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BACKGROUND & AIMS: Creatine is a dietary supplement with potential capacity to stimulate the phosphocreatine pathway and protein synthesis, through the stimulation of the PI3-K/AKT and mTOR cascade, its use in populations with reduced muscle preservation capacity (such as the older adults) can be an interesting and low-cost alternative. The aim of the present study was to evaluate the morphological, stereological and morphometric effects of the use of creatine monohydrate for 8 weeks on the renal, hepatic and muscular tissues of 26-month-old Wistar rats. METHODS: Twelve Wistar rats were divided into two groups of six animals each. Group 1 was not supplemented with creatine and received a standard diet consisting of water and chow. Group 2 received the same diet, but was supplemented with creatine monohydrate at a dose of 0.3 mg/kg of body weight diluted in 200 ml of drinking water for 8 weeks. RESULTS: Supplementation reduced muscle mass loss as indicated by the perimeter of the perimysium (group 1: 114.6 µm; group 2: 65.2 µm) and endomysium (group 1: 41,239.3 µm; group 2: 12,437.6 µm) compared to the non-supplemented group. In addition, a larger cross-sectional area was observed in group 2. No significant kidney or liver damage was observed in the supplemented group. CONCLUSIONS: The use of creatine is considered safe in the animal model used, as this amine does not cause glomerular reductions or hepatic degeneration.

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BACKGROUND: Spontaneous otogenic pneumocephalus is a rare condition caused by erosion of the tegmen tympani with subsequent entrance of air into the intracranial space. Its pathogenesis is thought to involve a previous state of intracranial hypotension, which pulls air into the intracranial cavity. The surgical management involves obliteration of the tegmen defect via a mastoidectomy or a middle fossa approach. Lumbar drainage has been used safely as an adjunct to middle fossa approaches so as to provide brain relaxation and decrease the incidence of postoperative cerebrospinal fluid leaks. CASE DESCRIPTION: A 66-year-old male patient with otogenic pneumocephalus caused by nose blowing underwent repair of a tegmen tympani defect through a middle fossa approach, with the aid of intraoperative lumbar drainage. Progressive neurologic deterioration was seen postoperatively with obtundation and anisocoria. Computed tomography scans of the head demonstrated marked midline shift and transtentorial herniation. Recumbency and blood patch failed to improve the neurological condition. Intrathecal infusion of normal saline enabled clinical and radiological improvement. CONCLUSIONS: Intraoperative lumbar drainage during a middle fossa approach for spontaneous otogenic pneumocephalus may dramatically aggravate a state of preexisting intracranial hypotension and lead to transtentorial herniation.

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Brachial plexus neuropathies are common complaints among patients seen at orthopedic clinics. The causes range from traumatic to occupational factors and symptoms include paresthesia, paresis, and functional disability of the upper limb. Treatment can be surgical or conservative, but detailed knowledge of the brachial plexus is required in both cases to avoid iatrogenic injuries and to facilitate anesthetic block, preventing possible vascular punctures. Therefore, the objective of this study was to evaluate the topography of the infraclavicular brachial plexus fascicles in different upper limb positions adopted during some clinical procedures. A formalin-preserved, adult, male cadaver was used. The infraclavicular and axillary regions were dissected and the distance of the brachial plexus fascicles from adjacent bone structures was measured. No anatomical variation in the formation of the brachial plexus was observed. The metric relationships between the brachial plexus and adjacent bone prominences differed depending on the degree of shoulder abduction. Detailed knowledge of the infraclavicular topography of neurovascular structures helps with the diagnosis and especially with the choice of conservative or surgical treatment of brachial plexus neuropathies.

Las neuropatías del plexo braquial son quejas comunes entre los pacientes atendidos en las clínicas ortopédicas. Las causas van desde traumas a factores ocupacionales y los síntomas incluyen parestesias, paresia e incapacidad funcional del miembro superior. El tratamiento puede ser quirúrgico o conservador, pero se requiere un conocimiento detallado del plexo braquial en ambos casos para evitar lesiones iatrogénicas y para facilitar el bloqueo anestésico, evitando posibles lesiones vasculares. Por lo tanto, el objetivo de este estudio fue evaluar la topografía de los fascículos del plexo braquial infraclavicular en diferentes posiciones de los miembros superiores adoptadas durante algunos procedimientos clínicos. Se llevó a cabo la disección de las regiones infraclavicular y axilar de un cadáver adulto, de sexo masculino, conservado en formaldehído. Se midió la distancia de los fascículos del plexo braquial en relación a las estructuras óseas adyacentes. No se observó variación anatómica en la formación del plexo braquial. Las relaciones métricas entre el plexo braquial y las prominencias óseas adyacentes difieren en función del grado de abducción del hombro. El conocimiento detallado de la topografía infraclavicular de las estructuras neurovasculares ayuda con el diagnóstico y sobre todo con la elección del tratamiento conservador o quirúrgico de las neuropatías del plexo braquial.

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