Knowledge-based virtualization of human anatomy: development of an interactive atlas of the upper limbs

Introduction: Currently, two types of atlas provide anatomical studies: those with two-dimensional images, and those compiled by interactive pictures; mostly drawn virtually. In recent decades, the development of virtual anatomical atlases has been encouraged and prioritized by both the technological advances and the need to facilitate and complement medical education. The aim of this study was to develop an interactive virtual atlas of the upper limbs. Material and Methods: A systematic dissection of three upper limbs (shoulder, arm, forearm and hand) of legally preserved cadavers in Anatomy Laboratory of São José do Rio Preto Medical School, SP (FAMERP) has been carried out. Results: A website has been developed to facilitate the learning of superficial and deep structures of the limbs comprising ten pictures showing the steps and the various structures and display devices (naming demarcated structures and text with relevant information about these). In addition, the website includes a photo gallery with subtitled images of the dissected upper limbs. Conclusion: In conclusion, virtual study of Anatomy by means of interactive-image display of dissected parts can facilitate and enhance the learning of the upper limbs.(AU)

Mobilization of fluids in large volumetric reductions during intensive treatment of leg lymphedema.

AIM: The aim of the current study was to evaluate fluid mobilization during the intensive treatment of leg lymphedema. METHODS: The mobilization of intracellular and extracellular fluids in the lower and upper extremities and trunk was evaluated with the intensive treatment of leg lymphedema in a prospective study. Mobilization of fluids was assessed by bioelectrical impedance using the InBody S10 device in ten patients with leg lymphedema, regardless of the cause. Treatment consisted of six to eight hours per day of Manual Lymphatic Therapy (Godoy & Godoy technique), Mechanical Lymphatic Therapy (RAGodoy device®) and a non-elastic cotton-polyester stocking. RESULTS AND CONCLUSION: A significant reduction in total water was observed for the lymphedematous limb, but with an increase in intracellular water of from 59% to 61%. Additionally, total water increases were observed in the limbs without lymphedema and in the trunk. There was an increase in total intracellular water of the extremities and trunk, but without any change in the extracellular water. In high-volume reductions during lymphedema treatment, fluids are displaced from the lymphedematous limb to extremities without lymphedema and to the trunk.

Application of stereological methods in health sciences

Stereology is defined as a Discipline consisting of a set of statistical-geometric procedures in order to obtain quantitative information of three-dimensional structures from their two-dimensional images. It becomes a methodological system for the determination of three-dimensional structures by means of mathematical interpretation of histological sections, which uses Mathematics, Geometry, Probabilistic Statistics, and above all, common sense as its main tools. This paper focuses on explaining stereological principles, techniques, grids, sample size and programs. Stereology is a quantitative and comparative method that uses planes, lines and points for the estimation of three-dimensional parameters of morphological structures from two‑dimensional parameters, using isotropy and randomness as prerequisites. Stereology seems to be an applicable tecnique in Health Sciences to mathematically demonstrate the relationship among the components density of a three‑dimensional structure.

Development of an educational software for the learningof obstetric anatomy addressed to nursing

Computational technology, such as software, computer program, has been a great tool for the Teaching-Learning process, mainly in Health Sciences. The aim of this study was to develop software (didactic CD‑ROM)on the Learning process of Obstetric Anatomy for Nursing by means of a judicious choice (Portuguese andEnglish languages) of 107 anatomical keywords related to the Obstetrics and sites related to the theme.This CD-ROM (Macromedia Dreamweaver® a computational tool), addressed to the Learning of ObstetricAnatomy for Nursing, could provide logical apprehension of obstetric anatomical terms from didactic texts,images and sites from Web. The educational software development favors an interaction between experts ofHuman Anatomy, Pedagogy and Computer Science. Computing tools applied to Health Sciences are useful topromote knowledge on virtual environments and to complement the Learning of Obstetric Anatomy.

Computational macroscopical patterning of the medullary striae of fourth ventricle

The aim of this study was to pattern macroscopically, by use of computational tools, the number and distributionof the medullary striae (MS) of fourth ventricle. After removing 71 fresh human brain stems, each respectiverhomboid fossa was photographed. The MS were carefully identified to be shaped and fulfilled by means ofa digital pen, using the Adobe Photoshop CS3® program. For absolute and relative analyses of number anddistribution, it was considered the maximum and minimum numbers of striae; striae that reached the ipsilaterallateral recess; presence of horizontal or oblique striae, with or without parallelism; and striae located at pontineor bulbar part of the rhomboid fossa. At least two MS per side were macroscopically detectable in 90.6% ofcases; they were bilaterally absent in 5.3% of pieces; and at least one medullary stria was present in both sidesof the rhomboid fossa in 92% of cases. As on the right side (36% of cases) as on the left (26.6%), two MS werefrequently more present. In 60% of cases, striae reached ipsilateral lateral recess on the left, and in 40% of caseson the right. It was detected horizontal, (non-parallel) oblique and parallel striae in 50.7, 86.7 and 26.7%of cases, respectively. Medial medullary striae were observed in the bulbar part of rhomboid fossa in 80% ofpieces, and in 36% of cases in the pontine part. The MS of fourth ventricle show high morphological variabilitydegree in relation to number and distribution.

Virtual medical and pedagogical applicability of human dermatome patterns: critical review of the literature

Dermatome is an area of skin supplied by the posterior (sensory) root of a spinal nerve derived from a single cord segment, which is a particular aspect of the peripheral distribution of sensory fibers. Its topographic study is important to identify nerve, radicular, or medullary damage. When mapped, these dermatomes are outlined on the body surface and their assessment poses a special challenge to physicians once the distinguished imaging methods are not concordant in some aspects. Computers have taken over increasingly importance as transmitters of anatomical information in both clinical and educational sceneries. The present study concerning the virtual teaching and learning of the human dermatome patterns carries out an update of the literature and its clinical and radiological applicability. Computed-based anatomy programs do not only complement conventional instructions methods, but also provide the groundbreaking means to represent, standardize, and disseminate knowledge of dermatomes. Computer-based programs capable of standardizing a tridimensional map of human dermatomes still need to be developed.

Lower-extremity amputation: a 6-year follow-up study in Brazil.

PURPOSE: To evaluate the 6-year mortality in 50 patients following lower-limb amputation. METHODS: The cumulative survival rate of 50 (28 men, 22 women) amputees aged 54 to 94 years (mean, 67.3; median, 73.5) was retrospectively studied from 1993 to 1998. Indications for above- or below-knee amputation were trauma (n = 2), vasculitis (n = 2), and critical ischaemia of the lower limbs (n = 46). Leg amputation was performed after anamnesis, physical examination, and angiography. All patients were followed up for 6 years by phone or domiciliary visit. A death certificate was verified when a patient was lost to follow-up. Statistical analysis was expressed by the actuarial survival curve. RESULTS: Of 50 amputees, 36 died in the 6 years following leg amputation: 22 in the first year, 3 in the second year, 5 in the third year, 2 in the fourth year, 2 in the fifth year, 2 in the sixth year; 14 remained alive after 6 years. CONCLUSION: Patients who underwent lower-limb amputation had a high 6-year mortality. Most deaths occurred in the first year.

Renal morphometry of fetuses rats treated with cadmium

El cadmio es un metal pesado que se encuentra en la tierra, aire y alimentos. Está presente en forma coditiana todos los días de la vida y actualmente es catalogado como un tóxico, teratogénico y agente carcinogénico. El cadamio causa numerosas lesiones a los órganos humanos y animales. Este trabajo tiene como objetivo investigar los efectos tóxicos en fetos de ratas expuestas a tratamiento con cloruro de cadmio. 10 ratas pre¤adas fueron divididas en dos grupos. Cinco ratas recibieron por administración intraperitoneal 5 mg/Kg de cloruro de cadmio por peso corporal, durante 10 días de pre¤ez y otras cinco ratas recibieron bajo las mismas condiciones del otro grupo, una solución de cloruro de sodio al 0.85 por ciento . Los fetos fueron extraídos junto con las placentas y funículos umbilicales a los 20 días de pre¤ez. La administración del cloruro de cadmio causó una reducción significativa en los pesos de los fetos y placentas. La longitud del funículo umbilical fue más corta en el grupo experimental que en el grupo control. El estudio evaluó las alteraciones morfológicas causadas en los túbulos proximal, distal, contorneados y colectores renales como también en las células del glomérulo renal. La morfometría evidenció alteraciones significativas en los túbulos proximales y en las células glomerulares y, en menor grado, en los túbulos distales. El borde en cepillo de la membrana celular se observó muy sensible y se visualizaron algunas alteraciones. Los glomérulos se presentaron con edema y la cápsula del glomérulo fue también afectada.

Preliminary evaluation of a new, more simplified physiotherapy technique for lymphatic drainage.

The aim of the present study was to evaluate a new, more simplified physiotherapy technique for management of peripheral lymphedema. Fifteen patients (11 female, 4 male) with ages varying from 22 to 63 years (average 54 years) were included in this study. All presented with stage I or II lower limb lymphedema confirmed by lymphoscintigraphy. Each patient underwent a newly designed modified manual lymph drainage technique regularly performed five times a week, one hour per session after one month. The new technique consisted of utilizing sticks, rollers or other cylindrical, flexible, and malleable material which served as a lymph promoting drainage device. All patients demonstrated a highly significant uniform reduction in girth of the leg affected by lymphedema (circumference reduction 2 to 4 cm; average 2.4 cm). After treatment, repeat lymphoscintigraphy suggested a generalized improvement in the scintiscans compared with the initial patterns. This new manual lymph drainage technique efficiently reduces peripheral lymphedema and is less cumbersome and time consuming than standard combined ("decongestive") physiotherapy methods.

Superficial thrombophlebitis and anticardiolipin antibodies--report of association.

The aim of this study was to determine a possible association between recidivist superficial thrombophlebitis and anticardiolipin antibodies. Forty-five patients with two or more episodes of superficial thrombophlebitis in lower limbs (33 women and 12 men with ages ranging from 17 to 60 years, average: 39.8) were studied. The control group was formed by 100 voluntary donors from the blood bank (83 men and 17 women, age range: 21 to 59 years, average: 35.4). Anticardiolipin antibody concentrations were determined by enzyme-linked immunosorbent assay (ELISA). For semiquantitative detection in human sera with use of QUANTA Lite ACA IgG/IgM--INOVA Diagnostic, Inc., and positive values were considered as 15 GPL units/mL and 12.5 MPL units/mL for immunoglobulin G (IgG) and IgM, respectively, as recommended by the test. The Odds Ratio method was chosen for statistical analysis with a confidence interval (CI) of 95%. In 15 patients (33.3%) anticardiolipin antibody positivity was detected, whereas in 12 patients (26.7%) it occurred as immunoglobulin M (IgM) anticardiolipin and in 3 (6.7%) as immunoglobulin G anticardiolipin. In the control group, positivity was found in 7 patients (7%) for those antibodies. Furthermore, the Odds Ratio = 6.64 with CI = 95% and values ranging from 2.48 to 17.82 (p < 0.05) were significant, as well as for IgM/IgG anticardiolipin proportion with Odds Ratio = 5.09, C = 95% and values varying from 1.33 to 19.54 (p < 0.05). The authors conclude that there is a correlation between the presence of anticardiolipin antibodies and recurrent superficial thrombophlebitis.

Bilateral pulmonary artery aneurysm associated with bilateral pulmonary thromboembolism, superior vena caval thrombosis, and Chagas' disease--a case report.

The authors report a case of bilateral pulmonary artery aneurysm in a patient with chronic Chagas' disease and compensated congestive heart failure in whom clinical clues suggested pulmonary thromboembolism, and the actual nature of the lesions was discovered at the time of conventional imaging investigations. This case shows the rarity of bilateral pulmonary aneurysm associated with bilateral pulmonary thromboembolism and the importance of an awareness of this condition in the differential diagnosis for lung masses.