Célio Fernando de Sousa Rodrigues

The deep plantar arch in humans: constitution and topography.

Abstract The integrity of the various structures within the feet depends on their blood supply. Lesions of the feet often require revascularization, which if successful avoids the need for amputation. To provide greater anatomical detail to aid vascular surgery and imaging, the anatomy and constitution of the deep plantar arch was studied in 50 adult cadaveric feet. The arteries of the foot were injected with red neoprene latex and dissected under magnification. The deep plantar arch, present in all feet, was the result of anastomosis between the deep plantar artery and the deep branch of the lateral plantar artery. The deep plantar artery was predominant in 72% of specimens (Type I arches) and the lateral plantar artery in 22% (Type II), with the contribution being equal in 6% (Type III). The medial plantar artery contributed to the medial segment of the deep plantar arch by its deep branch in 12% of specimens. The distance between the deep plantar arch and each interdigital commissure was generally constant, averaging 29% of total foot length. The deep plantar arch was located in the middle third of the foot in all specimens, being in the distal part of this third in 90%. The deep plantar arch is, therefore formed mainly by the deep plantar artery, a branch of the dorsal artery of foot its location can be estimated if foot length is known.

Biometric study of the relationships between palmar neurovascular structures, the flexor retinaculum and the distal wrist crease

During surgical exposure of the carpal tunnel it is possible to injure the neurovascular structures closely related to the flexor retinaculum, such as the superficial palmar arch and the communicating branch between the ulnar and median nerves. Because of the importance of these structures and with the purpose of increasing knowledge of anatomical details concerning to their location, a biometric study was performed on the retinaculum and the communicating branch, and between the communicating branch and the distal wrist crease, as well as between the retinaculum and the superficial palmar arch. We dissected 56 hands from 28 Brazilian formalin‐preserved cadavers of both sexes (24 male) at the Federal University of São Paulo–Escola Paulista de Medicina, Brazil. The communicating branch was observed in 96.4% of cases and the superficial palmar arch in 78.6%. The communicating branch was found between the common palmar digital nerve of the 4th interosseous space (from the ulnar nerve) to the homonymous nerve of the 3rd interosseous space (from the median nerve). In males, the distance between the distal wrist crease and the site where the communicating branch originates from the ulnar component had an average of 33.9±5.5 mm on the right side and 30.2±8.2 mm on the left. The distance between the distal wrist crease and the junction of the communicating branch with the common palmar digital nerve of the 3rd interosseous space was 43.6±6.9 mm on the right and 40.2±6.2 mm on the left side. Conversely, in 14.8% of cases (1 female), the communicating branch was observed to emerge from the common palmar digital nerve of the 3rd interosseous space. The distance between the retinaculum and the superficial palmar arch in the axial line of the 4th metacarpal bone was on average 7.3±4.3 mm on the right and 8.3±3.5 mm on the left side. At the same level, the distance between the retinaculum and the communicating branch was 6.2±3.7 mm on the right side and 5.1±2.8 mm on the left. These results can be used as a reference during surgical procedures in the palmar region.

The ulnar tunnel: a rare disposition of its contents

The ulnar tunnel is located at the proximal part of the hand radial to the pisiform bone and to the proximal part of the carpal tunnel. Inside it lie the ulnar nerve and artery. Compression of the ulnar nerve in this tunnel is often reported. Cysts, occupational trauma, fractures and muscle variations are among the main causes (Schjelderup, 1964; Kleinert & Hayes, 1971). Damage to the ulnar nerve and artery during the endoscopic decompression of the carpal tunnel has been reported recently (Agee et al. 1992; Nath et al. 1993; De Smets & Fabry, 1995). The structures within the ulnar tunnel are closely related to the medial part of the flexor retinaculum, in particular the ulnar artery which is located lateral to the ulnar nerve. During a study of this region we found a rare disposition of the contents of this tunnel. We believe that knowledge of this variation is important for the surgical anatomy of this region.

Trayecto del nervio gluteo inferior asociado a la división alta del nervio isquiático

El nervio gluteo inferior, ramo del plexo sacro, abandona la pelvis pasando generalmente por debajo del musculo piriforme. De este plexo se origina tambien el nervio isquiatico, el cual puede presentar variaciones en su relacion con el musculo mencionado, entre ellas, las que se refieren a la division alta del mismo. Sin embargo, son escasos los trabajos que correlacionen esta division con el trayecto del nervio gluteo inferior y su relacion con el musculo piriforme. Con el proposito de verificar una posible asociacion entre los trayectos de estos nervios, fueron disecadas 80 regiones gluteas de cadaveres de individuos brasilenos adultos en el Departamento de Morfologia de la Universidade Federal de Sao Paulo. Se encontraron dos tipos de variacion entre el nervio isquiatico y el musculo piriforme: en 9 casos (11,2 %) el nervio fibular comun paso a traves del musculo y el nervio tibial transcurrio por debajo de su margen inferior (Tipo I); en dos casos (2,5 %), correspondientes a un mismo individuo, el nervio fibular comun hizo su trayecto por sobre el margen superior del musculo piriforme y el nervio tibial paso por debajo de su margen inferior (Tipo II). En el tipo I, el nervio gluteo inferior paso a traves del musculo en 6 casos y en los 3 restantes una parte del nervio perforo al musculo y la otra paso por debajo de su margen inferior; en el tipo II, el nervio gluteo inferior transcurrio por debajo del margen inferior del musculo en uno de los casos y en el otro, una parte de este nervio se origino del nervio fibular comun y la otra, paso por debajo del margen inferior del musculo. El trayecto del nervio gluteo inferior a traves del musculo piriforme podria estar relacionado con la atrofia glutea observada en los pacientes con sindrome del musculo piriforme

Evaluation of oxidative stress markers in obstructive sleep apnea syndrome and additional antioxidant therapy: a review article

PurposeThe hypoxia and reoxygenation cycles in obstructive sleep apnea syndrome (OSAS) cause a change in the oxidative balance, leading to the formation of reactive oxygen species capable of reacting with other organic molecules impairing their functions. This study aimed to determine the best markers of oxidative stress in OSAS and what better antioxidant agent to be used to treat the disease.MethodsSearches were conducted in three different databases (PubMed, LILACS, SCIELO), using as descriptors the terms obstructive sleep apnea, oxidative stress, and antioxidant therapy. A total of 120 articles were found but only those considered of interest to the research were selected. Thus, 10 articles were included for further analysis regarding the biomarkers of oxidative stress in OSAS, and 6 articles to evaluate the antioxidant most often used for demonstration of efficacy.ResultsThe thioredoxin, malondialdehyde, superoxide dysmutase, and reduced iron were the most commonly used biomarkers and showed a more consistent relationship between increased oxidative stress and OSAS. As antioxidant therapy, vitamin C and N-acetylcysteine (NAC) presented interesting results as a reduction of oxidative stress, which may become an alternative to the complementary treatment of OSAS.ConclusionsThis review’s findings agree mostly to measure that the markers of oxidative stress in OSAS may be a contributing aspect to assessment and monitoring of patient, and the antioxidant therapy appears to be beneficial in the treatment of OSAS.

Abnormal disposition of a branch of the ulnar nerve in the flexor retinaculum.

The most frequent disposition of the structures within the ulnar tunnel is for the ulnar nerve to be located medial or posteromedial to the ulnar artery. The structures within the ulnar tunnel are closely related to the medial part of the flexor retinaculum. Lesions of the ulnar nerve and artery during endoscopic decompression of the carpal tunnel have been reported (Agee et al. 1992; Lee et al. 1992; Nath et al. 1993; De Smets & Fabry, 1995). An adequate anatomical knowledge of such structures and their variations is therefore important. During a study of the palmar region, we found that a special branch originated from the ulnar nerve in relation to the flexor retinaculum. Documentation of this variation will contribute to the knowledge of the anatomy of the ulnar nerve and its distal branches.

NIVEL DE BIFURCACION DE LA ARTERIA BRAQUIAL Y SUS RELACIONES CON EL NERVIO MEDIANO

Las arterias del miembro superior presentan variaciones debido fundamentalmente a modificaciones ocurridas durante el desarrollo embriologico. La bifurcacion de la arteria braquial en arterias radial y ulnar ocurre a nivel del codo pudiendo esta ser mas alta o mas baja. Con el proposito de determinar el nivel de bifurcacion de esta arteria y sus relaciones con el nervio mediano, realizamos un estudio morfometrico de estos parametros en 72 miembros superiores de cadaveres formolizados, adultos, brasilenos, de ambos sexos, utilizando para ello la diseccion y registrando los datos morfometricos con un paquimetro digital. Como punto de referencia se considero a la linea biepicondilar (LBE). En el 87, 5 % de los casos, la arteria braquial se bifurco distal a esta linea y en el 11,1 % fue proximal a la misma. La distancia promedio para la primera fue de 38,4 mm en el sexo masculino y de 30,00 mm en el femenino. El test de regresion linear aplicado para ver la posible relacion entre este nivel y la longitud del brazo no fue estadisticamente significativo. Cuando la bifurcacion fue distal a la LBE el nervio mediano cruzo ventralmente a la arteria braquial en 54,9 % de los casos y dorsalmente en 23,5 %. El punto de cruzamiento fue localizado a 64,6 mm de la linea biepicondilar

VARIACION ANATOMICA DEL MUSCULO SARTORIO

RESUMEN: Variaciones musculares y tendinosas son poco frecuentes, aunque han sido citadas desde hace mucho tiempo en la literatura anatomica. Durante las disecciones de un curso regular de Anatomia Topografica en la Universidad Federal de Sao Paulo, Brasil, encontramos un caso de musculo sartorio biceps. En la bibliografia consultada no se describe mucho acerca de este tipo de variacion muscular y solo algunos autores citan que el musculo sartorio normalmente se presenta biceps en los mamiferos inferiores y que en el ser humano, estas variaciones raras deben ser consideradas como un estado de persistencia involutiva del citado musculo.

CONSIDERACIONES ANATOMICAS SOBRE LA FUSION RENAL: RELATO DE UN CASO

Considerando la importancia clinica y quirurgica de la fusion renal, presentamos y discutimos un caso de esta malformacion, encontrada durante el transcurso de disecciones de rutina en la disciplina de Anatomia Humana de la Universidad Federal de Alagoas, Brasil. Esta union anormal de los rinones debe ser bien conocida por los profesionales de la salud, evitando asi, errores de diagnostico en la region abdomino-pelviana

Effect of the celexoxib in microscopic changes of the esophageal mucosal of rats induced by esofagojejunostomy

OBJECTIVE To evaluate the protective effect of celecoxib in the esophageal mucosa in rats undergoing esofagojejunostomy. METHODS Sixty male Wistar rats from the vivarium of the University of Health Sciences of Alagoas were used for the experiment. The animals were divided into four groups: Group I, 15 rats undergoing esofagojejunostomy with the use of celecoxib postoperatively; Group II, 15 rats undergoing esofagojejunostomy without the use of celecoxib; Group III, 15 rats undergoing celiotomy with bowel manipulation; and Group IV, 15 rats without surgery and using celecoxib. The observation period was 90 days. After the death of the animals, the distal segment of the esophagus was resected and sent for microscopic analysis. RESULTS esofagojejunostomy caused macroscopic and microscopic esophagitis. Esophagitis was equal in both groups I and II. In groups III and IV esophageal lesions were not developed. CONCLUSIONS celecoxib had neither protective nor inducing effect on esophagitis, but had a protective effect on dysplasia of the animals of group I.