Current concepts in plasticity and nerve transfers: relationship between surgical techniques and outcomes.

OBJECTIVE Neuroplasticity is analyzed in this article as the capacity of the CNS to adapt to external and internal stimuli. It is being increasingly recognized as an important factor for the successful outcome of nerve transfers. Better-known factors are the number of axons that cross the coaptation site, the time interval between trauma and repair, and age. Neuroplasticity is mediated initially by synaptic and neurotransmitter changes. Over time, the activation of previously existing but lowly active connections in the brain cortex contributes further. Dendritic sprouting and axonal elongation might also take place but are less likely to be prominent. METHODS The authors reviewed different factors that play roles in neuroplasticity and functional regeneration after specific nerve transfers. RESULTS The authors found that these different factors include, among others, the distance between cortical areas of the donor and receptor neurons, the presence versus absence of preexisting lowly active interneuronal connections, gross versus fine movement restoration, rehabilitation, brain trauma, and age. CONCLUSIONS The potential for plasticity should be taken into consideration by surgeons when planning surgical strategy and postoperative rehabilitation, because its influence on results cannot be denied.

Phrenic Nerve Transfer for Reconstruction of Elbow Extension in Severe Brachial Plexus Injuries.

Background Restoring elbow extension is an important objective to pursue when repairing the brachial plexus in patients with a flail arm. Based upon the good results obtained using the phrenic nerve to restore elbow flexion and shoulder stability, we hypothesized that this nerve could also be employed to reconstruct elbow extension in patients with severe brachial plexus injuries. Methods A retrospective study of 10 patients in which the phrenic nerve targeted the radial nerve (7 patients) or the branch to the long head of the triceps (3 patients) as a surgical strategy for reconstruction of the brachial plexus. Results The mean postoperative follow-up time was 34 months. At final follow-up, elbow extension graded as M4 was measured in three patients, Medical Research Council MRC M3 in five patients, and M2 in one patient, while one patient experienced no measurable recovery (M0). No patient complained or demonstrated any signs of respiratory insufficiency postoperatively. Conclusions The phrenic nerve is a reliable donor for reanimation of elbow extension in such cases, and the branch to the long head of the triceps should be considered as a better target for the nerve transfer.

Comparative Study of Nerve Grafting versus Distal Nerve Transfer for Treatment of Proximal Injuries of the Ulnar Nerve.

BACKGROUND: The prognosis for motor recovery associated with ulnar nerve injuries at a level proximal to the elbow is usually considered poor. Nerve transfers techniques were introduced as an alternative for the management of nerve lesions of the upper limb, aiming to improve the surgical results of those nerves for which direct reconstruction has not historically yielded good outcomes. METHODS: A retrospective chart review was conducted to compare the outcomes obtained using nerve grafting (20 cases) with those of distal nerve transfer (15 patients) for the treatment of proximal injuries of the ulnar nerve. Nerve transfer combined the suture of the anterior interosseous nerve to the motor branch of the ulnar nerve and the cooptation of its sensory branch to the third common digital nerve via an end-to-side suture. RESULTS: The Medical Research Council M3/M4 outcomes were observed significantly more often in the nerve transfer group (80 vs. 22%), and the mean values for handgrip strength were higher (31.3 ± 5.8 vs. 14.5 ± 7.2 kg). The groups were similar in attaining good sensory recovery (40 vs. 30%) and mean two-point-discrimination (grafting: 11 ± 2 mm; nerve transfer: 9 ± 1 mm). The mean value of the disabilities of arm, shoulder, and hand for the nerve transfer group (23.6 ± 6.7) was significantly lower than for grafting (34.2 ± 8.3). CONCLUSIONS: Distal nerve transfer resulted in better motor and functional outcomes than nerve grafting. Both techniques resulted in similar sensory outcomes, and nerve grafting was demonstrated to be a better technique for managing the painful symptoms associated with the nerve injury.

The radio-radial nerve transfer for elbow extension restoration in C5 to C7 nerve root injury.

Extension of the elbow is required to oppose gravity; however, activation of the triceps brachii is frequently underestimated during the surgical planning for brachial plexus injuries. This report aims to describe a novel technique of distal nerve transfer designed for elbow extension reconstruction in patients sustaining a C5-C7 nerve root injury. We report a patient sustaining a brachial plexus injury with triceps palsy and preserved finger extension motion; after careful intraneural dissection of the radial nerve, a fascicle innervating the extensor digitorum communis muscle was sectioned, derouted and connected to a motor branch to the lateral head of the triceps. Eleven months after surgery, elbow extension strength scored MRC M4. No deficits on finger extension were observed.

Clinical patterns of spontaneous recovery of paralyzed triceps brachii associated with C5 to C7 injuries of the brachial plexus.

Some patients who sustain C5 to C7 nerve root injuries may demonstrate a natural recovery of elbow extension via the lower trunk; however the surgical effect of the reinnervation of the triceps brachii in such cases is still unknown. This study aims to determine the incidence of spontaneous recovery of the tricipital function and to identify the clinical and/or radiological predictors of poor spontaneous functional rehabilitation of elbow extension resulting from injuries of the upper roots of the brachial plexus. We conducted a review of the charts of 24 subjects sustaining an upper trunk syndrome with complete elbow extension palsy and who did not undergone any intervention for reinnervation of the triceps brachii in the primary brachial plexus surgery. Two years posttrauma, the muscle was scored as M0 in 12 patients (50%), M1 in 3 (12.5%), M2 in 1 (4.1%), M3 in 4 (16.6%), and M4 in 4 subjects (16.6%). The number of avulsed roots and the preoperative power of the latissimus dorsi did not demonstrate any significance in predicting the outcome of spontaneous elbow extension recovery; whereas the preoperative paralysis of the muscles for wrist extension was determined to be reliable predictive parameter for poor natural recovery of tricipital function.

Triceps brachii reinnervation in primary reconstruction of the adult brachial plexus: experience in 25 cases.

BACKGROUND: Elbow flexion and shoulder abduction are the primary goals in brachial plexus surgery; however, reinnervation of the triceps is also an objective to be considered, as restoration of elbow extension improves the stabilization of the elbow and can provide a more powerful grasp. This study aims to demonstrate the author's experience with restoration of elbow extension function in cases of brachial plexus surgery in adults. METHODS: Records of 25 patients sustaining traumatic brachial plexus injuries who were treated surgically with reinnervation of the triceps were reviewed. Nine techniques were employed, including posterior cord reconstruction and nerve transfers using donors such as the ipsilateral C7 root, phrenic nerve, medial pectoral nerve, intercostal nerves, the spinal accessory nerve, and a motor fascicle of the ulnar nerve. The targeted structure was the radial nerve or the branch to the long head of the triceps. FINDINGS: Twenty-one subjects (83%) obtained triceps reinnervation, and good results (M3 or better) were observed in 19 cases (76%). M4 grade was noted in 36% of the cases, M3 grade in 40%, M2 grade in 8%, M1 grade in 8%, and M0 grade in 8% of the patients. The best outcomes were observed in the cases presenting a C5 to C7 palsy and those in which the nerve to the triceps was chosen as the transfer target. CONCLUSIONS: Reinnervation of the triceps can be achieved in most patients if adequate donor and recipient nerves are carefully selected based on an individual case-specific decision.

Endoscopically assisted release of the ulnar nerve for cubital tunnel syndrome.

PURPOSE: Recently, the simple decompression of the ulnar nerve has been advocated as the best surgical approach for the treatment of the cubital tunnel syndrome. Encouraged by the positive results observed with the use of the endoscopic approach for the treatment of the carpal tunnel syndrome, there have been reports about the use of endoscopes for decompression of the ulnar nerve at the level of the elbow since 1999. The objective of this study was to demonstrate the surgical results obtained with a simple and replicable technique employed for endoscopic release of the ulnar nerve in cases of cubital tunnel syndrome. METHODS: It was retrospectively studied thirteen patients who presented signs and symptoms of cubital tunnel syndrome and who were operated on by an endoscopically assisted technique, from 2007 to 2009. The approach included the use of a 0 degrees lens neuroendoscope usually employed for ventricular endoscopy. Preoperative clinical and electrophysiological data were collected and compared to those observed 6 months after the surgery. The Dellon's scale was used for rating the severity of the lesions, and the postoperative outcome was assessed based on the Bishop rating system. RESULTS: All procedures were completed successfully via the endoscopically assisted approach, and no surgery had to be converted to an open operation. Postoperatively, 76.9% of the cases were completely free of signs and symptoms (8 and 9 points on the Bishop scale), 15.3% presented with light complaints (7 points), and only one subject (7.6%) reached 5 points on the outcome scale. Complete normalization of the electrophysiological studies was also observed in seven patients, most of whom were classified preoperatively as Dellon's grades I and II, but three of whom were classified as grade III. Normalization of the sensory conduction studies was observed in ten cases, normalization of the motor conduction studies in six subjects, and in four patients, there was improvement in electromyographic parameters. CONCLUSIONS: The endoscopically assisted approach for decompression of the ulnar nerve at the level of the elbow is a minimally invasive technique that demonstrated surgical results similar to those reported via the open approach. It may have additional advantages such as the reduction of soft tissue manipulation, faster mobilization of the arm, and quicker return of the patients to their daily activities.

Quantitative analysis of the variation in angles of the carpal arch after open and endoscopic carpal tunnel release. Clinical article.

OBJECT: Previous studies have demonstrated that the volume of the carpal canal increases after open and endoscopic surgery in patients with carpal tunnel syndrome. There is some controversy regarding the contribution of the post operative widening of the carpal arch to the increment in carpal canal volume. The objectives of this study were to: 1) evaluate the degree of variation in the angles formed by the borders of the carpal arch following the surgical division of the transverse carpal ligament; and 2) determine if there are differences in the variation of these angles after the classical open surgery versus endoscopic carpal tunnel release.Methods. The authors prospectively studied 20 patients undergoing carpal tunnel syndrome surgery: 10 patients were treated via the standard open technique, and 10 underwent endoscopic carpal tunnel release. The angles of the carpal arch were measured on CT scans of the affected hand obtained before and immediately after the surgical procedures.Measurements were performed at the level of the pisiform-scaphoid hiatus and at the level of the hook of the hamate-trapezium hiatus. RESULTS: There was widening of the postoperative angles of the carpal arch after open and endoscopic division of the flexor retinaculum; however, the difference between pre- and postoperative angulations reached statistical significance only in those patients treated by means of the open procedure. The mean (+/- SD) values for the postoperative increase in the angles at the level of the pisiform-scaphoid hiatus were 5.1 +/- 0.4 degrees after open surgery and 2.5 +/- 0.3 degrees after the endoscopically assisted procedure (p < 0.05). At the level of the hook of the hamate-trapezium hiatus, the mean values for the widening of the angles were 6.2 +/- 0.6 degrees for the open surgery group and 1.2 +/- 0.4 degrees for those patients treated by means of the endoscopic technique (p < 0.05). CONCLUSIONS: The widening of the postoperative angles of the carpal arch is a phenomenon observed at the proximal and distal levels of the carpal canal, and it can be noted after both open and endoscopically assisted carpal tunnel release. The endoscopic procedure yielded less increase in these angles than the open surgery.

Functional assessment of C-5 ventral rootlets by intraoperative electrical stimulation of the supraclavicular segment of the long thoracic nerve during brachial plexus surgery.

OBJECT: Anatomical and functional assessment of the intradural segment of the spinal nerves is imperative in brachial plexus surgery, as the repair of postganglionic elements in the setting of a confirmed nerve root avulsion is of no benefit. None of the current techniques to detect these avulsions can provide full information that ensures the functional status of the preganglionic segment of the roots. The objective of this study was to evaluate intraoperative electrical stimulation of the supraclavicular segment of the long thoracic nerve (LTN) as a method to differentiate C-5 nerve root extraforaminal rupture from its intradural avulsion. METHODS: The author performed a prospective analysis of data obtained in 14 patients presenting with the loss of C-5 nerve root function secondary to traumatic brachial plexus injury. The patients were divided into 2 groups: 8 patients in whom the intradural segment of C-5 nerve root was preserved (5 cases of closed traction injuries in whom the computed tomography [CT] myelograms confirmed the integrity of C-5 root and 3 cases of open sharp injuries) and a control group of 6 patients in whom CT myelography demonstrated avulsion of the root. RESULTS: The results of the intraoperative electrical stimulation of the LTN and the surgical outcome of each patient were recorded. The LTN electrical stimulation elicited serratus anterior muscle contraction in cases in which C-5 root was not avulsed, and there were no responses in patients whose radiological evaluation had demonstrated nerve root avulsion. In those patients in whom LTN stimulation proved to be positive, the C-5 root was used as a graftable stump to the suprascapular nerve and/or to the posterior division of the superior trunk. In these cases, favorable results were observed regarding arm abduction in all cases -- Medical Research Council Grades M3 (37%) and M4 (62%). In the control group, the C-5 root was not used as a donor stump and a multiple nerve transfer technique was adopted as the preferred surgical option. CONCLUSIONS: Intraoperative electrical stimulation of the supraclavicular segment of the LTN is a useful complementary method to test the functional status of the C-5 ventral rootlets. If the test is positive (that is, a response is present) it is indicative of extraforaminal rupture of the root, and if negative, it is suggestive of its avulsion.

Suprascapular nerve release for treatment of shoulder and periscapular pain following intracranial spinal accessory nerve injury.

Iatrogenic injury to the spinal accessory nerve is one of the most common causes of trapezius muscle palsy. Dysfunction of this muscle can be a painful and disabling condition because scapular winging may impose traction on the soft tissues of the shoulder region, including the suprascapular nerve. There are few reports regarding therapeutic options for an intracranial injury of the accessory nerve. However, the surgical release of the suprascapular nerve at the level of the scapular notch is a promising alternative approach for treatment of shoulder pain in these cases. The author reports on 3 patients presenting with signs and symptoms of unilateral accessory nerve injury following resection of posterior fossa tumors. A posterior approach was used to release the suprascapular nerve at the level of the scapular notch, transecting the superior transverse scapular ligament. All patients experienced relief of their shoulder and scapular pain following the decompressive surgery. In 1 patient the primary dorsal branch of the C-2 nerve root was transferred to the extracranial segment of the accessory nerve, and in the other 2 patients a tendon transfer (the Eden-Lange procedure) was used. Results from this report show that surgical release of the suprascapular nerve is an effective treatment for shoulder and periscapular pain in patients who have sustained an unrepairable injury to the accessory nerve.

Peripheral nerve compression secondary to adjacent lipomas.

BACKGROUND: Nonneural sheath origin tumors include some rare benign and malignant lesions, and the compression of peripheral nerves by benign fatty tumors is infrequently reported in the medical literature. This study aims to review the authors' experience in treating patients with peripheral nerve compressions secondary to adjacent lipomas. METHODS: This study is a retrospective analysis of data about the patients who presented peripheral nerve compressive symptoms secondary to lipomas in the upper and lower limbs, treated during the period of 1999 to 2006. Included in the cases were those wherein the tumor was in contact with the nerve and the symptoms matched a respective nerve sensitive and/or motor innervation pattern. RESULTS: The upper extremity was the site of 5 (62.5%) of 8 lipomas, followed by the lower limb (2 lesions, 25%), and 1 tumor involved the brachial plexus (12.5%). In 5 cases, the clinical picture was similar to some entrapment neuropathy. Ultrasound imaging was useful to define the mass as a nonneural sheath origin tumor; MRI allowed a better analysis of the relationship of the tumor with other vascular, bony, or ligamentous structures. The lesions were ressected in all the patients, and there was good outcome in 7 cases (87.5%). Otherwise, we could identify signs of external compression on the direct inspection of the involved nerves in only 2 cases. CONCLUSIONS: The surgical treatment offers good outcomes in pain relief and neurological recovery, but one should not expect a real compression effect of the lipoma on the nerve during surgery.

Outcomes of Transferring a Healthy Motor Fascicle From the Radial Nerve to a Branch for the Triceps to Recover Elbow Extension in Partial Brachial Plexus Palsy.

Background: Triceps reinnervation is an important objective to pursue when repairing the brachial plexus for cases with upper roots injuries, and a number of different techniques have been developed in order to restore elbow extension in such cases. Objective: To demonstrate the surgical outcomes associated with the technique of transferring a single healthy motor fascicle from the radial nerve of the affected arm to a branch innervating 1 of the 3 heads of the triceps. Methods: A retrospective study of 13 adult patients sustaining an upper trunk syndrome associated with total elbow extension palsy who underwent the proposed technique as part of the surgical planning for reconstruction of the brachial plexus. Results: Outcomes scored as M4 for elbow extension were noted in 9 cases (70%), M3 in 3 (23%), and M1 in 1 subject (7%). No patient considered the postoperative strength for carpal or finger extension as impaired. There were no differences in outcomes by using a fascicle activating carpal or finger extension as donor, as well as regarding the use of the branch to the medial or lateral head of the triceps as the recipient. Conclusion: The technique of transferring a healthy motor fascicle from the radial nerve of the affected side to one of its nonfunctional motor branches to the triceps is an effective and safe procedure for recovering elbow extension function in patients sustaining partial injuries of the brachial plexus.

[Epidemiological study of the traumatic brachial plexus injuries in adults]. / Estudo epidemiológico das lesões traumáticas de plexo braquial em adultos.

OBJECTIVE: This study aims to provide information about epidemiological factors related to traumatic brachial plexus injuries in adults. METHOD: Prospective analysis of 35 consecutive cases, observed in a period of one year. RESULTS: Most of the lesions were supraclavicular (62%). Twenty-one cases occurred due to traction (60%), 9 to gun shot wound (25%), 3 to compression (8.5%) and two perforation/laceration (5.7%). Motorcycle accidents were the cause of trauma in 54% of patients. CT myelography demonstrated root avulsion in 16 cases (76%). Partial spontaneous neurological recovery was observed in 43% of the patients. Neuropathic pain occurred in 25 (71%) cases, and the use of some oral intake drugs (as amitriptyline or carbamazepine) controlled it in 64% of times. CONCLUSION: Traction is the most frequent mechanism related to brachial plexus injuries, and root avulsions are common in this cases. Pain and concomitant lesions are frequently observed in these group. In this series, the rate of incidence to the local population was 1.75/100000/year.

Peroneal nerve compression resulting from fibular head osteophyte-like lesions.

BACKGROUND: The anatomical relationship of the fibular head with the fibular nerve is a critical point in regard to injuries of peripheral nerves in the lower extremities. In this location, the peroneal nerve may be injured due to several mechanisms, and osteophyte-like lesions can be considered as a differential diagnosis. METHODS: The suitable literature concerning this association is reviewed and a case is presented. A 15-year-old adolescent boy presented with right peroneal nerve palsy on admission. The radiological examinations (computed tomography and magnetic resonance imaging) demonstrated an osteophytic lesion in the head of the right fibula. The patient underwent surgical decompression of the nerve and resection of the lesion. Postoperatively, there was a complete recovery of the deficits. CONCLUSIONS: The association of osteophyte-like bone changes and peroneal nerve palsy is rare. The differential diagnoses of these lesions include cartilaginous exostoses and osteochondromas, which may be related to hereditary multiple exostoses syndrome. The timing of the treatment plays an important role in the neurological recovery.

[Endoscopic carpal tunnel release: a comparative study to the conventional open technique]. / Descompressão do túnel do carpo pela técnica endoscópica: estudo comparativo com a técnica convencional aberta.

OBJECTIVE: The endoscopic carpal tunnel release became a minimally invasive alternative to the standard open technique, because of its theoretical benefits for reducing the postoperative morbidity. The present study goals to compare both techniques about the immediate results of such procedures. METHOD: Two groups of 15 patients underwent, respectively, to the endoscopic and conventional carpal tunnel release surgery. There was no statistical difference between both groups about the preoperative clinical aspects. RESULTS: In all of the cases there were complete resolution of the preoperative symptoms immediately after the procedures. One patient from the endoscopic technique group developed recidive of the symptoms one month after the surgery (6.6%). The oral analgesics intake time and the labor returning time was shorter in the group underwent to the endoscopic procedure. CONCLUSION: The endoscopic carpal tunnel release is an efficient procedure, offering the advantage to shortening the postoperative recovery.

Estrategia para el perfeccionamiento de la asignatura Elementos de Investigación Cualitativa en Salud / Strategy for the improvement of the subject Elements of Qualitative Health Research in the Nursing Major

RESUMEN Introducción: la educación médica en el siglo XXI plantea la necesidad de un nuevo proceso docente educativo, que se fundamente en los principios de la excelencia, calidad y pertinencia. Objetivo: elaborar una estrategia didáctica para el perfeccionamiento del proceso docente educativo de la enseñanza de la investigación cualitativa, que contribuya al desempeño de los estudiantes de la carrera Licenciatura en Enfermería en concordancia con la función investigativa del modelo del profesional. Métodos: se utilizó como método empírico la observación, y el análisis documental. Como método estadístico la estadística descriptiva. Resultados: Se evidencia la concordancia de los criterios de los expertos seleccionados con los autores revisados, en la que se le atribuye una gran importancia al papel de la investigación cualitativa como la herramienta para la construcción de la Enfermería como disciplina y profesión social. Conclusiones: dicha estrategia contribuye al perfeccionamiento desde lo instructivo, educativo y desarrollador del proceso docente educativo, a la vez que permite la incorporación de habilidades investigativas al desempeño profesional.

ABSTRACT Introduction: medical education in the 21st century poses the need for a new teaching-learning process, based on the principles of excellence, quality and relevance. Therefore, this research proposes how to improve the teaching-learning process of the qualitative research so that it contributes to the performance of students in the Nursing major in accordance with the research function of the professional model. Objective: to develop a didactic strategy for the improvement of the teaching-learning process of qualitative research in order to contribute to the performance of students in the Nursing major in accordance with the research function of the professional model. Methods: observation and documentary analysis as an empirical method. Descriptive statistics was applied as a statistical method. Results: the results of the evaluation of the experts, as indicators that define the strategic actions considered in order to be implemented in the strategy proposed, which demonstrates the agreement of the criteria of the chosen experts with the reviewed authors, where a great importance is attributed to the role of the qualitative research as the tool for the construction of nursing as a discipline and social profession. Conclusions: this strategy contributes to the improvement of the instructional, educational and developmental aspects of the teaching-learning process, and at the same time it allows the insertion of research skills into the professional performance.

Descriptive Analysis of Epidemiological Profile from Authors of Civil Claims Due to Supposed Medical Malpractice Against Neurosurgeons in Brazil

Introduction The neurosurgical practice often involves situations that require rapid and immediate decisionmaking, and a very lowmargin for error may eventually lead to an unsatisfactory clinical outcome. Thus, neurosurgery is considered as a medical specialty with high risk for the occurrence of litigation for supposed malpractice. The main objective of the present study was to identify the most prevalent epidemiological profile of the authors of civil claims for alleged malpractice against neurosurgeons, as well as to identify the legal strategies most commonly employed in this type of lawsuit. Methods This is a descriptive, retrospective and quantitative study, with review of the initials/exordials of all civil actions motivated by alleged malpractice against neurosurgeons, defended by an office specialized in Medical Law, from 2008 to 2018. Data were collected relative to the author of the action; the disease that led to the outbreak of the action; and some legal information of interest for the outcome of the litigation. Results During the period studied, 16 compensation/eviction claims were identified as being motivated by supposed neurosurgical malpractice. The average age of the authors was 51 years old; with a high school or undergraduate level of education in 75% of the cases, and especially from the Class B social extract (43%). Degenerative affections of the lumbar spine (12 cases, 75%) were the most common diseases that motivated the litigation, followed by brain tumors (2 cases, 12.5%), 1 case of carpal tunnel syndrome, and 1 case of chronic pain due to inflammatory radiculitis. The average value of the sponsored claim was 649,000.00 reais. Justice gratuity was granted in 80% of the cases and the reversal of the burden of proof by 30%. The main documentary evidence was medical reports ­ from third parties or the surgeon him/herself, and medical records.

Paravertebral abscess by Escherichia coli and melanoma metastasis in an older woman.

Paravertebral abscesses are usually caused by Staphylococcus aureus, and often affect older people with diabetes mellitus or immunosuppression. We report a huge lumbar abscess caused by Escherichia coli in an 81-year-old woman with diabetes and melanoma metastasis. Lumbar vertebra and surrounding soft tissues were involved by the Gram-negative infection, and imaging features were indicative of malignant condition. Diagnosis was established by images of magnetic resonance, histopathology, and bacterial culture from abscess fluid. This condition poses diagnosis challenges and seems to be increasing in frequency. Reports of case studies might enhance the suspicion index of primary care physicians about this entity.

Occipital lobe morphological anatomy: anatomical and surgical aspects.

BACKGROUND: The occipital lobe is an important region of the central nervous system and site of a wide variety of lesions. Different from others regions of the brain, whose anatomy has been already meticulously detailed, controversies about occipital lobe morphology can occasionally hinder the surgical approaches to it. METHOD: Twenty-six hemispheres were dissected, examining the distances of the medial structures of the posterior interhemispheric fissure region; identifying the sulci and gyri more frequently found in the lateral surface; and detailing the anatomy of the occipital horn of the lateral ventricle. Also, anatomical details of structures such as the calcarine sulcus and preoccipital notch were evaluated. RESULTS: Twenty-four hemispheres (92%) showed sulci with evident transverse trajectories in the lateral surface, and it was possible to identify marked longitudinal sulci in 16 (61%). All of the specimen presented a transverse sulcus in the inferior third of the lobe - labeled in this paper as Inferior Transverse Occipital - and 69% of the cases showed a transverse sulcus in the superior third - labeled as Superior Transverse Occipital. The occipital horn was present in 53% of the cases at level of the anterior boundary of the lobe. It was a half moon shaped cavity, whose the medial wall was formed by the calcar avis and the lateral wall, roof and floor formed by fibers of the tapetum. CONCLUSION: The occipital lobe presents parameters that are often recognized in most of the dissected brain and can be useful for the planning and performance of surgery in this area of the brain.

Uso de las tecnologías de la información y las comunicaciones en la carrera de Enfermería / Use of information technology and communications in the nursing career

RESUMEN Introducción: las nuevas tecnologías favorecen el desarrollo científico técnico de la sociedad, por lo cual se deben asimilar en el proceso enseñanza aprendizaje por los estudiantes de la carrera. Objetivo: caracterizar el uso de las tecnologías de la información y las comunicaciones por los estudiantes de la carrera Licenciatura en Enfermería de la Universidad de Ciencias Médicas de Pinar del Río entre enero y marzo de 2018. Métodos: estudio observacional, descriptivo, y transversal en los estudiantes de segundo año de licenciatura en Enfermería. Se emplearon métodos teóricos y empíricos. Se aplicaron medidas estadísticas como frecuencia absoluta y relativa porcentual. Resultados: se encontró que el 23,5 % no poseía acceso a ningún medio informático. La mitad del universo de estudio expresó poseer un teléfono móvil con sistema operativo Android o iOS. El 59,3 % de los estudiantes no empleaban la conexión institucional a Internet, el 23,5 % la emplea para fines docentes. El 76,5 % refirió utilizar las conferencias y materiales complementarios digitalizados para el estudio; el 46,9 % empleó tanto los medios digitales, como los convencionales. El 12 % de los estudiantes expresó que no encuentran útiles los medios informáticos para el aprendizaje. Conclusiones: Se encontró utilidad en el uso de las Tecnologías de la Información y la Comunicación en el proceso docente, los cuales poseen con elevado acceso; donde los teléfonos inteligentes, son las más empleadas, existiendo una pobre utilización del Internet para el proceso docente e investigativo. Los materiales en soporte digital son ampliamente empleados para el estudio.

ABSTRACT Introduction: new technologies favor the scientific and technical development of society, which is why they must be assimilated in the teaching-learning process by the students of the career. Objective: to characterize the use of information and communication technologies by students of the Degree in Nursing at the University of Medical Sciences of Pinar del Río between January and March 2018. Methods: observational, descriptive, and cross-sectional study in second-year undergraduate students in Nursing. Theoretical and empirical methods were used. Statistical measures were applied as absolute frequency and relative percentage. Results: it was found that 23,5 % did not have access to any computer medium. Half of the study universe said they own a mobile phone with an Android or iOS operating system. 59,3 % of the students did not use the institutional Internet connection, 23,5 % used it for teaching purposes. 76,5 % reported using conferences and complementary materials digitized for the study; 46,9 % used both digital and conventional media. 12 % of the students expressed that they do not find the computer media useful for learning. Conclusions: It was found useful in the use of Information and Communication Technologies in the teaching process, which have high access; where smartphones are the most used, there is a poor use of the Internet for the teaching and research process. The materials in digital support are widely used for the study.