Is the umbilicus truly midline? Clinical and medicolegal implications

A common misconception is that the umbilicus is a midline structure. To date, an anatomical survey examining whether the umbilicus is located at the midline has not been reported. This study measured the position of the umbilicus among 136 subjects, in two separate experiments. The results demonstrated that the umbilicus was not at the midline for nearly 100 percent of subjects and was more than 2 percent from the midline for more than 50 percent of subjects. This finding is of great importance for patient counseling in preoperative and postoperative settings. Because the discerning eye has repeatedly been demonstrated to be able to detect smaller asymmetries, these findings are significant and should be discussed with patients undergoing cosmetic abdominoplasty or reconstructive procedures, for preoperative informed consent. Education and preoperative demonstration can help prevent medicolegal ramifications. The umbilicus is rarely midline and, when critically analyzed, is located lateral to the midline axis more often than not.     

A simple technique for locating the umbilicus in abdominoplasty

A method for locating the umbilicus in abdominoplasty is described. The method utilizes a magnet sutured to the umbilical stalk and a locking device which determines the exact location of the umbilicus.     

Simplified technique for creating a youthful umbilicus in abdominoplasty

Reimplantation of the umbilicus remains a critical aesthetic component in abdominoplasty and transverse rectus abdominis musculocutaneous breast reconstruction. Although the ideal shape of the umbilicus has been debated, recent studies have shown the young, thin female with an attractive abdomen tends to have a small, vertically oriented umbilicus. The aesthetic considerations for reimplantation include position, depth, shape, and location of scar. The authors present a technique that is expedient and reliable and that addresses each of these variables. The umbilicus is sutured to the rectus fascia and reimplanted through a vertical incision in the abdominal flap. Subdermal sutures are placed from the umbilicus to the linea alba superiorly and inferiorly. These sutures create a vertically oriented shape and place the umbilicus in the midline. Shortening the umbilical stalk establishes depth and hides the closure of the umbilicus and abdominal flap within the stalk. The stalk length is easily varied, depending on the thickness of the panniculus. Defatting is performed through the vertical incision to allow easy visualization of the umbilicus. This technique creates depth, ensures optimal position, pulls the scar deep in the umbilicus, and produces a vertically oriented, youthful umbilicus. More importantly, a questionnaire given to patients who have undergone abdominoplasty with this procedure (n = 21) confirms that patients have a high level of satisfaction with the resulting shape, position, and overall appearance.     

Body composition in air and road inductees at high altitude during the initial days of acclimatization

 This study assesses body composition changes and their time course during the initial days of acclimatization to high altitude (HA). Comparisons were made between gradual and acute induction to HA using 60 male lowlander volunteers (24–28 years of age) divided into two equal groups for inducting them to HA. Thirty subjects were air-lifted from sea level (SL) to 3500 m HA in 1 h. These subjects were air inductees (AI). The other 30 subjects were transported in 4 days by road to the same location at 3500 m. These were road inductees (RI). After remaining for 15 days at 3500 m both groups were inducted to 4200 m by road. All the subjects could not reach the various altitudes at the same time due to logistical problems. Ultimately, data for each altitude (SL, 3500 m and 4200 m) were available for only 26 RI subjects and 10 AI subjects. Skinfold thickness (SKF) measurements for the subscapular, thigh, triceps, biceps, juxtanipple, umbilicus, suprailiac and calf regions were taken in order to calculate fat percentages. Measurements were taken at SL and on days 1 and 9 at both 3500 m and 4200 m. On day 1 at 3500 m, RI showed a significant fall in body weight (BW) with respect to SL but AI maintained it. On subsequent days at HA both groups showed a significant fall in BW and lean body mass but not in percentage fat. SKF in the biceps and triceps regions decreased significantly but in the umbilicus and suprailiac regions it significantly increased at HA in both groups. Body composition, along with other parameters, is discussed determining the acclimatization schedule for sojourners at HA. Possibly, translocation of body fat takes place from the periphery to deep body fat depots in the core/main trunk due to the cold at HA. Received: 8 May 1997 / Revised: 10 August 1997 / Accepted: 20 October 1997     

In search of the ideal female umbilicus

The umbilicus is essential to the aesthetic appearance of the abdomen. However, little research exists on what characterizes an aesthetically pleasing umbilicus. Often, the plastic surgeon is called on to reconstruct the umbilicus. Although a variety of reconstructive methods are available, no real standards define the appearance of an aesthetically pleasing umbilicus. To ascertain the characteristics of an aesthetically pleasing umbilicus, a photographic analysis was undertaken using 147 female participants between the ages of 18 and 62 years. Each subject's age, height, and weight were recorded. Photographs of each participant's umbilicus were then taken from 30 cm and 50 cm away. The photographs were reviewed by the authors, and each umbilicus was categorized on the basis of size, shape, hooding, or protrusion. The photographs were then reviewed by a panel and given a score between 1 and 10 to rate attractiveness. Using linear regression analysis, the effects of body mass index, shape, hooding, and umbilical protrusion on attractiveness were assessed. The T- or vertically shaped umbilicus with superior hooding consistently scored the highest in aesthetic appeal, whereas the presence of any degree of protrusion and a horizontal orientation or distorted shape detracted from the score. Those with a large umbilicus tended to score consistently lower than those with a smaller configuration. A desirable goal in umbilical reconstruction is, thus, to create a small T or vertically oriented umbilicus with the addition of a superior hood or shelf.     

Innervation zones location and optimal electrodes position of obliquus internus and obliquus externus abdominis muscles

The assessment of abdominal muscles has became popular in recent years because the study of “core muscles” is now considered a pivotal approach for a number of fields. The purpose of this study was to describe the innervation zone (IZ) locations and optimal electrode sites in two core muscles: the obliquus externus (OE) and the obliquus internus (OI) abdominis muscles. Twenty healthy male subjects were recruited and the IZ location was studied during a submaximal isometric contraction using multichannel surface EMG.The optimal electrode position for OI was found to be 2 cm lower the most prominent point of the anterior superior iliac spine, just medial and superior to the inguinal ligament. The optimal electrode position for OE was found to be 14 cm from the median line, lower the level of 1 cm above umbilicus, parallel to the line extending from the most inferior point of the costal margin to the opposite pubic tubercle (almost 45° with respect to the median line).Findings showed that for OI and OE muscles it is possible to provide indications for a muscle belly area suited for proper positioning of at least an electrode pair.     

An anatomical method for re-siting the umbilicus

The umbilicus is the only normal scar on the body and it is the most noticeable scar following abdominoplasty and TRAM or DIEP flap procedures. We describe a technique for resiting the umbilicus that attempts to recreate the anatomical structure by attaching the superficial fascia to the periumbilical skin to produce a fullness around the depression in which the umbilicus sits. This is aesthetically desirable and avoids the uncomfortable tethering of the umbilicus to the rectus sheath associated with other techniques.     

Two unusual umbilicoplasties.

We describe the creation of an umbilicus where none previously existed, during an abdominoplasty, and the cosmetic shaping of a stretched umbilicus after an umbilical hernia repair.     

Development and Validation of Computed Tomography Derived Anthropometric Regression Equations for Estimating Abdominal Adipose Tissue Distribution

The purpose of this study was twofold: (1) to develop multiple regression equations for predicting computed tomography (CT) derived intra-abdominal (IAF), subcutaneous (SCF), and total (TOTF= IAF+SCF) abdominal adipose tissue areas from anthropometric measures in adult white males with a large range of age (18–71 years) and percent body fat (2.0–40.6); and (2) to validate the new and existing equations that used similar Hounsfield Units (HU) for determining IAF for estimating these fat depots. One hundred fifty-one white male subjects had IAF, SCF, and TOTF determined by a single CT scan, skinfold and circumference measures taken and body density determined. Linear intra-correlations and factor analysis procedures were used to identify variables for inclusion in stepwise multiple regression solutions. IAF was estimated from age, waist circumference, the sum of mid-thigh and lower thigh circumferences, and vertical abdominal skinfold. SCF was estimated from age, umbilicus circumference, chest and suprailiac skinfolds. TOTF was estimated from age, body mass index (BMI), chest skinfold, and umbilicus circumference. R² for IAF, SCF, and TOTF was .73, .77, and .86 respectively. The existing and the new equations were validated on an independent sub-sample of 51 subjects. The only existing equation that met validation criteria had a validation R² = .67 for IAF. All three new equations met validation criteria with R ² validations of .75, .79, and .85 for IAF, SCF, and TOTF respectively. It is concluded that the new equations might be used as an inexpensive estimation of IAF, SCF, and TOTF in adult white males varying greatly in age and percent body fat.     

Refinements in abdominoplasty with emphasis on reimplantation of the umbilicus

First, the author describes the suprapubic deepithelialized triangular flap to eliminate the dead space that can result when the abdominal flap, elevated from the periumbilical zone, meager in fatty tissue, is sutured to the thick pubic region. Second, because of the frequently poor quality of circular periumbilical scars, the author proposes a superiorly based, round-shaped flap taken from the future umbilical location and then defatted. The umbilical cylinder is divided vertically down to its aponeurotic attachment to permit insertion of this round skin flap, which is then anchored to the aponeurosis and to the edge of the triangular gap. This method prevents retracted periumbilical scars. Finally, in secondary corrections after abdominoplasty, satisfactory results can be obtained only if the umbilicus is detached from either the skin or the aponeurosis. The author's technique for covering the hole at the old umbilical location makes use of a round flap from the new umbilical site.     

血红素对人脐静脉内皮细胞氧化应激损伤的保护作用

采用过氧化氢作用于人脐静脉内皮细胞 ,成功地制作了氧化应激损伤的细胞模型 ,将培养的细胞分为 3组 :正常对照组 ,损伤组 (给予过氧化氢 )和血红素组 (同损伤组的制备 ,预先加入血红素 ) .观察各组细胞在光、电镜下形态学和蛋白质电泳的改变 ,用MTT法检测了各组细胞的生长状态 .结果表明 :在血红素组 ,细胞生长状态、MTT水平和蛋白质电泳结果与损伤组相比有明显好转且差异显著 ,证明血红素对人脐静脉内皮细胞氧化应激损伤有明显的保护作用 .     

Masticatory muscle and temporomandibular joint pain in Croatian war veterans with posttraumatic stress disorder

The aim of this study was to investigate the prevalence and intensity of masticatory muscle and temporomandibular joint (TMJ) pain in Croatian war veterans with posttraumatic stress disorder (PTSD). The examined group consisted of 100 Croatian war veterans, in whom PTSD had previously been diagnosed. Patients were compared with 92 subjects who had not taken part in the war and in whom PTSD was excluded by psychiatric examination. The clinical examination consisted of palpation of the masticatory muscles, the prominent neck musculature, and TMJ. The examination technique used and the definition of items were previously tested for reliability and validity. 93% of the subjects with PTSD had masticatory muscle tenderness compared to 45.65% of the subjects in the control group (chi2 = 51.46, p < 0.0001). The most frequent painful location in the subjects with PTSD was the left lateral pterygoid site in 88%, and in subjects of the control group the right lateral pterygoid site in 28.26% of cases. The most painful location in the PTSD group was the left lateral pterygoid site in 72%, and in the control group the left posterior digastric in 4.35% of cases. 58% of the subjects with PTSD had TMJ tenderness compared to 3.26% of subjects in the control group (chi2 = 66.23, p < 0.0001). The most frequent painful location of TMJ in both groups was the left posterior capsule; in the PTSD group 38% and in subjects in the control group 2.17% of cases. The most painful location was the left posterior capsule in 28% of subjects with PTSD, while not one subject in the control group reported severe painful sensitivity. The very high frequency and intensity of pain in subjects with PTSD confirms the effect of stress on muscle and joint sensitivity, i.e. perception of pain.     

Extensive intraspecific variation in a Triassic ammonoid from Siberia

The ammonoid species Czekanowskites rieberin.sp . from the Lower Anisian of Arctic Siberia (River Olenek) shows an enormous range of intraspecific variability. The 700 investigated specimens are packed in one single concretion. They are all adult with preserved living chambers and apertural structures. Morphologically they range from keeled smooth suboxycones with narrow umbilicus, through feebly ribbed platycones with a little wider umbilicus, to subcadicones with relatively wide umbilicus and straight ribs with bullae. The morphological variation is continuous; all specimmh belong to a single genetically linked population, variants of one biospecies. This phenomenon, which is quite common in boreal Triassic ammonoid faunas, has in the past led to serious taxonomic oversplitting. It presents a serious challenge to current ideas about a close correlation between modeof life and shell morphology in arnmonoids.□ Amntonoidea, boreal Triassic, ecology. Siberia, variability .     

A simple technique for reconstruction of the umbilicus, using a conchal cartilage composite graft

A simple technique to reconstruct the umbilicus is reported in which a conchal cartilage composite graft, such as that used in tragus construction in the treatment of microtia, was employed with a very satisfactory result.     

Optimal inertial sensor location for ambulatory measurement of trunk inclination

Trunk inclination (TI) is used often to quantify back loading in ergonomic workplace evaluation. The aim of the present study was to determine whether TI can be obtained using a single inertial sensor (IS) on the back, and to determine the optimal IS location on the back for the estimation of TI. Gold standard TI, the angle between the vertical and the line connecting the L5/S1 joint and the trunk centre of mass, was measured using an optoelectronic system. Ten subjects performed experimental trials, each consisting of a symmetric and an asymmetric lifting task, and of a left–right lateral flexion movement. Trials were repeated and, in between trials, the IS was shifted in small steps from a location on the thorax towards a location on the sacrum. Optimal IS location was defined as the IS location with minimum root-mean-square (RMS) error between the gold standard TI and the IS TI. Averaged over subjects, the optimal IS location for symmetric and asymmetric lifting was at about 25% of the distance from the midpoint between the posterior superior iliac spines (MPSIS) to the C7 spinous process. The RMS error at this location, averaged over subjects, was 4.6±2.9°. For the left–right lateral flexion task, the optimal IS location was at about 30% of the MPSIS to C7 distance. Because in most activities of daily living, pure lateral flexion does not occur often, it is recommended place the IS at 25% of the distance from the MPSIS to C7.     

Morphology of umbilical vessels in human fetuses: a quantitative light microscope study

OBJECTIVE: To investigate the development of the intra-abdominal part of the umbilical vessels in human fetuses by light microscopy. MATERIALS AND METHODS: The location of the umbilicus and umbilical vessels in the abdominal cavity of 90 human fetuses of gestational ages 10-40 weeks was determined. The external vessel diameter, lumen diameter, wall thickness, tunica adventitia thickness, tunica media thickness and the number of vasa vasorum were recorded from cross-sectlons of the intra-abdominal part of the umbilical vessels. 1985). 1985). RESULTS: Umbilical artery agenesis was observed on the left side in two cases and on the right in one case. There was a positive correlation between gestational age and umbilical vessel measurements. There were differences between the vessel and lumen diameters, tunica media thicknesses of the vessels of the second and third trimesters, and the full-term period. There were also predictable differences between the vessel and lumen diameters, tunica media and tunica adventitia thicknesses of the umbilical vein and umbilical arteries. CONCLUSION: Detailed information on quantitative parameters of umbilical vessels at each gestational age may prove helpful in determining pathologies of umbilical vessels and illuminating certain syndromes.     

An electromyographic study of human gait both in water and on dry ground

The purpose of the present study was to define the degree of muscular activation while walking in water in order to aid rehabilitation therapists in their choice of exercises for daily clinical practice in aquatherapy. This study compares the electromyographic (EMG) activity of the rectus femoris, the soleus of the right lower limb and the contra-lateral lumbar erector spinae, during gait in water and on dry ground. The study was carried out on a group of seven healthy female subjects without past rachidian pathology. EMG recordings in water were taken with immersion to the umbilicus at "comfortable" speed. A total of five recordings were made at this speed, in water and on dry ground, with a one-minute rest between recordings. Integrated EMG results, averaged on eight gait cycles, show, for all the subjects, more erector spinae activity in water than on the ground (p<0.01). Soleus activity is greater during gait on dry ground for the whole group (p<0.01). For four subjects, the electromyographic (EMG) activity of the rectus femoris over the entire cycle is greater than that exhibited on dry ground.In the two experimental situations, no differences have been found either on amplitudinal peaks or on the shape of the patterns. The speed and gait cycle length are reduced in water (60% and 25%). Walking in water at an umbilical level increases the activity of the erector spinae and activates the rectus femoris to levels near to or higher than walking on dry ground.These data should be taken into account by the physiotherapist when designing a rehabilitation programme.     

Pathophysiology and Pathogenesis of Visceral Fat Obesity

Based on the analysis of fat distribution by computed tomography (CT) scans, the classification scheme for obesity should include visceral fat obesity in which fat accumulation is predominant in the intra-abdominal cavity. Obese subjects with visceral fat accumulation more frequently demonstrate impairment of glucose and lipid metabolism than those with subcutaneous fat accumulation. We have shown that visceral fat obesity is present in almost 90% of obese patients with ischemic heart disease. Even in non-obese subjects, visceral fat accumulation is correlated with glucose intolerance, hyperlipidemia and hypertension. Forty percent of non-obese subjects with coronary artery disease (CAD) had increased visceral fat. In non-obese subjects, visceral fat area assessed by abdominal CT at the level of the umbilicus correlates with metabolic risk factors, whereas in obese subjects the visceral fat area to subcutaneous fat area ratio provides a more significant correlation. From clinical and basic investigations, aging, sex hormones, excess intake of sucrose and lack of physical exercise have been suggested to be determinants for visceral fat accumulation. Since intra-abdominal fat (mesenteric and omentum fat) has been shown to have high activities of both lipogenesis and lipolysis, its accumulation can induce high levels of free fatty acids, a product of lipolysis, in portal circulation which go into the liver. Excess free fatty acids may cause the enhancement of lipid synthesis and gluconeo genesis as well as insulin resistance, resulting in hyperlipidemia, glucose intolerance and hypertension and finally atherosclerosis. Thus we propose a disease entity, visceral fat syndrome, which may increase susceptibility to atherosclerosis due to multiple risk factors induced by visceral fat accumulation.     

Non-invasive genetic sampling for molecular sexing and microsatellite genotyping of hyacinth macaw (Anodorhynchus hyacinthinus)

Molted feather sampling is a useful tool for genetic analyses of endangered species, but it is often very laborious due to the low quality and quantity of the DNA obtained. In the present study we show the parts of feathers that resulted in better yield of DNA. In descending order these were: blood clot outside the umbilicus, umbilicus (without blood clot), tip, inner membrane, and small calamus. Compared to DNA extracted from blood samples, DNA extracted from feathers produced microsatellite alleles of poorer quality and had to be processed immediately after extraction. As expected due to the level of DNA degradation, molecular sexing protocols that result in shorter PCR products were more efficient.