Foramen escapular osificado en una muestra poblacional colombo-chilena / Ossified scapular foramen in a Colombian-Chilean population sample

RESUMEN: Ocasionalmente la incisura escapular puede ser reemplazada por un foramen óseo producto de la osificación del ligamento transverso superior de la escápula. Esta formación ósea se considera un factor precipitante de la compresión del nervio supraescapular. Ciento noventa y cinco escápulas de individuos adultos pertenecientes a osteotecas de universidades de Colombia (114 escápulas) y de Chile (81 escápulas), fueron estudiadas macroscópicamente para determinar la presencia de un foramen escapular óseo. Ambas escápulas de un mismo individuo colombiano (1,75 % del total) presentaban el foramen escapular y una escápula izquierda (1,23 %) presentaba esta formación en un individuo chileno. La prevalencia de la osificación del ligamento transverso superior de la escápula es muy variable en los distintos estudios y tiende a situarse inferior al 10 %, sin embargo, puede constituirse en un factor de riesgo debido al atrapamiento o compresión del nervio supraescapular, hecho conocido como neuropatía supraescapular.

SUMMARY: Occasionally the scapular notch can be replaced by a bony foramen product of the ossification of the superior transverse scapular ligament. This bone formation is considered a precipitating factor for compression of the suprascapular nerve. One hundred and ninety-five adult scapulae from Colombian (114 scapulae) and Chilean (81 scapulae) university osteotheques were studied macroscopically to determine the presence of a bony scapular foramen. Both scapulae of the same Colombian individual (1.75% of the total) presented the scapular foramen and one left scapula (1.23%) presented this formation in a Chilean individual. The prevalence of ossification of the superior transverse scapular ligament is highly variable in the different studies and tends to be less than 10%; however, it can become a risk factor due to entrapment or compression of the suprascapular nerve, a fact known as suprascapular neuropathy.

Comparison between two different experimental models of osteoarthritis in rabbits. Intra-articular collagenase injection and anterior cruciate ligament transection

ABSTRACT PURPOSE: To compare two different experimental models of osteoarthritis in rabbits: intra-articular collagenase injection and anterior cruciate ligament transection. METHODS: Ten adult rabbits were randomly divided in two groups: COLL (collagenase group) and ACLT (anterior cruciate ligament transection). The COLL group was treated with 0.5 ml collagenase solution (2mg collagenase/0.5 ml sterile PBS), and the ACTL group was subjected to anterior cruciate ligament. After six and twelve weeks, respectively, the animals in the COLL and ACTL groups were euthanized. The gross appearance and histological examinations conducted in the cartilage articular surface was blindly scored according to the criteria developed by Yoshimi et al. (1994) and Mankin et al. (1971), respectively. RESULTS: The gross morphologic observation, macroscopic score and histological examinations have demonstrated that the ACTL group presented the highest scores, and lesions more severe than those in the COLL group. CONCLUSIONS: Both methods, anterior cruciate ligament transection and collagenase, applied to the stifle joint of the rabbits have effectively induced degenerative changes in the cartilage tissue, through statistically significant analysis (p≤0.05). The ACTL method has presented more severe lesions.

Estudo da auditoria de contas em um hospital de ensino / Estudio de la auditoría de cuentas en un hospital de enseñanza / Study of billing audits in a teaching hospital

RESUMOObjetivos:verificar os itens componentes das contas hospitalares, conferidos por enfermeiros auditores, que mais recebem ajustes no momento da pré-análise; identificar o impacto dos ajustes no faturamento das contas analisadas por enfermeiros e médicos auditores e identificar as glosas relacionadas aos itens conferidos pela equipe de auditoria.Método:pesquisa quantitativa exploratória, descritiva, do tipo estudo de caso único.Resultados:após a análise de 2.613 contas constatou-se que o item mais incluído por enfermeiros foram gases (90,5%) e o mais excluído medicamentos de internação (41,2%). Materiais de hemodinâmica; gases e equipamentos foram os que mais impactaram nos ajustes positivos. Os ajustes negativos decorreram de lançamentos indevidos nas contas e não geraram prejuízos de faturamento. Do total de glosas 52,24% referiu-se à pré-análise dos enfermeiros e 47,76% a dos médicos.Conclusão:a presente investigação do processo de pré-análise fornece subsídios que contribuem para o avanço no conhecimento sobre a auditoria de contas hospitalares.

RESUMENObjetivos:comprobar los elementos que componen las cuentas del hospital, controladas por enfermeras auditores que reciben más ajustes en el momento de pre-análisis, identifi car el impacto de los ajustes a la facturación de las cuentas examinadas por las enfermeras y los médicos auditores; identifi car las glosas relacionadas con los puntos otorgados por equipo de auditoría.Método:estudio cuantitativo, exploratorio, descriptivo, tipo de investigación de caso único.Resultados:después de análisis de 2613 cuentas se encontró que el elemento más incluido por el enfermeros fue gas (90,5%) y lo más excluido fue hospitalización medicamentos (41,2%). Materiales de gases y equipos hemodinámicamente fueron los más afectados en los ajustes positivos. Los ajustes negativos fueron el resultado de errores en las cuentas y no generan pérdidas de ingresos. El rechazo total fue de 52,24% en relación a la pre-análisis de las enfermeras y de 47,76% de los médicos.Conclusión:esta investigación del proceso de preanálisis proporciona subsidios que contribuyen al avance de los conocimientos sobre la auditoría de las cuentas de los hospitales.

ABSTRACTObjectives:to determine which component items of hospital bills, examined by nurse auditors, were adjusted the most during pre-analysis; to identify the impact upon revenue caused by the adjustments to bills analyzed by physician and nurse auditors; and to identify disallowances related to items checked by the audit team.Method:quantitative, exploratory, descriptive, singlecase study.Results:after analysis of 2,613 bills, it was found that the item most included by nurses was gas (90.5%) and the most excluded was inpatient drugs (41.2%). Hemodynamics materials, gases and equipment had the greatest impact on upward adjustments. Downward adjustments were the result of improper entries on bills and did not generate revenue losses. Of total disallowances, 52.24% were related to the pre-analysis of nurses and 47.76% to that of physicians.Conclusion:this study of the pre-analysis process provides input that enhances knowledge about hospital bill audits.

Síndrome ligamento arcuato medio / Median arcuate ligament syndrome

Background: Median arcuate ligament syndrome (SLAM) is caused by extrinsic compression of the celiac artery by fibrous bands of this ligament and periaortic lymph node tissue. Case report: We report a 59 years old man with a history of weight loss, epigastric pain and a postprandial murmur. The syndrome was diagnosed by CT angiography. The patient was operated, performing a midline laparotomy and releasing the extrinsic compression. An early and sustained remission of symptoms was achieved.

Introducción: El síndrome del ligamento arcuato medio (SLAM), es causado por la compresión extrínseca del tronco celíaco por bandas fibrosas de este ligamento y tejido ganglionar periaórtico. Caso clínico: Reportamos el caso de un hombre de 59 años con historia de baja de peso, dolor postprandial y soplo epigástrico, al cual se le diagnostica SLAM por medio de angioTC. Se realiza abordaje quirúrgico, con laparotomía media y liberación de la compresión extrínseca, logrando remisión de los síntomas de forma inmediata y sostenida. El SLAM es una causa infrecuente de dolor abdominal, requiere estudio por imágenes para su diagnóstico, la resolución quirúrgica constituye su tratamiento.

Osificación del ligamento estilohioideo en 3028 radiografías panorámicas digitales / Ossification of the stylohyoid ligament in 3028 digital panoramic radiographs

La mayoría de los diagnósticos de procesos estiloides elongados y osificaciones de ligamentos estilohioideos corresponden a hallazgos en el análisis de radiografías panorámicas. En la presente investigación se evaluaron 3028 Radiografías Panorámicas digitales, tomadas entre Junio de 2009 y Junio de 2011. Se registraron las osificaciones de ligamento estilohiodeo de acuerdo a sexo, edad y bilateralidad. El análisis de datos se desarrolló con el Test estadistico Chi cuadrado, con un nivel de significancia estadística a< 0,05. En las imágenes evaluadas se encontró una prevalencia de osificaciones de un 8,42%, siendo más frecuentes en individuos de sexo femenino, osificaciones bilaterales y con patrón discontinuo. En cuanto a la edad se evaluó de acuerdo a grupos de edad menor o igual a 40 años y mayores de 40 años, encontrándose relación con la variable patrón de osificación. También se encontró relación entre las variables lateralidad y patrón de osificación. El presente estudio entrega información relevante para la odontología y la otorrinolaringología.

Most diagnoses of elongated styloid processes and ossification of stylohyoideus ligaments correspond to findings in the analysis of panoramic radiographs. In the present study we evaluated 3028 digital panoramic radiographs, taken between June 2009 and June 2011. Stylohyoideus ligament ossifications were recorded according to sex, age and bilaterality. Data analysis was carried out with the chi square test, with a statistical significance level a <0.05. In the images assessed we found a prevalence of 8.42% of ossifications, which was more frequent in female subjects, and bilateral ossification discontinuous pattern. In terms of age we evaluated according to age group less than or equal to 40 and older than 40 years, as related to the variable pattern of ossification. We also found relation between laterality variables and patterns of ossification. This study provides information relevant to dentistry and otolaryngology.

Biochemical evaluation of the supporting structure of pelvic organs in selected numbers of premenopausal and postmenopausal Malaysian women.

Context: Pelvic organ prolapse (POP) is associated with menopause and changes in the proteins of the pelvic supporting system, but there is scant data on the precise alterations in Malaysian women. Aim: The aim of this study is to determine the differences in the extracellular matrices (ECM) of uterosacral ligaments in premenopausal and postmenopausal Malaysian women with or without POP. Settings and Design: The observational study was conducted for 9 months in three general hospitals involving 30 women who underwent hysterectomies for various indications except for carcinoma of pelvic organs. Materials and Methods: Three groups were identified: Premenopausal women (Group 1), postmenopausal women without POP (Group 2), and postmenopausal women with POP (Group 3). Age, duration of menopause, body mass index (BMI), parity, and vaginal deliveries were documented. Only 21 samples of the uterosacral ligaments were stained immunohistochemically for collagen I and III, matrix metalloproteinases (MMPs) 1 and 2, elastin, and tenascin. Statistical Analysis Used: Image J software analysis was utilized for quantification, while non-parametric statistics (Kruskal-Wallis with post-hoc Dunns Multiple Comparison test) was used for result analysis. Results: The profile parameters were not significantly different except for mean age and duration of menopause in Group 3. Samples from Group 2 showed lower expression of almost all proteins except MMP1 and tenascin (higher) as compared to Group 1. The changes appeared to be exaggerated in Group 3, though statistically insignificant. Conclusion: A significant difference in the expression of ECM was apparent in postmenopausal subjects as compared to premenopausal ( P = 0.05), compromising the uterosacral ligament tensile strength. The findings are proven similar as those changes in women from other studies.

Magnetic Resonance Arthrographic Dissection of Posterolateral Corner of the Knee: Revealing the Meniscofibular Ligament

PURPOSE: To evaluate meniscofibular ligament (MFibL) at the posterolateral corner of the knee joint on the magnetic resonance arthrography (MRA) with 70degrees knee flexion. MATERIALS AND METHODS: The MRA of the knee joint was performed at 70degrees knee flexion. Eighteen patients (19 knee joints) underwent scanning of sagittal, coronal, and axial fat-suppressed T1 weighted images (T1FS), and coronal fat-suppressed T2 weighted images. Sagittal three-dimensional (3D) gradient echo (GRE) images were also obtained. Retrospective review of 19 knee MRA studies was independently performed by two musculoskeletal radiologists. The statistical significance was proved by chi-square test. RESULTS: The MFibL ligament was optimally demonstrated on the far lateral sagittal 3D GRE and T1FS MRA images. The MFibL appeared as a curvilinear or straight hypointense band of variable thickness, extended from the posterolateral meniscus to upper anteromedial aspect of the fibular head. The MFibL was demonstrated with scale 2 (more than a half length of the ligament) by both reviewers in 73.68% (n=14/19) of the knee 3D GRE images and 89.47% (n=17/19) of the knee T1FS images. The visualization on T1FS and that on GRE were not statistically different from each other (p>0.05). The interobserver agreements were significantly good on both 3D GRE and T1FS images in detecting the ligament (kappa values, 0.642 and 0.683, respectively). CONCLUSION: The MFibL is well visualized on the far lateral sagittal MRA at 70degrees knee flexion, which could potentially be useful in recognizing structures in the posterolateral corner of the knee, including the MFibL.

Composição da matriz extracelular do ligamento cardinal de mulheres na pós-menopausa com e sem prolapso uterino / Composition of extracellular matrix of the cardinal ligament in postmenopausal women with and without uterine prolapse

O prolapso uterino tem sua incidência aumentada na pós-menopausa. O objetivo deste estudo é identificar as alterações na matriz extracelular do ligamento cardinal associadas à menopausa e ao prolapso uterino. Ligamento cardinal de três diferentes grupos de mulheres, pré-menopausa, prolapso uterino e pós-menopausa, foram identificados e biopsiados durante 57 histerectomias abdominais ou vaginais. As amostras foram processadas por métodos bioquímicos para caracterização e quantificação de glicosaminoglicanos sulfatados e colágeno. As concentrações relativas de glicosaminoglicanos foram obtidas por eletroforese. Procedimentos histológicos foram feitos para identificar fibras elásticas (Weigert), distribuição de colágeno (Picro Sirius) e decorin (imunohistoquímica). Nossos resultados mostraram aumento na concentração de GAG de 72,2%, redução na concentração de colágeno de 37% e diminuição de 22% de fibras elásticas no grupo de prolapso uterino quando comparado ao grupo da pós-menopausa (p<0,05, p<0,04 e p<0,05 respectivamente). As concentrações relativas de glicosaminoglicanos sulfatados para condroitin sulfato, heparan sulfato e dermatan sulfato não mostraram diferenças entre os três grupos. A organização do colágeno foi similar entre os três grupos e a marcação do decorin pareceu estar diminuída no grupo de prolapso uterino. Nossos resultados indicam alterações no metabolismo do tecido conjuntivo. O ligamento cardinal da mulher na pós-menopausa possui uma matriz extracelular mais densa. Esta alteração não ocorre na mulher com prolapso uterino.

Uterine prolapse has increase of incidence after menopause. The aim of this study was to identify the changes in extracellular matrix of cardinal ligaments associated to menopause and uterine prolapse. Cardinal ligament of 3 different groups (pre-menopause, menopause and uterine prolapse) are identified and biopsied during 57 women's abdominal or vaginal hysterectomy. Biopsy specimens were assessed by biochemical methods to characterize and quantify sulfated glycosaminoglycans and collagen. Relative concentrations of GAG were obtained by electrophoresis. Histological procedures are made to identify elastic fibers (Weigert) collagen distribution (Picro sirius) and decorin (immunohistochemistry). Our results showed increase in GAG concentration 72.2% in uterine prolapse group compared to menopause group (p<0.05). Collagen concentration was 37% lower in uterine prolapse group compared to menopause group (p<0.04). Relative concentration of GAG: heparan sulfate, chondroitin sulfate and dermatan sulfate showed no differences among three groups. Elastic fibers showed a significant reduction of aproximately 22% uterine prolapse group compared to menopause group (p<0.05). Collagen organization was similar in three groups and the staining pattern of decorin seemed to be decreased in uterine prolapse group. Our results indicate changes in connective tissue metabolism. Cardinal ligament in postmenopausal women has a denser extracellular matrix. This change is not observed in women with uterine prolapse.

Falciform Ligament Abscess after Omphalitis: Report of a Case

A falciform ligament abscess is a rare type of intra-abdominal abscess. A 2-yr-old male, who had omphalitis two months previously, presented with a fever and right upper quadrant abdominal pain. The ultrasound and CT scan showed an abdominal wall abscess located anterior to the liver, which was refractory to conservative management with percutaneous draninage and antibiotics. On the third recurrence, surgical exploration was performed and revealed an abscess arising from the falciform ligament; the falciform ligament was excised. A follow up ultrasound confirmed complete resolution of the abscess with no further recurrence.

Perivascular Epithelioid Cell Tumor (PEComa) of Abdominal Cavity from Falciform Ligament: A Case Report

We present a case of perivascular epithelioid cell tumors (PEComas) in the abdominal cavity at the falciform ligament. A 30-yr-old Korean man visited to hospital for the evaluation of a growing, palpable abdominal mass. He had felt the mass growing over 6 months. There was no family or personal history of tuberous sclerosis. The resected specimen showed a mass of 8.0x7.0x5.5 cm in size. Histological examination showed sheets of spindle-to-epithelioid cells with clear-to-eosinophilic cytoplasm. Immunohistochemically, tumor cells were positive for HMB-4 (gp100) and smooth muscle actin. They were also positive for the S-100, which is a marker of neurogenic and melanocytic tumors. Patient was treated with radical resection of tumor without any adjuvant therapy. He is well and on follow-up visits without tumor recurrence.

A review on the celiac trunk compression syndrome: some anatomic clinical-surgical aspects / Una revisión del síndrome de compresión del tronco celíaco: algunos aspectos anatómicos clínicos-quirúrgicos

The objective of this study was to review some celiac trunk compression syndrome aspects such as: symptom-posture relationship; absence of symptoms; syndrome-age relationship; angiographic study on anatomy of the celiac trunk stenosis; congenital or acquired origin; invasive diagnostic tests; surgical and postoperative results.

El objetivo de este estudio fue hacer una revisión del síndrome de compresión del tronco celíaco, en cuanto a aspectos tales como: relación síntoma-postura; ausencia de síntomas; relación síndrome-edad; estudio angiográfico sobre la anatomía de la estenosis del tronco celíaco; origen congénito o adquirido; tests diagnósticos no invasivos; resultados quirúrgicos y post-quirúrgicos.

Síndrome de Eagle bilateral: reporte de un caso / Bilateral Eagle´s syndrome: a case report

El síndrome de Eagle se caracteriza por la elongación del proceso estiloides y/o la calcificación de los ligamentos presentes en él, los que provienen embriológicamente del cartílago del segundo arco faríngeo (Reichert). Esto produce dolor intenso en la región craneocervical y limitación de los movimientos cervicales. Generalmente es confundido con otras patologías, tales como disfunciones en la articulación témporomandibular. El diagnóstico de esta entidad es realizado a través de los correctos exámenes clínico y radiográfico. En este trabajo se reporto un caso y se hace una breve revisión de la literatura, mostrando la importancia del correcto diagnóstico de esta entidad y su sintomatología.

The Eagle's syndrome is characterized by the elongation of the styloid process and/or their ligaments calcification, which come embryologically from Reichert's cartilage or second branchial arch. This produces pain in thecraniocervical region and limitation of cervical movements. Generally is confused with other dysfunctions, such as temporomandibular joint dysfunction. The diagnosis of this entity is by the correct clinical and radiographic exam. In this work is done reporting a case and makes a brief review of the literature, showing the importance of this entity correct diagnosis and their symptoms.

Síndrome de Ernest: revisão da literatura / Ernest's syndrome: literature review

A Síndrome de Ernest, componente da dor orofacial, é caracterizada pela inflamação do ligamento estilomandibular. O exame radiogrßfico não é de grande ajuda no diagnóstico desta síndrome, porém alguns autores sugerem uma possível calcificação desse ligamento. Uma história adequada, a palpação da inserção do ligamento estilomandibular e um bloqueio anestésico local da inserção ligamentosa afetada são de grande utilidade na confirmação diagnóstica. O objetivo do presente estudo é realizar uma revisão de literatura sobre essa síndrome, com intuito de ampliar os conhecimentos a despeito de sua etiologia, sintomas, diagnóstico diferencial e tratamento. Pôde-se concluir que a Síndrome de Ernest apesar das semelhanças com outras condições ßlgicas orofaciais existem sintomas que podem diferenciß-las. Com relação ao uso do laser e de sua eficßcia terapêutica, sugere-se que este pode ser utilizado isoladamente ou como coadjuvante em tratamentos convencionais, principalmente pelas suas ações analgésicas, antiinflamatórias e como reparador tecidual.

Ossification of superior transverse scapular ligament and its clinical implications

The superior transverse scapular ligament [STSL] bridges the suprascapular notch, converting it into a suprascapular foramen. The suprascapular nerves and the vessels traverse through the suprascapular foramen of the scapula. Often the STSL is ossified to produce compression of the suprascapular nerves producing resultant symptoms. The entrapment of the suprascapular nerve by the ossified STSL may result in symptoms like pain in the shoulder region and also result in wasting and weakness of the supraspinatus and infraspinatus muscles. Such a condition has to be differentiated from other conditions like rotator cuff tears. Often asymptomatic cases make the diagnosis difficult. The present study reports the anomalous ossified STSL detected in a bone specimen, discusses its anatomical and radiological aspects and describes its clinical implications

cadaveric study of ossification of spinal ligaments

A Cadaveric study of ossification of spinal ligaments. A descriptive study. Place and duration of study' University College of Medicine and Dentistry, Fatima Jinnah Medical College Lahore, FMH College of Medicine and Dentistry, Lahore. The study lasted from January 2002 till March 2004. A cadaveric study was done on vertebral columns of 50 skeletons Skeletons were studied in anatomy departments of different medical colleges. Each vertebral column was observed for any ligamentous ossification, and frequency of ossification of spinal ligaments was noted. Result: It was seen that in 2% of cadaveric skeletons spinal ligaments were ossified. This ossification was observed in thoracic and lumbar regions. Although ossification of spinal ligaments is a rare occurrence: by correlating this cadaveric study with some of the clinical studies the possibility of ossified spinal ligaments should he considered in evaluation of back pain, dysasthesia, urinary hesitancy, myelopathy, dysphagia and dyspnoea

Eagle's syndrome: review of literature and case report.

Eagle's Syndrome is caused by an elongated styloid process of the temporal bone or by ossification of the derivations of the second branchial arch. It is a source of craniofacial and cervical pain. Although the incidence of styloid process elongation is fairly common, only a small percentage of the patients exhibit symptoms associated with Eagle's syndrome. Like any other pain in the head and neck region it is an enigma. Eagle's syndrome is one of the glaring examples where the exact etiology eludes from the treating doctor for a long. It is important for the dental practitioner to be aware of this anomaly and its anatomic basis. Unilateral symptoms were present in one case of bilateral elongation.

Age related changes in the elastic fiber system of the interfoveolar ligament

In order to evaluate age related changes of the elastic fiber system in the interfoveolar ligament, we studied the deep inguinal ring from 33 male cadavers aged from stillborn to 76 years. Selective and alternated staining methods for elastic fibers were performed to differentiate oxytalan, elaunin, and mature elastic fibers. We confirmed quantitative changes of the elastic fiber system with aging. There was a significant and progressive reduction of the oxytalan fibers (responsible for tissue resistance) and a significant increment in the mature elastic and elaunin fibers (responsible for tissue elasticity). Furthermore, there were structural changes in the thickness, shortness and curling of these mature elastic fibers. These changes induced loss of the elastic fiber function and loss of the interfoveolar ligament compliance. These factors predispose individuals to the development of indirect inguinal hernias that frequently emerge in adults and aged individuals, especially above the fifth decade