OBJETIVO: Tentar correlacionar a hérnia de Spiegel com eventuais alterações anatômicas da parede anterolateral do abdome. Abordar as particularidades do estudo anatômico em cadáver, com destaque aos músculos oblíquo interno, transverso abdominal, aponeurose de Spiegel, linha semilunar e ao aparecimento de hérnias de Spiegel. MÉTODO: A parede anterolateral do abdome foi dissecada em 31 cadáveres frescos do Departamento de Patologia da Santa Casa de Misericórdia de São Paulo, sendo realizada nos dois primeiros cadáveres a dissecção unilateral e nos 29 restantes o estudo bilateral da parede abdominal, completando 60 dissecções. Considerando que operamos no Hospital São Luiz Gonzaga, da Irmandade da Santa Casa de Misericórdia de São Paulo, 13 doentes com 14 hérnias de Spiegel, pudemos correlacionar os elementos clínicos aos estudos anatômicos em cadáver. RESULTADOS: Defeitos encontrados nos músculos e aponeuroses: Oblíquo externo: 4/60 (6,6%) - Oblíquo interno: 6/60 (10%) - Transverso abdominal: 14/60 (23,3%). Disposição dos músculos em forma de feixes de fibras: Oblíquo interno: 10/60 (16,6%) - Transverso abdominal: 12/60 (20%). CONCLUSÕES: As variações anatômicas e os defeitos encontrados, durante as dissecções do oblíquo interno e transverso abdominal, não se acompanharam de hérnias de Spiegel no cadáver, já a gordura pré-peritoneal, dissecando as fibras da aponeurose de Spiegel e oblíquo interno, foi encontrada nas operações e nas dissecções, podendo representar uma relação entre os defeitos musculoaponeuróticos da parede anterolateral do abdome e a hérnia de Spiegel.

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Introduction: There is an enormous interest about improving international comparisons to provide relevant information for policy and planning in mental health. Most of the available information is provided at the macro-level (countries or regions). However, information gathered at the meso-level may diverge from data aggregated at higher territorial levels.

Abstract:Purpose: The standard description of local provision of services is critical to guide decision making. The available codes for the classification of health services at ICF and SHA 2.0 do not provide enough granularity to guide planning in specific areas such as mental health where services depending from other sectors are relevant and where a complementary classification may be needed. DESDE-LTC is an European classification of services for long term care funded by the European Agency of Health and Consumer and released in 2011Objectives: To use DESDE-LTC to produce the integral Atlas of the mental health care system of Catalonia (Spain) METHOD: DESDE-LTC has been used for mapping all regional services for persons with mental disorders in Catalonia including child and adolescent care, adult care, and main public sectors involving the departments of Health, Education, Social services, Labour and Justice. Service availability has been related to utilisation data from available health databases. Results:The Atlas indicates a significant increase of services in the last decade, although gaps have been described in care provision in some rural areas, as well as in child and adolescent care in the Southern part of Catalonia. This system also allowed for identifying outlayer services either in number of professionals or care capacity (places or beds). Gaps in reporting to the regional systems have also been identified either in relation to specific care provision (e.g. outpatient care provided by general hospitals) or by specific health districts. The standard information on service availability and capacity and the information on utilisation of hospital and outpatient services have been used for spatial analysis of administrative prevalence of mental disorders in Catalonia and for the analysis of the technical efficiency of small health areas in the mental care system.

Introduction: Semantic variability is a barrier to effective networking of long-term care (LTC) services. The same name may be used for services providing different activities (i.e. day centres), and services with different names may have a similar pattern of care delivery. Furthermore, services are complex constructs which depend on local characteristics, vary over time and do not allow comparisons like with like. At present there is no standard coding system of LTC in Europe. This fact impedes cross-national comparisons, hampers European statistics on service availability, access and use, and slows down the development of international care planning strategies and patient mobility.