The rat model of cervical dorsal root injury mimics the avulsion of dorsal roots in humans following brachial plexus injury, a condition that leads to debilitating sensory disturbances and intractable neuropathic pain that is not amenable to repair. This injury disrupts sensory inputs from the dorsal roots to the spinal cord and the damaged axons do not regenerate across the PNS-CNS interface, the dorsal root entry zone. This thesis investigated the role of OECs for repairing DRI-associated neuropathic pain, which has never been previously explored. Chapter 2 of this thesis characterised two DRI models, a partial (2-root) or complete (4-root) deafferentation of the rat forepaw. The 2-root animals developed persistent allodynia and hyperalgesia, whereas in the 4-root DRI, in contrast, reduced sensation (desensitisation) was found within the affected forepaw. The degree of deficits on performing complex, skilled forepaw movements was proportional to the severity of DRI. Sensory control of forepaw movements was permanently abolishes in animals with 4-root DRI. With the goal of repairing DRI-associated neuropathic pain, the efficacy of genetically modified OECs that carry a novel GDNF construct was examined. These modified GDNF-OECs were able to produce GDNF in vitro, however, died rapidly and failed to yield long term GDNF expression after both acute and delayed transplantation into the DRI spinal cord. Unmodified plain OECs were then used. The results show that delayed transplantation of OECs attenuated the development of DRI-associated allodynia and hyperalgesia. Central reorganisations occurred within the dorsal horn following DRI, including reduction in the area of deep dorsal horn, permanent depletion of IB4-labeled axons and restoration of CGRP-labelled afferents in the denervated superficial laminae. The development of neuropathic pain is suggested to be mediated by the aberrant expansion of large myelinated VGLUT1-positive afferents into the superficial laminae, which normally receive nociceptive inputs. The effect of OECs on modulating nociception seems to be mediated by factors other than inhibition of afferent sprouting. In conclusion, the results in this thesis demonstrated the potential effect of OECs for modulating DRI-associated neuropathic pain. This finding could have clinical applicability for resistant pain sequelae resulting from neurotrauma.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.

Methods of regional anaesthesia and regional postoperative analgesia are common in perioperative management of patients in traumatology-orthopaedics. One of most challenging fields of traumatology-orthopaedics is shoulder surgery. Shoulder surgery is associated with intense and long-lasting postoperative pain. It affects patients’ well-being, limits limb function and worsens results of surgical treatment. Determination of optimal methods for postoperative pain relief is very important in clinical practice. Several modern studies compared methods of systemic analgesia with continuous interscalene infusion of bupivacaine 0,15 - 0,25 % solution. Application of these concentrations of bupivacaine resulted in sufficient analgesia but profound motor blockade and anaesthetic toxicity were observed. There are few studies on interscalene infusions of small concentrations of bupivacaine. Data on effects of small doses of bupivacaine on intensity of motor blockade and adjuvant drugs on postoperative analgesia is lacking. AIM OF THE STUDY: to evaluate the quality of post-operative pain treatment after shoulder surgery using continuous perineural infusions of different concentrations (0.1% and 0.15%) of bupivacaine and bupicacaine (0.1%) in combination with adjuvant clonidine and effects on operated hand motor function. To assess clinical advisability of interscalene brachial plexus identification and catheterization using G. Meier’s technique. 159 patients scheduled for elective... [to full text]

Purpose The objective of this thesis is to establish an evidence-based clinical practice guideline for the primary management of obstetrical brachial plexus injury (OBPI). Four gaps are identified for management of OBPI in Canada: 1) The historic poor use of evidence, 2) Timing of referral to multidisciplinary care, 3) Indications and timing of operative nerve repair, and 4) Distribution of expertise in Canada. Methods The guideline is intended for all providers delivering perinatal care, and all specialists delivering care to OBPI patients. The consensus group was composed of clinicians representing each of Canada’s ten multidisciplinary centres. An original systematic review comparing the effectiveness of primary operative versus nonoperative management, and a review of Canadian OBPI epidemiology were completed. Quality indicators for referral to a multidisciplinary centre were established. Recommendations were based on best evidence, and interpretation of this evidence by clinical experts. An electronic modified Delphi approach was used for consensus, with agreement criteria defined a priori following RAND procedures. Results Nerve repair reduces functional impairment in OBPI versus nonoperative management of similar patients, and modern microsurgery has low incidence of major adverse events. The quality of evidence was low. Residual impairment is underestimated and uncharacterized in nonoperative literature. OBPI incidence was at least 1.24 per 1000 births in Canada, and consistent over the study period. The strongest risk factors for OBPI were comorbid humerus fracture, shoulder dystocia and comorbid clavicle fracture. Most patients were not referred to a multidisciplinary centre. The guideline group approved seven recommendations. Discussion Recommendations address the identified gaps in care, and guide identification, referral, treatment and outcome assessment for OBPI. The process established a new network of opinion leaders and researchers for further guideline development, and multicentre research. The next step is to facilitate the implementation of the recommendations. / Thesis / Master of Science (MSc)

Traumatic injuries to the spinal cord and brachial plexus induce a significant inflammatory response in the nervous tissue with progressive degeneration of neurons and glial cells, and cause considerable physical and mental suffering in affected patients. This thesis investigates the effects of the antioxidants N-acetyl-cysteine (NAC) and acetyl-L- carnitine (ALC) on the survival of motoneurons in the brainstem and spinal cord, the expression of pro-apoptotic and pro-inflammatory cell markers, axonal sprouting and glial cell reactions after spinal hemisection in adult rats. In addition, a novel MRI protocol has been developed to analyse the extent of neuronal degeneration in the spinal cord. Rubrospinal neurons and tibial motoneurons were pre-labelled with the fluorescent tracer Fast Blue one week before cervical C3 or lumbar L5 spinal cord hemisection. The intrathecal treatment with the antioxidants NAC (2.4mg/day) or ALC (0.9 mg/day) was initiated immediately after injury using Alzet2002 osmotic mini pumps. Spinal cord injury increased the expression of apoptotic cell markers BAX and caspase 3, induced significant degeneration of rubrospinal neurons and spinal motoneurons with associated decrease in immunoreactivity for microtubule-associated protein-2 (MAP2) in dendritic branches, synaptophysin in presynaptic boutons and neurofilaments in nerve fibers. Immunostaining for the astroglial marker glial fibrillary acidic protein and microglial markers OX42 and ED1 was markedly increased. Treatment with NAC and ALC attenuated levels of BAX, caspase 3, OX42 and ED1 expression after 2 weeks postoperatively. After 4-8 weeks of continuous intratheca ltreatment, NAC and ALC rescued approximately half of the rubrospinal neurons and spinal motoneurons destined to die, promoted axonal sprouting, restored the density of MAP2 and synaptophysin immunoreactivity and reduced the microglial reaction. However, antioxidant therapy did not affect the reactive astrocytes in the trauma zone. The inflammation modulating properties of ALC were also studied using cultures of human microglial cells. ALC increased the microglial production of interleukin IL-6 and BDNF, thereby possibly mediating the anti-inflammatory and pro-regenerative effects shown in vivo. To study degeneration in the spinal cord following pre-ganglionic and post-ganglionic brachial plexus injuries, adult rat models of ventral root avulsion and peripheral nerve injury were used. A novel MRI protocol was employed and the images were compared to morphological changes found in histological preparations. Ventral root avulsion caused degeneration of dendritic branches and axonal terminals in the spinal cord, followed by significant shrinkage of the ventral horn. Extensive astroglial and microglial reactions were detected in the histological preparations. Peripheral nerve injury reduced the density of dendritic branches but did not cause shrinkage of the ventral horn. Quantitative analysis of MRI images demonstrated changes in the ventral horn following ventral root avulsion only, thus validating the developed MRI technique as a possible tool for the differentiation of pre-ganglionic and post-ganglionic nerve injuries.

O desenvolvimento de um método eficiente de avaliação prognóstica precoce seria de grande utilidade na seleção de lactentes com plexopatia braquial obstétrica para cirurgias de reconstrução do plexo braquial. Realizamos estudos de condução motora em 54 pacientes entre 10 e 60 dias de vida. Foram comparadas lado a lado as amplitudes dos potenciais de ação musculares compostos dos nervos axilar (músculo deltóde), musculocutâneo (músculo bíceps), radial proximal (músculo tríceps), radial distal (músculo extensor comum dos dedos), mediano (eminência tenar) e ulnar (eminência hipotenar). A relação entre a amplitude do potencial motor do lado lesado sobre o lado são foi chamada de Índice de Viabilidade Axonial (IVA), sendo este calculado tanto a partir da amplitude negativa como da amplitude pico-a-pico. Os pacientes foram seguidos clinicamente e classificados em três grupos: Grupo A, com recuperação total até os seis meses de vida; Grupo B, recuperação satisfatória até os doze meses de vida, e Grupo C, recuperação insatisfatória até os doze meses de vida. Analisamos a curva ROC (Receive Operator Characteristic Curve) de cada IVA para definir o melhor ponto de corte para detecção dos pacientes do Grupo C (mau prognóstico). Para o nervo axilar, o ponto de corte ideal foi IVA menor que 10%, com sensibilidade de 88,2% e especificidade de 89,2% ou 91,9%. Para o nervo musculocutâneo, o ponto de corte foi a ausência de potencial de ação motor, com sensibilidade de 88,2% e especificidade de 73,0%. Para o nervo radial proximal, o ponto de corte foi IVA menor que 20%, com sensibilidade de 82,4% ou 94,1% e especificidade de 97,3% ou 100%. Para o nervo radial distal, o ponto de corte foi IVA menor que 50%, com sensibilidade de 76,5% ou 82,4% e especificidade de 97,3%. Para o nervo ulnar, o ponto de corte foi IVA menor que 50%, com sensibilidade de 58,8% e especificidade de 97,3% ou 100%. O IVA do nervo mediano teve um desempenho ruim e seu uso não pode ser recomendado. Os IVAs dos nervos radial proximal, radial distal e ulnar apresentaram maior especificidade do que o critério clínico mais utilizado para a avaliação prognóstica, ou seja, ausência de função bicipital aos três meses de vida. A sensibilidade dos IVAs dos nervos axilar, musculocutâneo, radial proximal e radial distal foram equivalentes à do critério clínico. A utilização do estudo de condução motora entre 10 e 60 dias de vida forneceu uma avaliação prognóstica mais precoce e mais específica do que o critério clínico, podendo ser utilizada para indicação cirúrgica destes pacientes. / Early prognostic assessment of obstetric brachial plexopathies would be a major step for rational selection of infants for brachial plexus surgery. We performed nerve conduction studies in 54 patients from 10 to 60 days of life. We compared sideto-side the compound muscle action potentials amplitudes from the axillary (deltoid muscle), musculocutaneous (biceps), proximal radial (triceps), distal radial (extensor digitorum communis), median (thenar eminence) and ulnar nerves (hypothenar eminence). The ratio between the amplitude of the affected limb and that of the healthy side was called Viability Axonal Index (VAI), which was calculated using both the negative and the peak-to-peak amplitudes. The patients were followed-up and classified in three groups: Group A, with full recovery at six months of age; Group B, with satisfactory recovery at twelve months of age, and Group C, with poor recovery at twelve months of age. We analyzed the ROC (Receive Operator Characteristic) curve of each VAI to define the best cut-off point for detection of Group C patients (bad prognosis). The best cut-off point for the axillary nerve was a VAI of less than 10%, whith sensibility of 88.2% and specificity of 89.2% or 91.9%. For the musculocutaneous nerve, the cut-off point was an absent motor action potential, with sensibility of 88.2% and specificity of 73.0%. For the proximal radial nerve, the cut-off point was a VAI of less than 20%, with sensibility of 82.4% or 94.1% and specificity of 97.3% or 100%. For the distal radial nerve, the cut-off point was a VAI of less than 50%, with sensibility of 76.5% or 82.4% and specificity of 97.3%. For the ulnar nerve, the cut-off point was a VAI of less than 50%, which sensibility of 58.8% and specificity of 97.3% or 100%. The VAI from the median nerve had a poor performance and its use could not be recommended. The VAIs from proximal radial, distal radial and ulnar nerves had better specificities compared to the most used clinical criterion: absence of biceps function at three months of age. The VAIs sensitivities from axillary, musculocutaneous, proximal radial and distal radial nerves were equivalent to the clinical criterion. The use of motor conduction studies between 10 and 60 days of age yielded an earlier and more specific prognostic estimation than the clinical criterion, and could be used for indication of surgery in these patients.

Submitted by Sandra Pereira (srpereira@ufrrj.br) on 2017-03-22T12:11:48Z No. of bitstreams: 1 2016 - Rodrigo Mencalha Moreira.pdf: 28440057 bytes, checksum: 791e667a1aa1132fd32db5ed549faf27 (MD5) / Made available in DSpace on 2017-03-22T12:11:48Z (GMT). No. of bitstreams: 1 2016 - Rodrigo Mencalha Moreira.pdf: 28440057 bytes, checksum: 791e667a1aa1132fd32db5ed549faf27 (MD5) Previous issue date: 2016-04-28 / Funda??o Carlos Chagas Filho de Amparo ? Pesquisa do Estado do RJ - FAPERJ / The brachial plexus block (BPB) remains one of the most intriguing topics of contemporary anesthesia because, due to the complex organization of this structure is associated with a significant number of failures. The aim of this study was to evaluate the effectiveness of ultrasound-guided associated with peripheral nerve stimulation BPB in rabbits. Initially, 80 plexus were dissected, so as to enable researchers in the gross anatomy of the region. Later, in the in vivo study, we used 40 male rabbits which were randomly divided into two groups: Group 1: Ultrasound-guided associated with peripheral nerve stimulation (US/ENP) BPB; Group 2: Peripheral nerve stimulation-guided (ENP) BPB. Under general anesthesia, axillary BPB was performed, under lidocaine 2% without vasoconstrictor injection at the maximum dose of 0,7ml.kg-1. The motor latency, motor block and volume difference between the BPB between the techniques were evaluated by recording motor action potentials compounds of the radial nerve. The measurement of skin temperature (ST), by infrared thermography, was carried out in areas of interest, previously stipulated in the forepaw, digits and forearm, in order to verify the correlation of the variation in the effectiveness of BPB. In 92.5% of the animals the nerves resulting consisted of connections between the ventral rami of the last four cervical spinal nerves (C5, C6, C7, C8) and first thoracic (T1). No significant difference was observed in time performance of US/ENP-guided BPB (4.3 ? 0.73 min) or ENP-guided BPB (6.4 ? 0.68 minutes), however, significantly less volume administration was necessary to local anesthetic in the US/ENP-guided BPB (0.61 ? 0.15 mL vs 1.22 ? 0.17; P <0.0001). Despite the lower volume used, it was observed that the US/ENP group had shorter on set time block (1.1 ? 0.45) compared to ENP group (1.95 ? 0.79; P <0.01). The US/ENP-guided BPB or ENP-guided BPB resulted in a substantial and significant increase in ST areas of interest in the radial, musculocutaneous, median and ulnar nerves (P < 0.001), however this increase was outstanding in hand and digits regions Thus it is concluded that the US/ENP-guided BPB is an effective and easy technique to reproduce in this experimental model which required lower volume of local anesthetic, provided a smaller motor latency and a higher motor blockade time when compared to the ENP-guided BPB. The increase in ST is a highly effective tool for assessing the effectiveness of BPB with predictive value, sensitivity and specificity of 100%. Furthermore, future clinical studies are needed to verify its correlation with the anaesthetized area. / O bloqueio do plexo braquial (BPB) permanece como um dos temas mais intrigantes da anestesia contempor?nea, pois, devido a complexa organiza??o desta estrutura, est? associado a um n?mero expressivo de insucessos. Com o estudo objetivou-se avaliar a efic?cia do bloqueio do BPB guiado por ultrassonografia associado a estimula??o de nervos perif?rico em coelhos. Inicialmente foram dissecados 80 plexos braquiais, de 40 cad?veres, de modo a capacitar os pesquisadores na anatomia macrosc?pica da regi?o. Posteriormente, no estudo in vivo, foram utilizados 40 coelhos do sexo masculino os quais foram aleatoriamente alocados em dois grupos experimentais: Grupo 1: BPB guiado por ultrassonografia associado a estimula??o de nervos perif?ricos (US/ENP); Grupo 2: BPB guiado por estimula??o de nervos perif?rivos (ENP). Sob anestesia geral, o BPB foi realizado, por via axilar, atrav?s da inje??o de lidoca?na 2% sem vasoconstrictor, na dose m?xima de 0,7ml.kg-1. A diferen?a entre o tempo de lat?ncia motora, tempo de bloqueio motor e do volume necess?rio para o BPB entre as t?cnicas foram avaliadas atrav?s da grava??o dos potenciais de a??o motores compostos do nervo radial. A mensura??o da temperatura cut?nea (TC), por termografia infravermelha, foi realizada em ?reas de interesse (AIEs), previamente estipuladas, nas m?os, d?gitos e antebra?os, de modo a verificar a correla??o de sua varia??o com a efic?cia do BPB. Em 92,5% dos animais os nervos resultantes foram constitu?dos das conex?es entre os ramos ventrais dos 4 ?ltimos nervos espinhais cervicais (C5, C6, C7, C8) e o primeiro tor?cico (T1). N?o houve diferen?a significativa no tempo de performance do BPB guiado por US/ENP (4,3 ? 0,73 min) ou por ENP (6,4 ? 0,68 min), no entanto, foi necess?rio a administra??o de um volume significativamente menor de anest?sico local no grupo guiado por US/ENP (0,61 ? 0,15 ml versus 1,22 ? 0,17; P < 0,0001). Apesar do menor volume utilizado, observou-se que o grupo US/ENP apresentou menor tempo para instala??o do bloqueio (1,1 ? 0,45) em compara??o ao grupo ENP (1,95 ? 0,79; P < 0,01). O BPB guiado por US/ENP ou por ENP resultou em um aumento substancial e significativo da TC nas AIEs dos nervos radial, musculocut?neo ulnar e mediano (P < 0,001), no entanto, este aumento foi mais contudente na regi?o da m?o e d?gitos. Nas AIEs dos nervos radial, mediano e ulnar na regi?o dorsolateral das m?os, foram observadas as maiores varia??es de temperatura no grupo US/ENP em compara??o ao ENP (radial 3,1 versus 2,0oC; mediano 4,5 versus 3,1 oC e ulnar 4,1 versus 3,6 oC). Dessa forma conclui-se que o BPB guiado por US/ENP ? uma t?cnica eficaz e de f?cil reprodutibilidade no modelo experimental utilizado a qual requereu menor volume de anest?sico local, proporcionou menor tempo de lat?ncia motora e maior tempo de bloqueio motor quando comparado ao bloqueio guiado por ENP. O aumento da TC ? uma ferramenta altamente eficaz na avalia??o da efic?cia do BPB com valor preditivo, sensibilidade e especificidade de 100%. Outrossim,futuros estudos cl?nicos s?o necess?rios para verificar sua correla??o com a ?rea anestesiada.

Estudos de prognóstico clínico consistem na predição do curso de uma doença em pacientes e são utilizados por profissionais da saúde com o intuito de aumentar as chances ou a qualidade de sua recuperação. Sob a perspectiva computacional, a criação de um modelo prognóstico clínico é um problema de classificação, cujo objetivo é identificar a qual classe (dentro de um conjunto de classes predefinidas) uma nova amostra pertence. Este projeto visa a criar modelos prognósticos de lesões traumáticas do plexo braquial, um conjunto de nervos que inervam os membros superiores, utilizando dados de pacientes adultos com esse tipo de lesão. Os dados são provenientes do Instituto de Neurologia Deolindo Couto (INDC) da Universidade Federal do Rio de Janeiro (UFRJ) e contêm dezenas de atributos clínicos coletados por meio de questionários eletrônicos. Com esses modelos prognósticos, deseja-se identificar de maneira automática os possíveis preditores do curso desse tipo de lesão. Árvores de decisão são classificadores frequentemente utilizados para criação de modelos prognósticos, por se tratarem de um modelo transparente, cujo resultado pode ser examinado e interpretado clinicamente. As Florestas Aleatórias, uma técnica que utiliza um conjunto de árvores de decisão para determinar o resultado final da classificação, podem aumentar significativamente a acurácia e a generalização dos modelos gerados, entretanto ainda são pouco utilizadas na criação de modelos prognósticos. Neste projeto, exploramos a utilização de florestas aleatórias nesse contexto, bem como a aplicação de métodos de interpretação de seus modelos gerados, uma vez que a transparência do modelo é um aspecto particularmente importante em domínios clínicos. A estimativa de generalização dos modelos resultantes foi feita por meio de métodos que viabilizam sua utilização sobre um número reduzido de instâncias, uma vez que os dados relativos ao prognóstico são provenientes de 44 pacientes do INDC. Além disso, adaptamos a técnica de florestas aleatórias para incluir a possível existência de valores faltantes, que é uma característica presente nos dados utilizados neste projeto. Foram criados quatro modelos prognósticos - um para cada objetivo de recuperação, sendo eles a ausência de dor e forças satisfatórias avaliadas sobre abdução do ombro, flexão do cotovelo e rotação externa no ombro. As acurácias dos modelos foram estimadas entre 77% e 88%, utilizando o método de validação cruzada leave-one-out. Esses modelos evoluirão com a inclusão de novos dados, provenientes da contínua chegada de novos pacientes em tratamento no INDC, e serão utilizados como parte de um sistema de apoio à decisão clínica, de forma a possibilitar a predição de recuperação de um paciente considerando suas características clínicas. / Studies of prognosis refer to the prediction of the course of a disease in patients and are employed by health professionals in order to improve patients\' recovery chances and quality. Under a computational perspective, the creation of a prognostic model is a classification task that aims to identify to which class (within a predefined set of classes) a new sample belongs. The goal of this project is the creation of prognostic models for traumatic injuries of the brachial plexus, a network of nerves that innervates the upper limbs, using data from adult patients with this kind of injury. The data come from the Neurology Institute Deolindo Couto (INDC) of Rio de Janeiro Federal University (UFRJ) and they are characterized by dozens of clinical features that are collected by means of electronic questionnaires. With the use of these prognostic models we intended to automatically identify possible predictors of the course of brachial plexus injuries. Decision trees are classifiers that are frequently used for the creation of prognostic models since they are a transparent technique that produces results that can be clinically examined and interpreted. Random Forests are a technique that uses a set of decision trees to determine the final classification results and can significantly improve model\'s accuracy and generalization, yet they are still not commonly used for the creation of prognostic models. In this project we explored the use of random forests for that purpose, as well as the use of interpretation methods for the resulting models, since model transparency is an important aspect in clinical domains. Model assessment was achieved by means of methods whose application over a small set of samples is suitable, since the available prognostic data refer to only 44 patients from INDC. Additionally, we adapted the random forests technique to include missing data, that are frequent among the data used in this project. Four prognostic models were created - one for each recovery goal, those being absence of pain and satisfactory strength evaluated over shoulder abduction, elbow flexion and external shoulder rotation. The models\' accuracies were estimated between 77% and 88%, calculated through the leave-one-out cross validation method. These models will evolve with the inclusion of new data from new patients that will arrive at the INDC and they will be used as part of a clinical decision support system, with the purpose of prediction of a patient\'s recovery considering his or her clinical characteristics.

A Anatomia comparativa de mamíferos vem sendo tema de pesquisas, nas áreas biomédica e biológica com o objetivo de se buscar conhecimentos que possam auxiliar na busca sobre o entendimento do binômio unidade-variedade, dentre os símios tem sido particularmente enfocados o Babuíno e o Rhesus que, entretanto, não são próprios do Novo Mundo. O Cebus apella, animal das matas do continente Sul-americano, distribuindo-se geograficamente por quase todo o Brasil, apresenta satisfatória adaptação à vida em cativeiro condição em que, inclusive, se reproduz com facilidade. Assim, é de nosso interesse focalizar, o Cebus apella, analisando a origem, a composição e os nervos resultantes de seu plexo braquial. O objetivo imediato deste trabalho é, dar seqüência ao conhecimento de sua Anatomia, visando também o fornecimento de subsídios para interpretações anatómo-funcionais do Cebus apella, comparativamente a outros animais. O objetivo a médio e a longo prazos é o estabelecimento do padrão anatômico deste animal, culminando com a elaboração de um Atlas - texto sobre a Anatomia do macaco Cebus apella. Utilizamos 20 animais, sendo 10 machos e 10 fêmeas, adultos, pertencentes ao acervo de pesquisas da Universidade Federal de Uberlândia. A preparação das peças anatômicas foi feita segundo a metodologia usual em estudos anatômicos. Os principais nervos oriundos do plexo braquial são: supraescapular, subescapular, musculocutâneo, radial, mediano, ulnar, axilar, toracodorsal, peitoral maior e peitoral menor. Em 57% dos espécimes dissecados o plexo braquial do Cebus está constituído por raízes de C5 a T1, em 21,4% de C5 a T2, em 14,3% de C4 a T1 e em 7,3% de C4 a T2. O plano dorsal do plexo braquial contribui para a formação dos nervos: frênico, peitoral maior e peitoral menor. O plano médio origina os nervos musculocutâneo, mediano, ulnar e cutâneo medial do antebraço, enquanto o plano ventral dá origem aos nervos supraescapular, subescapular, axilar, radial e torácico longo. Discute-se a ocorrência de pré e de pós-fixação do plexo, bem como a de seu deslocamento cranial e caudal. Em conclusão o plexo braquial do Cebus apella está constituído por raízes de C5 a T1 e é organizado em um plano ventral mais simples, um médio de complexidade intermediária e um dorsal mais complexo. / Comparative Anatomy of mammals has been a relevant theme of researches in the biomedical and biological areas with the objective of looking for more information that can aid for searching on the understanding of the unit-variety complex. Among the simians, Baboon and Rhesus have been particularly focused, although they are not from the New World. The monkey Cebus apella, animal of the forests of the South American continent, being geographically distributed for almost the whole Brazil, presents satisfactory adaptation to the captive life showing a great easiness of reproduction. Thus, we intended to study the monkey Cebus apella, analyzing the origin, the composition and the resulting nerves of its brachial plexus. The immediate objective of this study was to add information to the knowledge of its Anatomy, seeking the supply of subsidies for anatomo-functional interpretations of Cebus apella comparatively to humans and domestic animals. Further, we propose to establish the anatomical pattern of this animal, culminating with the elaboration of an Atlas - text on the Anatomy of the monkey Cebus apella. Twenty adult animals, 10 male and 10 female, belonging to the collection of anatomical pieces of the Anatomy Laboratory of the Federal University of Uberlândia were obtained and prepared through fixation and dissection. The major nerves originating from the brachial plexus were: the suprascapular, the subscapular, the musculo-cutaneous, the radial, the median, the ulnar, the axillary, the thoraco-dorsal, the pectoralis major and the pectoralis minor. In the dissected specimens, the brachial plexus of Cebus apella was constituted by the roots from C5 to T1 (55,00 ± 11,12%), from C5 to T2 (25,00 ± 9,68%), from C4 to T1 (15,00 ± 7,98%) and from C4 to T2 (5,00 ± 4,87%). The ventral plan of the brachial plexus contributed for the formation of the following nerves: the phrenic, the subclavius, the pectoralis major, and the pectoralis minor. The medium plan originated the musculo-cutaneous, the median, the ulnar, and the forearm medial cutaneous nerves, while the dorsal plan originated the suprascapular, the subscapular, the axillary, the radial, thoraco-dorsal and the long thoracic nerves. In addition, the occurrence of pre- and post- fixation of the plexus as well as its cranial and caudal displacement have been discussed. In conclusion, the brachial plexus of Cebus apella constituted by the roots from C5 to T1 is organized in a simpler ventral plan, a medium plan of intermediate complexity and a more complex dorsal plan.

Tez (Tıpta Uzmanlık) - Süleyman Demirel Üniversitesi, Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, 2009. / Kaynakça var.