Importância do raciocínio etiológico e topográfico de lesões: relato de neuropatia óptica traumática conduzida como acidente vascular cerebral / Importance of etiological and topographic injury reactions: report of a traumatic optic neuropathy conducted as a cerebrovascular accident

Introdução: O trauma ocular ou periocular pode afetar o nervo óptico e causar baixa acuidade visual ou alteração de campo visual. Essa lesão, denominada neuropatia óptica, quando de etiologia traumática, pode ser classificada como direta, através da compressão, perfuração ou laceração do nervo óptico por ação de corpos estranhos, fraturas do assoalho da órbita ou hemorragias, e indireta, quando a partir de um trauma externo ao globo ocular há lesão por transmissão da onda de choque ou desaceleração, levando à lesão do nervo óptico pelo estiramento de suas fibras ou edema comprometendo sua vascularização, comum nos acidentes automobilísticos e nas quedas. Descrição do Caso: O presente estudo objetiva relatar um caso de neuropatia óptica traumática conduzida erroneamente como acidente vascular cerebral em uma paciente do sexo feminino de 29 anos, com história de queda da própria altura. Discussão: A investigação feita pela história clínica, evolução do quadro e novos achados fundoscópicos permitiu o diagnóstico correto e melhor orientação da paciente. Conclusão: O conhecimento da neuropatia óptica traumática e da anatomia da via óptica têm extrema importância no raciocínio topográfico e etiológico das lesões traumáticas que cursam com comprometimento visual, poupando o paciente de possíveis intervenções invasivas e desnecessárias (AU)

Introduction: Eye or periocular trauma can affect the optic nerve and cause low visual acuity or visual field alteration. This lesion, called optic neuropathy, when of traumatic etiology, can be classified as direct, through compression, perforation or laceration of the optic nerve by action of foreign bodies, fractures of the orbit floor or hemorrhages, and indirect, when from an external trauma to the eyeball there is injury by transmission of the shock wave or deceleration, leading to optic nerve injury by stretching its fibers or edema compromising its vascularization, common in automobile accidents and falls. Case Report: The present study aims to describe a case of traumatic optic neuropathy mistakenly conducted as a stroke in a 29-yearold female patient with a history of falling from his own height. Discussion: The investigation was possible because of the clinical history, evolution of the condition and new fundoscopic findings that allowed the correct diagnosis and better orientation of the patient. Conclusion: Knowledge of traumatic optic neuropathy and anatomy of the optical pathway have extreme importance in the topographic and etiological reasoning of traumatic lesions that present with visual impairment, saving the patient from possible interventions invasive and unnecessary. (AU)

Impact of fetal brain ultrasound tutor smartphone application on normal anatomy learning.

OBJECTIVE: The "Fetal Brain Tutor 4us" (FBTApp) is a recently developed application for interactive multiplanar navigation through the normal fetal brain. The purpose of this work was to assess its impact on normal anatomy learning. METHODS: A multiple-choice quiz (MCQ) was administered to first-year resident doctors in Obstetrics and Gynecology in two separate sessions, before and 2 weeks after downloading the FBTApp. For each MCQ, the junior trainee was asked to use one out of five items to label a specific cerebral structure on an ultrasound image of a normal midtrimester fetal brain. Six sonographic images of the fetal brain on each of the three scanning planes (axial, sagittal, and coronal) were shown to the participants at either session. The results of the two sessions were analysed and compared. RESULTS: Overall, 216 questions were administered to the trainees in the 2-week study, 108 before and 108 after the use of the FBTApp. From the first to the second sessions, a significant increase of correct answers was noted (from 47/108 or 43% to 77/108 or 71%, P < 0.01). Particularly, a better improvement was obtained in the correct labelling of cerebral structures on the nonaxial (from 32% to 67%, +35%) vs axial (from 67% to 81%, +14%) view planes of the brain (P < 0.01). CONCLUSION: The use of FBTApp seems capable to improve the knowledge of the normal fetal brain anatomy in subjects naive to dedicated prenatal ultrasound. This improvement seems greater on nonaxial planes.

Bichectomia: sistematização técnica aplicada a 27 casos consecutivos / Bichectomy: technical systematization applied in 27 consecutive cases

Introdução: Embora realizada há muito tempo, a remoção da bola de Bichat ganhou notoriedade nos últimos anos devido a sua grande procura nos consultórios do cirurgião plástico. Mesmo quando adequadamente indicada, ainda é considerada um procedimento controverso, uma vez que ainda não existe uma técnica cirúrgica sistematizada na literatura atual, visando torná-la segura e reprodutível. Métodos: A técnica da bichectomia intraoral descrita no trabalho foi aplicada de maneira sistemática em uma série de 27 pacientes consecutivos, no período de 5 de janeiro de 2016 a 15 de dezembro de 2016. Resultados: A idade média dos pacientes foi de 32 anos, sendo 15% do sexo masculino e 85% do sexo feminino. A bichectomia foi realizada isoladamente em 6 pacientes (22%) e em conjunto com outros procedimentos em 21 pacientes (78%). O procedimento mais comumente associado foi a lipoaspiração cervical, realizada em 55% dos pacientes. A imensa maioria dos casos foram operados com anestesia geral (93%). Nenhuma complicação permanente e importante foi verificada no pósoperatório, apenas um caso de neuropatia transitória do ramo bucal e um caso de edema mais pronunciado, que prontamente se resolveram nas semanas seguintes. Conclusão: A remoção de gordura bucal pode ser realizada de forma previsível, rápida e segura, proporcionando diminuição volumétrica do terço inferior facial, com maior realce dos contornos faciais. Quando aplicada em um ambiente cirúrgico seguro, seguindo todos os padrões de segurança da cirurgia e respeitando os complexos limites anatômicos da região, nossa técnica levará os cirurgiões e pacientes a um resultado seguro e satisfatório.

Introduction: Despite buccal fat removal having been performed for a long time, its popularity has increased only in recent years, leading to a rise in the demand for bichectomy in plastic surgery clinics. Buccal fat pad removal is still considered controversial, even when properly indicated, especially with the lack of a systematized surgical technique to make it safe and reproducible. Methods: The intraoral bichectomy described herein was systematically applied in 27 consecutive patients from January 5, 2016 to December 15, 2016. Results: The mean patient age was 32 years; 15% were men, and 85% were women. Isolated buccal fat pad removal was performed in six patients (22%) and in combination with other procedures in 21 patients (78%). The main procedure combined was neck liposuction (55%), and most patients were operated under general anesthesia (93%). No permanent or significant complications occurred, and there were only two minor complications, i.e., inferior mandibular neuropathy and significant swelling, which improved without treatment during the following weeks. Conclusions: Buccal fat removal can be performed in a predictable, fast, and safe manner, leading to volumetric reduction of the lower third of the face, enhancing facial shape. When applied in a safe surgical environment, following all surgical security standards and considering the complex anatomical boundaries of the cheek, our technique can yield secure and satisfactory outcomes both for surgeons and patients.

Topographic anatomy of mandibular foramen in different age groups using panoramic radiographs

The purpose of this investigation was to document the most common position of the mandibular foramen and to compare its position in three different age groups, gender and sides on panoramic radiographs. The knowledge regarding the location of mandibular foramen is essential for administering the inferior alveolar nerve block, peripheral neurectomy and for performing osteotomy cuts with low inferior alveolar nerve morbidity. Two hundred mandibular foramina were studied on panoramic radiographs of one hundred patients (51 female and 49 male) with a mean age of 20.15±10.7 years. The patients were grouped into three age groups (≤13, 14-25, >25 years). Various measurements for the position of mandibular foramen were performed in horizontal and vertical dimensions using different landmarks and reference points. The ratios of horizontal and vertical dimensions were compared within three different age groups, gender and side. The majority of mandibular foramina were in the ratio range of 0.31-0.40 in all the three age groups horizontally and vertically with a significant difference in patients within the age group of ≤ 13 years from the other two age groups. The study showed that the mandibular foramen was located in the middle third of the ramus and the location of the mandibular foramen maintained bilateral symmetry in all the cases. The study indicated that the location of the mandibular foramen is variable. However, the superior and posterior fifths are found to be the safer zones. So, the positional changes of mandibular foramen with age are imperative, as in children they may be occasionally found in inferior third and therefore preoperative knowledge of the exact position of the mandibular foramen may guide the surgeon to develop a safe and accurate surgical technique avoiding any violation of the neurovascular bundle

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The variants of the retro- and hypotympanum: an endoscopic anatomical study.

The retro- and hypotympanum are hidden areas of the middle ear, only poorly recognized. Nevertheless, this region is of relevant clinical significance, since it is regularly affected by disease such as cholesteatoma. The aim of this study is to explore and describe the anatomical variants of the hypo- and retrotympanum by the means of transcanal endoscopy. We hypothesize a significant variability of this hidden region of the middle ear. Moreover, we believe that the minimal invasive, endoscopic access is suitable since angled scopes may be used to explore the region. To this end a total of 125 middle ears (83 cadaveric dissections, 42 surgical cases) were explored by the means of 3 mm straight and angled scopes. The variants were documented photographically and tabularized. The bony crests ponticulus, subiculum and finiculus were most frequently represented as ridges. The ponticulus showed the highest variability with 38% ridge, 35% bridge and 27% incomplete presentation. The subiculum was bridge-shaped only in 8% of the cases, the finiculus in 17%. The sinus tympani had a normal configuration in 66%. A subcochlear canaliculus was detectable in 50%. The retro- and hypotympanum were classified, respectively, to the present bony crests and sinus in a novel classification type I-IV. In conclusion, we found abundant variability of the bony structures in the retro- and hypotympanum. The endoscopic access is suitable and offers thorough understanding and panoramic views of these hidden areas.

[Application of acupoint anatomy localization method with colorful tube in education of acupoint anatomy].

To seek a precise and simple method for localization of acupoint in anatomical experiment teaching. Medical bone needles were inserted into acupoints. Then, self-mode copper probe needles were thrust along the center of the bone needles to open the inner structures of acuppoints. And probe needles were replaced by colored plastic tubes. Finally, bone needles were withdrawn so as to fix the plastic tubes into the acupoints to facilitate the later cutting. This method for acupoint anatomic positioning is of low cost with accurate positioning and simple manipulation, which has advantages in strong experimental and innovative values.

Evaluation of intraoperative brain shift using an ultrasound-linked navigation system for brain tumor surgery.

Image-guided neurosurgery using navigation systems is an essential tool to increase accuracy in brain tumor surgery. However, brain shift during surgery has remained problematic. The present study evaluated the utility of a new ultrasound (US)-linked navigation system for brain tumor surgery in 64 patients with intracranial tumors. The navigation system consisted of a StealthStation navigation system, a SonoNav system, and a standard US scanner. This system determines the orientation of the US images and reformats the images from preoperative computed tomography (CT) or magnetic resonance (MR) imaging to match the US images. The system was used intraoperatively to measure brain shift several times, using the results to guide tumor resection. US-linked navigation provided information regarding brain shift, and extent of tumor resection during surgery. Evaluation of brain shift was easily achieved in all patients, without using intraoperative CT or MR imaging. Accurate information regarding the true anatomical configuration of the patient could be obtained in all phases of the operation. Magnitude of brain shift increased progressively from pre- to post-resection and depended on the type of cranial structure. Integration of the US scanner with the navigation system allowed comparisons between the intraoperative US and preoperative images, thus improving interpretation of US images. The system also improved the rate of tumor resection by facilitating the detection of remnant tumor tissue. This US-linked navigation system provides information on brain shift, and improves the accuracy and utility of image-guided surgery.

Setting up a plastination laboratory at the Faculty of Medicine of the Autonomous University of Barcelona

Plastination is a laboratory tool used to preserve biological tissues that has been applied to morphological studies, teaching and research. The technique reduces exposure to toxic fumes and diminishes damage to anatomical preparations during their manipulation. Contrary to intuition, the basic technique of plastination does not require any significant economical investment. The technical equipment and laboratory products can be obtained with a limited budget. Moreover, facility requirements are simple and not very expensive if only the basic technique is pursued. In the present work, we report our experience in the design and setting up of a laboratory to plastinate anatomical preparations using the S10 standard technique at the Faculty of Medicine of the Autonomous University of Barcelona. We explain the different ways we used to finance this laboratory and the cost of the facility, the technical equipment and the laboratory products. We also report the first results concerning the first anatomical preparations obtained by us (AU)

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