Level VI lymph nodes: an anatomic study of lymph nodes located between the recurrent laryngeal nerve and the right common carotid artery. / Linfonodos do nível VI: estudo anatômico dos linfonodos localizados entre o nervo laríngeo recorrente e a artéria carótida comum direita.

OBJECTIVE: to describe the presence of lymph nodes and their relationships with demographic and anthropometric characteristics in a specific region, not yet described in anatomy compendiums, called by us Recurrent Carotid Recess (RCR) and located among the right recurrent laryngeal nerve, the right common carotid artery, and the right inferior thyroid artery. METHODS: 32 right cervical regions were harvested from cadavers within 24 hours post-mortem. The fibro-fatty tissue of the RCR was resected and prepared with formalin fixation. It was then subjected to an increasing sequence of alcohols (70%, 80%, and 90%), subsequently to a solution of Xylol, and finally to a solution of Methyl Salicylate, respecting the time required for each step. The macroscopic study was carried out on the diaphanized piece, observing the presence or not of lymph nodes. When present, they were photographed and their measurements were gauged with a digital caliper. In the microscopic study, hematoxylin-eosin staining was used to confirm the lymph node. RESULTS: the presence of lymph nodes was observed in 22 (68.75%) of the 32 specimens. The number of lymph nodes ranged from zero to six (mean of 1.56±0.29), per cadaver, and their mean size was 7.82mmx3.86mm (longitudinal x transversal diameters). CONCLUSION: the relationship between anthropometric data and presence of lymph nodes in the RCR (Fisher's exact test) was significant for medium-height individuals (p=0.03) and also white ones (p=0.04).

OBJETIVO: descrever a presença de linfonodos e suas relações com características demográficas e antropométricas em uma região específica ainda não descrita pelos compêndios de anatomia, por nós denominada de Recesso Carotídeo Recorrencial (RCR), localizada entre o nervo laríngeo recorrente direito, a artéria carótida comum direita e a artéria tireoidea inferior direita. MÉTODOS: foram dissecadas 32 regiões cervicais à direita de cadáveres com até 24 horas de post mortem. O tecido fibrogorduroso do RCR foi ressecado e preparado com fixação em formol. Em seguida, foi submetido a uma sequência crescente de álcoois (70%, 80% e 90%), posteriormente a uma solução de Xilol e, por fim, a uma solução de Salicilato de Metila, respeitando o tempo necessário de cada etapa. O estudo macroscópico foi realizado na peça diafanizada, observando a presença ou não de linfonodos. Quando presentes, foram fotografados e suas medidas foram aferidas com um paquímetro digital. No estudo microscópico, foi utilizada a coloração hematoxilina-eosina para confirmação do linfonodo. RESULTADOS: observou-se a presença de linfonodos em 22 dos 32 espécimes (68,75%), com o número de linfonodos por cadáver variando de zero a seis (média de 1,56±0,29) e tamanho com média de 7,82mmx3,86mm (diâmetros longitudinal x transversal). CONCLUSÃO: a relação entre dados antropométricos e presença de linfonodos no RCR (teste exato de Fischer) foi significante para indivíduos normolíneos (p=0,03) e também significante entre a etnia branca (p=0,04).

Pectoralis major myocutaneous flap in Head And Neck Surgery reconstructions: critical analysis.

OBJECTIVE: to evaluate the results of the use of the pectoralis major flap in the reconstruction of head and neck surgeries. METHODS: we conducted a retrospective study with data bank analysis and review of medical records of patients with head and neck cancer operated at the Discipline of Head and Neck Surgery, Surgery Department, São Paulo Holy Home of Mercy, using the pectoralis major flap for reconstruction, in a period of 16 years. We analyzed age, gender, primary site of neoplasia, clinical staging, preoperative radiotherapy (RT) and complications, classified as major and minor. RESULTS: the series comprised 92 patients, of whom 86 (93.5%) were men; the mean age was 61.39 (±11.35) years; the most common primary sites were the mouth, in 35 cases (38%), oropharynx, in 21 (22.8%), and larynx, in 18 cases (19.6%). The majority of patients were in stage IV (88/92, 95.6%) and only four (4.3%) had preoperative RT. The overall complication rate was 48.9%, but only 6.5%, characterized as major complications. In the univariate statistical analysis, we found no factors related to the occurrence of complications. Only the primary neoplasm site presented marginal significance (p = 0.06). CONCLUSION: the pectoralis major flap is safe, with few complete and effective losses in reconstructions in head and neck surgeries, with low rates of major complications, being an option to be considered.

Aneurysm of the Fibular Vein: A Case Report.

BACKGROUND: Aneurysms of the deep veins of the lower limbs are rare and often asymptomatic. Although natural history is unclear, these aneurysms have been associated with deep venous thrombosis and fatal pulmonary embolism events. To our knowledge, this case represents the fifth patient with isolated aneurysm of a calf vein described in the literature and the second one affecting the fibular vein. METHODS: We report the case of a 20-year-old white man with an aneurysm of the fibular vein that we believe is the second case in the literature RESULTS: After evaluation and diagnosis, the aneurysm was resected with full recovery of the patient. CONCLUSIONS: Treatment of this unusual condition seems to be mandatory for major thromboembolic events can be as high as 71% with 2 deaths, according to a review of 24 patients with popliteal vein aneurysms. Unlike proximal veins, where reconstruction is advisable, calf vein aneurysms can be safely managed by simple excision and ligature. In our patient, aneurysm resection eliminated symptoms, and good result was maintained in long follow-up.

Linfonodos do nível VI: estudo anatômico dos linfonodos localizados entre o nervo laríngeo recorrente e a artéria carótida comum direita / Level VI lymph nodes: an anatomic study of lymph nodes located between the recurrent laryngeal nerve and the right common carotid artery

RESUMO Objetivo: descrever a presença de linfonodos e suas relações com características demográficas e antropométricas em uma região específica ainda não descrita pelos compêndios de anatomia, por nós denominada de Recesso Carotídeo Recorrencial (RCR), localizada entre o nervo laríngeo recorrente direito, a artéria carótida comum direita e a artéria tireoidea inferior direita. Métodos: foram dissecadas 32 regiões cervicais à direita de cadáveres com até 24 horas de post mortem. O tecido fibrogorduroso do RCR foi ressecado e preparado com fixação em formol. Em seguida, foi submetido a uma sequência crescente de álcoois (70%, 80% e 90%), posteriormente a uma solução de Xilol e, por fim, a uma solução de Salicilato de Metila, respeitando o tempo necessário de cada etapa. O estudo macroscópico foi realizado na peça diafanizada, observando a presença ou não de linfonodos. Quando presentes, foram fotografados e suas medidas foram aferidas com um paquímetro digital. No estudo microscópico, foi utilizada a coloração hematoxilina-eosina para confirmação do linfonodo. Resultados: observou-se a presença de linfonodos em 22 dos 32 espécimes (68,75%), com o número de linfonodos por cadáver variando de zero a seis (média de 1,56±0,29) e tamanho com média de 7,82mmx3,86mm (diâmetros longitudinal x transversal). Conclusão: a relação entre dados antropométricos e presença de linfonodos no RCR (teste exato de Fischer) foi significante para indivíduos normolíneos (p=0,03) e também significante entre a etnia branca (p=0,04).

ABSTRACT Objective: to describe the presence of lymph nodes and their relationships with demographic and anthropometric characteristics in a specific region, not yet described in anatomy compendiums, called by us Recurrent Carotid Recess (RCR) and located among the right recurrent laryngeal nerve, the right common carotid artery, and the right inferior thyroid artery. Methods: 32 right cervical regions were harvested from cadavers within 24 hours post-mortem. The fibro-fatty tissue of the RCR was resected and prepared with formalin fixation. It was then subjected to an increasing sequence of alcohols (70%, 80%, and 90%), subsequently to a solution of Xylol, and finally to a solution of Methyl Salicylate, respecting the time required for each step. The macroscopic study was carried out on the diaphanized piece, observing the presence or not of lymph nodes. When present, they were photographed and their measurements were gauged with a digital caliper. In the microscopic study, hematoxylin-eosin staining was used to confirm the lymph node. Results: the presence of lymph nodes was observed in 22 (68.75%) of the 32 specimens. The number of lymph nodes ranged from zero to six (mean of 1.56±0.29), per cadaver, and their mean size was 7.82mmx3.86mm (longitudinal x transversal diameters). Conclusion: the relationship between anthropometric data and presence of lymph nodes in the RCR (Fisher's exact test) was significant for medium-height individuals (p=0.03) and also white ones (p=0.04).

Pectoralis major myocutaneous flap in Head And Neck Surgery reconstructions: critical analysis / O retalho do músculo peitoral maior nas reconstruções em Cirurgia de Cabeça e Pescoço: análise crítica

ABSTRACT Objective: to evaluate the results of the use of the pectoralis major flap in the reconstruction of head and neck surgeries. Methods: we conducted a retrospective study with data bank analysis and review of medical records of patients with head and neck cancer operated at the Discipline of Head and Neck Surgery, Surgery Department, São Paulo Holy Home of Mercy, using the pectoralis major flap for reconstruction, in a period of 16 years. We analyzed age, gender, primary site of neoplasia, clinical staging, preoperative radiotherapy (RT) and complications, classified as major and minor. Results: the series comprised 92 patients, of whom 86 (93.5%) were men; the mean age was 61.39 (±11.35) years; the most common primary sites were the mouth, in 35 cases (38%), oropharynx, in 21 (22.8%), and larynx, in 18 cases (19.6%). The majority of patients were in stage IV (88/92, 95.6%) and only four (4.3%) had preoperative RT. The overall complication rate was 48.9%, but only 6.5%, characterized as major complications. In the univariate statistical analysis, we found no factors related to the occurrence of complications. Only the primary neoplasm site presented marginal significance (p = 0.06). Conclusion: the pectoralis major flap is safe, with few complete and effective losses in reconstructions in head and neck surgeries, with low rates of major complications, being an option to be considered.

RESUMO Objetivo: avaliar os resultados do uso do retalho de músculo peitoral maior nas reconstruções de cirurgias de cabeça e pescoço. Métodos: estudo retrospectivo com análise de banco dados e revisão de prontuários de pacientes com câncer de cabeça e pescoço operados na Disciplina de Cirurgia de Cabeça e Pescoço do Departamento de Cirurgia da Santa Casa de São Paulo em um período de 16 anos, utilizando-se o retalho de músculo peitoral maior para reconstrução. Foram analisados idade, sexo, sítio primário da neoplasia, estadiamento clínico, radioterapia (RT) pré-operatória e as complicações encontradas, classificadas em maiores e menores. Resultados: a casuística foi de 92 pacientes, dos quais 86 (93,5%) eram homens; a média de idade foi de 61,39 (dp±11,35) anos; os sítios primários mais acometidos foram boca em 35 casos (38%); orofaringe em 21 casos (22,8%) e laringe em 18 casos (19,6%). A maioria dos pacientes encontrava-se no estádio IV (88/92; 95,6%) e apenas quatro (4,3%) tinham realizado a RT pré-operatória. A taxa global de complicações foi de 48,9%, mas apenas 6,5% caracterizadas como complicações maiores. Na análise estatística univariada, não foram encontrados fatores relacionados à ocorrência das complicações. Apenas o sítio primário da neoplasia apresentou significância marginal (p=0,06). Conclusão: o retalho de músculo peitoral maior é seguro, com poucas perdas completas e eficaz nas reconstruções em cirurgias de cabeça e pescoço, com baixas taxas de complicações maiores, sendo uma opção a ser considerada.

Prospective study of the neurotopographic adequacy of transverse incision in Lichtenstein inguinal hernioplasty.

Lichtenstein technique requires identification of the iliohypogastric, ilioinguinal, and genital branch of the genitofemoral nerves.The aim of the study was to verify if the transverse incision is suitable for identification of the iliohypogastric, ilioinguinal, and genital branch of the genitofemoral nerves.This study included 29 patients who underwent hernioplasty, and also 10 dissections of the inguinal regions from 5 cadavers. The anthropometric measurements included: incision size (IS) and topography, pubic angle (PA), body mass index (BMI), and the distance from the pubis to the incision and bi-iliac crest plane. The correlations between variables of interest and the ability to identify the nerves were assessed.Measures of height (P = 0.108), BMI (P = 0.343), and abdominal circumference (AbC) (P = 1.000); the correlations between incision IS and PA (r = -0.17, P = 0.406), IS and BMI (r = 0.56, P = 0.002), IS and AbC (r = 0.56, P = 0.002); incision and pubic heights (r = -0.26, P = 0.174); patient height and PA (r = -0.33, P = 0.092). The associations between these measures were: BMI (P = 0.136), AbC (P = 0.104), PA (P = 0.641), and IS (P = 0.399). The rates of successful nerve identification in patients and corpse were: iliohypogastric-29 (29)/9 (10), 100% (P = 0.147); ilioinguinal-29 (29)/10 (10), 100%; and genital branch of the genitofemoral nerve-26 (29)/9 (10), 89.7/80% (P = 0.488).The transverse incision permitted identification of the nerves for Lichtenstein hernioplasty.