Compressive Structures of the Median Nerve at the Elbow / Estructuras Compresivas del Nervio Mediano en el Codo

SUMMARY: The objective of this study was to analyze the potential for compression of the median nerve (MN) caused by the bicipital aponeurosis (BA), the humeral and ulnar heads of the pronator teres muscle (PTM) and the arcade of the flexor digitorum superficialis muscle (FDS) in recently deceased cadavers. In this analysis 20 forearms of 10 recently deceased adult male cadavers were dissected. Dissections were performed in the institution's autopsy room or anatomy laboratory. The short and long heads of the biceps brachii muscle, as well as the BA were identified in all upper upper limbs. The BA received contribution from the short and long heads of the biceps brachii muscle. In 12 upper limbs the BA was wide and thickened and in 8 it was supported by the MN. In 5 upper limbs, the BA was wide but not very thick, and in 3 it was narrow and not very thick. We identified the existence of the FDS muscle arcade in all dissected upper limbs. A fibrous arcade was identified in 4 forearms, a muscular arcade in 14 and a transparent arcade in 2 upper limbs. In all of them, we recorded that the arcade was in contact with the MN. We recorded the humeral and ulnar heads of the PTM in all dissected upper limbs, with the presence of fibrous beams between them along their entire length. The MN was positioned between the humeral and ulnar heads of the PTM in all upper limbs. In eight upper limbs (40 %), we identified that the BA had thickness and contact with the MN with the potential to cause its compression. Compression between the humeral and ulnar heads of the PTM by the fibrous connections has the potential to cause nerve compression in all upper limbs (100 %). We did not identify that the anatomical structure of the FDS arcade had the potential to cause compression in the MN.

El objetivo de este estudio fue analizar la potencial compresión del nervio mediano (NM) causado por la aponeurosis bicipital (AB), las cabezas humeral y cubital del músculo pronador redondo (MPR) y la arcada del músculo flexor superficial de los dedos (MFS). En este análisis se diseccionaron 20 antebrazos de 10 cadáveres masculinos de individuos adultos fallecidos recientemente. Las disecciones se realizaron en la sala de autopsias o en el laboratorio de anatomía de la Institución. En todos los miembros superiores se identificaron las cabezas corta y larga del músculo bíceps braquial, así como la AB. La AB recibió contribución de las cabezas corta y larga del músculo bíceps braquial. En 12 miembros superiores la AB era ancha y engrosada y en 8 estaba sostenida por el NM. En 5 miembros superiores la AB era ancha pero poco gruesa, y en 3 era estrecha y de menor grosor. Identificamos la existencia de la arcada muscular MFS en todos los miembros superiores disecados. Se identificó una arcada fibrosa en 4 antebrazos, una arcada muscular en 14 y una arcada delgada y transparente en 2 miembros superiores. En todos ellos registramos que la arcada estaba en contacto con el NM. Registramos las cabezas humeral y cubital del MPR en todos los miembros superiores disecados, con presencia de haces fibrosos entre ellas en toda su longitud. El NM estaba situado entre las cabezas humeral y cubital del MPR en todos los miembros superiores. En ocho miembros superiores (40 %), identificamos que la AB era gruesa y tenía contacto con el NM con potencial para causar su compresión. La compresión entre las cabezas humeral y ulnar del MPR, por las conexiones fibrosas, tiene el potencial de causar compresión nerviosa en todos los miembros superiores (100 %). No identificamos que la estructura anatómica de la arcada MFS tuviera el potencial de causar compresión del NM.

Deep plane facelift extendido. Técnica de disección diseñada para lograr el máximo reposicionamiento de la región centrofacial, definición del contorno del cuello y la línea mandibular / Extended deep plane face lift. Dissection technique designed to achieve maximum repositioning of the centrofacial region, defi nition of the contour of the neck and jaw line

El lifting de plano profundo es una técnica de rejuvenecimiento facial que nos permite lograr resultados altamente satisfactorios aun en casos de difícil resolución. El conocimiento detallado de la anatomía facial es de primordial importancia para su aprendizaje y perfeccionamiento. Es una técnica que insume mayor tiempo operatorio, ya que requiere una adecuada liberación de ligamentos faciales y cervicales para la correcta movilización de los tejidos y su reposicionamiento sin tensión, pero al mismo tiempo es segura y confi able.

Deep plane lifting is a rejuvenation technique. facial treatment that allows us to achieve highly satisfactory even in cases of diffi cult resolution. He met Detailed understanding of facial anatomy is of primary importance importance for your learning and improvement. It is a technique that requires more operating time, since it requires adequate release of ligaments facial and cervical for the correct mobilization of the tissues and their repositioning without tension, but at the same time time is safe and reliable.

Terminología anatómica: un camino difícil / Anatomical terminology: a difficult pat

En el presente artículo se hace una revisión sistemática o evaluativa de carácter descriptivo-exploratorio donde se buscaron los estudios más relevantes de forma sistematizada en relación a la terminología anatómica, se abordó su historia, su evolución hasta el presente y las dificultades existentes para su correcta aplicación y difusión(AU)

In the present article a systematic or evaluative review of descriptive-exploration nature is made, where the most relevant studies searched in a systematic way in relation to the anatomic terminology, its history, its evolution to the present and the existing difficulties for its correct application and dissemination were addresse(AU)

Internal carotid artery dissection associated with acute dengue virus infection: a case report / Dissecção da artéria carótida interna associada à infecção aguda pelo vírus da dengue: relato de caso

Cervical artery dissections (CAD) can occur spontaneously or as a direct result of significant trauma. Viral infections, such as SARS-CoV2, influenza, and Epstein Barr, are risk factors for spontaneous CAD. Dengue virus infections have dramatically increased in recent decades, and Brazil is one of the endemic areas. The dengue virus can cause headache and neurological complications such as encephalitis, myelitis, Guillain-Barré syndrome, and myositis. No report has yet been found in the literature of dissection of the internal carotid artery secondary to dengue infection. Our objective is to report the case of a patient with dissection of the internal carotid artery associated with acute dengue virus infection.

As dissecções da artéria cervical (DAC) podem ocorrer espontaneamente ou como resultado direto de trauma significativo. Infecções virais, como SARS-CoV2, influenza e Epstein Barr, são fatores de risco para DAC espontânea. As infecções pelo vírus da dengue aumentaram dramaticamente nas últimas décadas, e o Brasil é uma das áreas endêmicas. O vírus da dengue pode causar dor de cabeça e complicações neurológicas como encefalite, mielite, síndrome de Guillain-Barré e miosite. Ainda não foi encontrado na literatura nenhum relato de dissecção da artéria carótida interna secundária à infecção por dengue. Nosso objetivo é relatar o caso de um paciente com dissecção da artéria carótida interna associada à infecção aguda pelo vírus da dengue.

Anatomical and Clinical Education in Physical and Occupational Therapy: Influence of Integration and Soft Preservation / Educación Anatómica y Clínica en Terapia Física y Ocupacional: Influencia de la Integración y la Preservación Blanda

SUMMARY: Anatomy and clinical skills are taught separately to physical and occupational therapy students. Formaldehyde is the primary chemical used to embalm donors which creates a challenge in integrating clinical skills into the anatomy curriculum. This study aimed to evaluate the integration of clinical skills into anatomical education using Imperial College London- Soft Preservation (ICL-SP) and formaldehyde embalming through the evaluation of student perceived learning and confidence. Students were invited to complete a survey after dissecting an ICL-SP and formaldehyde embalmed donors and perform clinical tests. It was easier to dissect and identify neurovascular structures on ICL-SP donors compared to formaldehyde. Clinical tests, like measuring range of motion and ligament tests were also more realistic on ICL-SP donors. The integration of clinical skills in the anatomical curriculum increased student perceived understanding of associated anatomy (p < 0.001), gave better understanding of how anatomy is important to their professions (p < 0.001) and increased motivation to learn anatomy (p < 0.001). The integration of clinical skills into anatomical education can facilitate student learning with higher confidence performing clinical skills and is complemented by the utilization of the new ICL-SP methodology instead of the traditional formaldehyde preservation.

Las habilidades anatómicas y clínicas se enseñan por separado a los estudiantes de terapia física y ocupacional. El formaldehído es el químico principal que se usa para embalsamar a los donantes, lo que crea un desafío para integrar las habilidades clínicas en el plan de estudios de anatomía. Este estudio tuvo como objetivo evaluar la integración de habilidades clínicas en la educación anatómica utilizando Imperial College London-Soft Preservation (ICL-SP) y embalsamamiento de formaldehído a través de la evaluación del aprendizaje y la confianza percibidos por los estudiantes. Se invitó a los estudiantes a completar una encuesta después de diseccionar un ICL-SP y donantes embalsamados formolizados y realizar pruebas clínicas. Fue más fácil diseccionar e identificar estructuras neurovasculares en donantes ICL-SP en comparación con los fijados en formaldehído. Las pruebas clínicas, como la medición del rango de movimiento y las pruebas de ligamentos, también fueron más realistas en los donantes de ICL-SP. La integración de habilidades clínicas en el plan de estudios anatómico aumentó la comprensión percibida por los estudiantes de anatomía asociada (p < 0,001), dio una mejor comprensión de cómo la anatomía es importante para sus profesiones (p < 0,001) y aumentó la motivación para aprender anatomía (p < 0,001). La integración de las habilidades clínicas en la educación anatómica puede facilitar el aprendizaje de los estudiantes con mayor confianza en el desempeño de las habilidades clínicas y se complementa con la utilización de la nueva metodología ICL-SP en lugar de la conservación tradicional con formaldehído.

Dissectional Orientation: Morphological Variations of Teres Minor Muscle and its Nerve Supply

SUMMARY: The teres minor is one of the rotator cuff muscles that comprise the superior margin of the quadrangular space. Quadrangular space syndrome (QSS) refers to the entrapment or compression of the axillary nerve and the posterior humeral circumflex artery in the quadrangular space, often caused by injuries, dislocation of the shoulder joint, etc. Patients who fail the primary conservative treatments and have persistent symptoms and no pain relief for at least six months would be considered for surgical interventions for QSS. This cadaveric study of 17 cadavers (males: 9 and females: 8) was conducted in the Gross Anatomy Laboratory at the Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University. The cadavers were preserved in a 10 % formaldehyde solution and obtained ethical approval by the ethical commission of the Siriraj Institutional Review Board. The morphology of the teres minor muscle-tendon junction, the bifurcation type of the axillary nerve, and the length and number of the terminal branches of the nerve to the teres minor were documented. Specimens with quadrangular space contents and surrounding muscles that had been destroyed were excluded from the study. The results showed that 47.06 % of the specimens had type A bifurcation, 47.06 % had type B bifurcation, and the remaining 5.88 % had type C bifurcation. It was observed that 58.82 % had nonclassic muscle-tendon morphology, while 41.18 % were classic. The average length of the terminal branches of the nerve to the teres minor in males was 1.13 cm, with the majority having two branches. For females, many showed one terminal branch with an average length of 0.97 cm. Understanding the differences in anatomical variations can allow for a personalized treatment plan prior to quadrangular space syndrome surgical procedures and improve the recovery of postsurgical interventions for patients.

El músculo redondo menor es uno de los músculos del manguito rotador que comprende el margen superior del espacio cuadrangular. El síndrome del espacio cuadrangular (QSS) se refiere al atrapamiento o compresión del nervio axilar y la arteria circunfleja humeral posterior en el espacio cuadrangular, a menudo causado por lesiones, dislocación de la articulación humeral, entre otros. En los pacientes en los que fracasan los tratamientos conservadores primarios y presentan síntomas persistentes y ningún alivio del dolor durante al menos seis meses se considerarían para intervenciones quirúrgicas para QSS. Este estudio cadavérico de 17 cadáveres (hombres: 9 y mujeres: 8) se llevó a cabo en el Laboratorio de Anatomía Macroscópica del Departamento de Anatomía de la Facultad de Medicina del Hospital Siriraj de la Universidad Mahidol. Los cadáveres se conservaron en una solución de formaldehído al 10 % y obtuvieron la aprobación ética de la comisión ética de la Junta de Revisión Institucional de Siriraj. Se documentó la morfología de la unión músculo-tendón del músculo redondo menor, el tipo de bifurcación del nervio axilar y la longitud y el número de las ramas terminales del nervio para el músculo redondo menor. Se excluyeron del estudio los especímenes con contenido de espacios cuadrangulares y músculos circundantes que habían sido destruidos. Los resultados mostraron que el 47,06 % de los especímenes presentó bifurcación tipo A, el 47,06 % una bifurcación tipo B y el 5,88 % restante una bifurcación tipo C. Se observó que el 58,82 % presentaba una morfología músculo-tendinosa no clásica, mientras que el 41,18 % era clásica. La longitud pmedia de los ramos terminales del nervio hasta el músculo redondo menor en los hombres era de 1,13 cm, y la mayoría tenía dos ramos. En el caso de las mujeres, mostraron un ramo terminal con una longitud promedio de 0,97 cm. Comprender las diferencias en las variaciones anatómicas puede permitir un plan de tratamiento personalizado antes de los procedimientos quirúrgicos del síndrome del espacio cuadrangular y mejorar la recupe- ración de las intervenciones posquirúrgicas de los pacientes.

The Emergence and Effects of the First Anatomy Theatres in Western Europe / El Surgimiento y los Efectos de las Primeras Salas de Anatomía en Europa Occidental

SUMMARY: The spread of the idea that the human body should be learned from cadavers, especially under the leadership of Vesalius, and the strong support of this idea among surgeons and medical students of that period, led to the emergence of anatomy theatres, particularly in the rich centres of Western Europe. Anatomy theatres have become prestigious places that make contributions to financial income for the cities they are located in. They have contributed to the importance of universities with the students they attract. Anatomy has become a more visual and international science because of the spread of anatomical drawings in scientific medical books, the newly invented printing press making it easier to print more books and the increasing interest of the people of the period. Learning medicine has become easier with the spread of visual anatomy books and cadaver studies. Cadaver studies and anatomy theatres, which started to become widespread under the leadership of brave science warriors such as Vesalius, who lived in the Renaissance period, became the subject of the paintings of painters of the period such as Rembrandt under the name anatomy activities. It is beneficial and necessary for society to keep in memory what this period brought to the world of anatomy and the present with its historical processes.

La difusión de la idea de que el cuerpo humano se debe aprender a partir de cadáveres, especialmente bajo el liderazgo de Vesalius, y el fuerte apoyo de esta idea entre los cirujanos y estudiantes de medicina de ese período, condujo al surgimiento de las salas de anatomía, particularmente en los ricos centros de Europa Occidental. Las salas de anatomía se han convertido en lugares de prestigio que contribuyen a los ingresos económicos de las ciudades en las que están ubicados y han contribuido a la importancia de las universidades con los estudiantes que atraen. La anatomía se ha convertido en una ciencia más visual e internacional debido a la difusión de los dibujos anatómicos en los libros médicos científicos, la imprenta recién inventada que facilita la impresión de libros y el creciente interés de la gente de la época. Aprender medicina se ha vuelto más fácil con la difusión de libros de anatomía visual y estudios de cadáveres. Los estudios de cadáveres y las salas de anatomía, que comenzaron a generalizarse bajo el liderazgo de valientes guerreros de la ciencia como Vesalius, que vivió en el Renacimiento, se convirtieron en el tema de las pinturas de artistas de la época como Rembrandt bajo el nombre de actividades de anatomía. Es beneficioso y necesario que la sociedad guarde en la memoria lo que este período trajo al mundo de la anatomía y el presente con sus procesos históricos.

Sustancias psicoactivas, alumnos de anatomía y prepandemia COVID-19: prevalencia de uso y comparación de estudios transversales del periodo 2011-2019 / Psychoactive substances, anatomy and pre-pandemic COVID-19 students: prevalence of use and comparison of cross-sectional studies from the period 2011-2019

En estudios preliminares objetivamos alta prevalencia de uso de sustancias psicoactivas (SP) entre alumnos de Anatomía, con mayor impacto entre los recursantes o aquellos con actividades laborales. La causa del uso es multifactorial, pero se destacan factores de riesgo y precipitantes como la carga horaria de la currícula, exigencias de estudio, el distrés por el afrontamiento cadavérico negativo, el nuevo contexto educativo y la cantidad de horas de sueño. El objetivo fue comparar la prevalencia de uso de SP entre las cohortes de 2011-2019, con focalización en los factores determinantes conductuales. Estudio observacional, transversal y comparativo mediante encuesta estandarizada y anónima en 945 alumnos (año 2011= 122; año 2013= 158; año 2015=204; año 2017= 228; año 2019= 233). Se aplicaron parámetros estadísticos, se definió la significación como p -0.84; AA: r> -0.71). En el caso de ansiolíticos benzodiacepínicos, se asoció con falta de sueño y distrés por el afrontamiento negativo al estudio con cadáveres. En las cohortes comparadas por el lapso de 9 años hallamos alta prevalencia de uso de sustancias psicoactivas con tendencia al incremento. Las variables actividad laboral y recursante fueron determinantes para el uso de sustancias, y se asociaron cuestiones relativas a la adaptabilidad universitaria y afrontamiento de estudio negativo con el cadáver; todos con incidencia pedagógica en el proceso de enseñanza y aprendizaje.

SUMMARY: In preliminary studies, we observed a high prevalence of the use of psychoactive substances (PS) among Anatomy students, with a greater impact among recurrent students or those with work activities. The cause of use is multifactorial, but risk and precipitating factors stand out, such as the workload of the curriculum, study demands, distress due to negative cadaveric coping, the new educational context and the number of hours of sleep. The objective was to compare the prevalence of SP use between the 2011-2019 cohorts, with a focus on behavioral determinants. Observational, cross-sectional and comparative study using a standardized and anonymous survey in 945 students (year 2011= 122; year 2013= 158; year 2015=204; year 2017= 228; year 2019= 233). Statistical parameters were applied, significance was defined as p -0.84; AA: r> -0.71). In the case of benzodiazepine anxiolytics, it was associated with lack of sleep and distress due to negative coping with the study with cadavers. In the cohorts compared for a period of 9 years, we found a high prevalence of psychoactive substance use with an increasing trend. The variables work activity and recurrence were determinants for the use of substances, and issues related to university adaptability and negative study coping with the corpse were associated; all with pedagogical impact on the teaching and learning process.

Monoaxial Mechanical Tests on Porcino Knee Ligaments / Ensaios mecânicos monoaxiais nos ligamentos do joelho porcino

Abstract The failure of ligament reconstruction has different risk factors, among which we can highlight the period before its incorporation, which is a mechanically vulnerable period. Loss of resistance over time is a characteristic of living tissues. Dissection with bone insertions of the cruciate ligaments of animal models is not described; however, it is essential for monoaxial assays to extract information from tests such as relaxation. The present work describes the dissection used for the generation of a test body for the performance of nondestructive tests to evaluate the mechanical behavior. We performed dissection of four porcino knee ligaments, proposing a dissection technique for the cruciate ligaments with bone inserts for comparison with collateral ligaments. The ligaments were submitted to relaxation tests and had strain gauges placed during the tests. The results showed viscoelastic behavior, validated by strain gauges and with a loss over time; with some ligaments presenting with losses of up to 20%, a factor to be considered in future studies. The present work dissected the four main ligaments of the knee demonstrating the posterior approach that allows maintaining their bone insertions and described the fixation for the monotonic uniaxial trials, besides being able to extract the viscoelastic behavior of the four ligaments of the knee, within the physiological limits of the knee.

Resumo A falha da reconstrução ligamentar tem diferentes fatores de risco, dentre os quais podemos destacar o período antes da sua incorporação, o qual configura um período mecânico vulnerável. A perda de resistência ao longo do tempo é uma característica dos tecidos vivos. A dissecção com as inserções ósseas dos ligamentos cruzados de modelos animais não é descrita; todavia, para os ensaios monoaxiais, é fundamental extrair as informações de ensaios como os de relaxação. O presente trabalho realiza a descrição da dissecção utilizada para a geração de corpo de prova para a realização de ensaios não destrutivos para avaliar o comportamento mecânico. Realizamos dissecção de quatro ligamentos de joelho porcino, propondo uma técnica de dissecção para os ligamentos cruzados com as inserções ósseas para comparação com os colaterais. Os ligamentos foram submetidos a testes de relaxação e foram colocadas strain gauges durante os testes. Os resultados mostraram comportamento viscoelástico, validado pelas strain gauges e com uma perda ao longo do tempo, sendo que, em alguns ligamentos, as perdas chegaram a até 20%, fator este a ser considerado em trabalhos futuros. O presente trabalho dissecou os quatro principais ligamentos do joelho, demonstrando a abordagem posterior que permite manter as suas inserções ósseas e descrevendo a fixação para os ensaios uniaxiais monotônicos, além de ter conseguido extrair o comportamento viscoelástico dos quatro ligamentos do joelho dentro dos limites fisiológicos do joelho.

Dissecação anatômica como estratégia para o estudo do sistema neural em fetos humanos / Anatomic dissection as a strategy for the study of the neural system in fetuses / Disección anatómica como estrategia para el estudio del sistema neural en fetos

Esse trabalho busca relatar o processo de confecção de peças anatômicas para o ensino da anatomia humana a partir de material cadavérico fetal. Os discentes do curso de medicina da Universidade Federal do Paraná (UFPR) ­ Campus Toledo participaram do programa de voluntariado acadêmico e deram atenção especial aos aspectos técnicos do processo de dissecação, bem como a experiência subjetiva desse procedimento como ferramenta de aprendizado ativo. O procedimento foi realizado na sala de preparação de cadáver da UFPR ­ Campus Toledo, utilizando instrumental de dissecação e cadáveres humanos fetais com 20, 17 e 14 semanas de idade gestacional, direcionado de modo a expor as partes constituintes do sistema neural. Foram confeccionadas peças de cérebro, cerebelo, tronco encefálico, medula espinal, nervos espinais e suas estruturas associadas. Os voluntários envolvidos foram capazes de produzir material de estudo de qualidade através da dissecação e fortalecer seu conhecimento em anatomia humana e aptidão manual. Também foi dada atenção à importância e às limitações do processo de dissecação como estratégia de aprendizado em cursos da área de saúde. pôde ser observado que a dissecação pode fazer parte de uma formação completa e bem estruturada dos discentes, que por sua vez irão integrar a sociedade e a academia. Além disso, a exposição da topografia neural fetal pode servir de referencial para posteriores estudos que venham a utilizar essas informações.

This work aims to report the confection process of anatomic pieces for teaching human anatomy from fetal cadaveric material. The students of the medicine course of Universidade Federal do Paraná (UFPR) ­ Campus Toledo, took part in the academic volunteer program and paid special attention to the technical aspects of the dissection process, as well as the subjective experience of this procedure as an active learning tool. The procedure was performed at the cadaver preparation room of the UFPR ­ Campus Toledo, using dissection tools and human fetal corpses of 20, 17 and 14 weeks of gestational ages, directed so as to expose the constituent parts of the neural system. Pieces of the brain, cerebellum, brainstem, spinal cord, spinal nerves, and its associated structures were made. The involved voluntaries were able to produce quality study material through dissection, and strengthen their knowledge in human anatomy and manual skill. Attention was also given to the importance and limitations of the dissection process as a learning strategy in health courses. it was observed that dissection can be part of a complete and well-structured training of students, who in turn will integrate society and academia. In addition, the exposure of fetal neural topography can serve as a reference for further studies that use this information

Este trabajo tiene como objetivo relatar el proceso de confección de piezas anatómicas para la enseñanza de la anatomía humana a partir de material cadavérico fetal. Los alumnos del curso de medicina de la Universidade Federal do Paraná (UFPR) - Campus Toledo, participaron del programa de voluntariado académico y prestaron especial atención a los aspectos técnicos del proceso de disección, así como a la vivencia subjetiva de este procedimiento como herramienta de aprendizaje activo. El procedimiento fue realizado en la sala de preparación de cadáveres de la UFPR - Campus Toledo, utilizando herramientas de disección y cadáveres de fetos humanos de 20, 17 y 14 semanas de edad gestacional, dirigidos de forma a exponer las partes constitutivas del sistema neural. Se realizaron piezas del cerebro, cerebelo, tronco encefálico, médula espinal, nervios espinales y sus estructuras asociadas. Los voluntarios participantes pudieron elaborar material de estudio de calidad mediante la disección y reforzar sus conocimientos de anatomía humana y habilidad manual. También se prestó atención a la importancia y las limitaciones del proceso de disección como estrategia de aprendizaje en los cursos de salud. Se observó que la disección puede formar parte de una formación completa y bien estructurada de los estudiantes, que a su vez integrarán la sociedad y el mundo académico. Además, la exposición de la topografía neural fetal puede servir de referencia para estudios posteriores que utilicen esta información.

Membrane anatomy-based radical resection for esophageal cancer / 中华胃肠外科杂志

Radical resection of gastrointestinal tumors based on the membrane anatomy theory has significantly reduced the postoperative recurrence rate and improved the surgical efficacy. However, the theory of membrane anatomy has not been widely adopted in radical surgery for esophageal cancer. Our study found that the esophagus also has a membranous anatomical structure. As a foregut organ, the esophagus also has a mesenteric structure, and there is also a fifth metastasis pathway within the esophageal mesentery for esophageal cancers. The leak and metastasis of cancer caused by destruction of the mesenteric integrity may be the fundamental reason for the high postoperative recurrence rate. Using the nano carbon and indocyanine green fluorescence tracing technique, we demonstrated the lymphatic drainage of the upper esophageal segment to the left gastric artery mesenteric lymph nodes. Therefore, in the radical resection of esophageal cancer, we used the membrane anatomy theory for guidance to completely remove the esophageal cancer, esophageal mesentery, left gastric artery and its mesentery, as well as all structures within the mesentery, preventing the spread of cancer cells through the blood vessels, lymphatic system, and mesentery, and improving the efficacy and prognosis. This article elaborates on the theoretical basis of the anatomical structure of the esophageal membrane, embryonic development, imaging, autopsy, and endoscopic observation of the structure, as well as the application effect of the esophageal membrane anatomical theory in esophageal cancer radical surgery. It elucidates the anatomical structure of the esophageal membrane and the lymphatic drainage characteristics of esophageal cancer, reveals the law of lymphatic metastasis in esophageal cancer, optimizes lymphatic dissection strategies, and improves the efficacy of esophageal cancer radical surgery.

Recognition of the membrane anatomy-based laparoscopic assisted right hemicolectomy / 中华胃肠外科杂志

Although it has become a consensus in the field of colorectal surgery to perform radical tumor treatment and functional protection under the minimally invasive concept, there exist many controversies during clinical practice, including the concept of embryonic development of abdominal organs and membrane anatomy, the principle of membrane anatomy related to right hemicolectomy, D3 resection, and identification of the inner boundary. In this paper, we analyzed recently reported literature with high-level evidence and clinical data from the author's hospital to recognize and review the membrane anatomy-based laparoscopic assisted right hemicolectomy for right colon cancer, emphasizing the importance of priority of surgical dissection planes, vascular orientation, and full understanding of the fascial space, and proposing that the surgical planes should be dissected in the parietal-prerenal fascial space, and the incision should be 1 cm from the descending and horizontal part of the duodenum. The surgery should be performed according to a standard procedure with strict quality control. To identify the resection range of D3 dissection, it is necessary to establish a clinical, imaging, and pathological evaluation model for multiple factors or to apply indocyanine green and nano-carbon lymphatic tracer intraoperatively to guide precise lymph node dissection. We expect more high-level evidence of evidence-based medicine to prove the inner boundary of laparoscopic assisted radical right colectomy and a more rigorous consensus to be established.

Extracapsular dissection and minimally invasive procedures of primary benign parotid tumours: Case series

Extracapsular dissection is an old technique use for the removal of benign parotid tumours, which is not generally chosen as the first treatment option due to the association of recurrences in the past but is currently considered again accord to the aesthetic requirements of the patients. The general trend in the last decade is to return to minimally invasive procedures for this type of lesions, which are mainly conditioned by the pleomorphic adenoma and its positive margins in its capsule. By this, the purpose of this case series study is to analyze those patients diagnosed with benign parotid tumors and treated by extracapsular dissection in a tertiary hospital in Chile between 2018-2020.

Applying a unified model of fiber dissection, tractography, microscopic anatomy and plastination techniques for basic neuroanatomy education: Hacettepe University experience / Aplicación de un modelo unificado de disección de fibras, tractografía, anatomía microscópica y técnicas de plastinación para la educación básica en neuroanatomía: experiencia de la Universidad Hacettepe

SUMMARY: Anatomy education has gathered together a great many of many new modalities and was modified from classical lecture-based and laboratory practice system to the blended modules. In the scope of the present study, we develop a new, practical, cost- effective and efficient three dimensional (3D) educational model, which aimed to be helpful for the detection and better understanding of basic neuroanatomy education. Tractographic imaging, fiber dissection, microscopic anatomy and plastination techniques were applied to the white matter regions of the two brains. After the photographs that were taken were converted to 3D images, the specimens were plastinated. By way of establishing an educational model as a whole, we applied it to 202 second-year medical students. The students were separated into two groups when they attended to the theoretical lecture. Group 1 took the classical laboratory education; on the other hand, Group 2 received the newly designed educational model. Pre and post-tests were introduced to each group before and after laboratory sessions, respectively. The success scores were put to comparison. The average achievement scores of each group showed increase significantly (p<0.05) after the laboratory sessions, besides the increase in the post-test results of Group 2 was more statistically significant (p<0.05). Consequently, this new educational model enriched by newly designed unified methods could be regarded as useful for grasping and improving the basic neuroanatomy knowledge.

La educación en anatomía ha reunido una gran cantidad de nuevas modalidades, modificándose el sistema clásico de la práctica del laboratorio y de las clases basadas en conferencias, hacia los módulos combinados. En el ámbito del presente estudio, desarrollamos un modelo educativo tridimensional (3D) nuevo, práctico, rentable y eficiente, que pretendía ser útil para la detección y una mejor comprensión de la educación básica en neuroanatomía. Se tomaron imágenes tractográficas, disección de fibras, anatomía microscópica y técnicas de plastinación en los cerebros. Después de convertir las fotografías que se tomaron en imágenes 3D, se plastinaron los especímenes. A modo de establecer un modelo educativo en su conjunto, lo aplicamos a 202 estudiantes de segundo año de medicina. Los estudiantes fueron separados en dos grupos cuando asistieron a la clase teórica. El Grupo 1 tomó la educación clásica de laboratorio; por su parte, el Grupo 2 recibió el nuevo modelo educativo diseñado para el estudio. Se introdujeron pruebas previas y posteriores a cada grupo, antes y después de las sesiones de laboratorio. Se compararon las puntuaciones. Los puntajes promedio de rendimiento de cada grupo mostraron un aumento significativo (p<0,05) después de las sesiones de laboratorio. Además, se obtuvo un aumento en los resultados positivos, posteriores a la prueba del Grupo 2, siendo estadísticamente significativo (p<0,05). En consecuencia, este modelo educativo, enriquecido por métodos unificados de nuevo diseño, podría considerarse útil para captar y mejorar los conocimientos básicos de neuroanatomía.

The carotid and vertebral arteries discovery ­ initial findings / A descoberta das artérias carótidas e vertebrais ­ achados iniciais

The studies on the vascular system, including the cervicocephalic arteries (carotid and vertebral arteries), present a long trajectory, having their deep roots in the far past, considering the Western authors, having as representatives the Greek sages Alcmaeon, Diogenes, Hippocrates, Aristoteles, Rufus, and Galenus. They produced pivotal knowledge dissecting mainly cadavers of animals, and established solid bases for the later generations of scholars. The information assembled from these six authors makes it possible to build a quite clear picture of the vascular system, here specifically focused on the cervicocephalic arteries, and mainly of the extracranial segments. Thus, the carotid system became fairly well identified, origin, course, and name, as well as the origin of the still unnamed arteries running through the orifices of the transversal processes of the cervical vertebrae, and entering into the cranium. Almost all that was then known about human anatomy, since this period, and then throughout the Middle Ages, was extrapolated from animal dissections. This state of affairs was maintained until the 14th century, when human corpses dissections were again allowed.

Os estudos do sistema vascular, incluindo as artérias cervicocefálicas (artérias carótidas e vertebrais), apresentam um longo percurso, tendo suas raízes profundas no passado distante, considerando os autores ocidentais, tendo como representantes os doutos gregos Alcméon, Diógenes, Hipócrates, Aristóteles, Rufus e Galenus. Eles produziram conhecimento pivotal, dissecando principalmente cadáveres de animais e estabelecendo bases sólidas para as gerações futuras de estudiosos. A informação reunida desses seis autores permite construir um quadro bastante claro do sistema vascular, aqui focado especificamente nas artérias cervicocefálicas e principalmente nos seus segmentos extracranianos. Assim, o sistema carotídeo ficou bastante bem identificado, origem, trajeto e nome, assim como a origem das ainda não nomeadas artérias que percorrem os orifícios dos processos transversos das vértebras cervicais e entrando no crânio. Quase tudo que era conhecido sobre anatomia humana, desde esse período, e depois ao longo da Idade Média, foi extrapolado a partir de dissecções de animais. Esse estado de coisas foi mantido até o século 14, quando a dissecção de cadáveres humanos foi novamente permitida.

"Two spaces" lateral lymph node dissection based on fascia anatomy for low rectal cancer / 中华胃肠外科杂志

As a treatment of rectal cancer, lateral lymph node dissection (LLND) is still a controversial issue. The argument against LLND is that the procedure is complicated, and consequently results in a high incidence of postoperative urogenital dysfunction. The surgical modality from fascia to space is adopted by lateral lymph node dissection in "two spaces". This operation has significant advantages of clear location of nerves and blood vessels and simplified surgical procedures, so the surgical procedure can be repeated and modulated. The fascia propria of the rectum, urogenital fascia, vesicohypogastric fascia and parietal fascia constitute the dissection plane for lateral lymph node dissection.Two spaces refer to Latzko's pararectal space and paravesical space. During the establishment of fascia plane, the dissection of external iliac lymph node (No.293), commoniliac lymph node (No.273) and abdominal aortic bifurcation lymph node (No.280) can be performed. While in the "space" dissection, internal iliac lymph node (No.263), obturator lymph node (No.283), lateral sacral lymph node (No.260) and median sacral lymph node (No.270) can be removed. LD2 or LD3 lateral lymph node dissection prescribed by the Japanese Society of Colorectal Cancer can be completed according to the needs of the disease. This article describes the anatomical basis and standardized surgical procedures.

Severe hand contracture treated by external fixation after proximal row carpectomy and awake tenolysis after general anesthesia: A case report / 中华创伤杂志(英文版)

Wide-awake local anesthesia has many advantages. We describe a new method to use wide-awake local anesthesia with more flexibility. A 32-year-old man with a severe right-hand contracture after an iatrogenic tourniquet accident during an anterolateral thigh flap for a partial hand amputation underwent contracture release using external fixation after proximal row carpectomy and subsequent tenolysis. We performed most of the tenolysis procedure under general anesthesia and the final stage with an intraoperative assessment of active finger movement and dissection under local anesthesia. He regained his grip strength 2.5 years post-injury. General anesthesia is useful to treat a surgical site with extensive hard scars, whereas local anesthesia is useful for adjusting tension in an awake patient. The indication for wide-awake surgery is yet to be established; our method of combining general and local anesthesia in the tenolysis procedure illustrates the possibilities in expanding this method.

Efeito da ultrassonografia no ensino-aprendizagem da anatomia comparada a peças cadavéricas: revisão sistemática / Effect of ultrasonography on the teaching-learning of anatomy compared to cadaveric prosections: systematic review

Introdução: Com as novas determinações curriculares na educação médica e as dificuldades na obtenção de cadáveres, foi verificada a necessidade da inclusão de novas metodologias de ensino-aprendizagem na Anatomia. A ultrassonografia pode ser uma alternativa viável, pois oportuniza uma avaliação visual-espacial, dinâmica e em tempo real das estruturas anatômicas. Objetivos: Avaliar o efeito da ultrassonografia no ensino-aprendizagem da Anatomia comparada ao uso de peças cadavéricas por meio de uma revisão sistemática. Métodos: Trata-se de uma revisão sistemática, na qual foram coletados artigos das bases PubMed, LILACS e SciELO. Com os descritores utilizados foram obtidos 3.963 artigos. Após a leitura dos títulos e resumos foram selecionados 27 artigos para análise completa. Quatro artigos foram inclusos para serem utilizados após análise de elegibilidade. Resultados: Dois dos estudos demonstraram aprendizagem equivalente entre as condições de ensino cadáver e ultrassom. Duas pesquisas avaliaram a associação das metodologias (ultrassonografia mais estudo com cadáver) comparando com alunos expostos somente a peças cadavéricas. Em uma delas o grupo com ultrassonografia obteve pontuações maiores que o grupo controle, mas com tamanho de efeito moderado a pequeno e a outra pesquisa apresentou valores inferiores no grupo ultrassom, no entanto, sem significância estatística. Conclusão: Essa revisão evidenciou resultados favoráveis ao uso da ultrassonografia no ensino da anatomia, entretanto, poucos estudos comparativos com o uso de peças cadavéricas foram realizados o que impede a generalização desses efeitos. Portanto, mais pesquisas são necessárias, a fim de obter maior confiança para a sua inclusão no ensino-aprendizagem da anatomia na graduação médica.

Introduction: With the new curricular determinations in medical education and the difficulties in obtaining corpses, the need to include new teachinglearning methodologies in anatomy was seen. Ultrasonography can be a viable alternative, as it provides a visual-spatial, dynamic, and real-time assessment of anatomical structures. Objectives: Evaluate the effect of ultrasound in teaching-learning anatomy compared to the use of cadaveric specimens through a systematic review. Methods: It is a systematic review, in which articles were collected from the PubMed, LILACS and SciELO databases. With the keywords used, 3,963 articles were obtained. After reading the titles and abstracts, 27 articles were selected for complete analysis. Four were included for use after eligibility analysis. Results: Among them, two studies showed equivalent learning between the conditions of cadaver and ultrasound teaching. Two studies evaluated the association of methodologies (ultrasound plus cadaver study) comparing students exposed only to cadaveric parts. In one of them, the ultrasound group obtained higher scores than the control group, but with a moderate to small effect size, and the other study showed lower values in the ultrasound group, however, without statistical significance. Conclusion: This review showed favorable results for the use of ultrasound in the teaching of anatomy; however, few comparative studies with the use of cadaveric parts were carried out, which prevents the generalization of these effects. Therefore, more research is needed in order to obtain greater confidence for its inclusion in the teaching and learning of anatomy in medical graduation.

Dissecção espontânea da artéria coronária em gestação gemelar no terceiro trimestre: relato de caso / Spontaneous coronary artery dissection in a twin pregnancy in the third trimester: a case report

O infarto agudo do miocárdio no período gravídico-puerperal é uma condição rara em que a principal causa é a dissecção espontânea da artéria coronária. É um evento comumente subdiagnosticado, com pouca literatura disponível e elevado índice de morbimortalidade. Esse relato descreve o caso de uma gestante de 36 semanas de gravidez gemelar, monocoriônica-diamniótica, com infarto agudo do miocárdio secundário à dissecção espontânea da artéria coronária. As equipes de cirurgia cardíaca e obstetrícia optaram pela realização de parto cesariano e histerectomia subtotal, seguido da revascularização da artéria mamária descendente anterior. Discutem-se as orientações adotadas na dissecção espontânea da artéria coronária, bem como a abordagem terapêutica e a conduta obstétrica, quando essa condição ocorre durante a gravidez.(AU)

Acute myocardial infarction in the pregnancy-puerperal period is a rare condition the main cause of which is the spontaneous coronary artery dissection. A commonly underdiagnosed event with little available literature and a high rate of morbidity and mortality. This case reports a 36-week pregnant woman of mono-chorionic-diamniotic pregnancy who had a myocardial infarction secondary to a spontaneous coronary artery dissection. In a joint discussion between the team of cardiac surgery and obstetrics, it was decided to perform a cesarean delivery and subtotal hysterectomy followed by revascularization of the mammary anterior descendant. It discusses the conducts to be adopted in a case of spontaneous coronary artery dissection as well as therapeutic approaches and obstetric conducts to be taken in a case of dissection during pregnancy.(AU)