Whole mount microscopic sections reveal that Denonvilliers' fascia is one entity and adherent to the mesorectal fascia; Implications for the anterior plane in total mesorectal excision?

Background Excellent anatomical knowledge of the rectum and surrounding structures is essential for total mesorectal excision (TME). Denonviliers' fascia (DVF) has been frequently studied, though the optimal anterior plane in TME is still disputed. The relationship of the lateral edges of DVF to the autonomic nerves and mesorectal fascia is unclear. We studied whole mout microscopic sections of en-bloc cadaveric pelvic exenteration and describe implications for TME. Methods Four donated human adult cadaveric specimens (two males, two females) were obtained from the Leeds GIFT Research Tissue Programme. Paraffin-embedded mega blocks were produced and serially sectioned at 50 and 250 μm intervals. Sections were stained with haematoxylin & eosin, Masson's trichrome and Millers' elastin. Additionally, a series of eleven human fetal specimens (embryonic age of 9-20 weeks) were studied. Results DVF consisted of multiple fascial condensations of collagen and smooth muscle fibres and was indistinguishable from the anterior mesorectal fascia and the prostatic fascia or posterior vaginal wall. The lateral edges of DVF appeared fan-shaped and the most posterior part was continuous with the mesorectal fascia. Fasciae were not identified in fetal specimens. Conclusion DVF is adherent to and continuous with the mesorectal fascia. Optimal surgical dissection during TME should be carried out anterior to DVF to ensure radical removal, particularly for anterior tumours. Autonomic nerves are at risk, but can be preserved by closely following the mesorectal fascia along the anterolateral mesorectum. The lack of evident fasciae in fetal specimens suggested that these might be formed in later developmental stages

Measurement of Prompt Photons with Associated Jets in Photoproduction at HERA.

The photoproduction of prompt photons, together with an accompanying jet, has been studied in ep collisions at a centre-of-mass energy of 318 GeV with the ZEUS detector at HERA using an integrated luminosity of 77 pb-1. Cross sections were measured for the transverse energy of the photon and the jet larger than 5 and 6 GeV, respectively. The differential gamma+jet cross sections were reconstructed as functions of the transverse energy, pseudorapidity and x_gamma^obs, the fraction of the incoming photon momentum taken by the photon-jet system. Predictions based on leading-logarithm parton-shower Monte Carlo models and next-to-leading-order (NLO) QCD generally underestimate the cross sections for the transverse energies of prompt photons below 7 GeV, while the kT-factorisation QCD calculation agrees with the data better. When the minimum transverse energy of prompt photons is increased to 7 GeV, both NLO QCD and the kT-factorisation calculations are in good agreement with the data.Comment: 22 pages, 7 eps figues, 2 table