Distal insertional anatomy of the triceps brachii muscle: MRI assessment in cadaveric specimens employing histologic correlation and Play-doh® models of the anatomic findings.

OBJECTIVES: Assess the insertional anatomy of the distal aspect of the triceps brachii muscle using magnetic resonance imaging (MRI) in cadavers with histologic correlation and Play-doh® models of the anatomic findings. MATERIALS: Elbows were obtained from twelve cadaveric arm specimens by transverse sectioning through the proximal portion of the humerus and the midportion of the radius and ulna. MRI was performed in all elbows. Two of the elbow specimens were then dissected while ten were studied histologically. Subsequently, Play-doh® models of the anatomic findings of the distal attachment sites of the triceps brachii muscle were prepared. RESULTS: MRI showed a dual partitioned appearance of the distal attachment sites into the olecranon in all specimens. In the deeper tissue planes, the medial head muscle insertion was clearly identified while superficially, the terminal portion of the long and lateral heads appeared as a conjoined tendon. Histologic analysis, however, showed continuous tissue rather than separate structures attaching to the olecranon. CONCLUSION: Although MRI appeared to reveal separate and distinct attachments of the triceps brachii muscle into the olecranon, histologic analysis delineated complex but continuous tissue related to the attachments of the three heads of this muscle. The Play-doh® models were helpful for the comprehension of this complex anatomy and might serve as a valuable educational tool when applied to the analysis of other musculoskeletal regions.

High origin of the anterior band of the inferior glenohumeral ligament: MR arthrography with anatomic and histologic correlation in cadavers.

INTRODUCTION: The anterior band of the inferior glenohumeral ligament has been described to arise from the anteroinferior labrum, but we have observed that in some persons its origin is from the anterior or anterosuperior labrum, creating diagnostic difficulties. MATERIALS AND METHODS: Ten fresh unembalmed cadaveric shoulders underwent magnetic resonance arthrography (MRA) using a posterior approach with a 1.5 T GE magnet, with the following sequences: T1-weighted fast spin-echo in axial, coronal and sagittal planes, and T1 fat-suppressed spin-echo in the axial plane (TR/TE 600/20, section thickness 2.5 mm, 0.5 mm interslice space, number of signals acquired, two, field of view 12 × 12 cm, and matrix 512 × 256 pixels). Following imaging, the shoulders were frozen and later sectioned using a band saw into 3-mm sections corresponding to the axial imaging plane. Histological analysis was also performed to determine the origin of the anterior band. RESULTS: Four of the ten shoulders had an origin of the anterior band above or at the 3 o'clock position: one at the 1 o'clock position, two at the 2 o'clock position, and one at the 3 o'clock position. In another shoulder, the anterior band of the inferior glenohumeral ligament originated from the middle glenohumeral ligament, and in five other shoulders, the anterior band originated from the anteroinferior labrum as has been described in the literature. CONCLUSIONS: This finding is of clinical significance as a high origin of the anterior band of the inferior glenohumeral ligament leads to MR arthrographic finding that can simulate those of labral tears or detachments.

Prevalencia de falla ovárica y factores de riesgo en pacientes con Lupus Eritematoso Sistémico tratadas con ciclofosfamida intravenosa / Prevalence of ovarian failure and risk factor in patients with systemic lupus erythematosus

Introducción: la falla ovárica prematura es una consecuencia del manejo a largo plazo con ciclofosfamida, su prevalencia en pacientes con LES ha sido informada entre el 11 y el 59%, dependiendo de la ruta y dosis de administración. Estudios sobre la toxicidad gonadal con el régimen propuesto por el NIH son escasos en la literatura, por lo cual se realizó este estudio para determinar la prevalencia y los factores de riesgo asociados al desarrollo de falla ovárica en una población latinoamericana. Métodos: se tomaron 56 pacientes con LES tratadas con bolos de CFM mensuales, menores de 40 años y con menstruación normal al momento de iniciar la terapia y se compararon con respecto a la frecuencia de amenorrea con 43 pacientes con LES sin tratamiento con ciclofosfamida como grupo control. Posteriormente estudiamos en el grupo de CYC, las diferencias entre aquellas que hicieron amenorrea y las que continuaron con ciclos regulares. Este es un estudio descriptivo de corte transversal. Se aplicó chi-cuadrado, test exacto de Fisher y Mann-Withney según estuviese indicado. P menor de 0,05 se consideró significativo. Resultados: el 16,1% de los pacientes con CYC desarrollaron falla ovárica frente al 4,3% del grupo control. Con respecto al grupo que recibió CYC, se encontró un promedio de edad mayor en el grupo que desarrolló amenorrea que en aquellas con ciclos regulares, 35,2 frente a 26,7 años (p= 0,003), determinándose como punto de corte de riesgo ser mayor de 28 años al inicio de la CFM. La evolución de la enfermedad fue mayor en el grupo de amenorrea en comparación con las que continuaban con menstruación normal con una p= 0,003 (10,2 frente a 4,4 años). No se encontró diferencia en la dosis acumulativa, duración de la terapia o perfil inmunológico de las pacientes. Conclusión: la prevalencia de falla ovárica en mujeres colombianas tiende a presentarse a una edad más temprana y con mayor tiempo de evolución de la enfermedad a pesar de dosis acumuladas inferiores a las informadas en la literatura planteando una mayor labilidad al efecto tóxico de la CFM.

Background: premature ovarian failure is a cyclophosphamide (CYC) treatment adverse effect. The report of prevalence is among 11% and 59%, the variability depend on the route and dosage of CYC. There are few studies about gonadal toxicity with NHI CYC treatment protocol. We decided to establish the prevalence and risk factors associated with premature ovarian failure in a group of Latin-American lupus patients. Methods: 56 SLE patients under 40 years treated with intravenous CYC, with regular menstrual cycle at the beginning of the treatment, were compared with respect to the frequency of amenorrhea with 43 SLE patients without treatment with CYC as a control group. After that, we studied in the CYC group the differences between those who made amenorrhea and those that continued with regular cycles. This is a cross sectional and descriptive study. The data were analyzed by chi-square, Fisher’s exact test and Mann-Withney when it was necessary. P < 0.05 was considered significant. Results: 16.1% of SLE patients under intravenous CYC treatment get premature ovarian failure vs. 4.3% in the control group. With respect to CYC group, the mean age in the amenorrhea group was higher than the age in patients with regular menstrual cycles 35.2 vs. 26.7 years (p=0.03). We found than patients older than 28 years have a mayor risk for amenorrhea induced by intravenous CYC. The mean disease duration was higher in the amenorrhea group than in the regular menstrual cycle patients, p= 0.003 (10.2 vs. 4.4 years). No significant differences were observed in cumulative dosage, treatment duration or immunologic findings between groups. Conclusion: the prevalence of ovarian failure in Colombian women tends to appear at an early age and with a greater time of evolution of the disease in spite of inferior accumulated doses than those that are informed in the Literature, suggesting a mayor susceptibility to toxic effect of CYC.