ARS Medica Tomitana
vol. XVI - nr. 2 (61) - april - june 2010

20 Years Of Anatomy In Constanţa
P. Bordei, D. Iliescu, Elena Şapte

It started with only seven rooms, with some tables and chairs and, of course, students, but with an enormous desire to give birth to the Faculty of medicine in Constanta; those anatomy lectures and labs were the first student's teaching activities that began in Constanta. There were two anatomists and a surgeon (a very good one!) that become the pioneers! Former professor Dan Ulmeanu started the general medicine, the current professor Petru Bordei started the dentistry and the pharmacy and professor Vasile Sarbu become our Dean for nearly 12 years, with an extremely difficult task, as any beginning. Slowly, we completed the team with young professionals, many of them from the young doctors and residents in Constanta.

Modélisation 3D De La Tétralogie De Fallot
J. F. Uhl, Yasmine Benadjaoud, J. F. Paul, V. Delmas

RESUME. La tétralogie de Fallot est la plus fréquente des cardiopathies congénitales cyanogènes. Elle correspond à défaut de cloisonnement du bulbe artériel. Son évaluation est révolutionnée par le scanner avec reconstruction 3D. Grâce à celle-ci une visualisation incomparable, véritable dissection anatomique in vivo, permet de mieux apprécier la gravité des anomalies et de guider la tactique opératoire de réparation. Un cas clinique illustre l’intérêt de cette nouvelle approche anatomique.

Rotation Of The Two Pancreatic Buds In The Rat And Man Embryos During The Embryonic Period. Three Dimensional Computer Assisted Reconstruction. (Carnegie Stages 13-23)
M. Radi, J. Gaubert, R. C. Gaubert, V. Baecker, P. Travo, M. Prudhomme, G. Godlewski, D. Pradal-Prat

ABSTRACT. The purpose of the present study was to illustrate the modality of rotation of ventral and dorsal pancreatic buds by three dimensional (3D) reconstruction in the rat and the human embryos, during the Carnegie stages 13 -23. Serial sections of thirty rat embryos  and nine human embryos stages 13-23 were observed. The embryos were fixed in Bouin’s solution dehydrated, and paraffin embedded. The sections, 7µm thick, were cut in longitudinal or transverse planes and were stained alternately by hematoxylin-eosin or Heindenhain’s azan. The images were digitalized by Canon camera 350 EOS D. The 3 D reconstruction was performed by computer, using Cell Image Analyser computer. The two pancreatic buds ventral and dorsal, were clearly identified at stage 13, in anterior and posterior position respectively in relation to the duodenum. In stage 15, the duodenum started its rotation of 90° clockwise. The ventral bud moved of 90° from the midline to the right. In stage 16 the ventral pancreas continued its rotation until 180° in posterior position in the dorsal mesentery behind the duodenum. In stage 17 the two pancreatic buds were related closely to the ventral part of the portal vein. The two buds began to merge. The anterior face of the pancreas’s head was arising from the dorsal bud. The rest of the head including the omental tuberosity and the uncinate process emanated from the ventral bud. Between the stage 18 to the stage 23, no distinctive changes were recorded. At stage 23, the morphology of pancreas was definitive. The use of 3D Computer-assisted reconstruction of the rat pancreas illustrates the modality of the two pancreatic buds rotation and fusion. This method explains the final position of the pancreas. It could introduce the time as a fourth dimension, fundamental for the study of organogenesis and to explain numerous anomalies.

Modèle Anatomique Représentant La Dissection De La Tête Et Du Cou; Un Plâtre De Nicolas-Augier-Roux, Non Coloré
Patrice Le Floch-Prigent

RESUME. Le but de cette étude était d’apprécier la véracité anatomique d’une pièce représentant la dissection de la tête et du cou, en plâtre, non colorée de la collection Nicolas (avec Augier et Roux) appartenant aux collections pédagogiques des laboratoires d’anatomie, 45 rue des Saints Pères, Paris 6ème; d’en déterminer les techniques de présentation et de fabrication. La pièce a été observée après nettoyage et mensurations, et enfin des prises de vues photographiques numériques sous divers angles ont été effectuées.

Wrist Joint Synovial Folds In The Elderly: A Light Microscopy Study
S. Dyankova, D. Kamburov, G. Marinov

ABSTRACT. Age-related alterations in the structure of the synovial membrane play a crucial role in the pathogenesis of joint diseases. Very often these diseases are manifested on the background of advanced age-related changes in the synovial membrane. The present work demonstrates the results of research of the light microscopy structure of the synovial folds in the wrist joint complex. The microscopic structure of the synovial membrane demonstrates a considerable polymorphism. At certain places, its superficial layer is formed by several layers of synovial cells among which terminal vessels and synovial macrophages can be established. At single areas of plicae synoviales, the number of rows of synovial cells is greater than that described in the literature. Degenerative alterations in the synovial membrane are often observed. Initially, these changes manifest themselves by vacuolization and picnotic changes in the nuclei of the synovial cells followed by reduced number of these cells and occurrence of fissurae on the surface of the synovial membrane. With progression of the changes, one can establish large regions without any cells in them at all. The thickness of this layer progressively diminishes while the number of the fissures on its surface increases which results in deformation of the folds. These result convincingly demonstrate that the changes of the structure of plicae synoviales of the wrist joint in patients aged over 60 years relate to the age changes during the process of secretion-resorption of the intraarticular fluid which can cause the sensation of discomfort accompanied by a painful syndrome.

Modélisation 3D Des Malformations Veineuses Congénitales. Cas Clinique D’une Veine Marginale Persistante
J.F. Uhl, A. Ferdinand, O. Ami, C. Gillot, V. Delmas

RESUME. La veine marginale latérale persistante est une malformation congénitale de la vascularisation veineuse superficielle du membre inférieur. Son évaluation est révolutionnée par le scanner avec reconstruction 3D. Grâce à celle-ci une visualisation incomparable du réseau veineux du membre pelvien, véritable dissection anatomique in vivo, permet de mieux apprécier la topographie veineuse  et de dépister des anomalies des veines profondes associées qui conditionnent l’indication opératoire. Un cas clinique illustre l’intérêt de cette nouvelle approche anatomique.

The Relevant Anatomy Of Axillary Artery Cannulation In Acute Proximal Aortic Dissection
L. Seres-Sturm Jr., Z. Szabolcs, C. Nicolescu, L. Denes

ABSTRACT. In surgery of acute dissection of the proximal aorta the extracorporal circulation performed by cannulation of the axillary artery is more advantageous than the femoral route; it provides a selective anterograde cerebral perfusion and neuroprotection. Our 54 cases which underwent surgery demonstrate that in the axillary cannulation group global mortality decreased by 50% and cerebral mortality by 78 %, as compared to the femoral cannulation group. Because in axillary artery cannulation the brachio-cephalic pathway is the main factor, we interpreted its anastomotic variations and anastomotic circuits.

Issues Relating To The Perineal Portion Of Rectal Veins
V. Niculescu, M.C. Niculescu, Codruţa Petrescu, Roxana Folescu, M. Şelaru, Alina Şişu

ABSTRACT. Studying the perineal vein of the portion of the rectum should be performed in the general context of rectal veins, which originate in the rectal or hemorrhoidal plexus rich. It stretches the entire length of rectum, mesh network with more frequent and more numerous in the perineal portion where stands this small vein of form the ampoule of the rectum, which is outline future hemorrhoids. They are only human characteristics, they are generated by standing. Animals do not have hemorrhoids, but the monkeys already to meet. In the perineal portion of the rectum the small venous cavities ampoule shaped and varying sizes, make us believe that the venous ampoule act as pillows, hydraulic veritable pillows, which closing the sphincters fits together and thus contribute to contention. Implications in pathology must address the fact that superior rectal veins are draining in the port system and the middle and inferior rectal veins are draining in the inferior vena, making a portocaval anastomosis. We suggest the existence of a rectal port system or a hemorrhoidal port system, boundless notion still in anatomical nomenclature.

Sem, Histological And Immunocytochemical Investigations, In The Agger Of Varicose Great Saphenous Vein Valves
M. Kanellaki-Kyparissi, M. Minkov, K. Koliakou, V. Knyazhev, R. Guidoin, G. Marinov

ABSTRACT. It is well known that the valve agger is a part of the venous wall which plays an important role in the hydrodynamic function of the valve. However, the structure of the valve agger has not been completely clarified yet. The aim of the present study is to establish more detail on its structure, in both healthy and varicose human great saphenous veins. Segments of veins were examined by SEM, light microscopy, as well as by immunocytochemical methods. Some structural peculiarities were observed in this part of the valve complex. In the healthy veins, in comparison with the other parts of the venous wall, the valve agger was thicker and contained large number of vimentin-positive cells and small number of smooth muscle α-actin positive cells. During the varicose process the number of the latter cells was increased and some of them were observed in the valvular cusp’s stroma, in different distances from the agger. Whether this phenomenon may perform a reaction against the increasing hydrostatic pressure is discussed. According to our opinion, the valve agger may be the place where migration of smooth muscle α-actin positive cells takes place and, thus, it may be involved in the processes of development, survival, adaptation and pathology of the valve cusp.

Morphometry Of The Right Pulmonary Artery And Of Its Branches
M. Cambrea, R. Baz, D. Iliescu, P. Bordei

ABSTRACT. Using as study methods the dissection and the plastic (Technovit 7143) followed by corrosion with NaOH, and the study of ultrasonograms and CT examinations (3D reconstruction) on a total of 84 cases of right pulmonary arteries, we described the dimensional values (length and caliber) of the pulmonary artery and its collateral branches, and also assessing some other morphological characteristics, such as: their origin, direction, number, correspondence with bronchial branches. The length of the pulmonary artery, from the level of the pulmonary trunk bifurcation up to its first collateral division, we found a range from 2.94 to 5.3 cm, most often ranging between 3.8 to 4.8 cm. The caliber of the artery at its origin was between 1.40 to 2.67 cm, ultrasound sizes being smaller than those found on CT. The first collateral branch of the right pulmonary artery originated from a distance of 1 to 2.2 cm below the tracheal bifurcation, in relation with the vertebral column that origin can be found within the range of superior half of T5 to the inferior half of T7. The segmentary arteries of the superior lobe showed calibers of: apical - 6.5 - 7.8 mm, anterior - 7 to 8.4 mm, posterior - 6.2 to 7.5 mm. At the level of the superior pole, the apical and anterior arteries are more voluminous than their left correspondents with 1.5 to 3 mm; the posterior segmentary branch showed lesser while, in some cases, the left branch (when originates directly from the pulmonary artery) can be larger than the right one (always when of the right side are two posterior segmental arteries). In what concerns the middle lobe arteries, we found that lateral artery had a larger size (5.5 to 7.5 mm) than average (3.5 to 6.4 mm). Within the lower lobe, the superior segmental artery has a diameter of between 3.5 to 5.5 mm, sometimes being the largest branch of the lower lobe. Among the basal segmental arteries, the largest artery was the posterior basal, which we found a size ranging from 4 to 7.8 mm. In descending order of their size, the basal arteries are: the anterior (from 3 to 4.6 mm), the lateral (3.4 to 5.4 mm) and the medial (2.2-3.8 mm). Within the inferior lobe, both right and left upper segmental arteries showed a diameter approximately equal in size, with differences between them being 1 to 2 mm in favor of one of them. In the basal segmental arteries, we found the following: while within the right lung the largest was the posterior basal artery, in the left lung, frequently, the most voluminous is the lateral basal artery; the anterior basal arteries were approx. equal in size on both sides; the medial basal arteries were larger on the left side with approx. 0.5 to 1.5 mm than on the right side; the lateral basal arteries are more voluminous on the left side with 0.6 to 1.5 mm while the posterior basal arteries are more voluminous with 0.2 to 0.8 mm on the right side than on the left.

Placental Morphological Lesions In Preterm Birth. A Retrospective Cohort Study
Lidia Chircor, Mirela Cojocaru, V. Păştilă

ABSTRACT. The increased incidence of the premature newborn and premature mortality oblige to sustained research of the placenta. The authors wish to explore possible the hypothesis that abnormal microscopical morphology of the placenta is seen more frequently in cases of premature new-born placenta. The study concerne 1360 premature birth registered at the Constanta Clinic County Hospital in the last four years 2006 – 2009, 12 consecutive preterm deliveries’ placenta of premature newborn with gestational age 28-32 weeks (premature group) and 20 placentas from consecutive normal weight newborn babies delivered at term (control group). The macroscopic examination of the placenta reveals significant statistic smaller size and weight of the premature newborn placenta. Posterior located placenta and III degree maturation placenta characterize the premature group. The premature newborn group present loose shine, friable and less consistent placenta than the control group The placenta of the premature group is characterized by degenerative circulatory and inflammatory pathologic process. The chorionic villi present hyaline and fibrin dystrophy accompanied by angiomatosis and necrosis. Histologic examinations of the the placental reveals positive correlation for decidual ischemic transformation in premature bitrth. Diffuse decidual necrosis of the decidua basalis is relatively common in placentas of 23-32 week newborns. The acute, diffuse ischemic transformation of the chorion reflect the diminuation of the utero-placentar blood flow.

Morphometric Data Of The Blood Vessels From The Choroid Plexuses Of The Human Brain Ventricles
A. Darii

ABSTRACT. The digital values of the blood vessels from the choroid plexus of the human brain vary between them at different stages during ontogenetic development.
These variations are in direct concordance with morphological and functional development of the brain, choroid plexus and vascular network.

Genetic Induced Cardiovascular Malformations In Children
L. Onisai, S. I. Toma, Daniela Diaconescu, S. Diaconescu, C. L. Bold

ABSTRACT. CVMs represent one of the most common type of birth defects. Epidemiological studies have shown that CVMs are induced by tricloroethylene, bisdiamine and dioxine. Our study followed few pathogenetic chains: identification of new potential cardioteratogen agents; studying global gene expression profiles; specific signals transduction pathways and genetic regulatory circuits; CVMs are confirmes during the first year of life by cardiac catheterization, echocardiography, surgery and autopsy. The most common CVMs were: ventricular septal defect, atrial septal defects, atrio-ventricular septal defects in Down Syndrome, transposition of the great arteries with normal ventricualr septum, coartation of the aorta. All of the risk factors are categorical or dichotomous. Different genotypes are susceptible to environmental factors and induce CVMs.

Anatomical Aspects And Incidence Of The Three Headed Biceps Brachii Muscle
D. Precup, A.C. Trifan, A. Tamas-Szora

ABSTRACT. This study is aimed to present the anatomical characteristics of the third head of the biceps brachii muscle, a morphological variation discovered during dissections at the Department of Anatomy and Embryology of ,,Iuliu Hatieganu” University of Medicine and Pharmacy in Cluj Napoca. The biceps brachii muscle is classically described as a muscle originating from the scapula with two heads: the short head from the apex of the coracoid process and the long head from the supraglenoid tubercule. The variations of the biceps mainly consist in the existence of some accessory muscular or tendinous fascicles with different origins.  The method used in this study was the classical dissection of formalin preserved cadavers through which the occurrence of the accessory head was demonstrated. The morphological characteristics of this variation were observed, measured, photographed and recorded. In 17 cadavers, the occurrence of this variation was noticed in two cases, both bilaterally. In one of the cases, a unilateral muscular variation of the forearm, an unusual proper flexor muscle of the index, was observed. These supernumerary heads might be significant in producing the strong flexion as well as supination of the forearm. They may cause compression of neurovascular structures because of their close relationship to the brachial artery and median nerve. Variant biceps brachii may confuse a surgeon who performs procedures on the arm and may lead to iatrogenic injuries.

The Branches Of The Aortic Arch. Three Case Presentations Of Anatomical Variants
M. Gorun, C. Mihalache

ABSTRACT. The branches of the aortic arch, according to the classic anatomical description are represented by the brachiocephalic trunk (BCT) being the largest of the vessels, left common carotid artery (LCC) and left subclavian artery (LS). The origin of the LCC artery is more to the left close to the origin of the LS. However this configuration is only present in 80% of the cases, variations in the disposition of the 3 “classic” branches or the number of arteries arising from the arch can occur The presence of anatomical variations is very close related to the abnormal development of the aortic arches, and development of the heart in the embryonic life. The paper presents 3 cases of variants in the classic configuration of the branches of the aortic arch. In 2 of the cases the left vertebral (LV) artery arises from the aortic arch, between the left common carotid artery and the left subclavian artery: one case in an 7 moth spontaneously aborted human foetus, and one in an adult. In the third case, in a 45 years old male, the left subclavian artery was the largest of the 3 vessels and the origin of the brachiocephalic trunk and left common carotid arteries are very close.

Impairment Of Upper Viscerocranium Resistant Structures In Fractures Of Massive Facial
G. Stancu, Ghe. Stancu, Alina Maria Şişu

ABSTRACT. In massive facial injuries arise fractures which interested the resistance structures of the maxillary bone, nasal bone, zygomatic bone, the perpendicular plate of ethmoid bone, vomer bone,the perpendicular plate of palatine bone.
For this reason we consider appropriate the terminology “fracture of upper viscerocranium”. In the mechanical construction of upper viscerocranium the maxillary bone is the central morphologic structure involved in the largest proportion in forming the upper viscerocranium.
In addition, the two maxillary bones form other skeletal structures in upper viscerocranium, a uniform mechanical drawing which has the power to take, conduct and disperse the powerful forces of pressure through vertical columns:
• Nasofrontal pillar,
• Zygomatic pillar,
• Pterygoid pillar,
• Median-nasal pillar.


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