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ABSTRACT: The aim of this study was to show the connection between structure (anatomical and histochemical) and function (muscle contraction properties) of vastus medialis obliquus (VMO) and vastus medialis longus (VML). The non-invasive tensiomyography (TMG) method was used to determine the contractile properties (contraction time; Tc ) of VML and VMO muscle, as a reflection of the ratio between the slow and fast fibers in two groups of nine young men. VML and VMO significantly (P < 0.01) differ in the proportion of type 1 (59.6: 44%) and type 2b (6.3: 15%) fibers. The VML muscle is almost entirely composed of type 1 and type 2a fibers. In many samples of this muscle no type 2b fibers were found. The proportion of slow-twitch type 1 fibers is nearly twice as high as the proportion of fast-twitch type 2a fibers. These observations indicate that VML is a slower and more fatigue-resistant muscle than VMO muscle. These characteristics correspond to the different functions of the VML, which is an extensor of the knee, and to the VMO, which maintains the stable position of the patella in the femoral groove. Our results obtained by TMG provided additional evidence that muscle fibers within the segments of VM muscle were not homogenous with regard to their contractile properties, thereby confirming the histochemical results. Tc can be attributed to the higher percentage of slow-twitch fibers - type 1. The statistically shorter Tc (P ≤ 0.001) of VMO (22.8 ± 4.0 ms) compared with VML (26.7 ± 4.0 ms) in our study is consistent with previously found differences in histochemical, morphological and electrophysiological data. In conclusion, the results of this study provide evidence that the VML and VMO muscles are not only anatomically and histochemically different muscles, but also functionally different biological structures.
Journal of Anatomy 04/2013; · 2.37 Impact Factor
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ABSTRACT: The objective of this study was to determine precise localization and external diameter of the lower abdominal wall perforators as well as to investigate some vascularity differences between the same parts of perfusion zones II and III according to Hartrampf perfusion zones. The study was performed on 10 fresh cadavers (20 hemiabdomens) using the gelatin injection technique. All perforators were identified, and their localization and diameter were noted. Measurements were made at the level of the fascia. We noted localization and diameter of arteries on cross-sectional planes of either part of the flap. The median sum of the external diameter of all arteries in zone I was 17.01 mm. The median sum of the external diameter of all arteries in the medial 1/3 part of zone III was 4.17 mm, and in the medial 1/3 part of zone II, it was 0.96 mm. The median sum of the external diameter of all arteries in the intermediary 1/3 part of zone III was 2.16 mm, whereas in the intermediary 1/3 part of zone II, it was 0.81 mm. Significant differences were recorded between proximal and middle horizontal regions of zones II and III and between medial vertical part of zone III and medial vertical part of zone II. Anastomoses between zones I and II are considerably smaller compared with anastomoses between zones I and III. The best vascularized parts of the lower abdominal wall were perfusion zone I, then the inner 2/3 of zone III and medial 1/3 of zone II.
Microsurgery 11/2011; 32(1):43-9. · 1.61 Impact Factor
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ABSTRACT: The control of the left hepatic vein (LHV) and the common trunk of the middle hepatic vein (MHV) and LHV (CT) is considered difficult during liver resection and could be improved by detailed knowledge on the ligamentum venosum Arantii (LV).
The aim of this study was to describe the LV and its connections to the LHV and the CT and to present surgical relevance of the obtained data.
During autopsy of 50 cadavers of both sexes, the LV was exposed, measured and then dissected, simulating a surgical maneuver to facilitate the approach to the LHV and CT. The extrahepatic parts of the LHV, MHV and CT were measured.
The LV was 52-70 mm long and 5-8 mm thick. It had a fibrotic structure and was not patent in 96% of the cases. The extrahepatic part of the LHV measured 3-19 mm, that of the MHV 3-18 mm and that of the CT 4-15 mm.
LV dissection facilitated extraparenchymatous clamping of the hepatic veins: the extrahepatic parts of the LHV and CT measured > 3 mm in 86 and 84% of the cases, respectively.
Cells Tissues Organs 02/2009; 190(5):297-300. · 2.20 Impact Factor
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ABSTRACT: There are nearly no data on the hepatocaval ligament (HCL) in the anatomical literature, though it is of high importance during surgery of the right hemiliver. Aim: The aim of this study was to determine the frequency of the HCL, its description and its relations to the inferior vena cava (IVC) and the right hepatic vein (RHV) as well as the evaluation of the surgical relevance of the data obtained.
The dissection of the livers of 43 cadavers of both sexes was performed and the presence of the HCL was established. The ligament was measured and dissected to expose the IVC and the extrahepatic part of the RHV from its inflow to the liver parenchyma.
The ligament was present in 77% of the cases. It was 12-35 mm long and 3-18 mm wide. The extrahepatic part of the RHV was 2-12 mm long.
Dissection of the HCL revealed the terminal extrahepatic part of the RHV in all cases. Anatomically, resection of the right hemiliver with elective vascular control would be possible in 85% of the cases in which the length of the extrahepatic part of the RHV was > or =3 mm.
Cells Tissues Organs 01/2008; 187(3):243-6. · 2.20 Impact Factor
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ABSTRACT: A case of long diverticular colonic duplication producing acute abdominal pain in a 6-year-old girl is presented. Physical examination showed no signs of acute abdomen at the initial presentation. After a pain-free interval, there was a sudden onset of severe abdominal pain and a large tumor in the lower abdomen was observed. A plain x-ray showed an enormously dilated colonic pouch filled with gas. Excision of the T-shaped duplication and small part of the transverse colon was successful. Because of extensive fibrotic changes in the colon near the opening of duplication, a resection margin of at least 2 cm is recommended.
Journal of Pediatric Surgery 02/2006; 41(1):e59-61. · 1.45 Impact Factor
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ABSTRACT: The development of diagnostic methods and new surgical techniques means it is increasingly important to have accurate knowledge of the anatomy of the hepatic arterial and biliary systems, including their variations, at extrahepatic and intrahepatic levels. The aim of this study was to determine how often the biliary and arterial systems run together and branch in the same pattern. Fifty corrosion casts of the liver were used to analyse the origin and branching patterns of arteries and the confluences of bile ducts. In addition, both systems were analysed to determine the frequency of normal arrangements and variations. The congruence of the course of both systems was analysed at the porta hepatis and in the left and right hemilivers down to the segmental level. A congruent course of the arterial and the biliary systems was identified in 38% of cases at the porta hepatis, in 32% of cases in the left hemiliver and in 30% of the right hemiliver. The congruence of both systems at the porta hepatis and in the left hemiliver was identified only if both systems were normal. In the right hemiliver, however, the congruence of both systems was identified even when both systems were variable, but only in 10% of cases. The results of the study show that, on the basis of knowledge of the course and branching of one system, the other system cannot be predicted.
European Journal of Morphology 08/2005; 42(3):135-41.
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ABSTRACT: Thorough knowledge about the origin of the cystic artery is surgically important, especially when intraoperative or post-operative bleeding occurs in the gallbladder fossa. The arterial supply of the gallbladder was studied in 81 livers. The gallbladder was supplied by one cystic artery in 86% and by two arteries in 14% of cases. When a single artery was present, it originated from the right hepatic artery in 53% of livers. Other origins included the anterior or the posterior sectional hepatic artery, the replacing right hepatic artery, and in 5% of cases, segmental arteries for segments 4, 5, 6 and 8. When two cystic arteries supplied the gallbladder, both most commonly originated from the right hepatic artery (7% incidence). In 1% of cases, a subsegmental branch for segment 6 and a subsegmental branch for segment 5 respectively, originated from the cystic artery.
European Journal of Morphology 03/2003; 41(1):31-4.
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ABSTRACT: The arterial supply to the right hemiliver was studied in 80 liver casts. The arteries were divided into 10 groups according to their origin and branching pattern. The right hemiliver was supplied by one artery in 96% of cases and by two arteries in 4%. When there was only one artery it originated from the proper hepatic artery in 73/77 cases and from the superior mesenteric artery in 4/77 cases. The replacing right hepatic artery which originated from the superior mesenteric vessel supplied the whole right hemiliver in 5% of cases. The incomplete replacing right hepatic artery which supplied only a part of the right hemiliver was found in 4% of cases. The anterior section (segments 5 and 8) was supplied by one artery in 61%, by two arteries in 30% and by three arteries in 9% of cases. The posterior section (segments 6 and 7) was supplied by one artery in 66%, by two arteries in 31% and by three arteries in 3% of cases. Segments 5 and 7 were predominantly supplied by one artery, whereas segments 6 and 8 by two arteries.
European Journal of Morphology 01/2003; 40(5):267-73.
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ABSTRACT: The arterial supply to the left hemiliver was studied in 70 liver casts. The arteries were divided into 15 groups according to their origin and branching pattern. The left hemiliver was supplied by one artery in 53% of cases, by two arteries in 40% and by three arteries in 7%. The left hepatic artery, which originated from the proper hepatic artery, supplied all three left segments in 39% of specimens. The replacing left hepatic artery, which originated from the left gastric artery, supplied the whole left hemiliver in 3% of cases. The incomplete, replacing left hepatic artery supplied segments 2, 3 and a part of segment 4 in 6% of cases, and only segments 2 and 3 in 11%. There was one segmental artery for segment 2 in 86%, and two in 14%. Segment 3 was supplied by one artery in 87%, and by two in 13%. Segment 4 was supplied by one artery in 39% of cases, by two arteries in 43%, by three in 14% and by four arteries in 4%.
European Journal of Morphology 05/2002; 40(2):115-20.
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ABSTRACT: A morphological study of the right hepatic veins (RHVv) was conducted based on the shape and the confluence pattern of the superior right hepatic vein (SRHV) and the presence of accessory right hepatic veins. The study was performed in 110 undamaged, randomly selected, cadaveric human livers prepared using the corrosion cast methodology. The principles for classifying the RHVv into types were as follows: the length of the vein trunk, the confluence of 2 or 3 main tributaries that form a trunk, and the accessory right hepatic veins that modify the venous drainage of the right side of the liver. Four types of SRHV were identified. Type 1 (20%), type 2 (40%) and type 3 (25%) were the most common, while type 4 (15%) was linked to the accessory right hepatic veins in cases where they drain a surgically important part of the liver. Accessory right hepatic veins were found in a total of 31 casts (28%). The hepatocaval confluence was studied and the tributary-free part of the SRHV trunk before it entered the inferior vena cava was measured. The tributary-free part of the SRHV was longer than 1 cm in 77% of the casts. Anastomoses between the terminal tributaries of the veins involved in the drainage of the right side of the liver were also investigated.
Journal of Anatomy 09/2000; 197(3):487 - 493. · 2.37 Impact Factor
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ABSTRACT: The anterior approach to right hepatectomy using the liver hanging maneuver without liver mobilization claims to be anatomically evaluated. During this procedure a 4 to 6-cm blind dissection between the inferior vena cava and the liver is performed. Short subhepatic veins, entering the inferior vena cava could be torn and a hemorrhage, difficult to control, could occur.
On 100 corrosive casts of livers the anterior surface of the inferior vena cava was studied to evaluate the position, diameter and draining area of short subhepatic veins and inferior right hepatic vein. The width of the narrowest point on the planned route of blind dissection was determined.
The average value of the narrowest point on the planned route of blind dissection was 8.7+/-2.3mm (range 2-15mm). The ideal angle of dissection being 0 degrees was found in 93% of cases. In 7% we found the angle of 5 degrees toward the right border of inferior vena cava to be the better choice.
Our results show that liver hanging maneuver is a safe procedure. With the dissection in the proposed route the risk of disrupting short subhepatic veins is low (7%).
Hepato-gastroenterology 52(63):728-30. · 0.66 Impact Factor
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ABSTRACT: In a morphological study of the right hepatic veins anatomical characteristics of surgical importance were looked for.
110 cadaveric human livers were prepared by the corrosion casts method. The confluence patterns of the superior right hepatic vein, the hepatocaval confluence, the accessory right hepatic veins and the anastomoses between hepatic veins in the right hemiliver were examined.
Four types of the superior right hepatic vein, based on the length of its trunk and the confluence pattern of its main tributaries were determined and their frequency was calculated. Type I was found in 20%, type II in 40%, type III in 25% and type IV in 15%. Accessory right hepatic veins with a minimal caliber of 0.4 cm, which were always present in type IV, were also found in other types, all together in 27% of the casts. The tributary-free part of the superior right hepatic vein at hepatocaval confluence was longer than 1 cm in 77%. In the right hemiliver 109 anastomoses were found in 29/110 liver casts.
Knowing the characteristics of different superior right hepatic vein types and of the accessory right hepatic veins may be useful in segment-oriented liver resections and in right side living donor resections.
Hepato-gastroenterology 50(51):656-60. · 0.66 Impact Factor
