Distribution of saphenous vein valves and its pratical importance / Distribuição das válvulas da veia safena magna e sua importância prática

Objective: Among the veins used as a graft in myocardial revascularizations and ends, great saphenous vein is the most used. Knowing the presence and location of valves has great importance when evaluating the surgical anatomy of the great saphenous vein. Despite major surgical application and many works involving great saphenous vein, the number of valves present in it from the saphenous hiatus to the medial epicondyle of the femur is still described inaccurately. The objective of this study is to quantify the valves of the great saphenous vein from the saphenous hiatus to the medial epicondyle of the femur to determine the best portion of the great saphenous vein to perform revascularization surgeries. Methods: This is a crosssectional observational study in which it was analyzed great saphenous vein extracted from 30 cadavers. It was measured the length of the veins; (diameter) at its proximal, middle and distal, quantifying the number of valves in each one and the total number of valves at the great saphenous vein. Results: The frequency of valves in the great saphenous vein taken from the medial epicondyle of the femur to the saphenous hiatus was 4.82, ranging between 2 and 9. Moreover, there is a significant difference in the number of valves in the proximal and distal relative to the average. Conclusion: the median and distal portions of the saphenous vein in the thigh, are the best options for the realization of bridges due to the fact that these portions have fewer valves which therefore would tend to decrease the risk of complications connected with the valves in these grafts. .

Objetivo: Dentre as veias empregadas para revascularizações do miocárdio e de extremidades, a veia safena magna é a mais utilizada. Conhecer a presença e localização de válvulas é de grande importância quando se avalia a anatomia cirúrgica da veia safena magna. Apesar de grande aplicação cirúrgica e de muitos trabalhos envolvendo a veia safena magna, o número de válvulas presente nela desde o hiato safeno até o epicôndilo medial do fêmur ainda é descrito de forma imprecisa. O objetivo do presente trabalho é quantificar as válvulas da veia safena magna desde o hiato safeno até o epicôndilo medial do fêmur para determinar a melhor porção da veia safena magna para a realização de cirurgias de revascularização. Métodos: Este é um estudo transversal e observacional em que foram analisadas veias safena magna extraídas de 30 cadáveres. Foram realizadas as medidas das variáveis do comprimento das veias; (diâmetro) em suas porções proximal, média e distal; quantificação do número de válvulas nestas e número de válvulas total na veia safena magna. Resultados: A frequência de válvulas da veia safena contadas desde o epicôndilo medial do fêmur até o hiato safeno foi de 4,82, podendo variar entre 2 e 9. Além disso, houve diferença significante do número de válvulas da porção proximal em relação à média e distal. Conclusão: As porções média e distal da veia safena magna na coxa são as melhores opções para a realização de pontes em decorrência do fato destas porções terem menor quantidade de válvulas o que, portanto, tenderia a diminuir o risco de complicações relacionadas as válvulas nestes enxertos. .

Correlation between the Alvarado Scale and the macroscopic aspect of the appendix in patients with appendicitis / Correlação entre a Escala de Alvarado e o aspecto macroscópico do apêndice em pacientes com apendicite

Objective: To evaluate the possible association between the scale of Alvarado (EA) and macroscopic appearance (MA) of the appendix in patients with acute appendicitis. Methods: after receiving the diagnosis of acute appendicitis, EA data were collected. During appendectomy, MA data were collected. Data from patients without appendicitis were excluded. The Spearman correlation test was used to compare EA with Appendix MA (p < 0.05). Other variables were represented by simple frequency. The confidence interval (CI) of 95% was calculated for the correlation test. Results: Data were collected from 67 consecutive patients. The mean age was 37.1 ± 12.5 years and 77.6% of patients were male. The Spearman correlation test used for EA and MA was + 0.77 (95% CI 0.65-0.85, p < 0.0001). Conclusion: although correlation was not perfect, our data indicate that a high score on the scale of Alvarado in patients with appendicitis is correlated with advanced stages of the inflammatory process of acute appendicitis. .

Objetivo: avaliar a possível associação entre a escala de Alvarado (EA) e o aspecto macroscópico (AM) do apêndice em pacientes com apendicite aguda. Métodos: depois de receberem o diagnóstico de apendicite aguda, os dados da EA foram coletados. Durante a apendicectomia, os dados do AM foram coletados. Dados de pacientes sem apendicite foram excluídos. O teste de correlação de Spearman foi utilizado para comparar EA e o AM do apêndice (P<0,05). Outras variáveis foram representadas por frequência simples. O intervalo de confiança (IC) de 95% foi calculado para o teste de correlação. Resultados: os dados foram coletados de 67 pacientes consecutivos. A média da idade foi 37,1 ± 12,5 anos e 77,6% dos pacientes foram masculinos. O teste de correlação de Spearman usado para EA e AM foi + 0,77 (IC 95% 0,65 a 0,85, P<0,0001). Conclusão: apesar de a correlação não ser perfeita, nossos dados indicam que uma pontuação elevada da escala de Alvarado em pacientes com apendicite está correlacionada com estágios avançados do processo inflamatório da apendicite aguda. .

Formation of the azygos vein / Formación de la vena ácigos

The aim of the present study was to determine the most common origin of the azygos vein. Thirty cadavers male and female, white and non-white adult individuals of different ages fixed in 10 percent formaldehyde and dissected. All cadavers had an undisclosed clinical death and were donated to the Universidade Estadual de Ciências da Saúde de Alagoa s, Brazil. Eleven different formations were found. The right subcostal vein was was only observed in 13 cases (43.33 percent); the azygos vein was formed by the confluence of the right subcostal and right ascending lumbar vein in three cases (10 percent); by the right subcostal vein with a contribution from the inferior vena cava (IVC) in three cases (10 percent); by the right subcostal with contribution from IVC and right ascending lumbar vein in three cases (10 percent); by the right and left subcostal veins in two cases (6.66 percent); by the right and left subcostal veins and contribution from the IVC in one case (3.33 percent); by the right and left subcostal veins and left accessory renal vein in one case (3.33 percent); by the left renal vein in one case (3.33 percent); by the right subcostal and left gonadal veins with contribution from the IVC in one case (3.33 percent); by the right subcostal and left renal veins in one case (3.33 percent); and composed by the continuation of the 11th posterior intercostal vein in one case (3.33 percent). Based on the results, the right subcostal vein was the only structure with a significant presence in the formation of the azygos vein.

El objetivo del estudio fue verificar cual es la disposición más frecuente del origen de la vena ácigos. Fueron disecados 30 cadáveres de individuos adultos, de ambos sexos, de diferentes grupos étnicos, fijados en formaldehído al 10 por ciento, donados a la Universidade Estadual de Ciencias da Saúde de Alagoas. Se encontraron 11 formaciones diferentes. En 13 casos (43,33 por ciento) se observó sólo la vena subcostal derecha; en 3 casos (10 por ciento) la vena ácigos estaba formada por la confluencia de las venas subcostal derecha y lumbar ascendente derecha; en 3 casos (10 por ciento) formado por las venas subcostal derecha y una contribución de la vena cava inferior VCI; en 3 casos (10 por ciento) por las venas subcostal derecha y contribución de la VCI y lumbar ascendente derecha; 2 casos (6,66 por ciento) por las venas subcostales derecha e izquierda; en 1 caso (3,33 por ciento) por las venas subcostal derecha, izquierda y contribución de la VCI; en 1 caso (3,33 por ciento) por las venas subcostal derecha e izquierda y renal accesoria izquierda; en 1 caso (3,33 por ciento) por la vena renal izquierda; en1 caso (3,33 por ciento) por las venas subcostal derecha, gonadal izquierda y contribución de la VCI; en 1 caso (3,33 por ciento) por las venas subcostal derecha y renal izquierda y en 1 caso (3,33 por ciento) por la continuación de la 11 vena intercostal posterior. Con base en los resultados podemos concluir que la vena subcostal derecha fue la única estructura con presencia significativa en la formación de la vena ácigos.

Cerebellar vermis: topography and variations / Vermis cerebelar: topografía y variaciones

The vermis is described as the unpaired, median portion of the cerebellum to which the hemispheres are attached. Both the vermis and the hemispheres are formed by folia that, grouped together, are called lobules. The material analyzed consisted of a sample made up of 43 adult male cerebella fixed in 10 percent formaldehyde and sliced medially. The lingula was attached to the superior medullary velum in 100 percent (43) of the cerebella, varying only in size. In 80 percent (32) of the cerebella, the central lobe contained one folium; 7.5 percent (3) had two folia with the first larger than the second; 10 percent (4) had two folia with the second larger than the first; and 2.5 percent (1) had two folia of equal size. In 5 percent (2) of the cerebella, the folium of the vermis emerged from the declive; in 47.5 percent (19), the folium emerged from the central white matter; and in 42.5 percent (17), the folium emerged from the tuber. There was no variation in the lobules, culmen, pyramid, uvula or nodule in the sample studied. Contrary to what many believe, the folia of the cerebellum exhibit variations in form, number and arrangement. However, these variations are virtually unreported, which often hinders the determination of the limits of these structures by students of anatomy of the cerebellum.

El vermis se describe como la parte impar, mediana del cerebelo por la que los hemisferios están conectados. Tanto el vermis como los hemisferios están formados por folium que, de forma conjunta, se llaman lóbulos. El material analizado consistió en una muestra compuesta por 43 cerebelos de hombres, adultos, fijados en formol al 10 por ciento y cortados en rodajas en sentido medial. La língula se adjuntó al velo medular superior en 100 por ciento (43) del cerebelo, y sólo varían en tamaño. En el 80 por ciento (32) del cerebelo, el lóbulo central contenía un folium, 7,5 por ciento (3) había dos folium con el primero más grande que el segundo, 10 por ciento (4) tuvo dos folium con el segundo más grande que el primero, y 2,5 por ciento (1) tenía dos folium de igual tamaño. En el 5 por ciento (2) de los cerebelos, el folium del vermis surgido del declive, en el 47,5 por ciento (19), el folium surgido de la sustancia blanca central, y en el 42,5 por ciento (17), el folium surgido del tubérculo. No hubo, en la muestra estudiada, variación en los lóbulos, culmen, pirámide, úvula o nódulo. Contrariamente a lo que muchos creen, el folium del cerebelo presentan variaciones en la forma, número y disposición. Sin embargo, estas variaciones son virtualmente inadvertidas, lo que a menudo dificulta la determinación de los límites de estas estructuras del cerebelo, por los estudiantes de la anatomía.

Origin, Trajectory and Relationships of the Major Splancnic Nerve / Origen, Trayecto y Relaciones del Nervio Esplácnico Mayor

The major splancmc nerve is part of the nervous simpathic system and is placed in the posterior mediastine heading for the abdomen to innerve the abdominal visceras, and it's anatomical knowledge is of great importance to surgical procedures on this region. A descriptive anatomical study aimed to study the origin, trajectory and relationship of the major splancnic nerve. 44 nerves from 22 adult bodies, from both sex, from no defined race and maintained in formol at 10% were dissected. Many ways of origins to the splacnic nerve were observed, with only 7 cases being concordant with the researched authors. There were 25 nerves (56%) made from non sequenced origins. From the right nerves, 14 (63,8%) from the 22 cases originated from three or four roots from the simpathic trunk. In 12 (54,5%) left nerves, two or three contributions from the simpathic range were predominant. 22 nerves (16 from the right and 6 from the left) followed the descendant rout on the medial way and 22 nerves (6 from the right and 16 from the left) headed down following the spine side outline with no medial return. 21 nerves were found (6 from the right and 15 from the left) in a lateral location to the thoracic spine, 16 front-lateral nerves (9 from the right and 7 from the left) and 7 right nerves were anterior to the spine. We concluded there's no origin standard to the major splancnic nerve due to its large variety of origins. The major splancnic nerve may be placed in front to the thoracic spine after it's formation. Therefore, it's expected that this study may enlarge knowledge about the major splancmc nerve and reduce the risks caused by its damage in surgical procedures in the posterior mediastine.

El nervio esplacnico mayor es parte del sistema nervioso simpático y se ubica en el mediastino posterior, se dirige hacia el abdomen para inervar las visceras de la región. Su conocimiento anatómico es de importancia en los procedimientos quirúrgicos que se realizan en el abdomen. Este trabajo tuvo como objetivo estudiar el origen, trayecto y relaciones del nervio esplacnico mayor Fueron disecados 44 nervios de 22 cadáveres adultos, formolizados al 10%, de ambos sexos de diferentes razas. 25 nervios (56%) no tenían un origen secuencial. En el lado derecho, 14 casos (63,8%) se originaron a partir de tres o cuatro raíces del tronco simpático. En el lado izquierdo, en 12 casos (54%), el rango de contribución simpática predominante fue de dos o tres raíces. 22 nervios (16 del lado derecho y 6 del izquierdo) siguieron su descenso medialmente y los restantes 22 nervios (6 del lado derecho y 16 del izquierdo) se dirigieron caudalmente siguiendo la columna vertebral, contorneándola lateralmente sin dirigirse hacia medial. Se encontraron 21 nervios (6 del lado derecho y 15 del izquierdo) en una ubicación lateral a la columna vertebral torácica, 16 nervios en una ubicación anterolateral (9 del lado derecho y 7 del izquierdo) y 7 nervios derechos ubicados anterior a la columna vertebral. Concluimos que no hay un origen estándar del nervio esplacnico mayor . El nervio esplacnico mayor puede ubicarse anterior a la columna vertebral luego de su formación. Se espera que este estudio contribuya al conocimiento del nervio esplacnico mayor y así reducir el riesgo causado por daños en los procedimientos quirúrgicos realizados en el mediastino posterior.

Perfil das complicações após apendicectomia em um hospital de emergência / Post-appendectomy complication profiling in an emergency hospital

RACIONAL: A apendicite aguda é a lesão inflamatória cirúrgica aguda mais freqüente da cavidade abdominal. OBJETIVO: Analisar as complicações pós-operatórias mais freqüentes em apendicectomias. MÉTODO: Análise retrospectiva de pacientes submetidos à apendicectomias na Unidade de Emergência Dr. Armando Lages, no período de julho de 2005 a julho de 2006, aplicando-se um protocolo de pesquisa. RESULTADOS: Do total de 107 pacientes apendicectomizados, ocorreram complicações em 17%. Treze pacientes (54%) evoluíram com infecção da ferida operatória, seguida por abscesso de parede em 12,5% e pela peritonite em 8%. Houve 0,9% de reoperações e 0,9% de óbitos. Dos apendicectomizados 5,6% pertenciam à faixa etária pré-escolar, e destes 33% evoluíram com complicações. Nos escolares e adolescentes ocorreram 10% de complicações e nos adultos jovens, 20%. Adultos de meia idade e idosos, tiveram 66% de complicações. Dos que evoluíram em até 24 horas de doença,17,2% tiveram algum tipo de complicação no pós-operatório; entre 1 e 3 dias, 15% e os com mais de 4 dias, 57,2%. CONCLUSÃO: Complicações nas apendicectomias foram mais freqüentes nos extremos de idade, quando houve atraso no diagnóstico e tratamento, e nas fases mais tardias da apendicite aguda.

BACKGROUND: Acute appendicitis is the most common and frequent acute surgical inflammatory lesion of the abdominal cavity. AIM: To analyse the most common post-operative complications of patients submitted to appendectomies. METHODS: A retrospective analysis was performed using a research protocol, in patients submitted to appendectomies at Dr. Armando Lages´ Emergency Unit, between the period of July 2005 through July 2006. RESULTS: Complications occurred in 17% of a total of 107 appendectomized patients. Thirteen patients (54%) developed surgical infection wounds, followed by abdominal wall abscess in 12,5% and peritonitis in 8%. zero point nine percent of the patients had to be re-operated and 0,9% died. Of the appendectomized patients 5,6% were of preschool age, and of these, 33% developed complications. 10% of the complications occurred in patients of school age and adolescents and 20% occurred in young adults. Middle-aged adults and elderly patients, had 66% of complications. Of those who evolved in up to 24 hours of the disease, 17,2% had some sort of post-operative complication. Between 1 and 3 days, 15% and those with more than four days, 57,2%. CONCLUSIONS: Appendectomy complications were more frequent at extreme ages, when there was a delay in diagnosis and treatment, as well as in more advanced phases of acute appendicitis.

Colecistite aguda por ascaris lumbricoides / Acute cholecystites for ascaris lumbricoides

Biliary’s ascariasis is the most often ectopic site of this helminthiasis, but invasion of the worms into the gallbladder is quite rare. The autors report a case of a patient with clinical symptoms, compatible with cholecystitis induced by the worm, as shown by ultrasonography. Treatament was cholecystectomy and antihelmintic drug therapy with a good outcome.