Erosive Vulvar Lichen Planus and Risk of Vulvar Neoplasia.

OBJECTIVE: The aim of the study was to assess the risk of vulvar cancer and precursors in a cohort of women with vulvar lichen planus (LP) and the clinical and therapeutic features of these patients. MATERIALS AND METHODS: A retrospective cohort study, including all the women with the diagnosis of vulvar LP, followed in one institution during a period of 11 years, was performed. Demographic and clinical data, as well as treatment, follow-up, and histology results, were evaluated. RESULTS: A total of 127 women were diagnosed with vulvar LP. The mean follow-up time was 3.9 ± 0.5 years (range = 1-11 years). Ultrapotent topical corticosteroids were first-line treatment in 91.8% (n = 112), with 32 cases (25.2%) needing an alternative treatment. Overall, 30 biopsies were performed in 19 women (15%). Vulvar high-grade squamous intraepithelial lesion was diagnosed in 3 women (2.4%), 2 (1.6%) of whom were later diagnosed with vulvar squamous cell carcinoma. No cases of differentiated vulvar intraepithelial neoplasia were observed. CONCLUSIONS: Premalignant/malignant transformation in women with vulvar LP under surveillance and compliant with treatment is low. A close follow-up seems to be crucial to prevent future malignancy. Biopsies should be performed whenever a suspicious lesion seems during follow-up.

Knowledge of Vulvar Anatomy and Self-examination in a Sample of Italian Women.

OBJECTIVE: The aim of the study was to investigate the knowledge of vulvar anatomy and vulvar self-examination (VSE) in a sample of Italian women attending a gynecology clinic. METHODS: For this original research from May to July 2019, 512 women attending the Lower Genital Tract Clinic at the Department of Surgical Sciences of the University of Torino were invited to participate in a 29-question survey about vulvar anatomy, VSE, and sociodemographic details. Data were analyzed using descriptive statistics. RESULTS: Of 512 patients, 500 completed the questionnaire (98% response rate). The mean age of respondents was 41 years (range = 17-77 years). Education level was evenly distributed between elementary, high school, and university graduates. Only 15% of interviewed women were able correctly sketching vulvar anatomy. Seventy-six percent of the women had not heard about VSE, and 61% of the women approach their genitalia with feelings of shame and embarrassment. Only 23% of the women would seek medical advice after identification of possible abnormalities during VSE. A majority (69%) of the women would like to have more information about VSE and vulvar health through educational videos and social media. CONCLUSIONS: Education about VSE may lead to earlier diagnosis of vulvar cancers and other pathologies. Further efforts are needed to disperse information about normal external female genital anatomy and VSE to achieve self-confidence among women.

Cervical pessary for the prevention of preterm birth: is it of any use?

Preterm birth (PTB) represents a heavy burden in modern obstetrics as it is a major cause of perinatal morbidity and mortality. After the introduction of transvaginal sonography (TVS) screening, secondary prevention of PTB has been re-evaluated on the basis of pre-existing cervical length (CL) and meanwhile the cervical pessary has become an object of increasing interest. This device consists of a silicone cone acting mechanically, that can be easily placed or removed, but whose efficacy is still controversial. Therefore, this study aims to review the most recent evidence regarding its efficacy for prevention of PTB, together with the correct position, the evidence regarding the mechanism of action, the exclusion criteria for pessary placement and the reasons for precocious removal. Overall, it is well tolerated and there are no reports on severe associated side effects. Finally, we discuss published data regarding cervical pessary efficacy. Although results are still conflicting, it seems however to be an effective method for preventing PTB, both in singleton and multiple pregnancies, but further evidence is needed.

Identification of parathyroid glands: anatomical study and surgical implications.

While performing thyroid surgery, the unintentional lesion of parathyroid glands and laryngeal nerves results in a profound alteration in patient's quality of life. To minimize thyroid surgery morbidity, the surgeon must have an in-depth knowledge of the thyroid gland morphology and its anatomical relations in the anterior compartment of the neck. This work intended to simulate total thyroidectomies using cadaver parts and isolate fragments that may correspond to parathyroid glands. The thyroid glands and "eventual" parathyroid glands were then submitted to histological study. Ninety-two cadaver parts were used for macroscopic dissection. A total of 242 fragments were isolated, 154 of which were confirmed through histological study to be parathyroid glands. In 36 cases, all "eventual" parathyroid glands isolated during dissection were confirmed through histological verification. In 40 cases, some glands were confirmed. In 16 cases, none of the "eventual" parathyroid glands was confirmed. The 92 thyroid glands isolated during dissection were also submitted to histological study. In 21 thyroid glands, 16 parathyroid glands were identified in the histological cuts: 8 sub-capsular, 8 extra-capsular, 6 intra-thyroidal. There was no statistical difference between the dimensions of the parathyroid glands. Parathyroid gland identification and preservation are sometimes a challenge during thyroid surgery, difficulty that has been demonstrated during dissection of cadaver parts.

Effects of a short-term temperature increase on arthropod communities associated with pastures.

The impact of climate change on islands is expected to cause dramatic consequences on native biodiversity. However, limited data are available for arthropod communities in island agroecosystems. In this study, we simulate a small-scale climatic change (average of +1.2°C), using Open Top Chambers (OTCs) in forage crops in the Azores Archipelago (Portugal) and test the responses of arthropod communities associated with intensively-managed pastures. At three sites, twenty 1 x 1 m plots were established: 10 treatment plots with OTCs and 10 control plots. Arthropods were sampled with pitfall traps on two sampling events (winter and summer of 2020). When considering all species collected, arthropods' abundance was lower in OTCs. Specific taxa, namely spiders and beetles, showed a fast response to the OTCs' presence. The assemblage of non-indigenous spiders well adapted to pastures showed a significant difference in diversity with a slightly greater richness, but lower abundance inside the warmer plots. However, the presence of OTCs resulted in a decrease in beetle richness and abundance. This decline may be attributed to the multiple effects of warming. Therefore, it is imperative to conduct further investigations to elucidate the ecological processes that underlie the observed patterns.

Assessing the effects of climate change on arthropod abundance in Azorean pastures: PASTURCLIM project's baseline monitoring data.

Background: The data we present are part of the project PASTURCLIM (Impact of climate change on pasture's productivity and nutritional composition in the Azores). The project aims to assess the consequences of climate change (e.g. temperature increase) on the grass production and its quality for forage, as well as to assess changes in the arthropod communities associated with the Azorean intensive pastures. An in situ experiment was set up using Open Top Chambers (OTCs), in order to simulate an increasing of temperature (average of +1.2ºC) on pastures. In this contribution, we present the data relative to the arthropod sampling. New information: We provide an inventory of all arthropods recorded inside OTCs and in control plots in three intensively managed pastures dominated by grasses in Terceira Island (Azores): two of them dominated by ryegrass, Loliummultiflorum Lam. (Poaceae), located respectively at 186 m and 301 m above sea level; and one field dominated by common velvetgrass, Holcuslanatus L. (Poaceae), located at an altitude of 385 m.A total of 41351 specimens were collected. Organisms collected belong to four classes, 15 orders, 60 families and 171 species/morphospecies (including 34 taxa identified only at order, family or genus level). Therefore, for only 137 taxa, we have a scientific name associated (n = 38918). A total of 75% of the species (n = 129 species) are considered introduced (including all the species with indeterminate colonisation status that are possibly also exotic species (n = 7622)), representing 71% of the total abundance (n = 29664 specimens). A total of 19% of the species (n = 33 species) are considered native non-endemic representing 28% of the total abundance (n = 11608 specimens). Only one endemic species was sampled, the wolf spider Pardosaacorensis Simon, 1883 (1% of the species), representing 0.2% of the total abundance (n = 79 specimens). Spiders (5056 specimens) and beetles (18310 specimens) were the dominant taxa representing, respectively, 20 and 78 morphospecies.Since the main aim of this study was to have a better knowledge on arthropod communities present in Azorean pastures under a simulated temperature increase, the principal novelty of this paper is the contribution with distribution and abundance data to a baseline knowledge on the future consequences of climate changes on arthropod communities in Azorean pastures.

Outlook on the phase equilibria of the innovative system of "protected glycerol": 1,4-dioxaspiro[4.5]decane-2-methanol and alternative solvents.

Fundamental data on 1,4-dioxaspiro[4.5]decane-2-methanol are scarce. This work presents the foremost systematic data on the solubility of 1,4-dioxaspiro[4.5]decane-2-methanol in sustainable solvents such as water and ionic liquids accompanied by the interpretation of interactions occurring in such binary systems. 1,4-Dioxaspiro[4.5]decane-2-methanol, here called protected glycerol, has been synthesized in order to protect the two hydroxyl groups of glycerol, thus avoiding the formation of side products in a specific process. A series of imidazolium salts accompanied by pyridinium, phosphonium, and ammonium ones with various types of counterions were used in this study. The liquid-liquid and solid-liquid equilibrium measurements in binary systems were carried out by using a dynamic method at atmospheric pressure over the temperature range from 273.00 to 378.30 K or below the boiling point of the solvent. Among all tested sustainable solvents, protected glycerol exhibited limited solubility, with only a few of them in the temperature range studied. The majority of the examined ionic liquids, either hydrophilic or hydrophobic, showed complete miscibility with this monohydroxyol. The Fourier-transform infrared (FTIR) spectroscopy studies of solute and solvents showing a miscibility gap and of their mixtures were performed to obtain insight into major inter- and intramolecular interactions in the investigated systems. Furthermore, the differential scanning calorimetry was used for the first time to determine the melting point, the enthalpy of melting, and the temperature and enthalpy of the solid-solid phase transition of 1-allyl-3-methylimidazolium chloride [Amim][Cl]. The results for the solubility of protected glycerol in sustainable solvents can be used to design future alternative reactions, such as telomerization with protected glycerol in ionic liquids for more specific building blocks and extraction/or separation that involves these mixtures.

Distribution of arbuscular mycorrhizal fungi (AMF) in Terceira and São Miguel Islands (Azores).

BACKGROUND: The data, presented here, come from samples collected during three research projects which aimed to assess the impact of land-use type on Arbuscular Mycorrhizal Fungi (AMF) diversity and community composition in pastures of Terceira Island (Azores, Macaronesia, Portugal) and also in the native forest of two Azorean Islands (Terceira and São Miguel; Azores, Macaronesia, Portugal). Both projects contributed to improving the knowledge of AMF community structure at both local and regional scales. NEW INFORMATION: Little is known on the AMF communities from Azores islands and this study reports the first survey in two Azorean Islands (Terceira and São Miguel). A total of 18,733 glomeromycotan spores were classified at the species level from 244 field soil samples collected in three different habitat types - native forests (dominated by Juniperus brevifolia and Picconia azorica), semi-natural and intensively-managed pastures. Thirty-seven distinct spore morphotypes, representing ten glomeromycotan families, were detected. Species of the family Acaulosporaceae dominated the samples, with 13 species (38% of the taxa), followed by Glomeraceae (6 spp.), Diversisporaceae (4 spp.), Archaeosporaceae (3 spp.), Claroideoglomeraceae (3 spp.), Gigasporaceae (3 spp.), Ambisporaceae and Paraglomeraceae, both with the same number of AMF species (2 spp.), Sacculosporaceae (1 sp.) and Entrophospora (family insertae sedis). Members of the family Acaulosporaceae occurred almost exclusively in the native forests especially associated with the Picconia azorica rhizosphere, while members of Gigasporaceae family showed a high tendency to occupy the semi-natural pastures and the native forests of Picconia azorica. Members of Glomeraceae family were broadly distributed by all types of habitat which confirm the high ecological plasticity of this AMF family to occupy the more diverse habitats.

Varenicline for cognitive impairment in people with schizophrenia: systematic review and meta-analysis.

BACKGROUND: People with schizophrenia frequently have cognitive dysfunction, which does not respond to pharmacological interventions. Varenicline has been identified as a potential treatment option for nicotinic receptor dysfunction with a potential to treat cognitive impairment in schizophrenia. METHODS: We conducted a systematic review of Pubmed, Embase, Psycinfo, CINAHL and the Cochrane Schizophrenia Trial Registry for randomised controlled trials of varenicline in people with schizophrenia for cognitive dysfunction. We excluded trials among people with dementia. We then undertook a meta-analysis with the primary outcome of difference in change of cognitive measures between varenicline and placebo as well as secondary outcomes of difference in rates of adverse events. We conducted a sensitivity analysis on smoking status and study duration. RESULTS: We included four papers in the meta-analysis (n = 339). Varenicline was not superior to placebo for overall cognition (SMD = -0.022, 95% CI -0.154-0.110; Z = -0.333; p = 0.739), attention (SMD = -0.047, 95% CI -0.199-0.104; Z = -0.613; p = 0.540), executive function (SMD = -0.060, 95% CI -0.469-0.348; Z =- 0.290; p = 0.772) or processing speed (SMD = 0.038, 95% CI -0.232-0.308; Z = 0.279; p = 0.780). There was no difference in psychotic symptoms, but varenicline was associated with higher rates of nausea. Sensitivity analyses for smoking status and study duration did not alter the results. CONCLUSION: Within the present literature, varenicline does not appear to be a useful target compound for improving cognitive impairment in schizophrenia. Based on these results, a trial would need over 2500 participants to be powered to show statistically significant findings.

Surgical treatment of postoperative laparostomy and pyloroduodenostomy-Case report.

INTRODUCTION: Postoperative duodenal-cutaneous fistula represents a rare and very complex problem. In most cases operative management becomes necessary, but only after local and systemic stabilization and sepsis control. CASE PRESENTATION: A 39-year-old man was admitted for surgical management of laparostomy and pyloro-duodenostomy of the first (DI) and second (DII) duodenal segments with one year of evolution, as a complication of several surgical interventions. The patient had been previously submitted to surgical interventions in another institution for: 1- lower gastrointestinal haemorrhage: treated with total colectomy; 2- upper gastrointestinal haemorrhage: performed a pyloroduodenotomy and pyloroplasty; 3- evisceration: abdominal wall closure; 4- biliary peritonitis due to pyloroplasty dehiscence: submitted to laparotomy with placement of a gastrostomy tube and pyloroduodenostomy tube; 5- intestinal haemorrhage through the pyloroduodenostomy tube: inconclusive exploratory laparotomy plus laparostomy; 6- gastrointestinal haemorrhage and shock: submitted to jejunal segmental resection (haemorrhagic mucous nodule); 7- several complications related to drainage, fistulae and celiostomy. DISCUSSION: After initial medical treatment for local and systemic stabilization during four months, the following surgical procedures were performed: antrectomy; duodenectomy of DI and the suprapapillary part of DII; T-L gastrojejunostomy; duodenojejunostomy (DII and DIII) L-L at 40 cm of the gastrojejunal anastomosis; T-L jejunojejunostomy; abdominoplasty with a mesh and fibrin glue application; primary cutaneous closure. A multitubular drain was positioned near the duodeno-jejunal anastomosis and a suction drain was positioned in the subcutaneous space. CONCLUSION: The patient was discharged at the 60th postoperative day, asymptomatic and with a weight gain of 10 kg.

Surgical treatment of giant gist with acute gastrointestinal bleeding: Case report.

INTRODUCTION: Gastrointestinal stromal tumors represent about 1% of the tumors of digestive tract. Their presentation consists often of indolent symptoms. However, they can present as surgical emergencies in rare cases. This work presents a case of a giant jejunal GIST that required emergent surgical treatment. CASE PRESENTATION: A 60-year-old male presented with abdominal pain and acute low gastrointestinal bleeding. During observation a palpable mass was detected in the periumbilical region, left hypochondrium and left flank. A non-total colonoscopy was inconclusive. An Angio-CT showed a large exophytic tumor arising from the 4th duodenal segment and first jejunal segment with approximately 20 × 14 x 13 cm, with apparent intratumoral bleeding. Due to haemodynamic instability, the patient was submitted to emergency laparotomy, in which a large tumor was found arising from the first jejunal segment. A segmental enterectomy was performed and the post-operative period ran without complications. The histopathologic exam showed a gastro-intestinal stromal tumor of epithelioid cell nature, with low mitotic count (<5 per 50HPF), categorized as T4N0 stage IIIA. The imunohistochemical analysis revealed positivity for CD117 (c-kit) and DOG-1. The patient started Imatinib therapy, and is free of disease recurrence for 3 years. CONCLUSIONS: This case pretends to review an unusual presentation of a giant jejunal intestinal GISTs as well as its management in an emergent context.

Hydrogenation of Carbon Dioxide to Methane by Ruthenium Nanoparticles in Ionic Liquid.

The efficient transformation of carbon dioxide into fuels can be an excellent alternative to sequestration. In this work, we describe CO2 hydrogenation to methane in imidazolium-based ionic liquid media, using ruthenium nanoparticles prepared in situ as catalyst. The best yield of methane (69 %) was achieved using 0.24 mol % ruthenium catalyst (in [omim][NTf2 ], 1-octyl-3-methylimidazolium bistrifluoromethanesulfonylimide, at 40 bar of hydrogen pressure plus 40 bar of CO2 pressure, and at 150 °C.

New records and detailed distribution and abundance of selected arthropod species collected between 1999 and 2011 in Azorean native forests.

BACKGROUND: In this contribution we present detailed distribution and abundance data for arthropod species identified during the BALA - Biodiversity of Arthropods from the Laurisilva of the Azores (1999-2004) and BALA2 projects (2010-2011) from 18 native forest fragments in seven of the nine Azorean islands (all excluding Graciosa and Corvo islands, which have no native forest left). NEW INFORMATION: Of the total 286 species identified, 81% were captured between 1999 and 2000, a period during which only 39% of all the samples were collected. On average, arthropod richness for each island increased by 10% during the time frame of these projects. The classes Arachnida, Chilopoda and Diplopoda represent the most remarkable cases of new island records, with more than 30% of the records being novelties. This study stresses the need to expand the approaches applied in these projects to other habitats in the Azores, and more importantly to other less surveyed taxonomic groups (e.g. Diptera and Hymenoptera). These steps are fundamental for getting a more accurate assessment of biodiversity in the archipelago.

Parathyroid Hormone as a Predictor of Post-Thyroidectomy Hipocalcemia: A Prospective Evaluation of 100 Patients.

INTRODUCTION: Hypocalcemia is a frequent complication after total thyroidectomy and the main reason for prolonged hospitalization of these patients. MATERIAL AND METHODS: We studied prospectively 112 patients who underwent total or completation thyroidectomy between June 2012 and November 2013. Twelve patients with preoperative changes in parathyroid function were excluded. Parathyroid hormone and calcium levels were determined pre-operatively, immediately after surgery, on 1st day and on 14th day after surgery. RESULTS: Of the 100 patients enrolled, 60 have developed hypocalcaemia (60%) but only 14 patients had symptomatic hypocalcaemia. It mostly occurs 24 hours after surgery (76.7%). It was permanent in 3 patients and temporary in the others. In the 60 patients with hypocalcaemia, it has been found hypoparathyroidism in 19 patients immediately after surgery, in 14 patients on 1st day but only 3 had hypoparathyroidism (patients with permanent hypocalcaemia). Comparing the group of patients with and without hypocalcaemia we found a decrease of parathyroid hormone in both (immediately after surgery and on 1st day) but was more important in the hypocalcaemia group (p = 0.004 and p < 0.001). The decrease of PTH levels was more pronounced in the hypocalcaemia group, with significance on the first day (22.29% vs 50.29%, p < 0.001). The best predictor of hypocalcaemia identified was the decrease of parathyroid hormone levels > 19.4% determined on the 1st day (sensitivity = 82%; specificity = 63%). DISCUSSION: In our study there was a high incidence of hypocalcemia (60%), expressed predominantly 24 hours after surgery and conditioned, in these patients, a longer hospital stay. However, only 3 patients (3%) had permanent hypocalcemia. We still found a match in the oscillation of serum calcium levels and parathyroid hormone which identified the decrease in parathyroid hormone on the first day after surgery as a reliable predictor of hypocalcemia. CONCLUSION: Decrease of parathyroid hormone levels > 19.4% determined on 1st day is a good predictor of hypocalcemia after total / completation thyroidectomy, allowing to identify patients at higher risk of hypocalcemia, medicate them prophylactically and get early and safe discharges.

Genetic diversity of an Azorean endemic and endangered plant species inferred from inter-simple sequence repeat markers.

Knowledge of the levels and distribution of genetic diversity is important for designing conservation strategies for threatened and endangered species so as to guarantee sustainable survival of populations and to preserve their evolutionary potential. Picconia azorica is a valuable Azorean endemic species recently classified as endangered. To contribute with information useful for the establishment of conservation programmes, the genetic variability and differentiation among 230 samples from 11 populations collected in three Azorean islands was accessed with eight inter-simple sequence repeat markers. A total of 64 polymorphic loci were detected. The majority of genetic variability was found within populations and no genetic structure was detected between populations and between islands. Also the coefficient of genetic differentiation and the level of gene flow indicate that geographical distances do not act as barriers for gene flow. In order to ensure the survival of populations in situ and ex situ management practices should be considered, including artificial propagation through the use of plant tissue culture techniques, not only for the restoration of habitat but also for the sustainable use of its valuable wood.

[Identification and preservation of parathyroid glands in cadaver parts]. / Identificação e preservação de glândulas paratiróides em peças de cadáver.

INTRODUCTION: It is essential to know the thyroid gland morphology and its anatomical relations in the anterior compartment of the neck in order to minimize the rate of thyroid surgery morbidity, especially the lesion of parathyroid glands and laryngeal nerves. The aim of this study was the identification of parathyroid glands in cadaver parts and their histological confirmation. MATERIAL AND METHODS: Twenty cadaver parts were used to simulate thyroidectomies. During dissection, the thyroid glands and eventual parathyroid glands were isolated and then submitted to histological study. DISCUSSION: Twenty cadaver parts (anterior cervical organs) were used for macroscopic dissection during which 48 fragments that corresponded to eventual parathyroid glands were isolated, 35 of which were effectively confirmed through histological observation to be parathyroid glands. The 20 cadaver parts were then divided into three groups according to the number of histologically confirmed parathyroid glands. In the first group, composed of 11 cases, all eventual parathyroid glands were confirmed. In the second group, composed of six cases, only some glands were confirmed. In the third group, composed of three cases, none of the possible glands were confirmed. In seven of the 20 isolated thyroid glands, eight parathyroid glands were identified during histological study: four subcapsular, three extra-capsular, one intra-thyroidal. There was no statistical relation in the dimensions of the parathyroid glands. CONCLUSIONS: The knowledge of the anatomy of the central visceral compartment of the neck and its most frequent variations reduces but doesn't eliminate thyroid surgery morbidity, especially parathyroid iatrogenic excision, difficulty which has been demonstrated during the dissection of cadaver parts.

Introdução: É indispensável ter um conhecimento profundo da morfologia da glândula tiróide e das estruturas com ela relacionadas no compartimento anterior do pescoço, para minimizar a morbilidade decorrente da cirurgia da tiróide, nomeadamente a lesão das glândulas paratiróides e dos nervos laríngeos. Este estudo pretendeu identificar glândulas paratiróides em peças de cadáver, confirmando-as histologicamente.Material e Métodos: Foram usadas 20 peças de cadáver para simular tiroidectomias. Durante a dissecção, foram isoladas as glândulas tiróides e eventuais glândulas paratiróides, que foram submetidas a estudo histológico.Discussão: Foram dissecadas 20 peças de cadáver (regiões cervicais anteriores), sendo isolados 48 fragmentos que correspondiam a eventuais glândulas paratiróides, dos quais 35 foram confirmados histologicamente como sendo efectivamente paratiróides. Os 20 casos foram, então, divididos em três grupos, de acordo com o número de paratiróides confirmadas histologicamente. No primeiro grupo, constituído por 11 casos, todas as eventuais paratiróides foram confirmadas. No segundo grupo, constituído por seis casos, apenas algumas paratiróides foram confirmadas. No terceiro grupo, constituído por três casos, nenhuma das eventuais paratiróides isoladas era efectivamente paratiróide. Em sete das 20 glândulas tiróides isoladas, foram identificadas oito paratiróides no estudo histológico: quatro sub-capsulares; três extra-capsulares e uma intra-tiróideia. As dimensões das paratiróides não tinham relação estatisticamente significativa.Conclusão: O conhecimento da anatomia das estruturas do compartimento central do pescoço e das suas variações mais frequentes diminui, mas não elimina a morbilidade da cirurgia da tiróide, nomeadamente a excisão iatrogénica das paratiróides, cuja dificuldade de identificação foi evidenciada nas peças dissecadas.

[The anatomical variations of the extensor muscles of the hand fingers]. / Variantes anatómicas dos músculos extensores dos dedos da mão.

INTRODUCTION: The extensor tendons of fingers are subject of many variations, some of them quite frequent. MATERIAL AND METHODS: The dissection of the posterior region of forearm and hand was carried out, and the anatomical variations were documented. RESULTS: In Case 1 the extensor digitorum divided into 5 tendons: one for the index finger, one for the middle finger, two for the ring finger and one for the little finger; the extensor indicis proprius divided into two tendons: one for the index and one for the middle finger. In Case 2 the extensor digitorum divided into 4 tendons: one tendon joined the extensor pollicis longus, one tendon for the index, one for the middle finger and one for the ring finger with one slip to the little finger; the extensor indicis proprius divided into two tendons, one for the index and one for the middle finger; the extensor digiti minimi divided into two slips for the little finger. DISCUSSION/CONCLUSIONS: The existence of a double tendon from extensor digitorum for the ring finger is described in several studies. The tendinous slip from extensor digitorum to extensor pollicis longus is not a frequent finding. The double tendon from extensor digiti minimi may occur in 60 to 90% of cases. The knowledge of the most common variations of the tendons of extensor muscles is very important in surgical practice.

Introdução: Os músculos extensores dos dedos da mão estão sujeitos a múltiplas variações, algumas bastante frequentes.Material e Métodos: Foi efectuada a dissecção da região posterior do antebraço e mão de dois cadáveres, documentando-se as variações anatómicas encontradas.Resultados: No Caso 1 o extensor comum dos dedos emitia cinco tendões: um para o 2º dedo, um para o 3º dedo, dois para o 4º dedo e um para o 5º dedo; o extensor próprio do indicador emitia dois tendões: um para o dedo indicador e um para o 3º dedo. No Caso 2 o extensor comum dos dedos emitia quatro tendões: um tendão que se unia ao tendão do longo extensor do polegar, um para o 2º dedo, um para o 3º dedo e um para o 4º dedo que, por sua vez, emitia um tendão que se unia ao tendão do extensor do dedo mínimo; o extensor próprio do indicador emitia dois tendões: um para o dedo indicador e outro para o 3º dedo; o extensor do dedo mínimo emitia dois tendões para o 5º dedo.Discussão/Conclusões: A existência de um tendão duplo do extensor comum dos dedos para o 4º dedo tem sido verificada frequentemente em alguns estudos. É raro existir um tendão do extensor comum dos dedos para o longo extensor do polegar. Um tendão duplo do extensor do dedo mínimo pode ocorrer em 60 a 90% dos casos em alguns estudos. O conhecimento das variações mais frequentes dos tendões dos extensores dos dedos é importante para a prática cirúrgica.

[Rare anatomical variation of absence of the sciatic nerve: completely substituted by the tibial and common fibular nerve]. / Variação anatómica rara de ausência do nervo ciático: completamente substituído pelos nervos tibial e fibular comum.

INTRODUCTION: There are several reports of sciatic nerve anatomical variations. Some are associated with clinical entities, such as piriformis syndrome. We aim to report a rare anatomical variation of this nerve. CASES REPORT: Two leucodermic, 74 and 78-year-old male subjects, deceased of natural causes, without lower limb relevant medical history. In both subjects, the right sciatic nerve was absent, with an independent origin and course of the tibial and common fibular nerves. The contralateral sciatic nerve had the common anatomical presentation. DISCUSSION: After the analysis of the available data indexed in Medline, we conclude that we are reporting two cases of a rare anatomical variation (the absence of sciatic nerve, with an independent origin and course of the tibial and common fibular nerve). This anatomical variation may have clinical importance, as it may be, for example, a risk factor to unsuccessful sciatic nerve popliteal blocks and to the pyriformis syndrome.

Introdução: Existem várias publicações referindo variantes anatómicas do nervo ciático, algumas associadas a síndromes clínicos (como sendo a síndrome do músculo piriforme). Neste contexto, pretendemos apresentar uma variante anatómica rara do nervo ciático.Casos clínicos: Dois cadáveres leucodérmicos, masculinos, com 74 e 78 anos, falecidos de morte natural, sem patologia do membro inferior. Em ambos os casos, observou-se ausência do nervo ciático direito, tendo os nervos tibial e fibular comum origem e trajecto independentes, desde a sua origem nas raízes lombo-sagradas até à região poplítea. O nervo ciático contralateral apresentava a anatomia habitual.Discussão: Analisando a literatura, na Medline, realçamos que apresentamos dois casos raros de ausência do nervo ciático, com origem e trajecto independentes dos nervos tibial e fibular comum. Esta variante poderá ter implicações clínicas, nomeadamente ser um factor de risco para o insucesso de bloqueios anestésicos poplíteos e para a síndrome do músculo piriforme.