Magnetic resonance imaging, computed tomography, and conventional X-ray in 3 cases of symmelia

BACKGROUND: Symmelia is a rare birth defect, often combined with severe malformations of the urogenital system and the lower gastrointestinal tract. Additionally, a deformed pelvis and various degrees of separation of the lower limbs are present. CASES: We report the examination findings of 3 autopsy specimens of symmelia using magnetic resonance imaging (MRI) and computed tomography (CT) with 3-dimensional (3D) reconstructions, and conventional X-ray. CONCLUSIONS: MRI and CT with the addition of 3D visualization can be used additionally with autopsy and conventional X-ray images in the investigation of such complex anatomical abnormalities.     

Neural apparatus of perirenal and parapancreatic tissues during human embryogenesis]

The neural apparatus of the perirenal and parapancreatic fat tissue has been studied in human embryos, fetuses and newborns. Neurohistological techniques of Bielshowsky--Gross, Bielschowsky--Boek, Rasskazova and Ranson have been used . During embryogenesis certain differences are being formed in the structure of neural elements. These differences are characteristic for mature specimens and are especially noticeable in the structure of receptor terminals and ganglia. The neural apparatus of the paranephric fat tissue is forming with greater speed. Neural elements in different parts of the perirenal and parapancreatic fat tissue are not evenly distributed. Their greatest concentration is noted behind the pancreatic head and tail and at the level of the renal inferior pole and hilus.     

Right Hemihepatectomy by Suprahilar Intrahepatic Transection of the Right Hemipedicle using a Vascular Stapler

Successful hepatic resection requires profound anatomical knowledge and delicate surgical technique. Hemihepatectomies are mostly performed after preparing the extrahepatic hilar structures within the hepatoduodenal ligament, even in benign tumours or liver metastasis.^1-5. Regional extrahepatic lymphadenectomy is an oncological standard in hilar cholangiocarcinoma, intrahepatic cholangio-cellular carcinoma and hepatocellular carcinoma, whereas lymph node metastases in the hepatic hilus in patients with liver metastasis are rarely occult. Major disadvantages of these procedures are the complex preparation of the hilus with the risk of injuring contralateral structures and the possibility of bleeding from portal vein side-branches or impaired perfusion of bile ducts. We developed a technique of right hemihepatectomy or resection of the left lateral segments with intrahepatic transection of the pedicle that leaves the hepatoduodenal ligament completely untouched. ⁶ However, if intraoperative visualization or palpation of the ligament is suspicious for tumor infiltration or lymph node metastasis, the hilus should be explored and a lymphadenectomy performed.Open in a separate windowClick here to view.^{(14M, flv)}     

An attempt at comparing CT images of petrous bone with analogical sections of anatomical specimens

The purpose of the paper was to present comparative laminar anatomy of human temporal bone on the basis of cross-sections of autopsy specimens and CT scans made in identical thin layers. The investigations were made on 20 temporal bones taken during anatomopathological dissections of cadavers of men and women (aged 40 to 60 a) without visible pathological changes in the skull. The CT examinations were made by means of a Siemens Somatom DR 2 apparatus, using high resolution programme, on 10 patients who had pathological changes in the ear. The obtained scans were compared with temporal bone cross-sections, schemas of regular anatomical relation of 8 layers corresponding to routine CT examinations were worked out.     

Properties of the celiac trunk--anatomical study

Although anatomical properties and vessel variations of the celiac trunk are well explored in the literature, there is not so much information on the arterial diameters, and this data is important for surgical procedures and angiographic examinations. The aim of this study was to investigate properties of the celiac trunk in humans by using anatomical dissection. Ninety cadavers were dissected for the celiac trunk identification and arterial diameter measurements. The results of anatomical examination showed that in 72% of all cases the celiac trunk divides into the splenic artery and the common hepatic artery, while the left gastric artery arises as a first branch and had origin between aorta, all over the celiac trunk up to a bifurcation. From the 90 cadavers, 4 presented anatomical variations. Where normal anatomy was present, the mean length of the celiac trunk was 1.9 +/- 0.08 cm and its mean arterial diameter was 0.78 +/- 0.08 cm. The splenic artery had the largest diameter (0.61 +/- 0.05 cm) and the left gastric artery had the smallest diameter (0.38 +/- 0.03 cm). Our data represent original results about anatomical variations and arterial diameter of the celiac trunk and its main branches provided by anatomical dissection.     

Pancreatic adenocarcinoma presenting as sinistral portal hypertension: an unusual presentation of pancreatic cancer

A rare syndrome, sinistral (left-sided) portal hypertension resulting from splenic vein thrombosis secondary to pancreatic adenocarcinoma of the tail is presented here. Pancreatic cancer is notorious for presenting with vague and nonspecific symptoms, including but not exclusively weight loss, abdominal pain, and anorexia with or without jaundice. However, physicians should be aware that in the presence of splenic vein thrombosis, this finding alone puts pancreatic cancer high on the differential diagnosis.     

Preparation of large temporomandibular joint specimens for pathological study

Ten fresh temporomandibular joint (TMJ) specimens about 5 X 4.5 X 3.5 cm in size were removed at autopsy by 5 cuts according to appropriate anatomical landmarks. After routine formalin fixation, the whole-TMJ specimens were wrapped with a thin layer of self-curing resin and then cut with a low speed bone saw along the parasagittal plane predetermined by x-ray guidance. Each specimen was serially cut into 4 to 5 parallel slices of 3 mm thickness, which were then decalcified with 14% EDTA and embedded in paraffin. Histological sections of 5 microns were stained with hematoxylin and eosin. The procedures were accomplished within 20 to 24 days after autopsy. With this technique, the anatomical interrelationships among the various joint components could be maintained and the macroscopic and microscopic topography of the TMJ could be studied in the desired reference plane. Therefore, the corresponding changes among the joint components in a diseased TMJ could be thoroughly examined. This technique was also applicable for the study of large specimens containing both hard and soft tissues.     

Strain measurement in the medial collateral ligament of the human knee: an autopsy study

A strain transducer was developed which employs a magnetic field sensing device to detect linear displacement. The transducer was attached to the medial collateral ligament (MCL) of human autopsy specimens, minimally influencing their physiologic behavior. A strain 'map' of the MCL as a function of knee flexion (full extension to 120 degrees) both with and without abduction force was obtained. Our investigation revealed consistent differences in the strain patterns between proximal, middle and distal segments of the anterior and posterior borders of the MCL. Anatomic variations in the pattern of collagen fibers within the MCL, interactions between posterior oblique capsular fibers and the MCL, and the skeletal configuration may account for these varied strain patterns.     

Ultrasound identification and size determination of the palmaris longus tendon]

Since the palmaris longus tendon is subject to a wide range of anatomical variations (in 10% of the cases, aplasia is observed), the identification and determination of its length and thickness is of importance for the pre-operative planning of ligament reconstructive surgery. Thirty healthy volunteers aged between 6 and 50 years were examined using high-resolution 10-12 MHz US probes. We determined the length and thickness of the tendon, and its relationship to the median nerve in the distal region of the forearm. Thanks to the dynamic nature of the examination and the typical tendinous echo structure, the palmaris longus tendon was accurately identified by US in both children and adults. Ultrasonography is highly suitable for the identification of the palmaris longus tendon and aids the pre-operative planning of ligament reconstructions.     

Spleen Volume Variation in Patients with Locally Advanced Non-Small Cell Lung Cancer Receiving Platinum-Based Chemo-Radiotherapy

There is renewed interest in the immune regulatory role of the spleen in oncology. To date, very few studies have examined macroscopic variations of splenic volume in the setting of cancer, prior to or during therapy, especially in humans. Changes in splenic volume may be associated with changes in splenic function. The purpose of this study was to investigate variations in spleen volume in NSCLC patients during chemo-radiotherapy. Sixty patients with stage I-IIIB NSCLC underwent radiotherapy (60Gy/30 fractions) for six weeks with concomitant carboplatin/paclitaxel (Ca/P; n = 32) or cisplatin/etoposide (Ci/E; n = 28). A baseline PET/CT scan was performed within 2 weeks prior to treatment and during Weeks 2 and 4 of chemo-radiotherapy. Spleen volume was measured by contouring all CT slices. Significant macroscopic changes in splenic volume occurred early after the commencement of treatment. A significant decrease in spleen volume was observed for 66% of Ca/P and 79% of Ci/E patients between baseline and Week 2. Spleen volume was decreased by 14.2% for Ca/P (p<0.001) and 19.3% for Ci/E (p<0.001) patients. By Week 4, spleen volume was still significantly decreased for Ca/P patients compared to baseline, while for Ci/E patients, spleen volume returned to above baseline levels. This is the first report demonstrating macroscopic changes in the spleen in NSCLC patients undergoing radical chemo-radiotherapy that can be visualized by non-invasive imaging.     

Fréquence de la fixation physiologique de l’uncus pancréatique en scintigraphie à l’111In-pentétréotide : étude rétrospective chez 198 patients

AimThe aim of this study is to evaluate the frequency of physiological ¹¹¹In-DTPA-octreotide uptake in the pancreatic uncinate process, on SPECT-CT acquisitions.MethodsWe analysed retrospectively 247 patients ¹¹¹In-DTPA-octreotide SPECT-CT images realized in the nuclear medicine department of Haut-Lévêque hospital (CHU of Bordeaux, France) between June 2012 and March 2015. Intensity uptake of pancreas uncinate process was classified in comparison with physiological liver and spleen uptake. When positive, an uptake was considerated as physiologic when radiological investigations (CT, MRI or echoendoscopy) did not show anatomical lesion in the pancreatic head, or if no lesion appeared during clinical and radiological follow-ups.ResultsOne hundred and ninety-eight patients without uncus and cephalic pancreatic lesion were analysed. Forty-two percent had a physiological ¹¹¹In-DTPA-octreotide uptake in the pancreatic uncinate process. Uptake intensity was significant (greater than or equal to liver uptake) in 17%.ConclusionIntense physiological ¹¹¹In-DTPA-octreotide uptake of the pancreatic uncinate process can occur in 17% of cases on SPECT-CT acquisitions. This tracer accumulation can mimic malignancy in pancreatic head. Uptake in the pancreatic uncinate process should be correlated with morphologic examinations, such as CT, MRI or somatostatin PET-CT if available.     

Types of the cerebral arterial circle (circle of Willis) in a Sri Lankan Population

Background  

The variations of the circle of Willis (CW) are clinically important as patients with effective collateral circulations have a lower risk of transient ischemic attack and stroke than those with ineffective collaterals. The aim of the present cadaveric study was to investigate the anatomical variations of the CW and to compare the frequency of prevalence of the different variations with previous autopsy studies as variations in the anatomy of the CW as a whole have not been studied in the Indian subcontinent.     

Holistic approach to functional anatomy of the injured ankle joint

Talocrural joint injuries are among the most common injuries of the joints and therefore there is a need for a holistic approach to analysis of morphology, biomechanics and visualization of the talocrural joint ligamentary apparatus in different positions. The research was carried out on 20 fresh and conserved anatomical specimens of the lower leg on which X-ray, computed tomography, ultrasonography and stress analysis were performed before and after the lesion of ligaments. Also the gait of 130 adults without (100) and with ligament and joint capsule lesion (30) was analyzed by infrared telemetry. After complete discission of the lateral ligaments, arthrography and CT could register the lesion, while X-ray and ultrasonography could not detect it. Gait analysis of healthy and injured leg showed that the injured leg was significantly less loaded.     

Comparative genomic analysis of head and body/tail of pancreatic ductal adenocarcinoma at early and late stages

Pancreatic ductal adenocarcinoma (PDAC), one of the most lethal human cancers, can be divided into head and body/tail cancers anatomically. We previously reported a prognostic relevance of tumour location in resectable PDAC. This study aimed to further explore the mechanism underlying the molecular diversity between the head and body/tail of PDACs. We detected tumour genomes in 154 resectable (surgery) and non-resectable (biopsy) PDACs using a next-generation sequencing panel. Wilcoxon's rank test or Fisher's exact test was used for evaluating associations between clinical characteristics, mutation frequency and survival probability between the two cohorts. Compared with pancreatic head cancers, pancreatic body/tail cancers showed significantly more enriched genomic alterations in KRAS (97.1% vs 82.4%, P = 0.004) and SMAD4 (42.0% vs 21.2%, P = 0.008). At early stages (I-II), the SMAD4 mutation rate was significantly higher in pancreatic body/tail cancers than pancreatic head cancers (56.0% vs 26.5%, P = 0.021). At late stages (III-IV), pancreatic body/tail cancers presented significantly higher KRAS mutation rate (100.0% vs 75.8%, P = 0.001), higher frequency of MAPK pathway mutation (100% vs 87.8%, P = 0.040) and lower rates of druggable genomic alterations (30.8% vs 57.6%, P = 0.030) than pancreatic head cancers. Our work points out that pancreatic body/tail cancer seems to be more malignant than pancreatic head cancer at late stages.     

Epstein�CBarr virus-associated inflammatory pseudotumor of the spleen: report of two cases and review of the literature

We report two rare examples of Epstein–Barr virus (EBV)-associated inflammatory pseudotumor of the spleen. One patient presented with night sweats, abdominal pain, and weight loss and was found to have a splenic mass on CT scan suspected of lymphoma. The splenic mass in second patient was found incidentally at the time of work up for kidney stones. The pathologic examination of these splenectomy specimens showed similar histologic features. However, the spindle cells were composed of EBV-infected follicular dendritic cells in one case whereas the second case lacked significant follicular dendritic cell proliferation and showed only focal EBV-infected cells suggesting that these proliferations are heterogenous in nature.     

Stepwise reduction of functional spinal structures increase range of motion and change lordosis angle

Many investigators have performed studies on specific defect situations or determined the contribution on isolated structures. Investigating the contribution of functional structures requires obtaining the kinematic response directly on spinal segments. The purpose of this study was to quantify the function of anatomical components on lumbar segments for different loading magnitudes. Eight spinal segments (L4-5) with a median age of 52 years (ranging from 38 to 59 years) and a low degree of disc degeneration were utilized for the in vitro testing. Specimens were mounted in a custom-built spine tester and loaded with pure moments (1-10 N m) to move within three anatomical planes at a loading rate of 1.0 degrees /s. Anatomy was successively reduced by: ligaments, facet capsules, joints and nucleus. Data were evaluated for range of motion, neutral zone and lordosis angle. Transection of posterior ligaments predominantly increased specimen flexion for all bending moments applied. Supraspinous ligament also indicated to resist in extension slightly, whereas the facet capsules did not. Facet joints contributed to axial rotation, but not in lateral bending. The anterior longitudinal ligament was found to slightly resist in axial rotation, but strongly in extension. Nucleotomy caused largest increase of all movements. The unloaded posture of the specimens changed after ligament dissection, indicating ligament pretension. The region of lumbar spine is interesting for finite element (FE) simulation due to the high evidence of disc degeneration and injuries. This study may help to understand the function of specific anatomical structures and assists in FE model calibration. We suggest to start a calibration procedure for such models with the smallest functional structure (annulus) and to cumulatively add further structures.     

Collection protocol for human pancreas

This dissection and sampling procedure was developed for the Network for Pancreatic Organ Donors with Diabetes (nPOD) program to standardize preparation of pancreas recovered from cadaveric organ donors. The pancreas is divided into 3 main regions (head, body, tail) followed by serial transverse sections throughout the medial to lateral axis. Alternating sections are used for fixed paraffin and fresh frozen blocks and remnant samples are minced for snap frozen sample preparations, either with or without RNAse inhibitors, for DNA, RNA, or protein isolation. The overall goal of the pancreas dissection procedure is to sample the entire pancreas while maintaining anatomical orientation. Endocrine cell heterogeneity in terms of islet composition, size, and numbers is reported for human islets compared to rodent islets. The majority of human islets from the pancreas head, body and tail regions are composed of insulin-containing β-cells followed by lower proportions of glucagon-containing α-cells and somatostatin-containing δ-cells. Pancreatic polypeptide-containing PP cells and ghrelin-containing epsilon cells are also present but in small numbers. In contrast, the uncinate region contains islets that are primarily composed of pancreatic polypeptide-containing PP cells. These regional islet variations arise from developmental differences. The pancreas develops from the ventral and dorsal pancreatic buds in the foregut and after rotation of the stomach and duodenum, the ventral lobe moves and fuses with the dorsal. The ventral lobe forms the posterior portion of the head including the uncinate process while the dorsal lobe gives rise to the rest of the organ. Regional pancreatic variation is also reported with the tail region having higher islet density compared to other regions and the dorsal lobe-derived components undergoing selective atrophy in type 1 diabetes. Additional organs and tissues are often recovered from the organ donors and include pancreatic lymph nodes, spleen and non-pancreatic lymph nodes. These samples are recovered with similar formats as for the pancreas with the addition of isolation of cryopreserved cells. When the proximal duodenum is included with the pancreas, duodenal mucosa may be collected for paraffin and frozen blocks and minced snap frozen preparations.     

Heterogeneous distribution of plasma membrane glycoconjugates in pancreatic acinar cells

Flow-cytometric studies of lectin binding to individual acinar cells have been carried out in order to analyse the distribution of membrane glycoconjugates in cells from different areas of the pancreas: duodenal lobule (head) and splenic lobule (body and tail). The following fluoresceinated lectins were used: wheat germ agglutinin (WGA), Tetragonolobus purpureus agglutinin (TP) and concanavalin A (Con A), which specifically bind to N-acetyl D-glucosamine and sialic acid, L-fucose and D-mannose, respectively. In both pancreatic areas, two cell populations (R1 and R2) were identified according to the forward scatter (size). On the basis of their glycoconjugate pattern, R1 cells displayed higher density of WGA and TP receptors than R2 cells throughout the pancreas. Although no difference in size was found between the cells from duodenal and splenic lobules, N-acetyl D-glucosamine and/or sialic acid and L-fucose residues were more abundant in plasma membrane cell glycoconjugates from the duodenal lobule. The results provide evidence for biochemical heterogeneity among individual pancreatic cells according to the distribution of plasma membrane glycoconjugates.     

How reliable are morphological and anatomical characters to distinguish European wildcats,domestic cats and their hybrids in France?

Phenotypic variation in hybridizing species or subspecies is a prerequisite for allowing conservation ecologists and wildlife managers to identify parental populations and their hybrids in the field. We assessed the reliability of a set of eight morphological (body size and pelage characters) and four anatomical criteria (skull and intestine morphometric measurements) to distinguish between 302 French specimens classified as wildcat, domestic cat or hybrid on the basis of a Bayesian analysis (STRUCTURE) of their multilocus microsatellite genotypes. This aim was achieved by performing a set of multivariate analyses on morphological, anatomical and genetic data sets (Hill and Smith's analysis, co‐inertia analysis and discriminant analysis of principal components). Wildcats and domestic cats were very satisfactorily distinguished, even when using simple non‐invasive morphological criteria easily usable in the field like the morphology of the tail, dorsal line or flank stripes. Using anatomical instead of morphological characters slightly increased the discriminating power. Many more difficulties arose when we tried to distinguish hybrid specimens from both wildcat and domestic ones. Anatomical characters performed better than morphological ones in recognizing hybrids, but the assignment success rate remained very low, about 31.6% and 1.5%, respectively. Overall, the most discriminating characters were two continuous, derived anatomical characters: the cranial index followed by the intestinal index. Classification of specimens in three classes based on their microsatellite genotypes appeared to be inadequate for identifying hybrid specimens, as hybrid specimens seemed to be distributed along an anatomical continuum. With this observation in mind, we assessed the linear relationships between a proxy of the individual level of hybridization (q_ik) and the cranial and intestinal indices, respectively. Both relationships were highly significant. The greatest correlation was found with the cranial index (R² = 60.4%). Altogether, our results suggest that future work should be geared towards enhancing the measure of hybridization using more discriminating molecular markers and improving morphometric skull measurements through the use of modern geometric morphometric methods, using landmarks rather than skull dimension.     

On the anisotropy of the canine diaphragmatic central tendon

We studied the mechanical and anatomical anisotropy of the canine diaphragmatic central tendon (CT). Dumb-bell-shaped strips with effective dimensions of 10 x 2 mm (length x width) were cut from different regions of the canine diaphragmatic CT in two different orientations relative to the direction of neighboring muscle fibers. Specimens sampled with their long axial dimension oriented parallel to the neighboring muscle fibers were named Group-1 and those sampled with an orientation perpendicular to the neighboring muscle fibers were named Group-2. Results from one-dimensional stress-strain and tensile failure strength tests revealed that the CT is a nonlinear, inelastic, and anisotropic material. Group-1 specimens were found to have a higher stiffness, higher failure strength and higher strain energy density at failure than Group-2 specimens. Polarized microscopy showed that multiple sheets of collagen fiber bundles formed an orthogonal network in the tendon. Collagen fiber bundles along Group-1 direction formed parallel trajectory lines connecting the neighboring costal and crural muscles; bundles along Group-2 direction were observed to orient 90 degrees away. At the central apex region of the CT, collagen bundles of Group-1 formed a fan-like trajectory pattern. This collagen network architecture was compared favorably to the trajectories of an approximated principal stress field in the CT due to simulated contractile forces from its adjacent costal and crural muscles. These combined results suggest a structure-function relationship for the anatomical and mechanical anisotropy in the canine diaphragmatic CT.