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The coracobrachialis muscle belongs to the anterior group of the brachial region. Its main functions are flexion and adduction at the glenohumeral joint. It is highly morphologically variable, especially in the number of bellies, place of origin or insertion, and its relationship to the musculocutaneous nerve. Accessory structures associated with the coracobrachialis muscle include the coracobrachialis brevis or coracobrachialis longus muscle. The present case describes a three-headed coracobrachialis muscle with two such additional structures. One of these has a tendinous origin connected to the periosteum and located on the surgical neck of the humerus. Its insertion is fused with the third head of the coracobrachialis muscle. The other has a proximal attachment fused with the capsule of the shoulder joint, and its distal attachment is fused with the third head of the coracobrachialis muscle in place of its connection with the short head of the biceps brachii. This could result in better stabilisation of the glenohumeral joint; on the other hand, it could limit operational access during treatment of subscapularis tears.

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The aim was to determine the variations in the level of origin of carotid bifurcation and diameters of the common, internal, and external carotid arteries which is clinically important for several interventional procedures. Therefore, 165 human embalmed corpses were dissected. The data collected were analyzed using the Chi square-test and the Pearson correlation test. The results of previous studies have been reviewed. In relation to the level of the carotid bifurcation, taking as a reference point the hyoid bone, the values ranged from 4 cm below the hyoid body to 2.5 cm above the body of the hyoid, being the average height-0.33 cm, with a standard deviation of 1.19 cm. The right carotid bifurcation was established at a higher level (x = - 0.19 cm.) than the left one (x = - 0.48 cm.) (p = 0.046). On the contrary, no significant gender differences could be observed. The arterial calibres of the common and internal carotid arteries were higher in male than female. In the internal carotid artery (X = 0.76 cm.), the left was greater than the right (X = 0.72 cm.) (P = 0.047). However, no differences in the distribution of the calibre of the external carotid artery were found neither by side nor gender. Variations in the level of bifurcation and calibres of carotid arteries are relevant for interventional radiology procedures and head and neck surgeries. Knowledge of these anatomical references might help clinicians in the interpretation of the carotid system.

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PURPOSE: Lumbar discogenic diffuse pain is still not understood. Authors describe the sinuvertebral nerve (SVN) as one possible cause. Body-donor studies are rare and controversial. Therefore, the aim was to revisit the origin, course and distribution in a body-donor study. METHODS: Six lumbar blocks (3 female, 3 male) aged between 59 and 94 years were dissected. After removal of the back muscles, lamina, dura mater and cauda equina, the anterior vertebral venous plexus, spinal artery and SVN were exposed and evaluated. RESULTS: 43 nerves out of 48 levels could be evaluated. The origin of the SVN was constituted by two roots: a somatic and a sympathetic branch arising from the rami communicantes. In 4/48 intervertebral canals studied (8.3%), we found two SVN at the same level. In 35/48 cases, one SVN was found. In 9/48 cases, no SVN was found. The SVN had a recurrent course below the inferior vertebral notch; in the vertebral canal it showed different patterns: ascending branch (31/43, 72.1%), common branch diverging into two branches (10/43, 23.3%), double ascending branch (1/43, 2.3%) finalizing two levels above and a descending branch (1/43, 2.3%). In 12/43 cases (27.9%) the SVN had ipsilateral connections with another SVN. The distribution ended in the middle of the vertebral body supplying adjacent structures. CONCLUSION: A thorough understanding of the anatomy of the SVN might lead to significant benefits in therapy of discogenic low back pain. We suggest blocking the SVN at the level of the inferior vertebral notch of two adjacent segments. LEVEL OF EVIDENCE I: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

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PURPOSE: The quadriceps femoris has been described as a muscle composed by four heads: rectus femoris, vastus lateralis, vastus medialis and vastus intermedius. Each head fuse with the other ones making up the quadriceps tendon, which inserts into the patella. Nevertheless, there has been described a fifth component of the quadriceps muscle in recent anatomical publications. Understanding this fifth head may be important for orthopedics and radiologist. METHODS: Cadaveric dissection of left thigh of a female 83 years old was performed to demonstrate a fifth head of the quadriceps femoris muscle. RESULTS: In this study, a fifth head of the quadriceps femoris muscle was found in the left thigh of a female cadaver 83 years old. This fifth head was made up by four independent muscular fascicles attaching in a common flat tendon that joins distally with the lateral border of the quadriceps tendon. The fifth head found was supplied by branches of the ascending branch of the lateral femoral circumflex artery and by branches of the deep lateral division of the femoral nerve. CONCLUSIONS: The incidence of this fifth belly in cadaveric studies has been reported as a range from 29 to 100%. However, no published articles refer an anatomical finding such as this multi-bellied fifth head. The knowledge of the existence and location of the fifth belly is necessary to make accurate diagnosis of QF muscle strains. Its anatomical course may be involved in patellar tracking.

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Introducción: Se ha establecido que existen fuerzas eléctricas que tienen la capacidad de dañar la estructura dental generando su descalcificación. El objetivo es demostrar que el modelo electroquímico permite explicar el proceso de disolución del esmalte dental, a través de la aplicación de un potencial constante, a fin de registrar corriente eléctrica, liberación de ion Ca2+ y evaluar daño superficial del esmalte dental. Material y métodos: Estudio in vitro en 32 terceros molares sin caries, divididos aleatoriamente en dos grupos sumergidos en solución tampón láctico-lactato. Grupo 1, sometido a potencial de +1,5 V y grupo 2, se dejó evolucionar espontáneamente en el tiempo. Se cuantificó la concentración de Calcio (Ca2+) liberado (mg), a través de un espectrofotómetro de absorción atómica para establecer la concentración media por grupo. Se compararon las medianas mediante el test estadístico Wilcoxon Mann-Whitney usando el programa Stata v.11.2. Además, se realizó evaluación del daño superficial del esmalte dental por técnica de microscopía óptica y electrónica. Resultados: Se registraron corrientes no nulas en todos los dientes sometidos a potencial +1,5 V. La liberación de Ca2+ entre grupos arrojó mayor liberación mediana de Ca2+ en el grupo electrólisis (12,3 [RIC= 4,5-18,2] vs. 6,5 [RIC= 3,7-15,4]) y al observar bajo lupa estereoscópica y microscopio electrónico de barrido, se visualiza una mayor destrucción en el grupo 1. Discusión: Los resultados permiten verificar la hipótesis en cuanto a haber encontrado evidencia empírica respecto al comportamiento electroquímico del proceso de degradación del esmalte dental (AU)

Introduction: It has been established that there are electrical forces that have the capacity to damage the tooth structure generating decalcification. The aim is to demonstrate that the electrochemical model can explained the dissolution of tooth enamel, through the application of a constant potential, in order to register electric current, liberation from Ca2+ and to evaluate surface damage tooth enamel. Material and method: In vitro study on 32 third molars without caries, randomly divided into two groups immersed in a buffer of lactic-lactate solution. Group 1 underwent +1.5 V potential and Group 2 was allowed to evolve spontaneously over time. Ca2+ released (mg) was quantified through an atomic absorption spectrophotometer to set the average concentration per group. Means were compared using Wilcoxon statistical test Mann-Whitney using the Stata v.11.2 program. Also an evaluation of surface damage tooth enamel technique optical and electron microscopy was performed. Results: We recorded non-zero current on all teeth undergoing potential +1.5 V. The release of Ca2+ between groups showed higher median liberation from Ca2+ in the Electrolysis group (12.3 [IQR = 4.5 to 18 2] vs. 6.5 [IQR= 3.7 to 15.4]) and observed under stereomicroscope and scanning electron microscope, further destruction is displayed in group 1. Discussion: The results allow to bear out the hypothesis, it has been found an empirical evidence regarding the electrochemical behavior of the degradation process of tooth enamel (AU)

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Introducción: Recientemente se han introducido las resinas bulk-fill, las cuales pueden ser utilizadas con técnica monoincremental, disminuyendo el tiempo clínico y ofreciendo una técnica menos sensible. El objetivo de este estudio es evaluar la estabilidad marginal de una resina compuesta condensable, utilizando técnica incremental oblicua versus una resina monoincremental con activación sónica en restauraciones clase II. Materiales y método: A 16 terceros molares sanos se les realizó dos preparaciones cavitarias clase II. Las dimensiones de las preparaciones fueron estandarizadas: 3 mm de ancho vestibulolingual, 2 mm de profundidad y 1,5 mm en sentido mesiodistal para el cajón oclusal, y 3 mm de ancho vestibulolingual, 4 mm de profundidad y 1,5 mm en sentido mesiodistal para el cajón proximal, determinándose al azar restaurar una preparación con resina condensable FiltekTM P60 (3M(R) ESPE-USA) utilizando técnica incremental, y la segunda preparación con resina SonicFillTM (Kerr-USA) con técnica monoincremental y activación sónica. Las muestras se termociclaron en azul de metileno al 1%, se cortaron en sentido mesiodistal y analizaron mediante microscopio óptico. Se cuantificó el grado de penetración del agente infiltrador en el margen cavosuperficial oclusal y gingival de ambas resinas. Se realizó un test exacto de Fisher y posterior U de Mann-Whitney. Resultados: La profundidad de infiltración del borde cavosuperficial gingival fue significativamente menor para FiltekTM P60 comparado con SonicFillTM (p= 0,028). Discusión: Ambas técnicas presentaron valores similares de estabilidad marginal en el borde cavosuperficial oclusal, sin embargo la resinas FiltekTM P60 presenta una mayor estabilidad marginal en el borde cavosuperficial gingival (AU)

Introduction: Recently, bulk-fill resin shave been introduced, which can be used with a mono-incremental technique, shortening clinical time and offering a less sensitive technique. The purpose of this study was to evaluate the marginal stability of condensable composite resins by using incremental technique versus a bulkfill resin with sonic activation. Material and method: Two Black’s class II cavities preparations were performed on 16 healthy third molars. The overall dimensions and depth of cavities were standardized as follows: 3 mm wide, 2 mm deep and 1,5 mm of mesiodistal lenght at the occlusal box, and 3 mm wide, 4 mm deep and 1,5 mm of mesiodistal length at the proximal box. It was randomly determined to restore a preparation with condensable resin FiltekTM P60 (3M(R) ESPE-USA) using oblique incremental technique, while these cond preparation used SonicFillTM resin (Kerr- USA) with mono-incremental technique and sonic activation. These were thermocycled in methylene blue 1%, then cut in mesio-distal sense and analysed by optical microscope. The degree of penetration of the infiltrator agent in the oclusal cavosurface margin and gingival wall of both resins was measured. Fisher’s exact test and a subsequent Mann-Whitney U test were performed. Results: The amount of infiltration in gingival cavosurface margin was significantly lower for Filtek™ P60 compared with SonicFillTM (p= 0.028). Discussion: Both techniques presented similar values of marginal stability in the oclusal cavosurface margin, however, resinFiltekTM P60 has greater stability in the gingival cavosurface margin (AU)

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Introducción: Recientemente se han desarrollado las resinas bulk-fill que pueden ser utilizadas con técnica monoincremental, reemplazando la tradicional técnica incremental oblicua y acortando el tiempo clínico. El objetivo de este estudio es evaluar la adaptación de las resinas compuestas a las paredes internas cavitarias, utilizando técnica incremental oblicua y monoincremental con activación sónica. Material y método: Se utilizaron 15 terceros molares sanos, a los cuales se les realizó dos preparaciones cavitarias clase II con márgenes en esmalte, de dimensiones en sentido mesiodistal de 3 mm, vestibulolingual de 2,5 mm, profundidad oclusopulpar de 2 mm y profundidad oclusoproximal de 4 mm. Las preparaciones distales se restauraron utilizando la resina convencional FiltekTM Z350 XT con técnica incremental y las mesiales con la resina bulk-fill SonicFillTM con técnica monoincremental y activación sónica. Las muestras fueron cortadas en sentido mesiodistal y analizadas mediante microscopio óptico a aumento de 10× y 40×. Se midió el porcentaje de adaptación de ambas resinas y se realizó un test ANOVA de dos vías con prueba post hoc de Tukey. Resultados: No se encontró diferencia estadísticamente significativa en la adaptación interna cavitaria utilizando la técnica monoincremental con activación sónica y la incremental oblicua (p>0,01). Discusión: La técnica monoincremental con activación sónica, a pesar de tener un menor tiempo en el mercado, menor tiempo de entrenamiento clínico y menor consumo de tiempo clínico presentó valores similares de adaptación a las paredes internas cavitarias que la técnica incremental oblicua (AU)

Introduction: Recently, Bulk-Fill resins have been developed and they can be used with a mono-incremental technique, eliminating the traditional oblique incremental technique and shortening the clinical time. The aim of this study is to evaluate the internal adaptation of composite resins using oblique incremental and monoincremental techniques with sonic activation. Material and method: 15 healthy third molars were used and two enamel finished class II cavity was performed on each one of them. Dimensions were: 3 mm mesio-distal, 2.5 mm buccal-lingual, 2 mm occlusal-pulp depth, and 4 mm occlusal-proximal depth. The distal preparations were restored using a conventional FiltekTMZ350 XT (3M ESPE, USA) resin with oblique incremental technique and the mesial ones were restored using Bulk-Fill SonicFillTM (Kerr, USA) resin through mono-incremental technique and sonic activation. The samples were cut in a mesiodistal direction and analyzed with an optical microscopy at 10× and 40× magnification. The percentage of adaptation of both resins was measured, and a two-way ANOVA with Tukey correction was performed. Results: No statistically significant difference was found in the adaptation of both resins, using oblique incremental and mono-incremental techniques with sonic activation (p>0.01). Discussion: Both techniques reported similar values of adaptation, therefore, the mono-incremental technique with sonic activation is a recently introduced technique, which seems to be less sensitive than oblique incremental technique (AU)

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Forestier's disease or diffuse idiophatic skeletal hyperostosis is a systemic reumathological abnormality of unknown etiology. It produces calcificationossification of the anterior longitudinal ligament. The low dorsal region is the most affected in the raquis. These patients are tipically asymptomatic or with few symptoms (minimal joint pain, spinal pain, stiffness). Dysphagia is the most common symptom when the disease affects the cervical spine; less frequent is dyspnea, both secondary to extrinsic compression of the esophagus and trachea. Neurological complaints are quite rare. In the 1970s Resnick described specific radiological criteria for the diagnosis of Forestier's disease that are still used today. It affects men more frequently than women (2:1); the peak occurrence is in patients in their 60s. We present two cases diagnosed by severe difficulty with deglution, a 84 years-old woman and a 54 years-old man; we operated on them for surgical decompression of the esophagus with resection of osteophytes C3-C4 and C5-C6 respectively through a conventional anterolateral neck approach. Relief of difficulty in swallowing was immediately ensued.

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La enfermedad de Forestier-Rotes-Querol o "hiperostosis esquelética idiopática difusa" es una enfermedad reumatológica con afectación sistémica18. Consiste en la calcificación-osificación del ligamento longitudinal común anterior (LLCA), de etiología aún desconocida, sin otros cambios degenerativos. La región más frecuentemente afectada en el raquis es la región dorsal baja18,28. La mayoría de casos se mantienen asintomáticos o con mínimos síntomas como dolor articular leve y dolor de espalda25. El síntoma más común cuando está implicada la columna cervical es la disfagia; menos frecuente es la disnea, ambos síntomas secundarios a la compresión extrínseca del esófago y la tráquea. La presencia de déficits neurológicos es rara18,21,25. En la década de los 70 se definieron criterios radiológicos específicos para el diagnóstico de la enfermedad de Forestier que todavía hoy se emplean18,28,29,30. Predomina en varones en la década de los 60 años18,25. Presentamos en este trabajo dos casos diagnosticados por alteraciones importantes en la deglución, una mujer de 84 años y un varón de 54 años de edad; ambos fueron intervenidos quirúrgicamente para la extirpación-fresado de una exostosis ósea de gran tamaño existente en C3-C4 y C5- C6, respectivamente, mediante un abordaje anterior convencional a la columna cervical; la mejoría clínica fue inmediata tras la cirugía, con resolución completa del trastorno deglutorio

Forestier's disease or diffuse idiophatic skeletal hyperostosis is a systemic reumathological abnormality of unknown etiology18. It produces calcification ossification of the anterior longitudinal ligament. The low dorsal region is the most affected in the raquis18,28. These patients are tipically asymptomatic or with few symptoms (minimal joint pain, spinal pain, stiffness)25. Dysphagia is the most common symptom when the disease affects the cervical spine; less frequent is dyspnea, both secondary to extrinsic compression of the esophagus and trachea. Neurological complaints are quite rare18,21,25. In the 1970s Resnick described specific radiological criteria for the diagnosis of Forestier's disease that are still used today18,28,29,30. It affects men more frequently than women (2:1); the peak occurrence is in patients in their 60s18,25. We present two cases diagnosed by severe difficulty with deglution, a 84 years-old woman and a 54 years-old man; we operated on them for surgical decompression of the esophagus with resection of osteophytes C3-C4 and C5-C6 respectively through a conventional anterolateral neck approach. Relief of difficulty in swallowing was immediately ensued

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We present another case of delayed intracerebral hemorrhage after a ventriculoperitoneal (VP) shunting procedure. In this case, a right occipital intraparenchymal hematoma and associated intraventricular hemorrhage occurred six days after the operation for hydrocephalus secondary to subarachnoid hemorrhage in a 64 year old woman. It is a rare complication of VP shunting, with few cases reported previously in the literature. The presumed mechanism is the erosion of a cerebral blood vessel secondary to a close contact with the ventricular catheter; bleeding disorder, vascular malformation, head trauma or brain tumor were excluded in this patient.

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We present another case of delayed intracerebralhemorrhage after a ventriculoperitoneal (VP) shuntingprocedure. In this case, a right occipital intraparenchymalhematoma and associated intraventricularhemorrhage occurred six days after the operation forhydrocephalus secondary to subarachnoid hemorrhagein a 64 year old woman. It is a rare complication of VPshunting, with few cases reported previously in the literature.The presumed mechanism is the erosion of acerebral blood vessel secondary to a close contact withthe ventricular catheter; bleeding disorder, vascularmalformation, head trauma or brain tumor were excludedin this patient

Presentamos un caso de hemorragia intracerebraltardía tras la colocación de una derivación ventriculoperitoneal.Una paciente de 64 años de edad, con hidrocefaliasecundaria a una hemorragia subaracnoidea,sufre una hemorragia intraparenquimatosa occipitalderecha con hemorragia intraventricular secundariaseis días después de la intervención quirúrgica.Se trata de una complicación rara de la derivaciónventriculoperitoneal, con pocos casos publicados anteriormente.El mecanismo supuesto es la erosión de unvaso sanguíneo secundaria a un íntimo contacto con elcatéter proximal de la derivación; trastornos sanguíneos,malformaciones vasculares cerebrales, traumatismocraneal o tumor cerebral fueron excluidos en estapaciente

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We describe a 53 year old man with a two months history of frontal headache and right visual loss, with complete right blindness at the moment of diagnosis. Neither nasal obstruction nor endocrine symptoms were found. Computerized Tomography showed a neoplasm involving both paranasal sinuses and sellar region, with bilateral orbital extension. The patient underwent a bifrontal craniotomy with apparent complete excision. Histopathologic examination proved smooth muscle cells sarcoma (leiomyosarcoma). Clinical evolution was unfavorable, with rapid local recurrence. The patient died of cerebellar metastasis 4 months after the initial diagnosis and treatment. Leiomyosarcoma of the sinonasal tract is an unusual tumor, and we have found only 63 cases previously reported. The most frequent clinical presentation is nasal obstruction. Surgery is the treatment of choice, as far as radiotherapy or chemotherapy do not appear to slow disease progression. No relationship has been found between the aggressiveness of leiomyosarcoma of the sinonasal tract and morphologic parameters; instead, prognosis is dependent on the distribution of disease at clinical onset. Leiomyosarcoma of the sinonasal tract may be regarded as a locally aggressive neoplasm with only limited metastatic potential.

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The effect of continuous intraventricular infusion of phenytoin and valproic acid into the brain of pigs was studied through quantitative measurement of animal behavior, pathological study of animal's brain and measurement of the levels of these drugs in the blood and C.S.F. Two groups of five animals each were treated with increasingly doses of the drugs until the apparition of toxic effects and the dead of animals. Normal behavior was observed with doses up to 3 mg/day of phenytoin and 1.5 mg/day of valproic acid. Toxic effects consisted on severe unsteadiness and muscular rigidity. Pathological study of the brains revealed that there were no damage attributable to the intraventricular infusion of the drugs. The present study suggests that intrathecal or intraventricular infusion of phenytoin and valproic acid could be well tolerated by humans and it leads us to consider subsequent clinical studies in epileptic patients.

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