Human Anatomy in Cinema / La Anatomía Humana en el Cine

SUMMARY: A corpse is the body's final destination and, as a social construction, it challenges Western cultural taboos and practices around the corpse, having been shown in cinema. The present paper aims to analyze 17 films that portray Human Anatomy, identifying which themes specifically related to morphological sciences are addressed, namely: a) reactions to first contact with a cadaver, b) medical school and dissection classes, c) origin of cadavers, d) anatomy and suspense or horror movies, e) romance, drama and comedy, f) body snatchers/ resurrectionists, g) anatomical techniques, h) racism, prejudice and anatomy. This is a critical review of films in which, after thorough triple- blind analysis by the authors, it was observed that the encounter with the cadaver provides a series of emotions to the characters participating in the practical anatomy classes shown in the films, such as apprehension, fear, disgust, curiosity, etc. Generally, this surprising contact between the living and the dead is associated with the practice of dissection, which often results in the accentuation of emotions previously reported. From all this, it is concluded that the history of the teaching of Human Anatomy has been interestingly portrayed in cinema from different points of view.

Un cadáver es el destino final del cuerpo y, como construcción social, desafía los tabúes y prácticas culturales occidentales en torno al cadáver, habiendo sido mostrado en el cine. El presente trabajo tuvo como objetivo analizar 17 películas que retratan la Anatomía Humana, identificando qué temas específicamente relacionados con las ciencias morfológicas se abordan, a saber: a) reacciones al primer contacto con un cadáver, b) clases de medicina y disección, c) origen de los cadáveres, d) anatomía y películas de suspenso o terror, e) romance, drama y comedia, f) ladrones de cuerpos/resurreccionistas, g) técnicas anatómicas, h) racismo, prejuicio y anatomía. Se trata de una revisión crítica de películas en las que, tras un minucioso análisis triple ciego por parte de los autores, se observa que el encuentro con el cadáver proporciona una serie de emociones a los personajes que participan en las clases prácticas de anatomía que se muestran en las películas, tales como aprensión, miedo, repugnancia, curiosidad, etc. Generalmente, este sorprendente contacto entre vivos y muertos se asocia con la práctica de la disección, lo que muchas veces resulta en la acentuación de las emociones anteriormente relatadas. De todo ello se concluye que la historia de la enseñanza de la Anatomía Humana ha sido interesantemente retratada en el cine desde diferentes puntos de vista.

Cardiac corpuscles: a “new” morphofunctional entity?

he existence of “transitional muscular structures” between subendocardial branches (Purkinje fibers) and ventricular working muscle fibers (WF) was first described by the German anatomist, Kurt Goerttler, in 1964. He designated them as “subendocardial nucleus organs.” He supposed such fibers functioned as mechanoreceptors, controlling of the intensity of contraction of the ventricular musculature. Brazilian anatomist Ferraz de Carvalho described similar structures in 1993. A thorough literature search failed to identify any other research articles confirming or denying their existence. The objective of this work was to find such structures in subendocardial ventricular walls in human hearts. We collected fifteen formalin-preserved hearts from the Anatomy Department of São Paulo University and sectioned the apical portions on the right and left ventricles according to method used by Goerttler. We utilized conventional histology (light microscopy- LM), scanning electron microscopy (SEM), and a new preservation method called micro- plastination (MP). At the anterior wall of the right ventricle in the subendocardial region between the interventricular septum and moderator band, we found several bundles of fusiform and helicoidal fibers of similar histology to the WF. The bundles measured between 400 and 1150 µm in length and were separated from adjacent muscular fibers by thin collagen fiber, thus acting as a “pseudo capsule.” Some structures seemed to be linked to PF and were appeared to be lymphatic and blood vessels and nerves. We called those structures “cardiac corpuscles” (CC). The observation of the previously “unknown” CC in this initial study confirmed the previous descriptions and its discovery may contribute to new perspectives in the study of cardiac muscle structure and function.

Prototyping and 3D printing of computed tomography images with an emphasis on soft tissues, especially muscles, for teaching human anatomy / Prototipado e impresión 3D de imágenes de tomografía computarizada con énfasis en los tejidos blandos, especialmente músculos, para la enseñanza de la anatomía humana

The study on cadavers, although considered fundamental in the teaching of human anatomy, is limited in several universities, mainly due to the acquisition and manipulation of cadaveric material. Throughout history, several artificial anatomical models have been used to complement the real anatomical pieces. The present study offers a new alternative: the making of three-dimensional models from Computed Tomography (3D-CT) patient image acquisition. CT images from the USP University Hospital database were used. Patients underwent examinations for reasons other than the present study and were anonymized to maintain confidentiality. The CT slices obtained in thin cross-sections (approximately 1.0 mm thick) were converted into three-dimensional images by a technique named Volume Rendering for visualization of soft tissue and bone. The reconstructions were then converted to an STL (Standard Triangle Language) model and printed through two printers (LONGER LK4 Pro® and Sethi S3®), using PLA and ABS filaments. The 3D impressions of the thigh and leg muscles obtained better visual quality, being able to readily identify the local musculature. The images of the face, heart, and head bones, although easily identifiable, although seemed to present lower quality aesthetic results. This pilot study may be one of the first to perform 3D impressions of images from CT to visualize the musculature in Brazil and may become an additional tool for teaching.

Macroscopic, morphometric, and tomographic features of the mandible of the collared peccary (Pecari tajacu) applied to clinical morpho-physiology and imaging.

Veterinary dentistry is one of the specialties with the greatest potential to contribute to animal welfare; however, it requires a deep anatomical knowledge of the region to be treated. Therefore, the aim was to describe the macroscopic, morphometric, and tomographic anatomy of the mandible of the collared peccary in order to provide support for a better understanding of local morpho-physiology and to improve clinical procedures and interpretation of imaging exams in live adult specimens. Four mandibles from wild adult Pecari tajacu were used. The mandibles were submitted to CT scanning, and comparative analyses were performed using multiplanar views. Afterward, mandibular morphometry was conducted following the literature. Each hemimandible is composed of body, angle, and ramus. The main bony landmarks are the mandibular foramen, three main lateral mental foramina, two medial mental foramina, condylar and coronoid processes, and mandibular and angular notches. The teeth are bunodont, and the dental formula is I3/C1/PM3/M3. All bony structures were observed both in the prepared mandible and in the tomographic images and their 3D reconstruction. No obvious differences were observed in the morphometric data between males and females, or between right and left hemimandibles. It can be concluded that the mandible of the collared peccary may be anatomically structured to favor its omnivorous feeding habit. CT scan proved to be an excellent tool for evaluating the teeth and mandible, and it also provides reliable 3D bone reconstructions that can be helpful in the structural identification and the planning of oral care in live adult animals.

Comparative anatomy of blue-and-yellow macaw (Ara ararauna) and toco toucan (Ramphastos toco) beaks using macroscopic analysis and computerized tomography / Anatomía comparada de los picos de guacamayo azul y amarillo (Ara ararauna) y de tucán toco (Ramphastos toco) mediante análisis macroscópico y tomografía computarizada

SUMMARY: Clinically, avian medicine still finds it very difficult to treat wild patients due to the lack of reliable information about their anatomy and physiological parameters that make comparative analyzes possible. Considering that computed tomography (CT) is one of the most viable alternatives in radiography of the head, we describe the comparative anatomy of the beak in the Ara ararauna and the Ramphastos toco through this imaging modality and macroscopy analysis, providing additional information about their conformation and topography for clinical exams. Adult specimens of each were dissected after the CT and beaks were removed for macroscopic analyses. The macroscopic and tomographic findings for both species confirm the similarities in beak morphology and the dietary peculiarities of each.The CT scan proved to be a useful tool to visualize internal structures of the skull through a detailed virtopsy of regions that are difficult to access by the usual necropsy with a scalpel.

RESUMEN: Debido a la escasa información de la anatomía y de los parámetros fisiológicos que hacen posible los análisis comparativos en la medicina aviar, clínicamente resulta muy difícil el tratamiento de estos animales. Considerando que la tomografía computarizada es una buena alternativa, estudiamos la anatomía comparativa del pico en Ara ararauna y Toco Toucan utilizando imágenes y un análisis de macroscopía. Estos métodos proporcionaron información adicional referente a su conformación y topografía para el trabajo clínico. Después de analizar la tomografía se disecaron las muestras de especímenes adultos y se retiraron los picos para un análisis macroscópico. Los hallazgos macroscópicos y tomográficos para ambas especies corroboraron la relación morfológica entre los picos y las peculiaridades dietéticas de cada uno. Se demostró además, que la tomografía computarizada es una herramienta útil para visualizar las estructuras internas del cráneo de las aves, a través de una virtopsia detallada en áreas de difícil acceso durante una necropsia habitual.

Volumetric computed tomography reconstruction, rapid prototyping and 3D printing of opossum head ( Didelphis albiventris ) / Reconstrucción volumétrica por tomografia computarizada, prototipado rápido e impresión 3D de cabeza de zarigüeya ( Didelphis albiventris )

Natural anatomical pieces of wild animals are rare and teachers seek alternatives in satisfactory quantity and quality to inform their students. This article aims to describe the use of multiplanar reconstructions and 3D volume rendering computed tomography (CT) images, rapid prototyping and 3D printing of opossum head to create a biomodel to veterinary education in descriptive anatomy of wild animals. A six-step method study was conducted to construct the biomodel: (1) selection of opossum head from museum; (2) CT scanning of bones structures in veterinary hospital; (3) DICOM visualization medical images in multiplanar reconstructions and 3D volume rendering; (4) .dicom file conversion to .stl; (5) 3D printing of opossum head by rapid prototyping; (6) comparison of 3D model printed with the original anatomical piece. The use of CT images with their different forms of reconstruction can provide a more comprehensive 3D view of opossum craniofacial region and allow a better understanding of head anatomy of this species. The 3D printed biomodel can be a viable alternative to original bone specimens when used in anatomy education. However, further studies must be continued to validate the method in Veterinary Medicine courses.

Las piezas anatómicas naturales de animales salvajes son raras y los profesores buscan alternativas satisfactorias, en cantidad y calidad, para enseñar a sus alumnos. Este artículo tuvo como objetivo describir el uso de la reconstrucción volumétrica por tomografía computarizada, la creación rápida de prototipos y la impresión 3D de la cabeza de zarigüeya para obtener un biomodelo en anatomía descriptiva de animales salvajes para educación veterinaria. Se realizó un estudio en seis pasos para construir el biomodelo: (1) selección de cabeza de zarigüeya del museo; (2) tomografía computarizada de estructuras óseas en hospital veterinario; (3) visualización de las imágenes médicas en DICOM por reconstrucciones multiplanares y renderización de volumen 3D; (4) conversión de archivos .dicom a .stl; (5) impresión 3D de cabeza de zarigüeya mediante prototipado rápido; (6) comparación del modelo 3D impreso con la pieza anatómica original. El uso de imágenes de tomografía computarizada, con sus diferentes formas de reconstrucción, puede proporcionar una vista 3D más completa de la región craneofacial de zarigüeya y permitir una mejor comprensión de la anatomía de la cabeza de esta especie. El biomodelo 3D impreso puede ser una alternativa viable a las muestras óseas originales cuando se utiliza en la educación de la anatomía. Sin embargo, se deben continuar los estudios para validar el método en los cursos de Medicina Veterinaria.

Why to study opossums? / ¿Por qué estudiar las zarigüeyas?

Due to the very important role in Brazilian ecosystems, studying the anatomy of opossums is extremely relevant for their natural preservation and possible clinical and surgical interventions with captive animals. These marsupials occupy diversified niches being well distributed throughout the Brazilian territory. They collaborate in the control of urban and agricultural pests such as rodents and insects. They are also excellent dispersers of seeds through their feces. The conclusion is that opossums can be a great model for the study of the anatomy of wild animals.

Las zarigüeyas desempeñan un papel muy relevante en los ecosistemas brasileños, siendo extremadamente importante estudiar su anatomía para su preservación natural y posibles intervenciones clínicas y quirúrgicas de los animales en cautiverio. Estos marsupiales ocupan nichos diversificados y están bien distribuidos en todo el territorio brasileño. Colaboran en el control de plagas urbanas y agrícolas, como roedores e insectos. También son excelentes dispersores de semillas a través de sus heces. Por lo tanto, se concluye que las zarigüeyas pueden ser un gran modelo para estudiar la anatomía de los animales salvajes.

Unilateral giant renal angiomyolipoma and pulmonary lymphangioleiomyomatosis.

Angiomyolipomas (AMLs) are mesenchymal neoplasms, named so because of the complex tissue composition represented by variable proportions of mature adipose tissue, smooth muscle cells, and dysmorphic blood vessels. Although AMLs may rise in different sites of the body, they are mostly observed in the kidney and liver. In the case of renal AMLs, they are described in two types: isolated AMLs and AMLs associated with tuberous sclerosis (TS). While most cases of AMLs are found incidentally during imaging examinations and are asymptomatic, others may reach huge proportions causing symptoms. Pulmonary lymphangioleiomyomatosis (LAM) is a rare benign disease characterized by cystic changes in the pulmonary parenchyma and smooth muscle proliferation, leading to a mixed picture of interstitial and obstructive disease. AML and LAM constitute major features of tuberous sclerosis complex (TSC), a multisystem autosomal dominant tumor-suppressor gene complex diagnosis. The authors report the case of a young female patient who presented a huge abdominal tumor, which at computed tomography (CT) show a fat predominance. The tumor displaced the right kidney and remaining abdominal viscera to the left. Chest CT also disclosed pulmonary lesions compatible with lymphangioleiomyomatosis. Because of sudden abdominal pain accompanied by a fall in the hemoglobin level, the patient underwent an urgent laparotomy. The excised tumor was shown to be a giant renal AML with signs of bleeding in its interior. The authors call attention to the diagnosis of AML and the huge proportions that the tumor can reach, as well as for ruling out the TSC diagnosis, once it may impose genetic counseling implications..

Aortic dissection-induced acute flaccid paraplegia treated with cerebrospinal fluid drainage.

Acute aortic dissection is a life-threatening event in which prompt and correct diagnosis is associated with better outcomes. In most cases, there is chest or back pain. However, in rare cases, patients have little or no pain and other symptoms are more conspicuous at presentation. The autors reports the case of a 47-year-old female patient who sought medical attention for sudden-onset paraplegia. The physical examination was normal except for bilateral lower limb flaccid paralysis, with abolition of deep tendon reflexes and paraesthesia in both feet. Computed tomography showed aortic dissection, with partial thrombosis of the false lumen, starting after the emergence of the left subclavian artery and extending, toward the bifurcation of the aorta, to the left iliac artery. After cerebrospinal fluid drainage, the evolution was favorable.

Using the Graf method of ultrasound examination to classify hip dysplasia in neonates.

Developmental dysplasia of the hip (DDH) is one of the most common congenital orthopedic anomalies. Ultrasound examination employing the Graf method is used to diagnose DDH. We conducted a retrospective cross-sectional study of 222 neonatal patients (140 females and 82 males) submitted to ultrasound examination of the right and left hips between January of 2009 and May of 2011. The mean age was 5.0 days. The patients were grouped by laterality, mean alpha (α) and beta (ß) angles (in degrees), and hip type (as determined by the Graf classification). The data collected were statistically correlated. Mean α angle values were higher in males than in females, as well as being higher for right hips than for left hips (p < 0.001). In contrast, mean ß angle values were lower in males than in females, as well as being lower for right hips than for left hips (p < 0.001). Type Ia hips (i.e., mature hips) predominated in both genders and on both sides, having been found in 82.32% of the examinations of males and in 71.09% of those of females. The right hip was classified as type Ia in 78.38% of the examinations, and the left hip was classified as type Ia in 72.07%. Type IIa hips (i.e., immature hips) were found in 12.8% of the examinations of males and in 20% of those of females. The right hip was classified as type IIa in 13.96% of the examinations, and the left hip was classified as type IIa in 20.72%. The remaining hip types were less common. We emphasize the importance of ultrasound as a standard method of screening for DDH.

Idiopathic sclerosing encapsulating peritonitis: an uncommon cause of intestinal obstruction.

Sclerosing encapsulating peritonitis (SEP), also called encapsulating peritonitis, is a rare and benign cause of intestinal obstruction of unknown etiology. Its onset may be acute or subacute although there are some reports with a two-month history. More commonly, this entity is secondary to chronic peritoneal dialysis, ventriculoperitoneal and peritoneovenous shunting, the use of ß-blockers and systemic lupus erythematous. Recurrent episodes of bacterial peritonitis, intestinal tuberculosis, sarcoidosis, familial Mediterranean fever, gastrointestinal cancer, liver transplantation, intra-abdominal fibrogenic foreign bodies, and luteinized ovarian thecomas are also related to SEP. The idiopathic presentation is more rare. Abdominal pain, nausea, vomiting, weight loss, malnutrition, and clinically palpable mass characterize the clinical features. Diagnosis is frequently made with gross findings during surgery, imaging workup and histopathology. The authors report the case of a 36-year-old male patient with a 10-day history of abdominal pain that was operated on because of intestinal obstruction. Diagnosis was made preoperatively and confirmed by the intraoperative findings and histopathology.