Evaluation of the Association between Pelvic Diameters and Pelvic Types on Computed Tomography Images in Healthy Turkish Females / Evaluación de la Asociación entre Diámetros Pélvicos y Tipos de Pelvis en Imágenes de Tomografías Computarizadas en Mujeres Turcas Sanas

SUMMARY: Pelvis contributes to both human locomotion and obstetrics, and normal vaginal delivery is associated with a spacious inlet, a large interspinosus diameter. This paper aimed to measure crucial diameters of pelvic ring, and to determine both the prevalence of pelvic types, and labor types including normal vaginal delivery or caesarean section in Turkish healthy females. Additionally, it was aimed to evaluate presence of relationship between pelvic types and pelvic diameters. Labor shape of subjects was obtained from hospital records. This retrospective study was carried out on 165 healthy subjects aged between 18 and 45 years. Anteroposterior diameter of the pelvic inlet (APDI), anteroposterior diameter of the pelvic outlet, sacrum length (SL), sacrum depth, conjugata vera, obstetrical conjugate, the diagonal conjugate, diameter transversa, diameter bispinous, intertuberous diameter were measured. From these measurements, brim index was calculated and decided to gynecoid, anthropoid and platypelloid type. Also, the andoid type was calculated to the ratio of posterior sagittal diameter of the inlet to conjugata obstetrica. 50.91 % of participants has gynecoid type pelvis, followed by 24.85 % anthropoid type, 14.55 % platypelloid, and 9.70 % android type pelvis. There was a significant difference in APDI, SL, SD, Conjugata vera, Conjugata obstetrica, Conjugata diagonalis, Conjugata transversa, diameter bispinous, diameter intertubercularis and Brim index measurements according to pelvic types. the first degree of narrowing (conjugata vera from 11 to 9) was found in 18 pelvises and 12 pelvises with the pathological degree of narrowing bellonged to the platypelloid type followed by android type pelvis with 6 pelvices. The android type pelvis is not appropriate for natural labor and a good assessment of birth canal can reduce the labor risks. Also, only 7 females who delivered with cesarean have gynecoid type pelvic type. The APDI and SL were significantly lower in subjects having pathological narrowing according to conjugata obstetrica values.

La pelvis contribuye tanto a la locomoción humana como a la obstetricia. El parto vaginal normal se asocia con una entrada espaciosa y un diámetro interespinoso grande. Este artículo tuvo como objetivo medir diámetros cruciales del anillo pélvico y determinar tanto la prevalencia de los tipos pélvicos como los tipos de parto, incluido el parto vaginal normal o la cesárea en mujeres turcas sanas. Además, se buscó evaluar la presencia de relación entre los tipos de pelvis y los diámetros de la pelvis. La forma laboral de los sujetos se obtuvo de los registros hospitalarios. Este estudio retrospectivo se llevó a cabo en 165 mujeres sanas con edades comprendidas entre 18 y 45 años. Se midieron el diámetro anteroposterior de la entrada pélvica (APDPI), el diámetro anteroposterior de la salida pélvica, la longitud del sacro (SL), la profundidad del sacro, la conjugada vera, el conjugado obstétrico, el conjugado diagonal, el diámetro transverso, el diámetro biespinoso y el diámetro intertuberoso. A partir de estas mediciones se calculó el índice del ala y se decidió tipo ginecoide, antropoide y platipoide. Además, el tipo androide se calculó en función de la relación entre el diámetro sagital posterior de la entrada y la conjugada obstétrica. El 50,91 % de los participantes tenía pelvis de tipo ginecoide, seguida del 24,85 % de pelvis de tipo antropoide, el 14,55 % de tipo platipeloide y el 9,70 % de tipo androide. Hubo una diferencia significativa en las mediciones de APDPI, SL, SD, Conjugada vera, Conjugada obstétrica, Conjugada diagonal, Conjugata transversa, diámetro biespinoso, diámetro intertubercular e índice de ala según los tipos de pelvis. El primer grado de estrechamiento (conjugada vera del 11 al 9) se encontró en 18 pelvis y 12 pelvis, siendo el grado patológico de estrechamiento del tipo platipeloide seguido de pelvis tipo androide con 6 pelvis. La pelvis tipo androide no es apropiada para el parto natural y una buena evaluación del canal del parto puede reducir los riesgos. Además, solo 7 mujeres que dieron a luz por cesárea tenían un tipo pélvico de tipo ginecoides. El APDPI y SL fueron significativamente más bajos en mujeres que tenían estrechamiento patológico según los valores obstétricos conjugados.

Pelvimetric characteristics in agoutis (Dasyprocta prymnolopha) bred under human care / Características pelvimétricas em cutias (Dasyprocta prymnolopha) criadas sob cuidados humanos

The aim of the study was to establish the pattern of the agouti pelvis by obtaining external and radiographic internal pelvimetric values. Forty-three agouti (Dasyprocta prymnolopha), females and males bred in under human care were used. The parameters measured were the external biiliac diameter; the external biischiatic diameter; right and left external ilioischiatic diameters and radiographic internal measurements (true conjugated, the diagonal conjugated; the vertical, the sacral, sagittal, coxal tuberosity, upper biiliac, lower biiliac, and biischiatic diameter. The inlet pelvic area and the outlet pelvic area were calculated, as well the height/width ratios of the entrance area of the pelvis and the pelvic outlet area were calculated. The mean values for each body measurement of females and males were: weight 1.91kg and 2.04kg, external biiliac diameter 6.32cm and 6.30cm, external biischiatic diameter 4.34cm and 4.28cm, right external ilioischiatic diameter 9.01cm and 9.33cm, left external ilioischiatic diameter 9.13cm and 9.30cm, true conjugated 3.90cm and 3.68cm, diagonal conjugated 7.13cm and 6.91cm, vertical diameter 2.59cm and 2.45cm, sacral diameter 2.63cm and 2.44cm, sagittal diameter 3.30cm and 3.09cm, coxal tuberosity diameter 2.52cm and 2.43cm, upper biiliac diameter 6.28cm and 6.24cm, lower biiliac diameter 2.98cm and 2.58cm, biischiatic diameter 2.60cm and 2.70cm, height/width ratio - vertical/ lower biiliac diameter 0.88cm and 0.95cm, sagital/coxal tuberosity diameter 1.32cm and 1.28cm, inlet pelvic area 82.38cm and 77.83cm and outlet pelvic area 24.76cm and 20.07cm. Agouti are dolichopelvic animals, demonstrating the existence of a discrete sexual dimorphism in adults and low intensity correlations between the external and internal measures studied.

O objetivo deste estudo foi estabelecer o padrão da pelve de cutia, masculina e feminina, por meio da obtenção dos valores médios da pelvimetria externa e interna radiográfica. Foram utilizadas 43 cutias (Dasyprocta prymnolopha), fêmeas e machos criadas sob cuidados humanos. Os parâmetros medidos foram o diâmetro biilíaco externo; o diâmetro biisquiático externo; diâmetros ilioisquiáticos externos direito e esquerdo e medidas internas radiográficas (diâmetros conjugado verdadeiro, diagonal conjugado, vertical, sacral, sagital, tuberosidade coxal, biilíaco superior, biilíaco inferior e diâmetro biisquiático). A área pélvica de entrada e a área pélvica de saída foram calculadas , assim como foram calculadas as razões altura/largura da área de entrada da pelve e da área de saída da pelve. Os valores médios para as medidas das fêmeas e dos machos foram, respectivamente: peso 1,91kg e 2,04kg, diâmetro biilíaco externo 6,32cm e 6,30 cm, diâmetro ilioisquiático externo 4,34cm e 4,28cm, diâmetro ilioisquiático externo direito 9,01cm e 9,33cm, diâmetro ilioisquiático externo esquerdo 9,13cm e 9,30cm, diâmetro conjugado verdadeiro 3,90cm e 3,68cm, diâmetro conjugado diagonal 7,13cm e 6,91cm, diâmetro vertical 2,59cm e 2,45cm, diâmetro sacral 2,63cm e 2,44cm, diâmetro sagital 3,30cm e 3,09cm, tuberosidade coxal diâmetro 2,52cm e 2,43cm, diâmetro biilíaco superior 6,28cm e 6,24cm, diâmetro biilíaco inferior 2,98cm e 2,58cm, diâmetro biisquiático 2,60cm e 2,70cm, relação altura/largura - vertical/diâmetro biilíaco inferior 0,88cm e 0,95cm, diâmetro sagital/coxal tuberosidade 1,32cm e 1,28cm, área pélvica de entrada 82,38cm e 77,83 cm e área pélvica de saída 24,76cm e 20,07cm. As cutias são animais dolicopélvicos, demonstrando a existência de um discreto dimorfismo sexual em adultos e correlações de baixa intensidade entre as medidas externas e internas estudadas.

Cognition and reflection on the "lateral ligament of rectum" / 中华胃肠外科杂志

As total mesorectal excision (TME) for rectal cancer is widely carried out in China, lateral ligament of rectum, as an important anatomical structure of the lateral rectum with certain anatomical value and clinical significance, has been the focus of attention. In this paper, by comparing and analyzing the characteristics about ligaments of the abdomen and pelvis, reviewing the membrane anatomy and the theory of primitive gut rotation, and combining clinical observations and histological studies, the author came to a conclusion that lateral ligament of rectum does not exist, but is only a relatively dense space on the rectal side accompanied by numerous tiny nerve plexuses and small blood vessels penetrating through it.

Relaciones entre las fascias endopelvianas y el plexo hipogástrico inferior / Relationship between the endopelvic fascia and the inferior hypogastric plexus

El Plexo Hipogástrico Inferior (PHI) es un plexo difícil de definir y disecar, de allí la facilidad con que puede lesionarse tanto en la investigación anatómica como quirúrgica. Definir sus relaciones, con respecto a las fascias endopelvianas (FEP), incluyendo su formación y sus ramos, (Baader et al., 2003, p. 129)facilitaría su disección. Esta investigación anatómica pretende estandarizar Se utilizó material cadavérico perteneciente a la Tercera Cátedra de Anatomía de la Facultad de Medicina de la Universidad de Buenos Aires. Se disecaron un bloque de órganos de cadáver adulto formolizado (n=1) y diecisiete (n = 17) hemipelvis: cinco (n = 5) hemipelvis masculinas adultas formolizadas, nueve (n = 9) hemipelvis fetales formalizadas (7 masculinos y 2 femeninas), entre 18 y 36 semanas de edad gestacional calculada por la longitud femoral y tres (n = 3) hemipelvis adultas de cadáveres frescos, dos (n = 2) femeninas y un (n = 1) masculino. Se utilizaron elementos de microdisección y lupas.Pudimos distinguir tres sectores diferentes: el primero, preplexual, ubicado posterior y lateralmente a la FEP, donde los componentes simpáticos (nervios hipogástricos) y los parasimpáticos (nervios esplácnicos pélvicos) aún no han confluido para su formación. Un segundo sector, plexual, con el plexo ya completamente formado, ubicado en el espesor de la FEP. Por último, su porción terminal, ya desprovisto de la FEP, formado por nervios que se dirigen a la membrana perineal acompañados por vasos arteriales y venosos. Cada uno de estos sectores requiere distinto abordaje tanto en la disección anatómica como quirúrgica.

The Inferior Hypogastric Plexus (PHI) is a difficult plexus to define and dissect, hence the ease with which it can be injured both in anatomical and surgical research. Defining its relationships, with respect to the endopelvic fascia (FEP), including its formation and branches, (Baader et al., 2003, p. 129) would facilitate their dissection. This anatomical investigation aims to standardize different portions that require a different approach to preserve their integrity.Cadaveric material belonging to the Third Chair of Anatomy of the School of Medicine, Buenos Aires University was used. One (n=1) formolized male adult organ block and seventeen (n=17) hemipelvis were dissected: five (n=5) adult male hemipelvis formolized, nine (n=9) fetal hemipelvis formolized (7 male and 2 female), between 18 and 36 weeks of gestational age calculated by femoral length, and three (n=3) adult hemipelvis from fresh cadavers, two (n=2) female and one (n=1) male. Microdissection elements and magnifying glasses were used. We were able to distinguish three different sectors: the first, preplexual, located posterior and lateral to the FEP, where the sympathetic components (hypogastric nerves) and the parasympathetic (pelvic splanchnic nerves) have not yet converged to form the plexus. A second sector, plexual, with the plexus already fully formed, located in the thickness of the FEP. Finally, its terminal portion, already devoid of the FEP, formed by nerves that go to the perineal membrane accompanied by arterial and venous vessels. Each of these sectors requires a different approach in both anatomical and surgical dissection.

Diseño y aplicación piloto de un atlas imagenológico de pelvis femenina utilizando dispositivos móviles como apoyo al aprendizaje de la anatomía humana / Design and pilot application of an image atlas of female pelvis using mobile devices to support the learning of human anatomy

Resumen: Introducción: Las imágenes médicas constituyen un recurso de enseñanza-aprendizaje que complementa las metodologías tradicionales en el estudio de la Anatomía Humana para las profesiones de la salud. La pelvis femenina es una entidad anatómica compleja que contiene estructuras de varios sistemas, cuyas relaciones anatómicas son susceptibles de estudiar con detalle utilizando imágenes de resonancia magnética. Propósito: Diseñar una aplicación móvil como complemento al aprendizaje de la anatomía radiológica de la pelvis femenina y realizar una aplicación piloto a baja escala. Metodología: Se diseñó una aplicación móvil de anatomía normal de la pelvis femenina utilizando recursos gratuitos disponibles en línea, a partir de imágenes anonimizadas de resonancia magnética del archivo digital local. A partir de literatura anatómica relevante se seleccionaron las estructuras a rotular. Para evaluar la percepción de los usuarios, se diseñó y aplicó una encuesta por vía digital. Resultados: La aplicación móvil interactiva fue diseñada para dispositivos Android, con 7 secciones y 107 imágenes. Existió una adecuada recepción de la herramienta por parte de los seis estudiantes que participaron en la implementación piloto, destacando la accesibilidad como el principal aspecto a mejorar. Conclusión: Este atlas imagenológico a través de dispositivos móviles es un complemento del aprendizaje de la anatomía humana utilizando imágenes médicas.

Abstract: Introduction: Medical imaging is a teaching-learning resource that complements traditional methodologies in the study of Human Anatomy to health professions. The female pelvis is a complex anatomical entity that contains structures of several systems, whose anatomical relationships can be studied in detail using magnetic resonance imaging. Purpose: To design a mobile application as a complement to the learning of the radiological anatomy of the female pelvis and to carry out a pilot application in a small scale. Methodology: A mobile application of normal anatomy of the female pelvis was designed using free resources available online from anonymized magnetic resonance images from the local digital archive. The structures to be labelled were selected from relevant anatomical literature. In order to evaluate user's perception, a digital survey was designed and applied. Results: The interactive mobile application was designed for Android devices, with 7 sections and 107 images. There was an adequate reception of the tool by the six students who participated in the pilot implementation, highlighting accessibility as the main aspect to improve. Conclusion: This atlas imaging through mobile devices is a complement to the learning of human anatomy using medical images.

Radiographic pelvimetry in 0 to 24 month-old pacas (Agouti paca, Linnaeus, 1766) / Pelvimetria radiográfica em pacas de 0 a 24 meses de idade (Agouti paca, Linnaeus, 1766)

The pelvimetry consists of the metric determination of the pelvis dimensions and its use is directly related to the reproduction. The cartilage closure time of the ossification centers varies according to the bone, some closing already in the uterine life and others remaining present for many years. The objective was to evaluate, radiographically, the pelvic diameters by pelvimetry during the first 24 months of life in pacas, the second lagest Brazilian rodent and an animal that has shown big recent scientific interest, aiming the estimated age determination. Twelve pacas were used, which were monthly radiographed up from birth until 24 months old, with the animals anesthetized. The pacas are dolicopelvic animals and with pelvis presenting strong tendency to constant growth along the 12 first months of age, fact that can be useful in the approximated animals' age determination that do not have precise birth date, for example.(AU)

A pelvimetria consiste na determinação métrica das dimensões pélvicas, e sua utilização está diretamente relacionada à reprodução. O momento de fechamento da cartilagem dos centros de ossificação varia de acordo com o osso, algumas fechando já na vida uterina e outras permanecendo presentes por vários anos. Objetivou-se avaliar, radiograficamente, os diâmetros pélvicos, mediante pelvimetria, durante os 24 primeiros meses de vida de pacas, o segundo maior roedor brasileiro e sobre o qual tem havido grande interesse científico, para a determinação aproximada da idade. Foram utilizadas 12 pacas, as quais foram radiografadas mensalmente a partir do nascimento até 24 meses de idade, com os animais anestesiados. As pacas são animais dolicopélvicos e com pelve apresentando forte tendência ao crescimento constante durante os 12 primeiros meses de vida, o que pode ser útil na determinação aproximada da idade em animais que não possuem data precisa de nascimento, por exemplo.(AU)

Percepción de los estudiantes de anatomía humana frente a un método de enseñanza y aprendizaje basado en la construcción de un modelo de pelvis / Perception of human anatomy students facing a learning and teaching methodology based on the construction of a pelvis model

RESUMEN: Este estudio describe la percepción de estudiantes de anatomía humana frente a la actividad de construcción de modelos tridimensionales (3-D) a escala de pelvis. Pocos estudios evalúan la percepción de los estudiantes frente a una actividad de enseñanza y aprendizaje con modelos 3-D. La actividad se aplicó a un curso de anatomía humana de la carrera de obstetricia y puericultura a los cuales se les entregó modelos de estructuras óseas de la zona pélvica a escala real para que incorporaran las estructuras anatómicas (ligamentos, músculos, vascularización e inervación), finalizando la actividad se les entregó un cuestionario de percepción. 60 estudiantes realizaron la actividad de construcción de modelo anatómico 3-D y además completaron el cuestionario. Se reportaron niveles mayores al 93 % de estudiantes que sintieron motivación, creen que fue un facilitador del aprendizaje y que la actividad fue bien planificada. Entre los aspectos negativos se registraron: el tiempo de trabajo y los costos involucrados. Dada la positiva percepción de los estudiantes frente a las actividades de construcción de modelos anatómicos, se considera que es una metodología adecuada dentro de los procesos de enseñanza y aprendizaje de la anatomía humana.

SUMMARY: In this study, the perception of human anatomy students faced with constructing a three-dimensional (3-D) pelvis model (to scale) was studied. Few studies evaluate the perception of students facing learning and teaching methodologies with 3-D models. The activity was performed with students from a human anatomy course as part of the obstetrics degree, in which models of pelvic zone bone structures (to scale) were supplied in order to incorporate the anatomic structures (ligaments, muscles, vascularization and innervation). Once the activity was finished, a perception questionnaire was taken. 60 students participated in the activity of constructing the 3-D anatomical model and also completed the questionnaire. It was found that over 93 % of the students felt motivated, believed the activity facilitated learning and also that the activity was well planned. Some of the negative factors that were reported included time taken and the associated costs. Due to the positive perception of the students involved in the activity of constructing anatomical models, this is considered to be a suitable methodology for use during the process of teaching and learning about human anatomy.

Descripción anatómica de la miología del miembro pélvico y su relación topográfica con el sistema vascular y nervioso en un ejemplar de pudú ( Pudu puda ) / Anatomical description of pelvic limb myology and its topographic relationship with vascular and nervous systems in pudú ( Pudu puda )

RESUMEN: El pudú (Pudu puda) pertenece a la familia Cervidae y se estima que su población actual total es menor a 10.000 ejemplares, razón por la cual se encuentra en la categoría de "Casi Amenazado" y dentro de la lista roja de la Unión Internacional para la Conservación de la Naturaleza (IUCN). La causa de la reducción de su población, es la pérdida y la fragmentación de los bosques del sur de Chile, caza, depredación, atropellos, entre otros. En las últimas situaciones mencionadas, es frecuente observar lesiones en la zona corporal caudal y miembros pélvicos del animal. Debido a lo anterior, se considera importante generar estudios morfológicos en el pudú que puedan ser un aporte en el conocimiento de ésta especie en particular. El presente trabajo corresponde a un estudio descriptivo anatómico del miembro pélvico de un ejemplar de pudú hembra. Se describió la musculatura y sus principales relaciones con vasos sanguíneos y nervios desde proximal hacia distal, dividiendo al miembro pélvico en cuatro regiones topográficas: cintura pélvica, femoral, crural y del pie. Además, se realizó de forma complementaria un estudio morfométrico de cada región topográfica y cada músculo que la compone. Los resultados fueron comparados con rumiantes domésticos, en relación a lo descrito en la bibliografía anatómica clásica, observando que el ejemplar analizado posee características anatómicas similares a lo descrito para pequeños rumiantes, sin embargo, existen diferencias importantes de tomar en consideración, tales como: el m. de la fascia lata presenta dos porciones sobrepuestas; el m. sóleo presenta un mayor desarrollo; el paquete vasculo nervioso femoral se observa atravesando la porción craneal del m. sartorio y el m. gracilis forma parte del tendón calcáneo común. La información entregada en este estudio corresponde a un aporte anatómico que permite ampliar el conocimiento científico de ésta especie poco estudiada, protegida y vulnerable.

SUMMARY: The Pudu (Pudu puda) belongs to the family Cervidae and it is estimated that its total current population is less than 10,000 specimen, which is why it is part of the "Near Threatened" category and on the red list of the International Union for Conservation of Nature (IUCN). The cause of the reduction of its population is the loss and the fragmentation of the forests of the south of Chile, hunting, predation, crashes, among others. In the latter situations, it is common to observe injuries in the caudal area and pelvic limbs of the animal. Due to the above, it is considered important to generate morphological studies in the Pudú that can be a contribution in the knowledge of this particular species. The present study corresponds to an anatomical descriptive study of the pelvic limb of a female Pudú. Musculature and its main relationships with blood vessels and nerves were described from proximal to distal, dividing the pelvic limb into four topographic regions: pelvic waist, femoral, crural and foot. In addition, a morphometric study of each topographic region and each muscle was performed as complementary analysis. The results were compared to domestic ruminants, in relation to those described in the classic anatomical bibliography, observing that the analyzed specimen has anatomical characteristics similar to that described for small ruminants, however, several important differences were observed and should be taken into consideration: the M. tensor fascia latae presents two overlapping portions; the M. soleus is more developed; the vasculature of the femoral nerve is observed through the cranial portion of the M. sartorius and M. gracilis is part of the common calcaneus tendon. The information provided in this study corresponds to an anatomical contribution that allows furthering scientific knowledge of this protected and vulnerable species.

Determination of anterior pelvic index (API) to predict a narrow pelvis in adolescent girls / Determinación del índice de pelviano anterior (API) para predecir pelvis estrecha en adolescentes

Cephalopelvic disproportion in the pelvic inlet is a maternal risk factor in childbirth. A high number of dystocias are attended as emergencies and end in cesarean sections because there is no way to diagnose a narrow pelvis early on, a determination which would be easy to perform and at no cost to the patient. The aim of this study was to determine the Anterior Pelvic Index (API) as a predictive estimator of the obstetric conjugate diameter to differentiate narrow and normal pelvises. The study was conducted with 200 adolescent girls aged 14 to 19 years, from Quito, Ecuador; the parents signed the informed consent and the girls agreed to take part. The interspinous distance, height and obstetric conjugate diameter were measured by ultrasonography. Then the API was calculated and the predictive value of the obstetric conjugate diameter was obtained by simple linear regression. The average API value was 14.8 (CI 95 % 14.75 to 14.86) with a minimum value of 13.99 and a maximum value of 19.92. The association between the API and the obstetric conjugate diameter measured by ultrasonography produced a Pearson's correlation value of 0.543 (p=0.000). The simple linear regression test between the API and the obstetric conjugate diameter measured by ultrasonography was statistically significant. Therefore, it was determined that the prediction of the obstetric conjugate diameter, having the API as a predictor, can be calculated with the following formula:y=4.38+0.45*x and thus a possible narrow pelvis can be anticipated.

La desproporción feto-pélvica se puede producir en el estrecho superior de la pelvis, constituyéndose en un factor materno de riesgo en el parto. Un elevado número de partos distócicos son atendidos de emergencia y terminan en cesárea debido a que no existe un método de diagnóstico precoz de la estrechez pélvica, que sea fácil de realizar y sin costo para el paciente. El objetivo fue determinar el Índice Pelviano Anterior (API) como estimador predictivo del diámetro conjugado obstétrico para diferenciar pelvis estrechas y normales. El estudio fue realizado con 200 mujeres adolescentes de 14 a 19 años, de Quito, Ecuador, quienes cumplieron con la firma del consentimiento informado de los padres y el asentimiento de ellas. Se les midió la distancia interespinosa, la talla y el diámetro conjugado obstétrico ecográfico. Luego se calculó el Índice Pelviano Anterior y, mediante regresión lineal simple, se obtuvo el valor de predicción del diámetro conjugado obstétrico. El valor promedio del Índice Pelviano Anterior (API) fue de 14.8 (IC 95 % 14.75 a 14.86) con un valor mínimo de 13.99 y un valor máximo es de 19.92. La asociación entre el API y el diámetro conjugado obstétrico ecográfico produjo un valor de correlación de Pearson de 0.543 (p=0.000). La prueba de regresión lineal simple entre el PAI y el diámetro conjugado obstétrico ecográfico fue estadísticamente significativo. Por lo tanto, se determinó que la predicción del diámetro conjugado obstétrico, teniendo como predictor al PAI, se calculará con la siguiente fórmula : y=4.38+0.45*x y con ello se podrá pronosticar una eventual estrechez pélvica..

Esqueletogênese em punaré (Thrichomys laurentinus- Rodentia, Echimyidae) / Skeletogenesis in punare (Thrichomys laurentinus - Rodentia, Echimyidae)

O objetivo deste estudo foi descrever o desenvolvimento do esqueleto do punaré (Thrichomys laurentinus). Para tanto, foram utilizados 11 embriões e 12 fetos em diferentes estágios de desenvolvimento, sendo divididos em 4 grupos de acordo com o período gestacional. As amostras foram obtidas no Centro de Multiplicação de Animais Silvestres da Universidade Federal Rural do Semi-Árido, Mossoró-RN, Brasil. Após fixados em formol (10%) ou glutaraldeído (2,5%), foi realizada a analise morfológica com auxílio de lupa, sendo as características macroscópicas fotodocumentadas. Análises de raios-x e coloração por alizarina red foram realizadas para melhor compreensão do desenvolvimento ósseo. Nas análises de raio-x os embriões não apresentaram nenhuma radiopacidade, ao contrário dos fetos que apresentavam radiopacidade gradual ao longo dos grupos. No grupo II houve aumento de radiopacidade na região da coluna vertebral e das regiões mandibular e maxilar. No grupo III a radiopacidade estava aumentada nos membros pélvicos, nas costelas e na região frontal e no grupo IV nos membros torácicos e nas regiões occipital, temporal e frontal do crânio. Tais características foram confirmadas pelas analises histológicas e pela técnica de Alizarina Red. Com isso podemos concluir que o conhecimento acerca da embriologia do sistema ósseo normal é fundamental para o entendimento dos efeitos adversos causados pela nutrição e uso de drogas durante o desenvolvimento.(AU)

The aim of this study was to describe the skeletogenesis in punaré (Thrichomys laurentinus). We used 11 embryos and 12 fetuses in different stages of development, allocated into 4 groups. Samples were obtained from the Multiplication Center of Wild Animals, at Federal Rural University of the Semi-Arid, Mossoro/RN, Brazil. After fixed in formalin (10%) or glutaraldehyde (2.5%) the morphological analysis was performed with a magnifying glass, and the macroscopic characteristics were photographed. Analysis of X-rays and alizarin red staining was made to better understand the development of bone structures. In x-ray analysis, it was possible to verify that the embryos showed no radiopacity, unlike fetuses that had gradual radiopacity along of the groups. In group II, there was an increase in radiopacity in the spine, mandibular and maxillary regions. In group III, the radiopacity was increased in the hind limbs, ribs and in the frontal region, and group IV showed higher radiopacity in the thoracic limbs and occipital, temporal and frontal skull. These characteristics were confirmed by histological and alizarin red analysis. We concluded that the knowledge of normal skeletal embryology is critical for understanding of adverse effects caused by nutrition and use of drugs during the development.(AU)

Pelvimetry by reformatted computed tomography in 290 female pelvis: morphometric variations regarding age / Pelvimetría mediante tomografía computadorizada reformada sobre 290 pelvis femeninas: variaciones morfométricas de acuerdo a la edad

The Mexican government passed a new reform of article 11 of the General Law in 2014 regarding Women's Access to a Life Free of Violence, which states that a cesarean section may not be performed if a vaginal birth is viable. Cesarean sections are excessively indicated in Northen Mexico, using the diagnosis of cephalopelvic disproportion due to a narrow pelvis. Currently, there is no standardized morphometry of the female pelvis in a Mexican population to establish adequate diagnostic parameter. Our study measures the pelvic diameters of the birth canal using abdominopelvic computed tomography (CT). Two hundred and ninety CT from Mexican women between the ages of 18 and 50 were collected and 3D reformatted in order to morphologically measure the pelvic diameters of clinical relevance. Measurements were conducted by two diagnostic imaging specialists. The mean and standard deviation of the measured diameters were: anatomical conjugate diameter (ACD) 11.65±0.99 cm, the obstetric conjugate diameter (OCD) 11.73±0.98 cm, diagonal conjugate diameter (DCD) 12.49±0.98 cm and Interspinous distance (ISD) 10.41±0.78 cm. Significant differences were found in all four mean diameters in between the 20­29 age groups versus the >40, as well as between the 30­39 groups versus the >40. Our study shows that as Mexican women get older, the mean pelvic diameters become narrower.

El Gobierno mexicano aprobó una nueva reforma del artículo 11 de la Ley General del 2014, relativa al acceso de las mujeres a una Vida Libre de Violencia, que establece que una cesárea no se puede realizar si un parto vaginal es viable. Los partos por cesárea son indicados excesivamente en el norte de Mexico, con el diagnóstico de desproporción céfalo-pélvica debido a una estrechez de la pelvis. Actualmente, no existe una morfometría estandarizada de la pelvis femenina en una población mexicana para establecer parámetros de diagnóstico adecuado. Nuestro estudio mide los diámetros pélvicos del canal de parto mediante tomografía compudotarizada (TC) abdomino-pélvica. Se usaron 290 TC de mujeres mexicanas entre 18 y 50 años, los que fueron reformateados en 3D para medir morfológicamente los diámetros pélvicos de relevancia clínica. Las mediciones fueron realizadas por dos especialistas en diagnóstico por imagen. La Media y DE de los diámetros medidos fueron: diámetro anatómico conjugado (DAC) 11,65±0,99 cm, diámetro obstétrico conjugado (DOC) 11,73±0,98 cm, diámetro diagonal conjugado (DDC) 12,49±0,98 cm y distancia interespinosa (DIE) 10,41±0,78 cm. Se encontraron diferencias significativas en las Medias de los cuatro diámetros entre los grupos de 20­29 años de edad frente a las >40 años, así como entre los grupos de 30­39 años frente a los >40 años. Nuestro estudio muestra que a medida que las mujeres mexicanas avanzan en edad, los diámetros pélvicos medios son más estrechos.

Comparative anatomy of the pelvic nerves in bearded capuchins (Sapajus sp) / Anatomia comparativa dos nervos da pelve de macacos-prego (Sapajus sp)

Bearded capuchins (Sapajus sp), unexpectedly, share with chimpanzees behavioral features such as high cognitive ability, good memory, tool use with intermittent bipedalism, and social tolerance; although its anatomy is still little studied. To test the hypothesis that bearded capuchins might share similar anatomical features with chimpanzees, we investigated the pelvic nerves of the bearded capuchin and compared them with the data in the previous literature for modern humans, chimpanzee, and baboons in terms of origin, trajectory and innervated structures, when the data are available. Variation is very common in the primates because of, inter alia, 1) the problem of the anatomical position, i.e., some primatologists used the human anatomical position to describe those in non-human primates, while others used the non-human anatomical position, and the definition of anatomical position (human or non-human position) is not clear; 2) the lateralized and semi-bend pelvis limbs in non-humans primates compared with modern humans; 3) the absence of the some muscles (e.g., scansorius and ilioschiofemoralis) in modern humans in the thigh; and 4) the difference in the numbers of vertebrae among the authors, even in the same species, such as chimpanzees and bearded capuchins.(AU)

Macacos-prego (Sapajus sp), inesperadamente, compartilham com chimpanzés comportamentos como alta cognição e memória, uso de ferramentas com o bipedalismo intermitente, tolerância social. No entanto, sua anatomia ainda é pouco estudada. Para verificar a hipótese com qual espécie e/ou grupo de primatas os macacos-prego compartilham mais características, o objetivo deste trabalho foi estudar os nervos pélvicos do Sapajus e compará-los com dados da literatura anatômica sobre os seres humanos, chimpanzés e babuínos, considerando aspectos como origem, trajetória e estruturas inervadas. Foi observado que existem grandes variações nos nervos pélvicos entre os primatas estudados aqui, quais sejam, 1) o problema da posição anatômica, i.e., alguns primatologistas consideram a posição anatômica humana para os primatas, outros consideram a posição anatômica animal, e a opção por um ou outro não é clara nos textos; 2) o problema dos membros pélvicos em primatas não humanos serem lateralizados e semi-fletidos em relação aos seres humanos modernos; 3) o problema da ausência, nos seres humanos modernos, de alguns músculos da coxa em relação aos outros primatas como o escansório e o iliosquiofemoral; e 4) o problema da diferença do número de vértebras nos primatas estudados aqui, inclusive com diferenças para a mesma espécie citadas por diferentes autores tanto para chimpanzés como para macacos-prego.(AU)

Miologia do membro pélvico da paca (Cuniculus paca Linnaeus, 1766) / The myology of the pelvic limb of paca (Cuniculus paca Linnaeus, 1766)

Objetivam-se descrever os músculos do membro pélvico da paca (Cuniculus paca Linnaeus, 1766), mediante dissecção anatômica dessa região. Foram utilizadas dez Cuniculus paca adultas, machos e fêmeas, pesando entre cinco e 10 kg do plantel de pacas do setor de Animais Silvestres da FCAV, Unesp, Jaboticabal/SP. Os animais foram fixados em formaldeído 10% e conservados em solução salina a 30% para dissecação anatômica da musculatura da pelve, coxa e perna, identificando-se a origem e inserção de cada músculo. Os resultados foram fotodocumentados e discutidos com base na literatura sobre animais domésticos, ratos e cobaias. Salvo algumas variâncias na origem e inserção de cada músculo e na fusão dos ventres de alguns grupos musculares, de forma geral, a musculatura da paca assemelha-se a dos animais domésticos e a de outros roedores.(AU)

This study aimed to describe the muscles of the pelvic limb of paca (Cuniculus paca Linnaeus, 1766) through anatomical dissection of this region. We used ten adult pacas, males and females, weighing 5 to 10 kg from the group of pacas at the sector of wild animals of FCAV, Unesp-Jaboticabal, SP. The animals were fixed with 10% formaldehyde and preserved in 30% saline solution for anatomical dissection of the pelvis, thigh and leg musculature, with identification of the origin and the insertion of each muscle. Photos were taken and the results were discussed based on the domestic animal, rat and guinea pig literature. In general, the paca musculature resembles the one of domestic animals and other rodents; but some variance in origin and insertion of each muscle and in the fusion of some muscular groups of the bellies was observed.(AU)

Structural study of endopelvic fascia in prostates of different weights. Anatomic study applied to radical prostatectomy

PURPOSE: To evaluate the structure of the endopelvic fascia in prostates of different weights. METHODS: We studied 10 patients with BPH (prostates>90g); 10 patients with prostate adenocarcinoma (PAC) (prostates<60g) and five young male cadavers (control group). During the surgery a small sample of endopelvic fascia was obtained. We analyzed elastic fibers, collagen and smooth muscle. The stereological analysis was done with the Image Pro and Image J programs. Means were statistically compared using the one-way ANOVA with the Bonferroni test and a p<0.05 was considered statistically significant. RESULTS: The mean of the prostate weight was 122 g in BPH patients, 53.1g in PAC patients and 18.6g in control group. Quantitative analysis documented that there are no differences (p=0.19) in Vv of elastic fibers and in Vv of type III collagen (p=0.88) between the three groups. There was a significant difference (p=0<0.0001) in the quantification of SMC in patients with prostates >90g (mean=9.61%) when compared to patients with prostates <60g (mean=17.92%) and with the control group (mean=33.35%). CONCLUSION: There are differences in endopelvic fascia structure in prostates>90g, which can be an additional factor for pre-operatory evaluation of radical prostatectomy. .

Alternative treatment for open bite Class III malocclusion in a child with Williams-Beuren syndrome

Williams-Beuren syndrome (WBS) is a rare genetic condition that affects approximately 1 in every 20,000 - 50,000 live births. WBS children have specific skeletal deformities, dental malformations and rare lingual muscle dysfunction. The need for orthodontic and orthognathic therapy has arisen and has been considered a real clinical challenge even for experienced professionals, once it requires a complex and individualized treatment plan. This study reports a case of orthopedic expansion of the maxilla, in which a modified facial mask was used for protraction of the maxillary complex associated with clockwise rotation of the maxilla. In addition, special considerations about treatment time and orthopedic outcomes are discussed.

A síndrome de Williams-Beuren (WBS) é uma doença genética rara, acometendo, aproximadamente, de 1:20.000 a 1:50.000 crianças nascidas. As crianças com WBS têm deformidades esqueléticas específicas, má formações dentárias e, algumas vezes, disfunção muscular da língua. As necessidades ortodônticas e ortognáticas têm sido consideradas um verdadeiro desafio clínico, até mesmo para aqueles profissionais com vasta experiência, uma vez que requerem um plano de tratamento individualizado e complexo. Esse relato de caso aborda uma expansão ortopédica da maxila, em que foi utilizada uma máscara facial modificada para protração do complexo maxilar, acompanhada de uma rotação horária da maxila. Além disso, considerações especiais sobre o tempo de tratamento e resultados ortopédicos são discutidas.

Espinha bífida aberta em bovino: primeiro relato no estado de Minas Gerais / Open spina bifida in calf: first report in Minas Gerais state, Brazil

Relatou-se um caso de espinha bífida aberta em uma bezerra de seis dias de idade que apresentava decúbito lateral permanente, pescoço em posição de opistótono, membros torácicos estendidos, impotência funcional dos membros pélvicos e fístulação na região lombar. Todos os achados clínicos, radiográficos e necroscópicos, descritos neste trabalho, são compatíveis com um quadro de espinha bífida aberta, sendo este o primeiro relato no estado de Minas Gerais.

A case of open spina bifida is reported in a six day old calf which presented permanent lateral decubitus, opisthotonus neck position, stretched forelimbs, non-functional impairment of the hindlimbs and fistula in the lumbar region. All clinical, radiographic and necropsy finds described in this work are consistent with an open spina bifida case. This is the first case report in Minas Gerais State, Brazil.

Diseción pélvica: Mesorecto / Pelvic disection: Mesorectum

Introdución: El mesorecto es el tejido céluloadiposoque rodea al recto y que contiene el drenaje linfático yvascular del mismo. Es más grueso por detrás y en lascaras laterales del recto. Se trata de un auténtico sacoadiposo rodeado de una fina envoltura fibrosa, la fasciavisceral de la pelvis o fascia rectal.La diseción pélvica de un cáncer de recto consta decuatro etapas: la diseción posterior del recto, la disección lateral, la diseción anterior, y la seción distal delrecto.Materiales y Métodos: Se utilzaron ocho especímenesde hemipelvis fijados con formol al 10%. Se procedió ala diseción del mesorecto identifcando el tabique recto sacro, tomando nota del segmento sacro a la alturadel cual se encontraba. Se realizaron mediciones desdeel reborde anal hasta el fondo de saco de Douglas, hastael ángulo promontorio, hasta el vértice del coxis, y hastael borde superior del elevador del ano.Resultados: La distancia promedio fue de 9,6 cm desdeel reborde anal al fondo de saco de Douglas, de 5,7 cmdesde el reborde anal hasta el coxis, de 7 cm desde elreborde anal hasta el borde superior del elevador, y de18 cm desde el reborde anal hasta el ángulo promontorio.Discusión: Al cirujano compete especialmente el conocimiento de la técnica de reseción que es por su localización, reducido espacio de trabajo, y complejidad anatómica de la región, de particular difcultad. La escisióntotal del mesorecto constiuye hoy el standard en la patología rectal neoplásica con criterio de resecabildad.El mesorecto es una vaina celulovasculonerviosaperirectal donde no es tan simple durante el procedimiento quirúrgico individualizar los elementos, máximesi el paciente es obeso, con una estructura de máximogrosor en la cara posterior, lateral y prácticamente insignifcante en la cara anterior del recto.

Introduction: The mesorectum is the celularadiposetisue suroundig the rectum that contains the vascularelements of it. It is thicker at he posterior and side facesof the rectum. This is a genuine adipose bag suroundedby a thin fibrous cap, the visceral pelvic fascia or ectalfascia. Rectal cáncer pelvic disection consists of oursteps: the posterior disection, the lateral disection, theanterior disection, and the distal section of the rectum.Materials and Methods: Eight hemipelvis specimensfixed with 10% formalin were used. The mesorectumwas disected identifying the recto sacral fascia, notingthe sacral segment of its location. Measurements weretaken from the rim of the anus to the pouch of Douglas, tothe angle promontory, to the apex of the cocyx, and tothe top edge of the levator ani.Results: The average distance was 9.6 cm from the analrim to the pouch of Douglas, 5.7 cm from the anal rim tothe cocyx, 7 cm from the anal ridge to the top of theelevator, and 18 cm from the anal angle ridge to ridge.Discusion: surgeon responsibilty especialy knowledgeof the resection technique is its location, smalworkspace, and anatomical complexity of the region,particularly dificult.Total mesorectal excision is now thestandard in neoplastic rectal pathology criteria forresection. The mesorectum is a periectalcelulovasculonerviosa sheath where it is not so simplefor the surgical procedure identifes elements, especialyif the patient is obese, with a maximum thicknes ofstructure on the back, side and face almost negligible inthe front of the rectum.