Lower limit of normal of cross-sectional area of peripheral muscles and diaphragm measurements performed with ultrasound in full-term and preterm infants.

To stratify groups of infants by gestational age and identify the lower limit of normal (LLN) of the cross-sectional area of peripheral muscles as well as diaphragmatic excursion and thickness and parasternal activation during spontaneous respiration in full-term and preterm newborns. A cross-sectional study was conducted at a neonatal unit. Preterm newborns (PTNBs) with gestational age of 28 to 366/7 weeks and full-term newborns (NBs) with gestational age of 37 to 416/7 weeks, clinically and hemodynamically stable, breathing ambient air with no signs of respiratory distress were included. NBs on oxygen therapy, those with known genetic syndromes, malformations of the nervous system and those having undergone surgery were excluded. Ultrasound was performed over the rectus femoris, tibialis anterior, and biceps brachii muscles (cross-sectional area) and diaphragm (thickness and excursion). One hundred twenty NBs were stratified based on gestational age (< 30 weeks [n = 25]; 31 to 35 weeks [n = 51]; 37 to 41 6/7 weeks [n = 44]). Significant differences were found in the cross-sectional area of the rectus femoris muscles and thigh circumference of NBs > 37 weeks compared to the other 2 groups (p < 0.05). Differences were found in diaphragm thickness and excursion between the groups with gestational age > 37 weeks and < 30 weeks. Greater activation of the parasternal muscles was found in the PTNBs. With regard to LLN, significant differences were found between the groups with gestational age > 37 weeks and < 30 weeks for all variables analyzed and between the group with gestational age > 37 weeks and other 2 groups for the cross-sectional area of the rectus femoris, diaphragmatic excursion, and diaphragm contraction velocity. Differences were found among the groups in the size of peripheral muscles as well as diaphragm thickness and excursion. Moreover, greater activation of the parasternal muscle was found in NBs with gestational age < 30 weeks. This study establishes normal values of ultrasound measures for full-term and preterm newborns.

Effects of intradialytic inspiratory muscle training at different intensities on diaphragm thickness and functional capacity: clinical trial protocol in patients undergoing haemodialysis.

INTRODUCTION: Patients with end-stage renal disease (ESRD) undergoing haemodialysis (HD) commonly present with a sedentary behaviour and reduced functional capacity, factors that can compromise their prognosis. Intradialytic inspiratory muscle training (IMT) can increase respiratory muscle strength and, consequently, improve functional capacity, besides being easy to apply, cheap and performed in a supervised setting. However, few studies show the effects of this type of training applied at different intensities in this population. This study aims to compare the effects of IMT at different intensities in adults with ESRD undergoing HD. METHODS AND ANALYSIS: A randomised, double-blind, sham-controlled trial will be conducted on 36 subjects randomly allocated into three groups: IMT at intensities of 30% or 50% of maximal inspiratory pressure (intervention groups), or 10% of maximal inspiratory pressure (sham-IMT). All the interventions will be supervised and performed three times per week, for 12 weeks, totalling 36 sessions. The primary outcomes are the 6-minute walk test, diaphragm thickness and the response of VO2peak post-intervention. Respiratory muscle strength, 24-hour ambulatory blood pressure measurement and the Kidney Disease Quality of Life 36-item short form survey will be evaluated as secondary outcomes. ETHICS AND DISSEMINATION: This study has been approved by the Research Ethics Committee of the Hospital de Clínicas de Porto Alegre (ID: 2020-0458). The results of this study will be disseminated by conference presentations and peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT04660383.

Ultrasound assessment of diaphragm thickness in athletes / Evaluación por ultrasonido del grosor del diafragma en atletas

SUMMARY: The main purpose of this study was to examine the correlation between the aerobic and anaerobic performance of diaphragm thickness in athletes. That study was conducted with 15 team athletes (TA) (age 21.80 ± 2.40 years), 15 individual athletes (IA) (age 18.93 ± 2.31 years) and the control group (CON) 10 people living sedentary lifestyles (age 23.60 ± 2.91 years). In this study, diaphragm muscle thickness (B-mode ultrasonography), respiratory function (spirometry and maximum inspiratory (MIP) and expiratory pressures (MEP), aerobic capacity yo-yo intermittent endurance Test 1 (YYIET-1), and anaerobic power by Monark 834 E were assessed. The diaphragm thickness was determined from the intercostalspace between the 8th and 9th ribs at the expiration time by ultrasound and from the intercostal space between the 10th and 11th ribs at inspiration and then, the thickness of the diaphragm was measured from the diaphragm is seen best. There was a positive correlation between DiTins (r= 0.477) and DiTins-ex (r= 0.473) parameters of TA. In IA, there was a significant correlation between DiTins and DiTins-ex parameters and Peak Power (r= 0.495 and 0.435, respectively) and average power (r= 0.483 and 0.446, respectively). No significant correlation in all parameters of the CON group (p<0.05). As a result, it was determined that athletes with high diaphragm thickness had higher anaerobic performance, and athletes with thinner diaphragm thickness had better VO2Max capacity. The diaphragm thickness of the athletes in individual branches was thicker than the team athletes, and their anaerobic performance was also higher.

RESUMEN: El objetivo principal de este estudio fue examinar la correlación entre el rendimiento aeróbico y anaeróbico del grosor del diaframa en atletas. Dicho estudio se realizó con 15 deportistas de equipo (TA) (edad 21,80 ± 2,40 años), 15 deportistas individuales (IA) (edad 18,93 ± 2,31 años) y el grupo control (CON) 10 personas con sedentarismo (edad 23,60 ± 2,91 años). Se midió, el grosor del diaframa (ultrasonografía en modo B), la función respiratoria (espirometría y presiones máximas inspiratorias (MIP) y espiratorias (MEP), prueba de resistencia intermitente yo- yo de capacidad aeróbica 1 (YYIET-1) y resistencia anaeróbica potencia por Monark 834 E. El grosor del diafragma se determinó a partir del espacio intercostal entre las costillas 8 y 9 en el momento de la espiración por ultrasonido y del espacio intercostal entre las costillas 10 y 11 en la inspiración. Hubo una correlación positiva entre los parámetros DiT ins (r= 0,477) y DiTins-ex (r= 0,473) de TA. En IA, hubo una correlación significativa entre los parámetros DiTins y DiTins-ex y el pico Potencia (r= 0,495 y 0,435, respectivamente) y potencia media (r= 0,483 y 0,446, respectivamente). No hubo correlación significativa en todos los parámetros del grupo CON (p<0,05). Como resultado, se determinó que los atletas con mayor espesor del diaframa tenían un mayor rendimiento anaeróbico, y los atletas con menor espesor del diaframa tenían una mejor capacidad de VO2Max. El grosor del diafragma de los atletas en ramas individuales fue mayor que el de los atletas de equipo, y su rendimiento anaeróbico también fue mayor.

El diafragma, el hiato y la unión gastroesofágica / The diaphragm, the hiatus and the gastroesophageal junction

RESUMEN La unión del tubo esofágico con el estómago en lo que denominamos el cardias, su tránsito y relacio nes con el hiato diafragmático, las estructuras fibromembranosas que la fijan y envuelven, la existencia de un esfínter gastroesofágico anatómico y su real morfología, así como la interacción de todos estos elementos, han sido materia de controversia por décadas y aún hoy. Este artículo actualiza la descrip ción de tales estructuras.

ABSTRACT The point where the esophagus connects to the stomach, known as the cardia, its transition and re lationship with the diaphragmatic hiatus, its fibromembranous attachments, the existence of an ana tomic gastroesophageal sphincter and its real morphology, and the interaction between all these ele ments, have been subject of debate for decades that still persist. The aim of this article is to describe the updated information of such structures.

Morphology of the Diaphragm Muscle in Southern Tamandua (Tamandua tetradactyla) and its Importance in Cases of Traumatic Hernia.

The wall of the diaphragm can be affected by changes caused by physical trauma, allowing the passage of viscera between the abdominal cavity and thoracic cavity, thus reducing the space for pulmonary expansion, leading to the formation of hernia and possible death. Thus, we aimed to characterize, size and determine the topography of the diaphragmatic muscle in the Southern Tamandua, since clinical and surgical activities in wild animals have become a reality more and more present in veterinary medicine. We used six adult animals, x-rayed and dissected, followed by collection of fragments of muscular portions for histological analysis. Initially we observed that the animals presented 17 thoracic vertebrae, 3 lumbar vertebrae and 5 sacral vertebrae. The diaphragm was conformed by three segments: sternal, costal and right and left diaphragm pillar, with presence of tendinous centre that housed the passage of the caudal vena cava, called foramen of the caudal vena cava. Dorsally to the tendinous centre, already in the muscle portion, we located the esophageal and aortic hiatus. These findings, as well as the microscopic, were equivalent to that found in the general literature also, corroborating with descriptions already carried out in other mammals' diaphragms.

Morphological Characterization of Diaphragm in Common Squirrel Monkey (Saimiri sciureus)

ABSTRACT The wall of the diaphragm can be affected by congenital or acquired alterations which allow the passage of viscera between the abdominal and chest cavities, allowing the formation of a diaphragmatic hernia. We characterized morphology and performed biometrics of the diaphragm in the common squirrel monkey Saimiri sciureus. After fixation, muscle fragments were collected and processed for optical microscopy. In this species the diaphragm muscle is attached to the lung by phrenopericardial ligament. It is also connected to the liver via the coronary and falciform ligaments. The muscle is composed of three segments in total: 1) sternal; 2) costal, and 3) a segment consisting of right and left diaphragmatic pillars. The anatomical structures analyzed were similar to those reported for other mammals. Histological analysis revealed stable, organized muscle fibers with alternation of light and dark streaks, indicating transverse striation.

Morphological Characterization of Diaphragm in Common Squirrel Monkey (Saimiri sciureus).

The wall of the diaphragm can be affected by congenital or acquired alterations which allow the passage of viscera between the abdominal and chest cavities, allowing the formation of a diaphragmatic hernia. We characterized morphology and performed biometrics of the diaphragm in the common squirrel monkey Saimiri sciureus. After fixation, muscle fragments were collected and processed for optical microscopy. In this species the diaphragm muscle is attached to the lung by phrenopericardial ligament. It is also connected to the liver via the coronary and falciform ligaments. The muscle is composed of three segments in total: 1) sternal; 2) costal, and 3) a segment consisting of right and left diaphragmatic pillars. The anatomical structures analyzed were similar to those reported for other mammals. Histological analysis revealed stable, organized muscle fibers with alternation of light and dark streaks, indicating transverse striation.

Diafragma: trayectoria histórica del término y de sus descripciones anatómica y funcional / Diaphragm: historical path of the term and its anatomical and functional descriptions

RESUMEN: La historia es una disciplina que permite ordenar un conjunto de conocimientos, legados y realidades históricas complejas del ser humano a lo largo del tiempo y a través de las regiones. Por tanto, conocer la historia de civilizaciones, culturas y sociedades nos permite comprender y racionalizar la información y, posteriormente, tomar esta información para seguir construyendo una nueva realidad. Bajo este contexto, el objetivo de este trabajo fue analizar el origen y significado del término diafragma y, el conocimiento que se tenía de la anatomía y función de éste músculo, para comprender cómo, desde la trayectoria histórica, se construyó su definición actual. En los escritos de Homero, el diafragma fue reconocido como una estructura anatómica que no estaba vinculada a ninguna función en particular y en las primeras explicaciones fisiológicas de la respiración tampoco desempeñaba un rol este proceso. Hipócrates y Platón marcaron un punto de inflexión en la definición del término, ya que lo describieron como una estructura que separaba el tórax del abdomen, ajustándose correctamente con el significado del término diáphragma (διαφραγµα), "separación"; sin embargo, en la época clásica de Grecia fue asociado más frecuentemente a la mitología griega y a la espiritualidad humana considerando al diafragma como sede del pensamiento. Otro hito importante en la historia de este músculo fueron los estudios realizados por Galeno, a través de disecciones en animales y Vesalio en humanos, ya que describen, a partir de observaciones directas, con gran detalle la anatomía del diafragma y se aproximan de manera más adecuada a su función en el proceso de la respiración. Finalmente, Testut estructura y ordena este conocimiento, el cual se ha mantenido hasta la actualidad, en donde sólo ha cambiado la forma en la que se entrega esta información.

SUMMARY: Over time and throughout all regions, history has been a discipline allowing an established order of knowledge, legacies and complex historical experiences of human beings. Consequently, knowing the history of civilizations, cultures and societies allows us to understand and rationalize this information and use the information to continue building a new reality. In this context, the objective of this work was to analyze the origin and meaning of the term diaphragm, and knowledge of the anatomy and functions of this muscle. Based on this knowledge and its path throughout history its current definition was constructed. In Homer's writings, the diaphragm was recognized as an anatomical structure that was not linked to any particular function and in the early physiological explanations of breathing, and did not play a role in the breathing process. Hippocrates and Plato marked a point of inflection in the definition of the term, since they described it as a structure that separated the thorax from the abdomen, relating it correctly with the meaning of the term diáphragma (diafragma), "separation". However, in the classical period of Greece, it was more frequently associated with Greek mythology and human spirituality, considering the diaphragm as the seat of thought. Another important milestone in the history of this muscle were the studies Galen through dissection in animals, and Vesalius in humans, where both describe the diaphragm and its functions in great detail, approaching the detail of the breathing process more closely. Finally, Testut structures the information in a manner that has been maintained to this day, and the only change has been in the dissemination of the information.

Anatomical and functional deficiencies of the crural diaphragm in patients with esophagitis.

BACKGROUND: Inspiratory esophagogastric junction (EGJ) pressure is lower in gastroesophageal reflux disease (GERD) and patients fail to increase EGJ pressure during the inspiratory effort. The aim of this study was to assess the EGJ activity during inspiratory maneuvers (high-resolution manometry, HRM) and the crural diaphragm (CD) thickness (endoscopic ultrasound, EUS) in GERD. METHODS: Twenty esophagitis patients (average age 45 years, 7 grade A, 13 grade B) had HRM and EUS. Forty-three controls were recruited; 30 had HRM (average age 33 years), and 13 had EUS (average age 40 years). The EGJ contractility index (EGJ-CI) (mm Hg×cm) was measured during normal respiration and two inspiratory maneuvers: without and with inspiratory loads of 12, 24, and 48 cmH2 O (TH-maneuvers). A composite metric for TH-maneuvers ("EGJ total activity") was defined as the product of the maximal EGJ pressure and the length of its aboral excursion during the maneuver (mm Hg×cm). The CD thickness (cm) was measured during expiration (12 MHz). KEY RESULTS: Expiratory lower esophageal sphincter pressure and integrated relaxation pressure were lower in GERD. The EGJ-CI and the "EGJ total activity" were lower in GERD during TH-maneuvers (48-cmH2 O load: 168.4 ± 13.8 vs 114.8 ± 9.6, P=.006). Patients failed to sustain the inspiratory CD activity across the 12 and 48-cmH2 O efforts. The CD was thinner in GERD patients (0.37 ± 0.03 vs 0.49 ± 0.04, P=.02). The CD thickness correlated with the increment in the "EGJ total activity" in GERD without a hiatal hernia (r=.702, P=.016, n=11). CONCLUSIONS & INFERENCES: There are anatomical changes and functional failure of the CD in esophagitis patients supporting the possibility of a skeletal muscle deficiency in GERD.

Standardization of Sonographic Diaphragm Thickness Evaluations in Healthy Volunteers.

BACKGROUND: B-mode ultrasound can be used to measure diaphragm thickness at the zone of apposition. We believe it is necessary to develop normal values for diaphragm thickness at rest in a large group of healthy subjects and compare them with international results. METHODS: Ultrasound measurements of diaphragm thickness at expiratory rest were taken in 109 healthy individuals, with results stratified by sex, body mass index, and thorax circumference. The following methods were used for analysis and interpretation. Multivariable databases with descriptive statistical analyses were made. The Pearson chi-square test was used to evaluate the distribution between variables. Additionally, mean and SD values were calculated. For standardization, the data were separated by sex within a 95% CI, and we calculated a Z test. A 95% CI was also constructed for proportion analyses. RESULTS: One hundred nine healthy volunteers were included in the study, and the correlation between the body mass index and thorax circumference values with a Pearson chi-square test resulted in an r = 0.69. Additionally, the average value of diaphragmatic thickness was 0.19 ± 0.04 cm (95% CI 0.17-0.20 cm) for men and 0.14 ± 0.03 cm (95% CI 0.13-0.15 cm) for women (P = .001). There was no relation between body mass index thorax circumference, and diaphragmatic thickness. CONCLUSION: Real-time ultrasound of the diaphragm is a simple, inexpensive, and portable imaging technique that can provide qualitative anatomical information. The findings in this study show that sonographic diaphragm evaluations can be applied to the general population.

Diaphragm morphology of guinea pig (Cavia porcellus).

The diaphragm is the main respiratory muscle. Along with other respiratory muscles, the diaphragm is responsible for the muscular contraction that generates the respiratory cycle and, as a consequence, the gaseous interchanges in the lungs. Guinea pigs (Cavia porcellus Linnaeus 1758) are largely used as experimental animals in many biology applications due to their easy management, low cost, and docile behavior. As the diaphragm exerts important effects on lung physiology and function, this study aimed at investigating the morphological characteristics of the muscle, through macroscopic, microscopic, and scanning electron microscopy to add reference data for future studies. We observed a "U"-shaped tendineous center and its morphology was similar to other mammals. These results cooperate with the descriptive and comparative anatomy of mammals, besides can be used as control data for areas of surgery and stem cells.

Crossing the barrier: when the diaphragm is not a limit.

OBJECTIVE: The purpose of this article is to depict the anatomic pathways along which transphrenic spread of diseases and entities can disseminate. CONCLUSION: The abdomen and thorax form a continuum on which the diaphragm is an important but incomplete barrier to disease migration.

Effect of nitrofen in the final stages of development of the diaphragm muscle in rats / Efeito do nitrofen na fase final do desenvolvimento da musculatura do diafragma em ratos

PURPOSE: To evaluate the expression of myosin in muscle fibers of the diaphragm in experimental congenital diaphragmatic hernia (CDH). METHODS: Fetuses of pregnant rats were divided into four groups: External Control (EC), composed of non-manipulated rats; Nitrofen, composed of pregnant rats that received 100 mg of nitrofen (2,4-dichloro-4'nitrodiphenyl ether) diluted in olive oil on gestational day (GD) 9.5, whose fetuses developed CDH (N+) or not (N-), and Olive Oil Placebo (OO), composed of pregnant rats that received the oil on the same GD. The fetuses were collected on GD 18.5, 19.5, 20.5 and 21.5 (term = 22 days). We obtained body weight (BW) and photographed the diaphragm area (DA), hernia area (HA) and subsequent calculated the HA/DA ratio in N+ group. Samples of Diaphragm muscle were processed for histological staining with H/E and immunohistochemistry (IHQ) for myosin.} RESULTS: The fetuses of N- and N+ groups had decreased BW and DA compared to EC and OO groups (p <0.001). HA was decreased on GD 18.5 compared to 21.5 (p <0.001) and the HA/DA ratio showed no difference. IHQ showed decreased expression of myosin in nitrofen groups. CONCLUSION: CDH induced by nitrofen model contributes to the understanding of muscularization in the formation of the diaphragm where the myosin expression is decreased.(AU)

OBJETIVO: Avaliar a expressão da miosina na muscularização do diafragma na hérnia diafragmática congênita (CDH) experimental. MÉTODOS: Fetos de ratas foram divididos em quatro grupos: Controle Externo (EC), composto de ratas não manipuladas; Nitrofen, composto de ratas que receberam 100 mg de nitrofen (2,4-dicloro-4'nitrodifenil éter) diluído no azeite no dia de gestação (GD) 9.5, cujos fetos desenvolveram CDH (N+) ou não (N-) e Placebo óleo de oliva (OO), composto de ratas que ingeriram apenas óleo no mesmo GD. Os fetos foram coletados com 18,5, 19,5, 20,5 e 21,5 GD (termo = 22 dias). Foi obtido o peso corporal (BW) e tiradas fotografias da área do diafragma (DA), da hérnia (HA) e calculada a relação HA/DA no grupo N+. Amostras de diafragmas foram processadas histologicamente para coloração com H/E e imunohistoquímica. RESULTADOS: Os fetos dos grupos N- e N+ tiveram BW e DA diminuídos em relação aos grupos EC e OO (p<0.001). Só houve diferença na HA entre os GD 18.5 e 21.5 (p<0.001) e a relação HA/DA não mostrou diferença entre os grupos. A imunohistoquímica mostrou menor expressão de miosina nos grupos que receberam nitrofen. CONCLUSÃO: O modelo de CDH induzida por nitrofen contribui para entender a muscularização na formação do diafragma onde a expressão da miosina está diminuída.(AU)

Contribution towards the anatomy of the esophageal hiatus and its relationship with the presence of bundles of collagen fibers in its margins / Contribución a la anatomía del hiato esofágico y su relación con la presencia de haces de fibras colágenas en sus márgenes

The aim was to detect the presence of bundles of collagen fibers in the margins of the esophageal hiatus and establish if there is any relationship of these bundles with the anatomy of the hiatus. Ten adult male cadavers, with no gross anatomical alteration caused by trauma, surgery or disease, upon the esophageal hiatus were used in the study. A piece of anatomical structure comprising the diaphragm with the esophageal hiatus and adjacent tissues was removed, dissected and 10 percent formol embedding. With the aid of a digital caliper, measurements of the perimeter of the esophageal hiatus were done both in the abdominal and thoracic sides. For the structural study each margin was divided in six sections. Staining techniques of Masson and Picrosirius-hematoxilin were used. Collagen fibers bundles had been found in 8/10 studied cadavers, distributed in 13 margins of the hiatus, of which 7 to left and 6 to the right. The muscle fibers originating from the right pillar had participated in forming both margins of the esophageal hiatus in 60 percent of cadavers, while in 40 percent, the fibers of the left pillar had formed the medial side of the right margin. The right margin was statistically thicker than the left. It did not have a correlation between the measures of the vertices of the angles superior/inferior and the transversal measure of the esophageal hiatus. The measures between the vertices of the angles superior/inferior, respectively, with the central tendon and median arcuate ligament, had presented thoracic values that tended to the double, in relation to the abdominal ones, and had been statistically significant. These distances were smaller in cadavers who possessed bundles of collagen fibers in the margins of the esophageal hiatus. Bundles of collagen fibers bundles were found in 65 percent of the 20 margins of the esophageal hiatus. The margins of the esophageal hiatus were predominantly...

El objetivo fue detectar la presencia de haces de fibras de colágeno en los márgenes del hiato esofágico y establecer si existe relación de éstos con la anatomía del hiato. Fueron utilizados 10 cadáveres de individuos adultos de sexo masculino, sin alteraciones anatómicas evidentes causadas por trauma, cirugía o enfermedad, sobre el hiato esofágico. Fue retirada y disecada una sección anatómica que contendía el diafragma con el hiato esofágico y los tejidos adyacentes y luego fijada en formol 10 por ciento. Las medidas del perímetro del hiato esofágico se realizaron con ayuda de un caliper digital en los lados abdominal y torácico. Para el estudio estructural cada margen fue dividido en seis secciones y teñidos con Tricómico de Masson y Picrosirius-hematoxilina. En 8/10 cadáveres estudiados fueron encontrados haces de fibras colágenas, distribuidos en 13 márgenes del hiato esofágico, 7 izquierdos y 6 derechos. Las fibras musculares que originaban el pilar derecho participaron en la formación de ambos márgenes del hiato esofágico en 60 por ciento de los cadáveres, mientras que en el 40 por ciento, las fibras del pilar izquierdo habían formado el lado intermedio del margen derecho. El margen derecho fue estadísticamente más grueso que el izquierdo. No se encontró correlación entre las medidas de los vértices de los ángulos superior/inferior y la medida transversal del hiato esofágico. Las medidas entre los vértices de los ángulos superior/inferior, respectivamente, con el tendón central y el ligamento arqueado mediano, presentaron valores torácicos que fueron casi el doble em relación a los abdominales, y fueron estadísticamente significativos. Estas distancias eran más pequeñas en los cadáveres que tenían haces de fibras de colágeno en las márgenes del hiato esofágico. Los paquetes de fibras de colágeno fueron encontrados en 65 por ciento de los 20 márgenes del hiato del esófago. Los márgenes del hiato esofágico fueron formados principalmente por fibras...

Evaluación por imágenes del diafragma en el niño / Image evaluation of diaphragm in children

The anatomy, embriology andfunctions of the neonate 's diaphragm, as well as its anatomical and functional oddities were reviewed. And, in a deeper way, imaging studies were also reviewed; these have an important role in functional and anatomic evaluation of the diaphragm, each one with its own advantages and limitations. Chest X-rays allow an anatomic two dimensional evaluation of the diaphragm and constitutes the first approach in the study of diaphragm pathology in children; hence, the normal anatomy and the most common pathological signs are reviewed. Digestive tube studies using contrast media still are the best choice for diagnosis of hiatal hernia and of herniation through the foramen of Morgagni, where the colon is ascended. Ultrasound use is highlighted for the evaluation of diaphragmatic motility, as well as some of its advantages over fluoroscopy, which is and has been the method of choice in the diagnosis of diaphragmatic paralysis in children. Multiplanar images are the most complete method for the anatomic evaluation of the diaphragm, since they show its spatial orientation and allow the detailed evaluation of those pahologies where the anatomy is altered, such as diaphragmatic hernias, trauma and tumors.

Revisamos la embriología, anatomía y funciones del diafragma, sus particularidades anatómicas y funcionales en los neonatos y, en forma más profunda, los estudios por imágenes, que en la actualidad tienen un importante rol en su evaluación anatómica y funcional, cada uno de ellos con sus ventajas y limitaciones. La radiografía de tóraxpermite una evaluación anatómica en dos planos del diafragma y constituye la primera aproximación en el estudio de la patología del diafragma en los niños, por lo que se describe la anatomía normal y los signos de las patologías más frecuentes. Los estudios contrastados del tubo digestivo siguen siendo de elección para el estudio de las hernias hiatales y hernias de Morgagni en donde está ascendido el colon. Destacamos el uso del ultrasonido en la evaluación de la motilidad diafragmática, y algunas de sus ventajas sobre la fluoroscopia, que es y ha sido el método de elección en el diagnóstico de la parálisis diafragmática en los niños. Las imágenes multiplanares son un método más completo en la evaluación anatómica del diafragma, muestran mejor su orientación espacial y permiten la evaluación detallada de las patologías donde la anatomía está alterada, como hernias diafragmáticas congénitas, trauma y tumores.

Participação dos nervos intercostais na inervação do diafragma de gatos (Felis catus, Linnaeus, 1758) / Innervation of diaphragm through intercostal nerves in cats (Felis catus, Linnaeus, 1758)

O objetivo do presente trabalho foi avaliar a inervação do músculo diafragma em gatos, proveniente dos nervos intercostais, contradizendo diversos autores que afirmam ser este músculo inervado apenas pelos ramos dos nervos frênicos direito e esquerdo. Foi observado que existe a frequência de nervos dispostos entre o 8º e o 11º espaços intercostais.

The knowledge of organism's anatomy is essential to conduct any experiment or study with itself. Based on that, we decided to analyze and study in details the innervation of the diaphragm muscle from intercostal nerves in cats. It goes beyond other authors' analysis that describes only the innervation from phrenic nerves. Despite we have got a range of results, we observed a major frequency of eighth to tenth intercostal nerves going to diaphragm muscle.

Participação dos nervos intercostais na inervação do diafragma de gatos (Felis catus, Linnaeus, 1758) / Innervation of diaphragm through intercostal nerves in cats (Felis catus, Linnaeus, 1758)

O objetivo do presente trabalho foi avaliar a inervação do músculo diafragma em gatos, proveniente dos nervos intercostais, contradizendo diversos autores que afirmam ser este músculo inervado apenas pelos ramos dos nervos frênicos direito e esquerdo. Foi observado que existe a frequência de nervos dispostos entre o 8º e o 11º espaços intercostais.(AU)

The knowledge of organism's anatomy is essential to conduct any experiment or study with itself. Based on that, we decided to analyze and study in details the innervation of the diaphragm muscle from intercostal nerves in cats. It goes beyond other authors' analysis that describes only the innervation from phrenic nerves. Despite we have got a range of results, we observed a major frequency of eighth to tenth intercostal nerves going to diaphragm muscle.(AU)

Temporal segmentation of lung region MR image sequences using hough transform.

In this work, segmentation is an intermediate step in the registration and 3D reconstruction of the lung, where the diaphragmatic surface is automatically and robustly isolated. Usually, segmentation methods are interactive and use different strategies to combine the expertise of humans and computers. Segmentation of lung MR images is particularly difficult because of the large variation in image quality. The breathing is associated to a standard respiratory function, and through 2D image processing, edge detection and Hough transform, respiratory patterns are obtained and, consequently, the position of points in time are estimated. Temporal sequences of MR images are segmented by considering the coherence in time. This way, the lung silhouette can be determined in every frame, even on frames with obscure edges. The lung region is segmented in two steps: a mask containing the lung region is created, and the Hough transform is applied exclusively to mask pixels. The shape of the mask can have a large variation, and the modified Hough transform can handle such shape variation. The result was checked through temporal registration of coronal and sagittal images.

Alterações morfométricas em músculo respiratório de ratos submetidos à imobilização de pata / Morphometric alterations in respiratory muscle of rats submitted to paw immobilization

A imobilização é um recurso frequentemente utilizado na prática clínica, sendo comum em patologias álgicas e nas fraturas. O objetivo deste estudo foi analisar a influência do processo de imobilização em músculo do sistema respiratório, o diafragma. O experimento foi efetuado com 12 ratos Wistar machos divididos em dois grupos, controle e imobilizado. O procedimento de imobilização foi realizado através de um método alternativo de imobilização por fita adesiva, sendo mantida por duas semanas. Analisou-se a morfometria das fibras do diafragma com coloração de hematoxilina e eosina. Ao compararmos o diâmetro médio das fibras musculares do diafragma dos animais imobilizados (47,15μm ± 0,329μm) em relação ao controle (54,67μm ± 0,396μm), encontramos diferença estatística entre os grupos (p < 0,0001). Considerando os dados encontrados, foi possível concluir que a imobilização de pata, no modelo utilizado, foi capaz de gerar hipotrofia da musculatura respiratória, assim como um quadro geral de redução de massa corporal do animal.

Immobilization is a frequently used procedure in clinical practice and common in pain diseases and fractures. This study examined the influence of immobilization in a muscle-related respiratory system, the diaphragm. This experiment was conducted with twelve male rats divided into two groups, control and immobilized with an alternative method of restraining by tape, kept for two weeks. We analyzed the morphometry of the diaphragm muscle fibers with hematoxylin/eosin staining. Statistical difference was found (p < 0.0001) when the average diameter of the diaphragm muscle fibers of immobilized animals (47.15μm ± 0.329μm) was compared to the ones in the control group (54.67μm ± 0.396μm). Considering the results, it can be concluded that the immobilization of the animal paw in the used model was able to produce hypotrophy of respiratory musculature, as well as a general framework for reducing the mass of the animal.

Hérnia diafragmática congênita: revisão da literatura e relato de casos / Congenital diaphragmatic hernia: a literature review and case reports

A hérnia diafragmática congênita, tipicamente se apresenta na infância, no período neonatal imediato ou mais tardiamente em lactentes ou pré escolares, mas pode ser raramente detectada em adultos...Atualmente, com o advento de imagens digitais o diagnóstico precoce, até mesmo pré-natal, da hérnia diafragmática congênita tem contribuído para melhorar a morbidade e reduzir a mortalidade. O objetivo deste trabalho monográfico é fazer uma breve revisão bibliográfica sobre o tema em questão, revisando livros e artigos sobre o tema e descrevendo o mesmo de forma sucinta para então correlacioná-lo com os casos clínicos acompanhados no ambulatório de pediatria e pneumologia pediátrica do Hospital Universitário Antônio Pedro (HUAP).