Resumo O baço é suprido pelo fluxo sanguíneo da artéria e veia esplênicas. O objetivo desta comunicação é apresentar um baço ectópico suprido apenas pelo fluxo sanguíneo reverso proveniente dos vasos gastromentais esquerdos. Um paciente de 14 anos apresentou esplenomegalia pélvica suprida apenas por artéria e veia gastromentais esquerdas, conectadas aos vasos polares inferiores, que eram os únicos presentes nesse baço. Após a distorção do baço e a esplenopexia, o baço voltou às dimensões normais. Não houve intercorrências no acompanhamento do paciente. Em conclusão, os vasos gastromentais esquerdos são capazes de suprir o fluxo sanguíneo de todo o baço.

Abstract The spleen is supplied by blood flow through the splenic artery and vein. The purpose of this communication is to report an ectopic spleen supplied only by reverse flow through the left gastro-omental vessels. A 14-year-old boy presented with pelvic splenomegaly supplied only by the left gastro-omental artery and veins connected to the inferior polar vessels, which were the only vessels communicating with the spleen. After detorsion of the spleen and splenopexy, the spleen returned to normal dimensions. The patient had uneventful follow-up. In conclusion, the left gastroepiploic vessels are able to maintain the entire spleen blood supply.

RESUMO - RACIONAL: O conhecimento do sistema porta e de suas variações anatômicas contribui para prevenir acidentes cirúrgicos. Usualmente, a veia porta é formada pela confluência das veias mesentérica superior e esplênica, junto com suas principais tributárias: as veias mesentérica inferior, gástrica esquerda e pancreaticoduodenal. Entretanto, variações anatômicas são frequentes. OBJETIVO: Este artigo apresenta uma revisão da literatura em relação às variações anatômicas previamente descritas do sistema venoso porta e sua frequência. MÉTODOS: Foi realizada revisão sistemática de estudos primários nas bases de dados PubMed, Scielo, BIREME, LILACS, Embase, Science Direct e Scopus. As bases de dados foram pesquisadas pelas seguintes palavras-chave: Anatomia, Veia porta, Veia mesentérica, Formação, Variação, Variante anatômica, Veia esplenomesentérica, Veia esplênica, tributárias e Confluência. RESULTADOS: Foram identificadas doze variantes do sistema venoso portal, representando diferentes formações da veia esplênica, veia mesentérica superior e veia mesentérica inferior. A classificação de Thomson, do final do século XIX, refere três variantes mais frequentes, com predomínio do tipo I (M = 47%), seguido do tipo III (M = 27,8%) e do tipo II (M = 18,6%). CONCLUSÃO: A classificação de variantes de Thomson é a mais conhecida e responde por mais de 90% da variante venosa portal encontrada na prática clínica, na medida em que a soma das três junções é encontrada em mais de 93% dos pacientes. Embora mais raras e representando menos de 7% das variantes, as outras nove variações relatadas ocasionalmente serão encontradas durante muitas cirurgias abdominais.

ABSTRACT - BACKGROUND: Knowledge of the portal system and its anatomical variations aids to prevent surgical adverse events. The portal vein is usually made by the confluence of the superior mesenteric and splenic veins, together with their main tributaries, the inferior mesenteric, left gastric, and pancreaticoduodenal veins; however, anatomical variations are frequent. AIM: This article presents a literature review regarding previously described anatomical variations of the portal venous system and their frequency. METHODS: A systematic review of primary studies was performed in the databases PubMed, SciELO, BIREME, LILACS, Embase, ScienceDirect, and Scopus. Databases were searched for the following key terms: Anatomy, Portal vein, Mesenteric vein, Formation, Variation, Variant anatomic, Splenomesenteric vein, Splenic vein tributaries, and Confluence. RESULTS: We identified 12 variants of the portal venous bed, representing different unions of the splenic vein, superior mesenteric vein, and inferior mesenteric vein. Thomson classification of the end of 19th century refers to the three most frequent variants, with type I as predominant (M=47%), followed by type III (M=27.8%) and type II (M=18.6%). CONCLUSION: Thomson classification of variants is the most well-known, accounting for over 90% of portal venous variant found in clinical practice, inasmuch as the sum of the three junctions are found in over 93% of the patients. Even though rarer and accounting for less than 7% of variants, the other nine reported variations will occasionally be found during many abdominal operations.

ABSTRACT Purpose The spleen is relevant in blood purification, hematopoiesis, metabolism, and immune response to antigens, in addition to the storage and control on the release of metals and amino acids. Its functions concerning reproduction characteristics are still unknown. The objective was to study the influence of splenectomies on reproduction. Methods This study analyzed 25 mice couples, distributed into five groups: group 1 – control, no surgery: group 2 – control, submitted to laparotomy and laparorrhaphy only; group 3 – splenectomy in male mice; group 4 – splenectomy in female mice; group 5 – splenectomy in male and female mice. The animals were studied as regards the number of gestations and offspring generated in each gestation. Results A decrease in both the number of gestations and the number of offspring was verified in the male mice that had received a splenectomy when coupled with normal female mice. It is important to emphasize lower reproduction level when paired asplenic males with normal females, otherwise, the couples in which both mice had been splenectomized did not present change in the reproduction pattern. Conclusions A reduction in the number of pregnancies and litters occurs in mice couples when the male mice were previously splenectomized.

ABSTRACT Purpose To assess the influence of prolonged cyclosporine use on the macro- and microscopic morphology of the spleen. Methods 16 adult rabbits were divided into two groups (n = 8): group 1 – a placebo group, which was followed-up over a period of nine months; group 2 – which had taken an oral dose of cyclosporine (10 mg·kg–1·day–1) over nine months. At the end of this period, the splenic histoarchitecture of all animals was evaluated and the splenic corpuscles were measured. Results The spleens of the first group presented normal characteristics and dimensions. The second group, however, had a reduction in all dimensions and its tissue texture had become soft. The white pulp and the perivascular sheath had become reduced in size and the number of lymphoid follicles had also fallen (p = 0.002), manifesting less splenic corpuscles (p = 0.0012) and lymphocyte nuclear pigments (p = 0.03). Conclusions Prolonged use of cyclosporine reduces the spleen size, transforming it into a soft organ associated with a decrease in white pulp, perivascular sheath, lymphoid follicles and nuclear pigments in rabbits.

RESUMO OBJETIVO O consumo excessivo de álcool é um problema de saúde presente no mundo inteiro. Este artigo avalia o consumo de bebidas alcoólicas por estudantes de Medicina e sua relação com características pessoais e aspectos sociais. MÉTODOS Estudo realizado com estudantes dos 1o, 3o e 6o anos do curso de medicina da Universidade Federal de Minas Gerais no ano de 2019. Os alunos foram convidados a participar anonimamente, respondendo a um questionário com 15 perguntas relativas a características do estudante (sexo, idade, renda familiar, prática de atividades físicas, origem, condição de moradia e desempenho discente) e ao consumo de bebidas alcoólicas (início, motivo, ocasiões de uso, tipo de bebida, quantidade consumida). Os dados foram comparados com significância correspondente a p<0,05. RESULTADOS Um total de 382 estudantes de ambos os sexos respondeu ao questionário. O consumo de bebidas alcoólicas foi relatado por 85% dos entrevistados. Cerca de 70% dos alunos de 1o e 3o anos e 47% dos alunos do 6o ano foram motivados pela socialização com colegas. O consumo de bebida alcoólica foi prevalente entre os que praticavam atividades físicas (93%) e moravam com a família (89%). Ao redor de 80% consumiram bebidas alcoólicas antes do ingresso na faculdade, com maior frequência no sexo masculino. CONCLUSÕES O consumo de álcool começa durante o ensino médio, estimulado pela socialização. Os homens que praticam atividades físicas e moram com a família são os maiores consumidores.

SUMMARY OBJECTIVE Excessive alcohol consumption is a global health issue. This article aims to evaluate the consumption of alcohol by medical students in relation to their personal and social aspects. METHODS This study was conducted with students in the first, third, and sixth year of medical school at the Federal University of Minas Gerais in 2019. Students were invited to participate anonymously by responding to a questionnaire with 15 questions regarding student characteristics (gender, age, family income, physical activity, origin, housing condition, and academic performance) and alcohol consumption (onset, reason, occasions of use, type of drink, amount consumed). Data were compared with significance corresponding to p<0.05. RESULTS A sample of 382 students of both sexes responded to the questionnaire. Alcohol consumption was reported by 85% of students. About 70% of first and third-year students and 47% of those of the sixth year were motivated by socializing with peers. Alcohol consumption was prevalent among those who practice physical activities (93%) and live with their families (89%). Around 80% had consumed alcohol before starting medical school, and consumption was more frequent in males. CONCLUSIONS Alcohol consumption begins during high school, stimulated by socialization. Men who practice physical activities and live with their families are the largest consumers.

RESUMO Racional: Os linfomas não Hodgkin (LNH) são neoplasias primárias derivadas de linfócitos e o sarcoma de Kaposi (SK) é doença multicêntrica de etiologia viral, ambas associadas ao HIV. Objetivo: Avaliar características clínicas dos LNH e SK, relacionando fatores etiopatogênicos mútuos. Métodos: Foram avaliados retrospectivamente 101 prontuários. Os doentes foram analisados quanto a idade, sexo e soropositividade para o HIV, de acordo com o PRISMA guidelines. Os tumores foram classificados por estadiamento, presença de linfonodos regionais invadidos e tipo celular. Resultados: A idade variou entre 15 e 87 anos para o LNH e 25 a 54 anos para o SK, mas a idade dos pacientes com LNH associado com o HIV não ultrapassou 34 anos. A proporção homem: mulher foi de 1,8:1 para o LNH, enquanto SK foi registrado apenas em homens. A soropositividade para o HIV ocorreu em cinco pacientes com LNH e 14 com SK. A invasão de linfonodos regionais foi positiva em 62 com LNH e quatro com SK. Os linfomas foram 27,9% de baixo grau, 17,4% de grau intermediário e 12,8% de alto grau. A soropositividade para HIV, foi diagnosticada durante a propedêutica do tumor em 60% dos pacientes com LNH e 50% dos com SK. Conclusão: A maioria dos pacientes portadores de HIV descobriram a soropositividade durante propedêutica para LNH e SK, sem manifestações clínicas de AIDS. Todos os pacientes com LNH associado com o HIV eram jovens. Pacientes com LNH e com SK apresentam características epidemiológicas, clínicas e terapêuticas semelhantes entre si.

ABSTRACT Background: Non-Hodgkin’s lymphomas (NHL) are primary neoplasms derived from lymphocytes, and Kaposi’s sarcoma (SK) is a multicentric disease of viral etiology and is associated with HIV. Aim: To study the etiopathogenesis and clinical characteristics of NHL and KS, describing their mutual factors. Methods: This retrospective investigation was performed on 101 medical charts. The patients were studied according to their age, gender, and HIV-positivity, following the PRISMA guidelines. The characteristics of the tumors and comorbidities were analyzed according to their age and lymphatic metastasis. Results: The mean age of the patients ranged between 15-87 years for NHL and between 25-54 for KS, but the age of patients with NHL associated with HIV did not surpass 34 years. The ratio male: female was 1,8:1 for NHL, but only men presented KS. HIV-positivity was found in five patients with NHL and in 14 with KS. The stages of NHL were: I (21%), II (18,4%), III (26,3%), and IV (34,2%), but KS were found only at III (40%) and IV (60%) stages. The lymphatic metastases were positive in 62 patients NHL and in four with KS. HIV-positivity occurred in 60% of patients with NHL and in 50% with KS. Conclusion: The HIV seropositivity was revealed for most of patients during the NHL and SK propaedeutic and none of them present clinical manifestations of AIDS. NHL associated with HIV was found only in young patients. NHL and KS patients have similar epidemiological, clinical, and therapeutic characteristics.

Abstract Purpose: To evaluate a possible relationship between the size of the spleen and values of circulating blood elements in patients with schistosomatic splenomegaly. Methods: ixty one patients with hepatosplenic schistosomiasis mansoni underwent a clinical exam and peripheral venous blood was collected for a hemogram. The erythrocyte, hemoglobin, hematocrit, leukocyte, and platelet values were determined. All patients underwent abdominal ultrasound to measure the spleen. The hematological test results were compared to the size of the spleen. Results: The size of the spleen varied from 14.0 to 28.4 (19.9 ± 3.7) cm according to the ultrasound image. Thrombocytopenia was observed 58 (95%) patients, leukopenia in 55 (90%) patients, and anemia in 32 (52.4%) patients. Leukopenia was proportional to splenomegaly. Conclusion: Schistosomal splenomegaly leads to leukopenia in direct proportion to the size of the spleen.

Abstract Purpose: To evaluate the hepatic changes associated with gastric ischemia. Methods: Thirty male rabbits were studied, distributed in 3 groups (n=10). Group 1: ligature and section of the gastric vasculature and removal of the liver after three hours; Group 2: ligature and section of the gastric vasculature and removal of the liver after 6 hours; Group 3: ligature and section of the gastric vasculature and removal of the liver after 12 hours. Blood samples were collected immediately before surgery and after the determined time of ischemia in each group to evaluate the hepatic function. After the death of the rabbits, the liver was removed for macro and microscopic study. Results: An increase in aminotransferases and bilirubin occurred in groups 2 and 3. Total protein and albumin diminished in all of the animals. All of the rabbits from groups 2 and 3 presented hepatocellular necrosis. Conclusion: The devascularization of the stomach for a period of above three hours is associated with hepatic morphological and functional disorders.

Abstract Purpose: To evaluate the morphological effects of injected sclerosing agents into the liver. Methods: This study was performed on twenty dogs, distributed into five groups: Group 1 (n = 5) - control, Group 2 (n = 5) - injection of 50% glucose solution inside hepatic parenchyma and animals followed during seven days, Group 3 (n = 10) - injection of ethanol inside hepatic parenchyma and animals distribution into two subgroups Subgroup 3A (n = 5) - followed during 24 hours and subgroup 3B (n = 5) - followed during seven days (group 3B), Group 4 (n = 5) - ethanol injection inside left portal vein branch and followed during 24 hours. Livers were macroscopically evaluated, submitted to hepatic arteriography and portography, then histology. Results: All animals in Group 4 died within 23 hours due to diffuse hepatic necrosis. The animals of groups 2 and 3 had a satisfactory evolution. Fibrosis formed in the segment reached by the sclerosant solution and interruption of the contrast flow injected into the portal system. Conclusion: Intrahepatic parenchymal ethanol injection is well tolerated and causes sclerosis restricted to a specific segment; however, intraportal ethanol injection causes massive hepatic necrosis and can lead to death.

Abstract Purpose: To verify the influence of oophorectomy on lipidogram and glycemia. Methods: Fifty six female rats were divided into the following 7 groups (n = 8): group 1 - sham group, group 2 - oophorectomy 30 days, group 3 - oophorectomy 35 days, group 4 - oophorectomy 40 days, group 5 - oophorectomy 45 days, group 6 - oophorectomy 70 days, group 7 - oophorectomy 55 days. Animals were following by number of days according the group. Was evaluated the serum levels of glucose and lipid profile. Results: The oophorectomized rats presented higher glycemia. Groups 3, 4, 6 and 7 had a higher glycemia and LDL levels (except for group 6) and groups 6 and 7 had lowest levels of HDL. Group 7 had highest level of VLDL than oophorectomy groups. There was no difference in triglycerides levels. Conclusion: Oophorectomy was related to dyslipidemia and insulin resistance, mainly after 50th days.