Histological and immunohistochemical evaluations of the bone marrow from femur and sternal manubrium of dogs reactive for leishmaniasis by DPP® and ELISA tests / Avaliações histológica e imunoistoquímica da medula óssea do fêmur e do manúbrio esternal de cães reagentes para leishmaniose aos testes DPP® e ELISA

As the bone marrow is one of the most organs affected by canine visceral leishmaniasis (CVL), samples from this are frequently taken for parasitological tests, with occurrence of myelodysplastic changes, with consequent anemia, leukopenia, and thrombocytopenia. Thus, this study aimed to investigate the histological and immunohistochemical changes in the bone marrow of the femur and sternal manubrium of dogs reactive for leishmaniasis by DPP® and ELISA tests. For this, thirteen canines from the epidemiological routine for CVL carried out by the Directorate of Zoonosis Surveillance of Goiânia (DVZ), GO, Brazil, were subjected to anatomopathological examination. 46.2% of bone marrow samples from the femur showed a higher proportion of the red series, and 53.9% of bone marrow of the sternal manubrium evidenced a higher proportion of the red series. Also, there were varied macrophage hyperplasia, hemosiderosis, and megakaryocytic emperipolesis. Amastigote forms of Leishmania spp. in the bone marrow of the femur and sternal manubrium to histopathological and immunohistochemical evaluations were observed, with good agreement them, but without difference in the parasite intensity between the bone marrow of these anatomical sites. It was concluded that bone marrow of the femur and sternal manubrium of dogs reactive for leishmaniasis by DPP® and ELISA tests has histological changes resulting from the disease, regardless of the parasite presence or intensity, with macrophage hyperplasia, hemosiderosis, and emperipolesis being the main medullary changes in these animals. Also, the bone marrow of the femur and sternal manubrium are useful anatomical sites for the diagnosis of CVL by direct methods.

Como a medula óssea é um dos órgãos mais acometidos pela leishmaniose visceral canina (LVC), amostras desta são frequentemente colhidas para exames parasitológicos, sendo possível a ocorrência de alterações mielodisplásicas, com consequente anemia, leucopenia e trombocitopenia. Assim, este estudo teve como objetivo investigar alterações histológicas e imunoistoquímicas na medula óssea do fêmur e manúbrio esternal de cães reativos para leishmaniose aos testes DPP® e ELISA. Para isso, 13 caninos da rotina epidemiológica para LVC realizada pela Diretoria de Vigilância de Zoonoses de Goiânia (DVZ), GO, Brasil, foram submetidos ao exame anatomopatológico. 46,2% e 53,9% das amostras de medula óssea do fêmur e do manúbrio esternal apresentaram maior proporção da série vermelha, respectivamente. Além disso, havia variados graus de hiperplasia macrofágica, hemossiderose e emperipolese megacariocítica. Formas amastigotas de Leishmania spp. na medula óssea do fêmur e do manúbrio esternal às avaliações histopatológicas e imunoistoquímicas foram observadas, com boa concordância entre essas, mas sem diferença na intensidade parasitária entre a medula óssea desses sítios anatômicos. Conclui-se que a medula óssea do fêmur e do manúbrio esternal de cães reativos para leishmaniose aos testes DPP® e ELISA apresenta alterações histológicas decorrentes da doença, independente da presença ou intensidade do parasito, sendo hiperplasia de macrófagos, hemossiderose e emperipolese as principais alterações medulares nesses animais. Além disso, a medula óssea do fêmur e do manúbrio esternal compreendem sítios anatômicos úteis ao diagnóstico de LVC por métodos diretos.

Manubriosternal joint: synchondrosis or symphysis? Analysis of morphology and aging in humans.

INTRODUCTION: The uncertainty about the morphological classification of the manubriosternal joint is historical in the field of Anatomy and is still under discussion. This makes it difficult to teach and diagnosing related matters, especially those that require radiological images. In fact, this subject lacks specific data. PURPOSE: This study aims to describe the morphology of the manubriosternal joint and its age-related changes. METHODS: Thirty specimens were divided in three groups: young adults up to 35 years of age, middle-aged adults ranging from 36 to 55, and older adults over 56 years. The subjects were labeled, and blind analysis were performed using the macroscopic and microscopic analysis. RESULTS: The large presence of isolated fibroblasts and chondrocytes and the lower degree of isogenic groups proved that the manubriosternal joint is a symphysis. Its age-related changes involve the reduction of thickness and hydrated characteristics, loss of uniformity and arrangement of the collagen fibers, hyalinization and the presence of focal lesions, that corroborate with the degenerative process. CONCLUSION: The manubriosternal joint is classified as symphysis and the main age-related changes is the relative thickness of the tissue.

Análise do efeito do método Pilates no perfil postural de idosas / Analysis of the effect of Pilates method on the postural profile of elderly women

O processo de envelhecimento é caracterizado por diversas alterações morfológicas, fisiológicas, funcionais e bioquímicas. Objetivos: Investigar o efeito da aplicação de exercícios do método Pilates sobre ângulos e distâncias dos segmentos corporais de idosas. Métodos: Realizou-se um estudo quantitativo, de intervenção, com aplicação de 20 sessões de exercícios do método Pilates, duas vezes por semana, em uma população de 20 idosas, as quais passaram por uma avaliação postural biofotogramétrica pré e pós-intervenção. Resultados: Foram observadas diferenças posturais, constatando-se redução da distância do ângulo inferior da escápula, distância dos epicôndilos, distância do processo estiloide; distância entre T1 e os ângulos inferiores da escápula, diminuição do ângulo manúbrio do esterno e epicôndilos e alinhamento horizontal da cabeça. Conclusões: A prática de exercícios do método Pilates foi suficiente para promover melhora em algumas variáveis posturais. Recomenda-se a realização de novos estudos com população e frequência maiores para obter-se efeito positivo nas demais variáveis do perfil postural.

The aging process is characterized by various morphological, physiological, biochemical, and functional changes. Objectives: To investigate the effect of the application of Pilates exercises on angles and distances of the elderly women's body segments. Methods: We performed an interventional quantitative study consisting of the application of 20 sessions of Pilates exercises twice a week with a population of 20 elderly women who had undergone a postural assessment by biophotogrammetry prior to and following the intervention. Results: We observed postural differences and confirmed a reduction in the distance of the lower angle of the scapula, of the epicondyles, and of the styloid process; a reduction in distance between T1 and the lower angles of the scapula; a reduction in notch angle of the sternum and epicondyles; and horizontal alignment of the head. Conclusions: The practice of Pilates exercises was enough to promote improvement in some postural variables. It is recommended to carry out further studies with larger population and frequency to obtain positive effect on other variables of the postural profile.

Antropometría del martillo en humanos: un estudio anatómico directo / Anthropometry of the malleus in humans: a direct anatomic study

El conocimiento morfométrico de las estructuras del oído medio, incluidos cada uno de los oscículos, es importante para la comprensión de su complejidad biomecánica. Las características estructurales y dimensionales del martillo son registradas en 23 martillos de población mestiza adulta Colombiana. Las medidas registradas involucran el área de la cabeza, el cuello, el manubrio, el proceso anterior y lateral y el área de la articulación incudo-maleolar. Tres de los diecinueve registros tomados en este estudio pudieron ser comparados concienzudamente con otros estudios que mostraron similitudes. El largo total del martillo fue de 8,18 mm DE 0,24, la longitud del manubrio fue de 4,91 mm DE 0,25 y la proporción del largo del manubrio y el largo total fue de 60,11 % DE 3,47. Conforme a la población estudiada no se logro encontrar variación individual o pareada en la anatomía del martillo lo que lo hace un hueso morfométricamente uniforme y estable.

Morphometric knowledge of middle ear structures, including each of the oscicles, is important for the understanding of its biomechanics complexity. The structural and dimensional characteristics of the malleus are registered in 23 samples of Colombian adult mestizo population. Registered measures involve the area of the head, neck, the manubrium, the anterior and lateral process and the area of the incudo-maleolar joint. Three of nineteen records taken in this study could be carefully compared to other studies, which showed similarities. The total length of the malleus was 8,18 mm SD 0.24, the length of the handle was 4.91 mm SD 0.25 and the ratio of the length of the manubrium and the malleus total length was 60,11% of 3.47. In accordance with the studied population, individual or paired variations were not found in the anatomy of the malleus that makes it a morphometrically uniform and stable bone.

Anterior approach to the cervicothoracic junction: proposed indication for manubriotomy based on preoperative computed tomography findings.

OBJECTIVE: The purpose of this study was to present straightforward preoperative methods to define the need for manubriotomy in the anterior surgical approach to the cervicothoracic junction. METHODS: Preoperative MR imaging and CT scanning studies were performed in all patients. The CT images with sagittal reconstructions including the manubrium were done to apply the so-called surgeons' view line. This line is parallel to the inferior plateau of the superior healthy vertebrae or the vertebrae above the herniated intervertebral disc, and the decision concerning the need for manubriotomy depends on the correlation between this line and the manubrium. RESULTS: Preoperative planning of the need for manubriotomy was correct in all cases. Manubriotomy was never performed in C-7 corpectomy or C7-T1 discectomy cases; nevertheless, manubriotomy was needed in half of the cases when the T-1 corpectomy was the lowest level to be resected (8 cases), and in 4 cases the lowest level to be approached was T-2. The mean surgical time, bleeding volume, postoperative pain intensity, and length of hospital stay were less in the cervicotomy than in the manubriotomy group. CONCLUSIONS: By using the surgeons' view line and its correlation with the manubrium, the need for manubriotomy can be predicted without compromising decompression and reconstruction. The statistical differences observed in the surgical variables between the manubriotomy and cervicotomy cases justified the use of preoperative evaluation of the need for manubriotomy as an aid to surgical planning and to give the patient and family realistic expectations about the surgery.

Lesão oculta da articulação manúbrio-esternal associada à fratura da coluna torácica / Occult manubriosternal joint injury associated with fracture of the thoracic spine

Os autores relatam a ocorrência de lesão oculta da articulação manúbrio-esternal na avaliação inicial de um paciente com fratura da coluna torácica (T9). Foi diagnosticada fratura de T9 no paciente do sexo masculino de 37 anos de idade associada a déficit neurológico parcial. No atendimento inicial, as radiografias realizadas não demonstraram a lesão da articulação manúbrioesternal. Durante a reabilitação, após a estabilização cirúrgica da fratura da coluna torácica, subitamente o paciente sentiu dor intensa, acompanhada de deformidade ao nível do esterno, tendo sido diagnosticada luxação manúbrio-esternal nos exames de imagem. Devido à recidiva da luxação e de dor incapacitante, foi necessária a realização da redução aberta e fixação da articulação manúbrio-esternal. Na avaliação após 12 meses, o paciente apresentou recuperação completa da lesão neurológica, consolidação da artrodese do segmento vertebral T7-T11, e manutenção da redução da articulação manúbrio-esternal, que era assintomática durante a realização das atividades cotidianas.

The authors report the occurrence of an occult manubriosternal joint injury in the initial evaluation on a patient with a thoracic spine fracture (T9). This T9 fracture was diagnosed in a 37-year-old man and was associated with a partial neurological deficit. At the initial evaluation, the radiographs produced did not show the manubriosternal joint injury. During rehabilitation, after surgical stabilization of the thoracic spine fracture, the patient suddenly felt an intense pain accompanied by deformation at the sternal level. From imaging examinations, manubriosternal dislocation was diagnosed. Because of recurrence of the dislocation and the incapacitating pain, open reduction and fixation of the manubriosternal joint had to be performed. At the 12-month follow-up, the patient presented complete recovery of the neurological lesion, consolidation of the arthrodesis on the T7-T11 vertebral segment and maintenance of the reduction of the manubriosternal joint, which was asymptomatic during daily activities.

Alternativas quirúrgicas en el tratamiento de los tumores: de la pared torácica / Surgical alternative for the treatment of thoracic wall tumor

Los tumores de la pared torácica son neoplasias poco frecuentes, y de difícil tratamiento. Cuatro pacientes con neoplasias de la pared torácica fueron intervenidos en el Hospital Universitario de Maracaibo entre los años 2005 a 2008, con los diagnósticos de: plasmocitoma en dos pacientes y condrosarcoma en dos pacientes. Entre las intervenciones quirúrgicas realizadas destacan: resección de tumor de la pared torácica e interposición de malla en tres pacientes y resección de tumor esternal con interposición de malla y metacrilato en un paciente. La evolución posoperatoria fue satisfactoria en tres pacientes, un paciente en quien se interpuso malla y metacrilato se produjo el desplazamiento de la malla a un año de la intervención. Es importante en los pacientes con tumores de la pared torácica una adecuada planificación preoperatoria de la intervención para disminuir la morbilidad y mortalidad posoperatoria, y lograr mejores resultados quirúrgicos y funcionales.

The chest wall tumors are neoplasm with a low frequency and they are of difficult in the treatment. Four patients with chest wall neoplasm were operated in the Universitary Hospital from Maracaibo between 2005 at 2008 with the diagnoses of plasmacytoma in two patients and chondrosarcoma in two patients. The surgical procedures for us performed were: Chest wall tumor resection and mesh interposition in three patients and sternum tumor resection with interposition of mesh with methyl methacrylate in one patient. The postoperatory evolution was satisfactory in three patients and the patient with the reconstruction using mesh and methyl methacrylate had the displacement of the mesh after of a year of the surgical procedure. It is very important in the patients with chest wall tumors an adequate preoperatory evaluation with the objective of reduces the mortality and morbidity postoperatory and obtains better surgical and functional results.

Aspectos histológicos de la articulación manubrioesternal / Histologic aspects of the manubriosternal joint

La articulación manubrioesternal ha sido comúnmente un tema de discusión anatómico e histológico debido a sus diversas clasificaciones. Ha sido descrita como sínfisis, como cartilaginosa primaria o sincondrosis e incluso sinovial. El objetivo del trabajo fue examinar meso y microscópicamente la articulación manubrioesternal, con la finalidad de determinar el tipo de tejido que la constituye y de este modo definir el tipo de articulación, contribuyendo de esta manera al mejor conocimiento anatómico. Se extrajeron 10 esternones: 7 cadáveres frescos y 3 de cadáveres formolizados, cuya edades fluctuaban entre 40 y 60 años, de sexo masculino, todos de origen chilenos. En cada esternón se identificó la articulación manubrioesternal y se seccionó el hueso a 1 cm por arriba y 1 cm por abajo de la interlínea articular. Posteriormente, los segmentos fueron descalcificados para luego obtener 9 cortes en sentido anteroposterior: 3 de la parte mediana de la articulación y 3 de cada parte lateral próxima a la articulación esternocostal, los cuales fueron teñidos con hematoxilina-eosina y van Giesson. La observación microscópica permitió determinar que en 5 casos (50 por ciento) una fina capa de tejido hialino periférico cubría las superficies articulares del manubrio y cuerpo esternal, encontrándose entre las dos superficies una moderada capa (+++) de tejido fibrocartilaginoso. En 3 casos (30 por ciento), encontramos una fina capa de tejido hialino entre las superficies articulares y abundante tejido fibrocartilaginoso (++++) y en 2 casos (20 por ciento), el tejido cartilaginoso que recubría las superficies articulares eran muy abundante, con escasas presencia de fibrocartílago (++) en la región central. En 6 casos (60 por ciento) existía en el interior del fibrocartilago una pequeña cavidad. La articulación manubrioesternal presentó sus superficies articulares cubiertas con tejidos cartilaginoso del tipo hialino en relación con el tejido fribrocartilaginoso. Este último, un verdadero disco interpuesto entre las superficies articulares, en la mayoría de los casos con una pequeña cavidad, debido tal vez a la absorción que sufre la parte central de él, se aproxima más a una articulación sinovial que a una sincondrosis, producto de una calcificación periférica o de una sinostosis manubrioesternal