Perfusão arterial reversa gemelar: revisão da literatura / Twin reverse arterial perfusion: literature review

A perfusão arterial reversa gemelar é uma anormalidade rara que pode ocorrer em gestações gemelares monocoriônicas. Consiste em uma alteração na circulação fetoplacentária, com desvio de sangue de um dos gemelares para o outro, por meio de anastomoses arterioarteriais e venovenosas na superfície placentária e anastomoses arteriovenosas em áreas de circulação placentária compartilhada. O feto bombeador pode desenvolver insuficiência cardíaca devido ao aumento do débito cardíaco, e o feto receptor, perfundido por sangue pobre em oxigênio por meio do fluxo reverso, é severamente malformado, incompatível com a vida extrauterina. Este artigo apresenta o caso de uma gestação gemelar monocoriônica diamniótica, com manejo clínico conservador. O objetivo é relatar um caso de complicação rara de gestações monozigóticas e revisar condutas para diagnóstico e manejo adequado.(AU)

Twin reverse arterial perfusion is a rare abnormality that can occur in monochorionic twin pregnancies. It consists of an alteration in the fetal-placental circulation, with blood diversion from one of the twins to the other, through arterio-arterial and veno- venous anastomosis on the placental surface and arterio-venous anastomosis in areas of shared placental circulation. The pumping fetus may develop heart failure due to increased cardiac output, and the recipient fetus, perfused by oxygen-poor blood through reverse flow, is severely malformed, incompatible with extrauterine life. This article presents the case of a monochorionic diamniotic twin pregnancy, with conservative clinical management. The objective is to report a case of rare complication of monozygotic pregnancies and review procedures for diagnosis and adequate management.(AU)

Anastomosis between the posterior superior alveolar artery and the infra-orbital artery: a review of current terminology / Anastomosis entre la arteria alveolar superior posterior y la arteria infra-orbital: una revisión de la terminología actual

SUMMARY: The posterior superior alveolar artery (PSAA) and the infra-orbital artery (IOA) present intraosseous and extraosseous rami which form an anastomosis in the lateral wall of the maxillary sinus. This anastomosis is always present, however it has not yet been included in anatomical terminology (AT), and different terms are used in scientific communication to refer to it. The aim of this study was to carry out a review of the different terms used to name this vascular structure. A literature review was carried out on the terms used to name the anastomosis between the PSAA and IOA in imaging studies and human cadavers that assessed the presence/frequency of this anatomical structure. The search was carried out in the Medline, EMBASE and LILACS databases, in Portuguese, Spanish and English, with no date restrictions. Qualitative analysis was applied to the studies selected, analysing the terminology used to refer to the anastomosis between the PSAA and IOA. Of the 2108 original articles found, 60 were selected as potentially relevant and 54 studies were finally included for qualitative analysis. Sixteen terms were found to refer to the anastomosis between the PSAA and IOA, the most frequent being Posterior Superior Alveolar Artery (PSAA), followed by Alveolar Antral Artery (AAA). Many terms are used in the medical literature to designate the anastomosis between the PSAA and IOA, the most frequent being PSAA and AAA. There is a need to unify the terms used to designate this vascular structure, and to incorporate the selected term into anatomical terminology, in order to avoid confusion in scientific communication.

RESUMEN: La arteria alveolar superior posterior (AASP) y la arteria infra-orbital (AIO) tienen ramas intra y extra óseas que forman una anastomosis en la pared lateral del seno maxilar. Esta anastomosis está siempre presente, sin embargo, aún no ha sido incluida en la terminología anatómica (TA), por lo que en la comunicación científica se utilizan diferentes términos para referirse a ella. El objetivo de este estudio fue realizar una revisión sobre los diferentes términos utilizados para nombrar esta estructura vascular. Se realizó una revisión de la literatura sobre los términos utilizados para nombrar la anastomosis entre AASP y AIO en estudios imagenológicos y en cadáveres humanos que evaluaron la presencia/frecuencia de esta estructura anatómica. La búsqueda fue realizada en las bases de datosMedline, EMBASE y LILACS, en los idiomas portugués, español e inglés, sin restricción de fecha. Los estudios seleccionados fueron evaluados de forma cualitativa, analizando la terminología empleada para referirse a la anastomosis entre AASP y AIO. Fueron encontrados 2108 artículos originales, siendo seleccionados 60 artículos potencialmente relevantes y finalmente fueron incluidos 54 estudios para análisis cualitativo. Fueron encontrados 16 términos para referirse a la anastomosis entre AASP y AIO, siendo AASP el más frecuente seguido de arteria alveolo-antral (AAA). Son muchos los términos utilizados en la literatura médica para designar la anastomosis entre AASP y AIO, siendo AASP y AAA los más usados. La unificación de los términos utilizados para designar esta estructura vascular y su incorporación en la Terminología Anatómica contribuiría a evitar equívocos en la comunicación científica.

Síndrome de transfusão feto-fetal: revisão de literatura / Twin-twin transfusion syndrome: a literature review

A síndrome de transfusão feto-fetal é uma complicação das gestações gemelares monocoriônicas. Além de ocorrer comumente no segundo trimestre, apresenta elevada morbimortalidade fetal e neonatal, e taxas de incidência que variam de 10 a 15% dentre todas as gravidezes monocoriônicas. O objetivo deste estudo é realizar uma revisão de literatura a partir de levantamento bibliográfico acerca dos principais aspectos epidemiológicos, clínicos e terapêuticos da STFF. A base de dados PubMed foi consultada, uma vez que os termos de pesquisa utilizados foram "síndrome de transfusão feto-fetal", "diagnóstico" e "tratamento". Obtiveram-se sessenta e oito artigos de revisão de literatura e/ou revisão sistemática, sendo que apenas vinte e nove foram selecionados após aplicação dos critérios de elegibilidade. Em relação à fisiopatologia, a síndrome é explicada pela transferência sanguínea direta entre os fetos gemelares através de anastomoses arteriovenosas placentárias, conceitualmente determinando a existência de um feto receptor e outro doador. Embora as gestantes comumente se apresentam assintomáticas, as repercussões clínicas fetais costumam ser graves. O diagnóstico é exclusivamente ultrassonográfico e deve ser feito o mais precocemente possível, ressaltando-se a importância da detecção da corionicidade da gestação gemelar, além de acompanhamento ultrassonográfico seriado para rastreio do desenvolvimento da síndrome. Apesar de ainda não haver protocolo de tratamento bem estabelecido, a ablação dos vasos placentários a laser é tida como o padrão-ouro dentre as opções terapêuticas disponíveis. Apresenta elevada taxa de sobrevida de pelo menos um dos fetos e baixos índices de sequelas neurológicas neonatais, podendo ser realizada somente até a 26ª semana de gestação.

Twin-twin transfusion syndrome is a complication of monochorionic twin pregnancies. In addition to commonly occurring in the second trimester, it has high fetal and neonatal morbidity and mortality and incidence rates ranging from 10 to 15% among all monochorionic pregnancies. This study aims to perform a literature review based on a bibliographic survey about the main epidemiological, clinical and therapeutic aspects of TTTS. The PubMed database was consulted, as the search terms used were "twin-twin transfusion syndrome", "diagnosis", and "treatment". Sixty-eight literature review and systematic review articles were obtained, and only twenty-nine were selected after applying the eligibility criteria. About the pathophysiology, the syndrome is explained by direct blood transfer between the twin fetuses through placental arteriovenous anastomoses, determining the existence of a recipient fetus and another donor. Although pregnant women are usually asymptomatic, the clinical fetal repercussions are often severe. Diagnosis is exclusively ultrasonographic and must be made as early as possible, emphasizing the importance of detecting chorionicity in twin pregnancy, in addition to serial ultrasonographic follow-up to track the development of the syndrome. Although there is still no well-established treatment protocol, endoscopic laser ablation of vascular anastomoses is considered the gold standard among the available therapeutic options. It has a high survival rate for at least one of the fetuses and low rates of neonatal neurological sequelae and can only be performed until the 26th week of pregnancy.

Anastomosis Patterns between the Median and Ulnar Nerves in the Upper Limbs

There are four types of anastomoses between themedian and ulnar nerves in the upper limbs. It consists of crossings of axons that produce changes in the innervation of the upper limbs, mainly in the intrinsic muscles of the hand. The forearm has two anatomical changes ­ Martin-Gruber: branch originating close to the median nerve joining distally to the ulnar nerve; and Marinacci: branch originating close to the ulnar nerve and distally joining the median nerve. The hand also has two types of anastomoses, which are more common, and sometimes considered a normal anatomical pattern ­ Berrettini: Connection between the common digital nerves of the ulnar and median nerves; and Riche-Cannieu: anastomosis between the recurrent branch of the median nerve and the deep branch of the ulnar nerve. Due to these connection patterns, musculoskeletal disorders and neuropathies can be misinterpreted, and nerve injuries during surgery may occur, without the knowledge of these anastomoses. Therefore, knowledge of them is essential for the clinical practice. The purpose of the present review is to provide important information about each type of anastomosis of the median and ulnar nerves in the forearm and hand.

Aprimoramento técnico-motor: modelo de baixo-custo para treinamento de anastomoses vasculares / Technical-motor improvement: low-cost model for training vascular anastomoses

A anastomose vascular é uma das competências técnicas e motoras esperadas de um cirurgião vascular. O tempo, o refinamento e a qualidade da anastomose influem na patência vascular, nos resultados e nas possíveis complicações cirúrgicas. Por se tratar de uma habilidade motora, praticar a anastomose é necessário. O treinamento baseado em repetição, optando por modelos sintéticos a animais e visando a segurança do paciente é fundamental. Entretanto, no Brasil dispomos de poucos simuladores, em sua maioria, importados e de alto custo. A análise de modelos disponíveis no mercado nacional e no exterior levou a confecção de modelo de baixo custo para treinamento de anastomoses vasculares a partir de uma mistura de gelatina, glicerina e malha têxtil. Os testes realizados no modelo desenvolvido demonstraram que ele é eficiente e auxilia no treinamento de anastomoses vasculares. Palavras-chaves: Treinamento por Simulação. Anastomose Arteriovenosa. Técnica de Sutura.

Endovascular management of dissecting posterior cerebral artery aneurysm associated with persistent hypoglossal artery: A case report / Tratamento endovascular do aneurisma dissecante da artéria cerebral posterior associado à artéria hipoglossa persistente: relato de caso

Abstract Persistent embryological connections between the anterior and posterior circulations are rare entities. Persistent hypoglossal artery is the second most common persistent carotid-basilar anastomosis. As it is often associated with hypoplasia of vertebral arteries, it poses a challenge during endovascular interventions. We present a case of a 32-year-old woman who presented with occipital headache of four weeks' duration. Magnetic Resonance Angiography showed hypoplastic vertebral arteries with a persistent hypoglossal artery arising from the cervical segment of the left internal carotid artery and supplying the entire posterior circulation, associated with a dissecting aneurysm of the right posterior cerebral artery. Endovascular parent vessel occlusion was performed for the dissecting posterior cerebral artery aneurysm by navigating the guide catheter, microwire, and microcatheter through the persistent hypoglossal artery because the vertebral arteries were hypoplastic. Post-intervention, the patient did not develop any neurological deficit and was discharged in a stable condition.

Resumo Conexões embriológicas persistentes entre as circulações anterior e posterior são entidades raras. A artéria hipoglossa persistente é a segunda anastomose carotídeo-basilar persistente mais comum. Como está frequentemente associada à hipoplasia das artérias vertebrais, apresenta um desafio durante as intervenções endovasculares. Apresentamos o caso de uma mulher de 32 anos que apresentou cefaleia occipital com duração de quatro semanas. A angiografia por ressonância magnética mostrou artérias vertebrais hipoplásicas com artéria hipoglossa persistente surgindo do segmento cervical da artéria carótida interna esquerda e suprindo toda a circulação posterior com um aneurisma dissecante da artéria cerebral posterior direita. A oclusão endovascular do vaso parental foi realizada para o aneurisma da dissecção da artéria cerebral posterior pela passagem de cateter guia, microfio e microcateter pela artéria hipoglossa persistente, pois as artérias vertebrais eram hipoplásicas. Após a intervenção, a paciente não apresentou déficit neurológico e recebeu alta em uma condição estável.

Tributaries of the hepatic vein in the ostrich (Struthio camelus) / Afluentes da veia porta-hepática no avestruz (Struthio camelus)

The ostrich (Struthio camelus, Linnaeus 1758) is the largest bird in the world. It is of great economic importance in Africa and is found across several countries. With developments in breeding systems, morphological studies that facilitate the application of the knowledge are necessary, considering the species has unique anatomical features. The objective of the present study was to describe the major tributaries of the hepatic vein in the species. Ten viscera of adult individuals of both sexes, which were injected with Neoprene latex through the hepatic vein, were used to visualize their tributaries. After the vascular repletion, the tissues were fixed and conserved in 10% formaldehyde aqueous solution. The hepatic carrier system was dissected and photo-documented. The left hepatic vein receives blood from the proventricle and gastric ventricle, while the right hepatic vein is responsible for the drainage of blood into the following organs: spleen, through the proventriculosplenic vein; pancreas, through the pancreaticoduodenal vein; jejunum, through the jejunum trunk; and the colon, which forms the cranial mesenteric vein.(AU)

O avestruz (Struthio camelus, Linnaeus 1758) é a maior ave do mundo, com uma importância comercial acentuada na África e expandindo-se para diversos países. Assim, com o desenvolvimento dos sistemas de criação, tornam-se necessários estudos morfológicos que subsidiem as áreas aplicadas, pois a espécie apresenta características anatômicas próprias. O objetivo deste estudo foi a descrição dos principais afluentes da veia porta-hepática nesta espécie. Para a realização do presente trabalho, foram utilizadas dez vísceras de animais adultos, de ambos os sexos, que foram injetados com Neoprene látex por meio da veia porta-hepática para evidenciar os seus afluentes. Após a repleção vascular, os animais foram fixados e conservados em solução aquosa de formaldeído a 10%. O sistema porta-hepático foi dissecado e fotodocumentado. Observou-se que a veia porta-hepática esquerda recebe sangue da região do proventrículo e ventrículo gástrico. A veia porta-hepática direita é a responsável pela drenagem do sangue nos seguintes órgãos: baço, por meio da veia proventriculoesplênica, pâncreas, pela veia pancreaticoduonais, jejuno, por meio do tronco jejunal, e o cólon, que forma a veia mesentérica cranial.(AU)

Tributaries of the hepatic vein in the ostrich (Struthio camelus) / Afluentes da veia porta-hepática no avestruz (Struthio camelus)

The ostrich (Struthio camelus, Linnaeus 1758) is the largest bird in the world. It is of great economic importance in Africa and is found across several countries. With developments in breeding systems, morphological studies that facilitate the application of the knowledge are necessary, considering the species has unique anatomical features. The objective of the present study was to describe the major tributaries of the hepatic vein in the species. Ten viscera of adult individuals of both sexes, which were injected with Neoprene latex through the hepatic vein, were used to visualize their tributaries. After the vascular repletion, the tissues were fixed and conserved in 10% formaldehyde aqueous solution. The hepatic carrier system was dissected and photo-documented. The left hepatic vein receives blood from the proventricle and gastric ventricle, while the right hepatic vein is responsible for the drainage of blood into the following organs: spleen, through the proventriculosplenic vein; pancreas, through the pancreaticoduodenal vein; jejunum, through the jejunum trunk; and the colon, which forms the cranial mesenteric vein.

O avestruz (Struthio camelus, Linnaeus 1758) é a maior ave do mundo, com uma importância comercial acentuada na África e expandindo-se para diversos países. Assim, com o desenvolvimento dos sistemas de criação, tornam-se necessários estudos morfológicos que subsidiem as áreas aplicadas, pois a espécie apresenta características anatômicas próprias. O objetivo deste estudo foi a descrição dos principais afluentes da veia porta-hepática nesta espécie. Para a realização do presente trabalho, foram utilizadas dez vísceras de animais adultos, de ambos os sexos, que foram injetados com Neoprene látex por meio da veia porta-hepática para evidenciar os seus afluentes. Após a repleção vascular, os animais foram fixados e conservados em solução aquosa de formaldeído a 10%. O sistema porta-hepático foi dissecado e fotodocumentado. Observou-se que a veia porta-hepática esquerda recebe sangue da região do proventrículo e ventrículo gástrico. A veia porta-hepática direita é a responsável pela drenagem do sangue nos seguintes órgãos: baço, por meio da veia proventriculoesplênica, pâncreas, pela veia pancreaticoduonais, jejuno, por meio do tronco jejunal, e o cólon, que forma a veia mesentérica cranial.

A teenage patient with autosomal recessive polycystic kidney disease, a splenorenal shunt, and congenital hepatic fibrosis: a case report / Doença renal policística autossômica recessiva, shunt esplenorrenal e fibrose hepática congênita em adolescente: relato de caso

ABSTRACT A 16-year-old female patient previously diagnosed with autosomal recessive polycystic kidney disease (ARPKD) presented with acute bilateral pneumonia, upper gastrointestinal bleeding caused by ruptured esophageal varices, ascites, and lower limb edema. She required intensive care and an endoscopic procedure to treat the gastrointestinal bleeding. The analysis of the differential diagnosis for chronic liver disease indicated she had a spontaneous splenorenal shunt. Ultrasound-guided biopsy revealed the patient had cirrhosis, as characteristically seen in individuals with ARPKD. She had no symptoms at discharge and was referred for review for a combined transplant.

RESUMO Relato de caso de uma paciente adolescente de 16 anos de idade com diagnóstico prévio de doença renal policística autossômica recessiva (DRPAR), que apresentou quadro agudo de pneumonia bilateral e hemorragia digestiva alta por ruptura de varizes esofágicas, bem como ascite e edema de membros inferiores. Necessitou de estabilização clínica intensiva e tratamento endoscópico do sangramento digestivo. Após investigação dos diagnósticos diferenciais da hepatopatia crônica, diagnosticou-se shunt esplenorrenal espontâneo, e realizou-se biópsia hepática guiada por ecografia com diagnóstico de cirrose, espectro típico da DRPAR. Recebeu alta hospitalar assintomática e foi encaminhada para avaliação de transplante duplo.

A teenage patient with autosomal recessive polycystic kidney disease, a splenorenal shunt, and congenital hepatic fibrosis: a case report.

A 16-year-old female patient previously diagnosed with autosomal recessive polycystic kidney disease (ARPKD) presented with acute bilateral pneumonia, upper gastrointestinal bleeding caused by ruptured esophageal varices, ascites, and lower limb edema. She required intensive care and an endoscopic procedure to treat the gastrointestinal bleeding. The analysis of the differential diagnosis for chronic liver disease indicated she had a spontaneous splenorenal shunt. Ultrasound-guided biopsy revealed the patient had cirrhosis, as characteristically seen in individuals with ARPKD. She had no symptoms at discharge and was referred for review for a combined transplant.

Anastomosis entre vasos ilíacos y obturadores en la región retropúbica: estudio en cadáveres / Anastomosis among iliac vessels and obturators in the retropubic region: study in cadavers

Introducción: En las cirugías de la región retropúbica, la sección o ruptura de la anastomosis puede causar graves hemorragias de difícil control. Nuestro objetivo fue verificar la presencia o no de anastomosis arterial o venosa entre los vasos ilíacos y obturadores en la región retropúbica. Materiales y Métodos: Treinta cadáveres (14 hombres/16 mujeres; 60% de raza blanca y 40%, no blanca). Después de la disección, se verificó si había anastomosis y su distancia de la sínfisis púbica. Resultados: El 13,3% no tenía comunicación y el 86,6% tenía algún tipo de anastomosis (p <0,01), la anastomosis venosa fue la más frecuente (p <0,05). La distancia promedio entre la anastomosis y la sínfisis púbica fue de 5,7 cm. Al comparar el sexo, la anastomosis y el lado, el 57% de los hombres presentaba anastomosis en ambos lados, y el 81% y 88% de las mujeres la tenían en el lado derecho e izquierdo, respectivamente (p <0,05). Cuando se comparó la presencia de anastomosis con el lado, el 70% estaba en el derecho y el 73%, en el izquierdo (p >0,05). El 72% de los blancos y el 67% de raza no blanca tenían anastomosis (p >0,05). Conclusiones: La presencia de anastomosis es más frecuente que la ausencia y no existe diferencia significativa en cuanto al lado. Está localizada, en promedio, a 5,7 cm de la sínfisis púbica y la venosa es significativamente más frecuente. Es significativamente más frecuente en las mujeres. No hay diferencia estadística en cuanto a la presencia de anastomosis entre la raza blanca y no blanca. Nivel de Evidencia: IV

Introduction: During surgical interventions, section or rupture of the anastomosis may cause severe difficult-to-control bleeding. The aim of this study was to verify the presence or absence of arterial or venous anastomosis among iliac and obturator vessels in the retropubic region. Methods: Thirty cadavers (14 men/16 women; 60% white and 40% non-white). After dissection, the presence of anastomosis and its distance from the pubic symphysis were verified. Results: The 13.3% presented no communication and 86.6% presented some type of anastomosis (p<0.01). Venous anastomosis was more frequent (p<0.05). The mean distance from anastomosis to pubic symphysis was 5.7 cm. Regarding sex and side, 57% of male specimens presented anastomosis on both sides, while 81% and 88% of women had on the right and left side, respectively (p<0.05). Seventy percent of specimens had anastomosis on the right side and 73% on the left (p>0.05). Anastomosis was observed in 72% of whites and 67% of non-whites. Conclusions: Presence of anastomosis is more frequent than its absence, and there is no significant difference regarding side. It is located at 5.7 cm from the pubic symphysis and venous anastomosis is significantly more frequent. Anastomosis is significantly more frequent in females. There is no statistically significant difference between white and non-white races. Level of Evidence: IV

Variação nos tipos de irrigação do nodo sinoatrial em cães de diferentes raças / Variation in irrigation of the sinoatrial node in dogs of different breeds

Considerando a heterogeneidade anatômica e eletrofisiológica do nodo sinoatrial para a geração e propagação do potencial de ação, bem como as particularidades relacionadas a origem da sua irrigação sanguínea, este trabalho teve como objetivo analisar o comportamento das artérias envolvidas na irrigação do nodo sinoatrial em cães realizando uma análise descritiva e comparativa entre diferentes raças estudadas, detalhando a origem, o percurso e a ramescência dos vasos, assim como a eventual ocorrência de anastomoses. Ao todo analisamos resultados obtidos em 240 corações, os quais foram fixados em solução de formalina 10% e submetidos a diafanização de Spalteholz. A irrigação deste ocorre mediante colaterais oriundos do ramo circunflexo direito ou ramo circunflexo esquerdo, mostrando particularidades diferentes para cada raça. Assim, predominantemente, nas raças ora estudadas a irrigação arterial do nodo sinoatrial depende exclusivamente (63,6%), ou de anastomoses de colaterais da artéria coronária direita, havendo também participação dos ramo proximal atrial direito e intermédio atrial direito. Menos frequentemente (15,4%) o suprimento sanguíneo ocorre exclusivamente por conta do ramo proximal atrial esquerdo, oriundo do ramo circunflexo da artéria coronária esquerda. Os dados aqui apresentados sobre a origem da irrigação sanguínea do nodo sinoatrial e a ramescência dos vasos envolvidos nesta tarefa representam conhecimento fundamental para o desenvolvimento da clínica-cirúrgica em cães, da patologia e trabalhos de natureza experimental.(AU)

Considering the anatomical and electrophysiological heterogeneity of the sinoatrial node for generation and propagation of the action potential, as well as the particularities relating to the origin of blood nutrition, this study aimed to analyze the behavior of arteries involved in irrigation of the sinoatrial node in dogs performing a descriptive and comparative analysis between different breeds, with emphasis in the origin, pathway and branching of vessels, as well as the presence of anastomoses. Totally, 240 hearts were fixed in solution of formalin 10% and subjected to Spalteholz diaphanization. The vascularization of the sinoatrial node occurs by the right circumflex branch or left circumflex branch, showing several particularities according to the breed. Thus, predominantly in the studied breeds, the blood supply of the sinoatrial node depends exclusively (63.6%) or from anastomosis of the right coronary artery. There is also participation of right atrial proximal branch and right atrial intermediary branch. Less often (15.4%) the blood supply occurs exclusively from the left atrial proximal branch, which is a branch of the circumflex branch of the left coronary artery. In summary, our results related to the origin of the sinoatrial node blood nutrition and the branching of vessels involved on that represents a fundamental knowledge for the development and improvement of surgery in dogs, as well as for pathology and experimental research.(AU)

Variação nos tipos de irrigação do nodo sinoatrial em cães de diferentes raças / Variation in irrigation of the sinoatrial node in dogs of different breeds

Considerando a heterogeneidade anatômica e eletrofisiológica do nodo sinoatrial para a geração e propagação do potencial de ação, bem como as particularidades relacionadas a origem da sua irrigação sanguínea, este trabalho teve como objetivo analisar o comportamento das artérias envolvidas na irrigação do nodo sinoatrial em cães realizando uma análise descritiva e comparativa entre diferentes raças estudadas, detalhando a origem, o percurso e a ramescência dos vasos, assim como a eventual ocorrência de anastomoses. Ao todo analisamos resultados obtidos em 240 corações, os quais foram fixados em solução de formalina 10% e submetidos a diafanização de Spalteholz. A irrigação deste ocorre mediante colaterais oriundos do ramo circunflexo direito ou ramo circunflexo esquerdo, mostrando particularidades diferentes para cada raça. Assim, predominantemente, nas raças ora estudadas a irrigação arterial do nodo sinoatrial depende exclusivamente (63,6%), ou de anastomoses de colaterais da artéria coronária direita, havendo também participação dos ramo proximal atrial direito e intermédio atrial direito. Menos frequentemente (15,4%) o suprimento sanguíneo ocorre exclusivamente por conta do ramo proximal atrial esquerdo, oriundo do ramo circunflexo da artéria coronária esquerda. Os dados aqui apresentados sobre a origem da irrigação sanguínea do nodo sinoatrial e a ramescência dos vasos envolvidos nesta tarefa representam conhecimento fundamental para o desenvolvimento da clínica-cirúrgica em cães, da patologia e trabalhos de natureza experimental.(AU)

Considering the anatomical and electrophysiological heterogeneity of the sinoatrial node for generation and propagation of the action potential, as well as the particularities relating to the origin of blood nutrition, this study aimed to analyze the behavior of arteries involved in irrigation of the sinoatrial node in dogs performing a descriptive and comparative analysis between different breeds, with emphasis in the origin, pathway and branching of vessels, as well as the presence of anastomoses. Totally, 240 hearts were fixed in solution of formalin 10% and subjected to Spalteholz diaphanization. The vascularization of the sinoatrial node occurs by the right circumflex branch or left circumflex branch, showing several particularities according to the breed. Thus, predominantly in the studied breeds, the blood supply of the sinoatrial node depends exclusively (63.6%) or from anastomosis of the right coronary artery. There is also participation of right atrial proximal branch and right atrial intermediary branch. Less often (15.4%) the blood supply occurs exclusively from the left atrial proximal branch, which is a branch of the circumflex branch of the left coronary artery. In summary, our results related to the origin of the sinoatrial node blood nutrition and the branching of vessels involved on that represents a fundamental knowledge for the development and improvement of surgery in dogs, as well as for pathology and experimental research.(AU)

Compatibility and incompatibility in hyphal anastomosis of arbuscular mycorrhizal fungi

ABSTRACT: Arbuscular mycorrhizal fungi (AMF), which live in symbiosis with 80 % of plants, are not able to grow when separated from their hosts. Spore germination is not host-regulated and germling growth is shortly arrested in the absence of host roots. Germling survival chances may be increased by hyphal fusions (anastomoses), which allow access to nutrients flowing in the extraradical mycelium (ERM). Perfect anastomoses, occurring with high frequency among germlings and the ERM of the same isolate, show protoplasm continuity and disappearance of hyphal walls. A low frequency of perfect fusions has been detected among co-specific genetically different isolates, although fungal nuclei have been consistently detected in all perfect fusions, suggesting active nuclear migration. When plants of different taxa establish symbioses with the same AMF species, anastomoses between ERM spreading from single root systems establish a common mycelium, which is an essential element to plant nutrition and communication. The interaction among mycelia produced by different isolates may also lead to pre-fusion incompatibility which hinders anastomosis formation, or to incompatibility after fusion, which separates the hyphal compartments. Results reported here, obtained by analyses of hyphal compatibility/incompatibility in AMF, suggest that anastomosis formation and establishment of protoplasm flow, fundamental to the maintenance of mycelial physiological and genetic continuity, may affect the fitness of these ecologically important biotrophic fungi.

Compatibility and incompatibility in hyphal anastomosis of arbuscular mycorrhizal fungi

ABSTRACT: Arbuscular mycorrhizal fungi (AMF), which live in symbiosis with 80 % of plants, are not able to grow when separated from their hosts. Spore germination is not host-regulated and germling growth is shortly arrested in the absence of host roots. Germling survival chances may be increased by hyphal fusions (anastomoses), which allow access to nutrients flowing in the extraradical mycelium (ERM). Perfect anastomoses, occurring with high frequency among germlings and the ERM of the same isolate, show protoplasm continuity and disappearance of hyphal walls. A low frequency of perfect fusions has been detected among co-specific genetically different isolates, although fungal nuclei have been consistently detected in all perfect fusions, suggesting active nuclear migration. When plants of different taxa establish symbioses with the same AMF species, anastomoses between ERM spreading from single root systems establish a common mycelium, which is an essential element to plant nutrition and communication. The interaction among mycelia produced by different isolates may also lead to pre-fusion incompatibility which hinders anastomosis formation, or to incompatibility after fusion, which separates the hyphal compartments. Results reported here, obtained by analyses of hyphal compatibility/incompatibility in AMF, suggest that anastomosis formation and establishment of protoplasm flow, fundamental to the maintenance of mycelial physiological and genetic continuity, may affect the fitness of these ecologically important biotrophic fungi.(AU)

Continuous versus interrupted suture technique in microvascular anastomosis in rats

Purpose: To compare the continuous and interrupted suture technique on femoral artery on rats after vessel repair and 14 days after. Methods: Twenty rats were operated randomly divided into two group matched according to the suture technique used: interrupted or continuous. We performed a femoral anastomosis on the right femoral artery. We analyzed weight, arterial caliber, anastomosis time and patency after vessel repair and 14 days after. Results: There was no significant difference between groups in the weight (p=0.64), diameter of the femoral artery (p=0.95) and patency (p=1.00). The time spent in the anastomosis was 451 seconds in the continuous group and 718 seconds in the interrupted group, presenting significant difference (p 0.01). Conclusion: The continuous suture technique shows a similar patency rates than interrupted technique, however with a shorter time to perform the anastomosis.(AU)

Evaluación de la arteria alveolo-antral mediante tomografía volumétrica en población mexicana y su relación con levantamiento del piso del seno maxilar / CBCT evaluation of the alveolar antral artery in a mexican cohort and its relationship to maxillary sinus floor lifting

Introducción: El conocimiento de la anatomía de la región maxilar debe ser esencial para el cirujano antes de realizar levantamiento del seno maxilar para evitar complicaciones. La arteria alveolo antral forma una anastomosis intraósea con la arteria infraorbitaria a nivel de la pared antero lateral del seno maxilar, aproximadamente a una distancia de entre 18.9 y 19.6 mm desde el reborde alveolar maxilar. La arteria alveolo antral es la encargada de dar vascularidad a la membrana mucosa del seno maxilar, pared antero lateral del seno y tejido perióstico subyacente.Objetivo: Describir y establecer la frecuencia, diámetro y localización dela anastomosis entre la arteria infraorbitaria y la arteria alveolar posterior superior, llamada arteria alveolo antral y su relación con la cresta ósea alveolar en una población mexicana. Material y métodos: Se realizaun protocolo de estudio observacional, descriptivo y transversal en una población de 1,116 pacientes derecho habientes del Instituto de Seguridad Social y Servicios para los Trabajadores del Estado (ISSSTE), en el oriente de la Ciudad de México, mediante la revisión de estudios de tomografía volumétrica computarizada. Resultados: Se encuentra la anastomosis arterial en el 90 por ciento de los estudios revisados, correspondiente a 1,005 estudios de tomografía.

Introduction: In order to avoid complications, it is essential for surgeonsto have a detailed knowledge of the anatomy of the superior maxillarybone prior to performing any sinus lift procedure. The alveolarantral artery forms an intraosseous anastomosis with the infraorbitalartery at the level of the anterolateral wall of the maxillary antrum at anapproximate distance of between 18.9 and 19.6 mm from the maxillaryalveolar ridge. The alveolar antral artery is responsible for providingvascularity to the mucous membrane of the maxillary sinus, the anteriorlateral wall of the sinus, and the underlying periosteal tissue. Objective:To analyze and establish the frequency, diameter, and locationof the anastomosis between the infraorbital artery and the posteriorsuperior alveolar artery known as the alveolar antral artery, and itsrelationship to the alveolar bone crest in a Mexican cohort. Materialand methods. We conducted a cross-sectional observational descriptivestudy involving a cohort comprised of 1,116 patients of the Institute forSocial Security and Services for State Workers (ISSSTE) on the eastside of Mexico City. The study consisted of a review of CBCT studies.Results: The arterial anastomosis was found in 90% of the 1,005 CBCTstudies reviewed, based on which the following values were determinedfor the distance between the alveolar ridge and the canal of the alveolarantral artery: for the fi rst premolar, 18.24 mm; second premolar,17.35 mm; fi rst molar, 16.96 mm, and for the second molar, 18.75 mm.Conclusions: We established the average measurements for the locationof the vascular bundle in question and the measurements neededto safeguard it along its course, which is important for the preservationand osseointegration of bone grafts placed during maxillary sinus liftprocedures, thus providing a margin of safety not previously reportedin the literature for a Mexican cohort.

Clinical repercussions of Martin-Gruber anastomosis: anatomical study / Repercussões clínicas da anastomose de Martin-Gruber: estudo anatômico

OBJECTIVE: The main objective of this study was to describe Martin-Gruber anastomosis anatomically and to recognize its clinical repercussions. METHOD: 100 forearms of 50 adult cadavers were dissected in an anatomy laboratory. The dissection was performed by means of a midline incision along the entire forearm and the lower third of the upper arm. Two flaps including skin and subcutaneous tissue were folded back on the radial and ulnar sides, respectively. RESULTS: Nerve communication between the median and ulnar nerves in the forearm (Martin-Gruber anastomosis) was found in 27 forearms. The anastomosis was classified into six types: type I: anastomosis between the anterior interosseous nerve and the ulnar nerve (n = 9); type II: anastomosis between the anterior interosseous nerve and the ulnar nerve at two points (double anastomosis) (n = 2); type III: anastomosis between the median nerve and the ulnar nerve (n = 4); type IV: anastomosis between branches of the median nerve and ulnar nerve heading toward the flexor digitorum profundus muscle of the fingers; these fascicles form a loop with distal convexity (n = 5); type V: intramuscular anastomosis (n = 5); and type VI: anastomosis between a branch of the median nerve to the flexor digitorum superficialis muscle and the ulnar nerve (n = 2). CONCLUSION: Knowledge of the anatomical variations relating to the innervation of the hand has great importance, especially with regard to physical examination, diagnosis, prognosis and surgical treatment. If these variations are not given due regard, errors and other consequences will be inevitable.

OBJETIVOS: Descrever anatomicamente a anastomose de Martin-Gruber e reconhecer suas repercussões clínicas. MÉTODO: Foram dissecados 100 antebraços de 50 cadáveres adultos no laboratório de anatomia. A dissecção foi feita através uma incisão mediana em todo o antebraço e terço inferior do braço, dois retalhos incluindo a pele e subcutâneo foram rebatidos, para o lado radial e ulnar respectivamente. RESULTADOS: A comunicação nervosa entre os nervos medianos e ulnar no antebraço (anastomose de Martin-Gruber) foi registrada em 27 antebraços. Classificamos a anastomose em seis tipos. Tipo I: anastomose entre o nervo interósseo anterior e o nervo ulnar (nove membros); Tipo II: anastomose entre o nervo interósseo anterior e o nervo ulnar em dois pontos (dupla anastomose - dois membros); Tipo III: anastomose entre o mediano e o nervo ulnar (quatro membros); Tipo IV: anastomose entre ramos dos nervos mediano e ulnar destinada ao músculo flexor profundo os dedos, esses fascículos formam uma alça de convexidade distal (cinco membros); Tipo V: anastomose intramuscular (cinco membros); Tipo VI: anastomose entre ramo do nervo mediano para o músculo flexor superficial e nervo ulnar (dois membros). CONCLUSÃO: O conhecimento das variações anatômicas em relação à inervação da mão tem importância relevante, principalmente quando se considera o exame físico, diagnóstico, prognóstico e tratamento cirúrgico. Se essas variações não forem valorizadas, erros e consequências serão inevitáveis.

Anastomose intramuscular de Martin-Gruber / Intramuscular Martin-Gruber anastomosis

Objetivo: A finalidade deste trabalho foi apresentar a incidência,origem, curso e ralações anatômicas da anastomose intramuscular de Martin-Gruber. Método: Foram dissecados 100 antebraços de 50cadáveres adultos. A comunicação nervosa intramuscular entre os nervos mediano e ulnar no antebraço (anastomose de Martin-Gruber)foi registrada em cinco antebraços, três no antímero direito e duasno esquerdo, sendo uma bilateral. Todas as comunicações nervosas localizavam-se entre os nervos interósseo anterior e o nervo ulnar.Conclusão: As comunicações nervosas intramusculares, que registramos em 5% dos 100 membros dissecados, tem apenas a finalidade de suprir o músculo flexor profundo dos dedos, sendo pouco provável que tenham alguma influência na inervação dos músculos intrínsecos da mão. Nível de Evidência IV, Série de Casos.

Objective: This paper reports the incidence, origin, courseand anatomical relationships of intramuscular Martin-Gruberanastomosis. Methods: Anatomical dissection of 100 limbsfrom 50 adults cadavers was performed. The intramuscularMartin-Gruber anastomosis was found in five forearms, threein the right and two in the left side, one was bilateral. All communicationwere located between the anterior interosseousnerve and the ulnar nerve. Conclusion: The purpose of intramuscularMartin-Gruber anastomosis, which we found in 5%of dissected limbs, is to supply the flexor digitorum profundusmuscle and it is unlikely to have any influence on the innervationof the intrinsic muscles of the hand. Level of Evidence IV,Cases Series.