Anatomical Study of the Relationship between the Riché-Cannieu Anastomosis and the Kaplan Cardinal Line / Estudo anatômico da relação entre a anastomose de Riché-Cannieu e a linha cardinal de Kaplan

Abstract Objective To identify the location of the Riché-Cannieu anastomosis (RCA) in relation to the Cardinal Kaplan Line (KCL) and the Y line. Methods A total of 20 hands of 10 recently-deceased adult male cadavers aged between 27 and 66 years were dissected for the investigation of the relationship of the most distal point of the RCA with the KCL and with the Y line, drawn from the axis of the third metacarpal head, following the longitudinal axis of the hand. Results In 20 limbs, the most distal point of the nerve communication was positioned distally in relation to the KCL. The Y line was positioned on the radial side in relation to the most distal point of the RCA in 14 limbs, and it was positioned on the ulnar side in relation to the Y line in 6 limbs. The crossing between the KCL and the Y line occurred proximal to the RCA in 18 limbs; in 1 hand, it was positioned distal to the intersection between these lines; and in another hand, the KCL was positioned exactly on the RCA. Conclusion Knowledge of these anatomical relationships can prevent damage to nerve branches and thus also prevent paralysis of intrinsic muscles in surgical procedures in the palm of the hand.

Resumo Objetivo Identificar a localização da anastomose de Riché-Cannieu (ARC) em relação à linha cardinal de Kaplan (LCK) e à linha Y. Métodos Ao todo, 20 mãos de 10 cadáveres adultos do sexo masculino com idades entre 27 e 66 anos, recentemente falecidos, foram dissecadas para a investigação da relação do ponto mais distal da ARC com a LCK e a linha Y traçada a partir do eixo da cabeça do terceiro metacarpo seguindo o eixo longitudinal da mão. Resultados Nos 20 membros, o ponto mais distal da comunicação nervosa era distal à LCK. A linha Y estava no lado radial em relação ao ponto mais distal da ARC em 14 membros, e no lado ulnar em relação à linha Y em 6 membros. O cruzamento entre a LCK e a linha Y foi proximal à ARC em 18 membros; em 1 mão, era distal à intersecção entre essas linhas e, em outra mão, a LCK estava exatamente na ARC. Conclusão O conhecimento dessas relações anatômicas pode prevenir danos aos ramos nervosos e, assim, também prevenir a paralisia dos músculos intrínsecos em procedimentos cirúrgicos na palma da mão.

Remobilization with whole-body vibration improves functionality, histomorphometric parameters, and AQP1 expression in the soleus muscle of Wistar rats.

Background: Whole-body vibration (WBV) is used to enhance physical performance in sports and rehabilitation. The present study analyzed the effects of remobilization with WBV on the soleus muscle of Wistar rats. Methods: Twenty-eight animals were separated into four experimental groups (n = 7): CON (control); IM (immobilized); FR (immobilization and free remobilization); and WBV (immobilization and remobilization with WBV). The immobilization of the pelvic limb was carried out according to the standard protocol using a plaster cast for 15 days. For remobilization with WBV, a Frequency of 60 Hz was applied for 10 min, five days a week, for two weeks. After the remobilization period, the animals were euthanized, and the right soleus muscle was dissected followed by processing for histomorphometric analysis and immunolocalization of Aquaporin 1 (AQP1). Results: We observed a reduced larger diameter in IM compared to CON, with restored values in WBV. For the estimation of connective tissue, a significant increase was observed in the immobilized groups, while a reduction was noted in the remobilized groups. AQP1 expression decreased significantly in IM and increased in WBV. Conclusion: Immobilization caused morphofunctional damage to the soleus muscle, and remobilization with WBV is efficient and offers advantages over free remobilization.

Anatomical Study of the Relationship between the Riché-Cannieu Anastomosis and the Kaplan Cardinal Line.

Objective To identify the location of the Riché-Cannieu anastomosis (RCA) in relation to the Cardinal Kaplan Line (KCL) and the Y line. Methods A total of 20 hands of 10 recently-deceased adult male cadavers aged between 27 and 66 years were dissected for the investigation of the relationship of the most distal point of the RCA with the KCL and with the Y line, drawn from the axis of the third metacarpal head, following the longitudinal axis of the hand. Results In 20 limbs, the most distal point of the nerve communication was positioned distally in relation to the KCL. The Y line was positioned on the radial side in relation to the most distal point of the RCA in 14 limbs, and it was positioned on the ulnar side in relation to the Y line in 6 limbs. The crossing between the KCL and the Y line occurred proximal to the RCA in 18 limbs; in 1 hand, it was positioned distal to the intersection between these lines; and in another hand, the KCL was positioned exactly on the RCA. Conclusion Knowledge of these anatomical relationships can prevent damage to nerve branches and thus also prevent paralysis of intrinsic muscles in surgical procedures in the palm of the hand.

Description of the lateral fibulotalocalcaneal ligament in fetal specimens and its potential clinical implications.

PURPOSE: The increase in ankle sprains in children is a reflection of the greater inclusion of this population in sports. This places the calcaneofibular (CFL) and the anterior talofibular (ATFL) ligaments in focus for study. In adults, the presence of arcuate fibers extending between these two ligaments suggests the existence of a new anatomical and functional complex called the lateral fibulotalocalcaneal ligament of the ankle (LFTCL), which can be associated with the persistence of instability of the talocrural joint in ankle sprains. This study aimed to verify the presence of arciform fibers between the CFL and ATFL in human fetuses and to study the topography of the lateral ankle region. METHODS: Forty matched fetal ankles aged between 28 and 38 weeks, fixed in 4% formalin, were macroscopically, chemically and mesoscopically dissected and analyzed in stereoscope. RESULTS: The ATFL was characterized as a capsular ligament consisting of two fascicles (proximal and distal). The CFL was characterized as an extracapsular ligament. The LFTCL complex was verified in all specimens, characterized by the arcuate fibers between the ATFL and the CFL. CONCLUSION: Such results suggest that this functional unit is congenital and that it should be taken into consideration in the treatment of persistent ankle instabilities in the pediatric population.

Investigación anatómica del ápex cardíaco / Anatomical investigation of the cardiac ápex

RESUMEN Objetivo: Comprender la anatomía cardíaca es la clave para resolver incógnitas sobre su función. La estructura miocárdica continua y helicoidal desempeña un papel fundamental en los movimientos de torsión-detorsión. El ápex, parte constitutiva del ventrículo, ¿tiene relevancia en la dinámica cardíaca o es simplemente un fondo de saco? El objetivo del presente trabajo fue responder este interrogante. Material y métodos: Se utilizaron para los estudios anátomo-histológicos cuatro corazones de bovinos jóvenes y cuatro corazones humanos (dos embriones y dos adultos). Para esta investigación se realizaron dos procedimientos: a) desplegamiento del miocardio continuo para observar la disposición de las fibras en la punta del ventrículo izquierdo, denominada zona apexiana; b) cortes horizontales y longitudinales para estudiar la estructura del ápex. Los primeros se realizaron entre los 2/3 medio y apexiano, y los longitudinales seccionando la punta ventricular izquierda con una orientación ápex-base. Resultados: Hemos encontrado en todos los corazones humanos y bovinos estudiados que el ápex corresponde únicamente al ventrículo izquierdo, en donde se ubica el giro del segmento descendente en la continuidad ascendente del miocardio continuo. El fondo de saco apexiano no posee prácticamente plano muscular en su extremo final. Está tapizado por dentro por el endocardio y por fuera por el epicardio. El plano muscular es apenas un 10% en espesor del miocardio contiguo. La transiluminación reafirma este concepto estructural. Conclusiones: El ápex es un fondo de saco prácticamente sin músculo, en el que el endocardio y el epicardio se hallan adosados, pero que cumple funciones del soporte de las presiones intraventriculares y es parte constitutiva de los movimientos de torsión y detorsión.

ABSTRACT Objective: Understanding cardiac anatomy is the key to solve unknown issues about its function. The continuous and helical myocardial structure plays a fundamental role in its torsion-detorsion motions. Does the apex, a constitutive part of the ventricle, have relevance in cardiac dynamics or is it simply a cul-de-sac? The aim of this study was to answer this question. Methods: Four young bovine and four human hearts (two embryos and two adults) were used for the anatomo-histological studies. Two procedures were carried out for this investigation: a) the continuous myocardium unfolding to observe the fiber arrangement at the tip of the left ventricle, called the apical zone; and b) horizontal and longitudinal sections to study the structure of the apex. The horizontal sections were performed between the middle 2/3 and the apex, and the longitudinal ones, sectioning left ventricular apex, with an apex-base orientation. Results: In all the human and bovine hearts studied we found that the apex corresponds only to the left ventricle, where the twist of the descending segment is located, in the ascending continuity of the myocardium. The apical cul-de-sac has practically no muscular plane at its end. It is internally lined by the endocardium and externally by the epicardium. The muscular plane has only 10% thickness of the adjacent myocardium, a structural concept confirmed by transillumination. Conclusions: The apex is a cul-de-sac practically devoid of muscle, in which the endocardium and epicardium are attached, but which performs the functions of supporting intraventricular pressures and being a constitutive part of the torsion and detorsion motions.

Repensando el proceso de enseñanza-aprendizaje de la morfología en el mundo post-pandemia / Rethinking the teaching-learning process of morphology in the post-pandemic world

Las ciencias morfológicas incluyen el estudio de tres disciplinas que analizan el cuerpo humano: la anatomía macroscópica, la histología y la embriología, las cuales forman parte central del ciclo básico en todas las carreras de la salud. El aprendizaje morfológico ocurre en el laboratorio y se basa en el estudio de disecciones cadavéricas, preparaciones histológicas o muestras del desarrollo embrionario, con el propósito de lograr una adecuada compresión de las características morfoestructurales del cuerpo humano. Sin embargo, la pandemia por SARS-CoV-2 significó un cambio profundo en la forma de enseñar, incorporando métodos de enseñanza-aprendizaje utilizados du-rante la pandemia que incluyen estrategias como los microscopios virtuales, atlas interactivos o videos de disecciones, lo que ha llevado a algunos a cuestionar la necesidad de utilizar los laboratorios de morfología. La educación virtual ha aparecido como una alternativa factible de mantener post-pandemia, sin embargo, el paso por el laboratorio es irreemplazable en la formación de profesionales de la salud, permitiendo el desarrollo de otras competencias más allá de la aplicación del conocimiento. La morfología seguirá siendo la piedra angular en la formación de profesionales de la salud. El desafío es como a través de la innovación y la creatividad incorporamos las nuevas tecnologías digitales, agregando un nuevo valor al estudio de esta disciplina.

Morphological sciences include the study of three disciplines that analyze the human body: macroscopic anatomy, histology, and embr-yology, which are a central part of the basic cycle in all health careers. Morphological learning occurs in the laboratory, it is based on the study of cadaveric dissections, histological preparations, or samples of embryonic development to achieve an adequate compression of the morphological structure of the human body. The SARS-CoV-2 pandemic meant a profound change in the way of teaching. These, teaching-learning methods that have been implemented during the pandemic include virtual microscopes, interactive atlases, or videos of dissections, which has led some teachers to question the usefulness of morphology laboratories. Virtual education has appeared as a feasible alternative to maintaining in post-pandemic; however, going through the laboratory is irreplaceable in the training of health professionals, allowing the development of other skills beyond the application of knowledge. The morphology will continue to be the cornerstone in the education of health professionals. The challenge is how through innovation and creativity, we incorporate new digital technologies, adding a new value to the study of this discipline

Could Glyphosate and Glyphosate-Based Herbicides Be Associated With Increased Thyroid Diseases Worldwide?

The increased incidence of thyroid diseases raises a series of questions about what the main predisposing factors are nowadays. If dietary restriction of iodine was once a major global health concern, today, the processes of industrialization of food and high exposure to a wide variety of environmental chemicals may be affecting, directly or indirectly, thyroid function. The homeostasis of hypothalamus-pituitary-thyroid (HPT) axis is finely regulated through the negative feedback mechanism exerted by thyroid hormones. Allostatic mechanisms are triggered to adjust the physiology of HPT axis in chronic conditions. Glyphosate and glyphosate-based herbicides are pesticides with controversial endocrine disrupting activities and only few studies have approached their effects on HPT axis and thyroid function. However, glyphosate has an electrophilic and nucleophilic zwitterion chemical structure that may affect the mechanisms involved in iodide oxidation and organification, as well as the oxidative phosphorylation in the ATP synthesis. Thus, in this review, we aimed to: (1) discuss the critical points in the regulation of HPT axis and thyroid hormones levels balance, which may be susceptible to the toxic action of glyphosate and glyphosate-based herbicides, correlating the molecular mechanisms involved in glyphosate toxicity described in the literature that may, directly or indirectly, be associated to the higher incidence of thyroid diseases; and (2) present the literature regarding glyphosate toxicity in HPT axis.

Características clínicas, demográficas e histopatológicas de pacientes postoperados de cáncer colorrectal internados en el Servicio de Coloproctología del Hospital Nacional, Itauguá ­ Paraguay: periodo 2015 y 2018 / Clinical, demographic and histopathological characteristics of postoperative colorectal cancer patients admitted to Servicio de Coloproctología at the Hospital Nacional, Itauguá - Paraguay: period 2015 and 2018

RESUMEN Introducción: el cáncer colorrectal se desarrolla a partir de lesiones precursoras a nivel del colon, recto y ano, siendo responsable del 16,9 % de todas las muertes por cáncer y en los hombres es la tercera neoplasia maligna más común a nivel mundial. Objetivo: caracterizar a los pacientes postoperados de cáncer colorrectal del Servicio de Coloproctología del Hospital Nacional, Itauguá ­ Paraguay en el periodo entre 2015 y 2018. Metodología: estudio observacional descriptivo, retrospectivo de corte transversal. Se utilizaron fichas de pacientes postoperados de cáncer colorrectal del Servicio de Coloproctología del Hospital Nacional, Itauguá ­ Paraguay en el periodo entre 2015 y 2018. Resultados: del total de las 26 fichas de pacientes revisadas, el 70 % fue de sexo masculino y el rango etario más común fue entre 60 - 71 años (52 %); el tipo histológico de cáncer más frecuente fue el adenocarcinoma moderadamente diferenciado 78 %, el estadio más común fue adenocarcinoma de tipo II A (clasificación de la American Joint Committe on Cancer (AJCC-TNM) 65 %, presentó metástasis a distancia 3,81 % y la ubicación de cáncer más frecuente fue el recto 34,78 %. El motivo de consulta más frecuente fue hemorragia 70 %, la complicación más común fue la dehiscencia y no hubo óbitos. Conclusión: el mayor porcentaje de pacientes pertenece al sexo masculino y al grupo etario de mayores a 60 años, fue frecuente el adenocarcinoma moderadamente diferenciado y el estadio más común de tipo II A, la ubicación más frecuente fue el recto y motivo de consulta fue hemorragia (rectorragia)., por lo cual se deberían implementar medidas para la prevención de esta patología.

ABSTRACT Introduction: colorectal cancer develops from precursor lesions in the colon, rectum and anus, being responsible for 16,9 % of all deaths from cancer and in men it is the third most common malignant neoplasm worldwide. Objective: to characterize postoperative colorectal cancer patients of the Coloproctology Service of the Hospital Nacional, Itauguá - Paraguay in the period between 2015 and 2018. Methodology: descriptive, retrospective, cross-sectional observational study. Cards of postoperative colorectal cancer patients from the Coloproctology Service of the Hospital Nacional, Itauguá - Paraguay in the period between 2015 and 2018 were used. Results: of the total of the 26 patient files reviewed, 70 % were male and the most common age range was between 60 - 71 years (52 %); the most frequent histological type of cancer was moderately differentiated adenocarcinoma 78 %, the most common stage was adenocarcinoma type II A (classification of the American Joint Committee on Cancer (AJCC-TNM) 65 %, present distant metastases 3,81 % and the most frequent location of cancer was the rectum 34,78 % .The most frequent reason for consultation was hemorrhage 70 %, the most common complication was dehiscence and there were no deaths. Conclusion: the highest percentage of patients belongs to the male sex and to the age group over 60 years old, moderately differentiated adenocarcinoma was frequent and the most common stage was type II A, the most frequent location was the rectum and the reason for consultation was hemorrhage (rectorrhagia), for which measures must be implemented to prevent this pathology.

Methodological considerations for a model of endodontic treatment in Wistar rats / Consideraciones metodológicas para el modelo de tratamiento endodóntico en ratas Wistar

ABSTRACT The use of correctly designed animal models is a fundamental step prior to clinical trials in humans. Although rats are easy to house and handle, and have molars that resemble those of humans, very few researchers use them as a model for root canal treatment, probably due to their small size and the lack of relevant data necessary to reproduce the model. Our aims were to describe the anatomic and histologic characteristics of the mandibular first molar of the Wistar rat and present a standardised model for its experimental endodontic treatment. Twenty female rats were used. The characteristics of the mesial and distal roots were described histologically and the quality of the results achieved following the treatment protocol presented herein was assessed by means of digital radiographs, micro-CT and histological sections. The age of 55 days was found to be the most adequate for performing this technique, but we consider the interval of 50 to 60 days to be suitable. Both canals are oval, although in opposite planes, and the furcating-facing walls present the minimum dentine thickness. It was essential to become familiar with these aspects in order to decide upon the most appropriate instrumentation and obturation techniques that would enable replication of this model in basic science research.

RESUMEN El uso de modelos animales correctamente diseñados es un paso fundamental previo al desarrollo de ensayos clínicos en humanos. A pesar de resultar fáciles de criar y manipular y de poseer molares que se asemejan a los humanos, muy pocos grupos utilizan a la rata como modelo experimental para el tratamiento endodóntico probablemente debido a su pequeño tamaño y a la escasa información disponible para poder aplicar los modelos existentes. Nuestros objetivos fueron describir las características anatómicas e histológicas del primer molar inferior de la rata Wistar y presentar un modelo estandarizado para el tratamiento endodóntico experimental de esta pieza. Se utilizaron 20 ratas hembra. Las características de las raíces mesial y distal fueron descritas histológicamente y los resultados obtenidos fueron evaluados mediante radiografías digitales, microCTy cortes histológicos. La edad de 55 días demostró ser la más adecuada para ejecutar la técnica, pero consideramos que el intervalo de 50 a 60 días puede resultar apropiado. Se observó que ambos canales presentan una morfología oval, aunque en direcciones opuestas, y que las paredes furcales resultaron ser las que presentan el menor espesor de dentina. Familiarizarse con estos aspectos de la anatomía e histología del molar de la rata resultó fundamental para decidir sobre las técnicas de preparación y obturación más apropiadas que permitieran la replicación de este modelo en el campo de las ciencias básicas.

Methodological considerations for a model of endodontic treatment in Wistar rats.

The use of correctly designed animal models is a fundamental step prior to clinical trials in humans. Although rats are easy to house and handle, and have molars that resemble those of humans, very few researchers use them as a model for root canal treatment, probably due to their small size and the lack of relevant data necessary to reproduce the model. Our aims were to describe the anatomic and histologic characteristics of the mandibular first molar of the Wistar rat and present a standardised model for its experimental endodontic treatment. Twenty female rats were used. The characteristics of the mesial and distal roots were described histologically and the quality of the results achieved following the treatment protocol presented herein was assessed by means of digital radiographs, micro- CT and histological sections. The age of 55 days was found to be the most adequate for performing this technique, but we consider the interval of 50 to 60 days to be suitable. Both canals are oval, although in opposite planes, and the furcating-facing walls present the minimum dentine thickness. It was essential to become familiar with these aspects in order to decide upon the most appropriate instrumentation and obturation techniques that would enable replication of this model in basic science research.

Este estudo in vitro teve objetivo de avaliar o efeito de protocolos clareadores sobre a rugosidade de superfície (Ra), alteração de cor e micromorfologia de resina bulk-fill de baixa viscosidade (Filtek Bulk Fill Flow, 3M ESPE), alta viscosidade (Filtek Bulk Fill, 3M ESPE) e de uma resina composta nanoparticulada (controle) (Filtek Z350 XT, 3M ESPE). Quarenta amostras de cada resin composta (discos de 5 mm de diâmetro e 2 mm de espessura) foram aleatoriamente divididas em quatro grupos , de acordo com protocolo clareador (n=10): a) Gel de peróxido de carbamida (Opalescence, Ultradent Products) (2 horas/dia, por 14 dias); b) Gel de peróxido de hidrogênio (Opalescence Boost, Ultradent Products) (3 sessões de clareamento, uma por semana, 45 min/sessão); enxaguatório clareador (Listerine Whitening Extreme, Johnson & Johnson) (2 min/dia, por 14 dias); d) água destilada (controle). As amostras foram submetidas a leituras, em triplicata (Ra e cor (parâmetros CIELab) antes e depois do contato com os protocolos clareadores. A micromorfologia de superfície foi conduzida em microscópio eletrônico de varredura (MEV). Ra e parâmetros de cor (ΔL, Δa, Δb e ΔE) foram analisados por modelos lineares generalizados (α=0.05). A Ra da resina bulk-fill de alta viscosidade foi significantemente superior do que para os outros compósitos (p<0.05). A Ra aumentou significantemente (p<0.05) e a superfície ficou mais irregular (MEV) para todos os compósitos, independente do protocolo clareador (p<0,05). A resina bulk-fill de alta viscosidade obteve menor ΔE (p<0.05) do que a resina composta nanoparticulada, imersa em água destilada. Pode-se concluir que as características de cada resina composta influenciaram de forma mais significativa a Ra do que o protocolo clareador. A resina bulk fill de alta viscosidade apresentou menor alteração de cor.

Isolation and characterization of stem cells derived by human dental pulp from harvest based in rotary and manual techniques used in endodontic therapy / Isolamento e caracterização de células tronco da polpa dentária humana obtidas em instrumentação mecanizada e manual durante tratamento endodôntico

Objective: The aim of this study was to evaluate the impact on the isolation and characterization of stem cells from pulp tissues obtained through rotary instrumentation techniques compared to the manual technique. Material and Methods: Thirty permanent teeth were included, 15 of which were instrumented with rotational technique (Protaper SX) and other 15 with manual technique. Cells obtained were characterized by flow cytometry and proliferation was evaluated by the MTT assay. The plasticity was evaluated for adipogenic, osteogenic and odontogenic differentiations. Results: Cells isolated from the pulp of permanent teeth, by manual techniques, presented fibroblast morphology and were able to differentiate successfully. All lineages expressed CD29, CD73, CD90, CD105, CD146, CD166 and were negative for CD31, CD34 and CD45. MTT assay showing significantly increased proliferation of hDPSCs in 5 and 7 days of the culture. Conclusions: The present study demonstrated that manual instrumentation technique is one of the best candidates to harvest dental pulp tissue as the dental stem cell source due to ability effective expanded with less tissue invasion. The technique of rotational instrumentation proved to be very harmful to the tissues of the dental pulp, and we can't obtain cells using this technique. (AU)

Objetivo: O objetivo deste estudo foi avaliar o impacto no isolamento e caracterização de células-tronco de tecidos pulpares obtidos por meio de técnicas de instrumentação rotatória em comparação à técnica manual. Material e Métodos: Trinta dentes permanentes foram incluídos, 15 dos quais foram instrumentados com técnica mecanizada (Protaper SX) e outros 15 com técnica manual. As células obtidas foram caracterizadas por citometria de fluxo e a proliferação foi avaliada pelo ensaio MTT. A plasticidade foi avaliada quanto às diferenciações adipogênica, osteogênica e odontogênica. Resultados: células isoladas da polpa de dentes permanentes, por técnicas manuais, apresentaram morfologia de fibroblastos e foram capazes de se diferenciar com sucesso. Todas as linhagens expressaram CD29, CD73, CD90, CD105, CD146, CD166 e foram negativas para CD31, CD34 e CD45. O teste de MTT mostrou proliferação significativamente aumentada de hDPSCs em 5 e 7 dias da cultura. Conclusões: O presente estudo demonstrou que a técnica de instrumentação manual é um dos melhores candidatos para a colheita de tecido pulpar como fonte de células tronco dentárias devido à boa capacidade de proliferação celular com menor invasão tecidual. A técnica de instrumentação rotatória provou ser muito prejudicial para os tecidos da polpa dentária, e não possibilitou obter células. (AU)

Partial congenital absence of the pericardium: a case report

Abstract The complete or the partial absence of pericardium is a rare congenital malformation for which the patients are commonly asymptomatic and the diagnosis is incidental. The absence of the left side of the pericardium is the most common anomaly that is reported in the literature while the complete absence of pericardium or the absence of the right side of the pericardium are uncommon and their criteria are still unrecognized given their rare occurrence in clinical practice. This paper aims to report a case of 19-year-old male with the congenital partial absence of both sides of the pericardium and to highlight the symptoms and the different cardiac imaging modalities used to confirm the diagnosis of this defect.

Partial Congenital Absence of The Pericardium: A Case Report.

The complete or the partial absence of pericardium is a rare congenital malformation for which the patients are commonly asymptomatic and the diagnosis is incidental. The absence of the left side of the pericardium is the most common anomaly that is reported in the literature while the complete absence of pericardium or the absence of the right side of the pericardium are uncommon and their criteria are still unrecognized given their rare occurrence in clinical practice. This paper aims to report a case of 19-year-old male with the congenital partial absence of both sides of the pericardium and to highlight the symptoms and the different cardiac imaging modalities used to confirm the diagnosis of this defect.

MEDIAL FEMORAL CONDYLE CORTICOPERIOSTEAL FLAP: ANATOMIC STUDY.

OBJECTIVE: The medial femoral condyle corticoperiosteal flap is irrigated by the descending genicular artery, and when this is absent, by the superior medial genicular artery. The descending genicular artery divides into the muscular, saphenous, and osteoarticular branches. The objective of this study was to describe the variables involved in the dissection of the medial femoral condyle flap. METHODS: Thirty thighs from 20 cadavers were dissected and the following variables were recorded: age, height, weight, thigh length, presence of the descending genicular artery, whether the saphenous branch originated from the descending genicular artery, the length of the branches originating from the descending genicular artery, and the diameter of the descending genicular artery and the vena comitans. RESULTS: The descending genicular artery was present in 93.3% of the specimens (28/30). The saphenous branch originated from this artery in 76.7% of the dissections (23/70). The mean distance between the origin of the descending genicular artery and the knee joint was 13.4 cm (±Ù¡.4), the mean length of the descending genicular artery was 7.5 cm (±1.5), the mean diameter of the descending genicular artery was 1.9 mm (±Ù .3), and the mean diameter of the vena comitans was 1.7 mm (±Ù .3). CONCLUSION: The vascularized medial femoral condyle is a versatile option for reconstruction of musculoskeletal injuries. It allows transference of bone associated with muscle and skin, which are each nourished by independent branches. Level of Evidence IV; Case series.

OBJETIVO: O retalho ósseo vascularizado do côndilo femoral medial deve sua irrigação à artéria genicular descendente e, na ausência desta, à artéria genicular superior medial. A artéria genicular descendente comumente ramifica-se em: ramo muscular, safeno e osteoarticular. O estudo teve por objetivo analisar as variáveis relativas à dissecção do retalho ósseo do côndilo femoral medial. MÉTODOS: Foram dissecados 30 joelhos (20 cadáveres), registrando-se: idade; estatura; peso; comprimento da coxa; presença da artéria genicular descendente; se o ramo safeno tem origem na artéria genicular descendente; comprimento dos ramos da artéria genicular descendente e os diâmetros da artéria genicular descendente e veia comitante. RESULTADOS: A artéria genicular descendente esteve presente em 93,3% dos espécimes (28/30). O ramo safeno originou-se da artéria genicular descendente em 76,7% das dissecções (23/70). Distância entre origem da artéria genicular descendente e interlinha articular = 13,4 (±1,4) cm, comprimento da artéria genicular descendente = 7,5 (±1,5) cm, diâmetro da artéria genicular descendente = 1,9 (±0,3) mm, diâmetro da veia comitante = 1,7 (±0,3) mm. CONCLUSÃO: O retalho ósseo vascularizado do côndilo femoral medial mostrou-se a opção versátil para reconstrução de lesões do sistema músculo-esquelético. Permite a elevação de retalho ósseo associado à pele e tecido muscular, cada qual nutrido por ramos independentes. Nível de Evidência IV; Série de casos.

Medial femoral condyle corticoperiosteal flap: anatomic study / Retalho corticoperiosteal do côndilo femoral medial: estudo anatômico

ABSTRACT Objective The medial femoral condyle corticoperiosteal flap is irrigated by the descending genicular artery, and when this is absent, by the superior medial genicular artery. The descending genicular artery divides into the muscular, saphenous, and osteoarticular branches. The objective of this study was to describe the variables involved in the dissection of the medial femoral condyle flap. Methods Thirty thighs from 20 cadavers were dissected and the following variables were recorded: age, height, weight, thigh length, presence of the descending genicular artery, whether the saphenous branch originated from the descending genicular artery, the length of the branches originating from the descending genicular artery, and the diameter of the descending genicular artery and the vena comitans. Results The descending genicular artery was present in 93.3% of the specimens (28/30). The saphenous branch originated from this artery in 76.7% of the dissections (23/70). The mean distance between the origin of the descending genicular artery and the knee joint was 13.4 cm (±١.4), the mean length of the descending genicular artery was 7.5 cm (±1.5), the mean diameter of the descending genicular artery was 1.9 mm (±٠.3), and the mean diameter of the vena comitans was 1.7 mm (±٠.3). Conclusion The vascularized medial femoral condyle is a versatile option for reconstruction of musculoskeletal injuries. It allows transference of bone associated with muscle and skin, which are each nourished by independent branches. Level of Evidence IV; Case series.

RESUMO Objetivo O retalho ósseo vascularizado do côndilo femoral medial deve sua irrigação à artéria genicular descendente e, na ausência desta, à artéria genicular superior medial. A artéria genicular descendente comumente ramifica-se em: ramo muscular, safeno e osteoarticular. O estudo teve por objetivo analisar as variáveis relativas à dissecção do retalho ósseo do côndilo femoral medial. Métodos Foram dissecados 30 joelhos (20 cadáveres), registrando-se: idade; estatura; peso; comprimento da coxa; presença da artéria genicular descendente; se o ramo safeno tem origem na artéria genicular descendente; comprimento dos ramos da artéria genicular descendente e os diâmetros da artéria genicular descendente e veia comitante. Resultados A artéria genicular descendente esteve presente em 93,3% dos espécimes (28/30). O ramo safeno originou-se da artéria genicular descendente em 76,7% das dissecções (23/70). Distância entre origem da artéria genicular descendente e interlinha articular = 13,4 (±1,4) cm, comprimento da artéria genicular descendente = 7,5 (±1,5) cm, diâmetro da artéria genicular descendente = 1,9 (±0,3) mm, diâmetro da veia comitante = 1,7 (±0,3) mm. Conclusão O retalho ósseo vascularizado do côndilo femoral medial mostrou-se a opção versátil para reconstrução de lesões do sistema músculo-esquelético. Permite a elevação de retalho ósseo associado à pele e tecido muscular, cada qual nutrido por ramos independentes. Nível de Evidência IV; Série de casos.

Renal artery in tufted capuchin monkey: structure and morphometry / Artéria renal do macaco prego: estrutura e morfometria

The objective was to describe the structure of the renal artery in capuchin monkey at the level of the proximal and distal arterial segments. Morphometric analysis was performed referring to the thickness and quantification of tissue elements of the renal artery tunica media in both segments. Renal arteries of eight adult capuchin monkeys were collected for histological analysis of the two segments, being the proximal part branched from the abdominal aorta, and the distal part localized next to the renal hilus. The quantification of smooth muscle cells and connective elements was carried out in transversal sections of the two segments; for the tunica media, it was used the volume densities of smooth muscle cells, collagen and elastic fibers. Considering these volume densities obtained for each segment, it was verified that the proximal segment showed a marked myoconnective architecture, while the distal segment was characterized by a single muscular artery. Apparently, the mixed architecture of the proximal segment could be related to a blood flow control at the aortic emergence of the renal artery, which helped to guarantee a priority flow of enriched plasma into the kidney parenchyma.

O objetivo foi descrever a estrutura da artéria renal no macaco prego ao nível dos segmentos arteriais proximal e distal. Uma análise morfométrica foi realizada, tendo como parâmetros a espessura e a quantificação dos elementos constituintes da túnica média da parede vascular, nos dois segmentos. Foram coletadas as artérias renais de oito macacos pregos adultos para estudos histológicos dos dois segmentos, sendo o segmento proximal a parte originária da aorta abdominal e o segmento distal a parte arterial junto ao hilo renal. A quantificação de células musculares lisas e de elementos conjuntivos da matriz extracelular foi realizada em secções transversais dos dois segmentos, sendo empregadas para a túnica média as densidades de volumes (DV), dos componentes musculares e das fibras elásticas e colágenas. Tendo por base estas densidades de volumes obtidas para cada segmento arterial verificou-se que o segmento proximal apresentou estrutura mioconjuntiva marcante, enquanto que o segmento distal foi caracterizado como uma artéria muscular padrão. Aparentemente, a arquitetura mista do segmento proximal estaria relacionada com o controle de fluxo sanguíneo na emergência aórtica da artéria renal, garantindo um direcionamento prioritário de fluxo de plasma sanguíneo enriquecido para dentro do parênquima renal.

Renal artery in tufted capuchin monkey: structure and morphometry / Artéria renal do macaco prego: estrutura e morfometria

The objective was to describe the structure of the renal artery in capuchin monkey at the level of the proximal and distal arterial segments. Morphometric analysis was performed referring to the thickness and quantification of tissue elements of the renal artery tunica media in both segments. Renal arteries of eight adult capuchin monkeys were collected for histological analysis of the two segments, being the proximal part branched from the abdominal aorta, and the distal part localized next to the renal hilus. The quantification of smooth muscle cells and connective elements was carried out in transversal sections of the two segments; for the tunica media, it was used the volume densities of smooth muscle cells, collagen and elastic fibers. Considering these volume densities obtained for each segment, it was verified that the proximal segment showed a marked myoconnective architecture, while the distal segment was characterized by a single muscular artery. Apparently, the mixed architecture of the proximal segment could be related to a blood flow control at the aortic emergence of the renal artery, which helped to guarantee a priority flow of enriched plasma into the kidney parenchyma.(AU)

O objetivo foi descrever a estrutura da artéria renal no macaco prego ao nível dos segmentos arteriais proximal e distal. Uma análise morfométrica foi realizada, tendo como parâmetros a espessura e a quantificação dos elementos constituintes da túnica média da parede vascular, nos dois segmentos. Foram coletadas as artérias renais de oito macacos pregos adultos para estudos histológicos dos dois segmentos, sendo o segmento proximal a parte originária da aorta abdominal e o segmento distal a parte arterial junto ao hilo renal. A quantificação de células musculares lisas e de elementos conjuntivos da matriz extracelular foi realizada em secções transversais dos dois segmentos, sendo empregadas para a túnica média as densidades de volumes (DV), dos componentes musculares e das fibras elásticas e colágenas. Tendo por base estas densidades de volumes obtidas para cada segmento arterial verificou-se que o segmento proximal apresentou estrutura mioconjuntiva marcante, enquanto que o segmento distal foi caracterizado como uma artéria muscular padrão. Aparentemente, a arquitetura mista do segmento proximal estaria relacionada com o controle de fluxo sanguíneo na emergência aórtica da artéria renal, garantindo um direcionamento prioritário de fluxo de plasma sanguíneo enriquecido para dentro do parênquima renal.(AU)

Eyelid fissure dimensions in Japanese and in Brazilians of European descent over 50 years of age / Medidas das fendas palpebrais em japoneses e brasileiros de descendência européia após os 50 anos

ABSTRACT Purpose: To investigate differences in the palpebral fissure eyelid position in Japanese subjects and in Brazilian subjects of European descent over 50 years of age. Methods: A cross-sectional study evaluating 50 Japanese subjects and 50 Bra­­­zilian subjects of European descent over 50 years of age was performed to evaluate the effect of aging on eyelid position. Digital photographs were taken with the eyes in the primary position and transferred to a computer to be processed by Scion imaging software for evaluation of palpebral fissure width, height, and margin reflex distance (MRD). The data were statistically analyzed according to sex, age, and race. Results: The width of the eyelid fissure in Japanese subjects was higher than that in Brazilian subjects, whereas the height of the eyelid fissure and the MRD1 was higher in Brazilians than in Japanese (p<0.01). Width, height, and MRD1 were linearly associated with age only in the Japanese group (p<0.05); this association was observed only with width in the Brazilian group (p<0.05). There were no differences according to laterality in either group (p>0.05). Conclusion: There are racial differences in age-related changes in the eyelids, which are more marked in Japanese subjects.

RESUMO Objetivo: Investigar as diferenças no posicionamento da fenda palpebral em ja­po­neses e brasileiros de descendência européia maiores de 50 anos. Métodos: Estudo transversal avaliando-se 50 japoneses e 50 brasileiros de descendência européia maiores que 50 anos de idade, avaliando-se o efeito do envelhe­cimento sobre a posição palpebral. As fotografias digitais foram realizadas em posição primária do olhar e transferidas para um computador para serem processadas pelo software de imagem Scion, avaliando-se as medidas da altura e comprimento da fenda palpebral e distância margem-reflexo (MRD). Os dados foram analisados pela estatística segundo sexo, idade e raça. Resultados: O comprimento da fenda palpebral em japoneses foi maior do que o dos brasileiros, enquanto que a altura da fenda palpebral e MRD foram maiores nos brasileiros (p<0,01). O comprimento, altura e MRD foram associados à idade li­nearmente apenas em japoneses (p<0,05) e esta associação foi observada apenas quanto ao comprimento no grupo dos brasileiros (p<0,05). Não houve diferença quanto à lateralidade em ambos os grupos (p>0,05). Conclusão: Existem mudanças distintas no processo de envelhecimento palpebral de acordo com a etnia, que parecem ser mais intensas em pálpebras de japoneses.

Aspects of the macro and microscopic anatomy of the sciatic nerve in Wistar rats / Aspectos de la anatomía macro y microscópica del nervio ciático en ratas Wistar

The present study seeks to systematize morphological and morphometrical parameters and brings new data on the main branch of the lumbosacral plexus ­ i.e., sciatic nerve ­ in Wistar rats aged four and seven weeks. Sixteen female were divided into two groups, namely animals aged four weeks, and animals aged seven weeks. The specimens were studied at proximal and distal segments of the right hind limb sciatic nerves. Semi-thin transverse sections (0.25 µm thickness) were stained with 1 % toluidine blue, and the morphometric analysis was processed through the KS 400 software. Except for the number of fascicles and fascicular diameter, no differences were found between the proximal and distal segments. We observed differences when morphometric values were compared between 4- and 7- week old animals, with some exceptions (number of fascicles and myelinated fibers, and capillary area and number). The macroscopic data disagree with a previous description of the sciatic nerve being composed by two fascicles. Instead, sciatic nerve's only fascicle trifurcates or quadrifurcates at the distal third of the thigh. The total capillary area and density were calculated, and these are the first referential data for the sciatic nerve. Histograms of myelinated fiber and axons considering the animal ages were built. The results presented here are important because experimental studies, mainly studies on nerve regenerations require comparison with normal reliable data.

El objetivo fue sistematizar los parámetros morfológicos y morfométricos y traer nuevos datos sobre el ramo principal del plexo lumbosacro - es decir nervio ciático - en ratas Wistar de 4 a 7 semanas. Dieciséis ratas fueron divididas en dos grupos, con 4 y 7 semanas de edad. Las muestras estudiadas fueron los segmentos proximal y distal del nervio ciático derecho. Secciones delgadas (espesor 0,25 mm) fueron teñidas con azul de toluidina al 1 % y el análisis morfométrico se llevó a cabo utilizando el programa KS 400. Excepto para el número de fascículos y diámetro fascicular, no se encontraron diferencias entre los segmentos proximal y distal. Fueron observadas diferencias cuando se compararon los valores morfométricos entre animales de 4 y 7 semanas, con algunas excepciones (número de fascículos y fibras mielinizadas, área y número de capilares). Los datos macroscópicos no están de acuerdo con la descripción anterior del nervio ciático siendo compuesto por dos fascículos. En cambio, sólo trifurcación o cuadrifurcación fueron encontrados en el tercio distal del muslo. El área total capilar y la densidad fueron calculadas y estos constituyen los primeros datos de referencia para el nervio ciático. Se construyeron histogramas de fibras mielínicas y axones, teniendo en cuenta las edades de los animales. Los resultados presentados aquí son importantes porque los estudios experimentales, en especial aquellos sobre la regeneración nerviosa, requieren comparación con datos confiables normales.

Safety zone for posterosuperior shoulder access: study on cadavers.

OBJECTIVE: The posterosuperior shoulder access used in surgical treatment for acromioclavicular dislocation was constructed through dissection of 20 shoulders from 10 recently chilled adult cadavers, and the distances from this route to the nearby neurovascular structures were analyzed. METHODS: A Kirschner wire was introduced into the top of the base of the coracoid process through the posterosuperior shoulder access, in the area of the origin of the conoid and trapezoid ligaments, thus reproducing the path for inserting two anchors for anatomical reconstruction of the coracoclavicular ligaments. The smallest distance from the insertion point of the Kirschner wire to the suprascapular nerve and artery/vein was measured. RESULTS: The mean distance from the suprascapular nerve to the origin of the coracoclavicular ligaments at the top of the base of the coracoid process was 18.10 mm (range: 13.77-22.80) in the right shoulder and 18.19 mm (range: 12.59-23.75) in the left shoulder. The mean distance from the suprascapular artery/vein to the origin of the coracoclavicular ligaments was 13.10 mm (range: 9.28-15.44) in the right shoulder and 14.11 mm (range: 8.83-18.89) in the left shoulder. Comparison between the contralateral sides did not show any statistical difference. CONCLUSION: The posterosuperior shoulder access route for anatomical reconstruction of the coracoclavicular ligaments in treating acromioclavicular dislocation should be performed respecting the minimum limit of 8.83 mm medially.

OBJETIVO: Os autores fizeram o acesso posterossuperior do ombro usado no tratamento cirúrgico da luxação acromioclavicular, a partir da dissecção de 20 ombros de 10 cadáveres adultos recém-resfriados, e analisaram as distâncias da via às estruturas neurovasculares próximas. MÉTODOS: Introduziu-se um fio de Kirschner no topo da base do processo coracoide pelo acesso posterossuperior do ombro, na área de origem dos ligamentos conoide e trapezoide, para reproduzir o trajeto da inserção de duas âncoras para reconstrução anatômica dos ligamentos coracoclaviculares. Mediu-se a menor distância do ponto de inserção do fio de Kirschner ao nervo e à artéria/veia supraescapular. RESULTADOS: A média da distância do nervo supraescapular até a origem dos ligamentos coracoclaviculares no topo da base do processo coracoide foi de 18,10 mm (13,77 a 22,80) no ombro direito e 18,19 mm (12,59 a 23,75) no ombro esquerdo. A média da distância da artéria/veia supraescapular até a origem dos ligamentos coracoclaviculares foi de 13,10 mm (09,28 a 15,44) no ombro direito e 14,11 mm (08,83 a 18,89) no ombro esquerdo. Não houve diferença estatística comparativa entre os lados contralaterais. CONCLUSÃO: A via de acesso posterossuperior do ombro para reconstrução anatômica dos ligamentos coracoclaviculares no tratamento das luxações acromioclaviculares deve ser feita com respeito ao limite de 08,83 mm medialmente.