Arch of cricoid cartilage anatomical variation: morphological and radiological aspects.

The cricoid cartilage serves as an anatomical reference for several surgical procedures for access to the airway. Additionally, it serves as an attachment point for muscles that move the vocal folds. We present a case where the cricoid cartilage arch is divided into distinct superior and inferior arches, with a fibrous membrane between them. We did not find any similar description to this case in the literature, which makes it unique to date. This type of variation is important knowledge for clinicians and surgeons during airway management in the anterior neck region. The presence of this variation could induce an error during a palpation of the thyroid and cricoid cartilages, realized in clinical examination and surgical or emergency procedures.

Multiple variation of right renal and gonadal vascularization: report of two cases / Variação múltipla da vascularização renal e gonadal direita: relato de dois casos

Abstract We present two cases of multiple anatomical variations of the renal and gonadal vessels. The first case presented duplication of the renal vein and the presence of an accessory renal artery. However, the most interesting fact, in this case, was that the right gonadal vein emptied into the inferior right renal vein instead of ending in the inferior vena cava as would typically be the case. In the second case, we also found an accessory renal artery and the right gonadal vein emptied at the exact junction between the right renal vein and the inferior vena cava. Clinicians and surgeons should be familiar with anatomical variations to provide an accurate diagnosis during preoperative studies and to avoid surprises in abdominal surgical procedures.

Resumo Este estudo apresenta dois casos de variação anatômica múltipla de vasos renais e gonadais. O primeiro caso apresentou uma duplicação da veia renal e a presença de uma artéria renal acessória. Porém, o fato mais interessante nesse caso foi a veia gonadal direita desembocar na veia renal direita inferior em vez de terminar na veia cava inferior, como seria o normal. No segundo caso, além de também encontrarmos uma artéria renal acessória, a veia gonadal direita desembocava no exato ponto de junção entre a veia renal direita e a veia cava inferior. Clínicos e cirurgiões devem estar familiarizados com a presença de possíveis variações dos vasos renais e gonadais, sendo um conhecimento imprescindível para obter um diagnóstico mais preciso e para evitar surpresas em procedimentos cirúrgicos abdominais.

Experimental evaluation of 3-dimensional kinematic behavior of the cruciate ligaments.

PURPOSE: The purpose of this study was to evaluate a low-cost and easily reproducible technique for biomechanical studies in cadavers. In this kind of study, the natural effect of loading of the joint and shear forces are not taken into account. The objective is to describe the plastic deformation of the ligaments into 3-dimensional space. METHOD: For 18 intact human cadaver knees, the cruciate ligaments were divided into 3 fiber bundles, the tibial or femoral fixation points were marked, and 2 perpendicular different x-ray exposures were performed, thus obtaining radiographs of spatial projections of the bundle in 3 anatomic planes (frontal, sagittal, and transversal). From the measurements made on the x-ray films, we obtained the average distance between the 2 fixation points of the cruciate ligaments on the tibia and the femur at 4 different flexion angles. RESULTS: The distance between the fixation points of the medial and lateral fiber bundles of the cruciate ligaments did not change significantly during movement. There were, however, significant variations (P < .05) in the distance between the fixation points of the posterior fiber bundles of the anterior cruciate ligament and the anterior fiber bundles of the posterior cruciate ligament. CONCLUSIONS: This technique was efficient for demonstrating the plastic deformability of the cruciate ligaments. The results proceeding from this type of study can assist in the planning of physical rehabilitation programs.

Comparison of methods of measurement of the finger flexor muscles' strength through dynamometry and modified manual sphygmomanometer.

OBJECTIVE: To evaluate the reproducibility of the modified sphygmomanometer compared to hand dynamometer to measure muscle strength of the flexor muscles of fingers. METHODS: We assessed 40 healthy volunteers of both genders, aged between 20 and 55 years, who underwent the muscle strength test in the finger flexor muscles on both hands using two instruments for which the comparison was made between them. RESULTS: After statistical analysis by the paired Student's ttest, there was no significant difference between the values obtained in modified sphygmomanometer and hand dynamometer tests in relation to right and left sides (p > 0.05). Pearson's coefficient of correlation observed good correlations between them. CONCLUSIONS: The modified sphygmomanometer proved to be a reproducible technique for measuring muscle strength of the finger flexor muscles.

Comparison of methods of measurement of the finger flexor muscles' strength through dynamometry and modified manual sphygmomanometer / Comparação dos métodos de mensuração da força muscular dos flexores dos dedos das mãos através da dinamometria manual e esfigmomanômetro modificado

Objective: To evaluate the reproducibility of the modified sphygmomanometer compared to hand dynamometer to measure muscle strength of the flexor muscles of fingers. Methods: We assessed 40 healthy volunteers of both genders, aged between 20 and 55 years, who underwent the muscle strength test in the finger flexor muscles on both hands using two instruments for which the comparison was made between them. Results: After statistical analysis by the paired Student's t test, there was no significant difference between the values obtained in modified sphygmomanometer and hand dynamometer tests in relation to right and left sides (p > 0.05). Pearson's coefficient of correlation observed good correlations between them. Conclusions: The modified sphygmomanometer proved to be a reproducible technique for measuring muscle strength of the finger flexor muscles.

Objetivo: Avaliar a reprodutibilidade do esfigmomanômetro modificado para a mensuração da força muscular dos músculos flexores dos dedos das mãos através da comparação do mesmo com o dinamômetro manual. Métodos: Foram avaliados 40 voluntários saudáveis de ambos os sexos com idade entre 20 e 55 anos que realizaram o teste de força muscular dos músculos flexores dos dedos em ambas as mãos com os dois instrumentos para que fosse feita a comparação entre eles. Resultados: Após análise estatística feita pelo teste t de Student pareado, não foi observada diferença significativa entre os valores obtidos nos testes esfigmomanômetro modificado e dinamômetro manual em relação à lateralidade (p > 0,05), assim como, no teste do coeficiente de correlação de Pearson, foram observadas correlações quando analisados os valores obtidos no teste com esfigmomanômetro modificado versus o teste com dinamômetro manual. Conclusões: O esfigmomanômetro modificado mostrou ser uma técnica reprodutível para medir força muscular dos músculos flexores dos dedos.

Experimental evaluation of 3-dimensional kinematic behavior of the cruciate ligaments

PURPOSE: The purpose of this study was to evaluate a low-cost and easily reproducible technique for biomechanical studies in cadavers. In this kind of study, the natural effect of loading of the joint and shear forces are not taken into account. The objective is to describe the plastic deformation of the ligaments into 3-dimensional space. METHOD: For 18 intact human cadaver knees, the cruciate ligaments were divided into 3 fiber bundles, the tibial or femoral fixation points were marked, and 2 perpendicular different x-ray exposures were performed, thus obtaining radiographs of spatial projections of the bundle in 3 anatomic planes (frontal, sagittal, and transversal). From the measurements made on the x-ray films, we obtained the average distance between the 2 fixation points of the cruciate ligaments on the tibia and the femur at 4 different flexion angles. RESULTS: The distance between the fixation points of the medial and lateral fiber bundles of the cruciate ligaments did not change significantly during movement. There were, however, significant variations (P < .05) in the distance between the fixation points of the posterior fiber bundles of the anterior cruciate ligament and the anterior fiber bundles of the posterior cruciate ligament. CONCLUSIONS: This technique was efficient for demonstrating the plastic deformability of the cruciate ligaments. The results proceeding from this type of study can assist in the planning of physical rehabilitation programs.

OBJETIVO: Este trabalho sugere uma técnica de baixo custo e de fácil reprodutibilidade para o estudo biomecânico em cadáveres. Neste tipo de estudo os efeitos das cargas naturais na articulação não são estudados. O objetivo é descrever a deformação plástica dos ligamentos no espaço tridimensional. MÉTODO: 18 joelhos provenientes de cadáveres humanos tiveram seus ligamentos cruzados divididos em três feixes de fibras cada e suas respectivas fixações tibiais e femorais marcadas, quando foram submetidos a duas exposições radiográficas perpendiculares para podermos obter uma projeção dos ligamentos nos três planos anatômicos (frontal, sagital e transversal). Através das medidas feitas nas radiografias nós obtivemos a média da distância entre os pontos de fixação na tíbia e no fêmur em quatro diferentes graus de flexão. RESULTADOS: Analisando os dados nós observamos que a distância entre os pontos de fixação dos feixes medial e lateral de ambos os ligamentos cruzados não alterou de forma significativa durante o movimento. Contudo, houve variação significativa (p>0.05) na distância entre os pontos de fixação do feixe posterior do ligamento cruzado anterior e do feixe anterior do ligamento cruzado posterior. CONCLUSÕES: A técnica foi eficiente ao demonstrar a deformação plástica dos ligamentos cruzados. Os resultados provenientes deste tipo de estudo podem auxiliar no planejamento de programas de reabilitação física.

Estudo do efeito da corrente interferencial na tensãomuscular e na qualidade de vida em indivíduos portadores de disfunção temporomandibular / Impact of interferential current in muscle tension and quality of life in patients with temporomandibular disorders

As disfunções temporomandibulares (DTM) são classifi cadascomo a principal causa de dor não-dental na região orofacial.No tratamento destas disfunções, a efetividade da TENS é bemconhecida, o mesmo não ocorrendo com a corrente interferencial(CIV). O objetivo deste trabalho foi avaliar a infl uência da correnteinterferencial na diminuição da tensão dos músculos masseter etemporal fi bras anteriores, bem como a melhora da sintomatologiae qualidade de vida em portadores de DTM. Foram selecionadosnove indivíduos com diagnóstico de DTM há mais de seis meses deacordo com critérios de inclusão e exclusão bem defi nidos. Destesapenas dois concluíram o tratamento completo e foram incluídosneste estudo. A rotina de tratamento consistiu em aplicação da CIVem três sessões de 20 minutos para cada músculo bilateralmentedurante duas semanas. Os resultados foram avaliados através doquestionário de qualidade de vida SF-36 e da eletromiografi a desuperfície que foram aplicados no pré-tratamento, no dia seguintee 15 dias após o término das sessões para verifi carmos os efeitosimediatos e prolongados do tratamento. Nossos dados sugeremdiminuição da tensão RMS, após o término do tratamento, naposição de repouso mandibular sem contato oclusal, para ambosos indivíduos nos músculos masseter direito, masseter esquerdo etemporal direito e na posição de máxima contração isométrica voluntáriaem todos os músculos. Também foi notado aumento da tensãoRMS no músculo temporal esquerdo nos dois indivíduos...

Temporomandibular disorders (TMD) are classifi ed as the maincause of non-dental pain in the orofacial region. Th e eff ectivenessof TENS is well known, which did not occur with modular interferentialcurrent. Th e aim of this study was to evaluate the infl uenceof interferential current in decreasing tension of the masseter andtemporal anterior fi bers, as well as improvement in symptoms andquality of life in patients with TMD. We selected nine individualsdiagnosed with TMD for over six months according to inclusionand exclusion criteria clearly defi ned. Of these, only two completedthe full treatment and were included in this study. Treatment routineconsisted of application of VSD in three sessions of 20 minutesfor each muscle bilaterally during two weeks and the results wereassessed by questionnaire SF-36 and surface electromyography havebeen applied in pre-treatment, next day and 15 days after the endof the sessions to verify the immediate and prolonged eff ects oftreatment. Our data suggest a decrease in RMS tension after completionof treatment in mandibular rest position with no occlusalcontact for both individuals in the right masseter, left masseterand right temporal and location of maximum voluntary isometriccontraction in all muscles. It was also observed increased tensionin the left temporal muscle RMS in two individuals. Even withinthe limitations of this study mainly by the diffi culty of adherenceof patients to complete treatment and based on data obtained weconcluded that the modular interferential current showed resultscomparable to results reported in the literature for the eff ects ofTENS in reducing muscle tension, refl ecting improvement in thepain and consequently on the quality of life...

Variações anatômicas entre o nervo isquiático e o músculo piriforme e sua relação com a síndrome do piriforme / Anatomical variations between the sciatic nerve and piriformis muscle and relation to piriformis muscle syndrome

A Síndrome do Piriforme e caracterizada pela compressão do nervo isquiático quando este emerge da pelve. Ainda não existe consenso sobre o diagnostico clinico devido a semelhança com outras afecções da região lombar. O objetivo deste trabalho e estudar as variações anatômicas entre o nervo isquiático e o músculo piriforme e sua possível relação com a síndrome do piriforme. Foram, estudadas 104 regiões glúteas, de ambos os lados, de cadáveres adultos de ambos os sexos. Observamos três tipos de relação entre o nervo isquiático e o músculo piriforme, sendo: Tipo 1, quando o nervo isquiático emerge como tronco único, passando sob o músculo piriforme; Tipo 2, quando o nervo isquiático emerge dividido, com a parte fibular comum atravessando o meio do ventre do músculo piriforme e a parte tibial passando debaixo da margem inferior deste músculo; e Tipo 3, quando o nervo isquiático emerge como tronco único passando acima da margem superior do músculo piriforme. Com isso, concluimos que a presença de variações anatômicas do nervo isquiático com o músculo piriforme e um fator possivelmente relacionado com o aparecimento da síndrome do piriforme, sendo assim, e importante conhecê-las e considerá-las tanto no momento do diagnostico clinico, complementar, quanto no tratamento.

The Piriformis Muscle Syndrome is characterized by a sciatic nerve compression when emerges from pelvis. There is no consensus on clinical diagnosis as it is similar to other problems that affect the spine. The aim of this study was to observe the anatomical variation among the sciatic nerve and the piriformis muscles and their possible relation with the piriformis muscle syndrome. So, there were studied 104 gluteus parts from adult cadavers, men and women, previously both-sided dissected. We have observed three types of relation between the sciatic nerve and the piriformis muscles, as follows: Type 1 – when the sciatic nerve emerges as the only stem and passes under the piriformis muscle; Type 2 – when the sciatic nerve emerges and is shared with the common fibular portion which crosses the middle of the piriformis muscles venter and the tibial portion, passing down the inferior muscles edge; and Type 3 – when the sciatic nerve emerges as the only stem and passes up to the superior piriformis muscle edge. Therefore we concluded that the presence of the anatomical variations for the sciatic nerve and the piriformis muscle is possibly related to the piriformis muscle syndrome, and it is important to know them well and consider them for the clinical or additional diagnosis and the treatment as well.