RESUMO
SUMMARY: The objective of this study was to analyze the potential for compression of the median nerve (MN) caused by the bicipital aponeurosis (BA), the humeral and ulnar heads of the pronator teres muscle (PTM) and the arcade of the flexor digitorum superficialis muscle (FDS) in recently deceased cadavers. In this analysis 20 forearms of 10 recently deceased adult male cadavers were dissected. Dissections were performed in the institution's autopsy room or anatomy laboratory. The short and long heads of the biceps brachii muscle, as well as the BA were identified in all upper upper limbs. The BA received contribution from the short and long heads of the biceps brachii muscle. In 12 upper limbs the BA was wide and thickened and in 8 it was supported by the MN. In 5 upper limbs, the BA was wide but not very thick, and in 3 it was narrow and not very thick. We identified the existence of the FDS muscle arcade in all dissected upper limbs. A fibrous arcade was identified in 4 forearms, a muscular arcade in 14 and a transparent arcade in 2 upper limbs. In all of them, we recorded that the arcade was in contact with the MN. We recorded the humeral and ulnar heads of the PTM in all dissected upper limbs, with the presence of fibrous beams between them along their entire length. The MN was positioned between the humeral and ulnar heads of the PTM in all upper limbs. In eight upper limbs (40 %), we identified that the BA had thickness and contact with the MN with the potential to cause its compression. Compression between the humeral and ulnar heads of the PTM by the fibrous connections has the potential to cause nerve compression in all upper limbs (100 %). We did not identify that the anatomical structure of the FDS arcade had the potential to cause compression in the MN.
El objetivo de este estudio fue analizar la potencial compresión del nervio mediano (NM) causado por la aponeurosis bicipital (AB), las cabezas humeral y cubital del músculo pronador redondo (MPR) y la arcada del músculo flexor superficial de los dedos (MFS). En este análisis se diseccionaron 20 antebrazos de 10 cadáveres masculinos de individuos adultos fallecidos recientemente. Las disecciones se realizaron en la sala de autopsias o en el laboratorio de anatomía de la Institución. En todos los miembros superiores se identificaron las cabezas corta y larga del músculo bíceps braquial, así como la AB. La AB recibió contribución de las cabezas corta y larga del músculo bíceps braquial. En 12 miembros superiores la AB era ancha y engrosada y en 8 estaba sostenida por el NM. En 5 miembros superiores la AB era ancha pero poco gruesa, y en 3 era estrecha y de menor grosor. Identificamos la existencia de la arcada muscular MFS en todos los miembros superiores disecados. Se identificó una arcada fibrosa en 4 antebrazos, una arcada muscular en 14 y una arcada delgada y transparente en 2 miembros superiores. En todos ellos registramos que la arcada estaba en contacto con el NM. Registramos las cabezas humeral y cubital del MPR en todos los miembros superiores disecados, con presencia de haces fibrosos entre ellas en toda su longitud. El NM estaba situado entre las cabezas humeral y cubital del MPR en todos los miembros superiores. En ocho miembros superiores (40 %), identificamos que la AB era gruesa y tenía contacto con el NM con potencial para causar su compresión. La compresión entre las cabezas humeral y ulnar del MPR, por las conexiones fibrosas, tiene el potencial de causar compresión nerviosa en todos los miembros superiores (100 %). No identificamos que la estructura anatómica de la arcada MFS tuviera el potencial de causar compresión del NM.
Assuntos
Humanos , Masculino , Adulto , Antebraço , Nervo Mediano , Anormalidades Musculoesqueléticas , Síndromes de Compressão Nervosa/patologia , Cadáver , Dissecação , CotoveloRESUMO
El presente documento desarrolla las diferentes intervenciones en salud desde la promoción de la salud para las alteraciones musculoesqueléticas, prevención de las alteraciones hasta la atención que deberá ser diferenciada, según categorías funcionales en cualquiera de los niveles de atención, incluyendo las instituciones especializadas en habilitación y rehabilitación. Además, se desarrollan las consideraciones para la atención en habilitación y rehabilitación, que los profesionales de salud del SNIS deberán ejecutar, incluyendo los cuidados paliativos necesarios, las ayudas técnicas y tecnologías de asistencia
This document develops the different health interventions from health promotion for musculoskeletal disorders, prevention of disorders to care that must be differentiated, according to functional categories at any of the levels of care, including institutions specialized in habilitation and rehabilitation. In addition, considerations are developed for habilitation and rehabilitation care, which SNIS health professionals must execute, including the necessary palliative care, technical aids and assistive technologies
Assuntos
Credenciamento , Anormalidades Musculoesqueléticas , Doenças Profissionais , El SalvadorRESUMO
PIK3CA-related overgrowth spectrum (PROS) encompasses different clinical entities caused by somatic activating mutations in PIK3CA. Among PROS, CLOVES syndrome represents a severe phenotype with poor survival rate. We present the case of a 4-month-old girl with CLOVES syndrome successfully treated with alpelisib, a PIKC3A inhibitor.
Assuntos
Classe I de Fosfatidilinositol 3-Quinases , Tiazóis , Humanos , Classe I de Fosfatidilinositol 3-Quinases/genética , Feminino , Lactente , Tiazóis/uso terapêutico , Malformações Vasculares/genética , Malformações Vasculares/tratamento farmacológico , Nefrocalcinose/genética , Mutação , Lipoma , Anormalidades Musculoesqueléticas , NevoRESUMO
Sternal cleft is a rare malformation of the midline fusion of the sternal bars; the most common form is the superior partial defect. Surgical correction with primary closure is the gold standard. It is recommended that the procedure be performed before 3 months of age because of the greater compliance and maximal flexibility of the thoracic wall. These features ensure a safer repair with a low risk of complications and allow for a less extensive procedure that does not require the use of additional techniques. A midline incision is performed in the anterior thoracic wall, and the major pectoralis flaps are raised. The main surgical goal is to change the remaining sternum from a U to a V shape. Transfixing interrupted sutures are placed in the cartilaginous borders for midline closure. Hemodynamics and ventilation are monitored at this time. Closure is performed by layers.
Assuntos
Anormalidades Musculoesqueléticas , Parede Torácica , Humanos , Recém-Nascido , Anormalidades Musculoesqueléticas/cirurgia , Esterno/anormalidades , Esterno/cirurgia , Retalhos Cirúrgicos , Parede Torácica/cirurgiaRESUMO
Morphea and facial capillary malformations (port-wine stains) are distinct conditions that can affect the pediatric population. Early localized morphea mimicking a capillary malformation is an uncommon clinical presentation. We present two new cases of girls, aged 2 and 3 years, who presented with erythematous patches, initially diagnosed as capillary malformations, which were later diagnosed as morphea. We also performed a literature review, yielding 12 additional cases that underscore that the unusual presentation of morphea may delay correct diagnosis. Although early management of morphea reduces long-term sequelae, it is important to delay laser treatment for selected acquired vascular malformations, until the diagnosis of morphea is excluded.
Assuntos
Anormalidades Musculoesqueléticas , Mancha Vinho do Porto , Esclerodermia Localizada , Malformações Vasculares , Capilares/anormalidades , Criança , Feminino , Humanos , Mancha Vinho do Porto/diagnóstico , Esclerodermia Localizada/diagnóstico , Esclerodermia Localizada/epidemiologia , Malformações Vasculares/diagnósticoRESUMO
Abstract The caliber-persistent labial artery is a vascular anomaly in which a primary arterial branch penetrates into the submucosal tissue without reduction in diameter. Most lesions are benign and do not require treatment, except for complications and/or on patient demands. In this way, noninvasive diagnostic tools are preferred such as high-resolution and color Doppler ultrasonography which allow direct observation of the lesion, assessing its exact location and diameter at every axis, as well as the blood flow velocity. An excisional biopsy of these lesions or even their surgical extirpation could have a fatal outcome with profuse bleeding.
Assuntos
Humanos , Malformações Vasculares/diagnóstico , Doenças Labiais/diagnóstico , Anormalidades Musculoesqueléticas , Artérias/diagnóstico por imagem , Ultrassonografia Doppler em CoresRESUMO
Exercise intolerance, a hallmark of patients with heart failure (HF), is associated with muscle weakness. However, its causative microcirculatory and muscle characteristics among those with preserved or reduced ejection fraction (HFpEF or HFrEF) phenotype is unclear. The musculoskeletal abnormalities that could result in impaired peripheral microcirculation are sarcopenia and muscle strength reduction in HF, implying lowered oxidative capacity and perfusion affect transport and oxygen utilization during exercise, an essential task from the microvascular muscle function. Besides that, skeletal muscle microcirculatory abnormalities have also been associated with exercise intolerance in HF patients who also present skeletal muscle myopathy. This cross-sectional study aimed to compare the muscle microcirculation dynamics via near-infrared spectroscopy (NIRS) response during an isokinetic muscle strength test and ultrasound-derived parameters (echo intensity was rectus femoris muscle, while the muscle thickness parameter was measured on rectus femoris and quadriceps femoris) in heart failure patients with HFpEF and HFrEF phenotypes and different functional severities (Weber Class A, B, and C). Twenty-eight aged-matched patients with HFpEF (n = 16) and HFrEF (n = 12) were assessed. We found phenotype differences among those with Weber C severity, with HFrEF patients reaching lower oxyhemoglobin (O2Hb, µM) (-10.9 ± 3.8 vs. -23.7 ± 5.7, p = 0.029) during exercise, while HFpEF reached lower O2Hb during the recovery period (-3.0 ± 3.4 vs. 5.9 ± 2.8, p = 0.007). HFpEF with Weber Class C also presented a higher echo intensity than HFrEF patients (29.7 ± 8.4 vs. 15.1 ± 6.8, p = 0.017) among the ultrasound-derived variables. Our preliminary study revealed more pronounced impairments in local microcirculatory dynamics in HFpEF vs. HFrEF patients during a muscle strength exercise, combined with muscle-skeletal abnormalities detected via ultrasound imaging, which may help explain the commonly observed exercise intolerance in HFpEF patients.
Assuntos
Insuficiência Cardíaca , Anormalidades Musculoesqueléticas , Idoso , Estudos Transversais , Humanos , Microcirculação , Músculo Esquelético , Fenótipo , Volume Sistólico/fisiologiaRESUMO
The caliber-persistent labial artery is a vascular anomaly in which a primary arterial branch penetrates into the submucosal tissue without reduction in diameter. Most lesions are benign and do not require treatment, except for complications and/or on patient demands. In this way, noninvasive diagnostic tools are preferred such as high-resolution and color Doppler ultrasonography which allow direct observation of the lesion, assessing its exact location and diameter at every axis, as well as the blood flow velocity. An excisional biopsy of these lesions or even their surgical extirpation could have a fatal outcome with profuse bleeding.
Assuntos
Doenças Labiais , Anormalidades Musculoesqueléticas , Malformações Vasculares , Artérias/diagnóstico por imagem , Humanos , Doenças Labiais/diagnóstico , Ultrassonografia Doppler em Cores , Malformações Vasculares/diagnósticoAssuntos
Anormalidades Musculoesqueléticas , Costelas , Síndrome do Desfiladeiro Torácico , Descompressão Cirúrgica , Humanos , Anormalidades Musculoesqueléticas/complicações , Costelas/anormalidades , Costelas/diagnóstico por imagem , Costelas/cirurgia , Síndrome do Desfiladeiro Torácico/diagnóstico por imagem , Síndrome do Desfiladeiro Torácico/etiologia , Resultado do TratamentoRESUMO
Objetivo. Esta investigación se propuso establecer la relación entre los desórdenes musculoesqueléticos, el estrés y la calidad de vida de los docentes de un centro del Servicio Nacional de Aprendizaje. Materiales y Método. El estudio fue cuantitativo, no experimental, descriptivo. La muestra estuvo constituida por 55 docentes, seleccionados de forma probabilística aleatoria simple. Los instrumentos utilizados fueron el cuestionario nórdico de des-órdenes musculoesqueléticos, el cuestionario de estrés del Ministerio de la Salud y de la Protección Social y el test de calidad de vida WhoQol Bref versión en español, autorizado por la Organización Mundial de la Salud. El análisis de datos se realizó en el software SPSS versión 23, a partir de estadísticos descriptivos (mediana y rango intercuartílico) y correlativos (r Pearson y Rho Spearman), teniendo en cuenta la distribución normal, la cual se calculó a partir de la prueba Kolmogorov Smirnov. Resultados. Se encontró relación positiva y asociación estadísticamente signifi-cativa entre los desórdenes musculoesqueléticos y los síntomas de estrés y el estrés general (p<0,5 y p<0,01). También se encontró correlación negativa y asociación estadística entre los desórdenes musculoesqueléticos y la mayoría de dominios de la calidad de vida y resultados similares al relacionar el estrés con la calidad de vida (p<0,5 y p<0,01). Conclusión. Se encontró que, a mayor presencia de desórdenes musculoesquelé-ticos y estrés, menor es la calidad de vida en los docentes participantes del estudio
Objective. This research aimed to stablish the relationship between musculoskeletal disorders, stress, and quality of life of professors at a Servicio Nacional de Apren-dizaje campus. Materials and methods. The study was quantitative, non-experimental, de-scriptive. The sample was constituted by 55 professors, selected by a simple random sample. The instruments used were the Nordic Musculoskeletal Questionnaire, the stress questionnaire of Colombia Ìs Ministry of Health and Social Protection, and the Quality of Life Test, WhoQol Bref - Spanish version, authorized by the Word Health Organization. The data analysis was in SPSS-23, based on descriptive sta-tistics (median and interquartile range) and correlative statistics (r Pearson and Rho Spearman), considering the normal distribution, which is calculated according to the Kolmogorov-Smirnov test. Results. Positive relationship and a statistically significant association were found between musculoskeletal disorders and stress symptoms and general stress (p<0,5 and p<0,01). Negative correlation and statistical association were also found between musculoskeletal disorders and most domains of quality of life, as well as similar re-sults when stress was related to quality of life (p <0.5 and p <0.01).Conclusion. It was found that the greater the presence of musculoskeletal disorders and stress, the lower the quality of life in the teachers participating in the study