Bilateral Duplication of Gonadal Veins: a Case Report / Duplicación Bilateral de las Venas Gonadales: Reporte de Caso

The duplication of gonadal vessels is mainly found on the left side, with less numbers of bilateral cases. The objective of this work is describing a case of bilateral duplication of gonadal veins, where two veins were draining to inferior vena cava, being that the closest vein of kidney medial margin had a thickness of 2.68mm and was distant 64.41 mm of the organ. The second vessel had a thickness of 1.43mm and was distant 73.76mm. Two veins follow to left renal vein, being that the first vessel had a thickness of 2.7mm and was distant 21.8mm of the kidney medial margin; the other had a thickness of 1.64mm and was distant 35.13mm of the organ. The presence of variations on the local of drainage of gonadal vessels has clinical importance for comprehension of origin of varicocele cases, as well as the recurrence of them after surgical procedures.

La duplicación de las venas gonadales es más común en el lado izquierdo, con pocos casos bilaterales. El propósito de este reporte fue describir el caso de una duplicación bilateral de las venas gonadales, dos de las cuales desembocaban en la vena cava inferior. El vaso próximo del margen medial del riñon tenía un diámetro de 2,68mm y una longitud de 64,41 mm. La segunda vena tenía un diámetro de 1,43 mm y una longitud de 73,76 mm. Los dos vasos desembocaban en la vena renal izquierda. La primera vena tenía un diámetro de 2,7 mm y estaba a 21,8 mm del margen medial del riñon. La otra tenía un diámetro de 1,64 mm y se se localizaba a 35,13 mm del margen medial del riñon. La presencia de variaciones donde se produce el drenaje de los vasos gonadales tiene importancia clínica para la comprensión del origen del varicocele y la recurrencia del mismo, después de procedimientos quirúrgicos.

Analysis on the incidence of the fibularis quartus muscle using magnetic resonance imaging.

Objective. Quantify the presence of the fibularis quartus muscle and correlate it with the individual's sex and concomitant presence of the fibularis tertius muscle. Materials and Methods. We evaluated 211 magnetic resonance examinations (43.13% men and 56.87% women) on the ankle and hindfoot, produced between 2009 and 2011. Results. The fourth fibularis muscle was found to be present in 7.62% of the examinations and 75% of these also contained the fibularis tertius muscle. Conclusion. The incidence of the fourth fibularis muscle is variable; moreover, its incidence does not depend on the individual's gender or the presence of the fibularis tertius muscle.

Myocardial bridge associated with cardiovascular injuries in bovines adult of Canchim race.

BACKGROUND: The influence that myocardial bridge exercises over blood stream in the course of arterial segment under the bridge has been discussed by the scientific community. OBJECTIVE: To compare ultrastructural muscle tissue of myocardial bridge and the ventricular wall; to analyze the degree of injury to the tunica intima of the arterial segments, and look for possible changes that may precede or initiate the process of atherosclerotic lesions. METHODS: Forty Canchim bovine hearts were studied regarding alterations of the tunica intima from coronary arteries on the different myocardial bridge segments. For the microscopic examination, hematoxylin-eosin and fuchsin-resorcin staining following conventional microscope techniques were made. For the electronic microscopic examination, myocardial Bridge segments from twelve Canchim bovine hearts were collected from the ventricle wall and coronary artery and were processed according to conventional techniques. RESULTS: In the light microscopy, a higher frequency of lesions on prepontine and postpontine segments of the tunica intima was observed, compared to the pontine segment. Tunica intima thickenings were followed by a disarrangement on the internal elastic limitant lamina. These cells often presented their cytoplasmas engorged by lipidic drops, making up the so-called foam cells. Electronic microscopy revealed that the muscular fibers of the myocardial bridge are usually joined in a straight and smooth way presenting lateral branches with a greater number of mitochondria in the ventricular muscle than in the bridge. CONCLUSION: There are few differences between the muscle tissues studied; intimae lesions are less frequent in pontine regions compared to pre and post-pontine regions.

Ponte miocárdica associada a lesões cardiovasculares em bovinos adultos da raça Canchim / Myocardial bridge associated with cardiovascular injuries in bovines adult of Canchim race / Puente miocárdico asociado a lesiones cardiovasculares en bovinos adultos de la raza canchim

FUNDAMENTO: A influência que a ponte miocárdica exerce sobre a corrente sanguínea no curso do segmento arterial sob a ponte tem sido objeto de discussão pela comunidade científica. OBJETIVO: Comparar o tecido muscular ultraestrutural da ponte miocárdica e a parede ventricular; analisar o grau de lesão da camada íntima dos segmentos arteriais e investigar possíveis mudanças que podem preceder ou iniciar o processo de lesões ateroscleróticas. MÉTODOS: Quarenta corações bovinos da raça Canchim foram estudados em relação às alterações da camada íntima das artérias coronarianas nos diferentes segmentos de ponte miocárdica. Para o exame microscópico, foram feitas colorações por hematoxilina-eosina e fucsina-resorcina seguindo técnicas microscópicas convencionais. Para o exame de microscopia eletrônica, os segmentos da ponte miocárdica de doze corações bovinos Canchim foram coletados a partir da parede ventricular e da artéria coronariana e foram processados de acordo com técnicas convencionais. RESULTADOS: Na microscopia de luz, foi observada maior frequência de lesões em segmentos pré-ponte e pós-ponte da camada íntima, em comparação ao segmento ponte. Espessamentos da camada íntima foram seguidos por um desarranjo na lâmina limitante elástica interna. Essas células frequentemente apresentaram seus citoplasmas ingurgitados por gotas lipídicas, compondo as chamadas células de espuma. A microscopia eletrônica revelou que as fibras musculares da ponte miocárdica geralmente se unem de forma reta e lisa apresentando ramos laterais com um número maior de mitocôndrias no músculo ventricular do que na ponte. CONCLUSÃO: Há poucas diferenças entre os tecidos musculares estudados; lesões da camada íntima são menos frequentes em regiões da ponte em comparação com as regiões pré e pós-ponte.

BACKGROUND: The influence that myocardial bridge exercises over blood stream in the course of arterial segment under the bridge has been discussed by the scientific community. OBJECTIVE: To compare ultrastructural muscle tissue of myocardial bridge and the ventricular wall; to analyze the degree of injury to the tunica intima of the arterial segments, and look for possible changes that may precede or initiate the process of atherosclerotic lesions. METHODS: Forty Canchim bovine hearts were studied regarding alterations of the tunica intima from coronary arteries on the different myocardial bridge segments. For the microscopic examination, hematoxylin-eosin and fuchsin-resorcin staining following conventional microscope techniques were made. For the electronic microscopic examination, myocardial Bridge segments from twelve Canchim bovine hearts were collected from the ventricle wall and coronary artery and were processed according to conventional techniques. RESULTS: In the light microscopy, a higher frequency of lesions on prepontine and postpontine segments of the tunica intima was observed, compared to the pontine segment. Tunica intima thickenings were followed by a disarrangement on the internal elastic limitant lamina. These cells often presented their cytoplasmas engorged by lipidic drops, making up the so-called foam cells. Electronic microscopy revealed that the muscular fibers of the myocardial bridge are usually joined in a straight and smooth way presenting lateral branches with a greater number of mitochondria in the ventricular muscle than in the bridge. CONCLUSION: There are few differences between the muscle tissues studied; intimae lesions are less frequent in pontine regions compared to pre and post-pontine regions.

FUNDAMENTO: La influencia que el puente miocárdico ejerce sobre la corriente sanguínea en el transcurso del segmento arterial bajo el puente, ha sido objeto de discusión por parte de la comunidad científica. OBJECTIVO: Comparar el tejido muscular ultra estructural del puente miocárdico y la pared ventricular; analizar el grado de lesión de la capa íntima de los segmentos arteriales e investigar posibles cambios que pueden preceder o iniciar el proceso de lesiones ateroscleróticas. MÉTODO: Cuarenta corazones bovinos de la raza Canchim fueron estudiados con respecto a las alteraciones de la capa íntima de las arterias coronarias en los diferentes segmentos del puente miocárdico. Para el examen microscópico, se hicieron coloraciones por hematoxilina-eosina y fucsina-resorcina secundando las técnicas microscópicas convencionales. Para el examen de microscopía electrónica, los segmentos del puente miocárdico de doce corazones de bovinos de la raza Canchim, fueron recolectados así como de la pared ventricular y de la arteria coronaria y fueron procesados de acuerdo con las técnicas convencionales. RESULTADOS: En la microscopía de luz, observamos una mayor frecuencia de lesiones en segmentos de pre puente y pos-puente de la capa íntima, en comparación con el segmento puente. Los espesamientos de la capa íntima vinieron acompañados por un desarreglo en la lámina limitante elástica interna. Esas células a menudo presentan sus citoplasmas ingurgitados por gotas lipídicas, lo que compone las llamadas células de espuma. La microscopía electrónica reveló que las fibras musculares del puente miocárdico generalmente se unen de forma recta y lisa, presentando ramas laterales con un número mayor de mitocondrias en el músculo ventricular que en el puente. CONCLUSIONES: Existen pocas diferencias entre los tejidos musculares estudiados. Las lesiones de la capa íntima son menos frecuentes en las regiones del puente en comparación con las regiones pre y pos puente.

Anatomical indicators of dominance between the coronary arteries of dogs / Indicadores anatómicos de la dominancia en las arterias coronarias de perros

In humans, the right coronary artery is dominant. However, we did not find any citations in the literature concerning anatomical indicators of dominance among dogs. We used 30 hearts from mongrels of both sexes, fixed in 10 percent formalin. The branches of the coronary arteries were dissected with special attention to the levels that were considered to be reference points. In 96.7 percent, the circumflex branch of the left coronary artery reached or went beyond the crux cordis. The subsinuosus interventricular artery, ended before reaching the apex in 21 cases, at the apex in five cases and after the apex in four cases. The paraconal interventricular artery, ended before reaching the apex in two cases, at the apex in 11 cases and after the apex in 17 cases. The region of the heart apex was irrigated by branches of the left coronary artery, through the paraconal interventricular branch or through both of the interventricular branches. The mean length and number of ventricular branches of the left coronary artery were greater than those of the right coronary artery. The subsinuosus interventricular branch is a branch of the circumflex branch of the left coronary artery. In the hearts of dogs, the left coronary artery is dominant. The dominance pattern in dogs is different from the dominance pattern in human that is mentioned in the specialized literature.

En los corazones humanos la dominancia coronaria es derecha. Sin embargo, no encontramos referencias en la literatura sobre los indicadores de esta dominancia en perros. Utilizamos 30 corazones de perros de ambos sexos y raza mixta, fijados en formaldeído al 10 por ciento. Las ramas de las arterias coronarias fueron disecadas con especial atención a los niveles considerados como referencias. En 96,7 por ciento de los corazones, la rama circunfleja de la arteria coronaria izquierda excedió o llegó a la crux cordis. La arteria interventricular subsinuosa, terminó antes de llegar al ápice en 21 casos, en el ápice en 5 casos y después del ápice en 4 casos. La arteria interventricular paraconal, terminó antes de llegar al ápice en 2 casos, en el ápice en 11 casos y después del ápice en 17 casos. La región del ápice del corazón estaba irrigada por ramas de la arteria coronaria izquierda a través de la rama interventricular paraconal o a través de los dos ramas interventriculares. La longitud media y el número de ramas ventriculares de la arteria coronaria izquierda son más grandes que las ramas de la arteria coronaria derecha. La rama interventricular subsinuosa es una rama de la rama circunfleja de la arteria coronaria izquierda. En los corazones de los perros, sin embargo, la dominancia es izquierda. La norma de dominancia en los perros es diferente de la norma de dominancia en humanos encontrada en la literatura.

Anatomical study on coronary arteries in dogs

Coronary arteries from dogs are often used in experiments on the action of drugs, for clinical observations and surgical applications. The objective here was to observe the frequency, morphometry, quantity and destination of coronary artery branches, and the endings of these branches. Methods: For this anatomical study on coronary arteries, thirty hearts from mongrel dogs of various ages and both sexes were used, fixed in 10% formalin. The coronary arteries and their branches were dissected as far as the ends of the macroscopically visible ramifications. Results: There was one left coronary artery ending in two (86.7%) or three (13.3%) branches. The paraconal interventricular branch, of length 5.6-8.7 cm, issued 5 to 14 branches, 49.5% to the right ventricle and 50.5% to the left ventricle. The circumflex branch, of length 3.3-6.7 cm, issued 3 to 12 branches to the left ventricle (59.4%) and 1 to 6 branches to the left atrium (40.6%). There was one right coronary artery, of length 1.0-7.2 cm, which issued 6 to 21 branches: 61.1% to the right ventricle and 2 to 9 branches to the right atrium. The subsinuosal interventricular branch, of length 1.0-6.2 cm, issued 1-8 branches: 59.6% to the right ventricle and 40.4% to the left ventricle. Conclusions: Comparison between the results obtained from the present study and the results found in the specialized literature indicates that the distribution of the coronary branches in dogs and humans not is similar (AU)

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Anatomy of the septomarginal trabecula in goat hearts.

Our aim in this study was to examine the right septomarginal trabecula of goats regarding the frequency, origin course of the septal and free component, attachment to the papillaris magnus muscle and size . The material used consisted in 32 hearts from non-pedigree goats of both sexes, preserved in 10% formalin. The right septomarginal trabecula was present in all hearts. It could also present a prominence in the form of a cord in the septum before detaching and going towards the wall or the papillary muscle. We called this a septal component and found it in 69% of all hearts studied. In the remaining specimens, the exit of the septomarginal trabecula was abrupt, without presenting a septal component. It could be attached solely to the papillaris magnus muscle or to the papillary muscle and the ventricle wall, originated in the cranial third of the septum, and was attached to the middle third of the papillary muscle or its caudal third. Its free part, from the septum to the papillaris magnus muscle, ranged in length from 1.3 cm to 2.6 cm. The mean value was 1.7 cm, and the most frequent values were 1.9 and 1.5 cm. In conclusion, in goats, the septomarginal trabecula is a constant and invariable structure.

Morphometry of the human bicipital groove (sulcus intertubercularis).

BACKGROUND: The bicipital groove is located between the greater and lesser tubercles at the proximal extremity of the humerus and extends inferiorly. Citations that anatomic variations of the groove could give rise to sliding of the biceps brachii muscle tendon led us to initiate a morphometric study on this groove. MATERIALS AND METHODS: The study was done on 50 dry humeral bones from adults of both genders and from both sides. A digital caliper rule was used to measure the length, thickness and width of the bicipital groove and the humerus. The angles of the bicipital groove were measured with a goniometer. RESULTS: The average length of the groove was 8.1 cm and it corresponded to 25.2% of the length of the humerus. The width at the midpoint of the groove was 10.1 mm and corresponded to 49.7% to 54.5% of the width of the humerus. The depth was 4.0 mm and corresponded to 18.8% of the depth of the humerus. The mean angle formed by the groove lips was 106 degrees . CONCLUSION: This study confirmed the variability of the measurements presented by the groove in relation to all the aspects considered. LEVEL OF EVIDENCE: Basic Science.

Ausencia de inserción de las cuerdas tendinosas en los músculos papilares del ventrículo derecho de la cabra / Tendinous chords not inserted in the papillary muscles of the right ventricle of goats

A menudo se describe que la trabécula septomarginal derecha del corazón de las cabras presenta cuerdastendinosas. Sin embargo, en nuestras disecciones este no es un hallazgo frecuente en otras especies animales y elpresente trabajo se diseño para comprobar si las cuerdas tendinosas en esta especie se originan directamente deltabique interventricular. El material utilizado fueron 32 corazones de cabras de ambos sexos, de raza mestiza,conservados en formol al 10%. El ventrículo derecho se abrió mediante un corte en el punto central del troncopulmonar y continuando a través del cono arterioso hasta el borde derecho. Nuestros resultados mostraron que68,8% de los corazones presentaban al menos una larga cuerda tendinosa saliendo de la trabécula septomarginal.El origen fue predominantemente en el tercio de la trabécula cerca del tabique (58,3%), destinadas a la valvaseptal y fi jas en su borde libre (87,5%). La presencia de cuerdas tendinosas originándose directamente del ladoderecho del tabique interventricular se observó en 59,4% de los corazones. Estas son cortas aunque predominanen la región craneodorsal del tabique interventricular (76,7%). Ellas se fi jan a la valva septal (96,8%) y estándestinadas al borde libre (80%). La presencia de cuerdas tendinosas en la trabécula septomarginal no tienerelación con la presencia o ausencia de las cuerdas tendinosas en el tabique(AU)

The right septomarginal trabecula in goats frequently presents tendinous chords emerging from it. Sincewe had not observed such great occurrences in any other animal in which we had investigated the trabecula,we decided to conduct this study with the aim of establishing possible relationships with tendinous chords thatemerge directly from the interventricular septum. The material used consisted of 32 hearts from non-pedigreegoats of both sexes, conserved in 10% formalin. The right ventricle was opened by means of an incision startingat the central point of the pulmonary trunk and continuing through the arterial cone to the right margin. Ourresults demonstrated that 68.8% of the specimens presented at least one long tendinous cord emerging fromthe septomarginal trabecula. This emergence occurred predominantly in the third of the trabecula closest to theseptum (58.3%) and the cord headed to the septal cusp and attached to its free margin (87.5%). The presence oftendinous chords emerging directly from the right side of the interventricular septum was found in 59.4% of thespecimens. These were short, because they were predominantly in the craniodorsal region of the interventricularseptum (76.7%). They attached to the septal cusp (96.8%) and headed for the free margin (80%). The presenceof tendinous chords in the septomarginal trabecula was unrelated to the presence or absence or tendinous chordsin the septum(AU)

Sagittal suture of the human cranium and the time of closing / Sutura sagital en el cráneo humano y el tiempo de cierre

The observation of the stage of ossification of the sagittal suture has been adopted as possible approach of age evaluation in anthropology and legal medicine, as area of cranial pathologies: craniosynostosis and scaphocephaly and as diagnosis resource in tomographies. Regarding it, we found many controversies in the specialized literature, thus we decided to accomplish this research with the following objectives: to examine the ossification of the external surface of the sagittal suture, observing eventual differences due to age, sex and ethnic group. Our material consists of 88 dry craniums of variable ages, both sexes belonging to the ethnic groups: white and black. In that material we observed that: with progression of age, the relation between age and stage of ossification of the sagittal suture stops existing. The statistical analysis didn't demonstrate significant differences between sexes and ethnic groups in the stages of ossification of the sagittal suture. The ossification of the sagittal suture starts developing from the posterior third.

La observación de los estados de osificación de la sutura sagital han sido adoptados como posibles criterios de evaluación de la edad en Antropología y Medicina Legal, como un área de patologías craneales: craneosinostosis, escafocefalia y como recursos diagnóstico en tomografias. Encontramos muchas controversias en la literatura especializada, por lo tanto, decidimos realizar esta investigación con el objetivo de examinar la osificación de la superficie externa de la sutura sagital, observando eventuales diferencias debidas a la edad, sexo y grupo étnico. Nuestro material se componía de 88 cráneos secos de individuos de diferentes edades, de ambos sexos, pertenecientes a los grupos étnicos blancos y negros. En el material se observó: progresión de la edad y relación entre la edad y la etapa de osificación de la sutura sagital. El análisis estadístico no demostró diferencias significativas entre sexos y grupos étnicos en las etapas de la osificación de la sutura sagital. La osificación de la sutura sagital comienza a producirse desde el tercio posterior.

A importância da investigação de variações anatômicas das células etmoidais através da tomografia computadorizada no planejamentoda cirurgia endoscópica nasal: [revisão] / The importance of investigation of anatomic variations in the ethmoid cells by computerized tomography in the planning of endoscopic nasal surgery: [review]

As células etmoidais compreendem diversas cavidades que podem apresentar variações anatômicasnos indivíduos. Algumas variações merecem atenção quando associadas a sinusopatias e à necessidade de intervenção cirúrgica. A tomografia computadorizada, considerada padrão-ouro na investigação de doenças da cavidade nasal e no mapeamento anatômico dos seios paranasais, oferece informações acerca da anatomia das células etmoidais, essenciais para a minimização dos riscos cirúrgicos. O presente trabalho tem o objetivo de, mediante revisão bibliográfica, avaliar aimportância da tomografia computadorizada na investigação de variações anatômicas das célulasetmoidais para o planejamento pré-cirúrgico. Células não recorrentes, como as células de Haller, célula de Onodi e a aeração do agger nasi, permitem que a abordagem endoscópica seja planejada com cautela. A avaliação do teto etmoidal resulta em maior segurança quanto aos limites superiores da fossa nasal. O tamanho e o nível de pneumatização da bolha etmoidal, da crista etmoidal e da concha nasal média são importantes ao se avaliar os acessos endoscópicos, a gravidade dadoença, e até mesmo sua origem.

The ethmoidal cells comprise many cavities that show many anatomicalvariations. Some of these variations deserve special attention when associated with sinusitis and the need of surgery. Computed tomography, considered a gold standard on the pathological investigation of the nasal cavity and the anatomic descriptionof paranasal sinus, offers informations about these cells, essential to minimize the surgical risks. The authors present a bibliographic revision of the importance of computed tomography on the investigation of anatomic variations of ethmoid cells. Not recurrent cells in all individuals, like Haller's cells, Onodi's cells and pneumatization of agger nasi, will do the endoscopic approach withprecaution. The ethmoidal roof evaluation will result in more safetyon the upper limits of the nasal cavity. The size and pneumatization level of ethmoidal bulla, ethmoidal crest, and middle nasal concha are important on the evaluation of the endoscopic accesses and the gravity of the striked pathology and even diagnose your origin.

Estudo anatômico das artérias coronárias em caprinos / Anatomic study of coronary arteries in goats

A utilização de artérias coronárias de caprinos em pesquisas experimentais com objetivos de futuras aplicações em coronárias humanas motivou o interesse em verificar semelhanças ou diferenças morfológicas das artérias coronárias de caprinos com os citados na literatura para humanos. Foram utilizados 31 corações de caprinos SRD pesando de 76,5-107,7g fixados em formalina a 10 por cento. As artérias coronárias e seus ramos eram dissecados até as ramificações visíveis sob o pericárdio. A artéria coronária esquerda presente em todos os corações era única. Seu comprimento situou-se entre 8 mm e 17mm, terminava formando os ramos: interventricular paraconal e circunflexo (90,3 por cento) ou interventricular paraconal, circunflexo e angular (9,7 por cento). O ramo interventricular paraconal, presente em todos os corações era único. Seu comprimento variou de 80 a 140mm, emitia média de 12 ramos. O ventrículo direito recebia 49,5 por cento dos ramos e o ventrículo esquerdo, 50,5 por cento, dos ramos. Essa artéria podia terminar antes de atingir o ápice do coração (22,5 por cento), no próprio ápice (22,5 por cento) ou então passava pelo ápice e terminava no sulco interventricular subsinuoso (55 por cento). O ramo circunflexo era único, comprimento variou de 61 a 106mm, emitia média de 8,2 ramos. O ventrículo esquerdo recebia 53,4 por cento dos ramos e o átrio esquerdo, 46,6 por cento. Em todos os casos essa artéria chegava e ultrapassava a Crux cordis. A artéria coronária direita, presente em todos os corações, era única. Seu comprimento variou de 35 a 86mm, emitia a média de 8,6 ramos. O ventrículo direito recebia 56,1 por cento, dos ramos e o átrio direito 43,9 por cento. Em geral era a própria artéria que se comportava como ramo marginal direito. A artéria coronária direita não atingia a Crux cordis em 93,5 por cento. O ramo interventricular subsinuoso da artéria circunflexa podia ser: a) ramo longo ocupando a maior parte do sulco; b) ramo curto ...

The coronary arteries of the goats have been used to researches about to pharmacological actions, heart failure after connection of coronary arteries and others. Twenty-seven goat hearts, both sexes, fixed in formalin at 10 percent has been used in this study that analyzed the coronary arteries pattern in goats and if the same is similar to the human coronary arteries pattern. The left coronary artery is dominant and in relation to the length demonstrated average 1.15cm emitting two branches: interventricular paraconalis and circumflex. The interventricular paraconalis branch with average length 10.5cm issued branches to the both ventricles fairly, ending more frequently in the interventricular subsinuosis sulcus. The circumflex branch with average length 8.5cm issued branches to left ventricle and right atrium fairly. The left marginal branch is not constant. The right coronary artery, with average length 6.1cm issued branches to right ventricle and right atrium fairly, but the interventricular subsinuosis branch with average length 3.1cm is variable and can present one long branch, one short branch or one double branch, with the huge part for the right ventricle.

Estudo anatômico de pontos críticos no trajeto do nervo laríngeo recorrente: ligamento suspensor da glândula tireoide(ligamento de Berry) e cápsula da glândula tireoide / Estudio anatómico de puntos críticos en la trayectoria del nervio laríngeo recurrente: ligamento suspensorio de la glándula tiroides (ligamento de Berry)y cápsula de la glándula tiroides / Anatomical study of critical points in the trajectory of recurrent laryngeal nerve: suspensory ligament of thyroid gland (Berry ligament) and capsule of thyroid gland

Apesar da variabilidade apresentada pelo nervo laríngeo recorrente no trajeto em direção à laringe, os cirurgiões da região cervical concordam que os pontos críticos localizam-se nos níveis da artéria tireoidea inferior, do ligamento suspensor da glândulatireoide (ligamento de Berry), proximidade com a cápsula da glândula tireoide e passagem pelo músculo constritor inferior da faringe.Esta pesquisa abordou a relação do nervo laríngeo recorrente com o ligamento suspensor da glândula tireoide (ligamento de Berry) e com a cápsula da glândula tireoide. O nervo laríngeo recorrente apresentou relação de contato importante com o ligamento suspensor da glândula tireoide (ligamento de Berry), porém o envolvimento parcial do nervo é pouco frequente. O nervo laríngeo recorrente entra em contato com a cápsula da glândula tireoide, porém na maioria dos casos o contato é externo. Palavras-chave: Nervo laríngeo recorrente-anatomia & histologia. Glândula tireoide. Músculos faríngeos.

Despite the variability presented by recurrent laryngeal nerve in the trajectory towards the larynx, surgeons of the cervical region agree that the critical points are situated in the levels of the inferior thyroidal artery, suspensory ligament of thyroid gland(Berry ligament), proximity with the capsule of thyroid gland and the passage through the inferior pharyngeal constrictor muscle. This research has as its aim to investigate the relationship of recurrent laryngeal nerve with the suspensory ligament of thyroid gland (Berry ligament) and with the capsule of thyroid gland. Recurrent laryngeal nerve has an important relationship of contact with suspensory ligament of thyroid gland (Berry ligament), but the partial involvement of the nerve is not very frequent. Recurrent laryngeal nervecomes in contact with the capsule of thyroid gland, but in most cases the contact is external. Keywords: Recurrent laryngeal nerve-anatomy & histology. Thyroid gland. Pharyngeal muscles.

A pesar de la variabilidad presentada por el nervio laríngeo recurrente en la trayectoria hacia la laringe, los cirujanos de la región cervical convienen que los puntos críticos están situados en los niveles de la arteria tiroidea inferior, del ligamento suspensorio de la glándula tiroides (ligamento de Berry), de la proximidad con la cápsula de la glándula tiroides y del paso a través del músculo constrictor inferior de la faringe. Esta investigación tiene como su objetivo investigar la relación del nervio laríngeo recurrente con el ligamento suspensorio de la glándula tiroides (ligamento de Berry) y con la cápsula de la glándula tiroides. El nervio laríngeo recurrentetiene una relación importante de contacto con el ligamento suspensorio de la glándula tiroides (ligamento de Berry), pero la implicación parcial del nervio no es muy frecuente. El nervio laríngeo recurrente entra en contacto con la cápsula de la glándula tiroides, pero en la mayoría de los casos el contacto es externo. Palabras llave: Nervio laríngeo recurrente-anatomía & histologia. Glándula tiróides. Músculos faríngeos.

Estudo morfométrico do seio esfenoidal por meio da tomografia computadorizada / Morphometric study on sphenoidal sinus by computed tomography

Introdução: Inúmeras pesquisas a respeito da morfologia do seio esfenoidal em imagens têm sido realizadas, visto sua grande variedade em tamanho, forma e septação. O conhecimento das variações morfológicas desse seio é de extrema importância, principalmente no que se refere à indicação de procedimentos cirúrgicos que utilizam tal via de acesso. Objetivo: Analisar as variações anatômicas frequentes do seio esfenoidal em imagens de tomografia computadorizada no que diz respeito à septação, número de cavidades, altura e largura. Métodos: Foram utilizadas 66 tomografias de crânios de humanos adultos, sendo 31 femininos e 35 masculinos. A partir das imagens, efetuaram-se as medidas da altura e largura total do seio, bem como a análise da presença e quantidade de septos. Resultados: 60,60% dos seios apresentaram altura entre 11 e 16 mm, 36,4% possuíam uma largura total no corte coronal entre 23 e 28 mm, e 62,12% da amostra apresentaram apenas um septo. Com base nos dados analisados, pode-se inferir que o seio esfenoidal é uma estrutura constante e passível de inúmeras variações anatômicas entre os crânios pesquisados no que se refere às suas mensurações, sendo que o valor médio da altura é de 14,6 mm e o valor da largura é de 26,1 mm. Conclusões: A tomografia é uma ferramenta que mostra claramente as variações do seio, sendo um instrumento aliado na averiguação das mesmas, podendo ser solicitada antes do ato cirúrgico para evitar que estruturas vitais adjacentes sejam lesadas.

Introduction: Numerous investigations regarding the morphology of the sphenoid sinus in images have been carried out, given its large variability in size, shape and quantity of septums. The knowledge of morphological variations of this particular sinus are extremely important, especially regarding details of surgical procedures that use this route of access. Objective: to analyze the frequent morphological variations on the sphenoid sinus by computed tomography (CT) scans. Methods: Sixty-six images of adult human skulls were studied, 31 female and 35 male. From the images, measures of height and total width of the sinus were accomplished, as well as the presence and number of septums. Results: 60.60% of the sinus presented height between 11 and 16 mm, 36.4% had a total width in the coronal sections between 23 and 28 mm, and 62.12% of the sample showed only one septum. Based on the analyzed data, it can be inferred that the sphenoid sinus is a constant structure and subject to several anatomical variations among the searched skulls concerning their measurements, being the average height 14.6 mm and the average width 26.1 mm. Conclusions: CT scan is a tool that clearly shows sinus variations, being an ally instrument in their investigation, and may be requested before surgery to prevent injuries on vital structures adjacent to the sinus.

Indicadores anatômicos de dominância entre as artérias coronárias em caprinos / Anatomical indicators of dominance among the coronary arteries in goats

O interesse crescente em se utilizar artérias coronárias de caprinos em experiências como uma etapa para sua aplicação em coronárias humanas justifica o conhecimento anatômico mais detalhado dessas artérias principalmente para se avaliar as semelhanças e as diferenças. Em corações humanos utilizando-se a crux cordis e a procedência do ramo interventricular posterior como referências consideram-se três tipos de padrões: dominância direita, balanceada e dominância esquerda. No entanto, não encontramos citações na literatura sobre os indicadores anatômicos de dominância coronária em caprinos. Materiale método: Utilizamos 31 corações de caprinos de ambos os sexos, fixados em formalina a 10%. Os ramos das artérias coronárias eram dissecados com especial atenção para os níveis considerados como referências. O ramo presente no interior do sulco interventricular subsinuoso procedia do ramo circunflexo, ramo da artéria coronária esquerda. O ramo interventricular subsinuoso apresentou pelo menos um pequeno ramo que ultrapassava a crux cordis. A região do ápice apresentou predominância dos ramos da artéria coronária esquerda: interventricular paraconal e interventricular subsinuoso. A artéria coronária esquerda, através de seus ramos, também predominou no comprimento total e na emissão de ramos ventriculares inclusive para o ventrículo direito. Utilizando como referências os diversos critérios inclusive, os propostos por esta pesquisa, concluímos que em corações de caprinos o padrão arterial é dominância esquerda. A diversidade em relação ao padrão arterial entre caprinos e humanos requer que nas experiências efetuadas, em coronárias de caprinos, essa importante diferença seja observada

The growing interest in the use of coronary arteries of goats inresearches to posterior application in human hearts justifying the more detailed anatomical knowledge of this arteries mainly to evaluate their similarities and differences with the human arterial pattern. However, we not found anatomical studies on indicators of coronary dominance in goats. In the literature, we found only the definition of three kinds of pattern in human hearts: right dominance, balanced and left dominance. To this work we used 31 goats hearts, of both sexes and fixed and conserved in formalin at 10%. The branches of coronary arteries were dissected with special attention to the levels considered as references. The branch present in the interventricular subsinuosis sulcus had origin in the circumflex branch that is a branch of the left coronary artery. The interventricular subsinuosis branch presented at least a little branch that exceeded the crux cordis. The region of the apex presented predominance of the left coronary arterybranches: interventricular paraconalis and interventricular subsinuosis. The left coronary artery, through their branches, also dominated in total length and the issue to ventricular branches including for the right ventricle. Using references to various criteria including, those proposed for this research, we find that in goats hearts the arterial pattern is left dominance. The diversity in relation to the arterial pattern between goats and humans requires that in the experiments performedin the coronary goats, this important difference is observed

Arterial branches to the temporal muscle.

UNLABELLED: The temporal muscle is greatly used for forming myofascial flaps and transposition in cases of reconstructive and reparative plastic surgery of the face and neck. Despite this important application, lack of success has been reported, probably because of lack of knowledge of the anatomical characteristics of this muscle, such as variations in its blood supply. OBJECTIVES: To investigate the blood supply of the temporal muscle in order to provide an anatomical basis for reconstructive and reparative surgery of the face using flaps from the temporal muscle. This study was conducted by dissecting 21 half faces from cadavers of children (13 male and 8 female) that had been injected with neoprene latex through the common carotid artery. The temporal muscle usually received three or four arterial branches coming from the maxillary and superficial temporal arteries. The branches of the maxillary artery could be separate (anterior deep temporal, posterior deep temporal and accessory deep temporal arteries) or together with other branches of the maxillary artery, forming trunks. The branches of the superficial temporal artery were always separate (middle temporal artery). The anterior deep temporal artery originated in front of the coronoid process and the posterior deep temporal artery behind it. The numbers of arterial branches in the anterior and middle thirds of the muscle were similar and slightly greater than the number in the posterior third. The most frequent arterial branch in the anterior third was the anterior deep temporal artery; in the middle third, it was the posterior deep temporal artery; and in the posterior third, it was the middle temporal artery. The most frequent patterns of arterial branch presence in the temporal muscle were: a) anterior deep temporal, posterior deep temporal and middle temporal arteries; and b) anterior deep temporal, posterior deep temporal, accessory deep temporal and middle temporal arteries. The accessory deep temporal artery is a direct branch from the maxillary artery that originates at the level of the coronoid process of the mandible and participates in irrigating the anterior and middle thirds of the muscle.

Estudo anatômico das artérias coronárias de suínos Landrace / Anatomic study of coronary arteries Landrace pigs

A utilização de artérias coronárias de suínos em experiências sobre ação de fármacos para observações clínicas e aplicações cirúrgicas é freqüente. Para o estudo anatômico das artérias coronárias foram utilizados 30 corações fixados em formalina a 10 por cento de suínos Landrace, de ambos os sexos, idades entre 5 e 6 meses, peso de 80 a 110 kg. As artérias coronárias e os ramos foram dissecados até as ramificações visíveis macroscopicamente. Foi verificada a presença de uma artéria coronária esquerda, comprimento de 0,4-1,2cm, terminando em 2 (80 por cento) ou 3 (20 por cento) ramos. O ramo interventricular paraconal, comprimento de 10-16cm, emitiu 16-25 ramos sendo 52,3 por cento para o ventrículo direito e 47,7 por cento para o ventrículo esquerdo. O ramo circunflexo, comprimento de 7-15cm, emitiu 4-13 ramos para o ventrículo esquerdo (55,6 por cento) e 4-9 ramos para o átrio esquerdo (44,4 por cento). Observou-se uma artéria coronária direita, comprimento de 7,5-11,5cm, que emitiu 12-21 ramos sendo 57,4 por cento para o ventrículo direito e 42,6 por cento para o átrio direito. O ramo interventricular subsinuoso, comprimento de 5,1-10,2cm, emitiu 9-22 ramos sendo 50,9 por cento para o ventrículo direito e 49,1 por cento para o ventrículo esquerdo. A freqüência de ramos do ramo interventricular paraconal foi semelhante para ambos os ventrículos. A freqüência de ramos do ramo interventricular subsinuoso, ramo terminal da coronária direita foi semelhante para ambos os ventrículos. As comparações dos resultados obtidos nesta pesquisa com os resultados encontrados na literatura especializada indicam semelhança de distribuição dos ramos coronários nos suínos e nos humanos.

The experimental use of coronary arteries of swine to study drug action for clinical and surgical application is an important tool. For this anatomic study about coronary arteries, thirty hearts of Landrace pigs, of both sexes, 5 to 6 months old, weighing 80 to 110 kg, were fixed in 10 percent formalin. The coronary arteries and their branches were dissected until the visible ramifications. There was one left coronary artery, with length of 0.4-1.2cm, giving off 2 (80 percent) or 3 (20 percent) branches. The paraconal interventricular branch, with length of 10-16cm, emitted 16-25 branches, 52.3 percent for the right ventricle and 47.7 percent for the left ventricle. The circumflex branch, with length of 7-15cm, emitted 4-13 branches, 55.6 percent for the left ventricle and 44.4 percent for the left atrium. There was one right coronary artery, with length of 7.5-11.5cm, which emitted 12-21 branches, 57.4 percent for the right ventricle and 42.6 percent for the right atrium. The subsinuosus interventricular branch, length of 3-11cm, emitted 9-22 branches, 50.9 percent for the right ventricle and 49.1 percent for the left ventricle. The number of branches of the paraconal interventricular branch and the number of branches of the subsinuosus interventricular branch was similar for both ventricles. The results obtained in the present study compared with the literature indicate that the distribution of the coronary branches in swine and in humans is similar.

Anatomy of the tendinous cords of the interventricular septum of the human heart.

There are frequent citations in the literature stating that lesions of the tendinous cords cause functional disorders of the heart valves. This led us to conduct the present investigation on the anatomy of the tendinous cords. Our objective was to focus on the morphological characteristics of tendinous cords that are inserted directly into the interventricular septum, such as their frequency, number, dimensions and This study was conducted on 50 hearts from adults of both sexes that had been fixed in 10% formaldehyde. The right ventricle was opened by means of an incision parallel to the anterior interventricular groove, and the left ventricle was opened by means of a longitudinal incision in the middle of the pulmonary (left) surface. Our results showed that, in the right ventricle, these tendinous cords constantly appeared without the involvement of papillary muscles (98%). They ranged in number from one to ten, and between two and five was the most common (72%). They were short, mostly ranging from 0.3 to 1.9 cm in length (81.5%) and were preferentially located in the upper third of the interventricular septum (71.4%). They were usually attached to the septal cusp (76.7%) and sometimes to the anterior cusp (21.3%). The cusp insertion sites were the free edge (62%), ventricular surface (32%) and basal edge (6%). It was exceptional to find tendinous cords in the ventricular septum of the left ventricle. Tendinous cords directly inserted into the atrioventricular septum were constantly present in the right ventricle, with varying numbers. They were predominantly short because they were inserted into the upper third of the septum and most often headed towards the septal cusp. It was exception to find tendinous cords in the atrioventricular septum of the left ventricle.

Análise quantitativa de ossos suturais em crânios de humanos adultos / Quantitative analisys of the sutural bones in adult human skulls

Os ossos suturais são ossos supranumerários no interior dassuturas. São pequenos agrupamentos ósseos de forma irregularque freqüentemente aparecem ao longo da sutura lambdóidea. Oobjetivo deste trabalho é analisar quantitativamente a distribuiçãodos ossos suturais em crânios de indivíduos adultos observandosuas variações quanto ao local de aparecimento e quantidadede ossos por crânio. Foram utilizados 272 crânios de ambosos sexos e diferentes faixas etárias, pertencentes ao Museu deOssos do Departamento de Anatomia Descritiva e Topográficada UNIFESP-EPM, que foram analisados e fotografados parailustração deste trabalho. Em 98 crânios os ossos suturaisestavam presentes, dos quais 39% dos crânios tinham ossosunilaterais, 18% ossos bilaterais, 16% ossos medianos e 27%ossos em vários locais. Quanto ao número de ossos, na maioriados casos cada crânio possuía um osso sutural (49%), seguido dedois ossos suturais em 24% dos casos. Em relação ao local ondese encontram, a presença mais significativa está entre os ossosparietais e o osso occipital, sendo 36% dos ossos encontradosdo lado direito, 38,3% dos ossos encontrados do lado esquerdo e11,4% dos ossos encontrados medianamente. Os ossos suturaissão inconstantes e quando presentes aparecem com maiorfreqüência entre os ossos occipital e parietal de ambos os ladospodendo ser unilaterais, bilaterais ou medianos.

The sutural bones are extranumerical bones inside thesutures of irregular form which frequently appear along thelambdoidea suture. We intend to analyse them quantitativelyin adult human skulls, observing their variaton accordingto the place they appear and the number. Two hundred andseventy-two skulls of both gender and different age wereused. They belong to the Bone Museum of the Descriptive andTopographic Anatomy Department of UNIFESP-EPM, whichwere analysed and photographed to illustrate this researchwork. The sutural bones were presented in 36% of the skullsin which 39% of the cases they were unilateral, 18% bilateral,16% average and 27% dispersed. Most of the skulls (49%) hadonly one sutural bone followed by two (24%). In most cases,the bones were located between the occipital and parietalbones, 36% on the right side of the skull, 38.3% on the leftside of the skull and 11.4% average. The sutural bones areinconstant but appear more frequently between the occipitaland parietal bones in both sides and they can be unilateral,bilateral or average.

Estudo anatômico do músculo fibular terceiro em humanos / Anatomic study of the peroneus tertius muscle in humans

Introdução: O músculo fibular terceiro, encontrado na região crural anterior, é considerado inconstante, mas, diferentemente de outros inconstantes como os músculos piramidal e o palmar longo, apresenta origem e inserção ósseas e consistente ventre muscular, sinais que evidenciam um músculo com função definida. Material e métodos: Foram estudados 32 membros inferiores de ambos os lados de indivíduos adultos, do sexo masculino e de diferentes grupos étnicos, fixados em solução de formol a 10%. Mediante dissecação, analisamos: freqüência, origem, inserção, relações com o músculo extensor longo dos dedos e sua morfometria. Resultados: O músculo fibular terceiro esteve presente em 94% dos membros, sua origem em 83% verifica-se no terço médio da fíbula e sua inserção em 90% ocorre na face dorsolateral do quinto metatarsal. Efetuando a morfometria do ventre, constatamos variabilidade de largura e de comprimento. Devido à elevada freqüência de presenças, o músculo fibular terceiro pode ser considerado como constante e sua ausência uma variação. Apesar de não totalmente independente (40%) do músculo extensor longo dos dedos, sua autonomia de origem, de trajeto e de inserção é elevada. Eventuais diferenças em função do lado e do grupo étnico não foram confirmadas.

Introduction: The peroneus tertius muscle, placed in the anterior crural region, is considered inconstant but differently of other inconstant muscles like the pyramidalis and the palmaris longus muscles, it presents bone originand insertion and consistent muscular belly, signs that evidence a muscle with a definite function. Material and methods: We studied 32 inferior members from both sides of adults individuals, mile gender and from different ethnical groups, fixed in formaldehyde solution 10%, that we aimed, through dissection to analyze: frequency, origin, insertion, relations with the extensor digitorum longus muscle and morphometry. Results: The peroneus tertius muscle has been present in 94% of the members, its origin in 83% is verified at the medium third and its insertion in 90% occursin the dorsilateral face of the fifth metatarsal bone. Making use of the morphometry of the belly we have ascertained the variability of width and length. Conclusion: Due to high frequency of presence (94%), the peroneus tertius muscle may be considered constant. In spite the fact of not being able to consider it totally independent (40%) of the extensordigitorum longus, its origin anatomy, route and insertion is high. Eventual differences about the side and ethnicalgroup have not been found yet.