch of the flexor digitorum superficialis muscle, ulnar head with triple origin slips, and humeral head perforated by the median nerve.