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Objetivos. Verificar a efetividade da EEF aplicada em extensores de cotovelo e punho do membro superior de hemiparéticos crônicos para melhora da força, ADM (arco dinâmico de movimento), espasticidade e funcionalidade do membro. Método. Trata-se de um relato de casos em que três indivíduos (dois do sexo feminino e um do sexo masculino), apresentando hemiparesia crônica com predomínio braquiofacial e faixa etária entre 56 e 64 anos foram submetidos à aplicação de EEF com estimulação simultânea de extensores de punho e cotovelo por 30 minutos diários, duas vezes por semana, durante seis semanas. Foi feita avaliação da força, ADM, espasticidade e funcionalidade de membro hemiparético antes e após intervenção e também no segmento de cinco semanas após final da terapia. Resultados. Todos os pacientes apresentaram melhora na força, ADM e funcionalidade, e destes, dois apresentaram redução de espasticidade. Na avaliação de cinco semanas, verificou-se que apenas o quesito força não se manteve. Conclusão. A aplicação deste novo parâmetro de EEF com estimulação simultânea de extensores de punho e cotovelo mostrou-se benéfica para melhora funcional do membro superior de pacientes hemiparéticos crônicos.

Placement of a mediastinal drain is a routine procedure following heart surgery. Postoperative bed rest is often imposed due to the fear of potential risk of drain displacement and cardiac injury. We developed an encapsulating stitch as a feasible, effective and low-cost technique, which does not require advanced surgical skills for placement. This simple, novel approach compartmentalizes the drain allowing for safe early mobilization following cardiac surgery.

Abdominal aortic aneurysm is a pathological dilatation of the abdominal portion of the aorta artery. This enlargement increases the stress in the artery wall, which can cause the rupture of the vessel. The risk of rupture depends on a series of factors, but as it has a very high rate of mortality, once an aortic aneurysm is found, it is quite important to closely monitor it and, if it is necessary, plan an early intervention. Its most common symptoms are abdominal or back pain and a pulsatile feeling near the navel. Computed tomography is the best method to diagnose and size it.

Detect the main predictive non-motor factors related to independent community ambulation after stroke. Furthermore, we propose a scale to estimate the probability of a stroke patient achieving independent community ambulation after 6 months of rehabilitation.Prospective cohort. Subjects treated in a rehabilitation center in a large metropolitan area. Independent community ambulation was evaluated after rehabilitation according to the Hoffer classification. Functional ambulation was assessed at four levels: nonambulatory, nonfunctional ambulation, household ambulation, and community ambulation.Patients (n=201) with a moderate disability after stroke.The average time of hospitalization was 19.3 days. However, only 32.8% of the patients started the rehabilitation program during the first 6 months after stroke. We found that 121 patients achieved community ambulation (60.2%), 40 achieved household ambulation (19.9%), 12 achieved therapeutic ambulation (5.9%), and 28 were non-ambulatory after 6 months of treatment. Based on our final model, a scoring scale was created in order to evaluate the probability of stroke patients achieving independent community ambulation after 6 months of rehabilitation. Higher scores were associated with better chances of community ambulation within 6 months.The scale that evaluated these factors proved to have acceptable sensitivity and specificity to establish the prognosis of community ambulation after 6 months of rehabilitation.

The prevalence of cardiovascular disease risk factors (CVRF) increases linearly with age. Debilitating diseases within the ambit of physical medicine and rehabilitation can promote or aggravate pre-existing comorbidities and CVRFs. A high prevalence of CVRFs was noted in the medical histories of elderly patients receiving regular ambulatory follow up while performing adapted physical activity (APA) as therapy in a rehabilitation center. Objective: To evaluate the presence of CVRFs in the elderly who are practicing APA, in order to map the risk profile of this specific population. Method: Collection and observational analysis of data found in the medical histories of the elderly (> 60 years) practicing APA, and in regular ambulatory follow up, concerning several CVRFs (Systemic Arterial Hypertension - SAH, Diabetes Mellitus - DM, Dyslipidemia - DLP, Smoking; Excess weight/Obesity - EW/Ob, Family history - FH). Results: one hundred and ten (n = 110) elderly patients were found (average age 72.9 ± 7.1 years). Information in medical history about smoking, EW/Ob and FH, were only found in 11.8%, 52.7%, and 0%, respectively, and were thus excluded from posterior analysis. The prevalence of SAH, DLP and DM were 69.0%, 46.3%, and 27.2%, respectively. Only 18.2% of these elderly presented no CVRF (SAH, DLP, DM), 34.5% one associated factor, 33.6% two factors, 13.7% three factors. Of those evaluated, 28.2% already presented established cardiopathy. Conclusion: A high prevalence of SAH, DLP, DM and established cardiopathy among the elderly practicing regular APA in one rehabilitation center was noted, labeling this sample population with high risk profile. Cardiovascular risk factors of crucial importance like smoking, obesity, and a family history of cardiac disease were not appropriately mapped, with little such information found in the evaluated medical histories. Due to the size and specificity of the present study sample, this result could not express the actual national scope of rehabilitation centers, and should be better investigated in future studies. However, the present data are alarming and must be considered with special attention, since no appropriate map of CVRFs was made.

A fasciite plantar e causa frequente de dor no calcanhar e no pe que afeta cerca de 2 milhoes de americanos por ano. A fisioterapia e o tratamento inicialmente prescrito, e o sucesso do tratamento depende da adesao dos pacientes. Objetivo: Elaborar um manual de orientacoes e exercicios para pacientes com fasciite plantar, analisar a clareza, nivel de compreensao e a satisfacao dos pacientes leigos e fisioterapeutas acerca do manual. Metodo: Foram selecionados 30 fisioterapeutas e 30 pacientes que nao fossem analfabetos e que nao apresentassem nenhum deficit cognitivo. Foi aplicado um manual contendo 10 exercicios e orientacoes para pacientes com fasciite plantar. Resultados: Todos os exercicios e orientacoes tiveram alto indice de compreensao (acima de 90%). O manual foi considerado excelente pelos leigos e otimo pelos fisioterapeutas. Conclusao: O manual apresentou um nivel relevante de compreensao tanto entre os fisioterapeutas como entre os leigos, alem de alto indice de satisfacao entre as populacoes abordadas. Portanto, o manual pode servir de ferramenta complementar no tratamento dos pacientes com fasciite plantar.

Introduction Chagas disease is a major cause of cardiomyopathy and sudden death in our country. It has a high mortality when their patients develop New York Heart Association (NYHA) class IV. Objective The objective of this study is to analyze the clinical outcome of patients with Chagas' cardiomyopathy with congestive heart failure with optimized pharmacological therapy, undergoing cardiac resynchronization therapy. Methods Between January 2004 and February 2009, 72 patients with Chagas' cardiomyopathy in NYHA class III and IV underwent cardiac resynchronization therapy and were monitored to assess their clinical evolution. We used the t test or the Wilcoxon test to compare the same variable in two different times. A P value < 0.05 was established as statistically significant. Results The average clinical follow-up was 46.6 months (range 4-79 months). At the end of the evaluation, 87.4% of patients were in NYHA class I or II (P

OBJECTIVE To evaluate the prevalence of asymptomatic transitory myocardial ischemia during scintigraphy among amputees of vascular etiology as well as to ascertain correlation with atherothrombotic events during long-term follow-up. DESIGN A cohort, mean follow-up of 2.1 yrs study was performed in an outpatient rehabilitation clinic with 58 lower limb vascular amputees who were referred for rehabilitation, asymptomatic for coronary heart disease. Patients were evaluated for myocardial ischemia by dipyridamole scintigraphy, and occurrence of severe cardiovascular events (death, acute myocardial infarction, stroke, and peripheral ischemia with hospitalization) was assessed. RESULTS Of the 58 patients, 26 (44.8%) had positive dipyridamole myocardial scintigraphy for transitory myocardial ischemia. During follow-up, 12 subjects (20.7%), mainly diabetic patients (83%), registered a serious cardiovascular event, with 9 of 12 events having occurred in those who had tested positive for transitory ischemia on scintigraphy (P < 0.025). There were five deaths (19.2%) in those with a positive scintigraphy and a single death (3.1%) in those with a negative dipyridamole test, although the Kaplan-Meier survival curve and Cox regression were not significant (P = 0.09 and 0.1, respectively). CONCLUSIONS We found that 44.8% of patients with vascular lower limb amputation, asymptomatic for coronary disease, tested positive on myocardial scintigraphy for transitory myocardial ischemia. In a mean follow-up of 2.1 yrs, there was 10.3% of atherothrombotic events/year, with a higher death toll in those patients with positive scintigraphy.

OBJETIVO: Avaliar o perfil atual do paciente submetido a revascularização do miocárdio na Disciplina de Cirurgia Cardíaca da Faculdade de Ciências Médicas da Santa Casa de São Paulo, verificar o risco de mortalidade esperada neste grupo, por meio da aplicação do Sistema Europeu de Risco em Operações Cardíacas (EuroSCORE), e confrontá-lo com a mortalidade observada. MÉTODOS: Analisamos 100 pacientes consecutivos submetidos a revascularização do miocárdio, de maio de 2005 a novembro de 2006. Identificamos os fatores predisponentes à coronariopatia e analisamos os critérios de risco de mortalidade pelo EuroSCORE. Comparamos as taxas de mortalidade esperadas com as observadas na amostra. Aplicamos o teste do qui-quadrado para análise univariada e o teste de Hosmer-Lemeshow para ajuste do modelo de regressão logística. RESULTADOS: A mortalidade hospitalar foi 5,0%. Na análise univariada, para escore 0-2 a mortalidade prevista pelo EuroSCORE foi de 0,40% e a encontrada 0%. Para o escore 3-5, a mortalidade prevista foi de 1,45% e a encontrada 0%. Para escore >6, a mortalidade prevista foi de 3,15% e a encontrada 7,94%. As discrepâncias entre as porcentagens observadas e previstas não foram estatisticamente significantes (p = 0,213). O valor-p do teste de Hosmer-Lemeshow foi igual a < 0,001, indicando um ajuste ruim ou má calibração do modelo para o número de indivíduos na amostra atual. CONCLUSÃO: O EuroSCORE é um modelo preditor simples e objetivo de mortalidade operatória. Entretanto, para validação da análise de regressão logística, são necessárias centenas de indivíduos, o que limita a universalização de sua aplicabilidade. OBJECTIVE: The aim of this study was to assess the performance of the European Risk System in Cardiac Operations (EuroSCORE) model to predict mortality in patients undergoing myocardial revascularization at the Division of Cardiovascular Surgery of Santa Casa de São Paulo Medical School. METHODS: From May 2005 to November 2006, 100 consecutive patients undergoing coronary artery bypass surgery were retrospectively analyzed. The records of these patients were reviewed in order to retrieve those variables included in the EuroSCORE risk scoring method. The correlation of predicted and observed mortality was compared. Statistical analysis was performed using chi-square test for univariate analysis and Hosmer-Lemeshow Test for logistic regression model. RESULTS: Hospital mortality was 5%. For EuroSCORE univariate analysis, findings were as follows: score 0-2 predicted mortality 0.40%, observed 0.00%; score 3-5 predicted mortality 1.45%, observed 0.00%; score greater than 6 predicted mortality 3.15%, observed 7.94%. Although these differences, p-value was 0.213 with no statistical significance. The p-value for the Hosmer-Lemeshow Test was < 0.001 indicating poor calibration of the model for this sample. CONCLUSION: The EuroSCORE model is a simple, objective system to estimate hospital mortality. However, to validate the logistic regression analysis, it is necessary hundreds of patients, which limit its widespread application.

Introduction: The main rehabilitation objectives for the lower-limb amputee patients are: functional independence in their activities of daily living, locomotion and community reintegration. The return to work must be encouraged, as it promotes well-being, improves self-esteem and social integration and gives life a new meaning. Objective: To verify the work status and use of prosthetic lower limbs of amputee patients seen at Lar Escola Sao Francisco Rehabilitation Center - UNIFESP, Sao Paulo. Material and Methods: Retrospective study with patients seen between 1999 and 2005, presenting lower limb amputation and at least 18 years of age, working or studying at the time of the amputation. The sample consisted of 78 patients, 61 men and 17 women, with a mean age of 46.3 years. Amputation level was transfemoral in 50% and transtibial in 34.6% of the patients. Vascular diseases were the most prevalent cause of amputation (62.8%). Fifty-one patients (65.4%) had finished Elementary School. The interview by phone was carried out from December 2006 to January 2007. Results: Sixty-four percent of all patients used prosthetic lower limbs. A total of 10.2% of the amputee patients returned to work after a lower-limb amputation, and all of them returned to the same work they did before the amputation. Conclusion: Few amputee patients return to work after rehabilitation with prosthesis. Many factors, such as older age at the time of amputation and low level of schooling may be the cause of these results. Further studies are necessary for a better analysis of this outcome.

OBJETIVOS: Avaliar a função e a qualidade de vida dos pacientes pós-artroplastia de Girdlestone e comparar os resultados entre os grupos Girdlestone unilateral e o grupo com prótese total de quadril contralateral. MÉTODOS: estudo transversal no qual foram avaliados 9 pacientes com Girdlestone unilateral e 3 com Girdlestone em um quadril e prótese total no quadril contralateral. A avaliação constitui-se em aplicar o questionário genérico de qualidade de vida SF-36 e um questionário funcional específico para o quadril, Harris Hip Score (HHS). A comparação dos grupos foi realizada usando-se o teste t- Student e o teste de Fisher. RESULTADOS: Os pacientes do grupo Girdlestone unilateral apresentaram maior quantidade de domínios do SF-36 classificados como elevados, embora 77,8% destes tenham obtido resultados ruins no HHS. Todos os pacientes apresentaram o teste de Trendelenburg positivo e discrepância de membros, o que levou à marcha claudicante em 11 dos 12 pacientes avaliados. Destes, apenas 6 submeteram-se a fisioterapia pós-operatória. CONCLUSÃO: A qualidade de vida e a função pós-operatória de Girdlestone, na população brasileira, ainda necessita ser mais pesquisada, pois estes resultados são indicações do comportamento das variáveis de estudo e não podem ser consideradas encerradas. OBJECTIVES: To evaluate function and quality of life of patients submitted to Girdlestone's arthroplasty, and to compare outcomes between unilateral Girdlestone's group with the group with contralateral total hip prosthesis. METHODS: Cross-sectional study where 9 patients were evaluated with unilateral Girdlestone's and 3 with Girdlestone's in one hip and contralateral total hip prosthesis. The evaluation consisted in filling in a generic questionnaire on quality of life "SF-36" and a specific questionnaire for hip function "Harris Hip Score" (HHS). The comparison between groups was made by using the Student's t-test and the Fisher's test. RESULTS: The patients of the unilateral Girdlestone's group presented a higher number of SF-36 domains classified as high, although 77.8% of these showed poor results on the HHS. All patients had a leg-length discrepancy and positive Trendelenburg's test, which led to limping gait in 11 of 12 patients evaluated. Of these, only 6 underwent physiotherapy after surgery. CONCLUSION: Girdlestone's postoperative quality of life and function in a Brazilian population still requires further studies, because these outcomes are indicative of study variables' behavior and cannot be regarded as definite.

BACKGROUND: Quality of life has been one of the main issues for patients with a chronic condition.OBJECTIVE: To translate, adapt and validate a Brazilian Portuguese version of the Prosthesis Evaluation Questionnaire (PEQ).METHODS: The questionnaire was translated into Portuguese, back translated into English, and cross-culturally adapted to the Brazilian Population. Sixty-five transtibial unilateral amputees were recruited. The sample comprised 45 men and 20 women with a mean age of 44 years, 47 with traumatic amputations, 14 with vascular dysfunction and 4 with other reasons for amputation, and all of them fitted with prostheses. Patients were interviewed twice, at baseline and again after 15 days. The Brazilian Portuguese version of the SF-36 (a generic Quality of Life outcome measure) and the FIM (a Functional Independence Measure) were also administered.RESULTS: The internal consistency of the nine PEQ scales was tested by computing Cronbach's Alpha coefficients (0.65 - 0.89: high values). Student's t test coefficients were used for interobserver evaluation (0.35 to 084: reliable values with one exception- the Residual Limb Health scale), and Intraclass Correlation Coefficients (ICC), which ranged from 0.65 to 0.92: reliable values. Student's t test coefficients and ICCs were also used for intraobserver evaluation (0.42 to 0.83, except the Residual Limb Health scale and 0.80 to 0.94, respectively: reliable values). Correlations between PEQ, SF-36 and FIM were tested using Pearson's correlation coefficients, which were not statistically significant (p > 0, 01).CONCLUSION: The Brazilian-Portuguese version of the PEQ has high internal consistency and is a reliable quality of life measure for use in amputee patients, but is not associated with the SF-36 or FIM. CONTEXTO: Qualidade de vida tem sido a principal preocupação em pacientes com disfunção permanente.OBJETIVO: Traduzir, adaptar e validar uma versão Brasileira do Prosthesis Evaluation Questionnaire (PEQ).MÉTODOS: O questionário foi traduzido para o Português, retraduzido para inglês e adaptado culturalmente para a população brasileira. Sessenta e cinco amputados transtibiais unilaterais (45 homens, 20 mulheres, média de idade: 44 anos); 47 de etiologia traumática, 14 vascular e 4 de outras causas, todos protetizados, foram entrevistados duas vezes no mesmo dia e no intervalo de 15 dias. A versão brasileira do SF 36 (Medida de Qualidade de Vida genérica) e MIF (Medida de Independência Funcional) foram aplicadas.RESULTADOS: A consistência interna de 9 escalas da PEQ foi testada pelo coeficiente Alpha de Cronbach (0,65-0,89; valores altos). O teste T de Student foi usado para a avaliação interobservadores (0,35-0,84; valores de confiança, exceto para Escala de Saúde do Membro Residual) e para o Coeficiente de Correlação Intraclasses (ICC), que variou de 0,65 a 0,92, valores de confiança. O teste T de Student foi usado durante a avaliação intraobservadores (0,42-0,83; exceto para Escala de Saúde do Membro Residual) e o ICC também (0,80-0,94), ambos valores de confiança. A correlação entre PEQ, SF 36 e MIF foi testada pelo coeficiente de correlação de Pearson e foi estatisticamente insignificante (p>0,01).CONCLUSÃO: A versão brasileira da PEQ tem alta consistência interna e é uma medida de qualidade de vida confiável para pacientes amputados, mas não mostrou associação com SF 36 e MIF.

In traditional medicine in Mali, extracts derived from Mitragyna inermis (Willd.) O. Kuntze (Family: Rubiaceae) are commonly used to treat malaria. The antimalarial activity and the lack of genotoxicity in vitro and in vivo have been demonstrated in previous studies. Acute and chronic evaluation of the toxicity of the hydroethanolic extract of Mitragyna inermis leaves was performed in this study, according to the recommendations (cahier de l'Agence no. 3) of the French Drug Office. Two dosages (300 mg/kg and 3 g/kg) were given in one single administration by gavage to male and female rats. No animal died and no behavioral signs of acute toxicity were observed. Chronic toxicity studies over 28 days showed no changes in body weight and no macroscopic abnormality in the 14 organs examined after the animals were sacrificed. With the 3 g/kg/d drug dosage (100-fold higher than those proposed in man), only slight histological abnormalities were observed. Statistically significant differences, compared to control animals, in the weight of some organs and the values of some haematological or biochemical parameters were observed. However, these values always remained in the range given by the breeder for naive animals of the same strain. These investigations thus seemed to indicate the safety of repeated oral administration (up to 3 g/kg/d) of the hydroethanolic extract of Mitragyna inermis leaves, which can therefore be continuously used with safety by the African population in traditional treatment of malaria.

We have analyzed the effect of ischemia-reperfusion on expression of hepatic Na+,K+-ATPase on bile canalicular (BCM) and basolateral membranes (BLM) in human liver allografts using confocal laser scanning microscopy imaging. Na+, K+-ATPase, an integral membrane enzyme, plays a key role in the physiology and structure of hepatocytes, where it maintains the electrochemical gradients for Na+ and K+ across the cell membrane. The concentrations of these ions as well as their gradients regulate the active transport across the plasma membrane for bile acid and water from sinusoidal to canalicular membranes. In addition, Na+,K+-ATPase is also involved in cellular structure because of its close relationship with submembrane microfilaments and its implication in tight junction assembly. Therefore, Na+,K+-ATPase appears as an indicator of tissue viability and hepatic functionality during liver transplantation. Its localization and its function in BCM are still controversial. As in previous studies, we found an enzyme expression in both BLM and BCM. We show that ischemia induced a decrease in Na+,K+-ATPase expression only in BCM. This result could be explained by the differences in biochemical membrane environment between basolateral and bile canalicular Na+,K+-ATPase. Membrane lipid fluidity, which is more elevated in BLM than in BCM, could protect the enzyme during ischemia. After reperfusion, Na+,K+-ATPase expression was strongly decreased in both BCM and BLM. This alteration following reperfusion is probably due to multiple factors: direct alteration of the enzyme catalytic subunit and modification of its environment and membrane lipid fluidity by free radicals and changes in ATP levels and ionic distribution. This important decrease in Na+,K+-ATPase expression of both BLM and BCM could disturb not only hepatic secretory function but also cellular volume and structure during the postoperative period.

This is a retrospective study of 262 files on amputee outpatients, treated at Lar Escola Sao Francisco, Sao Paulo, from January 1998 to December 2002, with the purpose to map the epidemiological profile of the service. Predominantly, 71 % of amputations were observed on male patients, in which lower limb amputation represented 85,9 %, and the prevalence of amputation above the knee was 52,4%. The main cause for amputation on patients older than 50 years old was vascular etiology, which represented 72,9 %. It was observed a delay in the beginning of the rehabilitation process, with a reported treatment duration averaging 19,6 months, and reporting a mean treatment time of 10,7 months, which was shown to be greater than the one related at the reviewed literature. Besides, 25,2 % of the patients acquires prostheses. Furthermore, we correlated our data with 2 previous studies with the same rehabilitation service, with the purpose to compare the results observed in 3 different periods, and we observed a progress in the process of the amputee patients’ rehabilitation treated in our Institution.

Reticulated platelet count provides an estimate of thrombopoiesis in the same way as reticulocyte count is a measure of erythropoiesis. We applied thiazole orange (TO) staining, followed by fluorescence-activated flow-cytometric analysis, to platelets in whole-blood samples from normal subjects and 18 aplastic patients after chemotherapy for haematologic malignancies. The percentage of TO-positive platelets in 30 control subjects was 5.7 +/- 2.4% (mean +/- 1 SD), determining the threshold of reticulated platelet positivity as up to 10.5% (mean + 2 SD). In the 18 patients studied, the mean percentage of TO-positive platelets was 4.3 +/- 1.89% during aplasia and 23.3 +/- 9.43% during bone marrow recovery, respectively (P < 0.05). All patients had a percentage of TO-positive platelets of up to 10.5%. In comparison, mean platelet volume during bone marrow recovery increased in 12 cases of the 18 patients studied. We conclude that flow cytometric analysis of reticulated platelets is a sensitive and specific test for evaluating thrombopoiesis recovery during aplastic chemotherapy, and platelet transfusion should be reconsidered in these patients.

Estudos tem demonstrado que, quanto maior a severidade do dano neurologico em criancas com paralisia cerebral (PC), maior e o risco das doencas orais. Objetivo: Avaliar a influencia dos fatores: deficit intelectual, sensibilidade oral, habilidade manual e padroes clinicos da PC sobre a saude gengival de criancas com PC. Metodo: Participaram do estudo 106 criancas (10,7 ± 3,6) com PC, que frequentavam um programa de prevencao em Odontologia numa instituicao de referencia em reabilitacao em Sao Paulo - SP. Os dados relativos ao sexo, desordem do movimento, tipo clinico da PC e uso continuo de drogas foram coletados dos prontuarios. As avaliacoes clinicas odontologicas incluiram o Indice de Higiene Oral Simplificado (OIHS), o Indice Gengival (IG) e presenca do reflexo de mordida. Ainda foram realizadas as avaliacoes da sensibilidade oral, intelectual pelo Raven test e a habilidade manual pelo Sistema de Classificacao da Habilidade Manual (MACS). Foram utilizados os testes t-Student, Qui-quadrado e regressao logistica. Fixou-se nivel de significância em 5%. Resultados: O grupo 1 (G1) era composto por 47 criancas sem gengivite e o grupo 2 (G2) por 59 criancas com gengivite. As criancas do G2 eram significantemente mais velhas (p = 0,001), com tetraparesia (p = 0,016), em uso de medicamentos (p < 0,001) e com reflexo de mordida (p = 0,025). As criancas do G2 apresentaram valores significantemente maiores para o IHOS (p < 0,001) e IG (p < 0,001); porcentagens significantemente maiores de criancas com percentis inferiores a 10 (p = 0,036) para o teste Raven e com habilidade manual niveis IV e V (p = 0,002) do MACS. A chance de uma crianca apresentar gengivite cresce 23,5% para cada ano de idade, ate 5 vezes para cada 1 unidade de aumento do IHOS e cerca de 4,5 vezes com utilizacao de medicamento. Conclusao: O aumento da idade, o acumulo do biofilme e o uso de medicamentos aumentam o risco de gengivite em criancas com PC.

Knee osteoarthritis presents pain, loss of function, and joint swelling as its main symptoms. The joint swelling is defined as an accumulation of fluid in the joint due to the inflammatory process that contributes to progressive joint damage; it causes limitation in the range of knee motion, decreases proprioception, and affects the functional capacity and the quality of life of the individual. The measurement of articular cartilage volume is essential in clinical practice. The measurement of knee circumference using a measuring tape is a widely used, inexpensive, and accessible technique. However, as it is considered subjective, there is no evidence to support its use. Objective: To examine the reproducibility of this technique in patients with knee osteoarthritis. Method: Participants underwent two evaluations performed by two independent raters, at different times. The measurement of knee circumference was performed using a measuring tape 150 cm in length, taking as reference the superior pole of the patella. Results: The knee circumferences of 114 individuals were measured. According to the intraclass correlation coefficient (ICC), we observed a strong correlation (ICC = 0.98) between raters. Conclusion: The use of a measuring tape as a resource to measure knee circumference in individuals with osteoarthritis is a reliable and reproducible method.

Objetivo. avaliar os efeitos do treinamento funcional pós bloqueio químico na função motora, na amplitude de movimento passiva e na espasticidade de crianças com paralisia cerebral espástica. Método. foram selecionados 5 pacientes, porém somente 1 concluiu o estudo. O paciente LGP com diagnóstico de paralisia cerebral espástica diparética, do sexo masculino, e com 6 anos de idade, foi avaliado pré e pós bloqueio químico e pós intervenção fisioterapêutica. Os itens avaliados foram função motora grossa pelo Gross Motor Function Measure (GMFM), Amplitude de Movimento (ADM) passiva pela goniometria, e grau de espasticidade pela Escala Modificada de Ashworth. A intervenção fisioterapêutica consistiu em 12 sessões de treinamento funcional, com duração de 1 hora cada. Resultados.foi observado um aumento nos escores do GMFM e nos valores da ADM passiva em relação às 3 avaliações, sem grandes alterações no grau de espasticidade. Considerações finais. neste caso estudado houve melhora das habilidades funcionais com o treinamento funcional pós bloqueio químico. No entanto, sugerimos mais pesquisas com uma amostra maior para a comprovação dos resultados

Objetivo. Verificar os efeitos da fisioterapia na independência funcional e na qualidade de vida em pacientes no pós-operatório de tumor cerebral. Método. Participaram deste estudo 6 indivíduos no pós-operatório de tumor cerebral internados na enfermaria de neurocirurgia do Hospital São Paulo (HSP) no período de julho a dezembro de 2009. Foram mensuradas a independência funcional e a qualidade de vida por meio da Medida de Independência Funcional (MIF) e da Versão Brasileira do questionário de qualidade de vida (SF-36), respectivamente, logo após a cirurgia e ao término das intervenções fisioterapêuticas, realizadas por 5 dias consecutivos durante 45 minutos. Resultados. Os indivíduos apresentaram uma média de idade de 65±10.43 anos e 50% dos pacientes (n=3) apresentaram comprometimento motor de hemiparesia à esquerda. Ao término das intervenções fisioterapêuticas, observou-se na MIF um aumento de sua pontuação em 66.68% dos pacientes (n=4) variando entre 7 e 34 pontos e no SF-36 uma manutenção de sua pontuação em cerca de 50% (n=3) a 83.35% (n=5) dos pacientes. Conclusão. A maioria dos pacientes em pós-operatório de tumor cerebral apresentou um aumento de sua independência funcional, bem como, uma manutenção de sua qualidade de vida ao término das intervenções fisioterapêuticas.

Introdução. A paralisia cerebral (PC) gera alterações motoras e compensações que resultam em deformidades no paciente, entre elas, o pé equino. Um dos recursos terapêuticos amplamente utilizado em pacientes com PC é a eletroestimulação, cujos benefícios já são bastante conhecidos. Outra técnica, também muito utilizada na prática clínica e com efeitos ortopédicos comprovados, é a mobilização articular. Objetivo. Verificar os efeitos terapêuticos da associação entre a eletroestimulação em dorsiflexores e a mobilização articular de tornozelo em pacientes com paralisia cerebral diparética espástica com pés equinos. Método. Participaram do estudo três crianças com PC do tipo diparesia espástica, com idade entre 3 e 9 anos e que apresentavam deformidade redutível do pé em equino. Estas foram avaliadas quanto à função motora grossa, marcha, gasto energético, amplitude de movimento (ADM) e espasticidade. O protocolo de tratamento foi de 16 sessões, sendo duas vezes por semana, durante 30 minutos cada. Resultados. Todos os participantes apresentaram melhora na função motora grossa, na qualidade da marcha e na ADM ao término do tratamento. Conclusão. Associação dessas duas técnicas terapêuticas foi benéfica para promover a melhora da função motora grossa, da marcha e da ADM, para esta amostra restrita de pacientes.

We studied and quantified the effect of ischemia-reperfusion on hepatic F-actin on bile canalicular and basolateral membranes in human liver allografts by means of confocal laser scanning microscopy imaging. The phalloidin-FITC staining of F-actin was normal in liver hepatocytes before reperfusion but decreased significantly after reperfusion (by 25% of controls). These results indicate that hepatic F-actin alteration is produced during the reperfusion phase. This modification, probably induced by reactive oxygen species, could impair bile canalicular contraction and tight junction permeability and consequently bile secretion in the postoperative period.

We studied and quantified the effect of cyclosporine A on hepatic F-actin on bile canalicular and basolateral membranes in rats fed either soybean lecithin, triacylglycerol-enriched diet, or low-fat diet by means of confocal laser scanning microscopy imaging. The phalloidin-FITC staining of F-actin was quite normal in the lecithin-cyclosporine A group but decreased significantly in the other cyclosporine A-treated groups (by 40% and 25% of control in triacylglycerol-cyclosporine A and cyclosporine A groups, respectively). The alteration of F-actin by cyclosporine A, related to cholestasis evidenced by a decrease in bile salt secretion, was prevented by dietary soybean lecithin and amplified by dietary soybean triacylglycerol.

Because diabetes causes alterations in hepatic membrane fatty acid content, these changes may affect the Na+, K+-ATPase. In this study we documented the effects of streptozotocin (STZ)-induced diabetes on hepatic Na+, K+-ATPase catalytic α1-subunit and evaluated whether these changes could be normalized by fish oil supplementation. Two groups of diabetic rats received fish oil or olive oil supplementation. Both groups had a respective control group. We studied the localization of catalytic α1-subunit on bile canalicular and basolateral membranes using immunocytochemical methods and confocal laser scanning microscopy, and the Na+, K+-ATPase activity, membrane fluidity, and fatty acid composition on isolated hepatic membranes. A decrease in the α1-subunit was observed with diabetes in the bile canalicular membranes, without changes in basolateral membranes. This decrease was partially prevented by dietary fish oil. Diabetes induces significant changes as documented by enzymatic Na+, K+-ATPase activity, membrane fluidity, and fatty acid content, whereas little change in these parameters was observed after a fish oil diet. In conclusion, STZ-induced diabetes appears to modify bile canalicular membrane integrity and dietary fish oil partly prevents the diabetes-induced alterations.

We studied the effect of dietary soybean lecithin or triacylglycerol on hepatic Na+,K(+)-ATPase in cyclosporine A-treated rats by means of quantitative immunocytochemistry. Cyclosporine A-treated rats were fed lecithin or a triacylglycerol-enriched diet or a low-fat diet. As a control, one group was only fed the low-fat diet; the three other groups were treated with cyclosporine A solvent and received the low fat, lecithin, or triacylglycerol diet. Bile canalicular staining significantly decreased in all cyclosporine A-treated groups with the higher values in lecithin-fed rats. In basolateral membranes, no decrease was observed in the lecithin-cyclosporine group, in contrast to the other groups. The triacylglycerol-cyclosporine group had lower values in both membrane domains. The alteration of Na+,K(+)-ATPase by cyclosporine A was related to cholestasis evidenced by a decrease in bile salt secretion. These modifications were prevented by dietary soybean lecithin and amplified by dietary soybean triacylglycerol.

Resume Nous rapportons l’observation d’une femme de 25 ans qui presentait une elevation importante (2 571 UI/L) des phosphatases alcalines sanguines. Les dosages sanguins des transaminases, de la gammaglutamyl transpeptidase et de la bilirubine etaient normaux. L’echographie abdominale mettait en evidence une tumeur du foie droit. Il n’y avait pas de signe d’obstruction biliaire. L’activite de la phosphatase alcaline revenait a la normale apres la resection chirurgicale de la tumeur hepatique. L’analyse histologique concluait a un adenome hepatique non degenere. Les cellules tumorales presentaient un marquage intense pour l’activite de la phosphatase alcaline. Il s’agissait donc d’une secretion de phosphatase alcaline (type hepatique et biliaire) par un adenome hepatique.

BACKGROUND Asthma is characterized by alterations of the bronchial epithelium associated with inflammatory cell infiltrates and sub-epithelial fibrosis. Transforming Growth Factor-beta (TGF-beta) is an anti-inflammatory and fibrosing cytokine normally present in bronchial epithelial cells and also potentially produced by inflammatory cells. Thus, TGF-beta could play a role in the asthmatic process, and its expression could be modified in asthmatic airways. OBJECTIVE To test this latter hypothesis, we studied the bronchial distribution of TGF-beta in asthmatic patients. METHODS TGF-beta 1, 2, 3 distribution was studied by immunohistochemistry in bronchial biopsies from 12 asthmatic patients and 10 non-asthmatic subjects. RESULTS Bronchial epithelial cells from asthmatics were negative or faintly positive while a bright staining was detected in these from non-asthmatics (P < 0.01). In both groups, when inflammatory cells were present beneath the basement membrane, they were stained by the anti-TGF-beta antibody. CONCLUSION This study shows an altered compartimentalization of TGF-beta in asthma. (a) TGF-beta is scarse in asthmatic bronchial epithelial cells, which could favour the perennization of the bronchial inflammation, and (b) TGF-beta is present in inflammatory cells beneath the basement membrane, where it could be involved in the frequent sub-epithelial fibrosis.

Summary Background Asthma is characterized by alterations of the bronchial epithelium associated with inflammatory cell infiltrates and sub-epithelial fibrosis. Transforming Growth Factor-β (TGF-β) is an anti-inflammatory and fibrosing cytokine normally present in bronchial epithelial cells and also potentially produced by inflammatory cells. Thus, TGF-β could play a role in the asthmatic process, and its expression could be modified in asthmatic airways. Objective To test this latter hypothesis, we studied the bronchial distribution of TGF-β in asthmatic patients. Methods TGF-β1, 2, 3 distribution was studied by immunohistochemistry in bronchial biopsies from 12 asthmatic patients and 10 non-asthmatic subjects. Results Bronchial epithelial cells from asthmatics were negative or faintly positive while a bright staining was detected in these from non-asthmatics (P < 0.0l). In both groups, when inflammatory cells were present beneath the basement membrane, they were stained by the anti-TGF-β antibody. Conclusion This study shows an altered compartimentalization of TGF-β in asthma. (a) TGF-β is scarse in asthmatic bronchial epithelial cells, which could favour the perennization of the bronchial inflammation, and (b) TGF-β is present in inflammatory cells beneath the basement membrane, where it could be involved in the frequent sub-epithelial fibrosis.

Background The implant of devices in children is always a challenge. Implantable Cardioverter Defibrillator (ICD) therapy has been indicated to 14 children from March 2003 to June 2012 at Santa Casa de Sao Paulo Hospital. Ages ranged between 8 and 16 year old. The objective of this study was to analyze all pathologies, techniques, medical treatment and events related to these children. The following diagnoses were observed: Long QT syndrome (n = 2), Hypertrophic cardiomyopathy (n = 3), Brugada syndrome (n = 1), LV Noncompaction (n = 1), Congenital Heart Disease – postoperative (n = 3), Dilated Cardiomyopathy (n = 1), Catecholaminergic ventricular tachycardia (n = 1), Rhythmogenic right ventricular tachycardia (n = 1) and Idiopathic VT (n = 1). Syncope (n = 4), Ventricular Tachycardia (n = 6), or recovery from sudden death (n = 4) was the indication for ICD.

Background The use of vena cava filter has been broadly indicated for the prevention of pulmonary thromboembolism (PTE) in patients with contraindication for the use of anticoagulants, PTE recurrence during anticoagulation, prophylactic and temporary use in surgical patients with high risk of thromboembolism, and with contraindication for anticoagulation. This is a procedure of easy execution and low risk of complications. However, cases have been reported of the device migration to cardiac chambers with high morbidity and risk of death caused by arrhythmias, tricuspid valve insufficiency, cardiac tamponade, and cardiogenic shock. We are reporting the case of a patient submitted to neurosurgery who developed profound venous thrombosis immediately after surgery. Due to the formal contraindication for anticoagulation, she was submitted to a vena cava filter engraft.

OBJETIVOS: Avaliar o posicionamento estático da escápula no gradil costal em indivíduos saudáveis, por meio da avaliação clínica e radiográfica, avaliar a confiabilidade interavaliador do exame clínico e verificar a confiabilidade do método de avaliação em comparação ao exame radiográfico. MÉTODOS: Foram selecionados 30 indivíduos adultos de ambos os sexos sem diagnóstico de doenças nos ombros. O exame clínico estático, seguindo o protocolo sugerido por Burkhart e cols., foi realizado repetidamente por 2 examinadores independentes; a seguir, foi realizado o exame radiográfico, que posteriormente foi examinado pelo primeiro avaliador. RESULTADOS: 73,3% dos indivíduos apresentaram o posicionamento da escápula considerado dentro da normalidade. A confiabilidade interavaliador e a confiabilidade do exame clínico em relação à radiografia foram considerados baixa e muito baixa respectivamente. CONCLUSÃO: A reprodutibilidade da avaliação realizada por Burkhart foi considerada de satisfatória a boa, enquanto que a reprodutibilidade inter-avaliador do exame clínico estático e a reprodutibilidade do exame clínico com a radiografia foram consideradas de pobres a satisfatórias. Nível de Evidência III, Estudo de Pacientes não Consecutivos. OBJECTIVE: Evaluate the static positioning of the scapula on the rib cage in healthy subjects by means of clinical and radiographic evaluation to assess inter-examiner reliability of clinical examination and verify the reliability of this evaluation method compared to the radiographic examination. METHODS: We selected 30 adult individuals of both sexes with no diagnosis of shoulder pathology. The static clinical examination, following the protocol suggested by Burkhart et al, was performed repeatedly by two independent examiners, followed by the radiographic examination, which was later examined by the first evaluator. RESULTS: 73.3% of the subjects showed positioning of the scapula considered normal. The inter-examiner reliability and that of the clinical examination in relation to radiography were considered low and very low, respectively. CONCLUSION: The reproducibility of the evaluation performed by Burkhart was considered satisfactory to good, while the inter-examiner reproducibility of the clinical examination and the static reproducibility of the clinical examination with radiography were considered poor to satisfactory. Level of Evidence III, Study of Nonconsecutive Patientes.

Em amputações parciais do pé, a solução protética mais utilizada é o preenchimento anterior do calçado, adaptado à palmilha ou goteira . Entretanto, tanto do ponto de vista funcional quanto estético, estas soluções deixam a desejar. Comumente, as forças atuantes causam lesões de pele no coto e deformidade do calçado, quando não se usa goteria anti-eqüino de tornozelo. A goteira mantém a articulação tibio-társica rígidida. Este trabalho analisa os aspectos favoráveis e desfavoráveis da protetização a este nível de amputação. Cinco pacientes do sexo masculino, portadores de amputação parcial do pé, foram avaliados clinicamente e submetidos à análise de marcha. O processo de análise consistiu de filmagem da marcha em perfil e interpretação quadro-a-quadro em videocassete profissional. Os parâmetros da marcha analisados foram: cadência, comprimento do passo e da passada, e velocidade. A solução protético de preenchimento anterior do pé, adaptada à goteira, nos pareceu ser uma boa solução biomecânica .

Insulin resistance is an underlying cause of metabolic changes associated with cardiovascular diseases. Glucocorticoids are known determinant factors of insulin resistance. We quantified glucocorticoid receptor alpha (GRα) mRNA and 11 beta-hydroxysteroid dehydrogenase type 1 (11β-HSD1) mRNA in various tissues of 35 patients with previously established cardiovascular disease. This was a prospective study in a cardiac surgery patient setting. Samples of subcutaneous adipose tissue, epicardial fat, muscle, and peripheral blood mononuclear cells were examined. GRα and 11β-HSD1 mRNA were determined by real-time PCR. Mean age was 54.4 years. A significantly higher level of GRα mRNA was observed in muscle, with mean = 43.6 arbitrary units, median (p25-p75) = 39.4, compared to epicardial adipose tissue, with mean = 34.2, median (p25-p75) = 27.6, and to subcutaneous adipose tissue, with mean = 29.0, median (p25-p75) = 19.0, and lymphocytes, with mean = 17.5, median (p25-p75) = 14.02. When patients with diabetes mellitus were compared to patients without insulin resistance, significantly lower levels of GRα mRNA were observed in epicardial fat. Lymphocytes had the lowest 11β-HSD1 mRNA concentration. We also observed significantly reduced 11β-HSD1 mRNA levels in visceral fat when compared with muscle tissue. GRα and 11β-HSD1 mRNA levels differed among tissues involved in the pathophysiology of metabolic syndrome. We conclude that epicardial adipose tissue has lower GRαmRNA levels in insulin-resistant patients; this seems to be an adaptive and protective mechanism.

Pacientes com amputação transtibial têm um maior gasto energético durante a marcha com a prótese, necessitando consumir 20% a mais de oxigênio quando comparados a indivíduos normais na mesma velocidade relativa. Fisher et al. estudaram o gasto energético em pacientes não amputados em uso de muletas em terreno plano e escadas; concluíram que o volume de oxigênio (VO2) destes indivíduos atingia 40% do máximo esperado para os mesmos e que a freqüência cardíaca chegava à 62% da máxima prevista e portanto, que o uso de muletas em pacientes cardiopatas deveria ser feito com restrições. O gasto energético durante a marcha com muletas axilares é aproximadamente duas vezes maior quando comparada à marcha normal. O objetivo deste trabalho é comparar o gasto energético em pacientes amputados de membro inferior com uso de prótese e muletas. O paciente foi avaliado em relação ao gasto energético com prótese e com muletas axilares através do teste de Shuttle. O instrumento para avaliação foi o K4b2Ò, espiromêtro portátil da Cosmed. Nossos dados mostram que o paciente possui menor gasto energético com a prótese e portanto, percorre uma distância maior do que com as muletas.

The aim of this study was to assess a stroke clinic's performance in the diagnosis of hyperlipidemia and more specifically to evaluate the effectiveness of statins in patients with cerebrovascular disease not enrolled in a research study. The records of 370 consecutive patients seen at a stroke clinic over a 4-year period were reviewed, and information regarding neurologic diagnosis, lipid profile, and use and type of cholesterol-lowering medication was abstracted. Hyperlipidemia was defined as a total cholesterol level equal to or more than 200 mg/dL. Forty-eight patients meeting specific criteria were further analyzed to monitor the effects of statins. Cholesterol testing was obtained in 324 patients (88%) and 178 (55%) were hyperlipidemic, but only 86 (48%) patients received treatment. The mean cholesterol level of the 48 patients dropped from 246.2 mg/dL to 197.1 mg/dL (P < .0001) after the initiation of statin therapy, and significant reductions were present in subgroups with pretreatment levels of 200 to 249 mg/dL and 250 to 299 mg/dL. Of the 21 patients with repeated cholesterol testing more than 6 months after the first posttreatment test, only 11 (52%) maintained a level below 200 mg/dL. Effective control of hyperlipidemia can be achieved in patients with cerebrovascular disease, but not all are adequately tested or treated. Improved physician awareness and more effective health care delivery systems are needed.

The motor effort of jaw-closing muscles during maximal voluntary clenching (MVC) was compared between individuals with spastic cerebral palsy (CP) and nondisabled control subjects (CG). Bilateral electromyographic (EMG) activity of the anterior temporalis (AT) and masseter (MS) muscles was obtained during MVC in 22 subjects with CP and 29 nondisabled subjects. The oral functional status of the group with CP was evaluated using the Orofacial Motor Function Assessment Scale. The group with CP presented lower bilateral EMG activity during MVC compared to the control group for both AT and MS muscles. Comparisons of AT and MS EMG activity showed no difference in muscular effort. Subgroups with CP who were only slightly and very slightly orally impaired had a higher bilateral AT EMG activity compared to individuals with CP who were severely and moderately compromised. A statistically significant positive correlation was found between the oral motor function and EMG activity of the group with CP in all the muscles evaluated. Individuals with CP had motor weakness in the jaw-closing muscles, a condition that may compromise their masticatory function.

There is no consensus concerning thromboembolic prophylaxis in high-risk pregnant women with a previous his tory of heparin-induced thrombocytopenia. An alternative an ticoagulant therapy is danaparoïd, whereas unfractioned and low-molecular-weight heparin therapy is contraindicated. We report a case of successful thrombosis prophylaxis using dan aparoid in a high-thrombosis-risk pregnant woman with a his tory of heparin-induced thrombocytopenia during a previous pregnancy and Widal's disease.

We localized HCV C-100 protein in liver biopsies of 15 patients with chronic hepatitis C using immunohistochemistry. The results were compared to serum, tissue extract analysis of HCV RNA and in situ RT-PCR described in a previous study. HCV was detected in 80% of the sera tested, in 40% of the tissue extracts and in 80% and 60% of the tissue sections tested by immunohistochemistry and in situ RT-PCR respectively. Compared to the serum positive cases, 83% and 67% of the cases were respectively positive with immunohistochemistry and in situ RT-PCR and 41% were positive with tissue extract detection. Compared to the tissue extract positive cases, 25% and 50% of the cases were respectively positive with immunohistochemistry and in situ RT-PCR. Finally, 75% of the cases positive by immunohistochemistry were also positive by in situ RT-PCR. These results underline the complementarity of the different methods for the precise diagnosis of hepatitis C.

The present report considers the autopsic study of an homograft recipient who had been living for 18.5 years after a cardiac transplantation. The patient was treated by immunosuppressive therapy associating azathioprine and steroids. During the exceptionally long follow-up, two skin carcinomas and a lung carcinoma occurred successively. In addition, the autopsy allowed observation of a kidney adenocarcinoma associated to a polycystic disease, and a liver regenerative nodular hyperplasia containing several areas of severe dysplasia. These findings, when compared with those usually observed in immunodeficient patients, suggested the possibility that long-term immunosuppressive therapy may give rise to malignancies other than those arising after a short therapy.

A gravida with intrauterine fetal death who developed progressive chronic consumption coagulopathy was treated with heparin. When serial fibrinogen levels fell below 100 mg% and the prothrombin time was significantly prolonged, intravenously injected heparin corrected hypofibrinogenemia. A safe delivery followed administration of oxytocin. The authors emphasize the infrequent need for heparin therapy in the majority of cases of the intrauterine fetal death syndrome. Therapeutic guidelines for its use in selected cases are reviewed.