José Alberto Dias Leite

Histomorphometric Evaluation of Mechanoreceptors and Free Nerve Endings in Human Lateral Ankle Ligaments

Introduction: Joint mechanoreceptors have been studied and most of investigators recognize the potential role of mechanoreceptors in the proprioceptive function of joint. The aim of this study was to analyze the general innervation and the possible existence of sensory receptors in the lateral ankle ligament. Methods: Lateral ankle ligaments including anterior talofibular, posterior talofibular and calcaneofibular were obtained from 24 ankles of 13 male cadavers with ages ranging from 18 to 65 (mean 41.6) years. Each ligament was divided into three parts according to the bony attachments (proximal, central, and distal segments). Histologically mechanoreceptors (Ruffini, Pacini and Golgi) and free nerve endings were identified, and classified. Histomorphometric determination and evaluation of the density of the area of the receptor was performed by the point-counting methods. Results: The anterior talofibular, posterior talofibular, and calcaneofibular ligaments were endowed with mechanoreceptor and free nerve endings. There was a significant prevalence of Pacini (p < 0.001) compared with Ruffini and Golgi. However, there was no significant difference in the mechanoreceptors density in the different ligaments analyzed (p > 0.05) Conclusion: Innervation of the lateral ankle ligaments was confirmed in this study, suggesting that the presence of mechanoreceptors could have clinical implication as well as relevance in the proprioceptive function. Future electrophysiological studies will be required to define the role in the proprioceptive and nociceptive system of the ankle.

Effect of imiquimod on partial-thickness burns

BACKGROUND Burns can result in substantial morbidity through fibroblast proliferation and contracture. Imiquimod (IMQ), an immune response modifier and upregulator of endogenous cytokine expression, has been shown to suppress fibroblast proliferation. It is widely used in the treatment of viral, neoplastic and non-neoplastic skin conditions and has recently been tested in the reduction of hypertrophic scarring and keloids. To our knowledge, no other study has so far evaluated the effect of IMQ on cutaneous burns. METHODS Partial-thickness burns were produced on the dorsum of 32 Wistar rats. Right-sided wounds received saline and left-sided wounds received 5% IMQ cream three times/week following injury. Photographs taken on post-burn days (PBD) 4, 7, 14 and 21 were evaluated for wound appearance using a clinical assessment scale and a visual analog scale. Scars were measured by digital planimetry. Samples stained with hematoxylin-eosin were submitted to conventional histological analysis. Samples stained with Sirius Red were analyzed under polarized light for collagen morphometry. RESULTS Visual scores were higher in the saline group on PBD 21 (p<0.05). Wound edge migration rates were lower (p<0.05) and conventional histology showed accentuated inflammation and delayed reepithelialization in the IMQ group. Type-I and type-III collagen deposition increased in the saline group and decreased in the IMQ group. Conversely, the proportion between type-I and type-III collagen differed significantly between treatments on PBD 4 and 21 (p<0.05 in both cases). CONCLUSIONS Short-term topical imiquimod treatment of partial-thickness burns in rats did not improve clinical appearance and scarring but rather decreased fibrosis. Significant differences in collagen deposition were observed between the treatments.

Biomechanical properties of the biceps-labral complex submitted to mechanical stress

PURPOSE To determine biomechanical properties of the superior labrum-biceps tendon complex submitted to continuous and sudden mechanical strain. METHODS Eighteen shoulder specimens from 15 unclaimed corpses, ages ranging from 20 to 40 years, were submitted to continuous or sudden tensile tests using 3 different traction machines. Shoulders presenting signs of degenerative diseases or preexisting traumatic lesions were excluded. RESULTS Rupture of the distal portion of the long hand of the biceps occurred when stretching forces reached 290N in continuous traction and 384N in sudden traction. No labral-complex lesions were observed. CONCLUSION Either a simple continuous or a sudden uniaxial traction of the arm do not play a role in the genesis of superior labrum anterior-posterior (SLAP) lesions in the shoulder joint.

Histological study of rat ovaries cryopreserved by vitrification or slow freezing and reimplanted in the early or late postmenopausal stage

PURPOSE To compare two rat ovary cryopreservation techniques (vitrification vs. slow freezing) and two postmenopausal stages (early vs. late) with regard to graft take. METHODS Thirty-three Wistar rats were submitted to bilateral oophorectomy. One ovary was submitted to histological analysis while the other was cryopreserved by slow freezing or vitrification. The cryopreserved ovary was thawed and reimplanted in the greater omentum one week (early menopause) or one month (late menopause) after oophorectomy. One month after ovary reimplantation, the graft take was evaluated macroscopically and histologically. RESULTS Six of the animals were used ascontrols and seven died. The histological findings of 20 animals included atretic follicles (n=4), primordial follicles (n=2), and corpus luteum with primordial follicles (n=3). No ovarian tissue was found in 11 animals. Vitrification resulted in a higher graft take rate than slow freezing (50% vs. 38.5%), but the difference was not statistically significant. However, the graft take rate was 9.3 times higher in the early than in the late postmenopausal stage (61.5% vs. 14.3%) (p=0.043). CONCLUSION Vitrification was superior to slow freezing as ovarian cryopreservation technique, and grafting was significantly more successful when the ovary was reimplanted in the late postmenopausal stage.

Liberação do túnel do tarso pela técnica endoscópica: uma proposta de acesso cirúrgico

To establish to portals in cadavers, using anatomical delimitation points and geometrical lines, which allows the acess to the tarsal tunnel by the video-endoscopic technique and the comparison between the proximal-distal direction approach with the reverse one. This trial has included 18 cadavers and 36 ankles were studied. Starting with the biportal endoscopic technique, initially described and modified in this trial through geometrical lines and anatomical points delimitation, the tarsal tunnel was released in left ankles with the insertion of instruments using proximal-distal direction and the opposite to the right ankles. There were, in the right ankles, complete section of flexor retinaculum in 15 cases (83,3%) and partial section in 3 cases (16,67%). In the left ankles there were complete section of flexor retinaculum in 16 (88,89%) and partial section in 2 cases (11,11%). The average operative time was 19,44 minutes for the right limb and 18,33 minutes for the left limb. No damage to neurovascular structures has been observed in any case. According to the suggested technique, the total section of flexors retinaculum was obtained in all the cases after learning curve period without lesion of anatomical structures in the tarsal tunnel, no matter the direction chosen in the access way.

Synovial knee plica in newborn cadaver knee: a comparison between Anatomy and Arthro-TC

SUMMARY Fifty-two newborn knees were used to verify the validity of the arthro-TC of double contrast for the diagnosis of normal synovial plicas, aiming at classifying and verifying their quantitative incidence and ethnic distribution. The plica synovialis mediopatellaris was identified in brown (60%), white (40%) and black races (9%) in this study. The incidence in black people was quite low as compared to white and brown people. The most commonly found folds were the plica synovialis infrapatellaris (69%) followed by the plica synovialis suprapatellaris (44%) and plica synovialis mediopatellaris (31%). Plicas were not found in 6% of the knees. The communication of bursa patellares with the articulation of the knee is present at birth in 85% of newborns. Identification of plica synovialis infrapatellaris was difficult because it is covered by abundant fat tissue. Arthro-TC was studied and analyzed by six observers, three radiologists and three orthopedic surgeons. The results showed a medium sensibility of 72% and a medium specificity of 60% for radiologist versus 89% and 61% for orthopedist surgeons, respectively.

A link between osteomyelitis and IL1RN and IL1B polymorphisms—a study in patients from Northeast Brazil: 153 patients followed for 2 years

Background and purpose — Treatment failure of osteomyelitis can result from genetic susceptibility, highlighting polymorphisms of the interleukin-1 (IL-1) family members, central mediators of innate immunity and inflammation. Polymorphisms are DNA sequence variations that are common in the population (1% or more) and represent multiple forms of a single gene. We investigated the association of IL1RNVNTR (rs2234663) and IL1B-511C > T (rs16944) polymorphisms with osteomyelitis development in patients operated on because of bone trauma. Patients and methods — 153 patients who fulfilled the inclusion criteria were enrolled from a referral public hospital for trauma. All the patients were followed up daily until hospital discharge and, after this, on an outpatient basis. Patients were treated with prophylactic antimicrobials and surgery according to traumatology service protocol. The IL1RNVNTR and the IL1B-511C > T polymorphisms were determined by PCR and PCR-RFLP, respectively. Results — The IL1RN*2/*2 genotype was associated (OR: 7; p < 0.001) with a higher risk of osteomyelitis and was also significantly associated with Staphylococcus aureus infection. The haplotypes (combination of different markers) *2-C and *2-T were also associated with osteomyelitis development. Interpretation — IL1B-511C > T and IL1RNVNTR polymorphisms were associated with osteomyelitis development, which may have implications for patients with bone traumas. These data may be relevant for new therapeutic strategies for this disease.Background and purpose - Treatment failure of osteomyelitis can result from genetic susceptibility, highlighting polymorphisms of the interleukin-1 (IL-1) family members, central mediators of innate immunity and inflammation. Polymorphisms are DNA sequence variations that are common in the population (1% or more) and represent multiple forms of a single gene. We investigated the association of IL1RNVNTR (rs2234663) and IL1B-511C > T (rs16944) polymorphisms with osteomyelitis development in patients operated on because of bone trauma. Patients and methods - 153 patients who fulfilled the inclusion criteria were enrolled from a referral public hospital for trauma. All the patients were followed up daily until hospital discharge and, after this, on an outpatient basis. Patients were treated with prophylactic antimicrobials and surgery according to traumatology service protocol. The IL1RNVNTR and the IL1B-511C > T polymorphisms were determined by PCR and PCR-RFLP, respectively. Results - The IL1RN*2/*2 genotype was associated (OR: 7; p  T and IL1RNVNTR polymorphisms were associated with osteomyelitis development, which may have implications for patients with bone traumas. These data may be relevant for new therapeutic strategies for this disease.

Modelo experimental de artroscopia do quadril em cadáveres de recém-nascidos

The hip presents a complex topography and anatomy. Diagnostic procedures are generally not very helpful. However, direct access to the joint was made possible by the use of arthroscopy. Surgical indications for its use are becoming more frequent year after year. Usage in children is still not very common. This paper is aimed at developing an experimental model of hip arthroscopy. Damages resulting from its use in structures subjected to traction were evaluated. Twenty newborn cadavers were used to test the feasibility of the procedure. Six fetuses were used during the pilot project for the development of a research model. The remainder fourteen fetuses were used during the main study. Antero lateral and lateral ports were used for surgical access to the hip. Histomorphological studies of the hip structures were carried out in each case. Lateral and antero-lateral ports offered safe access and adequate viewing of most intra-articular anatomical structures through arthroscopy. It was not possible to see all structures through just one port. Hip arthroscopy is not an easy procedure although feasible in newborn cadavers weighing more than 1700 g. No macroscopic or histological lesions were identified in fetuses submitted to traction of up to 88 N.

Effect of propranolol on capsular reaction around silicone implants in guinea pigs

PURPOSE To evaluate the effect of propranolol on capsular architecture around silicone implants by measuring the inflammation, capsular thickness, and collagen fiber density, using a guinea pig experimental model. METHODS Thirty six adult male guinea pigs randomly divided into two groups (n=18) were used. Each one received a silicone implant with textured-surface. The capsular tissue around implants from untreated or treated animals with the beta-adrenoceptor antagonist propranolol (10 mg/kg, dissolved in daily water) were analyzed for inflammation by histological scoring, capsular thickness by computerized histometry, and collagen fibers type I and Type III density by picrosirius polarization at different time points (7, 14 or 21 days after silicone implantation). RESULTS Propranolol treatment reduced inflammation and impaired capsular thickness and delayed collagen maturation around the textured implant. CONCLUSION Propranolol reduces the risk of developing capsular contracture around silicone implants with textured surface.

Avaliação do nível de atividade física e fatores associados em estudantes de medicina de Fortaleza-CE

The objective was mainly to evaluate the Physical Activity Level in medical students. A cross-sectional, descriptive and analytical questionnaire was held in public and private medical schools and teaching hospitals of Fortaleza. A sample of 840 students, 409 males and 431 females, aged 17-33 years, was selected randomly. We used the International Physical Activity Questionnaire in short version. Most students (72.6%) were classified as sedentary or insuffi- ciently active. Lack of time and body aesthetic, respectively, are the main demotivation and motivation for physical activity. It is suggested additional studies addressed to this population, to establish a more accurate delineation of the factors that lead to physical inactivity.