Víctor Götzens

Anatomy of the ankle ligaments: a pictorial essay

Understanding the anatomy of the ankle ligaments is important for correct diagnosis and treatment. Ankle ligament injury is the most frequent cause of acute ankle pain. Chronic ankle pain often finds its cause in laxity of one of the ankle ligaments. In this pictorial essay, the ligaments around the ankle are grouped, depending on their anatomic orientation, and each of the ankle ligaments is discussed in detail.

The axillopectoral muscle (of Langer) report of three cases

Abstract The axillopectoral muscle, usually called Langer’s axillary arch instead of Langer’s arm arch, is a supernumerary muscle and is the principal anatomic variation of the axilla. Three cases of the muscle were observed originating from latissimus dorsi crossing over the axillary neurovascular bundle and inserting deep to the insertion of pectoralis major or into the coracoid process. Clinicians should be aware of its existence as it can give rise to different pathologies. It should be recognised and excised to expose the axillary artery and vein in patients with trauma and to perform axillary lymphadenectomy or axillary bypass. It should be considered in the differential diagnosis of axillary masses or in a history of intermittent axillary vein obstruction. If the muscle causes problems its excision should be curative.

Ultrasound-guided umbilical nerve block in children: a brief description of a new approach.

Background : The most popular peripheral nerve blocks used in umbilical hernia repair are rectus sheath block and paraumbilical block. However, multiple anatomic variations have been described and some complications may occur. Ultrasonographic guidance of peripheral nerve blocks has reduced the number of complications and improved the quality of blocks. This case series describes a new ultrasound‐guided puncture technique of the 10th intercostal nerve in pediatric umbilical surgery.

Migration pathways of hypodermically injected technetium-99m in dogs.

Hypodermic injection of technetium-99m (99mTC-pertechnetate) at points of low electrical resistance give rise to rapid, longitudinal, and progressive diffusion of the radioactive tracer. We assessed the effect of cutaneous incisions that did not intersect the migration trajectory of 99mTc-pertechnetate and the re-establishment of pathways after the suture of incisions that intersected the migration trajectory. Linear and rapid migration of 99mTc-pertechnetate was not altered or prevented by incisions that did not intersect the migration pathway. Different patterns of 99mTc-pertechnetate spread were found when incisions intersected the radioactive pathways until restoration of the normal migration pathway observed in undamaged skin occurred. In all experiments in which migration of 99mTc-pertechnetate was observed, lavage of surgical wounds was followed by disappearance of the 99mTc-pertechnetate migration observed around the suture. Linear migration of the tracer was not observed when the incision was left uncovered, filled with petroleum jelly, or with a solid silicone sheet, but it was seen when non-sutured incisions were filled with transonic or silicone gel or covered with a solid silicone sheet parallel to the cutaneous plane. These data show that after a cutaneous incision that intersected the diffusion trajectory of the radioactive tracer, linear migration of 99mTc-pertechnetate hypodermically injected at points of low electrical resistance was restored before healing of the cutaneous incision and was independent of incisions made on the skin not overlying the radioactive pathway. A mechanism similar to that of capillary electrophoresis is suggested to explain the hypodermic diffusion of inert particles through specific and constant linear pathways.

Supernumerary breast on the thigh of a woman

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PREVALENCE OF ANOMALIES IN THE APPENDICULAR SKELETON OF A FOSSORIAL RODENT POPULATION

The prevalence of macroscopic bone anomalies in the appendicular skeleton of wild rodents and, particularly, fossorial species is not well known. We examined 8,257 bones corresponding to 564 collection specimens (249 males and 315 females) of a fossorial form of water vole (Arvicola terrestris monticola). Animals were obtained monthly from July 1983 to December 1984 in the Aran Valley (Pyrenees). Most macroscopic anomalies were healed fractures or exostoses. The prevalence of anomalies was not significantly different between males and females but was clearly higher in adults than in juveniles and subadults. The frequency of alterations in the thoracic limb long bones was significantly higher than that in the pelvic counterparts. Aggressive intraspecific interactions and biomechanical factors related to burrowing may be associated with these differences. In females, remodeling of the innominate shape because of pregnancy and parturition could enhance fractures and exostoses in this structure.

Kinetics of hypodermically injected technetium-99m and correlation with cutaneous structures: an experimental study in dogs

We investigated the involvement of cutaneous structures in specific linear migration pathways of technetium-99m pertechnetate hypodermically injected at points of low electrical resistance in the metacarpus of male beagles. Skin-deep incisions were made in the front or back legs on either the same side as the 99mTc injection or on the opposite side. Incisions in the back legs did not affect the migration pattern. Incisions in the front legs before the injection of 99mTc prevented tracer migration. After the injection of 99mTc, incisions in the front contralateral leg caused sudden cessation of the migration, while incisions in the ipsilateral leg caused immediate disappearance of the pathway previously observed. Radioactivity was not detected in flaps obtained from the skin overlying the migration pathway or from the corresponding area of the contralateral leg. In conclusion, the specific linear migration pathways of 99mTc hypodermically injected at points of low electrical resistance cannot be explained by any known biological function. Although the migration of 99mTc does not seem to be strongly linked to any cutaneous structure, the skin overlying the radioactive pathway and the corresponding area of the contralateral leg must be intact if tracer migration is to take place.

The HIF1A C85T Single Nucleotide Polymorphism Influences the Number of Branches of the Human Coronary Tree

Objectives: Hypoxia is required for the development of the cardiovascular system. Tissue adaptation to low oxygen is mediated through hypoxia-inducible factor 1. Hypoxia-driven gradients of vascular endothelial growth factor within the heart drive vessel tip sprouting and the angiogenic phase of vasculogenesis. We hypothesized that functional variants of the HIF1A C85T single nucleotide polymorphism (SNP) are associated with the number of coronary artery branches in humans. Methods: Coronary artery branching in 88 individuals was assessed by dynamic counting of the arterial branches detected in coronary angiograms. Values were classified on the basis of the branches emerging from the right and left coronary arteries. HIF1A C85T genotypes were determined using TaqMan-based assays. A generalized linear model was used to measure the effect of each SNP on the response variables. Results: The presence of the T allele in the HIF1A C85T SNP was associated with few branches of the coronary arteries: 81.03 ± 1.79 for individuals with the CC genotype versus 74.09 ± 2.48 for T-carrying ones (p = 0.042). Conclusions: The functionality of HIF1A may influence the degree of branching of the human coronary tree. We propose that the HIF1A C85T SNP is a genetic marker that determines interindividual differences in the human coronary artery pattern.

The PLAU P141L Single Nucleotide Polymorphism Is Associated With Collateral Circulation in Patients With Coronary Artery Disease

INTRODUCTION AND OBJECTIVES Urokinase-type plasminogen activator, which is encoded by the PLAU gene, plays a prominent role during collateral arterial growth. We investigated whether the PLAU P141L (C > T) polymorphism, which causes a mutation in the kringle domain of the protein, is associated with coronary collateral circulation in a cohort of 676 patients with coronary artery disease. METHODS The polymorphism was genotyped in blood samples using a TaqMan-based genotyping assay, and collateral circulation was assessed by the Rentrop method. Multivariate logistic regression models adjusted by clinically relevant variables to estimate odds ratios were used to examine associations of PLAU P141L allelic variants and genotypes with collateral circulation. RESULTS Patients with poor collateral circulation (Rentrop 0-1; n = 547) showed a higher frequency of the TT genotype than those with good collateral circulation (Rentrop 2-3; n = 129; P = .020). The T allele variant was also more common in patients with poor collateral circulation (P = .006). The odds ratio of having poorly developed collaterals in patients bearing the T allele (adjusted for clinically relevant variables) was statistically significant under the dominant model (odds ratio = 1.83 [95% confidence interval, 1.16-2.90]; P = .010) and the additive model (odds ratio = 1.73 [95% confidence interval, 1.14-2.62]; P = .009). CONCLUSIONS An association was found between coronary collateral circulation and the PLAU P141L polymorphism. Patients with the 141L variant are at greater risk of developing poor coronary collateral circulation.

An inconstant ligament in the popliteal region associated to the superior genicular arteries: surgical importance

Materials and methodsIn the dissection of 60 knees of 30 cadavers (13 women and 17 men), a ligament was located in the posterior femur face above the lateral or medial condyle.ResultsThis ligamentous structure was found in 12 (20%) out of 60 knees studied (38% of the women and 35% of the men). It had a vertical arrangement and a constant direct relation to the superior (lateral or medial) genicular artery, and in no case it appeared as a posterior reinforcement of the capsule. The superior vessels were fixed by this ligament.DiscussionThis fixation may provide stability to the vascular tree but it could be a cause of post-surgical hemarthrosis in arthroscopy of the posterior knee area or in posterior or lateral knee approaches or it could be even implicated in vascular injury of the popliteal artery during knee dislocation.ConclusionThe objective was to describe this inconstant ligament and to study its clinical relevance for surgical procedures, and particularly for those using the posterior approach to the knee joint.