Functional and Physiological Methods of Evaluating Median Nerve Regeneration in the Rat.

The main goal of this investigation is to show how to create and repair different types of median nerve (MN) lesions in the rat. Moreover, different methods of simulating postoperative physiotherapy are presented. Multiple standardized strategies are used to assess motor and sensory recovery using an MN model of peripheral nerve lesion and repair, thus permitting easy comparison of the results. Several options are included for providing a postoperative physiotherapy-like environment to rats that have undergone MN injuries. Finally, the paper provides a method to evaluate the recovery of the MN using several noninvasive tests (i.e., grasping test, pin prick test, ladder rung walking test, rope climbing test, and walking track analysis), and physiological measurements (infrared thermography, electroneuromyography, flexion strength evaluation, and flexor carpi radialis muscle weight determination). Hence, this model seems particularly appropriate to replicate a clinical scenario, facilitating extrapolation of results to the human species. Although the sciatic nerve is the most studied nerve in peripheral nerve research, analysis of the rat MN presents various advantages. For example, there is a reduced incidence of joint contractures and automutilation of the affected limb in MN lesion studies. Furthermore, the MN is not covered by muscle masses, making its dissection easier than that of the sciatic nerve. In addition, MN recovery is observed sooner, because the MN is shorter than the sciatic nerve. Also, the MN has a parallel path to the ulnar nerve in the arm. Hence, the ulnar nerve can be easily used as the nerve graft for repairing MN injuries. Finally, the MN in rats is located in the forelimb, akin to the human upper limb; in humans, the upper limb is the site of most peripheral nerve lesions.

BD-2 and BD-3 increase skin flap survival in a model of ischemia and Pseudomonas aeruginosa infection.

The main aim of this work was to study the usefulness of human ß-defensins 2 (BD-2) and 3 (BD-3), which are part of the innate immune system, in the treatment of infected ischemic skin flaps. We investigated the effect of transducing rat ischemic skin flaps with lentiviral vectors encoding human BD-2, BD-3, or both BD-2 and BD-3, to increase flap survival in the context of a P. aeruginosa infection associated with a foreign body. The secondary endpoints assessed were: bacterial counts, and biofilm formation on the surface of the foreign body. A local ischemic environment was created by producing arterialized venous flaps in the left epigastric region of rats. Flaps were intentionally infected by placing underneath them two catheters with 105 CFU of P. aeruginosa before the surgical wounds were hermetically closed. Flap biopsies were performed 3 and 7 days post-operatively, and the specimens submitted to immunohistochemical analysis for BD-2 and BD-3, as well as to bacterial quantification. Subsequently, the catheter segments were analyzed with scanning electron microscopy (SEM). Flaps transduced with BD-2 and BD-3 showed expression of these defensins and presented increased flap survival. Rats transduced with BD-3 presented a net reduction in the number of P. aeruginosa on the surface of the foreign body and lesser biofilm formation.

Unconventional Perfusion Flaps in the Experimental Setting: A Systematic Review and Meta-Analysis.

BACKGROUND: Unconventional perfusion flaps offer multiple potential advantages compared with traditional flaps. Although there are numerous experimental articles on unconventional perfusion flaps, the multiple animal species involved, the myriad vascular constructions used, and the frequently conflicting data reported make synthesis of this information challenging. The main aim of this study was to perform a systematic review and meta-analysis of the literature on the experimental use of unconventional perfusion flaps, to identify the best experimental models proposed and to estimate their global survival rate. METHODS: The authors performed a systematic review and meta-analysis of all articles written in English, French, Italian, Spanish, and Portuguese on the experimental use of unconventional perfusion flaps and indexed to PubMed from 1981 until February 1, 2017. RESULTS: A total of 68 studies were found, corresponding to 86 optimized experimental models and 1073 unconventional perfusion flaps. The overall unconventional perfusion flap survival rate was 90.8 percent (95 percent CI, 86.9 to 93.6 percent; p < 0.001). The estimated proportion of experimental unconventional perfusion flaps presenting complete survival or nearly complete survival was 74.4 percent (95 percent CI, 62.1 to 83.7 percent; p < 0.001). The most commonly reported animal species in the literature were the rabbit (57.1 percent), the rat (26.4 percent), and the dog (14.3 percent). No significant differences were found in survival rates among these species, or among the diverse vascular patterns used. CONCLUSION: These data do not differ significantly from those reported regarding the use of unconventional perfusion flaps in human medicine, suggesting that rabbit, rat, and canine experimental unconventional perfusion flap models may adequately mimic the clinical application of unconventional perfusion flaps.

Cardiac computed tomography previous to atrial fibrillation ablation - effects of technological improvements and protocol optimization. / Tomografia computorizada cardíaca prévia a ablação de fibrilhação auricular ­ efeitos da evolução tecnológica e otimização de protocolos.

BACKGROUND: Cardiac computed tomography (CT) can provide a precise tridimentional anatomic map and exclude intra-cardiac thrombus. We aimed to access the impact of CT protocol optimization and technological evolution on the contrast and radiation dose as well as on image quality previous to atrial fibrillation (AF) ablation. METHODS: From a prospective registry of consecutive patients who underwent cardiac CT in a single center, we selected 270 patients in whom the CT was done for evaluation prior to AF ablation and they were distributed in 3 groups: Group1: the first 150 patients included; Group2: the last 60 patients performed with the same CT scanner; Group3: the first 60 exams performed with the new CT scanner. Quality of the protocol was access based on radiation dose, contrast volume used, the use of a second (delayed) acquisition, and on quantitative image quality analisis (signal to noise and contrast to noise ratios; density homogeneity racio between LA and LAA). RESULTS: We found a significant radiation dose as well as contrast dose reduction between the first and last subgroups (G1: 5,6mSv and 100ml; G2: 1,3mSv and 90ml; G3: 0,6mSv and 65ml). Even though group 3 had less radiation and contrast used it still had better quantitative image quality (signal/noise of 13,5; contrast/noise 14,8; density homogeneity racio of 0,92). CONCLUSION: Protocol optimization and technology both contributed to significant lower radiation dose and contrast volume used on cardiac CTs prior to AF ablation, without compromising image quality.

[Rethinking Sciatica In View of a Bilateral Anatomical Variation of the Sciatic Nerve, with Low Origin and High Division: Historical, Anatomical and Clinical Approach]. / Repensar a Ciatalgia Perante Variação Anatómica Bilateral do Nervo Isquiático, com Origem Baixa e Divisão Alta: Importância Histórica, Anatómica e Clínica.

INTRODUCTION: The aim of the present study is to report an original, unusual, case of bilateral anatomical variation of the sciatic nerve, with low origin and high division. MATERIAL AND METHODS: Anatomical dissection was performed on a 66 year-old female cadaver. The corpse was embalmed and conserved through our original embalming techniques. RESULTS: The particular anatomical variation was first detected during routine dissection classes for undergraduate students. The study was completed with contralateral dissection to unveil bilateral variation. In both hind limbs, the sciatic nerve had a low origin, deep below the mid-gluteal region, and suffered high division, near the lower margin of the gluteal region, after a short length of circa 8 cm, to divide into the common fibular and tibial nerves. DISCUSSION: We detect several cases of sciatic nerve high division, in the reports of the earliest anatomists, such as Leonardo da Vinci, Vesalius, Da Cortona, or Eustachius. Such ancestral interest for these anatomical variations demonstrates the importance of their knowledge for health professionals of different areas. CONCLUSION: The accurate study of sciatic nerve anatomical variations bears evident surgical, anaesthesiology and clinical applications. As more meticulous as our anatomical studies may get, one will never reach the state of perfection to consider such studies as definitive.

Introdução: O objectivo do presente estudo é o relato de um caso de variação anatómica do nervo isquiático, por origem baixa e divisão alta bilateral.Material e Métodos: Foi dissecado um cadáver feminino de 66 anos, conservado pelas técnicas originais desenvolvidas no nosso departamento.Resultados: No trabalho regular de dissecção cadavérica da disciplina de Anatomia Regional II detectou-se nervo isquiático, em ambos os membros, com pequeno trajecto, de aproximadamente, 8 - 10 cm, dividido em nervos fibular comum e tibial, ao nível da margem inferior do músculo glúteo máximo.Discussão: Casos semelhantes aos do presente estudo, foram descritos por alguns autores desde Leonardo da Vinci, Da Cortona, ou Eustachius, demonstrando a importância desse conhecimento, tanto em termos clínicos, como cirúrgicos ou anestesiológicos. Diversas ilações são possíveis, por revisão do presente caso, infrequente.Conclusão: Para além de proporcionar conhecimento prévio da anatomia loco-regional, o estudo das variações do nervo isquiático orienta o melhor seguimento de patologias, bem como acessos cirúrgicos e/ou anestésicos. Por mais meticulosos que sejam os nossos estudos anatómicos, jamais poderemos considerar terminada ou definitiva a investigação em anatomia humana.

Reconstruction of a 10-mm-long median nerve gap in an ischemic environment using autologous conduits with different patterns of blood supply: A comparative study in the rat.

The aim of this study was to evaluate in the Wistar rat the efficacy of various autologous nerve conduits with various forms of blood supply in reconstructing a 10-mm-long gap in the median nerve (MN) under conditions of local ischemia. A 10-mm-long median nerve defect was created in the right arm. A loose silicone tube was placed around the nerve gap zone, in order to simulate a local ischemic environment. Rats were divided in the following experimental groups (each with 20 rats): the nerve Graft (NG) group, in which the excised MN segment was reattached; the conventional nerve flap (CNF) and the arterialized neurovenous flap (ANVF) groups in which the gap was bridged with homonymous median nerve flaps; the prefabricated nerve flap (PNF) group in which the gap was reconstructed with a fabricated flap created by leaving an arteriovenous fistula in contact with the sciatic nerve for 5 weeks; and the two control groups, Sham and Excision groups. In the latter group, the proximal stump of the MN nerve was ligated and no repair was performed. The rats were followed for 100 days. During this time, they did physiotherapy. Functional, electroneuromyographic and histological studies were performed. The CNF and ANVF groups presented better results than the NG group in the following assessments: grasping test, nociception, motor stimulation threshold, muscle weight, and histomorphometric evaluation. Radial deviation of the operated forepaw was more common in rats that presented worse results in the other outcome variables. Overall, CNFs and ANVFs produced a faster and more complete recovery than NGs in the reconstruction of a 10-mm-long median nerve gap in an ischemic environment in the Wistar rat. Although, results obtained with CNFs were in most cases were better than ANVFs, these differences were not statistically significant for most of the outcome variables.

Reconstruction of a long defect of the ulnar artery and nerve with an arterialized neurovenous free flap in a teenager: A case report and literature review.

There is evidence that nerve flaps are superior to nerve grafts for bridging long nerve defects. Moreover, arterialized neurovenous flaps (ANVFs) have multiple potential advantages over traditional nerve flaps in this context. This paper describes a case of reconstruction of a long defect of the ulnar artery and nerve with an arterialized neurovenous free flap and presents a literature review on this subject. A 16-year-old boy sustained a stab wound injury to the medial aspect of the distal third of his right forearm. The patient was initially observed and treated at another institution where the patient was diagnosed with a flexor carpis ulnaris muscle and an ulnar artery section. The artery was ligated and the muscle was sutured. Four months later, the patient was referred to our institution with complaints of ulnar nerve damage, as well as hand pain and cold intolerance. Physical examination and ancillary tests supported the diagnosis of ulnar artery and nerve complete section. Surgery revealed an 8 cm hiatus of the ulnar artery and a 5 cm defect of the ulnar nerve. These gaps were bridged with a flow through ANVF containing the sural nerve and the lesser saphenous vein. The postoperative course was uneventful. Two years postoperatively, the patient had regained normal trophism and M5 strength in all previously paralyzed muscles according to the Medical Research Council Scale. Thermography revealed good perfusion in the right ulnar angiosome. The ANVF may be an expedite, safe and efficient option to reconstruct a long ulnar nerve and artery defect.

Blood Supply to the Integument of the Abdomen of the Rat: A Surgical Perspective.

BACKGROUND: Many fundamental questions regarding the blood supply to the integument of the rat remain to be clarified, namely the degree of homology between rat and humans. The aim of this work was to characterize in detail the macro and microvascular blood supply to the integument covering the ventrolateral aspect of the abdominal wall of the rat. METHODS: Two hundred five Wistar male rats weighing 250-350 g were used. They were submitted to gross anatomical dissection after intravascular colored latex injection (n = 30); conversion in modified Spalteholz cleared specimens (n=10); intravascular injection of a Perspex solution, and then corroded, in order to produce vascular corrosion casts of the vessels in the region (n = 5); histological studies (n = 20); scanning electron microscopy of vascular corrosion casts (n = 10); surgical dissection of the superficial caudal epigastric vessels (n = 100); and to thermographic evaluation (n = 30). RESULTS: The ventrolateral abdominal wall presented a dominant superficial vascular system, which was composed mainly of branches from the superficial caudal epigastric artery and vein in the caudal half. The cranial half still received significant arterial contributions from the lateral thoracic artery in all cases and from large perforators coming from the intercostal arteries and from the deep cranial epigastric artery. CONCLUSIONS: These data show that rats and humans present a great deal of homology regarding the blood supply to the ventrolateral aspect of the abdominal integument. However, there are also significant differences that must be taken into consideration when performing and interpreting experimental procedures in rats.

Stab injury to the preauricular region with laceration of the external carotid artery without involvement of the facial nerve: a case report.

BACKGROUND: Open injuries to the face involving the external carotid artery are uncommon. These injuries are normally associated with laceration of the facial nerve because this nerve is more superficial than the external carotid artery. Hence, external carotid artery lesions are usually associated with facial nerve dysfunction. We present an unusual case report in which the patient had an injury to this artery with no facial nerve compromise. CASE PRESENTATION: A 25-year-old Portuguese man sustained a stab wound injury to his right preauricular region with a broken glass. Immediate profuse bleeding ensued. Provisory tamponade of the wound was achieved at the place of aggression by two off-duty doctors. He was initially transferred to a district hospital, where a large arterial bleeding was observed and a temporary compressive dressing was applied. Subsequently, the patient was transferred to a tertiary hospital. At admission in the emergency room, he presented a pulsating lesion in the right preauricular region and slight weakness in the territory of the inferior buccal branch of the facial nerve. The physical examination suggested an arterial lesion superficial to the facial nerve. However, in the operating theater, a section of the posterior and lateral flanks of the external carotid artery inside the parotid gland was identified. No lesion of the facial nerve was observed, and the external carotid artery was repaired. To better understand the anatomical rationale of this uncommon clinical case, we dissected the preauricular region of six cadavers previously injected with colored latex solutions in the vascular system. A small triangular space between the two main branches of division of the facial nerve in which the external carotid artery was not covered by the facial nerve was observed bilaterally in all cases. CONCLUSIONS: This clinical case illustrates that, in a preauricular wound, the external carotid artery can be injured without facial nerve damage. However, no similar description was found in the reviewed literature, which suggests that this must be a very rare occurrence. According to the dissection study performed, this is due to the existence of a triangular space between the cervicofacial and temporofacial nerve trunks in which the external carotid artery is not covered by the facial nerve or its branches.

Low-dose ionizing radiation induces therapeutic neovascularization in a pre-clinical model of hindlimb ischemia.

AIMS: We have previously shown that low-dose ionizing radiation (LDIR) induces angiogenesis but there is no evidence that it induces neovascularization in the setting of peripheral arterial disease. Here, we investigated the use of LDIR as an innovative and non-invasive strategy to stimulate therapeutic neovascularization using a model of experimentally induced hindlimb ischemia (HLI). METHODS AND RESULTS: After surgical induction of unilateral HLI, both hindlimbs of female C57BL/6 mice were sham-irradiated or irradiated with four daily fractions of 0.3 Gy, in consecutive days and allowed to recover. We demonstrate that LDIR, significantly improved blood perfusion in the murine ischemic limb by stimulating neovascularization, as assessed by laser Doppler flow, capillary density, and collateral vessel formation. LDIR significantly increased the circulating levels of VEGF, PlGF, and G-CSF, as well as the number of circulating endothelial progenitor cells (EPCs) mediating their incorporation to ischemic muscles. These effects were dependent upon LDIR exposition on the ischemic niche (thigh and shank regions). In irradiated ischemic muscles, these effects were independent of the recruitment of monocytes and macrophages. Importantly, LDIR induced a durable and simultaneous up-regulation of a repertoire of pro-angiogenic factors and their receptors in endothelial cells (ECs), as evident in ECs isolated from the irradiated gastrocnemius muscles by laser capture microdissection. This specific mechanism was mediated via vascular endothelial growth factor (VEGF) receptor signaling, since VEGF receptor inhibition abrogated the LDIR-mediated gene up-regulation and impeded the increase in capillary density. Finally, the vasculature in an irradiated non-ischemic bed was not affected and after 52 week of LDIR exposure no differences in the incidence of morbidity and mortality were seen. CONCLUSIONS: These findings disclose an innovative, non-invasive strategy to induce therapeutic neovascularization in a mouse model of HLI, emerging as a novel approach in the treatment of critical limb ischemia patients.

A stab wound to the axilla illustrating the importance of brachial plexus anatomy in an emergency context: a case report.

BACKGROUND: Although open injuries involving the brachial plexus are relatively uncommon, they can lead to permanent disability and even be life threatening if accompanied by vascular damage. We present a case report of a brachial plexus injury in which the urgency of the situation precluded the use of any ancillary diagnostic examinations and forced a rapid clinical assessment. CASE PRESENTATION: We report a case of a Portuguese man who had a stabbing injury at the base of his left axilla. On observation in our emergency room an acute venous type of bleeding was present at the wound site and, as a result of refractory hypotension after initial management with fluids administered intravenously, he was immediately carried to our operating room. During the course of transportation, we observed that he presented hypoesthesia of the medial aspect of his arm and forearm, as well as of the ulnar side of his hand and of the palmar aspect of the last three digits and of the dorsal aspect of the last two digits. Moreover, he was not able to actively flex the joints of his middle, ring, and small fingers or to adduct or abduct all fingers. Exclusively relying on our anatomical knowledge of the axillary region, the site of the stabbing wound, and the physical neurologic examination, we were able to unequivocally pinpoint the place of the injury between the anterior division of the lower trunk of his brachial plexus and the proximal portion of the following nerves: ulnar, medial cutaneous of his arm and forearm, and the medial aspect of his median nerve. Surgery revealed a longitudinal laceration of the posterior aspect of his axillary vein, and confirmed a complete section of his ulnar nerve, his medial brachial and antebrachial cutaneous nerves, and an incomplete section of the ulnar aspect of his median nerve. All structures were repaired microsurgically. Three years after the surgery he showed a good functional outcome. CONCLUSIONS: We believe that this case report illustrates the relevance of a sound anatomical knowledge of the brachial plexus in an emergency setting.

Outcomes and satisfaction of two optional cadaveric dissection courses: A 3-year prospective study.

Teaching time dedicated to anatomy education has been reduced at many medical schools around the world, including Nova Medical School in Lisbon, Portugal. In order to minimize the effects of this reduction, the authors introduced two optional, semester-long cadaveric dissection courses for the first two years of the medical school curriculum. These courses were named Regional Anatomy I (RAI) and Regional Anatomy II (RAII). In RAI, students focus on dissecting the thorax, abdomen, pelvis, and perineum. In RAII, the focus shifts to the head, neck, back, and upper and lower limbs. This study prospectively analyzes students' academic achievement and perceptions within the context of these two, newly-introduced, cadaveric dissection courses. Students' satisfaction was assessed anonymously through a questionnaire that included items regarding students' perception of the usefulness of the courses for undergraduate teaching, as well as with regards to future professional activity. For each of the three academic years studied, the final score (1 to 20) in General Anatomy (GA), RAI, and RAII was on average 14.26 ± 1.89; 16.94 ± 1.02; 17.49 ± 1.01, respectively. The mean results were lower in GA than RAI or RAII (P < 0.001). Furthermore, students who undertook these courses ranked them highly with regards to consolidating their knowledge of anatomy, preparing for other undergraduate courses, and training for future clinical practice. These survey data, combined with data on participating students' academic achievement, lend strong support to the adoption of similar courses as complementary and compulsory disciplines in a modern medical curriculum. Anat Sci Educ 10: 127-136. © 2016 American Association of Anatomists.

Improvement of the embalming perfusion method: the innovation and the results by light and scanning electron microscopy.

Embalming is a chemical process that aims the preservation and sanitization of the human body indefinitely. The technique of embalming is an important tool in teaching and research in anatomy enabling the preservation of cadaveric material in good conditions (lessening any significant structural changes and maintaining the natural appearance). This article presents the results of embalmed cadavers in the course of arterial perfusion, through the use of a perfusion machine, particularly designed to this objective, and which allows the control of the embalming fluid injection process. The influence of this technique and the optimization of its parameters on the final quality of embalming were evaluated by sequential histological analysis of the cadaveric tissues using an original method of classification of samples collected from 17 deceased corpses of the Corpses Donation Office of the Department of Anatomy of Faculdade de Ciências Médicas from Universidade Nova de Lisboa, subject to the embalming technique developed in the Department. We concluded that, with this method, there is a decrease of the decomposition process at the time of embalming, which is effective at long term (over a year), requiring merely the maintenance of the body at low temperatures (4° C) and it is possible to observe that the tissue best preserved over time is muscle, showing a conservation considered optimal.

O embalsamamento é um processo químico que visa a preservação e sanitização do corpo humano por tempo indefinido. A técnica de embalsamamento é uma ferramenta importante no ensino e investigação em Anatomia viabilizando a conservação em boas condições de material cadavérico (minorando alterações estruturais significativas e mantendo a aparência natural). Este artigo reporta os resultados de embalsamamento de cadáveres obtidos por perfusão arterial, através da utilização de uma máquina de perfusão especialmente desenhada para o efeito. E que permite o controlo do processo de injecção de fluido de embalsamamento. A influência da técnica e a optimização dos seus parâmetros na qualidade final do embalsamamento foi avaliada através da análise histológicasequencial de tecidos cadavéricos e sua classificação por método original a partir de uma amostra de 17 cadáveres do Gabinete de Doação do Departamento de Anatomia da Faculdade de Ciências Médicas da Universidade Nova de Lisboa, sujeitos à técnica de embalsamamentodesenvolvida no Departamento. Concluímos que, com a utilização deste método, ocorre uma diminuição do processo de decomposição no momento do embalsamamento, o qual é eficaz a longo prazo (mais de um ano), exigindo apenas a manutenção do corpo a baixas temperaturas (4° C), sendo o músculo o tecido melhor preservado, com uma classificação considerada óptima.

Sciatic nerve high division: two different anatomical variants.

INTRODUCTION: Sciatic nerve variations are relatively common. These variations are often very significant in several fields of Medicine. The purpose of this paper is to present two such variants and discuss their clinical implications. MATERIAL AND METHODS: Three Caucasian cadavers with no prior history of lower limb trauma or surgery were dissected and found to present anatomical variants of the sciatic nerve. RESULTS: In all cases the sciatic nerve divided above the popliteal fossa. In two cases (cadavers 1 and 2) it divided on both sides in the inferior portion of the gluteal region in its two terminal branches: the common fibular and the tibial nerves. In another case (cadaver 3) the sciatic nerve was found to divide inside the pelvis just before coursing the greater sciatic notch. The common fibular nerve exited the pelvis above the pyriformis muscle and then passed along its posterior aspect, while the tibial nerve coursed deep to the pyriformis muscle. DISCUSSION: According to the literature, the anatomical variant described in cadaver 3 is considered relatively rare. This variant can predispose to nerve entrapment and thus to the pyriformis syndrome, sciatica and coccygodynia. The high division of the sciatic nerve, as presented in cadavers 1 and 2, can make popliteal nerve blocks partially ineffective. CONCLUSION: The anatomical variants associated with a high division of the sciatic nerve, must always be born in mind, as they are relatively prevalent, and have important clinical implications, namely in Anesthesiology, Neurology, Sports Medicine and Surgery.

Introdução: As variações do nervo isquiático são relativamente comuns e frequentemente muito significativas clinicamente. O objetivo deste trabalho é apresentar duas destas variações e discutir algumas das suas implicações clínicas.Material e Métodos: Três cadáveres caucasianos sem história prévia de trauma ou cirurgia no membro inferior foram dissecados, apresentando variações anatómicas do nervo isquiático.Resultados: Em todos os casos o nervo isquiático dividia-se acima da fossa poplítea.Em dois casos (cadáveres1 e 2) a terminação deste nervo ocorria na porção inferior da região glútea nos seus dois ramos terminais: os nervos fibular comum e tibial. Num outro caso (cadáver 3), o nervo isquiático dividia-se ainda dentro da bacia antes de percorrer a incisura isquiática maior. Neste caso, o nervo fibular comum saía da pelve acima do músculo piriforme, passando em seguida ao longo de sua face posterior, enquanto que o nervo tibial corria profundamente ao músculo piriforme.Discussão: De acordo com a literatura, a variante anatómica descrita no cadáver 3 é considerada relativamente rara. Esta variante poderá predispor a síndromes compressivos do nervo isquiático. A divisão alta do nervo isquiático, de que são exemplos os cadáveres 1 e 2, pode comprometer a eficácia dos bloqueios anestésicos ao nível da fossa poplítea.Conclusão: As variantes anatómicas associadas à divisão alta do nervo isquiático devem sempre ser tidas em consideração porserem relativamente comuns e terem importantes implicações clínicas, nomeadamente nas áreas de Anestesiologia, Neurologia, Medicina do Desporto e Cirurgia.

Radiologic anatomy of arteriogenic erectile dysfunction: a systematized approach.

INTRODUCTION: Erectile Dysfunction is a highly prevalent disease and there is growing interest in its endovascular treatment. Due to the complexity of the male pelvic arterial system, thorough anatomical knowledge is paramount. We evaluated the applicability of the Yamaki classification with Computerized Tomography Angiography and Digital Subtraction Angiography in the evaluation of patients with arteriogenic Erectile Dysfunction, illustrating the arterial lesions that can cause Erectile Dysfunction. METHODS: Single-center retrospective analysis of the Computerized Tomography Angiography and Digital Subtraction Angiography imaging findings in 21 male patients with suspected arteriogenic Erectile Dysfunction that underwent selective pelvic arterial embolization. Assessment of erectile function was achieved using the IIEF-5. The branching patterns of the Internal Iliac Artery were classified according to the Yamaki classification. The diagnosis of arteriogenic Erectile Dysfunction was based on the presence of atherosclerotic lesions (stenoses and/or occlusions) of the Internal Iliac Artery or the Internal Pudendal Arteries. RESULTS: The mean patient age was 67.2 years; with a mean IIEF of 10.6 points. Computerized Tomography Angiography and Digital Subtraction Angiography findings allowed classification of all the 42 pelvic sides according to the Yamaki classification. Twenty-four pelvic sides were classified as Group A (57%), 9 as Group B (21.5%) and 9 as Group C (21.5%). The Digital Subtraction Angiography detected 19 abnormal Internal Pudendal Arteries (with atherosclerotic lesions) (45%). The Computerized Tomography Angiography detected 24 abnormal Internal Pudendal Arteries (57%). CONCLUSION: Computerized Tomography Angiography and Digital Subtraction Angiography findings of arteriogenic Erectile Dysfunction include stenotic and occlusive lesions of the Internal Iliac Artery and Internal Pudendal Artery. The Yamaki classification is radiologically reproducible and allows easy recognition of the Internal Pudendal Artery in patients with arteriogenic Erectile Dysfunction.

Introdução: A disfunção erétil é uma doença com elevada prevalência existindo crescente interesse na sua terapêutica endovascular. Devido à complexidade do sistema arterial pélvico masculino, o conhecimento anatómico é fundamental. Avaliou-se a aplicabilidade da classificação de Yamaki na avaliação de doentes com disfunção erétil arteriogénica usando a Angiografia Tomográfica Computorizada e a Angiografia Digital de Subtração.Métodos: Análise retrospetiva dos achados imagiológicos de Angiografia Tomográfica Computorizada e Angiografia Digital de Subtração em 21 doentes do sexo masculino, com suspeita de disfunção erétil arteriogénica, que foram submetidos a embolização pélvica seletiva numa única instituição. A função erétil foi avaliada através do IIEF-5. O padrão de bifurcação da Artéria Ilíaca Interna foi caracterizado de acordo com a classificação de Yamaki. O diagnóstico da disfunção erétil arteriogénica foi feita baseado na presença de lesões ateroscleróticas da Artéria Ilíaca Interna e da Artéria Pudenda Interna.Resultados: A idade média foi de 67,2 anos; a média do IIEF foi 10,6 pontos. A Angiografia Tomográfica Computorizada e a Angiografia Digital de Subtração permitiram a classificação de todos os 42 lados pélvicos de acordo com a classificação de Yamaki. Vinte e quatro lados pélvicos foram classificados como Grupo A (57%), nove como Grupo B (21,5%) e nove como Grupo C (21,5%). A Angiografia Digital de Subtração detectou 19 Artérias Pudendas Internas anormais (lesões ateroscleróticas) (45%). A Angiografia Tomográfica Computorizada detectou 24 Artérias Pudendas Internas anormais (57%).Conclusão: Os achados por Angiografia Tomográfica Computorizada e Angiografia Digital de Subtração incluem estenoses e oclusões da Artéria Ilíaca Interna e da Artéria Pudenda Interna. A classificação de Yamaki tem reprodutibilidade radiológica e permite o reconhecimento da Artéria Pudenda Interna em doentes com disfunção erétil arteriogénica.

[Vertebral metrics: application of a new mechanical instrument to evaluate the spinal column]. / Métrica vertebral: a aplicação de uma nova tecnologia na análise da coluna vertebral.

OBJECTIVE: To present the results of the first application of the new technology - Vertebral Metrics - the analysis of the 3D position of the vertex of each spinous process in pregnant women. MATERIAL AND METHODS: The Vertebral Metrics was applied to women without associated pathology in four stages of pregnancy (12, 20, 32, 37 weeks gestation). We applied univariate linear models. RESULTS: We found that the differences that occur during pregnancy are more significant at the position y (anteroposterior). It was found also that there is a positive correlation between the biomechanical position of the vertex of each of the vertebrae with the homologous position of rest. DISCUSSION/CONCLUSION: Through Vertebral Metrics innovative results could be obtained in analyzing biomechanics of the spine. A device that has different applications can be easily adopted in areas such as orthopedics, neurosurgery, pediatrics and rehabilitation. It should also be noted that this instrument is not exhausted in the sample of this research because it can be further applied to the general population.

Objectivo: Apresentar os resultados da primeira aplicação da nova tecnologia ­ Métrica Vertebral ­ na análise da posição 3D do vértice de cada uma das apófises espinhosas, em mulheres grávidas.Material e Métodos: O Métrica Vertebral foi aplicado a mulheres, sem patologia associada, em quatro momentos da gravidez (12, 20, 32, 37 semanas de gestação). Aplicaram-se modelos lineares univariados.Resultados: Observou-se que as diferenças que ocorrem ao longo da gravidez são mais significativas ao nível da posição y (anteroposterior). Verificou-se, igualmente, que existe uma correlação biomecânica positiva entre a posição do vértice de cada uma das vértebras com a posição homóloga das restantes.Discussão/Conclusão: Através do Métrica Vertebral foi possível obter resultados inovadores na análise biomecânica da colunavertebral. É um dispositivo que tem diferentes aplicações podendo ser facilmente adoptado em áreas como ortopedia, neurocirurgia, pediatria e reabilitação. É de realçar ainda que este instrumento não se esgota na amostra da presente investigação pois pode ser futuramente aplicada à população em geral.

Brachial plexus morphology and vascular supply in the wistar rat.

INTRODUCTION: The rat is probably the animal species most widely used in experimental studies on nerve repair. The aim of this work was to contribute to a better understanding of the morphology and blood supply of the rat brachial plexus. MATERIAL AND METHODS: Thirty adult rats were studied regarding brachial plexus morphology and blood supply. Intravascular injection and dissection under an operating microscope, as well as light microscopy and scanning electron microscopy techniques were used to define the microanatomy of the rat brachial plexus and its vessels. RESULTS: The rat brachial plexus was slightly different from the human brachial plexus. The arterial and venous supply to the brachial plexus plexus was derived directly or indirectly from neighboring vessels. These vessels formed dense and interconnected plexuses in the epineurium, perineurium, and endoneurium. Several brachial plexus components were accompanied for a relatively long portion of their length by large and constant blood vessels that supplied their epineural plexus, making it possible to raise these nerves as flaps. DISCUSSION: The blood supply to the rat brachial plexus is not very different from that reported in humans, making the rat a useful animal model for the experimental study of peripheral nerve pathophysiology and treatment. CONCLUSION: Our results support the homology between the rat and the human brachial plexus in terms of morphology and blood supply. This work suggests that several components of the rat brachial plexus can be used as nerve flaps, including predominantly motor, sensory or mixed nerve fibers. This information may facilitate new experimental procedures in this animal model.

Introdução: O rato é provavelmente a espécie animal mais utilizada em estudos experimentais de reparação nervosa. Com este trabalho pretendeu-se aprofundar o conhecimento da morfologia e da vascularização do plexo braquial do rato.Material e Métodos: Trinta ratos adultos foram estudados relativamente à morfologia e vascularização do plexo braquial. As técnicas usadas foram a injecção intravascular e dissecção sob microscópio operatório, bem como técnicas de microscopia óptica e microscopia electrónica de varrimento.Resultados: Morfologicamente, o plexo braquial do rato é um pouco diferente do plexo braquial humano. O suprimento arterial e venoso do plexo braquial do rato deriva direta ou indiretamente dos vasos vizinhos. Estes vasos formam plexos vasculares densos e interconectados no epinervo, perinervo e endonervo. Vários componentes do plexo braquial do rato são acompanhados durante um trajecto relativamente longo por vasos sanguíneos relativamente calibrosos e constantes que fornecem o seu plexo epineural, tornando o seu levantamento como retalhos nervosos possível.Discussão: A vascularização do plexo braquial do rato não é muito diferente da reportada na espécie humana, tornando o rato um modelo animal útil para o estudo experimental da fisiopatologia e tratamento da patologia do nervo periférico.Conclusão: Os nossos resultados apoiam a homologia entre o rato e o Homem em termos de morfologia e vascularização do plexo braquial. Este trabalho sugere que vários componentes do plexo braquial do rato podem ser utilizados como retalhos nervosos, incluindo fibras predominantemente motoras, sensitivas ou fibras mistas.

[Giant cysts of seminal vesicles]. / Quistos gigantes das vesículas seminais.

We report a clinical case of a 60 year-old man, asymptomatic to whom was incidentally found two retrovesical cysts. Physical examination revealed hypogastric, elastic and painless masses; digital rectal examination documented a normal prostate gland. Computerized tomography confirmed the presence of two giant seminal vesicle cysts.

Relatamos o caso de um homem com 60 anos de idade, assintomático que é referenciado à consulta por achado acidental de dois quistos volumosos retro-vesicais. Ao exame objectivo identificaram-se massas hipogástricas, de consistência elástica, móveis e indolores; ao toque rectal caracterizou-se uma próstata elástica sem características suspeitas. A tomografia computorizada confirmou a presença de dois quistos gigantes das vesículas seminais.

An unusual variety of the extensor digiti muscles: report with notes on repetition strain injuries.

In over 500 human cadaveric dissections of arms and forearms, performed to the present date, we find frequent anatomical variations, corresponding to classic descriptions. Last year, we found a singular anatomic variation of the extensor muscles of the forearm, which seems previously undescribed. It is our strong belief that gross anatomy studies, and gross dissection should be updated and reintroduced in modern anatomical studies, for teaching, research, or surgical training purposes. We detected a peculiar anatomical variant of the Superficial Extensor Digiti Muscles in the forearm of a human 73 year old male Caucasian cadaver. We clearly identified a thick bundle of muscular fibres, connecting the main muscular shafts of the Extensor Digiti Minimi, and the Extensor Digitorum Communis Muscles, in a perfectly defined muscular expansion, bridging obliquely downwards and outwards, between the two main muscular shafts. In our series, this is the first occurrence of such anatomical disposition. Anatomical variations of the extensor tendons to the fingers are frequently detected in the wrist, hand and fingers compartments. The careful analysis of the variants of muscular shafts in the forearm compartment, as commonly reported in the earliest anatomical descriptions will bring renewed light to the functional assessment of the extensor mechanism of the human fingers. In this sense, we reviewed the oldest anatomical descriptions, from the 16th century to the present date.

Na série alargada de mais de 500 dissecções de antebraços e mãos cadavéricas humanas, efectuadas por rotina anual do Departamento de Anatomia da Faculdade de Ciências Médicas da Universidade Nova de Lisboa desde 1973, detectam-se frequentemente variações anatómicas, com especial incidência a nível dos tendões extensores dos dedos. Detectámos em 2011, uma disposição peculiar dos feixes musculares dos músculos extensores superficiais dos dedos de que, por extensa revisão bibliográfica, não encontramos descrição. Identificou-se um curto feixe de fibras musculares unindo os ventres principais dos músculos extensor comum dos dedos e extensor do dedo mínimo, na margem ulnar do terço médio do antebraço de um caucasiano do sexo masculino, com 73 anos de idade. Consultando textos de Anatomia publicados, desde o séc. XVI até á actualidade, verifica-se que as mais antigas descrições anatómicas se referem precisamente a uma maior coesão, com divisão baixa entre os ventres musculares destes dois músculos. Apresentámos os resultados preliminares deste estudo no XXII International Symposium of Morphological Sciences, em Fevereiro de 2012, reservando a redacção pormenorizada deste achado anatómico para um dos primeiros números da publicaçãoArchives of Anatomy da Sociedade Anatómica Portuguesa. É nossa profunda convicção de que os estudos anatómicos, e em particular a dissecção cadavérica humana, necessitam ser revalorizados e modernizados, no início do novo milénio, pelo seu imprescindível contributo aos estudos médicos, tanto em termos curriculares básicos, como ainda na investigação clínica e cirúrgica, ou em termos de treino pósgraduado de técnicas cirúrgicas.