Multidetector computed tomography angiography of the celiac trunk and hepatic arterial system: normal anatomy and main variants

Abstract Although digital angiography remains as the gold standard for imaging the celiac arterial trunk and hepatic arteries, multidetector computed tomography in association with digital images processing by software resources represents a useful tool particularly attractive for its non invasiveness. Knowledge of normal anatomy as well as of its variations is helpful in images interpretation and to address surgical planning on a case-by-case basis. The present essay illustrates several types of anatomical variations of celiac trunk, hepatic artery and its main branches, by means of digitally reconstructed computed tomography images, correlating their prevalence in the population with surgical implications.

Extracorporeal support for pulmonary resection: current indications and results.

Extracorporeal assistances are exponentially used for patients, with acute severe but reversible heart or lung failure, to provide more prolonged support to bridge patients to heart and/or lung transplantation. However, experience of use of extracorporeal assistance for pulmonary resection is limited outside lung transplantation. Airways management with standard mechanical ventilation system may be challenging particularly in case of anatomical reasons (single lung), presence of respiratory failure (ARDS), or complex tracheo-bronchial resection and reconstruction. Based on the growing experience during lung transplantation, more and more surgeons are now using such devices to achieve good oxygenation and hemodynamic support during such challenging cases. We review the different extracorporeal device and attempt to clarify the current practice and indications of extracorporeal support during pulmonary resection.

Individual Differences in True and False Memory Retrieval Are Related to White Matter Brain Microstructure

We sometimes vividly remember things that did not happen, a phenomenon with general relevance, not only in the courtroom. It is unclear to what extent individual differences in false memories are driven by anatomical differences in memory-relevant brain regions. Here we show in humans that microstructural properties of different white matter tracts as quantified using diffusion tensor imaging are strongly correlated with true and false memory retrieval. To investigate these hypotheses, we tested a large group of participants in a version of the Deese-Roediger-McDermott paradigm (recall and recognition) and subsequently obtained diffusion tensor images. A voxel-based whole-brain level linear regression analysis was performedto relatefractional anisotropyto indices oftrue andfalse memory recall and recognition. True memory was correlated to diffusion anisotropy in the inferior longitudinal fascicle, the major connective pathway of the medial temporal lobe, whereas a greater proneness to retrieve false items was related to the superior longitudinal fascicle connecting frontoparietal structures. Our results show that individual differences in white matter microstructure underlie true and false memory performance.

Ergonomics and musculoskeletal pain among postgraduate students and faculty members of the School of Dentistry of the University of Barcelona (Spain). A cross-sectional study

Objectives: To evaluate the intensity and location of musculoskeletal pain suffered by students and professors from different postgraduate programs of the School of Dentistry of the University of Barcelona (Spain), to identify the variables related to the occurrence of musculoskeletal symptoms and signs, and to establish possible preventive measures for such disorders. Materials and Methods: A cross-sectional study was made among students and faculty members from different postgraduate courses of the School of Dentistry at the University of Barcelona between May and June 2007. A total of 74 dentists (54 postgraduate students and 20 faculty members) completed an anonymous questionnaire containing 19 questions. The variables were divided into three main groups: sociodemographic information, ergonomic features and musculoskeletal pain arising from professional practice. Results: Most of the dentists (79.8%) had experienced some kind of musculoskeletal pain in the last 6 months. On comparing the different locations of pain (lumbar, cervical, dorsal, wrist, shoulder and others), the neck was found to be the most commonly affected location (58% of all subjects), and only 34% of the respondents took some preventive measures against musculoskeletal disorders. Women showed a higher frequency of intense pain involving the cervical, lumbar, dorsal and wrist areas (p<0.05). A higher incidence of wrist pain was recorded in professionals exclusively dedicated to oral surgery (p<0.05). No statistically significant correlation was found between the workload (hours) and pain in the different anatomical locations (p>0.05). Conclusions: An important incidence of pain symptoms secondary to musculoskeletal disorders was observed, particularly in the cervical region. Females and younger dentists showed a higher frequency of such symptoms. The implementation of preventive measures is necessary, in view of the high incidence of these disorders

Resultados científicos do cruzeiro do "Baependi" e do "Vega" à Ilha da Trindade: o gênero Firoloida, Prosobranchia Heteropoda

From the Jaseur Bank, off the Brazilian coast at 20º 30' S - 35º 50' W, were collected a few specimens of one of the less known species of the Heteropoda: Firoloida lesueuri (d'Orbigny). A detailed anatomical description follows aiming at the elucidation of some obscure points in the litterature on the subject and at showing the identity of most of the previously described "species" of the genus Firoloida. Special care was taken with the study of the nervous system of which most of the descriptions found were discordant. The author arrived at the conclusion that the pleural ganglia are either missing of fused to the cerebral ganglia, that the supraintestinal ganglion (left parietal ganglion) is present in the posterior region and is close to the subintestinal or right parietal ganglion, being both located near the rear end of the body. The innervations are described and discussed as well as the fusion of extensive tracts of the connectives. The present material is shown to be identical to F. kowalewskyi, well described by Vayssière and Tesch; F. desmaresti (Lesueur 1817) is shown to be undistinguishable from F. blainvilleana and F. gracilis. F. aculeata and F. gaimardi are here considered as "nomina nuda". F. liguriae Issel 1907 is admitted as separate species in spite of its insufficient description and, finally, F. vigilans (Troschel 1855), unsatisfactorily described from only one specimen is perhaps a valid species. A table is presented to show the slight differences between the 4 species which are undoubtedly very similar. F. desmaresti is found only in the Atlantic north of the line and a few points south and close to it as well as in dependent seas, while F. lesueuri is common to the south Atlantic, south Indie and south Pacific oceans, extending north only up to the Azores Islands. F. liguriae is from the south western Atlantic. ?F. vigilans would be an endemic species from Messina (Mediterranean).

Utilization of non-wood pulp in different fibers products

The correct utilization of non-wood raw material allows reducing tree cutting and reduces emissions of carbon dioxide from burning of non-wood plants on farmers fields. Also it allows increasing economical situation in regions that non-wood plants are grown and where they are converted into pulp and paper. Also it gives positive effect on population pressure of work by addition of working place. In the literature survey included an overview of the historical meaning of non-wood pulp on developing paper production and structure of non-wood pulps. Moreover, anatomical and chemical composition of straw, reed and bamboo were studied more detailed. Also, an overview of the utilization of non-wood pulp in papermaking was made. Especially tissue, tree-free and release papers were reviewed. In the experimental part the goal was to investigate suitability of non-wood pulp like wheat straw pulp and bamboo pulp for different fiber products. Finally release and tree-free paper products were selected for experimental studies. It was discovered that wheat straw, especially screened wheat straw, showed good results for release paper. Also utilization of wheat straw and bamboo pulp in tree-free paper showed good results and suitability of these non-wood pulps for tree-free paper production. Also it was noticed that addition of wheat straw pulp gave positive effect on initial wet strength for release and tree-free paper.

Foliar anatomy and histochemistry in seven species of Eucalyptus

This work aimed to describe the foliar anatomy of seven species of Eucalyptus, emphasizing the characterization of secretory structures and the chemical nature of the compounds secreted and /or present in the leaves. Anatomical characterization and histochemical evaluation to determine the nature and localization of the secondary compounds were carried out in fully expanded leaves, according to standard methodology. Anatomical differences were verified among the species studied, especially in E. pyrocarpa. Sub-epidermal cavities were the only secretory structures found in the seven species studied, with higher density in E. pellita and lower in E. pilularis. The following compounds were histochemically detected: lipophilic compounds, specifically lipids of the essential or resin-oil type and sesquiterpene lactones found in the lumen of the cavities of the seven species; and hydrophilic compounds, of the phenolic compound type found in the mesophyll of all the species studied and on the epidermis of some of them. The results confirmed the complexity of the product secreted by the cavities, stressing the homogeneous histochemistry nature of these compounds among the species. However, the phenolic compounds results may be an indication of important variations in adaptations and ecological relations, since they show differences among the species.

Lipotoxicity in Obesity and Coronary Artery Disease. Studies by PET, CT and MR

Lipotoxicity is a condition in which fatty acids (FAs) are not efficiently stored in adipose tissue and overflow to non-adipose tissue, causing organ damages. A defect of adipose tissue FA storage capability can be the primary culprit in the insulin resistance condition that characterizes many of the severe metabolic diseases that affect people nowadays. Obesity, in this regard, constitutes the gateway and risk factor of the major killers of modern society, such as cardiovascular disease and cancer. A deep understanding of the pathogenetic mechanisms that underlie obesity and the insulin resistance syndrome is a challenge for modern medicine. In the last twenty years of scientific research, FA metabolism and dysregulations have been the object of numerous studies. Development of more targeted and quantitative methodologies is required on one hand, to investigate and dissect organ metabolism, on the other hand to test the efficacy and mechanisms of action of novel drugs. The combination of functional and anatomical imaging is an answer to this need, since it provides more understanding and more information than we have ever had. The first purpose of this study was to investigate abnormalities of substrate organ metabolism, with special reference to the FA metabolism in obese drug-naïve subjects at an early stage of disease. Secondly, trimetazidine (TMZ), a metabolic drug supposed to inhibit FA oxidation (FAO), has been for the first time evaluated in obese subjects to test a whole body and organ metabolism improvement based on the hypothesis that FAO is increased at an early stage of the disease. A third objective was to investigate the relationship between ectopic fat accumulation surrounding heart and coronaries, and impaired myocardial perfusion in patients with risk of coronary artery disease (CAD). In the current study a new methodology has been developed with PET imaging with 11C-palmitate and compartmental modelling for the non-invasive in vivo study of liver FA metabolism, and a similar approach has been used to study FA metabolism in the skeletal muscle, the adipose tissue and the heart. The results of the different substudies point in the same direction. Obesity, at the an early stage, is associated with an impairment in the esterification of FAs in adipose tissue and skeletal muscle, which is accompanied by the upregulation in skeletal muscle, liver and heart FAO. The inability to store fat may initiate a cascade of events leading to FA oversupply to lean tissue, overload of the oxidative pathway, and accumulation of toxic lipid species and triglycerides, and it was paralleled by a proportional growth in insulin resistance. In subjects with CAD, the accumulation of ectopic fat inside the pericardium is associated with impaired myocardial perfusion, presumably via a paracrine/vasocrine effect. At the beginning of the disease, TMZ is not detrimental to health; on the contrary at the single organ level (heart, skeletal muscle and liver) it seems beneficial, while no relevant effects were found on adipose tissue function. Taken altogether these findings suggest that adipose tissue storage capability should be preserved, if it is not possible to prevent excessive fat intake in the first place.

ROOTING MINI-CUTTINGS OF Paulownia fortunei var. mikado DERIVED FROM CLONAL MINI-GARDEN1

ABSTRACTWe aimed to evaluate the technical efficiency of mini-cuttings technique on vegetative propagation of Paulownia fortunei (Seem.) Hemsl. var. Mikado, as well as the possible existence of anatomical barriers to its rooting. Therefore, plants originated from cuttings formed the mini-stumps and, consequently the clonal mini-garden, which was conducted in semi-hydroponic system. We evaluated the survival of mini-stumps and sprouts production for five successive collects, the percentage of mini-cuttings rooting and their anatomical description. The mini-cuttings were prepared with about 6 to 8 cm in length and two leaves reduced by about 50% in the upper third, being remained an area of, approximately 78 cm2 (10 cm diameter). The mini-cuttings were placed in tubes of 53 cm3, with substrate formed with fine vermiculite and carbonized rice hulls (1:1 v/v) and rooted in acclimatized greenhouse. After 30 days we evaluated the percentage of rooted mini-cuttings, radicial vigor (number and length of roots / mini-cutting), callus formation, emission of new shoots and maintenance of the original leaves. The mini-stumps showed 100% survival after five collects and an average production of 76-114 mini-cuttings/m2/month and rooting ranged from 70 to 90%. Mini-cuttings technique is efficient in to propagate adult propagules of the species and there are not anatomical barriers preventing roots emission.

Hepatectomia regrada por videolaparoscopia

With the improvement of laparoscopic techniques, endoscopic liver surgery has become feasible. While laparoscopic wedge liver resection are performed more frequently, laparoscopic (anatomical or nonanatomical) liver resection are still at an early stage of development and are somewhat controversial. We reporte laparoscopic hepatic resection without use of sophisticated laparoscopic instruments. A 47-year-old woman underwent radical mastectomy for adenocarcinoma in 1995. 1n the postoperative follow-up presented, a lesion in the left hepatic lobe and, after laparoscopic approach, left lateral segmentectomy was performed. The hepatic resection elapsed without complications. The surgical time was 4 hours and the blood loss was minimal, without transfusion being necessary.The abdominal drain was removed in 24 hours and the patient was discharged in the second postoperative day. Compared to the classic approach by laparotomy, this method was less traumatic, required a shorter hospital stay, and followed by faster recovery.

Volvo da vesícula biliar

A case of torsion of the gallbladder is presented. This is a rare condition that occurs when it is associated with anatomical variants related to abnormal fixation of the gallbladder to the liver bed. The blood irrigation is insufficient and the gallbladder develops necrosis. The abnormal implantation occurs in 4% of the population. If the gallbladder losses its fixations to the inferior margin of the liver with the presence of a 1011.g mesocyst a torsion can occur when this gallbladder twists axially with subsequent occlusion of the blood flow. The signs and symptoms are similar to those of severe acute cholecystitis: abrupt onset of the pain and large palpable mass below the right costal margin. The ultrasound can show a very large and anteriorly floating gallbladder: In this case, the ultrasound did not show any abnormal signs, so it is usually diagnosed at laparotomy and the treatement consists of cholecystectomy. This condition should be suspected in acute abdominal pain of unknown origin.

Anomalia da via biliar extra-hepática

We show an anatomical modification of extrahepatic biliary ducts in a fifty-eight years old female who presented right hipocondric pain, jaundice and fever two months after cholecystectomy. The patient underwent ERCP wich showed an anatomical modification that consists in an union of the right and left hepatic ducts, with insertion into the cystic duct, right hepatic duct, being a choledochus agenesis.

O estado da arte da cirurgia do baço, no início do século XXI

In the last fifty years evolution of scientific knowledge on the spleen provoked an entirely new approach to splenic surgery. It was shown that virulence may emerge as a significant consequence of environmental and evolutionary changes of some microbial communities, and devastating pathogenetic results of these changes become visible in human hosts without the splenic function. In other words: the spleen plays a pivotal role in the dynamic balance between biodiversity, microorganisms and immunogenecity in human hosts. Therefore, to preserve the "splenic immunologic repertoire" became an increasing commitment among surgeons. Understanding the integration of these multiple information on spleen, seems central to understand the new splenic surgery. Partial splenectomies (Réglées) - based on anatomical, experimental and clinical studies, developed at the University of Minas Gerais since the fifties - were successfully applied initially to treat the traumatic injuries of the spleen; in a following step, partial splenectomy were used to control hematological diseases. "Réglées" techniques on the spleen have conquered "ethical support, consilience status and clinical governance" to give birth to surgical therapeutic decisions on the spleen, in order to spare the structural integrity of the immune system. Splenic réglées procedures became a seminal achievement of splenic surgical practice. Initial results of "Partial splenectomies" - with conventional surgical armamentaria and techniques - were confirmed and improved by the introduction of techniques based on laparoscopic and endovascular approaches. And current usage of surgical splenic saving procedures propitiated the emergence of an appropriate lexicon for medical communication and became an "end point" of a "long-standing surgical inhibition" over the spleen.

Anomalia anatômica da veia porta: uma causa rara de impossibilidade de doação do lobo direito em transplante hepático intervivos

Living related liver transplantation is being increasingly used for patients that can not wait for a cadaveric organ. We describe a case of a right lobe donor who had a type III portal vein anomaly. On this anomaly the portal vein gives branches first to the right posterior vein and then to the right anterior vein and the left portal vein. The recipient had portal vein thrombosis that was recognized only during the surgery. The Doppler examination performed before the operation did not detect this thrombosis. The transplant was not accomplished. Anatomical anomaly of the portal vein may be a rare cause impossibility to organ donation in living related liver transplantation.

Duplicação uretral em homem adulto

Urethral duplication is a rare congenital anomaly. The clinical presentation and treatment varies because of the different anatomical patterns of this abnormality. We report a case of this entity in the adult male patient. The clinical, radiological and endoscopic findings, as well as the treatment are discussed.