Topografia dos órgãos abdominais em Didelphis albiventris / Topography of abdominal organs in Didelphis albiventris

O conhecimento da localização dos órgãos nas diferentes regiões do corpo do animal é essencial para a prática clínica, cirúrgica e para o diagnóstico por imagem. O objetivo do estudo foi descrever a anatomia topográfica abdominal do Didelphisalbiventris. Foram utilizados quatro cadáveres (animais jovens), dois destes destinados para o estudo macroscópico em peças a fresco e os outros fixados em solução aquosa de formaldeído a 10%. Os cadáveres foram dissecados e as estruturas anatômicas identificadas, analisadas e fotografadas. A maioria dos órgãos localizados na região abdominal dos cadáveres da espécie D. albiventris apresentou posição similar aos dos caninos, porém, alguns órgãos e a localização de determinadas estruturas apresentaram particularidades importantes, como a presença dos ossos epipúbicos, a ausência do lobo hepático quadrado, a presença de um ceco desenvolvido e o cólon dividido em três segmentos.

The knowledge about localization of organs in different regions of the animal's body is essential for clinical, surgical and diagnostic imaging practice. The purpose of this study was to describe the abdominal topographic anatomy of Didelphis albiventris. Was used four dead bodys (young animals), two of these was intended for the macroscopic study of fresh pieces and the others fixed in 10% aqueous formaldehyde solution. The corpses was dissected and the anatomic structures was identified, analyzed and photographed. Most of the organs located in the abdominal region of cadavers from species D. albiventris presented structure and position similar to canines, however some of these organs and localization of structures presented important particularities, like the presence of epipubic bones, absence of square hepatic lobe, presence of an developed cecum and colon divided into three segments.

Tratamento de queimaduras de segundo grau profundo em abdômen, coxas e genitália: uso da pele de tilápia como um xenoenxerto / Treatment of deep second-degree burns on the abdomen, thighs, and genitalia: use of tilapia skin as a xenograft

A pele de tilápia possui microbiota não infecciosa e estrutura morfológica semelhante à pele humana. Estudos clínicos fase II, ainda não publicados, mostraram resultados promissores na sua utilização para tratamento de queimaduras. Nos protocolos destes estudos, pacientes com lesões em áreas de dobras de pele, como genitais e região inguinal, foram excluídos, pois achava-se que o biomaterial não aderiria apropriadamente, resultando em um grau de cicatrização inferior. Relato de caso de paciente do sexo feminino, 18 anos, sem comorbidades, com queimaduras de segundo grau profundo em abdômen, região inguinal, parte da genitália e metade superior de ambas as coxas, envolvendo 13,5% da área total da superfície corporal. A pele de tilápia foi aplicada nas lesões levando a uma reepitelização completa com 16 dias de tratamento. Não foram observados efeitos colaterais. A pele de tilápia traz, portanto, a promessa de um produto inovador, de fácil aplicação e alta disponibilidade, que pode se tornar a primeira pele animal nacionalmente estudada e registrada pela Agência Nacional de Vigilância Sanitária, para uso no tratamento de queimaduras. Este relato de caso contribui para reduzir as limitações em relação às áreas anatômicas apropriadas para a aplicação da pele de tilápia, uma vez que, mesmo com a necessidade de reposição de pele, foram obtidos bons resultados com aplicação na genitália e região inguinal.

Tilapia skin has a non-infectious microbiota and a morphological structure similar to human skin. Phase II clinical studies, not yet published, have shown promising results in their use for the treatment of burns. In the protocols of these studies, patients with lesions in areas of skin folds, such as genitals and inguinal regions, were excluded, as it was thought that the biomaterial would not adhere properly, resulting in a lower degree of healing. Case report of a female patient, 18 years old, without comorbidities, with deep second-degree burns in the abdomen, inguinal region, part of the genitalia and upper half of both thighs, involving 13.5% of the total body surface area. Tilapia skin was applied to the lesions leading to a complete re-epithelialization with 16 days of treatment. No side effects were observed. Tilapia skin, therefore, brings the promise of an innovative product, easy to apply, and highly available, which can become the first animal skin nationally studied and registered by the Agência Nacional de Vigilância Sanitária, for use in the treatment of burns. This case report contributes to reduce the limitations concerning the anatomical areas appropriate for the application of tilapia skin, since, even with the need for skin replacement, good results were obtained with application to the genitalia and inguinal region.

Splenic artery tortuosity index on abdominal CT Scan: correlation with age, sex, BMI and abdominal cavity diameters / Índice de tortuosidad de la arteria esplénica en TC abdominal: correlación con la edad, el sexo, el IMC y los diámetros de la cavidad abdominal

Thorough knowledge of splenic artery course and morphology may help clinician to provide better practice. This Study aims at finding out if there was a relationship between splenic artery tortuosity index and age, sex, Body Mass Index (BMI) and abdominal cavity diameters. Routine abdominal Computerized Tomography (CT) scan images were retrospectively analyzed for 219 patients. Splenic artery tortuosity index was calculated. Abdominal cavity diameters were measured. Age, sex, and BMI were recorded. Splenic artery straight length (x) mean was 9.41 cm (SD 1.33). Splenic artery tortuous length mean was 15.15 cm (SD 3.31). Splenic artery tortuosity index mean was 1.63 (SD 0.36). Pearson correlation coefficient for Splenic artery tortuosity index vs. age was: 0.02 (P value 0.80). Splenic artery tortuosity index for females vs. males were 1.70 vs. 1.57 (P value 0.01). Pearson correlation coefficient for Splenic artery tortuosity index vs. BMI was 0.02 (P value 0.75). Pearson correlation coefficient for Splenic artery tortuosity index vs. abdominal cavity diameters were: Anterior-Posterior (AP) diameter -0.01 (P value 0.88) and transverse diameter 0.00 (P value 0.98). There may be a relationship between splenic artery tortuosity and female sex, but not with age, BMI and abdominal cavity diameters (AP and Transverse).

El conocimiento del curso y la morfología de la arteria esplénica puede ayudar al médico a proporcionar un diagnóstico y tratamiento oportuno al paciente. Este estudio tuvo como objetivo determinar si existe una relación entre el índice de tortuosidad de la arteria esplénica y la edad, el sexo, el índice de masa corporal (IMC) y los diámetros de la cavidad abdominal. Se tomaron imágenes retrospectivas, de rutina, de 219 pacientes de tomografía computarizada (TC) abdominal. Se calculó el índice de tortuosidad de la arteria esplénica. Se midieron los diámetros de la cavidad abdominal y se registró la edad, sexo y el IMC. La media de la longitud recta de la arteria esplénica (x) fue de 9,41 cm (DE 1,33). La longitud tortuosa de la arteria esplénica fue de 15,15 cm (DE 3,31). La media del índice de tortuosidad de la arteria esplénica fue de 1,63 (DE 0,36). El coeficiente de correlación de Pearson para el índice de tortuosidad de la arteria esplénica vs. edad fue: 0,02 (valor de P 0,80). El índice de tortuosidad de la arteria esplénica para las mujeres frente a los hombres fue de 1,70 frente a 1,57 (valor de P 0,01). El coeficiente de correlación de Pearson para el índice de tortuosidad de la arteria esplénica versus el IMC fue de 0,02 (valor de P 0,75). El coeficiente de correlación de Pearson para el índice de tortuosidad de la arteria esplénica frente a los diámetros de la cavidad abdominal fue: diámetro anterior-posterior (AP) -0,01 (valor P 0,88) y diámetro transversal 0,00 (valor P 0,98). Puede existir una relación entre la tortuosidad de la arteria esplénica y el sexo femenino, sin embargo no se encontró relación con la edad, el IMC y los diámetros de la cavidad abdominal (AP y transversal).

Análise anatômica da abdominoplastia / Anatomical analysis of abdominoplasty

A abdominoplastia está entre os procedimentos cirúrgicos mais realizados na cirurgia plástica, de forma que muitas variações técnicas têm sido criadas com o objetivo de se reduzirem as complicações e para se obter melhores resultados no contorno abdominal. Nesse contexto, a anatomia da parede abdominal ganha papel de destaque, uma vez que as justificavas em defesa de técnicas, como a abdominoplastia clássica e lipoabdominoplastia, estão atreladas a princípios anatômicos. Isso evidencia a necessidade do domínio da anatomia da região pelo cirurgião plástico, pois, além de entender os motivos de se adotar determinados procedimentos cirúrgicos, o torna mais capacitado de adaptá-los às características anatômicas de cada paciente, além de compreender as alterações morfofuncionais provocadas pela cirurgia. Diante disso, esse trabalho teve o objetivo de buscar na literatura estudos que enfocassem a descrição anatômica da abdominoplastia, tanto clássica quanto de outras variantes, como a lipoabdominoplastia, bem como as explicações anatomofisiopatológicas das principais complicações operatórias inerentes.

Abdominoplasty is a common surgical procedure in plastic surgery. Consequently, several technical variations have been created with the aim of reducing complications and obtaining better results in the abdominal contour. The anatomy of the abdominal region plays an important role in this procedure, since arguments in favor of techniques, such as classic abdominoplasty and lipoabdominoplasty are linked to anatomical principles. This highlights the plastic surgeon's need to have a good knowledge of the anatomy of this region. Not only will this knowledge enable plastic surgeons to understand the reasons for adopting certain surgical procedures, but it will also enable them adapt these procedures to the anatomical characteristics of each patient. In addition, this knowledge will help determine the morphological changes caused by surgery. Therefore, this study aimed to identify studies in the literature focusing on the anatomical description of both classical abdominoplasty and other variants, such as lipoabdominoplasty. It also aimed to discover the anatomical and physiopathological explanations for the major inherent surgical complications.

Is there a trans-abdominal testicular descent during the second gestational trimester? Study in human fetuses between 13 and 23 weeks post conception

ABSTRACT Objectives To confirm if a real inner descend of testis occurs, correlating the testicular position with fetal parameters and analyzing the position of the testes relative to the internal ring. Material and Methods Twenty nine human fetuses between 13 and 23 weeks post conception (WPC) were studied. The fetuses were carefully dissected with the aid of a stereoscopic lens with 16/25X magnification and testicular position observed. With the aid of a digital pachymeter the distance between the lower pole of the kidney and the upper extremity of the testis (DK-T) was measured to show the position of the testis. During the dissection we also indicated the position of the testes relative to the internal ring. Means were statistically compared using simple linear regression and the paired T-test. Results The 58 testes had abdominal position. The DK-T in the right side measured between 0.17 and 1.82cm (mean=0.79cm) and in the left side it was between 0.12 and 1.84cm (mean=0.87cm), without statistically differences (p=0.0557). The linear regression analysis indicated that DK-T in both sides correlated significantly and positively with fetal age. All fetuses with more than 20 WPC, heavier than 350g and with CRL over 22cm had a greater distance than the average DK-T. We xobserved that the 58 testis remains adjacent to the internal ring throughout the period studied. Conclusions The testes remains adjacent to the internal ring throughout the period studied, indicating that there is no real trans-abdominal testicular descent during the second gestational trimester.

Importância da preservação da artéria ilíaca circunflexa superficial do abdome na prevenção das necroses da parede abdominal em pacientes submetidas a miniabdominoplastias: estudo anatômico cirúrgico descritivo prospectivo / Importance of superficial circumflex iliac artery preservation to prevent abdominal wall necrosis in patients who underwent mini-abdominoplasty: an surgical-anatomic descriptive and prospective study

INTRODUÇÃO: A abdominoplastia é o terceiro procedimento mais realizado em cirurgia plástica. Na intenção de evitar complicações cirúrgicas, foi feito o estudo da artéria ilíaca circunflexa superficial do abdome (AICS), investigando a importância da sua preservação nestas cirurgias, como um dos fatores de alta importância na prevenção das necroses. MÉTODOS: O presente estudo anatômico prospectivo foi realizado no Serviço de Cirurgia Plástica do Hospital Agamenon Magalhães. Trinta e três pacientes foram submetidos à dermolipectomia abdominal à Pitanguy, com os retalhos cirúrgicos ressecados sendo submetidos a estudos hemodinâmicos para análise do território anatômico irrigado pela AICS. RESULTADOS: Foram operados 82 pacientes, sendo selecionados 33 que preencheram os critérios de inclusão para este estudo, seis (18,9%) foram excluídos por motivos técnicos. O grupo de pacientes em estudo apresentou faixa etária entre 23 e 49 anos (36,6 ± 7,5). O Índice de Massa Corporal variou de 22,0 a 30,5 (24,9 ± 2,1). O peso das peças cirúrgicas ressecadas variou de 450 a 1010 gramas (623,1 ± 141,5), o teste de Pearson entre IMC e peso das peças demonstrou importante correlação r = 0,91 e r2 = 0,83. Trinta e dois eram femininos (97%) e um masculino (3%). Uma paciente era portadora de hipertensão arterial sistêmica (3%). Vinte e sete eram pardos (81,8%), dois brancos (6,1%), três negros (9,1%) e um da raça indígena (3,0%). Nos estudos hemodinâmicos, as imagens e filmes obtidos demonstraram que a injeção do contraste iodado na AICS foi considerada adequada, compatível com o objetivo do trabalho em 25 (92%) pacientes e inadequada em dois (8%) pacientes. CONCLUSÃO: Os resultados hemodinâmicos deste estudo levam à conclusão que a preservação da AICS do abdome nas miniabdominoplastias tem relevante importância na prevenção das necroses da parede abdominal.

complications, a study of the superficial circumflex iliac artery of the abdomen (SCIA) was carried out to investigate the importance of this artery preservation in abdominoplasties as one of the high importance factors to prevent necrosis. METHODS: This prospective study was carried out at the Plastic Surgery Service of the Agamenon Magalhaes Hospital. We included 33 patients who underwent abdominoplasty using Pitanguy's technique where the resected surgical flaps underwent hemodynamic studies to analyze the anatomical area irrigated by SCIA. RESULTS: A total of 82 patients underwent surgery, of them 33 met the study inclusion criteria, and 6 (18.9%) were excluded for technical reasons. Patients' age ranged from 23 and 49 years (36.6±7.5), their body mass index (BMI) ranged from 22.0 to 30.5 (24.9 ± 2.1), and weight of resected surgical specimens ranged from 450 to 1010 grams (623.1 ± 141.5). Pearson's test between BMI and weight of surgical specimens showed significant correlation r = 0.91 and r2 = 0,83. We included in the study 32 women (97%) and 1 man (3%). One patient had hypertension (3%). Of the sample, 27 patients were pardo (81.8%), 2 white (6.1%), 3 black (9.1%) and 1 native south American (3.0%). In hemodynamic studies, images and videos obtained showed that injection of iodinated contrast in SCIA were considered adequate, and consistent with the objective of this study in 25 (92%) patients and inadequate for 2 (8%) patients. CONCLUSION: Hemodynamic results of our study indicated that preservation of SCIA of the abdomen in mini-abdominoplasties is important to prevent necrosis of abdominal wall.

Utilización del Ultrasonido como Valoración Inicial de la Indemnidad de la Pared Abdominal en Traumatismos por Herida de Arm a Blanca en Abdomen / Using Ultrasound as the Initial Assessment of the Indemnity abdominal wall Injuries stab wound in abdomen

Introducción: Los traumatismos abdominales penetrantes son debidos generalmente a heridas de arma blanca o heridas de arma de fuego. Todas deben explorarse instrumentalmente bajo anestesia local con el objetivo de determinar la integridad del peritoneo. El ultrasonido es una herramienta muy útil utilizada en trauma, además del FAST, se lo puede utilizar en la urgencia como método de gran ayuda al realzar la exploración inicial de la herida para evaluar la integridad del peritoneo. Objetivos: Destacar la importancia del conocimiento anatómico y la correlación anatomo-clínico quirúrgica y ecográfica en la interpretación de imágenes obtenidas por ultrasonografía en la evaluación de la integridad de la pared del abdomen en heridas penetrantes por arma blanca. Material y métodos: FAST y ecografía de partes blandas instrumentándose la herida abdominal bajo anestesia local evaluando la indemnidad del peritoneo mediante la observación por ultrasonografía del abdomen y de la pared antero lateral del mismo en 14 de 42 pacientes con heridas por arma blanca en abdomen en el Servicio de Emergencias del Hospital Municipal de Morón y en el Servicio de Cirugía General del Hospital Aeronáutico Central. Período entre Febrero 2014 y Marzo 2015. Resultados: 42 (100%) pacientes con heridas de arma blanca en abdomen. 28 (66,66%) fueron inicialmente intervenidos quirúrgicamente. A 14 (33,34%) se le realizó FAST en búsqueda de líquido libre y ecografía de partes blandas instrumentándose la herida abdominal bajo anestesia local evaluando la indemnidad del peritoneo. Conclusiones: El conocimiento de las estructuras anatómicas y la disposición de las mismas que componen la pared anterolateral del abdomen permiten facilitar el reconocimiento de la indemnidad o no del peritoneo en las imágenes obtenidas por ultrasonido en pacientes con heridas abiertas por arma blanca, evitando así la realización de procedimientos quirúrgicos innecesarios.(AU)

Introduction: Penetrating abdominal trauma are usually due to stab wounds or gunshot wounds. All instrumentally be explored under local anesthesia in order to determine the integrity of the peritoneum. Ultrasound is a very useful tool used in trauma, in addition to FAST, I can use the urgency as a means of great help to enhance the initial exploration of the wound to evaluate the integrity of the peritoneum. Objectives: Highlighting the importance of the anatomical knowledge and surgical and anatomical clinical ultrasound in interpreting images obtained by ultrasonography in the evaluation of the integrity of the abdominal wall in penetrating stab wounds correlation. Material and methods: FAST ultrasound was performed and soft tissue abdominal wound became operational under local anesthesia indemnity evaluating the peritoneum through observation by ultrasound of the abdomen and the anterolateral wall thereof in 14 of the 42 patients with stab wounds in the abdomen Service Municipal Emergency Hospital of Moron and the Department of General Surgery of the Central Aeronautical Hospital, period between February 2014 and March 2015. Results: Of the 42 (100%) patients with stab wounds to the abdomen, 28 (66.66%) initially underwent surgery, and 14 (33.34%) were performed in FAST Search of free fluid and soft tissue ultrasound became operational abdominal wound under local anesthesia indemnity evaluating the peritoneum. Conclusions: Knowledge of the anatomical structures and arrangement thereof comprising the anterolateral wall of the abdomen allow easy recognition of indemnity or not the peritoneum in the ultrasound images in patients with stab wounds open, thus avoiding making unnecessary surgical procedures.

Gross anatomy of the stomach of the cervus elaphus barbarus / Anatomía macroscópica del estómago del ciervo elaphus barbarus

The barbary stag is an intermediate feeder ruminant of the Cervidae family. The macroscopic anatomy of the stomach in one adult barbary stag was described. The stomach of the barbary stag was composed of the four classic compartments of the ruminants. The weight of the full stomach was 10.5 Kg. The ruminal papillae were distributed unevenly in the rumen. The maximum height of the cristae reticuli was 0.2 cm. The cellulae reticuli were mostly undivided. The curvatura omasi measured 15.0 cm and the omasum had 15 primary, 10 secondary, 10 tertiary and 17 cuaternaryLaminae omasi. The abomasum had about 12 plicae spirales abomasi.We concluded that the stomach morphology of the barbary stag had characteristics of other intermediate feeder ruminants.

El ciervo de Berbería es un rumiante perteneciente a la familia Cervidae family. Se describió la anatomía macroscópica del estómago de un ciervo de Berbería. El estómago del ciervo estaba compuesto por los clásicos cuatro componentes de los rumiantes. El peso lleno del estómago fue de 10,5 Kg. Las papilas ruminales estaban distribuidas de manera desigual en el rumen. La altura máxima de las crestas reticulares fue de 0,2 cm. La mayoría de las celdas reticulares estaban divididas. La curvatura del omasi medía 15,0 cm y la del omasum presentaba 15 láminas primarias, 10 secundaria, 10 terciarias y 17 cauternarias. El abomasum presentaba alrededor de 12 pliegues espirales. Concluimos que la morfología del estómago del ciervo de Berbería es semejante al de otros rumiantes.

Rolling technique for treatment of left displacement of the large colon in horses: 11 cases (2004-2009) / Técnica do rolamento para o tratamento de deslocamento à esquerda do cólon maior em equinos: 11 casos (2004-2009)

The left displacement of the large colon, a condition that commonly occurs in horses, has two clinical manifestations. Different treatments including medical treatment, rolling the horse under general anesthesia or surgical correction have been recommended. The diagnosis can often be made by rectal examination and confirmed by percutaneous ultrasonography. During the period between 2004 and 2009, 11 horses were treated for left displacement of the large colon by rolling the horses under general anesthesia, using a slightly different technique than the ones previously described. The clinical case selection was based on rectal palpation confirmed with ultrasonogram. Nine animals were successfully treated and two had to be submitted to surgery after three attempts of rolling. No short or long term complications were observed after the procedure. Only one animal had a recurrence of the clinical manifestation 10 months after the first treatment and was successfully rolled once again. Despite a bit different from the other rolling procedures, this also proved to be an effective procedure. Rolling a horse even when attempted more than once showed to be a safe procedure, however, we reinforce the need for special attention following the procedure in order to establish proper emergency procedures in case complications occur.

Durante o período de 2004 a 2009, 11 animais foram tratados para o deslocamento à esquerda do cólon maior, por meio da técnica de rolamento sob anestesia geral, com uma técnica distinta das demais previamente descritas. A seleção dos casos foi baseada nos achados da palpação retal e confirmada ultrassonograficamente. Nove animais foram tratados com sucesso e dois foram submetidos ao tratamento cirúrgico após três tentativas de rolamento. Não foram observadas complicações decorrentes do procedimento a curto e a longo prazos. Somente um animal apresentou recidiva do quadro clínico 10 meses após o tratamento e foi novamente submetido ao rolamento. Apesar da diferença com relação às outras técnicas, esta também se mostrou eficaz. O rolamento, mesmo quando realizado mais de uma vez, mostrou ser um procedimento seguro, porém enfatiza-se a necessidade de cuidados especiais aos animais após a sua realização, pois medidas emergenciais podem ser necessárias caso complicações decorrentes desta técnica ocorram.

Reconstrução anatômica da cicatriz umbilical / Anatomical reconstruction of the umbilicus

INTRODUÇÃO: A ausência da cicatriz umbilical causa alteração importante na forma do abdome, tornando-se, desse modo, imprescindível na anatomia do mesmo. Sua reconstrução deve seguir seus aspectos anatômicos, conferindo aspecto natural ao final do tratamento. A nova cicatriz umbilical deve ter boa forma, bom posicionamento, não apresentar cicatriz estigmatizante, estenose ou alargamentos, e ter aspecto natural. MÉTODO: Foram operados 162 pacientes submetidos previamente a gastroplastia aberta para tratamento de obesidade mórbida e 2 pacientes submetidos a cirurgia videolaparoscópica. Foram utilizados 2 retalhos retangulares paralelos, medindo 2 cm x 1,5 cm, que foram suturados entre si e fixados à aponeurose dos músculos reto abdominais. Os retalhos apresentavam a transição com a pele em forma curvilínea. A fixação dos retalhos foi realizada com 2 pontos paralelos, que atingiam a derme do retalho de um lado, a derme do retalho do lado oposto e a aponeurose. Desse modo, foi obtida a união dos 2 retalhos, comprimindo-se levemente a porção distal dos mesmos. Em seguida, foi realizada aproximação do tecido gorduroso ao redor da nova cicatriz umbilical. RESULTADOS: Com a técnica apresentada, obteve-se a formação de todas as unidades anatômicas (mamelão, sulco e rodete), além de profundidade adequada em todas as cicatrizes umbilicais reconstruídas. Não foi observado nenhum caso de estenose umbilical, cicatriz hipertrófica ou queloide nas novas cicatrizes umbilicais. CONCLUSÕES: A técnica apresentada para reconstrução da cicatriz umbilical, respeitando as unidades anatômicas, proporciona forma bem natural e, com o passar do tempo, ocorre uma sobra de pele em sua porção superior, conferindo graciosidade à mesma.

BACKGROUND: The absence of the umbilicus causes significant changes in the appearance of the abdomen, thus making it an essential part of anatomy. The reconstruction procedures should account of the anatomical position to ensure a natural appearance after treatment. The new umbilicus should have a good shape and appropriate position, but should not have an unaesthetic appearance, stenosis, or enlargement. METHODS: This study included 162 patients who previously underwent open gastroplasty for the treatment of morbid obesity and 2 patients who underwent laparoscopic surgery. We used 2 parallel rectangular flaps measuring 2 × 1.5 cm that were sutured together and fixed to the aponeurosis of the rectus abdominis muscles. The flaps exhibited a curvilinear-shaped skin transition. The attachment flaps were created with 2 parallel points that reached the dermis on both sides of the flap and aponeurosis. Thus, the union of 2 flaps was obtained, which were slightly compressed at their distal portion. Thereafter, the fat tissue around the new umbilicus was approximated. RESULTS: The technique described produced all anatomical units including a base, groove, and impeller as well as adequate depth of the umbilical scar in all cases. There were no cases of umbilical stenosis, hypertrophic scars, or keloid scars in the new umbilici. CONCLUSIONS: This technique for the reconstruction of the umbilicus takes into account the anatomical units and provides a very natural appearance, eventually resulting in a slight excess of skin in the upper portion, thus giving a graceful appearance.

Estudo anatômico de bolsões adiposos na região hipogástrica / Anatomic study of pockets areas in the hypogastrium

INTRODUÇÃO: Nas lipodistrofias da parede abdominal anterior, fatores genéticos, aumento de peso, idade e lasseamento da musculatura, de forma isolada ou associada, determinam alterações estéticas generalizadas ou localizadas no epigástrio, no hipogástrio ou, mesmo, em ambas as regiões. O objetivo deste estudo é descrever os limites, a disposição, as relações anatômicas das bolsas adiposas no hipogástrio com as estruturas vizinhas e suas dimensões. MÉTODO: Foram dissecadas 57 peças anatômicas de pacientes submetidas a abdominoplastia, em que o hipogástrio foi ressecado em monobloco. Além disso, foi realizada dissecção da parede abdominal anterior em 8 cadáveres. Em todas as peças, a camada lamelar foi ressecada, mantendo-se a derme-epiderme, a camada areolar e a fáscia superficial íntegras. RESULTADOS: Em todas as peças, foram observados dois cúmulos adiposos na camada areolar bilateralmente, simétricos, em forma de bolsa e de coloração peculiar. Essas bolsas foram também analisadas em relação aos tecidos cutâneos vizinhos: pele, fáscia superficial, camada profunda de gordura. CONCLUSÕES: A camada lamelar foi considerada estrutural como base da pele, pela sua fina espessura, e a camada areolar apresentou acúmulos e volumes variáveis de tecido adiposo nas diversas regiões do corpo, sem limites precisos, particularmente observados nas dissecções da parede abdominal inferior, pela sua elasticidade, pelo volume e pela coloração.

BACKGROUND: In lipodystrophies of the anterior abdominal wall, variables such as genetic factors, weight gain, age, and loss of muscle tone, either alone or in combination, determine generalized aesthetic changes or changes localized in the epigastrium, hypogastrium, or both. The aim of this study was to describe the limits, distribution, and dimensions of fat bags in the hypogastrium, as well as their anatomic relationships with the neighboring structures. METHODS: Fifty-seven anatomical specimens were dissected from patients undergoing abdominoplasty, during which the hypogastrium was resected en bloc. Moreover, the anterior abdominal wall was also dissected in 8 cadavers. In all samples, the lamellar layer was resected, keeping the dermis-epidermis, areolar layer, and superficial fascia intact. RESULTS: In all specimens, 2 symmetrical adipose clusters were observed bilaterally in the areolar layer, which were in the shape of a bag and had peculiar coloration. These bags were analyzed in relation to their neighboring tissues: the skin, superficial fascia, and deep fat layer. CONCLUSIONS: The lamellar layer was considered as a structural base of the skin, owing to its thinness. The areolar layer showed accumulations and varying amounts of fat in the various body regions without precise limits, which were particularly observed in dissections of the lower abdominal wall and identified by their elasticity, volume, and coloration.

The topography and gross anatomy of the abdominal gastrointestinal tract of the Persian squirrel (Sciurus anomalus) / La topografía y anatomía macroscópica del tracto gastrointestinal abdominal de la ardilla persa (Sciurus anomalus)

The persian squirrel (Sciurus anomalus) is the only member of the Sciuridae family found in the Middle East. It is herbivorous, feeding mostly on pine acorns and other seeds and fruits. It is a wild animal nesting in forest trees, although it is frequently found close to city gardens and parks. As Persian squirrels are also found in homes as "companion animals", veterinarian assistance may be sometimes required; this is a good reason to gain more specific knowledge of the anatomical features of this animal. Due to the scantiness of relevant literature, we carried out this study with the aim to provide further information on the topography and gross anatomy of its abdominal gastrointestinal tract (GIT). Seven animals of this species were utilized to measure the length, content weight and area surface of the relative segments of the abdominal GIT. The stomach is unilocular, lined with glandular epithelium; the small intestine is divided into duodenum, jejunum and ileum. The cecum is situated on the right side of the abdominal cavity and lacks the vermiform appendix observed in some rodents. The ascending colon is extensive, consisting of two loops and two straight parts forming a unique topographic arrangement, closely resembling the ascending colon of the horse. The transverse colon connects the ascending and the descending colon located on the left side of the abdominal cavity, and shows a distinct sigmoid flexure before entering the pelvic cavity. Overall, the in situ examination and the relative measurements of the various parts of the abdominal GIT suggest that the ascending colon is the main fermentation chamber in the Persian Squirrel.

La ardilla es el único miembro de la familia de los Sciuridae que se encuentra en el Medio Oriente. Es un herbívoro, come semillas, principalmente de pino, y fruta. Vive mayormente en el bosque en estado salvaje, aunque a veces se puede encontrar en las ciudades, en parques y jardines. Las ardillas persianas tambien se tienen en casas como mascotas y algunas veces es necesaria la atención del veterinario. Esta es una buena razón para conocer más profundamente sus características anatómicas. Teniendo en cuenta la escasa bibliografía existente a cerca de este animal, el objetivo de este estudio fue aportar nueva información sobre la anatomía topográfica y mascroscópica del tracto abdominal gastrointestinal (GIT) de la ardilla. Siete animales de esta especie han sido utilizados para medir el largo, el peso y el área de la superficie de los segmentos del GIT. El estómago es unilocular, alineado con epitelio glandular; el pequeño intestino está dividido en duodeno, jejuno e ileo. El ciego está localizado en la parte derecha de la cavidad abdominal y le falta el apéndice vermiforme que poseen los roedores. El colon ascendente es extenso, constituido de dos partes curvas y dos rectilíneas que forman una única dispoción topográfica cerrada como el colon ascendente en el caballo. El colon trasverso, que conecta el ascendente y el descendente, está localizado en el lado izquierdo de la cavidad abdominal y muestra una clara flexión sigmoide antes de entrar en la cavidad pélvica. En resumen, el examen in situ y las relativas medidas de las varias partes del GIT sugieren que el colon ascendente es la principal "cámara" de fermentación en la ardilla persiana.

Prediction of explosive power of basketball players based on their morpho-functional characteristics / Predicción de la potencia explosiva de los jugadores de baloncesto en función de sus características morfofuncionales

The aim of this study was to define the morpho-functional variables that best predict the explosive power of the lower extremities of basketball players of Kosova. On 113 basketball players average aged 21.3 years old, 15 morpho-functional variables were measured: stature, body weight, humeral perimeter, chest perimeter, abdominal perimeter, thigh perimeter, calf perimeter, triceps skinfold, subscapular skinfold, abdominal skinfold, thigh skinfold, calf skinfold, heart rate, VO2max.rel., and explosive power that was tested through Margaria-Kalamen Test. All tested basketball players are competitors in the Super League of Kosova. Linear regression of the data indicates that the system of 13 morpho-functional predictive variables explains 62.5 percent of total variability of the dependant variable. The variables that indicate positive influence on dependant variable ­ explosive power of the lower extremities are: thigh perimeter (b=.413), chest perimeter (b=.316), and heart rate (-2.01). According to the results of this study, one can conclude that basketball players with higher values of the volume of thighs, with balanced muscles and core stability, as well with low rate of heart frequency during resting period, will have higher explosive power of the lower extremities. So, the conditional coaches, during the training with the young basketball players, should pay more attention to develop these morphometrical variables.

El objetivo de este estudio fue definir las variables morfofuncionales que mejor predicen la potencia explosiva de los miembros inferiores de los jugadores de baloncesto de Kosovo. En 113 años jugadores de baloncesto con una edad promedio de 21,3 años, se midieron 15 variables morfofuncionales: estatura, peso corporal, perímetro del húmero, perímetro torácico, perímetro abdominal, perímetro del muslo, perímetro de la pierna, pliegue del tríceps, pliegue subescapular, pliegue abdominal, pliegues cutáneos del muslo, pliegues cutáneos de la pierna, frecuencia cardíaca, VO2max.rel, y el poder explosivo que fue probado a través de prueba Margaria-Kalamen. Todos los jugadores de baloncesto evaluados son jugadores de la súper liga de Kosovo. La regresión lineal de los datos indica que el sistema de 13 variables morfofuncionales predictoras explica el 62,5 por ciento de la variabilidad total de la variable dependiente. Las variables que indican una influencia positiva sobre la variable dependiente - potencia explosiva de los miembros inferiores son los siguientes: el perímetro del muslo (b = 0,413), perímetro torácico (b = 0,316), y la frecuencia cardíaca (-2,01). De acuerdo con los resultados de este estudio, se puede concluir que los jugadores de baloncesto con los valores más altos del volumen de los muslos, con los músculos equilibrados y la estabilidad de núcleo, así como con bajo índice de la frecuencia cardíaca durante el período de descanso, tendrán la mayor potencia explosiva de los miembros inferiores. Por lo tanto, los entrenadores durante los entrenamientos con los jóvenes jugadores de baloncesto, deberían prestar más atención al desarrollo de estas variables morfométricas.

Variações anatômicas do tecido celular subcutâneo pós-perda ponderal / Anatomic variations of the subcutaneous tissue after ponderal weight lost

Introdução: Os dois estratos de gordura que compõem o tecido celular subcutâneo variamde espessura nas diversas regiões do corpo, com o peso, idade, sexo e genética. Quandosubmetidos a amplas variações volumétricas decorrentes de cirurgia bariátrica ou por dietasextremas, alterações macroscópicas e histológicas são evidentes e generalizadas pelocorpo. Método: Foram estudadas 28 peças cutâneas cirúrgicas selecionadas nas regiõesepigástrica, peri-umbilical, hipogástrio e lombar, para avaliações na diferença de espessurae das suas características estruturais macroscópicas e distribuídas em três grupos: opadrão normal para fins comparativos, os que foram submetidos a cirurgia bariátrica e osque somente tiveram grandes perdas ponderais por dietas alimentares. Resultados: Macroscopicamenteforam encontradas alterações diversas das características padrões, na cordo tecido adiposo, na estrutura da fáscia superficial e na arquitetura dos lóbulos adiposos,porém similares nas regiões selecionadas.

Background: The two adipose stratus that compose the subcutaneous tissue present different thickness in the body regions, that suffer effects with the weight variations, age, genders and genetics. When submitted to extended body weight variations by bariatric surgeries or extreme diets, generalized macroscopic and histological changes are also observed.Methods: Twenty eight surgical skin human specimens obtained after surgeries, were selected from the epigastric, peri-umbilical, hypogastrium and flank regions to be evaluated in their thickness and structural variations, from patients after been submitted by bariatric surgery or diets with extensive ponderal weight lost. Results: Macroscopic analysis showed changes from the original patterns related to the fat color, at the superficial fascia and the architectural of the adipose lobules but similar in the selected regions.

Relación entre perímetro abdominal, nivel socioeconómico y presión arterial / Relation of abdominal circumference and socio-economic status to blood pressure

Objetivos: Relacionar perímetro abdominal y condición socioeconómica con presión arterial (PA) en comunidad urbana de Concepción. Métodos: Se midió el perímetro abdominal (PeA) de 8472 residentes mayores de 15 años de edad, proporcionados por edad, género y nivel socioeconómico. La PA fue medida con normas estandarizadas, realizando dos visitas en diferentes días, la segunda si la PA era mayor de 140/90 mm Hg. Los Pe A se distribuyeron en cuartiles, relacionando cada cuartil con los respectivos promedios de presión sistólica y diastólica y se establecieron coeficientes de correlación lineal mediante "r" de Pearson entre PeA y PA. Además, se estableció la frecuencia de cada cuartil de Pe A por nivel socioeconómico. Resultados: Los Pea tuvieron la siguiente distribución (cm): 1er cuartil, < 78; 2º cuartil, 78- 87; 3er cuartil, 88-96 y 4º cuartil, > 96. La prevalencia de hipertensión para niveles socioeconómicos alto, medio y bajo fue 17,9 por ciento, 19,5 por ciento y 24,5 por ciento, respectivamente. La PA promedio (mmHg) en hombres y en mujeres del 1er cuartil de PeA fue 112 y 109; en el 2º cuartil 118 y 118; en el 3er cuartil 123 y 122 y en el 4º cuartil 129 y 129, respectivamente. Los coeficientes de correlación entre PeA y presión sistólica y presión diastólica resultaron significativos en ambos géneros: r = 0,343, p<0.00001 y r = 0,281, p<0.00001, respectivamente. La distribución ( por ciento) de PeA fue inversa al nivel socioeconómico: en el nivel social bajo, el 22 por ciento estaba en el 1er cuartil de PeA, y el 28,8 por ciento en el 4º cuartil. En el nivel social alto se observó lo inverso: 38,9 por ciento estaba en el 1er cuartil de PeA, y sólo el 15.5 por ciento en el 4º cuartil (p<0.0001). Conclusiones: Hubo correlación positiva entre PeA y PA en ambos géneros. La frecuencia de mayor PeA en el nivel socioeconómico bajo podría explicar la mayor prevalencia de hipertensión en este grupo.

Aim: To correlate abdominal circumference (AC) and socio-economic status with blood pressure( BP) in an urban community of Concepción, Chile Methods: AC was measured in 8472 subjects above 15years of age, stratified by age, gender and socio-economic status. BP was measured by standard procedures, with a repeat recording when the initial value was > 140/90mmHg. BP was compared in quartiles of abdominal circumference and according to socio-economic status. Pearson "r" was used to correlate BP and AC Results: Cut points for quartiles of AC were 78, 87, and 96 cm. Prevalence of hypertension in high, medium and low socio-economic status was 17.9 percent, 19.5 percent and 24.5 percent, respectively Mean systolic BP was 112 - 109 mmHg (males - females) in the first AC quartile, 118 - 118, 123-122 and 129-129 in the second, third and fourth quartiles, respectively. A significant correlation between AC and BP (systolic and diastolic) was observed in both genders (r 0.345 and 0.281 for males and females, respectively, p<0.00001). 22 percent of low socio-economic subjects belonged in the first AC quartile compared to 28.8 percent in the 4th quartile. In contrast 38.9 percent of high socio-economic subjects belonged in the first AC quartile while 15.5 percent did so in the 4th quartile (p<0001). Conclusion: A positive correlation of AC and blood pressure was shown in both genders. A greater AC in low socio-economic subjects maybe related to a higher prevalence of hypertension in this group.

Establishing abdominal height cut-offs and their association with conventional indices of obesity among Arab children and adolescents

Obesity, particularly childhood obesity is common in the Middle East, but no studies have examined the relationship of sagittal abdominal diameter [SAD] or abdominal height to conventional markers of obesity in this region. This is the first study to document the association of SAD with measures of obesity among Arab children and adolescents. Nine hundred sixty-four Saudi children aged 5-1 7 years [365 prepubertal, including 146 boys and 219 girls; 249 pubertal, including 125 boys and 124 girls; and 350 postpubertal, including 198 boys and 152 girls] were included in this cross-sectional study. SAD was significantly correlated with indices of obesity regardless of gender, but was strongest among pubertal boys. The cut-off values were as follows: for prepubertal children, 14 cm [equivalent to 50th percentile among girls and 60th percentile among boys]; for pubertal children, 15 cm for girls [30th percentile] and 16 cm for boys [50th percentile], and for postpubertal, 21.5 cm for girls [70th percentile] and 22 cm for boys [80th percentile]. SAD is a reliable indicator of visceral obesity among Arab children and adolescents in particular. Prospective studies should be done to determine whether such an association translates to a promising risk factor for hard endpoints such as diabetes mellitus and coronary heart disease

Multiple vascular anomalies in the abdomen: a gross anatomical study / Múltiples anomalías vasculares en el abdomen: un estudio anatómico macroscópico

Knowledge of the branching pattern of the abdominal aorta is clinically important for any abdominal surgeon operating on parts of the gut or neighboring structures like the suprarenals, spleen, pancreas, liver, kidneys and ureter. The presence of abnormal inferior phrenic artery associated with aberrant branch from the celiac trunk supplying the pancreas and duodenum is a rare anomaly. In the present case, we observed four branches of the celiac artery i.e. (a) left gastric artery (b) common hepatic artery (c) splenic artery and (d) an aberrant branch, which took a course inferiorly towards the pancreas. The aberrant artery supplied the body of the pancreas and gave a branch which supplied the horizontal part of the duodenum and then entered the transverse mesocolon to supply the hepatic flexure and some portions of the ascending and the transverse colon. The inferior phrenic artery was absent on the left side. Concomitant anomalies of such type are to be kept in mind by the surgeon, while operating cases of carcinoma head of pancreas and performing kidney transplantations.

El conocimiento del patrón de ramificación de la aorta abdominal es clínicamente importante para cualquier cirujano abdominal que opere en partes del intestino o estructuras vecinas, como glándulas suprarenales, bazo, páncreas, hígado, riñones y uréteres. La presencia anormal de la arteria frénica inferior asociada con una rama aberrante originada del tronco celiaco, supliendo el páncreas y duodeno, es una variación anatómica rara. En el presente caso, se observaron cuatro ramas de la arteria celiaca: (a) arteria gástrica izquierda (b) arteria hepática común (c) arteria esplénica y (d) una rama aberrante, que tuvo un curso inferior hacia el páncreas. La arteria aberrante suministraba irrigación al cuerpo del páncreas y daba una rama para la parte horizontal del duodeno para luego entrar en el mesocolon transverso para irrigar la flexura hepática y algunas partes del colon ascendente y transverso. La arteria frénica inferior estaba ausente en el lado izquierdo. Anomalías concomitantes de este tipo deben ser consideradas por el cirujano, en casos de operación de carcinoma de cabeza de páncreas y la realización de trasplante renal.

Consideraciones anatómicas sobre la irrigación de la flexura cólica derecha / Anatomic considerations about the irrigation of the right colic flexure

El estudio tuvo por objetivo describir la irrigación de la flexura cólica derecha, con la finalidad de proporcionar conocimientos anatómicos más amplios respecto del tema, y que éstos puedan ser utilizados para mejorar la práctica quirúrgica. Fueron utilizadas 40 piezas anatómicas de abdomen de cadáveres humanos, de ambos sexos y diferentes edades, fijados en formaldehido al 10 por ciento, pertenecientes al Departamento de Morfología de la Universidad Federal de Alagoas, Brasil. Se observó que la flexura cólica derecha estaba irrigada: en la mayoría de los casos (42,5 por ciento) por la arcada anastomótica, formada por la rama ascendente de la arteria cólica derecha con la rama derecha de la arteria cólica media; en el 27,5 por ciento de los casos por la anastomosis entre la rama derecha de la arteria cólica media y la rama ascendente de la arteria íleo cólica; en el 22,5 por ciento de los casos por las ramas ascendente y descendente de la arteria cólica derecha y en el 7,5 por ciento de los casos por la anastomosis entre las ramas derecha e izquierda de la arteria cólica media. Podemos concluir que la arteria cólica media fue el vaso con mayor presencia (77,5 por ciento) en la irrigación de la flexura cólica derecha. La anastomosis predominante en la flexura cólica derecha ocurrió entre la rama ascendente de la arteria cólica derecha y la rama derecha de la arteria cólica media.

This study has as objective present data about the irrigation of the right colic flexure, in order to proportionate an ample anatomic understanding about this subject, and that can be useful to perfect the surgical exercise. Was utilized 40 abdominal anatomic pieces of human corpses, of both sexes and variable ages, fixed in formaldehyde at 10 percent, belonging to Departament of Morphology of the Universidade Federal de Alagoas, Brazil. Was observed that the right colic flexure was presented in the majority of the cases (42.5 percent) irrigated by the anastomotic arcade composed by ascending branch of right colic artery with the right branch of the middle colic artery; following by the anastomosis between the right branch of middle colic artery and the ascending branch of ileocolic artery, in 27.5 percent of the cases. The ascendant and descendant branches of the right colic artery nourished the right colic flexure in the 22.5 percent of cases; at the present the anastomosis between the right and left branches of the middle colic artery irrigated the right colic flexure in 7.5 percent of the cases. We concluded that the middle colic artery was the most present vase (77.5 percent) in irrigation of the right colic flexure. The most prevalent anastomosis in the right colic flexure occurred between the ascending branch of right colic artery and the right branch of middle colic artery.

Curvas de biometría fetal con edad gestacional determinada por ecografía de primer trimestre: Clínica Alemana de Santiago / Ultrasound fetal biometry charts: Clinica Alemana of Santiago, Chile

Antecedentes: La gran mayoría de las curvas ultrasonográficas de crecimiento intrauterino han sido basadas en una edad gestacional (EG) determinada por fecha de última menstruación segura y confiable, la que es discordante con la ecografía de primer trimestre hasta en un 20 por ciento. Objetivo: Presentación de un normograma para diámetro biparietal (DBP), circunferencia abdominal (CA) y fémur (F), en embarazos únicos con EG calculada por ecografía de primer trimestre. Métodos: En la Unidad de Ultrasonografía de la Clínica Alemana de Santiago, durante 2000 y 2004, se analizaron todos los embarazos simples con ecografía de primer trimestre, definida por embrión vivo, único, con longitud céfalo-nalgas entre 3 y 84 mm. Se revisaron todos los informes ecográficos realizados durante el mismo embarazo, con informe de DBP, CA y F. Se seleccionaron 4.762 ecografías realizadas a 2.614 embarazadas. Se comparó los resultados con curvas de referencia nacional e internacional. Resultados: El DBP de nuestra población a las 22 semanas es significativamente mayor que las publicadas por Chitty y Vaccaro, y similares a las de Kurmanavicius y Snijders; mientras que la CA es mayor y el fémur es similar a las demás curvas de referencia. Conclusión: Las curvas obtenidas y determinadas por la ecografía de primer trimestre son diferentes con las curvas de referencias comparadas. Esto deberá considerarse dado que la ecografía precoz para el cálculo de la edad gestacional se ha generalizado en la práctica obstétrica actual.

Background: Several reference charts for fetal biometry are published in the literature. The choice may affect directly on diagnosis of IUGR. Most of these charts defined gestational age by last menstrual period (LMP), nevertheless, LMP has shown to be discordant with first trimester biometry in up to 20 percent of the cases in the best of clinical situations. Objective: To build a normogram of fetal biometry based on first trimester CRL and not on LMP. Methods: Between 2000 and 2004, 20400 scans were performed. First trimester CRL was used for dating second and third trimester biometries. 4762 scans in 2614 pregnant women were used to build our normal biometry charts. Our results were compared to other reference charts. Results: BDP at 22 weeks'GA form our population was significantly greater than that from Chitty and Vaccaro and similar to Kurmanavicius y Snijders. The AC of our population was greater and FL was similar to those of reference charts. Conclusion: The fetal biometry of our population was statistically different from that of local and international reference charts. This is important as gestational age is determined by first trimester ultrasound for obstetrical use.