Amauri Clemente da Rocha

Cerebellar Vermis: Topography and Variations

SUMMARY: The vermis is described as the unpaired, median portion of the cerebellum to which the hemispheres are attached. Both the vermis and the hemispheres are formed by folia that, grouped together, are called lobules. The material analyzed consisted of a sample made up of 43 adult male cerebella fixed in 10% formaldehyde and sliced medially. The lingula was attached to the superior medullary velum in 100% (43) of the cerebella, varying only in size. In 80% (32) of the cerebella, the central lobe contained one folium; 7.5% (3) had two folia with the first larger than the second; 10% (4) had two folia with the second larger than the first; and 2.5% (1) had two folia of equal size. In 5% (2) of the cerebella, the folium of the vermis emerged from the declive; in 47.5% (19), the folium emerged from the central white matter; and in 42.5% (17), the folium emerged from the tuber. There was no variation in the lobules, culmen, pyramid, uvula or nodule in the sample studied. Contrary to what many believe, the folia of the cerebellum exhibit variations in form, number and arrangement. However, these variations are virtually unreported, which often hinders the determination of the limits of these structures by students of anatomy of the cerebellum.

Correlation between the Alvarado Scale and the macroscopic aspect of the appendix in patients with appendicitis

OBJECTIVE To evaluate the possible association between the scale of Alvarado (EA) and macroscopic appearance (MA) of the appendix in patients with acute appendicitis. METHODS after receiving the diagnosis of acute appendicitis, EA data were collected. During appendectomy, MA data were collected. Data from patients without appendicitis were excluded. The Spearman correlation test was used to compare EA with Appendix MA (p < 0.05). Other variables were represented by simple frequency. The confidence interval (CI) of 95% was calculated for the correlation test. RESULTS Data were collected from 67 consecutive patients. The mean age was 37.1 ± 12.5 years and 77.6% of patients were male. The Spearman correlation test used for EA and MA was + 0.77 (95% CI 0.65-0.85, p < 0.0001). CONCLUSION although correlation was not perfect, our data indicate that a high score on the scale of Alvarado in patients with appendicitis is correlated with advanced stages of the inflammatory process of acute appendicitis.

Formation of the Azygos Vein

SUMMARY: The aim of the present study was to determine the most common origin of the azygos vein. Thirty cadavers maleand female, white and non-white adult individuals of different ages fixed in 10% formaldehyde and dissected. All cadavers had anundisclosed clinical death and were donated to the Universidade Estadual de Ci encias da Saude de Alagoa s, Brazil. Eleven differentformations were found. The right subcostal vein was was only observed in 13 cases (43.33%); the azygos vein was formed by theconfluence of the right subcostal and right ascending lumbar vein in three cases (10%); by the right subcostal vein with a cont ributionfrom the inferior vena cava (IVC) in three cases (10%); by the right subcostal with contribution from IVC and right ascending l umbarvein in three cases (10%); by the right and left subcostal veins in two cases (6.66%); by the right and left subcostal veins andcontribution from the IVC in one case (3.33%); by the right and left subcostal veins and left accessory renal vein in one case (3.33%);by the left renal vein in one case (3.33%); by the right subcostal and left gonadal veins with contribution from the IVC in one case(3.33%); by the right subcostal and left renal veins in one case (3.33%); and composed by the continuation of the 11th posteriorintercostal vein in one case (3.33%). Based on the results, the right subcostal vein was the only structure with a significant presence inthe formation of the azygos vein.

Colecistite aguda por ascaris lumbricoides

Biliary’s ascariasis is the most often ectopic site of this helminthiasis, but invasion of the worms into the gallbladder is quite rare. The autors report a case of a patient with clinical symptoms, compatible with cholecystitis induced by the worm, as shown by ultrasonography. Treatament was cholecystectomy and antihelmintic drug therapy with a good outcome.

Distribution of saphenous vein valves and its pratical importance

Objective Among the veins used as a graft in myocardial revascularizations and ends, great saphenous vein is the most used. Knowing the presence and location of valves has great importance when evaluating the surgical anatomy of the great saphenous vein. Despite major surgical application and many works involving great saphenous vein, the number of valves present in it from the saphenous hiatus to the medial epicondyle of the femur is still described inaccurately. The objective of this study is to quantify the valves of the great saphenous vein from the saphenous hiatus to the medial epicondyle of the femur to determine the best portion of the great saphenous vein to perform revascularization surgeries. Methods This is a crosssectional observational study in which it was analyzed great saphenous vein extracted from 30 cadavers. It was measured the length of the veins; (diameter) at its proximal, middle and distal, quantifying the number of valves in each one and the total number of valves at the great saphenous vein. Results The frequency of valves in the great saphenous vein taken from the medial epicondyle of the femur to the saphenous hiatus was 4.82, ranging between 2 and 9. Moreover, there is a significant difference in the number of valves in the proximal and distal relative to the average. Conclusion the median and distal portions of the saphenous vein in the thigh, are the best options for the realization of bridges due to the fact that these portions have fewer valves which therefore would tend to decrease the risk of complications connected with the valves in these grafts.

Origin, Trajectory and Relationships of the Major Splancnic Nerve

El nervio esplacnico mayor es parte del sistema nervioso simpatico y se ubica en el mediastino posterior, se dirige hacia el abdomen para inervar las visceras de la region. Su conocimiento anatomico es de importancia en los procedimientos quirurgicos que se realizan en el abdomen. Este trabajo tuvo como objetivo estudiar el origen, trayecto y relaciones del nervio esplacnico mayor Fueron disecados 44 nervios de 22 cadaveres adultos, formolizados al 10%, de ambos sexos de diferentes razas. 25 nervios (56%) no tenian un origen secuencial. En el lado derecho, 14 casos (63,8%) se originaron a partir de tres o cuatro raices del tronco simpatico. En el lado izquierdo, en 12 casos (54%), el rango de contribucion simpatica predominante fue de dos o tres raices. 22 nervios (16 del lado derecho y 6 del izquierdo) siguieron su descenso medialmente y los restantes 22 nervios (6 del lado derecho y 16 del izquierdo) se dirigieron caudalmente siguiendo la columna vertebral, contorneandola lateralmente sin dirigirse hacia medial. Se encontraron 21 nervios (6 del lado derecho y 15 del izquierdo) en una ubicacion lateral a la columna vertebral toracica, 16 nervios en una ubicacion anterolateral (9 del lado derecho y 7 del izquierdo) y 7 nervios derechos ubicados anterior a la columna vertebral. Concluimos que no hay un origen estandar del nervio esplacnico mayor . El nervio esplacnico mayor puede ubicarse anterior a la columna vertebral luego de su formacion. Se espera que este estudio contribuya al conocimiento del nervio esplacnico mayor y asi reducir el riesgo causado por danos en los procedimientos quirurgicos realizados en el mediastino posterior

Características anatómicas del tendón extensor accesorio del dedo anular, procedente del músculo extensor del dedo mínimo

El musculo extensor del dedo minimo es una larga y estrecha lamina muscular que se origina en el epicondilo lateral del humero, en el tendon extensor comun, insertandose, generalmente, a traves de dos cintillas tendinosas, en la expansion extensora del dedo minimo. A veces, emite un tendon accesorio para el dedo anular.El objetivo del presente estudio fue conocer la incidencia, disposicion y trayecto de este tendon accesorio. Se estudiaron 60 piezas de miembros superiores, fijadas en formaldehido al 10 %, correspondientes a cadaveres de individuos brasilenos, adultos, de ambos sexos. El tendon accesorio fue encontrado en 7 manos (11,7% de los casos). La presencia de ese tendon tiene importancia funcional y clinico-quirurgica, pues en casos de lesiones en el dorso de la mano que afecten a los tendones del musculo extensor de los dedos, este tendon accesorio podria establecerse como una forma alternativa en la recuperacion del movimiento de la extension del dedo anular. Los resultados complementaran el conocimiento anatomico del conjunto de tendones que constituyen el dorso de la mano

Emergencia y Trayecto de las Arterias Epigástricas Superiores: Aplicación en los Abcesos Quirúrgicos Abdominales

El conocimiento de la vascularizacion de la pared anterior del abdomen es un importante instrumento para la realizacion de incisiones y punciones abdominales, contribuyendo a evitar algunas complicaciones reurrentes de este procedimiento. Con el proposito de estudiar la emergencia y el trayecto de las arterias epigastricas superiores, fueron disecados 32 cadaveres adultos, del sexo masculino, no fijados, blancos y no blancos, con edades entre 18 y 65 anos. Se observo el trayecto de las arterias epigastricas superiores, su emergencia y su forma de distribucion. Las arterias epigastricas superiores emergieron por atras del 7 cartilago costal en todos los casos. En el 75% de los casos las arterias epigastricas se presentaron como un tronco unico y en 15 casos (23,44%) bifurcadas, siendo 11 a la derecha y 4 a la izquierda y en 1 caso (1,56%) a la izquierda. En este ultimo, caso dio origen a tres ramos principales. Cuando era un tronco unico, su trayecto fue descendente de medial para lateral en relacion al margen lateral del musculo recto del abdomen. Cuando era bifurcada, sus ramos se separaron uno del otro luego de su emergencia, volviendo a convergir proximo a la cicatriz umbilical