Vaclav Baca

Bilateral avulsion of the puborectal muscle: magnetic resonance imaging‐based three‐dimensional reconstruction and comparison with a model of a healthy nulliparous woman

Obstetric trauma to the puborectal muscle seems to be an important cause of pelvic floor dysfunction in women. Due to the complicated three‐dimensional (3D) arrangement of the pelvic structures, two‐dimensional images are not sufficient to demonstrate its relationships in a complex fashion. Thus, we aimed to create a 3D computer model to visualize the normal female pelvic floor anatomy and to compare this with the anatomy after bilateral avulsion of the puborectal muscle following delivery.

Architectonic Arrangement of the Vasa Vasorum of the Human Great Saphenous Vein

Objective: The detailed spatial arrangement of the vasa vasorum (VV) of the human great saphenous vein (HGSV) was demonstrated in qualitative and quantitative terms. Materials and Methods: Segments of the HGSV taken from cadavers 12–24 h post mortem and from patients undergoing aortocoronary bypassing were studied by light microscopy of India-ink-injected specimens and by scanning electron microscopy of vascular corrosion casts. Results: Arterial feeders were found to approach the HGSV from nearby arteries every 15 mm forming a rich capillary network within the adventitia and the outer two thirds of the media in normal HGSV, while in HGSV with intimal hyperplasia capillary meshes extended into the inner layers of the media. Within the media, capillary meshes ran circularly. Postcapillary venules drained centrifugally towards the adventitial venous vessels which finally formed venous drainers running adjacent to the arterial feeders. Three-dimensional morphometry of vascular corrosion casts of VV revealed that diameters of (i) arterial VV ranged from 11.6 to 36.6 µm, (ii) capillary VV from 4.7 to 11.6 µm and (iii) venous VV ranged from 11.6 to 200.3 µm. Conclusions: The 3D network of VV suggests these layers are metabolically highly active and therefore require a continuous blood supply. We conclude, therefore, that the VV network must be preserved during in situ bypassing.

Endopelvic Fascia in Women : Shape and Relation to Parietal Pelvic Structures

OBJECTIVE: The endopelvic fascia is a confluent suspensory apparatus of the female pelvic organs. The aim of the study was to construct a three-dimensional model of the endopelvic fascia, defining its shape and its connections to the surrounding parietal structures. METHODS: We created a three-dimensional multiple-source computer model to simultaneously visualize and analyze all the structures within the female pelvic floor. This model integrates data from magnetic resonance imaging of 15 nulliparas under age 30 with no symptoms of pelvic floor dysfunction. The model also includes data from direct observation in the dissection laboratory and in surgical rooms, together with the relevant scientific literature. RESULTS: The endopelvic fascia has the shape of a semifrontally oriented septum, which surrounds the vagina and part of the uterine cervix and divides the pelvic floor into the anterior and posterior compartments. This confluent septum has specific connections to the pubic bone, anterior perineal membrane, perineal body, and superior fascia of the levator ani muscle. Additionally, the uterosacral part of the septum has three subdivisions— the “vascular part,” the “neural part,” and the true uterosacral ligament. Each of these subdivisions has a different physical link to the parietal structures. Three-dimensional illustrations and schemes were created to facilitate the understanding of the anatomy of these complex structures. CONCLUSION: Connecting descriptions of the geometry of the organs visible by magnetic resonance imaging with descriptions of their individual connections to the endopelvic fascia gave us unique information about the three-dimensional representation of the anatomy of the female lesser pelvis. The endopelvic fascia divides the lesser pelvis in a manner that is similar to the way the urorectal septum divides the embryonic cloaca. LEVEL OF EVIDENCE: III

The spatial arrangement of the human large intestinal wall blood circulation

The aim of the study was to describe and depict the spatial arrangement of the colon microcirculatory bed as a whole. Various parts of the large intestine and terminal ileum were harvested from either cadaver or section material or gained peroperatively. Samples were then injected with India ink or methylmetacrylate Mercox resin for microdissection and corrosion casting for scanning electron microscopy. The results showed that extramural vasa recta ramified to form the subserous plexus, some of them passing underneath the colon taeniae. Branches of both short and long vasa recta merged in the colon wall, pierced the muscular layer and spread out as the submucous plexus, which extended throughout the whole intestine without any interruption. The muscular layer received blood via both the centrifugal branches of the submucous plexus and the minor branches sent off by the subserous plexus. The mucosa was supplied by the mucous plexus, which sent capillaries into the walls of intestinal glands. The hexagonal arrangement of the intestinal glands reflected their vascular bed. All three presumptive critical points are only gross anatomical points of no physiological relevance in healthy individuals. Neither microscopic weak points nor regional differences were proven within the wall of the whole large intestine. The corrosion casts showed a huge density of capillaries under the mucosa of the large intestine. A regular hexagonal pattern of the vascular bed on the inner surface was revealed. No microvascular critical point proofs were confirmed and a correlation model to various pathological states was created.

Clinical anatomy of the calcaneal tuberosity

The aim of the study was a qualitative anatomical analysis of the macroscopic features of the surface of the calcaneal tuberosity, of the architecture of its cancellous bone and histological structure of the whole region. Dry human bones and pathological dissection material 24-36 h post mortem were used in the study. On the tuberosity, the variability of its surface relief and the two borders between the superior, middle and inferior facets were studied. More frequent medial declination of the inferior line, corresponding to the distal circumference of the Achilles tendon attachment, was found. Two systems of expressive condensation of cancellous bone just below the surface of the calcaneal tuberosity were described. In the histological part of the study, the distribution and different thickness of the fibrous cartilage layer covering the attachment region of Achilles tendon, the bottom of retro-calcaneal bursa and the whole surface of the calcaneal tuberosity were described. The functional and clinical relevance of results obtained are evaluated from the point of view of disciplines dealing with the pathology and surgery of the heel region. The relationships of official anatomical terms and a wide spectrum of clinical synonyms designating this region are discussed.

The course of osteons in the compact bone of the human proximal femur with clinical and biomechanical significance

The aim of the study was to analyze the structure and course of osteons in the compact bone of individual regions of the upper end of the femur and to consider the possible association with the course of typical peritrochanteric fracture lines. The issue of the architecture of this region has been dealt with by a number of authors since the first half of the nineteenth century, but until the present structural analysis it has been examined only by a few authors. We analyzed the structure of bones on specimens prepared by the method of repeated grinding, impregnating and polishing of the bone surface. We grounded and subsequently evaluated the bone in 20 dry specimens of the proximal femur, where the courses of the central vascular canals were described in the region of the femoral neck, the lesser trochanter, the greater trochanter, the intertrochanteric crest and line. The osteons were incorporated into a biomechanical model of the proximal femur and compared with the FEM model and correlation with the distribution of surface stresses was described. Certain areas were identified in the region of the trochanters where the course of osteons coincided with the course of the typical fracture lines of peritrochanteric fractures with typical fragments.

Terminologia Anatomica after 17 years: inconsistencies, mistakes and new proposals.

The article deals with our experience of Terminologia Anatomica (TA) in fields of education (of systemic and topographic anatomy) and clinical medicine (teaching of clinical anatomy and courses for young physicians in endoscopy). The anatomical nomenclature in Latin has been official for 120 years and its latest version for 17 years. Its main weak points should be discussed in public (or at least the discussion should be provoked), which is the reason for publishing the following findings and ensuing proposals. They are classified with seven groups: mistakes in TA, discrepancies in TA, multiplication of terms, synonyms in TA, identical terms for different structures, too long terms and missing terms in TA. The last group comprises missing terms in systemic anatomy, clinical anatomy, a paucity of terms in variant anatomy, in locomotion system and in topographic anatomy. Several attempts to draw attention to these have been made by the publication of inaccuracies in Nomina Anatomica and TA but this article summarizes and reviews current situation, emphasizing the weak points of the TA and brings several proposals and suggestions for further discussion.

The deep venous system of the lower extremity: new nomenclature:

The correct and precise nomenclature of the veins of the lower extremity is a necessary tool for communication. Three important changes have been done over the last 13 years. Terminologia Anatomica, the latest version of the Latin anatomical nomenclature, was published in 1998, extended in the area of the lower extremity veins with two consensus documents, in 2001, during the 14th World Congress of the International Union of Phlebology and in 2004 during the 21st World Congress of the International Union of Angiology. This article is a free continuation of two previous articles, reviewing the detailed anatomy and correct nomenclature of the superficial veins of the lower extremities and veins of pelvis. Now, it is concentrated on the deep venous system, in which 15 new terms have been added in both Latin and English languages.

Calcaneus, calcaneal tendon and retrocalcaneal bursa. Historical overview and plea for an accurate terminology.

Abstract Diseases and injuries of several specific structures in the heel region have been an enduring focus of medicine. The anatomical terminology of many of these structures has not been established until recently. The aim of the study was a historical analysis of the advances of anatomical terminology of three selected morphological units in the heel region-the Achilles tendon, calcaneus and retrocalcaneal bursa. It starts with a critical evaluation of the mythological eposes, the Illiad and Odyssey, describing the exploits of heroes in the Trojan war, followed by a review of relevant terms used for the designation of selected heel structures in the Middle Ages as well as in the 18th and 19th centuries. Principal versions of Latin anatomical terms used for the denotation of the mentioned structures are discussed. Recently applicable Latin terms and their recommended English synonyms, according to the latest version of Terminologia Anatomica (1998) are summed up. It surveys examples of “not very appropriate” terms, which are frequently used in clinical literature. The authors consider the use of official anatomical terms (both Latin and English) as an important step for the improvement of the clinical expressions and formulations.

Accessory brachial artery: a case report, embryological background and clinical relevance

Abstract Background: The accessory brachial artery (arteria brachialis accessoria) is a rare upper limb vascular abnormality, reported in less than one percent of cases. It is the artery originating from the axillary artery or the brachial artery, which rejoins the brachial artery further along its distal course within the arm or cubital fossa. Its detailed knowledge is necessary in transradial transulnar catheterization during coronary procedures, mainly due to its narrow caliber, which is responsible for the failure of the intervention performance. Objectives: Present a case of uncharacteristic branching pattern of the accessory brachial artery. Method: The case was observed during a routine dissection in the left axilla of a female cadaver at the Department of Anatomy at the Third Faculty of Medicine, Charles University in Prague. Results: The infrapectoral part of the axillary artery gave rise to a branch that descended distally along the medial side of the arm. This artery accompanied firstly the ulnar nerve, then it diverted laterally towards the median nerve and coursed hidden behind it to re-enter the brachial artery within the distal part of the arm, next to the biceps brachii muscle. The calibre of the accessory brachial artery was two mm only. Conclusion: The accessory brachial artery is a rare variant of the upper limb vascular system and its prevailingly narrow lumen can cause a failure of the transradial/transulnar catheterization intervention.