FLAVIA EMI AKAMATSU JACOMO

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Departamento de Cirurgia, Faculdade de Medicina - Docente
LIM/02 - Laboratório de Anatomia Médico-Cirúrgica, Hospital das Clínicas, Faculdade de Medicina

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  • article 11 Citação(ões) na Scopus
    Anatomical Basis of the Myofascial Trigger Points of the Gluteus Maximus Muscle
    (2017) AKAMATSU, Flavia Emi; YENDO, Tatiana Mina; RHODE, Ciro; ITEZEROTE, Ana Maria; HOJAIJ, Flavio; ANDRADE, Mauro; HSING, Wu Tu; JACOMO, Alfredo Luiz
    Myofascial pain syndrome is characterized by pain and limited range of motion in joints and caused by muscular contracture related to dysfunctional motor end plates and myofascial trigger points (MTrPs). We aimed to observe the anatomical correlation between the clinically described MTrPs and the entry point of the branches of the inferior gluteal nerve into the gluteus maximus muscle. We dissected twenty gluteus maximus muscles from 10 human adult cadavers (5 males and 5 females). We measured the muscles and compiled the distribution of the nerve branches into each of the quadrants of the muscle. Statistical analysis was performed by using Students f-test and Kruskal-Wallis tests. Although no difference was observed either for muscle measurements or for distribution of nerve branching among the subjects, the topography of MTrPs matched the anatomical location of the entry points into the muscle. Thus, anatomical substract of the MTrPs may be useful for a better understanding of the physiopathology of these disorders and provide basis for their surgical and clinical treatment.
  • article 10 Citação(ões) na Scopus
    Anatomical Study of the Innervation of the Masseter Muscle and Its Correlation with Myofascial Trigger Points
    (2020) PINHEIRO, Roberto Procopio; GAUBEUR, Matheus Aquesta; ITEZEROTE, Ana Maria; SALEH, Samir Omar; HOJAIJ, Flavio; ANDRADE, Mauro; JACOMO, Alfredo Luiz; AKAMATSU, Flavia Emi
    Background and Purpose: Myofascial pain syndrome (MPS) is widely prevalent in the general population; some reports estimate its prevalence ranges from 9 to 85%. Among the different locations where MPS may arise, pain related to the masseter muscle is referred as masticatory myofascial pain. MPS is characterized by myofascial trigger points (MTPs), which represent tender anatomical areas of a muscle where painful symptoms are elicited whenever stimulated. Previous publications have found MTPs to coincide with neuromuscular junctions at the motor end plate, at the innervation zone (IZ). Our study aimed to describe the innervation of the masseter muscle and relate it to clinically described myofascial trigger points (MTPs). Materials and Methods: We mapped the nerve fiber distribution into the masseter muscles from 16 cadavers by anatomical dissection. We divided the muscle into six regions, three superior (I-III) and three inferior (IV-VI), and classified the nerve's branches distribution according to these predetermined areas. Statistical analyses was made by Poisson distribution and logarithm link function followed by Bonferroni multiple comparisons (P<0.05). Results: All six areas received branches from the masseteric nerve. Areas I and II (upper posterior and upper intermediate, respectively) had a significant higher number of nerve entries as compared to the remaining areas. Conclusion: The penetration areas of the masseteric nerve have been established and MTPs are found in the innervation zones, clinicians should focus initially on the regions of the penetration points, for diagnostics and therapeutic measures, such as injections, dry needling and soft tissue interventions. Anatomical study of nerve supply to the masseter muscle can provide useful additional knowledge to further understanding masticatory myofascial pain and to direct therapeutic interventions and diagnostic studies of temporomandibular junction dysfunction.
  • article 3 Citação(ões) na Scopus
    Lymph drainage of the upper limb and mammary region to the axilla: anatomical study in stillborns
    (2018) CUADRADO, Guilherme de Arruda; ANDRADE, Mauro Figueiredo Carvalho de; AKAMATSU, Flavia Emi; JACOMO, Alfredo Luiz
    Purpose We studied the lymphatic drainage of the upper limb and mammary region directing to the axilla to investigate whether independent pathways can be observed or whether anastomoses and shared drainage occur between them. This analysis aimed to assess the safety of axillary reverse mapping (ARM) in breast cancer treatment and to understand the development of lymphedema after sentinel lymph node biopsy (SLNB) alone. Methods Seven unfixed stillborn fetuses were injected with a modified Gerota mass in the peri-areolar area, palm and dorsum of the hands, formalin fixed, and then submerged in 10% hydrogen peroxide solution. Microsurgical dissection was then performed on the subcutaneous cellular tissue of the upper limb, axillary region, and anterior thorax to expose the lymphatic vessels and lymph nodes. Results The dye injected into the upper limb reached either the lateral axillary group, known to be exclusively responsible for upper limb drainage, or the anterior group, which is typically related to breast drainage. There was great proximity among the pathways and lymph nodes. Communicating lymphatic vessels among these groups of lymph nodes were also found in all studied cases. Discussion Lymphedema remains a challenging morbidity in breast cancer treatment. ARM and SLNB aim to avoid unnecessary damage to the lymphatic drainage of the upper limb. However, our anatomical study suggests that ARM may have potential oncological risks because preserved lymph nodes may harbor malignant cells due their proximity, overlapping drainage pathways, and connecting lymph vessels among lymph nodes.
  • article 1 Citação(ões) na Scopus
    Photobiomodulation therapy increases collagen II after tendon experimental injury
    (2021) AKAMATSU, Flayia Emi; TEODORO, Walcy Rosolia; ITEZEROTE, Ana Maria; SILVEIRA, Lizandre Keren Ramos da; SALEH, Samir; MARTINEZ, Carlos Augusto Real; RIBEIRO, Marcelo Lima; PEREIRA, Jose Aires; HOJAIJ, Flavio; ANDRADE, Mauro; JACOMO, Alfredo Luiz
    A tendon is a mechanosensitive tissue that transmits muscle-derived forces to bones. Photobiomodulation (PBM), also known as low-level laser therapy (LLLT), has been used in therapeutic approaches in tendon lesions, but uncertainties regarding its mechanisms of action have prevented its widespread use. We investigated the response of PBM therapy in experimental lesions of the Achilles tendon in rats. Thirty adult male Wistar rats weighing 250 to 300 g were surgically submitted to bilateral partial transverse section of the Achilles tendon. The right tendon was treated with PBM, whereas the left tendon served as a control. On the third postoperative day, the rats were divided into three experimental groups consisting of ten rats each, which were treated with PBM (Konf, Aculas HB 750), 780 nm and 80 mW for 20 seconds, three times/week for 7, 14 and 28 days. The rats were sacrificed at the end of the therapeutic time period. The Sca-1 was examined by immunohistochemistry and histomorphometry, and COLA1, COLA2 and COLA3 gene expression was examined by qRT-PCR. COLA2 gene expression was higher in PBM treated tendons than in the control group. The histomorphometric analysis coincided with increased number of mesenchymal cells, characterized by Sca-1 expression in the lesion region (p<0.001). PBM effectively interferes in tendon tissue repair after injury by stimulating mesenchymal cell proliferation and the synthesis of collagen type II, which is suggested to provide structural support to the interstitial tissues during the healing process of the Achilles tendon. Further studies are needed to confirm the role of PBM in tendon healing.
  • article 3 Citação(ões) na Scopus
    Is there something new regarding triceps brachii muscle insertion?
    (2020) AKAMATSU, Flavia Emi; NEGRAO, Jose Renato; RODRIGUES, Marcelo Bordalo; ITEZEROTE, Ana Maria; SALEH, Samir Omar; HOJAIJ, Flavio; ANDRADE, Mauro; JACOMO, Alfredo Luiz
    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.
  • article 1 Citação(ões) na Scopus
    Is the colon mucosa affected by ten days of gastric restriction in an animal model?
    (2019) AKAMATSU, Flavia Emi; FONTES, Luiz Gustavo; ITEZEROTE, Ana Maria; SALEH, Samir; TEODORO, Walcy Paganelli Rosolia; ARTIFON, Everson; HOJAIJ, Flavio; ANDRADE, Mauro; PEREIRA, Jose Aires; MARTINEZ, Carlos Augusto Real; JACOMO, Alfredo Luiz
    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.
  • article 3 Citação(ões) na Scopus
    Anatomy of the Lymphatic Drainage of the Upper Limb and Breast and its Role in Lymphedema Prevention after Breast Cancer Treatment
    (2016) CUADRADO, G. A.; ANDRADE, M. F. C.; AKAMATSU, F. E.; JACOMO, A. L.
    The surgical treatment of breast cancer has been enhanced throughout the years in order to offer oncologically safer and more effective results with lower esthetic impact and fewer sequelae. The lymphedema of the upper limb is still an iatrogenic result of great incidence and morbidity after this treatment. A possible existence of independent breast and upper limb lymphatic pathways has become the issue of many researchers willing to minimize its occurrence. This review aims to compare the lymphatic pathways in the axilla described by traditional anatomy books and recently published articles about Axillary Reverse Mapping (ARM). With this purpose, a comparative table was made with the descriptions found in books and articles, a statistic table of the data collected, a flowchart of anastomoses among nodes and an analytical drawing of the most statistically mentioned drained areas. It was observed that there is great variability in the descriptions of drainage and anastomoses among the lymph nodes in the references used, so there should be a consensus of a universal description which also assembles possible anatomical variations. Furthermore, the findings brought about by recent studies show possible anastomoses among pathways and lymph nodes, however they have not been taken into consideration when ARM was initially proposed. Therefore, the axillary resection with the preservation of the posterior and lateral axillary lymph nodes is theoretically possible to avoid lymphedema of the upper limb, but the development of an updated universal description that involves all possible anatomical variations will provide a safer and more effective treatment.
  • article 3 Citação(ões) na Scopus
    Aneurysm of the Fibular Vein: A Case Report
    (2018) SALEH, Samir Omar; ANDRADE, Mauro Figueired Carvalho de; CUADRADO, Guilherme de Arruda; SALEH, Kassem Samir; AKAMATSU, Flavia Emi; JACOMO, Alfredo Luiz
    Background: Aneurysms of the deep veins of the lower limbs are rare and often asymptomatic. Although natural history is unclear, these aneurysms have been associated with deep venous thrombosis and fatal pulmonary embolism events. To our knowledge, this case represents the fifth patient with isolated aneurysm of a calf vein described in the literature and the second one affecting the fibular vein. Methods: We report the case of a 20-year-old white man with an aneurysm of the fibular vein that we believe is the second case in the literature Results: After evaluation and diagnosis, the aneurysm was resected with full recovery of the patient. Conclusions: Treatment of this unusual condition seems to be mandatory for major thromboembolic events can be as high as 71% with 2 deaths, according to a review of 24 patients with popliteal vein aneurysms. Unlike proximal veins, where reconstruction is advisable, calf vein aneurysms can be safely managed by simple excision and ligature. In our patient, aneurysm resection eliminated symptoms, and good result was maintained in long follow-up.
  • article 4 Citação(ões) na Scopus
    Morphometry and Frequency of the Pyramidalis Muscle in Adult Humans: A Pyramidalis Muscle's Anatomical Analysis
    (2020) HOJAIJ, Flavio Carneiro; KOGIMA, Rudolph Octaviano; MOYSES, Raquel Ajub; AKAMATSU, Flavia Emi; JACOMO, Alfredo Luiz
    OBJECTIVES: To verify the pyramidalis muscle's frequency (bilaterality, unilaterality, or absence) and morphometry (length of the medial border and width of its origin/base) in a sample of the Brazilian population and the anthropometric influence. METHODS: Dissection of 30 cadavers, up to 24h post-mortem. RESULTS: The pyramidalis muscle was present bilaterally and unilaterally in 83.33% and 3.33% of the cadavers, respectively, and absent in 13.33%. The muscles on the right and left sides were symmetrical in length but not in width; the pyramidalis muscles of men were longer, while those of the women were wider. We also found that there was greater variation in the dimensions (length and width) of the men's muscles. Finally, in this sample of the Brazilian population, the pyramidalis muscle's unilaterality was more prevalent than in other populations, and its complete absence was less prevalent. CONCLUSIONS: There were no cases of muscle duplication in one or both sides, as described in some studies. Despite all of its morphometric variation, the pyramidalis muscle maintained its triangular shape with longitudinal fibers in every case. Furthermore, no statistically significant correlation was noted between the muscles' dimensions and person's age, height, weight, or gender.
  • article 4 Citação(ões) na Scopus
    Anatomical Basis of the Myofascial Trigger Points of the Trapezius Muscle
    (2013) AKAMATSU, Flavia Emi; SALEH, Samir; PINESI, Henrique Trombini; RODRIGUES, Katarina Reichmann; ZANDONA, Cintia Benedicto; ANDRADE, Mauro; JACOMO, Alfredo Luiz
    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.