Sericin and swimming on histomorphometric parameters of denervated plantar muscle in Wistar rats / Sericina e natação sobre parâmetros histomorfométricos de músculo plantar desnervado de ratos Wistar

Abstract Objective To analyze the combined effects of the silk protein sericin and swimming exercise on histomorphometry of the plantar muscle in Wistar rats. Methods Forty adult rats were randomly allocated into 5 groups comprising 8 animals each, as follows: Control, Injury, Sericin, Swim, and Swim plus Sericin. Three days after crushing of the sciatic nerve the rats in the Swim and Swim plus Sericin Groups were submitted to swimming exercise for 21 days. Rats were then euthanized and the plantar muscle harvested and processed. Results Cross-sectional area, peripheral nuclei and muscle fiber counts, nucleus/fiber ratio and smallest muscle fiber width did not differ significantly between groups. Morphological analysis revealed hypertrophic fibers in the Swim Group and evident muscle damage in the Swim plus Sericin and Injury Groups. The percentage of intramuscular collagen was apparently maintained in the Swim Group compared to remaining groups. Conclusion Combined treatment with sericin and swimming exercise did not improve muscle properties. However, physical exercise alone was effective in maintaining intramuscular connective tissue and preventing progression of deleterious effects of peripheral nerve injury.

RESUMO Objetivo Analisar o efeito da proteína sericina associada ao exercício físico de natação na histomorfometria do músculo plantar de ratos Wistar. Métodos Foram utilizados 40 ratos adultos divididos aleatoriamente em 5 grupos, com 8 animais cada: Controle, Lesão, Sericina, Natação, Natação e Sericina. Três dias após a compressão do nervo isquiático, os Grupos Natação e Exercício e Sericina foram submetidos ao exercício físico de natação durante 21 dias. Após, os animais foram sacrificados, e o músculo plantar foi processado. Resultados Não houve diferença da área da secção transversa entre os grupos, quantidade de núcleos periféricos, quantidade de fibra, relação núcleo/fibra e diâmetro menor. A análise morfológica revelou que no Grupo Natação ocorreu hipertrofia das fibras, assim como nos Grupos Exercício e Sericina e Lesão, o dano muscular foi evidente. O percentual de conjuntivo intramuscular parece ter sido mantido no Grupo Exercício em relação aos demais grupos. Conclusão A associação da proteína sericina e exercício físico de natação não foi eficiente na melhora das propriedades musculares, embora a aplicação do exercício físico tenha sido eficiente na manutenção do conjuntivo intramuscular, e no não agravamento dos efeitos deletérios consequentes da lesão nervosa periférica.

Classification and fascicular analysis of variant branching pattern of femoral nerve for microsurgical intervention: a series of thirteen cadavers / Clasificación y análisis fascicular de las variantes en el patrón de ramificación del nervio femoral en intervenciones microquirúrgicas: una serie de 13 cadáveres

Femoral neuropathy associated with lower limb is treated by surgical intervention through activation/regeneration/grafting of nerve fibers by a nerve cuff electrode implant or neuro-prosthesis. These procedures require detailed and precise knowledge of neuro-anatomical variants of the femoral nerve and its fascicular anatomy so that the nerve injury can be investigated and treated more efficiently. The aim of the study is to uncover the variations both in the femoral nerve and its branches, to classify them and to bring out corresponding fascicular anatomy using a hypothesis based on the principle of consistency, continuity and traceability of fascicles. The study was carried out in the Department of Anatomy AIIMS Rishikesh using 13 matched lower limbs (26 femoral nerves) from 13 cadavers. The femoral nerve was exposed in the femoral triangle and traced to the posterior abdominal wall. Variations in the shape, size and course of the femoral nerve and its branches were analyzed. The fascicular arrangement was also conceptualized based on the hypothesis. Seven classes, high division, trunk anomaly, semi-scattered, scattered branching pattern, pectocutaneous, lateral cutaneous nerve of thigh and nerve to sartorius anomalies were detected. The corresponding fascicular organizations were modeled. The seven classes along with corresponding fascicular pattern will be very useful for neurosurgeons, radiologists, anesthetists and anatomists in diagnosis and treatment of femoral neuropathy.

La neuropatía femoral asociada con el miembro inferior es tratada por intervención quirúrgica a través de activación, regeneración e injerto de fibras nerviosas mediante un implante de electrodo de manguito de nervios o neuro-prótesis. Estos procedimientos requieren un conocimiento detallado y preciso de las variantes neuro-anatómicas del nervio femoral y su anatomía fascicular de modo que la lesión del nervio pueda ser investigada y tratada de manera más eficiente. El objetivo del estudio fue descubrir las variaciones tanto en el nervio femoral y sus ramas y clasificarlos a partir de la anatomía fascicular utilizando una hipótesis basada en el principio de la continuidad y trazabilidad de los fascículos correspondientes. El estudio se llevó a cabo en el Departamento de Anatomía AIIMS Rishikesh utilizando 13 miembros inferiores pareados (26 nervios femorales) de 13 cadáveres. El nervio femoral se expuso en el triángulo femoral y fue trazado en la pared abdominal posterior. Se analizaron las variaciones en la forma, tamaño y trayecto del nervio femoral y sus ramas. El patrón fascicular fue conceptulizado de acuerdo a la hipótesis planteada. Se detectaron anomalías clasificadas en: siete clases, división alta, anomalías de tronco, semi-dispersos, patrón de ramificación dispersa, pectocutáneo, nervio cutáneo lateral y nervio del músculo sartorio. Las clasificaciones junto con el patrón fascicular correspondientes serán de gran utilidad para los neurocirujanos, radiólogos, anestesistas y anatomistas en el diagnóstico y tratamiento de la neuropatía femoral.

Study of variations in medial sural cutaneous nerve, lateral sural cutaneous nerve and peroneal communicating nerve.

The sural nerve complex includes the Medial sural cutaneous nerve (MSCN), Lateral sural cutaneous nerve (LSCN), Peroneal communicating nerve (PCN) and Sural nerve. The sural nerve is the most frequently used donor nerve for peripheral nerve grafting. LSCN can be an alternative to sural nerve in situations requiring a limited length of nerve graft material, the peroneal communicating nerve may also be harvested. Fifty lower limb specimens were dissected and data was collected. The study included 16 male and 9 female cadavers. MSCN was observed in all 50 specimens, out of which 74% specimens had normal course and 22% had a transmuscular course. LSCN was present in 82% of specimens. PCN was arising from Common Peroneal Nerve (CPN) directly in 16% and as a common trunk with LSCN in 14% of specimens. PCN was absent in 28% of cases. So knowledge of variation in these nerves will help the surgeons while considering these nerves for nerve grafting.

Las Arterias Circunflejas Femorales en el Triángulo Femoral / The Circumflex Femoral Arteries in the Femoral Triangle

Conocer el origen y distribución de las arterias circunflejas femorales (AaCF) en el hombre, es importante en el momento quirúrgico de la reconstrucción vascular. Se disecó el contenido del triángulo femoral en 92 miembros inferiores de cadáveres formolizados, adultos, de sexo masculino y diferentes grupos étnicos, descubriéndose la arteria femoral (AF) y sus ramas originadas a nivel del triángulo femoral. Se localizó el origen de cada una de las AaCF determinándose el tipo y lugar de origen. La arteria circunfleja femoral medial (ACFM) se originó en 43 casos (46,7 por ciento) desde la AF; en 41 casos (44,6 por ciento) desde la arteria femoral profunda (AFP); en 7 casos (7,6 por ciento) en un tronco común formado por la AFP y AaCF y en un caso (1,1 por ciento) desde la arteria circunfleja femoral lateral (ACFL). La ACFM tenía en 75 casos (81,5 por ciento) un origen más proximal que la ACFL y en 9 casos (9,8 por ciento) su origen era al mismo nivel. La ACFL se originó en 68 casos (73,9 por ciento) desde la AFP; en 17 casos (18,5 por ciento) desde la AF; en 7 casos (7,6 por ciento) en un tronco común formado por la AFP y AaCF. El origen de la ACFL fue considerado independientemente si su ramo descendente se originaba desde ella o lo hacía desde la AF. Debido a la presencia de una serie de elementos nobles, conocer el origen preciso de las arterias y sus eventuales variaciones, adquiere especial importancia en los procedimientos realizados en la región.

It is important to identify the origin and distribution of the circumflex femoral arteries (CFA) at the time of vascular reconstructive surgery. The femoral triangle contents in 92 lower extremities of formolized adult male cadavers of different ethnic groups, were dissected uncovering the femoral artery (FA) and its branches originating at the level of the femoral triangle. The origin of each CFA was identified determining the origin type and location. The medial circumflex femoral artery (MCFA) originated from the FA in 43 cases (46.7 percent); from the profunda femoris artery (PFA) in 41 cases (44.6 percent); from a common trunk formed by the PFA and CFA in 7 cases (7.6 percent), and in one case (1.1 percent) from the lateral circumflex femoral artery (LCFA). In 75 cases (81.5 percent) the MCFA was most proximal than the LCFA, and in 9 cases (9.8 percent) it originated at the same level. The LCFA originated at the PFA in 68 cases (73.9 percent); from the FA in 17 cases (18.5 percent); from a common trunk formed by the PFA and CFA in 7 cases (7.6 percent). The origin of the LCFA was considered regardless, whether the descending branch originated therein or from the FA. Considering the presence of a number of important elements it is essential to identify the precise origin of the arteries and its eventual variations in procedures carried out in that area.

Bloqueo poplíteo para reducciones ortopédicas de extremidad inferior / Popliteal block for inferior extremity orthopedic reductions

Popliteal sciatic block is considered a good alternative analgesia for performing leg, ankle or foot’s fracture reduction at an emergency room. We hypothesized that performing the procedure in prone position rather than supine is better tolerated by the patients. Since 1995, we have used popliteal sciatic block carried out in both positions. Our study consists in 507 patients with fractures of the involved segment of the lower limb who presented at the emergency room from 1998 to 2008. All of them were treated with closed reduction and immobilization under popliteal sciatic block analgesia. The Procedure was performed by orthopedic surgeons guided by an anesthesiologist. 22.5 ml of lidocaine at 1.33 percent was used for obtaining paresthesia. Pain outcome was evaluated using the Visual Analog Scale (VAS) and by patient and surgeon questionnaire. Patient and surgeon’s satisfaction was 90 percent and 94 percent, respectively. Our series reports a simple, reliable and safe analgesia technique for closed fracture’s reduction of the lower limb at the emergency department.

Para reducciones de fracturas de pierna, tobillo y pie generalmente basta un bloqueo ciático, que realizado en la posición prona, produce dolor e incomodidad al paciente. Desde el año 1995 utilizamos en nuestro hospital el bloqueo poplíteo vía posterior en posición supina para estos procedimientos. Se analiza la experiencia de 10 años con 507 pacientes con lesiones del segmento a los cuales se les practicó reducción de su fractura con bloqueo poplíteo realizado por residentes de Ortopedia y Traumatología capacitados y supervisados por anestesiólogos. Se utilizó lidocaína 22,5 ml al 1,33 por ciento obteniéndose parestesias. La evaluación se realizó mediante escala EVA y encuesta al operador y paciente. El 90 por ciento de los pacientes y el 94 por ciento de los operadores dan una evaluación positiva del procedimiento. La técnica siendo simple, confiable y segura proporciona una excelente anestesia para reducciones de la extremidad inferior.

Reconstrução de lesões de partes moles do calcanhar com o uso de retalhos fasciocutâneos / Reconstruction of soft parts lesions of the heel with the use of fasciocutaneous

Introdução: O calcanhar exerce importante função em suportar o peso do organismo e propiciara deambulação. As lesões nesta área são graves e de difícil reconstrução, implicandogeralmente em longos períodos de internação hospitalar, altos custos hospitalares e prejuízosfuncionais significantes para as vítimas. A reconstrução de partes moles do calcâneo representaum desafio devido ao alto grau de especialização dos tecidos envolvidos, escassez epouca mobilidade relativa dos tecidos vizinhos. Método: Didaticamente, as lesões do calcâneoforam classificadas basicamente em duas: lesão anterior ou plantar e lesão posterior.As lesões anteriores foram reconstruídas preferencialmente pelo retalho em ilha baseado naartéria plantar medial e nas outras foi utilizado preferencialmente o retalho sural reverso.Resultados: Em um total de onze casos, oito foram submetidos a reconstrução pelo retalhosural reverso e quatro pelo retalho plantar medial. As lesões foram na maioria dos casosdevido a acidente automobilístico. Apenas um caso foi devido à ressecção neoplásica. Conclusão:Os retalhos fasciocutâneos regionais em ilha se mostraram bastantes eficazes parao uso proposto, além de exigirem menor tempo cirúrgico e melhor relação custo/benéfico,se comparado a reconstrução microcirúrgica.

Introduction: The heel has the important function of supporting the weight of the personand to propitiate the ability of walking. The lesions in this area are serious and difficultto reconstruction properly, usually implicating in long periods of internment in a hospital,high hospital costs and significant functional damages for the victims. The reconstructionof soft parts of the heel represents a challenge due to the high degree of specialization ofthe involved tissue and relative immobility of the surrounding tissue. Method: The lesionswere classified basically in two: anterior lesions or plantar lesions and posterior lesions.The anterior lesions were rebuilt preferentially using the plantar medial flap based on theplantar medial artery and the posterior lesions was used the reverse sural flap preferentially.Results: In a total of eleven cases, eight were submitted to reconstruction with reversesural flap and four with plantar medial flap. The lesions were in most of the cases due tocar accident. Only one case was due to the neoplasic resection. Conclusion: The regionalfascio-cutaneous flaps in island were shown plenty effective for the proposed use, besidesthey demand smaller surgical time and better relationship cost/beneficial compared to amicrosurgical reconstruction.

La inervación sensitiva segmentaria dermatomas, miotomas y esclerotomas / The segmentary sensitive innervation: dermatomes, myotomes and sclerotomes

Los mapas de dermatomas, miotomas y esclerotomas son usados por los neurólogos y por los anestesiólogos regionalistas en su práctica clínica habitual. La determinación de la sensibilidad de las diferentes estructuras del cuerpo humano se inició en el siglo 19, continúa hasta nuestros días y en general los nuevos métodos empleados para la determinación de la sensibilidad han corroborado las investigaciones de los primitivos autores. Al analizar la historia de la confección de mapas de sensibilidad de piel, músculo y hueso encontramos a todas las grandes figuras de la Neurología involucradas de una u otra forma en la investigación de este tema fascinante y observamos como el ingenio, la investigación sistemática y también el análisis de enfermedades y malformaciones, que permiten objetivar dermatomas y esclerotomas de otra manera invisibles, han permitido avanzar cada vez más en la confección de estos mapas. Debe tenerse presente que todos los mapas de dermatomas están compuestos de muchas observaciones individuales, ya que en cada persona se determinan sólo unos pocos dermatomas. Por esta razón todos los mapas que muestran dermatomas para todo el cuerpo deben ser vistos como aproximaciones que no toman en cuenta las variaciones individuales. Además a pesar de que generalmente se asume el dermatoma como una definición anatómica los mapas en uso han sido determinados por métodos fisiológicos. Todo lo anterior unido al hecho que se han usado métodos diferentes por cada investigador puede explicar las variaciones que se observan entre diferentes autores.