Surgical anatomy of the variations of the arrangement of the tendons of the muscles of the pes anserinus in male adults.

The descriptions of the morphology of the human pes anserinus (the combined insertions of the tendons expansions of medial muscles of the thigh) vary on the arrangement of the muscles and tendons that originate the so-called "goose's foot". Although descriptions found in the literature include up to 7 muscles, most of the authors indicated this anatomical structure as formed only by the insertions of the gracilis, sartorius and semitendinosus muscles. Our aim is to find out in Brazilian male adult cadavers the most frequent disposition of the tendons for application in the orthopedic practice. So far, 60 inferior members of 30 cadavers from the laboratories of the Anatomy Departments of the Medical Schools of the Universities of Mogi das Cruzes and Santos were studied. The dissection was performed in cadavers fixed in 10% formaldehyde solution. The specimens were then drawn and photographed. In all 30 cadavers only 3 muscles participated in the formation of the pes anserinus but several variations were found in the disposition of the tendons. Applications of the anatomical knowledge of this tendinous arrangement were discussed.

Selective inner hair cell loss in premature infants and cochlea pathological patterns from neonatal intensive care unit autopsies.

BACKGROUND: Deafness and handicapping sensorineural hearing impairment occur frequently in neonatal intensive care unit survivors for unknown reasons. PATIENTS AND METHODS: Hearing was tested early and repeatedly in neonatal intensive care unit patients with an auditory brainstem response (ABR) screener. The temporal bones of 15 nonsurvivors (30 ears) were fixed promptly (average, 5 hours) after death for histological evaluation. RESULTS: Among these patients, 12 failed the ABR screen bilaterally, 1 passed unilaterally, and 2 passed bilaterally. Cochlear histopathologic conditions that could contribute to hearing loss included bilateral selective outer hair cell loss in 2 patients, bilateral selective inner hair cell loss in 3 (all premature), and a combination of both outer and inner hair cell loss in 2. Other hair cell abnormalities were noted; the 2 infants who had passed the ABR screen demonstrated normal histological features. Neuronal counts were normal. CONCLUSIONS: Auditory brainstem response failure among these neonatal intensive care unit infants who died was extremely common in part owing to an unexpected histological alteration, selective inner hair cell loss among premature newborns, that should be detectable uniquely by the ABR testing method. Additional histological patterns suggest more than one cause for neonatal intensive care unit hearing loss. Hair cell loss patterns seem frequently compatible with in utero damage.

Isokinetic assessment of the flexor-extensor balance of the knee in athletes with total rupture of the anterior cruciate ligament.

The purpose of this study was to assess the flexor-extensor group of muscles of the knee in young athletes diagnosed with a total rupture of the anterior cruciate ligament (ACL). Eighteen knees of 18 athletes (14 men and 4 women) with an average age of 21.6 years (range 16-32 years) were assessed with a Cybex 6000 model isokinetic apparatus. The average internal between occurrence of the injury and assessment was 10.2 months (range 2-48 months). There was an associated meniscal injury in eight of the knees. Athletes with any other kind of associated injury, limitation, or blockage of the movement of the joint, significant pain during the exam, or interval between injury and exam of less than two months were excluded from the study. The parameters studied were the peak torque-velocity and flexor-extensor relationships at the constant angular velocities of 60 degrees/sec and 240 degrees/sec. Previous warming-up was done by means of an ergometric bicycle and adaptation with 3 submaximal repetitions. The contra-lateral side, which presented no injury, was used as control. Peak torque (PT) at the constant velocity of 60 degrees/sec was greater than that at 240 degrees/sec for knees with and without injuries. However, there was no significant difference between the injured and uninjured sides at 60 degrees/sec or at 240 degrees/sec. The average value for the flexor-extensor relationship at 60 degrees/sec on the injured was 60% ((6), compared to 57% ((10) on the contra-lateral side. At 240 degrees/sec, the average value was 75% ((10) on the injured side, and 65% ((12) on the contra-lateral side. In conclusion, despite the complete rupture of the ACL of one knee, the average values for the flexor-extensor relationship were similar on the injured and uninjured sides at the velocity of 60 degrees/sec. As the velocity increased, an increase in the values for the flexor-extensor relationship of the knee also occurred, indicating a tendency of the performance of the flexor muscle group to approach that of the extensor muscle group, and this tendency was more pronounced on the side of the injury.

Padronização da rotina operacional em banco de ossos realizada por um serviço hemoterápico: propostas de elaboração de normas / Guidelines to standardize an operation routine manual of a bone bank at Sírio-Libanês Hospital

Desde 1970 vem ocorrendo crescimento na utilização de ossos alogênicos em vários procedimentos ortopédicos, resultando na criação de bancos de ossos no mundo todo. Com o propósito de minimizar a morbidade nos receptores de ossos e padronizar procedimento operacionais para banco de ossos, os autores consideram necessário e fundamental estabelecer normas e critérios para regulamentar a doação de ossos. Seu objetivo é propor uma padronização para procedimentos operacionais em banco de ossos no Brasil. Com a finalidade de padronizar um manual operacional, vários manuais de padronização provenientes de instituições internacionais foram consultados, juntamente com a Portaria 1.376 do Ministério da Saúde (1993), por ser esta a referência concernente à doação de sangue no Brasil. Dessa maneira, parece ser plausível a adaptação de regulamentos internacionais para banco de ossos à legislação brasileira. Um manual de procedimentos operacionais em banco de ossos foi desenvolvido com o objetivo de padronizar os critérios para a retirada, identificação, processamento, estoque e liberação do material doado. Nesse manual também estão contidos os testes sorológicos mínimos para a investigação de doenças infecciosas e testes microbiológicos para o descarte de material contaminado. O banco de ossos necessita de um programa de controle de qualidade similar ao do banco de sangue. É recomendado que o banco de ossos seja gerenciado pelo banco de sangue, por sua experiência gerencial e sua estrutura operacional adequada para o manuseio do material doado.

[Retrospective study of traffic accident victims: incidence after the new National Traffic Code implantation]. / Estudo retrospectivo dos pacientes vítimas de acidente de trânsito: incidência após a introdução do novo código nacional de trânsito.

The authors present a study about the frequency of the injuries caused by traffic accidents on the orthopedic patients admitted to the emergency of Institute of Orthopedics and Traumatology at the Hospital das Clínicas of the School of Medicine São Paulo University, before and after the new National Traffic Code. They found a decreased number of polytraumatized patients and severe injuries after the beginning of this new legislation.

Avaliaçäo de atletas: metodologia do grupo de Medicina Esportiva do IOT/HC-FMUSP. Aplicaçäo em 11 maratonistas de elite / Evaluation of athetes: method of the IOT/HC-FMUSP Sports Medicine Group. Application in 11 high level marathon athletes

Foram avaliados 11 atletas de elite praticantes de maratona através do protocolo do Grupo de Medicina Esportiva do IOT-HC/FMUSP, criado para a avaliaçäo de 500 atletas jovens (8 a 18 anos), de dez modalidades esportivas (5 coletivas e 5 individuais). Os atletas responderam a questionário geral, ortopédico, nutricional e psicológico. Passaram por exame clínico e ortopédico completo. Foram submetidos a mensuraçäo antropométrica e de flexibilidade. Foram feitas a avaliaçäo e orientaçäo nutricional ao lado de provas laboratoriais, densitometria, cintilografia e eletrocardiografia. Para a análise do dicionamento cardiorrespiratório foram utilizados os testes de Harvard e Ruffier modificados, obtendo-se nas provas de pista a avaliaçäo final. Os 11 atletas mostraram-se, em sua maioria, aptos para a prática da maratona, com pequenas correçöes já transmitidas pelos avaliadores.

[Pyoarthritis of the knee--caseload of the Hospital das Clínicas da FMUSP 1990-1994 (86 cases)]. / Pioartrite de joelho--casuística do Hospital das Clínicas da FMUSP 1990-1994 (86 casos).

The authors performed a prospective study of 86 patients with septic arthritis of the knee between 1990 e 1994. The age, sex, predisposing factors, time between onset of symptoms and treatment, etiologic organism and their route of entrance in the joint, previous use of antibiotic the data from of treatment, stay at the hospital and complications were evaluated and compared with the literature.

[Pathologic synovial plica of the knee. Results of surgical treatment in 37 knees]. / Plica sinovial patológica do joelho Resultados do tratamento cirúrgico em 37 joelhos.

The authors present their results on the surgical treatment of pathologic synovial plica in 69 knees of 66 patients. In all patients the synovial plica was the primary pathology and there where no associated knee pathologies. 36 knees were operated between 1979 and 1986 by an open procedure, and 33 had arthroscopic surgery from 1986 to 1991. All patients had previous unsuccessful conservative treatment. The operation was a partial sinovectomy, including all the extension of the synovial plica. The results were obviously superior in the arthroscopic procedure, with 100% of excellent results and quick recovery. All patients in this group had a full range of knee movements by the end of the second week after surgery. In the open surgery group, only 76% of the results were excellent and the full range of movements was obtained only by the fourth or fifth week.

[Indications for surgical treatment in acute knee]. / Indicações do tratamento cirúrgico no joelho agudo.

Indications for surgical treatment in the acute knee injuries are discussed: obligatory and those in which the immediate surgical intervention can avoid chronicity of the condition. There must be taken in consideration also the factors such as age, sex and physical activity and state of ligaments, patella and eventual existence of necrosis.

[Femoropatellar pathology: concept update]. / Patologia fêmoro patelar: atualização de conceitos.

By biomechanical method the extensor mechanism of the knee is analysed, and the causes of instability and hyperpressure in the patello-femoral syndrome are discussed. Concerning these two entities, the author presents: definition, diagnosis, classification, clinical aspects, differential diagnosis, and surgical and clinical treatment.

Pathologic synovial plica of the knee. Results of conservative treatment.

Observations of 136 cases of pathologic synovial plica of the knee were analyzed with regard to etiology, symptoms, and the results of conservative treatment. The results obtained with conservative treatment were good in 40% of cases, average in 20%, and poor in 40%. In our opinion, these results justify the treatment of this condition with physical therapy before proceeding with surgical correction. The objective of physical therapy was to decrease the compressive forces in the anterior compartment of the knee by increasing the structural flexibility of the flexor and extensor muscles. This increase in flexibility was obtained by instituting stretching exercises for the hamstrings, gastrocnemius, and quadriceps.