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Background: Vascular diseases are associated with significant sequelae and clinical repercussions for the lives of affected patients, which are more serious among the elderly. The consequences of vascular disease, such as limb loss, chronic pain, prolonged hospitalization, and polypharmacy, reduce these patients' autonomy and independence, influencing their wellbeing and quality of life., Objectives: To determine the prevalence of depression and assess functional capacity in patients with vascular diseases admitted to a Vascular Surgery Service., Methods: This is a descriptive, cross-sectional study, carried out at the Vascular Surgery Service of a tertiary hospital with a non-random sample of patients selected consecutively. The geriatric depression scale short form (GDS-15) was used to assess depression and the Katz scale was used for functional assessment., Results: The prevalence of depression in these patients was 60.6%. Associations were observed between depression and consultation with a family doctor in the last 12 months, alcoholism, claudication, diabetes, and individuals who had had an amputation. Individuals' Katz index functional capacity scores were significantly associated with sociodemographic variables, conditions related to vascular disease, and hospitalization., Conclusions: There was a high prevalence of depression in patients with vascular diseases admitted to a vascular surgery service and important reductions in functional capacity in some groups, such as individuals with low educational levels, those who had chronic pain in the lower limbs, patients with diabetes, and those who had had an amputation., Competing Interests: Conflicts of interest: No conflicts of interest declared concerning the publication of this article., (Copyright© 2023 The authors.)

Popliteal artery aneurysms are the most frequent type of peripheral aneurysm, accounting for 85% of the all of these aneurysms. Usually asymptomatic, they are generally diagnosed during clinical examination. Incidence is higher among males and seniors. They are bilateral in 50% of the cases and 60% are associated with abdominal aortic aneurysms. This paper describes a 72-year-old male patient who presented with two bilateral pulsatile masses, one in each popliteal region, was otherwise asymptomatic, and had a history of hypertension and dyslipidemia. Clinical examination and ultrasound imaging confirmed a diagnosis of bilateral aneurysms of the popliteal arteries. Popliteal artery aneurysms can be treated with open bypass surgery, with or without aneurysm resection, or with endovascular surgery. This Therapeutic Challenge discusses these possibilities., Competing Interests: Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

Background: Anxiety and depression are highly prevalent neuropsychiatric conditions and are associated with chronic diseases, pain, loss of autonomy, dependence on others to perform routine activities, and loneliness. Depression often has a cause-and-effect relationship with other diseases, such as: acute myocardial infarction (AMI), systemic arterial hypertension (SAH), diabetes mellitus (DM) and peripheral arterial disease (PAD)., Objectives: To estimate the frequency of anxiety and depression in patients of both sexes with PAD admitted to a tertiary hospital., Methods: This is a descriptive, cross-sectional study, with a non-random sample selected consecutively. The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression, and the ankle-brachial index (ABI) was used to assess PAD., Results: The prevalence of anxiety in these patients was 24.4%, with associations between anxiety and monthly family income, smoking, and SAH. The prevalence of depression was 27.6%, with associations between depression and the female gender, being married or in a stable relationship, living on a family income of one minimum wage or less, not being an alcoholic, and having hypertension., Conclusions: There are high prevalence rates of anxiety and depressive disorders among patients with PAD, which are underdiagnosed and, hence, not properly treated., Competing Interests: Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

The present study aimed to perform a systematic literature review to assess the effects of phonation therapy on voice quality and function in singers. The systematic search was performed in February and updated in October 2017. No restriction of year, language, or publication status was applied. The primary electronic databases searched were LILACS, SciELO, PubMed, and Cochrane. Kappa coefficient was used to assess the agreement between examiners in judging article eligibility. The eligible articles were analyzed based on their risk of bias using the tools proposed by the Joanna Briggs Institute. Mendeley Desktop 1.13.3 software package (Mendeley Ltd, London, UK) was used to standardize the references of identified articles. The general sample consisted of 1965 articles screened out of the electronic databases. Two examiners analyzed the sample in the search for eligible articles. The agreement between examiners reached excellent outcomes (kappa coefficient = 0.88). After the selection, phase 6 articles remained eligible. Together, the eligible studies accounted 141 subjects (65 men and 76 women) aged between 18 and 72 years old. Electroglottography was considered as the most common method (83.33%) of assessment of the effects of phonation therapy in singers. The most prevalent exercises within the therapies were phonation into straws and phonation into glass tubes. The phonation into glass tubes immersed in water, straws, and LaxVox tubes promoted positive effects on the voice quality in singers, such as more comfortable phonation, better voice projection, and economy in voice emission., (Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To compare depressive symptoms among medical students taught using problem-based learning (PBL) and the traditional method., Material and Methods: Beck's Depression Inventory was applied to 215 medical students. The prevalence of depression was calculated as the number of individuals with depression divided by the total number in the sample from each course, with 95% confidence intervals. The statistical significance level used was 5% (p ≤ .05)., Results: Among the 215 students, 52.1% were male and 47.9% were female; and 51.6% were being taught using PBL methodology and 48.4% using traditional methods. The prevalence of depression was 29.73% with PBL and 22.12% with traditional methods. There was higher prevalence among females: 32.8% with PBL and 23.1% with traditional methods. The prevalence of depression with PBL among students up to 21 years of age was 29.4% and among those over 21 years, 32.1%. With traditional methods among students up to 21 years of age, it was 16.7%%, and among those over 21 years, 30.1%. The prevalence of depression with PBL was highest among students in the second semester and with traditional methods, in the eighth., Conclusions: Depressive symptoms were highly prevalent among students taught both with PBL and with traditional methods.

Background: Vascular diseases have a direct influence on quality of life (QoL) and directly affect patients' biopsychosocial aspects. Quality of life is therefore an important element for evaluation of vascular interventions., Objective: To assess QoL in inpatients with peripheral arterial disease at a vascular surgery service in a charitable tertiary hospital., Methods: This is an exploratory study, with a cross-sectional design, conducted at a vascular surgery service in a charitable tertiary hospital, assessing patients with peripheral arterial disease using two questionnaires, one on quality of life (the WHOQOL-Bref short form) and the other on sociodemographic conditions., Results: It was observed that the physical domain, environment domain and total QoL scores were the lowest for the whole sample of 127 interviewees. Additionally, an intragroup analysis showed that men scored higher in all domains when compared with women, with the exception of the social relationships domain., Conclusions: Women with peripheral arterial disease exhibited lower scores than men in all domains of the QoL questionnaire, except for social relationships., Competing Interests: Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

True aneurysm of the dorsal artery of the foot is extremely rare, and its clinical manifestations are little known. A case of a true dorsalis pedis artery aneurysm in a 51-year-old man, with no history of local trauma or injury on his foot, is presented. Clinical examination and ultrasonic imaging confirmed the aneurysm. Dorsalis pedis artery aneurysm after this had been exposed, the proximal and distal stumps of the dorsal artery of the foot were isolated and ligated, and the aneurysm was resected., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: The anterolateral ligament (ALL) of the knee has recently been described in detail. Most studies of the ALL have been conducted in adults; therefore, little is known about the anatomy and histology of the ALL in younger patients, and nothing is known about the fetal presence of the ALL., Purpose: To evaluate the ALL in human fetuses to determine its presence or absence and to describe its microscopic anatomy and histological features compared with the findings of studies conducted in adults., Study Design: Descriptive laboratory study., Methods: Twenty human fetal cadaveric specimens were used. The mean age of the fetuses was 28.64 ± 3.20 weeks. The ALL was dissected in the anterolateral region of the knee, and its anatomic parameters, including its origin, insertion, and path in relation to known adjacent anatomic landmarks, in addition to its length, width, and thickness over the path toward the tibia, were measured. After dissection, the ALL was removed en bloc with a portion of the lateral meniscus for histological analysis of 4-μm sections, hematoxylin and eosin staining, and immunohistochemical staining for type I collagen., Results: The ALL was located in all dissected knees. Its origin was located at a mean distance of 1.87 mm from the origin of the lateral collateral ligament, with variations from the center of the lateral epicondyle to posterior and proximal to it, and it exhibited an anterior-inferior path toward the tibia, an insertion in the lateral meniscus approximately 2.08 mm anterior to the popliteal tendon, and another insertion in the tibia between the Gerdy tubercle and the fibular head at 2.46 mm below the articular cartilage. The histological sections of the ALL showed well-organized, dense collagenous tissue fibers with elongated fibroblasts (mean, 1631 fibroblasts/mm 2 ) and a predominance of type I collagen., Conclusion: The ALL is present during fetal development, with anatomic and histological features similar to those of the adult ALL., Clinical Relevance: The findings of this study help to better understand the ALL's anatomy and histology from the fetal period to adulthood. The study presents the existence of the ALL since fetal development, emphasizes the characterization of the ALL, and brings important information to future pediatric ALL lesion studies.

A persistent median artery is a rare anomaly. It accompanies the median nerve along its course in the forearm and is of variable origin. It is associated with other local anatomical variations and may contribute significantly towards formation of the superficial palmar arch. In embryos, it is responsible mainly for the blood supply to the hand. The objective of this study was to research the frequency, type (forearm or palmar) and origin of the median artery in fetuses, correlating its presence with sex and body side. Red-colored latex was injected into 32 brachial arteries of human fetuses until its arrival in the hand could be seen. Twenty-four hours after the injection, the median arteries were dissected without the aid of optical instruments. Among the 32 forearms dissected, the median artery was present in 81.25 % (26) of the cases, and it was found more frequently in females and on the left side. Regarding origin, most of the median arteries originated in the common interosseous artery (38.5 %) and anterior interosseous artery (34.6 %). The mean length of the median arteries was 21.1 mm for the palmar type and 19.8 mm for the forearm type. The median artery has a high rate of persistence. It is important to be aware of this anatomical variation, since its presence may give rise to difficulties during routine surgical procedures on the wrist. Its presence may cause serious functional complications in the carpal tunnel, anterior interosseous nerve, round pronator syndromes, and ischemia of the hand.

Detailed knowledge of the possible anatomical and morphometric variations of the infraorbital foramen (IOF) is important for ensuring safe and successful regional anesthesia, and for avoiding iatrogenic nerve injuries during surgery on the middle third of the face. To conduct a morphometric study on the IOF, correlating this with sex and side of the cranium. Two hundred forty-two crania were used (148 male and 94 female). Measurements were made with the aid of digital calipers with precision to 0.01 mm. Presence of foramina and their multiplicity was also observed. The data were analyzed descriptively and analytically. Statistical significance was stipulated as 5% (P≤0.05). The IOF was found bilaterally in all the crania, and 26 of them presented multiplicity. The distance from the IOF to the anterior nasal spine was greater in males on both sides (P<0.001). Statistical differences between the sexes were also seen in relation to the following morphometric variables: height of the left IOF (P=0.007), width of the right IOF (P=0.004), and width of the left IOF (P=0.008), and the measurements were also larger among males. The IOF was present in all the crania and on both sides. It was morphometrically larger in males, on both sides.

Purpose: The human mandible is subject to stimuli during its growth phase and also in adulthood. One of these stimuli may be absence of teeth, which gives rise to mandibular remodeling. Morphological changes may occur in different areas of this bone, such as in the gonial, condylar and ramus regions., Objective: To investigate the influence of edentulousness on remodeling of the gonial angle of the mandible and the angle formed by the mandibular incisure., Materials and Method: Eighty-five dry mandibles from adults were examined: 42 from males and 43 from females. The mandibles were photographed using a camera coupled to a static support that was positioned 20 cm from the object to be photographed. The images were digitized and transferred to the Image J 1.42q software, in which the gonial angle of the mandible and the mandibular incisure angle were measured., Results: There were no differences in the mandibular and mandibular incisure angles in relation to presence or absence of teeth, or between the right and left sides. The mandibular incisure angle was greater in the women., Conclusion: Edentulousness did not cause remodeling of the gonial angle of the mandible or in the mandibular incisure angle.

Objective: To correlate the acromial curvature, using the angles proposed, with the subacromial space and types of acromion., Methods: Ninety scapulas were studied. The acromia were classified as types I, II or III. The acromial curvature was analyzed by means of the alpha, beta and theta angles. We also measured the distance between the anteroinferior extremity of the acromion and the supraglenoid tubercle (DA). The scapulas were grouped in relation to sex and age. The angles proposed were analyzed in relation to each type of acromion and also in relation to the measurements of the distance DA., Results: Out of the total number of acromia, 39 (43.3%) were type I, 43 (47.7%) type II and eight (9%) type III. The mean ages for each type of acromion (I-III) were 45.6, 55.2 and 51.1 years, respectively. The proportions of the different types of acromion varied in relation to sex and age. The evaluations on the mean beta angle (p = 0.008) and theta angle (p = 0.028), with comparisons in relation to each type of acromion and measurements of the distance DA (p = 0.037), were shown to be statistically significant., Conclusion: The angles proposed in our study can be used for morphometric analysis on the acromion, especially regarding its curvature, and can contribute towards studies on diseases of the shoulder and aid in surgical planning and analysis of the acromial slope, by means of radiography or magnetic resonance.

Five hundred students attending higher education institutions in northeastern Brazil responded to questionnaires about their anatomy classes; students represented a variety of different health sciences disciplines. Analysis of the responses revealed the participation of teaching assistants in a large percentage of classes and the use of teaching resources, particularly images, from conventional radiographs to magnetic resonance images. The number of classes for cadaver dissection and the number of students with access to that type of class were small. In most cases, dissection was performed according to anatomic regions or systems. Medicine and nursing students had the highest number of practical dissection classes. Most students were assessed using practical and theoretical tests. Findings revealed conditions similar to those found elsewhere. Resources should be renewed and used to improve teaching for students whose courses demand the study of human anatomy.

The metopic suture is located between the tubercles of the frontal bone. There are divergences regarding the exact time at which it closes, which ranges from the first to the tenth year of life, although it may persist into adulthood. This study was conducted on 134 dry crania from adult Brazilians, of which 95 were male and 39 were female. These were available in the anatomy laboratories of higher education institutions in Maceió, AL, Brazil. All the crania were examined macroscopically with regard to the presence (metopism: M) on absence of the metopic suture. M was considered to be complete (Mc) when it continued uninterruptedly from the nasium to the bregma and incomplete (Mi) when it was not present over its entire length. It was observed that Mc was present in 4.48% (6/134) of the skull examined, of which 50% (3/134) were male and 50% (3/134) were female. An incomplete metopic suture was found in 5.22% (7/144) of the crania and more frequently among males (3.73%; 5/134). Among the crania with a metopic suture, the dolichocephalic type predominated (7.46%) in relation to brachycephalic crania (1.49%) and mesocephalic crania (0.74%). There was no predominance of metopism between the sexes, while an incomplete metopic suture was slightly more common among males.

Background: Venous ulcers account for 70% of chronic leg ulcers and affect about 2-7% of the population, causing much socioeconomic impact and reducing patients' quality of life. In this study we aimed to describe the clinical features of venous ulcers and sociodemographic characteristics of patients with ulcers due to chronic venous disease (CVD)., Methods: This cross-sectional, observational study was conducted at the Vascular Surgery Service, Universidade Federal de Sergipe, in northeastern Brazil. The study included a consecutive series of 154 patients with active venous ulcers (CEAP C6) in the lower limb due to CVD. Sociodemographic characteristics (age, gender, race, monthly income, education, occupation, and caregiver) and clinical data (affected limb, ulcer site, etiopathogenesis, recurrence, and time elapsed since the first episode of ulcer) were collected. A possible correlation of time elapsed since the first episode of ulcer and number of recurrences with primary or secondary etiology was analyzed by Mann-Whitney U-test., Results: Of the 154 patients analyzed, 79% were female, 94% were ethnically black or brown, 90% had a monthly income less than or equal to minimum wage, 47% were illiterate, 35% had not completed elementary school, 50% had informal jobs, 19.5% were retired, and 18.2% received sick pay from the social security system. The mean age was 53.7 years. Both limbs were affected similarly, and venous ulcers were located predominantly on the medial aspect of the leg (84%). The median time elapsed since the first episode of ulcer was 36 months, being significantly higher in patients with venous ulcers of secondary etiology (P < 0.0003). The prevalence of recurrence was also significantly higher in patients with venous ulcers of secondary etiology (P < 0.001). According to CEAP classification, 65% of ulcers were primary (Ep), 94.1% demonstrated reflux involving the superficial system (As), 92% had incompetent perforators (Ap), 35% demonstrated reflux involving the deep system (Ad), and all ulcers showed reflux without obstruction (Pr)., Conclusions: Venous ulcers were more prevalent among low-income patients, especially chronic, recurrent ulcers of primary etiology. This finding highlights the need for improvements in patient care and surgical treatment in most cases aimed at ulcer healing and reduced recurrence. Better care would improve patients' quality of life and reduce social security expenditures., (Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.)

Introduction. The superior transverse scapular ligament (STSL) links the margins of the suprascapular notch and converts it into a foramen, through which, the suprascapular nerve and, on some rare occasions, the suprascapular vessels pass. This conversion often results from partial or complete ossification of the STSL and may produce compressive symptoms in the suprascapular nerve. Material and Method. Twenty shoulders from human fetuses were dissected without the aid of optical instruments and, using a digital pachymeter of precision 0.01 millimeters, length measurements and thickness measurements were made. The fetal age was from 21 to 33 weeks of gestation, with a mean of 27.6 ± 4.14 weeks. Results. There was no statistically significant difference in STSL length or any difference in the thicknesses at the medial and lateral extremities between the halves of the body (P ≥ 0.05). However, in the left half of the body, the medial extremity of the STSL was significantly thinner than the lateral extremity (P ≤ 0.05). Conclusion. Anatomical and morphometric details about the STSL were described in human fetuses. These findings, in fetuses, may encourage the pursuit of further studies to understand the morphofunctional role and meaning of this small ligament.

Purpose: The aim of the present study was to determine the frequency of occurrence of multiple renal arteries in human fetuses., Methods: Sixty kidneys from human fetuses (32 males and 28 females) were used, fixed and kept in 10% formol solution. The fetal age was estimated from the hallux-calcaneus length and ranged from 20 to 37 weeks of gestation, with a mean of 25.63 weeks. The renal arteries were dissected without the aid of optical instruments, and their number, length, topographical layout in relation to their origins in the aorta walls and distribution according to gender and kidney (left or right) were determined., Results: Out of the 60 kidneys investigated, 78.33% had a single renal artery and 21.67% had multiple renal arteries. Most of the renal arteries emerged from the lateral wall of the aorta between the levels of the lower third of the twelfth thoracic vertebra and the upper third of the first lumbar vertebra. The length ranged from 0.15 to 1.5 cm and was slightly greater in females., Conclusions: The frequency of findings of multiple renal arteries was 21.67%.

The main gastrocnemius trunk (MGT) drains all of the blood from the network formed by the gastrocnemius veins that emerge from the gastrocnemius muscle. Twenty MGTs were used (nine medial and eleven lateral), from male human cadavers of mean age 31.42±10.93 years, fixed in 10% formalin solution. The aim of this study was to analyze the arrangement of the bundles of collagen fibers in the wall of the MGT. Sections were stained using Masson's trichrome and picrosirius red solutions and were examined under a polarizing microscope. The bundles of collagen fibers in the wall of the MGT were seen to be arranged in a continuous three-dimensional network, in which bundles crossing in two fundamentally opposite directions formed meshes that, along with the bundles themselves, decreased in size from the tunica adventitia to the tunica intima. These findings may contribute towards understanding the state of functional adaptation of the MGT to responses of dilatation, distensibility and increased venous pressure, in normal and pathological situations., (Copyright © 2010 Elsevier GmbH. All rights reserved.)

Objective: To determine the metric measurements and to verify the attachment levels of the medial patellofemoral ligament in human cadavers., Methods: Seventeen knees (eight right and nine left knees) from 10 cadavers (nine male and one female) were dissected and stored in a 10% formaldehyde solution. All of the knees were whole and did not show any macroscopic signs of injuries., Results: The medial patellofemoral ligament was present in 88% of the knees studied, localized transversally between the medial femoral epicondyle and the medial margin of the patella. Its dimensions were quite variable, even between the knees of the same individual. The width of the patellar insertion ranged from 16 to 38.8 mm, with a mean of 27.90 mm, and its mean length was 55.67 mm. The margins of the ligament were concave or rectilinear. At the upper margin, the concave form predominated and was better characterized, while at the lower margin, the rectilinear form predominated., Conclusions: The medial patellofemoral ligament is a very distinct structure with variable anatomical aspects and is always located in a plane inferior to the vastus medialis obliquus muscle.

Soleus veins have been implicated as the site for deep venous thrombosis initiation. Detailed anatomic knowledge is required for the early diagnosis using non-invasive ultrasound techniques. In the present work, we describe the anatomy of the veins that emerge from the ventral face of the soleus muscle. Twenty-eight soleus muscles were dissected and 543 veins were found. The number of veins per leg ranged from 7 to 38. The distribution of these veins per quadrant ranged from 0 to 12. The greatest number of veins occurred at the superior lateral quadrant. Most soleus veins mainly drained into the posterior tibial and fibular veins. The mean length of the soleus veins ranged from 0.907 to 2.804 cm. We conclude that there is a wide variability in the distribution of soleus veins through the soleus muscle and their quadrants. The majority of the soleus veins drain into the tibial and fibular veins.