Variantele anatomice ale arcadei palmare superficiale: tip medianulnar, prezentare de caz și reviul literaturii

Background. One of the most common disorders of the upper limb is carpal tunnel syndrome whose compressive etiology depends on the anatomical variants of the forearm arteries. Palmar arches, their diameters and anatomical position of the vessels have drawn attention of interventionist and radiologist. Objective of the study. Evaluation of the prevalence of anatomical variations of superficial palmar arch and clinical details of presence of the median artery. Material and Methods. Arterial variations was performed on 25 adults upper limbs in the department of human anatomy of SUMPh „Nicolae Testemițanu”, Chișinău, Republic of Moldova. The variability of the forearm and hand arteries, topography ,course and their diameters have been documented Results. The data obtained showed that median artery was found in 4% of cases. The diameters are 2.2 mm proximally and 2.0 mm distally. The superficial palmar arch, in this case, is formed by the ulnar artery and median artery, this type is rare with clinical relevance in carpal tunnel syndrome. The right brachial artery terminated by trifurcation into median artery, ulnar artery and a rudimentary radial artery. The superficial arch was absent in 3 specimens. In the presence of the superficial arch the distribution of types was: radio-ulnar-17 specimens, ulnar-4 specimens, medio-ulnar-1 specimen. Conclusion. Present study revealed the significance of arterial variations for revascularisation, tissue transfers and replantation in microvascular surgery. An early diagnosis of abnormalities of vascular structures including aneurysm and thrombosis in carpal tunnel bring about nonsurgical approach. Introducere. Una din cele mai frecvente afecțiuni ale membrului superior este sindromul de canal carpian, a cărui etiologie compresivă depinde de variantele anatomice ale arterelor antebrațului. Arcadele palmare, diametrul lor și poziția anatomică a vaselor, au atras atenția medicilor chirurgi și radiologi. Scopul lucrării. Evaluarea prevalenței variantelor anatomice ale arcadei palmare superficiale și importanța clinică a prezenței arterei mediane. Material și Metode. Variantele arteriale au fost studiate pe material cadaveric (25 de membre superioare) în cadrul Catedrei de anatomie a omului, USMF „Nicolae Testemițanu”, Chișinău, Republica Moldova. Variabilitatea arterelor antebrațului și mâinii, topografia, traiectul și diametrele lor au fost documentate. Rezultate. Datele obținute denotă prezența arterei mediane în 4% din cazuri. Diametrul proximal constituie 2,2 mm, iar cel distal – 2,0 mm. Arcada palmară superficială în cazul dat este formată din artera ulnară și artera mediană, acest tip fiind rar, prezintă importanță clinică în sindromul de canal carpian. La membrul superior drept, s-a constatat trifurcarea arterei brahiale în artera mediană, ulnară și radială, ultima fiind rudimentară. Arcada palmară superficială deschisă s-a înregistrat în 3 cazuri. În prezența arcadei palmare superficiale, distribuția variantelor a fost următoarea: radio-ulnar – 17 cazuri, ulnar – 4 cazuri, median-ulnar – 1caz. Concluzii. Studiul prezent a relevat importanța aplicativă a variantelor arteriale pentru revascularizare, transferuri de țesuturi și replantare în chirurgia microvasculară. Diagnosticul precoce a patologiilor vasculare ca anevrism și tromboză în canalul carpian se soldează cu tratament nechirurgical

Evaluarea tipurilor de ramificare, anostomozelor și a diametrelor arterelor antebraţului și mâinii. Importanţa clinică

Catedra de anatomie și anatomie clinică, USMF „Nicolae Testemiţanu”, Chișinău, Republica Moldova, Conferința Ştiinţifică Internaţională ”Probleme actuale ale morfologiei” dedicată celor 75 de ani de la fondarea Universităţii de Stat de Medicină și Farmacie Nicolae Testemiţanu, Chişinău, 30-31 octombrie 2020Abstract Background: Evaluation of variations of the vascular supply of the hand and forearm and clinical significance for surgical procedures. Material and methods: Arterial variations was performed on 30 adults upper limbs in the department of human anatomy of SUMPh „Nicolae Testemiţanu”, Chișinău, Republic of Moldova. The diameter of radial and ulnar arteries were evaluated at the level of the bifurcation of the brachial artery and the radiocarpal joint. Anatomical variations in the formation, topography, and branching pattern of the superficial palmar arch have been documented. Results: In 78.5% of cases, the ulnar artery had a larger diameter than the radial artery, in 7.2% of cases the diameter of the radial artery was larger, and 14.3% of cases had equal diameters. When predominant supply was the ulnar artery the presence of the median artery was documented in 18.1% of cases. At the level of the radiocarpal joint the ulnar artery had a larger diameter in 53.4% (1.5-4 mm) the radial artery was dominant in 13.3% cases (3-4 mm) and in 13.3% of cases the diameters were the same (3.5-4 mm). On the right side, the radial artery was dominant in 79% of cases with the ulnar artery being dominant in 14% of cases, and in 7% of cases there was codominance. The complete superficial palmar arch was present in 26.6% of cases with the I dorsal metacarpal artery in 6.6% of cases. Conclusions: This study suggests that knowledge of variations in the branching pattern and diameters provides details of the forearm vessels for cases requiring invasive vascular procedures

Bilateral persistent median artery: a case report

Introduction. The median artery can persist in adult life and contribute to the formation of the superficial palmar arch. The persistent median artery (PMA) may compress the median nerve (MN) and has practical significance for surgeons. The presence or absence of anastomosis between the arteries that contribute to the formation of the palmar arch has been used to categorize the SPA as complete or incomplete. Case presentation. A routine anatomical dissection was performed on the upper limbs of a male adult cadaver aged 60–70 years who was fixed in a 10% formalin solution. This study presents a rare case of bilateral presentation of the superficial palmar arch formed by PMA. The left persistent median artery was identified as originating from the trifurcation of the ulnar artery into the median artery, the common interosseous artery, and the ulnar artery, 69 mm distal to the epicondyles of the humerus. At the wrist, the persistent median artery with a diameter of 2 mm passed through the carpal tunnel and revealed no anastomosis with the ulnar artery, forming the incomplete superficial palmar arch of the median-ulnar type. The right ulnar artery is subdivided into the common interosseous artery, the median artery, and the ulnar artery at a distance of 80 mm from the intercondylar line. The SPA is formed by the median artery (MA) and the superficial palmar branch of the RA. The palmar digital branches from the ulnar artery supplies the medial two-and-a-half fingers, while those from the median-radial type of SPA supplied the lateral twoand-a-half fingers and gave the radialis indicis. The thumb had additional blood supply from the princeps pollicis branch of the radial artery. Discussion. The PMA is a frequent abnormality that can induce carpal tunnel syndrome by pressing directly on the median nerve. According to several studies, the prevalence of persistent median artery varies between 1.1% and 27.1%. The palmar pattern was analyzed and had an incidence of 20%, more common in females than in males 1.3:1, appearing unilaterally more frequently than bilaterally 4:1. According to research, the prevalence of incomplete SPA varies from 3.6 to 54.76%. The angle between the ulnar artery and its common interosseous trunk was the most common source of origin of the median artery (59%). The palmar pattern usually joins the superficial palmar arch at 35% or ends as the 1st, 2nd, or 1st and 2nd common digital arteries at 65%. The median artery diameters varied from 0.8 to 2.6 mm, with a mean value of 1.7 mm. According to our results, the median artery in the palmar region has a diameter of 2 mm. This is the first case report in the human anatomy department that describes an incomplete palmar arch and bilateral persistent median artery in a cadaver. Conclusion. The SPA has received a lot of attention recently because of its importance in contributing to the vascular supply of the hand. Our discovery was notable in that it revealed the presence of MA as well as an anastomosis between MA, RA, and UA. These variations are essential in supporting medical students in improving their clinical practice knowledge

Variante anatomice ale arcadei palmare superfiale - tip medianulnar. Prezentare de caz și review-ul literaturii

Department of Anatomy and Clinical Anatomy, Nicolae Testemitanu SUMPhBackground. One of the most common disorders of the upper limb is carpal tunnel syndrome whose compressive etiology depends on the anatomical variants of the forearm arteries. Palmar arches, their diameters and anatomical position of the vessels have drawn attention of interventionist and radiologist. Objective of the study. Evaluation of the prevalence of anatomical variations of superficial palmar arch and clinical details of presence of the median artery. Material and Methods. Arterial variations was performed on 25 adults upper limbs in the department of human anatomy of SUMPh „Nicolae Testemițanu”, Chișinău, Republic of Moldova. The variability of the forearm and hand arteries, topography ,course and their diameters have been documented. Results. The data obtained showed that median artery was found in 4% of cases. The diameters are 2.2 mm proximally and 2.0 mm distally. The superficial palmar arch, in this case, is formed by the ulnar artery and median artery, this type is rare with clinical relevance in carpal tunnel syndrome. The right brachial artery terminated by trifurcation into median artery, ulnar artery and a rudimentary radial artery. The superficial arch was absent in 3 specimens. In the presence of the superficial arch the distribution of types was: radio-ulnar-17 specimens, ulnar-4 specimens, medio-ulnar-1 specimen. Conclusion. Present study revealed the significance of arterial variations for revascularisation, composite tissue transfers and replantation in microvascular surgery. An early diagnosis of abnormalities of vascular structures including aneurysm and thrombosis in carpal tunnel bring about nonsurgical approach.Introducere. Una dintre cele mai frecvente leziuni ale membrului superior este sindromul tunelului carpian, a cărui etiologie compresivă depinde de variantele anatomice ale areterelor antebrațului. Cunoașterea arcadelor palmare, a diametrelor și topografia vaselor sunt utile în chirurgie și în radiologie. Scopul lucrării. Evaluarea prevalenței variantelor anatomice ale arcadei palmare superficiale și a importanței clinice ale prezenței arterei mediane. Material și Metode. Variante anatomice arteriale au fost evaluate la 25 de membre superioare de la Catedra de anatomie si anatomie clinică a USMF „Nicolae Testemițanu”, Chișinău, Republica Moldova. Variabilitatea arterelor antebrațului și a mâinii, topografia, traiectul și diametrul acestora au fost documentate. Rezultate. Datele obținute au arătat că artera mediană a fost găsită în 4% din cazuri. Diametrele sunt de 2,2 mm proximal și 2,0 mm distal. Arcada palmară superficială, în acest caz, este formată din artera ulnară și artera mediană, acest tip fiind rar, cu prelevanță clinică în sindromul de tunel carpian. Artera brahială dreaptă s-a terminat prin trifurcație în artera mediană, artera ulnară și o arteră radială rudimentară. Arcada superficială a fost absentă la 3 exemplare. În prezența arcadei superficiale distribuția tipurilor a fost: tipul radio-ulnar-17, tip ulnar-4, tip medio-ulnar-1. Concluzii. Studiul a relevat semnificația variațiilor arteriale pentru vascularizaţie, transferuri de țesuturi și replantare în microchirurgie. Un diagnostic precoce al anomaliilor structurilor vasculare, inclusiv anevrism și tromboză în tunelul carpian, determină o abordare nonchirurgicală

Clinical particularity and diagnosis of development anomalies of brain and spinal cord

Clinica de Neuropediatrie, Departamentul Pediatrie, USMF „Nicolae Testemiţanu”In the study was evaluated the frequency of congenital brain malformations and their clinical manifestations to the new born and infants. It was appreciated their role in child’s neurological disability. All children included in the study underwent a complete neurological examination, were investigated neurosonographically, computed tomography (CT) - brain and magnetic resonance imaging (MRI). It was concluded that agenesis of the corpus callosum was the most common congenital brain malformation in children aged under 1 year, and most rare congenital brain malformations were anencephaly, and microgiria, hemimegalencefalia. The most common clinical manifestations were: neuropsychic retardation of varying degrees, axial and limb hypotonia, partial seizures / infantile spasms. Congenital malformations affects neurological development and reduced the ability of children, leaving a severe prognosis, in many cases. În studiu a fost evaluată frecvenţa malformaţiilor cerebrale congenitale şi manifestarile lor clinice la nou-nascuţii la termen şi sugari. A fost studiat rolul acestora în invaliditatea neurologică al copilului. Toţi copiii incluşi în studiu au fost supuşi unui examen cliniconeurologic complex, au fost efectuate următoarele investigații : examenul neurosonografic, tomografie computerizată cerebrală (TC) şi rezonanţa magnetică nucleară (MRI). S-a constatat, că agenezia corpului calos este una din cele mai frecvente malformaţii cerebrale congenitale la copiii cu vîrsta sub 1 an, iar cele mai rar întâlnite malformaţii cerebrale congenitale sunt: anencefalia, hemimegalencefalia şi microgiria. Cele mai frecvente manifestări clinice întâlnite la copiii cu malformații congenitale: retardul neuropsihic de diferit grad, hipotonia axiala şi a membrelor, crizele convulsive parţiale/spasmele infantile. Malformațiile congenitale marchează neurodezvoltarea şi stigmează abilităţile copilului, lăsându-i un prognostic sever, în multe cazur