[Anatomical variants of the medial calcaneal nerve and the Baxter nerve in the tarsal tunnel]. / Variantes anatómicas del nervio calcáneo medial y nervio de Baxter en el túnel del tarso.

The tarsal tunnel is composed of the posterior border of the medial malleoulus, the posterior aspect of the talus and the medial aspect of the calcaneus. The medial calcaneal nerve emerges from the posterior aspect of the posterior tibial nerve in 75% of cases and from the lateral plantar nerve in the remaining 25%. Finally, the medial calcaneal nerve ends as a single terminal branch in 79% of cases and in numerous terminal branches in the remaining 21%. To describe the anatomical variants of the posterior tibial nerve and its terminal branches. To describe the steps for tarsal tunnel release. To describe Baxter nerve release. The anatomical variants of the posterior tibial nerve and its terminal branches within the tarsal tunnel were studied. Then the Lam technique was performed; it consists of: 1) opening of the laciniate ligament, 2) opening of the fascia over the abductor hallucis muscle, 3) exoneurolysis of the posterior tibial nerve and its terminal branches, identifying the emergence and pathway of the medial calcaneal branch, the lateral plantar nerve and its Baxter nerve branch and the medial plantar nerve. Baxter nerve was found in 100% of cases. In 100% of cases in our series the nerve going to the abductor digiti minimi muscle of the foot was found; 87.5% of cases had two terminal branches. The dissections proved that a crucial step was the release of the distal tarsal tunnel.

Testosterone rapidly stimulates insulin release from isolated pancreatic islets through a non-genomic dependent mechanism.

The action of testosterone on the 45Ca2+ uptake and insulin secretion was studied in short-term experiments using isolated pancreatic islets of Langerhans. Testosterone (1 microM) stimulated 45Ca2+ uptake within 60 seconds of incubation on similar proportion than tolbutamide. Also, the hormone rapidly increased insulin release (34%; 180 seconds) on the presence of non-stimulatory concentrations of glucose (3 mM). Impermeant testosterone-BSA significantly stimulated the secretion of insulin to a lower percentage (10%). The action of the hormone is specific--neither 17beta-E2 nor progesterone stimulated insulin secretion in the presence of 3 mM glucose. The action of testosterone on insulin secretion was dose-dependent, and at rat plasma physiological concentrations (25 nM), stimulus was 17% (p < 0.05). In conclusion, in isolated pancreatic islets experiments, physiological concentration of testosterone rapidly stimulate insulin secretion and 45Ca2+ uptake through a membrane bound mechanism.

Dermolipectomia Abdominal em âncora após cirurgia bariátrica / Abdominal dermolipectomy in anchor after bariatric surgery

A obesidade mórbida é reconhecida atualmente como um grande problema para a saúde. Os tratamentos clínicos desta patologia são falhos quando avaliados a longo prazo. Isto levou os cirurgiões a desenvolverem técnicas que resultam em efeitos restritivos ou malabsortivos à ingestão de alimentos. Após alguns meses da cirurgia bariátrica, existe uma perda de peso maciça resultando em grande flacidez da pele do abdômen, mamas, coxas e braços. Neste estudo avalia-mos a técnica de Correa-Iturraspe para o tratamento da região abdominal em dezessete pacientes que apresentaram grande perda ponderal após cirurgia bariátrica.

Morbid obesity is increasingly recognized as a major health concern. Drug treatments of the morbid obese have entirely failed in the long run. These circumstances have constituted incentives for surgeons to develop techniques resulting in malabsorptive or restrictive effects on food intake. Some months after the bariatric surgery there is a massive weight loss and a great skin laxity mainly at the abdomen, breast, tights and arms. In this study we evaluate the Correa-Iturraspe technique to treat the abdominal region in seventeen patiens with massive weigth loss after bariatric surgery.

Tratamento cirúrgico da gigantomastia / Surgical Treatment of Gigantomastia

Mastoplastia redutora é um procedimento cirúrgico bastante requisitado por pacientes que apresentam mamas grandes associadas a dores lombres. As grandes hipertrofias impõem técnicas que permitam ressecções associadas ao tratamento da ptose que, na maior parte dos casos, é acentuada. Neste estudo analisamos as técnicas empregadas em 231 casos de mastoplastia redutora, realizados no Serviço de Cirurgia Plástica do Hospital de Clínicas da UFPR no período de 1998 a 2002, das quais 13,8 foram considerados casos de gigantomastia.

Women with big breasts and back pain claim for a reduction mammaplasty. Large volume breast reductions need special atention for the nipple areolar complex migration. In this study we analise the techniques used in 231 reduction mammaplasties performed at “Hospital de Clínicas da Universidade Federal do Parana” from 1998 to 2002. 13,8 of the cases where considered with very large hipertrophies.

Microssomia craniofacial: experiência de 105 casos em 7 anos / Hemifacial microsomy: experience with 105 cases during 7 years

A Microssomia Craniofacial é deformidade com grande variedade de apresentações clínicas. Tratamos 105 casos em 7 anos, entre 1996 a 2002. Os casos foram revisados enfocando as suas alterações anatômicas. A idade de início do tratamento foi entre 0 e 5 anos em 39, 6 a 10 anos em 27,6 e após 10 anos em 33,4. Em 44,8 o lado comprometido foi o direito, o esquerdo em 38 e bilateral em 17,2. O pavilhão auricular era normal em 10; microtia correspondeu a 81 das deformidades auriculares, anotia a 12,6, orelha constricta a 6,3, question ear a 4,2, duplicidade a 4,2 e ausência do lóbulo a 1. Em 65,7 dos pacientes o meato acústico estava ausente e em 2,8 havia atresia. De acordo com a classificação de Pruzanski, foram de 35,2 as alterações mandibulares de Grau I, 21,9 de Grau IIA, 16,1 de Grau IIB e 3,8 de Grau III. Em 22,8 a mandíbula apresentava-se normal. Paralisia facial foi encontrada em 11,4 e macrostomia em 22,8. Em 10 dos pacientes apresentavam alterações oftalmológicas, dentre elas, 3 casos dermóide epibulbar. Em 21,9 foram identificadas outras deformidades faciais, com 5 casos de hipoplasia de partes moles, 9 de fissuras lábiopalatais e 2 de atrofia do masséter.

Hemifacial Microsomia is a deformity with a great variety of clinical feature. We have been treating 105 cases in last 7 years. The revision is focusing over the anatomic disorders. The patients looked for treatment between 0 – 5 y.old in 39, 5 – 10 in 27,6 and after 10 years old in 33,4. In 44,8 of the patients the deformities were at right side and 38 in the left, and in 17,2 was bilateral. Normal ear was seen in 10. In patients with auricular deformities microtia was seen in 81, anotia 12,6, lop and cup ear in 6,3, question ear in 4,2, duplicity in 4,2 and absence of lobulus in 1. In 65,7 of the patients the meatus was absence and 2,8 with atresic meatus. According to classification of Pruzanski, 35,2 of mandibular deformities were grade I, 21,9 grade IIA, 16,1 grade IIB and 3,8 grade III. Mandible was normal in 22,8. Facial palsy was found in 11,4, and macrostomy in 22,8. Around 10 of our patients had ocular deformities, and 3 of them had epibulbar dermoids. Others facial malformation occurred in 21,9, included: soft tissue hipoplasia in 5 cases, cleft lip and/or palate in 9 cases, and masseter atrophy in 2 cases .

Estudo de doppler fluxometria em retalho de abdominoplastia / Study of Eco-Doppler fluxometry in abdominoplasty flap

A abdominoplastia tem-se difundido mundialmente, tanto esteticamente como de forma reparadora, e novas técnicas estão surgindo com o objetivo de minimizar as complicações isquêmicas do retalho e melhorar o contorno corporal. No período de janeiro a julho de 2002, vinte e uma pacientes, do sexo feminino, com idade variando entre 39 e 54 anos, apresentando alteração no abdome do tipo III e IV de BOZOLA, foram submetidas a abdominoplastia associada à lipoaspiração do abdome e flancos e descolamento apenas da porção central para plicatura da diástase muscular de acordo com a técnica de Saldanha(2001). Foi realizado um estudo com doppler fluxometria colo- rida dos vasos epigástricos superiores, inferiores e suas perfurantes músculo cutâneas, no pré-operatório e no décimo quinto dia de pós-operatório, avaliando a vascularização da parede abdominal superior e inferior, contabilizando os ramos perfurantes, calibre e fluxo sangüíneo dos vasos. Este estudo comprovou, através de doppler fluxometria, a preservação dos vasos perfurantes na região periumbilical e hipocôndrio e o aumento do calibre dos vasos em 9 e do fluxo sangüíneo em 56. A manutenção da irrigação sangüínea do retalho foi demonstrada clinicamente, através da boa evolução da cicatriz e ausência de complicações, como necrose da borda do retalho e seroma.

Abdominoplasty surgery has spread universally, both as aesthetic and reconstructive procedures, and new techniques are appearing with the goal of minimizing ischemic complications of the flap and bettering body contour. From January 2002 to July 2002, twenty one female patients, range of 30 to 54 years, presenting abdominal alterations classified as type III and IV of Bozola, were submitted to abdominoplasty combined with abdominal and flank lipossuction and central portion undermining for muscular diastasis plication according to Saldanha’s technique. Eco-doppler fluxometry of the superior and inferior epigastric vessels and of their cutaneous muscular perfurans was done preoperatively and 15 days after the surgery, assessing the superior and inferior abdominal wall circulation, counting the number of perfurans vessels, the diameter and vessels flow. This study showed, through eco-doppler fluxometry, perfurans vessel preservation at the periumbelical and hypocondric areas and enhancement of vessels diameter (9) and vessels flow (56). Blood flow maintenance was demonstrated clinically through the good scar evolution and absence of complications, as flap necrosis and seroma.

[Surgical anatomy of the sural nerve]. / Anatomia cirúrgica do nervo sural.

The sural nerve is generally used as a graft in nervous reconstructions due to its easy access and minimal sequelae after its withdrawal. Although this nerve presents a constancy in its topographical localization, anatomical variations are frequent. Thus, trying to determine the formation pattern of the sural nerve complex, 38 legs from 19 cadaveres were dissected. The data obtained differ from those of the literature as to the frequency of the occurrence of the two classically known patter (pattern I and II). Besides, it was possible to identify two other paterns (pattern III and IV) of the sural nerve formation not yet described The cutaneous nerve and the comunicating peroneal nerve were found in 21% of the cases. In the literature, the frequency is of 65.8% to 80%. Pattern II, where the sural nerve is originated from the medial sural cutaneous nerve, was identified in 52.6% of cases, while in the literature its frequency is of 20 to 34.2%. Pattern III, not yet described in the literature, had the sural nerve coming from the junction between the medial sural cutaneous nerve and the lateral sural cutaneous one, with a frequency of 21% of the cases. Pattern IV, also not yet described in the literature, had the sural nerve originated from the common fibular nerve in 5.2% of patients. It was also possible to identify in the sample the presence of the lateral sural cutaneous nerve (branch of the common fibular nerve) and of the peroneal communicating nerve (branch of the lateral sural cutaneous nerve) with anatomical characteristics indicating them as an alternative source of nerve grafts.

Actividad nitrificadora en suelos derivados del relleno sanitario

En el presente trabajo se estudia la nitrificación en suelos derivados del relleno sanitario, con una antiguedad de 2,5,7 y 9 años. Las muestras se obtuvieron en el Cinturón Ecológico sector Litoral del Río de la Plata (Buenos Aires, Argentina). Para evaluar diferencias cuantitativas entre las variables se utilizó la técnica del número más probable (NMP). Concluye que no se observa desarrollo diferencial entre las muestras analizadas y que el suelo posee capacidad de nitrificación

Actividad nitrificadora en suelos derivados del relleno sanitario

En el presente trabajo se estudia la nitrificación en suelos derivados del relleno sanitario, con una antiguedad de 2,5,7 y 9 años. Las muestras se obtuvieron en el Cinturón Ecológico sector Litoral del Río de la Plata (Buenos Aires, Argentina). Para evaluar diferencias cuantitativas entre las variables se utilizó la técnica del número más probable (NMP). Concluye que no se observa desarrollo diferencial entre las muestras analizadas y que el suelo posee capacidad de nitrificación

Electrophysiological changes of Sertoli cells produced by the acute administration of amino acid and FSH.

Electrophysiological studies were carried out using seminiferous tubules of "Sertoli cell enriched testes" of rats irradiated in utero. Sertoli cells were inserted with glass microelectrodes in a superfusion chamber continuously perfused with KRb buffer. The topical application of FSH (4.0 mU/ml) produced a biphasic effect characterized by a rapid hyperpolarization (less than 3 s) followed by depolarization. The depolarizing effect of FSH was prolonged and potentiated in the presence of 5 mmol/l alpha-methylamino-isobutyric acid in the bath medium of the superfusion chamber. Verapamil, at a dose (250 mumol/l) that nullified the stimulatory action of FSH in the amino acid transport, suppressed the depolarizing effect of FSH. It was concluded that in immature rat testes FSH produces electrophysiological changes that mediate the stimulatory action of the amino acid transport.

Biochemical factors involved in the FSH action on amino acid transport in immature rat testes.

Testes of 15-day-old rats preincubated and incubated during different times with various doses of FSH (0.2; 2.0 and 20.0 mU/ml) in Krebs-Ringer bicarbonate (KRb) buffer increase the uptake of [14C] methylaminoisobutyric acid and [14C] aminoisobutyric acid. The basal and FSH stimulated amino acid transport occurs at absolute lower levels when the protein or glycoprotein synthesis is inhibited by cycloheximide (350 mumol/l) or tunicamycin (12 mumol/l) or when the microtubules are depolymerized with colchicine (1.2 mumol/l). However, the proportional increase of amino acid transport produced by FSH was maintained. The blockage of the voltage-dependent Ca++ channels with verapamil or the competitive inhibition of the bivalent ion channels by Co++ or Ni++ nullified the stimulatory action of FSH on the amino acid transport. Also quinine, that blocks the ATP dependent K+ channels, abolished the FSH action. It was concluded that in immature rat testes FSH stimulates amino acid transport through a mechanism involving voltage-dependent Ca++ channels and ATP-sensitive K+ channel.

[Colonoscopy as primary procedure in the diagnosis of colonic neoplasms]. / Colonoscopia como exploración primaria en el diagnóstico de las neoplasias del colon.

Experience with colonoscopy as an initial procedure in the study of the colon is presented. 3.450 colonoscopies in patients with GI symptoms were performed by trained endoscopists using the intermediate length scopes (130cm) without fluoroscopy. In 90% of the cases the whole colon was studied in a mean time of 20 minutes. 382 neoplasms (11.07%) were diagnosed. Polips represented 90% of the lesions and 34.3% of them were adenomas. 30% of the adenomas and 34.4% of the malignant tumors were localized in the right colon. We emphasise that 82.7% of the polips found in the right colon were adenomas. As a side effect we had a sigmoid perforation, it represents 0.03%. Colonoscopies performed by a trained endoscopist is a highly diagnostic method with low degree of complications, making it the procedure of choice in the study of the colon in specialized centers.

Estimation of the daily intake of cadmium which may be consumed by students 12-17 years old in secondary schools in the city of Havana.

In the present article we offer information regarding the estimated amounts of cadmium which may be consumed by 12,000 students 12 to 17 years old, who attend boarding secondary schools. The method of analysis used to determine cadmium is that reported by the Association of Official Analytical Chemists using atomic absorption spectrometry with air-acetylene flame. The estimated quantities of cadmium which these students may consume according to the offered foods are smaller than those recommended as provisional tolerable weekly intake by the Joint FAO/WHO Expert Committee on Food Additives.

[Colitis caused by radiation: 20 years' experience]. / Colitis por radiación: 20 años de experiencia.

The 20 year experience with diagnosis and management of radiation colitis at the Gastroenterology Department of the Hospital Oncológico "Padre Machado" is presented. Of 404 cases, 98% were treated for carcinoma of the cervix. The most frequent symptoms were rectal bleeding (71%) and changes in the intestinal habitus (27.2%). Symptoms were present from one month to one year prior to radiation. Flexible sigmoidoscopy in 77.5% of patients showed Grade I and II actinic disease, and X Ray studies sowed Grade II and III in 80%. Thirty eight patients required surgical treatment.

Variación de uratos sericos en pacientes con infartos miocárdico durante la fase aguda / Urates serum changes in patients with myocardiol infarction during acute phose

Estudiamos un grupo de 32 pacientes, de los cuales 25 eran varones y 7 fueron hembras, con un rango de edad entre 39 y 85 años. A quienes se les diagnosticó infarto miocárdico agudo (IMA) según criterios clínicos electrocardiográficos y enzimáticos. Les fueron practicadas determinaciones de uratos séricos en las primeras 24 horas, 48 horas, 72 horas y posteriormente a las 6 semanas. Encontramos una clara tendencia a na elevación de los uratos séricos durante la fase aguda y descenso posterior de los mismos. Esta tendencia fue comparable en el grupo que cursó con valores de uratos séricos dentro del rango de lo normal. Una asociación con uremia encontramos en el grupo de pacientes que cursaron con valores de uratos séricos elevados. Mayor morbilidad y mortalidad en el grupo de pacientes que cursó con valores de uratos séricos elevados en las primeras 24 horas, al compararlos con el grupo de pacientes normouricémicos en el mismo momento. Concluimos: Los uratos se elevan y descienden durante el IM; La hiperuricemia sin uremia es inusual en infarto. El ácido úrico fue signo de mal pronóstico cuando se asoció en las primeras 24 horas del IM. Sugerimos que el ácido úrico tiene importancia pronóstica en IMA