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1.
Ann Anat ; 227: 151415, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31513915

RESUMO

BACKGROUND: The phrenicoabdominal branch of the left phrenic nerve passes between muscle fiber bundles within the costal part of the diaphragm near the pericardium. In most German textbooks of anatomy, however, its passage is described to be found in the esophageal hiatus. The aim of this study was to reevaluate its topography relative to the diaphragm in a multicentric study and to identify the initiation of this description. METHODS: In this multicentric study, the most dorsomedial branch of the left phrenic nerve was identified as the phrenicoabdominal branch in 400 embalmed anatomic specimens of Caucasian origin. The distance between its passage and the apex of the pericardium, the left border of the esophageal hiatus, and the inner aspect of the left sixth rib was measured on the cranial aspect of the diaphragm. Textbooks on human anatomy published in German language between 1700 and 2018 were reviewed for their description of the passage of the left phrenicoabdominal branch through the diaphragm. RESULTS: The first statement on the passage of the left phrenicoabdominal branch through the esophageal hiatus was given in 1791 by Sömmering. Since then, in German textbooks of anatomy, a duality in the description of the passage of the left phrenicoabdominal branch persists. In none of the individuals examined in this study, the left phrenicoabdominal branch passed through the esophageal hiatus. In 99.5% of all cases, it pierced the costal part of the diaphragm dorsal to or at the same level as the apex of the pericardium. The mean distances (standard deviations) were 3.4 (±1.5) cm to the apex of the pericardium, 5.8 (±2.2) cm to the esophageal hiatus, and 5.5 (±1.6) cm to the inner aspect of the left sixth rib. CONCLUSION: The findings on the position of the left phrenicoabdominal branch relative to the diaphragm help to improve topographical knowledge and prevent inadvertent nerve injury during surgical interventions on or near the diaphragm. Further to this, these results may form a substantial basis to adopt the correct description of the passage of the left phrenicoabdominal branch to anatomical textbook knowledge.


Assuntos
Diafragma/anatomia & histologia , Esôfago/anatomia & histologia , Nervo Frênico/anatomia & histologia , Anatomia/história , Cadáver , Embalsamamento , Grupo com Ancestrais do Continente Europeu , Feminino , Alemanha , História do Século XVIII , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Masculino , Pericárdio/anatomia & histologia , Costelas/anatomia & histologia , Livros de Texto como Assunto/história
2.
Thorac Surg Clin ; 29(4): 359-368, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31564392

RESUMO

Paraesophageal hernia represents a complex surgical problem involving significant distortion of the anatomy and function of the esophagus, stomach, gastroesophageal junction, mediastinum, lungs, and heart. Surgeons operating in the area must have deep understanding of the normal anatomy and pathologic derangements in patients with paraesophageal hernias. This article describes the normal anatomy and anatomic abnormalities in application to the various approaches used in the surgical repair of a paraesophageal hernia.


Assuntos
Diafragma/anatomia & histologia , Esôfago/anatomia & histologia , Hérnia Hiatal/cirurgia , Estômago/anatomia & histologia , Diafragma/diagnóstico por imagem , Endoscopia do Sistema Digestório , Esfíncter Esofágico Inferior/anatomia & histologia , Esôfago/diagnóstico por imagem , Hérnia Hiatal/diagnóstico por imagem , Herniorrafia/métodos , Humanos , Laparoscopia , Radiografia , Estômago/diagnóstico por imagem , Tomografia Computadorizada por Raios X
3.
Eur. j. anat ; 23(5): 389-392, sept. 2019. ilus
Artigo em Inglês | IBECS | ID: ibc-183870

RESUMO

Kyphoscoliosis is often associated with enlarged oesophageal hiatus. It is suggested that this spinal deformity leads to prolonged stretching of the diaphragm causing herniation of abdominal organs, particularly the stomach into the thorax. Such a hiatal hernia can compress thoracic viscera, produce symptoms like shortness of breath and intermittent pain after ingestion of food. This cadaveric report discusses a case of a giant, sliding-type of hiatal hernia accompanied by scoliosis with rightsided deviation of the thoracic aorta and smallsized left lung. All patients presenting gastrointestinal symptoms with coexistence of vertebral column anomalies should be evaluated for the occurrence of intra-thoracic stomach


No disponible


Assuntos
Humanos , Feminino , Idoso , Hérnia Hiatal , Escoliose , Mediastino/anormalidades , Mediastino/anatomia & histologia , Cadáver , Diafragma/anormalidades , Diafragma/anatomia & histologia , Tórax/anormalidades , Tórax/anatomia & histologia
4.
Obes Surg ; 29(9): 2814-2823, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31069692

RESUMO

PURPOSE: Gastric fistula is a severe complication following sleeve gastrectomy (SG). Chronic gastric fistula can progress to complex anatomical situations, such as esogastro-bronchial and/or esogastro-pleural (EGBP) fistulas. We decided to analyze the anatomical characteristics of these EGBP fistulas after SG. METHODS: Our work consisted of an analysis of the clinical, endoscopic, and radiological data of patients treated for EGBP fistulas after SG at the Georges Pompidou European Hospital from May 2009 to November 2017. RESULTS: A total of 11 patients were retrospectively included with available complete clinical, endoscopic, and radiological data. The origin of the fistula was mostly at the top of the staple line. The fistula's termination was pleural in 5 patients (45%) and bronchial in 6 (55%). In bronchial fistulas, 2 were proximal and 4 were distal, with the left pulmonary posterolateral segment (S10) being reached in each case. The trans-diaphragmatic passage was through the left cupola in 9 out of 11 patients (82%). In 2 patients, the passage was trans-hiatal (18%). Interestingly, the 2 eso-bronchial fistulas had a trans-hiatal passage with a termination in the proximal bronchus, while the 4 gastro-bronchial fistulas had a trans-diaphragmatic passage with a termination in the distal bronchus. All pleural fistulas were gastric with a trans-diaphragmatic passage. CONCLUSIONS: Esogastro-bronchial and gastro-pleural fistulas after SG originated mostly at the top of the staple line. Eso-bronchial fistulas had a trans-hiatal passage with a proximal bronchial termination, while gastro-bronchial fistulas had a trans-diaphragmatic passage with a distal bronchial termination.


Assuntos
Fístula Brônquica , Gastrectomia/efeitos adversos , Fístula Gástrica , Doenças Pleurais , Complicações Pós-Operatórias , Diafragma/anatomia & histologia , Humanos , Pulmão/anatomia & histologia , Pleura/anatomia & histologia , Estudos Retrospectivos
5.
Arch. bronconeumol. (Ed. impr.) ; 55(4): 195-200, abr. 2019. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-181510

RESUMO

Introduction: Invasive respiratory support is a cornerstone of Critical Care Medicine, however, protocols for withdrawal of mechanical ventilation are still far from perfect. Failure to extubation occurs in up to 20% of patients, despite a successful spontaneous breathing trial (SBT). Methods: We prospectively included ventilated patients admitted to medical and surgical intensive care unit in a university hospital in northern Mexico. At the end of a successful SBT, we measured diaphragmatic shortening fraction (DSF) by the formula: diaphragmatic thickness at the end of inspiration - diaphragmatic thickness at the end of expiration/diaphragmatic thickness at the end of expiration×100, and the presence of B-lines in five regions of the right and left lung. The primary objective was to determine whether analysis of DSF combined with pulmonary ultrasound improves prediction of extubation failure. Results: Eighty-two patients were included, 24 (29.2%) failed to extubation. At univariate analysis, DSF (Youden's J: >30% [sensibility and specificity 62 and 50%, respectively]) and number of B-lines regions (Youden's J: >1 zone [sensibility and specificity 66 and 92%, respectively]) were significant related to extubation failure (area under the curve 0.66 [0.5-0.80] and 0.81 [0.70-0.93], respectively). At the binomial logistic regression, only the number of B-lines regions remains significantly related to extubation failure (OR 5.91 [2.33-14.98], P < .001). Conclusion: In patients with a successfully SBT, the absence of B-lines significantly decreases the probability of extubation failure. Diaphragmatic shortening fraction analysis does not add predictive power over the use of pulmonary ultrasound


Introducción: El soporte respiratorio invasivo constituye una piedra angular en la medicina de cuidados intensivos. Sin embargo, los protocolos para retirar la ventilación mecánica todavía están lejos de ser perfectos. El fallo de extubación ocurre en hasta un 20% de los pacientes, a pesar del éxito en la prueba de respiración espontánea (SBT). Métodos: Se incluyeron de forma prospectiva pacientes con ventilación ingresados en una unidad médica y quirúrgica de cuidados intensivos de un hospital universitario del norte de Méjico. Tras el éxito en una SBT, se midió la fracción de acortamiento diafragmático (DSF) mediante la fórmula: (grosor diafragmático al final de la inspiración - grosor diafragmático al final de la expiración)/grosor diafragmático al final de la expiración × 100, y la presencia de líneas B en cinco regiones del pulmón derecho y del izquierdo. El objetivo primario fue determinar si el análisis de la DSF combinado con la ecografía pulmonar mejora la predicción del fallo de extubación. Resultados: Se incluyeron 82 pacientes, 24 (29,2%) con fallo de extubación. En el análisis univariante, la DSF (Índice de Youden: >30% [sensibilidad y especificidad del 62% y el 50%, respectivamente]) y el número de regiones con líneas B (Índice de Youden: >zona 1 [sensibilidad y especificidad del 66% y el 92%, respectivamente]) se relacionó significativamente con el fallo de extubación (área bajo la curva 0,66 [0,52-0,80] y 0,81 [0,70-0,93] respectivamente). En la regresión logística binaria, solo el número de regiones con líneas B se relacionó significativamente con el fallo de extubación (OR 5,91 [2,33-14,98], p<0,001). Conclusión: En pacientes con éxito en la SBT, la ausencia de líneas B disminuye significativamente la probabilidad de fallo de extubación. La fracción de acortamiento diafragmático no añade valor predictivo respecto al uso de la ecografía pulmonar


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Diafragma/anatomia & histologia , Pulmão/diagnóstico por imagem , Extubação/mortalidade , Diafragma/fisiologia , Ultrassonografia/métodos , Respiração Artificial/normas , Estudos Prospectivos , Cuidados Críticos , Diagnóstico por Imagem/métodos , Respiração Artificial/métodos , Ventiladores Mecânicos , Desmame do Respirador/mortalidade
7.
Clin Anat ; 32(6): 762-769, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30758865

RESUMO

Surface anatomy is considered a fundamental part of anatomy curricula and clinical practice. Recent studies have reappraised surface anatomy using CT, but the adolescent age group has yet to be appraised. Sixty adolescent thoracoabdominal CT scans (aged 12-18 years) were examined. The surface anatomy of the central veins, cardiac apex, diaphragmatic openings, and structures in relation to the sternal angle plane were analyzed. The results showed that the brachiocephalic vein (left and right) formed mostly posterior to the sternoclavicular joint. The superior vena cava formed close to the second costal cartilage, ±16.3 mm to the right of the midline. The apex of the heart was located in relation to the fifth intercostal space; ±78.6 mm to the left of the midline. The caval hiatus was in relation to T9 and T10; the esophageal hiatus was at T10; whereas the aortic hiatus was at T11. The sternal angle plane was in relation to the upper half of T5, which was also where the bifurcations of the trachea and pulmonary trunk were observed. The SVC/azygos vein junction and the concavity of the aortic arch were observed to be more than 10 mm superior to this plane. The results of this study further highlight the substantial variability of the surface anatomy between age groups. It also emphasizes the notion that surface anatomy is a dynamic variable and cannot be treated as a static observation. Clin. Anat. 32:762-769, 2019. © 2019 Wiley Periodicals, Inc.


Assuntos
Tórax/anatomia & histologia , Adolescente , Pontos de Referência Anatômicos , Veia Ázigos/anatomia & histologia , Veias Braquiocefálicas/anatomia & histologia , Diafragma/anatomia & histologia , Feminino , Humanos , Masculino , Articulação Esternoclavicular/anatomia & histologia , Tomografia Computadorizada por Raios X , Veia Cava Superior/anatomia & histologia
8.
PLoS One ; 13(12): e0208697, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30592726

RESUMO

The diaphragm is well known for its role as the principal muscle of respiration. However, according to previous studies, its role is multifactorial, from breathing through pain perception, regulation of emotional sphere, collaborating in gastroesophageal functions, facilitating the venous and lymphatic return, to an essential role in the maintenance of lumbar spine stability. The purpose of the study was to examine whether diaphragm function parameters (thickness and range of motion) are associated with static balance maintenance. A total of 142 participants were examined and divided into three groups: G1-patients qualified for lung resection due to cancer; G2 -patients after lobe resection; G3 -healthy subjects. Diaphragm thickness and excursion was measured using ultrasonography. Stabilometric parameters of balance were assessed by Zebris FDM-S platform. Greater diaphragm thickening during active breathing and diaphragm thickness fraction were associated with better static balance parameters. Limitation of diaphragm motion during quiet breathing and deep breathing was linked to balance disorders. There was no correlation between diaphragm muscle excursion during sniff maneuvers and balance parameters. Deterioration of diaphragm function observed after thoracic surgery was closely related with deterioration of balance maintenance. Impairment of diaphragm function manifested by decrease of muscle thickness and movement restriction is strongly associated with balance disorders in a clinical sample and among healthy subjects.


Assuntos
Diafragma/anatomia & histologia , Diafragma/fisiologia , Equilíbrio Postural/fisiologia , Adulto , Idoso , Diafragma/diagnóstico por imagem , Diafragma/fisiopatologia , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/fisiopatologia , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Amplitude de Movimento Articular , Respiração , Método Simples-Cego , Ultrassonografia , Adulto Jovem
9.
Comput Methods Biomech Biomed Engin ; 21(5): 399-407, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29996696

RESUMO

We aim to maximize the pumping volume of a pulsatile ventricular assist device, where the diaphragm is covered with an endothelial cell layer. These cells are estimated to survive a cyclic strain up to fifteen percent. To increase the pumping volume under this strain constraint we use an approach based on corrugation of the diaphragm in its reference configuration. The paper explains the parametrization scheme for finding corrugation shapes, addresses modeling and evaluation schemes and reports on the results of a parameter study. The results show that corrugated diaphragm shapes are effective for increasing pumping volumes under a strain constraint.


Assuntos
Diafragma/anatomia & histologia , Coração Auxiliar , Teste de Materiais , Fluxo Pulsátil , Humanos , Modelos Teóricos , Pressão
10.
J Gastrointest Surg ; 22(10): 1709-1714, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29916104

RESUMO

BACKGROUND: Right hemihepatectomy or systematic resection of segment 7 or 8 involves partial resection of the paracaval portion of the caudate lobe. However, the boundary between the caudate lobe and segment 7 or 8 remains unclear. We examined the anatomical territory of the caudate lobe with special reference to the boundary between the paracaval portion and segment 7 or 8 for precise anatomical hepatectomies. METHODS: We enrolled 63 consecutive healthy donor candidates for living-donor liver transplantation from 2012 to 2014 in this study. The caudate lobe was defined according to Kumon's subdivision system, and the boundary between the paracaval portion and segment 7 or 8 was investigated based on three-dimensional computed tomography scan images using SYNAPSE VINCENT®. RESULTS: The paracaval portion of the liver protruded on the liver surface underneath the right diaphragm on the ventral side of the right hepatic vein (RHV) in 10 participants (16%) and on the dorsal side of the RHV in 9 participants (14%). A branch of the RHV, the "paracaval vein," was found in all 63 participants and ran longitudinally along the right border of the paracaval portion (n = 30, 48%) and within segment 7 (n = 16, 25%) or segment 8 (n = 17, 27%). CONCLUSIONS: The paracaval portion of the liver protruded on the liver surface underneath the right diaphragm in one third of our participants. The paracaval vein can be a landmark for the boundary between the caudate lobe and the segment 7 or 8 in half of the cases.


Assuntos
Hepatectomia , Veias Hepáticas/anatomia & histologia , Fígado/anatomia & histologia , Adulto , Diafragma/anatomia & histologia , Diafragma/diagnóstico por imagem , Feminino , Veias Hepáticas/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Fígado/diagnóstico por imagem , Fígado/cirurgia , Transplante de Fígado , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Adulto Jovem
11.
An Acad Bras Cienc ; 90(2): 1845-1854, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29668804

RESUMO

The wall of the diaphragm can be affected by changes caused by physical trauma, allowing the passage of viscera between the abdominal cavity and thoracic cavity, thus reducing the space for pulmonary expansion, leading to the formation of hernia and possible death. Thus, we aimed to characterize, size and determine the topography of the diaphragmatic muscle in the Southern Tamandua, since clinical and surgical activities in wild animals have become a reality more and more present in veterinary medicine. We used six adult animals, x-rayed and dissected, followed by collection of fragments of muscular portions for histological analysis. Initially we observed that the animals presented 17 thoracic vertebrae, 3 lumbar vertebrae and 5 sacral vertebrae. The diaphragm was conformed by three segments: sternal, costal and right and left diaphragm pillar, with presence of tendinous centre that housed the passage of the caudal vena cava, called foramen of the caudal vena cava. Dorsally to the tendinous centre, already in the muscle portion, we located the esophageal and aortic hiatus. These findings, as well as the microscopic, were equivalent to that found in the general literature also, corroborating with descriptions already carried out in other mammals' diaphragms.


Assuntos
Cingulados/anatomia & histologia , Diafragma/anatomia & histologia , Hérnia Diafragmática/veterinária , Animais , Diafragma/diagnóstico por imagem , Feminino , Hérnia Diafragmática/fisiopatologia , Masculino , Músculo Esquelético/anatomia & histologia , Músculo Esquelético/diagnóstico por imagem , Tamanho do Órgão , Nervo Frênico/anatomia & histologia , Tendões/anatomia & histologia , Tendões/diagnóstico por imagem
12.
Crit Care ; 22(1): 109, 2018 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-29703214

RESUMO

BACKGROUND: Ultrasound (US) evaluation of diaphragmatic dysfunction (DD) has proved to be a reliable technique in critical care. In this single-center prospective study, we investigated the impact of US-assessed DD on noninvasive ventilation (NIV) failure in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and its correlation with the transdiaphragmatic pressure assessed using the invasive sniff maneuver (Pdi sniff). METHODS: A population of 75 consecutive patients with AECOPD with hypercapnic acidosis admitted to our respiratory intensive care unit (RICU) were enrolled. Change in diaphragm thickness (ΔTdi) < 20% during tidal volume was the predefined cutoff for identifying DD+/- status. Correlations between ΔTdi < 20% NIV failure and other clinical outcomes were investigated. Correlation between ΔTdi and Pdi sniff values was analyzed in a subset of ten patients. RESULTS: DD+ patients had a higher risk for NIV failure than DD- patients (risk ratio, 4.4; p <  0.001), and this finding was significantly associated with higher RICU, in-hospital, and 90-day mortality rates; longer mechanical ventilation duration; higher tracheostomy rate; and longer RICU stay. Huge increases in NIV failure (HR, 6.2; p < 0.0001) and 90-day mortality (HR, 4.7; p = 0.008) in DD+ patients were found by Kaplan-Meier analysis. ΔTdi highly correlated with Pdi sniff (Pearson's r = 0.81; p = 0.004). ΔTdi < 20% showed better accuracy in predicting NIV failure than baseline pH value and early change in both arterial blood pH and partial pressure of carbon dioxide following NIV start (AUCs 0.84 to DTdi < 20%, 0.51 to pH value at baseline, 0.56 to early change in arterial blood pH following NIV start, and 0.54 to early change in partical pressure of carbon dioxide following NIV start, respectively; p < 0.0001). CONCLUSIONS: Early and noninvasive US assessment of DD during severe AECOPD is reliable and accurate in identifying patients at major risk for NIV failure and worse prognosis.


Assuntos
Diafragma/patologia , Ventilação não Invasiva/normas , Avaliação de Resultados da Assistência ao Paciente , Doença Pulmonar Obstrutiva Crônica/terapia , APACHE , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Diagnóstico , Diafragma/anatomia & histologia , Diafragma/fisiopatologia , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Itália , Estimativa de Kaplan-Meier , Masculino , Ventilação não Invasiva/métodos , Estudos Prospectivos , Escala Psicológica Aguda Simplificada , Estatísticas não Paramétricas , Ultrassonografia/métodos
13.
Ann Anat ; 217: 47-53, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29510243

RESUMO

BACKGROUND: Injury and subsequent leakage of unrecognized thoracic duct tributaries during transthoracic esophagectomy may lead to chylothorax. Therefore, we hypothesized that thoracic duct anatomy at the diaphragm is more complex than currently recognized and aimed to provide a detailed description of the anatomy of the thoracic duct at the diaphragm. BASIC PROCEDURES: The thoracic duct and its tributaries were dissected in 7 (2 male and 5 female) embalmed human cadavers. The level of origin of the thoracic duct and the points where tributaries entered the thoracic duct were measured using landmarks easily identified during surgery: the aortic and esophageal hiatus and the arch of the azygos vein. MAIN FINDINGS: The thoracic duct was formed in the thoracic cavity by the union of multiple abdominal tributaries in 6 cadavers. In 3 cadavers partially duplicated systems were present that communicated with interductal branches. The thoracic duct was formed by a median of 3 (IQR: 3-5) abdominal tributaries merging 8.3cm (IQR: 7.3-9.3cm) above the aortic hiatus, 1.8cm (IQR: -0.4 to 2.4cm) above the esophageal hiatus, and 12.3cm (IQR: 14.0 to -11.0cm) below the arch of the azygos vein. CONCLUSION: This study challenges the paradigm that abdominal lymphatics join in the abdomen to pass the diaphragm as a single thoracic duct. In this study, this occurred in 1/7 cadavers. Although small, the results of this series suggest that the formation of the thoracic duct above the diaphragm is more common than previously thought. This knowledge may be vital to prevent and treat post-operative chyle leakage.


Assuntos
Diafragma/anatomia & histologia , Ducto Torácico/anatomia & histologia , Abdome/anatomia & histologia , Idoso , Aorta Torácica/anatomia & histologia , Veia Ázigos/anatomia & histologia , Cadáver , Quilotórax/patologia , Diafragma/irrigação sanguínea , Esôfago/anatomia & histologia , Feminino , Humanos , Sistema Linfático/anatomia & histologia , Masculino , Fluxo Sanguíneo Regional , Ducto Torácico/irrigação sanguínea
14.
An. acad. bras. ciênc ; 90(1): 169-178, Mar. 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-886912

RESUMO

ABSTRACT The wall of the diaphragm can be affected by congenital or acquired alterations which allow the passage of viscera between the abdominal and chest cavities, allowing the formation of a diaphragmatic hernia. We characterized morphology and performed biometrics of the diaphragm in the common squirrel monkey Saimiri sciureus. After fixation, muscle fragments were collected and processed for optical microscopy. In this species the diaphragm muscle is attached to the lung by phrenopericardial ligament. It is also connected to the liver via the coronary and falciform ligaments. The muscle is composed of three segments in total: 1) sternal; 2) costal, and 3) a segment consisting of right and left diaphragmatic pillars. The anatomical structures analyzed were similar to those reported for other mammals. Histological analysis revealed stable, organized muscle fibers with alternation of light and dark streaks, indicating transverse striation.


Assuntos
Animais , Masculino , Saimiri/anatomia & histologia , Diafragma/anatomia & histologia , Tamanho do Órgão , Valores de Referência , Fibras Musculares Esqueléticas , Hérnias Diafragmáticas Congênitas/patologia , Hérnias Diafragmáticas Congênitas/veterinária , Doenças dos Macacos/patologia
15.
An Acad Bras Cienc ; 90(1): 169-178, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29466481

RESUMO

The wall of the diaphragm can be affected by congenital or acquired alterations which allow the passage of viscera between the abdominal and chest cavities, allowing the formation of a diaphragmatic hernia. We characterized morphology and performed biometrics of the diaphragm in the common squirrel monkey Saimiri sciureus. After fixation, muscle fragments were collected and processed for optical microscopy. In this species the diaphragm muscle is attached to the lung by phrenopericardial ligament. It is also connected to the liver via the coronary and falciform ligaments. The muscle is composed of three segments in total: 1) sternal; 2) costal, and 3) a segment consisting of right and left diaphragmatic pillars. The anatomical structures analyzed were similar to those reported for other mammals. Histological analysis revealed stable, organized muscle fibers with alternation of light and dark streaks, indicating transverse striation.


Assuntos
Diafragma/anatomia & histologia , Saimiri/anatomia & histologia , Animais , Hérnias Diafragmáticas Congênitas/patologia , Hérnias Diafragmáticas Congênitas/veterinária , Masculino , Doenças dos Macacos/patologia , Fibras Musculares Esqueléticas , Tamanho do Órgão , Valores de Referência
16.
Anat Sci Int ; 93(1): 82-87, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27659947

RESUMO

The gastric cardia-the small area around the cardiac orifice including the abdominal esophagus-is an important target area for abdominal and thoracic surgeries, especially for laparoscopic procedures. In this study of 28 cadavers, a peritoneal earlobe-like appendage near the angle of His was identified as a useful indicator of the lateral margin of the abdominal esophagus, which is otherwise obscure because the peritoneum continues to the diaphragm without definite demarcation of this margin. This structure, which appears equivalent to the epiploic appendages, was commonly found to be present (in 22/28, 78.6 % of the 28 cadavers) and was 4-21 mm × 6-40 mm × 1-4 mm in size, triangular, round, or leaf-like in shape, contained fat, and was on an imaginary line along which the lesser omentum adheres to the lesser curvature and continues to the diaphragm (18/22, 81.8 %). This indicator is associated with the lesser omentum and is part of the gastrophrenic ligament, and could serve as a useful indicator of the margin of the gastric cardia, thus aiding surgeons performing laparoscopic surgery in this region.


Assuntos
Cárdia/anatomia & histologia , Idoso , Idoso de 80 Anos ou mais , Diafragma/anatomia & histologia , Esôfago/anatomia & histologia , Feminino , Humanos , Laparoscopia , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Omento/anatomia & histologia , Peritônio/anatomia & histologia
17.
Int. j. morphol ; 35(4): 1614-1622, Dec. 2017. tab
Artigo em Espanhol | LILACS | ID: biblio-893176

RESUMO

RESUMEN: La historia es una disciplina que permite ordenar un conjunto de conocimientos, legados y realidades históricas complejas del ser humano a lo largo del tiempo y a través de las regiones. Por tanto, conocer la historia de civilizaciones, culturas y sociedades nos permite comprender y racionalizar la información y, posteriormente, tomar esta información para seguir construyendo una nueva realidad. Bajo este contexto, el objetivo de este trabajo fue analizar el origen y significado del término diafragma y, el conocimiento que se tenía de la anatomía y función de éste músculo, para comprender cómo, desde la trayectoria histórica, se construyó su definición actual. En los escritos de Homero, el diafragma fue reconocido como una estructura anatómica que no estaba vinculada a ninguna función en particular y en las primeras explicaciones fisiológicas de la respiración tampoco desempeñaba un rol este proceso. Hipócrates y Platón marcaron un punto de inflexión en la definición del término, ya que lo describieron como una estructura que separaba el tórax del abdomen, ajustándose correctamente con el significado del término diáphragma (διαφραγµα), "separación"; sin embargo, en la época clásica de Grecia fue asociado más frecuentemente a la mitología griega y a la espiritualidad humana considerando al diafragma como sede del pensamiento. Otro hito importante en la historia de este músculo fueron los estudios realizados por Galeno, a través de disecciones en animales y Vesalio en humanos, ya que describen, a partir de observaciones directas, con gran detalle la anatomía del diafragma y se aproximan de manera más adecuada a su función en el proceso de la respiración. Finalmente, Testut estructura y ordena este conocimiento, el cual se ha mantenido hasta la actualidad, en donde sólo ha cambiado la forma en la que se entrega esta información.


SUMMARY: Over time and throughout all regions, history has been a discipline allowing an established order of knowledge, legacies and complex historical experiences of human beings. Consequently, knowing the history of civilizations, cultures and societies allows us to understand and rationalize this information and use the information to continue building a new reality. In this context, the objective of this work was to analyze the origin and meaning of the term diaphragm, and knowledge of the anatomy and functions of this muscle. Based on this knowledge and its path throughout history its current definition was constructed. In Homer's writings, the diaphragm was recognized as an anatomical structure that was not linked to any particular function and in the early physiological explanations of breathing, and did not play a role in the breathing process. Hippocrates and Plato marked a point of inflection in the definition of the term, since they described it as a structure that separated the thorax from the abdomen, relating it correctly with the meaning of the term diáphragma (diafragma), "separation". However, in the classical period of Greece, it was more frequently associated with Greek mythology and human spirituality, considering the diaphragm as the seat of thought. Another important milestone in the history of this muscle were the studies Galen through dissection in animals, and Vesalius in humans, where both describe the diaphragm and its functions in great detail, approaching the detail of the breathing process more closely. Finally, Testut structures the information in a manner that has been maintained to this day, and the only change has been in the dissemination of the information.


Assuntos
Humanos , História Antiga , História Medieval , História do Século XV , História do Século XVI , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XXI , Anatomia/história , Diafragma/anatomia & histologia , Terminologia como Assunto
18.
Adv Respir Med ; 85(4): 224-232, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28871591

RESUMO

The diaphragm is the primary muscle involved in active inspiration and serves also as an important anatomical landmark that separates the thoracic and abdominal cavity. However, the diaphragm muscle like other structures and organs in the human body has more than one function, and displays many anatomic links throughout the body, thereby forming a 'network of breathing'. Besides respiratory function, it is important for postural control as it stabilises the lumbar spine during loading tasks. It also plays a vital role in the vascular and lymphatic systems, as well as, is greatly involved in gastroesophageal functions such as swallowing, vomiting, and contributing to the gastroesophageal reflux barrier. In this paper we set out in detail the anatomy and embryology of the diaphragm and attempt to show it serves as both: an important exchange point of information, originating in different areas of the body, and a source of information in itself. The study also discusses all of its functions related to breathing.


Assuntos
Diafragma/anatomia & histologia , Diafragma/fisiologia , Mecânica Respiratória/fisiologia , Trabalho Respiratório/fisiologia , Junção Esofagogástrica/fisiologia , Humanos , Postura
19.
PLoS One ; 12(9): e0183853, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28877195

RESUMO

Duchenne muscular dystrophy (DMD) is a progressive degenerative disease that results in fibrosis and atrophy of muscles. The main cause of death associated with DMD is failure of the diaphragm. The diaphragm is a dome-shaped muscle with a fiber microstructure that differs across regions of the muscle. However, no studies to our knowledge have examined spatial variations of muscle fibers in dystrophic diaphragm or how aging affects those variations in DMD. In this study, diaphragms were obtained from mdx and healthy mice at ages three, seven, and ten months in the dorsal, midcostal, and ventral regions. Through immunostaining and confocal imaging, we quantified sarcomere length, interstitial space between fibers, fiber branching, fiber cross sectional area (CSA), and fiber regeneration measured by centrally located nuclei. Because DMD is associated with chronic inflammation, we also investigated the number of macrophages in diaphragm muscle cross-sections. We saw regional differences in the number of regenerating fibers and macrophages during the progression of DMD in the mdx diaphragm. Additionally, the number of regenerating fibers increased with age, while CSA and the number of branching fibers decreased. Dystrophic diaphragms had shorter sarcomere lengths than age-matched controls. Our results suggest that the dystrophic diaphragm in the mdx mouse is structurally heterogeneous and remodels non-uniformly over time. Understanding regional changes in dystrophic diaphragms over time will facilitate the development of targeted therapies to prevent or minimize respiratory failure in DMD patients.


Assuntos
Diafragma/patologia , Distrofia Muscular de Duchenne/patologia , Fatores Etários , Envelhecimento/patologia , Animais , Diafragma/anatomia & histologia , Diafragma/ultraestrutura , Modelos Animais de Doenças , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Microscopia Confocal
20.
Rev Mal Respir ; 34(6): 645-660, 2017 Jun.
Artigo em Francês | MEDLINE | ID: mdl-28502520

RESUMO

The diaphragm is the muscle most implicated in breathing. Its morphological exploration usually depends on pulmonary radiography, fluoroscopy, CT-scanning and MRI. Its function is evaluated by the classical respiratory functional tests, the measurement of maximum inspiratory and expiratory pressures, the transdiaphragmatic pressure and even an electromyogram. Ultrasound is a technique still insufficiently used in respiratory medicine. It offers, however, many advantages: it is easy to implement, there is no irradiation, it is usable at the bedside, particularly when the patient is immobile or in intensive care. The results of the examination are immediately available. It allows morphological and dynamic study of each hemidiaphragm as well as providing invaluable information on the thoracic and subdiaphragmatic environment. Its field of exploration is extremely wide: raised hemidiaphragm, dyspnea following a stroke or a surgical procedure (thoracic or abdominal), road accident trauma, diagnosis and follow-up of a paresis or paralysis, evaluation of diaphragmatic mobility during the course of COPD (Chronic Obstructive Pulmonary Disease) and many other pathologies. Ultrasound is insufficiently used in pleural disease and even less so in the evaluation of the morphology and function of the diaphragm.


Assuntos
Diafragma/diagnóstico por imagem , Ultrassonografia , Diagnóstico Diferencial , Diafragma/anatomia & histologia , Diafragma/patologia , Humanos , Monitorização Fisiológica/métodos , Transtornos Respiratórios/diagnóstico , Transtornos Respiratórios/patologia , Transtornos Respiratórios/terapia , Ultrassonografia/métodos , Ultrassonografia/estatística & dados numéricos
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