Bone Anatomy of the Thoracic Limb in the Common Hippopotamus (Hippopotamus amphibius) and White Rhinoceros (Ceratotherium simum)

SUMMARY: Although megaherbivores do not belong to the Brazilian fauna, they can be found in national zoos, which makes it important to know the anatomy of the locomotor apparatus to contribute to the clinical routine of zoos and veterinary rehabilitation centers. Thus, the aim of this study was to describe the anatomical structures of the thoracic limb bones in the common hippopotamus (Hippopotamus amphibius) and white rhinoceros (Ceratotherium simum) and to compare them with the bone structures described for other ungulates. The scapula had a triangular appearance in the common hippopotamus, whereas in the white rhinoceros it had a rectangular appearance. The acromion was observed only in the common hippopotamus scapula. The hippopotamus humerus did not have the intermediate tubercle, only the greater and lesser tubercles, unlike the rhinoceros which also has the intermediate tubercle. The two megamammals studied had an ulna not incorporated to the radius and seven carpal bones distributed in two bone rows. The common hippopotamus had four digits and four metacarpal bones, while the white rhino had three digits, hence three metacarpal bones. Although with some species-specific differences, the bone anatomy found in the studied megaherbivores was similar to that described for domestic ungulates, such as horses and cattle. The fact that the bones studied belong to articulated skeletons of the collection of the Museum of Anatomy made it difficult to identify some anatomical structures. This study can help veterinarians in bone health care, animal welfare and comfort of such species present in Brazilian zoological parks.

Aunque los megaherbívoros no pertenecen a la fauna brasileña, se pueden encontrar en zoológicos nacionales, lo que hace importante conocer la anatomía del aparato locomotor para contribuir a la rutina clínica de los zoológicos y de los centros de rehabilitación veterinaria. Por tanto, el objetivo de este estudio fue describir las estructuras anatómicas de los huesos de los miembros torácicos en el hipopótamo común (Hippopotamus amphibius) y el rinoceronte blanco (Ceratotherium simum) y compararlas con las estructuras óseas descritas para otros ungulados. La escápula tenía una apariencia triangular en el hipopótamo común, mientras que en el rinoceronte blanco tenía una apariencia rectangular. El acromion se observó sólo en la escápula del hipopótamo común. El húmero del hipopótamo no tenía el tubérculo intermedio, sólo los tubérculos mayor y menor, a diferencia del rinoceronte que también tiene el tubérculo intermedio. Los dos ejemplares de megamamíferos estudiados tenían una ulna no incorporada al radio y siete huesos del carpo distribuidos en dos filas óseas. En el hipopótamo común se observaron cuatro dedos y cuatro huesos metacarpianos, mientras que en el rinoceronte blanco se encontraron tres dedos, por lo tanto, tres huesos metacarpianos.A pesar de algunas diferencias específicas de cada especie, la anatomía ósea encontrada en los megaherbívoros estudiados fue similar a la descrita para los ungulados domésticos, tal como los caballos y el ganado. El hecho de que los huesos estudiados pertenezcan a esqueletos articulados de la colección del Museo de Anatomía dificultó la identificación de algunas estructuras anatómicas. Este estudio puede ayudar a los veterinarios en el cuidado de la salud ósea, el bienestar animal y el confort de las especies presentes en los parques zoológicos brasileños.

The Influence of Morphological Characteristics on the Ball Throwing Velocity in the Professional Handball Players / Influencia de las Características Morfológicas en la Velocidad de Lanzamiento del Balón en los Jugadores Profesionales de Balonmano

SUMMARY: The aim of this study was to determine influence of upper limbs on the ball throwing velocity. A total of 10 professional handball players (25.74±4.84 years) participated in this study. All of them were playing in the top Montenegrin professional handball league. The results obtained in this study shows that upper limbs have high influence on ball throwing velocity. This study provides normative data and performance standards for professional handball. Coaches can use this information to determine the type of anthropometric characteristics that are needed for handball. Anthropometric parameters such as arm length, wrist diameter, hand length and arm span are the most relevant aspects related to ball throwing speed, given that these parameters cannot be changed through training, they should be taken into account when discovering talents.

El objetivo de este estudio fue determinar la influencia de los miembros superiores sobre la velocidad de lanzamiento de la pelota. En el estudio participaron un total de 10 jugadores profesionales de balonmano (25,74±4,84 años). Todos ellos jugaban en la principal liga profesional de balonmano de Montenegro. Los resultados obtenidos mostraron que los miembros superiores tienen una alta influencia en la velocidad de lanzamiento de la pelota. Este estudio proporciona datos normativos y estándares de rendimiento para el balonmano profesional. Los entrenadores pueden utilizar esta información para determinar el tipo de características antropométricas necesarias para el balonmano. Los parámetros antropométricos como la longitud del brazo, el diámetro de la muñeca, la longitud de la mano y la envergadura del brazo son los aspectos más relevantes relacionados con la velocidad de lanzamiento de la pelota, dado que estos parámetros no se pueden cambiar mediante el entrenamiento, deben tenerse en consideración a la hora de descubrir talentos.

Superficial and Functional Lymphatic Anatomy of the Upper Extremity.

BACKGROUND: Knowledge of detailed lymphatic anatomy in humans is limited, as the small size of lymphatic channels makes it difficult to image. Most current knowledge of the superficial lymphatic system has been obtained from cadaveric dissections. METHODS: Indocyanine green lymphography was performed preoperatively to map the functional arm lymphatics in breast cancer patients without clinical or objective evidence of lymphedema. A retrospective review was performed to extract demographic, indocyanine green imaging, and surgical data. RESULTS: Three main functional forearm channels with variable connections to two upper arm pathways were identified. The median forearm channel predominantly courses in the volar forearm (99 percent). The ulnar forearm channel courses in the volar forearm in the majority of patients (66 percent). The radial forearm channel courses in the dorsal forearm in the majority of patients (92 percent). Median (100 percent), radial (91 percent), and ulnar (96 percent) channels almost universally connect to the medial upper arm channel. In contrast, connections to the lateral upper arm channel occur less frequently from the radial (40 percent) and ulnar (31 percent) channels. CONCLUSIONS: This study details the anatomy of three forearm lymphatic channels and their connections to the upper arm in living adults without lymphatic disease. Knowledge of these pathways and variations is relevant to any individual performing procedures on the upper extremities, as injury to the superficial lymphatic system can predispose patients to the development of lymphedema.

Anatomical characteristics of the bones of the thoracic limb of white-eared opossum (Didelphis albiventris) / Características anatómicas de los huesos del miembro torácico de la zarigüeya oreja blanca (Didelphis albiventris)

SUMMARY: The skeleton of the thoracic limb is one of the key aspects for the understanding of the habits and movement of different mammalian species. Considering the gap about studies related to marsupial osteology, this work proposes to study the aspects inherent to the skeleton of opossums, with emphasis on the detailed anatomical description of the bones that form the thoracic limb. For this purpose, the bones of six specimens of possums of the species Didelphis albiventris were used. These small to medium sized marsupials inhabit a wide range of South America, living in several types of habitats, being commonly described as arboreal omnivores and have anthropic habits. For the execution of this study, the bone accidents perceptible in the specimens were identified by superficial palpation, which were then radiographed. The thoracic limb bones were prepared by boiling and drying in the sun. Finally, from the radiographic images and the prepared bones, a detailed description of the anatomy of the bone components of the thoracic limb of Didelphis albiventris was made, joining the previously obtained data of surface anatomy. These data were compared with data from the literature, discussing the functional significance of the osteological findings of the thoracic limb of Didelphis albiventris.

RESUMEN: El esqueleto del miembro torácico es uno de los aspectos clave para el conocimiento de los hábitos y movimientos de las diferentes especies de mamíferos. Considerando los escasos estudios relacionados con la osteología marsupial, este trabajo se propusoestudiar los aspectos inherentes al esqueleto de la zarigüeya, con énfasis en la descripción anatómica detallada de los huesos que forman el miembro torácico. Para ello se utilizaron los huesos de seis ejemplares de zarigüeyas de la especie Didelphis albiventris. Estos marsupiales de pequeño a mediano tamaño habitan una zona amplia de América del Sur, viven en varios tipos de hábitats, se describen comúnmente como omnívoros arbóreos y tienen hábitos antrópicos. Para este estudio se identificaron mediante palpación superficial los accidentes óseos perceptibles en los especímenes, y posteriormente se tomaron imágens radiológicas. Los huesos de los miembros torácicos se prepararon hirviéndolos y secándolos al sol. Finalmente, a partir de las imágenes radiográficas y de los huesos preparados, se realizó una descripción detallada de la anatomía de los componentes óseos del miembro torácico de Didelphis albiventris, uniendo los datos de anatomía superficial obtenidos previamente. Estos datos se compararon con datos de la literatura, discutiendo la importancia funcional de los hallazgos osteológicos del miembro torácico de Didelphis albiventris.

Upper limb arterial pattern: clinical correlation and embryological perspective / Padrão arterial dos membros superiores: correlação clínica com perspectiva embriológica

Abstract Background Variations in the upper limb arterial pattern are commonplace and necessitate complete familiarity for successful surgical and interventional procedures. Variance in the vascular tree may involve any part of the axis artery of the upper limb, including the axillary artery and brachial artery or its branches, in the form of radial and ulnar arteries, which eventually supply the hand via anastomosing arches. Objectives To study the peculiarities of the arterial pattern of the upper limb and to correlate them with embryological development. Methods The entire arterial branching of forty-two upper limbs of formalin fixed adult human cadavers was examined during routine dissection for educational purposes, conducted over a 3-year period in the Department of Anatomy, Lady Hardinge Medical College, New Delhi. Results The study found: 1) One case in which a common trunk arose from the third part of the axillary artery, which immediately splayed into four branches (2.4%); 2) High division of the brachial artery into ulnar and radial arteries, in 3 cases (7.1%); 3) Pentafurcation of the brachial artery into ulnar, interosseus, radial, and radial recurrent arteries and a muscular twig to the brachioradialis in 1/42 cases (2.4%); 4) Incomplete Superficial Palmar arch in 3/42 cases (7.1%); and 5) Presence of a median artery in 2/42 case(4.8%) Conclusions This study observed and described the varied arterial patterns of the upper limb and identified the various anomalous patterns, supplementing the surgeon's armamentarium in various surgical procedures, thereby helping to prevent complications or failures of reconstructive surgeries, bypass angiography, and many similar procedures.

Resumo Contexto As variações no padrão arterial dos membros superiores são comuns e, assim, necessitam de total familiaridade para que os procedimentos cirúrgicos e de intervenção sejam bem-sucedidos. A variância na árvore vascular pode envolver qualquer parte da artéria axial dos membros superiores, incluindo a artéria axilar, a artéria braquial ou os seus ramos, na forma das artérias radial e ulnar, as quais, em algum momento, suprem as mãos através dos arcos anastomosados. Objetivos Avaliar as peculiaridades do padrão arterial dos membros superiores e correlacioná-las ao desenvolvimento embriológico. Métodos Foram examinados os ramos arteriais completos de 42 membros superiores de cadáveres adultos conservados em formalina, os quais eram rotineiramente dissecados para fins educacionais durante 3 anos no Departamento de Anatomia Lady Hardinge Medical College, Nova Delhi. Resultados O estudo apresentou cinco desfechos. 1. Foi constatado um caso em que um tronco comum surgiu da terceira parte da artéria axilar que imediatamente se disseminou em quatro ramos (2,4%). 2. Houve divisão maior da artéria braquial em artérias ulnar e radial em três casos (7,1%). 3. Em um caso, ocorreu pentafurcação da artéria braquial em ulnar, interóssea, radial, radial recorrente e de um galho muscular em braquiorradial (2,4%). 4. Foi constatado arco palmar superficial incompleto em três dos 42 casos (7,1%). 5. Foi observada a presença da artéria mediana em 2 dos 42 casos (4,8%). Conclusões Este estudo compreende o padrão arterial do membro superior e identifica os diversos padrões anômalos para agregar ao arsenal terapêutico de cirurgiões para diversos procedimentos cirúrgicos, com o objetivo de combater quaisquer complicações ou falhas de cirurgias reconstrutivas, de angiografias de cirurgias de revascularização e muitas outras.

Randomized Trial Comparing Preliminary Results of Radialization and Centralization Procedures in Bayne Types 3 and 4 Radial Longitudinal Deficiency.

BACKGROUND: The choice of surgical procedure in severe (Bayne and Klug types 3 and 4) radial longitudinal deficiency (RLD) is contentious. Existing studies have reported varying results with both centralization and radialization procedures. The purpose of this study was to compare the clinical and radiologic outcome of radialization and centralization procedures at a short-to-intermediate-term follow-up for the treatment of types 3 and 4 RLD. METHODS: Fourteen patients with 17 affected limbs having types 3 or 4 RLD were recruited in this prospective, randomized, controlled trial. After initial application of successive casts for soft tissue distraction, patients were randomized to 2 wrist alignment procedures-centralization and radialization. Clinical and radiologic parameters recorded at stipulated intervals until a final follow-up of 24 months included hand-forearm angle, ulnar bow, forearm length, arm length, total angulation, and range of motion at elbow, wrist, and fingers. RESULTS: Centralization was performed in 9 affected limbs, whereas radialization was performed in 8 affected limbs. Nine affected limbs had type 4 RLD, and 8 affected limbs had type 3 RLD. There was no significant difference in the hand-forearm angle in the immediate postoperative period. At 3 months, the radiologic hand-forearm angle increased to 19 degrees in the centralization group, while the radialization group showed an average increase to 4 degrees. This increase in the hand-forearm angle continued at 6-, 12-, and 24-month follow-up assessments. Worsening of the deformity was more in the centralization group, as compared with the radialization group. The forearm length also significantly differed in the 2 groups at 6-, 12-, and 24-month follow-up; however, when adjusted for preoperative lengths, the difference was significant only at 12- and 24-month follow-up. CONCLUSIONS: At a short-to-intermediate-term follow-up, radialization fares better than centralization in terms of recurrence of deformity and in terms of affecting the forearm length. Longer follow-up with a larger sample size is needed to draw definitive conclusions. LEVEL OF EVIDENCE: Level I.

Relationship between perimetric increase and fluoroscopic pattern type in secondary upper limb lymphedema observed by Indocyanine green lymphography.

To ascertain the relationship between the perimetric differences obtained between the limbs and the type of fluoroscopic pattern observed by Indocyanine green (ICG) lymphography in patients with upper limb lymphedema.A correlational descriptive study was carried out in 19 patients with upper limb lymphedema secondary to breast cancer. The perimetric increase was recorded in 11 anatomical regions after ICG injection, fluoroscopic patterns were identified using an infrared camera. The ICG patterns were categorized into worse (stardust, diffuse) or better (linear, splash) patterns.The pattern coincidence between the anterior and posterior regions of the edematous extremities was 45%. At the wrist level, a difference of 2 cm was associated with the presence of a worse fluoroscopic pattern, whereas perimeter differences of 4.25 cm in the elbow and 2.25 cm in the arm (12 cm from the epicondyle) were associated with the presence of a better fluoroscopic pattern.The perimetric differences observed between the healthy and affected upper limbs in 4 specific anatomical areas allowed us to predict the type of fluoroscopic pattern. ICG lymphography has facilitated the study of the posterior regions of edema, which are difficult to visualize using other imaging techniques.

The position of the upper limb during shoulder arthroscopy does not affect the distance between axillary nerve and glenoid.

PURPOSE: The segment of the axillary nerve (AxN) near the glenoid rim is at risk of iatrogenic lesion during arthroscopic procedures. We hypothesize that the distance between the AxN and the glenoid rim is not modified by the patient's positioning. The primary objective was to compare the position of the AxN with the inferior glenoid rim in lateral decubitus or in beach chair and positions of the upper limb. METHODS: Sixteen shoulders were dissected in beach chair position with the shoulder in neutral rotation. Needle one was placed in the axillary nerve where it was the closest with the inferior glenoid rim. In lateral decubitus with traction and 70° of abduction needle two was placed in the AxN at the closest with the inferior glenoid rim. The glenoid rim was marked with a needle at 6 o'clock. In beach chair position, the distance between needle one and the glenoid needle was measured for six positions. In lateral decubitus, measures were done for two positions of abduction. In lateral decubitus with 70° of abduction, the distance between needle two and the glenoid needle was also measured. RESULTS: The mean distance between AxN and the inferior glenoid rim was 14.4 mm in reference position in beach chair. The results showed the absence of difference between the positions during surgery except for lateral decubitus with 70° of abduction. CONCLUSION: Our study showed that the position of the shoulder during arthroscopic procedures cannot take away the AxN from the inferior glenoid rim. LEVEL OF EVIDENCE: Level IV-basic science study.

Differences in body composition of upper and lower limbs in elite taekwondo athletes / Diferencias en la composición corporal de los miembros superiores e Inferiores en atletas de taekwondo de élite

In this study, we analyzed the differences in body composition among athletes during different stages of their career Forty taekwondo athletes and 10 non-athletes (20 males and 30 females) with a mean age of 18.2 years (range, 15-23 years), a mean height of 173.4 cm, and a mean body weight of 64.8 kg were studied using dual energy X-ray absorptiometry and Biodex balance system. The bone mineral density of upper and lower limbs was higher among university athletes of both sexes than in high school athletes. The lean body mass of male athletes in the university was higher than in high school male athletes. By contrast, in case of females, the opposite results were obtained for the upper and lower limbs. Elucidation of the body composition according to career and sex of taekwondo athlete is worthwhile.

En este estudio, analizamos las diferencias de la composición corporal entre los atletas durante las diferentes etapas de su carrera. Se estudiaron cuarenta atletas de taekwondo y 10 no atletas (20 hombres y 30 mujeres) edad media de 18,2 años (rango, 15-23 años), una altura media de 173,4 cm y un peso corporal medio de 64,8 kg. Se utilizaron la absorciometría de rayos X de energía dual y el sistema de equilibrio Biodex. La densidad mineral ósea de las miembros superiores e inferiores fue mayor entre los atletas universitarios de ambos sexos, que en los atletas de educación secundaria. La masa corporal magra de los atletas varones en la universidad fue mayor que en los varones de la educación secundaria. Por el contrario, en el caso de las mujeres, se obtuvieron los resultados opuestos para las miembros superiores e inferiores. En conclusión se debe considerar un análisis de la composición corporal según la carrera y el sexo del atleta de taekwondo.

Correlación de la masa muscular apendicular medida por absorciometría dual de rayos X y antropometría en población pediátrica y adolescente sana / Correlation of appendicular muscle mass measured with dual-energy X-ray absorptiometry and anthropometry in a healthy population of pediatric and adolescent subjects

Resumen Introducción: Durante el proceso de crecimiento y desarrollo, los niños y adolescentes presentan cambios en su composición corporal. La masa muscular apendicular está relacionada con la movilidad, deambulación y, consecuentemente, con las actividades de la vida diaria. El objetivo del estudio fue determinar la correlación de la masa magra apendicular (MMA) de los miembros superiores e inferiores mediante absorciometría dual de rayos X (DXA) como método de referencia, en comparación con el área muscular apendicular (AMA) obtenida mediante antropometría. Métodos: Estudio transversal en niños y adolescentes sanos de 5 a 20 años de edad, residentes de la Ciudad de México y Área Metropolitana. Se incluyeron y midieron 1,081 sujetos clínicamente sanos. Resultados: La MMA obtenida con DXA y el AMA obtenida por antropometría tienen un coeficiente de determinación (r2) de 0.90. Al categorizarlos por percentil de índice de masa corporal, este se mantiene, aunque es ligeramente menor en el grupo de sujetos con obesidad, donde el coeficiente fue de r2 = 0.84. Conclusiones: La determinación de la masa muscular apendicular en niños y adolescentes mexicanos mediante antropometría es válida y precisa, y presenta una alta correlación con métodos como la DXA. La antropometría podría implementarse como parte de la evaluación de la masa muscular apendicular en el primer nivel de atención.

Abstract Background: Children and adolescents present changes in their body composition during their growth and development process. The appendicular muscle mass (AMM) is related to mobility, ambulation and, consequently, with the activities of daily life. The objective of this study was to determine the correlation of the AMM of upper and lower limbs, obtained by dual X-ray absorptiometry (DXA), as a reference method compared to the appendicular muscular area (AMA) obtained by anthropometric measurements. Methods: Cross sectional study in healthy children and adolescents from 5 to 20 years of age, residents of Mexico City and the Metropolitan Area. A total sample of 1081 clinically healthy subjects were included. Results: The AMM obtained with DXA and the AMA obtained by anthropometry showed a coefficient of determination (r2) of 0.90. Categorizing by percentile of body mass index, the correlation is maintained, being slightly lower in the group of obese subjects, where the coefficient was r2 = 0.84. Conclusions: Measurement of AMM in Mexican children and adolescents with anthropometry is a valid and accurate technic with a high correlation with methods such as DXA. Anthropometry could be implemented as part of the assessment of AMM in the first level care.

Descripción morfológica y morfométrica de la miología intrínseca del miembro torácico en un ejemplar de pudú (Pudu puda) / Morphological and morphometric description of thoracic limb intrinsic myology in a specimen of pudu (Pudu puda)

El pudú (Pudu puda) se clasifica como un artiodáctilo de la familia Cervidae y es el ciervo más pequeño. Se estima que su población se ha reducido, esto debido a varias causas, como son la pérdida de los bosques, depredación, caza y atropellos. El objetivo del presente estudio es describir la musculatura intrínseca del miembro torácico de un ejemplar de pudú, comparando los resultados observados con lo descrito para rumiantes domésticos en la bibliografía anatómica clásica. Se estudió la musculatura desde proximal hacia distal, dividiendo al miembro en cuatro regiones topográficas: región escapular, braquial, antebraquial y de la mano. Además, se realizó un estudio morfométrico indicando el largo, ancho y grosor de los músculos. Los resultados indican que el ejemplar de pudú posee características anatómicas similares a rumiantes domésticos, sin embargo, se deben considerar algunas diferencias, tales como: la porción escapular del m. deltoides se une de manera aponeurótica con el m. infraespinoso; las dos cabezas del m. flexor ulnar del carpo se encuentran altamente fusionadas; no se observó el tercer tendón del m. bíceps braquial; el m. tríceps braquial es bien desarrollado y presenta cuatro cabezas musculares bien diferenciadas; el m. ancóneo permanece de manera independiente de la cabeza lateral del m. tríceps; el m. flexor digital profundo presenta cuatro cabezas y el m. interóseo es macroscópicamente tendinoso. La información entregada en este estudio corresponde a un aporte anatómico que permite ampliar el conocimiento científico de esta especie que se encuentra poco estudiada, protegida y vulnerable.

The pudú (Pudu puda) is classified as an artiodactyl and is the smallest deer of the Cervidae family. It is estimated that its population has been reduced for a number of reasons, such as loss of forests, predation and hunting. The objective of this study is to describe the intrinsic musculature of the thoracic limb of a Pudu specimen, comparing the results with those described for domestic ruminants in anatomical literature. Musculature was studied from proximal to distal, dividing the limb into four topographic regions: scapular, brachial, antebrachial and hand regions. In addition, a morphometric study was conducted indicating the length, width and thickness of the muscles. The results indicate that the Pudu species has anatomical characteristics similar to those of domestic ruminants. However, some differences should be considered, such as the scapular portion of M. deltoides joins aponeurotically with M. infraspinatus; the two heads of M. carpis ulnaris are highly fused; the third tendon of M. biceps brachii; the M. triceps brachii is well developed and has four distinct muscle heads; the M. Anconeus remains independent of the lateral head of M. triceps brachii; the M. digitorum profundus features four heads and the M. interosseous is macroscopically tendinous. The information provided in this study corresponds to an anatomical contribution that allows furthering scientific knowledge of this protected and vulnerable species, which is scarcely studied.

The All but Forgotten Mascagni-Sappey Pathway: Learning from Immediate Lymphatic Reconstruction.

BACKGROUND: Upper extremity lymphedema occurs in 25 to 40% of patients after axillary lymph node dissection (ALND). Immediate lymphatic reconstruction (ILR) or the lymphatic micro- surgical preventative healing approach has demonstrated a significant decrease in postoperative rates of lymphedema (LE) from 4 to 12%. Our objective was to map the Mascagni -Sappey pathway, the lateral upper arm draining lymphatics, in patients undergoing ILR to better characterize the drainage pattern of this lymphosome to the axilla. METHODS: A retrospective review of our institutional lymphatic database was conducted and consecutive breast cancer patients undergoing ILR were identified from November 2017 through June 2018. Patient demographics, clinical characteristics, and intraoperative records were retrieved and analyzed. RESULTS: Twenty-nine consecutive breast cancer patients who underwent ILR after ALND were identified. Patients had a mean age of 54.6years and body mass index (BMI) of 26.6 kg/m2. Fluorescein isothiocyanate (FITC) was injected at the medial upper arm and isosulfan blue was injected at the cephalic vein, or lateral upper arm, prior to ALND. After ALND, an average 2.5 divided lymphatics were identified, and a mean 1.2 lymphatics were bypassed. In all patients, divided FITC lymphatics were identified. However, in only three patients (10%), divided blue lymphatics were identified after ALND. CONCLUSION: In this study, variable drainage of the lateral upper arm to the axillary bed was noted. This study is the first to provide a description of intraoperative findings, demonstrating variable drainage patterns of upper extremity lymphatics to the axilla. Moreover, we noted that the lateral- and medial-upper arm lymphosomes have mutually exclusive pathways draining to the axilla. Further study of lymphatic anatomy variability may elucidate the pathophysiology of lymphedema development and influence approaches to immediate lymphatic reconstruction.

Persistent median artery inside the carpal tunnel: description and surgical implications

The median artery is usually a transient vessel during the embryonic period. However, this artery can persist in adult life as the persistent median artery. This paper aims to describe this relevant anatomical variation for surgeons, review the literature and discuss its clinical implications. A routine dissection was performed in the upper left limb of a male adult cadaver of approximately 50-60 years of age, embalmed in formalin 10%. The persistent median artery was identified emerging as a terminal branch of the common interosseous artery with a path along the ulnar side of the median nerve. In the wrist, the persistent median artery passed through the carpal tunnel, deep in the transverse carpal ligament. The dissection in the palmar region revealed no anastomosis with the ulnar artery forming the superficial palmar arch. The common digital arteries emerged from the ulnar artery and the persistent median artery. Such variation has clinical and surgical relevance in approaching carpal tunnel syndrome and other clinical disorders in the wrist.

Anatomia óssea e muscular do antebraço e mão de Chrysocyon brachyurus (Carnivora, Canidae) / Bone and muscular anatomy of the antibone and handof Chrysocyon brachyurus (Carnivora, Canidae)

O lobo-guará Chrysocyon brachyurus Illiger, 1815, é o maior canídeo da América do Sul, pesa cerca de 25 kg quando adulto e está ameaçado de extinção. Descrições anatômicas contribuem para a complementação das informações sobre espécies silvestres e para implicações conservacionistas, clínicas e cirúrgicas. Objetivou-se descrever os ossos e os músculos do antebraço e mão do lobo-guará. A preparação das peças foi feita a partir dos métodos usuais de dissecação, em animais preservados em solução de formol a 10%. Os espécimes pertencem ao acervo didático do Laboratório de Ensino e Pesquisa em Animais Silvestres da UFU e são provenientes de indivíduos atropelados. Os ossos descritos foram: rádio, ulna, ossos cárpico acessório, cárpico ulnar e cárpico intermédio; ossos cárpicos I, II, III e IV; ossos metacárpicos I, II, III, IV, V; falanges proximais, falanges médias e falanges distais do primeiro ao quinto dedo. Os músculos observados foram: extensor radial do carpo; pronador redondo; braquiorradial; extensor comum dos dedos; extensor ulnar do carpo; extensor lateral dos dedos; supinador; abdutor longo do dedo I; flexor radial do carpo; flexor profundo dos dedos; flexor superficial dos dedos; flexor ulnar do carpo; pronador quadrado; interflexor; lumbricais; abdutor curto dos dedos I e II e flexor curto do dedo I.

The maned wolf Chrysocyon brachyurus (Illiger, 1815) is the largest canid in South America, weighs about 25 kg as an adult and is threatened of extinction. Anatomical descriptions contribute to the complementation of information on wild species and for conservation, clinical and surgical implications. The purpose of this study was to describe the bones and muscles of the forearm and hand of the maned wolf. The methodology was through the usual dissecting methods in animals preserved in 10% formalin solution. The animals belong to the didactic collection of the Laboratory of Teaching and Research in Wild Animals of the UFU and come from run over. The bones evaluated were: radius, ulna, carpal accessory, carpi ulnar and carpi intermedium; carpal bones I, II, III and IV; metacarpal bones I, II, III, IV, V; proximal phalanges, middle phalanges and distal phalanges from first to fifth finger. The muscles observed were: radial extensor carpal; pronator round; brachioradial; common extensor of fingers; ulnar carpal extensor; lateral extensor of the fingers; supinator; abductor long finger I; flexor carpi radialis; flexor deep fingers; superficial flexor of the fingers; ulnar flexor of the carpus; square pronator; interflexor; lumbrils; short abductor of fingers I and II and short flexor of finger I.

Comparación del dinamómetro Camry con el dinamómetro Jamar para su uso en adultos colombianos saludables / Comparing the Camry dynamometer to the Jamar dynamometer for use in healthy Colombian adults / Comparação dos dinamômetros Camry e Jamar para seu uso em adultos colombianos saudáveis

Objective: Hand grip strength can provide an objective index of general upper strength, but hand dynamometer has not been validated for use in Colombia. The objective was to determine the interchangeability between Camry electronic and Jamar hydraulic hand grip dynamometers in a population found on the campus of the Universidad Nacional de Colombia and the elderly living in a community. Methods: This was a cross-sectional concordance study on 18-88-year-old males and females. Data regarding their demographics, health, and anthropometric variables were collected/measured and the Lin concordance correlation coefficient (CCC) along with Bland-Altman plots were used for evaluating concordance regarding both devices. Results: One hundred and thirty-three subjects participated in this study (average age 47±20.74 years-old). Right hand (RH) grip strength was 32.15±9.96 kg with the Jamar dynamometer and 29.95±9.18 kg with the Camry device. It is worth highlighting that the Jamar instrument presents higher values than the Camry instrument (p <0.05). CCC was only significant at the population level and for the 40-59-year-old age group. Bland-Altman plots had narrow limits of agreement. Conclusion:We concluded that the Camry dynamometer could replace the Jamar dynamometer in the 40-59-year-old age group; furthermore, it would be appropriate for medical use in patient monitoring or follow-up due to the close values observed

Objetivo: La fuerza de agarre de la mano puede proporcionar un índice objetivo de la fuerza de los miembros superiores, pe-ro no se dispone de un dinamómetro de mano validado para su uso en Colombia. El objetivo fue determinar la intercambiabilidad entre los dinamómetros hidráulicos Jamar y el dinamómetro electrónico Camry en una población que se encuentra en el campus de la Universidad Nacional de Colombia y personas mayores que viven en una comunidad. Métodos: estudio transversal de concordancia realizado en hombres y mujeres de 18 a 88 años de edad. Se recolectó in-formación sobre variables demográficas, de salud y antropométricas. El coeficiente de correlación de concordancia de Lin (CCC) y los gráficos de Bland-Altman se utilizaron para evaluar la concordancia entre ambos dispositivos. Resultados: participaron 133 sujetos (edad promedio de 47 ± 20,74 años). La fuerza de agarre de la mano derecha fue de 32,15 ± 9,96 kg con el dinamómetro Jamar y de 29,95 ± 9,18 kg con el dispositivo Camry, destacando que el equipo Jamar presenta valores superiores al Jamar (p<0.05). La CCC solo fue significativa a nivel de la población y para el grupo de edad de 40 a 59 años. Los gráficos Bland-Altman presentaron límites de acuerdo estrechos. Conclusión: Concluimos que el dinamómetro Camry podría reemplazar el dinamómetro Jamar en el grupo de edad de 40-59 años; además, sería apropiado para uso médico en el monitoreo o seguimiento de pacientes debido a los valores cercanos observados.

Objetivo. A força de agarramento manual pode fornecer um índice objetivo da força dos membros superiores, mas um di-namômetro manual validado não está disponível para uso na Colômbia. O objetivo foi comparar os dinamômetros hidráuli-cos Jamar com o dinamômetro eletrônico Camry e establecer a possibilidade de equivalência no seu uso, na população do campus da Universidad Nacional de Colombia e em idosos que moram em uma comunidad. Métodos: estudo de concordância transversal realizado em ho-mens e mulheres de 18 a 88 anos de idade. Foram coletadas informações sobre variáveis demográficas, sanitárias e antro-pométricas. O coeficiente de correlação de concordância de Lin (CCC) e os gráficos de Bland-Altman foram utilizados para avaliar a de equivalência entre os dois dispositivos. Resultados: 133 sujeitos participaram (idade média de 47 ± 20,74 anos). A força de preensão da mão direita foi de 32,15 ± 9,96 kg com o dinamômetro Jamar e 29,95 ± 9,18 kg com o dispositivo Camry, destacando que a equipe do Jamar possui valores maiores que o Jamar (p < 0,05). O CCC foi significativo apenas no nível populacional e na faixa etária de 40 a 59 anos. Os gráficos de Bland-Altman apresentaram limites estreitos de concordância. Conclusão: Concluímos que o dinamômetro Camry poderia substituir o dinamômetro Jamar na faixa etária de 40 a 59 anos; Além disso, seria apropriado para uso médico no monitora-mento ou acompanhamento de pacientes devido aos valores próximos observados.

Osteologia do membro torácico de Lycalopex gymnocercus Fischer, 1814 (Carnivora, Mammalia): abordagens comparada, radiográfica e osteométrica / Osteology of the thoracic limb in the Lycalopex gymnocercus Fischer, 1814 (Carnivora, Mammalia): comparative, radiograpahic and osteometric approaches

O membro torácico é a parte do esqueleto pós-craniano que mais informações oferece sobre a locomoção e hábitos de vida de uma espécie. Objetivou-se realizar uma descrição macroscópica, comparativa, radiográfica e osteométrica do esqueleto do membro torácico de Lycalopex gymnocercus. Para tal foram analisados ossos de 24 espécimes adultos coletados mortos em rodovias. Foram realizadas descrições macroscópicas e comparadas com as de outros canídeos, imagens radiográficas para reconhecimento dos padrões de trabeculação e topografia óssea, mensurações lineares e tridimensionais e avaliações histológicas das clavículas. O esqueleto do membro torácico de L. gymnocercus apresentou adaptações morfofuncionais em todos os segmentos para a locomoção cursorial especializada e alguma capacidade de pronação e supinação para captura de presas de porte menor. Houve uma tendência de os ossos serem maiores nos machos, especialmente na região distal do úmero, presumivelmente para a fixação de músculos antebraquiais mais fortes. A clavícula vestigial foi encontrada em todos os espécimes, teve natureza predominantemente cartilagínea e foi significativamente maior nos machos. A conformação básica do esqueleto do membro torácico foi semelhante à dos canídeos domésticos e silvestres descritos na literatura, ainda que particularidades de L. gymnocercus sejam encontradas.(AU)

The forelimb is the part of the post-cranial skeleton that provides more information about locomotion and life habits of a species. The objective of this study was to perform a detailed macroscopic, comparative, radiographic and osteometric investigation of the thoracic limb of Lycalopex gymnocercus. Twenty-four adult specimens collected dead from roadkill were studied. Analysis included macroscopic and comparative descriptions to other canids, radiographic images for recognition of trabeculation patterns and topographical arrangement of bones, linear and three-dimensional measurements, and histological evaluation of the clavicles. The forelimb skeleton of L. gymnocercus presented morphological and functional adaptations in every segment for a specialized cursorial locomotion and some ability to pronation and supination for capture of small vertebrates. There was a tendency for the bones to be longer in males, especially in the distal end of humerus, presumably to fixation of stronger antebrachial muscles. The vestigial clavicle bone was found in all the specimens, had a predominantly cartilaginous nature and was significantly larger in males. The basic conformation of the forelimb skeleton was similar to that of domestic and wild canids described in the literature, although peculiar characteristics of L. gymnocercus have been found.(AU)

Drenaje Venoso Superficial del Miembro superior. Revisión bibliográfica / Upper limb superficial venous drainage. Bibliographic review

Introducción: El sistema venoso superficial del miembro superior ha sido ampliamente estudiado por su aplicación clínica, ya que la mayoría de los pacientes hospitalizados requieren de accesos venosos para el tratamiento de las diferentes patologías. Éstas vías son de por si, accesos venosos de corta duración y se colocan en venas subcutáneas. Muchas veces son susceptibles a complicaciones. El conocimiento de la anatomía es la piedra fundamental para el correcto abordaje de los vasos venosos del miembro superior. El estudio de la Anatomía Humana normal por anatomistas clásicos data de las primeras descripciones y dibujos realizados por las disecciones por Leonardo Da Vinci en el siglo XV hasta la actualidad con la aparición de estudios de imágenes complementarios. Metodología. Se realizó una búsqueda bibliográfica entre Junio y Julio de 2017 utilizando escritura científica, mapas conceptuales y lectura crítica a base de fuentes de información primaria como libros de texto, búsquedas avanzadas con filtros selectivos en Pubmed, con la utilización lenguaje MeSH. Se realizó la lectura crítica y se dividieron los artículos, en número de 30 en Primarios, Secundarios y Terciarios. En cuanto a los artículos primarios se incluyeron a los que se realizaba una descripción anatómica del drenaje venoso superficial del miembro superior, como secundarios la aplicación de dichos conocimientos anatómicos a la práctica de algún procedimiento en particular y como terciario aquellos que relatan eventos adversos en la realización de procedimientos quirúrgicos. Se describen numerosas disposiciones del drenaje venoso superficial del miembro superior Del Sol et al describe en más de un artículo, mediante una clasificación del I al V del comportamiento de las venas en la fosa cubital, en contraposición con la lectura clásica, confirma que la disposición de la M venosa en el codo no es una disposición frecuente. Conclusión. Es importante conocer la anatomía de las venas del miembro superior, ya que como ya hemos descripto en forma incansable, es asiento de múltiples procedimientos simples y complejos para el correcto manejo del tratamiento de un paciente. Las venas superficiales del miembro superior, presentan estrecha relación con las estructuras de la región, por lo que el desconocimiento llevara inevitablemente al error.

Introduction: The superficial venous system of the upper limb has been widely studied for its clinical application, since most hospitalized patients require venous access for the treatment of different pathologies. These routes are short duration venous accesses and are placed in subcutaneous veins. Many times they are susceptible to complications. Anatomy knowledge is the fundamental stone for the correct approach of the upper limb venous vessells.The study of normal human anatomy by classical anatomists dates from the first descriptions and drawings made by the dissections by Leonardo Da Vinci in the fifteenth century to date with the appearance of complementary imaging exams. Method: A bibliographic search was conducted between June and July 2017 using scientific writing, conceptual maps and critical reading using primary information sources such as textbooks, advanced searches with selective filters in Pubmed, with the use of MeSH language. The critical reading was made and the articles were divided into 30, in Primary, Secondary and Tertiary. As regard the Primary articles, an anatomical description of the upper limb superficial venous drainage was included, as Secondary articles the application of anatomical knowledge to the practice of a particular procedure, and as Tertiary those that report adverse events in the performing of surgical procedures that include the approach of these vessels. Numerous dispositions of the upper limb superficial venous drainage. Del Sol et al described in more than one article, within a contraposition to the classical reading, confirms that disposition of the venous M in the elbow is not a frequent disposition. Conclusion: It is important to know the anatomy of the upper limb veins, since as we already described tirelessly, it is the seat of multiple simple and complex procedures for the correct management of a patient's treatment. The upper limb superficial veins are closely related to the structures of the region. Ignorance will inevitably lead to error.

Origen alto de la arteria radial (Arteria braquirradial superficial): Presentación de 3 casos / High origin of the radial artery (superficial brachialarterial artery): Presentation of 3 cases

Se presentan tres casos de nacimiento alto de la arteria radial, todos en el miembro derecho, uno a nivel del tercio superior de la arteria braquial, el segundo caso a nivel del tercio medio de la misma y en el tercer caso el nacimiento de la arteria radial se produce a nivel de la arteria axilar. En todos los casos tienen un trayecto superficial en el brazo y antebrazo. En la mano forman el arco palmar arterial profundo de manera habitual. Estos casos representan el 7,5% de los 40 miembros disecados. El origen alto de la arteria radial es la variante más frecuente dentro de las anomalías del árbol arterial del miembro superior. Su importancia radica en el aumento de los procedimientos percutáneos sobre la arteria radial en cateterismos coronarios y en el cada vez más utilizado colgajo radial en las cirugías reconstructivas. Su trayecto superficial favorece los traumatismos y la confusión con venas, situación que puede ocasionar inyecciones medicamentosas accidentales en estas arterias con sus graves consecuencias.

We present three cases of high birth of the radial artery, all on the right limbone at the upper third of the brachial artery, the second at the middle third of the artery, and in the third case the radial artery arises at the level of the axillary artery. In all cases they have a superficial path in the arm and forearm. In the hand they form the deep arterial arch of the palmar in the usual way. These cases represent 7.5% of the 40 dissected members. The high birth of the radial artery is the most frequent variant within the arterial tree anomalies of the upper limb. Its importance lies in the increase of the percutaneous procedures on the radial artery in coronary catheterisms and in the increasingly used radial flap in the reconstructive surgeries. Its superficial pathway favors trauma and confusion with veins, a situation that can cause accidental drug injections in these arteries with their serious consequences.

Origem e distribuição das principais artérias do membro torácico de Cuniculus paca (Linnaeus, 1766) / Origin and distribution of the main arteries of the thoracic limb of Cuniculus paca (Linnaeus, 1766)

Objetivou-se descrever as artérias do membro torácico da paca (Cuniculos paca Linanaeus, 1766), mediante a dissecação da região. Para tanto, foram utilizadas 10 pacas adultas, machos ou fêmeas, pesando entre cinco e 10 kg do plantel de pacas do setor de Animais Silvestres da FCAV, Unesp, Jaboticabal-SP. Nos animais, injetou-se látex pela artéria carótida comum esquerda para preencher e corar todo o sistema arterial, seguido pela fixação em formaldeído a 10% e conservação em solução salina a 30% para dissecação anatômica das principais artérias do arco aórtico, braço e antebraço, identificando-se a origem e distribuição destes vasos. Os resultados foram foto documentados e discutidos com base na literatura sobre os animais domésticos, e roedores selvagens. De forma geral, as artérias do membro torácico da paca, assemelham-se com as dos carnívoros domésticos, do rato e da cobaia.(AU)

The aim of this study is to describe the arteries of the thoracic limb of paca (Cuniculos paca Linanaeus, 1766) by dissecting the region. We used 10 adult paca, males and females, weighting between five to 10 kg obtained from the breeding group at the Wild Animals Sector of FCAV, Unesp, Jaboticabal-SP. The animals were injected with latex by the left common carotid artery to fill and stain all the arterial system, followed by the fixation in 10% formaldehyde and preservation in 30% saline solution for anatomical dissection of the main arteries of the aortic arch, arm, forearm, identifying the origin and distribution of these vessels. The results were photodocumented and discussed based on literature about domestic animals and wild rodent. In general, the arteries of the thoracic limb of paca are similar to the domestic carnivores, rat and guinea pig.(AU)

Quantification of human upper extremity nerves and fascicular anatomy.

INTRODUCTION: In this study we provide detailed quantification of upper extremity nerve and fascicular anatomy. The purpose is to provide values and trends in neural features useful for clinical applications and neural interface device design. METHODS: Nerve cross-sections were taken from 4 ulnar, 4 median, and 3 radial nerves from 5 arms of 3 human cadavers. Quantified nerve features included cross-sectional area, minor diameter, and major diameter. Fascicular features analyzed included count, perimeter, area, and position. RESULTS: Mean fascicular diameters were 0.57 ± 0.39, 0.6 ± 0.3, 0.5 ± 0.26 mm in the upper arm and 0.38 ± 0.18, 0.47 ± 0.18, 0.4 ± 0.27 mm in the forearm of ulnar, median, and radial nerves, respectively. Mean fascicular diameters were inversely proportional to fascicle count. CONCLUSION: Detailed quantitative anatomy of upper extremity nerves is a resource for design of neural electrodes, guidance in extraneural procedures, and improved neurosurgical planning. Muscle Nerve 56: 463-471, 2017.