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Atrioventricular valve surgery poses a risk of myocardial infarction due to the proximity of the coronary arteries. Percutaneous techniques also present a risk of coronary injury. Our objective was to identify, on the mitral and the tricuspid annuli, the zones of high risk given their proximity to the circumflex artery and the right coronary artery, respectively. We dissected the courses of the circumflex artery and the right coronary artery in 25 explanted hearts. The distances were measured at reference points according to a clock-face model. Proximity was “very high”, “high”, or “relative” for distances of less than 5 mm, between 5 and 10 mm, or more than 10 mm, respectively. The mitral annulus zone of “high” proximity was located between “7:30” and “10:00” (minimum 6.5 mm at “9:30”). The tricuspid annulus zone of “very high” proximity was located between “1:30” and “3:00” (minimum 4.0 mm at “2:00”). The circumflex artery seemed closer to the mitral annulus in the hearts with left coronary dominance (n = 2), emphasizing the importance of the preoperative coronary angiography. Zones at risk of coronary damage were identified on the mitral and the tricuspid annuli between “7:30” and “10:00”, and between “1:30” and “3:00”, respectively. Knowing them can help interventionists avoid ischemic complications. Based on an innovative clock-face orientation scheme in which the distance data were collected at multiple reference points on a superimposed template, our study provides an intuitive and detailed overview of the critical distances between valves and arteries.

Introduction Given the high variability and fragility of the thoracic duct, good knowledge of its anatomy is essential for its repair or to prevent iatrogenic postoperative chylothorax. The objective of this study was to define a site where the thoracic duct is consistently found for its ligation. The second objective was to define an anatomically safe surgical pathway to prevent iatrogenic chylothorax in surgery for aortic arch anomalies with vascular ring, through better knowledge of the anatomical relationships of the thoracic duct. Methods Seventy adult formalin-fixed cadavers were dissected. The anatomical relationships of the thoracic duct were reported at the postero-inferior mediastinum, at levels T3 and T4. Results The thoracic duct was consistently situated between the left anterolateral border of the azygos vein and the right border of the aorta between levels T9 and T10, whether it was simple, double, or plexiform. It was located medially, anteromedially, or posteriorly to the left subclavian artery in 51%, 21%, and 28% of the cases, respectively, at the level of T3. At T4, it was posteromedial in 27% of the cases or had no direct relationship with the aortic arch. Conclusion These results favor mass ligation of the thoracic duct at levels T9-T10 between the right border of the aorta and the azygos vein, eventually including the latter. To prevent iatrogenic postoperative chylothorax in aortic arch anomalies with vascular ring surgery, we recommend remaining strictly lateral to the left subclavian artery at the level of T3 to reach the aortic arch anomalies with vascular ring at T4.

Resume L’examen macroscopique est une des etapes essentielles de l’examen anatomopathologique d’un prelevement de chirurgie thoracique. Il comprend la description de la piece operatoire et des lesions et l’echantillonnage precis et exhaustif des territoires tumoraux et adjacents a la tumeur. Cet examen necessite une bonne connaissance de la classification pTNM actualisee. Les pathologistes du groupe PATTERN se sont associes a des chirurgiens thoraciques, sous l’egide de la Societe francaise de pathologie, pour proposer des recommandations sur la prise en charge macroscopique des pieces operatoires pulmonaires pour carcinome. Cette demarche s’inscrit dans le contexte de la reedition du compte rendu d’anatomie pathologique structure des carcinomes pulmonaires, recommande par la societe francaise de pathologie et necessaire a une prise en charge standardisee des patients.

Background In medicine, the patient-centered approach is based on interpersonal skills, including communication, structuring the medical interview, and empathy, which have an impact on health professionals’ interpersonal relationships and the quality of care. Training courses on this issue are therefore being developed in universities. We hypothesized that specific training courses in the physician–patient relationship could improve interpersonal skills among medical students during simulated consultations and the immediate satisfaction of standardized patients. Methods This cross-sectional study enrolled fourth-year medical students who participated in a simulated medical consultation session with standardized patients. The evaluation of interpersonal skills was carried out using the Four Habits Coding Scheme, producing a synthetic score out of 115 points used as the primary endpoint. Some students benefited from the training courses offered by the university or by other organizations, mainly based on communication, active listening, or patient-centered approach. A comparison was made with students from the same graduating class who had not received any training. Results The analysis of the primary endpoint showed a difference of 5 points between the group of students who had attended at least one training course and those who did not (p = 0.001). This difference was even more marked when the students had completed several training courses, up to 14 points higher with three training courses (p = 0.001), each with positive results in different areas of the care relationship. Conclusions Physician–patient relationship training currently provided in initial education appears to be effective in improving interpersonal skills. A repetition of this training is necessary to increase its impact.

Dissection provides direct experience in anatomy, which constitutes an essential discipline for medical students. For this purpose, we created a dissection guide for students in the 2nd-year of medical studies at the Grenoble University School of Medicine. The objective was to evaluate this tool of reverse pedagogy in terms of student satisfaction and educational interest. Every 2nd-year student takes four sessions of limb dissection. To assist this dissection course, we developed a photographic guide launched in 2013. It includes an introduction presenting a methodology for dissection, followed by detailed protocols for each dissection area. Each step is illustrated with captioned photographs associated with a concise explanatory text. A questionnaire was then sent to 242 students to assess the impact of this tool and their overall satisfaction. Overall student satisfaction with this guidebook was rated 8.1 out of 10 with a 93.2% with significant improvement (p = 0.0137) and 78.7% of them declaring they had a better understanding of anatomy and mastery of the dissection techniques, respectively. In addition, students assessed the usefulness of the dissection guide at 3.6 out of 4 with the relevance of the content and presentation judged at 3.4 out of 4. Finally, the exam scores increased significantly with use of the guidebook (p

Bilateral adrenalectomy (BADX) has become an important treatment of Cushing's disease (CD), especially when other treatment options have failed. The aim of this study was to evaluate the long-term quality of life (QoL) of patients having undergone BADX for CD, in comparison to other therapeutic options.Thirty-four patients with CD were identified in two French centers: 17 underwent BADX and the remaining 17 one or more of the following treatments: surgery, medical therapy or radiotherapy. Three questionnaires were filled in by each patient in order to evaluate their QoL: Short Form-36 Health Survey (SF-36), Cushing QoL questionnaire and Beck depression inventory (BDI).The mean age of patients was 49.3±15.2 years. Average time lapse between diagnosis and BADX was 6.1 years. Results from each questionnaire adjusted to age showed a lower QoL among patients who underwent BADX. These were significant in most aspects of the SF-36 questionnaire (bodily pain P0.01, general health P0.01, vitality P≤0.05, social functioning P≤0.05), as well as in the Cushing QoL questionnaire (P0.05) and BDI (P≤0.05). Adrenal insufficiency appeared to be the major predictor of poor QoL whatever their initial treatment.Despite their clinical remission, patients who undergo BADX appear to be at a greater risk of suffering an impaired QoL due to more prolonged period of time with imperfectly controlled hypercortisolism combined with definitive adrenal insufficiency.

The aim of this original study was to determine the number of parathyroid glands that can be saved and reimplanted thanks to autofluorescence during thyroid surgery. Preservation of parathyroid function remains challenging during thyroid surgery. The parathyroid glands must be identified and immediately autotransplanted in the case of devascularization. Near-infrared autofluorescence of parathyroid glands has recently been proposed to help surgeons during the dissection. A total of 116 thyroid lobectomies were performed on 70 consecutive adult patients. Each lobectomy specimen was scanned in vitro with an autofluorescence imaging device. Every spot of autofluorescence was examined by the surgeon and subsequently the pathologist. The pathologist also performed a complete study of the rest of the lobe. We compared the results of the macroscopic and microscopic diagnoses. We detected 24 fluorescent spots on the specimens: 13 were considered to be parathyroid tissue by the surgeon and 11, non-parathyroid tissue. The pathologist confirmed the surgical diagnosis but also discovered 15 additional parathyroid glands that were hidden. Autofluorescence imaging of the thyroidectomy specimen with surgical inspection is safe, quick, noninvasive and can help detect the accidental removal of parathyroid glands. About 60% of these glands can be spared and autotransplanted during the surgery.

Summary Purpose Inferior vena cava (IVC) agenesis is an uncommon congenital vascular anomaly stemming from aberrant development during embryogenesis. It results from the failure of one or more of the supracardinal veins, subcardinal veins, vitelline veins or postcardinal veins to connect. The symptomatology resulting from this vascular malformation can be either absent or extremely rich and varied. Methods Thoracoabdominal-pelvic CT scan projections following iodine-based contrast product injection were analyzed and a three-dimensional model of vascularization constructed. Results Herein, an asymptomatic case of IVC agenesis with absence of the suprarenal and renal segments, with azygos continuation, presenting an accessory hepatorenal vein is reported. The presence of this type of accessory vein has never been described in the literature to date. The etiology of this case of IVC agenesis is explored in depth. We also analyzed the morphometric parameters of the IVC remnant segments and the azygos vein in order to quantify the dilatation of the collateral venous pathway overdeveloped to handle blood return. Conclusion Using the findings from this case and those reported in the literature, we provide general recommendations that should be taken into account before managing a patient, symptomatic or asymptomatic, admitted to the hospital with IVC agenesis.

Microscopic anatomical study of the hand requires difficult or destructive dissection techniques for each anatomical structure. Synchrotron phase-contrast imaging (sPCI) allows us to study precisely, at a microscopic resolution and in a nondestructive approach, the soft tissues and bone structures within a single 3D image. Therefore, we aimed to assess the capacity of sPCI to study the arterial anatomy of the hand and digits in human cadavers for anatomical purposes. A non-injected hand from an embalmed body was imaged using sPCI at 21-µm pixel size. The vascularization and innervation of the hands were virtually reconstructed at 84-µm resolution, and the medial neurovascular bundle of the third digit at 21 µm. The thinner-most distal structures were observed and reported. The diameter and thickness of the vascular and neural structures were defined on 2D computed tomographic axial projections, and using a granulometry method coupled to the 3D reconstructions. The vascularization of the hand was visible from the radial and ulnar arteries to the distal digital transverse anastomoses. The thinnest structure observed was the anastomotic arterial network around the proper palmar digital nerve. The latter emerged from the proper palmar digital artery and vascularized the nerve around its whole length and circumference. The perineural arterioles individualizable at this resolution had a diameter of 66-309 µm. In conclusion, sPCI allows both the arterial and neural anatomy of the hand to be studied at the same time, as well as the anatomical interactions between both networks. It facilitates the study of structures that have different sizes, diameters, thickness, and histological origin with great precision, in a noninvasive way, and using a single technique.

International audience; BACKGROUND:The Four Habits Coding Scheme (4-HCS) is a standardized instrument designed to assess physicians' communication skills from an external rater's perspective, based on video-recorded consultations.OBJECTIVE:To perform the cross-cultural adaptation of the 4-HCS into French and to assess its psychometric properties.METHODS:The 4-HCS was cross-culturally adapted by conducting forward and backward translations with independent translators, following international guidelines. Four raters rated 200 video-recorded medical student consultations with standardized patients, using the French version of the 4-HCS. We examined the internal consistency, factor structure, construct validity, and reliability of the 4-HCS.RESULTS:The mean overall 4-HCS score was 76.44 (standard deviation, 12.34), with no floor or ceiling effects across subscales. The median rating duration of rating was 8 min (range, 4-19). Cronbach's alpha was 0.94 for the overall 4-HCS, ranging from 0.72 to 0.88 across subscales. In confirmatory factor analysis, goodness-of-fit statistics did not corroborate the hypothesized 4-habit structure. Exploratory factor analysis resulted in two dimensions, with the merging of three conceptually related habits into a single dimension and substantial cross-loading for 15 out of 23 items. Median average absolute-agreement intra-class correlation coefficient estimates were 0.74 (range, 0.68-0.84) and 0.85 (range, 0.76-0.91) for inter- and intra-rater reliability of habit subscales, respectively.CONCLUSION:The French version of the 4-HCS demonstrates satisfactory internal consistency but requires the use of two independent raters to achieve acceptable reliability. The underlying factor structure of the original US version and cross-cultural adaptations of the 4-HCS deserve further investigation.

The pain involved in the herniated discs could be generated by some mobility of the nerve roots during straight leg raising (SLR). SLR produces some movement of nerves, but the magnitude of this displacement needs to be thorough, that is why we have investigated lumbo-sacral nerve root displacement in the spinal canal during the passive straight leg raise (SLR). Fourteen cadavers underwent laminectomy to mark the nerve roots of L2–S1 with lead balls. X-rays were taken during different movements imposed on the body: bilateral hip extension, left SLR then right and bilateral SLR. By superimposing these images two by two, the displacement of the nerve roots is quantified numerically during the various SLR maneuvers with respect to the reference position corresponding to the bilateral hip extension. The median range of the different nerve root movements ranged from 0.10 to 0.51 cm (p

Aim: Non-traumatic cardiac arrest is a major public health problem that carries an extremely high mortality rate. The Resuscitative endovascular balloon occlusion of the aorta (REBOA) procedure is currently being discussed as a possible technique to be used during Advanced Life Support (ALS) in humans with Cardiac arrest (CA). The aim of this study was to assess the training of emergency physicians in the procedures related to insertion of a novel REBOA catheter. Methods: We developed a training program using a simulated CA model on human cadavers. CPR was performed using the LUCAS device (Stryker/Jolife AB, Lund, Sweden). All cadavers were hemodynamically monitored. The Neurescue REBOA catheter (Neurescue REBOA device, Neurescue ApS, Copenhagen, Denmark) was inserted using a semi-surgical cut-down and sheath placement technique. Time needed to perform the procedures was measured. The procedures were instructed by 2 experts using video, procedural simulation on manikin and full-scale training on cadavers. Results: Six human cadavers were enrolled and a total of 12 procedures were performed by 2 expert investigators and 10 novice investigators. Eight semi-surgical cut-down producers including placements of the introducer sheath were performed on the first attempt and 4 required a second attempt. The median time required for the semi-surgical cutdown procedure and sheath placement by the novice investigators was: 6 min 48 sec (Min: 3 min 45 sec and Max: 26 min 25 sec). The median time required for the insertion and occlusion of the REBOA catheter by the novice investigators was: 3 min 22 sec (Min: 1 min 22 sec and Max: 7 min 5 sec). The median time required for full insertion for the novice investigators was: 11 min 14 sec (Min: 6 min 49 sec and Max: 28 min 15 sec). The mean aortic pressure during compression was: 31.9 mmHg (±17.0). Conclusions: Semi surgical cut-down and introducer sheath placement were performed in 1 or two 2 attempts for all novice investigators with an insertion time compatible with ALS during refractory CA. Simulation training on cadavers brings clinical realism and could be an important addition to the use of manikin or animal training models.

Objective:To report long-term follow-up of patients with multiple endocrine neoplasia type 1 (MEN1) and nonfunctioning pancreatic neuroendocrine tumors (NF-PET).Background:Pancreaticoduodenal tumors occur in almost all patients with MEN1 and are a major cause of death. The natural history and clinic

Summary Purpose Classically, the round ligament of the uterus (RLU) attaches distally in the ipsilateral labia majora. This attachment has rarely been described in adults. That is why we have performed an anatomical study focused on this distal ending. Patients We performed in 2015 the cadaveric dissection of 19 RLU. Methods In all cases, the RLU was individualized on its entire length from its uterine origin to the inguinal canal. Then this canal was open from its internal orifice to its external orifice. We described the distal attachment of the RLU according four areas: before the internal inguinal ring, after the external inguinal ring, under the pubic bone and in labia majora. Results We found 3 types of distal attachments with first an attachment after the external inguinal ring in more than half of cases (52.6%). Then, before the internal inguinal ring (26.3%) and under the pubic bone (22.1%). No RLU was found inlabia majora. However, the proximal attachment seems constant at the antero-superior face of uterus, near the tubo-uterine junction like its pelvic path under the broad ligament. Conclusion In adult, the RLU is a structure, which begins at the cranio-ventral part of the uterine bottom near the tubo-uterine junction. Then it passes under the broad ligament and reaches the inguinal canal, that it crosses in more half of cases. However, 3 distal attachment areas have been identified but never in the labia majora. Indeed, some anatomical information available in anatomical treaties seems not correct and should be amended.

Contexte Le catheterisme des veines surrenaliennes (CVS) est le gold standard pour determiner si un hyperaldosteronisme primaire (HAP) peut beneficier d’une surrenalectomie unilaterale. La TDM est jugee inferieure, car non specifique des adenomes secretant de l’aldosterone. Cependant l’etude SPARTACUS a retrouve un benefice identique aux surrenalectomies decidees sur la TDM ou le CVS. Ceci suggere que dans certains cas le CVS, habituellement normalise par le cortisol, est inferieur a la TDM. Objectif Evaluer l’interet d’une normalisation du CVS par l’adrenaline. Methodes et patients Un CVS avec mesure simultanee de l’aldosterone, cortisol et adrenaline a ete realise chez 78 patients porteurs d’un HAP, dont 34 avec gradient lateral > ou = 4 ont beneficie d’une surrenalectomie unilaterale. L’expression de CYP11B2, CYP11B1, CYP17 a ete evaluee par immunohistochimie sur 9 adenomes. Resultats Les gradients normalises par cortisol ou adrenaline etaient : – concordants dans 27/34 patients (groupe A) : 18 adenomes (moyenne 11 mm), 5 hyperplasies micro- et 2 macro-nodulaires, – lateralises uniquement par l’adrenaline : 5/34 patients (groupe B), 3 adenomes (moyenne 21 mm) 2 hyperplasies micronodulaires, – lateralises uniquement par le cortisol : 2/34 patients (groupe C), 2 microadenomes 8 et 6 mm. Le benefice tensionnel etait similaire dans les 3 groupes. 5/9 adenomes, dont le seul du groupe B etudie, exprimaient CYP 11B2 et CYP11B1 et CYP17, en faveur d’une secretion adenomateuse d’aldosterone mais egalement de cortisol. Conclusion Certains adenomes responsables d’HAP, bien visibles en TDM, secretent de l’aldosterone mais egalement du cortisol. Ils echappent au CVS normalise par le cortisol, mais pas au CVS normalise par l’adrenaline.

Objet L’etude de l’anatomie microscopique de la main necessite des techniques souvent fastidieuses et destructives specifiques a chacune des structures anatomiques etudiees. L’imagerie en contraste de phase par source synchrotron (sPCI) permet d’etudier precisement l’ensemble des tissus organiques a une resolution microscopique et de facon non destructive. Le but de cette etude etait d’attester de la faisabilite de la sPCI pour etudier l’anatomie de la vascularisation palmaire de la main. Methodes Une main provenant d’un corps non formole a ete imagee par sPCI a 84 μm et 21 μm sans injection de produit de contraste specifique. Sa vascularisation et son innervation ont ete reconstruites a 84 μm, puis le paquet neurovasculaire medial du troisieme doigt a 21 μm. Les structures les plus fines et les plus distales observees ont ete relevees. Le diametre et l’epaisseur des structures vasculaires et nerveuses ont ete determinees sur les coupes tomodensitometriques 2D et sur les reconstructions tridimensionnelles via une methode de granulometrie. Resultats La vascularisation de la main en sPCI etait visible depuis l’artere radiale et ulnaire jusqu’aux arcades digitales distales transverses. La structure la plus fine observee etait le lacis arteriel anastomotique peri-neural du nerf digital propre. Ce dernier provenait de l’artere palmaire digitale propre et vascularisait le nerf sur toute sa longueur et circonference. Les arterioles composant ce lacis etaient individualisables a cette resolution a partir de 66 μm de diametre et jusqu’a 309 μm. Conclusion L’imagerie sPCI permet d’etudier dans le meme temps l’anatomie arterielle et nerveuse de la main ainsi que les relations anatomiques entre ces deux reseaux. Elle permet d’etudier des structures de tailles variables et histologiquement differentes avec une grande precision, de facon non invasive et en ayant recours a une technique unique.

Introduction et objectifs La chirurgie valvulaire mitrale et tricuspidienne est a risque de complications ischemiques relatives a la proximite du reseau coronaire [1] , [2] , [3] . Malgre l’emergence recente de techniques percutanees destinees au traitement des patients a haut risque chirurgical, ces dernieres presentent egalement un risque de lesion coronaire [4] , [5] qui reste insuffisamment evalue. L’objectif de cette etude est de reperer les zones anatomiques de plus grande proximite entre les anneaux atrioventriculaires et les arteres coronaires adjacentes. Materiels/patients et methodes Les trajets de l’artere circonflexe (Cx) autour de l’anneau mitral (AM) et de l’artere coronaire droite (CD) autour de l’anneau tricuspidien (AT) ont ete disseques sur des cœurs explantes de corps donnes a la science. Les mesures entre la paroi coronaire et l’anneau valvulaire ont utilise un modele de cadran horaire sur calque afin de localiser intuitivement les zones a risque en pratique chirurgicale (tres grande proximite 10 mm). Resultats 25 cœurs ont ete disseques, issus de 20 femmes et 8 hommes d’un âge median de 88 ans. La zone a risque sur l’AM avec une grande proximite avec la Cx etait situee entre les reperes “07 :30” et “10 :00” (distance minimale de 6,5 mm au repere “09 :30”). Celle sur l’AT avec une tres grande proximite avec la CD etait situee entre les reperes “01 :30” et “03 :00” (distance minimale de 4,0 mm au repere “02 :00”). Conclusions La plus grande proximite entre AM et Cx et entre AT et CD se situe entre “07 :30” et “10 :00” et entre “01 :30” et “03 :00” respectivement sur notre modele de cadran horaire. La connaissance de ces zones a risque pourrait aider les chirurgiens cardiaques et de plus en plus de professionnels interventionnels a eviter des complications ischemiques severes dans leur pratique courante.

For radiologists, the venous drainage of adrenal glands is a key to the technique of selective adrenal venous sampling. For endocrine surgeons, it is key to adrenalectomy for carcinoma and pheochromocytoma. This study aims to demonstrate direct anastomosis between the left adrenal vein, the diaphragmatic circulation and the azygos system. Anatomical textbooks only offer very little information concerning the left adrenal vein (LAV) and its potential anastomosis with the reno-lumbo-azygo trunk (RLAT) and the diaphragmatic circulation.Between November 2014 and October 2015 in the LADAF (French Alps Anatomy Laboratory), we dissected 44 formalin-fixed adult cadavers.We found no direct anastomosis between the left adrenal vein and the reno-azygo-lumbar trunk and two anastomoses (4.5%) between the adrenal capsular vein and azygos system. A lumbo-azygo trunk has been found 38 times (86.3%), drained 35 times (79.5%) into the left renal vein and 3 times (6.8%) into the left genital vein. An inferior phrenic vein ending into an adrenal vein was highlighted in all cases, 6 times (13.7%) in a double adrenal vein and 38 times (86.3%) in a single one.No connections have been found between left adrenal vein and the RLAT, and frequency of the IPV is discordant with the literature. However, our findings concerning the capsular vessels' anastomosis with the azygos system, inferior diaphragmatic flow and double adrenal vein could have two clinical applications: Firstly, the ligation of the adrenal vein solely is not enough to entirely interrupt the adrenal vein drainage, and secondly, sampling of hormones in the LAV could be underestimated because of the risk of dilution.

Aim To provide an overview of cadaver models for cardiac arrest and to identify the most appropriate cadaver model to improve cardiopulmonary resuscitation through a systematic review. Methods The search strategy included PubMed, Embase, Current contents, Pascal, OpenSIGLE and reference tracking. The search concepts included “heart arrest”, “cardiopulmonary resuscitation” and “cadavers”. All studies, published until February 2019, in English or French, on research or simulation in the field of cardiac arrest and using cadaver models were eligible for inclusion. Results Overall, 29 articles out of the 244 articles located were selected. The characteristics of the studies and the cadaver models were heterogenous. Indeed, 31% of the studies lacked a proper description of the model used and its specificities. Fresh cadavers were used in 55% of the studies and chest compressions were performed in 90%. This model was appreciated for its realism in terms of mechanical properties and tissue conservation. Thiel-embalmed cadavers also showed promising results concerning lung and chest compliance. The lack of circulation stood out as the strongest limitation of all types of human cadaver models. Conclusion Four types of cadaver models are used in cardiac arrest research. The great heterogeneity of these models coupled with unequal quality in reporting makes comparisons between studies difficult. There is a need for uniform reporting and standardisation of human cadaver models in cardiac arrest research.

The objective of this study was to identify and analyze the anatomical variations in the termination of the thoracic duct (TD) in cadavers or patients by anatomical dissections and surgical or radiological procedures for better knowledge of the interindividual variations through a systematic review. The search strategy included PubMed and reference tracking. Studies were identified by searching the electronic Medline databases. The search terms included "TD," "Jugular Vein," "Subclavian Vein," or "Cervical," and the protocol used is reported herein. These search results yielded 20 qualitative review articles out of the 275 articles consulted. We collected all the important data from these 20 articles with 1,352 TD analyzed by varying sources in our search. Regarding the characteristics of the studies and the anatomy of the TD, the results were heterogeneous. The TD most commonly terminates in the internal jugular vein in 54.05% of cases (95% confidence interval [CI]: 54.03; 54.07), in the jugular-venous angle in 25.79% (95% CI: 25.77; 25.81), and in the subclavian vein in 8.16% of cases (95% CI: 8.14;8.18). Other terminations were found in 12% of cases. This systematic review provided an overview of the variations in the distal portion of the TD. This study can be helpful for surgeons in selecting the most appropriate methods to achieve successful surgical results and avoid complications, such as chylothorax; it also offers detailed information on the cervical termination of the TD in new diagnostic and therapeutic methods involving the TD. Clin. Anat. 32:99-107, 2019. © 2019 Wiley Periodicals, Inc.

In large congenital diaphragmatic hernias (CDHs), direct suture of the diaphragm is impossible. Surgeons can use a triangular internal oblique muscle (IOM) plus transverse abdominis muscle (TAM) flap. Its caudal limit faces the medial extremity of the 11th rib. Clinical studies show that the flap is not hypotonic but that the procedure could expose patients already presenting a hypoplastic lung to external oblique muscle (EOM) hypotonia. The aims of this study were to study EOM innervation by the 10th intercostal nerve (ICN) and ICN innervation to the IOM and TAM. Forty cadaveric abdominal hemi-walls were dissected. The number of branches and the trajectory of each specimen's 10th ICN were studied medially to the medial extremity of the 11th rib (MEK11) using surgical goggles and a microscope (Carl Zeiss®). The 10th ICN was consistently found between the IOM and TAM. There was a median of nine branches from the 10th ICN to the EOM, 77% of them medial to the MEK11. Median values of nine and 12 branches for the IOM and TAM were found, 60% and 51%, respectively, medial to the MEK11. These results argue in favor of good innervation to the IOM plus TAM flap but also indicate postoperative abdominal weakness exposing patients to herniation risks, as more than 75% of the branches from the 10th ICN to the EOM were sectioned or pulled away during flap detachment. Clin. Anat., 33:759-766, 2020. © 2019 Wiley Periodicals, Inc.

National audience

The feasibility of coronary artery bypass grafting using an internal thoracic artery (ITA) depends on the length of the graft with respect to the optimal route to reach the coronary target. The goal of this study was to assess the gain in length afforded by skeletonization and to evaluate the lengths of different pathways of the ITAs to the left coronary arteries. The left and right ITAs were dissected out from 20 specimens and measured before and after skeletonization. Distance between the origin of the right ITA and the base of the left atrial appendage, corresponding to the proximal circumflex artery, was measured for both the transverse pericardial sinus and preaortic routes. Skeletonization gave a significant gain of length for both ITAs. Analysis showed no significant correlation between the ITA length and the height, weight, and BMI of specimens. We found no association between the length of the sternum and the length of skeletonized RITA or LITA. The anterior route of the skeletonized right ITA was shorter than the transverse pericardial sinus route in 18 cases. The average length to the circumflex artery territory was 132.8 ± 23.5 mm in front of the aorta and 150.5 ± 18.8 through the transverse pericardial sinus with a gain of length of 17.7 mm (p

La Presse Medicale - In Press.Proof corrected by the author Available online since jeudi 3 decembre 2015

Anatomical dissection on cadavers can be a source of anxiety for medical students. Studies in other stressful settings have shown a reduction in anxiety when there is background music. The objective of this study was to determine if music can have an impact on student anxiety, student satisfaction, and student performance in dissection room. This cluster randomized interventional trial included 187 second-year medical students. The intervention was standardized background music, selected based on the literature, with a tempo of between 60 and 80 bpm. Six balanced clusters were randomized (1:1) to music or no music during dissection sessions. The main assessment criterion was a validated self-evaluation scale score for anxiety, the State Trait Anxiety Inventory. Student satisfaction was measured using a visual analog scale and dissection performance was evaluated by an examination. The outcomes were analyzed with mixed models adjusted on group effect, chronic anxiety, and confounding factors. A significant (58%) relative decrease in acute anxiety, odds ratio 0.423 [0.160; 0.710] was found for the music intervention group. Music also had a positive impact on performance with students in the intervention group attaining higher grades than those in the control group (0.42/10 higher, P = 0.0016). The study also showed a nonsignificant increase in satisfaction with 0.37 extra points (P = 0.137) in the intervention group. Background music had a significant impact on anxiety in the dissection room and on technical and theoretical performance in the subsequent anatomy examination. This music intervention could be extended to other stressful work environments.

Objet Les techniques de perfusion cadaveriques sont heterogenes et bien souvent imparfaites [1] . De nombreux facteurs entre en compte dans la reussite de la perfusion [2] , [3] . Ceux-ci ont rarement ete etudies et detailles. L’objectif de notre etude etait donc l’amelioration des modeles de revascularisation pour la simulation chirurgicale sur cadavres. Methodes Nous avons utilise une approche experimentale en deux etapes successives. La premiere partie de l’experimentation a teste le type de circuit et l’utilisation d’un rechauffeur de perfusion. La seconde etape concernait l’evaluation du produit d’injection [4] et du type de corps (embaumes ou non) selon un plan experimental factoriel. Pour comparer ces differentes techniques, nous avons developpe un score de realisme a partir des parametres tels que le volume recupere, la presence d’une circulation veineuse peripherique et arterielle abdominale. Resultats Nous avons montre lors de la premiere etape que l’injection d’un liquide rechauffe ameliorait la perfusion, tout comme l’utilisation de circuits arterio-arteriels et veino-veineux separes par rapport a un seul circuit arterio-veineux. Le liquide d’injection semble etre le parametre le plus important dans notre deuxieme etape, le coefficient de correlation est de 0,84 avec notre score de realisme. Le modele de revascularisation obtenant le meilleur score de realisme (4/6) etait celui obtenu avec un corps non embaume, a faible pression d’injection (20 mmHg) et avec un liquide dont la viscosite a ete augmente par gelatine (4 g/L). Les scores obtenus dans les autres configurations, c’est-a-dire a haute pression d’injection, avec des corps formoles ou avec une viscosite superieure du liquide, n’ont pas depasse 3/6. Conclusion Notre etude a permis d’affiner notre connaissance des parametres influant sur la qualite des modeles de revascularisation. L’utilisation d’un liquide rechauffe avec une concentration de 4 g/L de gelatine injecte a faible pression sur corps non embaume nous a permis d’obtenir les meilleurs resultats.

Objet La douleur impliquee dans les hernies discales pourrait etre generee par une mobilite des racines nerveuses lors du signe de Lasegue [1] , [2] . Ce signe entraine une mobilisation dont l’ampleur et le deplacement doit etre approfondie, c’est pourquoi nous avons etudie le deplacement des racines nerveuses lombo-sacrees dans le canal rachidien lors du signe de Lasegue. Methodes Quatorze cadavres ont subi une large laminectomie afin de marquer les racines nerveuses de L2 a S1 avec des billes plombees. Des radiographies ont ete prises lors de differents mouvements imposes au corps : extension bilaterale de la hanche, signe gauche, droit ou bilateral. En superposant ces images 2 a 2, le deplacement des racines nerveuses a ete quantifie numeriquement au cours des differentes manœuvres cliniques en comparaison a la position de reference correspondant a l’extension de hanche bilaterale. Resultats Les medianes des mouvements des racines nerveuses par rapport a la position de reference etaient comprises entre 0,10 et 0,51 cm (p Conclusion Le mouvement des racines nerveuses lombo-sacrees dans le canal rachidien etait statistiquement significatif en reponse au test clinique de Lasegue, hormis pour la racine la plus crâniale (L2) dans le Lasegue gauche. Ce mouvement est symetrique et plus important en cas de signe de Lasegue bilateral. Ces resultats anatomiques semblent correles avec les observations empiriques de la pratique clinique.

Introduction/objectifs La Corona mortis (CM) est une anastomose vasculaire inconstante reliant les systemes iliaques externe et interne, retrouvee en moyenne dans 49,3 % des cas dans la litterature [1] . Sa lesion est responsable d’accidents hemorragiques importants pouvant aller jusqu’a menacer le pronostic vital [2] . Approfondir nos connaissances anatomiques autour de la CM est indispensable pour prevenir les lesions iatrogenes dans le cadre des chirurgies du pelvis [3] . Le but de cette etude est de determiner la prevalence de la CM et de decrire precisement sa morphologie. Materiels et methodes Nous avons disseque 18 sujets anatomiques de facon bilaterale, soit 36 hemi-pelvis. Les dissections ont ete realisees selon un protocole precis et reproductible qui nous a permis de calculer la prevalence, de determiner la composition et de mesurer certains parametres morphologiques de la CM (longueur, diametre, hauteur d’implantation). Resultats La CM etait retrouvee dans 61,1 % des hemi-pelvis. Elle etait bilaterale chez 7 sujets sur 18 (38,9 %). En ce qui concerne sa composition, la majorite des CM rencontrees etaient veineuses (52,8 %, contre 2,8 % arterielles et 5,6 % arterio-veineuses). Les anastomoses s’implantaient principalement (70,4 % des cas) sur le tiers distal du vaisseau iliaque externe correspondant (artere ou veine). Conclusion Cette forte prevalence souligne l’importance de la CM et amene a reconsiderer son statut de simple variante anatomique. Lors d’abords anterieurs du pelvis, les chirurgiens se doivent de porter une attention particuliere a cette structure dans le but de prevenir de possibles consequences hemorragiques majeures.

Supplementary information accompanies this paper at https://doi.org/10.1038/s41598-018-31849-w.; International audience; Human vocal folds possess outstanding abilities to endure large, reversible deformations and to vibrate up to more than thousand cycles per second. This unique performance mainly results from their complex specific 3D and multiscale structure, which is very difficult to investigate experimentally and still presents challenges using either confocal microscopy, MRI or X-ray microtomography in absorption mode. To circumvent these difficulties, we used high-resolution synchrotron X-ray microtomography with phase retrieval and report the first ex vivo 3D images of human vocal-fold tissues at multiple scales. Various relevant descriptors of structure were extracted from the images: geometry of vocal folds at rest or in a stretched phonatory-like position, shape and size of their layered fibrous architectures, orientation, shape and size of the muscle fibres as well as the set of collagen and elastin fibre bundles constituting these layers. The developed methodology opens a promising insight into voice biomechanics, which will allow further assessment of the micromechanics of the vocal folds and their vibratory properties. This will then provide valuable guidelines for the design of new mimetic biomaterials for the next generation of artificial larynges.

The objective of this study was to identify the most appropriate cadaver perfusion techniques for surgical training through a systematic review with a description of the protocols used. The search strategy included PubMed and reference tracking. Studies were identified by searching the electronic Medline databases. The search concepts included perfusion, cadavers and simulation training, and the protocol used is reported. This resulted in a qualitative review of 12 articles out of 250 articles consulted. We collected all the important data from these 12 articles. Regarding the characteristics of the studies and the declotting or perfusion techniques, the results were heterogeneous. Indeed, in several studies, a good deal of information was unclear or insufficiently precise, making it unfeasible to summarize the data. The methods used were not sufficiently explicit and detailed. However, a majority of the fresh cadavers used tap water for declotting. Perfusion, type of fluid, number of pumps, pressure, pulsatility, and arterial or venous approaches differed greatly. Only two studies fulfilled five of our six realism criteria for surgical simulation. This systematic review provided an overview of all the different cadaver perfusion techniques. It could be used to establish a reference method of a simulation model.

Resume La paroi thoracique antero-laterale est une paroi articulee semi-rigide, osseuse, cartilagineuse et musculaire. La mecanique respiratoire depend de sa constitution intrinseque. Le vieillissement des tissus, voire une pathologie de ses constituants, peut alterer son bon fonctionnement a moindre cout energetique. Elle est egalement le lieu d’insertion d’elements musculaires pour les regions cervicale, scapulaire et abdominale, dont la fonction principale est associee a ces regions anatomiques. Cependant, leur fonction respiratoire accessoire peut s’averer importante pour compenser une insuffisance des constituants intrinseques de la paroi thoracique.

International audience; Since the last decades, the development of fundamental knowledge on mechanics and multi-physics phenomena driving biological systems has enabled the outstanding improvement of biomaterials able to mimic the mechanical behaviour of human soft tissues. Vocal-fold tissues are very challenging to replace as they possess specific abilities to endure large reversible deformations and to vibrate up to more than thousand cycles per second. Such unique performances result from complex physical and biomechanical features which remain poorly understood so far. This is mainly ascribed to a lack of knowledge of their unique macro-and microstructures, very difficult to investigate experimentally [1,2]. The 3D characterization of each constitutive element at the micrometric scale is a current challenge using confocal microscopy (limited depth of field), micro-IRM (limited spatial resolution) or X-ray microtomography in absorption mode (low sensitivity to distinguish fresh biological components owning similar absorptive properties). The present work aims (i) at characterizing the 3D microscale arrangement of the vocal-fold tissue on excised anatomical samples by means of X-ray synchrotron phase-contrast microtomography; (ii) at studying the relationship between 3D microstructure and vocal-fold biomechanical behaviour using a multiscale modeling approach. Regarding the experimental part, 7 human larynges have been scanned at mean (12.3μm) and high-resolution (0.65μm), using X-ray microtomographs of the ESRF's ID19 beamline. Histological colorations have allowed a comparative analysis of the acquired images using optical microscopy. A morphological and histological database will be presented, quantifying the 3D geometries, orientations and densities of vocal-fold fibrous structure. In agreement with the histological analyses, the striated-cells network of inferior thyroarytenoid muscle (vocalis) has been differentiated from the fibrous network of lamina propria (type-I and type-III collagen fibers, elastin fibers). Regarding the theoretical part, a recent 2D micro-mechanical model of the vocal folds [3] has been improved to account for the 3D fibrous networks of the tissue. The impact of several microstructural parameters (fiber-bundles initial diameter, waviness and orientation) on the vibro-mechanical response of the tissue has been evidenced.

International audience

The anatomy of gubernaculum testis (GT) is often discussed; however, the postnatal anatomy of the GT or scrotal ligament (SL) is rarely described. Hence, we performed an anatomical and histological study to analyze histologically the structures between testis and scrotum. We performed anatomical dissections on 25 human fresh cadavers’ testes. Each testis was removed with its envelopes and macroscopically analyzed. Then samples were included for histological study. Finally, they were analyzed under microscope, looking for attachments between testis, epididymis and scrotal envelopes. The absence of proximal and distal attachment was found in 56.0% of cases. Looking at the proximal attachment of the SL, the main one found is the epididymal attachment (28.0%), whereas no cases of testis attachment was found. Distally, there are more variations with scrotal attachment (12%) and cremaster attachment (12.0%). We found a significant prevalence of multiple adherences in 16.0% of cases too. Finally, in 15 cases (57.7%) an attachment is present between testis and epididymis, as it is commonly described. In the majority of cases there is no attachment of the lower pole of the testis and epididymis and these structures remain free. So it seems that the SL disappears with aging. Moreover, there is not only one kind of ligamentous attachment, but a high variability of attachments at the lower pole of the testiculo-epididymal structure. When it exists, this structure is never a real ligament and it seems more appropriate to use the term “attachments”.

Présentation pdf diffusée en ligne, figures publiées dans la photothèque du CNRS - donnant suite à Leroux et al., CNRS Le Journal, 2017http://www.cnrs.fr/insis/recherche/docs-evenements/HommeElastique_LucieBailly.pdf; National audience

La Presse Medicale - In Press.Proof corrected by the author Available online since vendredi 13 fevrier 2015

To determine the position of the lower loop of the ansa cervicalis (AC) compared to the inferior edge of the omohyoid muscle to guide minimally invasive surgery for the lateral oblique approach of parathyroid glands. Authors performed 36 anatomical dissections in the laboratory of anatomy (Laboratoire d’Anatomie Des Alpes Francaises) of the Grenoble medical school in 2012 on human cadavers. They independently measured the distance between the caudal extremity of the AC and the lower edge of the superior belly of the omohyoid muscle. Then, they controlled this measure on pictures. The study shows a majority of long AC (under the omohyoid muscle) in 66.7 % of cases. In addition, the AC was located on an average value of 0.1 cm below the lower edge of the omohyoid muscle (median −0.5 cm). Thus, two-thirds of AC are between 0 and −2 cm under the omohyoid muscle. Furthermore, the AC is generally non-symmetrical: there is a mean difference of 1.3 cm between the left and right AC. In this series, there are as many long AC on the right side as on the left side. These results are in contradiction with literature data. To preserve the ansa cervicalis and its phonatory functions, it is necessary for the surgeon to perform a systematic per operative identification of the AC because the position of the AC is mainly under the omohyoid muscle and because of an asymmetry. Per operative neurostimulation and/or magnified lenses might be helpful during the surgical approach.

International audience; The vocal folds are soft multi-layered laryngeal tissues, owning remarkable vibro-mechanical performances. Composed of collagen and elastin microfibrils' networks, the upper layers play a major role in the vocal-fold vibrations. However, the impact of these tissues' histological features on their mechanical behavior is still poorly known. This is mainly ascribed to their challenging experimental characterization: vocal folds together with their fibrous architectures are not easily observable in vivo; ex vivo mechanical tests are rare and complex to interpret [1]. Consequently, most of the vocal-fold mechanical models developed so far rely on phenomenological macroscopic approaches, roughly assuming a homogeneous vocal tissue with linear-elastic properties. Since 2010, a few authors have started to investigate and model the vocal-tissue collagenous fibrous microstructure, opening a new insight into voice biomechanics [2]. Theoretical formulations at the fiber scale still need to be developed. Thereby, this study aims at: (i) proposing an idealized but relevant model of the fibrous architecture of the vocal-fold upper layers; (ii) building a mechanical model able to predict the layers' multiscale properties from the above idealized architectures; (iii) assessing its relevance by comparison with a reference tensile database.