Richard Halti Cabral

The Occurrence of the Plantaris Muscle and its Muscle-Tendon Relationship in Adult Human Cadavers

Se estudiaron 20 miembros inferiores de cadaveres de adultos do sexo masculino con el fin de analizar la relacion anatomica de los musculos plantares y sus partes constitutivas. En todos las piezas estudiadas este musculo estaba presente y fue observado que la longitud del musculo en relacion a su vientre era aproximadamente tres veces superior a la del tendon.

Tratamento cirúrgico da rotura de parede livre do ventrículo esquerdo após infarto agudo do miocárdio

MATERIAL AND METHODS: Between January 1983 and May 1999, 12.405 patients were treated by the surgical team of the Heart Institute (InCor) with the diagnosis of acute myocardial infarction (AMI). From these patients, 127 (1.02%) had left ventricular free wall rupture as an ischemic complication of the myocardial infarction. The cardiac rupture was acute in 98 patients (77.1%) and sub-acute in 29 (22.9%). RESULTS: Twenty-four patients were operated on, 5 on acute rupture with 80% of hospital mortality and 19 on sub-acute rupture with 15.8% of hospital mortality. The post-operative overall survival including both groups was 70.8%. CONCLUSION: The conclusion was drawn that left ventricular free wall rupture is a severe complication of acute myocardial infarction that needs an immediate action. In acute ruptures, most patients develop hemodynamic deterioration without enough time to try to proceed any surgical correction. The sub-acute cases can be detected and monitored through periodic ecocardiographic exams after the AMI. In these cases the early surgical intervention, many times without using extra-corporeal circulation, has been increasing the chances of survival of the majority of these patients.

An Unusual Anatomical Variation of the Levator Scapulae Muscle

Debido a la importancia clinica y quirurgica del musculo elevador de la escapula, se hace necesario conocer mejor sus variaciones, principalmente la posibilidad de encontrar hallazgos relacionados con su desarrollo embriologico. Se presenta el caso de un musculo elevador de la escapula del lado izquierdo encontrado en un cadaver de sexo femenino de 58 anos. El musculo elevador de la escaula presentaba una bifurcacion en el punto medio en su trayectoria mas baja. La banda medial se fijaba en la parte anterior del musculo romboides mayor izquierdo; mientras que su banda lateral se fijaba en el angulo superior de la escapula despues de enviar una expansion hasta el musculo serrato anterior. El analisis morfometrico revelo un ancho maximo de 3,6 cm, punto de bifurcacion situado 6,6 cm bajo la insercion vertebral C1; longitudes de la banda medial 5,7 cm y lateral de 2,1cm. Las variaciones anatomicas del musculo elevador de la escapula pueden pasar inadvertidas, pero tambien pueden contribuir con algunas condiciones patologicas del cuello y espalda.

Análise direcional do fluxo sangüíneo miocárdico após revascularização transmiocárdica com laser de CO2: estudo através da ressonância magnética com imagens de gradiente ultra-rápido

OBJECTIVE: The aim of this work is to analyze the myocardial flow direction of patients submitted to transmyocardial laser revascularization (TMLR), using the first - pass magnetic resonance imaging (MRI). METHODS: Ten patients submitted to TMLR with CO2 laser (potency of 800 W) were studied with magnetic resonance imaging (MRI) of fast gradient ¾ eco- EPI hybrid sequence used in a 1.5 TGE CV/i scanner (Sigma CVMR - General Eletric ¾ Milwaukee-USA) to evaluate myocardial perfusion. Bolus of Gadolinium ¾ DTPA (0.1mmol/Kg) was injected by a peripherical intra-venous line at 5 ml/sec at rest and during peak stress of dypiridamole. The distribution of the contrast through the myocardial regions was analyzed. RESULTS: After a mean follow-up of 14.7 months, 6 (60%) patients showed significant myocardial ischemia at least in one of the left ventricular walls. The blood flow was inverted, from subendocardium to subepicardium, just in 1 (10%) patient. CONCLUSIONS: First-pass MRI is an efficient method to show the direction of the myocardial blood flow. In one of the studied patients, the inverted myocardial blood flow (from the endocardium to the epicardium), suggested the patency of the channels created by TMLR.

Rotura cardíaca após infarto agudo do miocárdio (IAM): uma complicação passível de correção cirúrgica?

PURPOSE: Analise the incidence of cardiac rupture within the patients received in our hospital with the diagnosis of AMI in a period of 10 years and try to identify cases when the cardiac rupture can be submitted to a successful approach. METHODS: 9162 patients were received by INCOR with the diagnosis of AMI in the period from January 1983 to december 1993. From these patients 1.05% had cardiac rupture as an ischaemic complication of the myocardium infarction. The average of age was 69.5 years and showing a predominance of white people (93.75%) and female sex (55.3%). Data from patients include clinical history, complementary investigations, drugs used in the treatment and surgical or anatomopathological findings. The cardiac ruptures were classified as acute and sub-acute, according to literature. RESULTS: We found 72 cases of acute myocardial rupture with a mortality rate of 98.6% and 24 cases of sub-acute myocardial rupture with 41.6% of deaths. Four patients were operated on acute rupture and 15 patients were operated on subacute rupture. The post surgery survival was 78.9%. The patients who had a successful thrombolitic therapy, 76.4% died while the others who received routine therapy, 86.1 % passed away. Once the thrombolitic therapy was given until an hour the mortality was 33.3%; from 3 to 6 hours it was 60% and after 6 hours it was 100%. When it turns to the lenght of time of the onset of the cardiac rupture after I AM treatment, it happend after 5 days just in 5.9% of the patients who received trombolitic agents but in 40.5% of the patients with the routine therapy. CONCLUSIONS: We recognized the importance and the necessity of a immediate action for the patient with cardiac rupture even in sub-acute cases when 30% of the patients with an echographic probability of having a progression of the transmural ischaemic area die. In acute ruptures the situation is dramatic and survical depends on logistic factors. In sub-acute conditions however, new sutureless techniques without using extra-corporeal circulation are now available and they will have a huge importance in the treatment of this extremely serious complication of AMI.

Terminología Morfológica Internacional: Algo Más que Anatomía, Histología y Embriología

LOSARDO, R. J.; PRATES, N. E. V. B.; ARTEAGA-MARTINEZ, M.; CABRAL, R. H. & GARCIA-PELAEZ, M. I. Terminolo-gia morfologica internacional: algo mas que anatomia, histologia y embriologia. Int. J. Morphol., 33(1):400-407, 2015.RESUMEN: El estudio de la terminologia morfologica internacional y su implementacion en una normativa es complejo. Latarea que realiza el grupo de expertos morfologos no es suficiente. Se explican algunos aspectos que nos acercaran al entendimi ento deesta problematica y se muestra el camino para superar este desafio.PALABRAS CLAVE: Terminologia; Anatomia; Histologia; Embriologia; Morfologia; Educacion medica; Linguistica.

Enxerto venoso intercoronariano na revascularização de artéria coronária comprometida por dissecção de aorta tipo I

A thirty nine-year-old patient presenting arterial hypertension was operated upon for type I acute aortic dissection. Due to important alterations in the ascendent aorta with involvement of the right coronary ostium, the surgical procedure included resection of the segment of aorta containing the intimal tear and replacement with a Dacron prosthesis, suspension of the aortic valve and ligadure of the right coronary ostium. Technical difficulties brought the necessity of a different approach for the myocardium revascularization. Instead of the traditional described procedures, an intercoronary venous graft was put between the anterior interventricular artery (branch of the left coronary artery) and the right coronary artery. The intercoronary graft presented a good flow since the begining, keeping a good myocardial contratility. Patient left the hospital in a good clinical condition, with preserved myocardial function. Intercoronary graft should be an efficient alternative for revascularization of a corohary artery involved by aortic dissections.