Variação anatômica do tronco celíaco e do sistema arterial hepático: uma análise por exames de imagem / Anatomical variations of the celiac trunk and the hepatic arterial system: an imaging analysis

Introdução: As variações anatômicas das artérias hepáticas e do tronco celíaco são de grande importância para cirurgias laparoscópicas, transplantes hepáticos, intervenções radiológicas e tratamento de lesões abdominais. O grande aumento de intervenções minimamente invasivas deixou os atos cirúrgicos com menos espaço para o reconhecimento de estruturas anatômicas. Métodos: Foi realizado um estudo retrospectivo do banco de dados do Hospital São Vicente de Paulo durante o ano de 2016, analisando imagens abdominais de tomografia computadorizada com contraste e angiotomografias que envolvem a aorta abdominal e seus ramos ­ um total de 461 imagens foram analisadas. Resultados: Dos 461 pacientes analisados, 86,9% apresentaram a conformação usual do tronco celíaco ­ cuja anatômica é a origem tríplice com as artérias gástrica esquerda, esplênica e hepática comum e artéria mesentérica superior se originando sozinha da aorta abdominal. Dentre as anatomias anômalas (13%), o padrão mais comum desses ramos foi a presença em 4,5% de um tronco hepatomesentérico e um tronco gastroesplênico. No sistema arterial hepático a conformação mais prevalente foram as artérias hepáticas direita e esquerda sendo ramos da hepática próprias em 66,3%. Das alterações anatômicas (33,2%), as mais comuns foram a presença de uma artéria hepática esquerda acessória ramo da artéria gástrica esquerda (7,8%). Conclusão: Variações anatômicas do sistema arterial hepático e do tronco celíaco são prevalentes, podendo apresentar diversos arranjos organizacionais. (AU)

Introduction: Anatomical variations in the hepatic arteries and the celiac trunk are of great importance for laparoscopic surgeries, liver transplants, radiological interventions and treatment of abdominal injuries. A large increase in the number of minimally invasive interventions hampered the recognition of anatomical structures in surgical procedures. Methods: A retrospective study was performed using the 2016 São Vicente de Paulo Hospital database of contrast-enhanced abdominal computed tomography images and computed tomography angiographies showing the abdominal aorta and its branches. In total, 461 images were analyzed. Results: Of the 461 patients analyzed, 86.9% had usual conformation of the celiac trunk, which trifurcates into the left gastric artery, the common hepatic artery and the splenic artery, while the superior mesenteric artery originates alone from the abdominal aorta. Among the cases of anomalous anatomy (13%), the most common pattern in these branches was the presence of a hepatomesenteric trunk and a gastrosplenic trunk in 4.5%. In the hepatic arterial system, the most prevalent conformation was the right and left hepatic arteries being branches of the hepatic artery proper in 66.3%. Of all anatomical variations (33.2%), the most common were the presence of a left accessory hepatic artery of the left gastric artery (7.8%). Conclusion: Anatomical variations in the hepatic arterial system and the celiac trunk are common, having different structural arrangements. (AU)

Association between altered proton magnetic resonance spectroscopy (1H MRS) findings and clinical symptoms of schizophrenia

Objective: To assess the metabolic alterations of the thalamus in subjects with schizophrenia compared to healthy subjects and to investigate whether specific schizophrenic symptoms are associated with metabolic alterations measured by 1H MRS. Methods: This is a case-control study including patients with schizophrenia diagnosed usingthe Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition, DMS-IV and the Operational CriteriaChecklist for Psychotic Illness (OPCRIT). Proton magnetic resonance spectroscopy (1H MRS) was used to assess metabolite concentrations (N-acetylaspartate, choline, creatinine, myoionositol and lactacte) in the left and rightthalamus of 13 patients with schizophrenia and 13 healthy controls. Results: In this study, concentrations of specific metabolites in the thalamus, determined by 1H MRS, were similar for individuals with schizophrenia andcontrols. It was observed that cases with family history of schizophrenia and disorganized speech demonstrated areduction in the ratio of the metabolites NAA /Cho in the thalamic nuclei on the right side. However, those withorganized delusions, hallucinations and non-affective auditory hallucinations had an increase of metabolites on theright side compared to the left thalamus. Decreased thalamic metabolic activity in patients with positive symptomswas observed in contrast with those who had well-organized delusions and auditory non-affective hallucinations,core symptoms of schizophrenia. Conclusion: A lateralized thalamic involvement was verified, suggesting thatorganic and genetic factors compromise the right thalamus and that the disorganization associated with delusionsand hallucinations compromises the left thalamic nuclei. Further studies to investigate the correlation betweensymptoms and thalamic dysfunction are warranted. (Rev Neuropsiquiatr 2011;74:183-190).

Objetivo: Evaluar las alteraciones metabólicas del tálamo en personas con esquizofrenia comparándolas con controles sanos e investigar si los síntomas específicos de la esquizofrenia están vinculados a alteraciones metabólicas medidas por 1H MRS. Métodos: Se realizó la espectroscopía por resonancia magnética (1H-MRS) para estimar concentraciones de metabolitos (N-acetil- aspartato, colina creatinina, mioionositol y lactato) en el tálamo izquierdo y derecho de 13 pacientes con esquizofrenia y 13 controles. Resultados: Las concentraciones de metabolitos específicos en el tálamo fueron iguales para las personas con esquizofrenia y los controles. Se observó que los pacientes con historia familiar de esquizofrenia y aquellos que presentaban lenguaje desorganizado tenían una reducción de los metabolitos NAA/Co en los núcleos talámicos de la derecha. Sin embargo, en aquellos delirios ordenados, alucionaciones no afectivas y alucinaciones auditivas los metabolitos del lado derecho tuvieron cierto aumento con relación a los núcleos talámicos de la izquierda. Se encontró una reducción en la actividad metabólica talámica en los pacientes con síntomas positivos, al contrario de aquellos que presentaron delirios bien ordenados y alucinaciones auditivas no afectivas, los síntomas más nucleares de la esquizofrenia. Conclusión: Se verificó cierta lateralización del envolvimiento talámico, sugiriendo que los factores orgánicos y los genéricos comprometen el tálamo derecho y que la desorganización asociada a los delirios y alucionaciones compromete los núcleos talámicos de la izquierda. Más estudios son necesarios para investigar la validez de la correlación entre síntomas y disfunción talámica.