Morphometry and Frequency of the Pyramidalis Muscle in Adult Humans: A Pyramidalis Muscle’s Anatomical Analysis

OBJECTIVES: To verify the pyramidalis muscle’s frequency (bilaterality, unilaterality, or absence) and morphometry (length of the medial border and width of its origin/base) in a sample of the Brazilian population and the anthropometric influence. METHODS: Dissection of 30 cadavers, up to 24h post-mortem. RESULTS: The pyramidalis muscle was present bilaterally and unilaterally in 83.33% and 3.33% of the cadavers, respectively, and absent in 13.33%. The muscles on the right and left sides were symmetrical in length but not in width; the pyramidalis muscles of men were longer, while those of the women were wider. We also found that there was greater variation in the dimensions (length and width) of the men’s muscles. Finally, in this sample of the Brazilian population, the pyramidalis muscle’s unilaterality was more prevalent than in other populations, and its complete absence was less prevalent. CONCLUSIONS: There were no cases of muscle duplication in one or both sides, as described in some studies. Despite all of its morphometric variation, the pyramidalis muscle maintained its triangular shape with longitudinal fibers in every case. Furthermore, no statistically significant correlation was noted between the muscles’ dimensions and person’s age, height, weight, or gender

Avaliação discente é importante ferramenta no aperfeiçoamento dos cursos de anatomia clínica

Background: Medical knowledge and students’ demands are under continuous changes and learning process must adapt accordingly. We retrospectively analyzed students’ evaluation of three different approaches employed in our course of Clinical Anatomy in the last decade. Methods: The University of São Paulo Medical School has a systematic evaluation of each discipline where students grade 38 different topics ranging to physical conditions to the quality of the classes. In this study, different methods to teach Clinical Anatomy to 2nd and 3rd year students of Medicine were confronted to the students’ evaluations, comparing the general appreciation of the course in different teaching approaches. We analyzed the changes in the Anatomy course from 1994 to the present and their impact based on the students´ evaluations. Results: Significant improvement in general evaluation was observed when the course changed from Problem Based Learning technique to a more formal approach with theoretical classes given by specialists, most of them invited from other Clinical Departments of the University. A still better evaluation was obtained as the practical demonstrations focused aspects showed in theoretical classes, which were given mostly by specialists trained in Anatomy. Discussion: Students' evaluation allows course coordinators to redirect objectives and teaching methods to adjust the course format as needed. Performance in final exams may also be analyzed together so effectiveness of the teaching method can be measured along with students’ satisfaction. Conclusion: Continuous feedback from students is essential to course coordinators to adequate strategies to face the modern challenges in the teaching/learning process and obtain the best results in courses of Clinical Anatomy.Introdução: O conhecimento médico e a demanda docente estão em constante e progressiva mudança e os processos pedagógicos devem ser adaptados conforme as necessidades para prover o máximo rendimento. Analisamos retrospectivamente a avaliação discente de três métodos diferentes utilizados no curso de Anatomia Clínica da FMUSP na última década. Métodos: A Faculdade de Medicina da Universidade de São Paulo oferece avaliação sistemática de cada Disciplina, com avaliação dos estudantes de 38 diferentes aspectos relacionados ao curso, de estrutura física até a qualidade das aulas. Neste estudo, métodos diferentes de ensino de Anatomia Clínica para os alunos de 2o e 3o anos de Medicina foram confrontados com as avaliações discentes ao final do curso. Foram analisadas as mudanças pedagógicas no curso desde 1994 até o presente e seu impacto baseado na avaliação dos estudantes. Resultados: Observou-se melhora significativa na avaliação geral quando o curso foi mudado da técnica de Aprendizagem Baseada em Problemas para uma abordagem mais formal, com aulas teóricas dadas por especialistas, em sua maioria convidada de outras Disciplinas da Faculdade. Uma avaliação ainda mais positiva ocorreu quando os aspectos práticos focaram aspectos demonstrados em aulas teóricas, na sua maioria dada por especialistas com formação em Anatomia. Discussão: A avaliação dos estudantes permite aos coordenadores do curso redirecionar os objetivos e os métodos pedagógicos para ajustar o formato do curso como necessário. As notas finais também podem ser analisadas conjuntamente para que a efetividade do método empregado possa ser avaliada em conjunto com a avaliação discente. Conclusão: A contínua avaliação dos estudantes é essencial para que os coordenadores dos cursos possam adequar suas estratégias para enfrentar os desafios atuais dos processos pedagógicos e obter os melhores resultados nos cursos de Anatomia Clínica

Morphometry and frequency of the pyramidalis muscle in adult humans

The pyramidalis muscle presents variable morphometry and frequency among populations, and the knowledge of such variations may serve as a support for clinical practice and surgical procedures. However, this muscle is little described in the medical literature, and studies of this order have not been performed in the brazilian population. Thus, we dissected 30 cadavers, exposing the pyramidalis and taking photos for posterior measuring in image processing program. We verified frequency - bilaterality, unilaterality and absence - and morphometry - medial border length and width at basis - of the muscle. We verified that there was length symmetry between right and left sides, but no width symmetry. Moreover, there were no statistically significant correlations between the muscle dimensions (length and width) and age, height, weight, nor gender, although, in the present study, men presented longer - but women wider - pyramidalis muscle. Furthermore, the dimensions range of the pyramidalis were bigger in men. Note: it was adopted significance level of 0.05; and two degrees of decimal accuracy. The data obtained was also compared to other studies, revealing that the brazilian population presented an average incidence compared to other populations and that unilaterality was more prevalent and its absence less prevalent than in other populations. Therefore: 1. Due to the muscle´s great variability it’s hard to use it as a reference for incisions; 2. The pyramidalis muscle proved to be very prevalent, enhancing the viability of using it as a graft and as source of stem cells for various purposes

Sternalis Muscle: A Case Report and Literature Review

Introduction and Objective: The sternal muscle is a rare anatomical variation found in the anterior chest wall. This study's objective was to make a narrative review of the anatomical and epidemiological aspects of the sternal muscle, as well as to present its finding in one of this group’s dissections. Materials and Methods: This study consisted of a literature review using Pubmed and LILACS platforms. Articles were analyzed regarding incidence, laterality, action, innervation, and vascularization of the sternal muscle. We also present a case report based  on a cadaveric dissection of the Hospital das Clínicas, Faculty of Medicine, University of São Paulo (HCFMUSP). Results: Our review included 22 articles. The anatomical variation incidence ranged from 1.96% to 5.55%, with a higher predominance of a bilateral presentation. The action of the sternal muscle is predominantly accessory and there are divergences in the literature regarding its innervation and vascularization. Our case reports the finding of a unilateral sternal muscle in the left paramedian line inserted in both sternocleidomastoid muscles, in a female patient. Conclusion: The sternal muscle has a small incidence in the population and it is usually bilateral. The anatomical knowledge of this muscle is important to prevent it from being confused with other structures commonly found in the chest and cervical region.  Significance/Implication: The importance of sternal muscle importance cannot be overlooked due to possible misinterpretations in imaging and its possible influence on mastectomies. Wider case series are necessary for a better definition of its irrigation and innervation

Interthalamic adhesion and Alzheimer’s: Preliminary study

OBJECTIVE: Identifying the prevalence and dimensions of the Interthalamic Adhesion (ITA) in corpses from the “Serviço de Verificação de Óbitos da Capital - USP”, considering factors as age, sex, weight, height, and diagnosis of Alzheimer’s disease (AD). METHODS: Fifty-seven corpses (31M/26F) were included in the study. The mean age was 66.2 (varying between 15 and 91). The analysis of the ITA was made after the encephalon’s removal from its cavity, which occurred by the transversal section of the skullcap, and, next, an axial incision in the inferior limit of the pons to separate the encephalon from the spinal cord. Fifty-four encephalons were submitted to medial sagittal incisions, two encephalons were submitted to axial cuts and one to a coronal section. Quantitative data were compared by the Student’s T Test, and qualitative data by the Chi-squared test. The Age vs Area analysis was made by linear regression. RESULTS: the prevalence of the ITA was 79%, not having differences in prevalence between sexes (p=0.68). Advanced ages presented lower areas in sagittal sections (p= 0.02). It does not appear to have a significant alteration in prevalence of the ITA and transversal section aerea in patients with AD. DISCUSSION: Unlike previous studies which observed higher prevalence and size of the ITA in females, differences in this parameters were not obtained in this study. Evidence of correlation between AD and lower sagittal section of the ITA, even without statistic significance, points to the need of further studies.OBJETIVO: Descrever dimensões e prevalência da Aderência Intertalâmica (AI) em cadáveres do Serviço de Verificação de Óbitos da Capital - USP, considerando idade, sexo, peso, altura e histórico pessoal de doença de Alzheimer (DA). MÉTODOS: Cinquenta e sete cadáveres (31H/26M) foram incluídos no estudo, com média de idade de 66,2 anos (variando entre 15 e 91 anos). A análise da AI foi feita após secção transversal da calota craniana e incisão axial no limite inferior do tronco encefálico seguida de retirada do encéfalo de sua cavidade. Cinquenta e quatro encéfalos foram submetidos a incisão sagital mediana, dois encéfalos foram submetidos a cortes axiais, e um encéfalo a secção coronal. Dados quantitativos foram comparadas pelo teste t de student, e dados qualitativos pelo teste de Qui Quadrado. A análise idade vs área foi feita por regressão linear. RESULTADOS: A prevalência de AI foi de 79%, não havendo diferença significativa entre os sexos (p=0,68).  Observou-se associação entre menores áreas de secção sagital e idades mais avançadas (p=0,02). Não houve diferença significativa na prevalência de AI nem na área de secção transversal em pacientes com DA. DISCUSSÃO: Ao contrário de estudos prévios, que associaram maior prevalência e tamanho de AI com sexo feminino, isso não foi observado em nossa casuística. Apesar de não ser estatisticamente significativa nota-se uma diferença importante nas áreas médias de secção sagital dos grupos com e sem DA, o que aponta para a necessidade de estudos subsequentes com amostras maiores

Doppler-guided hemorrhoidal artery ligation with rectal mucopexy technique: initial evaluation of 42 cases

The treatment of hemorrhoidal disease (HD) by conventional hemorrhoidectomy is associated with significant morbidity, mainly represented by the postoperative pain and the late return to daily activities. Doppler-guided hemorrhoid artery ligation (DGHAL) is a minimal-invasive surgical treatment for HD that has been used as an alternative method in order to reduce these inconveniences. OBJECTIVE: To analyze the initial results of the DGHAL technique associated with rectal mucopexy in the treatment of HD. METHODS:Forty-two patients with stage I, III and IV hemorrhoids who were submitted to DGHAL were analyzed from December 2010 to August 2011. Eleven patients (26%) were stage II; 21 (50%), stage III; and 10 (24%), stage IV HD. All patients were operated by the same surgeon under spinal anesthesia and using the same equipment and technique to perform the procedure. The 42 patients underwent ligation of six arterial branches followed by rectal mucopexia by uninterrupted suture. Nine patients needed concomitant removal of perianal skin tag. In the postoperative, the following parameters were evaluated: pain, tenesmus, bleeding, itching, prolapse, mucus discharge and recurrence. The mean postoperative follow-up lasted four months (one to nine months). RESULTS: Tenesmus was the most common postoperative complaint for 85.7% of patients followed by pain, in 28.6%, perianal burning, in 12.3%, mucus discharge and perianal hematoma in 4.7%. Two patients had severe postoperative bleeding and required surgical haemostasis, one of which needed blood transfusion. Ninety-five percent of the patients declared to be satisfied with the method. CONCLUSION: Even though DGHAL has complications similar to those of other surgical methods, its results present less postoperative pain, allowing faster recovery and return to work. Studies with more cases and a longer follow-up are still necessary to assess the late recurrence.O tratamento da doença hemorroidária (DH) pelas técnicas convencionais cursa com significante morbidade principalmente relacionada à dor pós-operatória e ao considerável tempo de afastamento do trabalho. A técnica de desarterialização hemorroidária transanal guiada por doppler (DHGD) associada à mucopexia retal é uma opção cirúrgica menos invasiva que vem sendo utilizada como método alternativo com objetivo de reduzir esses inconvenientes. OBJETIVO: Analisar os resultados iniciais com a técnica da DHGD associada à mucopexia retal no tratamento da DH. MÉTODO: Foram estudados 42 pacientes, portadores de DH de graus II, III e IV submetidos à técnica da DHGD, durante o período de dezembro de 2010 a agosto de 2011. Onze pacientes (26%) apresentavam DH do grau II, 21(50%) do III e 10 (24%) do IV. Todos os pacientes foram operados pelo mesmo cirurgião, sob anestesia raquidiana e sempre utilizando o mesmo equipamento e técnica para realização do procedimento. Os 42 pacientes foram submetidos à desarterialização de 6 ramos arteriais seguida de mucopexia retal por sutura contínua. Nove necessitaram remoção concomitante de plicomas perianais. No pós-operatório, foram avaliados os parâmetros: dor, tenesmo, sangramento, prurido, prolapso, perda de muco e recidiva. O seguimento médio foi de quatro meses (um a nove meses). RESULTADOS: O tenesmo foi a queixa pós-operatória referida por 85,7% dos pacientes, seguida da dor 28,6%, ardor perianal 12,3%, perda de muco e formação de hematoma perianal 4,7%. Dois pacientes apresentaram sangramento pós-operatório de maior intensidade necessitando hemostasia cirúrgica, sendo que em um houve necessidade de reposição sanguínea. Noventa e cinco por cento dos pacientes declararam-se satisfeitos com o método. CONCLUSÃO: A técnica da DHGD, apesar de apresentar complicações semelhantes a outros métodos cirúrgicos, apresenta bons resultados com pouca dor pós-operatória, possibilitando retorno rápido ao trabalho. Estudos com maior número de casos e tempo de seguimento mais prolongado ainda são necessários para avaliar a recidiva tardia

Corona Mortis: A Systematic Review of Literature

Our systematic review evaluates surgically relevant information about corona mortis (CM), such as anatomical structure, size, laterality, incidence, and anthropometric correlations. This study aimed to provide data about anastomosis in an attempt to avoid iatrogenic damage during surgery. Articles were searched online using the descriptor ‘‘Corona Mortis’’ in PubMed, Biblioteca Virtual em Sau´ de (BVS) (Literatura Latino-Americana e do Caribe em Sau´ de [LILACS], MEDLINE, indice bibliografico espan˜ ol en ciencias de la salud [IBECS]), and SciELO database. The time range was set between 1995 and 2020. The articles were selected according to their titles and later the abstracts’ relation to our research purpose. All the selected articles were read entirely. A manual search based of the references cited in these articles was also conducted to identify other articles or books of interest. Forty references fulfilled the criteria for this review. The mean incidence of CM was 63% (the majority venous) among 3,107 hemipelvises. The incidence of bilateral CM was lower than that of unilateral variations based on the analysis of 831 pelvises. The mean caliber of the anastomosis was 2.8 mm among 1,608 hemipelvises. There is no consensus concerning the anthropometric influences in CM. Finally, we concluded that CM is not an unusual anatomical variation and that we must not underestimate the risk of encountering the anastomosis during surgery. Anatomical knowledge of CM is, therefore, essential in preventing accidents for surgeons who approach the inguinal and retropubic regions

Cochlear implantation trough the middle cranial fossa: a novel approach to access the basal turn of the cochlea

The classic approach for cochlear implant surgery includes mastoidectomy and posterior tympanotomy. the middle cranial fossa approach is a proven alternative, but it has been used only sporadically and inconsistently in cochlear implantation.Objective: To describe a new approach to expose the basal turn of the cochlea in cochlear implant surgery through the middle cranial fossa.Method: Fifty temporal bones were dissected in this anatomic study of the temporal bone. Cochleostomies were performed through the middle cranial fossa approach in the most superficial portion of the basal turn of the cochlea, using the meatal plane and the superior petrous sinus as landmarks. the lateral wall of the internal acoustic canal was dissected after the petrous apex had been drilled and stripped. the dissected wall of the inner acoustic canal was followed longitudinally to the cochleostomy.Results: Only the superficial portion of the basal turn of the cochlea was opened in the fifty temporal bones included in this study. the exposure of the basal turn of the cochlea allowed the visualization of the scala tympani and the scala vestibuli, which enabled the array to be easily inserted through the scala tympani.Conclusion: the proposed approach is simple to use and provides sufficient exposure of the basal turn of the cochlea.Univ São Paulo, Hosp Clin, BR-05403000 São Paulo, BrazilUniv São Paulo, Dept Otorrinolaringol, Hosp Clin, BR-05403000 São Paulo, BrazilUniv São Paulo, Sch Med, BR-05403000 São Paulo, BrazilUniv São Paulo, Sch Med, Human Struct Topog Course, Dept Surg, BR-05403000 São Paulo, BrazilUniv São Paulo, Sch Med, Otorhinolaryngol Course, BR-05403000 São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc