Muscle thickness of the pectoralis major and rectus abdominis and level of physical activity in chronic hemodialysis patients / Espessura muscular do pectoralis major e do rectus abdominis e nível de atividade física em pacientes em hemodiálise crônica

Abstract Introduction: Patients on chronic hemodialysis tend to lose lean body mass and have sedentary behavior. Objective: To compare the level of physical activity and the morphology of the muscles pectoralis major and rectus abdominis of patients on hemodialysis with healthy subjects. Methods: We studied 17 patients and 17 healthy individuals. Muscle thickness were evaluated by ultrasound, and the level of physical activity by the International Physical Activity Questionnaire (IPAQ), long version. Results: The patients had lower thicknesses of the pectoralis major (5.92 ± 0.35 mm vs. 8.35 ± 0.62 mm, p < 0.001) and rectus abdominis (0.96 ± 0.10 mm vs. 2 21 ± 0.40 mm, p < 0.001) compared to healthy subjects. Patients were physically less active than healthy individuals: 1502.55(788.19-2513.00) MET-minutes/week vs. 2268.0(1680.0-4490,8) MET-minutes/week (p = 0.006); the weekly caloric expenditure of patients was also lower: 1384.0(480,7-2253.7) kcal/kg/week vs. 1680.0(1677.4-4950.0) kcal/kg/week (p = 0.010). The average time spent sitting per week of the patients was higher than in healthy subjects (394.0 ± 33.1 min/day vs. 293.0 ± 38.6, p = 0.009) as well as the average time spent sitting during weekend (460.0 ± 40.1 vs. 201.0 ± 10.7, p = 0.003). Conclusion: Chronic renal failure patients on hemodialysis have sedentary behavior and lower muscle thickness of the trunk.

Resumo Introdução: Pacientes que realizam hemodiálise crônica tendem a perder massa magra e ter comportamento sedentário. Objetivo: Comparar o nível de atividade física e morfologia dos músculos peitoral maior e reto do abdômen de pacientes que realizam hemodiálise com indivíduos saudáveis. Métodos: Foram estudados 17 pacientes e 17 indivíduos saudáveis. As espessuras musculares foram avaliadas por meio de ultrassonografia, e o nível de atividade física pelo Questionário Internacional de Atividade Física versão longa (IPAQ). Resultados: Os pacientes apresentaram menores espessuras do peitoral maior (5,92 ± 0,35 mm vs. 8,35 ± 0,62 mm, p < 0,001) e de reto abdominal (0,96 ± 0,10 mm vs. 2,21 ± 0,40 mm, p < 0,001) comparados aos sujeitos saudáveis. Os pacientes foram fisicamente menos ativos que os indivíduos saudáveis: 1502.55(788.19-2513.00) MET-minutos/semana vs. 2268.0(1680.0-4490,8) MET-minutos/semana (p = 0,006); o gasto calórico semanal dos pacientes também foi menor: 1384,0(480,7-2253.7) kcal/kg/semana vs. 1680,0(1677,4-4950,0) kcal/kg/semana (p = 0,010). O tempo médio gasto sentado por semana dos pacientes foi maior que dos sujeitos saudáveis (394,0 ± 33,1 min/dia vs. 293,0 ± 38,6, p = 0,009), assim como o tempo médio gasto sentado durante o fim de semana (460,0 ± 40,1 vs. 201,0 ± 10,7, p = 0,003). Conclusão: Pacientes renais crônicos em hemodiálise apresentam comportamento sedentário e menores espessuras musculares do tronco.

Clinical Implications caused by the agenesis of the RectusAbdominal Muscle’s (MRA) inferior venter

The rectus abdominal muscle is part of the anterior abdominal wall, having three to six bellies. In only oneof the 106 dissections already made in the “Faculdade de Ciências Médicas de Minas Gerais” AnatomyLaboratory was found a male cadaver who did not have inferior venter of this muscle bilaterally. Instead, at theleft side, was found a tendon that measured 5.5 cm laterally and 12 cm medially, and at the right side, therewas the same variation with a 15.5 cm length tendon, rising in the upper branch of the pubis and crest pubis.Despite being a rare variation, individuals who have showed it have increased potential for physiological andsurgical complications, in case they need interventions using inferior rectus abdominis muscle venter’s snips.

Variations in the pattern of formation of the abdominis rectus muscle sheath among Kenyans / Variaciones en el patrón de formación de la vaina del músculo recto abdominal en kenianos

The pattern of formation of the human rectus sheath exhibits variations, it is not clear if these variations are population specific. This study aimed at describing the pattern of formation of the rectus sheath in a select Kenyan population. Formation of the rectus sheath was analyzed in eighty subjects (47 male, 33 female) during autopsies and cadaveric dissection. The anterior wall of the rectus sheath in all cases was aponeurotic and firmly attached to rectus abdominis muscle. The posterior wall of the rectus sheath was aponeurotic in 71 (88.5 percent) cases, the rest were musculoaponeurotic and only seen in males. In all cases the aponeurosis of internal oblique abdominis split into two lamina; a deep lamina that fused with the aponeurosis of transverses abdominis at the lateral border of rectus abdominis and a superficial lamina that fused with aponeurosis of external oblique abdominis mid-way between the medial and lateral borders of rectus abdominis muscle. The pattern of formation of the rectus sheath among Kenyans shows some variations which have not been reported by previous workers. Knowledge of these variations is important in surgery as this sheath is always incised when making most aabdominal incisions.

El patrón de formación de la vaina del músculo recto abdominal humano muestra variaciones, no está claro si estas variaciones son población-específicas. Este estudio tiene como objetivo describir el patrón de formación de la vaina del músculo recto del abdomen en una población seleccionada de Kenia. La formación de la vaina del músculo recto del abdomen se analizó en 80 sujetos (47 hombres, 33 mujeres) durante autopsias y disección de cadáveres. La pared anterior de la vaina del músculo recto en todos los casos era aponeurótica y firmemente unida al músculo recto abdominal. La pared posterior de la vaina del músculo recto era aponeurótica en 71 (88,5 por ciento) casos, las paredes restantes eran musculoaponeuróticas y sólo se observaron en varones. En todos los casos, la aponeurosis del músculo oblicuo interno del abdomen se dividió en dos láminas, una lámina profunda que se fusionaba con la aponeurosis del músculo transverso del abdomen en el borde lateral del músculo recto del abdomen y una lámina superficial que se fusionaba con la aponeurosis del músculo oblicuo externo del abdomen a mitad del recorrido entre los bordes medial y lateral del músculo recto del abdomen. El patrón de formación de la vaina del músculo recto del abdomen, entre los kenianos muestra algunas variaciones que no han sido reportadas en trabajos anteriores. El conocimiento de estas variaciones es importante en cirugía ya que esta vaina es seccionada en abordajes abdominales.

Effect of Swimming Training on the Rectus Abdominis Muscle of rats: Morphological and Histochemical Aspects / Efecto de la Natación Sobre el Músculo Recto del Abdomen de la Rata: Aspectos Morfológicos e Histoquímicos

We investigated the effect of swimming training in rats on morphological characteristics, hypertrophy levels and metabolic and contractile adaptations of different fiber types in rat the rectus abdominis muscle. Rats were randoverly assigned to one of three groups (N = 5 each): a) swimming training for 1 h, twice a week (2x/w), b) 1 h five times a week (5x/w) for 9 consecutive weeks, or c) without any swimming training (Control). Body weight increased in 2x/w rats and decreased in the 5x/w ones. Muscle fiber diameters increased in both trained groups, with higher values in the 2x/w group. Aerobic exercise increased slow oxidative (SO) + fast-oxidative-glycolytic (FOG) fibers and decreased fast glycolytic (FG) fibers. In addition, SO fibers were increased and FOG + FG fibers were decreased in trained rats. Small and angulated atrophic fibers were also observed. These results corroborate that swimming exercise increases aerobic metabolism and thus oxidative and low contraction fibers. However, the used protocol induced, to a variable degree, changes in the muscle fiber morphology.

Se estudió el efecto de la natación en las características morfológicas, niveles de hipertrofia y las adaptaciones metabólicas y contráctiles de diferentes tipos de fibras en el músculo recto del abdomen de ratas. Las ratas fueron asignadas en tres grupos (N = 5 cada uno): a) natación por 1 hora dos veces a la semana (2x/s), b) 1 hora, cinco veces por semana (5x/s) por nueve semanas consecutivas y c) sin natación (control). El peso corporal se incrementó en las ratas 2x/s y disminuyó en 5x/s. El diámetro de las fibras musculares aumentó en ambos grupos entrenados, con mayores valores en las ratas 2x/s. El ejercicio aeróbico incrementó las fibras de oxidación lenta (OL) + las fibras de glicólisis oxidativa rápida (GOR) y disminuyeron las fibras de glicólisis rápida (GR). Además, las fibras OL aumentaron y las fibras GOR y GR disminuyeron en las ratas entrenadas. Se observó una pequeña atrofia y deshidratación de las fibras. Estos resultados corroboran que la práctica de la natación incrementa el metabolismo aeróbico, las fibras de contracción lenta y la oxidación. Sin embargo, el protocolo utilizado induce cambios en grado variable en la morfología de las fibras musculares.

Tensile strength of the posterior and anterior layer of the rectus abdominis muscle sheath in cadavers

PURPOSE: The aim of the present study was to assess, in cadavers, the resistance to medial traction of the posterior and anterior layer of the rectus abdominis muscle sheath. METHODS: An anatomical, prospective, self-controlled study was carried out in 20 male cadavers. An evaluation of the tension of the posterior and anterior layers of the rectus abdominis muscle sheath was performed following anatomical dissection of these structures. The traction necessary to advance the tissue ten millimeters was assessed using an analogic dynamometer. RESULTS: There was no significant statistical difference between the necessary traction at various levels of the anterior and posterior layers of the rectus sheath. However, medial advancement of the anterior layer of the rectus sheath required more traction strength than did advancement of the posterior layer to the midline. CONCLUSION: There is no difference in the tensile strength in the various levels of the anterior and posterior layers of the rectus sheath; however, medial advancement of the the anterior layer required more traction strength.

OBJETIVO: Comparar a resistência à tração medial das lâminas posterior e anterior da bainha do músculo reto do abdome em diferentes níveis supra e infra-umbilicais em cadáveres. MÉTODOS: Vinte cadáveres adultos foram submetidos à dissecção da parede abdominal anterior. Foram feitas alças com fio de náilon no plano aponeurótico em oito pontos diferentes na lâmina anterior e na lâmina posterior da bainha do músculo reto do abdome, sendo quatro destes pontos supra-umbilicais e quatro infra-umbilicais. Com o uso de um dinamômetro analógico, foi verificada a força necessária para o avanço medial de dez milímetros destes dezesseis pontos. RESULTADOS: Não foram encontradas diferenças significantes de medidas da resistência à tração entre os diferentes níveis da aponeurose anterior e posterior, mas quando se comparou as medidas obtidas na aponeurose anterior às obtidas na posterior verificou-se que a aponeurose anterior necessitou de maior força de tração para o avanço medial. CONCLUSÃO: Não há diferença de tensão ao longo da aponeurose anterior e posterior. A aponeurose anterior é mais resistente à tração medial quando comparada à posterior.

Tensile strength of the posterior and anterior layer of the rectus abdominis muscle sheath in cadavers / Tensão das bainhas anterior e posterior do músculo reto do abdome em cadáveres

PURPOSE: The aim of the present study was to assess, in cadavers, the resistance to medial traction of the posterior and anterior layer of the rectus abdominis muscle sheath. METHODS: An anatomical, prospective, self-controlled study was carried out in 20 male cadavers. An evaluation of the tension of the posterior and anterior layers of the rectus abdominis muscle sheath was performed following anatomical dissection of these structures. The traction necessary to advance the tissue ten millimeters was assessed using an analogic dynamometer. RESULTS: There was no significant statistical difference between the necessary traction at various levels of the anterior and posterior layers of the rectus sheath. However, medial advancement of the anterior layer of the rectus sheath required more traction strength than did advancement of the posterior layer to the midline. CONCLUSION: There is no difference in the tensile strength in the various levels of the anterior and posterior layers of the rectus sheath; however, medial advancement of the the anterior layer required more traction strength.

OBJETIVO: Comparar a resistência à tração medial das lâminas posterior e anterior da bainha do músculo reto do abdome em diferentes níveis supra e infra-umbilicais em cadáveres. MÉTODOS: Vinte cadáveres adultos foram submetidos à dissecção da parede abdominal anterior. Foram feitas alças com fio de náilon no plano aponeurótico em oito pontos diferentes na lâmina anterior e na lâmina posterior da bainha do músculo reto do abdome, sendo quatro destes pontos supra-umbilicais e quatro infra-umbilicais. Com o uso de um dinamômetro analógico, foi verificada a força necessária para o avanço medial de dez milímetros destes dezesseis pontos. RESULTADOS: Não foram encontradas diferenças significantes de medidas da resistência à tração entre os diferentes níveis da aponeurose anterior e posterior, mas quando se comparou as medidas obtidas na aponeurose anterior às obtidas na posterior verificou-se que a aponeurose anterior necessitou de maior força de tração para o avanço medial. CONCLUSÃO: Não há diferença de tensão ao longo da aponeurose anterior e posterior. A aponeurose anterior é mais resistente à tração medial quando comparada à posterior.

Morfologia e morfometria dos tipos de fibras do músculo reto abdominal de cadelas (Canis familiaris) durante a gestação / Morphologic and morphometry of rectus abdominis muscle fiber types of the during the gestation dog (Canis familioris)

Neste trabalho foram avaliadas as alterações morfológicas e o grau de hipertrofia das fibras de contração lentas (tipo I) e rápidas (tipo II) do músculo reto abdominal de cadelas adultas nas fases: pré-gestacional, 30 e 60 dias de gestação e 30 dias pós-parto (pp). Em todas essas fases, sob anestesia, foram removidas biópsias musculares, as quais foram congeladas. Cortes histológicos foram obtidos em um micrótomo e corados com hematoxilina e eosina (HE) para a avaliação da morfologia. Outros cortes foram submetidos à ATPase miofibrilar (m-ATPase), após pré-incubação em meio alcalino (pH = 10,4) e em meio ácido (pH = 4,4), visando à identificação das fibras tipo I e II. Nas cadelas virgens, o tecido muscular revelou-se constituído por fibras com diferentes diâmetros, com contornos poligonais, tendo um ou mais núcleos periféricos. Estas características foram similares nos animais com 30 dias de gestação. Aos 60 dias, ao lado de fibras com aparência normal, observaram-se fibras com contornos mais polimórficos e outras fibras de diâmetros muito pequenos. Aos 30 dias pp, as características do tecido foram similares às dos animais em fase pré-gestacional. Em todas as fases estudadas, os diâmetros fibras tipo II foram maiores do que as do tipo I. Aos 30 dias observou-se a redução significativa dos diâmetros de ambos os tipos de fibras e aumento significativo aos 60 dias de gestação. Durante a gestação, o estímulo crônico, representado pela expansão da parede abdominal, promoveu alterações da morfologia e morfometria das fibras.

The present paper deals with the evaluation of morphological and morphometric alterations of slow-twist (I) and fast-twitch (II) fibers of rectus abdominis muscle of adult female dog during pre-gestational phase, at 30 and 60 days of pregnancy and at 30 days after the porturition. At the every phases, using the open biopsy technique, muscle samples were collected. The samples were plunged. Histological sections were cut in a microtome. For general morphology, some sections were stained with HE. Subsequent sections were reacted for myofibrillor ATPase (m-ATPase), after alkaline (pH 10.4) and acid (pH 4.4) pre-incubations, in order to identificate type I and II fibers. In the pre-gestational phase, muscle tissue revealed to be composed by fibers with different diameters, presenting polygonal outlines and one or more periphery nuclei. At 30 days of pregnancy, muscle fiber characteristics were similar. At 60 days, in addition to the existence of normal fibers, polymorphic and small diameter fibers were frequent. At 30 days after the parturation, the morphology of muscle fiber were similar to that observed in the pre-gestational phase. In the four phases, type II fiber diameters were lager than type I. The diameters of both fiber types showed a significant reduction in the 30 days phase and a significative increasing at 60 days. The expansion of the abdominal wall during the pregnancy represents a chronic stimulus, induced changes in the morphology and in the fiber type diameters.

Clinical importance of unusual patterns of tendinous intersections of rectus abdominis muscle.

The objective of the present study was to note the different patterns of tendinous intersections of rectus abdominis muscle and its surgical importance. The tendinous intersections of rectus abdominis muscle were studied in dissected 46 human cadavers dissected over a span of 3 years. Only two unusual patterns of intersections; one with tendinous intersections arched, and the other with the intersections at different levels on the right and left sides of the same cadaver, were observed, in two different cadavers. The tendinous intersections are the sites of anastomosis of numerous blood vessels. Surgeons using the the Transverse Rectus Abdominis (TRAM) flap in autogenous breast constructive surgeries should be aware of such unusual patterns so as to design the TRAM flap accordingly. Biomechanics of rectus abdominis muscle may also be influenced by arched pattern of tendinous intersections instead of normal transverse pattern.

new method for the repair of Medicine and paramedian incisional herniasa Rectus Repair

Forty four patients with large and difficult mid-line and paramedian incisional hernias were included in. this study; 31 were females [70.5%] and 13 were males [29.5%]. Their ages ranged from 35 to 72 years with mean age .42.5 Twenty eight [64%] patients had infraumbilical incisional hernias, and 16 patients [36%] had supraumblical [cat incisional hernias. This study is a trial to restore the normal anatomy of mid line. Anterior rectus sheath, both recti muscles in close contact to each other, posterior rectus sheath, and peritoneum. This is by utilizing two incisions, one is made in anterior rectus sheath cm or more from the edge of the defect, completely encircle the defect, another two relaxing incisions are made in lateral part of external oblique aponeurosis. So it was called a "Rectus Repair". All patients underwent the rectus repair. Hospital stay ranged from 12 to 21 days.Early postoperative complications were minor as chest infection, seroma, wound infection. serous discharge, wound gaping, and sinus formation, all were conservatively controlled. Follow-up for 1 to 3 years with no detectable recurrence. Rectus repair provides anatomical reconstruction of abdominal wall in layers without tension on the suture lines