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.

Análise do exercício agachamento com e sem o uso de physioball e banda elástica em diferentes intensidades / Analysis of the squat exercise with and without physioball and elastic band in different intensities

RESUMO O objetivo do presente estudo foi analisar a atividade mioelétrica (EMG), o tempo sob tensão (TST) e a projeção dos joelhos no exercício agachamento sem o uso de implementos (SI) e com o uso de physioball (PH) e banda elástica (BE) em diferentes intensidades de esforço. Dez homens realizaram o exercício nos três protocolos com a intensidade de 50 e 100% de 10 RM. A distância entre joelhos no protocolo controle (51,25cm) foi menor quando comparada com o SI 50% (84,38cm; p < 0,001), com o SI 100% (88,80cm; p < 0,001) e com BE 100% (67,41cm; p = 0,014). A distância entre os joelhos também foi menor para os protocolos PH 100% (53,10cm; p < 0,001) e BE 100% (67,41cm; p < 0,001) comparada ao SI 100% (88,80cm). O Vasto Medial Oblíquo (VMO) apresentou maior ativação nos protocolos SI 50% (p = 0,035) e PH 50% (p = 0,028) quando comparados ao protocolo BE 50%. A realização do agachamento com cargas submáximas parece aumentar e diminuir a ativação do VMO quando realizado com PH e BE, respectivamente.

ABSTRACT The objective of the present study was to analyze the myoelectric activity (EMG), the time under tension (TST) and the knee projection in the squat exercise without the use of implements (SI) and with the use of physioball (PH) and elastic band (EB) at different intensities of effort. Ten men performed the exercise in the three protocols with the intensity of 50 and 100% of 10 RM. The distance between knees in the control protocol (51.25 cm) was lower when compared to SI 50% (84.38 cm, p <0.001), with SI 100% (88.80 cm, p <0.001) and with EB 100% (67.41cm, p = 0.014). The distance between the knees was also lower for the protocols PH 100% (53.10cm, p <0.001) and EB 100% (67.41, p <0.001) compared to the SI 100% (88.80 cm) protocols. The Vasto Medial Oblique (VMO) presented greater activation in the SI 50% protocols (p = 0.035) and PH 50% (p = 0.028) when compared to the EB 50% protocol. The accomplishment of squatting with submaximal loads seems to increase and decrease the activation of VMO when performed with physioball and BE, respectively.

Very low-calorie diet in candidates for bariatric surgery: change in body composition during rapid weight loss

OBJECTIVE: To analyze the changes in the body composition of morbidly obese patients induced by a very low-calorie diet. METHODS: We evaluated 120 patients selected from a university hospital. Body composition was assessed before and after the diet provided during hospitalization, and changes in weight, body mass index, and neck, waist and hip circumferences were analyzed. Bioimpedance was used to obtain body fat and fat-free mass values. The data were categorized by gender, age, body mass index and diabetes diagnosis. RESULTS: The patients consumed the diet for 8 days. They presented a 5% weight loss (without significant difference among groups), which represented an 85% reduction in body fat. All changes in body circumference were statistically significant. There was greater weight loss and a greater reduction of body fat in men, but the elderly showed a significantly higher percentage of weight loss and greater reductions in body fat and fat-free mass. Greater reductions in body fat and fat-free mass were also observed in superobese patients. The changes in the diabetic participants did not differ significantly from those of the non-diabetic participants. CONCLUSIONS: The use of a VLCD before bariatric surgery led to a loss of weight at the expense of body fat over a short period, with no significant differences in the alteration of body composition according to gender, age, body mass index and diabetes status.

Bases anatomofuncionales de la articulación de la cadera y su relación con la fractura / Anatomic-functional bases of the hip joint and its relation with the fracture

Introducción: la sobrecarga en la epífisis proximal del fémur genera fuerzas deformantes sobre las características anatómicas, que junto a la pérdida de la masa mineral ósea resultan en la ocurrencia de fracturas. Existe un aumento de la evidencia de que la anatomía de la cadera juega un importante papel en la etiología de la fractura. Objetivo: sistematizar los conocimientos referentes a las características anatomofuncionales de la articulación de la cadera y su relación con la fractura desde el punto de vista radiológico. Materiales y métodos: se realizó una investigación documental, cuyo objeto de estudio fueron los textos clásicos de anatomía humana, ortopedia y traumatología, radiología, así como los artículos científicos publicados en las bases de datos informáticas. Desarrollo: desde hace más de 20 años se estudian las relaciones entre la anatomía imagenológica de la cadera y la ocurrencia de fracturas en esta región. Los estudios que se han realizado sobre las características de los componentes estructurales del hueso, tanto en su configuración interna como externa, demuestran que existe relación entre la anatomía de la articulación de la cadera y la fractura de la misma. Conclusiones: el conocimiento sobre la estructura anatómica, sus características funcionales y la relación de sus dimensiones con el riesgo de padecer de fractura provee de una base sólida para el entendimiento de los mecanismos de producción de las mismas y el diseño de futuras acciones de intervención para su prevención y tratamiento (AU).

Introduction: the overload of the femur proximal epiphysis generates deforming forces on the anatomic characteristics that together with the loss of bone mineral mass result in fractures´ occurrence. There is an increase of the evidence that hip anatomy plays an important role in the fracture etiology. Objective: to systematize current knowledge on the anatomic-functional characteristics of the hip joint and their relation with the fracture from the radiological point of view. Materials and methods: a documental research was carried; the objective of study were the classical handbooks of Human Anatomy, Orthopedics and Trauma, and Radiology, and also the scientific articles published in medical databases. Development: the relationship between the hip imaging anatomy and the occurrence of fractures in this anatomical region have been studied for more than 20 years. The studies carried out on the characteristics of the bone structural components, both in their internal configuration as in the external one, showed that there is a relationship between the hip join anatomy and its fracture. Conclusions: knowledge on the anatomic structure, its functional characteristics, and the relationship of its dimensions with the risk of suffering a fracture, provides a solid basis for understanding the mechanisms of their occurrence and for the design of future intervention actions to prevent and treat them (AU).

Femoroacetabular impingement / Impacto femoroacetabular

ABSTRACT The femoroacetabular impingement (FAI) is as condition recently characterized that results from the abnormal anatomic and functional relation between the proximal femur and the acetabular border, associated with repetitive movements, which lead labrum and acetabular cartilage injuries. Such alterations result from anatomical variations such as acetabular retroversion or decrease of the femoroacetabular offset. In addition, FAI may result from acquired conditions as malunited femoral neck fractures, or retroverted acetabulum after pelvic osteotomies. These anomalies lead to pathological femoroacetabular contact, which in turn create impact and shear forces during hip movements. As a result, there is early labrum injury and acetabulum cartilage degeneration. The diagnosis is based on the typical clinical findings and images. Treatment is based on the correction of the anatomic anomalies, labrum debridement or repair, and degenerate articular cartilage removal. However, the natural evolution of the condition, as well as the outcome from long-term treatment, demand a better understanding, mainly in the asymptomatic individuals.

RESUMO O impacto femoroacetabular (FAI) é condição de caracterização relativamente recente; decorre de relações anatômico-funcionais anormais entre a região proximal do fêmur e o acetábulo, associadas a movimentos de repetição, que acarretam lesões no labrum e na cartilagem acetabular. As alterações são representadas pela retroversão acetabular ou diminuição da altura entre a borda lateral da cabeça e o colo femoral. Além disso, o impacto femoroacetabular pode ser secundário a fraturas do colo do fêmur com consolidação viciosa ou decorrer de osteotomias pélvicas que provocam o retrodirecionamento do acetábulo. Essas anomalias levam ao contato femoroacetabular patológico que origina forças de impacto e cisalhamento durante os movimentos do quadril. Em consequência, há lesão labral e artrose precoce. O diagnóstico é feito pela sintomatologia típica, sinais radiográficos e ressonância magnética. O tratamento fundamenta-se na correção das anomalias anatômicas, reparo do labrum e remoção da cartilagem lesada. Entretanto, há necessidade de conhecer melhor a evolução natural da afecção, principalmente nos indivíduos assintomáticos, bem como resultados do tratamento em longo prazo.

Neurovascular structures at risk during anterolateral and medial arthroscopic approaches of the hip / Estructuras neurovasculares en riesgo durante abordajes artroscopicos anterolaterales y mediales de la cadera

To describe the safety areas for placement of 5 anterolateral portals (anterior, anterior lateral, posterior lateral, proximal anterior medial and distal anterior medial portals) and 3 recently described medial portals (anterior medial, posterior medial and distal posterior medial portals) to provide topographical description of the safety of each. A descriptive, observational and cross-sectional study in which femoral triangle dissection was performed in 12 hips. 5 lateral portals and the 3 medial portals were placed. Clinically relevant neurovascular structures associated with each portal, were identified measured and documented. The lateral portal with the highest risk of injury to a nearby neurovascular structure was the anterior portal, the most adjacent to the femoral cutaneous nerve, 1.42 cm (±0.85) lateral to the portal. In the medial portals, the anterior medial portal has the narrowest margin in relation to the femoral artery, 2.14 cm (±0.35) lateral to the portal and medial to the obturator nerve by 0.87 cm (±0.62). The lateral portals have a higher safety margin; the portal with the most proximity to a neurovascular structure is the anterior portal, associated laterally with the femoral cutaneous nerve, presenting a higher risk of injury. Medial portals have a higher risk of injuring the femoral neurovascular bundle as well as the obturator nerve.

El objetivo fue describir las áreas de seguridad para la colocación de 5 portales estándar (portal anterior, anterolateral, posterolateral, portal anterior proximal medial y portal anterior distal medial) y 3 portales mediales emergentes (antero medial, portal posteromedial y posteromedial distal) para proporcionar una descripción topográfica de la seguridad de cada portal. Se realizó un estudio descriptivo, observacional y transversal, en la que se disecó el triángulo femoral de 12 caderas. Se colocaron los 5 portales laterales y los 3 portales mediales. Se documentó la medición de cada estructura neurovascular de relevancia clínica en relación a cada uno de los portales evaluados. En cuanto al portal de mayor riesgo entre los laterales, se encontró el portal anterior con mayor cercanía al nervio cutáneo femoral lateral (1,42±0,85 cm), ubicado lateral al portal. En los portales mediales el portal anterior medial tiene el margen más estrecho respecto a la arteria femoral (2,14±0,35 cm) lateral al portal, y medial el nervio obturador (0,87±0,62 cm). Los portales laterales tienen un amplio margen de seguridad, el portal con el margen más reducido es el portal anterior en relación al nervio cutáneo femoral lateral, presentando un elevado riesgo de lesionarlo, los portales mediales tienen un alto riesgo de lesionar las estructuras neurovasculares femorales y el nervio obturador.

Reference curves of the body fat index in adolescents and their association with anthropometric variables / Curvas de referência do índice de adiposidade corporal de adolescentes e sua relação com variáveis antropométricas

OBJECTIVES: To develop reference curves for the body fat index (BFI) in the pediatric population, in adolescents from the city of São Paulo, Brazil, and verify their association with body mass index and body fat percentage. METHODS: The study is part of the research project "Nutritional Profile of Adolescents from Public and Private Schools of São Paulo" that was performed in 2004-2005. A total of 4,686 adolescents (2,130 boys and 2,556 girls) aged 10-15 years were divided into two groups: 10-12 and 13-15 years of age. Body mass, height, body mass index, hip circumference, body fat percentage, body fat index, and sexual maturation performed by the self-assessment method (prepubertal, pubertal, and postpubertal) were analyzed. ANOVA was performed, as well as percentile distribution, Pearson's correlation, and Bland-Altman plot. RESULTS: In boys, there was an increase in body mass, height, body mass index, and hip circumference with advancing age and Tanner stage. In girls, there was an increase in body fat index and body fat percentage with advancing age and stage of sexual maturation. An association was found between body fat index and body mass index (r = 0.67 in boys and 0.80 in girls, p < 0.001) and body fat percentage (r = 0.71 in boys and 0.68 in girls, p < 0.001). CONCLUSION: The body fat index seems to reflect well the phenomena of sexual dimorphism in adolescence, is easy to perform, and represents a method that should be used in population samples. .

OBJETIVOS: Desenvolver curvas de referência do índice de adiposidade corporal para população pediátrica, em adolescentes da cidade de São Paulo, Brasil, e verificar a sua relação com o índice de massa corporal e percentual de gordura corporal. MÉTODOS: O estudo faz parte do projeto de pesquisa "Perfil Nutricional de Adolescentes de escolas Públicas e Privadas de São Paulo" realizado em 2004/2005. 4.686 adolescentes (2.130 meninos e 2.556 meninas) de 10-15 anos foram divididos em dois grupos: 10-12 e 13-15 anos. Massa corporal, estatura, índice de massa corporal, circunferência de quadril, porcentagem de gordura corporal, índice de adiposidade corporal e maturação sexual realizada pelo método de autoavaliação (pré-púbere, púbere e pós-púbere) foram analisadas. Foi feito ANOVA, distribuição percentilar, correlação de Pearson e o gráfico de Bland-Altman. RESULTADOS: Nos meninos, ocorreu aumento da massa corporal, estatura, índice de massa corporal e circunferência do quadril com o avanço da idade e estágio de Tanner. Nas meninas, ocorreu aumento do índice de adiposidade corporal e do percentual de gordura corporal com o avanço da idade e estágio de maturação. Foi encontrada uma associação entre o índice de adiposidade corporal com o índice de massa corporal (r = 0,67 nos meninos e 0,80 nas meninas; p < 0,001) e com o percentual de gordura (r = 0,71 nos meninos e 0,68 nas meninas; p < 0,001). CONCLUSÃO: O índice de adiposidade corporal parece refletir bem os fenômenos do dismorfismo sexual na adolescência, sendo um método de fácil realização que deveria ser mais utilizado em amostras populacionais. .

Morfología de la cadera y media de contracción muscular en bipedestación en la parálisis cerebral / Morphologie de la hanche et moyenne de contraction musculaire en position bipède dans la paralysie cérébrale / Hip morphology and average muscle contraction when standing in cerebral palsy

Introducción: en la parálisis cerebral la articulación de la cadera es una de las más afectadas; sus alteraciones conllevan complicaciones importantes. Aunque su desarrollo se relaciona con trastorno del tono muscular y desequilibrio entre el grupo abductor y el adductor no existen datos objetivos que permitan cuantificar la proporción exacta entre las contracciones de ambos grupos musculares, a partir de la cual esta articulación se encuentra en riesgo. Objetivos: mostrar en una población con parálisis cerebral la media global del porcentaje de contracción de los grupos abductores (µ por ciento Abd) y adductores (µ por ciento Add) de cadera en bipedestación y compararla con los distintos grados de alteración de dicha articulación. Métodos: se midió la actividad muscular en bipedestación de los grupos abductor y adductor en 19 caderas, de 10 sujetos con parálisis cerebral utilizando un electromiógrafo de superficie. Los resultados se expresaron en porcentaje respecto a la contracción máxima isométrica obtenida previamente en los mismos grupos musculares. Las caderas se valoraron utilizando estudios radiológicos. Resultados: la media del porcentaje de contracción del grupo adductor supera a la del grupo abductor en las caderas subluxadas y luxadas. En el estudio por casos, al comparar resultados individuales con la media global para nuestra población no se consigue una asociación significativa. Conclusiones: se intuye que aunque el grupo adductor es un factor importante en el desarrollo de la patología coxofemoral, no es útil como indicador del estado articular aun utilizando medias de población con alteraciones neurológicas(AU)

Introduction: the hip joint is one of the most affected joint in cerebral palsy and its alterations are one of the most important complications. Although its development is related to muscle tone disorder and imbalance between abductor and adductor groups, there are no objective data that allow us to quantify the exact proportion between contractions of both muscle groups from which this joint is at risk. Objective: show, in a population with cerebral palsy, the mean of contraction percentage of hip abductors (µ pecent Abd) and adductors (µ percent Add) groups when standing and compare it with the different degrees of alteration of this joint. Methods: muscle activity of the abductors and adductors groups when standing was measured in 19 hips of 10 subjects with cerebral palsy using a surface electromyography. Results were expressed in percentage regarding the maximum isometric contraction previously obtained in the same muscle groups. Hips were assessed using radiological studies. Results: the mean percentage of contraction of the adductor group exceeds the adductor group in subluxated and luxated hips. In these case studies, a significant association when comparing individual results with the overall mean for our population is not achieved. Conclusions: although the adductor group is an important step in the development of hip pathology factor, it is not useful as an indicator of this joint stage, even using population means suffering neurological disorders(AU)

Introduction: l'articulation de la hanche est l'une des structures les plus souvent touchées dans la paralysie cérébrale; son altération provoque des complications importantes. Bien que son évolution soit associée à un trouble du tonus musculaire et de l'équilibre entre le groupe abducteur et le groupe adducteur, il n`y a pas de données objectives permettant de calculer la proportion exacte entre les contractions de tous ces deux groupes musculaires, à partir de laquelle cette articulation est en risque. Objectifs: le but de ce travail est de montrer la moyenne totale du pourcentage de contractions du groupe abducteur (µ pourcent Add) de la hanche en position bipède dans une population atteinte de paralysie cérébrale, et de la comparer avec les différents grades d'altération de cette articulation. Méthodes: on a mesuré l'activité musculaire en position bipède des groupes abducteur et adducteur de 10 patients (19 hanches), atteints de paralysie cérébrale, en utilisant un électromyographe de surface. Les résultats sont exprimés en pourcentage par rapport à la contraction maximale isométrique obtenue préalablement dans les mêmes groupes musculaires. On a évalué les hanches en faisant des examens radiologiques. Résultats: la moyenne du pourcentage de contraction du groupe adducteur supère celle du groupe abducteur dans les hanches subluxées et luxées. Dans l'étude des cas, on n'a pas obtenu une association significative en comparant les résultats individuels avec la moyenne totale de notre population. Conclusions: bien que le groupe adducteur soit un facteur clé dans l'évolution de la pathologie coxofémorale, il n'est pas utile comme indicateur de l'état articulaire, même en utilisant des moyennes de populations atteintes d'altérations neurologiques.

Geometric morphometrics for the study of hemicoxae sexual dimorphism in a local domestic equine breed / Morfometría geométrica para el estudio del dimorfismo sexual hemicoxae en una raza equina doméstica local

Twenty-eight skeletonized hemicoxae from young animals (yearlings, 13 males and 15 females) belonging to the "Cavall Pirinenc Català" horse (Catalan Pyrenean Horse) breed were studied by means of geometric morphometric (GM) methods. Morphometric analysis was based on coordinates of 16 landmarks of the ilium and ischiopubic regions that were digitized on 2D photographic images. Sexes did not appear separated either by size or shape, the latter being independent of the former. K-means clustering of shape variables were used in order to classify individuals by sex and an average accuracy of 57.1 percent was achieved. Males were misclassified more frequently than females. For the iliac landmarks, which contributed to the total variance of shape with the higher degree, the value obtained increased to 60.7 percent for k-means. The ischiopubic complex contributed less to sex differentiation according to shape. It is concluded that the use of GM and multivariate statistics is not a reliable method to quantify pelvic shape and size differences between the sexes for equine yearlings. This is the first known study to apply GM to the hip of an equine breed.

Fueron estudiados mediante morfometría geométrica (MG) 28 hemicoxales esqueletizados de animales jóvenes (potrillos, 13 machos y 15 hembras) pertenecientes a la raza de caballos "Cavall Pirinenc Català" (caballo Pirineo Catalán). El análisis morfométrico se basó en las coordenadas de 16 puntos de interés de las regiones isquiopúbica e ilíaca, que fueron digitalizadas mediante imágenes fotográficas en 2D. Los sexos no aparecen separados, ya sea por tamaño o forma, siendo esta última independiente de la primera. Se utilizó el análisis cluster de las K medias en las variables de forma con el fin de clasificar a los individuos por sexo y se logró una precisión media del 57,1 por ciento Los machos fueron mal clasificados con más frecuencia que las hembras. Para los puntos de referencia ilíacos, lo que contribuyó a la varianza total de la forma con el grado más alto, el valor obtenido se incrementó a 60.7 por ciento de K medias. El complejo isquiopúbico contribuyó menos a la diferenciación sexual de acuerdo a la forma. Se concluye que el uso de MG y estadística multivariada no es un método fiable para cuantificar la forma de la pelvis y las diferencias de tamaño entre los sexos para primales equinos. Este es el primer estudio conocido para aplicar MG en la cadera de una raza equina.

Descrição anatômica do terço proximal da artéria circunflexa femoral medial: estudo em cadáver / Anatomical description of the proximal third of the medial femoral circumflex artery: a cadaveric study

OBJETIVO: Descrever através de estudo em cadáver a disposição anatômica do terço proximal da artéria cincunflexa femoral medial (ACFM). MÉTODOS: Foi avaliada a disposição anatômica do terço proximal da ACFM, através de dissecção em 12 quadris de cadáver, que após terem sua altura aferida em metros (M), foram determinados alguns parâmetros: Ângulo de lateralização da ACFM (Â), Profundidade da ACFM em relação a origem superomedial do músculo quadrado femoral (P), distância da ACFM em relação a inserção superolateral do músculo quadrado femoral (D). RESULTADOS: Quando comparamos a média dos parâmetros entre os sexos notamos: Masculino Â= 43.6 graus, feminino Â= 38.3 graus. Masculino D= 6mm, feminino D= 9.5mm. Masculino P= 20.8 mm, feminino P= 18.3mm. A média dos parametros  e P são menores no sexo feminino porém o parâmetro D no sexo feminino é maior. CONCLUSÃO: Devemos ter como parâmetro superficial de segurança para o terço proximal da ACFM o ponto de inserção superolateral do músculo quadrado femoral. Que o parâmetro D da ACFM no sexo feminino é maior do que no sexo masculino. Que desinserir o músculo quadrado femoral em sua origem no ísquio pode oferecer maior segurança a ACFM do que faze-lo em sua inserção femural. Nível de evidência IV, série de casos.

OBJECTIVE: To describe, in a cadaver study, the anatomical arrangement of the proximal third medial femoral circumflex artery (ACFM). METHODS: We evaluated the anatomic arrangement of the proximal third of the ACFM through dissection in 12 cadaver hips. After measuring their height in meters (M), several parameters were determined: angle of lateralization of ACFM (Â), Depth ACFM in relation to the superomedial origin of the quadratus femoris muscle (P), and distance of ACFM from the superolateral insertion of the muscle quadratus femoris (D). RESULTS: In the comparison of mean parameters between the sexes, it was noted that: Male  = 43.6 degrees, female  = 38.3 degrees. Male D = 6mm, female D = 9.5mm. Male P = 20.8 mm, female P = 18.3mm. The average for parameters A and P were lower in females, but parameter D was higher in females. CONCLUSION: We should use, as the secure surface parameter for the proximal third of the ACFM, the superolateral insertion point of the quadratus femoris muscle. The fact that the parameter D of ACFM is greater in females than in males. Disconnecting the quadratus femoris muscle at its point of origin in the isquio may offer greater security to ACFM than doing it at the point of femoral insertion. Level of Evidence.

Sonoanatomía de cadera / Hip ultrasound anatomy

El complejo articular de la cadera comprende la articulación coxofemoral, la región trocantérica y paquetes musculares susceptibles de lesiones traumáticas e inflamatorias. Los métodos de imagen diagnósticos tradicionales proveen imágenes limitadas de estas estructuras. La ecografía musculoesquelética nos permite obtener imágenes más detalladas en la práctica clínica diaria a un relativo bajo costo y en tiempo real. En este artículo se detallan la sonoanatomía normal y la técnica empleada en la evaluación de este grupo de estructuras.

The anatomical region of the hip includes the coxo-femoral joint, the trochanteric complex and various muscles prone to both traumatic and inflammatory diseases. The standard imaging diagnostic methods are often insufficient in the assessment of these structures. Musculoskeletal ultrasound allows real-time detailed images in the daily clinical practice with a low cost operation. In this paper we review the normal sonoanatomy of the hip and the technique used in its examination.

Coxa vara do desenvolvimento / Developmental coxa vara

OBJETIVO: Avaliar os aspectos clínicos e radiográficos observados após o tratamento operatório de pacientes portadores de coxa vara do desenvolvimento (CVD), além de revisar sua epidemiologia e história natural. MÉTODOS: Foram selecionados 19 pacientes (26 quadris) portadores de CVD submetidos à osteotomia valgizante subtrocantérica, com tempo médio de quatro anos e 10 meses e mínimo de 12 meses de seguimento. Foram analisadas a amplitude de movimento dos quadris, o sinal de Trendelenburg e a discrepância de comprimento dos membros inferiores. Na avaliação radiográfica, foi medido o ângulo epifisodiafisário (ED) e a distância articulotrocantérica (DAT) em diferentes momentos. RESULTADOS: Observou-se elevação média de 21º da amplitude de abdução dos quadris, assim como desaparecimento do sinal de Trendelenburg. Na avaliação da discrepância de comprimento, 72,2 por cento dos 18 pacientes analisados foram equalizados, considerando uma diferença residual de até 0,5cm entre os membros. A variação da DAT apresentou médias de -0,34cm no período pré-operatório, 2,18cm no pós-operatório imediato e 1,35cm na última avaliação, o ângulo ED apresentou uma média de 91º no pré-operatório, 142º no pós-operatório imediato e 133º na última avaliação. CONCLUSÃO: A osteotomia valgizante subtrocantérica, levando a ângulos epifisodiafisários próximos a 140º, foi eficiente ao longo do tempo na correção das deformidades.

OBJECTIVE: To evaluate the clinical and radiographic findings observed after surgical treatment of patients with developmental coxa vara (DCV) and review its epidemiology and natural history. METHOD: We selected 19 patients (26 hips) with DCVthat underwent subtrochanteric osteotomy with a mean follow-up period of four years and ten months and a minimum of 12 months of follow-up. We analyzed the range of motion of the hips, the Trendelenburg sign, and the discrepancy of the length of the lower limbs.In the radiographic evaluation, we measured the epiphyseal-diaphyseal (ED) angle and articulo-trochanteric distance (ATD) at different times. RESULTS: We observed an average increase of 21º in the amplitude of hip abduction, as well as the disappearance of theTrendelenburg sign. In assessing the length discrepancy, 72.2 percent of the 18 patients studied were equalized, witha residual difference of up to 0.5cm between the limbs. The rangeof the ATD showed an average of -0.34 cm in the preoperative period, 2.18 cm in the immediate postoperative period, and 1.35 cm in the last evaluation.The ED angle had an average valueof 91º preoperatively, 142º in the immediate postoperative period, and 133º in the last evaluation. CONCLUSION: The subtrochanteric valgus osteotomy, leading to epiphyseal-diaphyseal angles close to 140º, was effective in the correction of deformitiesover time.

Reprodutibilidade do volume de membros fetais pela ultrassonografia tridimensional utilizando o método XI VOCAL / Reproducibility of fetal limbs volume by three-dimensional ultrasonography utilizing the XI VOCAL method

OBJETIVO: Avaliar a reprodutibilidade do volume do braço e coxa fetais aferido pela ultrassonografia tridimensional utilizando o método eXtended Imaging Virtual Organ Computer-aided AnaLysis (XI VOCAL). MATERIAIS E MÉTODOS: Realizou-se estudo de reprodutibilidade com 43 fetos normais entre 20 e 37 semanas. Para o cálculo do volume do braço e coxa fetais utilizou-se o método XI VOCAL com delimitação de 10 planos consecutivos. Para o cálculo da variabilidade interobservador, um examinador realizou uma medida do volume do braço e coxa dos 43 fetos, enquanto um segundo examinador, sem o conhecimento prévio dos resultados do primeiro examinador, realizou uma segunda medida dos mesmos volumes. Utilizaram-se, para os cálculos estatísticos, o coeficiente de correlação intraclasse (ricc), gráficos de Bland-Altman e teste t-Student pareado (p). RESULTADOS: Observou-se alta reprodutibilidade interobservador. Para o volume do braço, obtiveram-se ricc = 0,996 (intervalo de confiança [IC] 95 por cento: 0,992; 0,998) e média das diferenças = 0,13 ± 1,29 por cento (95 por cento limites de concordância: -2,54; +2,54 por cento). Para o volume da coxa, obtiveram-se ricc = 0,997 (IC 95 por cento: 0,995; 0,999) e média das diferenças = 0,24 ± 7,60 por cento (95 por cento limites de concordância: -7,6; +7,6 por cento). CONCLUSÃO: O volume do braço e coxa fetais aferido pela ultrassonografia tridimensional utilizando o método XI VOCAL apresentou elevada reprodutibilidade interobservador.

OBJECTIVE: To assess the reproducibility of fetal thigh and upper arm volumes measurement by threedimensional ultrasonography utilizing the eXtended Imaging Virtual Organ Computer-aided AnaLysis (XI VOCAL) method. MATERIALS AND METHODS: This reproducibility study enrolled 43 pregnant women with healthy singleton pregnancies between 20 and 37 gestational weeks. The XI VOCAL 10 planes was the method utilized for volumetric measurement of the fetal limbs. The calculation of the interobserver reproducibility was based on blind volumetric measurements of fetal thighs and upper-arms performed by two observers in 43 fetuses. Intraclass correlation coefficient (ICC), Bland-Altman plots and paired Student's t-test (p) were utilized in the statistical analysis. RESULTS: A high interobserver reproducibility was observed. For the upper arm volume ICC was 0.996 (confidence interval [CI] 95 percent: 0.992; 0.998) and mean difference = 0.13 ± 1.29 percent (95 percent limits of agreement: -2.54; +2.54 percent). For the thigh volume, ICC was 0.997 (CI 95 percent: 0.995; 0.999) and mean difference = 0.24 ± 7.60 percent (95 percent limits of agreement: -7.6; +7.6 percent). CONCLUSION: Fetal thigh and upper arm volumes measured by three-dimensional ultrasonography with the XI VOCAL method presented a high interobserver reproducibility.

The morphometric analysis of crista phallica in identification of sexes / El análisis morfométrico de cresta fálica en la identificación de los sexos

Crista phallica (CP) is used to determine sex in anthropology and criminal forensic medicine; however, it does not exist in anatomic and radiological terminology. The purpose of this retrospective study is morphometric analysis of the CP. We studied radiographs displaying several different clinical indications from patients whose bone maturation were fully complete. The crista phallica located on both sides of the medial portion of ischiopubic ramus (IPR) were localized and their peak points were determined. The distance from these peak points to the inner cortex of IPRs were measured, as well as the angles between the tangents passing the peak points from both sides. We determined the distance of the IPR (DIPR) for males and females sequentially as 21.3 +/- 3.5 mm, and 17 +/-2.8 mm, angle of CP (ACP) as 149.1 +/-15.7, and 163.5 +/-13.4. It was identified that ACP for females is less than ACP for males (p<0.001). ACP and DIPR alone are not sufficient criteria to determine sex. Therefore, the results of our findings show that it would be more useful to study other specifications and their metric analysis in order to determine sex.

La cresta fálica (Crista phallica, CP) se utiliza para determinación de sexo en antropología y la medicina forense, sin embargo, no existe en la terminología anatómica y radiológica. El objetivo de este estudio retrospectivo es el análisis morfométrico de la CP. Estudiamos radiografías que muestran varias indicaciones clínicas diferentes de pacientes cuya maduración ósea fue totalmente completa. La cresta fálica se situó a ambos lados de la porción medial de la rama isquio-pubiana (RIP), donde su localización y sus puntos más altos fueron determinados. La distancia desde estos puntos más altos a la corteza interna de la RIP fueron medidos, así como los ángulos entre las tangentes que pasaron por los puntos más altos de ambos lados. Se determinó la distancia de la RIP (DRIP) para hombres y mujeres de forma secuencial como 21,3 +/- 3,5 mm, y 17 +/- 2,8 mm, ángulo de la CP (ACP) como 149,1 +/- 15,7 y 163,5 +/- 13,4. Se identificó que los ACP para mujeres fueron menores que las ACP para los hombres (p <0,001). ACP y DRIP por sí solas no son criterios suficientes para determinar el sexo. Por lo tanto, los resultados de nuestros hallazgos muestran que sería más útil para estudiar otras especificaciones y sus análisis métricos a fin de determinar el sexo.

Sex determination in mandibles in the first year of life by a quantitative approach / Determinación del sexo en mandíbulas en el primer año de vida mediante una aproximación cuantitativa

Numerous studies have shown that skeletal characteristics vary among different populations. Several authors suggest that it is possible to determine sex through the anatomical evaluation of children mandible, however there are few morphometrical studies conducted with such specimens. The purpose of this study was to analyze several mandibular dimensions and identify the ones that could be useful to perform sex differentiation in a sample of Brazilian young children. For this study we used 32 children dry mandibles of known sex, age ranging from 0 to 1 year old. The mandibles pertain to the collection of the Skull Museum of the Universidade Federal de Sao Paulo (UNIFESP). The parameters included bicondilar width, bigonial width, minimum width and height of the mandibular ramus, gonion-gnation length, height of the mandibular symphysis and transverse and anteroposterior condylar dimensions. The SPSS program was used to carry on the discriminant function analysis and the T test (p <0.05). There were no statistically significant differences that could allow identification of a specific parameter for sex determination. However, most of the dimensions were higher in male than in female, except for the minimum width of the mandibular ramus (0.2-0.16 mm) and transverse diameter of the right condyle (0.16mm). The values obtained for the anteroposterior diameter of the mandibular head were the most different between genders, although no statistically significance was found. Discriminant function analysis indicated that, despite differences, none of the evaluated parameters allow for sex classification with enough reliability. In conclusion, there is little sexual dimorphism in children's mandibles during the first year of life and anatomical analysis of this structure is not recommended as reliable quantitative approach for sex differentiation with forensic purposes.

Numerosos estudios han demostrado que las características esqueletales varían en las distintas poblaciones. Diversos autores indican que es posible la determinación del sexo en base a mandíbulas infantiles; sin embargo, existen escasos estudios morfométricos realizados en mandíbulas de niños brasileros. El propósito de este estudio fue analizar distintas dimensiones de mandíbulas y determinar aquellas de utilidad en el diagnóstico forense del sexo, en población infantil brasilera. Se utilizaron 32 mandíbulas de niños brasileros de entre 0 y 1 año de edad, de sexo conocido, pertenecientes a la colección de cráneos de la Universidade Federal de Sao Paulo (UNIFESP). Las mediciones mandibulares incluyeron ancho bicondilar, ancho bigonial, ancho mínimo y altura de la rama mandibular, longitud gonion- gnation, altura de la sínfisis mandibular y las dimensiones transversa y anteroposterior del cóndilo. Los datos obtenidos fueron sometidos al t test (p<0,05) y análisis de la función discriminante con SPSS. La mayoría de las dimensiones fueron superiores en hombres que en mujeres, con excepción del ancho mínimo de la rama mandibular (0,2-0,16 mm) y del diámetro transverso del cóndilo derecho (0,16 mm). El diámetro anteroposterior de la cabeza mandibular resultó la más dimórfica de las medidas analizadas, aunque ninguna diferencia resultó estadísticamente significativa. El análisis de la función discriminante indicó que a pesar de las diferencias, éstas no permiten clasificar de acuerdo al sexo, en base a las variables cuantitativas analizadas. En conclusión, la mandíbula de niño en el primer año de vida presenta escaso dimorfismo sexual y no se recomienda el abordaje cuantitativo para la determinación del sexo con fines forenses.

Rapid prototyping for rehabilitation purposes

Integration of technologies such as medical imaging, types of software such as pro engineer, and modern fabrication processes such as RP is important in the medical field. It enabled to solve some medical problems specially those considering bio-parts replacement and prosthesis. This study presents a methodology that helped replace the wearied hip joint by a bio-product with the same dimensions, size, and shape as the patient's hip joint using CAD system and a Rapid Prototyping technique

Estudo anatômico do retalho perfurante ântero-lateral da coxa / Anatomic study of the anterolateral thigh flap

INTRODUÇÃO: O retalho ântero-lateral da coxa é baseado em vasos perfurantes do ramo descendente da artéria circunflexa lateral femoral. Este retalho tem características muito interessantes para a cirurgia reparadora, como a pequena espessura, pedículo longo e excelente área doadora. No entanto, existem muitas controvérsias na literatura quanto aos vasos perfurantes e ao trajeto do pedículo deste retalho. Neste trabalho procurou-se estabelecer alguns parâmetros anatômicos e esclarecer estas controvérsias. MÉTODO: Estudaram-se 100 coxas de 50 cadáveres quanto aos seguintes aspectos: 1- Número e localização de perfurantes encontrados, 2- Trajeto do pedículo perfurante, 3- Trajetória intramuscular, 4- Comprimento do trajeto intramuscular, 5- Comprimento total do pedículo, 6- Diâmetro dos vasos e 7- Espessura do retalho. RESULTADOS: 1- Encontraram-se de 0 a 4 perfurantes por coxa estudada, todas em um raio de até 6cm do ponto médio entre a espinha ilíaca ântero-superior e a borda lateral da patela. 2- Os vasos perfurantes tinham trajeto músculo-cutâneo em 75,76% das coxas e septo-cutâneo em 24,24%. 3- Dos pedículos perfurantes com trajeto músculo-cutâneo, 86,67% possuíam trajetória indireta contra 13,33% com trajetória direta. 4- O comprimento médio do trajeto intramuscular dos pedículos foi de 3,67 ± 2,01 cm. 5- O comprimento médio do pedículo total foi de 11,31 ± 3,12 cm. 6- O diâmetro médio da artéria na origem do ramo descendente da artéria circunflexa femoral foi de 2,21 ± 0,85 mm e para as veias no mesmo local de 2,66 ± 1,33 mm e 2,10 ± 1,11 mm. 7- A espessura da tela subcutânea foi de 8,98 ±6,23 mm e da pele de 1,60 ± 0,76 mm. CONCLUSÕES: 1- Existiu uma pequena possibilidade de não haver pedículos perfurantes. 2- Quando presentes, os pedículos perfurantes do ramo descendente da artéria circunflexa lateral femoral eram encontrados em numero de 1 a 4, sempre em um raio de 6 cm a partir do ponto médio entre a espinha ilíaca ântero-superior e a borda...

INTRODUCTION: The anterolateral thigh flap is based on the perforator vessels of the descending branch of the lateral circumflex femoral artery. This flap has very interesting characteristics for the reconstructive surgery, like the small thickness, long pedicle and excellent donor site. On the other hand, there are many controversial data on the literature about the perforator vessels and the pedicle course of this flap. The aims of this study are to establish some anatomical parameters and clear some controversies. METHOD: A hundred thighs of 50 cadavers were studied for: 1- The number and location of the perforator vessels. 2- The course of the perforator pedicles. 3- The intramuscular course. 4- The length of the intramuscular course. 5- The total length of the vascular pedicle. 6- The diameter of the vessels. and 7- The thickness of the flap. RESULTS: 1- There were found from 0 to 4 perforators per thigh, all in a 6cm radius from the mid point between the anterosuperior iliac spine and the lateral border of the patella. 2- The pedicles was musculocutaneous in 75,76% of the thighs and septocutaneous in 24,24%. 3- Among the musculocutaneous pedicles, 86,67% had a direct intramuscular course, and 13,33% had indirect course. 4- The mean length of the intramuscular course was 3,67 ± 2,01 cm. 5- The mean total pedicle length was 11,31 ± 3,12 cm. 6-The mean artery diameter on the origin of the descending branch of the lateral circumflex femoral artery was 2,21 ± 0,85 mm and the mean vein diameter on the same spot was 2,66 ±1,33 mm and 2,10 ± 1,11 mm. 7- The mean subcutaneous fat tissue thickness was 8,98 ± 6,23 mm and the mean skin thickness was e 1,60 ± 0,76 mm. CONCLUSIONS: 1- There was a possibility of finding no perforators of the descending branch of the lateral circumflex femoral artery. 2- When present, the perforators pedicles were found in numbers between 1 to 4, always in a 6cm radius from the mid point between the anterosuperior iliac spine...

Comparação anatômica entre o retalho perfurante ântero-lateral da coxa e os retalhos cutâneos paraescapular e lateral do braço / Anatomical comparison of the anterolateral thigh perforator flap and the parascapular and lateral arm skin flaps

A descrição de retalhos cutâneos pediculados em ramos perfurantes musculares é recente. O retalho ântero-lateral da coxa é vascularizado por vasos perfurantes musculares do ramo descendente da artéria circunflexa femoral lateral. Trata-se de retalho de pouca espessura, pedículo vascular longo e calibroso e baixa morbidade de área doadora. Entretanto, a dissecção do trajeto intramuscular de seu pedículo é tecnicamente difícil. Sua indicação é por vezes questionada por tratar-se de retalho de características semelhantes a outros vascularizados por artérias cutâneas diretas ou septocutâneas. Estes têm menor variação anatômica e dissecção mais simples. O presente estudo avaliou as características anatômicas do retalho ântero-lateral da coxa, através de dissecção em cadáveres frescos, comparando-as com as do retalho paraescapular e lateral do braço. Foram dissecados 60 retalhos (20 retalhos ântero-laterais da coxa, 20 paraescapulares e 20 retalhos laterais do braço) em 20 cadáveres frescos, não formolizados, com menos de 24 horas após o óbito. Todos os retalhos tiveram os seguintes parâmetros avaliados: comprimento do pedículo vascular, espessura do retalho, diâmetro do pedículo vascular arterial e venoso. Além disso, foi avaliada a presença de trajeto intramuscular do pedículo vascular (apenas nas dissecções do retalho ântero-lateral da coxa). A análise comparativa evidenciou que o pedículo vascular do retalho ântero-lateral da coxa é mais longo quando comparado aos dos retalhos paraescapular e lateral do braço (p<0,001). O retalho cutâneo lateral do braço apresenta a menor espessura (p<0,001) e o menor diâmetro arterial e venoso do pedículo vascular (p<0,001). Constatou-se a presença de trajeto intramuscular do pedículo do retalho ântero-lateral da coxa em 17 (85%) casos. O comprimento médio do segmento intramuscular do principal ramo perfurante foi de 4,13+2,02 cm...

The description of the skin flaps based on perforator vessels is recent. The vascularization of the anterolateral thigh flap is based on perforator vessels coming from the lateral circumflex femoral artery. It has a thin skin paddle, a long and large vascular pedicle and low donor site morbidity. However, the dissection of the intramuscular path of its pedicle is technically difficult. Its indication is sometimes questionable since it is a flap with characteristics similar to others based on direct cutaneous or septocutaneous vessels, which have less anatomical variations and are easier to dissect. This study evaluated the anatomical characteristics of the anterolateral thigh perforator flap through the dissection of fresh cadavers, comparing them with those of the parascapular and lateral arm skin flap. Sixty flaps were dissected (20 anterolateral thigh, 20 parascapular and 20 lateral arm flaps) in 20 fresh cadavers, not perfused with formaldehyde, less than 24 hours after death. The following aspects were evaluated in all the flaps: length of the vascular pedicle, thickness of the flap and diameter of the arterial and venous vascular pedicle. Additionally, the presence of the intramuscular path of the vascular pedicle was evaluated (only in the dissections of the anterolateral thigh flap). The comparative analysis showed that the vascular pedicle of the anterolateral thigh perforator flap is longer when compared to those of the parascapular and lateral arm flaps (p<0,001). The lateral arm flap presented a pedicle with smaller arterial and venous diameter (p<0,001), in addition to being the thinner flap (p<0,001). It was verified that the vascular pedicle of the anterolateral thigh flap presented an intramuscular path in 17 (85%) cases. The average length of the intramuscular segment of the main perforator vessel was 4,13+2,02 cm. The data was compared and evaluated with variance analysis...

Modified OSTA index for referring women for DEXA measurement.

A retrospective study of 696 postmenopausal women with hip measurement by Dual-energy X-ray absorptionmetry (DEXA) from Sapphasittprasong Hospital, Ubon Rahatani and Srinagarind Hospital, Khon Kaen University. All variables: T-score, age and weight were collected and calculated by the original OSTA index and modified OSTA index. Thai osteoporosis foundation recognized Original OSTA index the cut point below or equal 4 as high risk of osteoporosis. The authors used the modified OSTA index for calculation without truncate, the authors found that the cut off point was <-3.5 making 79% sensitivity and 58.7% specificity while the original OSTA gave 73%, 62% respectively. The authors proposed modified OSTA index as a making-decision tool before sending the patient for bone mass measurement. That saves the expense of further investigation.