Resumo Este artigo tem como objetivo discutir as possibilidades de tratamentos conservadores e não medicamentosos para o linfedema. Foi realizada uma revisão não sistemática da literatura, com a inclusão de estudos realizados em humanos com diferentes tipos de linfedema. Várias abordagens de tratamento foram relatadas, sendo a terapia descongestiva complexa considerada o tratamento mais eficaz para o linfedema de membros. Outros tratamentos conservadores foram propostos, como taping, terapia por ondas de choque extracorpórea, acupuntura, fotobiomodulação, endermologia, compressão pneumática intermitente e eletroterapia de baixa intensidade e baixa frequência. A escolha da abordagem terapêutica a ser empregada deve considerar as características do linfedema, a experiência do terapeuta e os desejos do paciente. Além disso, como é uma condição crônica, o paciente deve aderir ao tratamento. Para isso, a proposta terapêutica pode ser a chave para um melhor controle do volume do membro.

Abstract This article aims to discuss the possibilities of conservative and non-pharmacological treatments for lymphedema. A non-systematic review of the literature was carried out, including studies involving human subjects with different types of lymphedema. Several approaches to lymphedema treatment have been reported and Complex Decongestive Therapy (CDT) has been considered the most effective treatment for limb lymphedema. Other conservative treatments have been proposed such as Taping, Extracorporeal Shock Wave Therapy, Acupuncture, Photobiomodulation Therapy, Endermologie, Intermittent Pneumatic Compression, and Low-frequency, Low-intensity Electrotherapy. The choice of the therapeutic approach to be employed should consider lymphedema characteristics, the therapist's experience, and the patient's wishes. In addition, since this is a chronic condition, the patient must adhere to the treatment. To this end, the therapeutic proposal may be the key to better control of limb volume.

Abstract Purpose: Previous studies have questioned whether the triceps brachii muscle tendon (TBMT) has a double or single insertion on the ulna. Aiming to provide an answer, we describe the anatomy of the TBMT and review a magnetic resonance imaging (MRI) series of the elbow. Methods: Forty-one elbows were dissected to assess the details of the triceps brachii insertion. Elbow plastination slices were analyzed to determine whether there was a space on the TBMT. Magnetic resonance imaging from the records of the authors were also obtained to demonstrate the appearance of the pre-tricipital space on MRI. Results: A virtual space on the medial aspect near the TBTM insertion site in the olecranon was consistently found on anatomic dissections. It was a distal pre-tricipital space. Magnetic resonance imaging demonstrated the appearance of the pre-tricipital space on MRI, and its extension was measured longitudinally either in elbow flexion or extension. There was no statistically significant difference between the measurements of this space in the right and left elbows or between flexion and extension (p > 0.05). The coefficient of variation was <10% for all measurements. Conclusion: Knowledge of this structure may be essential to avoid incorrect diagnosis and unnecessary therapeutic interventions.

Abstract Purpose To identify whether the colon mucosa is affected by ten days of gastric restriction in an animal model. Methods An experimental model of gastric restriction was devised using rats. The animals were submitted to surgical gastrostomy, and a cylindrical loofah was inserted into the stomach. We studied 30 adult male Wistar rats divided into three groups: the stomach restriction group (R10); the sham group (S10), which underwent the same procedure except for the loofah insertion; and the control group (C10). The expression of neutral and acid mucins was evaluated using histochemical techniques. Goblet cells and protein content were compared between groups using generalized estimation equations (GEEs). Bonferroni’s multiple comparison was applied to identify differences between the groups. All tests considered a 5% significance level. Results There was an increased expression of neutral mucins, acid mucins and goblet cells in the R10 group. Collagen was also enhanced in the R10 group. Conclusion The colon mucosa is affected by ten days of gastric restriction in an animal model, increasing neutral mucins, acid mucins and collagen content with trophic maintenance.

ABSTRACT Sea level oscillations in time scales between hours and days have a great vertical amplitude regarding the low lying coastal gradient of the beaches in the Rio Grande do Sul coast. However, the mechanism of oscillations is poorly understood since the scarcity of observational data makes it impossible to determine the forces that control sea level oscillations. Therefore, hourly sea level and wind time series with a time period of 650 days were examined. It has been found that the mean tidal and subtidal amplitudes were very similar to each other and that a considerable portion of the energy from sea level oscillations was due to astronomical forces. A new perspective was introduced when high and low frequencies were compared, leading to the comprehension that astronomical tides should be considered in coastal studies in southern Brazil. The sea level time series analyzed in this study showed that the maximum amplitude of the high spring tide was 0.53m, and that the subtidal rise caused by the wind reached up to 0.66m. In general, when large tidal and subtidal amplitudes are added, it can generate extreme events of sea level rise on the coast, which constitute a direct threat to coastal communities and habitats.

RESUMO Objetivo: descrever a presença de linfonodos e suas relações com características demográficas e antropométricas em uma região específica ainda não descrita pelos compêndios de anatomia, por nós denominada de Recesso Carotídeo Recorrencial (RCR), localizada entre o nervo laríngeo recorrente direito, a artéria carótida comum direita e a artéria tireoidea inferior direita. Métodos: foram dissecadas 32 regiões cervicais à direita de cadáveres com até 24 horas de post mortem. O tecido fibrogorduroso do RCR foi ressecado e preparado com fixação em formol. Em seguida, foi submetido a uma sequência crescente de álcoois (70%, 80% e 90%), posteriormente a uma solução de Xilol e, por fim, a uma solução de Salicilato de Metila, respeitando o tempo necessário de cada etapa. O estudo macroscópico foi realizado na peça diafanizada, observando a presença ou não de linfonodos. Quando presentes, foram fotografados e suas medidas foram aferidas com um paquímetro digital. No estudo microscópico, foi utilizada a coloração hematoxilina-eosina para confirmação do linfonodo. Resultados: observou-se a presença de linfonodos em 22 dos 32 espécimes (68,75%), com o número de linfonodos por cadáver variando de zero a seis (média de 1,56±0,29) e tamanho com média de 7,82mmx3,86mm (diâmetros longitudinal x transversal). Conclusão: a relação entre dados antropométricos e presença de linfonodos no RCR (teste exato de Fischer) foi significante para indivíduos normolíneos (p=0,03) e também significante entre a etnia branca (p=0,04).

ABSTRACT Objective: to describe the presence of lymph nodes and their relationships with demographic and anthropometric characteristics in a specific region, not yet described in anatomy compendiums, called by us Recurrent Carotid Recess (RCR) and located among the right recurrent laryngeal nerve, the right common carotid artery, and the right inferior thyroid artery. Methods: 32 right cervical regions were harvested from cadavers within 24 hours post-mortem. The fibro-fatty tissue of the RCR was resected and prepared with formalin fixation. It was then subjected to an increasing sequence of alcohols (70%, 80%, and 90%), subsequently to a solution of Xylol, and finally to a solution of Methyl Salicylate, respecting the time required for each step. The macroscopic study was carried out on the diaphanized piece, observing the presence or not of lymph nodes. When present, they were photographed and their measurements were gauged with a digital caliper. In the microscopic study, hematoxylin-eosin staining was used to confirm the lymph node. Results: the presence of lymph nodes was observed in 22 (68.75%) of the 32 specimens. The number of lymph nodes ranged from zero to six (mean of 1.56±0.29), per cadaver, and their mean size was 7.82mmx3.86mm (longitudinal x transversal diameters). Conclusion: the relationship between anthropometric data and presence of lymph nodes in the RCR (Fisher’s exact test) was significant for medium-height individuals (p=0.03) and also white ones (p=0.04).

Objetivo Descrever o processo de tradução e adaptação transcultural para o português (Brasil) do instrumento Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema (Lymph-ICF-LL). Métodos O processo foi realizado em cinco fases: tradução, retro-tradução, revisão por um comitê de especialistas, pré-teste e tradução final. A tradução inicial foi realizada por dois profissionais e a retro-tradução por dois tradutores. Um comitê de especialistas avaliou a semântica, equivalências idiomática, cultural, e conceitual das questões. Foi realizado um pré-teste em 10 pacientes com linfedema. Resultados Durante o processo de tradução e retro-tradução, foram identificadas pequenas diferenças que foram revisadas pelo comitê. Os pacientes incluídos no préteste identificaram 10 questões como sendo de difícil compreensão, as quais foram reavaliadas pelo mesmo comitê de especialistas. Conclusão Os resultados obtidos após o processo de tradução e adaptação transcultural permitiram a criação de uminstrumento que necessita ser validado emdiferentes populações brasileiras.

Objective The objective of the study is to describe the process of translation and cross-cultural adaptation of the Lymphoedema Functioning, Disability, and Health Questionnaire for Lower Limb Lymphoedema (Lymph-ICF-LL) into (Brazilian) Portuguese. Methods The process was comprised of five steps - translation, back translation, revision by an expert panel, pretest, and final translation. The first translation was performed by two professionals of the healthcare area, and the back translation was performed by two translators. An expert panel assessed the questions for semantics and idiomatic, cultural, and conceptual equivalence. The pretest was conducted on 10 patients with lymphedema. Results Small differences were identified between the translated and back-translated versions, which were revised by the expert panel. The patients included in the pretest found 10 questions difficult to understand; these questions were reassessed by the same expert panel. Conclusion The results of the translation and cross-cultural adaptation of the Lymph- ICF-LL resulted in a Brazilian Portuguese version, which still requires validation with various samples of the local population.

PURPOSE:To describe an effective experimental model to study the Achilles tendon healing.METHODS:Forty male Rattus norvegicus albinus,Wistar lineage adult male weighing 250 to 300g were used for this experiment and thirty were surgically submitted to bilateral partial transverse section of the Achilles tendon. The right tendon was treated with radio waves (RF) whereas the left tendon served as control. On the third postoperative day, the rats were divided into four experimental groups consisting of ten rats each which were treated with monopolar RF adjusted to 650 kHz and 2w, for two minutes twice a week and a group of normal animals without any intervention, until they were sacrificed on the 7th, 14th and 28th days, respectively. Tendons were weighed and collagen quantification was evaluated by hydroxyprolin content.RESULTS:Significant reduction in collagen content on day 7, 14 and 28 was related to control experiment to normal tendon (7 days, p<0.01; 14 e 28 days, p<0.05).CONCLUSION:The experimental model has been effective and available to be used to study Achilles tendon healing.

This study aimed to bring the trapezius muscle, knowledge of the locations where the accessory nerve branches enter the muscle belly to reach the motor endplates and find myofascial trigger points (MTPs). Although anatomoclinical correlations represent a major feature of MTP, no previous reports describing the distribution of the accessory nerve branches and their anatomical relationship with MTP are found in the literature. Both trapezius muscles from twelve adult cadavers were carefully dissected by the authors (anatomy professors and medical graduate students) to observe the exact point where the branches of the spinal accessory nerve entered the muscle belly. Dissection was performed through stratigraphic layers to preserve the motor innervation of the trapezius muscle, which is located deep in the muscle. Eight points were identified: In all cases, these locations corresponded to clinically described MTPs. The eight points where common in these twelve cadavers. This type of clinical correlation between spinal accessory nerve branching and MPT is useful to achieve a better understanding of the anatomical correlation of MTP and the physiopathology of these disorders and may provide a scientific basis for their treatment, providing useful additional information to therapists to achieve better diagnoses and improve therapeutic approaches.

El objetivo de este estudio fue correlacionar los sitios de entrada de los ramos del nervio accesorio en el músculo trapecio con placas motoras y los puntos de gatillo miofasciales. A pesar de las correlaciones anatomoclínicas se constituyeren en la principal característica de los puntos de gatillo, no hay informes en la literatura describiendo sobre la distribución de los ramos del nervio accesorio y su relación anatómica con los puntos de gatillo. Ambos músculos trapecio de doce cadáveres adultos fueron disecados por los autores (profesores de anatomía y estudiantes de postgrado en Medicina) para observar el punto exacto donde los ramos del nervio accesorio espinal penetraban en el vientre muscular. La disección se llevó a cabo respetando las capas estratigráficas para preservar la inervación del músculo ubicada profundamente a éste. Ocho puntos fueron identificados: En todos los casos correspondieron a la descripción clínica de los puntos gatillo miofasciales y eran comunes a todos los cadáveres. Esta correlación anatomoclínica entre la ramificación del nervio espinal accesorio y los puntos de gatillo miofascial es útil para una mejor comprensión de la fisiopatología de los puntos gatillo y puede proporcionar una base para un abordaje diagnóstico y terapéutico racional para estos trastornos.

Metástases linfonodais representam um dos principais fatores prognósticos no câncer colorretal. A ressecção linfonodal inadequada relaciona-se à menor sobrevida. A proporção entre linfonodos metastáticos (PLM) vem sendo utilizada como fator prognóstico em doentes com câncer de cólon. Poucos estudos avaliaram o impacto da PLM na sobrevida de doentes com câncer retal. OBJETIVO: Avaliar o impacto da PLM na sobrevida de doentes com câncer de reto não submetidos à quimioradioterapia pré-operatória. MÉTODOS: Foram incluídos 90 doentes com adenocarcinoma retal excluindo-se tumores de cólon, tumores sincrônicos, câncer colorretal hereditário e aqueles submetidos a tratamento radioquimioterápico pré-operatório. Os doentes foram divididos em três grupos segundo a PLM: PLM-0, sem linfonodos comprometidos; PLM-1, 1 a 20% dos linfonodos comprometidos; e PLM-2, mais de 21% dos linfonodos comprometidos. A identificação do ponto de corte da amostra selecionada foi obtida a partir da curva de características de operação do receptor (curva ROC). A sobrevida foi avaliada pelo teste de Kaplan-Meier, a diferença entre os grupos pelo teste de Cox-Mantel e a correlação entre as variáveis pelo teste de Pearson, adotando-se um nível de significância de 5% (p<0,05). RESULTADOS: A sobrevida em cinco anos relacionou-se à classificação de Dukes, TNM, número de linfonodos metastáticos e PLM. Houve diferença na sobrevida ao compararem-se as diferentes classes de PLM. Doentes classificados como PLM-0 apresentaram sobrevida de 85%, enquanto os pertencentes às classes PLM-1 e PLM-2, de 73 e 19%, respectivamente (p=0,0001). CONCLUSÃO: Os resultados encontrados mostraram que a PLM tem impacto na sobrevida de doentes com câncer de reto não submetidos à neoadjuvância.</

Lymph node metastases are a major prognostic factor in colorectal cancer. Inadequate lymph node resection is related to shorter survival. The lymph nodes ratio (LNR) has been used as a prognostic factor in patients with colon cancer. Few studies have evaluated the impact of LNR on the 5-year survival of patients with rectal cancer. OBJECTIVE: To evaluate the impact of LNR on the survival of patients with rectal cancer not submitted to preoperative chemoradiotherapy. METHODS: Ninety patients with rectal cancer excluding colon tumors, synchronous tumors, hereditary colorectal cancer and those undergoing preoperative chemoradiation. The patients were divided into three groups according t < 0.05). RESULTS: The 5-year survival was related to the Dukes classification, TNM, number of metastatic lymph nodes and LNR. A difference was observed in 5-year survival between the different classes of LNR. Patients classified as LNR-0 had a survival rate of 85%, while classes LNR-1 and LNR-2, 73 and 19%, respectively (p=0.0001). CONCLUSIONS: The results showed that the LNR has an impact on 5-year survival of patients with rectal cancer not submitted to neoadjuvant therapy.

OBJETIVO: Avaliaram-se os efeitos do clareamento dental caseiro na liberação de oxigênio a partir de dentes clareados, na resistência de união ao cisalhamento e microinfiltração de restaurações com resina composta. METODOLOGIA: Foram selecionados 40 incisivos bovinos para titulação dos níveis de oxigênio pelo método iodométrico e 26 dentes para resistência de união e microinfiltração. Para titulação os dentes foram divididos em 4 grupos: T1- clareado e titulado após 24 h; T2- clareado e titulado após 48 h; T3- não clareado e titulado após 24 h; T4- não clareado e titulado após 48 h. No grupo T5 não se usaram dentes, servindo como controle inicial do teor de oxigênio. Para cisalhamento associado a microinfiltração dividiram-se aleatoriamente os dentes em 2 grupos: CM1- clareado; CM2- não clareado. O regime de tratamento clareador (Opalescense a 15%, Ultradent, South Jordan, UT, USA) foi de 8 h por dia durante 3 semanas. Para as restaurações utilizou-se a resina Z250 (3M-ESPE, St. Paul, MN, USA) com adesivo Single Bond (3M-ESPE, St. Paul, MN, USA). RESULTADOS: Houve aumento significativo na liberação de oxigênio durante nas primeiras 24 h pós clareamento (ANOVA, P=0,0001). O teste t de Student confirmou diminuição da resistência de união para o grupo clareado (P=0,0001). Houve significante aumento na microinfiltração no grupo clareado, independentemente do examinador (teste de Wilcoxon: 1. P=0,0003; 2. P=0,0023; 3. P=0,0029). CONCLUSÃO: Há considerável variação nos resultados de liberação de oxigênio, resistência de união e microinfiltração em dentes submetidos a clareamento dental caseiro.

PURPOSE: This in vitro study evaluated the effect of home dental bleaching on oxygen release, shear bond strength to enamel, and microleakage of direct composite restorations. METHODS: Forty bovine incisors were used for oxygen dissolved titration by means of iodometric methods modified by azide iodine and 26 for the shear bond strength and microleakage tests. For titration the teeth were divided into four groups: T1 - bleached and titrated after 24 h; T2 - bleached and titrated after 48 h; T3 - unbleached and titrated after 24 h; T4 - unbleached and titrated after 48 h. T5 group served as control for the initial oxygen release rate. To analyze shear bond strength and microleakage, the teeth were randomly divided into two groups: CM1 - bleached; CM2 - unbleached. The bleaching agent Opalescence 15% (Ultradent, South Jordan, UT, USA) was applied for 8 h per day for three weeks. Z 250 (3M-ESPE, St. Paul, MN, USA) composite and Single Bond (3M-ESPE, St. Paul, MN, USA) adhesive were used for the composite restoration procedures. RESULTS: There was an increase in oxygen release during the first 24 h post bleaching (ANOVA, P=0.0001). The bleached teeth showed a decrease in shear bond strength (Student's t test, P=0.0001). The microleakage scores increased with bleaching independently from the examiner (Wilcoxon's test: 1. P=0.0003; 2 P=0.0023; 3. P=0.0029). CONCLUSION: Considerable variation was noticed in the results of oxygen release, as well as in the results of shear bond strength and microleakage on bleached teeth.

O estudo do genoma humano propiciou recentes descobertas de genes e de complexos mecanismos de controle da linfangiogênese. Neste artigo esses conhecimentos são revistos, com suas implicações na embriogênese e desenvolvimento do sistema linfático e na etiopatogenia de diferentes formas e síndromes de linfedema hereditário. Algumas doenças linfáticas de transmissão genética e síndromes de aneuploidia são descritas nas suas características genotípicas e fenotípicas. Os avanços na compreensão do crescimento e desenvolvimento dos vasos linfáticos devem trazer novas alternativas terapêuticas nas linfangiodisplasias e no controle da disseminação linfática dos tumores.

Recent advances in the exploration and manipulation of the human genome provided new insights into the intricate genetics and control of lymphangiogenesis. Implications for embryogenesis and development of the lymphatic system and its role in some familial and aneuploid syndromes are reviewed, along with their genotypic and phenotypic characteristics. Increased understanding of growth and development of the lymphatic vessels may bring new therapeutic options for lymphatic angiodysplasias and control of the lymphatic spread of tumors.