Morphological and morphometric analysis of Psoas Minor Muscle in cadavers

The Psoas Minor Muscle is considered inconstant and it’s often absent. This muscle consists of a short proximal fixation tendon originated from the sides of the twelfth thoracic vertebra, first lumbar vertebra and corresponding intervertebral disc, continuous with a short spindle-shaped morphology muscular venter, ending with a long distal fixation tendon inserted in the pectineal line of the pubis and iliopectineal eminence. Due to the lack of information in liteature regarding Psoas Minor muscle’s morphology and morphometry, this study aimed to obtain more detailed information about the muscle in order to expand knowledge of its morphology and morphometry. In order to perform this study, it was used as work material 30 cadaver parts of lower limbs belonging to the anatomical specimens’ collection of Federal Rural University of Pernambuco and Federal University of Pernmabuco. It was found in this study, an absence percentage of Psoas Minor Muscle around 73%. The muscles analyzed did not show any anatomical variation and presented as morphometric characteristics a proximal tendon with average length of 18.11 mm, a muscular venter with average of 71.25 mm for your lenght and a lenght for a distal tendon with average of 150.97 mm. This study confirms the literature’s descriptions, demonstrating the inconstancy of Psoas Minor Muscle and, in our results, it did not show any morphological changes related to its proximal or distal fixation, and to its muscular venter. However, our results showed unpublished data related to width and thickness of the muscle venter of the Psoas Minor.

Orthotopic liver transplantation for hepatocellular carcinoma: one center's experience in the Northeast of Brazil.

Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world and the third leading cause of cancer-related death. In this study, we sought to assess the outcome of patients with HCC who underwent orthotopic liver transplantation (OLT) in a center in the northeast of Brazil. Between May 2002 and July 2008, 294 OLTs were performed at our center. In 45 patients, HCC was confirmed by histological examination of the explant. Patients were predominantly men of ages ranging from 14-67 years. Hepatitis C virus was involved in 55.4% of the cases. Alpha fetoprotein (AFP) levels were normal in 65.2% of the patients and surpassed 100 ng/mL in only 10.4%. The median waiting time on the list was 10 months. Seventeen patients (37.7%) presented a solitary nodule, 19 (42.2%) had 2 or 3 nodules, and 9 patients (20%) had more than 3 nodules. The maximal diameter of the largest tumor was <3 cm in 26 patients (57.7%) and exceeded 5 cm in 6 patients (13.3%). Ten tumors were well differentiated, 32 were moderately differentiated, and 3 were poorly differentiated. Eleven tumors showed microvascular invasion. There have been 4 tumor recurrences. There was an association between microvascular invasion and tumor recurrence with a statistically significant relative risk. In conclusion, OLT is an excellent option for patients with HCC. The recurrence rate was low (<10%). However, we believe that more prospective studies are needed about OLT beyond the Milan criteria because our study suggested that microvascular invasion may be more important than tumor size or number.

Continuous versus interrupted suture for hepatic artery anastomosis in liver transplantation: differences in the incidence of hepatic artery thrombosis.

BACKGROUND: Hepatic artery thrombosis (HAT) is a serious complication after orthotopic liver transplantation (OLT) and remains a significant cause of graft loss. HAT following OLT has been reported in 3% to 9% of patients. Among the surgical factors considered to be associated with HAT, arterial reconstruction might be the most important. The goal of this study was to compare the incidence of HAT between interrupted suture (IS) and continuous suture (CS) techniques during hepatic artery reconstruction in liver transplantation. METHODS: We performed a retrospective analysis of 200 consecutive liver transplantations occurring between May 2002 and December 2006, including medical records for: age, gender, cold ischemic time, warm ischemic time, type and number of arterial anastomosis. Hepatic artery anastomoses were performed using a 7-0 prolene with a running CS in the first 105 patients (CS group), and with an IS in the last 95 patients (IS group). RESULTS: Statistical analysis of age, gender, cold and warm ischemia time, and number of hepatic artery anastomoses was not different between the CS and IS groups. Eleven episodes of HAT were identified in the CS group (10%) and two episodes (2%) in the IS cohort, a significant difference (P = .0173). CONCLUSIONS: Our results suggested that IS might be a better choice for hepatic artery anastomosis with a lower incidence of HAT.