SM Journal of Clinical Anatomy

Archive Articles

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Assessment of an Anatomic Variant That May Mimic Prefracture Findings of Drug-Associated Atypical Femoral Fractures on Conventional Radiographs: The Third Trochanter

Introduction: The study objective was to assess lateral femoral cortex variants that may mimic prefracture findings of drug-associated atypical femoral fractures (AFF) among hip radiographs.

Materials and Methods: Bilateral hip radiographs of 1493 consecutive patients (mean age 67.7, 804 women) were reviewed. Hips were positive if localized lateral subtrochanteric femoral cortical thickening (LSFCT) was present. Positive studies were divided into a medication group if history of bisphosphonate or denosumab use was present or a variant group. The medication group was subcategorized into a prefracture group if classing beaking LSFCT or a contralateral AFF was presentor a non-prefracture group. The LSFCT width, femoral head and lesser subtrochanteric distances were measured. Analysis of Variance (ANOVA) was performed (p <0.01) to compare the three groups, with post hoc Tukey HSD evaluation. Cross-sectional imaging for each group was reviewed.

Results: Of the1493 exams, 1079 were included. In the 24 patients with LSFCT, 8 patients were assigned to the medication group and 16 to the variant group. Of the 8, 3 met criteria for the prefracture group and 5 were subcategorized to the non-prefracture group. Differences among the prefracture versus the non-prefracture and variant groups were statistically significant (p<0.01). Cross-sectional imaging of the correlated LSFCT with the third Trochanter posterolaterally in the variant group and laterally for the prefracture group

Conclusions: The third trochanter is an anatomic variant that may mimic prefracture findings of drugassociated AFF. The third trochanter can be differentiated radiographically from prefracture AFF findings with a < 3 mm width and < 3mm lesser subtrochanteric distance.

 

Troy H Maetani1 *, Stacy E Smith2 and Barbara N Weissman2


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Branching Pattern of Collateral Branches of the Subclavian Artery

Introduction: The arteries of the posterior cervical triangle (lateral cervical region) are frequently used for flap design in plastic and reconstructive surgery. In particular, the musculocutaneous flaps, such as the flap of the lower trapezius and the dorsal scapular flap, are based on the integrity and functional availability of the dorsal scapular artery. Likewise, the cervico-dorsal and cervico-scapular flaps are based on the superficial cervical artery. We can assume that the mode of birth of these arteries - and the possibility of their origin directly from the subclavian artery - will have consequences on their vascular dynamics. These consequences can result in good or bad viability of the irrigated flaps. The objective of the present study was to highlight the birth modalities of the subclavian artery branches

Material and Methods: Dissection was performed in 58 anatomical regions from 32 non-formalin fixed cadavers. The cadavers had no history of surgery or deformity in the areas targeted for dissection (supraclavicular and dorsal regions). They were embalmed using a glycerin-rich, formalin-free solution to preserve tissue suppleness.

Results: The average age of the donors was 72.32 years (range, 34–90) and there were 21 males and 11 females. We find some similarities, with a predominance for types D (Cervico-scapular trunk from the thyrocervical trunk: 28%), A (Separate origin of superficial cervical, dorsal scapular, and suprascapular arteries: 19%), and C (Cervico-dorsal trunk from the subclavian artery: 15%).

Conclusion: There are many anatomical variations concerning the birth modalities of the collateral branches of the subclavian artery. Surgical teams should consider these variations when exploring the region of the lateral triangle of the neck.

Philippe Manyacka Ma Nyemb1,2*, Christian Fontaine3, Xavier Demondion3, Maurice Demeulaere3, Fabien Descamps3 and Jean-Marc Ndoye4


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Anatomical Apps and Smartphones: A Pilot Study with 100 Graduation Students

Background: Anatomical teaching is going through several changes. Several studies observed that the students are deeming anatomy as outdated and irrelevant. The rates of lectures attendance and interest are declining. In this context, tools such as body painting, board games and team quizzes are appearing in the classroom to aid and motivate the student. Often, these complementary tools showed positive results towards their goals in the learning process of several branches of medicine. The smartphone has also been used for these purposes, although the literature lacks studies regarding anatomy. The study conducted herein aimed to create a pilot version of an anatomical application for the smartphone and disseminate its usage in nursing students

Methods: A smartphone application was self-produced with the tool known as Fábrica de Aplicativos© (https://fabricadeaplicativos.com.br) and consisted of anatomical terms and their meaning (Dictionary of Anatomy). The students had the opportunity to use this application during the semester and by the end of the period they answered a questionnaire with questions about the quality and efficacy of the app, with the option of submitting suggestions for its improvement.

Results: 100 graduation students were enrolled in this study. The overall evaluation of the dictionary was excellent/great (65%), while critics such as the lack of better images, the lack of a search resource and the lack of sections were pointed out.

Conclusion: As such, it was observed that the smartphone may have a positive effect in the learning process of anatomy, as demonstrated by our study

Lucas Alves Sarmento Pires1 , Tulio Fabiano de Oliveira Leite2 , Albino Fonseca Junior1 , Marcio Antonio Babinski1 and Carlos Alberto Araujo Chagas1


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A Symptomatic Multiseptate Gallbladder without Gallstones

Multiseptate Gallbladder is a rare congenital abnormality, which can be totally asymptomatic or responsible for biliary pain in the absence of cholelithiasis or cholecystitis. In case of persistent symptomatology, cholecystectomy represents the treatment of choice

Damien Dousse1 *, Laura Marcu2 and Francesco Martini1


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Evidence for Endogenous Neurosteroid Production in the Mammalian Olfactory Mucosa: Immunocytochemical Localization of Cytochrome P450 SideChain Cleavage Enzyme

Steroid hormones and their metabolizing enzymes have previously been identified in the olfactory mucosa. Enzymes of the cytochrome P450 family that are thought to play a role in the metabolism or activation of airborne toxins have also been identified in mammalian olfactory mucosae. In the synthesis of steroid hormone, cholesterol is transported to the mitochondria where the side-chain cleavage enzyme (cytochrome P450scc) converts cholesterol into pregnenolone. Conversion of cholesterol to pregnenolone is an obligate step in steroid hormone production. The specific aim of this study is to identify cytochrome P450scc in the mammalian olfactory mucosae. Using polyclonal antibodies to cytochrome P450scc, we found immunoreactivity for cytochrome P450scc in the rat olfactory mucosa. Within the olfactory epithelium, the supranuclear region of sustentacular cells was immunoreactive for cytochrome P450scc. Olfactory neurons, basal cells, olfactory nerve axons and acinar cells of Bowman’s glands were unstained. In positive control tissue (adrenal glands), staining for cytochrome P450scc was seen in all layers of the adrenal cortex. The localization of cytochrome P450scc to sustentacular cells is consistent with a functional role for mitochondrial cytochrome P450scc in the production of olfactory mucosa-specific neurosteroids. These endogenous neurosteroids are most likely involved in the modulation of olfactory function

James D Foster*