Tendons are frequently used for reconstructive surgery. This includes palmaris longus, plantaris, the long extensors of the toes and fingers as well as the flexors of the fingers. The surgeon must base his or her selection of the donor tendon for grafting on what is needed, for example tendon size, length, and width. The most desirable tendons in reconstructive surgery are the palmaris longus and plantaris tendons. These two muscles are also considered to be the easiest tendons to harvest, and therefore they remain the ideal choices for plantaris,or tendon grafts. Apart from what is mentioned in the literature, questions remain such as: which characteristics do the palmaris longus and plantaris muscles possess that make them suitable for use as flaps or grafts in reconstructive surgery and; how can knowledge of the characteristics of these muscles improve reconstructive surgery in South Africa? The palmaris longus and plantaris muscles are indeed subject to variation, whether in the general anatomy, form, attachment, actions and/or prevalence. A statistical significant difference was found between the male and female sample when considering the length of the palmaris longus muscle. When comparing the palmaris longus muscle to the plantaris muscles, it was found that there is a statistical significant difference between them as well. Therefore, although these muscles may look alike, when it comes to the surgical aspect it is suggested that the palmaris longus is used when a wider tendon is preferred and the plantaris muscle when a longer tendon is needed. The prevalence of the palmaris longus and plantaris muscles compared well with studies done on other population groups. No correlation was found between the sex of the cadaver and the prevalence of the palmaris longus and plantaris muscles. In addition it was established that there is no relationship between the prevalence of the palmaris longus and plantaris muscles in the same individual. A possible phylogenetic degenerative trend for the palmaris longus muscle was also examined. After studying various age groups, it was determined that such a trend could not be established for this sample. In conclusion, based on the morphology and prevalence of the palmaris longus and plantaris muscles in a South African population, they are ideal for the use of flaps and/or tendon graft in reconstructive surgery. But it is of utmost importance that the reconstructive surgeon, working on South African patients, remember that both these muscles are subject to variation and not only will it be beneficial to employ proper detection methods to determine the viability of either muscle before considering its suitability in reconstructive surgery but also a sound knowledge of the anatomy of these muscles must be known. AFRIKAANS : Tendons word dikwels gebruik vir rekonstruktiewe chirurgie. Dit sluit die M. palmaris longus en M. plantaris, die lang ekstensors van die tone en vingers, sowel as die fleksors van die vingers in. Die chirurg moet sy of haar keuse van die skenkertendon baseer op dit wat benodig word, byvoorbeeld tendongrootte, ~lengte en ~breedte. Die mees gesogte tendons in rekonstruktiewe chirurgie is dié van M. palmaris longus en M. plantaris. Hierdie twee spiere word ook geag as die maklikste spiere om te oes / bekom, en daarom bly hulle die ideale keuse vir weefselsnitte of tendon-oorplantings. Afgesien van wat in die literatuur beskryf word, bly die volgende vrae onbeantwoord: Watter eienskappe maak M. palmaris longus en M. plantaris geskik vir die gebruik as weefselsnitte of tendon-oorplantings in rekonstruktiewe chirurgie en, hoe kan kennis van hierdie eienskappe van dié spiere, rekonstruktiewe chirurgie in Suid-Afrika verbeter? M. palmaris longus en M. plantaris is inderdaad onderworpe aan variasie van die algemene anatomie, vorm, aanhegtings, aksies en / of aanwesigheid en/of afwesigheid. 'n Statistiese beduidende verskil is gevind tussen die manlike en vroulike steekproef ten opsigte van die lengte van M. palmaris longus. M. palmaris longus is met M. plantaris ook vergelyk en daar was gevind dat daar 'n statisties beduidende verskil tussen hierdie spiere is. Alhoewel hierdie spiere dieselfde lyk, is dit belangrik om in ag te neem dat as dit by die chirurgiese aspekte kom, word daar voorgestel dat M. palmaris longus eerder gebruik moet word wanneer 'n wyer tendon verkies word en M. plantaris gekies moet word wanneer ‘n langer tendon benodig word. Daar is goeie ooreenkoms tussen die aanwesigheid en/of afwesigheid van M. palmaris longus en M. plantaris wanneer hul met studies, wat op die ander bevolkingsgroepe gedoen was, vergelyk word. Geen ooreenkomste was tussen die geslag van die kadawer en die aanwesigheid en/of afwesigheid van M. palmaris longus en M. plantaris gevind nie. Daarbenewens was dit vasgestel dat daar geen verhouding tussen die aanwesigheid en/of afwesigheid van M. palmaris longus en M. plantaris in dieselfde individu is nie. 'n Moontlike filogenetiese degeneratiewe tendens vir M. palmaris longus is ook ondersoek. Na die bestudering van verskillende ouderdomsgroepe, is daar bepaal dat so 'n tendens nie bevestig kon word vir hierdie steekproef nie. Ter afsluiting, die morfologie en die aanwesigheid en/of afwesigheid van M. palmaris longus en M. plantaris, in 'n Suid-Afrikaanse bevolking, is ideaal vir die gebruik van weefselsnitte of tendon-oorplantings in rekonstruktiewe chirurgie. Maar dit is van uiterste belang dat die rekonstruktiewe chirurg, wie met Suid-Afrikaanse pasiënte werk, onthou dat beide hierdie spiere onderworpe is aan variasie. Dit sal dus voordelig wees om behoorlike opsporingsmetodes te gebruik om die vatbaarheid van hierdie spiere in rekonstruktiewe chirurgie vas te stel, maar hy of sy het ook kennis van die anatomie van hierdie spiere, nodig. Copyright / Dissertation (MSc)--University of Pretoria, 2011. / Anatomy / unrestricted

Midportion Achilles tendinopathy (tendinosis) is a troublesome painful condition, often characterised by pain, local swelling, tenderness and functional disability. Despite extensive research, the pathogenesis is poorly understood and treatment remains challenging. Features related to the peritendinous connective tissue can be of importance. Recently it has been suggested that the plantaris tendon might be involved in this condition. Furthermore, it has been hypothesised that tendon pain and the tendinosis-related tissue changes in tendinopathy might be mediated by signalling substances such as glutamate and acetylcholine. A clinical observation, not scientifically evaluated, has been that unilateral treatment for bilateral Achilles tendinosis can lead to an effect on the contralateral side.      The aim of this work was to examine the morphology and innervation patterns in the plantaris tendon and the peritendinous connective tissue in between the Achillles and plantaris tendons in midportion Achilles tendinopathy, and to evaluate if plantaris tendon removal has an effect on Achilles tendon structure. Another aim was to determine if unilateral treatment for Achilles tendinopathy targeting the peritendinous connective tissue can result in bilateral recovery. Furthermore the presence of non-neuronal cholinergic and glutamate systems was examined.      Sections of plantaris tendons with adjacent peritendinous connective tissue from patients with midportion Achilles tendinopathy were stained for morphology (H&E), and innervation patterns were evaluated using antibodies against general nerve marker (PGP9.5), sensory (CGRP) and sympathetic (TH) nerve fibres and Schwann cells (S-100β). Furthermore immunostainings against non-neuronal aceylcholine (ChAT) and glutamate signalling components (glutamate, VGluT2, NMDAR1) were performed. Plantaris tendon cells were cultured and also stained for glutamate signalling components, and were stimulated with glutamate and glutamate receptor agonist NMDA. Furthermore, Ultrasound Tissue Characterisation (UTC) was used to monitor the integrity of the Achilles tendon collagen structure after plantaris tendon removal.      Plantaris tendons exhibited tendinosis-like tissue patterns such as hypercellularity, collagen disorganisation and large numbers of blood vessels. The peritendinous connective tissue between the plantaris and Achilles tendons contained large numbers of fibroblasts and blood vessels and to some extent macrophages and mast cells. A marked innervation was found in the peritendinous connective tissue and there were also nerve fibres in the loose connective tissue spaces within the tendon tissue proper. Most nerve fibres were identified as sensory fibres. Some nerve fascicles in the peritendinous connective tissue showed absence of axons but homogenous reactions for Schwann cell marker. Tenocytes and cells in the peritendinous connective tissue expressed ChAT, glutamate, VGluT2 and NMDAR1. Tendon cells in vitro expressed VGluT2, NMDAR1 and glutamate. UTC showed significant improvement of Achilles tendon integrity 6 months after surgical plantaris tendon removal and scraping procedure. Eleven out of thirteen patients reported of a bilateral recovery after unilateral surgical treatment.      The results of this work show that plantaris tendons exhibit tendinosis-like tissue changes, internal innervation and features that suggest occurrence of glutamate and acetylcholine production and signalling. Plantaris removal improves Achilles tendon structure suggesting possible compressive/shearing interference between the Achilles and plantaris tendons in tendinopathy. The peritendinous connective tissue shows marked innervation, which thus might transmit pain when being compressed. The partial absence of axons indicates a possible nerve degeneration. On the whole, the study gives new evidence favouring that the plantaris tendon and the peritendinous connective tissue might be of importance for pain and the tendinopathy process in midportion Achilles tendinopathy.

Sarcopenia, loss of muscle mass and function, is a common feature of aging. Oxidative damage and apoptosis are likely underlying factors. Autophagy, a process for the degradation of cellular constituents, may be a mechanism to combat cell damage and death. We investigated the effect of age on autophagy and apoptosis in plantaris muscle of male Fischer 344 rats that were either fed ad libitum, or mild, life-long calorie restricted (CR) alone or combined with life-long voluntary exercise. Upstream autophagy-regulatory proteins were either upregulated with age (Beclin-1) or unchanged (Atg7 and 9). LC3 gene and protein expression pattern as well as LAMP-2 gene expression, both downstream regulators of autophagy, however, suggested an age-related decline in autophagic degradation. Atg protein expression and LC3 and LAMP-2 gene expression were improved in CR rats with or without exercise. The age-related increase in oxidative damage and apoptosis were attenuated by the treatments. Both, oxidative damage and apoptosis correlated negatively with autophagy. We conclude that mild CR attenuates the age-related impairment of autophagy in rodent skeletal muscle, which might be one of the mechanisms by which CR attenuates age-related cellular damage and cell death in skeletal muscle in vivo.

INTRODUÇÃO: A Peroxisome Proliferator Activated Receptor- - Coactivator 1 ( PGC-1 e ) é proteína responsável pela conexão entre estímulos ambientais e resposta metabólica celular. Sua presença é importante em tecidos adiposo, hepático e muscular esquelético e, em animais, em tecido adiposo marrom. Interage com receptores nucleares modulando a biogênese mitocondrial e mantendo o equilíbrio termo energético celular com o meio ambiente. A redução da expressão de PGC-1 e da oxidação fosforilativa tem sido associada à resistência à insulina em doenças como Diabetes Mellitus tipo 2 e Síndrome Metabólica. OBJETIVOS: Avaliar o efeito do exercício na expressão da PGC-1 em tecidos alvos da insulina, como o fígado e músculos esquléticos soleus ( SOL ) e plantaris ( PLA ) de ratos machos Wistar e correlacioná-lo com a sensibilidade à insulina. METODOLOGIA: Ratos machos Wistar 190±15 g, n = 24, randomizados em 2 grupos: Ex ( exercício físico ) e Sd ( sedentário ) colocados respectivamente, em roda de atividade ou gaiolas comuns durante cinco semanas. Ao final do período, após jejum de quatro horas, foi colhido sangue para dosagens de glicose ( GLI ), insulina ( INS ) e ácidos graxos livres ( AGL ) e, em seguida, foram submetidos ao Teste de Supressão da Glicose e Insulina Endógenas com infusão durante 180 minutos de solução GLI ( 20mg/kg/min ) + INS ( 5 mU/kg/min ); amostras de sangue foram colhidas aos 140, 150, 160, 170 e 180 minutos. Terminado o teste e ainda sob anestesia, foram retirados os tecidos: fígado ( FG ) e músculos esquléticos ( PLA e SOL ), os quais foram imediatamente congelados e mantidos a -70ºC para posteriores análises. A expressão da PGC-1 foi avaliada pelo Western Blot com anticorpo policlonal anti- PGC-1. Análise estatística por teste t Student não-pareado e nível de significância 5%. RESULTADOS: Os dados se referem à média e erro padrão médio dos valores individuais das amostras. A distância percorrida na última semana ( km/dia ) pelo grupo Ex foi eficaz ( 5,61 ± 0,67 ). Não houve diferença no peso ( g ) dos ratos entre os grupos Ex e Sd ( 355,85 ± 9,51 x 375,68 ± 5,30 ) NS. Os valores de GLI jejum ( mg/dl ) foram semelhantes entre os grupos ( 117,6 ± 3,7 x 122,4 ± 2,6 ) NS. Entretanto, INS e AGL foram menores no grupo Ex: INS ( ng/ml ) ( 0,68 ± 0,12 x 1,45 ± 0,14 ) p < 0,001 e AGL ( mEq/L ) ( 1,12 ± 0,11 x 1,60 ± 0,11 ) p < 0,006. Durante o teste de supressão, os valores de GLI e INS na fase de estabilidade foram semelhantes entre grupos ( expressos em área sob a curva ): AUC GLI ( mg/dl/min ) ( 2,77 ± 0,12 x 2,95 ± 0,07 ) NS; AUC INS ( ng/ml/min ) ( 0,81 ± 0,15 x 0,99 ± 0,09 ) NS. A expressão da PGC-1 foi maior no PLA de ratos do grupo Ex e, em FG e SOL foi semelhante entre os grupos. CONCLUSÃO: O exercício físico durante 5 semanas em roda de atividade voluntária, aumentou a sensibilidade à insulina e a oxidação de ácidos graxos livres no jejum. A melhora da sensibilidade à insulina esteve associada à maior expressão da PGC-1 somente em músculo PLA. Estes dados sugerem que o aumento da sensibilidade à insulina no jejum não se relacionou com o aumento da expressão da PGC-1 em outros tecidos alvos da ação insulínica, como FG e SOL, neste modelo de estudo. / INTRODUCTION: The Peroxisome Proliferator-Activated Receptor- - Coactivator 1 ( PGC-1 e ) is a protein responsible for the connection between environmental stimuli and cell metabolic response. Its presence is important in fat tissue, hepatic and skeletal muscle and in animals on brown fat tissue. Interact with nuclear receptors modulating the mitochondrial biogenesis and maintain thermal energy balance with the environment. Diminished of PGC-1 expression and oxidative phophorylation has been associated to insulin resistance in diseases like Type 2 Diabetes and Metabolic Syndrome. OBJECTIVES: To evaluate the effects of exercise on the PGC-1 expression in target tissues of insulin, such as liver and skeletal muscles soleus (SOL) and plantaris (PLA) of male Wistar rats and correlates with insulin sensitivity. METHODOLOGY: Male Wistar rats 190±15g, n = 24, divided randomly into 2 groups: Ex ( physical exercise ) and Sd ( sedentary ), respectively placed in a voluntary running wheel cage or a standard cage for five weeks. At the end of study, after fasting for 4 hours, blood was collected for measurements of glucose ( GLU ), insulin ( INS ) and free fatty acids ( FFA ) then the animals were submitted to Test of Suppression Endogenous Glucose and Insulin, with infusion during 180 minutes of solution GLU ( 20mg/kg/min ) + INS ( 5mU/kg/min ); blood samples was collected at 140, 150, 160, 170 and 180 minutes. Finished the test and still anesthetized, the tissues were removed: liver ( LIV ), skeletal muscle ( SOL and PLA ) that were immediately frozen in liquid nitrogen and stored at -70ºC until analysis. The PGC-1 expression was evaluated by Western Blotting with polyclonal antibody anti-PGC-1. Statistical analysis by unpaired Students t test with significance level 5%. RESULTS: the data refer to the mean and standard error of individual values. The distance covered per day during last week ( km / day ) by Ex group was efficient ( 5,61 ± 0,67 ). There was no difference in weight ( g ) of rats between Ex and Sd groups ( 355,85 ± 9,51 x 375,68 ± 5,30 ) NS. The values of fasting GLU were similar between groups ( mg/dl ) ( 117,6 ± 3,7 x 122,4 ± 2,6 ) NS. However INS and FFA were lower in group Ex: INS ( ng/ml ) ( 0,68 ± 0,12 x 1,45 ± 0,14 ) p < 0,001 and FFA ( mEq/L ) ( 1,12 ± 0,11 x 1,60 ± 0,11 ) p < 0,006. During the suppression test the values of GLU and INS on stability step were similar between groups ( expressed in area under curve ): AUC GlU ( mg/dl/min ) ( 2,77 ± 0,12 x 2,95 ± 0,07 ) NS; AUC INS ( ng/ml/min ) ( 0,81 ± 0,15 x 0,99 ± 0,09 ) NS. The PGC-1 expression was greater in PLA of rats Ex than Sd group, and there was no difference in LIV and SOL between groups. CONCLUSION: The physical exercise during five weeks in voluntary running wheel increased the insulin sensitivity and fasting free fatty acids oxidation. The improvement of insulin sensitivity was associated with higher PGC-1 expression on PLA muscle only. These data suggest that increasing insulin sensibility on fasting is not associated with increasing of the PGC-1 expression in others targets tissues of insulin action, such as LIV and SOL, in this study model.

INTRODUÇÃO: A Peroxisome Proliferator Activated Receptor- - Coactivator 1 ( PGC-1 e ) é proteína responsável pela conexão entre estímulos ambientais e resposta metabólica celular. Sua presença é importante em tecidos adiposo, hepático e muscular esquelético e, em animais, em tecido adiposo marrom. Interage com receptores nucleares modulando a biogênese mitocondrial e mantendo o equilíbrio termo energético celular com o meio ambiente. A redução da expressão de PGC-1 e da oxidação fosforilativa tem sido associada à resistência à insulina em doenças como Diabetes Mellitus tipo 2 e Síndrome Metabólica. OBJETIVOS: Avaliar o efeito do exercício na expressão da PGC-1 em tecidos alvos da insulina, como o fígado e músculos esquléticos soleus ( SOL ) e plantaris ( PLA ) de ratos machos Wistar e correlacioná-lo com a sensibilidade à insulina. METODOLOGIA: Ratos machos Wistar 190±15 g, n = 24, randomizados em 2 grupos: Ex ( exercício físico ) e Sd ( sedentário ) colocados respectivamente, em roda de atividade ou gaiolas comuns durante cinco semanas. Ao final do período, após jejum de quatro horas, foi colhido sangue para dosagens de glicose ( GLI ), insulina ( INS ) e ácidos graxos livres ( AGL ) e, em seguida, foram submetidos ao Teste de Supressão da Glicose e Insulina Endógenas com infusão durante 180 minutos de solução GLI ( 20mg/kg/min ) + INS ( 5 mU/kg/min ); amostras de sangue foram colhidas aos 140, 150, 160, 170 e 180 minutos. Terminado o teste e ainda sob anestesia, foram retirados os tecidos: fígado ( FG ) e músculos esquléticos ( PLA e SOL ), os quais foram imediatamente congelados e mantidos a -70ºC para posteriores análises. A expressão da PGC-1 foi avaliada pelo Western Blot com anticorpo policlonal anti- PGC-1. Análise estatística por teste t Student não-pareado e nível de significância 5%. RESULTADOS: Os dados se referem à média e erro padrão médio dos valores individuais das amostras. A distância percorrida na última semana ( km/dia ) pelo grupo Ex foi eficaz ( 5,61 ± 0,67 ). Não houve diferença no peso ( g ) dos ratos entre os grupos Ex e Sd ( 355,85 ± 9,51 x 375,68 ± 5,30 ) NS. Os valores de GLI jejum ( mg/dl ) foram semelhantes entre os grupos ( 117,6 ± 3,7 x 122,4 ± 2,6 ) NS. Entretanto, INS e AGL foram menores no grupo Ex: INS ( ng/ml ) ( 0,68 ± 0,12 x 1,45 ± 0,14 ) p < 0,001 e AGL ( mEq/L ) ( 1,12 ± 0,11 x 1,60 ± 0,11 ) p < 0,006. Durante o teste de supressão, os valores de GLI e INS na fase de estabilidade foram semelhantes entre grupos ( expressos em área sob a curva ): AUC GLI ( mg/dl/min ) ( 2,77 ± 0,12 x 2,95 ± 0,07 ) NS; AUC INS ( ng/ml/min ) ( 0,81 ± 0,15 x 0,99 ± 0,09 ) NS. A expressão da PGC-1 foi maior no PLA de ratos do grupo Ex e, em FG e SOL foi semelhante entre os grupos. CONCLUSÃO: O exercício físico durante 5 semanas em roda de atividade voluntária, aumentou a sensibilidade à insulina e a oxidação de ácidos graxos livres no jejum. A melhora da sensibilidade à insulina esteve associada à maior expressão da PGC-1 somente em músculo PLA. Estes dados sugerem que o aumento da sensibilidade à insulina no jejum não se relacionou com o aumento da expressão da PGC-1 em outros tecidos alvos da ação insulínica, como FG e SOL, neste modelo de estudo. / INTRODUCTION: The Peroxisome Proliferator-Activated Receptor- - Coactivator 1 ( PGC-1 e ) is a protein responsible for the connection between environmental stimuli and cell metabolic response. Its presence is important in fat tissue, hepatic and skeletal muscle and in animals on brown fat tissue. Interact with nuclear receptors modulating the mitochondrial biogenesis and maintain thermal energy balance with the environment. Diminished of PGC-1 expression and oxidative phophorylation has been associated to insulin resistance in diseases like Type 2 Diabetes and Metabolic Syndrome. OBJECTIVES: To evaluate the effects of exercise on the PGC-1 expression in target tissues of insulin, such as liver and skeletal muscles soleus (SOL) and plantaris (PLA) of male Wistar rats and correlates with insulin sensitivity. METHODOLOGY: Male Wistar rats 190±15g, n = 24, divided randomly into 2 groups: Ex ( physical exercise ) and Sd ( sedentary ), respectively placed in a voluntary running wheel cage or a standard cage for five weeks. At the end of study, after fasting for 4 hours, blood was collected for measurements of glucose ( GLU ), insulin ( INS ) and free fatty acids ( FFA ) then the animals were submitted to Test of Suppression Endogenous Glucose and Insulin, with infusion during 180 minutes of solution GLU ( 20mg/kg/min ) + INS ( 5mU/kg/min ); blood samples was collected at 140, 150, 160, 170 and 180 minutes. Finished the test and still anesthetized, the tissues were removed: liver ( LIV ), skeletal muscle ( SOL and PLA ) that were immediately frozen in liquid nitrogen and stored at -70ºC until analysis. The PGC-1 expression was evaluated by Western Blotting with polyclonal antibody anti-PGC-1. Statistical analysis by unpaired Students t test with significance level 5%. RESULTS: the data refer to the mean and standard error of individual values. The distance covered per day during last week ( km / day ) by Ex group was efficient ( 5,61 ± 0,67 ). There was no difference in weight ( g ) of rats between Ex and Sd groups ( 355,85 ± 9,51 x 375,68 ± 5,30 ) NS. The values of fasting GLU were similar between groups ( mg/dl ) ( 117,6 ± 3,7 x 122,4 ± 2,6 ) NS. However INS and FFA were lower in group Ex: INS ( ng/ml ) ( 0,68 ± 0,12 x 1,45 ± 0,14 ) p < 0,001 and FFA ( mEq/L ) ( 1,12 ± 0,11 x 1,60 ± 0,11 ) p < 0,006. During the suppression test the values of GLU and INS on stability step were similar between groups ( expressed in area under curve ): AUC GlU ( mg/dl/min ) ( 2,77 ± 0,12 x 2,95 ± 0,07 ) NS; AUC INS ( ng/ml/min ) ( 0,81 ± 0,15 x 0,99 ± 0,09 ) NS. The PGC-1 expression was greater in PLA of rats Ex than Sd group, and there was no difference in LIV and SOL between groups. CONCLUSION: The physical exercise during five weeks in voluntary running wheel increased the insulin sensitivity and fasting free fatty acids oxidation. The improvement of insulin sensitivity was associated with higher PGC-1 expression on PLA muscle only. These data suggest that increasing insulin sensibility on fasting is not associated with increasing of the PGC-1 expression in others targets tissues of insulin action, such as LIV and SOL, in this study model.

Neurografi är en grundläggande metod för att diagnosticera perifera nervsjukdomar, metoden reflekterar det funktionella tillståndet av myeliniserade axon. Neurografi är uppdelat i två delar, motorisk och sensorisk neurografi. Vid undersökningen erhålls va-riabler så som amplitud, latenstid och nervledningshastighet, samtliga variabler är på-verkade av vävnadstemperatur. Vid kalla temperaturer sjunker nervledningshastigheten, amplituden förändras och latenstiden förlängs. Syftet med studien är att kartlägga till vilken grad temperaturen påverkar sensorisk neurografi och om motorisk neurografi på-verkas av temperatur. I studien undersöktes den sensoriska och motoriska grenen på n. tibialis vid hudtempe-raturerna &gt; 30° C, mellan 25 – 28° C samt &lt; 24° C. Huden kyldes med vatten och hud-temperaturen mättes med en örontermometer. Sensorisk nervledningshastighet och amplitud visade en signifikant skillnad mellan de tre temperaturintervallerna medan motorisk nervledningshastighet och amplitud inte vi-sade någon signifikant skillnad. / Electroneurography is a fundamental method for diagnosing peripheral nerve disorder, the method reflects the functional condition of the myelin coated axons. Electroneurog-raphy is divided into two parts, sensory and motor neurography. During the examination are variables as amplitude, latency and conduction velocity acquired, all those variables are affected by temperature. At cold temperature conduction velocity declines, ampli-tude changes and latency extend. The purpose of the study is to map out to what degree the temperature is affecting sensory neurography and if motor neurography is affected by temperature. The study examined the sensory and motor branch of n. tibialis at the skin temperature &gt; 30° C, between 25 – 28° C and &lt; 24° C. The skin was cooled by water and the skin temperature was measured by an ear-thermometer. Sensory conduction velocity and amplitude had a significantly difference at the three temperature intervals meanwhile motor conduction velocity and amplitude did not.

O presente estudo analisou as mudanças e adaptações geradas pelos protocolos de alongamento e exercício excêntrico nos músculos sóleo e plantar, após 10 dias de imobilização do membro posterior de ratas em desenvolvimento pós-natal. Para isso, 45 ratas da raça Wistar, com 21 dias de idade, foram divididas em 10 grupos: grupo imobilizado (GI); grupo imobilizado e treinado excentricamente por 10 dias (GITE(10)) ou 21 dias (GITE(21)); grupo imobilizado e alongado por 10 dias (GIAL(10)) ou 21 dias (GIAL(21)); grupo anestesiado (GA); grupo controle de 21 dias de idade (GC(zero)); grupo controle do imobilizado de 31 dias de idade (GC(Imob)); grupo controle de 10 dias com 41 dias de idade (GC(10)); grupo controle de 21 dias com 52 dias de idade (GC(21)). A imobilização foi aplicada por 10 dias no membro posterior direito dos animais, a fim de manter a posição de encurtamento dos músculos sóleo e plantar. Posteriormente, as ratas do GITE(10) e GITE(21) passaram pelo período de treino excêntrico em esteira declinada, por 40 minutos. Enquanto os animais do GIAL(10) e GIAL(21) foram submetidos ao alongamento mantido por 40 minutos, através da fixação da dorsiflexão máxima permitida pelo tornozelo. Após os protocolos, os fragmentos dos músculos sóleo e plantar foram retirados e submetidos às reações histoquímica, imunoistoquímica e bioquímica. Análise qualitativa e quantitativa (isoformas de MHC, proporção de fibras, diâmetro menor e relação capilar/fibra) foram realizadas. Para análise estatística foi usado o Modelo Linear de Efeitos Mistos com nível de significância de 5% e Intervalo de Confiança de 95%. A partir da análise temporal do desenvolvimento muscular dos animais, foram observadas características de imaturidade dos músculos sóleo e plantar (fibras arredondadas, núcleos volumosos, reatividade do tecido), principalmente em animais com 21 e 31 dias de idade. Aumento progressivo do diâmetro das fibras e da relação capilar/fibra, em ambos os músculos, foram observados. O predomínio de FT1 e maior expressão da MHCI já estavam evidentes no músculo sóleo, mesmo de animais com 21 dias de idade. O músculo plantar apresentou predomínio de FT2D na análise da mATPase, e a avaliação das isoformas indicou predomínio da MHCIId e MHCIIb. O procedimento de imobilização desencadeou alta reatividade do tecido, redução do diâmetro de todos os tipos de fibras, mudança na proporção das fibras (redução de FT1 no sóleo e aumento de FT2D no plantar) e na expressão das isoformas de MHC, e queda do número de capilares transversais. A aplicação do alongamento e exercício excêntrico provocou adaptações importantes como o aumento do diâmetro das fibras, modificação da proporção das fibras e aumento da relação capilar/fibra, em ambos os músculos. Da análise morfológica, o músculo sóleo apresentou maior reatividade, quando comparado ao músculo plantar, com grande quantidade de núcleos centralizados e halo basofílico. O treino excêntrico foi capaz de intensificar as respostas hipertrófica e angiogênica, principalmente no período de 21 dias de reabilitação. Portanto, o desenvolvimento muscular normal foi acompanhado por adaptações importantes que correspondem ao avançar da idade juntamente com o aumento da demanda funcional nessa fase. O dispositivo de imobilização foi eficaz para promover o desuso e encurtamento dos músculos avaliados. Diferenças nítidas entre a resposta adaptativa dos músculos sóleo e plantar são observadas em ambos os protocolos de reabilitação no animal bebê. / This study analyzed changes and adaptations in the soleus and plantar muscles induced by stretching and eccentric exercise protocols applied after 10 days immobilization of the hindlimb in developing female rats. Fortyfive Wistar female rats, 21 days old, were divided into 10 groups: Immobilized (IG); Immobilized and trained eccentrically for 10 days (IEG(10)) or 21 days (IEG(21)); Immobilized and stretched for 10 days (ISG(10)) or 21 days (ISG(21)); Anesthetized (AG); Control, 21 days old (CG(zero)); Control of immobilized group, 31 days old (CG(Immob)); Control group of 10 days, 41 days old (CG(10)) or 21 days, 52 days old (CG(21)). The animals had the right hindlimb immobilized for 10 days keeping the soleus and plantar mucles in a shortened position. Rats in the IEG(10) and IEG(21) groups were further submitted to eccentric training in a declining threadmill for 40 minutes, while the ones in groups ISG(10) and ISG(21) were stretched for 40 minutes by fixing the maximum ankle dorsiflexion. Fragments of the soleus and plantar muscles were removed and analyzed by histochemical, immunohistochemical and biochemical assays, after sacrifice of the animals. Qualitative and quantitative analysis were made of Myosin Heavy-Chain (MHC) isoforms, fiber proportion, minimum diameter and capillary/fiber ratio. Data was statistically analyzed by the method of Mixed Effects Linear Models with a significance level of 5% and confidence interval of 95%. Temporal analysis of muscle development suggested immaturity of soleus and plantar muscles (rounded fibers, voluminous nuclei and tissue reactivity) specially in animals aged from 21-31 days. Progressive increase of fiber diameter and the capillary/ fiber ratio was also observed. Predominance of FT1 fibers and higher MHCI expression were already evident in the soleus muscle even in 21 days old animals. Analysis of mATPase showed that FT2D fibers were predominant in the plantar muscle as were the isoforms MHCIId and MHCIIb. Immobilization produced high tissue reactivity, diameter reduction in all fiber types, changes in fiber proportion (reduction of FT1 in the soleus and increase of FT2D numbers in the plantar muscles) and MHC isoform expressions and decreased number of transversal capillars. Both, stretching and eccentric exercises induced important adaptations like increased fiber diameter, modified fiber proportions and increased capillary/ fiber ratios in the soleus and plantar muscles. Morphological analysis indicated that the soleus was more reactive as compared to the plantar muscle, showing large quantities of centralized nuclei and a basophilic halo. Eccentric training induced greater hypertrophic and angiogenic responses, specially during the 21 days rehabilitation. Thus, normal muscular development in this phase was accompanied by major adaptations, which correspond to advancing age and increased functional demand. The immobilization apparatus was efficient in preventing use and promoting shortening of the muscles evaluated. Sharp differences between adaptive responses of soleus and plantar muscles were observed in both rehabilitation protocols applied to baby animals.

Zusammenfassung Gefäßerkrankungen und Diabetes mellitus nehmen als Krankheiten der modernen Zivilisation zu. Sie gehen oft mit dem Risiko einer Amputation einher. Trotz verbesserter Therapie aufgrund des medizinischen Fortschritts steigen die Amputationsraten. Besonders gefährdet sind Patienten mit Diabetes mellitus. Aufgrund des besonderen Atherosklerosebefallsmusters mit Verschluss der kruralen Gefäße bei relativer Aussparung der Oberschenkel- und Fußarterien erzielen pedale Bypässe bei diabetischen Patienten besonders gute Ergebnisse im Hinblick auf die Wiederherstellung der Fußdurchblutung. Ein pedaler Bypass kann eine drohende Amputation oft verhindern. Voraussetzungen für eine pedale Bypass-Operation sind umfassende anatomische Kenntnisse über die Variabilität der Arterien im Operationsgebiet. Die vorliegende Arbeit befasst sich mit den Gefäßvariationen an Unterschenkel und Fuß. Mit unterschiedlichen Methoden wurden Alkohol-fixierte (n=12) und Thiel-fixierte (n=10) Beinpräparate auf arterielle Variabilität untersucht. Die Alkohol-fixierten Präparate wurden makroskopisch präpariert und fotografisch dokumentiert, außerdem erfolgte eine Probenentnahme zur histologischen Untersuchung der Atherosklerosegrade in verschiedenen Gefäßregionen (n=32) und die Herstellung von zwei Dauerpräparaten. An Thiel-fixiertem Material wurde die Digitale Subtraktionsangiographie (DSA) getestet. Folgende Fragestellungen waren zu beantworten: 1. Welche Variationen der Blutgefäße finden sich für den Unterschenkel und Fuß? Wie kommunizieren die Gefäße zwischen Fußsohle und Fußrücken? 2. Wie können kleinste Gefäße am Fuß präpariert und fotografisch dokumentiert werden? 3. Lässt sich an fixiertem Leichenmaterial eine Digitale Subtraktionsangiographie durchzuführen? 4. Zeigen proximale und distale Blutgefäße des Beines einen unterschiedlichen Befall der Atherosklerose? 5. Welche Bedeutung hat die Herstellung von Dauerpräparaten für den studentischen Unterricht? 6. Welche Bedeutung hat die makroskopische Anatomie für die Klinik? Die Ergebnisse und Schlussfolgerungen sind: 1. Während der makroskopischen Präparation fanden sich folgende Variationen: Trifurkation, Truncus tibiofibularis anterior mit hohem Abgang der A. tibialis posterior und Abgang der A. tibialis anterior aus der A. fibularis, eine sehr dominante A. fibularis bei schwach ausgeprägter A. tibialis posterior, ein Arcus plantaris durch den zweiten intermetatarsalen Spalt laufend, kräftig ausgebildete A. plantaris profunda, kräftiger tiefer Ast der A. plantaris medialis, stark ausgeprägte A. arcuata. Die den Arcus plantaris versorgenden Arterien, vor allem die A. plantaris lateralis und die A. plantaris profunda, variieren stark in ihrer Ausprägung. Sie sind Teil der „Ringanastomose”, die eine Durchblutung des Fußes über die Verbindungen verschiedener Gefäße zwischen Fußsohle und Fußrücken gewährleistet. Neben der A. plantaris profunda, die auch als Ramus perforans I bezeichnet wird, gibt es zwischen den Aa. metatarsales plantares und dorsales Verbindungen, die Rr. perforantes II-IV, die bei schwach ausgeprägter A. plantaris profunda die Gefäßversorgung sicherstellen und entsprechend stärker ausgebildet sein können. Die A. fibularis kann über ihre kommunizierenden Äste, dem Ramus perforans zur A. dorsalis pedis oder dem Ramus communicans zur A. tibialis posterior, an der arteriellen Versorgung der Fußsohle beteiligt sein. Bei schwacher Ausbildung der A. tibialis posterior und/oder A. tibialis anterior kann diese durch die A. fibularis als phylogenetisch ältestes und damit konstantestes Gefäß der drei Unterschenkelarterien sogar teilweise oder vollständig ersetzt werden. Die „Ringanastomose“ hat für die Gefäßchirurgie eine große Bedeutung. Beim popliteodistalen Bypass orientiert sich die Wahl des distalen Anschlussgefäßes daran, über welches Gefäß sich der Arcus plantaris angiographisch füllt. Eine Kollateralbildung beim Erwachsenen infolge atherosklerotischer Veränderungen über ursprünglich embryologische Gegebenheiten ist denkbar. 2. Die makroskopische Präparation kleinster Gefäße am Fuß wird durch die Injektion der roten Injektionslösung Microfil® erleichtert. Zur fotografischen Dokumentation ist eine Farbmarkierung der Arterien von außen notwendig, um den Gefäßverlauf sichtbar zu machen. 3. Digitale Subtraktionsangiographie an Leichenmaterial ist nur an Thiel-fixiertem Material möglich, da diese Methode die Gewebeverhältnisse in ihrer natürlichen Konsistenz erhält. Das Einbinden der Schleusen und die Injektion von Kontrastmittel in das Gefäßsystem sind durchführbar, weil die Gefäßlumina durchgängig bleiben. Alkohol- oder Formaldehyd-fixiertes Material ist für diese Zwecke ungeeignet, da das Gewebe aushärtet und in den Gefäßen befindliche Blutreste koagulieren. Dadurch wird eine Kontrastmittel-Injektion unmöglich. 4. Dass histologische Färbungen an langzeitfixiertem Material möglich sind, konnte bestätigt werden. Nach Modifikation der Färbevorschriften erlauben sie die Bewertung des Atherosklerosegrades. Der schwerste Befall mit Grad 4 befindet sich in den Arterien der Kniekehle. Die Fußarterien sind mit Grad 2 geringer befallen. 5. Dauerpräparate verbleiben in der anatomischen Lehrsammlung bzw. im Fundus von Anschauungsmaterial. Sie werden zukünftig zur Demonstration anatomischer Strukturen im Rahmen klinischer Kurse und im Studentenunterricht verwendet. 6. Die Anatomie als Grundlagenfach der Medizin hat in der Lehre einen hohen Stellenwert und in allen Studienabschnitten eine hohe klinische Relevanz. Gemeinsame Lehrveranstaltungen von Anatomie und Klinik wecken bei Studenten großes Interesse und fördern die Motivation. Im Rahmen der ärztlichen Aus- und Weiterbildung werden in klinischen Kursen am Institut für Anatomie beispielsweise Untersuchungsmethoden und Operationsbedingungen simuliert. Kliniker wiederholen, festigen oder vertiefen ihre anatomischen Kenntnisse. Vor allem die chirurgischen Fächer profitieren von diesen praktischen Trainingsmöglichkeiten. Wie die Arbeit am Beispiel der Gefäßchirurgie zeigt, bedingt eine gute Zusammenarbeit zwischen Anatomie und Klinik eine sichere klinische Praxis und eine lebendige Anatomie mit klinischen Bezügen. / Summary Vascular diseases and diabetes mellitus show rising frequency in the Western world and are often accompanied by amputation. The amputation rate is still increasing despite major developments in diagnostics and therapy. Especially patients with diabetes mellitus are at high risk. Because of the special pattern with more severe atherosclerosis in the crural vessels than in the femoral and pedal arteries, the pedal bypass surgery provides excellent vessel patency and limb salvage rates in diabetic patients and can often prevent amputation. A solid knowledge about anatomical variations in the operating area is a precondition for bypass operations. This dissertation deals with variations of arteries from the lower leg and foot. Lower legs from alcohol-fixed and Thiel-fixed cadavers were examined with different methods: The alcohol-fixed legs (n=12) were dissected macroscopically for variations of the arteries and documented by photographes. Samples along the vessel course (n=32) were taken for histological evaluation of the atherosclerotic degrees. Two legs were plastinated with polyethylene glycol. The Thiel-fixed legs (n=10) were tested for digital subtraction angiography (DSA). The following questions had to be answered: 1. Which arterial variations can be found for the lower leg and foot? How do the vessels communicate between the sole and the dorsum of the foot? 2. How are small foot vessels dissected for photographical documentation? 3. Can Thiel-fixed material be used for DSA? 4. Do proximal and distal vessels show different degrees of atherosclerosis? 5. Which relevance does plastination have for the medical education? 6. How important is Gross anatomy for the clinicians? Results and conclusions: 1. The following variations occurred: trifurcation, anterior tibiofibular truncus with high branching from the posterior tibial artery and the anterior tibial artery originating from the fibular artery, dominant fibular artery, plantar arch running through the second interosseus space, dominant deep plantar artery, dominant deep branch of the medial plantar artery, prominent arcuate artery. The arteries for the plantar arch, supplying most of the foot arteries, show a high diversification. They are part of the “ring anastomosis” which assures a good blood supply via different vessels connecting the dorsum and the sole of the foot. Beside the deep plantar artery, also named as “perforating branch I”, there are other connecting branches between the plantar and dorsal metatarsal arteries - the perforating braches II, III and IV. These branches are highly developed in case of an undeveloped deep plantar artery. The fibular artery can be involved in the blood supply of the foot via a communicating branch to the posterior tibial artery and the perforating branch to the dorsalis pedis artery. The fibular artery, which is phylogenetically the oldest crural vessel, can be highly developed in case of inferior anterior tibial artery and/or posterior tibial artery. The “ring anastomosis” is very important for vascular surgery. The inflow and outflow vessels of a popliteodistal bypass are chosen after angiography of the plantar arch showing the vessel for the supply of the plantar arch. 2. Macroscopical dissection of very small foot vessels can be facilitated by injection of a special plastic, Microfil®-solution. The arteries have to be additionally coloured by help of special markers for photographical documentation. 3. DSA can just be done with Thiel-fixed material. Thiel-fixation allows DSA because maintained in situ conditions. The blood is not coagulated and the vessels stay patent for contrast medium. Alcohol-fixed or formaldehyde-fixed material is not suitable for DSA because of clotted blood in the vessels impeding injection of contrast agent. 4. It is confirmed that histological examination is possible with long fixed material. After modification of the staining protocol the sections could be used for evaluation of the atherosclerotic degree. The popliteal arteries are more affected with degree 4 in comparison to the foot arteries with degree 2. 5. Plastinates are displayed in the anatomical collection of the Institute for Anatomy. They will be used for anatomical demonstrations in the lessons of students and in clinical courses. 6. Anatomy as basic knowledge is very important for teaching medical students and has a high clinical relevance in every phase of the medical course. Interdisciplinary lessons between anatomy and clinical disciplines awake interest and motivate students. Advanced medical training is obtained at the Institute for Anatomy by simulating endoscopic examination and developing new surgical techniques. Clinicians repeat, stabilize and deepen their anatomical knowledge. Especially surgeons benefit from these training possibilities. Using the example of vascular bypass surgery the present dissertation shows the value of a good cooperation between anatomy and clinic to provide a safe clinical practice and a lively anatomy with clinical references.

O presente estudo analisou as mudanças e adaptações geradas pelos protocolos de alongamento e exercício excêntrico nos músculos sóleo e plantar, após 10 dias de imobilização do membro posterior de ratas em desenvolvimento pós-natal. Para isso, 45 ratas da raça Wistar, com 21 dias de idade, foram divididas em 10 grupos: grupo imobilizado (GI); grupo imobilizado e treinado excentricamente por 10 dias (GITE(10)) ou 21 dias (GITE(21)); grupo imobilizado e alongado por 10 dias (GIAL(10)) ou 21 dias (GIAL(21)); grupo anestesiado (GA); grupo controle de 21 dias de idade (GC(zero)); grupo controle do imobilizado de 31 dias de idade (GC(Imob)); grupo controle de 10 dias com 41 dias de idade (GC(10)); grupo controle de 21 dias com 52 dias de idade (GC(21)). A imobilização foi aplicada por 10 dias no membro posterior direito dos animais, a fim de manter a posição de encurtamento dos músculos sóleo e plantar. Posteriormente, as ratas do GITE(10) e GITE(21) passaram pelo período de treino excêntrico em esteira declinada, por 40 minutos. Enquanto os animais do GIAL(10) e GIAL(21) foram submetidos ao alongamento mantido por 40 minutos, através da fixação da dorsiflexão máxima permitida pelo tornozelo. Após os protocolos, os fragmentos dos músculos sóleo e plantar foram retirados e submetidos às reações histoquímica, imunoistoquímica e bioquímica. Análise qualitativa e quantitativa (isoformas de MHC, proporção de fibras, diâmetro menor e relação capilar/fibra) foram realizadas. Para análise estatística foi usado o Modelo Linear de Efeitos Mistos com nível de significância de 5% e Intervalo de Confiança de 95%. A partir da análise temporal do desenvolvimento muscular dos animais, foram observadas características de imaturidade dos músculos sóleo e plantar (fibras arredondadas, núcleos volumosos, reatividade do tecido), principalmente em animais com 21 e 31 dias de idade. Aumento progressivo do diâmetro das fibras e da relação capilar/fibra, em ambos os músculos, foram observados. O predomínio de FT1 e maior expressão da MHCI já estavam evidentes no músculo sóleo, mesmo de animais com 21 dias de idade. O músculo plantar apresentou predomínio de FT2D na análise da mATPase, e a avaliação das isoformas indicou predomínio da MHCIId e MHCIIb. O procedimento de imobilização desencadeou alta reatividade do tecido, redução do diâmetro de todos os tipos de fibras, mudança na proporção das fibras (redução de FT1 no sóleo e aumento de FT2D no plantar) e na expressão das isoformas de MHC, e queda do número de capilares transversais. A aplicação do alongamento e exercício excêntrico provocou adaptações importantes como o aumento do diâmetro das fibras, modificação da proporção das fibras e aumento da relação capilar/fibra, em ambos os músculos. Da análise morfológica, o músculo sóleo apresentou maior reatividade, quando comparado ao músculo plantar, com grande quantidade de núcleos centralizados e halo basofílico. O treino excêntrico foi capaz de intensificar as respostas hipertrófica e angiogênica, principalmente no período de 21 dias de reabilitação. Portanto, o desenvolvimento muscular normal foi acompanhado por adaptações importantes que correspondem ao avançar da idade juntamente com o aumento da demanda funcional nessa fase. O dispositivo de imobilização foi eficaz para promover o desuso e encurtamento dos músculos avaliados. Diferenças nítidas entre a resposta adaptativa dos músculos sóleo e plantar são observadas em ambos os protocolos de reabilitação no animal bebê. / This study analyzed changes and adaptations in the soleus and plantar muscles induced by stretching and eccentric exercise protocols applied after 10 days immobilization of the hindlimb in developing female rats. Fortyfive Wistar female rats, 21 days old, were divided into 10 groups: Immobilized (IG); Immobilized and trained eccentrically for 10 days (IEG(10)) or 21 days (IEG(21)); Immobilized and stretched for 10 days (ISG(10)) or 21 days (ISG(21)); Anesthetized (AG); Control, 21 days old (CG(zero)); Control of immobilized group, 31 days old (CG(Immob)); Control group of 10 days, 41 days old (CG(10)) or 21 days, 52 days old (CG(21)). The animals had the right hindlimb immobilized for 10 days keeping the soleus and plantar mucles in a shortened position. Rats in the IEG(10) and IEG(21) groups were further submitted to eccentric training in a declining threadmill for 40 minutes, while the ones in groups ISG(10) and ISG(21) were stretched for 40 minutes by fixing the maximum ankle dorsiflexion. Fragments of the soleus and plantar muscles were removed and analyzed by histochemical, immunohistochemical and biochemical assays, after sacrifice of the animals. Qualitative and quantitative analysis were made of Myosin Heavy-Chain (MHC) isoforms, fiber proportion, minimum diameter and capillary/fiber ratio. Data was statistically analyzed by the method of Mixed Effects Linear Models with a significance level of 5% and confidence interval of 95%. Temporal analysis of muscle development suggested immaturity of soleus and plantar muscles (rounded fibers, voluminous nuclei and tissue reactivity) specially in animals aged from 21-31 days. Progressive increase of fiber diameter and the capillary/ fiber ratio was also observed. Predominance of FT1 fibers and higher MHCI expression were already evident in the soleus muscle even in 21 days old animals. Analysis of mATPase showed that FT2D fibers were predominant in the plantar muscle as were the isoforms MHCIId and MHCIIb. Immobilization produced high tissue reactivity, diameter reduction in all fiber types, changes in fiber proportion (reduction of FT1 in the soleus and increase of FT2D numbers in the plantar muscles) and MHC isoform expressions and decreased number of transversal capillars. Both, stretching and eccentric exercises induced important adaptations like increased fiber diameter, modified fiber proportions and increased capillary/ fiber ratios in the soleus and plantar muscles. Morphological analysis indicated that the soleus was more reactive as compared to the plantar muscle, showing large quantities of centralized nuclei and a basophilic halo. Eccentric training induced greater hypertrophic and angiogenic responses, specially during the 21 days rehabilitation. Thus, normal muscular development in this phase was accompanied by major adaptations, which correspond to advancing age and increased functional demand. The immobilization apparatus was efficient in preventing use and promoting shortening of the muscles evaluated. Sharp differences between adaptive responses of soleus and plantar muscles were observed in both rehabilitation protocols applied to baby animals.

Zusammenfassung Gefäßerkrankungen und Diabetes mellitus nehmen als Krankheiten der modernen Zivilisation zu. Sie gehen oft mit dem Risiko einer Amputation einher. Trotz verbesserter Therapie aufgrund des medizinischen Fortschritts steigen die Amputationsraten. Besonders gefährdet sind Patienten mit Diabetes mellitus. Aufgrund des besonderen Atherosklerosebefallsmusters mit Verschluss der kruralen Gefäße bei relativer Aussparung der Oberschenkel- und Fußarterien erzielen pedale Bypässe bei diabetischen Patienten besonders gute Ergebnisse im Hinblick auf die Wiederherstellung der Fußdurchblutung. Ein pedaler Bypass kann eine drohende Amputation oft verhindern. Voraussetzungen für eine pedale Bypass-Operation sind umfassende anatomische Kenntnisse über die Variabilität der Arterien im Operationsgebiet. Die vorliegende Arbeit befasst sich mit den Gefäßvariationen an Unterschenkel und Fuß. Mit unterschiedlichen Methoden wurden Alkohol-fixierte (n=12) und Thiel-fixierte (n=10) Beinpräparate auf arterielle Variabilität untersucht. Die Alkohol-fixierten Präparate wurden makroskopisch präpariert und fotografisch dokumentiert, außerdem erfolgte eine Probenentnahme zur histologischen Untersuchung der Atherosklerosegrade in verschiedenen Gefäßregionen (n=32) und die Herstellung von zwei Dauerpräparaten. An Thiel-fixiertem Material wurde die Digitale Subtraktionsangiographie (DSA) getestet. Folgende Fragestellungen waren zu beantworten: 1. Welche Variationen der Blutgefäße finden sich für den Unterschenkel und Fuß? Wie kommunizieren die Gefäße zwischen Fußsohle und Fußrücken? 2. Wie können kleinste Gefäße am Fuß präpariert und fotografisch dokumentiert werden? 3. Lässt sich an fixiertem Leichenmaterial eine Digitale Subtraktionsangiographie durchzuführen? 4. Zeigen proximale und distale Blutgefäße des Beines einen unterschiedlichen Befall der Atherosklerose? 5. Welche Bedeutung hat die Herstellung von Dauerpräparaten für den studentischen Unterricht? 6. Welche Bedeutung hat die makroskopische Anatomie für die Klinik? Die Ergebnisse und Schlussfolgerungen sind: 1. Während der makroskopischen Präparation fanden sich folgende Variationen: Trifurkation, Truncus tibiofibularis anterior mit hohem Abgang der A. tibialis posterior und Abgang der A. tibialis anterior aus der A. fibularis, eine sehr dominante A. fibularis bei schwach ausgeprägter A. tibialis posterior, ein Arcus plantaris durch den zweiten intermetatarsalen Spalt laufend, kräftig ausgebildete A. plantaris profunda, kräftiger tiefer Ast der A. plantaris medialis, stark ausgeprägte A. arcuata. Die den Arcus plantaris versorgenden Arterien, vor allem die A. plantaris lateralis und die A. plantaris profunda, variieren stark in ihrer Ausprägung. Sie sind Teil der „Ringanastomose”, die eine Durchblutung des Fußes über die Verbindungen verschiedener Gefäße zwischen Fußsohle und Fußrücken gewährleistet. Neben der A. plantaris profunda, die auch als Ramus perforans I bezeichnet wird, gibt es zwischen den Aa. metatarsales plantares und dorsales Verbindungen, die Rr. perforantes II-IV, die bei schwach ausgeprägter A. plantaris profunda die Gefäßversorgung sicherstellen und entsprechend stärker ausgebildet sein können. Die A. fibularis kann über ihre kommunizierenden Äste, dem Ramus perforans zur A. dorsalis pedis oder dem Ramus communicans zur A. tibialis posterior, an der arteriellen Versorgung der Fußsohle beteiligt sein. Bei schwacher Ausbildung der A. tibialis posterior und/oder A. tibialis anterior kann diese durch die A. fibularis als phylogenetisch ältestes und damit konstantestes Gefäß der drei Unterschenkelarterien sogar teilweise oder vollständig ersetzt werden. Die „Ringanastomose“ hat für die Gefäßchirurgie eine große Bedeutung. Beim popliteodistalen Bypass orientiert sich die Wahl des distalen Anschlussgefäßes daran, über welches Gefäß sich der Arcus plantaris angiographisch füllt. Eine Kollateralbildung beim Erwachsenen infolge atherosklerotischer Veränderungen über ursprünglich embryologische Gegebenheiten ist denkbar. 2. Die makroskopische Präparation kleinster Gefäße am Fuß wird durch die Injektion der roten Injektionslösung Microfil® erleichtert. Zur fotografischen Dokumentation ist eine Farbmarkierung der Arterien von außen notwendig, um den Gefäßverlauf sichtbar zu machen. 3. Digitale Subtraktionsangiographie an Leichenmaterial ist nur an Thiel-fixiertem Material möglich, da diese Methode die Gewebeverhältnisse in ihrer natürlichen Konsistenz erhält. Das Einbinden der Schleusen und die Injektion von Kontrastmittel in das Gefäßsystem sind durchführbar, weil die Gefäßlumina durchgängig bleiben. Alkohol- oder Formaldehyd-fixiertes Material ist für diese Zwecke ungeeignet, da das Gewebe aushärtet und in den Gefäßen befindliche Blutreste koagulieren. Dadurch wird eine Kontrastmittel-Injektion unmöglich. 4. Dass histologische Färbungen an langzeitfixiertem Material möglich sind, konnte bestätigt werden. Nach Modifikation der Färbevorschriften erlauben sie die Bewertung des Atherosklerosegrades. Der schwerste Befall mit Grad 4 befindet sich in den Arterien der Kniekehle. Die Fußarterien sind mit Grad 2 geringer befallen. 5. Dauerpräparate verbleiben in der anatomischen Lehrsammlung bzw. im Fundus von Anschauungsmaterial. Sie werden zukünftig zur Demonstration anatomischer Strukturen im Rahmen klinischer Kurse und im Studentenunterricht verwendet. 6. Die Anatomie als Grundlagenfach der Medizin hat in der Lehre einen hohen Stellenwert und in allen Studienabschnitten eine hohe klinische Relevanz. Gemeinsame Lehrveranstaltungen von Anatomie und Klinik wecken bei Studenten großes Interesse und fördern die Motivation. Im Rahmen der ärztlichen Aus- und Weiterbildung werden in klinischen Kursen am Institut für Anatomie beispielsweise Untersuchungsmethoden und Operationsbedingungen simuliert. Kliniker wiederholen, festigen oder vertiefen ihre anatomischen Kenntnisse. Vor allem die chirurgischen Fächer profitieren von diesen praktischen Trainingsmöglichkeiten. Wie die Arbeit am Beispiel der Gefäßchirurgie zeigt, bedingt eine gute Zusammenarbeit zwischen Anatomie und Klinik eine sichere klinische Praxis und eine lebendige Anatomie mit klinischen Bezügen. / Summary Vascular diseases and diabetes mellitus show rising frequency in the Western world and are often accompanied by amputation. The amputation rate is still increasing despite major developments in diagnostics and therapy. Especially patients with diabetes mellitus are at high risk. Because of the special pattern with more severe atherosclerosis in the crural vessels than in the femoral and pedal arteries, the pedal bypass surgery provides excellent vessel patency and limb salvage rates in diabetic patients and can often prevent amputation. A solid knowledge about anatomical variations in the operating area is a precondition for bypass operations. This dissertation deals with variations of arteries from the lower leg and foot. Lower legs from alcohol-fixed and Thiel-fixed cadavers were examined with different methods: The alcohol-fixed legs (n=12) were dissected macroscopically for variations of the arteries and documented by photographes. Samples along the vessel course (n=32) were taken for histological evaluation of the atherosclerotic degrees. Two legs were plastinated with polyethylene glycol. The Thiel-fixed legs (n=10) were tested for digital subtraction angiography (DSA). The following questions had to be answered: 1. Which arterial variations can be found for the lower leg and foot? How do the vessels communicate between the sole and the dorsum of the foot? 2. How are small foot vessels dissected for photographical documentation? 3. Can Thiel-fixed material be used for DSA? 4. Do proximal and distal vessels show different degrees of atherosclerosis? 5. Which relevance does plastination have for the medical education? 6. How important is Gross anatomy for the clinicians? Results and conclusions: 1. The following variations occurred: trifurcation, anterior tibiofibular truncus with high branching from the posterior tibial artery and the anterior tibial artery originating from the fibular artery, dominant fibular artery, plantar arch running through the second interosseus space, dominant deep plantar artery, dominant deep branch of the medial plantar artery, prominent arcuate artery. The arteries for the plantar arch, supplying most of the foot arteries, show a high diversification. They are part of the “ring anastomosis” which assures a good blood supply via different vessels connecting the dorsum and the sole of the foot. Beside the deep plantar artery, also named as “perforating branch I”, there are other connecting branches between the plantar and dorsal metatarsal arteries - the perforating braches II, III and IV. These branches are highly developed in case of an undeveloped deep plantar artery. The fibular artery can be involved in the blood supply of the foot via a communicating branch to the posterior tibial artery and the perforating branch to the dorsalis pedis artery. The fibular artery, which is phylogenetically the oldest crural vessel, can be highly developed in case of inferior anterior tibial artery and/or posterior tibial artery. The “ring anastomosis” is very important for vascular surgery. The inflow and outflow vessels of a popliteodistal bypass are chosen after angiography of the plantar arch showing the vessel for the supply of the plantar arch. 2. Macroscopical dissection of very small foot vessels can be facilitated by injection of a special plastic, Microfil®-solution. The arteries have to be additionally coloured by help of special markers for photographical documentation. 3. DSA can just be done with Thiel-fixed material. Thiel-fixation allows DSA because maintained in situ conditions. The blood is not coagulated and the vessels stay patent for contrast medium. Alcohol-fixed or formaldehyde-fixed material is not suitable for DSA because of clotted blood in the vessels impeding injection of contrast agent. 4. It is confirmed that histological examination is possible with long fixed material. After modification of the staining protocol the sections could be used for evaluation of the atherosclerotic degree. The popliteal arteries are more affected with degree 4 in comparison to the foot arteries with degree 2. 5. Plastinates are displayed in the anatomical collection of the Institute for Anatomy. They will be used for anatomical demonstrations in the lessons of students and in clinical courses. 6. Anatomy as basic knowledge is very important for teaching medical students and has a high clinical relevance in every phase of the medical course. Interdisciplinary lessons between anatomy and clinical disciplines awake interest and motivate students. Advanced medical training is obtained at the Institute for Anatomy by simulating endoscopic examination and developing new surgical techniques. Clinicians repeat, stabilize and deepen their anatomical knowledge. Especially surgeons benefit from these training possibilities. Using the example of vascular bypass surgery the present dissertation shows the value of a good cooperation between anatomy and clinic to provide a safe clinical practice and a lively anatomy with clinical references.