Vol 152, No 5 (2017)

The article provides general characteristics and the review of the results of the studies in clinical anatomy, curried out in S. S. Mikhailov Department of Operative Surgery and Clinical Anatomy at Orenburg State Medical University. The attention is focused on two directions of the research conducted at the Department: 1) the study of the venous bed of the central nervous system under normal, experimental and pathological conditions, and 2) the clinical anatomy of the organs, blood vessels, areas of the body.

In order to identify differences in the projection anatomy of the brainstem parts, depending on the form of the posterior cranial fossa, a projection analysis of CT scans of 160 patients of both sexes aged 18 to 70 years without skull and the brain pathology was conducted using the developed system of projection lines and bony landmarks. The variants of brainstem part location within the projection planes were determined: the medulla oblongata was located at the level of the plane of the lower margin of the external auditory meatus, the level of the Frankfurt horizontal plane corresponded to the border between the medulla oblongata and the pons, the plane the outer corner of the eye fissure coincided with the pons, the level of the nasion corresponded to the location of the mesencephalon. The spatial arrangement of the brainstem within the posterior cranial fossa, and the projection of its parts to the occipital and temporal region of the head had several variants and depended on the depth of the posterior cranial fossa. The differences demonstrated must be considered during the individual planning of surgical accesses to the posterior fossa structures.

The purpose of this study was to obtain new quantitative data on the anatomy of the human heart in the intermediate fetal period of ontogenesis based on the study of autopsy fetal material. The research was based on the study of torsos of 250 human fetuses at 16-22 weeks of development without pathology of the thoracic cavity organs. In the course of the study the data were obtained on fetal sectional anatomy of the heart including both general characteristics and those of each camera. The valves of the fetal heart were studied in detail, their sizes were measured and structural features were described.

The aim of the study was to detect the regularities of the formation of the topography of the organs of the lymphoid system of the thoracic cavity during the intermediate fetal period of ontogenesis. 191 human fetuses at the age of 16-22 weeks were examined using the methods of macro-microscopic dissection of saw-cuts according to N. I. Pirogov, the production of histotopograms, the study of projection anatomy, and the description of quantitative topography. It was found that the topography of the thymus was characterized by a clear stable skeletotopy, an expansion of the holotopic boundaries from the sternal to the midclavicular lines and a dynamic syntopy that manifested itself in the relationship with the diaphragmatic nerves, left brachiocephalic vein, heart chambers and large vessels of the mediastinum. The parietal lymph nodes of the chest are located between the inner thoracic vessels, in the projection of the costal-vertebral joints and under the the sympathetic trunk ganglia. At weeks 16-22, the most intensive growth was observed in the lateral pericardial and upper tracheobronchial lymph nodes. All groups of lymph nodes were found to descend by 1-2 thoracic vertebrae by week 22.

Using light, electron microscopy and immunohistochemistry, the changes in lung structure and matrix metalloproteinase 9 (MMP 9) expression were studied in 30 rats exposed to combined stress (intratracheal infusion of E. coli in association with emotional painful stress) and oxytocin (OT) injections. Studies have shown that the combined stress resulted in the increased expression of pulmonary MMP-9, accompanied by the activation of neutrophil and macrophage migration with the destruction of cells and intercellular substance in the lung. In animals treated with OT, the expression of MMP 9 was significantly reduced and was associated with lower levels of destructive changes and the infiltration of the lungs by neutrophils and macrophages. The results obtained suggest the pathogenetic role of MMP 9 in combined stress lesions and its involvement in the regulation of MMP 9 expression in the lungs.

The article describes the macro-microscopic peculiarities of the wall of different parts of human small and large intestine. Morphometric data are presented demonstrating differences in the thickness of intestinal wall and its tunics in different parts of small intestine and colon. It was found that the submucosa of the small intestine and colon was thicker than 200 μm, contained dense network of connective tissue fibers and was well vascularized. The data obtained constitute the microsurgical anatomy of the intestine, which is necessary for the development of microsurgical intestinal sutures and interintestinal anastomoses.

Using the method of computed tomography 245 patients were studied to examine in vivo topography of normal retroperitoneal space, kidneys and adrenal glands, and that one of aorta, inferior vena cava, ascending and descending colon, liver, spleen, pancreas, duodenum after radical nephrectomy for renal cancer. Individual peculiarities of the topography of the regions of retroperitoneal fat, kidneys and adrenal glands were shown. Retropancreatic and periadrenal tissue were distinguished. A general analysis of the dynamics of changes after nephrectomy demonstrated the main vector of displacement in the dorsal and medial directions with the cranial migration of the organs. It refers to the liver, duodenum, head of pancreas, ascending colon and inferior vena cava. Similar changes were typical to the body and tail of the pancreas, spleen, descending colon after left-sided nephrectomy. The new data obtained show changes of in vivo topography of the abdominal cavity in the postoperative period, they may be demonstrated by computed tomography.

Macro-microscopic structure and microtopography of calcaneal tendon were studied on 23 samples. It was found that calcaneal tendon had a regular structural organization characterized by close adhesion of tendon fibers, variable in shape and size, and a specific architectonics of their location. The total number of tendon fibers and the proportion of their different types can change throughout the tendon, which indicates the possibility of their fusion and division. Cellular space located along the anterior surface of the Achilles tendon - pre-calcaneal (Kager’s) fat pad is limited by the sheets of crural own fascia of the leg and an outer layer of paratendinium, internal processes of which divide the adipose tissue into individual lobules.