Luiz Carlos Buarque de Gusmão

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.

Válvulas da veia braquial comum: estudo anatômico

CONTEXTO: Boa parte das insuficiencias venosas e devida a incompetencia de suas valvulas. Como uma das alternativas cirurgicas, temos os enxertos venosos valvulados no segmento insuficiente. OBJETIVO: Descrever a anatomia das valvulas da veia braquial comum. METODOS: Foram selecionados 30 cadaveres do sexo masculino, independentemente de raca, que tinham seus membros superiores articulados ao tronco. Os mesmos estavam formolizados e foram mantidos em conservacao com solucao de formol a 10%. Utilizamos como criterio de exclusao a existencia de desarticulacao de um dos membros ou de alteracoes deformantes em topografia das estruturas estudadas. RESULTADOS: O numero total de valvulas identificadas foi de 28 em membro superior direito e de 33 em membro superior esquerdo, sendo 15 no segmento proximal direito e 21 no segmento proximal esquerdo. Mais de 91% das valvulas foram do tipo bicuspide e parietal. CONCLUSAO: Conclui-se que a veia braquial comum apresenta frequentemente valvulas do tipo bicuspide e parietal.

Bases anatômicas para o bloqueio anestésico do plexo braquial por via infraclavicular

BACKGROUND AND OBJECTIVES: This study shows the constant infraclavicular fossa presence, aiming at using it as a pathway for infraclavicular brachial plexus block. Determining the point where brachial plexus fascicles may be located within the fossa, the authors have proposed measurements from the anterior surface of the clavicle and the angle formed by the deltoid muscle and the clavicle (deltoclavicular angle). The first measurement allows the in-depth location of the site crossed by the brachial plexus. The second determines fascicles projection within the fossa, corresponding to the needle insertion point on the skin. METHODS: Measurements were made between the anterior surface of the clavicle and brachial plexus fascicles, and from the deltoclavicular angle to superficial fascicles projection. Based on the anatomic findings a technique of infraclavicular brachial plexus approach was proposed. RESULTS: A hundred infraclavicular regions in cadavers were analyzed. Infraclavicular fossa was detected in 96 cases where brachial plexus fascicles were totally or partially (97.9%) located. The distance between the anterior surface of the clavicle and brachial plexus fascicles was in average of 2.49 cm and from the deltoclavicular angle to superficial fascicles projection was 2.21 cm. CONCLUSIONS: Values obtained allow for the precise location of the needle insertion point which, when perpendicular to the skin, reaches brachial plexus without danger of causing pneumothorax or vascular injury, providing more safety to anesthesiologists and allowing the return to the practice of brachial plexus block below the clavicle.

Bases anatômicas para utilização do músculo fibular terceiro em retalhos miocutâneos

BACKGROUND: Myocutaneous flaps have been increasingly used in surgical reconstruction of the lower limbs, requiring the use of muscles that result in less functional and esthetic damage as flaps. This study aimed to evaluate the use of the fibularis tertius muscle (in terms of frequency and anatomy) as flaps in this procedure. METHODS: Sixty-four lower limbs from preserved cadavers were dissected and evaluated based on the following parameters: proximal insertion, distal insertion, syntopy, morphology, and morphometry. RESULTS: The fibularis tertius muscle was detected in 96.9% of the study cases. Most proximal insertions (96.8%) were found at the interosseous membrane, anterior border of the fibula, and anterior intermuscular septum. Most distal insertions (77.4%) were found at the lateral and dorsal sides of the 5th metatarsal. Mean value of muscle belly length was 17.89 cm and width was 1.95 cm. The mean length of the distal tendon with no muscle fibers was 1.2 cm, and the mean width was 0.45 cm. CONCLUSIONS: The fibularis tertius muscle is frequent and has a distinct morphology, making it a viable option for the repair of lower limb (distal segment) defects.

Ángulo de Inclinación del Fémur en el Hombre y su Relación con la Coxa Vara y la Coxa Valga

Los autores realizan mediciones en femures aislados, realizando comparacion de los datos obtenidos con los resultados encontrados en la literatura investigada, con el objeto de determinar de forma porcentual los valores limitrofes para clasificar la coxa como vara o valga. Fueron analizados 56 femures de cadaveres adultos, siendo determinado el angulo de inclinacion del femur, que fue medido a traves de un Goniometro. Utilizamos el patron poblacional normal de 66% (o test Z) para determinar cual es el intervalo donde se encuentra el alineamiento ideal. En las mediciones de los angulos de inclinacion de los 56 femures, los valores se encontraban entre 117,67 grados y 136,67 grados. Utilizando el patron poblacional normal de 66% (o test Z), verificamos que el intervalo ideal (o normal) se encuentra entre 117 grados y 136 grados, siendo este el intervalo donde se encuentra el alineamiento ideal. En este intervalo encontramos 47 femures (84%). La determinacion normal del angulo entre 117 grados y 136 grados, posibilita clasificar de coxa valga cuando el angulo de inclinacion esta debajo de 177 grados y coxa vara encima de 136 grados.

Drenaje de las Venas Facial, Lingual y Tiroidea Superior en el Hombre

La gran diversidad de descripciones acerca de las afluencias de las venas facial, lingual y tiroidea superior en el hombre, estas presentan una serie de controversias entre los autores investigados. Buscando ofrecer un patron para la formacion de troncos venosos a partir de las referidas venas, los autores realizaron la disecacion de 42 faces laterales del cuello de cadaveres humanos adultos, de ambos sexos, con edades variadas y fijados en formaldehido a 10%. Se observo la formacion de troncos venosos en 59,5% de los casos, habiendo ocurrido formacion del tronco tiroilingofacial en 38,1%, del tronco lingofacial en 14,2%, del tronco tiroilingual en 4,8% y del tronco tiroilingofaringofacial en apenas 2,4%. No fue encontrada la formacion del tronco tiroifacial descrito en la literatura. En los 40,5% de los casos en los que no hubo formacion de troncos venosos, las venas presentaron desembocaduras solitarias

Morphologic Aspects of Abductor digiti minimi Muscle in the Hand

Tanto el musculo abductor del dedo minimo como los otros musculos hipotenares presentan frecuentemente variaciones. De acuerdo con la literatura, el musculo abductor del dedo minimo puede estar compuesto por uno, dos o tres vientres musculares, como tambien puede presentar cabezas accesorias. Fueron disecadas 40 manos de cadaveres formolizados, para verificar la morfologia del musculo abductor del dedo minimo y sus variaciones. El musculo presento dos cabezas musculares en el 82,5 %, tres cabezas en el 15% y solamente una cabeza en el 2,5 % de los casos. No se observaron cabezas musculares accesorias. Hubo diferencias estadisticas al comparar las observaciones registradas del musculo, con los datos de la literatura. Los resultados encontrados en esta investigacion afirman que el musculo abductor del dedo minimo de la mano esta formado por dos cabezas musculares, en la mayoria de los casos. Es frecuente encontrar un musculo abductor del dedo minimo compuesto por tres cabezas

Evaluation of brachial plexus fascicles involvement on infraclavicular block: unfixed cadaver study

BACKGROUND AND OBJECTIVES This study shows how the diffusion of the anesthetic into the sheath occurs through the axillary infraclavicular space and hence proves the efficacy of the anesthetic block of the brachial plexus, and may thereby allow a consolidation of this pathway, with fewer complications, previously attached to the anesthesia. MATERIALS AND METHODS 33 armpits of adult cadavers were analyzed and unfixed. We injected a solution of neoprene with latex dye in the infraclavicular space, based on the technique advocated by Gusmão et al., and put the corpses in refrigerators for three weeks. Subsequently, the specimens were thawed and dissected, exposing the axillary sheath along its entire length. RESULTS AND DISCUSSION Was demonstrated involvement of all fasciculus of the plexus in 51.46%. In partial involvement was 30.30%, 18.24% of cases the acrylic was located outside the auxiliary sheath involving no issue. CONCLUSIONS The results allow us to establish the infraclavicular as an effective and easy way to access plexus brachial, because the solution involved the fascicles in 81.76% partially or totally, when it was injected inside the axillary sheath. We believe that only the use of this pathway access in practice it may demonstrate the efficiency.

Avaliação do envolvimento dos fascículos do plexo braquial no bloqueio por via infraclavicular: estudo em cadáveres não fixados

BACKGROUND AND OBJECTIVES This study shows how occurs the diffusion of the anesthetic into the sheath through the axiliary infraclavicular space and hence prove the efficacy of the anesthetic block of the brachial plexus, and may thereby allow a consolidation of this pathway, with fewer complications, previously attached to the anesthesia. MATERIALS AND METHODS 33 armpits of adult cadavers were analyzed and unfixed. We injected a solution of neoprene with latex dye in the infraclavicular space, based on the technique advocated by Gusmão et al., and put the corpses in refrigerators for three weeks. Subsequently, the specimens were thawed and dissected, exposing the axillary sheath along its entire length. RESULTS AND DISCUSSION Was demonstrated involvement of all fasciculus of the plexus in 51.46%. In partial involvement was 30.30%, and 18.24% of cases the acrylic was located outside the auxiliary sheath involving no issue. CONCLUSIONS The results allow us to establish the infraclavicular as an effective and easy way to access plexus brachial, because the solution involved the fascicles in 81.76% partially or totally, when was injected inside the axillary sheath. We believe that only the use of this pathway access in practice it may demonstrate the efficiency.

Estudo anatômico da veia braquial comum como via de drenagem colateral do membro superior

BACKGROUND: Trauma and thrombosis that can result in changes in the venous drainage of the upper limb, depending on the vascular territory interrupted, may have as a compensatory mechanism a collateral drainage channel that prevents damage to the venous return of that limb. The common brachial vein is a plausible and little known collateral channel for this purpose. OBJECTIVE: To describe the anatomy of the common brachial vein as a collateral drainage channel of the upper limb. METHODS: We have dissected 30 cadavers of people of different races, whose upper limbs were articulated to the trunk and preserved in a 10% formaldehyde solution. The exclusion criteria were disarticulated limbs or deformities in the topography of the studied structures. RESULTS: The common brachial vein was present in 73% (22/30) of the cadavers dissected. The common brachial vein drained into the axillary vein in 82% (18/22) and into the basilic vein in the proximal segment of the upper limb in 18% of the cadavers (04/22). CONCLUSION: The common brachial vein is frequently present, and, in most cases, it drains into the axillary vein.